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A Developing Profession–How Shall We Meet the Opportunities and Responsibilities of the Near Future?* (Abstract.)
1024
TH E JOURNAL OP TH E N A TION AL DEN TAL ASSOCIATION.
Case 6.-—Is report of three cases of inflammatory rheumatism in women of about same age, 65 years. All had hope less cases of pyorrhea, complicated with some apical infection. One case requires special mention, as it was seen in March, 1913, and advised to have the remainder of her teeth extracted (the lower ante rior six, all that remained). However, they were retained for two years longer, when she was delirious for three weeks in February and March of 1915, with high fever and rheumatism around her heart. In April they were extracted, and from that date, she has had steady im provement and went thru last winter and spring with comfort. Both other cases recovered after extraction of pyorrhea teeth. If time permitted, I could report many more interesting cases of recovery where medical treatment had entirely failed. In
conclusion, I would advise that pulps be removed, except when exposed or infect ed, as at best, it is a hazardous undertak ing, even in normal conditions; a per fectly filled canal is very rare. Guard against and remove all causes of gingivi tis, realizing that by avoiding pulp re moval, and the prevention of pus forma tion, you are removing the primary causes of systemic diseases and length ening the lives of your patients. Great deeds are being done by men of ambition and capacity for work in our profession. Great sacrifices are being made by the trustees of our Research Institute, in order that all dentists may better serve humanity. The greatest op portunity in history is dawning upon us. Our possibilities are limitless and our am bitions for achievements should fill us with virile determinations to do our level best. — Bulletin Colorado State D ental Association.
A DEVELOPING PROFESSION-HOW SHALL WE MEET THE OPPORTUNITIES AND RESPONSIBILITIES OF THE NEAR FUTURE?* (Abstract.)
By Edmund Noyes, D. D. S., Chicago, Illinois.
The methods of making pulp canal op erations as they should be made have been well and minutely described in a number of excellent papers. These have naturally enough dwelt most elaborately upon the difficult cases, and have had so much to say about working an hour or more over some fine canal and then try ing some more at another sitting and have insisted upon from two to four or five X-rays in the course of the proceed ings, at the same time requiring such elaborate arrangements for asepsis that I have feared a great many men, practic ing for patients in very moderate circum stances, will throw up their hands in de spair and say “ that practice is not for • A p ril, 1917, D en tal R eview .
us” and so be tempted to shirk their duty and responsibility in the matter and continue on in their same old way. In the first place, then, nine-tenths of all the teeth except the molars and lower incisors can, if in normal condition, have their pulp canals cleaned out and filled without any serious difficulty and with out consuming an unreasonable amount of time and the filling can be icarried to the end of the pulp canal, and we can know that it is there and can fill the re mainder of the canal without leaving any vacant spaces. It is to be remem bered that the pulp canal terminates in the dentin and the passage thru the cementum at the end of the root is only a foramen and Is usually very small. A
ITEM S OF IN TEREST.
broach that will go to the end of the ca nal will usually stop there and it re quires a very fine one to go beyond that and thru the foramen. All the cases in normal teeth can be treated and filled without any X-ray at all, an X-ray being necessary in cases of suspectei trouble in the apical space. The molar and lower incisors constitute a pretty large class, but a great many of these, probably much more than half, can be managed in the same way as the firstclass without very much more time and trouble except as the number of root canals is greater in the molars. As for the remainder of really difficult cases, if patients cannot remunerate us properly we should be willing to make considera ble sacrifices of our time and skill in the effort to treat them properly, for I hold that we should not accept a patient at all unless we are willing to do the difficult things for them as well as the easy ones. It is not very readily practicable to maintain in a dental office as com plete aseptic conditions as are accom plished in the surgical ward of a hos pital where major operations are made. The nearer we can approach to such con ditions, within reason, the better, but for root canal work such aseptic measures as are practicable may be adequately supplemented with the use of antiseptics. There is no place that I know of, except for the sterilization of instruments, where antiseptics may be more safely and usefully employed than in the pulp canals of the teeth. Broaches wound with cotton should always be sterilized after winding, and if proper care is used I do not believe it to be indispensably neces sary; the hands should be carefully wash ed, (I do not mean for fifteen minutes as the surgeons do), and then the fingers and thumbs that will come in contact with the cotton should be well rubbed with alcohol and a drop or two of oil of cloves may afterward be rubbed into the skin. If this is done I believe that cotton may be wound on a broach between the thumb
1025
and forefinger without danger of carry ing infection, however, it may be still further guarded by touching the end which goes deepest into the canal to any mild antiseptic. It should not be escharotic or irritating enough to destroy liv ing tissue cells or to poison or paralyze them in case any of it should go thru the foramen and reach the peridental mem brane in the apical space. Oil of cloves will do, or eucalyptol, and “ Black’s one, two, three” or camphophenique. The foregoing relates to pulp canals from which living pulps have been re moved, and which will never become in fected unless by the criminal careless ness o f the dentist. If pulp canals are already infected, containing dead pulps or associated with alveolar ab scesses, more effective germicides are necessary. Personally I do such cleaning as I deem prudent at the first sitting with instru ments dipped in formo-cresol, but I have not, for a good while, sealed any appre ciable amount of it in a pulp canal for twenty-four hours or more because I fear the possible destructive effects of forma lin on the peridental membrane in the apical space. Instead I seal in cotton dipped in oil of cloves or Black’s one-twothree with tincture of iodin added. This, I believe, will sterilize a pulp canal in a day or two so that the cleaning of it can be finished in safety. I suppose that a majority of the men who are making imperfect root fillings, badly constructed crowns and bridges and amalgam fillings without a rubber dam, without a matrix, and without fin ishing at a subsequent sitting are saying, and with great plausibility, that they cannot do better work and live on the fees their patients are willing to pay them. There are of course a few men who are incorrigibly incompetent, but it is my belief that the others could take fifty per cent, more time for their opera tions, charge double their present fees, and if they have any ability o f salesman
1026
TH E JO U RN AL OF TH E N A TION AL D EN TA L ASSOCIATION.
ship their fees would he paid more wil lingly than at present and their services would be better worth the larger fees than their present operations are for the small fees they are receiving. Certainly a crown that is made over a well filled root and constructed so that the gums and peridental membrane are preserved from irritation and injury is cheaper to any patient at ten to twenty dollars than a crown made for two to five dollars over a half filled root and so badly fitted that the subsequent abscesses or pyorrhea and the possible arthritis, endocarditis or some other serious infection cause a long illness and a big doctor’s bill in ad dition to the loss of the tooth.
RESEARCH W O R K
The dental profession is getting a “ black eye” from the medical profession and more and more from the public by reason of the men who are willing to lower their standard of skill and thoroness to meet the competition of cheap prices or the financial necessities of their patients and there are a few men who deserve much more severe condemnation because they are able after a while to increase their fees, sometimes to a very high figure but do not raise the standard of their skill even to the level of their ability. These are the worst of all for they have caused many people to believe that paying large fees does not insure a competent service.
B Y D E N T A L ST U D E N T S.
By H. Carlton Smith,* Ph. G., Boston, Mass.
A physician of high standing both in state and nation recently criticised the the teaching at Harvard Medical School as being too largely theoretical and too little practical. As a climax to his criti cism he cited an instance of a suggestion made to a second y e a r medical student that he do a little Research work. The criticism on the whole may be just or unjust, I do not know, but the at titude taken toward student research work concerns me greatly. For a num ber of years it has been my practice to try to interest second year D ental stu dents in some sort of original investiga tion. If this is unwise I am honestly anxious to be shown how and why it is so. I know the question has been raised whether research work should be under taken by anyone with only the average dental education, and that some of our most prolific dental writers have been ‘H a rva rd istry.
D en tal
S c h o o l,
D epartm en t o f
C hem
criticised because of an inadequate pre liminary chemical training. We are told that research workers like musicians are born, not made. This is undoubtedly true in respect to great re search workers or great musicians, but music has a value to others than great musicians, in fact the people absolutely tone deaf are very few and they usually like to sing, likewise the properly guard ed effort at original thinking can hardly be without value, great or less, to any individual. It has been said that the testimony of the untrained observer' is, as a rule, wholly untrustworthy. This may be put ting it a little strongly but granting it to be true, the fact remains that we are get ting a considerable volume o f testimony from sources giving evidence o f little if any training, and while it is obvious that such research work as students will do may not lead to important re sults, it will help in correcting present
TH E JOURNAL OP TH E N A TION AL DEN TAL ASSOCIATION.
Case 6.-—Is report of three cases of inflammatory rheumatism in women of about same age, 65 years. All had hope less cases of pyorrhea, complicated with some apical infection. One case requires special mention, as it was seen in March, 1913, and advised to have the remainder of her teeth extracted (the lower ante rior six, all that remained). However, they were retained for two years longer, when she was delirious for three weeks in February and March of 1915, with high fever and rheumatism around her heart. In April they were extracted, and from that date, she has had steady im provement and went thru last winter and spring with comfort. Both other cases recovered after extraction of pyorrhea teeth. If time permitted, I could report many more interesting cases of recovery where medical treatment had entirely failed. In
conclusion, I would advise that pulps be removed, except when exposed or infect ed, as at best, it is a hazardous undertak ing, even in normal conditions; a per fectly filled canal is very rare. Guard against and remove all causes of gingivi tis, realizing that by avoiding pulp re moval, and the prevention of pus forma tion, you are removing the primary causes of systemic diseases and length ening the lives of your patients. Great deeds are being done by men of ambition and capacity for work in our profession. Great sacrifices are being made by the trustees of our Research Institute, in order that all dentists may better serve humanity. The greatest op portunity in history is dawning upon us. Our possibilities are limitless and our am bitions for achievements should fill us with virile determinations to do our level best. — Bulletin Colorado State D ental Association.
A DEVELOPING PROFESSION-HOW SHALL WE MEET THE OPPORTUNITIES AND RESPONSIBILITIES OF THE NEAR FUTURE?* (Abstract.)
By Edmund Noyes, D. D. S., Chicago, Illinois.
The methods of making pulp canal op erations as they should be made have been well and minutely described in a number of excellent papers. These have naturally enough dwelt most elaborately upon the difficult cases, and have had so much to say about working an hour or more over some fine canal and then try ing some more at another sitting and have insisted upon from two to four or five X-rays in the course of the proceed ings, at the same time requiring such elaborate arrangements for asepsis that I have feared a great many men, practic ing for patients in very moderate circum stances, will throw up their hands in de spair and say “ that practice is not for • A p ril, 1917, D en tal R eview .
us” and so be tempted to shirk their duty and responsibility in the matter and continue on in their same old way. In the first place, then, nine-tenths of all the teeth except the molars and lower incisors can, if in normal condition, have their pulp canals cleaned out and filled without any serious difficulty and with out consuming an unreasonable amount of time and the filling can be icarried to the end of the pulp canal, and we can know that it is there and can fill the re mainder of the canal without leaving any vacant spaces. It is to be remem bered that the pulp canal terminates in the dentin and the passage thru the cementum at the end of the root is only a foramen and Is usually very small. A
ITEM S OF IN TEREST.
broach that will go to the end of the ca nal will usually stop there and it re quires a very fine one to go beyond that and thru the foramen. All the cases in normal teeth can be treated and filled without any X-ray at all, an X-ray being necessary in cases of suspectei trouble in the apical space. The molar and lower incisors constitute a pretty large class, but a great many of these, probably much more than half, can be managed in the same way as the firstclass without very much more time and trouble except as the number of root canals is greater in the molars. As for the remainder of really difficult cases, if patients cannot remunerate us properly we should be willing to make considera ble sacrifices of our time and skill in the effort to treat them properly, for I hold that we should not accept a patient at all unless we are willing to do the difficult things for them as well as the easy ones. It is not very readily practicable to maintain in a dental office as com plete aseptic conditions as are accom plished in the surgical ward of a hos pital where major operations are made. The nearer we can approach to such con ditions, within reason, the better, but for root canal work such aseptic measures as are practicable may be adequately supplemented with the use of antiseptics. There is no place that I know of, except for the sterilization of instruments, where antiseptics may be more safely and usefully employed than in the pulp canals of the teeth. Broaches wound with cotton should always be sterilized after winding, and if proper care is used I do not believe it to be indispensably neces sary; the hands should be carefully wash ed, (I do not mean for fifteen minutes as the surgeons do), and then the fingers and thumbs that will come in contact with the cotton should be well rubbed with alcohol and a drop or two of oil of cloves may afterward be rubbed into the skin. If this is done I believe that cotton may be wound on a broach between the thumb
1025
and forefinger without danger of carry ing infection, however, it may be still further guarded by touching the end which goes deepest into the canal to any mild antiseptic. It should not be escharotic or irritating enough to destroy liv ing tissue cells or to poison or paralyze them in case any of it should go thru the foramen and reach the peridental mem brane in the apical space. Oil of cloves will do, or eucalyptol, and “ Black’s one, two, three” or camphophenique. The foregoing relates to pulp canals from which living pulps have been re moved, and which will never become in fected unless by the criminal careless ness o f the dentist. If pulp canals are already infected, containing dead pulps or associated with alveolar ab scesses, more effective germicides are necessary. Personally I do such cleaning as I deem prudent at the first sitting with instru ments dipped in formo-cresol, but I have not, for a good while, sealed any appre ciable amount of it in a pulp canal for twenty-four hours or more because I fear the possible destructive effects of forma lin on the peridental membrane in the apical space. Instead I seal in cotton dipped in oil of cloves or Black’s one-twothree with tincture of iodin added. This, I believe, will sterilize a pulp canal in a day or two so that the cleaning of it can be finished in safety. I suppose that a majority of the men who are making imperfect root fillings, badly constructed crowns and bridges and amalgam fillings without a rubber dam, without a matrix, and without fin ishing at a subsequent sitting are saying, and with great plausibility, that they cannot do better work and live on the fees their patients are willing to pay them. There are of course a few men who are incorrigibly incompetent, but it is my belief that the others could take fifty per cent, more time for their opera tions, charge double their present fees, and if they have any ability o f salesman
1026
TH E JO U RN AL OF TH E N A TION AL D EN TA L ASSOCIATION.
ship their fees would he paid more wil lingly than at present and their services would be better worth the larger fees than their present operations are for the small fees they are receiving. Certainly a crown that is made over a well filled root and constructed so that the gums and peridental membrane are preserved from irritation and injury is cheaper to any patient at ten to twenty dollars than a crown made for two to five dollars over a half filled root and so badly fitted that the subsequent abscesses or pyorrhea and the possible arthritis, endocarditis or some other serious infection cause a long illness and a big doctor’s bill in ad dition to the loss of the tooth.
RESEARCH W O R K
The dental profession is getting a “ black eye” from the medical profession and more and more from the public by reason of the men who are willing to lower their standard of skill and thoroness to meet the competition of cheap prices or the financial necessities of their patients and there are a few men who deserve much more severe condemnation because they are able after a while to increase their fees, sometimes to a very high figure but do not raise the standard of their skill even to the level of their ability. These are the worst of all for they have caused many people to believe that paying large fees does not insure a competent service.
B Y D E N T A L ST U D E N T S.
By H. Carlton Smith,* Ph. G., Boston, Mass.
A physician of high standing both in state and nation recently criticised the the teaching at Harvard Medical School as being too largely theoretical and too little practical. As a climax to his criti cism he cited an instance of a suggestion made to a second y e a r medical student that he do a little Research work. The criticism on the whole may be just or unjust, I do not know, but the at titude taken toward student research work concerns me greatly. For a num ber of years it has been my practice to try to interest second year D ental stu dents in some sort of original investiga tion. If this is unwise I am honestly anxious to be shown how and why it is so. I know the question has been raised whether research work should be under taken by anyone with only the average dental education, and that some of our most prolific dental writers have been ‘H a rva rd istry.
D en tal
S c h o o l,
D epartm en t o f
C hem
criticised because of an inadequate pre liminary chemical training. We are told that research workers like musicians are born, not made. This is undoubtedly true in respect to great re search workers or great musicians, but music has a value to others than great musicians, in fact the people absolutely tone deaf are very few and they usually like to sing, likewise the properly guard ed effort at original thinking can hardly be without value, great or less, to any individual. It has been said that the testimony of the untrained observer' is, as a rule, wholly untrustworthy. This may be put ting it a little strongly but granting it to be true, the fact remains that we are get ting a considerable volume o f testimony from sources giving evidence o f little if any training, and while it is obvious that such research work as students will do may not lead to important re sults, it will help in correcting present