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The Intraoral and Extraoral Exam

Course Number: 337

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References / Additional Resources

  1. Ms. Casey Buentello, RDH, Ms. Buentello was a senior dental hygiene student at Lamar Institute of Technology in Beaumont, Texas when these photographs were taken.  Ms. Buentello is the patient depicted in most of the images.

  2. Ms. Elizabeth Carter, RDH, was a senior dental hygiene student at Lamar Institute of Technology in Beaumont, Texas when these photographs were taken.  Ms. Carter performed the role of operator in most of the images.

  3. Ms. Ruth Fearing-Tornwall, Associate Professor of Dental Hygiene at Lamar Institute of Technology in Beaumont, Texas.  Ms. Tornwall provided much needed technical assistance with setting up and posing the patient and operator for each of the images.

  4. SEER Cancer Stat Facts: Oral Cavity and Pharynx Cancer. National Cancer Institute. Bethesda, MD. Accessed February 1, 2022.

  5. Howlader N, Noone AM, Krapcho M, Miller D, Brest A, Yu M, Ruhl J, Tatalovich Z, Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2018, National Cancer Institute. Bethesda, MD. Accessed February 1, 2022.

  6. American Cancer Societ. Key Statistics for Oral Cavity and Oropharyngeal Cancers. Accessed February 1, 2022.

  7. Rethman MP, Carpenter W, Cohen EE, et al. Evidence-based clinical recommendations regarding screening for oral squamous cell carcinomas. J Am Dent Assoc. 2010 May;141(5):509-20. doi: 10.14219/jada.archive.2010.0223.

  8. Sung H, Ferlay J, Siegel RL, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021 May;71(3):209-249. doi: 10.3322/caac.21660. Epub 2021 Feb 4.

  9. Olson CM, Burda BU, Beil T, Whitlock EP. Screening for Oral Cancer: A Targeted Evidence Update for the U.S. Preventive Services Task Force [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2013 Apr. Report No.: 13-05186-EF-1.

  10. Straughan AJ, Zapanta PE, Goodman JF. Building Community Relations and Promoting Cancer Prevention: An Oral Cancer Screening Event. Otolaryngol Head Neck Surg. 2020 Dec;163(6):1073-1075. doi: 10.1177/0194599820942464. Epub 2020 Jul 14.

  11. Smith RA, Brooks D, Cokkinides V, Saslow D, Brawley OW. Cancer screening in the United States, 2013: a review of current American Cancer Society guidelines, current issues in cancer screening, and new guidance on cervical cancer screening and lung cancer screening. CA Cancer J Clin. 2013 Mar-Apr;63(2):88-105. doi: 10.3322/caac.21174. Epub 2013 Feb 1.

  12. Walsh T, Liu JL, Brocklehurst P, et al. Clinical assessment to screen for the detection of oral cavity cancer and potentially malignant disorders in apparently healthy adults. Cochrane Database Syst Rev. 2013 Nov 21;2013(11):CD010173. doi: 10.1002/14651858.CD010173.pub2. Update in: Cochrane Database Syst Rev. 2021 Dec 10;12:CD010173.

  13. Burzynski NJ, Rankin KV, Silverman S Jr, Scheetz JP, Jones DL. Graduating dental students' perceptions of oral cancer education: results of an exit survey of seven dental schools. J Cancer Educ. 2002 Summer;17(2):83-4. doi: 10.1080/08858190209528804.

  14. Zhang X, Liu D, Dong H, Li Y, Zhang Y, Wang X, Zhang B, Bian L. Factors associated with delay in presentation among patients for oral cancer. J Comp Eff Res. 2019 Sep;8(12):1003-1071. doi: 10.2217/cer-2019-0067. Epub 2019 Jul 10.

  15. Väisänen JA, Syrjälä AM, Pesonen PR, et al. Characteristics and medical-care-seeking of head and neck cancer patients: a population-based cross-sectional survey. Oral Oncol. 2014 Aug;50(8):740-5. doi: 10.1016/j.oraloncology.2014.04.009. Epub 2014 May 21.

  16. Tromp DM, Brouha XD, Hordijk GJ, Winnubst JA, de Leeuw JR. Patient factors associated with delay in primary care among patients with head and neck carcinoma: a case-series analysis. Fam Pract. 2005 Oct;22(5):554-9. doi: 10.1093/fampra/cmi058. Epub 2005 Jul 8.

  17. DeLong L, Burkhart NW. General and Oral Pathology for the Dental Hygienist 2nd ed. Wolters Kluwer/Lippincott Williams & Wilkins. Philadelphia, PA. 2013.

  18. U.S. Department of Health and Human Services. Administration on Aging (AoA). A Profile of Older Americans: 2020. Accessed February 1, 2022.

  19. Lynch DP, Oral cancer risk and detection. The importance of screening technology. RDH 2007 Sep;27(9):1010-112. Accessed February 1, 2022.

  20. Schantz SP, Yu GP. Head and neck cancer incidence trends in young Americans, 1973-1997, with a special analysis for tongue cancer. Arch Otolaryngol Head Neck Surg. 2002 Mar;128(3):268-74. doi: 10.1001/archotol.128.3.268.

  21. Chaturvedi AK, Engels EA, Pfeiffer RM, et al. Human papillomavirus and rising oropharyngeal cancer incidence in the United States. J Clin Oncol. 2011 Nov 10;29(32):4294-301. doi: 10.1200/JCO.2011.36.4596. Epub 2011 Oct 3.

  22. Centers for Disease Control and Prevention (CDC). Oral and Dental Health. Dental Visits. Accessed February 1, 2022.

  23. Siegel RL, Miller KD, Fuchs HE, Jemal A. Cancer Statistics 2022. CA CANCER J CLIN 2022;72(1):7–33. doi: 10.3322/caac.21708. Accessed February 1, 2022.

  24. Cotter JC, McCann AL, Schneiderman ED, De Wald JP, Campbell PR. Factors affecting the performance of oral cancer screenings by Texas dental hygienists. J Dent Hyg. 2011 Fall;85(4):326-34. Epub 2011 Nov 11.

  25. Horowitz AM, Siriphant P, Canto MT, Child WL. Maryland dental hygienists' views of oral cancer prevention and early detection. J Dent Hyg. 2002 Summer;76(3):186-91.

  26. Forrest JL, Horowitz AM, Shmuely Y. Dental hygienists' knowledge, opinions, and practices related to oral and pharyngeal cancer risk assessment. J Dent Hyg. 2001 Fall;75(4):271-81.

  27. Tax CL, Haslam SK, Brillant M, Doucette HJ, Cameron JE, Wade SE. Oral cancer screening: knowledge is not enough. Int J Dent Hyg. 2017 Aug;15(3):179-186. doi: 10.1111/idh.12172. Epub 2015 Aug 30.screening : knowledge is not enough. Int J Dent Hyg. 2017; Aug:15:3: 179-186.

  28. Pavão Spaulonci G, Salgado de Souza R, Gallego Arias Pecorari V, Lauria Dib L. Oral Cancer Knowledge Assessment: Newly Graduated versus Senior Dental Clinicians. Int J Dent. 2018 Feb 14;2018:9368918. doi: 10.1155/2018/9368918.

  29. Brocklehurst P, Pemberton MN, Macey R, Cotton C, Walsh T, Lewis M. Comparative accuracy of different members of the dental team in detecting malignant and non-malignant oral lesions. Br Dent J. 2015 May 8;218(9):525-9. doi: 10.1038/sj.bdj.2015.344.

  30. Daley EM, Thompson EL, Vamos CA, Griner SB, Vazquez-Otero C, Best AL, Kline NS, Merrell LK. HPV-Related Knowledge Among Dentists and Dental Hygienists. J Cancer Educ. 2018 Aug;33(4):901-906. doi: 10.1007/s13187-016-1156-5.

  31. Lehew CW, Kaste LM. Oral cancer prevention and early detection knowledge and practices of Illinois dentists--a brief communication. J Public Health Dent. 2007 Spring;67(2):89-93. doi: 10.1111/j.1752-7325.2007.00020.x.

  32. Patton LL, Agans R, Elter JR, Southerland JH, Strauss RP, Kalsbeek WD. Oral cancer knowledge and examination experiences among North Carolina adults. J Public Health Dent. 2004 Summer;64(3):173-80. doi: 10.1111/j.1752-7325.2004.tb02748.x.

  33. Lingen MW, Abt E, Agrawal N, et al. Evidence-based clinical practice guideline for the evaluation of potentially malignant disorders in the oral cavity: A report of the American Dental Association. J Am Dent Assoc. 2017 Oct;148(10):712-727.e10. doi: 10.1016/j.adaj.2017.07.032.

  34. Tomar SL, Logan HL. Florida adults' oral cancer knowledge and examination experiences. J Public Health Dent. 2005 Fall;65(4):221-30. doi: 10.1111/j.1752-7325.2005.tb03022.x.

  35. Bigelow C, Patton LL, Strauss RP, Wilder RS. North Carolina dental hygienists' view on oral cancer control. J Dent Hyg. 2007 Fall;81(4):83. Epub 2007 Oct 1.

  36. National Cancer Institute. Surveillance, Epidemiology and End Results Program. SEER Stat Fact Sheets: Oral Cavity and Pharynx Cancer. Accessed February 1, 2022.

  37. Sciubba JJ. Oral cancer and its detection. History-taking and the diagnostic phase of management. J Am Dent Assoc. 2001 Nov;132 Suppl:12S-18S. Erratum in: J Am Dent Assoc 2002 Apr;133(4):422.

  38. Ling H, Gadalla S, Israel E, Langenberg P, Zhan M, Dwyer DM, Groves C, Hopkins A, Steinberger EK. Oral cancer exams among cigarette smokers in Maryland. Cancer Detect Prev. 2006;30(6):499-506. doi: 10.1016/j.cdp.2006.10.005. Epub 2006 Nov 20.

  39. Young D, Xiao CC, Murphy B, Moore M, Fakhry C, Day TA. Increase in head and neck cancer in younger patients due to human papillomavirus (HPV). Oral Oncol. 2015 Aug;51(8):727-30. doi: 10.1016/j.oraloncology.2015.03.015. Epub 2015 Jun 9.

  40. Anderson KS, Dahlstrom KR, Cheng JN, et al. HPV16 antibodies as risk factors for oropharyngeal cancer and their association with tumor HPV and smoking status. Oral Oncol. 2015 Jul;51(7):662-7. doi: 10.1016/j.oraloncology.2015.04.011. Epub 2015 May 6.

  41. American Academy of Dermatology. Melanoma. Accessed February 1, 2022.

  42. National Cancer Institute. Surveillance, Epidemiology and End Results Program. SEER Stat Fact Sheets: Thyroid Cancer. Accessed February 1, 2022.

  43. Kondori I, Mottin RW, Laskin DM. Accuracy of dentists in the clinical diagnosis of oral lesions. Quintessence Int. 2011 Jul-Aug;42(7):575-7.

  44. The Oral Cancer Foundation. Accessed February 1, 2022.

  45. Rowan SD, Hu SL, Brotzman JS, Redding SW, Rankin KV, Vigneswaran N. Knowledge Assessment of the Dental Community in Texas on the Role of Human Papilloma Virus in Oropharyngeal Cancer. Tex Dent J. 2015 Aug;132(8):528-36.

  46. Shukla A, Nyambose J, Vanucci R, Johnson LB, Welch K, Lind E, Villa A. Evaluating the Effectiveness of Human Papillomavirus Educational Intervention among Oral Health Professionals. J Cancer Educ. 2019 Oct;34(5):890-896. doi: 10.1007/s13187-018-1391-z.

  47. American Dental Association. Oral Health Topics: Oral and oropharyngeal cancer key points. Focus on HPV. Accessed February 1, 2022.

  48. Center for Scientific Information, ADA Science Institute Reviewed by: Scientific Information Subcommittee, ADA Council on Scientific Affairs Topic Last Updated: October 8, 2018. Accessed February 1, 2022.

  49. Ferlay J, Soerjomataram I, Dikshit R, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer. 2015 Mar 1;136(5):E359-86. doi: 10.1002/ijc.29210. Epub 2014 Oct 9.

  50. Castellsagué X, Alemany L, Quer M, et al. HPV Involvement in Head and Neck Cancers: Comprehensive Assessment of Biomarkers in 3680 Patients. J Natl Cancer Inst. 2016 Jan 28;108(6):djv403. doi: 10.1093/jnci/djv403.

  51. Sung H, Ferlay J, Siegel RL, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021 May;71(3):209-249. doi: 10.3322/caac.21660. Epub 2021 Feb 4.

  52. Horowitz AM, Drury TF, Goodman HS, Yellowitz JA. Oral pharyngeal cancer prevention and early detection. Dentists' opinions and practices. J Am Dent Assoc. 2000 Apr;131(4):453-62. doi: 10.14219/jada.archive.2000.0201.

  53. Llewellyn CD, Johnson NW, Warnakulasuriya S. Factors associated with delay in presentation among younger patients with oral cancer. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2004 Jun;97(6):707-13. doi: 10.1016/j.tripleo.2004.01.007.

  54. Massano J, Regateiro FS, Januário G, Ferreira A. Oral squamous cell carcinoma: review of prognostic and predictive factors. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006 Jul;102(1):67-76. doi: 10.1016/j.tripleo.2005.07.038. Epub 2006 Jan 10.

  55. Rhodus NL. Oral cancer: Early detection and prevention. Inside Dentistry. 2007 Jan;(3)1.

  56. Siegel MA, Kahn MA, Palazzolo MJ. Oral cancer: a prosthodontic diagnosis. J Prosthodont. 2009 Jan;18(1):3-10. doi: 10.1111/j.1532-849X.2008.00373.x.

  57. Silverman S Jr. Demographics and occurrence of oral and pharyngeal cancers. The outcomes, the trends, the challenge. J Am Dent Assoc. 2001 Nov;132 Suppl:7S-11S. doi: 10.14219/jada.archive.2001.0382.

  58. Warren-Morris D, Wade P. Oral cancer exams: Does your practice pass? Tex Dent J. 2006 Jun;123(6):494-9.

  59. Chiang CP, Yu-Fong Chang J, Wang YP, Wu YH, Lu SY, Sun A. Oral lichen planus - Differential diagnoses, serum autoantibodies, hematinic deficiencies, and management. J Formos Med Assoc. 2018 Sep;117(9):756-765. doi: 10.1016/j.jfma.2018.01.021. Epub 2018 Feb 19.

Additional Resources


  • Sung H, Ferlay J, Siegel RL, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021 May;71(3):209-249. doi: 10.3322/caac.21660. Epub 2021 Feb 4.
  • Horowitz AM, Drury TF, Goodman HS, Yellowitz JA. Oral pharyngeal cancer prevention and early detection. Dentists' opinions and practices. J Am Dent Assoc. 2000 Apr;131(4):453-62. doi: 10.14219/jada.archive.2000.0201.
  • Llewellyn CD, Johnson NW, Warnakulasuriya S. Factors associated with delay in presentation among younger patients with oral cancer. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2004 Jun;97(6):707-13. doi: 10.1016/j.tripleo.2004.01.007.
  • Massano J, Regateiro FS, Januário G, Ferreira A. Oral squamous cell carcinoma: review of prognostic and predictive factors. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006 Jul;102(1):67-76. doi: 10.1016/j.tripleo.2005.07.038. Epub 2006 Jan 10.
  • Rhodus NL. Oral cancer: Early detection and prevention. Inside Dentistry. 2007 Jan;(3)1.
  • Siegel MA, Kahn MA, Palazzolo MJ. Oral cancer: a prosthodontic diagnosis. J Prosthodont. 2009 Jan;18(1):3-10. doi: 10.1111/j.1532-849X.2008.00373.x.
  • Silverman S Jr. Demographics and occurrence of oral and pharyngeal cancers. The outcomes, the trends, the challenge. J Am Dent Assoc. 2001 Nov;132 Suppl:7S-11S. doi: 10.14219/jada.archive.2001.0382.
  • Warren-Morris D, Wade P. Oral cancer exams: Does your practice pass? Tex Dent J. 2006 Jun;123(6):494-9.
  • Chiang CP, Yu-Fong Chang J, Wang YP, Wu YH, Lu SY, Sun A. Oral lichen planus - Differential diagnoses, serum autoantibodies, hematinic deficiencies, and management. J Formos Med Assoc. 2018 Sep;117(9):756-765. doi: 10.1016/j.jfma.2018.01.021. Epub 2018 Feb 19.

Additional Information


Acknowledgements


Our thanks are extended to the following individuals for their help in the production of this course.


  • Ms. Casey Buentello, RDH, Ms. Buentello was a senior dental hygiene student at Lamar Institute of Technology in Beaumont, Texas when these photographs were taken. Ms. Buentello is the patient depicted in most of the images.
  • Ms. Elizabeth Carter, RDH, was a senior dental hygiene student at Lamar Institute of Technology in Beaumont, Texas when these photographs were taken. Ms. Carter performed the role of operator in most of the images.
  • Ms. Ruth Fearing-Tornwall, Associate Professor of Dental Hygiene at Lamar Institute of Technology in Beaumont, Texas. Ms. Tornwall provided much needed technical assistance with setting up and posing the patient and operator for each of the images.
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