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NHS dentist crisis sparks fears deadly mouth cancers are going undiagnosed 

Mouth cancers could be going undiagnosed as a result of dentists refusing to offer consultations, medical leaders have warned.

Routine dental appointments always involve checks for signs of the disease, which include inflamed or white patches in the mouth, and small lumps or blisters. These examinations are vital, as the symptoms are often painless or not considered serious by patients.

If anything worrying is seen, a referral can be made to hospital specialists for a definitive diagnosis. Almost half of mouth cancers are first spotted in this way.

But last week a major survey showed that nine in ten NHS dental practices in England are not accepting new adult patients, and eight in ten won’t take on children.

Routine dental appointments always involve checks for signs of the disease, which include inflamed or white patches in the mouth, and small lumps or blisters. These examinations are vital, as the symptoms are often painless or not considered serious by patients.

As a result, cases of mouth cancer, also known as oral cancer, will undoubtedly have been missed, says Dr Jane Wilcock, chair of the Royal College of General Practitioners North-West faculty. ‘Patients often aren’t aware of a problem in the mouth until a dental hygienist or dentist notices something suspicious, such as a red or white patch inside the cheek or on the gums.

‘Not all will turn out to be cancer, but some will. The problem is, many people just can’t get to see an NHS dentist at the moment. With fewer examinations, inevitably cases of mouth cancer will go undiagnosed.’

Cancer expert Professor Patricia Price, chair of Radiotherapy UK and co-founder of the #CatchUpWithCancer campaign, says: ‘With oral cancer, speed of diagnosis and treatment is hugely important. If opportunities to catch it early are missed, more oral cancer patients will die needlessly.’

In January, the Government pledged an extra £50 million to fund 350,000 more dental appointments, yet the latest figures suggest this has had little effect.

The number of NHS dentists has fallen to its lowest in a decade to about 22,000, with nearly 1,000 quitting during the past year. A further 40 per cent are said to be looking to change career or seek early retirement this year.

Healthwatch UK spokesman Jacob Lant says calls to their helpline reveal a frustrating situation. ‘We’ve heard from patients who’ve been unable to get a dentist appointment for two years and then tried to make an appointment, only to find they’ve been deregistered because they’ve not attended in so long. They then can’t reregister, as practices aren’t taking on new patients.’

New cases of mouth cancer were already rising sharply before the pandemic. More than 8,722 people in the UK were diagnosed in 2019 – an increase of 97 per cent since 2000. Given that trend, and with no new data since 2019, the fear is that new cases will have gone undiagnosed.

One NHS Trust in England reported a 65 per cent drop in oral cancer referrals between 2020 and 2021, according to recent research from the Oral Health Foundation

One NHS Trust in England reported a 65 per cent drop in oral cancer referrals between 2020 and 2021, according to recent research from the Oral Health Foundation

One NHS Trust in England reported a 65 per cent drop in oral cancer referrals between 2020 and 2021, according to recent research from the Oral Health Foundation.

About two in three oral cancer patients are men, and three in four are over 55.

Tobacco use and heavy drinking increase the risk. It’s also caused by the human papillomavirus (HPV) – the same infection that causes cervical cancer.

In a third of cases, the tumour is in or on the tongue. It can also appear in the cheeks, the roof of the mouth, the tonsils, salivary glands and in the upper throat, including in the larynx, or voicebox as it’s better known.

Early warning signs include mouth ulcers that do not heal, persistent red or white patches in the mouth, unusual lumps and swellings and persistent hoarseness. If caught early, when tumours are small, 85 per cent of patients survive the disease. However, the majority of cases are picked up once the cancer has spread. Roughly half of these patients die within three years of diagnosis.

Early treatment may just involve surgery, but more advanced cancers require radiotherapy and chemotherapy.

‘At later stages surgery may involve a large part of the tongue, mouth or throat being removed,’ adds Dr Wilcock. ‘This can make life incredibly difficult.’

Oral Health Foundation spokesman Dr Ben Atkins says: ‘I’ve worked as an NHS dentist for 25 years and I’ve never seen challenges like we have at the moment. We’re now at a critical point.’

He adds: ‘If someone has an ulcer that’s not healing or another problem in the mouth, and they can’t get an appointment with a dental professional, then a they should see a doctor or pharmacist as soon as possible, and get checked out.’

One person who knows all too well the devastating impact of oral cancer is Kayleigh Samson, 31, whose mother Elizabeth died at 52 from the disease in April 2021. Elizabeth, from Ayrshire, first started suffering symptoms – including facial pain – in March 2020, just as the first Covid lockdown was imposed. Antibiotics prescribed remotely by her GP didn’t help. When the pain moved to her mouth, she tried to get a dental appointment but was told as she didn’t have a broken or missing tooth, or have bleeding in the mouth, she didn’t fit the criteria for emergency treatment.

Elizabeth managed to get a dental check-up in November that year and was referred for further tests at hospital a month later, where she was told she had a salivary gland tumour. ‘The doctor said it was very aggressive,’ recalls Kayleigh. ‘Mum didn’t smoke and only had a drink on special occasions. She’d been trying to tell people something was wrong, but had been fobbed off.’

In January, Elizabeth had surgery, losing three-quarters of her tongue and 13 lymph nodes in her head. But it came too late, as the cancer spread to her brain and lungs.

Kayleigh says: ‘It all happened so fast, it’s still hard to take in. My advice to anyone who senses a problem in their mouth is to keep pushing to see someone – anyone who might be able to take a look and offer some advice.’

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