How to know if you have had a good oral cancer examination.
As lay people we really do not always know what the doctor is doing, looking at, or thinking as they examine our mouths. Are they going to recognize the early signs of cancer? Are they looking where it routinely occurs? Are they using all the tools available to them when they are examining our mouths? Most of us would never know. But there are some things that will indicate to you if your professional is doing a thorough job or not. Clearly we all wish to just feel comfortable trusting our medical and dental professionals to do things well and correctly. In the real world that is not always possible or the case. Understanding the process helps you evaluate if you are in good hands, ones worthy of trusting your life to. Sounds severe, even harsh? You bet. But being informed is the first step in taking good care of yourself and recognizing potential problems early enough to have them caught at survivable state. When it comes to a doctor who may save your life by catching dangerous diseases at the earliest possible time, you need to be concerned with more than a great personality and chairside manner. So here is what to expect. Remember that any one of the signs and symptoms we mention here by itself could be something benign and non related to oral cancer.
Preparing for the exam: If you have dentures (plates) or partials, you will be asked to remove them. No one can see all the soft tissue areas of the mouth with any appliances in place.
Your health care provider will inspect your face, neck, lips, and mouth to look for any signs of cancer. Clearly a sore on your lip will be obvious to everyone, even you. But some of what they are looking for is very subtle. Is there asymmetry, or does part of your external mouth not move well, or possibly droop? Some doctors are looking at these things when you first approach and sit in the chair, and it may not be apparent to you that their observations are actually taking place. But a good practitioner is sensitive to these small give-aways... a slur in your speech, a corner of the mouth that does not seem to move well in concert with everything else, a subtle swelling on one side of your face causing asymmetry. By themselves, these are not areas of specific oral cancer concern, but they are all part of putting together the puzzle of different signs, which may indicate you are worthy of referral to a specialist, or further diagnostic procedures.
With both hands, he or she will feel the external area under your jaw and the sides of your neck, checking for lumps (enlarged lymph nodes) that may suggest inflammation or more. Many times if these nodes are painless but hard and enlarged, and feel like they are fixated in position, it can be a sign of cancer. When feeling the floor of your mouth (bi-manually palpating it), a finger is placed under your tongue and the fingers of the other hand placed under your chin. Rolling the soft tissues of the floor of your mouth between the two, they can detect enlarged nodes or other hard spots called indurations that may be an area of concern. Anyone not using their fingers to examine you and only looking with a mirror, or worse using just a pair of wooden tongue blades, is going to miss things. Touch is important. He or she will then look at and feel the insides of your lips and cheeks to check for possible signs of cancer, or pre-cancerous tissues changes, such as red and/or white patches, or thickened areas.
Your provider will have you stick out your tongue so it can be checked for swelling or abnormal color or texture. They will be watching to see if as you extend it, it deviates to one side or the other, a possible sign that something is affecting the nerves which control its movement. Then, using a small piece of gauze, he or she will gently pull your tongue to one side, then the other to fully visualize its edges, a common location for lesions to occur. They will likely feel the boarders of the tongue (again for hard spots) at the same time. A common site for oral cancer to occur is the base of the tongue where it begins to curve down your throat. This area cannot be visualized well unless the tongue is pulled forward, and the gauze is necessary to do this. If they did not do this, they have missed an important location to examine. The underside of your tongue will also be checked. No one forgets if their examiner pulled their tongue firmly out of their mouth to see this area.
In addition, he or she will look at the roof and floor of your mouth, as well as the back of your throat and the tonsillar pillars on each side. When viewed directly from the front, the opening to the back of your mouth and throat should appear symmetrical and not swollen on either side.
Please note that for the most part, those who do the examination with wooden tongue blades to hold your tongue down are doing two things incorrectly in our opinion. (This is more commonly done in medical environments then dental.) First a proper exam is partially tactile. They need to feel parts of your tongue, and mouth. They cannot do this with a wooden tongue blade. Secondly, many times they are actually putting the tongue blade right onto an area that needs to be visualized as they move your tongue left and right.
A good oral cancer exam is visual AND tactile. It takes eyes trained in what and where to look for things, and gloved fingers to feel particular areas as well. These are some of the things that you should expect. Some doctors will use additional devices to do the exam. These might be different kinds of lights and pre-examination rinses that help them visualize areas of suspicion, or they may even use a dye. Rest assured that while these add to the thoroughness of the exam, a well-done visual and tactile examination with the eyes and fingers only, when conducted by a trained professional, will do a good job of finding oral cancer early if it is done annually.
Some professionals are beginning to use adjunctive devices to assist them in doing a thorough screening. We believe that this is fine AS LONG AS A PROPER VISUAL AND TACTILE SCREENING IS DONE FIRST. These devices which include various lights, dyes, and even tissue collection brushes, may add to the process, but they are NOT a substitute for a properly done, white light, visual and tactile screening.
This is not a postponable elective procedure to have your professionals do. Annual opportunistic oral cancer exams are a must. When you get home after your examination, take a few minutes to take a good look inside your mouth with a hand mirror. You can also get a small interior mouth mirror from your dentist or the drug store. You could also ask the doctor to walk you on a "guided tour" through this while you are in the office. When you are aware of what your NORMAL mouth looks like, regular monthly exams that you do at home by yourself will allow you to recognize any changes that are taking place. These home examinations are particularly important if you are engaged in any known risk factors for developing the disease such as smoking or using smokeless tobacco. When you go in for your next exam, remember to bring to the examiners attention any area of concern that you may have felt or noticed. While it may be nothing, there is no harm in ensuring that your concerns have been examined carefully and the doctor has an opportunity to evaluate what you have noticed. Early detection of oral cancers by your professional examiner or yourself is the key to survival of this disease.