222 Theories and techniques of oral insplantology

Fig. 6-31. Inspecting the patient for cancer: all surfaces of the tongue should be examined, as well as the floor of the mouth. (Photographed by Ralph Basabe.)

ridge or on the floor of the mouth, may have already become cancerous—treatment should be promptly initiated (Fig. 6-27). Small localized lesions should be completely excised and larger lesions, if not al-ready proved malignant by biopsy, removed by gradual stripping. The irritating factors should be eliminated, and faulty dental restorative or prosthetic devices either corrected or discarded. The periphery of a dental appliance should never be allowed to remain over a leukoplakic spot.

Before initiating any restorative work with implant dentures, the condition should be treated and the tissues allowed to heal. Special care must be taken to repeatedly check a patient with a history of leukoplakia for recurrences. If the condition was caused by irritation from faulty dental work, the new fixed denture should eliminate the disturbance.

Malignant lesions. Because a great many presenting patients, particularly those requiring extensive reconstruction, will be over the age of 40, the

dentist should be very careful to check for cancer. Although cancer in other parts of the body is not his concern, the fact that some 15% of all cancers occur in the head and neck, usually on the tongue or lips, makes a cancer check-up by the dentist essential. He may be the first person to correctly evaluate certain signs and symptoms ignored by the patient.

While questioning the patient about his medical history, the dentist should ascertain if the patient is a heavy smoker of cigarettes or pipes, if he has been or is persistently hoarse or has any trouble swallowing, or if he has any sores in the mouth or on the lips that refuse to heal. Such questions are an important part of the dentist's responsibility toward his patient.

The dentist should routinely inspect the patient for precancerous lesions like leukoplakia, ulcerations, and abnormal pigmentation of the skin. Visually he should inspect the face at various angles for swelling and asymmetry (Fig. 6-28) . He should pal-