The below guide is abstracted from JADA, Vol. 136, p. 607

Pattaon LL, Elter JR, Southerland JH, Strauss RP: Knowledge of oral cancer risk factors and diagnostic concepts among North Carolina dentists: Implications for diagnosis and referral

SEVEN-STEP GUIDE FOR IMPROVING THE CHANCES OF DETECTING ORAL CANCER AT AN EARLY STAGE.

* Dentists should update patients' medical histories, with an emphasis on tobacco- and alcohol-use history. They should take the opportunity to encourage tobacco-use cessation and moderation in alcohol use.

* Dentists should let patients know they will receive a thorough oral cancer examination because they deserve it and the dentist cares about their well-being. Dentists should tell patients that they will deliver the best possible oral health care.

* Dentists should palpate the patient's neck bilaterally and refer him or her if swollen nodes are located that are hard, painless and mobile or fixed to underlying structures.

* Dentists should visually examine and bimanually pal-pate the oral mucosal surfaces for painless, red and/or white lesions or ulcers. They should pay particular attention to the high-risk areas of the ventrolateral tongue and floor of the mouth.

* Dentists should inform patients about their findings. They should seek a probable cause: is it traumatic/irritational, infectious, developmental, nutritional, caused by systemic disease, unknown? If the dentist is not particularly concerned, he or she should consider using adjunctive techniques, such as toluidine blue or the brush biopsy, encourage removal of all potential causes of the lesion and schedule a recall appointment for re-evaluation in two weeks. If the dentist is particularly concerned by the lesion's appearance and history of growth behavior, he or she should perform a full-thickness scalpel biopsy or refer the patient for a biopsy.

* If the lesion has not healed after two weeks, the dentist should perform a scalpel biopsy or refer the patient for a biopsy.

* If the biopsy results are uncertain or indicate that the lesion is benign, yet the dentist believes the lesion still might be malignant, he or she should perform a second scalpel biopsy or refer the patient for a second biopsy.