- With Mayo Clinic prosthodontist
Alan Carr, D.M.D.
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Alan Carr, D.M.D.
Alan B. Carr, D.M.D.
Dr. Alan B. Carr, Department of Dental Specialties at Mayo Clinic, is a consultant in the Division of Prosthodontics and a professor of dentistry at the Mayo Clinic College of Medicine.
Dr. Carr, a native of Hattiesburg, MS., received his prosthodontics training at Mayo. Following his training he has was an assistant professor at Marquette University and then became a full professor at Ohio State University where his clinical duties included Director of Maxillofacial Prosthetics at the James Cancer Hospital. He returned to Mayo in 2000.
Dr. Carr is board certified by the American Board of Prosthodontics. He served in the Air Force and has degrees from the University of Southern Mississippi, University of Mississippi and Mayo Graduate School of Medicine. He also is a member of numerous professional organizations including the American Academy of Maxillofacial Prosthetics, the American College of Prosthodontists and the American Dental Association. He has made dozens of international and national presentations, and is author of a dental textbook.
His clinical practice focuses on combined prosthodontics and reconstruction of patients with disabling oral conditions. His research interests include oral and craniofacial endosseous implants, tobacco cessation, and the impact of oral health on general health, especially for patients with chronic illness and the elderly.
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Question
Oral cancer screening: What tests are recommended?
What is the best way to screen for oral cancer? Are special oral cancer screening tests superior to an oral exam?
Answer
from Alan Carr, D.M.D.
Most dentists perform an examination of your mouth during a routine dental visit to screen for oral cancer. Some dentists may use additional tests to aid in identifying areas of abnormal cells in your mouth. The goal with oral cancer screening is to identify cancer early, when there is a greater chance for a cure.
Screening for oral cancer isn't without controversy, though. No oral exam or oral cancer screening test is proven to reduce the risk of dying of oral cancer. Still, you and your dentist may decide that an oral exam or a special test is right for you based on your risk factors.
Oral exam for oral cancer screening
Most dentists recommend an oral exam during your routine dental visit to screen for oral cancer. During an oral exam, your dentist looks over the inside of your mouth to check for red or white patches or mouth sores.
Many people have abnormal sores in their mouths, with the great majority being noncancerous. An oral exam can't determine which sores are cancerous and which are not. If your dentist finds an unusual sore, you may go through further testing to determine its cause. The only way to definitively determine whether you have oral cancer is to remove some abnormal cells and test them for cancer in a procedure called a biopsy.
Not all medical organizations agree about the benefits of an oral exam for oral cancer screening. For instance, the American Dental Association recommends all adults undergo periodic oral exams when they visit the dentist. The American Cancer Society recommends discussing oral cancer screening when you visit your dentist. But the U.S. Preventive Services Task Force doesn't recommend oral cancer screening because it hasn't been proven to save lives.
Additional tests for oral cancer screening
Some dentists use special tests in addition to the oral exam to screen for oral cancer. It's not clear if these tests offer any additional benefit over the oral exam for oral cancer screening. Special oral cancer screening tests include:
- Rinsing your mouth with a dye before an exam. Your dentist may apply a blue dye to the inside of your mouth or ask you to rinse your mouth with a blue dye before your oral exam. Abnormal cells in your mouth may take up the dye and appear blue. The blue dye can't distinguish between cancerous cells and noncancerous cells, so for people with an average risk of oral cancer this test isn't as helpful. Some studies have concluded there could be some benefit for people with a very high risk of oral cancer, such as those who've already been diagnosed with one oral cancer and have a risk of a second cancer.
- Shining a light in your mouth during an exam. Your dentist may also use a special light to examine the inside of your mouth. Brand names of these tests include ViziLite, Microlux, Velscope and Orascoptic. The special light makes healthy tissue appear dark and makes abnormal tissue appear white. Some researchers have reported finding abnormal areas with the special light that weren't discovered during a standard oral exam. But most studies haven't found this to be the case in general. There's little evidence that using a special light to examine the mouth has any advantage over a standard oral exam.
Special tests for oral cancer screening aren't always covered by dental insurance. Some tests may be covered if you have a high risk of oral cancer or if your dentist has discovered an area of abnormal cells in your mouth.
Who should consider oral cancer screening
People with a high risk of oral cancer may be more likely to benefit from oral cancer screening, though studies haven't clearly proved that. Factors that can increase the risk of oral cancer include:
- Tobacco use of any kind, including cigarettes, cigars, pipes, chewing tobacco and snuff, among others
- Heavy alcohol use
- Previous oral cancer diagnosis
Ask your doctor whether oral cancer screening is appropriate for you. Also ask about ways you can reduce your risk of oral cancer, such as quitting smoking and not drinking alcohol.
- Patton LL, et al. Adjunctive techniques for oral cancer examination and lesion diagnosis: A systematic review of the literature. The Journal of the American Dental Association. 2008;139:896.
- Lingen MW. Critical evaluation of diagnostic aids for the detection of oral cancer. Oral Oncology. 2008:44:10.
- Oral cancer screening (PDQ): Patient version. National Cancer Institute. http://www.cancer.gov/cancertopics/pdq/screening/oral/patient/allpages/print. Accessed July 22, 2009.
- ADA policy on prevention and early oral cancer detection. American Dental Association. http://www.ada.org/public/topics/cancer_policy.asp. Accessed July 23, 2009.
- Smith RA, et al. Cancer screening in the United States, 2008: A review of current American Cancer Society guidelines and cancer screening issues. CA: A Cancer Journal for Clinicians. 2008;58:161.
- Screening for oral cancer: Recommendation statement. U.S. Preventive Services Task Force. http://www.ahrq.gov/clinic/3rduspstf/oralcan/oralcanrs.htm. Accessed July 23, 2009.
- Carr AB (expert opinion). Mayo Clinic, Rochester, Minn. Aug. 10, 2009.
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