Oral Cancer Guideline (2026 Update)

These updated recommendations explore the use of four different adjuncts in early oral cancer detection. The first of a multi-part series exploring cancer detection methods assesses cytology 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), this first of a multi-part series exploring cancer detection methods provides recommendations on when cytology adjuncts may be appropriate.

Part two through four of the series will examine vital staining, light-based adjuncts, and salivary tests, respectively, to be published throughout 2026.

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

Please note: the infographic below may take a moment to load.

JADA March 2026
For guideline from JADA Evidence:

Read now
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
  • Systematic review: Cytology adjuncts to determine the need for biopsy for early detection of oral squamous cell carcinoma and potentially malignant disorders: An evidence summary of a living systematic review, Version 2025 1.0.
  • Oral Health Topics: Cancer (head and neck)
  • ADA Library resources
  • Search JADA for research related to oral cancer
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