Dental Cancer

An interesting conversation on the weekend somehow made its way to teeth and whether there were particular kinds of oral cancer specific to the tooth. Maybe our dentist readers can fill in some knowledge gaps here.

Tooth enamel has no living cells and so, unlike bone, cannot repair itself or become cancerous. However, the tooth does have living cells in the dental pulp, so perhaps they may be susceptible to transformation and uncontrolled growth. Clearly the easy answer would be to consult Pubmed. An even easier solution is finding the one paper that already did that for you, in this case a paper in The Lancet Oncology entitled Teeth: malignant neoplasms in the dental pulp? From the abstract:

[U]sing the search phrase “dental pulp” combined with “sarcoma”, “carcinoma”, or “neoplasms” in PubMed when using the MeSH search mode yielded no reports on primary malignant neoplasms. However, a hand search yields clinical reports on pulpal tumours that were published over a century ago.

OK, so tooth tumours do happen - or did over a century ago. Why aren't there any today? Water fluoridation? The authors offer some thoughts about that:

Because of the restricted space in a tooth, tumour expansion will probably lead to the formation of irritation dentine by secondary odontoblasts and, subsequently, to a haemorrhage infarct of the pulp. One hypothesis states that a purported neoplasm of the dental pulp leads to a chronic appositive pulpitis and–sooner or later–will be treated likewise by root-canal treatment or extraction.

So dental cancers may be happening with some frequency but manifesting and being treated as other conditions. Or maybe the dentists really know what's going on and would rather pocket the treatment fees themselves rather than referring patients for radiation and chemo. They are, after all, in the pocket of Big Floss.

Fact or Fiction: Suicidal Dentists

Which profession has the highest suicide rate? Dentists of course! We've all heard it before, so often it must be true. All that bad breath and gum disease would probably make me suicidal too. On the other hand, the exhorbitant prices of a 5 minute check-up is probably incentive enough to stick with it - you can't spend your tooth fairy money when you're dead. What are the facts though? Are dentists really depressive, or is it a ploy for pity so we don't view them all as Dr. Szell from Marathon Man? The straight dope had the following to say:

"Suicide among white male American dentists is higher than average but not as high as among white male American doctors. (Sorry to limit this to white men, but that's all the data I had to work with.) Don't fret, though. Dentists' death rates from other causes are lower, and on average they live several years longer than the general population. Ditto for doctors."

The literature on the subject indicates that dentists are actually no more prone to suicide than the general population and that gender or dental subspecialty are not good predictors of depression (with the exception of pediatric dentistry and periodontics where females were more depressed than their male counterparts). The most recent data suggests that overall, white male dentists have a lower suicide rate than the rest of the working population but the reverse is true when looking only at older dentists. Despite the persistance of this myth, there is no strong evidence that as a group dentists are more suicidal than other professions, let alone have the highest rate of all of them.