#7 – Does Oral Cancer Screening on every client

Clients are very concerned about oral cancer.  Review their health history for danger signs: Do they smoke?  Is there a history of cancer in their family?  Have they had cancer?

Explain to these high risk groups how important this exam is!

Complete Oral Examination

An oral cancer examination is completed routinely on all patients, especially on those patients who smoke.  The complete oral examination should include both INSPECTION and digital PALPITATION of extraoral areas as well as of the intraoral structures.  Adequate lighting, a tongue depressor, a dental mirror, gauze and a rubber glove or finger cot are the only material requirements.

‑ Dentures should be removed before the exam.  A local anesthetic spray may be needed for some to examine the base of the tongue and pharynx.

‑ Tenderness of the TMJ joint, color edema or bleeding of the gum, consistency of the saliva, odor of the breath, color and coating on the tongue should all be noted and if abnormal investigated further.

EXAM

1.  Look for skin blemishes, pigmentation, moles, asymmetry and swelling.

2.  Look at the neck for swelling or color changes.  Palpate the neck, two fingers next to the tongue pressing on the floor of the mouth while the other palpates the mandibular lymph nodes, (enlargement means infection).

3.  The cervical chain is best identified by palpating deeply with two fingers.

4.  Palpate the TMJ joint bilaterally with the mouth closed and then wide open.  Note tenderness, crepitus and deviation of the lower   jaw on opening.

5.  Examine the lips with the mouth closed and then open.  Note the color, texture, any surface abnormalities, or swelling.

6.  Palpate the lips for any induration.

7.  Examine visually and by palpation the mandible.  Mucobuccal fold and frenum with the mouth partially open.  Palpate the entire area.   Look for the color, character, and any swellings of the mucosa   interproximaly and in the vestibule.

8.  Using the fingers as retractors and with the mouth wide open, examine the inner aspect of the left cheeks and other areas covered   by the buccal mucosa.

9.  Inspect the dorsum (top) of the tongue with the tongue at rest and the mouth partially open for any swelling, ulceration, coating or   variation in size, color or texture.

10. With the tongue protruded look for any deviation, tremor, asymmetry or limitation of motion.  Note any variations in texture, size or   color.

11. Wrap a wet 2×2 gauze around the tip of the protruded tongue. Ask the client to say “Ahh” and observe  the base of the tongue and circumvallate papillae.

12. Hold the tongue with the gauze and move it to the pts’ left.  Look at the entire lateral border of the tongue and its attachments to   the floor of the mouth back to the anterior pillar.  Do the same with the right side of the tongue.

13. Release the tongue and tell pt. to touch the tip to the palate. Look at the ventral surface and note any varicosities and   swellings.  Inspect the floor of the mouth for swellings or other abnormalities.

14. Palpate the entire tongue, including the base for any induration.

15. Palpate the entire floor of the mouth ‑ identify the submaxillary gland.

16. With the mouth wide open and the pt’s head back, gently depress the base of the tongue with a mirror.  Inspect and palpate the hard   palate.

17. Observe and palpate the soft palate and uvula.

18. Instruct the pt. to say “Ahh” and inspect both fauces, the anterior pillars, and the posterior pillars.

19. The nasopharynx may be examined by placing the mirror behind the uvula.  Have the pt. breath through the nose and mouth.