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He could not controvert Mr. Bennett's statement or add anything to it, but he was not quite sure how far he intended to go with regard to the question of calcospherites. He took it that Mr. Bennett did not deny the chemical composition of them. It appeared to him that in cutting layers of dentine, particularly in bicuspid teeth, there was a distinct line between the two portions, a dark line, and therefore, although he was not quite clear about it, it might be that the specimen did show definitely two layers. It was perhaps more normal than abnormal.
Mr. DOLAMORE knew nothing at all as to why teeth erupted, but as Mr. Colyer had laid down a distinction between eruption and uncovering, perhaps Mr. Colyer had some clear idea as to why teeth erupted in the first instance.
Mr. COLVER said he could not go into that question. He held personal views on the subject, and could not help feeling that, to a great extent, there was a good deal in the development of the root. There was some process by which teeth came up, which was not uncovering. But his point was that the teeth at a late age do not move, while they did move when erupting in the ordinary way.
Mr. SPOKES mentioned a case he had seen within the last few months, in a man now aged 69, who had worn an artificial denture in the upper jaw for about four years. During that time the tip of the left upper canine made its appearance, or the alveolus was absorbed underneath the denture. He decided to extract the canine and found it a very difficult matter. There was a fully completed root with a little turned-up apex, and the direction of the root was right back behind where the bicuspids had presumably been.
Dr. BAKER said he did not raise the question of teeth erupting. He had at one time thought of going into the question of eruption very fully, but he saw it was quite impossible. With regard to inflammation round the bicuspid there was a discharge of pus, and he hardly thought it could be looked upon as being inflammatory in character.
Mr. COLYER said he did not say there was no inflammation there, because he took it that the capsule might get uncovered and become infected. He had seen one tooth-an impacted molar-in which there had been no productive inflammation. He was inclined to think there were vascular changes similar to the change obtained in blood vessels.
Dr. BAKER was afraid his information did not go any further with regard to calcospherites than what he had stated in his paper. With regard to the two layers of dentine he only used the words "two layers" as an easy method of describing what he meant. He did not mean to say there were two distinct layers, but he thought it was possible to trace one portion from another.
Casualty during Extraction.
COMMUNICATION MADE AT THE ANNUAL MEETING OF THE LEEDS AND DISTRICT BRANCH, APRIL 15, 1902.
By T. S. CARTER L.D.S.ENG.
CONSULTING DENTAL SURGEON TO THE GENERAL INFIRMARY, LEEDS.
It is with a strong conviction that, although I am admitting an error of judgment in the course I pursued, it is only fair in the interest of our profession that our failures should be recorded in addition to our successes. Imbued with this feeling I will briefly describe a casualty which occurred, which serves to remind us of the dangers to which we are all liable during extraction. All surgeons agree that when fracture of the superior maxillary bone occurs it is well to leave the fractured portions in situ, no matter how loose they are, as owing to the greater vascularity of the upper bones of the face union is hastened and necrosis rarely follows. Although I knew
this full well, yet at the critical moment I was persuaded by the anæsthetist to break this rule, with a result which might have been disastrous.
The patient, Miss F. H., aged about 25, required many extractions. She had an abnormally prominent V-shaped upper jaw, the central incisors being one inch in advance of the lower teeth, giving her the appearance of having a greatly receding chin. (Models shown taken before treatment.) The patient was anesthetised and I removed all lower teeth required, and then the upper ones, commencing on the patient's extreme left and finishing on the right side. In attempting to remove the right upper wisdom tooth the usual force was used in an outward direction and the tooth seemed to be coming readily. Having my left thumb, however, on the process on the outer side,
and my index finger on the inner, I felt, to my surprise, that not only was the tooth coming, but with it a large portion of alveolus. I applied all the digital pressure possible to retain the tuberosity in situ while I dislodged the tooth, but without avail. Having desisted and explained the position to the administrator, I found he strongly urged removal of the loose portion.
Regaining hold, and at the same time forcibly supporting with finger and thumb the adjacent parts, the tooth and attachment came away without stripping the gum. There was not much hæmorrhage or uncomfortable symptoms of any kind, but the medical attendant watched the case for a few days.
On examination of the specimen I found I had brought away the tuberosity, which formed a portion of the floor of the antrum and held the divergent fangs of what I believe to be an abnormal wisdom tooth. It will be noticed that the alveolar plates are as thin as wafer paper, and if held up to the light you can see through them. Owing to the fangs being so strongly attached to this thin bone it required less force to break through the tuberosity than to dislodge the tooth. The line of fracture naturally followed in the line of least resistance, and the result was therefore inevitable.
On examination of the patient's mouth two months later (the date of second models) I found to my surprise that there had been no ill results, but that all looked normal and healthy, the opening into the antrum having closed, and beyond a local flatness there was nothing to indicate that anything unusual had occurred.
Two Cases of Bullet Wound in the Mouth.
BY L. C. BROUGHTON-HEAD, L.D.S.ENG.
THE following cases showing the results of bullet wounds in the face may be of interest, as until recently, dental surgeons have had few opportunities of noting the effects of high velocity projectiles in the region of the teeth. The facts are briefly as follows.
In the first case, the patient was a sergeant in the Inniskilling Fusiliers, and was present with his regiment at the battle of Colenso. While lying in a trench he was struck obliquely by a bullet, the course of which is to some extent indicated in the accompanying photographs. (In fig. I the models are purposely not in articulation.) The bullet apparently first impinged on the lower right lateral incisor, cleaving off the greater part of the labial surface of the tooth. Passing upwards, the upper central incisors were similarly injured, and it then appears to have followed the course of the dental arch from
right to left-taking a somewhat downward and backward direction. From the canines to the lower left third molar the teeth were fractured at the level of the gum margin-the upper molars escaping-and the bullet eventually came out at the angle of the jaw just beyond the wisdom tooth. (Figs. 2 and 3.)
The upper left lateral and lower central incisors seem to have escaped unscathed, which may perhaps be accounted for by a previous irregularity in the arch. The patient states that prior to the wound all his teeth were present on the left side, both in the upper and lower jaws, though some of the back teeth were carious. When I saw him on March 15, two years and three months after the wound, his mouth was in a very unhealthy state, the gums congested, tender and hypertrophied, the fractured surfaces of the teeth discoloured and presenting an unsightly appearance; in most of them the pulp chamber had evidently been exposed, and the pulps necrosed, while numerous sinuses discharging pus were present over the apices of the teeth in both upper and lower jaws. The patient complained of considerable pain, chiefly in the region of the lower wisdom tooth. Beneath the scar of the aperture of exit of the bullet the outer plate of the mandible could be felt thickened and somewhat tender on pressure.
The history of the man subsequent to receiving the wound is instructive. He was sent down to Cape Town and kept in hospital for three weeks. The only treatment adopted seems to have been directed towards the healing of the external wound at the angle of the jaw. He stated, however, that the surgeon in charge removed a loose piece of tooth with a pair of scissors (? artery forceps).
The man returned to the front and fought with Buller's column through Pieters Hill into Ladysmith, where he contracted enteric fever and was invalided home, and ultimately discharged from the army. He states that from the time of receiving the wound he suffered continuous and intense neuralgia involving all the teeth on the left side, which was aggravated by the exposure to campaigning, and that he has never been free from pain since. It is quite conceivable that this severe neuralgia, combined with the privations he experienced, aided materially in so lowering his vitality as to make him fall an easy victim to enteric.
In the second case which came under my notice the effects of the bullet were confined to the maxilla. The man, a Highlander, was wounded at Magersfontein by a bullet entering the right cheek just above the crown of the second lower molar, which passed around the upper jaw and fractured the crowns of the upper teeth from the second right molar to the left canine; this tooth was left standing, and the bullet apparently expended its force in fracturing the root of the tooth longitudinally high up in its socket. The aperture of exit