DISCUSSION OF DR. PARR'S PAPER:
IMMEDIATE SEPARATION OF THE TEETH. [5]
Dr. J. G. Palmer:—I do not think I have anything in particular to say concerning rapid separation. I have the separator that Dr. Parr describes in his paper, and I also have a set of Dr. Perry's. The latter is, perhaps, the most nearly universal in its application of any. I cannot say that I agree with the doctor in regard to separating so rapidly in all cases: in some cases it is probably advisable to do it, but I would rather follow the lead of Dr. Faught's paper, and go a little slow. I think going slowly in separating teeth is as useful as it is in some other cases cited in the paper.
Dr. C. A. Meeker:—I have used Dr. Parr's separator for three years, and prefer it to any of the others that I have used.
Dr. Pinney:—Sometimes, when you have a couple of nice little teeth to fill, and you want to get to work and get it done, and you know your patient is going to be so nervous for a week after, if you put rubber between the teeth, that you cannot treat them, it is a great pleasure then to put on your separator and slowly and gradually get those teeth apart, with just one little squeal, so that you can put in your two fillings. This little instrument is one of the best things we have: it does not work in all cases, but it will in nearly all. It should be used carefully; you should not move the teeth in a second, or in a minute, but work carefully with it and you will be surprised to find how many times you can use a separator to advantage. Patients are better satisfied to have their teeth separated in this way, than be compelled to wear rubber or tape, or something of that kind, in the mouth—they say those things tire them.
Dr. Faught:—I would like to say a word about that one little squeal that has been spoken of. I do not think we dentists quite appreciate what that one little squeal means. I think it means a feeling of fear and distrust in our patients for years afterwards. I believe also that when we avoid giving pain to a patient, or stop a slight pain, it pays in our dealings with the patient in future years. They never forget it, but we forget them because we see so many of them, but each patient remembers that somewhere in his or her mouth there was one little turn given that caused intense pain, and they remember that you did it. It always causes a feeling of dread when they sit in our chairs again for another operation. I believe that we should, more than we do, try to protect our patients from every annoyance, however slight, even at the expense of a little more time. There are many cases where the use of mechanical separators is unobjectionable, and when it facilitates such work. I wish to call your attention to a method of separating not my own. It is the use of a little piece of tape. I hand a little piece of tape to my patient with instructions how to use it, and in the course of four or five days the necessary space is obtained, and quite painlessly. When they return the mouth is in condition for the operation, and they do not seem to have hurt themselves, and you have not hurt them.
Dr. Pinney:—After you have gained the beautiful space by the use of tape or some other appliance, do you not have sore teeth. One good point in favor of the separator is, that after you get these teeth separated, the pressure of the instrument is so positive that there is no pain whatever during the operation of filling. But when you separate them with tape, the teeth are loose and sore, and a little pressure upon them causes intense pain. The pain is so much greater than that which caused the little squeal in immediate separation, that almost any one would prefer the squeal.
Dr. Faught:—I would suggest the use of a little cocaine just before the operation.
Dr. Jennison:—I do not like to disagree with my friend, Dr. Parr, because he has given us a great many valuable things. I have not had much experience in the use of separators, for the reason that I cannot get my patients to submit to them. The moment I put one on and begin to turn the screw, the patient exclaims: “Take that off; I cannot stand it,” and I am compelled to take it off. Then in the use of the separator, I am always fearful of crushing the enamel, which I think is a very important thing to consider. With regard to separating immediately, it would be very desirable if we could do it under all conditions, or even under some conditions. I would like to see a separator of some sort for immediate use, and I have no doubt Dr. Parr can devise one, having plates not made of metal, and which will do the work of separating teeth without possible injury to the enamel. That, to my mind, is a very important point, and I agree with the essayist of the evening most emphatically that it is best to go slow in this matter. It has been said that teeth are sometimes so situated that you cannot pass anything through between them for the purpose of gaining space. When I find teeth in that condition, I introduce a piece of rubber dam; you can always get that in, and leave it there until the next day, and then I am usually able to put in something else, such as a bit of wood, which I generally use. I take time to separate. After I get space, if the teeth are still sensitive, I fill with gutta-percha and leave it for a few days, and soon the soreness is all gone.
Dr. J. A. Osmun:—I think it always best to be perfectly frank with your patients. If you must inflict pain, tell them you are going to do it, and why, but that you will be as careful as you possibly can, and you will find they will stand an immense amount of pain, and be satisfied when you are through.
Dr. Addleburg:—If you speak to the patients and tell them the operations will be painful, but that by inflicting pain you can serve them better, in most cases they will allow you to apply the separator, and they say it is much preferable to the old way of separating. I have some patients who will not allow me to use it, but most of them prefer the separator. Ladies especially say they prefer it, rather than have something between their teeth, when going into society; they would rather bear the little pain than the annoyance. I have used it for two years. After the teeth are separated I find them to be obtunded to such an extent that there is little pain in excavating and filling.