CONSERVATIVE DENTISTRY VERSUS TOOTHEXTRACTION. By J.
MILLER, L.
D. S. R. C. S.
It is not a little mortifying to those members of the dental profession, who aim at the highest ideal of their art, " The Conservation of the natural teeth," to find that the majority of the public still associate their work with the extraction of teeth, and the supply of artificial substitutes. This ignorance will not be considered so strange, as the same estimate ot the scope of dentistry is held, I regret to say, by far the larger proportion of the medical profession. Mr. F. N. Pedley, Dental Surgeon to Guy's Hospital, in a recent number of the Journal of the British Medical Association, on " How to reform the dental departments of our hospitals," " What can be more damaging to our says : profession, which rightly claims to be a branch of surgery, than the lamentable fact that medical men so frequently feel obliged to admit utter ignorance of the subject. The work done at the dental hospitals is admirable, but busy medical students cannot give the time to attend there, and they go into practice with the idea that the extraction of teeth, and their replacement artifiand science." cially, form the limit of our practice He proceeds to say that " the fault lies with those dentists connected with general hospitals, who do not take practical means to dissipate the illusion," and concludes by advising the increase of the dental staff at such institutions; so that something besides the skilful handling ot the forceps may be demonstrated for the benefit of the students, as well as for the patients
operated upon. I cordially agree with Mr. Pedley in his remarks, and wish him every success in his efforts, as until the medical profession begin to place a higher estimate upon our services, it is hopeless to expect that appreciative co-operation of our patients, which is indispensable to the advaucemeut of dentistry. It is this low estimate and
want of appre-
higher capabilities of dental England, or, I may say in Europe,
ciation of the
sur-
that gery in has allowed America to take the lead in everything appertaining to the dental art; and the Americans are at this moment, where we shall be if we are lucky, in 10 years to come. The average patient in England will cheerful!/ for a set of teeth, pay 10, 20, or even 30 guineas where he would begrudge half that sum for a conservative operation to preserve his natural ones. In America directly the opposite obtains an artisan, shop assistant, or a servant eveu, will willingly pay a 20 or 25 dollar to have the teeth filled, where they would
?there
girl
fee consider 10 dollars sufficient for artificial sub-
stitutes. 36
THE INDIAN MEDICAL GAZETTE.
270
[Sept.,
1888.
To extract a few decayed teetli and take the There can be no doubt but that much of the disfavour with which stopping of the teeth is model of a patient's mouth, does not call for a looked upon by a great many patients, is the very high degree of skill ; in fact, except for result of the culpable carelessness, and often it these preliminaries, it is work which can be, is to be feared, ignorant manner in which the and very often is, handed over to an aasistant operation is performed. Large amalgam fill- to complete. As these assistants can be had ings are frequently met with, placed almost or ad infinitum, it is easy to see how attractive the in direct contact with a living nerve, without mechanical work is, especially when rewarded any precaution {by a suitable nerve capping) to with liberal fees. To treat and save badly decayed teetli, to intercept the thermal changes, or to counteract the devitalizing influence of the mercury, with get diseased stumps into a healthy state, and which such stoppings are generally incorporated by fixing new crowns thereon make them useIn many instances where the pulp had become ful again for mastication is work which not diseased from exposure, instead of destroying and only requires a large expenditure of time and removing the morbid tissue to the very apices patience, but cannot be relegated to another to of the roots, rendering them thoroughly aseptic, perform. Hence the operating dentist ought, and filling the canals singly before attempting in all common fairness, to be paid lees commensurate with the higher training necessary to the to fill the tooth, us it should be done?shift is made by stuffing a pledget of cotton wool, successful performance of such work. saturated with creasote or other agent into the It, therefore, behoves everyone of us who are cavity, and placing over this what is intended impatient at the present state of affairs, to be The result of such for a permanent filling. up and doing, and to exert ourselves to the treatment can easily be imagined ?the pledget utmost in endeavouring to show our medical of wool soon forms a nest as it were for the friends, as well as our patients, that the true proliferation of the very worst elements of decay mission of our profession is to save rather than to and putrefaction, as no disinfectant or germisacrifice. cide yet discovered will long maintain any check That we shall eventually be able to dispense under such unfavourable conditions. with our foreceps altogether, I am not sanguine As an instance of the mischief accruing from enough to anticipate ; but as showing what may such malpractice, I may mention the case of a be done in the way of preserving the organs of young lady who was sent to me last cold wea- mastication, it will not be out of place to reShe was suffering from a fistulous openther. cord the result of the treatment of 1,000 teeth in situated immediately beneath the angle of various stages of ing decay, as presented in every the jaw, which had been troubling her for some practice. day eight or nine months. Her medical attendant had lanced it several times, and tried poulticing, but 720 A. Simple cavities with no beneficial result. Upon examining her B. Complicated cavities in which the mouth, I noticed a suspicious looking filling nerve required 71 capping in the second molar on the affected side, which Teeth in which the pulp was exposC. induced me to remove the tooth; when attached ed and diseased 78 to one of the roots was an abcess sac of an unin which Necrosed or those D. teeth, usually large size. A subsequent dissection of the nerve had died from expothe tooth showed it to be full of purulent matter, sure and other causes 88 and in the midst of in ...
...
...
which,
the
pulp cavity
was a
plug
tightly impacted
of cotton wool.
The key note to the whole question is education?and it was struck when a few bold spirits after infinite trouble and vexatious delay, succeeded in getting the Government of Great Britain to pass the Dentists Act of 1878 ;* since which time a change has 110 doubt taken place for the better, but it will be some years ere the new influence, which is gradually being infused into our ranks, will become sufficiently powerful to either oust the still remaining army of "tooth pullers," or compel them in selfdefence to adopt a different line of practice. *
This Act does not include India
has since
passed
Colonies will
an
soon
or the Colonies?Victoria Act of its own, and the other Australian
follow the example.
...
E. Abcessed teeth
...
F.
...
19
...
1,000
Extractions! Total
24
from the above table that the extractions are not quite 2 per cent, on the total number of cases; or if we count only the seriously affected teeth B, Cv D, E, the average is 7-25 per cent. It is only, however, fair to state, that among the 19 cases of extraction, were who did not present several mofussil It will be
seen
patients
themselves uutil the last extremity. f This does not include diseased stumps or teeth, which from old apre or other causes had become loose and useless for mastication.
MILLER, L.
D. S. R. C. S.
It is not a little mortifying to those members of the dental profession, who aim at the highest ideal of their art, " The Conservation of the natural teeth," to find that the majority of the public still associate their work with the extraction of teeth, and the supply of artificial substitutes. This ignorance will not be considered so strange, as the same estimate ot the scope of dentistry is held, I regret to say, by far the larger proportion of the medical profession. Mr. F. N. Pedley, Dental Surgeon to Guy's Hospital, in a recent number of the Journal of the British Medical Association, on " How to reform the dental departments of our hospitals," " What can be more damaging to our says : profession, which rightly claims to be a branch of surgery, than the lamentable fact that medical men so frequently feel obliged to admit utter ignorance of the subject. The work done at the dental hospitals is admirable, but busy medical students cannot give the time to attend there, and they go into practice with the idea that the extraction of teeth, and their replacement artifiand science." cially, form the limit of our practice He proceeds to say that " the fault lies with those dentists connected with general hospitals, who do not take practical means to dissipate the illusion," and concludes by advising the increase of the dental staff at such institutions; so that something besides the skilful handling ot the forceps may be demonstrated for the benefit of the students, as well as for the patients
operated upon. I cordially agree with Mr. Pedley in his remarks, and wish him every success in his efforts, as until the medical profession begin to place a higher estimate upon our services, it is hopeless to expect that appreciative co-operation of our patients, which is indispensable to the advaucemeut of dentistry. It is this low estimate and
want of appre-
higher capabilities of dental England, or, I may say in Europe,
ciation of the
sur-
that gery in has allowed America to take the lead in everything appertaining to the dental art; and the Americans are at this moment, where we shall be if we are lucky, in 10 years to come. The average patient in England will cheerful!/ for a set of teeth, pay 10, 20, or even 30 guineas where he would begrudge half that sum for a conservative operation to preserve his natural ones. In America directly the opposite obtains an artisan, shop assistant, or a servant eveu, will willingly pay a 20 or 25 dollar to have the teeth filled, where they would
?there
girl
fee consider 10 dollars sufficient for artificial sub-
stitutes. 36
THE INDIAN MEDICAL GAZETTE.
270
[Sept.,
1888.
To extract a few decayed teetli and take the There can be no doubt but that much of the disfavour with which stopping of the teeth is model of a patient's mouth, does not call for a looked upon by a great many patients, is the very high degree of skill ; in fact, except for result of the culpable carelessness, and often it these preliminaries, it is work which can be, is to be feared, ignorant manner in which the and very often is, handed over to an aasistant operation is performed. Large amalgam fill- to complete. As these assistants can be had ings are frequently met with, placed almost or ad infinitum, it is easy to see how attractive the in direct contact with a living nerve, without mechanical work is, especially when rewarded any precaution {by a suitable nerve capping) to with liberal fees. To treat and save badly decayed teetli, to intercept the thermal changes, or to counteract the devitalizing influence of the mercury, with get diseased stumps into a healthy state, and which such stoppings are generally incorporated by fixing new crowns thereon make them useIn many instances where the pulp had become ful again for mastication is work which not diseased from exposure, instead of destroying and only requires a large expenditure of time and removing the morbid tissue to the very apices patience, but cannot be relegated to another to of the roots, rendering them thoroughly aseptic, perform. Hence the operating dentist ought, and filling the canals singly before attempting in all common fairness, to be paid lees commensurate with the higher training necessary to the to fill the tooth, us it should be done?shift is made by stuffing a pledget of cotton wool, successful performance of such work. saturated with creasote or other agent into the It, therefore, behoves everyone of us who are cavity, and placing over this what is intended impatient at the present state of affairs, to be The result of such for a permanent filling. up and doing, and to exert ourselves to the treatment can easily be imagined ?the pledget utmost in endeavouring to show our medical of wool soon forms a nest as it were for the friends, as well as our patients, that the true proliferation of the very worst elements of decay mission of our profession is to save rather than to and putrefaction, as no disinfectant or germisacrifice. cide yet discovered will long maintain any check That we shall eventually be able to dispense under such unfavourable conditions. with our foreceps altogether, I am not sanguine As an instance of the mischief accruing from enough to anticipate ; but as showing what may such malpractice, I may mention the case of a be done in the way of preserving the organs of young lady who was sent to me last cold wea- mastication, it will not be out of place to reShe was suffering from a fistulous openther. cord the result of the treatment of 1,000 teeth in situated immediately beneath the angle of various stages of ing decay, as presented in every the jaw, which had been troubling her for some practice. day eight or nine months. Her medical attendant had lanced it several times, and tried poulticing, but 720 A. Simple cavities with no beneficial result. Upon examining her B. Complicated cavities in which the mouth, I noticed a suspicious looking filling nerve required 71 capping in the second molar on the affected side, which Teeth in which the pulp was exposC. induced me to remove the tooth; when attached ed and diseased 78 to one of the roots was an abcess sac of an unin which Necrosed or those D. teeth, usually large size. A subsequent dissection of the nerve had died from expothe tooth showed it to be full of purulent matter, sure and other causes 88 and in the midst of in ...
...
...
which,
the
pulp cavity
was a
plug
tightly impacted
of cotton wool.
The key note to the whole question is education?and it was struck when a few bold spirits after infinite trouble and vexatious delay, succeeded in getting the Government of Great Britain to pass the Dentists Act of 1878 ;* since which time a change has 110 doubt taken place for the better, but it will be some years ere the new influence, which is gradually being infused into our ranks, will become sufficiently powerful to either oust the still remaining army of "tooth pullers," or compel them in selfdefence to adopt a different line of practice. *
This Act does not include India
has since
passed
Colonies will
an
soon
or the Colonies?Victoria Act of its own, and the other Australian
follow the example.
...
E. Abcessed teeth
...
F.
...
19
...
1,000
Extractions! Total
24
from the above table that the extractions are not quite 2 per cent, on the total number of cases; or if we count only the seriously affected teeth B, Cv D, E, the average is 7-25 per cent. It is only, however, fair to state, that among the 19 cases of extraction, were who did not present several mofussil It will be
seen
patients
themselves uutil the last extremity. f This does not include diseased stumps or teeth, which from old apre or other causes had become loose and useless for mastication.
