Columbia Mnibtv^itp ^oc^^^ in tije dtp of i^eto ^orfe Retool ot ©ental anb 0xal ^urgcrp 3^eferente 2.itirarp Digitized by tine Internet Arciiive in 2010 witii funding from Columbia University Libraries http://www.archive.org/details/dentalpathologyt1895ingl DENTAL PATHOLOGY THERAPEUTICS IX THK FORM OF QUESTIONS AND ANSWERS COMPILED BY OTTO E. INGLIS, D. D. S. CAREFILLY REVISED AND APPROVED J. FOSTER FLAGG, D.D.S. PROFESSOR OF DENTAI- PATHOLOGY AND THERAPEUTICS IX PHILADELPHIA DENTAL COLLEGE THIRD EDITION. P H I L A D E E P H I A COPYKIGHT, OTTO E. INGLIS, 1892. ALL RIGHTS RESERVED. Printed by A. T. Zeising & Co., Philadelphia. Electrotyped by Duncan & Ross. CONTENTS. GENERAL PRINCIPLES. Life Force, 1; Means and Theory of Eelief, 4; Prefixes and Suffixes, 6; Principles and Practice of Dentistry, 7; Dental Pathology and Thera- peutics, 8; Definitions of Disease, Etiology, etc., 9; Signs and Symp- toms, 11; Intrinsic and Extrinsic Precedents to Disease, 12; Predis- posing and Exciting Causes, 14; Elements of Disease — Primary and Proximate, 24; Special Medicinal Stimuli, Cathartics, etc., 29; Blood — How Obtained, How Replenished, 43; Pulse, Its Varieties and Normal Frequency, 44; Constituents of Normal Blood, 47; Divisions of Blood, 48 ; Anajmia, 58 ; Plethora, 65 ; Determination of Blood, 73 ; Conges- tion of Blood, 78; True Inflammation, 81; Classes, Duration and Causes of Inflammation, 84; Reaction, 90; Results and Terminations of Inflammatory Action, 91 ; Adynamia, 108. DECIDUOUS TEETH. Anatomical and Physiological Divisions of Teeth, 109; Faces of Teeth, 112; Functions of Pulp and Pericementum, 113; Eruption of Deciduous Teeth, 115; Pathological Dentition — Symptoms and Terminations, 117; Remedy — Lancing, 125; Hemorrhage After Lancing, 142; Dangerous Period During Dentition, 146; Indications for Extraction of Deciduous Teeth, 147, PERMANENT I^EETH. Eruption of, 149; Pathological Eruption of Upper Wisdom, 150; Patholog- ical Eruption of Lower Wisdom, 151; Extraction of Six-Year Molars, 155. DENTAL CARIES. Dental Caries, 156; General and Local Causes, 157; Periodicity of Decay, 165; Efl:ect of Decayed Teeth Upon Others, 167; Sex in Caries, 168; Tobacco, 169; Theory Taught, 170; Prophylactic Treatment, 171; Relative Liability of Teeth to Decay, 174; Methodic Examination, Positions for Caries, 176. Odontalgia.— Causes, 182, 290, 351, 395. (iii) iv CONTENTS. Sensitive Dentine. -7-Classes Discussed Under, 183; Symptoms and Diag- nosis, 184. Cases With No Perceptible Cavities of Decay. — Locations and Appearance, 187; Acids as Cause of Sensitive Dentine, etc., 189; Its Treatment, 190 ; Neuralgic Complications Irom Sensitive Dentine, 192. Superficial Caries.— Removal of, 194 ; Sensitive Dentine in, 195, Simple Caries. — Remedies for Sensitive Dentine, 198; Topical Applications — Not Dangerous to Pulp, 203; Those Possibly Dangerous, 210; Those Liable to be Dangerous, 211; Chloride of Zinc, 213 ; Carbonate of Potas- sium, 230; Chromic Acid, 236; Ethylate of Sodium, 243; That Dangerous — Arsenic, 245; Pulp-Protectors, 249; Zinc Phosphates, 251; Systematic Consecutive Obtuuding, 252 ; Heat, Cold, Electricity, 254 ; Systemic Treatment, 263; Anaesthesia, 264. Deep-Seated Caries.— Deep-Seated Caries, 197; Condition and Treatment of Cavities, 268; Syringing, 273; White, Yellow and " Horny " Decay, 274; Conservation of Decay, 278, 301; Materials for Filling, 282; Dangers Prospective After Filling, 284 ; Recalcification, Tubular Con- solidation, Secondary Dentine, 286; Pulp Irritation, 290, 316, 354 ; Spontaneous Pain, 299; Pulp Conservation, 307, 393; Success and Failure, 308; Remedies, Intermediates, etc., 317; Gradations of Decay to Exposed Pulp, 321 ; Controlling Influences in Pulp Conservation, 323; Age, Temperament, 324; Dental Temperaments, 339; Physical Condition, Over-exertion, Sex, etc., 340; Third Cause of Odontalgia, 351; Periodicity, 353; Diagnosis of Exposed Pulp, 355 ; Medicaments Used for Soothing Pulps, 372. Pulp Capping.— 373 ; Qualities of Cappers, 376; Cappers, 379-388; Time Allowed Before Success Pronounced, 389; Lingering Death of Pulp, 392; Pulp Irritation from Disease of Surrounding Parts, 397; Pulp Irritation from Abrasion, 398; Cupping on Edges of Teeth, 401; Causes of Fracture of Teeth, 404. Absorption of Permanent Roots, 405. Pulp Nodules, 406-414. Fungous Gum and Fungous Pulp, 415-423. COMPLICATED CARIES. Pulpless Teeth Not Dead Teeth, 425; Dead Teeth, 427 ; Results of Death of a Pulp, 431 ; Discoloration of Tooth, 433; Pulpless Teeth Sometimes Better Than Teeth Wholly Vital, 438. Devitalization of Dental Pulp.— Cauterization, 440; Instrumentation, 442; Luxation, 443; Arsenic, 444; Tests for, 447; Characteristics of, 450 ; When Introduced, 451 ; Arsenic as a Vital Irritant, 452 ; Its CONTENTS. Action Internally, 454 ; Swallowing an Arsenical Application, 457 ; Sys- temic Action from Local Application, 458 ; Action Upon the Gum Tissue, 460; Forms iu Which Arsenic is Used, 463; The Application of Arse- nic for Pulp Devitalization, 464; Proper Preparation, 465; Proper Plac- ing, 468; Devitalizing Fibre, 471 ; Pockets, 472 ; Proper Guarding, 474 ; Proper Maintenance in Position, 479 ; Time Needful and Possi))le for Arsenical Applications, 480 ; Action of Arsenic Upon the Pulp, 484 ; Peri- dental Irritation a§ a Result of Arsenical Devitalization, 491 ; Absorp- tion of Arsenic by the Pulp, 492, 500 ; Suffusion, 493; Repeated Appli- cations of Arsenic, 495; Intractable Pulp, 493; Devitalization of Deciduous Pulps by Pressure, 498; Calcification and Decalcification of Roots, 502; Antagonistic Treatment of Deciduous and Permanent Teeth. 503. Pulsating Pulps, 504-509. ExTiKPATiON OF DENTAL PuLP.— Success in, 510 ; Essentials for, 511 ; Tapping, 512; Sensation in, 515; Broken Broaches in Canals, 517; Treatment of Single-Rooted Teeth, 520; Treatment of Multirooted Teeth, 522 ; Partial Devitalization, 516, 523; Medicaments for Canals, 524 ; Stopping Tooth, 525 ; Hemorrhage, 526 ; Peculiarities of Root Formation, 527 ; Extirpation of Deciduous Pulps, 529 ; Probabilities of a Palpless Tooth and Possibilities of a Pulpless Tooth, 530. EXOSTOSED, FUSED, ATTACHED AND GEMINOUS TEETH. Dental Exostosis, 533; Form of. 537; Causes of, .542 ; Symptoms of, 545; Sympathetic Trouble from, 546; The Fifth Pair of Nerves, 547; Treatment, 548; Fractures from Extracting Exostosed Teeth, 549. Fused Teeth.— Causes and Symptoms, 553-555. Attached Teeth, 556. Geminous Teeth, 557-560. • PERIODONTITIS. Stages of Inflammation Included m the Term, 562, General Dental Hypertes- thesia, 563 ; The Cause of Periodontitis, 567 ; The Five Grades of Perio- dontitis, 568 ; The Seventeen Recognized Causes, 569 ; Want of Occlusion, 570; Mal-occlusiou, 571 ; The Natural Moving Tendency of Teeth in the Mouth, 572 ; Salivary Calculus and Tartar, 573 : Loose Tooth or Root, 575; Induration of Tooth Tissue, 576; Cavities of Decay Imj)ingiDg Upon the Cemeutum, 579; Treatment of Hypertropliicd Gum. 580; Mechanical Irritation, 581 ; Split Teeth, 582; Dental Manipulation, 583; Excess of Filliug Material, 584; Inflammation of Pulp, 591; Varieties of Hemorrhage, 595; Forcible Withdrawal of Pulp, 599; VI CONTENTS. Putrescent Pulp, 601 ; Clouding, 603 ; Time Kequired for Putrescence of a Devitalized Pulp, 605 ; Venting, 608 ; Counter-Pressure, 613 ; Treat- ment of Tooth After Venting, 614; Previous Periodontitis, 616; Ke-establishment of Normality in Diseased Tissue, 618 ; Periodontitis from Sympathy, 619; Action of Medicine Locally, 622; Action of Medicine Systemically, 624 ; Action of Virus, 628 ; Signs and Symp- toms of Periodontitis, 629 ; The Health Line, 630 ; The Treatment of Periodontitis, 633 ; Acute and Chronic, 634 ; Chronic Forms of Perio- dontitis, 636 ; Prophylactic Treatment— Local and General, 638 ; Treat- ment for Second-Grade Periodontitis, 642 ; Treatment for Third Grade, 643; The Gutta-Percha Guard, 645; The Eubber-Dam Guard, 646; The -'H" Guard, 647; The Block Guard, 648; The Filling Guards, 649 ; The Placing of Guards, 650 ; Local Sedation, 651 ; Local Medication, 652 ; Drilling Apical Vent, 653 ; Constitutional Medication, 656 ; Antiseptic Treatment of Canals After Cure of Perio- dontitis, 658 ; Systematic Stopping and Unstopping, 660 ; Condition of Tooth After Cure of Periodontitis, 664 ; Stimulation for Suppuration, 666, 675 ; Fourth-Grade Periodontitis, 666 ; Chronic Periodon- titis, 667 ; The Kesults of Chronic Periodontitis— Watery Effusions, Indurations, 671. ALVEOLAR ABSCESS. Causes for, 680 ; Condition of Tooth After Cure, 681 ; Location of an Alveo- lar Abscess, 683, 698; Signs and Symptoms of Acute Alveolar Abscess, 686 ; Signs and Symptoms of Chronic Alveolar Abscess, 688 ; AVays in Which an Abscess May Discharge Its Pus, 689 ; Prognosis of Alveolar Abscess, 690 ; Possible Sequelae, 692 ; Palliative Treatment, 694 ; Curative Treatment, 695; Treatment of Tooth With and Without a Fistulous Opening, 696; Injections for Fistulse, 696; Diagnosis and Treatment of Abscess in a Bifurcation, 699 ; Canal Medicaments, 702 ; Treatment of Abscess With External Fistula, 703 ; Treatment of Abscess if Sac be Left After Extraction of Tooth, 708. CARIES AND NECROSIS. Diagnosis and Treatment of Carious Bone, 709 ; Diagnosis of Necrosis of Alveolar Process, 711; Cause and Treatment of Caries of Alveolar Walls, 712 ; Lesions Occasioned by Dead Teeth, 714 ; Diagnosis of Portion of Root Within Alveolus, 715. PYORRHCEA ALVEOLARIS. Cause, 717; Treatment, 718; Prognosis, 719. MEDICAMENTS. Arranged in alphabetical order. DENTAL PATHOLOGY AND THERAPEUTICS. GENERAL PRINCIPLES. 1. Question. — What is that force called upon which depends all response to remedial efforts ? Answei'. — Vis Vitce (life force). 2. What is this force called as a conservator? Vis Qonservatrix Naturce. 3. What as a medicator ? Vis Medicatrix Naturce. 4. What is the employment of indicated means for relief called? Ars Medendi. 5. What is the theory of relief called ? Matio Medendi. 6. What are the meanings and uses of the prefixes "hyper," "hypo," "a" or " an," "epi,"and the suffixes "itis" and "algia?" "Hyper," above, excessive; "hypo," under, beneath, defi- ciency; "a" or "an," without, lacking; '' epi," upon, on; "itis," inflammation; "algia," pain. 7. Define the " Principles and Practice of Dentistry." Such application of general facts as is subservient to the requirements of dentistry. 8. What is " Dental Pathology and TliL'ra})eutics? " Dental pathology considers the causes and different forms of the various diseases to which the teeth are liable; dental (1) DENTAL PATHOLOGY AND THERAPEUTICS. therapeutics considers the methods and medicaments used in the treatment of such diseases. 9. Define the terms "Disease" "Etiology," "Semiology" and "Nosology." "Disease," pervei^sipn of nutrition; "etiology," causes of disease; "semiology," the symptoms and signs of disease; "nosology," the classification of diseases. 10. Define the terms "Diagnosis" and "Prognosis." "Diagnosis," distinction of disease; "prognosis," the foretell- /.Tig of the probable and possible progress and termination of disease. 11. What are signs ? What are symptoms? Signs are indications which can be seen; symptoms are feelings as described by patients. 12. What is i\\Q first natural division of essential precedents to disease? "Intrinsic" and "Extrinsic." 13. What is the meaning of these terms ? "Intrinsic," excess or deficiency of functional action or of some constituent of the economy; "extrinsic," external agencies ■wliich have power to act on either mind or body. 14. What is the second natural division of these causes ? "Predisposing" and "Exciting." 15. What are predisposing causes? Circumstances which influence function or structure unfa- vorably, yet short of actual disease. 16. What are exciting causes? Causes which of themselves induce disease, or which promote the resulting effect of the predisposing cause. 17. Are the predisposing and exciting causes both necessary for disease ? , As a rule they are. 18. Name an example where both are not necessary. A splinter in the flesh is an exciting cause only. 19. Are these causes susceptible of tran.sposition ? Yes; an exciting cause may be at times a predisposing cause, and vice versa. 20. Give an example. Debilitating exposure to cold may predispose to diarrhoea from indigestible ingcsta. Transposition — One predisposed MEMORANDA. MEMORANDA. GENERAL PRINCIPLES. 3 through irritability of the intestines will incur diarrhoea by exposure to cold. 21. Name the predisposing causes of disease, according to Williams. 1. Debilitating influences. 2. Excitement. 3. Previous disease. 4. Present disease. .5. Hereditary constitution. 6. Temperament. 7. Age. 8. Sex. 9. Occupation. 22. Into what two classes are the exciting causes of disease divided ? " Cognizable " and " Non-cognizable." 23. Name some of each, according to Williams. f 1. Mechanical. 2. Chemical. 3. Ingesta. 4. Bodily exertion. 5. Mental emotion. 6. Excessive evacuation. 7. Suppressed or defective evacuation. 8. Defective cleanliness, ventilation and drainage. 9. Temperature and changes. 1. Endemic, -j ( Some of these regarded as 2. Epidemic, i Poisons. -j now cognizable from the 3. Infectious. J ^ bacteriological standpoint. Cognizable Causes. non-cognizable Causes. 24. What are the "elements" of disease? Functional, structural, circulatory and nutrient departures from normality. 25. AVhat is the division of the "elements" of disease? Into "Primary" and "Proximate." 26. Name the primary elements of disease. Structural. COXTRACTILE FiBEE, Functional. Irritability. Tonicity. r Sensibility. Nervous Structure, \ Voluntary motion. Secretory Tissue, Reflex action. L Sympathy. Secretion, Excessive. Defective. Abnormal. DENTAL PATHOLOGY AND THERAPEUTICS. 27. Name the proximate elements of disease.* Defective, ( General. "Anaemia." 1 Local. u Increased, ■-3 " Sthenic." General. "1 Diminished, ^ o " Asthenic." Increased, Blood Excessive, ^ "Determination." IX " Plethora." .2 Diminished, ClKCULATION. _ Local. ^ -1 " Congestion. " S Partly increased and ^ partly diminished, "Inflammation." Terminations of In- flammation: "Eesolution," "Suppuration," Perverted, "Cachsemia." "Gangrene," ] ^^ "Mortification," f ^o^*^ " Sloughing," (•?)! -'P^'^t^- Defective, ' 'Atrophy." "Caries," ^ q^ "Necrosis," li,ard - "Exfoliation."(?)tJ parts. nuteitiox of Tissues. Excessive, "Hypertrophy." , Degenerations. Perverted. ■ Depositions. . ^ Growths. 28. What is the diiFerence between a primary and a proximate element of disease ? The former considers the pathological condition of a certain function or structure ; the latter considers tlie modifications of circulation and the concomitant effects upon tissue. 29. Into what classes are special medicinal stimuli generally divided ? . " Cathartics," " Diuretics," " Diaphoretics " and " Sudorifics," "Expectorants," " Sorbefacients," " Eramenagogues,", " Siala- gogues," "Errhines." 30. What are " cathartics ? " Medicines which increase the alvine discharges. * Williams' Principles of Medicine— Clymer, pp. 92 and 93. t Questionable terminations dependent upon systemic power or necessary interference. MEMORANDA. MEMORANDA. GENERAL PKIXCIPLES. 31. How are they divided ? Into" Laxatives " or "Aperients," and "Purgatives," accord- ing as they act mildly or decidedly. 32. What peculiarity of action pertains to these ? Some act upon the superior portion of the intestines (exam- ple — calomel) ; some upon the inferior portion (example — aloes) ; others upon the "whole extent of intestines (exam- ple — sulphate of magnesia). 33. What are " diuretics ? " Medicines which increase the secretion of the urine. 34. What are " diaphoretics ? " Medicines which increase perspiration. 35. What are " sudorifics ? " Medicines which induce copious perspiration. 36. What are " expectorants ? " Medicines which excite secretory action in the air-passages. 37. What are " emmenaojo^ues ? " Medicines which are regarded as having the power of inducing or increasing the menstrual dischara;es. 38. What are " sialao;o2;ues ? " Medicines which induce an increased flow of saliva. 39. What are " errhines ? " Medicines which induce increased nasal discharges. 40. What is a " seton ? " A strip of linen, or piece of thread, which, by means of a seton- needle, is passed through a fold of the skin and allowed to remain. By occasional moving of this, counter-irritation is maintained. 41. What are " epispastics ? " Applications to the exterior of the body which produce redness, usually pain, and an eifusion of serum, thus separating the epiderm from the " cutis vera" and presenting what is called a "raw surface" (commonly called "blisters " ). 42. What are " alteratives ? " Medicines which are accredited with eifectino; a change for the better throusrli the general function of nutrition. 43. HoAv is blood obtained, and how is it replenished ? Obtained through digestion and assimilation ; replenished by food. DENTAL PATHOLOGY AND THERAPEUTICS. 44. What is the " pulse ? " At what points is it taken ? Pulse is the eifect of the heart-beat upon the blood in the arteries. Usually taken at the radial, brachial, temporal, carotid or femoral artery, or from over the heart itself. 45. Name the varieties of pulse and their opposites. " Frequent and slow " (refer to the number of pulsations in a minute); "hard and soft" (refer to compressibility — hardness indicates general strength ; softness indicates prostration) ; " quick and sluggish " (quickness indicates slight irritability and debility ; sluggishness indicates .exhausted irritability and debility); "full and small " (refer to volume of pulsation ; unreliable except when taken into consideration with other kinds of pulse) ; "• strong and weak " (strength is a general indication of health ; weakness, of an opposite condition) ; " regular and irregular" (belong to nervous disorders or idiosyncrasies). 46. Give the normal frequency of the pulse from foetal life to old age. Foetal heart, 140 beats per minute. At birth, 130 " " " First year, 110 " " " Second y.ear, 100 " " " Fifth year, 90 " " " Tenth year 85 " " " Puberty, 80 " " " Adult, 75 " " Old age, 80 " " " 47. What are the ordinarily classified constituents of the jlood — the relative proportions in normal blood ? *Eed and white corpuscles, 140 parts. Fibrin, 3 " Albumen, 70 " Fatty matters, 4 Salts, '. . 6 " Water, 777 " Total, 1000 " 48. What is the division of the blood in circulation ? Red and white corpuscles and liquor sanguinis. 49. What is the division of drawn blood? " Clot" and serum. •Approximate average proportions. MEMORANDA. MEMORANDA. GENERAL PRINCIPLES. 50. What is the "clot?" The red and white corpuscles suspended in meshes of fibrin. 51. What is serum ? The albumen, salts and fatty matters of the blood held in solu- tion by the water. 52. What is the first act of vitality in connection with the blood? Coagulation. 53. What is the last act ? Coagulation. 54. What constituent of the blood seems nearest allied to coag- ulation ? Fibrin. 55. What are the three great peculiarities of clot ? 1st, uniform coagulation with little contraction (showing healthy clot) ; 2d, .uniform coagulation with marked contraction and plainly "cupped" (indicative of anaemia); 3d, tough, con- tracted and concaved, with "buify coat" (occurring in general inflammatory conditions). 56. What is meant by the " buffy coat ? " The peculiar buif-colored film upon the surface of the " inflam- matory clot." 57. What is meant by "Anaemia;" "Spani^mia;" " Hyper- aemia ;" " Plethora? " Deficiency of red corpuscles; poor blood; abundance of red corpuscles; fullness of blood-vessels. 58. How is anaemia divided ? Into '• Acute " and " Chronic." 59. What is the cause of acute anaemia? Direct loss of blood by hemorrhage. 60. What are the symptoms in their order of severity Pallor; coldness; weak, small pulse; muscular debility ; gasp- ing; faintness ; complete syncope; death. 61. What is its treatment ? Remove cause by stopping hemorrhage; stimulate respiration by ammonia or electricity; administer tonics to give strength, and food to replenish blood ; give perfect rest. DENTAL PATHOLOGY AND THERAPEUTICS. 62. How is electricity applied in this case ? Place the " positive" pole at the nape of the neck, the "nega- tive'" at the ensiform cartilage; intermit twelve or fifteen times a minute. 63. What is the cause of chronic anaemia ? Loss in quantity or quality of blood, due to long-continued influ- ences. 64. What is the treatment for chronic anaemia ? The continued administration of phosphatic and chalybeate tonics and bitters (gentian, quassia, etc.), moderate exercise, journeying, and a judicious employment of time as to occupation, enjoyment, feeding and sleeping. 65. How is plethora first divided ? "Sthenic" and "Asthenic." 66. What is meant by sthenic plethora ? Excess of blood, with increased irritability and tonicity, com- bined with a tendency towards fevers and local inflammations. 67. What is meant by asthenic plethora? Excess of blood, with want of irritability and tonicity, combined with a tendency towards systemic depression. 68. What is the treatment for sthenic plethora ? Blood-lettino;, actual and medicinal sedation, li2;ht and limited diet, and decided exertion. 69. What is the treatment of asthenic plethora ? Tonic medication, moderate drastic purgation, strengthening and nourishing diet, and regulated moderate exercise. 70. How is plethora secondarily divided? General and local. 71. What is local plethora? Excess of blood in a part. 72. How is local plethora divided ? "Determination," "Congestion," "Inflammation." 73. What is the location and peculiarity of " determina- tion? " Location — In the arteries and arterial capillaries. Peculiarity — Excess of blood, with motion increased. 74. What is its exciting cause ? Irritation or stimulation. MEMORANDA. MEMORANDA. GENERAL PRINCIPLES. 9 75. What are its symptoms and effects ? Increased sensation and nutrition (hypertrophy). 76. What are the four means for treatment? "Depletion," "Derivation," "Relaxation," "Sedation." 77. AVhat are the meanings of these terms ? "Depletion," actual blood-letting; "derivation," a draining away of the blood to a distant part by derivatives; "relaxation," slight general or systemic weakening, as by small doses of nau- seants ; "sedation," actual local or systemic depression by sedatives. 78. What is the location and peculiarity of "congestion?" Location — Veins and venous capillaries. Peculiarity — Excess of blood, with motion diminished. 79. What are its symptoms and effects ? Blueness; purplish color; diminished warmth and sensibility; followed by numbness, coldness and painful distention in the part ; cessation of functional action ; transudations. 80. What are its four means for treatment ? Mechanical (pressure and support); astringents or stimulants: depletives ; rubefacients or sorbefacients. 81. What are the locations and peculiarities of "true inflam- mation ? " Location — Arteries, capillaries and veins. Peculiarity — Ex- cess of blood, with motion partly increased and partly diminished. 82. What are its signs and symptom ? Signs — Redness, heat (?) and swelling. Symptom — Pain. 83. Describe the relative changes of white and red corpuscles which are apparent, microscopically, in inflammation. White corpuscles increase in number and begin to adhere to the walls of the vessels and amass in the capillaries, thus arrest- ing the progress of the red disks. Some of the white globules work through the walls of the vessels, and are called exudation corpuscles. When one of these dies it becomes a pus corpuscle. 84. Into what two classes is inflammation divided? "Sthenic," "Circumscribed" or "Phlegmonous," and "As- thenic," " Diffused " or " Erysipelatous." 85. What are the three varieties of duration ? "Acute," " Subacute " and "Chronic." 10 DENTAL PATHOLOGY AND THERAPEUTICS. 86. What is the difference between the "general " and "den- tal" acceptation of these terms? General — Acute, three weeks. Subacute, between three and six weeks. Chronic, more than six weeks. Dental — Acute, three to four days. Subacute, four to seven days. Chronic, more than one week. 87. What are the two classes of irritants, or exciting causes? "Local or Direct;" " General or Indirect." 88. What are the three divisions of the "local or direct" irritants, or exciting causes ? Their meanings ? "Mechanical" (such as blows and splinters); "Chemical" (such as acids and caustics); " Vital " (such as escharotics, virus, malarial poison and arsenic). 89. What is the distinctive diflFerence between them ? Mechanical and chemical irritants wound or destroy both living and dead tissues; vital irritants act on living tissues only. (See 445.) 90. What is meant by " reaction ? " The recuperative act of vitality which follows depression. 91. What are the results of congestion and inflammation ? Effusions. 92. What is the difference between congestive and inflammatory effusions? Congestive effusions are non-organizable; inflammatory effu- sions are organizable in degree. 93. What are the varieties of inflammatory effusions? Euplastic, or highly organizable (cicatricial or reparative tissue); Cacoplastic, or less organizable (indurations, etc.); Aplastic, or non-organizable (curdy, yellow tubercles, etc.). 94. What are the terminations of inflammation ? Resolution or Suppuration. 95. What is meant by resolution ? Subsidence of inflammation, more or less absorption of effu- sions, and return to comparative normality. 96. What is the treatment to endeavor to effect resolution ? The use of such " antiphlogistics " as "stimulants," "seda- tives," "evacuants," "sorbefacients," "pressure," "friction," etc. MEMORANDA. MEMORANDA. GENERAL PRINCIPLES. , 11 97. What is meant by suppuration ? Failure of exudates to organize ; and the breaking down of circumvalhited tissues, which, with "white" and "tissue" cor- puscles, forms pus. 98. What is the treatment to effect this ? Stimulation. 99. What is the difference in degree between stimulation to effect resolution and stimulation to effect suppuration ? To eflfect resolution, stimulate in moderation (as can be comforta- bly endured) ; for suppuration, stimulate decidedly (all that can be endured). 100. What is the present theory of pus corpuscles ? They arc the devitalized "white corpuscles" and "tissue cor- puscles." 101. What is meant by the "pyogenic membrane ? " The dividing line between living tissue and pus. 102. Is this line truly a membrane ? No. 103. What are the symptoms of suppuration ? Diminution of heat, pain, irritation and vascular excitement; swelling becomes softened, with fluctuation upon tapping; redness replaced by yellowish or mottled color. 10-1. What is an " abscess ? " What is a " fistula? " A circumscribed cavity containing pus. A tract leading to an abscess. 105. What is " pointing ? " What is an " ulcer ?" The tendency of pus to the surface, usually indicated by a pale spot. A pus-discharging opening. 106. What is meant by "Gangrene," "Mortification," "Sloughing," "Caries," "Necrosis," "Sequestrum," "Exfolia- tion ? ' ' "Gangrene," incipient mortification; "Mortification," death and decomposition of the soft parts before sloughing ; " Slough- ing," the natural separation and throwing off" of soft parts; " Caries," ulceration of bone ; " Necrosis," death of bone ; " Se- questrum," dead bone; "Exfoliation," the throwing off" of dead bone ; also applied to the " elongation " of the teeth. 107. What is the systemic eff"ect of extensive suppuration ? Diminution of fever ; frequent, weak pulse ; chills and sweats, .with flashes of heat ; weakness ; exhaustion and possibly death. 12 DENTAL PATHOLOGY AND THERAPEUTICS. 108. What is meant by the term " adynamic ? " Debilitated vitality. DECIDUOUS TEETH. 109. How is a tooth anatomically divided ? Crown (that normally outside the gum) ; neck (that at the free edge of the gum) ; root or roots (that imbedded in the process) ; its end is called the apex. 110. How is a tooth physiologically divided? Enamel, dentine, piilp and cementum. 111. What is the first grand division of all teeth ? Upper and lower. 112. Name the faces of the teeth. Mesial, . . toward the central line. Distal, . . away from the central line. Labial, . . toward the lips, from cuspid to cuspid inclusive. Buccal, . . toward cheek, from first bicuspid to wisdom. Palatal superior jaw, -i T . , . „ . . } toward the hard palate or tongue. Lingual inferior jaw, J *- & Cutting edge, .... pertaining to incisors. Cusp, " " cuspids. Articulating, .... " " bicuspids and molars. 113. What are the various functions of the dental pulp ? A means of nutrient supply, sensation, preservation of trans- lucency and vital resistance. 114. What is the pericementum ? A vascular membrane between the cementum and the walls of the alveolus. It nourishes the cementum. 115. What is the order of eruption of the " deciduous " teeth ? Central Incisors, i ower, L upper, LATERAL INCISORS, | ^^^"^' ^ \[ ,^ ' \ upper, 9 " 10 FIRST MOLARS, I ^«^"'' ^1 '' ;^ ' I upper, 13 " 14 CANINES OR CUSPID, .... / lower, 17 || 18 ' I upper, 19 " 20 Second Molars, 23 " 30 5 to 7 months. 7 " 8 MEMORANDA. MEMORANDA. DECIDUOUS TEETH. 13 116. What are some of the exceptions to the general rule ? Some are born with a few teeth erupted. The lateral incisoi's vary as to period of eruption. Occasionally adults are edentulous from birth. 117. To what phase of dentition is infantile mortality largely due ? Pathological dentition. 118. What are the three divisions of pathological dentition ? 1st, moderate in severity, showing local signs and first six general symptoms ; 2d, decided in severity, showing in addition the next four general symptoms ; 3d, dangerous in severity, having in addition the three final symptoms — congestion of brain, convulsions and emaciation. 119. Where is the finger to be introduced in the mouth of an infant less than ten months old ? In the corner of the mouth, to avoid giving pain, no teeth being in process of eruption there. 120. Where, if more than ten months old ? At the front of the mouth, the incisors having erupted and the first molars being in process of eruption. 121. What are the general symptoms of pathological dentition ? Loss of appetite, peevish fretfulness, tossing restlessness, actual wakefulness, feverish thirst, painful paroxysms, continuous suffer- ing, bowels loose or constipated, exhaustion, tendency toward congestion of brain, congestion of brain, convulsions and emacia- tion. 122. How may pathological dentition, dangerous in severity, terminate ? It may even terminate in death. 123. What are the usual local signs of abnormal dentition ? Redness and swelling ; followed by whiteness of gums ; decided flow of saliva (" drooling ") ; desire to suck thumb or fingers ; biting the ring or spoon with determination ; alternately taking and refusing the breast ; desiring upright position (to counteract flow of blood). 124. What are the exceptions to this ? When some or all of these signs are absent 14 DENTAL PATHOLOGY AND THERAPEUTICS. 125. What is the first local remedy for pathological dentition? Lancing. 126. What is the relative resistance between normal and cicatricial tissue ? Cicatricial tissue is the weaker, because of its secondary forma- tion. 127. What is the best instrument with which to perform the operation of lancing ? A narrow-bladed, curved bistoury, wrapped with muslin, leaving exposed a quarter of an inch of the point. 128. How are the lower incisors to be lanced ? Parallel with and inside the cutting edges of the teeth. 129. How are the upper incisors to be lanced ? Parallel with and outside the cutting edges of the teeth. 130. Why this precaution to lance outside or inside of the incisor teeth ? In order that the lower teeth shall erupt so as to occlude inside the upper. 131. HoAv are lower first, lower second and upper second molars to be lanced ? Crucially, with the X-incision from the disto-lingual cusp to the mesio-buccal cusp, and from the disto-buccal cusp to the mesio-lingual cusp. • 182. How are upper first molars to be lanced ? Why ? Crucially, with the plus (+) incision from the lingual to the buccal aspect, and from the distal to the mesial. Because the cuts then incise the gum over the cusps. 133. How are cuspids to be lanced? Similar to incisors at first. 134. What is the treatment in pathological dentition after the cusps of cuspids are erupted ? Cut the ring of gum at two or four points. 135. What is the most thorough method of lancing molars in extreme cases ? Taking off a block of gum. 136. In performing this operation, what instruments are neces- sary ? Bistoury, tenaculum and decidedly-curved scissors. MEMORANDA. MEMORANDA. DECIDUOUS TEETH. 15 137. Which cuts should be made first ? Which afterwards ? First the lingual cut, disto-mesially ; afterwards the buccal cut; then the mesial cross cut. Piercing the gum block with tenaculum from beneath up, the distal cross cut should be made with scissors. 138. What are the immediate dangers from lancing? Injuring the enamel ; cutting tlie lips, gums, cheek or tongue, either from slipping of the instrument or sudden movement of the child. 139. How are these to be guarded against ? Wrapping blade of bistoury with muslin (see 127) ; properly finger-guarding the surroundings ; properly securing child ; care in lancing ; anticipating sudden starts. 140. What is the method of securing child ? For lower teeth have infant's head lying, face upward, on assist- ant's left thigh (operator also sitting) ; child's hands crossed and held on abdomen by right hand ; legs held by right arm : head held and eyes covered by left hand. For upper teeth reverse head to right thigh. 141. How should the child be placed as to light ? For upper jaw, feet towards light; for lower jaw, head towards light. 142. What is the subsequent danger from lancing ? Hemorrhage. 143. Which is the most dangerous form of hemorrhage ? Slow, oozing, atonic hemorrhage. 144. How is this dangerous ? Through the blood being swallowed, thus remaining unnoticed. 145. How is hemorrhage controlled ? By giving the breast or ring; by applying accurate local medication, as dental iodine, alcohol, tincture of chenopodium album or erigeron canadensis, or other styptics ; giving the chenopodium or erigeron internally (see medicaments) : pl.aeing patient in erect position ; hot water to feet. 146. What period of babyhood is the most fraught with danger from difficult dentition ? Why ? The second summer. Because then winter-born children cut their cuspids and summer-born children their second molars. The hot weather aggravates the pain of eruption. 16 DENTAL PATHOLOGY AND THERAPEUTICS. 147. What are the indications for extraction of the deciduous teeth ? When the inferior permanent oral teeth present outside the arch ; when the superior permanent oral teeth erupt inside the arch and behind the deciduous; and when, in conjunction with frail and weakened constitutions, complications are liable to arise from necrosed and exfoliating deciduous teeth. As a rule, it is better that deciduous teeth should remain until the proper absorp- tion of their roots is indicated by loosened crowns. 148. If deciduous molars are extracted between the ages of five and seven years, what injury may be inflicted? The developing bicuspids may be injured mechanically, inas- much as the roots of the deciduous molars are but partially absorbed and envelop approximately the developing crowns of the bicuspids. PERMANENT TEETH. 149. What is the order of eruption of the permanent, teeth? First molars, from 5| to 7 years. Central incisors, Lateral incisors, First bicuspids, Second bicuspids, Lower canines, Second molars, Upper canines, ........ Wisdoms, Lower teeth, as a rule, precede the upper by a few months. 150. What is the peculiarity of pathological eruption of upper wisdom teeth ? Its remedy ? Presenting buccally and growing into the cheek. Remedy — Grinding off cusps or extraction. 151. Which are generally the most difficult of the permanent teeth in pathological eruption ? Lower wisdom teeth. " 6 " 8 " 7 " 9 " 9 "10 " 10 "11 " 10 " 12 " 12 "14 " 13 " 15 " 17 "45 MEMORANDA. MEMORANDA. PERMANENT TEETH. 17 152. What are the symptoms, in their order of severity, of pathological eruption of the lower wisdom teeth ? Absence of wisdom tooth ; long before ready for lancing, pecul- iar, deep-seated pain ; pain sprangling in front of ear and down neck; difficulty of opening mouth and of mastication; diminu- tion or exacerbation of pain, devoid of periodicity; localization of pain in gum ; swelling of gum till bitten upon and wounded by upper molars ; high inflammation of gum ; contiguous parts swol- len ; tenderness externally on pressure ; enunciation and deglu- tition difficult to impossible ; teeth closed; loss of appetite; con- finement to bed; complete demoralization; nervous irritability; prostration, with quick and frequent pulse ; excessive salivation ; fetid breath ; puffy, bloated lips ; high fever ; extensive suppura- tion ; pyaemia and possibly death. 153. What is the treatment? In the first stages ' treatment is palliative. Externally, about the seat of trouble — laudanum, spirits of camphor, strong infusion of hops, mixture of laudanum, tincture of aconite and chloroform (equal parts), aconitia ointment or other anodynes which do not disfigure. Internally — for wakefulness, 5 or. 10 grains of Dover's powder, or 20 drops of laudanum, or 20 to 30 drops of solution of bimeconate of morphia, or a teaspoonful of solution of sul- phate of morphia, or 1 grain of opium ; when pain is localized, lance, making the X-incision frequently if indicated ; if this is not relieving, insert under flap a small portion of dental acetate of morphia paste, with adjunct of cocaine or menthol, on cotton ; if gums are lacerated, take off" a block of gum ; if teeth are shut, wedge open with soft wood, using anodynes or electricity exter- nally, or a general anaesthetic if necessary. 154. How should the electrodes be placed ? Positive over otic ganglion ; negative in hand of patient. 155. What are the indications for extraction of the six-year molars ? When it becomes improbable, at eleven years of age, that they will be preserved for any length of time ; when pulp is devital- ized before proper formation of root structure ; when protrusion of either arch or other irregularity or false occlusion may be corrected by their removal. 18 DENTAL PATHOLOGY AND THERAPEUTICS. DENTAL CARIES. 156. What is dental caries ? The softening and decalcification of tooth structure, analogous to ulceration of the soft parts. 157. What is the first cause ? A non-cognizable systemic influence, under which the non- essential portions of the economy are sacrificed for the conserva- tion of the essentials. 158. What are the two divisions of the predisposing causes of caries ? General and Local. 159. What are the four divisions of general predisposing causes ? Systemic, Thermal, Chemical and Parasitic. 160. Name some of the systemic predisposing causes. General weakness, typhoid conditions, struma, rapid growth and depressing influences, such as enervating modes ot living, anxiety, excessive study, undue exertion, pregnancy and nursing. 161. How do different diseases afiect caries ? Indirectly only, hy deranging the system and lowering the vitality ; as a consequence, teeth of low-grade temperamental attributes decay most easily. 162. How does struma impress caries ? Struma, in the lymphatic temperaments, predisposes to rapid and painless decay ; in the nervous temperaments, to sensitive, horny caries. 163. What are the three divisions of local predisposing causes? Structure, Form and Position. 164. Give the views taught in regard to influences dependent upon structure, form and position. Structure — In proportion as teeth are of dense structure do they resist decay. Form — Deep sulci, pits, depressions and fissures, though not necessarily productive of decay, render teeth more liable to caries. Position — Crowded or irregular dentures seem more liable to decay from mechanical abrasion and from increased retention of food and mucus. MEMORANDA. MEMORANDA. DENTAL CARIES. 19 PERIODS OF DECAY (Approximately.) Ist- - 5to 1 8 years. 2d- -12 " 20 " 3d- -30 " 35 " 4th- -45 " 50 " oth- -60 " 65 " Gth- -70 " 75 " 165. What is meant by "periodicity-' of caries? Its recurrence at certain periods, modified by temperament and physical condition. 166. Give the periods of decay and comparative cessation from decay. INTERVALS REASONS. OF EXEMPTION. (Approximately.) Systemic effect of dis. of childhood 8 to 12 years. Undue growth. 20 " 30 '• Family aud business cares. 35 " 45 '' Approaching latter end of life. ■< „„ vears ^ Beginning of dissolution. 65 to 70 years. Gradual loosening of hold upon life. 75 " 80 7th — 80 years, at which time rapid senile decay may supervene, followed soon after by death of patient. 167. What is taught m regard to the effect of a decaying tooth upon others? By tending to localize upon itself the decay, it exempts for a time those less liable to disintegration. 168. How are males and females affected in different degree as regards caries? Females are more liable to caries, because of indoor life, abnor- mal menstruation, pregnancy and care of children. Men have more fresh air and exercise, use tobacco, and, when free from excesses, are less likely to develop caries. 169. How does tobacco-chewdng prevent caries ? By acting as a sialagogue, thus bathing the teeth in the alka- line saliva. 170. What theory of caries is taught ? " Mechanico-Chemico- Vital," with "Parasitic" concomitants. 171. What is the prophylactic treatment of caries? 1st, systemic treatment, according to indications ; 2d, using at night Castile or carbolic soap, solution of bicarbonate of soda or lime water, with a soft brush ; brushing hard on the articulating faces of teeth and lightly from gum down on inner and outer faces ; dipping finger in chalk and rubbing into interstices of lower buccal teeth. 20 DENTAL PATHOLOGY AND THERAPEUTICS. 172. For what result is the use of these relied upon? Castile soap is cleansing and antacid ; carbolic acid soap is cleansing and antiseptic (it should be used to make a lather, which in turn should be rinsed through the spaces between the teeth), and is by far the best local prophylactic. The chalk corrects the acid condition of the mouth which supervenes toward morning ; lime water and bicarbonate of soda are antacids. 173. What is taught in regard to pulverized pumice? It is excellent for cleansing and brightening teeth and does not injure the enamel. 174. What is the relative liability of teeth to decay? 1. Lower first molar. 2. Upper first molar. 3. Lower second molar. 4. Upper second molar. 5. Upper lateral incisor. 6. Upper second bicuspid. 7. Upper central incisor. 8. Upper first bicuspid. 9. Lower second bicuspid. 10. Lower third molar. 11. Upper third molar. 12. Upper cuspid. 13. Lower first bicuspid. 14. Lower lateral incisor. 15. Lower central incisor. 16. Lower cuspid. 175. Of what practical importance is the knowledge of this? From the general stand-points of saving teeth, clasping plates or correcting irregularities, it is a safe guide to the saving of the best teeth. 176. How is methodic examination conducted? Beginning at any back upper tooth, carefully examine every surface of each tooth in regular order, finishing on lower teeth. 177. Name the positions liable to decay on each tooth. The mesial and distal faces of all teeth ; the sulci of molars and bicuspids ; the basilar pits of incisors and canines ; buccal faces and cervical margins of molars and bicuspids ; occasionally the labial and lingual surfaces of teeth. 178. What is needed for a thorough examination? Mouth mirror, spring and flexible probes, ligating thread or floss silk, and wedges. 179. What purpose does thread or silk subserve ? When passed between teeth it indicates, by fraying, a rough- ened surface of enamel. 180. How should teeth be wedged ? By gently introducing a flock of cotton or thin wedge of soft pine between the teeth. This should be repeated several times. MEMORANDA. MEMORANDA. DENTAL CARIES. 21 until the teeth are nicely separated. A thin piece of India rub- ber passed between teeth, or strong thread tied between teeth, may be useful where wedges are hard to start. When gum is to be pressed away, oil of cloves or oil of cinnamon should be placed on the cotton. Sandarac varnish touched to cotton wedge holds it in place. Jarvis's or Perry's separators are useful adjuncts in making examinations. ODONTALGIA. 181. What is Odontalgia (toothache)? Pain within or about a tooth or teeth. 182. What is the first cause of odontalgia? Sensitive Dentine. SENSITIVE DENTINE. 183. What are the four primary divisions under which sensi- tive dentine is discussed ? 1st, Cases with no perceptible cavities of decay ; 2d, Superficial Caries; 3d, Simple Caries; 4th, Deep-seated Caries. 184. What are the symptoms of sensitive dentine? Uneasy sensations, which may be located about the teeth, jaws, cheeks, eyes, nose, or even lips; position of cause of trouble not positively located unless touched ; aggravation from contact of salts, sweets and sours generally; from hot and cold applications frequently; from touch markedly — especially from finger-nail and metallic touch. 185. What is the special diagnostic of sensitive dentine? Pain upon touch ; cessation of pain upon removal of contact. 186. When examining for sensitive dentine what should be especially remembered ? To locate each place when examined, as the sensitivity is fre- quently temporarily obtunded by a single touch. CASES WITH NO PERCEPTIBLE CAVITIES OF DECAY. 187. What are the locations for these? 1st, at the necks of teeth ; sometimes denuded, sometimes not; 2d, in sulci ; 3d, upon the cusps, cutting edges and smooth artic- ulating faces of teeth. 22 DENTAL PATHOLOGY AND THERAPEUTICS. 188. What is their appearance? Sometimes imperceptible ; either hard, smooth and polished, or slightly soft under touch of excavator ; sometimes discolored ; unaltered in contour, or more or less sharply concave, as though worn by brush, but not always due to this. 189. What are the systemic considerations in regard to acid vegetables, condiments and medicines ? They induce a hyperacid condition of the stomach, and a con- sequent hyperacidity of the fluids of the mouth, causing sensitive dentine, setting the teeth on edge, increasing the tendency to decay, and producing general soreness of the teeth. 190. What is the systemic treatment ? 1st, forbid indulgence in acid fruits and the like for a few days or weeks, according to the severity of the case; 2d, correct hyperacidity of stomach by a half grain to .two grains of bicar- bonate of soda (or a quarter grain of carbonate of ammonia) in a tablespoonful of water, three or four times daily. Give the ammonia, if a diffusible stimulant would be desirable. When the trouble is but slight, fruits, etc., may be indulged in if medicine be used continuously to counteract the hyperacidity. 191. What are the applications to be made by patients ? Lime water, bicarbonate of soda, prepared chalk, phenol sodique (diluted), aqua ammonia (diluted), Castile and carbolic acid soaps. 192. What severe complications pertain to sensitive dentine aside from toothache ? Facial neuralgic complications, including otalgia and ophthal- malgia. 193. What is the cure for these ? Remove the cause. SUPERFICIAL CARIES. 194. What is taught in regard to removal of superficial caries in teeth proportionately liable to become carious ? Superficial caries is that form of decay which admits of easy removal by files, burs, disks or chisels. In teeth liable to become carious, it should be left until its progress indicates the intro- duction of a filling. DENTAL CARIES. 23 195. What is the treatment of sensitive dentine in this con- nection ? The same as in simple caries. SI3IFLE CARIES. 196. What is simple caries ? That depth of cavity which first requires a filling material. 197. What is deep-seated caries ? Cavities of such depth as render irritation of the pulp liable during medicating, excavating or filling, or as the result of the operation. 198. What is the first remedy for sensitiveness in cavities of simple caries ? Why advantageous 't Dryness. It obtunds sensibility, as dryness of the tongue interferes with taste. 199. What is the second remedy ? Rapid cutting with sharp excavators or burs. 200. What is the rationale of this ? The suddenness of the infliction modifies response. 201. What is the proper method of doing this? Why? Cut from Avithin outward, or bur slight undercut at the bot- tom and remove the periphery afterward. By these means the organic filaments are severed, and cannot conduct sensation from the outer portions to the pulp. 202. In engine work, what is the advantage of "motor" power over foot power ? Foot power is surging ; " motor " power gives steadiness. 203. Topical Applications. What are the four class divisions of these medicaments ? 1st, those which do not endanger the vitality of the dental pulp ; 2d, those Avhich 77iai/ possibly endanger the pulp ; 3d, those which are liable to endanger the pulp ; 4th, that which is dan- gerous to tlie pulp. 204. First. Name the remedies which do not endanger the pulp. Prepared chalk, bicarbonate of soda, oil of cloves, eugenol, aqua ammonia fortior, tannin Nos. 1 and 2, solution chloral, campho- phonique, nitric acid (because never used except in superficial 24 DENTAL PATHOLOGY AND THERAPEUTICS. sensitive dentine), dental tincture of aconite, menthol and muriate of cocaine. 205. Where are chalk and bicarbonate of soda to be used ? In cavities where moisture cannot be excluded ; they require moisture to produce effect. 206. Where should ammonia be used? The objections to its use In dry cavities, guarding the air-passages. Objections — Its pungent odor, irritant effect on soft tissues, and its liability to weaken with age. 207. Where is nitric acid efficacious ? In dry cavities of hard teeth, accurately applied to sentient point on a gold probe, guarding the surrounding tissues ; it eats out the cavity ; should be neutralized with bicarbonate- of soda. 208. How should cocaine be used ? In crystal form only, by pkcing a minute quantity into the cavity, which is slightly moistened with oil of cloves. Solutions are of little avail. 209. How are oil of cloves, eugenol and campho-ph^nique to be used? In sensitive cavities, when teeth require Avedging ; placed on the cotton wedge, they also obtund the gum while pressing aside. 210. Second. Name the remedies which may possibly endan- ger the pulp. In deep-seated caries — Creasote and carbolic acid (idiosyn- cratically), carbonate of potassium, caustic potash and chloride of zinc. (See Medicaments.) 211. Third. Name the remedies which are liable to injure the pulp. Chromic acid, phosphoric acid and ethylate of sodium. 212. What is tauglit of phosphoric acid? It should not be used, owing to its inferred devitalizing action upon the pulp. 213. Why is chloride of zinc called u " polychrest ? " Because of its wide range of medicinal application. 214. What is the range of medicinal application of chloride of zinc ? Detergent, tonic, astringent, stimulant, irritant and escharotic MEMORANDA. MEMORANDA. DENTAL CARIES, 25 215. What is the proper form in which to use chloride of zinc as an obtundent of sensitive dentine ? Why ? Deliquesced. Because no action will take place unless deli- quesced, and further dilution renders it irritant instead of escharotic. 216. What should be the condition of the cavity when applied ? As dry as possible, to produce the greatest effect. 217. What is the method of preparing chloride of zinc for dental use ? Refer to Medicaments. 218. What is the taste of chloride of zinc ? Sweetish-bitter, metallic, astringent taste. 219. What is the method of applying chloride of zinc ? From a probe, pointed stick, pellet of cotton or bibulous paper, or by oxychloride filling. 220. What treatment should precede the chloride of zinc application ? Systematic consecutive obtunding. (See 252.) 221. What are the usual sensations from chloride of zinc applications ? Painful sensations. 222. What is the peculiarity of the pain ? Cold, steadily increasing and steadily diminishing pain. 223. IIow long should the pain continue ? From three to ten or fifteen minutes. 224. What should be the characteristic of the pain ? Steady, full, round, bearable. 225. What kind of pain may supervene ? Throbbing, pulsating, jumping pain. 226. What does this signify, and how" is it treated ? However slight, it signifies pulp irritation. It is to be treated by syringing cavity with tepid water and applying oil of cloves, campho-phonique, tincture of l)enzoin, eugenol or Jamaica dog- wood. 227. What are the points in regard to excavating aifter chloride of zinc applications ? Begin on cessation of pain and excavate only that dentine which has been obtunded. 26 DENTAL PATHOLOGY AND THERAPEUTICS. 228. What care must be taken in repeated applications of chloride of zinc ? The fact of pulp approach must be considered and care taken not to irritate it. 229. What is the after-preparation of a cavity in which the dentine has been obtunded by chloride of zinc ? Neutralize by washing cavity with tepid water, then dry thoroughly, moisten dentine with oil of cloves, and dry again. 230. How is the application of carbonate of potassium pre- pared for dental use ? See Medicaments. 231. What is the method of applying it ? From a probe, sharp-pointed stick or pellet of cotton. 232. What is its effect ? What are the symptoms ? It obtunds sensitivity. Symptoms — Like those produced by chloride of zinc, but much less severe. 233. How is it neutralized ? By oil of cloves. 234. What is taught regarding it ? It is a safe and ordinarily reliable remedy. 235. What are the characteristics of chromic acid ? Its form is that of brilliant crimson-red crystals. It is a deli- quescent salt. 236. In what form should chromic acid be used as an obtundent? Deliquesced. 237. In what manner should one guard against danger ? Never rely upon the " rubber-dam " guard, as the acid is liable to get beneath it ; have cavity as dry as possible without it ; use chromic acid only in easy or accessible cavities in hard teeth, frequently neutralizing with dry chalk or bicarbonate of soda. 238. Why? Because it is a very dangerous and uncontrollable remedy, and is only indicated in extreme cases. 239. What are the symptoms accompanying its use ? Perfect quiet for a time, which may result in death of the pulp. 240. What is the indication for the use of chromic acid ? When chloride of zinc fails to produce other than a persistent, disagreeable pain. MEMORANDA. MEMOKANDA. DENTAL CARIES. 27 241. What of the employment of chromic acid in difficult places ? It should never be used in such places. 242. What is the after-treatment of cavity ? It is to be neutralized by syringing thoroughly with tepid Avater, made alkaline with bicarbonate of soda ;■ the cavity is then treated as in chloride of zinc applications. 243. What dangers are liable from chromic acid and ethylate of sodium other than danger to pulps ? They are liable to produce unmanageable ulcerations and sloughinn; sores. 244. What is taught of ethylate of sodium ? It is an obsolete remedy. 245. Fourth. That which is dayigerous to pulps. Give the various names usually employed for this medicament. Arsenic, white oxide of arsenic^ arsenious acid, ratsbane. (See 446.) 246. What is cobalt ? To what is its obtunding power due ? A brittle, reddish-gray metal ; magnetic ; slowly oxidizes in the air. Occurs in combination Avith arsenic, to which it owes its obtunding power. (Dr. Robt. Arthur, 1846.) 247. What is taught in regard to the use of arsenious o.xide or cobalt for obtunding sensitivity of dentine ? They should never be used, as sooner or later they will prob- ably devitalize the pulp.* 248. What is taught in regard to the use of arsenious oxide or cobalt in very small quantities, and for limited periods of time, to insure safety ? If used at and filling material. .285. How are pulps covered with dentine sometimes exposed after filling such cavities ? By death and disintegration of the film of dentine between the pulp and filling material. * (See 2 10.) DENTAL PATHOLOGY AND THERAPEUTICS. 286. How are pulps naturally protected ? By " recalcification," " tubular consolidation " or deposition of '' secondary dentine.' 287. What is meant by recalcification ? The replacement by the pulp of the inorganic matter of the dentine. (See 280.) 288. What is meant by tubular consolidation ? An excessive deposit of calcific matter in the dentinal tubuli, between the pulp and the external irritant. 289. What is meant by deposition of secondary dentine ? A formation of dentine within the boundaries of the physio- logical pulp cavity. 290. What "is the second cause of odontalgia ? Irritation of the dental pulp prior to exposure. 291. What five classes of irritants are spoken of under this head ? Mechanical, chemico-vital, vitiated fluids of the mouth (Avhen notably acid), thermal changes and infiltrations. (See 354.) 292. Give example of mechanical. Impacting of food or other pressure. 293. Give examples of chemico-vital. Decomposing food and seeds. 294. AVhat is the sign of vitiated fluids of the mouth ? Glairy viscidity, or "spider-web" appearance of the saliva. 295. Which teeth are most liable to be affected by cold air ? The upper incisors and cuspids, and lower incisors, cuspids and bicuspids. 296. Which is generally most irritating, hot or cold? Why? Cold. Because ice water at a temperature 60° below blood heat (98°) is easily borne in the mouth, Avhile liquids 40° above blood heat can scarcely be endured; it follows that cold can cause more deviation from the normal temperature by 20°, and be to that extent the more irritating. 297. What infiltrations are irritating 'i Salt, sweet and sour. 298. What are the symptoms of pulp irritation in such cavities ? Uneasy sensations, generally positively located at periods of recognized irritation ; no sharp, paroxysmal attacks ; no increase of pain upon pressure on tooth; no throbbing. MEMORANDA. MEMOKANDA. DEXTAL CARIES. 33 299. What is meant by "spontaneous" pain ? Pain occui'ring in the absence of any tangible irritant. 300. How does this influence prognosis ? Unfavorably ; the abnormality thus indicated is rarely combated successfully. 301. What is taught in this connection regarding masses of decayed dentine ? In conservative treatment of the pulps of poor teeth it is essential that the largest possible amount of the decalcified organic mass should remain in protected security. 302. What pulp considerations are referred to in this con- nection ? The pulp considerations bearing upon the future value of this conserved dentine are : The comparative normality of the pulp, its probable and possible recuperative power, together with the temperamental attributes and physical condition of the patient. 303. What two objects are gained by conservation of decayed living dentine ? 1st, the prevention of exposure and undue approach to pulp ; 2d, possession of an organized matrix, which, being "protected," may recalcify. 304. For the proper preparation of a cavity containing *' horny" decay, what is necessary? Dryness, secured by napkins or rubber dam. , 305. What may follow dryness and be caused by it ? Pain. 306. What is the best application for the relief of this V Oil of cloves, oil of cinnamon, campho-phenique. 307. Is pulp conservation universal under such treatment? In a vast majority of cases it is successful, but not universally so. Marked adynamic complication, Avith poor and non-recupera- tive temperaments, together with local and systemic influences, are factors which produce ftiilures in this direction. 308. What are the indications of success ? Gradual establishment of comfort, with but few periods of unea- siness or of recognized irritation. 34 DENTAL PATHOLOGY AND THERAPEUTICS. 309. What are the indications of danger ? Sensations of uneasiness ; occasional thought of tooth, accom- panied with undefined apprehension of trouble. 310. What are the symptoms of failure? Increasing response to heat ; occasional odontalgic and neu- ralgic pain ; no pain at first on pressure, but perhaps pain on tapping, owing to concussion of pulp, not to peridental irritation ; no sensation of elongation of tooth ; uneasiness and pain, inter- mittent or remittent, according to degree of aggravation, hut not 'periodic ; sometimes but little discomfort while pulp quietly dies, and sometimes such toothache as calls for immediate relief, 311. What are the symptoms accompanying the more marked cases ? Acute response to hot and cold, inducing paroxysms of odon- talgia ; tenderness on pressure from determination of blood, with its concomitant hyperaesthesia, outside of apical foramen. 312. What is the notable exception to these symptoms ? Congestion of the bulbous portion of the pulp, precluding response to heat and cold. 313. What is taught of "facial neuralgia" in this connection ? This gradual death of the pulp may produce neuralgic troubles of almost every grade of intensity and duration, intermittent or remittent, according to degree of aggravation, but not periodic. 314. What are the locations of the neuralgic pain ? From a superior incisor or cuspid, below the eye and in the cheek and upper lip ; from a superior bicuspid or molar, upward over the eye and into the ear ; from lower anterior teeth, decid- edly localized about the chin and lower lip ; from lower molar, backward to the eye, down the neck ; in rare cases even to the arm and hand. The salivary glands also appear to be excited to excessive secretion. 315. What are the possibilities in connection with congestion of the pulp ? Absorption of effusions and re-establishment of normality ; chronic congestion without positive trouble for an indefinite period ; active or passive death, and putrescence or mummifica- tion, such possibilities being controlled by age, temperament and physical condition. MEMORANDA. MEMORANDA. DENTAL CARIES. 35 316. What is the summary of causes of irritation in deep- seated caries ? 1st, vitally, by irritating and escharotic applications ; 2d, mechanically, by excavating ; 3d, by pressure, the result of plug- ging ; 4th, by conduction or other irritation after plugging. 317. What is the summary of remedies ? 1st, judicious applications and proper protection ; 2d, care in excavating and accurate knowledge of the location of pulp cavi- ties; 3d, by using lateral pressure, judicious impacting of foil, the interposition of a solid base to sustain unavoidable pressui'e, or the employment of plastic filling materials ; 4th, interposition of the indicated pulp-protecting material. 318. Name some intermediates and pulp-protectors. Temporary stopping, rubber varnish. Gutta-percha, arnica court-plaster, adhesive plaster, shred tin, crystal gold, sheet lead, tin foil, muslin dipped in camphor, quill, cork, ivory. 319. How is arnica court-plaster prepared for use ? A piece cut to proper size should be laid, back down, in a drop of water for fifteen minutes, and the application gently made, first removing excess of water by touching back of the plaster lo bibulous paper. 320. What are recommended as non-conducting and supporting intermediates in deep decay ? 1st, metal plate, fitted, warmed and placed in cavity, with temporary stopping underneath, adhering both to it and to the dentine ; 2d, temporary stopping, covered with oxychloride or zinc phosphate, which can, at the same time, subserve a purpose as a lining. 321. What are the gradations from "deep decay " to exposure? 1st, very deep decay ; 2d, nearly exposed pulp ; 3d, quite exposed pulp. 322. Are these always of equal import? Why? No. Because "deep decay" in the hervo-lymphatic tooth would call for all the care and skill required in an " almost exposed " pulp of a nervo-sanguine tooth, and the comparatively simple "nearness of decay to the pulp" in the bilio-lymphatic tooth is equivalent to " absolute exposure " in the bilio-sanguine. (See 337.) 36 DENTAL PATHOLOGY AND THERAPEUTICS. 323. What are the eight controlling influences in conservation of pulps ? Age, temperament, physical condition, sex, occupation, over- exertion (mental or physical), place of residen.ce and mode of living, thermal and barometric changes. 324. To what times of life does " age " refer? Youth, maturity and old age. These are again subdivided into periods of decay and comparative cessation from decay. (See 166.) 325. What is "temperament ?" " A peculiar state of the constitution depending upon the rela- tive proportion of its masses and the relative energy of its differ- ent functions." — S. R. Wells. 326. Of what importance is a knowledge of temperaments to a dentist ? A knowledge of the temperament is, when coupled with a knowledge of the age, physical condition, occupation and sur- roundings of an individual, a basis upon which to calculate all treatment of the teeth and to prognose all probabilities in connection therewith. In dental prosthesis it governs the sizes, shapes, shades and relative positions of artificial teeth. 327. What is the first division of temperaments ? Four basal temperaments — Bilious, Sanguine, Lymphatic and Nervous. 328. What is the second division of twelve " dual " tempera- ments ? 1st, Sanguo-bilious, Lymphatico-bilious, Nervo-bilious ; 2d, Bilio-sanguine, Lymphatico-sanguine, Nervo-sanguine ; 3d, Bilio- Lymphatic, Sanguo-lymphatic, Nervo-lymphatic ; 4th, Bilio- nervous, Sanguo-nervous, Lymphatico-nervous. 329. Into what two classes are temperamental attributes divided ? Internal and External. (See 330.) MEMORANDA. MEMORANDA. DENTAL CARIES. 37 o CO CO P M en en Ph H EH EH X P\ <1 1-5 <1 pq *• .i * >> o El P^'C "u t:: bC ^ § o o a a - — H C/3 C3 -t-> S< .5 t^ O lii a^ S « s; ^rr- 0^ -i^ a fc^ '73 ^ 9^ a a f^ cs o a 0/ ?5 o y .2 >;■- ■' -r a oj « ^T; 5 ^ * ^'^:;;a ^ ^ .^ -t^ >j /4 Q," a >> .2 a "^ fe ~ oTS^^ a S 4^ a c4 dj Oi a Si o .5 O o h' ■►^ '^ o 2 a u c « o) a sh ^ 'O 73 .„ a ■« iTt^ .9 i2 ?^ a .flu o J5^ a a c3 -_ 0) a S a a.^^ S ?i --S ^ c3 c3 ^ ^ a; ^^^-^.;^^'^ a -a'^" ' '^ -S •= 5 rt S cofri: !=c_h 2 ti fe a ^ oi a « r^ iJ) =" a a o g^ CD -r •,;3 « '^ X ■ - « i J rt^ ap s'T3 C3 O tH O O M 2 a CK 3 M) t- aj 4J ^ a 5 "3 -s ^ 'd a) o ?^ ^^ a ■5 a j^ -r^ '3 O r-i a a 3 s "-3 I a -g « o a ^-§-5 'C 2 a '- a -2 ° ,5 a c3 ^ r ^ 5^-^s -li aj a tiD a t; i* a 4) S S Oi CO bH ■" =" a .„ . 2a-|^al c « a '^ X •'-5 0:5 0) >^. O .fi M a 2 'O S S ^ ^ a aS g ° aSl a :=l 2 >^ I « rt a * I a*^ e^x. _ t- O r« ^ (P ,-3 fc. M 3; -a «=« >, a fl '^ >5.l « c3 ^ t- fcH - t* o J3 « .^ rt a" ?. t"csa,o?ftH— — -ja to CO g Q ^ ,ii) 'g a« -t^ _=i 2 M eS ^ - o 5 a ie^ tfi " 2 -^ S ^ g a i2 a a " S ^ a ^ s 5~ i 1 1 a W)>>.^ a 5" Q « — . p^ >,« a if) ^-1 '3 2.2 g a -a I,* 00 ^9.2 o 2^^ y H O X P^ a > > « ® ■^ o ■" *S ^""S a .- .2 a ®^ > ^ . :-^ S O r-2 ^ rt •'-' ^ w « ^ ^ aj ^ 3 is ,a ;.= 9 o a <: H a 5 a r o Q 3^? » 3 a « « a X fc St Hi:© 2 JrS O r-!" o CO -t^ 00 += ■<1 0) CO .£3 5 5*- * S w aJ ffl M DENTAL PATHOLOGY AND THERAPEUTICS. 331. From what three stand-points are the internal attributes considered ? General circulation, innervation and nutrition. 332. What is the grouping of temperaments for dental study called ? Dento-temperamental. 333. What is a dental temperament ? A binary or tertiary temperament — ^. e., one which names last the prominent characteristic and first the modifying attribute. In "bilio-sanguine," sanguine is predominant, modified by bilious. A still slighter modification is expressed, as in lymphatico-bilio- sanguine, or nervo-lymphatico-bilio-sanguine. 334. Why is the dual system adopted in this classification? It is usually sufiicient; modification of it must be studied from the indications. 335. Name the four classes into which temperaments are divided dentally. 1. — Bilio-sanguine. Sanguo-bilious. 2. — Lymphati co-sanguine. Lymphati co-bilious. Nervo-bilious. Nervo-sanguine. 3. — Sanguo-lymphatic. Bilio-uervous. Sanguo-nervous. Lympliatico-nervous. 4. — Bilio-lympbatic. Nervo-lymphatic. 336. What are the characteristics of each dass'i 1st, "Excellent;" 2d, "Good;" 3d, "Doubtful and anx- ious;" 4th, "Positively bad." 337. If sanguo-bilious follows bilio-sanguine, why does not sanguo-lymphatic follow lymphatico-sanguine? It will be seen that the reliable, hopeful and recuperative base of the lymphatico-sanguine becomes merely a slightly controlling influence over the utterly unreliable and non-recuperative base of the sanguo-lymphatic, while the bilious and sanguine attributes, when combined with each other, either as base or modifier, form two dental temperaments which are unsurpassed. 338. What are the characteristics of each dental temperament V See 339. MEMORANDA. 40 DENTAL PATHOLOGY AND THERAPEUTICS. in o 3 o o H < a. Decidedly above average in size ; form same as bilio-sangulne. Skin dark; not smooth; tend- ency to ehloasmatic spots, moles, taches and freckles. a 3 o •V a a % •2. -i a> ja <2 03 Dai k, with wavy tendency ; lux- uriant in quantity and coarse; beard full and wavj ; eyebrows dark, full and marked. bo a p 3 -S a « .a 03 E- a u aT bo Mouth large; lips usually firm- ly set and of brownish color. ■3 S bo a 03 .a u . 5S- «l 2a t- 03 COM M i.2 da s 'c. ca a a> bo ?> <1 a a) a 1 a. •g "a. 3 ■a a> a s "ca a . a> >, 1 S ca a. Good recuperative foice, which requires proper direction and help; not so hopeful as'lyniphatico -san- guine, but more persistent. < 6 o H v o ca a ca 3 ca o'*- ^^-ra a^l Sa-I 0* - =3 3 bo cat^'S " ^ 2 § • -3 >>'5 lull's .rj-rJ .a *-» a> cj c3 aj > ■a 1 5 0. is .--a !l 3 M 5 a 03 .a .a -a a f 1 a)" a> ,^ •a bo (D a a a) • •0 ^ ca Si's "3 a a.2 ^1 a Soja cS a) ^ &: §■2 .a ca Mo Ii -ta .2 a s§ ^ aj •a a a ^a ar !>.2 'a CO o 1-1 S o o a ■rH g a) 60 boa ca ca O 3 .Q 60 » -s a o _ la &->"' St <2 o a ?!, .q ^11 s- (u bo_2 2. 03 3 2 ::«^ 0) oTa J3 bD=S O) f, tu 0.2 ^ ill 2:^-3 to 2 a .i os^-caz? bom II C3 00 '-^ o§ -^a c i i 1 a OS i> ca &° rt I- -• ■^5-2 OiTI !- a).S |-9| ca _o "aJ bo a ja 5o^ a bo ca <» ij bo |.i 'O •'-3 £| m a ca oa- a ^ gl CO q aj a bO a ca s _a 'i g ca CB a a 1 'S, ■a a; h ca ta s aJ a 1 3 ajiS 'S ta ■2-Kai s S 3 f||l 11 ?r *-■ 4) 03 B o I M M ja £ 0) fl SfS-a C3 ■■^§2 Si ca '^ >; -in C "^ S 2 • - = tt) "^ o t^ CJ-^ |ceoa=3 a v, ca M 11 ■" bo 11 a M a « ca ^ •gS) <2~ &-§ ttJ ^ tu -g^a 3 « - .^• ._. ?,.S a* cartfS®^ ^ a g --t^ S5^a.S -■ga^l 3 " a< « -S^Sga 03 '^•- 0! ^r S 03 3 ^ 3 a> -( 3 a ® J S p. S.S p< ja ■a a OS a bc-a la ••• a.^ 5& >» •^ a ca _s a ca a" 3 -a ca -a >-. "3 a m rt a. ■|| aTos *" bo ai'O boa) -^-2 ^ a) a H ■a ii "t3 •- a) '3 3 a =* Sa- s>> 3 a ii2 ?> ii ■-0) '^ a 2 — sg ca " . a 3 > a _^ ca 3 .3 ca P. 1^5 ga, £•§ §1 a.a a> ^ ^^ 'a 02 O H < M Q !zi -<1 S 5 1 a < in 0. 1 i Pm a a N 5 ei H < ft i a H iz; § DENTAL CARIES. 41 'o r g a ^rS e8 ■p ' ^5 rt ^ _= 9 ^ g s'> --1. t-.S o O f^ !K CT3 o !? • -2 la •ga 2fl o= -file's, .res ...s ©"si ic :3 3 as ?^ a. sa 03 to — OJ H t^.S -'5 en « g* ^-"•^ S s C o-H- iU C -r 'O m" •E-= £ §.2i 3 tic's- ">S c c g o 5 III' ®t: ^.2rO =i CO £9 ;: o 4) — 3 C~ C Oi .S "S " £ 13 "* = S-a _ « > = _ m "^ — ^; &S = ^ a « -•-!,= == o ? i« X '- S 5.2-3 f- -5 ;«'«5s:-S aa O fe M n o o ^ ■3^ iS-r- o ^ « S'-3 o r "x " o-o « £ = "3 O CO cS 0-3 o g^ «< ■i'3 " TJ-^ r^« S tobo « = >-- x*^ So % o c « K«S = = g . c -p fc. c >.. e ! C £ iU O B C3 ..O.C M £"3 5 as - o : tc.i a = — 2 :.„ *j — .a ."a P.3 C —0) T ! ^ 5 H Oi ^ -=5 JE =-is rr oj '' c Q.>j w -— — — t^ S ^ 2 r-c: =! S c g. =! ca r; 3 t, I S~ ^~ g.a s) I b e.~ a.-o o 'S \ 2p-i I 42 DENTAL PATHOLOGY AND THERAPEUTICS. p o % 6 !3 Less than average size; decid- edly less than average osseous, muscular and contour develop- ment. a5 3 o a .2 P a -2 "3 III p ft'^ « gra OITS cs §§.2 .At) .- be cS D ■flrfl.CS to g:: » •-'55 gag Of the peculiar range from dark brown (almost black) to dark red (mahogany), and of all grades, both in quantity and quality; eyebrows either decidedly arched or almost straight, but usually marked; beard sometimes heavy, sometimes scanty, ranging in color like the hair. Less than average size; in color from hazel, or even lighter, todark brown or almost black; twinkle when pleased or snap when angry. a^ o es ?^ -3 fl •s'l fl D S- aft 03^ cS S3 03 ja ® fl 2 a o ag. S.'S -"« p 2ag ■.S fl o > a -O c8 0:2 "a ' a bO > S cs a P o II "2 .2 8 !«.S cs CO o <£lft ca "'^ m .fl'd.fl O M bo .a2 -^ KT-rt O p ■fl -&0 O fe bo.^ o ' g M 2 fl ,„'^ bo o 3 ?> CO o to o-ca 03 :a . a p £,a bOo ss .2-2 t| "3 ft 03 m "3 a o fl & 03 is |8 bo ^-g "" K^ Cm :S ft . |i "3 C •fH P "A o w 6 ;> S ft Pro "^ m" eg •'-' o g > rt oi o o .. . *^ o >. "3 p tp -« p c« ^ fl 5« |« IK S ■fl > .-a 11 .= iT p-j bO «2 IB (O -fl 1> gcS^ O (n O h ^ fl -w.T3-fl •iS^.bo fl c4 — 03 to „ ri CS L4 .2 .a ^■- So -'SSI ca-S c« 3 §.2 bo o2 ^1 3 1 a p 03 ft 2 ;='g2 *Jt-_ fl So Si ft.a 03 fl ftS 3 cO-rt CO fl bO+3 Eh O O a CO 2 >>o3 « g" a 3 o o 'il cs « *s bO 13 ._ oj ^22 2-Sg'l-g'S TSS^oofl-fl-c;" 2 ^ "^.g «» a " a g. fl*&i»>oaoQ..^ 0^>. *; g -" iH-^ .P SS ---fl rt.bft* o2-.2ra-ft- ftft -X-o' ^-SflpX" Sa .2-2 -< CD > 3 o> . CO » bi la .a ° m^ CO h to =* =* - ^ CO .2 O 03 a-^ ^1 03 a +^ O S.1 — .fl •-s 2 fl - m ft CO o 11 rt 03 J3 J. 3 u "S rfl 'fl 3 i p ^t .2 br^^ J3-M ^ 8 g 2 bc ga^ a m * 9 ftg " S5 boo > t: a •^ r. z -^ ^ ^^ •■c ".' ■^ !2i n & •0 a *- P-^.ti ^ J- rt ^ ^ 3 C ■" J3 - •- = tH _£3 — K _ !/- r^ a 01 2 oci aj; ft= c 60 61— :;: ;s ,a 5 — ' " ly CO ' B.JO SSggS 09 ■0 o. "O a 3 ,a 1* _^ t>> a fe ca a .^ ft a 'm SS ■s cr a p >i ^ 2 W "£ (1) o ai - O. 5-3 O ci _2 *> ^ ,S — 1:5 S is c. = ^~ fl'S S 5 ■- 0) 3 o «.2 2 » 3 g 5 2 o. 3 ■. a> 2 c S" !r ;:S < sa >.^ •= "5 "^ •■^ ;;^ S « C O = 3^ 5 M Ch £"' a S -- ii « ! o"S S =« ? ! » ^== -a a m =5 3'" o! o ' c< C a s ti ^ .2 *" S ■- -2 ca 2 ^^3 3 p o a . ■- 7- V -a S--^ 3 «- ITc 3 « _ C33~0=«.ii 3 ;£SSi2 . a-s coo. c^ 3 3 a S « -i s " a bo CO P g 2 !H = >> s2 2! ^ o a-OTj a H2 (sj « O O o PS'' :S » 3 O ^ 44 DENTAL PATHOLOGY AND THERAPEUTICS. 1 w Ph 6 > Average size ; usually of aver- age development, without beauty of form or face. CS 3 cr "S .2 p. i • 3_^ Cheeks full and soniewLat prominent; forehead good and usually high; jawsaverage; chin average and round. straight and medium in color ; eyebrows marked and arched ; b^ard straight and of medium quantity and quality. Grayish, inclining either to green or hazel ; of medium size, but possessed of a quick, 1 estless motion, with anxious and suspi- cious look. a a -o .2* a) bO a S s ^1 _o ■3 a CO --^ " C P, o b0^.idr§ IT'S ^ - t3 CO aX:- 3 3 >.tp ;2 o ^ a3 ^• O O ■'-' ^ ri ^.9&a| a> a a "S p CO a 'C 3 » CO . °-2 a. II- 111 S p. 1 CO g-2 g ""9 a'p. a P 5 5 g-s IS =M P- ■~3 s-p. ll ^1 13 P OS a) t3 "3 .a ^.9 OT) a ® "E j o o o H w bfi"- C< rt O O 11 C4 -!h |1| .2 so IDT) « g m cS A i Is <» z. 3 c3^ •*^"» be « §3 -.J !h O ^ •- -rri ® ^ rt go 3 (D cc . -22 "S ^ 3 '^■-^ .9a'Z| oi ca M _bo to a -^ o3 Op ^ <* a o O.P-« m bC« ID agga sag '^ t. H OJ OJ3^ *^ a 3-2=" .3 OJiJ 3 CO _bD-^ -d T- 3 2-5 □ 3 rj S 2 Sa g-'^.-S ft a ■3 t; "S ,a a to . 2^ 3 ® ^ 60 .3^0 11 _^ "3 p. oi .a 13 p aj 1 2 aj l> ■< f a a ^a |» a a »5 1 6 o 02 •So.2 5

L- III si: -.^ M ca p cu a 2 0) a jq" o o i 3 m ■|i 8 .So"" - c« 3 S !^ bBtu .-S-f P t-> ■-* CD -H i^-.-S a " « "H .9 =* ^'3 0,5 ■'. ;d CO 3T3 j- P.3 -.J 5^ d; _..-< T* g; — P P^rP i a 3 > >^2 « p. _cO _>. a, 03 ja 13 a CO a a 3 p. ^p" a, ' 3 "3 fl S S CO •-P >.9i a a s 1 2 s 1 ^ . 5 'a o—> • H O l-H Q 1— 1 5 OS ■< N M a » . 2 S « 3 Q .i>^ li S Ts'a _>. "a-^-s^n e3 It _>^ 'i ^0 ^S^^c-sS ■a •d •S3 2 c8 a C8 *^.2 a (lira's p 3 iais-ga • - -^ ■ - a S a) a) ■:;-j >.ui £; 33 pii=§:- g > c3 s ° •a "2 to g a) . ^ cs a 0. a ..2 ~ a aJ bo 58 « ■3 'u CO tS S S - £?S cs "3 OS ■■s A 0) > C3 li « > C3 S a'E'-S a -^ bo aJ a 1 "3 6: a, =* bo^-*^ ^9.5 a^ 4 a $ '3 g "Si. a.u) .S2 .ti <» . Ill Sal S ® £ ".20 a a . a a^g .- ^ *•* -11 OJ N p ^-^H^ .-•'H ^ ^ ;z; 2 bc-£ tjaa 3 >'.£i!a§«£ a '3 d £.2 M 3 3 aT •S° u — .2 2^£ = 11 a 5 ^ =* '" 0) ' " a) 01 .2 ■9|. ^ g « 2 . « s H Hi » C-4 TO %S3 □ 7S 3 < T3 ® ■C| J5 « ' a. ^g (a 2 S.5.§ a O < U 1 b o § HZ > H 1 < 5§ ^5 OS H 2 ^ 1^ s s to Z u CO 2 J j£0 H ■Jm u 2 « 7j a 05 a u 1 03 > a© ►HO 5 ^ g CO 46 DENTAL PATHOLOGY AND THERAPEUTICS. 340. In what manner does physical condition influence pulp conservation ? Good temperaments, with poor physical condition (such as typhoid conditions), respond but slowly to medication, while good physical condition, even in poor temperaments, assists largely in producing satisfactory results. 341. How does over-exertion act upon it? Over-exertion impairs physical condition. Exertion which produces a more or less continuous state of fatigue will be more or less detrimental to the recuperation of a pulp. 342. Sex. What circumstances in the male act adversely ? Greater exposure and more violent exertion than in the female. 343. What in the female ? Pregnancy, abnormal menses and other uterine complications. (See 168.) 344. In what manner does occupation influence it ? By causing over-exertion or enforcing positions which carry the blood to the head. Sedentary employment, poor ventilation, imperfect drainage (causing noxious gases), changes of tempera- ture, the mental anxiety connected with occupation, or anything which lowers the general vital force, diminishes the probability of pulp conservation. 345. How does mode of living act, beneficially or preju- dicially ? This acts upon physical condition in proportion as it is strength- ening or weakening, soothing or irritating, luxurious and healthful or penurious and unwholesome, nutritious or a mere pandering to the appetite. 346. What is taught regarding the influence of location or place of residence? Residence in malarial places has a decidedly adverse influence upon the general health, consequently upon pulp conservation. Pulps capped in healthy localities often give serious trouble and sometimes die when removed to unhealthy places. 347. How should such cases be treated when the patient is visiting only? Unless very pronounced, soothe pulp till patient can return to the healthy locality. MEMORANDA. MEMORANDA. DENTAL CARIES. 47 348. What constitutional support is recommended in such cases as have adynamic complications ? Mild gentian or quassia, boneset, nitro-muriatic acid alone or in combination with antiperiodics. 349. What is taught regarding thermal influences, either local or general ? Local applications of hot or cold shock pulps in proportion to loss of protecting dentine, unless non-conducting protectors or filling materials be used. Sudden changes of warm and cool temperature conduce to colds, congestions, fluxes and inflam- mations. These changes, together with continual exposure to heat or the shock of cold baths, may produce systemic effects adverse to conservation of pulps. 350. How do barometric changes influence pulp conservation ? Barometric changes are, as a rule, exciting and may cause much irritation. In this climate March and November are unfavorable months for conservative treatment, because of frequent and decided thermometric and barometric changes. 351. What is the third cause of odontalgia? Irritation of the dental pulp from almost complete or complete exposure and from dying pulp. 352. AYhat are the symptoms ? Paroxysmal and remittent or intermittent pain, but not peri- odic ; not always positively located ; very severe during parox- ysms; throbbing or jumping; great exacerbation from thermal, vital or mechanical irritation ; greater at times, generally during the night or while in recumbent position ; no increase of pain from pressure upon tooth, but sometimes upon tapping, due to concussion. (See 310 to 315.) 353. What does periodicity of the pain indicate ? Malarial or other endemic complications. 354. "Wliat are the six heads under which liability to ii'ritation prior to filling are discussed ? 1st, infiltration of salt, sweet and sour condiments (the most usual) ; 2d, direct contact with foreign bodies ; 3d, pressure of foreign material ; 4th, thermal irritation from even slight devia- tions of temperature ; 5th, mechanical irritation during excavating, etc. ; 6th, medicinal applications. (See 395.) 48 DENTAL PATHOLOGY AND THEKAPEUTICS. 355. What is the first and most important knowledge needed for diagnosing an almost exposed or exposed pulp ? Accurate knowledge of location, size and shape of pulp cavity. 356. What is taught in regard to the pulp cavity being a miniature of the crown of the tooth ? That it is so only in a general way, not sufiiciently so for accurate practice, fine cornua being found in blunt cusps and cornua of different lengths in cusps of nearly equal length. 357. What is taught in regard to the relative position of the pulp cavities in teeth in the hand and teeth in the mouth ? The position of teeth in the jaw is never that upright one given in diagrams or which is usua,l in manual examinations. In the superior teeth the crowns slant outwardly, while in the lower teeth they slant inwardly. These positions must be studied in the mouth before practical application of this knowledge can be made. 358. What four considerations obtain in relating cavities of decay with exposure of pulps? 1st, situation of cavity of decay ; 2d, depth of cavity ; 3d, direction of cavity ; 4th, character of caries. 359. What is taught in regard to depth of cavity ? This does not refer to actual depth, but to nearness of bottom of cavity to the pulp. 360. What of the character of caries ? In proportion as the decay is of the rapid variety is exposure -probable. 361. What are the four means of diagnosing almost exposed or exposed pulps ? 1st, visual test ; 2d, pressure test ; 3d, thermal test ; 4th, taxis. 362. How is the visual test made ? Either by direct observation or by reflection with the mouth- mirror, the cavity being properly cleansed and dried. 363. How should the mouth-mirror be prepared ? * Warmed carefully over the flame of a spirit-lamp, or by dipping into warm water, or by resting for a moment flat upon the tongue. 364. What is the appearance of the dentine overlying an almost exposed pulp ? Varying from altered shade of dentine and varied pink or red, even to dark shades of blue or brown. MEMORANDA. MEMORANDA. DENTAL CARIES. 49 365. What is the appearance of an absolutely exposed pulp ? The peculiar "orifice" appearance of even a needle-point exposure requires to be seen but few times to insure ready recognition. 366. How is the pressure test made ? By pressure with a pellet of cotton in the direction of the sus- pected exposure. 367. How is pain from sensitive dentine to be distinguished from pulp irritation ? The former stops on cessation of pressure, and is usually felt about the periphery of the cavity ; the latter usually continues for a short space of time after the irritant is withdrawn, and is felt in the location of the pulp cavity. 368. How is the thermal test made? By placing one drop of cold water against the side of the cavity and allowing it to run upon the pulp ; if no response is given, more cold water may be cautiously injected. 369. How is "taxis" performed? By very gently and cautiously touching the pulp with an untempered probe, guarding against nod of patient by pressing the thumb of left hand against upper teeth. 370. What would be liable to produce nod of patient ? Affirmative response to question regarding pain. 371. If no response be given by pulp upon taxis, what is the indication ? Death of at least the bulbous portion of the pulp. 372. What medicaments are recommended for the soothino- of almost exposed or exposed pulps ? Tincture of benzoin, laudanum, spirits of camphor, campho- phenique, oil of cloves, oil of cinnamon, fluid extract of piscidia erythrina, hydrate of chloral, eugenol, thymol, oil of cajeput, oil of eucalyptus, creasote or carbolic acid (only when intending to devitalize), acetate of morphia paste, menthol, muriate of cocaine, dental tincture of aconite, iodoform paste. PULP CAPPING. 373. What is pulp capping ? The placing of a protection for the conservation of an exposed or practically exposed pulp requiring more than an intermediate. 50 DENTAL PATHOLOGY AND THERAPEUTICS. 374. What are the first considerations ? Whether indications are favorable or unfavorable to the effort of pulp conservation. 375. What are taught as the governing influences in pulp conservation, good material for capping and proper manipula- tion conceded? Condition of pulp, temperament, age and physical condition decide the grade of help to be afforded to a pulp. (See 339.) 376. What are the seven desirable attributes for capping mate- rial, named in their order of importance ? Plasticity, non-irritating quality, porosity, soothing or healing quality, non-conductivity, resisting capability, durability. 377. Of what importance is porosity ? It absorbs the serum which oozes from the pulp, even through dentine. It is imperatively demanded when lymphatic or adynamic complications exist. 378. What is the advantage of plasticity ? Of durability ? Plasticity enables easy placing, with subsequent hardening, without irritation of pulp. Durability gives comparative per- manency to a capper in case of confluent decay or fracture of tooth substance. 379. Name a few materials which are used as pulp-cappers. Oxysulphate of zinc, plaster of Paris, oil of cloves pad, hydrated oxychlqride of zinc, varnishes, solutions of gutta-percha, medicated pastes under concave plates (Weston's caps), thin lead plate, tea-chest lead. 380. What is taught regarding gutta-percha as a capper? It is one of the standard applications ; should be used in chloroform or benzole solutions, either dropped upon the pulp or applied under concave plate. It possesses all the qualities except those of porosity and healing quality. 381. What is taught of oxysulphate of zinc ? It is an excellent capper, and is reasonably accredited with therapeutic as well as protective value. 382. What is taught of plaster of Paris ? It possesses all the attributes except that of durability. The cavity should be filled with the quick-setting plaster ; when hard, this should be cut out to desired depth. MEMORANDA. MEMORANDA. DENTAL CARIES. 51 383. How is the oil of cloves pad made ? By making a paste of oxide of zinc and oil of cloves, and applying as a first layer under oxychloride of zinc. 384. What is taught of oxychloride of zinc ? That its claims as an excellent conserver of pulps have not been positively proven, and that while it has many good points, and may sometimes produce just sufficient irritation of pulp to result in good, yet its known irritating power and its doubtful clinical record render it safer to reject it for this special purpose. 385. Does oxychloride possess the power of mummifying pulps which die under it? It does not possess such power, though pulps may mummify under it. 386. What is taught of hydrated oxychloride of zinc as a capper? It is regarded as a good capper. 387. What is taught of the zinc phosphates as cappers ? Their use in this connection is decidedly questionable. Though not absolutely so proven, the phosphoric acid they contain is supposed to have a devitalizing power over the pulp. (See 251.) 388. How is lead plate to be used? Cut to proper size ; with handle end of an excavator make it concavo-convex ; make hole in centre to allow for escape of sur- plus medicament; fill concavity with soothing medicaments and apply over point of exposure. 389. What length of time is taught as "probationary" prior to deciding whether efforts at pulp conservation are likely to be successful? From six months to a year. • 390. Is this length of time universally reliable? It is not; for pulps may give symptoms of failure in less time and may not do so for years. 391. What length of time should elapse before success may be pronounced? At least from five to seven years. 392. What is taught regarding teeth the pulps of which die lingering deaths? The pathological condition induced by slow death of the pulp is one of such chronic alteration of nutrition as to render liable. 52 DENTAL PATHOLOGY AND THERAPEUTICS. upon slight irritation, serious and frequently uncontrollable peri- dental trouble, resulting in comparatively early death of the peridentium, necrosis of the root and loss of the tooth. Quick devitalization permits of a more perfect return to normality. (See 618.) 393. What is taught regarding efforts at conservation of pulps ? That the value of the living pulp is exceedingly great, giving to its tooth almost every chance of future ijermanent usefulness, in place of the almost positive certainty of future liability to trouble, eventuating in the loss of the tooth ; therefore it is not only warrantable, but professionally imperative, that every effort should be made for the preservation of pulp vitality. 394. What three considerations contra-indicate efforts at pulp conservation ? 1st, decidedly marked pulp irritation, evidenced by several severe attacks of paroxysmal pain, in connection with a probable future of pain without possibility of relief; 2d, in cases where systemic condition is decidedly adverse to probability of success. and where the suffering from chronic disease is such that additional pain would be decidedly detrimental ; 3d, in cases where imme- diate immunity from all possibility of subsequent suffering is shown to be a necessity, from business or other important consid- erations. 395. What are the external causes of irritation to pulp other than the six already mentioned ? (See 354.) Prevention of exudation by filling ; loss of tooth substance from attrition ; fracture of tooth ; disease of the surrounding parts. 390. What is the internal cause ? Pulp nodules. 397. What are the five considerations in connection Avith pulp irritation from disease of the surrounding parts ? Salivary calculus ; tartar ; looseness of tooth ; abscess ; atrophy or absorption of either gum, alveolar process or roots. 398. How is pulp irritation from loss of tooth substance by attrition distinguished from sensitive dentine ? Sensitive dentine causes unlocalized uneasiness, which does not increase to paroxysms. (See 184.) The irritated pulp gives local- ized and paroxysmal pain. (See 298 and 352.) MEMORANDA, MEMOKANDA. DENTAL CARIES. 53 399. What instrument is used in the diagnosis of pulp exposure in cases largely abraded ? A probe, blunted in order to avoid plunging through the thin covering of dentine. 400. What is usually the best method of remedying irritation of the pulp from loss of tooth substance ? The grinding oft' of the occluding tooth, together with the building up of articulating fillings upon three or four not unduly worn antagonizing teeth, in order to preglude or retard further abrasion. 401. What condition is sometimes found analogous to a loss of tooth substance by attrition and eventuating in the same symp- toms ? Marked clean cupping occurring on the cutting edges, cusps and articulating faces of the teeth, such cavities presenting a smooth, defined and clean appearance. 402. To what is this due ? It is regarded as due not entirely to mastication, but to be a peculiar phase of dental caries, which disintegrates the dentine prior to the action of mastication. 403. How is this condition treated ? By preparation of cavity and filling, as in ordinary decay. 404. Upon what four causes is fracture of the tooth dependent? 1st, impingement upon hard substances, as bone, shells, shot or candy ; 2d, impingement upon only moderately hard substances, when extensive decay has left frail walls; 3d, blows or falls; 4th (very unusual), congestion of pulp. The symptoms of this are: Fullness within tooth, rapidly passing into extreme tension and pain, or into tense numbness and growing uneasiness. When the fracture occurs, a noise like a pistol-shot is sometimes heard by patient. ABSORPTION OF PERMANENT ROOTS. 405. What are the signs and symptoms of absorption of per- manent roots? Its treatment? Absence of discoloration of tooth ; neuralgic pain ; tenderness of cheek to pressure : pain in the eye, with amaurotic and possi- bly circulatory complications (sometimes sufl'used cornea and con- junctiva) ; decided response upon tapping; sometimes pricking 64 DENTAL PATHOLOGY AND THERAPEUTICS. sensation on pressure (from spieulated condition of root) ; great pain from decided hot or cold applications ; general sense of uneasiness about jaw, directly referable to the tooth ; almost uniiiersally undefinahle, hut positive conviction on the part of patient that removal of tooth would insure relief. Such teeth are dense in structure and very firmly set in their sockets. Treat- ment — Extraction. PULP NODULES. 406. What is ''nodular calcification? " The formation within the pulp of granular, lobular, kidney- shaped or spicular deposits of calcific matter, generally confined to body of pulp, though sometimes found in the canals. (See 396.) 407. What are the signs and symptoms of pulp nodules ? Continued or intermittent pain, commencing without knowr* irritant, and rapidly increasing in violence until unendurable i no periodicity, unless under malarial influence systemically ; sometimes slight external inflammation, but generally health line is normal ; peculiar sensitiveness of enamel on scratching it ; exquisite sensibility of dentine, increasing upon drilling. 408. How is diagnosis of this condition made? By difierentiation. 409. In making diagnosis of pulp nodules, what influence has temperament and physical condition ? Pulp nodules are usually found in connection with good physi- cal condition and high-grade temperaments of sthenic attributes. 410. What is the method pursued in devitalizing such pulps ? Preliminary treatment, systemically — Asafoetida pills and solution of bimeconate of morphia. Locally — Application, hy operator only, of aconitia ointment, followed by veratria ointment, if indicated, over the eyes, upon the temples, sides of nose and upon the cheeks (about and below infra-orbital foramen), avoid- ing eyes; use powerful obtundents for the hypersensitive dentine, as chloride of zinc, chromic acid, arsenious oxide or electricity; approach pulp cautiously, avoiding irritation ; soothe pulp irrita- tion if any ; apply arsenic ; make steady advances into pulp canals, with least possible irritation, using in them combinations of acetate of morphia paste, muriate of cocaine, menthol and dental MEMORANDA. MEMORANDA. DENTAL CARIES. 55 tincture of aconite, in conjunction with arsenious oxide ; no haste should be made ; when tooth is quiet, allow it to so remain for weeks if needs be. 411. What is taught in regard to complete extraction in cases of pulp nodules and absorption of permanent roots ? Every portion of root must be extracted, else little, if any, relief will be afforded. 412. What is the method of extracting such roots as are broken oif? Fissure-drill around root, using cocaine applications or dental helix as obtundent, and lift out with thumb-forceps. 413. AVhat is "phantom odontalgia?" A pain wliich recurs at intervals after extraction, resembling the pain experienced previous to extraction. It is caused by extraction of tooth during a period of intense irritation of external filament of nerve leading to pulp. 414. What is the best method of preventing this ? To absolutely quiet pulp for twenty-four hours and then extract ; then make application of acetate of morphia paste (with cocaine and menthol) in alveolus, precluding irritation by guard if neces- sary. FUNGOUS GUM AND FUNGOUS PULP. 415. What is fungous gum and fungous pulp ? A benignant hypertrophied condition of gum or pulp. 416. How is a fungous growth of gum within a tooth diagnosed from that of fungous pulp ? This cannot be done except by treatment. 417. W^hat is the treatment? Soothing, constringing, sorbefacient. Gradually press aside with cotton medicated with acetate of morphia or dental iodine until diagnosis can be made as to Avhether the growth is an ingrowing gum fungus or a pulp fungus. 418. What indicates fungous pulp ? The fact that the growth does not arise from a cavity or per- foration, but from a pulp canal. 419. What is taught regarding color as a diagnostic sign ? Fungous gum and fungous pulp are alike in color, from light pink to dark purple ; color is, therefore, not a diagnostic. 56 DENTAL PATHOLOGY AND THERAPEUTICS. 420. What is taught regarding sensitivity as a diagnostic symptom ? Fungous gums and fungous pulps may be either exquisitely sensitive or devoid of sensitivity; therefore sensitivity is no diag- nostic. 421. What is taught of applying arsenic at once ? Never apply at once ; because, if the fungous growth is hyper- trophied gum, the arsenical impress will be given to the tissues outside of the tooth. 422. What is a perforation ? A cavity, excavation or drill-hole perforating the cementum. 423. How is it treated ? Moisten cotton-wool with oil of cloves or fluid cosmoline and press gently into cavity ; impinge upon outside tissue just suffi- ciently to permit accurate contour healing ; this accomplished, gently dry cavity with absorbent cotton, place smooth pieces of low-heat white gutta-percha (warmed) over orifice, and secure in position. A drill-hole should be enlarged inwardly to a conical shape for obvious reasons. (See Plastics and Plastic Fillings, p. 138.) COMPLICATED CARIES. 424. What is complicated caries ? That stage of decay Avhich requires for its proper treatment pulp cavity and canal work. 425. Is a pulpless tooth a dead tooth ? No; because the cementum and pericementum are still vital ; the enamel and dentine only are devoid of nourishment. (See 114.) 426. Why is the dentine dead ? Because the pulp is the source of its nutrition, and the pulp is dead. 427. What, then, constitutes a dead tooth ? One the pulp and pericementum of which no longer perform their functions. 428. What is the natural result of such a condition ? Exfoliation. MEMORANDA. MEMORANDA. COMPLICATED CARIES. 57 429. Is a dead tooth ever tolerated in the jaw ? Occasionally ; in such cases it may usually be left until indica- tions point to its removal. 430. What are such indications ? Unbearable annoyance, irremediable elongation, unsightly dis- coloration, injurious pus formation, caries or necrosis of contigu- ous parts. 431. What natural results may follow the death of a pulp ? Loss of vital resistance, translucency, nutrition and sensation of dentine. (See 118.) 432. What untoward results may follow the death of a pulp ? Discoloration of tooth, periodontitis, alveolar abscess, necrosis of root and caries, or necrosis of surrounding process, with their probable attendant neuralgic complications. (See 714.) 433. What is the cause of loss of translucency ? A disorganization of the contents of the dentinal tubuli. 434. What is the cause of discoloration ? Infiltration of tooth tissue by external or internal discoloring material. 435. Is it possible to remove this discoloration ? Not always ; sometimes by excavating the discolored dentine, or whitening with prepared chalk and lining with oxychloride or oxyphosphate of zinc, a reasonable restoration of color may be made ; but frequently, with the use of all means, discoloration may recur. 436. What two remedies present to this condition of final discoloration ? 1st, pivoting or crowning ; 2d, extraction and replacement by artificial substitute. 437. What is taught of bleaching ? It is of doubtful value, the darkness frequently returning worse than before. 438. Is a tooth ever better when pulpless than when fully vital ? Yes ; the value of a pulp diminishes in proportion as the pabu- lum which it distributes is of poor quality. In such teeth fillings often prove more durable after devitalization ; the tooth is, how- ever, liable to the diseases which follow devitalization. 58 DENTAL PATHOLOGY AND THERAPEUTICS. DEVITALIZATION OF DENTAL PULP. 439. What are the four means of devitalizing a pulp ? 1st, cauterization ; 2d, instrumentation ; 3d, partial luxation ; 4th, appropriate medicament. 440. What is actual cauterization ? It consists in heating a fine wire to a white heat and plunging it into the pulp (obsolete), or in the appropriate use of the electrical cautery. 441. What is potential cauterization? The application of nitrate of silver, caustic potash or Vienna caustic (quicklime and caustic potash, equal parts, made into a paste with alcohol). (Methods obsolete.) 442. What is instrumentation? 1st, broaching — the act of quickly, piercing, twisting and extirpating by means of smooth or barbed broaches (admissible only in centrals and cuspids) ; 2d, puncturing — the act of punct- uring acetate of morphia paste, muriate of cocaine, dental tincture of aconite or arsenious oxide paste into a pulp by means of gradual and repeated thrusts with an exceedingly fine puncture- probe prior to extirpation. Care must be taken not to pass through apical foramen. 443. What is luxation ? A partial extraction of the tooth, by means of which exter- nal connection with pulp is severed and devitalization follows. It is then to be gradually returned into place and properly guarded against irritation from occlusion. 444. What is meant by devitalization with appropriate medi- cament ? The use of some medicament which shall either kill the pulp through its own impress or so obtund it that pressure may accomplish the desired end. 445. What is an impress ? In this connection it means the production of a dynamic vital irritation. (See 89.) 446. What is arsenious oxide? An oxide of the metal arsenic, obtained from Bohemia and Saxony during the smelting of cobalt ores; also obtained by MEMORANDA. y MEMORANDA. COMPLICATED CARIES. 59 roasting the arsenical sulphide of iron, which oxidizes, forming arsenious oxide (AS2O3); this is then resublimed. (See Phar- macopoeia.) 447. What are the tests for adulteration of arsenic? 1st, by subliming on metal plate; residuum indicates impurity; 2d, blow-pipe test gives odor of garlic, indicating arsenic. 448. Name the principal tests for the presence of arsenic. The ammoniacal nitrate of silver test, Marsh's test, Reinsch's test. 449. Which test is usually employed in dentistry? Reinsch's test. (See any work on Chemistry.) 450. What are the characteristics of arsenious oxide ? Sublimes at 425° Fahr.; condenses into octahedral crystals; has no smell except when burned; has a faint, sweetish taste; sparingly soluble in cold water; largely soluble in boiling water; very soluble in alkaline solutions and in hydrochloric acid; is not at all soluble in creasote, oily carbolic acid or oil of cloves; forms compounds of arsenites. 451. When and by whom was arsenic introduced into dental practice ? Introduced by Dr. John R. Spooner, of Montreal, and made known to the profession in 1836 by his brother, Dr. S. Spooner. 452. Why is arsenic called a dynamic vital irritant ? Because of the very small quantity necessary to produce such decided impress and such extended devitalization of tissue. 453. What experiments prove this ? A lai'ge frog may be killed and preserved from putrescence by the persistent application of one-twenty-fifth of a grain of arsenic to its leg; arsenic may then be found in every portion of its body. 454. What action has arsenic internally? Tonic, antiperiodic, pulmonic, detergent, escharotic or a vital irritant poison, according to the size of the dose. 455. What is a tonic dose? One-twentieth to one-tenth of a grain three times a day. 456. What is the quantity used in pulp devitalization ? One-fiftieth to one-twenty-fifth of a grain. 60 DENTAL PATHOLOGY AND THERAPEUTICS. 457. What, then, in case of the loosening of an arsenical application, are the safest things that can happen ? 1st, ejection from the mouth ; 2d, swallowing (tonic). 458. Do arsenical applications ever act injuriously systemically through the pulp ? Yes; in rare but seemingly well authenticated cases symptoms of systemic arsenical poisoning from pulp devitalization have occurred without perceptible local irritation. 459. What action has arsenic on the dental pulp ? It is a dynamic vital irritant only. (See 454.) 460. What action has it on gum tissue ? It is a sure cause of death of the part unless removed. (See 453.) 461. When arsenic destroys the gum, what is the appearance of the part? The usual darkened, discolored and turgid appearance of slough- ing tissue. 462. What is the remedy for this condition? Scraping or burring out the darkened and softened parts until tissue capable of healthy granulation is reached ; dress with styp- tic cotton and soothing, healing medicaments, as tincture of calendula or campho-phenique. 463. In what forms is arsenic used? In powdered form ; in pastes ; in devitalizing fibre ; as cobalt. (See Medicaments.) 464. What four considerations govern the application of arse- nic to a pulp ? 1st, proper preparation for application ; 2d, proper placing of medicament ; 3d, proper guarding against danger to gums, tongue, lips and cheeks ; 4th, proper maintenance in position. 465. What of proper preparation ? Leave all edges possible; syringe cavity with warm water; excavate painlessly to a concavity ; gently enlarge, if possible, the orifice of pulp exposure ; stop pain, if aching, that pulp may be quiet when the arsenical impress is made. 466. Why is it improper to apply arsenic to an inflamed pulp ? Because its inflamed condition prevents the induction of the proper impression. MEMORANDA. MEMORANDA. COMPLICATED CARIES. 61 467. What is the effect of arsenic, when applied, upon a partially devitalized pulp ? ' It is probable that no effect would be produced. 468. What of proper placing ? Place accurately by cotton or probe 07i the pulp in such tempera- ments as have dominating bilious or lymphatic attributes, and near the pulp in such temperaments as have dominating nervous or sanguine attributes. Be careful not to get arsenic on gum ; apply obtundents on a separate pellet of cotton. 469. How is arsenic applied by puncture? By puncturing with a sharp pi"obe directly into the bulbous portion of the pulp or larger portions of canals of upper teeth. 470. What is the danger in arsenical applications? The escape of arsenic from the cavity. 471. Where is devitalizing fibre used? In cases where danger exists to gum tissue or where only shallow "pockets" are obtainable. 472. What is a pocket? A hole drilled into a tooth in the direction of, and as near as possible to, the pulp, in which arsenic is applied for the purpose of devitalization. It is usually made in such a position that it may be enlarged into a tap-hole ? 473. When are pockets especially indicated ? When cavities of exposure are so situated as to forbid proper ingress to pulp canals, and especially if they impinge upon cementum. 474. What is taught of proper guarding ? As the cervical portion of the tooth is reached the danger from leakage increases. 475. What precedes an arsenical application in approximal cavities? The pressing against the gum, between the teeth, of an elon- gated pellet of cotton saturated with oily carbolic acid. 476. What three purposes does this subserve ? 1st, mechanically presses gum away from the cavity ; 2d, offers a mechanical and medicinal barrier to the passage of arsenic (see 450); 3d. eschars the mucous membrane. Arsenic will not pass through dead tissue. 62 DENTAL PATHOLOGY AND THERAPEUTICS. . 477. How should an approximal cavity opposite to that in which an arsenical application is to be made be guarded from the arsenic ? .By filling it either permanently or with temporary stopping. 478. How should the cheek or lip be guarded in cases of ligated arsenical applications in shallow buccal or labial cavities ? Such applications should not be made. In such cases arsenie would only be applied with the view to subsequent pulp devitali- zation. For such application a "pocket" should be made. (See 472.) 479. What are the methods of maintaining in position an arsenical application ? 1st, by cotton and oily carbolic acid, secured with sandarac or mastic varnish ; 2d, by temporary stopping ; 3d, by oxy phosphate or nitro-phosphate of zinc; 4th, by " facing " amalgam. Method No. 1 is used when depth of cavity and retaining periphery permit. Temporary stopping may cover applications of long duration and be used in cavities too shallow to permit the use of cotton ; it is non- leaking. Methods Nos. 3 and 4 are to be used over applications of long duration, in connection with marked exposure to attrition ; unlike all other plastic filling materials, they are non-leaking. 480. What length of time is needful and possible for arsenical applications ? From three or five hours to one or more weeks is usually need- ful, but it is possil^e that arsenic may remain until, from pulp 'putrescence, peridental irritation is induced. 481. Why is it ever left thus long ? That the most complete devitalization may permit the most painless extirpation. 482. If arsenic be sealed in the pulp cavity of a perfectly developed tooth, will it pass through dentine and cementum ? It will not. 483. Why is this the case, when arsenic will pass through dentine and affect the pulp ? Bead dentine will prevent its passing to cementum, while living dentine will insure its passage to the pulp. MEMORANDA. MEMORANDA. COMPLICATED CARIES. 63 484. How is arsenic introduced into the pulp tissue ? Through the medium of the circulation. 485. What is usually the first effect of an arsenical application upon a pulp ? It produces "determination" of blood, with its concomitant pain and throbbing. 486. If the irritation cannot be carried beyond this point what is to be done ? Remove application, syringe, soothe pulp, and renew appli- cation. If still the same result, puncture an application into the pulp. 487. What follows " determination ? " "' Congestion," with its concomitant fullness and loss of sensa- tion. 488. How does " congestion " devitalize the pulp ? By causing cessation of nutrition. 489. Does "true inflammation" ever ensue? Sometimes. Indicated by severe paroxysms of throbbing pain, which follow the dull feeling. They are often bearable and will generally pass away in a half hour. This true inflammation adds to the congestion, there being three or four waves of congestion, of about ten minutes each. 490. Does arsenic pass through the apical foramen of a fully- formed tooth ? • It does not, unless forced through, because its absorption is interfered Avith by congestion. (See 78.) 491. What is taught regarding cause and treatment of any peridental irritation which supervenes upon arsenical devitalization? Its cause is not directly referable to arsenical irritation, but to the nutrient effusion of " determination " previous to the estab- lishment of new channels of circulation. Treatment-^In marked cases apply dental aconite to gum persistently ; in sthenic patients also spot with dental iodine. 492. What proofs exist that arsenic is not absorbed by the pulp of a fully-formed tooth ? 1st, if absorbed it would preserve the pulp, whereas, as a rule, it putresces in due season; 2d, Reinsch's test, which detects ^ g i ; ,^,) Q of a grain, shows no arsenic in the dead pulp. 64 DENTAL PATHOLOGY AND THERAPEUTICS. 493. What result, in connection with tooth tissue sometimes follows an application of arsenic ? Suffusion — a pinkish or purple discoloration of the crown and neck of the tooth, caused by the infiltration of haematin into the dentinal tubuli. 494. What is its treatment ? Open and cleanse canals, stop temporarily above suffusion, wash with tepid water, and leave open to the fluids of the mouth for a few days. Do not use "bleachers." 495. What governs the repeated applications of arsenic? In teeth of the upper jaw, even by instrumentation, it is comparatively safe practice, though care must be observed not to force ai"senic through the apical foramen. (See 460). In teeth of the lower jaw instrumentation is apt to force the arsenic through; therefore a second application by contiguity (on pellet of cotton) is alone admissible. 496. What is meant by an intractable pulp? A pulp which it is found impossible under any circumstances to devitalize by arsenical applications. 497. How are such pulps to be treated? Cover with powerfully-soothing medicaments under concave caps, as attempts at devitalizing by other means usually result in loss of the tooth. 498. How are the pulps of deciduous teeth devitalized ? By inducing such gradual pressure as will be tolerated upon the pulp, by means of cotton pellets medicated with eucalyptus or cajeput (alternates), dental tincture of iodine, creasote, carbolic acid, acetate of morphia paste, muriate of cocaine or oil of cloves. These medicaments permit pressure, which produces congestion, and thereby devitalization of the pulp. 499. Where is pressure indicated ? In deciduous teeth and in such of the permanent teeth as have not fully-formed apical foramina. 500. Why not use arsenic? It may he applied for an hour only, to prepare for pressure, but if left longer it may go through the apical foramen and affect the adjoining tissues. MEMORANDA, MEMORANDA. COMPLICATED CARIES. 65 501. What carries it through the foramen in these cases ? The large foramen allows of free circulation and consequent absorption of arsenic. (See 484.) 502. What is the guide to the formation of roots ? The following table, obtained by a careful observation and comparison of specimens, and which is a reasonably close approximation to a safe guide.* 3. 503. What are the six considerations which maintain system- atic antagonism in the treatment of deciduous and permanent teeth ? 1. Permanent teeth are for perma- nent use. 2. Permanent teeth are filled for permanent purposes. 3. Permanent roots are usually not fully formed when the crowns need attention. 4. Irritation of pulps interferes with formation of permanent roots. 5. Devitalization of pulps prevents formation of permanent roots. 6. Every consideration points to the great utility of even crownless permanent roots. Deciduous teeth are for temporary use. Deciduous teeth are filled for tem- porary purjjoses. Deciduous roots are absorbing or absorbed when the crowns need attention. 4. Irritation of pulps interferes with absorption of deciduous roots. 5. Devitalization of pulps prevents absorption of deciduous roots. 6. Every consideration points to the early loss of rootless deciduous crowns. PULSATING PULPS. 504. What is meant by a " pulsating pulp ? " One which visibly pulsates in unison with the arteries. *In view of the saving of teeth for long-continued future use, the importance of this table cannot be overestimated. tAll the specimens examined indicated the tardy formation of the roots of the bicuspids, both superior and inferior. 66 DENTAL PATHOLOGY AND THERAPEUTICS. 505. To what is it probably due ? Probably due to enlarged apical foramen. 506. What is the prognosis ? Unfavorable. 507. What symptoms distinguish it from pulp dying? Decided pain, long-continued paroxysms of severe suffering, soreness upon pressure, throbbing pain, and imperative demand for relief. 508. What is the condition of the health line ? Perfectly normal. 509. What is the treatment? Careful entrance of tooth, control of probable hemorrhage, sedation of pulp with dental aconite, and careful devitalization, as for deciduous pulps. EXTIRPATION OF THE DENTAL PULP. 510. Upon what does the average of success resulting from this operation depend? Thoroughness of extirpation, favorable auspices, and after- treatment. (See 530.) 511. What are the essentials to thorough pulp extirpation? Free openings, affording easy access to pulp canals, either through the cavity of decay or through an opening made intention- ally for the purpose of affording such ingress, called a "tap-hole." 512. What is to be done with the cavity of decay in case it does not afford ready ingress to pulp canals ? Treat it as an ordinary cavity, and fill permanently at once. 513. What is the point for " tap " in each tooth? Superior centrals and laterals on lingual face. " cuspids on tuberosity or disto-labially. " first or second bicuspids ou articulating or buccal face. " first molars on articulating (best), buccal (next best), or mesial face (fair). " second molars on articulating, mesio-articulating or bucco-articulating face. " third molars on mesio-articulating face. Inferior centrals and laterals on lingual face, just posterior to cutting edne. " cuspids on disto-labial portion, near the gum. " bicuspids on mesio-buccal face. " first, second and third molars on mesial, buccal or mesio-articulating face. COMPLICATED CARIES. G7 hl-i. What is the method of tapping ? Spot enamel with diamond or inverted-cone drill, and enter pulp cavity Avith spear-pointed drill ; enlarge this opening with successive sizes of rose drills until the contour lines of the pulp cavity are obliterated; syringe with tepid water. 515. What is the first indication in pulp extirpation ? Probe gently to ascertain as to sensation. 516. What does sensation indicate ? That the pulp is not thoroughly devitalized and that it should be obtunded, or that a second application of arsenic should be punctured into it. (See 469 ; also 495.) 517. What is the danger to broaches in extirpating? Breaking them off in the canal. 518. What is the objection to leaving a bi'oken broach or probe in the canal? It presents a mechanical barrier to future venting of the tooth. 519. What methods are recommended for removal of such broken fragment of broach ? If broach is loose, leave common salt in the cavity for a few days, Avhen it can be easily removed, or draw it out by means of a magnetized probe ; if tight, bur-drill around broach till end is exposed and lift out with pliers. 520. Give the treatment of canal in single-rooted teeth. Extirpate as thoroughly as possible ; syringe out remaining fila- ments with tepid water; clean Avith alcohol and glycerine, and intro- duce taper-twisted dressings of cotton dipped ni fluid cosmoline, not filling the canal flush with the pulp chamber; place a small ball of cotton in the mouth of tlie canal. 521. What is this called ? The " guard pellet." Its use is to prevent the sudden drawing doAvn of the cotton dressing when drilling near the pulp cavity. 522. Give treatment of canals in multirooted teeth. Beginning with the largest, extirpate and prepare each in turn, as in single-rooted teeth ; the cotton dressings are thus not disturbed nor canals refilled with d/bris during the preparation of smaller canals ; as a last thing, ])r!or to temporarily stopping the tooth, Avork medicament, by means of fine probes, into the smallest canals. (38 DENTAL PATHOLOGY AND THERAPEUTICS. 523. What medicaments are recommended for use in fine or tortuous canals where devitalization has been only partial ? Puncture acetate of morphia paste, with or without muriate of cocaine ; if this does not satisfactorily obtund the sensitivity, puncture deliquesced chloride of zinc. 524. What medicaments are recommended for ordinary canal- work after recent devitalization? Glycerin, alcohol, oils of cloves, cinnamon, cajeput or eucalyp- tus, eugenol, campho-phenique, fluid cosmoline, acetate of mor- phia paste, menthol, inspissated canal dressing, iodoform paste. 525. How long should the tooth remain temporarily stopped ? About a Aveek, or until the irritation about the apical foramen has subsided. (See 491.) 526. What is taught in regard to liemorrliage governing this ? Red bleeding is regarded as favorable (except in cases of hemorrhagic diathesis), and is usually followed by coagulation and prompt healing of parts. On the contrary, effusions, or " white bleeding," may take place, enforcing repeated stopping and unstopping before relieved. This occurs generally in patients of the lymphatic temperament. The safest method is to allow time for a thorough devitalization and separation of pulp from outside tissue by sloughing. 527. Is it always possible to clean and fill to the very apex of all roots ? No ; fine, tortuous and bayonet-shaped roots often render such operations impossible of accomplishment. 528. Which teeth generally present peculiarities of root forma- tion ? Superior bicuspids sometimes have three roots ; superior second molars have usually a flattened root formation ; sometimes very fine, hair-like buccal canals, which cannot be even entered ; superior third molars have frequently three, sometimes four, five or more well-defined roots and canals ; lower cuspids occasionally have two roots ; inferior first and second molars have often two mesial canals, sometimes a flattened distal canal, and infrequently two distal canals, making four canals to the tooth; sometimes three or four distinct roots; inferior third molars have usually two canals; sometimes three ; sometimes three roots ; usually more or less curved. MEMORANDA. lJlc Equal parts. Chloroform, ' Used as a substitute for aconitia ointment, especially in cases of neuralgic trouble from pathological eruption of lower wisdoms. 100 DENTAL PATHOLOGY AND THERAPEUTICS. Laudanum and Arnica. R Tincture of arnica, | j, ^ Laudanum, J Or, R Tincture of arnica, | Equal parts. • Sol : Bimeconate of morphia, > Are alternates. Used in cases of mild peridental trouble, on muslin pads, over affected tooth. May swallow the saliva. Lead Water and Laudanum. R Acetate of lead, ^i. Laudanum, ^i. Water, Oi. Antiphlogistic for external application. Lime Water. — Place a lump of unslacked lime in a bottle of water, making a saturated solution. Useful in sensitive dentine, both locally and systemically. As solution is used, add more water indefinitely. Lotoelia, Tincture of. — Alternate to tartrate of antimony. Dose. — Two or three drops every three or four hours, to slight nausea. Menthol (crystals). — Cooling ; soothing. Used with acetate of morphia paste or inspissated canal dressing, or other medicaments, when its qualities are needed. It softens the paste. Mixed with paraffine or spermaceti, is used ad libitum for soreness of jaw and neuralgia. Mercury, Bichloride of. — (Diluted, 1 to 1000.) — Is an excel- lent disinfectant for canals. Use with care. Has disagreeable taste. Morphia, Acetate of. — Used in acetate of morphia paste ; in arsenical paste ; in inspissated canal dressing. Morphia, Bimeconate of (Solution). — (Solution of same strength as laudanum.) A good make will remain clear ;* alternates with opium and morphia administrations, being especially indi- cated in nervo-biliou.^ and bilio-nervous temperaments. Dose. — A half teaspoonful, pro re natd. * If kept absolutely from the light. MEMORANDA. MEMORANDA. MEDICAMENTS. 101 Morpliia, Hypodermic Injection of. — For sensitive den- tine. Dissolve in water hypodermic pellet containing sulpliate of morphia, | gr.; sulphate of atropia, y^ gr., and inject into arm. Morphia Paste, Acetate of. R Acetate of morphia. Oil of cloves, q. s., to make paste. Pain obtundent. A portion of this is used alone or with menthol (a crystal or two), or with cocaine (a small portion), or a part of a drop of dental aconite, as indicated ; also used for pulp puncture. Nitric Acid, 41°. — Used for obtunding sensitive dentine and for canker sores. Napkin mouth and dry canker sore : touch sore with nitric acid on pointed stick till entirely white ; causes pain ; obtunded by oil of cloves on pellet of cotton, previously prepared. Pepper Bag-s. — See Capsicum Bags. Peroxide of Hydrog-en. — Used for the treatment of pus- making surfaces ; for disinfecting canals ; for treating canker sores in the mouths of children. Plie'uol Sodique (Hance Bros. & White's). — Very acceptable and efficacious medicament. Pain obtundent, styptic, detergent, antiseptic, disinfectant, stimulant; is a useful injection for fistuhie ; useful as a mouth-wash ; ten to thirty drops to lialf tumbler of water. Piscidia Erythrina, Fluid Extract of (Jamaica Dog- wood). — Used in difficult devitalization in canals ; is notable pain obtundent; sedative; applied locally and administered systemic- ally, is eminently antineuralgic. Systemic dose, one-half tea- spoonful, pro re natd. Potash, Chlorate of. — Make saturated solution in water. Used (either full strength or diluted, as is agreeable) to hold in the mouth in cases of peridental trouble and sore mouth generally ; should be occasionally swallowed hjr the systemic etlect. 102 DENTAL PATHOLOGY AND THERAPEUTICS. Potassa, Caustic (in sticks). R Caustic potassa, ) Carbolic acid (crystal), | ^'l"*^ P^"^*"" (Robinson's remedy.) Rub together. Used for sensitive dentine and in pyorrhoea alveolaris. Potassium, Bromide of. — When given for the relief of dental suflfering, should administer at least forty grains, and more if the patient is accustomed to its use , administer in water. Potassium, Carbonate of. — Fill small bottle half or three- quarters full ; add glycerine; rub up in mortar; return to bottle ; add glycerine as used. Used in sensitive dentine ; especially indicated in the variety about necks of teeth ; does not injure mucous membrane. Potassium, Nitrate of. — Eminently cooling. Used in pulp cavity in severe periodontitis. (See 653.) Potassium Ointmeut, Iodide of. R Iodide of potassium, ^i. Simple cerate, 5 i. Add one drop of liquor potassa to prevent discoloration. If ointment crystallizes, spatulate before using. Used for indurations or slowness of absorption. Potassium, Permang-anate of. — Used in strong solution for disinfecting canals ; in mild solution for sweetening the breath. Quinia, Sulphate of. — Antiperiodic; usually an excellent remedy in neuralgia, but clinical experience seems to show that it is contra-indicated in dental neuralgia. Red Precipitate Ointment. R Red oxide of mercury, gr, Ixii. Benzoated cerate, .^i, or gr. xv. ,:^ij. Is a good lip salve ; relieves rough, scaly and cracked lips. Application — -Open crack and rub ointment in; do this for several visits, until strong cicatricial tissue is formed. Salt and Water. — (Strength of ocean water.) — Excellent stimulant and detergent in inflammation of the mucous mem- brane; also useful injection for fistulse. MEMORANDA. MEMORANDA. Sodium, Silico-fluoride of. — Used in saturated solution as germicide for cavities and canals. Packed dry into'' dry canals is a good permanent antiseptic dressing. Sulphuric Acid, Dilute. R Sulphuric Acid, | j, ^ ^ ^^^^_ Water, j h r Useful for the opening of canals ; dissolves tooth substance and debris, facilitating the passage of probes into fine canals ; acts simultaneously as a germicide. Should be used with a gold (clasp metal) or iridio-platinum probe. To be neutralized with a satu- rated solution of bicarbonate of soda. MEDICAMENTS. . 103 Sandarac Varnish. R Oil of cinnamon, Jss. Oil of cloves, 3ss. Alcohol, 5i. Gum sandarac, q. s. Used to saturate cottons, and thus i-ender them more subservient to the varied requirements of maintenance in position, exclusion of moisture and retention of medicaments. Smelling- Salts. B Muriate of ammonia, -i Bicarbonate of soda, f^^^^'^ P^'*^' Oil of cloves, a few drops. Place simple cerate around the glass stopper of the bottle. Soda, Bicarbonate of. — (Ordinary baking soda.) Used in sensitive dentine, and for systemic hyperacidity. (See 190.) Styptic Cotton. B Monsel's solution, 2 parts. Water, 1 part. Steep absorbent cotton in the mixture and dry. Used as adjunct in cases of hemorrhage requiring mechanical retention of the clot. Sulphuric Acid, Dilute. R Sulphuric acid, 1 part. Water, 3 parts. As a stimulant injection, seems especially indicated in con- nection with cases of caries and necrosis. Sulphuric Acid, Aromatic. Uses. — Same as of the dilute. Not recommended. Tannin. — Astringent and styptic. Used after extraction in cases of hemorrhage or insufficient clotting ; also used in combi- nation with glycerine as obtundent in sensitive dentine. Tannin and Water. — Useful as astringent for external use; to be applied on cloths. 104 DENTAL PATHOLOGY AND THERAPEUTICS. Tannin ]S"o. 1 R Tannin, ^i. Glycerine, §i. Mix in a mortar with gentle heat. Obtundent of sensitive dentine. Tannin No. 2. R Tannin, ^ii. Glycerine, §i. More powerful obtundent than No. 1. Tartrate of Antimony and Potassinni (Tartar Emetic). — Produces vital depression, and thereby systemic sedation. Dose. — One grain every three or four hours to slight nausea. Always inquire of patient as to usual effect of this drug. Temporary Stopping. R White wax, 1 dwt. (full). Eed gutta-percha base-plate, 4 dwt. Precipitated chalk, 4 dwt. Melt wax first ; add gutta-percha, and melt thoroughly ; then add chalk in small quantities, thoroughly incorporating it with the gutta-percha ; partially cool and roll into sticks with hands, and afterwards with a plate of glass. Is non-leaking. Used for covering canal medicaments and arsenical applications; for filling bulbous portion of pulp cavity ; as intermediate. Veratria Ointment. — Avoid with utmost care the mouth and eyes. R Veratria, gr. xx. Simple cerate, 3 i. Uses. — To be used on failure of aconitia ointment to act, or to increase the action of aconitia ; is never used before aconitia. It produces a decided, persistent, irritating or burning sensation analogous to nettle. Use in pieces the size of a quarter of a pea. (Powerful poison.) Veratrum Viride, Tincture of. — Give by pulse. Admin- ister two or three drops and wait several hours ; then reduce pulse by drop doses, and keep reduced by one drop each two or three hours. MEMORANDA. MEMORANDA. MEDICAMENTS. 105 Vinegar and Water. — Excellent antiphlogistic for external use ; to be applied on cloths. Zinc, Chloride of. — Deliquesce crystals in a saucer, and pour oiF supernatant liquid for use; keep in glass- stoppered bottle. Used in sensitive dentine and as dernier ressort in canals for devitalization ; is used for injection of fistulas in solutions of varying strengths, from powerfully stimulant to mildly detergent. Ziuc, Iodide of. — (Full strength.) Stimulant injection. Zinc, Sulphate of. — Stimulant injection. (See 696.) COLUMBIA UNIVERSITY LIBRARIES This book is due Jn til? date indicated below, or at the expla ion of a defin^tl't^i&d after the date of borrow-g^ - provided by the library rules or by special arrangement with the Librarian in charge. C28(747; MlOO RK57 Inglis In4 1891 Annex COLUMBIA UNIVERSITY LIBRARIES (hsi.stx) RK57ln4 1895C.1 2002447380