I have blogged about mouth cancer before. We had mouth cancer screening days in the practice, there was a national mouth cancer awareness day.
It’s not one of the more famous ones, there isn’t a national campaign where we wear a ribbon or a flower or have a coffee morning at work for it, but it’s certainly there in the background messing around with people’s lives. Before I was an orthodontist I used to work at the junior levels of various oral surgery departments around Northern Ireland and England and saw many patients receive treatment for it. Those patients were referred to us from one source or another, but for the most part (I think) the dentists and doctors that referred them into us might only see one case of this disease in their career.
I saw a documentary on TV once where a soldier said that you could go through an entire career in the army and not only would you never shoot anyone, you would probably never release the safety catch on your rifle. And yet there are wars happening around the world all the time. Oral cancer is a bit like that. A hospital department will deal with many cases every week and most regular dentists might see it once if at all. But when they do they need to recognise it and send it on to the people that see enough of these patients to give them the best treatment.
For me, it happened where I’d least expect it. Mouth cancer is usually a disease that’s more likely to affect older people, more likely to affect smokers, and more likely to affect people that drink alcohol. More likely doesn’t mean always and less likely doesn’t mean never.
The patient that we saw it in was 15 years old.
We’d just started to prepare to put the braces on and they mentioned that a tooth felt rough against the tongue. It was rough on the side nearest the tongue, unusual because it wasn’t actually broken or sharp, so I smoothed it. That fixed the problem on the day, but at a subsequent visit a few weeks later they told me that the area was still sore and the tongue was swollen. There was a white area on the tongue (not unusual when rubbing against something) but a swelling around it that I could feel. That was unusual enough to take a photograph of it and send it on to a surgeon that I trust.
That’s Professor Leo Stassen. I met the guy about 30 years ago by a fairly random series of events when I was working as a wandering minstrel sort of junior surgeon. I was reasonably well qualified and experienced for the grade I was in and worked for an agency that would direct me at a weekend's notice to hospitals that were short of junior staff because someone was on holiday or taking professional exams and they still needed a minimum number of people to run the emergency cover that a hospital needs. I was sent off to Middlesborough for a month to work for a trio of consultants who in their own way would be very influential in their field (maxillo-facial surgery) in the UK. On one afternoon, we had a joint clinic with the hospital in Sunderland where the consultants would discuss interesting cases and none of the regular junior staff in Middlesborough were available to go, so I accompanied my newly acquired consultant up to Sunderland General Hospital for the afternoon. We talked about the comedians Cannon and Ball on the journey. Rather, I talked and he listened. Probably in a state of incredulity.
Prof Stassen would have no memory of me from that afternoon, but I remembered him. He was very good with younger patients who were easily overwhelmed by the strangeness of their circumstances. By an odd series of events I ended up doing my orthodontic training in his hospital and we ended up sharing a corridor. He did the jaw surgery for my boss’s patients. And when we both ended up in Dublin decades later, he did the jaw surgery for mine.
We live in a time where dental and oral health and technology meet in ways we couldn’t have imagined back then. I was able to take photographs of the swelling on my patient’s tongue and have them to Prof Stassen within a few minutes. He advised an urgent referral so we made the arrangements.
“It’s probably nothing serious, but it’s important to be sure that it’s not serious and then get going with the braces. “