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

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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

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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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is the relatively happier one of having their septic roots lying exposed in all their nakedncss surrounded with tartar, over- grown it may be by foul, septic, fungating gums. This sepsis is relatively open and above board-it stares one in the face -when it is looked for. At the worst it is covered by plates-which they have been told not to remove CU-covering septic roots-which they have been told to keep CD, in order to prevent any falling in of the gums. The conditions in these cases, atrociously septic as they are, are comparatively easily dealt with, for they can be seen and recognizedg and even if the patient refuses to have his roots removed, much of the sepsis is superficial and can be got at and removed by careful daily swabbing with antiseptic lotions. And if this can be done regu- larly the patient may ultimately be induced to have the septic root removed. For the evil of sepsis in the mouth is a very prevalent one and can never be adequately dealt with by driving every sufferer from it through the already overtaxed and overburdened hos- pitals of the dental profession. Even after it is dealt with anti- septically in the manner above described by the doctors and surgeons whose cases it complicates, there will always remain sufficient for the dental surgeon to undertake in his own sphere. The surroundings which I would fain see provided in both general and dental hospitals and children's schools for carrying out these initial and all-important antiseptic dressings of the mouth would be special dressing-rooms free from all costly ap- pliances of dental chairs and dental apparatus, and furnished simply with the simpler antiseptic furniture of a surgical dress- ing-room. If patients could learn that they could have their gums and teeth antiseptically dressed by a competent nurse without any pain or discomfort to themselves, the evil of oral sepsis could be greatly prevented or kept in check. For they would learn from this experience what they cannot learn now- namely, the antiseptic objects and the benefits of cleanliness of the mouth. As one hospital patient put it, 'No one had ever told me before.' There can be no doubt that the future of oral pathology and treatment, and therefore of practical dentistry, depends upon the extent to which those who occupy themselves with these subjects are trained in the principles and impregnated with the fundamental truths of Oral Sepsis and Oral Antiseptics. The problem is an important one for the dental profession, and its solution is an important one in the interests of public health, especially of our school children, 30 to 50 per cent of whom suffer from dental and oral sepsis and its tonsilitie, phar- yngeal, glandular and other defects. For a while a large body of that profession are engaged in dealing successfully with the difficult problems of dental disease and of oral sepsis, another body is no less steadily engaged in promoting sepsis of the worst character .and degree by ignoring the fundamental truths con- nected with the anatomy, physiology and pathology of the tis- 23