Oral Cancer Guideline (2026 Update)

These updated recommendations explore the use of four different adjuncts in early oral cancer detection. The first three parts of the multi-part series exploring cancer detection methods assess cytology, vital staining, and light-based adjuncts.

Early detection of oral potentially malignant disorders (OPMD) and oral squamous cell carcinoma (OSCC) can improve patient prognosis. Biopsy remains the reference standard for diagnosing OPMDs and OSCC, but advances in diagnostic technologies and living guideline methodologies have created a need for updated guidance on early cancer detection. Developed in collaboration with the Center for Integrative Global Oral Health at the University of Pennsylvania School of Dental Medicine (Penn Dental Medicine), the first three parts of a multi-part series exploring cancer detection methods provides recommendations on when cytology, vital staining, and light-based adjuncts may be appropriate.

Part four of the series will examine salivary tests, to be published summer 2026.

For questions or comments about the living guideline, please contact livingguidelineprogram@ada.org.

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To view full guidelines in JADA Evidence:

Cytology
Collection of a cell sample from an oral mucosal abnormality with a brush.
Article
Article
Vital staining
Use of a stain to detect increased relative DNA content on abnormal mucosal lesions.
Article
Article
Light-based
Use of a specialized light to detect abnormalities that are not visible under white light. 
Article
Article
How should clinicians implement these recommendations into practice?

The interactive living guideline is designed to be implemented directly in clinical practice. It functions as a chairside decision support tool, allowing clinicians to quickly review current recommendations, supporting evidence, and patient-centered considerations in real time. Because the guideline is continually updated, clinicians can be confident they are applying the most current evidence into practice.

Clinician resources
Patient resources
ARCHIVE: 2017 Guideline: Evaluation of Potentially Malignant Disorders in the Oral Cavity Clinical Practice Guideline

A panel of experts convened by the ADA Council on Scientific Affairs presents a clinical practice guideline to inform clinicians about the potential use of adjuncts as triage tools for the evaluation of lesions, including potentially malignant disorders (PMDs), in the oral cavity.

Key Points

  • Clinicians should obtain an updated medical, social, and dental history and perform an intraoral and extraoral conventional visual and tactile examination in all adult patients.
  • For patients with suspicious lesions, clinicians should immediately perform a biopsy of the lesion or refer the patient to a specialist.
  • Salivary and light-based adjuncts are not recommended for evaluating lesions for malignancy.

Clinician resources