The dental hygienist’s guide to oral pathology in patients with oral cancer

Dental hygienists are the unacknowledged heroes in oral health care, diligently working to protect their patients’ oral health. Besides removing plaque and polishing teeth, hygienists can identify early signs of potentially life-threatening conditions, including oral cancer. One of the most common cancers affecting humans across the globe is oral cancer, and early detection can significantly reduce morbidity.¹

The key to successful treatment outcomes is early detection and intervention. The dental hygienist's keen eye, skilled hands, and understanding of oral anatomy equip them to identify oral pathology in patients with oral cancer.

More about oral cancer … 8 steps for documenting oral lesions

In 2023, according to the Oral Cancer Foundation, “Close to 54,000 Americans will be diagnosed with oral or oropharyngeal cancer this year. It will cause over 9,750 deaths, killing roughly 1 person per hour, 24 hours per day. Of those 54,000 newly diagnosed individuals, only slightly more than half will be alive in 5 years (approximately 57%). This is a number that has not significantly improved in decades.”²

Following is an overview of what to look for when examining oral cancer patients, how to differentiate typical from atypical findings, and steps to take when pathology is suspected.

Understanding oral cancer

There has historically been a high death rate associated with oral cancer, not because it is difficult to detect or diagnose, but because it is discovered late in its development. In its early stages, oral cancer can often go undetected by the patient as OC is frequently asymptomatic and likely to cause second primary tumors.²

Individuals with oral cancer have malignant cells growing in their mouth or throat, such as the lips, tongue, cheeks, floor of the mouth, and hard and soft palate. A dental hygienist’s knowledge of oral cancer risks and signs is crucial, especially those involving persistent mouth sores, swallowing difficulties, lumps or bumps, and white or red patches.

More about oral cancer … Oral cancer: Are you asking the right questions?

Detailed oral examination

Dental hygienists are responsible for performing a detailed oral exam for oral cancer. Mastering this skill allows them to detect potentially life-threatening conditions and intervene early on.

Steps to conduct a thorough oral cancer exam

Start by reviewing the patient’s medical and dental history.
Note any risk factors for oral cancer, including tobacco use or alcohol consumption, HPV infection, and previous cancer history.
Ensure the patient’s comfort.
Give patients a detailed explanation of the purpose of the examination
Obtain their consent.

Areas to check carefully during the oral cancer exam

Lips: Look for ulcerations, discolorations, or abnormal growths on the inner and outer surfaces of the lips.
Tongue: Check the sides of the tongue, including the lateral surfaces, undersurface, and tip of the tongue, for signs of change in texture, color, appearance, ulcers, or any other irregularities.
Floor of the mouth: Palpate the floor of the mouth for lumps or masses and examine it thoroughly. Inspect for red or white patches and ulcers.
Buccal mucosa: Examine the inner lining of the cheeks. Look for persisting abnormalities, such as red or white patches, that have been present for more than two weeks.
Palate: Examine the hard and soft palates for lesions or other changes. Pay special attention to the junction between the hard and soft palates.
Oropharynx: Use a tongue depressor to gently hold down the patient’s tongue; observe any abnormalities in the tonsils and check the back of the throat for unusual lumps or masses.
Lymph nodes: Gently palpate the lymph nodes in the head and neck region. Focus on the submandibular, submental, preauricular, and cervical nodes. Assess the area and note any enlargement, tenderness, or masses.

How to distinguish between typical and atypical findings

A typical finding refers to a series of common oral changes that are often benign. These lesions may be aphthous ulcers, irritation fibromas, mucoceles, or benign lesions.³

If certain features deviate from the norm, they are considered atypical findings. Atypical findings might include irregular shapes, rapid growth, asymmetry, induration, persistent red or white patches, and unexplained bleeding.

More about oral cancer: Pathology case: A lesion suspicious for lip cancer

What to look for when suspecting oral pathology

If a patient with oral cancer exhibits any abnormal oral symptoms, vigilantly follow these guidelines:

Document: Record the abnormality’s location, size, and appearance in the patient's chart.
Monitor: If the lesion remains unchanged after two weeks and is nonthreatening, reevaluate at the next appointment.
Refer for biopsy: If the lesion has atypical characteristics, refer the patient to an oral surgeon or dentist experienced in oral pathology for a biopsy.
Communicate with patients: Communicate your findings compassionately to the patient, emphasizing that time is of the essence for determining an accurate diagnosis and treatment.

Dental team collaboration is key

If oral pathology is discovered in an oral cancer patient, it’s crucial that the entire dental team (including the oral surgeon, dentist, and oncologist) work together to ensure an accurate diagnosis. Through collaboration dental professionals can provide comprehensive care and develop an effective treatment plan.

Once the cancer has been definitively diagnosed and staged, treatment can begin. Oral cancers are treated best with a multidisciplinary approach that includes surgeons, radiation oncologists, chemotherapy oncologists, dental practitioners, nutritionists, and rehabilitation specialists. Chemotherapy is commonly combined with radiation, and sometimes surgery is involved.²

Several devices have been developed to help clinicians detect oral pathology more easily. In 2019, Saini et al. stated, “Fluorescence diagnosis is emerging as a promising method in the differentiation of cancerous lesions and thus helping in the determination of resolution for the surgical resection of the affected area of malignancy very accurately. This study evaluated the usefulness of an autofluorescence handheld device (OralID) to detect oral premalignant lesions.”¹

Your role as a dental hygienist

Dental hygienists have a vital role in detecting early signs of oral cancer and other oral pathologies. Patient outcomes will significantly improve when you conduct thorough oral examinations, are able to distinguish between typical and atypical findings, and take prompt action when pathology is suspected. Diagnosing oral cancer early gives patients a chance to receive successful treatment and enjoy a better quality of life.

Editor’s note: This article first appeared in Through the Loupes newsletter, a publication of the Endeavor Business Media Dental Group. Read more articles and subscribe to Through the Loupes.

References

Saini R, Cantore S, Saini SR, Mastrangelo F, Ballini A, Santacroce L. Efficacy of fluorescence technology vs conventional oral examination for the early detection of oral pre-malignant lesions. A clinical comparative study. Endocr Metab Immune Disord Drug Targets. 2019;19(6):852-858. doi:10.2174/1871530319666190119103255
Oral cancer facts. Rates of occurrence in the United States. The Oral Cancer Foundation. https://oralcancerfoundation.org/facts/
Oral cancer. Cleveland Clinic. Reviewed January 27, 2022. https://my.clevelandclinic.org/health/diseases/11184-oral-cancer