January 15, 2021
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Taking the bite out of cavities in 2021

The Wealth of Health

George Malkemus
Tobacco use can cause mouth cancer
November 27, 2020

Mark Twain once said, “Quitting smoking is easy.  I’ve done it a thousand times.” Stopping tobacco use is difficult because all tobacco forms – cigarettes, E-cigarettes, cigars, pipe smoking and smokeless [spit] tobacco – contain nicotine.  And nicotine causes addiction or dependence.  However, compared to Mark Twain’s day, there are many modalities to make quitting tobacco use easier.  If you're using tobacco, research the many methods available to stop; quitting is the best thing you can do for your health.

With COVID-19, risk from smoking is greater than ever.  Smoking is already a known risk factor for respiratory diseases, heart disease and cancer.  Lung cancer directly related to smoking is widely known.  

Less known is cancer of the throat and mouth that are directly caused by tobacco use.  In America, 30,000 people will be diagnosed with oral cancer or pharyngeal cancer this year. This results in 8,000 deaths, roughly breaking down to one death every hour of every day.  What makes this figure so terrifying is that early detection of oral cancer symptoms can result in an 80 to 90 percent recovery rate. Diagnosing symptoms of oral cancer too late is what keeps mortality rates so high.

Over 90 percent of all oral cancers are squamous cell carcinomas, which are directly linked to tobacco use. This cancer can be located on the tongue, cheeks, soft palate, lips, tonsils and throat.   Cancer-causing substances in tobacco mutate the genes, which control cell behavior. These mutated genes grow and spread and multiply at an uncontrolled rate.  Lab studies have now shown that electronic cigarette vapor causes DNA damage in cell cultures [as well as, traditional tobacco] even in nicotine-free vapor.

Early diagnosis

The earlier oral cancer signs are diagnosed the better. In fact, it can mean the difference between life and death. An oral cancer screening should be done at every dental examination and cleaning.  In my practice, I use a dental video camera and a visual examination to check for oral cancer on the roof and floor of the mouth, on the surface, underside and base of the tongue, along the insides of the lips and cheeks and the soft palate and tonsils. The face, jaw and neck are checked as well.

Many sores, such as biting or burning the inside of the mouth or a loose-fitting denture or a cold sore, can mimic the appearance of oral cancer, but most will resolve within two weeks.  If any sore, discoloration, irritation or swollen tissue in the mouth does not resolve within two weeks on its own, it should be checked by a dentist and possibly have a biopsy taken.

The development of mouth cancer

Mouth cancer develops in stages.  The first sign is leukoplakia, a whitish toughening of the oral tissues.  This is a pre-cancerous stage where the cells are beginning to change slightly.  Usually, the progression to cancer is reversible at this stage if the tobacco use is stopped and the area will change back to health pink tissue.  At the next stage of progression to cancer, the tissues will usually become red, raised and slightly raw.  This can advance to a sore, swollen, ulcerated area.  If left untreated, this can become an enlarged grotesque growth, which can lead to disfigurement from surgery and often death.

The location of the mouth cancers is related to the type of tobacco used and where the tobacco is most concentrated.  Cigarette smokers most often have tissue changes on the tongue, soft palate, and tonsils, as well as the throat and lungs.  Pipe smokers tend to have tissue changes and cancer on the lip where the pipe is held or on the roof of the mouth where the smoke first touches.  Cigar smokers have the greatest amount of lip cancer from the tobacco juices concentrating on the lips where the cigar is held. 

When smoking tobacco, the smoke penetrates throughout the mouth, so cancer can be found throughout the mouth.  Cancer from chewing tobacco almost always appears in the spot it is placed. When I do an exam on a patient who chews tobacco, I usually see tissues changes in the area the tobacco is placed.  Instead of healthy pink, soft tissue, I find a whitish toughened tissue that looks a lot like a callous.  This is a pre-cancerous stage. I always recommend that the patient stop tobacco use 

and if they are not going to stop then lessen use.  And in the case of chewing tobacco, if they are going to continue, then move it around to different spots in their mouth.

Who is at risk for mouth cancer?  

With tobacco use, it is a continual long-term effect on the tissues, which causes cancer.  So, people who have been smoking for many years are at a greater risk for mouth, throat and lung cancer.   So, it is found most often in people over 40 with the risk increasing in the 50s, 60s and 70s.  Smokeless tobacco is the exception with most cases found in people who are in their 20s and 30s and some cases even in teenagers. This is due to the cancer-causing juices being concentrated in one location.  Twenty-eight different cancer-causing substances have been found in smokeless tobacco!

Heavy alcohol use is linked to oral cancer as well.  In particular, smokers who are also heavy alcohol drinkers increase their oral cancer risk significantly. These two substances act together to become even more deadly and more debilitating.

Mouth cancer treatment

If a suspicious sore, lump or swelling in the mouth last longer than two-weeks, it should be seen by a dental professional.  Often a biopsy of the area will be taken and analyzed by a laboratory. In the event that a positive diagnosis is received, oral cancer treatment will require the help of several doctors from many fields of medicine. Oral cancer treatment generally involves an oral surgeon, a radiation oncologist (doctor trained to give X-ray treatments), an oncologist (cancer doctor trained in chemotherapy) and a rehabilitation and restorative specialist. Squamous cell carcinoma grows aggressively, so often large resections of the tongue, lip and/or jaw are necessary along with strong treatments of radiation and chemotherapy.  Of course, the earlier the cancer is found, the lighter the treatment.  That is why early detection is so critical.

 Tobacco use causes mouth cancer.  The best option is to quit.  If unable to quit, it is imperative that one visits his/her dental professional twice a year for an oral cancer screening.


 Enjoy Life and Keep Smiling! 


George Malkemus has a Family and Cosmetic Dental Practice in Rohnert Park at 2 Padre Parkway, Suite 200. Call 585-8595, or email info@  Visit Dr. Malkemus’ Web site at