History Taking/Examination/Communication/Treatment Planning Flashcards
You are a GDP. A 40yo female presents to you C/O facial pain.
- Take a full facial pain history
- What features would suggest the facial pain is atypical
6 mins
Introduction - name and designation
Pain Hx - Site (where, fixed/changes, diffuse)
Onset (how long lasts, when started)
Character (sharp shooting/dull throb/mixed)
Radiation (pain elsewhere)
Associated Sx (fever, malaise, lymphadenopathy, inflammation)
Timing (when better/worse, sleep affected)
Exacerbating/relieving factors (what makes it better/worse, analgesia, frequency, effectiveness)
Severity (pain scale 1-10 - constant/changes)
MH - conditions, meds, vitamin deficiencies
SH - stress, recent lifestyle changes
Atypical - no identifiable cause, no dental pathology, diffuse, difficult to isolate/localise, chronic, continuous, crosses anatomical boundaries, very severe, analgesia ineffective, variable type/character, ‘sleep affected’, multiple prev dental treatment with no effect, no physical signs of disease, no inflammation
You are a DCT in Oral Surgery. A 35yo female is referred by her GDP for pain and clicking in the TMJ. Please examine the masticatory system.
There is no need for any further history or any management options.
6 mins
Introduction - name and designation
Obtain consent - going to look and feel EO and IO. May be uncomfortable but will help to confirm diagnosis. Any questions.
EO exam - asymmetry, skin, lips (lesions/competence), neck (lumps/bumps/pain/tenderness)
TMJ - bilateral palpation. Open/close mouth - click/pop/grind, deviation on opening/closing, clunky opening, pain, max opening (approx. 45mm) and protrusion (approx. 10mm)
MoM - clench together on back teeth. Palpate masseter and temporalis. Any pain/tenderness. Open against resistance (hand under jaw) and move side to side to test lateral and medial pterygoid
IO exam - ST - HP/SP, tonsils, BM, tongue (d/v/l), FoM, gingiva. Look for tongue scalloping, linea alba.
Dentition - look for canine/loss of canine guidance (canine blunting, posterior cusp flattening), wear facets.
Can also palpate masseter IO (clench together, thumb outside cheek, finger in upper buccal sulcus)
Perform a neck examination in this 30yo male who has presented with a neck swelling.
What information would you want if you were to describe the neck swelling?
6 mins
Introduction - name and designation
Obtain consent - feel of your neck for lumps and bumps, help provide some more info for diagnosis. May be slightly uncomfortable. Any questions
Bimanual palpation of neck nodes - submental, sublingual, submandibular, deep cervical lymph nodes (DCLN - anterior border of SCM), supraclavicular, DCLN (posterior border of SCM - jugulo-omohyoid and jugulo-digastric), occipital, pos-auricular, pre-auricular, facial/buccal/parotid.
If not neck node - check thyroid (GP blood tests), ask pt to swallow (does it move/is it fixed)
Describing a lesion (6 S’s)
Site - where (neck levels), central, jaw, uni/bilateral/muntiple, nearest structures, fixed/tethered or movable
Size - diameter (X x Y) in mm (orientation). Fluctuating?
Shape - round/irregular/bean-like
Surface - normal, ulcerated, blistered, inflamed, punctured, infected, blanches, scabbed, blue, etc.
Consistency - firm, rubbery, soft, fluctuant, cystic, fixed/tethered
Surrounding anatomy - normal/not, involved, discoloured, inflamed, fixed to lump
You are a GDP. A 26yo female attends for a new patient assessment. You notice she has unusual facial bruising and strangulation bruising/marks around her neck. When you ask her about it, her story is vague and seems implausible. You suspect she is a victim of domestic abuse.
Discuss your concerns with the patient.
6 mins
Introduction - name and designation.
Use AVDR structure (ask, validate, document, refer)
Ask - is everything ok? Do you feel safe? I noticed some unusual bruising on your face and neck - would you be able to tell me how it happened? Have you spoken to anyone about it>
Validate - I’m concerned about your safety. You don’t deserve to be hit, no one deserves to be hit.
Document - in pt’s own words, as well as clinical notes. Draw injuries and describe them. Take clinical photos if consent given (NOT on pt’s phone)
Refer/signpost - encourage pt to reach out and seek help and support. Has to self-refer. Can give info about local services available or Scottish Domestic Abuse and Forced Marriage Helpline (0800 027 1234). If concerned about risk to life/threat to life of someone else (child, etc.) - call police.
Can also anonymously report on Police Scotland website
You are a GDP. Take a medical history from this 41yo male, who has attended today as a new patient for a new patient assessment.
6 mins
Introduction - name and designation
General questions - feeling well today? Any recent hospital stays? Any recent hospital (outpatient)/GP visits? Do you see your GP/practice nurse often? Are you under the care of any hospital specialist?
If female - are you pregnant?
Quick MH - use JAMTHREADS
Jaundice, anaemia/bleeding conditions, MI/angina, thyroid/TB, hypertension/heart disease, rheumatoid arthritis/rheumatic fever, epilepsy/fits/faints, asthma/COPD, diabetes, stroke.
Systemic enquiry
CVS - heart problems, MI, IHD, HTN, cholesterol, angina
RS - breathing problems, asthma, COPD, bronchitis, pneumonia, emphysema
GI - stomach, bowel, liver, hepatitis
GU - UTI, STI, problems with waterworks
Derm - any conditions/problems
Neuro - any conditions/problems, headaches, prev brain aneurysm/haemorrhage
Haem - any conditions, easily bruise, excessively bleed
Psych/mental health - any conditions, active/previous
Medications - names, doses, what for, compliance. Prescribed, over-the-counter (vitamins, herbal remedies, alternative medicines), illicit/illegal
Allergies - what to, nature (how severe/what happens), when was last reaction, ever been hospitalised (think anaphylaxis)
FH - first degree relatives, significant problems, reason if dead
SH - smoking, alcohol, occupation, family/lives with
Any other information
You are a GDP. Take a pain history from a 52 year old female who attends as an emergency appointment.
6 mins
VOSCE
Introduction - name and designation
Site - where, uni/bilateral, fixed/moves
Onset - when started, how long for, on/off
Character - sharp, shooting, dull, throb, change over time, variable
Radiation - pain elsewhere, when, where
Associated Sx - fever, malaise, nausea, vomiting, aches, lymphadenopathy
Timings - when better/worse, night/early morning, constant, kept awake at night, duration (seconds, minutes, hours, days)
Exacerbating and relieving factors - what makes it better/worse - eating/talking/biting, hot/cold/sweet. Analgesia - what, frequency, effective or not
Severity - pain scale 1-10, constant/variable
Any other information
You are a GDP. A 36yo male attends for a new patient assessment C/O bleeding gums when brushing his teeth. This has been going on for several years. He is aware his teeth are getting shorter, but is not concerned by their appearance.
He has no other Sx.
MH: F+W. No conditions or medications.
PDH: last attended 2yrs ago. Brushes x1/day, no ID cleaning.
SH: smokes 20 cigarettes per day (has considered stopping), drinks 12 units of alcohol per week.
Diet: drinks 1 litre of fizzy juice each day.
Look at the clinical photographs and radiographs provided. Explain your findings, diagnoses and proposed management to the patient.
Clinical photos - photo 1
Radiographs - XRs 1
Study casts - show generalised wear (palatal), instancing lower molar
12 mins
(1 min reading, 3-4 mins to formulate diagnoses and proposed management, 7-8 mins to explain findings to pt)
MOSCE
Clinical photos - shortened clinical crown height, gingival erythema (particularly interdental papilla)
Radiographs - mild/moderate generalised horizontal bone loss. LL8 - disto-angular impaction (PE). LR8 - mesio-angular impaction (PE). Caries 46 mesial.
Introduction - name and designation
Obtain consent to go through findings with pt
Explain findings - gums are red/inflamed, particularly in between the teeth. There is some evidence of tooth wear (teeth are shorter than normal), particularly on the inside surface of the upper front teeth and you have an instanding lower molar (out of position), but this doesn’t need treatment.
On the XRs (show pt x-ray!) - mild/moderate bone loss throughout the mouth. The bone holds the teeth in and starts to recede back when irritated by bacteria. There is some decay in a back right molar tooth that will need treatment. You also have impacted lower wisdom teeth - they are part of the way through into your mouth, but not completely.
Dx and Mx - generalised mild/moderate (stage II grade B) periodontitis, currently unstable. Due to plaque, particularly in between teeth building up and not being removed causing calculus. Causes inflammation (bleeding when brushed), small swelling of the gums, allowing bacteria to get under the gum and start to eat away at the bone. Can’t be cured, but can manage - brushing x2/day with fluoride TP, ID brushing x1/day (largest brush size that doesn’t scrape in between teeth. In and out 10x per space). No MW. PMPR - scale teeth above and below gum to remove build up and provide clean surfaces, to help make cleaning easier.
Exacerbated by smoking - impairs healing, increases risk of treatment not working. Quitting - lowers risk of tooth loss, mouth cancer and other cancers, general health effects. Quit Your Way/smoking cessation services are available and can offer free NRT to help you quit.
Decay in 46 M - need filling (white filling - more expensive, but bonds to tooth or silver filling - cheaper, just as good, doesn’t bond. Any preferences)
Impacted lower 8s - could get them removed surgically, but would only advise if start causing problems. Advise now to KUO
Diet advice - fizzy juice is acidic, causes tooth substance to start to wear away, making teeth smoother and smaller. Reducing fizzy juice will help to reduce effects. Alternatives - dilute with water, use straw, rinse mouth with water afterwards. Don’t brush immediately after.
Tooth wear management - can monitor with study casts/photos every 6-12 months. Can also place composite on the back of the front teeth to stop them wearing away and provide more support - start to wear away filling material rather than tooth.
Any questions
Confirm understanding and happy with proposed plan
Describe how you would chart teeth in a phantom head with a nurse
6 mins
Check nurse happy with UR/UL/LL/LR (Q1-4)
Chart teeth present/absent (round 1)
Chart restorations present (round 2)
Chart caries/failing restorations and treatment required (round 3)
Chart BPE, comment on OH
Check nurse is happy, get nurse to repeat back
You are a GDP. A mother brings in her 4yo daughter for a check up.
During the examination, you noticed unusual bruising behind both ears and on the soft tissues at her clavicle (as if she has been grabbed by both shoulders).
When you ask the child about these injuries, the mother briefly mentions she fell at school, before going back to speak on her phone.
As you proceed, you notice some unusual burns inside her mouth as well as rampant caries.
What would make you suspicious that these injuries were not due to accidental trauma? Discuss your concerns with the examiner and how you would proceed in this situation
6 mins
Suspicion of non-accidental injury due to soft tissue bruising in sites not covering bone (nose, orbits, chin, etc.).
NAI Sx - abnormal/multiple bruises, abrasions, lacerations, burns, bites, strangulation marks, eye injuries, hair pulling, fractures, tooth trauma, feral injuries.
Dental neglect - rampant caries, multiple appointments missed (WNB). Unkempt appearance
Index of suspicion - delay in seeking help, story vague/lacking detail/vary between persons and tellings, account not compatible with injury, abnormal parent mood/preoccupied, abnormal parent/child interaction, child may say something contradictory, history of previous injury/family violence.
Mx - urgent dental treatment if required (out of pain), ensure wounds not infected, etc. Raise concerns with parent - be honest about your suspicions and seek consent to report (these types of injuries have to be reported). Ask if family need any help. Record incident, injuries, conversation and findings and refer to social services. Confirm social services follow-up, ensure dental review/treatment booked.
Discuss with colleagues and the child protection/safeguarding lead in the practice
If unsure, seek advice from colleagues/social services/indemnity.
Even if mother refuses consent for reporting, these injuries have to be reported. Do not seek consent where risk of harm to child (consider calling police)
You are a GDP and have been asked to see Mr Smith, a 56yo male patient of one of your colleagues, who had a crown fitted by your colleague last week. The crown has since fallen off and Mr Smith is extremely unhappy.
Manage this situation
6 mins
Introduction - name and designation
Opening question - what seems to be the problem? Can I offer any assistance?
Listen to pt without interrupting.
Respond - I can see that you’re upset and I can understand why. I’m sorry that you feel this way and sorry for what has happened. Let me see what we can do.
Offer treatment - if you want, it would be simple enough to recement it. We could do that just now or at a time that suits you - we’ll work around you. If this was to happen again soon, then we would look at other reasons why this is happening.
Going forward, I’m more than happy to take over the treatment and discuss it with my colleague who cemented it initially and feedback to you. I’m not too sure how this has happened, but I’ll try to find out.
Once again, I’m sorry this has happened. There won’t be a charge for the treatment today, I’m just sorry about the inconvenience of this crown falling out and you having to come back and see us. If you still have confidence in us, we would be happy to continue treating you going forward.
Any questions.
If pt requests formal complaint - advise as following:
If you would like to register a complaint with the practice, I can advise you on how to do that. If you write in to/email the practice, we have to acknowledge this within 3 working days, although it is often within 24 hours.
We will then open up an investigation and you’ll hear back within 5 working days with the outcome of the investigation or we’ll let you know that we need more time to investigate - usually that happens if it’s quite a complex issue and we need to speak to multiple people. If that is the case, we will have an outcome for you within 20 working days after than.
If you are unhappy with the outcome, then you can refer it onto the Scottish Public Services Ombudsman. They are completely independent and will look into the handling of the case and the outcome for you and provide further assistance.
Any questions.
Once again, I’m sorry this has happened and as I said there will be no charge today and I would be happy to see you back for a check up or further treatment in the future
You are a GDP. You have been running late and your next patient, Mrs Smith has had to wait in the waiting room for an hour.
She is unhappy because she has had to wait an hour and is saying the receptionist was rude to her.
Manage this situation
6 mins
Introduction - name and designation
Opening question - can I offer any assistance?
Listen to pt without interrupting.
Respond - I can see that you’re upset and I can understand why. I’m sorry that you feel this way and sorry for what has happened. Let me see what we can do. Would you be happy telling me what our receptionist said to you?
I’m sorry this has happened. We don’t want any of our patients to feel like they’re not welcome here and it’s not appropriate that you were spoken to like that. If it would be alright with you, I’d like to speak to the receptionist about this and can provide feedback to you.
I think it would be appropriate for the whole practice to engage in a training session about this topic and what are appropriate ways to manage the situation because, as a team, we’ve fallen short of the standards we set for ourselves and the standards that our patients expect from us. I can only apologise for this.
If you still have time to see us today, I’d be more than happy to see you. If not, we can rebook at a time that’s convenient to you. What would you like to do?
Again, I’m really sorry that this has happened. I’m going to speak to the rest of the team and ensure this doesn’t happen again.
Any questions
If pt requests formal complaint - advise as following:
If you would like to register a complaint with the practice, I can advise you on how to do that. If you write in to/email the practice, we have to acknowledge this within 3 working days, although it is often within 24 hours.
We will then open up an investigation and you’ll hear back within 5 working days with the outcome of the investigation or we’ll let you know that we need more time to investigate - usually that happens if it’s quite a complex issue and we need to speak to multiple people. If that is the case, we will have an outcome for you within 20 working days after than.
If you are unhappy with the outcome, then you can refer it onto the Scottish Public Services Ombudsman. They are completely independent and will look into the handling of the case and the outcome for you and provide further assistance.
Any questions.
Once again, I’m sorry this has happened and as I said there will be no charge today and I would be happy to see you back for a check up or further treatment in the future
You are a GDP. Mrs Smith, a 57yo female, has been sent to you by her oncologist. She has been diagnosed with breast cancer is is due to start chemotherapy soon.
She doesn’t know why she has to see a dentist.
On examination, she has a grossly carious 36. A PA XR reveals extensive caries tracking subcrestal, with an area of apical infection around the root.
Explain the relevance of dental health for cancer treatment, provide your proposed treatment of tooth 36 and discuss the oral side-effects of chemotherapy that Mrs Smith should be aware of.
6 mins
VOSCE
Introduction - name and designation
Acknowledge cancer diagnosis - how are you doing?
Why need to see GDP - here to be assessed as being dentally fit. Chemo wipes out the immune system, increasing the risk of getting seriously ill if you catch an infection. We want to remove any sources of potential infection in the mouth before treatment and reduce oral complications/side effects and avoid any unscheduled interruptions in treatment to have dental treatment. Does that all make sense?
Dental treatment - full mouth scale, making teeth easier to keep clean, smooth down sharp teeth, soft splint
36 - gross caries and PAP. This tooth has extensive decay, below the gum. Unfortunately I can’t treat the decay and keep the tooth, so the tooth is going to have to be removed. I realised this may be a shock, especially if it’s not been giving you any bother. I would advise that we remove it very soon, because we like to leave 7-10 days for it to help before you start chemo. Once your treatment course is finished, we can then look at restoring the space
Prevention - it’s really important to try to keep your teeth and mouth as clean as possible during treatment, to reduce the risk of infection. Brush 2x/day for 2 mins with soft toothbrush. We’ll prescribe you stronger toothpaste to help reduce the risk of decay (Duraphat 5000ppm). ID cleaning x1/day. Fluoride varnish application. Consider fluoride trays
Diet - avoid spicy, acidic foods and fizzy and fruit juices. avoid alcohol (particularly spirits) and smoking, limit/avoid coffee and tea
Peri-chemo treatment - no treatment unless emergency.
Side effects and their Mx -
Mucositis (suck ice cubes, lidocaine gel/spray, benzydamine MW)
Candida (maintain OH, denture hygiene. Antifungals if required)
Dry mouth - cancer cells divide quickly, so chemo targets cells that divide quickly - cancer, hair, lining of mouth and salivary glands. 50-60% reduced saliva after one week, further 20% reduction after 6 weeks. Thicker, more acidic saliva, altered taste, more difficult to swallow. Recovery is variable, but often long-term - over years. Risks - dysphagia, dysarthria, dyspepsia, reduced QoL, increased caries risk, perio, candida, unretentive dentures, sialadenitis. Mx - regular sips of water, SF gum, artificial saliva (gel/spray/pastilles), saliva stimulants. Topical fluoride - 5000ppm Duraphat. fluoride MW. CHx irregularly.
Any questions
Give contact number in case of emergency and arrange review appointment
You are a DCT in Restorative Dentistry. Mr Smith, a 63yo male attends the multidisciplinary cancer clinic for a dental assessment before he starts cancer treatment.
He has recently been diagnosed with mouth cancer (on his tongue) and is due to receive surgery and radiotherapy to treat this.
Explain the relevance of dental health for cancer treatment and discuss the oral side-effects of radiotherapy that Mr Smith should be aware of.
6 mins
Introduction - name and designation.
Acknowledge cancer diagnosis - how are you doing?
Why need to see dentist - here to be assessed as being dentally fit. Radiotherapy can damage lymphatic channels, making it more difficult for you body to flush out infections. Implement enhanced prevention plan and also remove any sources of infection from the radiation field. We want to remove any sources of potential infection in the mouth before treatment and reduce oral complications/side effects and avoid any unscheduled interruptions in treatment to have dental treatment. Does that all make sense?
Prevention - it’s really important to try to keep your teeth and mouth as clean as possible during treatment, to reduce the risk of infection. Brush 2x/day for 2 mins with soft toothbrush. We’ll prescribe you stronger toothpaste to help reduce the risk of decay (Duraphat 5000ppm). ID cleaning x1/day. Fluoride varnish application. Consider fluoride trays
Diet - avoid spicy, acidic foods and fizzy and fruit juices. avoid alcohol (particularly spirits) and smoking, limit/avoid coffee and tea
Peri-RTx treatment - no treatment unless emergency.
Side effects and their Mx -
Mucositis (suck ice cubes, lidocaine gel/spray, benzydamine MW, mucosal shields for radiotherapy)
Candida (maintain OH, denture hygiene. Antifungals if required)
Dry mouth - cancer cells divide quickly, so chemo targets cells that divide quickly - cancer, hair, lining of mouth and salivary glands. 50-60% reduced saliva after one week, further 20% reduction after 6 weeks. Thicker, more acidic saliva, altered taste, more difficult to swallow. Recovery is variable, but often long-term - over years. Risks - dysphagia, dysarthria, dyspepsia, reduced QoL, increased caries risk, perio, candida, unretentive dentures, sialadenitis. Mx - regular sips of water, SF gum, artificial saliva (gel/spray/pastilles), saliva stimulants. Topical fluoride - 5000ppm Duraphat. fluoride MW. CHx irregularly.
Trismus - opening exercises
Neck fibrosis - moisturise neck
Dysphagia - SALT, sip water to swallow
Hoarseness - sip water regularly
ORN - plan for XLAs in liaison with specialists
Any questions
Give contact number in case of emergency and arrange review appointment
You are a GDP. Ms Smith, a 28yo female who works in TV attends for an emergency appointment. She has had an accident which has injured her face.
After completing an examination and appropriate investigations, you have diagnosed a vertical root fracture on tooth 11. It is unrestorable.
Explain your findings and the management options available to Ms Smith.
Ms Smith has no other injuries and you do not need to to undertaken a history.
6 mins
Introduction - name and designation
General questions - how have you been?
Breaking bad news as per SPIKES - setting, perception, information, knowledge, empathy, summary
Setting - sitting down, pt comfortable, speaking to them at eye level, open body language
Perception - can you tell me what happened? Are you aware of the problem? Do you have any idea or feelings about what could be the problem? Are you concerned about anything in particular?
Information - I’ve had a look at the tooth that’s broken and taken some x-rays - would you like me to talk you through what I’ve found and what your options are going forward?
(use props - demo findings on x-ray, etc.)
Knowledge - I’m afraid that the news isn’t what you were hoping for. (Pause)
The tooth is fractured below the gum, into the bone, or the socket. I wish I had better news. (Pause)
Unfortunately there is nothing we can do to save the tooth - it’s unrestorable and will need to come out. I’m really sorry.
Empathy - Pause. I’m really sorry to have to tell you this. I understand it’s not what you wanted to hear and will be hard for you. I realise it will all be a bit of a blur at the moment, but are there any immediate questions that come to mind?
Listen. Let the pt dictate the pace of conversation - let the news sink in.
Summary and close - once again, I’m sorry to have to tell you that the tooth can’t be saved. We have some options going forward - we can take an impression today and provide you with a short-term removable plate to replace that one tooth. Or we can to bond the tooth next to the teeth beside it as a very short-term option (natural tooth bridge). Going forward we can have a discussion about long-term options - either a denture, a bridge or an implant.
Do you have any questions?
I’ll give you our contact number so that if any other questions come to mind you can give us a call. If I’m busy, I’ll give you a call back as soon as I’m able to.
Does everything I’ve said make sense? Do you have any thoughts about what you would like to do?
You are a GDP. Mr Smith, a 64yo male, attends for results of a biopsy you performed last week. Mr Smith is a non-smoker, but consumes half a bottle of spirits (40%) each day.
The pathology report states there is evidence of epithelial dysplasia.
Discuss the diagnosis with the patient and provide advice regarding his alcohol intake.
6 mins
VOSCE
Introduction - name and designation
General questions - how have you been?
Breaking bad news as per SPIKES - setting, perception, information, knowledge, empathy, summary
Setting - sitting down, pt comfortable, speaking to them at eye level, open body language
Perception - can you tell me your understanding of things up until now? Do you know why you had the biopsy? And do you know what you’re here today for? Are you concerned about anything in particular?
Information - when you were here last we performed a biopsy - we took a sample of the tissue and sent it to the lab, so they could look at it under a microscope and give us an idea of what’s happening and give us a diagnosis. I have the report back from the lab, would you like me to talk you through it?
Knowledge - so the lab have told us that the sample we sent them have evidence of epithelial dysplasia. This means that the cells are growing abnormally. This is not cancerous, you’ll be pleased to know.
Pause, let that sink it.
Dysplasia is a scale, ranging from mild to severe and beyond this to something called carcinoma in situ, which is essentially a tumour that hasn’t started to spread. The areas of abnormal cell growth can progress up the scale or back down the scale and this can be influenced by risk factors, such as smoking and alcohol. I have to let you know that there is an increased risk of this area, or other areas in your mouth, becoming cancer compared to someone without dysplasia. But the area can also go back to normal. The way this could happen, in your case, is by reducing your alcohol intake, or quitting it altogether.
At the moment, you consume about 3-4 bottles of spirits per week. This is around 100 units of alcohol. The national recommended maximum is 14 units per week, over 3 or more days and leaving at least 2 days per week when you don’t drink alcohol. This is roughly equivalent to around half a bottle of spirits per week.
As well as increasing the risk of mouth cancer, alcohol increases the risk of you having a stroke and having serious problems with your heart and liver. In your mouth, it puts you more at risk of losing teeth through gum disease, causing decay and wear/erosion of your teeth, causing a dry mouth and increasing the amount you bleed.
Empathy - Pause. I realise it will all be a bit of a blur at the moment, but are there any immediate questions that come to mind?
Has anyone ever told you that they think you drink too much?
Listen. Let the pt dictate the pace of conversation - let the news sink in.
Summary and close - once again, this is not cancer, but it does increase your risk of getting mouth cancer, unless you’re able to cut out your alcohol intake. Think of this as an eye-opener or a first warning. If you’d like help to cut out alcohol, there are excellent support services (AA) that you can access yourself. You can also speak to your GP.
We’ll keep an eye on your mouth and see you every 3-6 months to take photos. If there are any changes then we may want to re-refer you to get another biopsy.
Does everything I’ve said make sense? Do you have any questions?
I’ll give you our contact number so that if any other questions come to mind you can give us a call. If I’m busy, I’ll give you a call back as soon as I’m able to.
