At every checkup, before the cleaning begins, we spend a couple of minutes examining your tongue, cheeks, throat, and neck. Most patients never register it as a distinct step. It is one of the most important things we do.
It is a visual and tactile examination. We look at your lips, the front and underside and both edges of your tongue, the floor of your mouth, the roof of your mouth, the inside of your cheeks, and the back of your throat. Then we palpate the soft tissues of your neck and under your jaw, checking for lumps or enlarged lymph nodes.
It takes about two minutes, requires no special equipment, and is completely painless. We do it at every routine exam, for every adult patient.
The American Cancer Society estimates roughly 60,480 new cases of oral cavity and oropharyngeal cancer in the United States in 2026, and about 13,150 deaths. That works out to approximately one death every hour.
What concerns the profession is the direction of travel. Incidence rates have risen by about 1 percent per year since the mid-2000s, driven largely by cancers linked to human papillomavirus. Oropharyngeal cancer mortality has been increasing by nearly 2 percent per year in recent data, reversing decades of decline.
The traditional risk factors remain significant: tobacco in every form, including cigarettes, cigars, pipes, and smokeless tobacco; heavy alcohol use, which multiplies risk considerably when combined with tobacco; prolonged sun exposure for cancers of the lip; increasing age; and being male.
But the HPV-associated cases have changed the picture. A meaningful share of oropharyngeal cancers now occur in people with no significant tobacco or alcohol history, and they are appearing in younger adults than the traditional profile would predict. If you have been assuming this is not relevant to you because you have never smoked, that assumption is no longer a safe one.
You see the inside of your own mouth more often than we do. Contact us if any of the following persists for more than two weeks:
Five-year survival for oral and oropharyngeal cancer is substantially higher when the disease is still localized than when it has spread to lymph nodes or beyond. Yet a large proportion of cases are still found at a later stage.
The reason is straightforward and worth stating plainly: early lesions rarely hurt. If you wait for pain to prompt a visit, you are waiting for a symptom that typically appears only after the disease has progressed. That is the entire argument for a routine screening you did not ask for and will barely notice.
First, some perspective. The large majority of things we find are benign — a cheek bite, a canker sore, irritation from a sharp filling or a denture edge, or a harmless variation in anatomy. Finding something is common. Finding something serious is not.
When we do see an area of concern, we document and photograph it, remove any obvious source of irritation, and bring you back in about two weeks. Most such areas resolve on their own in that window. If it has not resolved, we refer you for a biopsy, because a screening identifies areas that warrant investigation — only a biopsy can determine what something actually is. We will explain each step, and we will not leave you waiting on an answer without a plan.
Oral cancer found early, before it has spread, has a substantially better outcome than oral cancer found late — and early lesions are usually painless. That is precisely why a routine screening beats waiting until something hurts.
We perform one at every routine examination, which for most patients means twice a year. Patients with elevated risk factors may benefit from closer monitoring, which we would discuss with you directly.
HPV vaccination prevents infection with the HPV types most associated with oropharyngeal cancers, including HPV-16. Vaccination recommendations and timing are set by your physician, and it is a worthwhile conversation to have with them.
No. Smokeless tobacco is an established risk factor for oral cancer, and it also causes gum recession and tooth damage at the site where it is held. We are glad to talk through cessation resources without any lecturing.
A conventional visual and tactile examination by a trained clinician remains the foundation of oral cancer screening. Adjunctive devices exist, but the evidence that they improve detection over a careful conventional exam in general practice is limited. Thoroughness and consistency matter more than the technology.
This article is for general education and is not a substitute for an in-person evaluation. Every mouth is different — schedule an exam with Dr. Constandelis to discuss what's right for you.
Written by Dr. Dena Constandelis, DMD
Dr. Constandelis received her DMD from the University of Medicine and Dentistry of New Jersey (now Rutgers School of Dental Medicine) and practices in her hometown of Clifton, NJ, where she took over her father's practice.
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