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and the sharp spicula of bone trimmed, with engine burs, tincture of

iodine full strength may be forced into the cyst sac, by saturating

tufts of cotton-wool and allowing them to remain, again repeating

the treatment at intervals of a day. If necrosis of bone be present,

it is good practice to alternate the iodine treatment with aromatic

sulphuric acid. Cases generally yield to this treatment in from six

week to three months. I have seen cases not yielding to treatment for

nine months. There are other and shorter methods in the treatment

which perhaps some would prefer--the cutting down through the body of

the tumor, by making a crucial incision and scraping out the contents

of the sac, afterwards allowing nature to do the rest--but I do not

believe it is the best or safest way. There is surely a much greater

loss of structure, which is never restored as in the former method by

granulation, after the secreting cells have been destroyed by medicinal

applications of iodine and sulphuric acid treatment.--_Medical and

Surgical Reporter._

ARTICLE V.

THOROUGHNESS.

BY L. P. DOTTERER, D. D. S.

[Read before the South Carolina Dental Association.]

Though scarcely more than a novice in the vast field of Operative

Dentistry, I have gleaned sufficient experience from observation and

practice to know that THOROUGHNESS is the surest means of success.

Just as the tillers of the soil sow their seeds, watch their crops,

and reap their harvests, so must we do our duty, advise our patients

as to the best means of preservation, and would that I could say, reap

our harvest. There has been so much written upon this subject that I

have nothing _new_ to say, but will touch upon several points, and in

giving my idea of thoroughness, as there applied, I may draw out some

discussion.

The first step towards the preparation of the mouth for dental

operations is the removal of calculus and decayed fangs. Let this be

done in a manner that will _insure future cleanliness_, where the

proper after attention is given on the part of the patient.

As regards the preparation and filling of cavities, there are so many

conflicting conditions, that we must be governed entirely by the case

before us; but to be thorough in our preparation, we must so shape the

cavity as to have the walls nearly plumb, uniform margin, slightly

undercut. In proximal cavities there may be a groove or pit at cervical

wall, but do not have it too near the margin, on account of its

liability to produce fracture, and consequent failure at that point.

On grinding surfaces, cut out all fissures leading into cavity, and be

careful to have no angles.

The margin, after all, is the most important point; for just here

failure begins, especially at the cervical wall, and care should be

taken to thoroughly remove all softened structure, and aim to reach

a solid foundation. These margins should be carefully trimmed and

burnished, and thus our cavity is ready for the filling.

We often hear practitioners decry the rubber-dam, and boast of their

skillful use of the napkin; but, gentlemen, many are the failures

consequent! For in deep proximal cavities, the dam is invaluable in

keeping guard against oozing moisture from the gums, which, without

this precaution, will flow upon the filling without our knowledge.

The dam adjusted, we proceed to form a mass of non-cohesive gold, and

where the walls are strong enough, we can continue with this material

throughout. But where cohesive gold is necessary, we should cover our

borders, as far as possible, with soft foil; for this is more adaptable

to the walls. Another advantage to be found in non-cohesive gold, is

its pliability, ease of starting, and rapidity in finishing. We should

thoroughly condense from beginning to end, whatever may be the kind of

foil used.

Filing and finishing is too often hurried through, leaving a surplus

of material at the cervical wall, or lapping the edges--another sure

cause of failure; and every care should be directed to finish in such

way that an instrument passing over the line of demarkation cannot

detect it. After filing, we would use pumice, either on a strip of

orange-wood, or by some other convenient means, and then polish. The

same general rule holds good in amalgam work, and the main cause of

failure in these cases is that lack of thoroughness in finishing.

In grinding surface cavities, where the enamel leading thereto is

funnel-shaped, we often introduce too much amalgam, extending it

beyond the margins of the cavity, and finishing to a fine edge. This

material, when hard and bit upon, will fracture perpendicularly around

the margins, giving the finishing a bulged appearance, and exposing a

V-shaped crack, which will invite decay. Consequently, we should remove

all surplus material, and finish at the very margin of the cavity. When

gold is used, this precaution is not so necessary, as the edges of a

gold filling will not fracture. Since we do not have to mallet amalgam,

it is natural to suppose we don't require firm margins, but this is

a mistake; and as much, or even more care should be exercised in the

preparation of a cavity for amalgam than gold, as tooth-structure seems

to waste away more rapidly from the former.

Let our motto be, "Whatever is worth doing at all is worth doing well."

If applying arsenic or a disinfectant, cover it with gutta-percha,

for the patient may be delayed a few days longer than we anticipate;

and what is worse than removing a foul piece of cotton, and finding

the tooth in a poorer condition than we left it? If we introduce a

temporary stopping on account of exposure or frailty, let it be done

thoroughly; and after relating its importance to the patient, caution

her to return at a certain time for its removal and permanent filling.

We must be teachers at our chairs, if we wish the public to appreciate

us, and we should instruct patients in the proper care of their teeth

by an intelligent and thorough use of the brush, pick, etc.

Such is the importance of thoroughness in dental operations. This paper

does not half express it, but for fear of trespassing too much on your

valuable time, I commend these ideas to your criticism.--_Southern

Dental Journal._

ARTICLE VI.

WHAT FILLINGS SHOULD WE USE?

DR. W. G. A. BONWILL, PHILADELPHIA.

When I look back at my commencement and reflect that my early practice

was founded on what the older men in authority had published and

taught, and how I feared to do other than they demanded, I shudder at

the many teeth I extracted I now know might have been saved, with even

the amalgam of that day. And I tremble at the advice _now_ given by the

authorities that _gold_ only should be used as a permanent filling.

Young men knew no better, but the older do. God forgive them, I cannot.

While I do not belong to the disciples of the new departure, _so far as

their theory is concerned_, I stand side by side with any person _who

can save teeth by plastic materials_, where gold cannot be used. Better

do this than persist with gold indiscriminately, and lose teeth, rather

than stoop to conquer with _any article_ that is _not gold_. The public

are demoralized on the subject of _gold_. "Are you not going to fill my

teeth with gold?" says nearly every new customer; "Dr. ---- would not

think of using anything else." A city operator must have more than the

usual quota of courage to stand before the societies and state "he has

been using _amalgam_ more freely of late." For the first eight years of

my practice I would not touch it, because Doctors Elisha Townsend and

J. D. White passed their anathemas on everything but gold and tin. I

worked myself nearly to death with tin to find it preserves from caries

but not from attrition. Since 1862, I have been feeling my way, and

while I think I have reared many beautiful and substantial monuments of

gold, and have perfected machinery with which to do it, yet I consume

more amalgam than ever before.

A gold filling _properly_ impacted, with cavity judiciously prepared,

and the walls shaped as to forbid future decay, _will save_,

irrespective of the frailty of their bony structure? But as thousands

of teeth _cannot be so prepared_, both of strong and of frail

organizations, and the circumstances _cannot_ be controlled, we should

resort to something that will enable us the more surely to meet the

issue.

To enumerate the many cases of peculiar character that forbid the use

of gold, would be too great a task. Physical impossibilities lie in the

way of every undertaking; and it is for the successful engineer, who

is well acquainted with his material, and their relative strength and

_adaptability_ for his purposes, to so use each, that his design will

be consummated, and which shall not by future wear, prove a failure.

There is a fitness in every material that experience has proven to

be specially adapted for a given work, and when this general law is

recognized and we become first-class engineers, we shall the better

see where we can adapt our materials to the work to be done, and we

can be the more certain of success, for it is founded on the logic of

mechanics and physical law.

Where is the dentist that first lays out his design and orders

materials best adapted for specific portions of it?

As well say everything should be made only of iron, or steel, or

wood, as that every tooth should be filled with gold; or, as _equally

ridiculous_, that the amalgam or some one of the plastic fillings

should be the only material used.

It is not _necessary_ to found a _creed or departure_ on a law of

_incompatibility_ to tooth substance. We need not look so far into the

unknown and unknowable. We poor, short-sighted creatures must have

the tangible; not a hypothesis on a _supposed theory_. Any one with

half an eye can see just where the incompatibility is; not between gold

and dentos, but between dentos and untutored and unskilled brain and

hands to _carry out the law of adaptibility_--the correlation of forces

involved.

One skilled in the use of the mallet, with the rubber-dam and a

substantial starting point, with walls ever so frail, can perfectly

impact and complete the work in gold filling, _provided the

surroundings are there_. But allow _one little vacuum_ between the

tooth substance and the filling, and a _capillary tube_ will be formed

to suck up _fermentable material_; and the _acid generated_ will act

on the tooth whether it be filled with gold, amalgam, oxyphosphate, or

gutta-percha. A thousand capillary tubes making porosity in the gold

or the amalgam, will not do it; but if there is one, however small,

between dentos and filling, destruction is sure.--_Transactions of the

Odontological Society of Pennsylvania._

ARTICLE VII.

SOME METHODS OF SEPARATING TEETH WITH WEDGES.

BY DR. DWIGHT M. CLAPP, OF BOSTON.

[Read at the joint meeting of the Massachusetts and Connecticut Valley

Dental Societies, held at Worcester, Mass., June, 1885.]

Among the many disagreeable and annoying, not to say painful, things

that patients have to suffer at the hands of dentists, nothing,

perhaps, is received with greater dread and disgust than the

announcement that the teeth must be "wedged" before filling. Some,

a small minority among us, I think, always fill without previous

separation. In regard to the necessity for it, I will enter no argument

here, but only say that personally I am a firm believer in wide

spaces between the teeth at their necks, and labor to the best of my

ability to obtain this result. It is most likely that many of you are

using the same means that I am to get the desired room for filling,

but by presenting and discussing the subject, it is possible we may

obtain some help in doing what I fear the most of us find, at times,

difficult and perplexing. For a long time rubber was about the only

thing used for separating. It has some good qualities and many bad

ones. It probably causes more pain and annoyance to the patient than

any other wedge. Its liability to slide into contact with the gum,

causing great pain and soreness, and even suppuration, has caused me

to entirely abandon its use, I am willing to admit that it may be used

successfully sometimes. The best rubber to use, if it must be used

at all, is that of which the most inelastic tubing is made, or the

erasers sold by stationers, cut into suitable shape. Wedges of wood

are well adapted to cases where the sides of teeth to be wedged are

nearly parallel, or where there is less space at the gum than at the

points of the teeth. The wedge should be about as wide as the length

of the crown, that is, it should extend from the cutting edge to the

gum, nearly. It should be so shaped and trimmed as to not irritate the

tongue or cheek. One advantage of the wooden wedge is that it is more

cleanly than tape, cotton, or silk. This same class of teeth, those

with nearly parallel sides, can be separated as successfully, and I

think with less pain, with tape. Linen tape of various widths and well

waxed is the best. It should be folded so as to be of proper width and

thickness, and then drawn into place. A sharp knife is preferable to

scissors for cutting off the ends. The tape should be thoroughly waxed,

which assists materially in getting it between the teeth, and renders

it more cleanly when left in the mouth for several days. In teeth with

cavities so situated that cotton can be crowded in with sufficient

force, this is one of the best wedges that can be used, as regards both

effectiveness and comfort. It is necessary to so place the cotton that

the force of expansion will be exerted against adjoining teeth and not

expanded within the cavity. By once changing the cotton, space enough

can generally be obtained. It is difficult to adjust and keep wedges in

place between teeth having more or less space at the gum, and touching