Columbia University School of Dental and Oral Surgery - Dental Columbian Yearbook (New York, NY)

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Oral Diagnosis EDWARD V. ZEGARELLI A-B., D.D.S., M.S. Associate Professor of Dentistry The practice of diagnosis may be made simple and accurate if certain basic principles are followed. To illustrate I will describe briefly two subjects — a member of the dental staff — and a disease of the mouth. Attempt to identify each subject: 1A. The person is a white male, in the sixties, appears younger; medium build; dresses conservatively; wears horn-rimmed glasses; is clean-shaven; has wavy-black hair with that greyness which lends that look of distinction. IB. Due t,o illness sleeping is irregular; smokes filter cigarettes; has a high tolerance for alcoholic liquids; loquacious and lovable; idealistic and practical; intimate with both extreme joy and sadness; expert hunter and financier; astute student of the Civil War, politics, and world history; possesses vast scientific knowledge, a skillful dentist, diagnostician, clinician and teacher. 2A. The disease is ulcerative affecting the soft tissues of the mouth; the ulcers which are small, round, superficial and multiple are yellowish-grey with red borders. 2B. Only mouth tissues are affected; adult women more often; recurrent; ulcers last ten to fourteen days; variable remission period follows healing; associated with hypovitaminosis, allergy, hormonal imbalance, herpes simplex virus and psychogenic stimuli; therapy uniformly unsuccessful; of no danger to life of patient. Most students will recognize easily the subjects described. But, were the descriptive in- formation limited to the outward or clinical appearances alone, as contained in the first paragraphs, would your diagnosis be as accurate? Dependence on visual features for con- clusive diagnosis is often insufficient and may lead to error. A more intimate acquaintance with a person or disease is essential if one is to know and recognize them. Knowledge of the inherent qualities and characteristic together with an understanding of the total entity will distinguish and differentiate the person or disease. Note the contents of the second paragraphs. These are the subjects ' descriptive qualities, their inherent natures, their habitual character- istics. Knowledge of these features not only clarifies the specific entity but it also aids in portraying the most important aspect of diagnosis, namely, differentiation, the art of dis- tinguishing one disease from another. Lack of a thorough and total understanding of a subject precludes its proper appreciation, Without this understanding one can hardly expect to know and diagnose the essential prerequisites to accurate therapy. Dr. Edward V. rt ZEGARELU k ■ ▼) —•■-?] eph A. Cutti Joseph A. Cuttita Jack Budowsky Ferdinand A. Tuoti John D. Piro A.B., M.S., D.D.S. D.D.S. D.M.D. D.D.S. Ida M. Golomb D.D.S. Eval Lindec Radiology Jesse L. Lefcourt Marcella Halpert Lester E. Rosenthal Joseph Serio D.D.S. D.D.S. D.D.S. D.D.S. Lawrence Daum D.D.S. Eugene M. Tedaldi B.S., D.D.S Robert J. Kelle B.S., D.D.S

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MAURICE J. HICKEY, D.M.D., M.D. Associate Dean of the Vacuity of Medicine for Dental and Oral Surgery Executive Officer, Department of Dentistry Professor of Oral Surgery

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.EWIS R. STOWE, D.D.S. Professor of Dentistry Director, Division of Stomatology STOMATOLOGY Periodontology In recent years, there has been an increasing awareness of the importance of the periodontium in the restoration and maintenance of dental health. The modern dentist is not concerned solely with repairing an individual tooth, but studies the relationships of teeth to their adjacent and opposing teeth and to the dentition as a whole. He observes the forces to which teeth are subjected, and realizes that the amount and the health of the periodontal supporting structures determine the success with which these forces will be withstood. He uses methods by which the occlusal forces may be distributed and reduced to levels which can be tolerated by the periodontium. He raises the resistance of the periodontal structures to breakdown by reducing to a minimum the chronic inflammatory state which results when calculus, debris and inadequately made restorations are present. He is aware of the nutritional and metabolic disturb- ances which may affect the resistance to breakdown. All this knowledge leads to a prevention of much periodontal disease as a result of early treatment of its main causes. The dentist today makes more complex restorations because he treats successfully more cases involving periodontal breakdown. However, this very complexity makes it even more important that the periodontal sup- port of each tooth concerned be maintained in order to preserve the restoration. The ideas and techniques which are involved in the protection and treatment of the periodontium are taught in periodontology courses, but most of them are far from the exclusive property of periodontology. There are increasing numbers of dentists specializing in periodontia, who are trained to care for advanced breakdown, but periodontal treatment of some sort is required in the vast ma- jority of patients in any general practice and the techniques for this should be known and practiced by each dentist. Periodontology includes more than techniques, however, and the concepts learned in it will affect almost every dental procedure performed in the modern dental practice. Dr. Leonard Hirschfeld FRANK E. BEUBE L.D.S., D.D.S. Clinical Professor of Dentistry Saul Schluger D.D.S. D.D.S. A.B., D.D.S. B.S., M.A., D.D.S. 13 Robert Gottsegen AJJJ).S. Ellen N. Hosiosky Bernard H. Wasserman Seymour Algus tym.iy n.rvs n.n.s. n n ;