Sir, an 83-year-old gentleman was referred by his general dental practitioner to the A&E department at our unit for what appeared to him to be a dental abscess associated with the lower right 7. On further questioning about the history, the patient mentioned that he had noticed that the swelling had been rapidly increasing in size over the last four weeks and that he was beginning to experience an increasingly numb lower lip. Given the patient's general appearance it transpired that he had also begun to notice unexplained weight loss.

On examination, we found an unusual exophytic growth (Fig. 1) on the lower right mandibular ridge which had encapsulated the patient's lower right 7. It was noted that there was obvious buccal and lingual expansion of the mandibular cortex.

Fig. 1
figure 1

Unusual exophytic growth on the lower right mandibular ridge

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The patient was treated acutely which included excision of the lesion and extraction of the tooth. A histological diagnosis of metastatic renal cell carcinoma was made, and the patient underwent further investigation and management of his primary cancer.

Metastatic spread of cancer to the oral cavity is a rare phenomenon; it accounts for approximately 1% of malignant oral tumours1 and when found it usually represents a poor prognosis2 for the patient and late stage disease.

We believe this case highlights not only the importance of the prevention and detection of mouth cancer but the impact it can have on a patient's life. This patient, despite experiencing systemic symptoms, had not sought medical advice. Although not suspecting it was cancer, it was his general dental practitioner who referred the patient in a timely manner, kickstarting his oncological care.

There is a wide array of resources available for general dental practitioners to aid in the screening of oral cancer, one of which is the Oral Cancer Recognition Toolkit3 which we believe is a helpful adjunct to use at dental check-up appointments. Where oral cancer is suspected, an appropriate referral via the 2-week-wait pathway to their local maxillofacial unit would be required.