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

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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

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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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tists have placed gold crowns, Richmonds and Logans, in cases where a gold filling should have been utilized as the better pre- servative device, but the conscientious dentist will always re- tain as his unvarying rule that, when a tooth is of sufficient strength to retain a filling and bear stress of mastication, that the filling should be used in preference to the crown except in cases where the particular root is to be used as an abutment for a bridge. It is an indisputable fact that metal fillings and gold crowns have been placed in and on carefully prepared teeth and that no sepsis was produced and no injurious results, either direct or remoteg but that, on the contrary, these fillings and crowns have not only maintained asepsis, and precluded further inroads of caries, but have also aided in mastication, thus maintaining for the patient a degree of health, which otherwise would be affected to a greater or less extent. We all have these fillings and crowns in our own mouths, and we still survive. As you will notice, Dr. H'unter's denunciation is not bounded by the American crown and bridge, but includes plates which patients have been instructed not to remove, and that these said plates sometimes form a covering for septic roots, which the patient has been advised to retain in order to prevent falling in of the gums. This is a method in practice scarcely to be found in America, but widely allowed on the Continent, and which should be denounced, not only as unsanitary, but also as malpractice in its worst form. An appreciable deficiency in the number of teeth in the mouth of a patient will result in defective mastication, and this will produce, of itself, such conditions as an overworked stomach, indigestion, dyspepsia, etc. Dr. Hunter places the dental surgeon last in his mention of those who treat oral sepsis. In this country the dentist is the oral specialist, the true stomatologist, It may be true that in England the physician refers his cases of oral sepsis to the den- tist, with fear and trembling, not knowing whether the result will be for better or for worse, and, as a consequence, he may have found it more conducive to the good health of the patient to treat these cases in his own office, but the physicians of this country generally refer all such cases to the dental surgeon, and the physicians are very seldom, if ever, dissatisfied with the re- sult. On the contrary, they acknowledge that in some instances the patient's ultimate recovery has been solely due to the services rendered by the dental surgeon. The writer could cite many cases of gastric and intestinal disturbances which have come under his professional care, and after searching for, locating in the mouth, and recognizing the causes of these troubles, means were taken to place the mouth in as nearly an aseptiic condition as possible, supplying, if necessary, a further number of dental digits to aid in mastication, thus relieving the alimentary canal of a steady How of septic material andlessening the work required by the stomach to transform the food into chyleg both of which 26