[Sound of medical instruments and doctor murmuring]
[Robert H. Johnson, M.D.:] Once you have developed a system,
an examination of the mouth can be done quickly and should be a part of your routine examination of patients.
From a general health standpoint, an oral examination will help you detect infections that may contribute to systemic diseases,
like subacute bacterial endocarditis, or conversely, there may be oral manifestations of systemic diseases.
In either case, your general treatment plan would be influenced.
In addition, the advanced oral cancer like this one is difficult to manage, and routine examination can result in earlier diagnosis.
I'll now run through a routine oral examination for you. I'll also show you some oral cancers in their early stages.
Good light is important; a head lamp is preferable.
A flashlight does not furnish adequate light.
Also, it leaves you with only one hand free.
You won't need any additional equipment other than what is ordinarily in your office.
It's important to take a history.
If there are symptoms, explore them fully before proceeding with the examination.
A convenient first step is inspection of the skin of the head and neck.
Check all skin lesions closely.
Pigmented lesions especially should be carefully evaluated.
If your patient wears a denture, remove it before you examine the mouth.
These should be checked. Ill-fitting dentures are a frequent cause of traumatic lesions.
Occasionally a denture sore may be malignant.
The chronic denture sore on this patient's upper gum was malignant.
It's handy to begin with the lips.
This innocent-appearing abnormality, commonly called leukoplakia, actually is an invasive carcinoma.
While the lip is retracted, inspect the anterior teeth for dental caries.
The gum should be inspected for abnormalities.
Next the buccal mucosa and the Stensen's duct.
If the patient is a pipe smoker, you may discover this kind of leukoplakia.
This lesion was carcinoma in situ.
Note any pathologic changes of the posterior teeth and gums.
The roof of the mouth should be systematically inspected.
Innocent-appearing lesions may be serious.
A cytologic smear from this red area reveals suspicious cells, and the biopsy report was carcinoma.
Next, examination of the soft palate, uvula, posterior pharyngeal wall, and tonsils.
The tongue is depressed to inspect the posterior pharyngeal wall,
and then retracted to look at the tonsils and tonsillar pillars.
Also, the posterior floor of the mouth, the lower teeth, and gum can be examined at this time.
Now, we'll examine the ventral surface of the tongue, the anterior floor of the mouth, and the gums of the lower front teeth.
The dorsal and lateral surface of the tongue can be examined by gripping it with a piece of gauze.
Stick out your tongue.
Let me show you two different tongue cancers.
This small, white lesion was found during a routine examination of a 41-year old female.
A smear revealed suspicious cells and the biopsy report was carcinoma.
This small ulcer was found in a 26-year old male with a history of syphilis.
Cytology was positive and the biopsy report was carcinoma.
It's advisable to palpate the entire mouth.
The neck should be examined routinely.
Any palpable lymph nodes may represent metastatic disease.
We're basically interested in helping you detect oral cancers, preferably in their earliest stage.
If there's any uncertainty about any abnormality, a referral may be in order.
Now I'd like to present the chief of the Public Health Service Cancer Control Program, Dr. William Ross.
[Dr. William Ross:] We are faced with a number of problems in our struggle to control oral cancer.
Relatively, it has a low incidence.
In addition, there is a high incidence of non-malignant lesions in the mouth.
Yet our projects and those of the Veterans Administration,
all of which were conducted in large medical centers by competent staff,
reveal that over 20 percent of all lesions found were unsuspected.
The unsuspected did not have the typical signs and symptoms of cancer.
They were biopsied only because cytologic specimens were taken,
and abnormal cells were found.
Most oral lesions you will see in your patients will be non-malignant,
but unless you actively try to reach a diagnosis for all lesions,
the cancers will remain undetected until they are far advanced.
The associated benefits of oral examinations are many.
First, the discovery of pre-malignant lesions.
Second, the discovery of other systemic conditions.
And finally, an increased awareness of the problems of dental and oral hygiene.
As physicians, you have a responsibility for the total health of your patients.
Your cooperation in an oral examination program is essential.