Soft tissue examination: two minutes intercepts what the patient does not report

Examination of the soft tissues is the part of the visit most often skipped, because the patient comes about their teeth and attention goes there.

It is however the only occasion on which an asymptomatic lesion can be intercepted, and oral mucosal lesions in their early stages do not hurt.

The hygiene appointment is the best moment for it, because it recurs regularly, lasts long enough, and the mouth is already illuminated and retracted.

Systematic method matters more than duration. A fixed sequence takes two minutes and leaves no area out; a random inspection looks at different points each time.

A workable sequence starts at the lips and vestibules, proceeds to the cheeks, then the hard and soft palate, then the tongue in all its aspects, and finishes with the floor of the mouth.

The highest-risk areas for oral carcinoma are the floor of the mouth, the lateral borders and the ventral surface of the tongue. They are also the areas least well inspected.

The lateral border of the tongue is examined by grasping the tip with gauze and drawing it sideways. Without this manoeuvre, the posterior part of the border stays invisible.

The floor of the mouth is examined with the tongue raised to the palate, and it should also be palpated, because a submucosal lesion is felt before it is seen.

Lesions warranting investigation have recognisable features: a white plaque that does not rub off, a red velvety patch, an ulcer without evident cause, an area indurated on palpation.

The simplest and most useful criterion is temporal: any lesion not healing within two or three weeks, after removal of any local causes, should be referred for assessment.

Photographic documentation of a doubtful lesion permits objective comparison at the next review, and is more reliable than memory.

Referral is not a diagnostic failure but the correct behaviour. One referral too many costs a consultation; one too few can cost months in a condition where time determines prognosis.

In summary: the hygiene appointment is the right moment, a fixed sequence is worth more than duration, the lateral border of the tongue and the floor of the mouth require active manoeuvres, and any lesion not healing within three weeks is referred.