WEBVTT 00:00:00.000 --> 00:00:07.500 [Tone] 00:00:07.500 --> 00:00:17.666 [National Library of Medicine, HF0658, This transfer made: 1/31/06, Length: 00:08:05] 00:00:17.666 --> 00:00:29.666 [Screen dark] 00:00:29.666 --> 00:00:32.532 [Sound of medical instruments and doctor murmuring] 00:00:32.533 --> 00:00:36.766 [Public Health Service Cancer Control Program, William L. Ross, M.D., presents] 00:00:36.766 --> 00:00:36.832 [National Library of Medicine, HF0658, This transfer made: 1/31/06, Length: 00:08:05] 00:00:36.833 --> 00:00:43.499 [Examination of the Mouth] 00:00:43.500 --> 00:00:50.000 [With Robert H. Johnson, M.D., Senior Investigator, Surgery Branch, National Cancer Institute] 00:00:50.000 --> 00:00:52.000 [Robert H. Johnson, M.D.:] Once you have developed a system, 00:00:52.000 --> 00:00:57.600 an examination of the mouth can be done quickly and should be a part of your routine examination of patients. 00:00:57.600 --> 00:01:05.833 From a general health standpoint, an oral examination will help you detect infections that may contribute to systemic diseases, 00:01:05.833 --> 00:01:14.366 like subacute bacterial endocarditis, or conversely, there may be oral manifestations of systemic diseases. 00:01:14.366 --> 00:01:18.999 In either case, your general treatment plan would be influenced. 00:01:19.000 --> 00:01:29.666 In addition, the advanced oral cancer like this one is difficult to manage and routine examination can result in earlier diagnosis. 00:01:29.666 --> 00:01:36.432 I'll now run through a routine oral examination for you. I'll also show you some oral cancers in their early stages. 00:01:36.433 --> 00:01:43.199 Good light is important; a head lamp is preferable. A flashlight does not furnish adequate light. 00:01:43.200 --> 00:01:46.366 Also, it leaves you with only one hand free. 00:01:46.366 --> 00:01:51.866 You won't need any additional equipment other than what is ordinarily in your office. 00:01:51.866 --> 00:01:54.099 It's important to take a history. 00:01:54.100 --> 00:01:58.966 If there are symptoms, explore them fully before proceeding with the examination. 00:01:58.966 --> 00:02:09.766 A convenient first step is inspection of the skin of the head and neck. 00:02:09.766 --> 00:02:15.166 Check all skin lesions closely. 00:02:15.166 --> 00:02:22.599 Pigmented lesions especially should be carefully evaluated. 00:02:22.600 --> 00:02:27.500 If your patient wears a denture, remove it before you examine the mouth. 00:02:27.500 --> 00:02:33.866 These should be checked. Ill-fitting dentures are a frequent cause of traumatic lesions. 00:02:33.866 --> 00:02:37.132 Occasionally a denture sore may be malignant. 00:02:37.133 --> 00:02:47.599 The chronic denture sore on this patient's upper gum was malignant. 00:02:47.600 --> 00:03:04.833 It's handy to begin with the lips. 00:03:04.833 --> 00:03:15.799 This innocent-appearing abnormality, commonly called leukoplakia, actually is an invasive carcinoma. 00:03:15.800 --> 00:03:26.500 While the lip is retracted, inspect the anterior teeth for dental caries. 00:03:26.500 --> 00:03:40.266 The gums should be inspected for abnormalities. 00:03:40.266 --> 00:03:49.766 Next the buccal mucosa and the Stensen's duct. 00:03:49.766 --> 00:03:53.532 If the patient is a pipe smoker, you may discover this kind of leukoplakia. 00:03:53.533 --> 00:04:01.899 This lesion was carcinoma in situ. 00:04:01.900 --> 00:04:08.900 Note any pathologic changes of the posterior teeth and gums. 00:04:08.900 --> 00:04:15.233 The roof of the mouth should be systematically inspected. 00:04:15.233 --> 00:04:17.799 Innocent-appearing lesions may be serious. 00:04:17.800 --> 00:04:29.566 A cytologic smear from this red area reveals suspicious cells, and the biopsy report was carcinoma. 00:04:29.566 --> 00:04:37.199 Next, examination of the soft palate, uvula, posterior pharyngeal wall, and tonsils. 00:04:37.200 --> 00:04:41.033 The tongue is depressed to inspect the posterior pharyngeal wall, 00:04:41.033 --> 00:04:47.966 and then retracted to look at the tonsils and tonsillar pillars. 00:04:47.966 --> 00:04:55.932 Also, the posterior floor of the mouth, the lower teeth, and gum can be examined at this time. 00:04:55.933 --> 00:04:59.133 Now, we'll examine the ventral surface of the tongue, 00:04:59.133 --> 00:05:07.699 the anterior floor of mouth, and the gums of the lower front teeth. 00:05:07.700 --> 00:05:13.466 The dorsal and lateral surface of the tongue can be examined by gripping it with a piece of gauze. 00:05:13.466 --> 00:05:41.066 Stick out your tongue. 00:05:41.066 --> 00:05:44.832 Let me show you two different tongue cancers. 00:05:44.833 --> 00:05:50.499 This small, white lesion was found during a routine examination of a 41-year old female. 00:05:50.500 --> 00:06:01.633 A smear revealed suspicious cells and the biopsy report was carcinoma. 00:06:01.633 --> 00:06:07.866 This small ulcer was found in a 26-year old male with a history of syphilis. 00:06:07.866 --> 00:06:16.632 Cytology was positive and the biopsy report was carcinoma. 00:06:16.633 --> 00:06:30.666 It's advisable to palpate the entire mouth. 00:06:30.666 --> 00:06:33.199 The neck should be examined routinely. 00:06:33.200 --> 00:06:43.800 Any palpable lymph nodes may represent metastatic disease. 00:06:43.800 --> 00:06:50.733 We're basically interested in helping you detect oral cancers, preferably in their earliest stage. 00:06:50.733 --> 00:06:56.133 If there's any uncertainty about any abnormality, a referral may be in order. 00:06:56.133 --> 00:07:03.499 Now I'd like to present the chief of the Public Health Service Cancer Control Program, Dr. William Ross. 00:07:03.500 --> 00:07:08.400 [Dr. William Ross:] We're faced with a number of problems in our struggle to control oral cancer. 00:07:08.400 --> 00:07:10.666 Relatively it has a low incidence. 00:07:10.666 --> 00:07:14.966 In addition, there's a high incidence of non-malignant lesions in the mouth. 00:07:14.966 --> 00:07:17.766 Yet our projects and those of the Veteran's Administration, 00:07:17.766 --> 00:07:22.566 all of which were conducted in large medical centers by competent staffs, 00:07:22.566 --> 00:07:27.366 reveal that over 20 percent of all lesions found were unsuspected. 00:07:27.366 --> 00:07:31.566 The unsuspected did not have the typical signs and symptoms of cancer. 00:07:31.566 --> 00:07:34.866 They were biopsied only because cytologic specimens were taken, 00:07:34.866 --> 00:07:38.199 and abnormal cells were found. 00:07:38.200 --> 00:07:43.300 Most oral lesions you will see in your patients will be non-malignant, 00:07:43.300 --> 00:07:46.633 but unless you actively try to reach a diagnosis for all lesions, 00:07:46.633 --> 00:07:50.566 the cancers will remain undetected until they are far advanced. 00:07:50.566 --> 00:07:54.032 The associated benefits of oral examinations are many. 00:07:54.033 --> 00:07:57.366 First, the discovery of pre-malignant lesions. 00:07:57.366 --> 00:08:01.066 Second, the discovery of other systemic conditions. 00:08:01.066 --> 00:08:06.632 And finally, an increased awareness of the problems of dental and oral hygiene. 00:08:06.633 --> 00:08:11.166 As physicians, you have a responsibility for the total health of your patients. 00:08:11.166 --> 00:08:17.466 Your cooperation in an oral examination program is essential. 00:08:17.466 --> 00:08:22.066 [Clinical material furnished through the Audio-Visual Service of the American Dental Association] 00:08:22.066 --> 00:08:24.299 [Produced for the Cancer Control Program by Fidelity Film Productions, Dallas, Texas] 00:08:24.300 --> 00:08:26.533 [For the Cancer Control Program: Technical Consultant, Richard L. Hayes, D.D.S., 00:08:26.533 --> 00:08:28.399 Production Consultant, Richard O. Deitrick] 00:08:28.400 --> 00:08:30.633 [U.S. Department of Health, Education, and Welfare, Public Health Service, 00:08:30.633 --> 00:08:33.666 Bureau of Disease Prevention and Environmental Control, National Center for Chronic Disease Control]