The OPTISMILE Podcast 105 - Oral Cancer – What to Look For

Oral cancer is one of the less talked about cancers, yet awareness, early detection, and routine screening can make the difference between a simple follow-up and life-changing treatment. In this episode, Dr Clifford Yudelman from OptiSmile joins the conversation to explain what oral cancer looks like in its earliest stages, why it is becoming more common in younger non-smokers thanks to HPV, how alcohol and tobacco multiply risk, and what patients should be checking for in their own mouths. He also explains why a painless sore is often more worrying than a painful one, and why every dental checkup at OptiSmile includes an oral cancer screening.10 Questions with Summary Answers1. [1:13] Is oral cancer rare, or is it becoming more common?It is not rare, and globally it is becoming more common. While it was traditionally linked to older men who smoke and drink heavily, that profile is changing quickly. Cancers of the mouth, tongue, and throat are rising, especially those linked to HPV. In South Africa it is a significant problem, often diagnosed late, and it does not receive the same public awareness as breast or prostate cancer.2. [2:35] What is the link between HPV and oral cancer?HPV-16 in particular is now recognised as a major cause of oropharyngeal cancers, affecting the back of the tongue and throat. These cancers are biologically different from the tobacco and alcohol related ones, often occur in younger patients with no smoking or drinking history, and are primarily transmitted through oral sexual contact. They tend to respond better to treatment but are often detected later because early symptoms are subtle.3. [3:54] What does a suspicious lesion or patch look like inside the mouth?Early signs are usually subtle rather than dramatic. A persistent ulcer, a small red patch, a white patch, or a mixed red and white area that does not heal within two to three weeks is a warning sign. Other red flags include unexplained lumps, thickened areas, numbness, or changes in texture. Pain is not a reliable indicator as many early oral cancers are completely painless. Persistence is the key warning sign.4. [4:52] Why is it so important to check the sides of the tongue and the floor of the mouth?The sides of the tongue and the floor of the mouth are the most common sites for oral cancer because the tissue there is thinner and has a very rich blood supply. Most people never look at these areas themselves. Dr Yudelman suggests gently pulling the tongue out with a piece of gauze to inspect the sides and underside, and feeling under the jaw for lumps or enlarged lymph nodes.5. [5:47] What is the VELscope and how does it help?The VELscope is a screening device that emits a specific wavelength of light causing healthy tissue to fluoresce. Through the scope, abnormal tissue appears darker or irregular. It does not diagnose cancer but enhances detection during a clinical exam, similar to how a UV light highlights changes invisible to the naked eye. It is widely used in the USA and other countries but is not readily available in South Africa.6. [7:03] Does oral cancer actually hurt in the early stages?Usually no, and this is one of the most important messages. Pain only tends to arrive once nerves are affected, which is often later in the disease. Common painful mouth ulcers that come and go over a week or two are almost always harmless. The real concern is a non-painful sore or patch that simply will not heal. Do not rely on pain as a warning system, rely on persistence.7. [8:00] How does alcohol combined with smoking multiply the risk?The two have a synergistic effect rather than just an additive one. Strong alcohol such as whiskey, gin, brandy, or even high-alcohol mouthwashes makes the oral tissues more permeable, allowing tobacco carcinogens to enter the cells more easily. People who smoke and drink heavily have a dramatically higher risk than those who do only one. Reducing or stopping either habit lowers risk significantly.8. [10:17] What is the survival rate if oral cancer is caught early versus late?When detected very early, the five-year survival rate can exceed 80 per cent. Once it has spread into the lymph nodes or surrounding tissue, survival can drop well below 40 per cent, and the treatment becomes much more aggressive, often involving major surgery, radiation, and chemotherapy. Early detection reduces suffering and the extent of treatment required, as well as saving lives.9. [11:01] How should patients do a self-exam at home?Once a month, in good lighting, check your lips, cheeks, gums, tongue, floor of the mouth, and throat. Natural daylight inside a car with the visor mirror down works surprisingly well. A magnifying makeup lamp is also useful. Then feel along the lips, cheeks, and under the jaw for lumps or enlarged lymph nodes. This is especially important for heavy smokers, vapers, users of tobacco pouches, and heavy drinkers.10. [13:01] How often does OptiSmile screen for oral cancer during checkups?At every checkup. Dr Yudelman and the other dentists and hygienists at OptiSmile routinely examine soft tissue, the tongue, the floor of the mouth, and the neck lymph nodes. Photographs are taken for review, and suspicious areas are either monitored or referred to an oral pathologist or periodontist for biopsy. Vigilance at every visit is how early changes are caught before they become serious.OutroOral cancer is a topic many people would rather not think about, but awareness and routine screening save lives. The simplest takeaways from this episode are to watch for any sore, patch, or lump in the mouth that does not heal within two or three weeks, to check the sides and underneath of your tongue regularly, and to remember that no pain does not mean no problem. Heavy smokers and heavy drinkers should be especially vigilant, but with HPV-related oral cancers rising, even non-smokers benefit from regular professional screening. If you have not had your mouth properly examined in the last six to twelve months, it is worth booking a checkup.Further ResourcesDental Checkups in Cape Town – What to Expecthttps://optismile.co.za/dental-solutions/dental-checkup/Explains what is included in an OptiSmile dental checkup, including the routine oral cancer screening of the lips, cheeks, tongue, and soft tissue.Dental Problems and Solutionshttps://optismile.co.za/dental-problems/A broader overview of oral conditions OptiSmile screens for and treats, including early warning signs, sensitivity, and enamel wear.Advanced Dental Technology at OptiSmilehttps://optismile.co.za/dental-technology/An overview of the Leica microscope, 3D imaging, and other diagnostic tools OptiSmile uses to detect small changes in the mouth before they become serious problems.Gum Disease – Early Signs, Professional Care, and Recovery (Podcast)https://optismile.co.za/blog/gum-disease-early-signs-professional-care-and-recovery/A companion episode on another condition where early detection by the dentist makes a significant difference to outcomes.Professional Dental Cleaning Explained (Podcast)https://optismile.co.za/blog/professional-dental-cleaning-explained/Covers what happens at a routine hygiene visit, which is often where soft-tissue changes are first noticed by the hygienist or dentist.Book an Appointment at OptiSmilehttps://optismile.co.za/If you have a lump, ulcer, patch, or area of numbness that has not healed in two to three weeks, a professional assessment is the sensible next step.Disclaimer: The content provided in this podcast, "Save Your Money Save Your Teeth" on Medical Mondays, is for informational and educational purposes only. It is not intended to serve as dental or medical advice. The insights and opinions expressed by Dr. Clifford Yudelman and any guests are designed to foster a better understanding of dental health, preventive measures, and general well-being, but should not be interpreted as professional dental or medical recommendations. Dr. Clifford Yudelman does not diagnose, treat, or offer prevention strategies for any health conditions directly through this podcast. This platform is not a substitute for the personalized care and advice provided by a licensed dental or healthcare professional. We strongly encourage our listeners to consult with their own dental care providers to address individual dental health needs and concerns. The information shared here aims to empower listeners with knowledge about dental health but must not be used as a basis for making health-related decisions without professional guidance. Your dental care provider is the best source of advice about your dental and overall health. Please always seek the advice of your dentist or other qualified health professionals regarding any questions or concerns about your dental health.