Dear K,

I have found that there is a good bit of overlap in services performed by oral surgeons and ENT's....and even, in some cases, plastic surgeons.

Which one is best depends on their training and experience. For example, our local oral surgeon is a dental professional, doing great work with difficult extractions and even some bone grafting. This particular man, in this small city, does not have the patient volume to give him the experience to deal with major cancer surgery. He did my biopsy, but he would not consider....nor would I have considered him.....for my surgery.

The same goes for the ENT's here. They might be helpful in diagnosing cancer and referring a patient to the larger centers, but they are not experienced enough to do the surgery and follow-up treatment.

I was referred to an Oral and Maxillofacial surgeon at our state medical school. He has both a DDS and an MD degree. He is well known nationwide, and he did a great job on my surgery, doing all of my extensive surgery without making an incision on the outside of my face (exc. for the neck dissection, of course.)

I had wanted to go to M.D.Anderson.....and will if I have any recurrence....but we had a snafu in communication. As it turns out, the doctors who do this work at MDA are ENT's, and they usually do a facial incision for surgery like mine, so I escaped that, just by chance.

I don't doubt that I received the very best surgery possible. And I feel that my surgeon was well-versed in follow-up care. I, fortunately, did not require radiation or chemo, according to national treatment guidelines, but it made me nervous not to have gone to a large cancer center with a team approach. This anxiety alone made me uncomfortable and pointed out the importance of having confidence in your treatment team.

Six months after my surgery, I went to MDA for some second opinions, to be certain that I had been treated in the most proper manner, and they agreed that I had been treated just as they would have.

My discomfort with not having gone to the large center taught me the value of having total confidence in one's treatment. That is a very important factor.

So.....once you get a diagnosis through your local ENT, my advice is to go then to a large center where they treat head and neck cancer all the time, and let them decide which specialty is best for your treatment.

I would NOT, personally, (and I am married to a physician) consent to being treated for oral cancer locally. In my opinion, there are not enough patients in a private practice to give a physician the experience he/she needs to treat this properly and thoroughly. You need the advantage of lots of experience, and the team approach. You want the advantage of having a physician who has the experience with tissue preservation, since any removal in the mouth involves tissue vital for oral function.

Sooooooo You asked for an opinion......I just couldn't resist giving you my full answer, since there is no one answer to which is more appropriate, the oral surgeon or the ENT. Your local ENT can biopsy and assist with the diagnosis, but you should then take your results to the CCC of your choice and let them take it from there. They will want to re-test your biopsy most likely. This is a comfort also, to be certain that you are on the right track.

Please let us know what the ENT says tomorrow. Good Luck!

I would not presume to make any recommendations about whom you should see; I can only tell you our experience.

An oral surgeon is a dentist with advanced surgical training in the oral cavity; an ENT is a physician with advanced training, including surgery, in treating the area generally known as "ear, nose and throat" (and also includes the mouth).

I expect my husband was initially referred to an oral surgeon because it was his dentist who first identified the area of concern. She was more plugged in to the dental community, and a large part of this particular oral surgeon's practice deals with the identification of oral pathology. (Many oral surgeons primarily do such procedures as wisdom teeth extraction -- that's not whom you would want to see.)

The oral surgeon does not treat oral cancer. When my husband's first pathology report came back, showing moderate dysplasia (not cancer), the oral surgeon referred him to a local ENT to remove the leukoplakia (the oral surgeon's biopsy was on only a tiny part of it). Once the second pathology report, from the excisional biopsy, came back as showing SCC, my husband switched his care to an ENT cancer specialist at Johns Hopkins, about an hour away. The ENT in northern Virginia is very good, but he also deals with sleep apnea, hearing loss and such.

Because my husband's cancer was totally removed in the excisional biopsy, he is seen through the regular Hopkins ENT department, not at the Kimmel Cancer Center, but his doctor is one of the oral cancer specialists.

Hope this helps. Let us know how your appointment goes tomorrow. (And I agree completely with Colleen about getting your care, if you need it, at a large cancer center with a dedicated head/neck cancer clinic. That's all they deal with.)

-- Leslie

Kershaw,
My 2 cents worth.
First, I have to agree with Brian and Jerry, find a new dentist. I find it very unprofessional and unethical for a dentist (or any other professional) to tell you, "it didn't look good but they would wait and see until my next visit (3 months). " A lot can happen in three months. I really wonder if this guy knows the thought process and worry he kindled in you.
Second, can you see the white spots? Are they on both sides? My suspicion is that they are only on the lower and on both sides.
Third, ENT's and Oral Surgeon's are not all created equal. I would not rule out either specialty as long as you are certain they have the knowledge and skills and experience to treat you.
I know some are going to disagree with me here, but read the whole post before you get your back up.
The scope of practice of ENT's, Oral Surgeons and many other specialities for that matter depends upon the interests of the individual. I personally know ENT's who have not been in an O.R. since specialty school, I also work and refer to an ENT who is on the local Tumor Board, he was a dentist for five years and went back to school and now is a Surgical ENT and MO who limits his pratice to the treatment of OC and H&N cancer. On the other hand, I know Oral surgeons who basically do limited surgery and take out wisom teeth. I also have an Oral surgeon who I refer to who was in dental school when I was there. He finished his training and then went to Italy for two years to study Oral Cancer Treatment and Facial reconstruction. He is a Dentist, Medical Doctor, Board Certified Oral Surgeon, and holds Diplomas in Oral Caner treatment and Facial reconstruction. I'm wandering here...
My point is ...check the credentials of your doctors, ask them about their experience in treating similar patients.
I believe that a team approach in a major cancer treatment center is the best avenue for any cancer treatment. I only mention the above regarding individual specialists for thos who cannot go to a CCC. So check the credentials.

E-mial me if I can answer any questions or help you in any way.

Cheers,

Mike

Thanks Mike. What my dentist said is that where my wisdom teeth were taken out it shows a white patch that does not come off on my left side of the mouth. I also have a very dry mouth. I am headed to the dtr. today and will see what happens. Thanks so much to all for you support and knowledge.

I had my biospy today. Boy that was quite a lot of skin they took. I now have to wait 7-10 days. I am not sure what to think. Do you think I need to be concerned since they went ahead and did a biospy??

Sorry I spelled biopsy incorrect.

Hi,

I would be concerned if they DIDN'T do a biopsy. This is the only way you will know if anything is wrong. With the holiday this week, the biopsy results will take longer than usual. I would still call the office in a week to see if it came back. My experience is that biopsy results don't usually take more than 3 working days.

And don't worry about the spelling. If korect spelng wuz a reqirament too posst hear, nun of us wood bee alowed on the fourum.

Jerry

Sorry...as my kids would say, "too corny, dad"

Very nervous! Results are in waiting to hear from the doctor. Will keep you posted.

we are here waiting with you !

good luck with Biopsy and prayers are with you.

Whatever you do in a process like this, do not wait and seek treatment and as much advise as soon as possible. Time is an enemy. The inidividuals on this website seem to give good advise and wish I had found this prior to my treatment. I heard prior to treatment (I had neck lymph involvement - advanced diease) words like neck dissection, radiation, chemo (cisplatin, carboplatin and others), Erbitux, neoadjunctive treatment with chemo, imune response treatment between surgery and treatment, three drug chemo, etc. Knowing where to go and making a decision is key. As Brian said your dentist should have sent you someplace sooner. Hopeful it is only nothing and you can move on without issue.

best

Michael J.

Stager IV T1N2bMO base tongue dx 7/6/06 tx 9/22/06