Daffodil Day: raising awareness of dental dangers

The Australian Dental Association marked Daffodil Day by highlighting the risks of cancer that can occur in the mouth.

Daffodil Day raises funds for the Cancer Council to continue its work in cancer research, patient support programs and prevention programs for all Australians. The practice’s own community work is listed under supporting charities.

Why this matters

Despite advances in treatment, survival rates for oral cancer remain low — and the reason is not the treatment.

According to Dr Peter Alldritt, Chair of the ADA’s Oral Health Committee, oral cancers tend to be detected late. Recognising the risk factors and signs is therefore vital. Oral cancer: how your dentist can help with early detection and oral cancer: signs, risk factors and how your dentist can help go through both in detail, and what are the causes, symptoms and treatment of mouth cancer? covers what happens after a diagnosis.

The point made in the ADA’s Daffodil Day material was stark: detected early, the chance of surviving oral cancer is high — the figure cited at the time was around 90 per cent — yet overall survival remains poor, because most cases are not found early.

The gap between those two facts is entirely about when the diagnosis is made. Survival statistics vary by site, stage and study, and change over time — Cancer Council Australia and Cancer Australia publish the current Australian figures.

What the published figures say now

This article was written in 2014. The independent literature published since has not softened the picture; if anything it has sharpened it.

A 2024 review in the Australian Journal of General Practice, peer reviewed and written with Dental Health Services Victoria and the RACGP, describes oral cancer as among the top 10 most common cancers, and reports that “oral cancer has a relatively low five-year survival rate, at around 50%, mostly due to diagnostic delays”. Dental Health Services Victoria separately puts the Australian caseload at more than 4,000 new cases of head, neck and lip cancers each year, with an estimated 2,642 cases of lip and oral cancers in 2022 and the figure expected to rise. (The two organisations count slightly different groups of cancers, which is why their totals differ — read each figure with the definition attached to it.)

Closer to home, Cancer Council Victoria reports that in 2023, 1,226 Victorians were diagnosed with oral and oropharyngeal cancer — 883 males and 343 females, a rate of 23 per 100,000 males and 8 per 100,000 females. The median age at diagnosis was 64 in males and 67 in females. It accounted for 3.1% of all cancers diagnosed and 2.6% of cancer-related deaths in Victoria that year, making it the 6th most commonly diagnosed cancer in the state and the 11th most common cause of cancer death.

None of that is a reason for alarm at a mouth ulcer. Oral cancer is uncommon and ordinary ulcers are extremely common. It is a reason to take the two-week rule below seriously rather than treating it as a formality.

The misconception worth correcting

People usually associate smoking with cancer — but oral cancers can also occur in non-smokers.

That matters, because non-smokers are the group most likely to dismiss a symptom as nothing.

The Victorian trend data gives that statement some weight. Between 2008 and 2023 the age-standardised incidence rate in males rose by an average of 0.1% a year — a result Cancer Council Victoria notes was not statistically significant, meaning it cannot confidently be considered a real change. In females, between 2017 and 2023, the rate increased by an average of 3.2% per year. The 2024 AJGP review describes, in the same vein, “an emerging subgroup of non-smoking and non-drinking middle-aged women with tongue cancers” as a concerning trend.

In other words, the group whose risk is rising fastest is not the group the public health messaging has historically been aimed at.

The two-week rule

Ulcers or lumps in the mouth which do not heal within two weeks should be treated with suspicion.

That is the single most useful thing on this page. Most mouth ulcers resolve within a week to ten days. One that does not, or one that keeps recurring in the same place, needs to be looked at — not waited out. The cause of mouth ulcers and their usual treatments covers the ordinary kind, which is the great majority of them.

The AJGP review sets the same threshold slightly wider and gives the reason it exists: patients with “any unexplained and/or non-healing changes or symptoms in the mouth for more than two to three weeks (eg a persistent ulcer, red patches, lumps, a sore throat, or erythematous or speckled lesions) should have an oral cancer screen”. It also records the fact that makes a time-based rule necessary at all — “initial lesions of oral cancer are generally painless”. Pain is not the trigger. Persistence is.

The high-risk sites are specific, and they are not the ones people check in a mirror: the review names the lateral margins of the tongue and the floor of the mouth as the highest-risk sites, while noting that a thorough examination covers face, jaw, chin and neck as well as lips, cheeks, gums, tongue, floor of the mouth and both palates.

Other changes worth acting on: a red or white patch that will not rub off, persistent hoarseness, numbness of the lip or tongue, a lump in the neck, unexplained bleeding, loose teeth with no dental cause, or difficulty or pain on swallowing. The AJGP review’s own list is shorter and worth memorising — an unexplained mouth ulcer or lump, an unexplained neck lump, white or red patches of the lining of the mouth, and unexplained tooth mobility or a non-healing extraction site. If it is the gums bleeding rather than the tissue, see bleeding gums and what is gum disease? — far more often the explanation, but still something to raise rather than ignore. Loose teeth with no obvious cause are covered in periodontal (gum) disease.

The four months that matter

The AJGP review cites an Australian study finding “an average diagnostic delay of approximately four months between symptom onset and initial histological diagnosis”.

That delay is the whole problem in one sentence, and part of it sits with the patient and part with the system. The part you control is the first few weeks. Nobody will think you are wasting their time.

Risk factors

Drinking and smoking. Regularly drinking more than four standard drinks on a single occasion increases your risk of oral cancer. The ADA’s material noted that young adults who both smoke and drink alcohol raise their risk many times over — the two together are considerably worse than either alone. What impact does wine have on my teeth? covers the more everyday effects of alcohol on the mouth. On the smoking side, are e-cigarettes bad for my teeth? and the effects of vaping on your oral health set out what is and is not known about the substitutes.

Age, and sex. The AJGP review lists age over 45, especially in men, among the established risk factors — consistent with the Victorian median age at diagnosis of 64 and 67.

Areca (betel) nut chewing. This is the risk factor most often missing from Australian public messaging. The review names it alongside tobacco and alcohol, and notes it is “a growing trend in Australia, coinciding with an increasing number of immigrants, which might affect the rate of oral cancer diagnosis in the future”. If you or a family member chews betel quid, say so at your appointment; it changes what the examination is looking for.

Limited access to dental care is itself listed as a risk factor in the same review — not because irregular attendance causes cancer, but because it removes the examination that would find it early.

Extended exposure of the lips to the sun. Lip cancer is the risk most people never think to protect against; SPF lip balm is the countermeasure.

Poor diet — a diet low in or without vegetables. How does your diet affect your teeth? and caring for your teeth: 8 steps to dental health cover the dental side of the same advice.

Smoking remains the dominant risk factor, and the ADA’s figure at the time was that more than 75 per cent of oral cancers in Australia occur in people who smoke — which still leaves close to a quarter who do not.

Human papillomavirus (HPV) is now also recognised as a risk factor for cancers of the oropharynx, and the pattern of disease has shifted since this material was first published. Are there ways to avoid dental problems? lists HPV among the conditions with recognised oral associations.

What to do about it

Checking for signs of oral cancer is part of the regular check-up your dentist carries out, which is one of the less-appreciated reasons to attend routinely rather than only when something hurts. How often should I go to the dentist?, is it important to have a family dentist? and start the New Year with a dentist check up all bear on whether that examination actually happens.

A dentist examines the tongue, floor of the mouth, cheeks, palate, throat and neck as a matter of course — areas you cannot properly see yourself. 5 questions you’ve always wanted to ask your dentist and what does a dental hygienist do? describe what else is happening during a routine appointment, and dental cleans and hygienists is the service page.

Your GP can do this too — and statistically is more likely to see you

This is the part of the 2024 review that deserves repeating on a dental website even though it points away from one. In 2020–21, only 48% of Australians had seen a dental professional in the previous 12 months, while in 2021–22 almost 90% received at least one Medicare-subsidised service. The review also cites an Australian study of newly diagnosed oral cancer cases which found that, before diagnosis, patients had visited their GP far more often than their dental practitioner.

Screening needs no special equipment — the review describes it as a visual and physical examination performed with gloves, a mouth mirror, a tongue depressor and a torch. So if you have a persistent change in your mouth and no dentist, that is not a reason to wait. Ask your GP. The RACGP now hosts an e-learning module on oral cancer prevention, early detection and referral, developed by Dental Health Services Victoria with the RACGP, the University of Melbourne, Cancer Council Victoria and the Victorian Comprehensive Cancer Centre.

Check your own mouth as well, and raise anything that has not healed in two weeks. Do I need to use a tongue scraper? and should I use a tongue scraper? are a reminder that most people never look at their own tongue at all — which, given where the high-risk sites are, is the habit most worth changing.

A dental examination is a screening step, not a diagnosis. Anything suspicious is referred for specialist assessment and biopsy, which is the only way a diagnosis is made. Why would I need to see a dental specialist?, Specialist Care, what does oral and maxillofacial surgery involve? and oral and maxillofacial surgeons describe who that referral goes to. Where surgery removes part of the face, Australian hospital becomes a centre of excellence in facial prosthetics covers the reconstruction that follows.

Common questions

This page quotes 90%, 50% and 75% survival. Which one applies to me?

None of them, strictly — and understanding why is more useful than picking one.

Those three numbers are answers to three different questions, from three different sources, over three different periods and populations.

“Around 90 per cent” was the ADA's 2014 Daffodil Day figure for cancer detected early. It is a statement about stage at diagnosis, not about oral cancer as a whole, and it is now more than a decade old.
“Around 50%” is the 2024 Australian Journal of General Practice review's figure for five-year survival across all cases nationally, which it attributes “mostly to diagnostic delays”. It is averaging early and very late diagnoses together.
75% is Cancer Council Victoria's most recent five-year relative survival figure for oral and oropharyngeal cancer in Victoria, for the period 2018–2022. Its own trend data shows that figure has risen from 61% in 1983–1987, which is a genuine improvement over forty years.

Three things explain most of the gap. What is counted: "oral cancer" and "oral and oropharyngeal cancer" are not the same group of diseases, and HPV-associated oropharyngeal cancers generally do better than tobacco-associated tongue and floor-of-mouth cancers, which pulls a combined figure upward. Which measure: relative survival compares people with the cancer against the general population of the same age and sex, so it is not the same quantity as raw five-year survival. When and where: Victoria in 2018–2022 is not Australia across all years.

What survives all of that, and is the reason the page exists, is the direction: stage at diagnosis is the dominant variable, and it is the only one a reader can do anything about. A number between 50 and 90 per cent is not a prediction for any individual, and anyone who has been diagnosed should take their figures from their own treating team, who know the site, the stage and the histology. Cancer Council's 13 11 20 line can also talk it through.

Is there a national screening programme for oral cancer, like there is for bowel or breast?

No. Cancer Council Australia lists the national population-based screening programmes available in Australia as those for breast cancer, cervical cancer and bowel cancer, provided free to eligible people, with a National Lung Cancer Screening Program since added for those at highest risk. Oral cancer is not among them, and no letter will arrive inviting you to be screened.

That absence is the practical reason this page matters. For the cancers with a programme, the system finds you. For oral cancer, detection depends on two things happening opportunistically: somebody looking during an appointment you attended for another reason, and you noticing something and acting on it.

The first of those is what a routine dental examination provides, and it is free of extra charge in the sense that it is part of the check-up rather than a separate service. The second is the two-week rule above.

One thing worth being clear about: there are commercial adjunctive devices marketed for oral cancer detection — lights, dyes, rinses. We have not found independent Australian guidance in our reference material supporting their routine use, and the 2024 AJGP review describes competent screening as a visual and physical examination with gloves, a mouth mirror, a tongue depressor and a torch. If you are offered an add-on test at a fee, it is fair to ask what evidence supports it and what it would change.

How do I check my own mouth, and what am I looking for?

Somewhere with good light and a mirror, once a month, takes about two minutes. The point is not to diagnose anything. It is to notice a change and to notice it early.

Look where the risk actually is. The AJGP review names the lateral margins of the tongue and the floor of the mouth as the highest-risk sites — the sides of the tongue and underneath it. Almost nobody looks there. Put the tongue out, then move it to each side, and lift it to see the floor of the mouth beneath. A piece of gauze or a tissue helps you hold the tongue.

Then work through the rest in the same order every time: lips inside and out, the lining of both cheeks, the upper and lower gums front and back, the roof of the mouth, the soft palate at the back, and the top surface of the tongue. Finish by running your fingers down both sides of your neck and under the jaw, feeling for a lump.

What you are looking for, using the review's own list: an unexplained ulcer or lump, an unexplained neck lump, white or red patches of the lining of the mouth, and unexplained tooth mobility or a non-healing extraction site. Add anything numb, anything that bleeds without cause, and hoarseness that will not shift.

The rule that makes it work: act on persistence, not pain. The review is explicit that “initial lesions of oral cancer are generally painless”, which is precisely why a painless patch gets ignored for months. Anything unexplained that is still there after two to three weeks gets an appointment.

A self-check is not a substitute for the examination at a check-up, which covers ground you cannot see. It is what fills the eleven months in between.

Does where I was born change my risk?

The Victorian data says yes, and it points in a direction that may surprise you.

Cancer Council Victoria compared age-standardised incidence rates of oral and oropharyngeal cancer among Victorians by region of birth for the period 2018–2022. Among men, the highest rate was 26 per 100,000 in those born in the Australia and New Zealand region, and the lowest was 10.5 in those born in the Southern and Central Asia region. Among women, the highest was 10 per 100,000 in those born in the UK and Ireland region, and the lowest 4.9 in those born in the Middle East and North Africa region.

That is worth sitting with, because betel nut chewing is often discussed as a migrant-community risk factor and the incidence data does not show those communities carrying the highest burden in Victoria. Both things can be true: areca nut is a recognised carcinogenic exposure that the AJGP review flags as a growing one in Australia, and Australian-born men currently have the highest measured incidence rate in this state. Alcohol, tobacco and sun exposure to the lips remain the dominant drivers of the overall Australian pattern.

The practical reading is not to revise your personal risk up or down on the basis of a birthplace statistic. It is that exposures travel with people, and so do assumptions. Tell your dentist or GP what you actually do — smoke, vape, drink, chew betel quid, work outdoors — rather than relying on anyone's mental picture of who gets this disease. Age-standardised rates describe populations. They do not describe you.

Something in my mouth has been there three weeks. What do I actually do on Monday?

Book an appointment, and use specific words.

Who to ring. A dentist or a GP — either can perform the examination, and the 2024 review makes the point that Australians see GPs far more often than dentists, and that people later diagnosed with oral cancer had typically visited their GP more often than their dental practitioner beforehand. If your dentist cannot see you this week and your GP can, go to your GP. Do not wait for the one you would prefer.

What to say when you book. Not "I need a check-up". Say: "I have an ulcer / lump / patch that has not healed in three weeks and I would like it examined." That sentence changes the appointment length and the urgency it is given. Say how long it has been there, because duration is the clinically meaningful detail.

What will happen. A visual and physical examination of the mouth, tongue, floor of the mouth, palate, and the neck and jaw — the review describes it as needing only gloves, a mouth mirror, a tongue depressor and a torch. It is quick, and it is not uncomfortable beyond having your tongue held.

What you should leave with. One of two things: a clear explanation of what the lesion is and why it is not concerning, or a referral. A dental or medical examination is a screening step, not a diagnosis — only a biopsy diagnoses oral cancer. If you are told to "keep an eye on it", ask for a specific review date and put it in your calendar, and ask what would make you come back sooner.

If it is still there at that review, say so plainly and ask for the referral. The average diagnostic delay in the Australian study quoted above was approximately four months from symptom onset to histological diagnosis. Some of that is unavoidable; the weeks spent hoping it will go away are not.

Where to read more

The ADA site referenced in the original 2014 material, oralcancerfacts.com.au, no longer operates. Current Australian information is available from:

Cancer Council Australia — cancer.org.au, including the 13 11 20 information and support line
Cancer Council Victoria — for the Victorian incidence and survival figures quoted above
Head and Neck Cancer Australia — headandneckcancer.org.au
Your dentist or general practitioner, who can examine and refer

Practical details

Smile Solutions, Level 1, 220 Collins Street, Manchester Unity Building, Melbourne VIC 3000 — getting here. Phone 13 13 96, contact us, or theteam@smilesolutions.com.au. Monday–Friday 8.00am–6.00pm, Saturday 8.30am–1.30pm, Sunday by appointment. The clinical team is listed by name.

If you have an ulcer, lump, red or white patch, or numbness that has persisted beyond two weeks, book an examination rather than waiting for a routine visit.

Published 21 August 2014. This article draws on material first published by the Australian Dental Association; quoted comments are attributed to Dr Peter Alldritt. Statistics cited are those published at the time and should not be relied on as current — Cancer Council Australia and Cancer Australia are authoritative. Figures added later in this article are attributed where they appear: the five-year survival, diagnostic-delay, risk-factor and screening statements come from a peer-reviewed 2024 review in the Australian Journal of General Practice; the Australian caseload figures from Dental Health Services Victoria; the 2023 Victorian incidence, median-age, trend, country-of-birth and relative-survival figures from Cancer Council Victoria; and the list of national screening programmes from Cancer Council Australia. All are third-party figures, not Smile Solutions data, and all change over time. Survival percentages describe populations over defined periods and are not predictions for any individual. General information only; it is not a diagnosis and does not replace advice from your treating practitioner or doctor.

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