Yes, I know what my photo looks like. But if a recent survey is to be believed - and with only a little rationalization - we are all too sexy for our shirts. As I was driving home tonight, the radio station was offering the trivia question of the day. The 10th caller with the correct answer would win some serious prizes! The question was, “What is the sexiest profession?” I tried to phone in the answer “dentistry,” but I wasn’t the 10th caller. The correct answer was “firefighter.” I was very disappointed. We were so close on this one. They save buildings, we save teeth. They save lives, we save lives. They risk their lives and spend a lot of time working out, we don’t. Ooh, we were so close on this one!
Saving lives is not the first thought that comes to my mind when we read practice-management journals. I want to tell you about my experience as a new dentist. I was working in a group practice with six offices scattered throughout central Indiana. One day, I was called in to cover for the senior dentist. Most of the appointments had been rescheduled, but I was expected to cover the hygiene exams. I performed my examinations the way I was taught in dental school. Imagine my surprise when the second patient presented with a 5mm x 10mm ulceration in the left tonsillar pillar. The patient was unaware of the sore and had no pain in the area. I showed the lesion to the patient and advised her to contact my boss for a possible biopsy. I caught some serious grief. I had scared a patient and no biopsy was performed!
I didn’t last long after that, but I learned something very important after I left that practice. A few months after the incident, the husband of the patient came to my office. I wasn’t there when he came in, so he left a message for me. It seems his wife had been suffering from headaches that were progressively worsening. One day, the headaches were so severe, she went to the emergency room. The patient died from metastatic cancer. My referral was too late and a biopsy was never performed, but the patient’s husband wanted me to know that I was the only health professional who had even recommended further testing.
In the 25 years since that time, I have never lost a patient to oral cancer. I have quite a few patients who have been diagnosed with cellular abnormalities, and a few cases where the abnormalities progressed to some form of oral cancer. I am absolutely amazed at how aggressive some of these lesions seem to be. We have a fantastic tool in the fight against oral cancer in the Oral CDX brush biopsy kit, and there is a simple three-step program that will help you bat 1,000 against oral cancer.
However, the first - and most important - step is to perform the oral cancer screening exam you were taught in dental school and to do it on every patient you see. When you see a patient for a limited, periodic, or emergency exam, I believe you should start with an oral cancer screening. This benefits the patient and it can also benefit your practice if you inform the patient about what you are doing. I always preface my explanation of examination results with a verbal acknowledgement of the oral cancer screening. Patients are impressed with the professionalism of your examination when you inform them that you always perform an oral cancer exam and they have no areas of concern.
Step two is to develop your protocol for biopsy. I have found the Oral CDX kit to be quick, complete, and painless. The procedure is simple for the entire office. The kit contains complete instructions for billing, as well as complete clinical instructions. I have never used anesthetic when performing a brush biopsy, and I have never had a patient complain of pain, even when I see tiny bleeding points. The only drawback for the patient is that if the results are abnormal, the patient must have an incisional biopsy. I believe this is a fair trade-off because only a few lesions will require further information.
The final step is all on your shoulders. As a general dentist, you should research the specialists in your area and find out which oral surgeons and oncologists are the most focused on oral cancers. Your patients will ask where they should go, and you owe it to them to refer them to the very best. This referral may be a life or death issue, and absolutely must not be based on PPO networks or saving dollars. If we all focus on saving lives, maybe next year dentistry will be the sexiest profession!
Dr. Michael Gradeless, a 1980 graduate of Indiana University, practices preventive dentistry in Indianapolis with an emphasis on cosmetics and implants. He is an adjunct faculty member at Indiana University, where he teaches the Pride Institute university curriculum of dental management. He also is the editor for the Indiana Dental Association. Contact him at (317) 841-3130 or e-mail to firstname.lastname@example.org.