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QUIZ QUESTIONS,
         COURSE ON
DENTAL  PATHOLOGY AND
     THERAPEUTICS,
PHILADELPHIA DENTAL COLLEGE.
     PROF. J. FOSTER FLAOG. D. D. S.
        answered by
     WILLIAM C. FOULKS, D. D. S.
President of the Quiz Association of the
    Philadelphia Dental College.
 GEO. A. FOWLER & CO.
2228 RIDGE AVENUE,
     1882. 
                       V\fU

                         F57 + 4




Entered according to the Act of Congress, in the year Eighteen
           hundred and Eighty Two—1882, by
                WM. C. FOULKS, D. D. S,
in the Office of the Librarian of Congress, at Washington, D. C.
              ALL RIGHTS RESERVED. 
DEDICATION.
       J. FOSTER FLAGG, D. D. S.


             IN RECOGNITION OF HIS
    UNTIRING, PERSEVERING AND FAITHFUL LABOR
JN THE FURTHERANCE OF A PROPER, COMFORT-GIVING AND
        SCIENTIFIC PRACTICE OF DENTISTRY,

             THIS WORK
IS RESPECTFULLY DEDICATED 
 
 
•*
-» 
PREFACE.
  Nearly all .the questions in this little book were
first  arranged by  Prof. J. Foster Flagg,  D. D. S.
Subsequently they  were printed  in pamphlet form
by the Philadelphia Dental College for the  benefit
and guidance of the students.
  The answers have been compiled from " notes "
on Dr.  Flagg's lectures,  therefore,  no  claim  to
originality is advanced, other than combination  of
Questions and  Answers in book form.
                                   W.  C. F. 
 
CONTENTS.
CEXERAL PRINCIPLES.......1__v>C>
Sensitive Dentine    .......2l>__'JS
Superficial Caries      ,......     2S
Simple (.Varies.........2<S___:->«..)
Deep Seated Caries.......:;«)__.)(',
Pulp Capping..........")(*,__(',4
Complicated Caries.......C,4_71
Extirpation of Dental Pulp   ....  71—7">
Dental Exostosis    .......7-3—77
Fused Teeth..........     77
Attached Teeth.........     7S
(Jeminous Teeth.........     7<S
Periodontitis.........7S—S:)
Alveolar Abscess    .......S:>—S<S
                APPENDIX.
Miscellany.........«SS—1)7
Arsenic     ..........1)7—US
Oxv-Chloride of  Zinc.......     U<S
                  TABLES.
Exciting Causes of Disease......0
Primary Elements of Disease......4
Proximate    ..    ,,     ,,     ......5 
 
 
 
                DENTAL

  PATHOLOGY  &  THERAPEUTICS
                 ----0----

         GENERAL PRINCIPLES.

  What is that  force called, upon  which depends
all response to remedial efforts?
   Ans. Vis Vita
  What is this force called as a conservator?
  Ans. Vis Conservatrix.
  What, as a medicator?
  Ans. Vis Medicatrix Natura.
  What is the employment of indicated means foi
relief called?
  Ans. Ars Medendi.
  What is  the  theory of relief called?
  Ans. Ratio Medendi.
  What  are the  meaning  and  use of "hyper,"
"hypo," "a" or "an," "epi," "itis?"
  Ans. " Hyper," " above," " excessive;" " hypo,"
" under," " beneath," " deficiency; " " a "or " an,"
"from,"  "without," "lacking;" "epi,"  "upon,"
" on;" " itis," " inflammation."
  Define the Principles and Practice of Dentistry. 
2         GENERAL PRINCIPLES.
  Ans.  The general Principles of Medicine, applied
to the treatment  of disease, as related to the teeth.
  Define the terms "Dis-ease," "Etiology," "Semi-
ology," "Nosology,"  "Diagnosis,"  "Prognosis,"
" Prophylaxis " and " Hygienics."
  Ans.  "Dis-ease," "alteration of nutrition;" "Eti-
ology," "cause of disease; " "Semiology,"  "phe-
nomena of disease; "  " Nosology,"  " classification
of disease;" "Diagnosis," "distinction of disease;"
" Prognosis,"  " the  fore-telling of the course  and
termination  of  disease; "   " Prophylaxis"  and
"Hygienics," "prevention of disease."
  What  is  the first  natural division of " essential
precedents " to disease?
  Ans.  " Extrinsic " and " Intrinsic."
  What is the meaning of these terms ?
  Ans.  " Extrinsic," " external agencies which op-
erate on the body or  mind; " " Intrinsic," " cause,4.
existing within the body, independent of any obvi
ous external influence."
  What is the second natural division of these terms ?
  Ans.  " Predisposing " and " Exciting."
  Are these causes always of the same class ?
  Ans.  No.
  Are they susceptible of transposition ?
  Ans. They are.  The exciting cause may be the
pre-disposing,  or  the  pre-disposing  may  be  the
exciting cause. 
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         GENERAL PRINCIPLES.         3

  Into what two classes are the " Exciting " caus-
es of disease divided?
  Ans. "Cognizable" and "Non-cognizable" agents.
  Name some of the "Cognizable."
  Name some of the "Non-cognizable."
  Ans. (See Table I.)
TABLE  I.
H
GC

<
o


H
EH
H
o
0
H
i—i

O
O
o
O
o
 I
o
CO

^ 52;
w
o
Mechanical.
Chemical.
Ingest a.
Bodily exertion,
Mental emotion.
£  <{  Excessive evacuation.
     Suppressed or defective
     evacuation.
     Defective cleanliness,
     ventilation & drainage.
     Temperature & changes
<«  f Endemic.
   I  Epidemic
I In
FECTIOUS.  J
o
CO
o
CO
What is the division of the "elements" of disease?
Ans. Primary and Proximate. 
TABLE II.
PRIMARY  ELEMENTS
       OF  DISEASE.
 STRUCTURAL,      FUNCTIONAL,
CONTRACTILE FIBRE.
(Irritability
( Tonicity.
NERVOUS STRUCTURE, <
( Sensibility.
 Vol. motion.
 Reflex action.
.Sympathy.
SECRETORY  TISSUE,   Secretion.
p
g Red corpuscles
« White  „ '

^ Fibrin
o .
co Albumen
H
140.

  3.
 70,
£ 2 R E D AND WHITL
§ i corpuscles and
o &
|iq § Liquor sanguinis.
  i—i
  o
                       Red and white
g Fatty Matters  4.   * g corpuscles and
Salts
§ Water
  6.
777.
^ ^ Fibrin, forming
ft pq
                       "clot," and Serum.
  Any of the above elements, pathologically view-
ed, may be Excessive, Defective or Abnormal. 
 
 
           TABLE  III.
PROXIMATE ELEMENTS
        OF  DISEASE.
o
EH
<

O

o
p
o
o
M
£	CO
o	H
h-1	&
EH	02
hH	02
tf	h-1
EH	EH
p	fe
525	O
Defective,
An.emia.
 eral.
CAL.
(Gen
( Loc

' General. <
Excessive,
Plethora.<
( Increased,
 "Sthenic."
 Diminished,
L "Asthenic."
.Local.
Perverted, Cachjemia.
r Defective, Atrophy.
                'Increased,
                 " Determination. "
                 Diminished,
                 "Congestion."
                 Partly increased &
                 partly diminished,
                 " Inflammation."
                i Terminations.
                 "Resolution,"
                 "Suppuration,"
                 " Gangrene."
                 "Mortification."
                 "Sloughing, '(?)
                 "Caries,"
                 "Necrosis,"
                 "Exfoliation." (?)
Excessive, Hypertrophy.
            / Degenerations.
Perverted,  ) Dep os itions.
            (Growths. 
6         GENERAL  PRINCIPLES.
  What  is  meant  by  " cathartics ? "
  Ans. Medicines which increase the alvine dis
charges.
  What  other  terms are relatively analagous, and
what are their meanings ?
  Ans. "Aperients," from aperio, "to open;" —
" Laxatives, " from laxo, laxatum, " to loosen ;" —
" Purgatives," from purgo, purgatum, " to cleanse,"
" to purge ;" — " Drastic "  Purgatives,  from the
Greek drastikos, " powerful," "active ;" — "Hydra-
gogues,"  from  the Greek hudor, "water," and
hago,  "to bring away;" — "Cholagogues," from
the Greek chola, "bile," and hago, "to carry off,"
" to bring away."
  Name  medicaments and  peculiarities.
  Ans.   Aperients  are  small  doses of the  saline
cathartics; such as Citrate of Magnesia,  Tartrate
of Potassium,   Bi-tartrate of Potassium,  Seidlitz
Powders, &c.  A very mild action upon  the whole
tract of the bowels  is produced by this class.
  Laxatives—  Tamarind,  Manna,  Cassia, Castor
Oil,  Aloes,   Tropical  fruit, Fresh  or Dried and
Stewed  fruits,  Bran, Sugar, Molasses, &c.   These
are usefully  employed in habitual  constipation,
and  promote  a mild  and  largely   mechanical
action  of the bowels — either by  the amount  of
innutritious   material they contain, which excites
the bowels to action, or by slightly stimulating the
alimentary  secretions and  muscular coat. 
 
 
GENERAL  PRINCIPLES.         7
   Purgatives — Rhubarb,  Aloes,   Castor Oil,  Sa-
lines, &c.  This  class is more decided, but  similar
in action to the last  mentioned — generally pro-
motes three or four stools.
   Drastic Purgatives — Croton Oil, Gamboge, Ep-
som Salts,  Hellebore, &c.  This class causes* severe
action of the bowels, together with griping, irrita
tion and pain of the mucous membrane.  They are
especially indicated  in cases where counter-irrita-
tion is   desired.
   Hydragogues — Elaterium,   Colocynth,   Jalap,
Senna,  Podophyllum, &c, produce large and wa-
tery stools.   They  are  used  in  various   sthenic
inflammatory diseases for the purpose of depletion.
   Cholfrgogues — Podophyllum,   Calomel,  Blue
Mass, &c.  These medicines increase the  flow of
bile, which  acts upon  the  internal  coat  of  the
intestines as a purge — used in altered conditions
dependent  upon  the  liver.  Much  difference. of
opinion  exists as  to whether any medicines may be
correctly termed  cholagogues.
   How  do  cathartics  act?
   Ans.  In three ways — 1st.  By  stimulating  the
muscular coat of  the bowels, to augment peristaltic
action — 2nd.  By  increasing the  discharge from
the mucus membrane and glands of the alimentary
canal — 3rd.  By causing a greater  flow  of bile
which acts as a purge.
   For what are cathartics used? 
8         GENERAL PRINCIPLES.
  Ans.  1st.  To unload  the  bowels — 2nd.  To
promote  secretion and relieve habitual  constipa-
tion,  &c — 3rd.  For  depletion in  inflammatory
diseases.
  How is "Hyper-catharsis" to be checked?
  Ans. By the  use of opiates, sometimes by stim-
ulants.
  What are " diuretics? " — name some.
  Ans. Medicines which  increase the secretion of
urine.  Tine. Digitalis, Hyoscyamus, Squills,  Col-
chicum, Copaiba, &c.
  What are "diaphoretics? " — name some.
  Ans. Medicines which  moderately increase per-
spiration.   Carbonate Ammonia,  Sulphate Anli-
mony, Camphor, &c.                     #
 • What are " sudorifics? " —name some.
  Ans. Medicines which  produce copious perspira-
tion.  Dulcamara,  Ipecacuanha,  Spirits  Mender-
eras, Steam Bath, &c.
  What are " expectorants? " —name some.
  Ans. Medicines which  cause discharge from the
air  passages.    Sol. Muriate or  Carb.  Ammonia,
Tar, Vinegar, Ether  vapors,  Wild  Cherry, Tolu,
Ammoniac, &c.
  What  is "depletion?"  What  is "sedation?"
  Ans. Blood-letting;  though the system may be
depleted by cathartics,  diaphoretics, starvation, &c.
Sedation implies depression of the vital power.
  What are " emmenagogues?" 
 
 
      *  GENERAL  PRINCIPLES.         9
   Ans.  Medicines  which  excite or  promote  the
menstrual flow; most of them are uterine tonics.
   What  are " sialagogues?"
   Ans. Medicines, irritants, &c, which increase the
flow of saliva and mucus.
   What  are " errhines? "
   Ans. Medicines, stimulants, and irritants, which
are emyloyed to make an  impression upon  the
Schneiderian membrane, causeing more or less  dis-
charge of mucus from the  nose.   When sneezing is
produced they are termed Sternutatories.
   What  is  a "seton?"
   Ans. A  long strip of linen passed through skin
and cellular tissue, and  allowed to  remain;  fre-
quent moving of the strip produces "counter-irrita-
tion."
   What  are  " epispastics ?"  — name  some —
peculiarities.
   Ans. Applications  which inflame  the  skin  and
oy their irritating action,  cause  determination  and
congestion,  with concomitant  effusions,  serous or
sanious, which effusions, accumulating between the
skin and cellular tissue  at point  of irritation, raise
the  cuticle  into " blebs"  or   " blisters."  Can-
tharides,  Mustard, Croton Oil, &c, are prominent
epispastics.
   What  are "alteratives?"
   Ans. Medicines which act upon the functions  ji 
10        GENERAL  PRINCIPLES.
nutrition, to change and neutralize morbid or re-
dundant matters in the  circulation.
  How is blood obtained, and how is it replenished?
  Ans.  Obtained by digestion assimilation, &c. and
replenished by food.
  What is the "pulse " — at what points is it taken?
  Ans.  " Pulse" is the beating of the heart — taken
at the femoral artery,  over the  heart, or  at the
brachial, radial,  carotid and temporal arteries.
  Name half a dozen varieties of pulse and  their
opposites.
  Ans.  " Frequent and slow," " hard and soft,"
"quick and sluggish," "strong and weak," "full and
small," " regular and irregular."
  Give the normal  frequency of the  pulse,  from
foetal life to old  age.
  Ans.   Foetal heart.      140  per minute.
         Just after birth,  130   „     ,,
          1st year,         110   „     ,,
          2nd „          100   „
          5th  „          90    „
          10th „          85    „
         Puberty,         80    „     „
         Adult,            75    „     „
          Old age,          80   ,,     ,,
  What are the  ordinarily classified  constituents
of the  blood —  the  relative proportion  in  normal
blood ? 
 
4
k 
          GENERAL  PRINCIPLES.        11
 •  dns. (See Table II.)
   What is the division of the blood in circulation"7
   Ans. (See Table II.)
   What is the division of drawn blood?
   Ans. (See Table II.)
   What is  the  first act of vitality in connection
 with the blood ?
   Ans. Coagulation.
   What is the last act?
   Ans. Coagulation.
   What constituent of the blood  seems  nearest
 allied to coagulation ?
   A/i9.  Fibrin.
   What are the  three  great peculiarities of clot ?
   Ans. 1st, Uniform coagulation  with little  con-
 fraction,  2nd, Uniform coagulation with marked
 contraction  and plainly " cupped; "  3rd, Inflam-
 matory clot, tough, contracted, concave and " buffy
 coat."
   What is meant by the " buffy coat " ?
   Ans. The peculiar surface color  of the " inflam
 matory clot," caused by the " fibrin " and " white
 corpuscles."
   What is meant by  "ancsmia; "  "spansemia;"
 "hypersemia;" "plethora?"
   Ans. Lack or want of red blood ;  poor  blood;
local excess of blood;  fulness of blood vessels.
   How is anaemia divided ?
   Ans.  Into " acute "  and "chronic." 
12        GENERAL PRINCIPLES.
  What is the treatment for " acute " anaemia ?
 . Ans.  Remove cause ; administer tonics.
  What is the treatment  for " chronic " anaemia ?
  Ans.  Administer tonics ; remove cause.
  How is plethora first divided ?
   ins.  " Sthenic " and " Asthenic."
  What is the treatment for " sthenic " plethora ?
  Ans.  Blood-letting, actual and medicinal,  seda-
tion, diet, exercise, &c.
  What is the treatment for " asthenic " plethora ?
  Ans.  Blood-letting,  tonics,  stimulants,  altera-
tives, aperients,  diuretics, hygienics, &c.
  How  is plethora secondarily divided ?
  Ans.  General and local.
  How  is local plethora divided ?
  Ans.  " Determination," " Congestion," " Inflam-
mation."
  What is the location and  peculiarity of  " deter-
mination ? "
  Ans.  In the  arteries and arterial  capillaries —
excess of blood with motion increased.
  What is its exciting cause ?
  Ans.  Irritation or stimulation.
  What are its symptoms and  effects ?
  Ans.  Increased Sensation; Stimulation ; Plyper-
 trophy.
  What are the four means for treatment. ?
  Ans.   Depletion ; Derivation ;  Relaxation ;  Se-
 dation. 
 
 
           GENERAL PRINCIPLES.        13

   What is the location and  peculiarity of "con-
gestion ?"
   Ans.  Veins and venous capillaries — excess of
blood with motion diminished.
   What are its symptoms and effects ?
   Ans. Redness ;  blueness ; purplish color; slight
warmth and   sensibility;  soon after,  numbness,
coldness and painful distension  in the part; cessa-
tion of functional  action; transudations, &c.
   What are its four means for treatment ?
   Ans. Mechanical;  Astringents  or  stimulants;
Depletives;    Rubifacients  as  counter-irritants;
Evacuents, &c.
   What are the locations and peculiarities of " true
inflammation ?"
   Ans. Arteries, capillaries  and veins — excess of
blood  with motion partly increased   and partly
diminished.
   What are its signs ?  What its symptom ?
   Ans. Redness, heat, swelling — pain.
   Describe the relative changes of white and  red
corpuscles, which  are apparent, microsconically, in
inflammation.
   Ans. White corpuscles increase in mimber,  and
begin to adhere to the walls  of the vessels; some
stick in the tortuous capillaries  thus  arresting the
progress of the red disks.  Some of the white glob-
ules work through the walls of the  vessels,  and are
then   denominated exudation  corpuscles.  When
one of these dies, pus formation is begun.
   Into what classes is inflammation dividee ? 
14 '      GENERAL  PRINCIPLES.
  Ans.  "Sthenic,"  "Asthenic," "Phlegmonous"
or "Circumscribed," "Erysipelatous," "Syphilitic"
'< Scrofulous," &c.
  What are the three varieties of duration?
  Ans.  "Acute," "Sub-acute" and " Chronic."
  What are the two classes of  " exciting causes?"
  Ans.  " Local or direct;"  " General or indirect."
  What  are  the three  divisions  of the " local or
direct" causes ?
  Ans.  " Mechanical,"  " Chemical" and "Vital."
  What is  meant by the  distinctions  mechanical,
chemical and vital?
  Ans.  Such as a blow,  wound, &c, — such  as an
acid, escharotic, &c, — vital irritants, such as virus,
malerial  poison, &c.
  What is  meant by "reaction?"
'  Ans. The "vital act" which follows depression.
  What is  the result of inflammation ?
  Ans.  Effusion.
  What  are the varieties  of inflammatory effu-
sions ?
  Ans.  " Euplastic; " " Cachoplastic; " Aplastic."
  What  is the difference  between congestive and
inflammatory effusions?
  Ans.  Inflammatory effusions are organizable, and
congestive  effusions, as  a rule, are not.
  What are the terminations of inflammation?
  Ans.  Resolution or Suppuration.
  What is  meant by "resolution?" 
 
 
           GENERAL PRINCIPLES.        15
   Ans. Subsidence of inflammation,  more  or  less
 absorbtion of effusions  and  return  to normality.
ft  What is the  treatment to endeavor  to effect
 resolution ?
   Ans. "Sedatives;" "Antiphlogistics;"  "Evacu-
 ants;" "Attenuants;"   "Sorbifacients;"  "Pres-
 sure;" "Friction," &c
   What is meant by  "suppuration?"
   Ans.  The  chemical  dissolution  and  breaking
 down of circumvallated parts; "white" and "tis-
 sue" corpuscles forming "pus."
   What is the treatment to effect this?
   Ans. Stimulation.
   What is the present theory of  "pus corpucles " ?
   Ans.  They  are  the "white corpuscles"  and
 "tissue corpuscles."
   What is meant by the "pyogenic membrane?"
   Ans. The  "parietes" or "line of circumvalla-
 tion,"  between living tissue and pus.
   What are the symptoms  of suppuration ?
   Ans. Loss  of color,  paleness, coldness, lack of
 sensibility,  fluctuation  on  tapping,  yielding  on
 pressure, &c.
   What is  an  "abscess?" what is a "fistula?"
   Ans.  A circumscribed cavity containing pus — a
 pus  discharging  opening  or  tract, leading  to an
 abscess.
   What is  "pointing?" what is an "ulcer?" 
16       GENERAL PRINCIPLES.
  Ans.  The tendency of pus to the surface — an
open, pus forming surface.
  What is meant  by "Gangrene" — "Mortifica-
tion,"  "Sloughing,"  "Caries," "Necrosis," "Se-
questrum," "Exfoliation?"
  Ans. "Gangrene," incipient mortification; "mor-
tification," complete death  and decomposition  of
a part  before  separation  by  natural  processes;
" sloughing," the process by which nature throws
off a foreign or dead body in  a stream  of pus;
" caries," ulceration of the bone; " necrosis," death
of a  circumscribed portion of bone;  "sequestrum,"
a portion of bone loosened and surrounded  by pus;
" exfoliation," the separation or scaling off of dead
bone from the  living; applied  also to the process
by which teeth gradually " elongate " or grow out
of the alveolar structure.
  What is the systemic  effect of extensive suppur-
ation ?
  Ans.  Lowering  of fever;  pulse frequent but  less
strong; heat subsides or alternates with  "chills"
and  sweats;  weakness,  exhaustion, wasting of tis-
sues, &c.
  How is a  tooth anatomically divided?
  Ans.  Crown, neck and root, or roots.
  How is a  tooth physiologically divided?
  Ans.  Enamel,  dentine,  pulp  and cementum. 
 
 
GENERAL  PRINCIPLES.        17
   What is the order of eruption of the " deciduous "
teeth?
   Ans.                       „     n     ,.
                       ( upper 7  too months.
     Central incisors,  J lower 5  „7    „
                       ( upper 9  „  10  „
     Lateral   „       J lower g  „  9    „
                       ( upper 13 „  14   „
     First molars,      £ iower 11 „  12   „
                       ( upper 19 „  20   „
     Canines,          ^ lower 17 „  18   „
     Second, molars,          23 „  30   „
   What are some exceptions to the general rule ?
   Ans. Some are born with a few teeth erupted;
the lateral incisors vary as to period of eruption;
there are cases on record of persons who have been
edentulous from birth.
   To what phase of dentition is infantile mortality
largely due ?
   Ans.  Pathological  dentition.
   What are the general symptoms of pathological
dentition.
   Ans. Loss of appetite, peevish  fretfulness, toss-
ing restlessness, actual wakefulness, feverish thirst,
painful paroxysms, continuous suffering, bowels
foose or constipated, congestion of brain, emaciation
and death.
   What are the usual local signs of abnormal den-
tition ? 
18       GENERAL  PRINCIPLES.

  Ans.  Redness of gums, marked flow of saliva,
desire  to suck  the  thumb or fingers, biting the
spoon or ring with  determination, alternately re-
fusing and taking the breast, &c.
  What are the  exceptions to these ?
  Ans.  When some or all of these signs are absent.
  What is the remedy ?
  Ans.  Mechanical.
  What is the relative "resistance" between nor-
mal and cicatricial tissue ?
  Ans.   Cicatricial tissue is  the weaker, because
of its  secondary  formation.
  How are lower incisors to be lanced ?
  Ans.  Parallel with the cutting  edges of the teeth,
and to the inner, or lingual margin of the gums.
  How are upper  incisors to be lanced ?
  Ans.   Parallel  with the cutting  edges  of the
teeth, and to the outer, or labial margin of the gums.
  How are lower  first molars to  be lanced ?
  Ans.  Crucially, from  the posterior lingual cusp
to the anterior buccal cusp, and from the posterior
buccal cusp to the anterior lingual cusp.
  How are upner first molars to  be lanced ?
  Ans. Crucially, from the posterior aspect to the
Linterior, and from the lingual to the  buccal.
  How are  cuspids to be lanced ?
   Ans. Similar  to incisors at first.
   What is the indication in pathological dentition,
after the cusps of cuspids are erupted ? 
 
 
 
 
GENERAL  PRINCIPLES.        19
  Ans. Cut the ring of gum at two or four points.
  How are second molars to be lanced ?
  Ans. Same as lower first molars.
  "What is the  mcst  thorough method of lancing
 nolars in extreme cases ?
  Ans.  Take  off  a  block of gum.
  What are  the three divisions of Pathological
Dentition ?
  Ans. Moderate in severity,  decided in severity,
dangerous  in  severity.
  Where is the finger to be introduced in the ex-
amination of the mouth of an infiint less than ten
months  old ?
  Ans. In the  corner of the mouth, as the teeth
giving trouble are not there in process of eruption.
  Where  if more than ten months old?
  Ans. At the front  of the mouth,  for the same
reason.
  What are the immediate dangers from lancing ?
  Ans. Cutting the gums, cheek, tongue, &c, eith-
er from slipping of the instrument, or sudden mo-
tion of the child.
  How are these to be guarded aginst ?
  Ans. Wrapping the blade of lancet with muslin,
care in lancing, properly securing  the  child, and
anticipating sudden starts.
  What  is  the subsequent danger7
  Ans. Hemorrhage.
  How  is hemorrhage controlled? 
20        GENERAL  PRINCIPLES.
  Ans. By application of " styptics,"  mechanical
means, systemic treatment, gravity, &c.
  What is the most dangerous form of hemorrhage?
  Ans. Slow, oozing, atonic hemorrhage.
  What is the order  of eruption of the  permanent
teeth?
  Ans.  First   molars,  from  5 Mo 7  years.
Central incisors,	, 6	„8
Lateral ,,	„ 7	„9
First bicuspids,	, 9	„10
Second „	„ io	„11
Canines,	, 13	„15
Second molars,	, 12	„14
Wisdom,	„ 17	„45
  Lower teeth precede the upper by a few weeks.
  What are the indications for  extraction of the
deciduous teeth?
  Ans.  When the superior  permanent oral  teeth
erupt inside the arch  and behind  the deciduous;
when the  inferior  permanent oral teeth in like
manner present outside the arch;  where, in  con-
junction with  frail and weakened   constitution,
complications  are liable to arise  from their reten-
tion.  As a rule, it is best that the  deciduous teeth
should remain until the proper absorption of their
roots is indicated by loosened crowns.
  What are the indications  for  extraction of the
six-year molars?               »
  Ans.  Where it becomes improbable that they will 
 
 
          GENERAL  PRINCIPLES.        21
be comfortably preserved for  any length of time;
when so far decayed and diseased as to  fail in re-
sponse to proper treatment before eruption  of the
twelve-year molar; when pulp is devitalized before
proper calcification of tooth structure; where pro-
trusion of lower arch, or other irregularity, or false
occlusion may be corrected by their removal.
   Which  are generally the most  difficult  of the
permanent teeth in pathological eruption ?
   Ans.   Lower wisdom teeth.
   What is the first grand division of all teeth ?
   Ans.   Upper and lower.
   Name  the "faces"  of  the teeth.
   Ans.  "Mesial," "Distal," "Labial,"  "Palatal,"
 'Buccal,"  "Lingual,"  " Cutting edges," "Articu-
 lating surfaces " and " Cusps."
   What is " Dental Pathology and Therapeutics ? "
   Ans. Dental  pathology considers the causes and
 different forms of the various diseases to which the
 teeth are liable.
   Dental therapeutics  considers the  medicines and
 remedies  wnich are used in the treatment  of such
 diseases
   What  is  dental  caries?
   Ans. The softening  and decalcification of tooth
 structure, or disease of the bone analagous to ulcer-
 ation of the soft parts.
   What  is  the "first cause?"
   Ans. Non-cognizable systemic influence. 
22        GENERAL  PRINCIPLES
  What are the two divisions of the  pre-disposing
causes of caries?
  Ans.  General  and  Local.
  What  are the two  divisions  of general pre-dis-
posing causes ?
  Ans.  Systemic  and Local.
  What are the three divisions of local pre-disposing
causes ?
  Ans.   Structure,  Form, Position.
  Name some of the systemic pre-disposing causes.
  Ans.   Thermal, Chemical,  Parasitic.
  Give the  views taught in regard to thermal, chem-
ical, and parasitic influences.
  Ans.   Thermal  change  does not  immediately
affect tooth structure,  but indirectly pre-disposes  to
decay by shock to the pulp.
  Chemical action may be  ascribed to tne fluids of
the  mouth, decomposition  of  food, &c, softening
and decalcifying  tooth structure.
   Parasitic influence is not exerted until decay has
commenced — is a concomitant of decay.
   Give  the views taught in regard  to  influences
dependent upon Structure, Form and Position.
   Ans. Structure — teeth of hard,  solid structure
resist decay and other destructive forces markedly.
   Teeth of j)oor, soft structure soon  fail, and rap-
idly yield to opposing influences.
   Form — teeth  having  deep sulci, pits, depres- 
i 
 
          GENERAL PRINCIPLES.        23
sions, cracks, and fissures are more liable to decay
than if perfect.
   Position — teeth which are crowded to  iront of
the mouth, or do not occlude properly are liable to
decny from  retention  of food,  inspissated mucus,
&c, or  from mechanical abrasion.
   What is meant by " periodicity " of caries ?
   Ans.  Its recurrence at certain periods  modified
by temperament, mode of life,  physical condition,
systemic drain, &c.
                    Int. of comparative cessation
                      1st.  bet.  8 and 12 years.
                      2nd.  „    20 „  30  „
                      3d.   „    40 „  55   „
                      4th.  variable at  60   ,,
                      5th.  bet. 65 and 70 years.
                      6th.   „    75 „  80   „
7th. 80 years, at which time a tooth may  decay
rapidly and is soon followed by death of the patient,
   What is taught in regard  to the  effect of  a de-
caying tooth upon others ?
   Ans.  A decaying tooth, has no  destructive  influ-
ence  upon  otner teeth, but tends  to localize the
acid or alkaline action of the fluids of the mouth,
thus exempting for a time  other teeth which are
next liable to decay from any  decided  disintegrat-
ing influence.
   How  are males and females affected in different
degree as regards caries ?
Periods of decay.	
1st. 5 to	8 years.
2nd 12 „	20 „
3d. 30 „	40 „
4th. 55 „	90 »
5th. 60 „	65 „
6th. 70 „	75 „
 
24       GENERAL  PRINCIPLES.

  Ans.  Females are more liable  to caries, because
of sex, mode of life, menses, pregnancy, care ol
children, &c. — men have more outdoor life, exer-
cise, smoke, chew  tobacco,  and when  free from
excesses are less likely to be troubled with caries.
  How do different diseases affect caries ?
  Ans.  Disease  does not act upon  tooth structure
directly, but affects the system, altering and de-
ranging its  normal working;  as  a sequence, teeth
which are low in vitality suffer.
  How does  struma impress  caries?
  Ans.  Lowers  general vitality,  pre-disposes to
formation of watery tissues, unconsolidated struc-
tures, markings  on  the teeth (which, however, are
not likely to become centers of decay) so that when
decay begins it makes rapid progress.
  What is  the  theory  of caries taught?
  Ans. Mechanico-Chemico-Vital  with   Parasitic
concomitants.
  What is taught in regard to " brushing " teeth ?
   Ans. A soft brush should be used, once or twice
daily, cleaning well the grinding and  cutting sur-
faces ; brush lightly from the necks over  the outer
and  inner surfaces.
  What in regard to  " pulverized pumice ? "
  Ans. It is an  excellent article for cleansing and
brightening teeth,  does not injure  the enamel  or
gums  if properly used, should be applied with  a 
 
4 
          GENERAL PRINCIPLES.         25
soft pine stick.   It is prepared for dental use from
the ordinary  pulverized pumice, by  washing and
decanting  several times, and allowing the coarser
particles to settle, until finally the water containing
the finest powder is filtered and the powder dried.
   What is the relative liability of teeth to decay ?
   Ans. Lower first molar, upper first molar, lower
second molar, upper second molar, upper lateral in-
cisor, upper second bicuspid, upper central incisor,
upper first bicuspid, lower second bicuspid, lower
third molar, upper third molar, upper cuspid, lower
first  bicuspid, lower lateral  incisor, lower  central
incisor, lower cuspid.
   Of what practical importance is knowledge 01 this ?
   A.ns. It is a safe guide for the extraction of teeth
under all  circumstances; permits of a comparative
saving of  the best teeth, in correction of irregulari-
ties ; is a  guide to the " clasping " of proper teeth
for plates; is  also a  general controlling factor  in
the practice of thorough dentistry, from  the stand-
point of saving teeth.
   How is " methodic examination " conducted ?
   Ans. Begin  at any back  tooth, and  passing  in
regular order, thoroughly examine every surface of
each tooth.
   Name the positions liable to decay on each tooth.
   Ans. Approximate surfaces of central and lateral
incisors, also  of molars and bicuspids; the  sulci  of
molars and bicuspids,  also the basilar pits of later- 
26
SENSITIVE DENTINE.
al incisors and canines; buccal faces  and cervical
margins of molars and bicuspids.
  What are the instruments needed for a thorough
examination?
  Ans. Mouth  mirror, probe, ligature or floss silk,
and  wedges.
  What  is  Odontalgia?
  Ans.   Pain  in  and  about a  tooth.
  What  is  the first cause  of  odontalgia?
  Ans.   Sensitive  Dentine.
             Sensitive Dentiee.
  What are the four primary divisions under which
sensitive dentine is discussed ?
  Ans.  1st. Cases with  no perceptible  cavities of
decay. 2nd. Superficial Caries. 3rd.  Simple Caries.
4th.  Deep Seated Caries.
  What are the symptoms of " sensitive dentine? "
  Ans.  Uneasy sensations  which, may  be  located
about the teeth, jaws, cheeks, eyes,  nose, lips, &c,
aggravated by contact of sweets and sours; position
of trouble not positively located unless touched.
  What is the special diagnostic of sensitive dentine ?
  Ans.  Instant pain upon  touch, instant cessation
on removal.
   CASES WITH NO PERCEPTIBLE CAVITIES OF DECAY.
  What are the locations for these ?  Appearances ?
  Ans.  About  the necks of teeth, in  sulci, on the
cusps, articulating surfaces and cutting edges.   At 
 
 
          SENSITIVE  DESTINE.         27
times nothing is perceptible, again, the  sensitive
parts,  especially  about  the  necks of teeth,  are
mooth, hard and polished, or hard without polish ;
again,  soft,  discolored,  unaltered  in  contour,  or
cupped,  concave in  the  sulci, cusps  and cutting
edges.
   What  are the systemic  considerations  in  regard
to acid vegetables, fruits, condiments, &c?  What
is the  medication?
   Ans.   They  bring  on an acid  condition  of  the
stomach, which in turn influences the fluids of the
mouth, causing  sensitive  dentine, setting the teeth
on edge,  increasing existing decay, &c.  In treating,
forbid indulgence (for a few days, or a week, accord-
ing to severity of the case) of food containing sours,
as pickles,  strawberries, apples,  peaches, lemons,
tomatoes, &c.  Medication is alkaline.
   What  are the domestic local applications ?
   Ans. Lime, soda, chalk,  aqua ammonia, phenoi-
sodique,  &c.
   What  is the domestic systemic medication ?
   Ans. Two gr. doses of bi-carbonate of soda in
water; take three or five times daily for a week;
phenol-sodique five or ten drops in one-half tumbler
of water, and rinse the mouth;  deprive of acids.
   What  is the action taught of two unlike  metal
fillings ?
   When  touching, galvanic action is prevented, the
dentine preserved, and a favorable condition of the 
28        SUPERFICIAL CARIES.
oral fluids maintained — if not in actual contact, a
shock may be caused  when the different metals are
connected by the tong  e, cheek or saliva.   This
usually occurs during mastication, and varies in
intensity.
  What is taught of  the  union  of amalgam  and
gold plate ?
  Ans. From the gentle, continuous and stimulat-
ing galvanic action which is  exerted,  a beneficial
effect is produced upou the mouth, and  even  upon
general health.
  What  severe complications pertain  to  sensitive
dentine, aside from toothache?
  Ans. Neuralgic  complications.
              Superficial Caries.
  What  is taught in  regard  to removal ot " super-
ficial  caries," in  teeth  proportionately  liable to
become carious ?
  Ans. Superficial  caries is  that stage of  decay
which  permits of its  easy removal by use of files,
burs,  corundum  wheels  and the like.   In teeth
liable to become  carious, it should be let alone until
its progress indicates  intervention by filling.
              Simple Caries.
  What  is  simple caries?
  Ans. That  stage of decay where a  filling first
becomes a necessity. 
 
 
SIMPLE CARIES.            29
   What is  the first remedy for " sensitiveness " in
 cavities  of "simple caries?"
   Ans. Dryness.
   How is this supposed to be advantageous ?
   Ans. Dryness obtunds  sensibility; as, for exam-
 ple, the  tongue  when dry  cannot transmit the
 sense  of taste, &c.
   What is the  second remedy?
   Ans. Rapid cutting with sharp instruments.
   What is the  rationale  of this.
   Ans. A finger may be shot or cut off  quickly,
 and the  pain  experienced at the moment will  be
 very slight; the shock  obtunds the  nerves for the
 time being.  The same  explanation is  given to
 the  rapid cutting of dentine.
   What is the proper method of doing this ? Why ?
   Ans. Cut from within outwards, or, if engine bur
 is used, under cut lightly at the  bottom, and  tnen
 bur  out the  dentine  to same depth.  By under-
 cutting, all sensation  from cutting  such portions
 above  is prevented, the tubuli being cut  at their
 base, no sensation can be transmitted to the pulp.
   Topical  applications.   What is  the four  class
 division of these medicaments?
   Ans. First.  Those which do not endanger the pulp.
   Second.  Those which may possibly endanger the
 pulp.
   Third. Those which are  liable to  endanger the
pulp. 
'60
SIMPLE CARIES.
  Fourth.  That which  is dangerous to pulps.
  First.  Those which do not endanger the pulp.
  Name  ten or more remedies under this head.
  Ans. Prepared Chalk,  Bi-Carbonate of Soda, Oil
of Cloves,  Aqua Ammonia  Fortior, Chloroform,
Naboli No. 1, 2  and 3,  Nitric  Acid,  Quick-lime,
Dent. Tine, Aconite, &c.
  Second. Those which may possibly endanger the
pulp.  Name three or  four remedies under this
head.
  Ans. Creasote, Carbolic Acid, Carbonate of Pot-
assium, and Chloride of Zinc.
  Give the collodion and glycerine  tests for crea-
sote  and carbolic acid.
  Ans. Equal parts of glycerine and creasote, make
a turbid  mix, the creasote floating on top;  equal
parts of glycerine and carbolic acid  make  a clear
solution.'  Take alcohol  and collodion equal parts
add creasote, a clear solution  results.  Take alcohol
and collodion equal parts, add carbolic acid, a gel-
atinized mass results.
  Third.  Those which are liable to  endanger the
pulp. Name three or four remedies under  this head
  Ans.  Chromic Acid, Phosphoric Acid, Ethylate
of Sodium, Chloride of Calcium.
  What  is taught of phosphoric acid?
  Ans. Dangerous, because of  its slow,  quiet and 
 
 
              SIMPLE CARIES.            31
persistent action, may be years after  its use before
pulp dies; other remedies being safer, and  equally
efficacious, its use should be avoided.
   Why is chloride of zinc called a " polychrest ? "
   Ans.  Because  of its  wide range  of medicinal
application.
   What is  the range of medicinal application of
chloride of zinc?
   Ans. From a mild, antiseptic and astringent, to
a powerful escharotic.
   What is the proper f©rm  in which to use chlo-
ride of. zinc, as an obtundent of sensitive dentine?
   Ans.  Deliquesced.
   Why?
   Ans. If used in the form of crystal, it must de-
liquesce before any action on tooth tissue takes place ;
if it  is  diluted, its strength is  impaired, and  an
irritating instead of an escharotic effect is produced.
   What are  the  usual sensations from chloride of
zinc applications ?
   Ans. Painful sensations.
   What is the peculiarity of  the pain ?
   Ans. Cold, gradually increasing and gradually
diminishing pain.
   What is the method of preparing chloride of zinc
for dental use 1
   Ans. Take chloride of zinc and  glycerine equal
parts of  one-half ounce, mix in mortar until stiff; 
32            SIMPLE  CARIES.
then  place in a bottle and let  stand for a  couple
of weeks.
   What is the taste of chloride  of zinc ?
   Ans. Sweetish,  metallic, astringent taste.
   What is the method of applying chloride of zinc ?
   Ans. With a go Id probe or pointed stick, pellet,
or by oxy-chloride filling.
   What is taught  of  the accompanying-use of oil
of cloves?
   Ans.  It stops  the pain.
   What is the usual duration of pain from chloride
of zinc applications ?
   Ans. From three to ten, or fifteen minutes.
   What are the exceptions to this ?
   Ans. Where  it lasts for an hour or longer.
   What should be the characteristic of the pain ?
   Ans. Steady, Full, Round and Bearable.
   What kind of pain may supervene ?
   Ans. Throbbing, Pulsating, Jumping pain.
   What does this signify, and how is it treated ?
   Ans. It signifies pulp  irritation — treated  by
soothing, sedative  and anti-phlogistic remedies.
   What are the points in regard to excavating after
chloride of zinc applications ?
   Ans. Begin to excavate about half a minute after
the pain ceases, then excavate only to the depth of
the film of obtunded dentine.
   What is the after preparation of a cavity in which
the dentine has been obtunded by chloride of zinc ? 
 
 
              SIMPLE CARIES.            33
  Ans.  Neutralize by washing  with tepid water,
and apply oil of cloves.
  How  is  carbonate  of potassium prepared  for
dental use?
  Ans.   xv.  grs. carbonate potassium  to  i. oz. of
glycerine.
  What is  the method  of  applying  it?
  Ans.  On a gold probe, sharp-pointed  stick, or a
small pellet of cotton.
  What is its effect ? what are the symptoms ?
  Ans.  Its effect is to obtund  sensitiveness;   no
symptoms.
  How  is it neutralized ?  What is the sign of com-
plete  neutralization ?
  Ans.  It  is  neutralized by oil of cloves; if  any
potassium is present the oil of cloves turns yellow;
when the oil is not discolored, complete neutraliza-
tion has been effected.
  What is  taught  regarding  it?
  Ans.  It is a good, safe and reliable remedy.
  How is  chromic  acid made ?
  Ans.  By the action of sulphuric acid on the solu-
tion of bi-chromate of potassium, or  by heating the
latter with nitre.
  What is  its  appearance ?
  Ans.   Deep red  crystal.
  What kind  of a  salt is  it?
  Ans.   Deliquescent. 
34
SIMPLE CARIES
  In what form should chromic acid be  used as an
obtundent?
  Ans.   In  liquid  form.
  In what manner should one guard against danger?
  Ans.   Never apply the  " rubber  dam" when
using it, the acid is liable to get beneath the dam
and do much injury before discovered; use only in
easy or accessible cavities, and hard teeth.
  Why?
  Ans.  Because  it gives no  warning pain when
acting upon the tissues.
  What  of  the  employment  of chromic  acid in
difficult places?
  Ans.  It should  never be  used.
  What are  the symptoms accompanying its use ?
  Ans. Perfect quiet  for a time, which may result
in death  of the pulp.
  What  are the  indications of danger ?
  Ans.   Growing, gnawing  pain.
  What  is  the  after  treatment?
  Ans. The cavity should be dried and saturated
with  oil  of  cloves.
  How is it neutralized, and what is the final prep-
aration of the cavity  ?
  Ans. With  chalk,  carbonate of soda, or other
alkali.  Finally the  cavity  should  be dried  and
saturated with oil of  cloves  or carbolic acid,  and
again dried prior  to filling.
  What is the appearance of ethylate of sodium ? 
• 
« 
 
 
SIMPLE  CARIES.
35
   Ans. Light istraw color at  first, dark  orange
yellow after keeping.
   How is it applied ?   What are the symptoms ?
   Ans. With a gold wire probe, or  sharp-pointed
 stick — quiets or  obtunds  sensibility.
   How is it neutralized ?  What care is needed in
its use ?   How is danger to be avoided ?
   Ans. Neutralize  with bi-carbonate  of soda; same
care as for chromic acid, that it does not reach  the
tissues — place only in  accessible cavities.
   What dangers are liable  from chromic acid and
ethylate of sodium, other than danger to pulps ?
   Ans. Danger to the tissues from the ulcerous and
unmanageable sloughing sores they produce.
   Fourth. That which is dangerous to pulps.  Give
the various names of this medicament.
   Ans. Arsenic, white oxide  of arsenic, arsenious
acid, ratsbane.
   What  is cobalt ?  To what is its obtunding power
due?
   Ans.  A  brittle, reddish gray metal, magnetic,
slowly oxidizes in  the air; occurs in combination
with arsenic, to which its obtunding  power is due.
   What  is taught in regard to the use of arsenious
acid, or cobalt, for obtunding sensitive dentine ?
   Ans. It shouid  never be used, as  it will sooner
or later  devitalize  the  pulp.
   What  is  taught  in regard to using very  small 
 36            SIMPLE CARIES.
 quantities of arsenic,  and for limited periods of
 time to ensure  safety?
   Ans. If used at all, it will cause death of the pulp.
   What medicaments are not liable  to injure  the
 pulp,  when  used for  sensitive  dentine in  deep-
 seated cavities of decay?
   Ans. Chalk, Carbonate of Soda, Acetate  of Mor-
 phia, Oil  of  Cloves, Atropia,  Chloroform, Alcohol,
 Camphor,  &c,
   What medicines may possibly injure  the  pulp in
 such cases ?
   Ans.  Chloride of Zinc, Carbonate of Potassa,
 Naboli No. 3, Nitrate of Silver, Nitric Acid, &c.
   What medicines are  liable to injure the  pulp in
 such cases ?
   Ans.  Creasote,  Carbolic  Acid, &c.
  What are  the materials deemed  best as  pulp
 protectors  against such  medicaments ?
  Ans. Zinc  Sulphate,  Fowler's Temporary  Stop-
 ping, Capping Varnishes, &c.
  How are  these  applied?
   Ans. Zinc  Sulphate is carried  on  the end of a
 spatula to  the cavity, and gently pushed from  the
instrument with a probe to position desired;  the
material at tnis stage, being ol " cream-like " con-
sistency, adapts itself  without pressure.   It is a
 "non-irritant" and becomes   "sufficiently  hard"
for  a pulp protecter.  Fowler's Temporary  Stop-
ping is warmed, pressed into wafers of  the  desiredX 
 
 
SIMPLE CARIES.             37
size,  picked  up  with a  warm  probe,  softened,
placed in position and the edges sealed with a warm
burnisher.   This makes a thoroughly tight, and non-
irritating  protector.   Varnishes  are  applied on a
pellet of cotton, which is  inserted into the cavity,
gently " wiped" around and quickly withdrawn.
This makes a very thin lining, and still  serves as
a pulp protector.
  What  is  taught regarding Zinc Phosphates in
this connection ?
  Ans.  In view of the comparative uncertainty and
doubt of their ultimate action upon the pulp, it is
deemed best to restrict their use to experimentation.
  What three local applications beside those men-
tioned ?
  Ans.   Heat,  Cold,  Electricit}^.
  What  are  the various  forms  of  heat ?
  Ans.  Hot  air,  hot fluids, galvanic cautery, re-
flected heat,  &c.
  What  are the various forms of cold?
  Ans.   Cold  drinks,  cold air,  ice, spraying of
Sulphuric Ether, Rhigalene or other volatile liquids,
on the part to be rendered insensate.
  How is  electricity used?
  Ans.   By means of  the " Dental Helix."
  What three important considerations govern the
application of a current ?
  Ans.   1st.  Must be a primary interrupted cur- 
38
SIMPLE  CARIES.
rent; 2nd. Pleasant, not rasping; 3rd.  Place  en-
tire control  of increase and rapidity ot current in
the hands of the patient.
  What unpleasant results may follow electricity ?
  Ans.   May  paralyze  the patient,  cause  tonic
spasms,  &c.
  If unpleasant sequellse follow electricity, how are
they to be removed ?
  Ans.  Reverse the current by changing the poles.
  What medicaments are recommended for general
jr systemic effect in reducing sensitivity of dentine?
  Ans.  Bi-Meconate of Morphia, Sulphate of Mor-
phia Opium, Laudinum, Paregoric, &c.   Good, also
results from an alternation of a two-grain assafoetida
pill (sugar coated)  with ten  to  twenty  drops of
solution of the Meconate of Morphia (same strength
as laudanum).
  How are  they to  be  administered?
  Ans.   Systemically,  by small  doses.
  What  is  the  last resort?
  Ans.   Produce  general  insensibility.
  How is this effected?
  Ans.   By Anaesthesia.
  What is taught of the safety of anaesthesia ?
  Ans.  The operator must understand the use of
the agent employed.  No agent, which in a minute
or two, can  produce total exemption  from  pain
during  a severe  operation, can  be regarded  as
perfectly  safe. 
 
*t
9 
           DEEP SEATED  CARIES.        39

            Deep  Seated  Caries.
  What is deep  seated  caries ?
  Ans.  Where,  from  the  progress  of decay, the
cavity is such as to  render liable irritation of the
pulp during excavating, filling, or  as  the result of
the operation.
  What is the general condition of such cavities ?
  Ans.  They are  full of  "debris,"  decomposing
food, and  more or less broken  down " tooth  struc-
ture."
  How  may more injury than  oenefit  be inflicted ?
  Ans.  By removing  too much of the decalcified
dentine.
  What is the two-fold action of cavity contents ?
  Ans.  To protect the pulp from thermal changes,
pressure, &c, also to hasten -decay by giving rise to
decomposition of  organic  matter,  food, &c, con-
tained in the cavity.
  What is the first step in preparation ?
  Ans.  Wash out the cavity with tepid water, gently
stir or loosen with a blunt probe remaining debris,
and wash again;  then break down enamel edges,
so that by free  opening easy access  may be  had for
further  operations.
  What is to be  especially avoided ?
  Ans.   Any irritation, shock or  compression of
the pulp.
  How  should such cavities be syringed?
J 
40        DEEP  SEATED CARIES
  Ans.   Gently, with tepid water, directing  the
stream from the syringe against the walls  of the
cavity, rather than toward the pulp.
  Into what three classes  are such washed  and
dried cavities divided?
  Ans.   Those  containing  white  decay,  yellowish,
brownish and blackish decay, decay of'hornyconsistency.
  Give  some peculiarities  concomitant with  soft
white decay.
  Ans.  External  edges  almost soft, easily  broken
dowm, with  frequent  detachment of large portions
of enamel structure with  slight expenditure of force;
the  decay is short grained, homogenous, of  that
quality which permits easy removal and ready in-
gress to  dangerous proximity to pulp; very little
sensation or  change of color in the dentine as the
pulp is  approached.
  Give the peculiarities concomitant with "yellow-
ish," " brownish " and " blackish " decay.
  Ans.  External edges are of varied strength, but
all are reasonably strong; control every movement
of the  excavator.  This  class has  a  reasonable
amount  of  warning  sensitiveness, and a marked
change of color in dentine  to aid our knowledge of
the  probable location  of  the  finest  extremities
of pulp  points.
   Give the  peculiarities concomitant with decay of
" horny "  consistence.
   Ans.  The decay is long grained and tough; great 
 
\
t
t 
           DEEP  SEATED CARIES.        41
caution  must be  observed to  "lift"  and "cut"
such  decay from within, out; if improperly cut  or
lifted from without, in, the  grain runs deeper and
deeper, and if  thoroughly  removed, or  carelessly
manipulated, may end in exposure of the pulp.
   What is taught relative to conservation of this ?
   Ans.  Being  decalcified dentine,  its proper and
judicious conservation is eminently to be desired as
the best and most acceptable pulp capping known.
   What of its  medication?   What governs  the
appropriateness of medicaments?
   Ans.  The decalcification being  largely due  to
acid  action, the   indications   are,  1st.   Alkaline
treatment; 2nd.  Simple, soothing  and. protecting
applications; 3rd.  Be  especially careful  that  no
medicaments liable to coagulate albumen or fibrin,
or to disorganize organic structure, are applied.
   What considerations govern the choice of filling
materials ?
   Ans. Compatibility with tooth structure, tenuity
of the walls, and thickness  of dentine overlying the
pulp; whether these will bear the pressure, or pro-
per working of the filling material to be introduced.
   What governs the introduction of such fillings ?
   Ans.  Care in working,  direction of pressure, if
painful, stop until the pain ceases.  In making hard
fillings, pack lightly near the pulp,  increasing  the
solidity toward the surface. 
42        DEEP  SEATED CARIES.
  Beside danger from immediate trouble, what dan-
gers are prospective!
  Ans.  Irritation from thermal changes, prevention
of exudation from pulp, absorption or liquefaction
of the structure between the pulp and filling ma-
terial, and conditional concomitants.
  How are pulps,  covered with dentine, sometimes
exposed after filling such cavities ?
  Ans.  By absorption or liquefaction of the film of
dentine between the pulp and filing material.
  How are pulps sometimes naturally protected ?
  Ans.   By  " recalcification,"  " tubular consolida-
tion" and "deposition of seconda-y dentine."
  What is meant by " tubular consolidation ?"
  Ans.  A deposit of calcific matter in the dentinal
tubuli,  obliterating and closing  their calibre  and
orifices.  This deposition takes place in the dentine,
between the  pulp and the external irritant.
  What is meant  by deposition of secondary den-
tine?
  Ans.  At the point  of irritation the pulp exudes
a plasm,  which  in the process  of time  becomes
hardened or calcified.
  What is the second cause  of odontalgia?
  Ans. Slight irritation of the dental  pulp before
exposure, and when nearly exposed.
  What five classes of irritants are spoken of under
this head?
  Ans.  Mechanical, Chemico-vital, Vitiated fluids 
 
 
           DEEP SEATED  CARIES.        43
of tne mouth,  Thermal changes  and Infiltrations.
  Give  examples of  mechanical.
  Ans.  Impacting of food, or other material, exert-
ing pressure.
  Give  examples of  chemico-vital.
  Ans.  Putrescing food, decomposing seeds of fruit,
berries, and the like.
  What are the signs of vitiated fluids of the mouth ?
  Ans.  Acid viscidity, or  " spider-web" appear-
ance  of saliva.
  What teeth are most liable to be affected by cold
air  in the upper  jaw?
  Ans.   Incisors  and  cuspids.
  Which  in  the  lower  jaw?
  Ans.   Incisors, cuspids,  and bicuspids.
  Which  is generally most  irritating, hot or cold ?
  Ans.  Cold.
  Why?
  Ans.  98 degs. F.  is blood heat; ice water is about
60  degs. lower, and  can be easily and even comfort-
ably  borne  in  the  mouth; hot drinks or liquids
above 140 degs. can scarcely be endured, and have
a difference in temperature of but little more  than
40  degs.   Therefore, as possible  irritation is pro-
portionate to variation in temperature, cold can be
more intense in its effects by  20 degrees.
  What  infiltrations  are  irritating?
   Ans.   Salt,  sweet  and  sour.
  What difference  exists between the  method ot 
44        DEEP  SEATED  CARIES.
such irritation in sensitiyV dentine, and in cavities
of deep decay ?
   Ans.  Irritation of sensitive dentine occurs from
pressure of food, instrument, finger-nail contact, &c.
In  cavities of deep  decay,  irritation  occurs  from
simple  infiltration.
   What are the symptoms  of pulp  irritation in
such  cavities?
   Ans. Uneasy sensations, positively located, great-
est at  periods of recognized irritation, no sharp,
paroxysmal attacks, no increase of pain upon pres-
sure  of tooth,  no throbbing.
   What is meant by spontaneous pain ?
   Ans. Pain occurring-in the absence of any tangi-
ble irritant.
   How  does  this  influence  prognosis?
   Ans.  It is  decidedly unfavorable, being  indi-
cative of abnormality, which  is, as a  rule, beyond
diagnosis.
   What is taught  regarding  masses  of  decayed
dentine ?
   Ans. From the standpoint of treating and saving
the pulps of poor teeth,  it becomes obligatory that a
sufficient portion of  the decalcified,  but organic
mass, should be  allowed to remain and live in pro-
tected  security.
   What pulp  considerations are referred  to in this
connection ?
   Ans. It refers to the pulp  being  in a state of 
I
I 
 
           DEEP  SEATED  CARIES.        4;~
health or disease, the probable and possible recupera-
tive power of the pulp, together with various con-
siderations of "temperament," "physical condition "
and the like, which may have a bearing upon these
points.
   What two  objects are gained by conservation of
decayed, living dentine ?
   Ans. 1st.  Prevention of exposure and undue ap-
proach to pulp.  2nd. Possession  of an organized
matrix, which being " protected,"  may recalcify.
   Is success universal under such treatment ?
   Ans. In view of the local and systemic influences,
which, as a rule, largely negative conserving efforts
in general, as well as in dental practice, it may not
be  positively asserted that success  uniformly  and
universally follows all intelligent and well directed
attempts;  but that in the large majority of such
cases (so treated) the active, efficient and beneficial
service afterwards  rendered  by such teeth,  give
comfortable,  thankful and positive assurance as to
the  propriety and  advisability of  the practice ad-
vocated.
   What are the indications  ot  success ?
   Ans. A gradual, and more or less decided free-
dom from uneasiness in  and  about  the tooth,  few
(if  any) periods  of " recognized  irritation," even
from carelessness or forgetfulness during mastica-
tion, biting, thermal changes and the like, followed 
46        DEEP SEATED CARIES.
by  perfect comfort and  exemption  from  painful
reminder  of the  tooth.
  What  are the  indications  of danger?
  Ans.   Gradual, growing feeling  of uneasiness,
slightly  increasing response  to  cold,  increased
thought and care of the tooth, sometimes, an unde-
fined apprehension of some trouble about to result.
  What  are  the symptoms  of  failure ?
  Ans. A  scarcely perceptible,  yet  increasing re-
sponse to  heat, occasional  pain, neuralgic  trouble,
nervous  exaltation and  systemic  sympathy from
reflex  action.
  What  is taught of "facial neuralgia"  in  this
connection ?
  Ans. " Slow  dying" of  the pulp may  produce
neuralgic troubles of almost every grade, intensity
and  duration.  The " twinges " may be  frequent
or infrequent, decided, severe, exquisitely  painful,
or absolutely torturing,  agonizing or  benumbing.
If the seat of the trouble be  in  an upper molar or
bicuspid, the  direction of the pain will be from the
tooth upward about the temporal region, backward
into the  ear  and head, and down the neck.
  If from the upper canine or oral teeth, the direc-
tion will  be upward, extending over  the lip, cheek,
side of nose, under the eye and deep  in the socket;
even over the  forehead  and cranium.  If from a
lower molar,  the direction will  be backward to the
ear, down the neck, &c. 
 
 
           DEEP SEATED CARIES.        47
  The pain from  the  anterior lower teeth is more
decidedly localized about the lip, jaw, chin, anterior
portion of neck, &c.   The salivary glands also ap-
pear to be excited to excessive secretion.
  What  are  the possibilities  in  connection  with
congestion of the pulp ?
  A?is.  The  effusions may be absorbed, and the
normal tone and circulation re-established.   It may
possibly remain in a chronic congested state without
giving any positive trouble for an indefinite  period-
It may have an active 01 passive death, and become
putrescent, or it  may mummify — all such possi-
bilities  being  controlled or modified by tempera-
ment, age and systemic influence, &c.
   What is the summary of  causes  of irritation in
deep  seated  caries ?
   Ans.  1st. Vitally,  by irritating and  escharotic
applications.  2nd.  Mechanically,  by excavating.
3rd.  By pressure, such as  results  from plugging.
4th.  By conduction, or other irritation after plug-
ging— such as results from a blow, biting pieces
of ice, bone, wood, string, &c.
   What is  the  summary  of  remedies ?
   Ans.   First.  Judicious  application  of medica-
ments, and the proper protection of the  pulp from
the action of such medicines as  may possibly  or
are likely to cause irritation.
   Second.  Care in excavating, and  accurate knowl-
edge  of pulp cavities. 
48       DEEP  SEATED  CARIES.
   Third.  Using lateral pressure in plugging, proper
and judicious packing of foil or other material, in-
terposition of solid base which may sustain unavoid-
able pressure, and the use of plastic fillings.
   Fourth. Interposition of non-conducting or porous
intermediate filling.
   AYhat are the gradations between " deep "  decay
and exposure — two or three ?
   Ans.  Three. 1st.  Very deep decay. 2nd.  Near-
ly exposed, or near the pulp. 3rd. Almost or quite
exposed pulp.
   Are  these always  of equal import?
   Ans.   They are  not.
   Why?
   Ans.   " Deep" decay  in the  nervo-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 pulp"  of the  bilio-lymphatic, compares
with " absolute exposure " in the bilio-sanguine.
   What are the eight controlling influences in con-
servation of pulp ?
   Ans.   Age,  barometric   and thermal  changes,
temperament, sex, place  of residence and mode of
living, physical condition, over exertion  and occu-
pation.
   To what time  of life does age refer?
   Ans.  Youth, maturity  and  old age.   Each  of
these are again subdivided into very marked peri- 
•
tr 
•
% 
          DEEP SEATED CARIES.        49

ods of  comparative cessation  from  decay.   The
first twenty years  of life  are  most marked with
trouble; systemic,  as  in the  bones  and  various
organs;  local,  as   markedly exhibited in  decay,
imperfect calcification of the teeth, &c.
  What is the first division of " temperaments ? "
  Ans.  Four  basal temperaments — Bilious, San-
guine.  Lymphatic,  and Nervous.
  What is the second division  of twelve tempera-
ments ?
  Ans.   1st.  Sanguo-bilious,  Lymphatico-bilious,
Nervo-bilious.   2nd. Bilio-sanguine,  Lymphatico-
sanguine, Nervo-sanguine.  3rd.  Bilio-lyinphatic,
Sanguo-lymphatic,  Nervo-lymphatic.   4th.  Bilio-
nervous, Sanguo-nervous,  Lymphatico-nervous.
This is called the " dual" division.
  Into what two classes are temperamental attri-
butes divided?
  Ans.  Internal  and  External.
  What are the external attributes of teeth of the
Bilious temperament ?
  Ans.  Slightly narrow at the necks, almost the
same size from necks to  cutting edge,  yellowish in
color, strongly fixed in the jaw, strong enamel, &c.
  What are the external  attributes of the Sanguine ?
  Ans. Dense  structure, strongly fixed in the jaw,
beautiful," translucent,  light to  dark  cream  color,
crowns appear shorter   than other teeth;  of the
same size from neck to cutting edge, " horseshoe "
arch, worn cutting  edges. 
50        DEEP SEATED  CARIES.
   What are the external attributes of the Lym-
phatic ?
   Ans.  Large and " bulky," constricted atthe neck
and cutting edges, and bulging in the  body;  not
strongly fixed in the  jaw; of a white  or whitish
yellow,  pallid  color.
   What are the external attributes of the Nervous ?
   Ans.  Narrow at the necks, and increasing in  size
to the cutting edges; long, brilliant in color, from
a pearly white to a bluish white ;  fine, sharp cusps,
fully formed, and seldom worn — presenting, as  a
whole, a bright and pleasing appearance.
   What are the internal attributes of the Bilious ?
   Ans.  Strength, permanence, endurance capability,
persistence ; slow but determined recuperation.
   What are the internal attributes of the Sanguine ?
   Ans.  Volume of nutrition, reliable  recuperation
from molecular to systemic;  dense structure.
   What are the internal attributes of the Nervous ?
   Ans.  Comparatively dense structure, good organ-
ization,  lacking perfect solidity; quickness and  fre-
quency  of recuperation and resistance, rather than
reliability and permanence.
   What are the internal  attributes  of  the Lym-
phatic ?
j.
   Ans.  Bulky, looseness of structure and tissue,
tending  more toward feebleness, lacking in strength;
tardy and feeble of recuperation ;  degeneration  and
relapse is liable. 
 
 
 
 
           DEEP SEATED  CARIES.        51
  From  what three  standpoints are the internal
attributes considered ?
  Ans.  General innervation, circulation and nutri-
tion.
  What is the grouping of temperaments for dental
study called ?
  Ans.   Den to-Temperamental.
  Into how many classes are temperaments divided
dentally ?
  Ans.   Into  four.
  Name  the first class.
  Ans.   Bilio-sanguine,  Sanguo-bilious.
  Name  the  second  class.
  Ans.  Lymphatico-sanguine, Lymphatico-bilious,
Nervo-bilious,  Nervo-sanguine.
  Name  the  third  class.
  Ans.  Sanguo-lymphatic,  Bilio-nervous, Sanguo-
nervous,  Lymphatico-nervous.
  Name  the  fourth  class.
  Ans. Bilio-lymphatic,  Nervo-lymphatic.
  What  are the characteristics of the first class ?
  Ans.   "Excellent."
  What are tne  characteristics of the second ?
  Ans.   " Good."  .
  AY hat  of the  third?
  Ans.   "Doubtful and  anxious.''
  The fourth?
  Ans.   Positively "diabolical."
  If Sanguo-bilious follows Bilio-sanguine, why does 
52       DEEP  SEATED CARIES.
not Sanguo-lymphatic follow Lymphatico-sanguine?
  Ans.  Because of a difference in basal attributes—
the sanguine base giving  strength, volume of nu-
trition, hopeful recuperation &c, to  the Lymphatico-
sanguine temperament.   The Lymphatic base, on
the contrary, being slow, bulky, feeble, and lacking
both  in  reliable  recuperation and good nutrition,
naturally gives place to a temperament with strong-
er basal attributes.  The Bilio-sanguine  and the
Sanguo-bilious being strong in the  basal  and mod-
ifying attributes,  they properly follow in regular
order.
  In  what  manner does  " physical  condition" in
fluence pulp conservation ?
  Even though temperamental  attributes  be good,
if the system is depressed from  any cause, the vital
force  of pulps is diminished, and response  to  ordi-
nary medication is  in consonance,  with the  disor-
dered physical condition.   It is often the case, how-
ever,  that pulps grading low  (as regards  tempera-
mental  attributes)  give  decided and  encouraging
response when  their  possessors  are  in vigorous
health.
  How does " over exertion " act upon it ?
  Over  exertion directly lowers vitality,  not only
of the whole body,  but  of every  cell; pulps  are
thus indirectly affected,   become  unable to resist
the advance of caries, weaken, fail and die.   This
is especially marked in individuals of an anaemic,
low grade temperament. 
 
 
          DEEP SEATED CARIES.         53
  In what manner does " sex " influence it ?
  Ans.  Failure in both sexes is about the same, yet
at certain periods sex appears to markedly influence
(negatively) preservation of pulps and teeth.
  How  does pregnancy affect it ?
  Ans.  Pregnancy appears  to have a  decided and
adverse influence.
  In what manner does "occupation"  influence it?
  Ans.  Sedentary  employment, lack  of  ventila-
tion, imperfect drainage,  changes of temperature,
&c, together with depressed mind,  weakened  phy-
sical  condition,  &c,  exert  an adverse  control
In  fact, anything tending  to lower general  vital
force, either directly or indirectly, diminishes the
probability of recuperation and response on the part
of pulps.
  How does " mode of living "  act, beneficially or
prejudicially ?
  Ans.  If mode of living is improper;  if appetite is
improperly  indulged , or if food is  insufficient and
of poor quality,  clothing scanty, &c, the system
will be deranged, vitally lowered,  and pulps give
little response to local  conservative  treatment.  On
the contrary, if all such conditions be reversed, the
conditions for conservative treatment of the pulp in
any individual (modified by temperament) are alike
most favorable.
  What is taught regarding influences of location,
or place of residence ? 
54       DEEP  SEATED CARIES.
  Ans.  Persons residing in localities where malaria
is present are weakened and depressed by its influ-
ence.   In such persons, disease tends to the period-
ic type.   Therefore conservative treatment  under
such conditions is uncertain and often fails.   It has
been observed  where pulps have been  capped in
healthy localities, and the patients,  by change  of
residence have  been afterward subjected  to the in-
fluence of malaria, that serious  trouble,  and often
death of such pulps, frequently followed.
  What is taught regarding " thermal " influences
either local or general ?
  Ans.  Local applications, such as hot or cold food,
cold liquids, cold air, &c.  produce injurious effects
upon pulps in proportion as the latter are approach-
ed by caries, chemical abrasion  or  other agencies
Changes of temperature alternately enlarge and con-
stringe the superficial blood  vessels, and thus  dis-
pose to congestions, fluxes and inflammations which
impair tonicity and vitality.   This pervertion of
the circulation gives rise to  general  systemic  de-
rangement, which is adverse to  pulp conservation.
  How  do " barometric " changes influence pulp
conservation ?
  Ans.  As a  rule, the  influence  of barometric
changes is exciting.   March and November  in  this
climate  are unfavorable months for  conservative
treatment because of barometric changes.
  What is the  third cause of odontalgia ? 
 
 
           DEEP SEATED  CARIES.        55
   Ans,  Irritation of the dental pulp from "almost"
or " complete " exposure — dying pulp.
   What are the  symptoms?
   Ans.  Paroxysmal and remittent, or intermittent
pam; not periodic, not  always positively located;
very severe during paroxjmis, throbbing or jump-
ing; great exacerbation from thermal, vital or mechan-
ical irritation; greater at times,  generally  during
the night; no increase of pain  from  pressure,  but
sometimes from concussion.
   What are the six  heads under which liability to
irritation, prior to filling, are discussed ?
   Ans.   1st. Infiltration of sweet or sour.  2nd
Direct contact with  foreign bodies.  3rd.  Pressure
of bodies. 4th. Thermal irritation. 5th. Mechani-
cal irritation. 6th. Medicinal applications.
   What is the first and  mosf important knowledge
needed  for diagnosing almost exposed or exposed
pulps ?
   Ans.  Anatomical peculiarities pertaining to pulp
cavities.  Their position, extent, general  direction
and  depth  of covering  (normally) of the cornua;
the portion, or portions of pulr which are (normal-
ly) most accessible,  and which  lie nearest  to the
surface, &c.
   What is taught in regard  to  the  pulp  cavity
being a minature of the crown of the  tooth ?
   Ans.  Thatvit is always a minature, is  not true,
except  in a  general way.   The  cornua  of pulps 
56            PULP  CAPPING.
are  sometimes  elongated,  sometimes  shortened.
  What is taught in regard to the relative position
of the pulp cavities in teeth in the hand and in
teeth in  the  mouth ? "
  Ans. Teeth in the jaw never have that upright
position given in diagrams, or usual in manual ex-
aminations, and are usually in direct apposition with
each other.   Therefore, as their surroundings  and
position have much to do with a correct understand-
ing in this regard, a full appreciation must be had
of teeth  in both positions, in order that a thorough
application of such knowledge  may be  practically
applied.
  What four considerations obtain in relating cavi-
ties of decay with exposure of pulps ?
   Ans.   1st.   Situation of cavity of decay.  2nd.
Depth of the cavity.  3rd. Direction of the cavity.
4th. Character of the  caries.
  What  are  the four  means  of diagnosing almost
exposed or exposed pulps ?
   Ans. 1st. Heat and cold. 2nd. Vision. 3rd. Taxis.
4th. Pressure ot instrument.
                Pulp  Capping.
   What  are  the  first considerations?
   Ans.  Whether chances are in favor of any effort
to be made toward conservation, and whether the 
 
 
PULP CAPPING.            57
increased skill required to meet even a diminished
likelihood of success, is possessed.
  What are  taught  as  the  governing influences in
pulp conservation — good material for capping, and
proper manipulation conceded ?
  Ans.  Condition of the pulp, temperament, age,
systemic condition, &c, have their governing influ-
ence, and must be considered in deciding the grade
of exertion warranted, in any individual case.
  What are  the seven  desirable attributes for cap-
ping  material?
  Ans.  Non-conductivity, Non-irritating, Porosity,
Plasticity,  Resisting capability, Durability, and the
advantage  of healing  or soothing attributes, with
compound  or simple applications.
  Name a few  materials which are used as pulp
protectors.
  Ans.   Cork, Ivory,  Quill,  Gold plate,  Tin foil,
Thin Lead plate, Asbestos,  Plaster of Paris, Gutta
Percha, Oxychloride of  Zinc,  Gold Beaters Skin,
Lacto-phosphate  of Lime,  Hydrated Oxy-chloride
of Zinc, Zinc-phosphate,  Oxy-sulphate of  Zinc, Oil
of  Cloves  pad,  Varnishes, Arnica  Court  plaster
(water  proot).
  What is  taught  regarding  gutta percha as  a
capper ?
  Ans.  It is one of the standard applications; is
non-irritating if  properly applied, non-conducting,
in harmony  with tissue ana1 tooth structure, easily 
58            PULP  CAPPING.
adapted, sufficiently resisting, and may be  consid-
ered good.
  What of oxy-chloride of zinc ?
  Ans.  It is irritating and escharotic if applied in
excess — has many good points, and there may have
been many cases where its  application as a pulp
capper has been productive of just sufficient irritation
of pulp  to result in good.  But as there is at  present
no known  possible  method by which to determine
the probable exact degree  of irritation  resulting
from the application of a certain quantity  in indi-
vidual cases, it is deemed wise to reject it for this
special  purpose.
  What of hydrated oxy-chloride of zinc ?
  Ans.   Receipt for  making.  Water,  one part;
chloride and powder, two.   Mix.   In some  cases
it may be very good,  and is less irritating than the
pure oxy-chloride;  but as other materials are better
in many respects, it  becomes simply a matter  of
prudence as regards its use.
  What of  lacto-phosphate?
  Ans.  It is regarded as acceptable to pulp struc-
ture.   Three ingredients enter  into its  composi-
tion.  1st. Magma-phosphate of lime (moist).  2nd.
Merck's lactic  acid. 3rd.  Powdered phosphate of
lime (dry).
  What of  zinc-phosphate?
  Ans.  When  the  peculiar,  slow but far-reaching
and destructive action of phosphoric acid is consid- 
 
 
PULP  CAPPING.            59
 ered, together with the fact that most zinc-phos-
 phates  after  mixing  have an acid taste,  and re-
 action— their use may be termed questionable.
   What of oxy-sulphate of  zinc?
   Ans. It is  ahout the best capper for  general use
 that we have; is easily adapted, even in inaccessi-
 ble cavities ;  sets quickly and sufficiently hard ;  is
 non-irritating and non-conducting;  porous, plastic,
 and in  harmony alike  with  tooth structure and
 pulp  tissue.
   What length of time is taught as " probationary "
 prior to deciding whether efforts at  pulp saving are
 successful ?
   Ans.  From six months to a year.
   Is this length of time universally reliable ?
   Ans.  It  is not,  for pulps may give  symptoms of
 failure in less time, and may not do so for years.
   What is taught regarding  teeth, the pulps  of
which  die  lingering deaths?
   Ans.  A  tooth in which the pulp has died a " lin-
gering death " does not last so long,  and is more
liable to give  trouble in the future, than a tooth  in
 which the pulp has been quickly devitalized.   Long
continued  pain,  alteration  of the circulation and
alteration  of  nutrition in and about the tooth and
contigous tissues, results in the establishment of a
decided adverse impress, which, upon the applica-
tion of an exciting  cause, develops with more  or less
celerity and  intensity.  A  tooth which  has  not 
60
PULP  CAPPING.
been  subjected to such long continued, depressing
and  pre-disposing influences, permits (after  death
of .pulp)  of a  more  perfect  re-establishment  of
comparative  normality.
  What four considerations contra-indcate efforts
it pulp conservation ?
   Ans. 1st. When pulps give decided evidence of
marked irritation,  with  a probable future  of no
relief.   2nd. When the  person is sick, systemic
condition is poor, and they are unable to bear any
additional pain.  3rd.  When freedom from future
trouble (possible from death of  pulp)  is  desired,
4th.  When time cannot be allowed for conservative
treatment, devitalize.
   Name ten or  more means of external irritation
to pulps.
   Ans. Thermal irritation, Ice, Mechanical,  Medi-
cinal, External attrition, Fracture of tooth,  Disease
of surroundings  of  tooth, Pressure of foreign  mate-
rials, Direct contact of foreign bodies, Infiltration
of salt, sweets  and sours, Lack  of occulsion, Pre-
vention of exudation.
   What is the internal cause of irritation ?
   Ans.  Pulp nodules.
   How is  the  absorption of permanent roots di-
agnosed ? 
 
 
PULP  CAPPING.
61
  Ans.  Pain is neuralgic; located about the cheek
(which at times i3 tender when pressed), in the e}^e,
&c.;  great  pain  from hot  or cold applications;
sometimes a peculiar pricking sensation from press-
ing the tooth, and decided response from  tapping
or striking it.  The teeth, as a rule, are good and
strong  as regards their  structure, and are firmly
set in their  sockets.
   What is " nodular calcification ? "
   Ans. It consists, practically, in the formation of
small nodules of calcified matter within the  pulp
tissue;  is generally confined  to  the body of the
pulp, but at times nodules are found  within the
pulp  canals.
   What is  the recognized connection between ab-
sorption of permanent roots, or nodular calcification,
and dental caries ?
   Ans. Absorption occurs in  teeth, the crowns of
which are sound and  symmetrical.   Nodular calci-
fication occurs in the  pulps of teeth, the crowns of
which  are also  perfect in every respect.  There-
fore, even though decay may be, and often  is found
in connection with such teeth, it cannot be claimed
to have a cause and effect relation to either of the
above conditions.
   What is taught regarding  complete extraction in
these cases ?
   Ans. Every portion of root must be extracted,
otherwise very little, if any, relief will be afforded.
   What is the underlying principle which  governs 
62
PULP  CAPPING.
practice in the treatment of irritation from pulp
nodules ?
  Ans.  The utmost care and caution is required,
that a steady advance toward the pulp may be made
with the least possible irritation.
  What are the symptoms of pulp nodules ?
  Ans.  Enamel is sensitive, and responds to touch.
Striking  or tapping the tooth elicits  painful re-
sponse.   The  character of the pain may be con-
tinued or intermittent, and  become more violent as
the abnormal condition continues, or is influenced
by the system, &c.  Generally the gum and health
line  have  the  normal  appearance;  usually the
dentine is  highly sensitive (though  at  times this
is  not met with); the pulp  just previous to, and
upon exposure is extremely sensitive to pressure.
  How is diagnosis of this condition made ?
  Ans.  From symptoms alone.
  What influence has  temperament and physical
condition in connection with pulp nodules ?
  Ans.  Nodular  calcification  is seldom  found in
connection with low grade temperamental attributes
and weakened system: high  grade  temperaments,
such as Sanguo-bilious, Lymphatico-sanguine,  ner-
vo-sanguine and the like are  more liable to it on
account of sthenic irritation  and the powerful re-
cuperative and protective efforts of vital parts.
  What is the preliminary treatment ?
  Ans.  Administration of Assafoetida in pill form,
and solution Meconate of Morphia; local application
of Aconitia ointment (Aconitia two  grains, simple 
 
 
PULP CAPPING.
63
cerate one dram), followed by ointment of Veratria
(Veratria one scruple,  simple cerate  one  dram).
Use in very small portions (about size  of common
pin head.).   Rub gently over the  eyes, temples,
sides of the nose, and about  the  cheeks.  Be very
careful not to get ointment into the eyes.
   What of the entrance to pulps  in such teeth ?
   Ans.   This should be effected with  the  utmost
care.   For obtunding sensitive dentine  use Chrom-
ic acid, Arsenical paste, Chloride of zinc, Electricity,
&c.  For devitalizing the pulp, use Arsenical paste.
   What is " phantom odontalgia  ? "
   Ans. It is that form of odontalgia which has its
origin  in a location from which a  tooth or  teeth
have been extracted.
   What is the best method for preventing this ?
   Ans. Using a medium sized round or oval bur,
drill into the socket,  and thoroughly lacerate the
tissue at the bottom.   After washing and cleansing
the parts, apply aconite and morphia paste.   Sys-
temic medication may also be considered, in obsti-
nate cases.
   How is a  fungus  growth  of gum within a tooth
diagnosed at once from that  of a  fungus pulp ?
   Ans. This cannot be done; it  requires time and
treatment before a correct diagnosis can be given.
   What is the first treatment for both ?
   Ans.  Soothing, absorbent, astringent.
   Ans.   Why ?
   Ans.  Because you cannot  be assured, at first, as 
84        COMPLICATED CAKIES.
to whether it is hypertrophied gum or pulp tissue.
Therefore,  to  be positively assured as to the true
condition, such treatment must be followed as shall
tend to reduce the enlargement sufficiently to per-
mit satisfactory diagnosis as to its origin.
           Complicated  Caries.
  What  is  complicated  caries?
  Ans. That stage of decay connected with a pulp-
less  tooth,  or  which requires  for  its  successful
treatment, the devitalization and extirpation of the
dental pulp.
  Is  a pulpless tooth a dead tooth?
  Ans. It is not as regards the cementum and peri-
cementum ;  it is when reference  is had to the en-
amel  and dentine.
  Why?
  Ans.   The  vital and  nutrient forces, supplied
through the pulp  to  the dentine and enamel, are
entirely cut off from these structures upon death of
the pulp.  As  the cementum  is nourished  by  the
peridentium, and it in turn by proper nutrient ves-
sels, they still live after death of  the pulp.
  What are the various functions of the dental pulp ?
  Ans.   A  means  of nutrient  supply, sensation,
preservation of translucency,  vital resistance, &c.
  What are the probabilities of a pulpless tooth ?
   Ans.  The probabilities  of a pulpless tooth are
graded according to  the temperament, occupation 
/ 
 
COMPLICATED  CARIES.         65
and  general  physical  condition of the individual.
For  example :   If all things are encouraging, then
a favorable prognosis in regard to future comfort of
the tooth, its future service and the like, may be
given.  In this connection, it must be remembered
that over  work in relation to the tooth itself, is a
powerful, exciting and pre-disposing cause to dis-
ease.  Therefore, the position of the tooth, and the
amount of work  it is expected  to do, should be
carefully considered.
   What are the possibilities of a pulpless tooth ?
   Ans. The  possibilities  of a pulpless tooth cannot
be  graded, as  we are  unable to  determine the
amount and duration of vital resistance a peridental
membrane will successfully offer under the various
altered conditions to which it may be in turn  sub-
jected.  Therefore, the possibilities include most of
the comparatively normal and diseased conditions
u&Tfally found  in connection with  pulpless teeth.
For  instance:  Under adverse  influences such a
tooth  may remain  quiescent and comparatively
comfortable for an indefinite period;  again, under
the most  hopeful  auspices, it may be productive of
so much infliction as to necessitate removal.
   What are the four means of devitalizing a pulp ?
   Ans. Luxation, the twisting  or loosening of a
tooth in its socket; Devitalization with appropriate
medicament; Extirpation, or Broaching and Punc-
turing; Actual Cautery. 
66         COMPLICATED CARIES.
  What is " puncturing," and with what appliances,
instrumental and medicinal, and how, is it done?
  Ans.  Puncturing consists in devitalizing the pulp
by means of instrumentation.  A  straight instru-
ment, tapering to a fine and extremely sharp point,
is used; delicacy of manipulation is essential, as by
repeated, gentle and gradually advancing thrusts,
aided by obtunding applications of the dental Tine.
Aconite, Arsenious acid &c, progress is made  and
vitality destroyed.
  What is Arsenious acid,  and  from  what,  and
how, is it obtained ?
  Ans. Arsenious acid is an oxide  of the metal Ar-
senic.   It is obtained by burning  Arsenic in the
open air; the oxide is formed, rises in  vapor,  and
is condensed in the flues  of the  chimney.  It is a
violent poison, condenses in octahedral  crystals, by
which it may always be recognized.  It is not very
soluble in water; very soluble in alkaline solutions;
has a feeble acid  reaction;  forms  arsenites; has a
feeble, sweetish, rough taste.
  Give three or four tests for arsenic.
  Ans. Ammoniacal Nitrate of  Silver  gives with
arsenious acid a yellow arsenite of silver.
  The  production of arseniuretted  hydrogen, by
using Marsh's apparatus, and allowing the burning
jet to impinge on  a cold,  white  porcelain surface.
The brownish black spot is deposited;  or by  heat-
ing the glass tube through which the gas is passing, 
 
# 
 
 
COMPLICATED  CARIES.         67
the characteristic ring is deposited just in advance
of the heated  portion.   The Blow pipe test  gives
garlic odor.  If there is an  unsublimed residuum,
the arsenic is impure.
   Reinsch's  test.   Macerate the suspected tissue
in water; add one-tenth bulk of fluid  hydrochloric
acid and boil for half an hour  with bright copper
foil;  if arsenic be present the  copper  will  have a
gray metallic  crust.
   Who introduced arsenious acid in dental practice?
   Ans.  Dr. J. R. Spooner, of Montreal.
   What is the  date  of its  introduction?
   Ans. It was made known by his brother, Dr. S.
Spooner in 1836.
   What is the  solubility of  white oxide of arsenic
in creasote, carbolic acid and oil of cloves ?
   Ans.  Insoluble  in  all.
   What is taught  regarding  arsenical irritation
through  a  normal  sized apical foramen in a fully
formed tooth ?
   Ans. There  can be  no irritation to surrounding
tissue through such a foramen, unless  the arsenic is
forced through.
   What of the probabilities in not  fully formed
teeth ?
   Ans. Such irritation may be produced, if the ap-
plication is allowed to  remain too long, or  is often
repeated.  Caution should  be  observed in connec-
tion with its use in children's teeth. 
68        COMPLICATED CARIES.
  What  regarding  the  length of time  needful and
possible for arsenical applications.
  Ans.  No positive time may be given,  but usually
from two to twenty-four hours; sometimes by mere-
ly placing the arsenic  in the tooth and  taking  it
out again; possibly a year.
  What regarding cause and  treatment of  any
peridental irritation which supervenes upon  arsen-
ical  devitalization ?
  Ans.  Cause. The separation between living  and
dead tissue immediately beyond the apical foramen,
also consequent diversion of the normal circulation,
particularly  to the peridental membrane, is  pro-
ductive  of determination, &c, with concomitant
exalted  vitality,  tenderness and the  like.
  Treatment. As a rule, the inherent vital force of
the  parts is  sufficient to re-establish, comparative
normality in a short space of time;  when the  ten-
derness continues or increases, proper soothing anti-
phlogistic  or stimulating applications  should be
made to the  gum, as  indicated by the  signs and
symptoms.
   What are the three forms of arsenical applications?
   Ans.   Arsenical Paste, Devitalizing Fibre and
Cobalt.
   How is each form prepared and applied ?
   Ans.  Arsenical Paste.
   Arsenious  acid,  grs.  v. basis.
   Morph. acetas,  grs.  x. adjuvans. 
 
■%
* 
m          COMPLICATED  CARIES.         69
   Creasotum vel carbolic acid, gtts. x. constituens,
 Misce.   Apjply with a probe, or on a pellet of cotton.
   Devitalizing Fibre.   Absorbent cotton is reduced
 by cutting  and cross cutting to a fine, soft fuzz;
 this is then incorporated with  a mixture  composed
 of arsenious  acid, tannin, carbolic acid and opium.
 It is then dried, and separated in small pieces for
 convenient application.
   Cobalt is powdered and made into a paste with
 any medicament desired.  As it owes its efficacy to
 arsenic  in  combination, its use, care in applica-
 tion, &c, would be the same as arsenic.
   What are  the four considerations which  ensure
 to arsenical applications the best results ?
   Ans.  Dryness, direct application of medicament,
 proper quantity and maintenance in position.
   What is the danger in arsenical applications, and
 what are the  four means for guarding against it ?
   Ans.  That it may get out of the cavity upon the
 gum and mucous membrane of the mouth.   Guard
 with napkin or rubber dam, properly prepare the
 cavity,  accurately place medicament, securely close
 the orifice of  insertion with Temporary Stopping.
   What is the proof that pulp devitalization is not
 due entirely to the action of arsenic ?
   Ans.  The pulp putrifies if allowed to remain in
 the tooth.   It has been conclusively proven that 
70        COMPLICATED CARIES.
tissue containing arsenic, though in  minute quanti-
ty, does not putresce, even with the conditions of
heat, moisture and air most favorable.
  What result in connection with tooth tissue some-
times follows an application of arsenic 1
  Ans. Suffusion of blood produced by the intense
determination  and  thorough congestion; pinkish or
purple discoloration of tne crown and  neck of the
tooth.
  How would  you treat a " suffused " tooth ?
  Ans. Canals should be cleansed and  temporarily
stopped above the  suffusion, the cavity thoroughly
washed, and the tooth left open to the fluids of the
mouth.  In a*  few hours or days a comparatively
natural color is restored.
  What governs repeated applications of arsenic in
teeth of the upper or lower jaw ?
  Ans. In the upper, proper applications may be
repeated with  comparative safety, as regard is had
to the escape and subsequent effects of the medica-
ment upon the gum and contiguous mucous mem-
brane — gravity,  and  the  oral fluids tending  to
prevent any local action should  leakage occur.   In
the lower, gravity and oral fluids  are alike favor-
able to leakage and local action of the medicament.
  What are the six considerations which maintain 
I 
 
EXTIRPATION OF DENTAL PULP     71
systematic antagonism in the  treatment of deciduous
and permanent teeth ?
  1. Deciduous teeth are for
temporary use.
     Deciduous teeth are filled
  2.
for temporary purposes.
  3. Roots  are  absorbing or
absorbed when the crowns need
attention.
  4. Irritation  of pulps inter-
feres with absorption of roots.
  5. Devitalized pulps prevent
true absorption of roots.
  6. Every consideration points
to the  early loss of rootless
crowns.
  1. Permanent teeth are for
permanent use.
  2. Permanent teeth are filled
for permanent purposes.
  3. Roots are not fully formed
when such attention to crowns
is required.
  4. Irritation  of pulps inter-
feres with formation of roots.
  5. Devitalized pulps prevent
formation of roots.
  6. Every consideration points
to the usefulness of crownless
roots.
         Extirpation  op the Dental  Pulp.
   Upon what  is the average of  success  in this
operation dependent?
   Ans.  Time of year, physical condition of patient,
temperament, &c.
   What is the point for " tap " in each tooth ?
   Sup. centrals    on  palatal face.
        laterals      „      „     „
        Cuspids     „      „   tuberosity.
        1st bi-cus.  „  articulating or  mesial face.
        2nd.  „      „      „     face.
        1st.  molar  „      „  buccal or mesial face.
        2nd.   „     „      „  mesio- articulating, or
                            bucco-articuiating face.
        3rd.   ,,    ,,   mesio-buccal articulat.  face. 
72    EXTIRPATION OF DENTAL PULP.
  Inf. centrals and laterals on  lingual  face  just
               posterior to cutting edge.
    „   cuspids   on disto-labial near edge of gum.
    ,,   1st bi-cus. „  mesio-buccal face.
    ,,   znci. ,-,   ,,    ,,     ,,      ,,
    „   1st. molar,, mesial, buccal or  art.  face.
       9nrl
    .,   .jiiii.  ,,   ,,    ,,      ,,    ,,   ,,    ,,
    „   3rd.  „   „ mesio-buccal face.
  Which teeth give better promise of success, those
of the upper jaw, or those of the lower ?
  Ans.  The  upper.
  Why?
  Ans. Because of the greater vitality and  lighter
character  of  the surrounding osseous structure;
gravity, also,  exerts a beneficial influence upon the
effusions of congestion, inflammation, &c, thus as-
sisting  in  the prevention of external scars, &c,
which might occur  from abscess, and the like.
  What is the first indication in  pulp extirpation?
  Ans. Probe gently to ascertain as to sensation.
  What is the danger to broaches in extirpating?
  Ans. Breaking them off in the canal.
  What is the objection  to leaving broken broach
or probe in the canal ?
  Ans. Presents mechanical difficulties to future
venting of the tooth. 
 
 
      EXTIRPATION OF DENTAL PULP.    73
   Give treatment of canal in single  rooted teeth.
   Ans. Gain access, open wide, clean out well with
glycerine and alcohol, or  oil of cloves.   Work out
filaments of pulp with probes; any remaining por-
tions should be  removed by syringing with tepid
water and  phenol-sodique.   As  each canal is thus
prepared as thoroughly as possible, dry and fill with
oil of cloves or glycerine.   This is done by working
medicaments into canal by means of a fine probe;
any  surplus should  afterward be  removed  with
oibulous paper, and a dressing  of cotton gently in-
serted, being careful not to fill  the canal flush with
the pulp-chamber.
   Give treatment of canals in multi-rooted teeth.
   Ans.  Beginning with  the  largest, open, clean
and  dress in turn, same as  single roots.  As the
cotton  is not  flush with the  pulp-chamber,  it  is
not disturbed in drilling and cleaning other portions
of the cavity and other canals.  The finest canals,
which do  not permit  of cotton dressing,  being
simply  filled  with the  medicament used.   The
pulp  chamber  and entrance is  then temporarily
stopped, usually for a week.
  Wh}' is the largest  canal treated first ? 
 74    EXTIRPATION OF DENTAL PULP.

   Ans. Because the bulk of devitalized tissue is thus
 removed, re-entrance of debris prevented into canals
 that  have been cleaned, and  the final  and proper
 treatment (working in medicaments by means of
 probes) of the smallest canals just before tempora-
 rily closing the tooth, allowed.
   Ans. If the parts about the apex of the root ex-
 hibit but slight deviation from normality, and tem-
 peramental attributes, physical condition, &c, are
 good, then a short space  of time will generally be
 required.  If, however, the parts become tender,
 and irritation increases  (especially  in low grade
 temperaments) then  the proper  supporting  anti-
* phlogistic treatment must  be followed, and time
 allowed for the re-establishment of a comparatively
 normal condition.
   What is taught in regard to hemorrhage govern-
 ing this ?
   Ans. It is not  to  be  regarded as a positively
 favorable or  unfavorable indication, except under
 normal conditions.  Sometimes no bleeding is pres-
 ent, and yet from  the constant oozing  of  effusions
 through apical foramen, such teeth require time and
 accurate stopping and  unstopping before a perma- 
 
 
DENTAL  EXOSTOSIS.
nent filling can be introduced.  The safest method
to follow is that which permits of the sloughing and
separation  of canal tissue from outside tissue; the
parts heal naturally, and no  hemorrhage  or ir-
ritation is  produced by withdrawal of the  pulp.
Temperament, physical  condition, &c, are to be
considered in this connection.
  What is meant by a "pulsating" pulp?
  Ans.  One  which throbs  or  pulsates in unison
with the arteries.
  To what is this probably due?
  Ans.   Enlarged apical foramen.
  What  is the  prognosis?
  Ans.  Will run  on to periodontitis.
  What signs distingnisn it from pulp dying ?
  Ans. Decided  pain, long continued paroxysms of
severe suffering,  throbbing pain and  imperative de-
mand for relief.
            Dental  Exostosis.
  What  is the  cause of this disease?
  Ans. Slight and continued peridental irritation.
  What time is required for its development ?
  Ans.   Months;  usually  years.
  What  is its  apearance ?
Ans. Chalky, at times harder and yellowish white;
again, polished and hard.
  What  is its  form? 
76         DENTAL EXOSTOSIS.
  Ans._ 1st. Nodular; 2nd. Circumscribed or api-
cal ;  3rd.   Extended or diffused.
  At what age does it  occur ?
  Ans.  Usually found only in adult and aged teeth.
  What is the relative liability of teeth to exostosis ?
  Ans.  Incisors and cuspids number  tAventy-five
per cent.; bicuspids and molars seventy-five per cent.
  What connection has  dental  caries  with this
disease ?
  Ans.  It is one of the most infrequent causes, and
is dependent upon three considerations:
  First. Position.   This  must be  under the  free
edge of the gum, and encroaching upon  the  ce-
mentum.
   Second.  Extent.   It  is not necessary  that such
cavities shall be very large, but if not, then they
must encroach  more  upon cemental than dentinal
structure.
   Third.  Character of decay.  The slow variety is
more  likely to produce  exostosis than  the more
rapid forms.
   What is the division of causes of exostosis ?
   Ans. First.   Mechanical.   Any mechanical  irri-
tation  which,  is strong  and  frequent, or weak
and  persistent, is liable to  cause it;  such  as
knocking the  teeth together, breaking or crack- 
 
I 
FUSEDTEETH.      m      77
ing  hard things, biting  off  threads, strings, &c,
protrusion of fillings  so  as to impinge upon, and
irritate the peridentium;  slow deposition  of  tartar;
mal-occlusion, &c.
   Second.  Vital.  Large  metallic plugs, especially
large  root  fillings, dental caries, alveolar  abscess,
necrosed roots and exostosed teeth.
   What is its usual treatment ?
   Ans.  Careful extraction.
   What might  be its treatment?
   Ans. Extraction, removal of exostosis and re-
plantation—very questionable practice.
   What are the symptoms of exostosis ?
   Ans.  Dull, gnawing, uneasy sensations ;  usually
 located in or aoout the tooth or root affected ; not
 necessarily  persistent;  never very acute;  some
 response to  pressure  and tapping, but not decided.
                 Fused Tee th.
   What is  the  peculiarity of these?
   Ans.  These have an individual and  separate pulp
for  each tooth.
   What are the ordinary causes of irritation which
 produce such a condition ?
   Ans.  Exostosed teeth may, by extension of irri-
 tation, induce it;  mal-position of a  neighboring
 tooth from abnormal direction of growth sometimes
 produces sufficient irritation to fuse its roots with
 those of other teeth.   Generally it may be stated 
78        ATTACHED  TEETH  &c.
 that irritation of root tissue causes fused teeth.
              Attached Teeth.
   What is the peculiarity of these ?
   Ans.  They have separate pulps, and are mechanic-
ally attched to each other by the intervening walls
of their alveoli.  Bone and cementum do not unite.
             Geminous Teeth.
   What is  the peculiarity of these teeth ?
   Ans.  Practically they have  but one pulp.
   What  causes these  teeth?
Ans.  Abnormality of crown  tissue.
   What operatien is condemned in connection with
these  teeth?
   Ans.  Separation.
   To what teeth do geminous pulps mostly pertain ?
   Ans.  Mostly to centrals and laterals; sometimes
laterals  and cuspids are united.
              Periodontitis.
  What is  the meaning of this term?
  Ans. Inflammation  of the peridentium.
  What is  the location of this disease ?
  Ans.  In  the peridental membrane.
  What are the three causes of general periodontitis ?
   Ans.  Functional derangement, systemic debility
and systemic hyper-acidity. 
 
 
              PERIODONTITIS.            79
   What is the treatment advised for the first two ?
   Ans. Consign them to general practice.
   What for  the  third?
   Ans. Small doses of  alkali such  as  bi-carbohate
of soda.
   What are the five grades of periodontitis ?
   Ans.  First grade.   Marked soreness  of tooth,
circumscribed as to  tissue irritation, prompt in ap-
pearance of symptoms, prompt in resolution or
permanent  cure if cause is removed,  and requires
no support when drilling vent.
   Second grade.   Possesses more marked soreness
of tooth, not so prompt in appearance of symptoms,
more extensive as  to  tissue irritation  (occurs in
high grade  patients), more deliberate  resolution as
to the result of accurate and persistent medication.
This grade requires some support when drilling vent.
   Third grade.   In N. B. or N. S. patients, devel-
ops with sufficient  celerity, soreness  all over the
parts, pronounced throbbing on pressure of tooth,
general febrile excitement, cheeks  red and flushed,
systemic sympathy, &c.;  requires utmost gentle-
ness and accurate, persistent medication, together
with promptness in  affording some relief.
   Fourth grade.   Necessitates an almost immediate,
and frequently an immediate abandonment of anti-
phlogistic medication, and by proper stimulation to 
80
PERIODONTITIS.
induce suppuration.   This grade can be recognized
by the  non-success of the ordinary antiphlogistic
treatment, cleaning of tooth, &c.
  Fifth grade.  Occurs in B. N. and B. L. tempera-
ments.  Very little comfort or success can be hoped
for in this grade.   The teeth on either side of the
affected one  are exquisitely  tender  and respon-
sive ; tissue irritation is extensive; medication does
no good;  cannot run on to  suppuration;  only a
high grade, active inflammation;  great systemic
sympathy.   Extraction is the only  remedy,  and
then persistent and accurate  treatment is required
to prevent the loss of several  teeth in  the same
manner.
  What are the seventeen recognized causes of per-
iodontitis ?
  1st.  Want of occlusion.
  2nd.  Mal-occlusion.
  3rd. Salivary calculus and tartar.
  4th. Looseness of tooth "or root.
  5th. Induration of tooth tissue.
  6th. Cavity of decay impinging on the cementum.
  7th. Mechanical irritation.
  8th. Dental manipulation.
  9th. Excess of filling material.
  10th. Inflammation of  pulp.
  11th. Excision of pulp without alleviating hem-
orrhage. 
 
 
              PERIODONTITIS.            81
  I2tn.  External irritation by forcible withdrawal
of pulp.
  loth.  Putrescent pulp.
  14th.  Previous periodontitis.
  15th.  Action of medicine locally.
  16th.  Action of medicine systemically.
  17th.  Action of virus.
  What are its symptoms?
  Ans/ Knowledge of the presence of the tooth,
desire to work it with the finger, or press it with
the tongue; soreness; peculiar,  acute, throbbing
pain, beating with the circulation; violent suffering
from  striking  and tapping, not  only  the  affected
tooth,  but,  possibly, adjoining ones.
  What is its  sign ?
  Ans.  Interference  with, or obliteration of,  the
health line.
  What is the health line ?
  Ans.  A  line of demarkation between  the  pale
pink and deep red gum tissue.
  What is the decisive test for peridental irritation?
  Ans.  Tapping upon the tooth, and pressure.
  What is the only termination ot periodontitis ?
  Ans.    Resolution.
  What  form of dental disease is established  by
any other termination ?
  Ans.   Alveolo-dental abscess.
  What are the  three local and  two general consid-
erations in the treatment of periodontitis ? 
82
P E _U 10 D 0 N TITIS.
  Ans.  Local.   1st. Removal of irritants, vital or,
mechanical.  2nd. Absolute rest of the parts.  3rd.
Application  of tonics, astringents  or stimulants
counter-irritants, sedatives &c.
  General.  1st. Diet, rest, exercise.   2nd. Some
aperient,  as  Hunyadi water,  Epsom  salts, small
dose largely  diluted;  add one-half bottle  Citrate
of Magnesia — take before breakfast.
  Into what two forms is periodontitis divided ?
  Ans. 1. Sthenic, acute, circumscribed or phlegmon-
ous. 2. Asthenic, chronic,  diffused or erysipelatous.
  What complications render the second form more
difficult of treatment ?
  Ans. Temperamental and systemic complications.
  What are the two forms of general treatment in
periodontitis ?
  Ans. Prophylactic or Preventive,  and Curative.
  What is the division  of the chronic form of
periodontitis ?
  Ans.  Benignant and Malignant.
  How is a local or systemic cause of periodontitis
diagnosed ?
  Ans. If a local cause, the inflammation stops, as
a rule,  at the mesial line.  If this point is passed,
the inflammation is purely systemic or complicated
with a local cause.
  What are  the systemic  causes?
  Ans.  1st,   Syphilitic  virus.   2nd.  Mercurial
poisoning. 3rd.  Phosphorus. 
 
 
/ 
 
           ALVEOLAR  ABSCESS.         83
            Alveolar  Abscess.
  Give tne  definition  of  alveolar  abscess.
  Ans. A  cavity containing pus, having its incipi-
ency in the cancellated  structure between the alve-
olar plates.
  What are the six causes given for alveolar abscess?
  1st. Putrescent pulp.
  2nd. Tartar.
  3rd. A necrosed  tooth or root.
  4th. Carious bone.
  5th. Necrosed bone.
  6th.  Foreign materials,  such as oyster  shell,
pieces of bone, coal, &c, from the food; splinters,
bristles from  tooth brush,  portions of  filling ma-
terial, protruding canal fillings, broken probe, &c.
  In what condition are the parts placed by the
removal of any one of the last five causes ?
  Ans. In a  condition which permits of a natural
restoration to health.
  In what condition  is a tooth left bv removal of
the other cause ?
  Ans. In such  condition, as  by proper treatment
("frequent stopping and unstopping," &c.) to  give
reasonable  hopes for  a longer or  shorter period of
comfort and usefulness.
  Why ?
  Ans. Because " previous disease " constitutes a 
84        ALVEOLAR  ABSCESS.
" pre-disposing cause " to disease in the future ; so
that when an  "exciting cause" is again  applied,
the parts being in only a comparatively normal con-
dition, are easily disordered and irritated.
   What is the difference in treatment of abscess
from  putrescent  pulp with fistulous opening, o,nd
without ?
   With a fistulous opening.   First effect an entrance
to pulp cavity; open widely and gain free access;
remove all putrescent material by means of probes,
syringing and antiseptic medicaments,  being careful
not to force medicaments through fistulous opening.
Use easy, soothing canal dressing, such as Iodoform
paste, Morphia, Iodoform,  Oil of Cloves, Calendu-
la, Oil of Cajuput &c; by which treatment the natu-
ral healing of the abscess and fistula in a short space
of time  is  permitted.   After such treatment  the
tooth may be filled at once, if desired.
   Without fistulous opening.   Having no exit except
by way  of the  apical  foramen  out through  the
tooth.   Such  teeth feeling long, sore and  tender
 to the touch, require counter-pressure  when drilling
 relief hole, for the evacuation of pus.   The gum
 should be gently pressed  until not only all pus is
 evacuated,  but some blood  appears; a little  pus
 will afterwards form (from some degenerated tissue
 necessarily left about the apex of the  roots) even
 in the best temperaments, and more will form  in 
 
 
           ALVEOLAR  ABSCESS.         85
low  grade temperaments.   A first consideration,
then, is  whether  the  abscess will be  sufficiently
relieved  by the vent hole for a  natural cure,  or
whether a fistulous opening will have  to  be estab-
lished.   This may be determined by leaving the
tooth open for two or three days, when, if relief is
not  sufficient, it  will be announced by return of
pain, swelling &c. (especially if relief  hole is  stop-
ped  up);  a choice is then had of three  things:  1st.
Hastening on  to suppuration and formation of
fistula by closing vent hole and applying a pepper
bag; 2nd. Lancing through the tissue; 3rd. Drill-
ing  an opening through alveolus to apex of  root,
thus making an artificial fistuia.   To  do this with
comparative comfort to patient, give gentle inhala-
tions  of chloroform one part, and alcohol two or
three parts until the glow and buzzing  is felt by the
patient.  For drilling use  a strong, tough drill.
   What are  the various medicaments recommended
for use inside of teeth which have abscessed  from
putrescent pulp?
   Ans.  They may be included under  the heads of
 " soothing or  antiphlogistic," " stimulating " and
 " antiseptic " medicaments. Acetate Morphia paste,
Glycerin, Alcohol,  Tine.  Calendula,  Oil  Cajuput,
Eucalyptus,  Cloves, Tine. Capsicum, Iodoform, &c.
   What  medicaments are recommended to be ap- 
86         ALVEOLAR  ABSCESS.
plied upon the gums in cases without fistula)?
  Ans. Oil of Cloves, Aconite offic, Tine. Arnica,
Lead-water and Laudanum, Tine. Iodine offic, Cap-
sicum,  Ginger,  Chloroform, Hamamelis, Phenol-
Sodique, Tine. Calendula, &c.
  What medicaments are recommended for intro-
duction to fistula by syringing ?
  Ans. Tine. Calendula, Tine. Arnica, Tine, Cap-
sicum,  Phenol  Sodique, Laudanum,  Hamamelis,
Chloral Hydrate, Chloride  of Zinc, Sulphuric acid,
Carbolic acid, Iodoform, Chlorate of Potassa, Oil of
Cloves, Glycerin, &c.
  Which are used in full strength, and which diluted?
              Full Strength.
      Phenol Sodique.     Tine. Capsicum.
      Oil of Cloves.      Hamamelis.
      Glycerin.          Laudanum.
           Aromatic Sulphuric  Acid.
                 Diluted.
      Carbolic Acid.    Tine. Capsicum.
      Tine. Calendula,  Tine. Arnica,
      Phenol Sodique.  Sulphuric Acid.
      Iodoform.        Chloride of Zinc.
      Chloral Hydrate. Chlorate of Potassa.
  What is the strength of each dilutlion ? 
 
y 
ALVEOLAR  ABSCESS.
87
  Ans. Carbolic acid, 1 part to 25 or 50 of water,
    Tine. Capsicum,  1   „ to 10, 15 or 30
    Tine. Calendula,  „   „ „ 10 or 20
    Tine. Arnica,
    Phenol Sodique,
    Sulphuric acid,
    Chloride of zinc,
    Glycerin,
    Chloral Hydrate
   What  are the possibilities and  probabilities of
recurrence of abscess ?
   Ans.  The possibilities  are that it may  recur at
any time; the probabilities are that it will not recur
within a reasonable period.
   Upon  what  do these depend?
   Ans.  Age, sex, temperament,  occupation, mode
of life, physical condition, systemic drain, &c.
5	3)	15
10	r;	20
3	>5	6
5	JJ	15
3	55	5
5	53	10
 
APPENDIX.
               MISCELLANY.
  What are the essentials to be recognized in con-
nection with pulp extirpation ?
  Ans. Free openings, easy access to pulp cavities
and  canals, soothing  and cleansing  medication,
thorough, gentle manipulation, and the recognition
that more or less time  is required  for the restora-
tion of comparitive normality about the apex of the
root.
  Is it always possible to clean and fill to the very
apex of  roots ?
  Ans.  It is not.  Many  roots, from their  small
size, peculiar shape, position, &c, are accessible for
only a limited portion of their extent.
  What  are the  six considerations in connection
with pulp irritation from disease of the surrounding
parts ?
   Ans.  Salivary calculus, tartar, looseness of tooth,
abscess and atrophy or absorption of  either gum,
alveolar  process,  or  roots. 
 
 
MTSCELLANY.
89
  If deciduous first molars  are extracted between
the ages of five and seven years, what injury may
be  inflicted?
  Ans.  Mechanical injury to the  permanent  bi-
cuspid ; for at this time the  roots of the deciduous
molar  are but slightly  absorbed,  and  clasp  the
nearlv developed crown of the bicuspid.
  In what rare cases of irritation does the *' health
line " remain unchanged ?
   Ans.  Pulsating pulps, nodular calcification, api-
cal or  circumscribed  exostosis and circumscribed
necrosis.
   How is pulp irritation from loss of tooth sub-
stance distinguished from sensitive dentine ?
   Ans.  If pulp is irritated, the most tender spot is
directly over the  portion or portions of pulp most
nearly exposed;  if sensitive dentine, it  is usually
more on  one edge than in the central part of the
abrasion.
   What is the difference in the  character of  the
pain arising from  irritation  of the pulp from  loss
of  tooth substance by attrition, and that from sen-
sitive dentine?
   Ans. The pain from sensitive dentine is not pos-
itively  located unless  touched,  but gives a general
sense of uneasiness through the teeth, jaws, cheeks,
eye and adjacent  parts;  these symptoms  appear
gradually and continue for long  periods  of time, 
90
MISCELLANY.
exhibiting no paroxysms of severe suffering.  The
pain from irritated pulp is generally more decidedly
localized even  to  the affected  tooth; it  appears
quite suddenly, increasing in intensity day by day,
developing paroxyms of increasing  severity.  Hot
and  cold  applications cause  much  pain;  cooling
liquids relieve the irritation induced by hot drinks,
such as soup, coffee, tea, chocolate &c. while tepid
water  affords  equal relief  when   the  irritation
has  resulted from the contact  of  ice-cream,  ice-
water &c.
  What in this connection is an important diagnos-
tic between sensitive dentine and an almost exposed
pulp?
  Ans   The possible cessation of response  on the
part  of sensitive dentine after only one touch, and
the probable  continuation  of response on the part
of an  almost  exposed pulp after any number of
touches.
  What is usually the best method of remedying
irritation of the pulp from loss of tooth substance ?
  Ans.  The cutting away of the tooth, which an-
togonizes and abrades the one giving pain, together
with the judicious  selection of three or four not
unduly worn, articulating teeth, for the purpose of
making shallow cavities and introducing ordinary 
 
 
MISCELLANY.               91
crown or surface fillings, that further abrasion may
be precluded, or, at least, retarded.
  What condition is sometimes found analogous to
a loss of tooth structure by attrition, and eventu-
ating in the same symptoms ?
  Ans.  Sometimes  a marked clean cupping occurs
on the cutting edges, cusps and  articulating faces
of teeth.
  To what  is this ckie ?
   Ans.  It  is not  due entirely  to mastication,  but
may be regarded as one peculiar phase of dental
caries;  the exposed dentine being different in  ap-
pearance from  the  polished and  hardened surface
usually  resulting  from  the  wear  of  mastication.
The dentine  (in this cupping caries) seems  to be
softened, and  therefore yields more readily than
the enamel to the disintegrating influence  of mas-
tication ; in  consequence of this, the  interior  and
edges of  such cavities present a smooth, defined
and clean appearance.
  How is  this condition treated?
   Ans.  In the same manner as loss of tooth sub-
stance  by attrition.
  Upon what is fracture of the teeth dependent ?
  Ans.  Upon one  of four causes.
  Name them.
  Ans.  1st.  Impinging upon some hard substance
during mastication, such as bone, coal, shot, nut-
shells,  oyster-shell, metal fillings loosened and de- 
92              MISCELLANY.
tached by pressure  of  food, &c, or,   2nd.  Where
decay has largely progressed, leaving thin walls of
enamel which are easily broken by the pressure of
ordinary food, such as pop-corn, candy, bread-crust,
or even soft  bread.  3rd.  Fracture from  blows or
falls, or, 4th. (Very unusual)  fracture from con-
gestion of  the  pulp.   When this  occurs, there is
usually a sense of fulness in the tooth,  rapidly pass-
ing into extreme  tension  or pain,  or into  tense
numbness and growing uneasiness.
  Give some important points in relation to the
re-establishment of normality in diseased tissue.
  Ans. First. In proportion to the extent and sever-
ity of disease in connection with any tissue, is the
re-establishment of normality rendered impossible.
  Second. Slight irritation usually  permits of a re-
turn to comparative normality, but a decided irri-
tation renders such return less probable.
  Third. Slight inflammation sometimes permits of
the re-establishment of apparrent normality but it
much  more frequently gives decided evidence of
what is termed " weakness " of the part, by reason
of irritation, if not of recurrence of positive, though
slight, inflammation.
  Fourth.  Severe  inflammation  may  be  regarded,
practically, as a deviation so great as to preclude the
possibility of a return to absolute health on the part
of any organ or tissue  so affected.
  What  is meant by  " thoroughness" as under- 
 
 
MISCELLANY.
93
stood from the "New Departure"  standpoint?
   Thoroughness  means  tooth  saving  not  "tooth
filling'" exemption from pain, not "infliction;" gen-
tle yet thorough impact, not "forcible conformity;"
harmony, not golden jarring ;  resistence proportion-
ed to demand; " perfect adaptation " to the  require-
ments of the case, whether "tightness" or looseness;
comfortable service rather than "elegance  of finish."
   Under what circumstances is  "external irritation
by forcible withdrawal of pulp  " easily possible ?
   Ans. During removal of recently devitalized pulps,
particularly from teeth of Sanguo-lymphatic, Nervo-
lymphatic, or Bilio-lymphatic patients.
   Is it proper to place medicaments in teeth (which
have had peridental irritation from putrescent pulps)
immediately after giving relief  by drilling into pulp
cavities ?    Why ?
   Ans. It is not;  as increased  irritation, either by
permeation of  already irritated tissues,  or  by me-
chanically obstructing  the only avenue for the pas-
sage of existing effusions (by inspissation of contents
of  pulp cavities and canals) would follow.   Espe-
cially should medication on cotton pellets or twists
be  avoided.
   What is the one symptom  which  indicates very
reliably the complex pathological condition  of peri-
odontitis from inflammation of a  pulp?
   Ans. The peculiar duplex character  of the pain, 
91              MISCELLANY.
by which is added to the tenderness, upon pressure,
the throbbing and the sense of tooth elongation, a
decided alternate exacerbation and amelioration of
suffering.
  Is paroxysmal  suffering  or exacerbation con-
nected  with true  periodontitis?
  Ans.  Usually it is not; but when such combina-
tion  is present, a pulp is dying from peridental
irritation,  especially when between  paroxysms a
response to hot or cold  fluids is had.   This holds
good so far as single rooted teeth are concerned.
  Upon what do acute and chronic forms of peri-
odontitis depend ?
  Ans.  Upon temperament and physical condition.
All high grade temperaments (from first to third
grade)  are  liable  to the acute form, provided  the
system is not depressed.   Low grade temperaments
(such as Bilio-lymphatic) have chronic  form.
  What is the difference between the two forms ?
  Ans.  Time  of duration.   If lasting  from one to
three or five days, it is acute, after this it is called
chronic.
  What is the line of distinction between period-
ontitis  and alveolar abscess ?
  Ans.  As soon as one drop of pus forms, periodon-
titis  ends and abscess begins.
  What  medicaments are recommended for con-
trolling hemorrhage ?
  Ans.  Tine.  Erigeron Canadensis  is  used  where 
 
 
 
V
/ 
MISCELLANY.
95
patient is or  bilious type, dark hair, dark eyes, &c.
For  those with  light hair, fair skin, &c, use Tine.
Chenapodium Album.   Both are styptics and  hae-
mostatics.   Dose: gtts.  in. to v. once every  half
hour, or  gtt. i.  every ten  or  fifteen minutes until
effects are produced.
   When is Tine, of Iodine used in a tooth ?
   Ans.  In treatment of fungus gum or pulp, and
for  pain  obtunding  and devitalizing  purposes in
children's  teeth.
   What  is  the  treatment for induration of tooth
tissue ?
   Ans.  Nothing can be done.  Systemic treatment
is the only hope.
   What  is  the  cause of induration?
   Ans.  It appears to be due to calcification of  root
structure, and consequent exfoliation of the tooth.
   Under  what  three  heads is "excess  of filling
material" considered ?
   Ans.  First. On the articulating surface, bringing
all impact on one tooth.
   Second.   On any face of a tooth, where the  cav-
ity impinges on the cementum.
   Third.   Excess through apical foramen.
   Which  form  of  excess is  incurable ?
   Ans.  Excess through apical foramen, especial-
ly when canal has been solidly filled with foil, oxy-
chloride and cotton, gutta percha &c.
   What is the first indication for periodontitis from
putrescent pulp ? 
96
MISCELLANY.
  Ans.   Give relief by drilling vent hole, or in
some manner permitting the mephitic gas to escape.
  What  are three considerations under this head?
  Ans. First.  How  to drill vent hole with least
infliction to patient.
  Second. Where an opening into  the pulp  cham-
ber  can  be effected with  the least injury to the
tooth, and the best lookout for future considerations.
   Third.  Gaining a fair access to canals in order
to obtain the best results.
  Where are " relief holes " usually drilled ?
  Ans.  From the incisors to the  second bicuspids
at the necks  disto-buccally.
  On the  second bicuspids buccally.
  On the  molars mesio-buccally.
  How long has the drilling of vents been in practice ?
  Ans.   About  forty  years.
  What  is the result of drilling a vent ?
  Ans.  It  not only affords an avenue for the escape
of mephitic gas, but also permits the pericemental
membrane to relieve itself of exudations.
  What  is meant by " tiding over " a pulp ?
  Ans.  At times, in persons of low grade tempera-
mental attributes (especially in warm weather), the
system is in such weakened condition as not to have
sufficient strength to set up a flow of blood, power-
ful enough to destroy a pulp, even when arsenic is
applied for the purpose of devitalization.   The case
is then treated in such  manner as to give the great- 
 
 
A 11 S E N I C.
97
est amount of comfort until the system is'in proper
condition to respond to arsenic.
     "What are signs ?  What are symptoms ?
  Ans.   Signs are what Doctors  should  observe.
Symptoms are what patients feel and should describe.
                  Arsenic.
  What  time is  required for arsenical devitaliza-
tion  of the pulp?
  Ans.   There is no  relation  between time and
arsenical  action ; the time required is  governed en-
tirety by temperament and physical condition.
  Why is  it improper  to  apply arsenic to an in-
flamed pulp ?
  Ans. Because, on account of the full and distended
blood-vessels and retarded circulation, its dynamic
and  vital impression cannot be produced.
  What  is the effect of arsenic when  applied on
the surface of partially devitalized pulps ?
  Ans.   No effect whatever.
  What  effect is produced by arsenic  when applied
to a  dead pulp ?
  Ans.   No effect.
  Does the  presence of  the  arsenical  application
arevent decomposition of the pulp ?
  Ans.   It does not.
  If arsenic  is sealed in the pulp cavity of  a per-
fectly developed tooth, can it  pass through dentine
ind cementum?
  Ans.   It cannot. 
98        OXY-CHLORIDE  OF  ZINC.
  If arsenic, when applied to a tooth, passes through
the dentine and affects the pulp, why will it not
pass through dentine (when sealed in pulp cavity)
and affect the cementum ?
  Ans.  Because, the dentine  being dead, offers an
effectual barrier to its passage.
  How  soon after application of arsenic is it possi-
ble for alveolar abscess to  supervene ?
  Ans.  It  depends entirely upon  temperament,
physical condition, &c.   Generally from one month
to a year.
           Oxy-Chloride of Zinc.
  Does  Oxy-Chloride of Zinc possess the power of
mummifying pulps which  may die under it ?
  Ans.  It possesses no such power.
  Is  Oxy-Chloride  used  as a  permanent fillinsf
material ?
   Ans.  It is not, except in rare cases.
   Why?
   Ans.  Because it fails in two ways:  1st.  From
attrition;  2nd.   From solution or disintegration
at the cervical portion of the filling.
   What is it especially used for ?
   Ans.  As  a lining to cavities having thin,  frail
walls. 
 
 
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