Dentistry/Velescope

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Question
QUESTION: Hi,
My husband goes every 6 months to his dentist for a cleaning. He uses the velescope to check his mouth and every time the area on the left side of his tongue that breaks out in geographic tongue spots always shows up darker. But he has a few smaller areas on the tip of his tongue that don't show up dark under the light of the velescope. Why would on ares present darker constantly and thd other not? Is this normal?
Plus the area on the back left side gas a permantly bare lighter spot like the taste buds are gone for good. Is this also normal for gt? He did have the biopsy done like 2 yrs ago showing chronic inflammation consistent with gt for some reason I still worry its more like oral cancer.

Always shows up darker

http://i1209.photobucket.com/albums/cc393/kkingery83/EFF0C23D-EDD2-4A1F-8FA6-863

Had never shown darker

http://i1209.photobucket.com/albums/cc393/kkingery83/53014F19-1F10-4ECC-B776-962

ANSWER: Hi Kim and thanks for your question.

My biggest concern is not the health of your husband's mouth, which has been confirmed by your dentist at his regular 6-monthly recall appointments as well as getting the all clear after having a section of his tongue biopsied, but your inability to accept the repeated all-clears which his oral health gets.

In brief the the VELscope system is NOT a diagnostic test, but is rather an adjunctive visualization tool, which helps dental professionals discover a wide range of unhealthy tissue in the mouth, including oral pre-cancer and cancer. However, the VELscope is NOT a stand-alone diagnostic test and must be used in conjunction with the standard oral soft tissue exam and hence the clinical findings must be interpreted with insight of oral health and disease process in mind. It also has the ability to detect several other intra-oral conditions such as viral, fungal and bacterial infections, inflammation from a variety of causes (including lichen planus and other lichenoid reactions), squamous papillomas and salivary gland tumours. And I mention these not for you or your husband to start worrying about another condition which he does not have, but only to illustrate its range of use and a positive result does not mean cancer necessarily. I cannot teach you what you think you need to know to be able to positively diagnose oral cancer in your husband - for that you should find a clinician whom you trust. Your very clear obsession with oral cancer is certainly not healthy Kim and you should be aware that stressing and worrying about any condition, whether its present or not, is placing your body under undue strain, including that of your immune system.  There are many reports world wide of people who has overcome cancer by keeping their minds strong and focused and "willing" themselves healthy again. Don't let your mind run away with you and affect your general health in a negative way or give in to the obsessive tendency of doubting what educated professionals have told him repeatedly.  

I am sure that you can appreciate the difficulty of my position, not being able to examine your husband and only being presented with random intra-oral images of various sections of his mouth, with no pattern, chronological order or correlation to each other - other than your, and forgive me, perceived hypochondria and obsession with oral cancer. You cannot expect me, from what you have sent me repeatedly, to give your husband a diagnosis of anything other than which he has received repeatedly by several clinicians - even the biopsy results indicate chronic inflammatoric change, consistent with GT and if any other area of your husbands mouth had pathology, this would have been identified and pointed out at consultation. Otherwise please assume that there is nothing of concern for either you or him. The mouth is not static environment and the oral cavity of everyone varies greatly. Just because the appearance of one region varies in some respect from others, does not make it in itself pathology. Again, this is why we spend considerable years at University, in the hope that one day our patients will be able to put their faith in our knowledge and in so doing be able to make their lives a bit less complicated and stressful.

All I can suggest, again, is for your husband to address these concerns with his dentist directly, just to make sure that all is still fine, because clinical examination is a vital part of making any diagnosis - which I sadly do not have the benefit of, communicating with you in this way.  I wish you both the very best, all the same, and trust that at some point, you will be able to put the correct level of faith in the hands which are trying to heal you.

Kind regards
Dr Craig Peck

---------- FOLLOW-UP ----------

QUESTION: I know I am obsessed with oral cancer. This obsession started over two yeas ago. My husband has used smokeless tobacco since I have known him. I never inches looked in his mouth or even thought about cancer. He went to his dentist and came home and said the dentist said he needed to cut way back bc he had a patch in his cheek and he wanted to see him in a moth. Since then I have worried. He got the all clear and even quit for 6 months only to start back up. It doesn't matter what I do he doesn't want to stop. I know I can't force him but I am always worried bc he chews. I hate worrying it takes up so much time and energy in my life that I could be spending with my two young daughters. I have tried many things like medication and thearpy and nothing has helped me get through this. I would give anything to have a normal life free from this constant fear and obsession with oral cancer. I guess I ask questions bc the reassurance helps me even if is for a short period of time. I know many people who use smokeless tobacco and there spouses don't check there mouth or worry about cancer. I tried everything and I don't know where to go from here. So I guess with my first questions why would one area of gt show up dark under the velescope and the other area look normal. Do you know why that's would happen?

Answer
Hi Kim

Well, I am pleased that you are aware of this unhealthy obsession, but continuing in this manner is hardly a way to address the problem and by me constantly replying to you, I feel I am only feeding your obsession. You are more than welcome to ask me questions in the future but I will not reply to any questions which involve your husbands soft tissues and likelihood of oral cancer. With him using any form of tobacco, there is a increased risk of developing cancer, although this is not a certainty. The most you can do is keep trying to motivate to put an end to using all together and making sure that he he doesn't miss his 6-monthly recall  check-up appointments. Has he considered hypnotherapy for stopping - its actually quite effective and hassle free, do some internet research and try to find a licensed practitioner in your area who could help you. I hope you understand the reasoning behind my decision not encourage your obsessive behavior pattern with this issue, but just know that I have not abandoned you and will gladly help out where ever i can in the future. Best of luck and it is encouraging to see that a good woman such as yourself cares about the man she is married to - well done.

Kind regards
Craig

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Dr Craig W Peck ( B.Med.Sc., B.Ch.D., Clin. Botox, Cosmet. Derm.)

Expertise

I am a General Dental Practitioner, with special interests in Cosmetic Dentistry & facial aesthetics and Periodontology, placing a strong emphasis on the establishment and maintenance of a healthy periodontium (the support structure of the tooth) before cosmetic options are considered. I uphold all principles of prevention above interventional treatment and try as far as possible, to remain conservative in my approach. I believe in detailed, open and honest patient discussion, establishing what the patients expectations are and what the reality is of achieving this and involving the patient at every level of the treatment. I have strong principles on ethical treatment and appropriate patient management. I have chosen to treat and rehabilitate many nervous and phobic patients, who, for whatever reason, find it impossible to take part in the very important task of even a routine check-up. I will accept questions relating to general and cosmetic dentistry (in conjunction with the use of facial cosmetic procedures) and dental fears/phobias. I will be more than willing to answer any academic questions in dentistry, biology, physiology, psychology and health sciences in general. As most dentists will tell you, there is often not only one way of dealing with a dental issue - so very often, there is no precise right and wrong way of approaching the problem. All clinicians vary when it comes to treatments and what works best in their hands is often the treatment that is advised. Be understanding of this and bear in mind that nothing lasts forever! Patients are happy to accept only a one-years warrantee when buying a new car, but seem to expect that dental work is going to last them their lifetime.

Experience

I have worked for many years in the UK and RSA as a general dental practitioner - within the NHS, private practice and the government dental health services. I am certificated for the administration of Botox and Dermal Fillers for facial lines and wrinkles as I have attended further courses in minimally invasive facial cosmetic procedures. I started seeing an increasing number of patients who presented with severe to moderate dental fears, even with full-blown phobias, so I started with the slow and patient task of tackling this problem and have successfully rehabilitated many patients. The key is good, effective, concise and understandable communication, shifting control from the dentist to the patient in order to slowly, but confidently, regain their trust back in dentistry, thereby giving them the feeling of achievement and this self-empowerment which drives them to the next level of treatment.

Organizations
Academy of General Dentistry. American Dental Education Association. IAPAM (International Association for Physicians in Aesthetic Medicine). Professional Speakers, Writers and Managements Consultants in Dentistry. The British Dental Association. UK Aesthetics Group. ARC - Aesthetic Professionals. Botox. Aesthetics & Beauty. American Association for Dental Research. FDI - World Dental Federation. SOURCE1uk. World Dental Hygiene Forum. ProDentalCPD. Public Health Dentistry. Dentist Network. LinkedIn. Who's Who of South Africa.

Education/Credentials
B.Med.Sc. Degree (Medical Physiology and Medical Virology; Physiology Cum Laude; Stell 1994). B.Ch.D. Degree (Bachelor of Dental Surgery; Clinical Dentistry Cum Laude; Stell 1997). CPR and CPR-Advanced Courses (2000/2001; UK). Clinical Botox (UK, 2001). Cosmetic Dermatology (Botox and Dermal Fillers; RSA 2011).

Awards and Honors
Placed on the Dean's List at University for academic achievement (1994). Highest achievement in the subject Dental Materials. Medal from 3M and the Radiology Association of South Africa for highest achievement in the subject Dental Radiology and Imaging. Medal from The Periodontal Association of South Africa for highest achievement in the subject Periodontology. Highest achievement for Oral Medicine. Highest achievement in Oral Pathology. Received the DASA (Dental Ass. of South Africa) Gold Medal for highest achieving dental student across the 5 1/2 years of the Degree. Passed the subject, Clinical Dentistry with distinction in final year.

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