Evaluating the implant candidate 223

Fig. 6-32. Inspecting the patient for cancer: the palate, tonsils, and pharynx should not be neglected. The dentist may be the first medically trained person to spot potentially dangerous lesions. (Photographed by Ralph Basabe.)

pate the submental, submandibular, parotid, and cervical glands (Fig. 6-29). Firm, fixed swellings are suspicious findings.

The mouth should then be checked, with the corners of the mouth, labial frenum, parotid duct openings, buccal mucosa, gingiva, and teeth receiving special attention (Fig. 6-30). The lateral surface, dorsum, and undersurface of the tongue should be examined, as well as the floor of the mouth (Fig. 6-31) . Then the hard palate, soft palate, tonsils, posterior pharyngeal wall, and uvula should be inspected (Fig. 6-32).

When radiographic studies are done of proposed implant sites, cancer should not be ruled out if any abnormalities are seen. (See also Bone Neoplasms, p. 235.)

If suspicious lesions are found, the dentist may take a specimen for biopsy or, better, refer the patient to an oral surgeon (Fig. 6-33) . Although it may be tempting to excise the lesion, particularly if it is small, the condition requires specialized care. It may not be the only manifestation of cancer in the body.

It would be extremely irresponsible to insert implants in a patient suspected of having cancer of the mouth. Accidentally cutting into a lesion may release cancer cells that will spread elsewhere in the body. Once the lesions have been treated, the patient's doctor should be consulted as to the advisability of dental implants.

EVALUATING RELATED STRUCTURES

In addition to the condition of the teeth and the tissues investing them, the character of other structures in the mouth or associated with it should be carefully investigated. Through heredity, trauma, disease, or poor habits the jaws may develop characteristics that contribute to poor occlusion and subsequent dental and periodontal problems. The patient should be examined to determine whether his jaw closure and muscle attachments are normal and his remaining teeth in good occlusion. Frequently, because of tooth loss and periodontal disease, difficulties are present. The dentist should determine the cause of these difficulties and evaluate correcting them in terms of an implant intervention.