Dental caries, definition and treatment, by GV Black (1908)

I am re-reading the seminal book of GV Black about dental caries. The first volume, about the pathology, is superb. All the research done in the last 50 years had confirmed most of their statements. Unfortunately, most of the dentists are, even now, trained (not educated) by the contents of the second volume, focused to the surgical treatment of caries. Now, almost any dentist can recite the Black's classification of fillings, but almost none can recite the definition of caries stated by Black.

Well, I utterly recommended this book to any dentist interested in dental caries. There are some errors, as the use of explorers and the preference for pulp exposure for deep caries, but you have to keep in mind that this book was written more than 100 years ago…

Well, here are some highlights:

What is caries?

Caries in its simplest expression consists in a chemical dissolution of the calcium salts of the tooth by lactic acid, followed by the decomposition of the organic matrix, or gelatinous body, which, in the dentin, is left after the solution of the calcium salts.
…always begins upon the surface, never in the interior. Decay of the teeth is therefore caused by an agent acting from without the tooth, never from within the tooth. It is something extraneous to the tooth, acting upon the surface in the beginning and penetrating little by little into its substance

The progress of caries is limited, or even stopped, in a number of different ways.

…it becomes the duty of the dentist to prescribe the manner of its use; not only to prescribe the manner of use, but to teach his patients the correct use of the brush.
There are very few persons who need other than the ordinary straight tooth brush. A cheap tooth brush is generally the best tooth brush, because it is small, there are not so many bristles in it, and they will get in between the teeth better. Examinations should be made at intervals to see that regular and correct habits become fixed

Treatment of caries

It is intrinsically wrong to treat tbe subject of filling teeth simply from the mechanical standpoint; it is wrong in that it tends to produce in the minds of students the idea that filling teeth is a purely mechanical pursuit. This is far from the proper conception of the facts. In filling teeth, the closest use of our knowledge of the pathology of dental caries and of the local conditions of its occurrence, and of its recurrence after fillings have been made, should be put to full use in every case, in order that the greatest benefit may be derived from filling operations

Fillings are not curative in the same sense that vaccination is curative against smallpox — preventive; such remedies remove the tendecy to disease; something of a material nature is introduced into the blood and cellular elements of the whole body that tends to counteract the disease. Nothing of this kind is done in filling teeth. No systemic change is produced as a direct effect. That is to say, fillings do not remove the tendency to caries, and the curative effect of a filling is literally no broader than its outline.

The complete divorcement of dental practice from the studies of the pathology of dental caries, that existed in the past, is an anomaly in science that should not continue. It has the apparent tendency to make dentists mechanics only..

It must be understood that treatment by filling should be supplemented and supported, in all cases of considerable susceptibility to caries of the teeth, by fairly vigorous and healthful chewing of food and by artificial cleaning with the brush in the hands of the patient. For this purpose, careful training of the individuals should be seriously undertaken by the dentist with the same care that he would bestow upon any operation he performs for their relief.

What should be considered a permanent filling? What do we mean by permanent?

…incipient decay of the enamel or the deeioer decays of the proximal surfaces will be stopped, provided the surface is such that it can be kept fairly clean.