As dental care providers it is our top priority to ensure that our patients are accurately diagnosed, educated, and protected from oral diseases. This is true when it comes to pathology in the oral cavity, especially for potentially dangerous disease processes like aggressive and malignant tumors. Some patients are not aware of the pathology occurring in them, so it is our job as dental professionals to give our patients an idea of each step of the process of handling dangerous pathology.
Prior to the Diagnosis
Perform a thorough head and neck examination to ensure you find all signs of the disease process. Be sure to obtain an accurate history of the patient’s medical, dental, and social history. Make sure that you do your best to discover any potentially risky habits or behaviors your patient may take part in (smoking, heavy alcohol consumption, poor diet). This information may be a helpful link to the final diagnosis. Document an accurate description of the lesion(s) in your patient’s dental chart. This is an important step as it can help you with your clinical impression and come up with differential diagnoses. Clinicians should provide a clear picture of the disease process when talking to their patients and referring clinicians who may become involved with the case.
“Many patients feel anxiety once they are told that there may be something wrong, so you may need to explain the process to them multiple times and give them an opportunity to ask questions.”
When discussing the pathology with the patient, use terminology the patient can comprehend. This is not the time to show off your oral pathology skills. The patient needs to have a clear understanding of your findings and what steps are needed to obtain a diagnosis and future therapy. Many patients feel anxiety once they are told that there may be something wrong, so you may need to explain the process to them multiple times and give them an opportunity to ask questions. Speak slowly and pause and ask the patient if they have any questions if you feel there is any confusion.
Use radiographs, intra/extraoral photos, or mirrors to show the patient the affected areas. Using visual aids gives the patient an idea of where the lesion is located and helps the dentist explain why it needs to be addressed. Avoid telling the patient a definitive diagnosis prior to receiving the biopsy report. Lesions can sometimes look more ominous in appearance but may be reactive or non-aggressive benign lesions, which can be treated by surgical excision. The last thing we want to do is scare our patients with incorrect information. Speak with your patient about the clinical impression and why having a biopsy completed is important. If you as the clinician are ever unsure about a lesion, reach out to colleagues for additional guidance.
After the Diagnosis
If you as the clinician decide to complete the biopsy in your practice, be sure to document the procedure and have the patient return to your practice for a postoperative visit. At this visit, share a copy of the biopsy report and explain the diagnosis and what the next steps are. If the diagnosis is in fact a tumor or disease process that requires long-term therapy, be there for your patient as they go through the treatment process. There is a team of other healthcare professionals who will be caring for the patient as they go through therapy. You may want to see how you can be a part of the interprofessional team. Being a part of this team not only ensures that dental care is addressed during treatment, but you also show the patient that you are there to support them. In the event the patient is referred out for the biopsy, be sure to document this referral, obtain a biopsy report, and document any therapy that will be required after the diagnosis is finalized.
“If the patient decides not to have the pathology addressed, be sure to address the importance of having the biopsy completed, and the consequences of not having the biopsy to the patient. It is also important to remember that the patient has autonomy over their health. We can encourage them to seek out therapy, but we cannot force them to undergo treatment.”
If the patient decides not to have the pathology addressed, be sure to address the importance of having the biopsy completed, and the consequences of not having the biopsy to the patient. It is also important to remember that the patient has autonomy over their health. We can encourage them to seek out therapy, but we cannot force them to undergo treatment. This can be hard to digest because our nature as dentists is to diagnose and to treat the problem, but we must remember the patient has the right to choose how their health is handled. Be sure to document the discussion you had with your patient and they have made the decision to forgo the biopsy or treatment after the diagnosis has been rendered.
The overall health and comfort of our patients is our primary goal as dentists. It is our responsibility to address any pathology noted in the head and neck region. We also need to help our patients comprehend the nature of the lesion(s) and the steps required for diagnosis and future treatment. Once a diagnosis has taken place, we can be there for our patients by continuing to provide any dental treatment that may be needed prior to, during, and after treatment of the pathology. We should let our patients know that we care and will be behind them as they go through the process of treatment.
Dr. Rashida Wiley is an Oral and Maxillofacial Surgeon practicing in Sacramento, CA. She received her DDS from Meharry Medical College, earned her certificate at the Oral and Maxillofacial Pathology Residency Program, and has served as assistant professor at the University of New England College of Dental Medicine and the University of Kentucky College of Dentistry.