WHY DENTAL COVER BY SA’s MEDICAL AID SCHEMES ARE INSUFFICIENT

The South African Dental Association (SADA) today said in a statement that the actual cover for dentistry by South Africa’s Medical Aid Schemes in many instances does not even reimburse the costs of the actual material in dental treatments let alone pay for the professional time of dentists.

According to the statistics reflected in the annual reports of the Council for Medical Schemes (CMS), medical aid scheme payouts to dentists and dental specialists have declined from 8.4% in the late nineties to 3.5% in 2012.

Visits to dentists by medical scheme beneficiaries - at least once a year - decreased during 2011 from 233.2 per thousand to 227.6 per thousand. This translates to only 0.4 per cent of medical scheme beneficiaries visiting a dentist at least once a year! This is particularly unnerving in view of the minimum recommendation of two visits a year required to maintain basic oral health.

Maretha Smit, Chief Executive Officer of the South African Dental Association, says that despite the high percentage of GDP allocated to health in our country the health outcomes are extremely poor and there is an urgent need to focus attention on prevention and primary care in dentistry.  “Very few patients understand the limitations of dental cover through their Medical Aid Schemes. Also, scheme rates offered to dentists, in many instances, fall way below the actual costs of treatment and service.  The inadequacy of current funding models to provide sufficiently for dental care might ultimately lead to the demise of the profession.”

Maretha emphasized that it is time that medical scheme members – and, especially prospective members – start asking serious questions and demand that benefits in this area of basic medical care be re-structured. She further pointed out that, in the context of the current economy and the pressure brought about by medical schemes’ insufficient cover for essential dental procedures, that the man in the street is placing dentistry low on the list of essential needs.

Statistics released by the Government Employees Medical Schemes recently revealed that 41% of women and 31% of men suffer from oral disease in South Africa, with 64% of women and 56% of men having lost some of their teeth. Such alarmingly high statistics underscores the urgent need for dental services to receive a higher priority by Medical Aid Schemes.

“It is extremely short-sighted of Medical Aid Schemes to ignore the irrefutable fact that there is a direct correlation between oral health and very serious systemic diseases, such as cardio vascular, pregnancy, respiratory as well as multitude of other serious ailments,” says Maretha. “These conditions, which in the long-run cost a fortune to treat, may very well be avoided if cover was provided for the relatively much lower costs of effective and preventative dental treatments.”

Further complications arise in the dentist/ patient relationship when medical aid schemes, in their effort to offer a competitive package to their members, give the impression that their scheme benefit for dentistry is in fact a fair fee for the procedure. Says Maretha: “Some schemes even go as far as to inform members that the practitioner is “overcharging” if he/she charges more than the scheme benefit!”

When considering a medical aid scheme, the prospective member must also be aware of the whole issue of network agreements. These agreements state that the patient is obliged to go to a specified network of providers where he/she will be guaranteed a contracted low fee per procedure. Maretha says that it is unfortunate that these fees mostly are not determined through any scientific cost studies and “network fees” in many instances are below cost price for the procedure. The practitioner is not allowed to refuse treatment on such contracts and is therefore often incurring losses on such procedures.

Maretha adds:  “During 2012 there has been a huge amount of publicity regarding the cost of private healthcare and the Minister of Health is on record for being very critical about the cost of private healthcare - to such an extent that he intended to launch an investigation into the cost drivers in the space.”

SADA’s response to the investigation is extremely positive. “We would welcome such an investigation as we very well know that it is not the coal face practitioner – your family doctor and dentist – who are driving the cost of private healthcare.  The problem resides in the administration of healthcare and particularly in the bureaucracies of the hospitals, medical schemes, scheme administrators and, especially, in the commissions paid to brokers.”

 

Maretha backs up her statement by quoting from the 2011 annual report of the Council of Medical Schemes: “It is quite obvious where the money goes.  Of the total R93.2 billion spent by the schemes in 2011, it emerged that R34.1 billion went to private hospitals and R12.124 billion went to non-healthcare costs such as administrator and managed care fees.  Medical specialists received R 21.3 billion, while general practitioners and dentists received a mere R6.8 and R2.6 billion respectively of the total pie.

“There is huge wastage in the system especially the exorbitant funds paid to brokers. And, these brokers are not in effect bringing any significant number of new patients to the market but rather just move members around from scheme to scheme.”

The Professional Provident Society (PPS) recently conducted a survey of dentists in which the professionals were also asked if they would remain in South Africa for the foreseeable future. Shockingly, there was a 4 percentage point decrease from a previous survey to 73% in 2012.  When paired with recent data released by the Pondering Panda survey - which revealed that the overall number of youths between the ages of 18 - 34 who want to emigrate had increased from 25% to 36% over a period of three months – this change in outlook by dentists is most worrying and indicates an attitudinal shift which could cost the country dearly in the long-term.

“Dentists in South Africa are by no means being remunerated in line with the years of study and the excellent skills they are taught at universities,” Maretha continues. ”The high outlay for basic equipment, and the staggering costs of materials, most of which are imported from abroad, leaves very little room for a fair profit. And, very few patients understand that their Medical Aid Schemes are responsible for this failure for basic dentistry to be made accessible and that the scheme rates offered to dentists, in the majority of cases, fall way below the actual costs of good average treatment and service.”

Maretha concludes: “It is time that the public is made aware that medical aid schemes in South Africa is not covering dentistry as a basic healthcare need. One only needs to do a quick internet search where websites such as Hellopeter.com lists a myriad of complaints from members in respect of insufficient cover for dentistry. And, without decent cover for dental services medical aid members are at risk of developing far more serious diseases which, in the end, cost the medical schemes a great deal more than sufficient dentistry and, which also put their members’ health at the risk of serious and long-term impairment.”

Johannesburg, Friday, 28^th December 2012

NOTES TO EDITORS:

1.    To understand the scope of dental services – and especially in a country such as South Africa where relatively few people have access to basic dental services – the public needs first understand the differences between general dentistry and cosmetic dentistry.

2.    General dentistry focuses on your oral well-being and taking excellent treatment of your teeth so dental troubles do get a foothold. Essentially, general dentistry provides preventative procedures and a good dental care program and it is therefore essential for people to have regular dental check-ups and expert cleanings performed. A general dentist is also consulted for root canal treatment, tooth whitening, gum problems and the preparation and fitting of dental crowns, the application of dental sealants and, if all else fails, tooth extractions.

3.    Cosmetic dentistry is a somewhat more specialized area of dentistry that requires innovative teaching that goes over and above the training of general dentistry. While it is not recognized as a separate specialty within dentistry – which means that there is no restriction on any dentist performing cosmetic dentistry – professional cosmetic dentists normally require extensive additional training that can take years. This means a heavy commitment of time, money, and energy for the dentist and, in terms of the actual profits made in South Africa through performing elective surgery on patients, it scarcely merits acquiring such additional skills.

4.    Most people will go to a cosmetic dentist to improve the appearance of their smiles. Cosmetic dentistry treatment options consist of porcelain veneers, dental crowns, tooth whitening, tooth-coloured fillings and dental implants.

5.    The single biggest difference between general dentistry and cosmetic dentistry is the variation and application of different technologies. For each of these areas of dentistry there exists state-of-the-art technology; for the former apparatus to assist in keeping your mouth functional and trouble-free and for the latter equipment to artfully craft tooth restorations.

FOR FURTHER INFORMATION:

1.   Maretha Smit

    Tel: (011) 484 5288, Mobile: 084 627 3842, Fax: (011) 642 5718

e-mail: msmit@sada.co.za

2.   Mixael de Kock

Tel: 011 646 8501, Mobile: 083 651 4424/ 071 226 8063/

Fax: (011) 646-8501

e-mail: coq@mweb.co.za

The Big Teeth of Small Business

Clem Sunter, in his keynote address to the South African Dental Society (SADA) Congress 2012, themed Dental Dignity for All and, which conference concluded in Cape Town this weekend, said that one of the key indicators of South Africa’s economic growth will be government’s attitude to small business.

Sunter had the dentists in sutures when he started out his talk by saying that he was the cabaret before the congress got into the serious business of teeth. But, the laughter soon died down when he got his teeth into a world scenario most likely to play out in the foreseeable future. The growth period of the past decades has resulted in too much credit and, as a result, the world now finds itself in a hangover period. It is a world in which he observes an aging population and, it is a world in which there will be greater demand for services and a concomitant decrease in productivity.

According to Sunter the whole investment game has changed and he said that “it is now a race between poverty and death.” Therefore, globally, if there isn’t an “upswing” in sight, then professionals such as dentists would have to decide what they should do to stimulate their businesses. It is essential to rethink the core business requirements of all professions against a background of reduced disposable income and where the focus is shifting from niceties to necessities.

Sunter’s view is very much in line with the congress theme of Dental Dignity for All and which, amongst other issues,  also addressed oral health considerations in an aging population. In this respect Dr. Michael I. MacEntee, professor of Prosthodontics and Dental Geriatrics, ELDERS Research Group reminded dentists that they are treating patients and not only teeth. This is particularly true for older people as well as those of lesser social economic means. “Often there are times when less advanced treatments are required in order to make patients feel comfortable and, to maintain their dignity as opposed to the application of advanced dental technology.”

“It was important for SADA, in presenting this conference to strike a balance between the basic needs in dentistry and the need for dentists to be fully informed about emerging trends in digital dental technology,“ says Dr Paul van Zyl, scientific convener of the congress, featuring 12 international and 15 local speakers.

Sunter believes that in every sphere of South Africa we have pockets of excellence and said these pockets gave him hope for the country. “Whereas in America individual excellence is celebrated, in South Africa we tolerate mediocrity and cut down the tall poppies.”

In conclusion Sunter suggested to the gathered dental fraternity that what the world is missing is the fact that the Chinese economy is being built on small business and entrepreneurship and not on state-owned enterprises or big business. It is a pity that South Africa has a most ambivalent attitude to small business – red tape and labour laws inhibit rather than stimulate the emergence of this sector. In reality, it would be far more profitable for all if the State created one million small businesses instead of promising to create five million jobs. The exponential affect of a stimulated small business sector would result in a real solution to the problems of unemployment in this country.

Maretha Smit, Chief Executive of SADA says, “This conference addressed the actual issues within dentistry as it moves into a future South Africa. All the speakers and topics highlighted the central theme of self-respect for both the dental professional and for the patient. We need to recognize all who work in the dental team and, especially those professionals who operate businesses, employ people, pay taxes and deliver services that will bring dental dignity to all.”

Johannesburg, 8^th November 2012

FOR FURTHER INFORMATION:

1.     Maretha Smit

    Tel: (011) 484 5288, Mobile: 084 627 3842, Fax: (011) 642 5718

e-mail: msmit@sada.co.za

2.    Mixael de Kock

Tel: 011 646 8501, Mobile: 083 651 4424/ 071 226 8063/

Fax: (011) 646-8501

e-mail: coq@mweb.co.za

The Riddle of the Missing Tooth Faerie

The South African Dental Association (SADA) today warned that during the last number of years, once thriving dental practices have been going bankrupt while emigration continues to void the profession.

Maretha Smit, Chief Executive of SADA said in a statement that payouts to dentistry from medical aid schemes have been reduced from 8.4% in the late nineties to 2.2% last year. “It is time that members of Medical Schemes start asking serious questions and demand that benefits in this area of basic medical care are re-structured. If not, there will be very few dentists left in a country that can hardly afford the further loss of any of its medical services, let alone dentists.”

Maretha further pointed out that in the context of the current economy and the pressure brought about by medical schemes which are not providing adequate cover for essential dental procedures, the man in the street is placing dentistry low on the list of essential needs.

“Dentists in South Africa are by no means smiling. The high outlay for basic equipment, and the staggering costs of materials, most of which are imported from abroad, leaves very little room for a fair profit. And, very few patients understand that their Medical Aid Schemes are responsible for this failure for basic dentistry to be made accessible and that the scheme rates offered to dentists, in the majority of cases, fall way below the actual costs of good average treatment and service.”

Maretha Smit also expressed SADA’s dismay at the way in which reality television shows are distorting the perceptions that the public holds of dentists and dentistry and how, in a developing country such as South Africa, these shows are diverting the attention from the real need for good general dentistry and dental services to our communities.

“We are gravely concerned about media reports that South African dentists are smiling because of the profits they are making. These reports are distorted out of context and the impression is created that dental practices are making huge profits. This is simply not true of a profession which is known be struggling to keep its doors open to the public.

The reality of the matter is that true profits on cosmetic dentistry - the more profitable of the dental services – run between 10 – 20% only!”

Maretha continues: “Most serious businessmen will smirk at such low profit margins which, in themselves, again are much higher than the profit margins for most dental specializations in South Africa and, significantly higher than that for general dentistry! If the profit margins in elective dentistry is this minute then one can very well understand why so many dentists are leaving the country. Dentists must be allowed an opportunity at earning a decent professional income – very few people can be expected to be dedicated to a vocation without any reward whatsoever.”

It is time that the public is made aware that dentistry in South Africa is a profession under threat and that it is a threat that extends to every household and every family of this country. Unless, the crisis in dentistry in South Africa is addressed soon there will be no smiles from anyone around and the question will be as to whatever had happened to the tooth fairy.


Johannesburg, Friday 6th January 2012

TEETH CHATTERING TWITTER TATTLING TALE

In a chat at a gathering of Western Cape dentists well-known Joburg-based media man Mixael de Kock said that the time has come to make peace with the fact that social media is here to stay. The professions can only benefit from participation and engagement on social sites, provided it is done in an appropriate and planned manner.

This past weekend, Mixael spoke at the Summer “Chattering” of the South African Dental Association (SADA) Western Cape Branch, hosted at a Cape Town City Bowl hotel which was themed the “Star Wars of Dentistry”. Despite this upbeat take on social media, he remains of the opinion that the mainstream media will retain the edge in leading public opinion for many years to come.

“Specifically in Africa, traditional newspapers, television and radio will continue to show positive growth until such time as mobility connects the majority of Africans to the web”, said Mixael. “Also, until bloggers’ posts are perceived to be as credible and responsible as that put forward by qualified journalists, the mainstream media will retain its pre-eminence in the shaping of worldviews.”

“While conventional advertising is being displaced by social media, it will never replace informed and educated opinion which, for now, largely remains the preserve of the time-honoured traditional media.”

Mixael made reference to his colleague Anton J van Rensburg’s views expressed in the December issue of the marketing industry’s mouthpiece, Advantage and said: “I fully concur that the social media mix is an extremely important and a relatively low-cost option that can have a direct impact on public perception but at the same time, I must stress that it is not the silver bullet that many makes it out to be.”

Mixael is of the opinion that there is a tendency to over-value opinion expressed in social media. “In the good ol’days, organisations did not rush to public lavatories every morning to refute the previous night’s graffiti. Cyberspace today fulfils the role of the toilet walls of yesteryear and a lot of reaction to these social media scribbling boils down to overreaction by over-zealous public relations and marketing practitioners.”

But he also stressed that there are many pitfalls awaiting the unwary and stated that one should never underestimate the downside of the social media. Mixael used as a case-study, the huge public fall-out that followed the recent Duren debacle when a junior ad agency employee twitter-tattled on God’s intention with male private parts.

“Another one of the key problems with cyberspace is that it creates virtual and surreal worlds which serve as the hide-outs for the mentally disturbed and the socially inept and where unsuspecting users may easily fall prey to cyber criminals.”Mixael concluded his chitchat by stressing the importance of erring on the side of the conservative when evaluating social media and warned that one should be realistic as to what may be reasonably achieved through time spent on the net.

“The most important thing to remember is that when on the web one should take special care in meaning what you say and saying what you mean and that you should always do so accurately, in good taste and mindful of impeccable manners and common sense.

If this is done, the chitter-chattering can’t go wrong!”

Johannesburg, 6th December 2011

SOCIAL MEDIA: Applications for Dentistry (Full Text)

Hereunder follows the full text of a paper delivered at the South African Dental Association (SADA) Western Cape Branch SUMMER MEETING, held on Saturday 3 DECEMBER 2011 and themed “Star Wars of Dentistry”.

Mixael de Kock initially was skeptical about the value of the social media. However, he has revaluated his views and in this paper highlight the positive spin-offs that may be achieved from participation in Web-based communication. He will also gives some perspective to the limitations of and what may be reasonably achieved through the social media.

JOHANNESBURG PRESS CLUB 2011 NEWSMAKERS OF THE YEAR

The Johannesburg Press Club wishes to announce that Archbishop Emeritus Desmond Tutu and the Public Protector, Advocate Thulisile Madonsela, jointly have been nominated the Johannesburg Press Club’s 2011 Newsmakers of the Year.
Mixael de Kock, Chairman of Johannesburg Press Club said, “Both the Archbishop and the Public Protector have displayed extraordinary courage, commitment and consistency in fulfilling their respective duties to the people of South Africa and, in particular, they have been nominated for the excellent manner in which they interacted with and made themselves accessible to the media.”
Archbishop Emeritus Desmond Tutu is receiving the award for being the most quoted social commentator and social critic, for his Census 2011 ambassadorial duties, for his continuing moral leadership and, in particular, for his courage in addressing the issues around the Dalai Lama incident.

Adv Madonsela is being honoured for her unfailing, direct and courageous stance against immoral activities, her particular work ethic and her veracity and devotion to leading the Public Protector of South Africa’s office. She is particularly being lauded for her ongoing maintenance of cordial and positive working relationship with the media.

The Johannesburg Press Club Newsmaker of the Year has become a most sought-after award and last was bestowed in 2005 on Trevor Manuel for his handling of the media in communicating the issues of the South African economy.

Mixael de Kock said that the Johannesburg Press Club’s decision was not solely based on how much news a nominee generated during the year but also on how the news was communicated and to what extent the country benefitted from such news.

De Kock continued: “Both the Archbishop and the Public Protector responded immediately, accurately and with integrity regarding issues during 2011 and, in their respective fields of influence, they ensured that the values of democracy were upheld and that freedom of speech and access to information were assured at all times.”

Today the Archbishop and the Public Protector noted their delight in being nominated and will be accepting the award at a gala event to be announced.

Advocate Madonsela said in a statement that she would be accepting the award on behalf of her team at Public Protector South Africa. “I would like to express my gratitude to the Johannesburg Press Club for the honour bestowed on my team and we are humbled by the gesture. We hope that we will continue to serve the people of South Africa with courage and commitment”.

Johannesburg, Monday, 5 December 2011

Oro-pharyngeal Cancer: A sexually transmitted disease

The South African Dental Association (SADA) today announced its oral health theme for the year. Ms Maretha Smit, CEO of SADA says that Oral Cancer (OC) and Oro-pharyngeal Cancer (OPC) will be the association’s theme of its public awareness programme for the next twelve months. “SADA will focus the attention on all the different causes and relevant aspects pertaining to this subject and, our first briefing session to the media, therefore, deals specifically with the alarming increase in Oro-pharyngeal Cancer (OPC) as a result of oral sex.”

The causal link between OPC and oral sex in the younger generation, especially young males, is menacing as Oro-pharyngeal cancer can be caused through the invisible presence of the Human Papilloma Virus (HPV). This virus, with its more than a hundred sub-types, is relatively prevalent. The high-risk variants of the HPV virus cause cervical cancer in women and, consequently, through the practice of oral sex, can be transmitted to the oral cavity where it can be one of the causes of Oro-pharyngeal cancer.

Professor André van Zyl, together with Professor Willie van Heerden, both of the School of Dentistry, Faculty of Health Sciences, University of Pretoria - and active members of SADA - will be the programme leaders for the association’s awareness campaign regarding OC and OPC. They are of the opinion that the younger generation, while avoiding infection with HIV by practising oral sex, may be exposing themselves to the possibility of HPV infection.

“Oral sex is perceived to be a safer sexual behaviour in an AIDS dominated world”, says Van Zyl. “However, while it is true that the spread of HIV infection is lowered through the practice of non-genital sex, the spread of HPV has become more prevalent and, in turn, the cases of HPV-related Oro-pharyngeal cancer have increased dramatically over the past decade.”

HPV-related cancer occurs mostly in young adults. Van Zyl continues: “These young people could never imagine that they might develop Oro-pharyngeal cancer, and, it therefore is imperative that regular dental check-ups are conducted to ensure an early diagnosis of cancer in either the oral cavity or in the Oro-pharyngeal area.”

According to statistics, multiple oral sex partners significantly increase the risk for becoming infected by the Human Papilloma Virus (HPV), which may then lead to the development of Oro-pharyngeal Cancer (OPC). “While this type of cancer, if detected in the early stages, responds very well to chemo-radiation therapy and can be cured by such modern treatment, the tragedy is that in most cases the diagnosis is made too late and the patient often succumbs to the disease.”

Maretha says that the dental community is aware of the dangers that oral sex poses for the younger generation in particular and, that dentists have been made vigilant to a possible spike in the incidence of this type of Oro-pharyngeal Cancer in the years to come.

“Today a range of new diagnostic technologies are available that can be utilized to assist the dentist in ensuring that all suspicious oral lesions are properly evaluated. A dentist is the most appropriate health care professional to perform these examinations and be responsible for patient management, which may include referral for appropriate cancer treatment”

Maretha further states that OC/ OPC are diseases that globally affect up to 400 000 new patients per year. “While this statistic in itself is disturbing, the shocking fact is that 50% of people affected by OC/ OPC will die within five years of diagnosis.”

“These relatively poor survival rates have not changed significantly over the last 50 years and are in stark contrast to several other types of cancers where improvements in diagnosis and treatments have led to many types of cancer being regarded as curable diseases today.”

Professor van Zyl adds: “Should OC/ OPC be identified by the dentist at an early stage, then there is every possibility to stop the process and achieve a cure. It is for this reason, and the fact that dentists are trained particularly to detect early OC/ OPC - in that they are the healthcare professionals who routinely examine the oral cavity – that all efforts should be focused on raising public awareness and on encouraging people to visit the dentist strictly on a half-yearly basis.”

It is one of SADA’s stated objectives to ensure that its members are encouraged to utilise all knowledge and cutting-edge technology available to dental practitioners to protect patients and to ensure that OC/ OPC, which may be deadly, are identified in the very early stages. Maretha says, “This emphasises the need for regular dental check-ups. In excess of 90% of people who are diagnosed in the early stages of OC/ OPC survive as opposed to as low as 12% when these cancers are detected in the very late stages.”

Maretha Smit also announced a list of the other causes of Oral and Oro-pharyngeal cancer, each of which will be highlighted and discussed as separate subjects during the course of the “SADA Oral Cancer Awareness Year”.
Johannesburg, 4th October 2011


NOTES TO EDITORS:

1. Please note that Oral Cancer (OC) can be divided into two anatomically different areas, namely Oral Cancer (cancer of the mouth) and Oro-pharyngeal Cancer (cancer of the throat or OPC), each with distinctly different challenges and often different causes. Throat Cancer (OPC) simply is a term used for Oral Cancer (OC) which manifests further back in the mouth. The mouth and throat are two interconnected areas and covers a relatively large area.

2. OC is a cancer that starts in the lining mucosa of the oral cavity and is often associated with a visible alteration of the mucosa, called a potentially cancerous lesion.

3. In developing countries the incidence of OC is still on the increase whereas it is on the decline in some western countries.

4. An additional factor which clouds the whole issue of OC in South Africa is the fact that not all OC cases are taken up in the official cancer statistics of the country. This is owing to the fact that often it is picked up too late and patients receive no formal diagnosis and palliative care only is given to make their last days more comfortable. (We owe our patients more than this in a civilized country!) There is thus an under-estimation of the true burden of OC in this country.


Causal Factors and other Facts regarding Oral Cancer

1. Oro-pharyngeal cancer: A sexually transmitted disease
Over the last 30 years an increase has been seen in cancer of the head and neck areas. This is mainly because of an increase in Oro-pharyngeal cancer, a subset of head and neck cancer. The Human Papilloma Virus (HPV) is linked to Oro-pharyngeal cancer (OPC) and HPV is sexually transmitted, with the odds of infection linked to the number of oral sex partners. HPV Oro-pharyngeal cancer seems to affect mostly young males between 20-40 years of age, whereas traditional tobacco-alcohol associated OC’s and OPC’s are usually seen later in life.


2. Hubbly-Bubbly and Oral Cancer
All forms of tobacco are carcinogenic – meaning they put the user at risk of developing oral and Oro-pharyngeal cancer. Hookah-pipe smoking (called Hubbly Bubbly in South Africa) is becoming more popular internationally and, especially in our country, Hookah cafés are gaining in popularity. Research has shown that a one-hour Hookah session involves inhaling 100-200 times the volume of smoke inhaled from a single cigarette.


3. Alcohol
The role of ethanol in alcoholic beverages holds the same risk for causing oral cancer as the nicotine in tobacco. When used in conjunction with tobacco, it accounts for up to 75% of oral cancers. The role of alcohol is complex and especially young people need to be educated about the dangers of alcohol as a cause of oral cancer.


4. Areca nut chewing
Worldwide 600 million people chew the Areca nut. Almost 60% of all oral cancers occur in South-East Asia, mainly because of Areca nut chewing, alone and in combination with other products. In KwaZulu- Natal, Areca nut chewing is still very prevalent amongst the Indian community and most users are unaware of the dangers involved. There is a need to develop a programme to educate these communities about this dangerous pastime and, especially the younger generation needs to be made aware of this menace.


5. Warning signs of Oral Cancer
The abysmal 5-year survival rate of people with oral cancer has remained largely unchanged over the last 50 years. This is partly owing to the late diagnosis of oral cancer in most patients. Patients need to be educated about the danger signs and how they themselves may play a role in ensuring earlier diagnosis and, consequently better survival rates. This is one of the most important aspects of working towards a better quality of life for oral cancer patients.


6. If worried – who should you see?
Oral Cancer (OC) and especially Oro-pharyngeal Cancer (OPC) straddles many specialities and professions. The importance is that all need to work together towards the common goal – improving the survival rate of oral cancer – especially amongst the poorest of the poor. The dentist remains the only trained health care worker who will screen oral health routinely, and has to be an important front person for diagnosing this increasing disease. Getting the dentist to diagnose cancer early and to liaise with the other health care workers for successful management of oral cancer – is the challenge. Most oral cancers go through a phase of early changes that have not become cancerous yet. These can easily be spotted by the dentist, using special screening tools. Early diagnosis can lead to a cure of the oral cancer. There have been major advances in cancer screening over the last 3 years and patients and dentists should both be aware of these. It, therefore, also is of crucial importance to incorporate South Africa’s primary health care workers into this team of professionals.


7. How is oral cancer managed?
If oral cancer is diagnosed early, the management and survival is significantly better and more successful than if diagnosed late (90% versus 20%). As management of the cancer still largely relies on surgical excision, the focus on early intervention is of critical importance. Radiation and chemotherapy is as successful as surgery in some cancers. Knowing the HPV status of Oro-pharyngeal cancer (OPC) is of critical importance, as it carries a much better survival rate than HPV-negative Oro-pharyngeal cancer (OPC).


8. What can the patient contribute to lowering the risk of oral cancer?
Aside from abstaining from the use of risk factors such as tobacco and alcohol abuse, patients can lower the actual risk of developing Oral Cancer (OC) – by eating themselves healthy! Certain foodstuffs such as fruit and non-starch vegetables can lower the risk of oral cancer substantially. Patients need to be made aware of the exact role of foodstuffs that are beneficial.

9. Benefits of coffee
Over the past few years it has emerged that coffee with its potent anti-oxidants, can actually lower the risk of developing oral cancer. Coffee has other benefits too, and if used in moderation, can promote health. Current research has not found any other beverage with these protective properties.


10. Are certain sections of the South African population more at risk of oral cancer development?
Yes! Certain sections of the population are more at risk, especially the poor, the malnourished and those far from health care services. As poverty is a serious problem in South Africa, we need to formulate strategies to combat the role poverty may play in adverse oral cancer outcomes. Information regarding oral cancer lowering diets, information about diagnosing oral cancer, risk factors and such – need to be incorporated in school curricula, especially at primary school level. This message needs to be taken to every person in South Africa.

11. CAN HPV VACCINE PROTECT AGAINST ORO-PHARYNGEAL CANCER?
Vaccination against the Human Papilloma Virus (HPV) is now regarded as standard procedure in the prevention of cervical cancer in females and provides protection against a range of disease caused by the specific HPV variants targeted by the vaccine. The past two years there has been increased support for the vaccination of males. The USA’s Centers for Disease Control and Prevention (CDC) now recommends routine vaccination for males from as young as nine to the age of 26 years old. The vaccine protects males against genital warts, anal cancer and Oro-pharyngeal Cancer (OPC). More research is expected to emerge during the coming 12 months and, hopefully, the costs of the vaccines will decrease concomitantly.