which are reached by the medicament. in so short a time as ten minutes.

The experiments on Dakin's chlorazene and dichloramin-T give much encouragement for their use. They are, however, painful and destructive in over 0.5 per cent. strength. It must be remembered that this conclusion was drawn when eucalyptol was the solvent; the solvent chlorcosane eliminates this irritative action, so that percentages of dichloramin-T of over 6 per cent. may be used.

Among the general summary the points which are of special interest are- -(1) The efficiency of a root treatment is greater a few hours after it has been placed in the tooth than after several days' or even one day's time; (2) all areas of cementum and dentin are difficult to sterilize, as well as tend to reinfection when the medicated root dressing is left more than a few hours; (3) the medicaments that are most efficient, namely, silver nitrate and formalin, are very objectionable, the former by its discoloration and the latter by its destructive and irritating properties, except when used very dilute and for a short time, and then quite efficiently. The signification of this last cryptic phrase is revealed in Oral Health for April 1918, by Price, in a description of the method of Cameron of Girard College, Philadelphia, for the sterilization of root-canals, which Price characterizes as superior in results to any other current method. Put 4 per cent. solution of formalin into the accumulated débris and use it as a solvent for washing out the pulp chamber and canals, but not undertaking to put any of it through or to the apex. Follow this with a 2 per cent. solution of formalin. The canals are not flooded, but merely moistened with this solution. Place a hot wire into the canals, and when the solution is raised in temperature to about 120°, which will not be particularly unpleasant to the patient, formaldehyd gas is given off rapidly and profusely, and passes into the structures of the tooth. Teeth treated in this way show a very high percentage of efficiency, and the laboratory tests of Price and collaborators have confirmed it as more efficient than the methods used in the past. All is done at one short sitting, and the canals are immediately filled. In this way the irritative after-effect of formalin is quite obviated.

[American Journal of Clinical Medicine, Chicago, April 1918.]

Causes of Bad Breath. BY C. W. CANAN.

Bad breath may be owing either to local causes or to systemic disease. Among the causes that are local there is dental caries; however, bad mouth odor more often is a consequence of decaying food particles adhering to the teeth. The breath is very characteristic in pyorrhea alveolaris. Bad breath may arise from diseased conditions of the nasal cavity; especially so in chronic hypertrophic rhinitis. It is very fetid in gangrenous stomatitis, and sickening in necrosis of the jaw. Diseases of the tonsils, larynx, and pharynx disagreeably influence the breath. In follicular tonsillitis and pharyngitis, the odor is due to decomposition of the secretions and particles of food filling the follicles, and is like that of fecal matter, while that of diphtheria is suggestive of putrefaction. Canan does not refer to the breath in cases of Vincent's infection of the oral mucosa, which is so characteristic as to be almost pathognostic.

Among the systemic diseases in which the breath odor is adversely modified, Canan mentions diabetes mellitus, glaucoma, pyemia, chronic alcoholism, gastric and intestinal disturbances, nasal and oral localizations of syphilitic infection, aphthous stomatitis, uremia, gastric and hepatic carcinoma, pulmonary abscess, and chronic bronchorrhea. In addition to the above it is known that fits of anger or great excitement may and often do produce fetid breath; the breath of some women is always offensive during their menstrual periods; there are certain individuals, seemingly in perfect health, who have a bad-smelling breath all the time, usually attributable to faulty elimination.

Canan briefly considers the treatment. He makes the serious mistake of outlining the treatment in cases where the cause is localized in the oral cavity, and inferring that the general practitioner is able to deal effectively with such cases. Where the physician by elimination has located the cause of bad breath in the oral cavity, there remains nothing legitimate for him to do but to refer the patient to the dentist. The converse of this is fully appreciated by the dentist.

The particular paragraph of the treatment

This article is a very sensible and wellillustrated one, of some interest to dentists from the standpoint of war surgery. The employment of this method in an operation on the jaw sequent to fracture with loss of substance is described, and also as applied in general in wounds of the face. They conclude with a statement of the principles that should govern the science of bone-grafting. It must be remembered that a so-called living autogenous bone-graft is alive only by virtue of the osteoblasts that are free on its surfaces and in the mouths of the Haversian canals. All the rest of the graft dies, and is absorbed. It owes its value in bridging gaps and in encouraging union of ununited fractures to the fact that during the process of its absorption the osteoblasts which invade it from its own surfaces and from the neighboring bones build up new bone to take the place of that which is absorbed, so that ultimately the break in the continuity of the injured bone is bridged by new and healthy bone.

This established fact indicates at once the necessity for perfect contact of the graft with fresh, healthy bone in the fragments, and shows the reason for extending the graft well beyond the sclerosed extremities. It also shows the importance of using, as a graft, bone from which the periosteal and endosteal surfaces have not been removed, and it is on these surfaces that the greatest number of osteoblasts is to be found. For the same reason the graft should be made from bone which is as porous as the requirements of the case, in relation to strength, will allow. Hence the value of the rib as a graft, particularly if it has been opened up so that the osteoblasts of its interior can obtain the

necessary supply of lymph. After the prin

cipal graft has been inserted as many small pieces as possible should be packed around it, the fragmentation increasing the surface area exposed, and hence increasing the number of surviving osteoblasts. In those cases in which the, introduction of living osteoblasts is not an essential feature of the operation, the value of boiled bone must not be overlooked, as it possesses many of the virtues of the autogenous graft without some of its disadvantages.

[Journal of the American Medical Association, January 5, 1918.]

The Disinfection of Pneumococcus-carriers. BY JOHN A. KOLMER AND EDWARD STEINFIELD.

In the DENTAL COSMOS for December 1916, p. 1425, attention was called to the marked germicidal action of ethyl-hydrocuprein upon pneumococci. At that time it was suggested that this drug might be of some benefit in the treatment of pyorrhea alveolaris, in view of the fact that pneumococci are found in pyorrhetic pockets along with the closely related streptococci. The report now to be considered further enhances the desirability of putting this proposition to test. The authors have studied the disinfection of sputum and the mouth with solutions of various cinchonics in a menstruum of liquor thymolis. Their experiments demonstrate that the latter solution alone in dilution of from 1: 4 to 1: 10 possesses some germicidal activity for pneumococci, and aids in disguising the bitter taste of cinchona compounds. This problem has been mainly approached from the laboratory side, employing both normal mouth secretions harboring type 4 pneumococci and the sputum of pneumonia convalescents harboring type 1 pneumococci. The pneumococcidal activity of the disinfectant under study was largely determined by mouse inoculation.

The systematic use of ethyl-hydrocuprein hydrochlorid (1: 10,000) in a 1: 10 dilution of liquor thymolis, twice or more daily, is not dangerous from the standpoint of toxicity due to swallowing portions of the drug, is not unpleasant (bitter taste readily removed by rinsing mouth with plain water), and may aid in ridding the mouth of virulent pneumococci. Similar solutions, incorporated in a dental cream, may be used for cleansing the teeth. For washing the mouth or gargling,

[Bulletin of the Canadian Army Medical Corps, Ottowa, March 1918.] Infectious Ulcero-membranous Stomatitis and Gingivitis. By BowMAN.

Clinical and bacteriological examination was made of 1000 men in camp to learn (1) the number of men who cleaned their teeth carefully and the number who did not; (2) the number of men in each group showing Vincent's organisms present in significant number; and (3) the number of cases of clinically infectious gingivitis in each of these groups. There were 816 men with clean teeth; 314 (38.4 per cent.) showed Vincent's organisms present, but very few in number; 20 (6.4 per cent.) showed large numbers of spirochetes and fusiform bacilli, and were clinically positive cases.

Of the 1000 men 184 showed unclean teeth; 139 (75.6 per cent.) of these showed a few Vincent's organisms; 59 (32 per cent.) showed the organisms present in large number, and these cases were all clinically positive.

This is the detailed history of a single case. The patient denied venereal disease or recent exposure of any kind. The infection was apparent within twenty-four hours after he had had his teeth cleaned by a dentist. The whole picture presented a most severe type of mouth infection. Bacteriological examination showed an organism, identified with the diplococcus of Neisser.

The patient was sent to the hospital, isolated, and treated with a mouthwash of a saturated solution of thymol. The mouth and throat were swabbed daily with a 2 per cent. silver nitrate solution. Forty-eight hours after institution of treatment, the exudate began to disappear, leaving a raw, bleeding surface. At no time was there any odor from the mouth. Smears were negative on the twelfth day. Cultures were also negative.

Paper Points in Cleaning Root-canals. -Paper points may be passed along the canals with less danger of forcing dead material through the apex of the root than it would be possible to do with cotton wound upon a broach. Paper points also absorb moisture much more quickly and thoroughly, and give a better idea of the size and length of the canals.-D. H. SQUIRE, Journ. N. D. A.

Polishing Material for Dentures.-When the denture has been filed and dressed with the scrapers, the surface may be smoothed very rapidly by the use of equal parts of pumice, emery, and silex of medium fine grit.

By uniting these powders with equal parts of beeswax and hard oil the spattering and dust will be avoided and polishing will be a comparatively clean proceeding.-Pacific Dental Gazette.

Opening of the Pulp Chamber in Tender or Sore Teeth.-In caring for these teeth, frequently the patient cannot stand the pressure of instrumentation necessary to open the pulp chamber. To overcome this to a large extent I would advise the placing of a ligature of Cutter's silk around the neck of the tooth, and have the patient bring traction on the tooth, allowing him to pull as

hard as the pressure that is being exerted by the bur. In the case of the mandibular teeth the ligature may be placed over the head in order to pull up on these teeth. Another method that serves nicely is to place some modeling compound between the teeth to hold them apart, and then extend two wings of this material laterally, molding it into the interproximal spaces. When this splint is cooled and in place it will support the tender tooth during the operation, reducing pain to a large extent.-F. H. FRAHM, Pacific Dental Gazette.

Preparing the Stump for a Crown.When preparing the stump of a bicuspid or molar for a crown by grinding with stones and vulcarbo disks, angles are made that are very difficult to reduce. This trouble can very largely be overcome by the use of cloth and paper disks treated with a little vaselin or lard oil to keep them from getting wet and useless. These disks can be compelled to curve, and will cut only on one side; also they are not nearly so liable to injure the soft tissues.-Pacific Dental Gazette.

Preparation of the Mouth Cavity Previous to Dental Operations. In preparing the mouth cavity previous to a dental operation it is essential that the field of operation be as clean and free from bacteria as possible. In order to get a clean field the following procedures are suggested: (1) Mechanical cleansing of the teeth in the office before operating. (2) The use of a good spray of mouthwash. (3) Applying only a well-disinfected rubber dam, the tooth surface being disinfected before applying it as well as after.

If the above procedures are carried out one may be satisfied that he is operating in a clean but not a sterile field.-ADAH ROBERTA HOLMES, Journ. Calif. State Dental Association.

Root-canal Treatment a Specialty.-In view of our latest investigations and thoughts on this subject, there is little doubt that the treatment of pulpless teeth will soon become a well-recognized specialty. Many dentists are naturally unfitted for operations of this nature. As long as it is considered to be a duty of general practitioners they are forced to make an attempt to do what they realize they are not fitted for. It if were a well-recognized specialty, a large proportion of dentists would delightedly abandon such operations. The new standard of practice would receive a much earlier recognition if the subject were only discussed by such men as devote their time to the practice.-M. L. RHEIN, Dental Items of Interest.

Deaths from Cancer.-One woman out of seven and one man out of eleven, at the age of thirty-five, die of cancer. An average of 73,800 deaths occurred from cancer in the last ten years. In New York state in 1913, 9528 deaths were caused from cancer, nine times as many deaths as from typhoid fever. In twenty years the death-rate of cancer has increased 166.6 per cent., and if this deathrate continues for the next twenty years, it will be greater than the death-rate of consumption. Estimates indicate that from nine to twenty-six per cent. of all cancers are found on the tongue. Most of these cancers are on exposed surfaces where they may be discovered early, operated upon, and cured.— ALONZO M. NODINE, Dental Summary.

Vulcanite Tooth Replacement.-Several days ago the writer was shown a rather unique method of replacing a broken tooth in a vulcanite denture. After selecting a tooth of the right mold and shade, it is fitted into the recess of the broken tooth, with clearance for the pins, but without cutting the pink vulcanite. Then a horseshoe shaped loop several millimeters deep is cut in the vulcanite lingually to the tooth, leaving an island at the base sufficiently strong to resist a part of the strain that naturally will fall on this tooth. Now a small wire is twisted around the heads of the pins of the tooth, and fitted into the horseshoe-shaped groove. Lastly the tooth and wire are fastened and the case finished by sealing the repair work with zinc phosphate cement. This makes a rapid, easy repair that will last from six months to several years.-F. H. FRAHM, Pacific Dental Gazette.

The Mouth in a State of Health.Were one to try to state the conditions that are essential to a state of health in the human mouth, they might be summarized under certain headings.

First would be placed occlusion. Why? Because occlusion not only is one of the most important factors in the maintenance of a state of health in the mouth, but we need to realize more than we do as a profession that occlusion is the mechanism through which normal function molds every anatomical detail of its entire structure. So during the whole period of development of the human mouth, occlusion, through the forces generated in function, is the means of development of the anatomical form and the most minute microscopical detail of every structure, and is one of the most powerful factors in the maintenance of health.-FREDERICK BOGUE NOYES, Journ. Allied Dental Societies.

The Basic Principle of Fixed Bridge Work.-Fixed bridge work which has proved to be the most successful and has rendered the fullest measure of service through years of vigorous usage is work which first of all has been made in accordance with the principles that it should be attached to or supported by one or more abutments when of straight alignment, and should receive additional attachment and support from one or more intervening abutments or piers when of curved alignment.

This law we believe to be based upon sound physiologic and mechanical principles; it is one which may be intelligently and definitely understood, and it specifically prohibits the employment of fixed bridge work in all cases where there is an insufficiency of anchorage teeth for proper support.

Fixed bridge work which has been constructed and applied outside of this principle is in some degree a failure from its inception, and if it is possible to compare failures, it is noticeable that the degree of failure seems to be in proportion to the extent of deviation from this principle.-A. J. BUSH, Journ. N. D. A.

Pyorrhea Alveolaris.-In the March number of the New York State Journal of Medicine are the papers and discussions presented in a symposium on Infections of the Cervical Lymph Nodes at a session of the annual meeting of the Medical Society of the State of New York, held at Utica, N. Y., in the spring of 1917. Pyorrhea alveolaris was a subject thoroughly presented. An important practical idea in the treatment of this disease was offered by George E. Barnes, M.D., of Herkimer, N. Y., who said "An important matter is the prevention of infection of the nodes and of other parts of the body. Apart from those cases in which operative treatment is required there are many cases of pyorrhea alveolaris and a few cases of tonsillar crypt infection in which hygienic practice may be sufficient. This applies more particularly, of course, to adults. After brushing the teeth subsequent to each meal, about a teaspoonful of water is taken into the mouth, and flushed around while suction is made on all infected parts of the mouth and fauces. If the pyorrheal pockets and tonsillar crypts are not kept clean by this procedure, operative treatment must be further considered."

Removing Root-fillings.-In removing faulty root-fillings or artificial obstructions, chloroform under pressure should be employed at first for gutta-percha, using either a pledget of beeswax or unvulcanized rubber to get pressure for a few moments; then, with the canal flooded with chloroform, take a

fine smooth broach and endeavor to work down through or at the side of the guttapercha, following the smooth broach with either a Donaldson barbed root-canal cleanser or a Kerr root-file of suitable size to remove the gutta-percha, repeating the process until the obstruction is passed. The canal then is washed with chloroform until the cotton is not stained by gutta-percha. In this washing, as well as the opening, every precaution is used not to force any of the contents of the canal through the apical end of the root.

Most root-canal pastes are soluble in acid, and when these are found, sulfuric acid should be used instead of the chloroform. When cement or gold has been used, the utmost caution must be employed in picking and cutting these out. As a cutting agent in these cases, I use the No. round bur, which must be employed with the most painstaking effort if trouble is to be avoided.-W. G. EBERSOLE, Dental Summary.

Reliefs in Artificial Dentures.-If a hard area is sufficiently pronounced so that it can be easily detected with the light touch of the finger, and the surrounding tissues and ridges are even slightly soft or yielding, it is well to place a relief of 20 to 22 gage over the most prominent part, and another thickness of 28 gage over the entire area of the bone.

It is always well to relieve more than one thinks is necessary, rather than too little, for the relief will serve the double purpose of a relief (or to eliminate leverage during masticating pressure) and an air-chamber, both of which are valuable if properly placed.

The writer does not believe in an airchamber as it has generally been applied for retention, for the reason that, if it overlies soft tissue, it is only a question of a few days when the tissue will be drawn into it, and it will be of no value for the retention of the denture; and in many cases it will be the cause of hypertrophied tissue or a hard growth that will ultimately act as a fulcrum on which the plate will ride.

If the relief is placed over a hard bony area, there is, as a rule, no tissue that can be drawn into it, and if made deeper than the bony prominence, it will act as a permanent air-chamber and relief.

Relief for hard ruga. In many cases the rugæ are very hard and prominent, and it is important that a small instrument be used to scrape out the impression directly over each The relief should be very light, and may be sufficient to insure against the chafing of the base plate when making up the trial plate.

one.

Many plates have been condemned as failures simply because some one of the rugæ