hoofstukke
Why Oral Cancer Awareness Matters
[00:00:04 – 00:01:22]
Oral cancer is a topic that doesn’t receive nearly the public attention it deserves. Unlike breast or prostate cancer, it rarely features in awareness campaigns, yet survival rates are poor precisely because it is so often caught late.
begrip the warning signs, knowing the risk factors, and getting screened regularly can make an enormous difference to outcomes. Early detection is genuinely life-saving.
Is Oral Cancer Becoming More Common?
[00:01:22 – 00:02:34]
Oral cancer is not rare. Globally, the incidence of cancers affecting the mouth, tongue, and throat is rising. While it has traditionally been associated with older men who smoke and drink heavily, that profile is shifting significantly.
In South Africa, oral cancer is a serious health issue that is frequently diagnosed at an advanced stage, which worsens outcomes considerably. The public perception that it is uncommon is largely due to a lack of awareness campaigns rather than a lack of cases.
The Link Between HPV and Oral Cancer
[00:02:35 – 00:03:53]
Human papillomavirus, particularly the HPV-16 strain, is now recognised as a major cause of oropharyngeal cancer — cancers affecting the back of the tongue and throat. These differ biologically from cancers caused by tobacco and alcohol.
HPV-related oral cancers often affect younger patients with no history of smoking or heavy drinking, and are primarily transmitted through oral sexual contact. Although they tend to respond better to treatment, they are frequently detected late because their early symptoms are very subtle.
This shift in the typical patient profile makes thorough oral examinations — including the throat and base of the tongue — more important than ever.
What a Suspicious Lesion Looks Like
[00:03:54 – 00:04:52]
Early oral cancer does not always look alarming. It may appear as a persistent ulcer, a red patch, a white patch, or a mixed red-and-white area that simply does not heal within two to three weeks.
Other warning signs include unexplained lumps, thickened areas, numbness, or changes in texture. Pain is not a reliable indicator — many early cancers are completely painless. The key red flag is persistence: anything that has not resolved on its own within a few weeks should be examined by a dentist promptly.
Why the Tongue and Floor of the Mouth Matter Most
[00:04:52 – 00:05:46]
The sides and underside of the tongue are among the most common sites for oral cancer. The tissue there is thin and has a rich blood supply, making it particularly vulnerable — yet it is an area most people never think to examine themselves.
A simple self-check involves gripping the tongue with a piece of gauze, pulling it out, and carefully inspecting the sides and underside. Subtle changes can often be felt before they become visible, which is why a proper clinical examination also includes feeling along the jaw and neck for any unusual lumps.
The VELscope: Enhancing Detection of Abnormal Tissue
[00:05:47 – 00:07:03]
The VELscope is a screening tool that uses a specific wavelength of light to cause oral tissue to fluoresce. Healthy tissue fluoresces normally, while areas containing abnormal cells appear darker or irregular under the device.
It is more widely available in the United States than in South Africa, and it does not diagnose cancer on its own. However, it serves as a useful enhancement to a standard clinical examination, helping clinicians identify suspicious areas that might otherwise be missed.
Pain Is Not a Warning Sign You Can Rely On
[00:07:03 – 00:08:00]
One of the most important points about oral cancer is that it is often completely painless in its early stages. Common mouth ulcers that are sore and heal within a week or so are generally nothing to worry about — the concerning lesion is the one that develops and simply does not get better.
Pain typically only appears once the cancer has begun to affect nerve tissue, by which point the disease may already be at an advanced stage. The absence of pain should never be taken as reassurance that a persistent change is harmless.
How Alcohol and Smoking Multiply Risk
[00:08:00 – 00:10:16]
Alcohol and tobacco do not simply add to each other’s harmful effects — they have a synergistic relationship that multiplies risk dramatically. Hard spirits in particular make oral tissues far more permeable, allowing cancer-causing molecules from tobacco to penetrate more easily.
People who both smoke and drink heavily carry a substantially higher risk of oral cancer than those who do either alone. Alcohol-containing mouthwashes used regularly have also been associated with similar tissue changes.
Reducing or eliminating either habit lowers overall risk. Stopping smoking entirely is the most impactful step, but even moderating alcohol intake — for instance, switching from spirits to a lighter drink — offers meaningful benefit.
Survival Rates: The Case for Early Detection
[00:10:17 – 00:11:00]
When oral cancer is detected at an early stage, the five-year survival rate can exceed 80 per cent. Diagnosed late — once the cancer has spread to the lymph nodes or surrounding tissue — that figure can fall well below 40 per cent.
Late-stage treatment is also far more aggressive, potentially involving extensive surgery, radiation, and chemotherapy. Early detection not only saves lives but significantly reduces the burden of treatment required.
How to Perform a Self-Examination at Home
[00:11:01 – 00:13:00]
A monthly self-examination is particularly worthwhile for those with significant risk factors such as heavy smoking, vaping, tobacco pouch use, or heavy alcohol consumption. Using good lighting — natural sunlight reflected in a car’s rearview mirror works surprisingly well — examine the lips, cheeks, gums, tongue, floor of the mouth, and throat.
With clean hands, also feel for any lumps or bumps along the cheeks, lips, and beneath the jaw where lymph nodes are located. A magnifying makeup lamp with a ring light can also be helpful for a thorough look.
Self-examination does not replace professional screening, but it builds familiarity with what is normal and helps identify changes that warrant prompt attention from a dentist.
Oral Cancer Screening at OptiSmile
[00:13:01 – 00:14:31]
At OptiSmile, oral cancer screening is an integral part of every examination — not an optional add-on. Dentists and hygienists routinely inspect and palpate the soft tissues, including pulling out the tongue to check all surfaces, and take clinical photographs of anything that warrants monitoring.
Any area of concern is reviewed at a follow-up appointment to determine whether it has resolved, and patients are referred to an oral pathologist or periodontist for a biopsy if anything suspicious is identified. The message from this episode is clear: do not ignore changes in your mouth, and do not underestimate the value of a regular tandheelkundige ondersoek — it could be about much more than just your teeth.
Transcript
Eon Engelbrecht (0:04)
Hello and welcome to Save Your Money, Save Your Teeth, the podcast where we unpack the dental topics that can make a real difference to your health, your confidence, and also your quality of life. I’m Eon, and today we’re talking about a very important subject that doesn’t always get enough attention: oral cancer. It’s one of those topics that can sound a little intimidating, but the more we talk about it, the more we realise how important awareness really is. Knowing what to look for, understanding the risk factors, and getting checked early can have a major impact. Joining me again is Dr Clifford Yudelman from OptiSmile to help us better understand the signs, the risks, and why routine screening matters so much. Dr Yudelman, it’s great to have you with us again.
Dr. Clifford Yudelman (1:00)
Great to be back, thank you. After smoking and vaping last time, I thought we would go straight into oral cancer this time.
Eon Engelbrecht (1:13)
You don’t hear about oral cancer that often, or at least I don’t. Is oral cancer rare, or is it becoming more and more common?
Dr. Clifford Yudelman (1:22)
It’s not rare. In fact, it is becoming more common globally. While it has traditionally been associated with older men who smoke and drink heavily, that profile is changing a lot. Worldwide data shows that the incidence of cancer in the mouth, the tongue, and the throat is increasing, especially those cancers linked to human papillomavirus, or HPV.
In South Africa, oral cancer is a significant health issue. It’s often diagnosed late, or very late, which really worsens outcomes. One of the reasons it feels rare to the public is that it doesn’t receive the same awareness campaigns as breast cancer or prostate cancer, yet survival rates for oral cancer are quite low because it’s often detected at an advanced stage. The key message is that oral cancer is common enough that routine screening matters, and early detection can be life-saving.
Eon Engelbrecht (2:35)
Okay, and what is the link between HPV, or human papillomavirus, and oral cancer?
Dr. Clifford Yudelman (2:43)
HPV, particularly HPV-16, is now recognised as a major cause of cancer in the oropharynx, which includes the mouth and throat. So we’re talking about the back of the tongue and the throat. These cancers are biologically different from those caused by the usual route, which is tobacco and alcohol.
HPV-related oral cancers often affect much younger patients and can occur in people with no history of smoking or heavy drinking. Transmission is primarily through oral sexual contact. Importantly, HPV-positive oral cancers often respond better to treatment than traditional oral cancers, but they are frequently detected later because the symptoms are very subtle. This changing landscape reinforces the importance of thorough oral examinations that include the throat and the base of the tongue, not just the teeth and the gums.
Eon Engelbrecht (3:54)
Doctor, what do we have to look out for? What does a suspicious lesion or patch look like inside the mouth?
Dr. Clifford Yudelman (4:01)
They don’t always look dramatic. Early oral cancer may present as a persistent ulcer, a little red patch, a white patch, or a mixed red and white area that doesn’t heal within two or three weeks. If you’ve got one of these and it’s just not going away, it’s time to get it looked at.
Other warning signs include unexplained lumps, thickened areas, numbness, or changes in texture. Pain is not a reliable indicator. Many early cancers are completely painless. But the red flag is persistence. Basically, if it doesn’t go away on its own within a few weeks, you should get it looked at. That is very important. Patients should look inside their own mouth and pay attention.
Eon Engelbrecht (4:52)
I believe it’s also very important to check the sides of your tongue and the floor of your mouth. Is that correct?
Dr. Clifford Yudelman (4:59)
Yes, it’s the most common site for oral cancer. The tissue there is thinner and has a very rich blood supply, which makes it more vulnerable. This is a place very few people look at themselves. You can grab your tongue with a piece of gauze, pull your tongue out, and look at the sides of your tongue to check.
If you’re listening to this podcast, check your tongue. Have a proper look. Look at the back of your tongue, but especially the sides and underneath. We always look at this when we examine a new patient, and subtle changes can be felt before they are visible. It’s similar to checking for lymph nodes under the jaw and around the angle of the jaw for any lumps or bumps. This is one reason why many of these early changes are overlooked.
Eon Engelbrecht (5:47)
Okay, and what is the VELscope and how does it help dentists see these invisible changes?
Dr. Clifford Yudelman (5:56)
I included this question primarily for people in America and other countries where the VELscope is available. It’s actually not used as commonly as it should be, and we can’t easily get it in South Africa. It’s basically a screening tool with a specific wavelength of light that makes tissue, like gums and the sides of the tongue, fluoresce.
You look through the special scope and healthy tissue fluoresces in one way. It’s a bit like a UV light or a disco light, and it fluoresces differently from tissues that have abnormal cells. Suspicious areas look darker or irregular. It doesn’t diagnose cancer, but it can help you see abnormal areas much faster in a patient’s mouth. It improves detection of abnormal tissue during a clinical examination. It’s not a replacement for a proper exam, but an enhancement. It just improves vigilance and reduces the chance of missing early changes.
Eon Engelbrecht (7:03)
Doctor, can you tell us, does oral cancer actually hurt in the early stages?
Dr. Clifford Yudelman (7:10)
I’m pleased this came up, because it is the one thing I really want to tell people. Just because something doesn’t hurt does not mean it’s nothing to worry about. In fact, if you have a nasty-looking ulcer with no pain, I would run to the dentist.
A lot of the time people get those common mouth ulcers that come and go. Those painful ulcers are nothing to worry about — they heal after a few days or a week. Some people do get lots of them, but they know from experience that they always heal.
What we’re talking about here is something that develops and doesn’t actually get better. It usually only starts hurting once nerves are affected. So don’t rely on pain. Rather go and see your dentist.
Eon Engelbrecht (8:00)
I also want to talk about risks. How does alcohol combined with smoking actually multiply the risk?
Dr. Clifford Yudelman (8:09)
I’m pleased you used the word multiply, because they have what’s called a synergistic effect. They work together. They’re very good partners, unfortunately.
Hard liquor especially, like whiskey, gin, or brandy — these burn the tissues. I also don’t like alcohol-containing mouthwashes. Sometimes smokers might use a very strong alcohol-containing rinse, which has also been associated with similar effects to strong spirits. It makes the tissues a lot more permeable, which allows the cancer-causing molecules from tobacco to enter more easily. That multiplies the risk rather than simply adding to it.
Studies for years have shown that people who both smoke and drink heavily, instead of just doing one or the other, have a dramatically higher risk of oral cancer than those who do either alone. My late mother was a heavy smoker and died from a heart attack, but she didn’t drink at all, and my dad was a dentist. She never had any sores or cancer in her mouth. My father, who was never a drinker or a smoker, got oral cancer in his mouth which actually spread from a cancer he had on his forehead, and it moved into his lymph nodes. That’s a different situation to cancers that start primarily in the mouth. He survived that, he lived another 15 years, he had surgery and radiation.
Reducing one or both of these habits really lowers overall risk. Obviously, completely stopping smoking is ideal, and even reducing the alcohol — perhaps switching from a stiff scotch to a light beer — is better than nothing.
Eon Engelbrecht (10:17)
Yes. And doctor, what is the survival rate of oral cancer if it’s caught early versus late?
Dr. Clifford Yudelman (10:26)
If it’s detected at a very early stage, the five-year survival rate can exceed 80 per cent. But if it’s diagnosed late, once it has spread into the lymph nodes or surrounding tissue, survival rates can drop well below 40 per cent. And the treatment becomes much more aggressive. We’re talking hectic surgeries, sometimes where they remove half your face, combined with radiation and often chemotherapy. The contrast is really stark. Early detection not only saves lives but it reduces suffering and the extent of treatment required.
Eon Engelbrecht (11:01)
And would you encourage patients to do a self-exam at home? And if yes, how can they do so?
Dr. Clifford Yudelman (11:08)
Yes. I think that’s one of the strong points of this podcast today. I really do want people who are heavy smokers, including vapers and those using tobacco pouches, in combination with heavy drinking, to be a little bit more alert. You can thank me later.
Make sure that once a month, in good lighting, you look at your lips, your cheeks, your gums, your tongue, the floor of your mouth, and your throat. Sometimes the best lighting is actually in your car, with the rearview mirror flipped down and the sun shining right inside your mouth. It’s hard to use a torch because it’s too bright. One of those makeup lamps with a magnifier and a round light would be very good.
Then feel for lumps and bumps. With clean hands you can feel your lips and cheeks and also under your throat, where lymph nodes swell when you have a sore throat. Self-examination isn’t routinely encouraged, and people aren’t really taught how to do it, but it is helpful. It doesn’t replace professional screening.
Whenever I have a heavy smoker or someone who looks like a heavy drinker, they often say something like, “Oh, I had a heavy weekend.” I always look extra carefully in those patients. But I’ve also seen lots of patients with little warts or papillomas caused by transmissible viruses, and I send them to get biopsied so they don’t change into cancer. Please take heed if you are a heavy smoker and a heavy drinker.
Eon Engelbrecht (13:01)
Just before you go, doctor, how often does OptiSmile screen for oral cancer during checkups?
Dr. Clifford Yudelman (13:09)
Myself, the other dentists, and the hygienists at OptiSmile are always vigilant. We’re looking, we’re feeling, we’re pulling out the tongue, we’re checking. It’s not a one-off event. We take photographs if there’s anything we want the patient to come back and review in a few weeks, to see whether something has gone away. We always refer patients to an oral pathologist or a periodontist for a biopsy if we suspect anything. That’s how one prevents these things from getting worse, and hopefully saves some lives.
Eon Engelbrecht (13:44)
Absolutely. Dr Yudelman, thank you so much once again for sharing these really valuable insights on oral cancer, what we need to look out for, and why early detection is so important. We really appreciate it.
Dr. Clifford Yudelman (14:00)
Thank you very much, and I’m looking forward to speaking to you next week.
Eon Engelbrecht (14:05)
Absolutely. I think the big message from today’s conversation is simple. Don’t ignore changes in your mouth, and don’t underestimate the value of a regular dental checkup. It could be about much more than just your teeth. To learn more or to book an appointment, visit OptiSmile.co.za. That’s it for Save Your Money, Save Your Teeth for this week. We’ll catch you again next time.
Aankondiger (14:52)
Ontdek die wêreld van tandheelkundige uitnemendheid met OptiSmile. Sluit by ons aan vir 'n weeklikse podcast met dr Clifford Yudelman, 'n gesoute kenner met 40 jaar se tandheelkundige ervaring oor vier kontinente. Kry unieke insigte en kundige tandheelkundige advies deur OptiSmile.co.za te besoek vir artikels wat die pad na optimale mondgesondheid verlig. As jy ongeëwenaarde tandheelkundige sorg in Kaapstad soek, kontak OptiSmile of bespreek direk aanlyn op OptiSmile.co.za. OptiSmile, waar wêreldwye kundigheid plaaslike sorg ontmoet.
Vrywaring: Die inhoud verskaf in hierdie poduitsending, "Save Your Money Save Your Teeth" op Mediese Maandae, is slegs vir inligting en opvoedkundige doeleindes. Dit is nie bedoel om as tandheelkundige of mediese advies te dien nie. Die insigte en menings uitgespreek deur Dr. Clifford Yudelman en enige gaste is ontwerp om 'n beter begrip van tandheelkundige gesondheid, voorkomende maatreëls en algemene welstand te bevorder, maar moet nie geïnterpreteer word as professionele tandheelkundige of mediese aanbevelings nie.Dr. Clifford Yudelman diagnoseer, behandel of bied voorkomingstrategieë vir enige gesondheidstoestande direk deur hierdie podcast aan. Hierdie platform is nie 'n plaasvervanger vir die persoonlike sorg en advies wat deur 'n gelisensieerde tandarts of gesondheidswerker verskaf word nie. Ons moedig ons luisteraars sterk aan om met hul eie tandheelkundige sorgverskaffers te konsulteer om individuele tandheelkundige gesondheidsbehoeftes en bekommernisse aan te spreek. Die inligting wat hier gedeel word het ten doel om luisteraars te bemagtig met kennis oor tandheelkundige gesondheid, maar moet nie as 'n basis gebruik word om gesondheidsverwante besluite te neem sonder professionele leiding. Jou tandheelkundige sorgverskaffer is die beste bron van advies oor jou tandheelkundige en algemene gesondheid. Soek asseblief altyd die advies van jou tandarts of ander gekwalifiseerde gesondheidswerkers in oor enige vrae of bekommernisse oor jou tandheelkundige gesondheid.
