Detecting Oral cancer
 

A Guide for Health Care Professionals
 

inciDence anD survival 

Oral cancer accounts for roughly two percent of 

all cancers diagnosed annually in the United States. 

Approximately 36,500 people will be diagnosed with 

oral cancer each year and about 7,900 will die from the 

disease. On average, 61 percent of those with the disease 

will survive more than 5 years. 

tHe iMpOrtance Of 

early DetectiOn 

Early Detection Saves Lives 

With early detection and timely treatment, deaths 

from oral cancer could be dramatically reduced. 

The 5-year survival rate for those with localized 

disease at diagnosis is 83 percent compared with only 

32 percent for those whose cancer has spread to other 

parts of the body. 

Early detection of oral cancer is often possible. Tissue 

changes in the mouth that might signal the beginnings 

of cancer often can be seen and felt easily. 

Warning signs 

Lesions that might signal oral cancer 

Two lesions that could be precursors to cancer are 

leukoplakia (white lesions) and erythroplakia (red lesions). 

Although less common than leukoplakia, erythroplakia 

and lesions with erythroplakic components have a much 

greater potential for becoming cancerous. Any white or 

red lesion that does not resolve itself in 2 weeks should 

be reevaluated and considered for biopsy to obtain a 

definitive diagnosis. 

Other possible signs/symptoms of oral cancer 

Possible signs/symptoms of oral cancer that your 

patients may report: a lump or thickening in the oral 

soft tissues, soreness or a feeling that something is caught 

in the throat, difficulty chewing or swallowing, ear 

pain, difficulty moving the jaw or tongue, hoarseness, 

numbness of the tongue or other areas of the mouth, or 

swelling of the jaw that causes dentures to fit poorly or 

become uncomfortable. 

If the above problems persist for more than 2 weeks, 

a thorough clinical examination and laboratory tests, 

as necessary, should be performed to obtain a definitive 

diagnosis. If a diagnosis cannot be obtained, referral to 

the appropriate specialist is indicated. 

risk factOrs 

Tobacco and Alcohol Use 

Most cases of oral cancer are linked to cigarette smoking, heavy alcohol use, or the use of both tobacco and 

alcohol together. Using tobacco plus alcohol poses a much 

greater risk than using either substance alone. 

HPV 

Infection with the sexually transmitted human papillomavirus (specifically the HPV 16 type) has been linked 

to a subset of oral cancers. 

Age 

Risk increases with age. Oral cancer most often occurs 

in people over the age of 40. 

 

Sun exposure 

Cancer of the lip can be caused by sun exposure. 

Diet 

A diet low in fruits and vegetables may play a role in 

oral cancer development. 

WHat yOu can DO 

A thorough head and neck examination should be a 

routine part of each patient’s dental visit. Clinicians 

should be particularly vigilant in checking those 

who use tobacco or excessive amounts of alcohol. 

•	 EXaMine your patients using the head and neck 

examination described here 

•	 TAKE A HISTORY of their alcohol and tobacco use 

•	 InfOrM your patients of the association between 

tobacco use, alcohol use, and oral cancer 

•	 FOLLOW-UP to make sure a definitive diagnosis is 

obtained on any possible signs/symptoms of oral cancer 

tHe eXaM 

This exam is abstracted from the standardized oral 

examination method recommended by the World Health 

Organization. The method is consistent with those followed by the Centers for Disease Control and Prevention 

and the National Institutes of Health. It requires adequate 

lighting, a dental mouth mirror, two 2 x 2 gauze squares, 

and gloves; it should take no longer than 5 minutes. 

tHe eXaMinatiOn
 

Figure 1—Face Figure 2—Lips Figure 3—Labial mucosa Figure 4—Labial mucosa

Figure 5—Right Buccal mucosa Figure 6—Left Buccal mucosa Figure 7—Gingiva Figure 8—Tongue dorsum 

Figure 9—Tongue left margin Figure 10—Tongue right margin Figure 11—Tongue ventral

Figure 12—Floor Figure 13—Hard palate Figure 14—Oropharynx Figure 15—Palpation

The examination is conducted with the 

patient seated. Any intraoral prostheses are 

removed before starting. The extraoral and 

perioral tissues are examined first, followed by 

the intraoral tissues. 

I. The Extraoral Examination 

◆ FACE: (Figure 1) 

II. Perioral and Intraoral Soft Tissue 

Examination 

◆ LIPS: (Figure 2) 

◆ LABIAL MUCOSA: (Figures 3 and 4) 

◆ BUCCAL MUCOSA: (Figures 5 and 6) 

◆ GlNGlVA: (Figure 7) 

◆ TONGUE: (Figures 8–11) 

◆ FLOOR: (Figure 12) 

◆ PALATE: (Figures 13–15) 

Oral lesiOns
 

Suspicious for Oral Cancer 

Homogenous leukoplakia in the floor of 

the mouth in a smoker. Biopsy showed 

hyperkera-tosis. 

Clinically, a leukoplakia on left buccal mucosa. 

However, the biopsy showed early squamous cell 

carcinoma. The lesion is suspicious because of the 

presence of nodules. 

Nodular leukoplakia in right commissure. Biopsy 

showed severe epithelial dysplasia. 

Erythroleukoplakia in left commissure and 

buccal mucosa. Biopsy showed mild epithelial 

dysplasia and presence of candida infection. 

A 2-3 week course of anti-fungal treatment may 

turn this type of lesion into a homogenous 

leukoplakia. 

Lesion photos courtesy Jens Jörgen Pindborg, Dr. Odont. Exam photos courtesy Joseph Konzelman, D.D.S. 
For additional copies of this poster contact:

National Institute of Dental and Craniofacial Research 

National Oral Health Information Clearinghouse 

1 NOHIC Way

Bethesda, MD 20892-3500

1–866–232–4528

http://www.nidcr.nih.gov

This publication is not copyrighted. 

Make as many copies as you need.

National Institute of Dental and Craniofacial Research

Revised March 2011

Detecting

A Guide for

Oral

Health Care

cancer

Professionals

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

National Institutes of Health

The examination is conducted with the patient 

eXaM revieW

seated. Any intraoral prostheses (dentures or 

partial dentures) are removed before starting the 

examination. The extraoral and perioral tissues are 

examined first, followed by the intraoral tissues.

i. tHe eXtraOral eXaMinatiOn

◆ face: (Figure 1) The extraoral assessment 

includes an inspection of the face, head, and 

neck. The face, ears, and neck are observed, 

noting any asymmetry or changes on the 

skin such as crusts, fissuring, growths, and/

or color change. The regional lymph node 

areas are bilaterally palpated to detect any 

enlarged nodes, and if detected, their mobility and consistency. A recommended order 

of examination includes the preauricular, 

submandibular, anterior cervical, posterior 

auricular, and posterior cervical regions.

ii. periOral anD intraOral

sOft tissue eXaMinatiOn

The perioral and intraoral examination 

procedure follows a seven-step systematic 

assessment of the lips; labial mucosa and sulcus; 

commissures, buccal mucosa, and sulcus; gingiva 

and alveolar ridge; tongue; floor of the mouth; 

and hard and soft palate.

◆ lips: (Figure 2) Begin examination by 

observing the lips with the patient’s mouth 

both closed and open. Note the color, 

texture and any surface abnormalities of 

the upper and lower vermilion borders.

◆ laBial MucOsa: (Figures 3 and 4) With 

the patient’s mouth partially open, visually examine the labial mucosa and sulcus 

of the maxillary vestibule and frenum and 

the mandibular vestibule. Observe the color, 

texture, and any swelling or other abnormalities of the vestibular mucosa and gingiva.

◆ Buccal MucOsa: (Figures 5 and 6) Retract 

the buccal mucosa. Examine first the right 

then the left buccal mucosa extending 

from the labial commissure and back to the 

anterior tonsillar pillar. Note any change in 

pigmentation, color, texture, mobility and 

other abnormalities of the mucosa, making 

sure that the commissures are examined 

carefully and are not covered by the retractors during the retraction of the cheek.

◆ glnglva: (Figure 7) First, examine the 

buccal and labial aspects of the gingiva 

and alveolar ridges (processes) by starting 

with the right maxillary posterior gingiva 

and alveolar ridge and then move around 

the arch to the left posterior area. Drop to 

the left mandibular posterior gingiva and 

alveolar ridge and move around the arch to 

the right posterior area.

 Second, examine the palatal and lingual 

aspects as had been done on the facial side, 

from right to left on the palatal (maxilla) 

and left to right on the lingual (mandible).

◆ tOngue: (Figure 8) With the patient’s 

tongue at rest, and mouth partially open, 

inspect the dorsum of the tongue for any 

swelling, ulceration, coating or variation 

in size, color, or texture. Also note any 

change in the pattern of the papillae covering the surface of the tongue and examine 

the tip of the tongue. The patient should 

then protrude the tongue, and the examiner should note any abnormality of mobility 

or positioning.

(Figure 9) With the aid of mouth mirrors, 

inspect the right and left lateral margins of 

the tongue.

(Figure 10) Grasping the tip of the tongue 

with a piece of gauze will assist full protrusion and will aid examination of the more 

posterior aspects of the tongue’s lateral 

borders. 

(Figure 11) Then examine the ventral surface. 

Palpate the tongue to detect growths.

◆ flOOr: (Figure 12) With the tongue still 

elevated, inspect the floor of the mouth 

for changes in color, texture, swellings, 

or other surface abnormalities. 

◆ palate: (Figures 13 and 14) With the 

mouth wide open and the patient’s head 

tilted back, gently depress the base of the 

tongue with a mouth mirror. First inspect 

the hard and then the soft palate.

(Figure 14) Examine all soft palate and 

oropharyngeal tissues. 

(Figure 15) Bimanually palpate the floor 

of the mouth for any abnormalities. All 

mucosal or facial tissues that seem to be 

abnormal should be palpated.