Dentistry Expert Discusses Delayed Diagnosis of Oral Cancer Recurrence

This case involves a female patient who had been under the care of the same dentist for several years, with whom she consistently kept twice-yearly appointments. The woman had suffered from oral cancer which had been successfully treated one year prior to the events of the incident in question. The patient had been under the care of another physician who had been monitoring her for recurrence of cancer, and had taken a biopsy of the previously affected area that did not reveal the presence of cancer. However, the woman’s cancer had reoccurred, and the negative biopsy result was evidently obtained in error. It was claimed that the cancer may have been visible in dental x-rays taken around the time of the biopsy.

Question(s) For Expert Witness

1. How often do you read xrays?

Expert Witness Response E-006938

There is no standard of care regarding the frequency of dental x-ray readings and, in fact, radiographs are constantly coming under attack from many who say they are abused and overtaken. In fact, most insurance companies will only pay for a full set of radiographs or a panoramic film every 5 years (on average). Thus, most dentists don't take or retake those types of radiographs too often unless a clinical situation warrants it. If there was no clinical evidence of a problem, then the dentist would not likely take full radiographs very often due to costs, lack of insurance coverage, and radiation exposure. Now, that being said, given the patient's history, it depends on what the original diagnosis was as to how often radiographs should be repeated. I would think most surgeons, radiologists, pathologists would probably recommend once per year for the first five years if it was a malignant lesion, then maybe every 2-3 years after that. However, if the original diagnosis was something benign, the experts may not recommend further radiographic follow up nearly as often, and further radiographs may depend upon what the patient's risk factors, medical history, etc. are like. It would seem that the issue here would fall on the pathologist for the misdiagnosis rather than the general dentist who would assume the diagnosis was made correctly and the appropriate treatment rendered by the correct specialist.