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Home , Hard palate, Oral cancer

DETECTING ORAL A Guide for Health Care Professionals

INCIDENCE AND SURVIVAL WARNING SIGNS RISK FACTORS WHAT YOU CAN DO

Oral cancer accounts for roughly two percent of Lesions that might signal oral cancer & Use A regular dental check-up is an excellent opportunity all diagnosed annually in the United States. Two lesions that could be precursors to cancer are Tobacco use (cigarettes, , pipes, and smokeless for a head and neck examination. Clinicians should Approximately 40,000 people will be diagnosed with (white lesions) and (red lesions). tobacco) is a risk factor for oral cancer. Heavy alcohol be particularly vigilant in checking those who use oral cancer each year and about 7,800 will die from the Although less common than leukoplakia, erythroplakia use also increases the chances of developing the disease. tobacco or excessive amounts of alcohol. disease. On average, 60 percent of those with the disease and lesions with erythroplakic components have a much The risk is even greater for people who use both tobacco will survive more than 5 years. greater potential for becoming cancerous. Any white or and alcohol than for those who use only tobacco or • EXAMINE your patients using the head and neck red lesion that does not resolve itself in 2 weeks should only alcohol. examination described here be reevaluated and considered for to obtain a • OBTAIN A HISTORY of their alcohol and tobacco use THE IMPORTANCE OF definitive diagnosis. HPV Infection with the sexually transmitted human • INFORM your patients of the association between EARLY DETECTION Other possible signs/symptoms of oral cancer papillomavirus (specifically the HPV 16 type) has been tobacco use, alcohol use, and oral cancer It’s important to find oral cancer early when it Possible signs/symptoms of oral cancer that your linked to a subset of oral cancers. • FOLLOW-UP to make sure a definitive diagnosis is can be treated more successfully. patients may report: a lump or thickening in the oral obtained on any possible signs/symptoms of oral soft tissues, soreness or a feeling that something is caught The 5-year relative survival rate for those with localized Age cancer in the , difficulty or swallowing, ear disease at diagnosis is 83 percent compared with only 36 pain, difficulty moving the or , hoarseness, Risk increases with age. Oral cancer most often occurs percent for those whose cancer has metastasized. THE EXAM numbness of the tongue or other areas of the , or in people over the age of 40. This exam is abstracted from the standardized oral Early detection of oral cancer is often possible. Tissue swelling of the jaw that causes dentures to fit poorly or examination method recommended by the World changes in the mouth that might signal the beginnings of become uncomfortable. Sun exposure Health Organization. The method is consistent with cancer often can be seen and felt easily. Cancer of the can be caused by sun exposure. If the above problems persist for more than 2 weeks, those followed by the Centers for Disease Control and a thorough clinical examination and laboratory tests, Prevention and the National Institutes of Health. It as necessary, should be performed to obtain a definitive Diet requires adequate lighting, a dental mouth mirror, two diagnosis. If a diagnosis cannot be obtained, referral to the A diet low in fruits and vegetables may play a role in 2 x 2 gauze squares, and gloves; it should take no longer appropriate specialist is indicated. oral cancer development. than 5 minutes. THE EXAMINATION

Figure 1—Face Figure 2— Figure 3—Labial mucosa Figure 4—Labial mucosa

Figure 5—Right Buccal mucosa Figure 6—Left Buccal mucosa Figure 7—Gingiva Figure 8—Tongue dorsum

Figure 9—Tongue left margin Figure 10—Tongue right margin Figure 11—Tongue ventral

Figure 12—Floor Figure 13—Hard Figure 14—Oropharynx Figure 15—Palpation Exam photos courtesy Joseph Konzelman, D.D.S.

The examination is conducted with the I. The Extraoral Examination ◆◆ LIPS: (Figure 2) ◆◆ TONGUE: (Figures 8–11) patient seated. Any intraoral prostheses are ◆◆ FACE: (Figure 1) ◆◆ LABIAL MUCOSA: (Figures 3 and 4) ◆◆ FLOOR: (Figure 12) removed before starting. The extraoral and perioral tissues are examined first, followed by II. Perioral and Intraoral Soft Tissue ◆◆ BUCCAL MUCOSA: (Figures 5 and 6) ◆◆ PALATE: (Figures 13–15) the intraoral tissues. Examination ◆◆ GlNGlVA: (Figure 7) ORAL LESIONS Suspicious for Oral Cancer

Erythroleukoplakia in left commissure and buccal mucosa. Biopsy showed mild epithelial Clinically, a leukoplakia on left buccal mucosa. and presence of candida infection. Homogenous leukoplakia in the floor of the However, the biopsy showed early squamous cell A 2-3 week course of anti-fungal treatment may mouth in a smoker. Biopsy showed hyperkera- . The lesion is suspicious because of the Nodular leukoplakia in right commissure. Biopsy turn this type of lesion into a homogenous tosis. presence of nodules. showed severe epithelial dysplasia. leukoplakia. Lesion photos courtesy Jens Jörgen Pindborg, Dr. Odont. DETECTING

A Guide for For additional copies of this poster contact: National Institute of Dental and Craniofacial Research National Oral Health Information Clearinghouse 1 NOHIC Way ORAL Bethesda, MD 20892-3500 1–866–232–4528 http://www.nidcr.nih.gov Health Care

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Professionals

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES July 2013 National Institutes of Health NIH…Turning Discovery Into Health®

EXAM REVIEW ◆◆ LIPS: (Figure 2) Begin examination by ◆◆ GlNGlVA: (Figure 7) First, examine the buc- (Figure 10) Grasping the tip of the tongue The examination is conducted with the patient observing the lips with the patient’s mouth cal and labial aspects of the gingiva and with a piece of gauze will assist full seated. Any intraoral prostheses (dentures or par- both closed and open. Note the color, tex- alveolar ridges (processes) by starting with protrusion and will aid examination of the tial dentures) are removed before starting the ture and any surface abnormalities of the the right maxillary posterior gingiva and more posterior aspects of the tongue’s lateral examination. The extraoral and perioral tissues are upper and lower vermilion borders. alveolar ridge and then move around the borders. arch to the left posterior area. Drop to the examined first, followed by the intraoral tissues. ◆ (Figure 11) Then examine the ventral ◆ LABIAL MUCOSA: (Figures 3 and 4) With left mandibular posterior gingiva and alve- surface. Palpate the tongue to detect I. THE EXTRAORAL EXAMINATION the patient’s mouth partially open, visu- olar ridge and move around the arch to the growths. ally examine the labial mucosa and sulcus right posterior area. ◆◆ FACE: (Figure 1) The extraoral assessment of the maxillary vestibule and frenum and ◆◆ FLOOR: (Figure 12) With the tongue still includes an inspection of the face, head, the mandibular vestibule. Observe the Second, examine the palatal and lingual elevated, inspect the floor of the mouth and neck. The face, ears, and neck are color, texture, and any swelling or other aspects as had been done on the facial side, for changes in color, texture, swellings, or observed, noting any asymmetry or chang- abnormalities of the vestibular mucosa and from right to left on the palatal () other surface abnormalities. es on the skin such as crusts, fissuring, gingiva. and left to right on the lingual (). growths, and/or color change. The regional ◆◆ PALATE: (Figures 13 and 14) With the ◆◆ BUCCAL MUCOSA: (Figures 5 and 6) Retract ◆◆ TONGUE: (Figure 8) With the patient’s areas are bilaterally palpated mouth wide open and the patient’s head the buccal mucosa. Examine first the right tongue at rest, and mouth partially open, to detect any enlarged nodes, and if detect- tilted back, gently depress the base of the then the left buccal mucosa extending inspect the dorsum of the tongue for any ed, their mobility and consistency. A rec- tongue with a mouth mirror. First inspect from the labial commissure and back to the swelling, ulceration, coating or variation ommended order of examination includes the hard and then the . in size, color, or texture. Also note any the preauricular, submandibular, anterior anterior tonsillar pillar. Note any change in change in the pattern of the papillae cervical, posterior auricular, and posterior pigmentation, color, texture, mobility and (Figure 14) Examine all soft palate and other abnormalities of the mucosa, making covering the surface of the tongue and oropharyngeal tissues. cervical regions. sure that the commissures are examined examine the tip of the tongue. The patient (Figure 15) Bimanually palpate the floor II. PERIORAL AND INTRAORAL SOFT carefully and are not covered by the retrac- should then protrude the tongue, and the of the mouth for any abnormalities. All tors during the retraction of the . examiner should note any abnormality of TISSUE EXAMINATION mucosal or facial tissues that seem to be mobility or positioning. The perioral and intraoral examination proce- abnormal should be palpated. dure follows a seven-step systematic assessment of (Figure 9) With the aid of mouth mirrors, the lips; labial mucosa and sulcus; commissures, inspect the right and left lateral margins of buccal mucosa, and sulcus; gingiva and alveolar the tongue. ridge; tongue; floor of the mouth; and hard and soft palate.