CHAPTER 16.

ZONE THERAPY--MAINLY FOR DENTISTS.

There are four reasons why zone analgesia--as we call the pain-relieving properties of zone therapy--are not more generally used by dentists. One is that the dentist doesn’t wish to put himself in the embarrassing position of suggesting such a foolish-seeming thing to his pain-racked patient. Another is that the patient herself thinks she’s conferring a favor upon the dentist by permitting him to spend five or ten minutes’ valuable time in attempting to alleviate her sufferings, and make the ordeal of cavity preparation or scaling comparatively painless.

Also, to press over the roots of a tooth for three, four, or more minutes--exerting, after toleration is established, all the force of which the operator is capable--is hard work. It’s much quicker and easier, and less likely to numb the dentist’s thumb and finger, to “slap” a gas cone over the patient’s nose, or inject cocaine around the gums--which, to my mind, hurts almost as badly as having the tooth extracted.

There is yet another reason, however, which partially justifies the previous three. The analgesic results of zone pressure are not sufficiently uniform to “bank” on. In other words, a dentist, led by previous successes, might be tempted confidently to assure a patient of the painlessness, under zone analgesia, of a certain operation. But when he commenced to work he might almost lift the top of his victim’s head off. To obviate this do not limit the pressure to three minutes only, and do not attempt to operate or extract until a puncturing test with a sharp instrument shall prove the part to be desensitized.

Also, I would here emphasize that there is no use in attempting, with zone analgesia, to relieve pain if it is desired to remove a nerve. We do not pretend to explain why it is possible, for instance, to work thirty-five minutes, (as demonstrated before the Mass. Dental Society by Dr. B. A. Sears, of Hartford) and cut the jaw bone all to pieces in order to remove an impacted wisdom tooth, while we are unable to thrust a nerve broach into a root canal. But the fact remains, and some time, when pathologists and other experts have studied these problems, we may know why. But for the present, we must be content to be guided by dearly-bought experiences.

There is no known way of telling in advance, just what degree of analgesia success is assured. Dr. M. W. Maloney, of Providence, R. I., and Dr. Wm. J. Hogan, of Hartford, Conn., claim successful results with about 80% of their cases. Dr. Everett M. Cook, of Toledo, Ohio, writes that he is easily successful in 75% of his cases. Dr. Thomas J. Ryan, of New York, is quite uniformly successful in desensitizing the gums for pyorrhoea treatment. While other dentists range on down to as low as 50% of successes, or even to zero.

There are probably very definite reasons for this, although it may be difficult to convince the average dentist that such exist. First, it requires a fine technic to find the various dental nerves, and, by commencing gently, and gradually increasing pressures, to anesthetize them without hurting the patient more than the operation might have hurt him. In which case he has the pain of the operation plus the pain of attempting to analgesize his unresponsive nerve points.

Next, when pressures are made over the fingers, especially where no clamps or rubber bands are used, there is a tendency to skimp on the time devoted to the finger squeezing. The dentist or his assistant will give the job a “lick and a promise”--and let it go at that. They don’t use sufficient time or sufficient force really to accomplish anything.

And third, they won’t take the time properly to learn the zones and the teeth relations, and apply in a serious way the knowledge so acquired.

However, for the benefit of those dentists who may be interested in learning how to desensitize cavities in sensitive teeth, or do some of the necessarily painful scaling of tartar and other deposits in pyorrhea, and for the particular benefit of several million of their patients throughout the country, I would say that pressure by an assistant exerted over the joints of the thumb (the assistant would do better completely to “cover” the joint, using thumbs and fingers of both hands for this purpose), will mitigate or quite control the pain in the incisor and occasionally the cuspid teeth of the side corresponding to the finger being squeezed.

Never let the patient do this for himself, unless you provide him with clamps or wide rubber bands for the purpose, as he cannot be trusted to make the pressures long enough or strong enough to accomplish satisfactory results.

Pressure exerted over the first or second joint of the first finger will control pain in the cuspid and bicuspid teeth. The second finger is related to the two molars, but sometimes the third (or ring) finger must also be employed for this region.

In other words, pressure upon the thumb, fore-finger, middle, and ring fingers of either hand will control correspondingly pain in the incisors, cuspids and bicuspids and the two molars on either side of the median line, providing that there is no great inflammation or no abscess in the vicinity of the corresponding teeth.

Occasionally the “control” over-laps, in which case it is necessary to use also the finger next to the zone finger, and in the case of wisdom teeth, to get the best results it is sometimes advisable to use both the third and the little finger--as the fourth and fifth zones merge in the head.

A very successful method practiced by some experts--particularly where extraction must be done--is to grasp the offending tooth as near the apex of the root as is practicable, and with the thumb and finger make firm pressure for three, four, or more minutes--by the watch. This usually produces a degree of anaesthesia lasting about one half hour, although pressure can, if necessary, be reapplied at any time.

Other dentists and oral surgeons get excellent results by pressing on the “heel of the jaw”--the point directly back of the wisdom tooth, ponderously known as “the tuberosity of the superior maxillary.” This produces a very complete and lasting anaesthesia of the entire jaw of the side affected, and permits of the painless extraction of teeth living in the immediate neighborhood.

With the lower front teeth, it has been found that to press or hold the inferior (or lower) dental nerve, where it enters the ramus (or groove) of the lower jaw, gives good anaesthesia. Also pressure with the finger on the inferior dental nerve, where it exits from below the bicuspid tooth (called by doctors the mental foramen) will usually anesthetize that half of the jaw.

Many operators, the better to “focus”, prefer to use the blunt end of an instrument (the handle of an excavator is excellent) upon this inferior dental nerve.

The proper application of these principles cannot fail to be of immense value to the dentist and oral surgeon in their daily practice. In relieving toothache and neuralgia, in removing deposits, in extracting teeth, and in fact in most painful operations which dentists are called upon to perform, this pressure technique should prove invaluable, as many dentists are learning every day.

And further, the application of these principles will inevitably encourage public interest in dentistry, and will materially diminish the sum total of pain and suffering that humanity is called upon to endure. Indeed, it is common--and highly gratifying--among many dentists now using zone analgesia--to have sensitive patients--those upon whom, because of past exhausting and nerve-racking experiences, they have always dreaded working--say “Well, Doctor, if you never hurt me any more than you did today I shall never again fear to come to you.”

Mothers will find this method a safe and certain means of relieving themselves and their children of an immense amount of pain and discomfort. For, while they cannot, of course, hope to possess the technical knowledge enabling them to find and exert pressure upon the nerves themselves, it is a comparatively simple matter for them to rigidly grasp the roots of an aching tooth between their thumb and finger, and temporarily relieve pain--at least until they can take little Alfred or Alice to the dentist.

If this may not seem feasible, they can, by remembering the fingers that correspond with the particular zone it is desired to influence, do much to relieve distressing conditions in that zone until such time as the doctor or dentist can be visited, by squeezing, or by applying rubber bands around the proper fingers.

For example: At a dinner party the other night one of the guests complained of severe pain in the right upper first molar. I told her to squeeze firmly the joint of her second or middle finger, which advice she considered a very ill-timed and pointless joke. Insisting that I was serious and helpfully disposed, she obeyed instructions, and in a very few minutes beamed complete relief from her dental anguish.

Another instance in which toothache was relieved in what might be called an _outré_ manner was reported by Dr. J. F. Roemer of Waukegan, Ill., who operated with a pair of rubber bands upon the aching teeth of a young traveling man. Dr. Roemer writes that this man came to the office with an extremely painful and sensitive condition, chiefly affecting the incisor teeth. As the knight of the leather bag explained it his teeth were so “sore” that he could not eat any solid food whatever, and he didn’t much relish the food he drank. It was impossible for him to close his teeth together without causing great distress. A dentist who had examined the salesman could find nothing wrong with the teeth, from the dental standpoint.

Dr. Roemer, however, examined him in a characteristic zone therapy way. He searched the patient’s fingers with a metal comb to find out what was the matter with his teeth. This search disclosed the presence of “spots” on the insides of the thumb and first finger which were acutely sensitive to pressures from the teeth of the comb.

The diagnosis established, the treatment was simplicity itself. Commencing with light pressures upon these sensitive areas the doctor gradually increased the force applied to the comb, at the same time engaging the owner of the thumb and teeth in conversation relative to his business, and to the political situation--this latter a perennial source of interest-absorbing conversation in the West.

After about ten minutes of this operation the doctor looked up and asked his victim “how the teeth were getting along.” After cautiously testing their sensitiveness by means of various biting pressures, the patient responded that “while they were still a little ‘sore’ the pain had entirely left.”

The doctor then issued instructions as to how to apply rubber bands in order to make the proper pressure, which is to use one-fourth inch bands about two inches in length, bind them around the first joint--counting from the tip--of the thumb and first finger, leave them on until bluish discoloration appeared, then remove, and re-apply after a few hours.

The traveling-man reported the following day that he had enjoyed a good night’s sleep--the first for many nights--and after forty-eight hours of this treatment he telephoned that all pain and sensitiveness had completely disappeared.

In neuralgia and other painful conditions of long standing, where there are no decayed teeth--or other dental causes for the pain--many permanent cures have been effected by pressure treatment. Almost it would seem that whatever tends to reduce the pain would also help remedy its cause, no matter how remote.

As illustrating, in detail, the successful “home treatment” of neuralgia, another case of Dr. Roemer’s is most interesting. The Doctor says “I saw recently a patient with tri-facial neuralgia of two years’ standing. Nothing had relieved permanently. The attack which brought him to me was of four or five days’ duration. During this time he had been unable to eat. Even the attempt to speak would bring on an acute paroxysm of pain of a sharp piercing nature, which radiated over the entire left side of the face, extending from the lower and the upper jaw, and up into the left eye. These paroxysms left him as ‘limp as a rag.’

“He had been advised to have the nerve cut, as offering the only relief for his trouble.

“I applied rubber bands on the joints nearest the tip of the thumb and forefinger of the left hand. In less than ten minutes my patient was talking and laughing, and we had quite a visit.

“I told him nothing about what was being attempted with the bands, so he wasn’t ‘hypnotized.’ After we saw results, however, I instructed him to apply the bands every half hour if the pain continued, and as it decreased to lengthen the interval of the applications.

“When next I saw him, several days after, he laughingly said, ‘Oh, I apply the rubbers once a day now, as I don’t want that pain to come back.’ He is now enjoying life better than he has for years, thanks to ‘those fool rubber bands,’ as his daughter called them.”

Many dentists secure a very satisfactory degree of analgesia--sufficient for excavating or treatments--by compressing firmly the lip or cheek immediately over the tooth that is to be worked upon. (See Fig. 27.) But as a rule, for extraction purposes, they prefer pressure over the roots, or directly upon the various branches of the dental nerves. (See Figs. 25 and 26.)

One of the most significant facts in connection with zone therapy is the intimate relation between morbid dental conditions and pain or even pathological changes in practically every section of the body. It has been demonstrated beyond a shadow of doubt, that points--or foci--of infection within the mouth, or in the teeth, frequently manifest disturbances most remote from their point of origin.

This is one reason why many physicians and surgeons, using the method, make a routine practice of sending every patient, in whom dental disease is even suspected, for a thorough overhauling by a competent dentist.

Another reason for striving to keep all our original teeth in their places is that nature intended to preserve the continuity--if it may be so termed--of our various nerve zones. Sound, healthy teeth and roots in their normal occlusion, seem to assist in the normal functioning of the entire zone chain of which they are important links.

Asthma, congestions, headaches, neuralgia, conditions affecting the nerves of the head or the ears, or even partial deafness, have been materially improved, and many times completely cured, by the application of a galvanic cautery around the necks of the teeth, by pressure on the teeth themselves in the zone affected, or even by having the patient “grind” the particular teeth related to those areas which it is attempted favorably to influence.

In several instances, chronic frontal headaches in children have been cured by correcting faulty occlusion of the front teeth by that branch of dentistry known as “Orthodontia.” When after several months’ treatment, the teeth were restored to their normal alignment, and continuity of the nerve zone was re-established, the headaches cleared up, and there has been no return of them.

Occasionally it happens that a patient will go to a physician who uses zone analgesia to be prepared for the services of a dentist who doesn’t. Only recently a man suffering from indigestion and rheumatoid arthritis (rheumatism of the joints with progressive stiffening) was advised by his physician to have his teeth removed, the doctor insisting that because four wisdom teeth were the only teeth he had that were not decayed and completely broken down, nothing else would cure his indigestion and rheumatism.

His heart action was such that it would have been dangerous to administer cocaine--much less a general anesthetic.

Therefore, for the removal of his 27 teeth and stumps, the pressure method was decided upon. His physician accompanied him to the dentist, and doctor and dentist, for the next twenty minutes made the proper pressures on the fingers and on the inferior dental nerves.

All the lower teeth were then removed--without a particle of pain. Pressures were then repeated on the fingers and the palatine nerves, and the teeth in the upper jaw were likewise removed.

Of the entire 27, only two gave much pain on extraction, and these were most strongly attached to the bony processes (the sockets and attachments by which teeth are held in place). Bleeding following this wholesale extraction was very slight.

It may be interesting to know that after the gums had healed and the patient had worn artificial teeth for a few months, his appetite and digestion improved, he began to gain in weight, and there was an almost complete relief from the rheumatic symptoms and the joint stiffening.

In some instances physicians have applied the pressures in their own offices, and have then sent the patients--with rubber bands bound tightly around their finger joints in order to maintain the analgesic influence--to the dentist, where their extraction or cavity preparation has been painlessly done.

And occasionally great pleasure and satisfaction is afforded both patient and doctor when some sufferer calls up on the ’phone at two or three in the morning and inquires what finger to press to relieve the pain of a certain tooth, especially when the advice given has been followed by relief.

It has been for many years a quite general piece of knowledge among dentists that the application of menthol to the mucous membrane of the nose, on the same side as an aching tooth, would very frequently stop the toothache. If dentists will now apply a slight elaboration of this bit of zone analgesia technic they may possibly save themselves many gray hairs. What their patients will save in agony, apprehension, and the drain on their vitality cannot be even estimated.