Various

“ Our dental societies in their reports show that some are very successful in their endeavors to save exposed pulps: that others don't kill babies for the sake of having a funeral, and attempt to save everything: while others, whose experiences are just as extensive, whose observations and opinions are just as much to be respected, claim that an exposed pulp that has ached or been inflamed, can never become healthy by any treatment whatsoever. ”

“ In cases of a malformation of the pulp or tooth, but under ordinary circumstances, in cases that we usually meet, such exposure of the pulp I believe to be wholly inexcusable. The practitioner of to-day in opening into a cavity knows, or should know, that he is liable to come into contact with the pulp, and he therefore ought to excavate with the greatest possible care, and with the careful instructions given in the schools to-day there is no excuse for his exposing that pulp. ”

“ It seems to me that in all the cases of actual exposure, the question of capping the pulp is merely one of expediency for the purpose of keeping the tooth along. You do not wish to destroy the pulp at that time, perhaps, because it is a young tooth; or perhaps you dread the trouble and inflammation which is likely to ensue from the use of arsenious acid at that time, or possibly the patient is going away. In those cases I have had no trouble in putting a dressing in, which has kept the tooth quiet for a long time, but I always expect that sooner or later I will have a dead pulp to attend to. ”

“ I never cap with oxyphosphate unless I wish death to take place. It has been said by one of the speakers to-night that the nerve has no means of absorbing dead matter, as the pulp has no absorbents. Even if it had, I should not want it to come in contact with the oxyphosphate. Phosphoric acid is an escharotic, and I don't know why a creamy mixture of it and the oxide should be flown over an exposed pulp, unless to destroy it. If a pulp stands this treatment and lives, it is tough. An acid that will etch glass, or dissolve silver, will destroy soft tissue. ”

“ Occasionally I find one that comes back after a time, showing signs that the tooth is dead, and of course the tooth is then opened and treated; but the proportion of them is so very small that I believe in a conservative treatment of them, and think the first thing to be done is to get rid of whatever congestion there may be, if any, and I do not see why a pulp should not then live as well under a careful and skillful capping as it should against the hard, bony wall of the pulp cavity. ”

“ We are taught that a cement filling is not a permanent one, and especially should not be used below the gum border; but we are advised to use open-face crowns and to set them on with cement. If cement will not last when put into a cavity of a tooth at the gum line, we should hardly imagine that it would last very long when only protected by a thin gold band placed below the gum line, where secretions have continual play at it. ”

“ When it has reached that stage, the only thing to be done, in my opinion, is to apply arsenious acid and destroy it.
Dr. Werner:—I look upon the treatment of a pulp principally from the standpoint of whether such pulp is absolutely necessary for the welfare of the tooth. The pulp is a formative organ. Its function decreases as the tooth develops. In young persons it is largest; grows smaller and smaller, and in old age it is nearly ossified or obliterated; that is, its retrogressive stage begins materially after the crown of the tooth erupts through the gum. ”

“ From a surgical standpoint the amputation of part of the pulp may at times be successful, for we know how resistive they often are to any kind of arsenious acid treatment, yet I should never do it unless it were in a partially developed tooth, where the life of the pulp is essential. What the surgeon does after trepanning the skull, we should do in capping or bridging over the pulp cavity. He does not flow escharotics like oxychloride or oxyphosphate of zinc over the brain. He mechanically covers and takes good care not to press on the contents of the cavity. ”

“ The pericementum cuts no figure in implantation of teeth.
Implanted teeth can never be successful for these reasons: First, teeth are developed from a different structure than bone. If dried pericementum took on new life and performed its functions as before, it would be a success. If we could implant immediately after a tooth is extracted, success is more probable. It would be equal to skin or bone graft. If the cementum becomes reorganized, it can grow only at the expense of the dentine. If resorbtion takes place in vital tissues it certainly is so in dead tissues. ”

“ The tooth pulp must be treated in the same way; a simple mechanical covering over it being all that is necessary. Whether you put a metallic cap, or whether you put court plaster, or one of gutta-percha (though I should hesitate about using the latter) , makes little difference, only be sure that you do not press upon the pulp. With the knowledge we have to-day in treating devitalized teeth, there seems little reason for a young man to risk trying to save bad cases of exposed pulps. It is in extreme practice successful only for the time being—sooner or later ending in failure. ”

“ If a tooth has been aching, and there is congestion about the pulp, or an exuding of pus, I invariably destroy it. I don't believe a pulp can be brought to a healthy condition to stand capping after it has reached that stage. But there are many cases where patients have neglected their teeth and had a little pain, or after taking sweets, they have a severe toothache that soon passes off, so that at the time of examination there is no soreness nor inflammation ”

“ I fail to see how we can justify ourselves, or do justice to the patient by subjecting them to a painful and, possibly, an imperfect operation, with the probabilities that they will again be obliged to seek for relief from the same offending member. ”

“ I do not excavate carious dentine as far as it can be, and I don't think that theory will work out in all cases. If bacteria are there after the cavity has been thoroughly cleansed and tightly stopped, they must find an early death in some way.
Dr. Niles:—I am very glad to hear Dr. Reilly speak as he does. It is perfectly consistent with the accepted theory of decay. Decay does not progress where moisture and oxygen are excluded; therefore a cavity thoroughly dried out and hermetically sealed is good treatment and sound in theory. ”

“ It is only necessary, from a mechanical standpoint, to retain metallic fillings, but I think some day we will have a plastic filling that will require very little excavation—simply the wiping out of the cavity and the thorough removal of the actual decayed portion, leaving all that has sensation—treating the cavity antiseptically, and when in an aseptic condition, fill it with this plastic filling. The surgery of to-day is very much modified. Muscles and bone are not cut away as they were forty, or even twenty years ago. ”

“ Phosphates or chlorides mixed to the consistency of cream make an unstable, strongly acid compound, that when hard very soon dissolves in water, or to a large extent will become deteriorated in water or moisture. In my opinion, the best treatment to save a pulp, provided the patient is strong and robust enough to help out any treatment, is to relieve it from all irritation, disinfect it, and let nature take [Pg 547] care of it. Any non-irritating mechanical means you can use to that end will be more beneficial than stimulating, bleeding, etc. ”

“ After a root has been in a diseased condition for a year or more, it is questionable whether treatment, however carefully given, will place that root in a condition to be crowned and do the work of the original tooth.
The second class is beyond the bounds of practical dentistry, and no operator who has any regard for his reputation will attempt this class of crown work, unless he has a mercenary object in view.
All who have attempted the third class have made many failures. ”

“ The abusive use of open-face crowns must not be overlooked. These classes of crowns for bridge work should never be used, as they are simply not practical. We have yet to see one which will last any length of time. They have no strength nor durability. One of their weak points is the band around the labial surface of the tooth which in course of time cracks. Another is the free access which the secretions have to do their work upon the cement which holds the crown in place. ”

“ Fletcher:—The experiments of the men go to show that bone will become organized when ivory will not. The only part of a tooth that may be organized is the cementum. The line of reorganization or absorbtion is a softened tissue, so when the process reaches the crown and is about complete, the crown drops off. If a very fresh tooth is implanted, the membrane may be accepted. ”

“ I believe a large proportion of failures in the capping of exposed pulps is due to the lack of skill on the part of the manipulator. We speak of accidental exposures in excavating; I believe that that exposure is almost inexcusable. I don't believe any graduate of the dental school of Harvard College has any right to punch an excavator into a pulp unless he intends to do it when he starts. ”

“ Let the nerve alone; nature has provided a covering, why should it be torn away? If there is any irritation, it is very easily removed. In my opinion, a pulp is never inflamed to an extent that needs treatment when it is free from soreness by percussion. If there is inflammation at all in the pulp there will be periosteal disturbance to give warning; but if the periodental membrane is not inflamed, it may be concluded that the pulp is free from irritation ”

“ As for ourselves, though we be accused of being controlled by one permanent notion, truth compels us to say that the employment of our ethereal alluminous paste has enabled us to preserve the teeth of our patients, even when these organs were attacked with most intense inflammations. Its sedative and extraordinary anti-spasmodic quality does not fail to triumph over the inflammatory erytheism of the dental nervous system and its appendages to such an extent that all pain and all irritation cease at the end of some days, sometimes on the next day. ”

“ President, when a pulp is destroyed by an oxyphosphate filling it makes one of the dirtiest heaps of debris that I have met. It goes all to pieces and makes a very bad mess. I have used oxychloride for capping and had better results than with the oxyphosphate. ”

“ If we were not able to judge something of the depth of decayed dentine, we would be in constant danger of exposing the pulp. If you cannot tell by the feeling of your excavator when you are near the pulp, I would like to know what you are going to do in those cases where you cannot see the bottom of the cavity? ”

“ As an anchorage, its greatest is, I believe, under amalgam fillings in cases of badly broken down molar and bicuspid crowns where, on account of excessive decay and nearness of the pulp, reliable undercut cannot be obtained, and if it could be, would so weaken what remained of the crown as to deprive it of strength to carry the filling. ”

“ To-day ivory is inserted and made useful in the place of bone, and why should not tooth substance that has sensation be preserved? We have to cut it away simply because we have to shape the cavities to retain the metallic fillings; that is, we treat mechanically instead of therapeutically. In the near future I hope we shall know better than to cut away that which should be saved. ”

“ A patient came to my office something over two years ago. On a lower right second bicuspid was an exposure near the margin of the gum, which was capped, and that patient had not been in to see me since that day until yesterday, and would not have come then had there not been a pain in that locality. In examination I found that decay had started below the gutta-percha, upon the cervical wall, which I had placed there for protection, after the first capping, and had again exposed the pulp. The patient had suffered for two or three weeks with neuralgia before coming in. ”

“ I am a firm believer in treating exposed pulps, with arsenious acid. I have tried almost everything else during the last fifteen years and have found nothing that will especially preserve the life of a pulp. ”

“ Resolved, That in the death of this estimable young man, the Southern Illinois Dental Society has lost one of its most earnest and enthusiastic members, the world a useful and honorable citizen, and the social circle a faithful and beloved companion ”

“ Bernheim says hypnotism is produced by what he calls suggestion. The operator says certain things, and the patient imagines them to be true. During this time all the functions are normal, except the first time, when there is usually more or less excitement. The proportion of persons susceptible to hypnotism is placed at about 18 per cent. in both sexes.
This has been used with considerable success in organic lesions, hysteric, neuralgic and rheumatic affections. It is difficult to produce when an operation is in view. ”

“ Idiosyncracies of persons have much to do with lesions of the teeth, but there are often other causes also. A patient comes from some other operator, and ignorant of what has been done, he is apt to be misled. All causes which are not directly associated with the trouble, if first eliminated, the diagnosis is much easier. The prejudice and ignorance of the patient must be considered. ”

“ Third—organization takes place better when the tooth is moderately tightly fitted in solid bone, and for this reason the cicatrix of bone formed after the extraction of a tooth is the most favorable place for implanting teeth.
Fourth—that the resorbtion and rebuilding of the tissues of the body necessitate the absorbtion of the dentine of the roots of implanted teeth, and thereby their loss. But that as a temporary replacement of lost teeth, the operation of implantation is justifiable to those who comprehend it to be such. ”

“ The shading of the thin walls by the amalgam is absolutely prevented by the cement. I have in my own mouth a molar in which the filling was loosened by mastication five times on account of the cavity being one of the kind where reliable anchorage could not be obtained. The pulp finally became exposed from frequent cutting away of tooth structure, and the sixth filling was anchored by taking advantage of the pulp chamber, or a portion of it. To use cement as anchorage for amalgam, this is the process: Mix the amalgam according to your custom ”

“ In dressing of wounds, ulcers, etc., the antiseptic influence of glycozone is rather slow if compared with that of peroxide of hydrogen, with which it may, however, be mixed at the time of using.
It has been demonstrated in Pasteur's laboratory that glycerin has no appreciable antiseptic influence upon the virus of hydrophobia; therefore, I mixed the virus of hydrophobia with glycerin, and at the expiration of several weeks all the animals which I inoculated with this mixture died with the symptoms of hydrophobia. ”