Dr. Reilly:—I reached my conclusions while wiping out the cavity with the forceps and cotton, and I thought then, and it is my feelings now, that decay had not gone on in that cavity at all. I think it is possible for such a condition of affairs to exist; I think that things stand still in such a condition. I had a case the day before yesterday which was treated some ten years ago, and on removing the filling I found the pulp canals filled with cotton. There was no odor at all—perhaps the cotton was slightly discolored, but the cavity was in apparently the same condition in which it had been left; and it seems to me that if a tooth would remain in that condition with cotton, why wouldn't it be preserved under gutta-percha in just the same condition? I don't know why the gentleman should conclude that it would decay? What leads him to think that it would decay?
Dr. Smith:—I don't know that it is so, but I have read somewhere that in decayed dentine there exists "pesky little bugs," and if a cavity is stopped up and these micrococci, or bacteria, cannot get at the oxygen which comes to a cavity from the outside, they will work in to the dentine and decalcify the tooth substance in the search for that food which they live on. It is not my theory, but I read it somewhere, and in my practice I either kill the bugs or take them out.
Dr. Reilly:—That theory may be all right, but it does not work out in my practice. The experience that I had with this young man has been repeated over and over. I do not excavate carious dentine as far as it can be, and I don't think that theory will work out in all cases. If bacteria are there after the cavity has been thoroughly cleansed and tightly stopped, they must find an early death in some way.
Dr. Niles:—I am very glad to hear Dr. Reilly speak as he does. It is perfectly consistent with the accepted theory of decay. Decay does not progress where moisture and oxygen are excluded; therefore a cavity thoroughly dried out and hermetically sealed is good treatment and sound in theory. Nature has formed a covering to the nerve, and although nothing but the matrix of that covering may remain, I would not tear it away if an attempt is to be made to save the nerve. I would retain it with its odontoblastic connections with the pulp. I believe it is the only reasonable theoretical and practical course to follow. Let the nerve alone; nature has provided a covering, why should it be torn away? If there is any irritation, it is very easily removed. In my opinion, a pulp is never inflamed to an extent that needs treatment when it is free from soreness by percussion. If there is inflammation at all in the pulp there will be periosteal disturbance to give warning; but if the periodental membrane is not inflamed, it may be concluded that the pulp is free from irritation; provided, of course, it has never been painful or previously inflamed.
Dr. Reilly:—I would like to relate my experience with cases of this kind which have been right under my eye and care for some two and one-half years. When I first began to fill my babies' teeth, I made it a point that they were not going to be frightened. The eldest is six years old, and has been under treatment for nearly three years, and during that time she has never experienced any pain in the chair, and she will come to my office any time with confidence,—in fact she seems to like it. Her teeth are very poor, and in the first ten cavities I did not do any excavating whatever. I practically did not remove any decayed dentine. I simply stuck in fillings wherever there was a cavity and depended entirely on dryness, and I have had good results from it, with no dead pulp up to the present time. After the first dressing of cement I endeavor to remove carious dentine.
Dr. Taft:—Did you use a rubber dam?
Dr. Reilly:—No, sir. The teeth were too short and it could not be done without causing some pain. My principal object was to avoid pain.
Dr. Werner:—Did you put in any gutta-percha fillings?
Dr. Reilly:—Yes, sir. I put in some at first; then cement, and I have used copper amalgam in crown cavities.
Dr. Gillett:—It seems to me that the case which Dr. Reilly has related is merely the ordinary temporizing with children's teeth, the object being to save them pain, and the case would be somewhat different with adult teeth in which there has been a large amount of decay, and when we expect to do permanent work. I do not see how that decayed, diseased matrix can be non-irritating, as Dr. Niles claims.