In using it locally if you wished to begin with the same doses, it would be necessary to dilute one drop of Squibb’s oleate with three drops of bland oil for each drop of the mixture to contain 1
200 of a grain.
An application of this medicament would be more effective, I believe, in relieving the pain of an exposed or inflamed pulp than those remedies now in use. I can testify from personal experience of the frequent inefficacy of the local application of oil of cloves and chloroform, while the use of the stronger remedies, as ninety-five per cent. carbolic acid or pure creosote, can only be efficacious by more or less coagulating and therefore in so far destroying the nerve tissue and the pulp. And this I take it is always to be avoided when practicable. I hope therefore, that some of you will give this remedy a trial, and verify practically my suggestion.
Having relieved the pain by one way or another, what means do you adopt to stop the progress of the caries and restore the tooth as a useful member of the economy?
Now if our considerations as to the origin of caries were true, that it is a disease due to the agency of septic micro-organisms, the logical consequence is that successful treatment must be in the line of antiseptic treatment. I presume this will cause a smile at the presumption of an outsider venturing to enter on so practical a subject, and perhaps some one will mentally quote the line about “fools” rushing in where angels fear to tread. But it is possible that much of your practice may have been truly antiseptic, just as the wise surgeon’s has been, long before we knew the why and wherefore of what experience has now taught us to be true. We are all more or less like the hero of Moliére’s comedy, who was astonished to find when he arrived at middle age that he had been talking prose all his life without knowing it.
Now if we analyze your proceedings in the treatment of caries, and thus relieving the painful or inflamed pulp, let us see if they are not based on antiseptic principles, even though unconsciously employed.
First of all I take it you aim to remove all the carious material by means of your instruments, and the success of the operation is dependent on the thoroughness with which that is done. Does not that seem as if you were removing a true infective centre, and thus obviating the first condition favorable to the development of caries—the presence of micro-organisms.
Now let us see how you combat the second favoring condition, and that is the presence of a suitable pabulum; is not that done by the simple mechanical interposition of your filling between the diseased surface and the fluids in the mouth?
Again we found a certain degree of moisture needed, do you not scrupulously dry as well as clean out your cavity, and is not your filler non-absorbent as far as possible?
Fourthly. We found a certain degree of warmth was favorable; that is, of course, always present in the living body, and in choosing a good non-conductor of heat as your plugging material, it is with reference to the secondary effects of caries, the pain caused by thermal extremes, and not with special reference to the disease itself. Indeed, could we obtain a substance which would combine the resistance to organic and chemical action that gold does with the poorness of conducting power of gutta percha, it would be a great advance.
The presence of air in the decayed tooth is also prevented by the mechanical means; while lastly you substitute an artificial tissue to resist in place of the dentine and enamel that is gone.