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Salivary Calculi
SALIVARY CALCULI B y W . I. J o n e s , D .D .S ., C olum bus, O h io
H E art o f distinguishing one dis ease from another and the ability to determ ine the nature and cause o f pain are absolutely essential to the successful treatm ent o f a n y departure from a state o f h ealth w hether it be in the realm o f dental surgery or in that o f general m edicine. T h e fo llo w in g case illustrates the necessity fo r a carefu l evaluation of all the evidence presented.
T
Fig. i.— Dense rounded mass at lower border o f mandible, on right side. It was difficult to say whether the mass was inside or outside the mandible.
H istory — A woman, aged 69, rather frail and asthenic, presented a multiple vitamin deficiency, mild hypertensive cardiac vas cular disease, slight impairment of the hear ing and some signs of senility. She had been hospitalized for rest and observation and she complained of many bodily aches and pains of moderate degree following a supposed influenza and the extraction of the teeth about ten weeks previously. T he particular pain that occasioned my entrance into the case affected the oral cavity and the region of the right lower jaw. M outh Exam ination .— The lips were red Jour. A .D .A ., Vol. 28, September 1941
and the tongue was very red, with papillary atrophy, and somewhat sore. There was no swelling or pus. Pain was elicited upon pres sure on the alveolar ridge and the floor of the mouth, with a rather free intermittent flow of saliva that was aggravated by eating or even by the odor of food. This symptom, which is often indicative of either a partial or complete obstruction of the salivary ducts, in this case arose in Wharton’s duct. Roentgenographic Examination.----Small
Fig. 2.— Definite location of mass inside mandible and about three-fourths inch linqually from bone. In this case, the calculus was in the submaxillary gland, near the open ing to W harton’s duct.
dental films disclosed no root abscesses or tooth fragments. A lateral roentgenogram of the jaws (Fig. 1) showed a shadow of a dense mass near the lower border of the mandible about 1J inches anteriorly from the angle, on the right side. An occlusal plane roentgenogram (Fig. 2) definitely located the mass on the lingual surface of the mandible. Operation .— T he mass was removed intra-orally, under local anesthesia, through an incision i-J inches long in the floor of the mouth. Then, with curved artery forceps
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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
and by blunt dissection, the opening was enlarged in the direction of the mass suffi ciently to adm it the introduction of the left index finger under the calculus. T h en with the finger as a traction hook and stabilizer, and with continued blunt dissection, to re move the surrounding tissue, the mass was gradually “ teased” toward the opening in the floor of the mouth where, with a sharp knife, it was dissected from its bed in its entirety. It proved to be a salivary calculus, roughly roundish, spiculated and three-fourths inch in diameter. Pain was abolished, and the wound quickly healed.
CON CLUSION
1. A patient should not be accused of emotional instability until all the possible physical causes o f distress are eliminated. There are probably not so many neurotics as there are poor diag nosticians. 2. X -ray pictures must be taken from more than one angle. 3. A sharp knife should not be used unless the operator can see what he is cutting. 327 East State Street.
A NEW TECHNIC FOR TAKING IMPRESSIONS FOR STABLE LOWER DENTURES B y L e e W . A t k i n s o n , D .D . S ., Salem, Ohio
A N Y discussion of the technic here presented must begin with an acknowledgment o f m y debt to Sidney G. Fournet, of N ew Orleans. His brilliant analysis of the principles of stability and his practical demonstration that they could be incorporated into lower dentures have furnished an in dispensable foundation for the present technic. Further, he must be recognized as one who has ended dentistry’s long quest for a method whereby any lower jaw m ay be fitted with a truly stable denture, a denture that will function as part of the jaw. Although there is no mouth which an experienced and competent operator cannot fit by using Dr. Fournet’s technic, certain features of the technic have nevertheless prevented stable lower den tures from coming into general use. First, the difficulty and com plexity of Read before the American Academ y of Restorative Dentistry, Cleveland, Ohio, Sep tember 8, 1940. Jour. A .D .A ., V o l. 28, Septem ber 1941
the technic have discouraged m any den tists entirely. Second, the amount of time which the execution of the technic consumes has compelled those who have mastered it to set a fee entirely beyond the capacity of the average purse. Still, the result obtaind by the FournetTuller technic has made every man who has used it ashamed to give his patients anything less, and there are few such dentists who have not striven and hoped for some shorter and simpler w ay to the same result. M y first effort toward a shorter and simpler lower denture technic was finally successful, although not until much later. T o take a final upper impression, I had long used a “ trubase” tray prepared from a preliminary compound impression. T o eliminate from this tray the distortions carried over from the preliminary im pression, the tray is taken as it comes from the laboratory and fitted directly to the maxillae. This is done by first heating a section of the flange to soften
H E art o f distinguishing one dis ease from another and the ability to determ ine the nature and cause o f pain are absolutely essential to the successful treatm ent o f a n y departure from a state o f h ealth w hether it be in the realm o f dental surgery or in that o f general m edicine. T h e fo llo w in g case illustrates the necessity fo r a carefu l evaluation of all the evidence presented.
T
Fig. i.— Dense rounded mass at lower border o f mandible, on right side. It was difficult to say whether the mass was inside or outside the mandible.
H istory — A woman, aged 69, rather frail and asthenic, presented a multiple vitamin deficiency, mild hypertensive cardiac vas cular disease, slight impairment of the hear ing and some signs of senility. She had been hospitalized for rest and observation and she complained of many bodily aches and pains of moderate degree following a supposed influenza and the extraction of the teeth about ten weeks previously. T he particular pain that occasioned my entrance into the case affected the oral cavity and the region of the right lower jaw. M outh Exam ination .— The lips were red Jour. A .D .A ., Vol. 28, September 1941
and the tongue was very red, with papillary atrophy, and somewhat sore. There was no swelling or pus. Pain was elicited upon pres sure on the alveolar ridge and the floor of the mouth, with a rather free intermittent flow of saliva that was aggravated by eating or even by the odor of food. This symptom, which is often indicative of either a partial or complete obstruction of the salivary ducts, in this case arose in Wharton’s duct. Roentgenographic Examination.----Small
Fig. 2.— Definite location of mass inside mandible and about three-fourths inch linqually from bone. In this case, the calculus was in the submaxillary gland, near the open ing to W harton’s duct.
dental films disclosed no root abscesses or tooth fragments. A lateral roentgenogram of the jaws (Fig. 1) showed a shadow of a dense mass near the lower border of the mandible about 1J inches anteriorly from the angle, on the right side. An occlusal plane roentgenogram (Fig. 2) definitely located the mass on the lingual surface of the mandible. Operation .— T he mass was removed intra-orally, under local anesthesia, through an incision i-J inches long in the floor of the mouth. Then, with curved artery forceps
1477
1478
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
and by blunt dissection, the opening was enlarged in the direction of the mass suffi ciently to adm it the introduction of the left index finger under the calculus. T h en with the finger as a traction hook and stabilizer, and with continued blunt dissection, to re move the surrounding tissue, the mass was gradually “ teased” toward the opening in the floor of the mouth where, with a sharp knife, it was dissected from its bed in its entirety. It proved to be a salivary calculus, roughly roundish, spiculated and three-fourths inch in diameter. Pain was abolished, and the wound quickly healed.
CON CLUSION
1. A patient should not be accused of emotional instability until all the possible physical causes o f distress are eliminated. There are probably not so many neurotics as there are poor diag nosticians. 2. X -ray pictures must be taken from more than one angle. 3. A sharp knife should not be used unless the operator can see what he is cutting. 327 East State Street.
A NEW TECHNIC FOR TAKING IMPRESSIONS FOR STABLE LOWER DENTURES B y L e e W . A t k i n s o n , D .D . S ., Salem, Ohio
A N Y discussion of the technic here presented must begin with an acknowledgment o f m y debt to Sidney G. Fournet, of N ew Orleans. His brilliant analysis of the principles of stability and his practical demonstration that they could be incorporated into lower dentures have furnished an in dispensable foundation for the present technic. Further, he must be recognized as one who has ended dentistry’s long quest for a method whereby any lower jaw m ay be fitted with a truly stable denture, a denture that will function as part of the jaw. Although there is no mouth which an experienced and competent operator cannot fit by using Dr. Fournet’s technic, certain features of the technic have nevertheless prevented stable lower den tures from coming into general use. First, the difficulty and com plexity of Read before the American Academ y of Restorative Dentistry, Cleveland, Ohio, Sep tember 8, 1940. Jour. A .D .A ., V o l. 28, Septem ber 1941
the technic have discouraged m any den tists entirely. Second, the amount of time which the execution of the technic consumes has compelled those who have mastered it to set a fee entirely beyond the capacity of the average purse. Still, the result obtaind by the FournetTuller technic has made every man who has used it ashamed to give his patients anything less, and there are few such dentists who have not striven and hoped for some shorter and simpler w ay to the same result. M y first effort toward a shorter and simpler lower denture technic was finally successful, although not until much later. T o take a final upper impression, I had long used a “ trubase” tray prepared from a preliminary compound impression. T o eliminate from this tray the distortions carried over from the preliminary im pression, the tray is taken as it comes from the laboratory and fitted directly to the maxillae. This is done by first heating a section of the flange to soften