Philadelphia – The first set of recommendations and good practice statements that are part of a living guideline on the early detection of oral squamous cell carcinoma and potentially malignant disorders has been released by the ADA Living Guideline Program, a collaboration between the American Dental Association (ADA) and Penn Dental Medicine’s Center for Integrative Global Oral Health (CIGOH).
Published in the March issue of The Journal of the American Dental Association, the statements reaffirm that clinical oral exams remain foundational to the early detection of oral cancer. The guideline also maintains that a punch or scalpel biopsy followed by histopathological assessment remains the first choice for reaching a definitive diagnosis of oral squamous cell carcinoma or oral potentially malignant disorders.
In addition, findings in the guideline recommend against the use of cytology adjuncts to determine the need for biopsy or referral in adults with abnormal tissue in the oral cavity or on the lip because the tests — which involve collecting a sample of cells from a mucosal abnormality with a brush — could produce false positive results. They also recommend against using adjuncts to screen asymptomatic adults without clinically evident mucosal abnormalities, as evidence supporting this use is lacking.
Another recommendation suggests that clinicians offer a cytology adjunct to adults with clinically worrisome mucosal abnormalities only when a biopsy is not possible, advisable or indicated. The purpose of the test would be to inform — not determine — decisions about biopsy or referral. A good practice statement from the guideline further advises that negative cytology results do not rule out disease and if a mucosal abnormality persists or progresses despite a negative result, clinicians should perform a biopsy or refer the patient to a specialist to avoid delayed diagnosis.
The development of this set of recommendations and good practice statements was led by a team of methodologists from CIGOH that includes Dr. Alonso Carrasco-Labra, Director of the Cochrane Oral Health Collaborating Center at Penn Dental Medicine and Associate Professor in the Department of Preventive & Restorative Sciences, and Olivia Urquhart, Associate Director of Health Care Guidelines at CIGOH and instructor in the Department of Preventive & Restorative Sciences.
The recommendations were formed with rigorous methodology — including a living systematic review — by an expert multidisciplinary guideline panel chaired by Mark Lingen, D.D.S., Ph.D., Professor of Pathology at the University of Chicago Medicine and former member of the ADA Council on Scientific Affairs. Public comment from oral health care professionals also contributed to the development of these recommendations.
Three additional sets of recommendations for this living guideline — an update to a 2017 clinical practice guideline – are expected to be published later this year. They will address vital staining adjuncts, light-based adjuncts, and salivary tests.
Clinical practice guidelines developed as part of the ADA Living Guideline Program, established in 2025, provide oral health care providers and patients with more frequent evidence-informed recommendations to advance oral and overall health. The program upholds the methodological rigor of traditional guidelines, but living guidelines are updated as new evidence becomes available.
To read the full guideline online and access an interactive infographic with the recommendations and other resources, visit ADA.org/OralCancerGuideline. The guideline is also available at JADA.ADA.org. It has been published in a new section of JADA called JADA Evidence, which will present living guidelines as they are developed to help bring the latest oral health care recommendations to clinicians.