Objectives: To explore factors underlying African Americans' perceptions of oral cancer and the oral cancer exam. Study findings were used to guide development of oral cancer messages designed to increase oral cancer exams among African Americans. Methods: Focus groups were conducted to understand African Americans' attitudes and expectations regarding oral cancer and oral cancer exams. Results: Respondents lacked knowledge of personal susceptibility to and the severity of a late-stage oral cancer diagnosis. Participants had limited knowledge of risk factors. Discussion: Findings point to the need for improved patient education and communication between the public and dental providers.