Oral Cancer Screenings: Dentists

as the GateKeepers for Early Detection

By Ross Brockman, DMD, MD

G. E. Ghali, DDS, MD Willis-Knighton Health System Department of Oral & Maxillofacial Surgery

Oral cancer is a serious condition that affects millions of people worldwide each year.

As dentists, we play a critical role in detecting and treating oral cancer in its early stages, when it is most treatable.

One of the key factors in early detection of oral cancer is being able to recognize the appearance of a suspicious lesion. Oral cancer lesions can appear in various forms. It is important for dentists and hygienists to be familiar with their appearance.

The most common type of oral cancer is squamous cell carcinoma, which accounts for more than 90% of all oral cancers. Squamous cell carcinoma typically appears as an erythroplakia, or non-healing ulcer which can present on keratinized or nonkeratinized mucosa, tongue, or lips. It may also appear as a lump or growth that is painless at first but may become painful as it grows.

Other types of oral cancer, such as sarcomas, salivary gland malignancies, lymphoma or melanoma, may appear differently. The majority of these appear as a nonpainful swelling or growth, while melanoma may present as a dark or multicolored lesion with irregular borders.

In addition to being familiar with the appearance of oral premalignant and malignant lesions, dentists should also be aware of the risk factors for oral cancer, which include: tobacco use, heavy alcohol consumption, a history of sun exposure, and certain viral infections such as human papillomavirus (HPV).

The oral cancer screening process involves several steps:

Step 1: Medical history review.

The first step is reviewing the patient’s medical history, including any risk factors for oral cancer, such as tobacco use, heavy alcohol consumption, a history of sun exposure, or long-term treatment with immunocompromising drugs such as those used for autoimmune diseases or solid organ transplant.

Step 2: Visual inspection.

The second step is a visual inspection of the oral cavity, including the lips, cheeks, tongue, floor of the mouth, and roof of the mouth. The dentist will be looking for any abnormal growths, ulcers, or lesions. We find a good exam is best done using a dental mirror or cotton tip applicator working in a systematic fashion checking the cheeks, alveolar gingiva, vestibule, lips, tongue, floor of mouth, finishing with the palate and tonsillar pillars in the same order every time. When evaluating the tongue and floor of mouth, we will often use gauze to grasp and manipulate the tongue examining the lateral borders to the base of tongue, then ventral tongue and the floor of the mouth.

Step 3: Physical palpation.

The third step is physical palpation of the oral cavity, using gloved fingers to feel for any mass effect from visible or non-visible lesions. Palpation should be performed in a way to support the region palpated with one hand and palpate with the other. For example, the floor of the mouth should be palpated with gentle submandibular pressure to allow elevation of the floor of the mouth. Another telltale sign of the malignant disease is the indurated or firm feeling a malignancy causes when invading surrounding normal tissue or tethering of structures which would normally be mobile.

Step 4: Neck palpation.

The fourth step is palpation of the neck, feeling for any enlarged lymph nodes or masses. The neck is divided into several levels which are numbered based on their anatomical location relative to the muscles of the neck.

The most common levels of the neck for regional spread of oral cancer are levels I-III, which include lymph nodes located in the submandibular, upper jugular, mid jugular, lower jugular, and supraclavicular regions, respectively.

The frequency of lymph node involvement varies, depending on the location and the stage of the oral cancer. Tumors located in the floor of the mouth, tongue, and tonsil areas have the highest risk of neck metastasis.

Palpation of the neck is a crucial component of the oral cancer screening process as it can help to identify any metastatic spread of the cancer beyond the oral cavity. If enlarged lymph nodes are detected, even if a primary lesion is not noted, further imaging studies or biopsy may be necessary. Cervical lymphadenopathy can be a presenting sign of other nonoral cancer malignancy including laryngeal, thyroid, and lymphoma.

In conclusion, as a dentist or dental hygienist, it is important to conduct regular yearly oral cancer screenings and be aware of the appearance of premalignant lesions and early oral cancer. Early referral for biopsy, within 2-3 weeks, is essential for suspicious lesions. The dental team is a vital part in the early detection of head and neck cancer.

Residency Line of Credit

3 Years

Up to $45,000

Payments within 90 days of residency completion Advances of $15,000 per year

5 Years

Up to $75,000

Interest only payments starting in the beginning of the 4th year

Advances of $15,000 per year