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Author |
Topic: Doctors,
Ent's, and Dentists |
happydog
Member
Member # 175
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Hello Great List,
Thanks to the info here and some (gentle) prodding/suggestions
from Brian H. especially, I have an appt. to have my "lump/bump
thing" looked at by an Oral Surgeon on Monday. It took about
20 minutes on the phone with our (annoying) health insurance
to find a "network provider" but we did. When I first called
to make the appt. I think I was getting the brush-off, as
the scheduling gal said she'd have to mail me a "packet" to
complete, then the Dr. would "review it" and THEN (maybe)
set my appt! Good lord! Fortunately when I asked "but what
if I have a growth in my mouth", etc. she changed her tune
and was very pleasant. I guess they must be swamped with TMJ
patients or something! Anyway, I've got the consultation for
Monday and I'm trying not to be too nervous. The "thing" will
have been there at least a month, tomorrow, as that is when
I noticed it - who knows how long it really was there (right
tonsillar fossa.) Thanks again for the wonderful information
here and for the guidance of "who" to see (ENT vs. Oral Surgeon
vs Dentist) etc. I'll be sure to let you know how it goes.
Thanks,
Michelle (Happy Dog)
Posts:
7 | From: Midwest USA | Registered: Jun
2002 |
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youngerag
"Above & Beyond" Member (200+ posts)
Member # 12
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Good Luck Michelle. Keep us posted on the outcome of your
appointment. Many good thoughts are with you.
Anne.
--------------------
Anne G.Younger
Life has never been better.
Posts:
204 | From: Wilmington, Delaware | Registered:
Mar 2002 |
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happydog
Member
Member # 175
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Hello again!
I had my (first and only) Oral Surgeon visit on Monday 6/24.
He saw the "thing" I've been describing here on the BB and
he said it "did not look angry" and therefore to check back
with him in 3 weeks. I know *full well* I should've opened
my mouth (no pun intended) right then and DEMANDED a brush
biopsy (or other Bx) but I just went along. Now I am furious
with myself that I've got to wait for him to "check it" again.
Something seemed to "possess me" in that damn chair and I
didn't stand up for myself. Oh well. This O.S. did have another
O.S. in his office come take a look, and he said it was "probably
nothing"; when I said what do you MEAN "probably" and he said
"well the only way to know for sure is to take a piece of
it out and we don't need to do that right now"... this Dr.
did get his digital camera at least and took a photo of it,
so we'll have something to compare to in 3 weeks. The original
O.S. DID comment that my uvula had a couple "red dots" on
it but he didn't seem concerned about THOSE either! And I
hadn't even noticed THOSE myself... am I just kidding myself
by waiting the 3 weeks - i.e. should I go back to these guys
and insist on a Bx NOW, or find another O.S. (or ENT?) and
move on right away?
Thanks for listening- I feel like a big wuss.
Michelle and herd (Happy Dog)
Posts:
7 | From: Midwest USA | Registered: Jun
2002 |
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kimt30
Member
Member # 200
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Michelle this is your body. You dictate to the doctors what
you want done. You need peace of mind to what the "thing"
is. This is what we pay for. I was advised by my ENT that
a brush biopsy doesnt get enough tissue/cells. It can give
you a false negative. My dentist did a brush after a year
of him watching it, which was negative. Im still waiting on
the tissue results that my ENT did.If you still dont feel
comfortable with the answers you get after the brush, if you
do it. Go for a 2nd opinion. Dont be afraid to tell them how
you feel. Good Luck!
Posts:
6 | From: Michigan | Registered: Jun
2002 |
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Mark
Giles
Member
Member # 5
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Michelle,
My advice would be to contact a good ENT as soon as possible.
In my humble opinion, which Brian may well disagree with,
when it comes to cancer, dentists, including oral surgeons,
are simply not up to the task. The sign of a good dentist
is that they actually recognize their limitations and refer
you to an MD/DO.
My own dentist referred me to an oral surgeon last October,
when a sore under my tongue did not heal. The oral surgeon
then did an excisional (not brush) biopsy, which then proved
to be positive. He was very prompt in giving me the bad news,
and immediately referred me to an ENT. Since this oral surgeon
was an experienced maxillofacial surgeon, who performs a wide
variety of restorative procedures, I asked him why he was
"passing me off" to an ENT. He said once oral cancer has been
positively diagnosed, the ENT is the next appropriate stop.
He said the work of an oral surgeon is primarily restorative,
not curative, and something as serious as cancer is the proper
domain of the medical community (MDs and DOs). Now that's
a good dentist!
Assuming you want real peace of mind, Michelle, I would find
a good ENT as quickly as possible and have him or her do a
thorough workup. It may very well end up being a completely
benign condition, but, regardless of outcome, you want to
make sure you receive the diagnosis from the person most qualified
in the area of head and neck cancers. Simply revisiting the
oral surgeon while he "tries" different approaches is a waste
of precious time.
Remember too, that the ENT is not the be-all and end-all when
it comes to oral cancer. As Brian has pointed out many times,
oral cancer requires a multidisciplinary approach, tapping
into the expertise of dentists, oral surgeons, ENTs, head
and neck surgeons (many, but not all ENTs are), medical oncologists,
radiation oncologists, and speech therapists. But in terms
of initial diagnosis, and possible surgical treatment, the
ENT is really the expert in this area.
I would also like to mention that my own ENT echoes the comments
of kimt30's ENT (see previous post): a brush biopsy does not
provide adequate tissue sampling to render a definitive diagnosis,
especially with certain types of oral cancer such as tongue
cancer (my type). This is not to say that it's not a valuable
screening tool. In other words, if the test is positive, it
has obviously proved its worth by providing an early diagnosis
and possibly saving one's life. But if it's negative, the
result may be inconclusive. Cancer cells may still be present
in the deeper tissue layers, that the brush will never reach.
Here again, this is a judgement call for a qualified ENT,
who will assess the location of the lesion, your overall health
history, etc., so don't kick yourself for not demanding one
at the oral surgeon's office. (Frankly, I think the brush
biopsy is designed primarily for dentists, whom we don't want
wielding scalpels too close to vital structures such as one's
tongue! My own dentist would probably agree.)
Best of luck to you, Michelle, and please remain optimistic.
Remember, as of this moment, you have absolutely no reason
to be otherwise.
Mark
--------------------
Mark Giles
Stage II Tongue Cancer Survivor
Posts:
12 | From: Southeast Michigan | Registered:
Mar 2002 |
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gnelson
Supporting Member (50+ posts)
Member # 212
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Michelle, I went through exactly what Mark Giles did. I haed
loose teeth pulled by my dentist who didn't like the looks
of "things", he sent me to an oral surgeon who did one biopsy
that showed Verracua,
He didn't like that and called me and demanded I come in for
a second biopsy, somewhat deeper.
I really did not want to but he insisted. After this one my
mouth went crazy growth was unbelieveable, sent me to ENT
doctor. Things moved real fast then, tumor panel, tests, removal
of more teeth, Then surgery to remove tissue and part of bone.
That was two years ago but ,I still need more reconstruction.
After all this I'd say don"t fool around with anything wrong
with your mouth . gnelson
Posts:
73 | From: Pennsylvania | Registered: Jun
2002 |
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Brian
Hill
Administrator
Member # 4
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Mark is consistently one of the most informed posters on this
board, but he is right, I disagree with a little bit of his
last posting. For sure anyone involved in general dentistry
is the guy that I think should be finding suspicious tissue
first, after all, they are in a lot of mouths every day. And
I would have to say that I don't believe that it is a general
dentists position to be making a cancer diagnosis, but they
should refer the patients out to someone more qualified. That
person should be doing a biopsy of the suspect area since
that is the only definitive way to diagnose cancer. This biopsy
and diagnosis procedure is well within the realm of the oral
and maxillofacial surgeon. In their defense I would have to
say that these guys do some pretty sophisticated surgery.
In one procedure in particular, a Le Forte, they take your
face apart in about 12 pieces and resize the components and
put it back together. An ENT isn't qualified to do a procedure
of this sophistication. Many do extensive cancer surgeries
that involve the oral environment, and act as part of the
treating team. Mark may be thinking of dentists who are considered
exodontists (also surgeons) who only specialize in extracting
teeth. I know a lot of ENT's that do not do surgery at all.
For that matter I had two ENT's that misdiagnosed my own oral
cancer, so while I think they are capable of many things and
some do extensive surgeries, if I was going to get cut, they
probably wouldn't be my first choice. But for that matter
when it came to oral cancers and neck dissections, neither
would an oral and maxillofacial surgeon. I want a head and
neck surgeon, or an otolaryngologist, to wield the blade.
Both oral and maxillofacial surgeons and ENT's are more than
competent to do biopsies, and make a diagnosis of oral cancer.
Lastly many dentists, particularly periodontists, spend the
bulk of their time wielding a scalpel on soft tissue, and
they too do some pretty sophisticated and very detailed cutting.
So In my book, I wouldn't want a general MD doing diagnosis
in my mouth, something they have not done a good job of so
far, any more than I would want a general dentist making a
cancer diagnosis. Cancer is the domain of specialists..
Also, oral surgeons are not involved in restoration of anything.
(This is probably a terminology issue) At best they place
implants which are latter restored by a prosthodontist, or
they may do a graft of bone (this may be thought of by some
as a restoration), but in the strictest sense even that is
later restored by someone else. Restorative issues are not
their domain, and they are not trained in restoration.
Regarding the brush biopsy, this is indeed only a screening
device, and even a positive return must be followed up by
an incisional biopsy, it's written right in their protocols.
As to getting into deep cancers that do not manifest as a
surface lesion, their package insert also states that the
brush is contraindicated for that type of sampling. Anyone
using it would hopefully read that, or know this to be obvious.
If it isn't on the surface where the brush can scrape it,
you can't sample it. BUT having said that, I wouldn't put
down the brush biopsy procedure. Its only shortcoming is that
it doesn't provide cellular architecture. This means that
the cells collected are not in the specific arrangement they
were in when they were part of your body. They are all scrambled
up from the scraping. This is an important fact, because in
order to determine the extent of the cancers progress, you
need to see the layers of cells as they were in your body,
(the architecture), to determine how deep it has invaded into
the tissue. So while it will definitively diagnose cancer,
it cannot be used to determine other issues which are necessary
before proceeding with treatments. It is only the first diagnostic
step, intended primarily for use by people who do not routinely
do incisional procedures, or where the suspect tissue really
isn't that worrisome, but rather than watch and wait, it is
a painless alternative. If the brush biopsy were unreliable
at diagnosing cancer, I guarantee you 100's of thousands of
women would be wasting their time getting a PAP every year,
which is essentially a brush biopsy. Incisional and punch
type biopsies also have their shortcomings. The doctor performing
the procedure must get the right piece of tissue. If you looked
at an erythroplakia the size of a quarter and somewhere in
the middle of it was the actual cancer tissue that was similar
in color without an open ulceration, they can be pretty tough
to delineate and cut the right section of tissue. You sure
don't take the whole quarter size piece, as there are other
risks in doing so. So even these techniques are subject to
errors.
--------------------
Brian, stage 3 oral cancer survivor. OCF Founder and Director.
"The first responsibility of a leader is to define reality.
The last is to say thank you. In between, the leader is a
servant."
Posts:
366 | From: Laguna Beach, CA | Registered:
Mar 2002 |
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Mark
Giles
Member
Member # 5
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First of all, when it comes to the field of dentistry, I will
always defer to Brian. He's worked most of his life in the
dental implant industry, has lectured throughout the world
on the subject, and has, no doubt, rubbed shoulders with the
"creme de la creme" of the dental community, so his credentials
on the subject are not open to question.
Second, I agree with him that I used the word "restorative"
inappropriately in the above post. I meant something akin
to "cosmetic" or "elective". The oral surgeon was simply saying
he did not wish to deal with a pathological process, like
cancer.
I am certainly not here to disparage the dental profession
in any way. My experience with both my dentist and the oral
surgeon who biopsied my tongue has been a positive one. I
was never the victim of "benign neglect" on the part of my
dentist. Rather, I was the victim of my own ignorance and
inaction, as I allowed 4 months to pass before seeing my dentist
about the sore
on my tongue.
I don't view this as an argument about the relative worth
of dentists vs. doctors. Both are (or should be) allies in
the prevention and treatment of disease. And both have an
important role to play in managing our personal health care.
The question is: What is that role?
The fact is that doctors, by virtue of their extensive and
intensive training, view the human body as an integrated whole.
Although most will eventually specialize (e.g. surgery, dermatology,
psychiatry), they will all endure several grueling years of
medical school that will expose them to the intricacies of
all the major organ systems. Even during their residency,
when they begin to branch off in different directions, they
are still required to perform 6-month rotations in specialties
other than their own.
Dentists, however, are specialists from Day One. The focus
of dentistry is the human oral cavity and its surrounding
structures. And while they also take courses in anatomy, physiology,
etc., the bulk of their training centers around a relatively
small piece of the body's real estate. There's nothing wrong
with that, but it's not the best training for dealing with
systemic disease.
And I happen to believe that cancer is a systemic disease.
No matter how localized the primary lesion may be, the body,
mind and soul is under attack, and remains vulnerable to further
attack. I have no doubt that an oral surgeon may have the
technical prowess to disassemble my face and piece it back
to together. But I want a doctor who can see beyond my oral
cavity, who
can order up diagnostic tests, interpret those tests, and
make sound clinical judgements about the disease's effect
on me as a whole.
Obviously, many patients have been successfully diganosed
and treated for oral cancer by dentists and oral surgeons.
And just because ENTs have an MD degree doesn't make them
gods, or any less fallible than the rest of us. As Brian indicated
above, he was misdiagnosed by an ENT. On the other hand, there
are 2 replies in the "Introduce Yourself" section, under "See
a doctor, not a dentist" which express doubts about dentists'
ability to detect cancer. (The oral surgeon who biopsied my
tongue remained certain I did not have cancer, even after
excising the tissue.)
So, in Michelle's case, she is already seeing an oral surgeon,
and is having some concerns about his treatment plan (or lack
thereof). Rather than spending too much time at this level
of expertise, or hopping from one oral surgeon to another,
I think she'd be wise to consult an ENT, who not only specializes
in diseases of the throat, but has the broader perspective
that comes with a medical school background and many years
(we hope) of clinical experience.
--------------------
Mark Giles
Stage II Tongue Cancer Survivor
Posts:
12 | From: Southeast Michigan | Registered:
Mar 2002 |
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SandraW
Contributing Member (25+ posts)
Member # 201
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Sandra here (Helen's daughter). I posted the "See a doctor
not a dentist" message. To clarify, I certainly don't expect
a dentist (or a primary care physician for that matter) to
be able to *diagnose* oral cancer. But I do expect them to
know a lot more than I do and I expect them to recognize when
a lesion is serious (though out of their purview) and needs
followup.
An "It's not anything serious" or "It's only a fever blister"
from a respected dental professional can cost a patient weeks
if not months of precious time in following up on a lesion
that could be cancer.
My mother's surgery is tomorrow, July 2nd. Say a prayer for
her. Thanks.
--------------------
Sandra
My mother's caregiver
Posts:
26 | From: North Carolina | Registered:
Jun 2002 |
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Brian
Hill
Administrator
Member # 4
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I agee with you both. I want a dentsit to recognize that something
is amiss. I see him every 6 months, and he's looking around
in the right spot. I want an oral surgeon, a periodontist,
or and ENT to biopsy the area and tell me if it is cancer
or not. Then I want a team of oncologists of various diciplines,
surgery, radiation, chemo etc. to hopefully cure me. After
it all that, if there is any reconstructive work to be done,
I want a prosthodontist to replace that missing chewing power.
That is my idea situation. In this world it doesn't happen
that way often, and that is the problem.
--------------------
Brian, stage 3 oral cancer survivor. OCF Founder and Director.
"The first responsibility of a leader is to define reality.
The last is to say thank you. In between, the leader is a
servant."
Posts:
366 | From: Laguna Beach, CA | Registered:
Mar 2002 |
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