Review of Dental Literature and Art. [Volume: 2, Issue: 7, February, 1861, pp. 385-400]

REVIEW OF DENTAL LITERATURE AND ART.

393

there may have been, where, at some point beneath the cavity, the nerve
has made a feeble effort to protect itself. If so, they have escaped my
observation; and I think I should have noticed them, as in excavating a
cavity, when I approach that point where anatomy says the nerve should
be, I have almost held my breath, lest an incautious cut should expose it;
and if, from accident or necessity, that point was reached, I have invariably found the nerve, or the fetid chamber where it died. From this, I
am persuaded, as well as from all the information I can derive from
others, if I except some few cases to be mentioned in another place, that
the efforts of the nerve to protect itself from caries are so slight and so
rare, in comparison to the numberless cases met with every year where
no effort has been made, that they scarcely arise to the dignity of an
exception.
"The question then arises, if caries is removed by thorough excavation,
the nerve is exposed and healthy, have we any known means to stimulate
that nerve to take care of itself, by depositing a septum of bone between
itself and the plug? Is the plug of itself a sufficient stimulant, as is the
grain of sand in the shell of the oyster; or must we resort to other
means? If so, what? Medication? What are the agents, or is rest
sufficient? Hitherto it has been supposed that the nerve was simply exposed, but not wounded. If wounded, would that complicate the case?
If so, how much? What would be the prognosis; or would that depend
upon the nature of the wound, whether it was a point, or a line, a simple
slit, leaving the edges of the periosteum in apposition, or whether there
was an actual loss of substance? If there is merely a slit, will it heal
kindly by first intention; and will that be just enough inflammation to
insure the necessary deposit? Or, if there is a loss of substance, will
that place heal and be restored? If so, how? By granulation? Then
there must be secretion, effusion. Where is that secretion to go, after the
tooth is thoroughly plugged; and what is to become of it, if it finds
lodgment? Will it putrefy, or be absorbed? Here a delicate question
arises. How much irritation or inflammation can we set up in the nerve,
incased as it is in a solid wall of bone, and not produce engorgement, or
gangrene? And provided there should be too much phlogiston, have we
any special antiphlogistics to reduce it?
" I have before remarked that I had seen cases where the nerve had
deposited dentine of repair, to protect itself from caries. A few words
will dispose of them, and show that they do not constitute an independent
class, but really belong to that class in which the nerve deposits dentine
of repair, to protect itself from the gradual wear of teeth in mastication.
They were, so far as I recollect, cases where, at some time, caries had been
active, but from some cause, generally from the removal of a tooth, where
the cavity was on the approximal surface, the smaller cavity in the remaining tooth ceased to increase, and the decay lay dormant for several
years. In plugging such teeth, I have often found secondary dentine,
and in some of them also calcific deposits. Now, the long time in which
caries has lain dormant in these teeth fulfills.all the conditions that exist
in the gradual wear of the teeth during mastication. It gives the nerve
time to protect itself and shows that the only thing necessary, so far as
we now know, to enable it to protect itself, by a secondary deposit of
dentine, is time, or the gradual loss of substance of the tooth during several years. The past summer I was plugging some teeth for a gentleman
of seventy years of age. While preparing the front approximal cavity
VOL. iI.-28.