Monthly Archives: February 2012

Consent – Dental Protection Part 4


In order both to understand the information provided, and to give the necessary authority for consent, a patient must be competent. “Competence” in this context means the patient’s ability to understand the explanations given, about:

  • The nature and purpose of a particular procedure;
  • Its likely effects and risks; and
  • Any alternative treatment and how these alternatives might compare. Continue reading

Oral Cancer: Treatment Options and Complications

Continued from Part 4

What are the principles of treatment for oral cancer?


Individuals with oral cancer often present too late for cure and some may not benefit from treatment. Three treatment options are possible:

  • Attempted cure
  • Active palliative care
  • Supportive care only pending death

If cure is attempted, the highest chances of success are given by multimodality treatment – a combination of surgery, radiotherapy, and more rarely, chemotherapy. The most aggressive treatment that the individual is able to withstand will be recommended because if the first round of treatment fails, the chances of survival are much reduced. Continue reading

Consent – Dental Protection Part 3


We can influence patients consciously or subconsciously by the way in which we communicate with them. For example

The words we use

Whether the words are written or spoken, a patient’s perception can easily be influenced by the words that we choose to use. Some patients will be particularly reactive or sensitive to the use of certain words (eg. “cut”, “drill”, “inject”, “bleeding”, “painful” etc); when you are discussing a procedure face to face you can usually see this reaction, and deal with it there and then. But when you use the same words in a letter, you don’t get this opportunity. Continue reading

Oral Cancer: Investigations and Staging

Continued from Part 3

What are the investigations needed for oral cancer?


Investigations are done to see the extent of cancer and to confirm the diagnosis. The following investigations may be indicated:

  • Jaw radiography or x-ray
  • Chest x-ray or computed tomography (CT). This is important as a pre-anesthetic check especially in individuals with known airways disease, and to demonstrate second primary tumors or spread to lungs or lymph nodes, ribs or vertebrae.
  • Magnetic resonance imaging (MRI) or CT of the primary site, of the head and neck, and suspected sites of distant spread. MRI is particularly useful to determine tumor spread, soft tissue involvement and lymph nodes involvement.
  • Electrocardiography
  • Blood test: full blood picture and hemoglobin, blood for grouping and cross-matching, urea and electrolytes, and liver function tests.
  • Biopsy. Biopsy is a tissue sample taken for histopathological analysis and it gives confirmative diagnosis. Continue reading

Consent – Dental Protection Part 2

A landmark legal case involving a medical practitioner (a surgeon) broke new ground just a few years ago and demonstrated just how far the UK courts would go in order to uphold patient autonomy, even in the face of well-established legal principles:

I start with the proposition that the law which imposed a duty to warn on a doctor has, at its heart, the right of a patient to make an informed choice as to whether, and if so when and by whom, to be operated on Continue reading

Oral Cancer: Risk Factors Part 3 and Symptoms

Continued from Part 2

Chronic infections

candidal leukoplakia in a person who smokes heavily ©

Chronic candidal infection

This is often associated with speckled leukoplakias and such lesions are particularly prone to undergo cancerous transformation, though the role of candidal or yeast infection in malignant transformation must be regarded as uncertain. Continue reading

Consent – Dental Protection Part 1

A patient’s informed consent to investigations or treatment is a fundamental aspect of the proper provision of dental care. Without informed consent to treatment, a dentist is vulnerable to criticism on a number of counts, not least those of assault and/or negligence – which in turn could lead respectively to criminal charges and/or civil claims against the dentist. Furthermore, the question of consent arises increasingly at the heart of complaints made under the NHS Complaints Procedure, and complaints to the General Dental Council on matters on professional ethics and conduct. Continue reading

Oral Cancer: Risk Factors Part 2

Continued from Part 1


Betel quid (paan) and other chewing habits

Paan chewing is one of the most widespread habits in the world and is practiced by over 200 million people worldwide. It is particularly common in South-East Asia and the Indian subcontinent and is also prevalent within these ethnic communities in parts of the USA. The composition of the quid varies but basically consists of betel nut and slaked lime wrapped in a betel leaf to which tobacco and various spices are often added. The quid is usually placed in the cheek pockets and is frequently kept in the mouth for a long time. As the quid is chewed, alkaloids are released from the nut and the tobacco which are said to aid digestion and to produce a slight euphoric effect. The habit is more common in women than in men, and although the frequency of use increases with age the habit often starts in childhood. Continue reading

Types of sterilizers used in dental setting

It is vital that the type of sterilizer being used is clearly identified as this dictates not only what can be processed in the chamber but also how the machine is tested and validated.

When purchasing a new machine the cost is obviously a focal point. What is often not apparent is the ongoing cost of validating the machine after purchase. This is particularly essential when purchasing a vacuum sterilizer. Continue reading

Oral Cancer: Facts and Risk Factors Part 1


Oral cancer is the sixth most common cancer reported worldwide. Oral cancer affects twice as many men as in women. For every 100,000 people, 6.3 males and 3.2 females are likely to develop mouth cancer. However this difference is less than it has been in the past, partly due to changes in smoking habits. Continue reading