A highly skilled dentist has successfully identified a brain tumour in a patient after spotting subtle neurological warning signs during an initial assessment.
Kieran Gohel Andrews, the resident dentist at St Andrew’s Healthcare, says that from the moment he saw the patient, he knew something was not right.
He said: “As soon as I call a patient’s name, the assessment has already started. This is even more important working with the patients that I do, as it can take a number of appointments before they feel comfortable enough to let me look in their mouths.
“I’m trying to ascertain; Can they hear me? Do they make eye contact? How are they walking? I’m looking at their face, their cheeks, lips, brows, to see whether the facial nerves are functioning as they should. That’s where the clinical assessment begins.
“And on this occasion, I noticed the patient’s facial muscles were not moving symmetrically. He also appeared to have some form of lip paralysis, which tells me there’s a problem somewhere between the brain and the lip in terms of nerves. It was subtle, but there was enough evidence for me to raise the alarm.”
The patient was immediately sent to Northampton General Hospital, where subsequent medical investigations revealed a space occupying lesion in the brain, something that requires urgent specialist assessment.
Kieran believes providing specialist dental care within a secure psychiatric environment may be the only service of its kind in the UK.
In the 18 months since joining the charity, he has treated hundreds of severely unwell patients with no serious incidents in the dental chair, despite being surrounded by tools that are required to do his job.
Due to the nature of his patients’ fluctuating capacity and complex medical needs, his role requires a level of vigilance that extends far beyond oral health alone.
He added: “This case shows why dentistry in a psychiatric hospital is about far more than teeth. You have to understand the whole person, their physical presentation, their neurological function, their mental state. Sometimes the signs of something serious are incredibly subtle.”
The patient is now undergoing further investigation and care from the hospital’s medical team.
Associate Director of Physical Healthcare Martin O’Dowd said: “This case is a powerful reminder of why integrated, multidisciplinary care is absolutely vital in mental health settings. Physical health problems can be incredibly easy to miss when someone is severely unwell, and it takes a clinician with exceptional vigilance to spot the early signs.
“Kieran’s attention to detail and his willingness to look beyond the immediate dental issue meant a potentially serious condition was identified far earlier than it might otherwise have been. The changes in the patient’s face were so subtle that only someone with Kieran’s expertise and instinct would have recognised them and acted so decisively."
