This video contains the latest recommendations from the 2017 ADA
clinical practice guideline on the evaluation of oral mucosal abnormalities.
This video offers step-by-step instructions for evaluating adult
patients for potentially malignant disorders or PMDs and oral cancer during
a routine dental exam in your clinic. First begin the exam by asking your
patient if any new dental issues have emerged since their last visit or
appointment, during the medical history recollection pay attention to risk
factors such as being male, older, smoking, and alcohol consumption with the
patient's response in mind next perform a conventional visual and tactile
intraoral and extra oral exam. Throughout the exam use inspection and palpation to
look for any changes in color, contour, consistency and function begin the extra
oral exam by examining the head and face with both the front and back taking note
of any asymmetries and the presence of pigmented lesions for such lesions use
the American Cancer Society's ABCDE rule to assess for melanoma risk look for
asymmetry border irregularity color changes diameter greater than six
millimeters and evolution of the lesion over time. Next observe and palpate the
neck on both sides if lymph nodes are identified pay
attention to the size consistency whether they are painful and whether
they freely move or are fixed in place when evaluating the lips note any change
in the Vermilion border, mucosa and chemisiers as well as the lips color, contour
consistency, and function look for in durations and ulceration
ask your patient to open their mouth and begin the intra oral exam by inspecting
the cheeks, retract the tissue with your thumbs and gently pinch the cheek
between your fingers looking for a hidden masses
use a mirror to examine the alveolar processes and gingiva look for changes in
color, consistency, or a tooth with bone loss out of proportion with the rest of
the arch pay special attention to the presence of a lesion with a history of
poor healing. Carefully inspect and palpate the hard and soft palate looking
for abnormalities while depressing the tongue with the mirror ask the patient
to say ah to have better access to the uvula and tonsillar pilers using gauze
move the tongue to the left and to the right to examine the entire dorsal
tongue pay attention to the lateral and ventral tongue as well complete this
assessment palpating the tongue and nearby salivary glands this aspect of
the exam is important as nearly half of all potentially malignant lesions are
usually found in this area ask the patient to touch their top front teeth
with the tip of their tongue so that the floor of the mouth can be inspected and
palpated. Use two hands when palpating this area after the exam clinicians
should consider two potential clinical scenarios either the patient exhibits no
lesions or has some type of mucosal abnormality. For patients without a
lesion no further action is necessary although light base and salivary test
adjuncts have been proposed to evaluate mouths without lesions none of these
tools have been proven effective and as a result they aren't recommended for use.
For patients with a lesion the majority of these lesions will be innocuous some
common causes of innocuous lesions include trauma para functional habits
and dental restorations these innocuous lesions require periodic followup with
the patient to provide therapy and/or monitor the lesion in instances in which
an innocuous lesion does not resolve or in instances in which a lesion is
suspected to be a PMD immediate biopsy or referral to a specialist is
recommended many adjuncts have been proposed as tools to assess PMT's sooner
rather than later unfortunately current evidence doesn't
support the use of adjuncts because of their high frequency of false positives
which results in unnecessary complications and costs. When evaluating
patients for PMD's and oral cancer please remember get to know your
patient during your patients exam update their history and have a conversation
about oral cancer risk factors keep in mind that this could be a stressful
situation for the patient and maybe even for the clinician conducting the exam
time is important for potentially malignant lesions biopsy or refer the
patient immediately be skeptical of the use of adjuncts current evidence does
not support the use of these tools in the general population please monitor
and critically appraise the literature for the emergence of new evidence in
this field look to the ADA's most current recommendations for insights for
more information on the ADA's clinical recommendations for PMD and oral cancer
evaluation please visit ADA.org/oralcancer