Article
The importance of routine dental examinations
I would like to share with you a case that I witnessed lately. The emphasis is on the importance of routine dental examinations and checking for intra- and extra-oral changes at these appointments. An 86-year-old female patient presented with a well-defined, non-tender soft swelling at the junction of the hard and soft palate, which was not related to any of her teeth. The size of the swelling was 3 x 3.5 cm. She had no dysphagia and described it as being present on and off for a few years. The swelling had been picked up by her new GDP, who referred the patient to the maxillofacial department. She wore a maxillary denture
Medically, the patient had a history of atrial fibrillation, asthma and anaemia. Tests included a fine needle aspiration, which was suggestive of a low-grade polymorphous adenocarcinoma. A biopsy showed that it was either a low-grade salivary gland tumour, or a low-grade adenocarcinoma. Another possible tumour that can develop in this area is an adenoid cystic carcinoma, which is more malignant. Investigations included an urgent full blood count and a head and neck MRI, which showed palatal bony erosion into the nasal cavity. Treatment was planned to excise the tumour with a partial maxillectomy, followed by a reconstruction with a temporal muscle flap. An obturator plate was fitted, which would impact her quality of life (Figure 1).
As dentists we need to remember to scan the whole oral cavity, including the soft tissues, during our routine examinations. Moreover, we need to educate our patients and the public that seeing a dentist is not only for teeth, or when you have toothache, but also to detect such tumours early. This education can be given in person, or through national awareness campaigns via the media.
This case is a reminder of the need to look at the whole mouth.