Read Ebook: The Archives of Dentistry Vol. VII No. 4 April 1890 by Various Eames W H William Henry Editor Stockton C S Editor

Font size: 10 px 15 px 20 px 25 px 30 px 35 px

Background color: BlackWhiteGrayLight GrayDark GrayDim Gray

Text color: BlackWhiteGrayLight GrayDark GrayDim Gray

Apply/Save settings

Ebook has 200 lines and 18174 words, and 4 pages

Editor: W. H. Eames C. S. Stockton

Transcriber's Note.

BY H. H. KEITH, D.D.S., ST. LOUIS.

There are no more useful lessons than those contained in the incidents and accidents of office practice. If we do not communicate the knowledge gained, the event is limited to the individual. Not alone should we record our successes and apparent achievements, that we may stimulate the energy of the younger members of our profession, but as faithfully read the story of our failures.

In 1877, "S. A.," a boy of ten years of age was presented with a mesial corner of the right superior central incisor broken in such a manner that the pulp, though not exposed, had died. The tooth was much discolored, abscessed, and very loose. A few days treatment sufficed to bring the tooth into a comfortable condition, when the boy's visits ceased. Some time elapsed: when he next came the tooth was elongated fully one-half the length of crown. The gums presented a most unfavorable appearance, and extraction was at once pronounced as the only proper treatment. At the earnest solicitation of the boy's mother this was deferred until the next day, and such treatment applied as the case seemed to indicate. Just here it may be well to say that exploration showed the root was not fully developed, the canal being quite large and funnel-shaped. So marked was the improvement the next day, that all idea of extraction was dismissed, and the root was finally filled with gutta-percha. A temporary filling of oxyphosphate was then introduced, and allowed to remain for two years. Then the contour was restored with gold. This filling was again replaced six years later with another of gold, which remained to within a short time ago, when a porcelain faced crown took its place. Deferring extraction to the next day has saved this tooth for thirteen years so far, with prospects of many years valuable service yet.

The second case is that of a right inferior second molar, a root filled with gutta-percha being allowed to fill pulp chamber, on which was placed a gold filling, February 20, 1878. In 1887 the gentleman complained of discomfort, but it was sometime before the cause was ascertained. The tooth had been split through its antero-posterior length, the fracture terminating nine-sixteenths of an inch below the point of the crown, on the lingual side. The fractured piece was removed, and the gum pressed out by means of gutta-percha, to give a better view of the remaining root. It was finally decided to attempt to restore the tooth by means of a band and crown. The fragment removed was used as a model from which dies were made, on which was struck a piece representing the lost part, having extensions sufficiently long to encircle the remains of the crown. This, when adjusted in position, was partly filled up on the inside with gutta-percha. A porcelain cusp crown was then arranged to antagonize the superior teeth. For a time everything seemed to go well. A little inflammation about the margin of the gum upon the lingual side instead of decreasing, suddenly grew worse, and pus was formed at the point of division of the roots. This finally yielded to treatment, and now the tooth is apparently in perfect health. The cause of this fracture appears to have been elasticity of the gutta-percha, under the pressure of the gold filling.

Case 3:--E. W., a boy of nineteen years of age, had broken a point off the right superior central incisor, not quite exposing the nerve, which subsequently died. The accident occurred some five years previous to his visit to me. The canal was found large and funnel-shaped, and was treated in the following manner: The lower portion was enlarged a trifle more than the diameter at the apex. A piece of lead was then introduced, and found to extend to the top by accurate measurement. In order to produce an accurate adaptation of the lead to the surrounding walls at the apex, the lead was reduced with fine sandpaper, the scratches of the sand being parallel to the long axis of the tooth. When the lead was forced into place, these fine ridges could be seen to be flattened when examined with a magnifying glass, and an adjustment continued in this manner, until the lead was found to close the apical foramen completely. The filling was completed with gutta-percha, and a porcelain crown was mounted upon the root. This has remained in a favorable condition up to the present time, about a year and a half.

Case 4, is that of a central incisor, pulp destroyed, canal filled, in which a Howe screw-post was used as an anchor to secure a large contour filling. Some time after, the tooth began to show a decidedly green discoloration, near the neck, which gradually extended throughout the crown. The filling was removed and replaced, however, using a screw of silver and platinum instead. I have here two specimens of roots in which the Howe post has been used, and have seen two other cases in the mouth, the same green stain appearing in all.

When the Howe post was put upon the market by the White Manufacturing Company, their agents refused to tell of what metal they were made, but gave the impression that they were some form of platinum and iridium alloy. They proved, however, to have been made of chrome steel. Besides the disagreeable discoloration of all these roots, I am inclined to the believe that the chrome salt formed, acts as a constant irritant to the peridental or dental membrane, and will result ultimately in the loss of the tooth.

Case 5:--In this case the left superior second bicuspid was devitalized and became discolored. The gentleman who was the lady's dentist at the time, desiring to improve the appearance of the tooth, removed the dentine extensively on the labial surface, and proceeded to fill with gold. When the tooth came into my hands for treatment, I found the part of the filling against the lingual wall well condensed, but that against the frail labial wall quite soft, and this portion of the filling had leaked, and the tooth was again discolored, showing that in order to avoid undue pressure on the thin enamel wall, insufficient force had been applied to condense the gold. Would it not have been better in this case, and in fact in all similar cases, to have sacrificed somewhat the appearance of the tooth and made a more permanent filling by the removal of all that portion of the enamel which was liable to fracture.

Case 6, is one of those mistakes in diagnosis which are liable to occur in almost any practice. Miss E. presented herself with every appearance of an abscessed right superior second molar, a large sac protruding into the mouth, opposite the palatine root. The tooth was so extremely loose and so sore that the patient would not allow it to be opened. The abscess sac was opened and syringed out, and two days later the soreness of the tooth had sufficiently subsided to permit the removal of the filling. Drilling toward the pulp chamber, a short distance, developed the fact that the tooth contained a living nerve. The result of this case showed that the abscess was caused by the lodgement of a fragment of a wooden toothpick between the first and second molar.

Another case, in my own mouth. The second left superior molar had for years stood alone, which facilitated a thorough cleansing upon all sides: I was therefore somewhat surprised at what appeared to be the development of a case of pyorrhoea alveolaris. The tooth continued sore, becoming looser, until its removal was a necessity. Neuralgia, and all the symptoms of a dying pulp had been present for three months. On extracting the tooth the nerve was found to be alive, and not much congested. The three roots were absorbed upon their inner surfaces. Exploration of the socket revealed the fact that a portion of the process enclosed by the three roots had been entirely absorbed. As the socket did not close in the usual time, I made an examination, and the probe revealed the presence of the missing wisdom tooth. The tooth has still continued to come down, but has not yet reached the gum line.

Another case in my own mouth is of interest: the result of wearing a wedge for three weeks between the first molar and the second bicuspid, on the right side. Some time after the tooth was filled, the first bicuspid became sensitive to heat and cold, and showed symptoms of peridental inflammation. Had a patient come to me describing the conditions of this tooth, I think I should have at once drilled into it, and applied the arsenic, but as it was in my own mouth I did nothing; and for fifteen months this tooth gave more or less trouble, but finally these disagreeable symptoms subsided, and the tooth is now apparently perfectly well.

DR. G. L. CURTIS, of Syracuse, has been acting as Dr. Garrettson's assistant in oral surgery this winter, in Philadelphia.

CAMPHO-PHENIQUE.

BY J. W. DOWNEY, M.D., STATE CENTRE, IOWA.

Campho-phenique is a germicide and antiseptic or nothing, therapeutically considered; and discussing its properties necessarily opens the entire subject of germicides and antiseptics, a subject fraught with peril to the writer or speaker, especially if he is not a practical chemist, pathologist, and microscopist.

Nothing in pathology is better established than the fact that certain microscopic germs cause disease, and no point in therapeutics is better known than the fact that a few drugs will, within the limit of safety, destroy these germs, and thus most effectually cure or prevent disease.

I have purposely omitted comparison with other drugs of this class, as the bichloride was by far the most effectual of any in general use before the introduction of campho-phenique.

If these figures are correct, they answer the first question. Certainly, if campho-phenique is from 6 to 25 times as effectual as a safe solution of bichloride of mercury, then it should have the preference in all cases where it is applicable. To the second point, which is the safest germicide, we all should be competent witnesses. The mercuric bichloride is known to be a virulent poison, and therefore ranks lowest in this respect, with carbolic acid closely following it. Campho-phenique is absolutely free from toxic or caustic properties. This I have had frequent opportunity to prove, and no doubt many gentlemen present have had a similar experience. Applied to the unbroken skin it produces no sensation whatever. On cut surfaces there is a slight burning sensation when first applied, followed by anaesthesia.

Being non-poisonous, non-irritant, campho-phenique ranks first as a safe germicide.

Now to the third point, which is the most agreeable. The brassy metallic taste of the bichloride is intolerable, the taste and smell of carbolic acid and creosote are disagreeable to most people, and the odor and meagre antiseptic properties of iodoform should banish it from the operating room. Campho-phenique has a pleasant odor and agreeable taste, this should establish its claim as the most agreeable germicide. I have yet to hear the first patient complain of its odor or taste.

From the foregoing data I am led to conclude--

It seems to me that this endorsement from a teacher and author of such acknowledged ability as Dr. Flagg, ought to place campho-phenique in the armamentarium of every dentist in the land. And now a word on its special uses, and I am through.

First and foremost as a pulp canal dressing in the various pathological conditions, from recent devitalization to alveolar abscess. Here it will take the place of corrosive sublimate, carbolic acid, creosote, oil of cassia, oil of cloves, iodoform, or any germicide heretofore used, except peroxide of hydrogen. If thoroughly rubbed on the gum or injected with a hypodermic syringe, it acts efficiently as a local anaesthetic, not equal however to cocaine, but there are no constitutional effects following its use, and there is no danger of the tissues sloughing. It is quite efficient as an obtunder of sensitive dentine.

The very disagreeable ache which sometimes follows the extraction of abscessed teeth is almost instantly relieved by placing a pledget of absorbent cotton saturated with campho-phenique deep in the painful socket.

These are a few of the chief uses to which this new candidate for favor can be applied; others will suggest themselves to each practitioner. Before closing I want to mention its use for a condition which is not in the realm of dental pathology, but which is a source of annoyance to every dentist who uses plaster and hard water. I refer to the condition generally known as chapped hands. It is one of the numerous forms of eczema, and is greatly relieved by campho-phenique. I use the following formula:

? Campho-Phenique, . . . . . . . Oil of Cade, . . . . . . . . . aa ?i Rose Cosmoline, . . . . . . . . ?i M. Sig.--Apply frequently.

Campho-phenique should never be mixed with water or glycerine. It will mix in all proportions with alcohol, ether, chloroform, and all fatty substances. In dentistry it will seldom be necessary to dilute it at all. Gentlemen, give it a trial, and when you have weighed it in the balance of experience and found it wanting, we will assist you in writing its fate upon the wall.

ETHER AS AN ANAESTHETIC.

BY DR. A. C. KELLOGG, DECORAH, IA.

For over a quarter of a century ether, as an anaesthetic, has stood at the front of all anaesthetics, as the safest, most reliable agent to use in all surgical operations. Being a faithful advocate of this time-tried friend, which has done so much for humanity, a brief description of its qualities and effects will constitute the theme of this paper.

Sulphuric ether is prepared by distilling alcohol with sulphuric acid. For many years after its first discovery the profession were not aware of its anaesthetic properties, but looked upon it as a mere chemical curiosity. Amusing incidents are related of many who inhaled it for the exhilarating and intoxicating effects it produced. But to the late Dr. Horace Wells is probably due the gratitude we truly feel for giving to the profession its true anaesthetic properties, in the painless performance of all surgical operations, no matter how severe. Since that date it is used almost exclusively in all the leading hospitals, medical and dental colleges throughout the land.

Very few deaths have been reported from its administration, and, indeed, if that proper care and knowledge of the agent be used, together with a pure article, and an intelligent understanding of the pathological condition of the patient, the death rate would sink to a minimum, and I doubt not that if a death should occur, after all these precautions, its true reason might find an explanation in some other cause.

To insure the best results from ether, it should not be inhaled after a full meal. Dr. Turnbull recommends a biscuit or cracker, and a glass of wine or a tablespoonful of brandy, half an hour before, always avoiding for several hours previously the annoyance of a full stomach. Serious complications and deaths have resulted from lumps and particles of indigested food becoming lodged in the trachea and glottis, from the act of vomiting, as ether, with many people, produces vomiting, and a recent meal is often reproduced.

The apparatus for administering ether is very simple, consisting in a towel or newspaper folded in cone form, with a moistened sponge at the apex to receive the fluid. During the first part of inhalation it is well to hold the cone a little distance from the patient's face, that the first few inhalations may be mixed with atmospheric air, otherwise an oppressed, smothered feeling may possess the patient. This feeling happily passes away in a few minutes, and the cone may be held close to the face, bringing the patient under its influence as soon as possible; better results are obtained, the after-effects pass away sooner, and there is less danger of nausea than when administered slowly, taking a long time to bring the patient under its influence.

It is well to observe that the temperature of the room be warm and well ventilated, avoiding all draughts. The patient should be in a recumbent position--better perfectly horizontal, all tight garments around the waist and throat should be loosened, allowing perfect freedom to the organs of respiration. With a finger on the pulse, an ear to the breathing and an eye to the patient, the operator is to judge when anaesthesia is complete.

The physiological action produced can be summed in a few words. Observation shows that the functions of the cerebrum are affected first; next, the anterior or motor centers soon fail to respond to mechanical irritation, yet the functions of the medulla-oblongata are performed. This is the proper stage to appreciate, for, if the inhalation be still further carried on, the sensory and finally the motor functions of the medulla-oblongata are involved, and death ensues from paralysis of the respiratory centers.

In conclusion, I must not fail to observe that ether has a peculiar and exciting effect on the genital organs, and a prudent operator will not fail to have a third party present throughout all the period of anaesthesia, otherwise his honor and reputation might be forever blasted by the emphatic assertions of some female laboring under the unhappy delusion of having been injured beyond reparation.

DISCUSSION OF DR. STODDARD'S PAPER: PORCELAIN FILLINGS.

PRESIDENT BRIGGS:--Gentlemen, I think we all are paying more attention to porcelain fillings than we formerly did. Since 1883 I have referred to them in my lectures as one of the methods of preserving the teeth, and have used them in my practice. One point particularly interesting to me is the method Dr. Stoddard uses, of packing the clay into the plaster impression, biscuiting it, then removing the surrounding plaster and finishing the fusing. I presume it is because the carver I have employed does not do this that he fails to give me good results from irregular impressions. I imagine he tries to take them out while they are in the clay, and of course, cannot, if the shapes are peculiar.

DR. SMITH:--My method of using porcelains is so similar to what Dr. Stoddard has just presented that my remarks will be largely an endorsement of his paper. I do only the operative part; the laboratory part is done by my assistant, so I have only that part requiring the shaping of the cavity and taking the impression. I have a number of questions I want to ask Dr. Stoddard on working his furnace, but that hardly comes in to what you would call discussion. I like the method I have used, that is, taking an impression of the cavity, baking the enamel and setting in cement or gutta-percha. I have also ground them in, and, as Dr. Stoddard says, it is a very difficult thing to grind them in entirely. Even a very large cavity will seem very small when you get the porcelain between your fingers and attempt to grind it into place. I think it is a much better way to take the impression and bake the body and enamel it, as Dr. Stoddard has suggested. I would further say, Mr. President, that I am using the porcelains where we find large cavities in molars: for instance, dead teeth, where we have a compound cavity, either the mesial or distal surfaces in connection with the crown, and where amalgam is prohibited and the teeth too weak for gold. I find that when an impression is taken of the cavity, and the filling made as Dr. Stoddard says in his paper, and set in cement, that it makes a very nice-looking filling, and one that wears exceedingly well. I use the porcelain in that way a great deal and obtain from it success and satisfaction.

DR. TAFT:--There is but little I can say on the subject before us, from the fact that I have had no experience whatever in making porcelain fillings; although so frequently do cases present themselves in my practice, where porcelain tips and inlays would no doubt make not only as durable but more artistic fillings, by far, than gold or any of the plastics, that I feel encouraged to adopt this method after listening to the interesting paper of the evening, and upon examination of the specimens before us. In looking over the specimens I notice quite an appreciable difference in color between the inlay and the tooth itself, more so in some than in others. This may, of course, be due to the fact that possibly the inlays were placed in some of them previous to extraction. I do not yet quite understand how the doctor mixes his material so as to get the color of the inlay as nearly like that of the tooth as is possible, and should like to have him explain the point a little more thoroughly.

DR. STODDARD:--I neglected to say that it was impossible to match the color of these dry, dead teeth out of the mouth, but there is no difficulty at all in the mouth. You have a baked sample of your body, which you keep, and from which you select your color.

DR. BIGELOW:--Mr. President and gentlemen: I have never used any of the porcelain fillings myself, but several cases have come under my observation, and the greatest objection that occurred to me, at least in those cases, was the well-defined line of demarkation between the filling and the tooth itself; not but what the porcelain was good color, but it was the material it was set in. A gentleman once opened his mouth and showed me his teeth, and spoke of the great pleasure and comfort that he had taken since his teeth were filled in that way. The porcelain fillings were made for him by a dentist in New York City. To me they were very much more unsightly than gold, possibly because the material used in setting them was not a good match in color for the natural teeth. I think I may have seen one of the cases that Dr. Stoddard has spoken of in his paper. So far as the porcelain itself was concerned, it was a very good match for the tooth, but the line of demarkation was very distinct, almost as much so as if gold was used, though perhaps the strength would be greater. I don't know, perhaps Dr. Stoddard manufactures his own cements and gets his shades just right, thereby overcoming this objection.

DR. TAFT:--There is one other place, Mr. President, where it seems to me these porcelain tips or fillings may not be always practicable that may be illustrated by a case in hand: namely, that of a patient whose upper incisors upon examination were found to be filled with fine fractures, extending along the surface of enamel from the biting edge well up towards the margin of the gums. In the left superior central I found what seemed at first to be a very small proximal cavity, and started very carefully to excavate it from the palatal side, when the corner of the tooth soon afterwards chipped off, and in still further excavating,--hoping to fill with gold,--it continued, in a most aggravating manner, to chip away more and more. To get the smallest possible undercut or groove to retain the gold seemed an utter impossibility, and the longer and more carefully I worked, the more discouraging it became, until finally I was obliged to give up altogether the attempt to fill the tooth with gold and to replace the broken corner with oxyphosphate cement.

Now, here would have been an excellent opportunity for a porcelain tip, provided a man had the requisite skill to get sufficient anchorage for it without experiencing the same difficulty that I encountered in attempting to make a gold filling. I should like to ask Dr. Stoddard what his own experience has been with this class of teeth: if it is possible to adapt porcelain tips in such cases, and if so, how long they would be likely to remain. They are the most discouraging sort of teeth, I think, we have to deal with, but fortunately, cases as bad as the one just cited do not confront us very often.

DR. STODDARD:--I should think that that was a case where it would be scarcely practicable to put in a porcelain filling, unless the tooth could be backed with platinum and the filling held that way, rather than by pins running into the tooth substance.

DR. ALLEN:--Mr. President and gentlemen: I have had no practical experience with porcelain fillings, but I was much interested in the paper just read. While I was abroad last summer I met Mr. Dall, the gentleman referred to by Dr. Stoddard, and he showed me some very beautiful specimens of porcelain fillings in teeth which he had prepared out of the mouth. His method in dealing with proximate cavities in superior front teeth, where the lingual, proximal and labial edges are involved, is to build up the lingual, cervical, and half of the proximal walls with gold, leaving a cavity for the insertion of porcelain, which, when finished, is a great success from an artistic point of view, as it does away with the objectionable display of a large gold filling. Mr. Dall cuts his porcelain inlays from teeth manufactured by C. Ash & Sons.

DR. MERIAM:--Mr. President, the body referred to is Ash's Tube tooth body. Ash, I believe, has always refused to sell it in bulk. I know that a number of American gentlemen have wished to experiment with it. Either the Harwood or the Thompson blow-pipe will bake it; of course, it would be very easy to bake in the Stoddard furnace. I do not know that it has ever been imitated or reproduced in this country. Of course, we often hear of Dr. Herbst's glass fillings.

There is one question I would like to ask Dr. Stoddard, which he can answer after I have finished, and that is, how far his body corresponds with the body usually used for the porcelain teeth of the shops? Does it have to fuse at a lower heat, or is it substantially the same?

Share on: WhatsApp @Hash Facebook Tweet