Oral HPV Risk and Cigarette Smoking

The Journal of the American Medical Association has published a study by researchers at Johns Hopkins School of Public Health that found cigarette smokers more likely to be positive for human papillomavirus (HPV)-16 compared with non-smokers.  A total of over 6,800 adults ages 18 to 59 were tested for HPV and recent nicotine use by measuring their blood and urine samples.

Smokers of at least three cigarettes per day have a 31% increased risk of HPV infection as a result of raised levels of a metabolite of nicotine called cotinine.  2% of tobacco users were infected with HPV while less that 1% of non-smokers were. The concern is that because of the fact that as few as three daily cigarettes increases the risk of HPV by one third, and the fact that oral HPV is a virus that can trigger throat and mouth cancers, the combination of the two means a higher risk of cancer also.

Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309

AMA, FDA: E-Cigarette Regulations

In 2010, the Food and Drug Administration (FDA) determined that e-cigarettes were to be regulated in the same manner as tobacco and nicotine products.

While there has been some suggestion, and conflicting studies, that e-cigarettes can be used as a method of tobacco cessation, there is also the concern that use e-cigarettes by minors can be a gateway to tobacco use.

Due to the uncertainty of the research, and the potential harm, the American Medical Association (AMA) has recently announced new recommendations: a minimum age purchase rule, child-proof and tamper-proof packaging, restrictions on flavors that are attractive to potential young smokers, labeling, and a ban on unsupported claims that e-cigarettes help people quit smoking.  Also it recommends listing the toxic materials and their potential harmful effects.

Robert G. Tupac, DDS, FACP, Inc.,
Diplomate, American Board of Prosthodontics
(661) 325-1275 | www.drtupac.com
5060 California Ave., #170, Bakersfield, CA 93309

Relief From Oral Mucositis

What is oral mucositis?

Oral mucositis is an inflammatory condition of the tissues that line the mouth and throat.  It can be exquisitely painful.  It is caused by many medications, medical conditions, and treatment for oral cancer.  Currently, paychotherapy, analgesics, and oral rinses are all part of the armamentarium against oral mucositis.  Some of the formulas include chamomile, antiseptics, immunomodulatory agents, topical anesthetics, and antibacterial agents.  In addition, some compounds include antifungal agents, antiviral agents, mucosal barriers, and coating agents.  Many different approaches are being evaluated because there is still such a large unmet medical need.

A new study has found that doxepin rinse may result in a modest but significant improvement in mouth and throat pain over a four hour period.  It is both an anesthetic and analgesic.

Source: J Clin Oncol. 2014;32(15):1571-1577, from ChemotherapyAdvisor

Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309

FDA Warning Labels for Tanning Beds

The statistics are alarming:  32% of all 12th grade girls report using tanning beds. Because such exposure poses the highest risk for skin cancers for young persons under the age of 18, the Center for Disease Control and Prevention has issued new guidelines for visible warnings on tanning beds and booths.

The FDA has reclassified the devices from ow-risk to moderate-risk devices and requires warnings that these devices put users at a greater risk of skin cancer.

Robert G. Tupac, DDS, FACP, Inc.,
 Diplomate, American Board of Prosthodontics
(661) 325-1275 | www.drtupac.com
5060 California Ave., #170, Bakersfield, CA 93309

Use Mouthwash In Moderation

Mouthwash Linked to Oral Cancer

Some of the mouthwashes available on the market today advertise as being as a substitute to and just as effective as tooth brushing.  These products tout their easy availability and the benefit of keeping your breath fresh all day long.  However, it turns out, according to a newly published study from the University of Glasgow, in the journal Oral Oncology, that overuse of mouthwash is linked to oral cancer.

Overuse of Mouthwash 

A study of 1,962 oral cancer sufferers and 1,993 healthy people in thirteen centers in nine countries found that rinsing with such products more than three times per day was associated with an increased risk of the development of mouth and throat cancer.  This is due to cancer causing chemicals in the mouthwashes being absorbed by the mucosal lining of the mouth and throat tissues.  The evidence suggests that overuse of mouthwashes to mask denture odors, periodontal disease, bad breath, smoking, or alcohol intake increases the risk of oral cancer.


Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309

Oral Cancer Demographics and Risk Factors

Smoking Increase Risk 37-Fold 

In the US there are an estimated 36,450 new cases of oral cancer diagnosed each year, 25,420 in men and 11,120 in women.  Nearly 7,880 people die of cancer of the oral cavity and pharynx each year.  The average age for diagnosis is 62 years and 1.02% of people born today will be diagnosed with it during their lifetime.

Approximately 90% of oral cancer is on the surface and called squamous cell carcinoma.  Traditional risk factors are tobacco and alcohol.  When someone smokes and drinks, their risk is increased 37-fold.  Higher risk sites include the tongue and floor of the mouth.  Cancer of gum tissues accounts for about 10% of all oral cancers.

Although the average age for diagnosis is 62 years, a rapidly growing number of younger patients without traditional risk factors are being diagnosed with HPV- related tumors of the tonsils and base of the tongue.

Source: AAOMS Surgical Update, Vol 24, 1

Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309

We Treat Oral Cancer Patients

Maxillofacial Prosthetics

As Bakersfield's only full time Board Certified Prosthodontist, I have the privilege of working with the area's finest head and neck tumor surgeons.  Many times I have found myself in the operating room with these expert physicians fashioning intraoral appliances for patients undergoing tumor surgery.  This area of treatment is called Maxillofacial Prosthetics.

Oral Cancer Screening

Although the prognosis for long term survival is improving for many types of cancers, depression and death by suicide among patients with cancer is a concern.  In a study of 32,487 patients, Yu, etal., reported in the Archives of Otolarygology and Head and Neck Surgery, compared changes in cause of death in four time periods from 1980 to 2007.  They used standard mortality ratios to compare deaths from suicide, cardiovascular disease and pneumonia among patients with oral cancer and oral pharyngeal cancer.  Over the 27 year period, cardiovascular disease related deaths decreased by 45.9% and pneumonia related deaths decreased by 42.9%.  However, suicide deaths increased by 406.2%.  The significant increase in suicide rates are tied to risk factors such as age 55 to 64 years, certain marital status (divorced, separated or never married), advanced tumor stage, treatment with radiotherapy alone and pharyngeal tumor location.  Depression is a treatable condition and suicide is often preventable.  Because of long-standing professional relationships with their patients and the ability for oral cancer screening at dental visits, dentists may be in a position to provide appropriate support and referral for early intervention for patients with oral cancer. 

Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309

Oral Cancer Symptoms and Appearance

Oral Cancer has Many Symptoms

Oral cancer can present with many different symptoms.  Often, a non-healing ulcer (wound), whether or not it is painful, is the first presenting symptom.  A recent study suggests that the onset of orofacial pain that worsens during function may be an important predictor for the transition from oral pre-cancer to cancer.  Screening patients who have new-onset orofacial pain may lead to a diagnosis of early resectable head and neck cancer, and may improve quality of life and survival rates for patients.

Various Symptoms 

Other symptoms that should raise suspicion include:  white or red spots, bleeding mouth sores, increased mouth pain, loose teeth, poor fitting dentures, non-healing extraction socket, ear pain, lip or tongue numbness, difficult or painful swallowing, change in speech or a lump in the neck.  It is very important to remember that any white/red lesion or ulcer in the mouth that has not healed within three weeks should be evaluated.

Oral Cancer Screening 

Dr. Tupac provides oral cancer screening as part of new patient and patient recall examinations. He also works with Dr. Tung Trang, Chief of Head and Neck Oncology, of Kern Medical Center with the prosthetic treatment of cancer patients both in the operating room and after tumor surgery for patients recovering with surgical defects.  Dr. Tupac had almost 40 years of experience in the prosthetic reconstruction of oral cancer patients to reestablish near normal function as it relates to speaking and eating in addition to maintaining facial appearance.

Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309

Warning Signs of Oral Cancer

As part of our celebration of Oral Cancer Awareness Month, these are the warning signs of oral cancer:

• red or white patches in or behind the mouth
• mouth sores or ulcers that bleed easily and do not heal
• unexplained lump in the neck, throat or floor of the mouth
• difficulty or discomfort swallowing
• pain and tenderness in segments of teeth or gums
• change in the fit of dentures or partial dentures
• visible change in mouth tissue
• unpleasant sensations (pain, discomfort, numbness)
• diminished ability to perform normal functions such as opening jaw, chewing or swallowing
• unexplained swelling or fullness in neck 

Your Board Certified Prosthodontist is trained in oral cancer screening procedures.





Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309

April Is Oral Cancer Awareness Month

As a Board Certified Prosthodontist, Dr. Tupac treats many patients who have had oral cancer.  Special techniques and prosthetic devices are often necessary and training in this area is confined to an area called maxillofacial prosthetics, and Dr. Tupac has had forty years of experience in the treatment of head and neck cancer.

That's why all new patients, all recall patients and all patients who return to the office after not having been seen for a year get a full examination of their oral soft and hard tissues.  This oral cancer screening is performed just as a matter of course, because  early detection is always associated more successful treatment.  If you have any questions about any areas of your mouth, be sure to ask when you see us!


Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309

Oral Cancer Survival Best with Surgery First--Study

ChemotherapyAdvisor continues to be a superb source of cancer-related news.  A study reported by JAMA Otolaryngology-Head and Neck Surgery, under the direction of Dr. Steven Chinn of the University of Michigan, retrospectively evaluated 19 patients who had surgically treated advanced oral cavity squamous cell carcinoma.  The study groups were divided according to chemoradiotherapy first and then surgery and surgery first and radiotherapy.  Statistical analysis showed a significantly greater five year survival rate for those patients who were treated with resection surgery first.

For details: www.chemotherapyadvisor.com


Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309

HPV Infections in the Mouth

HPV can infect oral tissues.  A subgroup of oral cancer clearly is associated with HPV.  Oral HPV is transmitted sexually but also can be transmitted from mouth to mouth and vertically from an infected mother during delivery.  A detailed description of the mechanism by which an HPV lesion develops into oral cancer, with pictures, is found in JADA August 2011, 142(8), pp905, at www.jada.ada.org

Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309

Cigar Smoking and Cancer

Cigarettes vs Cigars

Cigarette smoking causes cancer.  Is it the same for cigar smoking?  Cigars are composed usually of a single type of tobacco, rather than a blend, which is air-cured and fermented.  While a cigarette contains less than one gram of tobacco, a cigar can have up to 20 grams of tobacco.  The National Cancer Institute has established that cigars:

• have a higher level of cancer-causing substances (nitrosamines) than cigarettes
• have more tar, for every gram of tobacco smoked
• have a higher level of toxins, because the wrapper is nonporous and the burning of the tobacco is less complete, resulting in higher concentrations of toxins

Cigars Causes Cancer

Cigars cause cancer of the oral cavity, larynx, esophagus and lung.  It may also cause cancer of the pancreas.  Daily smokers, particularly those who inhale, are at increased risk for developing heart disease.
Even if smoke is not inhaled, high levels of nicotine are absorbed through the lining of the mouth.  Since a single cigar can potentially provide as much nicotine as a pack of cigarettes, cigars are addictive.

Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309

Smokeless Tobacco and Cancer

Smokeless tobacco is tobacco that is not burned.  It is available in different forms: chewing tobacco is loose leaves or bricks, and snuff is finely cut or powdered and either loose or in pouches.

Risk of Cancer

Smokeless tobacco contains at least 28 chemicals that have been found to cause cancer.  The level of tobacco-specific nitrosamines, formed during the growing, curing, fermenting and aging of the tobacco, is directly related to the risk of cancer.

The International Agency for Research on Cancer has reported that smokeless tobacco causes oral cancer, esophageal cancer and pancreatic cancer.  Furthermore, it is associated with and may cause heart disease, gum disease and oral lesions other than cancer.

Smokeless Tobacco Is Additive

Smokeless tobacco is also considered addictive because of the amount of nicotine absorbed by the lining of the mouth.  When absorbed through mouth tissues, the nicotine goes directly into the bloodstream and is transported to the brain.

Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309

We Perform Oral Cancer Screenings

Oral cancer can present with many different symptoms.  Often, a non-healing ulcer (wound), whether or not it is painful, is the first presenting symptom.  A recent study suggests that the onset of orofacial pain that worsens during function may be an important predictor for the transition from oral pre-cancer to cancer.  Screening patients who have new-onset orofacial pain may lead to a diagnosis of early resectable head and neck cancer, and may improve quality of life and survival rates for patients.  

Oral Cancer Symptoms

Other symptoms that should raise suspicion include: white or red spots, bleeding mouth sores, increased mouth pain, loose teeth, poor fitting dentures, non-healing extraction socket, ear pain, lip or tongue numbness, difficult or painful swallowing, change in speech or a lump in the neck.  It is very important to remember that any white/red lesion or ulcer in the mouth that has not healed within three weeks should be evaluated. 

Oral Cancer Screening

Dr.Tupac provides oral cancer screening as part of new patient and patient recall examinations.  He also works with Dr. Tung Trang, Chief of Head and Neck Oncology, of Kern Medical Center with the prosthetic treatment of cancer patients both in the operating room and after tumor surgery for patients recovering with surgical defects.  Dr. Tupac had almost 40 years of experience in the prosthetic reconstruction of oral cancer patients to reestablish near normal function as it relates to speaking and eating in addition to maintaining facial appearance.

Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309

We Perform Oral Cancer Screenings

Oral Cancer Symptoms

Oral cancer can present with many different symptoms.  Often, a non-healing ulcer (wound), whether or not it is painful, is the first presenting symptom.  A recent study suggests that the onset of orofacial pain that worsens during function may be an important predictor for the transition from oral pre-cancer to cancer.  Screening patients who have new-onset orofacial pain may lead to a diagnosis of early resectable head and neck cancer, and may improve quality of life and survival rates for patients.  

More Oral Cancer Symptoms

Other symptoms that should raise suspicion include: white or red spots, bleeding mouth sores, increased mouth pain, loose teeth, poor fitting dentures, non-healing extraction socket, ear pain, lip or tongue numbness, difficult or painful swallowing, change in speech or a lump in the neck.  It is very important to remember that any white/red lesion or ulcer in the mouth that has not healed within three weeks should be evaluated.  

Oral Cancer Screening

Dr.Tupac provides oral cancer screening as part of new patient and patient recall examinations.  He also works with Dr. Tung Trang, Chief of Head and Neck Oncology, of Kern Medical Center with the prosthetic treatment of cancer patients both in the operating room and after tumor surgery for patients recovering with surgical defects.  Dr. Tupac had almost 40 years of experience in the prosthetic reconstruction of oral cancer patients to reestablish near normal function as it relates to speaking and eating in addition to maintaining facial appearance.

Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309

Oral Cancer Ups Suicide Risk

Cancers combined for men, women, and children continued to decline in the United States between 2004 and 2008, according to the Center for Disease Control and Prevention, as reported in the May 2012 issue of the journal CANCER. 

The overall rate of new cancer diagnoses (or incidence) among men decreased by an average of 0.6% per year between 2004 and 2008; and for women by 0.5% per year from 1998 to 2006, with level rates from 2006 to 2008.  The special feature section highlights the effects of excess weight and lack of physical activity on cancer risk.  Esophageal adenocarcinoma, cancers of the colon and rectum, kidney cancer, pancreatic cancer, endometrial cancer, and breast cancer among postmenopausal women are associated with being overweight or obese.  Several of these cancers also are associated with not being sufficiently physically active.  For more than 30 years, excess weight, insufficient physical activity, and an unhealthy diet have been second only to tobacco as preventable causes of disease and death in the United States.  The journal notes that continued progress against cancer in the United States will require individual and community efforts to promote healthy weight and sufficient physical activity among youth and adults. 


Source:  CDC, March 28, 2012   


Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309

Mouthwash Not Associated With Oral Cancer

There has been a longstanding controversy whether use of mouthwash containing a high alcohol content and the risk of oral cancer are associated.  Researchers from the European Institute of Oncology, the International Prevention Research Institute, and the Istituto di Ricerche Farmacologiche Mario Negri conducted an analysis of epidemiological studies of mouthwash containing more than 25% alcohol and oral cancer.  Eighteen studies were included in the meta-analysis and researchers reported there were no statistically significant associations between regular use of mouthwash and risk of oral cancer.  They found, furthermore, no significant trend in risk of oral cancer associated with daily usage of mouthwash, and no association between reported use of mouthwash specifically containing high alcohol content and risk of oral cancer.  





Source:  Annals of Agriculturaland Environmental Medicine 19(2):173-80

Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309

HPV Oral Cancer on the Rise

Human papillomavirus (HPV) is responsible for more than 5% of all cancers, including all cervical cancers.  Presently, an estimated 63% of oropharyngeal cancers are caused by HPV, and tha percentage is rising.  At current rates, oropharyngeal cancer will become the leading HPV-related cancer in the United States by the year 2020, surpassing the yearly number of cervical cancers.  An estimated 7,400 new cases of HPV-related oropharyngeal cancers are diagnosed annually.  These cases are highest among adults in their late 20's and late 50's.  Men outnumber women 4:1.  These cancers are most commonly found on the tonsils.  Others are found at the base of the tongue.  In these areas, diagnosis is usually at advanced stages (75% stage III/IV), with lymph node involvement.

While the prevalence of HPV infection is about 7% in the general population, it can be as high as 20% for those with more that 20 lifetime sex partners (oral, anal, and/or vaginal) or who smoke more than 20 cigarettes daily.


Source: www.chemotherapyadvisor.com


Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309

Dealing With the Oral Effects of Chemotherapy

Chemotherapy helps treat cancer.  It can also cause side effects in your mouth.  The drugs are used to kill cancer cells and your body reacts to them in different ways.  Typical oral problems are painful mouth and gums, dry mouth, burning, peeling or swelling tongue, infection and change in taste.  Your dentist is an important part of your cancer treatment.  Prevention of serious side effects is more likely if you visit your dentist at least a month before the therapy begins.  A dentalcheckup, teeth cleaning, x-rays and treating problems will make your mouth healthy and make it more likely you will stay on your cancer treatment schedule.  

Healthy Mouth 

During chemotherapy:  keep your mouth moist by drinking a lot of water, and use sugarless gum or a saliva substitute.  Brush your teeth and gums with an extra-soft toothbrush and a fluoride toothpaste and floss where there is no bleeding.  Avoid alcohol mouthrinses and instead use a solution of 1/4 tsp each of baking soda and salt in one quart of warm water, followed by a plain water rinse.  Sipping liquids with your meals will make eating easier.  Soft and moist foods are easier to swallow.  Spicy or acidic foods can be irritating, and tobacco and alcohol make oral tissues drier.  Take advantage of seeing your dentist if there is anything you are concerned about, since side effects can last for some time even after the chemotherapy is complete.  

Source:  National Institute of Health  

Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309