Mouth Cancer: The Signs to Look For and When to Act

Almost everything that appears in your mouth is harmless and clears up on its own. The reason this page exists is the small number of things that do not, because with mouth cancer the difference early detection makes is very large indeed.

The short answer

Mouth cancer is uncommon, but outcomes depend heavily on how early it is found. The single most useful rule to remember is three weeks: anything unexplained in your mouth that has not settled within three weeks should be looked at, even if it does not hurt. Painlessness is not reassurance. Your routine dental examination includes checking the soft tissues of your mouth, tongue, throat and neck, which is one of the better reasons to keep attending when your teeth feel perfectly fine.

What to look for

• An ulcer or sore that has not healed in three weeks. The most common presenting sign. Ordinary ulcers from a bitten cheek or a rubbing denture heal within a week or two.
• A red or white patch that will not rub off and does not resolve.
• A lump or thickening anywhere in the mouth, on the tongue, on the lip, or in the neck.
• Unexplained bleeding from an area that is not a gum you have been brushing.
• Numbness or altered sensation in the lip, tongue or chin with no dental cause.
• Teeth becoming loose without gum disease to explain it, or a denture that has suddenly stopped fitting.
• Persistent difficulty or pain on swallowing, a feeling of something catching, or hoarseness lasting more than three weeks.

Look inside your mouth in good light once a month. Cheeks, under and on top of the tongue, the floor of the mouth, the roof, the gums and your lips. You are looking for something new that stays.

Keeping this in proportion

Most of the signs above turn out to be something innocent. Recurrent mouth ulcers, a cheek bitten in your sleep, a denture edge rubbing, lichen planus, a burn from hot food, or a viral infection all account for far more cases than cancer does. The point of the three week rule is not that you should assume the worst; it is that you should not spend six months waiting to see, because that waiting is what changes outcomes.

Equally, do not be reassured by the absence of pain. Early mouth cancer is frequently painless, which is precisely why it gets ignored.

What raises the risk

• Tobacco in any form. Smoking, and chewed or smokeless tobacco, which carries a high risk.
• Alcohol. A risk factor on its own, and the combination with tobacco is considerably more dangerous than either alone rather than simply the two added together.
• Betel quid, paan and areca nut, with or without tobacco added.
• HPV. Human papillomavirus is now recognised as a significant cause of cancers at the back of the mouth and throat, including in people who have never smoked.
• Sun exposure, for cancers of the lip specifically. A lip balm with an SPF is a sensible habit if you work outdoors.
• Age and a previous history, though a meaningful share of cases now occur in younger people with none of the traditional risk factors.

What happens if we see something

We will tell you plainly what we can see, and we will not speculate about what it is. Where anything meets the criteria for concern, you are referred on the urgent suspected cancer pathway, which aims for you to be seen by a specialist within two weeks. Most of those referrals turn out to be nothing serious, and that is exactly how the system is meant to work. Being referred is not a diagnosis.

If something has been in your mouth for three weeks, do not wait for your next routine appointment. Ring us, or see your GP, whichever you can get into sooner. A new patient examination is £89 including X-rays, or £60 if you are already with us.

Frequently asked questions

Does mouth cancer hurt?

Often not in the early stages, which is the most dangerous thing about it. Pain tends to arrive later. Judge by whether something is persisting, not by whether it is sore.

Can my dentist actually spot it?

Checking the soft tissues is a standard part of a dental examination, and dentists look inside a lot of mouths, which makes them well placed to notice something that does not belong. We cannot diagnose cancer, only recognise what needs investigating and refer it quickly.

How do I tell an ordinary ulcer from something worse?

Mostly by time. Ordinary ulcers are painful, often recurrent in the same sort of places, and gone inside two weeks. Be concerned about something that is painless, has a raised or hardened edge, sits on the side of the tongue or the floor of the mouth, and is still there after three weeks.

I smoke and drink. What should I actually do?

Keep attending for examinations so someone is looking regularly, check your own mouth monthly, and know that cutting either one down reduces risk. Because the two multiply each other, reducing both makes more difference than you might expect.

If you have noticed something that has not gone after three weeks, please get it looked at. Call us on 01625 574609. Our prices are published on the fees page, and we would far rather see you about something that turns out to be nothing.

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