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Oral cancer - a tale of two patients

Blog Author Robert Donald

Blog Date 21/09/2018

Dentist examines patient


I picked up a follicular lymphoma in one of my patients in January 2014. Brian had no symptoms or discomfort and was in for his 6 monthly dental examination.


I noted a small lump on one of his tonsils. He is a retired non-smoker and a "social " drinker (he had previously been a smoker, but gave up 25 years ago). He managed to see his GP, who is also a part time oncologist at Raigmore hospital, the same day as my appointment and she did an urgent referral to oral max fax and treatment was commenced quickly.


He wrote to me soon after the lump was removed. 


For the attention of Dr Robert Donald:


During my appointment on 17 January (6 month check) you advised me to see my GP as you found a lump on one of my tonsils. My GP has asked me to pass on her thanks and congratulations as your intervention has led to a diagnosis of Follicular Lymphoma following the removal of the lump (a tumour) and a full CT scan. Obviously I add my thanks to you for your vigilance and advice. I have an appointment with a haematologist at Aberdeen next week and will find out whether treatment is to follow.


Rest assured that all this has not made me 'dental phobic' and I shall phone asap for an (overdue) appointment with the dental hygienist as I had to postpone my arrangement for April.


Yours in gratitude




I also had another retired patient recently who had not been in for a dental exam for a year. He had a symptomless lump on his tongue. He had been to see his GP as he had been feeling a bit run down but his GP could not find any problem. He did not have any history of smoking or alcohol consumption. The oral surgeon who saw him did not suspect anything sinister and wrote me a letter to this effect.


However his biopsy result revealed an aggressive cancer. The patient sent me a very nice letter before commencing treatment thanking me for picking this up. He kept in touch with me, letting me know about his progress. Unfortunately he did not survive and died of the cancer shortly after.


I think these two cases highlight the importance of early detection and the need for at least six-monthly oral examinations. Both patients did not flag up for risk factors (although the patient who survived gave up smoking 25 years earlier).


I often wonder "what if". If the second patient had come to see me sooner, perhaps I could have saved his life?


Regardless of what the Scottish government comes up with in their guidelines about examination intervals, I know that in my 35 years' experience of being a General Dental Practitioner, it is in my patients' best interest to come for an exam at least once every six months.


Robert Donald

Chair, BDA Scottish Council


Oral cancer in Scotland - turning the tide

We are currently surveying dentists in Scotland to find out about their views experiences of oral cancer services. The survey results will help us shape an action plan and national referral pathway to be presented to ministers in the Scottish Government in November. Through this we hope to achieve improved outcomes for patients through prevention, early detection and uniform access to the best current surgical and restorative treatments.


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