REPORT 
OF THE 
Committee on Dental Practice. 
By M. L. Rhein, M. D., D.D.S., New York City. 
Read before the Dental Society of the State of New York at its twentieth annual 
meeting, held in the city of Albany, on Wednesday, May 9th, 1888. 
Reprinted from DENTAL REVIEW for June 1888. REPORT OF THE COMMITTEE ON DENTAL PRAC- 
TICE. 
M. L. Rhein, M. D., D.D.S., New York City. 
The past year has been prolific in material for your commit- 
tee's report. The meeting of the International Medical Congress 
furnishes a stimulus to which is due in a large measure the 
many advances made in our practice. When a patient turns 
over to our care the welfare of his dental organs, what is our 
first duty ? Put them in a condition of cleanliness, for this is ab- 
solutely necessary before, in the majority of cases, a true concep- 
tion can be formed of what work is demanded. For the removal 
of calcareous deposits the dental depots are flooded with instru- 
ments, but the profession is somewhat divided as to the merits of 
the two systems, viz: the push and pull movement. Now your 
committee believe in both of these methods ; whenever the in- 
strument does not come in contact with the gum, the push 
method is, generally to be preferred; but as soon as this style is 
used under the gum it produces unnecessary laceration of the 
parts, and there is danger of portions of the deposit being lost 
among the pericemental tissues, and later, starting up an irritation 
as foreign bodies. It is here that the pull instruments are so effi- 
cacious, for with them there is no excuse for losing any of the 
deposit or lacerating the tissues unnecessarily. The pull form of 
instrument should terminate with an acute angle but a trifle re- 
moved from a right angle, though unfortunately nearly all of them 
have perfect right angle terminations, sometimes even tending to 
obtuseness. The instrument should be of the best of temper, hav- 
ing a delicate termination, and the edge always in good condition, 2 
so that when by carefully inserting it under the border of the de- 
posit a moderate pull will always cause it to come away. The 
cutting end of the instrument whenever feasible should conform 
to the shape of the tooth. Notable instruments of the pull class 
are found in the Baylis and Abbott sets, and of the push style 
in the Cushing and Atkinson forms. Having removed all the cal- 
culary deposits the polishing with the pumice powder comes next. 
The wetting of this with hydrogen peroxide instead of water 
has been found of great value. Brown's metal strips with moist- 
ened pumice, stand unrivaled for polishing approximate surfaces, 
but should always be supplemented with dental floss. 
We have heard very little during the past year of the Herbst 
method of filling teeth. The great danger of defects ultimately 
appearing around the enamel margins has caused the abandon- 
ment of the method by many of its former advocates. On the 
other hand, the beautiful adaptability of the Wolrab gold in lin- 
ing cavity walls has been of inestimable benefit to us, insomuch 
as it has put all our gold manufacturers on their mettle ; and to 
Mr. Williams, we award the palm of eclipsing the Wolrab gold in 
his late production, crystalloid gold. The mallet, however, still 
reigns supreme, either in the shape of the electric, engine, auto- 
matic, hand, or the very recent production of Dr. Bliven of the 
pneumatic, which is the very closest imitation in form of blow to 
the electric. 
The past few years have finally settled the fact that in all 
approximal fillings complete contour restoration must be made so 
as to insure the best practical results; and all separations are to 
be avoided and condemned. 
The proper use of alloy fillings has received a great stimulus 
of late. Your committee cannot condemn too severely the habit 
so many practitioners have of carelessly inserting an amalgam 
filling in a manner that says, plainer than speech, anything will 
do here, considering the price to be paid. The use of copper 
alloy has been largely advocated during the past year. Its great 
objection is its extreme blackness, which is always an unpleasant 
thing to see in any mouth. Equally good fillings can be made of 
the light colored alloys if they are properly inserted and finished. 
Having first adjusted the rubber dam, prepare the cavity as care- 
fully as for gold. Then weigh the alloy and mercury and mix it 3 
thoroughly in a mortar, being careful to have it soft enough if 
contour work is needed. Pack in small masses with the rotary 
method, and when sufficient amalgam is inserted take small 
pieces of gold foil, No. 1, and after annealing burnish them 
lightly over every exposed portion of the filling. The gold will 
be entirely taken up by the excess of mercury and disappear, 
leaving perfect edges, and a finish the color of bright steel, which 
will take as fine a polish as a gold filling. 
The immediate separation of teeth has been very much en- 
couraged by the admirably constructed separators introduced by 
Drs. Perry. Parr and Morey. While of inestimable benefit at 
times, great harm has been done by their improper use. 
The use of the matrix has been very much increased of late, 
so that to-day it is a necessary adjunct of every dental office. It 
is, however, a standing menace to the future of operative 
dentistry. The beautiful restorations of our Varneys and Webbs 
will soon pass away and be looked upon as a lost art if the matrix 
is not kept from the hands of dental students. It is one of the 
rocks lying in young men's paths which will surely wreck them 
if not avoided. Many of our experienced practitioners have 
discovered that the place for the matrix is limited, if a perfectly 
constructed filling be the object. To Drs. Jack, Brophy, Guil- 
ford, Woodward, Miller and Herbst we are indebted for our best 
patterns of matrices. 
Fillings when completed, so as to thoroughly restore the nat- 
ural contour, should be given an enamel finish. 
For restoring cutting edges of teeth, gold and platinum com- 
bined is the best material. 
Outside of amalgam, plastic fillings are to be deprecated, ex- 
cept for temporary work in tiding over certain periods in the 
mouths of young people, or for the capping of pulps. Since our 
present method of so successfully treating pulpless teeth has 
come into use, many practitioners have not attempted the task of 
saving exposed pulps in teeth of matured formation. The Morey 
drill has been of great service in this line. By the use of cocaine 
hydrochlorate there need be no pain of any consequence; the 
root or roots being thoroughly cleansed, are syringed with a 
solution of mercuric bichloride in hydrogen peroxide (one 
grain to the ounce), thoroughly dried with hot air, bibulous paper 4 
cones, or the galvano-cautery. A few fibres of cotton wound 
around a delicate broach and covered with chloro-percha solution 
is passed through the entire length of the canal, giving the very 
dry sides of it an opportunity to suck in the solution. A solid 
cone of gutta-percha is then forced to the end of the root and 
packed home with chloroform, and over this a small amount of 
oxyphosphate is placed, and the tooth is ready for permanent 
filling, everything being performed in one sitting. 
In materia medica, hydrogen peroxide and mercuric bichloride 
have thoroughly displaced carbolic acid and creosote, accomplish- 
ing the additional benefit of ridding us of their vile odors. Cocaine 
has found a permanent place in our cabinet, and antipyrine is 
looming up as a very serviceable remedy in controlling neuralgic 
spasms. We have not yet discovered a specific obtunding agent 
for sensitive dentine. In this direction Dr. Ottolengui has 
recently reported some very wonderful results, reporting no fail- 
ures in about fifty cases. The method of procedure is to use an 
ether spray directly against the dentine, having first thoroughly 
dried the cavity with blasts of hot-air. 
For using remedies we very frequently have to have recourse 
to the hypodermic syringe, a form of which lately introduced by 
Dr. Dunn, of Chicago, is a great improvement, where no great 
force is required. The atomizer and spray are also in general 
use. 
The treatment of pyorrhoea alveolaris has made rapid strides 
during the past few years, and to-day the presence of this disease 
is no longer recognized as a legitimate pretext for the extraction 
of a tooth. In the treatment of this affection, seeing that the 
teeth are clean, which means a great deal, is the first step. Then 
follows the procedure of thoroughly washing out the pus pockets 
with a germ destroyer, for which purpose nothing surpasses the 
mercuric bichloride and hydrogen peroxide mixture. This is im- 
mediately followed by strong stimulating treatment as a paste 
made from crystal carbolic acid and caustic potash, to be followed 
with a soothing dressing of glycerine and tannic acid, which is in 
most cases all that is required. The most difficult types of this 
disease to treat successfully, are those where the roots have lost a 
large portion of their attachment, for in these cases excessive 
motion prevents all attempts of nature at reproduction of tissue. 5 
Fig. 1. 
Implanted Tooth, Andrews'. Extracted after 1^ Years x 150. 
DD-Dentine of root. 
B-Beginning formation of bay-like excavations. 
DS-Shred of dentine, detached and coiroded. 
C-Calcareous deposits in granulation tissue. 
GG- Granulation tissue myxomatous structure. 
FC -Fibrous connective tissue filling the flat bays of the dentine. 
CL-Capillary blood-vessel in longitudinal section. 
CO'-Capillary blood vessel in transverse section. 
CF- Capillary blood-vessel in formation. 6 
The chairman of your committee has successfully demonstrated 
the fact, that in these apparently incurable cases, all that is re- 
quired is to assist nature by holding the teeth in an immovable 
position, when reproduction of tissue is ascertain to proceed as in 
the milder forms of the disease. The binding wire and all forms 
of ligation are not only uncleanly and too temporary, but permit a 
certain amount of motion which in these aggravated cases is just 
sufficient to prevent the permanent adhesion of the new proto- 
plasmic formations. To insure success, unite a sufficient number of 
the teeth together permanently and the desired object is attained. 
The case presented before the First District Society in January has 
since steadily improved, and we trust to show the same at one of 
the clinics next winter. Since then we have performed the opera- 
tion on two other cases with equally gratifying results. We have 
also received communications from various men who have adopted 
this treatment successfully, so that we can at this day safely rec- 
ommend it as the proper method of treatment of the severest 
types of pyorrhoea alveolaris. 
Implantation of natural teeth has received a great amount of 
attention during the past year, and many are to-day extensively 
engaged in the practice. The present outlook is however very 
gloomy as to its becoming an operation of any permanent value. 
We have heard its wonderful success heralded all over the 
country, but in truth there can be no permanent success recorded 
in so short a time; even in the wonderful result portrayed in this 
month's Cosmos by Dr. Curtis of your committee, Dr. Black has 
shown that the ultimate dissolution of the root substance had com- 
menced. Already the numerous failures of many reported complete 
successes demonstrate that the end of the illusion is approaching, 
and the operation will soon be a thing of the past. The microscop- 
ical examination of the tooth removed from Dr. Younger's mouth, 
also reported in this month's Cosmos, clearly demonstrates that in 
this case absorption had taken place similar to that which we find 
in the shedding of a deciduous tooth. 
At a special clinic of the First District Society held on Octo- 
ber 15th, 1886, Dr. W. J. Younger implanted an inferior central 
incisor in the mouth of Dr. C. L. Andrews. This tooth has since 
been under continued observation by the chairman of your com- 
mittee. It became very firm soon after being inserted, and changed 7 
its color to conform to the other teeth, as they all do. It was a 
typical case of success, and we have seen many experts deceived 
m picking out the implanted tooth. Dr. Andrews, a dentist him- 
self, felt quite proud of the result, and everything pointed to a long 
continued usefulness of the new member of his inferior maxilla. 
But about September, 1887, he first noticed that the tooth was get- 
ting a little loose. This he attributed to an injury received in 
eating corn, and ligated it and gave it every other attention; but 
it grew from bad to worse until, on February 21, your chairman 
extracted the tooth and immediately placed it in a weak solution 
of chromic acid. It was at once taken to the laboratory of Prof. 
Carl Heitzman, and left with him for microscopical examination 
for the benefit of the report of this committee. Prof. Heitzman 
gave the specimen his careful attention, and returned to us four 
of the best sections, and india ink drawings of two of them ready 
for publication. His report of the specimens is as follows : 
" New York, April 8th, 1888. 
The root of the implanted tooth which you brought for ex- 
amination a few weeks ago appeared to the naked eye re- 
duced to about one third of its original size. The reduction 
was caused by deep erosions and irregular cavities that have 
replaced the original tooth tissues, viz: the cementum and the 
dentine. 
"After the tooth had been softened in a chromic acid solution, 
the root was cut into thin slabs, and the appearances, under the 
microscope, were as follows: The dentine is corroded almost 
around the whole periphery of the root. Only in one place can 
a trace of cementum be seen. The bordering line of the dentine, 
toward the excavations, is fluted and made up of crescentic lines, 
corresponding to bay-like excavations, which follow in varying 
sizes in large numbers. The dentinal canaliculi, in which the 
dentinal fibres are still recognizable, terminate abruptly along the 
concave borders of the bays (see B, Fig. 11). Here and there 
apparently closed spaces of varying sizes are seen at the eroded 
borders of the dentine. Both the small and large bays and 
the spaces are filled with a myxomatous granulation tissue 
(see G G), in which numerous partly wide capillary blood-vessels 
run, mostly filled with blood corpuscles (see C L). In places 
where the bays are shallow a delicate layer of fibrous connective 8 
tissue is seen attached to the dentine (see F C). The myxo- 
matous tissue holds in many places globular masses of lime- 
deposits (see C); and in some places are seen debris of dentinal 
tissues (see D S), with irregular, eroded contours, still holding 
dentinal canaliculi, and obviously having escaped dissolution. 
Along one surface the bays appeared to be filled with coagulated 
serum of blood, in which blood-corpuscles andisolated medullary 
corpuscles were suspended; here evidently hemorrhage had 
taken place, immediately before the removal of the tooth, that 
led to the destruction of the, granulation tissue. The pulp 
chamber is lined mostly by primary dentine; a small portion, how- 
ever, shows the formation of secondary dentine of the ordinary 
variety, with scanty and irregular canaliculi. Both the primary 
and secondary dentine border the pulp chamber with globular 
masses, pierced by dentinal canaliculi, but showing nowhere ex- 
cavations like those at the periphery of the root. Toward the 
apex of the root, where the corrosion of the dentine is most con- 
spicuous, the pulp chamber has disappeared, and the dentine is 
eaten away to such an extent that only thin ledges of it are 
seen. The process that has led to such an advanced destruction 
of the root is the same as that which brings about the absorption 
and destruction of the roots of temporary teeth before shedding. 
(Signed) Dr. C. Heitzman." 
Other forms of oral surgery, such as treatment of antral 
abscesses, alveolar abscesses, removal of carious and necrosed 
bone, for the relief of facial neuralgia, are all receiving more 
attention in dental practice than formerly. Special surgical in- 
struments fitted to the dental engine for the purpose are now to 
be found in the majority of dental offices. 
Prosthetic Dentistry is not backward in the grand progress 
made by our profession. One fact has, however, deeply impressed 
itself on the minds of your committee. The very best sentiment 
of the profession has been loud and definite in its decision, ex- 
cept in extraordinary cases, that non-conducting materials should 
not be used as a base for upper dentures. While the upper cel- 
luloid and rubber plate has been so severely condemned, its man- 
ufacture seems to remain just as extensive, and the consequent 
detriment and injury to the public just as great. 
Bridgework, where justified, has come into very considerable 9 
Fig. 2. 
Implanted Tooth, Andrews'. Extracted after Years x 500. 
DD-Dentine of root. 
B- Bay-like excavation in dentine, near corroded border. 
DS-Shreds of dentine, detached and corroded. 
FC-Fibrous connective tissue, filling the flat bays of the dentine. 
GG-Granulation tissue of myxomatous structure. 
CL-Capillary blood-vessel in longitudinal section. 
CO-Capillary blood vessel in oblique section. 
CC-Capillary blood-vessel in cross section. 
CF-Capillary blood-vessel in formation. 10 
favor. It is, however, a subject of great dispute in the profession 
to-day. Like everything of value, it is overdone. The dentist 
who believes that there is but one and only one perfect method 
of bridgework is like his extreme opponent, who condemns the 
use of bridgework in toto. The one sees his bridge as the only 
panacea for every one who comes along, the result being he does 
more harm than good. The other sees only the cases which 
have resulted in disaster, consequently he condemns the entire 
procedure. Of all operations in dentist^ not one demands such 
perfection and accuracy in workmanship as a properly con- 
structed bridge. How few of them possess it; and as a result 
we see so many people going about with mouths so foul in odor 
that all their friends prefer to keep them at a distance. The 
so-called cleansing spaces of bridgework are a delusion. The 
teeth must set firmly against the gum, and the palatal or lingual 
contour should be perfectly developed. Where practicable, 
nothing surpasses the porcelain bridgework of E. Parmly Brown. 
Properly inserted, your committee has seen an expert deceived in 
picking out the bridge from the adjoining teeth. Its permanency 
has been tested for some years and not found wanting. With 
our improved continuous gum furnaces the manufacture of these 
bridges has become very easy. 
In crown work, every passing day brings its changes and im- 
provements from the simpler forms of crowns like the Logan and 
Brown to the more difficult ones backed and contoured with 
gold. Like its more complicated fellow, bridgework, an imper- 
fectly placed crown soon has much trouble in store for the poor 
patient doomed to wear it, and we may be pardoned for changing 
an old saying into, " heavy the root that wears such a crown." 
The pus-laden pockets, blind and fistulous abscesses by the 
thousand, cry out against such a debasement of a noble work. 
Labor-saving devices in the shape of electric, water, gas and 
condensed air motors are in very extensive use, but for many who 
can not make use of these means, a great boon has been received 
in the rubber wheels, rims and foot-pads for the dental engine 
devised by Dr. C. S. Ward well. 
The report of your committee is necessarily but a mere 
synopsis, but it is hoped that the points touched upon will lead 
to a discussion which will only be beneficial to our society.