Fortunately, most diseases that begin in the mouth are adequately treated and do not cause systemic involvement. Now, the mouth can be the origin of diseases with systemic involvement due to different causes such as infectious, metastatic or inflammatory.
Diseases that start in the mouth can be avoided with good prevention and hygiene. We must take extreme hygiene and explore its surface regularly (both the mucosa and the dental).
Surely you already know that most tumors of the oral cavity can be detected with a simple physical examination. We cannot overlook, under any circumstances, a precancerous lesion.
What is it about? It is a tissue whose morphology is altered, so it is more likely to degenerate into cancer.
The oral cancer is 3% of the total organism neoplasms. In many cases it may be preceded by a visible precancerous lesion that we have not paid attention to. Therefore, we insist on the importance of reviewing the oral cavity (inspection and palpation).
Any lesion clinically suspected of being premalignant should be biopsied to confirm or rule out the existence of a cancerous lesion.
The early detection of precancerous lesions or cancer in the oral cavity improves prognosis and survival (in terms of fewer aggressive treatments, better cure rates and better quality of life). Please do not be scared by the appearance of a small canker sore (due to orthodontic friction or stress), but if it does not progress favorably, consult your doctor.
What are the most common locations of oral cancer?
In decreasing order they would be: the lateral border of the anterior part of the tongue, the floor of the mouth, the area behind the last lower molar, the gum, the cheek, the lip and the palate.
In general, the global survival of oral cancer at five years is around 60%, although it differs according to the location and extension at the time of diagnosis (in cases with metastases at the beginning, survival drops drastically).
The consumption of alcohol and tobacco are the most important known predisposing factors, although there are other relevant factors such as viral infections, poor oral hygiene, the use of defective dental prostheses (due to repetitive chronic trauma to the oral mucosa), nutritional deficiencies, etc..
As you may have assumed, before the appearance of a precancerous lesion, the first behavior to follow will be the immediate cessation of tobacco and alcohol consumption, as well as any irritating factor of a mechanical nature such as a poorly fitted prosthesis.
What are the most common precancerous lesions in the mouth?
- Leukoplakia: It looks like a white plaque. It is painless. Its most frequent location is on the floor of the mouth or on the tongue. But not all white lesions are precancerous, it may simply be a mild mycosis.
- Erythroplasia: it is a red, shiny and velvety plaque, with well defined edges and painless. More frequent in the oral mucosa. It has a high percentage of malignancy.
- Actinic cheilitis of the lip: Especially on the lower lip. Related to sun exposure. It is a small dry, fissured, and scaly area on the lip. Pain and bleeding may appear.
- Keratosis of the palate or whitish lesion of the mucosa of the palate associated with heavy pipe tobacco smokers.
- Oral lichen planus: cause unknown. Chronic inflammation that affects the skin and mucosa and can present different aspects: starry and reticulated white spots, red and inflamed area or sores. They can cause a burning sensation or pain. It is not contagious.
Diseases that start in the mouth, infections
These are the most common precancerous lesions in the mouth that can degenerate into oral cancer, which in turn can cause distant lesions(metastasis).
In addition to an oncological origin, an infection in the mouth can also be the cause of other distant lesions. And is that any infectious focus that nests in the mouth, of any cause, can cause a migration of the infectious focus to another anatomical place. For example, bacterial pharyngitis can lead to bacterial tonsillitis (with sore throat and pain when swallowing, fever, headache, and poor general condition). If the infectious focus is not treated, it can cause a distant infectious focus due to the spread of the bacteria.
Do you mean that all sore throats are treated with an antibiotic? Absolutely. We will indicate an antibiotic in the case of bacterial tonsillitis with pus plaques on the tonsils (at this point I am going to tell you that most pharyngotonsillitis are viral in origin and do not require antibiotics). When there are doubts about the possible bacterial cause, we perform a “rapid detection of streptococcal antigen” smear that consists of the analysis of a scraping sample from the tonsillar surface and the posterior wall of the pharynx. Once confirmed, we prescribe the antibiotic and solve the problem, in most cases.
If the focus is not eradicated, the patient should be reexplored to rule out the presence of local complications such as phlegmons, abscesses (peritonsillar, Ludwig’s angina…), epiglottitis or distant involvement such as: otitis, sinusitis, rheumatic fever, glomerulonephritis(renal involvement ) and even toxic shock.
How can a pleural tonsillitis cause, for example, a distant infective endocarditis?
The bacteria causing the infectious focus travels in the blood causing a transient bacteremia and nests at a distance where it colonizes and causes another infectious focus, in this case in a heart valve. High fever will be the most frequent symptom, as well as other general nonspecific symptoms such as poor general condition, asthenia, weight loss, arthromuscular pain, cardiac involvement… What are the responsible germs? The most frequent Streptococcus and Staphylococccus.
What ideas are we left with about diseases that start in the mouth?
An examination of the oral cavity is recommended for all those patients who present at any time one or more suspicious signs or symptoms to prevent diseases that begin in the mouth(oral ulcer that does not heal within seven to 10 days, pain or discomfort in the oral cavity persistent without apparent cause, presence of thickening or any whitish or reddish lesion on the mucosa, throat, tongue, tonsil, or floor of the mouth, difficulty in swallowing or chewing, alterations in the voice, appearance of masses in the neck, etc.)
Although it is rare, an infectious disease or tumor of origin in the oral cavity can have a serious systemic repercussion. Therefore, do not be afraid of a minor temporary injury or dismiss a persistent injury that does not heal in a reasonable time. When in doubt, go to the doctor. We will explore you carefully.
WHAT YOU SHOULD KNOW…
- Do not be afraid of the appearance of a small canker sore(due to friction from orthodontics or stress), but if it does not progress favorably, consult your doctor.
- Any infectious focus that nests in the mouth, of any cause, can cause a migration of the infectious focus to another anatomical place and cause diseases that begin in the mouth.
- Although it is rare, an infectious disease or tumor of origin in the oral cavity can have a serious systemic repercussion.