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of more or less rapid decay, as well as those which the deposit of

tartar, or other cause, had become entirely divested of periosteal

nourishment, would be promptly condemned as unfit to remain in the

jaws, regarded in fact as foreign bodies liable to give rise, not only

to cerebral irritation and disease in the organs of special sense,

through the propagation of local disturbances in the mouth to the

regions mentioned, but to endanger likewise the general health through

purulent matter discharged into the mouth from alveolar abscesses,

to be continuously swallowed for a long time, or, indeed, in some

instances, to be absorbed and thus produce septic?mic poisoning. It is

certainly gratifying to note the establishment of instruction in oral

surgery in some of the medical schools, and it is to be hoped that this

subject will receive the attention its importance demands."

Dr. Sexton cites the readers of the _Record_ to eight cases of otalgia

resulting from diseased teeth. I have no doubt but a majority of the

dentists before me to-day have met with almost that number of cases in

practice every week; nor do you find it a difficult thing to render

prompt relief, and that, too, in a large majority of cases, without the

use of the forceps. And I believe that I am warranted in saying that in

at least three-fourths of the cases met with in our practice, we find

the reflex pain in the ears due to exposed living pulps, and not to

"dead teeth in the jaws."

That diseased teeth do cause reflex trouble, not only in the head,

but frequently in more remote parts of the body, is a fact well-known

to every competent dentist. I am glad that Dr. Sexton has at last

discovered the fact, that diseased teeth do frequently cause reflex

pain in the ears, and in other neighboring parts, and that alveolar

abscesses very often cause catarrhal affections of the maxillary sinus

and of the nasal passages, and that diseased teeth will endanger the

general health. It is to be regretted, however, that the doctor has

found it necessary to charge this unfortunate state of affairs to the

ignorance of dental practitioners, who are in no way responsible for

but few of the many cases met with in practice, for there can be no

doubt but a very large majority of the teeth causing the troubles above

referred to have never received any treatment whatever at the hands

of dentists, and because Dr. Sexton has discovered that in certain

cases pulpless teeth (or dead teeth as he calls them), has caused the

ailments above referred to by Dr. Sexton, there can be no doubt. Every

dentist of any considerable experience can enumerate such experiences

by the score, and the medical profession has only been too slow to

recognize the facts discovered by Dr. Sexton.

The only difficulty with these medical gentlemen is, that they have

drawn very erroneous conclusions from the important discoveries they

have made. Their limited knowledge of the minute structure of the

dental tissue, and the source from which each derives its life, is

manifested by the erroneous statements upon which they have based their

arguments, and then after arguing from false premises, Dr. Sexton says:

"In regard to the treatment of pulpless teeth, the practice in vogue

seems the reverse of procedures founded on well-established surgical

principles." And in an editorial of the same issue we are informed that

the treatment of diseased teeth is carried, to what "the medical minds

regard as a dangerous extreme."

That some members of our profession have been over zealous in their

efforts to save all diseased pulps alive, there can be no doubt. We

will occasionally meet with an enthusiast in our profession who will

say, "I have no use for forceps, I never extract teeth." I have heard

that statement made on the floor of the Iowa State Dental Association.

That incurable diseased teeth should not be tolerated in the jaws

does not admit of discussion. Good common sense ought to settle that

question. And again, there are extremists who never devitalize diseased

pulps, no matter how badly exposed, but "doctor them up," and stupify

them, and then bury them in a living grave. Much evil has grown out of

this practice.

Some one has said that to cap a badly exposed pulp is to create a

slumbering volcano, and he might well have added that such volcanoes

have but a limited time to slumber. Gentlemen, there are in our

own country ten thousand volcanoes belching forth--not pure molten

lava--but impure gases and putrescent matter of the most sickening

character. The craters to these volcanoes are not found on the mountain

top, but they are found in human mouths--in the antrum of Highmore, in

the nasal passages, and externally on the face, neck, or even on the

chest.

When the pulp of a tooth is dead and confined within its bony walls

an outlet is sought, and must be affected for the escape of impure

gases arising from the decomposing pulp and for the putrescent matter

associated with it. When thus confined its only way of escape is

through the dental foramen, and into tissues adjacent thereto. The

pressure thus brought to bear upon the bony walls surrounding the apex

of the root will in time perforate it at its weakest point, and the

poisonous matter is forced through the opening thus formed and into the

soft tissues, which soon yield to the pressure, and the imprisoned mass

of corruption is liberated. The pain and swelling now subsides, but a

dangerous nuisance has been created. The channel formed from the apex

of the root to an external opening will not close while it is used for

the passage of foul matter and gases that will flow unceasingly from

the pulp canal.

The remedy of course is to remove the cause, and assist nature in

affecting a cure, and to do this the pulp chamber must be opened, its

contents removed, the canals cleansed and disinfected, the abscess

healed, and the roots filled to the exclusion of all fluids and

purulent matter. But how often this is not done. How many thousands of

suffering mortals are to-day dragging out miserable lives because of

these drainage tubes emptying themselves into the oral cavity--into

the maxillary sinus or into the meatus of the nose. Such an abiding

nuisance in the mouth cannot long exist without ruining health. But how

few of the unfortunate sufferers realize the cause of their nervous

irritability, their loss of appetite, their feeling of lassitude,

their lack of energy, and their general prostration. And here let me

say, that but few, in comparison to the number of these unfortunate

sufferers seek relief at the hands of the dental practitioner. The

patient is neither sick nor well, but debilitated and "good for

nothing." The family physician is consulted, nervines and tonics are

administered, but to no avail. The septic matter is vitiating the air

that is breathed, and poisoning the food that is eaten. The saliva

that is poured into the mouth from the various glands must mingle with

this poisonous matter and carry it into the stomach.

Sanitary means are being employed in all our cities at the present

time, in view of the cholera scourge that it is feared will sweep over

our land the coming summer. Our physicians wisely talk and write about

the baneful influences of impure water, about miasma arising from the

decomposition of vegetable matter, and about unwholesome food, and it

would be well if the public would heed their timely warnings. And as

dental practitioners, I feel that we, also have an important duty to

perform, in enlightening our patients, and the public so far as we are

able to do so, in the direction I have above indicated.

The subject is of paramount importance, and as the opportunities come

to us in every day practice, let us not fail to impress upon the minds

of our patient (when we find it necessary to do so), the fact that a

clean mouth is essential to health.

The agitation of this subject, by the medical profession, is a step

forward. Hitherto medical men have not given the matter the attention

its importance demanded.

And now that this new light has dawned upon Dr. Sexton, it is not

strange that, in hastily drawing his conclusions, he should have

mingled much of error with the truths he has discovered. Possibly some

of the cases that have come under his notice may have been the result

of bad practice on the part of incompetent dental practitioners, but

to charge the dental profession with their short-comings would be a

matter of great injustice. Dr. Sexton is too hasty in his conclusions.

First, he discovered that certain pulpless teeth had caused certain

ailments, hence he condemns all pulpless teeth. He has discovered that

certain dentists have failed to treat such teeth successfully, hence he

condemns the dental profession for attempting to save teeth, it would

be equally fair to condemn the whole medical profession, because of

the incompetency of some of its members. But before dismissing the

subject of pulpless teeth, it may be well for us to examine the subject

a little more carefully from the standpoint of the medical writers

above referred to. We cannot afford to make a mistake with regard to

so important a matter. The higher a man stands in his profession, the

more serious the mistakes he makes, and the more important it is that

his practice be sound. An enthusiast or an extremist may injure a good

cause. There are such men in our ranks.

A few years ago a prominent dentist said, "The tooth's pulp is its

soul, and it is criminal to destroy it."

I heard another prominent dentist say, "If I find a part of the pulp

dead, I amputate the dead tissues, and save the balance of the pulp

alive."

A dentist has just moved away from Burlington, who has been in practice

there for fifteen years, and during that time he has been using arsenic

for obtunding sensitive dentine, and he has succeeded in accomplishing

his purpose admirably. I have found in one month half a dozen filled

teeth containing dead pulps, and, of course as many alveolar abscesses

in active operation. The evils arising from such abominable methods of

practice are simply appalling.

* * * * *

I have less frequently met with cases where those fistulous openings

were on the neck or chest. In those cases the roots of the teeth are

usually long, and when the abscess breaks through the lower border

of the jaw, and the pus comes in contact with the soft tissues, it

follows the course of the muscles and forms a sinous as it gravitates

to some point on the neck or chest. I have known of a number of such

cases being under medical treatment for years, where the affection

was supposed to be of a strumpous nature, and the real cause was

not suspected, and in every case a rapid recovery has followed the

extraction of the offending tooth.

* * * * *

Gentlemen, I have no doubt but the most of you are disappointed in

the nature of this paper. I have scarcely alluded to the treatment

and filling of pulpless teeth. That had not been my purpose. But I

have wished to call attention to the fact that a large majority of

the ailments above referred to have been due to diseased teeth that

have never received any attention whatever at the hands of competent

dentists.

That pulpless teeth and roots may be treated, filled, and preserved

in health in a majority of cases, is a settled question. Every

well-informed dentist knows that to be a fact, the distinguished Dr.

Sexton and the able editor of the _Medical Record_ to the contrary

notwithstanding.--_Iowa State Med. Reporter._

ARTICLE III.

DEAD TEETH IN THE JAWS.

TRUMAN W. BROPHY, M. D., D. D. S.

In reply to Dr. Sexton on this subject, Dr. Brophy makes these

pertinent remarks in the journal of the American Medical Association:

Dr. Sexton says: "The retention in the jaws of teeth which are

diseased, have become irredeemably sensitive to thermal influences,

or deprived of adequate periosteal nourishment through calcareous

formations about the roots, very frequently gives rise to nervous

diseases about the head. I am convinced that these reflected nerve

influences manifest themselves much oftener since dentistry has come

more extensively into practice during the present generation, and

greater efforts are made to retain defective teeth in the jaw."

That diseases of the teeth are often the center from which pain is

reflected to the eyes, ears and other parts, all experienced clinical

observers must admit. But that these pathological conditions of the

teeth, from which reflected pain has its origin, can be and are

successfully treated and cured with rare exceptions, as effectually as

any other diseases, is a fact too well-established to be set aside.

It is not possible to describe in this letter the method by which the

various diseases of the teeth are treated, but suffice it to say that

"teeth which are diseased from death of the pulp or from caries" _do

not_ "become irredeemably sensitive to thermal influences." In proof of

this statement, many thoroughly educated medical men, practicing the

specialty of dental surgery, will testify.

"Teeth deprived of adequate periosteal nourishment, through calcareous

formations about the roots, very frequently give rise to nervous

diseases about the head." To this statement I assent, but dissent as

to the remedy not mentioned but implied, _i. e._, the removal of the

teeth. If the calcareous deposits mentioned have destroyed so much of

the pericementum and the alveolar processes as to render the teeth

very loose; if, indeed, the teeth have lost their bony support and

are retained by means of a remnant of pericementum only, they cannot,

of course, be restored to permanent health and usefulness, and their

removal is, therefore, indicated. Teeth in this condition "frequently

give rise to nervous diseases about the head."

On the contrary, if the calcareous deposits have not destroyed the