PAT 14 Dental Lab Comprehensive Notes on Oral Examination and Cancer Screening

Overview and Oral Cancer Epidemiology

• Definition: An oral examination is a systemic inspection of all oral structures to detect abnormalities and potentially life-threatening oral malignancies.
• Oral Cancer Key Statistics:
  • Oral cancer is the 6th deadliest type of cancer.
  • Over 48,000 new cases were estimated to be diagnosed in the United States in 2016.
  • One person in the United States dies from oral cancer every hour of every day.
  • The tongue is the anatomical site with the highest incidence of oral cancer.
• Prognosis & Screening:
  • Detected at the earliest stages, oral cancer carries an 80% survival rate.
  • The American Dental Association (ADA) recommends a thorough oral examination as a routine part of every patient's dental visit.

Risk Factors and Lesion Evaluation

• Risk Factors:
  • Age: Incidence peaks in individuals aged 55 to 74 years.
  • Gender: Men are 2 times more likely than women to develop oral cancer.
  • Sunlight: Direct exposure is a primary risk factor for lip cancer.
  • Tobacco and Alcohol Use: Concurrent use of tobacco and alcohol creates a significantly higher risk than using either substance alone.
• Malignant Precursor Lesions:
  • Leukoplakia: White mucosal lesions that serve as possible precursors to cancer.
  • Erythroplakia: Red mucosal lesions that possess a greater malignant potential than leukoplakia.

• Clinical Protocol for Suspicious Lesions:
  • Reevaluate any red or white lesion after 2 weeks.
  • Perform a biopsy if a suspicious lesion does not resolve within 2 weeks.
  • Refer the patient to a specialist for any oral symptom persisting longer than 2 weeks.

Clinical Examination Framework

• Seven Subgroups of the Oral Examination:
  1. Lips and vermillion border
  2. Oral cavity and mucosal surfaces
  3. Underlying structures of lips and cheeks
  4. Floor of the mouth
  5. Salivary gland function
  6. Tongue
  7. Palate, tonsils, and oropharynx
• Patient Preparation:
  • Explain the clinical procedure clearly to the patient.
  • Request the removal of removable dentures and lipstick.
  • Position the patient in a supine position.

Anatomical Subgroups and Specific Procedures

• Lips and Vermillion Border:
  • Anatomy: Key structures include the vermillion border and lip commissures.

• Findings: Normal lips are smooth, intact, and touch at rest. Notable abnormal findings include cheilosis at commissures, herpetic lesions, angioedema, lip pits, and facial asymmetry.
  • Salivary Glands and Ducts:
• Anatomy: Comprises the parotid gland (parotid/Stensen's duct), submandibular gland, and sublingual gland (sublingual caruncles and folds).

• Procedure: Express saliva from duct openings using a cotton applicator to assess functional flow.
• Notable Findings: Xerostomia (decreased salivary flow), sialoliths (salivary calculi), mucoceles, and ranulas.
  • Tongue:
• Papillae Identification:
  • Filiform Papillae: Hairlike projections covering the anterior $\frac{2}{3}$ dorsum.
  • Fungiform Papillae: Mushroom-shaped projections scattered on the dorsum.
  • Foliate Papillae: 3 to 5 large red projections on the posterior lateral borders.
  • Circumvallate Papillae: V-shaped row of 8 to 12 large papillae located on the posterior dorsum.

• Procedure: Inspect ventral surface, retract tongue laterally with damp gauze to inspect lateral borders, and bidigitally palpate the entire muscle body.
• Notable Findings: Ankyloglossia, macroglossia, geographic tongue, black hairy tongue, and fissured tongue.
  • Palate, Tonsils, and Oropharynx:
• Anatomy: Hard palate, soft palate, palatine uvula, palatine tonsils, anterior/posterior tonsillar pillars, and pharyngeal wall.

• Procedure: Digital palpation of hard palate using intermittent pressure (to prevent gagging); visual inspection of oropharynx using a mouth mirror while the patient says "ahhhh".
• Notable Findings: Palatine torus, bifid uvula, cleft palate, petechiae, tonsillitis (enlarged tonsils with exudate), and deviated uvula.