"Besides gold, the only material which can be used with any hope of permanent success is tin foil. Some dentists call it silver, and a tooth which cannot be filled with it cannot be filled with anything else so as to stop decay and make it last very long. It can be used only in the back teeth, as its dark color renders it unsuitable for those in front. When the general health is good, and the teeth little predisposed to decay, this metal will preserve them as effectually perhaps as gold; but where the fluids of the mouth are much disordered it oxidizes rapidly, and instead of preserving the teeth rather increases their tendency to decay." (Dr. Robert Arthur, Baltimore, 1845, "A Popular Treatise on the Diseases of the Teeth.")

The false idea that a patient must have good health, normal oral fluids, and teeth little predisposed to decay, or else if filled with tin the decay would be hastened, originated with a German or English author, and has been handed down in works published since early in 1800. It even crept into American text-books as late as 1860, the authors of which now disbelieve it.

"Tin undergoes but little change in the mouth, and may be used with comparative safety." ("Surgical, Mechanical, and Medical Treatment of the Teeth," James Robinson, London, 1846.)

"Tin is soft, and can be easily and compactly introduced, but it is more easily acted on by the secretions of the mouth than gold and is less durable, but in the mouth of a healthy person it will last for years. Still, inasmuch as it cannot be depended on in all cases, we are of the opinion that it should never be employed." ("The Human Teeth," James Fox, London, 1846.)

The italics are ours. Every metal has a limited sphere of usefulness, and it should not be expected that tin will contend single-handed against all the complicated conditions which caries presents.

"Of all the cheaper materials, I consider tin the best by far, and regard its use fully justifiable in deciduous teeth and in large cavities, as it is not every man who can afford the expense of nine leaves of gold and four hours of labor by a dentist on a single tooth." (Dr. Edward Taylor, Dental Register of the West, 1847.)

"I consider tin good for any cavity in a chalky tooth: it will save them better than anything else." (Dr. Holmes, 1848.)

"Tin can be used as a temporary filling, or as a matter of economy. It may be rendered impervious to air and dampness, but it corrodes in most mouths, unless it comes in contact with food in chewing, and then it rapidly wears away; it does not become hard by packing or under pressure, and that it forms a kind of a union with the tooth is ridiculous." (Dr. J. D. White, 1849, Dental News Letter.)

"A tin plug will answer a very good purpose in medium and large cavities for six years. Much imposition has been practiced with it, and it is not made as malleable as it should and can be. An inferior article is manufactured which possesses brilliancy and resembles silver. This is often passed off for silver foil. No harm comes from this deception except the loss of the amount paid above the price for tin; but even this inferior tin foil is better than silver." ("The Practical Family Dentist," Dewitt C. Warner, New York, 1853.)

"Tin made into leaves is employed as a stopping material; with sufficient experience it can be elaborated into the finest lines and cracks, and against almost the weakest walls, and teeth are sometimes lost with gold that might have been well preserved with tin. I saw an effective tin stopping in a tooth of Cramer's, the celebrated musical composer, which had been placed there thirty-five years ago by Talma, of Paris." ("The Odontalgist," by J. Paterson Clark, London, 1854.)

Refer to what the same author said in 1836.

"Tin is the best substitute for gold, and can often be used in badly shaped cavities where gold cannot." (Prof. Harris, 1854.)

"Tin is better than any mixture of metals for filling teeth." (Professor Tomes, London, 1859.)

In 1860 a writer said that "such a change may take place in the mouth as to destroy tin fillings which had been useful for years, and that tin was not entirely reliable in any case; it must not be used in a tooth where there is another metal, nor be put in the bottom of a cavity and covered with gold, for the tin will yield, and when fluids come in contact with the metals, chemical action is induced, and the tin is oxidized. Similar fillings in the same mouth may not save the teeth equally well. Filling is predicated on the nature of decay, for only on correct diagnosis can a proper filling-material be selected."

Reviewing the foregoing statement, we believe that a change may take place in the mouth which will destroy gold fillings (or the tooth-structure around them) much oftener than those of tin. It is now every-day practice to put tin into the same tooth with another metal; if the bottom of a cavity is filled with tin properly packed, it will not yield when completed with gold, and if the gold is tight, the oral fluids cannot come in contact with both metals and produce chemical action or oxidation; similar fillings of gold in the same mouth do not save the teeth equally well. Should we expect more of tin in this respect, or discard it because it is not always better than gold?

In Article V of the "New Departure Creed," Dr. Flagg says, "Skillful and scrupulous dentists fill with tin covered with gold, thereby preventing decay, pulpitis, death of the pulp, and abscess, and thus save the teeth."

In 1862 Mr. Hockley, of London, mentions tin for filling, and the same year Dr. Zeitman, of Germany, recommended it as a substitute for gold, particularly for poor people.

"Is tin foil poisonous? If not, why are our brethren so reluctant to use it? Is it nauseous? If not, why not employ it? Will it not preserve the teeth when properly used? Then why not encourage the use of it? Does its name signify one too common in the eyes of the people, on account of its daily use in the tin shops, or do patients murmur when the fee is announced, because it is nothing but tin? Is it not better than amalgam, although the patient may believe it less costly? Eleven good plugs, twenty-nine years old, in one mouth demonstrates that tin will last as long as gold in many cases." (F. A. Brewer, Dental Cosmos, 1863.)

"So much tin foil is used for personal and domestic purposes that the following is important: Ordinary tin foil by chemical analysis contained 88.93 per cent. of lead; embossed foil, 76.57 per cent.; tea foil, 88.66 per cent.; that which was sold for the pure article, 34.62 per cent. Tin foil of above kind is made by inclosing an ingot of lead between two ingots of tin, and rolling them out into foil, thus having the tin on the outside of the lead." (Dr. J. H. Baldock, Dental Cosmos, 1867.)

The author used tin foil for filling the teeth of some of his fellow-students at the Ohio College of Dental Surgery in 1867.

"Amalgam should never be used in teeth which can be filled with tin, and most of them can be." (Dr. H. M. Brooker, Montreal, 1870.)

"I have used tin extensively, and found it more satisfactory than amalgam. Dentists ignore tin, because it is easier to use amalgam, less trouble. This is not right. If your preceptor has told you that amalgam is as good as tin, and he thinks so, let him write an article in its defense. Not one dentist in ten who has come into the profession within the last ten years knows how to make a tin filling, and only a few of the older ones know how to make a good one." (Dr. H. S. Chase, Missouri Dental Journal, 1870.)

"Among the best operators a more general use of tin would produce advantageous results, while among those whose operations in gold are not generally successful an almost exclusive use of tin would bring about a corresponding quantum of success to themselves and patients, as against repeated failures with gold. The same degree of endeavor which lacked success with gold, if applied to tin would produce good results and save teeth. A golden shower of ducats realized for gold finds enthusiastic admirers, but a dull gray shower for tin work is not so admirable, even though many of the teeth were no better for the gold as gold, nor so well off in the ultimate as with tin." (Dr. E. W. Foster, Dental Cosmos, 1873.)

In 1873 Dr. Royal Varney said, "I am heartily in favor of tin; it is too much neglected by our first-class operators."

"Tin stops the ends of the tubuli and interglobular spaces which are formed in the teeth of excessive vascular organization; if more teeth were filled with tin, and a smaller number with futile attempts with gold, people would be more benefited." (Dr. Castle, Dental Cosmos, 1873.)

"If cavities in teeth out of the mouth are well filled with tin, and put into ink for three days, no discoloration of the tooth (when split open) can be seen." (W. E. Driscoll, Dental Cosmos, 1874.)

"Tin makes an hermetical filling, and resists the disintegrating action of the fluids of the mouth. If an operator can preserve teeth for fifteen dollars with tin, which would cost fifty dollars with gold, ought he not to do so? Upon examination of the cavities from which oxidized plugs have been removed, these oxids will be found to have had a reflex effect upon the dentin; the walls and floors will be discolored and thoroughly indurated, and to a great degree devoid of sensitiveness, although they were sensitive when filled. Tin is valuable in case of youth, nervousness, impatience, high vitality of dentin, low calcification, and low pecuniosity." (Dr. H. Gerhart, Pennsylvania Journal of Dental Science, 1875.)

"Tin Foil for Filling Teeth." Essay by Dr. H. L. Ambler, read before the Ohio State Dental Society. (Dental Register of the West, 1875.)

"Some say that if tin is the material the cavity must be filled with, that it must be filled entirely with it, but advanced teachings show differently." (Dr. D. D. Smith, Dental Cosmos, October, 1878.)

"Frail teeth can be saved better with tin than with gold. I never saw a devitalized pulp under a tin filling." (Dr. Dixon, Dental Cosmos, May, 1880.)

"Tin may be used as a base for proximate fillings in bicuspids or molars, in third molars, in children's permanent molars, in the temporary teeth, and in any cavity where the filling is not conspicuous." (Dr. A. W. Harlan, Independent Practitioner, 1884.)

"Tin in blocks, mats, and tapes is used like non-cohesive gold foil, but absence of cohesion prevents the pieces from keeping their place as well as the gold." ("American System of Dentistry," 1887.)

This is virtually saying that there is cohesion of non-cohesive gold, and that for this reason it keeps its place better than tin. It has always been supposed that there was no cohesion of layers of non-cohesive gold, and as the tin is used on the non-cohesive plan, therefore one keeps its place as well as the other. We claim that generally in starting a filling, tin will keep its place better than cohesive or non-cohesive gold, because it combines some of the cohesiveness of the former with the adaptability of the latter.

"Tin will save teeth in many cases as well or better than gold. Put a mat of tin at the cervical wall of proximate cavities in molars and bicuspids, and it makes a good filling which has a therapeutic effect on tooth-structure that prevents the recurrence of caries, probably because the infiltration of tin oxid into the tubuli is destructive to animal life. Where the filling is not exposed to mechanical force, there is no material under heavens which will preserve the teeth better." (Dr. Beach, Dental Cosmos, 1889.)

"I extracted a tooth in which I found a cavity of decay which had extended toward a tin filling, but stopped before reaching it; on examining the tooth-structure between the new cavity and the tin filling, it was found to be very hard, indicating apparently that there had been some action produced by the presence of the tin." (Dr. G. White, Dental Cosmos, 1889.)

"Pure tin in form of foil is used as a filling and also in connection with non-cohesive gold." (Mitchell's "Dental Chemistry," 1890.)

"Tin ranks next to gold as a filling-material." (Essig's "Dental Metallurgy," 1893.)

"Tin is good for children's teeth, when gold or amalgam is not indicated. It can be used in cavities which are so sensitive to thermal changes as to render the use of gold or amalgam unwise, but it can only be used in cavities with continuous walls, and should be introduced in the form of cylinders or ropes, with wedge-shaped pluggers having sharp deep serrations, thus depending upon the wedging or interdigitating process to hold the filling in the cavity." ("Operative Technics," Prof. T. E. Weeks, 1895.)

"Tin for filling teeth has been almost superseded by amalgam, although among the older practitioners (those who understand how to manipulate it) tin is considered one of the best, if not the very best metal known for preserving the teeth from caries. In consequence of its lack of the cohesive property, it is introduced and retained in a cavity upon the wedging principle, the last piece serving as a keystone or anchor to the whole filling. Each piece should fill a portion of the cavity from the bottom to the top, with sufficient tin protruding from the cavity to serve for thorough condensation of the surface, and the last piece inserted should have a retaining cavity to hold it firmly in place. The foil is prepared by folding a whole or half-sheet and twisting it into a rope, which is then cut into suitable lengths for the cavity to be filled." (Frank Abbott, "Dental Pathology and Practice," 1896.)

"Forty-three years ago, for a young lady fourteen years of age, I filled with non-cohesive gold all the teeth worth filling with this metal; the rest I filled with tin. Three years after that there was not a perfect gold filling among the whole number, and yet the tin fillings were just as good as when made. The explanation as to why the tin fillings lasted so much longer than the gold ones was, that there must have been something in the tin that had an affinity for the teeth and the elements that formed the dentin, by which some compound was formed, or else it must have been in the adaptation." (Dr. H. Gerhart, Dental Cosmos, January, 1897.)