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

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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

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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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sues with which they deal. To gold cap a healthy or diseased tooth in order to beautify or 'preserve' CD it is the negation of every one of these truths-a veritable apotheosis of septic sur- gery and of surgical and medical. malpractice. ' The meflical ill-effects of this septic surgery are to be seen every day in those who are the victims of this gilded den- tistry-in their dirty-gray, sallow, pale, wax-like complexions, and in the chronic dyspepsias, intestinal disorders, ill-health, anaemias, and nervous f'neurotic'j complaints from which they suffer. In no class of patients and in no country are these, in my observation, more common than Americans and in America, the original home of this class of work. No one has probably had more reason than I have had to admire the sheer ingenuity and mechanical skill constantly displayed by the dental surgeon. And no one has had more rea- son to appreciate the ghastly tragedies' of oral sepsis which his misplaced ingenuity so often carries in its train. Gold fillings, gold caps, gold bridges, gold crowns, fixed dentures, built in, on and around diseased teeth, form a veritable mausoleum of gold over a mass of sepsis to which there is no parallel in the whole realm of medicine or surgery. The whole constitutes a perfect gold trap of sepsis of which the patient is proud and which no persuasion will induce him to part with. For has it not cost him much money, and has he not been proud to have his black roots elegently covered with beaten gold, although no ingenuity in the world can incorporate the gold edge of the cap or crown with the underlying surfaces of the root beneath the edges of the gums? There is no rank of society free from the fatal effects on health of this surgical malpractice. Such are the fruits of this baneful so-called 'conservative dentistry.' The title would be a fitting one if the teeth were a series of ivory pegs planted in stone sockets. But the teeth being what they are-namely highly developed pieces of bone tissue, possessing, I would point out, a richer blood and nerve supply than any piece of tissue of the same size in the whole body-and planted in sockets of bone with the closest vascular relations to the bone and the soft tissues of the periosteum and the gums, the title that would best describe the dentistry here referred to would be that of 'septic dentistryf Conservative it is, but only in one sense. It conserves the sepsis which it produces by the gold work it places over and around the teeth, by the satisfaction which it gives the patient, by the pride which the dentist repsonsible for it feels in his 'high class American' work and by his inability or unwillingness to recognize the septic ef- fects which it produces. It should be remembered in judging of the justice or in- 'justice of Dr. Hunter's criticism of American Dentistry, that there are many fakirsg both in England and on the Continent, who have appropriated the title of American Dentist, and have completely disgraced both themselves and that title. The work executed by these pretenders, to a great extent, shows 24