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published a paper on "Earache in Children," which I considered then, as I do now, a very instructive production, and in excellent taste. I fully agree with him in all his remarks on the subject of dental irritation standing in a causative relation to pain in the ears. One paragraph, however, is faulty in its conclusions, which is that "periostitis and alveolar abscess" may be the cause of pain in the ears. I deny this, and my reasons therefor will appear as I proceed. One week later Dr. Sexton had a communication in the Medical Record entitled, "Does the Eetention of Dead Teeth in the Jaws Exert an Unfavorable Influence on the Health?" and answered it himself by stating that he did believe such teeth to be detrimental to health, even though they were filled, because " the presence of fillings in these cases is an effectual barrier to the natural escape of deleterious products, unless indeed alveolar abscesses form." Dr. Sexton's instruction or reading on dental subjects at that time must have been of the most elementary character. While he does not in the above letter advise the wholesale and indiscriminate extraction of pulpless teeth, he says: "I am quite sure that I have seen many recoveries in my aural practice quickly follow the removal of a defective tooth,"—not a pulpless tooth. He regards a pulpless tooth as in a certain sense a foreign body, and its "entire separation from the jaw is usually only a question of time." A few weeks later Sir Oracle himself speaks over the well known signature, X. His letter is entitled "The Influence of Dead Teeth upon the Health." He says: "The care of such teeth has formed a very large part of my practice for twenty-five years, and I feel competent to speak as to the feasibility of their being rendered in every instance, except where exostosis or malformation is present, quite as durable and innocuous as if their vitality had never become impaired." He laments that so few oral surgeons pay attention to this branch of practice (the treatment and filling of roots), and further laments (it really grieves him to say so) that there is not more "than one oral surgeon in a thousand does it (the filling of a root) with uniform success, and probably not two in a thousand at all." I hope this truly excellent and skillful oral surgeon still dwells in Gotham, as it would be a great pity that the metropolitan city of the New World should be deprived of the services of the " one oral surgeon" among the thousand resident here in Brooklyn, and part of "Jersey," who alone can fill "with uniform success the root of a tooth which is not exostosed or malformed." Sir Oracle, overcome almost by the thought that he of all dental surgeons in your vicinity wrestles successfully with root canals (in the filling of them), which "must invariably be done with metal," catches his breath long enough to say: "The proprietors or managers of dental depots
could doubtless, if they considered it best to do so, give the names of those who are qualified to fill a root." Such twaddle as the above is sincerely swallowed by our guileless medical friends, who preach texts to us about things of which they know little, which in turn are swallowed by our own innocent ducklings.
A little later, July 14, 1883, Dr. Frank Abbott, of New York, furnished a letter to the same journal, in which he agreed substantially with Dr. Sexton. It is not my purpose to review that letter entire. The author says: "In ninety-nine cases out of every hundred I should say they (pulpless teeth) do exert an unfavorable influence on health." If the doctor means by this statement teeth which have had their roots filled, then I dissent from his sweeping conclusions. I cannot agree with him when he states that septic matter from the decomposition of the organic portion of the enamel and dentine is absorbed by the living cementum after the filling of a carious cavity in a pulpless tooth, the root of which has been rendered aseptic and properly filled. Decomposition of the organic matrix does not take place under such conditions; it may occur when the filling is defective or the dentine is unprotected by it. I dissent from his statement that the pulp cannot be removed entire in more than one-half the cases where it is attempted, and believe that I will be supported in this disagreement by the majority of observant surgeons practicing dentistry. There are eight incisors, four cuspids, and four lower bicuspids which are provided with nearly straight roots. I conceive it possible for the skillful dentist to remove the pulp from the roots of all the teeth above enumerated. It is almost as practicable to perform the same operation in the upper bicuspids. Thus you may see that at least twenty of the thirty-twTo teeth are so situated, as to ease of access to the roots and physical conformation of the same, that their pulps can be removed. Of the twelve remaining molars, I think it possible in more than fifty per cent, to remove the whole of the pulp. I further believe that if its removal is attempted at the proper period after its death, —eight days thereafter—there are few teeth (less than five per cent.) from which it may not be wholly removed. The paragraph which states that "it is true that the tooth or teeth may not be painful, but some remote part, such as the eye or the ear, may be affected, or a neuralgia extending over the side of the face or head may be the result," is misleading to the accurate searcher for cause, and is not in accord with my observations. It is assumed that the proposition is true, that pain may be reflected to the eye, or the ear, or other portions of the body, when a tooth pulp is vital, and it is exposed or nearly so, from contact with external agencies,—cold, heat, pressure, its injury by a blow; the deposit of nodules of dentine in
its substance; abrasion of the tooth, or other injury—mechanical, chemical, or pathological; but to assert that pain is reflected from a perfectly filled root to remote parts, the tooth not being painful to purcussion, is to establish a new law in reflex action, which it is needless to remark is not founded on logic. We may and do have pain from the retention of noxious products in the pulp canal, or from their escape through the apical foramen, but it is mediate or diffused to the region of the tooth's habitation, until a sac is formed of such size that by impingement of a nerve we get a reflex pain. He would be a dullard indeed who could not diagnose the cause under such circumstances. A period of more than a year elapsed before the editor was provided with a text whereon he might playfully toy with the subject of dead teeth in the jaws. The publication of "Pain in the Bars due to Irritation in the Jaws," reported by W. A. Bartlett, M. D., from a series of cases in the aural service of Samuel Sexton, M. D., was the occasion of his plunging into the hitherto placid stream of neglect of his favorite diversion. The report of cases alluded to above undoubtedly disclosed this fact, that the majority of the teeth termed "dead" were simply carious, with living pulps; hence capable of producing reflex pain, but erroneously described as pulpless. Herein lies the offense. The surgeon in charge, "commenting on this subject, drew attention to the frequent attendance of females suffering from aural trouble through sympathy of the nerves, and the comparative in frequency of the complaint among men; even in children he thought the greater number of otalgias occurred among females. In reference to the treatment of these cases, it was believed that, since dentistry had become such a popular (!) business, and dead and diseased teeth had been so carefully retained in the jaws, through their influence, especially among the better-to-do, nervous diseases about the head were becoming alarmingly common. The very general custom of wearing false teeth in the mouth attached to vulcanite (?), rubber, celluloid, and other plates was an evil of vast proportions. Indeed, he sometimes thought that the evil done through ill-advised dentistry was greater than the possible good arising from the work of the more capable dentists." I wonder who encourages " the very general custom of wearing false teeth "? Is it the surgeon who advises extraction, or the one who carefully retains "dead," not diseased, teeth? I only use the above quotation, because it nullifies itself. The picture is presented of a special teacher of practitioners of medicine first lamenting that so many dead and diseased teeth were too carefully retained in the jaws, to the detriment of the health of the patient, and afterwards asserting that the wearing of artificial substitutes was an "evil of vast proportions." The dentist who could follow the advice of this very logical teacher would soon have a clientele whose grinning ivories would never be seen by the public.
I am a believer in the acquisition of knowledge, but it does not always follow that the instructor instructs; hence I beg your indulgence a little longer to pay my compliments to the editor.
In the same number (October 4, 1884, page 379) may be found an editorial entitled "Dead Teeth in the Jaws." The editor says: "The clinical notes on aural disease in another part of the Becord furnish additional evidence of the perils of tooth-saving." The speaker would say rather the perils of tooth-losing, as more teeth were ordered to be extracted than filled. I partially agree with the editor when he says: "A great deal of the nervousness with which some people are affected at the present day is attributable to the ill-advised retention of dead teeth, and the unskillful stopping of teeth when the pulp is sensitive, though not irreparably impaired . by caries." But the undeserved fling at the intelligence, ability, and scholarship of the "individuals (dentists) whose limited knowledge of medicine does not prevent them from 'treating' dead teeth long after their presence in the jaws has given rise to alveolar abscesses, and neuralgias more or less painful," is, like the boomerang of its projector, more likely to prove dangerous to him who aims than the one aimed at. The editor has a vision— he becomes almost prophetic. He says: "It would not be strange if, in the course of events, the day would soon come when just the contrary practice would prevail; when all teeth without pulps, and hence in process of more or less rapid decay, as well as those which, from the deposit of tartar or other cause, had become entirely divested of periosteal nourishment, would be promptly condemned as unfit to remain in the jaws—regarded, in fact, as foreign bodies liable to give rise not only to cerebral irritation and disease in the organs of special sense, through the propagation of local disturbances in the mouth to the regions mentioned, but to endanger likewise the general health, through purulent matter discharged into the mouth from alveolar abscesses, to be continuously swallowed for a long time, or, indeed, in some instances, to be absorbed, and thus produce septicemic poisoning." The fortunate manufacturer of artificial teeth would necessarily be the gainer in such an improbable event. The people are to be congratulated that the practice of dentistry is still to be conducted by one whose " medical training usually * * * is entirely too superficial to qualify him to treat disease, whether arising from the state of the teeth or not; in point of fact, his training does not always prevent harm being done to persons who are willing to have placed in the mouth some one or more of the numerous harmful dental appliances of the day." The happy thought that all medical and surgical knowledge is centered in the truly medical man —the possession even of the minimum amount being denied us in the specially mechanical departments—must cause our only too human hearts to be torn with conflicting sentiments of admiration for the editor's profundity, and sorrow for the humble position to which dental surgery may aspire.
The appearance of the editorial just alluded to brought forth letters from Brs. J. Morgan Howe and C. E. Nelson, New York, and J. S. Marshall, Chicago. They were singularly lucid, and amply touched the several points involved in the retention of dead teeth in the jaws. While they dissented from the conclusion that pulpless teeth should be very generally extracted, they all agreed that medical men should themselves be better informed in dental anatomy, pathology, therapeutics, and surgery than they now were in these several branches. All of the letters here spoken of were couched in the kindest and most complimentary language, and the writers were polite enough to thank both editor and contributor for calling attention to the subject of pulpless teeth. A week later the present writer protested against the strictures of the editor on the intelligence, learning, and ability of dental surgeons, and at the same time analyzed the "cases" as reported by Dr. Eartlett, wherein it was shown that few if any pulpless teeth were responsible for the pain in the ears. A little later Dr. Sexton indited another letter to the Record on dead teeth in the jaws, fearful "lest silence might be construed as yielding assent to your correspondent'^ views." The author is not able to differentiate between symptoms of dental irritation, which are always local when teeth are pulpless and the roots have been filled, and pain that proceeds from pulp exposure, impingement, or the simple eruption of a tooth. He tries to show what was not intimated in "Pain in the Ears," etc., that "the extraction and filling of the teeth, where required, it may be said, is intrusted to our own dentists, who are competent to do such work.' In other words, he seeks to divide the responsibility for extraction of teeth in the series of reported "cases" with "our own dentists." I have no disposition to treat Dr. Sexton unfairly, or to be captious or hypercritical, but when he deliberately sits down to answer his critics, and says "inflammation of exposed dentine cannot surely be entirely arrested in any case by filling the pulp-cavity with any known extraneous material," then I say his knowledge of diseases of the teeth is too superficial to entitle his views to command our serious attention. Dentine loses its capability of being inflamed or becoming sensitive after the death of the pulp. It will not be profitable to further discuss Dr. Sexton's views on the retention of pulpless teeth in the jaws. In the same number the editor discusses the