International Abstracts



The Surgical Principles Governing all Dental Practice

At the Country Week Convention of the New South Wales Branch of the Australian Dental Association, Dr. E. Stanley Wallace, pleaded for a more intense surgical outlook in the practice of dentistry. A denture may be mechanically perfect, and esthetically leave nothing to be desired, and yet be surgically wrong in that it may have results to the detriment of any or all of the hard or soft tissues of the mouth or of parts more remote. This is frequently seen in cases of pyorrhea, where the disease is not recognized by the prosthetist, and an unsuitable type of restoration is provided. Orthodontist also sometimes fall into a similar error, in spite of the conscientious care with which they carry out their procedures. General practitioners, too, will do well to remember that a tooth is but a unit of the mouth, the mouth a unit off the alimentary system, the alimentary system but a unit of the whole body. Dr. Wallace states without hesitation that at times the retention of a devitalized tooth is sufficiently important to justify a certain measure of risk, but such a decision throws an increasing responsibility upon the operator to carry out each step of the operation in such a way that the risk of subsequent infection is reduced to a minimum he knows, however, of no method of treatment by which the risk can be eliminated entirely. Shell crowns he would reject, but allows dowelcrowns “a grudging place” because of esthetic considerations. In designing dentures it would be better to show much more respect than usual for the marginal tissues round standing teeth.

A special plea is made for the early detection of pyorrhea and other gingival troubles, no matter how early the stage of inflammation of infection appears to be. The paper concludes with a summary of the surgical principles which should govern all dental practice. These are as follows:–

(1)    Carefully consider every case, not only as to present needs, but as to future possibilities.

(2)    Plan the operation or operations with a view to leaving the patient surgically better off than before anything was done.

(3)    Carry the operation out with such care that there is no menace to neighboring tissues.

(4)    Complete the operation so as to leave no source of irritation, and let there be no undue delay in completing.

(5)    Have regard to asepsis as far as is necessary for the protection of the patient, but avoid making a fetish and thus inviting ridicule.


Most patients, the essayist adds, greatly appreciate a little sound advice as to how to care for and maintain what has already been done, and how to avoid a recurrence of similar conditions in the future.






Acid Base Balance and Pyorrhea


Acid base balance should be maintained as near to the neutral point as possible. Unfortunately there is no easy method of determining the blood pH. As dentists, however, we are not really concerned about an acidosis or an alkalosis, but rather with a possible tendency to an acidosis or to an alkalosis. The body mechanism is always endeavoring to maintain this balance, and it is usually slightly on the alkaline side of pH7. These tendencies to deviate from this point (says Dr. Reginald Krauss in The Dental Journal of Australia) concern us in our pyorrhea treatment.


In diabetes and nephritis there is a shift to the acid side, and we should find if these conditions exist before we commence treatment, for in both diabetic and nephritic conditions there is a clinical picture of pyorrhea.


Whenever the blood pH rises above or falls below its neutral point, we are liable to get this clinical picture of pyorrhea. To get an accurate diagnosis of a causative factor is extremely difficult, and as it is useless to treat this lesion locally only, we should by a process of elimination clear the field of as many possible causes as we can, for instance, acetone bodies appear in the urine in large amounts in diabetics with acidosis, and Dr. Krauss has found acetone bodies in 76 per cent of pyorrhea patients, yet only 3 per cent had a diabetic history.


We need to separate the ketosis of diabetes from that which is not diabetic. In nephritis the inability properly to excrete waste products of nitrogen metabolism is one of the difficulties which arise as a result of renal disease. The chlorides and phosphates is one of the most important methods of getting rid of an excess of acid.


When the phosphate excretion is impaired, bringing about an increase in acid phosphate of the blood and tissues, the result is a swing to the acid side, but we can eliminate this as a causative factor by the renal test and by calculating the quantity of chlorides and phosphates.


This is easily done. This type of acidosis will also give the typical clinical picture of pyorrhea. The essayist points out that smoking, where carbon monoxide is inhaled (as much as 3 per cent in the case of cigarettes, and even in the case of cigars up to 7 per cent), carbon monoxide combining with and fixing part of the haemoglobin—preventing it from transporting its full measure of oxygen to the tissues—would indirectly bring about alkalinity, with tartar deposits.