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Bacteriologic Study of Normal Vital Teeth*
894
The Journal of the American Dental Association
From these many condensed expressions can be gained much satisfaction and food for practical application. T o be sure, we are not yet agreed on the etiology of many gingival dis eases. W e are not agreed as to whether “ In severe cases that were treated surgically by resecting the gum tissue to eliminate pockets, the end-results after five years have been vastly better than where the treatment was .con fined to scaling and curetting.” M any were in accord with the dentist from Chicago
who says,
“ If
by
operative
procedures you mean gum resection, I have never, to my knowledge, had a patient w ho required it.”
CONCLUSIONS
1. Notwithstanding the divergence o f opinion on operative procedure, the evidence is overwhelmingly positive that the dental profession is successful in the treatment o f pyorrhea conditions, and year by year we are improving endresults. 2. W e are now o f one accord with the great idea o f increased skill for diagnosis, also the necessity for raising tissue resistance by gum stimulation as “ gum culture,” which must become a fixed habit by the patient. W h en this cooperation o f the patient has been gained, we can produce satisfactory endresults. 803 A tla n ta N ation al Bank B uilding.
BACTERIOLOGIC STUDY OF NORMAL VITAL TEETH* By LOUIE T . AU STIN , D. D. S., and TH O M A S J. COOK, D. D. S., Rochester, Minn. H IS study was undertaken for two purposes: to secure a control fo r the large number o f pulpless teeth cul tured at T h e M ay o Clinic, and to de termine the correctness of the opinion that a large percentage o f normal vital teeth yield cultures o f streptococci.
T
H enrici and H artzell,1 in 1919, cul tured twenty-two normal vital teeth and all cultures were negative. In their cul tures o f vital teeth affected with pyor rhea, 42 per cent were positive; o f those affected with caries, 43 per cent were positive; and of those affected with both *F ro m the Section on D en tal Surgery, T h e M a y o C lin ic, an d the D iv is io n o f E x p e ri m ental B a cte rio lo g y , T h e M a y o F oun dation. 1. H e n rici, A . T ., and H a rtze ll, T . B .: B a c te rio lo g y o f V ital Pulps, J. D en t. Res., 1: 419-422, 1919.
Jour. A. O. A., May, igsg
pyorrhea and caries, 46 per cent were positive. C LIN IC A L M A TERIAL
Specimens for bacteriologic study were obtained from the apices o f normal vital teeth. These teeth were removed usually because there were a scattered few and a full denture was advised. In cases in which a number of pyorrheal or pulpless teeth were being removed and one or tw o normal vital teeth were present, a full denture was advised. In such cases, the teeth to be cultured were treated with the usual precaution and removed first. N ot more than two teeth were cultured in any one case. T E C H N IC
T h e patient is placed on the operating table and the same precautions are used
895
Austin and Cook— Normal Vital Teeth as in other surgical procedures concern ing sterile towels, gloves, gowns, instru ments and so forth. T h e patient’s head and chest are covered with sterile towels and the operative field is completely walled off with sterile gauze. T h e area about the tooth that is to be removed is dried with a sterile swab. It is then painted with 3 per cent iodin, care being taken to have it penetrate well into the gingival margin about the tooth. Seventyfive per cent alcohol is then applied to the area and it is dried with a sterile swab. The area is then tested for sterility by swabbing the field with a sterile swab R e s u lt s o f C u lt u r e s
T e e th C ultured
V i t a l ............................................... Pulpless (c o n tr o ls )...................... R oen tgen ologically negative. R oen tg en olog ically p ositive.
N um ber
100 100 50 50
fro m
by means o f pipets to tw o tubes o f glucose-brain broth and one tube o f glucosebrain-agar as well as being streaked on a blood-agar plate. T h e apex is placed in one o f the tubes containing glucosebrain broth. Glucose-brain broth and glucose-brain-agar are used in this study because of their nutritive qualities, which are especially favorable for the growth o f organisms encountered in infections about the oral cavity. T h e long tubes o f brain broth provide every degree o f oxygen tension; the brain at the bottom renders it anaerobic, while the top may be favorable for aerobic growth.
100 V i t a l a n d 100 P u l p l e s s T e e t h Cultures in G lucose-B rain-A gar
C ultures in G lucose-B rain B roth
C olonies
P osi tive
N ega tive
No G row th
0 to 20
4 89 84 94
96 11 16 6
96 11 16 6
3 2 4
and placing the swab in a tube o f glucosebrain broth, which serves as a control. It is then placed in the incubator with the other cultures, and if a growth is obtained, the operative field and cultures are considered contaminated and the cultures are discarded. T h e tooth is then extracted, and while it is still held in the extraction forceps, the apex is severed with special cutting forceps, and dropped into a screw-top tube containing about 1 c.c. gelatinLocke solution and sand. T h e tube is immediately sealed, taken to the bactéri ologie laboratory, and placed on a shak ing machine for ten minutes, so as to macerate as much as possible the tissue about the apex o f the severed root ends. T his shaken material is then transferred
20 to 50
50 to 100
O ver 100
9 8 10
1 3 2 4
75 70 80
O f the 100 cultures from normal vital teeth which were free from con tamination, 4 per cent showed positive growths o f streptococci in glucose-brain broth and 96 per cent o f the cultures were negative (tabulation). O f the 4 per cent that gave positive cultures, 3 per cent showed less than twenty co l onies in glucose-brain-agar, and 1 per cent showed approximately 100 colonies. These cultures were incubated for as long as tw o weeks before they were dis carded. A possible explanation for the 4 per cent o f positive cultures may be that some o f these cultures were obtained from patients who were not only har boring a large number o f infected teeth, some o f which were immediately adja cent to the vital tooth cultured, but
896
The Journal of the American Dental Association
were also suffering from infective dis eases. In the pulpless group, which was used as a control, it was interesting to note that there was not a great difference in the percentage growths o f streptococci in the series o f roentgenologically nega tive teeth cultured and that of the roentgenologically positive group. In the roentgenologically negative group, the teeth cultured yielded Strep tococcus viridans in 84 per cent o f the cultures, and 16 per cent were negative in glucose-brain broth. In brain-agar, 4 per cent showed up to twenty colonies; 8 per cent, from twenty to fifty ; 2 per cent, from fifty to 100, and 70 per cent, from 100 to countless colonies. In this series o f fifty roentgenologically nega tive pulpless teeth, there were four root canals that were one-quarter filled, twelve that were one-half filled, twentyfour that were three-quarters filled and ten that gave evidence o f having a com plete filling.
In the roentgenologically positive group o f pulpless teeth, positive cultures o f Streptococcus viridans were found in 94 per cent of the cultures in glucosebrain broth, and 6 per cent remained negative. In glucose-brain-agar, 6 per cent did not give a grow th; 10 per cent yielded from twenty to fifty colonies; 4 per cent, from fifty to 100 colonies, and 80 per cent from 100 to countless colonies. In this series, five root canals did not have fillings, nine were onequarter filled, twelve were one-half filled, eighteen were three-quarters filled and six had complete fillings. O f the 100 pulpless teeth, including the roentgenologically negative and the roentgenologically positive groups, 89 per cent gave a positive growth o f Strep tococcus viridans and 11 per cent did not give a growth. O f this series, 75 per cent yielded more than 100 colonies in agar, which indicated that consider able infection was present in most of the cases.
ALVEOLECTOMY* By ROY R. RALSTON, D .D .S ., Omaha, Nebr. H E present method of extraction of teeth is unscientific. T h e reason for the extraction of teeth is loss of function or an existing pathologic condi tion. It is a w ell known surgical fact that blind curettement is a very unsatis factory procedure.
T
T h e term “ alveolectomy” was sup plied by the late D . E. Jenkins of the University of Omaha. T his operation, * R ea d b e fo re the A m e rica n Society o f O ra l S urgeons an d E xodontists, M in n ea p olis, M inn., A u g . 18, 1928.
Jour. A, D. A., May, 1929
which was first performed by W illiam L . Shearer o f Omaha, in 1905, was fo r merly called external alveolectomy. It was the opinion o f D r. Jenkins, in the beginning, that only the external plate of the alveolar process was removed. T his was not the case. T h e mucoperiosteum was reflected buccally and lingually, and all diseased areas were thoroughly re moved and the stress bearing areas of the ridge arched. W h en this was brought to the attention of D r. Jenkins, he de
The Journal of the American Dental Association
From these many condensed expressions can be gained much satisfaction and food for practical application. T o be sure, we are not yet agreed on the etiology of many gingival dis eases. W e are not agreed as to whether “ In severe cases that were treated surgically by resecting the gum tissue to eliminate pockets, the end-results after five years have been vastly better than where the treatment was .con fined to scaling and curetting.” M any were in accord with the dentist from Chicago
who says,
“ If
by
operative
procedures you mean gum resection, I have never, to my knowledge, had a patient w ho required it.”
CONCLUSIONS
1. Notwithstanding the divergence o f opinion on operative procedure, the evidence is overwhelmingly positive that the dental profession is successful in the treatment o f pyorrhea conditions, and year by year we are improving endresults. 2. W e are now o f one accord with the great idea o f increased skill for diagnosis, also the necessity for raising tissue resistance by gum stimulation as “ gum culture,” which must become a fixed habit by the patient. W h en this cooperation o f the patient has been gained, we can produce satisfactory endresults. 803 A tla n ta N ation al Bank B uilding.
BACTERIOLOGIC STUDY OF NORMAL VITAL TEETH* By LOUIE T . AU STIN , D. D. S., and TH O M A S J. COOK, D. D. S., Rochester, Minn. H IS study was undertaken for two purposes: to secure a control fo r the large number o f pulpless teeth cul tured at T h e M ay o Clinic, and to de termine the correctness of the opinion that a large percentage o f normal vital teeth yield cultures o f streptococci.
T
H enrici and H artzell,1 in 1919, cul tured twenty-two normal vital teeth and all cultures were negative. In their cul tures o f vital teeth affected with pyor rhea, 42 per cent were positive; o f those affected with caries, 43 per cent were positive; and of those affected with both *F ro m the Section on D en tal Surgery, T h e M a y o C lin ic, an d the D iv is io n o f E x p e ri m ental B a cte rio lo g y , T h e M a y o F oun dation. 1. H e n rici, A . T ., and H a rtze ll, T . B .: B a c te rio lo g y o f V ital Pulps, J. D en t. Res., 1: 419-422, 1919.
Jour. A. O. A., May, igsg
pyorrhea and caries, 46 per cent were positive. C LIN IC A L M A TERIAL
Specimens for bacteriologic study were obtained from the apices o f normal vital teeth. These teeth were removed usually because there were a scattered few and a full denture was advised. In cases in which a number of pyorrheal or pulpless teeth were being removed and one or tw o normal vital teeth were present, a full denture was advised. In such cases, the teeth to be cultured were treated with the usual precaution and removed first. N ot more than two teeth were cultured in any one case. T E C H N IC
T h e patient is placed on the operating table and the same precautions are used
895
Austin and Cook— Normal Vital Teeth as in other surgical procedures concern ing sterile towels, gloves, gowns, instru ments and so forth. T h e patient’s head and chest are covered with sterile towels and the operative field is completely walled off with sterile gauze. T h e area about the tooth that is to be removed is dried with a sterile swab. It is then painted with 3 per cent iodin, care being taken to have it penetrate well into the gingival margin about the tooth. Seventyfive per cent alcohol is then applied to the area and it is dried with a sterile swab. The area is then tested for sterility by swabbing the field with a sterile swab R e s u lt s o f C u lt u r e s
T e e th C ultured
V i t a l ............................................... Pulpless (c o n tr o ls )...................... R oen tgen ologically negative. R oen tg en olog ically p ositive.
N um ber
100 100 50 50
fro m
by means o f pipets to tw o tubes o f glucose-brain broth and one tube o f glucosebrain-agar as well as being streaked on a blood-agar plate. T h e apex is placed in one o f the tubes containing glucosebrain broth. Glucose-brain broth and glucose-brain-agar are used in this study because of their nutritive qualities, which are especially favorable for the growth o f organisms encountered in infections about the oral cavity. T h e long tubes o f brain broth provide every degree o f oxygen tension; the brain at the bottom renders it anaerobic, while the top may be favorable for aerobic growth.
100 V i t a l a n d 100 P u l p l e s s T e e t h Cultures in G lucose-B rain-A gar
C ultures in G lucose-B rain B roth
C olonies
P osi tive
N ega tive
No G row th
0 to 20
4 89 84 94
96 11 16 6
96 11 16 6
3 2 4
and placing the swab in a tube o f glucosebrain broth, which serves as a control. It is then placed in the incubator with the other cultures, and if a growth is obtained, the operative field and cultures are considered contaminated and the cultures are discarded. T h e tooth is then extracted, and while it is still held in the extraction forceps, the apex is severed with special cutting forceps, and dropped into a screw-top tube containing about 1 c.c. gelatinLocke solution and sand. T h e tube is immediately sealed, taken to the bactéri ologie laboratory, and placed on a shak ing machine for ten minutes, so as to macerate as much as possible the tissue about the apex o f the severed root ends. T his shaken material is then transferred
20 to 50
50 to 100
O ver 100
9 8 10
1 3 2 4
75 70 80
O f the 100 cultures from normal vital teeth which were free from con tamination, 4 per cent showed positive growths o f streptococci in glucose-brain broth and 96 per cent o f the cultures were negative (tabulation). O f the 4 per cent that gave positive cultures, 3 per cent showed less than twenty co l onies in glucose-brain-agar, and 1 per cent showed approximately 100 colonies. These cultures were incubated for as long as tw o weeks before they were dis carded. A possible explanation for the 4 per cent o f positive cultures may be that some o f these cultures were obtained from patients who were not only har boring a large number o f infected teeth, some o f which were immediately adja cent to the vital tooth cultured, but
896
The Journal of the American Dental Association
were also suffering from infective dis eases. In the pulpless group, which was used as a control, it was interesting to note that there was not a great difference in the percentage growths o f streptococci in the series o f roentgenologically nega tive teeth cultured and that of the roentgenologically positive group. In the roentgenologically negative group, the teeth cultured yielded Strep tococcus viridans in 84 per cent o f the cultures, and 16 per cent were negative in glucose-brain broth. In brain-agar, 4 per cent showed up to twenty colonies; 8 per cent, from twenty to fifty ; 2 per cent, from fifty to 100, and 70 per cent, from 100 to countless colonies. In this series o f fifty roentgenologically nega tive pulpless teeth, there were four root canals that were one-quarter filled, twelve that were one-half filled, twentyfour that were three-quarters filled and ten that gave evidence o f having a com plete filling.
In the roentgenologically positive group o f pulpless teeth, positive cultures o f Streptococcus viridans were found in 94 per cent of the cultures in glucosebrain broth, and 6 per cent remained negative. In glucose-brain-agar, 6 per cent did not give a grow th; 10 per cent yielded from twenty to fifty colonies; 4 per cent, from fifty to 100 colonies, and 80 per cent from 100 to countless colonies. In this series, five root canals did not have fillings, nine were onequarter filled, twelve were one-half filled, eighteen were three-quarters filled and six had complete fillings. O f the 100 pulpless teeth, including the roentgenologically negative and the roentgenologically positive groups, 89 per cent gave a positive growth o f Strep tococcus viridans and 11 per cent did not give a growth. O f this series, 75 per cent yielded more than 100 colonies in agar, which indicated that consider able infection was present in most of the cases.
ALVEOLECTOMY* By ROY R. RALSTON, D .D .S ., Omaha, Nebr. H E present method of extraction of teeth is unscientific. T h e reason for the extraction of teeth is loss of function or an existing pathologic condi tion. It is a w ell known surgical fact that blind curettement is a very unsatis factory procedure.
T
T h e term “ alveolectomy” was sup plied by the late D . E. Jenkins of the University of Omaha. T his operation, * R ea d b e fo re the A m e rica n Society o f O ra l S urgeons an d E xodontists, M in n ea p olis, M inn., A u g . 18, 1928.
Jour. A, D. A., May, 1929
which was first performed by W illiam L . Shearer o f Omaha, in 1905, was fo r merly called external alveolectomy. It was the opinion o f D r. Jenkins, in the beginning, that only the external plate of the alveolar process was removed. T his was not the case. T h e mucoperiosteum was reflected buccally and lingually, and all diseased areas were thoroughly re moved and the stress bearing areas of the ridge arched. W h en this was brought to the attention of D r. Jenkins, he de