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VOLUME XII.
1922.
EDITOR:
Wallace Seccombe, D.D.S., F.A.C.D., Toronto, Canada.
CONTRIBUTING EDITORS:
C N. Johnson, M.A., D.D.S., F.A.C.D Chicago
Richard G. McLaughlin, D.D.S Toronto
W. E. Cummer, D.D.S Toronto
J. Wright Beach, D.D.S Buffalo, N.Y.
DEPARTMENTS
To THE Dental Profession:
C. N. Johnson, M.A., D.D.S., F.A.C.D., Chicago.
MULTUM IN ParVO:
C. A. Kennedy, D.D.S., Toronto, Canada.
The Compendium:
Thos. Cowling, D.D.S., Toronto, Canada.
Published by
ORAL HEALTH PUBLISHING CO.
Toronto, Canada.
INDEX-
Page
PHOTOGRAPHS
A.bbott, Lt.-Col. Harry R.,
L.D.S., D.D.S., M.D.S., Lon-
don, Ont 2
Beatty, W. J., R.C.A., Toronto 112
Moore, F. Percy, L.D.S., D.D.S.,
Hamilton, Ont 302
Orton, Forrest H., D.D.S.,
F.A.C.D., St. Paul, Minn. . . 7G
Whittaker, H. F., B.D.S.,
F.A.C.D., Edmonton, Alta. . . 302
Wilson, Dr. George H., Cleve-
land, Ohio 149
Woodbury, Frank, D.D.S.,
Ph.D., Halifax, N.S 40
CONTRIBUTORS
Ante, I. H., D.D.S, Toronto . . 56
Anthony, L. P., D.D.S. , Phila-
delphia, Pa 354
Ausubel, Herman, D.D.S.,
Brooklyn, N.Y 208
Bagnall, J. Stanley, D.D.S.,
Halifax, N.S.. 69-102-213-256-330
Beach, J. Wright, D.D.S.
(Habec), Buffalo, N.Y 170-
211-257-295-368-403
Blum, Theodor, D.D.S., M.D.,
New York 177
Box, Harold K., D.D.S., Ph.D.,
F.A.A.P., Toronto . . 185-223-265
Brekhus, J. P., B.A., D.D.S.,
Minneapolis, Minn 89
Brown, Robt. K., D.D.S., Ann
Arbor, Mich 150
Cameron, Dora Lawrence,
Wenatchee, Wash... 25-61-84-107-
143-173-212-219-258-
320-365-410
Campbell, Dayton D., D.D.S. . . 175
Cannon, Raymond F., D.D.S.,
Ann Arbor, Mich 158
Cecil, Captain George, Paris,
France 405
Clay, John W., D.D.S., Cal-
gary, Alta 254-363
Page
Cowling, Thomas, D.D.S., To-
ronto 26-70-97-140-335-372-437
Cox, George E 210
Cummer, W. E., D.D.S., To-
ronto 149-303-339
Day, Roscoe A., San Francisco,
Cal 427
Falconer, Sir Robert, To-
ronto 321
Forsyth, T. O., D.M.D 134
George, Dr. Ruggles 422
Grant, E. A., D.D.S., Toron-
to 133-395
"Habec" (Dr. J. Wright
Beach), Buffalo, N.Y. .. 170-211-
257-295-368-403
Hacking, W. J., D.D.S., New
Westminster, B.C 172
Hippie, A. H., D.D.S., Omaha,
Neb 261
Hunter, Wm., C.B., M.D.,
F.R.C.P., London, Eng 411
Howard, G. C, D.D.S., West
Union, W.Va 218
Johnson, C. N., L.D.S., M.D.S.,
M.A., Chicago, 111. . . 24-105-167-
366-401-433
Kawakami, Tamejiro, D.D.S.,
Tokyo, Japan 4
Kennedy, C. A., D.D.S., To-
ronto . . 23-67-108-133-334-362-374
Kennedy, Edward, New York. 174
Kritchevsky, Dr. B., Paris,
France 418
Lindsay, Ashley W., D.D.S.,
China 55-85-144
MacBoyle, R. E., D.D.S., Chi-
cago, 111 77
McDonald, P. E., B.Sc, To-
ronto 47
McLaughlin, R. G., D.D.S., To-
ronto ; 72,220,441
Moore, F. Percy, D.D.S., Hamil-
ton, Ont 390
Nelson, A. A., D.D.S., Detroit,
Mich . 31
INDEX — (Continued)
Page
Oberg, A. T., D.D.S., Vancou-
ver, B.C 253
Orton, Forrest H., D.D.S.,
F.A.C.D., St. Paul, Minn. . . 14
Parker, C. W., D.D.S., Regina,
Sask 32-255-294
Porter, John F., Toronto .... 90
Seccombe, Wallace, D.D.S.,
F.A.C.D., Toronto . . . 43-130-265
Seguin, Dr. P., Paris, France . 418
Smith, Tom, D.D.S., Langdon,
N.D 375
Thompson, Lt.-Col. W. G., Ham-
ilton, Ont 258
Thornton, A. W., D.D.S., Mon-
treal, P.Q. . 117
Thornton, R. D., D.D.S., To-
ronto 14
Trigger, T. C, D.D.S., St.
Thomas, Ont 61
Wright, W. W., D.D.S., Winni-
peg, Man 33-68-216-364
ORIGINAL COMMUNICATIONS
Abbott, The Late Harry R. . . 105
Adams, J. G., Dentist and
Philanthropist 265
Autogenous Vaccines in Cases
of Focal Dental Infection,
Use of 134
Betty Suck Your Thumb 219
Bridge Work, Favorable Con-
ditions for 14
California State Dental Asso-
ciation, Report of Science
and Literature Committee . . 174
Cast Gold Inlay, General Con-
siderations of the 158
Classification of Tooth Prepar-
ations for Bridge Abutments
on Vital Teeth 89
Constructive Optimism 403
Crime of Indifference, The . . 25
Crown and Fixed Bridge Work
Modernized 77
Dental Library, The Necessity
for a 90
Dental Missionary: His Place
and Opportunities, The .... 85
Pago
Dental Nomenclature, Report
of Committee on 354
Dental Nurse in Embryo, The 333
Dental Service, Dept. of Public
Health, Toronto, Annual Re-
port of 113
Dentinal-Cemental Junction,
The 185
Dirty Dishes 143
Discoloration of Gums and
Mucous Membrane of the
Mouth 47
Do Unto Others 173
Empyema of the Antrum;
Case Report 172
First Teeth, The 84
Foundation and the Super-
structure, The 117
"Habec" Makes a Flying Trip
into Highbrowland 211
"Habec" Re-appears 170
Histological and Histo-Patho-
logical Studies of the Den-
tal Pulp 223-265
How to Chew 365
How to Study 56
Inside and Outside 25
Jungle Dentistry — A Danger-
ous Operator 405
Malocclusion as a Factor in
Deformity 375
Mayo Clinic, A Visit to the . . 167
Moving In 212
National Dental Association
and Return, To the. . ..366-401-433
Nerve Specialist, A 320
Nurses' Lectures, Outline of. . 130
One in Four Thousand 21
Ontario Dental Association,
President's Address, May,
1922 390
Orologist 21
Our Little Friends 368
Plenty of Water 60
Pre-Dental Year, The 43
Professional Individuality .... 295
President's Address, O.D.A.,
May, 1922 390
Prospects for Dental Practi-
tioner in Quebec Province.. 126
INDEX— (Continued)
Page
Six-Year Molars 258
Somnoform, A Valuable Aid in
Dentistry 395
Theory and Practice of Par-
tial Denture Service, An Out-
line of the 303-339
Those Precious Teeth 107
Two Curtains 410
Way, Henry H., D.D.S., St.
Thomas — An Appreciation .
West China Union Univer-
sity, The First Graduate of
the
West China Union University
and Dental College 144
When the Dentist Wakes Up. 257
W^ilson, Dr. George H., Cleve-
land, Ohio, — An Apprecia-
tion
Winnipeg Friend Writes to
"Habec," A
61
00
149
332
PROVINCIAL EDITORS'
CORNER
Alberta 254-363
British Columbia 217-253
Manitoba 33-68-216-332-364
Maritime Provinces. 34-69-102-213-
256-330
Ontario 256
Saskatchewan 32-255-294
SELECTED ARTICLES
Arrangement of Teeth in Par-
tial Denture Construction . 31
Bacteriology of Dental Caries,
The 370
Cast Swedged Gold Base .... 175
Deciduous Teeth, The 427
Dental Public Service in Japan
— Its Present Condition .... 4
Denture Construction 176
Dignity and Importance of
Dentistry, The 65
Diseases of the Teeth and
Mouth as Causes of Organic
Disease 165
Fit for Any Queen 422
Page
Full Time System For Teach-
ers in Medicine, The Pros
and Cons of the 424
Growing Old 13
Local Versus General Anes-
thesia 208
March Winds, The 146
Modelling Compound in Im-
pression Taking, Use of ... 174
Nature and Manipulation of
Dental Amalgams and a
Standardized A m a 1 g a m
' Technique, The 150
Oral Surgery for the Dental
Practitioner 177
Orthodontia, Its Place in a
Dental Course 261
Practical Hints for Oxygen
Gas Extractions 210
Rational Treatment of Pyor-
rhea Alveolaris, The 41S
Septic Anaemia as a Complica-
tion of Pernicious Anaemia 411
Teaching of Mouth Hygiene in
the Public Schools, The 218
What Should the Dental Stu-
dent be Taught, so that he
may have a Correct Appre-
ciation of His Relation to
Affairs of Life, — Ethical,
Political. Economical, Finan-
cial? 321
When Finances Permit 148
Why Not Give a Lecture? ... 145
EDITORIALS
Camouflage "Dental Water".. 36
Dental Conventions and Manu-
facturers' Exhibits 182
Dental Profession United, The 147
Dental Office Inspection 337
Dentist as a Defendant in a
Suit for Alleged Malprac-
tice, The 72
Dentist as an Expert Witness,
The 220
Dentistry and the Daily Press 259
T^enti«try and Health Propa-
ganda 183
Dominion Dental Council 299
INDEX — (Continued)
Page
Nineteen-twenty-two — A Get-
together Year for Canadian
Dentists 35
Public Responsibility of Den-
tal Colleges 109
Respect for Law and Order . . 73
Rotary and School Dental
Clinics 373
Should Professional Men Ad-
tise? 409
Unprofessional Conduct 441
Why You Should Attend the
C.D.A. Convention This
Year 37
EDITORIAL NOTES
Dr. Beach President of a
Great State Philanthropy . . 300
C.D.A. and O.D.S. Convention 74
Dental Index Bureau Organ-
ized 1909 110
Dominion of Canada Income
Tax Returns 148
Downing, Dr. Augustus S.,
M.A., LL.D., Honored 74
In Honor of Drs. Noyes and
Gilmer 222
Modern Crown and Bridge
Work 222
Post Graduate Course, R.C.D.S. 300
Will You Be Alive Next Year? 184
COMPENDIUM
Pages 26, 70, 97, 140, 335, 372
MULTUM IN PARVO
Pages. 23, 67, 108, 133, 334, 362, 374
OBITUARY
Abbott, Lt.-Col. H. R., L.D.S.,
D.D.S., M.D.S. London, Ont. 3
Adams, Dr. J. G., Toronto... 265
Steele, Mr. Thos., Columbus,
Ohio 417
Wilson, Dr. George H., Cleve-
land, Ohio 149
Woodbury, Dr. Frank, Halifax,
N.S 41
Page
SOCIETY PROCEEDINGS
Alpha Omega Convention .... 410
American Academy of Perio-
dontology 67
American Dental Library and
Museum Association 108
American Institute of Dental
Teachers 374
American Society of Ortho-
dontists 67-410
C.D.A. and O.D.S. Convention
22-67-315^ft*5 ^7 '
California State Dental Asso-
ciation 174
Dewey School of Orthodontia,
Alumni Society 22
Michigan State Dental Society 338
National Dental Association
Convention 67-166
Ontario Dental Society, Presi-
dent's Address, May, 1922.. ^5 3^\
Waterloo County Elects Offi-
cers 256
MISCELLANEOUS
Book Review, "Electro-Radio-
graphic Diagnosis" ........ 37
Canadian Dental Research
Foundation, Convention Re-
port 315
Dominion Dental Council Ex-
amination Results 11-359
Index of Dental Periodical
Literature, Annual . 338
Marking Palatal Denture
Limits 181
Michigan State Dental Exam-
inations 96-336
Post Graduate Course for
Dental Practitioners .297
Setting Up Diatoric Teeth .. 166
I
In this theatre of man's life,
it is reserved only for God
and angels to be lookers-on.
— Pythagoras
Lt.-Col. Harry R. Abbott, L.D.S., D.D.S., M.D.S.
London, Ontario.
Born 1855. Died 20 December, 1921.
gD=
DlL
OPAL HEALTA
A JOURNAL THAT STANDS FOR THE ** OUNCE OF
PREVENTION," AS WELL AS THE ** POUND OF CURE**
m
m
VOL. 12
TORONTO, JANUARY, 1922
No. 1
In Memoriam
Dr. H. R. Abbott, L.D.S., M.D.S., London, Ont.
IT IS with profound regret that we chronicle the passing of Dr.
Harry Abbott, one of the outstanding figures of Canadian Den-
tistry, who, after an illness of some weeks, died in Victoria Hos-
pital, London, on Tuesday, the 20th of December, 1921, in his
67th year.
Dr. Abbott was a native of London, being the youngest son
of the late Alexander S. Abbott, who was City Clerk for over thirty-
two years. After completing his dental course at the Royal College
of Dental Surgeons, he practiced in Exeter for a short period, and
then returned to London and engaged in practice with the late Dr.
Li. H. Nelles, subsequently opening an office of his own in the Edge
Block. He remained unmarried and resided with his sister, Mrs.
A. J. Tully. Besides his sister, he is survived by two brothers.
Samuel W., of London, and Alexander W., of Charleston, 111. W.
H. Abbott and Drs. Chester and E. C. Abbott are nephews.
Dr. Abbott's work as a member of the Board of Directors of the
R. C. D. S., extending over a period of twenty-two years, was much
appreciated by the Dental Profession. Commencing as President of
the London Dental Society, he has held the office of President of
Ontario Denial Society, President of the R. C. D. S. Board of Direc-
tors, and of the Dominion Dental Council. He was a member of
the Executive of the D. D. C. from its inception to the time of his
death.
In recognition of Dr. Abbott's most worthy and continuous ser-
vice to the Dental Profession and his Alma Mater, the Board of
4 ORAL HEALTH
Directors of the R. C. D. S. about a year ago hung an oil portrait
upon the walls of the College, of which the frontispiece of this issue
is a reproduction.
It was not alone in dental circles that Dr. Abbott was well and
favorably known. As Lieut. -Colonel of the First Hussars, he took
over command of that regiment in 1911. Dr. Abbott endeared
himself to his officers and men, and on that memorable Sunday of
August 4th, 1914, he offered the services of himself and regiment
for duty overseas. He was also a popular member of the London
Hunt and Country Club, in the days when riding to the hounds was
a much-followed pastime. Dr. Abbott was active in the work of
the London Old Boys* Association, and was President of this body
at the time of his death. He was also a prominent member of the
Masonic Order, being President of Tuscan Lodge No. 195, Past
Potentate of Mocha Temple, member of St. John's Chapter Royal
Arch Masons, member of Richard Coeur de Lion Preceptory, and
a member of the Scottish Rite. Dr. Abbott was also a member of
Eureka Lodge I. O. O. P., and an attendant of the First Methodist
Church, London.
All the bodies above mentioned were represented at Dr.
Abbott's funeral, and the large group of citizens and many messages
and floral tributes from distant points bore eloquent testimony to
the high esteem in which Dr. Abobtt was held by his many friends.
The Dental Profession has suffered a great loss in the passing over
of Harry Abbott, and his years of unselfish service for his chosen
profession will prove an inspiration to all the younger graduates.
When the history of Canadian Dentistry is written. Dr. Abbott's
name will occupy an important place, because of the constructive
work which he accomplished.
Dental Public Service in Japan^Its Present
Condition
Dr. Tamejiro Kawakami, Tokyo Dental College.
DENTAL public service in Japan has made great progress
m recent years as in other countries of the world. Serious
harm which one's oral sepsis inflicts upon his general health
bemg well recognized by Japanese in general, the importance of
oral hygiene finds an active response on the part of the educators
and the civil officials as well as physicians and dentists, the more
so because of the popular approval of the theory of focal infection,
recently developed in the United States. Hygiene for children
ORAL HEAL 1 H 5
also attracted the attention of the Government officials upon the
conclusion of the recent European war and caused several institu-
tions to be newly established and developed.
Dental Association Has Contributed Much.
The Dental Societies' Association of Japan is the most compre-
hensive dental association in Japan, combining 65 dental associations
throughout the country since its inauguration in 1 893. It is constantly
striving toward the study of dental administration and popularization
of oral hygiene, and has, in fact, contributed a great deal for the
dental, public service in Japan. The president is Dr. Morinosuke
Chiwaki.
Oral inspection of school children is carried out by the school
medical inspectors in elementary schools, in compliance with the
legal provision regarding the school medical inspection.
Oral Inspection Practiced Regularly.
The educational department ordinance of March, 1900, regu-
lating medical inspection of pupils from elementary course to college
course, specifies that oral inspection must be carried out annually
together with other physical inspection, giving '*teeth'* as an item,
and in its revision of 1912, modified the specification into an examin-
ation of "decayed teeth," in particular, which apparently excludes
attention to other oral diseases. This is perhaps because of the tact
that Japanese schools take their medical inspectors' staff exclusively
from physicians and can not require of them the minute dental
examination of the children's teeth. The medical (sanitary) authori-
ties of the educational department, however, are earnestly endeavoring
to make good this defect, and give lectures to the school medical
inspectors in the department every year in order to let these physicians
learn something of dental specialties from the dental specialists.
Moreover, people are alive to the influence which defective teeth
exercise upon the health of children, and fully appreciate the urgent
necessity of providing their schools with dentists; so the day to see
modification of the school medical-inspection regulation which will
require the provision of a dental surgeon for each school may not
be far distant.
Some Cities Employ Dental Assistants.
In certain cities and districts where people entertain advanced
ideas in sanitation a dental assistant to the school medical inspector
is engaged to allow children to undergo a fuller oral inspection, and
in Tokyo they commenced, in 1919, to let school children undergo
an inspection by dental experts in civil practice, i.e., dentists not of
the regular school inspector staff. Kyoto (which is the former
capital, with a population of 591,305), and Hiroshima (one of the
6 ORAL HEALTH
largest cities in the west, population 160,504), practice a similar
method. The percentage of children suffering from decayed teeth
was found as follows in the recent inspection:
Percentage
of Children Percentage of
^r , r- . ^ Suffering From Decayed
IName of Lxaminer Towns Decayed Teeth Teeth
Kawakami Tokyo 89. 5 21.0
C>o Suburbs of Tokyo. . 86.0
Yamamoto Kyoto 91.0 13.4
Nittono and Matsui . . . Chiba 98 . 9 22 . 0
Many Children Have Decayed Teeth.
These figures show that the average number of sufferers from
decayed teeth among Japanese children in the city schools are some
90 per cent., almost at the same level as that of Europe and America.
At the joint inspections by Drs. T Kakawami and S. Endo in June,
1919, in the Fourth Middle School, of Tokyo (at present a typical
one m the prefecture from the standpoint of instruction), among boys
whose ages range from 12 to 19, the sufferers from decayed teeth
stood at 90.1 per cent., and the average number of decayed teeth
was four to each sufferer. Naturally, the condition was found in
the lower first molar more than in any other tooth. An investigation
at the Bancho Elementary School, in Tokyo, on July 8, 1919, showed
that of the 1,143 children there were 159 (13.8 per cent.) not making
use of the toothbrush at all, but the number decreased to 32 (2.8
per cent.) after a lecture on hygiene.
School Dental Clinics.
Few Japanese elementary schools are provided with dental
clmics. We much regret this, and are endeavoring to persuade the
educational authorities to appreciate the defect, and we have come
to the conviction that several schools in Tokyo and Osaka should be
provided with them in the near future. Not a few middle schools
(m which the boys are chiefly from 1 2 to 17 years of age or more)
and girls' schools, however, are provided with them. In the First
Middle School of Tokyo prefecture Dr. M. Tone opened a clinic
in April, 1918, and the Third Girls' School of the same prefecture
has had one since 1915. Many elementary, middle, girls', and
normal schools now provide a room where the students may clean
their teeth.
ORAL HEALTH 7
Free Dental Dispensaries.
These are not many in number, also to our regret. Tokyo
has had one these several years in the naval hospital (accessible to
the public also) under the direction of Dr. T. Takashima. The
Tokyo Municipal Electric Work (street car and light) Committee
opened a dispensary for its w^orkmen in August, 1920, started by a
philanthropic co-operative association to which drivers, conductors,
signalmen, workshop employees, and other laborers only are admitted.
This dispensary had a dental clinic, chiefly attended by Dr. T.
Hasegawa. Again, the Saisei-Kwai (a philanthropic association
having as its foundation the fund contributed by the late Emperor
Meiji) is going to open a dental clinic in the near future.
Industrial Dental Dispensaries.
These have increased in number during recent years. Since
the factory law was passed in 1919, several factories have installed
their own dental dispensaries for the treatment of their workpeople.
These have been especially successful among the raw silk mills' workers
of Nagano prefecture (the largest silk-producing district in Japan).
A number of dispensaries have also been started in the various mining
districts. The one with the finest equipment is found to be that of
the Japan steel factory of Muroran, in the Hokkaido (the North
Island or Yezo), for many years under the superintendency of Dr.
H. Ishihara. Last November the Hidachi gold mine (about 80
miles northeast of Tokyo, owned by Mr. F. Kuhara, who made a
fortune in the recent war) established a very line dental clinic, headed
by Dr. S. Aoki, for the benefit of the miners.
Oral Hygiene Exhibitions.
Several of these have been held in recent years, either indepen-
dently or subordinate to the general hygiene exhibitions, and a number
of specimens, models, and charts have been shown to enhance the
public knowledge of oral hygiene. The Dental Societies' Association
of Japan has prepared three sets of specimens for exhibitions, each
consisting of 45 models and 65 pictures, and offers them free of charge
to any exhibition to be held. A hygiene exhibition seems to be one
of the most popular entertainments for the up-to-date Japanese and
interests people at large, men and women, old and young.
In consideration of this the bureau of hygiene has been
encouraged to hold a number of these exhibitions in quick succession
in combination with various private societies having a similar objecc
in view. The same bureau has this year opened a hygiene exhibition,
giving, of course, a place to oral hygiene, and has enlightened the
Fokyo people in no small measure, attracting visitors to the number
of 30,000 during the session between October 24, 1 920, and Novem-
8 ORAL HEALTH
ber 21. The bureau took this opportunity to attempt a step further
toward the prevention and stamping out of such alleged national
diseases as tuberculosis, trachoma, and dental ailments, etc., empha-
sizing the necessity of taking precautions against them. They held
*'Tuberculosis day" on October 30, "Oral Hygiene day" en Novem-
ber 5, and "Trachoma day" on November 3, in 1920, this being the
first attempt of the kind in this country. That this step has awakened
the people to the necessity of being on their guard against dental
ailments is very interesting to us, and shows the great advance which
the theory of oral hygiene has made in recent years.
Public Propaganda for Oral Hygiene.
Oral Hygiene Day. — The success of "Oral Hygiene Day" was
due to the efforts of the Dental Societies' Association of Japan and
the Tokyo Dental Association. They got nine motor cars for general
propaganda and several others to assist, assigning three each to the
three divisions into which the city had been divided for the work of
the day. In each of these cars one or two dentists, accompanied by
press men and civil officials, set out and, flying the flag of propaganda
for precaution against decayed teeth, ran through almost all the
important streets of the city and delivered speeches at almost every
corner and square to impress the people of the dangers arising from
neglect of the teeth. In addition, about 500 students of the six
dental colleges of the city stationed themselves at more than 60 posts
here and there in the town in groups of half a dozen or so, and
distributed handbills and the small flags of dental propaganda among
the passers-by. As the handbills and small flags thus given out number
200,000 and 50,000, respectively, it follows that nearly one out of
every ten of the 2,173,162 inhabitants of Tokyo was presented with
either a handbill or a small flag in this way.
Further Campaigns Have Been Arranged.
The publicity of this "Decayed-teeth day" movement was
extensive. The chief dailies of the city all gave their assistance and
popularized its purport throughout the country. Encouraged by this
success, further campaigns of a similar nature have been arranged,
one to be held next year. None of the Japanese cities has as yet
inaugurated an oral hygiene week Hke that of New York as their
municipal work, but they pay due attention to movements of this
sort, and we may well expect to see such a movement realized on a
somewhat large scale under public auspices in the near future. As
an instance of its practice in a hmited scope, we may mention the
Hikawa Elementary School of Akaska (this district being chiefly
inhabited by the educated class). Mr. S. Asakura, the master of
this school, is an earnest advocate of oral hygiene. He appointed
ORAL HEALTH 9
an oral hygiene week in his school in December, 1916, this being his
first attempt, and repeated it between May 30, 1920, and June 5,
on both occasions presenting to his pupils the necessity of oral hygiene.
The result of his first attempt was, that on the first day of the
week of the 834 children of the entire school, only 479 (58 per cent.)
made use of their toothbrush, while at the end of the week the per-
centage of those using the toothbrush once a day only was 96 and
those using it twice a day was 78.
The writer fully trusts that Japan will soon witness '*Oral
Hygiene Week" carried out in the same manner as it has been in
New York and in other western cities.
Free Oral Hygiene Lectures.
These lectures are held very often in various parts of the country.
They are given in the elementary schools, middle school, girls' schools,
and normal schools. There are also lectures given for the general
public.
Oral Hygiene Lectures by the Dental Societies* Association of
Japan. — The association has for its members the dental specialists
of the country and has up to this time done much for the promotion
of oral hygiene throughout Japan. Their lecture corps commenced
its work in 1914, with Dr. Yoshio Mukai as one of the lecturers. His
lectures are frequently given in connection with the various exhibitions,
hygienic and otherwise, accompanied by pictures from his magic
lantern, and also by moving pictures having for their subjects "Oral
Hygiene" or "Toothache." The films are chiefly imported from the
United States, and the lantern slides have been specially designed for
the association by Dr. Okumura.
Lecturers Supported by Private Funds.
Travelling Oral Hygiene Lectures. — Mr. Tomijiro Kobayashi,
of Tokyo, has spent an immense amount of money from his own pocket
for the popularization of oral hygiene, and has financially supported
this lecture corps, beginning with 1913 up to the present. The corps
travels about the country and freely offers their services for a talk
on oral hygiene to any elementary, middle, girls', or normal school
and also to the general public.
Mr. Kobayashi inherited a strict devotion to Christian doctrines
from his late father, who originated the idea of this lecture corps, it
being a natural outcome of his sincere religious altruism. The corps
has among its lecturers Drs. Sosaku Midorikawa and Gisaburo
Shimidzu. To the former is to be accredited the honor of having
outlined the plan for the lecture corps in accordance with Mr. Kobay-
ashi's idea, who assisted him to put it upon the solid foundation on
which, very fortunately, it stands at present. This, no doubt, is
fully worthy of a minute description in the history of Japanese oral
10 ORALHEALTH
hygiene. Mr. Kobayashi has also given large contributions in his
efforts to popularize and spread oral hygiene knowledge.
Oral Hygiene Summer Lecture Class.
This was first opened in August, 1918, in Tokyo. Nearly 300
teachers, selected chiefly from the elementary schools, besides a num-
ber of instructors from the middle and normal schools, throughout
the country, attended a very successful course of lectures delivered
by physicians of high standing and by dental specialists. The course
covered one week. The second lecture, held in Tokyo in 1919, and
the third one, held in Kyoto in 1920, met with similar success. On
all these three occasions Mr. Kobayashi had been generous enough
to defray half the travelling expenses of each attendant.
Dental Education in Japan.
Finally, a word about the dental education in Japan. Japan
has 12 dental schools at present, of which 10 admit boys only and
two girls only. Of these four, known by the names of "Tokyo,"
"Nippon," "Osaka," and "Toyo," have the same standing as the
regular United States dental colleges, and students are licensed to
practice upon their graduation without Government examination. The
Tokyo Dental College, at present under the direction of Dr. M.
Chiwaki, dates from 1880, and is the oldest dental institution in Japan
and continues to send out the largest number of graduates every year,
70 per cent, of all the dentists in the country being alumni of the
Tokyo Dental College. Dr. Chiwaki has been the head and dean
of the college for a score of years, from 1 900 to 1 920, and is accredited
with the highest honors in Japanese dental circles.
Aided by Private Munificence.
Last year he generously consolidated the college he had founded
into a juridical foundation, the whole contribution being valued at
450,000 yen, or 225,000 American dollars. In addition to this,
through Dr. Chiwaki's efforts the sum of 650,000 yen ($325,000)
was presented to the college, contributed by alumni, dentists at large,
and public-spirited citizens. The latter fund is intended for the
enlargement and extension of the college buildings and equipment.
Other schools besides the above-mentioned four are of a little lower
standing, being chiefly night schools, and their graduates are licensed
to practice after passing Government examinations, which are held
every year.
Japan has not yet estabhshed a dental college under Govern-
ment control. Two medical colleges only among the various univer-
sities have dental departments, namely, the Tokyo Imperial University
and the Keio Gijuku University (founded by the late Mr. Yukichi
ORAL HEALTH
11
Fukuzawa). Three medical schools of high technical grade in the
cities of Chiba, Nagoya, and Kyoto, admitting directly the graduates
of the middle schools (explained before), and giving four years'
mstruction, have also their dental department, but they are provided
with clinics only, and no lectures are given.
Licensed Dentists Rapidly Increase.
The number of licensed dentists in Japan at present, according
to statistics taken in February, 1 920, is 6,409, or six times the number
m 1907. To this number is added the newly licensed dentists, num-
bering about 600 every year. This is a hopeful sign and the road
leading to a general understanding of oral hygiene in Japan stretches
before us bright and promising.^ — School Life.
Dominion Dental Council of Canada
Examinations September, 1921.
The following have passed in Physics and Chemistry:
Allen, E. F.
Atkinson, Wm.
Beattie, Preston
Bedell, Wilson
Brayley, R. E.
Cline, H. M.
Coon, A. W.
Coutts, W. M.
Crough, E. M.
Dobbs, E. R.
Flett, D. M.
Flora, W. S.
Ganthier. J. A.
Greig, G. I.
Harvie, H. G.
Heather, M. P.
Hendry, W. R.
Honey, E. M.
Johnson, K. P.
Kemp, F. F.
Lawley, J. H.
Mann, S. C.
Martin, G. M.
May, C. H.
Mahaychuk, M.
Miles. R. L.
Mitchell, Wm.
Mumford, J. R.
MacDonald, N. S.
Macdonald, H. W.
MacDonald, H. C.
MacLean, F. J.
Nelson, C. A.
Nowal, T. H.
Parrott, J. R.
Rowan, E. R.
Rubenstein, J.
Seal G. D. H.
Smith, W. L.
Somerville, E. S.
Stewart, E. A.
Staughton, G. E,
Tanton, C. A.
Taylor, A. W.
Trueman, Wm. L».
Tucker, M. S.
Usher, C.
Whyte, J. P.
Williams, R. A.
Wilson, R. H.
The following have passed in Physiology and Histology: —
Allan, A. W. M.
Allen, E. F.
Atkinson. Wm.
Beattie, Preston
Bedell, Wilson
Cline, H. M.
Coon, A. W.
Crough, E. M.
Dobbs, E. R.
Flora, W. S.
Gauthier, J. A.
Graham. J. E.
Greig, G. I.
Harvie, H. G.
Heather, M. P.
Hendry, W. R.
Hobbs, H. E.
Honey, E. M. •
Johnson, K. P.
Kay, L. D.
Kemp, F. F.
Lyons, G. W.
Mann, S. C.
May. C. H.
Mumford, J. R.
MacDonald, H. C.
MacLean, F. J.
McLachlan, H. T.
Nelson, C. A.
Nowal. T. H.
Noonan, R. L. A.
Pullar, T. G.
Rubenstein, J.
Smith, W. L.
Somerville, E. S.
Stewart, E. A.
Staughton, G. E.
Staughton, John O.
Tanton, C. A.
Towner, C. J.
Trueman, Wm. L.
Tucker, M. S.
Usher, C.
Vivian, F. W.
Ward, W. A.
Williams, R. A.
Wilson, R. H.
12 ORAL HEALTH
The following have passed in Operative Dentistry (Practical) : —
Rubenstein, J.
The following have passed in Prosthetic Dentistry (Practical) : —
Rubenstein, J.
The following have passed in Operative Dentistry (Written) : —
Dinnewell, R. E. MacKenzie, Annie S. Rubenstein, J.
Gott, A McDowell, W. A. Teal, G. E.
Whyte, J. P.
The following have passed in Prosthetic Dentistry (Written) : —
Akins, S. C. MacKenzie, Annie S. Teal, G. E.
Gott, A. Rubenstein, J. Whyte, J, P.
The following have passed in Anaesthetics: —
Dinnewell, R. E. McDowell, W. A. Teal, G. E.
Holt, T. F. Rubenstein, J. Whyte, J. P.
The following have passed in Materia Medica and Therapeutics —
Akins, S. C. Mitchell, Wm. Rubenstein, J.
Harvie, H. G. McDowell, W. A. Turner, Wm. J.
Kerr, W. J. Niebel, E. H.
The following have passed in Orthodontia: —
Dinnewell, R. E. MacKenzie, Annie S. Smith, G. R.
Dob'bs, E. R. Rubenstein, J. Teal, G. E.
Whyte, J. P.
The following have passed in Medicine and Surgery: —
Daly, A. P. Robbs, E. R. MacLeod, W. D.
Derbyshire, A. O. Holt, T. F. Rubenstein, J.
Dinnewell, R. E. Layton, N. Mc. Teal, G. E.
Whyte, J. P.
The following have passed in Pathology and Bacteriology : —
Akins, S. C. Kerr, W. J. Niebel, E. H.
Dobbs, E. R. Lawley, J. H. Rubenstein, J.
Flett, D. M. (Path.) MacDonald, H. W. Whyte, J. P.
The following have passed in Jurisprudence and Ethics: —
Dinnewell, R. E. Mitchell, Wm. Rubenstein, J.
Dobbs, E. R. MacKenzie, Annie S. Teal, G. E.
Whyte, J. P.
ORAL HEALTH
13
The following have passed in Anatomy:-
Allan, A. W. M.
Allen, E. F.
Atkinson, Wm.
Beattie, Preston
Bedell Wilson
Bliss. H. C.
Bradley, H. M.
Cline, H. M.
Coon, A. W.
Coutts, W. M.
Crough, E. M.
Dobbs, E. R.
Downe, F. N.
Flora, W. S.
Gauthier, J. A.
Graham, J. R.
Greig, G. I.
Heather. M. P.
Hendry, W. R.
Honey, E. M.
Johnson, K. P.
Kemp, F. F.
Lawley, J. H.
Maloney, Bertha
Mann, S. C.
Martin, G. M.
May, C. H.
Miles, R. L.
Mitton, G.
Morton, P. W.
Mumford J. R.
MacDonald, N. S.
MacDonald, Hubert C.
MacKenzie, Wm. F.
MacLean, F. J.
McBain, W. W.
McLachlan, H. T.
McLeod, D. A.
Nelson, C. A.
Nowal, T. H.
Noonan, R. L.
Parrott, J. R.
Porter, J. R.
Ross, B. R. .
Rowan, E. R.
Rubenstein, J.
Skilling. H. R.
Smith, W. L.
Somerville, E. S.
Stewart, E. A.
Staughton, G. E.
Staughton, John O.
Tanton, C. A.
Taylor, A. W.
Towner, C. J.
Treleane, R. L.
Trueman, Wm. L.
Turner, Wm. J.
Tucker, M. S.
Usher, C.
Walmsley, L. D.
Walsh, J. L.
Wansbrough, R. C.
Ward, W. C.
Weatherhead, W. A.
Weber, G. H.
Williams, R. A.
Wilson, R. H.
Woods, A. R.
Theory and Practice of Partial Denture Service
IN the next issue of Oral HEALTH we hope to publish a resume
of a paper upon the above subject by Dr. W. E. Cummer, as
presented before the Society of Dental Science of New South
Wales.
Growing Old. — Professor J. Arthur Thomson, in his admirable
book "The Control of Life," counsels his readers to cultivate as many
interests as possible. This is the most effectual way to keep the mind
young. It would be interesting to know what proportion of the com-
munity continue to the end of life to cultivate interests and thus to
widen their mental horizon. Not one in ten, perhaps not one in fifty.
The proportion is smaller among women than among men. Among
the masses the interest of the women is practically limited to domestic
affairs and local gossip. Even among the men of the educated
classes the mental outlook is often surprisingly narrow — limited, let
us say, to business and golf. Professor Thomson thus describes the
process of growing old: — "The bones become lighter and less re-
sistant, and some of them break easily; the muscles become weaker
and stiffer, hence the stoop; the nervous system becomes slower and
less forceful, and the heart less vigorous; the arteries are less elastic;
the parts begin to fail to answer to one another's call, and then from
hour to hour we rot and rot." — The Medical Press.
Favorable Conditions for Bridge Work
As Presented by Forrest H. Orton, D.D.S., Before the
Toronto Dental Society, December, 1921.
Reported by R. D. Thornton, D.D.S,
WHEN the subject of crown and bridgework is announced
as the topic for consideration at a dental meeting, the minds
of most dentists turn to the mechanical aspect of the subject,
i.e., methods of making these restorations. Dr. Orton, however,
chose to approach the subject in a very different but most interesting
and instructive manner. Instead of presenting some new mode of
abutment preparation or so-called self-cleaning intermediate section
of the bridge, he reviewed the conditions which the dental prac-
titioner should strive to establish so that the artificial appliance, when
inserted, might function, as nearly as possible, like the natural organs.
The following quotation from Dr. Orton's address, with the accom-
panying chart, will serve to introduce his views on this important
subject:
Quotation:
"Personal contact and familiarity with the opinions of your
Iv ading dentists and teachers, encourages me in believing that you
are in a receptive mood to receive the point of view I shall present.
"The many facts presented by the subject of Crown and
Bridge have been tabulated on this chart and this table forms the
working basis, in fact our only guide, in the construction of what
is known as fixed bridge work. In the construction of removable
bridge work we are influenced by these same factors, including sev-
eral coimplications owing to the nature of the work.
"An analysis of this table will show that our development has
been concerned principally in the details of construction and an
ingenuity in devising bridge attachments. As a result, no phase
of restorative dentistry can boast of as great a variety of methods
as can the art of crown and bridge, fixed bridge, removable
bridge, etc. Each method has been exploited with partisan zeal
by its particular advocates.
"The title of Crown and Bridge- on the programme usually
suggests or engenders in the mind of the reader the expectations of
some new method or improvement in method. We are still
depending upon the introduction of some method to solve the prob-
lem.
"I am going to ask you to view this subject from a different
angle and it is this: Is the method or the particular technique we
ORAL HEALTH
Chart edited by Dr. Edwin Mauk, University of California
Chart A
Conditions as Met — Crown and Bridgework.
Factors.
Favorable
Unfavorable.
Bridge space
Short
Long
Bridge alignment
Straight
Curved
"Bite"
Masticating force
Average
Light
Abnor- Close or
Abnor. long
Heavy-
Opposiag teeth
Artificial
Occl. length normal
Natural
Extruded
Abutments, position
Normal
Parallel
Out of arch
Converging
Diverging
Axes crossed
Abutments, roots
Normal number
Normal length
Normal direction
Fused
Short
Tortuous
Peridental
Attachment
of
Abutments
Thin, dense
Covers entire
Roots
Thickened
Loosened
Part destroyed
Inflamed
Pulps of
Abutments
Receded
Normal tone
Large (Yng. patient)
Diseased.
BASIC CONSTRUCTION PRINCIPLES— CROWN AND BRIDGEWORK.
1 — Physiologic Tone of all supporting and investing tissues.
2. — Adequate Support for the bridge structure in proportion to the work
demanded of it.
3 — Protection to Soft Tissues by outline and contour form in accord-
ance with Dental Anatomy.
4. — Normal Articulation — implying also Normal Occlusion. (Esthetics)
might employ after all the important thing? Should we regard crown
and bridge work as an end in itself or shall we regard it as merely
a means to an end?
"Since its introduction upwards of thirty years ago, there have
been great improvements and refinements of method. But as gen-
erally practised, it has failed to meet the prophylactic requirements
that are regarded as essential by the leading pathologists of today.
Every other branch of restorative dentistry, operative dentistry, pros-
thetic dentistry and even orthodontia, have had to face this problem,
and all with the exception of crown and bridge have progressed past
this stage of their evolution.
"Broadly speaking, they have all agreed on the same principle;
16 ORAL HEALTH
whatever the method employed, the end in view could be summed
up in the words, restoration of function.
"It was an epoch-making step in the evolution of each of these
divisions of dentistry, when a general recognition of the end in view
was regarded as the important thing and not the method.
"It is a significant fact that in each instance the advance, above
noted, was preceded by a study of unfavorable conditions to be met
and overcome, and a classification of these conditions.
"In operative dentistry the significance of the bearing which
normal shaped contact points had on production of unfavorable
conditions (interproximal space, well shaped embrasures, and the
areas of susceptibility and immunity) or on the production of favor-
able conditions.
"In prosthetic dentistry the study of the soft tissues, muscle
attachments and relation of occlusal planes to the condoyle path.
"In orthodontia the relation of the arches as influenced by bone
development, and success in diagnosis, are dependent upon how
clearly we are able to recognize and remove the unfavorable con-
dition caused by the absence of these factors.
"In no division of restorative dentistry are we confronted by
as many unfavorable conditions as in those cases of mutilated arch
due to the loss of one or more teeth where attempted repair by some
form of bridge work is usually resorted to.
"Lacking any data as to the progressive change following the
loss of one or more teeth, we have perhaps done the most natural
thing; we have followed precedent, we have applied the remedy
which we have been taught by those who spoke with authority. We
are all influenced by what the logician calls *the bias of happy
exQrcise.* We are influenced by the thing we like to do, ine thing
we do the besit.
"Whether it be a fixed bridge, a removable bridge or a par-
tial denture, in the absence of data on which to base a diagnosis,
tradition and dogma would take its place.
"Pefore we can hope to overcome the problem, we must under-
stand the problem. Assuming for the sake of argument that no
method yet devised has a universal application, i.e., would be the
best method in every case, what guide have we in selecting the par-
ticular type or method best adapted to the case in hand? Before
we can decide this question we must know what changes take place
as a result of the loss of any particular tooth or teeth — we must
learn to recognize these variations.
OF<AL HEALTH 17
Bridge Attachments for Vital Teeth.
"The selection of a proper bridge anchorage for vital teeth
requires attention to the following points:
The length of the span;
The bite or occlusion;
The size, shape, or length of the teeth ;
The age of the patient from the standpoint of dental anatomy;
The possibility of existing or recurring decay in that particular
location of the mouth;
Nature of the saliva; whether thick mucus or normal;
Presence or absence of erosion;
Heavy or spongy bony sockets (allowing of Httle or much move-
ment of the teeth in mastication) ;
Personal care of the mouth in general.
Taking these and perhaps many more things into consideration
we have before us the choice of many forms of inlays and crowns."
End of Quotation.
A glance at the buccal and lingual aspects of the accompany-
ing cut (Fig. 1) (Black's Fig. 131) will show that a very definite
Fig. 1
relation exists between the upper and lower teeth in the ideal natural
arrangement. It is towards this arrangement which Nature aims
at, that we should endeavor to make our crowns and bridges. A
study of a number of models where one or more teeth have bee^i
lost will illustrate a few of the changes that occur in the occlusion
locally. Further study, however, must be made to learn the exten-
sive changes that occur, resulting in facial deformity and interference
with normal structures. In the case of lower first molars, some 59 per
cent of a large number of models under observation showed one or
both of these teeth missing. The local result is a drifting forward
18 ORAL HEALTH
of the second and third molars, with a tendency to tip lingually.
The second bicuspid roitates, intrudes, and frequently assumes a
marked distal inclination. The result of this tipping is a loss of the
area of the occlusal surfaces which meet the opposing teeth of the
upper arch. This throws an extra stress on the teeth of the opposite
side, with the result that the constant wear upon this one side changes
the occlusal plane, as shown in the accompanying illustration (Fig.2),
Fig. 2
SO that the buccal cusps of the lower teeth and the lingual cusps
of the upper teeth are extensively worn away. Owing to the tipping
on the one side and the wear on the opposite side, the bite is per-
mitted to close slightly, so that the stress then comes upon the an-
terior teeth. The loss of the first molar and the additional stress on
the anterior teeth produce a backward movement of the lower jaw,
which results in loss of facial dimensions, a change in the relation
of the neck muscles, the throat, the hyoid bone, and other organs
attached to the mandible. The closing of the bite changes the
shape of the nose, jowls appear, and the condyles may impinge on
the external auditory meatus, and the eustachian tubes, causing deaf-
ness.
An acquaintance with the foregoing changes impresses one with
the seriousness of the task of making artificial restorations. Dr.
Monson has devised an articulator which makes it possible to meas-
ure fairly accurately the position of the occlusal plane. Most stu-
dents of the movements of the mandible agree that the curve of
Spee in the lower arch conforms to the arc of a sphere. Assuming
that the distance from the centre of the condyles to each other and
to the mesio-incisal angles of the lower central incisors forms an
equilateral triangle, Mr. Monson believes that the sphere to which
the curve of Spee should conform would have a four-inch radius.
Lines run from the centre of this sphere through the long axis of
the posterior teeth should be parallel to the long axis of those teeth
(See Fig. 3).
ORAL HEALTH
Q
A study of the crowns so frequently inserted on posterior teeth
would indicate that the long axis of the crowns and their occlusal
surfaces are often changed from the natural arrangement. Not only
does this affect the occlusal surfaces, but the embrasures, the con-
tact points, and the convexities on the buccal and lingual surfaces
are frequently disturbed. A study of Fig. 4 will illustrate the direc-
FiK4.
tion of food-stuffs in the excursions of mastication. Fig. 5 will illus-
trate the position of the contact points occluso-gingivally and bucco-
lingually. Tlie self-cleansing possibilities of artificial appliances will
depend very largely upon the care given to these details of the axial
surfaces of our restorations. We have become quite careful of the
form and size of interproximal spaces and embrasures in our opera-
20
ORAL HEALTH
bndge appliances J.tuc^'^V^:::^?:^ To''^ '^ T"" ^"^
greater attention. In the na,t ILT , <^°"^equently require
- solder the .but."e:i:^^tL^'r rerTedL:: plltV'ora V^ ^"^^
extensive V as the inl^^/ ^v ^ "cuidie parts ot a bridge as
.it, Th,^ doe^„oTVanXV:1h^.:e"njft^;r ^"^"f ^
because its weakest navt ic f i ^^^engtii ot the apphance.
On the other tnt fL:^Ttjra,tZ"' '1 ^'"""T
.■iterproximal spaces and embrasurt A n ^ '" ^^^"""f *"
abutment to the intermediat/nlTf!u /^ "^rrow union of the
sary. This should bT made so thltfh "'^^^ " "" *^' '^ "^«^-
tissues would be convex To th., > u u '"""^^^ "^^^^^' *<^ soft
that area by anrcLTTetfod ' T id"alsoT;''i^ " ^'^.T
cleaned by natural conditions such as flow If he .alL'Tc "^'''^
part ? hisTapi ma/^pTytr' t"^'^"^ -T^^^ '"' ^^^ ^^^^^^
function'piaced :« c::,^i:\e:.h'^"'"'" '^^"^'^^'^ '^''"' "^^ --^-
n.akeri%rsibt wthThetrr:' °" "^z- 'f""^''"'^ ^^'■^"'--
satisfactory! we must tal fnt '°'"'J° "'''' t"^ ^'''^^' '''''''-"°"'
merely as a means toward establishing normal conditions In "eTd
of seemg a space to be filled by a bridge, we should think of the
ORAL HEALTH 21
patient's entire dental armament, of the other functions of the teeth
beside mastication, of their importance to the other tissues of the
face, and then study the proper relation of the lower teeth to the
upper and make our restoration to conform to these requirements.
Another frequent cause of failures in crown and bridge work
is due to a lack of care in examining the tissues surrounding our
abutment teeth. Quite often, during the process of extraction, the
alveolar septum is broken away, thus destroying the support of the
next tooth in its socket. Any tooth having its investing tissues dis-
turbed in this manner cannot be looked upon as a favorable one
to be used as an abutment for a bridge. The loss of this support
is sufficient handicap to the tooth in performing its own function,
without having additional stress placed upon it by the insertion of
a bridge.
The accompanying chart shows a classification of certain con-
ditions, favorable and unfavorable, which have to be considered
in crown and bridge work. When a patient presents for examina-
tion, a study should be made of these conditions and the mode of
restoration selected that will turn the greatest possible number of
unfavorable into favorable conditions, so that the artificial appliance
inserted and the natural teeth remaining will have an opportunity
to function properly with regard to the part they play in diges-
tion, in oral cleanliness, in esthetic effect, and in restoring and
maintaining the proper relation of the associated structures of the
head and neck. >!
One In Four Thousand
o
NE in every 4,000 of Canada's population is a practising
Dentist. Truly a comparatively small group, but vitally neces-
sary from the standpoint of Public Health.
"Orologist."
AT a recent cle.'^.tal convention the suggestion was made by
one of the members, that Dentists should be known as "Orolo-
gists." This is just another one of those faddy ideas (whose
name is legion in these latter days) without any practical advantage.
As for us, we prefer the time-honored name "Dentist."
22 ORAL HEALTH
A Word about the Joint Convention, May, 1922,
Canadian Dental Association and Ontario
Dental Society
PROGRAMS of successful Dental Conventions are not obtained
ready-made, nor are they picked from trees. The Committee
in charge of the Joint Convention of next May fully realize
this fact. Instead of w^aiting for a deluge of talent to pour in upon
them, they have been conducting a careful search for men best fitted
to present the subjects decided upon and to carry out the Convention
policy of this year. Their efforts, extending over several months,
are yielding splendid results. Even now^ a program is drafted which
would do credit to the best of dental organizations and still there
is time to perfect it before the Convention date.
A Practical Policy.
The policy is to make this year's a "Practical Convention.*'
This decision intends no reflection on the scientific grounding neces-
sary to the intelligent practice of dentistry, but the 1 922 Convention
will seek, by clinics and demonstrations, to emphasize the practical,
rather than the theoretical, in up-to-date dentistry.
Also it will be a bright and a cheerful function. The Enter-
tainment Committee are fully aware that "All work and no play
etc., etc.," and are determined that no such misfortune will occur
at this particular gathering. Entevtainment and recreation are
being abundantly provided.
You will be acquainted with further details later. In the mean-
time remember the date — May 15, 16, 17, 18, 19 — a five-day Con-
vention in the King Edward Hotel, Toronto.
Dr. E. A. Grant, 229 College St., Toronto, is the secretary
of the Joint Committee. He will bring before the Committee any
suggestion you may have for the betterment of this Convention,
which is ])our Convention.
Clarence E. Brooks.
Alumni Society of the Dewey School of Orthodontia
THE next annual meeting of this society will be held on April
27-28, 1922, at the Edgewater Beach Hotel, Chicago. The
usual high standard of the meetings of this society will be main-
tained. All interested in orthodontia are cordially invited to attend
these meetings.
741-43 David Whitney Bldg., Ceorge F. Burke, Secretary;.
Detroit, Michigan.
D
HVLTUM IN PAHVO
This Department is Edited by
C. A. KENNEDY, D.D.S., 2 College Street, Toronto
HELPFUL PRACTICAL SUGGCSTIONS FOR PUBLICATION, SENT IN BY MEM-
BERS OF THE PROFESSION, WILL BE APPRECIATED BY THIS DEPARTMENT
D
D
Hydrochloric Acid Fumes in the Laboratory. — Never boii
Hydrochloric acid where there is a possibility of the fumes coming in
contact with metal instruments, as corrosion will surely follow.
Formula of the Fluid Flux That Does Not Pit. — Pow-
dered Borax, 7 drachms; Powdered Boracic Acid — C.P., 7
drachms. Put all in a pint bottle and add: Distilled cold water, 6
ounces. Shake well until all is dissolved; then filter, pouring back
the liquid, until perfectly clear. Put in a 6-ounce bottle and label:
*^ fluid Flux."' Besides this, take a 1 -ounce 'pomade" bottle for use
in the laboratory.
A Novel Rubber Dam Punch. — After having adjusted a
rubber dam to the number of teeth an operator thinks necessary, it
sometimes happens that he will find that if another tooth adjoining
was ligated, he would have a better field in which to operate. The
old method of drawing the rubber dam taut over the tooth and nick-
ing it with a sharp instrument often proves disastrous to the entire dam
by causing it to tear. This may be obviated by simply heating a
pointed tapering instrument and pushing it through the dam without
stretching it first, as puncturing it while stretched produces a slit and
not a hole. This method produces a hole equal to that made by a
regular punch.
Sensitive Necks Of Teeth. — Frequently we find that, follow-
ing upon recession of the gums, the necks of teeth about the position
of the junction of the enamel and cementum become extremely sensi-
tive, without, however, any caries being established. Carefully dry
any such area, using the electric hot air syringe, and pack with a
ball of cotton a small portion of "Lily" desensitizing paste (Buckley)
against the exposed dentinal tubules, and seal to place with Ash's
Crown Sticky Wax, applied with a small heated wax spatula. The
sticky wax will hold the paste in position better than calxine for a
period long enough to ensure desensitizing of the surface involved.
Ernest F. Deck, Dental Science.
The Grime of Indifference
WHEN a man becomes indifferent he becomes useless. When
he gets to the point where he says he does not care, he is on
the straight road to deterioration. It is true that some men
care too much — they worry, and stew, and fret, and fume, over the
merest trifles. They magnify the small things of life till they make
mountains of them, and yet these men are to be tolerated more readily
than the men who are indifferent to the great moving mass of humanity
about them.
A selfish indifference to the welfare of others is at the bottom of
many of the ills of society today. A man who can witness suffering
and not be moved by it is not human, and it must be remembered
that there is much suffering aside from physical discomfort.
Great men have never been indifferent men. They have always
been concerned deeply with the welfare of their fellowman. Darwin,
Gladstone, Kitchener, Lincoln, Grant, Lee — ^hundreds of such names
might be mentioned to prove the deep and abiding concern which
great men have felt for their fellows.
And probably the worst form of indifference is that of pro-
fessional indifference — I mean the indifference of professional men for
their patients. When I see physicians or dentists giving their patients
unnecessary pain I recoil, and I do not mean by this that analgesia or
conduction anesthesia must be used for such operations as cavity
preparation. I mean that every operator should develop such skill
in the handhng of instruments, and exercise such care and considera-
tion, that these operations can be performed with the minimum of
discomfort. It helps a patient wonderfully to realize that the operator
is sincerely interested in the case, and solicitous to perform the work as
nearly as possible without pain. It is always recognized that the
establishment of confidence is necessary to accompHsh the best results
in the practice of a profession, and confidence is never gained by
indifference.
ORAL HEALTH 25
Neither should a professional man be indifferent to the advance-
ment made in his calling. It is almost a crime for a dentist to refuse
to keep himself informed on the progress being made in dentistry. His
patients are entitled to the benefit of every real advance in methods
or treatment, and the man who shuts himself away from his fellow
practictioners or refuses to keep informed through the means of study-
ing the best literature, is not worthy the name of a professional man.
A policy of "I should worry" has no place in a professional
practice. Men should worry when it comes to the welfare of their
patients — at least they should take such an interest in them that they
give serious thought to the best means of serving them. To go along
day after day merely following a routine of least resistance, and
oblivious to the moral obligations involved in professional life, is to
fall far short of fulfilling one's mission as a true professional man.
Indifference is the great outstanding enemy of progress. It dwarfs
ambition, and fosters sloth. It plants the seeds of disintegration and
defeat, and leaves the will-to-do prone upon its palsied back. In-
difference in any walk of life is a calamity — indifference in professional
life is a crime. ^-^ x-» y^ y^
5a^
To Prevent Galvanic Action Between Gold and
Amalgam. — In exceptional cases where it is necessary to insert an
amalgam filling which comes in contact with occluding gold, galvanic
action may be prevented by painting the amalgam filling with tincture
iodine. — Percy Moore, D.D.S., Hamilton.
Inside and Outside
Suppose you only cleaned outside,
And never used a broom,
And never washed tha floors or walls,
Or cleaned inside the room.
I'd like to know what folks would say.
And what you'd think yourself, —
Not only spoil the room, I know.
But it would spoil your health.
Suppose you only wash your face,
And never go inside,
Or wash your mouth or clean your teeth ;
Why sp3cks of food would hide.
I'd like to know what folks Avould say,
And what you'd think yourself, —
Not only spoil your pretty teeth
But also spoil your health!
— Mrs. Dora Lawrence Cameron, Wenatchee, Washington.
DIr- ~=iO
' THE COMPENDIUM '
This Department is Edited by
THOMAS COWLING, D.D.S., Toronto
A SYNOPSIS OF CURRENT LITERATURE RELATING
TO THE SCIENCE AND PRACTICE OF DENTISTRY
Athletics or Physical Exercise.
DURING the war our young people, both men and women,
were introduced to many and varied phases of physical train-
ing to which they had previously been unaccustomed. That the
results accruing therefrom were (on the whole) beneficial, no one
will gainsay; but like many other good innovations, they may event'
ually prove disastrous if given too high a valuation.
Take for instance the prevailing athletic tendency which has such
a fascination for young women, especially those attending many of
our academic institutions. Medical authorities frequently view the
popularity of athletics among women with such alarm that they
write to the press endeavoring to warn the public regarding what they
deem to be a serious post-war problem. Recently there appeared in
The Daily Mail, an English publication, a lengthy article from the
pen of a leading physician, in which he states his views, in part, as
follows: "There has sprung up among us a class of girls who seriously
menace not only their own future health, but also the birth-rate of the
country. The declining birth-rate is not only due to the deliberate
limitation of families, but also to the fact that many women — far
more than ever before — are unable to bear children. As a medical
man I meet and see all types of women, and a sad impression that is
constantly being received is that there is a studied repression of
feminine instincts by many of our young women. These naturally
attractive girls and women scorn men and profess a holy horror of,
and avowed repugnance for the idea of marriage. This cult, for it is
nothing else, seems to be rapidly progressing, and it is being imbibed
wholesale in many of our big girls' schools. The chief offenders seem
to be physical training and sports mistresses in our schools and
teachers of similar subjects in college and massage schools. These
women hold up to their pupils an ideal of the wonderful possibilities,
from a purely athletic and physical standpoint, of a woman's body,
and encourage them to believe in their ability to rival and beat men.
ORAL HEALTH 27
They point a scoffing finger at the dull, domestic, subservient life
which they say marriage offers. Many women — particularly the
extreme physical-training, athletic type — ruin their health and become
either incapable of bearing children or capable of bearing them only
with great difficulty; others early become the neurotic, selfish type of
woman whom medical men know to be the worst type of patient.'*
Certainly this is not a pleasant picture of the results accruing from a
misconception of athletics among women.
Athletics among men may also prove harmful or beneficial accord-
ing to the amount of use or abuse which they are given. Dealing
particularly with the question of athletics for the professional man,
it is obviously fair to assume, though many might not like the classi-
fication, that professional men are the "middle-aged" men. The
years spent in preparation for our work were the "youthful" years
and we must take that fact into our consideration when considering
the selection of suitable exercises for our individual needs. It is the
failure to recognize our true classification that oftentimes leads to
unsatisfactory results from our endeavors to keep fit.
The selection of a suitable form of exercise is a difficult thing. Few
men are frank enough to admit it, however, consequently in many
instances ill, rather than good results come from our sports. When
an elderly man suddenly indulges in vigorous exercises to which he
is quite unaccustomed, (many do this with the false idea of making
up for lost time), he is apt to cause serious systemic injury. The ill-
effects in such a case might be quite as serious as would be those result-
ing from great mental strain. Someone has put it very aptly by stating
that many professional men take week-end outings and indulge in
strenuous and unusual forms of exercise, when they are tired men-
tally, and return to their duties physically fatigued as well. Fortun-
ately there is a medium course to follow.
That time is well spent which is devoted to a careful selection of
forms of sports or exercises best suited to our individual requirements.
Unfortunately, many of our athletic and recreation clubs do not study
the individual. They have not the time, inclination or equipment for
this work. All men are (as a matter of convenience) grouped to-
gether and given the same work to do. Consequently some benefit
while others are losers.
If a man has passed into middle life and has been accustomed to
strenuous exercise from his youth, then he may, with benefit to him-
self, continue such exercises. Not so with the man who has led a
sedentary life. He must accustom himself slowly and by easy stages
to the new experience. It will not do to add the exercise hours to the
rest of the day's work. We mean that if one takes up these exercises
after the completion of the customary amount of work has been done
28 ORAL HEALTH
little or no good will accrue therefrom. In fact positive harm may
result by indulgence in hard exercise when the body is already tired
out. It is best to make the exercise part of the day's routine, to be
indulged in during the usual working period.
When a business man plans some new undertaking he calmly plots
out the proposed method of operation, probable costs of same, pos-
sible difficulties to be encountered and surmounted, etc., and then, if
the outlook is favorable, he proceeds with the undertaking, having
first set up adequate safeguards against possible failure or losses.-
That is his method with his business affairs; but watch him when he
decides that his body requires physical exercise. He suddenly decides
to join a gymnasium or club and hastens to make up for lost time*
He plunges into the most strenuous forms of exercises, apparently
believing that if a small dose is good, a larger dose will be better.
He is impatient. Results must show early or he is discouraged. In
order to hurry along the desired results he increases the number and
severity of the chosen or alloted exercises. Something must and some-
thing does give way. Serious impairment to body health results
before the foolishness of such a course is frankly recognized.
Professional men, especially dentists, who feel the need of exercise
would be well advised to go slowly at first. A brisk walk to the
office each morning for a month or two, is a splendid way to inure
oneself to more vigorous efforts. Later on, introduce some form of
exercise for the limbs and back. In this way one may work up to the
stage where general gymnastics may be indulged in without harm.
Men past their prime of life would do well to recognize that violent
exercises are for the young only.
That this view is not held by all we freely admit. Sir James
Cantlie, of London, England, has recently started what is jocularly
described as "a crusade against old-age.'* He maintains that a man
of forty or fifty should be at his best. A series of exercises suitable for
middle-aged persons of sedentary habits has been arranged. Sir
James maintains that it is a fatal mistake to hug the old arm chair
and neglect to take sufficient exercise. Such a practice usually
develops rheumatic and associated ailments.
Tlie "Hospital" in an article commenting on Sir James Cantlie's
views undertakes to give some additional words of advice. It says:
"When you are forty or fifty, don't imagine you are twenty or
thirty. In the brittle period of middle age it is almost as easy to bring
about disaster by attempting too much as by attempting too little.
Not a few middle-aged men who served in the army, and were abso-
lutely fit to do their own military job, began after many years of
abstinence, to play Association and even Rugby football, and in
ORAL HEALTH 29
many cases they were entirely incapacitated in consequence. It is a
very good thing to urge men of all ages to take methodical exercise,
diet themselves rationally, and to take other elementary precautions
to keep themselves in good health. But there is an ill-considered
tendency at the present time to suggest that there exists some magic
formula by which a man need never be so old as he is. Physical
fitness is a relative condition, having a somewhat different significance
at different ages. We know of no arbitrary device, including the
rapturously advertised thyroid gland which will give back youth to
old age. "Putting back the clock" is a pleasant fiction, and the
experiences of men famous in the ring or in other branches of sport
and athletics who have sought to "come back" have not been encour-
aging. Middle age is too often old age, and youth is sometimes
middle age; but middle age can not be youth."
Perhaps the true conception of the entire question of man's respon-
sibility in the matter of athletics or physical exercise may be given
in the words of E. W. Beatty, K.C., President of the Canadian
Pacific Railway. He says: "Responsible executive work demands
intense concentration, and power of quick decision, but it is hard to
concentrate one's thoughts or be mentally dynamic under the handicap
of physical inertia or fatigue. The wise man, therefore, stores up
physical reserve against mental strain by taking regular exercise. One
does not need to be an athlete, but a healthy and well-balanced
physique is a necessary asset in business life where the nature of one's
work entails high nervous tension."
Dentists more than any other professional men, on account of the
amount of nervous energy used up in their work and the confinement
of office work, ought to give heed to this important question of health
through exercise.
Odontalgia Following Absorption of Bismuth Subnitrate
For Ulcer of the Stomach.
T T is a common practice and generally regarded as a harmless one
^ to administer large doses (as much as 1 600 grns. in 48 hours has
been given) of bismuth subnitrate for cases of gastric ulcer. A por-
tion of the bismuth is eliminated by the saliva and if the drug is given
for an extended period it is possible that buccal irritation of a more
or less severe type may result. In "La Semaine Dentaire" of October,
1921, a case is cited by J. Estaule where the doses of bismuth (10
grns. each twice daily) resulted in a toothache of an extreme type in
the molar teeth. These teeth upon examination proved to be per-
fectly sound and healthy. Upon cessation of the bismuth treatment the
toothache disappeared, but when renewed even in small doses
neuralgia-like paroxysms would recur and always in the molars.
30 ORAL HEALTH
Fatal Poisoning From Swallowing Arsenic Treatment
Placed in a Tooth.
ALICHTWITZ, Zahnaerztliche Rundschau, October, 1921.
, reports the following case : A dentist about to leave his office
at night put an arsenical paste treatment in one of his molars
in order to relieve toothache. The paste contained arsenic, cocaine
and carbolic acid. The toothache stopped and he went to a social
function a few hours later. He ate his dinner and later returned
home. At two o'clock in the morning he became sick and on examm-
ation he discovered that the arsenical dressing was no longer in the
tooth. He had apparently dislodged and swallowed it when eating.
Collapse followed soon after the initial attack and four days later
he died. An estimate of the contents of the paste used, which was
about the size of a pea, showed 1 15-1000 of a grain of arsenic
(about 1.7 grains) or about 23 times the limit of safety. One should
use only sufficient arsenic to cover the head of a common pin.
A Simple Method of Controlling Hemorrhage in
Hemophiliacs.
IN Dental Cosmos, Dr. J. G. Leavitt, of Hollywood, Calif., gives
an account of a method for the control of bleeding following
extraction of teeth for patients with hemorrhagic tendencies. It
is a method suggested by Dr. Martin J. Ott, of University of
Minnesota.
A patient with a history of being a bleeder presented himself for
examination. Extractions were necessary. After removing the teeth
the operator observed a continuous oozing of blood. Tuis lasted for
several hours in spite of all the usual astringents and hemostatics.
Finally the dentist punctured his own finger, saturated a piece of
sterile cotton with the blood and applied it to the bleeding surfaces
caused by the extraction of the teeth. In a few minutes the bleeding
stopped. The explanation is that the constituents lacking in the
patient's blood were supplied by the dentist from his own serum.
Diet and Teeth
MAJOR N. DUNN, R.A.M.C, is reported in December issue
of Journal of Dental Science as follows: "Every girl should
learn how to feed a child. The so-called mistress of the house
is, in the majority of cases, a fraud. Even if she knows how to cook
and bake, she knows nothing about the constituents of the various
food-stuffs; she knows nothing about the effect of the industrial arts
on diet; she does not know that probably the only natiiral foods
remaining are mother's milk and raw fruit. The same diet which
causes decay of the teeth in all probability causes appendicitis, ulcer
of the stomach and possibly cancer of the stomach, too. The Ameri-
ORALHEALIH 31
can continues to eat a ridiculous diet and hires an expensive man to
patch up his teeth. He suffers widely from appendicitis, ulcer, and
cancer of the stomach, in spite of the dentistry. For many years prior
to 1914 I had charge of a hospital for poor country arabs. They
had no dentistry and no tooth brush. In fourteen years no case of
appendicitis, ulcer, or cancer of the stomach, abcess or cancer of the
breast, rheumatic fever, or tonsils or adenoids was diagnosed. The
diet they ate and the water they drank kept their mouths and intes-
tines clean and their teeth sound."
Arrangement of Teeth in Partial Denture Construction
By a. Alfred Nelson, D.D.S., Detroit, Mich.
PARTIAL dentures are what they imply, i.e., restorations for
partial edentulous mouths. The vast majority that are con-
structed are intended to supply substitutes for the lower bicuspids
and molars.
When natural teeth are lost, those that usually go first are the
lower first molars. The tongue having nothing to confine it laterally,
becomes wide in this region with the result that when teeth as wide
bucco-lingually as the natural teeth are inserted, the tongue does not
have sufficient room within which to function, thus causing a dislodg-
ment of the restoration. If molars, say a millimeter narrorver than
the natural ones are used, a greater degree of efficiency will result.
This applies to the upper arch as well. The combination of Trubyte
molds that will give good satisfaction are bicuspids mold No. 32L
and molars mold No. 28L. This combination is very efficacious in
full denture work as well.
In the selection of the anterior teeth for cases involving such
restorations, it is essential that the size and shape of the teeth be in
harmony with the face.
In arranging the anterior teeth, lapping or rotating the centrals
and laterals will enhance the esthetics of the case.
TTie idea that all teeth in the same jaw must be placed contact to
contact in artificial restoration is a fallacy. That is the ideal, but the
ideal is the exception rather than the rule.
Please bear in mind that if necessity demands, then and only then
is the full complement of bicuspids and molars necessary in either a
full or a partial denture. Do not hesitate to space the teeth if necessity
demands and if the laws of leverage will be enhanced by so doing. It
is absolutely essential that the fullest masticating efficiency be restored
in a restoration and this can only be accomplished by meeting the
needs of the case. — The Denial Summary.
1
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PROVINCIAL EDITORS
■■■■B CORNER
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SASKATCHEWAN
Reported by C. W. Parker, D.D.S.
IT is generally recognized that nothing has a greater tendency
toward the advancement of professional ideals than that members
of the profession come together from time to time, exchange views
on various subjects of interest to all, and become better acquainted
with one another's successes and failures, discussing those things in
which each one should be deeply interested in the community, not
only as professional men, but as citizens as well.
The population of this Province is scattered over a large area, and
therefore in the matter of local societies Saskatchewan, relatively
speaking, has not a large number. In the larger centres, however,
local societies have been formed for some time, and are doing good
pioneer work, laying foundations for the future of which the Pro-
fession need have no fear.
Regma has an active society meeting monthly under the Presidency
of Dr. M. R. Parkin. Two addresses have been given recently to
its members on the subject of "Closer Co-operation between Medical
and Dental Practitioners.'*
Saskatoon Society (Dr. G. H. Harris, President) meets regularly,
and has been having some interesting discussions on "Partial Den-
tures," "Anaesthesia," and "School Dentistry," doing some clinical
work as well.
Moose Jaw Society (President "Bruce" Dixon) has this year
adopted the study club idea, and the members are deriving much
benefit from their studies in "Radiodontia" and "Cavity Prepara-
tion."
Swift Current Society, under the guidance of Major G. L.
Cameron, covers a large area and has an excellent working club,
dealing this year with such topics as "Synthetic Restorations," "Con-
ductive Anaesthesia" and "School Dental Examinations."
ORAL HEALTH 33
Rosetown District, in the Northwest part of the Province, has been
organized by Dr. S. Moyer, and although this society does not meet
as frequently as some of the others, is doing effective work among its
own members and in the community.
As our population becomes more dense and the various communities
large enough to support professional men, other local societies will be
formed, as they undoubtedly form the nucleus around and about
which our large Provincial Association is built.
MANITOBA
Reported by W. W. Wright, D.D.S.
DENTISTRY in Manitoba is in a healthy condition. No, I
don't mean all the dentistry that has been done has healthy
surroundings, but I do think that the Profession in this Province
is awake to its responsibility. The spirit of fraternal co-operation
prevails to a remarkable degree, — at least that is what one feels, and
that is what we are told by outsiders.
In addition to a live Dental Society in Winnipeg, there is a bounc-
ing younger brother club known as the Western Manitoba Dental
Society, with headquarters at Brandon. They have just completed
their Annual Convention. Besides frequent visits of clinicians from
the south and east, many valuable papers and discussions arise from
our members, and we have our share of excellent local talent.
Specializing is becoming quite a craze in Winnipeg lately. During
the last six months one Dentist has announced "Practice limited to
extracting and diagnosis," another "Extracting and X-Ray," another
"Children under sixteen years only," another "Children and Ortho-
dontia only." One is away, preparatory to specializing on pyorrhea,
and another intends specializing on Dentures. From all reports this
wave has hit other cities before Winnipeg, with results rather disastrous
to some of the participants.
Cheer up! We are quite "Progressive" in Manitoba. Here's your
health! We're with you, Saskatchewan and Alberta.
Dr. Bailly Smith, of Minneapolis, gave an afternoon and evening
clinic before a well attended meeting of the Winnipeg Dental Society
on December 3rd, 1921, at the Fort Garry Hotel.
Dr. Douglas Brown gave a clinic and paper recently at Brandon,
before the members of the Western Manitoba Dental Association, on
"Nerve Blocking and Removal of Teeth with Granuloma."
Those who have found practice rather slow lately are looking for-
ward to a big week in February, when one of the world's greatest
Winter Carnivals is to be held in Winnipeg.
34 ORAL HEALTH
NOVA SCOTIA
Oral Hygiene in Nova Scotia.
THE Oral Hygiene Education Committee of the Nova Scotia
Dental Association has been doing splendid work in the organ-
ization of services for school children, as vv^ell as establishing
a dental clinic for children of pre-school age in the City of Halifax.
The services for the school children are carried on in the College
Infirmary of Dalhousie, by means of a grant from the Massachu-
setts-Halifax Health Commission.
In the new out-patient hospital being built by Dalhousie Uni-
versity there will be provision for a Dental Infirmary for the public,
school children, and children of pre-school age.
Another forward step has been the linking up of the dental
educational work with the Red Cross Rural Health Caravans.
The demand for state dental service in Nova Scotia has so
increased that an organized effort is being made to secure the
appointment of a Provincial Dental Health Officer, and it is fully
expected that this very desirable development will be brought about
during the present year.
The Nova Scotia Dental Association voted $100.00 to Oral
Hygiene work during the current year.
A very excellent committee has charge of this work, the per-
sonnel of which is as follows: G. K. Thomson (Chairman), F. W.
Ryan, A. W. Faulkner, R. H. Woodbury, Frank Woodbury, S. G.
Ritchie (Secretary).
A Few Reasons Why Prices Are High
BECAUSE of people who hate to be seen in the same hat
twice.
Because of folks who ride in taxis until they lose their
waistline.
Because of the same folks who ride on horseback trying to
regain their waistline.
Because of people who demand more service than they need.
Because of people who are willing to pay for more service than
they get.
Because of folks who have never learned how to economize.
Because of folks who have learned how to economize, but would
rather tell ether people how to do it than do it themselves.'*
ORAL HEALTH
a
EDITOR:
WALLACE SECCOMBE, D. D.S., F.A.C.D., Toronto, Ont.
CONTRIBUTING EDITORS:
C N. JOHNSON, M.A., D.D.S.. F.A.C.D., Chicago.
RICHARD G. Mclaughlin, D.D.S., Toronto.
W. E. CUMMER, D.D.S., Toronto.
J WRIGHT BEACH, D.D.S., Buffalo, N.Y.
Entered as Second-class Matter at the Post Office, Toronto.
Subscription Price, Canada and United States, two dollars per annum;
elsewhere three dollars. Single Copies, 25c.
Original Communications, Book Reviews, Exchanges, Society Reports, Personal Items, and other
Correspondence should be addressed to the Editor, Oral Health, 102 Wells Hill Ave., Toronto, Canada.
Subscriptions and all business Communications should be addressed to The Publishers, Oral Health,
Royal Bank Building, 269 College St., Toronto, Canada.
Vol. XII.
TORONTO, JANUARY. 1922
No. 1
H
EDITOR.IAL1
IZI
Nineteen Twenty-Two — A Get-together Year
for Canadian Dentists
THE last gun in the world war was fired over three years ago,
and we have now passed through the most critical of the
reconstruction years. Many difficulties undoubtedly remain to
be faced, yet the world has gone far along the road toward stability,
prosperity and good-will. The year 1 922 will surely be the first of a
cycle of many years of prosperity and progress. Though commercial
conditions have been so disturbed that dental practitioners have felt
the effect during the past year, economists are now agreed that there
is a decided tendency toward improvement, and we all may enter
the new year with optimism and a sure confidence in the future.
The practice of Dentistry affords a wonderful opportunity for
service, by the prolongation of life, the maintenance of health, and
the increase in efficiency of the worker. Whether engaged in private
or public dental practice, members of the profession should ever keep
in mind the important character of health service it is their privilege
to render. To serve to the utmost of their ability, practitioners must
'get together" in a spirit of mutual helpfulness, that one may profit
from the experience of another.
36 ORALHEALTH
Get Together Locally.
Some men become self-centred and care little about their confreres
who practise in the immediate vicinity. Get together and form a
local society. Arrange meetings in the form of a study club; further
oral hygiene propaganda; develop School Dentistry or some other
form of organized effort for the children of the community. The lack
of interest of even one local dentist may be the determining factor
between a live local society and no society at all.
Get Together Provincially.
Link up with your Provincial Society, and learn something
of what other local groups are doing. You will be surprised to find
how many study groups are at work in every part of Canada. A
study club may be composed of only two or three men or comprise a
larger number. Numbers do not necessarily affect the work done. It
depends upon the spirit behind the thing.
Get Together Nationally.
The Canadian Dental Association meets in Toronto May 15th
to 1 9th, 1 922. This will be the best Canadian Convention ever held.
You may imagine it as something of a sacrifice to attend, but the
fact is, you cannot afford to miss the Canadian meeting this year.
Let's all get together in May. It will be a real Canadian convention,
combined with the Ontario Dental Society meeting, and a great
gathering is assured.
Nineteen twent^-trvo, a get-together year for Canadian Dentists.
If this is to be accomplished, every Canadian Dentist must do his
part. •
Camouflage "Dental Water
9?
ONTARIO Dentists have received literature from a Montreal
firm, urging the sale of a dentifrice, known as "dental water,"
and said to be "the only dentifrice approved by the Academy
of Medicine of Paris."
The (most interesting feature is the statement that this "dental
water" contains 80 per cent, of alcohol. One would almost think
that this firm would have named this so-called dentifrice "fire water,"
instead of "dental water."
To quote: ''For your personal use we will quote you prices as
shown on our confidential list enclosed. By comparing these with
wholesale and retail prices you will figure the real advantage we are
glad to ofer. These prices are strictly confidential and you will oblige
us by k^epirig them so. We will welcome any suggestion to help us
to give every satisfaction, for we whh to make this dental water well-
known by its quality, as well as by our service.''
ORAL HEALTH 37
Oral Health has turned a copy of the correspondence over
to the proper authorities, in the hope that this Montreal firm may be
stopped in its mad career of selHng a solution containing 80 per cent,
of alcohol under the name of a mouth wash.
We believe the members of the Dental Profession in Ontario
have sufficient regard for their own name, as well as that of the Dental
Profession, to call a spade a spade and not be a party to any device
which appears to be a camouflage and likely to bring discredit to
those who have any part in it.
Why Should You Attend the CD. A. Convention
This Year
IT IS generally agreed that success or failure depends more than
anything else upon judgment.
Your success can be measured directly by adding together
the results of your correct decisions — then subtracting the losses in-
curred by your mistaken decisions.
Upon enquiry it will be found that by far the majority of these
mistakes are due to incorrect or incomplete information. Your logic
and reasoning are correct, but they are no better than their founda-
tion of fact. The best judgment and most perfect logic in the world
are apt to be absolutely wrong if they are working from hearsay,
rumor, guesswork, or only a part of the facts of the case.
Judgment — the single factor that decides the degree of your
success — is largely a matter of having all the facts, of knowing
instead of guessing.
This is one reason Tp/ip ^ou cannot aford to miss this Conven-
tion.
Book Review
ANEW text-book on Electro-Radiographic Diagnosis, by
Howard Riley Paper, D.D.S. (C. V. Mosby Co., St. Louis)
has just reached Oral Health. As the author correctly states,
"Nothing is more worthless than an incorrect diagnosis, and no mat-
ter how well the wrong treatment is applied it remains the wrong
treatment."
This comprehensive little volume of 150 pages goes fully into
the subject of (1) Showing how frequently the "electric" test for
vitality is necessary; (2) teaching in detail the technique of its appli-
cation.
Until the past four years but few dentists had used this test;
primarily, it is claimed, because the value and importance of the test
38 ORAL HEALTH
was not fully appreciated, as well as the necessity for acquiring know-
ledge of correct technique. Possibly this has been, as the author
states, because of the inadequacy of the electrodes.
The whole subject appears to be one which being "well known
of is little known about" — about the only class of men familiar with
the test are a few radiodontists. Merely applying an electrode to
a tooth, and seeing if it is alive or not, is on a par with daubing an
alloy with mercury into a cavity and calling it an amalgam filling.
The real advantage of this test, it is claimed, is ( 1 ) because
there is less likelihood of a misinterpretation of the radiograph; (2)
the application of the test enables the operator to select those teeth
which should be radiographed with special care; (3) it assists in
radiographic interpretation and points out the particularly suspicious
teeth, reducing the number of make-overs necessary; (4) it reduces
the cost to the patient; (5) it also reduces the dangers of the making
of so many photos.
Several chapters are devoted to a detailed description and ex-
planation of the apparatus to be used and technique applied, with
necessary care to be taken. A specially good chapter is devoted
to the application of the test to nervous patients and children.
The writer claims that criticisms of the method where the tester
has apparently failed and the skiagraph been correct are no criti-
cisms at all and here is where the value to the practitioner surely lies.
The salient points in the criticisms are :
(1) Did the operator touch a metal filling?
(2) Did the operator touch the gum line tissue?
(3) Did the operator touch unsupported enamel?
(4) Did the operator use the wrong kind of electrode and touch
the patient's lip or cheek?
(5) Was the patient nervous and jumped without receiving
sensation ?
(6) Was tooth sore and was electrode pressing against this
the cause of the pain?
(7) Was tooth covered with moisture and did current travel
across to another vital tooth?
In other words, did the operator know his business?
This will suffice to give the reader some little idea of the possi-
bilities of this test which the author is prepared to show is capable
of recording the most exacting details required by the operator.
Twenty-two determinations of the clinical value of the test are set
forth, after which a number of cases are discussed in detail.
Altogether the text provides the reader with a full and com-
plete description of the test in diagnosis.
P. £. McD.
Stimulate the heart to love and
the mind to be early accurate,
and all other virtues will rise
of their own accord.
— Coleridge
Frank Woodbury, D.D.S., Ph.D.,
Dean, Dental Department, Dalhousie University,
Halifax, N.S.
Born 26 January, 1853. Died — 5 February, 1922.
OPAL HEALTA
A JOURNAL THAT STANDS FOR THE '♦OUNCE OF
PREVENTION," AS WELL AS THE *" POUND OF CURE"
nil' =Uf^
VOL. 12 TORONTO. FEBRUARY, 1922 No. 2
In Memoriam
Doctor Frank Woodbury, Halifax, N.S.
CANADIAN Dentistry has lost another of its great men, in the
passing of Dean Woodbury, of the Dental Faculty of Dal-
housie University, Halifax. Dr. Woodbury was contemporary
with the late Dean Willmott of Toronto, and since the death of the
latter Dr. Woodbury has been spoken of as the Dean of Canadian
Dentistry and Nestor of the Profession.
The late Dr. Woodbury was a true-hearted Christian gentleman,
sincere, honest, courageous, and ever ready to stand unfalteringly
by his convictions. He never did a mean thing, and his life was an
example to his students and an inspiration to his friends and confreres.
It seems unthinkable that Dr. Harry Abbott and Dr. Frank
Woodbury, two of the stalwarts in the Dominion Dental Council
of Canada, should join one another upon the other side within the
space of a few short weeks.
The Editor was in Halifax a few days before the death of Dean
Woodbury, as a member of a commission of the Carnegie Foundation,
making a survey of the Dental Department of Dalhousie University.
Following the survey, a banquet was tendered Dr. Gies and the
other commissioners at the Halifax Club. The Lieutenant Governor
of Nova Scotia, the Chairman of the Board of Governors, and
President of the University, all referred with justifiable pride to the
work of the Dental Faculty, and particularly to the self-sacrificing
efforts of the Dean. Dr. Woodbury, in his reply, spoke feelingly of
the up-hill fight that marked the early days of Dental education in
Nova Scotia, and of his joy in the development and enlargement of
the School. The whole banquet resolved itself into a personal tribute
to Dean Woodbury, and it proved to be his last public appearance.
42 ORAL HEALTH
After the banquet Dr. Woodbury walked back to the hotel, and the
writer will ever cherish the few kindly words of farewell exchanged
with him who, five days later, was to pass on forever. Dr. Wood-
bury's real self remains as a benediction to inspire his many friends
throughout the Dominion and beyond.
Dr. Woodbury was virtually the founder of the Faculty of Dentistry
of Dalhousie University, the department being known at its inception
as the Maritime Dental College. He was the past president of the
Canadian Dental Association, and at the time of his death was
president of the Dominion Dental Council.
Dr. Woodbury's illness was a matter of only a few days. He had
been in the best of health for three years. His two sons. Dr. Karl
Woodbury, who was in partnership with his father, and Dr. Frank V.
Woodbury, were with him within an hour of his death. Dr. Wood-
bury had retired, and was apparently asleep, when those in the room
heard a slight groan and found the end had come.
Dr. Woodbury was prominent in Methodist circles, and active in
Sunday School organization throughout his life, being a membei of
both the World's and International Sunday School Committees, Dr.
Woodbury was also a director of the School For The Deaf, Halifax.
President MacKenzie, of Dalhousie University, in paying tribute
to the late Dr. Woodbury, said: "My first feeHng on learning of the
death of Dr. Frank Woodbury, was one of personal loss. The.
passing of one with whom I had been so closely associated, and whom
I had come to admire so greatly as a man and as a citizen, and whose
friendship and esteem I valued highly, brought a feeling of sadness
which I know many hundreds of men will share with me. His going
will leave a distinct gap in the ranks of those in Halifax who go
about doing good. Service was no mere catchword in his case.
"To Dalhousie University and to its Dental Faculty particularly,
the loss of Dr. Woodbury is a very heavy blow. As the Dean of the
Faculty of Dentistry, he has been a great source of strength in the
carrying on of that Department, both as a teacher and as an adminis-
trator. Without detracting in any way from what is due his col-
leagues, one can say that the starting of a Dental College in HaHfax
sprung from the inspiration and vision of Dr. Woodbury, and that its
rather phenomenal success is greatly due to his untiring energy and
labor in its behalf. To it he sacrificed many of his personal interests,
and even himself. No one outside of the University knows how much
of his time and thought and strength he gave to the building up of
the School which he started fourteen years ago, for he spent himself
in the service. The time he gave to it had to be stolen from the busy
days of a professional practice. But it was a labor of love, for he
saw that the work was to be done and felt that he must do his part.
"Simple and unassuming by nature, he did not do his work for
ORAL HEALTH 43
praise, but he had it in full measure, especially a week ago on the
occasion of the visit to the University of five dental experts who came
to study the standing of the Dental School, for the Carnegie Founda-
tion. There is no doubt that at that time Dr. Woodbury overtaxed
his strength, but it was like him to not consider himself when service
was the alternative. His name will be forever associated with the
Dental School, which is his monument.*'
The Pre- Dental Year
Wallace Seccombe, D.D.S.,
Ro})al College of Dental Surgeons, Toronto.
THE primary function of the dental profession is to serve the
public. In the final analysis dental laws as well as dental
education justify themselves only in so far as they are related to
the welfare of the people.
The cost of attendance at dental school is approximately one
thousand dollars per session. The Pre-Dental year, when considered
as the first year of a five year course, involves this additional expendi-
ture along with one year of time. The only ground upon which this
outlay can be defended is the absolute need of an extra year, in
preparing graduates to render "the best possible service" to the
public.
There are those who, at the present time, refuse to seriously con-
sider the pre-dental standard, claiming its universal adoption would
seriously reduce the number of students-in-training, and furthermore
that there is already a shortage of dental practitioners, and therefore,
as a matter of public policy, the pre-dental standard should not be
adopted.
We do not believe the premise to be well taken. Experience shows
that the raising of standards does not reduce the total number when
averaged over a two or three year period. Upon the contrary, raised
standards frequently result in an actual increase in numbers along
with a marked improvement in the capabilities and general character
of the applicants. This fact has been amply illustrated at the Dental
Department of the University of Montreal this present session. In
Ontario, it has been found in medicine, that the higher entrance
requirements have been raised, and the more the medical course has
been lengthened, the greater the influx of students to that Depart-
ment. Courses requiring higher standards make a stronger appeal
to the better type of student. This fact has been so evident in Ontario
Universities, that the Faculties of Arts, in self-protection, have taken
steps to raise entrance requirements to the same standards as have
44 ORAL HEALTH
prevailed in the Faculties of Applied Science and of Medicine. The
Faculty of Dentistry in self-protection against the poorer type of
student, will doubtless take similar action. Should this occur, we
believe there will be little, if any, depreciation in the number of dental
students, but a very marked appreciation in their scholarship. We
must have standards comparable to those of medicine, to attract the
right type of student.
There is a tendency toward higher standards in all the professions,
with a stressing of the fact that true professional men are not self-
seekers, but citizens specially trained to render important service to
the community, and as dentists materially assist in the maintenance of
the health of the people. Dentistry cannot hold back while the other
professions are moving forward. Public opinion will always support
the standards of the professions being raised to that point, whatever
it may be, which is essential to the professions keeping abreast of
every advance in Science and Practice.
We believe that dental teachers will agree with Dean Webster
that "candidates now seeking admission to dental schools are much
less mature than those of a decade or more ago. Although they
present all the scholastic attainments necessary, many of them are not
sufficiently developed in experience or judgment to be entrusted with
the practice of a calling which is related so vitally to the health of
the people." The additional year certainly tends to develop more
mature judgment, accurate observation, logical thinking and habits
of study. Dentistry is an intimate personal service. The character
and attainments of the operator are important factors in success. The
cultural and educational advantages of the pre-dental year are
surely admitted by all.
Important as are the foregoing considerations, the vital reason for
the higher standard is its absolute necessity, for a foundation upon
which to build the present-day dental education. In modern
dentistry, *'the best possible service*' includes not only the replacement
of lost tooth tissue (operative and prosthetic dentistry in all their
branches), but an intelligent study of fundamental physiological and
pathological principles in relation to the human body, and the under-
lying causes of dental diseases and their prevention. The dental
profession is assuming an impossible task, if it hopes to care for the
dental needs of the people by putting 90% of its effort into the
restoration of lost tooth tissue and 10% into the study of the primary
causes of dental disease. After three years' experience in the chair
of preventive dentistry, it is my unqualified judgment that the extra
year in the science subjects is absolutely necessary, that the graduate
may intelligently deal with the fundamental problems involved in the
prevention of dental disease. Preventive dentistry is simply applied
physiology, and physiology is applied physics and chemistry. Thus
ORAL HEALTH 43
the science subjects relate themselves directly to the preventive as well
as the reparative side of dental practice.
We must be trained to practise as dental physicians as well as
dental surgeons, with a vision cultivated beyond the circumscribed
area of the dental arch. It is upon this general ground that the
argument in favor of the five-year course must necessarily rest.
Dr. Arthur D. Black has said "that the dental course is lacking
in time allotted to the fundamentals of medicine. There appears to
be no good reason why the dentist should not have a general know-
ledge of medicine as any other specialist, which means that eventually
our dental and medical schools must have the same requirements for
admission and the same courses in the fundamentals of medicine. At
the present time our medical schools require two years in a college
of Liberal Arts for admission, four years in medical school, and one
of interneship in an hospital. Dentistry has during recent years
required high school graduation for admission and a four-year dental
course." In other words, seven years as compared to four.
At the Royal College of Dental Surgeons, we started out with
the idea that the pre-dental year was an extra year of matriculation,
that is, a fifth year at high school, or a first year at University, spent
in the study of certain prescribed subjects, and to be followed by the
regular four-year dental course. Students have been given the option
of taking the pre-dental work either in our own college, at a high
school, or a university.
The registration of five-year students at the R.C.D.S. has been as
follows :
Session 1 91 9-20 17 students
1920-21 75
1921-22 5b
In addition to those in attendance in the first year at the R.C.D.S.,
session 1921-22, there are approximately forty-five other students in
the high schools of Ontario completing pre-dental studies, preparatory
to enrolling in a four-year course next session.
The plan of permitting students the option of completing pre-dental
work elsewhere than in the dental faculty, we have found quite
unsatisfactory because of (1) lack of uniformity in high school
courses throughout the country. (2) Serious difficulty experienced
by students in obtaining a course covering all of the pre-dental
subjects, and (3) impossibility, under these conditions, of correlating
the pre-dental work with the balance of the course. Our Board and
Faculty have ceased to look upon the pre-dental year as an extra
year of matriculation work. We have come to consider it rather as
the first year of a five-year dental course. This decision was reached
after two years of experience with pre-dental students, some of whom
were trained in our own college and others elsewhere. Aside from
46 ORAL HEALTH
the lack of uniformity of high school courses, we have found it
impossible to develop a curriculum on a five-year basis owing to the
comparatively large number of students taking the work at divergent
points.
Commencing next session, therefore, all Ontario candidates will be
required to take the pre-dental course at the R.C.D.S. The five-
year course (that is to say, five years beyond four years at high
school), will enable us to gradually move back into the first year part
of the work now given in the four-year course, and ultimately, leave
the fifth year to be devoted largely to clinical and hospital training.
We believe that the five-year dental course is absolutely necessary in
the training of the modern dentist, and further, that dental faculties
should control the curriculum for the entire period. Such a plan,
then, will have the two-fold effect of:
1 St. Strengthening the scientific side of the course and particularly
the underlying medical and dental sciences.
2nd. Leaving more time for the application of these principles at
the chair-side, in actual practice in the clinical departments.
Our entire faculty appreciates the vital need for the pre-dental
year. Will you bear with me while I quote briefly three of our
professors? The following from :
Dr. W. E. Cummer: "After careful study and observation I have
concluded that the pre-dental course of studies is one of the most
important advances in dental teaching in many years, particularly
from a practical and also a cultural standpoint. While some of these
subjects ordinarily begin and end in Junior Matriculation, the definite
injection of the dental viewpoint in each, not only adds a great
interest to the subject, but gives the student a broad view of the
relative part with the whole, as for example, the relation of that
branch of physics with which dentistry is concerned to the whole
field of scientific engineering and other branches of physics, and the
common ground of all. I have felt keenly since graduation the need
of both instruction and review of English, moderns, mathematics,
shop technic, drawing, and modelling, and all of the pre-dental
subjects, and, if at all possible, will take a number of these classes
in company with the pre-dental students.*'
Dr. R. D. Thornton reports as follows: "The subjects taught in
the pre-dental year, especially drawing and clay modelling, have
been found of inestimable value in the teaching of dental anatomy.
The pre-dental student acquires a knowledge of form. He knows
how to analyse the outline of a tooth or shape of the arch, and is
therefore able to study the details of the anatomy of the teeth and
surrounding structures to much better advantage because of his pre-
dental training. He acquires a keen sense of appreciation of the
graceful curves which make for the harmonious outline of the human
ORAL HEALTH 47
form, and is thus enabled to produce in his artificial restorations,
harmony with the natural teeth remaining, or with the contour of the
facial features. The teaching of dental anatomy has certainly been
made easier by the courses given in our pre-dental year."
Dr. Thomas Cowling says: "There frequently exists in the minds
of dental students the misconception that chemistry is of minor impor-
tance in a dental course, such misconception being the result of
indifferent teaching methods of many preparatory schools. Hereto-
fore a student may have reached the Sophomore or Junior Year, with
his mind somewhat confused regarding the basic principles of chem-
istry, to find later on, that an intimate knowledge of the subject is
essential in a modern dental curriculum. In a five-year course the
teacher has an opportunity to clarify any hazy misconceptions of the
subject, to take the mystery out of chemistry, and to focus the
student's attention on the vital relationship existing between this
subject and the practice of modern dentistry. Pre-dental chemistry
proves of inestimable value as a preliminary to later and more
advanced work in this fundamental science."
We have had prepared a printed outline of the pre-dental course
as given at Toronto, copies of which have been distributed among
those present. We would draw your particular attention to the
subjects of modelling and drawing and their special application to
dentistry, and the courses in physics, and manual training, which are
so intimately related to dentistry and which, as specialized courses,
are not available elsewhere than in a college of dentistry.
Discoloration of Gums and Mucous Membrane
of the Mouth
P. E. McDonald, B.Sc.
Ro])al College of Dental Surgeons, Toronto.
IN treating the subject of discoloration of gums and mucous
membrane of the mouth or oral cavity, it becomes at once almost
permissible to add — "by the action of poisonous agents" — either
as solids, liquids or gases.
While certain discolorations are present in the various stages of
Periclasia, they are for the most part, quite apart from the distinct
discoloration arising from certain poisonous agents. For this reason
•et us discuss the subject of poisons a little before considering those
agents exhibiting a toxic action.
What is a Poison? One authority says it *'is a substance
which is able chemically to act on an organism in such a way that
48 ORALHEALTH
it affects a permanent or transient injury to its organs and functions;
an injury consequently to the health and well-being of the person
affected.'* Other authorities extend the boundaries of this definition,
but "a substance capable of being taken into any living organism
and causes by its own inherent chemical nature impairment or
destruction of function" seems quite adequate.
A classification of the poisons is necessary if we are to intelligently
understand the particular action of each, — especially on the super-
ficial tissues as now under consideration. A very detailed classifica-
tion is given by Blyth, and also Kobert, but for the present discussion
the following seems sufficient: —
First — Superficial. This causes anatomical lesions such as irrita-
tions, corrosions, etc.
Second — Blood Poisons. These change the constituency of the
blood when absorbed by it — such as haemalytic action.
Third — Poisons with definite internal action. These are the ones
which act on the organs or tissues in a specific manner,
N.B. — It should here be noted that some poisons exhibit all three
tendencies.
A poison may be absorbed by the system either as dust in fine
particles (solid), a liquid, or gas by the lungs, aHmentary tract or
the skin. The manner in which it may gain access is of utmost
importance, and may be described as follows:
Through the skin it gains access by means of being dissolved in
the secretions of the skin or wound, and then absorbed in solution.
Those poisons which are capable of dissolving the fat of the skin
are so absorbed. Liquids may break down the resistance of the
skin covering, causing an inflamed surface which is raw. All poisons
enter more easily by mucous membrane, as its resistance is weaker.
This is a particularly important factor when considering the mucous
membrane of the oral cavity. The quantity of poison absorbed
determines the effect. Every poison is without effect if assimilated in
correspondingly small quantities. There is consequently a minimum
dose of a poison which can only be ascertained and specified when
the qualitative properties and weight of the organism are considered :
therefore its relative value. The strongest effect is destruction of life
function of organism; concentration is a large factor as well as time
of absorption.
There are two very important divisions to poisoning which may
now be mentioned, i.e., CHRONIC poisoning, and AcuTE poisoning.
The former arises from the gradual and repeated absorption of small
quantities, producing slow onset of symptoms; while the latter arises
from a sudden absorption of larger quantities.
Some poisons act so quickly (as, for example, gases and liquids)
that a subject is powerless to avoid their onslaught. Some come
ORAL HEALTH 49
unnoticed, such as odorless gas and poisonous liquids on the skin.
Susceptibility should also be mentioned in referring to the action of
any poison on the subject.
If a patient is exposed to repeated contact with poison he becomes
increasingly susceptible (not immune, as might be expected, such as
contact with vaccine) , therefore acclimatization is impossible. Innate
hyper-sensitiveness of the individual toward a poison is called an
idiosyncrasy.
Gases are most quickly absorbed, and all elimination is affected
by the kidneys, intestinal tract and respiratory organs. It is important
to remember that a poison which is absorbed may have a CUMULA-
TIVE effect in the body. Some undergo in the organism chemical
change, through which poison is lessened or increased, as, for example,
in the oxidation of benzene into phenol; organic poisons and their
final end-products — carbonic acid, water, etc.
This general discussion should lead to a better understanding of
the fundamental action of poisons on the system. Each poison has
some further peculiarity all its own, which will be dealt with in
discussing each one separately.
Let us now deal with the agents causing discoloration, and also
what environment is conducive to a condition of discoloration of the
mucous membrane of a person subject to the influence of poison ; and
briefly note what change of surroundings or remedies are necessary
to clear up any case.
The most important of all by far is lead. "Plumbism" is not only
the most to be dreaded but also the commonest, and the practitioner
must ever be on the lookout in industrial clinics, etc., or when practis-
ing near large industries, for evidence of trouble in the mouth.
Particularly look for it among workers in lead, as in the plumbing
trade, house painters, colourists, type founders, type setters, artists,
gilders, workers in arsenic, gold, and calico printers. Lead has been
found by the analyst in most of the ordinary foods such as flour,
bread, beer, cider, wines, spirits, tea, vinegar, sugar, confectionery,
etc. It has been found in drugs, especially those manufactured by
the use of Sulphuric Acid (the latter nearly always contains lead),
and those salts or chemical products which (like citric or tartaric
acids) are crystallized in leaden pans. Hence the extremely numerous
ways in which lead may enter the system unnoticed.
Just two striking examples to show how manifold are the ways in
wh'ch a subject may be affected. A baker used old painted wood
m the construction of a baker's oven. No less than sixty people fell
ill as a result. On another occasion a cabman had a drink of beer
each morning at a certain saloon. The beer standing in the pipes
all night became impregnated with lead and he fell ill to "plumbism."
On more than one occasion the British Government has taken
50 ORAL HEALTH
definite action, as well as the governments of the other nations. A
report from a departmental committee on the subject reported as
follows : —
"It is known that if lead (in any form), even in what might be
called infinitesimal quantities, gains entrance into the system for a
lengthened period by such channels as the stomach, by swallowing
lead dust ; or through the medium of food or drink, by the respiratory
organs as in the inhalation of dust through the skin, there is developed
a series of symptoms the most frequent of which is colic. Nearly ail
the individuals engaged in factories where lead or its compounds are
manipulated look pale, and it is this bloodlessness and the presence
of a BLUE LINE ALONG THE MARGINS OF THE GUMS close to the
teeth that herald the other symptoms of "plumbism." A form of
paralysis known as "wrist drop" or lead palsy often affects the hands
of the operators. . . •"
This will give the dentist, and particularly the young practitioner,
some idea of the importance of observing closely any discoloration of
the gums in order to render the best possible service to his patients.
Still further symptoms have developed among workers handling
vulcanized rubber (Taylor's Princ. Med. Jurisprudence) and wrap-
ping foods in tin foil.
An acute attack, which is seldom fatal, in addition to having
the usual blue line around the gums, shows symptoms by a metallic
taste, with burning and a sensation of dryness in the mouth, vomiting
in about fifteen minutes, constriction in the throat, cramps, etc., and
a very sick patient.
In chronic lead poisoning, which may arise through the most
unsuspecting channels, as already mentioned, we find general ill-
health, disturbed digestion, lessened appetite, bowels confined, skin
yellowish hue, and the gums show a BLACK STREAK, from two to
three lines in breadth, which by microscopical examination and chemi-
cal tests alike show to be sulphide of lead. Occasionally the teeth
turn black.
Especially in females any symptoms of lead poisoning should be
noticed, as the most serious and extreme tendency to abortion is
prevalent. M. Paul states that in four women habitually exposed
to lead, who had fifteen pregnancies between them, ten terminated by
abortion, two by premature confinement, three went the full term but
one of the three children was dead, the second only lived twenty-
four hours, and only one of the fifteen lived fully. The dentist will
shirk his duty not to be able to diagnose a condition of lead poisoning
when it presents itself.
Another source of lead poisoning is in drinking water, and
especially in rural districts where well water is the source of supply.
Pure rain water, neutral distilled water and pure snow will all erode
ORAL HEALTH 31
lead, but do not materially dissolve it. The metal is detached in
scales like iron rust and is only slightly dangerous, but in low-lying
districts as moorlands, where there is apt to be acidity found, say
where peat is found, often sulphuric acid due to bacterial action and
contamination occurs.
The best advice for treatment is to keep the bowels open, along
with removing the cause and drinking lots of water.
Another poison, CoPPER, is somewhat similar in action to lead.
Like lead it may enter the system in a multitude of ways, even our
food, such as potatoes, carrots, beans, spinach, as well as most of
the fruits, contain small quantities. Cocoa is particularly high in
copper content. It is often found in aerated waters, the tin Hning
of the cylinders having become corroded. Rain water off copper
roof finding its way into water supply often occurs. Preserved
vegetables are dyed bright and attractive green, such for example as
peas, beans, cucumbers, etc., by boiling in copper vessels. Copper is
used in the arts and in alloys, and is a large constituent of bronzing
powders.
In Acute ccpper poisoning we have definite, easily observed
symptoms. For example, after swallowing a large dose of copper
sulphate, there was (according to Maschka) a violent blue vomiting,
thirst, constriction in the throat, coppery taste in the mouth. Patient
was pale, edge of lips and angles of mouth were colored BLUE, as
well as the surface cf the tcngue. In post-mortem appearance we
find the mucous membrane of the mouth changed to a dirty brown
color and easily detached.
In case of poisoning by verdigris (subacetate of copper), found
so frequently on cooking utensils and plated ware, besides severe
systemic inflammation and distension we find the mucous membrane a
DIRTY BLUISH GREEN color, affording valuable indications.
In Chronic copper poisoning there is a great resemblance to the
symptoms for lead, and there is a marked GREEN line on the margins
of the gums. Coppersmiths in an industrial plant might easily provide
this class of patient. Corrigan found the gum line colored, but
describes it as purplish red. Workers in copper, as for example such
a plant as the Canadian Westinghouse at Hamilton, Ont., might
be found to exhibit a general black discoloration of the mucous
membrane of the whole alimentary tract, resembling carbon.
Elimination takes place mainly by the excretory organs.
Bismuth is used considerably in pharmaceutical preparations, and
in the arts is found as alloys and solders. Calico printing and sub-
nitrate as a paint (pearl white) also provide source of supply for this
poison. Meyer and Stanfield found in researches that from Bismuth
preparations, especially where wounds are present (as in the mouth,
for example), there is a marked stomatitis and salivation, loosening
52 ORAL HEALTH
of the teeth, a black color of the mouth and ulceration. Excretion
is through the excretory organs.
Another poison is SILVER. It is found mostly as nitrate and
oxide in medicinal preparations, and we also find it everywhere in
the arts, as, for example, in hair dyes, marking inks, etc.
Acute poisoning is rare except where an unusually large dose
would be taken by accident. CHRONIC poisoning is, however, more
common. There is a peculiar and indelible color to the skin, the
body becoming greyish blue to black color. The mucous membrane
becomes inflamed (Gimpon) and there is a marked VIOLET line
around the edge of the gums. After death particles hke curd — like
silver chloride— adhere to the mucous membrane, extending down to
the serous coat. Silver nitrate causes a local whitening of the gums
and mucous membrane.
Mercury is so universally found in preparations and in the arts
that one is bound to find evidences of it in practice. Many patent
and quack medicines contain mercury. If it is rubbed on the skin it
is absorbed, and all the effects of *'mercurialism" result, just the same
as when by fumes the mercury is inhaled in finely divided particles,
or from the corrosive salts.
No matter how mercurial poisoning is contracted, we have result-
ing a very serious condition of the patient. The most marked symp-
toms are salivation and a BLUE LINE around the gums, fetid breath,
and disorder of the digestive organs. Salivation has been so profuse
that two gallons of saliva have been secreted daily, alkaline in color,
and with a bad odor. The teeth that are already carious decay
rapidly, loosen and come out. The inflammation may extend to the
jaws and necrosis of the bone set in. The stomatitis, however, is the
most marked symptom. Abortion in females often results from
absorption of mercury which occurs among women employed in
making barometers.
In Acute poisoning by a corrosive salt such as mercury chloride,
we have death following in from one to five days (F. A. Falck). The
symptoms are a constriction and burning heat in the throat, and the
mucous membrane of the oral cavity becomes shrivelled and white
(similar to silver nitrate). Treatment consists of inducing vomiting,
copious albuminous drinks, white of eggs and milk. General con-
dition should be strengthened without stimulation, baths given;
electricity applied, etc. Post-mortem appearances show the mucous
membrane to have a remarkable blacJ^ color, mottled with patches
of a lighter line. In acute poisoning you have the escharotic whitening
of the mouth, throat, and the mucuos membrane will be mostly
destroyed altogether. The sulphide of mercury is thought to be the
cause of the blackened condition.
A most striking point, worth repeating, is that externally applied
ORAL HEALTH 53
corrosive sublimate causes inflammation in the alimentary canal
almost the same in intensity as if the poison had been swallowed.
Cases are on record where intense inflammation of thr stomach and
intestines has occurred, and the mucous tissues being a SCARLET red,
swollen, and with many vesications.
Every dentist should be in a position to notice the action and effect
of this metal. When small doses of a non-irritating preparation of
the drug are given continuously for a certain length o.f time, the
first effects are observed in the mouth, for it has a selective influence
on the jaws, gums and adjacent structures. There is produced an
increased flow of saliva, fetor of the breath, redness of the gum
margins, pericementitis, causing soreness of the teeth when jaws are
forced together. If the drug is continued condition becomes worse.
In industrial centres constant watch should be kept. The cumulative
effect of the drug is very great. Potassium Chlorate dissolved in am-
monium water, used as a mouth wash, is a good remedy for the
loosened teeth. For necrosis of bone. Cook and Mawhinney recom-
mend 50 per cent, solution of phenol sulphonic acid. Morphine and
tonics also aid.
Zinc has a marked action, i.e., local dehydrating any tissue with
which it comes in contact, therefore intensely caustic in the chloride
form. Death may follow its external use. The appearance after
death, due to poisoning which has occurred within a few hours, of the
mucous membrane of the mouth is a marked change in texture and
white opaque color.
The only discoloration in Iron compounds to other than the tooth
structure itself is to be found in the post-mortem examination, where
the cavity of the mouth has the mucous membrane blackened by
contact of the liquid and covered with a blackish layer.
Chromium or Chrom compounds cause ulceration of the mucous
membrane which is hard to heal, especially at back of mouth and
tonsils, palate, and larynx. There is no antidote but silver, and silver
compounds are used somewhat. There may be a gradual absorption
giving a BLACK edge to the gums, and darkening of the hair and
nails, followed by dark spots on the skin. In severe cases these
coalesce, so the whole surface is blackened and glossy, due to the
absorption of the reduced silver in the body. The dark coloring on
the skin is due to the action of light.
Arsenic, while one of the most powerful poisons known, does not
exhibit any marked effect on the mucous membrane of the oral cavity
except where it has been used to devitalize the pulp tissue. There is
seldom any pain connected with the devitalization of the gum tissue,
and here is where the great danger of extensive necrosis lies. The
gum turns WHITE and becomes lifeless, and the tooth sore to per-
cussion. In more severe cases the destruction of soft tissue, if un-
54 ORAL HEALTH
noticed, goes on until the alveolar process between the affected teeth
is lost, together with one or two teeth on either side. Wash the
tissue and bring on hemorrhage and then flush with stimulating anti-
septics.
Antimony, like arsenic, has a deep penetrating power, affecting,
however, the alimentary canal from the stomach onward for the most
part. In post-mortem cases, however, we find ulcers and pustules and
a general irregular appearance and a dull grey color, with edges
varying from brown to black.
Adrenalin, when appHed to the mucous membrane, produces
such extraordinary contraction of the capillaries and arteries as to
diminish greatly the blood supply, and tissue becomes blanched white.
Death occurs from either paralysis or arrest of respiration.
Cantharides cause great inflammation and reddening of the
mucous membrane of the mouth. The tongue is denuded of its
epithelial layer and lips and mucous membrane are swollen.
Phosphorus is a poison whose symptoms are seen in a necrosis
of the lower jaw, commonly known as "Fossy Jaw." Adami and
McRae refer to the appearance of an ulcerative stomatitis in which
the gums become oedematous and spongy. The jaw-bone may be
exposed and the ulcerative process becomes extensive. Ulcerative
stomatitis has its peculiar discoloration and the mucous membrane
becomes involved, but the writer does not think the classification of
phosphorus with lead or copper, for example, to be quite the proper
procedure in a discussion of discoloration. Buckley states "the
dominant action of phosphorus is upon the osseous system" (p. 187).
Ammonia, when applied to the unbroken skin, does not have same
intense action as potash, nor does it coagulate albumen. Blood
mixed with it becomes dark red, then darker, and finally black or a
dirty brown red. The oxygen is expelled, the haemoglobin destroyed
and the blood corpuscles dissolved. The albumen of the blood is
changed to alkali-albuminate, and the blood itself will not coagulate
and the same remains in a fluid condition. General symptoms are
irregular irritation, redness and swelling of tongue and pharynx.
Caustic Potash and Soda causes the mucous membrane to
become white- — here and there denuded and the inflammation and
erosion present.
Coming to a study of the Tar Acids, we find CARBOLIC AciD
(phenol), when applied to the mucous membranes, blanches the sur-
face white, causing a burning sensation which is followed by numb-
ness. The part then turns a RED color, then BROWN, and eventually
desquamation occurs. Due to its action in coagulating albumen, the
degree is limited and becomes only superficial. Alcohol, when
applied, neutralizes the caustic action and is the best remedy. Post-
mortem appearances show brownish wrinkled spots.
ORAL HEALTH 55
NiTRO and Amido Compounds of the aliphatic and aromatic
series (i.e., blood poisons which form methaemoglobin) have the
characteristics of this series in the action on the blood. The exact
action is as follows: — The normal oxyhaemoglobin (blood coloring
matter) is changed to methaemoglobin, into which oxygen is so
firmly combined that the internal exchange of gases necessary to life
becomes impossible. Methaemoglobin has a dark CHOCOLATE-
BROWN COLOR and is clearly defined in the spectrum. Severe poison-
ing may be had by merely spilling on the skin. Grey-BLUE dis-
coloration of the mucous membrane, especially the lips, occurs — even
before the subject feels unwell. The usual treatment is same as for
other systemic poisons.
Nitrobenzene, when inhaled, induces especially formation of
methaemoglobin in the blood. Early discoloration of the mucous
membrane and skin, which assumes a BLUE or GREY-BLACK, is
characteristic. Signs of asphyxia and convulsions follow an acute
attack. Similarly DiNITROBENZENE gives an early discoloration of
the mucous membrane when inhaled as dust, etc., and shows marked
symptoms of poisoning.
NiTROPHENOLS are most toxic, and these have a characteristic
GREY-BLUE discoloration of the mucous membrane and CHOCOLATE-
BROWN color of the blood produced by methaemoglobin.
Trinitrophenol (Picric Acid) compound has a strong irritating
action on the mucous membrane, and when absorbed, as for example
in acid dust, causes inflammation of the mucous membrane of mouth
and air passages with a jaundice-like appearance or discoloration.
A rash appears resembling that of the measles or scarlet fever.
The First Graduate of the West China
Union University
Ashley W. Lindsay, D.D.S.
TC. WHANG, B.D.S., West Chma, (Bachelor of Dental
, Surgery), secured his degreee in June, 1921, after completing
a six years' course in the Faculty of Dentistry of the West
China Union University.
Mr. Whang was one of three students who were early chosen and
prepared to enter the Dental Profession. One of the three boys, a
brilliant young fellow, was drowned, another proved too weak in
body for the sustained study required. Mr. Whang alone has com-
pleted the course. He entered the University in the year 1915, regis-
tering as a medical student. In Medicine he secured the funda-
mentals of Surgery, Medicine, Pathology, Histology, etc , e^c. In
56 ORAL HEALTH
the year 1917 the University opened a Department of Dentistry,
under the Medical Faculty. Mr. Whang became the first Dental
student. In the year 1919 the University raised the Department of
Dentistry to the position of a full Faculty, and it is from this Faculty
that Mr. Whang secured the first dental degree granted in China.
It need hardly be emphasized that we w^ho pioneered Dental
Missions in West China view^ the achievements of the past decade
and a half vs^ith considerable satisfaction. Not only have we been
successful in initiating and carrying on a large Dental Department,
in connection with the Canadian Methodist Mission, but we have
been instrumental in establishing the first Dental College in China,
and at such an early date produced a graduate dentist.
Mr. Whang has contributed largely to this achievement by a
splendid command of the English language. This qualification
permitted the possibility of his using English text books, and a large
use of English in his instruction. To the present, there has been but
a mere beginning of the translation of dental text-books into Chinese
In this very necessary and all important contribution to dental progress
in China, Mr. Whang should contribute a large share.
Mr. Whang is a Christian, with a broad vision of his responsibility
toward his countrymen, and his influence on the community should be
far-reaching.
Modern dentistry, practised by qualified Chinese, stands at the
threshold of the future. With men such as Mr. Whang as pioneers,
we may rest assured that the profession will secure an honorable and
worthy place in society, that his Alma Mater will achieve fame, and
Canadians, who have made possible his education, will feel deepest
satisfaction.
How to Study
Irwin H. Ante, D.D.S., Toronto.
(The folloTving manuscript is a resume of material presented by
Dr. Ante to the students of the Royal College of Dental Surgeons,
as an introduction to their course in Crown and Bridge Work, and
it occurred to the Editor that the material would he of interest to the
graduate Dentist, as well as to the under- graduate.)
THERE is a best way of doing almost everything. There are
usually a number of good ways of doing a thing and innumer-
able bad ways. If your method of study is a bad one, you are
likely to be disappointed ; if a good one it is sure to bring satisfactory
results. The soundness of the following suggestions has been approved
by experienced students and teachers. If you earnestly follow them,
ORAL HEALTH 57
you may have the fullest confidence that your course in Dentistry will
surpass your highest expectations.
Some students have a vague impression there is some painless
method of instilling know^ledge without conscious effort on their part.
We bid you rid yourself of this delusion and brace yourself for work.
The man who will not work for knowledge has neither the judgment
to appreciate it, nor the energy to make adequate use of it if he had
it. The necessary work will be difficult at times, but will repay your
earnest efforts by the pleasures it will afford you while studying, and
the mental and material benefit that it will confer for all time.
Concentration.
Concentration is the first essential for study. It is what we would
call in Baseball language, "Keep your eye on the ball," which is a
fine example of alert and controlled attention. An idea on the page
performs the same as a baseball, but is much easier to keep in sight
with careful attention. Try to thread a needle. Yoii will have to
concentrate your attention upon the eye of that needle until your own
eye smarts with the effort. But you thread the needle. Now let us
apply this idea to study. In study your mind's eye has to be focused.
The idea on the page is the eye of the needle. The thread is your
thought. You have to concentrate or focus your attention on the idea
until your thought penetrates and goes right through it. Now if you
have patience and persistence, and think the work worth while, you
can use the same thread to link up all the ideas on the page into one
connected whole. While study is certainly work, it need not be
drudgery. Nearly every game that is worth while is work, but it
should be also a pleasure. Now there is just one thing that will make
your studies a pleasure and that is interest
Interest.
Interest makes even the hardest thing a pleasure; lack of interest
make success in a very easy subject impossible. If you haven't suffi-
cient interest to enable you to give your studies and work the concen-
trated attention that is necessary to ensure your successful mastering
of it, then you will have to create interest. How? By making your
imagination get busy, and show you what a thorough mastery of
this Dental course is going to mean to you. If you are absorbingly
interested in Dentistry, — so interested that you would rather read a
good dental journal or your lessons than a magazine of fiction, — then
your mind will gather and hold information relating to Dentistry as
surely as the magnet holds all the steel filings that come within its
range.
System.
System is another essential for successful study. You must have a
time for study, and a plan of study. You should have a certain time
58 ORAL HEALTH
of the day, and certain days set apart for study, and let nothing inter-
fere with your plan to devote that period to study. Every normal
human being is the creature of habit, and if you are v^ise, you will
make habit your friend in this w^ork. Without the habit of systematic
work, you can never go far in Dentistry or any other calling.
Place and Conditions.
Almost as important as the question of time is that of place and
environment. If possible, get away by yourself, or in a room where
people are not talking or doing anything to distract your attention.
Have a table to yourself and a comfortable chair with the light so
adjusted as to fall on the paper from over your left shoulder. Exercise
paper, pencil, or pen, etc., should be at hand, so that you need not
interrupt your work to look for them. Sit upright when you study.
Don't be too comfortable or allow yourself to slump in an easy chair,
or your intellect will quickly be lulled into sleep even if your eyes
remain open.
It is not possible to lay down exact rules for everyone. Examine
yourself, and the conditions under which you live and work. Then
decide on the methods of study that will be best for you, but remember
that you can make habit your ally or your enemy in this work.
Survey.
It is advantageous to read a chapter throughout before beginning
to study it in detail. Some people think that they have got all that is
worth while out of a chapter after reading it this way once or twice;
but this is seldom a fact, and such people deprive themselves of a
chance of ever becoming truly well-informed on any subject. The
first reading should be only to get a general view of the purpose and
plan of the chapter. Thorough knowledge can be obtained only by
detailed study of the paragraph, sentence and word by word, referring
whenever necessary to a good dictionary.
Mark Your Lessons.
Devise some simple system of marking your lessons, so that when
going over your lesson you can indicate that which is most important
or worth giving attention to when reviewing. Besides marking your
lessons, it is well to make notes. The mere act of writing the thought
helps to fix it in your mind, and you will often find it possible to take
your notes and use them, when you could not conveniently take your
reference book.
Memorizing.
Avoid memorizing word for word. When you learn it off by
heart, the heart is never there. Pay careful attention to the words
until you understand exactly what the author is trying to tell you, and
ORAL HEALTH 59
then forget the words, but do not forget the idea, because ideas are
what you are after, not words.
The best way to memorize the ideas is by giving absolute attention,
and then fixing the thought in your mind by frequent review. When
you have studied a paragraph, run over the ideas in your mind with
book closed. Review occasionally by reading rapidly work that you
have been already over, paying particular attention to portions that
you have marked.
Timing.
By studying and testing yourself as suggested in the above para-
graph, you can soon get an idea of your speed in mastering a lesson.
Then if you value your time, you can save an immense number of
hours by keeping up to your best rate of study all the time. You will
have more time to spare than if you permit yourself to drowse over
your studies.
Work and Rest.
If you follow these few sugestions and apply yourself to your work
and study with your entire might, you will find that you cannot study
very long without a feeling of fatigue. The stronger the concentra-
tion, the more quickly will the mind grow weary. Devote half an
hour to concentrated study, and then rest for five minutes. By working
and resting you should be able to devote an hour or two to earnest
study without being tired when you have finished. The result of this
method will be most gratifying in the amount of work covered.
Value Your Moments.
Nearly everyone wastes many minutes in the day by failing to use
the particles of time that come between the larger tasks. These
fragments of time you can use to excellent advantage by thinking
over your lessons or work. Those passages that were not quite clear
to you while studying, became transparent as you turn your thoughts
upon them in these leisure moments. Soon the knowledge ceases to
belong to a book but becomes entirely your own, a part of yourself.
Study hard and regularly, but think even more than you study. This
is the best way to digest and assimilate what you have been learning.
Conversation.
As an aid to classify your thoughts, talk is of great value. Talk
about your lessons and work with the members of your own family
or friends. Talk with your demonstrator and professor, tell them
what you have learned and get their opinion. It will often be helpful
to you. Talk with your fellow-students. It will do you good to find
that you still have a good deal to learn; and if they don't expose your
60 ORALHEALTH
ignorance, you will help to cure theirs and interest them in a subject
that they ought to know a lot about.
Put It To The Test.
Don't believe all that you read in the text books or journals with-
out putting it to the test. Think, weigh, reflect, question, and when
you can't agree, get in touch with someone that does know. No
living man knows all about Dentistry; old beliefs are continually
being revised and new discoveries made. It may be that you will
make some of the great discoveries. Anyhow, it will be mighty inter-
esting to investigate and try out what you are taught in your lessons.
The best way to put your lessons to a test and make them of the
greatest possible interest to you is to apply to practice, at the first
opportunity, the things you learn. Visit other offices of general practi-
tioners and specialists, and see how things are done there. You would
be welcome. It is hard to find a real Dentist who does not delight
in showing his work to others who are interested, and in discussing
questions in regard to success and failure.
Learn By Doing.
The "learning by doing" method is the ideal way. You will find
that everything will take on clearer and deeper meaning as soon as
you have learned it by doing it and it will be stamped indelibly upon
your memory.
A thing may have been proved beyond the chance of a doubt by
experts, but so long as it is only book learning, it remains only a
theory to you. It becomes fact only when you prove the thing in your
own experience to be a fact. Therefore, we repeat, put your lessons
to the test of practice. Investigate and question, and tell us what
results you get. Your experience will be mighty interesting to us
and will prove of great value to you. Let us work together for all we
are worth for the greatest efficiency in the Profession of Dentistry.
Plenty of Water
If little flowers would droop and die
Had tliey not lots of' water
What would become of you and I
Or any son and daughter
Had we not lots of water too?
That's what I'd like to know.
It's lots of water every day
That makes us liva and grow.
-(Dora Lawrence Cameron, Wenatchee.
s
ORAL HEALTH 61
An Appreciation
Henry H. Way. D.D.S., St. Thomas.
The members of the Elgin Dental Soctet'^, meeting in St. Thomas,
Ontario, February, 1922, honored Dr. Way, the oldest member of
the Society, and expressed their appreciation of his many estimable
qualities. In honoring Dr. Way his confreres and colleagues honored
one of the pioneers of Canadian Dentistry.
Reported by T. C. Trigger, D.D.S.
WE are assembled this evening for the purpose of honoring one
of the members of the Elgin Dental Society, for his long
and useful service to the public, and as an honored and
beloved member of our profession. We have known him for a great
many years as a patriot and true friend, ever ready to say a kind
word for his fellow practitioner and others whom he has met. These
are but a few of the many noble characteristics of our worthy
associate, Dr. Henry H. Way, and we ask him to accept these
remarks in their truest meaning.
He gives us a lasting impression of the many noble purposes of
his life, and well may we say to him, —
"There are loyal hearts, there are spirits brave.
There are' souls that are pure and true;
Then give to the world of the best you have
And the best will come back to you."
Certainly these lines apply admirably to the Doctor, for he has
placed culture and intellectual training of the mind, high and noble
thoughts, above everything else to be obtained in this life.
Dr. Way was born in the small town, Kennet Square, a short
distance from Philadelphia, Penn., where he attended the public
school and the Academy. After completing his preliminary studies
he entered the Pennsylvania College of Dental Surgery, graduating
\in the spring of 1874. As a student he indentured in the office of
his father. Dr. Alben Way, who practised for a few years in Phila-
delphia and later in Kennet Square.
His father was an experienced dentist and skilled mechanic, and
his ability was shown in scientific experiments in mineral products for
the manufacturing of artificial teeth. He equipped a laboratory with
a blast furnace. He ground the minerals for the main body of the
teeth, — namely, kaolin, feldspar and silex. The ingredients were
fused into artificial teeth which he used in his regular practice.
During the Doctor's course at the Pennsylvania College he had
many notable teachers, to whom the profession owe much at the
62 ORAL HEALTH
present day, such as Professors J. Foster Flagg, Stelwagon, James
Truman, and their contemporaries.
While attending his course of studies, women students were
admitted and at graduation several women received diplomas. At
that time there was much opposition to having women attend college
lectures, as some thought that full instructions would not be given
in certain subjects, such as anatomy.
The Doctor spent several years in practice in the United States,
afterwards coming to Canada in 1880, and before being permitted
to open an office in Ontario passed a special examination at the
R.C.D.S., Toronto, and ever since that time has been continually,
and still is, in practice in the City of St. Thomas, Ontario.
The discussion of the evening developed into an historical sketch
of the early days of dentistry and an outline of office routine as
practiced when Dr. Way was a young man.
In those days a student was more anxious to be with a good
Dentist to obtain practical work than he was in selecting the most
reputable Dental College, and in this way they obtained a good
knowledge in the making of artificial teeth to be used in the con-
struction of artificial dentures made of metal, as vulcanite was not
known as yet. At that time silver was used principally for making
plates. They were more generally used than gold ones.
The construction of these dentures required the patient to wait
fully two weeks before obtaining them.
The porcelain teeth were made with holes through them, in which
were inserted wire pins, and then riveted to the plate, — a more
tedious technique than constructing dentures in these days. Certainly
we have an easy time compared to those early days of mechanical
dentistry. What a remarkable advance in this branch of dentistry!
At that time whole dentures were made out of practically one piece
of porcelain involving the whole palatine surface. Soon after came
the introduction of vulcanite for making artificial dentures.
Dr. Way was contemporary with many eminent dentists. The
great and talented Professor J. Foster Flagg was noted principally
for his new departure in the discovery of the various plastic materials
for filling teeth. Others following up his ideas were Drs. Townsend
and Arrington, who helped to introduce them into Dentistry.
Dr. Flagg at a special meeting of New York Odontological
Society m 1877, on the subject of "Plastic Filling and the Basal
Principal of the New Departure," stated:
"That which I bring you to-night is no growth of a day. It is no
/work of a year, I therefore recognize that what seems to me to
sound as it ought to sound, will sound to you just as it ought not to
sound. I shall present to you the time-honored and ordinary
i
ORAL HEALTH 63
'accepted creed' of dentistry, and I shall advocate before you the
diametrically antagonistic 'creed of the New Departure.' Do you
suppose it is a new thing for me to be antagonizing accepted
dentistry? No, gentlemen, it is not a new thing. For more than twenty
years I have known what it is to be upon the 'right side.' Twenty
years a.vo, my very good and highly esteemed friend. Prof. Robert
Arthur, enunciated his belief in leaving decay in the cavities of teeth
and filling over it, for a wise and special purpose, as he thought, and
it was stigmatized as nasty, dirty, slouchy work; and our great man.
Prof. J. D. White, said that when he could not spend time to pro-
perly clean out the cavities he would retire from practice. Here
is a document written by my honored father's own hand, giving an
account cf the action of a college faculty on the question: "When
the faculty of the old college met for the purpose of arranging the
last 'Announcement' of that school, exception was taken by Prof.
White to what he considered as 'false doctrine' on the part of Prof.
Arthur in regard to two prominent features in our art, both of which
he considered of vital importance to our success as instructors, and
to the successful practice of many of our graduates. The first of
these was, that Prof. Arthur advocated the leaving of caries in the
cavity of a tooth and plugging thereon; and the second, deemed
equally objectionable, that of using 'sponge gold' as a material for
filling teeth, and as a substitute for gold foil. Now, although every
other member of the faculty fully coincided with Prof. White in his
opposition to this practice of Prof. Arthur,
He further states "that more than twenty years ago. Prof. Elisha
Townsend gave his contemporaries the assertion that he 'saw daily
the undeniable evidence of the fact that teeth could be saved with
amalgam, which he could not save with gold.' His memory is
revered by us all. As a worker in gold he was unsurpassed. As a
proof of his estimation of plastic filling, he gave to his profession
'Townsend's Amalgam,' — that material with which we began our
labors, — the material which had so much of good in it that we were
more and more impelled, as the years passed by, to recognize its
value.
"I feel that I owe much to Prof. Townsend, for he made the way
of experiment easy for me. Within a very short time after his death,
nearly two hundred families became my patients. This not only
placed me (then a beginner in Philadelphia) at once in full practice,
but enabled me to cultivate a ground for plastic filling which had
been well broken by one in whom they had unbounded confidence.
Now, gentlemen, the statistics which I propose to offer to-night have
been based upon this experience.
Dr. Way during his life-time has experienced many wonderful
developments in dental practice. In the early days non-cohesive was
64 ORAL HEALTH
the only kind of gold known, and anyone who is familiar with this
kind of gold will know full well the great difficulty experienced in
operating with this kind of gold. The introduction of cohesive gold
was a great advancement in filling teeth, as the process was by a
means of gold welding and not by adhesion of the particles of gold
after being welded together. Many became experts in filling teeth
by this process. Dr. Varney became a renowned operator in filling
jteeth with this form of gold, as well as Dr. Louis Jack of Phila-
delphia. The introduction of Nitrous Oxide for the extraction of
teeth and other operations brought about a great revolution and
revelation in Dentistry, as so many Dentists took advantage of this
means for extraction of teeth, and thus made a new and great demand
for artificial teeth. Such men as Colten and Thomas became great
specialists in this department of Dentistry.
Among the notable personages whom Doctor Way has met and
become associated with in his early days of dentistry are many who
have passed the way of "a greater dentistry." Some of them to this
day are living, but most of them have passed beyond.
He was personally acquainted with (and heard him lecture on
more than one occasion) the most famous surgeon of his day, Prof.
Samuel D. Gross, — a man who still stands pre-eminent in American
Surgery. Time will not permit mention of others, save passing
reference to that highly polished and distinguished dentist, Dr.
Thomas W. Evans, who was born in Philadelphia in 1825. He
became so renowned that he won royal favor, being Court Dentist
to royal personages, notably Napoleon III. When France became
engaged in the war with Germany in 1870, he was instrumental in
helping the Princess Eugenie to escape by admitting her to his home
and then helping her to find her way to England. Dr. Evans left a
vast fortune, which was to be used for a Dental Institute, which has
since been located on Fortieth and Spruce Streets, Philadelphia.
In conclusion, we wish to state that we are pleased to have Dr.
Way with us this evening in the best of spirits, and still enjoying
health in keeping with his advanced years. He has taught us many
of the attributes of a contented mind. Well may we say, —
"So let us live in sweet content
As we pass on, and on through life;
No matter how our ways are bent.
Come! let us five to meet the strife. — T.'*
We trust. Dr. Way, that you may be spared for a number of
years to enjoy the blessings of this goodly heritage, and continue to
join us from time to time in our society meetings as a life member of
the Elgin Dental Society. Therefore, it is with extreme pleasure that
we have assembled on this occasion, and on the behalf of our Society
wish you to accept these words as a token of our sincere esteem.
65
99
"The Dignity and Importance of Dentistry
AN eminent educator in an address on "Correlation in the Teach-
ing of Dentistry and Medicine," quotes Mr. Abraham Flexner,
Secretary of the General Education Board, as saying:
"We have come to see in the last few years that dentistry
is a branch of medicine of the sam.e dignity and importance
as pediatrics, obstetrics, gynecology or any other specialty.
. . . The new school of medicine will, it is hoped, undertake
to place training in dentistry on the same academic and
scientific level as training in medicine and surgery."
Taken at its face value the above-quoted statement is an interesting
demonstration of medical psychology that either knowingly or
subconsciously portrays the inner workings of the medical professional
mind, as that mind is prone to react toward dental professional
stimuli. A brief critical analysis of the statement may therefore be
not without interest and may possibly lead to some conclusions useful
in bringing about such a correlation of teaching in dentistry and
medicine as will redound to the good of all concerned.
First then, "We have come to see in the last few years that dentistry
is a branch of medicine of the same dignity and importance as . . .
any other specialty."
It is fair to assume that "We" in this case means the medical
profession or at least those competent to speak with authority on;
behalf of the medical profession.
It is now over eighty years since Chapin A. Harris and Horace
H. Hayden, both medical men, imbued with precisely the same idea
as we have quoted from Mr. Abraham Flexner, made overtures to
the Trustees and Faculty of the Medical School of the University of
Maryland with a view to placing "training in dentistry on the same
academic and scientific level as training in medicine and surgery."
History records that their proposal was rejected with scorn, and
with the result that dentistry, now hailed as a dignified and important
specialty of medicine, on being refused admission to the medical
household established its own centres of education, developed its own
literature and professional associations, and an autonomous control
of its professional activities that thus far has enabled it to survive
and work out its own destiny. In short, dentistry has justified its
right to survive, despite the fact that it has been treated by the medical
schools and their progeny with the scant courtesy usually accorded to
an illegitimate child through more than three-quarters of a century
of its existence, — denied recognition for its attainments, refused
admission to medical associations and councils, scoffed at as a
mechanic art and the status of its degree sneered at as the impertinent
badge of a partial culture.
66 ORAL HEALTH
Now we seem to have been discovered — not only discovered, but
we are found to be a profession of dignity and importance equal in
these desirable characteristics to the other recognized specialties of
medicine. Now what is to happen? Pursuing the psycho-analysis
of our quoted text the answer is not far to seek. V o'da! "The new
school of medicine will, it is hoped, undertake to place training in
dentistry on the same academic and scientific level as training in
medicine and surgery." That is to say, now that we are discovered
and found to be dignified and important the medical school will
undertake to place training in dentistry on the same academic level
as training in medicine and surgery. *****
Then what ? There is no intimation as to the future relative status
of dentistry to medicine after the medical school has undertaken to
reorganize the basis of education in the dental school, so we infer
that the utmost that can happen will be that the medical school and
its progeny will continue to realize that the dental school and its
progeny are dignified and important.
But will that proposed rearrangement of affairs be a material
benefit either to dentistry or medicine? Let us consider for a moment
the circumstances surrounding this new medical discovery of t he
dignity and importance of dentistry. History records that after nearly
three-quarters of a century of consignment to medical oblivion
dentistry suddenly loomed large on the horizon of medical conscious-
ness through the clinical findings of Sir William Hunter with respect
to oral sepsis and its relation to systemic disease.
In many respects the publication of Hunter's papers was the
most important contribution ever made to either dental or medical
literature. For dentistry they acted as a potent counter-irritant that
compelled a revision of dental technique in harmony with the vital
activities of the oral tissues and the pathogenic flora of the mouth
cavity. To medicine they opened the door to therapeutic possibilities
before unknown or neglected, and compelled a study of conditions
that had been tacitly regarded as unimportant, possibly the mechani-
cal and therefore professionally undignified art of the dentist.
Hunter's communications threw a new light on the matter, a new
light literally, for in principle the relation of mouth infection to
systematic disease was a part of the literature of dentistry worked to
a demonstration by W. D. Miller, a dentist almost a quarter of a
century before Hunter's studies were published. So it will be readily
seen how it was that the dignity and importance of dentistry came
to be discovered and is not a thing of recent developments. *****
The assumption that the medical profession has or should have
monopolistic control of those biologic sciences that are the founda-
tions of the healing art is a fallacy that dies hard in the medical
mind, notwithstanding that the historic pathway of organized medicine
ORAL HEALTH 67
is strewn with the wrecks of practical attempts to prove the title of
organized medicine to all medical knowledge.
Dentistry has for its whole history been gradually including all
those elements of scientific medical knowledge needful for its growth
and successful practice. Its academic preparations, its scientific basis
is already close to if not a parity with that required for medical and
surgical training. While the dignity and importance of dentistry is
a recent medical discovery, dentistry itself can scarcely be said to
have yet revealed itself to the medical mind. Some day perhaps a
newer type of medicine may take over the control of dental education,
but — "not yet, Amarillo, not yet!" — Editorial, Dental Cosmos.
Announcements of Dental Meetings
American Societ]) of Orthodonists, April 24, 25, 26, 1922, Edge-
water Beach Hotel, Chicago, 111. Ralph Waldron, Secretary.
Combined Convention of Canadian Dental Association and
Ontario Dental Society, also Canadian Dental Faculties Association
and Dominion Dental Council, May 15, 16, 17, 18 and 19, 1922,
at King Edward Hotel, Toronto, Ont. E. A. Grant, 229 College
St., Toronto, Secretary.
American Academy of Period ontology, July 10, 11, 1922, Drake
Hotel, Chicago, 111. J. Herbert Wood, Secretary, Cleveland, Ohio.
National Dental Association, July 17-21, 1922, Ambassador
Hotel, Los Angeles, Cal. Otto U. King, Secretary, 127 N. Dear-
born St., Chicago, 111.
To Summarize. — Oral Prophylaxis for the prevention of decay
and pyorrhoea encroachment is of such vital importance as to demand
the attention not only of the medical and dental profession, but of all
people. Pathological areas and pyorrhoea should receive our earliest
attention. Eradication, either by treatment, or, if not expedient, by
extraction, should be our aim. — H. C. Moxham, Dental Science.
Rubber Dam. — If rubber dam is used more than once, after
boiling in soda water and drying, a little French chalk rubbed on
will give a velvety surface again. — T. I. Williams, Sydney, Dental
Science.
Quick Repair for Porous Places in Plates. — Whenever
you desire a quick repair for porous places in plates, cut out that part,
save the fine powder, mix powder with synthetic porcelain, then fill
cavity. After this has solidified and is polished it is very difficult to
detect place repaired. Use rubber filings from some plate you are to
repair. — C. /. Faison, Dental Summary.
PROVINCIAL EDITORS'
CORNER
MANITOBA ITEMS.
Reported by W. W. Wright, D.D.S., Winnipeg.
THE annual meeting of the Manitoba Dental Association was
held on the second Monday in January, and was well
attended. The report of the President, Secretary, Treasurer
and Registrar, showed the association to be in a healthy condition as
regards paid-up dues, general finances, prosecutions, etc. When the
result of the election was known, it was found that two new faces had
appeared among the members of the board, in the persons of Hubert
A. Croll and J. F. Taylor.
A very unanimous vote of appreciation was passed for the services
of Dr. G. F. Bush, President, who retired after nearly twenty-five
years of unbroken service on the Manitoba Dental Board, during
which time he had occupied each of the various offices at different
times.
For several years there has been a wish, a keen desire, an agitation
on the part of some of our members for an educational or publicity
campaign on the care and importance of the teeth, etc. At last we
are going to get in the procession and do something. A committee
representing The Manitoba Dental Association and The Winnipeg
Dental Society has been appointed, of which the members are: W.
W. Wright, Chairman; Roy Bier, D. A. McCarten, H. J. Merkeley
and C. J. F. Jackson.
Thirty-two former members of all ranks of the C.A.D.C. had a
very enjoyable reunion dinner on Saturday, February 4th, at the Fort
Garry Hotel. The president. Dr. C. H. Moore, occupied the chair.
This is the second annual reunion. Among the dentists present were
Drs. H. A. Croll, J. F.Morrison, D. P. Stratton, B. S. Bailey, H.
C. Jeffrey, J. M. Rogers, D. A. P. McKay Hodgson, R. J. Yeo,
A. W. Myles, Stoddart, K. M. Johnson, Dougals Brown, N. C.
Carmichael, F. J. Lawson, W. W. Wright, J. A. Dow and A. E.
Clint.
ORAL HEALTH 69
MARITIME PROVINCES.
Reported by J. Stanley Bagnall, D.D.S.
THE regular monthly meeting of the Halifax Dental Society was
held on January 31st, 1922. Instead of the regular paper, the
evening was devoted to a discussion of three questions adapted
from a recent article by Dr. E. S. Best, on "Pulps and Pulpless
Teeth." The questions for discussion were incorporated in the notices
sent to the members of the Society. The experiment was very success-
ful, and most interesting discussions took place.
Dr. G. R. Hennigar opened the discussion on the first question:
*'Do you think that the importance of the part teeth play in focal
infection is over-estimated or under-emphasized, or has been fairly
estimated? Dr. Hennigar read a short paper outlining the problem,
illustrating his remarks with some excellent lantern slides of cases
where focal infection had played a part. He also read a number of
interesting letters on the subject from Drs. W. A. Price, C. R.
Turner, Kurt H. Thoma and Dr. Burden. Dr. F. W. Ryan, con-
tinuing the discussion, noted the tendency of so many movements to
swing to extremes, and felt that many diseases attributed to focal
infection might be the result of some other cause, as errors of diet, etc.
Dr. F. W. Dobson opened the discussion on the subject: "From
an anatomical standpoint, is the removal of the tooth pulp and the
sealing of the canal a feasible operation? If not, why not? If so,
under what conditions? This question gave rise to the most interesting
discussion of the evening, a large number of the members taking part.
Dr. Dobson believed that in normal, well-shaped teeth pulps can be
successfully removed. He advocated the use of broaches, reamers,
etc., and a final cleansing with such chemicals as Sodium and
Potassium. He felt that the operation of filling the canals was a more
difficult one. The general opinion of those who continued the discus-
sion was that strong chemicals of all kinds should not be used in root
canals, because of the danger to the pericementum. The late work
of Dr. Clyde Davis was freely discussed and favorably commented
on.
Dr. F. W. Ryan opened the discussion on : "What do you advise
and what is your procedure in the treatment of vital teeth where the
decay is so extensive that its entire removal will mean exposure of
the pulp"? Dr. Ryan discussed the various types of decay, and felt
that they had an important bearing on the question. Also that the
position of the tooth, and the age of the patient should be taken into
consideration.
The meeting closed after a demonstration of a Radioscope and
a pulp testing machine by Dr. Hennigar.
n
n
THE COMPENDIUM
This Department is Edited by
THOMAS COWLING, D.D.S., Toronto
A SYNOPSIS OF CURRENT LITERATURE RELATING
TO THE SCIENCE AND PRACTICE OF DENTISTRY
The Restoration of Incisal Corners, the Pulp Being
Intact.
THE following technique is described by Dr. Martin-Sultan in
La Semaine Dentaire, December, 1920: —
Preparation of the Tooth. Trim the fractured angle but
leave the original line of the fracture whether the line be concave or
convex; by doing this the least amount of dental tissue is sacrificed
and because, with a concave or convex line, one has less to fear from
the pivots (to be described immediately) undergoing a stress to dis-
place the gold inlay.
Then with a fissure bur cut two small canals one to two millimetres
deep at right angles. These canals are for the anchor posts for
the gold corners. Their diameter should be three-tenths to five-tenths
of a millimetre.
To increase the strength of the restoration, cut the fractured surface
in the shape of a roof, so that the openings of the two small canals
are on the crest of it. This method of cutting increases the resistance
in the labial and lingual directions.
Malting the Wax Inla}). Introduce into the horizontal canal which
is just below the pulp, a gold post, bent bayonet shape, about one-
half a millimetre from the edge of the canal and projecting about
two millimetres beyond the corner which is to be restored. Intro-
duce into the vertical canal, parallel with the pulp, a graphite point
of the same diameter as the gold post to be inserted therein. This
point reaches into the bend of the first gold post. Bending of the
vertical wire is necessary when the corners are small, otherwise the
gold post and the graphite point would meet. Mould the corner in
wax, allowing the graphite point to pass beyond the incisal edge.
Harden the wax by cooling and withdraw the model laterally by
fracturing the graphite point, allowing the part within the canal to
remain there.
Cast the Inla^. The graphite point is held in place in the invest-
ment by its extremity, which projects five millimetres into it. Remove
with a bur the graphite from the canals in the inlay and tooth.
ORAL HEALTH 71
Fixing the Cold Inla^, Fill the two canals in the tooth with
cement and coat both the tooth and inlay with it; then place the
latter in position with the fixed post and immediately introduce a
second post through the canal in the inlay to the bottom of the verti-
cal canal in the tooth. When the cement is hard, cut off the end of
the post and polish. When the incisors are so close that sufficient
separation is impossible to remove the wax impression laterally,
proceed by making the vertical post the fixed one. The anchorage
obtained by posts at right angles and by the angular cutting of the
fractured surface is such that the restoration cannot be removed
except by breaking the tooth. A rigid wire must be used for the posts.
Some Uses of Base-Plate Gutta Percha.
IN an address delivered before the Society of Dental Science,
N.S.W., Dr. Basil Jones gives some of the uses of gutta-percha.
These are as follows:
1 . Permanent fillings in cavities below the gum margin.
2. For fillings in temporary teeth.
3. A separating material.
4. A compressor for applying cocaine to pulps.
5. For temporary setting up of dowel crowns.
6. For temporary setting of hollow metal gold crowns and bridges.
7. Permanent setting of dowel crowns in combination with cement.
8. For taking impression of roots where compression of gum is
needed and a mold required.
One important use of gutta-percha is in its application to the
temporary and permanent setting of dowel crowns. Any detachable
pin crown can be set in a very short time by filing the pin to give
plenty of space to take up the gutta-percha. The pin is then barbed
with a sharp knife and fine strips of base-plate gutta-percha are
run around it with the pin hot. The gutta-percha coated pin, with
crown, is then adapted to the moistened root canal, placed in correct
line, and compressed so that the base-plate fills perfectly the inter-
vening space between the root and porcelain crown. It is then with-
drawn and gutta-percha trimmed to just cover the root, and with
thin cement placed in the socket of the crown, it is returned to the
pin and set into correct position. The same procedure is followed for
the permanent setting of these crowns, except that the gutta-percha
around the barbed pin is reduced to allow a strong coating of cement
between the wall and intervening gutta-percha. The base of the
porcelain crown is also ground to the root as perfectly as possible,
so as to allow practically no gutta-percha exposed to the fluids of
the mouth. These crowns are easily removed should any trouble
arise in the root. The gums in contact with gutta-percha will show
very little, if any, irritation even after long use.
CZD
ORAL HEALTH
EDITOR:
WALLACE SECCOMBE, D.D.S., F.A.C.D., Toronto, Ont.
CONTRIBUTING EDITORS:
C N. JOHNSON, M.A., D.D.S.. F.A.C.D., Chicago.
RICHARD G. Mclaughlin, D.D.S., Toronto.
W. E. CUMMER, D.D.S., Toronto.
J WRIGHT BEACH, D.D.S., Buffalo, N.Y.
Entered as Second-class Matter at the Post Office, Toronto.
Subscription Price, Canada and United States, two dollars per annum;
elsewhere three dollars. Single Copies. 2oc.
Original Communications, Book Reviews, Exchanges, Society Reports, Personal Items, and other
Correspondence should be addressed to the Editor, Oral Health, 102 Wells Hill Ave., Toronto, Canada.
Subscriptions and all business Communications should be addressed to The Publishers, Oral Health,
Royal Bank Building, 269 College St., Toronto, Canada.
Vol. XII.
TORONTO, FEBRUARY, 1922
No. 2
Q
E.DITOR.IAL1
S
The Dentist as a Defendant in a Suit for
Alleged Malpractice
THIS is one of the unenviable and unwelcome positions in which
even the most careful and skilful dentist may unexpectedly find
himself. In the routine of his daily practice an unfortunate
occurrence has taken place, whereby the patient is injured. In due
course the practitioner is the recipient of a legal document claiming
damages for the patient because of injury received through alleged
wrong practice on the part of the dentist.
When you are threatened with court proceedings of such a char-
acter, it is good policy not to say anything or do anything hastily. A
little sane consideration and forethought as to the proper course of
procedure may save much worry and expense afterwards.
When damages are claimed and suit threatened, two courses are
generally open to the practitioner: either to negotiate terms of a
settlement or fight the matter out in the courts. If the dentist feels
he is at fault, and that the patient has suffered because of his want
of care or skill, then it is clearly his duty to properly recompense the
patient for the injury wrought. Such a course is the only just one,
and will place the practitioner and the profession in a proper light
before the public.
When, however, such a settlement is arranged by which, for
ORAL HEALTH 73
example, the dentist agrees to recompense the patient for all medical
and hospital expenses, then it is a wise precaution to obtain from the
patient a signed statement absolving the dentist from any further
responsibility in the matter.
However, if the dentist is convinced that the claim is an unfair one,
and that he is bemg made the victim of unreasonable and unscrup-
ulous demands, then, in the best interest of his own security and the
future safety of the profession, he should not agree to any compromise
or settlement other than a complete withdrawal of the accusation.
It is a well-established rule that before the patient or complainant
can be awarded damages he must prove to the court that there was
wrong practice on the part of the dentist, that the patient was
injured, and that such injury was the result of and could be traced
directly to such wrong practice. These three essential points must
be proven, and they must be shown to follow each other as cause and
effect.
Now, having determined to defend and justify your treatment of
the case before the court, it behooves you to put on your professional
and legal armour and leave no stone unturned to build up a defence
so strong that victory is almost assured before the proceedings are
opened. Many, very many, such cases are lost, not because the
dentist is at fault professionally, but because of faulty and loose
preparation before going into the court-room.
Under such circumstances it is wise to take a few of your profes-
sional colleagues into your confidence. Then place your case in the
hands of your legal counsel, and see to it that he is made acquainted
with every phase of the situation. Last, but not least, make sure that
you have as expert witnesses one or two of the most experienced
practitioners or specialists in this particular line of practice.
Remember always, that in this individual case of yours you are
not only defending yourself from this unjustifiable attack, but that
you are by so doing guarding the profession in general from a repeti-
tion of such unreasonable demands.
In all such cases we should never forget the broader professional
outlook, and realize we are the sentinels on guard to discourage and
ward off all such attempts on the good name and standing of the
profession.
R. G. M.
Respect for Law and Order
IF any body of men should show respect for law it should surely be
the lawyers and judges; and we find that the American Bar
Association recently passed the following resolution in reference to
the prohibitory law.
74 ORAL HEALTH
*'When for the gratification of their appetites, lawyers, bankers,
merchants and manufacturers and social leaders, both men and
women, scoff at this (prohibition) law, or any other law, they are
aiding the cause of anarchy and promoting mob violence, robbery
and homicide. They are sowing dragon's teeth, and they need not
be surprised that no judicial or police authority can save our country
or humanity from reaping the harvest.*'
Whether he favors the prohibitory law or not, every citizen who
desires his country to prosper will surely refrain from anything which
is calculated to foster lawlessness or produce anarchy.
The Canadian Dental Association Convention
THE quality of dental service rendered our patients bears a
definite relationship to our complete knowledge of our subject.
M. T. Sheahan has said: "Recollect that the value of any
statement or decision rests upon the knowledge of those who make it,
and that the statement of one who does not know absolutely of what
he is talking is worthless. How important it is to success, that we
should know thoroughly of what we are to do or say. Do not be
(you who read this) of those who say 'I think,' 'I guess,' but determine
to be one of those who may say *I know.' "
That is what one might call "Good Judgment," and what better
way is available for Canadian Dentists to develop good judgment
than to attend the meetings of the combined Canadian and Ontario
conventions in Toronto in May next?
Dr. Augustus S. Downing Honored
THE Dental Profession of New York State tendered a Banquet
to Dr. Augustus Downing, M.A., LL.D., at Hotel Astor,
New York City, on the evening of Saturday, 28th January,
1922, as an expression of gratitude for what he has accomplished
for the advancement of professional education. Dr. Downing is an
honorary member of the New York State Dental Society, and in
his official capacity as State Commissioner of Professional Education,
has been of inestimable service to the dental profession in main-
taining the proper standards of the profession along with a keen
appreciation of dentistry's obligations to the public.
Casting With Nitrous Oxide. — How many inlays, bars,
clasps and saddles can you cast with 100 gallons of nitrous oxide,
mixed with artificial or natural gas? Dr. Percy Moore, of Hamilton,
reports 254 separate casting operations with 1 00 gallons.
SUCCESS in any one line is no
more an accident than the ball
player's batting average is a
streak of luck. It is putting the
right hits in the right place and
keeping the good work up — it's head
work.
— Conveyor
Forrest H. Orton, D.D.S., F.A.C.D.
Professor of Crotpn and Bridge Work. College of Dentistry,
University of Minnesota.
St Paul, Minn.
wm
m
m
OPAL HEALTA
A JOURNAL THAT STANDS FOR THE ** OUNCE OF
PREVENTION," AS WELL AS THE '* POUND OF CURE''
1^
m
VOL. 12
TORONTO, MARCH, 1922
No. 3
Crown and Fixed Bridge Work Modernized
By R. E. MacBoyle, D.D.S., Chicago.
H*
IN the consideration of the subject of "Crown and Fixed Bridge
Work," it will be my purpose to attempt to analyze it, diagnosing
its troubles, and also to suggest remedies which I hope will aid
m bringing it back into its useful and rightful place in dentistry.
The present status of this branch of our profession is evidently
one of confusion and uncertainty as judged by the various attitudes
toward it of many dentists. Many have become radical in their
views against fixed bridges in favor of other methods, and when a
wave of this kind once starts it is generally carried to the extreme, and
the pendulum of conservatism becomes unbalanced and swings too
far. I believe there is a reason for this, however, which I will attempt
to point out; and I believe there is now evidence of the pendulum
swinging back from its extreme radical position to one more normal,
and I hope by this effort to aid in bringing about this result.
This branch of dentistry, where rightly used, is too valuable as
a satisfactory means of supplying missing teeth to allow it to remain
in its present rather dejected position, and I believe that it is possible
to rescue it and bring it into more popular favor than it has ever
before enjoyed.
There is always a cause for every effect, and the cause for the
confusion and the uncertainty regarding fixed bridge work, as I see
it, lies within a chain of conditions which have not been thoroughly
understood.
Stating the case briefly, conditions concerning this work have
radically changed within quite recent years; or rather, our knowledge
of conditions has radically changed, and I believe that dentists, gen-
♦'lead before the Toronto Dental Society, January, 1922.
78 ORAL HEALTH
erally, have not changed their methods to meet the changed con-
ditions. Dentists have known that something had occurred w^hich
demanded different methods, but many have evidently been unable
to determine just v^^hat it was, and the majority, I believe, have con-
tinued to employ the old methods, not fully realizing the new con-
ditions. Many, of course, realized the new conditions, and realized
also that the old methods would not meet their requirements success-
fully, and, not having new and ideal methods to take the place of
the old, adopted other methods than fixed bridges, and this accounts,
to a large degree, for the radical wave toward removable appliances,
and from this viewpoint it was justifiable.
The first thing to consider in our analysis is what brought about
the change of knowledge of the conditions concerning fixed bridge
work; and the answer is, the X-ray. The next in order is, what has
the X-ray taught us, or what should it have taught us? and I believe
that the answer to this question reveals to us the secret of our con-
fusion and uncertainty.
If we have studied the revelations of the X-ray and interpreted
them at all correctly, we have learned, first, that we must conserve
the pulps of teeth; second, that we must avoid irritation of the gingival
soft tissues; third, that we must procure balanced occlusion with and
upon our bridges; and fourth, we must use the proper style of dum-
mies in our fixed bridges, keeping in mind one of the most important
qualities necessary, which is, cleansableness. Now if this truly out-
lines the revelations of the X-ray, then, of course, many of the old
methods for many cases are practically obsolete; and we must have
new methods, more ideal and more universally adaptable, in order
to meet the new requirements, and especially where we have sound,
or practically sound, vital teeth to deal with.
Before the advent of the X-ray we were taught that teeth should
be devitalized when used as abutments, and I believe that dentists
generally have stopped this practice. Also, before the X-ray in
connection with this work, gingival irritation was usually considered
as simply a local condition of little importance, and, unfortunately,
it has not been corrected to any great extent, because, to correct this,
more ideal methods must be employed, and this condition of gingival
irritation is the second in importance which is bringing, and has
brought, condemnation upon fixed bridge work. The bad effects
of improper occlusion is a condition which, as yet, dentists generally
do not realize the seriousness of, as well as the uncleansableness of
improper dummies, so that, in reality, devitalization is the only factor
which has been corrected to any great extent, and the serious part
of this phase of the matter is that, with the cessation of devitalization,
we very often find an increase of gingival irritation, for the reason
ORAL HEALTH 79
that the vital abutment teeth are not prepared as properly for the
reception of telescope crowns as were the devitalized ones.
If the foregoing is true, then there is a crying demand for more
ideal abutment pieces for vital teeth, and if these can be procured,
and if we, by their use, can avoid the conditions above enumerated,
fixed bridge work will come into its own, and the present condemna-
tion of it will cease, and we, as dentists, will in many cases supply
our patients with missing teeth in, I believe, the most satisfactory
manner to all concerned. There are other abuses not mentioned
above, such as using fixed bridges in spans too large and in cases
where the abutment roots are not sufficiently sound, and it requires
careful diagnosis and good judgment to avoid abuses of thi(>
character.
This branch of dentistry, I beheve, is the most abused, for the
reason that it is possible of the most abuse, and it is the duty of
dentists to realize their responsibility in the matter and know that
if they are to continue the use of fixed bridge work they must make
every effort to modernize their methods and scientific basis.
I would call your attention to the fact that a great deal of
extracting, both necessary and unnecessary, is being done, and
will continue to be done, for at least some time to come, and by this
process a demand is created in many cases for the most satisfactory
means of supplying one, two, and three, and oftentimes, in the
anteriors, four missing teeth. The question arises, how are we going
to best do this? and I personally believe that the most ideal method
in the majority of cases is with the properly constructed and adapted
fixed bridge, and it simply remains for us as dentists to devise ideal
abutment pieces and dummies in order to meet the modern demand,
and this I believe to be easily within the range of possibilities.
Telescope Crowns.
As long as we retain broken-down, devitalized teeth there will
be a place for the telescope crown, but for vital posterior teeth, in
the majority of cases, it is not suitable to meet the present demands,
for the reason that there is not to exceed one per cent, of all of these
crowns in existence to-day that do not cause more or less gingival
irritation, and in the majority of these cases considerably more than
less, and this is because the abutment teeth are not properly prepared.
We, at least, attempt to teach the proper preparation, but for
various reasons the majority of dentists become careless regarding
this matter, and I believe that just so long as telescope crowns are
used upon vital teeth, just so long will they be abused. This is true,
no doubt, of all banded crowns, but net to the extent of the tele-
scope, and what I believe to be the reason for this I will refer to
later on.
80 ORALHEALTH
Preventive Dentistry.
We hear a great deal these days about preventive dentistry, and
I would call your attention to the fact that this should not be con-
fined to the children. All dentistry of every variety, w^ith children
and adults alike, should be preventive from the view^point of pre-
venting all irritation, and certainly a great majority of our crowns
and fixed bridges have not met this requirement in the past, and if
we are to continue this work we must keep in mind the preventive
idea as a most important phase of the problem.
Dummies.
It has been my observation that oftentimes the dummies used, and
especially in posterior bridges, are, I believe, of improper form and
variety to best meet the requirements of cleansableness and non-
irritation, and I believe this is a phase of the subject which should
be studied and considered more carefully. Non-irritation and
cleansableness are certainly two of the qualities which dummies
should possess, and if so, the dummies for upper posterior bridges
should have no shelves or concavities at the lingual or gingival which
make cleansing practically impossible. Also there should be no
saddles, and although, while the ginbival portion of the porcelain
should be in contact with the soft tissue, it should not extend too far
gingivally, causing it to be in contact with too great a surface. I
believe that the most universally adaptable dummy at the present
time for the upper posterior is made by using the porcelain pin facing
and the metal cusp, for the reason that you can shape it on the
lingual with a long sloping surface which the patient can cleanse.
These facings should be narrowed in at the gingival portion, leaving
an interproximal or washable space between each dummy and also
between the dummies and the abutments to allow cleansing. The
porcelain which contacts the soft tissue should be convex in form
and highly polished, having no sharp edges. In long bite cases we
can use the all-porcelain dummies, such as the "Goslee," for upper
posteriors, because in long bites we can procure the long sloping
surface at the lingual, and allow porcelain to contact the tissue
instead of metal; but in the medium or short bites, the porcelain pin
is best. However, no matter what style of dummies you use, keep
in mind the necessary qualities mentioned above. Regarding the
metal cusps in connection with the porcelain pin facing for upper
posterior dummies, I will call to your attention the fact that the metal
is not conspicuous if adapted properly, as it is the buccal surface of
the uppers which is exposed to view. Regarding the width of the
cusps from buccal to lingual I will say that the shorter the bite the less
this width should be.
For the lower posterior dummies the gingival should never con-
ORAL HEALTH | 81
tact the soft tissue, but a washable space left between the dummy
and ridge, and in medium or long bite cases I consider the "Goslee"
tooth the ideal dummy, but in short bites the all-metal dummy is
necessary, except possibly on the first lower bicuspid, where a por-
celain facing should be used, in order to avoid the buccal display of
metal which is conspicuous in this position. The all-porcelain teeth
should be used for lower posterior dummies wherever possible, for
the reason that it is the occlusal surface which is conspicuous in the
lower posterior bridges. For the anterior dummies, of course, por-
celain of some variety must be used, keeping in mind always the
cleansable qualities necessary, and whether the porcelain facings of
pin, or "Steele" variety, or the "Goslee" be used depends upon the
length of bite and general conditions.
Indications for Fixed Bridge Work.
The indications for fixed bridge work, I believe, as a rule, to be
in the smaller cases of one, two, or three missing teeth between two
abutments, and in the anterior, in the case of the four missing incisors,
either upper or lower, and oftentimes we may join the smaller bridges
by means of solder, making a larger bridge possessing more than two
abutments. The abutment root should be sound and solid, not
affected by pyorrhoea or other conditions causing looseness. In
posterior cases we are never warranted in supplying more than three
dummies between two abutments, and if the third molar is the distal
abutment three dummies are too many for a fixed bridge unless
conditions are most favorable. Full upper or full lower one-piece
fixed bridges, I believe, as a rule are contra-indicated. In these
conditions a removable structure is, as a rule, indicated. Also, if
the molars are missing on one side, a fixed bridge should not, as a
rule, be made for the opposite side, but rather a removable structure
made to supply both sides; and the same rule would apply to the
larger anterior spaces if the posteriors were missing on either or both
sides.
Now I have attempted to briefly analyze the present status and
conditions relative to fixed bridge work, and have criticized the older
methods as not being adequate in meeting conditions as we know
them to be to-day, and I believe that the new methods advocated
are not ideal, and I have said that unless we devise more ideal
methods to meet the present conditions, then fixed bridge work must, to
a large degree at least, be discontinued. In other words I have torn
down, as it were, the older structures, and logically, as an advocate
of fixed bridge work, I must have something to offer to take the place
of that which I have criticized. I will, therefore, now submit to you
for your consideration types of abutment pieces, one for the posterior
and another for the anterior vital teeth, which I recommend as ade-
82 ORAL HEALTH
quate to take the place of the older abutment pieces, and to meet
the present requirements, incidentally bringing fixed bridge work into
popular favor.
An ideal abutment piece must possess the following qualities:
First, minimum of tooth mutilation; second, adaptability to vital
teeth; third, non-irritating to gingival soft tissues; fourth, no
anaesthetic necessary for preparation; fifth, must be cleansable;
sixth, avoid splitting of the tooth; seventh, can be successfully con-
structed by the average dentist; eighth, of good aesthetic appear-
ance; and ninth, successful cementation.
I will first present the posterior abutment piece, which is a com-
bination of occlusal inlay and a full or partial band, and is made
by the indirect casting method. Figure one shows the prepared
lower molar; the abutment piece removed in rough casting; and
the finished piece in plate. In the preparation the occlusal fissures
are cut out and extended through to the mesial, buccal and lingual
surfaces, where the occlusal inlay portion attaches to the band
portion, and the part of the tooth to which the band portion is
adapted must be straightened. At the soldering surface the band
must extend gingivally to the normal gum line, while at the buccal
and lingual the band does not extend down to the gum Ime. The
cusps are not ground, and there is no shoulder or cut in finishing line
at the gingival edge of the band. To get an idea of the adaptation
to the tooth, visualize a perfectly fitting inlay for the occlusal portion,
and the band portion and the straightened surface of the tooth should
approximate each other, the same as two perfect panes of glass.
The gingival edge must be bevelled in and in perfect adaptation tQ
the tooth, so that an instrument or scaler may be drawn over it
without catching. With this adaptation there is no chance for the
cement to wash out.
I will refer back for a moment to the shell crown band and the
reason why its adaptation to vital teeth will always be faulty. It is
because it is most difficult, and often almost impossible, to straighten
the tooth at the gingival area at the buccal and lingual surfaces,
and in this new abutment piece this area is avoided, making the
straightening process very simple and requiring slight tooth mutila-
tion. The cusps may be covered, but this is only necessary in case
of building up or restoring the occlusion.
Tech NIC Construction.
This posterior abutment piece is cast in one piece by the indirect
method. The tooth is prepared, and impression of it taken with
inlay wax confined in a suitable thimble matrix, festooned to avoid
the sides of the tooth which have not been straightened. Make a
model of the tooth by filling the impression with Brophy*s Universal
ORAL HEALTH 83
Investment Material or Weinstein*s Clasp Investment. After allow-
ing this to crystalize for fifteen minutes, place in warm water and
separate. While the model is moist, fill in the occlusal fissures and
build on the band portion with fused inlay wax, carving as desired,
and smooth surfaces perfectly. Next attach the sprue wire, and
saturate the waxed model in water and invest the same as an inlay,
using the same material as was used to make the model. After
twenty minutes boil out the wax and heat carefully, avoiding over-
heating of the investment, and cast, using for the special pieces with
free band ends the cast clasp metal, and for the pieces with moro
attachments to the inlay portion use inlay metal. These may all be
cast on with clasp metal, but inlay gold is sufficiently rigid for the
full pieces, and it will permit burnishing of the margins, if necessary;
Build the free ends of the band in the special pieces heavier than
the band portion of the full pieces. If the technic is followed care-
fully, no grindings will be necessary on the inner surface, and, of
course, the finished pieces will be no better than the preparatiori
of the tooth, the impression, or the model; consequently, exacting
and careful technic is necessary.
Just a word about the claims of the movable-removable bridge
advocates. It is my personal opinion that the claims made for the
necessity for individual tooth movement are considerably exagger-
ated, and I base my opinion upon the evidence of many properly
constructed fixed bridges which have come under my observation,
and which have given good service for years without evidence of
irritation or injury to the abutment teeth and surrounding tissues. In
my opinion gingival irritation and unbalanced occlusion are the
causes in most cases of the troubles attributed to the immovability of
the abutment teeth. A tooth is not supposed to wobble around like
a dying top. The peridental membrane acts as a cushion, and a
properly balanced fixed bridge, in my opinion, does not prevent to
any injurious degree the individual movement of the abutment teeth,
and especially in the fixed bridges of reasonable size.
To make a successful completion of this problem we need an
ideal fixed abutment piece for the six anterior teeth both above and
below, and I herewith submit for your consideration Figure 9,
which shows four views of this abutment piece, which I advocate
for vital teeth taking the place of older methods. This is a metal
construction covering the lingual, mesial and distal surfaces of the
tooth, perfectly adapted and extending to the gum line at the mesial
and distal, avoiding the gum line at the lingual, and anchored by
means of two pins located near the incisal area, well toward the
mesial and distal, and extending into small canals drilled into the
tooth well removed from the pulp area. These canals are slightly
less than one-sixteenth of an inch in depth in the larger teeth, and
84 ORAL HEALTH
20 gauge in size. In the narrower teeth, such as the lower incisors,
two pins, one milHmetre in length, and gauge 22 are used. Placing
the pins at the incisal area makes this abutment piece adaptable to
the lower incisors as well as to the larger anterior teeth, and, when
studied, it is found to be the logical place for the pins, for the reason
that in both uppers and lowers the pins should be at the place of
most stress, and the incisal area is the place. It is possible to place
a third pin in the area of the cingulum of the tooth, but this is rarely
found to be necessary.
I call your attention to the slight mutilation of the tooth; also
that there are no grooves cut, and no shoulder at the gingival. The
incisal edge is bevelled about 45 degrees, and the metal extends just
slightly to the labial of the contact point of the mesial and distal
surfaces. The labial contour of the tooth is not impaired, but in
the preparation any bell shape is removed from the surface covered,
so that the adaptation is perfect at all margins. This anterior abut-
ment piece is made preferable by the swaging and burnishing method,
taking an impression of the prepared tooth in modelling compound,
then make a cement model from this impression, over which you
swage pure gold 34 gauge, and over this swage a second piece for
reinforcing 22 carat 34 gauge, putting this second piece aside until
you have fitted the first piece to the tooth in the mouth and soldered
to it the pins. After the pins are soldered to the first pure gold
backing, place it on the tooth in the mouth, and trim and burnish
it perfectly. Remove this carefully, fill with crown and bridge
investment, and adapt the second piece for reinforcement. In the
second backing, cut holes large to fit over the projecting pins; also
cut a slot in the centre of the second backing, and in soldering the
two plates together place the pieces of solder in the slot and around
the pins. Further reinforcement can be done, if desired, by sweating
solder upon any portion of the structure thought necessary.
The First Teeth
"And clean them every time you eat, for if a speck should stay
Those little teeth would start at once to crumble and decay."
But there they were, so sharp and white, and Mother said to me,
"You must be careful of those teeth, as careful as can be.
"And celan them every time yo ueat, for if a speck should stay
Those little teeth would start at once, to crumble and decay."
That's why I use my little brush and never dare neglect
To clean them well, for if I do, I know what to expect.
— Dora L. Cameron, Wenatchee, Wash.
ORAL HEALTH 85
The Dental Missionary, His Place and
Opportunities
Ashley W. Lindsay, D.D.S.
Dental Facult};, West China Union University^.
ALLOW me to introduce to you Doctor Ashley Lindsay, a
missionary from West China.'*
"Delighted to meet you. I understand that you medical
men are much appreciated by the Chinese," replies my new
acquaintance. It is then that my sponsor explains that I am not a
medical, but a dental missionary; that I pioneered Dental Missions,
inaugurating the Dental Arm of service for the Canadian Methodist
Church in West China.
"Why, I have never thought of dentistry as having any part in
missions."
"That may w^ell be," answers my friend, "for dentistry as a
branch of missionary work has not been generally adopted by our
Mission Boards; but Doctor Lindsay's church has found dentistry
a well-worth-while addition to its mission force, and the Christian
Union University of West China, in 1919, raised its Department
of Dentistry to the status of a Faculty, believing that it filled a
very necessary place in its educational scheme."
The above paragraphs detail a very typical introduction which
I receive, as I go from place to place, in Canada and the United
States.
Though the dental missionary is not the only mission worker who
is not a familiar figure in the eye of the general public, he has per-
haps been the least advertised. In truth, it is only in some of the
more recent publications dealing with modern missionary projects,
in which we find emphasis placed on that fact that many forces,
little suspected by the rank and file of church people, are being
enlisted and utilized in the effort to evangelize and Christianize the
heathen world.
The world experiences of the last decade have done much to
change our ideas and ideals of Christian duty. The day when
the Church was only anxious to promulgate creeds, whether at home
or on the mission fields, is giving place to its desire to build character.
To accomplish this, many more and diversified types of missionary
agents are being employed. It is not fifteen years ago since the
Church of which I am a member, still had in its regulations, the
rule that all male missionaries sent to the foreign field should be
either ordained men or medical workers. It was only when, because
of the necessity of sending out a practical printer, who had no
86 ORAL HEALTH
theological training, that the rule was changed so as to allow of
any type of Christian man necessary to the cause, to be engaged.
My path of introduction into mission life as a dentist was not all
strewn with roses. It was with some considerable difficulty that I
secured my appointment to the foreign field, and then, largely,
because it was argued, that I might be regarded as a medical worker.
Shortly before leaving Canada I had the opportunity of meeting a
returned missionary. After introductions were over, my friend, for
such she has since become, said, "So you are the dentist who is
appointed to go to our field; it is too bad, for your profession is
not required on our field, and you are, through your appointment,
preventing a medical worker or an evangelist being sent." Much
water has passed under our missiv n bridge since that day, for there
have been sent to our foreign fields, printers, accountants, business
men, builders, three other dentists besides myself, and many other
types of worker who are vital parts of the modern force of an
up-to-date mission.
Happily, so far as dentistry on our mission field is concerned,
we can now speak with conviction in our belief that it has proved
a valuable adjunct to the missionary program. Our hope is that its
possibilities may be better known. While one or two Mission Boards
have appointed Dentists, it would seem that most of the Denomina-
tional Boards have been slow in recognizing that Dentistry is just
as truly a need in the foreign field as is Medicine. The medical
missionary finds his sphere of service in bringing healing to the sick,
in teaching sanitation and prevention of disease, and in preparing
the natives themselves to become physicians and surgeons. The
dental missionary should, can, and is now, to some extent, doing
these same tasks.
An analysis of the reasons why the dentist as a missionary has
not been more widely employed, would reveal a variety of reasons.
Prominently amongst these, would be the old but familiar idea that
"dentistry is a luxury" rather than a primary essential to the up-
building and maintenance of health, whether of body, mind o!
spirit. But the more pertinent reason would be found in the mis-
informed attitude of the bulk of the missionary body on the mission
field in regard to the qual fications required to produce an efficient
dentist.
Modern Dentistry is very popular among the people of most
backward nations. To meet this condition there has grown up a
type of native dental worker, ever on the increase. The apparent
easy acquisition of the mechanics of dentistry, enabling this individual
to place in the mouth an artificial denture which looks like the real
thing, has made the work an attraction largely for the uneducated.
Missionaries, unfortunately, have taken at face value the claims
ORAL HEALTH 87
of these men, and because they have an outfit of modern tools, have
believed them capable of ministering efficiently to their own people,
and, in many cases, accept their services personally, willingly, or
through dire necessity. In my practice I have been called on to
relieve amongst missionaries and natives many serious conditions
subsequent to treatments given by these so-called dentists.
That there are a number of qualified dental practitioners in these
Oriental lands, men who have had their training in England or
America, is quite true, but they are few in number, as compared
to the remainder who have only such training as may be picked
up while assisting in the office of a western dentist, in one of the
coast cities or in one of the "training shops" managed by these
"assistant graduates.'* If it be a fact that these men are qualified
to minister ^-o the dental needs of their countries, it would indicate
that either the natives are inordinately clever or that we in the West
are on the wrong track in demanding such high qualifications for
matriculation into our Dental Schools, and further, in requiring
four or five years of intensive study and practice before graduation.
China, the country with whose Dental conditions I am most fami-
liar, is full of dental quacks, who are preying on the credulous public.
Now, would you like to be the patient of Dr. Shae, of Tsi Liu
Tsing? Let me tell you of his dental education. Through some
means, unnecessary to state, he induced an unqualified Japanese
so-called "Dentist,'* then residing in Chungking, a treaty port, to
come to his city and open up a "Dental shop" in his house. Mr.
Shae's scheme was by this means, to be tutored by his guest, through
watching his methods and manipulations. The Japanese refused
to consent to this plan, knowing from experience, that only in keep-
ing his practice secret, could he retain his trade. But, Mr. Shae
was not to be beaten thus easily in securing an education. Feigning
acquiescence to the Japanese wishes, he privately prepared a hole
in a partition, in such a way that he could observe all operations
without being seen himself. After a few months of his "peep-hole
education" he manipulated the strings so that his unwilling teacher
departed the city. Securing a few tools from Shanghai, he then
opened his own "dental shop," but, it was not very long before he
felt the need of further knowledge. Writing to me, he asked if I
would kindly sell him a supply of drugs which I used, and further,
would I provide him with instructions as to their proper use.
To believe that such individuals can be of any useful service to
their fellow-men is surely stretching one's common sense too far.
The native medical man, with his emperical and crude methods
and drugs, is of more value and less harm to his people. Our
Missionary Societies are doing much in the training of native
physicians to take the place of the old type of medicine man; why
not also train dentists to meet the growing demand for dental
attention?
88 ORALHEALTH
In my opinion then, the dental missionary can fill a very needy
place in mission economics and program, which, stated briefly, is
summed up in the following paragraphs.
1. Together with the physician, working to conserve the lives
of the missionaries so that they may do their tasks with the efficiency
of good health. Missionaries are not so plentiful that they can be
spared from their work either temporarily or permanently, if good
dental and n^sdical attention will prevent.
2. With the physician in ministering to the children of missionaries.
In this day, when the worth of the individual child is being better
recognized and appreciated, especially the potential value of the
missionaries' children, as future missionaries, increased importance is
attached to the proper care of the teeth as a factor in growth and
bodily perfection.
3. Sharing with our medical brothers in the relief of pain and
the elimination of disease amongst a people who without qualified
expert assistance would have no hope.
4. Through the prestige of his work, the dental missionary opens
doors of many classes of society to Christian influence, which would
otherwise be closed. In our practice, we have attended in our
province nearly every Governor and important government official
in the last fifteen years.
5. Through the production of qualified dental graduates, who
go out amongst their own people as Christian leaders and good
dentists. All the Western dentists the home church might send out
to the foreign field, would be but a drop in the bucket, as regards
the need; but our teaching will soon multiply numbers and give for
the future a valuable contribution to the upbuilding in character
of an awakening people, and in the estabHshing of an efficient
nucleus of a much-needed profession.
In conclusion, the opportunities of the dental missionary may be
stated to be twofold: the one, the value of which I have dilated
on in the preceding paragraphs, namely, that of contributing to
the general missionary effort; the second, the singular opportunity of
service for the individual dentist himself. Working for such a cause
in a land hoary with history, and an ancient civilization, now
waking to a future pregnant with possibilities for world peace and
the Kingdom, there is an intense pleasure, a keen interest and a
compelling incentive. Add to this the realization that your pro-
fession is starting with the right and proper perspective of * 'service"
as its ideal, rather than "self-interest," which a non-Christian train-
ing, be it ever so good, is sure to produce. Such an opportunity, I
believe, should provide reward enough for any Christian man who
has high ideals for his profession and for a most truly successful Hfe.
CLASS I-A
CLASS II-A
CLASS III-A
CLASS I-A
CLASS II-B
CLASS III-B
CLASS I-B
CLASS II-C
CL'ASS m-c
GLASS I.
The Anterior Veneer Type
Classification of Tooth Preparations
For Bridge Abutments on Vital Teeth
By J. P. Brekhus, B.A., D.D.S., Asso. Prof, of Crown and Bridge, Dental College,
University of Minnesota
A % Veneer preparation, including the lingual
and proximal surfaces with axial and
incisal retention grooves.
Indicated on the six anterior teeth.
Veneer preparation, including the lin-
gual and proximal surfaces with
axial retention grooves onlg.
Indicated on centrals and later Is
with thin incisal third of the crown.
A % yeneer crown, including the IVI. O. D. L.
surfaces.
Indicated on upper molars and bicus-
pids.
D % Veneer Crown, including the M. O. D. B.
surfaces.
Indicated on lower molars and bicus-
^ pids.
^ Full
< B
I
CLASS II.
The Posterior Veneer Type
<
I
veneer crown.
Indicated on Posterior Teeth
A. When a great deal of enamel surface has been disintegrated by decay.
B. When the maximum retention form is essential for the retention of the bridge.
C. When =t is essential to include the crown in its entirety to improve occlusion,
alignment and contact.
GLASS III.
The Inlay Type
A
B
M.
M.
0. or D. 0. inlays.
0. D. inlays.
Indicated on bi-
cuspids and
molars as
C
M.
O. D. inlays, includ-
abut ments
ing one or more
cusps.
for short
bridges.
90 ORAL HEALTH
The Necessity for a Dental Library
By John F. Porter, Toronto.
UPON conversing with older practitioners we are informed that
few new things are told, yet many different expressions are
uttered, each new thought being turned and twisted about
until the sound of these utterances seems so different from that heard
before that we are apt to regard it as new. Often Dentists are
called upon to address dental societies and write articles for maga-
zines, then they wonder what has been said before and who spoke
or wrote it. Only large libraries have the information. To write
intelligently, the would-be author must consult the records, so in
expressing himself, he will not repeat former writers except to give
credit where it is due. If the dentist should express a new thought
or give a new version of some known fact, he wants to go on record
as the author of such fact, and that record should be so placed
that all others may see it and be guided accordingly.
There are very few dentists in practice who can afford to main-
tain such a library of dental journals as to cover the whole field of
monthly or quarterly publications for a number of years back and
keep on adding to it, hence the burden must be carried by either
national, state or local societies, or by dental educational institutions.
As the dental societies have no fixed abode, it necessarily falls to the
lot of the dental schools to gather copies of all dental publications,
be they annual, semi-annual, quarterly or monthly. Also copies
of dental books published as text books for students or genera]
reading for the profession. All these should be so arranged that
one wishing to consult any author can readily find the articles
required, and when found, there should be comfortable facilities
to read and copy if necessary. This necessitates a large airy room,
lined with shelves filled with complete volumes of all dental litera-
ture, dictionaries, lexicons and encyclopedias. Chairs and tables
should be so arranged as to be utilized. There should also be copies
of standard charts; in fact, every record available for study or
reference. This necessitates a librarian who knows in a general
way, the literature of the profession — a librarian who is deeply
interested in the work, to whom the searching for certain required
articles is a pleasure only satisfied when the desired information
is found.
In Philadelphia, prior to 1895, Dr. James E. Garretson did
much to mold the lives of those students who came within the circle
of his influence. He was fond of insisting that every student should
own at least five books. These, he said, should be — Gray's
ORAL HEALTH 91
Anatomy, U. S. Dispensatory, Brown's Grammar of English
Grammars, Burton's Anatomy of Melancholia, a medical dictionary.
With Garretson's System of Oral Survey, a student was then
equipped to go on with his dental studies. From Dr. Garretson,
too, came the old phrase "Go to the Books," which is as true to-day
as it was then; and the continually going "to the books" day after
day by students of the age and practitioners both young and old
with receptive and retentive minds will recompense the individual
for the time and work spent in following Dr. Garretson's advice.
Many dental colleges throughout the world are realizing more
and more the need of libraries and are using their small libraries
as a nucleus with the idea of adding to it from time to time. Among
the foremost of these colleges is the Vanderbilt University School
of Dentistry. It was discovered that there were many incomplete
volumes of journals and proceedings of special State organizations,
and a plan was originated to arouse the interest of the Alumni and
friends of the college. Requests and petitions were sent out for
all old journals, titles and dates. Those journals that were not
needed could be readily exchanged for needed ones with other
dental libraries. The Northwestern University School of Dentistry
did practically the same. The Journal of the National Dental
Association has been acting as a clearing house, so to speak, for the
exchange of dental journals.
Hie Northwestern University Dental School, realizing the utmost
importance of having a good library, has also made great strides
in that direction. Their prospectus announcing the Seventeenth
Annual Post-Graduate Course, contains the following paragraph:
"In order to make the large and well organized library of the school
serve the largest possible number, arrangements have been made
by which the services of an expert dental abstractor are available
for the entire dental profession. Dentists who are writing papers
for societies, or who wish to study the literature of a particular
subject may secure selected lists of articles at nominal rates, which
will be supplied on application. This plan of furnishing reliable
abstracts makes it possible for the dentist who does not have access
to a large dental library to have placed before him in condensed
form all of the information he desires."
During the past world war, it was clearly shown how urgently
needed was good reading matter. If the war, then, did only one
thing, it was to stir the people to think, and to think hard, about
all sorts of questions. Such mental exercise has not been indulged
in by the human race for generations.
The men who do big things differ from those who don't, chiefly
in the activity of their minds. The big men keep up a continual
mental struggle collecting and absorbing new facts, studying to
92 ORAL HEALTH
understand them, trying to put two and two together — until out
of this activity they hit upon good practical ideas which they see
clearly. No mentally lazy man ever had a really good idea. Good
ideas are born in brains that keep working.
Of the many millions of men that were enlisted in the army,
quite a large percentage could neither read nor write. Instructors
were provided, and an earnest study was carried on in the different
camps. These young men became students overnight, as it were, and
came home embued with the desire for book learning. In the
American and Canadian newspapers it was no common thing to see
headings by the Knights of Columbus, Young Men's Christian
Association, Young Women's Christian Association and Red Cross
asking for books for the soldiers. These organizations carried on in
every camp from eight to twenty branch libraries. Magazines by
the hundreds of thousands were sent to the Allied boys and were
read by them. Some contained current topics, while others were full
of the latest research and knowledge of focal infection.
Dr. Harry F. Lotz. in one of his articles, quotes the following:
**A member of the Will-Grundy County Dental Society received his
commission on Friday, with instructions to report the following
Monday at Camp Pike, Little Rock, Arkansas. The writer had
the pleasure of being with this fellow worker when he turned the
key in his office door, perhaps for the last time, and I wish you to
know that the only things he carried out of his office were his dental
books, saying, 'I will need them in camp.' Do you think our soldier
boys are safe in the hands of this lieutenant? I do."
It is claimed that Andy Carnegie as a boy, when given the run of
a rich man's technical library, made good use of it so that he stored
up the knowledge that he utilized so well in later years.
In this advancement of the times when so much is being done to
educate the children of the masses more widely is the time for dentists
to fortify themselves, for the younger classes are the citizens of
to-morrow, and among their number are the chosen leaders. The
older people are moving around in clubs, places of learning, sports
and amusement places. Among the latter we have the moving
picture houses which seem to entertain the largest percentage of the
people; they act in many cases as good educators. The above things
and hosts of others surely have an incentive value to the professional
man to keep abreast with the times and do more reading. In this
class we have the dentist.
There is only one way in which the dentist may keep in touch
with the advancement of his profession, and that is by constant read-
ing of the periodical literature in which are recorded from month to
month the latest improvements and suggestions in the various methods
of procedure. As a previous writer on this subject aptly expressed it:
ORAL HEALTH 93
*'The periodical literature of dentistry is a serial story and an ever
unfolding record of dental achievement. Each instalment, whether
it be a copy of a journal, a book, a pamphlet, or a report, adds its
incidents to the main trend of the story."
Dr. Lotz writes the following in the Dental Deview: "The dental
profession has long borne the stigma of being a non-reading profes-
sion. Before writing this paper I outlined the making of a survey
in one of the large office buildings in Chicago, which is given over to
the housing of many dentists. I have been so depressed with the
advice given me by my friends that I did not have the heart to go
through with it, such remarks as these, "Floor space is too valuable
to have a desk, books and journals.' *Why, hardly a dentist would
see you between the hours of nine to five, let alone take time to tell
you how many journals he subscribes for, reads, etc' Thank good-
ness, that membership in the Illinois State Dental Society brings two
journals at least, to every member to-day, and two good journals —
the Journal of the National Dental Association and the Dental
Review, but a survey should be made and if dentists are subscribing
and reading dental journals, let us stamp out that stigma that
dentists are a non-reading profession."
The average dentist when asked what he does to keep abreast
with the new ideas in the profession will usually answer, if he is like a
few I have spoken to, "that he is too busy in his practice and too
tired and mentally exhausted when the day's work is done, to devote
any considerable amount of time and energy to study." While on
the other hand we have a few who subscribe for a few journals, and
either read them or cast them aside. But it might be said right here
that if one only looks around and uses good sound judgment, he will
find the dentist who spends his spare moments reading current
literature and up-to-date text books, is the one who commands the
best practice. He does this because his work stands the test and the
patients are not slow to realize the improvements he is bringing about
in equipment and technique. These patients do not mind paying
such a dentist a reasonable fee, for they are quick to realize the
benefit.
The late G. O. Black who, as many claim, was the pioneer of
Dentistry, always set aside an hour each day for reading. There
was no one more busy and no one more accomplished than he. Even
to-day we have a lot of his works recognized and used in the dental
colleges. He wrote books on dental pathology and operative
Dentistry that are still in use.
At present we have a host of new text books and old ones being
revised. Among some of the important ones in use by up-to-date
dentists are: Dewey's Orthodontia; Peeso's Crown and Bridge;
Smith's Anaesthesia; Brother's Dental Jurisprudence; Evan's Crown
94 ORAL HEALTH
and Bridge; Hodgen's Metallurgy; Black's Operative and
Pathology; Davis' Operative; Brophy's Oral Surgery; Thomas'
Oral Anaesthesia; Jordan's Bacteriology; Adami and McCrae's
Pathology; Turner's Dental Hygiene; Johnson's Success in Dental
Practice; Gray's Antantomy; Wilson's Prosthetic Dentisty; Crane's
Root Canal Technique; Long's Materia Medica; Ward's Opera-
tive Dentistry; Johnson's Operative Dentistry; Marshall's Opera-
tive Dentistry, and hosts of others.
We have the follow^ing journals : The Dental Cosmos, The Dental
Summary, The Dental Digest, The Dental Research, Journal of
The National Dental Association, Dominion Dental Journal, Oral
Health, North-western Journal, Items of Interest, Dental Outlook,
Dental Register, The International Journal of Orthodontia and Oral
Surgery and Oral Hygiene.
Recognizing the need of publishing a monthly index of dental
literature that will serve as an intelligent guide to the busy practioner,
with limited time available for study, the National Institute of
Dental Teachers some years ago persuaded the establishment of the
Dental Index Bureau to devise ways and means of publishing a
monthly index of periodical literature, after noting what a decided
success the Dewey decimal system adapted to dentistry by Arthur
p. Black, was when used in the historical booklet of the Illinois
State Dental Society, 1914. It contained a classified index of
administration papers, discussions and clinics as published in the
transactions of the society from 1 865 to 1914.
Dr. Black says: "It is also hoped that the publication of this index
by the Illinois State Dental Society will be of material aid in estab-
lishing it as the standard plan of the future in the indexing of dental
literature. Good literature made easily accessible, serves to
strengthen the mind and hand of every progressive practitioner.'*
Upon reading my December issue of the National Dental Associa-
tion Magazine, I noticed that an index of dental literature for five
years, 191 1-1915, has been completed, and is edited by Dr. A. D.
Black. This contains an index to periodicals published in England,
Scotland, Canada, Australia, New Zealand and United States. It
is published by the Dental Index Bureau, under the auspices of the
American Institute of Dental Teachers. This is truly a wonderful
boon to the profession in that it aids and saves time in looking up
things.
When looking through some older magazines I noticed that the
first annual meeting of the Dental Library Association was held in
New Orleans in 1919. Its purpose was the creating and fostering
of dental libraries and museums, at the same time it brought about a
closer relationship among those interested in the making of dental
libraries and museums. A. F. Ishman was elected president and
B. W. Weinberger, secretary.
ORAL HEALTH 95
The general trend of feeling to-day seems to be moving towards
formation of study clubs in cities and towns. Dr. Conzett dealt with
this in his article that he read before the National Dental Association
in August, 1918, which was published just lately in the journal of
that association. The following are extracts from it: "The ideal
study club is one which is composed of a small group of men drawn
together with the desire to study the problems surrounding some
special subject. The watchword of the modern study club is concen-
tration— forgetting other things until it and the problems surrounding
it are mastered. In our study clubs we have advised that they be
not larger than twenty men, and if possible, even smaller than that, —
these men to choose their subject and then obtain the services of
some man that is a master of it, and under his direction and guidance,
study it in a practical theoretical manner until it is mastered in all
its relations.'* *'The Demonstrator recommends the necessary books
for study between sessions, and conduct quizzes upon the work that
he has outlined at the time of the next regular meeting. In this way
a taste for study is engendered that will not cease with the comple-^
tion of the club work.**
In the above paragraph the study club has proved the value of ^
good library and the help it renders the profession. It also proves
to the backward dentist that he is slipping, and the great effect that
reading of current literature and text books could have. If the books
are hard to procure, then the value of the library increases. Some
men have small Hbraries of their own, but only wealthy men and
institutions can operate and keep abreast of the times with larger
libraries.
In reading Dr. C. N. Johnson's book, "Success in Dental
Practice,*' we find clearly outlined the advantages and results
attained in keeping up-to-date in the medium of a library. He says:
"In approaching the records and bookkeeping the author realizes
that he is assuming a herculean task in attempting to convince the
dental profession of the necessity for keeping accurate records.*'
A library as classified by Dr. N. S. Hoc, of the University of
Michigan, should contain, (1) Historic literature; (2) Scientific
research; (3) Published books; (4) Current literature; (5) Portraits
and history of eminent men of the profession.
The general custom in most schools and one adopted by the Royal
College of Dental Surgeons last year is to require students to buy
all text books used in courses, and so far as they are willing to urge
the purchase of other books on the various subjects. At present the
owning of text books is made the requirement for admission at the
above college. It has been proved that no student can do himself or
his instructor justice who does not own and study his text books along
with his course. In some subjects there are several books written, and
96 ORAL HEALTH
it can hardly be expected that the student will have in his possession
all approved text books on every subject in the curriculum. There-
fore it becomes necessary for the college library to have a sufficient
number of reference books (not required text books) in its reading
room so that students may look up citations given by the instructor.
This plan makes it possible for students to either withdraw^ them for
home reading, or the constant attendance of a librarian and an open
reading room.
Never more than now has the need of an adequate library with
an attendant who is well posted on things pertaining to dentistry
been demonstrated. Many of the boys in the senior class have been
experiencing the greatest difficulty in getting enough subject matter
together for their essays. This one thing has demonstrated fully the
advantage of having a library for getting the desired information.
Every dental college should have, then, an extensive good working
library; this is a necessity. It should be in charge of a capable
custodian and should be up-to-date in every department. Every
instructor should have enough interest in his department to have an
active desire to use such a library and so keep himself up-to-date
for the benefit of his students and the generation of a universal
attitude of inquiry. Then better classification will follow and more
intensive use of our literature in the school should develop a closer
relationship between the dental student and the practitioner. This
will make the student realize what he is going to meet and be up
against when he gets out into his practice. He will develop a
broader view on the problems of life. The same may be said of our
older practitioners who have been practising for some few years, and
have been falling behind. In their case never was a dental library
/more needed. It is to be hoped that the need of a good working
library will soon be recognized by every active dental practioner.
Michigan Dental Examinations
THE next examination in dentistry in this State will be held in
the City of Ann Arbor, Dental College, the week of June 5th
to 1 1 th inclusive. Application blanks, and all information
relative to this examination may be had by applying to Dr. E. O.
Gillespie, 745 David Whitney Bldg., Detroit, Mich.
E. O. GILLESPIE, Secretary.
Removing Blood Stains. — The walls of a cavity are apt to
become stained with blood during the process of pulp removal and
cavity preparation. Hydrogen peroxide is not nearly so quick to clean
this off as is normal salt solution once applied, on cotton-wool. — (W.
Stewart TacIc, Dental Science Journal of Australia).
![■
"n
' — 1
^ THE COMPES DIL M ^
This Department is Edited by
THOMAS COWLING, D.D.S., Toronto
A SYNOPSIS OF CURRENT LITERATURE RELATING
TO THE SCIENCE AND PRACTICE OF DENTISTRY
1 —
-jj- ^
The Reactions of Enamel to Injury and Disease.
ENAMEL, the hardest, densest structure of the body, may be
regarded as an entirely dead tissue. Such is the claim made by
Dr. Arthur Hopewell-Smith m a lecture delivered in London,
July 25th, 1921, before the National Dental Hospital, and reported
in The British Journal of Dental Science of September, 1921. The
reactions of a cell or a tissue or an organ of the body to pathological
disturbances indicate a response on the part of that cell, tissue or
organ which is intended to be of the utmost benefit to it, by enabling
it to throw off any malevolent condition which may threaten its
well-being. These reactions occur continuously everywhere. They
are manifestations of vital phenomena — of that bioplasmic irritation
which goes on to form one of the constituent principles of life, and
they are universal, and admit of no variation.
On the death of a tissue its various cellular activities cease; there
is no reaction to injury or disease. Man's body is composed of
living cells. Every part, with the sole exception of the crystalline lens
in the ocular apparatus and some of the dental tissues, is alive. The
lens and teeth are from this point of view unique bodies and afford
interesting objects for the highest consideration in the question of their
relation to the effects of injury and disease.
It may be stated that of the three calcified constituents of the teeth,
enamel and cementum are outside or practically outside the pale of
nutrition and vitality. They are not alive in the strictest sense of the
term. Dentine, a substance which is neither wholly dead nor com-
pletely alive, being semi-vitalized so to speak, falls more or less into
the same category.
What life is, no one knows. The physiologist describes it as a
process of those changes going on in protoplasm, which acting
together, give rise to energy, and are used for the purpose of self-
protection.
98 ORALHEALTH
Certain fundamental vital properties can be recognized and
explained even in very low^ forms of life. These include: irritability,
adaptation, contractility, metabolism, reproduction, bio-osmosis,
respiration, functional inertia. Enamel conforms, so far as present
knowledge extends, to none of these requirements. Enamel may
reasonably be compared to the shells of molluscs, inasmuch as it
owes its origin to the functional activities of the cells called amelo-
blasts, which are homologous and analogous with the epithelial cells
of the "mantle" found in these animals. Ameloblasts are ectodermic
and immediately speciaHzed from the stomodeal epithelium. There
is no life in the shells of marine animals.
Enamel is a highly specialized secretion which underwent calcifica-
tion at the time of its formation. Each ameloblast pours out a sub-
stance which hardens by normal physiological processes. The
ameloblast itself undergoes no transmutation. Enamel develops from
within out. The first deposited material is frequently of poor
quality. This is the so-called "soft" enamel as distinguished from
"hard" enamel. It is possible therefore to differentiate the "acute"
or rapid and "chronic" or slow dental caries. Enamel contains no
vasular supply, or nervous system, no cellular elements. Nor does
lymph pass into it. Hence there can be no inflammation. Enamel
cannot repair itself after injury. And further, it would appear that
once it has been fully formed it can undergo but few distinctive
chemical or physical changes consequent upon disease occurring in
the oral cavity.
The pathological conditions — injury as opposed to disease — which
it may undergo, depend principally upon mechanical causes such as
attrition, erosion, abrasion, etc. In case of fracture, repair of enamel
is unknown and impossible. It has no inhertnt power of defence
or regeneration.
Enamel is affected by physical changes in the dentine beneath. If
the dentine becomes dried out it shrinks and minute cracks appear
in the adjacent enamel. Enamel itself cannot undergo contractility.
When the pulp dies the dentine is deprived of its limited nutrition
by lymph circulating in its tubes. As long as the dentine is semi-
vitalized this does not take place. Enamel, once formed, is fully com-
ipleted. It cannot receive additions of its like nature on its surface.
A tumour of enamel is unknown and inconceivable. It cannot react
to general disease after it has once been fully developed. By injury,
induced by purely physical and chemical means, it is reduced in
amount through the action of acid secretions or the enzymes of caries
— ^producing bacteria contained in the oral cavity.
ORAL HEALTH 99
The Man And The Child.
UNDER this title "The Hospital" comments briefly as follows:
It is no new truth that man is the product of the child, and it
cannot be too strongly emphasized that a happy childhood is
essential to a well-balanced adult life. Although there is no need to
fear heredity, yet there is danger to a child if it is brought up in a
home where the parents are unstable and the environment is an
unhappy one. It is the psychological atmosphere of the home and
the school which is the foundation of success in after-life far more than
any scholarships; intelligence should be the aim of education rather
than learning.
There are risks in early brilliancy in children — risks which parents,
in the gratification of seeing their children standing well with their
instructors and school companions, do not always appreciate. Both
in the animal and vegetable kingdoms it will be found that rapid
development connotes a short life history. By unwise use, or by
intensive pressure, the energy which ought to be spread over years
may be, and too frequently is, exhausted at an early period of life.
Orderliness of mind is all-important; the mind dominated by
emotion tends to be "sloppy" and unstable.
A Plea For Moderation.
DR. W. S. Hinder, in the October issue of The Dental Science
Journal, reviews the present status of the dental profession and
makes a plea for careful study of the merits of innovations in
preference to the common practice of accepting them with blind
enthusiasm. The weary dentist is continually confronted by some
fresh obstacle, which he must surmount if he is to keep abreast of
the times. Truly the path of dentistry, like that of true love, "never
did run smooth." Many new theories are constantly being presented
to us, some from purely scientific motives, others, unfortunately,
tinged with commercialism. We should carefully examine all these,
blowing off the froth, and we shall probably find a sediment that is
well worth preserving.
At one time cataphoresis was hailed as a treatment par excellence
in the treatment of pulps and sensitive dentine. The principle unques-
tionably was good, but the time consumed in its application militated
against its value in every-day practice, and its application became
limited and gradually faded out.
Next, pressure anaesthesia was received with enthusiasm, so
much so that many operators discarded the use of arsenic altogether.
In the treatment of single-rooted teeth, the pressure method met with
some degree of success, but the occasional occurrence of periapical
irritation, which caused the patient some considerable pain and the
dentist a good deal of anxiety, tended to lessen its popularity.
100 ORAL HEALTH
Following this came hypodermic injections of various drugs which
were more or less poisons, and which had to be absorbed. The
effects were always uncertain. In extractions the case is altered, for
the subsequent hemorrhage reHeves the surrounding tissues and the
drug is expelled.
Then came analgesia, and it was heralded as a wonderful thing.
It is doubtful whether many use it now. The principle of operating
when the patient is partially anesthetized is unsound.
Early in the century, new life was infused into baked porcelain
work. New and convenient forms of furnaces were introduced,
together with a supply of more easily controlled bodies. It affords
great satisfaction now to see these inlays doing good service after
fifteen or twenty years, but, unfortunately, satisfaction does not pay
the rent, and I fear that the fact that patients were not prepared to
pay a fee commensurate with the skill and time required tended
to lessen the popularity of the work. Of the casting process intro-
duced by Taggert, little need be said, because it has come to stay,
and rightly so. It would be a mistake, however, to have it supersede
the foil filling entirely.
The muscle trimmer is with us to-day. It is a laborious process,
and one which needs special materials and appHances, which may
be purchased at a special price. One expert's system demands the
use of no less than six new materials, trays, plaster compositions, etc.
Be a "muscle trimmer" by all means, but be moderate, and do not
think you have found the royal road to overcoming all the difficul-
ties to be encountered in impression taking. Experience alone will
teach you that, and if, perchance, you strike a case which does not
respond to your efforts, maybe some friend of experience and old-
fashioned methods will help you out.
Then we come to the great "facial infection tragedy." It is fifteen
years since Dr. Hunter brought out his little book on oral sepsis.
The wave of enthusiasm started, gathered strength and swept all
before it. Pyorrhoea specialists sprang up like mushrooms, each with
a heaven-sent sense of touch, and each with a set of instruments
entirely his own, which might be bought for a consideration. From
the various sets of instruments we were enabled to select a few that
helped us to do more accurate and better work. We have learned
that in single-rooted teeth pyorrhoea of quite an advanced stage can
be arrested and can, with the co-operation of the patient, be made
to remain so, but without that co-operation recurrence and failure
are certain. In multi-rooted teeth, early stages may be successfully
treated, but where much alveolar absorption has taken place,
extraction is the only resort — not ruthless extraction, for, very often,
the removal of a badly affected molar will enable us to save the two
adjoining teeth. There is little evidence to prove the claims for
ORAL HEALTH 101
regeneration of alveolar tissue and of physiological attachment of
gum tissue to cementum, etc. The gums, though receded, may,
under treatment, become pink, firm and healthy, and so closely hug
the cementum that the pockets are obliterated, but there is no
physiological attachment. It is high time that we differentiated
between gingivitis and pyorrhoea. An extensive treatment, and a
large fee, are not always necessary to cure gingivitis.
Now we come to the villain of the play: the wholesale extractor.
It is a lucrative practice conducted sometimes under the cloak of
scientific treatment. In these days, when we are striving for recogni-
tion as a branch of the medical profession, this practice is going far
towards reducing the profession of dentistry to that of a tooth
carpenter.
What of these pathological areas? Where is the proof that every
tiny shadow cast at various angles by the X-ray is an infected area?
The wholesale extractor does not need proof; he sees his work before
him and does it. How many of them would be willing to sacrifice
his own pathological teeth on the altar of their belief?
A moderate course of practice might be taken in connection with
these radiographic areas. In dealing with multi-rooted teeth, where
a well-defined shadow appears, indicating a probable area of
infection, extraction is the only resort, because there is no reasonable
chance of successful treatment through the minute root canals which
we find in these teeth. In single-rooted teeth, however, especially
upper incisors, if the area be circumscribed, we should make every
effort to save them. The canals are easy of access, and we have
means at our disposal — such as ionic and other treatments — by
which these areas can be sterilized with some degree of certainty.
Failing this we may establish a sinus surgically, or we may resort to
apicoectomy and curetting of the cavity. It is possible that these tiny
spots in the picture are the result of a slight irritation caused at the
time of filling the root, persisting but a few days and leaving a scar.
It is reasonable to suppose that if an active process continued, we
should get an extension of the area, yet many of these teeth show
no alteration from time to time.
We should not accept every new theory or practice that is put
before us without first analyzing it and then applying it conscien-
tiously to the best interests of our patients.
Rubber Bowls. — If the upper part of the rubber bulb of your
chip blower wears out, cut the lower half off. This makes an ideal
plaster bowl for small work, such as inlays and small bridges. — (//.
E. Bliler, Dental Facts).
PROVINCIAL EDITORS
:B
CORNER
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MARITIME PROVINCES
Reported by J. Stanley Bagnall, D.D.S.
THE sudden death of Dr. Frank Woodbury, D.D.S., LL.D.,
was learned of with the deepest regret by all who knew him.
While his influence on the progress of Dentistry in Canada as
a whole was very great, it is here in the Maritime Provinces and
especially in Dalhousie College that he will be missed most. Those
of us who were his students feel that we have lost a very dear friend
who was always ready to help us. But we are fortunate in having
been associated so intimately with him and to have felt the influence
of his high ideals, which will carry on, long after he is gone.
THE regular monthly meeting of the Halifax Dental Society
was held on January 31st, 1922. Instead of the regular
paper, the evening was devoted to a discussion of three ques-
tions adapted from a recent article by Dr. E. S. Best on *'Pulps and
Pulpless Teeth.'* The questions for discussion were incorporated in
the notices sent to the members of the society. The experiment was
very successful, and most interesting discussions took place.
Dr. G. R. Hennigar opened the discussion on the first question:
"Do you think that the importance of the part teeth play in focal
infection is over-estimated or under-estimated, or has been fairly
estimated?*' Dr. Hennigar read a short paper outlining the prob-
lem, illustrating his remarks with some excellent lantern slides of cases
where focal infection had played a part. He also read a number of
interesting letters on the subject from Drs. W. A. Price, C. R.
Turner, Kurt H. Thoma and Dr. Burden. Dr. F. W. Ryan, con-
tinuing the discussion, noted the tendency of so many movements to
swing to extremes, and felt that many diseases attributed to focal
infection might be the result of some other cause, as errors of diet, etc.
ORAL HEALTH 103
Dr. F. W. Dobson opened the discussion on the subject: "From
an anatomical standpoint, is the removal of the tooth pulp and the
sealing of the canal a feasible operation? If not, why not? If so,
under what conditions?" This question gave rise to the most inter-
esting discussion of the evening, a large number of the members taking
part. Dr. Dobson believed that in normal, well-shaped teeth pulps
can be successfully removed. He advocated the use of broaches,
reamers, etc., and a final cleansing with such chemicals as sodium
and potassium. He felt that the operation of filling the canals was
a more difficult one. The general opinion of those who continued
the discussion was that strong chemicals of all kinds should not be
used in root canals, because of the danger to the pericementum. The
late work of Dr. Clyde Davis was freely discussed and favorably
commented on.
Dr. F. W. Ryan opened the discussion on : "What do you advise
and what is your procedure in the treatment of vital teeth where
the decay is so extensive that its entire removal will mean exposure
of the pulp?" Dr. Ryan discussed the various types of decay, and
felt that they had an important bearing on the question. Also
that the position of the tooth and the age of the patient should be
taken into consideration.
The meeting closed after a demonstration of a radioscope and
pulp testing machine by Dr. Hennigar.
The monthly meeting of the Nova Scotia Institute of Science was
held in Dalhousie College on February 13th, and was of special
interest to dentists. The evening was devoted to a discussion of a
group of Eskimo skulls. A general description of the skulls was given
by Dr. John Cameron, M.D., D.Sc, and a description of the
dentition by Dr. Stephen G. Ritchie, D.M.D. It was a rare oppor-
tunity to learn more about the dentition of the Eskimo. The lecturers
covered the material rather broadly as the complete scientific reports
of their investigations are to follow in the near future, and judging
from these advance reports there will be much of interest for the
dentist in the report of their study of these skulls.
The most striking fact was the perfection of the dentition. In the
whole collection of about 30 skulls there was not a decayed tooth, and
the only evidence of tartar was in one skull where there was an
ankylosis of the temporo-mandibular joint. The teeth were in nearly
all cases all present at death. A race that is, or at least was, at a
comparatively recent date free from caries and tartar formation should
well repay further study.
The wear of the teeth was extreme and even on skulls of young
adults there was practically no crown left, the tooth being worn
104 ORAL HEALTH
down almost to the cemento-enamel junction. This excessive wear
was accompanied by a very complete deposit of adventitious dentine,
which completely filled up the portion of pulp chambers which would
otherwise have been exposed.
The arches were in all cases very regular and formed sections of
almost perfect ellipses.
The teeth were very large and well formed, the measurement in
many cases exceeding the greatest measurements listed by Dr. G. V.
Black, and in several of the skulls the third molar was the largest
tooth, the second next, and the first the smallest.
The complete report on these Canadian Eskimos will be awaited
with interest.
PERSONAL MENTION
DR. G. A. POLLEY, of Lunenburg, has been forced to take
a long vacation to regain his health. Dr. Policy is one of
the oldest practising dentists in Nova Scotia. Dr. H. V.
Ferguson is in charge of his practice during his absence.
Dr. J. H. Lawley has opened an office in Glace Bay, C.B.
Dr. C. E. Dexter has moved from Caledonia, N.S., to Digby,
N.S.
Dr. J. W. Cormier has moved from Amherst, N.S., to Weymouth,
N.S.
Dr. N. MacGregor Layton, lately connected with the Red Cross,
has opened an office in Truro, N.S.
Drs. L. E. and E. B. Eaton, who have been practising for
fifteen or twenty years in India, have opened an office in Wolfville,
N.S. Their father, who practised in Canning, N.S., was one of
the early dental practitioners in Nova Scotia.
Dr. Eraser Buck, of Guysborough, N.B., has ceased practice.
Dr. Fred Primrose, who practised in Baltimore, is in poor health
and living with his son. Dr. V. Primrose, who is practising in Wolf-
ville, N.S.
Guarantees. — Bruce Walker, the colored custodian at the
Kansas City Western Dental College, made a rather neat reply to a
question a patient asked him the other day. It seems the patient was
a prospect for a full upper and lower denture, and in the course of
his conversation with Bruce, he asked him if the College guaranteed
its work. Bruce said: "Shucks, man, God Almighty didn't guarantee
the teeth He gave you. How can you expect poor humans like us to?"
— (Hettinger* s Dental News.)
The Late Harry Abbott
1HAD known him ever since shortly after my graduation. Some-
times it seemed as if I had known him always. 1 cannot think of
dentistry in Canada without thinking of Harry Abbott. Tho
shock of his passing is tempered only by the cherished memory of the
many joyous occasions on which it was my privilege to see him anc^
visit with him. No dental gathering in Ontario was ever quite com-
plete for me unless he was present, and usually he was present. His
cheery smile lingers with me yet as the rose tints brighten the western
sky after the sun has dropped to rest.
Big-hearted, generous, lovable, spontaneous, and substantial — he
was a rare combination. He wrought for the welfare of dentistry
during his whole career, and few men in the Province or Dominion
had his grasp of the needs of the profession in his beloved land.
He was courageous to the point of sublimity when it came to the
contention for any principle which seemed to him necessary for the
welfare of the public whose servant he always assumed to be. He
had a heart of sympathy and encouragement for the young man who
was just entering the profession, but this did not blind him to the duty
he owed to the people in keeping out incompetent men. I have often
seen him lashed between his sense of duty and his tendency toward
leniency. This is the experience of every conscientious examiner.
Harry Abbott has left his impress upon dentistry in Ontario in a
very unusual way. His long and valuable service in a public capacity
places the profession in his debt beyond their power to pay, and yet
it was his blessed privilege to know before his death how very much
he was appreciated by his colleagues. The granting of the M.D.S.
degree last May came to him as a sweet savor of the esteem and
respect in which he was held by his fellow members on the Board,
and in reciting the circumstances to the writer he confided the fact
that he was so overwhelmed that he could scarce hold back the tears.
He was always the first to willingly grant honors to others and always
106 ORALHEALTH
the last to look for honors himself. In the tenderness of his heart he
was one of the most appreciative men I have ever known, and his
countenance glowed with gratitude whenever a favor was done for
him.
Such men as Harry Abbott leave the world better than they find
it, and it is the ultimate of their example and their achievement which
tends surely toward our advancing civilization. They are constructive
in their policies, and efficient in their practical lives, and the sum total
of their contribution to human welfare cannot be measured by the
small span of their material lifetime.
Whenever I go to a Canadian meeting in the future there will be
something lacking. I shall miss the genial personality of our beloved
friend, and yet out of the mists of the past I shall see in the realm of
memory a rainbow halo hanging over the head of one who is gone,
and the smile that breaks through the veil and parts the mist will be
the smile of Harry Abbott.
(?.9i.f^
3a^
American Dental Library and Museum
Association
THE next annual meeting of the American Dental Library and
Museum Association will be held Monday, July 1 7th, at the
Hotel Ambassador, Los Angeles, California.
The membership consists now of over forty dental libraries, and
trust that all dental institutions owning a library will join same.
In order for the Association to accomplish its purpose it will be
necessary and an advantage to all dental libraries to be members.
Any institution or individual interested in dental literature or history
are eligible for membership.
B. W. WEINBERGER, Secretary.
40 East 41st Street, N. Y.
Treatment After Extraction. — After extracting a tooth,
whether by nerve-blocking, infiltration, or local injection, be sure to
clear away fractured bone from the socket. Press outside mucous
membrane with thumb and index-finger; wash the socket out with
saline solution and swab with an application saturated with iodine,
then instruct the patient to apply cold applications to the outside of
the face for about twenty minutes. — (S. C. Dental Record.)
— JUVENILE JINGLES —
Contributed to ORAL HEALTH by Dora L. Cameron,
Wenatchee, Wash,
Those Precious Teeth
I didn't have a tooth at all,
That's what my Mother said,
When nurse first brought me in to her
And laid me on the bed.
I had a tiny rosebud mouth,
So very, very small,
She didn't think there would be room
For teeth to grow at all;
But by and by the wee teeth came —
Two little ones below.
Then other teeth kept coming in
Till I was three years old.
Ten pearly teeth above, below
Made twenty teeth in all,
"All perfect teeth," our Dentist said,
Though they were very small.
He warned my Mother to take care
And let no wee holes come:
"The better kept the baby teeth
The better each new one.
"Those teeth will drop out, one by one.
And others take their place;
Far stronger teeth, much bigger ones,
They'll fill up every space.
"At six years old four other teeth,
Big double ones, will grow —
We must be careful of those teeth,
They're permanent, you know.
"At twelve four more teeth will appear.
At eighteen wisdom teeth.
And that will make just thirty-two,
Enough to chew tough beef."
The Dentist said, and Mother smiled,
"We'll do the best we can,
I'd like this boy of mine to make
A really perfect man."
D
MULTUM IN PAEVO
This Department is Edited by
C. A. KENNEDY, D.D.S., 2 College Street, Toronto
HELPFUL PRACTICAL SUGGESTIONS FOR PUBLICATION, SENT IN BY MEM-
BERS OF THE PROFESSION, WILL BE APPRECIATED BY THIS DEPARTMENT
D
D
Oral Diagnosis. — In examination of the mouth, any lesion with
which we come in contact, that cannot be accounted for through
dental disease, should be looked upon with the gravest suspicion. In
the more suspicious cases, the dentist is justified in refusing to do
dental work until a Wassermann test is made, for the reason that
this disease may be transmitted to the innocent. All these lesions must
be identified before discharging a patient. It is only by the strictest
vigilance on the part of the practitioners in all branches of medicine
that this disease may not get beyond control. Dentistry must do her
part and this can be done only by a more careful survey of the whole
mouth. — (Chalmers J. Lyons, Dental Summary.)
Technic Of Mixing Investment. — Use the very largest
rubber bowl and put into it a greater amount of water than you
would actually require, sift the investment material into the water
through a small sieve and allow the material to settle in the bottom of
the bowl until the excess water becomes clear. With a rubber ear
syringe withdraw the water. With your spatula incorporate into
your mix the investment which did not submerge into the water, rotate
the bowl gently in both hands for about ten seconds and you are
ready to proceed. With a number one or number two camel's hair
brush the creamy mixture is taken from the bowl and gently put on
the wax pattern. Be sure never to paint it in. This will avoid all air
bubbles. Again the wax pattern and sprue former are completely
covered, the ring is placed in position, and the remainder of the invest-
ment is slowly poured down the side of the ring. Be careful to avoid
jarring. — {Dental Summary).
Hemorrhage. — ^In obstinate cases of hemorrhage after extraction,
after most drugs have failed, try turpentine. — {Gordon C. Barkley,
Dental Science Journal of Australia) .
I Am Not Bound To Win, but I am bound to be true. I am not
bound to succeed, but I am bound to live up to what Hght I have. I
must stand with anybody that stands right, stand with him while he
is right, and part with him when he goes wrong. — {Abraham Lin-
coin).
ORAL HEALTH
EDITOR:
WALLACE SECCOMBE, D.D.S., F.A.C.D., Toronto, Ont.
CONTRIBUTING EDITORS:
C. N. JOHNSON, M.A., D.D.S.. F.A.C.D., Chicago.
RICHARD G. Mclaughlin, D.D.S., Toronto.
W. E. CUMMER, D.D.S., Toronto.
J. WRIGHT BEACH, D.D.S., Buffalo, N.Y.
Entered as Second-class Matter at the Post Office, Toronto.
Subscription Price, Canada and United States, two dollars per annum:
elsewJjere three dollars. Single Copies, 25c.
s
Original Communications, Book Reviews, Exchanges, Society Reports, Personal Items, and other
Correspondence should be addressed to the Editor, Oral Health, 102 Wells Hill Ave., Toronto, Canada.
Subscriptions and all business Communications should be addressed to The Publishers Oral Health
Royal Bank Building, 269 College St., Toronto, Canada.
Vol. XII.
TORONTO, MARCH, 1922
No. 3
H E D I T O I^I AL H
Public Responsibility of Dental Colleges
THE responsibility of Dental Colleges to graduate only those
students who are reasonably sure to prove themselves worthy in
the practice of Dentistry, — worthy both as to character and
professional ability, — is generally recognized. But a further public
responsibility rests upon the professional colleges, namely, to inform
themselves regarding the local needs of the public for the service they
are training men to render, and when intelligently informed, to
encourage graduates to locate for practice in districts where the
greatest public need exists.
In meeting these responsibilities. Dental Colleges will find it neces-
sary to co-operate with the Dental Licensing Boards of the States or
Provinces concerned.
Dental Colleges will serve the State no less than their own
graduates by assuming this public responsibility.
The lollov/ing reasons suggest themselves as pointing to the need
for some such action by the College Faculties and Licensing Boards:
(a) The teachers* intimate knowledge of each graduate's personal
and professional qualities makes intelligent selection possible.
(b) Such policy would strengthen the local position of the college
end encourage students to remain for their dental education in
the area in which they expect to practise.
(c) Would impose an added obligation upon graduates to serve
to the utmost of their ability, that they may uphold the
standards of their Profession and bring honor to their Alma
Mater.
no ORAL HEALTH
(d) Would have the effect of stressing the obHgations of the
college to the community as a whole.
We believe that this new development is essential to the establish-
ment of contact between the public and the young graduate in
Dentistry. It will serve as an introduction of the graduate to the
district in which he is to practice, will prevent over-crowding in cer^
tain areas, and create in the mind of the graduate the thought that to
serve the public is the great duty for which he has been prepared.
In carrying this plan into effect the Royal College of Dental
Surgeons has made a survey of conditions of dental practice in both
the Urban and Rural Districts of Ontario, and the information
obtained is being classified and made available to members of the
graduating class.
Dental Index Bureau Organized 1909 under the Auspices
of the American Institute of Dental Teachers
THE 1916-20 volume of the Index to Dental Periodical Litera-
ture is just off the press, and Dr. Abram Hoffman has issued
the following statement which will be of interest to the pro-
fession :
The edition is limited and orders accompanied by the remittance
should be sent at once to the undersigned. The price of the volume
delivered to all points within the United States and Canada is $6.00
and to all other points $6.50 (New York Exchange).
The Index is not a publication for profit. The officers serve with-
out remuneration and every dollar received is used in connection with
the preparation and distribution of the Index.
The third volume of the series, covering the literature from 1 839 to
1880, is now in preparation and will be ready for delivery about
October first. This will be the foundation of every dental library and
of inestimable value to every person interested in dental literature.
There is also in preparation the volume covering the period from
1921 to 1925. The Index for this term will be published in the form
of four annual paper bound books, the type of these being rearranged
and included in a cloth bound volume at the expiration of 1 925. The
first of these paper bound books, covering the year 1 921 , will be ready
for delivery about May first. Price and particulars later.
A. HOFFMAN, Secretary-Treasurer.
381 Lin wood Ave., Buffalo, N. Y.
Oral Health urges its readers to give support to the Dental Index
Bureau by purchasing a copy of the Index. The volume is of
inestimable value in locating any particular article in the literature or
in finding a complete list of all the articles that have been published
upon any given subject.
SMILE
IT takes sixty-five muscles of the
face to make a frown, but only
thirteen to make a smile ....
Why waste your energy .^^ KEEP
SMILING.
W. J. Beatty, R.C.A.,
Demonstrator in Art, Roy^al College of Dental
Surgeons of Ontario.
OPAL HEALTA
A JOURNAL THAT STANDS FOR THE '^ OUNCE OF
PREVENTION," AS WELL AS THE ** POUND OF CURE''
oil
VOL. 12 TORONTO, APRIL, 1922 No. 4
Annual Report of Dental Service, Department
of Public Health, Toronto, 1921
Edmund A. Grant, D.D.S.,
Director Denial Services Department of Public Health, Toronto.
THIS report briefly summarizes the service rendered by the Dental
Service of the Department of PubHc Health in the public and
separate schools, and the hospitals of Toronto, under the direc-
tion of Dr. Charles J. Hastings, Medical Officer of Health.
The work in the public schools was carried on by a stafF of twenty-
six dentists on half time service. Three of these devote all their
attention to making a survey of the children's mouths, so that in the
course of the school year, each child is examined and the parent
notified of the dental conditions found. Through their classroom
talks, they spread the gospel of oral hygiene and the care of the teeth.
To further impress this on the child, each one is given at the time of
the examination, a brief circular emphasizing the chief essentials of
mouth health. The educational value of this to the child, and further-
more to the parents, is enormous. Through this agency many parents,
being thus informed of the need, are led to place their child in the
care of the family dentist. For those who are unable to pay for
dental treatment, the service conducts three extraction and nineteen
operative clinics which are distributed over the city so as to best serve
the needs of the school population.
During the year, 55,586 children were examined, and of these
28,752 or 52^^ were found to have notifiable defects. While this
is a large percentage, yet it is a vast improvement over the conditions
existing before the service was inaugurated, when the average was
about 979^, and shows that a great deal has been accomplished.
In the extraction clinics 15,108 deciduous, and 2,275 permanent
teeth were extracted, and 13,385 local and 1,134 general anaesthetics
administered. In addition, some operative work was undertaken,
1,142 treatments being given and 471 fillings inserted.
114 ORAL HEALTH
The public school operative clinics completed the following opera-
tions for 26,750 children, of whom 20,090 were completed.
Extractions of deciduous teeth 1 4, 1 1 8
Extractions of permanent teeth 692
Treatments 1 7,292
Prophylaxis 5,047
Amalgam fillings 1 6,958
Cement fillings 9,421
Temporary fiillings 2,244
Total No. of operations 65,772
In addition to this, through the efforts of the school nurses 3,795
children had their dental treatment completed by private dentist.
For the separate schools there are only two dentists to care for the
needs of 10,000 children. This year the plan was followed when
schools re-opened in September of having both these dentists devote
all their time to the survey, and this was completed by November;
10,323 children were examined, of whom 8,861 or 86% had
notifiable defects, truly an alarming condition. In some schools the
percentage was as high as 97%, and in fact one small school showed
100%, requiring dental treatment. There is urgent need for another
dentist on this staff.
In addition to completing a survey, the following operations have
been performed:
Extractions of deciduous teeth 980
Extractions permanent teeth 122
Local anaesthetics administered 184
General anaesthetics administered 42
Treatments 488
Prophylaxis treatments 93
Amalgam fillings 796
Cement fillings 905
Temporary fillings 86
Total No. of operations 3,696
The following operations were completed during the year by the
hospital staff of six dentists in the four city hospitals :
Extractions 11 ,340
Local anaesthetics 1 ,828
General anaesthetics 777
Treatments 1 ,849
Amalgam fillings 327
Cement fiillings 280
Temporary filHngs 208
Full dentures 658
Partial dentures 670
I
ORAL HEALTH 115
Repairs to dentures 226
Resets 17
Crowns 25
No. of patients treated 1 3,775
At the request of the officers of the I.O.D.E. Preventorium, a
portable cHnic was installed there for two weeks until all the dental
needs of the institution had been cared for. The following operations
were performed for 61 children:
Deciduous teeth extracted 31
Permanent teeth extracted 3
Treatments 52
Amalgam fillings 72
Cement fillings 35
Total operations 193
56 children completed.
Early in the year the service sustained a severe loss in the death of
Major W. R. Greene, who only a short time before had been
appointed Director of Dental Services in succession to Dr. W. E.
Willmott. Major Greene had a splendid record of service overseas,
and displayed a keen interest and untiring energy in this new sphere
of work. His sudden taking away was deeply regretted by his many
friends in the service and throughout the dental profession. The
position remained vacant until the undersigned was appointed on
August 1st, 1921.
The Department also lost the services of Dr. C. E. Stewart, of
Kimberley School, and Dr. C. A. Collard of Western Hospital, who
resigned, the former moving away from the city, and the latter giving
up practice on account of ill health. They had always given efficient
service and their resignations were reluctantly accepted. Dr. J. S.
Butler was appointed to succeed Dr. Stewart at Kimberley School,
and Dr. W. A. Madill, a former member of the staff, who had been
released for overseas duty, was reappointed, in place of Dr. Collard.
The staff was also increased by the appointment of Drs. G. S. Paul
and Ross Anderson to take charge of new clinics. New clinics were
opened in Lansdowne School and Keele Street School, For this
purpose the most modern equipment obtainable was secured — of a
unit type with a child's chair, as designed by the S. S. White
Company for the Forsyth Dental Institute of Boston.
While considerable has been accomplished, yet a careful perusal
of this report will show that quite a number of the children are still
uncared for. Another factor to be considered is that the school
population is increasing rapidly each year. The Board of Education
estimate that the public school population will increase this year by
10,000. How could the Dental Service be best expanded to meet
this increased need? As previously mentioned, the clinics are only
116 ORAL HEALTH
operated on part time service and it would seem that the simplest
method of supplying sufficient service, would be to convert some of
the present half-time clinics into full time service. These could be
selected in most congested districts where the need was greatest. It
is felt that if four clinics in the public schools — one each in the four
most populous school districts— were put on full time, the press-
ing demand of the next year or two would be satisfactorily met.
Similarly another dentist added to the separate school staff would
enable this service to more effectively cope with the need. This
expansion, while it would mean a slightly increased staff, would not
involve the purchase of any additional equipment, as it is already
available. It would simply mean that some equipment now lying idle
for half a day would be in use full time.
It is hoped that it will be possible, some time in the near future, to
place a dentist on duty at the Weston Sanitarium. There is a beauti-
fully equipped dental operating room in the Queen Mary building
there, but with no one to staff it.
This report is put forward at the present time for the information of
the Dental Profession, and also with the object of enlisting their
support and co-operation, more particularly those practising in
Toronto. Complaint is sometimes made that the dental examination
as recorded on the survey chart, is not thorough enough. If one
should stop to realize the magnitude of the task, 85,000 children to
be examined yearly, and that this examination is generally made in
the class room, using only a wooden tongue depressor, this criticism
would be less often heard. Further, sometimes considerable interval
may elapse between the time of the examination and the time the child
comes to the family dentist, and many things may have occurred at
this rapidly developing age. Temporary teeth marked for extraction
may have already exfoliated, new cavities may have appeared or
become noticeable. The important thing about this examination is
that it separates the sheep from the goats — that those having defec-
tive teeth carry a notice to their parents, warning them that dental
attention is urgently required.
The service is at all times anxious to encourage the sending of the
child to the family dentist, and only undertakes treatment at the
request of the parent who signs a form stating inability to pay for the
service. It is just here we would appreciate the sympathetic support
of the profession. When a child comes back from the family dentist
and says: "Our dentist says not to bother having these teeth filled, as
the teeth will all come out some day,** we feel under such circum-
stances, that someone has "let us down" rather badly. Fortunately
this does not occur very often, and we believe that the great majority
are behind us in the effort to improve the dental health of the rising
generation.
The Foundation and the Superstructure
A. W. Thornton, D.D.S.,
Dean, Dental Department, McGill University.
1 LISTEN ED a day or two ago to a gentleman from Rochester,
who was giving an address on "Mental Disarmament." He
pictured the world's condition when not only National Disarma-
ment, as we understand that question, would be an accomplished
fact, but when Mental Disarmament also should rid the world of
many of its prejudices, its misunderstandings, and its fixed animosi-
ties.
He used this significant sentence in connection with the social
fabric which this Mental Disarmament was to bring about in this
old world, rent as it is at the present time with unrest. "In every
building which is to serve a useful purpose the superstructure must be
in proportion to the substructure." Will you permit me to define his
words, in order that we may have a common starting point?
Definition of Foundation or Substructure — The basis of a build-
ing; the solid ground on which a structure rests. That part of a
structure which is below the surface of the ground. The principles,
basis, grounds or reasons on which an opinion, notion or belief, is
founded.
Superstructure — A structure or building erected on something else,
especially the building raised on a foundation, as distinguished from
the foundation itself. This last is perhaps the one which will suit us
best.
I have chosen the title of my paper, not because it is in any way
closely related to our professional activities, but rather to draw atten-
tion, in a somewhat diagrammatic manner, to the beginning, the
present attainments, and the future possibilities of the profession or
calling to which we belong, and for which we exercise a fondness,
more or less pronounced.
When I say that I wish to draw attention to the beginning of
Dentistry, I have no intention of going into the evidence of a very
early knowledge of some forms of Dental operations, as practised by
prehistoric men, or of the evidences of Dental restorations, obtained
from the pyramids of Egypt or the catacombs of Rome. These
things may perhaps be properly referred to as the foundations, the
underground part, but I wish to speak more particularly of the lower
stories of the superstructure, the portion in which we of the present
day have had some part.
118 ORAL HEALTH
There are perhaps none of the men here present, who belong to
the ancient and honorable past. But there are many here who have
personal knowledge of the days of indentures and preceptors.
What of that part of the superstructure built during the last
twenty-five years of preceptor training? I am not one of the school of
weeping prophets who believe that "the former days were better than
the latter," but there is much to be said in favor of a system of office
training, under a preceptor.
Those of us who have been in Dental Education work for any
length of time know full well that many of the young men and women
who receive our degrees and start in practice for themselves, are not
by any means as well equipped as they might be, either to render
efficient service to patients, or to grapple with the financial problems
or professional difficulties which they must of necessity encounter.
Association, in the early years of practice, with an older man, with
experience in practice as well as in commercial affairs, has been of
inestimable value to hundreds of men who entered the profession
twenty-five or thirty years ago.
I know, as well as any of you know, the many drawbacks of the
old indenture system, for there were preceptors of every possible
standard, high and low, honest and dishonest, capable and incapable,
good, bad and indifferent, but the difficulty to-day is that we send
out our graduates without any practical knowledge of office manage-
ment, professional ethics, or obligation to patients.
I believe that in all our schools much could be done to remedy this
defect in professional training.
I am not unmindful of the fact that lectures are given in all our i
schools, in Ethics, History and in Economics. I have nothing but
praise for such training. But I know, too, that first-hand knowledge
of a profitable investment in a house, or a piece of farm land in a
good location, or some safe interest-bearing bonds, first-hand knowl-
edge I say, personal relationship with some one fortunate enough to
have become "wise in these ways" would be a great help to many of
our graduates who go out to become the "prey" of financial vultures.
In addition to the help which might be given along business lines,
think of the tremendous advantages to a young man to come in con-
tact with a man of wisdom and experience, and to learn by personal
observation, the methods adopted in meeting patients, in deahng
with the difficulties which are inseparable from active practice, and
the personality, which after all plays almost as great a part in suc-
cessful practice, as the fundamental knowledge peculiar to our
professional calling.
ORAL HEALTH 119
Have I perhaps wandered somewhat far afield? My only excuse
is that I have seen so many of our graduates, proud of their newly
acquired degree, but hopelessly weak in many of the things that go to
make up what we are pleased to term "success in life," and may I
make this further statement, but illy prepared to render the kind of
service, which a suffering people has a right to expect.
But to return to our lower story of the superstructure of dentistry.
What were our schools teaching thirty years ago, and what were our
men practising? Well, I can say with all confidence that the bill of
fare in the colleges of that date was not calculated to produce mental
dyspepsia.
If the students of to-day could peruse the curriculum of the colleges
of thirty years ago, they might perhaps be inclined to laugh. But if
we who are teaching and practising to-day feel any tendency to
cultivate a feeling of superiority over those men at whose feet we sat,
let us not forget that "there were giants in those days;*'
If we have knowledge of which they were ignorant, let us bear in
mind that the men of former years, by unremitting toil, laid the
foundation of that knowledge. If we to-day have an enlarged vision
it is because we are standing on the shoulders of such men as: — J. B.
Willmott, Luke Tesky, "God's friend Theophilus," W. T. Stuart,
Black and Garretson, Guilford and Stellwagen, Darby and Perry
and Land, and scores of others whose names are household words in
Dentistry.
These men sowed and we have reaped. They have labored and
we have entered into their labor.
What did we in those days learn? We learned to extract teeth,
more or less efficiently. We learned to fill teeth with alloy. But to-day
we have alloys incomparably better because G. V. Black gave his
mind to the problem of the "flow" or change which took place in
these fillings after insertion.
We learned to insert fillings of cohesive gold foil, and to the ever-
lasting detriment of dentistry, it is now becoming almost a lost art.
We learned something of cavity preparation, and in that field also,
Black has since laid foundations in eternal principles.
We learned something of root canal work, but we have since
learned that we were then merely groping in darkness. We learned
to make artificial dentures, and perhaps nothing in our realm has pro-
gressed so rapidly, and changed so completely, in the past twenty-
five years, as Dental Prosthesis.
There are men in this room who never listened to a lecture in
Crown and Bridge work during their entire College course. Some of
us now wonder if they missed very much. But crown and bridge
120 ORAL HEALTH
work has not been an unmixed evil. The advent of crown and bridge
work taught the pubHc at least one good lesson, viz. : that some forms
of Dental work must of necessity be adequately paid for. Unfortun-
ately, however, much of the crown and bridge work from the days of
Richmond until the present, would be dear at any price. I am
inclined to look upon the rise and fall of crown and bridge work, as
it has been practised in all too great a majority of cases, as the
blackest page in the history of dentistry. Perhaps, however, it was
necessary in the evolution which has brought us to our present day
recognition.
I quite realize that when I come to speak of Orthodontia I must
take off my shoes, for I am standing on holy ground. But we have
learned that: —
"All earth is crammed with Heaven,
And every common bush afire with God;
But only those who see take off their shoes.
The rest sit around it and eat blackberries.*'
The development of Orthodontia as a part of Dentistry has meant
untold blessing to a very limited number of persons. Perhaps no part of
Dentistry has fallen so far short of its wonderful possibiHties as the
practice of Orthodontia. Many features enter into the results thus far
attained, by this much-discussed and many-sided question.
The time required to treat a case demands a fee which places
treatment of malocclusion beyond the reach of any but the wealthier
classes. To-day Orthdontia is in the class with eight-passenger
Packards, Cadillac Limousines, and Pierce Arrow Sport Cars. What
we desire is a ''Ford Service' that will take us where we want to go
without the attendant frills.
At the recent meeting of the American Institute of Dental
Teachers, this subject was very freely and fully discussed, and as a
result of this, I believe that the near future will witness a very marked
change in the teaching necessary to fit our students to do a very
considerable amount of this work.
I can see no reason why our students should not, when they
graduate from our colleges, be as well qualified to practise Ortho-
dontia as they are to make Prosthetic Restorations, or to do creditable
work along operative lines.
No special kind or amount of brains is necessary in the one case or
in the other. I have absolutely no sympathy with the statement of a
very prominent American Orthodontist, when he says that Orotho-
dontia is more closely related to Science or to General Medicine than
it is to Dentistry. Nor have I any sympathy with the further state-
ment by the same prominent Orthodontist, that the correction of
ORAL HEALTH 121
Dental irregularities should never be attempted in the Clinic of a
Dental School, and that the greater part of the work thus attempted
is a criminal procedure.
It is a well known axiom in business that a universal demand or
need creates a supply. The need of honest Orthodontia practice is
known by every man in the Dental Profession to-day. I need not,
before this audience, lay any stress upon the terrible misfortunes
attendant upon malocclusion, contracted nares, enlarged tonsils, and
sunken chests, the usual concomitants of those conditions which
demand intelligent treatment such as is now being given to an
extremely limited number of persons.
This is a question with which the Dentists of to-day must grapple,
if the superstructure which we are raising is to be worthy of the
foundation which was laid by the worthy men of the past.
It is not a question of easy solution but the difficulties to be over-
come are not insuperable, and the end sought is worthy of the efforts
of the best men in the Profession.
Am I still treading on dangerous ground as I pass from the holy
ground of Orthodontia to the "Sanctum Sanctorum," of Pyorrhea or
Periclasia?
What do we know of this "disease,*' "malady," "condition," or
"manifestation"? The name matters not, we all know what is meant.
Is it due to a specific organism? Is it due to an inherited tendency?
May so-called pyorrhea, by metastatic action, produce a pathological
condition in some part of the body remote from the mouth and teeth?
Is it any way responsible for so-called rheumatoid conditions, and is
there a direct relationship between pyorrhea and joint lesions, and
valvular lesions of the heart?
What medicinal agents have a curative effect in the treatment of
this lesion? Is it in some way related to dietetics? Will it yield to
treatment of a purely mechanical nature? Is the administration of
internal medicine desirable? What are we to teach present day
students in regard to this very prevalent condition?
My reasons for asking these questions may be very briefly stated.
Within the last few weeks I have seen a number of patients in the
Hospital who have been treated by so-called Specialists for so-called
Pyorrhea. One of these patients, a man of about forty years of age,
gave me this history of his condition.
About eight months ago, feeling that there was something wrong
with his mouth conditions, he consulted his Dentist, who told him that
he had Pyorrhea and sent him to a Specialist to be treated.
The patient said to me: "I have been taking treatment for eight
months. The specialist tells me that I am getting better. I have been
taking one kind of pill before breakfast, another kind of pill in the
122 ORAL HEALTH
middle of the forenoon, another kind of pill before supper, and a
fourth kind before retiring, but in spite of it all, / am losing my
teeth.'' Examination of this patient's mouth showed one upper molar
on the left side so loose that it could have been removed with the
fingers.
On the right side, the lingual root of the second molar was entirely
exfoliated so that an instrument could be placed over the apical
foramen. The remaining teeth in this patient's mouth showed a
deposit of saHvary calculus, the removal of which brought about a
very much improved condition.
A physician attached to the Montreal General Hospital, of which
institution our Clinic is a part, said to me the other day at the dinner
table: *'What do you know about the treatment of Pyorrhea with
Thyroid Extract?" To my shame I had to confess that I didn't know
anything about it.
Another physician a day or two after asked me if I knew what
results were being obtained in the treatment of Pyorrhea with
Radium. Once again I had to admit my ignorance.
I am convinced that such cases as those to which I have just
referred might be multiplied by the thousand. What are we to do in
the matter ? I desire to put myself on record as saying that I have seen
in the past ten years, not one or two or ten cases, but hundreds of
cases, where not only was the mouth condition improved, and in
many cases made entirely healthy, but as a result of this treatment in
these cases the general health of the patients was wonderfully
improved. These results were brought about not by Specialists, but
by ordinary Dental Students in an ordinary Dental Clinic, and the
results were not due to the application of any medicinal agent, but
due wholly to the removal of mechanical irritants and in some few
cases to the correction of faulty occlusion.
The question arises and must be met by every intelligent Dentist.
What is the relation of the General Practitioner in Dentistry to the
patient who presents in ordinary routine practice, and in whose mouth
there is a more or less well defined evidence of that condition, which
for want of a better name, is very generally spoken of as Pyorrhea?
Permit me to revert to a sentence which I have already used in
discussing what we were taught twenty-five or thirty years ago. I
said we learned to extract teeth more or less efficiently. In conformity
with other phases of the work of the General Practitioner in Dentistry,
the extraction of teeth has been exalted to the dignity of a specialty,
and is now known as Exodontia.
Many men to-day are speaking of Preventive Dentistry, but just
at the present time there seems to be no immediate prospect that
Preventive Dentistry will, in the near or even distant future, eliminate
the necessity of extracting human teeth. Perhaps nothing in connection
ORAL HEALTH 123
with our professional work has contributed so largely to the lowering
of our professional standard as has the necessity for extraction, and
the manner in which it has been done.
It is not to be wondered at that people of all classes have always
had a holy horror of having their teeth extracted. The pain was
always excruciating, the loss of the extracted teeth nearly always
noticeable, and the change brought about by such extraction was, in
almost every instance, undesirable, from the esthetic standpoint.
When the use of forceps supplanted the turnkey, a very marked
advance was made, but the pain, the dreaded pain, still remained,
and Dentists and Dentistry were always associated in the public
mind with these horrors.
The introduction of Nitrous-Oxide as a general anaesthetic did
much to alleviate this dreaded pain, and to rob the operation of much
of its dreaded horror. Local anaesthesia has still further contributed
to the lessening of the dread of this frequent necessity.
And yet a great dread remains to those who must suffer the loss of
natural teeth. I was delighted a few weeks ago when I noticed in
one of the Journals, an article dealing with this question. If I mistake
net, the article mentioned the fact that some Dentist in Ontario had
discovered some agent which could be locally applied, and such
application rendered the extraction of teeth painless. What a God-
send it would be!
Any man of ordinary ability may learn to extract teeth quickly. But
there is something more to the extraction of teeth than their rapid
removal from the alveolar sockets. The condition in which the mouth
is left, the condition of the alveolar process, as well as the condition
of the soft tissues, should be kept as prominently in mind by the
operator who is doing this work, as the removal of the teeth.
For many years we have been spoken of as Dental Surgeons, and
the public generally associate our '*surger^** with the extraction of
teeth. I believe that much is possible in this field, much that would
rob this operation of the dread to which we have referred, and at the
same time be more in keeping with the modes of procedure, as well as
the after-results of modern surgery, as practised in other parts of the
body.
It strikes me very forcibly that just at this point a very considerable
advance might be made in the education of our students. The under-
lying principles of Surgery, the necessity for cleanliness, the adaptation
of tissues, the use of surgical needles and other instruments, the
function and application of the many forms of ligatures now in use,
the dressing of wounds, and many other things which will occur to
the minds of all of you should, I am persuaded, form a part, and a
very interesting part, of the teaching of Dental Students.
I have not said a word about Radiology, or as it is commonly
spoken of, X-Ray work in Dentistry. Some years ago in a paper
124 ORAL HEALTH
which I read, I made this remark: *'In the very near future an X-Ray
machine will be as much a necessity in a modern Dental office, as an
operating chair or a Dental engine."
The time has come more quickly than most of us thought. But we
must learn this fact, that while a Radiograph or X-Ray film may
reveal many things, and may be a real help in determining conditions
in many obscure cases, at the same time it must be borne in mind that
it is extremely easy to be misled by an X-Ray film, and very, very
frequently we will be surprised when we discover extensive areas of
pathological tissue where none at all was suspected, and on the other
hand, that we find no such condition in a region where we were sure,
from the Radiograph, that infection to a marked degree was present.
Care must ever be our watchword in deaHng with this part of our
daily work.
In conclusion, we are perhaps all ready to ask the question : What
is the nature of the Superstructure of the Dental Edifice which we are
now building? There can be no manner of doubt of the trend of
public opinion and professional thought in regard to the part which
mouth conditions play, in connection with the general health of the
human body.
Much that is unreliable, unscientific, and unethical is being written
and talked of in regard to systemic infection from local mouth condi-
tions. But while that is true, it is equally true that the half has never
been told of the evil which may follow in the wake of neglected
mouths and infected teeth.
I want to lay upon the shoulders of the Dentists of this country the
full share of the burden which they must assume, as w^ll as the duty
which devolves upon every man in the Profession, of becoming, and
remaining, as intelligent as it is humanly possible to be, regarding his
individual part in ministering to the comfort and happiness of the
patients who entrust themselves to his care, and his duty also to
exercise that unceasing care which will prevent any operation which
he may perform, from producing any pathological condition, or
accentuating any such condition which may be present when such
patient comes for treatment.
I spoke a moment ago of the trend of "public" opinion. Another
factor presents itself in regard to this matter. The men and women
who know most of the suffering to which human flesh is heir (I refer
to the physicians of this country) know that no line of demarcation
can be drawn between metastatic infection, which may develop as
a result of a diseased mouth or diseased teeth, and metastatic infection
from any other part or organ.
Because of this knowledge, physicians to-day, as never before, are
seeking the co-operation of the Dentist. Our schools and colleges must
prepare the graduates of the future to meet the demands which
physicians are justified in making.
ORAL HEALTH 125
We have used for many years the term "General Medicine," to
cover the ailments and treatment of every part of the body. To-day
it is impossible, absolutely impossible, for any one man to deal intelli-
gently with the pathological conditions of the whole body. Because
of this difficulty, men, more and more, are specializing in various
fields.
We hear from many sources the statement that: "Dentistry is a
specialty in Medicine." The truth intended to be conveyed is not well
stated. The fact is that General Medicine, as that term is used,
implies the treatment of disease in any or every part of the body.
With this thought in mind. General Medicine means a "partial"
knowledge of many of the branches which are now known as
"specialties," and Dentistry cannot possibly be separated from the
others.
There are three words very freely heard to-day at all Medical
gatherings, and I wish to commend to my confreres the study of these
three words, with the hope that we will study them as closely as
possible, that our field of usefulness may be enlarged as we carry on
from day to day in the practice of our own specialty.
The first of these words is Etiology and the definition of the
word is: "The doctrine of causes, specifically of the causes of disease;
causation."
The second word is Metabolism and the definition of the
word is: "Tissue-change, the sum of chemical changes whereby the
function of nutrition is effected; it consists of anabolism, or the
constructive or assimilative changes, and catabolism, or the destructive
or retrograde changes."
The third word is Metastasis, and the definition of this word
is: "The shifting of a disease, or its local manifestations, from one
part of the body to another, as is seen in mumps when the symptoms
referable to the parotid gland subside and the testis becomes affected.
(2) In cancer, the appearance of neoplasms in parts of the body
remote from the seat of the primary tumor."
Around these three words, as centres, much of the educational
training of the Dentists of the future must of necessity revolve.
"Knowledge comes but Wisdom lingers,
All things here are out of joint;
Knowledge comes but slowly, slowly.
Creeping on from point to point."
May we not all hope for, and look forward to, a day when, as a
United Body, every individual member of the Profession will do
what in him lies to increase the general fund of knowledge, so that
the greatest good may come to the great Public to which we minister;
and still further, to lessen the terrible prevalence of the suffering
which follows in the wake of Dental caries.
Surely this is a consummation devoutly to be wished for.
Prospects for Young Dental Practitioner
in Province of Quebec
[The folloTving article has been forrvarded to Oral Health from a
contributor in the Province of Quebec. Our correspondent map
have taken a rather one-sided view of dental conditions as the^ exist
in Quebec. HoTvever, the columns of Oral Health are open to any
and all who wish to present their views or discuss **the other side of the
question.'* — Editor.]
IT is safe to say that the average student enters college not only
with very little forethought of whether he is endowed with those
qualities which make for success in what he is choosing for his life
work, but also with very little knowledge of the requirements of the
various provinces, in one of which he might later wish to practise, and
the possibilities of success open to him there.
Some of our greatest educators have told us that the child must be
well advanced before it is seven years of age if it is to make a mark
in the world. If this be true, should we not know something of the
various fields in which we may desire to carry on our work, the
requirements for license which must be met, and conditions which
make for or against success in practice, before we have advanced to
our final year? This information is not always readily obtained, so
it is the purpose of this article to tell something about conditions in
the Province of Quebec.
It is interesting to note that there are according to the latest informa-
tion available, only 453 licentiates in the province under consideration,
very few of whom have a graduate assistant, — a graduate of Dental
Surgery who is not a licentiate. This is rather startling when we
consider the population of Quebec as compared with that of Ontario,
and when we consider that there are more dentists in the city of
Toronto than in the whole of the Province of Quebec. Here is
evidently a province where the young graduate should in due time
achieve success, but let us consider the question in detail.
The first efforts to organize the dental profession in the Province of
Quebec were made in 1866, but it was not until 1869 that it was
incorporated under the name of the Dental Association of the Pro-
vince of Quebec. This body served its purpose until 1909, when the
laws governing the profession were changed to what are now known
as the Revised Statutes of Quebec, Articles 5030 to 5084. At the
same time the name was changed to the College of Dental Surgeons
of the Province of Quebec.
The Act was first administered by a Board of Governors consisting
of eleven men, but this number has since been increased to fifteen.
I
ORAL HEALTH 127
On this Board, Montreal has twelve representatives, w^hile the rest
of the province has three, one each for the districts of Quebec, Sher-
brooke and Three Rivers. This Board of Governors has the power
to make by-laws regarding the honour and dignity of the profession,
discipline, examinations for study and practice, and in general con-
trols the practice of dentistry.
The C.D.S.P.Q. (the licensing Board) will net accept the certifi-
cate of the University Matriculation Board, 1908, as a preliminary
examination for students entering dentistry and who intend practising
in this province, although one possessing it may enter McGill or
University of Montreal and proceed to the degree of D.D.S.
At the last meeting of the members of the C.D.S.P.Q. it was
recommended that the program of the said examination should be
made 100 per cent, harder than the one already in existence.
Private schools may prepare a candidate for this examination.
Failing this, if one has sufficient means, he may engage a tutor. The
ordinary school system of the Province of Quebec does not cover all
the work prescribed for this examination. As a result, the number of
failures is unusually high, four or five times greater than those of the
University Matriculation Examination, which, in our opinion, is based
on a curriculum which gives the student an infinitely better ground
work in those subjects so essential to one taking up the study of
dentistry. Rarely is a student successful in his board examination on
his first attempt.
May we give some of the causes of these failures, apart from that
already given. On each paper there are from four to eight questions.
Each question asks for one fact which can be put down in most cases
in less than a sentence. The student may have a very good know-
ledge of the subject, but cannot answer satisfactorily the questions
as they are asked. They are general, vague, and cover such a wide
field that one must have a knowledge such as we find only in an
encyclopaedia, to cope with it. Is it too much to say that an educa-
tion, to be of value, must be a classified knowledge, not a mere
conglomeration of facts?
On top of this examination we have a general increase in the
standard of elementary education required until by June, 1927, we
require eight years of classical studies culminating in a B.A., B.Sc,
or B.L. degree. These will be accepted from any university recog-
nized by the College of Dental Surgeons Province of Quebec, but the
one, two, three ^ears Arts required until that date must he put in at
a Quebec University. Then having successfully completed this work
one is free to commence his dental studies, but his course must be
carried on either at the University of Montreal, or McGill University,
and a representative of the Board of Governors is present at each
examination to assess the student. No other college is recognized by
128 ORAL HEALTH
this B.O.G. In the past there have been cases where a native of
the Province of Quebec has taken a course abroad from his native
province, obtained permission of the Board to put a bill through the
Provincial Government (costing him from five hundred to eight
hundred dollars), and after trying a licensed examination has been
granted an L.D.S. In all cases the preliminary examination must be
met. In no case can a D.D.S. get his L.D.S. until four years have
elapsed since he met the preliminary requirements.
It is difficult for us to understand the attitude of Quebec to the
Dominion Dental Council, but it is evidently due to a desire to keep
the profession from being overcrowded. Less reasons advanced are
that French is not taught in the public schools of the rest of Canada,
but neither is English taught to French students in what corresponds
to the public schools in Quebec. French is a compulsory subject on
matriculation papers. The English practitioner thinlcs he has none
too large a population from which to draw his clients.
Regulations of the Dental Board, Quebec.
To be legally admitted to the study of Dental Surgery in the Province
of Quebec, the candidate must:
1. — From June 1921 to June 1927, (a) Present a certificate stating
that he has successfully passed the special m&triculation required by the
Board of Governors, and that he is nineteen years of age, or else be a
bachelor of arts, letters or sciences (B.A., B.L., B.S.). (b) Hold a
matriculation certificate from a recognized university of the Province of
Quebec stating that he is regularly admitted to study Dental Surgery
therein, because (a) he has completed in June 1921, five years of classical
studies (Belles-lettres for French university college, or four years high
school, plus one year college for English university) ; in June 1923, six
years of classical studies Rhetorique in French university college or four
years high school, plus two years college in English university) ; in June
1925, seven years of classical studies (Philosophy Jr., or four years high
school, plus three years college) ; in June, 1927, eight years of classical
studies (Philosophy Sr.), or four years high school, plus four years
college; (b) he has successfully passed all examinations required at the
end of each of above mentioned periods of study; (c) or he has made
equivalent studies and successfully passed equivalent examinations
before the Matriculation Board of the University.
2. — After June 1927, the candidate must: (a) Present a certificate
stating that he has successfully passed the special matriculation examina-
tion prescribed by the Board, and is 19 years of age, or hold a University
diploma of B.A., B.S., or B.L., or (b) hold a certificate from University
of the Province of Quebec stating that he has been regularly admitted to
study therein, because: (a) He has completed eight years of classical
studies or four years high school, plus four years college, (b) has success-
fully passed all required examinations, or (c) has made equivalent studies
and has successfully passed examination thereon before the Matricula-
tion Board of the University.
3. — In and after 1929 hold a bachelor's diploma from a university
recognized in good standing by the Board of Governors.
The Curriculum for the English Candidates is as follows: —
Group A— rClassics.
Xatin — Caesar's commentaries, Books I, II, III; Virgil's Eneid, Books I.
II. Questions on Grammar and Constructions.
ORAL HEALTH 129
English — Grammar and Analysis. Knowledge of one of Shakespeare's
plays. "Othello," for 1922-1923.
Prench — Questions on Grammar and Analysis. Translation into English
of Extracts from Fenelon's "Aventures de Telemaque." Translation
of short English sentences into French.
Literature — Principles of the subject, with the History of Greek and
Roman literature of the classical age, and of English literature from
the beginning of the 17th century to the present time.
History — Outlines of Greek and Roman History with a rather more
detailed History of England, France and Canada.
Geography — Modern, especially of Britain and France, and of their
colonies and possessions, especially of Canada.
Group B — Sciences.
Arithmetic — To the end of Square Root, and a practical knowledge of
the Metrical System.
Algebra — To simultaneous equations of the first degree, inclusive.
Geometry — Euclid, Books I, II, III, and the first twenty propositions of
Book VI, also the measurement of the surfaces and volumes of the
geometrical figures.
Botany — As in Gray's "How Plants Grow."
Chemistry — As in Remsen's "Elements of Chemistry.''
Philosophy — Logic, as in Jevon's Logic to page 182. Intellectual and
Moral Philosophy, as in Christian Brothers' Philosophy, by L. Poissy.
Physics — Elementary Statics and Dynamics of Solids and Fluids, with
the Chapter on Heat, according to Peck's.
Notice.
Candidates may take one Group at one Examination and the other
Group at the next subsequent Examination. If a candidate fails in only
one subject, he will have to take over that subject only. In order to pass,
the candidate must obtain 60 p. c. on Latin, English, French and Arith-
metic, and 50 p. c. in the other subjects. Candidates must produce
certificates of good moral character.
The Examinations are held at Montreal, on the first Wednesday in
April and second Wednesday in September. Applications to be made in
person to the Secretary, accompanied with the receipt of the Treasurer
for matriculation fee, at least fifteen days before the date of Examination.
—Fee $20.00.
It can readily be seen that it is next to impossible for any student
residing outside the province of Quebec to meet these requirements.
The financial outlay, and the element of risk in not being able to
*'carry on*' until one can obtain a license is too great. Evidently
a great majority of the students native to the province are of the same
opinion, for the dearth of dental surgeons has already been shown.
The question naturally arises, "What has been the effect of these
conditions? What do we find?" Are a few men reaping a harvest?
No. There are a few men who have a successful practice. Dentistry
is always a battle, but here perhaps to a greater extent than any-
where in Canada. Large areas of Quebec have but few dentists,
the public are not educated to dentistry, nor to a proper value of
the services rendered.
The lack of dental education perhaps accounts for the few practi-
tioners who find it profitable to specialize. Nothing is being done
at the present time but Orthodontia and Prosthesis.
Outline of Lectures on Dentistry to
Nurses in Training
LECTURE 1.
INTRODUCTORY.
PLAN OF INTRODUCTORY LECTURE.
Undermentioned subjects not treated in detail. Simply sketchy out-
line, to awaken interest of class and show definite relationship of Dentistry
to the nurses' work.
Review the more important questions to be covered in Dental lectures
to nurses.
(a) Importance of teeth, — Esthetic, Expression, Appearance, — Articula-
tion.
(b) Good teeth and good health.
(c) Mouth vestibule — voluntary 3 inches of alimentary tract.
Thorough incorporation of ptyalin with starchy foods.
Mastication — first step in digestive process.
Natural teeth compared with artificial substitutes and efficient
mastication.
(d) Oral cleanliness.
Mouth toilet.
Oral Hygiene in sick room.
Previous to anesthetic.
(e) Dental disease and systemic disease.
Focal infection.
Two main paths of infection.
Local manifestations of general disease.
(f) Dentistry and Social Service.
Organized State Dentistry.
Institutions, Dental Service in Hospitals (In and Out Patients).
Industrial Dental Clinics.
School Dental Service.
LECTURE 2.
THE TEETH AND INVESTING TISSUES.
(a) Dental Anatomy and Gross Histology.
Dental Tissues, including pulp and surrounding parts. Perio-
dontal tissue.
Difference between pulpless tooth and dead tooth.
Names, number, and surfaces of deciduous and permanent teeth.
(b) The Developing Tooth.
Dates of calcification and eruption.
Alignment, contact and occlusion.
LECTURE 3.
NORMAL FUNCTION— MASTICATION.
(a) Evolution and development.
(b) Digestion and local cleansing.
Nature's Cleanser.
100-200 lbs. pressure — removes sticky carbohydrate.
Clear bacteria out of mouth.
Quantity toast chewed before breakfast — incubated — developed
more acid than after.
Mouth never so clean as at close of proper meal — right kind of food —
ample chewing.
Debris of clean food.
Wash away debris of fresh food, mouth-rinsing with abundance of water.
ORAL HEALTH 131
importance of Mastication.
1. Exercise of the teeth gives —
Blood supply.
Calcification.
Strength and resistance of investing tissues.
2. Development of Arches.
3. Cleansing of surfaces of teeth.
(a) Hard food.
(b) Abrasive food — fibrous — whole wheat.
4. Excites abundant fiow of saliva.
Presence foreign substance reduces efficiency of saliva as cleans-
ing agent.
LECTURE 4.
ABNORMAL ARCH
IRREGULARITY OF TEETH.
Form of lower two-thirds of face depends largely on position of teeth.
Normal condition — certain forces guide — pressure of tongue — lips —
cheeks — and teeth already in mouth.
If teeth in proper position (none lost), face usually assumes proper pro-
portions and lines of beauty. , :. ^
Causes of Irregularity.
Early loss deciduous teeth (jaw lacks development).
(These function from 5-10, most important years. (Don't call them
temporary.)
Mouth breathing —
Excessive pressure cheeks on posterior teeth.
Narrowing of arch.
Upper teeth protrude — lower receding — producing narrow face,
vacant look, sub-normal intelligence.
Thumb sucking — Tongue — Cheeks.
Excessive use rubber nipples.
Lip Biting — nail biting.
Leaning head on hands.
Loss of Permanent teeth.
Bottle feeding to be deplored, — (a) exercise Jaws, (b) character of food.
Modified cow's milk best substitute — certain elements lacking*
Tight lacing of mother during pregnancy.
Handicap of features — looked upon as expressive of weak character — but
result of dental neglect. Ultimately has this effect and influencing
character of individual.
LECTURE 5.
DENTAL DISEASE.
(a) Etiology of dental caries and Periodontoclasia.
Same fundamental causes of disease in mouth as in other parts.
Saliva.
Physiological balance.
Dental balance.
(1) Physical.
(2) Chemical.
(b) Progressive stages in Dental Caries.
Pulpitis — Devitalization — Pericementitis — Counter-irritant —
Poultice — Home treatment and remedies.
(c) Progressive stages in Periclasia.
(d) Two main paths of infection.
(e) Diseases of soft tissues.
132 ORAL HEALTH
LECTURE 6.
PREVENTIVE MEASURES.
Susceptibility and Immunity.
(a) Quality of tooth structure.
Some teeth better calcified and more resistant.
Gradual tempering and aging of teeth, partially accounts for
susceptibility in youth — all osseous structure hardens.
General Health
Sickness.
Period of adolescence and susceptibility.
(b) Mastication.
(c) Diet — most important.
(d) Mouth Toilet.
(1) Tooth Brush.
Size, style, shape of handle, correct use.
(2) Dentifrice.
Powder or Paste.
(3) Tape.
(4) Mouth rinsing.
Water.
Antiseptics — condemn use of strong drugs.
(5) Tongue scraper.
(6) Gum massage.
LECTURE 7.
SCHOOL DENTAL SERVICE.
(a) Dental Laws Governing.
May examine, providing clinic available; and in large cities
Shall examine and give prophylaxis.
Exclusion for lack of treatment.
Always secure parents' consent.
(b) Two plans of organization.
Large central clinic. ^. ;ua.
Individual units in each school. - i
• Advantages and disadvantages of each.
(c) Full time or part time Dental Officers.
Dental compared with .Medical.
Office hours. Full time school hours insufficient.
Advise part time operators — more experienced.
(d) Dental Assistants (Dental Nurse).
(e) Co-operation with regular nurse.
Home and School
(f) Pre-school clinics.
(g) Service available to all children, rich or poor,
(h) Co-operation with school teacher.
Reading, writing, composition, story hour.
Periodical examination and monthly report to parents on oral
cleanliness.
(i) Examination of teeth and charting,
(j) Preventive service in schools.
ORAL HEALTH 133
LECTURE 8.
HOSPITAL DENTAL SERVICE.
(a) Local health centre.
(b) Adult poor, out-patient department.
(c) In-patient service and proper standards oral hygiene as hospital
routine.
(d) Organization of service.
Regular practitioners.
Dental internes.
THE SICK ROOM. . ,
(a) Preparation of patient for general anesthetic and operation.
(b) During pregnancy.
(c) Invalids and convalescents. ^
(d) Children.
(e) Drugs — tonics in capsule or tablet form.
Especially Iron Salts — dilution increases destructive action on teetli
Glass tubes do not protect teeth from drug.
INDUSTRIAL DENTAL CLINICS.
(a) Advantages, both economic and health standpoint.
(b) Regular, systematic examination — Prevention,
(c) Self-supporting through nominal charge each sitting, or
(d) Maintained by employer.
Cementing a Gold Inlay. — The unfavorable results obtained
with dental cements outside the mouth have created the impression
that our cement possesses no great degree of tenacity when used in the
mouth. This is erroneous. The best cements which are balanced for
use in the mouth will give unsatisfactory results when used where
they may dry out, and conversely, the best cements which are cor-
rectly balanced for use in a dry environment, are not the best to use in
the mouth. To sum up: Make an inlay which absolutely fits the
cavity. Do not desiccate the dentin. Retard the setting of the cement.
Mix a large quantity of cement. Just satisfy the chemical affinity.
Do not trap air. Mallet inlay to place. Burnish margins into a
locking embrace. — (Dental Items).
To Replace a Facing. — Use calipers to get the exact size of the
facing in mm. Select a facing the proper shade and cut the pins off
with a separating disk. Cut two vertical grooves on the back of the
facing, and slightly dovetail to slip over pinheads in the bridge. You
can tell when the grooves are deep enough when the pins have disap-
peared in the grinding. As this method requires no drilling in the
solder the lingual surface of the bridge is left smooth to the tongue.
If carefully done the repair cannot be detected. — (Dental Sum-
mary).
The Use of Autogenous Vaccines in Gases of
Focal Dental Infection
T. O. Forsyth, D.M.D.
THE development of the science of immunity is one of the most
interesting chapters in the history of Medicine. It can be traced
back many years before Christ, when at this time it was more
or less of a superstitious means of combating disease.
For instance, we read in the story of Mithridates, the King of
Pontus, that he immunized himself against poison, by drinking the
blood of ducks that had been treated with a corresponding poison.
Hippocrates taught that the factor which causes disease is also
capable of curing it. Edward Jenner was the first man to make any
marked progress in the theory of immunization, when he demonstrated
in a scientific manner that cow-pox conveyed to man protected him
from small-pox.
The next epoch of importance was eighty years later, when
Pasteur made his discoveries in bacteriology and inoculation, and so
it has been a process of evolutionary research down to the present
time when it has become a very important branch of Medicine.
There is still much work to be done along this line, because as yet it
is wholly theoretical, and although in many cases you know that a
certain substance injected into a patient will have a specific effect
on that patient, yet you do not know why or how that effect is
bi ought about. There are many theories regarding this, but it would
be impossible to go into them this evening, with any degree of
thoroughness.
However, before we can speak intelligently upon the use of
vaccines in cases of oral sepsis, it is necessary that we should touch
upon the mechanism of immunity. The question of immunity is,
apart from its practical aspect, intimately connected with problems
of pure theory. It is, however, known that certain bacteria are
capable of producing in the medium in which they are grown certain
poisonous substances which have the effect of paralyzing:, or rendering
less active, the protective mechanism of the body. This substance
is called toxin.
In explaining: the nature of this toxin it is necessary to call your
attention to the process of digestion carried on in unicellular
organisms. In the ameba, when food, in the form of bacteria
or other small parasites, is ingested, vacuoles form, and into these
vacuoles is poured a distinctly acid enzyme, which proceeds to digest
*Read before the "Winnipeg Dental ?5cciety, March 24th. 1922.
ORAL HEALTH 135
the ingested bacteria. It is probable that the toxin of the bacteria
acts in very much the same manner as does this digestive substance
of the ameba, excepting that this enzyme of toxin from the bacteria
is effective only in an alkaline medium. This toxin is the substance
which paralyzes the anti-bacterial mechanism of the host which it
invades.
Certain organisms excrete large amounts of a highly poisonous
toxin. Examples of these are the diphtheria and tetanus bacilli.
Other organisms are called endotoxic, which means that these
poisonous products are not liberated until the organism is destroyed.
This, however, is not true in all cases, as it has been demonstrated
that toxin is present in the media in which certain of these organisms
are grown. Take, for instance, in the case of Streptococcus, when
media in which these organisms have been grown is passed through
a Berkfeld Filter, and is filtered free of these organisms, and this
bacteria-free filtrate is injected into certain animals, a distinct febrile
reaction is set up. 7 his is not due to the protein substance in the
media itself, because control-animals do not react to such injections.
A great deal of work has recently been done on this subject by
Huntoon of Philadelphia, in which it was proved that there is a
certain amount of protective substance excreted by the bacteria
themselves. The production of this substance can be accelerated
by introducing into this medium certain agents which have an inhibi-
tory influence upon these organisms. This inhibitory substance must,
however, be added very slowly, since a sudden change would result
in the destruction of the bacterium.
So far, we have attempted to demonstrate the presence of toxic
substances excreted by bacteria. These toxic substances are manu-
factured by organisms in localized areas, and disseminated through
the body by means of the lymphatic and blood circulation. It is
the dissemination of these toxic substances which gives rise to manifes-
tations of disease in parts of the body other than those infected by
these organisms. It is easily understood, therefore, that organisms
in the localized areas — and here we have particular reference to
those infections which are often seen in the bone immediately
surrounding the apices of infected teeth — are capable of producing
a clinical manifestation so frequently met with in medicine, and,
moreover, are capable of not only transmitting their viruses by this
means, but the bacteria themselves often migrate to ether parts of the
body for which they have an affinity. (Dr. B.'s Pat. Endocarditis.)
It has been pointed out by Colyer, of the Royal Dental Hospital,
of London, that deep-seated infections involving the body of the jaws
are far from being rare instances of this migration of infection.
The foregoing has all been an explanation of the production of
136 ORAL HEALTH
toxin by bacteria. Now let us look upon the human mechanism
of anti-body formation, and the manner in which the body protects
itself against these infections. When the cells of the body become
affected by the products of microbal growth, they immediately, if
not overwhelmed by the toxin, as is shown in the toxemias of
diphtheria and tetanus, produce anti-substances which are called
lysins, agglutinins and precipitins, and antitoxins. These function
as follows: The agglutinins arrest the activity of the organism; the
precipitins cause a massing together into clump formation of the
organism; the lysins then attack it and destroy it by dissolution, or
by their solvent action; this permits the liberation of the endo-toxin.
Thereupon the last reserve is called forth, which is the anti-toxin.
None of these substances are in the body in large quantities normally.
They are all products of stimulation by bacteria, and are extremely
specific in their action. Hence, tetanus antitoxin would not protect
against a toxemia inducted by the diphtheria toxin, and a staphylo-
coccic vaccine would not protect against a streptococcic infection.
Here let us go a little further into the detail concerning the
infections with which we are to deal in this paper. In the strepto-
coccus family alone there has been demonstrated a large number of
specific types. These types are closely inter-related, and all, or
nearly all, are capable of producing infections of more or less severity
m almost any part of the body, but it has been demonstrated that
certain types of these organisms have a selective action upon certain
tissues of the body. For example, we have an organism which, upon
passing through a number of animals, produces in nearly every case
a streptococcus endocarditis. Another organism almost invariably,
when infecting lesions of the skin, produces an erysipelas. We have
only to recall to you the prevalence of streptococcus in the recent
epidemics of so-called influenza, and its selective action upon the
lung tissue.
It is, therefore, most urgent that, in combating a streptococcic
infection by means of vaccine, wherever possible the specific organism
be used, and in a mixed infection all of the organisms, excepting
those which are clearly contaminating, incorporated into the vaccine.
A great deal of theoretical discussion has been aroused recently
on the value of ionization in cases of dental streptococcic infection.
This seems to have its value in so altering the media in which these
organisms live that they cease to proliferate and eventually die.
Since this subject is foreign to the paper we have under discussion
we will go no further into details.
The use of vaccines in the treatment of all sorts and kinds of
infection has certainly its ups and downs — its ups, when prepared
scientifically and administered in a scientific fashion — and its downs
ORAL HEALTH 137
when used by shot-gun methods. Since vaccine therapy is of
undoubted scientific value, and further, since it is based on almost
pure theory, it is necessary, in order to obtain the best results, to
follow this theory logically. If one were to introduce into the body
of a patient, already suffering from a slow toxemia, a huge dose
of killed bacteria, which are easily soluble by the lysins already
manufactured in response to the infection then present, it would have
a negative effect rather than a positive one. This negative effect
would be produced by overwhelming the cells with endotoxin, and
would tend to lower the resistance rather than build it up. If,
however, the dose was gradual, amounting to only that which the
organism could easily take care of, and gradually increased until
the immunity of the patient was at its maximum, a decidedly
beneficial result would be obtained.
Now, the reason for using vaccine is to assist the body in combating
toxin or poisons caused by bacterial invasions. Now then, when
you liberate more freely this toxin by curetting an abscess, you
throw into the body the poison or bacteria in its highest state of
virulency. In this high state of virulency, if the infection is very
great, it will render less active or paralyze the protective mechanism
of the blood. If, on the other hand, you kill and attenuate these
organisms, you render them more easily absorbed and ingested by
the protective body cells. Therefore, you increase the protective
mechanism by stimulating a specific leucocytosis without an over-
stimulation which results in paralysis.
Another reason of vaccine therapy is that you can regulate your
dose and can extend it over a period of time. Neither of these
points can be accomplished by letting the infection freely into the
blood stream by curettement.
Now, the question arises, "When should vaccine be used?"
This has to be decided by your own judgment entirely. As I have
said before, vaccine therapy is largely theoretical and therefore no
hard and fast rules can be laid down for its use. There are many
cases where it will fail to bring about any desired result, but we do
get a decided beneficial reaction in many cases, and my experience
has been that it lessens the liability of referred infections such as
arthritis or neuritis from reoccurring.
Before giving the history of a few cases I might say that only
cases which have been treated for some time, are of value, as treat-
ments are of no use if you get results for a short time and then have
a re-occurrence of the systemic symptoms the same as before. There-
fore, the cases which I will cite here are of one year's standing and
over:
L Mr. M., aged 31; very painful case of rheumatism; could
138 ORAL HEALTH
not turn over in bed. Lower bicuspid was removed and curetted.
Autogenous vaccine was given six days after. In two weeks he
was about his work as usual. There has not been a re-occurrence.
This was two years ago.
2. Mr. K., aged 30; pain in occipital region; general run down
condition. Very little rarefication about the apices of three treated
teeth. Upon removing one it was found to have a marked long
chain streptococcus infection of the haemolyticus type. Other treated
teeth removed and vaccine prepared and administered. In one
month he noted a change in his general condition. He was able
to do more work without being tired, also the pain had left his head
entirely. Also no re-occurrence.
3. Mr. W., Bank Manager, aged 38; complained of a tired
feelmg all the time; every afternoon he would get a rise of tempera-
ture from 1 to 21/2 degrees. Only source of infection about his mouth
was a cuspid tooth which had been resected two years previously.
This was removed and cultured; mixed infection of staph and strept'
Marked improvement noted in a short time after administration of
vaccme. He is now healthy and has been so for a period of sixteen
months.
4. Mrs. W., aged 30; severe muscular pains; had every conceiv-
able treatment without avail; two lower centrals were slightly
mfected and were removed as a last resort. A culture showed a
streptococcus infection and a vaccine prepared and administered.
1 his patient has been absolutely free from pain for eighteen months.
When these cases were done I did not have any blood counts
made, and nothing was done in order to build up statistics of any
value, other than whether or not the patient was better.
At the present time I am having blood examinations made of ail
cases where I can obtain the patient's consent. In this way I can
build up some valuable information regarding the changes takin;^
place in the blood after the removal of infectious foci, and also after
the administration of vaccine.
At present I have only one case of sufficient age to report on
1 his is a Mr. L., aged 35. He was troubled with gall bladder
which was removed at Mayo's two years ago. He did not feel
any better and returned there again for examination, when they
recommended that his teeth be removed. When he reported to me his
leucocyte count was over eleven thousand. I removed two of these
teeth at a time until they were all out. He had a marked strepto-
coccus haemolyticus infection. The period of extraction was approxi-
mately one month. Immediately after his blood count was down
to mne thousand two hundred. Vaccine was administered and his
leucocyte count was increased and maintained for a period of six
ORAL HEALTH 139
weeks. During this time he did not feel any change. This probably
was due to the reaction of the vaccine. However, when the vaccine
was discontinued he immediately began to improve. In a short time
his blood count was slightly below nine thousand. He continued
improving in health and at present is feeling better than he has for
years. The point I wish to make here is, that by introducing a
vaccine into the body over a period of time, you keep a continual
stimulation of the protective body mechanism in action until all the
bacterial toxins are destroyed. If, on the other hand, you did not use
a vaccine the stimulation of the protective body cells would be of
a limited short duration.
I would like at this time to be permitted to express my appreciation
of the help in my small research work, by the Winnipeg Diagnostic
Laboratory. Mr. Sperry, who is their bacteriologist, has been more
than generous with his time and work in aiding me, by the way of
making blood counts, haemoglobin contents, differential counts,
cultures, etc. He has gone as far as to offer his services in the way
of blood examination, to the men of our profession who are sufficiently
interested in this subject to obtain the complete history of the cases
and to follow them up; this service is offered free of charge.
I hope a good number of our men will take advantage of this,
as it is the number of cases that count in research work. One case,
or fifty cases, are of no value, but if several hundred cases were
compared, you would have material on which to base some sound
conclusion. I don't know of any other way in which to obtain this
information other than doing it yourself. In the literature on this
subject you will find so many differences of opinion that it is hard
to draw any conclusions.
There is just one more thing I wish to say before closing; it may
be somewhat foreign to this paper, but is, I think, closely enough
related to mention. That is this: "It is not the size of the rarefication
about the apex of a tooth that denotes the amount of infection, but
the kind and virulency of that infection.**
A Good Silex Investment. — A good smooth investment
material for inlay work and the coating of any wax pattern may be
made as follows : Take three pounds of the best powdered silex you
can obtain, one pound of Kerr*s white model plaster and four ounces
of Venetian Red, mix them thoroughly by sifting through a flour
sifter. When the color has become uniform, the mix will be satisfac-
tory.— (F. W. f ., Pacific Dental Gazette.)
Iodine Stains. — Fresh stains produced by tincture of iodine can
be immediately removed from the hands by applying to the stained
area a strong solution of ordinary washing soda. — (British Dental
Journal).
n
THE COMPENDIUM
This Department is Edited by
THOMAS COWLING, D.D.S., Toronto
A SYNOPSIS OF CURRENT LITERATURE RELATING
TO THE SCIENCE AND PRACTICE OF DENTISTRY
n
College Training for College Professors.
A GREAT deal of criticism has been levelled at our system of
educating students and sometimes we are accused of giving
them "too liberal" an education. There are many critics w^ho
think that dentistry should be restricted absolutely to the mechanical
part of the v^^ork. To those among us w^ho hold such views, the
following editorial comment appearing in a recent issue of "The
Etude," a musical journal, will be followed with some interest, if not
with approval. The editor's views are expressed in part as follows:
"Some of the most amazingly uninformed men and women we have
ever known have been graduates of colleges of high standing. Every
once in a while the Editor receives a letter from a college graduate
showing the chirography, the mentality, the vacuity, and the inanity
of a stupid youth in his early teens. On the other hand many of the
best educated men we have ever met never had more than a common
school training at the start. Lt. Comm. John Philip Sousa, erudite
by dint of hard self-study, is one evidence of this. Few college profes-
sors are in the same class with him in the matter of general cultural
information. Dr. Russell P. Conwell, who has founded a University,
and educated thousands of young men and young women out of his
own earnings as a pastor and a lecturer, recently stated that he had
been investigating the cases of over four hundred prominent American
leaders in many walks of life who had never attended college, — yet
who were really well educated men.
"Notwithstanding all this, anyone with vision can see that the time
is coming in America when any man who does not possess a fine
academic high school and college training, will be at a disadvantage
in competition with his equally gifted but adequately trained rival.
"Take the case of the professional musician who desires to teach in
a college or university of standing. There are now numerous
musicians in such schools who have had scant collegiate or academic
advantages. They have had a fine conservatory training and are able
musicians. However this may be, it is impossible for the other mem-
bers of the faculty of a college not to look with distrust upon the man
ORAL HEALTH Ml
who has not had an academic training — until they become acquainted
with the individual and are assured that he has, by his own study,
acquired an equivalent.
"This is one of the main reasons why music as a collegiate subject
in many schools received a cold shoulder in bygone days. Of course
in some schools there was unquestioned down-right jealousy of the
music department because it produced such a large revenue.
"Sir Robert P. Stewart (1825-1894), Professor of Music at
Dublin University, was the first to require that the examinations for
musical degrees also include the so-called 'literary subjects.' This
example was followed at Cambridge and the musical tendencies of
the future will unquestionably be toward the higher general education
of musicians.*'
This comment of The Etude is of particular interest to us just now
in view of the controversy being waged both in the Medical and
Dental journals, as well as in the newspapers, concerning this
tendency towards a more liberal education for professional men.
False Ankylosis Due to Deciduous Tooth in Sinus.
A CASE of unusual interest is reported by Dr. H. F. Chaiken,
of Reading, Pa., in the December issue of Journal of
Orthodontia. The particulars are as follows: A young lady
school teacher, age twenty-four, was unable to open her mouth and
suffered greatly with pain in the temporal region. Examination
showed an impacted third molar. This was looked upon as the cause
of the trouble, and it was extracted. After this she could open her
mouth more readily and her complete recovery was looked for. How-
ever, in two weeks' time the trouble recurred in an aggravated form.
It was impossible to insert even a spatula between the teeth.
An X-Ray examination was made on a large X-Ray plate, and
there was seen to be a foreign body in the sinus. It resembled a
tooth. Under a general anesthetic, the maxillary sinus was opened
up and the crown of a deciduous molar removed. There was also a
great amount of necrotic bone. After curetting and washing with a
normal salt solution, the sinus was closed. Two days later the pain
had disappeared and the patient was able to open her mouth without
feeling any difficulty. It is difficult to understand how the tooth got
into the sinus.
NiGRiTiEs Linguae.
AN instance of the occurrence of this unusual disease is given in
The British Journal of Dental Science, November, 1921, being
reported by Dr. Albray of Newark, N. J. The patient, a
man, aged 35, complained of soreness of his tongue and gums. The
latter condition was cured by removing tartar. The tongue showed a
142 ORAL HEALTH
pyramidal dark brown and black discoloration extending half way
from the tip back to the base in the median line. The papillae were
elongated. The tongue was slightly swollen, and pigmentation in
groups of small spots was seen on its under surface. There was no
pain. Copper sulphate (10 per cent.) was used. In two days the
entire dorsum linguae was covered with dark brown or black fur. The
patient described the aspect of his tongue as being Hke "a forest of
Christmas trees." The papillae were greatly elongated, some as
much as 5mm. These could be removed by tweezers without pain.
The condition was practically cured in three weeks. The cases of
nigritiae linguae which have been recorded differ in detail and often
persist without, however, giving rise to inconvenience. In the above
case there was malodorous breath indicating some stomatitis, but this
is not always present. Nigrities linguae is sometimes confused with
the condition known as melanoglossia. This disease occurs in asthenic
aged persons or in syphilitics and appears to follow chronic irritation
of the tongue which sets up glossitis. Then follow infiltration and
epithelial thickeining, hyperkeratosis of the filiform papillae and
pigmentation.
Studies in Root Canal Sterilization.
DR. J. A. MARSHALL, of San Francisco, in the Journal of the
National Dental Association, July, 1921, reports some findings
of his researches in regard to the correlation of laboratory study
of root-canal sterilization with clinical practice. Solutions of crystal
violet and brilliant green were used to illustrate the degree of penetra-
tion of antiseptics into dentin. In many cases the dye penetrated
through all the dentin substance to the dentino-cemental junction, but
in no case was it possible to demonstrate the penetration into the
cementum.
In comparing the action of Howe's silver nitrate treatment with
that of the dyes selected, the degree of penetration was shown to be
about equal. Varnishes and wax applied to the coronal portion of the
tooth aids in preventing the penetration of the stain. In view of the
fact that there is no demonstrated connection between the dentin and
the cementum, except through the apical foramen, antiseptics applied
to the walls of the root-canal remain in the tissue.
Deteriorating Dental Goods.
DR. H. HAYES-NORMAN, of Adelaide, Australia, writing
in The Dental Science Journal, deplores the fact that the
present-day amalgam alloys are not meeting the requirements
of dentistry as well as many of those made about fifty years ago. He
says: "Amalgams have for many years been deteriorating both in per-
manence of form and color. Fifty years ago there was an American
alloy for amalgam work which remained a pale grey color, and was
ORAL HEALTH 143
very little inclined to shrinkage. Massive contour fillings could be
built with it, even to the extent of an imitation crown of a bicuspid
or a molar, without the aid of a matrix; hence it is apparent that it
was very plastic. Unfortunately the manufacturer soon died and the
formula was lost. Vigilance is the only safeguard against the con-
stant deterioration of manufacturers' goods, not only in the case of
amalgam alloys, but in almost every other product."
Root Treatment.
THE use of a preparation containing boro-glyceride in the treat-
ment of putrescent roots is advocated by Dr. Reginald S.
Boys, of Toowoomba, Queensland. A complete report of his
paper appears in The Dental Science Journal of Nov., 1921.
In support of this method he says : "The glycerine tends to find its
way into all the tubules of the denture, and helps in a more complete
sterilization of the tooth substance. Glycerine is known to have an
inhibitory action on most organisms — witness its use as a vehicle for
small-pox vaccine to destroy other possible infective organisms. For
root treatments it may be combined with eugenol-creosote or cinna-
mon. It is better to take a slight risk of staining whilst otherwise
dealing with the tooth in a way that does not cause chronic apical
trouble than to use, say, formalin preparations, which, while they do
not stain, are apt to produce such troubles after treatment.
The method of procedure is : ( 1 ) open up and remove as much as
possible of the septic dentine and pulp; then apply a dressing of
boro-glyceride and cinnamon. (2) Two days afterwards remove
balance of root contents; treat canals with hydrogen peroxide, and
re-dress with the boro-glyceride treatment. (3) Repeat, if necessary,
and, later, when the root appears wholesome, fill it, using the follow-
ing mixtures:
Boro-glyceride, q. s.
Thymol 1 — ,,
Precip. Calcium Phosphate r
Iodoform J ^"^"'"y;
Then insert gutta percha points to fill canal tightly, moistening with
chloroform plus resin solution.
Dirty Dishes
If Mother said, I'll only wash the dishes once a day,
I'll let the dirty dishes stand and let the silver stay,
I wonder how you'd feel at noon and how you'd feel at night
I don't believe clean boys and girls would want to eat a bite.
If dirty dishes are so bad, how much worse dirty teeth,
That you would chew your food with them is really past belief,
Because the dirt from off those teeth, if carried down below.
Will start disease, do dreadful things. I want you all to know.
— Dora L. Cameron
West China Union University and Dental
College
Ashley W. Lindsay, D.D.S.
WEST CHINA consists of three provinces — Szechuan, Kwei
Cheo, Yunan. These provinces contain about 100,000,000
people. Chengtu, the city, in which the Union Uni-
versity is situated, is the capital of Szechuan, the largest,
wealthiest and most populous province of China. The city has long
been recognized as the educational and political headquarters of
the West of China. Szechuan is isolated from East and Central
China through the lack of easy communications. There are no
railroads entering the province. The only entrances into the province
are over a mountain pass, to travel by which it is necessary to be
conveyed by sedan chair, a many weeks' journey from Peking, and
by the River Yangtsi, up which now are running during the summer
months (high water) small steamers. Travel is very expensive and
prohibitive to students.
University a Union.
The Union University is both inter-denominational and interna-
tional, being maintained by a union of the American Baptist Foreign
Mission Society, the Church Missionary Society of England, the
Friends' Foreign Mission Association of Great Britain and Ireland,
the General Board of Missions of the Methodist Church, Canada,
and the Board of Foreign Missions of the Methodist Church, U.S.A.
General Information.
The West China Union University has the only Dental College
teaching University grade work in China. The Dental Faculty
was inaugurated in December, 1919. The courses are taught in
the Chinese language. One student has already been graduated in
Dentistry, having secured his first year's training in Medicine.
There are now four Canadian and one American Dentist work-
ing full timj under the missions contributing to the University.
The General Board of Missions of the Methodist Church of
Canada have a Dental Department which was started in the year
1907 and this Department has a plant which can care for the
laboratory and clinical instruction at present.
The Needs for the Future.
All the factors are present to initiate a great College of Dentistry
for the West of China, but to carry out a plan worthy of the possi-
bilities and need, large funds must be supplied.
ORAL HEALTH 145
The Rockefeller Foundation in taking up with the Medical
School of Union Mission work in the North of China, is giving
East China a wonderful object lesson in Medical Education and
at the same time doing one of the most useful pieces of social and
Christian service for the Chinese people. Dentistry offers the same
possibilities for a large constructive and forward policy. All that
is lacking is money and men. With our present shortage of money in
all our Mission bodies, we can hope for but small increases in staff
in tiie near future.
We need, to place our Faculty of Dentistry in position to render
its best service, adequate building and equipment with several
additional members on the staff.
With our present outlook, in ten years we can expect perhaps
twenty-iive graduates in Dentistry. With proper assistance we
could have many more and a wide prestige in Dental Education
and the foundation of a worthy dental profession.
Why Not Give a Lecture?
THE necessity of passing on to the public the salient facts about
dentistry, dental treatment, and mouth hygiene has been for
years a topic of conversation in professional circles.
It is perhaps less frequently a matter of action.
Certain concrete aspects of this all-important question may be
considered in the following terms:
Firstly, do the members of the general public need information
about dentistry and oral hygiene? They most certainly do.
Secondly, are they receptive towards such information?
There is no need to remind our readers that educational advance-
ment is always a slow process. For years the population manifested
extreme indifference in regard to general education, whereas to-day
even the poorer classes have learnt the value of knowledge in the
interests of their own advancement, and put themselves in the way
of obtaining it.
Similarly there is an ever-growing body of the people keenly in-
terested in dentistry, particularly in relation to their personal welfare,
ready to appreciate and act on all the vital information presented
to them in this connection. Not only must these people have their
desire for technical knowledge satisfied; their number must be con-
siderably increased in the interests of the whole community.
Who should supply this information? The dentists, naturally.
Thev alone have the necessary knowledge, and, after all, it is their
field.
How can this information be supplied? There are numerous
146 ORAL HEALTH
methods, some of which we shall consider on other occasions. Here
we are concerned with the possibilities of the lecture. In every
community there are endless opportunities for every dentist at some
time to give a talk on dentistry to the general public. Many refrain
from doing so in the idea that it is beyond them. But we would
point out that every dentist gives educational explanations of tech-
nical matters to his private patients and that the same facts would
serve equally well in most cases for a wider audience.
Salient facts, stripped of technicalities, and expressed in the sim-
plest language possible, are the secret of a good "lay lecture.**
If ^ou can't speak for an hour or more to an audience of hundreds
in a big centre, why not do the work that lies nearest at hand in
your own district and give a short talk to a small society? Every
little helps.
Oral Topics will publish all the matter obtainable to help in
this work, and we extend a cordial invitation to all dentists who
have given public lectures to send us their manuscripts for publica-
tion, in the idea of helping their colleagues who may desire to give
similar lectures.
To our readers we would say — keep your copies of this journal.
You will gather much useful material for your propaganda work
by so doing. — Oral Topics.
The March Winds
MARCH is a great bluffer, is it not? Its winds howl, it makes
loud pretence of the terrible things it is going to do, and it
does its best to prove to us that winter isn't over and isn't
going to be. But all the while the pussywillows are bursting, the
advance guards of the great bird migration are with us, and the
hylas are getting ready for their spring song. We are not deceived
by all the bluster; we know that March isn't as bad as it looks
and sounds; we know that it couldn't stop the coming of spring
even if it tried. Life also looks like a great bluff and bluster at
times, does it not? It makes great pretence of the terrible things
it is going to do to us, and its winds sometimes are rather chill. But
its heart is good and kind, and if we can only see beneath its oft-
forbidding surface, it promises great things for the days to come. —
Guardian.
ORAL HEALTH
EDITOR:
WALLACE SECCOMBE, D. D.S., F.A.C.D., Toronto, Ont.
CONTRIBUTING EDITORS:
C. N. JOHNSON, M.A., D.D.S.. F.A.C.D., Chicago.
RICHARD G. Mclaughlin, D.D.S., Toronto.
W. E. CUMMER, D.D.S., Toronto.
J. WRIGHT BEACH, D.D.S., Buffalo, N.Y.
Entered as Second-class Matter at the Post Office, Toronto.
Subscription Price, Canada and United States, two dollars per annum;
elsewhere three dollars. Single Copies, 25c.
Original Communications, Book Reviews, Exchanges, Society Reports, Personal Items, and other
Correspondence should be addressed to the Editor, Oral Health, 102 Wells Hill Ave., Toronto, Canada.
Subscriptions and all business Communications should be addressed to The Publishers Oral Health
Royal Bank Building, 269 College St., Toronto, Canada.
Vol. XII.
TORONTO, APRIL, 1922
No. 4
H
EOITOR.IAIJ
The Dental Profession United
H
THE Dentists of Canada have much to learn from the dental
profession of the United States in the matter of organization.
The National Dental Association is a representative, central,
administrative body, the membership of w^hich is composed of practi-
tioners in good standing in the several State Dental Societies.
Membership in a State Society, in turn, involves membership in a
Local Dental Society. An organization of this character exerts a
unifying force throughout the entire profession and enables the
National body to speak vs^ith an authoritative voice upon all matters
pertaining to the w^elfare of the profession.
The Dental practitioners of Canada have had to face the serious
obstacles of wide geographical location and differences in language,
in maintaining their national professional affiliations. The National
Dental Convention is held from year to year in different sections of
the United States, owning to the difficulty of securing a representative
gathering of dentists from the more remote points. This difficulty,
being greatly magnified in Canada, places the greater obligation upon
the members to make every reasonable effort to attend the meetings
of the Canadian Dental Association.
"United we stand — Divided we fall*' is a worthy sentiment, the
attainment of which is to be encouraged and striven for. Naturally
there are honest differences of opinion, but in a democratic associa-
148 ORAL HEALTH
tion, these are always submerged in the will of the majority, the
larger issues absorbing so much time and energy that not a vestige
of effort remains for the furtherance of the smaller, personal, or purely
selfish enterprises.
This spirit is manifesting itself in the city of Toronto, as elsewhere,
in the appointement of a Committee to enlarge the local organization
and plan a programme that will meet every requirement of the profes-
sion. It is intended to organize study groups and classes as units of
a larger body or Academy. The suggestion has been made that the
Academy, at as early a date as possible, arrange for permanent
quarters where library, secretarial, and other facilities will be readily
available to the members.
Throughout Canada there is a definite movement toward the
development of local study groups among the dentists of the
Dominion. The linking up of these groups through Local, Provin-
cial and National Associations, will utilize the potential forces of the
profession for the good of all and result in greatly improved dental
service for the Canadian people.
Dominion of Canada Income Tax Return
RETURNS for income for the year ending 31st December,
1921, must be filed in duplicate with the Local Inspector of
Taxation on or before 30th April, 1922.
In the case of dental practitioners, cash receipts for the year are
entered upon the "income side,'* while upon the "expenditure side"
all legitimate expenses, including the following amounts, should be
tabulated: Rent (give name and address of landlord); telephone,
light, janitor service; dental supplies, drugs; laundry, stationery
supplies; salaries, including laboratory expenses or dental laboratory
charges; business tax, if any; repairs to equipment; fire insurance
(equipment), malpractice insurance, interest paid on borrowed
money (name person, amount and rate) ; depreciation on library,
furniture and equipment, 10 per cent, on cost.
When Finances Permit
PUBLIC-SPIRITED generosity is a most admirable sentiment
which often exists in unexpected quarters. Dentistry is the
most powerful single factor for the welfare of any community.
Dentistry should let the public-spirited men know what they can
do for humanity when finances permit. ^Ora/ Topics.
go
iJ!
m
m=
OPAL HEALTA
A JOURNAL THAT STANDS FOR THE ''OUNCE OF
PREVENTION," AS WELL AS THE ♦'POUND OF CURE''
IE
m
VOL. 12
TORONTO. MAY, 1922
No. 5
An Appreciation, Dr. George H. Wilson,
Cleveland, Ohio.
By W. E. Cummer, Toronto.
rHE sad news of the unexpected death of Dr. George H. Wilson,
of Cleveland, one of the best known writers and teachers on
the American continent, reached here to-day.
Dr. Wilson was obliged recently to undergo a surgical operation,
and, in spite of his advancing years, was progressing favorably, when
quite unexpectedly the end came, April the 12th, 1922, at his home
in Cleveland.
130 ORAL HEALTH
As Dean of living Prosthetic writers and teachers, his place will
be indeed difficult to fill. He has appeared before numberless society
meetings and classes in all parts of the continent, and has been the
recipient of many honors. Canadian dentistry will long remember
him as having appeared before the Canadian, Maritime Provinces,
Ontario, Toronto, and other Canadian Dental Associations.
For many years he was Professor of Prosthetic Dentistry in the
Western Reserve University at Cleveland and Associate Professor
in University of Southern California. He was Associate Editor of the
"Dentists' Magazine," during the period of its existence, and for over
forty years has been the contributor of a very large number of articles
in current Dental Literature, bearing the stamp of his originality, pro-
found study, and tireless effort. In addition to this. Dr. Wilson con-
ducted a busy practice, confined to denture work, in Cleveland, Ohio,
and latterly also in Los Angeles, California.
Dr. Wilson's life work, however, was crystallized in his well known
and widely-used text book, "Dental Prosthetics," known probably by
the large majority of dentists, both graduate and undergraduate. In
this fine work, now in its fourth edition. Dr. Wilson gave the best of
his latter years of life, and in this has given to the dental profession
probably his most enduring monument.
It is with an irreparable sense of loss that the writer seeks to pay a
tribute of affectionate gratitude to his memory. His life was a con-
stant mirror of finest qualities with which noble manhood is endowed,
and but to know him was to love him. Never has the writer remem-
bered, over a long and close association, a harsh word having passed
his lips, and blended with enormous capacity for close study, investi-
gation, and literary and pedagogic work was an intense love for all
that was beautiful, noble, and true. Dr. Wilson was possessed of a
ceaseless desire to give his very best to his fellow-dentists and to those
whom they serve.
April 19th, 1922. W. E. C.
The Nature and Manipulation of Dental Amal-
gams and a Standardized Amalgam Technic*
Robert K. Brown, D.D.S., Ann Arbor.
AN amalgam is a combination of two or more metals, one of which
is mercury. An alloy is a union of two or more metals. Hence
an amalgam is an alloy containing mercury.
The production of a dental amalgam depends on the property of
mercury of dissolving most other metals to the point of saturation,
forming alloys that set or harden when allowed to stand for a time.
♦Michigan State Dental Society Bulletin.
ORAL HEALTH 151
The resulting amalgam is probably due to the formation of a chemical
compound between mercury and one or more of the constituent
metals, and also probably from a mechanical mixture to some extent.
Dental amalgams are divided into two classes, viz:
Class I. High percentage silver alloys whose general formulae are:
Silver 65-68
Tin 26-28
Copper 3-5
Zinc V>-2
c
c
0
This class of alloys is free from decrease in volume, stronger, more
stable in form, works harder and sets quicker than those in Class II.
Class. II. Low percentage silver alloys whose general formulae
are:
Silver 43-48%
Tin 48-58%
Zinc 1-2%
These alloys are weaker, lighter in color, easily amalgamated and
slower setting than those in Class I.
The high silver alloys reach their maximum strength in about ten
days and remain stationary. The low silver alloys reach their peak
in five days, although it gradually increases with age.
The high silver alloys are about 75% stronger than the low silver,
and due to their greater affinity for mercury for the same weight of
alloy produce fillings about twenty-five percent greater in volume
than the low silver alloys. This is to be considered when purchasing
an alloy from an economical standpoint.
Solutions and mixtures generally possess the properties of their
constituents and this is true of amalgams to a great extent. Silver
and tin being the basis of the alloy we would expect their properties
to predominate. Zinc and copper are added as they possess certain
qualities which are desirable to use as modifiers.
We will briefly enumerate the different properties possessed by the
metals used in amalgams generally.
Properties of Silver.
1 . It unites with mercury in all proportions.
2. It controls the setting of the mass.
3. It increases volume change.
4. It increases edge strength.
5. It lessens flow.
6. It tarnishes in the mouth.
^^2 ORAL HEALTH
Properties of Tin.
1. It unites with mercury in all proportions at all temperatures.
2. It forms a weak crystalline compound.
3. It retards setting.
4. It decreases in volume.
5. It increases the flow.
6. It imparts plasticity to the mass.
It IS seen that silver and tin are diametrically opposed in a great
many of their properties and are essential to an amalgam if propor-
tioned correctly.
Properties of Copper.
1 . It unites with mercury with difficulty at ordinary temperatures.
2. A definite proportion hastens setting.
3. It increases edge strength.
4. It lessens flow.
5. It does not change in volume or tarnish in the mouth.
Properties of Zinc.
1. It unites with mercury easily and in definite proportions.
2. It increases volume.
3. It hastens setting.
4. .It increases edge strength.
5. It lessens flow, improves the color and imparts smoothness to
the mix.
Gold, as far as present research has developed, imparts no desirable
qualities and several undesirable ones, such as springiness when
packing and toughness when used in an alloy.
It is possible some properties of gold may later be discovered
making it a more desirable and valuable addition.
Certain points controlHng the behavior of alloys other than
amalgam are well known to metallurgists and these also control the
behavior of an amalgam. These are packing or casting pressure,
packing time, trituration or mixing time, size of the alloy used the
temperature at which amalgam is kept, its annealing and its age
It has been observed that there is a contraction immediately after
the combination of alloy and mercury in the mass, then a slow expan-
sion 1 his IS followed by a slower contraction bringing the volume
back to approximately that at which the alloy was first made, pro-
vided the alloy is of high percentage silver class and properly made
However, pressure in packing will modify this, greatly due to
increase in action between the mercury and the alloy for combining
substances brought into more intimate contact speed the reaction A
continual pressure will also result in a similar condition.
Trituration, or mixing of mercury and alloy, has to do with the
ORAL HEALTH 153
contact of the alloy and mercury and will accelerate the reaction,
although the ratio of alloy and mercury used is a great factor and
must be considered closely with it. Varying percentages of alloy and
mercury are found to effect an amalgam's behavior very greatly if not
properly controlled.
The finer the alloy particles the more acceleration there is to the
reaction and the earlier the appearance of characteristic features.
The question of temperature is not under the control of the dentist
and though important, cannot be considered.
Every day in our practice we see constantly before us the result
of the phenomena of contraction and expansion in alloys. This accom-
panies the setting of amalgam. The variance in volume change is
under the control of the manufacturer to quite an extent. He can
modify it by his composition of the alloy, or its annealing. As a
result, the manufacturers now produce amalgams from a fixed
formula as they can follow a definite technic in production and
secure as pure raw material, that is, containing the same percentages
of impurities in different batches, as they wish. This was impossible a
few years ago.
In the annealing of an alloy, temperature is the main factor. The
amount of temperature necessary to anneal an alloy varies with
different alloys. 1 20 degrees F. for two to seven days will generally
do it, or the alloy may be suspended in a test tube in boiling water
(212 degrees F) for twenty minutes. Annealing affects the strength,
volume change, rate of setting and the percentage of mercury
necessary to make a plastic mass in an amalgam.
This is used as a trade-getter by the manufacturer, for by his various
methods of annealing or not annealing at all, he produces his slow,
medium and quick setting alloys.
Low temperature and a longer time bring about a more complete
annealing due to a restoration of the molecules of the alloy to their
original position.
As we stated, annealing seems to increase the strength of high
silver alloys up to a certain point. Manufacturers now anneal their
product to produce the desired properties after they have annealed
them. Summarizing the result of annealing an alloy we may say it
affects the volume change, reducing expansion in those that expand,
and increasing contraction in those that contract. It increases the
strength of the high silver alloys, shows the rate of setting and requires
less mercury to amalgamate.
The strength of amalgams is considered in regard to their crushing
resistance and their resistance to flow. Crushing resistance is the
property of an alloy to resist force without fracturing. It is studied
as the properties of the metals used to form the alloys individually,
and the properties of the amalgam mass.
154 ORAL HEALTH
Copper and tin give strength, while tin decreases it and zinc gives
strength in a relation between that of copper and silver. Hence the
composition of the alloy, then the process of annealing, chilling and
alloying are important factors in measuring its efficiency. An amal-
gam's strength will be increased with a use of greater packing
pressure.
The temperature of an amalgam when subjected to stress has a
marked influence on its ability to resist it. This is due to the fact that
the alloy is worked in the cold state and decreases in strength with
a rise in temperature more markedly than an alloy that has been cast
and allowed to cool.
The alloy must have been triturated three to five minutes depending
on the speed of the operator, remembering that if the maximum time
is used, the packing must be done quickly. Enough mercury must
always be used to react fully with the alloy. Too little mercury will
give a weak mass as some alloy will not be dissolved in the mercury.
An amalgam's strength depends also on the age of the filling. For
the low packing pressures we use in the more inaccessible points in
the mouth, a greater time, say three or four months, should elapse
before the maximum strength has developed in the filling.
A freshly cut alloy will not allow of a complete union of alloy and
mercury on account of the rapidity of the reaction. Hence proper
annealing will give proper time to triturate and increase the product's
strength even in a freshly cut alloy.
Flow is the property of an alloy to resist force without change in
shape. Tin has the property of continued flow under pressure, while
silver and copper will flow and stop until a greater pressure is applied.
Flow is also modified by the percentage of mercury in the amalgam,
its manner of trituration, the condition of the cut alloy, and the manip-
ulation of the mass.
All washing or annealing of alloys should be left to the manu-
facturer unless the alloy has been contaminated. To wash an alloy
small quantities of hydrochloric acid or alcohol are used.
Amalgam is placed near gold in its thermal conductivity. It is
insoluble in the mouth unless having a high copper content. Copper
and tin seem to give them some antiseptic properties as we can all
attest.
An operator should buy high silver alloys and only from a reput-
able manufacturer. Filings are the best form to use. The slow
setting or the annealed form is bought if the manufacturer offers a
quick and slow setting form.
The essentials for a standardized amalgam technic may be listed
as follows:
1 . Correct cavity preparation.
2. The use of a reputable high silver alloy.
ORAL HEALTH 155
3. The adaptation of a well made matrix if the cavity does not
possess four walls.
4. The use of the rubber dam where possible.
5. Correct trituration of the mass.
6. Correct instrumentation and condensation of the amalgam.
7. The restoration of proper contour, contact and a high polish
to the restoration being made.
Going briefly into detail, cavities are prepared essentially as those
for foil, except that the cavo-surface angles should be made wider to
increase the edge strength of the filling, all connections between the
occlusal and any of the four walls of the tooth should be as wide as
possible to protect against flow, enamel walls should be bevelled the
depth of the enamel and all possible means of retention utilized.
We have considered the alloy to be used previously.
A matrix for each individual case in hand should be made. We
use 36 gauge sheet copper. This is annealed by heating to a red heat
over a flame and plunged into water, repeating this two or three
times. The metal is now sterilized as well as workable. This band is
fitted to the tooth, in mesio-occlusal or disto-occlusal fillings it does
not have the ends soldered to each other giving us a complete matrix
around the tooth, but is used as it is, cutting it about one-eighth of
an inch beyond the cavity margin. It is now contoured to the case,
being sure it covers the cervical floor. It is marked on the inside
where the contact should be if the contact is to be restored and a hole
is drilled through the band with a No. 4 round bur. Thus when the
band is held in position on the tooth by ligatures, the amalgam will
be forced through this hole and intimate contact with the adjacent
tooth secured. In order not to have this contact present a duplication
of this hole, it is thinned away around all its edges on the inner or
cavity side with a small Miller stone until the band slopes into the
contact hole, and not with a sharp angle as would otherwise be.
At each cervical end the band is turned up at the corner to engage
the ligature we use. This is waxed ligature thread. A pair of shears
are used to cut from the contact hole we have made in the band to its
cervical edge. Thus when the amalgam has set sufficiently, we cut
the ligature from the matrix and pull each end up and around the
contact we have established, and do not disturb i, as the slit we made
weakened the matrix to this point and allows of its easy removal.
Use a double ligature and a surgeon's knot to hold matrix in
position and place the matrix in disto and mesio-occlusal cavities after
the dam is applied.
Cotton, spunk or orangewood wedges may be used at the cervical
to hold the matrix close to the cervical floor. They are placed between
the adjacent tooth and matrix in the embrasure and sufficient pres-
sure applied to bring the matrix close to the cervical floor of the
156 ORAL HEALTH
cavity. This prevents an overhanging cervical on the filling with its
very undesirable sequela.
When a restoration is made involving nearly all or the greater
of the coronal part of the tooth, a circular copper band is made by
soldering the ends together to a previous measurement of the tooth
by means of a dentimeter. This band is contoured so all cervical
margins are covered, the contact points are marked by a burnisher
in their proper location on the inner surface of the band and cut with
a bur. These are slit to the gingival as before. The bands are
trimmed so the patient closes his mouth normally as this matrix must
stay in position for twenty-four hours at least. Lugs are turned up
in the cervical area of the band at points where cavity margins are
not present, these hold the ligature down in place. This band is
li gated as the other, the cervical floor burnished in and held by suitable
means, then the dam is applied.
Have all condensing instruments at hand, put the alloy and
mercury, correctly proportioned, in a motar and triturate for about
two or three minutes. The mass is then removed to the hand, the
excess mercury removed during hand manipulation until the mass
can be rolled into a rope without breaking and will show thumb
markings plainly. Excess mercury should not be squeezed out in
muslin or chamois as this causes a loss of too much time.
Flat or cup shaped instruments with serrated ends should be used
for packing, as the W. G. Crandall set of sixteen. Seven of these are
bayonet shaped for use in the upper jaw and are of different sizes,
and seven are binangles for use in the lower jaw. Two are used to
brush off the excess mercury that comes to the surface during conden-
sation.
In packing, heavy steady pressure is best. Wedge the mass against
cavity walls, then in the center as this wedges against the walls and
secures closer adaptation. Use as large pluggers as possible, and do
not break up the mass any more than necessary in packing. Be sure
and fill all undercuts or crevices thoroughly. The amalgam mass
must not be too sloppy but rather stiff to secure a good margin. Fill
the cavity to overflowing, then condense with a mallet and orange-
wood stick. Allow it to harden somewhat. Remove the dam and
proceed with the carving. Use the set of Frahms or Hollenbacks
carvers designed for this purpose. Carve from the amalgam to the
margins. With the dam off, you can carve to correct occlusion and
articulation. Here the artistic ability of the dentist can be brought
out.
Simple matrices as for M. O. and D. O. cavities can now be
removed and the excess trimmed off and the cervical finished with
Black's amalgam knives. This is far more easily done now than
after the amalgam has set and is very essential.
ORAL HEALT H 157
Fine sandpaper strips are passed below the contact point and the
proximal surface roughly polished. At a subsequent sitting at least
forty-eight hours later the final polish is given. Strips, stones and
discs are used, then a mirror finish given with pumice on felt or
bristle wheels and whiting. At yearly intervals these fillings should
be inspected, any expansion of the mass ground down and the filling
repolished.
We should not use amalgam in the six anterior teeth either in the
upper or lower jaw and seldom anterior to the molars. Its greatest
value perhaps is in the restoration of badly decayed and broken down
teeth. Here it is more often indicated than crowning, for if correctly
done will cause much less subsequent irritation.
In devital teeth, posts of twelve to sixteen gauge nickel silver wire
may be cemented in the canals, nicked for added retention both on
the part of the cement and of the amalgam, and the pulp chamber
squared out for added retention.
In vital teeth small gold or indio-platinum posts may be cemented
in areas away from the pulp as added retention.
The dental profession at large is doing very poor amalgam work.
Cheap alloys are used, their manipulation not understood, or if
known, not applied, and no consideration given to the application of
a proper matrix, the securing of a contact point or points as needed,
no carving attempted and polishing never thought of.
From one of our most invaluable filling materials we have secured
results that stare each of us daily in the face. We see the flat, un-
polished surfaces, the lacking contact, those wide, overhanging
cervicals, and those cavity forms where retention seems to be merely
a trust in God.
To remedy this we must educate our patients so as to secure a
higher fee for this class of work. Our cavity preparation is as exacting
as that of the gold foil or inlay, its correct insertion almost as difficult,
and its polish if anything, harder.
We should consider amalgam on a basis with gold work. It is
not an easy working mass to plug a hole with, which has never been
carefully prepared with all traces of decay removed. It is indicated
m many places, and in some of our practices is used more than any
other material. It has done us good service in the past, even badly
as we have mistreated it. What it would do if used as our present
knowledge indicates is conjecture. I have an idea it would be raised
far above the plane it now occupies. Let us all give it a fighting
chance.
General Considerations of the Cast Gold Inlay"
Raymond F. Cannon, D.D.S., Ann Arbor.
A PERFECT cast gold inlay may be defined as one which in
contour, cusps, ridges, sulci, etc., is an exact reproduction of
the lost tooth structure, and when placed in the tooth cavity,
its marginal relationship must exactly register and be in perfect
continuity with the prepared cavity margins; or stated in another
way, it must be an exact metal replica of a perfectly adapted,
carved, contoured, polished and scientifically manipulated wax
pattern, when said pattern is in the tooth cavity in the mouth.
The first consideration is the preparation of the cavity in which
there are seven principles involved:
1 . We must obtain the outline form.
2. The resistance form.
3. The retentive form.
4. The convenience form.
5. The removal of the remaining carious dentine.
6. Finish the enamel wall.
7. Make the toilet of the cavity.
The outline form implies the doctrine of the extension for pre-
vention and the esthetic form. We know that there are certain
areas of the tooth surface that are susceptible to the beginnings of
decay and others that are not affected in the least.
Vulnerable areas or areas of high susceptibility are divided into
two classes; first, those in which decay has its inception through
structural defects, as in grooves, pits and fissures, and second, those
in which the beginning of decay is caused by an unclean environ-
ment. The latter class of cavities is frequently spoken of as smooth
surface cavities. The most vulnerable area and place where we
most frequently find decay is on the approximal surfaces of the
teeth just gingivally to the contact point. The immune areas are
those that are kept clean by the excursion of food in mastication and
by the movement of the tongue and lips. The buccal, labial, lingual
and occlusal surfaces are all immune areas when there are not any
structural defects present.
In making our outline form then to conform with the doctrine
of extension for prevention, we must cut our cavity buccally and
lingually, so far that the margins of the finished inlay will be per-
fectly clear of approximating tooth or filling in the tooth. It must
be so far out that it will be self cleansing, that is, that the bolus of
the food as it travels down the tooth, as it is crushed in the act of
mastication, will scour the margin of the filling from occlusal to
*Michigan State Dental Society Bulletin.
ORAL HEALTH 159
gingival. It is at the gingival angle that the most care should be
taken, for here is the point of greatest susceptibility and here more
than anywhere else is the recurrence of decay. The gingival margin
should be carried w^ell under the free margin of the gum, for we
know that the tooth does not decay under healthy gum tissue. Upon
the occlusal surface it is necessary to involve the defects as pits and
fissures, and carry the margins into smooth territory.
In outlining the esthetic form, make a cavity preparation that
will permit of perfect tooth restoration and make all lines of a gently
flowing curve, avoiding all sharp angles that come within range of
vision.
The resistance form is that form which will resist the thrust force
that will come upon the finished inlay. The ideal preparation for
the resistance form is the box shape, flat seat, and almost parallel
walls with a sufficient depth to insure a mass of gold that will not
flow under the stress that it will have to bear.
The retentive form is that form which we give to a cavity that
will prevent the inlay from being pulled out of the cavity. This is
obtained by making all the walls as nearly parallel as possible and
also a cervical incHne.
The convenience form is that form which we give to a cavity that
enables the operator to withdraw the wax without distortion. This
form is of greatest importance, for no matter how well a cavity may
be prepared, if the filling material is not perfectly adapted to the
walls of the cavity, thereby hermetically sealing the cavity against
the ingress of moisture, the filling is a failure.
It is always necessary to remove all of the infected dentine, for
not to do so will endanger the life of the pulp. Far better to remove
a healthy pulp and fill the pulp chamber and canals than to allow
it to die under a filling and have the entire dentine infected by
organisms of putrefaction.
That the cavo-surface angle be bevelled on all horizontal surfaces
as the occlusal and cervical, is an important factor for a perfect
cavity. This is done that all of the short enamel rods may be removed
and the inlay adapted to strong enamel walls.
The toilet of the cavity involves the removal of all debris and the
thorough cleansing of the cavity. It is advisable to wash out the
cavity with warm water, then dry and cleanse with alcohol or chloro-
form, previous to the insertion of the temporary stopping in the interim
of the making of the inlay. ^ If this is not done the patient is sent
away with a plug of gutta-percha placed upon a mass of infected
material in the cavity and organisms will be forced into the dentine
tubules.
The use of stones in cavity preparation should be discouraged,
except in opening up a cavity, while the use of burs and chisels
160 ORAL HEALTH
without a doubt must be encouraged. The final shaping, trimming,
planing and bevelling is all done with sharp chisels, for it is with
these only that absolutely smooth surfaces can be obtained. Stones
are not practical because they are untrue in most cases and so would
produce uneven margins.
Having prepared the cavity, our next procedure is the taking of
the wax pattern. To obtain the best results, Taggert's inlay wax is
used, because it moves to place in an exact manner, carves easily,
burns out, leaving practically no residue, and the mass, the size of an
inlay, can be unseated with compressed air and removed from the cor-
rectly shaped cavity without distortation.
If the cavity is an approximal occlusal preparation a matrix
retainer such as the Ivory or Wagner pattern can be used to good
advantage. The matrix is fitted rather loosely to the tooth, thus
allowing a thin layer of wax where introduced to squeeze out
between the cervical portion of the tooth and the matrix thereby
affording a slight feather. With the matrix in place, a cone of wax
is carved to approximately the shape of the cavity, then softened
over a flame and introduced first into the approximal portion with
a steady and ever increasing pressure until it ceases to flow. After
the wax has hardened sufficiently, the occlusal surface is softened
with a hot spatula and the patient is asked to bite down slowly to
obtain the occlusion. Each depression is hollowed out with a carver.
The grooves and sulci are carved to anatomical form. The excess
on the margins is carefully trimmed off, leaving only a slight feather
of wax. Having completed the trimming and shaping of the wax to
the desired form and size, it is removed with an explorer and then
attached to a sprue former.
Let us next consider a property of inlay wax, which is of vital
importance; namely, the effects of temperature change. This
variation is an essential factor in determining the success or failure
of a cast gold inlay to accurately register with cavity margins at all
points. Increase in the temperature causes an expansion of the wax
and lowering temperature causes the wax to shrink.
There are two direct forms of technic which may be carried out
in wax pattern manipulation. First, the Expanded Pattern method.
The principle or foundation upon which the Expanded Pattern
technic is erected lies in the fact that the pattern must be invested
at a temperature sufficiently above tooth cavity temperature to com-
pensate for the shrinkage in the gold on cooling from the temperature
when molten to room temperature. The chief argument against
this technic is that the wax pattern does not expand equally in all
directions since the thickness of the wax varies in different areas.
TTie other form of technic is the Cold Investing — Cold Mold
Casting method. We will only consider the cold investing part of
ORAL HEALTH 161
the process at this time. As far as the wax pattern and its invest-
ment is concerned this method is much better founded. As a rule
most of the inlays are made in the bicuspid and molar region and
the temperature of the wax is essentially mouth temperature or 95
degrees Fahrenheit. Before withdrawing the wax, the tempera-
ture is slightly lowered. The pattern is then mounted on a sprue
former and base and immersed in water at 95 degrees Fahrenheit.
Notice that in this method we try to maintain the temperature of
the wax pattern from the time of withdrawal from the cavity and
through the investing process, at about 95 degrees Fahrenheit or
mouth temperature. While the pattern is immersed at 95 degrees
Fahrenheit the investment powder is mixed with water that is warm
enough so that when at the time of investing, the investment will be
95 degrees Fahrenheit. It is easy to see that there should be no
change or shrinkage of the wax if this method is carried out carefully.
In the indirect method the wax is taken from the amalgam die
at room temperature, 65-80 degrees Fahrenheit, and should always
be poured up in an investment of the same temperature.
We are now ready to invest the wax pattern, so a few words
will be said on mixing and pouring up the plaster. Taggert*s inlay
investment like most other investments contains silica and Plaster
of Paris. Graphite is also used as a filler for the interstices.
Plaster of Paris is used as the cementing substance. With the
investment comes the weighing device. The larger bowl is filled with
the investing powder and placed on the balance stand. Enough
water is added to the smaller bowl to counterbalance the plaster.
Hie water and powder are spatulated in a rubber bowl for two and
one-half minutes, then rotated and jarred for two minutes, after
which time we should have a thorough incorporation. The pattern
is then painted with the investment by means of a small art brush.
Hie ring is placed down over the sprue former and base and the in-
vestment poured down the inside wall of the flask.
The setting of the investment should cover a period of about one
hour or preferably two hours, but it should not exceed that time
because of possible distortion. After the setting has occurred, the
crucible former or base is removed with a twisting motion, and the
sprue former is heated and carefully withdrawn in a direct line with
its longitudinal axis. The flask is now ready to be burned out.
One of the most efficient if not the best oven that is used
throughout the country today is one which was designed and made
by Doctor Travis, a member of our own faculty. The oven is con-
structed of transite and is box-like in appearance. On one side
there is a close fitting door. The top of the oven has a hole to admit
the mercury bulb of the thermometer. A spreader is placed above
the hole for the flame so that the heat of the flame does not go
162 ORAL HEALTH
directly upward and heat one flask more than another. This burner
should maintain a uniform and increased temperature with a maxi-
mum heat of 320 degrees Centigrade or 608 degrees Fahrenheit.
The flask is placed in the oven and the time consumed is about one
hour, which is divided as follows: The first twenty minutes is spent
in raising the temperature up to 80 degrees Centigrade at which
time the Taggert's inlay wax melts. In the drying and burning out
process there are three forms of water which are given off; namely,
mechanical water or that which can be squeezed out like the water
in a sponge, the water of loose combination and water of close
combination. During the first twenty minutes the mechanical water
is driven off. Care should be taken not to hasten the time in bringing
the temperature to 80 degrees Centigrade because the melted wax
will bubble with the rapidly evolved water and cause a roughened
and powdery appearance with a breaking down of the walls of the
mold. The next 25 minutes is spent in raising the temperature from
80 degrees Centigrade to 320 degrees Centigrade. This time is
what is called the period of dissemination in which liquified water
permeates the investment. 320 degrees Centigrade is a fixed tem-
perature marked by the appearance of smoke and by this time the
water of loose and close combinations has been driven off. The last
period of ten or twelve minutes which is the period of carbonization
and volatilization is maintained at the maximum temperature of 320
degrees Centigrade. Herein the volatile elements of the wax are
driven off, leaving the carbon perfectly disseminated throughout the
mass of the investment, and sealing the pores of the mold cavity,
thus giving a smoother cast.
The residual carbon acts as a flux and prevents oxidation in casts
made of oxidizable alloys. Our recent experiences have taught us
that it is highly desirable to reduce the depth of our cavities and
cover more area for frictional retention. Deep cut cavities resulted in
pulp changes with many devitalizations, while thin veneers left more
dentine between the metal and the pulp.
These veneers to have sufficient strength must be cast of hard
alloys most of which are much more oxidizable than the pure metal,
and the residual carbon tends to produce a cleaner and smoother
cast. The employment of harder alloys for carrying bridges there-
fore requires a more exact technic because of the fact that imperfec-
tions are more difficult to correct in the setting and the margins
harder to draw.
When the process of burning out has been completed, the rings
are placed on a screen supported on a tripod, where they are per-
mitted to cool.
There are different methods of casting the gold inlay. Among
the most successful of these is the use of the centrifugal machine.
ORAL HEALTH 163
The weight of the molten metal is transmitted as force by being
held to a curved path when in rapid motion with the revolving flask,
— the so-called centrifugal force. The flask and gold both revolve
and the result is to project the gold outward and so expel the air
and fill the mold. Enough gold is melted in the crucible so that after
cast, there will be at least three pennyweights of excess button. The
gold is brought slightly above the melting point with a sharp and
intense flame so as to concentrate the heat only on the gold. If the
gold is cast at a temperature higher than the melting point, the
shrinkage is increased on cooling from that point to room temperature
because of the longer time it takes to cool. The molten gold is forced
into the cold mold and thus induces an immediate congealing against
the walls. It is at this time that the excess button comes into play.
Since the excess is the last to be thrown it is the last to congeal.
Should there be any shrinkage of the inlay while congealing, a little
molten gold is fed in through the sprue which is proved by the slight
depression or hole in the excess button.
Another method of casting is by use of the Taggert machine. Here
the gold is thrown into the mold by gaseous pressure with nitrous
oxide. The gold is melted in the depression in the flask, the lever
of the machine brought down, thereby turning on the pressure which
forces the molten gold into the mold. The chief objection to this
method of casting lies in the fact that the flask is made hot by the
flame playing on the gold over the sprue hole.
A third form of casting is the suction machine. The investment
is a little more porous to permit the exhaustion of air. When the
air is exhausted from the mold we have created a partial vacuum
and as there is a fraction of the atmospheric pressure of about eight
to fourteen pounds per square inch on the molton gold above the
sprue hole.
After the inlay is cast, the flask may be chilled in water, the
inlay scrubbed off, and pickled by heating to redness and plunged into
HCl acid. The button is cut off and with stones and marginal
trimmers, the cast is fitted and adapted to the margins of the cavity,
leaving no overhanging edges.
We are now ready to inlay. Cotton rolls are placed between
the cheek and teeth to check the flow of saHva. The cavity is then
dried with alcohol followed by blasts of warm air. This leaves on
the cavity walls, saliva crystals, which are removed by washing the
cavity with a weak solution of distilled water and cement liquid.
Alcohol may then be used to dry the cavity. The cement should
be finely ground, slow setting and not too thickly mixed. Having
coated the cavity surface of the inlay with the cement, it is pressed
to place and tapped with an orange wood stick and mallet. This
expels the surplus cement. Still the inlay does not register with the
cavity margins by 1-150 of an inch or the thickness of the cement.
164 ORAL HEALTH
Cement is not only used as an adhesive material but also as a
caulking substance, and since it is a crystalline substance, the energy
of the compressed tooth structure forces all the crystals harder and
harder against the inlay and tooth structure. The margins of the
inlay are drawn toward the tooth substance with a fine stone and
burnishers pinching off the cement line and causing the gold to lock
into the enamel rods producing a hermetically sealed restoration.
Analyzing the importance of recognizing temperature changes and
the sequela when executing cast gold inlay technic, we seem to find
that there is:
1. A change in dimensions of the wax pattern by cooling when
removing.
2. Change in the dimensions of this impression by change in the
temperature when investing.
3. Change in the shape of the pattern due to elasticity of the
wax.
4. Change in dimensions of the investing medium in its process
of setting. This is not so important since the change is so slight.
5. Change in dimensions of the investing medium in the process
of heating and cooling.
6. Shrinkage of gold reproduction due to its own contraction or
cooling from the molten state to room temperature. Dr. Ward has
computed the shrinkage of an M. O. D. inlay one-half of an inch in
length to be about sixteen ten-thousandths of an inch.
Before concluding, it might not be out of place to enumerate some
of the troubles peculiar to inlay technic and as far as possible to give
the causes. The following may be apparent when the investment is
opened :
1 . Excess metal button separated from the cast, the divided ends
of the sprue rounded due to loss of pressure.
2. Sprue not divided but the whole cast tending to the globular
form due to insufficient initial pressure sometimes, but usually to not
heating the gold sufficiently.
3. Cast is true to pattern except for the edges which are rounded
due lo pressure casting with insufficient heating of the gold, or wax
not well burned out, and causing a lack of pressure.
4. Surface of gold appearing crystalline and etched, is due to
the gold being too hot on entering the mold, fusing the walls of the
mold and solidifying against the roughened surface.
5. Thin projections of edges; a feathering of gold beyond the
cavity limits is due to cracks and checks in the investment caused by
overheating, or too great pressure without sufficient support.
Now we have a restoration which exactly replaces that portion
ORAL HEALTH 165
of the tooth substance which has been lost, the margins of which
cannot be detected with an explorer and presenting no cement line
to the dissolving effect of saliva and one which restores lines, cusps,
sulci, planes, and one which is capable of immediately and perman-
ently sustaining the maximum force of occlusion of the human jaws.
Diseases of the Teeth and Mouth as Causes of
Organic Disease
MUCH evidence has accumulated in recent years to suggest that
dental and oral infections are often causative factors in bring-
ing on various forms of organic disease. Isolated cases of
such important conditions as rheumatic fever and various heart affec-
tions have been traced by physicians to infected teeth ; and, as if to
prove their contention, symptoms of these conditions have disappeared
or subsided on the removal of the focus of infection in the mouth.
Such isolated instances, however, have not been sufficiently numerous
to permit of any safe generalization. It has seemed desirable, there-
fore, to make a study of this subject to determine the degree to which
certain organic diseases can be traced to original foci in the mouth.
During the last nine months the New York State Dental Society and
the Metropolitan Life Insurance Company have cooperated in
making such a study among the Industrial policyholders of the Com-
pany. Letters of inquiry were sent out to physicians in all cases
during this period where the cause of death of the policyholder seemed
to indicate the possibility of oral infection as a source, and the physi-
cians were requested to indicate whether dental or oral infection was,
in fact, a causative factor in the fatal disease. The results, to date,
are very interesting and suggestive.
A total of 774 replies were received to 1 ,232 letters of inquiry. In
167 or 21.6 per cent, of the cases, the physician stated that infection
of the teeth or buccal cavity was present; in 61 or 7.9 per cent, of the
774 cases they stated definitely that they considered the buccal cavity
infection as a distinct causative factor to which the disease, which
eventually caused death, was a sequel. Thus, out of 43 inquiries with
reference to acute articular rheumatism, 14 per cent, were positive as
to the buccal cause. In 98 cases of myocarditis, 8 or 8.2 per cent,
were reported as positive. In 11 7 cases of mitral regurgitation, 1 1 or
9.4 per cent, were so returned. In 144 anemia cases, 10 or 7 per cent,
gave mouth infection as the primary cause. In 1 1 8 cases of ulcer of
the stomach, 9 or 7.2 per cent, were positive; and in 95 cases of
infectious endocarditis, 8 or 8.4 per cent, were positive.
In addition to the diseases above mentioned, the replies gave indica-
tions that mouth infections frequently cause fatal arthritis deformans,
osteomyelitis, septicemia, chronic gastritis and meningitis. We must
166 ORAL HEALTH
wait, however, for a larger number of cases in connection with these
diseases. The results are negative, so far, for pericarditis and for
skin diseases.
These results,while based on too small numbers to be conclusive are,
obviously, very suggestive, and justify further inquiry into this subject.
The impression of dentists and physicians as to the gravity of mouth
infection as a cause of serious organic disease appears to be borne out
by these preliminary results. The investigation will be continued
until a sufficient number of cases is available to form a basis for
definite conclusions as to the importance of mouth infections as known
causative factors in fatal cases of several important organic diseases.
A more detailed report will be made by the New York State
Dental Society at its annual meeting next May. — Statistical Bulletin.
Setting Up Diatoric Teeth
WHEN setting up diatoric teeth in full vulcanite denture work
much time can be saved and more satisfactory results obtain-
ed by placing the four posterior teeth en bloc in the wax rims
of the trial plates, leaving these teeth wired together just as they come
from the supply house. This wire framework later becomes part of
the finished denture but is entirely concealed by the vulcanized rub-
ber.
The method has these points of advantage : First, it aids in flask-
ing by more securely retaining the teeth in position while boiling out
the wax and packing the rubber and, second, it aids ii preventing the
teeth from becoming dislodged or broken out from the finished
denture. — L. A. Wright, Dental Cosmos.
National Dental Convention
THE twenty -sixth annual convention of the National Dental As-
sociation will be held in Los Angeles, California, July 17th to
21st, 1922.
The Ambassador, one of the city*s newest and largest hotels, situ-
ated in the heart of one of the most beautiful residential districts, will
be convention headquarters and practically all sessions can be held in
the hotel or on the grounds.
The Local Committee on Arrangements can safely state that this
meeting will provide an excellent program, demonstrating; that "Den-
tistry can add ten years to the average of human life." This commit-
tee can also safelv state that our visitors will be well entertained dur-
ing their sojourn in Los Angeles.
It is none too earlv to plan a vacation, westward, in July, 1922,
and to send for hotel reservations.
A Visit to the Mayo Clinic
E
VERYONE in the medical and dental world has heard of the
Mayo Clinic at Rochester, Minn., but everyone does not fully
realize what this institution means to the science and art of
medicine and dentistry. It was my pleasure to visit the Clinic in
February under the most favorable conditions, and while I am unable
to portray all the wonderful things I saw, yet I feel as if I should like
to give a glimpse of it here and there, with the hope that those who
read may take the first opportunity to visit this institution and see for
themselves.
It was through the courtesy of Dr. Boyd S. Gardner, Director of
the section of Dental Surgery, that I was privileged to go through the
institution to the best advantage in the limited time at my disposal.
Hearing that I was to attend the meeting of the Minnesota State
Dental Association at Minneapolis, he one day called at my office
and gave me such a cordial invitation to stop off at Rochester, that
I could not well decline — particularly in view of the fact that it had
long been my desire to see the clinic.
I had the pleasure of having as my travelling companion. Dr. Carl
D. Lucas, of Indianapolis, who was also on his way to Minneapolis,
and we put in a day so full of interest and entertainment that it will
never be forgotten by either of us. I must confine myself to my own
impressions, but I am quite sure that if Dr. Lucas were to record his,
they would tally with mine.
In order that my readers may grasp something of the magnitude of
this institution, I must first give a few statistics. There are about 250
physicians on the medical staff, including the surgeons. The dental
section consists of about twenty-five people, nine of whom are dentists.
The number of non-professional employees at the Mayo Clinic and
the allied hospitals is approximately 2,500. This, of course, includes
168 ORAL HEALTH
the nurses. For the past few years the number of registered patients
has been approximately 60,000 per year. Just let all of that sink
into you! Think of the energy, industry, executive ability, patience,
perseverance, and mental vision necessary to bring all of this about.
Emerson has said that: "Every great institution is but the lengthened
shadow of one man." Of the Mayo Clinic it may truly be said that
it is the lengthened shadow of three men — the elder Mayo who
started it, and the two sons, Charles and William, who have
developed it to its present state of perfection. (That word "perfec-
tion" is always used in a relative sense. There is no such thing as
perfection in this world, and I can imagine that if you should suggest
to either of the Mayo Brothers that their institution was perfect they
would hold up their hands in deprecation).
I met my friend. Dr. E. C. Rosenow, who has charge of the
bacteriological investigation in the Clinic — a man who is constantly
delving into the problems presented by the great army of invahds
who come to the institution. I saw his rabbits and heard his dogs,
and there was an army of them. I met Drs. Austin ahd Meisser, of
the Dental Section, the former engaged in the section work itself, and
the latter in the bacteriology as it relates to dental diseases, in con-
junction with Dr. Rosenow. I met the chief surgeons of the staff, and
saw Dr. Charles Mayo operate. In this connection let me refer to
one feature of the Mayo Clinic which must commend itself to every
physician and dentist in the land. All operations are open to members
of the profession with ample amphitheatre accommodations, atten-
dants, gowns, etc., freely provided. The educational value of all this
cannot be estimated, and it is philanthropic in the highest degree. A
visiting physician or dentist is made to feel so perfectly at home that
he goes away with increased respect for his profession and for the
Mayo Clinic in particular.
The physical equipment of the various hospitals and laboratories
is of course the last word in this line. It could not all be thoroughly
examined in a week, and the task of gathering it has been a life-
time effort. The library is one of the finest I have ever visited, con-
taining as it does all the standard medical and dental works, as well
as periodical literature up to date.
In a brief consideration such as this, it is quite impossible to deal
with the medical and dental treatment given to patients in this
institution. That would make many chapters in itself, embodying as
it does the details of diagnosis, treatment — medical and surgical —
after care of the patient, etc. It is a battle with disease of every
phase from the moment a patient enters the door till he leaves. All
of this is very impressive, and it is of course the thing that would most
ORAL HEALTH 169
interest the average medical man and dentist. But I am frank when
I say that it is not this feature of the Mayo Qinic which left its
greatest impression on me, or which has impelled me to write of it.
The outstanding thing which loomed largest in my consciousness as
I visited the institution, and which lives with me most vividly since I
left it, is the policy which directs it and the soul which vivifies it.
In their dealing with the staff and employees, and with the vast
army of patients who come to them, the Mayo Brothers proceed on
the theory that everybody is honest. It may be said in contention that
everybody is not honest, and that it is unsafe to assume this attitude.
Well and good — for argument's sake — but is it not better to face the
world with this theory than to foster an atmosphere of suspicion, and
treat people accordingly? I would rather suffer the humiliation of
being imposed upon occasionally by an unworthy person who has
betrayed my confidence, than to wrongfully suspect even one indivi-
dual in the myriads of the human race. And I believe the Mayos
feel the same way.
In their financial arrangement with patients they aim to make the
fee commensurate with the patient's purse, and there are doubtless
many persons who are taken through the routine of treatment at less
than actual cost. Manifestly others must be charged sufficiently to
compensate for this, else the clinic could not survive, but that the
basis of remuneration is correct is amply demonstrated by the immense
success of the institution. Among the staff and employees there is an
esprit de corps which is most inspiring. It is a perfect democracy, a
single illustration of which is the Hotel Damon where a 25 cent lunch
is served, which for quality — well it makes me hungry to think of it.
At our table that day, enjoying this lunch, were Drs. Charles Mayo,
Rosenow, Gardner, Lucas, Austin, Meisser and myself. What would
I not give to gather the same coterie again and listen to the conver-
sation— what would I not give to hear them as companions every
day! Long live the Mayo Clinic.
J^i^
Our Buffalo Letter
(The Editor welcomes Habec back to the fold. While the Pre-
paredness League of American Dentists, presided over b^ Dr. Beach,
Tvas worl^ing trvent'^-four hours per da]^, rve had not the heart to
expect regular contributions from dear old Habec, but now —
Wh}) Not? All in favor? — Contrary minded? — Carried Unani-
mously!)
Habec Reappears.
BACK again for a short visit, fellows, just to pass the time of day
and greet you with that old-time spirit of fraternal license which
always characterized the mental ravings of the erstwhile
Habec. During the long midnight of his silence, Habec's dreams
have often been of his staunch Canadian friends, who so patiently
bore with him during the period of his journalistic outlawry in the
columns of Oral Health. "Them were happy days," that seem to
grow nearer and dearer as time recedes, and draw closer and tighter
the mystic cords that bind heart to heart and hand to hand. Some-
where, Bill Shakespeare has gurgled this cute little thought, which
seems to check up with our regular spring inventory:
"Those friends thou hast and their adoption tried.
Grapple them to thy soul with hoops of steel.'*
At this point, while rounding sob corner, we could wax moistfully
sentimental, but in order to keep the grounds dry for the afternoon
game we will drop the curtain on the prologue and open the main
show under the head of new business, with Gus Kennedy in the chair.
If Habec's whisperer was working good, he would loudly proclami
this simple digest of the truth, — that Gus "requested" this modest re-
cital of Hamlet for the benefit of a thirst-riven race of bootleggers and
the millions of unemployed and dependent cork-screws. And why
pick on Hamlet, vou soliloquize? Because it sounds good to the
nostrils of the famished : Hamlet : (def. Webster) , a small ham — and
so the crazy Dane dost deign "To be or not to be."
Therefore we burst the thin walls of the cocoon, spread our filmy
wings, and once agam soar into the great world of dentistry, where
moth and rust tarrieth not. because no lodging place abideth. The
few short years since Oral Health was wont to spread the records of
Habec upon its pages have been signally momentous for our pro-
fession.
Developments have occurred in such rapid succession that only the
mental speed artist can keep his dental flivver within hailing distance
of the pacemaker, and it makes some of us old "76'ers" bob mighty
fast to dodge the dust of the "also rans." But there's quite a number
of the old lads who still have a few lively sprints left in their mileage
ORAL HEALTH 171
book, and every little while one of us tears off a few hundred just to
give the ultra-wise young a sample of the "spirit of '76."
FV instance, there's Charley Johnson, who signs himself C. N. Of
course, the Canadian boys don't like him a bit, but over on this side
he stands tolerably well in some localities. Do you know of a better
sprinter than C. N.? He always lines up at the pole 'longside the
three-year-old prospects, and, although he may not get away just as
quick at the drop of the flag, yet he is alTva\)s there at the finish, and
refuses to be nosed out by the field. More power to the power that
lies beneath his quiet and serene exterior! More service and more
love be his, to be added to the great store that he now possesses. Does
not his life exemplify the powerful thought that:
"He who has vision and a programme becomes a conqueror"? Let
the young dentist learn this lesson from the life of C. N. Johnson and
he will have unveiled the secret upon which to build his own success.
Truman Brophy — Truly, a name to conjure with in the medical
and dental worlds. A living exponent of the geratest of all principles
embodied in the combined force of three simple words: Service above
Self. Can our constricted vision comprehend all that this thought con-
veys of unselfish effort covering a period of more than fifty years? Has
this wonderful scion of our profession ever been found wanting?
Consider all that he has brought to medicine and dentistry; and con-
sider all that he has yet to leave. We sometimes wonder if such great
characters are being produced to-day, or will be in the future. We
fear the mould is somewhat shattered, if not hopelessly broken.
George B. Snow — Do you know that George is gaily flirting with
the three-figure class? Although he is several California semesters
under the high limit register, yet he is a much safer bet than a "take-
all" throw, best three out of five. We have a faint hunch that George
is trying to give a demonstration of how high he can run the vulcanizer
thermometer without blowing the safety disc. It is evident that he is
keeping the boiler in good repair at his beautiful, rose-smothered home
at Long Beach, and we hail him as another remarkable member of
our profession who knew when to ease off and float peacefully in the
offing under sunny skies and cooling shades. But, kind reader, George
is not a 1919 license plate. Far be he from such! He wears a 1922,
and it is safe to say that his application is already in for 1 923. The
key to the above statement is that George is no back number; he is
working every day, and is planning for the future. Automatic plug-
gers. vu^canizers, etcetera, et al, form the evidence for the defence,
and there is nothing to offer in rebuttal. Truth is, George has our old
chum, "Osseouspart" Napoleon, skidded into a lamppost when it
comes to conquering the great armies of invention. His address in
1930 will be the same as now.
Thornton, A. W. — Ever hear of him? Well whatever vou may
have heard, we say it is the truth, becau-^e a chemxal analysis has
172 ORAL HEALTH
never disclosed wood alcohol, creosote, or German dyes in his make-
up. Although the profession of Dentistry furnishes him with the
means to procure the wherewithal to agitate his stomach at fairly
regular intervals, yet the force through which his fame has been
scattered to the four winds of heaven has been his superlative ability
to agitate human emotions to an inspirational degree. What an en-
viable faculty and masterful art ! On both sides of the Volstead line
we are proud of him and worship at his shrine.
How easy and enjoyable it would be for Habec to continue to
juggle on the end of his lead pencil, in a most familiar way, name
after name of the famous in our mystic circle, but we will spare you
this time, and later, perhaps, may draw a few more life-sized
biographical sketches according to the latest Cubist fashion.
— Habec.
Empyema of Antrum: Case Report
By W. J. Hacking, D.D.S.
A^eiP Westminster, B.C.
MRS. N., age 22, presented on Feb. 17th, complaining of
pain in the right maxilla, with periodic spells of toothache,
extending over about two years. Six weeks previous to the
time she reported to me she had experienced considerable pain, and
upon visiting a dentist, he inserted a large amalgam filling in the
lower third molar, thinking this tooth to be the cause of the reflected
pain. This, however, failed to relieve her. She consulted two other
dentists, with no better results.
Upon reporting to me for examination, I found the upper teeth in a
good state of preservation, pulps all vital, first molar missing, second
molar occupying the position of first molar, in close contact with the
second bicuspid. No external signs of inflammation, only slight
tenderness of second molar upon percussion. There was a very small
amalgam filling in the occlusal surface of this tooth, and a large re-
cently-inserted amalgam filling in the lower wisdom tooth. I gave
her an appointment for the following Monday, for further observation.
Upon her return she reported considerable pus discharge into her
nose and throat during the night. Her face was swollen and the
second molar loose. I diagnosed empyema of the antrum from some
unknown source of infection. Upon further questioning I found she
had her tonsils removed, while badly infected, about two years ago,
which may have had something to do with infecting the antrum.
I removed the second molar, under block anaesthesia, getting an
immediate flow of thick pus. After washing out the cavity and a
careful inspection, I found the floor of the antrum had necrosed away
to such an extent that I could readily insert the bulb of a Cameron
ORALHEALTH 173
lamp into the antrum. I removed all necrosed bone and thoroughly
curetted the interior of the antrum of polypi, etc., irrigating with normal
salt solution, alternated with a 2 per cent, solution of chlorozene. The
opening, in my opinion, being much too large to fill in with a blood
clot, I decided to try to keep out the food particles by plugging with
paraffin, rather than the usual method of packing with sterile gauze,
because of the gauze absorbing the fluids of the mouth, and rapidly
becoming offensive. In order to retain the wax plug in position, I
shaped an Angle regulating clamp band to the second bicuspid, then
cut a piece of gold plate, large enough to cover the opening where
the tooth was extracted. This plate I soldered to the clamp band. I
then shaped my paraffin wax to approximate the roots of the tooth
extracted, but somewhat shorter and conical in shape. This wax plug
I placed in the socket, retaining it in position with the gold plate and
band clamped to the second bicuspid.
Upon returning the next day, she reported a slight discharge on
lying down, through her nose, but had a very comfortable night,
suffering no pain to speak of. I loosened the clamp and removed the
band from bicuspid, the paraffin plug coming away clean. There was
no odor or discharge, no particles of food had gotten into the antrum,
and a normal blood clot was closing in at the apex of the socket. She
continued to report at intervals of from one to three days for observa-
tion and irrigation and to have the wax plug gradually shortened. At
the end of the first week the floor of the antrum was completely
covered, and the socket rapidly filling in with healthy regenerative
tissue. At the end of the second week I was able to leave off the
clamp band and plug, and at no time had any particles of food
penetrated into the antrum to interfere with rapid recovery to health.
Do Unto Others
Be careful of the little ones,
Who to your office go,
For you were once a child yourself
And just as scared I know.
When Doctor told you open wide
I know you shut up tight
And when he pulled your baby tooth
You had a real fist fight.
You do to children as you would
That they had done to you.
You'll find the children doing just
As you would have them do.
— Dora L. Cameron
Report of the Science and Literature Committee
of the GaUfornia State Dental Association
for the Month of October, 1921
John E. Gurley, D.D.S., Chairman.
San Francisco, Cal.
Each month articles are assigned to those of the committee who rep-
resent a particular branch of dentistry, and who then prepare their
abstracts, which are submitted to the committee at the next meeting.
The following are herewith submitted for your consideration:
USE OF MODELLING COMPOUND IN IMPRESSION
TAKING.
By Edward Kennedy, New York.
''Dental Cosmos,'" June, 1921.
Abstracted by Dr. E. K. Peters, Fresno.
RECOGNIZING the subject as an important one. Claiming no
originality and giving due credit to others. Admitting himself a
convert from plaster to compound impression technique because
of certain successes obtained in its use. Making comparisons in favor
of compound and giving proofs to support his position in the form of
facts and practical experiences of his ow^n and others. This, in brief,
is the opening of the above named paper in which the vs^riter gives food
for thought for every man who takes impressions, no matter what his
opinions may be.
The author then carries his readers through the technique he follows
in takin?: the upper impression, making of study casts, forming the
tray and preparing the compound. In preparation of the compound
consideration is given to equipment to obtain proper temperature, and
manipulation.
After instructing the reader in placing the compound in the tray, he
leads you through the work of taking the impression, testing and cor-
recting until the impression is a model of the plate to be.
The author then takes you through the work of the lower impres-
sion, every step of which should be studied and understood before at-
tempting to do the work. As in the upper impression, the work is test-
ed before it is passed as completed and ready to be used to form the
model.
The introduction of this paper is well worth the reader's time and
study. But it does not go unsupported for the paper is one continu-
ation of valuable information from beginning to end.
ORAL HEALTH 175
Last but not least is the author's advice to beginners. He, hke
every other compound worker, has been through the stages of learn-
ing to handle the material; to know how is good, but one must de-
velop skill as well as knowledge.
The reader of this paper must not overlook the discussions which
appear on page 642 of the same issue. Dr. Norman Essig led in the
discussion and freely admits that he will have a different opinion and
is not ready to give up plaster as an impression material.
Dr. Frank A. Fox followed next in the discussion, and while he is
very much of the same opinion as the author, he readily f"nds room
for a good healthy discussion. . — —-'
The third discusser. Dr. Charles R. Turner, still finds room to bring
out some good points and should not be overlooked by the reader.
Dr. Kennedy then closes the discussion and in a few words recog-
nizes corrections, answers questions and puts over a real punch or two
which every one should get.
In closing the discussion, the author pays a very nice tribute to the
pioneers in compound impression work which, to those who have made
use of the principles as taught by those who pioneered this work, can
not help but be appreciated.
CAST SWEDGED GOLD BASE.
By Dayton D. Campbell, D.D.S.
'^Dental Summary,** December, 1920.
Abstracted b\; Dr. E. K. Peters, Fresno.
IT is the author's opinion that the cast gold base is second only to
the platinum base of the continuous gum denture. Esthetics of
gums is the advantage claimed for the porcelain denture.
The cast gold base will serve all other purposes of a continuous
gum artificial restoration and satisfy the demands of the most exact-
ing.
Thermal conductivity and ease of cleansing are cited as two points
of superiority claimed, as well as the thinner construction in the vault,
while the weight which is so often spoken of as an objection is clearly
shown as not to be so considered.
Weight in the lower denture is shown to be of no advantage for re-
tention and yet of not sufficient significance to be a disadvantage.
The author then describes with words and pictures his methods of
forming models, wax patterns, investing, burning out and casting.
Attention is called to the writer's method of casting in the cow bell.
A simple method of forming attachments is described. Finally the
176 ORAL HEALTH
swedging and finishing of the cast and the formation of the vulcanite
rim to complete the denture.
The author gives a concise but thorough paper and every one inter-
ested in the prosthetic art will do w^ell to read it carefully.
DENTURE CONSTRUCTION.
Dayton D. Campbell, D.D.S.
^'Dental Summary,*' February, 1921.
Abstracted b}) Dr. E. K. Peters, Fresno.
THE author considers the proper preparation of the mouth as the
first step in construction of a denture. He recognizes the sub-
ject as one covering a very large field and evidently sees the
need of starting, in all denture construction, with the proper founda-
tion.
After calling attention to three ways of removing the remaining
teeth, namely, pulling, extracting and surgical removal, he advises the
reader that surgical removal is preferable and gives evidence to sup-
port his claim.
A simple method of retaining the natural teeth in position as a guide
in the set-up of the artificial is given, which is followed by the tech-
nique of Dr. W. L. Shearer of Omaha, for the surgical preparation
of the mouth.
The writer suggests and gives a method of construction of a base,
carrying rest blocks, to be worn immediately after the operation and
until the dentures are placed in the mouth.
Coming to the impression, the writer grants the compound worker
equality in results, but states his preference — a combination of the
Hall, Green and Wilson technique.
Stopping for a moment in the thought of his work, the author takes
a little rap at the compound worker for his failure of the past by
telling tne reader of the ten-day or temporary fit which gave the be-
ginner in compound so much trouble.
Note — The beginners in compound work have all had these ex-
periences, and the successful compound technician is one who has
overcome that difficulty along with others.
The writer admits that compound impressions can doubtless be tak-
en, but advises the novice to follow the technique he gives. He grants
the expert compound worker his just dues, gives a reason for using the
technique he describes and then gives the technique for the taking of
impressions with compound, plaster and wax.
ORAL HEALTH 177
Briefly, the work is as follows: A compound impression is taken.
This impression is then post damed with the black carding wax, trim-
med to size and covered with a plaster wash, which is used to take a
second impression.
Quite a little stress is laid on the placing of a hold in the center of
the upper impression, which is of value in seating the final impression.
ORAL SURGERY FOR THE DENTAL PRACTI-
TIONER.
By Theodor Blum, D.D.S., M.D., New York.
'The Dental Ouilookr April 1921.
Abstracted by Ceo. A. Hodges, Turlock.
THE essayist believes that *'special cases should be treated by the
specialist,'* still he considers it '*of great importance that the
general dental practitioner should have at least a thorough
theoretical knowledge of the subject, so as to be able to diagnose
pathological conditions in and about the mouth, though he may not
treat them himself.*'
The following subjects are taken up and elaborated upon:
1. "Malposed and impacted teeth."
'*I believe that unerupted teeth, when their proper time for erup-
tion has passed, as well as impacted teeth, should be either placed into
their normal position or removed as early as possible.
2 "Supernumerary teeth."
*'The above remarks hold good for supernumerary teeth."
3. "Infected wisdom tooth pocket."
"Tliis is an infection of the gum flap covering a partly erupted
wisdom tooth, especially a lower one. The simple and permanent
treatment consists of the removal of the tooth if circumstances permit.
However, as long as these teeth are very often not only in normal
position but also useful, conservative treatment is indicated, during
which I practically always avoid incision of the flap, but carefully
cleanse the same, applying tincture of iodine and placing a small piece
of iodoform gauze into the pocket to permit free drainage. Such
dressings are changed daily. This infection may travel to the peri-
dental membrane of the affected tooth, causing pericementitis, the
periosteum of the mandible causing periostitis and the submaxillarly
lymph glands causing adenitis. Peritonsillar and pharyngeal ab-
scesses have been observed as sequellae of the above-mentioned con-
ditions."
4. "Extract the teeth."
"The extraction of teeth is probably more frequently attended to by
the general practitioner than any other minor operation about the
178 ORALHEALTH
mouth for which recognized specialists exist. An X-ray examination
of every tooth to be extracted is advisable, but it must be made a rule
to do so in case of devitalized teeth and those which are very loose.
An unsuspected apical area in the first and a possible fracture in the
latter one are the more important reasons for it. If no roentgenogram
is available, the roots should be so much more carefully examined for
fractured apices and apices denuded of pericementum. A consider-
able number of teeth should, as a rule, not be extracted at one time.
In a case of serious infection, it is unquestionably indicated to extract
a limited number only during a single operation. It is not only the
shock of the operation which should govern us in deciding this ques-
tion, but rather the consequences arising from liberating a large num-
ber of living micro-organisms into the blood stream by removing a
large number of infected teeth during an operation, such interference
being equal to an injection of living micro-organisms. It is my prac-
tice to divide the removal of the teeth of a patient into four parts, ex-
tracting the teeth of one-half of the jaw at a time but finishing one
side first before starting the other. It should be made a rule to always
see a patient the day after an extraction. It is well for the general
dental practitioner to understand that although the removal of the
outer plate of bone in every case of extraction has been advocated re-
cently, such procedure is far from being generally adopted. In diffi-
cult cases we all have to resort to this, and if so, be sure that the two
incisions on the buccal or labial side consist of two widely diverging
lines beginning at the gingival pyramids on either side of the tooth or
teeth and forming approximately a right angle. If then, after the re-
traction of the flap, the outer plate overlying the root or roots is re-
moved, there will be enough bone left on either side to well support
the broad flap sutured into position. Sutures are usually removed
from the fifth to seventh day. The dermal suture has proven most
satisfactory during the last year.
"If operations have to be performed in the alveolus some distance
from its free border, a semi-circular incision is made (as is customary
for a root amputation), to avoid destruction of the alveolar ridge,
which interference later on may prove troublesome for the practitioner
when replacing the lost teeth with a plate or bridge.
**It is practically always advisable to suture a flap except when re-
moving a malposed cuspid on the palatal side, in which case, if the
other teeth are in position, the ordinary replacing of the flap is suffi-
cient."
5. "Granuloma."
"If a so-called granuloma (chronic apical pericementitis) is present,
this should be entirely removed when the tooth is extracted. If, how-
ever, the granuloma fortunately comes out with the root, curettage is
entirely superfluous The dense layer of bone surrounding the granu-
loma must not be disturbed. It protects the cancellous bone surround-
ing it.'*
ORAL HEALTH 179
6. "Root amputation."
"Another operation often performed by the general dental practi-
tioner is root amputation. It is advisable in those chronic cases where
one can expect to have, after the operation, enough alveolus left to
firmly hold the root and enough of the root remains to make it service-
able. In carefully selected cases the operation will be successful as a
mode of treatment for chronic apical pericementitis, radical cysts and
perforations or fractures near the apex; it is also indicated if, for what-
ever reason, the root canals cannot be filled to the apex. All teeth
can be amputated if their apical areas are accessible. Ordinarily,
however, only the teeth up to and including the second bicuspid are
considered. Any of the well-known root canal technics performed
before the operation answer the purpose and no other special atten-
tion need be given to pulp canals and dentine. For obvious reasons,
the chisel should not be used to remove the apex, a large round bur
being the instrument of choice, by starting at the apex and cutting
towards the crown until the cut end of the root is continuous with the
general cavity formed by the bone after the granulomatous or cystic
tissue has been removed with a curette. The wound is sutured as a
rule, even if a large cavity is present, as long as one can be reasonably
assured that the blood clot filling it will not break down. Root re-
section, however, is not an ideal operation, the remaining root being
partly a dead body, but it is performed for the lack of anything bet-
ter that would answer the same purpose."
7. "Cysts."
"Hiere are three types of cysts, the most common being the
radicular one, most frequently found between the twentieth and
thirtieth year and originating, as believed at present, from diseased
tooth roots, temporary or permanent; the second type is the follicular
cyst having its origin from a tooth follicle of either a permanent or
supernumerary tooth; the third is the multilocular cyst. The physical
examination, supported by X-ray findings, makes the diagnosis rather
simple, except in those cases where the proximity to the maxillary
sinus makes the differential diagnosis so much more important. The
treatment is, of course, surgical, and this again, conservative or radi-
cal. The radical procedure consists of the entire removal of the cyst
membrane, which can easily be peeled off the surrounding bone with
a curette or periosteal elevator. The sharp edges of bone and the
overhanging soft tissues are smoothed down, the outer flap replaced
and held in position with iodoform gauze or sutures, or both. The
healing takes much longer than in the conservative treatment, which
differs in the following: After making an incision through the buccal
soft tissues, the flap is retracted and the outer half of the cyst mem-
brane, including the overlying bone, is removed in such a manner that
only a shallow inner cyst half (including the cyst membrane) remains.
In this way, a circular wound is left to granulate, and even parts of
180 ORAL HEALTH
this may be covered by suturing the mucous membrane and underlying
tissues and periosteum to the cyst membrane. The wound is packed
a few times with iodoform gauze and thereafter taken care of by the
patient, who syringes the cavity after meals. Finally it flattens out
entirely and is hardly noticeable. The multilocular cyst, which is only
found in the region of the mandibular angle, must be removed com-
pletely, but does not indicate resection of the jaw."
8. "Solid tumors.**
"Of the solid tumors, we find practically all varieties in the oral
cavity. The treatment of all tumors, whether benign or malignant, is
radical, meaning not only the early removal but also the extirpation
of the same, by making the incision well out into the sound tissue with-
out conservation of healthy neighboring teeth or bone."
9. "Infections of the jaws."
"Infections of the jaws, especially those caused by diseased teeth,
are most frequently seen by the general dental practitioner. The un-
derlying principle in the treatment of these conditions is the free evacu-
ation of pus. It seems more advisable to wait for the disappearance
of the acute symptoms which soon follows the evacuation of pus, at
which time the teeth can be safely removed and granulomas of cysts
properly dealt with, no matter what complications (like fracture of a
tooth) may arise."
10. "Maxillary sinus infection."
"In case of maxillary sinus infection, non-vital molars and bicuspids
on the affected side should surely be subjected to dental treatment
first, if a fair degree of success can be expected, but even in vital
teeth, deep pockets should not be overlooked.
"In a so-called low antrum, which in extreme cases may even extend
under the nose (sinus platinus) , not only the molars and bicuspids but
also the cuspids and incisors must be considered. Dentists as well as
oral surgeons (unless they also specialize in nose and throat work)
will save themselves a lot of annoyance by only treating infections of
the maxillary sinus of dental origin, otherwise they may drain a sinus
for months while it is continuously reinfected through the nose or ad-
jacent sinuses.**
1 1. "Accidents that demand surgery.**
"During root canal treatment, broken, smooth and barbed broaches
have been pushed through the apical foramen into the surrounding
tissues. Broken scalpels, roots in the maxillary sinus and many foreign
bodies have been removed by the author from various parts about the
jaws and face. The operation for their removal should not be under-
taken unless the operator feels reasonably sure of success and is pre-
pared in every respect to perform the same.**
12. "Oral focal infection.**
ORAL HEALTH 181
'*In the absence of symptoms of focal infection, I surely would ad-
vise leaving in position any number of non-vital teeth if their root
canals have been treated with one of the well-known methods of root
canal therapy, if they are otherwise serviceable. In the presence of
symptoms of focal infection (no matter what the age of the patient),
I would only advise the removal of non-vital teeth as a last resort. In
other words, only after the whole body has been examined and any
pathological condition present dealt with. In such case, every non-
vital tooth must be removed if one wants to eliminate all possible foci
of infection.
"In closing I wash to express my opinion regarding the practice of
minor oral surgery by a general dental practitioner. It is self under-
stood that in an emergency, one may be called upon and must then
do almost anything. The dentist who has prepared himself in many
ways to practice the specialty of oral surgery only should be chosen as
the operator; as a rule, the general practitioner is unfit for many rea-
sons, lack of proper equipment, training and assistance being the more
important ones. Major oral surgery, however, must not be practiced
by one who is licensed in dentistry only. The dentist has no moral or
legal right to practice major oral surgery, and if the present laws per-
mit it, they should be amended, because there is no dental school any-
where giving the student the fundaments, far less the actual practical
instruction necessary for their proper preparation."
Marking Palatal Denture Limits
M
AKE the base plate shorter palatally than the finished plate is
to be ; place in the mouth and instruct the patient to **open wide
and partially close,'* at the same time gently touching with the
finger the region slightly back of the junction of the hard and soft
palate to ascertain how much real displacing pressure is exerted by the
moving tissue just back of the hard palate. Previously prepared
strips of base-plate wax one-eighth to one-fourth inch wide by one
inch long are now singly introduced into the mouth in contact with
the lingual surface of the base plate, one end extending beyond to the
limit of the finished denture. With hot spatula attach the strips to
base plate — three or four strips are sufficient. The base plate with
strips attached is now transferred to the cast which is graved where
the wax extensions indicate will be the proper palatal denture limit.
The same method may also be applied to ascertain the buccal and
labial denture limits. — Joseph Hormer, Cosmos.
ORAL HEALTH
EDITOR:
WALLACE SECCOMBE, D. D.S., F.A.C.D., Toronto, Ont.
CONTRIBUTING EDITORS:
C. N. JOHNSON, M.A., D.D.S.. F.A.C.D., Chicago.
RICHARD G. Mclaughlin, D.D.S., Toronto.
W. E. CUMMER, D.D.S., Toronto.
J. WRIGHT BEACH, D.D.S., Buffalo, N.Y.
Entered as Second-class Matter at the Post Office, Toronto.
Subscription Price, Canada and United States, two dollars per annum;
elsewhere three dollars. Single Copies, 25c.
0
Original Communications, Book Reviews, Exchanges, Society Reports, Personal Items, and othe
Correspondence should be addressed to the Editor, Oral Health, 102 Wells Hill Ave., Toronto, Canada
Subscriptions and all business Communications should be addressed to The Publishers Oral Health
Royal Bank Building, 269 College St., Toronto, Canada.
Vol. XII.
TORONTO, MAY, 1922
No. 5
H
EDITOR.IAL1
Dental Conventions and Manufacturers'
Exhibits
H
THE writer has attended numerous dental conventions during the
past few years, and has noted the keen interest displayed by
practitioners in the Manufacturers' Exhibit. There are a few
in the profession who would utterly ban the manufacturer from the
precincts of the convention building; but the great majority of dentists
view the Manufacturers' Exhibit as an opportunity for studying the
latest advances in manufacture, both of instruments and suppHes, and
always find the exhibit a matter of education as well as interest.
From the manufacturers' side it would appear to be vitally neces-
sary that he be accorded some place in dental conventions, that he
may have the opportunity of conferring with the practitioner and thus
keep in close touch with the needs of the men whom he desires to
serve.
The instruments and materials used in dental restorations are so
vitally concerned in the success or failure of many operations, that it
is clearly in the interest of the profession that the manufacturer absorb
sufficient of the dentist's viewpoint that he may produce goods of such
a character as to assist the dentist to perform the best possible service
for the patient.
Some of the manufacturers spend large sums of money annually
upon scientific research, that their product may be the very best pro-
ORAL HEALTH 183
curable. A very cursory consideration is sufficient to bring to one's
mind many instances where the manufacturer has led the way in the
application of scientific knowledge to his product. The effect has been
to revolutionize certain phases of dental practice. Upon the contrary,
there are other manufacturers who give little, if any, concern to newer
developments or to the application of scientific principles to the manu-
facture of their product.
These two classes of manufacturer are well known; and they are
easily recognizable by the personnel of their demonstrating staff. In
one case the presentation is scientific, while in the other it is absolutely
empirical. The latter type is exemplified by the demonstrator who, at
a recent convention, gave a "spiel" directly contrary to the approved
teaching of the profession. And the strange part was, that an in-
terested group of dentists constantly hung about that demonstrator
and clung to every word he uttered, as though the story was the last
word in advanced dental thought and progress. And those dentists
were the same men who, one hour before, listened intently to a scien-
tific presentation of a dental subject by one of the leading members of
the profession!
The individual dentist is partly to blame, but not entirely. The
convention committees are more to be censured for permitting such
teaching within the convention walls. Even the side shows of a
country fair are carefully censored. What justification is there for
permitting the admittance to the exhibit of a scientific convention, of
manufacturers who promulgate teaching at complete variance with
the best thought of the profession and directly opposed to what is
being taught at the regular sessions of the convention?
The time has surely come to draw a line. Just as we have a
credentials committee to determine upon the ethical standing of
dentists, so we must have exhibitors' credentials committees, who will
exercise supervision to the extent of excluding from dental conventions
the unscientific or unscrupulous manufacturer, and put the ban upon
exhib't demonstrators who state what is contrary to the approved
thought and practices of the profession. — W. S.
Dentistry and Health Propaganda
THE United States Federal Department of Health is engaged in
a very worthy work of an educational character, in holding
health institute meetings at fifteen selected points throughout the
United States. Public meetings and health exhibits are arranged,
and conferences held with health officers and workers in local dis-
tricts. A school of instruction is also held for the public health nurses.
This is all very excellent, and much good will doubtless be accom-
plished through these health institutes. But surely there must be some
184 ORAL HEALTH
official place for dentistry in such a programme? How can any com-
prehensive health propaganda be planned without recognition of the
dental phases of the problem? Dentistry is an integral part of public
health. Public health organization is incomplete and inefficient with-
out an intelligent application of dental principles.
The relation of the teeth to general health, the relation of foci of
infection about the teeth and surrounding parts, to systemic disease,
and the physiological relation of the body to the teeth and of the
teeth to the rest of the body, all point to the vital necessity of makmg
dental instruction an essential part of every health movement. It is
the manifest duty of the dental profession to bring these matters to the
attention of health departments and stand ready to lend every possible
assistance to the success of the work. ^- ^•
''Will You Be Alive Next Year?
99
UNDER this rather striking title, the Life Extension Institute, Inc.,
of 25, West 45th Street, New Work City, publishes a full-page
advertisement in the New York Times Book Review. The
point of especial interest to members of the dental profession is that the
advertisement devotes two paragraphs to tooth conditions which read
as follows: —
"A man may live for years with an abscessed tooth and be una-
ware of the fact. Yet all the time the poison from this infection creeps
slowly through his body, ever gravitating towards the weak spot. Ap-
parently unimpaired, he goes his way until one day the weakened,
damaged organ abruptly ceases to function and another unlim.ely
death is dedicated to ignorance.
"And of every thousand people whose teeth we X-ray, 58 per cent,
show root abscesses. Out of 4,100 consecutive cases that had routine
X-rays, only 76 showed absolutely normal conditions.'*
Another paragraph states that not 2 per cent, of those examined are
normal in every respect, and it shows what it calls a "Life Span
Chart," the details of which are said to be compiled from actual
figures.
This chart shows that the normal life should reach 70 years, but
that the average expectation of life at b'rth is only 51 years. The
same chart shows that the average period of working; productivity is
from the ages of 1 8 to 42, and the period of good health is from 1 8 to
31. These facts are quite as interesting concerning the dentist himself
as they are when related to any of those whom he serves.
m
m
OPAL HEALm
A JOURNAL THAT STANDS FOR THE ^ OUNCE OF
PREVENTION,- AS WELL AS THE -POUND OF CURE**
m
D
VOL. 12
TORONTO, JUNE, 1922
No. 6
The Dentinal-Gemental Junction
Harold K. Box, D.D.S., Ph.D., F.A.A.P.,
Royal College of Dental Surgeons^ Toronto.
THE object of this bulletin is to demonstrate a simple but
extremely important histological fact, that the canal system of
the cementum stands in direct communication with that of the
dentine.
The cementum may be defined as a thin, hard substance, which is
a product of the cementoblasts of the pericementum, and which forms
an external covering of the roots of the teeth of man and many
animals. Overlying the dentine and beginning at the amelo-cemental
junction, it extends to the apex of the tooth. It is the softest of the
calcified dental structures. In childhood it is always thin, but it
increases in thickness with age. It is laid down in layers or lamellae
which are always thin on the gingival portion of the root and thicker
toward the apex.
Fig. 1. — Cenienlal lamellae.
186
ORAL HEALTH
Generally speaking, cementum can be divided into two types,
differing greatly in relation to their cell contents.
Tlie first type, which we shall term the non-cellular, is represented
in the cementum of the gingival third and usually part, if not all, of
the middle third of the root. The second or cellular type is found in
the apical third, and only occasionally, part of the middle third. This
division is based on the writer's findings that cemental lacunae, con-
taining cement cells, are rarely present in the gingival third, occa-
sionally in the middle third, and are practically constant in the
apical third, where they also occur in by far the greatest numbers.
Non-cellular cementum is generally, to all appearances, structure-
less. As stated previously, it does not contain any cemental lacunae
and therefore no cement corpuscles. This type of cementum in man
normally measures in thickness from 1 50 to 250 microns.
Fig. 2. — Non-cellular cementum.
In the cellular cementum, radiating from the lacunae in all direc-
tions, are numerous fine channels which branch and subdivide as
they extend into the cemental matrix. These are known as canaliculi.
They anastomose freely with those from adjoining lacunae and they
also maintain a communication between the lacunae near the surface
and the pericementum. In the cemental lacunae are found cells,
termed cement corpuscles, fine projections from which extend into the
canaliculi, bringing each cemental cell in close relation to a certain
zone of matrix over which it has control. The cement corpuscles
ORAL HEALTH
187
Fig. 3. — Non-cellular cement^im and a human scalp hair. Non-cellular cemen-
tum is extremely thin, from a clinical standpoint, and in this instance,
of the same thickness as the scalp hair.
F"lg. 4. — Non -cellular cementum, showing the insertion of the pericemental
fibres.
188
ORAL HEALTH
communicate freely with one another by union of some of their fine
protoplasmic extensions, the other offshoots extending into the
canaliculi as delicate processes of variable length. The corpuscles
in the lacunae near the surface of the cementum, by means of some
of their extensions, seem to be joined to protoplasmic bodies in the
pericementum. There is, then, in cellular cementum a continuous
network of living protoplasm throughout its matrix. The cement
corpuscles and their processes should be considered as being con-
tinually bathed in lymph plasma. This plasma circulates throughout
the lacunae and canalicuH which form an inter-communicating net-
work of lymph spaces similar to that found in bone. The nutrition of
the cement cells and the matrix is thus insured.
Fig. 5. — Cellular cementum, demonstrating cemental lacunae near the surface.
Note the canaliculi radiating from the lacunae; also that the canaliculi
of neighboring lacunae anastomose freely.
ORAL HEALTH
189
Fig. 6. — Cellular cementum, showing canaliculi of cemental lacunae near the
surface, extending to the surface of the cementum; also the anasto-
mosis of the canaliculi of neighboring lacunae.
Flfl. 7. — Cellular cementum, showing an extremely large and long passage
extending from the pericementum to lacunae.
190
ORAL HEALTH
Fig. 8. — Cellular cementum. Note the uninterrupted canal system formed by
the anastomosis of canaliculi of neighboring cemental lacunae. The
lacunae shown in this figure are situated midway between the surface
of the cementum and the dentinal-cemental junction.
The dentine is the substance which constitutes the bulk of the
tooth and which gives to it its characteristic shape. The mass o{
dentine consists of an organic matrix impregnated with lime salts and
permeated by parallel canals which radiate from the pulp cavity to
the surface. These canals contain protoplasmic extensions of the
odontoblasts, which are tall columnar cells situated along the
periphery of the pulp, and at their pulpal extremities for a short
distance, the neurofibrils from the pulp.
ORAL HEALTH
191
Fifl. 9.— Odontoblasts.
Fig. 10.— Odontoblasts.
192
ORAL HEALTH
The matrix seems to be a homogeneous translucent substance. Von
Bbner, who is responsible for the demonstration of a stroma of connec-
tive tissue in bone, believes, as does Mummery, that in dentine there
is also a fine connective tissue stroma. Mummery showed that at the
periphery of the pulp, certain connective tissufe fibres could be demon-
strated passing from the pulp into the dentine matrix, and to them
he gave the term "odontogenic fibres.'*
Fig. 11. — Odontogenic fibres. These connective tissue fibres pass from the pulp
into the dentine matrix.
When the intertubular matrix has been subjected to the action of
strong acid for some days, a transparent material remains, which,
when examined microscopically, proves to be a collection of isolated
sheaths or tubes. They are known as the "dentinal sheaths of
Neumann** because of that writer *s careful study and description of
them.
When stained by silver nitrate, Golgi*s rapid method, the sheaths
are rendered black while the matrix remains unchanged. This would
seem to indicate that the zone immediately surrounding the canals
differs from the matrix in the degree of calcification.
ORAL HEALTH
193
Fig. 12. — Dentinal sheaths of Neumann.
Fig. 13. — Dentinal sheaths of Neumann.
194
ORAL HEALTH
Penetrating the dentine in every direction, radiating from the pulp
cavity and extending to the outer periphery of the dentine, are count-
less numbers of small tubes. The calibre of these tubes decreases as
they proceed outw^ards. In the coronal and gingival portions of the
dentine, each tubule describes in its course to the amelo-dentinal and
dentinal-cemental junctions marked curves w^hich are know^n as the
primary curvatures. The course is not direct, as numerous small
spiral turns can be seen on each tubule. These are called the secondary
curvatures. An enormous number of tiny branches are given off from
the main tubules, particularly in the dentine of the root. These small
twig-like branches anastomose freely, providing a continuous netw^ork
of passages in the dentine. In the crown these lateral branches are
not so plentiful. At the amelo-dentinal junction the tubules branch
dichotomously.
Fig. 14. — Dentinal tubules.
ORAL HEALTH
195
Fig. 15.— Dentinal tubules.
Fig. 16.— Dentinal tubules. This figure is a typical example of the anastomosis
of the fine branches of the main tubules.
196
ORAL HEALTH
Fig. 17. — Dentinal tubules and their fine lateral branches. This figure demon-
strates the enormous number of tiny branches given off from the
main tubules.
Fig. 18. — Dentinal tubules and their fine lateral branches. These small twig-
like branches anastomose freely, providing a continuous network ol'
passages in the dentine.
ORAL HEALTH
197
Fig. 19. — Spindle-shaped enlargement at ending of a dentinal tubule.
Extending from the odontoblasts on the surface of the pulp and
entering the dentinal tubules, are fine cytoplasmic processes known as
dentinal fibrils. Modern histological methods have made the
demonstration of these fine prolongations of the odontoblasts a com-
paratively simple matter. Their existence w^as first demonstrated by
Sir John Tomes. TTiis noted dental investigator proved that these
fibrils are soft uncalcified structures, a fact which made his discovery
outstanding.
Previous to this time, it was generally thought that these odonto-
blastic projections were calcified and rigid. In sections where the
pulp is torn away from the surface of the dentine, the dentinal fibrils
may be seen stretching from the odontoblasts into the pulpal openings
of the dentinal tubes. Owing to their extensibility, they are partially
drawn out from the tubules and lengthened somewhat, before sever-
ance takes place.
198
ORAL HEALTH
Fig. 20. — Dentinal fibrils.
Fig. 21.— Dentinal fibrils. The pulp is torn away from the surface of the
dentine and the dentinal fibrils may be seen stretchmg- from the odonto-
blasts into the pulpal openings of the dentmal tubes.
ORAL HEALTH
199
Fig. 22. — Dentinal fibrils. This figure shows a cross-section of dentine, and
dentinal fibrils may be seen in the dentinal tubules.
As stated previously, the object of this bulletin is to demonstrate
that the canal system of the cementum stands in direct communication
with that of the dentine. It has been shown above that in the cellular
cementum there is an uninterrupted canal system formed by the
anastomosis of the processes of neighboring cemental lacunae, and
that this system is connected with the pericementum by means of some
of the fine canaliculi of the outer lacunae. Also, that in the dentine,
there is a continuous network of passages, provided by the inter-
connection of enormous numbers of fine lateral branches given ofE
throughout the course of each dentinal tubule. This system is, of
course, maintained in direct connection with the dental pulp. These
cemental and dentinal systems are not completely separated from
each other by the zone of homogeneous dentine and cementum
which has been considered by some investigators to constitute an
impasse to inter-communication.
The diversity of opinion of noted investigators on this subject
prompted the writer, some years ago, to undertake further intensive
200 ORAL HEALTH
work. It will be pertinent at this time to quote some of the opinions
which have been advanced on this point.
Charles Tomes: — "The cementum is very closely, indeed insepar-
ably, connected with the dentine, through the medium of the granular
layer of the latter; the fusion of the two tissues being so intimate that
it is often difficult to say precisely at what point the one may be said
to have merged into the other. And, in this region there is an
abundant passage of protoplasmic filaments across from the one to
the other.** — (A Manual of Dental Anaiom}).)
Bodecker: — "The living matter of the cementum is uninterruptedly
connected with that of the periosteum, and continues with the living
matter of the dentine, either through intervening protoplasmic bodies
in the interzonal layer, or directly with the dentinal fibres.** —
(Anatomy and Pathology of the Teeth.)
Noyes: — "Most authorities state that the spaces of the granular
layer communicate with the canaliculi of the cementum as well as the
tubules of the dentine. This the author has been unable to confirm.
On the other hand, the granular layer seems to be separated from the
cementum by a thin layer of dentine, and is apparently structureless.
This is separated from the cementum by a dark line and the first
layer of the cementum usually does not contain any lacunae or
canaliculi.*' — (Dental Histology and Embryology).
Black : — "The cementum so far as has been demonstrated receives
no sustenance whatever through the dentine.** "Cementum is
dependent on the peridental membrane for the maintenance of the
life of the cement corpuscles.** "When stripped of its peridental
membrane, it becomes a dead tissue, no matter if the pulp of the tooth
is alive.'* — (Special Dental Pathology).
Hopewell-Smith — Referring to the contents of the granular layer,
states: "Their contents, according to Bodecker are soft protoplasm
which is in connection with the contents of the tubules on one side
and the canaliculi of the cemental lacunae (when they exist) on the
other. It would seem, however, that it is by no means easy to prove
this assertion. The granular layer is stained with the utmost difficulty
by the action of carmine or any other basic, acid or aniline dyes. It
is more likely to be beyond the pale of nutrition.**
"There is, therefore, under healthy conditions, no chain of living
matter joining the pulp to the periodontal membrane.** — (The Histo-
logy (xnd Patho- Histology of the Teeth ) .
Andrews'. — "The cementum is thus seen to be a more or less
laminated bone matrix, containing exceptionally large bone
corpuscles, with numerous canaliculi anastomosing, with others or
with the dentine, through, but not with the interglobular spaces of the
dentine edge near the cementum.*' — (The Development of the
Teeth, and some of the contested points in regard to their development
ORAL HEALTH 201
and structure). The Journal of Dental Research, Vol. 1, No. 3,
Sept., 1919.
A number of histologists believe, then, that primary cementum,
which is the layer in contact with the dentine, extending from the
amelo-cemental junction to the apex, exists as a solid, dense and
nearly structureless zone of calcified basic substance, and which forms
a barrier making impossible any connection between the cemental
lacunae and the dentinal tubules. From an examination of the
majority of ground sections this statement would appear to be true.
Any communication from a cemental lacuna to a dentinal tubule or
to a process from one of the irregularly-shaped cavities in the granular
layer, would take place through a canaliculus from a cemental
lacuna. This canaliculus is an extremly fine process, corresponding
in size to one of the delicate lateral branches of the dentinal tubules.
This connecting canaliculus, therefore, would necessarily be involved
in the process of deposition of the first or basic layer of cementum
which, in the ground sections, appears to be homogeneous. Very few,
if any, ground sections show to advantage the numerous minute
branches which emanate from the dentinal tubules and join them to
each other.
It was evident to the writer that if any advance were to be made
in the study of these tissues, a different and improved technique in the
preparation of sections must be evolved, a technique which would
reveal the true appearance of these delicate structures. It has often
been stated that sections made from chemically softened specimens
do not exhibit the dentinal tubules and their branches as well as
ground sections. This has not been the case in the experience of the
essayist. As stated before, a lacuna can have a connection with the
dentine only through one or more of its canaliculi, therefore, since most
of the findings of investigators in this field have been based upon the
use of ground sections, it will readily be seen that canaliculi crossing
the zone of more or less homogeneous tissue might fail to be observed.
The same technique used by the writer in demonstrating the
extremely fine branches of the dentinal tubuli, as seen in figures 14,
15, 16, 17, 18, 19, 20, was applied to the study of this particular
problem.
Instead of finding a tissue of no apparent structure intervening
between the cellular cementum and dentine, the following fact was
observed. Communication between the cementum and the dentine
does exist, and occurs in three ways. First, the fine extremities of the
dentinal tubules may have anastomosis directly with the canaliculi
of the cemental lacunae. Second, the dentinal tubules often terminate
join the canaliculi of the cemental lacunae. Third, pear-shaped,
club-shaped or irregular spaces in the granular layer on the border of
in spindle-shaped enlargements, from which fine processes extend to
202
ORAL HEALTH
the dentine have direct connection with the dentinal tubules, and also
communicate with the lacunae of the cementum through their fine
canaliculi.
In viewing the following photomicrographs, certain phenomena of
optics must be kept in mind. The thinnest sections which can be cut
will present an appreciable depth as seen through the microscope. It
therefore, is often necessary in the study of these processes, to follow
them by focussing progressively through different planes in order to
trace them. A photomicrograph showing this particular type of
passage will reveal sharply only those structures appearing in the
plane for which it is focussed. Adjacent portions of the same structure
occurring in other planes will be revealed vaguely or not at all. Many
fine passages, because of their direction, are cut transversely and
appear under the microscope as fine dots.
The writer in preparing the following photomicrographs has
endeavored, as far as possible, to show passages occurring in one
plane. It will be readily understood that the passages here shown
constitute but an extremely small proportion of these important
structures.
Fig. 23. — A dentinal-cemental passage. This figure proves that communication
between the dentine and the cementum does exist. On the left of the
figure may be seen a spindle-shaped enlargement of a dentinal tubule,
from which a fine process extends to join canaliculi of a cementa)
lacuna.
ORAL HEALTH
203
Fig. 24. — A dentinal-cemental passage. From a spindle-shaped enlargement of
a dentinal tubule, on the left of the figure, a fine passage may be seen
extending to a cemental lacuna.
Fig. 25. — A dentinal-cemental passage. From a large pear-shaped space on the
border of the dentine, on the left of the figure, a fine process extends
to the cemental canaliculi.
204
ORAL HEALTH
Fig. 26. — A dentinal-cemental passage. The dentine is on the left of the figure,
the cementum on the right.
Fig. 27. — A dentinal-cemental passage. From a large irregular-shaped space in
the granular layer on the border of the dentine having direct connec-
tion with the dentinal tubules, on the left of the figure, a fine process
extends to a cemental lacuna.
ORAL HEALTH
205
Fig. 28. — A dentinal -cemental passage. From an irregular-shaped space on the
border of the dentine, on the left of the figure, a process extends to a
canaliculus of a cemental lacuna.
Fig. 29. — A dentinal-cemental passage. On the left of this figure, enlargements
of two dentinal tubules have joined to form a small passage which
extends to a cemental lacuna.
206
ORAL HEALTH
Fig. 30. — Dentinal- cemental passages. From irregular-shaped spaces on the
border of the dentine, on the left of this figure, two passages are
demonstrated extending to cemental lacunae. The lower passage is
shown vaguely, as it is not on the same plane as the one above.
Fig. 31. — Dentinal-cemental passages. From an irregular-shaped space on the
border of the denture, on the left of the figure, processes extend to
cemental canaliculi. These processes, because of their direction, are
cut transversely and appear as fine dots.
1
ORAL HEALTH
207
Fig. 32. — A dentinal-cemental passage. From the fusion of two dentinal tubules,
on the left of this figure, a fine process extends to a canaliculus of a
cemental lacuna. The dentinal tubules are not revealed sharply, as
they are not on the same plane as the sharply-defined cemental lacuna.
Bulletin Number Three, Canadian Dental Research Foundation.
The photomicrographs illustrating this bulletin were made by Professor G. R. Anderson
of the University of Toronto and the Royal College of Dental Surgeons.
This bulletin was read in part or in full at the following:
National Dental Association, New Orleans, Oct., 1919.
American Academy of Periodontology, New Orleans, Oct., 1919.
Montreal Dental Club, Jan., 1920.
McGill University, Montreal, Jan., 1920.
First District Dental Society, New York, March, 1920.
Columbia University, March, 1920.
Ontario Dental Society, May, 1920.
Ottawa Dental Society, March, 1922.
Local versus General Anesthesia
By Herman Ausubel, D.D.S., Brooklyn, N. Y.
'The Denial Outlook^ April 1921.
Abstracted fcp Dr. Geo. A. Hodges, Turlock.
IN this article the essayist gives you a synopsis of his impressions
gained and conclusions drawn from intimate association with the
most prominent oral surgeons and exodontists in New York City.
He finds nitrous-oxid oxygen anesthesia objectionable for the fol-
lowing reasons :
1 . "You have to watch a delicate and complex machinery which
necessitates the assistance of a trained anesthetist that very few of us
can afford.*'
2. **A mouth prop must be used to keep mouth wide open during
the operation, which is a great obstacle and a nuisance.'*
3. "Gas is more disagreeable to patient than novocain, both during
and after the administration. The headaches and malaise felt after
the operation is also a great disadvantage."
4. "The psychic pre and after effects must also be taken into con-
sideration. Quite a number of reported and unreported deaths have
occurred during the administration of N O, caused by the psychic fear
of the patient or some unknown trouble."
5. "Inability of patient to co-operate under general anesthetic is a
great drawback and hindrance in the proper execution and successful
accomplishment of our work."
6. "Field of operation is obscured with blood and saliva, which is
inhaled and swallowed and the endless sponging interferes with and
prolongs the operation."
7. "Grave results might follow the administration of N O, particu-
larly so in subjects afflicted with high blood pressure, as in arterio-
sclerosis.**
8. "Special preparation of patient necessary, like abstaining from
food for several hours, loosening of corsets and collars, emptying of
bladder, etc.*'
He has boiled down the favorable indications for general anes-
thesia, especially for N2O, to the following:
1. "In cases of trismus, when patient cannot open the mouth for
the injection of a local anesthetic."
2. "In cases of extensive infection where it is feared that a local
anesthetic might spread the infection into healthy tissues.*'
ORAL HEALTH 209
3. "In children and highly nervous and hysterical patients who
cannot stand the sight of an instrument; ether may be used with ad-
vantage in stubborn, uncontrollable children."
4. *'In surgical operations of short duration, like the opening of an
abscess or removal of small tumor, where mouth inhaler may be used
to advantage and removed during the operation."
5. "Where a good number of loose, unbroken down teeth are to be
extracted in different parts of the mouth, where several infections would
be necessary. A good deal of time will thus be saved by a general
anesthetic, without having the objectionable features enumerated
above."
On the other hand, novocain-suprarenin. Ringer solution, applied
subperiosteally or conductively, gives us an anesthesia period of from
one-half to one hour or more, thus giving us ample time to do the most
difficult work in a most deliberate and conscientious manner. No
mouth-prop in our way, no fighting, no vomiting, no headache nor
malaise after operation; no fear of "eternal" sleep is indulged by pa-
tient, no special preparation of patient necessary, neither are grave
results to be feared. We get full co-operation of patient, saving us
the expense of an assistant ; field of operation is not flooded with blood
due to constricting properties of adrenalin, which is the most powerful
stringent known, and which dose may be increased or reduced at will
according to conditions by using different tablets on the market in dif-
ferent proportions of solution.
The occasional ill-effects of local anesthesia as the breaking of
needles, hematomas, injection into muscle tissue, oedemas, after-pains,
etc., may be almost entirely eradicated by a thorough knowledge of
anatomy, by mastering the technique of injection, proper instrumentar-
ium, fresh isotonic drugs of proper strength, observation of thorough
asepsis and a little common sense.
The progressive, wide-awake man does not confine himself to one
particular agent or method, but applies them all in well-selected cases,
according to their indications.
He uses the ethyl chloride spray, nitrous oxide and oxygen, conduc-
tion, subperiosteal, intraosseous, peridental, pressure or pulpal anes-
thesia whenever they are indicated individually or in combination to
accomplish the desired result.
It if best to approach every subject with open eyes, grasp all the
possibilities and use them to the best advantage.
Ehmmate the fad, the extreme, and follow the centre, the happy
medium, which is the safe and sane road for all broad-minded men to
pursue.
Practical Hints for Oxygen Gas Extractions
DO not use gas on very stout patients or you will have trouble.
Use a local instead.
It is usually safe to use it on anyone who is well enough to
walk to the office, if properly administered.
It is essential that the patient have confidence in the operator; tell
the patient to concentrate on a pleasant thought; do not give any in-
structions about breathing unless the patient starts to breathe too
fast; if instructed beforehand he will surely drain the bag. If the gas
tank goes dry when half under, the case will usually be a failure.
One of the chief reasons for failure to get the tooth and loss of con-
fidence on the part of the patient is caused by the patient slipping
down in the chair while under the gas. To prevent this occurrence all
one has to do is to close in the arms of the chair against the thighs be-
fore starting and it will hold the patient as in a vise. The only way
he can get up is to take the chair with him.
As a rule it is foolish to extract a third molar that is as thin as an
egg shell, as it is a dangerous procedure fishing out the pieces, and if
the root is cone shaped it usually shoots out of the forcep. If this oc-
curs drop the forceps, pull the head forward and get out the pieces
with your finger.
To prevent pieces of teeth passing down the throat adjust the pa-
tient's head so that the occlusal surfaces of the. upper posterior teeth
are practically level; this will cause the base of the tongue to rest
against the soft palate thereby closing the throat from the mouth.
One of the dangers of using the nasal inhaler for extraction work is
the possibility of giving the patient too much gas, thus decreasing the
reflexes. If one should lose a tooth in this condition the patient can
not readily cough it up.
As a general rule it is better to do the work under local anesthesia
if the work cannot be done in a minute's time, which is the duration of
time for painless work when face inhaler is used.
Unless one is naturally quick and adept at extraction work it is well
not to experiment with gas machines, as the patient is pretty sure to
get poor service unless the case is very easy. It seems that the most
difficult cases want gas.
Frequently the tooth is extracted and after the patient has returned
to consciousness he states that he felt the pain. TTiis is usually due to
the fact that the patient was not completely under when the face-piece
was removed: again it takes eighteen seconds for the final gas inhal-
ation to reach the nerve centres and if one waits a few moments after
removing the face-piece the best results will be attained.
— Ceo. E. Cox, Dental Summary.
Our Buffalo Letter
Habec Makes a Flying Trip Into Highbrowland.
MAYBE we will not surprise you with our broad knowledge of
psychology, or convince you of our intimate relationship with
those profound occult forces that sway the mind of man and
influence his conduct in life, but we are ready to admit some slight
acquaintance with this new twentieth century science, with which the
enlightened seem to be quite familiar, while the unenlightened appear
to have mastered its intricate problems. This fact makes it a very
dangerous plaything and requires the good sense of the more serious
minded to keep it on an even keel.
Psychology is said to be the science of mind, and mind is the
laboratory of thought, hence psychology is the medium through which
mind distributes thought in myriad and divers ways. "As a man
thinketh in his heart so is he;" and this is where we come in. It is
essential for the dentist ever to keep the thought of success in mind,
that it may be lodged in the minds of his patients. The result is to
inspire confidence in his ability and to establish that gratifying rela-
tionship so much desired by the professional man.
Let us draw a picture of the ideal dentist. As prime fundamentals
he must have health, good address and requisite education. He must
be imbued with the spirit of unselfish service and exemplify this prin-
ciple in his daily work. Monetary consideration must be secondary
at all times, and "for value received" made a constant working com-
panion. These are the apparent or external qualifications. We
must now turn to the great within — ^that fathomless realm so meagrely
charted and entirely removed from that which we call personality;
we have entered the labyrinth of mind — subliminal and subconscious
mind.
Consciousness, a quality of mind, puts us in touch with all that
exists in the external world; while subconsciousness, a reflex of
consciousness, registers upon the deep tablets of the brain every
thought, original or transmitted, that passes through the mind. Herein
we find association of events, persons, objects, etc., originating. The
long dormant thought is resurrected by a passing object; the sight of
a face unexpectedly, may instantly recall a picture of events woven
through many years of the past. All this, and more, is familiar to
each of us and cogently impresses the importance of this unmastered
force quietly awaiting the call to respond to our demands, no matter
how taxing they may be.
We would like the young dentist to take particular note of the last
212 ORAL HEALTH
statement, for it is in this division of the mind that he will find his most
potent source of development, his greatest means of expansion and
progress.
Dentistry is a taxing occupation, and we need all the help we can
secure to fortify us against the onslaught of devastating nerve strain.
We have this help in psychology properly applied, but it must be
fortified by a power stronger than human. It must have its tenacles
deeply imbedded in the divine, and he who would master himself an4
his circumstances must follow the same path trodden by the great and
noble characters of the present and the past. It is the only direct and
common sense route.
This does not mean that he must follow all the rites and forms of
the church or adhere to all the complex man-made laws, but he must
attain a high standard of equanimity through constant intercourse
with the Great Source of supply. This result must be secured through
right thinking and practice, for it does not come in a day or a year,
but through the constant succession of days and years devoted to
service. Each day of unselfish service takes on added value and is
enjoyed in an ever-increasing ratio until the dentist has no "bad days'*
and no "cranky patients." When you have reached this high plane
you have become the ideal dentist and a positive success in your
profession. Your patients will love you and your reputation will
supply the income of a big fortune well invested.
Habec will produce another instalment on this subject as soon as
the factory resumes operations on full-time schedule. Perhaps he will
tell you how England and France are now being **Coo-aid."
HABEC.
Moving In
Four Six-Year Molars are waiting, my dear,
And anxious to move right in;
A little mouth that is pure and clean,
Where no dirt lurks within.
"We come to stay if you treat us right,
And we'll work for you every day;
We'll grind your food with greatest care,
And never ask for pay.
"But if you neglect us, you'll be sad.
And sorry we ever came,
For we'll start to decay, indeed we will.
And cause you dreadful pain.
"There's just one way to keep us fit.
And keep you happy, too —
And that's to wash us every day.
When every meal is through."
—DORA LAWRENCE CAMERON, Wenatchee, Wash.
BRITISH COLUMBIA-
ALBERTA— ]OHN W. CLAY, D.D.S.
914 Herald BIdg., Calgary
SASKATCHEWAN— C. W. PARKER, D.D.S.
Imperial Bank BIdg., Regina
MANITOBA—^. W. WRIGHT. D.D.S.
767 Warsaw Ave., Winnipeg
ONTARIO— Lieut-Col W. G. THOMPSON
28 King St. West, Hamilton
Qt/EB EC— ALBERT DELORME. D.D.S.
713 St. Catherine St., East, Montreal
MARITIME PROVINCES— STANLEY BAGNALL. D.D.S.. Halifax. N.S.
MARITIME PROVINCES.
J. Stanley Bagnall, D.D.S.
AT the last regular meeting of the Halifax Dental Society Dr.
Kenneth McKenzie gave a talk on "Mental Suggestion."
Mesmer (1734-1815) thought that people had magic fluids
which could be passed from one to the other. He started his seances
in Vienna, where he obtained considerable success, but was later
banished. He then went to Paris, and there had an enormous fol-
lowing. He was very successful there also, but later had to flee. The
time and place of his death are unknown. But his name survives in
the term Mesmerism. Other writers before Mesmer's time had
described the same phenomena, and had related cures from its use;
but in no case had organic disease been cured by Mesmerism.
The subject fell into disrepute in England in the early part of the
1 9th century, but was still carried on in France.
The term Mesmerism is now seldom used, and has given place to
the wider term Mental Suggestion. It is to be regretted that there
should be so much mysticism surrounding "Suggestion," and that
crowds of credulous dupes should flock to each new exponent of the
cult. That there is a real use for Mental Suggestion in the field of
Medical Therapeutics was proved in England during the war, and a
special hospital was established for the treatment of neurological
cases. The speaker related some very interesting experiences he had
observed while stationed in this hospital. One soldier had been shell
shocked, and was paralysed for three years. He had been in general
hospitals for one and a half years, and had been seen by many
eminent specialists, none of whom were able to make him walk. He
was sent home and remained there for a year and a half. And was
214 ORAL HEALTH
then sent to this special hospital for treatment, where he was cured by
mental suggestion in three days. Cases of functional paralysis and
functional blindness were also cured there. Another interesting group
were those who could either not speak at all, or only in whispers.
Some were cured by suggestion in fifteen minutes. The essence for a
cure was the necessity for realizing that the case was a functional
one, and then making the patient believe that he could speak. When
cured there was no danger of a relapse.
Cures of this nature have been made for many years, but the
rationale of the cure had never been understood. The speaker told
of a case in his own practice of a man who could not speak. The
patient gave a history of intermittent periods when he was able to
speak. Dr. McKenzie was convinced that the case was one of
functional paralysis, which could be cured by suggestion. He
instructed the patient to return on the following Thursday evening,
but the man recovered his voice the evening before the appointment.
Three factors help in the recovery from disease:
1. Natural power of recovery of body; patient establishes an
immunity to that disease.
2. Action of a particular remedy, continual attempt made by
medical men to assess remedies at their proper value.
3. Suggestion.
These three factors are not always present in the cure of any one
disease. Thus in the case of measles, the whole cure is result of
natural recovery. Whilst in other cases whole cure is brought about
by suggestion. With many diseases there are two or more factors
involved in recovery.
There is a close relation between the physical and the psychical,
and the two are intimately bound together. Thus a professional man
who overworks may get indigestion, accompanied by pain. He then
goes off on a fishing trip and these symptoms all disappear. The
explanation is that worry is psychical and interferes with bodily
functions, then if the worry is removed digestion goes on at the old
pace. There is actually indigestion present, the patient does not
imagine it. Again, on the other hand overeating may cause worry,
here the physical produces the psychical. There is also an effect on
the endocrins. A Harvard professor a few years ago made a study
of the thyroid content of the blood. He found there was a change in
the quantity produced by fear, hunger, rage and pain. A psychical
cause here produces a definite bodily change.
Suggestion plays a part in every walk in life, and there is a place
in Dentistry for Mental Suggestion Everyone has met the patient
who suffered from a violent toothache, which disappeared^ the minute
ORAL HEALTH 215
patient suffered was crowded out of his mind by the new idea. If
a patient is told he is not suffering pain while he really is, result is that
he really feels more pain. Also if a patient is told that a certain
operation is going to hurt, this will make the patient feel the pain ail
the more. But if he is told that it will only hurt a little, then the
patient does not mind the pain as much. The patient should, of
course, not be told an operation will not hurt, when it will.
The medical men of the past have not paid enough attention to
the curative powers of Mental Suggestion, especially in those cases of
functional disease which respond most readily to its use.
The above are merely notes on the lecture, and not an exact report.
A new step in Public Health is being taken this month in the
County of Antigonish. A fully equipped Health Caravan will tour
the county for a month. The staff consists of a doctor, dentist and
nurses. The first health caravans in the province were sent out two
years ago. At that time the whole Province was covered by two
caravans which only visited the larger centres, and no adequate
preliminary investigation of the health conditions of the various
sections had been made. This time the county, where the Clinic is to
work, has been divided into twelve groups; and the clinic will stop at
a central point in each group for a period of two days. And in addi-
tion to this the county has been accurately surveyed by the county
public health nurse. Large posters have been placed in all prominent
places giving the locations and dates at which the caravan will stop.
During the stops public health talks are given. Early reports of the
clinic point to its instant success, and a fuller report of the work will
be given later.
W. H. Young, D.D.S., (Dal 1922), is the Dental Officer with
the Red Cross Health Caravan at present touring Antigonish
County, N.S.
The following graduates of Dalhousie, 1922, are locating for
practice at places indicated: G. Green, D.D.S., Hunter River,
P.E.Is.; Z. I. Grono, D.D.S., New Waterford, C.B.; A. C. Hay-
ford, D.D.S., Mahone Bay, N.S.; D. M. Reed, D.D.S., Middleton,
N.S.; H. W. McDonald, D.D.S., Sydney Mines, C.B.
THE regular monthly meeting of the Halifax Dental Society
was held on Tuesday, March 14th. Professor J. A. Dawson
of Dalhousie University read a paper on "The Present Status
of the Theory of Evolution." The lecturer gave a most interesting
discussion of the leading theories dealing with evolution.
The Annual Meeting of the Nova Scotia Dental Association will
be held in Halifax on July 13th and 14th.
216 ORAL HEALTH
MANITOBA.
W. W. Wright, D.D.S.
IT is so easy to say nice things about a person — anybody can do
that, but it takes a real friend with plenty of tact to make critical
remarks about you for your betterment.
The writer met a friend on the street the other day, — a fine hand-
some chap and a very promising dentist. But! The reason for the
"but" in this case was that his teeth were so stained and unclean
looking that his smile was simply spoiled, his attractiveness particu-
larly as a dentist was discounted to an unreasonable extent immedi-
ately. I felt I should say: "For heaven's sake, why don't you clean
your teeth?" I have noticed how lax some dentists are about the care
of their own teeth, and since it does us good to be reminded of our
shortcomings sometimes, I have taken the liberty of using this space
at my disposal. Personally, I find it very convenient at times to
explain things to patients by showing them my own teeth, fillings,
gums, etc., and would certainly feel handicapped were I ashamed
to do so. I am satisfied that often a wavering, doubting patient has
been put at ease as to the best thing to have done by knowing just
what I have had done for myself. Here's hoping the party who
caused this outburst may read these lines and benefit by them.
Perhaps, because of our attitude toward the advertising question
in general, we look for "ads" about dental supplies to stick pretty
close to the truth. This remark is occasioned by an "ad" I see appear-
ing quite generally regarding a certain electric mouth lamp which
gives you "an accurate idea of how ever}) blind abscess appears in
every patient's mouth when transilluminated," etc. The writer asked
the manufacturer of this particular lamp to diagnose a case for him
which happened to be in the office, but tTie case proved to be an
exception. The lamp is a useful adjunct to the office, but of very poor
diagnostic value for a blind abscess, and if purchased for that purpose
only, is suited for the box containing your other memoirs of wasted
money. At least, such is the writer's opinion, as it tells me nothing
about a blind abscess that I cannot as well determine without it.
I feel so satisfied over having spent thirty cents on a sand egg-
timer for my office recently that I've got to tell you about it. It is
conceded that if we mix amalgam by hand with mortar and pestle
it must be mixed at least three minutes. Those three minutes do not
pass nearly so quickly as I often used to think they did. Try it and
ORAL HEALTH 217
see. Place the timer where it can be seen by you or the nurse, but
not easily by the patient, as it does not add to the attractiveness of a
room. ;^ ;^ ;^ ;^ y ;^
The Winnipeg dentists are again conducting golf competitions and
games, using alternate Wednesday afternoons. The golf committee
this year consists of Drs. T. O. Forsyth, Manly Bowles, C. F. A.
Jackson, J. A. Dow and C. H. Moore.
Dr. Harry Risinger is removing to Detroit, Mich., and was
tendered a complimentary dinner at the Fort Garry hotel by a number
of his confreres. ;^ ;^ ;^ ;^ ;^ ;^
Winnipeg is to have a building built for and owned by physicians
and dentists. The South-East corner of Graham and Kennedy
Streets, 100x150 feet, has been purchased, and construction is to
start immediately, with the object of having the building ready to
occupy by December. The rents in buildings on the main business
streets are reaching such high points, and the question of longer leases
so unsatisfactory, that it was felt something had to be done. Dr. C.
P. Banning is seretary of the building organization, which at present
plans accommodation for one hundred physicians and dentists.
BRITISH COLUMBIA.
THE Victoria Dental Society held the annual meeting in the
form of a Banquet in Dominion Hotel, on April, 23rd, 1 922.
During the evening reports were read by the retiring officers
of the society and the report of the nominating committee unanimously
adopted. The following are the officers for the ensuing year: Presi-
dent, Dr. William Russell (re-elected) ; vice-president. Dr. R. E.
McKeon (re-elected); secretary. Dr. E. W. Hetherington ; treasurer.
Dr. B. Cummings Richards (re-elected) ; executive committee, Drs.
H. Hare, W. N. Gunning and G. J. C. Walker.
At the conclusion of the dinner. Dr. R. Ford Verrinder expressed
the regret of members of the dental profession at the impending
departure from the Province of Mr. Henderson, who for the past
twelve years had capably represented the Temple-Pattison Company
in British Columbia, and has now been promoted to the office of
Dominion sales manager of the firm with future headquarters at
Toronto. Mr. Henderson was the recipient of a handsome desk
clock in leather-bound case, and suitably engraved. In acknow-
ledging the gift the recipient thanked the members for many kind-
nesses shown him, and promised a continued interest in their welfare,
hoping on periodical occasions to revisit the Province. — E. W.
Hetherington, D.M.D., Scretar];.
The Teaching of Mouth Hygiene in the Pubhc
Schools *
By G. C. Howard, D.D.S., West Union. W. Va.
IT IS PRETTY HARD for a professional man to talk on a sub-
ject or introduce legislation pertaining to the profession he prac-
tises without the public conceiving the idea he is doing it for
the profession or his own personal benefit. Permit me to say I am not
in the Legislature for personal gain or honor, have no political aspira-
tions ; but to tell you the truth, I am especially interested in the life and
health of the boys and girls of West Virginia.
In looking after the bigger things of County and State, I am afraid
we have overlooked some of the smaller things, which are really justly
and truly the greatest of all. One, I am sure you will agree with me,
is the life and health of our boys and girls. We owe it to them that
they may have a strong physical body, and thereby be the better
enabled to go out and fight the battles of life and reach the highest
points in educational attainments, making better men and women, and
last, but not least, better citizens. You will notice that I put: health
first before you apply the mechanical, because without a good strong
physical body you cannot attain the highest standard of scholarship,
especially if the pupil is disturbed with aching teeth and abnormal
oral conditions. The teeth lay the foundation for the health and
strength of mankind. It is the teeth that first receive, work upon and
prepare the food that is the fuel of the body ; then the first and great-
est step to good health is to have good teeth.
It is to be deplored that the number of persons who realize the value
and appreciate the comforts of good health is so small. Only eight
per cent, of the population of the United States have a true conception
of the value of the teeth, and pay proper attention to them. The
other ninety-two per cent, are content to go through life with deformed
faces, unsanitary and unhealthy bodies, and suffer great pain because
they are ignorant of the true functions of the teeth, or are too neglect-
ful and careless to give them the required attention. This is just to
give you a little idea of how the people regard one of the greatest as-
sets to the comfort and well-being of one's life and health.
From a health standpoint it is more important that the child's teeth
be brushed after each meal than to wash the face on rising, although
we will admit both are essential.
True, it is a clean tooth never decays, and that statement would
seem to be ouite important enough of itself, but when to that know-
ledge is added the further fact that clean, well-kept, properlv cared-for
teeth mean the health of the entire body and its immunity from the at-
*Presented at the Banquet, West Virginia State Dental Society, 1921.
ORAL HEALTH 219
tacks of diseases of many kinds, the importance of the subject becomes
paramount to all of us. The care of the mouth and teeth is the one
great duty that each one of us owes to himself, that each parent owes
to his child, that each teacher owes to every pupil, and every edu-
cator owes to those under him and about him.
Every child is entitled to the privilege of growing up healthy and
strong. Don't wait for your child to outgrow this condition. Help
the little fellows to get all there is out of food and out of life. Look
over the reports of the medical and dental inspectors in the public
schools who have made but a glancing examination of the mouths,
and you will find that decayed teeth outranked all other physical de-
fects combined. Such mouths and teeth breed disease; such children
cough and sneeze millions of germs made virulent and active in an
ideal breeding ground. Then again, the teeth are a crushing, masti-
cating machine, and are frequently ruined by the time the child has
reached twelve or fourteen years of age. It is true they can limp
through life with this dreadful handicap, just as an automobile can
climb a hill on three cylinders, but you can rest assured that a child
with wretched teeth at fourteen is travelling on his second speed until
he reaches thirty-five, and from there on he drops into low gear to
finish the journey in a slow and uncertain state.
A chain is no stronger than its weakest link. Mastication, digestion
and assimilation — there is a three-link chain. If we weaken mastica-
tion by losing or injuring the teeth, we have weakened the one vital
link of the chain UDon which our health and lives depend.
The first asset the State and Nation has is its boys and girls. Why
not teach mouth hygiene in the public schools? — Dental Summary.
Betty Suck Your Thumb
Little Betty Suck Your Thumb
Was a pretty baby;
But. alas! when she grew up,
Made a homely lady.
Betty's Mother did her best —
Tried to break this habit,
Betty now is sad herself
That she ever had it.
For she spoiled her pretty mouth,
Changed the shape completely —
Gone the winsome little face
That could smile so sweetly.
Pushed her teeth all out of place,
Yes, indeed she did it,
Children wise won't suck their thumbs.
No, not for a minute.
—DORA LAWRENCE CAMERON, Wenatchee, Wash.
ORAL HEALTH
I
EDITOR:
WALLACE SECCOMBE, D.D.S., F.A.C.D., Toronto, Ont.
CONTRIBUTING EDITORS:
C. N. JOHNSON, M.A., D.D.S.. F.A.C.D., Chicago.
RICHARD G. Mclaughlin, D.D.S., Toronto.
W. E. CUMMER, D.D.S., Toronto.
J. WRIGHT BEACH, D.D.S., Buffalo, N.Y.
Entered as Second-class Matter at the Post Office, Toronto.
Subscription Price, Canada and United States, two dollars per annum;
elsewhere three dollars. Single Copies. 25c.
Original Communications, Book Reviews, Exchanges, Society Reports, Personal Items, and othei
Correspondence should be addressed to the Editor, Oral Health, 102 Wells Hill Ave., Toronto, Canada.
Subscriptions and all business Communications should be addressed to The Publishers Oral Health,
Royal Bank Building, 269 College St., Toronto, Canada.
Vol. XII.
TORONTO, JUNE, 1922
No. 6
H
Er>ITOR.IAL(
The Dentist as ?n Expert Witness
H
THE wise professional man is constantly preparing and fortifying
himself for any emergency or unusual demand that may be
sprung upon him as a member of his profession. One of the
emergencies he may at any time be called upon to meet is that of
being summoned as an expert witness.
An ordinary witness is one who is summoned to testify as to what
he saw or heard on a certain specified occasion, — a simple under-
taking if he but tell the truth. The case of an expert witness is some-
what more difficult and more complicated.
An expert witness is one called to give his opinion on some profes-
sional or technical matter before the court, of which he has special
knowledge or experience. In the case of a dental expert, that opinion
is based on his professional learning and his observation of the dental
facts involved in the case. If, in the course of his evidence, he is
found in error, it shows either a lack of learning in the profession in
which he is claiming to be an expert, or a want of care in his obser-
vation of the dental facts upon which his opinion is based. Hence,
the expert witness has need of special knowledge and thorough
preparation of the particular case under consideration.
The dentist is liable to be called as an expert witness to testify
ORAL HEALTH 221
either in a civil suit for damages against a fellow practitioner, as to
whether the particular treatment complained of, was in accordance
with the usual and customary practice under the circumstances, or
wherein it was not. As, for example, in the treatment of a putrescent
pulp and the filling of the root canal, whether the operations showed
proper and skilful procedure, or whether a denture was properly
constructed and is a reasonable fit, etc., etc. Or, he may be called
upon by the State to give expert evidence in a criminal case for alleged
malpractice, as in the case of death resulting from improper adminis-
tration of an anesthetic. Again, he may be summoned by the State
to identify a dead or living person by means of the teeth and dental
operations performed thereon.
In whatever sphere of dental activity the dentist is called upon to
give evidence, he would be well advised, before going into the witness
box, to make thorough preparation, acquainting himself thoroughly
with the whole question under consideration and the facts that are to
be proven or disproven. As an expert he should be able to support
his opinion by clinical experience and observation, as well as from
other and accepted authorities. As an honest expert he should
approach all such investigations with an open mind, his only object
being to bring out the truth, in order that justice may be done.
Moreover, having undertaken to give expert testimony in a par-
ticular case, and having made all necessary preparation, the position
and conduct of the dentist in the witness box is a matter for some
consideration.
This is an ordeal that most professional men approach with con-
siderable hesitation and misgiving. However, little difficulty or
embarrassment will be encountered if the witness has not erred in
either of the two important essentials, viz., to make careful preparation
and to tell the simple truth.
There are generally three stages in the examination of an expert
witness. First, a few questions intended to ascertain and show to the
court that he is qualified by knowledge and experience to appear as
an expert witness in this case. Second, the friendly counsel, after
some preliminary questions, asks him for his opinion in the matter
before the court. Third, the cross-examination by the opposing
counsel. This cross-examination is, of course, the crucial test. The
opposing counsel who is conducting it will in one or many ways
endeavor to lessen the value of the expert's opinion in the eyes of the
jury. However, if the witness has given his opinion simply, straight-
forwardly and truthfully, and is prepared to support that opinion by
the best authorities on the subject, he need not fear the most rigid
cross-examination.
The manner in which the expert gives his evidence when on the
stand is of importance. He should be a willing witness, testifying
222 ORAL HEALTH
frankly and fully as to all questions asked him, without, of course,
volunteering unsolicited information. He should not give the impres-
sion that he is keeping back any evidence. Such a demeanor would
be likely to lessen the value of his opinion in the eyes of the jury.
Again, the expert witness should avoid, as far as possible, the use
of technical terms or language. The temptation is strong just to
"show off" a little before the court; but he should remember that the
object of his evidence is to make the subject plain and simple to the
lay minds of the jury, and not to demonstrate his own knowledge.
Further, the witness should, as far as possible, be definite and
explicit in all his answers. Loose or ambiguous answers frequently
lead to the undoing of the witness. *'How long have you been in
practice, doctor?" should not be answered, "Five or six years," but
definitely, — "Five years" or "Six years," as the case may be. "Have
you had much experience in this kind of practice, doctor?" should not
be answered "Yes, considerable," but (if correct) "I have treated
ten such cases during the past year." Such definite answers leave no
loophole for further comment, and the jury will be impressed by the
clear and decisive way in which such answers are given.
Finally, the witness should avoid losing his temper, even under the
greatest provocation; but, throughout, should endeavor to give his
evidence in a decided, but courteous and modest manner — R.G.McL.
Modern Grown and Bridge Work
DO you remove a piece of bridgework from the mouth, after its
sojourn in the oral cavity for even a short period, and find it
sweet and hygienic? Why did you rush the piece of work to
the tap ? Was it any less offensive while it remained in the patient's
mouth ?
Many dentists who believe in oral cleanliness are commencing to
feel uncomfortable about "Modern Crown and Bridgework,* *and to
wonder if, after all, many of our methods of replacement have not
been more or less of a failure.
In Honor of Drs. Noyes and Gilmer
THE Illinois State Dental Society tendered a complimentary
banquet to Dr. Edmund Noyes and Dr. Thomas L. Gilmer, in
honor of their half century of service to the Society. The
banquet was held on Tuesday evening, May the Ninth, 1 922, at the
New Leland Hotel, Springfield, Illinois.
gff
oil
OPAL HEALTA
A JOURNAL THAT STANDS FOR THE '♦OUNCE OF
PREVENTION," AS WELL AS THE ** POUND OF CURE"
m
m
VOL. 12
TORONTO, JULY, 1922
No. 7
Histological and Histo-Pathological Studies
of the Dental Pulp
Harold Keith Box, D.D.S., Ph.D., F.A.A.P.
The Normal Constituents of the Dental Pulp.
THE dental pulp is a delicate connective tissue of an embryonal
type. "The embryonal type of connective tissue consists of a
delicate protoplasmic network containing a semi-fluid inter-
cellular substance. The netw^ork is formed by the union of the pro-
cesses of irregularly branched stellate or fusiform cells whose oval
nuclei are embedded in the plate-like masses of faintly granular
cytoplasm. The intercellular ground substance is semi-fluid and
depending on the stage of development, either structureless or
traversed by indistinct fibrilli. The latter owe their origin to the cells
and are produced by differentiation of the cytoplasm." (Piersol.)
Fig. 1. Odontoblasts.
224
QRA1.;HE ALTH
Along the periphery of the pulp is a layer of tall, columnar cells
known as the odontoblasts. During the period of dentine formation,
these cells are large and nucleated, and more or less columnar in
shape. Some are short and thick, while others are long and thin. The
nuclei are large and oval and are situated in the pulpal third of the
cells. The walls of the nuclei are well defined. Extending into the
dentinal tubules are long cytoplasmic processes known as the dentinal
fibrils. In many instances two fibrils are given off from a single
odontoblast. In some sections can be seen three or four. Delicate
processes can be traced from the pulpal ends of the cells into the
"basal layer of Weil," which consists of a comparatively pale and
translucent zone lying between the inner ends of the cells and the
pulp.
Fig. 2. Odontoblasts.
Cells and Matrix.
In the root portion of the dental pulp, the cells are fusiform with
the long axis parallel with the canal. In the coronal portion, the cells
are round and branched cuboidal. In the large irregularly branching
cells the cytoplasmic extensions are generally three or four in number,
giving a stellate appearance to them. The processes given off by
the cells soon taper down to mere threads which extend for a great
distance throughout the intercellular substance. Some of the exten-
sions of the stellate cells project for quite a distance before narrowing
ORAL HEALTH
225
and in many cases they sub-divide into two or more threads. The
cytoplasm of the cells is faintly granular, the nuclei fairly large and
ovoid in shape. In them a distinct chromatin network can be seen.
Some nuclei seem to take the stain more deeply than others.
Fig-. 3. Pulp cells.
Upon reviewing the researches by the most noted dental histolo-
gists, on the intercellular substance of the pulp, it is evident that very
little is known concerning its structure. There are many conflicting
opinions. The essayist feels that the studies shown in the following
figures will give us a more definite understanding of the nature of this
tissue. The fine elements in the pulp matrix are not brought into view
unless special stains are employed to color them. Mallory makes the
statement that connective tissue cells produce under different condi-
tions three kinds of fibrils, fibroglia, collagen and elastic. In mucous
connective tissue, mucus composed of a group of nitrogenous, albu-
minous substances called mucins, occurs between the collagen fibrils.
The fibroglia fibrils have an intimate relationship to the cytoplasm
of the cell. They are very delicate, forming part of the periphery
of the cell from which they arise and run along its cytoplasmic pro-
cesses.
Collagen fibrils run in wavy bundles made up of delicate fibrils,
cemented together.
The elastic fibrils occur in the form of a network of fibrils varying
in size, and are found only in certain situations as in the walls of the
blood-vessels.
226
ORAL HEALTH
In figures numbered 4 and 5, special preparations and studies can
be seen. It will be observed that there is very little unoccupied space.
In the sections from which the photomicrographs were made the
collagen fibrils are shown as reddish-brown wavy bundles, the
fibroglia as blue fibrils. In figure No. 5 elastic fibrils can be seen
around the blood vessels.
Fig. 4. Collagen fibrils in pulp.
It must not be overlooked that besides the fibrils mentioned, there
are also in great abundance throughout the matrix, the hair-Hke pro-
cesses of the cells.
As a point of interest, it might be stated that Raphael Isaacs, of
the Anatomical Laboratory of the University of Cincinnati, in obser-
vations on connective tissue and neuroghar fibrillae, believes, after a
study of living connective tissue in cover glass and hanging drop pre-
parations, that the intercellular substance is homogeneous.
The connective tissue fibrillae described as exoplasmic fibrillae by
Mall and others do not appear in the living intercellular connective
tissue colloid. They can be produced in fresh tissue under the
microscope through any agency which will cause the material distri-
buted in the intercellular substance, to shrink up. The pattern and
delicacy varies with different fixatives. He also believes the spindle-
shaped type of connective tissue cell to be the most stable form, the
stellate cells often reverting to this shape when freed from surrounding
pressures.
ORAL HEALTH
111
Fig-. 5. Elastic fibrils in pulp.
Fig:. 6. Processes of pulp cells.
228
ORAL HEALTH
Blood Supply.
The arteries which vascularize the pulp are branches of the Superior
and Inferior Dental and Infra-orbital divisions of the Internal
maxillary artery. Usually three or four branches enter the pulp
through a minute canal in the apex of the root. Sometimes we find
two or three canals instead of one. In many cases, usually adult
teeth, there is but one artery nourishing the pulp. Shortly after its
entrance, each artery passing occlusally, repeatedly gives off branches
which become smaller in calibre as the surface of the pulp is
approached. Beneath the odontoblasts, a rich capillary plexus is
formed. Small veins following the course of the arterioles collect the
blood, and becoming larger in calibre, following the course of the
larger arteries, they proceed to the apical foramen where they pass
out.
The walls of the blood-vessels of the pulp are unusually delicate,
the smaller veins and sometimes fairly large ones being composed,
like the capillaries, of a single layer of endothelium. The larger
arteries have a few muscle fibres in the media, and for an adventitia
a slight condensation of the connective tissue. Some elastic fibres are
found in the walls of the large arteries.
The endothelial cells do not produce any intercellular substance
unless it be cement substance. They are more or less flattened, the
oval nuclei centrally located and taking the stain less deeply than
the connective tissue cells.
Fig-. 7. Blood-vessel entering apical foramen.
ORAL HEALTH
229
Fig. 8. Artery and vein in pulp.
^'^"the ?,"rf^^l ^.T/T..^' """'1 '^-^ branches, which become smaller in calibre as
tne surtace of the pulp is approached.
230
ORAL HEALTH
Fig. 10. A large blood-vessel in the pulp, the walls of which are composed, of
a single layer of endothelium.
Fig. 11. Capillaries on the periphery of the pulp.
ORAL HEALTH
231
Fig. 12. Capillaries on the periphery of the pulp.
The Nervous System.
This subject above all others in dental histology has held the fore-
most place in the field of earnest endeavor for half a century. The
study is a fascinating one and also of first importance, especially in
relation to the innervation of the dentine.
Three or more nerve trunks, in company w^ith the arteries, enter the
apical foramen and pass into the pulp in the direction of its long axis.
These trunks contain the medullated nerve fibres. In nearly every
case, the main trunks follow a course parallel to the large arteries
and in their distribution seem to follow^ the arterioles. As the
periphery of the pulp is approached, the branches consist, in many
cases, of two or three nerve fibres running parallel. In the sub-
odontoblast region, the medullary sheaths are lost, and as beaded
fibres, the nerve filaments enter into an intricate plexus from which
they pass between and around the odontoblasts. Many pass to the
dentinal ends of the odontoblasts, some uniting with others to form a
delicate plexus, but others pass into the tubules and can be traced for
a short distance.
No subject in dental histology has attracted the attention of a
greater number of investigators than the study of the termination of
the neurofibrils which pass from the plexus of Raschow in the sub-
odontoblast region of the pulp toward the dentine. From a purely
histological standpoint, it has proved to be one of great fascination.
232
ORAL HEALTH
and has been a topic of much controversy. A description and demon-
stration of the writer's findings on this topic will be made the subject
matter of a future bulletin.
Several methods have been employed which bring out in different
ways the nerve supply of the pulp, and in order to interpret them
easily a few lines on the structure of nerve fibres is of importance.
The fundamental part is the central cord or axis cylinder. This
extends through the whole length of the nerve fibre from its origin
m the neurone to its terminal arborization. The axis-cylinder is sur-
rounded by a relatively thick coat known as the medullary sheath
outsi^de of which lies the neurilemma, a thin structureless envelope
1 he medullary sheath consists of two parts, a delicate framework
and myelm, a fatty substance that fills it. The sheath is not uniformly
contmuous, but is almost completely interrupted at regular intervals
marked by constrictions. These constrictions are known as the
nodes of Ranvier." In a fresh condition, this sheath is homogeneous
but changes soon occur and segments can be seen, separated from
each other by narrow clefts that extend obliquely from the neurilemma
to the axis-cylinder. These are known as Schmidt-Lantermann
segments.
Fig. 13. The medullary sheaths of pulpal nerves.
ORAL HEALTH
233
Pig. 14. The medullary sheaths of pulpal nerves.
Fig-. 15. Axis-cylinders of nerves in the pulp.
234
ORAL HEALTH
Fig. 16. Axis-cylinders of nerves in the pUlp.
Concerning the neurofibrillar arborizations which appear as deli-
cate filaments minutely beaded, Schafer's explanation, which is
accepted by most authorities, is: *'That the fibrils are not solid, but
of a semi-fluid nature is probable from the fact that they easily
become varicose with little beadlets or droplets upon their course.
This is what one would expect with a viscous fluid but not with a
solid.**
While the nerves of the pulp consist chiefly of medullated fibres,
the sensory fibres which convey sensation from the tissues to the brain,
others, which are non-medullated, are frequently observed accom-
panying them. These non-medullated fibres constitute the neuraxes
of neurones, the cell-bodies of which are situated in sympathetic
ganglia. According to Bohm, Davidoff and Huber, the ganglia of
the sympathetic nervous system "comprise those of the two great
ganglionated cords found on each side of the vertebral column, and
extending from its cephalic to its caudal end, with which may be
ORAL HEALTH
235
Fig-. 17. Neuro fibrillar arborizations beneath the odontoblasts.
grouped certain cranial ganglia having the same structure, namely,
the sphenopalatine, otic, ciliary, sublingual and submaxillary ganglia;
also three unpaired aggregations of ganglia found in front of the
spinal column of which the cardiac is in the thorax, the semilunar in
the abdomen, and the hypogastric in the pelvis; and further, large
numbers of smaller ganglia, the greater number of which are of
microscopic size and are found in the walls of the intestinal canal and
bladder, in the respiratory passages, in the heart, and in or near the
majority of the glands of the body."
These non-medullated fibres in the dental pulp branch repeatedly,
and at their terminations, naked varicosed axis-cylinders end in the
form of clusters of granules on the blood-vessels. Some of the small
lateral twigs terminate in one or two small granules.
From a careful examination of text-^books and current literature,
the essayist is of the opinion that these endings of the neuraxes of
sympathetic neurones have never been previously observed in the
dental pulp.
236
ORAL HEALTH
Fig-. 18. Endings \)f axis-cylinder of sympathetic neurone on a blood-vessel in
the dental pulp.
Fig. 19. Neuraxes of sympathetic neurones on pulpal blood-vessel.
ORAL HEALTH
237
Fig. 20. Neuraxes of sympathetic neurones on pulpal blood-vessel.
Fig. 21. Cluster of granules on pulpal blood-vessel, the termination of an
axis-cylinder of sympathetic neurone.
238
ORAL HEALTH
Fig. 22. Cluster of granules on pulpal blood-vessel, the termination of an
axis-cylinder of sympathetic neurone.
Pathology of the Dental Pulp.
The pulp being a very soft tissue in intimate relation with, and
enclosed in a hard covering of dentine, presents to the student of
pulpal pathology, many obstacles in the process of fixation and
sectioning. The difficulty of perfecting a technique by which the
tissue can be examined microscopically, with a minimum of change
brought about in the process, and the fact that the normal structure
is not thoroughly understood, accounts in part for much of the
obscurity surrounding the true pathological changes in the dental
pulp. By keeping in mind the following peculiar characteristics of
this organ, as a background from which to view these morbid changes,
the essayist feels that the modifications of general principles mani-
fested in this tissue will be better appreciated.
(1) The inexistence of collateral circulation in the dental pulp
causes it to pass quickly from certain hyperemic conditions to infarc-
tion and necrosis. "'W'^'
(2) The pulp is incased in a hard, unyielding tissue, the dentine,
and in hyperemic disturbances, this prevents swelling and restricts the
exudation of serum.
(3) The great vascularity of the dental pulp, the delicate structure
of the walls of the blood-vessels, and the semi-fluid nature of the
matrix, render this tissue susceptible to circulatory changes.
ORAL HEALTH 239
(4) A state of balance is present in the normal pulp, with an
abundant vascular supply on the one hand and a protective covering
of tissue on the other. Loss of this tissue, so often the case as in
caries, abrasion or erosion, creates a new condition, subjecting the
pulp to increased irritations.
(5) The fact that there is but one outlet for the veins increases
the danger of strangulation.
(6) Owing to the close relationship between the blood supply of
the pulp and the pericementum, disturbances in the pericemental
circulation are frequently manifested in the pulp. The periapical
pericementum receives blood-vessels from the medullary spaces of the
bone, some of which, on subdivision pass through the apical foramen
into the pulp. In the majority of cases of traumatic occlusion, the
periapical tissues are subjected to a force of unnatural magnitude.
The dental pulp, then, is peculiar in that its blood supply passes
through a region subject to circulatory disturbances of traumatic origin.
Tliese, in turn, are often manifested in the pulp. It is the opinion of
the writer that many necrotic pulps of an otherwise obscure etiology,
and certain of the degenerations of the pulp, because of nutritional
interference, can be accounted for in this way.
(7) The pulp on account of its delicate structure is peculiarly
subject to degenerations.
Lesions Produced by Special Injurious Agents.
(1) Sudden changes of temperature.
Extremes of heat or cold produce alterations in the circulation of
the pulp. Loss of normal covering of the pulp renders it susceptible
to lesser extremes. Frequent sources are hot and cold foods, the
polishing of fillings, and the injudicious or unscientific grinding of
enamel.
Reaction.
The writer is inclined to hold that the "p^^ysiological" hyperemia
in mild thermal changes is largely a capillary one. The periphery of
the pulp is supplied by a rich capillary plexus and is affected first in
stimuli from without. The hyperemia is brought about by a stimula-
tion of the vasodilators (neurotonic). When these stimuh are re-
peated in excess, a "pathological" hyperemia is produced, by the
paralysis of the vasocontractors ( neuroparalytic). The onflow of
blood through the capillaries is hindered, more blood is poured into
the arteries, with the result that they become congested.
A direct arterial hyperemia is often the result of sudden thermal
extremes. The arteries are expanded and varicosed, the plasma zone
is lost, and the vessels are filled with masses of densely packed red
and white blood-cells. Areas can be seen in which the red cells have
escaped into the surrounding tissues. The veins are collapsed, circu-
lation cannot be restored and the pulp dies.
240
ORAL HEALTH
Fig. 23. Capillary hyperemia of pulp.
Fig-. 24. Capillary hyperemia of pulp.
ORAL HEALTH
24
Fig. 25. Pathological hyperemia of pulp.
Fig". 26. Pathological hyperemia of pulp.
242
ORAL HEALTH
'"'%/\he''b"rc;?fSLl'',?;!";iS'"of°,'ts'c^ou'rs"i."- """' '"« ^"°™°- ^"-'^"°n
'"'^•b.?,'od-?5!s'°^4"i;ou'i?Sf?„'"i.Lfe'au^''.* ^""'- ^°'« «>« ""-' »* ">e red
Jl
ORAL HEALTH
243
(2) A Blow.
The arteries which nourish the pulp and pericementum have a
common origin. The same is true of the nerves. An injury to the
pericementum from a blow on the tooth, is often manifested in the
pulp ao a direct arterial hyperemia. If the blow has been severe,
the capillary anastomoses at the periphery of the pulp are not ade-
quate to carry on the circulation, a pathological hyperemia results,
followed by death of the organ through infarction. Greenfield of
Edinburgh has demonstrated that within five hours after an obstruc-
tion, an infarct is always intensely congested and reddish-purple.
Later, when necrotic changes have taken place, the part becomes
paler and of a pinkish color. The condition known as "coagulation
necrosis" takes place at this stage. The cells undergo the changes
peculiar to necrotic cells, finally becoming homogeneous. Cells,
capillaries and their contents become more or less fused with each
other, forming a structureless mass.
(3) Traumatic Occlusion.
In every case of traumatic occlusion, undue pressure is exerted in
the direction of the long axis of the tooth. The entire pericementum
is subjected to an abnormal strain, and invariably there is produced a
Fig. 29. Arterial hyperemia of pulp.
244 ORAL HEALTH
circulatory disturbance, varying in degree, throughout this tissue.
Certain types of traumatic occlusions tend to produce an excessive
condensation of the periapical pericementum. Dependent upon the
intensity of this condensation, the blood-vessels are more or less con-
stricted and the flow of blood through them is partly cut off. When
the pressure is removed, there is a consequent dilatation of the blood-
vessels. Owing to the close relationship between the blood supply
of the pericementum and the pulp, this disturbance is frequently
manifested in the pulp as an arterial hyperemia.
(4) Bacteria.
-Exposure to carious dentine is the greatest source of infection to
the dental pulp. Other common causes are accidental exposure and
contact with the saliva through fracture in the dentine and from the
general circulation.
In caries, bacteria gain entrance into the pulp shortly after the
dentine in contact with it becomes softened. The different stages
by which bacteria penetrate the dentine and finally reach the pulp,
are seen in Figures Nos. 30, 31, 32, 33, 34, 35, 36.
When the acid produced by bacteria on the surface of the enamel
has dissolved out the cement substance between the enamel rods and
has filtered down through the spaces formed, to the amelo-dentinal
junction, decalcification of the dentine soon follows. Shortly after
the enamel rods begin to fall out bacteria find entrance into the fine
tubules at the periphery of the dentine.
The dentine is continually decalcified in advance of the growing
micro-organisms which easily pass along the tubules. Due to the
action of enzymes produced by the bacteria, the organic matrix is
changed and the infected tubules become enlarged. In many
instances the enlargement is regular along the whole course of the
tubules, while others are characterized by the presence of oval swell-
ings situated here and there upon the tubules. The former have been
called *'pipe-stem'* tubules, and the latter "liquefaction foci."
Tliese foci are crowded with bacteria and many of them fuse
together to produce cavities which ultimately destroy the dentine.
ORAL HEALTH
245
Fig". 30. Bacterial plaque and early stage of tubule infection.
Fig-. 31. Bacterial plaque and more extensive tubule infection.
246
ORAL HEALTH
Fig. 32. "Pipe-stem" tubules and small "liquefaction foci."
Fig-. 33. Larger "liquefaction foci" in caries of dentine.
ORAL HEALTH
247
Fig. 34. Fusion of "liquefaction foci.
Fig-. 35. Extensive caries of dentine.
248
ORAL HEALTH
Fig. 36. Late stages in caries of dentine (cavity formation).
Fig. 37. Masses of dentine undermined by bacterial invasion.
As was stated before, bacteria find entrance into the pulp shortly
after the dentine in contact with it has been decalcified. 1 he
softened dentine is filled with micro-organisms and the pulp is
practically exposed to the saliva. These micro-organisms, including
pyogenic ones, make their way through the odontogenetic zone, pass-
ORAL HEALTH 249
ing between the odontoblasts into the "basal layer of Weil," where
they usually spread laterally. The toxins and injury done to the
tissue cells soon induce an abundant emigration of polymorphonuclear
leukocytes. In addition, fibroblasts and vascular endothelium proli-
ferate abundantly to replace cells of their own type which have been
destroyed. Necrosis, occuring quickly for a definite area surrounding
the bacteria, is the characteristic injury produced by the toxin of the
staphylococcus pyogenes aureus. Through the action of the ferments
secreted by the polymorphonuclear leukocytes, the necrotic tissue is
digested and softened, so that abscess formation occurs.
In the writer's sections on infections of the dental pulp, the areas
of leukocytic infiltrations seems to fall into three groups :
(a) The infiltration is regional and superficial. Upon removal of
the softened tissue and exposure to the saliva, it is followed by a
progressive ulceration.
(b) The infiltration is regional, often multiple, and deep within the
substance of the pulp, followed by liquefaction and pus production,
and death of the pulp.
(c) The infiltration is diffuse, with a predominance of plasma cells.
(a) Regional and superficial infiltrations.
Examples of type of reaction in the dental pulp, from the earliest
stage when the overlying infected dentine is still in contact with this
tissue, to the later stages where there is manifested a great loss of
pulp tissue through ulceration, are shown in Figures 38, 39, 40, 41,
42, 43. In Figure 38, an infiltration of leukocytes has taken place
on the surface of the pulp, although actual contact with the saliva
has not been established. In Figure 39, the softened dentine has
been so removed that the pulp is subjected to the fluids of the mouth.
On the surface, the tissue is breaking down. A line of demarcation
can be seen between the necrotic area and the regenerating fibroblasts
and budding capillaries. The ulceration is progressively destroying
the pulp. In figure 40, the entire pulp is infiltrated with leukocytes
and loss of tissue is taking place superficially. The whole pulp is in a
state of degeneration. The blood vessels are choked with red and
white blood-cells. In figure 41, can be seen a typical example of
gradual destruction of the pulp by ulceration. The pulp has been
lost in the pulp chamber and the suppurative process is proceeding
into the root-canals. Fibroblasts are attempting to wall off the
condition. In Figure 42, a fine example of ulceration of the pulp is
shown. In the section from which this was taken, abscesses are
present in the deeper portions. At the pulpal edge of the ulcer,
fibroblasts are proliferating in great abundance. Budding capillaries
in great numbers are extending from all directions toward the surface
250
ORAL HEALTH
attempting to fill the area with frame -work of new vessels. On the
surface there is an exudate made up of fibrin, dead leukocytes and
bacteria.
"Fig. 38. Ulceration of the pulp. Small leukocytic infiltration near the surface.
Fig. 39. Ulceration of the pulp, later stage.
ORAL HEALTH
251
Fig. 40. Ulceration of the pulp, later stage.
Fig. 41. Ulceration of the pulp, later stage.
252
ORAL HEALTH
Fig. 42. Pulpal ulceration.
Fig. 43. Pulpal ulceration. High magnification near ulcer edge.
{To be completed in August issue)
Provincial Editors' Corner
BHITISH COLUMBIA— A. T. OBERG. D.D.S.,
833 Granville St., Vancouver
ALBERTA— ]OHN W. CLAY. D.D.S.
914 Herald Bldg., Calgary
SASKATCHEWAN— C. W. PARKER, D£).S.
Imperial Bank Bldg., Regina
MANITOBA—^. W. WRIGHT. D.D.S.
767 Warsaw Ave., Winnipeg
ONTARIO— Lieut-Col W. G. THOMPSON
28 King St. West, Hamilton
Qf/SB EC— ALBERT DELORME. D.D.S.
713 St. Catherine St., East, Montreal
MARITIME PROVINCES— STANLEY BAGNALL. D.D.S., Halifax. N.S.
BRITISH COLUMBIA.
AT its May meeting the Vancouver Dental Society closed its
activities for the winter season. Officers for the coming year
vs^ere elected as follows: President, Dr. O. J. Courtice; Vice-
President, Dr. J. F. Hill; Secretary-Treasurer, Dr. G. L. Plant;
Executive Committee, Drs. W. J. Bruce, E. C. Jones, T. W. Snipes,
J. S. Bricker and A. T. Oberg.
A great number of activities have been undertaken during the
past season. Study clubs that have been in progress throughout the
year, and those in charge, follow: Prosthesis: Drs. F. P. Smith and
W. J. Hacking. Gold Inlay Restorations: Dr. T. W. Snipes.
Anatomy and Oral Anesthesia: Drs. E. L. Cox, W. S. Watson
and A. T. Oberg. The Prosthetic Club worked in sections, each
section carrying through a practical case in the mouth. Gold inlay
work was taken through the study of tooth form by carving plaster
models, histological and anatomical studies of structures involved,
and the principles of applying these to the practical making of inlays.
The Anatomy Club secured, for the first time in this province, ana-
tomical material, dissection of which was carried out at the Van-
couver General Hospital. This was later followed by practical
clinics at that institution, and by lectures on the more involved
features of anesthesia in their relation to the anatomy of the region.
On February 26 a large mid-winter clinic was held, clinics on
practically all branches of the work being given. It was the object
of this clinic to develop clinicians among the younger men, and this
was successful to the extent that of thirteen clinicians exhibiting, nine
were men who had never before given clinics.
During the winter Dr. Percy E. Howe, of Boston, spent a day
with the members of the society, giving lectures and demonstrations
on his work on silver nitrate and formalin root canal treatment, and
on diet.
254 ORAL HEALTH
Arrangements are under way for the annual picnic of the Van-
couver Dental Society. This will probably be again held in con-
junction with the Victoria Dental Society's outing, in view of the
notable success of the 1 920 picnic.
The retiring officers for 1921-22, to whom the big share of the
credit for the winter's work is due, were: President, Dr. J. S.
Bricker; Secretary-Treasurer, Dr. W. K. Sproule.
The Vancouver Society, as well as all other districts in the
province, regret the transfer of Mr. John W. Henderson, for many
years past local manager of the Temple Pattison Company, to
Toronto. "Jack," in leaving Vancouver, also left a large number
of warm personal friends among the profession and the citizens gener-
ally. Before his departure a complimentary dinner was tendered
to him, at which he was presented with an illuminated address by
the society, in appreciation of his sincere and constant co-operation
with them in all their activities during his stay here.
A. T. O.
ALBERTA.
IT is worth noting that there have been two attempts to obtain
Private Bills to practise Dentistry in Alberta during the past
winter. The Liberal Government, which has had control in pro-
vincial politics since Alberta became a province, was thoroughly
beaten by the Farmer Party at the election last fall, and a strong
majority Farmer Government stepped into its place.
There have been many rumors of drastic action against the pro-
fessions, but the Legislature has been meeting since early in Feb-
ruary, and the members of the Executive Council especially, con-
trary to public opinion, have shown a desire to uphold the standard
that has previously been thought necessary to safeguard the interests
of the public.
It was probably due to these rumors that two men, both absolutely
unsafe to be allowed to practise dentistry, made serious efforts to
obtain private bills.
One tried to bring political pressure to bear on the Premier and
members of the Council prior to the session of the Legislature. Strong
opposition to these efforts was aroused, and the applicant realized
the hopelessness of his case before the session opened. The other
applicant got so far as to have his bill introduced into the House,
but it was defeated by a large majority on the second reading, mem-
bers of the Government and the Opposition both voting against it.
The acceptance of either of these applications would have resulted
in a precedent on w^hich many other applications would have been
based for years to come.
ORAL HEALTH 255
Officers of the Calgary Dental Society for the year beginning
May. 1922: President, Dr. W. A. Piper; Vice-President, Dr. T.
Skinner; Secretary-Treasurer, Dr. E. R. Upton.
^ T' T* •T*
A special meeting of the Calgary Dental Society was held on
June 2nd, to say farewell to Dr. H. G. Robb, on his leaving Calgary
to take up the practice of Exodontia in Toronto.
Dr. Elmer Wright sketched the career of the guest of the evening
since his arrival in Calgary eleven years ago. Dr. Robb has been
a useful citizen, taking a very active part in the work of Central
Methodist Church, has been a worker in the Calgary Dental Society,
a valued member and officer of the Board of Directors of the Alberta
Dental Association, and a good friend to the members of the dental
profession in Calgary.
Dr. E. M. Doyle presented, as a token of appreciation from the
society, a diamond tie pin to the retiring member.
¥ V T» ^
There passed away, on April 1 3th last. Dr. W. A. Hicks, of
Calgary.
The late Dr. Hicks was a graduate of the Philadelphia Dental
College, coming to Calgary in 1905. He practised his profession
till 1913, when ill-health made it necessary for him to give up his
practice. During the past three years he carried on a useful work
with the S.C.R. until it was terminated by his last illness early in
February.
Dr. Hicks was a prominent Mason, a member of the Committee
on Dental Research of the Canadian Dental Association, and had
been a member for some time of the Alberta Dental Board. His
passing away was a distinct loss to his many friends in Alberta.
J. w. c.
SASKATCHEWAN.
Annual Convention, Saskatchewan Dental Society.
THE fifth annual convention of the Saskatchewan Dental Society
held its meetings at Saskatoon city, on June 8th, 9th and 10th,
and, in point of attendance and interest taken in the proceed-
mgs, has net thus far been excelled.
The members of the local society left nothing undone to make the
convention a real success.
Mornings were taken up with clinics and business sessions, and
the afternoons given over to Dr. A. E. Webster, of the Royal Col-
lege, and Dr. A. W. Thornton, of McGill Dental Faculty, who
delivered a series of lectures en Preventive Dentistry.
256 ORAL HEALTH
The Regina, Moose Jaw and Saskatoon Study Clubs presented
clinics, as well as Drs. Chant, King and Brass.
Friday evening the annual banquet was held at the King George
Hotel, at which Dr. Thornton delivered one of his usual eloquent
addresses on "Dentistry's Place in the Healing Art."
In connection with the annual convention was also held the annual
golf tournament, and this year the cup, donated by the Temple-
Pattison Company, was won by Dr. Watchler, of Yorkton.
Regina was selected as the next place of meeting, and the follow-
ing officers were elected to carry on for the ensuing year: President,
Dr. C. W. Parker, Regina; Vice-President, Dr. F. C. Harwood,
Moose Jaw; Secretary-Treasurer, Dr. C. H. Weicker, Regina.
Educational, Programme and Research Committees were ap-
pointed also, consisting mainly of Regina practitioners.
Drs. Webster and Thornton were made honorary members of
the Society. p ^^ p
ONTARIO.
Dentists of Waterloo County Elect Officers.
THE annual meeting and dinner of Waterloo County Dental
Association was held at the Hotel Kress, Preston, June 9th,
1 922. The election of officers resulted as follows : President, Dr,
M. H. Hagey, Preston; First Vice-President, Dr. C. Henderson,
Hespeler; Secretary-Treasurer, Dr. R. O. Winn, Kitchener; Pro-
gramme, Dr. L. Koeppel, Kitchener. ^^r p .^
L
MARITIME PROVINCES.
1ST of graduates in Dentistry, Dalhousie University, 1922, are
as follows: —
Green, George Emerald, P.E.I.
Grcno, Zola Ivanhoe Halifax, N.S.
Hayford, Albert Clay Freeport, N.S.
Keith, William Eraser Halifax, N.S.
MacDcnald, Howard Weldon Sydney Mines, N.S.
Purdy, Clarence Frederick Montgomery Moncton, N.B.
Reed, Donald Muir Middleton, N.B.
Young, William Henry Westport, N.S.
J. S. B.
Our Buffalo Letter
HABEC WRITES UPON THE SUBJECT: "WHEN THE
DENTIST WAKES UP."
THIS title is not intended to be misleading, for we are going to
talk about the most important event in your life — when })ou
rvalue up in the morning. Perhaps it doesn't mean much in your
sweet young life, for you have never missed waking up for the last
17,250 mornings; but we hope to convince you that there is a whole-
some difference in the individual system of accomplishing this feat.
You may work by the system of Cartoonist Briggs on "How to start
the day right," or by that of Gloomy Gus on "How to get a funeral
face before breakfast"; but all such systems are sure to culminate
in the "end of an imperfect day."
The average dentist wakes up with a bucket full of exposed pulps,
several yards of bridge work and many rows of false teeth on his
wearied mind, and he goes forth to the battle of the day with set
jaws and grim determination to conquer the enemy by fair means
or foul.
But this is not the kind of awakening we are going to talk about.
We have in mind that wonderful spirit of awakening that insures
a state of tranquil joyousness the whole day through. In fact, we
are going to talk about the psychology of waking up. We are also
going to discount the effect of the Welsh rarebit you ate at a late
hour the night before, by asserting that the philosophical psychologist
has a formula for an eye-opener that robs the rarebit of its ponderous
weight and gives to it all the fluffiness of the frosting of an angel-
food cake.
How may this be done? By adjusting your spiritual radio to
catch the waves sent out from that great broadcasting station whence
emanates only the purest essence of divine energy. When you have
entered the subconscious realm of slumberland, you have tucked
away outward consciousness for the night. You have passed out
of the living, external day into that recreative sphere, the storehouse
of the mind. Your conscious life is suspended, and you have become
as one dead. Eternity for you has ceased. But the morning comes,
the closed lids fall apart, familiar objects appear, and you are awake.
Once more vou have returned to outward consciousness, and you
are ushered into a new world; you have been "born again.**
You have now arrived; life*s greatest moment is here. How suc-
cessfully you shall live the wonderful hours of this greatest of all days
depends entirely unon your first thoughts. They must be prayerful,
helpful thoughts. Try the psychologv of this formula for the begin-
ning of the prospective day. Let the first silent thoughts of the
258 ORAL HEALTH jf
waking hour be of thanksgiving to the Creator for the inestimable
privilege of aw^aking once more into His beautiful world. Humbly
ask that the duties of the day may be devoted, through the Master
Workman, to the service of humanity. You will have made the
master stroke of the day, and, come what may, you are fortified
against the inroads of disturbing elements and have placed yourself
upon a plane high above the common peccadillos of the dentist's
avocation.
Perhaps it may be due to false reasoning, or to the failure to
recognize the full value of anesthetic agents as aids in our daily
work, but Habec has up to this time been unable to conform his
old-fashioned notions to their free use in the avoidance of discomfort
from dental operations. No one will, however, doubt our firm belief
in the conduction and infiltration methods of anesthesia nor in their
positive value as humane aids in rendering good dental service; but
cur plea is for a better understanding of the psychological factor in
this connection.
We are convinced, after long years of observation, that, the
dentist should endeavor to build up the mental reserve of his patient
to meet the usual demands of regular dental service, and thereby
establish a quality of resistance to discomfort that will create within
the patient a higher plane of mental and moral control. Fear of
pain is our omnipresent antagonist, which may be largely dissipated
by the properly directed application of psychology.
Someone has said: "Pain is not evil unless it conquers us."
Why, then, do we permit ourselves to be so easily conquered?
It is essentially an individual question, and the answer principally
depends upon the mental poise or the quality of mental control of
the affected person. The strong, comprehending mind quickly
masters the situation and finds itself the conqueror, while the less
resistant, fearful mind welcomes any means of avoiding so-called
pain, which is largely made up of baneful fear.
Habec.
Six Year Molars
When sister or brother are six years old.
Four strong molars, big and bold,
(Pushing in at the end of each row.
Where the ten little teeth so safely grow)
Will find a place, and rooted deep,
These permanent teeth you must always keep.
So, mothers, beware and watch with care
As soon as you find those molars there.
While the other teeth, they will lose some day,
The six year molars have come to stay.
—DORA LAWRENCE CAMERON, Wenatchee, Wash.
ORAL HEALTH
EDITOR:
WALLACE SECCOMBE, D.D.S., F.A.C.D., Toronto, Ont.
CONTRIBUTING EDITORS:
C. N. JOHNSON, M.A., D.D .S.. F.A.C.D., Chicago.
RICHARD G. Mclaughlin, D.D.S., Toronto.
W. E. CUMMER, D.D.S., Toronto.
J. WRIGHT BEACH, D.D.S., Buffalo, N.Y.
Entered as Second-class Matter at the Post Office, Toronto.
Subscription Price, Canada and United States, two dollars per annum ;
elsewhere three dollars. Single Copies, 25c.
a
Original Communications, Book Reviews, Exchanges, Society Reports, Personal Items, and othei
Correspondence should be addressed to the Editor, Oral Health, 102 Wells Hill Ave.. Toronto, CanadA"
Subscriptions and all business Communications should be addressed to The Publishers Oral Health.
Royal Bank Building, 269 College St., Toronto, Canada.
Vol. XII.
TORONTO, JULY, 1922
No. 7
H
EDITOR.IAIJ
Dentistry and the Daily Press
H
DURING the recent Canadian and Ontario Dental Associa-
tions convention, held at Toronto, the daily press of the city
was most generous in its allotment of space dealing with con-
vention matters. In every case references to the progress and status
of dentistry as an important branch of the healing art were cordial
and appreciative. The following editorial, published in The Mail
and Empire of May 1 6th, indicates the sympathetic attitude of both
the public and the press toward the dental profession, as compared
with a decade ago.
"There is an ancient joke about the dread which a visit to the
dentist inspires, but there is nothing but cordiality in the welcome
that Toronto extends to the dentists who are convening in this city.
They are benefactors to the human race, strong auxiliaries of the
physicians. Their labors are more exhausting, for dentists work
with their hands as well as with their brains, and they receive less
pay, although their services may make the difference between health
and misery. As in the case of the physician, the years in which a
dentist can earn enough money to support himself after the time
when he is no longer able to work at the chair are limited. They
260 ORAL HEALTH
are fewer, for while the venerable, wise old family doctor is a
familiar and respected friend, there are few aged dentists in practice.
Those who protest at charges of from $5 to $10 an hour should
remember this, and should also take into consideration the fact that
dentistry has every right to be ranked as a learned profession. If
there are any rich dentists, the extreme probability is that they did
not make their fortunes by operating the drill and probe. However
eminent and popular a dentist may be, he has not the opportunity
of turning himself into a joint stock company, employing dozens of
assistants and thus becoming wealthy. His skill lies in his own hands
and in his own brain. He can seldom bequeath a great practice to
his heirs.
Few sciences and arts have progressed so swiftly in the past
generation as the science and art of dentistry. The discovery of
laughing-gas was almost as revolutionizing to dentistry as was the
discovery of the circulation of the blood to medical practice. Since
then there has been a steady improvement in technique, and in the
theoretical branch of the calling. Quite as important as the discovery
which robbed tooth-extraction of its pain without imposing a strain
upon the heart, has been the development of preventive dentistry.
Nowadays one does not wait until he has a painfully decaying tooth
before he goes to the dentist. He goes twice, three times, or perhaps
oftener, a year at regular intervals, being reminded of his appoint-
ment by a notice from the dental office. His teeth are then examined,
and orifices are filled while they are still minute and when practically
no pain is involved in the operation. Deposits of tartar are removed,
and thus by preventive treatment pyrrohoea, a disease of the gums
that formerly was supposed to be incurable, and which, if not
checked, will result in the loss of the teeth, is checked and abolished.
Undoubtedly more ailments take their rise in teeth troubles than are
generally supposed, and a man whose teeth and mouth are in a good
sanitary state will be in much better physical and mental condition
than one who has neglected prophylactic dentistry. Canada has
reason to be proud of Canadian dentists, who rank with Americans
as the best in the world.'*
Every member of the profession should appreciate this public
recognition of dentistry as a vital necessity to the individual and
community, and make "service'* the guiding principle of dental prac-
tice. Thus will dentistrv prove its worthiness to retain an honored
place among the learned professions.
OPAL HEALTA
A JOURNAL THAT STANDS FOR THE '^ OUNCE OF
PREVENTION," AS WELL AS THE ^ POUND OF CURE*'
Hll' 'tF^
VOL. 12 TORONTO, AUGUST, 1922 No. 8
Orthodontia — Its place in a Dental Course
A. H. HiPPLE, D.D.S., Omaha.
THIS symposium is the direct result of a very notable paper on
"The Teaching of Orthodontia in Dental Schools,*' read by
Dr. Frederick B. Noyes, at the meeting of the Institute last
year. In that paper Dr. Noyes said that "Up to the present time,
the dental colleges have absolutely failed in the teaching of this sub-
ject." He went further and said,^ "in general the dental graduate
is not even decently intelligent in the fundamental principles of the
subject." Speaking of the results of this failure to educate students
properly he used this language, "I mean exactly what I say when I
say that most of the orthodontia that is being done to-day by general
practitioners, and by many so-called specialists, is a crime against
the public and a sin against innocent children."
The Executive Board of this Institute does not want the teaching
of any subject in our curriculum to be a failure; it does not want
the schools to graduate men who are not even decently intelligent
in any subject connected with dentistry, and it does not want the
country filled with practitioners who are committing crimes against
the public and sinning against innocent children. In the hope that
the presentation of a number of papers at the same time might result
in a solution of the problem, this symposium was arranged.
From a rather careful study of the paper by Dr. Noyes, I find
that his views are as follows:
1 . Orthodontia is a specialty of dentistry, and should be practised
only by specially trained individuals.
2. Orthodontia is more closely related to rhinology, pediatrics,
orthopedic surgery and medicine, than it is to dentistry.
3. We must give up the idea that it is necessary for our dental
colleges to turn out men equipped to practise orthodontia.
262 ORAL HEALTH
4. No student should ever be allowed to treat a case of ortho-
dontia.
5. All students should be required to take a course in the scientific
principles of orthodontia and its fundamental technic.
6. The orthodontia clinic should not be on the same floor as the
dental infirmary, — the idea being to remove from the mind of the
student the dental idea, and create an orthodontic atmosphere.
7. Every student should be required to attend the orthodontia
clinic and write up what is done.
In making these statements. Dr. Noyes apparently voiced the
opinions of most of the men who are practising orthodontia as a
specialty, and of most of the men who are teaching it in our schools,
and unconsciously, in my judgment, has made it plain why the teach-
ing of orthodontia has not been more successful. In my opinion, the
chief obstacle to the successful teaching of this subject in our schools
is the attitude of the teachers themselves toward the subject.
To illustrate just what I mean by that statement, let us suppose
that the teachers of prosthetic dentistry in our schools were men who
practised prosthetic dentistry as a specialty and that they really
believed that no graduate of a dental school should be allowed to
construct an artificial denture for a patient until he had fitted himself
to do so by special post-graduate study. Let us suppose that they
considered denture construction to be more closely allied to orthopedic
surgery or some other branch of medicine than to dentistry; that it
is not the mission of a dental college to turn out men equipped to do
prosthetic work and that no student should ever be allowed to con-
struct a denture for a patient. Let us suppose that in order to
impress the student with the importance of the subject every effort
was made to remove from his mind the dental idea and to create in
his mind a prosthetic atmosphere. Let us suppose that the student was
instructed in the principles of denture construction by lectures and
was required to attend clinics where experts did actual work upon
patients but that he personally was never allowed to take an impres-
sion or place an artificial denture in the mouth of a living subject.
Now if that were the attitude of our schools and of our teachers
toward the teaching of prosthetic dentistry and we were attempting
to teach it in that way, what would the course amount to and what
would the students know about it when they graduated? As a
matter of fact we could not get results if we violated the ordinary
rules of pedagogics in teaching prosthetic dentistry and we cannot
get results if we violate them in teaching orthodontia.
Orthodontia belongs to dentistry and not to rhinology or medicine.
It is taught in all dental colleges and the dental degree is the only
one that confers the right to practise it. It fits into our dental
curriculum very nicely. It presupposes a knowledge of anatomy
which every student ought to have. It involves a knowledge of the
ORAL HEALTH 263
inclined planes of the teeth, which belongs to dental anatomy and
should be taught there. It deals with the causes of mal-occlusion,
in which every dental operator is interested, and it endeavors to
correct the results of mal-occlusion as every dentist should do in his
operative and prosthetic restorations. The taking of impressions and
construction of models does not differ materially from similar pro-
cedures in prosthetic work, and the adjustment of the necessary
appliances in the mouth is very similar to the fitting of crowns and
bridges. Why should we not, then, teach orthodontia as we teach
operative and prosthetic dentistry? Why should we not let the
student learn by doing, as well as by hearing and seeing? Why
should we not apply to the teaching of orthodontia the things we
learned years ago in regard to the teaching of other branches of the
curriculum?
Of course if the graduate is to make no practical use of what he
has learned and is never to attempt the treatment of a case of ortho-
dontia, clinical instruction is perhaps of little value tj him, but I
believe that we are in duty bound to graduate men who can and
will undertake the treatment of these cases. Notwithstanding the
attitude of the men who are practising orthodontia as a specialty,
the public expects a dentist to be able to regulate teeth. Dr. Noyes
tells us that it is ancient history to talk of regulating and straighten-
ing teeth and that to do so shows that one is behind the times. From
the standpoint of the orthodontist his position is probably well taken
but it is interesting to note that the very latest and most authorita-
tive statement on the subject by the dental profession speaks of that
very thing.
The Dental Welfare Foundation has prepared a series of cards
for the dissemination of concise, reliable dental information to the
public. The text of each card has been censored by a committee of
the National Dental Association, and has the official endorsement
of that organization. Millions of these cards are being printed and
mailed out by direction of the dentists of the country and on number
ten of the series this statement appears: "If your children's teeth are
irregular have them straightened." The people who read those cards
have the right to assume that the dentists of their respective communi-
ties will be prepared to meet the demand thus created. It will not
do for the dentist practising in a small town to refer all of his patients
to a specialist in a distant city. In my own state of Nebraska there
are tens of thousands of people who live more than 400 miles from
an orthodontia specialist. How many parents whose children's
teeth are irregular will be able to follow our instructions and have
them straightened if it involves treatment by a specialist 400 or 500
miles away? The day may come when the services of specially
trained orthodontists will be reasonably available in all parts of the
country but that condition will not exist for many years to come.
264 ORAL HEALTH
This is a day of specialization and it seems to me that the colleges
would do well to consider carefully just what their attitude is to be
toward the teaching of orthodontia and other specialties of dentistry.
Should the teacher of orthodontia be encouraged to remove from the
mind of the student as far as possible the dental idea and create for
his benefit an orthodontic atmccphere? Should the teacher of exo-
dontia try to obliterate the dental idea and create an exodontic
atmosphere? Should the teacher of crown and bridge work make
the student forget that he is studying dentistry while he breathes an
engineering atmosphere? I believe in atmosphere and I believe that
everything possible should be done to broaden the outlook of the
student, but it seems to me that we make a serious mistake if we fail
to impress upon his mind that dentistry embraces everything connected
with the teeth, including all of their local and systemic relations, and
that while the specialist may very properly devote himself to the study
and treatment of some particular class of cases he is still practising
dentistry. I believe that the dental idea is the biggest idea that we
can put into the mind of a dental student and that it should dominate
all of his professional studies and activities. Let us see to it that his
idea of dentistry is comprehensive enough to include everything that
can be done in the mouth of an individual to prevent disease, to
improve his health if it needs improvement, to add to his comfort and
to enhance his good looks.
The correction of mal-occlusion is a very important part of dentis-
try and from some of the things that we hear we might imagine that
it is the exclusive field of the orthodontists. As a matter of fact, they
only deal with a restricted part of the field and in a restricted way.
They are doing a wonderful work for children, for which they receive
and deserve the most sincere gratitude, but what are they doing to
correct mal-occlusion in the mouths of adults? We are dealing with
it every day in our clinics and we are teaching our students to treat it
as a part of the dental idea. Sometimes we have them treat it with
a carborundum stone, sometimes we have them treat it by separating
the teeth and giving them proper contact points, sometimes we have
them treat it by means of bridges or artificial dentures and sometimes
we have them treat it with a pair of forceps. The student is taught
that by doing these things he is rendering his patient a real dental
service. Why not teach him that he can render a greater dental
service by correcting mal-occlusion in the mouths of children while
the jaws are in a formative state, thereby preventing future trouble?
And while teaching him the value of that service why not let him do
the work under proper supervision and learn how to render it most
efficiently by actual practice and experience, just as he learns to
render it to adults by actual practice and experience?
— Proceedings American Institute of Dental Teachers.
J. G. Adams, Dentist and Philanthropist,
Wallace Seccombe, D.D.S., Toronto.
THE pioneer work of J. G. Adams in organizing dental clinics
for school children is known and appreciated throughout the
Dominion of Canada and beyond. Dr. Adams was located
in dental practice in the city of Toronto, and always interested him-
self in the dental needs of school children, and particularly the poor
children of the city.
His interest in school dental clinics exten(;k_back for fifty years, to
a time when public sympathy was not aroused, and the pioneer in
any public health movement had a difficult path to tread. And in
those early days Dr. Adams did not even have the whole-hearted
support of many within the dental profession, who entirely failed
to realize the public responsibilities of the dentist in maintaining the
dental health of the people.
Dr. Adams passed over at the age of eighty-three, after a life
crowded full of unselfish service.
The writer was associated with the late Dr. Adams as a student
of dentistry, and can testify to the unselfish and whole-hearted service
of Dr. Adams in behalf of the poor of the city. He was truly a
great missionary. He established the first public dental clinic, and
was instrumental in the organization of school dentistry in this
country.
To Dr. J. Frank Adams, of Toronto, and other members of the
family, sincerest sympathy is extended in their great personal loss.
Histological and Histo-Pathological Studies
of the Dental Pulp
Harold Keith Box, D.D.S., Ph.D., F.A.A.P.
(Continued from July issue)
(b) Regional and deep infiltrations.
Figures 44, 45, 46, 47, 48, are examples of different stages of this
type, from a very minute accumulation of leukocytes to the formation
of definite abscesses deep in the tissue of the pulp. In Figure 44,
can be seen a very early stage where the infiltration of cells is very
small. Figures 47 and 48, show abscesses in the interior of the pulp,
where considerable extension of tissue solution has taken place.
Fibroblasts and capillaries proliferated for repair are being included
in the extension of the destructive process.
266
ORAL HEALTH
Fig-. 44 Abscess of the pulp. Small leukocytic infiltration deep in the tissue
of the pulp.
Fig-. 45. Abscess of the pulp, later stage.
ORAL HEALTH
267
Fiff. 46. Abscess of the pulp, later stage.
Fig. 47. Abscess of the pulp. Note the great extension of tissue solution.
268
ORAL HEALTH
Fig-. 48. Abscess of the pulp.
Fig-. 49. Necrotic pulp.
ORAL HEALTH
269
(c) Diffuse infiltration.
In an examination of a number of infected pulps, the writer has
frequently noticed a type of diffuse infiltration where no sign of tissue
destruction can be observed. Plasma cells seem to be the conspicuous
feature. Some observers believe that these cells do not play any part
in the development of fibroblasts and that they are derived from
lymphocytes. Maximow, a noted pathologist, holds the view that
these cells originate either from lymphocytes or connective tissue cells
and may develop into fibroblasts.
Figures 50 and 5 1 , show examples of this type in which the greater
bulk of the pulp tissue is filled with plasma cells. Extending through
them in all directions, are newly formed capillaries. The writer
believes that in these cases, the inflammatory reaction has extended
over a considerable length of time and that the infective agents are of
a mild character. The evident conclusion from these studies is, that
infections of the dental pulp practically always terminate in its death.
*•.«' y.
Fig. 50. Diffuse infiltration of the dental pulp.
270
ORAL HEALTH
Fig-. 51. Diffuse infiltration of the dental pulp. High magnification.
Repair.
Lesions involving destruction of tissue as in necrosis of abscess
formation, tend to heal by granulation tissue. This term is applied
to young tissue composed of fibroblasts and vascular endothelium
w^hich are reproducing to replace destroyed connective tissue and
blood-vessels. The fibroblasts appear as flat elongated cells with
large pale vesicular nuclei containing a delicate framework of
chromatin. The cytoplasm extends from each end of the cell as one
or more processes. Hand-in-hand, new capillaries are formed from
the proliferation of the endothelium lining the dilated superficial
capillaries. They appear at first in the form of pointed buds con-
sisting of spindle-cells with cytoplasmic processes which are sent out
first. The individual buds tend to grow towards one another and
form narrow columns which unite laterally to construct a ramifying
vascular net-work. Finally many of these newly formed capillaries
ORAL HEALTH
271
disappear, while only the largest ones persist in the fully formed scar
tissues. The essential part of granulation tissue is fibroblasts and
vascular endothelium. The ability of the pulp to produce these is
very marked and the essayist cannot help but believe that recovery
from a slight infection w^ould readily take place if the surrounding
conditions were made favorable. As a matter af fact, the conditions
for repair are usually very unfavorable and the granulation tissue is
always complicated by the presence of foreign bodies as necrotic
cells, red blood-corpuscles and bacteria. A purulent exudation
continues to pass through the newly formed tissue which is progres-
sively included in the destruction process and ends in the death of the
organ.
Note. — -The opinion has been expressed many times that the power
of healing is very low in the pulp.
Fig. 52, Evidence of the ability of the pulp to repair,
tissue.
Note area of cicatricial
112
ORAL HEALTH
Fig. 53. Evidence of the ability of the pulp to repair. Note area of cicatricial
tissue.
Fig. 54. Evidence of the ability of the pulp to repair. Note area of cicatricial
tissue.
ORAL HEALTH 273
Fig. 55. Evidence of the ability of the pulp to repair. Note area of cicatricial
tissue.
(5) Sharp edges of the pulp chamber in carious cavities.
Hyperplasia of the pulp: — This is a chronic inflammatory con-
dition, associated with caries that has produced a fairly large perfora-
tion of the wall of the pulp chamber and a consequent exposure of
the pulp. The margins of the pulp chamber are sharp, and
apparently are etiological factors in the formation of a large soft mass
of tissue which pushes out into the cavity. The growth consists of: —
(a) A superficial layer of stratified squamous epithelium which
appears to occur there as a result of transplantation of epithelium from
the gingivae.
(b) A stroma of fibrous connective tissue which forms a supporting
frame-work.
(c) The bulk of the mass is composed of granulation tissue of a low
type. The cells are large, and round or oval with large nuclei.
Hopewell-Smith gives the following very excellent description of
this tissue: — *Tt is composed largely of cells of the mesodermic type
of variable size, round or oval, derived directly from pre-existing cells,
and chiefly concerned in the formation of the bulk of the mass of the
new tissue; of the plasm cells of Unna; of many polymorphonuclear
iiyaline leucocytes; of large mononuclear hyaline leucocytes, which
are considered by Metchnikoff to be able to become transformed into
fixed connective tissue cells; of *mast-cells,' so-called; and finally, if
Cwl
274
ORAL HEALTH
necrotic material is present, or if foreign bodies — eig., a splinter of
dentine — exist, of multinucleated giant cells, whose function is some-
what of a phagocytic type.**
Fig. 56. Hyperplasia of the pulp.
(6) Stimuli which increase the irritability of the dentinal nerves and
fibrils.
From a histological aspect, many different types of calcified forma-
tions are added in the course of pathological conditions in the pulp, to
the primary dentine. Usually, it is not difficult to distinguish the
secondary growth from the first formed dentine. From a calcification
that closely resembles the normal dentine, to a tissue that does not
seem to have a point in common with it, countless variations
may be found and it would be impossible to make a
classification that would include all. However, from hundreds
of sections prepared by the writer, most types can be included
in seven main groups. The work of Black was followed in
these investigations, and the essayist wishes to acknowledge the free
use of his classification, in part, in this work. The method of prepar-
ation applied in the study of the course and delicate branchings of the
dentinal tubules was of the greatest value in the work on these different
types of secondary calcifications.
ORAL HEALTH 275
(a). True Secondary Dentine.
In this group, the secondary formations resemble more than any
of the others, the primary dentine. The tubules are continuous with
those of the primary dentine and extend to the surface of the pulp.
Generally, the tubules are fewer in number, and quite often there is
some deviation from the course of the original tubules.
(b). A secondary dentine in which the tubules at first resemble
the normal dentine, but gradually become irregular and disappear,
succeeded by a clear calcification.
(c). Calcifications attached to the walls of the pulp chamber
which are homogeneous throughout. Regarding this type, Hopewell-
Smith describes it as follows: "This new kind of dentine has, as its
favorite site, the base of the carious excavation into the pulp chamber.
It may be irregularly rounded in shape. Its structure in some places
conforms to that of a more or less homogeneous ground-glass-like
matrix, similar to that of hyaline cartilage; in others it has a distinctly
granular or fibrous appearance.*'
(J). Secondary calcifications which are made up of clear or gran-
ular areas and irregular tubules, twig-like tufts and breaks resembling
lacunae in bon&.
(e). Tumor-like masses of secondary dentine which have grown
into the pulp tissue and are attached to the primary dentine by
pedicles. Black has stated that these formations are rare.
(/). A secondary deposit, having the appearance of a mass of
calcospherites fused together.
(g). Osteo-dentine. A secondary formation in the pulp chamber
attached to the primary or secndary dentine and which contains
lacunae resembling those of bone, embedded in a granular or tubular
matrix. In the description of this type of calcification, according to
Black: **The undoubted osseous formations met with in the pulp
chamber of the human teeth are very rare. In making this statement
I exclude all hard formations in which bone corpuscles are not
present. This seems not to have been done by many who have written
on this subject; but, on the other hand some writers seem to have
called almost all irregular formations osteo-dentine. The great bulk
of these have not the slightest resemblance to bone. The cases of
osseous formations within the pulp chamber that I have met with,
have all presented the general characters of cementum and have been
found in the root-canal attached to the dentinal wall or resting upon
some irregular formation which separates them slightly from the
dentine.**
276
ORAL HEALTH
Fig-. 57. True secondary dentiiK
Fig. 58. A form of secondary dentine.
ORAL HEALTH
277
Fig". 59. A form of secondary dentine.
Fig. 60. A form of secondary dentine.
278
ORAL HEALTH
Fig-. 61. A form of secondary dentine.
Fig. 62. A dentinal tumor.
ORAL HEALTH
279
Fig". 63. A dentinal tumor.
Fig, 64. Osteo-dentine.
280
ORAL HEALTH
Fig-. 65. Mass of fused calcospherites.
7. Arsenic.
The changes that occur in the dental pulp as a result of the action
of arsenic are as follows:
(a). The endothelium lining the blood-vessels is destroyed and
everywhere throughout the pulp a general diapedesis of red cells has
occurred. Upon examination of a large number of pulps one cannot
help but notice the absence of vessels lined with normal endothelium.
(b). The connective tissue cells appear larger than usual, but the
connective tissue fibres and the odontoblasts seem to have undergone
no change.
(c). Arkovy states, in regard to its action upon the nervous tissue:
"The effects upon the neurilemma is to somewhat increase the number
of its nuclei while in the axial part granular destruction of the myelin
sets m, and the axis-cylinder begins in various locations to disappear,
while in others the notchy tumefaction of the axis-cylinder usually seen
only in cases of central lesion, can be plainly made out.*'
(d). Arkovy found also that arsenic trioxide, when applied to a
vital pulp, did not produce coagulation of the tissue.
ORAL HEALTH
281
»fi-
i".' . ..,«>.. ^ •tS<»"1ft' V."-
^
Fig-. 66. Chang^es in the pulp, due to arsenic.
Degenerations of the Dental Pulp.
Stimulations and depressions of the activity of the cell, by various
influences such as toxins, lack of nutrition, increase or lack of internal
secretions, bring about a variety of changes, many of vv^hich can be
distinguished morphologically. There may be an increase in the
amount of certain cell constituents such as albuminous granules,
glycogen and fat. Then again, new^ substances may be formed
within or outside of the cell, for example, mucin and hyalin. The
dental pulp is very subject to degeneration because of its delicate
structure and its peculiar environments.
1. Post-mortem Changes.
In the normal pulp that has been removed and not fixed for twenty-
four hours, the nuclei of the cells take the stain deeply, owing to a
diffusion of the chromatin. If the process of fixation is deferred a
little later, the nuclei do not stain at all. When bacteria are present
in a pulp that has been removed and fixation has not taken place
shortly after, many alterations occur due to a multiplication of the
bacteria and the liberation of their ferments. Fibroglia fibrils lose
282
ORAL HEALTH
their staining properties rather quickly, the collagen and elastic fibrils
retaining theirs much longer. The endothelium lining the blood-
vessels tends to strip off.
2. Ar eolation of the Pulp,
This condition is one frequently met with in the study of the
pathology of the dental pulp. The early stages are marked by the
presence of a few areolae in the matrix.
In the later stages this condition may extend to large areas of the
pulp tissue. It seems to be associated with hyperemic disturbances.
The pulp cells disappear and extending everywhere through the
matrix may be seen very fine connective tissue fibres. According to
Black, "These areolae are evidently filled with fluid; hence a kind
of oedema of the organ which in the enclosed pulp chamber has prob-
ably destroyed the cellular elements.'*
Fig. 67. Areolation of the pulp.
ORAL HEALTH
283
Fig, 68. Areolation of the pulp.
3. Reticular Airoph)) and Fibroid Degeneration.
In the study of the degenerations of the pulp the essayist had
occasion to prepare a great many sections, and numerous examples
were noticed where the pulp tissue had almost completely disap-
peared, and was substituted by a firm fibrous connective tissue in
which the nuclei stained very poorly and sometimes not at all.
Certain cases were seen in which the pulp chamber contained a single
strand of fibrous connective tissue, the odontoblasts, blood-vessels and
nerves being absent. In others, there seems to be an increase of the
connective tissue fibres in certain areas, forming fairly dense strands,
many large spaces lying here and there throughout them. Occasionally
the fibres run in parallel straight lines and have the appearance of
thickened walls of blood-vessels. Others, again, present throughout
the pulp-chamber a fine reticulum of connective tissue fibres, in which
the histological appearance of normal pulp tissue cannot be seen
anywhere. Hopewell-Smith regards fibroid degeneration as the
natural old-age termination of the life of a healthy pulp.
284
ORAL HEALTH
Fi^. 69. Fibroid degeneration of the pulp.
Fig. 70. Fibroid degeneration of the pulp.
ORAL HEALTH
285
4. Degeneration Evidenced b]) the Presence of Fat.
When fat is visible in cells where normally it is absent, its presence
there is due to some interference with cell function, as in faulty
nutrition or injury produced by toxins. Some observers believe that
all such intracellular fat is brought as nourishment to the cells through
the blood and lymph, and owing to cell degeneration, cannot be
utilized. Others hold that it arises directly within the cell from a
change of certain of its constituents into fat. Degenerations of the
pulp associated with the presence of fat in the tissue cells are not
common.
Fig. 71. Cell degeneration evidenced by the presence of fat in the pulp.
5. Mucoid Degeneration.
In the embryonal connective tissue of the dental pulp, mucus
occurs between the collagen fibrils produced by the cells. Mucus
contains a group of nitrogenous, albuminous substances known as
mucins, which are coagulated by boiling and precipitated by acetic
and dilute mineral acids. They swell up with water, forming a slimy
stringy substance. With hematoxyhn, mucus substances usually stain
a pale grayish blue to intense blue. In certain degenerative conditions
of the pulp, areas have been noted, sometimes quite large, in which
are present fine stringy substances that have the characteristic staining
properties of mucus and which the writer believes to be a mucoid
degeneration.
286
ORAL HEALTH
Fig. 72. Mucoid degeneration of the pulp.
6. Hyaline Degeneration.
Hie term hyalin js applied to a body of albuminous nature which
is distinguished from the other substances of the hyaline group such
as mucus, colloid and amyloid, chiefly by its appearance, its homo-
geneous character and its high refractive power. It is not coagulated
by acids and remains unchanged in water, salt solution, alcohol or
ether. It is distinguished by its marked affinity for the acid anilin
dyes as eosin, orange and acid fuchsin. According to the work of
the essayist, it is not commonly seen in the degenerations pf the pulp.
(a). Hyalin in Connective Tissue.
Under certain conditions the collagen fibrils of connective tissue
became unrecognizable by a deposit of hyalin between them. In
connective tissue that has been newly formed or where it has under-
gone sclerotic changes, this is frequently seen.
(b). Hyalin in Plasma Cells.
Hyaline droplets of various sizes frequently develop in the
cytoplasm of plasma cells. They frequently become extra-cellular
through the degenerations of the cells, and are often called "Russell's
fuchsin bodies." They are frequently present in chronic inflammation
of the dental pulp.
ORAL HEALTH
287
(c). Hematogenous Hyalin.
Mallory asserts: '*Necrotic cells and fibrils and red blood-corpus-
cles bathed in serum frequently undergo a hyaline change due to the
formation of fibrin. In this way, hyaline masses of various sizes and
shapes may be formed in the blood-vessels, (hyaline thrombi), and
in the tissues."
(J). Hyalin in Blood- Vessels.
Hyalin occasionally occurs in the w^alls of the blood-vessels in the
form of multiple droplets which fuse together to form homogeneous
hyaline walls. Capillaries frequently become enveloped in this
manner.
Fig. 73. Hyaline degeneration of the pulp (class A.)
7. Necrosis.
When death occurs suddenly to cells, singly or in groups, while
the surrounding tissue retains its connection with the body, the process
is called necrosis. When the injurious influences lead to gradual death
of cells, the term used is necrobiosis. The causes of necrosis are
numerous.
The destruction of cellular material in the dental pulp may take
place in degenerative processes which occur in certain cell-complexes
288 ORALHEALTH
ending in their separation from the rest of the body. Death of circum-
scribed portions of tissue may result from the action of toxins of many
sorts. When the blood supply is cut off, which so frequently happens
in many disturbances in the circulation of the pulp, necrosis of the
tissues ensues.
Certain changes in the nucleus and cytoplasm are characteristic of
necrotic cells. One of the characteristics of dying tissue is a progres-
sive disappearance of the chromatin of the nucleus, (karyolysis).
The nuclei fail to take the stain normally. They may contract into
a variable mass of more or less coherent fragments arranged in the
most irregular manner, and which stains intensely, (pyknosis) or
become broken up into amorphous particles (karyorrhexis). The
cytoplasm may stain feebly with reagents that normally affect only
the nuclei, or it may become coagulated and homogeneous, staining
deeply with acid dyes.
8. Calcification and Calcareous Deposits.
During pathological conditions certain substances may attract
lime salts. Calcification may take place in the inert interstitial
matter between the cells, but not in the living cells themselves.
Necrotic tissue anywhere may become calcified. Many different
theories have been brought forward to explain the phenomenon.
Adami writes: "Obviously it is not a precipitation of the salts
normally present in the affected areas, the lime salts are brought to
the part by the lymph and in dead or dying cells or in the interstitial
material of low vitality are rendered insoluble and deposited. The
chemical process underlying this, appears in some cases at least, to
be that a fatty degeneration of cells is accompanied by the liberation
of fatty acids which combine with the calcium in the lymph to form
compound calcium soaps. In this combination the weaker fatty acids
are phosphoric and carbonic acids with the subsequent deposit of
insoluble calcium phosphate and carbonate in the dead tissues.**
Old infarcts, chronic inflammations and suppurations which have
been calcified are frequently seen. Lime salts are deposited in
various homogeneous substances, the products of secretion and degen-
eration. In the arteries, calcareous infiltration may occur following
hyaline and fatty degeneration.
Mallory believes that fat products play a part in the process.
Professor Wells, of Chicago, has shown that hyaline cartilage and
hyaline-degeneration material possesses a very great affinity for
calcium.
ORAL HEALTH
289
Fig". 74. Hyaline and calcareous degeneration of the pulp.
Fig. 75. Calcareous degeneration of the pulp.
290
ORAL HEALTH
Fig". 76. Total ealcilication of the pulp.
One of the most common types of calcification in the pulp is the
so-called pulp nodule. These formations have a great variety of
shapes and appear singly or in groups. They are classified as
follows: —
( I ) . Irregular or serrated type.
(2). Smooth — In some of these oval lime bodies, lamellae are
observed in w^hich the layers are arranged concentrically. When
view^ed under high pow^er, very fine canals are seen, radiating from
the centre of the formation through the different lamellae, and some-
vv^hat resemble the canaliculi of bone.
(3). Fusiform. Deposits are often met vv^ith in the root canals.
They are, as a rule, fusiform or oval in shape.
(4). Jointed. Sometimes these masses attain a large size and
become jointed together exercising pressure on the structures in the
pulp.
Calcoglobulin Deposits.
Concerning these irregular masses, w^hich are so frequently found
associated with inflammatory conditions. Black has written: "This
formation is associated with the formation of what are known as pulp
nodules. It possesses the same form of elements common to the pulp-
nodule, including the forms of the calcospherite, but is soft enough to
be readily cut with the knife in the preparation of sections, while the
pulp-nodule is very hard. It has been present in a number of the
pulps I have cut, always in the inflamed portion, and usually near the
ORAL HEALTH
291
point of exposure, often lying immediately beneath the layer of
odontoblasts, but occasionally much deeper within the tissues of the
pulp. It usually occurs in irregular masses, occasionally of consider-
able size; and scattered about these, there are generally a number of
small globular forms, many of which have the onion-like layers of the
calcospherite distinctly marked."
Fig. 77. Serrated pulp nodule.
Fig-. 78. Smooth pulp nodule.
292
ORAL HEALTH
Fig. 79. Jointed pulp nodule.
Fig-. 80. Fusiform pulp nodule.
y
ORAL HEALTH
293
Fig. 81. Calcoglobulin deposit.
Calcospherites.
Small spherical calcific bodies are occasionally found in the pulp
tissue and they have been called calcospherites. Black has compared
their appearance to that of a cross-section of a tiny onion.
Fig. 82. Calcospherites.
BRITISH COLUMBIA— k. T. OBERG. D.D.S.,
833 Granville St., Vancouver
ALBERT A~]OVi>i W. CLAY. D D.S.
914 Herald Bldg., Caigary
SASKATCHEWAN—C. W. PARKER. D.D.S.
Imperial Bank Bldg., Regina
MANITOBA— '^. W. WRIGHT. D.D.S.
767 Warsaw Ave.. Winnipeg
OATTAff/O— Lieut-Col. W. G. THOMPSON
28 King St. West, Hamilton
QUEBEC— KLBERT DELORME. D.D S.
713 St. Catherine St., East, Montreal
MARITIME PROVINCES— STANLEY BAGNALL. D.D.S., Halifax. N.S.
SASKATCHEWAN.
Vacation Time.
THIS is the time of the year when everyone — nearly everyone —
is either enjoying a vacation or making plans that they may get
away from their exacting labors for a breathing spell.
There are many members of the dental profession who think they
cannot afford to take holidays. This is an entirely mistaken idea, for
there is no doubt whatever that there is not a member of the profes-
sion who can afford to do without one.
Owing to the very nature of our work, the close application and
confinement to office, the necessary exactness of our daily routine, the
fact that we are dealing constantly with people who are under high
nervous tension, all tends to make it imperative that we "cease from
our labors*' now and again in order that we may store up that energy
and self-control to enable us to carry on for another year.
How often do we find, when we call up one of our confreres about
five o'clock in the afternoon, and challenge him to friendly contest on
the golf links or tennis courts, that he has several people coming in to
have treatments changed or that he does not feel like taking an hour
or so in the open for fear a patient might come in.
Some time ago the writer asked one of the brethren if he intended
to take his vacation in August this year. His reply was perhaps
humorous, that at about that time he expected a patient in to have a
denture made and that he could not afford to lose it.
Little do we realize what a month away from the office means to
us and to our clientele as well. Every dentist especially owes it to
himself and to his patients that he keep himself in the best possible
physical condition, for only in so doing will he be able to give that
service which he seeks to render. Let every dentist in Canada ap-
preciate the fact that he can do more and better work in eleven
months than he can in twelve, just as .in the industrial world it is re-
cognized that a worker can do more in six days than in seven, then,
and possibly then only, will he make sure that he is not chiselled out
of his month's vacation. C. W. P.
Our Buffalo Letter
In Which Haeec Discourses Lightly on Professional
Individual! lY.
FOR a little light, warm weather refreshment. Professional Indi-
viduality will serve as an easily digested condiment. Individ-
uality is frequently expressed by distinctive personality. A per-
son has individuality — an individual has personality. In the profes-
sions its influence is legion. It is sometimes difficult to tell where per-
sonality leaves off and individuality begins, for there is a difference
between personal individuality and individual personality. Perhaps
an apt illustration of these qualities would be to liken personality to
the conscious mind and individuality to the subconscious mind. Like
the conscious mind, personality receives its impression from the external
world and in turn expresses or reflects such impressions; whereas, indi-
viduality, like the subconscious mind, gives expression to that which
has been gleaned or stored from the external or conscious personality.
It, therefore, finds expression in extraordinary ways and gives to the
individual characteristics which distinguish him as himself. Personal-
ity may be observed by the naked eye, for instance, John Brown is
recognized as he passes along the street, but the individuality of John
Brown may be established only upon contact with his inner conscious-
ness.
And now, after this little game of shuffleboard with these two
brotherly and sisterly terms, Habec will attempt to pick out a few
choice nugatines to tickle the professional palate. Nuga, number 1 :
What is it that strikes the new patient squarely in the face when he
opens the reception room door? It is, perforce, the dentist's personal-
ity, and should it not be pleasing, he might never go beyond this vesti-
bule of the dentist's deeper self. It is, however, his individuality that
leads to extended relations through having given the patient evidence
of unusual skill or the recognition of an equivalent attribute. Fame
germinates in personality and blossoms in individuality. Habec di-
rects your attention to the Sphinx, Cleopatra and King David, as
examples, and for modern illustrations to our own Rob Reade, Colonel
Thompson, and Henry Ford, who turns out from his great factory
several thousand samples of his individuality each day. As Elbert
Hubbard might have said, had it occurred to him: Individuality
lives of itself but it requires the undertaker and his embalming fluid
to successfully preserve the personality.
No better example of the perpetual vitality and indestructibility
of individuality may be sighted than that bequeathed by Elbert Hub-
296 ORALHEALTH
bard I. to Elbert Hubbard 11. The spirit of that great personality,
though hidden in a watery grave, is resurrected in the person of El-
bertus II., whose guiding genius is the imperishable individuality of
his famous sire. Thus it is illustrated time and again, even within
the ranks of our own profession.
Nuga, number II: You take off your personality at night and
hang it on a hook, but your individuality goes to bed with you. Irv-
ing Cobb in a bathing suit would lose much of his personality but he
would still be well clothed in his original individuality. Rather ex-
tended observation leads Habec to pronounce the above a depend-
able rule, applicable to the skilled professions and to the clergy.
Those who have attended a dentists' seashore picnic in the bathing
season are in position to give testimony in the affirmative. Your per-
sonality may open the door to the halls of culture and of fame, but it
will be your individuality that will put you on the favored calling
list. Self-expression is a synonymous term and has a definite value
in the mental equipment of the wide-awake dentist.
Nuga, number III, is the port of entry into that broader value of
comprehensibility to which personality and individuality are the step-
ping stones. It is the expression of a profound knowledge of the
worth-while things of life which has to do with the higher develop-
ment of our faculties. It is here that the dentist finds himself in touch
with the world beyond that of every day significance, and he realizes
the narrowness of ordinary professional life built upon personality and
individuality alone, and that a trinity must be established to make
complete that which has up to this time been confined to material
development. This might be termed the completion of the triangle,
through spirituality. By carrying the development of self into this
higher sphere, no obstacle of a material nature will dismay the den-
tist or render his daily practice anything but the happy consummation
of an ideal service to grateful humanity.
After this little juggling match with the three "alities,*^* it would
appear that professional individuality has a definite value in our spe-
cial field and should be cultivated as a practical asset for the dentist.
The subject is worthy of better and more exhaustive treatment, but
the object at this time is to call attention to the distinction between
the two "alities" and to give them relative significance in relation to
our daily work. The ultimate issue will result in the fourth member
of the "ality" family, — re-ality.
Habec.
POST'GRADUATE COURSE
FOR DENTAL PRACTITIONERS
TO BE HELD AT
THE ROYAL COLLEGE OF DENTAL SURGEONS
OF ONTARIO
From Tuesday, 5th September, 1922, until
Saturday, 1 6th September, 1922
The Post-Graduate Course to be held this year includes the
subjects of: —
Preventive Dentistry and Crown and Bridge Work
Dietetics Full Dentures
Physical Diagnosis Periodontoclasia
Dental Diagnosis Exodontia and Minor Surgery
Radiography Anaesthesia: General, Local and
Interpretation of X-Rays Conduction
Partial Dentures Sterilization, Cavity Preparation
and Root Canal Technic.
The time-table of the course is as follows: —
TIME TABLE
Tuesday — 5th Sept. — A.M Registration
Course A (2 days)
Tuesday — 5th Sept. — -P.M Preventive and Dietetics
Wednesday — 6th Sept. — all day Physical Diagnosis
[Dental Diagnosis
Thursday — 7th Sept. — A.M \ Radiography
[Interpretation of X-Rays
Course B (3 days)
Thursday — 7th Sept. — P.M ]
Friday — 8th Sept. — all day [Partial Dentures
Saturday — 9th Sept. — A.M [Crown and Bridge Work
Monday — II th Sept. — all day J
Course C (4^2 days)
Tuesday — 12th Sept ]
Wednesday — 1 3th Sept
Thursday — 14th Sept j-Full Dentures
Friday — 15th Sept
Saturday — 1 6th Sept
Course D (2^/2 days)
Tuesday — 12th Sept ] Periodontoclasia, Theory and
Wednesday — I 3th Sept j- Practice
Thursday — 1 4th Sept. — A.M J
Course E (2 '72 days)
Tuesday — 12th Sept 1 Exodontia and Minor Surgery
Wednesday — 1 3th Sept /
Thursday — 14th Sept. — A.M [Anesthesia:
\ General, Local and Conduction
Course F (2 days)
Thursday — 14th Sept. — P.M "j Sterilization
Friday — I 5th Sept {-Cavity Preparation
Saturday — 16th Sept J Root Canal Technic
Registrants shall make selection of optional courses, as follows:
A, B and C — or A, B, D and F — or A, B, E and F
298 ORAL HEALTH
The members of the Faculty of the Royal College of Dental
Surgeons will take charge of these classes in the several departments,
including Drs. A. E. Webster, W. E. Cummer, Wallace Seccombe,
Harold K. Box, F. Arnold Clarkson, Frank D. Price, I. H. Ante and
Edgar W. Paul.
All classes will be held at the College Building, corner of College
and Huron Streets, Toronto, and each subject will be taken up in
relation to its practical application to dental practice.
The College Infirmary will be open and suitable patients will be
available for clinical material.
In the Prosthetic Department the members will be asked to
divide themselves into groups and patients will be assigned to each
group. This will give members of the group opportunity for carrying
on any part or all of the restoration, or, should they so desire, to ob-
serve the work of the others or of the staff. Members are urged to
undertake as much practical work as possible, in order to obtain the
greatest benefit from the course.
At the conclusion of each subject, a period will be set aside for
questions and consultation on cases, having in view the practical
application of instruction to office practice.
No time nor expense will be spared to make this course of such a
character that members will return to their practice having enjoyed
the personal contact with their professional brothers, both during
class and during the hours of relaxation, and equipped to use informa-
tion which they have gained, for the benefit of their patients and
themselves immediately upon their return.
The Board of Directors has placed the fee at such a nominal sum
that all may attend without this being a matter of concern. The fee
for the course, or any part, will be $25, payable at time of application.
Licentiates in actual practice in the Province of Ontario, and who are
not in arrears of their annual fee, will be charged a fee of $10.
As the number of registrants is to be limited, practitioners inter-
ested should communicate with the Superintendent of the College at
an early date that a place may be reserved in the class.
Address:
The Superintendent
ROYAL COLLEGE OF DENTAL SURGEONS
240 College Street
Toronto, Ont.
ORAL HEALTH
EDITOR:
WALLACE SECCOMBE, D.D.S., F.A.C.D., Toronto, Ont.
CONTRIBUTING EDITORS:
C. N. JOHNSON, M.A., D.D.S.. F.A.C.D., Chicago.
RICHARD G. Mclaughlin, D.D.S., Toronto.
W. E. CUMMER, D.D.S., Toronto.
J. WRIGHT BEACH, D.D.S., Buffalo, N.Y.
Entered as Second-class Matter at the Post Office, Toronto.
Subscription Price, Canada and United States, two dollars per annum;
elsewliere three dollars. Single Copies, 25c.
0
Original Communications, Book Reviews. Exchanges, Society Reports, Personal Items, and othei
Correspondence should be addressed to the Editor, Oral Health, 102 Wells Hill Ave., Toronto, Canada
Subscriptions and all business Communications should be addressed to The Publishers Oral Health,
Royal Bank Building, 269 College St., Toronto, Canada.
Vol. XII.
TORONTO, AUGUST, 1922
No. 8
H
EDITOR.IAIJ
Dominion Dental Council
H
THE Dominion Dental Council continues to exercise its helpful
influence upon Canadian Dentistry. At its meeting in Toronto
during the Canadian Dental Association Convention, reports
were presented showing its affairs to be in excellent condition.
Sincere regret was expressed in the death of two of the original
D.D.C. Executive Doctors, Frank Woodbury, of Halifax, and
Harry Abbott of London.
It was reported that British Columbia had given notice of with-
drawal from the D.D.C. on January 28th, 1921, and the hope was
expressed that British Columbia's withdrawal would be but a tem-
porary one and that upon certain readjustments being made B. C.
would again be numbered among the agreeing provinces.
The Treasurer's audited statement showed that the Council had
invested in Victory Bonds $20,100 and $2,870 deposited in the bank.
Statement of receipts and expenditures for the past two years in-
clude:
Receipts,— CUss "A"— $6,985; Class "D"— $1,415; and Class
*'C" — $500. Total — $8,900. Expenditures, — Examiner's Fees —
$3,195; Examiner's Expenses, — $316; printing and stationery, $815;
office expenses, $37; postage and telegrams, $206; Express — $109.
300 ORAL HEALTH
The sum of six hundred dollars was voted for research purposes to
be paid to the Canadian Dental Research Foundation, under the
condition that the amount be equally distributed among the Dental
Faculties in the agreeing provinces to carry on research under the
general direction of the C.D.R.F. Should any such Faculty be not
in a position to undertake research work during the ensuing term of
two years, the whole amount to be available to those in a position to
take advantage of this offer.
The next Biennial meeting of the D.D.C. will be held in Vancou-
ver during the meeting of the Canadian Dental Association.
Post Graduate Course — R.G.D.S
ANNOUNCEMENT of a Post-graduate Course for dental
practitioners, to be held at the Royal College of Dental Sur-
geons from Tuesday, 5th September until Saturday, 16th Sep-
tember, 1922, is published elsewhere in this issue The course in-
cludes some of the more important phases of modern dental practice
and is to be of practical importance to practitioners. An interesting
feature of the course is the option given registrants to select those sub-
jects which appeal most to their individual needs.
The entire fee for the two weeks' instruction is placed at the nom-
inal sum of $25, while licentiates in actual practice within the pro-
vince of Ontario, and who are not in arrears of annual fee, will be
charged a fee of $10.
Those intending to register for this course should forward applica-
tion to the Superintendent of the College, 240 College St., Toronto,
without delay, that a place in the class may be assured.
Dr. Beach President of a Great State
Philanthropy
DR. J. Wright Beach, of Buffalo, who contributes to ORAL
HEALTH under the nom de plume Habec, has been elected
President of the New York State Society for Crippled Child-
ren. It is always a pleasure to record the public activities of mem-
bers of the profession who are good citizens as well as good dentists.
Indeed, the interests of dentists are so broadening in these latter days,
that it is questionable whether modern standards permit a man to be
classed as a good dentist unless he is also a good citizen.
:\^,
■^f.i^
PROFITABLE
EXCHANGE
•'You have a dollar,
I have a dollar,
We exchange.
You have my dollar,
I have your dollar,
We are no better off.
BUT
"Suppose you have an idea,
I have an idea,
«.. . We exchange, ^f-
t • "■'■ You now have two ideas.
And I have two ideas.
We have increased our ideas,
One hundred per cent."
Dr. F. Percy Moore, L.D.S. Dr. H. F. Whittaker, F.A.C.D.
Hamilton, Ont. Edmonton, Alta.
President Ontario Dental Association President Canadian Dental Association
Doctors Whittaker and Moore were presiding officers at the
1922 combined convention of the Canadian and Ontario Dental
Associations at Toronto.
DlL
m
OPAL HEALTA
A JOURNAL THAT STANDS FOR THE '♦OUNCE OF
PREVENTION," AS WELL AS THE « POUND OF CURE''
m
m
VOL. 12
TORONTO, SEPTEMBER, 1922
No. 9
An Outline of the Theory and Practice of
Partial Denture Service
W. E. Cummer, D.D.S.,
Royal College of Dental Surgeons, Toronto.
EXPLANATORY NOTE.
1. Partial Denture SERVICE, includes (a) Theory, defined as "the classi-
fied knowledge of the subject" (Wilson) and (b) Practice, the use of this-
classified knowledge in guiding the hands in the various handicraft-operations-
necessary in the replacement of lost teeth.
2. The THEORY of partial denture service is made up chiefly of a working:
knowledge of the
(a) Natural structures and functions to be restored (gross and minute),
including their probable behavior when subject to unusual stresses.
(b) Standardized parts, which when brought into proper juxtaposition,
will result in an appliance which will
1. Restore structures and functions as maybe by human
agency.
2. Prevent further injury to structures and functions.
(c) Prevention of injuries to these parts —
1. Injuries which naturally result in the loss of teeth;
2. Injuries from improperly designed and constructed artificial
parts.
3. The PRACTICE of Partial Denture Service. Having acquired, and ment-
ally classified the above theoretical principles, these may be used as a guide to
correct manipulation in the Practice of Partial Denture Service. Practice is
made up of four stages: Design, Construction, Installation and Maintenance.
4. Design. A mental or graphic picture must precede all engineering
construction. In Partial Denture design the theoretical principles are made
use of as needed in the development of design. The main item of practical
value of this demonstration is that of a mental and graphic technique for the
development of any design for any combination of teeth in four simple stages.
5. Construdtion. Having developed mentally or on paper the correct
design, the next stei) is that of actual construction. Accuracy, lightness, small
bulk as possible, rapidity, ease, and low cost are of primary importance.
In the opinion of the writer, much research and invention are needed here.
6. Installation. Many a fine piece of well designed and constructed Pros-
thetic work is become a failure for the sole reason of lack of care in installa-
tion. Hence the importance of this step.
7. Maintenance and Repair. Many a piece of well designed, constructed
and installed I*rostheti(; work becomes a failure for the sole reason of improper
maintenance and prompt necessary repairs. The patient here divides the
responsibility with the dentist. Hence also the importance of this step.
304
ORAL HEALTH
GhartM
Partial Denture Service
(continued) ROYAL COLLEGE DENTAL SURGEONS
THEORY OF B^RTIAL DENTURE SERVICE -'A mrkmg/6?ow/eifgp 6f>
\2 /issoasfc p^rh.
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STRUCTURES
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FUNCTIONS.
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POTH STRUCTURES AND FUNCTIONS.
Figure No. 1. Duplicate of chart as shown,
theoretical knowledge — A, B, C, with detail.
Note three divisions of
THEORY.
I. Restoration.
It is manifestly impossible to attempt the restoration of structures
and functions wholly and partially lost without an intimate knowledge
ORAL HEALTH 305
of each of these, both gross and minute. The necessity of subjecting
both the teeth and associate tissues to unusual stresses requires a know-
ledge of the probable behavior of these tissues under these stresses, in
order to utilize these tissues as much as possible and avoid overload.
Incidentally the dental profession requires a very considerable amount
of data on this probable behavior of tissues under various loads, from
research investigation not yet done.
2. Standardized Parts.
In manufacturing practice, standardized products are assembled
by the juxtaposition of standardized parts by manufacturing pro-
cesses. This juxtaposition may be varied for special needs or uses;
for example a variation in the juxtaposition of parts of an automobile
will result in a variety in the product, with a proportion of the parts
identical in each.
In partial denture design the process is a mental or mental-graphic
one with a mental store house of six classes of standardized parts
located in the mind of the Dentist as a result of his theoretical studies.
This forms the second branch of the theory of partial denture service
as may be noted in detail in figure No. 2 (page 5).
3. Bases, Attachments, Teeth.
The base, or that part in contact with the mucosa, includes the
saddles and parts connecting saddles, discussed under Design, step 1
and 2. Vulcanite as a material is indicated in cases which may
require rebasing, especially after recent extraction. The attachment
here describes that element which joins the teeth to the base, usually
vulcanite, occasionally gold (with tube teeth, crowns, or similar). The
teeth used are usually vulcanite pin teeth, detachable facings or tube
teeth. The sulcus angle of these teeth should be made ,to correspond
with that of the remaining teeth, and all of the detail of marginal and
transverse ridges, grooves, etc., should be present to allow the escape
of cut food and prevent overload.
4. Retention, and Objectives in Retention.
All that is required in retention of any artificial restoration is
fixation sufficient to oppose gravity or the displacing effect of mastica-
tion. Gravity in uppers is very slight, a matter of ounces, and the
bulk of masticating force tends to seat the denture in position. Hence
only a slight retentive force is necessary, except in small removable
bridges, which may be swallowed, in which the retentive force should
be positive, requiring some effort to remove.
Obviously the piece should be retained so far as possible at the
centre of gravity. In addition to this the following objectives may be
noted: —
306
ORAL HEALTH
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ORAL HEALTH
307
(a) Use of simple retainer (as clasps) of smallest possible con-
tact-area instead of compound retainers (as Roach attach-
ments, etc.) as far as possible for both preventive and
economic reasons.
(b) An effort to use two only retainers with fulcrum line (imag-
inary line between direct retainers) passing through the
centre of gravity of restoration (Class 1 -2-3) with or with-
out indirect retainers. (See figure No. 3.)
(c) The use of three or more direct retainers if (a) paired teeth
may not be found opposite, with fulcrum line in centre of
gravity, or if (b) a splint-support for teeth of impaired
pericementum is required.
Direct Retainers.
Retainers are subdivided direct and indirect, direct retainers such
as clasps and similar applying the retentive force directly at the point
of application. As noted figure No. 2 these are simple (as clasps,
cribs, etc.) and compound (as Roach, ring and stud, etc.). The
simple retainers are preferable over compound retainers because no
5.
Cast WfTHOuT DtKtuBE iii>i"€«DCNni»» Cast With DENTURE Class
Cast Without Dentubc.
UPm OCKTVM.
Cast Wttm Dent^be CLASS 3
Figure No. 3. Indirect Retention.
A. shows a restoiation which would be unsuccessful because the fulcrum
line lies to one side of the centre of gravity of the piece, and the saddle in the
cuspid region would be unstable.
B. shows the restoration A corrected by a 14 gauge extension reaching to
the second molar at a horizontal point on the occlusal surface at which the
articulation will admit. This ])rings the centre of gravity coincident with the
fulcrum line, and stal)lizes the unsuj)ported part of the saddle (the cuspid
region. The above is an example of class one with direct retainers diagonally
opposite.
C. a class two restoration (with direct retainers diametrically opposite),
unsuccessful because the fulcrum line lies outside the centre of gravity.
D. same as C, corrected by indirect retention l:)ringing the centre of gravity
coincident with the fulcrum line. As noted figure No. 5, indirect retainers are
of various types, contact only, and also carrying teeth, restoring spaces, etc.
308
ORAL HEALTH
cutting of tooth tissue is necessary. Compound retainers are indicated
when excavation of tooth tissue is either necessary or has been already
done.
6. Indirect Retainers.
Direct retainers should be ordinarily two in number and should be
placed directly opposite with an imaginary line joining them (fulcrum
line) passing through the ctiitre of gravity of the restoration. Fre-
quently this is impossible because the fulcrum line joining the two teeth
adjacent to the edentulous space may lie outside the centre of gravity
of the restoration. Hence an extension brought into contact with a
suitable tooth remote from the unsupported part of the restoration will
bring the fulcrum line to the centre of the piece. These extensions are
called indirect retainers as noted Figure No. 3.
7. Connectors.
In cases in which the presure of mastication is either wholly carried
by the teeth or roots or divided between these and the mucosa, a 14
Figure No. 4. A simple non-rigid connector (W. A. Giffen) of 18 gauge
elastic wire. An independent saddle movement is here secured, but without
support from adjacent teeth.
Figure No. 5. A compound non-rigid connector (Dresch). Mr. Dresch has
stated that, by the use of vulcanized rubber between the links pressure may
be divided between teeth and mvicosa. Models furnished kindness Dr. L. F.
Furnas, Cleveland, Ohio.
ORAL HEALTH
309
gauge wire soldered to the clasp, or other retainers, placed usually in
the embrasure, (see Fig. 1 1 ) and attached by solder to the balance
of the frame work may be used.
Should, however, for such causes as flabby mucosa, few remaining
teeth, or similar, it may be deemed unsafe to divide the pressure for
fear of overload of the pericementum, non-rigid connectors may be
used. Examples of two types are shown, rigid and non-rigid. Figure
No.'s 4 and 5.
8. Occlusal Rests.
Occlusal rests if used transmit all or part of the pressure of mastica-
tion to the teeth and preicementum upon which they may rest. These
are of various types as noted (Figure 2) for various purposes, as noted
hereinafter.
9. Prevention of Drifting, Exfoliation, Excessive Stress,
Wear and Stagnation.
These changes following the loss of teeth are usually preventable
^^^M^^M
^^i^#,^^
Figure No. 6. An instance of progressive drifting and exfoliation following
extraction with increase of traumatic occlusion.
(a) Before extraction.
(b) Immediately after extraction, no traumatic occlusion.
(c) Lower molar tipping forward and separating both upper and lower,
bicuspid driving upper bicuspid distally.
(d) The same condition only considerably worse, with exfoliation.
(e) and (f) The same with separation of upper anterior. At any stage
these progressive conditions could have been checked by well de-
signed partial restorations.
Figure No. 7. Excessive stress and consequent wear. The approximate
losses in area, hence masticating efficiency is indicated above.
(a) Complete Denture.
(b) One tooth at the end of a series, loss approximately 12.2%.
(C) Two teeth, loss approximately 21.1%.
(d) One tooth in centre of a series, loss approximately 23.3%.
(e) Two teeth, loss approximately 23.3%.
(f) Three teeth, loss approximately 34.4%.
(g) Two teeth, loss approximately 17.7%.
(h) Three teeth, loss approximately 23.3%.
(i) Four teeth, loss approximately 31.1%.
In each case these losses indicate the same stress heretofore carried by
the complete denture and now assumed by the remaining teeth. It might also
be noted that, when a tooth is extracted form the centre of a series, the function
of five others is interfererl with as in (d), the function of Nos. 2-3-4-5 is inter-
fered with, with complete loss of function of the extracted tooth No. 1.
310
ORAL HEALTH
by the immediate insertion of well designed partial restorations, and
are as follows:
1 . Drifting, limited or extensive, usually with and occasionally
without traumatic occlusion.
2. Exfoliation, limited or extensive, usually with or occasionally
without traumatic occlusion.
3. Excessive stress and consequent wear on remaining teeth.
4. Stagnation of non-occluding teeth.
Reference to these to patients who are not inclined to accept pro-
posed treatment is often of value.
Ixrr Elevation, Casts
Antcriob Elevation. Casts
Right Elevation. Casts
Figure No. 8. A sample of stagnation, with Nature's tooth brush (e.g.,
the passage of food over teeth driven by teeth and occlusion) absent. Especi-
ally with a lack of salivary balance, the above is apt to occur. Note difference,
left and right elevation of cast.
10. List of Most Frequent Causes of Injury to Struc-
tures, AND Interference WITH Functions as Common-
ly Found in Partial Denture Design and Con-
struction, Insertion, and Maintenance (in part).
Here follows a list in part as enlarged from 22 items. Figure 1,
No. 6 (injuries as the result of faulty appliances) , with most frequent
examples of each. It may be noted that, capillarity, impingement,
interference, and the three out of the five mechanical advantages
(torques, levers and incline planes) include all of these destructive
forces.
STRUCTURES.
1 1. Enamel, Dentine and Cementum, Intensive Caries Pro-
duction, Erosion and Wear.
(a) Capillary retention against enamel, (faulty or at fissures)
from clasps, occlusal rest, or pads causing intensive caries
production.
(b) Capillary retention against dentine by clasp, pad, or other
constructional parts, causing intensive caries production.
(c) Capillary retention against cementum by clasps, base, or
other constructional parts, causing intensive caries produc-
tion.
(d) Clasps and other parts over inlay margin, causing intensive
caries production.
(e) Clasps and other parts over eroded areas, causing further
erosion, caries or both.
(f) Abrasion, usually from porcelain in overload relation to
abraded teeth.
OR AL HE ALTH 311
(g) Attrition, usually from natural teeth in overload.
(h) Use of compound retainers rather than simple, resulting in
unnecessary destruction of tooth tissue,
(i) Unneccessary number and contact area of direct retainers.
12. Gingivae, Impingement and Interference.
(a) Impingement against gingival margin, or septal gingivae
by clasps, etc.
(b) Impingment against gingival margin, or septal gingivae by
saddle and other constructional parts.
(c) Impingment against gingival margin, or septal gingivae by
"settling" clasps and saddles, especially after recent
extraction.
(d) Interference from unprotected gingival margin and septal
gingivae from lack of occlusal protective contours, such as
marginal ridges, cusps, etc.
(e) Interference from unprotected gingival margin, and from
septal gingivae from lack of axial protective contours.
13. Mucosa and Subjacent Bone, Overload.
(a) Overload from small saddle area in proportion to mastica-
tion area, and pressure, without occlusal rests.
(b) Local overload, improper muscle trimming, saddle outline,
etc.
(c) Local overload from incorrect forecast of compensation for
hard areas, and settling.
(d) Overload of mucosa from relation of direct retainer and
mucosa with too much pressure on mucosa.
14. Mucosa and Subjacent Bone, Strangulation.
(a) Parallel wrought and cast clasps, connectors, and com-
pound retainers which do not release after pressure applied
from too tight construction, etc.
(b) Clasps with excess towards gingival cone.
(c) Indirect retainers adjusted too tight.
(d) Overloads on mucosa as above.
(e) Relations between saddles and direct retainers giving
mucosa too much pressure.
15. Pericementum and Mucosa, With Subjacent Bone,
Overload.
(a) Local overload, from warpage in construction and too
great pressure at one or more points.
(b) Overload, from lack of escape groves, with flat cutting
contacts rather than line contacts.
(c) Overload from all constructional parts preventing exact
central occlusion.
312 ORAL HEALTH
16. Pericementum, Overload.
(a) Overload from occlusal rests, from expected absorption
(especially after recent extraction) with no rebasing.
(b) Overload from large saddle area on each side of remain-
ing tooth or teeth, w^ith occlusal rests.
(c) Overload from medium saddle area, soft mucosa, v^ith
occlusal rests.
(d) Clasps without occlusal rests too heavy to admit of ver-
tical "slip" especially with soft mucosa.
1 7. Pericementum Torque, Vertical.
(a) Cast clasps too wide on free saddle.
(b) Cast clasps too thick on free saddle.
(c) Cast clasps (B.L.) wide body on free saddle.
(d) Cast clasps (M.D.) too wide at free ends and attached to
free saddle.
(e) Cast clasps (B.L.) too thick at free ends and attached to
free saddle.
(f) Cast clasps (L.A.) attached to free saddles as above.
(g) Reinforced wrought clasp attached to free saddle as above,
(h) Improper relief on all clasps (E.G. right angles to fulcrum
line).
18. Pericementum, Torque, Horizontal.
(a) Cast clasps on single teeth.
19. Pericementum Incline Plane, (Wedge) Mesio-distal.
(a) Interfering embrasure hooks above contact point.
(b) Connectors improperly soldered to free end of clasps.
(c) Too much solder, connector to clasp.
(d) Occlusal rest too short and on incline plane.
(e) Improperly placed rigid connectors on leaning teeth.
(f) Improperly placed clasp bodies on leaning teeth.
(g) Rigid 2-3 loops too short.
20. Pericementum, Incline Planes, Bucco-lingual.
(a) Indirect retainers on incline planes without occlusal rests on
direct retainers.
(b) Improperly placed rigid connectors on leaning teeth.
(c) Improperly placed clasp bodies on leaning teeth.
(d) Skeleton work too rigid.
21. Pericementum, Incline Plane, M.D. B.L.
(a) Teeth interfering with occlusion.
(b) Teeth interfering with articulation.
(c) Parts interfering with occlusion.
(d) Parts interfering with articulation.
ORAL HEALTH 313
(e) Shrinkage and distortion of metallic frame-work.
(f) Contours too full, inlays, crowns, etc.
22. Pericementum, Incline Plane, Axial.
(a) Clasp above or below line of widest cross section.
(b) Rebound of displaced mucosa, with relation of direct re-
tainers and mucosa too close without occlusal rests.
23. Pericementum, Lever 1st Class. (P.F.W., Ex. Shears).
(a) Indirect retainers too tightly adjusted.
(b) Cast multiple clasps on single groups of teeth.
(c) Indirect retainer too close to fulcrum line.
(d) Teeth set outside ridge.
(e) Certain Class III cases with free saddle on soft mucosa.
24. Pericementum, Lever 2nd Class. (P.W.F., Ex. Nut-
Cracker) .
(a) Cast multiple clasps on single groups of teeth.
25. Pericementum, Lever 3rd Class (F.P.W., Ex.
Tweezers).
Indirect retainers, no occlusal rest on direct retainer. (Re-
mainder of mechanical advantages, e.i. screw and pulley, not
found).
26. Pericementum, Combinations of any or all Mechan-
ical Advantages.
(a) Cast clasps with rigid connectors on flabby mucosa, with-
out provision for correlation of movement of saddle and
anchor tooth.
27. The Dental Pulp, Periapical Tissues, Various
Injuries.
Because of the interdependence of the dental pulp, perice-
mentum, dentine, enamel, cementum and gingival tissues, injuries
to the dental pulp, followed by diseases of the dental pulp, with
sequelae, may occur from any or all of the foregoing causes.
28. Cheeks, Tongue and Soft Tissue, Impingment and
Irritation, Leading Possibly to Malignancy.
(a) Improper overhang to prevent tongue and cheeks biting.
(b) Positioning of constructional parts not close enough to pre-
vent irritation to tongue and cheeks.
(c) Improper finishing, rounding off of sharp edges, elimination
of feather edges, etc., (should include a study of the micro-
scopy of the polished and aseptic surfaces).
314 ORAL HEALTH
FUNCTION.
Injuries may result from lack of application of all known principles,
especially in:
29. Mastication and Ultimate Digestion, etc.. Various
Injuries.
(a) All missing teeth and surfaces not supplied, (for example
with special occlusal pads to secure greatest masticating
surface).
(b) Lack of anatomical articulation on partials, (various
mechanical advantages as before mentioned).
(c) Lack of positive retention in small pieces and danger of
swallowing of piece.
30. Speech and Voice, Lisping, Thick Speech, etc.
(a) Parts crossing ahead of bicuspids to be between rugae or
failing this, wide flat cast or swage pieces (avoiding lisping,
etc.)
(b) Parts crossing distal to first molar, bar or similar not cross-
ing approximately opposite to the second molar, causing
thickening of speech.
(c) Parts not close to mucosa. (Causing both lisping and indis-
tinct enunciation).
3L Hearing, Interference With.
(a) Neglect of sufficient intermaxillary distance in restoration,
(may interfere with opening of meatus by condyle tipping
back and causing obstruction. See literature, Monson,
Wright and others).
BOTH STRUCTURE AND FUNCTION.
Almost all of the foregoing injuries to structure and function may
occur, or may be aggravated through breakage, settling, or other
contingencies difficult or impossible to forsee. After insertion these
may be prevented by proper inspection and maintenance including
the following:
32. Maintenence, (the Patients Part).
(a) Cleansing five times per day.
(b) Saliva flush.
(c) Removal at night.
(d) Use of notification system for periodic examination fur-
nished by dentist.
(e) Prompt repairs if necessary.
(f) Study of suitable literature provided by dentist.
(To be completed in October issue)
The Canadian Dental Research Foundation
Report Presented to Canadian Dental Association Con-
vention, May, 1922.
THE Board of Directors of the Canadian Dental Research
Foundation, composed of two Directors from each Province of
Canada and two Directors appointed by the Canadian Den-
tal Association, beg to report as follows: —
Five Research Bulletins have been issued:
Bulletin, Number One —
The Evolution of the Periodontal Pus-Pocket.
—Harold K. Box, L.D.S., D.D.S., Ph.D., F.A.A.P.
Bulletin, Number Two —
The Rupert Hall Method for Entire Upper and Lower Denture
— W. E. Cummer, D.D.S.
Bulletin, Number Three —
The Dentinal-Cemental Junction.
— H. K. Box, L.D.S., D.D.S. , Ph.D., F.A.A.P.
Bulletin, Number Four —
The Histological and Histo-Pathological Studies of the Dental Pulp.
H. K. Box, L.D.S., D.D.S., Ph.D., F.A.A.P.
Bulletin, Number Five —
Theory and Practice of Partial Denture Service with Special Reference to a
Graphic Method of Design.
— W. E. Cummer, D.D.S.
The Financial Report of the Foundation is presented herewith,
showing a balance in the Trust account of $10,430.51 and in the
Current account of $20.99.
Since the last meeting of the Canadian Dental Association held
in Ottawa in August, 1920, the total subscriptions have grown from
$6422.53 to $12,512.51— a net increase of $6090. Thus, we have
practically doubled our subscriptions in two years.
Subscriptions actually paid-up and deposited in the Trust Account
with the National Trust Company are from time to time invested in
Government Bonds, so that the income from these investments will
amount this year to approximately $600.00. In past years we have
not even had this amount of interest income and our Current funds
have been supplemented by generous grants from the Royal College
of Dental Surgeons, and the Canadian and Ontario Dental Associa-
tions, and which have enabled the Foundation to carry on its work.
We are yet a long way from our objective of a $100,000 Trust
Fund and sincerely urge upon the members of the profession through-
out Canada their duty toward this very important work.
316
ORAL HEALTH
The Foundation has continued to send all bulletins to the profes-
sion, without charge, in the confident hope that a generous response
will be made by every Dentist throughout the country.
Respectfully submitted,
J. S. Bagnall W. C. Oxner R. G. McLean,
Geo. F. Bush O. B. Price President.
J W Clay F W. Ryan
W. D. Cowan f". E." Smallwood Eudore Dubeau,
J. S. Dohan F. P. Smith Vice-President.
W. A. Hicks A. E. Webster Wallace Seccombe,
E. C. Jones H. F. Whittaker Secretary
J. M. Magee
H. J. Merkeley E. A. Grant, W, E. Cummer,
Sylvester Moyer Associate Sec.-Treas. Treasurer.
CANADIAN DENTAL RESEARCH FOUNDATION.
AUDITOR'S STATEMENT OF ASSETS AND LIABILITIES.
(December 31st, 1921.)
ASSETS.
Current Account:
Cash in bank $ 186.3S
Accrued Interest on Investments 163.68 350.06
Trust Account:
Cash in Trust Company 614.30
on hand 95.00
Unpaid Subscriptions 1,672.00
Due from Current Account 46.88
Investments 9,231.70 11,659.88
$12,009.94
LIABILITIES.
Current Account:
National Trust Co., Limited $ 6.25
H. H. Sparks 6.34
Trust Account 46.88
59.47
Surplus 290.59 350.06
Trust Account:
Interest in abeyance 12.37
Surplus, being- total subscriptions to date 11,647.51 11,659.88
$12,009.94
AUDITOR'S STATEMENT OF RECEIPTS AND DISBURSEMENTS
TRUST ACCOUNT.
(From the date of the inception of the Foundation to December 31st, 1921).
RECEIPTS.
Subscriptions $ 9,975.51
Interest on Investments 143.62
Trust Funds fi5.78
$10,184.91
DISBURSEMENTS.
Investments:
Province of Ontario 6 %— 1941— $3,000 $2,948.70
6 %— 1943— 2,000 2,070.00
Victory Loan 51/2%— 1934— 1,500 1.41.3.00
51/2 %_1933— 1,500 1,500.00
War Loan 51/2%— 1931— 1,200 1.200.00
war i.oan 5i|4_i937_ 100 100.00 $ 9,231.70
Accrued Interest on Investments ^^'r a
Cost of transferring $1,500 Victory Loan Bond .50
Interest remitted to Secretary-Treasurer 187.46
9,475.61
Cash on hand $ f^'Hn r-A,. oa
in Trust Company 614.30 (09. oO
$10,184.91
ORAL HEALTH 317
AUDITOR'S STATEMENT OF RECEIPTS AND DISBURSEMENTS.
CURRENT ACCOUNT.
(From the date of the inception of the Foundation to December 31st, 1921.)
RECEIPTS.
Grants from Board of Directors, R.C.D.S $1,000.00
Canadian Dental Association 200.00
Ontario Dental Society 200.00
Anonymous Contribution from Toronto Dentist 100.00
Interest, Investments held by Trust Company 131.25
$1,500, Victory Loan Bond 247.50
Trust Funds 56.21
$1,934.96
DISBURSEMENTS.
Stationery, Bulletins, Pamphlets and Postage $1,028.43
Incorporation and Legal Fees 304.60
Dr. W. A. Price, Cleveland 157.00
Auditing Dental Hockey Club Accounts, 1917 40.00
Dr. R. B. Stewart, re Research Work 200.00
National Trust Co., Limited, Charges 13.86
Interest and Exchange 4.69
1,748.58
Cash in Bank, December 31st, 1921 186.38
$1,934.96
THORNE, MULHOLLAND, HOWSON & McPHERSON,
Chartered Accountants.
SECRETARY-TREASURER'S FINANCIAL STATEMENT.
(Of period from Dec. 31st, 1921, to May 13th, 1922).
TRUST ACCOUNT.
RECEIPTS.
National Trust Company:
Invested Funds— Dec. 31st, 1921 $ 9,231.70
Uninvested Funds— Dec. 31st, 1921 614.30
$9,846.00
Cash on hand— Dec. 31st, 1921 95.00 9,941.00
Adjustment as per auditor's report 46.88
Subscriptions paid from Dec. 31, 1921, to date 455.00
$10,442.88
Less interest on $450.00 bond held by National Trust Company to
your account, but the ownership of which has not been established. 12.37
$10,430.51
National Trust Co.— May 13th, 1922:
Invested Funds $ 9,231.70
Uninvested Funds 1,198.81
SUBSCRIPTIONS PAID.
To Dec. 31st, 1921, as per auditor' .s report $9,975.51
" May 13th, 1922, as per attached list 455.00
TOTAL PAID $10.4.30.51
SUBSCRIPTIONS UNPAID.
Subscribed to May 13th, 1922 12 512 51
Paid to May 13th, 1922 lo',43o!51
TOTAL UNPAID $2,082.00
318
ORAL HEALTH
CURRENT ACCOUNT.
(Period from Dec. 31st, 1921, to May 13th, 1922).
RECEIPTS.
■Rninnrp in Bank, Dec. 31st, 1921
giteres? recSved from National Trust Company on Investments.
186.38
265.00
$451.38
DISBURSEMENTS.
National Trust Co. Adjustment as per auditor's statement.
H H Sparks, Printing subscription forms
Stainton, Downey & Evis, Ltd , Cash Book ••••••••
Thorne, Mulholland & Co., Auditmg to Dec. 31, 1921
Interest and exchange
Photo-Engravers, Ltd., re Bulletm cuts
Balance in bank, May 13th, 1922
46.88
6.36
2.00
25.00
.15
350.00
$430.39
20.99
$451.38
DETAILED
(To
Abar, Dr. Harry S $
Abbott. Dr. E. C
Agnew, Dr. R. G
Amy, Dr. W. B
Anderson, Prof. G. R
Anderson, Dr. H. W
Ante, Dr. Irwin H
Armstrong, Dr. J. W
Babcock, Dr. A. B
Baird, Dr. D
Baker, Dr. E. S
Ball, Dr. T. E
Barkley, Dr. W. K
Beirel, Dr. G. D
Black, Dr. Jas. E
Black, Dr. W. A
Bothwell. Dr. J. A
Box, Dr. R. M
Boyle, Dr. L. H
Bregman, Dr. B
Brooks, Dr. C. E
Butler, Dr. T. E. C
B. C. College of Dental Sur-
geons
B. C. Dental Association
Campbell, Dr. E. H
Canning, Dr. O. W
Chalmers. Dr. W. L
Childerhouse. Dr. W. C
Clapp, Dr. G. W
Clarke, Dr. Harold
Clarkson, Dr. P. E
Clay, Dr. J. W
Code, Dr. H. M
Collard, Dr. C. R
College of Dental Surgeons of
the Province of Quebec . .
Conboy, Dr. F. J
Coon, Dr. W. H
Coram, Dr. G. H
Coram, Dr. J. W
Corrigan, Dr. C. A
Cote, Dr. F
Cowling, Dr. T
Cummer, Dr. W. E
Dalyrmple, Dr. W. A
Davidson, Dr. H
Dental Co. of Canada, Ltd...
Dental Hockey Club, 1917
Derbyshire, Dr. A. O
Drewbrook. Dr. L
Duff, Dr. J
Eaton, Dr. H. E
LIST OF SUBSCRIPTIONS
December 31st, 1921).
c nn Emmett, Dr. George 5.00
.m Fallis, Dr. C. 0 25.00
^i'Z Fife, Dr. B. 0 50.00
100-00 Fish. Dr. G. V 15.00
^^?-^S Forbes. Dr. A. W 50.00
ll'Z Frawley, Dr. G. L 10.00
ll'Z Frawley, Dr. S. L 50.00
fo^-^X Gausby, Dr. E. L 25.00
JHn Giimian, Dr. G. E 10.00
^Hn Godfrey, Dr. R. J 30.00
i^Ho Gow, Dr. George 100.00
]yryr, Graham, Dr. Howard 100.00
JH?. Graham. Dr. J. S 100.00
l?-^^ Grant, Dr. E. A 25.00
^•^2 Grieve, Dr. G. W 100.00
.I'Z Gunton, Dr. G. A. C 10.00
?^-X^ Halifax Dental Society 50.00
^2-J2 Haslett. Dr. R 5.00
,^^X Henderson, Dr. R. H 5.00
1^00 Hicks, Dr. W. A 25.00
1^-2^ Himelstein. Dr. I. L 25.00
15.00 Hoag, Dr. H. W 5.00
50.00 Hoffman. Dr. R. W 25.00
Holmes, Dr. Wendell 15.00-
100.00 Hord, Dr. A. M 10.00
100.00 Hoskin, Dr. H. A 25.00
5.00 Huggill, Dr. W. L 15.00
15.00 Husband, Dr. F. C 100.00
40.00 Hutchinson. Dr. John 100.00
5.00 Hva Yaka Dance lOO.Oa
125.00 Ingram. Dr. J. W 10.00
100.00 Irwin, Dr. J. E 5.00
10.00 Jones. Dr. Fred H 10.00
25.00 Kates, Dr. M 25.00
5.00 Krueger, Dr. L. F 45.00
50.00 Laidlaw. Mr. W. C 25.00'
Lapp. Dr. J. S 20.00
500.00 Laving^Dr.X J. ............ 25.00
100.00 Leggett. Dr. W. C 5.00
125.00 Lewis, Dr. T. H 15.00
40.00 Loftus, Dr. J. J 10.00
50.00 i,ong, Dr. V. C 25.00
25.00 Lundy, Dr. B 15.00
5-00 Mahoney, Dr. C. J 10.00-
25.00 Mallory, Dr. Fred 13.00
50.00 Marshall. Dr. T. R 5.00
2.00 Mason. Dr. A. D. A 200.00
20.00 Miller Memorial Contribution 1,602.98
100.00 Mills, Dr. John 10.00-
1,917.53 Morton, Dr. G. V 10.00
5.00 Mover, Dr. C. E 10.00
10.00 Mullen. Dr. A. E 10.00
10.00 Murrav, Dr. F. W 5.00
100.00 Murray, Dr. F. W 30. 00-
ORAL HEALTH
319
McCartney, Dr. C. J 10.00
McDonagh, Dr. A. J 100.00
McDonald, Dr. Wm 5.00
McGill, Dr. T. N 25.00
McGowan, Dr. E. S : . . 15.00
McGuire, Dr. Wm 10.00
Mcintosh. Dr. R 5.00
McLachlan, Dr. J. P 10.00
McLaughlin, Dr. R. G 150.00
McLean. Dr. R. G 275.00
Mclnally, Dr. Harry L 3.00
McRae, Dr. M. F 10.00
Nova Scotia Dental Associ-
ation 150.00
Ontario Dental Association.. 150.00
Ott, Dr. B. M 10.00
Paul. Dr. E. W 200.00
Pearson, Dr. C. E 100.00
Perdue, Dr. G. H 5.00
Pilkey, Dr. J. S 10.00
Plaxton. Dr. O. G 30.00
Price, Dr. F. D 50.00
Price, Dr. W. A 50.00
Priestman, Dr. J. A 10.00
Purdy, Dr. J. H 5.00
Pivnick, Dr. M 25.00
Reid, Dr. J. H 5.00
Rhind, Dr. J. E 35.00
Riggs, Dr. L. F 50.00
Rondeau, Dr. V 5.00
Ross, Dr. Hugh 5.00
Ross, Dr. J. F 50.00
R. C. D. S. Surplus Hanau
Dinner Fund 3.00
Sadleir, Dr. E. A 15.00
Schaffer, Dr. Bernard 15.00
Schwart, Dr. M 25.00
Scott. Dr. C. G 10.00
Scott, Dr. J. K 5.00
Scott, Dr. W. A 100.00
Seccombe, Dr. Wallace 200.00
Semple, Dr. Arnold 15.00
Sheldon, Dr. J. M 10.00
Sivers, Dr. W 31.00
Slade, Dr. J. A. 25.00
Smith, Dr. L. Gerald 25.00
Smith, Dr. Percy St. C 10.00
Smith, Dr. S. T., San Fran-
cisco 65.00
Smith, Dr. W. C 100.00
Snell, Dr. C. A 35.00
Snelgrove, Dr. C. V 100.00
Sparrow, Dr. M. W 25.00
Steel, Dr. G. J 25.00
Stewart, Dr. R. A 100.00
Strath, Dr. J. R 10.00
Students of R.C.D.S 760.00
Students' Parliament R.C.D.S 50.00
Subirana, Dr. L., Madrid, Spain 5.00
Sutton, Dr. C. E 50.00
Switzer, Dr. W. G 25.00
Temple Pattison Co. Limited 100.00
Thomas, Dr. P. C 5.00
Thornton, Dr. R. D 50.00
Throsby, Dr. Geo 50.00
Thunder Bay Dental Associ-
tion 100.00
Trotter, Dr. W. C 25.00
Walker, Dr. R. R 15.00
Watson, Dr. P. J 5.00
Webster, Dr. A. E 75.00
White, Dr. J 5.00'
White Co. of Canada, Ltd.,
S. S lOO.OOi
Willmott, in memory of late
J- B 100.00'
Woollatt, Dr. R. S 15 00-
Wright, Dr. W. H 50.00
Wunder, Dr. W. M 5 00
Wylie. Dr. T. H 5.00-
Ziegler, Dr. C. H 10.00
Total Subscriptions 11,647.51
Less unpaid 1,672.00-
Subscriptions received $9,975.51
Subscriptions Received Since December 31st, 1921, and not included
Auditor's Report.
Arnold, Dr. E. F., Toronto.. $ 5.00
Allen. Dr. A. H., Peterboro.. 10.00
Anonymous 1.00
Barnes, Dr. O. E., Assiniooia,
Sask 25.00
Brett, Dr. A. J., Regma, Sask. 25.00
Baxter, Dr. H. A., Montreal,
Que 10.00
Berry, Dr. R. N., Caledonia,
Ont 10.00
Dawson, Dr. T. W., Toronto. 5.00
Kelley. Dr. Charles J., Tor-
onto 10.00
Phillips, Dr. Geo. C, Tor-
onto 5.00
Irwin, Dr. W. W., Moose Jaw,
Sask 50.00
Winthrope, Dr. P. W., Saska-
toon, Sask 25.00
Gillies, Dr. W. J., Saskatoon,
Sask 25.00
Moyer, Dr Sylvester, Rose-
town, Sask 25.00
Harwood. Dr. F. C, Moose
Jaw. Sagk 25.00
Fasken, Dr. L. J. D., Moose
Jaw, Sask 25.00
Johnson, Dr. Archie L,,
Moose Jaw, Sask 25.00
Switzer, Dr. P. K., Saska-
toon, Sask 25.00
Grant. Dr. R. N., Regina,
Sask 25.00
Ness. Dr. W. B., Calvai. Sask. 25.00
Skinner, Dr. F. E., Saskatoon,
Sask 25.00
Rondeau. Dr. V. Rouleau,
Sask 25.00
Salter, Dr. A. P., Saskatoon,
Sask f
Weicker, Dr. C. H., Regina,
Sask
McKellar, Dr. H. E., Carlyie,
Sask
Smale. Dr. R. E., Regina,
Sask
Smith, Dr. W. F., Regina,
Sask
Eraser, Dr. J. E., Shawna-
von. Sask
Chegwin. Dr. A. E., Moose
Jaw, Sask
Campbell, Dr. E. C, Saska-
toon, Sask
Hart, Dr. O., Gull Lake,
Sask
Howden, Dr. D. S., Moose Jaw,
Sask
Graham, Dr. F. R., Estevan,
Sask
Cameron, Dr. G. L., Swift
Current, Sask
Schweitzer, Dr. H. M., Regina,
Sask ....
Carson. Dr. H. G., Saskatoon,
Sask
Parker, Dr. Chas. W., Regina.
Sask
Martin, Dr. F. W., Saskatche-
wan, Sask
Kroshus. Dr. G. L., Moose "
Jaw, Sask
Silknitter, Dr. J. Moose Jaw.
Sask
Smith, Dr. H. L.. Toronto.
Snell, Dr. C. A., Toronto
in
25.00
25.00
25.00
25.00
25.00
25.00
15.00
25.0a
25.00
25.00
25.0a
25.00
25.00
25.00
25.00
25.00
25.00
25.00
lO.Ort
15.00
f
320
ORAL HEALTH
Subscriptions Received Duri
Fleming, Dr. J. A., Pres-
cott, Ont 10.00
Ganton, Dr. W. J., Uxbridge,
Ont 10.00
Jordan, Dr. G. G., Toronto .. 25.00
Gunton, Dr. G. A. C, Toronto 2.00
McLaughlin, Dr. R. C., Paris,
Ont 1.00
Moyle, Dr. C. T,, Brantford,
Ont 1.00
Elliott, Dr. E. V., Dunnville,
Ont 5.00
Lederman, Dr. Sangster, Kit-
chener, Ont V 2.00
Moore, Dr. F. P. Hamilton,
Ont 25.00
Merkeley, Dr. H. J., Winni-
peg, Man 25.00
Hartman, Dr. H. N., Meaford,
Ont 10.00
ng CD. A. Convention, 1922.
Willinsky, Dr. Bernard, Tor-
onto 5.00
Emmett, Dr. G., Toronto 5.00
Hamel, Dr. Philippe, Quebec . 5.00
Charron, Dr. Ernest, Mont-
real 5.00
Marshall. Dr. O. A., Belle-
ville, Ont 5.00
Elliott, Dr. C. A., Detroit,
Mich 5.00
Dubeau, Dr. Eudore, Mont-
real 100.00
Strang, Dr. A. M.. Montreal. 10.00
Cummer, Dr. W. E., Toronto 10.00
McDonald, Dr. Jas. F., Ham-
ilton, Ont 10.00
Gardiner, Dr. E. R., Toronto. 25.00
O'Flynn. Dr. J. F., St. Cath-
arines, Ont 25.00
Fisk, Dr. G.
Subscriptions Received Since CD. A. Convention.
v., Toronto.... 10.00 Alberta Dental Association.
200.00
1922 $13,079.51
This amount not included in
Total Subscriptions to July 1st,
Note — Saskatchewan subscriptions total $832
financial statement as returns not yet received.
E. A. GRANT,
Associate. Secretary-Treasurer
'A Nerve Specialist'
"I'm having trouble with my nerves,
Say, Doctor, what's the matter?
The very slightest little thing,
My teeth begin to chatter."
"Go up and see good Doctor Russ,
The Dentist in this building.
He'll find a dead tooth with some pus.
To bet my life I'm willing."
I tried my best then to explain.
The Doctor looked with sorrow.
"That poison in your mouth, you see.
May cause your death to-morrow.
"You're wasting precious time, my friend;
Why, teeth like yours should never
Remain another day or hour.
You'll find Russ kind and clever.''
Again I tried hard to explain.
But, dsaf to all my pleading.
The clever 'Doctor hurried on:
"It's artificial teeth you're needing."
My nerves somehow got bad again,
My teeth began to chatter.
I shook so hard, the Doctor paused
To see what was the matter.
He tried to hold my shaking chin.
But shaking worse than ever,
My set of teeth, jarred loose, fell out.
And struck the floor together.
—DORA LAWRENCE CAMERON, Wenatchee, Wash.
What Should the Dental Student be Taught,
so that He may have a Correct Appreciation
of His Relation to Affairs of Life — Ethical,
Political, Economical, Financial ?
Sir Robert Falconer, President University of Toronto
[Ever^ reader should study Sir Roberts Address. It is ivell Jvorth
while and proved to he the outstanding feature of the recenli
meeting of the American Institute of Dental Teachers.]
IN discussing the subject assigned to me I shall not venture to linger
very long upon the latter half of it, the economic and the financial
sub-divisions. I had the pleasure of listening to your President's
admirable address this morning and to the discussions which followed,
and I judge that the economic side of a dentist's education is really
somewhat more important than I had believed it to be. Let me
merely say this: In my judgment one of the very important things
on the financial and economic side of a dentist's education is really
somewhat more important than I had believed it to be. Let me
merely say this: In my judgment one of the very important things
on the financial and economic side is not the acquiring of economic
sufficiency, but the right way in which to spend such wealth as may
be from time to time acquired by a dentist, if he ever does acquire
wealth. In fact, Mr. President, I think you will agree with me that
one of the necessities of our modern life is that people as a whole
who possess wealth, or who possess even a competency, should learn
how to spend that wealth and that competency in the right way. A
vast amount of the unrest that at present exists would be dissipated,
and a very great deal of the envy that is directed at capital would
disappear, were the possessors of that capital and that wealth so
informed and so trained as in the first place to have the desire, and
in the second place to know how, to spend their wealth or their
competency in the right way. In my opinion the spending of wealth
rather than the acquisition of wealth causes greater blame or ap-
proval; and it is one of the requirements of our modern life that on
the economic and the financial side there should be a much more
widespread appreciation of the duty which rests upon those who have
wealth, so to direct their intelligence that they may be led to spend
it properly. I rather think that this comes back to a certain personal
quality, possibly to a certain ethical attitude to a generous tempera-
ment, which, however, may be trained, and which will be trained
not merely in the class-rooms or in such instruction as is given to a
dentist, but in the give and take of life. It is the result of the man-
322 ORAL HEALTH
hood of our citizenship. I think the burden cannot be laid as a
necessity merely upon the dentist — he is only one among others.
Therefore I shall not linger upon this phase of the subject.
The question is asked: How is a dentist to be trained in order
that he may have a correct appreciation of his relation to the affairs
of life? I take it that by that title you mean something like this:
How is the dentist to be so trained as to take his proper place in
society? How is he to be so trained as to show forth in the practice
of his profession a wise manhood and a good type of citizenship?
Now, probably some will say at once that the chief way in which a
dentist can fulfill his function as a citizen is by being a dentist of the
very best order possible — that it is his first and primary duty to be a
dentist primarily and all the time, and that if he can serve the public
by showing forth qualities of mind and of skill applied with such
diligence and such singleness of purpose as is within his power, he
will in the very practice of his profession perform the highest function
that he as a dentist is to perform. And there is a vast deal of truth
in that — it cannot be denied that many of the greatest men in the
world have made almost their entire contribution to society through
the skill and genius with which they have carried out the life work
that was definitely theirs. Certainly no man can ever justify any
slackness with which he addresses himself to his professional work by
pleading that he is fulfilling other duties of citizenship. If he is remiss
in the duty that lies directly at his hand, that is to say, in being a
first-class professional man, in the duty that is his and in which he
is trained, then if he fails in that, he cannot atone for his failure by
being a well-known man in pubHc affairs, whether municipal, state,
or national. So I have a great deal of sympathy with those people
who say that the primary duty of any man in his profession is to
stick to his job and to be in that profession the very best that he pos-
sibly can be. In fact, if in all professions that rule were lived up to
a little more fully, there would be fewer failures than there often are.
We cannot serve two masters — we must serve the one well.
But, though what I have said is absolutely true, this does not mean
that the practice of the profession exhausts the whole round of man-
hood, and I believe there is quite a function for a dentist to perform
even when not engaged in the special work incident to his profession.
However, his function in other lines may be the more poorly per-
formed because of the very skill which, in another side of his life, he
exercised in his own profession. Therefore what I ask you to
consider to-night is in what way we should train a dentist in order
that he may take his full place in society.
There are two sides to this question: The professional side, and
the side of his manhood. In order that I may get at my subject I
am going to ask you to consider two definitions that I have taken
ORAL HEALTH 323
from the Century Dictionary. First, the definition of a trade: '*A
trade is specifically the craft or business which a person has learned
and which he carries on as a means of livelihood or for profit, par-
ticularly mechanical or mercantile employment; a handicraft, as.
distinguished from one of the liberal arts or the learned professions."
Second, the definition of a profession: '*A vocation in which pro-
fessed knowledge of some department of science or of learning is used
by its practical application to the affairs of others, either in advising,
guiding, or teaching them, or in serving their interests or welfare in
the practice of an art founded on it. It involved professed attain-
ments in special knowledge in contrast with mere skill. A practical
dealing with affairs in contrast with mere study or investigation, and
an application of such knowledge to uses for others as a vocation in
contrast to its pursuit for one's own purposes.'*
So a trade is a handicraft. The dentist, while unquestionably
exercising one of the most exquisitely delicate of all handicrafts,,
would by no means be willing to rank himself with a man in business
or a man in the pursuit of a trade — dentistry is something beyond
that. In addition to your handicraft, you have something that has
given you the rank of a profession.
There are two main divisions, as 1 take it, in that definition which
I think justify the imparting of the term "pj'of^ssion" to dentistry. I
am not going to put these divisions in the same order, but reverse
them. The first is that a profession is based upon a wide and liberal
knowledge of the subject or the art to which a man is devoting his
powers. Secondly, it is of the nature of a vocation for service. The
matter of trade in which mere livelihood is so very prominent, that
matter of mere livelihood and of financial returns, recedes into the
background, and the idea of a vocation for service comes forth
prominently.
In order that I may lead up to what I hope will throw some light
on the subject, let me illustrate the idea of the word profession his-
torically. As you know, from time immemorial there have been what
have been called the three learned professions — the church, law,
medicine. Although hardly necessary here, a review may be of some
advantage to us; therefore, I want to show how the ideas that I have
brought out as to the meaning of the word profession have been
illustrated by the history of these three professions, and why they
have received recognition.
The Church. From near the middle ages when religion came into
more prominence, the ministry of the church was based upon the
widest knowledge of the time. Almost without exception the great
universities were established for the purpose of the study and promo-
tion of ecclesiastical knowledge, theology, and canon and civil law.
In the middle ages the church was at the foundation of knowledge..
324 ORAL HEALTH
The universities of Paris, Oxford and Cambridge were great ecclesi-
astical institutions. From the beginning and right down to the present
time, the ministry in all its branches has maintained its hold on the
people, partly because of the fact that it has required a thorough
education in its members, and whenever it ceases to have a thorough
education the respect of the people will disappear. In addition to
that, of course, the Christian ministry is a body, group or profession
v/hich is definitely set aside for service. All down through history
that was the idea of Christian ministry — service. Certainly if it was
a matter of financial returns, they have not been very successful, if a
matter of service we hope they have been.
The Law. I shall not go back farther than to English and
American law in the eighteenth century. English and American
law have run much the same course, and in the eighteenth century
Law was regarded as one of the professions to which a gentleman
could devote himself. Diplomacy, the army, the church, law — ^these
were the chief professions. They were paid for by the state. There
was an established church, army and navy paid by the state,
diplomacy paid by the state. Shortly after this at least one branch
of the legal profession was also regarded as belonging to a learned
profession — that of the barrister as distinguished from the attorney.
The attorney accepted fees, the barrister was given honoraria which
were non-collectable by law. He got them, but not because he sued
for them. And from these barristers the judges were chosen.
De Tocqueville, in writing on "Democracy in America'* in 1835,
said: "The aristocracy of the United States at that time was the
legal profession.'* And the legal profession in its higher branches
has always been accepted in the United States as one of the primary
professions. In its higher branches the law is based on breadth of
learning. But, you say, what about its service? Yes, it is based
also on service because we know that society depends upon the justice
with which law is both made and upheld. The invisible links that
bind us together are the most potent of all links, and the men who
create those links and who keep them strong and firm are always
recognized as being among the greatest benefactors of the community.
The lawyer, therefore, has always been a public servant in marked
degree.
Medicine. In the history of medicine we go farther back than for
Law or for the church — away back to the time of Hippocrates. In
his day Hippocrates was ranked as one of the greatest of Athenian
thinkers. He stood out as one of the most learned of the men of
Athens. He devoted his entire time to the advancement of the pro-
fession, you know his idea as to the ethics its members should observe,
an idea still accepted by the medical profession. And happy is the
profession which, in the background of its life, has such a tradition
as came down from Hippocrates and which has been perpetuated by
ORAL HEALTH 323
such an oath, and is based upon the most accurate knowledge of the
day. The Hippocratic oath bids the disciple to swear fealty to his
teacher, and also bids him exercise reverence towards all patients who
come under his care in regard to their life, their health, their bodily
and mental ills; and the possibility that the profession should be
turned to a mercenary purpose is by the oath of Hippocrates removed
from its ideal. There we have pure professionalism at the beginning.
All through history we have that same idea following the medical
profession and to-day the purposes and activities of the general
practitioner are not by any means bounded by the ordinary duties
mherent in his profession, but, if he is to receive the reward which the
ideals of the most highly trained medical men warrant, his work must
be performed in a spirit of broad humanism which makes the medical
man a representative in the community and a leader among his
fellows.
So we see that the learned professions are all based on the same
fundamental principles — breadth of knowledge, a broad basal pre-
paration, and a spirit of service to the community.
Training of the Dental Student.
How is the dental profession to prepare itself for its service in the
community? How is the dental student to be trained in order that
he may become a fit and proper member of society and to show forth
the real function of a professional man ? It seems to me quite obvious
how this education should be carried out. In the first place there
must be a broad basic education. As I listened to the papers pre-
sented here at the morning session I was struck by the way in which
the training that you are demanding for the dentist runs parallel with
that which is required for the ordinary medical man. And it looks
to me as though, as time goes on, more and more there will be a train-
ing on the professional side that is partly similar and partly parallel.
The necessity of having an expert knowledge of the oval cavity was
mentioned; but it is becoming recognized more and more that thor-
oughly to understand any one part of the body, one must understand
the whole body, and that the basis of training and knowledge must
be very much widened. That special knowledge of the oral cavity
is necessary is obvious. But the dental man must know the structure
of this wonderful organism, on the one side so machine-like, on the
other side so mysterious and so passing all knowledge. He must
know the organism on its mechanical, psychological, and personal
sides. But there is more than that. Why, we ask, is the medical
man trained in all the pre-medical sciences, or even the sciences that
are not strictly medical at all? Why does the student begin with
biology, chemistry, physics? Why does he pass on to physiology,
biochemistry, chemical pathology, etc., on to pathology — why all
that? Partly, as stated, that he may become acquainted with the
326 ORAL HEALTH
organism with which he is to deal, and also incidentally the student
is being trained scientifically. The laboratory is used everywhere
and his powers of observation are being made acute. It is not that
he remembers all these things. He must, of course, remember the
most outstanding things, but it is that he is being given a scientific
attitude of mind; in other words, he is being given an education
along that line. We know what a vast difference in interpretation
IS manifested by different men when they are asked to give an account
of an ordinary happening — we get the most diverse accounts of what
has taken place. The inaccuracies of observation are notorious.
Certainly success in medicine, just as in dentistry, depends on accur-
acy of observation. And the training of the scientific mind is partly
at least the training to see, to know what to look for, and to be sure
that you have found what is there. That is really the basis of
diagnosis, and if diagnosis is necessary in surgery and in the practice
of medicine, it is surely becoming increasingly necessary in dentistry
also, a diagnosis which leads you back to causes. What were we
dealing with this morning? One could not help but be impressed
by the change that seems to be coming over dentistry, just as it is
coming over the rest of medicine. You are turning to preventive
dentistry now, just as in medical schools they are turning to preventive
medicine. What is the basis of preventive medicine and preventive
dentistry? It is just that — the scientific observation which enables
you to trace diseases to and attack them at their sources. Therefore
if you are to perform your function as a dentist this scientific attitude
of mind must be very prominent. You may say I am getting away
from my text, but this is not so very far away. One of the reasons
why a professional man holds his place in the community is that he
IS highly educated and has been trained to observe causes. And 1
am quite confident that the more thorough the scientific education
that is given a dentist or medical practitioner, the more certain we are
to have a man who will also be able to bring his powers to bear on
the troubles that are at the base of the body politic. Is it not a
pleasure to listen to the discourse of a thorough student of public
affairs as he diagnoses the causes that lie at the root of many ills
that lie around us? He is a shrewd observer, his powers have been
well trained, and by reason of being well trained he has become an
observer and student of complex events on which he becomes a
competent adviser. Therefore a thoroughly trained man in his pro-
fession may be a more useful man when his powers of judgment and
observation are called into action in social and economic affairs.
The next point in the training of a dentist that he may take his
place in society and also develop his ethical and political conscience,
is that he must have a liberal education, which is a term that is very
often used. I would not wish to be understood as inferring that a
scientist who has been thoroughly trained is not possessed of a liberal
ORAL HEALTH 327
education. He is. But by the term liberal education, we imply such
an education as will liberate the powers of man's mind. Of course,
science does that to a degree, but what I refer to is the powers of
man's mind liberated through science, expanded not through exact
observation, but by the study of human life as it expresses itself in
a great literature. That is really what liberal education is — the
broadening of a man's judgment and powers by bringing him out
into the larger world that is presented to us in the stream of any great
national literature. An education, from the three R's up, has always
had and will continue to have that element in it — the realization
that a man when he appears for a few years is not an isolated specki
that therefore he cannot plunge into his life as though there were
nothing behind him, but that he comes out of a mysterious past and
is a debtor to that past, for he has been served by it. Therefore out
of that past, through literature and its history, certain accumulated
truths reach him which are to be lived over anew by him, not as
handed down to him in so many packages, but presented in the form
of living thought to be readjusted by him and made a part of his
own mind, enabling him to rise as a member of the race to which he
belongs even though he live in the world for only thirty or forty years.
That is the function of great literature, and its study broadens a man's
mind and places him in a new environment. So if he is to understand
political and ethical problems he must be liberally educated.
Again, half our problems are solved by an accurate diagnosis.
One of the reasons why we frequently are so backward and blunder-
ing is that there are so many half-educated people — earnest, but half-
educated, — without a liberal training, and who through the impulse
of their enthusiasm and of a kindly and good heart attack a problem
that they are not prepared to solve, and often they do greater harm
than if they had left it alone. A liberal education is an education
which widens a man's mind sufficiently to show him the track along
which the experience of the race has told him he should go.
Therefore if any professional man is to fulfill his highest function
as a citizen apart from his profession, he can only do it in the best
way through the study of literature. It does not matter very much
what literature it is. You know the constant battle that goes on
between the exponents of classical and modern literature. We all
appreciate the value of classical literature, but for the purposes out-
lined we are not by any means confined to it. English literature is
perhaps the most magnificent in the world, at least the only one that
can vie with Greek, and in poetry there is nothing surpassing it.
In French also as in English you have all that is necessary to give
the real student a liberal education through the knowledge of a first-
class world of literature. Tlie ability to use one's own tongue fluently
is the mark, of course, of a liberally educated man; the ability to
choose exactly the right word for a certain thought is the mark of
328 ORAL HEALTH
an educated man; the ability to take the language that you have
and make it the instrument of your own thought, is the mark of a
liberally educated man. One will never be able lucidly to express the
idea he has in mind unless behind that idea the thought is clear, so
that spiritual ideas may be fitted with a language adequate for
them. To take his proper place in public affairs, the well-trained
professional man should be able to use his own tongue, whatever that
tongue may be, in a precise, accurate, logical and expressive way,
and I do not think we can pay too much attention to the training of
students in that respect.
Then again, one of the results of a liberal education is that a
man should be a reader. He should enjoy literature and know how
to use it; not picking up ordinary books to while away an hour, but
Taking the great classics in which the thoughts of mankind are inbed-
ded, books that are hard to read and that tax the understanding to
get their innermost thought, interpreting a sentence at a time and
arriving at your own conclusions with regard to the ideas set forth.
Through reading books in that way, a little at a time, pondering
ihem, digesting them, taking them to yourself, you will create a
taste for the higher literature, thereby attaining a standard of judg-
ment that is your own and not another's. It becomes your own when
you do the hard thing, understand what is there, criticize it and
say, — I know it now, and I either believe it or do not believe it. In
this way you develop, you grow, your mind is becoming rapidly
educated in a liberal way through daily companionship with good
books, hard books, books that have in them the experiences of the
race. For many it is the Bible, for others something else — some great
book founded on the experience of mankind. A book like that is
creative and educates one liberally. How many of us take time for
that? Life is so shallow and full of haste that we do not take the
time. But if we can get this habit ingrained in our students we will
thereby create an ability on their part which will help them to carry
on and improve the activities of the world.
The professional man should read books that bear upon the
economic problems of the day; he should know the history of his
country; he should know the industrial history of the world in this
century, he should be able to determine what the movements about
us indicate; he should be able to form judgments in regard to what
is going on in the world, and if he is to be a worthy member of society
he should have his own opinion on these things and not merely pick
up from some one else. He gets that as he reads history and studies
moral and economical problems, and many of the best books to be
recommended to our students might be in those directions.
Another essential factor is appreciation for the beautiful. Beauty
is not, after all, such a very remote thing in life. This country is
rapidly developing in aesthetics, its taste is steadily improving, and
ORALHEALTH 329
so it is going to be a place to which artists will naturally turn. It
is a mark of an inferior civilization to be devoid of art, to be absorbed
in the merely material things of life and not be able to separate itself
from the ordinary vocations. As I see it, an appreciation of the
beautiful should be fundamental for any man who is to take his
proper place in society.
Just a word or two as to the other side. I said that the other side
of a professional calling was its public service. Here is one of the
dangers: In all professions corruption comes in when the profession
itself gives way to a mercenary motive, when mere livelihood is all
that is thought of and the acquisition of a competence is the promin-
ent desire of those pursuing it. A mercenary motive is never far off,
but it is always corrupting. There is not much danger of the mercen-
ary motive coming into the life of a scientific man, the man in his
laboratory, but there is always danger outside of that. And in
reading over the history of the professions I found that one of the
essentials in those professions was that the financial return was not by
any means a primary element. Every profession has to guard itself
against the corruption that lies at its door. When it is tempted to
become too mercenary in spirit, and when the public needs its services
greatly and is willing to give anything for them. It is not only your
profession, but other professions also which are to-day faced with
that danger, a recurrent danger all down through the centuries. It
is the age-old struggle of the mercenary side with the idealist spirit.
And to keep the profession pure, idealism should certainly be kept
clearly before the students in their education. What is the best way
to avoid the mercenary spirit? I cannot but feel that the best way
is through the receiving of a liberal education. If a man's spirit has
been humanized by literature, by pure minds, by art, a hobby which
absorbs a great deal of his time, he is not going to become such a
slave to his profession that he will in the first place devote all his
time to acquiring gain, and, in the second place, to selfishly con-
serving it. His salvation will come from having other purposes,
whether as a reader or as one who wants to benefit the public, —
whatever it be that carries him out of himself and enables him to
fasten his mind and thought upon something other than the very
money-getting itself — that is his main protection. And, as I said
before, his soul becomes humanized and the passion grows within
him to contribute to the welfare of those about him, to serve by his
profession those whom he is competent to serve, and so to devote him-
eelf to the ideal side of life that he can never forget that man's life
does not consist in the abundance of the things which he possesses.
If that conviction has entered into his soul he will fulfill the admoni-
tion of Francis Bacon when he says: *'I hold that every man should
be a debtor to his own profession."
— Proceedings, American Institute of Dental Teachers.
BRITISH COLUMBIA— A. T. OBERG. D.D.S.,
833 Granvilie St., Vancouver
ALBERTA— JOHN W. CLAY. D.D.S.
914 Herald Bldg., Calgary
SASKATCHEWAN— C. W. PARKER, D.D.S.
Imperial Bank Bldg., Regina
MARITIME PROVINCES— STANLEY
MANITOBA— Sf/. W. WRIGHT. D.D.S.
767 Warsaw Ave., Winnipeg
ON^TAR/O— Lieut-Col. W. G. THOMPSON
28 King St. West, Hamilton
QUEBEC— ALBERT DELORME. D.D.S.
713 St. Catherine St., East, Montreal
BAGNALL. D.D.S., Halifax. N.S.
MARITIME PROVINCES.
THE thirty-second Annual Convention of the Nova Scotia Den-
tal Association was held on July 13th and 14th in Dalhousie
University, Halifax. A large number of members were pres-
ent from outside points and the Convention was one of the best in
recent years.
The first day of the Convention was devoted to reports of com-
mittees and general business. The most important matters of business
taken up were the questions of legislation and oral hygiene. A Pro-
vincial Oral Hygiene Executive was formed; this consists of one
member in each of the cities, towns and villages, of the Province,
where there is a practising dentist. These members will work in con-
junction with the central committee, which is in Halifax. Steps have
also been taken to have an Instructor in Oral Hygiene appointed to
the staff of the Normal College in Truro.
The question of legislation, more particularly of its enforcement
and improvement, was one of the most keenly discussed matters be-
fore the meeting. There was a gratifying interest on the part of all
the members in this question, and plans were drawn up to assist the
Provincial Dental Board in the enforcement of the law. The dis-
cussion closed with a hearty vote of thanks to the Board in apprecia-
tion of the work already done to enforce the law. One case of illegal
practice is being prosecuted at the present time.
The greater part of the second day of the session was devoted to
the reading and discussion of the following papers:
**Pre-operative treatment. Post-operative Complications, — Causes
and Treatment in Exodontia." By Dr. G. R. Hennigar.
Discussion opened by Dr. E. S. Allen.
"Root Canal Therapy, (Conservation of pulp, Method of Re-
moval and Filling Technique), by Dr. F. W. Ryan.
Discussion opened by Dr. R. H. Woodbury.
"Partial Restorations, — Removable and Fixed."
Discussion opened by Dr. J. P. Parker.
ORAL HEALTH 331
The papers were all very interesting and led to a splendid discus-
sion by a number of the members present.
Dr. H. Clay, S.C.R. Dental Officer at Kentville Sanitorium, gave
an interesting report of the work which is being done at that institu-
tion. He stated that practically all patients were in urgent need of
dental treatment, when admitted to the sanitorium. Dr. Clay cited
some very interesting cases of patients who were greatly improved in
health, as a result of the dental treatment given.
The following officers were elected for the coming year: President,
Dr. J. P. Parker, Sydney, C.B.; 1st Vice-Pres., Dr. G. N. Stults,
Halifax, N.S.; 2nd Vice-Pres., Dr. H. O. Harding, Yarmouth, N.
S. ; Secretary, Dr. J. Stanley Bagnall, Halifax, N.S. Dr. J. T. Le-
better, Sydney, C. B., was elected to complete the executive commit-
tee.
It is hoped that next year it will be possible to arrange a union
meeting of the three Maritime Provinces.
V •!• •!• •I'
At the meeting of the Provincial Medical Association, held last
week in Sydney, C.B., a resolution was passed favoring the appoint-
ment of a Provincial Dental Officer.
tfi •!• ^ •5t»
Dr. W. R. Wilkes died of heart failure in St. John, N. B. The
late Dr. Wilkes had practised for a number of years in St. Stephens,
N. B.; he had served in the C.A.D.C., and had opened an office in
St. Catharines, Ont., just before his death.
•!• •!• •5r "J*
A medical conference held at Antigonish, N. S., on the 15th of
June, dealt with several matters of interest to the Dental Profession.
A. W. Faulkner, D.D.S., represented the Oral Hygiene Committee
of the Nova Scotia Dental Association. There was a general dis-
cussion of the health conditions in Antigonish County, as found during
the tour of the Travelling Medical Clinic. The following resolution,
moved by Dr. Faulkner, was discussed and adopted for the consid-
eration of the Provincial Government. Resolved: "That in consid-
eration of the dental conditions found as a result of the Antigonish
Clinic, this conference recommend to the Provincial Government the
appointment of a full time dental officer on the staff of the Depart-
ment of Public Health.**
The Antigonish County Travelling Health Clinic was organized
by Dr. Craig of the Nova Scotia Red Cross; and the personnel con-
sisted of a physician, dentist and two nurses. The estimated cost for
the clinic for one month was $1000.00; and the actual cost, exclu-
sive of motor cars, was only $690.00.
Dr. W. H. Young, the Clinic dentist, made a report of the dental
work performed. The Clinic made 1 3 stops in 27 clinic days. There
332 ORAL HEALTH
were 1109 extractions, of which 67% were first permanent molars;
and the total number of patients treated was 877. The children were
instructed in the use of the tooth brush; and health talks, illustrated
by motion pictures, were given at every stop.
The Clinic is at present working in the neighboring county of Guys-
boro, where a large share of the expenses have been met by two of
the citizens.
This Travelling Clinic has served once again to emphasize the
need of dental attention, especially in the outlying districts, while a
very necessary work has been performed, and the people concerned
are to be congratulated for their interest; still one cannot but regret
the necessity for the sacrifice of such a large number of teeth, and
hope that in the near future cHnic facilities may be advanced to the
point where more preventive dentistry may be practised.
¥ *5c' •!• •!•
Dr. L. S. Saunders has resumed practice in Kentville, N. S., after
a long absence in Halifax, N.S., and the United States.
Dr. W. Curry, of Hartland and Woodstock, N.B., has moved to
Western Canada.
Dr. L. O. Leger, of Chatham, N. B., has retired from active prac-
tice and moved to St. John, N. B.
Dr. H. L. Mitchener has given up his practice in Mahone, N. S.,
and moved to Alberta, where he intends to practise in either Carbon
or Rocky Mountain House.
We regret to announce the death of Dr. M K. Langille, of Truro,
N. S., and of Dr. H. C. Patton, of St. Stephens, N. B.
J. S. B.
MANITOBA.
A Winnipeg Friend Writes to Habec.
In reply to Habec's letter in July ORAL HEALTH.
My Dear Habec, —
Allow me, stranger, to compliment you upon your recent note en-
titled "When the Dentist Wakes Up.'* My first thought was not of
a physical awakening, but a mental or spiritual awakening, — and so
I was surprised. And when a fellow reads a surprise now and then,
he is naturally pleased. Your psychology and its formula of how to
start the day right, requires, of course, a correct mental and spiritual
attitude. Then you say to the dentist: "Now you have the master
stroke." Habec, I don't know you, but I'll venture one look into the
pupils of your eyes. I can image deep pools, with a background of
thought; at first your lids are wide open, then when a fellow shakes
your hand they close a bit and you focus your steady gaze a little
closer as you look at a fellow. You don't bother looking at his shoes
the first five minutes, at least, — you just look him in the eye.
ORAL HEALTH 333
Now then, you see that is a character sketch, and what have I been
trying to say? Just this, — I've figured out a strong character, full of
fun; and that is a rare combination.
Now that I like you, friend, let me stand just a little on the other
side of the line, because of the next little sentence of yours, — "Per-
haps to the failure to recognize the full value of anesthetic agents
but Habec has up to the present time been unable to
conform his old-fashioned notions." Now, Habec, you say that just
as though we were all afraid of you. You feel you must be about
right in your own mind, and that these new fan-dangled ideas don't
just work out in office practice. Habec! Pain does conquer ninei])-
i'lve per cent of them! Your moral teaching is fine, but — but — but —
your patient, remember, wants not a moral lesson (unless he is a life-
long friend,) — he wants a tooth filled, and drilled, and perhaps ex-
tracted, and he doesn't want to be hurt, and maybe he doesn't want
to know what's going on. Well, Habec, don't criticize him. You'd
think he was a fine fellow, when you played golf with him, but now
you feel he's a coward. He is not a coward. He's sensitive, over-
worked, worried a little; probably his business worries him, his family
may be a little trouble to him, sickness, etc. His life is so full from
morning till night that he's on the thin-edge most of the time. Now
he simply won't stand the "nerve-racking" business any longer. That's
what he thinks, and as a man thinketh in his heart, — etc. You know,
Habec, I want you to face the sun "anesthesia." That's a part of
me, (it's mind and body and soul of me!) and I like you, Habec, but
I want you to become converted. It's not so easy, but with a fellow
like you, anything is possible. Then it is easy.
"A WINNIPEG FRIEND."
The Dental Nurse in Embryo
I'd like to be a dentist with a plate upon the door
And a little bubbling fountain in the middle of the floor;
With lots of tiny bottles all arranged in colored rows
And a page-boy with a line of silver buttons down his clothes.
I'd love to polish up the things and put them every day
Inside the darling chests of drawers all tidily away;
And every Sunday afternoon when nobody was there
I should go riding up and down upon the velvet chair.
R. F.
n
MULTl/M IN PAEVO
This Department is Edited by
C. A. KENNEDY, D.D.S., 2 College Street, Toronto
HELPFUL PRACTICAL SUGGESTIONS FOR PUBLICATION, SENT IN BY MEM-
BERS OF THE PROFESSION, WILL BE APPRECIATED BY THIS DEPARTMENT
D
D
Electric Vibrator in Dentistry.— In nerve blocking I find
an electric vibrator very helpful for massaging after injection has
been made. If used directly over foramen you will obtain quick
anaesthesia. I also use a vibrator in my laboratory for jarring air
from freshly-poured impressions, and more especially Spence Com-
pound. This is quicker than using a lathe, and eliminates all air
bubbles. — Dental Surgeon.
Vulcanite Dentures.— It sometimes happens that a little piece
of red rubber comes through the pink on the labial part of the gum,
and so spoils the appearance of the case. Bur this out, leaving the
edges defined and slightly undercut. Have the cavity of a definite
shape, round or square. Next get a piece of old pink gum which
has been vulcanized, and cut it to the size of the hole, or very slightly
larger. Hold this on a spatula over the bunsen burner (do not burn
It), and while warm force it into the cavity. Hold firmly till it is
cold, then smooth off and polish. — Dental Science.
Infection of the Antrum from a Lateral Incisor.— The
patient, a soldier, had suppuration of the right antrum, with a dis-
charge from the nose, and also from a sinus situated above the first
molar. The molars, premolars, and canine on the right side appeared
healthy. The lateral incisor was deeply carious and broken down.
When the tooth was extracted there was a flow of pus from the
socket. A probe was passed up the socket in the direction of the
antrum for a distance of 6 cm. A second probe passed through
the sinus above the first molar touched the first probe. Radiographs
were taken which showed the two probes in contact in the antrum.
The discharge from the antrum ceased on the day following the
extraction, and the two openings rapidly closed. This showed that
the patient was not suffering from a true sinusitis, but from an abscess
which had burst into the antrum. This abscess was due to infection
from the lateral incisor, an extremely rare occurrence. — Revue de
Stomatologic.
□
THE COMPENDIUM
This Department is Edited by
THOMAS COWUNG, D.D.S., Toronto
A SYNOPSIS OF CURRENT LITERATURE RELATING
TO THE SCIENCE AND PRACTICE OF DENTISTRY
E
The Operative Management of Children in General
Practice.
SUCCESSFUL dental operative measures for the little folk are
at once highly desirable and extremely difficult of accomplish-
ment. Any suggestions leading to a solution of this difficult
fjroblem are of more than usual interest. In the "Oral Hygiene,'*
Dr. Paul A. Barker, of Denver, Colorado, offers many valuable
suggestions as to the successful management of this department of
dentistry.
To the child mind first impressions are lasting ones; consequently,
if possible, let his first visit be one that he will remember with
pleasure rather than with fear and trembling. The operator, his
assistant and office should be as immaculate as possible, as children
are strongly impressed with outward appearances. Learn the child's
first name before he comes into the operating room, and receive him
with a cheerful greeting. After he is in the chair explain to him
every move you make. This will increase his faith in your word.
Whenever possible do nothing at the first appointment which will
cause pain, and yet the impression should be left with the child that
something has been done. A complete record of the condition of
the mouth is made and filed away for future reference. Temporary
teeth with pus present are opened up and washed thoroughly with
warm, sterile water and equal parts of tricresol and formalin sealed
in with a quick setting temporary cement, being very careful not
to cause any pressure. This is all that ought to be done at the first
sitting, and in 95 per cent, of cases pain will be relieved. This
gives the patient confidence in the dentist, and much more work can
be accomplished at subsequent sittings when a permanent filling is
inserted. TTiis consists of a root filling containing zinc oxide, aristol
and eugenol, or, in doubtful cases, tricresol and formalin instead
of eugenol. Gutta percha or any other paints should not be used
in the root canals of deciduous teeth, because when root absorption
takes place the paint will stick down into the tissues and, with the
movement of the tooth in mastication, this will cause irritation.
Cavities in deciduous teeth should be prepared by cutting away
with a small wheel or inverted cone bur enough decay to give body
336 ORAL HEALTH
to the filling and a good undercut. The cavity is then filled with
red copper cement unless it is an occlusal pit cavity, when amalgam
may be used. Amalgam, however, should not be used on a
proximal or two-surface cavity in a deciduous molar, because of the
danger of overhanging margins. Amalgam has no adhesive proper-
ties, and will be forced down upon the delicate gum tissues and form
a pocket that is a wonderful breeding place for bacteria. There
IS no equal for red copper cement for saving children's teeth. It
will last as long as the average deciduous tooth, it is easy to
manipulate, and there is seldom any recurrence of decay about the
filling.
For the little mesial and distal cavities of the upper anteriors
where the teeth are thin and brittle, and the best method is to trim them
down smooth with a disc and then reduce silver nitrate upon them,
according to the Howe method. If the teeth are short and thick, a
small undercut cavity may be prepared, and in it place a paste of
zinc oxide, eugenol and powdered silver nitrate, which soon hardens
and prevents further decay, or the cavity may be filled with a white
permanent cement.
Frequently the first permanent molar is looked upon by the child's
parent as a deciduous tooth, and it is allowed to decay and abscess
almost beyond hope of saving. Yet it is important to retain this
tooth, in order to maintain the arrangement of the arch. To save
this six-year molar, begin by cutting away all soft decay from under
the buccal and occlusal walls, and then break down the enamel
with chisels. The cavity is now well opened, with all overhanging
edges broken away and the bottom presenting a mass of decayed
denture which extends clear through to the pulp chamber. The
complete removal of this material will expose the pulp — perhaps a
vital one. If possible, try and sterilize the tissue that is protecting
the pulp. Having isolated the tooth as much as possible, reduce
with formalin some ammoniacal silver nitrate upon the tissue (Howe's
method). If the cavity extends very near the pulp, use oil of cloves
or eugenol instead of formalin to precipitate the ammoniacal silver
nitrate solution. This will set up less irritation. The tooth may
darken, but this is preferable to a dead pulp. Isolate the pulp
with a cement base and use any permanent filling material in the
cavity.
Michigan Dental Examination
THE next examination to be held in this State for those seeking
license to practise dentistry in Michigan will be held in the city
of Ann Arbor at the Dental College, November 1 3th to 1 8th,
1 922, inclusive.
All information relative to credentials, blanks, etc., may be had by
addressing Dr. E. O. Gillespie, Secretary, 743 David Whitney Bldg.,
Detroit, Mich.
ORAL HEALTH
EDITOR:
WALLACE SECCOMBE, D.D.S., F.A.C.D., Toronto, Ont.
CONTRIBUTING EDITORS:
C. N. JOHNSON, M.A., D.D .S.. F.A.C.D., Chicago.
RICHARD G, Mclaughlin, D.D.S., Toronto.
W. E. CUMMER, D.D.S., Toronto.
J. WRIGHT BEACH, D.D.S., Buffalo, N.Y.
Entered as Second-class Matter at the Post Office, Toronto.
Subscription Price, Canada and United States, two dollars per annum;
elsewhere three dollars. Single Copies. 25c.
0
Original Communications, Book Reviews, Exchanges, Society Reports, Personal Items, and othei
Correspondence should be addressed to the Editor, Oral Health, 102 Wells Hill Ave., Toronto, Canada
Subscriptions and all business Communications should be addressed to The Publishers Oral Health,
Royal Bank Building, 269 College St.. Toronto. Canada.
Vol. XII.
TORONTO, SEPTEMBER, 1922
No. 9
Q
E r> I T O R.I AL
Dental Office Inspection
H
INSPECTION of dental offices in the Province of Ontario was con-
sidered at the last meeting of the Provincial Dental Board, w^hen a
resolution favoring systematic inspection by the Dental Board was
adopted.
The question arose through complaints having reached the Board
that certain licentiates were not practising their profession in such a
way as to give full force and effect to their training, experience and
judgment as acquired in the course of their dental education, particu-
larly in the matter of sterilization.
It was felt that unless the Dental Board assumed this responsibility,
the Board of Health, or some other authorized body, might initiate
some form of dental office inspection. The responsibility really be-
longs to the Provincial Board to see that dental licentiates carry on
their practices in accord with the accepted teaching of the profession.
To take any other position would be to assume that the responsibility
of the Dental Board was ended when a license to practise was grant-
ed, and that the licentiate could then proceed to practise as he chose,
irrespective of the interests of the public or the good of his patients.
Such a position would be both dangerous and absurd.
The Board decided that dental office inspection should be carried
on by the Dental Board in co-operation with the Provincial authori-
338 ORAL HEALTH
ties, and gave notice that any licentiate who failed to enforce, as a
regular office routine, mechanical and surgical cleanliness according
to approved methods of practice, would, upon conviction before the
Discipline Committee, be liable to suspension.
It is to be hoped that this decision upon the part of the Board will
have the desired salutary effect upon those who have been careless in
this regard. Disciplinary action would not only seriously affect the
professional standing of the accused licentiate, but would cast a re-
flection upon the entire profession.
A profession, being in a sense a brotherhood composed of men
unselfishly striving to render a service to their fellows, places an obli-
gation upon every member to so carry on his work that he will bring
credit on his confreres as well as himself, and do nothing to cast a
shadow upon the good name of the profession.
w. s.
Annual Index of Periodical Literature, 1921
381 Linwood Ave., Buffalo, N.Y.,
June 21, 1922.
Dr. Wallace Seccombe,
Editor, Oral Health,
269 College St., Toronto, Ont.
Dear Doctor:
The Annual Index of Dental Periodical Literature for the year
1921 is now ready for deHvery.
The contents have been prepared with the same care and atten-
tion to detail that has characterized the previous volumes, and the
make-up is similar in general to the books already published. This
book contains all of the English periodical literature for the year,
and is complete to January 1st, 1922. There are one hundred and
forty-four lYi by lOJ^ inch pages, securely bound with paper
covers.
As the edition is limited to seven hundred and fifty copies, I sug-
gest that dentists make use of the order card by early mail. The
cost is two dollars for volume bound with paper cover.
Yours very truly,
A. Hoffman, Secretary-Treasurer.
Michigan State Dental Society
THE Michigan State Dental Society will hold its Annual Con-
vention March 27th — 31st, 1923, in Detroit. For information,
write Bion R. East, D.D.S., Chairman, Local Arrangements
Committee, 504 Fine Arts Bldg., Detroit, Mich.
gill, -^
OPAL HEALTK^
A JOURNAL THAT STANDS FOR THE ** OUNCE OF
PREVENTION," AS WELL AS THE "POUND OF CURE**
^' ^^
VOL. 12 TORONTO, OCTOBER, 1922 No. 10
An Outline of the Theory and Practice of
Partial Denture Service
W. E. Cummer, D.D.S., Royal College of Dental
Surgeons, Toronto.
(Continued from September issue)
PRACTICE OF PARTIAL DENTURE SERVICE.
33. Subject Matter, General.
The practice of partial denture service consists of: —
(a) Examination of the semi-edentulous patient for discovery
of the details w^hich have bearing on the case.
(b) The notation of the injuries consequent on extraction to be
prevented or avoided.
(c) The most favorable juxtaposition of standardized parts
with which to accomplish this purpose.
After the preliminary examination, follows the practical applica-
tion of the theory previously acquired to the special condition found in
the mouth of the semi-edentulous patient. This detail may be best
redistributed in an engineering sequence as follows: —
(a) Design.
(b) Construction.
(c) Installation or insertion.
(d) Maintenance and repair.
(d) The subsequent phases of construction, installation, and
maintenance, in which details of prevention constantly
• recur.
34. Preliminary Examination.
This may be done in part, or, if consultation with specialist difficult
or impossible, in whole by the attending Dentist. The interdepend-
Gharf *3.
Partial Denture Service
Royal golle6E Dental Surgeons
PRAPTIflE OP PARTIAL DENTURE SERVICE ■-cA,/<^^^^tioncf.
!\. Ocner^/ ^x&/77//7^f/o/7
Z De/?/^/ £/C3/77//7&f/0/7
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4^
Figure No. 9. Chart on Partial Denture Service as shown,
stages, with detail as subsequently described.
Note four
ORAL HEALTH 341
ence of other branches of dentistry may be noted here, and a sug-
gested sequence follows: —
History.
1. Questioning of patient as to any pathological condition out-
side of mouth; if apparently present reference to physician
for examination.
Objective Sy^mptoms.
2. General Dental examination for all Dental disease, which
may or may not give rise to systemic disease as above, with
or without radiographs. If obscure, preferably by expert
dental diagnostician.
Subjective Symptoms.
3. Particular dental examination, and consultation with, and
treatment from, if necessary:
(a) Preventologist : — Various items as elimination of
predisposition to dental disease, etc. No restoration may
be begun with any assurance of success while predisposi-
tion to dental disease exists in the mouth.
(b) Peridontist: — Various items, as probable condition of
pericementum under stress, relief from overload, disposi-
tion of stresses, etc.
(c) Orthodontist: — Various items, as preference of ortho-
dontic treatment over prosthetic, combined orthodontic
and prosthetic treatment, inclusion of orthodontic appli-
ances as retainers in prosthetic appliances, etc.
(d) Oral Surgeon : — Various items, as preference of surgi-
cal treatment over prosthetic, combined surgical and pros-
thetic treatment, etc.
(e) Exodontist: — Character of mucosa support which will
probably follow extraction and possible alveolectomy to
improve these. Indications of alveolectomy with pros-
thetic restorations for esthetics, etc.
(f) Any or all of above.
In all cases certain preliminaries, as charts, models, etc., may be
necessary, previous to special examination for prosthetic work. Here
follows a list indicating the use or non-use of these: —
1 . None — Simple cases evident on inspection.
2. Charts only — Simple cases not evident on inspection.
3. Charts and study models^ — More difficult cases not evident
on inspection, with marked variations from normal of con-
dition and position of teeth not readily noted on charts.
(Variations on a horizontal plane only).
342 ORALHEALTH.
4. Upper and lower study models — Ditto with marked varia-
tions of position of teeth between upper and lower jaws.
(Variations on a vertical and horizontal plane).
5. Upper and lower study models mounted on articulator from
bite blocks — ditto when sufficient facets are not present for
securing the occlusal position.
Here follows a special dental examination for denture design and
specification (after Prothero) in which various items are noted for
further use in design and specifications, construction, installation, and
maintenance.
1. Number and location of remaining teeth and spaces. Note
these on chart, step No. 1 , design.
2. Condition of remaining teeth.
3. Condition of mouth and mucous membrane.
4. Condition of alveoler border, extent of absorption, location
of muscular attachments and frena.
5. Condition, location and extent, hard and soft areas.
6. Relation of upper and lower ridge.
7. Condition of saliva.
35. Design and its Definition.
A design of a partial restoration is a :
(a) Mental picture, or,
(b) Mento-graphic supplemented by drawing of the proposed
restoration which should be, as far as possible, completed
before any material is collected or work begun.
The mental process in design involves:
(a) A mental storehouse of the pictures of the standardized
parts from which all partial dentures may be constructed,
acquired from theoretical studies, as already noted.
(b) A knowledge as to their correct use, i.e. greatest functional
efficiency and least destructive tendency upon natural teeth,
also acquired from the theoretical studies.
(c) Examination for discovery of conditions peculiar to case.
(d) The knowledge of a simple working procedure in secur-
ing above mentioned mental or graphic pictures, suitable
for case in hand.
The above being complete, the actual four steps in design may be
then begun.
36. Steps in Design.
The writer's hypothesis (2^*^ check) is that Dentists and students
may best learn to design all partial dentures above a certain grade of
difficulty by a graphic method, (involving the use of a rubber stamp
ORAL HEALTH 343
(C. W. Mack & Co., 42 Adelaide West, $2.50), or printed chart of
fourteen teeth) in four definite and distinct steps in which the above
mentioned preventive considerations continually recur in redistributed
order.
1 . Saddles.
2. (0) Parts connecting saddles.
3. (4) Direct and indirect retention and connectors. (At this
stage the case is classified).
4. (3) Occlusal rests if indicated (this order subject to varia-
tions).
For simple cases both charts and models may be omitted; while
in complex cases, especially those in which the bite must be lengthened,
both charts, study models articulated and the presence of the patients
are sometimes required in order to develop a design.
37. Saddles Design.
Allocation of Load to Mucosa.
In the design of saddles, the mucosa is given its share of the load.
The softer the mucosa the larger should be the saddle. A slightly
intermittent pressure is more favorable, and a steady pressure in excess
compresses the circulation, causes a so-called **strangulation" with
absorption similar to too great peripheral valve seal on full dentures.
In outline the saddles should be kept away from the gingival
margin. With regard to saddle-area. Dr. Chaye's statement of
"saddles area must equal combined pericemental areas of teeth missing
and supplied'* probably approaches close to the solution (Items of
Interest, November, 1915). Professional knowledge regarding this
fundamental exists almost entirely from professional experience,
more or less definite. Until research on proper loading of
mucosa, proper loading of the teeth and correlation of saddles and
tooth movement is done, partial dentures will continue to wreck teeth.
In the opinion of the writer the subject is so lacking in accurate data
that a series of factors to be weighed in the choice of support
(mucosa, root, or combination) is all that is available. Fig. 12.
Below follows steps in saddle design:
Upper and Lower.
1 . Buccal periphery, posterior, to be carried to peripheral valve
seal.
2. Buccal and labial periphery, anterior, as above unless no
artificial gum is desired.
3. About teeth 1 — 2mm space to avoid capillarity.
4. Lingual periphery as determined by area of mucosa support
desired and in the next step. (Parts connecting saddles).
344 ORAL HEALTH
38. Parts Connecting Saddles.
These (when required) are almost always located to the lingual of
the teeth, occasionally buccal and labial, and may be developed as
below. The choice between a partial denture or two or more pieces
of bridge work often arises here.
Upper and Loxver.
1. If alternate space and tooth or similar use continuous con-
struction.
2. If alternate space and group of teeth, or similar, use skeleton
construction.
Upper.
3. If parts required to cross anterior, flat or semi-round, cast or
wrought, and placed in a suitable depression between
rugae. If this not possible, flat wide piece.
4. If parts required to cross posterior, between first and second
molar, cast or wrought, flat or semi-round, depending upon
grade, and compensated for differences between hard and
soft areas.
4a. Choice between anterior, posterior, or both. This depending
on strength of appliance required, range, available space,
occupation and choice of patient, and other factors.
// Soft Mucosa, Upper.
5. All saddles should be extended to cover mucosa on working
side of fulcrum line over entire vault.
Lower.
6. All parts connecting lower saddles, lingual bar, low as
muscle attachment will permit, and one or two mm. lingual
from soft tissues.
39. Position and Choice, Retaining Devices (at which
step the case becomes classified),
Under this head the clasp of smallest dimension consistent with
efficiency to reduce capillarity is preferred, if possible two only in
number (classes 1-2-3). Cast clasps should not be used in locations
causing torques. And the writer notes with pleasure the increasing
popularity of clasps of narrower contacts from the writings of Dr.
Roach and others. A suggested detail for the positioning and choice
of retainers follows :
1. With small straight edge to hand, choose paired (class
1 -2-3) or triplet, (class 4) in the following steps.
ORAL HEALTH
345
C.-I«.
H.m [HMIRF
iPPt
Rt)EN
,Kt
■■■
st Wl
" i>i-"«t Class
^
s
M
^
f
#
%
2
w
<Ks.
J
^^
C«^7 Wit
HOITOEVTIBE
LuisE
DtvnRE
Ca-
T Wit
hdenti RE. Class 1
WITH DfMiRt Class 2
Figure ^o. 10. In step No. 3 in design the case becomes classified.
Kepresentative cases (with inversion) of each of the four classes.
1. Class one cases witin direct retainers diagonally opposite, direct
and indirect retention.
2. Class two cases with direct retainers diametrically opposite, direct
and indirect retention.
o. Class three cases with direct retention on one side, direct retention
only.
4. Class four cases with three or more direct retainers in a semi-
triangular, or semi-quadrilateral relationship, direct retention only.
(a) Lay straight edge across opposite pairs of natural teeth
adjacent to edentulous spaces, so as to allow the straight
edge to pass across the centre of area of figures outlined
in steps 1 and 2 (usually omitting central, lateral and third
molars). Classes 1 and 2.
346 ORAL HEALTH
This being inexpedient:
(b) Lay straight edge across opposite pairs of natural teeth
adjacent to edentulous spaces, so as to allow the straight
edge to pass across the centre of area of the entire arch,
(classes 1 and 2). Add indirect retainers usually omitting
the use of central and lateral upper and lower. This brings
the fulcium line in centre of area of the piece.
(c) Lay straight edge on pairs of teeth in line on one side of
figure developed in steps 1 and 2, which may afford reten-
tion, with or without auxilliary adhesion, (class 3). This
being inexpedient:
(d) Lay straight edge on three teeth, (or if necessary four
teeth) in a semi-triangular or semi-quadrilateral relation-
ship. (Class 4).
2. Select from ( 1 ) the most favorable paired group, or if not
possible, (2) the triplet or quadruplicate group of teeth
most suitable for clasps.
(a) Teeth with decided opposing convexities, (M.D.-B.L.-
L.L X 2).
(b) Teeth of good pericemental and enamel condition.
(c) Teeth with freedom from caries, erosion, abrasion, large
fillings, inlays, etc.
(d) Teeth remote as possible from the anterior mouth.
(e) Teeth with other indications for clasps as not mentioned
above.
3. This being in whole or in part impossible, choose, (as above)
compound retainers, especially in teeth either requiring, or
with readily removable large inlays, crowns or similar:
(a) Non- precision if saddle supported at one end only.
(b) Precision (if grade of work admits and if saddles sup-
ported at both ends) or non-precision, chiefly^ removable
bridges.
4. In classes 1 and 2 add indirect retainers, if necessary, (con-
tact or carrying stress of mastication) as in figure No. 5,
upon suitable teeth omitting upper and lower, centrals and
laterals. These indirect retainers to be directly opposite
unretained portions of saddles.
40. Supplementary Notes on Clasps.
1. All clasps must touch the enamel only. This is of greiatest
importance for preventive reasons.
2. Independent Movement of Clasp and Saddle and **5/rp.**
In addition to a sufficiently firm grasp of the anchor
tooth, a clasp should be sufficiently resilient to allow a
ORAL HEALTH
347
"slip" or a slight movement of the clasp up and down and
round the anchor tooth. This movement allows the saddle
or the anchor tooth to move independently in a limited
degree of the saddle, minimizing torque and overload (pro-
vided the mucosa is not of soft texture) , in which a non-rigid
connector is needed, as already noted. This represents
approximately a universal joint in which an independent
movement is possible within small limitation.
3. Choice of Cast, Wrought, or Composite Clasps.
A large percentage of losses of anchor teeth from torque,
are due to the use of cast clasps, possibly too wide and too
thick , lacking in resiliency, and corresponding "slip,"
and retaining a free saddle, (a saddle directly retained at
one end only) resting in turn upon soft mucosa. This is the
most frequent example of the main contra-indication of the
cast clasp, viz: "Cast clasps must not be used in any in-
stance which, because of relative non-resiliency, and conse-
quent lack of slip, they may subject an anchor tooth to
vertical or horizontal torques from free saddles on mucosa
of any degree of compressibility." Under the latter cir-
cumstances, the wrought (preferably) wire band or com-
posite clasp is indicated, which ordinarily possesses suffi-
cient slip and elasticity to accommodate this difference or
movement, and with in extreme cases non-rigid connectors.
Cast clasps find a special use in short spaces with suitable
teeth for clasps at each end of space, in which wrought
clasps are contra-indicated because of danger of swallowing.
I FREE END OF«
CLASP _ •
Parts of
Bucco Lingual
CLASP
I
"\
OF
BODY
CLASP
SURFACE I
OCCLUSAL y REST
14 G.
EMBRASURE
WIRE
FREE END OR
CLASP
IN CENTRE
OF EMBRASURE
BODY
GROUP
OF
"CLASP
PARTS
y
Figure No. 11. Parts of a bucco- lingual clasp. The arrangement varies in
other types to a certain extent. Note the clasp ordinarily encircles 6-S or i^
the circumference of the tooth. Parts of clasp as above noted. Note position
of 14 gauge connector in embrasure.
348 ORAL HEALTH
Notes on Design of Individual Clasps.
All clasps consist of:
(a) Two resilient and contoured free ends or their equivalent,
equidistant above and belovv^ line of widest cross section.
(b) A body connecting the free ends which is more or less
resilient. The proper position of the contoured free ends is
that of conformation to the contours of the pair of opposing
convex surfaces, as chosen, resulting in a positive grip,
assisted by tenso-friction, not more than sufficient to hold
the restoration to place.
Body must be (a) below leaning tooth surfaces; (b)
narrow especially at right angles to fulcrum line.
41. Connectors.
These may be of 14 gauge wire placed in the embrasure except in
cases in which extreme disproportion exists between the movements of
the saddle and anchor tooth, or for other reasons. In such cases non-
rigid connectors may be used, as Giffen, Nicholls, Weinstein, Dresch,
or similar. See Figures 2-7-8.
42. Position and Choice of Occlusal Rests.
(Allocation of load to the teeth and their pericementa. Load
must he applied to teeth coincident Tvith their long axes onl^.)
At this stage the occlusal rests, (if their use is thought desirable)
may be drawn in, which allocates a load to the teeth. This is also
an unexplored field, and in the judgment of the writer is best taught
by factors indicating root support as attached, (Fig. 12) governed by
the general principles, that saddles resting on soft mucosa tend to
throw bulk of the stress on the teeth, and also that teeth of diminished
or diseased pericementum should not be given this duty. Some writers
on this subject condemn this principle, thus eliminating the allocation
of the load for the tissues designed by nature for the purpose; the
dental pericementum — in which the writer is unable to wholly concur.
In many cases the sequelae following non-occlusion may be pre-
vented with large occlusal rests. Capillarity in these may be mini-
mized by keeping the gold out of contact with the deep sulci.
A sequence for the development of these follows :
1. Determine support of piece; see factor chart Fig. 12.
2. Sketching in occlusal rests.
(a) If mucosa support no occlusal rest.
(b) If root support entirely (removable bridges) occlusal
rests. Figure 2, with or without saddles.
ORAL HEALTH 349
PARTIAL DENTURE SERVICE
/?0m C0UE5E OfD£^/rAl SUPG50NS
FACTOR CHART
f^r Me pi/rpase ofjss/sf//?^ /n f/^e (/e/erm//jj//on i^ffi/ppor/-, (sfeps""3
I. SOME FACTORS INDICATING MUCOSA SUPPORT :-
Zjrggr s^ak/Ze une^s w/f/i s//rss of /r7js^/C27f-/o/r c^rr/ed pr/'/njr//// l^y s^cf^/Jks
^/kf si/^^ce/7f mi/cos^ , ^nc/ w/'/Aai// occ/^s^/ reifs ^re //7(y/c^fe(/ //? p/Vjflo//-
Cai) /^r<^r cf/s/snces o/iescA s/t/e of /v/ns/mj^^ecf/r .
^) less /2rkvr2r/>^ a}/?cif///o/7 ofperAx/nenfum af/^j^ z^y^/'/jlf/t^ ,
or /7a3^ jrif^/'/^/f/e /br siz/tpor/".
(cO Zess /Jrm C£>/?(y/y/o/7 ofZ^e /ni/cos^.
(e) Pressz/rc /?vm //re :rr7/^^o/7/j//7^ ^ee/A wbaye /Ae ^yere^.
2. SOME FACTORS INDICATING ROOT SUPPORT ■-
fr77i7//er s<7dc/Z0S a^/ZA s/nsss of/n^sZ/c^rf/o/? c^rrf7ei/ p/imur/A/ />// /^e i^M ^/7d
/Ze/'r perke/nenf^ : ^ntf a////j occ/£/s<7/ res/s , ^/v maf/'c^/ecf /n pra/for//o/? jb:-
(^) ^/77^//er af/s/<2r/7ce A^/wee/i Z/re remj//?//?^ 7^/r.
0) l^r^er ^/tjou/?/ 0fper/ce/r7e/?/i/m i^/xZ/f jyj//jZ/e Srsuppor/.
Cc) M<fr^ ^y^r.2rZ/e a)nif///(f/7 ofper/i:e/77e/7/u/n o/*7^A
2ry2r/'/£7^/e fr si/pporA,
(jcy) Mv<0 //r/77 co/f^/Y/o/? off/re mi/cvs^.
3. SOME FACTORS 1NDICATIN6 COMBINATION SUPPORT'-
of/ne£//a/n ^n?<r ^/jc/ u//M occ/i/s^/ /<ef3^ .
/^ /'/^c//c^t//y //f^ re/77^/'/7atr ^//^e 2^^ cases'.
^o^"-"'
tH"^
Figure No. 12. Factor Sheet. From the al)Ove, in proportion to the factors
above, and present in the proposed restoration, is the type support chosen —
(a) Root.
(b) Mucosa.
(c) Combination support of both root and mucosa.
350 ORAL HEALTH
(c) If mucosa and root support with ample space for
occlusal rest: quarter, half, full, or multiple occlusal pads
as required to close space.
(d) If both mucosa and root support with small space for
occlusal rest; buccal or lingual entry surface occlusal
rest: M.D., B.L., or L.I., rigid loops; recessed occlusal
rests. Remove small amount of enamel from marginal
ridges of upper and lower teeth involved, if absolutely
unavoidable, and without approaching the dentine.
Note. — Usually all teeth adjacent to spaces must share support.
Note. — All M.D. clasps and B.L. and L.A. clasps considerably
covering occlusal cone of tooth attached act as occlusal rests.
Note. — Upon all uncut cone-shaped teeth (e.g., cuspids) either
M.D. — B.L. — or L.I. rigid 2-3 loops are indicated.
43. Construction.
Maintenance of accuracy is the chief difficulty in construction and
much research in stresses and strains in bent and cast metal to avoid
distortion is necessary. A shrunken casting or distorted framework
exerts a permanent stress on anchor teeth which must result in ruin.
Interference in anatomical articulation may be checked by intelligent
use of adjustable articulators and the Wadsworth attachment is re-
commended with sulcus angles of natural and artificial teeth to be
identical. Escapes provided on occlusal surface tend to reduce over-
load. In Figure 6 a series of items in construction may be noted,
details of which would fill an essay of considerable size.
44. Insertion or Installation.
Too much stress cannot be laid on the necessity for proper adjust-
ment at this stage, both before, immediately after, and for a short time
subsequent; and during the initial stages of the practical use of the
appliance. At this stage the final and accurate distribution of stresses
on teeth, mucosa, or both, is done, and to a large extent, the life history
of the remaining teeth is determined. The operation may be con-
ducted entirely by the use of thin wax, carbon paper, and spot-
grinding, not omitting the instructions to patients as to method of
insertion and removal.
45. Maintenance and Repair, (presupposing healthy oral
conditions) .
Preventive items (in part). (The dentist's part.)
(1) Settling clasps and saddles, gingival impingement, etc.,
correction.
ORAL HEALTH 351
(2) Correction of impingement hard area or elsewhere.
(3) Watching for overload from occlusal rest with no rebasing
in expected absorptions (especially after recent extraction) ;
and for various overloads not correctly anticipated in saddle
and occlusal rest designs.
Oral Health Conditions. (The patient's part.)
(a) Cleansing five times per day.
(b) Saliva flush.
(c) Removal at night.
(d) Use of notification slips for periodic examination to be
furnished by Dentist.
(e) Report for repairs, rebases, etc., if necessary.
The first three items of personal hygiene, as above, may be
given direct appeal, with leference to the parallel of maintenance of
all kinds. Prophylactic notification system is equal with partial
denture notification systems in the opportunity for prevention, as
injuries which may result from broken clasp, occlusal rest or similar,
cannot be foretold with accuracy.
46. Conclusion.
Realizing with concern the lack of professional knowledge of the
subject of partial restorations, and, to a certain extent, the lack of
real interest in the subject, the writer offers the following suggestions
in conclusion.
1 . Research of partial denture problems to be included in as
many research programs as possible. From probably few causes are
more teeth lost than at present from lack of this knowledge. Here
follows a few suggested details:
(a) Design.
1 . Checking hypothesis of design and classifications with 2^^
or more cases.
2. Study of proper distribution of stresses of all kinds on
teeth, mucosa, or combination support.
3. Clasp design to minimize capillarity and other disadvantag-
eous factors.
(b) Construction.
1. Simple and standardized impression technique.
2. Elimination of warpage and distortion by similar standard-
ized instruction.
3. Reduction of cost and improvement of production methods.
352
ORAL HEALTH
(c) Installation, Maintenance, etc.
L Periodic records of selected cases checking efficiency of de-
signs in present use.
r:tf^
^^r\
^
Sj^
^
y^ivvx
?oA
/-•■.
■'^/J^
if
^^A
s\
/
''■'fl*-^-*
®\
J
\
W^
""" /^
L
■-■ -^
Wy*&
B5
Cast WrrMOUT Denti'RE
LP
PER DENTLR
^
C.s
w,
TH DFNTt
t Class 1
WlIHUlNURECHSSl
Figure No. 13. A group of class 1 cases.
CAsr Without Oen
Figure No. 14. A group of class 2 cases.
ORAL HEALTH
353
...r»,:„oill.ts
T.fl Lo»t»l
LVT,«
C,>T W
1H nf^
Tt«ECuss3
%
~)(%
^
\l("'
^
%
/ -4
^
■A
d
F
I v^i UiiH l'ivn»LCn>S 3
U">IK OtMlKL
WITH U[vnRlCLA&S3
Oil HmiolTDi
Figure No. 15. A group of class 3 cases.
1 i.f.Ti.1 cutss 4
^*~'*"" """>'« Class*
Figure No. 16. A group of class 4 cases.
Also every support to proposed Partial Denture Society to be
formed by the "National Dental Association" this summer at Los
Angeles (1922).
Report of Committee on Dental Nomenclature*
By L. p. Anthony, D.D.S., Philadelphia, Pennsylvania,
Chairman.
(Presented to House of Delegates, National Dental Association, Los
Angeles, California, July 17-21, 1922.)
YOUR committee begs to report as follows : The purpose of the
nomenclature of dentistry as of any profession is to provide the
means for the intelligible interchange of ideas to the end that its
development and growth may progress and keep pace with that of the
other professions.
Through its literature each profession becomes acquainted with the
state of development of its sister professions and thereby is judged as
to its intellectual status and the verity of its accomplishments. The
scientific status, the exactness of knowledge, the cultural developments
and the mental habits of a profession are distinctly reflected in its
literature, and the retarding influence of insufficient and defective
vehicles of expression must be removed if it is to keep pace with the
other learned professions.
We are all conscious of the fact that the development of dentistry
for the past two decades has been moving forward with such rapid
strides that our present terminology no longer meets the demands of the
science and imposes a serious handicap upon our progress that we can
ill afford to longer ignore.
The expansion of the field of dental activities resulting from the
general recognition of the interrelationships of oral infections and
bodily disease has necessitated an equivalent increase in our descrip-
tive nomenclature. In response to this need for a larger terminology
we have unfortunately been flooded with a group of terms that are
manifestly amateurish in conception and defective in their etymology,
hence they fail to correctly function as descriptive designations.
It is quite apparent that the busy practitioner is indifferent to this
important phase of our literature, seemingly being content with and
almost demanding that the subject be dealt with by those intimately
concerned with the historical record of dentistry in the literature —
namely, teachers, writers, editors, etc., they being in a better position
to undertake the task involved in the harmonizing of our present
terminology and enlarging it to meet our requirements.
Since the notable efforts of Black, Guilford, Molyneaux, Wilson
and others at the time of the World's Columbian Dental Congress,
and later those of the American Institute of Dental Teachers, little
"This report will be published in the Transactions of the American Dental
Association, held in Los Angeles. California, 1922. These may be purchased at
$1.00 each through the office of the American Dental Association, 5 N. Wabash
Avenue, Chicago, Illinois.
ORAL HEALTH 355
has been done to increase and enlarge our nomenclature with the ex-
ception of some individual efforts. Individual efforts, while they may
be praiseworthy and often productive of much good, inevitably lead
to confusion in the use of several words to mean the same thing, and
mainly serve to impress more forcibly the necessity for co-ordination of
efforts to the desired end.
Any effort, however, to standardize our nomenclature should be
made with a definite purpose of conforming it as closely as possible to
the general laws of nomenclature as already accepted by the biological
sciences. The desirability of this course needs only to be mentioned
here; so also it is only necessary to suggest the resulting enormous
saving of duplication of work in the elemental phase of the undertaking
that would accrue from this course.
There is a two-fold responsibility involved in the adoption of a
scientific dental terminology. Terms must not only express their
meaning with precision, but as in medicine many terms are used to
express a relation to the pathological or other biological phenomenon.
These terms must not only be correct in an etymological sense; they
must be so coined as to have a correct scientific meaning, and those
who originate them must not only possess the cultural fundamentals
necessary to constructive work in the science of nomenclature, but must
also have a broad scientific vision, as well as an intimate knowledge
of the subject in all its aspects.
Realizing the desirability of co-ordinating the various efforts being
made to bring about uniformity of dental terms, and conscious of the
necessity for a distinct forward step in the field of dental nomencla-
ture, the Dental Editors' Club, an organization composed of the
editors of dental magazines of the United States and Canada, at its
meeting in Milwaukee passed the following resolution:
Whereas, the Dental Editors' Club of North America at its meeting in Mil-
waukee, August 17, 1921, realizes the pressing need for standardization of dental
terms, l)e it
Resolved, That the Dental Editors* Club of North America petition the
House of Delegates of the National Dental Association to appoint a standing
committee on nomenclature, to whom matters relating thereto emanating from
various committees on nomenclature of other organizations be referred for
consideration, to the end that the standardization and harmonizing of our
technical dental terms may be under the direction and control of our national
organization.
Pursuant to the intents and purposes of the above resolution, the
National Dental Association appointed the following committee on
Dental Nomenclature: Drs. C. N. Johnson, Otto U. King, H. E.
Friesell, H. L. Wheeler, and L. P. Anthony as chairman.
Soon after the adjournment of the Milwaukee meeting, the chair-
man of the committee took steps to get in close touch with those who
have shown interest in this phase of dentistry with the result that many
suggestions from individual members of the profession were offered as
to the adoption of new words and many criticisms made upon words
now in use. We also have had the co-operation of several subordinate
356 ORAL HEALTH
organizations of the National who have suggested words relating par-
ticularly to the specialties with which they are concerned.
The committee, while feeling the necessity of prompt action in regard
to some of the words and suggestions offered, does not feel that it can
present a final and definite report on all terms that have been consid-
ered at this time.
It is not an easy task to decide upon the adoption of a certain class
of words in dental nomenclature, as the conditions are continually
changing and it is practically impossible in some instances to foresee
all the difficulties that may subsequently arise in the use of a word.
As an example one word will suffice. All are familiar with the
long drawn out discussion of the use of the words "model" and "cast."
After so many years the profession has about accepted the word "cast"
as preferable to "model," as the word "model" is incorrect in the
sense in which it has been so long used in dental literature. Now that
"cast" has been accepted, the development of the method of inlay
casting has much confused the use of the word "cast" so that now it is
quite difficult in some instances to apply the word generally.
There is also much unforeseen difficulty in other phases of dental
literature, namely, conforming our nomenclature to that of the other
biologic sciences. We cannot afford to disregard the nomenclature
of other sciences in forming our own, and, while there are instances in
which we have by determined effort succeeded in establishing the use
of some words which have conflicted with their use in other sciences,
we do not feel that it is worth the effort and the resulting confusion
consequent thereto. As examples of the latter, we might cite such
words as "articulate," "cuspid," "bicuspid," "mandible," etc. In the
case of the last mentioned word it has caused much confusion in
anatomical nomenclature for the reason that the nomenclature of the
teeth, jaws and surrounding parts has been built around the word
"maxillary" applied to both jaws, and the adaptation of mandible has
been difficult and thus far not accomplished completely in relation to
the anatomical terms given to the parts contiguous to the mandible.
All of this may, however, be avoided if we keep to the suggestion in
the forepart of this report, i. e., that our nomenclature be designed to
conform to that of the other biologic sciences.
The objection is often raised to so-called hybrid words, i.e., words
which have both Greek and Latin derivative root words. This occurs
to the committee as being more or less pedantic. The vast majority of
the words of our language are of Greek and Latin origin, and such
being the case there is no valid reason to the committee why, if the two
languages are chosen and preferred as derivative languages, we should
not avail ourselves of the advantages to be gained by a combination of
the two in forming our words.
Generalities with regard to nomenclature, its purposes and the best
methods of deciding upon terms, are all well and good as suggesting
ORAL HEALTH 357
principles upon which to work, but we realize that what is most
desired particularly is some concrete result reached by the committee.
We have therefore and with careful deliberation prepared a list of
words which we recommend to the association for adoption and use in
the sense in which we suggest they should be used. We also present
some words suggested which do not seem to conform to the intents and
purposes of dental nomenclature, and which we recommend be
abandoned as promptly as possible.
List of Words Recommended.
alveolectomy (L. alveolus + Gr. ektome excision). Excision of a portion of the
alveolar process.
alveolotomy (L. alveolus, [process] + Gr. tome, cut). Incision into the
alveolus of a tooth, as for locating the end of a root of a tooth.
anesthesia. Preferable to anaesthesia.
apicoectomy (L. apex, gen. apices, the end [of a tooth root] -|- Gr. ektome,
excision). The operation of excising the end of the root of a tooth. To be
used in preference to apectomy; apicectomy.
artificial denture. Preferable to plate.
cuspid. In preference to canine.
cementum. To be used in preference to cement.
conduction (adj.). To be used in preference to conductive, as in conductiort
anesthesia.
deciduous (adj.) To be used as designating the teeth of the first dentition, in
preference to the terms "temporary," "milk" or "baby."
dentural (adj.) (L. dens, dentis, tooth). Relating to the denture.
first molar. To be used in preference to "six-year malar," "sixth-year molar."
mandible (L. mandibula from mandere, to chew). The lower jaw.
maxilla, pi. maxillae (L. maxilla, jaw). The upper jaw.
morsal and occlusal (adj.). To be used synonymously as relating to the masti-
cating surfaces of the bicuspid and molar teeth.
centric occlusion. To be used to express the relation of the inclined planes
of the teeth when the jaws are closed in the position of rest.
eccentric occlusion. To be used to express the relation of the inclined planes
of the teeth in the excursive movements of the mandible.
mesial and distal. These terms as used to-day have been objected to as not
being in conformity with anatomical nomenclature, where they are used to
indicate relation to the median line of the body. They have, however, become
so fixed in dental nomenclature that we do not suggest any change.
pathodontia (Gr. pathos, disease + odous, tooth). That branch of dentistry
which has for its purpose the study and treatment of diseases of the teeth.
pathology (Gr. pathos, disease + logos, treatise). That branch of medical
science which treats of morbid conditions, their causes, symptoms, etc. This
term is being loosely used to indicate a disease or pathologic condition, which
is confusing, unnecessary and undesirable.
pediadontia (Gr. pais, paidos, child + odous, tooth). That branch of dentistry
which has for its purpose the study and treatment of children's teeth and
mouth conditions.
periodontia (Gr. peri, around, + odous, tooth). That branch of dentistry
which has for its purpose the study and treatment of diseases occurring
around the teeth and their roots.
periodontal (Gr. peri, around, -f odous, tooth). Relating to the alveolo-dental
ligament. To be used in preference to peridental.
periodontoclasia (Gr. peri, around + odous, tooth, + klassis, breaking [down]).
The destructive degeneration of the tissues about the root of a tooth. Sub-
stituted for pyorrhea alveolaris; Riggs' disease; interstitial gingivitis.
periclasia (Gr. peri, around, + klassis, breaking [down]). Used as a shorten-
ing for convenience of periodontoclasia. Should be used with a qualifying
word, as in itself it does not mean anything in particular.
pontic (L. pons, pontis, a bridge). (Adj. and noun.) A substitute for a natural
tooth. Used in preference to dummy.
bicuspid. In preference to premolar.
prosthesis (n.) (Gr. pros, to, + tithemi, to place). Preferable to prothesis.
(Because of the more defirifte application of the Greek preposition pros, as
compared to pro in this form.)
pro.sthetics (n.). Preferal)lo to prothetics.
(For same reason as in prosthesis.) -x , * 4.1, ..
pulpless tooth. To be used in preference to "dead tooth, devital tooth,
"devitalized tooth." In cases where there is a "vital" pulp m a tooth or a
"non -vital" pulp, it should be so designated; e.g., a tooth with a vital pulp,
or a tooth with a non-vital pulp. _, . * j- *
radiologv (n.) (L. radius, ray + Gr. logos, treatise). The science of radiant
energy. To be used as the generic term to indicate radiant energy from
wiiatever source.
358 ORAL HEALTH
radiogram (n.) (L. radius, ray, + Gr. g-ramma, a writing). The product or
tangible result, as the film or the print thereof, of the radiographic process,
actuated by radiant energy of whatever source.
radiograph (verb) (L. radius, ray + graphein, to write). The act or process
of making a radiogram.
radiography. The art of making radiograms.
radiopaque (L. radius, ray + opacus, shady). Term applied to a substance
that is impermeable to the various forms of radiant energy.
radiolucent (L. radius, ray + lucere, to shine). Term applied to substances
that allow the passage of radiant energy light, but offer some resistance.
radioparent (L. radius, ray + parere, to appear). Term applied to substances
that freely transmit the light of radiant energy.
roentgen ray. To be used in preference to X-ray, and only where the specific
ray is indicated.
roentgenology. The study and use of the Roentgen ray in its application to
medicine and dentistry.
roentgenography. The art of making roentgenograms.
roentgenogram. The shadow picture produced by the Roentgen ray on a
sensitized film, or the print from the film.
roentgenograph (v.) The act of making a roentgenogram.
second molar. To be used in preference to "twelve-year molar," or "twelfth-
year molar."
third molar. To be used in preference to "wisdom tooth."
Vincent's infection. To be used to express the ulcero-membranous stomatitis
caused by Vincent's spirillum and fusi-form Bacillus; in preference to
Vincent's angina; the latter being more applicable to the throat infection.
x-ray (n.) This word is used indiscriminately as a noun and verb. It should
not be used as a verb. The word Roentgen ray is preferable. It should
also be used with small x rather than with the capital X, if used at all.
penetology. These two words have been suggested, the first to mean odon-
talysis, the science of radiant energy, and the latter, examination of the
teeth. We see no justification for either etymologically or otherwise.
The committee is pleased to state that in the near future there will
be available places of accessible record of the activities in the field
of dental nomenclature that have not been open to the profession
since the passing of Harris* Dental Dictionary. If the present plans
mature as proposed there will soon be issued no less than three diction-
aries devoted to dentistry, namely, one compiled by Dr. W. R.
Dunning, under the auspices of the American Institute of Dental
Teachers; one compiled under the direction of Dr. Louis Ottofy, of
Chicago, and a third compiled by the chairman of this committee.
The committee and the profession can thus feel assured of a perma-
nent continuing record of its activities in the future.
In conculding the report, your committee earnestly solicits the co-
operation of committees on nomenclature and of individuals who are
actively interested in this subject, to the end that our nomenclature
may be as expeditiously as possible enlarged to meet the needs of the
profession.
Respectfully submitted,
L. Pierce Anthony, Chairman,
C. N. Johnson,
Otto U. King,
H. E. Friesell,
H. L. Wheeler,
Committee.
* The House of Delegates by unanimous vote received, adopted, and author-
ized the publication of this report.
Dominion Dental Council Examination Results,
June, 1922
Allen, X.
Bannerman. C. J.
Barber, J. C.
Balfour, G. E.
Berst, M. R.
Caldhick, L. W.
Cummer, H. H.
l^avidson, A. G.
Davidson, H. T.
Dixon, H. W.
Devine, E. W.
Evans, J. D.
Fumerton. A. S.
Graham, J. E.
Green, Geo.
Gauthier. J. A.
Hall, H. R.
Heidgerken, G. F.
Hall, AV. J.
Allen, X.
Bannerman. C. J.
Barber, J. C.
Balfour, G. E.
Berst, M. R.
Davidson, A. G.
Davidson, H. T. '
Dixon, H. W.
Devine, E. W.
Evans, J. D.
Fumerton, A. S.
Graham. .T. E.
Green. Geo.
Hall, H. R.
Heidgerken, G. F.
Jackson, W. R.
Passed in Operative Dentistry
Hamilton, C. W.
Jackson, W. R.
Jov, Marion
Keith, W. F.
Kerr, W. ' J.
Keyes, E. C.
Knight, H. N.
Kemp, E. G.
Kemp, F. F.
Lent, F. E.
Lequeyer, L. J.
Long, H. J.
Leismer, H. C.
Magrath, J. L.
Mihaychuk, M.
Mollins, N.
Murdock, E. L.
MacDonald, H. W.
MacKenzie, A. S.
Passed in Prosthetic Dentistry
Joy, Marion
Keith, W. F.
Kerr, W. J.
Keyes, E. C.
Knight, H. X.
Kemp, E. G.
Lent, F. E.
Long, H. J.
Leismer, H. C.
Magrath, M.
Magrath, J. L.
Mihaychuk, M.
Murdock, E. L.
MacDonald, H. W.
MacKenzie, A. S.
Xiebel, E. H.
(Clinical)
McDonagh, Aileen
McLeod, D. A.
Xiebel, E. H.
Xetherton, W. J.
Porter, J. F.
Parrott, J. R.
Prestien, G. L.
Rupert, E. A.
Ritchie, J. S.
Rouse, D.
Seale. G. W. H.
Sharon, W. A.
Turner, W. J.
Wright, L. H.
Webb, M. E.
Wilson, M. R.
Whitaker, R. J.
Wilkes, H. F. D.
Yoerger, W. G.
Yack, L. C.
(Clinical)
Xetherton, W. J.
Porter, J. F.
Parrott, J. R.
Prestein, G. L.
Rupert, E. A.
Ritchie, J. S.
Rouse, D.
Robertson, G. A.
Seale, G. W. H.
Stevenson, W. M.
Turner, Vi'. J.
Webb, M. E.
Wilson, M. R.
Whitaker, R. J.
Wilkes, H. F. D.
Yoerger, W. G.
Allen, X^
Bannerman. C .T.
Barber, J. C.
Caldbick, L. W.
Corbett, F. M.
Cummer, H. H.
Davidson, A. G.
Davidson, H. L.
Dixon, H. W.
Evans, .1. D.
Fumerton, A. S.
Graham, J. E.
Green, Geo.
Hall, U. R.
Heidgerken. G. F,
Jack.son, W. R.
Passed in Operative Dentistry
Jarvis, C. R.
Joy, Marion
Keith, W. F.
Keyes, E. C.
Knight, H. X.
Lent. F. E. .
Lequeypr, L. .7.
Long, H. J.
Magrath, M.
Magrath, J. L.
Mihaychuk, M.
Mollins, N.
Murdock, E. L.
MacDonald, H. W.
McConaghy, J. W.
McDonagh, Aileen
Passed
Allen. N.
Bannerman, C. .1.
Barber, J. C.
Caldbick. L. W.
Corbett, F. M.
Cummer. H. H.
Davidson, A. G.
Davidson, H. T.
Dixon, H. W.
Elkerton, W. C.
Evans, J. D.
Fumerton, A. S.
Graham, .T. E.
Green. Geo.
Hall. H. R,
Heidgerkon, G. P.
Hindson, J. D. W.
in Prosthetic Dentistry and
Jackson, W. R.
Jarvis, C. R.
Joy. Marion
Keith, W. F.
Keyes, E. C.
Knight, H. N.
Lent, P. E.
Lequeyer, L. .1.
Long, H. J.
Magrath, M.
Magrath, J. L.
Mihaychuk, M.
Mollins, N.
Murdock, E. L.
MacDonald, H. W.
McConaghy, J. W.
McDonagh, Aileen
(Paper).
McLeod, D. A.
Xiebel, E. H.
Xetherton, MV. J.
Porter, J. F.
Purdy, C. F. M.
Robertson. G. A.
Rupert, E. A.
Shragge, G. E.
Snell, A. R. J.
Sutter, S. H.
Seale, G. W. H.
Turner, W. J.
Wagner, G. W.
Webb, M. E.
Wilson, M. R.
Yoerger, W. G.
Metallurgy.
McLeod, D. A.
Xiebel, E. H.
Xetherton, W. J.
Porter, J. F.
Purdy, C. F. M.
Robertson, G. A.
Rupert, E. A.
Shragge, G. E.
Snell, A. R. J.
Sutter, S. H.
Seale, G. W. H.
Turner. W. J.
Wagner. G. W.
Webb, M. E.
Wilson, M. R.
Yoerger, W. G.
360
ORAL HEALTH
Allen, N.
Bagnall, J. S.
Bannerman, C. J.
Barber, J. C.
Caldbick, L. W.
Corbett, F. M.
Cummer, H. H.
Davidson, A. G.
Davidson, H. T.
Dixon, H. W.
Fumerton, A. S.
Graham, J. E,
Green, Geo.
Gott, A.
Hall, H. R.
Heidgerken, G. F.
Passed in Anesthetics.
Jackson, W. R.
Joy, Marion
Keith, W. F.
Keyes, E. C.
Knight, H. N.
Lequeyer, L. J.
Long, H. J.
Magrath, M.
Magrath, J. L.
Mihaychuk, M.
Mollins, N.
Murdock, E. L.
MacDonald, H. W.
MacKenzie, A. S.
McConaghy, J. W.
McDonagh, Aileen
McLeod, D. A.
Niebel, E. H.
Netherton, W. J.
Porter, J. F.
Purdy, C. F. M.
Robertson, G. A.
Rupert, E. A.
Shragge, G. i-;
Snell, A. R. J.
Sockett, R. J.
Seale, G. W. H.
Turner, W. J.
Wagner, G. W.
Webb, M. E.
Wilson, M. R.
Yoerger, W. G.
Passed In Materia Medica and Therapeutics.
Allan, A. W. M.
Allen, Norman
Bannerman, C. J.
Barber, J. C.
Blight, T. F.
Clay, M. A.
Climo, C. B. H.
Coristine, W.
Craigie, C. C.
Crosby, H. S.
Croft, O. L
Cummer H. H.
Curtis, D. I.
Davidson, A. G.
Davidson, H. T.
Dexter, C. R.
Dixon, H. W.
Dunlop, H. C.
Flkerton, W. C.
Elsey, J. G.
Evans, J. D.
Fluck, W. L.
Fumerton, A. S.
Gawley, R. J.
Gray, L. M.
Good, A. W. G.
Allen, N.
Bannerman, C. J.
Barber, J. C.
Caldbick, L. W.
Corbett, F. M.
Cummer, H. H.
Davidson, A. G.
Davidson, H. T.
Dixon, H. W.
Evans, J. D.
Fumerton, A. S.
Graham, J. E.
Green, Geo.
Gott, A.
Hall, H. R.
Heidgerken, G. F.
Allen, N.
Bannerman. C. J
Barber, J. c
Blight, T. F.
Caldbick, L W
Clay, M. A.
Climo, C. B. H.
Coristine, Wilfrid
Craigie, C. C.
Crosby, H. S.
Cummer, H. H.
Davidson, A. G.
Gooding, S. B.
Hall, H. R.
Hallett, C. N.
Hamilton, W. S.
Hindson, J. D. W.
Jackson, W. R.
Jarvis, C. R.
Johnson, K. P.
Keith, W. F.
Kenny, F. P.
Keyes, E. C.
Kilbourne. L. A.
Knight, H. N.
Langtry, J. H.
Leoueyer, L. J.
Magrath, M.
Magrath, J. L.
Maloney, Bertha
Miller, W. A.
Mihaychuk, M.
Mollins, N.
MacDonald, N. S.
MacDonald, H. W.
MacRitchie, G. R.
McCord, D. W.
McConaghy, J. W.
McDonagh, Aileen
McGinnis J. A.
McLellan, A. J.
McLeod. C. D.
McLeod, D. A.
McMachen, W. L.
McMillan, D. B.
Netherton, F. J.
Netherton, W. J.
Pickering, A. B.
Purdy, C. F. M.
Robertson, G. A.
Robinson, G. A.
Roop, L. B.
Ross, B. R.
Rushton, J. A.
Rupert, E. A.
Smith, G. C.
Snell, A. R. J.
Sockett, R. J.
Sutter, S. H.
Seale, G. W. H.
Thompson. Hazel
Ward, J. C.
W^bb, M'lton
Wilson, M. R.
Passed in Jurisprudence and Ethi
cs.
Jackson, W. R.
Joy, Marion
Keith, W. F.
Kerr, W. J.
Keyes, E. C.
Knight, H. N.
Lent, F. E.
Lequeyer, L. J.
Long, H. J.
Magrath, M.
Magrath, J. L.
Mihaychuk, M.
Mollins, Norma
Murdock, E. L.
MacDonald, H. W
McConaghy, J. w'
McDonagh, Aileen
McLeod, D. A.
Niebel, E. H.
Netherton, W. J.
Porter, J. F.
Purdy, C. F. M.
Robertson, G. A.
Rupert, E. A.
Shragge, G. >'
Snell, A. R. J.
Seale, G. W. H.
Turner, W. J.
Wagner, G. W.
Webb, M.
"Wilson, M. R.
Yoerger, W. G.
Passed in Pathology and Bacteriology.
Davidson, H. T.
Dexter, C. R.
Dixon, H. W.
Elkerton, W. C.
Elsey, J. G.
Evans, J. D.
Pluck, W. L.
Fumerton. A. S.
Graham, J. E.
Gooding, S. B.
Gott, A.
Hall, H. R.
Heidgerken, G. F.
Hindson, J. D. W,
Jackson, W. R.
Johnson, K. P.
Joy, Marion
Keith. W. F.
Kenny, F. P.
Keyes, E. C.
Killins, M. G.
Knight. H. N.
Langtry. J, h.
Lequeyer, L. J.
ORAL HEALTH
36
Long, H. J.
Magrath, M.
Magrath, J. L.
Maloney, Bertha
Miller, W. A.
Mihaychuk, M.
Mollins, Norma
Murdock, E. L.
MacDonald, N. S.
McCord, D. W.
McConaghy. J. W.
McDonagh, Aileen
McLellan, A. J.
McLeod, C. D.
McLeod. D. A.
McMillan, D. B.
Xetherton, F. J.
Netherton, W, J.
Porter, J. F.
Purdy, C. F. M.
Robertson, G. A.
Robinson, G. A.
Roop, L. B.
Rupert, E. A,
Smith, G. C.
Snell, A. R. J.
Seale, G. W. H.
Thompson, Hazel
Turner, W. J.
Wagner, G. W.
Webb, M.
Wilson, M. R.
Yoerger, W. G.
Passed in Medicine and Surgery.
Allen, N.
Bannerman, C. J.
Barber, J. C.
Caldbick, L. W.
Corbett, F. M.
Cummer, H. H.
Davidson, A. G.
Davidson, H. T.
Dixon, H. W.
Fumerton, A. S.
Graham, J. E.
Green, Geo.
Gott, A.
Hall, H. R.
Heidgerken, G. F.
Jacksort, W. R.
Joy, Marion
Keith, W. F.
Kerr, W. J.
Keyes, E. C.
Knight, H. N.
Lequeyer, L. J.
Long, H. J.
Magrath, M.
Magrath, J. L.
Mihaychuk, M.
Mollins, Norma
Murdock, E. L.
MacDonald, H. W.
MacKenzie, A. S.
McConaghy, J. W.
McDonagh, Aileen
McLeod, D. A.
Niebel, E. H.
Netherton, W. J.
Porter, J. F.
Purdy, C. F. M.
Shragge, G. E.
Snell, A. R. J.
Sockett, R. J.
Seale, G. W. H.
Turner, W. J.
Webb, M.
Wilson, M. R.
Allen, N.
Bannerman, C. J.
Barber, J. C.
Caldbick, L. W.
Corbett, F. M.
Cummer, H. H.
Davidson, A. G.
Davidson, H. T.
Dixon, H. W.
Evans, J. D.
Fumerton, A. S.
Graham, J. E.
Green, Geo.
Gott, A.
Hall, H. R.
Heidgerken, G. F.
Passed in Orthodontia.
Jackson, W. R.
Joy, Marion
Keith, W. F.
Kerr, W. J.
Keyes, E. C.
Knight, H. N.
Lent, F. E.
Lequeyer, L. J.
Long, H. J.
Magrath, M.
Magrath, J. L.
Mihaychuk, M.
Mollins, Norma
Murdock, E. L.
MacDonald, H. W.
McConaghy, J. W.
McDonagh, Aileen
McLeod, D. A.
Niebel, E. H.
Netherton, W. J.
Porter, J. F.
Purdy, C. F. M.
Robertson, G. A.
Rupert, E. A.
Shragge, G. E.
Snell, A. R. J.
Sockett, R. J.
Seale, G. W. N.
Turner, W. J.
Webb, Milton
Wagner, G. W.
Wilson, M. R.
Yoerger, W. G.
Passed in Physics and Chemistry.
Adams, C. G.
Allan, A. W. M.
Allen, N.
Anthony, A. B.
Blight, T. F.
Boyd, C. T.
Bregman, M. A.
Caldbick, L. W.
Clements. R. W.
Connell, J. L.
Coristine, Wilfrid
Croft, O. L.
Curtis, D. L.
Dalgleish, R. R.
Duncan, H. D.
Dunham, J. E.
Dunlop, H. C.
Forbes, R.
Fraser, H. R.
Fumerton. A. S.
Gray, L. M.
Greacen, G. W.
Good, A. W. G.
Gourlie, H. E.
Hallett, C. B.
Harlow, W. E.
Hamilton, W. S.
Heal, H. N.
Heaslip, W. L.
Hill, V. R.
Keith, W. F.
Kilbourne, L. A.
Logan, G. M.
Magrath, J. L.
Maloney, Bertha
Marrigan, J. E.
More, W. G.
MacDougall, G. G.
Macintosh, C. E.
MacKenzie, W. F.
McConaghy, J. W.
McGinnis, J. A.
Mclnnes, A. C.
McLellan, A. J.
McLeod, D. A.
Netherton, F. J.
Purdy, C. F. M.
Robertson, G. A.
Ross, D. R.
Rowland, C. L.
Shepherd, R. P.
Shaffner, B.
Sinclair, G. A.
Simon, M. L.
Smith, G. C.
Spence, Maude
Stewart, H. R.
Sutherland. A. M.
Sutter, S. H.
Sweet, T. L. P.
Tackaberry, W. J.
Thompson, Hazel
Toole, J. E.
Turner, W. J.
Ward, J. C.
Wagner, G. W.
Wilkinson, J. S.
Wilson, M. R.
Whyte, G. W.
362
ORAL HEALTH
Adams, C. J.
Anthony, A. B.
Beck, C. L.
Boyd, C. T.
Bregman, M. i\
Clements, R. W.
Connell, J. L..
Coons, K.
Croft, O. L.
Dalgleish, R. R.
Dixon, H. W.
Duncan, H. D.
Dunham, J. E.
Dunlop, H. C.
Forbes, Roberta
Fraser, H. R.
Gray, L. M.
Greacen, G. W.
Good, A. W. G.
Gourlie, H, E.
Adams, Chas. G.
Anthony, A. B.
Botting, D. M,
Boyd, C. L.
Bregman, M. A.
Clements, R. W.
Connell, J. L.
Coristine, W.
Croft, O. L.
Dalgleish. R. R.
Duncan, H. D.
Dunham, J. E.
Dunlop, H. C.
Forbes, Roberta
Fraser, H. R.
Gray, L. M.
Greacen, G. W.
Good, A. W. G.
Gooding, S. B.
Hallett, C. B.
Passed in Anatomy.
Hallett, C. B.
Harlow, W. E.
Heal, H. N.
Heaslip, W. L.
Hill, V. R.
Kilbourne, L. A.
Langille, R. M.
Logan, G. M.
Magrath, M.
Mallabar, J. W.
Magee, M. A.
Marrigan, J. C.
Mills, J. G.
More, W, G.
MacDougall, G. G,
Macintosh, C. E.
McConaghy, J. W.
McGinnis, J. A.
Mclnnes, A. C.
McLellan, A. J.
Netherton, F. J.
Pickering, A. B.
Rowland, C. L.
Shepperd, R. P.
Shaffner, B.
Sinclair, G. A.
Smith, G. C.
Somers, S. N.
Spence, Maude
Stewart, H. R.
Sutherland, A. M.
Sutter, S. H.
Sweet, T. L. P.
Tackaberry, W. J.
Toole, J. E.
Wagner, G. W.
Wilkinson, J. S.
Whyte, G. W.
Passed in Physiology and Histology.
Heal, H. N.
Heaslip, W. L.
Hill, V. R.
Jackson, W. R.
Kenny, F. P.
Langille, R. M.
Magrath, M.
Magrath, J. L.
Magee, M. A.
Maloney, Bertha
Marrigan, J. C.
Mills, J. G.
More, W. G.
MacDonald. N. S.
MacDonald. H. W.
McConaghy, J. W.
Mclnnes, A. C.
McLellan, A. J.
McLeod, D. A.
McMillan, D. B.
Netherton, F. J.
Pickering, A. B.
Rowland, C. L.
Shepherd, R. P.
Shaffner, B.
Sinclair, G. A.
Simon, M. L.
Smith, G. C.
Somers, S. N.
Spence, Maude
Stewart, H. R.
Sutter, S. H.
Sweet, T. L. P.
Tackaberry, W J
Toole, J. E.
Turner. W, J.
Wilkinson, J. S
Whyte, G. W.
No More Sore Fingers.— To hold crowns when you polish
them, use a wooden clothes pin. — Dental Surgeon.
Setting up Diatoric Teeth.— When setting up diatoric teeth
m full vulcanite denture work, much time can be saved and more
satisfactory results obtained by placing the four posterior teeth
en bloc in the wax rims of the trial plates, leaving these teeth wired
together just as they come from the supply house. This wire frame-
work later becomes part of the finished denture, but is entirely con-
cealed by the vulcanized rubber.
Styptic for Excessive Bleeding.— Almost a saturated solu-
tion of acid tannic in hazeline (or liq. hamamelidis) used on swabs
(after a small quantity has been boiled with water and the wound
thoroughly syringed with this to remove, if necessary, clots, etc.).
Durmg the past fifteen years I have never known it to fail. Cleaner
than hq. ferri perchlor, and safer than adrenalin. In bad cases I
also give 20 grains of cal. lactate in five grain tablet iorm.— Dental
Magazine.
*»*
\^^
PROVINcIaL EDITORS' CORNER
BRITISH COLUMBIA— A. T. OBERG. D.D.S.,
833 Granville St., Vancouver
ALBERTA— JOHN W. CLAY. D.D.S.
914 Herald Bldg., Calgary
SASKATCHEWAN— C. W. PARKER, D.D.S.
Imperial Bank Bldg., Regina
MANITOBA— '^. W. WRIGHT. D.D.S.
767 Warsaw Ave., Winnipeg
ON^TAR/0— Lieut-Col. W. G. THOMPSON
28 King St. West, Hamilton
QUEBEC— ALBERT DELORME. D.D S.
713 St. Catherine St., East, Montreal
MARITIME PROVINCES— STANLEY BAGNALL. D.D.S., Halifax. N.S.
ALBERTA.
THE annual meeting for 1 922 of the Alberta Dental Association
was held at Calgary July 10th.
The meeting passed a resolution asking the Calgary Dental
Association to entertain the Association at a convention in 1923, a
grant of one thousand dollars towards the expenses being passed.
Dr. A. E. Hennigar, of Calgary, was appointed chairman of the
Central Convention Committee, to act in the event of the offer being
accepted.
The Committee having in charge the preparation of a new Dental
Act for the Province presented a draft act for the approval of the As-
sociation. The draft was accepted, together with a recommendation
for the division of the Province into electoral districts for the election
of members of the board of directors, and with this alteration the
committee was instructed to obtain legislative sanction to the new Act
as soon as considered advisable.
A grant of $200.00 to the Canadian Dental Research Foundation
was passed in approval of the work being carried on by that body.
The Board of Directors of the Association is as follows: — Dr. A.
E. Hennigar, President; Dr. M. L. Moore, Vice-Pres. ; Dr. A. B.
Mason, Representative to the Senate of the University of Alberta;
Dr. Leslie Mclntyre, and Dr. John W. Clay, Sec.-Treas., Registrar
and Representative to th? Dominion Dental Council.
Dr. H. F. Whittaker, of Edmonton, tendered his resignation as
Alberta's representative to the Dominion Dental Council. In so do-
ing, Dr. Whittaker severed, for the time being, his connection with
the Board of Directors of the Association, after an almost continuous
service to the Association in various offices, beginning soon after the
formation of the Association when Alberta became a Province in
1906.
The Oral Hygiene Committee, under Dr. O. F. Strong, of Edmon-
ton, and Dr. V. H. Macauley, of Calgary, reported a number of
lantern lectures and a general educational campaign carried on
throughout the year. A couple of lanterns have been purchased and
364 ORALHEALTH
a number of slides prepared, and the same committee will carry on an
active campaign throughout the Province during the coming year.
Education of the Provincial Government as to the need of taking over
this work on a large scale, would probably be a useful direction of
energy on the part of this committee.
Let me commend and corroborate the remarks of Dr. W. W.
Wright, of Winnipeg, in the June issue of Oral Health regarding the
use of transillumination for diagnosis of focal conditions at the apices
of teeth.
My careful trial in the dark room has not disclosed shadows in a
number of cases in which, either clinically or radiographically, infec-
tion has been demonstrated.
While not decrying the use of these valuable little lamps in dental
practice, I should like to add the testimony of their unreliability in my
hands for the diagnosis of apical conditions. J. W. C.
MANITOBA.
OUR illustrious Canadian-American dentist. Dr. C. N. Johnson,
was a guest at dinner of the Winnipeg dentists on July 31st.
It is difficult to find words to sufficiently express one's admiration
for this man. His sterling character, his undiminished energy, his
power of expression, and his genial personality, together with many
other lovable traits, combine to make him a leader second to none. It
was an inspiration to me to meet him for the first time, and I thought of
the wonderful influence for good he must have had and is still exert-
ing over the many, many students and practitioners with whom he
has come in contact. May his shadow never grow less!
Dr. K. C. Campbell visited Winnipeg recently en route to Lon-
don, England, where he intends practising. "K. C.*' has been fruit-
farming near Victoria since the War, which has undermined his
health. However, we are glad to know that he has regained his for-
mer '*pep'* and is just as noisy as ever. **K. C." is held in the very
highest regard by all who know him and their best wishes certainly
followed him to London.
Cupid has been busy this year with our confirmed bachelors.
Dr. "Rorie" McGillivray was married recently, and another still
more "confirmed" than "Rorie" is about to be married.
Some Winnipeg golf players are certainly getting into fine shape.
One of them is now able to do the eighteen holes on a pint and a half.
ORAL HEALTH 365
The new building for physicians and dentists at the corner of Ken-
nedy Street and Graham Avenue, Winnipeg, is now under construc-
tion.
The Winnipeg Dental Society were much honored in having Dr.
Thornton, Dean of the Dental Department of McGill University, as
their guest and speaker recently.
Dr. A. E. Webster was also a guest of the Winnipeg Dental So-
ciety one of our hottest days this summer. Although the number
present was not as large as it certainly would have been had the
meeting not happened to be just before a holiday and a brief
notice, yet one of the most valuable discussions occurred. Dr. Web-
ster explained the attitude of leading authorities on some of our most
perplexing problems.
On the invitation of Dr. H. A. Croll, the Vice-President, a meet-
ing of the Western Manitoba Dental Society was recently held in
Souris, many members taking advantage of the good roads to motor in.
Drs. E. H. Clark and H. B. Gorrell, of Minnedosa; W. L. Sawyers,
of Carberry; R. J. Dunsmuir, of Virden; W. A. McLaren, of Kil-
larney; C. H. McKenzie, of Hartney; R. S. Rose, E. R. Howes, A.
L. Church and S. Doran, of Brandon; H. J. Merkley, of Winnipeg;
S. Corristine, of Brandon, M. McDonald, of Minnedosa, and H. A.
Croll and W. Mitchell, of Souris, attended. Dr. H. J. Merkley, of
Winnipeg, gave clinics on Impression Taking and Articulating ac-
cording to the Hanau method, which were very much appreciated.
At the conclusion of the clinic the members paid a visit to the Souris
and Glenwood Memorial Hospital, where they were entertained by
the Matron, Nurse Newton and the staff of nurses. In the evening
the dentists and their wives held a banquet in the King Edward Hotel,
at which Dr. Merkley spoke on several subjects of dental interest.
w. w. w.
How to Chew
Chew very slowly, chew, chew, chew, —
That's what all wise children do.
Little teeth so sharp and white,
Are made to chew each little bite.
Little jaws will stronger grow
If they're exercised, you know.
If you would be glad and gay.
Chew your food well every day.
DORA LAWRENCE CAMERON.
Wenatchee, Wash.
To the National Dental Association and Return
1WAS correct in saying *'To the National/' but when I came away
it was "The American." At the Los Angeles meeting the name
was changed to that held by the original body, and henceforth it
will be The American Dental Association. Travelling more than
7,000 miles gave me the opportunity to observe many things, which,
if properly recorded, might be of interest to readers of Oral Health,
but manifestly I can write of only a few which seemed to me the most
significant.
The first thing that interested me on this trip — as is the case with
every trip I take — was the Pullman porter. If any one wants to study
real human nature let him go direct to the porter, and he will find it in
its purest form. The Pullman porter is the best example I know, of
the virtues and limitations of our common humanity. He is essentially
the real thing. Of course he is not always alike, but when he is at
his best he is almost perfect. By that I mean that he starts out on the
journey with the same attentive, solicitous, and accommodating de-
meanor that every porter displays when he is brushing a passenger off
at the end of the trip. To do this is a stroke of genius on the part of the
porter, and it wins him many a dollar that he would not otherwise get.
But some porters are blind enough to start the journey in an indifferent
attitude, studying their own comfort and conscience rather than that
of the passengers till near the completion of the journey. Then a sud-
den transformation takes place. I have never seen one who was not
suave and gracious when he was working the traveller for a tip — and
in this they are very human. Most people are more considerate of the
other fellow when they want a favor. Some porters and some people
have never learned the fundamental lesson that the greatest happiness
and surest advantage comes from serving others for the very love of
serving, rather than for the hope of material reward. When I see a
porter who seems to take a delight in making his passengers comfort-
able and happy from the very beginning of the journey to the end, I
feel that he has mastered the supreme lesson of life, and can set an
example to many of those who aspire to a higher station in the social
scale.
ORAL HEALTH 367
If we extend the average railway journey out into the devious jour-
ney of life, and then apply the lessons learned from the porter, we shall
find that we are daily missing much of the joy of living in our neglected
opportunities for serving others and making the world a happier place
in which to live. We should begin at the earliest age of reason and
responsibility to cultivate kindness and consideration, and then try to
run true to form for the rest of the journey.
But the most impressive thing, after all, about the porter is his
splendid technique. When he goes to make up a berth he is a finished
artist. I have watched the process many a time, and never without
profit. The expert porter — and most of them are expert when it comes
to this — never makes a false move. He is an object lesson to all of us,
and I have often wished that the rank and file of the student body in
our dental colleges could study his methods and adopt them in their
daily work. We would not encounter so much false motion, or so
much conspicuous awkwardness.
The porter can do one thing I have never seen any one else achieve.
He can sit bolt upright and sleep. When my friend. Dr. Richardson,
of Worcester, Mass., saw one doing this on the train going out he said:
*'Sam, how in the world can you do it?"
"Easies* thing you evah see," said the porter. *T jes* natchally do
it. But didja' notice I alius sits facin' de windah? That's so the
conductah thinks I'se lookin' out." Evidently it is against the rules to
sleep during the day on a Pullman.
We had a special train going from Chicago to Los Angeles, with
1 5 1 dentists and members of their families on board. It was in charge
of Dr. D. C. Bacon, chairman of the Transportation Committee of the
American Dental Association, which ensured us the best of attention.
We stopped over a day at Colorado Springs, saw Pike's Peak, 14,109
feet high — as high, by the way, as I shall ever care to go — and my
family and I dined with some friends at the Broadmoor Hotel, a
beautiful place near the foothills. Our train was parked till 4 o'clock
the following morning to enable us to go through the famous Royal
Gorge on the D. & R. G. Ry. in daylight, and as I sat and watched
that enormous cliff through the rocks with the river dashing along at
the bottom of it, I wondered how many centuries it has taken to cut
the passage. Verily, the works of nature are stupendous.
At Salt Lake City we were met by a delegation from the Utah
State Dental Society, and driven around that wonderful city, which I
have on a previous occasion written up in Oral Health. We were
also taken out to their bathing resort, Saltair, on Salt Lake, and many
of our members enjoyed a dip in real salt water. Then we went to the
museum in the same enclosure with the Mormon Temple and Taber-
nacle, and spent a very pleasant and profitable half hour looking at
the souvenirs of early Utah life. In the Tabernacle the regular daily
organ recital had just been held, and we regretted that we had been
368 ORALHEALTH
too late to hear it. When this was communicated to the authorities
they most graciously offered to give a special recital for our benefit,
and I have seldom enjoyed anything more than this. The courtesy
and hospitality accorded us by the dentists, and by the citizens of Salt
Lake City, made a very pleasant chapter in our journey to Los An-
geles, and some day I should like to see the American Dental Asso-
ciation meet at Salt Lake City, so that the profession generally might
get a better idea of the wonders of Utah.
We had boarded the train Sunday night in Chicago, and by easy
stages we reached Los Angeles Friday P.M., where we were met and
captured by the whole hearted dentists of the "City of Angels." But
the story of the meeting must be told in another chapter.
Our Little Friends
By Habec.
HABEC must tell his Canadian friends of an activity that is unique
in its mission and in its appeal to the deeper impulses of the
heart. It is the International Society for Crippled Children, and
its founder and president, Edgar Allen of Elyria, Ohio, has been
honored by having his birthday made a State holiday. He has given
fourteen of the best years of his life to the cause of the crippled child
and is the official "Daddy" of them all. Habec could fill page after
page in recounting the unselfish service and the glorious results accru-
ing to his little friends through his diligent efforts, but the action of the
legislators of the State of Ohio is, in itself, sufficient proof of the place
he holds in the hearts of the people.
Habec is bringing this subject to your attention because it has a
definite connection with our profession. Nothing is more important to
the handicapped child than preventive and corrective dentistry.
Aside from the value of a good masticatory equipment, the necessity of
eliminating focal infection in these cases, is paramount. There exists
today a great army of these children whose progress toward cure is
retarded because of inadequate dental attention and Habec appeals
to that vitally beneficient principle, the fostering agent of our daily
service, to bring into realization a definite plan whereby we may con-
scientiously meet this demand upon our professional energies. At any
rate, the dental branch of the subject is intimately correlated with all
the plans now being formulated for the welfare of our less fortunate
little brothers and sisters.
It was our good fortune, as president of the New York State So-
ciety for Crippled Children, to attend a recent meeting of the Interna-
ORAL HEALTH 369
tional Society at Chicago, at which time a very ambitious program was
adopted, functioning primarily through Rotary because of its great
basic principle of Service above Self. The plans are world-wide in
scope and are adapted to conditions existing amongst all peoples, for
the crippled child is the same everywhere.
Extended experience points definitely to the following procedure:
First, locate the crippled child through a careful survey by specially
trained organizations and persons. Second, gain the co-operation of
parents. Third, ascertain ability to pay for cure. Fourth, arrange
for means of treatment. Fifth, have mental and physical examination
by experts. Sixth, place the child in a special school for observation
and mental improvement. Seventh, proceed with physical correction
and development. Eighth, complete cure i n convalescent homes,
which includes training to make the child as nearly self supporting as
conditions will permit. Ninth, continue surveillance by systematic
follow-up care at home.
The International, State and Provincial societies are essentially co-
ordinating, directing and policing agencies through which it is planned
to utilize existing organizations for this work and to establish new
means as may be required. This is a general outline of the work we
have undertaken and Habec takes pleasure in stating that it will be
done with all reasonable speed.
In the words of the New York Rotary Club, we are endeavouring
to reclaim the birthright of the crippled child, putting new hope into
the hearts of the thousands and transferring them from dependent
liabilities to economic and social assets. Instead of discarding them
as dross from the fire of human tragedy, we shall treat them with the
acid of human effort to bring out the golden specks and make them
shine with all the brilliance of the hidden gem.
Economists agree that this class of human frailties present greater
possibilities in return for expended effort and outlay than any other.
In fact, aside from the great humanitarian urge and gripping insistence
of this glorious cause, there is far greater salvage, if you will, than
from any other human source. Will we help reclaim them to health,
usefulness and happiness? The answer was given more than two
thousand years ago and can never be changed. "Inasmuch as ye did
it unto one of the least of these, ye have done it unto me."
And the dental profession, by virtue of its sacred birthright, has a
definite place in this great forward movement. Does not your chest
expand much further with pardonable pride at your added importance?
The crippled child has come to save us from ourselves — to mock the
god of lust and of gain — to shame the idol of selfishness — to loose
the milk of human kindness and to add glory to our service in the field
of humanity.
Ah! Buddy, take a slant at it and begin to really and truly live.
Spend your dollars on these kiddies and should it make your pocket
370 ORAL HEALTH
empty it will make your heart overflow. So you see that the mission
of our profession is to put forth our best efforts to eliminate the dental
handicaps of these children, particularly that of the focal infection.
In due time Habec will return to you with a definite plan whereby we
may proceed in an organized manner to render constructive service
where it is so much needed.
Splendid work is being done in Canada and soon organized Rotary
effort and influence will be felt. Habec is somewhat familiar with the
service being rendered in Toronto and particularly at the great hospital
of Dr. A. Mackenzie Forbes, which so peacefully rests within the
breast of noble Mount Royal, a most fitting place to nurse little child-
ren back to health and happiness. Your own Doctor Thornton pre-
sides over their dental welfare, which is sufficient warrant of
conscientious and adequate service.
Habec urges his fellow dentists to look well to the crippled child in
their midst and seek every opportunity to give them the best attention
our special training will afford. We also invite correspondence and
suggestions with a view to giving the child assistance and developing a
standard plan of dental treatment for these worthy little patients.
Habec.
The Bacteriology of Dental Caries
THE interesting paper by Professor James Mcintosh, Mr. War-
wick James, and Dr. Lazarus-Barlow on dental caries and
bacteria, which has appeared in the Lancet, is a valuable
addition to knowledge of the aetiology of this disease. On the
bacteriological side it represents a distinct advance, for whereas
before bacteria could only be implicated as providing the source of
the acid which destroys the calcified tissues of the teeth, without
specifying the organisms involved, we now appear to be within
measurable distance of knowing definitely the precise nature of the
bacterial agents in the process and the conditions under which they
work. The brilliant researches of W. D. Miller, which stand out the
more conspicuously in proportion as we discover more of the various
aspects of dental caries, showed very clearly that the carbohydrate
foodstuffs provided the pabulum from which the lactic acid respon-
sible for the destruction of the teeth was derived, and also that the
chemistry of the process was due to bacterial agency. Since then
research has been chiefly devoted to the dietetic aspect of the disease,
and the labours of Dr. Sim Wallace have resulted in much valuable
addition to our knowledge. On the bacteriological side the advances
have been slower; though attempts to implicate a special organism as
the cause of the acid formation have failed, yet research has steadily
advanced in the direction of isolating certain organisms from the
abundant flora of the mouth as being more directly concerned in the
production of dental caries. The work of P. R. Howe in 1917
ORAL HEALTH 371
represented a considerable advance, for he was able to show that the
Moro-Tissier group was constantly present in dental caries. He did
not conclusively demonstrate their aetiologic role, but pointed out that
more nearly than any other organisms did they possess the attributes
for inaugurating the process of dental caries.
At this point the work of Mcintosh, James, and Lazarus-Barlow
carries on the knowledge a stage further; the two organisms [? one]
they have isolated in a very large percentage of cases resemble the
organisms described by Howe, though differing in certain cultural
reactions. Their careful and ingenious technique appears to leave no
loophole for error, and shows very clearly that they are fully cognizant
of the complexity of the problems to be solved. It may be premature
to assert the specificity of the microbic agent in dental caries — much
more work needs to be done before that is possible, but at least a clear
pathway of research is opened up through the cumulative endeavours
of past and present workers in this field. The importance of eluci-
dating the problem of dental caries lies in its application to the
prevention of the disease rather than to its treatment. The latter
depends on mechanical removal of infected dentine and enamel, the
shaping of the cavity in accordance with certain physical principles,
and the filling of it with a watertight plug. Though a better under-
standing of the pathology of dental caries may not be without its
mfluence on conservative dentistry, it is hardly likely that it will
materially modify it. On the other hand, the prevention of dental
caries is entirely dependent on a correct pathology. At present the
principles of preventive dentistry are based almost entirely on the
dietetic factor in caries. Dr. Sim Wallace allows no significance to
the structure of the dental tissues. Yet, considered theoretically, it is
obvious that since the carbohydrate pabulum and the bacteria which
can turn it into lactic acid are the two necessary elements in the pro-
duction of dental caries, its incidence might be lessened by dealing
with the bacterial factor as well as by attempting to eliminate corbo-
hydrate stagnation. If there were many organisms in the mouth
capable of causing acid formation, then the possibility of influencing
the incidence of the disease by altering the mouth flora might not be
feasible, but if there are only one or two organisms possessing this power,
then such a method of attack on dental caries might be conceivable.
At any rate the possibility of enlisting another weapon in the cam-
paign against dental caries should be borne in mind. It must also be
remembered that the further studv of these acid-forming organisms,
with reference to the conditions which favour or inhibit their growth,
and whether all forms of carbohydrate food are equally fermentable
by them, may have a repercussive effect on knowledge of foodstuffs
in their relation to dental caries, and so enable us to formulate the
principles of prevention with greater surety. We look forward with
interest to further instalments of a piece of research which offers many
and valuable possibilities. — Editorial in the Lancet.
n
ig
THE COMPENDIUM
This Department is Edited by
THOMAS COWUNG, D.D.S., Toronto
A SYNOPSIS OF CURRENT LITERATURE RELATING
TO THE SCIENCE AND PRACTICE OF DENTISTRY
The Proper Treatment of Enamel.
THAT we do not fully appreciate the true character of tooth
enamel, and consequently do it much injury in many of our
prophylactic operations, is the claim set forth by Dr. J. P.
Carmichael, who writes regarding this matter in the "Dental Sum-
mary.*'
Having once scratched the enamel, it is most difficult to remove
these scratches and restore the natural brilliancy. The same sub-
stances that scratch enamel will scratch glass; for instance, try pumice
stone on a pane of glass, and notice the effect — it scratches the sur-
face, just as it does the enamel. Powdered pumice stone, no matter
how finely powdered, will wear the enamel surface. It destroys the
natural brilliancy of the enamel. When the tooth is dry, the ill
effects of the pumice may be readily observed. Not only has the
lustre and brilliancy been destroyed, but the porosity of the tooth
texture has been opened, and the enamel made susceptible to stains
and the adhesion of foreign matter. Some dentifrices cause like
results because they contain powdered pumice stone.
Tooth texture possesses a quality of viscosity making it capable
of being drawn, an effect similar to the burnishing of metal. Hiis is
often noticeable on the occluding surfaces of teeth where the enamel
is worn away. The dentine will be found to be, oftentimes, as hard
as the enamel itself, a result of the friction in masticating at the
occluding surfaces whereby nature demonstrates that to polish and
harden the enamel properly, friction is required. To polish the
enamel of teeth, the important thing to remember is that the powder
must be one that does not scratch the surface. A friction polish
which possesses a definite quality of resistance for burnishing the
surface is required. Obviously such a substance will be effective
only when applied dry. It will restore the natural, sparkling briU
liancy to enamel, even after it has been dulled or scratched by
pumice or other harmful agents.
ORAL HEALTH
EDITOR:
WALLACE SECCOMBE, D.D.S., F.A.C.D., Toronto, Ont.
CONTRIBUTING EDITORS:
C. N. JOHNSON, M.A., D.D .S.. F.A.C.D., Chicago.
RICHARD G. Mclaughlin, D.D.S., Toronto.
W. E. CUMMER, D.D.S., Toronto.
J. WRIGHT BEACH, D.D.S., Buffalo, N.Y.
Entered as Second-class Matter at the Post Office, Toronto.
Subscription Price, Canada and United States, two dollars per annum,
elsewhere three dollars. Single Copies, 25c.
0
Original Communications, Boole Reviews, Exchanges, Society Reports, Personal Items, and other
Correspondence should be addressed to the Editor, Oral Health, 102 Wells Hill Ave., Toronto, Canada.
Subscriptions and all business Communications should be addressed to The Publishers Oral Health,
Royal Bank Building, 269 College St., Toronto, Canada.
Vol. XII.
TORONTO, OCTOBER, 1922
No. 10
H EDITOR.IAIJ H
Rotary and School Dental Clinics
Appointment of Provincial Dental Officer Essential
TO Plan.
ROTARY Clubs the world over have been asked by the Inter-
national Boys' Work Committee to adopt an active Boys*
Work Programme for the year 1 922-23.
This programme includes plans for a greater public interest in School
affairs and more active co-operation between Rotarians and Boards
of Education, School authorities and School teachers.
The **Back-to-School" campaign is to be more vigorously carried
on, and each community will be urged to make better provision for
supervised playgrounds, gymnasia, swimming pools, and summer
camps, for recreational and athletic activities.
Members of the Dental Profession will be glad to learn that Rotary
is also to encourage each community, through its School Board, to
provide Dental Clinics in connection with the Schools.
The early appointment of a Provincial Dental Officer in each
Province of Canada is absolutely neecessary if the work in the several
municipalities is to be carried on in the most efficient way. A Provin-
cial Officer is necessary if the Clinics are to co-operate with one
another and adopt a uniform system of records, which is so essential
if a provincial organization is to be the result.
374 ORAL HEALTH
Rotary is to be commended for its forward step in relation to
School Dental Clinics. It remains for the Government in each
Province to appoint a Dental Officer to devote his entire time to
assist in the organization of local School Dental Clinics, encouraging
co-operation among the clinics and installing a uniform system of
records, so that Provincial Statistics will be available covering the
needs of the work and recording the progress made from year to year
in meeting these needs.
This is real Community Health Service, which every Dentist will
be found to support, even though its adoption may temporarily cause
readjustments in his own private practice.
American Institute of Dental Teachers
THE Thirtieth Annual Meeting of the American Institute of
Dental Teachers, will be held at Creighton University, Omaha,
Nebraska, Hotel Fontenelle headquarters, January 22, 23, 24
and 25, 1923.
A cordial invitation is extended to all persons interested in dental
teaching.
A. H. HIPPLE, President.
ABRAM HOFFMAN, Secretary.
281 Linwood Ave., Buffalo, N.Y.
Rubber Dam for Use in Fitting Porcelain Crowns. —
Apply rubber dam to three teeth, one on each side of tooth to be
crowned; but on the root to be crowned, force silk well under gum,
slightly under — labially, if preferred. Select tooth and grind to fit
and finish; no blood and no ragged gum to, perhaps, cause gingi-
vitis.— Dental Science.
To Secure Exact Occlusion. — For full sets of teeth it is often
difficult to get the occlusion exact and "flat.*' Some prosthetists
take emery flour and mix with oil. After remounting on the anatom-
ical occluding frame, they smear the grinding surfaces with this, then
work the sets, and gradually wear the occluding surfaces until they
close "flat." This is very tedious. Avoid this by smearing upon
these surfaces hydrofluoric acid, being careful to use fresh acid, and
only a little. Set the case aside for two or three hours. Now smear
with emery powder and oil, and the surfaces will easily wear down
to that very desirable solid and flat occlusion. This also removes
the glaze. The teeth will not dance or tip, other things being equal.
■ — Dental Facts.
Wr
m
SL
OPAL HEALTA
A JOURNAL THAT STANDS FOR THE ''OUNCE OF
PREVENTION,** AS WELL AS THE *♦ POUND OF CURE**
le
m
VOL. 12
TORONTO. NOVEMBER. 1Q22
No. 11
Malocclusion as a Factor in Deformity
By Tom Smith, D.D.S., Langdon, North Dakota.
THAT there is a definite plan in nature to develop to perfection
there can be no doubt. Every natural process has a definite
plan that is beautiful, if not interfered with. Let us take for
example the maple leaf. Every perfect maple leaf has a definite
geometric balance. There is no mistaking its proportions. When it
is perfect it is beautiful. When its development is interfered with by
sting of insect, lack of nutrition, or the unbalancing of nature's plans
from any cause, it loses its naturally beautiful proportions and becomes
ugly just to the same degree that it falls short of development to the
definite mathematical balance. This applies not only to leaf form
but also to leaf arrangement. As far back as 1878 Schwendener (6)
published "The Mechanical Theory of Leaf Arrangement," and
later Kerner and Oliver (2) discuss and prove that even the distribu-
tion of leaves on the circumference of the stem is entirely a mathemati-
cal arrangement.
This same idea may be followed throughout all nature. The study
of chemistry proves that nature is not haphazard, but absolutely
definite and balanced to the most minute detail of its finest sub-
divisions. In physics we find this same condition, and a fine example
is that of the crystals. In astronomy the balance is so perfect that the
appearance of comets may be foretold many years in advance and
to the accuracy of the fraction of a minute. In fact this great natural
law of balance is universal. The presence of a Great Divine Per-
sonality with a definite design back of all this is apparent. It is
evident that all things, including man, were created perfect. Our
Creator being perfect must of necessity have made perfect creations.
He is recognized by many as the Great Geometrician and rightly so
376 ORAL HEALTH
Through abuse or disregard of definite laws much deformity has been
caused, and it would appear that man has fallen from physical per-
fection to his present condition.
In all nature we find that if there is a lack of conformity to the
ideal or perfect the thing loses beauty and becomes ugly. All beauty
has a mathematical basis. The ideal or beautiful is attained by
function developing well-balanced geometric proportions. If function
is interfered with it must follow that development to the ideal will be
interfered with and there will be a consequent loss of balance and
beauty.
With the foregoing as a basis it is most logical to assume that there
is a definite plan in nature to develop perfect teeth with perfect
occlusion, in human beings, and that there will be a definite mathema-
tical plan underlying this whole development. If function is not
interfered with, not only the occlusion and teeth, but all of the masti-
^ 1
:
Illustration No. 1
eating apparatus and its associated structures, as well as the whole
cranium, will be developed to a symmetrical harmonious relationship
and upon a geometric plan. (4).
It was Dr. Bonwill (4) who gave us the first scientific dimensions
of which we can make practical use in the development of this theory,
that of the equilateral triangle of four inches from condyle to condyle,
and from the condyles to the mesio-incisal angle of the lower central
incisors. This triangle is not always equilateral for the reason that
function and development have not always been perfect.
Dr. Monson (4) has gone further and builds his principles of
occlusion upon a geometric basis of calculation which carries with it
absolute proof in every detail. This basis of his calculation is that of
the figure of a sphere of approximately eight inches. The radius of
this sphere is, of course, four inches.
The occluding surface of every tooth in the normal jaw will be
found to be tangent to the radial line of the long axis of each tooth.
One of our chief troubles is that we have been made to study detail
ORAL HEALTH
377
phases of anatomy of the teeth and of their deformities, and we have
neglected the study of the teeth and associated structures collectively.
The result has been that no matter how^ fine our detail operations of
repair have been they have not borne sufficient relationship to the
masticating mechanism as a whole.
The bony structure of the jaws and of the whole body is built up
Illustration No. 2
in accordance with the amount of stress the muscles place upon it. In
other words, the bony structure develops in proportion to muscle
function. "Food and function equal force and form." (4). Food is
the determining factor of function. Proper development of the ideal
in the face and cranium must come through proper food and function.
We will now look over a number of illustrations of two skulls and
I believe the study of these will prove the correctness of the foregoing
statements. The first group of these illustrations is made from various
bones of a disarticulated skull I obtained in Chicago in 191 L Figure
1 is an upper view of this mandible. This is as perfect a mandible
and dentition as one may find. You will observe the Bonwill triangle
is equilateral, each of its three sides being four and one-eighth inches
or i 05 mm. These measurements were taken from the centre of the
Illustration No. 3
378 ORAL HEALTH
condyle head as that is the rotation point. Each of the sigmoid
notches is one and three-eighths inches or thirty-five mm. in width.
In fact the various measurements of this mandible show it to be almost
perfectly balanced. When this mandible is properly mounted upon
the correct instrument the fact is demonstrated that the centre of
applied force, or the centre of the sphere upon which this occlusion is
developed, is equidistant from each and every cusp and is also
equidistant from the centre of the condyle heads. In Figures 2, 3 and
4 the teeth of the maxillae are occluded to those of the mandible.
Figure 2 being a front view. Figure 3 a side view and Figure 4 an
upper view. It will be observed that the maxillae are developed to
the mandible and accurately balanced. Figure 5 is an inner view of
the two parietal bones, and here again we find accurate balance. In
Figure 6 there are four bones, all viewed from the inner side. Here
we have another aspect of the two parietal bones which again shows
their correct balance. The two upper bones are the occipital and
Illustration No. 4
frontal and their symmetry is perfect. In studying all of the bones
of this disarticulated skull it is truly wonderful to observe their balance
and beauty. This development is, of course, the result of proper
function, and proper function is impossible unleess all teeth are present
and in correct occlusion.
The second group of illustrations are made from a skull that I was
fortunate enough to find in Lincoln, Neb., last January. This skull
is very asymmetrical. The reason is apparent. The subject had lost
both lower left first and second molars and the third molar was erupted
in such an abnormal position that all molar function was lost on the
left side. In Figure 7 we view this mandible from above. It is very
patent that the loss of the left molar function resulted in all work being
forced upon the right side and consequently the development of the
mandible was greater on that side. Not only the mandible but the
maxilla and all of the cranial bones are much more developed on the
right than on the left side, as is apparent by these illustrations and
ORAL HEALTH
379
measurements. Referring to Figure 7 we find that the Bonwill
triangle is not equilateral but scalene. The base being 93 mm. or
three and eleven-sixteenths inches, the left side is 103 mm. or four
and two-sixteenths inches, and the right side measures 1 1 6 mm. or
four and nine-sixteenths inches. It is interesting to note that the left
sigmoid notch measures 29 mm. and the right sigmoid notch measures
Illustration No. 5
37 mm., making just about one -third of an inch difference. Figure 8
is a front view of this skull and plainly shows the excessive develop-
ment on the right side. Figure 9 is a view of the base of the cranium.
Here again we find the development stronger on the right side than on
the left, and especially in the zygoma. Figure 10 illustrates the
cranium from above. Measuring from the medial line we find the
greatest left lateral width to be 63 mm. or two and one-half inches,
and the greatest right lateral width to be 80 mm. or three and one-
eighth inches. The circumference of the skull is nineteen and three-
quarter inches, the right side being ten and one-quarter inches and the
left side nine and one-half inches. After studying these measure-
ments and illustrations carefully, what more convincing arguments may
we present for proof of tlve statement, "Food and function equal force
and form." (4) ?
Allow me to again quote from Dr. Monson (4), "For the purpose
Illustration No. 6
380
ORAL HEALTH
of study it is necessary to obtain as perfect a skull as possible, one
having a complete set of natural teeth. I advise a subject that has
lived tc the age of thirty or thirty-five years, as one of this age would
be more likely to have facets vs^orn on all of the teeth denoting full
function of mastication. (Such a one is illustrated in the first group
of slides. Figures I to 6). An individual having lost teeth on one side
of his mandible would naturally have an excessive function on the
opposite side, and in this manner, both muscular and osseous structures
are excessively developed, throwing the mandible to one side." (This
is the case in the group of illustrations of the second skull. Figures
7 to 10).
Keep in mind that in the ideal, the long axis of every tooth points
to a common centre, which is the centre of the sphere upon which the
occlusion is developed. The greatest crushing surface, the occlusion, is
at right angles to the long axis of the teeth (4). It must follow that
the total action of the muscles converges to this same common centre.
Illustration No. 7
This group of muscles demonstrates the physical law that to every
action there is an equal and opposite reaction. The radial pomt of
this sphere must be the centre of applied force as all of the teeth
converge to it.
The third group of illustrations consists of the eight following slides
and are from photographs of the mandible and maxillae of the ideal
skull mounted upon the Mandibulo-Maxillary instrument. These are
so mounted for the purpose of showing the conformity of the teeth
and their supporting structures to the figure of a segment of a sphere.
These and all other illustrations and drawings used in this paper were
made under the direction of Dr. L. L. Eckman of the Monson Re-
search and Clinic Club and have been copyrighted for the Club and
are here used for the first time.
Figue 1 1 shows the mounted mandible in perspective and its rela-
tion to the condyle cord. Figure 1 2 shows the general conformity of
ORAL HEALTH
38
the spherical pyramid from periphery or occlusion to the vertex. Figure
I 3 illustrates the three-sided pyramid with the Bonwill triangle as the
base. The angles of the Bonwill triangle are on the periphery of the
sphere and are all equal. The angles at the vertex are in the centre
of the sphere and are equal to those of the Bonwill triangle. In
Figure 1 4 note the general conformity of the bones forming the crush-
Xllustration No. S
ing base. Figure 1 5 is a segment of a sphere. Note the conformity
of the cusps and condyles to the base of the spherical pyramid. Figure
16 shows a front view of a pyramid with the Bonwill triangle as its
base. The dotted line is from condyle to condyle the same as in
Figure 1 3, but taken at a different angle. In Figure 1 7 we see the
long axis of the teeth touching at the common centre. Figure 18 is
similar to Figure 15, but with the superior maxillary bones or crushing
base in proper relation to the mandible in centric occlusion. Note the
general pitch of the teeth, from a side view, pointing to the centre of
the sphere. The large circle is in the median line of the skull. The free
end of the upper dotted curved line passes through the condyle head,
consequently this point is two inches closer to you and hence appears
higher on the sphere.
!*.
riiustration Xo. 9
382
ORAL HEALTH
It is well to remember that the Bonwill triangle is not always an
equilateral triangle of four inches. However, if the occlusion is devel-
oped upon an eighth-inch sphere, whether the triangle be equilateral,
or not, the sum of the three sides will be twelve inches. In other words,
the sum of the three sides of the Bonwill triangle, whether it be
equilateral, isosceles, or scalene, divided by three is equal to the
radius of the sphere upon which the occlusion is developed. The great
majority of cases will have a four-inch radius although I have one
patient with a radius of a trifle over four and one-fourth inches.
The technic of transferring the facial dimensions is very accurate
and the check bites prove or disprove its correctness so that any mis-
take may be easily detected and corrected.
The foregoing principles of occlusion I have gleaned from Dr.
Monson, either from his writings or from personal conversation. While
Illusti-ation No. 10
they are more or less expressed in my own language and with my own
illustrations the principles are entirely his.
It is doubtless true that faulty occlusion is more productive of
diseases of the mouth and teeth than is any other one factor. There
is a growing opinion that the members of the dental profession are
more responsible for the prevalance of faulty occlusion in patients*
mouths than is any other single cause. Link these two facts together
and we see plainly that our profession has a very significant condition
facing it. We may well ask the question. How long do we intend to
trifle with this important problem of occlusion?
If we give this problem a fair degree of thought and study we
must admit that, unintentionally, we have been wrecking many
occlusions by our operations of a restorative nature. This may prove
to be the case even in the restoration of a single cusp. We have also
been allowing a great many faulty occlusions to escape our notice
when it has been or should have been our duty to direct the attention
ORAL HEALTH
383
of our patients to the condition. The difficulty has been a lack of
knowledge rather than one of intentional neglect. It is our duty to
make a careful study of the occlusion of every patient who presents
for examination, just as much as it is our duty to examine the mouth
carefully for dental periclasia. When the occlusion is found to be
faulty we should direct our patients' attention to it and to the numerous
Illustration No. 11
disorders which may be attendant upon it just the same as we do
when we find a condition of periclasia present. The patient has
this service due him and it ought to be a criminal offence if we fail to
inform our patients of these facts, if we are aware of them.
It is a fact that each cusp has a definite relationship to each of
the other cusps in both arches and to the masticating apparatus as
a whole. This should make us pause and consider the necessity for
checking up the occlusion before any restorative operation is initiated.
We should also observe the proper methods of correcting and main-
taining the occlusion during these operations so that a harmonious
result may be obtained and a real benefit rendered our patients. When
an operation involving even a part of an occlusal surface of a tooth
is contemplated the operator should not only have a definite under-
Illustration No. 12
384 ORAL HEALTH
standing of the basic principles of occlusion but he should incorporate
those principles into the operation.
There is considerable confusion in the use of the term "occlusion,"
or I should say in the way it is used. One would very naturally
think that the term "normal occlusion" referred to a perfect occlusion,
for that is the inference. However the term "normal occlusion" is
applied to the teeth when in centric occlusion. It must be remembered
that teeth may be in normal occlusion when in centric position and
that these same teeth, in function, may show considerable obstruction
to functional range. In other words, a patient may have a so-called
normal occlusion and still have a decided closure of the bite involving
the loss of facial dimensions and also in function there may be a very
decided case of traumatic occlusion owing to the fact that a cuspal
interference exists.
Study Casts.
It is becoming more apparent to many of us that study casts and
Illustration No. 13
mouth surveys should be made of all our cases as a preliminary step
to the actual operation. We have an instrument now which will permit
us to mount our casts in such a way that they will accurately repro-
duce every movement of the jaws from which these casts were made.
With this advantage we are surely no longer in a position where we
can afford to neglect this most important phase of dentistry. This
procedure may seem slow and awkward at first, but with practice in
the technic the slowness disappears, and the awkwardness develops
into a definite skill which affords wonderful opportunities to study the
functional relationship of the units of mastication. The fact that
study casts, where properly obtained and correctly mounted, repre-
sent the position of each tooth when at rest as it is held or hangs in
the arches when the mouth is open, places this technic in a class by
itself.
It is claimed that even under normal conditions the teeth will
depress into their sockets one-fiftieth of an inch under the force of
ORAL HEALTH 385
mastication (1). They will shift in their positions more readily
under occlusion, either in centric position or in functional range, when
trauma exists in the periodontium and especially if a loss of fixation
obtains in any of the units (8). This very condition is one of the
important factors which makes it impossible to diagnose the occlusion
by clinical observation. The reverse condition is found with mounted
Illustration No. 14
casts for here we have a rigidity existing both in the plaster teeth and
the instrument upon which they are mounted, permitting easy detec-
tion of cuspal interference to functional range. This not only assists in
making the diagnosis of the occlusion more simple but allows of a
more ready and accurate correction. In fact the whole scheme of
mount casts is vastly superior to that of clinical observations. It
allows of a full outer view or a full lingual view at one time and
permits of a better opportunity to study the occlusion as well as giving
us very fine records of the case.
Various Cases.
Let us review some of the cases which are frequently coming under
the observation of the dentist. In the case of a patient seeking our
services in the restoration of a single occlusal surface or a part of an
Illustral ion Xo. 15
386 ORAL HEALTH
occlusal surface, are we going to bear in mind the many details of a
very fine operation with the exception of the most important? Are w^
going to complete this operation so that in centric position its occlusion
appears perfect while in functional range it will cause trauma to the
supporting structures or periodontium and eventually break these
structures down or cause irreparable injury? This condition is well
illustrated in a case from my own practice, where a very shallow
mesio-occlusal filling had been placed in an upper second bicuspid.
The case came to my notice about one year after the operation had
been made. The operation was good in every detail except the
main factor of occlusion. During that year the tooth had lengthened,
owing to lack of occlusion, and when it came into occlusion the
wrong plane was established with the result that it came under Class
3 of force application (7) and a wedging process was instituted with
the gliding of one plane past the other, forcing the tooth to one side
Illustration No. 16
of its socket. The radiograph discloses a narrow rarefied area in the
process between the roots of these approximating teeth, and also a
slight thickening of the peridental membrane. The tooth had lost its
fixation to a very marked degree and it was only a matter of a few-
more months until it would have been necessary to remove it. Thij;
particular case is not uncommon but it is infrequently noticed. It not
only limited the range of occlusion, but had a marked tendency to
lessen the functional activity of the mouth, and particularly that im-
portant function of swallowing, for the tooth had developed, along
with the definite loss of fixation, a considerable tenderness to occlusal
pressure. This was aggravated both by the positive and negative
pressures applied in the act of swallowing, so that this function
became of no importance as far as the drainage of the mouth and
Eustachian tubes was concerned. After the occlusion had been
corrected the patient was taught to swallow properly again and
also instructed as to some of the purposes of that function. Without
further instruction or care the soft tissues of this mouth have improved
ORAL HEALTH 387
wonderfully. I may add that the looseness of this tooth was not alto-
gether caused by the gliding of one inclined plane past another; but
due to the lengthening of the tooth both the buccal and lingual cusps
had become points of obstruction to either right or left lateral range.
In reconstruction work such as bridges and partial dentures the
tendency to traumatic occlusion is even more marked, for the reason
that more occlusal surfaces are being restored and there is, propor-
tionately, more opportunity of faulty occlusion. It is interesting to
make full study casts of all mouths in which we find what might be
termed excellent bridge work. Then properly mount these casts upon
the instrument and study the occlusion. It will be found that in the
majority of these cases, while they may be in normal occulsion in
centric position, there will be prominent obstructions to occlusal range
or a lack of occlusion altogether. There is usually more or less
Illustration No. 17
obstruction. These high points cause trauma to the supporting struc-
tures of the abutment teeth, and in time the whole operation is a
partial or complete failure. Is it any wonder that the fixed bridge
has come in for so much adverse criticism and ridicule? The trouble
is not that good strong abutments will not stand up under proper
occlusion, but that they will not stand up under the beatings of
traumatic occlusion carried down to them from the bridge. Are we
to continue this practice of making bridge-work, operations upon very
small segments and without regard to functional activity, or are we
going to perform operations on our patients, taking into consideration
the fact that a bridge is not made to fill a very small space in one arch,
but that it is to restore functional activity to the whole mouth and
associated structure? Most of us have been guilty of focusing our
attention upon the unit instead of the masticating apparatus as a
whole.
Dr. Arthur P. Little (3) has very ably put the case in the follow-
388 ORAL HEALTH
ing statement: "We find that since the time of the early Egyptians
we have been filling spaces in the dental arches with a total disregard
for the fundamental principles which go to make up successful recon-
struction work. If our reconstruction work is to reach a higher type
of efficiency we must consider thoughts which are essential. As I
look back upon my own partial denture work I can readily see that
my greatest fault was that of narrow vision. The natural result was
that I saw in every mutilated mouth an opportunity to make a
denture This was generally considered an end in itself. Instead of
seeing the mouth as a whole, instead of realizing the importance of
the correct anatomical relationship of the dental arches, instead of
recognizing the physiological functions of the mouth, I saw only an
empty space which a partial denture could close. I had no idea of
occlusion. In other words I saw only a small fraction of the situa-
tion ; I could not recognize the more important possibilities that present
themselves in reconstruction work."
Again, our patients seek full dentures. Are we going to maintain
Illustration No. 18
the old standard of opening the bite to the hp lines and arranging
the teeth on this same faulty standard? Are we to arrange the
occlusion upon unnatural planes and then proceed to the technical
part of the operation in the most approved manner? It is doubtless
true that the majority of full dentures close the patient's bite at least
three-eighths of an inch. Many of the partial dentures have the
same tendency, but not to such a marked degree. It has been shown
us that this closure of the bite leads to endless troubles for the patient
(5), troubles such as faulty drainage of the mouth and of Eustachian
tubes; lessened muscular activity, for the closure of the bite shortens
the distance between the origin and insertion of these muscles, and
there is a consequent diminution in the tone of the muscles and in the
muscle pull; encroachment of the head of the condyle upon or into
the external auditory meatus resulting in the majority of cases in
partial deafness and in a few to complete loss of hearing. This con-
ORAL HEALTH 389
dition also crowds the inside of the mouth. The tongue is crowded
back and thereby impairs not only its own function, but also the
function of the adjacent parts. Many cases of throat trouble and
nervousness and doubtless some forms of goitre are caused by the
unnatural position these soft parts are forced to assume through
closure of the bite.
Thirty-Eight Cases of Defective Hearing.
I wish to present some very valuable data with which Dr. Monson
has furnished me. Thirty-eight cases of defective hearing were re-
viewed. Of these thirty-eight cases eighteen were using full dentures
when presented. In all of these the facial dimensions were short of
normal and in 80 per cent, they were very short. After new dentures
were constructed there was an improvement in the hearing of each
case. In some the improvement was marked and a few regained
normal hearing. In every case the facial dimensions were restored to
normal in the construction of the new dentures. Of the remaining
twenty cases all had bridges or partial denture restorations of some
kind. All were short on facial dimensions and all showed improve-
ment in hearing after having had their teeth removed and full
dentures substituted which restored or built up the face to its proper
dimensions. The cause of these cases of defective hearing was the
encroachment of the head of the condyle upon or into the external
auditory meatus or by a lessened patency of the Eustachian tubes
due to crowding.
This is only a very small part of the data which has been gathered
on this subject. I give this small portion merely to cite some specific
cases so that the conditions may be more thoroughly brought to your
attention.
Definite Working Plans.
It is exceedingly odd that while we all recognize the masticating
apparatus in its normal state as such a beautiful and well-balanced
machine, we should not consider it as a whole when operating
upon it and cease to do piecemeal work. An architect or an engineer
always has a definite plan to follow in any construction work. They
must know the part each unit is to play in respect to every other unit
and to the whole. Why should not we, as dentists, follow this same
course? Our properly mounted study casts must, of necessity, be the
working basis. Upon these casts we must plan our operations and
upon these or similar casts we should complete our operations.
Conclusion.
I cannot conclude this paper without again calling your attention
to the fact that the big problem which is confronting our profession
to-day is that of OCCLUSION. It looks exceedingly large because
390 ORAL HEALTH
of the fact that it has been so grossly neglected. What are we going
to do? Our patients come to us for service. Are we going to sow
destruction in their mouths? We cannot continue the old practice
much longer. We cannot relegate it to the specialist for it enters into
and is a basic principle of all of our operations. There never was a
larger opportunity in the whole field of dentistry than that which the
problem of occlusion is offering us to-day. It enters into and is
dominant in every branch of reconstruction work. Is it too much to
suggest that we study it and apply our knowledge to our every-day
work? I believe we cannot do less.
BIBLIOGRAPHY.
1. Hartzell, Thomas B., and Henrici, Arthur T. "The Dental Path: Its
Importance as an Avenue to Infection," Surgery, Gynecology and Obstetrics,
January, 1916.
2. Kerner and Oliver. "Natural History of Plants."
3. Little, Arthur P. "Filling Spaces or Building for Efficiency." Read
before West Central Minnesota District Dental Society, July, 1921
4. Monson, George S. "Occlusion as Applied to Crown and Bridge Work,"
Jour. Nat. Dental Assoc, May, 1920.
5. . "Impaired Function as Result of Closed Bite," Jour. Nat. Dental
Assoc, October, 1921,
6. Schwendener. "Mechanical Theory of Leaf Arrangement," Berlin, 1878.
7. Stillman, Paul R. "Traumatic Occlusion," Jour. Nat. Dental Assoc,
August, 1919.
8. Smith, Tom. "Traumatic Occlusion and Its Correction in the Treatment
of Pyorrhea Alveolaris," Jour. Nat. Dental Assoc, December, 1922.
President's Address, Ontario Dental Society,
May, 1922
F. Percy Moore, D.D.S., Hamilton.
IT is a privilege to address you at the conclusion of my year of office
as President of the Ontario Dental Society. I desire to express
on behalf of the Ontario Society our deep feeling of gratitude to
the Canadian Association and to our distinguished Colleague, who as
President of the CD. A. has just addressed you, and to the members
of the Dental Profession representing every part of our broad Do-
minion, who have encouraged us by their attendance at this joint
Convention. I say on behalf of myself and my fellow-officers
"WELCOME."
Our profession in common with others, and following the general
trend of business, has experienced a very trying condition of affairs
during the past few years. This is largely due to he uncertain finan-
cial and economic conditions existing, not only in this country, but
throughout the world. But I am glad to say that we in Canada feel
that matters have made a definite improvement of late, — that broadly
speaking "Business is better, not very much better, but better." We
may now look forward with confidence to a gradual, but very real,
improvement, and an early return to those normal conditions which
are so essential to the progress and welfare of the people.
But we must all do our part in connection with our own profession.
ORAL HEALTH 391
to bring about the results so devoutly to be wished. The problem of
our profession is a National one, and a comprehensive National
scheme is required to cope with the present Dental situation. A begin-
ning has been made, which at least is a recognition of the existence of
the problem, and of its menace to Public Health.
It is not my intention to outline any special scheme, but it is well
that we should consider the problem of the prevention of dental
disease from three important standpoints: —
1st. — The need for a widespread recognition of the fact that dental
disease is a harmful thing, and along with this a knowledge of the
ways in which teeth are destroyed, and the means by which they may
be kept healthy; and to spread widely this information that through
the knowledge of the parent, the child may be relieved of dental
disease.
2nd. — The further extension and systematization of school dental
inspection and treatment, including children of pre-school age.
3rd. — Adequate remedial dental treatment brought within the
reach of all, and a standardization of methods that will bring results
and a greater confidence in the claim of our profession to be a neces-
sary adjunct to Public Health needs.
Much has been done in Canada in the matter of the Public educa-
tional feature. The ever increasing number of school clinics, the
provision of clinics in Sanatoria, Hospitals and Industries, and the
remarkable statistical records available in consequence, are some of
the more definite good results.
Without desiring in any way to reflect on the many splendid work-
ers in the Cause of Health generally, may I suggest, that very careful
attention be given to the effects on the enthusiasm of the workers, (and
naturally on the results of their work) if in the extension of dental
service, the workers be hampered by the sometimes well meaning, but
unpractical, restrictions which may result from the placing of such
clinics under the direct control or authority of one who is not a dentist.
It is admitted that there is need for executive control, but in the well
meant zeal of many Departments of Health, the desirability of per-
mitting to the Services composing it, the necessary autonomy to en-
courage them to give their best effort and to progress along what they
know to be the proper lines, is too often overlooked.
In this connection it is sufficient for my point to remind you, that
until the Canadian Army Dental Corps became a distinct unit of the
C.E.F., it was an ineffective body. Had that recognition not been
conceded, and its members encouraged by the consequent latitude
afforded through a trained directing head, the story of the C.A.D.C.
would not have been the glorious page that it is in the annals of the
Canadian Expeditionary Forces.
Unfortunately our Profession, in common with others, suffered
greatly through the War. One of the serious difficulties that arose
392 ORALHEALTH
was the inability of that splendid body, the Ontario Oral Hygiene
Committee, to meet the Public requests for practitioners for private
practice and for school Dental service, owing to the absence of so
many men serving in the Dental Corps, and by reason, too, of the
gradually increasing demand upon those remaining, for dental service
among the civilian population.
More recently there has been a very altered situation in our pro-
fession. With the lessened demand for dental service, the inability of
many to pay for that service, and the re-establishment in private
practice of those of the Dental Corps discharged from military service,
it now becomes very necessary in the public interest that the Oral
Hygiene Committee of our Association should again take up their
great work of educating public bodies in the need of good teeth and
the relationship between good teeth and good health. Our brethren
across the line are doing a good deal in this way, aided considerably
by the Department of Education of some of the larger cities, and by at
least one of the great Insurance Companies. May I suggest that by
means of bulletins, public lectures, and through the ever available
generosity of the press, this work should be energetically carried on,
stressing particularly the acknowledged fact that the real work of the
Dental Surgeon today is the Prevention of Dental Disease. To
accomplish this it is necessary to take the public into our fullest confi-
dence. To a very great extent it is in the hands of parents to ensure
for their children that most proceless boon, "a sound set of teeth,"
without which children cannot hope to have that physical condition
which will permit them to compete successfully in the various walks of
life.
Health problems are everywhere being discussed, and everywhere
there is an inclination to listen, and to lend aid where but a few years
ago no encouragement whatever was available. Undoubtedly there
are now more who know that —
"It so falls out
That what we have we prize
Not to the worth
Whiles we enoy it, but being lacked and lost
Why then we ken its value."
Undoubtedly the war, notwithstanding its ill effects, has furnished
some measure of compensation in the spreading of a knowledge of
dental conditions, their effects on the system and the possibilities of
remedy. In the records of the Canadian Army Dental Corps can be
read the unhappy story of neglect of the teeth and the serious conse-
quences therefrom. And in the records of the work done by that
splendid corps can also be read a growing public appreciation of our
profession, greater co-operation between the professions of Medicine
and Dentistry and a spreading of the knowledge of Oral Hygiene by
those who have been helped.
ORAL HEALTH 393
Undoubtedly the work of the C.A.D.C., and the knowledge of that
work made known throughout Canada, has focused the attention of
the people of the Dominion upon the dental profession to an extent,
which could not have been accomplished to the same extent without
the unfortunate opportunities of the dreadful occasion. This was the
great contribution made by those who served in the C.A.D.C., and
the knowledge of that, may to some extent, in the great Law of Com-
pensation, be taken as a fitting memorial to those of our profession who
died in the great cause.
" They shall not grov/ old as we who are left grow old.
Age shall not weary, nor the years condemn;
At the going down of the sun, and in the morning,
We shall remember them.'*
It will be your good fortune today to hear from one of our Col-
leagues, whose part in the work of the war has been outstanding and
whose name will be associated with the Dentistry of the war, as long
as the history of Dentistry in Canada shall endure.
I am glad to be able to assure you, gentlemen, of the continued
advance in research work on behalf of our profession. The establish-
ment of schools for graduate studies, and the financial assistance
accorded all works of research, not only by Governments, but by great
Industrial and Financial Bodies, is most encouraging. It is undoubt-
edly upon the results of research that we must depend for the
furtherance of the knowledge necessary to keep pace with the growing
requirements of our own as well as all other professions.
It is not generally understood how far-reaching the effects of scien-
tific investigations may be upon the average person. It seems a far cry
from the accurate measurement of length to the development of an
improved dental amalgam; yet this is just what has occurred in
connection with some of the recent work of the United States Bureau
of Standards which found it desirable to determine the ingredients,
which would make up the best quality of amalgam filling, having in
mind the possibility of coefficients of expansion differing widely from
that of the tooth substance. The results of this Bureau's work have
been embodied in a formula which was made part of the specifica-
tions for this material, of the War Department of the U.S.A. This is
but another evidence of the growing need for Standardization of
methods.
The Canadian Dental Research Foundation, the Official Research
body of the Profession, will report much success during the year.
Organized as it is, in a most democratic fashion, (its Directors con-
sisting of two representatives of each Provincial Dental Board in
Canada, and two representatives of the Canadian Dental Associa-
tion) it has a great work to do. Its effort extends over a wide scope
394 ORAL HEALTH
of operations and it has a flexible executive capable of adjusting itself
to all circumstances.
I ask of you that you subscribe generously to this splendid work,
and that by your encouragement of those directing it, you may place
it upon a strong and lasting basis. This will bring to those responsible
for its formation the grateful appreciation of the many who are to
follow us. To make true progress in the future we must take the past
with us for reference and as a guide. We cannot begin from today.
The outlook must be backwards as well as forwards, if past error is
to be avoided. Retrospect is undoubtedly valuable. To know what
is and has been permits us to rightly understand what ma^ fee, and this
is a basis for research. We owe much to those pioneers of our profes-
sion, who so long laboured in an unappreciative age, more or less
misunderstood, but who have made more easy the way for us, their
disciples. It is for us to further improve our profession by the discipline
and standardization of our studies, by the extension of the period of
undergraduate study and by improved standards of requirements for
practice. It is only in this way that we can ensure to the public the
service of qualified men.
We may, I think, feel justly proud of the continued development of
the Royal College of Dental Surgeons. The College has fully con-
sidered all of the foregoing, has been responsible for the lengthening of
the course of dentistry to five years, and has also recognized its own
responsibility towards its graduates. The need for post graduate
service exists now as never before. The proper organization of this
work will bring about the desirable result of placing in the various dis-
tricts of Ontario, where the need exists, trained graduates with a field
available for the exercise of their talents, and with a recognition of
their duty towards their college and society in general.
We have steadily progressed from the early days of John Hunter,
the founder of the English School, (when the subject of dentistry was
treated philosophically rather than practically) and from the year
1803 when it would appear that the practice of making teeth and
cleaning them was in the hands of silversmiths or jewellers. It was
only in 1 855 that the National Convention of Dentists was organized
and the first annual meeting held in Philadelphia; and it is only within
a bare century that dentistry has taken the rank of a distinct pro-
fession. And yet we must remember that the Ancient Egyptians
understood phases of the art, (commonly regarded only as inventions
of modern times) if we are to believe the evidence of the ancient tombs
of the Egyptians showing artificial teeth of ivory or wood and some
fastened on gold plates. And we must continue to progress, and by
your intelHgent co-operation we in Canada will at least equal the
highest standards of the world.
The programme of this joint Convention is a most comprehensive
and extensive one, reflecting much credit on those responsible for its
ORAL HEALTH 393
preparation. Very great care has been exercised in the matter o?
permitting members who expressed a desire, to select those clinics,
which most appeal to them, with proper provision for their attendance
accordingly. The character and ability of those in charge needs no
comment on my part, and I am proud indeed, at the conclusion of my
term of office to be able to present to you, — a combined membership
of the Canadian and Ontario Societies, — such a splendid opportunity
for furthering the knowledge possessed by the leaders of our profession,
who are to be with us during the next four days. I am sure that the
results of this Convention will prove most stimulating. The knowledge
acquired, the friendships renewed and made, and the publicity which
will come from it, can but reflect their force in years to come in the
character, quality and result of all our work.
It has been a great pleasure to have worked with my Executive
during the year and to have had some part in the work of the Con-
vention Committees. I cannot close without expressing my sincere
appreciation of the spirit of unselfishness and desire to serve, that has
marked all our meetings, and I am sure that the result of the Conven-
tion will have justified your Committee's ambition that this be the
greatest convention that our profession has ever been privileged to
attend.
I desire to thank His Honour the Lieutenant-Governor, and our
good friend, the Mayor of Toronto, for their cordial words of welcome
and to assure them that we, as a body, heartily congratulate both of
them on having attained to the distinguished offices which they are now
filling with such marked ability.
Somnoform, a Valuable Aid in Dentistry
By Edmund A. Grant, D.D.S.,
Royal College of Dental Surgeons of Ontario.
Director, Dental Services, Department of Public Health, Toronto
PEOPLE to-day are demanding more and more, relief from even
the slight pain of dental operations. Whether it is the speed
of modern life, the motor car, jazz, the movies or what you will,
nerve fibres refuse to stand the strain. Our patients still regale us
with tales of their grandmother or some other relative who had
"seventeen teeth out all at once and never took anything" and in the
same breath insist on a general anaesthetic for the removal of a loose
tooth, even throwing strong hints that they are in dire need of stimula-
tion from a bottle, which they suspect a dentist can give them with-
out incurring danger of committing B.O.T.A. No doubt we have
all noticed the increasing number of patients who seem to be in a
bad way after such operations, but there is little cause for worry,
most of them are just looking for a little "touch."
396 ORAL HEALTH
Conduction Anaesthesia has made great strides recently, due to
improvement in the technic and local anaesthetic agents, but there are
some areas of the mouth difficult to control by this means, on account
of the numerous anastomosing nerve branches, and the uncertainty of
reaching exactly the foramen or other location where the solution is
to be deposited, so that successful anaesthesia is not always assured.
While the specialist who is busy giving courses may tell us they are
all easy, I venture to say that the average practitioner is confining
himself to a few injections which his experience tells him can be
counted on to give fairly uniform results. Occasionally cases will
be encountered that seem to be immune to the action of the drug or
have an idiosyncrasy which forbids its use. Others again are so
hypersensitive that they cannot force themselves to submit to an
operation while conscious, no matter how painless it may be. It
will therefore be seen that there is a large place in dentistry for
general anaesthetics.
While nitrous oxide and oxygen is admittedly the safest gen-
eral anaesthetic, it is the most difficult of all to administer, also its high
mitial cost and expensive upkeep are factors which interfere with its
more general use. The writer believes that next to N2O and O, Sora-
noform is the most suitable general anaesthetic for many dental opera-
tions and would make a plea for its use in offices not equipped with
the other. Our license gives us the right to administer general anaes-
thetics and it becomes therefore a duty to make ourselves proficient.
Proficiency can only be gained by frequent administrations and the
young graduate just starting in practice would experience little
difficulty by commencing with Somnoform. He would learn many
things about general anaesthesia, signs of the different stages, to recog-
nize deep anaesthesia or distress signals, the management of the
patient during anaesthesia, the operating period and during recovery,
to operate rapidly under the special conditions, the reaction of
different types of people to general anaesthetics, etc. This experience
would be most valuable, if he should wish later on to employ any
other agent, as the general principles are much the same.
Somnoform was first introduced by Dr. G. Rolland of Bordeaux,
France, in 1899. Dr. Rolland was Prof, of Anaesthesia in the
Dental School there, and not being satisfied with the anaesthetics
then in use, carried on experiments with various mixtures for about
four years in an endeavor to find a mixture which would measure up
to the requirements he laid down for an ideal anaesthetic; which
would "enter into, sojourn in, and make its exit from the organism in
the same manner as oxygen does*'; further, that the tension of the
agent should be greater than that of oxygen in order that it might
replace oxygen in the alveoli of the lungs, and as the degree of vola-
tility of a gas determines its pressure, the more volatile, the more
easily it is absorbed and made to take the place of oxygen. Somno-
form, which is a mixture of Ethyl Chloride, Methyl Chloride and
ORAL HEALTH 397
Ethyl Bromide resulted from these experiments; it seemed to give all
the valuable anaesthetizing properties of each of the ingredients while
greatly decreasing their dangerous properties. The proportions have
been slightly modified since its first production, to give greater safety,
and are now as follows: —
Ethyl Chloride 83%
Methyl Chloride 16%
Ethyl Bromide 1 %
Being highly volatile it is supplied in glass ampules and adminis-
tered by the closed method through a special inhaler such as the
Stratford-Cookson, the ampule being broken after it is placed inside.
There are two types of inhalers, those which cover both mouth and
nose, which are most generally used, and those which cover the nose
only and are used for analgesia or where it is desired to continue the
administration while operating.
The question arises, to whom may Somnoform be safely admin-
istered and what are the dangers to be guarded against? As a
general rule, full-blooded active persons will be found the most diffi-
cult to anaesthetize, especially those accustomed to outdoor life, while
on the other hand, weak anaemic or sick people take the anaesthetic
beautifully and lapse into deep sleep without any excitory stage.
Heart lesions are not a contra-indication as this organ is rarely
primarily affected, although, of course, it is affected indirectly as a
result of shock. Diseases of the lungs are a more serious contra-
indication. Respiration is first affected, so that if breathing is main-
tained, danger need not be feared. The following are elements of
danger: —
(1) Ignorance and inexperience of the Anaesthetist.
(2) Physical condition of the Patient.
(3) Length of duration of Anaesthetic.
(4) Shock.
Other things being equal, the shorter the duration, the greater
the safety. This is a strong argument in favor of Somnoform with
its rapid induction and quick elimination.
Let us briefly consider shock, or depression. It may be circulatory,
respiratory, or a composite of both. S])mptoms: Patient quiet and
dazed, mucous membrane pale, pulse rapid but weak, blood pressure
low, temperature frequently below normal, reflexes diminished or
gone, respiration shallow, skin cold and clammy, increased respira-
tion and perspiration. Cause: Too sudden, frequent or prolonged,
painful or forcible stimulation of the afferent nerves, thus producing
exhaustion of the medullary nerve centres controlling respiration and
circulation. A common cause of shock is operating during partial
anaesthesia, either starting too soon or continuing too long. It is just
this fact which brought analgesia, which for a time had considerable
vogue, into unpopularity. While quite successful for cavity prepara-
398 ORAL HEALTH
tion, scaling deep pockets or such minor operations, it was not suffi-
cient to control the pain resulting from more extensive operations
such as removal of the pulp. Pain felt while partially under an
anaesthetic gives a much more severe shock than if no anaesthetic had
been administered. In other words, the patient is not in as good a
condition to stand pain and resist shock.
In administering the anaesthetic, the patient should be placed in
as nearly a recumbent position as possible, taking care that the head
is not too far back, with the neck in a strained position, as this would
make breathing difficult. All the text-books say corsets and other
tight clothing should be loosened, but to be candid, the writer rarely
insists on this precaution. The present day corset is not the con-
stricting harness of years ago. Of course, clothing at the neck
should be loosened and collar or tight neck-bands removed. These
might become very dangerous through the patient slipping forward
in the chair, causing them to tighten. Spasm of the glottis must be
watched for. If it occurs at the beginning it is due to a too-concen-
trated vapour at the start. If towards the close, to blood, mucus,
saliva, stomach contents or other foreign matter collecting in the back
of the throat and preventing respiration. The necessary instruments
should be all ready to hand, placed in order of use in a folded steril-
ized towel, to screen them from the patient, yet only requiring the
towel to be turned back to be instantly available. They should
include a mechanical gag and tongue forceps. The mouth is then
propped open with a rubber block on side opposite to operation, the
throat covered with sponge or gauze napkin. These, of course,
should be tied with a long string, to prevent swallowing. The
ampule is then broken in the inhaler at a little distance from the
patient, and never while it is in position on the face as the loud report
would alarm them ; and administration commenced.
Somnoform is a beautiful anaesthetic in operation. There is no
cyanosis, the patient has good color throughout and the pulse is gen-
erally slightly stimulated; they pass usually into quiet slumber with-
out any excitement. It is only necessary to breath naturally, differ-
ing from N2O where deep inhalations are required, and unlike N2O
does not produce anaesthesia by asphyxiation, but is a true anaes-
thetic.
In order to ensure a smooth and successful administration, the
operator must assume a quiet, confident demeanor, thus assuring the
patient that he is in good hands. The slightest trace of nervousness
or lack of confidence on his part would be fatal to success. There
should be no noise in the room, even the running water in the fountain
will disturb. Communication with the assistant should be by means
of signals only. She should thoroughlv understand her part, be
ready to receive the inhaler at a second's notice, hand instruments
and control the patient if anv struggling occurs. The only conver-
sation permitted should be a few words of assurance to the patient in
ORAL HEALTH 399
a quiet firm voice that everything is going all right, breath naturally,
they are doing splendidly, etc. Even when coming out, this quiet-
ness should be continued as the patient's hearing powers are greatly
accentuated and any unnecessary noise might greatly alarm or excite
them.
The anaesthetic should be administered very slowly. After placing
it on the face, the first five or six inhalations should be pure air, then
the aperture in the apparatus slightly opened to allow just a whiff
of the vapor and gradually increasing it every three or four breaths.
After about ten seconds, quietly suggest to the patient to keep one
finger moving and in about another ten seconds the valve may be
fully closed, cutting off outside air and giving the pure vapor. If
there is any excitement or struggling it is usually from too rapid
mduction and may be controlled by admitting more air. Although
in the case of a small child too young to understand or co-operate,
who cries and struggles from fright, the only thing to do is to force the
anaesthetic and quickly carry them past this stage. From then on,
the writer prefers, with head close to the patient to listen intently
to the breathing, for while respiration continues, no danger need be
feared. When the finger stops moving is a helpful sign but not
always indicative. One should listen for the slight snore in the
breathing that comes from relaxation of the soft palate and which is
one of the best signs of deep anaesthesia. This should be reached in
from thirty to forty seconds from start of administration and is then
followed by an operating period of from one and one-half to two
minutes. The operator must of course work quickly to accomplish
everything decided upon, before the patient commences to drift out.
While minor work such as trimming of gums or removal of loose frag-
ments may be accomplished in this stage of partial anaesthesia, as
said before, there is danger of shock if anything more severe is
attempted. If not through, it would be better to desist until another
time, than to run any danger of this, as the patient if even only
slightly hurt at this stage will be convinced that they felt every part
of the operation. Rather, the patient should be allowed to recover
in perfect quietness. At the right moment suggest to them in a low
voice, that it is all over. The operation has been successful and
there is no pain. Never ask the patient "Did it hurt?" but assure
them emphatically there was no pain, they did not feel anything, etc.,
and they will generally agree with you. If an electric fan is avail-
able, it should now be turned en and the window opened to give the
patient plenty of fresh air. A large basin should be at hand in case
there is any nausea, but this is very rare and usually due to the patient
having swallowed considerable blood. It need hardly be said that
this or any other general anaesthetic should not be administered, espe-
cially to lady patients, without a third person present. An assistant
is almost essential, but if one is not present, the patient's relative or
friend should be asked to step into the operating room. In recov-
400 ORAL HEALTH
ering, the patient, not quite realizing where they are or what has hap-
pened, and being under the suggestion of the subconscious mind, may
be alarmed at some fancied idea and start to struggle. They should
never be violently restrained as this only increases the excitement.
They should be gently prevented from breaking anything or injuring
themselves while continuing to remind them where they are and
everything is all right. The writer believes that this mistake is com-
monly made by medical anaesthetists and that dentists are usually
more successful in this work than physicians. Not long ago he
entered a hospital clinic where a patient was recovering from an
anaesthetic. The interne and three nurses were vainly trying to hold
down a big husky country wench who jumped up and down so
frantically that one feared any moment the chair would break. All
the time she was loudly calling for her mother. On telling the nurses
to let go, and quietly assuring her she was all right she immediately
subsided. In my own recent experience, about the only two cases
where trouble was experienced, the patients were both physicians,
and one of them a specialist in anaesthesia. They both struggled
violently, purely a case of mental suggestion.
In looking over a collection of testimonials from dentists as to
their experiences with Somnoform, a novel suggestion was noted.
This dentist stated that he placed half a pint of boiling water in the
rubber bag before starting and that this warmed the anaesthetic vapor
and gave a much smoother administration. I have never tried this
personally, so cannot vouch for the statement, but it is a well known
fact that N2O and O works much more smoothly when warmed
and there is far less danger of bronchial irritation. Most apparatus
for the administration of this agent are equipped with a warming
device, electrical or otherwise. Of course, these gases as they come
from the cylinders, are intensely cold. It is doubtful if the Somno-
form vapor is at a very low temperature and one would be almost
afraid that the vapor would to a certain extent be soluble in the
water.
Somnoform is the only general anaesthetic used in the Dental Ser-
vice in the Toronto schools. The number of administrations must
now run into several thousands without any serious results having
been recorded. Aromatic Spirits of Ammonia, Amyl Nitrite Cap-
sules and Greeley Units containing Camphor-in-oil are always kept
on hand in clinics where general anaesthetics are used. One clinic
has an ingenious arrangement contrived by the inventive dentist in
charge. From a pulley attached to the ceiling hangs a rope with a
hook on one end and a weight on the other. When administering
Somnoform, the hook end is drawn down from the ceiling by means
of a stick and fastened to the ring on the inhaler. When the dentist
desires to start operating, he simply releases the apparatus and it
flies to the ceiling out of the way oi both himself and his assistant.
To the National Dental Association and Return
X
(Continued from October Issue).
HE 1922 meeting of the American Dental Association will go
X down in history as one of achievement. The fear had been ex-
pressed that on account of the distance, and the fact that many
dentists had found collections rather difficult in recent months, the
attendance would be disappointing, but surely when one saw the
crowds at the Ambassador Hotel, where the sessions were held, the
fear was at once dispelled. I have not access, at the time of writing,
to the exact registration, but the Secretary, Dr. King, informed me the
second day of the meeting that it had then exceeded the 4,000 mark.
In any event there was a sufficiently large attendance to ensure a
splendid meeting.
It goes without saying that the entertainment of the Los Angeles
dentists was organized and up to the minute — that is only in accord-
ance with their established reputation. They met the first contingent
at the train, and from that time on till the last lingering sojourner had
waved a reluctant farewell, they apparently did not sleep, and they
ate only when they could get a visitor to dine with them.
Between you and me, if those people out there — bless their hearts —
didn't lie so blandly about the glories of California — I should have
said Southern California — that is, if they didn't do it all the time — if
they just did it ninety-nine one-hundredths of the time, and let us rest
the other one-hundredth — I would love them. And again, between
you and me — I love 'em any way. And I am going to acknowledge
further that I have one friend out there who does not hesitate to tell
the truth. I have heard this Los Angeles man admit that there were
some very splendid things about San Francisco, and he also agreed
that last winter in Southern California they had a frost, or rather his
statement ran: "It was not only a frost- — it was a freeze.*' It
is men of that type who will eventually save Southern California. If
a people frankly acknowledge their limitations, one may have perfect
confidence when they claim their virtues.
402 ORAL HEALTH
Many outstanding things happened during the meeting at Los An-
geles, the most noteworthy of which was, probably, the change of
name. In the early days of dental organizations in the United States
there were two large and representative Associations: the American
Dental Association, and the Southern Dental Association. The time
came when it was recognized that for the best interests of dentistry
these two should merge into one. This was done under the name of
the National Dental Association. It has for some time been manifest
that this name was not the most appropriate, and so at Los Angeles,
with the hearty endorsement of all concerned, the name was changed
to the American Dental Association, under which designation the
organization will function in the future.
Another matter which will be of immense importance as it relates
to dental literature, was the report of a Committee on Nomenclature.
At the 1921 meeting in Milwaukee a committee was appointed for
the purpose of studying our nomenclature and systematizing it in
accordance with the modern trend of professional thought, and this
committee, under the able chairmanship of Dr. L. P. Anthony of the
Dental Cosmos, brought in a very constructive report. The committee
was continued, and it is the present plan to keep this committee at
work until a more logical and comprehensive nomenclature is worked
out.
The Judicial Council presented a report embodying a new Code of
E/thics, one section of which calls for special mention. This section
makes it unprofessional for a practitioner of dentistry to pay or accept
commissions on any kind of professional service whatsoever, where
patients are referred from one practitioner to another. This provision
is very emphatic and sweeping in its scope, and when properly en-
forced, as it surely will be, it means the elimination of one of the most
pernicious practices that ever crept into the professions.
The principle of reciprocity of licensure between States gained
ground by the appointment of a committee to study the situation, who
by educational methods are to foster a sentiment among the various
States, which shall ultimately result in a more unified action on the
part of legislatures and State Boards of Examiners, to the end that the
present incongruous situation be elitninated, whereby a wholly compe-
tent and worthy practitioner of dentistry — one who is honored in his
community, and welcomed into society — at once becomes a criminal
if he steps across a State line and attempts to do the very things by
which he has brought honor upon himself at home. We need greater
breadth of vision in all our State and National policies, and this is
assuredly a step in that direction.
Canada has achieved more in the way of solving this difficult prob-
lem than has the United States. The Dominion Dental Council fur-
nishes a clearing house whereby a candidate may qualify for practice
in most of the Provinces with one examination, and this is a step in
the right direction.
ORAL HEALTH 403
After all, with the horrible spectacle of the great World War so
recently and so vividly before us — one of the greatest perversions of
intellect in all human experience — we may yet be heartened and en-
couraged by the sublime fact that our organized institutions are mov-
ing constantly forward to a fuller realization of equity and justice
among men. This is a marvelous age in which we live, and when I
contemplate the wondrous possibilities of the immediate future, I can-
not quite alienate myself from the inconsequent and altogether foolish
hope that I may be permitted to live and labor long enough to see
some of these reforms brought into full fruition.
Another prominent feature of the Los Angeles meeting was the
Public Health Exhibit, which was staged in a separate tent on the
Ambassador grounds. In it were portrayed the various methods for
bringing the gospel of oral hygiene home to the people, and it was a
revelation even to dentists themselves to see the unique ideas that had
been evolved in the different localities. If the people of the United
States do not become properly impressed with the significance of oral
health it will not be the fault of those in charge of this exhibit. An
army tent with full dental equipment was also shown in connection
with the health exhibit.
All in all, the meeting of 1922 will be recorded as one of growth
and accomplishment, and the officers and committees are entiUed to
the grateful appreciation of the entire dental profession. The next
meeting will be held in the city of Cleveland, Ohio, which ensures, on
account of its central location, an altogether greater attendance, and
we trust an even higher aim at constructive effort.
J^%^
Our Buffalo Letter
By Habec.
CONSTRUCTIVE OPTIMISM
GOOD morning, friends, have you been psychologized? 'Tis
said "one may as well be dead as out of style,'* so get psycho-
logized at your earliest convenience and save vaccination from
all other contagious diseases, as it is far more convenient for the
dentist to have a sore head than a sore arm. This being a new kind
of mental aberration, the symptoms are, as yet, somewhat obscure
and have not been recorded in scientific terms, but you will recognise
the subtle workings of the occult influence and know that you are
404 ORAL HEALTH
being boosted onto a higher plane of some-thing-or-other, whatever
it may be. And when you arrive, you will be glad that you came
and will join the great chorus of psychologized spirits in that soul-
inspiring ballad of old: "Home was never like this.*' In the enforced
temporary absence of the great liquid spiritualizer, psychology is an
excellent substitute, and when taken under the directions of an expert
psycho-artist, it has been found to give favorable reaction in many
common disorders.
If you have been properly psychologized you will discover that
you have been raised to an exalted sphere wherein all relations of life
take on higher significance and even the prosaic routine duties of each
day will give you added joy and satisfaction in their performance.
It is, however, rather astonishing to the thoughtful person that so
many people of usually good judgment, must be told of their mental
shortcomings and needs by those who are pleased to style them-
selves practical psychologists. It also appears that psycho-analysis
is rather an avenue of self-deprecation than a means of stimulating
latent powers to constructive action. An eminent London psychia-
trist recently pointed out the danger of placing too much dependence
in conclusions arrived at through an attempt to analyze one's own
mental equipment and calibre, also emphasizing the grave conse-
quences of depending on the other fellow's survey without a careful
checking up.
Constructive optimism, you will be told, is the main root of the
psychology tree, furnishing it with support and nourishment to make
it flourish like the proverbial green bay tree, and radiate its beneficent
glory to appreciative mankind. O! that some bright dentist might
discover the means of feeding this constructive pabulum to our patients.
The life of the dentist would then become an emerald pathway to
victory.
Perhaps you will contend that optimism is always constructive, but
a careful analysis has convinced Habec that optimism may become
destructive if it is not tempered by the qualifying influence of com-
mon sense. Optimism carried to excess creates a condition wherein
the imagination runs wild and speedily reduces the prospects of the
victim to elemental destruction.
Optimism is a God-given attribute of the young, and its free devel-
opment ofttimes is due to favorable environment. Its value as a
builder is not appreciated until the individual discovers its construc-
tive influence in the attainment of a well-rounded character. It is
then found, along with other helpful qualities, to possess distinct
economic worth as, for example, in salesmanship. In the practice
of dentistry, salesmanship has its place but, ours being a profession,
its application is supposed to have reached a higher plane than in the
salesmanship of commerce.
The psychologist must build continuously upon optimism that is
ORAL HEALTH 405
constructive in character and definite in its application. We recog-
nise merit in all of those who have recently acquired this popular
source of teaching as a means of livelihood, but before swallowing
the bait, hook and sinker of the wily angler, a quiet survey of the
qualifications of the lecturer in relation to his attainments, previous
successes, etcetera, in other fields, might influence your decision as to
the probable value of the instructions.
For the age of **senescence," Dr. G. Stanley Hall, eminent psycho-
logist, would say, optimism is a lifebuoy, for when the dentist is firmly
seated upon the toboggan and it quietly begins to slip away from
its moorings, its speed will be regulated more by the guiding hand of
habitual optimism than by any other influence. He who early begins
to store this veritable kinetic energy, will finish the slipping process
long after the pessimist has begun serving his eternal sentence beyond
the western horizon.
In conclusion, Habec offers the passing thought that it is better to
concentrate upon the accomplishment of a great absorbing object and
through service rendered to others, receive in return an impartial
analysis of one's mental capacity which the public is sure to give.
All of which is the final fruitage of Constructive Optimism. — Habec.
Jungle Dentistry
By Captain George Cecil,
Paris, France.
A Dangerous Operator.
JUNGLE dentistry is of two kinds, the one being more "jungly"
than the other, and India is the scene of its activities. In the
villages bordering on the jungle one occasionally comes across a
government compounder, — a native who has a smattering of chem-
istry and rather less of medicine. In receipt of a salary on which he
lives comfortably, and looking forward to an adequate pension, he
passes tranquil days prescribing simple remedies for the equall}^
simple villagers, and peaceful nights dreaming of future retirement
and a seat on the Municipal Board. For Tulsi Ram is a man of
ambition. "The fate of every man he has bound about his neck,'*
says the Eastern proverb, and Tulsi Ram has long since decided
that his particular fate is to sit upon a Drains and Roads Committee.
The position, you must understand, is one of great honor; the Muni-
cipal Councillor is amongst the "notables" of the village.
Meanwhile, the man of chemicals and pills frequently acts as a
dental surgeon. The equipment of the dispensary includes a set of
forceps: and though the Indian Government does not expect the can-
didate for compounder honors to take a course of dental surgery, he
406 ORAL HEALTH
must be prepared to extract. The compounder, for his part, is ever
ready to operate. To be known as "Government Dental Surgeon
to the village" greatly enhances his dignity. In fact, the more teeth
he draws, the greater his pride. "How are you getting on, baboo ?**
enquiries the inspecting Indian Medical Service Officer of the newly-
appointed compounder. "Your Honor, I doing first class," is the
delighted reply of the compounder, who speaks English, — of sorts.
"Already, in three weeks, I have extracted, with all necessary force
and skill, more teeth than did my predecessor in six months of tenure
of office." "Splendid, baboo. And what have you in that
bucket?" "Two teeth, sar, extracted from suffering jaws instanter
after some trouble caused by struggling patients who are now bellow-
ing loud in their hut next door." "Show me, baboo, the fruits of
your labor." Tulsi Ram does so, proudly displaying a couple of
absolutely sound teeth.
When in doubt, the compounder extracts. The patient himself is
uncertain as to which tooth is troubling him, and Tulsi Ram cannot
be expected to know better than the sufferer; so, if chided by the
inspecting officer, he takes refuge in words, which are as the breath of
life to him. "Your Honor's favor is asked. The Government has
provided instruments for use, and if not used your Honor would
accuse me of neglect of duty. So I gladly extract. These natives
are ignorant ones, having no advantages of education similar to you
and me, sar."
No Anaesthetic.
The village dispensary is not supplied with local anaesthetics
and the customary syringe and needles. Cocaine, however, is fur-
nished, and the compounder is instructed to rub it on to the patient's
gum. Sometimes, with a view to carrying out orders, Tulsi Ram fol-
lows the prescribed treatment; but he might just as well paint the door
handle with cocaine. Should the conscientious fellow decide upon an
external application, he cheerfully expends half a bottle on the object
of his ministrations, who, immensely gratified at so much attention,
begs the Doctor-Sahib not to hurry. When, however, the writhing
patient feels the first horrid wrench, he considers that haste is the
highest of all the virtues.
Occasionally the compounder is invited to attend a native land-
owner of substance who lives at a distance. He makes the journey
in a bullock cart, or el^ka, a two-wheeled vehicle, which proceeds at
the rate of about two and a half miles an hour over a road which is
all ruts and holes. Or he may take his place in a camel-s/ifgram, a
sort of large double-decker cage with wooden bars in place of doors,
the fare being the equivalent of a half-penny a mile, and the speed
equally unpretentious. Arrived at his destination, the compounder
learns that the lord of the manor has suffered terrible agonies, but that
now (by the blessing of Allah, the Most High, to whom be all praise,)
ORALHEALTH 407
he is sleeping. "Allah," returns the traveller, "is great; I too will
sleep." Spending a day or two in slumber and feeding, and in expect-
ing a summons to the presence, the dentist patiently awaits develop-
ments. The patient again is wracked with pain, and the compounder
is desired to operate. This time he makes no mistake, for the molar
has a cavity the size of a pea. Assuming his best professional air, and
seizing the cleanest forceps in the collection, he (literally) attacks the
tooth, which eventually yields to superior force. Handing over a bottle
of antiseptic mouth-wash, and receiving as his fee five rupees, a bag
of mangoes, and a cluster of bananas, Tulsi Ram returns to the rural
surgery. Like the village blacksmith, he feels that something has been
accomplished — something done.
Sometimes the operator is paid in kind. A small sack of rice
(the natives' staple food) is the extent of the patient's bounty, with a
few oranges thrown in. Or he may have to whistle for his fee, the
colored land-owner having strange ideas upon the subject of payment.
"Allah wills it," is the compounder's sole comment. — A fatalist, you
see.
Far from the Madding Crowd.
The actual jungle dentist lives in the woods. He usually is an
elderly native, who, in his youth, has been a Government compound-
er, or even an assistant surgeon in a hospital directed by the Indian
Medical Service. Having blundered most frightfully, he has incurred
the wrath of his superiors, premature retirement and a trifling pension
having followed their decision. So he dwells amongst the palm trees,
wild orchids, chattering monkeys and screeching paroquets, inhabiting,
a tiny and picturesque bungalow, in the roof of which scorpions and
snakes probably have taken up their abode. Once a month the hermit
makes for the nearest magistrate's to draw his pension and to lay in a
stock of stores. During the journey he halts at an obscure hamlet or
village, extracting the neglected teeth of suffering black humanity, or
lancing a wailing infant's gum. Should there be many in need of his
services, he may take a fortnight to cover fifty miles; the news that he
is on the move spreads from mouth to mouth, and the shandrydan in
which he travels will be stopped every few l^os. (A l^os is a stretch-
able distance varying from a mile to a mile and a half.) ''Mera dani
men durd hai' ("in my tooth is a pain") says the village patriarch.
''Usko nilgai do'' ("pull it out") adds the afflicted one, folding his
arms and prepared for the worst, "//o g^aT' (" 'tis done!") ex-
claims the dentist, adding: ''char anna do'' — ("give me fourpence").
The traveller charges for his professional services according to
the social standing of the patient. The "headman" can easily afford
the trifling sum demanded, and half the amount is within the means of
the village postman. But the poor cowherd has no money to throw
away upon luxuries. So the wanderer makes a bargain which is
advantageous to both parties. "You have an aching tooth, O brother^
408 ORAL HEALTH
and I a raging thirst. Fill this bowl with milk, and out comes that
tooth." A quid pro quo arrangement.
Rough and Ready.
There is yet another jungle practitioner, who cannot boast of any
sort of professional qualitication. Glorying in the possession of a rusty
pair of forceps, he applies them indiscriminately to whichever tooth
requires removing — and does not trouble about the consequences. Or
he may have inherited from his great-grandfather that dreadful instru
ment of torture, the "key." Mercifully for the native patient, he can
put up with a good deal, or the "key" might be the death of him.
Occasionally blood-poisoning sets in, and the victim loses his life as
well as his tooth. Still, nothing happens to the wielder of the rust-
encrusted "key." Should he be threatened with arrest, there is little
to prevent his trying another jungle; and a coin dropped into a native
policeman's itching palm always is a good investment. If the worst
comes to the worst, an alibi costs very few annas. For a rupee a
Hindu will declare that at the time of the alleged operation taking
place the accused was many a mile away, while the Mahometan, too,
has his price.
Once in a while the jungle dentist attempts to fill a tooth. A
well-to-do patient who is too infirm to travel, and who cannot prevail
upon a white practitioner to leave a far-distant "station," sends for
him. The attempt, unfortunately, is not a success. The enterprising
operator has accepted the offer because of the fee; but as his instru-
ments consist solely of a rough file, the preparation of the tooth is,
from the very first, doomed to failure. And the only filling with which
the fellow is acquainted is gutta-percha !
An Apologetic Operator.
Once in a blue moon, as the Irish say, the jungle dentist has a
stroke of luck. An Englishman, lured by shikar (sport), penetrates
into the wilds. Consumed by an appalling toothache, he sends for the
tooth-puller. "It's got to come out," says he, "and I daresay you'll
hurt me like the deuce." There is no mistake about the hurting. The
sahib does not feel like himself again till he has taken a very stiff
whiskey-and-soda. But he pays a generous fee and exonerates the
dentist, who loudly laments having inconvenienced the "high-born."
"Your Honor is my father and my mother! The fault is not mine,
but of this accursed instrument — a very wretch among all instruments !
I am indeed unfortunate to have caused pain to your Honor, but it is
better to suffer for a second than for a day. The high-born is indeed
magnanimous to have so readily pardoned his slave!" The Eastern
metaphor, it will be perceived, is a flowing one.
For a swollen face arising from dental troubles the jungle practi-
tioner invariably prescribes a neem leaf poultice. The neem tree
abounds in the jungle; and if the remedy does no good, it at least
does no harm. And it costs the dentist nothing; the infinitesimal fee is
clear profit.
ORAL HEALTH
EDITOR:
WALLACE SECCOMBE, D. D.S., F.A.C.D., Toronto, Ont.
CONTRIBUTING EDITORS:
C. N. JOHNSON, M.A., D.D.S.. F.A.C.D., Chicago.
RICHARD G. Mclaughlin, D.D.S., Toronto.
W. E. CUMMER, D.D.S., Toronto.
J. WRIGHT BEACH, D.D.S., Buffalo, N.Y.
Entered as Second-class Matter at the Post Office, Toronto.
Subscription Price, Canada and TTnited States, two dollars per annum ;
elsewhere three dollars. Single Copies, 25c.
I
Original Communications, Book Reviews, Exchanges, Society Reports, Personal Items, and other
Correspondence should be addressed to the Editor, Oral Health, 102 Wells Hill Ave., Toronto, Canada-
Subscriptions and all business Communications should be addressed to The Publishers Oral Health,
Royal Bank Building, 269 College St., Toronto, Canada.
Vol. XII.
TORONTO, NOVEMBER, 1922
No. 11
H EOITOR.IAL1 IZI
Should Professional Men Advertise ?
PROFESSIONAL men have no commodities to sell. They
have nothing but their own personal services to offer. A pro-
fessional man, in a sense, offers himself, his time, energy and
skill, to his client or patient, for a given time for a consideration.
Certain newspapers have recently taken the position that professional
men should be permitted to advertise if they so desire. But would it
really be in the public interest for lawyers, doctors, dentists, and
other professional men to buy space in the press at so much per line,
and use the same to acquaint the public with the personal virtues and
skill of the advertiser or with a pre-determined tariff of fees?
Back of every professional question, and of the ethics of the pro-
fession, is that which may be summed up in one word — "honesty."
What does the average patient know of the professional service
rendered? How can he tell whether one, two, or ten visits are
necessary? Suppose the professional man does advertise that he
will do a certain thing for a certain sum; when the patient calls he
may be told that some other and entirely different operation is neces-
sary, or that the case is exceptional and unusual and will require
special treatment.
The honesty of the professional man is the sole protection of the
public.
410 ORAL HEALTH
An important study of conditions the world over, and in all pro-
fessions, will disclose the fact that in the main it is the charlatan and
quack that resort to advertising. Would any sane observer argue
that the advertising professional man is, in the main, the honest prac-
titioner whose sole interest is that of his patient? Quite the contrary.
The quack in either medicine or dentistry, the shyster lawyer, all pose
as public benefactors, but in reality are parasites upon society, practis-
ing their mercenary methods, and obtaining the greatest fee possible,
with little regard to the service rendered.
The American Society of Orthodontists
THE twenty-second annual meeting of the American Society of
Orthodontists will be held in Chicago, at the Edgewater Beach
Hotel, April 9th, 1 0th and 11th, 1923. A cordial invitation
is extended to all those interested in Orthodontia to meet with us.
BURT ABELL, President,
WALTER H. ELLIS, Secretary-Treasurer,
397 Delaware Ave., Buffalo, N. Y.
Alpha Omega Convention
THE Fifteenth Annual Convention of the Alpha Omega (Dental)
Fraternity will be held in Philadelphia, Pa., on December 27,
28, 29, 1922. For detailed information, address the Supreme
Scribe, Dr. B. M. Brickman, 6334 Woodland Ave., W. Phila., Pa.
Two Curtains
I have two curtains over my eyes, —
They're fastened in my head,
And every night I pull them down
When I get into bed.
i always shut my mouth up tight.
Keep breathing through my nose,
Because there are two little holes
Through which the pure air goes.
And when old Sand-man comes around
To take his good-night peep,
He s sure to find me in my bed
And sound and fast asleep.
DORA LAWRENCE CAMERON.
Wenatchee, Wash.
OPAL HEALTA
A JOURNAL THAT STANDS FOR THE ** OUNCE OF
PREVENTIONS AS WELL AS THE '' POUND OF CURE''
nil' — ^trn
V01^12 TORONTO, DECEMBER, ^922 No. 12
Septic Anaemia as a Complication of Pernicious
Anaemia
By William Hunter, CB., M.D., F.R.C.P.
Senior Ph\)sician, The London Fever Hospital; Consulting Physician,
Charing Cross Hospital.
Editorial Note.
Dr. William Hunter, the eminent British Phy^sician, performed
a great service to the Dental Profession and to humanit]^, when some
years ago, in an epoch-malting address, he established the relationship
between dental foci of infection and systemic disease. The result of
Dr. Hunter's address was that dentists the World over revised their
methods of practice, and gave greater consideration to asepsis and the
saving of the tooth primarily contingent upon its restoration to health.
ORAL HEALTH readers will be glad to read this further
paper by Dr. Hunter. The complete paper was published in the
Lancet, and We reproduce here those sections of the paper which are
of special interest to the Dental Profession. — Editor.
INTERESTING and infcrming as the foregoing facts may be
regarding the great haemolytic disease, an even greater interest
and practical importance attaches to the second outcome of my
etudies regarding anaemias. That outcome is the complete differen-
tiation of another form of anaemia which I have termed septic
anaemia; and the discovery of the great part it plays not only as an
anaemia existing by itself, but even more as a frequent accompaniment
and complication of other forms of anaemia, and indeed of other
diseases.
Its discovery arose out of my studies (in 1900) regarding the
412 ORAL HEALTH
presence of the common septic conditions I termed oral sepsis as an
intense complication — not the causa causans {pace many erroneous
statements) — of the great haemolytic disease pernicious anaemia
marked by sore tongue, as I have described in the previous section. I
find, namely, that this oral sepsis itself can and often does cause a
form of anaemia quite different from the haemolytic anaemia of the
sore tongue disease. The anaemia so called is not an anaemia sui
generis as the former is ; it is an anaemic condition produced by long-
standing sepsis — chiefly streptococcal — such as accompanies dental
disease, or may be found from time to time in adjacent parts, especially
the antrum and nasal air sinuses.
This septic anaemia is, in my experience, the commonest form of
all anaemias. It varies much in degree, often mild, but at times very
severe, simulating and approaching even that of the sore tongue,
haemolytic anaemia — for example, down to 20 per cent, of red cells.
But it differs totally in its pathology from the above-mentioned glos-
sitic (or pernicious) anaemia in being non-haemolytic, and in owing
its character to deficient blood formation, just as much as the haemo-
lytic anaemia owes its character to excessive blood destruction. The
cause of it in nine-tenths of cases is, as I have just stated, unrecognized
and very common sepsis, connected with bad teeth and periodontal
disease (pyorrhoea) — "oral sepsis"; in other cases it is overlooked
sepsis in the antrum and nasal sinuses.
But, as I have stated, the intense clinical interest of this anaemia
is that it may not only exist alone. Far more frequently it exists along
with and complicates other anaemias in which similar conditions of
oral sepsis are present, and herein lies part of the great importance of
oral sepsis in connection with the disease called pernicious anaemia.
"Glossitic Anaemia" plus "Septic Anaemia" in the Same
Patient: Importance of Sepsis as a Complication.
In addition to the history or presence of sore-tongue lesions, which
I regard as of utmost diagnostic importance, the mouth in glossitic
anaemia patients generally presents when first seen another class of
infective lesions connected not with the tongue but with the teeth.
These are the septic conditions which I term "oral sepsis" (1900). I
have kept them apart from the glossitic lesions because they are of a
different character and significance. However bad they may be,
they do not in the absence of sore tongue or its history point to the
diagnosis of the idiopathic haemolytic disease, glossitic anaemia. On
the other hand, any history of sore tongue, however slight it may be, in
an anaemic patient should raise the suspicion of this haemolytic
disease, even if little or no oral sepsis is present.
In most cases, however, the conditions of oral sepsis presented
when the patient first comes under notice are very bad. Thus to quote
only one case:
ORAL HEALTH 413
"Many of his teeth are quite loose, both in the upper and
lower jaw; they are all very septic, showing periodontitis,
pyorrhoea, and calcareous tartar deposits, and much septic
gingivitis, and there are in addition a number of carious teeth
and septic stumps. He has neglected his teeth, and has been in
the habit of himself pulling them out as they became loose."
A pretty septic story is thus presented by such cases — a story
prior to 1900 invariably present in all cases throughout the history of
the disease, and still presented in some degree or other by every case
when it first comes under notice.
What is the importance of these septic lesions around the teeth?
It is, I find, of a threefold character, to which I draw your special
attention.
I. — Power of Producing Septic Anaemia. — The one to which I
am especially drawing your attention to-day is the power of chronic
streptococcal sepsis per se in producing a delinite and sometimes ex-
treme degree of the anaemia I have termed "septic anaemia." But
important as this is in connection with the prevalence of oral sepsis and
the part it is thus playing in causing all sorts of degrees of anaemia —
for example, in young children, young adults, and especially in young
girls who are already so liable to anaemia of non-infective nature —
this power per se of producing anaemia by no means exhausts its
special importance as a complication of the haemolytic disease, gloss-
itic anaemia. For in this latter disease the tongue is the seat of lesions
which cause cracks and fissures and abrasions of its covering epithe-
lium, exposing it therefore in special degree to any septic infection in
the mouth. And when one remembers how constantly the tongue is in
movement, expanding and contracting, it must act like a sponge in
absorbing the intense streptococcal sepsis present in many cases, thereby
favoring the production of septic anaemia. Furthermore, the action
of septic infection is to retard blood formation in the bone marrow (a
pale bone marrow). It thus counteracts the action of the haemolytic
infection, which is to stimulate blood formation (red bone marrow).
The removal of the sepsis, therefore, frees the bone marrow from a
markedly depressing influence, and allows the full compensatory
powers of the bone marrow free play. The result is shown by the
remarkable and increased powers of recovery of the haemolytic disease
on removal of the sepsis.
2. — Power of Producing *'Septic Gastritis** and **Septic Enter-
itis.**— In this latter disease oral sepsis plays another important part,
— ^the one which first drew my attention to it, and the one which I
endeavored to describe in my first account of this subject in 1900.
That part is the power of oral sepsis in inducing unhealthy conditions
of catarrh in the stomach and intestine ("Septic gastritis" and "septic
enteritis," as I termed them,) — in the alimentary tract. It is these
that constitute the class of "certain favorable conditions" which in my
414 ORAL HEALTH
first studies in 1 890 I concluded to be necessary for the contraction of
the haemolytic infection (a specific one) underlying the haemolytic
disease and glossitic anaemia. My studies have fully confirmed the
importance of this action of oral sepsis. Prior to 1 900 the most dis-
tressing features of that disease were the frequency of gastric and
intestinal symptoms; the loss of appetite, the distaste for food, the
nausea, recurrent sickness and vomiting, the looseness of bowels, or the
recurrent and oftentimes persistent diarrhoea which marked the pro-
gress of this disease — for example, vomiting every day for two or three
months. While symptoms of gastro-intestinal disturbance are still
definite features of the disease, I never see nowadays this class in the
severe degree I formerly witnessed in every case. All the patients
recently under my care have indeed been singularly free from them,
except from time to time in a slight degree. I attribute this happy
result to the removal of all oral sepsis — all teeth from the cases — and
to the consequent removal of that factor as a potential cause of gastric
and intestinal trouble, or as a potential complication and adjuvant of
the action of the specific haemolytic lesions that may be, and in all
cases are, present in seme part or other of the gastric or intestinal
mucosa.
3. — Septic Lesions around the Teeth as Seats of the Haemol\)tic
Infection of Glossitic Anaemia. — But a third (and in my judgment
the most important) part, from a pathological point of view, played
by oral sepsis in connection with the haemolytic disease, glossitic
anaemia, is the one I have now indicated. This is that the lesions
around septic teeth, the open wounds connected with septic gingivitis —
for example, especially under calcareous masses of tartar — the
pyorrhoea, the carious roots, the presence of gold caps or bridges, et
hoc genus omne, are lesions in which the haemolytic infection of the
disease also takes root and by which its persistence in the body is
favored. So important is this that in my observation the first seat of
that infection is in all probability in most cases such open septic lesions
around the teeth. It incubates itself there, thence spreads to the
tongue, which afterwards becomes its special seat, and thence spreads
to the mucosa of the stomach and intestine.
In short, the exact pathogeny of this disease— its mode of
spread — could not be better described than in the words used by one
patient regarding it:
"His illness began with sore tongue; his tongue always got
inflamed every three weeks, accompanied by some discomfort in
the stomach and lower down, as if he were inflamed all the way
down."
Or, as another equally well described it:
"The tongue became sore about three weeks ago. The
soreness seems to go right through to back passage. It appears
fo be perfectly well for a time; then a relapse occurs every two
or three weeks.*'
ORAL HEALTH 415
Or as another described it;
"His illness began with sore tongue, quickly followed by
yellowish complexion (haemolysis) and great weakness (anae-
mia). He told several doctors that he thought the sore tongue
had soemthing to do with it, but they attached no importance
to It."
If this be the character of the haemolytic infection — namely,
located in the tongue, mucosa of stomach and intestine, and wakening
into activity every two or three weeks — the importance of open septic
wounds around the teeth, in the sockets of the teeth, and in the bone
around the sockets, as the seats of the haemolytic infection, becomes
extreme. For this infection is undoubtedly present in the tongue, and
must invariably be passing from the lesions of the tongue to the sockets
of the teeth. Or, conversely, if preserved in the lesions around the
teeth, it must constantly be passing to the tongue (stomach and intes-
tine), grievously aggravating the amount of the haemolytic infection
already present.
A circulus vitiosus is thus created between the tongue lesions and
the oral septic lesions. Therefore this oral sepsis in this great haemo-
lytic disease glossitic anaemia, already characterized by the great
persistence of its own infection, is of altogether supreme importance.
So great is the part it plays that in my judgment there is no safety from
it in this disease except by the radical measure of removing every
tooth — whether bad or apparently good — in order to remove all the
potential haemolytic infection which may be present in the septic
■lesions around the teeth already diseased, or that may subsequently
find root in teeth which, although apparently good at the time, may
later on become diseased. I have never failed to see immediate benefit
follow the removal of even one or two bad teeth, and great benefit
follow the removal of as many as seemed bad or doubtful. But I have
never failed to regret, in every case I have seen, when watchmg its
subsequent course — and seeing how persistent the haemolytic infection
is — that I have not been allowed to remove all the teeth in the first
instance, in order to get rid once and for all of the important potential
complication of new seats of infection being formed around teeth as
they subsequently become bad.
Frequency of Oral Sepsis in "Glossitic Anaemia."
On this point I have, since I first announced it in 1900, had no
manner of doubt — such as many, including not a few teachers, seem
apparently to have, judging from what I sometimes hear. Their
furthest admission regarding the matter does not go beyond the very
guarded and non-committal one that *T am inclined tp think there
may be something in it, although, of course, not as much as you be-
lieve. Why, I have seen cases of pernicious anaemia without any
teeth!" (Many such cases are now being seen — ^since 1900, when
the importance of removing septic teeth was first drawn attention to.
416 ORAL HEALTH
Further, pernicious anaemia is far more common in hospitals than
formerly was the case, for the reason that far more chronic cases are
now ahve.)
My own doubts have long been dispelled, as theirs also would
have been, by the painful and tragic experience I had shortly after
1 900 of seeing several scores of private patients in rapid succession in
the course of a few years, all of them presenting features of sepsis in
the teeth and mouth that were perfectly lamentable. The majority ot
them were found at death's door, literally sodden with neglected sepsis,
in addition to their real severe disease, although on an average they
had had their disease on them for about two years before I saw them.
So bad was it that I found it impossible to carry out the measures of
antisepsis and removal of septic teeth which were clearly indicated,
albeit at that time doubtfully regarded alike by the doctor and still
more by the patient. ('Tt beats me to understand what my teeth
have got to do with my disease," as one patient in a desperate state
remarked.)
The worst experience was of seeing the great majority of these
earher patients die within an average of three and two-third months
from the time of my seeing them. Thus, out of my first group of 44
private cases, death occurred in 35 cases: 14 in less than a month
(most of them within a few days), 16 within two months, 21 within
three months, 25 within four months, 27 within five months, 28 within
six months, 31 within seven months, and 35 within eight months.
That picture represents the severity and character of the great
idiopathic anaemic disease which throughout my studies I have
designated "pernicious anaemia" — the disease which I find to be
distinguished by its glossitic and haemolytic features, the disease to
which I therefore now give the title of "glossitic anaemia." Such,
however, is not the picture which that disease may, since 1 900, present
if it be freed from sepsis and the septic anaemia which complicates it.
It remains the same disease sui generis. But when thus freed from
sepsis it represents milder clinical features and a much better clinical
course than anything it was ever capable of showing prior to 1900,
before the era of anti-sepsis in anaemia which then commenced.
Increased Powers of Recovery after Removal of Sepsis.
When sepsis is removed what is the result? Are the powers of
recovery of this haemolytic anaemia thereby increased? Are the
features or course of the disease when freed from sepsis and septic
anaemia in any degree modified from that presented by the disease
previous to 1900, when I first formulated my conclusions?
My own experience is that they are notably modified. The full
true features of this idiopathic haemolytic disease, when thus freed from
sepsis, have been presented to me time and again during the past
twenty years, as they never were seen and never existed before. The
dreadful, hopeless pictures which it formerly presented I never now
ORAL HEALTH 417
see in any of my cases in whom I have been able to carry out the full
measures of antisepsis I consider necessary. However severe the
disease may be — and it is always severe; however sharp its individual
attacks may be — and they can be of the severest character (for in-
stance, the patient lying in a state of unconsciousness and coma for a
whole week, the doctor giving no hope, and stating that the patient
could not last till morning, as in one of the last cases seen) ; I have
time and again seen the patient recover, as if by miracle, and restored
in two or three months, sometimes even in a month or two, to an ap-
pearance of robust health and vigor, with high color, high blood count
(90 per cent.), declaring that he had never felt so well in his Hfe. (In
the case above referred to the patient came and reported herself,
apparently a picture of perfect health with beautiful complexion and
color, two months after she had been at death's door.)
These results, indicating better powers of recovery of this disease,
may possibly, it may be said, be due to improved methods of treatment
of the disease — for instance, to the use of salvarsan, neo-salvarsan,
novarsenobillon, transfusion, excision of spleen, better methods of giv-
ing arsenic, etc., of which one reads from time to time in connection
with the treatment of such cases. But in the group of 1 50 cases under
my care during the thirteen years 1900 to 1913, I have used no new
method of treatment other than the antiseptic treatment against gastro-
intestinal sepsis, which I recommended for the first time in 1 890, and
the measures of oral antisepsis which I recommended in 1 900. I have
only on one occasion injected salvarsan; I have never used the other
arsenical drugs of this character; I have never injected arsenic hypo-
dermically; and finally, as regards arsenic, I have never given a dose
of more than 5 minims at a time, and my usual dose has been 2 to 3
minims given by the mouth in the form of Hquor arsenicalis. If my
cases have shown the increased power of recovery that I have above
described, as they undoubtedly have, the only new measure of treat-
ment with which their improvement can be associated has been the
great, and to my mind the all-important, one of strictest antisepsis
above referred to, thereby enabling the disease to manifest its own
great powers of recover]) when freed from complicating sepsis.
Mr. Thomas Steele, Deceased
T
HE profession will regret to learn of the death of Mr. Thomas
Steele, founder and vice-president of The Columbus Dental
Mfg. Co., on Saturday, October 28th, 1922.
The Rational Treatment of Pyorrhea
Alveolaris"^
By Dr. B. Kritchevsky and Dr. P. Seguin,
Of the Pasteur Institut at Paris.
OUR bacteriological and experimental research work enables us
to affirm that the fundamental lesions of pyorrhea alveolaris
are lesions of necrosis, caused by the association of the buccal
spirochaeta and of the fusiform bacillus. These lesions are often
followed by suppuration due to secondary infection, which is caused
principally by aerobic and anaerobic cocci.
The above bacteriological observations, as well as the histological
study of the lesions of human pyorrhea, enable us to set forth the
rules for the treatment of this disease.
The histological examination of tissues detached from pyorrhea
patients during the different periods of the disease, showed us that
the fuso-spirochaetic infection proceeded by stages, the resistance
opposed to this infection by the various tissues varying considerably.
The first obstacle encountered by the fuso-spirills during their
invasion of the gingival tissue is the epithelium pavimentum and its
corneous layer. As soon as an opening is made in the corneous
coating, these organisms spread out between the latter and the
superficial layers of the epthelial cells. They cause the horny cover-
ing to become detached, and thus lay bare a large surface of the
epithelium. Their penetration is then facilitated. The spirochaeta
may be seen to creep into the intercellular spaces, to surround each
cell by a sort of network, to destroy — presumably by their diastasis
action^the uniting filaments, and thus to cause the collapse, cell by
cell, of the epithelium.
When this destruction is effected, they meet a second obstacle —
the derm. The same process again takes place: here, the close con-
junctive fibres of the derm offer the same protection as the corneous
coating of the epidermis. They form a mechanical obstacle difficult
to surmount; but if the defence put up by the organism is insufficient,
or if the flora is particularly virulent, this obstacle also is gradually
destroyed and the microbial association can then reach the cellular
tissue.
Here the microbes have the better of it, for the loose cellular tissue
is pre-eminently favorable to the rapid invasion of spirochaetae and
fusiforms. They may be seen multiplying and spreading in this
tissue to a considerable extent.
The examination of Fig. 1 shows all these stages clearly. At the
top of the drawing can be seen the ulceration of the epithelium, the
invasion of the derm through a narrow opening and the spreading
*Klectros kindly loaned by The Dental Surgeon.
ORAL HEALTH
419
out of the fuso-spirills in the depth of the cellular tissue. We con-
sider this establishment of facts as very important, for it shows the
mechanism of the formation of distant pyorrhea abscesses which are
so often observed in this disease.
"^fct^.
Fig. 1. Section of a pyorrheaic ulcerated gum tissue
Silver impregnation.
A. corneous layer; B, pavinentous epithelium; C, ulceration; D, fibrous
tissue; E, infiltrated area of fuso-spirills in the celkilar tissue.
At a still greater depth the. fuso-spirill flora comes into contact
with the periosteum and the bony tissue.
Fig. 2 shows the attack of the periosteum. Following a process
which is always identical, the microbes penetrate between the peri-
x-^ i
^
Fig. 2. Section of an alveolar bone tissue.
Silver impregnation.
A, osseous tissue; W. detached i)ei'iosteum; C. layer of pus.
420 ORAL HEALTH
osteum and the bone; then, little by little they detach and mortify the
periosteum in such a manner as to denude the bone to a greater or
lesser extent.
Fig. 3 shows us how the destruction of the bony tissue is effected.
Fig.' 3. Section of a necrosed alveolar bone tissue.
Silver impregnation.
A, osseous tissue; B, necrotic excavation in the bone filled with fuso-spirills;
C, layer of pus.
In examining numerous sections of pyorrhea tissue, we were struck
by the absence, in the seats of necrosis, of any reaction by the leuco-
cytes. The organic defence in pyorrhea is not affected by fagocy-
tosis.
We believe that in pyorrhea alveolaris the processes of defence
and of cure are effected principally through the formation of cicatrical
tissue — a very dense fibrous tissue which constitutes an obstacle of
which the attack by the fuso-spirills is very difficult.
Taking these bacteriological and our private ♦ observations as a
basis, we have arrived at the conclusion that the treatment of pyorrhea
should be carried out as follows :^ —
1 . Fight the fuso-spirochaetic infection.
2. Fight the secondary infection, if any.
3. Bring the tissues into a complete state of defence.
]. It is now established that the medicament which is the most
efficacious in the treatment of fuso-spirilla infections is arsenobenzol.
How should it be used in pyorrhea cases?
When a microscopic examination has revealed the predominance
of spirochaetae over the agents of secondary infection (cocci, vibrions,
etc.), one may be quite sure of obtaining good results by the method
of chemiotherapy, provided the medicament reaches the microbes.
Now, our histological research work has shown us that the spiro-
chaetae are deeply buried in the tissues. The arsenobenzol will not
reach them unless it is administered by intravenous or intra-muscular
injection. For instance, three to five intravenous injections of 0.15 to
ORAL HEALTH 421
0.25 centigrammes of novo-arsenobenzol suffice in many cases to cause
the spirochaeta to disappear from the secretions.
This general treatment should always be completed by the instal-
lation of a 1-10 glycerined solution of neosalvarsan in the gingival
pockets and cavities. In most cases, the arsenic treatment, even
applied alone, brings a very rapid and considerable improvement
in the condition of the gums. The clinical improvement coincides
w^ith the disappearance of the spirochaeta from the secretions.
2. When a microscopic examination reveals the predominance of
agents of secondary infection over the fuso-spirill and when the
slightest pressure on the gingival border causes a flow of pus, it often
happens that the arsenical treatment applied alone is insufficient. As
a matter of fact, the arsenobenzol acts preferably on the spirochaeta
only, its action on the agents of suppuration being very slight.
In such a case two treatments are indicated: —
1 . The use of the usual antiseptics — salts of fluorine, sanoram,
peroxide of hydrogen, chromic acid, various caustic solutions, etc.
2. Auto-vaccination.
For performing the latter we recommend the iodized pyovaccine
method, perfected by Weinberg and Seguin in the treatment of
wounds. This vaccine is very easy to prepare, its reactions are
reduced to a minimum, and it is very efficacious.
To prepare it, remove, with the dropping-tube, about ^^ cc. of pus,
dilute it in 10 cc. of sterile physiological water, so as to obtain a
distinctly opalescent emulsion. Add to this a sufficient quantity of
Gram*s solution (1-200 iodo-ioduretted solution) to give it the color
of light beer. After ten minutes' contact, the germs are dead and
the vaccine can be injected.
An> febrile or painful reaction will be avoided by beginning with
small doses (2 to 4 drops injected sub-cutaneously). Repeat the
injection every second day, increasing the quantity.
3. No surgeon would think of dressing a wound or treating it by
vaccination without previously cleaning it as thoroughly as possible
by the excision of the necrosed tissues, the removal of foreign bodies,
etc. The treatment of pyorrhea should be based on this funda-
mental rule.
We cannot insist in this article on the different methods used to
attain this end. A large quantity of special instruments have been
made for polishing the roots and scraping the necrosed tissues of the
alveolus. It may be stated that each individual practitioner has his
own methods and habits.
Our friend. Dr. W. Davenport, of Paris, has had success with
the use of blunted drills which he inserts deeply into the pyorrhea
pockets, and which enable him to remove quickly and completely all
tissues which are becoming necrosed.
In several cases we have obtained very satisfactory results with
422 ORAL HEALTH
Dr. Arthur Zentler's (Journal of the American Medical Association,
9th November, 1918, page 1530) radical method which consists in
excising the gum tissue, denuding the roots and the necrosed alveolar
border, extirpating all dead tissues with a curette, and suturing the
mucous membrane.
It is obvious that the choice of the operating technique will depend
on the seriousness of the case, and will be subject to the practitioner's
judgment, but in any event the object of the surgical operation should
be twofold: —
1 . To remove all the necrosed or infected tissues.
2. To obtain healing through the formation of fibrous tissue
which, as we have already stated, constitutes the most efficient
obstacle to fuso-spirochaetic invasion.
The prevention of pyorrhea and the preservation of the results
obtained through its treatment is a problem of very great importance.
— Dental Surgeon.
Fit For Any Queen
This little stor^ Was written b^ Dr. Ruggies George of the Cana-
dian Red Cross, after a morning spent in one of the Toronto Schools
with one of the examining Dentists.
While written primarily for publication in the Junior Red Cross
Magazine, it Was thought it might be useful to the Dental Profession
for educational propaganda.
Any Dentist who Would care to see any of the Work of the Dental
Service in the Toronto Schools will be heartily welcomed by Dr. Grant
and his staff, and every effort made to mal^e his visit interesting. —
Editor.
^ ^ AV/ELL, did you ever, that is the sixth today!"
VV It was my friend, the druggist, who spoke. I had
come across to his store for my usual evening chat, for he
was a friendly man and I enoyed talking to him.
"The sixth what?" I asked, not knowing what he meant.
"The sixth child to come for toothache medicine. It is good for
business, but I hate to see those kids suffer. Still, I suppose it's only
their first teeth and it won't matter much if they have to be pulled out.
But I wonder why teeth were ever put in their heads if they have to
ache like that."
I thought a moment and then asked — "What do the children buy
mostly in this store?"
"Oh! candy of course. You see, they pass here on their way from
school and most of those who have coppers to spend seem to spend
them on candy. Poor stuff, too. I visited a candy factory once and
ORAL HEALTH 423
it was none too clean. Not the sort of place I'd like my own little
girl to get things to eat. I don't like to sell the trash, but then one has
to make a living."
After this we talked of other things until 1 went home to bed to
dream of a great tooth with an enormous hole in it; and all around
the tooth was a ring of all-day-suckers sucking hard. They made a
horrible, gurgly, sucking sound just like running water out of the bath.
Perhaps there was a reason for the sound I heard in my dream for in
the middle of the dream my bedroom door opened and Ted called —
*' 've had my bath; better get yours now or you'll be late for break-
fast."
Soon after this I moved to the city and did not see my friend, the
druggist, until I returned to the old town two years later. When I
dropped in to see him on the evening of my return, nothing seemed to
be changed. The same old bottles of green and yellow still blinked
in the window and the picture of the Prince of Wales smiled as gaily
as ever at the photograph of Babe Ruth on the opposite wall. But I
did notice that the soda fountain looked a little rusty and that the old
candy counter now was filled with tooth brushes. Somehow, this
reminded me of our chat of two years before.
"Still handing out candy and toothache medicine?" I asked.
He laughed — "No, not nearly so much. Funny thing happened.
Soon after you left, the school dentist came to this town, looked at all
the children's teeth, and, would you believe it, he found that nine out
of ten of those youngsters had bad teeth. This made the parents
pretty angry. They had never imagined it was so bad as that and
they went to the School Board to have a School Dentist. So they
appointed Dr. Billings and he looks them over once a year and tells
the parents of the youngsters who need fixing up. Besides, there's the
school nurse — she is new since you left — and she shows the children
how to use a tooth brush and explains how candy and suckers rot
their teeth. Finally, Mrs. Higgins, the grocer's wife, gave a prize to
each class for the child with the best set of teeth. Even the little ones
in kindergarten have a song about good teeth. They sing it to the
tune of "Sing a Song of Sixpence." It goes something like this: —
"Sing a Song of Toothpaste
Sing a Song of Toothpaste
At morning and at night.
Twent]) healthy little teeth
Strong and shining Tphite.
Every day I brush them
To ^eep them bright and clean.
Are not they a set of pearls
Fit for any Queen?''
The Pros and Cons of the Full- Time System
For Teachers in Medicine
[Much discussion has recently) occurred regarding the relative
advantages of part-time and full-time teachers in medicine.
The Pros and Cons of this intensely interesting subject are
published herervith because the^ are equally applicable to
Dental Teachers and consequently Tvill prove of interest to the
Dental profession.]
Advantages of the Full-Time System.
By One in Favor of It.
THE disadvantages of the part-time system in clinical subjects
may be divided into two groups or categories. In the one, which
we may call general, is the indubitable fact that instructors who
have acquired their knowledge of disease solely by observation of
symptoms, through the experience of clinical practice, cannot be in a
position to direct the student's mind to seek out the underlying cause
of the disease which is responsible for the symptoms. A teacher of
this class, unless he be of exceptional ability, cannot expect to be
able to stim.ulate in the student that enquiring habit of mind which
alone will enable him to advance abreast of medical scientific knowl-
edge, and unless our students are stimulated by their instructors in
this way, we cannot expect them to become better physicians or
surgeons than their instructors.
The second group of disadvantages are of a more practical nature
and the chief of them may be enumerated as follows:
1 . The demands of private practice must as a rule take precedence
to those of the teaching clinic if the physician or surgeon is to build
up and retain a large clientele. This principle is so well recognized
that teaching appointments must often be considered as secondary to
"urgent calls" from private patients.
2. The day of the general practitioner is usually so completely
filled with the duties of his practice that he has but little time or
energy left for the perusal even of the general medical journals and
still less for serious study of the special journals and monographs in
which the discoveries of modern medical and surgical science are
expounded.
3. Under the conditions set forth above it is impossible for one
man who is primarily engaged in practice to undertake control of
all the teaching of nledicine or surgery. This has to be divided
among several, with the result, as experience. shows, that there is but
little correlation of instruction and the student often completes his
course with a very poorly balanced knowledge of disease. With no
ORAL HEALTH 425
one of the group of senior instructors personally responsible for see-
ing to it that the whole vast field of medicine or surgery is adequately
covered and the instruction properly graded and correlated, it is
inevitable that the instruction must be one sided. Under the part-
time system, the hospital wards are usually divided into several
services with a physician or surgeon in charge of each, and the
students are sent either in groups throughout the year or as a whole
at different periods of the year to the services with no one of the
service heads endowed with sufficient authority to see that the in-
struction on one service is properly correlated with that of another.
The following are among the most striJ^ing benefits of the full-time
system :
1 . The instruction of the various parts of the subject is properly co-
ordinated and systematized. Under the guidance of the head of the
department, the various instructors meet frequently to discuss ques-
tions of policy in teaching, particularly with regard to nomenclature
and classification of diseases and symptoms, theories of etiology,
principles of treatment, etc. Unless someone is given paramount
authority to require this correlation of teaching, it can never be
successfully effected and without it the student is bound to get a
poorly balanced course of instruction and to be bewildered by the
divergent views of his different teachers. Experience has shown that
this can be done without sacrifice of individuality in teaching.
2. The examination system is unified so that there is little chance
of poorly trained students slipping through.
3. The cases in the wards are assigned by a carefully administered
system to those men who are best qualified to treat them, and every
aid to diagnosis is provided for by the team work of a group of
specialists who are constantly working together.
4. Classes are not missed because the instructor is detained by a
private case which it is impossible for him to leave. However well
a service consisting entirely of part-time men be organized, this miss-
ing of classes is inevitable.
5. The students are brought in contact with different types of
teachers at proper stages in their educational progress. They are
not asked to wander aimlessly in out-patients departments before
ihey have become familiar with the principles of diagnosis in the
wards.
6. All the clinical material of the hospital being available, it is
possible to show to the entire class, cases that are illustrative of all
the commoner diseases. Under the old system it was not infrequently
the case that many students went through their course in Medicine
and Surgery without actually seeing many types of disease.
426 ORAL HEALTH
Fundamental Weaknesses of the Full-Time System.
B}) One Opposed to It
1 . Full-time professorships and team or group practice are devices
evolved in the attempt to bridge over the gap between the man in
the trenches (the doctor in charge of sick folk in the home — and
95 per cent, of all sickness must be cared for in the home) and the
G.H.Q. at the Base (the research laboratories on which progress in
Medicine depends).
The lines of communication have been enormously extended in
the past fifty years, and particularly in the past ten years, by the
developments in Physics, in various branches of Chemistry, in Em-
bryology and other special departments of Anatomy, in Physiology,
in Psychology (if it can be called a science), and in other directions.
2. Workers in these latter fields have as a rule no sense of pro-
portion. They fail to remember that the human mind is finite, and
that the day is long past when any one living man can cover more
than a fraction of the fields they are exploring. Confusion of thought
has arisen, and they have forgotten that qua Medicine their subjects
are only a means to an end, not an end in themselves. They have
erected their research, usually conducted on abstract lines, into an
industry which they believe to have a right to exist on its own ac-
count. This position the physician or surgeon responsible for the
lives of his fellow creatures can never admit to be either sound or
justifiable in the relation between science and the healing art. Hip-
pocrates, born 460 B.C. and in a pagan community, in one of his
aphorisms puts the question right for all time when he says that *Tt
is the duty of the physician in undertaking the care of a sick person
to place the sick man and his friends and all his surroundings in
train for his recovery.'*
3. Another confusion of thought has emerged in the failure of the
pure science school to differentiate, in the curricula which they pre-
scribe, between the scope and methods of teaching which suit the
ends of the investigating and "researching" graduate, and those
applicable to the floundering undergraduate. Cognate with this
error is the very erroneous idea that research work in these subjects
ancillary to medicine is of itself cultural, and humanizing, and broad-
ening. On the contrary, the product obtained by these methods is,
so far as contact with the sick is concerned, very apt to be a mere
arid scholasticism rather than a humane and helpful scholarship
capable of providing what the sick chiefly need, i.e., moral support
and relief in their times of fear and pain. The system is much more
apt to produce technicians than clinicians.
4. This is very far from saying that research in general is not
desirable; it is both desirable and necessary, but must be made to
occupy its proper place in the scheme of medical training. Without
ORAL HEALTH 427
it, progress, real progress that is, in medicine is not possible. But the
full-time professor, and his adjunct, the group or team system of
leaching and practice, not only fail to give to the patient what he
most needs, moral support, but fail to provide for the public a type
of practitioner who can, without the technical skill required of the
modern physicist or physiologist or chemist, appropriate for clinical
uses in his contact with the sick the useful part of the research man's
work, and be a source of comfort and encouragement and rehef to
the public whom he serves.
5. The teacher of medicine would do well to note the synchron-
izing of the modern drift of the public to the irregular healer, to
quacks and wonderworkers and untrained pretenders, to Spiritualism
and Christian Science (sic), with the advent of our modern methods
of teaching, and present-day ideas of the relative importance of the
various subjects of the medical curricula of the day. There is more
than mere coincidence in it, though it is not intended to imply that
the one is the sole cause of the other. — University of Toronto
Monthly^. .
"The Deciduous Teeth"*
By Roscoe a. Day, San Francisco, Calif.
WE ARE SAFE in saying that perhaps it has only been in the
last ten or fifteen years that the child's physical welfare has
been taken at all seriously; it would be better to say that
medical science has discovered the fact that it is a better procedure to
begin at the beginning of Nature's endeavor and assist her as much
as possible toward the attainment of normality at maturity. I am sure
that the men in medicine are in perfect accord in that r^^gard. Through
their efforts the laity are being educated to the fact that it is of great
importance to give -^very assistance possible to the child for the sake
of his future physical welfare.
Beginning at the earliest age possible, seeking the advice of the
family ohysician or the pediatrician, to overcome any physical defect
or rearrange the diet, environr..ent, etc., action is usually taken at this
early period in order to assure the perfection of results at a more
mature life.
The medical man in his work, to the best of his ability, gives such
advice as he conscientiously knows to cover all aspects of human de-
velopment. His observation of the oral ca\tly, we feel safe in saying,
J? to some extent superficial; he knows the number of deciduous teeth
that should erupt in the arch at a given age and perhaps has a slight
knowledge of their position in the arches; also in a measure he may
determine whether caries is present or any other pathological condi-
tion exists.
*Rea(l before the ralifornia State Dental Association. .Tnno 20. 1921.
428 ORAL HEALTH
Perhaps, then, he has served his client well, and if at all in doubt as
to the oral cavity and its contents, he usually suggests that the dentist
be consulted to secure his judgment and advice.
As stated before, medical science takes the earliest possible cog-
nizance of the child's w^elfare, hence the dentist must live up to the
progress of our great profession, dentistry, and keep pace in every pos-
sible way with its allied professions and co-workers.
By so doing the dentist must accept the child at these tender ages
and give the services and advice that will assure, as near as possible,
at maturity, nature's original intentions, as far as the oral cavity is
concerned. It is hardly presuming too much to say at this time that
the average man in dentistry is not ambitious to care for the child's
mouth, for reasons of temperament on the part of the child, or his
great sympathy and love for children may overcome him to the extent
that he cannot cause suffering in operative procedure. He may be
entirely too busy along other lines in dentistry, not having the time at
his disposal for their welfare.
The demand is increasing yearly, through the medical man and
through the parents in all cultured and well-meaning homes, and, in
fact, by every care-taker of children, for early observation and atten-
tion of the dental apparatus from every aspect pertaining to the de-
velopment of t'he child. The dentist must be thoroughly versed on all
subjects pertaining to the physical development of the oral cavity, so
that he will be able to advise intelligently and, to an extent, give the
probable prognosis of the case presented, whether it be physically
and anatomically perfect or anatomically abnormal and physiologi-
cally imperfect.
There are numerous things to be taken into consideration upon the
examination of ^hese small patients. A complete history is necessary
whenever physical defects are present related to heredity of type, tem-
perament, diet, environment, etc. ; each individual case being given
special consideration from every aspect bearing upon the case.
Nature is always true to form and is most kind toward all living
th'ngs and rarely errs, and then only when interference prevents per-
fection on her part. Her endeavors toward creation are marvellous,
whether of the higher or lower animal life, and she presents result? in
most instances that are perfection within themselves. In our country
we do not have any set type of man, resulting from differei:t racial
marriasjes, perhaps more pronounced in our United States than else-
where in the world. We have what is termed the inherited individual
type
Nature's architectural lines in the child, when normal, are based
up'^n the result of the union of its parents, and that must be given ccn-
siderat'on in regard to the anatomical lines of the entire structure. The
anatomy of the oral cavity is governed accordingly; hence arcli for-
mation, tooth form, facial bone outline and articulation, muscular
ORAL HEALTH 429
placement and functioning, and occlusion of the teeth are created and
arranged as to the inherited type of each individual.
Normal occlusion must first be thoroughly taken into consideration,
and I do not believe it is possible, for anyone affiliated with dentistry,
to be fully equipped with the science of dentistry, unless he is thor-
oughly familiar with normal occlusion. It is the basis of successful
dentistry from every point of mechanics, whether operative, prosthetic,
and in many instances in the treatment of pathological conditions in
teeth and tissues of the mouth. The occlusion of the deciduous teeth
and arches is of paramount importance to the future mouth develop-
ment up to and inclusive of maturity.
Many is the time that parents state in our offices, "Why, Dr. Doe
told me to wait until all of the permanent teeth had erupted, before
taking into consideration the occlusion of the teeth and other functions
of the oral cavity." That theory might have been in vogue twenty or
thirty years ago, but today it is antiquated, and through years of prac-
tice, research and progress we have learned that it is all wrong. The
younger the better for treatment, whenever any malformation or mal-
occlusion makes its appearance.
Nature's tendency is always toward normal development, physi-
cally speaking, unless some form of interference prohibits. So, if for
any reason nature has been interrupted in her process of development,
it is only due her to give such assistance as may be necessary to elim-
inate the causes and stimulate her to a development corresponding to
as near the normal as possible at the age of the patient under observa-
tion. Then why wait? If any etiological factor upsets nature's orig-
inal intentions, why is it not logical to come to the aid at the earliest
possible age and give her such assistance as is needed?
It is of paramount importance to take into consideration the decid-
uous arches and teeth whenever necessary and to compare them with
the general physical make-up of the child, as to type, anatomical de-
velopment and general health, past and present.
The pediatrician tells us that a physically normal child does not
have any discomforting annoyance or reflex through dentition. He
probably is correct in that; a physically normal child does n6t suffer
reflex disturbances from dentition. But through investigation and in-
quiry by these same men we find that the greater majority of children
do suffer from reflex disturbances from dentition, in some form or an-
other, and much depends on the type and physical characteristic of
the child as to the extent of the disturbances taking place. During
this period the child is practically under the observation of the physi-
cian, but I feel that the dentist could be of great service in conjunction
with the physician by applying local assistance in several forms, and I
beheve that the future will call us to assist much more in this regard
than we have in the past.
After the deciduous dentition has been completed there is an abun-
430 ORAL HEALTH
dance of work for the dentist to do in all cases, whether normal or
otherwise. In normal cases the dentist has a function to perform in
educating the parent or caretaker to the proper care of the oral cavity
from every possible hygienic standpoint, as well as in performing any
necessary preventive work, to maintain the mouth up to as near the
normal, through the deciduous period, as it is possible to do. Nature
is most appreciative of such efforts, which are reflected upon the gen-
eral physical welfare of the child.
We all know that the structure of the deciduous teeth is lower in
resistance than that of the permanent successors. The deciduous mem-
bers are only intended to serve for a period of a few years until they
are succeeded by the permanent teeth. Hence it is most essential to
closely observe at frequent intervals these deciduous teeth and dis-
courage any pathological condition that may arise and have a ten-
dency toward their destruction, and to check up the occlusion to see
that the cusps of the erupting teeth are locked normally, — it will mean
much toward the future normal development of the oral apparatus, for
by so doing any of the naturally maintained mechanical stimuli will
not be lost. The occlusion of the teeth is thus maintained in normal
function, helping toward arch development, and with the locking of
cusps and the inclined planes and the normal mesio-distal contacts
functioning normally, it all works along the hnes of nature's plans of
arch development.
It is wasted energy to go into detail as to what results when we lose
all or any of these normal functions. We can briefly say that the
mechanical stimuli are lost and development processes greatly im-
paired through any destruction of deciduous tooth material. Also any
pathological condition that exists causes an extra tax upon the physical
resistance of the child.
Perhaps one of the saddest conditions is the lack of care of the
teeth, permitting caries to destroy tooth material to the extent that the
pulp tissue is involved, usually resulting in some pathological complica-
tion. This fault is usuallv traced to the carelessness or ignorance of
the parent in most cases. How difficult it is to treat a deciduous tooth
so involved with any degree of success is well known, and in many in-
stances reoccurrence of trouble follows after diligent services have been
performed.
In failures of that character it usually means premature loss of the
offending member, thus causing nature's system of mechanics of occlu-
sion and development to be greatly interrupted. In cases in which one
or more teeth are prematurelv lost it is most essential to make some
effort to mechanically retain the space in the arch, so as to avoid lack
of growth in that region sufficient to interfere with the total occlusion
and perhaps impaction of the permanent tooth.
There is another condition quite frequently met with in deciduous
mouths, and one that most parents do not take as seriously as they
ORAL HEALTH 431
should, owing to their satisfied feeling of mind that everything is so
beautiful to their eye from the esthetic standpoint, — that is the non-
absorption of the roots of the deciduous teeth at the scheduled ages,
preventing the permanent successor to erupt at all and causing it to be
misguided in the alveolus and possibly erupt in an impacted position
or out of line and into a mal-occlusion. We often hear the parent
remark, "It doesn't seem possible that my child could have such a
mouth at this age, because it had such beautiful baby teeth." The
result was that they were too beautiful for the good of the future
occlusion.
You all know that with normal body-growth the arches develop in
proportion, assisted by the pressure of the erupting permanent member
to succeed its predecessor, the deciduous tooth, plus muscular pressure
and other normal functions of the oral cavity. This growth is greatest
from about three and one-half to six years, and in a normal child how
readily one can follow the development during this period. The
arch growth is pronounced and it is beautiful to see nature do its work.
Arch growth, it will be noted, is in accordance with every other body
development, proper spacing in the anterior region of both arches
takes place, creating sufficient room for the permanent incisors to erupt
normally, also lengthening of both arches takes place, thus permitting
the first permanent molar to take its proper position.
Whenever body development is insufficient, lack of arch develop-
ment exists, resulting in lack of proper spacing and lengthening of
both arches, not allowing sufficient room to permit the permanent teeth
to succeed the deciduous members properly in the arches, causing
them to erupt either lingually or labially to normal, or else through
loss of mesiodistal contact an axle rotation of these teeth will take
place and they will be entirely out of alignment, thus resulting in a
total collapse in that region and loss of nature's system of mechanical
development and arch growth. This usually is the case when the
child's deciduous occlusion was too beautiful for the future permanent
occlusion.
Habits of childhood, acquired in numerous ways, should be
guarded against, brought about usually bv some form of nasal
stenoses, enlarged and infected tonsils, and other pathological condi-
tions, finger and thumb habits, lip habits, tongue habits and apparatus
used to soothe the irritated or spoiled child. Whenever discovered,
the parent should be told the disastrous results if permitted to continue,
as they are usuallv a potent factor in the causation of mal-formation
of the arches and mal-occlusion of the teeth. Environment many
times is responsible for total anatomical mal-development, which re-
flects on the oral cavity. Environment plus improper feeding is another
factor causinej so commonlv a form of disturbed development known
as mal-nutrition, a very serious condition which should be given early
attention. Interrupted ductless aland functioning, we are certain, has
a pronounced effect upon oral development.
432 ORAL HEALTH
After considering some of the characteristics associated with child-
hood that bring about these mal-formations and mal-occlusions, we
will enter more technically into the development and occlusion of the
deciduous mouth.
At the time of birth all tooth germs are formed, with the exception
of the second and third permanent molars, each lying in a separate
crypt in the bone of the arches, awaiting their turn for eruption. The
lower centrals are the first to make their appearance, and then the
upper centrals, or perhaps the lower laterals before the upper centrals,
until the twenty deciduous teeth have erupted each in its respective
position in the deciduous arches.
This dentition begins at no specified period as to age, but usually
from the sixth to the eighth month, extending over a period to the ages
of two or two and a half or three years. It depends upon the physical
characteristics of the child. Jaw growth is in accordance with total
body growth, and is assisted by the tongue and the associated organs,
by pressure upon the lingual surfaces, as well as by the mechanical
stimuli of the muscles of the face and mastication upon the labial and
buccal surfaces, plus the pressure of respiration in normal breathing
and in mastication.
Inharmonious functioning of these forces are influences that may
cause the cusps of the erupting deciduous teeth to lock abnormally and
bring about a mal-occlusion. The period in the life of a child that is
of vital importance from a dental standpoint, I believe, is perhaps
ignored by many men in our profession. It is a period that will have
the controlling influence upon the oral apparatus at maturity and
thereafter in many aspects, — that is, the period from the age of com-
pletion of eruption of the deciduous teeth up to and inclusive of that
of the eruption of the permanent ones; the transition period in the
arches from the deciduous to their successors, the permanent ones.
In the normal child we can note natural arch growth beginning to
take place from about four years on. In nature's anticipation to make
sufficient space to accommodate the succeeding permanent teeth,
spacing between the deciduous incisors will begin, showing natural
arch growth, assisted by the mechanical stimuli afforded by the pres-
sure of the permanent tooth follicles, permitting the first permanent
teeth to take their proper positions in the arches and in normal rela-
tionship mesio-distally to the adjacent teeth.
At this time I wish to emphasize the importance of an auxiliary
to a more positive diagnosis and probable prognosis of all deciduous
mouths when they come under our care, — ^that is, radiograms of the
entire jaws, including the teeth and tooth follicles. It gives positive
proof of what confronts the orthodontist, and he can then with clear-
ness act in a professional capacity as an adviser, and future operative
procedures are assured of greater accuracy, entirely eliminating any
guesswork or snap judgment. — The Pacific Gazette.
To the National Dental Association and Return
(Continued from November Issue)
THE present article must deal solely with our personal experiences
in returning from the Los Angeles meeting, and it will contain
nothing of professional interest or value. We left Los Angeles
on the evening of July 20th, before the close of the meeting, in order
to catch our ship at Seattle. We had planned to call at San Francisco
and Portland on our way to Seattle, but we had little time to give to
either place. At San Francisco we did manage to drive up Twin
Peaks, and through Golden Gate Park, making a brief call at the
Chinese quarters. Here we learned that the number of Chinese in
San Francisco has materially lessened. We were told that at one
time it was estimated that there were more than 100,000 Orientals
living in the city, but at present there are fewer than 20,000. They
have apparently gone out in the country on the farms, and if this is
true it is surely a most encouraging feature of the Chinese question in
California.
I have before stated that there is an atmosphere all its own about
San Francisco. It is the city of romance and adventure, dating back
even beyond the days of the Argonauts of '49, when the golden fleece
was sought by so many pioneers. The Golden Gate has always been
synonymous with the gateway to the Orient, and the flavor of Oriental
life was thus early infused into San Francisco, where it remains to an
alluring degree to this day. Then it brings up late memories of equal
interest — memories of Bret Harte, of Joaquin Miller, and of the im-
mortal mountain lover, John Muir. It is always a dangerous privilege
to give me free rein in speaking of San Francisco — I never know when
to stop.
It so chanced that Dr. R. Ottolengui, of New York, was on the
same train going from Los Angeles to Seattle, and I learned more
about entomology than I had ever known before. Chiefly I learned
that Dr. Ottolengui has the finest collection of butterflies — "moths*' he
calls them — that has probably ever been gathered together by any one
434 ORAL HEALTH
individual. He had many beautiful illustrations with him and as I
looked them over I marveled at the industry, perseverance, and en-
thusiasm which enabled him to gather such a wonderful collection. I
have never seen anything like it, and I never expect to see anything to
surpass it. It is the saving grace of our existence to have some one
absorbing fad to occupy our attention and divert us from the daily
routine of our occupation, and in this collection Dr. Ottolengui has a
most fascinating means of utilizing his spare moments. His chief
object in going up into British Columbia on this trip was to gather
some specimens, and the first thing I knew I found myself watching
for every chance butterfly that fluttered by. If you ever get an oppor-
tunity, please ask Dr. Ottolengui to show you his collection.
As we rode along between San Francisco and Portland we saw
some beautiful scenery and at the foot of one mountain there were a
couple of wild deer — young ones — within a stone's throw of the
train. We were in Portland only a few hours, and that in the evening,
so I did not get a chance to renew my acquaintance with the splendid
men of that city.
On Sunday morning we awoke in Seattle, and such a day as we
had in that wonderful city would be hard to duplicate. Dr. Ottolen-
gui took an early boat for Victoria while my family and I waited over
for a night boat which ran to Vancouver and Prince Rupert. Some
of the ships of the Pacific fleet were lying in the harbor, among others
the hospital ship, the Mercy, and the repair ship, the Vestal. We had
been given a letter by Pasadena friends to Lieut. -Commander Crowell
of the Vestal, and as we were anxious to see the machinery on a ship
of this type we boarded a launch and went out to visit her. I wish I
could give my readers something of an idea of the marvels of that ship.
She is only 465 feet long with a crew of 400, but in that restricted
domain she is a wonderland of miracles. Repairs must be made in the
Navy in record time, and we were told of one piece of machinery
which was cast and finished between Thursday and Sunday, which in
an ordinary foundry on land would require several weeks. They have
the facilities on board that narrow ship for making a 3,000 pound
casting, a feat that would test some of our pretentious plants on shore.
Of course to accomplish these marvelous results their equipment must
be of the most advanced and expensive type, and as we passed around
from one department to another and saw the intricate and mammoth
machinery I was lost in wonderment at the ingenuity of man. I would
not attempt to estimate the cost of that single arm of the navy, nor the
expense of maintaining it, but as I came away I could not escape the
reflection that there is something wrong with our civilization, when all
this stupendous expenditure of money, energy and ingenuity must be
devoted to the most efficient means of slaughtering our fellowmen.
And it is not the heathen or savage that we are arming against, but
men of our own race and plane of civilization — men just like we are
ORAL HEALTH 435
in most of the essentials of life, men who love their families as we do,
who have the same aspirations that we have, the same admiration for
the beautiful and the pure in life — and yet — and yet, we have not
learned to live with them on this earth in peace and harmony. We
have net, and they have not, attained to the fundamental fact of our
existence that the greatest sin of our common humanity is that of sel-
fishness. It is at the bottom of every war whether of individuals or of
nations, and not till we purge this foul pestilence from our very nature,
and learn to look in a broadminded way at the other man's point of
view, shall we achieve the highest function of our ordained existence
— that of living together in peace and harmony.
The reflection has often been made that there is no estimate of the
immense good that could be done if all the money and energy in the
world which is now being expended in perfecting the implements of
war could be diverted to peaceful pursuits, and the beneficent purpose
of preventing disease, and ameliorating the sufferings of humanity. It
is a sad reflection that we have gone so far astray in our ideals, and
not till all the nations of all the earth shall have accepted the profound
conviction that we must achieve a new point of view, can we ever hope
to enter even the portals of that kind of an existence to which we as a
human family are logically destined. Every one, no matter what his
sphere in life, should preach the doctrine of tolerance, of forbearance,
of consideration, and of brotherly love. It is the only solution of our
difficulties — the only sure means of regenerating the world.
When we came on shore from the Vestal we were met by a friend
who showed us more of Seattle that day than we had ever hoped to
see. Sometimes I think I would not exchange professional life for any
other kind of an existence. It frequently brings one in contact with
people in a more intimate relationship than that of other pursuits.
Several years ago one of my patients brought a gentleman in my
office, and introduced him as Mr. Schoenfeld of Seattle. He was
suffering from a very troublesome tooth, and plainly showed the suffer-
ing in his face. I was fortunate enough to be able to afford him
almost immediate relief, and soon sent him on his way rejoicing. It
was of course all-in-the-day's-work with me, and I thought nothing
further about it. But Mr. Schoenfeld persisted in remembering it.
He said it changed the whole tenor of his life that day, and made it
possible for him to play a game of golf, when otherwise he would
have been most uncomfortable.
When this Chicago friend heard I was going to Seattle he insisted
on me calling on Mr. Schoenfeld. I hesitated on the ground of dis-
turbing Mr. Schoenfeld, who I knew was a very busy man. His reply
was so emphatic that I could not well ignore it. Said he: "Mr.
Schoenfeld would be deeply hurt if he thought you would pass through
Seattle without going to see him." That settled it. I had called him
up before going on board the Vestal, and on our return he was waiting
for us at the dock.
436 ORAL HEALTH
When he drove us up through the town I did not recognize one
famiHar landmark. The last time I was there it was a city of ups and
downs, with cables to drag the cars over the hills. Now the hills have
been torn down and the place leveled, and I did not know whether to
be glad or sorry. But 1 was lost in admiration at the enterprise and
energy which had changed the surface of the earth, and made the city
a convenient one in which to get around and transact business.
Mr. Schoenfeld drove us about the city that day nearly seventy
miles, with never a dull moment. He showed us the Government
locks, and the wonderful land-locked harbor inside. He showed us
Lakes Washington and Union, and a fleet of twenty-four ships which
made my heart sad. They were lying idly side by side, slowly going
to "innocuous desuetude." They had been built by the Government
during the war at a cost of between $300,000.00 and $400,000.00
each, and had never been put in service. Now they were being dis-
posed of for $1,600.00 each — a loss to the Government of more than
$7,000,000.00, to say nothing of the interest on the investment since
they were built. Another concrete example of the folly of war.
We drove to the beautiful Seattle Yacht Club, where we enjoyed
such a delicious luncheon that it makes me hungry this minute to think
of it. We spent the afternoon driving through the fine residential dis-
tricts and beautiful parks, and visited the spacious grounds of the
University of Washington. It was at this latter place that I received
the surprise of my trip, and witnessed the crowning glory of that won-
derful day in Seattle. They are erecting some buildings on the
University campus that I predict will be a greater asset to Seattle than
any of her other marvellous achievements. They are beautiful beyond
anything I have ever seen in the way of buildings, not excepting even
those in far-famed Europe, where art is supposed to have attained its
highest expression. I did not get the name of the architect, but no
matter — it needs no encomium of mine to write his name high on the
scroll of fame. The buildings speak for themselves, and for the genius
of the man who designed them.
As we drove down toward the pier that Sunday evening, I felt that
it was "the end of a perfect day," my sole regret being the fact that
Mr. Schoenfeld positively refused to permit me to adequately express
our appreciation. Whenever I started to thank him he interrupted
with a charming abandon — "Please, Doctor, don't spoil what has
been to me a most delightful experience. The pleasure has all been
mine. If any of your friends ever come to Seattle, just let me know."
Can any one wonder that with such citizens as that the city of
Seattle is famed wherever her name is known?
^a^
"~i
*— 1
H THE COMPENDIUM h
This Department is Edited by
THOMAS COWUNG, D.D.S., Toronto
A SYNOPSIS OF CURRENT LITERATURE RELATING
TO THE SCIENCE AND PRACTICE OF DENTISTRY
—
zir i}=
Casting Processes from the Standpoint of the
Metallurgist.
THERE are few subjects that hold as much interest for dentists
as that of the casting of metals. General practitioners and
specialists are all interested in clearing up difficulties and per-
fecting some system whereby molten metals may be cast into molds in
such a manner that uniformly accurate casts will be produced. The
widespread use of inlays, removable bridge work, partial dentures,,
clasps, etc., renders this subject of casting one of paramount import-
ance to us as dentists. No doubt it was the recognition of this fact
that prompted the Los Angeles County Dental Society to have
M. W. Wilkinson, EM., MS., take up this important subject and
offer suggestions whereby many of our common difficulties and mis-
takes may be overcome. A complete report of his paper is pub-
lished in the March, 1922, edition of the '^Pacific Dental Gazette.**
In his opinion the production of accurate and dependable gold
castings is not controlled wholly by metallurgical knowledge, but
due consideration must be given the physical characteristics of invest-
ment compounds, the wax of which the pattern is made, the method
employed in burning out the wax, etc.
One of the outstanding difficulties in producing good castings is
the difficulty of properly melting alloys which contain oxidizable
metals. There seems to be no uniformity of methods covering this
important process.
The melting temperature is that temperature at which all the con-
stituent metals of an alloy are thoroughly liquid. The lower the
melting temperature, the more readily the material to be cast can
be converted into the liquid state, and the more conveniently it can
be cast. Coin gold, 90% gold and 10'^^^ copper, melting point
1735 P., is more easily liquified and cast than an alloy; 907^ gold
and 10% platinum, melting point 2085 F. There are dental oper-
ations, however, such as subsequent soldering and resoldering, that
necessitate the melting temperature of gold alloys used in dentistry
being sufficiently high to allow for the use of the highest gold solder,
and it is well to choose casting golds with this in mind. The melting
438 ORAL HEALTH
temperature of gold alloys is directly influenced by the proportion
by weight of constituent metals. Briefly, this influence of the alloy-
ing metals now used in dental casting golds, on pure gold, melting
point 1945 F., is as follows:
Copper, although higher fusing, 1980 F., lowers the melting point,
10% by weight lowering it as much as 210 F.
Silver is almost neutral in its effect, lO^f showing no appreciable
lowering of its melting point.
Platinum, melting point 3190 F., raises the melting point very
fast, 10% producing this effect to the extent of 140 F.
Palladium, melting point 2820 F., although lower fusing than
platinum, raises the melting point of pure gold much faster, ]0%
raising it 205 F.
Iridium is so high fusing that it cannot be used in dental casting
golds in that it will not stay mixed, tending to segregate in casting.
Zinc, of course, is the metal used in gold solders to lower their
fusibility.
Fluidity is an important property of casting golds. The degree
of fluidity again is dependent upon the composition to a certain
degree, but more especially on the degree of overheating above the
melting temperature in mehing. The more thinly fluid the gold is
without reaching the point of superheating, the more readily and
the more completely it will fill the details of the mold. New gold is
always more thinly fluid than gold that has been previously melted,
for the reason that absorbed gases and oxidation cause it to be
sluggish. This, however, can be overcome in part by the correct
use of the proper fluxes.
Many of the difficulties encountered in the casting of precious
metal alloys, such as occlusion of gases, brittle or incomplete cast-
ings, can be laid to oxidation of the so-called base metals with which
the gold is alloyed. The noble metals, gold, platinum, palladium,
ordinarily speaking, do not oxidize. Metals such as silver and cop-
per, essential to the strength of the precious metal alloy, do oxidize
under the influence of atmospheric air, the air and gas blow-pipe, or
the oxygen and gas blow-pipe, when melted previous to casting. If
these oxides are not removed, they will enter the casting as such and
a brittle gold results, the cohesion between the molecules of metal
being broken by intermingled molecules of metallic oxides. A sub-
stance which possesses the property of combining with or reducing
these oxides, forming with them a fusible slag, thereby increasing
the fluidity of melted metal, is called a flux.
An oxidizing flux may sometimes be used, such as saltpetre
(potassium nitrate) and borax. Such a flux would be suitable in
melting pure gold or metals that are non-oxidizable, copper and
other base metals, being impurities, are oxidized, and these are dis-
solved in the borax, thus purifying the gold as it is melted. When
ORAL HEALTH 439
a button of alloyed gold has been melted and remelted a good many
times without the addition of new gold, it has become so contami-
nated with oxides and other impurities that it is necessary to melt it
thoroughly with a large quantity of oxidizing flux before it is in
proper condition to be cast. The removal of copper from an alloy
may result in a loss of strength. Hence an oxidizing flux is used only
as a means of cleaning very dirty buttons, and its use is always fol-
lowed by a melting on a carbon block with a reducing flux.
A reducing flux is one possessing the property of combining with
oxygen forming a liquid slag. It contains something that has a
greater affinity for oxygen than that of the oxidizable metals, there-
fore the metals are relieved of their combined oxygen, the same going
into the slag. It is apparent, then, that theoretically no metallic
oxides enter the gold casting, and that no copper or other base
metal is lost in the process of melting and fluxing. This is not
entirely true, however, under the severity of a highly oxidizing flame
impinging directly upon a partially exposed metallic surface, but
the benefit derived is so marked as to make the proper and constant
use of a reducing flux essential in the correct handling of alloyed
golds. All alloyed gold buttons, previous to melting to be cast,
should be melted thoroughly on a carbon block almost to a white
heat, using large amounts of reducing flux, so that the button almost
swims in the flux. When the button has solidified and has reached
a dull red, chill in water, to remove adhering flux, boil in a weak
hydrochloric acid solution to remove surface oxidization, and neutral-
ize the acid by dipping into a concentrated soda solution. The
button is then ready for casting. Just previous to casting sprinkle
just a minute quantity of the reducing flux on the surface of the
melted metal. This will reduce surface tension, and allow the metal
to flow freely. The cleaner the flux the more freely the metal will
flow. Flux that has been melted and remelted in contact with
bodies that it dissolves finally becomes sticky and sluggish when
melted, and is then an excellent drawback to free flowing gold.
A gold alloy when molten may absorb gases. This impairs its
casting properties. Blisters on gold plate and pitted surfaces on
gold castings may be traced to this cause. Cast pure gold and cast
gold alloys are not dense in their structure when viewed under the
microscope. This means that between the molecules of metal there
are minute spaces filled with entrapped gas or air. By cold working
of cast metals such as rolling, hammering or drawing, a wrought
condition is induced, in which the molecules of metal are compressed
on themselves, increasing their density and thus increasing
their specific gravity. The minute spaces between the mole-
cules are eliminated in part, producing greater cohesion between the
molecules, thereby increasing the strength of the metal and
forcing out a large proportion of the gas locked in the
440 ORAL HEALTH
cast metal. If, however, a few pockets of gas remain after
rolling, these are compressed, and upon heating or annealing the gas
expands, and blisters are formed on the surface of the metal. The
volume of the occluded gases increases materially with the tem-
perature, so this process is more plainly perceptible with refractory
or high fusing metals, and with the use of high temperature and fast
melting devices. One who uses the ordinary gas and air blow-pipe
in melting casting golds never has the trouble from pitted golds such
as would occur if oxygen and gas were used, provided there is suffi-
cient heat to thoroughly melt the gold. Longer time is required to
melt the gold, and hence more time is allowed for the removal of
the gases before casting. A little flux in connection with the melting
will have a tendency to take up a great deal of the gases and pre-
vent the condition of "spitting."
The ill effects of these occluded gases in a metal may be prevented
sometimes by adding to the metal a body which enters with the
dissolved gas into a non-volatile combination that does not again
disintegrate. This must be a substance which has a great chemical
affinity for the dissolved gas. Copper has a great affinity for oxygen.
Silver absorbs and dissolves large quantities of oxygen in melting,
making it difficult to cast pure silver without blowholes. If we add
copper to the silver the absorbed oxygen chemically should combine
with the copper. This results in a more or less brittle casting. If
we melt the casting with a large quantity of dissolving and reducing
flux, as can be done on a carbon block, these oxides of copper would
be removed by solution in the flux.
Uniformity in castings is gained only through careful manipula-
tion, endeavoring to have, as nearly as possible, the same combination
of gases in the mixture from the blowpipe, the same position of the
flame on the metal, the same amount of reducing flux, and, as
nearly as possible, the same casting temperature. In connection with
casting temperature as an aid to securing uniformity, it is well to
choose the various casting golds for inlays, bridgework, clasps, etc.,
of as near the same melting or casting temperature as possible.
The principle of casting oxidizable metals where the melting is
accomplished by a direct open flame impinging upon the surface of
the metal, is wrong without doubt. To prepare alloys containing
base metals, such as copper, a reducing atmosphere is absolutely
necessary. The same is true of the melting of these alloys after they
are prepared. How to obtain these conditions in the melting and
casting of dental golds is a problem still unsolved, and a problem
which, if solved, will aid materially in producing gold castinejs of
proper degree of strength and elasticity, free from porosity and fol-
lowing in every detail the lines of the mold. Such castings are now
being made, but not uniformly so.
ORAL HEALTH I
EDITOR:
WALLACE SECCOMBE, D.D.S., F.A.C.D., Toronto, Ont.
CONTRIBUTING EDITORS:
C. N. JOHNSON, M.A., D.D.S.. F.A.C.D., Chicago.
RICHARD G. Mclaughlin, D.D.S., Toronto.
W. E, CUMMER, D.D.S., Toronto.
J. WRIGHT BEACH, D.D.S., Buffalo, N.Y.
Entered as Second-class Matter at the Post Office, Toronto.
Subscription Price, Canada and United States, two dollars per annum;
elsewhere three dollars. Single Copies, 25c.
Original Communications, Book Reviews, Exchanges, Society Reports, Personal Items, and other
Correspondence should be addressed to the Editor, Oral Health, 102 Wells Hill Ave., Toronto, Canada.
Subscriptions and all business Communications should be addressed to The Publishers Oral Health,
Royal Bank Building, 269 College St., Toronto, Canada.
Vol. XII.
TORONTO, DECEMBER, 1922
No. 12
H
EDITOR.IAIJ
Unprofessional Conduct
H
LEGISLATIVE authority to revoke the license of a dental
surgeon for "Unprofessional Conduct" will be found in most
or all Dentistry Acts. However, very few, if any, of these
acts make any serious attempt to define or illustrate what is meant
by "Unprofessional Conduct," preferring rather to leave such inter-
pretation to the profession, and, if need be, to the courts.
It may be that this is the better plan, as any attempt to define or
enumerate the different acts or conduct that could be pronounced
unprofessional would be a difficult task. The judges of our own land
to whom this matter has been referred for an interpretation have
seldom failed to deal with the matter in accord with the standard
laid down in professional ethics.
In the English courts perhaps the most outstanding case on record
is that of Allison vs. The General Council of Medical Education and
Registration. It was, in this case, proved that a physician had
pubhshed a large number of advertisements in newspapers which
contained reflections upon medical men generally, and their methods
of treating their patients. The advertisement also recommended the
public to apply to him for advice, and stated his address and the
amount of the fee he charged.
The Council caused his name to be struck off the medical regis-
ter for "infamous conduct in a professional respect." The court
442 ORAL HEALTH
before whom the matter came on an appeal confirmed the judgment
of the Council. Lord Esher, in giving judgment, said in part: "If it
is shown that a medical man in the pursuit of his profession has done
something with regard to it which would be reasonably regarded as
disgraceful or dishonorable by his professional brethren in good repute
and competency, then it is open to the General Medical Council to
say that he has been guilty of *infamous conduct in a professional
respect.' The question is, not merely whether what a medical man
has done would be an infamous thing for anyone else to do, but
whether it is infamous for a medical man to do. An act done by
a medical man may be infamous, though the same act done by anyone
else would not be infamous."
The same definition holds true in the case of a dental prac-
titioner. For clearness and conciseness. Lord Esher's definition of
"Unprofessional Conduct" is difficult to improve upon. The test
upon which he bases this judgment is both ethically and legally
unrefutable.
For example, would such a competent and reputable practitioner
so neglect the care of his office and instruments as to be a menace
to the health of his patients? Would he purposely deceive his patients
as to the character of the services rendered, that a larger fee might
be collected? Would a competent and reputable dentist commer-
ciaHze his profession by advertising glaringly in the public press
special prices for dentures or other restorations at certain hours or
on certain days?
Perhaps it is against the last-mentioned breach of professional
conduct that dentists should be particularly on guard. And in
referring to this matter I cannot do better than quote the opinion of
an outstanding leader of the dental profession on this continent— Dr.
Edmund Noyes, of Chicago, author of "Ethics and Jurisprudence
for Dentists." Dr. Noyes says in part:
**So deeply rooted and universal among professional men is the
conviction that public advertising of the commercial sort is incon-
sistent with professional self-respect, that nothing else will so quickly
and certainly cause a man to be ostracised by his professional asso-
ciates and cut him off from all professional societies. Moreover,
the advertisements themselves are so commonly untruthful or mis*
leading, and the practice they represent so often incompetent and
unscrupulous, that advertising has come to be looked upon as the
badge of quackery by the community as well as by the profession.
And the man who descends to it must expect to find the better classes
of people shunning him. That is to say, such advertising is quite as
sure to repel the most desirable patients as it is to attract a less
desirable class of people."
R. G. McL.
^
This book must be returned to
the Dental Library by the last
date stamped below. It may
be renewed if there is no
reservation for it.
APH2 3
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t
s^ry'
270-7-60
Harry R. Abbott
Memorial Library
FACULTY OF DENTISTRY
TORONTO
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