It's not just a twist of the tongue

Complementary and alternative treatment of oral cancer patients may offer benefits

BY Debra Grant, RDH, MA

Due to the vigilance of dental hygienists, as well as the increase in oral cancer awareness, more people are becoming aware of the importance of an oral cancer screening. For a few years, nationwide oral cancer walks have helped to bring that awareness to the forefront and unite hygienists for a single cause.

Oral cancer is now being recognized as a huge threat to public health because of its high morbidity and mortality. It is estimated that each year that 484,000 people are diagnosed with oral cancer in the world and approximately 261,000 people die of this disease. In China, almost 12,000 cases of oral cancers are diagnosed each year and approximately 5,000 patients die of the disease. A number of factors are associated with the increase of risks of oral cancer. The risk factors include age, tobacco and alcohol consumption, human papilloma virus infection, and race.

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Additional Reading Resources

• Dental coding truths and myths
• The details of oral cancer screening
• 5 things dental professionals need to know about oral cancer

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When you have cancer, you are likely to hear about ways to treat your cancer or relieve symptoms that your doctor hasn't mentioned. Everyone from friends and family to Internet groups and websites may offer ideas for what might help you. These methods can include vitamins, herbs, and special diets, or other methods such as acupuncture or massage, to name a few.

Complementary and alternative therapies

Not everyone uses these terms the same way, and they are used to refer to many different methods. So it can be confusing. We use complementary to refer to treatments that are used along with your regular medical care. Alternative treatments are used instead of a medical doctor's treatment.

• Complementary methods: Most complementary treatment methods are not offered as cures for cancer. Mainly, they are used to help you feel better. Some methods that can be used along with regular treatment are meditation to reduce stress, acupuncture to help relieve pain, or various teas for prevention or to relieve symptoms. Some complementary methods are known to help, while others are not evidence-based.

• Alternative treatments: Alternative treatments may be offered as cancer cures. These treatments have not been proven safe and effective in clinical trials. Some of these methods may pose danger or have life-threatening side effects. But the biggest danger in most cases is that you may lose the chance to be helped by standard medical treatment. Delays or interruptions in your medical treatments may give the cancer more time to grow and make it less likely that treatment will help.

I had to write the above as a disclaimer, even though I live in both worlds of Eastern and Western medicine. This is where hygienists come in as prevention-focused champions for our patients. We were taught in the world of Western medicine, but we have been given healthy brains to use and discern what is best for our patients as oral health consultants and providers. It is our responsibility to educate ourselves for the good of our patients.

Twisting the Tongue

When we perform oral cancer screenings, we ask the patient to stick out the tongue, grab it with the gauze, twist the tongue, and so on. We go through the routine that we were taught in hygiene school. Many of us take it for granted that we'll never find anything. We look. We assess, and we move on. We have the latest diagnostics that have been helpful, at the very least, to the point of making both the patient and ourselves more aware of what is inside their mouth.

What about extraoral screenings? At best, some of us tap out the Morse code and call it a day. How far do we take our screenings? Where do we begin and where do we end? Why is there not a standard protocol and we learn differently throughout the country?

As an Oraspa therapist, we pride ourselves on covering every square millimeter of epidermis from just below the thyroid to the 7th Chakra (or top of the head)! We learn the basics in traditional Chinese medicine (TCM), basic dermatology, and advanced oral cancer and comprehensive thyroid screenings. They just happen to feel really good to the patient, which makes them want to repeat their prophy appointment all over again or never leave the treatment room. (This appointment takes no more time than hygienists' typical schedule.)

In the two-day Oraspa training, we learn how to always make the patient experience our number one concern. For example, typically a hygienist or dentist, when we do an extraoral cancer screening, will palpate, circle, rub, and grab. We do many things that pull on the skin of the patient. This is not comfortable, and you can add the unpleasant smelling gloves on top of it. Patients can't wait to get it over with. In Oraspa, we use a dollop of specific nonallergenic lotion, begin below the thyroid and work our way up. This is done in a series of bio-rhythmic movements complemented with aroma-science, eliminating the patient's fear in dentistry all for the purpose of screening the entire head and neck anatomy for any suspicious lesions in conjunction with opening three of the Seven Chakras or Energy Channels.

It is easy to see why people with cancer think about alternative methods. You want to do all you can to fight the cancer. The idea of a treatment with few or no side effects sounds great. Sometimes medical treatments like chemotherapy can be hard to take, or they may no longer be working. Patients are being self-driven to find alternative methods due to cost and wanting something different.

Alternative treatments

No complementary or alternative medicine treatments can cure mouth cancer. But complementary and alternative medicine treatments may help you cope with mouth cancer and the side effects of cancer treatment.

New discoveries in the treatment of cancer do not center only on conventional medicine. In our haste to get to grips with a cure for cancer, natural products may be overlooked and dismissed in the fight against such an aggressive disease.

In December, the Academy of General Dentistry reported that a new study had found that simply swishing green tea around the mouth halts the growth of new oral cancer cells and breaks down and kills existing oral cancer cells. The antioxidants (polyphenols) in the tea work to remove the free radicals or oxidants and prevent gene mutations. As an added bonus, the polyphenols can kill cancerous cells without harming normal cells and inhibiting their growth. Similarly, a chemical found in tomatoes may prevent or treat oral cancer, and one derived from soybeans has been found to shrink abnormal growths that lead to cancer. While these are not cures, their activity may in the future lead to therapies that compliment conventional treatment modalities.

Perhaps combining these ancient remedies with Western scientific advances is the way to finding an effective cure for cancer. Combrestatin - a cancer-fighting drug made from the bark of an African tree - is performing with dramatic effects in tests. The active ingredient extracted from the bark attacks the blood vessels that grow with tumors, while leaving normal blood vessels alone.

Green Tea - Extracts from green tea may prevent the formation of mouth cancers in people with risk signs of the disease, according to a new study from Texas. Over 50% of participants in a University of Texas M.D. Anderson Cancer Center study experienced a clinical response to the green tea extracts.

Vassiliki Papdimitrakopoulou, MD, the lead researcher at M.D. Anderson Cancer Center, noted, "While still very early, and not definitive proof that green tea is an effective preventive agent, these results certainly encourage more study for patients at highest risk for oral cancer. The extract's lack of toxicity is attractive - in prevention trials, it's very important to remember that these are otherwise healthy individuals and we need to ensure that agents studied produce no harm. We need to further understand if green tea offers longer-term prevention effects for patients."

According to the researchers, almost 60% of people taking the two highest doses of the green tea extracts had a clinical response. Just over 36% of people in the lowest extract dose group had a clinical response, compared to 18% in the placebo group.

Another study followed 41 people with oral leukoplakia, a condition that can be an initial sign of oral cancer risk. Green tea extract had powerful benefits. In fact, over half of the participants were less likely to develop mouth cancer due to taking green tea extract. Polyphenols in tea, which include EGCG (epigallocatechin gallate) and many others, are protective against many types of cancer.

Turmeric - One of the most comprehensive summaries of turmeric studies to date was published by the respected ethno botanist, James Duke, PhD., in the October, 2007 issue of Alternative & Complementary Therapies. The journal reported, "Turmeric (Curcuma long) is a culinary spice that spans cultures. It is a major ingredient in Indian curries, and makes American mustard yellow. But evidence is accumulating that this brightly colored relative of ginger is a promising disease-preventive agent as well, probably due largely to its anti-inflammatory action."

Reviewing some 700 studies, Dr. Duke concluded that turmeric appears to outperform many pharmaceuticals in its effects against several chronic, debilitating diseases, and does so with virtually no adverse side effects. Here are some of the diseases that turmeric has been found to help prevent or alleviate: Alzheimer's disease, arthritis, and cancer.

In cancer, Dr. Duke found more than 200 citations for turmeric and cancer and more than 700 for curcumin and cancer. Curcumin has powerful antioxidant and anti-inflammatory properties, and is the most active constituent of turmeric. He noted that the handbook "Phytochemicals: Mechanisms of Action" cited curcumin and/or turmeric as being effective in animal models in prevention and/or treatment of colon, mammary, prostate, liver, esophageal and oral cancer. Duke said that the effectiveness of the herb against these cancers compared favorably with that reported for pharmaceuticals.

How do you get more turmeric into your diet? One way is with turmeric tea. There are also extracts in tablet and capsule form available in health food stores. Look for supercritical extracts in dosages of 400 to 600 mg, and take three times daily or as directed on the product.

Of course, one can also simply indulge in more curried dishes, either in restaurants or at home. However you do it, adding turmeric to your diet is one of the best moves toward optimal health you can make. The anti-inflammatory marker alone is the key.

Alternative treatments for fatigue

Many people undergoing radiation cancer therapy experience fatigue. A general physician can treat underlying causes of fatigue, but the feeling of being utterly worn out may persist despite treatments. Complementary therapies can help you cope with fatigue. Have your patient check with their doctor about trying:

• Exercise. Gently exercise for 30 minutes on most days of the week. Moderate exercise, such as brisk walking, during and after cancer treatment, reduces fatigue.

• Massage therapy. During a massage, a massage therapist uses his or her hands to apply pressure to your skin and muscles. Some massage therapists are specially trained to work with people who have cancer. Develop a relationship with a well educated massage therapist. There can be precautions on massage therapy and white blood cell count, so make sure they check with their physician and oncologist.

• Relaxation. Activities that help them feel relaxed may help them cope. Listening to music, prayer, meditation, reading, writing in a journal, listening to natural sounds, Himalayan salt lamps, and aroma-science (not candle therapy).

These treatments can be employed alone or in combination, depending on the clinical stage and histology of oral cancer. Beside primary treatments, oral cancer patients may require additional care to ameliorate the side effects of treatment, such as oral pain due to the tumor or oral mucositis, weight loss, fatigue, nausea, vomiting, and altered salivary gland function. The costs for treating oral cancer bring a heavy financial burden to both social resources and patient's family.

Smile-on (a United Kingdom-based newsletter) has reported several scientific breakthroughs that are helping the fight against oral cancer. In August 2000, the latest trials on Foscan (medicated photodynamic therapy) manufactured by Scotia Pharmaceuticals indicated that it might be a very important therapy in the treatment of head and neck cancer. Photodynamic therapy uses light to activate light-sensitive drugs in the treatment of cancer and other diseases. Trials indicated that Foscan was an effective procedure with minimal morbidity and good cosmetic results.

Medical Solutions' Fairfield DNA Ploidy System is a system capable of predicting whether a patient with oral leukoplakia is at risk of developing oral cancer. Digital imaging technology is used to analyze the cell nuclei from a biopsy of each patient and compute the amount of DNA per cell. Those with a normal amount of DNA per cell were found to have a low risk of developing cancer (97% survival rate), while those with white patches and abnormal amounts of DNA were at high risk (16% survival rate).

According to the Oral Cancer Foundation, gene therapy continues to play an important role in medicine, no less so than in the treatment of cancer. Scientists recently found that two immune-system proteins - interleukins IL-2 and IL-12 - effectively fight oral tumors in mice, and scientists believe that this therapy holds great promise in the treatment of head and neck squamous-cell carcinoma in humans. Also, a new oncogene called GKLF was discovered last summer that may play a key part in the development of oral cancer. Researchers found that the expression of GKLF is unique to oral and breast cancer and tests found that when GKLF was over-expressed in mice, they developed the early changes of malignancy and, finally, overt cancer. Now, this new gene will be a therapeutic target for drug discovery and other treatment strategies.

Thanks to our peers and colleagues, we are opening new chapters and awareness with oral cancer. The bottom line is there is hope where there used to be none. Education of the dental hygienist in alternative methods is important for, at the very least, to be informed and be able to speak to our patients with knowledge and authority. Prevention is our business, and we take it seriously. RDH

Debra Grant, RDH, MA, is currently president of International Health Seminars, Inc. She is a speaker in holistic alternative therapies in dental hygiene and creator of the professional Tongue Prophy. In 1986, Debra founded the company, Oraspa, Inc., the leader in dental spa training. She can be reached at [email protected]. Monthly training courses in advanced alternative therapy with Oraspa™ can be found on their website. www.Oraspa.com