Editorial: Dragged Kicking and Screaming into the Ether

Editorial: Dragged Kicking and Screaming into the Ether

William E. Stein, D.D.S.*:

I had always considered myself a “progressive” dentist in the best sense of the word; “progressive” sadly has become a pejorative term for a political faction to which I most emphatically do not subscribe. I always tried to be in the forefront, up on the latest things, but sadly as time marched on I found much to my chagrin that I had become a Luddite (look it up).

One cold January day I made the frigid trek to Duluth for a meeting of the truly-in-the-true-sense progressive Northeastern District Dental Society. One of the speakers was a prominent periodontist, who spoke on oral cancer detection. As you dear readers will note, we have an excellent article on oral cancer in this issue**, so I will sit here calmly and wait until you read it and return …

Welcome back! For my last 38 years in dental practice, I have lived with the constant fear that I would miss a diagnosis of oral cancer in one of my patients. Oral cancer is not common. As the clinical article states: “The Minnesota Oral and Maxillofacial Surgery Department since 2008 has been referred 69 cases of oral and pharyngeal cancer.” Of course, a lot of the cases wind up in the capable hands of our ENT colleagues.

In the course of my career I have diagnosed five or six cases. Most were painfully obvious, but a couple were really sneaky. Of course, in a small town, these patients also happen to your best friends. One dear lady presented with a really mean looking gingival lesion on the papilla of tooth #28. We sent her for a perio consult. The specialist, one of the best I have ever known, thought it was some kind of inflammatory reaction. While it certainly looked like it, there was just something weird about it - cancer many times “just doesn’t look right”. I sent my friend for a biopsy, which turned out to be squamous cell carcinoma “in situ”. Thank God it was caught in such an early stage that the extraction of two teeth and removal of the surrounding bone were all the treatment she needed. She was restored with a fixed partial denture with gingival shaded porcelain in the pontic area.

One case I missed, or maybe couldn’t have found, was a case of pharyngeal cancer in an 18-year-old young lady I had known from birth. She was a Girl Scout, raised in a family that subscribes to clean and virtuous living, yet here she was diagnosed by her physician after having persistent pain upon swallowing.

We never know where this disease will strike.

Getting back to the dental meeting, the speaker showed us a new aid in oral cancer diagnosis, the VELscope.† From their promotional material: “VELscope is a revolutionary hand-held device that provides dentists and hygienists with an easy-to-use adjunctive mucosal examination system for the early detection of abnormal tissue. It is based on the direct visualization of tissue fluorescence and the changes in fluorescence that occur when abnormalities are present. The VELscope Handpiece emits a safe blue light into the oral cavity, which excites the tissue from the surface of the epithelium through to the basement membrane (where premalignant changes typically start) and into the stroma beneath, causing it to fluoresce. The clinician is then able to immediately view the different fluorescence responses to help differentiate between normal and abnormal tissue. In fact, VELscope is the only non-invasive adjunctive device clinically proven to help discover occult oral disease.”

Well, that’s quite a claim, but being a slight bit color challenged, anything that would help me in my oral cancer diagnosis would be welcomed. So I bought one, and I was most pleased with the results. The company naturally wants to promote its product, so they mention that a modest extra charge for the exam will pay for the unit and it will become an income source. I think enough of it that I don’t charge any extra for it. It is good insurance for me, reducing the risk of missing a lesion. In fact, since we started using it, we have already diagnosed one premalignant HPV palatal lesion on a middle-aged woman.

Much to the credit of the company, they have vastly improved the product; the original was fairly expensive, bulky, needed time to warm up, and was suspended on a cord. The new unit is cordless, starts instantly, is brighter, and it is easier to visualize the tissues – and, it’s about half the cost of the original. How often does this happen?

Happy with the success of my VELscope venture, I blissfully attended a local “hi-tech” dental expo. I left after purchasing a digital X-ray system. I love it. I can’t imagine I practiced so many years without it. Of course, then our office management software didn’t fit the X-ray program, so we had to buy a whole new system. I am blessed with a very computer-savvy staff, but still, change is tough. I remember one day a patient said, “Wow, that’s quite a program!” I replied that yes, in the future we hope to be totally paperless. My dear office manager overheard and gently whispered to me, “We’ve been paperless for over a month.”

I also bought a digital impression system, which is wonderful when either I or it performs our duties correctly. I live in hope.

Inspired by all this I got a smart phone, an Android.

Then the transmission went out on my faithful eight-year-old Explorer SUV. I traded it for a shiny red Escape with a computerized navigation system. The young man who sold it to me said, “Do you have a cell phone?”

I said, “Why yes, an Android.”

He replied, “Great, watch this.”

He hit a few buttons, and my cell phone and all my contacts were installed into the brain of my new car.

If only I can live long enough to figure out all the stuff that this artificial intelligence can do for me and my patients!

To quote the “Beach Boys” (look them up, or Google or better yet Bing ‘em): “I guess I just wasn’t made for these times.”

 

†The author does not have any financial interest or association with the manufacturers of the products mentioned in this article.

 

*Dr. Stein is Executive Editor of Northwest Dentistry. He is a general dentist in private practice in Aitkin, Minnesota, AitkinDent@AOL.com

**“Maxillofacial Oncology at the University of Minnesota: Treating the Epidemic of Oral Cancer” by Jill Sink, D.D.S., and Deepak Kademani, D.M.D., M.D., FACS, Northwest Dentistry, May-June 2011, pages 13-16.