Dental filling

“ Inflammation of exposed dentine cannot surely be entirely arrested in any case by filling the pulp cavity with any known extraneous material, and especially is handicraft wanting to even imperfectly protect the minute and often tortuous canals leading down to the apical foramina of the majority of the teeth. ”

“ Let our motto be, "Whatever is worth doing at all is worth doing well." If applying arsenic or a disinfectant, cover it with gutta-percha, for the patient may be delayed a few days longer than we anticipate; and what is worse than removing a foul piece of cotton, and finding the tooth in a poorer condition than we left it? If we introduce a temporary stopping on account of exposure or frailty, let it be done thoroughly; and after relating its importance to the patient, caution her to return at a certain time for its removal and permanent filling. ”

“ The professed incompatibility of gold as a filling material with tooth bone, seems to me to be at variance with the frequent success which we all must have experienced, in the use of that filling in cavities on the labial surface of the roots of the upper incisors. ”

“ The force of the article which says that “a poor gutta-percha filling, in its proper place, is better than a good gold one,” seems to depend on the question as to what is the proper place for a gutta-percha filling: surely not the place where we can insert a good gold plug, if by “good,” is meant one that is not only solid, but also sufficiently tight to exclude all moisture from the cavity. ”

“ With amalgams, as with the other plastic materials, a perfect filling of its kind has yet to be discovered, for a measure of uncertainty seems to exist in all of them; but as a proof that an amalgam may make a good useful filling, I can say that I have seen more than one apparently in a perfect condition after thirty years’ wear, and I cannot but think that much of the discredit attaching to its use, arises from its being the filling we naturally have recourse to in all cases of doubt and difficulty. ”

“ That portion against the wall of the cavity is the last removed by wear, so that further caries is prevented so long as there is any reasonable amount of tin left. If at this time the tooth has become sufficiently solidified, proper anchorage can be cut in the tin or tooth, one or both, as judgment dictates, and the filling completed with gold. A tin filling, confined by four rather frail walls, may condense upon itself, but it is so soft and adaptable that the force which condenses it continually secures the readaptation at the margin; thus there will be no leakage or caries for years. ”

“ 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. ”

“ The most of the patients who come to us with exposed pulps have a debilitated state of the system. It is not the best vitalized class of people, but those who are sickly and delicate, and who have not much reserve force for the body, to say nothing about the teeth. The question of conservative treatment, in a large majority of cases, with the hope of any lasting results, I shrink from. If I can painlessly treat my patient and take him past the trouble by destroying the pulp and filling the cavity and canal, I feel that I have done the best that can be done for him. ”

“ In proximal cavities attacked by this kind of caries, separate freely on the lingual side, and fill with tin. When such fillings have been removed the dentin has been found somewhat discolored and greatly solidified as compared to its former condition; this solidification or calcification is more frequent under tin than gold, which is partly due to the tin as a poor conductor of heat. Nature will not restore the lost part, but will do the next best thing—solidify the dentin. In some cases, under tin, the pulp gradually recedes, and the pulp-cavity is obliterated by secondary dentin. ”

“ Never pick the teeth with a pin or needle. The biting off of thread, finger nails, and other hard material may crack the enamel. It may also be softened and eaten away by acid formed where food remains about a tooth. For this reason a quill or wooden pick or piece of tough thread, called dental floss, should be used to clear the teeth of food after each meal. Slimy matter collects over the whole surface of the teeth, and is likely to cause decay in spots unless it is cleaned off night and morning with brush and water. ”

“ When one or more teeth have appeared in an irregular position and offend the walls of the oral cavity or else the tongue, the excision (resection) of the tooth or teeth must be performed with a pair of strong pincers, whose shape must vary according to whether the teeth are situated externally or internally with regard to the dental arches. But as after the resection there will almost always remain some points or sharp irregularities, which by their presence would continue to irritate the soft parts, it will be necessary to remove these irritating prominences by means of the file. ”

“ Against incipient caries, Hirsch used simple cauterization, which he held to be capable of arresting the morbid process, at least in many cases. He says, however, that when a real carious cavity exists, it is absolutely necessary to stop it; and for this purpose, rather than metallic or resinous fillings, he prefers a cement of turpentine and quicklime, made into a paste with varnish of oil of linseed. Nevertheless, when it is a case of the lower teeth, tin-foil is also, according to him, an excellent filling material. ”

“ He insists on a principle of capital importance that has only had its full application in the nineteenth century, viz., that the instruments to be used for the extraction of teeth ought to vary according to the tooth to be extracted. For the removal of the incisors, he says, the “goat’s foot” should have the preference; the canines ought to be extracted with the common dental forceps, but sometimes, when they are decayed, they may be extracted with greater security with the pelican; for the small molars the straight-branched pelican is to be preferred, for the large molars the curved pelican ”

“ 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. ”

“ It always does more harm than good to file or to scrape the decayed part of a tooth, without stopping it afterward, as by thus doing, says the author, one only renders it still more liable to the access and the action of harmful external influences. In preparing the cavity for stopping, the bottom of it should be more ample than its external aperture, that the filling may remain firm.
For extracting molars, he makes use either of the pelican or of the key; for the incisors and the canines, of the forceps ”

“ Good tough foil, well condensed by hand or mallet force, stays against the walls of a cavity and makes a tight filling, and ought to be called as near perfect as any filling, because it preserves the tooth, and gives a surface which will wear from five to twenty years, depending upon the size and location of the cavity and tooth-structure. Buccal cavities in the first permanent molars, and lingual cavities in the superior incisors, filled for children from six to eight years of age, are still in good condition after a period of twenty years. ”

“ This material is easy to manipulate, but great care is required in condensing at cavity-margins, so as to make a tight filling, and also not injure the margins. It makes as hard a surface as tin foil, and [67] can be cut, polished, and burnished so that it is smooth and looks well; it can be used in temporary or chalky teeth, as a small amount of force condenses it. By using a matrix proximal cavities can be filled from one-fourth to one-half full, and the rest filled with gold, relying on the form of the cavity to hold the gold, regardless of its connection with the fibrous material. ”

“ Tin is good for children's teeth, when gold or amalgam is not indicated. It can be used in cavities which are so sensitive to thermal changes as to render the use of gold or amalgam unwise, but it [25] can only be used in cavities with continuous walls, and should be introduced in the form of cylinders or ropes, with wedge-shaped pluggers having sharp deep serrations, thus depending upon the wedging or interdigitating process to hold the filling in the cavity. ”

“ As to the particular or local treatment, it consists, first of all, in washing the teeth with aqua vitæ or with a vinous decoction of mint, salvia, melissa, pepper, or pyrethrum. Then it is necessary to fill the carious cavity with gallia248 and root of cyperus,249 mastich, myrrh, sulphur, and camphor, wax, ammoniacum, asafetida and the like. As may be seen, Guy does no more than mention the substances used in his days for the filling of carious teeth, and does not tell us what various combinations were formed with the said materials, nor the proportions in which they were used. ”

“ A very good way is to proceed to fill the cavity with gold the same as if cement were not to be used for anchorage, holding the gold in place with another instrument, and when sufficient has been inserted to nicely take the form of the cavity, to take out, place a little cement in the cavity, then force the gold back to place, and after waiting a minute or two for the setting, go on and finish the filling. ”

“ When the aforesaid means of cure—that is, the mouth washes and the filling—are of no use, Guy advises the margins of the carious cavity being taken away with a scalpel and file, so that alimentary substances may not be retained inside it. ”

“ Giving gas for tooth-extraction is all very humane in its way, but the time for anaesthetics is when the patient first decides that he must go to the dentist. From then on, until the first excavation is started, should be shrouded in oblivion.
There is probably no moment more appalling than that in which the tongue, running idly over the teeth in a moment of care-free play, comes suddenly upon the ragged edge of a space from which the old familiar filling has disappeared. The world stops and you look meditatively up to the corner of the ceiling. ”

“ I use it in the grinding surface of molars and bicuspids, buccal cavities in molars and bicuspids, cervical fissure pits in superior incisors, proximal cavities in bicuspids and molars. If proximal cavities are opened from the occlusal surface, the last portion of the filling should be of cohesive gold to withstand mastication. In simple cavities I place as many pieces as can be easily introduced, using my pliers as the wedging instrument to make room for the last pieces, and then condense the whole. ”

“ This preparation will keep a filling perfectly dry in the mouth, and when removed the filling will be found hard as stone. There is nothing better for lining cavities, holding nerve-caps in position, holding a preparation in place when devitalizing a pulp where the tooth is so much broken away as to make it difficult to prevent a filling showing through the enamel, and for many other purposes."
High-heat gutta-percha has been used as a base in deep occlusal, buccal, and approximal cavities, [94] completing the fillings with tin. Occlusal cavities may be filled with tin ”

“ Evidently desiring to describe the mode practised by the specialists of those days for fixing artificial teeth, he erroneously imagines that the metal thread was passed through the holes drilled in the natural teeth; this would have been impossible, first, because of the atrocious pain due to the sensibility of the dentine and of the dental pulp, and then because of the pathological consequences to which the perforation of the teeth would have given rise. ”

“ Although the dentine is not as unchangeable as enamel, but manifests, by becoming firmer or softer, that it is not quite uninfluenced by tissue-changes, yet its caries is not an irritative process that the dentine takes an active part in, but a passive process, and consequently the removal of all diseased portions and the protection of the non-carious part of the tooth suffices to stay the morbid process completely. ”

“ Unfortunately the great majority of parents rarely think of their children's teeth until too late to preserve them intact. Even among families where the rule of brushing the teeth twice daily prevails, regular dental examination is often not required. Doctors and dentists themselves have not been trained to realize that the teeth are a most dangerous source of infection when unclean. Does your dentist insist upon removing tartar and food particles beyond your reach, upon polishing and cleansing, or does he regard these as vanity touches, to be omitted if you are in a hurry? ”

“ It is a good material for filling many cavities in the temporary teeth, and children will bear having it used, because it can be placed quickly, and but little force is required to condense one or two layers of No. ”