Using regular dental checkups, healthcare providers can look for abnormal tissue. To do this, they may shine a light in your mouth that makes healthy tissue look darker and identifies pre-cancerous or cancerous tissues more easily.
A large, multicenter study using PHCWs to perform visual screening found a 27% reduction in oral cancer mortality with up to 4 cycles of screening and referral compliance for expert examination.
Preparing for Your Visit
The best way to protect yourself from oral cancer is by visiting your dentist regularly for an oral cancer screening. This is especially important if you have certain risk factors, including smoking or excessive alcohol consumption.
Oral cancers that are screened early have a much greater chance of being successful treated. The goal of an oral cancer screening is to find pre-cancerous tissue changes before they develop into a more serious condition. This allows your dentist to take care of them before they can cause more severe problems in the future.
During an oral cancer screening, your dentist will examine your mouth and throat to look for red or white patches, sores that won’t heal, lumps or bumps and other symptoms. They may also use a special dye, shine a light in your mouth or scrape the area to get a sample of the cells.
A biopsy can be used to determine whether or not the area is cancerous. If the tissue is cancerous, it can be removed and sent to a lab for further testing. This procedure is quick, painless and usually doesn’t require anesthesia. If it is determined that the area is pre-cancerous, your dentist will typically schedule you for a follow up visit in a few weeks to see if the problem has grown or changed.
During Your Visit
A routine oral cancer screening only takes a few minutes to perform and is usually part of a regular dental appointment. The dentist will examine your face, lips, neck, interior of the nose and oral cavity for signs of abnormalities such as bumps, swelling, asymmetries or patches of color. You will be asked to remove all dental appliances, including dentures and retainers in order for your dentist to see all areas of your mouth.
If a concerning-looking sore is discovered, your dentist will feel the area with their fingers to try and get a better look at the tissues surrounding it. You will want to be sure to tell them if any lumps or nodules are painful, as this can indicate that the tissue is cancerous and needs additional testing.
Your healthcare professional may also rinse your mouth with a solution that coats the lesions with dye, which helps them to be more easily identified. They can also use a special light to illuminate your mouth and make healthy tissue look dark and abnormal tissue appear white. Occasionally, a biopsy will need to be performed in order to confirm whether or not the area is cancerous. This involves taking a small sample of the tissue with a brush, piece of cotton or wooden stick and sending it to be examined under a microscope.
Post-Visit Testing
After you’ve had oral cancer surgery, your doctor will want to see if the tumor has come back or spread. This may require further testing, which can be done at regular follow-up visits. These tests can also help find second cancers in the mouth or throat.
Regular dental checkups can be important in finding early signs of oral and oropharyngeal cancers (and pre-cancers). Your healthcare professional will look at your face, neck, lips, gums, inside of the cheeks, jaw, tongue and cheek areas and behind the tonsils for asymmetries, bumps or discolorations and feel around for tender spots. They might use a tool that coats abnormal tissues with a dye or a fluorescent light that illuminates these tissues to show abnormalities.
Studies of screening adjunctive techniques in primary care have generally reported low sensitivity compared with standard visual examinations. This is largely due to the difficulty in distinguishing oral potentially malignant disorders (OPMDs) from benign “look-alike” conditions.
Many OPMDs occur in the front of the mouth (oral cavity) and are often associated with tobacco and heavy alcohol consumption. However, a growing number of OPMDs develop in the rear of the mouth known as the oropharynx and are often related to HPV16 infection. The PHCWs’ ability to identify such opportunistic opportunistic lesions is limited by their level of training and experience. Some PHCWs in low-income countries have been trained and given mobile phone applications that allow them to send images deemed “screen positive” for consultation with a remote specialist (Birur et al, 2019; Haron et al, 2021).
Treatment
To determine whether an abnormal area is a cancer, or a pre-cancer, the dentist will take a small tissue sample from the lesion and send it to a lab. The cells are analyzed under a microscope to see if they contain pre-cancer or cancer.
If cancerous cells are detected, a biopsy will be needed to confirm the diagnosis. After the biopsy, doctors can use staging information to recommend treatment options. Staging is based on how far the cancer has spread and can be used to predict your chances of recovery.
In addition to examining the mouth, your dental professional will ask you about your history with tobacco and alcohol use, as well as any family history of head and neck cancers. They may also want to know if you have any symptoms, such as sores that do not heal or lumps or bumps in your mouth or neck.
Several methods of screening for oral cancer have been evaluated, including invitation to attend screening events, opportunistic screening at dental practices and integration of oral cancer screening with general health screening. Screening models that combine adjunctive aids to enhance visual examination and salivary or blood-based tests using proven biomarkers would seem to have potential as well.