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The Intraoral and Extraoral Exam

Course Number: 337

Adjuncts for the Oral Cancer Screening

A panel convened by The American Dental Association (ADA) Council on Scientific Affairs to address the benefits and limitations of oral cancer screenings and the use of adjunctive screening aids concluded that screening by means of visual and tactile examination to detect potentially malignant lesions may result in detection of oral cancers at early stages of development, but there is insufficient evidence to determine if screening alters disease-specific mortality in asymptomatic people seeking dental care.3 The panel noted that additional research regarding oral cancer screening and the use of adjuncts is needed. However, the panel suggested that clinicians should observe the patient during routine examinations with both visual and tactile examination for any oral lesions and remain alert.3

Adjunct technologies and products available today, such as fluorescence, may provide the clinician with additional information and may help the patient visualize suspicious areas; however, they cannot determine what a lesion is or whether it is malignant or benign.41 A biopsy involving the removal of part or all of a suspicious area of tissue and microscopic evaluation by a pathologist to determine its histological makeup is the gold standard for determining a definitive diagnosis. A study by Kondori, et al. in 2011 reported a high rate (43%) of misdiagnosis of oral lesions by dental practitioners when they based their diagnosis on clinical observations alone. The study conclusion supports the histologic diagnosis or biopsy as the standard of care41 When malignancy is discovered, a second opinion may be appropriate.

The oral examination adjuncts listed on the following pages are currently available for use in offices, but they are considered *only adjuncts* to the complete oral cancer examination consisting of both visual and tactile examinations. The adjuncts can be categorized as follows:

  1. Tissue staining techniques

  2. Brush cytology to detect abnormal cells

  3. Devices that aid in visually detecting abnormal tissue through the use of different wavelengths of light including: blue, amber, white or violet