What are the important questions when evaluating an oral lesion?

Discovering an oral lesion in the patients’ mouth can be a cause of concern and can provoke fear and anxiety in the patient. Diagnosing the lesion requires a thorough medical and dental history, clinical exam including a possible biopsy, as well as asking appropriate pointed questions about the lesion.

In conjunction with the health history and clinical examination, the clinician can ask the following questions to form a clearer picture of the oral lesion and how to manage it.

When did you first notice the lesion and how long has it been present?

• Look for signs of trauma in the oral cavity and relieve them, if possible.
• Ask the patient if they remember how or when the irritation occurred.

Do you have any oral habits or incurred any trauma to the area, recently?

• Often abnormal appearances of oral tissues can be attributed to denture irritation, tobacco or alcohol use, burns from hot liquids/foods, cheek biting or irritation from a broken or sharp tooth edge and chemical burns (aspirin use).
• Rule out the most common or obvious causes.

Have you noticed a change in the shape, size or colour of the lesion?

• Whitish lesions that have changed to a speckled appearance should be evaluated immediately and may suggest malignancy.
• Has the lesion multiplied in number or size from its original state?

Do you have any pain associated with this lesion?

• What causes pain, when does it occur, when does it dissipate?
• Patients are often unaware that oral cancer does not cause pain.

Are you feeling any numbness or loss of sensation?

• Loss of feeling associated with a lesion can be common with malignant lesions.

Have you noticed any swollen lymph nodes?

• Palpation and examination of lymph nodes for tenderness or enlargement can indicate the presence of infection or inflammation
• Lymph node involvement may also be a symptom of oral cancerous conditions

Do you have any other unexplained symptoms?

• Does the patient have a fever, malaise, nausea, difficulty swallowing?
• How long have these symptoms, if any, been present?

Source: Manual of Minor Oral Surgery for the General Dentist, Wiley, 2006