Solicitor Graham Balmforth, reviews the causes and effects of oral cancer, its diagnosis and where it may have been missed or misdiagnosed by a dentist.
Oral Cancer
Introduction
Probably among the least well publicised diseases, oral cancer, like any cancer, can affect anyone. Oral Cancer appears at a statistically higher rate in men over 50. It is the 11th most common form of cancer recorded. In the UK the rate of diagnosis of oral cancer has risen by 50% in the last 10 years. The current reliable figures (2011) indicate a total diagnostic figure of 6767 cases. Antagonistic features are tobacco and alcohol usage although the human papillomavirus is now linked to the disease and is set to become a significant diagnostic indicator for clinicians.
Oral cancers appear in various forms and can effect all parts of the mouth including the tongue. The most frequently occurring sign is the appearance of a mouth ulcer which appears resistant to treatment. White or Red patches in the mouth are also typical of the early appearance of the disease. Additionally, bumps or lumps in the jaw or neck can be an early visual indicator.
The most common type of mouth cancer is Squamous cell carcinoma which accounts for 9 out of 10 treated cases. Also appearing regularly is oral malignant melanomas (which can appear anywhere inside the mouth) and adenocarcinomas which usually appear in salivary glands.
Your Dentist
It is of course not regular practice among the population generally to make regular visual inspections of the mouth and tongue and in fact it is typically the case that only when something feels wrong to us that we will seek confirmation from an expert. However, if you are a regular visitor to your dentist then, it is appropriate that s/he will be undertaking visual inspection for you. Clearly a Dentist has access to tools and equipment that will allow a better inspection than you can perform in front of the bathroom mirror and your Dentist has the advantage of specialised training in what should appear normal or otherwise. At check-up the Dentist should perform a full oral cavity inspection and use a mirror to access every part of the mouth to inspect for irregularities. If there is any doubt in the dentist’s mind that there may or may not be something of concern present, then he has the full capability to refer to a specialist direct without the intervention of your GP. A typical complaint made by our clients is that the Dentist attempted several courses of antibiotics in a frustrated attempt to shift persistant ulcers or advised stronger and stronger mouthwash and / or medicated toothpastes before finally giving up and making a referral that should realistically have been several months earlier.
Dental Negligence
There are regular and unfortunate instances of dentists not picking up on oral cancer at all. There are also instances of misdiagnosis and of delayed diagnosis. In each case the effect is similar, the cancer has more time to develop and spread, which in turn makes treatment more difficult and with less chance of success. In some cases the delay may well mean that the cancer has advanced to the stage where intrusive surgery is required where, had the matter been diagnosed earlier then the non-invasive therapies and medication could have been deployed successfully such as Radiotherapy or Chemotherapy.
The use of a full visual inspection at check-ups is easily discarded by a busy Dentist who has a waiting room full of patients. The consequences for the individual whose disease goes untreated however, could not be more significant.
The Diagnosis and Treatment
It would seem that at the moment, diagnosis is usually forthcoming after a biopsy, this may be taken by your dentist or it may be an issue for the cancer unit of your local hospital. If you suspect oral cancer but your dentist has failed to act or you feel that your concerns are not being addressed adequately then you should seek second opinion from your GP in the first instance. They may be able to refer you to a specialist. In any event following biopsy and subsequent diagnosis it would appear that treatment is usually swift and successful. The combination of chemotherapy radiotherapy and surgery has proved to be more effective than any one treatment taken into isolation.
Recovery rates following early detection are good and survival rates are high. The efficacy of treatment though is largely dependent upon early diagnosis and to this end statistical research is currently being collated. One thing is quite clear though, Dentists are at the front line in fighting this cancer and it is their expertise that can make the difference for any individual.
How can we help
At Applebys we have significant experience of both Squamous cell carcinoma and adenocarcinomas, having litigated on these cases extensively. We have a bank of experts who have up to date practice experience in these areas and are fully aware of how best the complexities of coming to a diagnosis (often working backwards from treatment or late presentation) should have worked for your treating Dentist. Additionally, we are aware, through our extensive experience of how best to martial the evidence in such cases and how to formulate the schedule of damages which can be very extensive indeed. Taking this level of service together with our Dental No Win No Fee written guarantee and it is no wonder that Applebys is a first choice for such a large segment of the public seeking redress.
Graham Balmforth March 2016.