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

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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

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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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utter disregard for correct adaptation of crowns and fillings, to cervical margins and where porcelain or gold extends sub-gin- givallyg with the result that manifestations have made 'them- selves evident-locally-in inflammatory suppurating and ne- crotic conditions, and systematically is a sepsisg which may cause chronic dyspepsias, intestinal disorders, general ill-health, anae- mias, and neurotic conditions. Furthermore, it is lamentable that we are compelled to re- late that the professional services rendered by some of our com- patriot dental surgeons is of comparatively low gradeg result- ing in severe septic conditions for the wearerg but this work of low order has been quite as harshly criticized by conscientious dentists of America as it has been by Dr. Hunter. Crown and bridge work is of so comparatively recent origin that, like other innovations, its real limitations and defects, and also its merits, may behcorrectly estimated only by prolonged ex- perimentation. American' inventiveness has supplied many con- trivances, which have been inteded as improvements on the origi- nal principle on trial. Therefore, it is not to be wondered at that the wake of this swiftly improving branch of prosthetic art should hold records of wreckages, such as could be caused only by improperly constructed prosthetic dental appliances. Even granting the preceding facts, we fail to understand why Dr. Hunter should be so unreasonable as to denounce as septic, or as the cause of sepsis, every dental conserving device known to present-day dental art. For example, Dr. Hunter asserts that, to gold-cap a healthy or diseased tooth, in order to beautify or preserve QPD it is a veritable apotheosis of septic surgery. This is rather too strong a condemnationg when one reflects that previous to the placement of a crown, filling or bridge, the teeth involved are relieved of all caries and septic infection, and are placed in as nearly an aseptic condition as it is possible to render them, great care being given to the con- dition of the pulp-or if pulp has been extirpated-the pulp canal receives due attention, and the peridental membrane is relieved of all pressure from the presence of calcerous deposits, by suit- able instrumentation and medicinal treatment. Then again, great care is maintained to have correct cervical margins of filling, and sub-gingival adaptations of crownsg and that the conscien- tious conservative dentist places a self-cleansing bridge in all cases, which indicates its use, is taken for granted. There- fore, owing to these preliminary preparations of teeth involved, and the subsequent care maintained, we do NOT build in, on or around diseased teeth, these various works of dental pros- thesis as Dr. Hunter cerdits us with doing. When these crowns are imperfectly constructed and adapted so that no intimate con- nection is produced between the cervical edge of the crown and that portion of the root immediately below the gingiva and thus impinges upon the gingiva and peridental membrane tissues, there are developed conditions fully justifying Dr. Hunter's re- buke. We know that there have been many instances where den- 25