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Oct 10
Questions from a grieving wife

We can make a difference in the early detection of oral cancer

grieving wifeAll patients, whether they are aware of it or not, arrive in our practices with the expectation of a thorough and complete assessment that informs a definitive diagnosis. Accordingly, dentists have a unique opportunity to positively impact the early detection of suspicious oral lesions which may prove to be oral cancer.

Today I had a difficult conversation with a woman whose husband recently died following a diagnosis of oral cancer. She said their dentist didn't act definitively when an oral mucosal lesion present over a period of some years failed to heal. The patient's wife told me that when he asked their dentist about it he was told "just keep doing what you're doing".

His wife described watching her husband of 49 years suffer as the very late and difficult treatment failed.  He became unable to talk, eat or even swallow without excruciating pain.  She said he dealt with pain, stress, and ultimately, death, with dignity and grace.  Her conclusion was this: "Negligence caused my husband's death."

It is common for patients to blame their dentists when they experience a poor treatment outcome. As complaint investigators we know this does not necessarily mean the dentist did not meet the expected standard. However, the question is always the same: was everything done that should have been done, and in a timely manner?

In this case, the patient's wife wanted answers:

  • Aren't dentists taught to examine the mouth to detect anything abnormal?
  • Don't dentists worry if something doesn't heal?
  • Aren't dentists trained to know when to refer patients if they are concerned something is wrong, or they don't know what it might be or what they should do?

Dentists have a unique and sobering responsibility with respect to early detection. This responsibility is shared with our medical colleagues; however, their training understandably does not place the same emphasis on oral mucosal disease compared to dental training in this area.

Specialists in oral medicine, oral surgery, ear, nose and throat (ENT) and head and neck surgery have particular expertise in this area and frequently examine the patient and provide a biopsy only following a referral from a general dental practitioner. During the course of College investigations, medical and dental specialists have commented that they are seeing patients far too late.

General practitioners are extremely important members of a larger team, all of whom share the same commitment to early detection, resulting in early treatment and best possible outcomes.

The following suggestions are designed to help you serve the best interests of your patients in the early detection of oral cancer:

  1. Never underestimate the critical importance of a careful extraoral and soft tissue examination. Expect the unexpected. Maintain the rigor and attention we were taught to bring to this during our training. Never give it up.

  2. Document, document, document! Record any unusual finding with a description, appropriate measurements, and photographs.

  3. Compare your clinical findings at frequent intervals and don't wait to react to troubling findings, such as progression or poor healing.

  4. Think outside the box: it's not always about teeth or periodontal disease. Consider the possibility of oral mucosal diseases, including oral cancer.

  5. Remember that only a biopsy provides the information necessary to establish a definitive diagnosis.

  6. Refer early, particularly if you are not proficient in providing a biopsy or if there is the slightest doubt in your mind about what you are seeing. If something does not seem right, or you can't explain it to yourself or the patient, get help. Trust your gut. It's okay to tell the patient you are not sure and that another opinion is indicated.

  7. Be prepared for patients to resist referrals or biopsies. Be sure the patient understands your concerns and the reasons for the management you are strongly recommending. Any refusal should be clearly documented in the record.

  8. Present your clinical findings to the patient with confidence. Emphasize the importance of establishing a definitive diagnosis.

  9. Consider sharing your findings and concerns with the patient's family doctor and any other medical or dental specialists also involved in the patient's care.


Remember: general practitioners are important members of a larger team, all of whom share a commitment to early detection, early treatment and best possible outcomes.

From the desk of Dr. Meredith Moores (mmoores@cdsbc.org)

Dr. Moores was a member of the Early Detection of Oral Cancer Working Group that created the Clinical Practice Guideline for the Early Detection of Oral Cancer with the BC Cancer Agency. For guidance about the appropriate use of oral cancer screening techniques to help dentists make informed decisions about screening for oral cancer, please refer to the guideline.