Page 47 - An essay on the diseasesof the jaws, and their treatment

DISEASES OF THE JAWS. 25 and caustics, the actual cautery, or the knife for the extirpation of the lining membrane of the teeth;* and lastly, and above all, the * Until recently, the means used for destroying the sensibility of the teeth •were nitric acid and the actual cautery; but the dentists of the present day have become more fastidious in regard to the substances they employ for this purpose. Thus, chloride of zinc, pure tannin, nitrate of silver, and arsenic, have each their admirers, and one ingenious Frenchman (see " Lancet," 1834—35, i. p. 931) has invented a modification of the hydrogen jet on spongy platinum to supersede all other cauteries, actual or potential. But the most effectual plan for accomplish- ing the destruction of the vitality of the teeth is a combination of chemictd and mechanical means, recommended by Mr. Saunders, in his lectures at St. Thomas's Hospital. " In order to do this," says the lecturer, " the dentist will, with a sharp cutting instrument, remove a layer of the carious bone, and, at the same time» by a sharp and dexterous movement, excise the exposed surface of the pulp. We have now a bleeding, instead of an inflamed and highly tense surface; and if we now apply a few granules of the white oxide of arsenic, an eschar is formed in the course of a few hours, which will be totally insensible, and capable of sustaining pressure. ... I prefer to apply the arsenic on a plegget of wool or lint, previously dipped in creosote. This then constitutes the radical treatment for the actual forms of toothache, and is preliminary to the restoration of the organ to its wonted function, by the very beautiful and valuable operation, now so well understood and so generally employed " [namely, ' stopping.'] (" Forceps," March, 1845, p. 50.) To medical men it is unnecessary to point out that an eschar formed on the pulp of a tooth'obeys the same laws as an eschar of any other tissue, and that* consequently, however minute the process may be in such parts, separation by ulcerative inflammation must naturally follow the formation of a slough here aa elsewhere, and I leave it to them to judge, whether such a state of parts constitutes a proper preparation for the insertion of a material to take the place of the lost substance of a carious tooth. To me it appears hardly less objectionable than would be the production of gangrene in the stump of an amputated leg, as a pre- paration for the adjusting of an artificial limb. But the truth is, that the eschar re- sulting from this application of arsenic is tantamount to destruction of the entire pulp, which, so far from being a texture capable of throwing off"an eschar of its substance, and then healing, is a delicate tissue of vessels and nerves, that incurs the most imminent danger of being destroyed by even a slight and superficial wound. The artificial destruction of the pulp, moreover, is never effected, without in- volving in necrosis some portion of the walls of the pulp-cavity of the tooth. I regret to observe, that Mr. Tomes also is an advocate of this destructive treatment; which is, nevertheless, utterly at variance with that physiology of which he is so eminent and successful a cultivator. " It is a very good practical rule," he says, " if in removing the softened dentine, or in pressing a probe in the cavity, pain is felt, but only so long as the instrument remains in contact with the tooth, to proceed to plug the cavity; but if the pain continues after with- drawing the instrument, to postpone plugging, and resort to some means to restore the pulp to a healthy condition, or to produce its destruction" ("Aledical Gazette," 1847, vol. xxxix. p. 357.) " Escharotics," he continues, at p. 756, * may be used in a diluted form, so as to destroy the surfiice only, or they may be applied in a more concentrated state to kill the whole body of the pulp." The sole object of stopping carious cavities being to preserve a/irc the teeth that are affected with them, and the operation, so far as it is curative (and not pimply prerentive, and of the nature of a restoration of lost parts, like the after