Why a “free exam” can cost you

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Recently, a patient came to me because he was having trouble eating. He had this sore on his lip that was not going away. He had seen his primary care doctor who had placed him on antibiotics stating that he had sepsis in his lip from a hospital stay. They were ready to place him on medication for herpes when his wife stated that wasn’t it. They sought out a dentist.

There are chains of dental offices which are corporate owned who offer a free exam and x-rays due to the back end of the business. They know cost is something that limits patients to seeking care.

This gentleman did not have upper teeth. He had a stroke a while back and did not seek having them replaced. He also had 8 remaining teeth. He was given a treatment plan for a full set of dentures and was recommended to have the teeth extracted because they were the source of his pain. The wife stated, he is not hurting in his mouth, it is his lip which was a sore spot and not healing.

Had they proceeded with treatment, it would have cost thousands of dollars and the sore would not likely go away. Being that he had a stroke, it was very unlikely that he would have the coordination to wear dentures. This would have handicapped him and further impacted the nutrition he would have been able to injest.

I offered an exam that he would have to pay for which would give them at least some sense of direction how to proceed. The wife was in desperate need of attention because he was in such pain and nothing was working so far.

I took out my oral pathology book from 30 years ago and looked up non-healing lip ulceration. He led me to a differential diagnosis of oral cancer. I suggested he get it biopsied either by an oral surgeon or a dermatologist to make sure of what it was. I placed some topical numbing cream which finally gave him a little bit of relief.

They sought the dermatologist. The PA came and said it was herpes and was ready to prescribe some Zovirax..again. The wife stated she wanted to see the doctor. The PA said he was busy with patients. The wife demanded to see him because they too were patients and she had been seen by a “professional”. The doctor came in and said, let’s do a biopsy.

This came back from the pathology lab as oral squamous cell carcinoma. He had to have a very invasive surgery to remove it all but all is well now.

If it weren’t for this patient’s wife and questionable judgement, he might have died from this cancer. There were signs in his history that led to it. 1. History of drinking and smoking, 2. Prior cancer other places in his body.

Are we too busy or looking after our self interest too much in order to ask a few more questions? Do we finally wake up and listen when someone refuses to be blown off by prescribing medications? Do we just expect someone will go away when they don’t get the answer they hope to hear?

The corporate chains are doing what they want to – looking after the profit margin of their shareholders. Some of these corporate chains are owned by doctors. Most of them hire dentists right out of school. They do not have the mentorship of another doctor. They have the people in there running a mill to sell dentures and extractions and then not take care of them after the fact.

If that is the care you seek for a dental professional, that is fine. There is a place for you.

If you truly want to look after your oral health, insist on an oral cancer screening and offer to pay for a light assisted oral cancer exam.