le sio n , and th e en larg ed n ode a re signs o f la te c a n cer. If w e a re to c u re oral c a n c e r w e m ust act m uch , m uch e a r­ lier— b ack to th e stag e w h e re th e su r­ face lesio n lo oks so in significant and b en ig n th a t o u r initial im pulse is to ig n o re it. W ith o u r p re se n t sta te o f k n o w led g e, this is w h ere w e m ust sta rt. T o d o this req u ire s th e care fu l, th o u g h tfu l, and sy stem atic ex am in a­ tio n o f th e h ard an d soft stru c tu re s o f th e oral c av ity by an e x p e rt, be h e d en ­ tist o r p h y sician . A m o n g o u r tools fo r m aking an early diagnosis let us n o t fo rg et th e help th a t cy to lo g y can p ro v id e. A l­ m ost 15 y ears ago, H e n ry S an d le r d e m o n s tra te d in a d ram a tic w ay how c y to lo g y co u ld help in d iagnosing oral carc in o m a in situ; a first ste p in re d u c ­ ing m o rta lity from this d isease. T h e c y to lo g ic m eth o d is e a sy , u su ally p a in le ss, w ell a c c e p te d by p a tie n ts, an d q u ite in ex p en siv e. W hile it is no t a s u b s titu te fo r b io p sy , its u se will trig g er b iopsy o f th o se lesions th at m ight o th e rw ise be ignored. I w ould urge all d e n tists to d isc u ss this w ith th e ir lo cal p ath o lo g ist an d m ake a r­ ra n g e m e n ts to utilize th is v alu ab le test. ROLA N D A. LOEB, M D CYTOLOGY LABORATORY, LT D . LA N C A ST E R , PA

‘Im p r a c tic a l’ sta te m e n t m In th e Ju n e j a d a , R ich ard T h o m a s G la ss a n d his co lleag u es d escrib ed “ T e a c h in g self-exam in atio n o f th e head and neck: a n o th e r a sp e c t o f p re ­ v en tiv e d e n tis try ” (page 1265). T h e c o n c e p t o f self-ex am in atio n w as q u ite in terestin g an d I certain ly a p p la u d th e d esirab ility o f in creasin g th e p a tie n t’s a w a re n e ss o f a b n o rm al­ ities o f th e head an d n e c k regions. H o w e v e r, I sh o u ld like to ta k e issu e w ith a sta te m e n t e x p re sse d o n page 1266: “ T h e p a tie n t is told to o b se rv e any lesio n fo r tw o w eek s a n d if healing has n o t o c c u rre d w ithin this tim e sp an , to call th e d e n tist im m e d ia te ly .” It is o u r teac h in g , an d m y belief, th a t th e d e n tist is in a b e tte r p o sitio n to ex am in e th e p a tie n t a n d d eterm in e “ if healing h as n o t o c c u rre d .” T o ex ­ p e c t th e naive p a tie n t to ex am in e su ch a reas as the p a late and la teral b o rd e rs

o f th e to n g u e is, in m y o p in io n , im ­ p ra ctic a l. S u b tle a b n o rm a lities o r in­ c o m p le te healing easily could b e o v e r­ lo o k ed by th e p a tie n t. F u rth e r, th e p a tie n t w h o is a h e a v y u s e r o f alco h o l a n d a h ea v y sm o k e r is k n o w n to h a v e a h ig h er in c id e n c e o f o ral m alignancy. S om e au th o rs h av e su g g ested th e se p a tie n ts h av e a 15.5 tim es g re a te r risk o f oral c a n c e r. T h is p a tie n t w o uld be p a rtic u la rly u n reli­ ab le in self-ex am in atio n an d “ selfd ia g n o sis.” T h e re fo re , D r. G la s s ’s te c h n iq u e w o u ld h a v e lim ited u se fu l­ n e ss in this high risk p o p u latio n . I fo u n d th e a rtic le q u ite in terestin g , b u t w ould p re fe r th a t e m p h asis be g iv en to self-ex am in atio n an d n o t to self-diagnosis. S T U A R T L . F IS C H M A N , D M D

If th e ex a m in ers tre a te d th e ir p a ­ tie n ts o r th e ir office sta ff th e w ay th e y tre a te d u s, th e y w o u ld n o lo n g er h a v e p ra c tic e s. I h a p p e n to b elieve th a t th e s e clinical ex a m in a tio n s d o no t a c c u ra te ly e v a lu a te a s tu d e n t’s clin­ ical ability o r ju d g m e n t. B u t if th e y m u st be g iv en , c a n ’t th e e x a m in e rs at le a st b e h a v e like g e n tle m e n ? T h e u su al a ttitu d e o f su c c e ssfu l b o a rd c a n d id a te s, o n c e th e ir a n g er su b sid e s, is “ I ’ve g o t m ine n o w , you fight y o u rs .” T ru e , this is w ritte n in a n g e r. B ut if th e re is e v e r a n y th in g I c a n d o to c o rre c t th is in ju stic e, I will d o it, an d I will jo in an y m o v e m e n t to se e th a t stu d e n ts are tre a te d a s I w ould like to be. JO S E P H C. S C O T T I, D M D BRONX, NY

PR O FE SSO R , ST A T E U N IV E R S IT Y O F N E W YORK A T B U F F A L O

E y e injuries in d e n ta l o ffice ‘H u m ilia tin g e x p e rie n c e ’ m I am w riting to you as a n ew co l­ league. M y e n tra n c e in to th e p ro fe ssio n , a fte r having been ta u g h t to c a re fo r th e p a tie n ts I tr e a t an d to em p a th ize w ith th e ir fe a rs, w as a hum iliating e x p e rie n c e . I a m referrin g to th e N o rth e a s t R eg io n al B o ard ex am in a ­ tio n . B elieve m e, I d o n o t m e a n to b rag w hen I say th a t I w as a g o od stu ­ d e n t. I w as priv ileg ed to re ce iv e sev ­ eral d e p a rtm e n ta l a w a rd s, w as e le c t­ ed to O m ic ro n K a p p a U p silo n , and g ra d u a te d first in m y class o f 75. I am a little e m b a rra ss e d to sta te th is, b u t I d o so to show th a t this le tte r is n o t so u r g ra p e s, an d I am n o t b itte r a b o u t failing th e b o a rd s; I p assed . N o o n e sh o u ld b e su b je cte d to an e x p erie n c e like th is. A fte r fo u r y ears o f d en tal e d u c a tio n , to be fo rc e d to su b m it to th e sa rc a sm an d h a ra ssm e n t w e u n d e rw e n t is to b e d eg ra d e d as a p e rso n an d a s a p ro fessio n a l. A s one o f m y c la ssm a te s (also in O K U , and now in a p o stg ra d u a te o rth o d o n tic s p ro g ram ) said , “ It w as like pledging a fra te rn ity , a n d th is w as H ell W e e k .” S ev en o f m y c la ssm a te s failed th e b o a rd s. P e rh a p s o n e o r tw o d e se rv e d to fail. N o n e o f th e o th ers h a v e an y id e a o f w hy th e y faile d , an d th e b o a rd will n o t tell th e m w h y . T h is is ad ding in su lt to in ju ry .

502 ■ LETTERS TO THE EDITOR / JADA, Vol. 91, September 1975

m In re g ard to th e Ju n e j a d a a rtic le on a v o id a b le a d v e rs e e v e n ts in d e n tistry b y P e te r M ilgrom (page 1282), I w ish to a d d o n e a re a to his list o f av o id ab le a d v e rs e d en tal o u tc o m e s th a t I feel is e x tre m e ly im p o rta n t an d all to o o ften o v e rlo o k e d . I a m referrin g to ey e in ju ries in th e d e n ta l office. T o d a y w e a re p ra c ticin g sit-d o w n d e n tistry w ith th e p a tie n t in a h o rizo n ta l p o sitio n . W e c o n sta n tly h a v e sh arp in stru m e n ts h a n d e d to us o v e r th e p a tie n t’s fa c e , a n d re a c h fo r h a n d p iec es w ith sh a rp b u rs. W e c a rry c o tto n p elle ts lad en w ith ac id s, m ed ­ ic am e n ts, v a rn ish e s, an d w h o k n ow s w h a t else to w ith in in ch e s o f th e e y es. W e rem o v e to o th stru c tu re a n d filling m aterials a t u ltra sp e e d , a n d th e s e p a rtic le s a re n o w p ro p e lle d v e rtically d u e to th e p a tie n ts h o riz o n ta l p o sitio n . F ro m m y o w n e x p e rie n c e I h a v e h a d am alg am land o n th e p a tie n t’s c o rn e a o n se v e ra l o c c a sio n s, a n d h a v e h a d to th en a tte m p t re m o v a l, a p ro c e ­ d u re fo r w h ich w e a re n o t tra in e d . A sk a n y o p h th alm o lo g ist a b o u t th e healing o f a sc ra tc h e d co rn ea . A b o u t tw o y e a rs ag o , a s I w as re ­ m oving a p a rticle o f am alg am fro m a p a tie n t’s e y e , I th o u g h t o f th e s e th in g s. I th o u g h t esp ecially o f th e fact th a t in m y d e n ta l train in g , a s late as 1969, w e w e re to ld to re m o v e p a tie n ts ’ g la sse s to “ a v o id b reak in g th e m .”

Letter: Teaching self-examination of the head and neck: another aspect of preventive dentistry.

le sio n , and th e en larg ed n ode a re signs o f la te c a n cer. If w e a re to c u re oral c a n c e r w e m ust act m uch , m uch e a r­ lier— b...
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