Oral cancer and its detection. History-taking and the diagnostic phase of management.
BACKGROUND
Comprehensive patient evaluation begins with an accurate analysis of all factors of the patient's history before the physical examination is performed. Risk factor identification is particularly important in most cases of oral mucosal dysplasia and carcinoma, as it alerts the clinician to an increased susceptibility for such alterations. The armamentarium of the dentist, which ranges from noninvasive indicators to a scalpel biopsy, permits a thorough evaluation of any observed mucosal changes. Newer additions to this armamentarium have been developed and are emerging that aid in the process of characterizing lesions, thereby facilitating appropriate management.


METHODS
The author presents methods of assessing and analyzing a patient's oral health status. He discusses carcinogens and cofactors, as well as dietary considerations, in the development of oral mucosal precancer and cancer. He also presents details of the clinical evaluation, which can lead the clinician to possible further evaluation and analysis by an expanding array of diagnostic tools.


RESULTS
The article identifies the factors a clinician should consider when evaluating the dental patient, from initial presentation and risk factor identification to the use of traditional assessment parameters. New and evolving diagnostic tools, coupled with cell and tissue characterization by an oral and maxillofacial pathologist, remain critical in terms of patient management and in maintaining optimum standards of care.


CONCLUSIONS
A comprehensive oral examination must include integration of each patient's in-depth health history and the physical findings. Appreciation of subtle surface changes as a possible harbinger of pathology and the traditional process of observation combined with new and emerging tools now allow for earlier diagnosis that will translate into improved outcomes.
Sciubba
J J
JJ
Department of Otolaryngology, Head and Neck Surgery, Johns Hopkins Medical Center, 601 N. Caroline St., Room 6243, Baltimore, Md. 21287-0910, USA. jsciubb@jhmi.edu
D000428:Alcohol Drinking; D001706:Biopsy; D002277:Carcinoma / Q000175:diagnosis; D004396:Coloring Agents; D003581:Cytodiagnosis; D004032:Diet; D004198:Disease Susceptibility; D004358:Drug Therapy; D006801:Humans; D008019:Life Style; D008163:Luminescent Measurements; D008487:Medical History Taking; D009062:Mouth Neoplasms / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D019647:Oral Surgical Procedures; D027383:Papillomaviridae / Q000502:physiology; D010808:Physical Examination; D011230:Precancerous Conditions / Q000175:diagnosis; D012307:Risk Factors; D012725:Sexual Behavior; D012907:Smoking; D013472:Sunlight
D004396:Coloring Agents