Screening for oral cancer: A step-by-step guide for dental hygienists

April 11th, 2018
A magnified view of cancerous cells in the mouth

A magnified view of cancerous cells in the mouth. Photo: Department of Diagnostic Sciences, Texas A&M College of Dentistry

Dental hygienists are on the front lines in early diagnosis and treatment of oral cancer. With the rise of oral cancer related to HPV — human papilloma virus — it is even more important that dental professionals be vigilant in screening patients for this type of cancer, and that patients know what to expect during the exam.

“We used to think that oral cancer only occurred in older patients who smoked and drank alcohol. Now we know that 70 to 80 percent of oral cancer is a result of the human papilloma virus,” said Jane Cotter, assistant professor at Texas A&M College of Dentistry’s Caruth School of Dental Hygiene. “Because of HPV, we are now seeing oral cancer in patients who are in their 20s and 30s who have no history of tobacco use.”

A thorough oral cancer screening can be completed in less than two minutes.

During the screening, hygienists should ask the patient the following questions:

  1. Have you noticed any lumps or swelling in your head or neck?
  2. Have you had any changes in your voice or difficulty swallowing?
  3. Are you currently using tobacco or vaping products?

Conducting the oral exam

  • The neck from the jawline to the clavicle should be palpated lightly. Cancer-involved lymph nodes are hard to miss. They are hard as a rock, and only the skin will move when touched.
  • Remember that spots where saliva pools can be considered high risk for oral cancer. These include the floor of the mouth, the posterior ventrolateral borders of the tongue and the oropharynx.
  • Patients should be instructed to stick their tongue out as far as they can and move it left to right.
  • The tongue is then grasped using a piece of gauze and gently pulled so that the ventrolateral borders can be checked.
  • Lastly, ask the patient to say, “AAAHHH,” so the oropharynx can be inspected.
  • Any lesion, sore or irregularity that is unilateral and does not resolve within two weeks should be sent for biopsy. A biopsy is the only way to confirm a cancer diagnosis.
  • Adjunctive oral cancer screening devices or stains only aid in discovery of abnormal or thickened tissue and should be used along with a physical exam. They should never be used in place of the above-outlined screening method.

— Ladawn Brock