Can Your Dentist Detect Cancer?

During your dental examination, your dentist (or even your dental hygienist) may discover a growth or signs inside your mouth that look abnormal. The dental professionals may suspect a type of oral cancer, but they will not test for it, nor will they diagnose it.

The only way to confirm a diagnosis of oral cancer is to biopsy the suspicious tissues and to send samples for examination.

Odds are your dentist will refer you to an oral surgeon or to an oncology practice to conduct the biopsies and make a diagnosis.

The National Institute of Dental and Craniofacial Research says oral cancer represents 3% of all cancers diagnosed every year in the United States. The American Dental Association says more than 54,000 people are diagnosed every year, and around 11,000 die from it.

What dentists can & cannot do

The American Dental Association explains that dentists are often the first medical professionals to notice oral cancer symptoms. During routine exams, dentists ask about oral health symptoms and then conduct a complete visual exam. Their medical training can help them detect issues that could indicate oral cancer.

The National Cancer Institute says no single test can diagnose cancer. However, most people need a biopsy of suspicious tissue for a clear diagnosis. People with suspected cases of cancer may also require laboratory tests, imaging scans, and other procedures.

While your dentist may be an expert at spotting signs of cancer, you’ll need a physician or oncologist to perform cancer testing. These professionals can also create treatment plans to help you treat dangerous cells inside your mouth.

What is my dentist looking for?

During an oral cancer screening, the dentist examines the tissues inside your mouth and lips. In addition, your gums are checked carefully for gingivae, as well as the inside of your cheeks and underneath and the sides of your tongue.

The dentist also looks at the roof of your mouth as well as the floor of your mouth.

What happens if my dentist finds something?

If your dentist spots unusual signs and symptoms in your mouth, don’t assume that means you have cancer. The American Dental Association explains that many common conditions can look like cancer, but they’re something different. Your doctor may ask you to come back for a follow-up exam in a week or two to see if the spot has changed or disappeared.

If the spot persists, your dentist may refer you to a physician or oncologist for more testing. To diagnose cancer, your doctor may use the following tools:

• Blood testing: High or low levels of substances like metabolites, fats, and proteins can tell your doctor about your organ health.

• Biopsies: Your doctor may test liquid from the suspicious area, or your doctor may take a small amount of the tissue and test it for cancer.

• Scans: Your doctor may use an MRI, x-ray, ultrasound, or CT scan to determine the size of the tumor and decide how to treat it.

In a large study of people diagnosed with cancer, researchers found delays of about 165 days between suspicion and diagnosis. Your treatment team may move faster, but it’s not unusual to wait a long time between seeing a spot and starting cancer treatment.

Risk factors associated with oral cancer

There are several risk factors associated with developing oral cancer, and most stem from behaviors that can be avoided.

The National Institute of Dental and Craniofacial Research says the following risk factors are associated with oral cancer:

• Tobacco use, including cigarettes, electronic cigarettes, chewing tobacco, and snuff

• Human papillomavirus (HPV) infection

• Sun exposure

• A diet low in fruits and vegetables

• A family history of oral cancer

• Increasing age (as most cases are diagnosed in people older than 40)

If you have several risk factors for oral cancer, talk to your doctor. Together, you can determine how often you should be screened for problems.

Signs you should report to your dentist if you suspect oral cancer

Oral cancer often appears as a sore or growth in or around your mouth and is one that will not go away. It can include the floor of your mouth, soft and hard palate, throat, tongue and lips. All types of cancer are serious, and this form can be life-threatening if it is not caught in an early stage and treated appropriately.

You should alert your dentist about a potential cancer issue if you:

• Have unexplained bleeding in your mouth

• Experience a dramatic weight loss

• Notice changes in your bite

• Find bumps, lumps, eroded areas, rough crusts or spots on your gums, lips, or other areas in your mouth

• Have persistent sores on your mouth, neck, and face that bleed easily and do not heal within two weeks

• Have unexplained tenderness, pain or numbness in any area of your neck, mouth, or face

• Experience difficulty swallowing, speaking, chewing or moving your tongue or jaw

• Have ear pain

• Endure chronic hoarseness, sore throat or changes in your voice

• See velvety red, white, or speckled white-and-red patches in your mouth

• Have a persistent feeling that something is caught in the back of your throat or if you have lingering soreness in the back of your throat

If you experience any of these symptoms, don't wait for your bi-annual checkup. Contact your dentist right away.

If you notice white or red patches, lumps, ulcers or other growths, you should also get to your dentist as soon as possible. These symptoms are not precursors to cancer, but they’re also issues that should not linger without treatment.

What happens during a dental cancer screening?

Although dentists won’t diagnose oral cancer, they can—and do—screen for it.

If you have an oral cancer screening, it typically begins with the dental hygienist updating your medical history. This history is necessary to learn about any new medications you might be taking or if you have had a recent disease diagnosed. The history will most likely include questions about your lifestyle risk factors for oral cancer and whether (and how much) you smoke and drink alcohol.

The dentist will want to understand your current health status, including whether you have any dental concerns. Refrain from withholding any information that could hinder your evaluation.

The dental cancer screening will include areas inside and outside of your mouth. The screening should also include an exam of your neck and head and an intra-oral exam of your lips, palate, tongue, cheeks, gum tissues, and the floor of your mouth.

If any suspicious areas are detected, your dentist will recommend a biopsy of the area or refer you to an oral surgeon.

Types of lip & oral cancer

More than 90% of mouth-related cancers are squamous cell carcinoma, says the American Cancer Society. They start out as flat squamous cells in the lining of the throat and mouth, and doctors like to pinpoint where the cancer began. The most common locations are as follows:

• On the tongue

• On the tonsils

• On the oropharynx (the middle part of the throat)

• On the gums

• On the floor of the mouth

Limitations of oral cancer screenings

Visually detecting premalignant oral lesions is a problem across the globe. There is a vast difference in detecting these lesions versus diagnosing skin lesions such as melanoma.

Melanoma visual screening has a 93 to 98 percent specificity and sensitivity rate. An explanation for the limitations surrounding the detection of oral cancer visually is that this cancer is often subtle and rarely demonstrates clinical characteristics seen in advanced cases.

Besides their clinical differences, premalignant lesions associated with oral cancer are highly varied in how they present. These lesions often mimic common reactive or benign conditions. There is also a growing realization that doctors cannot detect some premalignant cancerous lesions with the naked eye. They need additional screening aids for correct detection.

What to expect

During the oral cancer screening, the dentist will look inside your mouth and cheeks for white or red patches or sores. They will also feel the tissue in your cheeks and mouth to check for lumps and other abnormalities. The exam will also cover your neck and throat for lumps. Sometimes a dentist will use special tests in addition to the oral exam in their oral cancer screening. Special tests can include:

• Oral cancer screening light. The dentist may perform an additional test using an oral cancer screening light. By shining a light into your mouth, it will make healthy tissue appear dark and the abnormal tissue will appear white.

• Oral cancer screening dye. The dentist may want to perform an additional test outside the oral exam by rinsing your mouth with a special blue dye. Abnormal cells inside your mouth absorb the dye and appear blue.

Next steps if your dentist is concerned

If the oral exam raises concerns with your dentist, and they suspect you might have oral cancer, they will recommend a follow-up visit within the next few weeks to check if the abnormal area is still present, whether it has grown, or if there is change in the suspicious area.

The dentist may remove a sample of cells to send to the laboratory for testing to check for cancer cells but more likely you will be referred to your primary care physician or to a lab for more in-depth testing. You should expect to undergo an endoscopy, an X-ray or a biopsy.

You could also undergo:

• A test for HPV

• A CT scan

• An MRI

• An ultrasound

• A PET scan

Doctors may start with one or two tests and progress to other tests if the earlier ones are inconclusive.

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