Columbia University School of Dental and Oral Surgery - Dental Columbian Yearbook (New York, NY)

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I 3 WILLIAM LEFKOWITZ D.D.S. Assistant in Dentistry CHARLES F. BODECKER D.D.S. Professor of Dentistry EDMUND APPLEBAUM D.D.S. Assistant Prof, of Dentistry DRAL HISTOLOGY A thorough knowledge of Dental Histology is the foundation upon which is built one ' s understanding of most of the fundamentals of dentistry. There is no dental field in which a careful consideration of the histological aspect is not a factor before treatment is undertaken. The interrelations between oral his- tology and oral pathology or oral physiology are quite obvious to all. The alleviation of pain during operative procedure is a problem concerning all members of the dental profession, but it is to the histologist that we are indebted for our basic knowledge. According to Prof. C. F. Bodecker of Columbia, the most sensitive areas of the tooth are I) the pulp, 2) the dentino- enamel junction, 3) the granular layer of Tomes, 4) the inter-globular spaces. Most of the pain occurs when these areas are being impinged upon. The histological explanation for this is that the pulp con- tains delicate nerves; the dentino-enamel junction is saturated with peripheral sense organs which are minute branches of the dentinal fibrils; the granular layer of Tomes is composed of non-calcified organic material and dental lymph which is directly connected with the pulp through the dentinal fibrils; the inter- globu.ar spaces are filled with non-calcified dentinal matrix permeated with dental lymph. Another source of pain is the expansion of the dental lymph with sub- sequent pressure on the pulp during operating pro- cedure. G. V. Black ' s principles oF cavity preparation are all histologically sound. One of the main causes of recurrent decay can be traced to those operators who do not flare and bevel the enamel to make cer- tain that the enamel rods at the cavo-surface angle rest on sound dentin. If the cavity preparation has unsupported enamel rods these will chip off under stress of mastication and secondary decay is a surety. It is the study of dental histology that correlates the embryologic formation of the teeth, the calcifi- cation of the various oral tissues, and their changes during the life of the dentition to the various ab- normal conditions of tooth structure and occlusion. DRAL ANATDMY 4Xt JACOB ERDREICH D.M.D. Assistant in Dentistry MOSES DIAMOND D.D.S. Associate Prof, of Dr HERBERT D. AYERS A.B., D.D.S. Assistant in Dentistry 17

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HOUGHTON HOLLIDAY A.B.. D.D.S. Professor of Dentistry EVALD UNDER Technician HARRY H. MULHAUS Technician RADIDLDGY In 1916, the first course in Radiography was given by Prof. Gillett and his assistants in the fourth and fifth years (the dental course then was 5 years long). The fourth year course was devoted to a study of the theory and technique, while the fifth year in- cluded in addition to further technique a study and interpretation of radiographs. It is to be noted that this was the concluding year of the dental curriculum. With the growing realization that Radiography is a science which gives to the dentist an insight, a sixth sense, in the diagnosis and treatment of all den- tal ills, the Radiology course was offered to men in the second and third years, i.e. before clinical prac- tice was started. The interpretation of x-rays is now given early in the junior year in the Oral Diagnosis lectures. It is the radiogram, more than any other single factor, that has made preventive dentistry the key- note of the profession. The use of x-rays in all fields of dentistry is indispensable and their value as a diagnostic aid is incalculable. The taking of a full set of x-rays is a routine procedure in the dental in- firmary before a patient is to be treated. This even applies to edentulous cases so that we are sure root fragments, cysts, tumors and bone diseases are ab- sent before the case is undertaken. At the same time we can see the amount of bone resorption and thick- ness of the cortical plate which serve as an indication of the duration of service that can be expected of the dentures. If a field of dentistry has to be singled out as one which gained the most by the innovation of the x-ray, it would probably be operative dentistry. In- terproximal and recurrent decay can be seen in the x-ray. This one factor has probably saved more teeth than all others combined. The number of mechanical pulp exposures has been reduced to a minimum be- cause the operator can see the proximity of the decay to the pulp. The vitality of a tooth can be judged and the degree of degenerative processes in the pulp, if present, can usually be accurately estimated by a careful study of the x-ray. Necrosis of the pulp is not necessarily indicated in the x-ray. Although pulp stones, impossible to detect otherwise, can also be demonstrated. Mention should be made of the fact that in the Orthodontic Clinic it is considered foolhardy to treat a patient before x-rays have been taken. The x-ray is the only possible method of knowing beforehand the position and number of the incoming permanent dentition. Recently, emphasis has been placed on the corre- lation between dental and systemic conditions. This is shown quite clearly in many cases in which arthritic conditions were cleared up after removal of abscessed teeth. Periapical abscesses and, incidentally, the con- dition of the peridental membrane show quite cleany in the x-ray. 16

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LESTER R. CAHN D.D.S. Associate Prof, of Dentistry HENRY A. BARTELS B.S., D.D.S. Assistant Prof, of Dentistry DRAL PATHDLDGY Modern dental students receive a thorough training in the basic medical sciences. For the first two years the curriculum is almost identical with that ot the medical schools. Too many students consider this an obstruction, a requirement that must be met before the last two years of Dentistry can be reached. The conception of Dentistry here consists solely ot the restorative phases such as Crown and Bridge and Prosthetics. These latter subjects are methods of treatment the success of which justifies our existence as practitioners of the healing arts. The success or failure of any treatment depends on an accurate recognition of the factors which caused the necessity for treatment. Conditions similar to the one in question must be ruled out by certain diagnostic features and confirmed by whatever scientific tests are at our disposal. This correct diagnosis depends on a thorough knowledge oF the underlying pathology. Herein lies the value of the medical background. Many have felt the futility of studying metastases of cancer and the migration of leukocytes in an inflam- mation of the kidney, but it is this type of knowledge that helps the alert dentist to diagnose oral conditions and apply the correct curative and restorative measures. To restate briefly, success depends on efficiency of treatment which depends on correct diagnosis which in turn depends on a thorough knowledge of pathology. The most beautiful bridge may fail because the abutments reside in areas of diseased bone. An ap- parently chronic infectious swellinq of a salivary gland may really be an epithelioma. A local gingival swelling may indicate a blood dyscrasia. A periosteal gumma may be mistaken for an acute alveolar abscess and lead to needle ss extractions. Further examples are un- necessary to pursue the point. The dentist cannot repair, replace, and restore the health of teeth and ignore the remainder of the com- plex mechanism of the body. Oral manifestations of systemic diseases should be recognized and referred for proper treatment, blood tests should be used more often in cases of profuse hemorrhage, radiographs should be consulted before any restorative measures are taken, and suspicious swellings should be biopsied before any decision is reached. Thus, pathology trains us to be mouth physicians and stomatologists. It has been said that pathology is the basis of all Medicine; truly it is also the basis of Dentistry. PEDDDDNTIA SOLOMON N. ROSENSTEIN B.S., D.D.S. Assistant Prof, of Dentistry EWING C McBEATH D.D.S., B.S., B.M., M.D. Professor of Dentistry LEWIS R. STOWE D.D.S. Associate Prof, of Dentistry 18