[.REPRINTED FROM THE DENTAL COSMOS, OCTOBER, 1878.] 
COMBINATION AND THERAPEUTIC ACTION 
OF SOME FILLING-MATERIALS. 
BY D. D. SMITH, M.D., D.D.S. 
(Read before the American Dental Association, August 9th, 1878.) 
Who has not mentally asked the question, as ho has taxed himself 
and his patient to almost complete exhaustion in some dental opera- 
tion of unusual magnitude or length, Is there not some way either 
to prevent this destruction of tissue or to restore these organs when 
attacked, unattended by the severe mental and physical strain upon 
the operator, and the shrinking, dread, and suffering to the patient 
which the present general practice and teaching involves ? 
Is the popular impression true that generation after generation 
the teeth of civilization are degenerating, and their power of resisting 
decay lessening? and shall dentistry still persist in averting the evil 
by the use of one remedy, mechanically applied, in all cases and in 
all conditions ? 
Is there no consolation other than this that the profession can 
offer to the tens of thousands who have never shared its blessings, 
and to many others suffering abuse from burring-engines, dental 
mallets, rubber dams, and other appliances, who are in doubt if it 
confers a blessing or a curse? 
Has not the present aspect of dentistry a near parallel in the prac- 
tice of general medicine of a few years ago, when calomel was of al- 
most universal application ? Every age, temperament, and condition 
felt its power for good or evil. Whatever the trouble, cerebral, tho- 
racic, or abdominal, local or general, calomel as a remedy had its advo- 
cates. A generous and earnest spirit in medical science, aiming to 
relieve suffering and prolong human life, searching for cause and ob- 
serving effect, broke the bounds of established usage and teaching; 
tried other means and remedies, until now, with the truly educated, 
mercury in any and all its forms is but an adjunct in general practice. 
Medicine is not so narrow as to withhold its hands from remedies 
of merit, because, forsooth, they are not hoary with age and use. 2 
Do not the broken arches and the edentulous mouths, continually 
presenting, plainly testify that dentistry as now taught and practiced 
is unable to cope with the diseased conditions of human teeth ? 
If the profession would avert this evil, observation must be more 
extended and accurate; new remedies must be sought and applied, 
investigation by experiment made popular, and the employment of 
other than mere mechanical remedies encouraged. 
The deductions from the teaching of all our text-books, from peri- 
odicals and society discussions, point to the use of one filling-material 
only in a given cavity—and that efficient in proportion as it is me- 
chanically manipulated—for the treatment of all carious conditions 
and for the restoration of teeth. 
If gold is recommended, the inference, if not the positive teaching, 
is that the filling, to be honestly and efficiently made, must be all of 
gold; if tin is the material, the cavity must be filled entirely with 
tin; and so also of amalgams, gutta-percha, and oxychloride of zinc*. 
The exception to this is in some more recent and advanced teachings 
on the use of gutta-percha, tin, lacto-phosphate and the oxychloride 
cements as coverings for exposed pulps; and different materials for 
use in roots, whatever may be adopted to complete the filling. It is 
not too much to say that any consideration or discussion of other 
filling-materials than gold, of their composition or methods of use, 
of their behavior in varied conditions of the oral cavity, or of their 
distinctive properties, has been evaded or frowned upon as too ele- 
mentary and unimportant to engage the attention of writers or 
speakers. The desire to be known only as a “ first-class operator” 
has held timid ones chained almost exclusively to the mechanical use 
of one material, and caused the loss to dental science of many an 
otherwise earnest investigator. 
To inquire if some two or more of the present filling-materials can- 
not be conjointly used in the same cavity for better preservation and 
greater comfort to the tooth ; also to inquire if there may not be some 
hitherto unsuspected therapeutic action in dental oxychloride of zinc 
preparations, are the special objects of this paper. 
That fillings fail because of lack of adaptation to the walls of cavi- 
ties is a fact generally believed and admitted, and that gold is the 
most difficult material to perfectly adapt in many cases is also known 
and admitted. That the oxychloride of zinc cements are among the 
best, if not the best, preservatives in cavities of decay is a truth which 
will become as fully admitted when it is as well understood. If 
decay has ever been known to commence anew under an oxychloride 
of zinc filling when in place, the attention of the writer has never 
been called to the fact. 
Chloride of zinc locally applied is recognized as among the most 3 
efficient agents known for promoting healthy granulations, as “in 
addition to its escharotic properties it appears to exercise a greater 
influence over the vital action of neighboring parts” than most other 
caustics ; the separation of its eschar leaving healthy and vigorous 
granulations. It is equally efficient as an antiseptic and a disinfectant. 
As an application to chronically inflamed and suppurating gums at 
the festooned margins, after the removal of tartar, it probably has 
no equal. This liquid, meeting so fully the indications for an antiseptic 
and a stimulant to the production of healthy tissue in a cavity of 
decay, mixed with the various preparations of oxide of zinc, forms a 
close and seemingly impervious union with the walls of cavities. 
There are good reasons for the belief that these cements when 
properly manipulated not only exclude moisture, but that they do for 
diseased dental tissue what chloride of zinc does for more vascular 
tissue, viz., stimulate the production of healthy structure in the parts 
with which they are brought in immediate contact and in the near 
surroundings. 
Illustration: Ten years ago a cavity of decay was filled in a left 
superior sixth-year molar with oxychloride of zinc and gold. The 
decay was deep-seated and involved the whole mesial face of the 
tooth. A portion of softened dentine was left covering the almost 
exposed pulp, and the oxychloride placed directly upon it. Enough 
of this cement was cut away to allow for the introduction of a gold 
filling, to protect the walls of the cavity and the oxychloride. The 
tooth was of a character to decay readily and rapidly, but the 
only object had in view in filling the cavity in the manner described 
was the better protection of the pulp, by interposing a non-conductor 
between it and the gold. Something more than six years after, it 
was deemed advisable to remove this filling for the purpose of gaining 
access to a small cavity in the distal face of the second bicuspid, 
which had been forced backward by occlusion until it rested in the 
concavity of the finished surface of the gold filling. The conditions 
were such that the removal of this filling permitted access to the 
cavity in the bicuspid without cutting or wedging, hence the adoption 
of the plan. Other fillings made entirely of gold and introduced about 
the same time in other teeth in this mouth had failed, and had been 
replaced in the mean time. 
The dentine under the gold and oxychloride in question had under- 
gone a decided transformation, changing from soft to hard and dense 
structure, seemingly capable of resisting decay without further pro- 
tection. This exhibition of the beneficial action (as it seemed) of the 
oxychloride of zinc made a profound impression. And as its cautious 
use in all classes of cavities from that time to the present has given 
correspondingly good results, the most favorable conclusions have 4 
been formed for the practice of lining all cavities with an oxychloride 
cement, whatever the external filling is to be. 
In many cases time can be saved in filling, the certainty of the 
operation increased, and the tooth rendered more comfortable to the 
patient; and further, thousands of pulps which under the all-gold 
system must be sacrificed or capped but to die under the filling, can 
by this method be comfortably and permanently saved. 
The antiseptic and stimulating action of the chloride of zinc is of 
a most beneficial character, inducing in many cases better organiza- 
tion of the tissues in the living parts to which it is applied. 
The manipulations in their simplest form consist in excavating a 
given cavity in the usual way and then filling entirely with some one of 
the best oxychloride of zinc cements,—under the rubber dam if prac- 
ticable. Having been allowed to set and harden for a few minutes 
enough of the cement is cut away or excavated to form a cavity for 
securely introducing a gold surface filling. By this means the cavity 
can be nearly filled, or merely lined with the cement, and it kept from 
disintegration by a filling of gold. The color of the dentine is thus 
preserved, the pulp isolated from thermal shocks, and the preservation 
of the tooth more certainly secured. 
In ordinary crown cavities, and in many cases of deep-seated caries 
in approximate cavities, this manner of procedure simplifies and 
shortens the operation of filling, but in small or shallow cavities com- 
plicates it. The cavity may be of such a nature as to render the 
conjunction impracticable. When such cases occur, the cavity can be 
filled entirely with gold, tin, or any other filling material in the usual 
way. In deep-seated crown and other cavities where under-cuts exist, 
if the enamel is strong, it need not be cut away, for when the decay 
is removed and the cement carefully and securely packed in its place, 
it forms a support when hard equivalent to true dentine. A cavity 
cut in it to a depth a little greater than the thickness of the enamel 
reduces the final filling with gold to an operation of the simplest 
character, as this new cavity has a hard, firm base of cement, and a 
boundary of cement and tooth-material, or of the latter alone. 
It may well be inquired if there are not some objections to the use 
of the oxychloride cements in the manner proposed. There is one 
objection, and it is believed to be the only one worthy of mention. 
It causes pain in the tooth immediately on application, varying in 
degree and duration with the extent of the decay and the character 
of the tooth. The sharpest and most prolonged pain is usually ex- 
perienced in young or soft teeth, and its duration is from three to 
fifteen, and rarely to thirty, or even sixty minutes. The pain is 
greatly lessened or entirely obviated by dextrous and intelligent 
manipulation, which will follow a study of its peculiarities and its 5 
continued use.* Its extensive application for the past two years in 
all classes of teeth and cavities, as a covering for recently-exposed 
pulps and in hyperesthetic conditions of the dentine, has failed to de- 
velop an uncontrollable or even a markedly obstinate case of odon- 
talgia, 
Exposed pulps may be first protected with lacto-phosphate and a 
Weston cap, with an oxide of zinc pad, with gutta-percha, or in any 
manner which seems most desirable, and the cement placed over the 
capping used. The oxide of zinc pad is made by mixing the powder 
of any oxychloride cement with creasote or oil of cloves, using but a 
very small quantity of either liquid. By patting this mixture with 
a spatula it can be worked into a mass aptly termed a pad. This can 
be used as a covering applied directly to the pulp, or to prevent pain 
in deep-seated caries. It is unquestionable that the therajDeutic action 
of the oxychloride is much diminished, if not completely arrested, by 
a covering of gutta-percha over the pulp, while the oxide of zinc pad 
modifies but does not prevent its action, and for this reason it is es- 
teemed, and has proved in practice a better and safer capping for 
pulps than gutta-percha. 
That the action of the chloride of zinc is not wholly interrupted 
by the pad is evident in the fact that the powder of which the pad is 
made becomes in a short time consolidated and almost homogeneous 
with the oxychloride of zinc used to cover it. 
To recapitulate, we find the advantages of the oxychlorides as 
linings or as basal fillings, to consist in tbe saving of time; perfect 
apposition of filling-material with the walls of the cavities; solid base 
and actual support to frail walls; secure anchorage for metallic fill- 
ings ; ready adaptation in places difficult or impossible of access with 
gold; no discoloration of the material itself, and a preventive of dis- 
coloration in dentine ; comfort, especially to highly-organized teeth ; 
a stimulant to the production of healthy tissue, and the most effectual 
preservative known in dentistry. 
* It has been urged that the chemical combination which is the result of bring- 
ing together oxide and chloride of zinc destroys the therapeutic effect of the 
latter, but the fallacy of such reasoning is shown by the facts here stated; and 
further, an application of oxychloride of zinc carelessly or injudiciously made 
produces pain undistinguishable in character from that of an application of chlo- 
ride of zinc in the same place.