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WHAT EVERY DENTIST SHOULD KNOW ABOUT SURGICAL LESIONS OF, AND IN THE REGION

OF, THE UPPER AND LOWER JAW.

WITH ESPECIAL

REFERENCE TO THE EARLY

OF THE PRECANCEROUS LESIONS.

RECOGNITION

By Joseph Colt Bloodgood, M. D., Baltimore.

(Paper delivered before the National Dental Association, Rochester, N. Y., Wednesday, July 8, 1914.)

T

HE dentist has a rare opportunity

to observe the beginnings of certain lesions which may be, or may develop into, malignant tumors, and other less malignant, or benign, lesions, the earlier recognition of which will accomplish a cure of the disease with less mutilation and discomfort to the individuals than at a later stage.

Dentistry was one of the first, in the medical profession, if not the first, to develop and practise preventive measures, and today the majority of educated people recognize the importance of submitting to frequent examinations of their teeth.

When the dentist looks at his patient as he rests in the dental chair, his vision should go beyond the teeth. At a glance

he can observe the entire face and notice the presence of small warts, or moles, or subepidermal nodules, or little zones of keratosis, or ulcers. When he sees such lesions on the face, he should instruct the patient on their significance and suggest the importance of an immediate examination by a competent physician or surgeon. The area of the upper and lower lip can be inspected before the mouth is opened, and the little precancerous lesions there looked for as on the face.

When the mouth is open, the tongue and floor of the mouth should be inspected. Cancer of the tongue begins in the most insignificant local lesion and then grows rapidly to a lesion which requires not only the most expert, but the most

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as having potential possibilities as a focus of cancer.

The smoker with leucoplakia should be urged to cease smoking, and any individual with a changed area of mucous membrane should have the teeth in that region most carefully cleansed and smoothed of any rough or ragged surface. If this removal of the possible cause-tobacco and ragged teeth-is not followed by healing within a few weeks -at the most three weeks-the individual should be immediately examined by a surgeon. In the case of ulcers on the mucous membrane the patients' blood should at once be taken for a Wassermann reaction. If this is negative, the surface secretion should be studied for

Photograph of excised piece from lower lip. The dark area is a smokers' burn.

White male, aged 60; lesion one year. Complete local excision November, 1913. Microscopic section shows that the dark tissue is composed of degenerated hornified epithelium; beneath this there is a thin layer of epidermis without papillary-body formation.

ulcer is no longer a simple syphilitic ulcer, but epithelial infiltration has taken place, and perhaps cancer has developed. The patient with leucoplakia should also be subjected to a Wassermann reaction, but in my experience this lesion has rarely been associated with syphilis. The best treatment for leucoplakia seems to be the removal of the cause-tobacco in any form, the daily employment of a solution of bicarbonate of soda as a mouth-wash, and the most painstaking care of the teeth. I have had no experience with the vaccine treatment. It is my opinion that all irritating caustic applications are contraindicated. When an area of leucoplakia ulcerates, I feel that it should be looked upon as a surgical,

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Epethelial Tumor Face.

treated with the cautery by inexperienced hands before they came under my observation, and for this reason the recurrent carcinoma was much more ifficult to eradicate.

I have never observed cancer of the gum about the teeth unless there was a definite history of leucoplakia, or bad teeth, usually a neglected ulcerating tooth, or a sinus, a non-extracted root. Any sinus in the region of the teeth is a very potent precancerous lesion. All such sinuses should be made to heal at once.

Pain in the region of the teeth may be

had many or all their teeth extracted, and this is true in many other strictly surgical diseases in the region of the jaws. The most important instrument of precision for an examination when there is obscure pain without palpable swelling is the X-ray. This will show a nonerupted tooth, expansion of the bone of the upper or lower jaw, bone formation, and bone destruction-all conditions which rarely, if ever, depend upon lesions of the erupted teeth. Unfortunately today, the usual practise in both dentistry and medicine, is to treat the patient for symptoms before a thoro examination in search for the etiological factors of such symptoms.

My experience teaches me that den

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Benign basal-cell subepidermal nodule of face.

Male, aged 27; brownish, smooth mole seven years. Excision. No recurrence 16 years. This represents the earliest appearance of this type of precancerous lesion.

Swelling of the alveolar border, or the so-called gum-boil, due to an infection about one or more teeth, is of such frequent occurrence, that I am afraid most patients who seek advice because of such a painful swelling of the gums, receive at once from their dentists treatment on the diagnosis of a simple infection. Most of my cases of ossifying peri

non-infected lesion. In carcinoma this is a very dangerous procedure, and often the disease is disseminated and made inoperable by such a practise. A little more care and a little delay for a more careful investigation will do no harm if the lesion is an infection, and will do the greatest good for the rarer, but more malignant lesions.

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