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of any use for mastication, as it has no antagonist. On the right side, just as in upper, no molars are to be found. Mastication consequently performed by the anterior teeth, and the bicuspids on the right side. In this case it can be questioned whether the operating dentist has taken the second molars for the first, or if he has in any case extracted them, expecting that the third molars would replace them, an expectation that, as we have seen above, is not always fulfilled.
Statistical table showing the number of different teeth present at ages of 7 to 16 years. Where the first and second molars are present in about the like number the figures are underlined (compare same places on next table).
Shows the percentage in which the different teeth are decayed at the ages of 7 to 16 years. The figures in heavy type show the frequency of caries for the first and second molars at the ages when the first molar is present in like number as the second
Mr. W. B. PEARSALL drew the attention of the members to the supreme importance of the six-year-old molar, which he considered the sun of the solar system round which all the other teeth revolved. He thought efforts should be made to have the diagrams illustrating the paper reproduced, and the trouble caused by the wrongful extraction of the teeth put on record. Any man who studied anatomy and looked at the jaws of children must be confronted with the fact that ruthless extraction was not always the wisest course to pursue. He congratulated their Swedish guest on having enlightened the Association on a matter on which there had been great confusion, and hoped the paper would be the beginning of a great scientific and orderly way of investigating matters.
Mr. RUSHTON asked whether in the first instance the six-year-old teeth were extracted for regulation purposes, and secondly, whether the regulation was frequently carried out by any mechanical appliance.
Mr. FISHER said he had been particularly struck, in looking at the models, with the fact that the Swedish people were fast following on their heels. With regard to the extraction of the first molars, he did not think it had ever been held at the British Dental Association meetings that anyone would be willing to part with them for any purpose if they could be retained.
Mr. W. E. HARDING thought the extraction of the molars had been carried out at far too early a period. If the extraction had been necessitated by an abscess or pain it was not fair to put that forward as an illustration of the result of extracting the first molar with a view of permanent benefit to the mouth, because it had been done for a temporary reason. He held very strongly that the extraction of the first molar, the six-year-old molar, should never be undertaken except when one was compelled to extract on account of an abscess or something of that kind, until the second molar was absolutely in occlusion with its opponent on the other jaw. That practice should be carried out, and what Mr. Alfred Woodhouse called a splint put in the mouth. That was a very simple appliance to prevent the second molar from too rapidly filling the place that was occupied by the first molar, relief being obtained in the front of the mouth which would not otherwise occur. If the six-year-old molar was taken out too early, before the second molar had been erupted, a state worse than the first was obtained. If the extraction had not been made so early the result was very much better than the series of slides which had been exhibited.
Mr. W. HERN said he had been struck very forcibly with the effect, as shown on the screen, of the extraction of the six-year-old molar. It did not relieve to any serious extent the crowding of the anterior teeth. The models seemed to fix that point on one's mind rather more forcibly than before, and showed not only the bad results, or the mal-occlusions which resulted from the extraction of these teeth, but also emphasised the point of saving the six-yearold molar and extracting for the relief of the irregularity of the front teeth further forward. If the six-year-old molars had been saved and the first bicuspids removed, with a little mechanical help, or even without it, probably many of the bad results noted would have been lessened or avoided. He wished to accentuate the immense importance of delaying the extraction of the teeth till somewhat later than was usually done. He had seen cases which were complete failures from too early extraction of the first molar teeth; further, where these teeth are extracted for the relief of crowding in the incisor or bicuspid region a skeleton plate should be at once inserted to prevent the forward travelling of the second molar, or the space obtained by the extraction would be rapidly filled by the forward movement of the second molar. He did not wish the reader of the paper to go away with the impression that the dentists of this country wantonly sacrificed six-year-old teeth. Every year advances were made in the profession in the conservative treatment of teeth, and the possibilities of subsequent crowning must be weighed in our decisions when dealing with a regulation case. The liability to caries of the second molar was a point which could not be too carefully borne in mind, and the loss of the six-year-old molars, followed by the weakness of the twelve-year-old molars, might result in a mouth becoming lamentably crippled. He thought perhaps too much importance had been attributed to symmetrical extraction; it was of importance, but no hard and fast rule could be laid down. The later diagrams exhibited showed up to what an advancing age the teeth would re-arrange themselves; in fact, it seemed to him that nearly all through life the moulding effect of the lips and tongue and the mechanical effects of the bite manifested themselves.
Mr. BRUNTON thought the paper pointed to the importance of the revision of the text-books, which taught that the six-year-old molar was the most prone to decay.
Mr. BETTS thought that the paper emphasised one lesson, namely, that parents should be pressed to bring their children for inspection before they attain their six-year-old teeth. He once impressed upon a young mother to bring her first child to him, certainly by the time it was 7, for the purpose of inspecting the teeth. The child came to him at 63 years with toothache, with an exposed nerve in the six-year-old teeth, and three other lamentable decays. In the future he always advised them to bring their children at a much earlier date.
Mr. PIDGEON wished to accentuate the last speaker's remarks with regard to six-year-old molars. In his experience, very few parents knew when the first molar came. Most of them were under the impression that the first tooth in the second dentition was the front incisor, simply because the first incisor came first in the first set of teeth. He always made it a most important point in conversation with parents to impress upon them that the first tooth in the second series of dentition was the six-year-old molar; therefore, even if they neglected the first set of teeth-which he thought they should not do they should be taught to bring their children at 6.
Mr. FORBERG: Mr. President, ladies and gentlemen, I thank you for the kind interest you have shown in my paper, and will now try to answer the questions asked. One of them was whether, in the cases shown, regulating appliances were used? My answer is No.
One of the hypotheses of the symmetrical extraction theory is that by the operation room is gained, and that thus the crowding of the teeth will be helped spontaneously. As far as my experience goes this is a mistake. The anterior teeth remain, as I have shown, practically unchanged in their position. The molars, on the other hand, move forward, and occupy (sooner or later) the places of the extracted teeth. Besides, the normal size of the jaw is by no means unaffected by the operation in question. Mr. Fisher has shown that the jaws may become so small that there can be “crowding with only eleven teeth present!" Well, gentlemen, I think the cases Mr. Fisher has laid before us are very interesting, in so far that they show the results that often follow when we try to play the part of Providence and improve upon nature. We put in motion forces which are not under our control, and the result of which we cannot predetermine.
There have been several ways of "gaining room" proposed and tried— extraction, filing of teeth, V-shaped separations, and so forth. Well, I am in the habit of trying different methods in my own mouth, for about twenty-five years ago I had a V-shaped separation made between a second bicuspid and a first molar. I stood unpleasant wedging of food there for about three or four years, then I had two contour fillings made, and since that time feel considerably happier. The poor fellows whose mouths Mr. Fisher has shown have my sympathy. I feel truly sorry for them.
As I said in my paper, it is not my intention to advocate that the first molar ought never to be extracted; you cannot always follow general rules. We must study every case before we make a diagnosis and decide upon our treatment. Just as in the case of other teeth, so ought these to be removed if they are so badly decayed that neither filling nor crowning will preserve them, and especially if the tooth has been so early destroyed that the roots have not become sufficiently developed to be treated or to bear a crown.
Abscess has been mentioned. Well, I do not consider an abscess sufficient
reason to remove a tooth. I have even kept, treated and filled first molars, where there have been fistulas of long standing opening through the cheek.
Mr. Pearsall has spoken about "salting of teeth," as he puts it; in my paper I have recommended just such treatment.
Then nursing of the teeth has also been mentioned. Well, gentlemen, that is just what we ought to do. We ought to nurse these teeth as well as we can, and you will often find that after you have nursed such a tooth through that most dangerous period to which I have called attention, you have to reconsider your decision to extract it, the tooth having become so hard that you could treat and fill it permanently.
Yesterday I placed on the table some copies of a paper which I read last year at the Dental Congress in Paris. The statistics laid down there proves that the frequency of caries in the first molars increases about 9 per cent. every year till the twelfth year, after which time it remains almost stationary. We ought consequently to nurse the teeth through that dangerous period, and to educate our patients and the public as to the value of the six-year molar as a permanent tooth.
And again, as in my introduction, now in my closing remarks I appeal to you, gentlemen of the British Dental Association--who have shown such interest in the preservation of the teeth of the children, you who first of all took up the question of the investigation of school children's teeth, and thereby set us an example which we in other countries have followed, and who have carried the question of dental hygiene and the appointments of school dentists so far, that even a school dentists' society has here been formed-I appeal to you to influence the conditions, so that the children need not in the future be compelled to dispense with the teeth that ought to be their principal permanent
A Phase of Dental Practice.
BY WARWICK HELE, L.D.S., R.C.S.
THE plea for the highest possible excellence in each and every detail of practice is desirable, but is it practical? Granted that such an ideal standard should be kept in view, are we likely to attain to it?
"To do the best possible under existing circumstances" is far more likely to come within our attainment. An experience of over forty years of practice has brought conviction that no hard and fast. line can be laid down as the best practice, even in the simplest cases, and when ways and means come to be an integral part of the consideration, then the exhortation to do the best possible, under existing circumstances, applies with greater force, both for the benefit of the patient and the dentist.
The rapid development of mechanical appliances-aids to dental surgery-are a little apt to make the practitioner of to-day dependent upon the methods prescribed for their use, so much so that, given a certain operation to be performed, the latter-day dentist is at sea without the special paraphernalia he has grown accustomed to. This