ALUMNI BULLETIN Indiana University School of Dentistry

VOL.V JANUARY, 1943 No. 2 Growth and Develop­ Endocrine Therapy Dr. Harry J. Healey Re- Second Class of ment of Curriculum 1n Dentistry ceives Navy Commission 1942 Graduates Planned at Meeting Dr. Harry Healey, a full time (Manuscript submitted by Dr. member of the dental faculty since Class Five Months Ahead of Isaac Schour, Department of His- Normal Graduation Faculty Elects Planning Commit­ tology, University of Illinois Col- 1931, will soon leave the university tee To Evaluate Suggested lege of Dentistry) to join the armed forces. Under the accelerated program Improvements. Dr. Healey graduated from this begun a year ago by the entire The role of the endocrines in school in 1931 and was appointed university, the school of dentistry, At its last regular meeting the the production of dental disease dental intern for the year 1931-32. along with other departments of faculty of the School of Dentistry is not as yet definitely established. He was made clinical instructor in the university, has graduated an­ elected a committee the duty of For the most part, statements in 1932 which appointment he held other class. Commencement exer­ which is to evaluate the present the literature which relate endo- until 1937 when he was promoted cises were held on December 20th, teaching program and make rec­ crine dysfunctions as etiologic to Assistant Professor of Opera­ 1942, in the new auditorium on ommendations designed to promote agents in dental diseases are not tive Dentistry and Assistant Su­ the Bloomington campus. Twenty­ the further growth and develop­ I supported by substantial clinical perintendent of the Clinic. four seniors received the degree ment of our school. or experimental evidence. We are indeed sorry to lose Dr. Doctor of Dental Surgery. This This committee has had two Investigation of a number of Healey, but we feel fortunate to is the second class in dentistry meetings at which various meth­ patients in this institution suffer- have such a person as Dr. Healey graduating from Indiana Univer­ ods of attacking the above prob­ ing from known endocrine dys- to represent Indiana University sity in 1942. They began their lem were considered. A question­ functions reveals certain dental School of Dentistry. senior schedule in May. naire has been mailed to each symptoms which can be associated Since coming to Indiana, I have The Indiana State Board of member of the faculty with the with the endocrine dysfunction. found Dr. Healey exceptionally co­ Dental Examiners conducted its object of obtaining their sugges­ These are: (a) retarded eruption operative. He has responded glad­ examination during the last week ti~ns as to methods of procedure of the teeth, (b) disturbed growth ly to any request for extra cur­ prior to graduation, and all stu­ and modifications for improve- of the bony jaws, and ( c) perio- ricular activities as well as regu- dents who took the examination ment. dontal disturbances. Since disturb- Jar duties and has at all times passed. The school is proud of Faculty Questionnaires Contain ances in tooth formation or cal- exerted a helpful attitud~ with the this record and feels that this Suggestions. (Continued on page 3) student body and faculty. class has made an exceptionally Most of these questionnaires Dr. Healey has been commis- fine record. have been returned, and many con­ f ac ulty Seminar Meeting sioned as Lieutenant in the United President Bryan Speaks to Class structive and helpful suggestions States Navy Reserve and has been at Honor Program have been offered. These reports ordered to active duty.-William Awards were presented at an indicate, without doubt, the posi­ On Thursday, November 17th, H. Crawford, Dean. Honor Day program at which tive determination of the faculty 1942, the dental school faculty held President Emeritus William Lowe to make our dental school among its second seminar meeting, the Bryan was the principal speaker. the best in the country. first of such meetings for the win­ Fifty-five Freshman Den­ These exercises we.re held in H urty It is our feeling that, although ter of 1942-43. Hall in the State Board of Health we are daily confronted with re­ The faculty members gathered tal Students Enter I. U. on the morning of December 11th strictions resulting from the war in the seminar room of the dental with the student body, faculty, and effort, there must be no laxity in school building for lunch and in­ The first day of classes for the assisting staff in attendance. In our educational standards; rather formal discussion from 12 to 12 : 30 freshman dental students found his talk President Bryan empha­ they must steadily improve looking o'clock. At 12 :30 a paper was fifty-five carefully selected stu­ sized the importance of a knowl­ toward the day when this war presented by Dr. Van Huysen, de­ dents eager to begin their prepar­ edge of the fundamental sciences shall have ended; and we will have scribing the results of a study of ation for the practice of dentistry. in professional education because a flying start in the direction of the sugar content of saliva. This This is the largest class beginning it offers the only solid foundation the above mentioned goal. study showed that ordinarily, that their study of dentistry that In­ upon which a professional man Committee Personnel Announced. is, at least one hour following the diana has entered for many years. can continue to be successful in a It is the evident desire of the taking of food or drink into the Of these fifty-five, forty are resi­ changing world. faculty and the committee repre­ oral cavity, slight amounts of su­ dents of Indiana, and eight are Dr. Robert W. Langohr and Dr. senting it that we follow certain gar are present in the saliva. from bordering states. Floyd W. Weatherford were elect­ measures and comparisons in mak­ Paraffin stimulated saliva con­ Three of the freshmen, Mr. J. ed to the honorary dental frater­ ing our evaluations and recom­ tained a sugar level of from 0 to P. Arvin, Mr. Frank R. Long­ nity, Omicron Kappa Upsilon. mendations. The following items 18 milligrams per 100 cubic centi­ camp, and Mr. J. G. White, are Both of these graduates are re­ have been suggested: (a) our own meters. The average salivary su­ sons of alumni of Indiana Univer­ maining at the school as interns. conception of what is required in gar level of 204 samples taken sity School of Dentistry. Scholastic awards were also given the ideal program; (b) a com­ from 9 individuals proved to be 8 Each member of the freshman to Dr. J. William Lytle and Dr. parison of our plant and program milligrams per 100 cubic centime­ class has already received his com­ Harold D. Furst. Dr. Lytle re­ with those certain other recog­ ters. Similar scientific meetings mission in the Army or Navy or ceived a year's subscription to the nized dental schools; and (c) rE>- are being planned by the faculty has made application for such "American Journal of Orthodon- ( Continued on page 2) for the future. commission. ( Continued on page 3) JANUARY, 1943 2 ALUMNI BULLETIN of statistical percentages, but sev­ 6th pounds of the Uliron type, and Karsner: Human pathology. deaths have so resulted, and with sulfamethylthiazole. eral ALUMNI BULLETIN ed., 1942 severe cases Cyanosis due to the formation reports of moderate to School of Dentistry Levy: Textbook for dental assist­ are not un­ of sulfhemoglobin was reported by of granulocytopenia Indiana University ants. 1942 the literature. The the early workers. This was con­ common in Indianapolis, Indiana Lott & Gray: Law in medical and frequent oc­ sidered due to the simultaneous condition is of most dental practice. 1942 14 days or more of A free and non-profit bulletin is­ use of sulfanilamide and sulfate curence after Lundy: Clinical anesthesia. 1942 evidence indi­ sued quarterly by Indiana Univer­ vathartics, and is responsible for therapy. Available for the McCulloch: Disinfection and ster­ sity School of Dentistry the warning against the use of cates that conditions of granulo­ purpose of keeping its Alumni in­ ilization. 1936 cytopenia resulting from other activities and prog­ such cathartics in sulfonamide formed of the is not accentuated by the ress of the school. thearpy. causes The cause of the cyanosis has sulfonamides. Editor-in-Chief Toxic Reactions of the explained. In Leukocyte counts dropping to HARRY J. HEALEY not been completely be 5000 or less per cmm. during ther­ Research Editor some instances it appears to Sulfonamide Drugs apy should, in the opinion of Long VIRGIL D. CHEYNE due to methemoglobin, while in other cases significant amounts of and Bliss, indicate a prompt ces­ Entered as second-class matter De­ Administration With Caution dem- sation of therapy, forcing of fluids at the post office in methemoglobin have not been cember 31, 1941, rich in vitamins, par~ at Indianapolis, Indiana, under Some Cases onstrable. and diets the Act of August 24, 1912. Pub­ Long and Bliss feel that cya- ticularly vitamin C. lished four times a year, by The In an effort to broaden the nosis per se is not an alarming Reactions Involving the Erythro­ of Dent­ Indiana University School scope of sulfonamide activity, with and are inclined to dis­ cytes Indianapolis, Indiana, in the symptom, istry, of toxicity, a of other Mild, hemolytic anemias, char­ months of January, April, July, a lessened incidence regard it in the absence and October. larg.e number of sulfonamide com­ symptoms. acterized by a slow progressive pounds have been prepared and in­ Acidosis drop in hemoglobin and in red Vol. V January, 1943 No. 2 vestigated. Of these, only six have In sulfanilamide therapy, this cell count, have been reported in achieved recognition in this coun­ condition results due to the loss numerous instances. If the hem­ School try: Sulfanilamide, sulfadiazine, of sodium through the urine. It oglobin thus drops to 60 per cent The Dental sulfapyridine, sulfathiazole, neo­ may be avoided by the simultan­ or below, withdrawal of the drug Library prontosil and sulfaguanidine. It eous administration of sodium bi- is advised. This is usually fol­ should be mentioned that a his­ carbonate or lactate. Such loss of lowed by a rapid regeneration of tory of toxic reaction to one of sodium does not apparently oc­ erythrocytes. Transfusions may new books have The following these drugs should indicate cau­ cur with sulfapyridine, sufathi­ be indicated if drug therapy is added to the Library since been tion in subsequent administration azole, or sulfadiazine. still necessary at this time. 1942: September 25, of any of the sulfonamide deriva­ Drug Fever Acute hemolytic anemias, char­ Remedies, 8th edi­ Accepted Dental tives. Toxic reactions occurring This condition may be differen­ acterized by a sudden onset, with 1942. tion, in the course of sulfonamide ther­ tiated from the fever incident to rapid drop in hemoglobin and red Dental Association: Lec­ American apy have been frequently reported infection in that it occurs gen­ cells, jaundice, and liver disturb­ military dentistry. 1941. tures on in the literature. Such side ef­ erally after 5 to 9 days of therapy, ance have been reported; this type Dental Association: American fects will not be reviewed. at a time during which the fever of toxic reaction has occurred most Study of dental ineeds of adults Symptoms Referable to the Nerv- of infection should have abated. commonly during the first to in the United States. 1940. ous System Long and Bliss have noted it in fifth days of therapy. There is Synopsis of pathology. Anderson: 9 per cent of their adult patients, evidence that Negro patients may 1942 Dizziness-may be severe enough and in 3 per cent of children be particularly subject to the de­ in American to simulate alcoholic intoxication. Asgis: Orientation velopment of hemolytic anemia. 2nd ed., 1942 Dizziness is more frequently en­ treated. dentistry. Drug fever is predominantly of Acute hemolytic anemia is a se­ Manual for differential countered in ambulatory patients, Bernier: importance in that it is a danger rious toxic reaction. Transfusions of oral lesions. 1942 in patients receiving intensive diagnosis signal of the development of more of blood have been of value, and scientist. therapy, and in alcoholic addicts. Black: From pioneer to liver, dam­ be withheld if The use of alcohol accentuates this serious toxicity such as the drug should 1940 age, anemia, or agranulocytosis. compatible with the state of the Dentist's own problem. reaction. Campbell: Dermatities infection. Patients with a his­ 1939 Headache has been associated Various types of skin rashes tory of acute hemolytic anemia Clapp: Dentist faces his future. as a warning signal of more se­ have been common with sulfanila­ seem particularly subject to the 1939 vere types of reaction-drug fever, mide and sulfathiazole--less com­ development of the same condition Methods of treat­ anemia, dermatitis, and others. In Clendenning: mon with sulfapyridine. Such upon subsequent therapy. ment. 7th ed., 1941 itself, the headache is of little rashes have been more common in There is no good evidence to Courville: Untoward effects of ni­ significance. A sense of depres­ patients exposed to the sun, and indicate that sulfonamide drugs trous oxide anesthesia. 1939 sion and of melancholia has been the reaction is considered to be, exert any deleterious effect upon Cowdry (ed.) : Problems of ageing. noted. Mental acuity and physical in part at least, a photo-sensitiza­ the male sperm, the female ova 2nd ed., 1942 response may be dulled. tion. Porphyrins, appearing in the or the progress of pregnancy. ' Davis: America organizes mede­ Loss of appetite (nausea, and urine in such cases of photo-sen­ cine. 1941 vomiting are of frequent occur­ sitization, may be reduced by the Davis: Clinical operative dentistry. rence, particularly with sulfapyri­ administration of nicotinic acid. A Growth and 1939 dine, less so with sulfathiazole. Due reddening of conjunctiva and (Continued from page 1) DeVighne: Time of my life. 1942 to the excretion of these drugs in­ sclera has been noted following Dewey & Anderson: Practical or­ to the stomach from the blood, embodied in the pro­ sulfathiazole therapy. quirements 6th ed., 1942 and to the probable presence of a thodontics. Liver Damage gram of the Council on Dental Eliason : First aid in emergencies. central component in the reaction, Several instances of fatal ter­ Education. 1942 these symptoms may not be avoid­ and mination to sulfonamide therapy Dean Crawford, the faculty, Fishbein: Medical writing. 1938 ed by the use of parenteral ad­ in the have been reported following a this committee are united Forbes: Paul Revere and the world ministration or by the use of en­ to pro­ picture of jaundice or acute yellow desire and determination he lived in. 1942 teric coated tablets. atrophy. High-carbohydrate, low­ pose a program which will more Frost: Practice dentistry and Instances of neuritis, resulting fat diets have been recommended. than fulfill the foregoing ideals. make a profit. 1939 in muscle tenderness, visual im­ Acute Leukopenia with Granulo- The personnel of the Planning Goldman: Peridontia. 1942 pairment or loss of motor func­ cytopenia Committee is as follows: Dean Hoskins & Bevelander: Outline of tion have been rare with the com­ Evidences of a destructive effect Crawford, Drs. J. L. Wilson, D. A. histology. 1942 pounds considered here. Such re­ upon the granulocytes have not Boyd, T. D. Speidel, and F. C. Huffman: Manual for medical rec­ actions have been reported during been numerous from the standpoint Hugh es, Chairman. ord librarians. 1941 the use of di-sulfanilamide com- January, 1943 ALUMNI BULLETIN 3 Vitamin D, and Calcium wise minor defect. The incisal Pathologic Wearing of lncisal Edges edges of upper and lower teeth should have this constant atten­ An~ Phosphorus Com­ tion. Thus harmonious form and (Manuscript Submitted by Dr. strong anterior edge to edge bite function may be maintained. pounds in Dental Therapy Grant Van Huysen, Professor of with straight regular enamel mar­ Oral Diagnosis) . gins and freedom from cusp in­ (Manuscript submitted by Dr. All too frequently the incisal terference. Endocrine Therapy edges of our patient's teeth in­ Isaac Schour, Department of His­ The persistence of the shearing stead of presenting an even har­ (Continued from page 1) tology, University of Illinois Col­ arrangement of the anterior teeth monius regularity present a pic­ cification can occur during early lege of Dentistry.) into the fifth decade usually re­ ture much like that of the accom­ sults, as it has in this case, in a tooth development (infancy and In the young growing child vi ta­ panying illustration. Here one loss of palatal enamel plate of the early childhood) it is theoretically m an D and calcium compounds are sees in the mouth of a 49 year old upper and labial enamel plate of possible that cases of early (con­ essential factors for the good cal­ male ragged, broken and uneven the lower incisors. Some of the genital) endocrine dysfunction cification of the growing bones biting edges along with distema underlying supporting softer den­ should show such disturbances. Ac­ and teeth. These should be ob­ formation and other evidence of tin is also usually lost at this tually, however, disturbances in tained by dietary means rather alveolar absorption around the same time. The labial enamel tooth formation or calcification than through medications. Cal­ lower central incisors. Improper plates of the upper and the lingual are rare even in congenital cretin­ cium compounds obtained from abrasion, therefore, has not only plates of the lower anteriors be­ ism. Abnormal eruption of the foods seem to be better assimilated produced a result detrimental to ing the last parts to become worn teeth and growth of the jaws can and retained. Foods also supply the appearance of the individual remain as high ridges preventing and do occur only in the child. other necessary nutritional ele­ but has also been responsible for free movement of the incisors up­ However, both types of disturbance ments not found in purified vita­ the loss of bony tissue support of on each other. These thin edges can be associated more frequently min products. some of the teeth. of unsupported enamel in addition with non-endocrine than endocrine In the non-growing adult, al­ It is only on rare occasions that to offering interference to normal cases. though not needed to the same one finds in the mouths of patients occlusion usually fracture irregu­ On the other hand, whenever extent as before, vitamin D, as who are approaching middle age, larily producing, as the picture il­ abnormal tooth formation or cal­ well as calcium and phosphorus thirty-two teeth with uniformly lustrates so well, a disagreeable cification. periodontal disease, dis­ compounds, are still an essential abraded occlusal surfaces. reduc­ appearance. These ridges, because turbed eruption of the teeth or part of the diet, since they play a tion of incisal overbite and an oc­ of their interference to free move­ growth of the jaws, or caries is part in the calcification of the clusal plane which permits the ment of the teeth one with another, investigated in the dental clinic, bones and the maintenance of the lower jaw to move freely without have changed the direction of endocrine dysfunction can rarely integrity of other tissues. How­ cusp interference. In fact, one stress upon the supporting tooth if ever be p~oved. There are ever, such compounds do not play must study the masticatory appar­ tissues with the result that over many factors, both local and sys­ any role in the enamel and dentin atus of primitive man either his­ a period of time bone has been lost temic, other than endocrine dys­ once these tissues are fully formed toric or contemporary to find the around the lower central incisors function that are more usually as­ and calcified. The vitamins and type of physiologic abrasion which and some tooth movement and sociated with dental disease. calcium compounds can have no di­ is normal for the age of the indi­ diastema formation has taken place. When the relationship between rect influence upon the avascular vidual. A denture functioning un­ This type of disfigurement of endocrine dysfunction and perio­ and acellular enamel and dentin in der good physiologic conditions tooth form, loss of supporting tis­ dontal disease can be establishedr the erupted tooth. should show by the time the fourth sues, and tooth movement can best as in uncontrolled diabetes, un­ There is no established experi­ decade of life is reached an an­ be handled by preventive measures. treated hypo- or hyperthyroidism, It should be the policy of every mental or clinical evidence that terior edge to edge bite with in­ or hypo- or hyperpituitarism, such practitioner at the time the teeth vitamins or calcium compounds cisal edges that are smooth and relationship does not occur in more regular. are cleaned and scaled to examine than 65% of the cases studied, have any direct relation to the The type of pathologic abrasion the incisal edges and remove with or no more than in any non-endo­ production or the prevention of presented by the illustration, al­ a sandpaper disc any unsupported crine group. The procedure in caries. There is, on the other though not extreme, is the one labial or lingual enamel plates. such cases is the treatment of the hand, evidence, both experimental seen frequently in civilized man. The unsupported enamel has no disease as well as the specific and clinical, to the contrary. When The teeth shown in the picture strength. It fractures readily and treatment of the dental condition. caries does occur, it may be caused still have high cusps upon the interferes with occlusal movement It would be foolish to cure a perio­ by dietary: factors othe_r than the posterl.or teetJi with a slight an­ of the teeth during mastication. dontal disturbance (if this were lack of vitamin or calcium com­ terior overbite. Had true physio­ Much of the bone absorption about possible) in an active diabetic or pounds. The physical character logic abrasion of the teeth taken lower anterior teeth may be pre­ cretin without also treating the of the food and the carbohydrate place, there would have been a vented by attention to this other- endocrine dysfunction. content of the diet play an im­ However, on the basis of our portant part in the production of present knowledge, there is no in­ caries-as does the lack of clean­ dication for the prescription of en­ liness, quality and quantity of the docrine therapy by the dentist; saliva, bacteria, etc. the physician should treat the en­ Recent scientific clinical inves­ docrine dysfunction and the dentist tigations do not show that caries can be produced or arrested by the dental disorder. vitamins or calcium compounds. Therefore, special vitamin or cal­ Second Class cium compound therapy is not in­ dicated in the prevention of caries. (Continued from page 1) While nutritional factors can be tics and Oral Surgery" presented related to the growth and main­ each year to the outstanding sen­ tenance of the alveolar bone and ior in the departments of oral the gingivae in both children and surgery and orthodontia. Dr. Furst adults, any nutritional deficiency received the Certificate of Merit severe enough to disturb these presented by the American Society structures is serious enough to of Dentistry for Children for his warrant the attention of the phy­ outstanding ability as a student in sician, lest other and more vital the department of children's den­ structures be affected. tistry. 4 ALUMNI BULLETIN JANUARY, 1943

mercury and iodine compounds are ameter. If they are retained their ring tumors have been described especially likely to produce an obstructive influence invites acute in connection with the salivary Diseases of the abundance of saliva. Other than inflammatory exacerbations af­ glands. Mixed tumors, carcinoma, the discomfort, an abundance of fecting primarily the parenchyma­ sarcoma and several benign varie­ Salivary Glands saliva results in no known harm. tou s tissues; or if saliva is re­ ties are found, of which about 75 Disturbances that cause a reduc­ tained under pressure for any per cent occur in the parotid. Of Note: The above consideration tion, however, brings about the length of time atrophy and fibro­ this number, about 95 per cent of the salivary glands is an ex­ loss of the protective action which sis of the gland will be the final are of the mixed variety. cerpt from a chapter on glands this fluid exerts upon the teeth result. Salivary duct calculi are Altho~gh the mixed tumor is of the oral cavity written by Vir­ and oral tissues. Through its loss easily demonstrated by palpation usually considered benign, of 297 gil D. Cheyne, which will appear the lubricating, cleansing and neu­ or roentgenological methods (Fig­ cases studied by McFarland, 23 in a new textbook on dental his­ tralizing power of the oral cavity ure 2) and are removed by gently tology edited by Balint Orban. is destroyed. Moreover, a normal expressing from the duct or inci­ per cent recurred after operation flow of saliva is a guard against sion. When calculi involve the and 13 ultimately proved fatal. Although the gross and histo­ infection, particularly of the as­ gland substance proper, total ex­ Perhaps the high percentage of logic features of the salivary cending type which is likely to tirpation of the gland may be ad­ recurrence is due to the fact that glands are well known, it might occur in the salivary ducts and visable. the capsule of the parotid is tight­ be permissible to outline some of glandular tissue. ly adherent to the parenchymatous them briefly. Grossly, they may Inflammatory processes are fre­ tissue, thus making complete re­ be divided roughly into the major quently the cause of a disturbance moval of the tumor difficult. glands (parotid, submaxillary, and in the flow of saliva. Inflamma­ Congenital malformations of the sub lingual; Figure 1) and the tion of the parotid gland is com­ salivary glands may vary from smaller or scattered elements (la­ mon; in the submaxillary, sublin­ atresia of the ducts to complete bial, buccal, glossopalatine, pala­ gual and smaller glands, less com­ aplasia of the gland. Such dis­ tine and glands of the tongue). mon. Acute, chronic, and specific turbances are more common in the Microscopically, the cells are ar­ are the types encountered. Pyo­ floor of the mouth in connection ranged in acini and produce either genic organisms are the chief of­ with the alveolingual complex, but an albuminous or mucous secretion. f enders in acute infections, mak­ they are not unknown in the pa­ These may be grouped in single ing their entry most frequently in rotid area. Atresia is less com­ glands as one type, but more com­ debilitated individuals suffering mon than aplasia, but when pres­ monly the cells are found in from infectious fevers or general ent causes disfiguring cysts or mixed proportions. All glands postoperative complications. The tumor-like growths to appear. The possess branching excretory ducts·. infection may be confined to the large sublingual gland is most These are arranged much as the ducts (sialodochitis) or, less fre­ frequently affected, giving rise to trunk and branches of a tree. The quently, spread to the parenchyma the so-called ranula, in the floor smallest branches pick up the se­ of the gland (sialaddenitis). In­ of the mouth. The glands of eretory product of the cells located flammation cf the gland substance .~ Blandin-Nuhn, located in the an- at their outer ends and carry it itself is usuallv severe. When it Figure .2.-Calculi in submaxillary terior part of the tongue, are sus­ to progressively larger ducts. progresses to suppuration, surgery duct. ceptible to cystic involvement as is the accepted method of treat- a result of closure of their ducts. ment. Infectious parotitis (mumps) is These are designated as musocus Glass-blowers and players of the most common example of spe­ cysts or mucoceles. Mucocles are wind instruments are especially cffic inflammation of the salivary quite commonly found in connec­ subject to infection of the salivary tion with the smaller glands of glands. This disease shows tender ducts. The heightened intraoral the oral cavity, where they prob­ pressure tends to dilate the ducts swelling of the parotid region, ably result from a mild infection ..-...... ;.,___ :? and counteract the normal outflow usually bilateral, with mild fever, of the ducts with consequent clos­ 7 of saliva. Bacteria carried with but no leucocytosis. Tuberculosis, ure. They are, however, of incon­ sequential concern and usually dis­ 5 food debris into an area of stag- syphilis, and actinomycosis affect 4 nated saliva are provided with an the salivary glands infrequently. appea:r after rupture and dis­ ideal environment for their growth The etiological agents may be hem­ charge of their contents. and multiplication. Such areas atogenous born or carried to the Aberrant glands are encounter­ may expand to the size of a nut gland substance as a result of an ed occasionally, arising in connec­ or an egg and when excised they tion with the development of the Figure 1.-Dissection to show sali­ ascending infection from the sa­ are found to contain a mixture of glands. The alveolingual complex vary glands. 1, parotid salivary liva. air, saliva and pus. area is the most common location gland; 2, accessory parotid; 3', Mikulicz's disease is a type of where they have arisen as acces­ parotid duct; 4, submaxillary sali­ Infection of the ducts of the infectious granuloma, rare in oc­ sory glands which have become de­ vary gland; 5, sublingual salivary salivary glands may cause a clump curence, which affects the salivary tached. These glands remain func­ gland; 6, sterno-cleido-mastoideus of dead cells or bacterial debris and lacrimal glands, occasionally tional, but because they lack an muscle; 7, masseter muscle; 8, pos­ to be thrown into a constricted the lips and eyelids. It makes excretory duct, the secretion ac­ terior facial vein. area in a duct with the formation its appearance as a symmetrical, of a salivary thrombus or plug indolent enlargement which may cumulates within their structure All of the salivary glands are which causes further expansion last several years. A dry mouth and causes distention with result­ :subject to disease similar to other and blockage of flow. If allowed is one of the accompanying symp­ ant cyst formation. soft tissue structures in the body. to remain the thrombus acts as toms. The histology is that of Temporary swelling sometimes Fortunately, however, such dis­ a nidus which attracts calcium lymphocytic infiltration of the in­ results in the salivary glands by turbances are relatively infre­ salts, leading to the formation of terstitial connective tissue and, if the obstruction of a duct by op­ quent. When they do occur the a salivary calculus or stone. persistent, ultimate destruction of erative procedures. Use of the result may be either an increase Chronic inflammation may fol­ the parenchymatous elements. The rubber dam or prolonged pressure in the flow of saliva (sialism) or low acute infection, but the agent blood picture remains normal. by cotton rolls are common etio­ a decrease (xerostomia). Secre­ chiefly responsible is a salivary Therefore, it must be differentiat­ logical agents. Such swellings oc­ tion is increased in mental and calculus. These occur most often ed from Mikulicz's syndrome cur at the time the work is in nervous affections, occasionally in in the submaxillary gland system which is associated with such gen­ progress and disappear soon after acute fevers, and during attacks (90 per cent), where they vary in eral processes as leukemia, Hodg­ the obstruction is removed and the of generalized stomatitis. Injec­ size from minute particles to de­ kins disease, and syphilis. saliva has had an opportunity to tions of certain drugs, particularly posits several centimeters in di- A variety of infrequently occur- discharge.