Home Care of The Interproximal Spaces*

Gracey— H om e Care of Interproximal Spaces CONCLUSIONS

985

adequate diet as outlined in this paper.

T h e information accumulated thus far

I f any emphasis is to be placed, the pa­

as to the relation o f diet and preventive

tient should be instructed to consume a

dentistry points to the fact, at least, that

high mineral, high vitamin and relatively

an inadequate diet produces nutritional

high protein ration that requires vigorous

conditions that predispose to dental caries.

chewing ; o f low cereal and carbohydrate

T h e knowledge of certain phases of den­

intake, especially o f cane sugar and candy,

tal caries is still debatable and, in order

ending the meal with natural fruits and

to

have

a

sane viewpoint,

the

inter­

fruit juices rather than puddings, cakes,

relationship of environmental and nutri­

pastries and highly sweetened desserts.

tional factors rather than any one factor

It is in the eating customs and homemade

should be emphasized. U n til w e know

foods o f older times, combined with the

the role o f the many and various food

sane scientific facts of our newer knowl­

factors as entities in preventive dentist­

edge o f nutrition, that w e must seek the

ry, w e should merely insist that the pa­

foundations of health in the diet o f man

tient

living in modern civilization.

follow

the normal well-balanced

H O M E CARE OF T H E IN T E R P R O X IM A L SPACES* B y C L A Y T O N H . G R A C E Y , D .D .S ., D etroit, M ich .

O R E recent demonstrable advance

M

designed toothbrush and practical plans

in the science of oral hygiene or

for its use at home by the patient, the

the prevention and treatment of

problems o f oral hygiene, prevention and

dental disease cannot be attributable to

treatment have been greatly simplified.

the discovery or promotion o f any new

A n d now we believe that another very

or radical procedures surgical, chemical

important step is being taken toward

or mechanical. N o r can it be due to the

their solution through the more scientific

acceptance of

consideration of the home care o f the in­

any scientific dietary or

endocrine therapy. Each day has brought

terproximal spaces.

forth its contradiction of yesterday’s hope.

IM PO R TA N C E O F H O M E CARE

O bviously, then, we m ay reason that such advance must be due to a more rational

Excepting only that rare, self-sufficient

conception and application o f the simplest

m outh

yet unquestionably the most important

sporting w orld, might be called a “ nat­

which,

in the parlance of the

factor in the promotion of oral hygiene

u ral,” it is necessary for every mouth to

and the stimulation o f tissue resistance

have, first, the most careful supervision

and regeneration; namely, “ home care.”

by the dentist and, secondly, the most

Since the advent of the more correctly

meticulous home care by the patient in order that disease, such as caries, perio­

*Read before the Section on Periodontia at the Seventy-Seventh Annual Session o f the American Dental Association, New Orleans, La., Nov. 5, 1935. Jour. A .D .A ., V ol 23, June, 1936

dontoclasia and V in cent’s infection, may be prevented.

T h e importance of these

two factors in the treatment o f perio­

The Journal of the American Dental Association

986

dontoclasia

and

V in cen t’s

infection

is

the

greatest

proportion

of

caries,

the

second only to their importance in the

greatest number o f pyorrhea pockets and

field o f prevention.

practically all acute cases o f V in cen t’s

Such a premise has

long been accepted. Fallacies lie princi­

infection have their inception.

pally in the degree o f thoroughness of

proximal walls at or under the contact

such supervision and home care.

points, bitewing films and explorers are

N o t unlike tissues of the body, those o f the m outh require a health supervision

daily disclosing evidence o f

O n the

beginning

enamel décalcification and dental caries,

and care that is constantly alert to the

in both children and adults.

ever-increasing demands o f the biophysi­

not due alone to an unobstructed line of

cal and pathologic expectancies o f age.

exposure

that

the

A n d it is

roentgenogram

pre-

Fig. 1.— Variety o f instruments suggested by members o f profession for specific care of interproximal spaces.

Fig. 2.— Composition handle toothbrush bent to facilitate cleansing and stimulation o f distal surfaces and tissues of teeth abutting eden­ tulous areas.

Fig. 3.— Handle bent in opposite direction for mesial areas. sents more absorption in the interseptal

A s youth proves quite sufficient, so age

bone than in that of either the buccal or

proves quite insufficient, dictating always

the lingual areas. Pockets in these regions

an intensification o f oral hygiene. Since this paper is intended merely to

are not only more numerous, but are also more advanced, and their symptoms, in­

renew our consciousness o f the special

flammation, blood stagnation, hypertro­

need of the interproximal spaces, it would

phy

seem logical to recall that in these spaces

nounced.

arid

detachment,

are

more

pro­

Here, too, we find that V in ­

Gracey— H om e Care of Interproximal Spaces cent’s infection, both the acute and the

987

has such a predilection for the interproxi­

chronic types, evidences a definite procliv­

m al spaces and that oral hygiene is a

ity to inception.

deterrent to dental disease, it follow s

H ence, the bulk o f correct charting,

logically that procedures in oral hygiene

diagnosis and prognosis is cast on the

should center on the care of these areas.

roentgenographic and clinical picture of

T o paraphrase a timely aphorism: “ T a k e

the proximal w alls, the septal alveolar

care o f the interproximal spaces and the

crest and the tissues that form the struc­

mouth w ill

tures of the spaces.

until this thought becomes crystallized

W h a t exact influence faulty hygiene

take care o f itself.”

N ot

w ill w e find a satisfactory response to

might have on the preponderance o f caries

prophylactic procedures in the prevention

and periodontal disease in these areas is

o f caries or in the prevention and treat­

still to some extent problematic. Certain

ment of periodontoclasia and Vincent’s

direct

infection.

relationships

must

be

acknowl­

edged in view o f the follow ing clinical

L et us review part o f the physical back­

facts: 1. Caries seldom appears on those

ground that might substantiate such a

tooth surfaces that are kept rigidly clean.

statement.

Fig. 4.— M andible in position to permit brush to reach buccal and distal surfaces of inaccessible molars.

Fig. 5.— Example o f areas frequently noted which demand special equipment for their care.

2. Pockets are seldom known to develop

T h e enamel w alls of the teeth forming

on the proximal w alls or roots o f teeth

the embrasures are more inclined to the

the soft tissues of which are constantly

gross

subjected to the stimulating influence of

food debris and waste o f the mouth secre­

oral hygiene.

accumulation

of

mucin

plaques,

3. Symptoms of progress­

tions than those parts of the tooth crown

ing pocket formation are reduced and

that are constantly under the cleansing

usually disappear under such influence.

and polishing influences o f the saliva and

4. T h e interproximal tissues are practi­

the ever motile tissues o f the cheek and

cally immune to Vincent’s infection when

tongue.

their

logic hygiene o f the m outh, supplemented

resistance

is

established

by

oral

hygiene. I f w e can admit that dental disease

In spite of the average physio­

by an average artificial prophylactic care, there is found in these regions undis­

988

The Journal of the American Dental Association

turbed foreign irritants in varying quan­

it w ould seldom be necessary for outside

tities.

hygienic influences to be em ployed; but

T h e gingivae, delegated by form and

not often do w e find such a combination

location to protect the most vulnerable

functioning for the complete protection

of the periodontal tissue relationships,

o f these susceptible areas. T h e anatomic

the periodontal membrane attachment,

structure of teeth, with their lobular sur­

are divided geographically into the buc­

faces deflecting food from the crevices

cal, lingual and septal gingivae.

Since

and over the gum tissues, should have a

the protective function o f these tissues

protective as w ell as a stimulating influ­

is primarily to deflect food and prevent

ence. O n e must but think of their highly

its impaction in the cervical crevice and

specialized end-organ circulation, react­

particularly between teeth, the septal por­

ing sensitively to the presence o f foreign

tion, lying in the interproximal spaces,

irritants and inadequate stimulation, to

should naturally be considered the most

realize the importance of this protection

significant.

The

physical

environment

to the gingival tissues. T h e slightest de­

created by the proximal walls o f the

viations, so common in the horizontal,

Fig. 6.— Decided improvement noted in hy­ giene and health of interproximal spaces if protected by instruments which pass well into the areas, cleansing approximal tooth surfaces and stimulating soft tissues.

Fig. 7.— M etal handle carrying interchange­ able, semihard rubber point placed in position for home care o f interproximal spaces. perpendicular

or

lateral

relationships,

w ill promote a disturbance in the delicate teeth, which, even in normal apposition,

balance o f nature’s mechanism.

tend to form a trap for the retention of

Further evidence of the weakness of

food and debris, makes these septal tissues

these tissues and their special demands

dependent for the discharge o f their obli­

m ay be found in the localization o f the

gation not only on their ability to fill the

acute V incen t’s lesion, which almost in­

interproximal spaces but also on the tex­

variably first attacks and destroys the

ture and shape o f their structure.

crest o f the interproximal papillae, and

U n der ideal conditions, this exacting responsibility is fulfilled very satisfacto­

leaves in its wake a battered and ex­ tremely m utilated septal tissue.

rily. I f all teeth were in normal alinement

T h e dental profession has been alert

and foods were o f a proper consistency,

to this menace and for many years has

989

Gracey— H om e Care of Interproximal Spaces accepted, though somewhat casually, the

the w alls o f teeth and their surrounding

premise that these spaces are most in need

tissues brought to light the interesting

of oral hygiene. Irrefutable evidence lies

fact that the toothbrush and the dental

in the history o f the toothbrush and tooth

floss were often falling far short o f meet­

brushing.

ing their responsibility.

U sed

primarily

to beautify

Even after very

teeth, the toothbrush later became an in­

thorough brushing and the use of dental

strument for the promotion o f dental

floss, considerable debris could usually be

health and, with such recognition, came

demonstrated, w ith every evidence o f in­

modifications in its size, design and bristle

sufficient tissue stimulation.

placement.

o f this conclusion and the more recent

Such

improvements

were

In the light

based chiefly upon an effort to make the

knowledge of dental health demands, it

bristles more accessible to the interproxi­

was realized that such equipment was not

m al spaces.

always sufficient to meet the many prob­

T h e n , as symptoms of re­

newed health appeared, further consider­ ation was given to a more efficient tech­ nic

or

plan

with

which

lems o f oral hygiene. Because o f such concrete evidence of

toothbrushes

the partial ineffectiveness o f the tooth-

Fig. 8.— M ore recent design o f interdental stimulator.

Fig. 9.— Cotton-wrapped toothpick in holder for interproximal cleansing and stimulation.

should be used. A s in its design, so in its

brush,

use, the m otivating thought in the im­

equipment have been brought forward by

provement o f the brush was the proper

the profession.

care o f the interproximal space.

dentists are regularly prescribing, both as

T h e use o f dental floss and tapes was

several

types o f (F ig . 1 .)

supplementary T o d a y , many

a preventive measure and a treatment aid,

introduced to further improve these areas.

the use o f some special instrument or

T h o ro u gh and systematic rinsing began

brush designed to more thoroughly clean

to play its part in cleansing and stimu­

the tooth w alls o f the embrasures and

lating the tissues.

more vigorously stimulate the interlying

A s dentistry came to a realization that

tissues. T h ose patients who cooperate to

dental disease was constantly present in

the extent of spending the time and effort

the interproximal spaces, in spite of these

required for such special interproximal

health aids, a more intimate inspection of

stimulation

are

always

compensated

The Journal of the American Dental Association

990

through an improvement in the health of

resorption. H e further contends that the

the m outh and through m any tangible

bone underlying a periodontal pocket is

symptoms of heightened resistance.

not influenced by décalcification, nor is

In presenting a case for such specialized

there, at any time, in a true periodontal

equipment, further evidence o f specific

pocket, necrosis o f bone. H e states : “ T h e

demands

process o f bone resorption m ay be re­

of

the

interproximal

spaces

for cleanliness and stimulation might be

placed at any time by new bone form a­

considered.

tion provided the etiologic factor for re­ sorption, namely the progressive inflam­

HORNIFICATION1

mation of the overlying tissues, has ceased

It is known that that part o f the m u­

to act.” 2 Such a finding bespeaks, first,

cous membrane surrounding the teeth and

an increased mechanical stimulation of

form ing the gums and interdental papil­

the overlying tissues.

lae has, under norm al circumstances, a hornified or keratinized surface.

T h is

hornification o f the gingival mucosa is an

Fig. 10.— Pointed orangewood carried in tubing, bent for accessibility to various parts o f mouth. essential

factor

in the maintenance of

healthy gingivae.

T h is may be accom­

ESTHETICS In a consideration o f the esthetic qual-

Fig. 11.— W edge-shaped point, holder made o f toothbrush handle.

held

in

ity of teeth, probably nothing is so essen­ tial as the status o f the tooth walls b or­

plished simply by combining normal den­

dering the interproximal spaces.

tal care with scrupulous cleanliness and

stains and accretions on these surfaces

rigid stimulation.

D ark

destroy the so-called sparkle and beauty o f clean, full-rounded teeth.

POTENTIAL REGENERATION GAGGING D r . K ron feld has shown, by photo­ micrographs of several pockets on the sep­

It has been the unpleasant experience

tal bone, that the alveolar process in­

of many patients to find that the brush,

volved was in a state o f pure osteoclastic

when used in certain areas o f the mouth,

1. Orban, Balint: Hornification o f the Gums,2. J.A .D .A ., 17:1977 (N ov.) 1930.

Kronfeld, R u d olf: J. Periodontology, 6:22 (Jan.) 1935.

991

Gracey— H om e Care of Interproximal Spaces particularly in the posterior palatine or

the handle (F ig . 3 ) .

low er lingual regions, w ill precipitate a

it possible to reach practically all tooth

most uncomfortable feeling of “ gagging.”

walls and tissues abutting on edentulous

T h is nervous condition, which is hard to

spaces with

control, usually concludes with the pa­

brushes with composition handles m ay be

Such brushes make

accuracy

and

ease.

O n ly

tient favoring these areas, and results in

so conformed by submerging the handle

lack o f complete care. Even the size and

in hot water until it is quite pliable and

shape of the small, more scientifically de­

then bending it forcibly with flat-nosed

signed

toothbrushes

this reaction.

w ill

The

not

alleviate

advantage o f some

compact little device over the toothbrush

laboratory pliers held very close to the bristle

tufts,

the

while

grasping

the

handle firmly in the hand.

m ay be visualized if such a device is used

T h e more recently invented interproxi­

for the prophylactic treatment of the in­

mal prophylactic instruments are found

terproximal spaces in these regions and

capable o f doing this same work w ell.

also the entire gingiva and neighboring

T h e curved handle o f many designs gives

surfaces o f the teeth.

ready access to the proximal surfaces, and,

PROXIMAL SURFACES OF EDENTULOUS SPACES

at the same time, sufficient force may be applied to their movement over teeth and tissues for thorough cleaning. T h e y are

Rarely do we find that the proximal

also adapted for reaching under the in­

surfaces of teeth abutting on edentulous

clined surfaces of teeth which have tipped

areas are kept clean or their tissues prop­

either mesially or distally into edentulous

erly stimulated. T h e reason is quite ap­

spaces, a wedge-shaped and ofttimes very

parent. In the application of the average

deep crevice entirely unapproachable by

toothbrush

technic,

not

specifically

the toothbrush being thus formed.

planned

care

these

areas,

to

for

the

bristles of the brush are literally forced

BUCCOPOSTERIOR MAXILLARY AREAS

away from these surfaces by the buccal

Probably the most neglected interprox­

or lingual convexity of the tooth. W i t h

imal spaces are those o f the maxillary sec­

no compression from an immediate ap­

ond and third molars. W i t h some prac­

proximating tooth, there is little if any

tice and very little effort, these seemingly

contact made with the proximal tooth

inaccessible

w all or the gingival tissue.

Even the

may be reached by the toothbrush and

thorough flossing o f these areas is neg­

other equipment as readily as those in the

lected, patients invariably assuming, un­

anterior part o f the m outh, and with only

tissues

and

tooth

surfaces

less otherwise advised, that these sur­

an equal limitation.

faces, apparently so accessible, are being

mandible into

adequately cleaned and massaged through

swinging it outward on the side which is

routine procedures.

a

B y dropping the

relaxed

position

and

Special brushes that

to be brushed, it w ill be found that a very

can be made in the office are often ade­

comfortable avenue of approach has been

quate to meet this need.

For distal sur­

formed. T h rou gh this, the brush may be

faces, such a brush may be made by bend­

carried to the buccal and even the distal

ing

surfaces o f the most remote third molar,

the bristle-holding

portion

o f the

brush forward toward the handle and to

by placing the handle cheekward until

a point approximately at right angles to

it takes a position nearly at right angles

it (F ig . 2 ) .

For the mesial surfaces, the

to the profile (F ig . 4 ) . T h e lateral m ove­

brush holding portion is bent back on

ment o f the ascending ramus o f the m an­

992

The Journal of the American Dental Association

dible and the relaxation o f the buccal

rather than specifically, I can only state,

cheek tissues combine to make this op­

empirically, that m y personal experience

portunity. Some experimentation w ill be

and that o f many dentists, with w hom I

necessary to orient the mandible in both

have discussed this problem, leads m e to

its downw ard and its outward movement

believe that the more intensive hygiene o f

before the maximum space is obtained.

the

W ith o u t such help, it is difficult to ac­

m edium o f specialized prophylactic de­

complish prophylactic treatment with any

vices, is, in many cases, proving to be a

type o f equipment in these regions.

very necessary factor both in the preven­

patients

master

spaces,

through

the

tion o f caries and in the prevention and

PATIENT VARIABLES M ost

interproximal

treatment o f periodontal disease. I have

a

carefully

yet to find a single instance in which a

taught tooth brushing routine and are

patient, when properly instructed, has not

able, provided their interest and enthu­

been able to improve the health conditions

siasm is sustained, to obtain favorable re­

o f the mouth over those that were pres­

sults.

ent when controlled by the toothbrush

T h ere is a type o f patient, which

might include both men and w om en, w ho,

and dental floss alone. T h o se regions o f

in spite of the most concerted applica­

the m outh that had been particularly in­

tion, both mental and physical, seem to

accessible and were seldom satisfactorily

be unable to acquire what often seems a

responsive to even the most intensive use

formidable

hygiene.

of the toothbrush (F ig . 5 ) have shown

T h o u g h it might appear to be follow ing

almost immediate improvement— an im ­

technic

of

oral

the path o f least resistance, the addition

provement almost as startling as that fo l­

of one of the more practical types o f inter-

low ing a

proximal prophylactic instruments w ill,

ment in the dental office.

to a large extent, overcome such indivi­

thorough

Inflammation,

prophylactic

chronic

in

treat­

many

in­

stances, has been noted to recede and

dual shortcomings. SPECIAL INTERPROXIMAL PROPHYLACTIC EQUIPMENT

color improvement to appear at once. Hypertrophied gum tissue assumes a more normal condition and resorption o f pocket

Such special equipment for the care of

forming

tissue

is expedited

(F ig .

6 ).

the interproximal spaces is not accepted

T o o th surfaces that had been constantly

universally

covered

by

the

dental

profession.

with

stains,

heavy

mucous

M a n y claim it to be unnecessary and feel

plaques and mouth débris are immeasure-

that use of a toothbrush o f correct design,

ably cleaner under their influence.

manipulated with a practical technic, plus

It was quite recently that the first in­

the use of dental floss, is sufficient to pro­

strument thus designed for the specific

tect the mouth.

care o f the interproximal spaces was sug­

O thers state that m e­

chanical stimulation, overemphasized by

gested

such instruments, is potentially more in­

years, some periodontists and others in­

to

the

dental

profession.

For

jurious than beneficial to those sensitive

terested in the care o f the periodontal tis­

tissues.

Still others assert that it is an

sues, have, for want o f something more

imposition to ask a patient to add to an

practical, been recommending to their pa­

armamentarium the efficient use o f which

tients the use o f ordinary round tooth­

already taxes their patience and enthu­

picks. Results from such additional stim­

siasm.

ulation and cleansing had been so un­

In

refuting these claims in general

satisfactory that the need for a more prac­

993

Gracey— H om e Care of Interproximal Spaces tical device and one which could be rec­

compressing soft tissues for stimulation,

ommended with greater safety has long

such an instrument, it seems, w ould be

been felt.

less cleansing than w ould softer mate­ rials and could not be recommended for

TYPES OF EQUIPMENT

the latter purpose.

Brush bristles, and nonirritating m a­

A brush carrying one tu ft of bristles

terials such as rubber, soft tropical wood

on either end of a long slender handle

and cotton, and even metals are used in

was planned several years ago by D r .

the various instruments that have been

Chichester.

designed.

the right direction, though less practical

T h e points are usually round

or triangular. I

have

T h is was an initial step in

than certain brushes later suggested.

found

instrument

Brushes o f various sizes and shapes

a short, serrated handle,

with handles designed to make them more

carrying a small interchangeable triangu­

practical for unusual problems can be

composed of

that

an

lar semihard rubber point, quite com ­

purchased or often, as heretofore sug­

pletely fills the need (F ig . 7 ) .

gested,

T h is re­

quires little instruction in its use, is quite

be made to fit

the

individual

needs.

harmless and provides a medium both for

O rangew ood sticks can be pointed in

cleansing the interproximal walls o f the

a pencil sharpener and boiled and bent to

teeth and for stimulating the soft tissues

any desired angle or may be cut off at

o f the interproximal space.

It is readily

desired lengths and placed in the end of

cleansed, very durable and compact in

a small piece of metal tubing, which may,

size and shape.

in turn, be bent to any angle (F ig . 1 0 ).

Changes in this design

Sm all porte polishers can be carved

have already been affected (F ig . 8 ) . Considerable interest is evidenced to­

from toothbrush handles with little prac­

day in a soft nonfibrous tropical wood

tice and, with orangewood points, wedge-

point, in general shaped and used very

shaped or round, can be placed in the

much like a toothpick.

hands of the patient with instructions

T h is is treated

with a germicide and shaped to permit it to pass between the teeth and compress the

soft

tissues,

a

very

satisfactory,

though somewhat unexplainable, feeling

for their use ( Fig. 1 1 ) . T h e use of lock pliers and cotton pel­ lets has its place in certain conditions. T h ese

suggestions

from

within

and

o f well-being in the tissues remaining

without the profession are presented with

after its use.

the hope that some w ill be found helpful.

Still another type is based upon the the­

A t least a great w ant is being partly

ory that the use of cotton wrapped about

satisfied with the opportunity to place in

the end o f a fore-shortened round tooth­

the hands o f our patients better working

pick,

tools,

carried

in

a

specially

designed

handle, w ill promote interproximal hy­

to

combat the

forces militating

against oral health.

giene with less danger and greater effi­

T h o u g h recognizing the responsibility

ciency than use of the toothpick alone

as one to be divided between patient and

(F ig . 9 ) .

dentist, w e must first accept our obliga­

D r . Charters recommends the use of

tion to promote oral hygiene. Every op­

N o . 14 or 18 gage wire, o f silver, compo­

portunity to suggest better methods, to

sition, copper or gold, which is bent for

modernize the application o f mechanical

accessibility with the end pointed and

therapy and to maintain the patient’s in­

highly

terest and enthusiasm must be improved.

polished.

A lthough

capable

of

994

The Journal of the American Dental Association

W i t h a full appreciation o f such influ-

ences, dentistry cannot let up in its search for more pertinent oral hygiene measures.

“ T h e shadow must not be accepted for

the substance.” 966 Fisher Building.

SAFEGUARDING THE FOUNDATION* B y C . N . J O H N S O N , D .D .S ., L .D .S ., C h ica go, 111.

S

O much has already been said about

servative and thoughtful men argue in

the growing importance of attention

clarion tones against the extraction of

to the supporting structures o f the

teeth merely because there was approach­

teeth that it would seem almost super­

ing dissolution of the tissues around them

fluous to again call attention to the sub­

and the reason for this protest is that

ject at this time. But w hat are w e to do

these men know only too w ell that there

Despite all o f the admonition

is no justification for the loss of many of

that has been given by some of our fore­

these teeth. T h e y have in their practices

about it?

most practitioners, the neglect that is ap­

preserved altogether too many o f them to

parent on every hand stands against us

sit idly by and longer sanction the policy

as a profession and challenges our repu­

of laissez faire.

tation as a body of men and wom en hav­

L et us discuss the attitude o f many of

ing at heart the best interests of the

our profession the moment the least im­

people that we are supposed to serve.

pairment takes place in the gingival tis­

O n e of the most pernicious doctrines

sues. For some reason, there seems to be

that have ever been advanced has become

a

currently prevalent to the effect that dis­

the onset o f gingival irritation, and the

eases of the supporting structures of the

anomaly is presented that, in the first in­

teeth are not amenable to treatment.

It

stance, when the affection begins, little

has become almost a shibboleth to an­

attention is paid to it, as if it were o f no

nounce that “ pyorrhea cannot be cured.”

consequence whatever, and the moment

T h is nonchalant disposition o f the ques­

the disease is recognized at all, the pro­

tion has been permitted to pass muster

fession immediately throws up its hands

as

established

doctrine

altogether

too

most

unaccountable

indifference

to

in despair and assumes that it cannot be

long, and it has resulted in the needless

cured at all.

loss o f numberless useful and serviceable

an attitude as this is one o f the most in­

teeth.

comprehensible

W h y so many practitioners have

virtually thrown up their hands in the

T h e lack o f logic in such manifestations

of

our

professional experience, yet it is some­

face o f this disease and let the case go

thing that confronts us every day o f our

by default is beyond comprehension.

lives.

W e have heard some o f our most con­

I f we wished to be hypercritical, or if we were disposed to be improperly lack­

*Read before the Section on Periodontia at the Seventy-Seventh Annual Session o f the American Dental Association, New Orleans, La., Nov. 5, 1935. Jour. A .D .A ., Vol 23, June, 1936

ing in

dignified

expression,

we

might

with justification exclaim : “ W h a t is the matter

with

the

profession?”

Surely