+Transcriber's Notes+
1. Typos have been silently corrected.
2. Variations of spelling and hyphenation are as in the original.
3. The text version is coded for italics and the like mark-ups i.e.,
(a) italics are indicated thus _italic_; (b) small-caps are indicated
thus CAPS; (c) Single image is indicated as [Illustration:]
4. One footnote moved to the end of book.
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[Illustration: "cover-page"]
THE
AMERICAN JOURNAL
OF
DENTAL SCIENCE
VOL. XIX. THIRD SERIES.--OCTOBER 1885. No. 6.
ARTICLE I.
NERVOUS ENERGY.
BY DR. E. PARSONS, SAVANNAH, GEORGIA.
[Read before the Georgia State Dental Society, May, 1885.]
GENTLEMEN--The subject I have chosen for your consideration at this,
our Annual Meeting, is "Nervous Energy, how Actuated, and its Varied
Phenomena." No one can question the importance of knowing all that can
be known about it.
There is an invariable law by which means mind acts on matter, and it
is my purpose, in this paper, to briefly elucidate what I have learned
by reading, observation and experience on the subject. The great
advantage of meeting in council is an increase in knowledge on all
subjects in any way relating to our profession. We have many things yet
to learn that will be, when known, of great benefit to both ourselves
and the public.
Science demands a full and free investigation of all or any causative
principle by which life is manifested, or death produced. So long as we
draw our conclusions only from appearances, we shall often be deceived
in a correct diagnosis; consequently often fail to cure diseases that
come within the legitimate bounds of our specialty.
Proper remuneration for our services are absolutely necessary for the
respectable maintainance of ourselves and those dependent on us; but
our best men are laboring unweariedly in their endeavor to elevate our
standard throughout the world, but particularly in our own country, and
this Society can do much to help them in their onward march, developing
all possible improvements in Scientific Dentistry.
Again, we all have a full consciousness of three things--we love,
we think, we act. But few have a scientific knowledge of the means
employed by which mind acts on matter. There are such varied forms and
circumstances controlling its development, that we need not marvel
at anything that comes within the sphere of our observation. As we
are brought face to face with almost every possible condition of
the nervous system, our opportunities for investigating the various
manifestations of nervous energy, its source and supply, may we not
equal any other specialty in solving the great problem of cause and
effect manifesting nervous energy? As the brain is the seat of all
sensation, I briefly present some of the best authenticated views
of its organization. I think you all will agree with me that it is
wonderfully constructed by Infinite Wisdom for the development of the
finite mind. In the elucidation of my subject, let us not forget the
fact that the blood has much to do with the various conditions of
the nervous system. It holds, or should contain in solution, all the
elements necessary for the growth and sustenance of every organ in the
body; it is both a receiver and a giver; it is fed from what we eat and
drink, without which it cannot perform the office intended.
THE BRAIN.
The brain is divided by the septum into two lobes, right and left
sides; also, into the cerebrum and the cerebellum, front and back
sides. Phrenologists divide the lobes into about forty convolutions,
assign to each a distinct office, and by careful observation of each as
to their development, profess to know individual character, and point
out what kind of occupation one, by nature, is best fitted for.
In 1840, Dr. Sherwood, of New York, by ingenious experiments,
demonstrated the fact that the brain has four large poles, two in the
cerebrum and two in the cerebellum, and from these proceed not only the
convolutions, but every nerve in the body. By these, and experiments
in animal magnetism, he maintained that animal magnetism is the motive
power of the human system, and without it there can be no connection
between mind and matter.
In the Fall of 1844, I invited several of our most eminent physicians
to meet me at my office to witness some experiments in magnetism. My
subject for demonstration was a young man of unimpeachable character,
twenty-three years of age. My visitors were very skeptical on the
subject of magnetism. There had been some public exhibitions, but the
result did not satisfy them.
I said, as the science of phrenology is ridiculed by some, I wished
first to exhibit each convolution of the brain, in a state of
exaltation, while he is as wide awake as we are. To prevent any
suspicion of collusion, I handed them a chart containing the names of
the different convolutions of the brain, and requested them to write on
paper any question or the name of the organ, for me to excite.
The first paper had on it mirth. I placed the point of my finger over
the organ, and he immediately broke out into an uncontrollable fit of
laughter. I passed off the influence and he instantly became calm. They
asked him what he laughed at. He said he did not know; he could not
help it.
The second paper had on it veneration. I excited the organ, and he
immediately bowed his head and assumed the attitude of the most zealous
pietist, and appeared to be in earnest prayer.
The next paper had on it music. I excited the organ, and he immediately
commenced singing with as much earnestness as if his life depended on
it.
The next paper had on it combativeness. I excited the organ; he
immediately doubled his fist and pitched into an imaginary enemy in the
most vigorous manner possible.
Not to take up too much space in this paper, I will only add, we went
through with about twenty of the organs with equally marked results,
which both pleased and astonished my friends. They said they now
thought there was much more truth in the science of phrenology than
they had supposed possible. I then said you have seen the effect of
so-called animal magnetism; I will now exhibit a different phase of
it. I magnetized him in the usual way, and said he is now as oblivious
to all external impressions as if his five senses had no existence.
Examine him and satisfy yourselves.
After a thorough examination, Dr. Richardson said he believed he could
cut off his leg and he would not feel it. I demagnetized him, which
restored him to full consciousness. They questioned him about it. He
said he did not remember anything done in that state. They then said
if it was practicable it would be a good thing in surgical operations.
They thanked me for the pleasure of witnessing the experiments, and
retired.
To understand the different nervous conditions of patients is of vast
importance to both dentists and physicians. This cannot be attained
without close observation and experience. If the nervous temperament of
a patient is known, we shall have a key to guide us in our treatment in
every individual case. Temperament is usually divided into six distinct
classes:
1st. Nervous bilious; 2d. Nervous sanguine; 3d. Nervous lymphatic; 4th.
Bilious nervous; 5th. Sanguine nervous; 6th. Lymphatic nervous.
You have doubtless observed a difference in the quality of human teeth.
We usually find the best in the nervous bilious temperament, and the
poorest in the lymphatic nervous. Viciated tastes and habits do not
change the shape of the teeth when once formed, but their quality.
Science demands discrimination under varied circumstances; it is not
possible to treat all alike, and be equally successful. I shall refer
to this again below.
I now present you with a few incidents in practice which may serve as a
basis for a better elucidation of my subject:
1st. In the Fall of 1835, I was called to see a gentleman at eight
P. M., represented to be suffering greatly, and unable to come to my
office. I was introduced to a large man walking the floor in great
agony. Seating him in a chair, I found the left side of the face
swollen; a purple colored spot over the antrum; the first molar on the
left upper jaw filled with gold; tooth firm, but evidently devitalized.
I diagnosed the trouble to be abscess in the antrum. I extracted the
tooth; he sprung out of the chair and dropped on the floor, face
downwards, and quivered like an ox struck on the head with an ax. I
used cold water freely to his head, and soon brought him to; placed
him back in the chair; made a free passage through the front labial
socket into the antrum, and the pus flowed freely. He then laid down
on the bed much relieved; gave him a half grain of opium; waited about
twenty minutes and injected the antrum with warm green tea; directed
his head to be kept cool with cloths wet with cold water; left him with
a promise to call again in a few hours; called again about three P.
M.; was told he had been sleeping several hours; I injected the antrum
with a weak solution of nitrate of silver; saw him the next morning and
again injected the antrum with a much stronger solution of nitrate of
silver; the swollen cheek appeared almost natural; said if he needed my
service any more to come to my office. About a week later he called on
me; brought me a sack; said a few hours before that he blowed it out
through the left nostril; it was about one and a fourth-inch long, and
about the size of an ordinary goose-quill; it was soft with a leathery
like appearance; said he was all right; paid his bill; have not seen
him since.
2d. In September, 1836, I was called by a physician to see his wife. He
said she was suffering terribly from facial neuralgia, and thought it
was caused by a tooth. She was in her eighth month of pregnancy. He had
applied the usual remedies, which gave no relief. I examined her teeth;
found both the third-molars on upper jaw decayed, and on slightly
tapping them with the handle of an instrument, the pain was greatly
increased. He said he was afraid of the consequences, in her state, of
having the teeth extracted. I told him nothing else would give relief.
She said take them out, it cannot be worse than I am now suffering. I
parted the gums from the teeth with a lance; I had barely completed
this part of the operation when she fainted; her mouth was open; I
took my forceps and extracted both teeth; brought her head forward to
prevent the blood running down her throat; we soon brought her back
to consciousness, and the first thing she said was: "I cannot have
them out." Her husband said: "Darling, they are both out." She said,
"Are they? I did not feel it; I am so glad; the pain is all gone." The
Doctor said to me--"You are a bold man: I would have stopped you if
I could, but you was too quick for me." I afterwards learned that no
serious result followed the operation.
3d. In August, 1856, a young lady, aged about twenty, came to my office
at eight o'clock A. M. Temperament nervous, lymphatic. Said she had not
slept a wink all night. Her face was pale, hands cold, pulse feeble.
Said she had a mortal dread of having a tooth extracted. I put my
mouth-mirror into her mouth for examination, and saw the tooth caused
the trouble. In an instant she fainted. I took my forceps and extracted
the tooth, used restoratives and soon brought her to. The first thing
she said was--"I cannot have it out." I showed her the tooth. She said:
"Oh! I am so glad I did not feel it;" and left the office laughing
about it.
4th. In the Fall of 1858 a lady called to have the two upper front
incisors filled. She appeared to be middle-aged, and apparently in good
health. On examination, the teeth were very close together--not badly
decayed, but must be separated for sufficient room to enable me to do
the work properly. Our only means, then, was either wedging or filing
them. I filed about one quarter of what was necessary, and she fainted.
I then filed as rapidly as possible while she was unconscious, and
completed this part of the operation, and used restoratives, and soon
brought her to. I gave her a glass of wine, and completed the operation
without further trouble.
5th. In the Fall of 1874, a lady called to have a tooth extracted.
She appeared to be in good health; said she was almost distracted
with toothache; was afraid to take chloroform; was afraid as of death
without it. I said the pain would be only momentary, and would not kill
her. I extracted the tooth, and she fainted. My usual remedy in such
cases was hartshorn and cold water. Through mistake, I took up a vial
of the Essence of Gaultheria, poured a little on a handkerchief, held
it to her nose, and was surprised to see how quickly she recovered
consciousness. This prompted me to experiment with it. I concluded that
if it was a good restorative, it might be a useful preventative.
I soon had a chance to test it. A lady called to have an ulcerated
tooth extracted. She was in delicate health: face swollen, hands cold.
She said she would like to take chloroform, but her physician said she
must not take it; she knew she would faint without it. I told her I
thought that could be prevented. I took a doily, folded it small, and
poured about a teaspoonful of the essence on it. I told her to inhale
through her nose, and exhale through her mouth. She continued this
until her brain was pretty well stimulated, and the tooth extracted.
She showed no signs of syncopy, and could hold a glass of water as
still as I could. I have not had any one to faint away in my office
since.
In the Spring of 1874, a lady, aged about sixty, came to consult me.
She said that her teeth were so bad she could not eat any ordinary
food; had disease of the lungs; was forbidden to take chloroform.
After an examination, I told her she had eight teeth in the upper jaw
that could not possibly be made useful, and she had better have them
extracted. She said she had never had one extracted without fainting
dead away. She could not think of having more than one out at a time.
Her temperament, nervous sanguine, emaciated hands cold, pulse very
feeble. I told her if she would follow my directions I would take
them all out and she would not mind it more than one, and guaranteed
she could not faint if she tried. I explained the effect of the
wintergreen, and said it would do no more harm than a glass of good
wine. I administered the article, as before described, until her face
flushed, tears ran down her cheeks, then extracted the eighth teeth
without her closing her mouth. She asked if they were all out, and I
said yes. She said, "Is it possible?" I gave her a glass of water. It
did not show the least tremor of the nerves. She left, giving me many
thanks, saying that she felt much better than when she came into the
office.
I could relate many more similar cases, but do not deem it necessary.
My object is to show what may sometimes be done to advantage in cases
of syncopy, and also the means of preventing it while performing a
painful operation.
As before said, the brain is the seat of all sensation; and our
patients, no matter how nervous they are, if the brain is properly
stimulated, cannot faint--caused by the extraction of teeth. When my
patients are known to be pregnant, I always use the stimulant above
described before performing any painful operation; it always prevents
any severe shock of the nervous system when in this condition. If any
one wishes to know how to prepare the Essence, it is as follows: To one
pint of alcohol add one ounce of the Oil of Gaultheria, commonly called
Wintergreen. Shake it well and it is fit for use.
In passing from a conscious to an unconscious state, all the
Clairvoyants I have questioned on the subject say it is affected by
a change of polarity of the sensatory organs, and the principle is
the same whether caused by animal magnetism, syncopy or anæsthetic
agents, and if only the voluntary organs are affected thereby, there
is no danger to life, but if polarity in the involuntary is reversed,
the heart ceases to beat and death is instantly the result. I was the
first in this city to administer ether for the purpose of extracting
teeth without pain. In a few cases it developed paroxysms of hysteria;
otherwise no harm was done. I have administered ether, chloroform and
gas to over two thousand persons. With chloroform, I had three cases
that barely escaped death in my chair; with gas, some after deleterious
effects followed in two cases.
Admitting man's physical organization to be a magnetic machine, the
deaths that have occurred are easily explained, when caused by these
powerful drugs. The voluntary organs are under the control of the will,
and during our waking hours there is a constant draft on our magnetic
supply; it is best recuperated by sleep, when the will is at rest.
The involuntary organs do not sleep until death ends our earth life.
We can readily understand that if by any cause polarity in the two
large poles in the cerebrum are reversed, the gateway by which we gain
a knowledge of things about us is closed so perfectly that physical
sensation is impossible. On the other hand, if the equilibrium between
the two large poles in the cerebellum are not well balanced, just
in this proportion some kind of ailment is the result. Let us not
forget that the will has no control over these poles, and all medicine
that does not beneficially act on them is non-curative. Now, just in
proportion as anæsthetic agents disturb their equilibrium, they are
dangerous, it makes no difference whether polarity is reversed or
destroyed; in either case the principle of life can no longer act on
the nerves by means of its intermediate; the heart ceases to beat,
and restoration is impossible. Chloroform is more easily administered
than ether or gas, and most convenient when the patient cannot come
to the office; but we should remember that many deaths have occurred
when given for the purpose of extracting teeth, and that, too, when
least expected. The public mind is more horrified at one death in the
dentist's office than twenty caused by a railroad smash-up. We have now
the means that will stimulate the nerves, greatly mitigate the pain and
not endanger either life or health.
I have long desired a perfectly safe anæsthetic that can be
administered no matter what the condition of the patient. I am now
creditably informed that Dr. Mayo, of Boston, some eighteen months ago,
by various experiments, produced a compound article that satisfied
him was harmless. He would not put it on the market until it had been
thoroughly tested by both dentists and surgeons. All who tested its
effect and efficiency testified to its great superiority over all other
known anæsthetics for dental and minor surgical operations. It is
now only a few months since he made arrangements for its manufacture
and appliances, and put it on the market. He has named it Mayo's
Vegetable Vapor Anæsthetic. I have been using it for extracting teeth
very successfully. The nitrous oxide causes the patient, when fully
under its influence, to have very like the appearance of a corpse. The
action of this new anæsthetic does not act on the vital organs, and the
patient appears like one in a natural sleep, and, in my opinion, is
perfectly safe and without danger to life or health.
Our patients come to us for either a preventative or curative
treatment. As before said, we are brought face to face with almost
every conceivable condition of the nervous system, and the more true
knowledge we have of it the better are we able to satisfactorily manage
them. Some come in a very excitable, and some in a very depressed
state. We need means to quiet the former and stimulate the latter.
Again. To be fully entitled to the name of Scientific, we must know
something of the laws of life, in order that we may obey them and fight
life's battles manfully--doing justice to others and with credit to
ourselves. Life, in itself, is not creatable, but given to us with
power to properly use or abuse, the end being the creation of the
finite mind. I have explained above the means by which it acts on
matter, but as a further illustration, let me say, you drop an article
on the floor, gravitation holds it there; you desire to pick it up, how
can you do it; if you have sufficient will-power it will act on the
magnetic element, this on the nerves, these on the muscles. You stoop
down and pick it up, and probably not one in ten thousand have a single
thought about the necessary means by which you are enabled to do so, so
little do we reflect about causative principles involved in what we do.
So far as our voluntary organs are concerned they may be compared to
a locomotive engine. They are both useless if the motive power is
wanting. To make the engine useful, steam must be generated by means
of fire and water; and to make our voluntary organs useful, animal
magnetism must be generated by means of life and the atmospheres. The
engineer controls the steam power, and human will controls the magnetic
power, and when properly applied, if the machine is in good order,
locomotion is the result in both cases. I will only add, the steam
acts on the piston heads and causes the crank to move and the wheels
to rotate. Magnetism acts on the nerves, then on the muscles, and
man moves in any direction he chooses. A dentist with a strong will,
if he uses the proper means, can more easily and favorably impress
his nervous patient than one with a weak will, and the reason is, he
imparts more of his animal magnetism, which has a stimulating effect on
the nerves of his patient. There is a magnetic sphere emanating from
both man and beast, particularly when in motion. Were it not so, no dog
could follow their tracks successfully. All pain is the result of an
obstruction of a normal flow of the magnetic current, whether caused by
disease or otherwise.
Arsenic, applied to the nerve of a tooth, destroys its polarity, and
applied to any other nerve it is no longer capable of being actuated
by the magnetic current, without which there can be no sensation, and
death is the result. Physical endurance depends largely on the mind and
the state of the nervous system. The difference in individuals to bear
pain is marvelous; some one can have a tooth extracted and seem to care
but little about it, while others, without the use of a preventative,
appear to suffer intensely, and in some cases the operation causes
syncopy.
In conclusion allow me to say, a vast field lies before us, and if
cultivated properly this Society will in due time reap a rich harvest,
the benefits of which cannot now be estimated.
The grand distinction between mind and matter may be seen thus: If we
give any physical object to another, we part with it, but if we give a
new idea on any subject, we do not part with it, but in so doing its
boundaries are enlarged in our minds.
The space occupied in briefly presenting my views on the subject I
have chosen is greater than I at first intended, but the fundamental
principles which underlie everything with which we have to do, and
the importance of fully understanding them, is my only apology for
occupying so much of your time.--_Dental Luminary._
ARTICLE II.
PULPLESS TEETH.
BY DR. WILSON, OF BURLINGTON, MEMBER OF THE FACULTY OF THE DENTAL
DEPARTMENT OF THE STATE UNIVERSITY.
[Extracts of a paper read before the Iowa Dental Association at its
late annual meeting.]
A pulpless tooth is not necessarily a dead tooth, but a dead tooth is,
of course, a pulpless tooth. The adjectives "pulpless" and "dead" are
not, therefore, synonymous, although frequently so used, especially
by medical writers. Let us note the marked distinction between the
two. A pulpless tooth may be a part of the living organism--a dead
tooth has its nutritive supply entirely cut off, and it is in every
sense a foreign body--it is dead and inert. The former may be restored
to health and usefulness--the latter should always be condemned as a
nuisance that cannot be abated without the use of the forceps. * * * *
Having thus briefly called attention to the fact that the dentine and
cementine derive their vitality from independent sources--that the life
of the one is not dependent upon the life of the other--that a pulpless
tooth is not necessarily a dead tooth--we are prepared to consider,
understandingly, the subject of this paper. It may, however, seem like
presumption on the part of the writer, in thus offering the foregoing
to an intelligent body of dentists, when every student of dentistry at
the close of his junior year should fully understand the facts above
stated. But I am led to a consideration of this subject from articles
entitled, "Dead Teeth in the Jaws," that have appeared, from time to
time, during the last two years, in the New York _Medical Record_, and
as those articles come from high sources in the medical profession,
they deserve more than passing notice. The able editor of that journal,
and Dr. Samuel Sexton, a distinguished oculist and aurist of New York
City, being the principal writers referred to.
The _Medical Record_ of October 4, 1884, contains a report from the
aural service of Dr. Sexton, entitled, "Pain in the Ears due to
Irritation in the Jaws." He describes a number of cases of otalgia in
which he found the lesion to be in diseased teeth.
He goes on to say that "since dentistry had become such a popular
business, and diseased teeth had been so carefully retained in the
jaws, nervous diseases about the head were becoming alarmingly common."
The same number of the above journal contained an editorial on "Dead
Teeth in the Jaws," which read as follows: "Perhaps the time is near at
hand when medical men should be themselves better informed concerning
diseases of the jaws and mouth, rather than refer the ailments of this
region to individuals whose limited knowledge of medicine does not
prevent them from 'treating' dead teeth long after their presence in
the jaws has given rise to alveolar abscesses and neuralgias more or
less painful. It would not be strange if in the course of events, the
day would soon come when all teeth without pulps, and hence in process
of more or less rapid decay, as well as those which the deposit of
tartar, or other cause, had become entirely divested of periosteal
nourishment, would be promptly condemned as unfit to remain in the
jaws, regarded in fact as foreign bodies liable to give rise, not only
to cerebral irritation and disease in the organs of special sense,
through the propagation of local disturbances in the mouth to the
regions mentioned, but to endanger likewise the general health through
purulent matter discharged into the mouth from alveolar abscesses,
to be continuously swallowed for a long time, or, indeed, in some
instances, to be absorbed and thus produce septicæmic poisoning. It is
certainly gratifying to note the establishment of instruction in oral
surgery in some of the medical schools, and it is to be hoped that this
subject will receive the attention its importance demands."
Dr. Sexton cites the readers of the _Record_ to eight cases of otalgia
resulting from diseased teeth. I have no doubt but a majority of the
dentists before me to-day have met with almost that number of cases in
practice every week; nor do you find it a difficult thing to render
prompt relief, and that, too, in a large majority of cases, without the
use of the forceps. And I believe that I am warranted in saying that in
at least three-fourths of the cases met with in our practice, we find
the reflex pain in the ears due to exposed living pulps, and not to
"dead teeth in the jaws."
That diseased teeth do cause reflex trouble, not only in the head,
but frequently in more remote parts of the body, is a fact well-known
to every competent dentist. I am glad that Dr. Sexton has at last
discovered the fact, that diseased teeth do frequently cause reflex
pain in the ears, and in other neighboring parts, and that alveolar
abscesses very often cause catarrhal affections of the maxillary sinus
and of the nasal passages, and that diseased teeth will endanger the
general health. It is to be regretted, however, that the doctor has
found it necessary to charge this unfortunate state of affairs to the
ignorance of dental practitioners, who are in no way responsible for
but few of the many cases met with in practice, for there can be no
doubt but a very large majority of the teeth causing the troubles above
referred to have never received any treatment whatever at the hands
of dentists, and because Dr. Sexton has discovered that in certain
cases pulpless teeth (or dead teeth as he calls them), has caused the
ailments above referred to by Dr. Sexton, there can be no doubt. Every
dentist of any considerable experience can enumerate such experiences
by the score, and the medical profession has only been too slow to
recognize the facts discovered by Dr. Sexton.
The only difficulty with these medical gentlemen is, that they have
drawn very erroneous conclusions from the important discoveries they
have made. Their limited knowledge of the minute structure of the
dental tissue, and the source from which each derives its life, is
manifested by the erroneous statements upon which they have based their
arguments, and then after arguing from false premises, Dr. Sexton says:
"In regard to the treatment of pulpless teeth, the practice in vogue
seems the reverse of procedures founded on well-established surgical
principles." And in an editorial of the same issue we are informed that
the treatment of diseased teeth is carried, to what "the medical minds
regard as a dangerous extreme."
That some members of our profession have been over zealous in their
efforts to save all diseased pulps alive, there can be no doubt. We
will occasionally meet with an enthusiast in our profession who will
say, "I have no use for forceps, I never extract teeth." I have heard
that statement made on the floor of the Iowa State Dental Association.
That incurable diseased teeth should not be tolerated in the jaws
does not admit of discussion. Good common sense ought to settle that
question. And again, there are extremists who never devitalize diseased
pulps, no matter how badly exposed, but "doctor them up," and stupify
them, and then bury them in a living grave. Much evil has grown out of
this practice.
Some one has said that to cap a badly exposed pulp is to create a
slumbering volcano, and he might well have added that such volcanoes
have but a limited time to slumber. Gentlemen, there are in our
own country ten thousand volcanoes belching forth--not pure molten
lava--but impure gases and putrescent matter of the most sickening
character. The craters to these volcanoes are not found on the mountain
top, but they are found in human mouths--in the antrum of Highmore, in
the nasal passages, and externally on the face, neck, or even on the
chest.
When the pulp of a tooth is dead and confined within its bony walls
an outlet is sought, and must be affected for the escape of impure
gases arising from the decomposing pulp and for the putrescent matter
associated with it. When thus confined its only way of escape is
through the dental foramen, and into tissues adjacent thereto. The
pressure thus brought to bear upon the bony walls surrounding the apex
of the root will in time perforate it at its weakest point, and the
poisonous matter is forced through the opening thus formed and into the
soft tissues, which soon yield to the pressure, and the imprisoned mass
of corruption is liberated. The pain and swelling now subsides, but a
dangerous nuisance has been created. The channel formed from the apex
of the root to an external opening will not close while it is used for
the passage of foul matter and gases that will flow unceasingly from
the pulp canal.
The remedy of course is to remove the cause, and assist nature in
affecting a cure, and to do this the pulp chamber must be opened, its
contents removed, the canals cleansed and disinfected, the abscess
healed, and the roots filled to the exclusion of all fluids and
purulent matter. But how often this is not done. How many thousands of
suffering mortals are to-day dragging out miserable lives because of
these drainage tubes emptying themselves into the oral cavity--into
the maxillary sinus or into the meatus of the nose. Such an abiding
nuisance in the mouth cannot long exist without ruining health. But how
few of the unfortunate sufferers realize the cause of their nervous
irritability, their loss of appetite, their feeling of lassitude,
their lack of energy, and their general prostration. And here let me
say, that but few, in comparison to the number of these unfortunate
sufferers seek relief at the hands of the dental practitioner. The
patient is neither sick nor well, but debilitated and "good for
nothing." The family physician is consulted, nervines and tonics are
administered, but to no avail. The septic matter is vitiating the air
that is breathed, and poisoning the food that is eaten. The saliva
that is poured into the mouth from the various glands must mingle with
this poisonous matter and carry it into the stomach.
Sanitary means are being employed in all our cities at the present
time, in view of the cholera scourge that it is feared will sweep over
our land the coming summer. Our physicians wisely talk and write about
the baneful influences of impure water, about miasma arising from the
decomposition of vegetable matter, and about unwholesome food, and it
would be well if the public would heed their timely warnings. And as
dental practitioners, I feel that we, also have an important duty to
perform, in enlightening our patients, and the public so far as we are
able to do so, in the direction I have above indicated.
The subject is of paramount importance, and as the opportunities come
to us in every day practice, let us not fail to impress upon the minds
of our patient (when we find it necessary to do so), the fact that a
clean mouth is essential to health.
The agitation of this subject, by the medical profession, is a step
forward. Hitherto medical men have not given the matter the attention
its importance demanded.
And now that this new light has dawned upon Dr. Sexton, it is not
strange that, in hastily drawing his conclusions, he should have
mingled much of error with the truths he has discovered. Possibly some
of the cases that have come under his notice may have been the result
of bad practice on the part of incompetent dental practitioners, but
to charge the dental profession with their short-comings would be a
matter of great injustice. Dr. Sexton is too hasty in his conclusions.
First, he discovered that certain pulpless teeth had caused certain
ailments, hence he condemns all pulpless teeth. He has discovered that
certain dentists have failed to treat such teeth successfully, hence he
condemns the dental profession for attempting to save teeth, it would
be equally fair to condemn the whole medical profession, because of
the incompetency of some of its members. But before dismissing the
subject of pulpless teeth, it may be well for us to examine the subject
a little more carefully from the standpoint of the medical writers
above referred to. We cannot afford to make a mistake with regard to
so important a matter. The higher a man stands in his profession, the
more serious the mistakes he makes, and the more important it is that
his practice be sound. An enthusiast or an extremist may injure a good
cause. There are such men in our ranks.
A few years ago a prominent dentist said, "The tooth's pulp is its
soul, and it is criminal to destroy it."
I heard another prominent dentist say, "If I find a part of the pulp
dead, I amputate the dead tissues, and save the balance of the pulp
alive."
A dentist has just moved away from Burlington, who has been in practice
there for fifteen years, and during that time he has been using arsenic
for obtunding sensitive dentine, and he has succeeded in accomplishing
his purpose admirably. I have found in one month half a dozen filled
teeth containing dead pulps, and, of course as many alveolar abscesses
in active operation. The evils arising from such abominable methods of
practice are simply appalling.
* * * * *
I have less frequently met with cases where those fistulous openings
were on the neck or chest. In those cases the roots of the teeth are
usually long, and when the abscess breaks through the lower border
of the jaw, and the pus comes in contact with the soft tissues, it
follows the course of the muscles and forms a sinous as it gravitates
to some point on the neck or chest. I have known of a number of such
cases being under medical treatment for years, where the affection
was supposed to be of a strumpous nature, and the real cause was
not suspected, and in every case a rapid recovery has followed the
extraction of the offending tooth.
* * * * *
Gentlemen, I have no doubt but the most of you are disappointed in
the nature of this paper. I have scarcely alluded to the treatment
and filling of pulpless teeth. That had not been my purpose. But I
have wished to call attention to the fact that a large majority of
the ailments above referred to have been due to diseased teeth that
have never received any attention whatever at the hands of competent
dentists.
That pulpless teeth and roots may be treated, filled, and preserved
in health in a majority of cases, is a settled question. Every
well-informed dentist knows that to be a fact, the distinguished Dr.
Sexton and the able editor of the _Medical Record_ to the contrary
notwithstanding.--_Iowa State Med. Reporter._
ARTICLE III.
DEAD TEETH IN THE JAWS.
TRUMAN W. BROPHY, M. D., D. D. S.
In reply to Dr. Sexton on this subject, Dr. Brophy makes these
pertinent remarks in the journal of the American Medical Association:
Dr. Sexton says: "The retention in the jaws of teeth which are
diseased, have become irredeemably sensitive to thermal influences,
or deprived of adequate periosteal nourishment through calcareous
formations about the roots, very frequently gives rise to nervous
diseases about the head. I am convinced that these reflected nerve
influences manifest themselves much oftener since dentistry has come
more extensively into practice during the present generation, and
greater efforts are made to retain defective teeth in the jaw."
That diseases of the teeth are often the center from which pain is
reflected to the eyes, ears and other parts, all experienced clinical
observers must admit. But that these pathological conditions of the
teeth, from which reflected pain has its origin, can be and are
successfully treated and cured with rare exceptions, as effectually as
any other diseases, is a fact too well-established to be set aside.
It is not possible to describe in this letter the method by which the
various diseases of the teeth are treated, but suffice it to say that
"teeth which are diseased from death of the pulp or from caries" _do
not_ "become irredeemably sensitive to thermal influences." In proof of
this statement, many thoroughly educated medical men, practicing the
specialty of dental surgery, will testify.
"Teeth deprived of adequate periosteal nourishment, through calcareous
formations about the roots, very frequently give rise to nervous
diseases about the head." To this statement I assent, but dissent as
to the remedy not mentioned but implied, _i. e._, the removal of the
teeth. If the calcareous deposits mentioned have destroyed so much of
the pericementum and the alveolar processes as to render the teeth
very loose; if, indeed, the teeth have lost their bony support and
are retained by means of a remnant of pericementum only, they cannot,
of course, be restored to permanent health and usefulness, and their
removal is, therefore, indicated. Teeth in this condition "frequently
give rise to nervous diseases about the head."
On the contrary, if the calcareous deposits have not destroyed the
pericementum and alveolar processes to a very great extent, the
condition is amendable to intelligent treatment and cure. In answer
to the assertion that "Reflected nerve influences manifest themselves
much oftener since dentistry has come more extensively into practice
during the present generation," I would say, that with equal propriety
it might be said that reflected nerve influences manifest themselves
more frequently since gynæcology has come more extensively into
practice. To attribute the obvious increase of nervous diseases during
the present generation to diseases of the teeth is a statement not
only "sweeping," but "overdrawn." _Much harm_ is no doubt done by some
of the modern appliances "for retention in the mouth of substitutes
for absent teeth," and the unhealthy state of the gums and contiguous
parts, established and maintained by the presence of these substitutes,
unquestionably give rise in many cases to reflected pain.
When Dr. Sexton attempts to establish a _law_ governing the management
of diseased teeth, it must be based on more substantial grounds
than those which he presents. The case related of his patient, the
"medical man, who practices dentistry," and who was convinced that
an inflammation of one of his ears began from the time the upper
second molar of that side was treated for a diseased pulp, is simply
an assumption, on the part of the patient, that the ear trouble had
its origin from the diseased tooth, and the patient's diagnosis of
his own case seems to have been accepted by Dr. S. as conclusive. The
ear disease in this case may have emanated from the diseased tooth,
but no evidence is produced to that effect. In regard to the query as
to "whether it is safe practice to retain dead teeth in the jaws," I
would say that thousands of people in our own country have had pulpless
(not dead) teeth in their jaws many years, which are exempt from
pericemental disease, and which serve all the purposes for which teeth
were provided. To ask whether it is safe practice to retain these,
so-called, dead teeth in the jaws when they have been comfortable and
useful from ten to forty years and promise to remain so through life,
seems like a proposition too injudicious to need comment. While the
death of the pulp results in "cutting off the source of nutrition from
the dentine," it does not follow "that in a large number of instances
irritation can not be easily controlled."
Neither does the tooth become a foreign substance. The dentine and the
enamel are, of course, no longer nourished after the death of the pulp,
but their resisting structure renders them capable of maintaining their
integrity many years after the pulp has been removed; and pericementum
will nourish the cementum and thereby retain the tooth in its alveolus
in a comfortable condition. In order, however, to thus retain the
tooth and prevent inflammation from supervening, the devitalized pulp
must be removed, the pulp canals thoroughly disinfected and filled
with a plastic material which hardens when in position. Dr. S. most
clearly exhibits his imperfect knowledge of the dental operations in
vogue when he says: "Inflammation of exposed dentine cannot surely
be entirely arrested in any case by filling the pulp cavity with any
known extraneous material, and especially is handicraft wanting to
even imperfectly protect the minute and often tortuous canals leading
down to the apical foramina of the majority of the teeth." To arrest
"inflammation of exposed dentine by filling the pulp cavity," in the
opinion of Dr. S. would seem to be most desirable. How a tissue without
nourishment and consequently without vitality can take or maintain
inflammation is beyond comprehension. The impervious filling which
I have mentioned will close the apical foramina, together with the
canal, which "in the majority of cases" _is not_ tortuous to a degree
of rendering the perfect filling of the root difficult or uncertain,
and the assertion that the dental surgeon "is able only to offer a
hopeful but uncertain prognosis in these cases" is contrary to well
established fact. There are no diseases to which mankind is heir more
scientifically and effectually cured than the diseases of the teeth in
question.
Again: "The dead tissues of the dentine will sooner or later, most
likely, be transmitted through the tissues of the cementum to the
periosteum." Communication between the lacunæ canaliculi of the
cementum with the tubuli of the dentine is not free; indeed, it seldom
exists, hence it cannot be "that through the periosteum alone the
dentine may long derive some nourishment."
About 22,000,000 teeth are annually extracted in the United States, and
I regret to say this enormous loss of teeth is to no small extent due
to the indifference manifested by physicians in the anatomy, physiology
and pathology of these organs. It is a fact, no one will attempt to
gainsay, that hygienic measures directed toward the preservation of the
deciduous set, if understood, are seldom recommended by the general
practitioner to the families under his charge. The premature loss of
these teeth paves the way for early lesions of the permanent set. The
pain resulting from advanced caries of the deciduous teeth, owing to
the difficulties encountered in controlling the patient, is not easily
treated; moreover, the injurious impressions thus made on the system of
the child abide through life. There is no doubt hundreds of thousands
of teeth are unnecessarily extracted each year, and then drugs are
given with a view of curing the patient of the disorders of digestion
and other abnormal conditions which follow, and which in turn arise
from imperfect mastication of food, verily for the want of teeth.
We need to know "what's the matter" in the treatment of these "nervous
diseases about the head," as in all others, and apply a remedy which
will bring the abnormal tissues back to health. Too often, indeed, has
it happened that patients, by advice of their medical attendants, have
submitted to the loss of many, and, in some instances, to all their
teeth, in the vain endeavor to be relieved from trigeminal neuralgia.
You may ask, Why this useless loss of teeth, and all the resulting
evils? Because the advice given was not wise; the etiology of the
affection was not understood.
There are certain pathological conditions of the teeth which have not
been mentioned in this discussion, and which give rise to reflected
pain of the eyes, ears, and other parts.
Among these may be mentioned exostosis of the roots of teeth and
nodules of calcific matter within the pulp canals in contact with
a living pulp. The former of these conditions has been regarded
incurable, the removal of the tooth with the united bony tumor being
indicated. In favorable cases, however, this tumor may be excised and
removed without removing the tooth. The pulp nodules of calcified
deposits within the pulp chamber may be, in a large majority of cases,
successfully removed without sacrificing the tooth.
No one approves more than I the removal of the causes of disease.
It is no more necessary to extract a tooth at the root of which an
alveolar abscess has formed than it would be to amputate a limb for
the cure of an abscess of the medullary substance of its bone. Disease
of the eye sometimes requires that it be enucleated, but the honest,
skilled ophthalmologist _would not_ remove the eye when he _knew_ he
could restore it to usefulness. The spirit of the teachings of Dr.
Sexton's articles is far from being progressive. Nor is this all; many
assertions are not based on fact, but on erroneous impressions. Our
duty to our profession and the laity is not to destroy but to save; and
while ignorance is ever working its mischief in all vocations in life,
it is not just to accept the results of such work as a basis on which
to found a law.
ARTICLE IV.
DIAGNOSIS AND TREATMENT OF DENTRITIC CYSTIC TUMORS OF THE JAWS.
BY JOHN S. SMITH, D. D. S., LANCASTER, PA.