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: Poor Oral Hygiene Linked to Higher Cancer Risk?

Science Friday: Poor Oral Hygiene Linked to Higher Cancer Risk?An observational Swedish study has revealed that out of almost 1400 people studied between 1985 and 2009 where 35 of the participants died of cancer, the cancer patients had higher levels of dental plaque than the survivors, as reported by Time.com.

The researchers at the Karolinska Institute and the University of Helsinki revealed that participants in the study with high levels of dental plaque were 80% more likely to die prematurely of cancer during the 24-year study period than people with little to no dental plaque.

According to the Austrailian News, the study authors wrote, “Our study hypothesis was confirmed by the finding that poor [mouth] hygiene, as reflected in the amount of dental plaque, was associated with increased cancer mortality.”

The reasearchers have not determined that bad oral hygiene actually causes cancer, but state that what they found was only observational. But they warn that plaque could be a contributing factor in people with existing genetic predispositions to cancer.

“We don’t know if dental plaque could be a real causal part of cancer,” lead author Birgitta Soder of the department of dental sciences at the Karolinska Institute tells Time.com. “But it is a little scary to see that something we all have in our mouths can play such a role.”

What are your thoughts? Do you think poor oral hygiene can contribute to a higher cancer risk?

Read more at: Got Plaque? It May Be Linked with Early Cancer Death

Dental Care: Do Dental X-Rays Cause Brain Tumors?

Dental Care: Do Dental X-Rays Cause Brain Tumors?Last week the American Cancer Society published Yale University research findings that dental patients who received frequent dental X-rays a generation ago, are at greater risk for developing meningioma, a non-cancerous brain tumor.

The Yale study involved more than 1,400 dental patients from around the U.S. who were diagnosed with the non-cancerous tumor. The study also tracked a similar group of dental patients who did not have a meningioma.

What the Yale researchers discovered is that patients with meningioma were twice as likely to have had dental X-ray exams where they bit down on a tab of X-ray film at least once a year when they were children.

An even greater link was discovered between meningioma and the single X-ray outside of the mouth. Dental patients who had the panorex dental exam when they were younger than 10-years-old had almost five times greater the risk for meningioma.

Since the research publication dentists have found themselves on the defensive regarding dental X-rays.

The American Dental Association released a statement on the study asserting the following, “The ADA has reviewed the study and notes that the results rely on the individuals’ memories of having dental X-rays taken years earlier. Studies have shown that the ability to recall information is often imperfect. Therefore, the results of studies that use this design can be unreliable because they are affected by what scientists call ‘recall bias.'”

In the ADA statement, Dr. Alan G. Lurie, a radiation biologist and head of radiology at the University of Connecticut School of Dental Medicine, voiced concerns about the study’s design and outcomes. “I think it’s a very flawed study,” said Dr. Lurie, who is also president of the American Academy of Oral and Maxillofacial Radiology.

He characterized at least one outcome of the study—reflected in a table that related meningioma risk to types of dental X-ray examination—as “biologically impossible.”

Said Dr. Lurie, “They have a table, Table 2, in which they ask the question, `Ever had a bitewing,’ and the odds ratio risk from a bitewing ranges from 1.2 to 2.0, depending on the age group. Then they asked ‘Ever had full mouth’ series, and the odds ratio risk from a full mouth series ranged from 1.0 to 1.2.

“That’s biologically not possible because the full mouth series has two to four bitewings plus another 10 to 16 periapicals. A full mouth series, just to round things off, is 20 intraoral X-rays of which two to four are bitewings. They are showing that one bitewing has 50 to 100 percent greater risk than a full mouth series that has multiple bitewings plus a bunch of other films. That’s biologically not possible.”

Explaining this gross internal discrepancy is difficult, as the epidemiologic and statistical methods are widely accepted, Dr. Lurie said. He attributes the perceived discrepancy in the data to possible recall bias in the patients involved in the study.

“Epidemiologists are very aware of this bias,” Dr. Lurie said. “What happens is you’re asking people to remember what kind of dental X-rays they had 10, 20, 30 or 40 years ago. It’s anecdotal, and the argument is that it’s just as anecdotal for the group without meningiomas as it is for the group with meningiomas. That is not necessarily true.”

In this week’s survey, The Wealthy Dentist asked dentists if the news reports will change how their dental practice uses X-rays. We are curious what dentists think about the study and if any patients are calling dental practices questioning X-rays.

To take part in the survey, click here, or leave us a comment and tell us your thoughts on dental X-rays and this study.

For more on this study see: ADA Releases Statement on Dental X-rays Study

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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