What kind of doctor treats an A-V malformation in the tongue?
August 28, 2019 10:16 AM   Subscribe

The dentist wants me to go see an oral surgeon to get an old trauma-induced AV malformation in my tongue checked out. I don't want to see an oral surgeon because my dental insurance is awful, but my medical insurance is good. Can I see a medical specialist of some sort, instead? If so, what kind?

A web search gets me lots of advice on brain AVMs, which are not my problem. My tongue is not bothering me, but the dentist is concerned, saying I could quickly bleed to death if my tongue were to get injured again.
posted by chromium to Health & Fitness (5 answers total)
Do you have a primary care physician? This would be something to discuss with them, they should have an idea of what kinds of specialists are available in your region.
posted by ewok_academy at 10:38 AM on August 28, 2019

The oral surgeon may also be able to bill your medical insurance, instead of or in addition to your dental insurance. This would be something to discuss with your medical insurance and with the oral surgeon’s office. The lines between dental and medical get murky with this kind of issue, as I understand it.
posted by MadamM at 10:44 AM on August 28, 2019 [3 favorites]

ENTs routinely perform surgical procedures on the mouth and tongue. This isn’t a procedure I’m familiar with (I understand what you’re describing, I’ve just never cared for a patient who’d had an AVM in that location). Still, I’d start there.
posted by pecanpies at 10:47 AM on August 28, 2019 [5 favorites]

As mentioned, oral surgeons' (and even dentists') services are sometimes billed as medical (same with vision vs. medical). Check your medical plan terms (and/or call someone with the plan) to find out.
posted by Pax at 5:48 PM on August 28, 2019 [1 favorite]

You might also seek a maxillofacial surgeon, who is a person who is qualified both as a dentist and as a surgeon (I don't want to think about their education costs!). My son had extensive dental and jaw surgery done, and it went through the medical insurance, not dental. It required going to a major academic medical center, which can support physicians and dentists who are very specialized. This doctor taught both in Penn's dental and medical schools. If you are in the area I'd be happy to recommend him.

The site of your A-V malformation may dictate which specialist will operate, but I think this would not be a dentist. This is a vascular problem, not a dental problem. You will also want to know that the surgeon is skilled at repair, so your tongue does not look or feel odd. I doubt this is in the bailiwick of a typical plastic surgeon, though.

Also, what is the issue your dentist is concerned with? Does he think there is a chance this AVM could burst? This is an issue with AVMs generally, since veins are thin walled and not designed to withstand the higher pressure of pumped blood. Arterial walls are thicker. When they are joined together in a malformation, arterial pressure can sometimes burst the wall of the thinner vein, and bleeding can occur. Some bleeds are more problematic than others. As you say, AVMs in the brain can cause catastrophic injury. However, if your tongue AVM bursts, your mouth is a bad place to have uncontrolled bleeding. I would pursue at least one, if not two other opinions. It may be that watching over time for any changes in size is a reasonable approach, but this is something best discussed with a qualified physician.

I'm not a doctor, and this isn't medical advice. It's a distillation over a career of surgical ICU and liver transplantation nursing. You should seek medical (not dental) advice. But your dentist has given you an appropriate nudge. You'd probably be surprised how often a dentist's referral causes a patient to pursue important medical treatment.
posted by citygirl at 6:06 PM on August 28, 2019 [2 favorites]

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