Going to the dentist for some may mean going in for periodic hygiene sessions, straightening crooked teeth and treating any trauma or cavities. In reality, the dentist and dental hygienist are concerned with the care of the entire oral cavity, starting with the health of the supporting tissues of the teeth such as the gums, periodontal ligament, and alveolar bone.

The periodontist, in particular, is the dentist who deals specifically with the treatment of diseases affecting the gums.

At the first visit, the patient is first evaluated from a general health point of view; it is essential to take a thorough history to check for any ongoing drug therapy and the presence of systemic diseases. Of these, great importance is glycemic control; in fact, diabetic patients are at greater risk of developing periodontal disease. It will therefore be necessary to make sure that glucose levels are well controlled. This is done either by checking glycated hemoglobin values in the last blood tests (a parameter that reflects blood sugar levels over the last 3 months or so) or by a simple chairside test where blood glucose is detected through a small drop of blood.

In addition to the presence of ongoing caries, individual susceptibility to the development of future carious lesions is assessed. This is done through the use of tools such as the cariogram, which allows for an assessment based on the patient’s diet, the amount of bacterial plaque on the teeth, the quality of saliva, the presence of past caries, and the actual likelihood of avoiding new caries. The assessment allows the patient to be shown through a graphic image (pie chart type) the risk of developing new cavities and how to avoid them in the future making him/her more aware and involved.

During the first visit, gum health is also assessed. Through the use of a periodontal probe (small millimeter instrument) to measure the gums, one is immediately able to understand if the patient has healthy gums or if there is a suspect for periodontitis one will need to go deeper into the diagnostic process.

During the first visit, we evaluate not only the health of the teeth but also that of all tissues of the oral cavity such as the tongue, lips, oral mucosa lining the cheeks, floor of the mouth, and gums. Even before assessing dental health, an oral cavity screening is conducted to check for soft tissue lesions. Through careful observation and palpation, we verify the absence of lesions that may exhibit precancerous signs. The goal of oral cavity screening is to identify the possible presence of lesions at an early stage thus being able to greatly increase their chances of treatment. In fact, when diagnosed at an early stage, precancerous and malignant lesions can be removed while they are still small with a greater chance of treatment.

Mucosal lesions of the oral cavity may present as persistent white or reddish swellings that do not heal or as a wound that struggles to heal. These should be considered warning signs that lead us to visit the dentist because they may be pre-cancerous or cancerous lesions.

Oral cancer is relatively common and can affect the tongue, palate, lips, gums, and pharynx. The most common site is the tongue; carcinomas of the tongue account for about 30% of all oral carcinomas.

Certain habits represent risk factors that can increase the likelihood of having oral cancer:

• tobacco use in any type through cigarettes, cigars, pipes, or chewables
• frequent alcohol intake
• a positive history of oral cancer
• a history of significant sun exposure

Cancer of the oral cavity may present as a white or red spot, a wound that is struggling to heal, or persistent swelling that is not necessarily painful. Situations such as these should not be underestimated; we work with specialized oral pathologists who are able to indicate whether the lesion should be kept monitored or whether further investigation will be necessary.

If a suspicious lesion is identified we may recommend a follow-up visit after about 14 days to check for spontaneous healing or it may be necessary to biopsy or remove the suspicious tissue to determine through histologic analysis whether cancer cells are present. If necessary, we may also refer the patient to a specialist who deals with oral diseases.

When present, malignant lesions are usually removed surgically with concomitant removal of the surrounding lymph nodes. In cases requiring very extensive excision, bone or soft tissue reconstructions may be necessary. In most cases, a treatment phase with radiation therapy and chemotherapy will follow.

Treatments can be quite invasive, which is why it is essential to undergo periodic screening and work on prevention.

With this in mind, periodontal supportive therapy involving professional hygiene sessions repeated over time at regular intervals, depending on each patient’s susceptibility, has not only the advantage of maintaining healthy gums and teeth but also allows monitoring of soft tissue health and early interception of the possible presence of precancerous lesions.