I am writing in response to Dr. Charles Hapcook’s November JADA column, "Risk Management Considerations for Oral Cancer" (
JADA 2005;136: 1566–7
). Dr. Hapcook writes, "For abnormalities or suspicious lesions found during the evaluation, the dentist should either schedule the patient for a reevaluation or properly refer the patient. Failure to follow these procedures on a timely basis can result in a more severe medical and dental consequence for the patient and an onerous legal consequence for the dentist, especially in the case of oral cancer."
Many JADA readers, no doubt, are well aware of the value of the oral brush biopsy in the early detection of precancerous and cancerous oral lesions. The great majority of oral abnormalities are not "suspicious" and, therefore, do not warrant referral or need for biopsy. Rather, dentists are faced, almost daily, with evaluating lesions that have minimal or no suspicious features, and no obvious etiology.
It is precisely these types of lesions that dentists should evaluate with the brush biopsy, since some will prove to be pre-cancerous or cancerous, despite their benign appearance. These types of lesions develop in all ages, including in young patients, in those with no risk factors for oral cancer and, increasingly, in women.
Personally, I have found the brush biopsy to be an invaluable and reliable tool in my practice. The brush biopsy provides my referring dentists and, more importantly, my patients, assurance that a lesion is evaluated adequately at the time it is detected—not two weeks later. My patients are already extremely apprehensive about undergoing a surgical procedure in their mouth, but the noninvasive brush biopsy is a stress reliever for my patients and for me.
Dr. Hapcook writes about the legal consequences of misdiagnosing oral cancer, yet his omission of the brush biopsy is ironic, given an editorial by Glazer,1 who writes, "Since the brush biopsy is not a difficult procedure to perform, requires no anesthesia, causes minimal or no bleeding or pain, and carries the ADA Seal of Acceptance, the failure to evaluate oral lesions that may be precancerous or cancerous, even when you do not suspect them of being so, is inexcusable, and makes you liable!"
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