March 10, 1999

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Recently, a national dental journal ran an excellent feature article on oral cancer and urged dentists to be more pro active in educating patients on the dangers of smokeless tobacco. What struck me most about the article, though, was what it didn’t say. It didn’t tell dentists that the second leading cause of this disease, according to medical literature, is ill-fitting dental devices.

Several years ago, I was asked to assist in a case in New England involving oral cancer. A young college student had been balancing her time between beauty pageants and academic studies until she underwent radical neck surgery to remove most of her tongue and much of her face and neck in an attempt to stop a rapidly advancing cancer. For months, she had complained to her orthodontist of pain and soreness where the retainer he placed in her mouth was irritating her gums. He dismissed her persistent complaints, however, as did the dentist at her college infirmary.

Her father, a physician, didn’t learn about his daughter’s problem until he noticed a slight slur in her voice over the telephone. Alarmed at what she told him, he advised her to see an oncologist as soon as possible. Unfortunately, it was too late.

The father contacted me, puzzled that cancer researchers at a nearby medical school found unbelievably high levels of nickel - many times higher than concentrations known to cause cancer - dissolving out of the retainer into her saliva. I explained that many bacteria, such as those that colonize irritated areas of the mouth, cause nickel to corrode and form compounds that are highly carcinogenic. Intimate, prolonged contact between carcinogenic chemicals and irritated tissue is a deadly combination - the same reason snuff causes oral cancer.

These observations gave me pause to think more seriously about something that had been in the back of my mind for a long time. Irritation had developed in the gums around one of my teeth when it was fitted with a crown fifteen years earlier. The problem never went away. I had asked several dentists over the years what they thought but they dismissed my suspicion that the crown was the source of the irritation.

Finally, a microbiologist from Utah and I were lecturing in Europe on the need for dentists to sterilize handpieces (dental drills). When I asked her what she thought about the problem with my crown, she exclaimed: "My husband (a renowned dentist) lectures on that all the time. You should see the pictures he’s taken of reactions to nickel in crowns and bridges."

The good news, she said, is that the condition heals dramatically within days after replacing the devices with nickel-free alloys. Needless to say, my dentist was the first person I visited upon returning home. He was impressed at how soon the chronic irritation disappeared after replacing the porcelain crown with a gold one.

My relief over getting rid of the crown, however, was tempered. I had noticed that a lymph node in my neck directly beneath the crowned tooth had been growing larger for well over a decade. I had asked several physicians to check it during regular physical examinations. They didn’t think it warranted a biopsy.

After having the porcelain crown removed, however, I talked with a local surgeon and insisted that he x-ray the area. I was concerned that nickel may have reached and irritated a lymph node in the proximity of the crown. The node that was troubling me turned out to be far larger than any of my physicians had thought. Immediate surgery was recommended. The good news was that it wasn’t malignant.

Out of curiosity, I dropped by a local dental laboratory one day with my old crown in hand. The technician took one look and said "Sure, the band around the base of that crown is full of nickel. Crowns made of base metals in the mid 1980's are especially high in nickel because the price of precious metals went out of sight."

I took this seriously when it came time for my children to have braces. I was particularly concerned that, like me, they develop skin rashes when they wear rings or bracelets made with nickel alloys. This means any contact with nickel in their mouths will also be a source of constant irritation. I was relieved to find a local orthodontist willing to order nickel-free alloys at no extra cost for making their braces.

My story ends on a flight back to Atlanta last year, when a young surgical nurse seated next to me struck up a conversation. Pointing to my scar, I mentioned that the only thing I’ve ever had removed was a lymph node. As she touched the corresponding place on her own neck, she said: "You know, I’ve had that exact same problem for the past ten years."

"Have you had any dental work in that area?," I asked. "Now that you mention it," she said, "I had a tooth crowned there ten years ago right when the problem started. Why do you ask?" Just a coincidence? Probably. Nevertheless, dentists should take a closer look inside their own shop when it comes to oral cancer. They need to educate themselves and their patients on its second leading cause – irritation associated with dental work.

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