There are a great many different agents used for the bleaching of the teeth, but I will not consume any more of your valuable time, as I find that my paper is already quite lengthy.
Dr. W. N. Morrison is very proud of his son, who carried off the gold medal at the Missouri Dental College.
INCIDENTS AND ACCIDENTS OF OFFICE PRACTICE.[1]
BY H. H. KEITH, D.D.S., ST. LOUIS.
There are no more useful lessons than those contained in the incidents and accidents of office practice. If we do not communicate the knowledge gained, the event is limited to the individual. Not alone should we record our successes and apparent achievements, that we may stimulate the energy of the younger members of our profession, but as faithfully read the story of our failures.
In 1877, “S. A.,” a boy of ten years of age was presented with a mesial corner of the right superior central incisor broken in such a manner that the pulp, though not exposed, had died. The tooth was much discolored, abscessed, and very loose. A few days treatment sufficed to bring the tooth into a comfortable condition, when the boy's visits ceased. Some time elapsed: when he next came the tooth was elongated fully one-half the length of crown. The gums presented a most unfavorable appearance, and extraction was at once pronounced as the only proper treatment. At the earnest solicitation of the boy's mother this was deferred until the next day, and such treatment applied as the case seemed to indicate. Just here it may be well to say that exploration showed the root was not fully developed, the canal being quite large and funnel-shaped. So marked was the improvement the next day, that all idea of extraction was dismissed, and the root was finally filled with gutta-percha. A temporary filling of oxyphosphate was then introduced, and allowed to remain for two years. Then the contour was restored with gold. This filling was again replaced six years later with another of gold, which remained to within a short time ago, when a porcelain faced crown took its place. Deferring extraction to the next day has saved this tooth for thirteen years so far, with prospects of many years valuable service yet.
The second case is that of a right inferior second molar, a root filled with gutta-percha being allowed to fill pulp chamber, on which was placed a gold filling, February 20, 1878. In 1887 the gentleman complained of discomfort, but it was sometime before the cause was ascertained. The tooth had been split through its antero-posterior length, the fracture terminating nine-sixteenths of an inch below the point of the crown, on the lingual side. The fractured piece was removed, and the gum pressed out by means of gutta-percha, to give a better view of the remaining root. It was finally decided to attempt to restore the tooth by means of a band and crown. The fragment removed was used as a model from which dies were made, on which was struck a piece representing the lost part, having extensions sufficiently long to encircle the remains of the crown. This, when adjusted in position, was partly filled up on the inside with gutta-percha. A porcelain cusp crown was then arranged to antagonize the superior teeth. For a time everything seemed to go well. A little inflammation about the margin of the gum upon the lingual side instead of decreasing, suddenly grew worse, and pus was formed at the point of division of the roots. This finally yielded to treatment, and now the tooth is apparently in perfect health. The cause of this fracture appears to have been elasticity of the gutta-percha, under the pressure of the gold filling.
Case 3:—E. W., a boy of nineteen years of age, had broken a point off the right superior central incisor, not quite exposing the nerve, which subsequently died. The accident occurred some five years previous to his visit to me. The canal was found large and funnel-shaped, and was treated in the following manner: The lower portion was enlarged a trifle more than the diameter at the apex. A piece of lead was then introduced, and found to extend to the top by accurate measurement. In order to produce an accurate adaptation of the lead to the surrounding walls at the apex, the lead was reduced with fine sandpaper, the scratches of the sand being parallel to the long axis of the tooth. When the lead was forced into place, these fine ridges could be seen to be flattened when examined with a magnifying glass, and an adjustment continued in this manner, until the lead was found to close the apical foramen completely. The filling was completed with gutta-percha, and a porcelain crown was mounted upon the root. This has remained in a favorable condition up to the present time, about a year and a half.