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Second set of recommendations published April 6 in JADA<\/p>\n
by Mary Beth Versaci<\/p>\n
April 06, 2026<\/p>\n
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The latest recommendations to be released from the American Dental Association\u2019s living guideline on early oral cancer detection reiterate the importance of clinical exams while advising against the use of vital staining adjuncts to evaluate the need for biopsy.<\/p>\n
\u201cOral cavity and oropharyngeal cancers are common malignancies and are associated with significant morbidity and mortality,\u201d said 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. \u201cDental professionals are uniquely qualified to perform regular conventional and visual tactile exams to identify precancerous and cancerous lesions at earlier clinical stages, thereby improving outcomes.\u201d<\/p>\n
These recommendations and good practice statements on vital staining adjuncts \u2014 published online<\/a> April 6 and in the June issue of The Journal of the American Dental Association<\/a> \u2014 are the second set to be released from the living guideline. They address the use of special staining liquids, specifically toluidine blue, that highlight areas in the mouth that appear to show abnormal signs.<\/p>\n The statements reaffirm that clinicians should perform a comprehensive extraoral and intraoral clinical exam on all adults, communicate its role in the early detection of mucosal abnormalities, and obtain patients\u2019 updated medical, social and dental histories. 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.<\/p>\n The guideline includes conditional recommendations against the use of vital staining adjuncts to determine the need for biopsy or specialist referral in adults with any mucosal abnormality in the oral cavity or on the lip or to screen for the potential need for biopsy or referral among asymptomatic adults with no clinically evident oral mucosal abnormality in the oral cavity or on the lip.<\/p>\n The guideline states that evidence does not support the use of vital staining adjuncts to determine which lesions require biopsy or referral, reliance on these adjuncts may lead to unnecessary procedures or delayed diagnosis, and clinicians should perform a timely biopsy or referral if they identify mucosal abnormalities.<\/p>\n Because the recommendations in the guideline are considered conditional \u2014 meaning they are based on the limited evidence available at this time \u2014 different courses of action could be appropriate based on clinicians\u2019 and patients\u2019 values and preferences, according to the guideline.<\/p>\n \u201cBased upon the currently available science, we do not recommend the use of vital staining as a screening adjunct to aid in the decision-making process of determining which patients require a biopsy to diagnose oral potentially malignant disorders and oral cavity cancer,\u201d Dr. Lingen said.<\/p>\n This living guideline on the early detection of oral squamous cell carcinoma and potentially malignant disorders is an update to a 2017 clinical practice guideline on the evaluation of potentially malignant disorders, including oral cancer.<\/p>\n 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 continually updated as new evidence becomes available.<\/p>\n The guideline development was led by a team of methodologists from the Center for Integrative Global Oral Health at the University of Pennsylvania School of Dental Medicine. Its recommendations were formed with rigorous methodology \u2014 including a living systematic review and a scoping review \u2014 by an expert multidisciplinary guideline panel chaired by Dr. Lingen. Public comment from oral health care professionals and extensive interest-holder engagement also contributed to the development of these recommendations.<\/p>\n To read the full set of recommendations and good practice statements online and access an interactive infographic as well as other resources, visit ADA.org\/OralCancerGuideline<\/a>.<\/p>\n The guideline is also available at JADA.ADA.org<\/a>. 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.<\/p>\n