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subject from the stand-point of agreement with his contributor, and hence no new light is shed on the matter for the enlightenment of the "mere mechanics who constitute by far the greater number of (dental) students." We find another article in the Record for November 22, but its discussion has no place here.

The number for December 13 closes the discussion on the part of the editor, who says: "We are in receipt of numerous communications on the above subject ('Dead Teeth in the Jaws'), mostly covering ground that has already been gone over." His opinion is unchanged, as witness his closing paragraph: "While instances of harm from retention of such defective teeth are so frequently occurring in practice, and persons with dental skill are unable to realize the mischief being done, the safer course is to advise that all dead teeth be removed, at least until such time arrives when medical specialists can determine with certainty that teeth are not the seat of any trouble that can possibly injure the patient."

It is hard to obey the sentence, but the dentists fall into line when the bugle sounds, and the clicking of the handles of the forceps must be heard all over the land until the last "dead tooth" has been plucked from its socket, or the "medical specialists (in embryo) can determine with certainty that teeth are not the seat of any trouble that can possibly injure the patient." The efforts of the pioneers who have departed hence; the study, inventive genius, and special knowledge of innumerable bright lights, in the desire to save pulpless teeth for their owners, it seems, from this final decree, have proven valueless. For a similar ease of misdirected and misapplied energy I know of no parallel. The delicate barbed broaches must be laid aside; the fine root-pluggers must be converted into exploring-needles; the attenuated gold and lead wires, the oxychlorides and phosphates, solutions of shellac, paraffin, gutta-percha, and other root-filling materials must be banished from our cases, and the manipulative dexterity so hardly earned in the preparation and filling of roots of teeth is no longer needed for the special labor which wo erstwhile so delighted in I Gone from us the glory and satisfaction after the successful accomplishment of an operation which might have prevented an unsightly breach in the dental palisade! Are we to supinely sit and allow the temple to be overthrown while we yet inhabit it? I trust not. The thousands and hundreds of thousands of pulpless teeth, free from irritation or the possibility of reflecting it, retained in the mouth by the knowledge and skill of dental surgeons all over the civilized world, should stimulate us to make known the fact that he who wilfully or ignorantly sacrifices one such tooth without just reason is to be regarded as a Nihilist, and only to be welcomed back into the fold of good-fellowship after he shall have promised to sin no more. The retention of pulpless teeth in the jaws is & fixed fact which has come to stay. The series of letters and editorials so largely quoted from, instead of diminishing the practice of retaining them, will cause medical practitioners to hesitate before ordering an otherwise useful member to be extracted. Efficient mastication of food is as essential to digestion as assimilation is essential to perfect nutrition. The natural teeth are infinitely superior for that purpose to any form of artificial substitute. It cannot be, nor is it intended to assert? that pulpless teeth with unfilled roots are not detrimental to health, on account of the purulent matters escaping from them to be swallowed. Exostoses, caries, and necrosis of the alveolar processes are among the well-understood reasons why such teeth are and must continue to be (unless restored to normality) deleterious to the health of the possessor; but the majority of pulpless teeth or roots which have antagonists, natural or artificial, are amenable to successful treatment. None are more capable of defending the affirmative of this proposition than the distinguished gentlemen whom it is my pleasure to address. The pain which may be reflected to the eye, ear, or other portion of the head or body, caused by a carious living tooth or the retarded eruption of a malformed tooth, is easily understood when it is remembered that the pulp is destitute of the tactile sense. Not so, however, when we have to deal with a pulpless unfilled tooth. In the latter we have the tactile sense of the peridental membrane augmented by the irritation at the apex of the root, which enables the careful diagnostician to locate the cause of the pain even before it has become diffused to any very considerable extent. It is certain that no pain will be felt in the eye, ear, or opposing jaw, unless there be exostosis of the root, or a cyst of large dimensions, or other mechanical cause, which will favor impingement of a branch of the adjacent dental nerve, whence the pain may be reflected. Such cases are rare. The effects of pulpless teeth remaining in the jaws, when the roots have been imperfectly filled or not filled at all, has been the theme of many surgeons not practicing dentistry, judging from the frequent reference to such effects in hospital and infirmary reports. The majority of such effusions, are inexact, because the reporters, from lack of special knowledge, are unable to separate the cases of pain induced by living pulps from those in which the pain proceeds from their decomposition. Who among my listeners can point to a single half-dozen well authenticated cases of reflex nervous irritation relieved by the extraction of a filled pulpless root which was free from tenderness to pressure or percussion? I do not come before you with the weight of advanced years and a half century's experience in the practice of dentistry, but I come with the results of careful inquiry and more than a dozen years of experience and observation in the practice of retaining pulpless teeth in the jaws, to which should be added at least a respectable knowledge of the anatomy and pathology of the teeth, pericementum, and adjacent structures, and these combined have convinced me that all teeth or roots with antagonists may be rendered useful and free from irritation, when pulpless, by simple methods of treatment, either surgical or therapeutical. It is not only possible to fill the roots of at least ninety-five per cent, of such teeth, but when they have been filled to their apices the possessor is no more conscious of them than of other living teeth. That dental surgeons are as capable of exercising care, skill, and judgment in the treatment of putrescent pulps, alveolar abscesses, and other dental lesions, direct or reflex, as specialists in other branches of the medical sciences, none but the uninformed or narrow-minded would deny. That there are incapables and drones in this special field I do not controvert, but such examples of dead weights to the usefulness of the whole medical profession are not limited to the specialty of dental surgery. I would make the plea for dental surgery and her practitioners, that a necessity exists for its practice larger than that of any other specialty in the domain of medicine; and for the latter, that they are ceaseless and tireless workers for a scientific basis on which to found their practice.



[Read before the Southern Dental Association, at New Orleans, March 31, 1885.]

A Question is not to be questioned when all agree; but many dissenters may quickly evolve the truth. A brief review of the opinions of others relating more especially to doubtful points in connection with pyorrhea alveolaris, will probably assist our researches and better enable us to sift the facts from the tangled mass of diverse expression.

When this disease, as distinct from other inflammatory lesions of the oral carvity, was first brought prominently before the dental profession, hundreds of practitioners had observed as its probable cause a deposition of salivary calculus, and naturally enough they concluded that its origin was strictly local. But from the time when Dr. Rehwinkel, of Chillicothe, and myself saw fit to oppose this view of its causation, at a meeting of the American Dental Association in Chicago, opinion has very materially changed, and to-day finds the advocates of local and systemic causation pretty evenly balanced. The local-cause theorists are at variance as to the cause, some claiming salivary calculus as its origin; a limited number sanguinary calculus, and still others that the affection is resultant from a "peculiar organism of fungous growth which always fills the pockets."

To Dr. Riggs, of Hartford, is justly due, I think, the impulse to investigation in this matter, and 1 look upon him as the pioneer of the local-origin theory. If I am not misinformed, Dr. Riggs claims that salivary calculus is the immediate cause, and his treatment, so far as I have been able to learn, is certainly consistent with such view, besides being, in my estimation, far superior to the local treatment of other theorists. Dr. Ingersoll, of Iowa, advocates the theory of sanguinary calculus as a cause, stating that often when no salivary deposits were present the sanguinary calculus would be found far up the roots of teeth,—which I think correct, but would prefer the term serumal calculus. Dr. Black, of Illinois, presents the latest local-origin theory, in support of which, and confirmatory of his microscopic investigations, he has the results of similar research by Dr. Witzel, of Essen, Germany, whose article bearing upon the subject was somewhat earlier than that of Dr. Black's. This is one of the numerous germ theories, and is founded upon the fact of the presence in these cases of little hot-beds of peculiar organisms of fungi, which, according to supporters of the theory, cause a melting away of the pericemental membrane—by what means is not definitely understood, but presumably by the "digestive fluids of the fungous growth causing a re-molecularization of tissues exposed to their action."

As I understand it, the characteristic symptoms and signs of this much-dreaded malady vary somewhat in their nature. The progress of the disease differs also in accordance with formation of the parts, habits of the patient, environment, nature of cause, and whether the latter be hereditary or acquired. The incipient symptoms are by the casual observer seldom noticed as such, simply for the raason that they are in their expression somewhat analogous to those occurring in pericementitis or submucous irritation from ordinary causes. Dr. Black says the disease is first rendered apparent by a red line at the border of the gum, and asserts his belief in this as a constant first symptom. Now, while this may be true as it refers to occasional first apparent signs, it is, according to my observation, no part of the truth as it refers to first symptoms. First symptoms are not seen; they are felt. About the earliest subjective symptoms are either a sense of fullness or a feeling of impactedness in the vicinity of the teeth involved. That there should be a variation in incipient symptoms in different cases or in different localities in the same mouth, is probably on account of difference in the shape of the teeth, the direction of contact, and point of initial lesion. The above symptoms are usually followed by more or less soreness and a springy feeling under delicate percussion, the soreness gradually lessening as the disease progresses until the lesions become so extensive as to admit the action of deposited irritants, when it returns and abates alternately, as the parts are relieved by cleansing and depletion or congested by close contact with irritating deposits. Following these primary symptoms come the more pronounced (though difficult of detection) objective symptoms and signs. The first of these is not "a red line at the border of the gum," but a slight prominence or thickening at that point, with no perceptible change in color from that normal to the part. In not a few cases the foregoing manifestations are successively present, and yet no deposits of a calcareous character are to be seen or felt, and occasionally not even a disruption of the tissues at the neck of the tooth or teeth thus implicated. At this stage of the disease the "red line" may follow, though generally not until there has been present a slightly bluish or purplish tint, which is indicative of increased size of the capillaries, congestion, and carbonization of the blood at the point referred to. This color passes away with disruption of tissues implicated, and is gradually replaced by a more angry-looking red line, though not always; especially is it not so when the lesion exists between the teeth. Following these symptoms and signs, the dissolution of continuity goes on between gum and tooth, the objective symptoms become much more marked with the influx or deposit of additional irritants, and in turn the periosteum at the margin of the process or over the septa between the teeth is laid bare and subjected to the exciting causes of dissolution which had induced its exposure. The destruction of the peridentium advances toward the apex of the root; the pericementum melts away; there is a break in the round of nutrient circulation that had once supplied the alveolar border, and the work of disintegration proceeds in the wake of decreasing nutrition. Shortly after the process begins to soften the external indications will vary in different cases. There may exist a dark turgidity of the gum, or simply a more or less bluish-red line, showing the depth and direction of the dissolution, —this latter only when the attack is on the posterior or anterior surface of the root. Again, neither of the foregoing signs may be present—nothing but a slightly-raised, thickened, and loosened condition of the gum at its margin to indicate anything wrong. In such a case, especially if but little pus can be pressed out, it is usually indicative of greater integrity of tissue, and if occurring in cases of heredity, records a decline in the system of the remote cause or predisposition.

The points which are usually first attacked are those which it might naturally be expected would be affected, viz., where there

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