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Focal Infection Associated with Pulp Stone: Report of a Case
T h o m p s o n — F o c a l I n f e c t io n a n d P u l p St o n e 2 1 . T e u s c h e r , G. W., and Z a n d e r , H. A.: Prelim inary R eport on Pulpotomy. Northwest. Univ. Bull., 3 9 :4 -8 , December 1938 . 2 2 . R e s t a r s k i , J. S.: Preserving V itality o f Pulps Exposed by Caries in Young Children. Illinois D. J., 9 :2 - 7 , January 1940 . 23 . P r i n z , H e r m a n n : Diseases of Soft
Structures of T eeth and T heir T reatm ent. Ed. 2 . Philadelphia: Lea & Febiger, 1928 , p. 10 7 . 24 . A i g u i e r , J. E .: D ental M edicaments, Care, Use and Application in Every Day Practice. D. Cosmos, 70: 329 - 340 , M arch 1928 . 630 West O ne H undred Sixty-Eighth Street.
FOCAL INFECTION ASSOCIATED WITH PULP STONE: REPORT OF A CASE B y L . E. T h o m p s o n , M .D ., Salida, C olo. History.•— A wom an, aged 36, married, first seen in M a y 1936, com plained of red ness of the left eye w ith blurring of vision and some pain in the eye. T h e personal history was negative except for the fact that a large num ber of large red sore spots had appeared all over both legs in the past sev eral months and frequent attacks of severe neuritis in the shoulders had been experi enced for several years. T h e fam ily history was essentially negative. Exam ination.— Exam ination revealed a severe type of plastic iritis. Com plete physi cal and laboratory exam ination revealed nothing except a low hem oglobin (60-70), a low red count and a high white count (12,000 to 15,000); rather extensive h e a k d childhood tuberculous lesions in the lungs, several teeth containing fillings of various sizes, and large numbers of Heberden’s nodes and o f rheum atic nodules on both legs. T hree of the teeth looked grossly pathologic. Treatm ent.— D ental consultation was ob tained and the report was negative. U nder rigid eye treatment, the iritis cleared up in three or four weeks, the patient gained weight and the blood picture returned virtually to normal. T h e rheum atic nodules and the neuritic attacks persisted. Course.— T h e follow ing M ay, this history was duplicated exactly, but this time in the right eye. D uring the winter of 1937, the patient was in C alifornia for two months and returned w eighing more than ever before in her life and w ith the blood picture normal. W hile in California, she had seen a dentist who told her that her teeth were normal, and at another time a dentist had reported them normal. Jour. A .D .A ., Vol. 29, September 1, 1942
In June 1938, another attack of iritis de veloped, but this time in both eyes and so fulm inating that vision rapidly decreased to light only. A bout this time, tinnitus devel oped in the right ear. A nother dentist was seen and the dental report was still negative. T h e patient refused to have any teeth ex tracted on the chance that rem oval o f this potential source of infection m ight help. A nother eye specialist made a diagnosis of tuberculous iritis, but suggested x-ray exam ination by a man who did nothing but make dental x-ray diagnoses. I almost convinced the diagnostician that at least two teeth should be removed, but, after studying the plates carefully, he decided that the teeth were normal. In the meantime, the patient rapidly lost about 10 pounds and the blood count changed to about 60 per cent hemoglobin, w ith red cells around 3,000,000 and white cells about 15,000. She still refused to have teeth rem oved on the chance that she might be helped. T h e eye treatment was continued for some time, w ith no im provem ent. T h e tinnitus continued w ith no change except slight tem porary improvement after tubal inflation, and in July, the patient had an attack of vertigo, ataxia, nausea and vom it ing so severe that she was forced to stay in bed twenty-four hours. Operation.— T w o other eye specialists con sulted suggested that the teeth were the most likely cause o f the trouble, and one of them refe'rred the patient to a dentist who was also a physician. A fter x-ray and other examinations, he decided that at least two teeth should be removed, and to this the patient finally consented. W ithin a week,
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her eyes improved and, after lengthy treat ment, they returned practically to normal. The rheumatic nodules almost completely disappeared, as did the neuritis, except for infrequent slight attacks in the left shoulder. The tinnitus also continued, but was not so severe. Pathologic examination and culture of the extracted teeth showed a strong growth of short chain streptococcus from the inside of the teeth (pulp stones). Outcome.— The patient remained almost entirely well for two and one-half years ex cept for occasional slight neuritic attacks, an occasional red nodule on the legs, slight tinnitus and one rather severe attack of ver tigo, ataxia, nausea and vomiting in January
1939 In August 1940, she again developed an iritis in the right eye, but this time of a much milder type. The remaining teeth with pulp stones were promptly removed and cultured and showed short chain strepto coccus. Within a short time, the eye cleared up and the tinnitus completely disappeared. The few remaining Heberden’s nodes dis appeared. When seen recently, she had had no more neuritis and had gained 13 pounds. In every way, she is in better health than she has been in over six years. c o n c l u sio n s
1. While its most serious aspects were ophthalmologic, this case also had otologic factors which were serious. 2. The x-ray evidence cannot be too greatly depended on. 3. Medical men must frequently advise extraction of teeth regardless of, and often in spite of, dental advice. 4. Wholesale removal of teeth is not to be advocated as a cure-all of disease elsewhere in the body, but, after complete examination of the patient and in the absence of other causative factors, abnormal teeth should be removed. 5. Whether abnormal teeth act as foci or whether their removal merely has a reaction in the nature of a foreign protein reaction, there is definite proof that their removal does frequently result in the cure of disease elsewhere in the body, and often of the eyes, ears, nose and throat. Under the term “ ab normal,” I include those which contain pulp
stones, even though they be otherwise nor mal. 6. Six dentists examined the teeth of this patient and pronounced them normal. Since becoming interested in teeth and their pathologic possibilities as a result of this case, I have seen a case of optic neuritis which cleared up after removal of a tooth with a pulp stone; tic douloureux which was cured in the same manner, and severe sharp shooting pains in the ear and a laryngitis that were cured by the removal of diseased teeth. ^b i b l i o g r a p h y S t a f n e , E. C., and S z a b o , S . E.: D. Cos mos, 7 5 :160, February 1933. N e w m a n , M. F .: D. Cosmos, 7 5 :589 , June
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S c h u l t z , A. M .: D. Cosmos, Corresp., 7 7 : 205, February 1935. L o g a n , W. H . G .: ]. D. Res., 15:333, Sep tember 1935. L o g a n , W . H. G .: Are Pulps and Investing Tissues of Completely Embedded Teeth In fected? J.A .D .A ., 2 4 :853 , June 1937. S e y b o l d , J. W .: Pulp Stones and Devital ized and Impacted Teeth as Factor in Sys temic Disease. J.A.D .A., 26:1627, October 1939 K ro nfeld , R udolf: Histopathology of Teeth. Philadelphia: Lea & Febiger, 1933, p. 57 S e y b o l d , J. W ., and K r e t s c h m e r , O. S . : D. Cosmos, 78:292, March 1936. R e i m a n n , H . A., and H a v e n s , W. P.: Y ear Book of Dentistry. Chicago:. Year Book Pub lishing Co., 1940, pp. 65-67. R o s e n o w , E . C .: Internat. Clin., 2 : 2 9 , June 1930. Bla c k , B u tler and L a n g ; quoted by H a d e n , R . L . : Dental Infection and Systemic Disease. Ed. 2. Philadelphia: L ea & Febiger, 1936, p. 65. • M a c N e v i n , M . G., and V a u g h a n , H. S.: Mouth Infections and Their Relation to Sys temic Disease. V ol. 2. New York: Purcell Research Memorial, 1933. R o s e n o w , E. C .: Proc. D. Centenary Cele bration, 1940, pp. 261-281. K i r b y , D. B.: Ann. Dentistry, 6:65-80, June 1939 S t u a r t , C. W .: Deep Infections of Head and Neck. J.A .D .A ., 27:922-926, June 1940. Id em : Illinois D. J., 9:237-239, July 1940. B a t s o n , O . W .: }. s d Dist. D. Soc. (N .T .), 25:195-196, December 1939. Woolworth Building.
Structures of T eeth and T heir T reatm ent. Ed. 2 . Philadelphia: Lea & Febiger, 1928 , p. 10 7 . 24 . A i g u i e r , J. E .: D ental M edicaments, Care, Use and Application in Every Day Practice. D. Cosmos, 70: 329 - 340 , M arch 1928 . 630 West O ne H undred Sixty-Eighth Street.
FOCAL INFECTION ASSOCIATED WITH PULP STONE: REPORT OF A CASE B y L . E. T h o m p s o n , M .D ., Salida, C olo. History.•— A wom an, aged 36, married, first seen in M a y 1936, com plained of red ness of the left eye w ith blurring of vision and some pain in the eye. T h e personal history was negative except for the fact that a large num ber of large red sore spots had appeared all over both legs in the past sev eral months and frequent attacks of severe neuritis in the shoulders had been experi enced for several years. T h e fam ily history was essentially negative. Exam ination.— Exam ination revealed a severe type of plastic iritis. Com plete physi cal and laboratory exam ination revealed nothing except a low hem oglobin (60-70), a low red count and a high white count (12,000 to 15,000); rather extensive h e a k d childhood tuberculous lesions in the lungs, several teeth containing fillings of various sizes, and large numbers of Heberden’s nodes and o f rheum atic nodules on both legs. T hree of the teeth looked grossly pathologic. Treatm ent.— D ental consultation was ob tained and the report was negative. U nder rigid eye treatment, the iritis cleared up in three or four weeks, the patient gained weight and the blood picture returned virtually to normal. T h e rheum atic nodules and the neuritic attacks persisted. Course.— T h e follow ing M ay, this history was duplicated exactly, but this time in the right eye. D uring the winter of 1937, the patient was in C alifornia for two months and returned w eighing more than ever before in her life and w ith the blood picture normal. W hile in California, she had seen a dentist who told her that her teeth were normal, and at another time a dentist had reported them normal. Jour. A .D .A ., Vol. 29, September 1, 1942
In June 1938, another attack of iritis de veloped, but this time in both eyes and so fulm inating that vision rapidly decreased to light only. A bout this time, tinnitus devel oped in the right ear. A nother dentist was seen and the dental report was still negative. T h e patient refused to have any teeth ex tracted on the chance that rem oval o f this potential source of infection m ight help. A nother eye specialist made a diagnosis of tuberculous iritis, but suggested x-ray exam ination by a man who did nothing but make dental x-ray diagnoses. I almost convinced the diagnostician that at least two teeth should be removed, but, after studying the plates carefully, he decided that the teeth were normal. In the meantime, the patient rapidly lost about 10 pounds and the blood count changed to about 60 per cent hemoglobin, w ith red cells around 3,000,000 and white cells about 15,000. She still refused to have teeth rem oved on the chance that she might be helped. T h e eye treatment was continued for some time, w ith no im provem ent. T h e tinnitus continued w ith no change except slight tem porary improvement after tubal inflation, and in July, the patient had an attack of vertigo, ataxia, nausea and vom it ing so severe that she was forced to stay in bed twenty-four hours. Operation.— T w o other eye specialists con sulted suggested that the teeth were the most likely cause o f the trouble, and one of them refe'rred the patient to a dentist who was also a physician. A fter x-ray and other examinations, he decided that at least two teeth should be removed, and to this the patient finally consented. W ithin a week,
1644
T h e J o u r n a l o f t h e A m e r ic a n D e n t a l A s s o c ia t io n
her eyes improved and, after lengthy treat ment, they returned practically to normal. The rheumatic nodules almost completely disappeared, as did the neuritis, except for infrequent slight attacks in the left shoulder. The tinnitus also continued, but was not so severe. Pathologic examination and culture of the extracted teeth showed a strong growth of short chain streptococcus from the inside of the teeth (pulp stones). Outcome.— The patient remained almost entirely well for two and one-half years ex cept for occasional slight neuritic attacks, an occasional red nodule on the legs, slight tinnitus and one rather severe attack of ver tigo, ataxia, nausea and vomiting in January
1939 In August 1940, she again developed an iritis in the right eye, but this time of a much milder type. The remaining teeth with pulp stones were promptly removed and cultured and showed short chain strepto coccus. Within a short time, the eye cleared up and the tinnitus completely disappeared. The few remaining Heberden’s nodes dis appeared. When seen recently, she had had no more neuritis and had gained 13 pounds. In every way, she is in better health than she has been in over six years. c o n c l u sio n s
1. While its most serious aspects were ophthalmologic, this case also had otologic factors which were serious. 2. The x-ray evidence cannot be too greatly depended on. 3. Medical men must frequently advise extraction of teeth regardless of, and often in spite of, dental advice. 4. Wholesale removal of teeth is not to be advocated as a cure-all of disease elsewhere in the body, but, after complete examination of the patient and in the absence of other causative factors, abnormal teeth should be removed. 5. Whether abnormal teeth act as foci or whether their removal merely has a reaction in the nature of a foreign protein reaction, there is definite proof that their removal does frequently result in the cure of disease elsewhere in the body, and often of the eyes, ears, nose and throat. Under the term “ ab normal,” I include those which contain pulp
stones, even though they be otherwise nor mal. 6. Six dentists examined the teeth of this patient and pronounced them normal. Since becoming interested in teeth and their pathologic possibilities as a result of this case, I have seen a case of optic neuritis which cleared up after removal of a tooth with a pulp stone; tic douloureux which was cured in the same manner, and severe sharp shooting pains in the ear and a laryngitis that were cured by the removal of diseased teeth. ^b i b l i o g r a p h y S t a f n e , E. C., and S z a b o , S . E.: D. Cos mos, 7 5 :160, February 1933. N e w m a n , M. F .: D. Cosmos, 7 5 :589 , June
1933 -
S c h u l t z , A. M .: D. Cosmos, Corresp., 7 7 : 205, February 1935. L o g a n , W. H . G .: ]. D. Res., 15:333, Sep tember 1935. L o g a n , W . H. G .: Are Pulps and Investing Tissues of Completely Embedded Teeth In fected? J.A .D .A ., 2 4 :853 , June 1937. S e y b o l d , J. W .: Pulp Stones and Devital ized and Impacted Teeth as Factor in Sys temic Disease. J.A.D .A., 26:1627, October 1939 K ro nfeld , R udolf: Histopathology of Teeth. Philadelphia: Lea & Febiger, 1933, p. 57 S e y b o l d , J. W ., and K r e t s c h m e r , O. S . : D. Cosmos, 78:292, March 1936. R e i m a n n , H . A., and H a v e n s , W. P.: Y ear Book of Dentistry. Chicago:. Year Book Pub lishing Co., 1940, pp. 65-67. R o s e n o w , E . C .: Internat. Clin., 2 : 2 9 , June 1930. Bla c k , B u tler and L a n g ; quoted by H a d e n , R . L . : Dental Infection and Systemic Disease. Ed. 2. Philadelphia: L ea & Febiger, 1936, p. 65. • M a c N e v i n , M . G., and V a u g h a n , H. S.: Mouth Infections and Their Relation to Sys temic Disease. V ol. 2. New York: Purcell Research Memorial, 1933. R o s e n o w , E. C .: Proc. D. Centenary Cele bration, 1940, pp. 261-281. K i r b y , D. B.: Ann. Dentistry, 6:65-80, June 1939 S t u a r t , C. W .: Deep Infections of Head and Neck. J.A .D .A ., 27:922-926, June 1940. Id em : Illinois D. J., 9:237-239, July 1940. B a t s o n , O . W .: }. s d Dist. D. Soc. (N .T .), 25:195-196, December 1939. Woolworth Building.