Why do I need a dental exam, my teeth and gums feel fine?

April 1, 2015

 

 

Dental problems are often silent even serious ones

Most of you know that dental problems are often silent in the early stages. It isn’t until they are catastrophic that they really start talking to you. Think tooth pain/root canal. Early diagnosis makes treatment easier and cheaper, but even when catastrophic we can solve most dental problems. A “dental exam” involves more than just looking at your teeth and gums. The consequences of some of the other things we look for during an exam are also not painful in their early stages, much more difficult to deal with and not solvable by us. Yes we are talking about cancer.

More than just your teeth and gums

Sometimes it may seem like we just come in and say hello, but every time we look at you we are looking at more than just the teeth and gums in your mouth. We usually do not make a big deal about out doing it or our findings unless we see something that concerns us. Getting people freaked out about the potential for cancer does little good unless we are using it as a scare tactic to get them to change a bad habit like tobacco chewing, smoking etc. Brandon and I both received the Oral Medicine and Oral Pathology award at the UCLA School of Dentistry, which indicates we know professionally how to evaluate lesions. We both credit Dr. Russ Christensen’s course on oral pathology for teaching us to be observant and what to look for. We both admit at the time that we couldn’t see the importance of all the rare and strange symptoms and problems we had to memorize, but the fact is, we use the knowledge everyday.

Given all that I think, it’s even more important that we care and are conscientious.

Personal history concerning cancer

My history of concern goes back way before dental school and is personal. During one of my “sabbaticals” from college (some would say I dropped out), my wife Debi and I moved to Mammoth Mountain to go skiing for the season. We worked in a ski shop, skied almost everyday and received lots of sun exposure. Blond hair, green eyed Debi was good about sunscreen; however, she did not like to get sunscreen in her hair so she missed the area on the side of her face next to her ear. I sleep on the right side, so every morning I woke up, I would see the right side of her face. I noticed a mole in front of her ear changing shape, color and size. I may have been just a ex-student and ski mechanic at the time, but I had enough biology in school to know this was not good.

The biopsy showed it was a serious level 4 Melanoma. A seven hour, seven surgeon radical neck dissection operation at UCLA and immune therapy followed. The surgeons did a great job; you can hardly tell. For over forty years she has been cancer free. So, I come by my interest in pathology from a very personal level and so does Brandon. Did I save the love of my life life by forcing her to get that biopsy? We will never know, nor do I want to even think about it.

So, what does this mean for you our patients and the dental exam at our office. Not only do we look around inside your mouth at the cheeks, tongue and gums but we look at the whole you. We focus on the head and neck as that is our main area of concern. We check the skin on your neck, face and lips. We are not dermatologists but we have sent numerous patients to the dermatologist to be examined and biopsied both inside and outside the mouth. We have helped in the early detection of numerous precancerous areas, basal cell carcinomas, squamous cell carcinomas and melanomas. We have even sent dermatologists to the dermatologist.

 

Even other health Professionals

Recently a surfer/doctor friend was in for cleaning and exam and I noticed an area on his lip that I did not like. I pointed it out to him but he dismissed my concern and insisted that his daughter had bumped him in the mouth a couple of weeks ago. He claimed he was “monitoring” it and it was just healing. I explained that I thought he should get it biopsied. A couple of weeks later a full page article about skin cancer appeared in the San Diego Union newspaper and he was widely quoted as the expert. Not the best photo but it does show the subtle change in the lip.squamous cell carcinoma on lip of MD

 

Six months later he returned and the hygienist noted a small scar on his lip. When asked he sheepishly admitted that he had an excision of what turned out to be squamous cell carcinoma. I know it was difficult for him, but he finally admitted that my insistence did motivate him to get it biopsied. This is not to brag but to point out that even other health professionals can be dismissive of a “dental exam.” We try to keep the atmosphere in our office friendly and light, but we are serious about our concern for you. The intra-oral camera has made monitoring changes much easier allowing us to record and monitor so that we can take a more conservative approach. When we make recommendations we have good reason and your best interest at the foremost. We may come in and “say hello” several times a year, but we only charge for a “dental exam” once a year.

As an aside, we all know the best way to prevent sun damage is sunscreen. My favorite is Sun Bum. Multiple options for strength and convenient application, reasonable cost and it stays on even in tropical water when you are surfing.

We do not pretend to be real doctors but your mouth can reflect other health problems as well from diabetes to immune disorders which we will cover a another time. For now just realize we are looking out for more than just your teeth during that yearly “dental exam”.