By Siobhann DunnBBC Scotland

When 29-year-old Roisin O'Leary found a lump on her jaw she knew it was not good, but she never expected cancer.

"I'd had some pain in my jaw and my wisdom teeth and they planned to take them out in April and May, but then because of lockdown everything got cancelled," she said.

"Throughout the year I kept getting this pain and then September is when I actually noticed a lump forming."

Eventually, Roisin, from Paisley, had her wisdom teeth removed but the lump kept growing.

"By January it was getting bigger and the right side of my jaw was all swollen," she said.

"I kept calling the dental hospital and telling them things were changing quite quickly."

The hospital carried out a biopsy and a CT scan before Roisin was told it was a cancerous tumour.

'I'm not mad'

Roisin has a type of cancer called osteosarcoma which, in the jaw bone, is extremely rare.

Approximately 1,200 Scots are diagnosed with some form of head and neck cancer each year. Osteosarcoma amounts to about 40 of those cases.

Roisin told BBC Scotland she felt an odd sense of relief at finding out what was wrong.

"I'd been speaking to my GP about my mental health and anxiety," she said.

"I told her I thought I was going mad, something didn't feel right with me. It was just my body's way of letting me know something wasn't right."

'Lockdown'

At the beginning of the pandemic, dental check-ups came to a halt and services were operating at a fraction of their usual capacity.

According to Public Health Scotland, by the last quarter of 2020, patients accessing dental appointments had dropped by a third on the year before.

The British Dental Association said that those figures were deeply concerning and they warned of a "looming oral health crisis" in months and years to come.

David McColl, chair of the British Dental Association (BDA) Scottish Dental Practice Committee, said: "Even before the pandemic, Scotland's oral health inequalities were a national scandal.

"Now, that gap looks set to widen, with public health programmes suspended and millions unable to access care.

"Dentists are losing the chance to act on the early signs of decay, gum disease and oral cancers. If we're ever going to turn the page we need to see real commitment from government."

Scotland's National Clinical director, Prof Jason Leitch told BBC Scotland that the chief dental officer had been working hard on the phased return to a "new normal" for dentistry.

He said it was difficult because the nature of dentistry posed a risk of spreading Covid, especially through aerosol generated procedures.

Prof Leitch said the mitigation for this problem was lots of PPE and "fallow" time between patients, which means fewer people can be seen and longer waiting times.

'Saving lives'

Glasgow's Dental school consultant in restorative dentistry, Dr Beth Burns, said routine check-ups were vital for detecting problems such as oral cancers which often go unnoticed until a dentist identifies the signs.

"Dentists are examining the soft tissue in the mouth, they're looking for early signs of disease and often spot those early." she said.

"Someone who presents early and is diagnosed early has a survival rate that is about 90% at five years, whereas for people who are diagnosed late with oral cancer the survival rate drops to around 30% - so it's a huge difference."

Dr Burns said people could do more to look for the signs themselves.

"A lot of people know about examining their boobs if they're a woman, or balls if they are a man, but they don't know about examining their mouth," she said.

"But it's actually really important that patients are looking in their mouth and going to a dentist at an early stage."

'Fight or flight'

Roisin is now undergoing a 10-month treatment plan which includes chemotherapy and surgery to remove part of her jaw bone.

Her bone will be removed and reconstructed with skin grafts from her leg.

The surgery will be intensive. She will have facial scaring and may need speech therapy, but she remains upbeat and is making plans for when it is over.

"I'm just focusing on coming out the other side," she said.

"I can't wait to have everybody together again.

"I hope that when I'm better I'll be able to travel."

She urged others to get their dental check-up and see their GP if something is not right.

Her message is to keep smiling.

"There's not much else you can do really, you can't just sit and wallow," she said.

"It's fight or flight really, I'm going to fight this with positivity."

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