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

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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

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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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causative factors in the eliminating of the gastric and intestinal disturbances. Another inference drawn by Dr. Hunter is that among Americans, chronic dyspepsias, intestinal disorders, ill-health, anaemia and neurotic complaints are all victims of this gilded dentistry. Now, as a nation, Americans have a mode of living all their own. There are many matters in the 'daily routine of the average American citizen which are not at all commendableg such as abrupt haste at meals, the grab and run method, fol- lowed at Boston lunch counters at the noontime meal',g when a hot gulp of black coffee places the grande finale to the rush back to work. Now, the grab and run method is not conducive to thorough mastication, nor is black coffee con- ducive to a freedom from nerves, if continued indefinately, as it usually is in this country. Even should said citizen pos- sess an average aseptic mouth, with a full compliment of teeth, his digestion and nerves will suffer nevertheless, and this, plus the fact that he is a hustler and pays more attention to his business than to bodily health, will induce the chronic dispepsias, ctc., which Dr. Hunter states he found so common among Americans. If this average American citizen had some crowns in his mouth would be be a victim, necessarilly, of this gilded dentistry ? Of course, we would not expect Dr. Hunter to find conditions in America similar to those found in England, for while the average American considers himself fortunate to be able to grab and run as occasion requires, the Englishman, in mid- afternoon, turns old Father Timeis face to the wall while he interests himself in the ceremonious consumption of a sand- wichette and a thimble of tea, together with such delicious bits of gossip as may be inteposed, and possibly a cigarette, in all consuming, along with the above menu, one hour of time, part of which is readily employed by the stomach in its premier work. No chance for any intestinal disturbances, or neurotic complaints, where the digestive apparatus is so well cared for. The doctor also claims that deposition of tartar is a re- sult of gingivitisg whereas, we know that so-called tartar is one of the causes of gingivitis. In concluding, the writer admits that a conscientious den- tist will not place crowns and bridges on diseased teethg no more than a conscientious surgeon would sew up an infected wound. ' If Dr. Hunter infers that a perfect gold iilling inserted in any tooth, irrespective of pcridental membrane's conditions, will produce or magnify a septic condition of that tooth, or mouth- he is talking in a ridiculous manner, which displays his ig- norance of even ordinarily good dentistry. The dental work he describes is so vastly inferior to that being accomplished daily by hundreds of practitioners that we are led to believe that he is decidedly wrong in his estimate of American' Conservative Dentistry. It would seem that the most lametable phase of the qt: