Evaluating the implant candidate 217

would not but would instead be very beneficial to the particular individual.

Cheilitis. When the vermilion borders of the lips become dry and then begin to scale or crack and burn, cheilitis is probably the cause. Cheilitis is often found in patients who suffer from food allergies. If the condition is known to result from an allergy, it may be easily relieved by removing the offending foodstuff from the diet. Antihistamine therapy may also help. Although the condition is annoying, the patient may be an implant candidate unless he is prone to other widespread allergic manifestations.

Cheilosis. Cheilosis, which appears at the corners of the mouth, is characterized by pallor, erythema, and fissures. It may be caused by a riboflavin deficiency, but it is also common in edentulous patients with poorly fitting dentures, which seem to provoke the condition. Cheilosis is frequently complicated by infection with Candida albicans, a condition called perleche and characterized by the development of grayish-white lesions.

Cheilosis is difficult to cure, particularly if continually aggravated with poorly fitting dentures. Here obviously is a situation where an implant-supported denture would be therapeutic.

Chancres. Chancres are ulcerating lesions on the mucous membranes. They may be the first sign of syphilis, in which case they are painless and hard and their fluid is extremely infectious. Syphilic chancres generally disappear without treatment in 10 to 40 clays, to be later replaced by small mucous patches and warty rnasses near the angles of the mouth that signal the secondary stage of the disease. They may heal spontaneously but tend to recur. A patient suspected of having syphilis should be immediately referred to a medical doctor. Also, the dentist should be extremely cautious in sterilizing his equipment after handling a chancre.

Cankers. If painful ulcers of the buccal mucosa and lips are present, they may be cankers, or aphthous stomatitis. These cankers may occur singly or in groups and recur persistently for months or years. Why they occur is difficult to discover, and so treatment is usually limited to pain-relieving bland mouthwashes. An implant-borne denture should be no more irritating to cankers than natural teeth, and because of its stability it is far superior to conventional removable dentures.

Edema. When the lip or lips swell suddenly, the condition may result from trauma, neurogenic conditions, an insect bite, or an allergic reaction. The consequent edematic lip is stiff and feels awkward.

Usually the edema goes away in a few days, but in some people the swelling may become permanent and the lip becomes solid and rubbery. This condition, called macrochelia, may contraindicate implants, as the stresses on the dental restoration may be abnormally traumatic.

If edema occurs frequently on the lips or gums as a result of an allergic reaction, the patient's proneness to allergies may contraindicate implants.

Blisters. Blisters are symptomatic of a great many conditions caused by viral, physical, and chemical agents. The more common viruses are Herpes simplex, Herpes zoster, the group A Coxsackie vi-ruses, and those viruses that cause chickenpox and smallpox. In the last cases, it will not be necessary for the patient to open his mouth to detect disease.

The condition caused by the group A Coxsackie viruses is called herpangina and usually occurs in epidemic form in infants and small children, who are generally not implant candidates.

The blisters caused by H. zoster are limited to one side of the mouth and break down to form painful ulcers that heal spontaneously in a few days. However, the site may continue to be painful for several weeks. The blisters in the mouth are a reflection of an acute infection of the central nervous system. The epidermis and the dermis supplied by the peripheral nerves arising from affected root ganglia become infiltrated, with a serous exudate beneath the stratum corneum giving rise to the vesicles. In affected cutaneous areas elsewhere in the body the condition is known as shingles.

H. zoster is either closely related to or identical with the virus that causes chickenpox. However, whereas chickenpox occurs mostly in young children, shingles is normally seen in persons over 50 years old. As after a chickenpox episode, the patient is generally immune to recurrences of shingles after the first attack. However, postherpetic neuralgia may follow, and the pain may persist for years. If the geniculate ganglion is involved, the patient may experience facial paralysis, but this is only temporary.

In a patient suffering persistent pain, the decision to use implants must depend upon the severity and location of the pain. It would be very easy for a patient with postherpetic pain to claim that implants have aggravated the situation.

Blisters that arise from physical burns or from contact with chemicals and allergenic agents may contraindicate implants only if the patient is continually exposed to the provocative agents.

Cold sores. Cold sores, or fever blisters, are