By Paul Feuerstein, DMD
We spend an inordinate amount of time diagnosing the oral cavity for disease and wracking our brains for solutions to save teeth and dentitions. The focus of this article is to go a step further and try to save patients’ lives. There are several methods for early oral cancer detection. The first is a basic head and neck exam.
I have talked many times about headlights and magnification. Just using the old overhead light may not be enough, although some of the new LED lights are quite bright. To paraphrase the old saying, “You don’t see what you don’t see.”
There are products such as ViziLite Plus, VELscope, and Identafi that give you vision beyond the surface tissues. These have been highlighted in this column and other DE columns, as well.
There are also further inspection options, such as OralCDx, as well as traditional biopsies. Several new companies have joined this initiative with a variety of devices and techniques to help give the dentist, hygienist, and assistant a better understanding of what they are seeing.
Many of us, though, have not looked at a pathology book or taken a course in this realm for years. Companies such as Lexicomp publish simple photo “atlas” books with excellent photos and explanations of some common lesions. Lexi also offers this atlas in a smartphone app, along with the drug database, and it is searchable.
Everyone is due for a refresher. One of my favorite lecturers is Dr. John Svirsky from Virginia Commonwealth University who, believe it or not, gives a very entertaining lecture on pathology at many dental meetings. Whether it is John or someone else, I reiterate – we should all return to this basic education.
We also lose sight of our edentulous patients who, once the case is delivered, are never seen again. There is no reason these patients cannot come in for an exam, even a (denture) cleaning.
Billions of dollars are spent on adhesives, liners, etc., to keep ill-fitting dentures going for years. Irritations are sure to be found. Of course, the oral cancer exam should be performed. It is easy – no teeth in the way.
Another reason for this is for a simple revenue stream. These patients should be able to afford a simple clinical exam fee that will benefit their health. Many of these patients have dental coverage that they are not using. How many might say, “My dentures are very loose or I lost a tooth off this denture.” Just think about it.
We then have an interesting issue about referral. Many times we see a questionable lesion or finding. We then must come up with verbiage to tell patients they should get a second opinion.
Some of us are quite direct and mention the “C” word, while others prefer a softer approach or put off a discussion until a follow-up a couple of weeks later to “see how things are doing.” The danger with a “soft sell” is, if there were any symptoms that have disappeared or if it were asymptomatic in the first place, the patient might not return.
This leads to follow-up and referral issues. In this day and age, it might be a simple instruction to have the patient email you or vice versa, but there are HIPAA issues.
Can we use email to correspond with patients about their medical issues? Furthermore, can we email a referral or information to a specialist about a patient? The privacy laws are quite clear, and yet the majority of us use email anyway. The rules are “clearly” spelled out in 84 pages at www.hhs.gov.
To help us in this quest, a number of companies offer a secure, compliant portal to get the referral and information to the proper places. There are several email encryption services – some that are free – that can easily be found in a web search.
A few companies are trying to be dental specific, including edossea.com, dentalsharing.com, brightsquid.com, and recordlinc.com. These are only a few that I have come across at recent dental meetings. More are on the way.
These companies allow the referring office to simply and securely upload information to their respective site. Then, through a variety of techniques, they get these to the office or people who need the information. Some of these sites offer sharing of information among several people by allowing virtual study clubs. Again, these are secure.
I have discussed some of this information before, but it is rapidly changing. So, keep your eyes open. Having said this, truly keep your eyes open in patient exams.
Dr. Paul Feuerstein installed one of dentistry’s first computers in 1978. For more than 20 years, he has taught technology courses. A general practitioner in North Billerica, Mass., since 1973, Dr. Feuerstein maintains a website (www.computersindentistry.com), and can be reached at [email protected].
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