Brian,

I am all in favor of referrals but here is something you need to know about the real world of dentistry. The very early kinds of tissue changes the signal stage I lesions look so innocent that when the patients are sent out for referral the most common response is for the oral surgeon, oral medicine, ent, periodontist, whomever to look at the lesion at say "it's nothing". At least with a brush biposy that shows an atypical result you may get some attention. When I showed my leukoplakia to an ENT, he literally laughed at me and asked why I was wasting anyone's time. The brush biopsy results normally take less that a week to get. Most patients do not know how long a lesion has been present in their mouths. Mine was present for about 4 months before someone took me seriously enough to do a brush biopsy. I know what all of the literature says but you have to apply all of that in the real world. These general dentists are not doing brush biopsies to diagnose cancer, they are doing them so that the doctor they refer the patient to for biopsy may take the lesion more seriously. Early detection saves lives has to be hammered into the heads of the oral surgeons, the ents, the oral medincine docs, the periodontists. It is not the general dentists who are watching and waiting. At least not the ones I educate.

Barb