OP178: Progression of oral cancer from early to late stage after invasive dental treatments

https://doi.org/10.1016/j.oraloncology.2013.03.186Get rights and content

Introduction

Patients with oral cavity squamous cell carcinoma (OSCC) often present initially to a dentist complaining of a dental problem. These early cancerous changes are at times misdiagnosed as chronic infection resulting in invasive and often multiple dental procedures. This not only delays diagnosis and treatment, but also affects the integrity of cortical bone and promotes mandibular invasion, resulting in accelerated progression of the disease.

Methods

A retrospective review of OSCC patients, presenting after multiple dental treatments, was performed. The clinical findings, imaging, treatment and pathology were reviewed.

Results

There were a total of 15 patients (nine females). The median duration of symptoms before their initial dental visit was 21 months (range: 6 months to 15 years). The presenting complaints included chronic oral lesions, ulcerations, swelling or jaw pain. Dental treatment, in the form of dental extractions, periodontal surgery or scaling and root planning without tissue biopsy, was the first treatment rendered on all of these patients. Nine patients (60%) were diagnosed with an OSCC within 6 months of the dental procedure, two were diagnosed within 1 year and the others over one year following the procedure. The primary tumors were located on the gingiva, floor of mouth or retromolar trigone. Eleven patients (73%) had bone involvement, eight patients (53%) had nodal metastases and five patients (33%) had perineural invasion at the time of diagnosis.

Conclusion

Disrupting the mandibular periosteum in the proximity of an otherwise T1 lesion could facilitate bone invasion and thus accelerate the progression of OSCC to T4 tumor. If oral cancer is suspected, a biopsy should be performed prior to dental procedures such as extraction or periodontal surgery is initiated.

This could expedite diagnosis, prevent treatment delays and potentially improve therapeutic outcome.

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