Dr. Niles:—If it was irritating you would have inflammation.
Dr. Gillett:—A pulp will sometimes stand much irritation without showing evidence of inflammation. An inflamed pulp is not always painful. My experience with decalcified dentine under fillings has been gained chiefly from removing fillings which other dentists have inserted over such decalcified dentine, and I have seen many cases where the results were anything but satisfactory.
Dr. Niles:—I have had some experience in that line myself during the last thirty years, and I have generally found decalcified dentine under good fillings to be in as good condition as when it was left there. In most cases it was left there, not with any idea of conservative treatment, but because the dentist was too lazy to take it out. I do not believe that decalcified dentine, thoroughly cleansed and dried, and hermetically sealed, can do any harm whatever to a nerve, or create any irritating effect. I would not leave a sloppy piece of dentine in the bottom of a cavity, which could not be well dried; neither would I leave the cavity half-full of decay, because in that case I could not reasonably expect that there would be no irritation.
Dr. Eddy:—If my memory serves me right, Dr. Niles once read a paper before the American Academy of Dental Science, in which he stated that in those cases of decalcified dentine in the bottom of the cavity he invariably used arsenious acid, and treated them the same as he would an exposed pulp, and it went on record. Now, to-night, he seems to be advocating an entirely different method.
Dr. Niles:—I should like to see that statement. I have written a paper on the subject—you will find it probably in the Independent Practitioner—but I don't think you will find the statement there that I always destroy the nerve in cases where there is decalcified dentine at the bottom of the cavity. Of course, where I have inflammation in the pulp and the tooth is sore, I should destroy the pulp.
Dr. Briggs:—Rules have their exceptions, and when I make the statement that I do not believe in capping pulps, I still claim the privilege of having certain exceptions. It seems to me that in all the cases of actual exposure, the question of capping the pulp is merely one of expediency for the purpose of keeping the tooth along. You do not wish to destroy the pulp at that time, perhaps, because it is a young tooth; or perhaps you dread the trouble and inflammation which is likely to ensue from the use of arsenious acid at that time, or possibly the patient is going away. In those cases I have had no trouble in putting a dressing in, which has kept the tooth quiet for a long time, but I always expect that sooner or later I will have a dead pulp to attend to. In fact, the most of the pulps that I have capped to preserve, are pulps that are not exposed, but are protected by a thin layer of dentine, perhaps decalcified, but which I could easily make aseptic. Many cases of pulp stones are the result of putting a filling too near the pulp, which is irritating and causes a formation. In those cases I remove the irritant and put in a dressing. That dressing is made by mixing the oxide of zinc with an antiseptic which has some anæsthetic property—say some essential oil; then covering that with a thin layer of copper plate, and then putting a hard filling over that. There is always an uncertainty about it, and four, eight or even twelve years is not always time enough to prove the success of capping the pulp. It may be that after twelve years you find a pulp stone formed that will give all the trouble and exhibit all the symptoms of neuralgia. If your tooth is fully formed, it is better to get the pulp out of the way and to fill it properly, and have a good, healthy tooth. It has been said this evening that the office of the pulp is to form the tooth, and when the tooth has been fully formed its usefulness is, to a greater or less extent, over, and the tooth can do good service without it, and this opinion I agree with.
Perhaps right here would be a good place to mention something which I intended to speak of later on, under the head of "Incidents of Office Practice." We have, all of us, more or less trouble from applying arsenious acid, and I have lately found that where the pulp is exposed, I can, by wiping a 20 per cent. solution of cocaine over the surface, inject without pain a twenty per cent. solution of cocaine, and after a few moments remove the pulp entirely, also without pain. My brother and myself have operated several times on such cases lately with satisfaction to ourselves and our patients. I say several cases, because we have disposed of some old cases which had resisted the arsenious acid and had been hanging along waiting for "something to turn up."
Dr. Gillett:—Dr. Briggs' remarks concerning injecting cocaine solution, and removing pulps in this way, brought to my mind that the chief use that I make of cocaine is in connection with arsenious acid, when I am going to destroy a pulp. My method is to moisten the end of an instrument, and pick up with it some of the cocaine crystals, making a pellet the size of two or three pinheads, and seal it in with the arsenious acid. I find it very helpful in controlling the pain in connection with such application.
PRESENTATION OF SPECIMENS.