When I have the opportunity and the
privilege to speak to dental students
what I tell them is that they are the
front line for protecting their patients
from oral cancer. It's a rare
disease, but they need to have a high
level of suspicion. Every patient that
they see they need to examine their neck,
look in the mouth, and if there's a
concerning area, they need to refer that
patient for an evaluation and biopsy.
>>As dentists, as dental students, it's very
important when a patient comes in to
perform a visual and tactile exam of the
oral cavity, looking for any lymph nodes,
abnormal lymph nodes, and then you go
inside the mouth, and you know, during
dental training you're taught what is
normal, and so anything that deviates
from normal, you have to document and
decide, "well, what's going on?"
>> One of my favorite quotes that I give to students
all the time: "Remember, there's a person
attached to those teeth." Because what
happens is students get so focused on
the teeth that they don't look around at
the rest of the tissue and do a proper
extraoral and intraoral exam, and it all starts
with diagnosis -- early detection -- no two
cancers really look alike, and you know,
they shouldn't think that "oh well, it
didn't look like that; it can't be a
cancer." >>So the beauty of our Oral Cancer Center here at NYU College of Dentistry
is that we have a number of specialists
that all play a part in the
multidisciplinary treatment and
management of these patient populations.
One is the oral and maxillofacial
pathologist, and they're very important
because when we take a biopsy, that
tissue is sent to the pathologist. >>No
diagnosis can be made without a biopsy,
and a tissue biopsy is the gold standard
of diagnosis. Tissue in the mouth is
three-dimensional, so that doesn't
always translate well onto the slide. So
that can make it very difficult
to determine whether it's part of the
cut, or you know, there was actual
infiltration. So what we do is we consult
with other pathologists, and we're very
fortunate here at this large institution
to have multiple oral pathologists, so
whenever there is some uncertainty, we
have other people and other pathologists
to give second opinions and consult with,
which we often do before we sign
out any malignancy. >>So trying to get
these patients, working to get these
patients where they're restored to
health is an enormous challenge, and the
challenge is greatest for the patient. It
involves dentists who need to restore
their teeth, and we often work with a
maxillofacial prosthodontist, who has
expertise in replacing both hard and
soft tissues. What's unique about the NYU
Oral Cancer Center is we've been able to
get those individuals all working
together.  >>I think many of the dentists themselves
don't know what the existence of the
maxillofacial prosthodontist is and what
they can do. So my job here is to make
sure that I fabricate prostheses that's
going to allow the patients to be able
to do all these normal things that we do
every day, and then they are able to heal
as fast as they can.
Having the coherent team here is super
important, so it's not the amount
of a time or how many communications
that we actually exchange between other
team members, but rather like are we
communicating efficiently and
effectively for the patients to be able
to provide the right type of care at
the right time but we need more of a
maxillofacial pathologist for managing
this type of patients. >> In a lifetime or
in a career, in a 30 year career, you know,
a dentist is not going to come across
many cancers, but you know, if you're
looking, then you can really make an incredible
difference to that patient's life.
you
