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Early detection

March 1, 2007
In one of my favorite audio programs “The Strangest Secret” by Earl Nightingale, the speaker recounts the following incident:
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by Barry F. Polansky, DMD

In one of my favorite audio programs “The Strangest Secret” by Earl Nightingale, the speaker recounts the following incident:

“Some years ago, a reporter asked the late Nobel prize-winning doctor, Albert Schweitzer, ‘Doctor, what’s wrong with men today?’ The great doctor was silent a moment, and then he said, ‘Men simply don’t think!’”

Motivational speaker Jim Rohn suggests that all success begins with the development of a personal philosophy. Creating a philosophy requires lots of self-reflection and thinking. Henry Ford said, “Thinking is the hardest work there is.” Thinking is hard work because most efforts produce nothing at all, but if you spend time in thought, eventually an idea will come that could change a person’s life forever.

On the exhibit floor of the Jacob K. Javits Center at the Greater New York Dental Meeting, I was discussing a new technology, the VELscope from LED Medical Diagnostics. A mini-crowd was gathered around the booth, giving rapt attention to a salesman describing a technology that has been around for awhile, but primarily in the hands of dermatologists.

The salesman was doing a nice job of describing the mechanics of how the VELscope - an imaging device - could help dentists detect intraoral tissue changes at an early stage, thereby preventing oral premalignant lesions (OPL) from progressing to dysplasia and eventually to invasive forms of carcinoma, such as squamous cell carcinoma (SCC).

The salesman went on to point out that the incidence of oral cancer in the United States has been estimated at 29,370 new cases, with 7,320 related deaths. He explained how dentists could play a major role in screening patients for this dreaded disease, and how the VELscope could assist the surgeon because it clearly outlined the extent of the lesions.

Diagnosing oral cancer is certainly one of the fundamental services dentists should provide for their patients. The problem is that most cancers are diagnosed in the later stages. I know that every case of oral cancer I have diagnosed has been in the late stages. The salesman at the Greater New York Meeting was trying to convince the doctors gathered around him that early detection was that important.

My personal story

That’s when I interrupted him and rolled up my pants to reveal a bandage halfway between my ankle and knee. The audience’s attention quickly turned to me and my story. I was still dressing a wound that I incurred from Mohs surgery to remove a squamous cell carcinoma. Four months post-surgery, I am still dressing that wound. I explained how the lesion just “appeared” one day. It would have been nice to know that below my skin, cells were being corrupted while I slept.

After I told my story, the questions began. People wanted to know more. They wanted to know more about squamous cell carcinoma and how it could impact them. This was the ultimate in “what’s in it for me” thinking! The technology was coming alive through my experience. The data and details the salesman presented paled next to the story of my own experience with squamous cell carcinoma.

It didn’t matter what the illumination, sophisticated filtering, and natural tissue fluorophores could do - these were just features related to the benefits. More important than features or benefits was what I brought home from the meeting … an epiphany.

Early detection is key

Early detection is what people really want! Not necessarily the technology, but the ability to prevent more invasive, time-consuming, and expensive procedures, not to mention the horrendous consequences. Prevention is a topic that dentists have been discussing since before the days of Robert Barkley and the Society of Preventive Dentistry.

No one could argue with the intellectual concept of prevention, but to bring it home, emotionally, that’s the key. No piece of diagnostic equipment without a strong philosophy of early detection will work.

A new attitude and the right diagnostic tools

Dentists have been trained to detect caries and periodontal disease. My new perspective led me to rethink entropy. One definition of entropy is the inevitable and steady deterioration of a system or society. This may sound a little depressing, but as a dentist - a physician of the masticatory system - I had to see entropy in a new light.

Not only could the VELscope help me detect cellular changes, I had to take on a new attitude about caries, periodontal disease, and, of course, what Pete Dawson claims to be the No. 1 threat to our dentitions - occlusal disease.

With my new attitude, I began to look at diagnostic tools as the key to implementing my early detection philosophy. The lesion on my leg made me think that although I considered myself a pretty good diagnostician, maybe I could see more. KaVo’s DIAGNOdent, the microscope, and the VELscope are some of the tools available that enable dentists to really get in there at a cellular level ... beyond what is visible to the naked eye. That's where the action is!

But finding the problem is just part of the story. As many of my mentors have said, “Getting it off the shelf is the hard part.”

Better verbal skills bring the message home

I love magic. Whenever I go into a magic shop, I ask for a demonstration of the newest magic trick. I usually buy the trick and learn how to perform it. One of the things that makes any magic trick work is the “patter,” the verbal skills that mesmerize the person observing the trick. Not that the diagnostic tools we use can be compared with magic, but we need to use better verbal skills to bring the information home. People respond to personal stories (like the squamous cell cancer in my leg).

When dentists can involve patients emotionally in understanding the importance of the services we provide, then their objections will diminish. Some patients embrace technology, others are suspicious of it, but everyone stands up and listens when they realize what’s in it for them. Dentists who have problems getting patients to accept radiographs need to improve their verbal skills rather than trying harder to describe the technology.

The future of medicine and dentistry is in early detection. You would be shocked to know what we have available right now in the field of early detection of cancer. Chew a pill and a biomarker will lead doctors to sites that were invisible. Baby boomers want this! I know because I do ... and since I have embraced my new attitude, I see that my patients want it, too!

Albert Schweitzer, one of the greatest thinkers of modern times, once said, “A thinking man feels compelled to approach all life with the same reverence he has for his own. Thus, all life becomes part of his own experience.”

Maybe one day dentists will ask patients about preventing all the diseases that break down health and lead to cancer, caries, periodontal disease, and occlusal disease. Asking patients if they want to prevent disease is a lot more important than asking, “Are you happy with the color of your teeth?”

Barry F. Polansky, DMD, practices in Cherry Hill, N.J. Author of the book, The Art of the Examination, and publisher of “Dental Life,” Dr. Polansky is on the visiting faculty of the Pankey Institute. E-mail him at [email protected].

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