Dr. Eddy:—I would just like to mention that hydronapthol may be fearlessly used in all cavities without causing any escharotic action.
With regard to the spongy condition that Dr. Clapp speaks of, it must be thoroughly dried out with a hot air syringe. If it cannot be thoroughly dried, it is better to remove it.
Dr. Werner:—In regard to the question asked by Dr. Clapp, I should say that it would depend on the amount of sensibility yet left in the partly decalcified leathery part of the dentine spoken of. If that still has sensibility, I should believe in treating it not so much escharotically as antiseptically. Again I wish to assert my opinion, that after the foramen was closed and the tooth well developed, it would not be a great calamity for a tooth if the pulp were devitalized and the pulp cavity well filled. I am much of the opinion that a tooth in a devitalized condition resists better than a live tooth the attacks of caries. This is perhaps an extraordinary statement to make, and I know is contrary to the teachings of good authority, yet the many pulpless filled teeth I see free from decay, while their living neighbors do decay, leads me to this opinion.
Dr. Reilly:—I would like to state a little experience that might cover Dr. Clapp's case partly. Some time ago a young lad came to my chair whose father had great difficulty in getting to go to a dentist's office. There were two enormous labial cavities in the central incisors. I did not attempt to excavate at all. I had been cautioned before that it would be hazardous to try it, as he was a fearful little fellow to get along with, and his teeth were very sensitive. I simply wiped out the cavities as well as I could, getting them dry without causing pain, and filled them with gutta-percha. He came again a few weeks ago, and the dentine was all there, much harder, as I remember it, than it was on the first visit. I removed it the last time and filled them without any trouble. Now, I do not think it is any risk to leave decalcified dentine in the bottom of a cavity, providing it is tightly sealed; but, as Dr. Eddy says, I should depend more on the drying process than on the use of antiseptics.
Dr. Werner:—Dr. Reilly brought up a very important point. Much less excavation than is generally done is necessary for the absolute control of decay, and that all excavation that gives pain is, in one sense, unscientific. It is only necessary, from a mechanical standpoint, to retain metallic fillings, but I think some day we will have a plastic filling that will require very little excavation—simply the wiping out of the cavity and the thorough removal of the actual decayed portion, leaving all that has sensation—treating the cavity antiseptically, and when in an aseptic condition, fill it with this plastic filling. The surgery of to-day is very much modified. Muscles and bone are not cut away as they were forty, or even twenty years ago. To-day ivory is inserted and made useful in the place of bone, and why should not tooth substance that has sensation be preserved? We have to cut it away simply because we have to shape the cavities to retain the metallic fillings; that is, we treat mechanically instead of therapeutically. In the near future I hope we shall know better than to cut away that which should be saved. I have a very hard little patient whose parents wish me to save his teeth but not to give him pain, and the little fellow will not stand any excavation. His teeth are being preserved at the only disadvantage of having to have a great many temporary fillings.
Dr. Smith:—I do not quite understand the logic of Dr. Reilly's conclusions. I may misunderstand him. He tells of a case coming to him where he did not see fit to excavate; he placed in that cavity some gutta-percha; the gutta-percha after being in a while was removed and the cavity excavated. Now, how did he know the depth of decay at the first sitting? and not knowing the depth of the cavity, how did he know that decay had not gone on in that cavity?
Dr. Reilly:—I think I was cautious about that statement. I said, to all appearances, it had not decayed. Of course, I could not tell absolutely, only from my experience in excavating I judged it was about the same as when I first saw it, perhaps a little harder. If we were not able to judge something of the depth of decayed dentine, we would be in constant danger of exposing the pulp. If you cannot tell by the feeling of your excavator when you are near the pulp, I would like to know what you are going to do in those cases where you cannot see the bottom of the cavity?
Dr. Smith:—Yes; but you say you did not use your excavator in this case.