Cookey - This is a complete failure on the doctors part. This is what malpractice laws were intendend to address. Were I the patient in that case, I would be in court with the individual who failed to refer me to someone for evealutaion... (had he not aready killed me and then my heirs would be asked to continue in my behalf) and the doctor would lose. In the cases I have testified at, the very situation that you describe HAS occured, and those dentists are not just out money (via their insurance companies settlements, since they know these are not winnable), the insurance companies have twice - in cases that I have been invovled in - cancelled the docs insurance. In the US you cannot practice without it. They are essentially out of the dental business. In the UK things are different because of the nature of socialized medicine, and they have some protections from prosecution as a result.

Riley - dentists are trained in school about oral cancer and how to screen for it. That they do not, is not an issue of training, it is an issue of choice. Faliure to do a through screening is a failure to meet accepted standards of care. That the public has been ignorant of this, and that the dental community has let us down for decades, does not make the facts any different. This will change, even if dentists have to be litigated into making the change.

Brian, Riley, Cookey,

I would like to reiterate what Brian stated. Dentists are all trained extensively in H&N examination and H&N, OC cancer. We all had to pass standardized board exams sometimes more than one set depending on which state/province or county you practice in and these exams have a large section devoted to Oral diagnosis. We all know what to look for and what the signs and symptoms are and what normal and abnormal feel and look like. If individuals Dentists, MD's or whomever for that matter, as Brian has stated many times, choose not to look for it, it will not be found or referred.
It does not take long to do the full OC exam of the H&N and intra oral, and if you look at the description of a comprehensive/new patient oral exam it includes (I am not sure of the wording in the U.S. but I know it's there)a full head and neck as well as oral visual and palpation examination with documentation of abnormal findings.

It amazes and saddens me when something so simple as a tongue ulcer is overlooked or put off. If it is not normal looking and is present for longer than 14 days and doesn't go away, regardless if it is painful or not, it needs to be investigated.

My 2 cents,

Cheers,

Mike

Mike........NOWWWWWWWWWW we're back where we started......on the subject of professionals' role in the early detection and diagnosis process. There are far too many patients on this forum who can tell tales of having their cancers overlooked by both dentists and ENT's. Mine was not just overlooked......It was absolutely not recognized when it was there for all to see, ...classic text-book oral cancer. My dentist simply did not give me the care that I had a right to expect. There is a presumption of proficiency with our professionals. Mike has define what that is for a dentist, in the area of oral cancer detection. The facts are that some don't accept that responsibility evidently.

I am certain that some ENT's are just as guilty. But those who pay the price are you and me.

Too right !!!!!

Now I am not sure if I should post this, considering what happened after my original post at the start of this thread :rolleyes:
But someone made a statement to me today, 'anything nasty in the mouth never hurts' Now I don't know enough to contradict this, BUT I feel that is a rash generalisation.
Sunshine.. love and hugs
Helen

Helen,

If you have a question you should post it, you want to know and on most issues someone has the answer.
I assume by "Nasty" this person was referring to OC. Unfortunatly, many people and even Dentists, MD's, ENT's etc. believe this and tell people this. Every body is different and every H&N and OC even though they may be similarly named, classified and have the same behavioural characteristics is different as well.

Remember, the terms "Never & Always", have little use in medicine and oncology.

Pain is not and has never been used, at least in any textbook, journal article or lecture I have attended, as a major indicator or clinically descriptive term to rule out any kind of H&N or OC. Pain is usually one of the last characteristics used in the long differential diagnostic lists to decide if something abnormal is "Nasty" and/or needs further investigation or biopsy. It usually appears last or next to last and goes something like this (I'm paraphrasing here),...Pain, not always but sometimes present in varying intensities in different patients. Pain may or may not be from the initial lesion and may or may not be present if the lesion has invaded other structures or tissues. Wow!! That's pretty vague.

I personally don't use the prescence or abscence of pain in my clinical decision making process regarding abnormalities in the head, neck, or oral cavity. I note it and query about it but that's about it.

I have personally been involved with SCC base of tongue in an elderly gentleman that was excruciatingly painful. He had complained of the problem for 18 months to his MD and dentist. His wife was my patient and asked me to have a look. I sparyed topical in the back of his throat and then examined him. When I pulled his tongue forward with my gauze I froze, there was a 2 cm round ulceration with indurated borders and tissue necrosis that crossed the midline. He had hard fixated submandibular nodes and cervical nodes. Similar lesions were present on both tonsillar pillars. I immediatly referred him on an emergency basis, he went right from my office, to a surgical ENT at our local Cancer Treatment Center. Unfortunately he passed away several week later from pneumonia brought on by the rigors of chemo and radiation.

Ok...Rambling...

Nasty things in the mouth can be painful.

I hope this answers your question.

Mike

Dr Mike
When I said I wasn't sure about posting the question it was a little tongue in cheek(excuse the pun) I have no wish to be the cause of more furore on this board.
I have a warped sense of humour, which sometimes does not come over in my posts.
Thank for you reply, that's what I thought, it was to much of a generalisation for me.
Sunshine.. love and hugs
Helen

Helen,

This is certainly not true as I can tell you that the lesion that I had on my tongue hurt. You are not the only one that has heard this and unfortunately it is a very misleading statement.

Jerry

My Dad's first symptoms were pain. He had his teeth cleaned and then the pain started. Initially he thought that the dentist had knocked some bacteria loose when he had his teeth cleaned and it had resulted in an infection. For three months he went to the dentist every two weeks, complaining of the increasing pain. The pain was also in the area where his partial plate touched. The dentist started cutting the plate down and even suggested that he not wear it until his mouth was better. Finally, a red, blistery rash appeared in his mouth. On that visit the dentist called an oral surgeon and dad left the dentists office and went straight way to the oral surgeons office and had a biopsy. The rest is history.

Dear P-girl....your dad's lesion began much as mine did, exc. when it presented itself as a lesion with, as you call it, "a red, blistery rash," my dentist did not recognize it. I realize that this is one, individual practitioner who was not properly educated and motivated to diagnose oral cancer, and that most are more alert than that. This was a young-ish dentist....not brand new, not elderly.....has young children, 6-10 yrs. old.....recently trained.....There is simply no excuse. It's a good thing I am not the suing type, because this is a clear case of "failure to diagnose," when a practioner does not perform within the reasonable expectation of his specialty. He allowed my clearly visible lesion to remain for over 8 months, not recognizing it even when it was classic, as you father's was. I had to insist on more attention, and then he reluctantly sent me to the periodontist....still not the right place to be......and that dr. sent me immediately to the oral surgeon for a biopsy.