Ladi Yakubu’s ailment started as a toothache two years ago. Later, she noticed that her gums were swollen and bleeding regularly. Over time it turned to an ulcer.
Her sister Maria narrated that Ladi had bought over the counter pain relief medicines, and when she got no relief, some family members recommended herbal medicines, which she kept using for over a year. The ulcer had grown so big that she couldn’t talk or eat properly.
People around her told her it was a ‘spiritual attack’ and her journey of visiting spiritual homes began. By the time she was taken to the hospital, she was very emaciated and weak. She was diagnosed with oral cancer after a series of tests, and died a few weeks after the treatment commenced.
The World Health Organisation (WHO) says oral cancer includes cancers of the lip, other parts of the mouth and the oropharynx and combined rank as the 13th most common cancer worldwide. It says oral cancer is more common in men and in older people, more deadly in men compared to women and it varies strongly by socio-economic circumstances.
According to the Minister of Health, Dr Osagie Ehanire, oral cancers also known as mouth cancers claim about 764 lives in Nigeria every year.
He said oral cancers remain one of the leading causes of cancer related deaths in Nigeria due to late reporting in hospitals, and inability of healthcare workers to detect the lesion early and refer appropriately among others.
He said this has caused a huge economic burden on the sufferers and their families and these could have been prevented if these lesions were detected early.
The minister stated this during an oral cancer training program organised by the Cleft and Facial Deformity Foundation (CFDF) in collaboration with the University of Hong Kong in Abuja. It was themed ‘The use of artificial intelligence in the early detection of oral cancer and oral potentially malignant disorders.’
Represented by the head of the dentistry division of the ministry, Dr Gloria Uzoigwe, he said Nigeria also records 1,146 new cases of oral cancers annually.
Risk factors and causes
Prof. Bukola Folashade Adeyemi of the University College Hospital, University of Ibadan said use of tobacco, and alcohol, oral sex and excessive use of foods prepared over naked flames such as suya, roasted fish, continuous infections in the mouth, are risk factors for oral cancers in Nigeria.
She said over 50 per cent of people diagnosed with oral cancer die of the disease every year in the country. “That is enormous and these are persons who are very important and precious to their people and others,” she said.
She called for early diagnosis, adding, “This is because if a disease affects a single person in the population, the individual, family and close friends are at a loss. Over 700, 000 people dying every year in the country can be rescued. So we talk about early diagnosis, and avoidance of established risk factors,” she said.
Dr Agho Theophilus, a Senior Consultant in oral medicine at the National Hospital Abuja said one of the leading causes of oral cancer is use of tobacco and tobacco products.
He said Human Papilloma Virus (HPV) infection and use of ultraviolet (UV) light has also been indicated.
On prevention, Prof. Bukola Folashade Adeyemi said, “Individuals that avoid these things give themselves a reduced risk of having oral cancer. I am not saying that it is only people exposed to these factors that are the only ones having oral cancer, some people have some genetic anomaly within them that could also cause it.
“These days, some young people don’t smoke again, they use what they call e-smoking; they also use other gadgets called glass chambers, shisha, they are still dangerous.
“We try to advise people to avoid perverse ways of sexual behaviour such as oral sex, avoidance of agents that have been associated with carcinogenesis,” she said.
Dr Agho Theophilus, a Senior Consultant in oral medicine at the National Hospital Abuja said the government should make tobacco smoking unattractive adding that ways the government could do so is packaging of tobacco to show that tobacco is dangerous to health, and by making it not readily available.
He said the government should establish a tobacco smoke free zone, encourage people to take fruits instead of tobacco; and also abolish the use of shisha, and hookah.
“The government should increase tariffs on cigarettes, smoking and tobacco products because that is the leading cause. Then consumption of alcohol should also be discouraged. And one of the ways to do this is increasing tariffs on alcohol. If the government can do that, I believe that the burden of oral cancer would be reduced” he added.
He said HPV infection from oral sex causes oral cancer, adding that people who engage in oral sex should protect themselves by using dental dams.
Dental dams are latex or polyurethane sheets used between the mouth and vagina or anus during oral sex.
Dr Theophilus said dental dams are available in shops and pharmacies, and that a condom can also be improvised as an oral dam where a dental dams is not available. “Dental dam is better but in case it is not available, a condom can also be used,” he said.
He said protective shades can be used as protection against UVB light. He also called for the extension of HPV vaccination, which is currently only available for women to boys and men.
He advised that no teeth issue should be trivialised.
“From as simple as a tooth ache you should report to the hospital or to the dentist. When you notice an ulcer that is not healing, or notice you are bleeding regularly when brushing your teeth, you should report to your dentist, prevention is better than cure.
“We should seek help from professionals. I’m not doubting the role of spirituality. But let doctors do their jobs,” he said.
He also advised the public to see the dentist at least twice every year. “It is advocated that even children should have their first dental visit at least at age one year,” he added.
The Executive Director of the Cleft and Facial Deformity Foundation, Dr Seidu Bello, said artificial intelligence helps in early detection of oral cancers and oral potentially malignant disorders.
Bello, who is also a consultant maxillofacial surgeon, said it could be used to predict with more than 90 per cent accuracy that someone could develop cancer in another 10 years.
He said the use of artificial intelligence for oral health is currently close to zero level in Nigeria.
He said, “Artificial intelligence can assist in the early detection of oral cancer because if we are able to detect it early, we stand the chance of saving many lives.”
The president of the Nigerian Dental Association, Dr Tope Adeyemi, who was represented by the Secretary General of the association, Dr Ukachi Nnawuihe called for full integration of oral health in the primary health care services in the country to ensure easy access to oral health care for Nigerians, especially those at the underserved areas. He advised people to go for regular dental checkups at least twice a year.
The health minister, Dr Osagie Ehanire said the federal government would launch a new oral health policy in November this year, adding that efforts are in top gear by the ministry of health to train community health workers on oral health and also increase oral health awareness amongst the population to about 50%.