Knowledge Assessment

Compiled by Hillel Ephros, DMD, MD
Diplomate, American Board of Oral and Maxillofacial Surgery
Academic Fellow, American Academy of Oral Medicine

1. Public awareness of oral cancer, its risk factors and its signs and symptoms is:

• a. very good – most survey respondents are highly knowledgeable
• b. fair – about half of survey respondents are knowledgeable
• c. poor – only a small minority of respondents have significant knowledge regarding oral cancer

2. Which of the following may be obstacles to early detection of oral cancer:

• a. “warning signs” are actually manifestations of more advanced disease
• b. early oral cancer is generally asymptomatic and may be difficult to see
• c. the oral cancer exam may not be done by enough clinicians on their patients at risk
• d. all of the above

3. Behaviors that have been shown to increase the risk of developing oral squamous cell carcinoma include:

• a. cigarette smoking
• b. heavy alcohol consumption
• c. cheek biting
• d. a and b only

4. Which of the following conditions has NOT been associated with some elevation of the risk for oral cancer:

• a. erosive lichen planus
• b. chronic periodontitis
• c. ingesting six or more alcoholic beverages daily
• d. submucous fibrosis

5. Oral cancers in men who smoke cigarettes and drink heavily are more likely to occur:

• a. on the attached gingiva
• b. on the hard palate
• c. on the dorsum of the tongue
• d. on the lateral tongue and floor of the mouth

6. The high risk sites for oral cancer in men who smoke cigarettes and drink heavily are:

• a. the soft palate complex
• b. the lateral tongue / posterior floor of mouth
• c. the anterior floor of the mouth
• d. all of the above

7. The earliest clinical manifestation of oral cancer in men who smoke and drink heavily is generally:

• a. a persistent change in the mucosa that includes redness
• b. a flat, homogenous white lesion
• c. a painful ulcer
• d. a firm, fungating mass

8. A persistent (>3 months) red and white lesion in the anterior floor of mouth of a smoker is to be viewed as:

• a. possibly dysplastic and worthy of close observation
• b. likely to be benign but worthy of documenting in the chart
• c. a potential cancer with biopsy mandatory
• d. none of the above

9. Requirements for a thorough oral cancer examination include:

• a. a dental mirror
• b. a good light source
• c. a gauze square
• d. all of the above

10. When conducting and oral cancer examination, it is generally advisable to:

• a. focus on notable findings first
• b. work around the mouth in a reproducible, systematic fashion
• c. look only at the high risk sites in high risk patients
• d. all of the above

11. It is often difficult to visualize the most posterior portion of the floor of mouth. One way to bring more of this area into view is:

• a. aggressive use of the mirror
• b. pushing up gently on the submandibular region of the neck while retracting the tongue with a mirror
• c. having the patient stick out his/her tongue and say “ah”
• d. none of the above

12. An oral lesion is found in a known, reliable patient and is judged to be of clinical suspicion. The recommended course of action is:

• a. immediate scalpel biopsy
• b. remove potential irritants and have the patient return in two weeks
• c. laser vaporization of the lesion
• d. none of the above

13. Diagnostic adjuncts may be helpful for:

• a. screening of high risk patients with no visible mucosal abnormalities
• b. evaluating subtle oral lesions that might be dismissed as benign
• c. helping to determine the need for and best location for a scalpel biopsy
• d. all of the above

14. Toluidine blue and the brush biopsy:

• a. are redundant as both perform the same functions
• b. are not to be used together
• c. are compatible and may be used together
• d. none of the above

15. Use of a handheld fluorescent optical device such as the VELscope:

• a. may highlight areas of mucosal abnormality possibly enhancing the routine visual examination
• b. requires viewing of the mucosa after treatment with an acetic acid solution
• c. is necessary to see whether toluidine blue stain has been taken up by the tissue
• d. none of the above

16. Toluidine blue:

• a. is now packaged together with a chemiluminescence kit
• b. allows clinicians to highlight early oral cancers for biopsy guidance
• c. when used as a rinse, may pick up subtle changes not noted on routine visual examination
• d. all of the above

17. The reason that nearly 50% of Americans diagnosed with oral cancer die of the disease within 5 years of diagnosis is:

• a. the chemotherapeutic agents available for oral cancer are completely ineffective
• b. oral cancer often eludes diagnosis until it becomes large and symptomatic
• c. squamous cell carcinoma is not affected by radiation therapy
• d. none of the above

18. A 62 year old male with a long history of cigarette smoking and heavy alcohol consumption is diagnosed with an early, asymptomatic, stage I floor of mouth cancer when he visits the dentist for an unrelated dental problem. He admits to no significant medical history, takes no medications and has no known drug allergies.

Which of the following statements about this man is the most likely to be correct:

• a. it is highly likely that he will die of this particular oral cancer
• b. his treatment will likely require a combination of radiation, chemotherapy and radical surgery
• c. he has a significant chance of developing or has already started developing a separate cancer somewhere in his upper aerodigestive tract
• d. all of the above

19. Dentists and hygienists seeing patients previously treated for oral squamous cell carcinoma should:

• a. conduct regular surveillance for these patients
• b. view any mucosal abnormality as a possible cancer until proven otherwise when examining these patients
• c. encourage optimal oral health care in these patients
• d. all of the above

20. For oral cancer patients about to undergo radiation therapy:

• a. all dental treatment should be deferred until the “golden period”
• b. dental treatment is least likely to lead to problems if deferred for 6 months to one year after radiation
• c. any necessary dental treatment should be done prior to radiation after which, treatment may be limited by the dose of radiation and the tissues affected
• d. patients tolerate routine dental treatment during radiation therapy without difficulty

21. What percentage of sexually active Americans are likely to be infected with HPV?

• a. 15%
• b. 33%
• c. 50%
• d. 98%

22. Which strain of HPV is most closely connected with cervical cancer and some oral cancers?

• a. HPV-18
• b. HPV-31
• c. HPV-40
• d. HPV-16

23. Which of the following are the high risk sites for HPV-associated oral cancer?

• a. anterior floor of mouth
• b. gingival and buccal mucosa
• c. posterior tongue and tonsillar region
• d. all of the above

24. The prognosis for individuals with HPV-associated oral cancer seems to be a bit better than for those with oral cancer related to heavy alcohol use and cigarette smoking.

• a. True
• b. False

25. Infection with HPV inevitably leads to the development of an HPV-associated oral cancer.

• a. True
• b. False

Answer Key

1. c
2. d
3. d
4. b
5. d
6. d
7. a

8. c
9. d
10. b
11. b
12. b
13. d
14. c

15. a
16. d
17. b
18. c
19. d
20. c
21. c

22. d
23. c
24. a
25. b