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In defence of the cowhorns
Responding to Adrian Curtis' interesting letter in the February issue of DU just a few things about my beloved cowhorns that I do not think I have ever used intentionally to split a tooth. Although I would consider the separation of roots of multi-rooted teeth prior to individual removal, to be the least traumatic form of extraction. I do still have my 1976 undergraduate copy of Geoffrey Howe's Minor Oral Surgery,1 which contains much still of value, but in common with all 20th century texts, it has one very important chapter missing, and that is the chapter on ‘Closed and atraumatic extraction techniques'. The conventional use of a cowhorn is a closed technique, in the sense that a soft tissue flap is not used, but it is traumatic in the sense that crushing, fracture or removal of bone can occur, in common with almost all extraction techniques! Closed techniques using forceps, elevators and luxators, are important worldwide because the majority of tooth extractions are performed when the luxury of a surgical hand piece is not available (my opinion). On school patrols in Papua New Guinea, the commonest tooth I was asked to take out was probably the grossly carious lower first permanent molar. I would have had a surgical handpiece with me, but if used, I would have needed to wait an hour for it to go through the pressure cooker before the next use. Cowhorns often came to the rescue. Back in the UK, operating day bed lists, it was not unusual to be performing clearances on young adults (methadone mouth). Interesting when sugar-free medication appeared, the drug-induced xerostomia and insatiable thirst for fizzy drinks still caused havoc with the dentition. To take out up to 28 teeth in less than an hour would rely on rapid closed extraction techniques. Cowhorns to the rescue. Also this century, we have seen the arrival of the physics and power forceps, both drawing on the concept of guiding a beak along the periodontal space (like the cowhorns), but also introducing the reciprocal bumper. These ‘Beak & Bumper’ forceps in the hands of the experienced clinician perform a rapid, albeit traumatic, closed extraction. This century has seen pleas from implantologists to preserve bone, and also the spectre of bisphosphonates and now, COVID, good reasons not to raise a flap in anger. Most recently we have seen the ‘sprocket pullers’ appear in the form of the Benex and others. The only technique to my knowledge claiming to be closed and atraumatic!
We all use procedures that we are familiar and confident with to the exclusion of others (I have no experience of using the eagle beak), but maybe our patients should be informed of what else is out there, and why we are doing what we do.
Thank you cowhorns, long may you live.