Orthodontist Sued for Missing a Cancerous Lesion

Should Orthodontists Be Held Liable for Missing a Cancerous Lesion?

Lawsuits can strike fear in the hearts of dentists – not only for the costs involved, but for the damage they inflict on a dentist’s reputation that has taken a lifetime to build.

Where does liability end and common sense begin?

Recently the NY state court found that orthodontist Dr. Michael Donato was not negligent in the death of former patient Stephanie Hare. Ms. Hare’s family held Dr. Donato responsible for Stephanie’s death due to failing to detect a cancerous lesion during a December 2003 visit.

In April 2004, a lump was detected on her tongue by Dr. Donato, who ultimately referred her to an oral surgeon. But by then, the cancer was in its advanced stages. She died seven months later.

The family was seeking a $2.3 million award from Dr. Donato for pain and suffering.

The case pivoted around whether jurors would believe the cancerous lesion was present on Dec. 19, 2003 when Ms. Hare’s family said she complained of soreness to Dr. Donato; whether Dr. Donato should have found the lesion during a routine orthodontist examination; and whether he followed standard dental care during the exam.

“Stephanie’s death was not anybody’s fault,” Dr. Donato’s lawyer, Douglas Fitzmorris, told jurors in his summation. “Stephanie died of cancer. Dr. Donato is not to blame. The whole specter of this lesion being missed by Dr. Donato is not what happened. There was no deviation from accepted practice.”

And the jury agreed with Fitzmorris’ assessment of the case.

Should an orthodontist be held liable if he misses a cancerous legion? What if the patient’s complaints sound like issues stemming from braces and not cancer?

For more on this story, see Staten Island Advance.

Science Friday: Saliva Test May Help Dentists Detect Oral Cancer Sooner

Science Friday: Saliva Test May Help Dentists Detect Oral Cancer SoonerMichigan State University surgeon Barry Wenig is teaming up with a Lansing-area dental benefits firm on a clinical trial to create a simple, cost-effective saliva test to detect oral cancer, a breakthrough that would drastically improve early oral cancer screening.

It is estimated that oral cancer kills one person, every hour, every single day.

Trimira’s Vice President Jerry Trzeciak states that “Oral cancer is typically detected by a doctor, not a dentist, by which time it is usually a late-stage diagnosis,” he said. “In fact, 40 percent of those diagnosed with oral cancer will be dead in five years and 78% diagnosed with Stage IV, late-stage cancer will be dead in five years. Early detection of oral cancer would improve the survival rate to 80 to 90%.”

Trzeciak noted that fewer than 15% of those who visit a dentist get screened regularly; rarely is the best available technology used.

“When you look at the five-year mortality rate for oral cancer, it’s scary,” Trzeciak said at the AAOMS 91st Annual Meeting in Toronto. “Oral cancer is more deadly than the more familiar cancers: breast, cervical, and prostate, and also more deadly than liver, kidney, thyroid, or colon cancers.”

Oral cancer is growing at double-digit rates, despite declines in alcohol and tobacco use. That is due to HPV-16 and -18 spread through all forms of sex, but particularly oral sex. For that reason, oral cancer is increasingly showing up in the young adult population. The fastest-growing group is females in their forties.

According to the Times, Wenig, a professor in the College of Human Medicine’s Department of Surgery and lead investigator on the project, is working with Delta Dental of Michigan’s Research and Data Institute to compile study data and recruit dentists.

The study will enrol 100-120 patients with white lesions or growths in their mouths and tonsil areas to test as part of the clinical trial.

Wenig and his team will be looking for certain biomarkers previously identified by researchers at UCLA; the biomarkers have been shown in studies to confirm the presence of oral cancer.

By creating a simple saliva test which could identify the biomarker’s presence, physicians and dentists would know which patients need treatment and which ones could avoid needless and invasive biopsies.

Wenig is collaborating with PeriRx, a Pennsylvania company that will sponsor upcoming trials with the Food and Drug Administration.

For more on this story see: Simple Saliva Test to Detect Oral Cancer Early

Science Friday: Medicated Patch Fights Oral Cancer

As reported by Health News Digest, researchers at The Ohio State University Comprehensive Cancer Center have developed a medicated oral patch that allows a chemoprevention drug to be released directly into precancerous lesions in the mouth over an extended time.

In the study published online by the journal Pharmaceutical Research, Dr. Susan Mallery and co-investigator, Dr. Peter Larsen of Ohio State, tested a patch using simulated saliva as well as lab animals.

From the Heath News Digest article –

The study evaluated the drug fenretinide, a synthetic derivative of vitamin A that has highly promising anti-cancer properties. Until now, scientists have failed to achieve a therapeutic, systemic dose of fenretinide because of drug toxicity and rapid release from the body. By using a new mucoadhesive patch invented by a team from Ohio State’s Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC-James) and the University of Michigan, the researchers developed a delivery system that can provide continuous drug therapy to saliva-coated oral tissue.

In an online report published March 7 in the Journal of Clinical Oncology, the authors found an alarming trend: incidences of oral tongue cancer climbed 111% in young white females. This patch is an important step in fighting this rising cancer epidemic.

For more on this story see: Medicated Patch Shows Promise in Oral Cancer Prevention

Dentists Say Oral Cancer Screening is an Essential Role for Dentists

oral cancer foundation Dentists believe that oral cancer screening is an essential role for dentists. Our survey found that 96% of dentists consider oral cancer screenings to be an important part of their job.

“Oral cancer screening better be one of the services EVERY dentist should be offering on a regular basis. We do so at our office and have had a couple patients that have been officially diagnosed with oral cancer and before they saw us, they didn’t know they had it,” said one dentist.

Among survey respondents, 96% say oral cancer screenings are important; 4% offer screening, but believe other services they offer are more important; and 0% felt general dentists should not be performing oral cancer screenings for their dental patients.

Here’s a sample of what dentists had to say about oral cancer screening:

  • “My mom died from oral cancer and she was not in the risk groups. I make sure I tell all my patients that when I’m doing the oral cancer screenings every time I do an exam.” (New York dentist)
  • “I have found several. Unfortunately two were in late metastatic stages and the patients were terminal.” (Illinois dentist)
  • “I feel oral cancer screenings are important and we need more healthcare providers such as denturists, DHAT’s, CDHC’s, and independent practices for dental hygienists to work more on a public health level for those that can’t afford a trip to the dental office.” (Wyoming denturist)
  • “It should be done more often.” (Orthodontist)
  • “I do only visual; started by my hygienist and then confirmed by me with recommendations.” (Texas dentist)
  • “We have recently purchased the Velscope system because we understand the importance of advanced oral cancer screenings.” (Arizonia dentist)
  • “Whether using an adjunctive screening device, visual exam, or both, dentists need to be doing oral cancer screenings on a regular basis.” (General dentist)
  • “The incidence of oral cancers and HPV is increasing dramatically, and we need to do our part to change our patient’s awareness of this trend by screening our patients regularly.” (General dentist)
  • “A Velscope should be a required piece of equipment in every dental office. Ignorance is not Bliss!” (Oregon dentist)
  • “The question is ‘why aren’t all dentists and dental hygienists performing this life saving examination on all their patients?’ With the new technologies that are available . . .this exam should be mandatory!” (General dentist)

Read more: Dentists Firmly Believe in Oral Cancer Screening

April is Oral Cancer Awareness Month. For more information see the The Oral Cancer Foundation website.

Dentists Beware: Oral Tongue Cancer in White Females Jumps 111%

Oral Tongue Cancer in White Females Jump 111%April is oral cancer awareness month. Of course, dentists are on the lookout for oral tongue squamous cell carcinoma 12 months a year.

In an online report published March 7 in the Journal of Clinical Oncology, the authors found an alarming trend: incidences of oral tongue cancer climbed 111% in young white females.

For the past thirty years, occurrences of oral cancer have increased in both white men and white women, ages 18 to 44, but the trend is most noticeably advancing in young white women at an alarming rate.

Lead author of the report Bhisham Chera, MD, is the assistant professor in the Department of Radiation Oncology at the University of North Carolina School of Medicine.

Dr. Chera was quoted in Medscape Medical News stating, “Lately, we have been seeing more oral tongue cancer in young white women in our clinic. So we looked at the literature, which reported an increase in oral tongue squamous cell carcinoma in young white individuals, but couldn’t find any information about gender-specific incidence rates, so we decided we should take a look at the Surveillance, Epidemiology, and End Results data.”

For the past three decades, oral cavity squamous cell carcinoma has been on the decline, while oropharyngeal squamous cell cancer has been on the rise. The authors of the report felt these changes were most likely due to the decreased use of tobacco and the association between the carcinogenic strains of HPV and cancer of the oral cavity.

Dr. Chera and the other authors reviewed the HPV status of their young white female patients with oral tongue tumors.

They did not find an association between HPV and the 111 percent rise in oral tongue cancer cases.

Due to the fact that oral tongue squamous cell carcinoma is not usually associated with HPV, the doctors are searching for the possible root cause for the stark increase in cases.

According to Medscape Medical News, the authors of the report noted that oral tongue squamous cell carcinoma in young white women “may be an emerging and distinct clinical entity, although future research is necessary before broad conclusions can be drawn.”

Dentists and primary care physicians should be more cognizant of oral tongue squamous cell carcinoma in this group of patients,” said Dr. Chera. “At this point, the incidence is very small, and widespread screening may not be cost effective.”

“I would say that if a young white person has complaints of a persistent sore on their tongue, cancer should be moved up higher on the differential, based on our study,” he added. Dentists should not only examine dental health but also examine the tongue. They are in a position to provide effective screening.”

Have you noticed an increase in cases in your dental practice?

To read the complete article, visit Medscape Medical News.

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