- Email: [email protected]
The development of cancer instruction in the dental school
Operative THE
DEVELOPMENT THE RAYMOND
Oral
Surgery
OF CANCER INSTRUCTION DENTAL SCHOOL
F. KAISER,
M.l).,*
BETHESDA,
IN
MD.
I
NSTRUCTION in oral cancer is rapidly becoming established as an essential part of the dental school curriculum. Although organized effort to promote cancer education in the dental school has been in existence only four years, interest in the oral aspects of the disease and its implementation into curricula is already notably widespread. As with most efforts of this type, concerted instruction in oral cancer was forced in the beginning to grow through trial and error and without the benefit of guiding precedents. The difficulties of introducing new instruction into curricula were anticipated and did occur. But appreciation of the assistance that dentists can give to cancer control has seen acceptance and wide expansion of training that will enable future members of the dental profession to recognize the early symptoms of oral cancer. As an estimate of the size of the oral cancer problem, it was reported in 1947 that 20,000 persons developed cancer of the buccal cavity. In addition, a large number of skin cancers occurred on areas that would be subject to scrutiny by the dentist. The majority of these individuals could be cured if adequate therapy were instituted early. The key to the importance of the dentist in cancer control lies in the fact that he has the opportunity to observe oral lesions routinely in their first stages of growth. Educational campaigns have succeeded in establishing habits of frequent visits to the dentist. Therefore, the dentist may discover lesions early enough to mean the difference between curable and incurable cancer. The oral cavity is one of the most accessible body sites. Thus, with knowledge of the history of his patients, the alert and well-trained dentist is able to observe suspicious changes with little difficulty. In some instances he may take a biopsy or refer the patient to a physician without arousing undue anxiety. He may also schedule a later appointment in order to follow up the course of a lesion or to determine whether the patient has sought the medical care suggested. In the treatment of oral malignancies, the dentist can render invaluable aid to the physician. He can contribute a great deal by correcting dental conditions prior to, and after, therapy. Extensive surgery may also require his services for prosthetic and restorative procedures and attendant rehabilitation. One of the stimuli which have prompted instruction in cancer to become a vital part of the dental school curricula is the teaching grants program of the National Cancer Institute. Knowing that the dentist could be a dominant figure pg;~c;
*Chief,, Cancer Control~Branch, Institute of the NatIonal
and Institutes
Chief, Training and Project of Health, Pubhc Health
1028
Grants Serwce,
Section, Federal
National Security
in the recognition of oral cancer, the Institute became interested in organizing ii program that would assist dental schools in presenting students with cancer The Council on Dental Education of the American I)ental :iss(linstruction. ciation was approached by the Institute, and at a meeting in 1947 the Coun(4l It \\-a s agreed that, such a program would be of hcnetit to the dental profession. the expressed feeling of the Council that instruction iI1 early tlia$iosis. ill particular, would be desirable. Accordingly, the grants-in-aid program for dental schools was initiated 1)) the National Cancer Institute wit,h approval of the Kat,ional Advisory (‘a~~*~ Council. To help the schools get started, the Council recommended t,llat the> first review existing teaching programs, then, by the best means availwblc~. correlate clinical and basic science instruction relating to cancer. I~‘urt,licr, tlie schools were advised to stimulate student interest by instituting cancer research where possible. The limit of aid that any school might receive was set at $5,0~0, renewable annually, and continuing support from year to pear was assured w far as possible. The maximum grant was small, but, thcrc was no inteniion of complete financing. Rather, the grants were designed merely as an impetus f1)1 initiating a permanent program of instruction which would be supported adtlitionally by the schools and other interested groups. Concurrently with C’anrc~~ Instit,ute grants, additional financing t)y unirersit>- funds has been fort tlcomirlg in most,cases. Up to the present time, 40 of the 12 dental schools in the I’nited Statcls have received grants from the Institute for the inauguration or expansion 01 cancer teaching programs. Of the currently active grants, 31 are now lwilrg supported for the fourth year. AS grant applications and progress reports were reviewed in Oct,ober, l!i:il, it was noted that although no two schools were pursuing identical progranls. definite trends toward uniformity were arising, that is, students in a n~nnb~ 01’ schools arc receiving, by and large, the same instruction in the rrcognitiorr ()I’ cancer. IIowever, as was expected, methods of instruction have varied, dcpentling upon what the school t,hought best in view of its available staff and f’acilitiis. Although nine schools state that oral cancer is taught in a “separate d(bpart-. ment” and 11 list it as a separate course, instruction in these schools and in all others is rorrelated”$etween several departments. The ferling is that C~IIWI~ should not, he “taken out of context,” or isolat,cd from t tic many fields i)f dentistry with which it is associated. However, many scliools report that tli
1030
RAYMOND
F.
KAISER
sented as part of the subject matter in general or oral pathology, and in 23 of these schools, cancer teaching is emphasized in both fields of instruction. Corresponding laboratory work is performed in histopathology in 33 schools. Oral cancer teaching receives emphasis in oral diagnosis in 36 schools, 6 of which make the point that it is the hub of their programs. In 7 schools students are required to follow cases through from history and clinical findings to incision for biopsy, and tissue preparation, diagnosis, and therapy. Elsewhere, These materials might inmaterials are prepared in advance for the student. clude case histories, histologic slides, photographs, photomicrographs, fresh specimens, and x-rays from which the student would make a diagnosis. A few teaching centers require that students be able to diagnose selected typical lesions. Although biopsy technique is taught in only 7 schools, students in 24 scl~ools observe the procedure, and several schools plan expansion in this area. Laboratories operated by a few schools offer tissue diagnostic services to local practitioners and have been found a worth-while adjunct to teaching programs. In 33 schools similar emphasis is use of radium and tracers for diagnosis to construct radium
cancer teaching is stressed in surgery, and in 24 schools placed in radiology. In the latt,er instance, the therapeutic radon seeds is included, as well as the use of radioactive in a few schools. At one school, dental residents learn how molds for topical application to mouth lesions.
Prosthetic and restorative methods are studied in 11 schools as measures additive to the care of cancer patients prior to and following treatment. Instruction in this area is apparently more common at the graduat,e level, and funds from a number of grants are used for prosthetic training of dental interns and residents. Lectures on cancer prevention in 7 schools deal with public health and oral hygiene and with irritants and other suspected causes of cancer. Here the student is urged to treat chronic irritations, ulcerations, and infections, as well as to correct malformed teeth that may cause precancerous conditions. Other fields in which cancer is given special emphasis are: dental medicine, 16 schools; general dentistry, 4 schools; and follow-up, 4 schools. Lectures on follow-up care point up the need for special attention to the social adjustment of patients. Biochemistry, physiology, anatomy, and bacteriology are also part of several cancer programs. Clinical Instruction.-From the standpoint of clinical training, there is no doubt that the great majority of teachin, 0‘ centers consider the presentation of actual cases in clinics or hospitals an essential parallel to cancer teaching in the classroom. Through clinic attendance the student may observe at first hand the appearance and management of undiagnosed diseases, puzzling lesions, and In, 30 schools students, usually in small groups, witness frank cancer. therapeutic procedures in head and neck clinics, oral clinics, and general tumor clinics. In 3 schools they make ward rounds with staff members of Major operations are observed by hospitals affiliated with the dental schools. students in 3 schools.
CANCER
IKSTRUCTIOS
IX
DESTAI,
SClIOO1.
IWll
attendance of students in diagnostic clinics 01 at, clinical pathologica 1 conferences is a, part, of oral cancer teaching in II sc*hocrls. Ordinari1Y. c)nl! graduate students do nlore than take case histories in the WUI’W of Ptietl: care. The exception is one school t,hat has a special tliagnostic teaching clillic* where, t,hree hours weekly, seniors examine patients atltl. :lidetl I)y Inic~rosc~ol)ii. study of sLqe(:tecl. tissue, make diagnosis (II’ st~l(~c~tetl PasCs l~ltlet gSniclarl~‘cJ(I? the clinic stafI+. Clinical instruction is also accomplished through tlemonstrat,ion calinics (23 schools), tumor conferences (7 schools). t’oll~~w-~~~~ clinics (,5 schools 1. all(i semina t*s ( 12 schools). In 25 schools teaching programs have been estentled to gracluate students, faculty members, and dental practitioners. This is achieved by periodi i* seminars, lectures, and conferences to which all practitioners in a given Stat P or area are invited. In addition, a number 01’ gralltecs have found it he~~efihl to their teaching to have some training for tlt>ntal IILII’S~~S, hygienists, ilrl~l technicians. Cancer Coordinators.-As no attempt has Iwn matle to set cancr~* spal.t from existing curricula, it is not surprising that directors of cancer teaching programs have been drawn from a variety of departnlents. Each grantee designates one and sometimes two program directors as cancer coordinators charged with the integration of cancer instruction. Twenty coordinators arc in the fields of oral or general pathology, 5 are in oral surgery, 4 in 0~1 medicine, 3 in oncology, 2 in histology, and 1 in prosthetics. Their positio?is range from dean, 7; head of a department,, 7; professor, 14; associate professor, 9 ; assistant professor, 4; to chairman of: rttsearcah, 2, In addition, more t,han half of the ~cl~o01s have appointed coordinating c*ommittees consisting of principal staff members assigned to cancer tcaehing in various tlepart,lnents. Kot the least of the difficulties eucoulltered 1)~ granters is that of ;I+ sembling adequate teaching personnel. ,4gain and again grantees have bt1c.n forced to direct their programs into new avenues or postpone certain phases IIC them when teachers thought to be available c~ould not be obtained. AI pr’cscllt only a handful of instructors devote full time to cancer instruct,ion; homcrtr, an average of two and one-half instructors spend the (Jqnivalrnt, of full time in each school, and fellow instructors are cwploy~l l)\- onefourth of the schouls. The average figures arc misleading, however, since as many as 19 part-t,imc itistructors have been reported in one school. Visiting lecturers arc drawn npcm rather hcavilv, and in some schools arc the sole lecturers. In all, 26 institntions use some part of their grants for guest sprakcrs. AZ few schools hwvcafourid wnotheianswer : they are training their own staff’ and giving financdial assistance to graduate students in eschangc for their teaching services later. Knturally the teaching programs cannot nperate with instructors alone. and most schools employ grant funds for a clerk or st,enoprapher, one 01’f\zo technicians, and, in some cases,a photographer or artist. Teaching Devices.-Among teaching devices, t,he tendency toward rise OI visual aids has become more pronounced in all scdhools. (Classroomand clinical
1032
RAYMOND
F.
KAISER
instruction is augmented by photographs, photomicrographs, tissue slides, and motion pictures. The practice of one school is to take Kodachrome photographs of clinic patients when they are admitted and throughout the course of treatment. A significant part of diagnostic instruction is leaning more upon the gross and microscopic appearance of lesions as revealed by color photography. The purchase of photographic equipment is probably the chief expenditure for supplies and equipment of all grantees. Other means of demonstration that are ga,ining popularity as teaching implements are specimen displays in 16 schools, exhibits in 12, tumor museums in 10, models in 9, and moulages in 6. It is noted that after four years of continuing assistance, at least threefourths of the grantees must still use part of their funds for the purchase of equipment, much of which is of the most basic kind. Expanded programs, of course, account for many items such as additional dental chairs, microscopes, and examining instruments. Because school faculties have realized that proficiency is developed best in students who have a true interest in the subject, they have gone to considerable pains to build up such interest. For example, 15 schools are following the recommendations of the National Advisory Cancer Council by conducting research with which the students become acquainted through lectures or seminars or by serving as assistants to investigators in the universities. In 3 schools, students are required to write essays on the role of the dentist in tumor diagnosis and treatment. Prizes are offered for the best essays. An incentive used by one school is to award a prize each year to the first student who finds an oral cancer case. Summary As cancer instruction in the dental schools is reviewed, it is evident that dentists are being prepared for prominent roles in the control of cancer. The disease ‘is far more familiar to graduating dentists today than it was just a few years ago. The knowledge possessed by present graduates is a most significant index of the increasing responsibility taken by the dentist in cancer control. Since the oral cavity is one of the most accessible cancer sites, and dental patients are seen at regular intervals, the dentist who is equipped with knowledge of neoplastic growths may discover the earliest and most curable lesions. Current teaching programs place greatest emphasis on cancer in oral and general pathology and in oral diagnosis. Attendance at diagnostic and tumor clinics, much increased, is enabling students to gain fuller understanding of clinical cancer and associated diseases. Prosthetic and restorative methods are also increasing in importance. The use of visual materials has now spread to all schools and these materials are considered an extremely valuable teaching asset. It is noteworthy that discussions of the social aspects of patient care and rehabilitation have been added to several curricula. As dental students acquire skill in discovering malignancies, it is apparent that they will widen the spectrum of dentistry by a considerable degree. At the
same time it is possible that they map 1~; largcl>- rrsponsiblc of the oral cavity under control.
t’or bringing
canw~~
References 1. Cheyne,
Virgil I).: Relation of Pathology tb Dentistry, Proc. Am. Aswc. 1)ent. Schooli 19: 170, 1942. 2. Conlev, John J.: Cancer of the Mouth, Bull. C’onnecticut State 1). A. 23: 34. 1946. 3. Lloyd”,‘Ralph S.: Role of the Dentist ‘in Oral Cancer Detection, Pub. Hoaltk Rep. 63: Rx-9312 -_---
7
1948. ---.
The Ijentist’s Responsibility, I). Ratliog. 4. Robinson, Hamilton B. G.: Oral Malignancies. & Photog. 21: 1, 1948. -5. Martin, Hayes: Mouth Cancer am1 the Dentist, XIV .York, 1919, A\mrriwn i”:nlc~i~ Society-, Inc. 6. Weisherger, David: The Role of the Dentist in (:ancer Control. Cancer--A AVanual fl)r Practitioners, Boston, 1950, Massachusetts Division of American Cancer Society. 7. Kaiser, R,apmond F.: The Oral Cancer Teaching Program in Dental Srhools,. PII!,. Health Rep. 66: ‘757-761, 1951.
DEVELOPMENT THE RAYMOND
Oral
Surgery
OF CANCER INSTRUCTION DENTAL SCHOOL
F. KAISER,
M.l).,*
BETHESDA,
IN
MD.
I
NSTRUCTION in oral cancer is rapidly becoming established as an essential part of the dental school curriculum. Although organized effort to promote cancer education in the dental school has been in existence only four years, interest in the oral aspects of the disease and its implementation into curricula is already notably widespread. As with most efforts of this type, concerted instruction in oral cancer was forced in the beginning to grow through trial and error and without the benefit of guiding precedents. The difficulties of introducing new instruction into curricula were anticipated and did occur. But appreciation of the assistance that dentists can give to cancer control has seen acceptance and wide expansion of training that will enable future members of the dental profession to recognize the early symptoms of oral cancer. As an estimate of the size of the oral cancer problem, it was reported in 1947 that 20,000 persons developed cancer of the buccal cavity. In addition, a large number of skin cancers occurred on areas that would be subject to scrutiny by the dentist. The majority of these individuals could be cured if adequate therapy were instituted early. The key to the importance of the dentist in cancer control lies in the fact that he has the opportunity to observe oral lesions routinely in their first stages of growth. Educational campaigns have succeeded in establishing habits of frequent visits to the dentist. Therefore, the dentist may discover lesions early enough to mean the difference between curable and incurable cancer. The oral cavity is one of the most accessible body sites. Thus, with knowledge of the history of his patients, the alert and well-trained dentist is able to observe suspicious changes with little difficulty. In some instances he may take a biopsy or refer the patient to a physician without arousing undue anxiety. He may also schedule a later appointment in order to follow up the course of a lesion or to determine whether the patient has sought the medical care suggested. In the treatment of oral malignancies, the dentist can render invaluable aid to the physician. He can contribute a great deal by correcting dental conditions prior to, and after, therapy. Extensive surgery may also require his services for prosthetic and restorative procedures and attendant rehabilitation. One of the stimuli which have prompted instruction in cancer to become a vital part of the dental school curricula is the teaching grants program of the National Cancer Institute. Knowing that the dentist could be a dominant figure pg;~c;
*Chief,, Cancer Control~Branch, Institute of the NatIonal
and Institutes
Chief, Training and Project of Health, Pubhc Health
1028
Grants Serwce,
Section, Federal
National Security
in the recognition of oral cancer, the Institute became interested in organizing ii program that would assist dental schools in presenting students with cancer The Council on Dental Education of the American I)ental :iss(linstruction. ciation was approached by the Institute, and at a meeting in 1947 the Coun(4l It \\-a s agreed that, such a program would be of hcnetit to the dental profession. the expressed feeling of the Council that instruction iI1 early tlia$iosis. ill particular, would be desirable. Accordingly, the grants-in-aid program for dental schools was initiated 1)) the National Cancer Institute wit,h approval of the Kat,ional Advisory (‘a~~*~ Council. To help the schools get started, the Council recommended t,llat the> first review existing teaching programs, then, by the best means availwblc~. correlate clinical and basic science instruction relating to cancer. I~‘urt,licr, tlie schools were advised to stimulate student interest by instituting cancer research where possible. The limit of aid that any school might receive was set at $5,0~0, renewable annually, and continuing support from year to pear was assured w far as possible. The maximum grant was small, but, thcrc was no inteniion of complete financing. Rather, the grants were designed merely as an impetus f1)1 initiating a permanent program of instruction which would be supported adtlitionally by the schools and other interested groups. Concurrently with C’anrc~~ Instit,ute grants, additional financing t)y unirersit>- funds has been fort tlcomirlg in most,cases. Up to the present time, 40 of the 12 dental schools in the I’nited Statcls have received grants from the Institute for the inauguration or expansion 01 cancer teaching programs. Of the currently active grants, 31 are now lwilrg supported for the fourth year. AS grant applications and progress reports were reviewed in Oct,ober, l!i:il, it was noted that although no two schools were pursuing identical progranls. definite trends toward uniformity were arising, that is, students in a n~nnb~ 01’ schools arc receiving, by and large, the same instruction in the rrcognitiorr ()I’ cancer. IIowever, as was expected, methods of instruction have varied, dcpentling upon what the school t,hought best in view of its available staff and f’acilitiis. Although nine schools state that oral cancer is taught in a “separate d(bpart-. ment” and 11 list it as a separate course, instruction in these schools and in all others is rorrelated”$etween several departments. The ferling is that C~IIWI~ should not, he “taken out of context,” or isolat,cd from t tic many fields i)f dentistry with which it is associated. However, many scliools report that tli
1030
RAYMOND
F.
KAISER
sented as part of the subject matter in general or oral pathology, and in 23 of these schools, cancer teaching is emphasized in both fields of instruction. Corresponding laboratory work is performed in histopathology in 33 schools. Oral cancer teaching receives emphasis in oral diagnosis in 36 schools, 6 of which make the point that it is the hub of their programs. In 7 schools students are required to follow cases through from history and clinical findings to incision for biopsy, and tissue preparation, diagnosis, and therapy. Elsewhere, These materials might inmaterials are prepared in advance for the student. clude case histories, histologic slides, photographs, photomicrographs, fresh specimens, and x-rays from which the student would make a diagnosis. A few teaching centers require that students be able to diagnose selected typical lesions. Although biopsy technique is taught in only 7 schools, students in 24 scl~ools observe the procedure, and several schools plan expansion in this area. Laboratories operated by a few schools offer tissue diagnostic services to local practitioners and have been found a worth-while adjunct to teaching programs. In 33 schools similar emphasis is use of radium and tracers for diagnosis to construct radium
cancer teaching is stressed in surgery, and in 24 schools placed in radiology. In the latt,er instance, the therapeutic radon seeds is included, as well as the use of radioactive in a few schools. At one school, dental residents learn how molds for topical application to mouth lesions.
Prosthetic and restorative methods are studied in 11 schools as measures additive to the care of cancer patients prior to and following treatment. Instruction in this area is apparently more common at the graduat,e level, and funds from a number of grants are used for prosthetic training of dental interns and residents. Lectures on cancer prevention in 7 schools deal with public health and oral hygiene and with irritants and other suspected causes of cancer. Here the student is urged to treat chronic irritations, ulcerations, and infections, as well as to correct malformed teeth that may cause precancerous conditions. Other fields in which cancer is given special emphasis are: dental medicine, 16 schools; general dentistry, 4 schools; and follow-up, 4 schools. Lectures on follow-up care point up the need for special attention to the social adjustment of patients. Biochemistry, physiology, anatomy, and bacteriology are also part of several cancer programs. Clinical Instruction.-From the standpoint of clinical training, there is no doubt that the great majority of teachin, 0‘ centers consider the presentation of actual cases in clinics or hospitals an essential parallel to cancer teaching in the classroom. Through clinic attendance the student may observe at first hand the appearance and management of undiagnosed diseases, puzzling lesions, and In, 30 schools students, usually in small groups, witness frank cancer. therapeutic procedures in head and neck clinics, oral clinics, and general tumor clinics. In 3 schools they make ward rounds with staff members of Major operations are observed by hospitals affiliated with the dental schools. students in 3 schools.
CANCER
IKSTRUCTIOS
IX
DESTAI,
SClIOO1.
IWll
attendance of students in diagnostic clinics 01 at, clinical pathologica 1 conferences is a, part, of oral cancer teaching in II sc*hocrls. Ordinari1Y. c)nl! graduate students do nlore than take case histories in the WUI’W of Ptietl: care. The exception is one school t,hat has a special tliagnostic teaching clillic* where, t,hree hours weekly, seniors examine patients atltl. :lidetl I)y Inic~rosc~ol)ii. study of sLqe(:tecl. tissue, make diagnosis (II’ st~l(~c~tetl PasCs l~ltlet gSniclarl~‘cJ(I? the clinic stafI+. Clinical instruction is also accomplished through tlemonstrat,ion calinics (23 schools), tumor conferences (7 schools). t’oll~~w-~~~~ clinics (,5 schools 1. all(i semina t*s ( 12 schools). In 25 schools teaching programs have been estentled to gracluate students, faculty members, and dental practitioners. This is achieved by periodi i* seminars, lectures, and conferences to which all practitioners in a given Stat P or area are invited. In addition, a number 01’ gralltecs have found it he~~efihl to their teaching to have some training for tlt>ntal IILII’S~~S, hygienists, ilrl~l technicians. Cancer Coordinators.-As no attempt has Iwn matle to set cancr~* spal.t from existing curricula, it is not surprising that directors of cancer teaching programs have been drawn from a variety of departnlents. Each grantee designates one and sometimes two program directors as cancer coordinators charged with the integration of cancer instruction. Twenty coordinators arc in the fields of oral or general pathology, 5 are in oral surgery, 4 in 0~1 medicine, 3 in oncology, 2 in histology, and 1 in prosthetics. Their positio?is range from dean, 7; head of a department,, 7; professor, 14; associate professor, 9 ; assistant professor, 4; to chairman of: rttsearcah, 2, In addition, more t,han half of the ~cl~o01s have appointed coordinating c*ommittees consisting of principal staff members assigned to cancer tcaehing in various tlepart,lnents. Kot the least of the difficulties eucoulltered 1)~ granters is that of ;I+ sembling adequate teaching personnel. ,4gain and again grantees have bt1c.n forced to direct their programs into new avenues or postpone certain phases IIC them when teachers thought to be available c~ould not be obtained. AI pr’cscllt only a handful of instructors devote full time to cancer instruct,ion; homcrtr, an average of two and one-half instructors spend the (Jqnivalrnt, of full time in each school, and fellow instructors are cwploy~l l)\- onefourth of the schouls. The average figures arc misleading, however, since as many as 19 part-t,imc itistructors have been reported in one school. Visiting lecturers arc drawn npcm rather hcavilv, and in some schools arc the sole lecturers. In all, 26 institntions use some part of their grants for guest sprakcrs. AZ few schools hwvcafourid wnotheianswer : they are training their own staff’ and giving financdial assistance to graduate students in eschangc for their teaching services later. Knturally the teaching programs cannot nperate with instructors alone. and most schools employ grant funds for a clerk or st,enoprapher, one 01’f\zo technicians, and, in some cases,a photographer or artist. Teaching Devices.-Among teaching devices, t,he tendency toward rise OI visual aids has become more pronounced in all scdhools. (Classroomand clinical
1032
RAYMOND
F.
KAISER
instruction is augmented by photographs, photomicrographs, tissue slides, and motion pictures. The practice of one school is to take Kodachrome photographs of clinic patients when they are admitted and throughout the course of treatment. A significant part of diagnostic instruction is leaning more upon the gross and microscopic appearance of lesions as revealed by color photography. The purchase of photographic equipment is probably the chief expenditure for supplies and equipment of all grantees. Other means of demonstration that are ga,ining popularity as teaching implements are specimen displays in 16 schools, exhibits in 12, tumor museums in 10, models in 9, and moulages in 6. It is noted that after four years of continuing assistance, at least threefourths of the grantees must still use part of their funds for the purchase of equipment, much of which is of the most basic kind. Expanded programs, of course, account for many items such as additional dental chairs, microscopes, and examining instruments. Because school faculties have realized that proficiency is developed best in students who have a true interest in the subject, they have gone to considerable pains to build up such interest. For example, 15 schools are following the recommendations of the National Advisory Cancer Council by conducting research with which the students become acquainted through lectures or seminars or by serving as assistants to investigators in the universities. In 3 schools, students are required to write essays on the role of the dentist in tumor diagnosis and treatment. Prizes are offered for the best essays. An incentive used by one school is to award a prize each year to the first student who finds an oral cancer case. Summary As cancer instruction in the dental schools is reviewed, it is evident that dentists are being prepared for prominent roles in the control of cancer. The disease ‘is far more familiar to graduating dentists today than it was just a few years ago. The knowledge possessed by present graduates is a most significant index of the increasing responsibility taken by the dentist in cancer control. Since the oral cavity is one of the most accessible cancer sites, and dental patients are seen at regular intervals, the dentist who is equipped with knowledge of neoplastic growths may discover the earliest and most curable lesions. Current teaching programs place greatest emphasis on cancer in oral and general pathology and in oral diagnosis. Attendance at diagnostic and tumor clinics, much increased, is enabling students to gain fuller understanding of clinical cancer and associated diseases. Prosthetic and restorative methods are also increasing in importance. The use of visual materials has now spread to all schools and these materials are considered an extremely valuable teaching asset. It is noteworthy that discussions of the social aspects of patient care and rehabilitation have been added to several curricula. As dental students acquire skill in discovering malignancies, it is apparent that they will widen the spectrum of dentistry by a considerable degree. At the
same time it is possible that they map 1~; largcl>- rrsponsiblc of the oral cavity under control.
t’or bringing
canw~~
References 1. Cheyne,
Virgil I).: Relation of Pathology tb Dentistry, Proc. Am. Aswc. 1)ent. Schooli 19: 170, 1942. 2. Conlev, John J.: Cancer of the Mouth, Bull. C’onnecticut State 1). A. 23: 34. 1946. 3. Lloyd”,‘Ralph S.: Role of the Dentist ‘in Oral Cancer Detection, Pub. Hoaltk Rep. 63: Rx-9312 -_---
7
1948. ---.
The Ijentist’s Responsibility, I). Ratliog. 4. Robinson, Hamilton B. G.: Oral Malignancies. & Photog. 21: 1, 1948. -5. Martin, Hayes: Mouth Cancer am1 the Dentist, XIV .York, 1919, A\mrriwn i”:nlc~i~ Society-, Inc. 6. Weisherger, David: The Role of the Dentist in (:ancer Control. Cancer--A AVanual fl)r Practitioners, Boston, 1950, Massachusetts Division of American Cancer Society. 7. Kaiser, R,apmond F.: The Oral Cancer Teaching Program in Dental Srhools,. PII!,. Health Rep. 66: ‘757-761, 1951.