The Work of the National Society of Denture Prosthetists and Its Relation to the American Dental Association*

The Work of the National Society of Denture Prosthetists and Its Relation to the American Dental Association*

O w e n — T h e W o r k o f the N ational Society of D en tu re Prosthetists these facts and theories and the material that he himself has accumulate...

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O w e n — T h e W o r k o f the N ational Society of D en tu re Prosthetists

these facts and theories and the material that he himself has accumulated. From such an analysis, it is clear that much that goes under the name of re­ search is not research. Particularly is this true of those who approach a prob­ lem with a preconceived notion and merely assemble facts and data to verify that notion. Probably there is no such a thing as pure dental research. M any o f the dis­ coveries that have particularly benefited dentistry have been made in fields en­ tirely outside dentistry, such as the dis­ covery of the nature and application of the roentgen ra y ; and it is equally true that investigation in dental fields is in­ evitably of significance in other fields. In order to gain some idea of the v o l­ ume of overflow into the dental field from outside sources, the articles listed in the cumulative index published by the American M edical Association have been studied. In one such list, and this is typical of a total o f 326 articles listed,

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236 came from sources that may be denominated dental and ninety from medical sources. O f the latter, quite naturally, the preponderance was found in the fields o f anatomy, eye, ear, nose and throat and focal infection. Another method of approach was made through the chemical abstracts, and this has been analyzed by one of us (H . C. B .) recently in the Dental Cosmos. T h e overflow here largely concerns diet, vitamins and drugs such as germicides and antiseptics, and the volume is surprisingly large. Since the recent consolidation of the Cumulative Index and the Index M edicus, a large number o f dental journals are included in the subject matter in­ dexed. N ot only does this supply a bird’s-eye view of the total volume of work done, but it also supplies a useful key to the dental literature on any sub­ ject. I f to this is added the material in chemical abstracts, the approach to literature on dental research is made somewhat easier.

THE WORK OF THE NATIONAL SOCIETY OF DENTURE PROSTHETISTS AND ITS RELATION TO THE AMERICAN DENTAL ASSOCIATION* By ELBERT BRITTEN OWEN, D.D.S., St. Louis, Mo. H E consideration that prompted the writing o f this paper, which presents the individual point o f view o f a member o f both the National Society o f Denture Prosthetists and the

T

*R ea d b e fo re the Section on Full D en tu re P rosth esis at the Seventieth A n n u a l Session o f the A m e r ic a n D en tal A sso cia tio n , M in n e ­ a p olis, M in n ., A u g . 23, 192S.

Jour. A. D. A., January, 1929

American Dental Association, is four­ fold in character. T h e points to be considered are: 1. Is interest in the subject o f full denture construction waning? 2. Is denture prosthesis being over­ specialized ? 3. Is there an undercurrent of dissatisfaction in the profession with the

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T h e Journal o f the Am erican D en ta l Association

progress that has been work ?

made

in

this

full maxillomandibular case. This time, at the fees any o f us command, should 4. W h at has the National Society not make such a difference as to prevent any one able to pay a fee at all from of Denture Prosthetists to do with receiving service. these questions? T o the first of these questions, I will answer that reports have been received indicating a lack o f interest in some lo­ calities, while from other sections come reports of continued and renewed in­ terest. W ith the idea o f analyzing the situation to determine the point o f view o f those showing a lack o f interest in the subject of full denture construction, inquiries were made, and it was found that there was a general feeling among members of the profession that the tech­ nics offered today are too complicated to be practical in a general practice; that they are too time-consuming fo r the av­ erage fe e ; that there is no agreement among those prominent in the w ork as to what is the best technic now advo­ cated, and no agreement as to what is the best articulating instrument. T o the second question, the answer may be made that denture construction is not being overspecialized. Just what is meant by overspecialization was learned by contact with some w h o made the assertion, as follow s: T h e subject, theoretically and practically, becomes so complicated and time-consuming that only those devoting their, entire time to denture construction have time to prac­ tice it, and because o f this thousands o f patients not able to pay specialists fees are being deprived o f the most scientific denture service. T his claim cannot be substantiated because the most time-consuming technic known today w ould not, after a little practice by the operator, add more than a few hours to the total time now consumed in constructing a

A s to the next question, there surely is an undercurrent o f dissatisfaction with the progress made in this subject. Those o f this opinion feel that there is still too much dissension among the many advo­ cates of technics, and that the much de­ sired standardization o f technic is sadly lacking. A nd this, they feel, is an un­ necessary condition, considering the number of able men working on the sub­ ject ; giving rise to the thought that per­ sonal ambition centering around the manufacture and sale o f articulators is playing a great part in retarding prog­ ress ; that men for selfish reasons will not yield a point for harmony and scien­ tific advancement. A further discussion o f these consid­ erations w ill be brought out in the next phase o f this paper, which deals with the National Society o f Denture Pros­ thetists ; its relation to these thoughts just brought o u t; and its relation to the American Dental Association and the general profession. T e n years ago, the National Society o f Denture Prosthetists was organized by a small group o f interested men who met in Chicago during the annual ses­ sion of the National Dental Association in 1918. It was organized as a research society, its primary intention being to conduct extensive research w ork at its meetings. It soon developed that the amount o f research work that could be done at the meetings was lim ited; there­ fore, the society was soon converted into a clearing house for the work each in­ dividual had done in his own office. T he

O w e n — T h e W o r k of the N ational Society of D en tu re Prosthetists

men meet each year, and pool their ideas and experiences, and a discussion fo l­ lows. T h a t these discussions are healthy may be vouched for by any outsider who has attended any of these sessions. One advantage o f an organization o f this kind with rather a small membership is that the members become so w ell ac­ quainted that a straightforward expres­ sion of views, even though heated, may be indulged in without the unpleasant­ ness o f personalities entering into it. M en in the society who are often of di­ rectly opposite views on scientific mat­ ters, and their arguments on the floor of the meetings often o f the most heated variety, are the best of friends. D is­ cussions of this kind have sometimes, when heard by outsiders, given rise to the rumor thaf the society gives all its time to contention, but such an idea is entirely erroneous. In the earlier years o f the existence of the society, there was scarcely a point in the technic o f scientific denture con­ struction on which there was whole­ hearted agreement. M any members were in a haze, because inexperienced in the much discussed points. T oday, through study, experience, discussions and demonstrations, many disputed points have been solved to the satisfac­ tion and agreement o f the entire society. As one example of this, only a few years ago the principle of adaptability, or the establishment of conditions peculiar to each individual on an instrument, and the building o f dentures to harmonize with these conditions, was neither ac­ cepted nor appreciated by a very large number. T oday, this principle is al­ most universally accepted, and technics are devised and instruments built with this in view. Lack o f time prevents enumerating many other examples.

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T h e purposes o f the society have been much misunderstood, and many expec­ tations on ihe part o f the profession have not materialized, for the simple reason that they have not been within the scope of the purposes o f the society. For instance, we have many times been asked such questions as: W h en are you men going to tell us what articulator is best, what technic you are going to adopt, what impression material is best? W hen are you going to standardize technic, etc., etc. ? Answers to these questions will never be forthcom ing from the National So­ ciety o f Denture Prosthetists as long as it is constituted as it is at the present time. T h e society is neither judge nor jury for the profession. It is not a self­ constituted authority to interpret prin­ ciples, instruments and materials for the profession, and such authority has never been granted to any one by the Am eri­ can Dental Association. Because the society has never given out such information, it has been ac­ cused o f being close-mouthed and re­ luctant about disclosing its findings. T o this, I may answer, if an answer is neces­ sary, that practically every member o f the society is drawn on heavily in the matter o f time for attendance at meet­ ings, where he gives freely o f his knowl­ edge and experience, much o f which has been gained through his association with his fellow members o f'th e National So­ ciety of Denture Prosthetists. A nd this must of necessity be the extent o f dis­ semination through that body, since the society is only a pooling place for ideas, where they may be freely discussed. It cannot act as judge, and therefore, it cannot put out information with its own official stamp of approval. Its individ­ ual members may give out all the infor­

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T h e Journal of the Am erican D en ta l Association

mation they wish as individuals, and the society encourages such action on the part o f its members. Y o u hear much of standardization with reference to technic and principles. Principles may be and have been to a great extent standardized, but technic cannot and should not be standardized. W here standardization begins, progress stops. H ad we standardized the technic of building dentures five years ago and considered our progress to that time as at an end, we would have been in much the same position as motor car builders had they stopped improvements on cars five years ago. W h en a thing, regard­ less o f what it is, is not perfect, we have no right to consider it good enough and to stop trying to improve it. Fixing an authoritative standard for denture construction at the present time would be a great mistake. W e must continue to make progress from time to time. Various men w ill continue to improve technic, and technics w ill continue to differ in their application, and men in the profession everywhere w ill have to judge for themselves which o f the tech­ nics appeal most to their own powers of application. T h a t the various technics advocated for the construction o f dentures seem complicated and difficult o f application has given rise to the contention that this branch has been overspecialized, and a loss o f interest on the part o f the pro­ fession has been the result. I f we recog­ nize that conditions peculiar to the in­ dividual exist; and if we recognize the necessity o f building dentures in har­ mony with these individual conditions, it must o f necessity require a technic embracing several steps, more or less time-consuming. T h a t these technics are

too complicated to be mastered is out o f the question. A ny dentist with the ability to make an inlay or a jacket crow n or a good edentulous impression is able to carry out even the most com­ plicated technic that has been advocated; this, of course, with a little experience. Any technic seems complicated that has never been tried, but a little effort to master them renders all technics simple. Naturally, these methods are more time-consuming. Anything done more thoroughly and more accurately, any­ thing better fitted to the individual re­ quirements of the patient, w ill require more time than less scientific procedures. But this should not cause lack o f inter­ est in a subject, but renewed interest. T h e National Society o f Denture Prosthetists w ill continue to strive, as it has in the past, to further perfect den­ ture construction, and at the same time simplify the procedures as far as they can be simplified without loss o f effi­ ciency. In this task, we welcome any help that may come from those who are not members o f this organization ; and, in this connection, permit me to say that this society recognizes many men of outstanding ability who are not members. W h ile this prosthetic society was not organized by authority o f the American Dental Association, nor does it have the official sanction o f that body, we recog­ nize the American Dental Association as our parent organization; require membership in it as a qualification for membership; hold our meetings at the same place and at a time when practi­ cally our entire membership can attend the Association meeting. W e cooperate freely in the programs o f the parent body, thereby giving to the dental pro­

O w e n — T h e W o r k o f the N ational Society of D en tu re Prosthetists

fession for their approval such material o f value as has been presented to our society, and practically at the same time. T h e National Society of Denture Pros­ thetists pledges its continued support to and cooperation with the parent body, and further pledges its efforts toward simplification consistent with efficiency. T hrou gh its individual members, it pledges the fullest measure of dissem­ ination of such knowledge as may be disclosed at its meetings. C O N C L U S IO N

U ntil the American Dental Associa­ tion authorizes some person or group of persons to interpret officially principles, technics, and instruments for the pro­ fession, such interpretation cannot be forthcoming. Surely this society cannot assume self-constituted authority in such matters. D IS C U S S IO N

C . N . Joh nson, C h ica g o , III.: T h is p ap er o f D r. O w e n ’ s is a s tra ig h tfo r w a r d state­ m ent o f the con d ition s w h ich to d a y exist in the fu ll denture situation. H e asks the qu es­ t io n : “ Is interest in the su bject o f fu ll d en ­ ture construction w a n in g ? ” T h is brin g s up a con sid e ra tio n that co n fro n ts us in e v e ry departm en t o f d entistry. W e find that there are w a v e s o f interest in the v a r io u s subjects that sw eep the p ro fe ssio n p e rio d ic a lly , and w h en one o f these w a v e s is in o p e ra tio n , our literatu re is filled w ith articles o n that p a r ­ ticu la r topic. F ull denture w o r k is n o d i f ­ fe re n t in this resp ect fr o m oth er subjects, and, d u rin g recent y ears, w e h a v e seen m ore p a p ers on that to p ic than had a p p e a re d p r e ­ v io u s ly in a d eca d e. I f the in terest is w a n ­ ing, it is o n ly fo llo w in g the n a tu ra l course o f events in such m atters. W h o ca n p red ict w h a t w ill be the next fu r o r ? D r . O w en asks i f denture prosth esis is b e in g o v e r s p e ­ c ia liz e d . T h e sam e an sw er m a y be g iv e n to this that w o u ld be g iv e n to any o th er out­ sta n d in g d epartm en t o f d entistry. O f the d esira b ility , even the necessity, o f sp e cia l­ iza tion in dentistry, there can be n o question. S p ecia liza tio n has d e v e lo p e d the v a r io u s d e ­

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partm ents in a w a y that n e v e r could h a v e been a p p roa ch ed w ith ou t it. T h e sum total o f the effects o f sp ecia liza tion has been m ost ben eficial, and it has' b ecom e such an in tegra l p art o f ou r p ro fe ssio n a l p rog ress that there is no argum ent as to its d esira bility. But ev e ry th in g g o o d ca n be ov e rd o n e , and there is a w id e sp re a d fe e lin g , w h ich seems to me ju stified, that sp ecia liza tion has been o v e r ­ done in dentistry. W h e th e r o r not fu ll d en ­ ture w o r k has been sp ecia lized too m uch, I can n ot say, but I sh ould lam ent the d a y that this se rv ice ev er becom es so intricate and com p licated that it ca n n ot be p e rfo rm e d ac­ ce p ta b ly by the rank and file o f the p r o fe s ­ sion. T h e sam e th in g is true o f dentistry that is true o f m ed icin e— there has g r o w n up a ten d en cy to sp ecia lize too m uch in both p rofe ssion s, and the m ost useful service that has been ad m in istered b y these p rofession s in the p a st is th reaten ed w ith extin ction i f present tendencies continue to p re v a il. T h e r e is no question th at the g en era l p ra ctition er, as represen ted b y the fa m ily p h ysician and fa m ily dentist, has been instrum ental in b r in g in g g rea ter c o m fo r t to the hum an fa m ­ ily than an y oth er class o f p rofession a l m an, and this is said w ith a fu ll rea liza tion o f the m a rv e lou s a d v a n ce s m ad e in the m a n a g e­ m ent o f d isease b y specialists. T h is is not the p la ce to discu ss in d eta il this m atter o f sp ecia liza tion , but it m a y be said in p assin g that there is no m ore d a n g e r o f o v e r sp e c ia l­ iz in g in fu ll denture w o r k than in any other. It is a m atter that w ill ev en tu a lly be r e g u ­ lated b y the in e x ora b le la w o f su pply and d em a n d . D r. O w e n has re fe r re d to “ an un­ d ercu rren t o f d issa tisfa ction in the p r o fe s ­ sion w ith the' p ro g r e ss that has been m ade in this w o r k .” N o on e questions the sin ­ ce rity o f p u rpose o f the m en m ost prom inen t in fu ll denture con stru ction , but there has been an un qu estion ed d isap poin tm en t on the p art o f the p ro fe ssio n in the apparent lack o f sta n d a rd iza tio n o f this w o r k b y the le a d ­ ers in this sp ecia lty . A t least, it has seem ed that there w a s such a lack o f agreem en t that it has been c on fu sin g . P ossib ly this is m ore ap p aren t than real, and also p ossib ly i f it is real, it is u n a v o id a b le . It m a y be that stand ­ a r d iza tion is p e cu lia r ly difficult in this sp e­ cialty, and yet sta n d a rd iza tion has been a ch iev ed to a g r e a te r d eg ree in oth er d e p a rt­ ments o f our w o r k , in op e ra tiv e dentistry, fo r instance, In this, there is no d isposition fo r the p ot to call the kettle bla ck, but this at least m a y be said that i f a tooth needs to be

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T h e Journal of the Am erican D en ta l Association

filled, there is a cle a re r co n ce p tio n on the p a rt o f the rank and file as to h o w it should be d on e than there is as to the m ost a ccept­ able m eans o f in sertin g a fu ll denture. A n d there is a c o n v ictio n on the p a rt o f m any that it m igh t be p ossible fo r ou r le a d e rs in this w o r k to g et closer togeth er than they are. W e con fid en tly h op e that this m a y be consu m m ated b e fo r e v e r y lo n g to the co m ­ plete satisfa ction o f all. D r. O w en has raised the qu estion as to the relation o f the N a ­ tional S ociety o f D en tu re P rosthetists to these v a riou s con sid era tion s. I am not sufficiently fa m ilia r w ith the w o rk o f this o rg a n iz a tio n to m ake any pertinen t com m ent e x cep t th is: I k n ow so m an y o f these m en p e rso n a lly that I h a v e un bou nded con fid en ce in their earnestness and their ability, and I h a v e not the slightest doubt o f their ultim ate solution o f all their p rob lem s. I f there has been som e heated discu ssion , as D r. O w e n has in ti­ m ated, it is on ly becau se m en o f real c o n ­ v ictio n can n ot be expected to a r r iv e at a com m on basis o f agreem ent, and can n ot make

real p ro g ress w ith ou t a fra n k ven tila tion o f their v a r y in g op in ion s. Som etim es, an a p ­ paren t d isag reem en t is o n ly an earnest effort to find the truth, and w e m ust n ot m ake too b ig a b u g -a -b o o o f a little honest c o n tro ­ v e rsy . I h a v e n oth in g bu t the best o f w ish es fo r this society, and I trust that it w ill co n ­ tinue to fu n ction w ith unabated v ig o r . I w o u ld con sid er it a real d etrim en t to d en ­ tistry i f it sh ould e v e r b ecom e in a ctiv e. W e need all the o r g a n iz e d effort that w e can h a v e in den tistry to m ake it a d v a n ce as it should, and it is the m ost na tu ra l th in g in the w o r ld fo r m en w h o are interested in the sam e line o f effort to g et togeth er w ith a com m on p u rp ose and study the p rob lem s that c o n fr o n t them in th eir d a ily w ork . little

danger

that there

w ill

be

T h e r e is too

m any

societies in the dental p rofe ssio n as lo n g as e v e r y society has a real m ission and is d o in g a real w o rk , and these requirem ents seem to be

am p ly

m et b y

the

N a tion a l

S ociety

of

D en tu re Prosthetists.

THE PULPLESS TOOTH, ITS PATHOLOGY AND CON­ SERVATION; A NEW METHOD AND TECHNIC OF FILLING ROOT CANALS* By J. P. BUCKLEY, PH.G., D.D.S., F.A.C.D., Hollywood, Calif. T might appear on first thought that reading a paper on the pulpless tooth before the Section on Partial Denture Prosthesis was inappropriate ; but to those who have read and studied the published proceedings of the Section for the past few years, and thereby learned the breadth of your vision in the construction of your restorations, no subject it w ould seem to me is o f greater significance. Therefore, I am happy to discuss with you men the pulpless tooth,

I

*R ea d b e fo re the Section on P a rtia l D e n ­ ture P rosth esis at the S eventieth A n n u al Session o f the A m e r ic a n D en tal A sso cia tio n , M in n e a p o lis, M in n ., A u g . 21, 1928.

Jour. A. D. A., January, IQSQ

its pathology and conservation, which includes the treatment of the case and the filling o f the root canal. In an article read before the American Dental Association in Dallas, Texas, in 1924, I discussed in detail the subject of bone, its pathology and regeneration. Other writers in recent years have also discussed bone from various points o f view ; and, while this phase o f my sub­ ject is of prime importance, I need only at this time to review briefly what has been published before. A microscopic study of the structure of bone shows that the framework is composed of lamellae, or strands o f con­