Oral cancer screening can help prevent death and suffering from this disease. It’s a simple process that’s part of something everyone should do anyway: regular dental checkups.
Your healthcare professional will shine a light in your mouth and look at the tissue for signs of pre-cancer or cancer. They may use a dye (toluidine blue) to highlight abnormal areas. They can also scrape an area with a brush to collect cells for exfoliative cytology.
The Dentist Exam
While it is a common practice for dentists to examine teeth and gums during checkups, most patients do not realize that this also includes a screening for oral cancer. During an oral cancer screening, the dentist examines areas inside and outside of the mouth to look for lesions, sores or discolorations. The dentist will feel the lymph nodes on the head and neck and may take a small sample of tissue (called a biopsy) to test for cancerous cells.
During an oral cancer screening, the dentist is likely to ask questions about the patient’s general health, as well as their past history with mouth sores and abnormalities. This will help the dentist determine if there are any risk factors for oral cancer such as tobacco or excessive alcohol use, HPV infection or prolonged exposure to sunlight.
The dentist may use a mirror and light to get a better look at the inside of the mouth, and will also look at the neck, lips, cheeks and floor of the mouth for abnormalities. The dentist will also feel the cheeks, tongue and the roof of the mouth for any unusual bumps or changes in texture. In addition to a visual and tactile examination, the dentist might also make use of technological tools during a screening such as the FDA-approved VELscope, which shines a safe blue light into the mouth to highlight precancerous or cancerous cells.
The Tongue Exam
The tongue is one of the most important and easiest oral structures to examine. The professional will stick it out and look for a white coating, red spots or lumps, and any other changes in color, texture or size. They will also feel the outside of your mouth and neck for any enlarged lymph nodes which could be a sign of infection or cancer.
They will also feel the base of your tongue where it curves down into your throat. This is the most common location for Oral cancer to develop, and it is usually related to tobacco use or the HPV16 virus which also causes cervical cancers. Symptoms may be very subtle, like a persistent hoarse voice, or more noticeable, such as a difficulty swallowing food.
If they find anything unusual, they will ask you to rinse your mouth with a special mouthwash that makes healthy tissues appear dark and abnormal tissue white. They will then shine a blue light over the tissue, which shows any abnormal areas more clearly. In some cases, they will also send any images of your tongue to a specialist for further evaluation. Mobile applications have been developed and piloted for this purpose, and PHCWs can even send images to a remote specialist via WhatsApp. This has been used successfully in India and Corboda (Birur et al. 2019).
The Floor of the Mouth Exam
Using a mouth mirror and a hand piece, your dentist will examine the sides of the tongue (lateral margins), checking for red areas, swelling, or bumps. He will also palpate the ventral surface and the base of the tongue, looking for lumps or enlarged lymph nodes that feel hard and fixed in place. These are often painless, but they can be a warning sign for tonsillar cancer.
Next, your dentist will look at the hard and soft palates of the mouth. He or she will check the firm area of the roof of the mouth for any concerns, as well as the softer area of the throat that sits behind the palate. The doctor may also ask you to swallow so he or she can see if you have trouble with swallowing, which could be a sign of a cancerous lesion on the base of the tongue or a more serious problem in the throat.
Your dentist may use tools like toluidine blue dye to identify areas of tissue that might be cancerous or precancerous. They might also rinse your mouth with a fluorescent mouthwash, then shine a special light in your mouth, which makes healthy tissues look dark and abnormal tissues seem white. In addition, some doctors use a brush to collect cells from suspicious areas of the mouth and send them to a lab for testing. If the cell tests are positive for cancer, you will need to see an oncologist – a doctor who specializes in treating cancer.
The Scalp Exam
Oral cancer and the closely related throat (oropharyngeal) cancers can be deadly when not caught early. They tend to be asymptomatic, mimicking benign conditions and may not be recognized until they reach advanced stages. This is in part why screening is so important.
Most oral cancers develop in the front of the mouth and are often related to tobacco and alcohol use. In the rear of the mouth, which includes the tonsils and base of the tongue, tumors are more frequently caused by sexually transmitted human papillomavirus (HPV) infection. In fact, the incidence of HPV-related oropharyngeal cancer is increasing and it can be difficult to distinguish from other types of precancerous tissue changes without biopsy.
During an oral cancer screening, the healthcare provider will use their fingers to feel for any lumps or bumps in the jaw and neck area. They might also coat any suspicious areas with a colorless dye, like toluidine blue, to help them see any abnormalities more clearly.
While some people may be uncomfortable with the physical examination, most people who have undergone oral cancer screening report it as a positive experience. The reason for this is that it is quick, painless and – compared to many other medical and dental procedures – relatively inexpensive. For this reason, some people might prefer oral cancer screening to more invasive tests such as an MRI or colonoscopy.