University of the Pacific School of Dentistry - Chips Yearbook (San Francisco, CA)

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AMERICAN CONSERVATIVE DENTISTRY VERSUS ORAL SEPSIS. jackson H. Smith, Dental Senior. Fear of open discussion implies feebleness of inward con- viction, and great sensitiveness to the expression of individual opinion is a mark of weakness. -Oliver Weimclell Holmes. CBeing an objection to an article on Oral Sepsis, deliv- ered at McGill University, Montreal, Canada, by Wm. Hunter, M. D., F. R. C. P., on October 3, 1910, and which was reproduced in the London Lancet, January, 1911.j In commencing these comments on behalf of American Conservative Dentistry the writer fully realizes that it would be far more satisfactory should the reader be able to study Dr. I-Iunter's article in its entiretyg but, owing to its length, the editor-in-chief of our estimable annual considers it would be a waste of good paper to reproduce it in full, and consequently we will have to content ourselves with the quotation of the more salient of these pointed remarks of this learned English physi- clan. Although there has been much discussion of Dr. Hunter's remarks among professional circles, and in dental journals and the daily press, there does not seem to have been brought out, in these discussions, appropriate judgments of the details of the doctor's criticismsg and no moral has been drawn for the good of dental practitioners in general and students of dentistry in par- ticular. Discussion, without reason and result, is merely a waste of time and energy. Dr. I-Iunter's article, as a whole, no doubt has great value as a contribution to the cause of oral hygiene, but there are many objectionable featuresg which, if allowed to go unrepudiated and unassailed, would stand as truth, and would, as a consequence, be harmful, to a degree, to American Con- servative Dentistry--that genuine and highly meritorious article. To quote Dr. Hunter in part: The title 'Oral Sepsis' was first introduced into medical literature in a paper entitled, 'Oral Sepsis as a Cause of Dis- ease.' My object in seeking for a special name, and after con- sideration in creating this one, was to emphasize the great fact that it is not the absence of teeth, but the presence of sepsis, that it is not dental defects, but septic effects, that it is not de- fective mastication, but the effective sepsis associated with such dental defects or often present in conditions of gingivitis apart from such defects, that are responsible for the ill health asso- ciated with 'bad' mouths. The subject of 'oral sepsis,' as I designated and defined it- namely, the septic lesions of streptococcal and staphloeoceal infection found in the mouth-belongs to no one department of medicine or surgery. It is common ground on which the gen- - 21

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strator to proceed with a discussion or an experiment without understanding every detail. The result is that he sees little or no connection between the subjects treated in the textbooks and the things which he works with in the laboratory. The first object of a course in the study of Chemistry is to develop a scientific habit of thought. Neither the studying of the bare theories nor the performance of random experiments can do this. The characteristic phenomena should be thoroughly understood and the relation between the theories and these phe- nomena recognized. The study of Chemistry should not be made to consist in storing a mass of disjointed facts to be used when called upon, but rather a series of interdependent ideas resulting as a matter of logical sequence. It is hardly necessary to emphasize the importance of lab- oratory work as a part of a course in the study of Chemistry. A good student never fails to question the demonstration on any point of doubt, and one experiment well done does far more good than being told about it half a dozen times. It is well to note that a badly performed experiment should be done over again at the earliest opportunity, and cleanliness be scrupulously ad- hered to. By adherence to the suggestions mentioned and by a consci- entious application to the subject, the study of Chemistry can be made to be one of the most interesting of studies rather than the bete noir which it appears to be to the majority of stu- dents. The great advantage in the knowledge of the subject is readily observed in the studies allied to Medicine and Dentistryg for example, one cannot obtain a thorough knowledge of Physi- ology without a knowledge of Chemistry. The physiology of digestion is purely and simply a study of the chemistry of the enzymes and of the protein molecule, etc. Materia Medica is. essentially Medical Chemistry. One can proceed along these lines of argument with other subjects too. Moreover, by the study of Chemistry the student familiarizes himself with things. he uses, and therefore cannot help but be beneficial in numerous. ways. So it is to be hoped that students in future will not be so ready to propound that ever-ready question, What good is Chemistry in the study of a profession ? The desire and Search for knowledge in themselves should be sufficient to avoid the presentation of any arguments. 20

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eral doctor, physician or surgeon, the throat, nose and ear, and eye specialistg specialists in children's diseases, i11 stomach dis- eases, in 'rheumatic' diseases, in fevers, in skin diseases, in ner- vous and mental diseases, and, lastly, the dental surgeon, all meet on terms of equal responsibility. In its earliest manifesta- tions no special knowledge is required to deal with itg a sound grasp of the principles underlying antisepsis alone is required. Unfortunately for the patient, it is precisely this grasp which I grieve to say is wanting. The course of the septic infection is from the gums to the periodonteum Cperiostemj of the root, and thence to the bone of the sockket. The results are septic gingivitis with ulceration, septic periodontitis Cperiostitisj with ulceration Cpocket forma- tionj, rarefying osetis of the tooth itself or of the socket with loosening of the tooth. As a result an accompaniment of the whole of these processes, we have the formation and deposition of tartar in larger or smaller amounts on the edges of the gums, in the pockets, or on the tooth itself. The prime casual factor in all these processes is the septic infection, all the other pro- cesses-gingivitis, periodontitis and periostitis, osteitis and tar- tar deposits--are the results of this septic inflammation and ulceration. Even if the teeth were not subject to a very marked septic infective process-that which we term caries and cario-necrosis- and always remained intact except in so far as they were af- fected by the septic infection in the gums and in the periosteum of the sockets, the infective processes in the gums constitute very important septic wounds and are a great source of sepsis to the body. As a matter of experience this is often the case. The teeth remain intact, or at least free from obvious caries or cario-necrosisg but the gums and periosteum of the sockets are the seat of the numerous septic wounds. These effects are shown by septic suppuration, by deposit of tartar, sometimes in great masses on the teeth, on the gum margin and beneath the gum margins, by the formation of pockets Cseptic ulceration of periodonteum-periostitisj, absorption of bone and loosening of the teeth in their sockets. You will observe that all these septic conditions are pro- duced, or intensely aggravated, by 'toothplates' covering necrosed roots, by amalgam and gold fillings, which have become septic, by porcelain crowns with gold collars, by gold caps over dis- eased teeth, gold bridges and other gold fixed dentures, which, however good to begin with, are never really aseptic, and are liable to become extremely septic. The worst cases of septic gastritis, enteritis and colitis, of ill-heath, anaemia, obscure septic fever and other manifesta- tions of medical sepsis are in my experience those in which the greatest so-called 'care,' the greatest amount of 'American skill,' in the shape of gold work, has been bestowed on the mouth. It is in poor patients that these septic conditions are most common. They have had 'no care' of their mouths-their fate 22