Dental Tribune United Kingdom Edition

May 23-29, 201110 Feature United Kingdom Edition E lderly patients are often ac- companied to a consulta- tion by well meaning adult children. These children, them- selves parents, especially those with some medical knowledge, often second guess treatment. They often want second opinions from others not related to dentistry. These “others” do not know the full extent of a dentist’s or dental spe- cialist’s training and background, and they then take over treatment. This is very often to the detriment of the patient, leading to expensive, unnecessary and harmful results. Case report An elderly lady living with a carer in a retirement home, was brought in by her daughter, who is a phar- macist. Her son, an ENT Surgeon, lives overseas. The main problem was a painful swelling of her face, present for 10 days. She had been earing a full upper denture which was now uncomfortable. The only significant medical problem, apart from early dementia, was that she had been a smoker for many years, but had given up 20 years ago. The extra oral examination re- vealed a oedematous swelling of the right side of the upper lip and cheek. There was also a swelling of the right submandibular lymph node. At the time this was thought to be as a result of the inflamed swelling of the cheek. The intraoral examination re- vealed an ill fitting upper denture with a large and inflammed swell- ing of the buccal sulcus around the 16 area where there was a root present. A panorex xray demon- strated the presence of a root in the 16 area. A radiolucency was visible above the apex and extending into the maxillary antrum. Clinically the lesion was suspicious for a ma- lignant neoplasm, but as there was an inflammation from the 16, irri- tated by the denture it was decided to treat the patient with antibiotics for a week and then to reassess for possible biopsy. Now the interference kicked in. The daughter, unbeknown to me, decided to take her mother to head and neck surgeon for a second opinion, who decided to remove the submandibuar lymph node under GA. He had diagnosed the lesion as lymphoma and was mak- ing arrangements for the lady to undergo chemotherapy thereafter. It was now that I was informed by the daughter of what was to take place. Apart from the fact that both the daughter and the head and necksurgeonhadnotspokentome about the second opinion, my fear was that the chemotherapy would lower the lady’s resistance to infec- tion and that the roots should be removed. Reluctantly the head and neck surgeon and the ENT son al- lowed me to be present in theatre at the time the lymph node was to be excised, so that the roots could be removed. To my horror the large ulcer in the mouth had not healed, but in fact had enlarged. The head and neck surgeon still thought that the ulcer was related to an infection from the tooth roots. However, I insisted that some tis- sue from the ulcer be sent away for histopathlogical examination. The Pathologist confirmed that was in fact a lymphoma. Had there been no family inter- ference, I would have biopsied the lesion under local anaesthetic and made the diagnosis. The patient would not have had to undergo a procedure to remove a lymph node and neck disection and could have been referred on for the chemo- therapy. Interference in treatment by members of the family often leads to an adverse outcome. DT Family Interference About the author Dr Mike Ostrofsky B.D.S., M.Dent (MFOS)(Wits)is a Maxillo Facial and Oral surgeon in practice in Cape Town. He holds an appointment as a part time senior consultant in the departments of Maxillo Facial and Oral Surgery at the University of the Western Cape and at No 2 Military Hospital. He has been in private practice for 35 years and his main interests are in implantology, or- thognathic surgery, TMJ surgery and dento-alveolar surgery. Dr Mike Ostrofsky discusses how a little bit of knowledge can adversley affect treatment