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some substance which will seal the pockets, shut and protect them from bacterial incursion is advisable. Many substances have been recommended for this purpose. The most valuable one of which the writer has knowledge is the following:

Merck's beechwood creosote saturated with all the iodine it will dissolve.

This makes a heavy black oily mixture

It may

Fig. 17 C.

thought advisable by the operator, the coating may be repeated every other day for several days, thus maintaining a condition of approximate asepsis. The author might state in passing that the application of this double coating to sutured incisions in the mouth protect these edges from infection and renders a wound much more comfortable than otherwise would be the case. also be applied to the cut edges where third molars have been uncovered by removing the gum. As soon as the bleeding has been checked by the application of hot packs, the cut surfaces may be coated with this heavy iodine solution followed by the tannic acid glycerine solution and the cut surface will be protected from infection and also from the irritation of the movement of the tongue. The method of carrying on pyorrhea treatment should follow certain definite lines and the judgment of the operator should be governed by the condition of the patient. In cases where we have only mild gingival inflammations and shallow pockets, the work may be rapidly accomplished without hurt to the patient. On the contrary, if the patient be subnormal in resistance, the pockets deep and heavily loaded with organisms, then the operation should be continued over a period of weeks involving only two or three teeth at each treatment. There are two reasons for this course.

The first is that if the limiting wall of granulation tissue so beautifully shown to be present in all these pockets by the pathological work of Talbot and others, I repeat, if the limiting wall of granulation tissue be broken down rapidly, an enormous inoculation of the patient occurs at once, and this enormous inoculation may result in an acute disturbance, wherein metastatic transfer plays an important part, and result in a myocarditis, endocarditis, joint infection, or acute abscesses, or chronic infection of the kidney.

The author has learned by bitter expe

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and is to be applied to the gum edge and to the neck from one-eighth to a quarter of an inch to the gum edge and reaching up on the tooth neck to the enamel of the crown. Carefully preventing the saliva from touching this after it has been placed, we immediately apply a second coat composed of glycerine in which we have incorporated all the tannic acid that it can be made to dissolve. Thus the tannic acid most completely covers the first coat of creosote-iodine, and, if it is placed before moisture comes in contact with the creosote-iodine, the two solutions seem to unite and form a dense, tough, black brown material which will cling to the tissues from twenty-four to forty-eight hours, protecting the gingival margin from a bacterial incursion for that period of time. If

for the simple reason that

massage tends to shrink and toughen the gum tissue and prevents further bony callus being poured out. As soon as the operator is satisfied with the amount of bony callus which he has gained, he may then begin massage. This massage should be

rience in the treatment of actual cases that haste in the treatment of these subnormal cases is exceedingly dangerous and subversive to the best interests of the patient, as he has noticed acute joint infection and even pneumonia to result in rapid sequence from, as he believes, over-inoculation from the tearing down of the limiting wall of the granulation tissue which must of necessity be broken down in the rapid treatment of these

A second reason for slow treatment by easy stages of these pyorrhea cases lies in the fact, that if the dosage of bacteria be gradually increased from

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cases.

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After Treatment.

Blood pressure fell from 150 to 120. No treatment and no emetine or other drug was administered, showing clearly that it is possible to bring about great changes in the treatment of Pyorrhea without drugs by efficient surgery only.

time to time, the ability of the blood stream to overcome the recurring doses of bacteria which of necessity must be forced into the blood stream by the surgical treatment, gradually raises the immunity of the individual so that at the end of a period of a month or six weeks' treatment of a case of this type, the patient's general resistance is steadily raised, appetite, ambition, and general well-being enhanced. In fact, treatment so carried on has all the good advantages of a polyvalent vaccine and none of its disadvantages. The post-operative care of an individual deserves also careful consideration. MASSAGE-WHEN AND WHY ADMIN.

ISTERED Massage of the gum margins should not be commenced following operative treatment until all outpour of bony callus from the process edge has ceased

suited to the gum tissue. Perhaps the best method of massaging the gums is with the cut end of the short heavy cot. ton roll. The dry cotton roll clings to the gum tissue and when held in a haemostat of a kuroris is easy of use by the patient. Its advantages are briefly that it expels the stagnant fluid from an oedematous gum margin and permits in. flow of fresh arterial blood. The act of massaging the gum margin drives into the circulation any bacteria that may

SO

a

have gained access into the tissue and places them where the leucocytes of the general blood stream will rapidly phagocyte them. General massage is in itself a kind of auto-vaccination and drives the enemy out of the field of action where it is more easily conquered and replaces the enemy in the field of action with new soldiers from the blood stream with the added benefit that the epithelial coat and connective tissue composing the gum is caused to grow more firm and dense and resistant, thus fortifying the gum margin from further infection by enhancing a more perfect structure and locking the door to further infection. The weekly use by the patient of the disclosing stain to guide him in his daily mouth hygiene has a double benefit. The solution now used by most men for disclosing purposes is that mentioned in the beginning of the article, and, tho many times published by those who use it, the writer will give its composition once more for the benefit of the younger men who do not happen to be acquainted with it: Iodine, fifty grains, zinc iodide and potassium iodide each fifteen grains, water and glycerine each four drams, making a total liquid bulk of one ounce with a total bulk of eighty grains of solid material incorporated therein. This should be very carefully triturated and may be sponged on the soft tissues and tooth surfaces without harm occasionally. The author believes it is too concentrated for daily use. Its double benefit accrues from the fact that it destroys instantly the vitality of the bacteria with which it comes in contact and also brings into view the fields where they grow in greatest number undisturbed, thus guiding the patient to a more careful effort in the daily hygiene of the mouth.

Daily prophylaxis by the patient is the greatest safeguard against reinfection and the monthly prophylaxis treatment by the dentist is the best guide to the

patient's endeavor. Treatment by the dentist should be very carefully done and not left to careless hands. In this prophylaxis work the injury of the gum should be distinctly avoided as well as injury of the enamel surface and exposed cementum. It is possible to conceive that too vigorous or ill-advised use of the polishing material on either the enamel or dentine surfaces can do these tissues great harm, even destroying or cutting grooves in them, and has given ground for criticism by many conservative men. This phase of treatment is

well understood that the author deems it unnecessary to discuss it under a special head.

There is, however, one more thought regarding this matter which appeals to the writer as vast importance, and that is the question of so guiding the daily life of a patient in the matter of food and diet that the oral cavity as well as the balance of the body increases its immunity to all types of infection. The work of Doctor Pickerel and Professor Gies of Columbia in this direction should be read and understood by every one of us. The work at present being carried forward by one of our

number, Professor Bunting of the University of Michigan also should bear fruit in this direction. The net result of the work of Professors G. V. Black (*1), Pickerel (*2), and Gies (*3), has been to indicate to us that we can accomplish an enormous amount for our patients by first limiting diet to exactly what we need for our daily regeneration, thus avoiding excessive deposits of calculus, ingesting those foods which tend to produce a salivary fluid inimical to the growth of bacteria, and the use of such fluids and mouth washes which will promote a normal salivary outpour. This to the mind, of the writer is an enor

own

*1- Black, in Dental Review 1913, *2--Pickerel on Decay.

*3--Gies' research report, Journal of Allied Societies.

mously valuable contribution and should never be lost sight of.

The title and scope of this paper does not admit of a lengthy discussion of these phases of the treatment of pyorrhea and prophylaxis, and the author feels in closing his paper, that in order not to create the idea in the minds of

this audience that he believes surgical treatment of pyorrhea is the Alpha and Omega of the subject, it should be stated that the powers that make for immunity should be always carefully considered.

I thank you for your kind invitation to appear before you and for the delightful courtesies that I have received at your hands.

ARE ENDAMEBAE IMPORTANT FACTORS IN THE

ETIOLOGY OF PYORRHEA ALVEOLARIS?

A STUDY OF THEIR HABITS.

Weston A. Price, M. S.D. D. S., Directing Researches for the Scientific Foundation and Research Commission of the National Dental Association.

Le Rue P. Bensing, A. B., Research Assistant, Cleveland, Ohio.

A

are

S DIRECTED, by the Scientific
Foundation and Research Commis-

sion, this department has been making special investigations to establish methods for the identification and differentiation of pathogenic and non-pathogenic organisms of the mouth and its lesions. This is a preliminary and partial report, made at this time to assist those who

with difficulty, taking up the study of endamebae, to outline some of the as yet unanswered problems relating thereto and to suggest some lines of parallel work for the co-operation of those of the prosession who may be in a position to assist in their solution.

The problem that is most vitally concerning the dental profession at this moment is, apparently, the relation of endamebic infection to so called pyorrhea alveolaris and the possibility of its cure with emetine. (1) The microscopic study is one essential line of approach and in order to provide a correct conception of what may be seen in the microscopic field, we will first review the characteristics of the living organisms. We should see and study reproductions of them which reveal their normal individualities, including not only their physical forms but also their natural movements in life's processes. There is as much dif

ference in the appearance of some organisms, when living normally and when dried and stained, as in the swimming swan or the bounding deer when seen at home in their haunts or when their skins are hanging in a tannery. We can learn to identify the swan or the deer by their skins in the tannery or the organisms of the mouth in the stained slide, but we have not learned to know them and their individualities, manners and habits until we have become familiar with them in their natural environments. We have found the motion pictures to be by far the best means for studying the habits of mouth organisms, for by this method we can make them do the same act over and over, with normal rapidity or with any desired slowness. While our studies have included various organisms of the mouth, we will present here chiefly studies of the normal vital motions of the endamebae and their relations to pyorrhea alveolaris. Unfortunately, it is impossible to adequately illustrate in still pictures what is shown in motion pictures, however, a good idea can be gotten by taking out pictures from the series at definite intervals. As indicated, nearly all of these shown are selected at onehalf second intervals of time, where the pictures are taken 16 to 20 per minute. In these shown, however, we have en.

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