Cancer in the differential diagnosis of orofacial pain

The clinician must maintain an awareness that at some time a patient may present in their busy dental practice with a chief concern of dental, sinus, or TMD-like pain that, in fact, is of cancer origin. The question remains if an earlier diagnosis can be established in cases similar to those illustrated. It is mandatory that a thorough medical and dental history be taken by all health care practitioners along with a systematic and comprehensive examination when addressing head and neck pain. This includes careful examination, including inspection and palpation, of the oral and extraoral structures and the cervical lymph nodes at regular intervals in all patients but especially in those who are at high risk. History of smoking and alcohol use is of particular concern. Early head and neck cancer is usually symptomatic. Persistence in applying this practice philosophy is imperative.