Tarreva

..correct spelling is Tarceva

(sorry about hijacking this thread!)

Dr. Mike,
My dentist is (and has been, overly cautious) since he couldn't diagnose a 6 cm tonsil tumor that was a huge big tan rubbery blob displacing my uvula. He means well and I have been with him a long time. My H&N cultured it and it was positive for candidiasis. Already been through the Tx and moved on.

I have used Nystatin in the past - yuck! Give me Diflucan or Clotrimizole troches anyday The troches were actually quite tolerable and not bad tasting at all.

It was just a little strange to have thrush after all of this time (almost 5 years post Tx). I had IMRT and my salivary function is practically normal. My blood chemistry is all within normal limits (excpet my liver enzymes but I have had HCV for over 50 years so nothing new there). My general health is better than ever except for some minor collateral damage from the RT.

Gary,
I'm glad to hear that you are in good health..afterall that is most important to your well being. I too can say the same regarding my health and I feel blessed, as I'm sure you do, that we can say this..we Gary, know we are healthy due to all the attention, care and diagnostic tests we have been through.
Here's a little spin on the treatment that we have been through and most don't realize(albeit, different cancers, different areas and different treatments)in our current situations we know we are healthy that's better than the average Joe walking down the street...to me, that's a wonderful feeling.
It's an ever changing dynamic beast, the human body, then add the rigors that cancer therapy adds.
All it takes is something to upset the balance of the normal flora of the oral/nasal cavity and viola...thrush. I have had similar troubles and get equally as disgruntled as you. My cancer was in my leg and the surgical margins are past the jewels...so I'm sure I do not have to tell you where I have some recurring "yeast".

Could open a bakery or a brewery, diflucan is marvelous, my "smarties" minus the chocolate. Topical antifungals help but are greasy and uncomfortable...(ladies, I'm probably one of the only males with sympathetic ears regarding yeast infections...hehe).

Any how Gary, as for your dentist, if you are still comfortable with him you should talk to him about your concerns. Too often I loose a patient to another office, (it happens all the time), because they feel embarassed, or don't want to waste my time, or don't want to tell me how to do my job, or don't want to step on my toes. One thing cancer has taught me is I will state my opinion when it's warranted and accept all praise and criticism...cancer removed my filter, it didn't change my opinions but, now those I come in contact with hear what I have to say whether they agree or disagree. Cancer also taught me that I am human and no better than any other person, so...I have Dr. in front of my name, big deal...I respect, and appreciate and am no better than anyone else.
We tend only to hear the negative things after people leave and rarely get compliments. I tell all my patients, "If you like how we look after you tell your friends, call me or come talk to me about any concerns anytime...and I will do my best to rectify any problems or make modifications to my "routine" if it is percieved to be lacking, If you are ever uncertain, or unhappy, or feel like you were not treated appropriately in any way regarding any part of our realtionship with you call me and I will do my best to rectify the problem." I then give them my home phone number and home e-mail address.
We, (dentists), get trapped by our "routine" because it is preached to us from day one in school. It's hard to add and welcome new additions to that routine. I never do the same examination sequence twice...I know I cover everything because my assistant has a checklist. This allows me to stay fresh and when available add new ideas, techniques and equipment.
Jerry and I are both advocates for the VELScope and are both registered users of the technology. We believe it is in the best interest of the people we treat to offer them this technology, it's expensive, but my patients deserve the same as I do. I'm sure I have and/or will err in my diagnosis or treatment of someone. I would like to have that "someone" fill me in on it so I can learn from it and not have it happen to anyone else.

To your continued health and happiness,

Mike

Mike,
I have talked to him, he has seen exactly 3 oral patients in his entire career (me being one of them)- I started with him as patient number 12 in 1971. He's a great dentist and I still have all of my teeth today. But one thing he is not, is an ENT or head & neck surgeon which is highly specialized. Most tumors aren't even in the normal field of view for where most dentists and hygenists go.

I think its a great thing that dentists are getting access to more screening tools. I would like to see some hard data in the future that this really is resulting in a difference in early detection and not giving patients a false sense of security. I had (and still am) getting regular oral cancer exams by my hygenist -they still "missed" a 6 cm highly visible tumor. Even went so far as to tell me that they didn't think "I had anything to worry about". This is not just my story here but many others as well. Brian has worked long and hard on working with the ADA and educational programs for dentists. IMHO I think that this a worthwhile endeavour - but knowing what I know now, I would be getting regular screenings from an ENT annually after 40 or so anyway and earlier if tobacco and/or alcohol were a regular part of my lifestyle.

Gary,
Sure ENT's are specialized, as are dentists. Belive it or not dentistry used to be a specialty that one went into after medicine.
You should be a little more thorough before you belittle my passion.

You have data on your statement Gary, because if you do I'd like to see it; "Most tumors aren't even in the normal field of view for where most dentists and hygenists go." How would you know?


By nature of her allowable duties , a dental hygienist, RDH, is not able to make a diagnosis, interpret a radiograph or perform an exam. A literal interpretation of this is, she cannot tell you you have a cavity, or gingivitis because they are medical terms that are diagnosis. She can say, you have a brown spot on your tooth, or you have red bloddy gums.
This is a difficult subject for a lot of dentists to swallow (pardon the pun) especially with the dental HMO's that are out their.

The law in the U.S. and Canada is clear on this.

If anyone has been charged the fee for an examination in a dental office the Dentist had to conduct the exam. If you did not have a dentist, DDS or DMD actually look in your mouth it is fraud.

You are confusing the roles of a Dentist with that of a Hygienist.

Well this has gotten plenty out of hand.

In my own case I had my dentist and hygienist miss a good-sized visible lesion right next to a crown that was being done. Several months later when a node jumped out in my neck, I went to an ENT (with a neck presentation and my level of knowledge at the time dentistry didn

"There is NO EVIDENCE of what Gary states related to locations for oral cancer to occur and to whom it is visible." And where did I make that statement in this thread?

If visualization is that obvious then why bother with scopes or mirrors?!?!

I know from personal experience that the visual exam I get from my hygenist consists of looking under my tongue. The tongue would have to be moved to the side with a tongue depressor to visualize the tonsils since they are jammed in by the side of the tongue and how do you visualize the base of the tongue in the dentists office? My H&N guy uses specialized heated mirrors for that purpose (and another un-named dentist here has expressed the same concerns to me - and he uses a VELscope too). I'm always willing to learn something new.

Sorry to hijack your thread Helen!

Gary - with respect as always for your significant knowledge. I stated clearly the issue is not the types of equipment used, or even heating mirrors over an alcohol lamp (to prevent fogging as people breath through their mouth

Brian, as a cancer survivor I fully understand where you're coming from. We want all the 'advance notice' we can get. However, I think it's optimistic to expect most dentists to be 'cancer aware', as it were. Dentists are concerned primarily with teeth and the underlying bone structure. That is the way they are trained. And, you must admit, oral and H&N cancer are not all that common.

As you point out, symptoms may include some ulceration or lesion in the mouth (or in my case, a swollen lymph node under the jaw). In most cases however, it is a damnable disease that progresses without symptoms until it is well underway.

In my own case, my GP (not even a GP, really, but the nurse practitioner) picked up on the swollen lymph node as an indication of cancer. The ENT blew it off as a 'plugged saliva gland', costing me 4 additional months before diagnosis.

Should dentists be 'cancer aware'? Sure, but a comprehensive screening won't be happening anytime soon.

An interesting discussion.Can i just throw in my two cents worth by asking how ANY dentist can see a man with a huge ulcer on his tongue clearly visible to the naked eye four times over six months,and still not advise him to see a doctor?