Our patients already know they need regular check-ups for breast or prostate cancer. It's a no-brainer that we should also normalise screening for oral cancer in the same way and teach our patients about their anatomy so they act fast when something feels wrong.
“When you prioritise this talk, patients will see you as a true healthcare professional, not just a 'tooth fixer.' Every single appointment becomes a chance for systemic care,” adds Joss Harding, dental hygienist and president-elect at the Mouth Cancer Foundation.
In this interview with Joss, we discuss practical tips on fitting cancer screening into every check-up, the significance of HPV as a major risk factor, and how to avoid common communication and referral blunders.
Nearly 80% of UK adults have heard of mouth cancer. But why do so few know the actual signs and risks?
There are a few reasons. We don’t talk about it enough with patients, often because there isn’t time. That’s why oral health practice websites should include clear information and links for patients. If you can’t cover it in the appointment, you can simply say, “Here are the links on our website, please go there to look for more information.”
When we share that information, it doesn’t just stay with the patient in the chair. They might pass it on to family, friends, or colleagues. Someone might mention an ulcer that won’t heal, and your patient might remember, “My oral health professional said to get that checked.” That simple reminder could make all the difference.
Sometimes it’ll turn out to be something minor, like a B12 or iron deficiency or a reaction to the surfactant in a toothpaste, but it could also be something more serious that needs early diagnosis. So these conversations matter far beyond the individual patient.
The foundation you’re president of is called the Mouth Cancer Foundation, but you often stress that oral health professionals should also talk to patients about head and neck cancer.
These terms often overlap. Depending on the research, head and neck cancer might include the mouth, throat, tonsils, skin, or even the brain.
It’s important to know what you’re looking at when reading research, whether it focuses on mouth cancer or head and neck cancer. In the US, for example, much of the research uses the term “oral cancer,” which we tend not to use in the UK. The terminology can get confusing, as many of these terms overlap or mean the same thing.
How common are these cancers at the moment?
Sadly, last year, cases in the UK hit over 10,000 for the first time, which is a big jump. It’s rising really fast. Around the world, about 650,000 people are diagnosed with head and neck cancer every year. The numbers have gone up a lot in the last 10 to 20 years, mostly because of HPV.
Why is it especially important for oral health professionals to talk to patients about these cancers?
Some people don’t visit the dental office very often, usually only when they’re in pain or if they can afford it. It might not be part of their routine. So every appointment, no matter how rare, is a chance to share a bit of information and raise awareness.
"The worst thing you can do is nothing. Create your own screening system. Some professionals do it at the start of the check-up, others at the end. If a dentist and hygienist are both seeing the patient, they can decide who takes the lead, but it should always be done."
Once you’ve mentioned it, they can’t unhear it. Every conversation counts, even if it’s just a quick chat or pointing them to your website for more information.
Many oral health professionals focus mainly on teeth rather than overall health. Is head and neck cancer screening actually part of dental training, or is it missing from the curriculum?
Yes, it is part of the education and taught in universities, but it can sometimes slip off the radar. I think it’s absolutely vital that it stays front and centre.
We should not only check the teeth, but also the outside of the mouth — the tissues, the jaw joints, along the jawline for lymph nodes, down the throat, and around the collarbone.
Inside the mouth, it’s not enough to use a mirror. You need to feel the tissues. Pull the tongue out gently with gauze, ask the patient to move it from side to side, and use your light and magnification to get a proper look.
I'd say that with topics like this, the way oral health professionals communicate is key.
It truly is. Don’t do intraoral and extraoral checks without explaining what you’re doing. Patients often don’t realise it’s a cancer screening. I usually ask, “Has your dentist or hygienist done this before? Do you know what it is?” They might say, “Yes, it feels like a massage. Is it a jaw joint check?” and I’ll explain, “Actually, it’s a head and neck cancer screening.” You can see the surprise on their face!
We need to be more confident in explaining why these checks matter. I always tell patients, “Once a month, check your mouth, head, and neck. If you find any lumps, bumps, ulcers, or sore patches that last more than three weeks, come and see us. We’ll fit you in for a quick check.”
Some patients do come back between visits because they’ve noticed something, and that’s exactly what we want. But if we don’t explain why we’re doing these exams, the message is lost. Research shows many patients say they’ve never had a screening, even though they have. They just didn’t realise it.
Let’s take a closer look at the risks. What are the main factors that increase the chance of developing mouth cancer?
Smoking and vaping are big risk factors. Nicotine pouches are also a potential future risk, but the research is not yet available. Drinking more than 14 units of alcohol a week also raises the risk, and smoking and drinking together can increase it by up to 30 times. HPV is another major cause, and diet and poor oral hygiene can play a part, too. But sometimes, people develop head and neck cancer with no clear reason at all.
HPV isn’t something people often talk about. How does it increase the risk of mouth cancer?
HPV, or human papillomavirus, is actually a group of about 200 viruses, and a couple of them are sexually transmitted. Most types of HPV are harmless. But some types are linked to an increased risk of certain types of cancer, particularly HPV 16 & 18. I always remind patients that HPV isn’t a disease, it’s a virus, and most of us will have it at some point in our lives.
Typically, boys and girls aged 12 and 13 are offered the HPV vaccine, which helps protect not just against cervical cancer, but also head and neck, penile, and anal cancers. I always tell young people how important that vaccine is — it’s already reduced cervical cancer rates by 87%.
In the UK, girls started getting the vaccine in 2008, and boys in 2019. They should have included boys from the start, but at least now both are covered. Hopefully, in 20 or 30 years, we’ll really see the long-term benefits. I often share links to the NHS page or other reliable sources so people can read up on HPV and the vaccine.
What role can oral health professionals play?
We need to feel more confident talking about HPV and the vaccine with our patients. Sometimes it’s even grandparents asking about it for their grandchildren, which is great. Most of us probably have or have had HPV without knowing it, so helping patients understand that and encouraging vaccination can make a real difference.
Some of your patients may be a little bit surprised that you are talking to them about an HPV vaccination. I would be surprised if my dentist or hygienist brought it up.
My role is health education. I make the talk relevant to head and neck cancer. If you have the conversation correctly, it's not an issue. I haven't had any patient who refused to talk about that. To the contrary, a lot of them find it really interesting.
Should oral health professionals talk about oral cancer and its risks with every patient at every checkup?
Yes. With every new patient, I follow a routine — I talk about tooth decay, gum disease, tooth erosion, and then move on to head and neck cancer risks. I always do both the intraoral and extraoral checks. It’s a lot to cover in that first appointment, but when they come back, it’s just a quick recap.
It’s so important to have that conversation because if patients are doing self-checks, they need to understand why. And honestly, most of my patients already know how important it is, and they want me to check and reassure them that everything looks fine.
That’s great that so many patients are aware. Are oral health professionals usually the first to spot signs of oral cancer?
Often, yes. Sometimes a patient might have a sore or ulcer that won’t heal, so they go to the pharmacy first. The pharmacist might then tell them to see their GP or their dental professional. At the Mouth Cancer Foundation, we’re creating resources for pharmacies, because many people either can’t afford to see a dentist or don’t want to bother one.
"A lot of people still think we only fix teeth, so they go straight to the GP. But the more we talk about anatomy and the full scope of what we do, the more patients realise that we’re experts in the head, mouth, and neck."
What are some of the most common signs an oral health professional might notice during an exam?
It can be something as simple as a red or white patch, an ulcer that won’t heal, or a tender spot around the mouth or neck that you can feel during the exam. It’s always worth asking the patient if they’ve noticed anything unusual or slow to heal. Even a bad smell between the teeth could be just food trapped or halitosis — but it could also be a sign of something more serious.
If we take an X-ray, maybe for a loose tooth, it can sometimes show something suspicious. If I see anything that doesn’t look quite right, I’ll often ask a colleague for a second opinion, then book the patient to come back in two or three weeks. If it’s still there, I’ll take photos and include them in the referral letter.
So once you make a referral, the specialist takes over the diagnosis?
Yes, exactly. I usually tell the patient, “I’m not entirely sure what this is, but I’d like a specialist to take a look.” It’s natural for them to worry, so I explain why they’re being referred: “We’re just being cautious and getting this checked. It doesn’t mean it’s cancer — only a biopsy can confirm that.” That gentle explanation really helps manage their anxiety.
What are some common mistakes professionals make when talking to patients about cancer risks or referrals?
One big mistake is not explaining why the patient is being referred. I often hear from hospital teams that patients arrive not knowing what their appointment is for, and that shouldn’t happen. There’s even a box on most referral forms that asks, “Have you explained to the patient why they’re being referred?” Always make sure that the answer is yes.
Do you have any advice for talking about oral cancer with patients in a gentle and reassuring way? A lot of professionals avoid it because it can feel uncomfortable.
The worst thing you can do is ignore something and hope it goes away. If you spot something, explain it to the patient and make sure to follow up. If they can’t see what you’re talking about, take a photo with the intraoral camera and show it to them on the screen. Then you can say, “Can you come back in three weeks so we can check it again? If it’s still there, we’ll refer you to the hospital. Does that sound okay?”
Most patients will agree because they understand it’s better to be safe and get it checked. The key is to communicate clearly, review the patient, and be ready to have that conversation if a referral is needed.
What kind of self-checks can oral health professionals recommend to patients?
The Mouth Cancer Foundation website has a great self-screening video and other helpful resources. It shows how to check inside and outside the mouth, as well as around the head and neck. It’s also a good idea to have someone else check areas that are hard to see, like the tops of the ears or the back of the head.
Do you think oral cancer screening should be mandatory at every dental checkup?
It depends on the situation. If a patient comes in with severe tooth pain, that’s obviously the priority. But ideally, I think oral cancer screenings should be done at the start of every exam. If that’s not possible, even taking a quick look and talking about self-checking is still valuable. You can also ask your dental nurse to help with that.
Should it always be done? Absolutely. Is it always possible? Not necessarily. I don’t think it needs to be a strict regulation, but I do hope every professional makes it part of their routine because it can truly save lives.
Joss Harding is an award-winning dental hygienist based in Gloucestershire and has been in dentistry for over thirty years. Her passion for helping patients’ mouths before, during and after cancer treatment began in 2016. Joss has been published in medical and dental publications sharing her knowledge to support healthcare professionals and patients. Joss regularly presents nationally and is passionate about raising awareness of mouth cancer, its side effects and the importance of ongoing care. She is proud to have recently published a peer-reviewed textbook with 56 contributors, “Care of head and neck cancer patients for dental hygienists and dental therapists”, with the royalties donated to the Mouth Cancer Foundation.