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Does Experience Justify Prophylactic Odontotomy?
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can be tried in place periodically, and as Space maintainers are contraindicated long as it can be placed in position, we if the follicles of the permanent teeth know that the space is not closing and are absent or missing and it is deemed so a maintainer is not necessary. H ow advisable to close these spaces to obviate ever, as soon as it becomes impossible a future prosthetic replacement. Even to place the gage in position, it is evi here, each case is an individual problem, dent that some steps must be instituted calling for special study. In cases of to preserve the necessary space for the so-called distal occlusion, particularly eruption o f the succeeding tooth. when there is a lack o f mandibular A factor of great importance in pre grow th,. I should advise preservation of venting drifting o f the teeth is the inter the spaces caused by loss o f the sec deciduous mandibular molars, locking o f opposing cusps. W ith sharp, ond well-defined cusps in good occlusion, even though the bicuspid or premolar there is a tendency for this locking to follicle is absent, until such time a.5 prevent teeth from drifting. the distal occlusion has been cor I have not mentioned the extrusion rected. o f the opposing teeth attending loss o f In conclusion, I would say that there tooth structure. This should be given is no definite contraindication to the as much consideration as the loss o f placement of space maintainers in the space and should be anticipated and pre mouths o f children. vented. 634 Madison Avenue.
DOES EXPERIENCE JUSTIFY PROPHYLACTIC ODONTOTOMY? By H. S h i r l e y D w y e r , D .D .S ., Brooklyn, N. Y. A S m y part in this symposium, I shall consider the question “ Does E x perience Justify Prophylactic Odontotom y?” from four angles : 1. M o tivating known conditions. 2. T h e prob lem. 3. T h e scope o f the problem. 4. Methods o f attack. 1. T he motivating known condition. From 90 to 96 per cent o f school chil dren in the United States have dental caries, and, as a result, from 70 to 75 per cent o f adults (on relief rolls) are in need o f dentures, owing to a 60 per cent loss of masticating efficiency. 2. T h e problem. T o eliminate or preRead before the Section on Children’s Den tistry and Oral Hygiene at the Eighty-First Annual Session of the American Dental As sociation, Milwaukee, Wis., July 19 , 19 3 9 . Jour. A.D.A., Vol. 27, July 1940
vent this condition is the problem. 3. T h e scope of the problem. A n y dis ease affecting from 90 to 96 per cent of our child population ceases to be an indi vidualistic problem and becomes a com m unity problem, requiring social consid eration and a public health viewpoint of treatment. 4. Methods of attack. W hat proved method or methods which meet the essen tials of preventive practice are to be con sidered as practical? It is fairly wellestablished practice, with our present knowledge, to recommend three control m easures: a. M outh hygiene, which, like any other surface cleansing process, is an ad junct to health and esthetics, but not of itself necessarily a specific preventive.
D
w yer—
P r o p h y l a c t ic O
d ontotom y
b. Diet, which means changing the and effort, prevent the spread of decay in dietary habits of an entire nation. A t these defects and thus protect the teeth.1 present, being complicated with emo 2. Painlessness o f operation. It is only tions and endocrines, it is still in the ex when the earliest possible application of prophylactic odontotomy has been neg perimental stage. c. O perative intervention or prophy lected that pain becomes a factor in most lactic odontotomy, which, like vaccina Class I cavities. W ith a sharp bur and tion, is a known specific, simple o f appli an engine at slow speed, prophylactic odontotomy is a quick and painless op cation, painless, quick and inexpensive. M ilton J. Rosenau, authority on pre eration. J. M . W isan2 w rites: “ The fact ventive medicine and public health, says that the operation (prophylactic odon of vaccin ation: “ Vaccination is a minor totomy) was painless, increased the child’s surgical operation. No person unfamiliar willingness to obtain dental treatment.” M cBeath, in a recent article on den with surgical cleanliness should be per tistry for children, suggests choosing the mitted to perform this ‘little’ operation.” Like vaccination, prophylactic odontot smallest defects first because “ The sim omy is a justifiable operation, and, like plicity o f the operation and minimum of any other operation, it must be properly discomfort will not permit realization of performed. O ne author speaks of his the child’s fears and he becomes more horror at cutting into a beautiful tooth. receptive for more complicated pro This is unadulterated emotional bun cedures at subsequent visits.” 3 3. Econom y of operation. M aurice combe, comparable to refusing to protect W illiam w rites: a child’s future health by vaccination be Since every enamel defect must, for rea cause of possible scarring of the beautiful skin o f the arm— a rationalization of the sons already stated, grow progressively worse operator’s negligence in failing to take all unless immediate corrective treatment is pro known measures to protect the child’s vided, it is to the greatest advantage of the patient that the treatment be instituted future dental health. T h e failures in immediately, which means in early child prophylactic odontotomy occur in the hood. Such measures (prophylactic odontot hands of the negligent operator and can omy) are simple, speedy, and therefore not be blamed on the operation. L et us inexpensive. briefly state the essentials of a preventive Whether it be in public service or pri service to determine whether experience vate practice, time is the principal factor with prophylactic odontotomy fulfils in cost, and any operation which con these requirements. serves time reduces cost. Dr. Wisan again i. Ease of application. Prophylactic furnishes us with evidence when he says: odontotomy consists practically of the Prophylactic odontotomy proved to be an preparation of a pit or fissure so that a economical procedure, since it was possible simple Class I cavity is formed, which is to perform a greater number of operations then filled. I leave it to the dental pro than if the teeth were allowed to decay fession to demonstrate a simpler opera before treatment. According to figures com tion in the whole field o f dentistry. For piled by the County Superintendent’s office, authority, I refer to “ H ealth Dentistry the cost per operation was $0 .69 , the lowest cost reported among the seventeen school for the Community,” wherein we find : dental clinics in Union County. Investigations have shown that dental ca ries is particularly apt to occur on certain surfaces of the teeth because of imperfec tions in the anatomical structure of those surfaces. These imperfections in structure lend themselves very easily to correction; simple operations, which require little time
4. Universality of application. No sci entific data have as yet been published nor criteria evolved which indicate a pre dictable immunity to dental caries in chil dren. O n the contrary, much material has been published showing the universal
logé
T
he
Journal
of th e
A
m e r ic a n
prevalence o f enamel defects and their need o f immediate correction. A study made in 1928 by carefully trained observers using specially prepared charts showed the fo llo w in g:
D
ental
A
s s o c ia t io n
the percentage of school population taken care of by the clinic o f from 25 per cent in 1930 to 66.6 per cent in 1933, with fewer clinic hours (185 hours in 1930 to 174 in 1933) and a reduction in the number o f defective teeth per p u p il: On a re-examination made nine months after the first one, it was found that out of seven defects per pupil in 1930; two de 616 pre-carious fissures, there were developed fects per pupil in 1933. 568 carious cavities. Another way of stating Similarly, it might be pointed out that, this would be that 92.2 per cent of the during the seven years in which the New fissures had become carious cavities in nine York University Child Research Clinic months’ time.1 was in existence, we did not lose one first T h e report o f the Clara W achtel D en permanent molar. Prophylactic odon tal Clinic in Jerusalem emphasizes this as totomy was carefully practiced in this follows: . . prophylactic fillings, for clinic, and we had ample opportunity to instance, valuable to the child of six or observe and record the effect o f time on seven years old, are much more so to a these cases. child three or four years of age.” 2 Every properly conducted dental serv 5. Practical prevention through pro ice program in this country emphasizes phylactic odontotomy. Is it practical and the necessity for caring for pits and fis what m ay we expect? L et us see what sures— prophylactic odontotomy. Public others have to say. health departments are dependent on E. E. Starr w rites: “ Logical thinking budgets for their funds, and proof of ac decides that prophylactic odontotomy is complished good must be shown before indicated in all deep pits and fissures in money is allotted. O ne o f the features of newly erupted first molars.” 4 the N ew Y o rk C ity program is the im Isadore T eich states: “ As soon as the mediate care o f all pits and fissures. tooth has sufficiently erupted, these pits Is there any justification for the prac and fissures should be filled in the usual tice of prophylactic odontotomy? Just w ay.” 5 as I have striven throughout this paper Report of the C lara W achtel Dental to keep m y own personal views out, so I C lin ic: “ T he essence of prevention ob now propound the question, with the one viously lies in the early detection o f de request that facts rather than subj.ective fects and their correction.” 1 observations be accepted. R em em ber: A n observer in N ew Zealand sa y s: “ In “ T he enamel defect o f today is the cari N ew Zealand, where every school child ous cavity o f tomorrow.” receives the benefits of prophylactic b ib l io g r a p h y odontotomy, the reduction in the loss of teeth has been most marked.” 1 . Health Dentistry for the Community. D r. Haenke, o f Australia, reports Committee on Community Dental Service, lowering costs o f dental care with in New York Tuberculosis and Health Associa tion. creased saving o f teeth as the result of 2 . W i s a n , J. M.: Preventive Dental Service prophylactic odontotomy. in the School Clinic. D . Cosmos, 7 5 : 12 0 7 , J. M . Wisan, in his report “ Preventive December 1 9 3 3 . Dental Service in the School Clinic,” 2 3 . M c B ea th , E. C.: Comments on Dentis says: “ A ll the permanent molars that try for Children. D. O utlook, 2 6 :2 18 , May 1939have received prophylactic odontotomy 4 . S t a r r , E. E.: Significance o f Early Den treatment are now in sound condition.” tal Caries. J.A.D.A., 2 6 : 1089 , July 19 3 9 . He also shows some interesting results 5 . T e i c h , I s a d o r e : Operative Dentistry for through a period of years as the result of Children. D . O utlook, 2 6 :207 , May 19 3 9 . this practice; for instance, an increase in 80 Hanson Place.
T
he
Journal
of th e
A
m e r ic a n
D
ental
A
s s o c ia t io n
can be tried in place periodically, and as Space maintainers are contraindicated long as it can be placed in position, we if the follicles of the permanent teeth know that the space is not closing and are absent or missing and it is deemed so a maintainer is not necessary. H ow advisable to close these spaces to obviate ever, as soon as it becomes impossible a future prosthetic replacement. Even to place the gage in position, it is evi here, each case is an individual problem, dent that some steps must be instituted calling for special study. In cases of to preserve the necessary space for the so-called distal occlusion, particularly eruption o f the succeeding tooth. when there is a lack o f mandibular A factor of great importance in pre grow th,. I should advise preservation of venting drifting o f the teeth is the inter the spaces caused by loss o f the sec deciduous mandibular molars, locking o f opposing cusps. W ith sharp, ond well-defined cusps in good occlusion, even though the bicuspid or premolar there is a tendency for this locking to follicle is absent, until such time a.5 prevent teeth from drifting. the distal occlusion has been cor I have not mentioned the extrusion rected. o f the opposing teeth attending loss o f In conclusion, I would say that there tooth structure. This should be given is no definite contraindication to the as much consideration as the loss o f placement of space maintainers in the space and should be anticipated and pre mouths o f children. vented. 634 Madison Avenue.
DOES EXPERIENCE JUSTIFY PROPHYLACTIC ODONTOTOMY? By H. S h i r l e y D w y e r , D .D .S ., Brooklyn, N. Y. A S m y part in this symposium, I shall consider the question “ Does E x perience Justify Prophylactic Odontotom y?” from four angles : 1. M o tivating known conditions. 2. T h e prob lem. 3. T h e scope o f the problem. 4. Methods o f attack. 1. T he motivating known condition. From 90 to 96 per cent o f school chil dren in the United States have dental caries, and, as a result, from 70 to 75 per cent o f adults (on relief rolls) are in need o f dentures, owing to a 60 per cent loss of masticating efficiency. 2. T h e problem. T o eliminate or preRead before the Section on Children’s Den tistry and Oral Hygiene at the Eighty-First Annual Session of the American Dental As sociation, Milwaukee, Wis., July 19 , 19 3 9 . Jour. A.D.A., Vol. 27, July 1940
vent this condition is the problem. 3. T h e scope of the problem. A n y dis ease affecting from 90 to 96 per cent of our child population ceases to be an indi vidualistic problem and becomes a com m unity problem, requiring social consid eration and a public health viewpoint of treatment. 4. Methods of attack. W hat proved method or methods which meet the essen tials of preventive practice are to be con sidered as practical? It is fairly wellestablished practice, with our present knowledge, to recommend three control m easures: a. M outh hygiene, which, like any other surface cleansing process, is an ad junct to health and esthetics, but not of itself necessarily a specific preventive.
D
w yer—
P r o p h y l a c t ic O
d ontotom y
b. Diet, which means changing the and effort, prevent the spread of decay in dietary habits of an entire nation. A t these defects and thus protect the teeth.1 present, being complicated with emo 2. Painlessness o f operation. It is only tions and endocrines, it is still in the ex when the earliest possible application of prophylactic odontotomy has been neg perimental stage. c. O perative intervention or prophy lected that pain becomes a factor in most lactic odontotomy, which, like vaccina Class I cavities. W ith a sharp bur and tion, is a known specific, simple o f appli an engine at slow speed, prophylactic odontotomy is a quick and painless op cation, painless, quick and inexpensive. M ilton J. Rosenau, authority on pre eration. J. M . W isan2 w rites: “ The fact ventive medicine and public health, says that the operation (prophylactic odon of vaccin ation: “ Vaccination is a minor totomy) was painless, increased the child’s surgical operation. No person unfamiliar willingness to obtain dental treatment.” M cBeath, in a recent article on den with surgical cleanliness should be per tistry for children, suggests choosing the mitted to perform this ‘little’ operation.” Like vaccination, prophylactic odontot smallest defects first because “ The sim omy is a justifiable operation, and, like plicity o f the operation and minimum of any other operation, it must be properly discomfort will not permit realization of performed. O ne author speaks of his the child’s fears and he becomes more horror at cutting into a beautiful tooth. receptive for more complicated pro This is unadulterated emotional bun cedures at subsequent visits.” 3 3. Econom y of operation. M aurice combe, comparable to refusing to protect W illiam w rites: a child’s future health by vaccination be Since every enamel defect must, for rea cause of possible scarring of the beautiful skin o f the arm— a rationalization of the sons already stated, grow progressively worse operator’s negligence in failing to take all unless immediate corrective treatment is pro known measures to protect the child’s vided, it is to the greatest advantage of the patient that the treatment be instituted future dental health. T h e failures in immediately, which means in early child prophylactic odontotomy occur in the hood. Such measures (prophylactic odontot hands of the negligent operator and can omy) are simple, speedy, and therefore not be blamed on the operation. L et us inexpensive. briefly state the essentials of a preventive Whether it be in public service or pri service to determine whether experience vate practice, time is the principal factor with prophylactic odontotomy fulfils in cost, and any operation which con these requirements. serves time reduces cost. Dr. Wisan again i. Ease of application. Prophylactic furnishes us with evidence when he says: odontotomy consists practically of the Prophylactic odontotomy proved to be an preparation of a pit or fissure so that a economical procedure, since it was possible simple Class I cavity is formed, which is to perform a greater number of operations then filled. I leave it to the dental pro than if the teeth were allowed to decay fession to demonstrate a simpler opera before treatment. According to figures com tion in the whole field o f dentistry. For piled by the County Superintendent’s office, authority, I refer to “ H ealth Dentistry the cost per operation was $0 .69 , the lowest cost reported among the seventeen school for the Community,” wherein we find : dental clinics in Union County. Investigations have shown that dental ca ries is particularly apt to occur on certain surfaces of the teeth because of imperfec tions in the anatomical structure of those surfaces. These imperfections in structure lend themselves very easily to correction; simple operations, which require little time
4. Universality of application. No sci entific data have as yet been published nor criteria evolved which indicate a pre dictable immunity to dental caries in chil dren. O n the contrary, much material has been published showing the universal
logé
T
he
Journal
of th e
A
m e r ic a n
prevalence o f enamel defects and their need o f immediate correction. A study made in 1928 by carefully trained observers using specially prepared charts showed the fo llo w in g:
D
ental
A
s s o c ia t io n
the percentage of school population taken care of by the clinic o f from 25 per cent in 1930 to 66.6 per cent in 1933, with fewer clinic hours (185 hours in 1930 to 174 in 1933) and a reduction in the number o f defective teeth per p u p il: On a re-examination made nine months after the first one, it was found that out of seven defects per pupil in 1930; two de 616 pre-carious fissures, there were developed fects per pupil in 1933. 568 carious cavities. Another way of stating Similarly, it might be pointed out that, this would be that 92.2 per cent of the during the seven years in which the New fissures had become carious cavities in nine York University Child Research Clinic months’ time.1 was in existence, we did not lose one first T h e report o f the Clara W achtel D en permanent molar. Prophylactic odon tal Clinic in Jerusalem emphasizes this as totomy was carefully practiced in this follows: . . prophylactic fillings, for clinic, and we had ample opportunity to instance, valuable to the child of six or observe and record the effect o f time on seven years old, are much more so to a these cases. child three or four years of age.” 2 Every properly conducted dental serv 5. Practical prevention through pro ice program in this country emphasizes phylactic odontotomy. Is it practical and the necessity for caring for pits and fis what m ay we expect? L et us see what sures— prophylactic odontotomy. Public others have to say. health departments are dependent on E. E. Starr w rites: “ Logical thinking budgets for their funds, and proof of ac decides that prophylactic odontotomy is complished good must be shown before indicated in all deep pits and fissures in money is allotted. O ne o f the features of newly erupted first molars.” 4 the N ew Y o rk C ity program is the im Isadore T eich states: “ As soon as the mediate care o f all pits and fissures. tooth has sufficiently erupted, these pits Is there any justification for the prac and fissures should be filled in the usual tice of prophylactic odontotomy? Just w ay.” 5 as I have striven throughout this paper Report of the C lara W achtel Dental to keep m y own personal views out, so I C lin ic: “ T he essence of prevention ob now propound the question, with the one viously lies in the early detection o f de request that facts rather than subj.ective fects and their correction.” 1 observations be accepted. R em em ber: A n observer in N ew Zealand sa y s: “ In “ T he enamel defect o f today is the cari N ew Zealand, where every school child ous cavity o f tomorrow.” receives the benefits of prophylactic b ib l io g r a p h y odontotomy, the reduction in the loss of teeth has been most marked.” 1 . Health Dentistry for the Community. D r. Haenke, o f Australia, reports Committee on Community Dental Service, lowering costs o f dental care with in New York Tuberculosis and Health Associa tion. creased saving o f teeth as the result of 2 . W i s a n , J. M.: Preventive Dental Service prophylactic odontotomy. in the School Clinic. D . Cosmos, 7 5 : 12 0 7 , J. M . Wisan, in his report “ Preventive December 1 9 3 3 . Dental Service in the School Clinic,” 2 3 . M c B ea th , E. C.: Comments on Dentis says: “ A ll the permanent molars that try for Children. D. O utlook, 2 6 :2 18 , May 1939have received prophylactic odontotomy 4 . S t a r r , E. E.: Significance o f Early Den treatment are now in sound condition.” tal Caries. J.A.D.A., 2 6 : 1089 , July 19 3 9 . He also shows some interesting results 5 . T e i c h , I s a d o r e : Operative Dentistry for through a period of years as the result of Children. D . O utlook, 2 6 :207 , May 19 3 9 . this practice; for instance, an increase in 80 Hanson Place.