Naventhan A/L Chanthirasekar

A158105
How to Check Patients for Oral Cancer?
The video provided step by step instructions to evaluate patients for potentially malignant
disorders (PMD) and oral cancer during routine dental examination.
Firstly, ask the patient if there is any new dental issues arose since the last dental visit. During
history taking, extra attention should be paid to the risk factors such as being male, older, having the
habit of smoking and alcohol consumption.
Next, intraoral and extraoral examinations are performed. Note any changes in colour,
contour, consistency and function via inspection and palpation. Extraoral examination begins with
examining the head and face for any asymmetries and presence of pigmented lesion. ABCDE rule by
American Cancer Society is used to assess for melanoma risk whereby A-asymmetry, B-border
irregularity, C-colour changes, D-diameter more than 6mm and E-evolution of the lesion over time.
Next palpate the neck area, to identify the lymph nodes and assess their size and consistency, either
painful, freely moveable or fixed in place. After that is the lips. Check for changes in the Vermillion
border, mucosa and commissure of the mouth. Also inspect the lip colour, contour, consistency and
function as well as if there is any induration and ulceration.
Intraorally, inspect the cheeks by retracting the tissues with thumb and gently pinching the
cheeks between fingers looking for hidden masses. By using a mouth mirror, examine the alveolar
process and gingiva by looking for any changes in colour, consistency or a tooth with abnormal bone
loss. Extra attention is paid to presence of lesion with poor healing history. The soft and hard palates
should be palpated for any abnormalities. Inspect the uvula and tonsils by using a mirror to depress
the tongue and asking the patient to say ‘ah’ for better access and visualisation. A gauze should be
used to examine the tongue by moving it left and right, inspecting the dorsal, ventral and lateral
surfaces. The tongue and nearby salivary glands are palpated as half of PMD are found in this area.
The floor of the mouth is inspected by instructing the patient to push the tip of the tongue towards the
upper front teeth.
Two clinical scenarios should be considered by the clinician which are if the patient exhibits
no lesion or has some type of mucosal abnormality. If there is no lesion, no further action are taken.
If the patient has some type of mucosal abnormalities, they are usually innocuous which are
caused by trauma, parafunctional habits or dental restorations. They need periodic follow up to
provide therapy and/or monitor the lesion. If the lesion does not resolve or suspected to be PMD,
immediately do biopsy or refer to specialist.
There are adjuncts present to assess PMD sooner but current evidence does not support using
it as they have high frequency of false positive that can cause unnecessary complications and costs.
In conclusion, when evaluating patient for PMD or oral cancer, get to know the patient.
During every visit and examination, update their history and explain to them on oral cancer risk
factors. Next, time is very important especially for PMD for the biopsy and referral to specialist that
needs to be done immediately. Be sceptical on usage of adjuncts as current evidence does not support
its usage on general population. Lastly, monitor and critically appraise literatures for emergence of
new evidence in the field.