Stopping or Filling.—This is one of the most important and delicate operations the dentist has to perform. The first step to be taken in filling or "stuffing" a tooth, as it is sometimes called, is to clear away all decayed and decaying substance. For this purpose, a number of slender digging and excavating steel instruments, termed "exca vators," are required. With these the hollow in the tooth is scooped out and thoroughly cleaned. If pain be occasioned by this process, the operation of " destroying the nerve," as it is called, had better at once be resorted to. This is performed in several ways. Where the tooth is single-fanged, as in front-teeth, the nerve, or more correctly the pulp, may be bored out by passing a slender broach, or square and pointed steel wire, up into the central cavity of the tooth, with a slight rotary motion. When this cannot be done, however, the best plan is to destroy the nerve by some caustic applica tion, such as arsenious acid, chloride of zinc, carbolic acid, etc., carefully applied. The method of doing this is to clean the tooth thoroughly out, and then to apply a little of the caustic on a pellet of cotton wool about the size of a barley-pickle or a grain of rice —pressing it well into the decayed hollow, and then filling it over with soft bees-wax. This should be allowed to remain there for six, eight, or twelve hours; it may at the end of that time be taken out, and the stopping proceeded with.
The cavity being properly shaped and cleaned out until its walls are of sound and hard tooth-bone, it is to be well dried, and the plug of stopping-material inserted: Various substances are employed for this purpose, and the mode of using each is some what different. For temporary stoppings, pure gutta-percha is a serviceable material, A quantity sufficient to fill the cavity, and somewhat more, is to be gently warmed over a spirit-lamp—not in hot water—and when quite plastic, is to be firmly pressed with a blunt-pointed or "plugger," into all the interstices of the hollow in the tooth—more and more being pressed in, until the surface of the plug so formed is on a level with the surface of the tooth, when all the superfluous portion should be removed, and the solid plug smoothly finished.
A set of stoppings known as osteo-plastic fillings have recently been introduced, and are inserted into the tooth in a soft condition, where they harden in the course of a few minutes.
Another variety of stopping-material consists of amalgams of different kinds. Many absurd statements have been made regarding the evil effects of amalgam stoppings, but the only real disadvantage attending their use is shrinkage, and that many of them get black in the mouth, and discolor the tooth, while some that do not get black are friable, and crumble away in a short space of time. They are to be readily obtained, made up, and under various names. None of them seem very much superior to what is known as the platinum and gold alloy amalgam. The amalgam, then, whatever one it may be, is to be rubbed up with mercury to a firm, plastic consistence, and carefully introduced into the dried cavity in the same way as described regarding the gutta-percha, and is to be finished off in precisely a similar manner.
Gold-stopping is an operation of a much more complicated and difficult description. The materials used here are either gold-foil—that is, thick gold-leaf—or the peculiar substance, or rather the peculiar form in which gold exists, known as sponge-gold, or "pellets" of gold made up in a soft spongy condition of various sizes ready for use. In stopping a tooth with gold, even more care is necessary in preparing the cavity than what has been already inculcated. Its shape must now be particularly taken into account, and the nearer it approaches to a cylindrical form the better. The gold-foil, when it is employed, should be cut into strips, their breadth varying according to cir cumstances. Various modes of packing the gold are adopted, the chief object being that the foil shall lie in the cavity in such a way that its edges, and not its flat surfaces, shall be presented at the surface of the plug; otherwise the plug will be liable to injury by layers of it peeling off. In stopping with Sponge, or other forms of gold, the pre paratory steps are the same as for foil-stopping; it is, however, necessary to be more careful that no moisture be allowed to interfere with the operation.
The surface of a gold plug, formed in either of these ways, should be well consoli dated by hard pressure with a blunt plugger, or lightly hammered with a suitable mallet, and the superfluous portion being removed, it ought to be burnished until it assume a brilliant metallic lustre.
Ectraction.—This is the principal surgical operation falling to the dentist. It is most commonly demanded in consequence of what is termed toothache—a disorder which, however, is not always one and the same in its nature. This want of uniformity in the nature of those diseased states to which teeth are subject, and which are compre hensively denominated toothache, leads to the conflicting results obtained from those applications recommended for its cure. These remedies are numerous, and of various characters. To explain their mode of action, and the particular symptoms indicating the selection of each one in preference to another, would here be out of place. Their intention, in general, is either to destroy the nervous fibers existing in a tooth, or to narcotize and render them insensible. Among those acting in the former manner are such as creosote, arsenious acid, carbolic acid, pepsine, chloride of zinc, nitrate of silver, alum, tannin, etc.; among those acting in the latter mode arc chloroform, laudanum, ether, spirit of camphor, etc. There is no necessity for describing the method of their application, further than to remark, that in all cases the decayed cavity should previously be well cleaned out, otherwise the remedy employed may be altogether prevented from reaching the spot where it is intended to act.