Carranza’s Clinical Periodontology, 12th Ed, Chapter 16

Figure 16-25: B) The lesion seen mesial to #14 could erroneously be ‘dismissed’ as a localized periodontal condition secondary to the damaged amalgam restorations contributing to food impaction. Too many practitioners might assume that this lesion is innocuous and will ‘resolve’ with scaling/root planning and improved oral hygiene, particularly when there appears to be a visible etiologic factor. As stated in this chapter on page 242, the gingiva is not a frequent site of oral malignancy. However, practitioners must maintain a ‘guilty until proven innocent’ stance when faced with an undiagnosed lesion. There have been too many stories of oral healthcare providers ‘assuming’ rather than following up and being certain. The maximum amount of time this lesion should be ‘watched’ for improvement is 2 weeks, after which biopsy for definitive diagnosis is indicated. What is the presumptive decision is to repair the amalgams allowing for improved contact between #13 and #14, and it takes several weeks to have an appointment opening and then several more weeks to see if improved oral hygiene and less food impaction can clear the lesion? This squamous cell carcinoma could become less treatable in that amount of time. ‘Guilty until proven innocent’ should replace ‘watch and wait’.