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 I. Hearing, and How to Keep Bt, 
 
 By CHAS. H. BURNETT, M.D., of Philadelphia, 
 
 Consulting Aurist to the Fennsytvaiiia Institution for the Deaf and Dumb, 
 Aurist to the Presbyteriaji Hospitat, etc. 
 
 II. Long Life, and How to Reach It, 
 
 By J. G. RICHARDSON, M.D., of Philadelphia, 
 
 Professor of Jnygieji»iti the University of Fen7isylvania, etc. 
 
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 Surgeon to the Wilts \Eyej Hospitat. 
 
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 VII. The IVlouth and the Teeth, 
 
 By J. W. WHITE, M.D., D.D.S,, of Philadelphia, 
 
 Editor of the Dental Cosmos. 
 
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AMERICAN HEALTH PRIMERS. 
 
 EDITED BY 
 
 W. W. KEEN, M.D., 
 
 Fellow of the College of Physicians of Philadelphia, 
 AND Surgeon to St. Mary's Hospital. 
 
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AME^^J^CAN H-EALTH PRIMERS. 
 
 .1 \ £^ ^, 
 
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 86 
 
 
 '^'y 
 
 t.% 
 
 Mouth and the Teeth. 
 
 % 
 
 BY 
 
 J. W. WHITE, M.D., D D.S., 
 
 Editor of the Dental Cosmos. 
 
 i 
 
 PHILADELPHIA: 
 LINDSAY & BLAKISTON. 
 
 1879. 
 
Vi/ «w C. 
 
 Copyright. 
 LINDSAY & BLAKISTON. 
 
 1879. 
 
CONTENTS. 
 
 CHAPTER 
 
 I. Introductory 
 
 II. The Mouth 
 
 III. Anatomy of the Teeth 
 
 IV. Development of the Teeth 
 
 V. Eruption of the Temporary Teeth . 
 VI. Difficult Dentition .... 
 VII. Care of the Temporary Teeth . 
 VIII. Sixth-Year Molars .... 
 IX. Shedding of the Temporary and Erup 
 
 TION OF THE PERMANENT TeETH 
 
 X. Nutrition of the Teeth 
 XI. Food in its Relations to the Teeth 
 XII. Nervous Relations of the Teeth 
 
 XIII. Constitutional Peculiarities, Varieties 
 
 AND Defects of the Teeth 
 
 XIV. Irregularities of the Teeth 
 
 I * V 
 
 9 
 13 
 32 
 44 
 47 
 50 
 60 
 
 64 
 
 68 
 76 
 78 
 84 
 
 94 
 98 
 
VI CONTENTS. 
 
 CHAPTER PAGE 
 
 XV. Tartar, or Salivary Calculus . . io6 
 
 XVI. Decay of the Teeth, or Caries . 
 XVII. Toothache — Extraction — Hemorrhage 
 XVIII. Hygiene of the Mouth . 
 
 XIX. Reparative Treatment . 
 XX. Substitution — Artificial Dentures 
 
 no 
 117 
 126 
 138 
 143 
 
DIAGRAM OF FOOD AND AIR TRACTS. 
 
 The solid line throuth Mouth and Gullet represents the course 
 taken by food and drink ; the dotted lines through Mouth, 
 Nasal Passages, and Air- Tube represent the course taken by 
 the air. 
 
 viii 
 
THE 
 
 MOUTH AND THE TEETH. 
 
 CHAPTER J. ___ 
 
 INTRODUCTORvGEORGr LVANS, 
 
 THE mouth is not only the ^M^^^j^&liW^'ai'cf ''^^ 
 characteristic, but it is also the most important, 
 of all the features. No other portion of the human 
 organism is of such complex structure, and no other 
 has such diversified functions to perform. 
 
 The preservation of the health of the mouth is es- 
 sential to the general well-being. Disease of the 
 body involves an unhealthy condition of the mouth, 
 and is manifested by perceptible changes in the 
 tongue, gums, lips, and mucous membrane. On the 
 other hand, it is reasonable to conclude that an un- 
 healthy condition of the mouth will act prejudicially 
 to the general health of the organism. The breath, 
 if made oifensive by a diseased state of the mouth 
 or teeth, cannot be wholesome when inhaled into the 
 lungs and brought into contact with those delicate 
 structures, the air-cells ; nor can it exercise the best 
 
 9 
 
lO THE MOUTH AND THE TEETH. 
 
 influence upon the blood, which depends in great 
 measure for its quality upon the purity of the air 
 supplied to the lungs. Moreover, it is very undesir- 
 able to transmit offensive matters into the stomach, as 
 vitiated saliva or food polluted by noxious secretions. 
 
 The value of a good set of teeth — a complete and 
 perfect "denture" — is not to be computed, if only 
 the service of dividing and masticating the food be 
 considered ; mastication being the first step in a 
 series of processes by which the food is transformed 
 into nourishment adapted to the needs of the sys- 
 tem. When to this consideration we add their im- 
 portance in assisting vocalization — distinctness of 
 utterance in speech and song — and the necessity for 
 their preservation in order to maintain the natural 
 symmetry of the features, it would appear to be a 
 positive duty that every one should study to avoid the 
 causes which tend to the premature destruction of the 
 teeth. 
 
 There is abundant reason for an effort to awaken a 
 general interest in the prevention and arrest of the 
 process of decay in human teeth. That there has 
 been a progressive deterioration in the quality of the 
 dental outfit of mankind through successive genera- 
 tions, is claimed by many observing practitioners of 
 dentistry. There can be no doubt that dental caries 
 is on the increase — is well-nigh universal ; while 
 recession of the gums and absorption of the support- 
 
INTR OD UC TOR Y. 1 1 
 
 ing alveolar processes are fearfully prevalent, even in 
 the mouths of the young. If these tendencies are to 
 be successfully combated, it must be not alone nor 
 chiefly through the manipulative skill of dental oper- 
 ators, but through a better appreciation by the people 
 of the causes of the deterioration and of the means 
 by which it may be counteracted. The importance 
 of a wide diffusion of information in regard to these 
 matters has been recognized by every intelligent 
 dentist. It is high time that more attention be given 
 to the subject. 
 
 Matters of much less importance to personal ap- 
 pearance, of vastly less account to individual com- 
 fort, and beyond all question of smaller moment to 
 health and life, are made the subjects of constant 
 study and care ; while the amount of information 
 possessed by the public in this direction is lament- 
 ably small, and much of that is erroneous. Many 
 otherwise intelligent people are sadly deficient in a 
 proper comprehension of this subject. There are no 
 other organs of the body which are not more appre- 
 ciated than the teeth, and yet there are none the 
 neglect of which entails more serious results. 
 
 It is estimated that twenty millions of teeth are 
 annually sacrificed in the United States. The crim- 
 inal neglect thus exhibited involves not only this 
 waste of teeth, but is the fruitful cause of abscesses, 
 facial deformities, neuralgias, dyspepsias, headaches, 
 
12 THE MOUTH AND THE TEETH. 
 
 eye and ear troubles, and other morbid conditions. 
 Protracted derangements of sight, of hearing, and of 
 the general health not infrequently have their unsus- 
 pected origin in the mouth. 
 
 For these reasons, the facts relating to the forma- 
 tion, structure, development, eruption, character, func- 
 tions, and diseases of the teeth, and to the preservation 
 of their health and that of the associated parts, should 
 be better and more generally understood. 
 
 In the hope of awakening interest and stimulating 
 thought with reference to the intelligent care of the 
 mouth this monograph has been prepared. 
 
CHAPTER II. 
 
 THE MOUTH. 
 
 THE mouth is the organ of taste, of speech, of 
 song, of mastication, and of insalivation ; the 
 avenue for the entrance of the food and drink essen- 
 tial to life, and the channel through which passes 
 much of the air which is inhaled, as well as that 
 which is expired. The same membrane which lines 
 its cavity is continued throughout the nose, the 
 throat, the stomach, and the intestinal canal; through- 
 out the larynx, the windpipe, the bronchial tubes, and 
 the lungs. It is thus closely related to the functions 
 of digestion and respiration, while by open passages 
 direct communication is maintained with the eyes, 
 ears, and nose, and by the nerves, with which it is 
 abundantly supplied, with every part of the body. 
 
 The mouth is made up of the lips, cheeks, upper 
 and lower jaws, with their alveolar processes ; the 
 hard and the soft palate, the tongue, salivary and 
 mucous glands, mucous membrane, gums, and teeth. 
 It is a wonderful combination of bones, muscles, 
 arteries, veins, nerves, glands, membranes, and a cu- 
 
 2 13 
 
14 THE MOUTH AND THE TEETH. 
 
 rious structure of hard and soft tissues constituting the 
 teeth. These, like ail other parts of the body, depend 
 upon the general system for their development and 
 nourishment. 
 
 The lips, which are fleshy folds surrounding the 
 orifice of the mouth, and the cheeks, with which they 
 are continuous, forming the sides of the face and the 
 boundaries of the mouth, are composed of true skin 
 externally and mucous membrane internally, between 
 which are the muscles which produce their move- 
 ments; also, blood-vessels, nerves, and small bodies 
 called mucous glands, having ducts or tubes opening 
 by minute orifices upon the inner or mucous surfaces. 
 These glands secrete a fluid which helps to lubricate 
 the mouth. (By the terms ' ' secrete ' ' and ' ' secretion, ' ' 
 as here used, is meant a process by which various 
 matters derived from the blood are collected and dis- 
 charged at particular points in order afterwards to be 
 employed for special purposes in the economy.) 
 
 The palate or roof of the mouth, well shown in 
 the Frontispiece J consists of two portions — the hard 
 palate in front, and the soft palate (called the velum) 
 behind it, terminating in a central pendulous structure 
 — the uvula, commonly but erroneously called the 
 palate. The hard palate, which is a bony plate, is 
 covered by a dense tissue called the periosteum {^around 
 a bo7ie). The soft palate is a soft, movable fold or 
 curtain of mucous membrane, inclosing muscular 
 
THE MOUTH. 1 5 
 
 fibres. It serves important purposes in the mech- 
 anism of the mouth, assisting materially in the ar- 
 ticulation of sound, in the act of swallowing, and, 
 conjointly with certain muscles connected with it and 
 with the tongue and pharynx, preventing the passage 
 of food into the nose, which opens into the upper 
 part of the throat above the soft palate. 
 
 The tongue is a muscular body lying on the floor 
 of the mouth within the lower dental arch. It is cov- 
 ered by mucous membrane, beneath which are mucous 
 glands having orifices opening upon its surface. It 
 is the organ of the special sense of taste, and presides 
 over the processes of mastication and swallowing. The 
 exquisite sensibilities of touch and taste residing in the 
 tongue are important aids in mastication. Its sense 
 of taste informs us of the qualities of the food, and 
 its sense of touch recognizes its physical condition — 
 consistency, size, form, and when it has been suffi- 
 ciently masticated. By its muscular structure it col- 
 lects and moves the food from one side of the mouth 
 to the other, and, with the aid of the lips and cheeks, 
 keeps it between the masticating surfaces of the teeth. 
 When the food is in a sufficiently softened condition, 
 the tongue collects it upon its upper surface and passes 
 it backward into the pharynx — a funnel-shaped canal 
 situated on the middle line in front of the spinal 
 column, between the base of the skull and the esoph- 
 agus or gullet — which serves as a common origin for 
 
1 6 THE MOUTH AND THE TEETH. 
 
 the digestive and respiratory tracts, giving passage to 
 the air during respiration and to the food at the time 
 of deglutition or swallowing. By virtue of its com- 
 plicated muscular structure the tongue is also capable 
 of the great variety of movements essential to suction 
 and to speech. At the base of the tongue is a cartila- 
 ginous oval or triangular flap called the epiglottis, its 
 apex attached, the other and larger part free. Its 
 special use seems to be to cover the glottis (an aper- 
 ture in the larynx or the apparatus of voice, situated 
 at the top of the trachea or windpipe), and thus pre- 
 vent the passage of food into the air-tubes. The 
 tongue sympathizes with all derangements of the 
 general system — especially with those of the ali- 
 mentary canal. As an index of the state of the 
 general system, it affords, doubtless, more varied 
 information than any other single means of judg- 
 ment. Its bulk, color, dryness or moisture ; the 
 character of its surface, of its coatings, and of its 
 movements show to the skilled observer the degree, 
 progress, and stage of systemic derangement. The 
 tongue is liable to a variety of local diseases and 
 injuries. Among the latter, ulcers, sometimes very 
 serious, are caused by the persistent irritation of the 
 jagged edge of a broken or carious tooth or a project- 
 ing root. Similar effects from like causes are also 
 produced upon the cheeks. Whenever such sources 
 
THE MOUTH. 1 7 
 
 of irritation are recognized, they should be promptly 
 corrected. 
 
 Opening upon the mucous surfaces of the mouth 
 are the excretory, or discharging ducts or tubes of 
 three pairs of salivary glands — the parotid, the sub- 
 maxillary, and the sub-lingual. The parotid glands 
 (so named from two Greek words signifying " ear " 
 and ^^near" — near the ear) are the largest of the 
 three pairs, weighing from a half ounce to an ounce 
 each. They are situated upon the sides of the face 
 immediately below and in front of the external ear. 
 Their ducts lead to outlets, which can usually be readily 
 seen, upon the inner surfaces of the cheeks opposite 
 the second molar teeth of the upper jaw. The glands 
 called submaxillary {beneath the jaw) are situated 
 below the lower jaw, and have their outlets on either 
 side of the middle line beneath the tongue. The 
 glands called sublingual {beneath the torigue) are 
 situated beneath the mucous membrane of the floor 
 of the mouth, their ducts — from eight to twenty in 
 number — opening under the tongue. 
 
 The secretions or products of the mucous and sali- 
 vary glands differ in character as do those of the latter 
 from one another. They differ also in the quantity 
 of fluid which they discharge, and as to the causes 
 which excite their action. The parotids are called 
 the masticatory glands, because they are not found 
 generally except in animals which are furnished with 
 2* B 
 
1 8 THE MOUTH AND THE TEETH, 
 
 grinding or masticating teeth. A larger quantity 
 of secretion takes place from them than from either 
 of the other salivary glands, especially during the 
 movements of the jaw in eating, and particularly 
 on that side of the mouth on which the chewing is 
 being done. When thus stimulated to action they 
 pour out an abundant secretion, which becomes in- 
 corporated with the food during mastication, uniting 
 dry particles into a coherent mass. These glands are 
 also active during the movements of the jaw caused 
 by continuous speaking. The parotid gland is the 
 seat of the inflammation in the disease called mumps. 
 The submaxillary glands are more immediately con- 
 cerned in the sense of taste. They are found only 
 in those animals which subsist on food which ap- 
 peals to that sense, being almost entirely absent in 
 the grain-eating birds. They are excited to special 
 activity by the introduction into the mouth of sapid 
 (tasteful) substances. The sublingual glands are par- 
 ticularly stimulated by the act of swallowing. 
 
 The secretion from the parotid glands is a clear and 
 limpid fluid ; that from the submaxillary glands is 
 clear, but thick and viscid ; that from the sublingual 
 is thick, glutinous, and ropy. All are slightly alka- 
 line. 
 
 The function of the parotid glands is supposed to 
 be to moisten the food, and thus, by the aid of 
 mastication, to give it the requisite consistency and . 
 
THE MOUTH. I9 
 
 Convert it into a homogeneous mass ; that of the 
 submaxillary, to promote the solution of soluble sub- 
 stances, in order that they may make an impression 
 upon the nerves of taste ; that of the sublingual, to 
 lubricate the food, and thus facilitate its passage into 
 the pharynx. 
 
 The secretion of the mucous glands of the lips, 
 cheeks, gums, tongue, floor and roof of the mouth, is 
 a more or less viscid, transparent, or somewhat turbid 
 fluid, generally slightly acid. 
 
 These different and distinct secretions all unite to 
 form the fluid ordinarily termed saliva. This mixed 
 fluid is in health inodorous, insipid, slightly viscid, 
 and generally alkaline, but so slightly as to be de- 
 tected only by chemical tests ; it is composed of 
 water holding animal and various earthy matters in 
 solution. It is this mixed fluid by which the cavity 
 of the mouth is kept constantly moistened — a neces- 
 sity, if for nothing else, that the parts may be in 
 proper condition for the purposes of speech. Another 
 important office of the saliva is its dissolving effect 
 upon soluble substances introduced into the mouth, 
 thus bringing them into contact with the nerves of 
 taste, which is essential to the enjoyment of food. 
 It also lubricates the surfaces of the mouth and teeth, 
 and thus prevents the adhesion of food to them. In 
 consequence of its glutinous and frothy character, it 
 imprisons innumerable globules of air along with the 
 
20 THE MOUTH AND THE TEETH. 
 
 food with which it becomes mixed, thus tending 
 greatly to favor the subsequent solution of the latter 
 by the fluids of the stomach. It also coats the masses 
 of food when ready for swallowing, thus favoring their 
 easy transmission to the stomach. To these varied 
 offices must be added another — a certain chemical 
 effect upon the food (changing starch and cane or 
 crystallizable sugar into grape or uncrystallizable 
 sugar), which is the first step in the series of chem- 
 ical processes (digestion) by which the food is pre- 
 pared for the uses of the economy. That the action 
 of the saliva upon starchy foods is of great importance 
 becomes apparent when it is understood that starch 
 as such is insoluble, and would therefore be not only 
 valueless as nutriment, but a positive burden in the 
 alimentary tract, while the sugar into which it is con- 
 verted by the saliva is readily soluble and nutritious. 
 Still another, and a curious as well as important, result 
 of the slight but constant discharge from the mucous 
 and salivary glands, is its direct influence upon the 
 sense of hearing. Its presence, even when unnoticed 
 and during sleep, causes the act of swallowing at short 
 intervals, which effects the opening of the Eustachian 
 tube (a passage leading from the ear to the throat) 
 and permits the renewal of air in the cavity of the 
 middle ear— a condition essential to the maintenance 
 of perfect hearing. A most interesting provision is 
 shown in the fact that a nerve (the chorda tympani), 
 
THE MOUTH. 21 
 
 whose function it is to excite the secretion of saliva, 
 passes through the middle ear, and thus establishes 
 a direct relation between the sense of hearing and 
 the salivary glands, so that certain discordant sounds 
 cause an abundant secretion of saliva, the swallow- 
 ing of which serves by the constant renewal of air 
 to protect the ear from irritation, as before explained. 
 As a result of other curious nervous connections, the 
 salivary secretion, so essential, as has been shown, 
 to the functions of speech and of hearing, is also 
 stimulated by the sight, smell, or even the thought of 
 savory food. The quantity of saliva discharged into 
 the mouth varies with the condition of the food intro- 
 duced, being abundant in proportion to the dryness 
 of the food. Its secretion varies, also, with the vary- 
 ing health of the body. It is much diminished and 
 sometimes almost suspended by fear, anxiety, or other 
 depressing emotions. In diseased conditions of the 
 general system its character is variously modified, 
 becoming acid or excessively alkaline ; acting upon 
 the soft tissues of the mouth, causing ulcerations of 
 the mucous membrane and recession of the gums ; 
 acting upon the hard tissues, causing their disinte- 
 gration. 
 
 Diseased conditions, therefore, of the general sys- 
 tem influence unfavorably the health of the mouth, 
 and notably of the dental organism. In febrile 
 conditions there is more or less suppression of 
 
22 THE MOUTH AND THE TEETH. 
 
 the secretions of the salivary glands, and often a 
 greatly increased and vitiated secretion from the mu- 
 cous glands, which because of its viscidity collects 
 and thickens about the teeth, entangling with it vari- 
 ous extraneous matters and d3ris found in the mouth, 
 its accumulation being favored by the fact that during 
 illness the usual cleansing of the mouth and teeth by 
 thorough rinsing and the brush is neglected ; and, as 
 ordinarily at such times there is but slight demand for 
 food, and especially for food requiring mastication, 
 the deposit is left undisturbed and soon undergoes 
 fermentation, becoming strongly acid. Thus it often 
 happens that during a severe illness very serious in- 
 roads are made upon the integrity of the structures 
 of the teeth, which are attributed frequently and 
 erroneously to the medicine taken. It follows, there- 
 fore, that during sickness these untoward influences 
 should be combated with more than ordinary care. 
 Such care is suggested not only by the rapidly de- 
 structive effects of the vitiated salivary and mucous 
 secretions upon the teeth, but by the vicious circle 
 thus established ; the products of the deranged action 
 of these glands not only creating local mischief, 
 but causing an irritation of the mucous membrane of 
 the alimentary tract, and by this means, as well as by 
 their presence, resulting in an impairment of the di- 
 gestive fluids. The exhalations from a diseased mouth 
 may also produce an injurious eff'ect upon the bron- 
 
THE MOUTH. 2$ 
 
 chial tubes and lungs, and through them upon the 
 blood. 
 
 Sometimes, and owing to various causes, such as 
 wounds, burns, abscesses, or dead and ulcerated roots 
 remaining in the mouth, the continuity of the ducts 
 or tubes of the salivary glands is destroyed, and false 
 openings upon the cheek, chin, or throat result. In 
 such cases the secretion is discharged through the 
 false opening, and poured over the external parts. 
 Sometimes also, from similar or other causes, these 
 ducts become obstructed, in which case the secretion, 
 continuing and finding no means of escape, distends 
 the tissues, and forms a soft tumor called a ''ranula," 
 generally upon the lip, or upon the floor of the mouth 
 beneath the tongue. Such conditions require, of 
 course, surgical interference for their cure. 
 
 The gum is a thin, compact, tough, elastci, fibrous 
 tissue enveloping the alveolar processes, and surround- 
 ing the teeth at their necks. It is continuous with 
 the mucous membrane which lines the inside of the 
 lips and cheeks and the floor and roof of the mouth, 
 and at the necks of the teeth with the membrane 
 (called the pericemcnticm) which lines their sockets 
 and also invests their roots. In a healthy condition 
 the gum has comparatively little sensibility, bearing 
 without irritation the friction to which it is subjected 
 in mastication. This insensibility is also evidenced 
 by the immunity from pain when the gums are used 
 
24 
 
 THE MOUTH AND THE TEETH. 
 
 in chewing, by the child before the eruption of teetli 
 
 and by those wlio have suffered the loss of their teeth. 
 
 Fig. I. shows one-half of the upper jaw. The 
 
 upper jaw — called the sii- 
 perior inaxilla — is formed 
 by two bones united in the 
 central, or median, line of 
 the face. Each of these 
 bones contributes to the for- 
 mation of three cavities — 
 the roof of the mouth, the 
 outer wall and floor of the 
 nose, and the floor of the 
 socket (the orbit) of the eye. 
 Each upper jawbone has 
 a triangular - shaped cavity 
 called the antrum (a cave) ; the floor of which is 
 sometimes perforated by the roots of the teeth if they 
 are unusually long. The upper jaw is tightly wedged 
 in by the outer bones of the face, and has no power 
 of motion — the teeth of the upper jaw presenting a 
 fixed surface, against which those of the lower are 
 brought to bear in mastication. That part of the 
 upper jaw which carries the incisor teeth has a sepa- 
 rate centre of development, and in early intra-uterine 
 life in man is a separate bone called the "incisive" 
 or "intermaxillary" bone. It remains a separate 
 bone in most adult mammals, but is generally closed 
 
THE MOUTH. 
 
 25 
 
 in man. Occasionally the fissure between this bone 
 and the upper jaw is not closed on one side or both. 
 This deformity is called "cleft-palate." When the 
 fissure is in the lip only, it is called '•' hare-lip," from 
 its resemblance to the grooved lip of the hare. The 
 anatomical development explains why this is never in 
 the middle line, but always on one side, or in case of 
 ''double hare-lip" on both. Hare-lip often exists 
 alone, but where the palate is cleft the lip is apt to 
 be so too, though this is not always the case. 
 
 The lower jaw — called the itiferior maxilla, or 
 mandible (shown in Fig. 11.) — is the largest and 
 strongest bone of the face. It consists of a curved hor- 
 izontal portion (the 
 body), and two up- 
 right portions called 
 the rami (singular, 
 ramus — a branch). 
 In infancy these up- 
 right portions form 
 an obtuse angle with 
 the horizontal por- 
 tion ; in the adult, 
 almost a right angle, 
 
 the angle becoming again obtuse in old age. 
 these modifications in the lower jaw which to a large 
 degree give the characteristic forms to the face in in- 
 fancy, in maturity, and in old age. Fig. III. shows the 
 3 
 
 Fig. II. 
 
 It is 
 
26 
 
 THE MOUTH AND THE TEETH. 
 
 relative forms of the lower jaw at these three periods 
 of life. A canal of considerable size runs through the 
 body of the lower jaw, giving space for the passage of 
 
 blood-vessels and 
 
 nerves for the sup- 
 ply of the teeth. 
 These pass out 
 through openings 
 beneath the bicus- 
 pid teeth on either 
 side (shown in Fig. 
 III.), and are dis- 
 tributed to the chin, 
 1 wer lip, and gum 
 / of the lower jaw. 
 The closure of the 
 jaws is effected by 
 f ur pairs of strong 
 luuscles — two at- 
 tached to the outer 
 and two to the inner 
 
 Fig. III. 
 
 side of the rami of the lower jaw. The peculiar ar- 
 ticulation or jointing of the lower jaw in man allows 
 of a great variety of movements, in keeping with the 
 diversified character of his food, as well as with other 
 and varied uses. 
 
 The alveolar processes consist of two plates of bone, 
 an outer and an inner, forming borders to the jaws 
 
THE MOUTH. 
 
 27 
 
 and supports to the gums. These are connected by 
 transverse plates, dividing the space into numerous 
 cavities which form the sockets of the teeth. An 
 upper jaw from which the teeth have been recently 
 extracted is il- 
 lustrated in Fig. 
 IV. The edges 
 of the alveolar 
 processes dip 
 down between 
 the teeth, so that 
 their margin 
 presents a fes- 
 tooned appear- 
 ance. At the 
 bottom of each socket there is an opening to admit 
 the passage of the blood-vessels and nerves of the 
 teeth. After the loss of the teeth the alveolar pro- 
 cesses are absorbed and disappear ; so that the roof 
 of the mouth generally loses its arched appearance 
 and becomes nearly flat, and the lower jaw assumes 
 the peculiar form characteristic of old age. When 
 the processes are carious or have been absorbed, the 
 teeth become loose and have to be removed. 
 
 The pericementum is a tough, fibrous tissue which 
 invests the roots of the teeth and lines their sockets. 
 The cementum or outer layer of the roots receives 
 its nourishment through it. It is owing to this fact 
 
 Fig. IV. 
 
28 THE MOUTH AND THE TEETH, 
 
 that after the death of its pulp a tooth still possesses 
 a certain amount of vitality, and is therefore re- 
 tained in its socket, — frequently for years, — which 
 would not be the case if it did not hold a vital rela- 
 tion to the jaw. The pericementum, moreover, while 
 attaching the teeth firmly to their sockets, serves as an 
 elastic pad or cushion, preventing to a considerable 
 extent the damaging effects upon the teeth which 
 would otherwise be experienced from accidental blows 
 or other violence, as well as from the thoughtless and 
 unnecessary voluntary injury by efforts to crack nuts, 
 untie knots, and other like foolish procedures. 
 
 The movements of the masticatory apparatus of the 
 human being are more complex and more varied than 
 of any other animal, resembling those of both the 
 flesh-eating and grazing species, showing, as does 
 also the comparative anatomy of the teeth, that the 
 human race is adapted to live on a mixed diet. 
 The process of mastication, which is one of very great 
 importance, consists in dividing and comminuting 
 the food by the teeth, reducing it to a state of com- 
 plete disintegration, which is a necessary condition 
 for its insalivation — the mixture of the food with the 
 fluids of the mouth — and subsequently for the action 
 of the digestive fluids of the intestinal tract. Food 
 is more or less easily digested in proportion as it has 
 undergone thorough mastication. To appreciate this 
 fact, it must be remembered that stomach digestion 
 
THE MOUTH. 
 
 29 
 
 is chiefly chemical. It will, therefore, be readily un- 
 derstood that the more finely the food is divided 
 before it is brought into contact with the digestive 
 fluids, the larger will be the surface exposed to their 
 action, and consequently the more easily will it be at- 
 tacked and the more speedily will it be dissolved, just 
 as any solid is more readily dissolved if first ground 
 to a powder. It is not easy to overrate the importance 
 to the digestive process of a thorough preliminary 
 mastication. Masses of food introduced into the 
 stomach may remain for a long time — days, even 
 weeks — undissolved, disturbing its functions and 
 undergoing fermentative and putrefactive changes, 
 caused by warmth and moisture, creating gases and 
 acids, and, if not expelled by vomiting, becoming a 
 source of irritation and disturbance in its course 
 throughout the whole length of the intestinal tract. 
 In fact, if mastication is not properly performed, 
 the subsequent process of digestion is likely to be 
 deranged. There is no more common cause of indi- 
 gestion or dyspepsia than imperfect mastication ; no 
 more fruitful source of headache, neuralgia, nausea, 
 heartburn, flatulence, cramp, diarrhea, dysentery, and 
 various other disorders. Indigestion, largely induced 
 by imperfect mastication, is the prevailing malady 
 of civilized life — probably the occasion of more dis- 
 orders than can be traced to any other one cause. 
 The result is, of course, the same, whether the fault 
 3* 
 
30 THE MOUTH AND THE TEETH. 
 
 lies in the haste with which the food is swallowed 
 without proper mastication, or whether the mastica- 
 tory apparatus be defective. There is no question that 
 in many cases an increase of longevity is fairly at- 
 tributable to the improved facilities for mastication 
 secured by proper attention to the natural teeth, or in 
 case of their loss by the use of artificial teeth. It 
 should be remembered that when, owing to imperfect 
 mastication, the food is passed into the stomach in a 
 crude state, and therefore unfit for digestion, the teeth 
 themselves suffer by reason of the resulting vitiation 
 of the digestive fluids, which by regurgitation exercise 
 an injurious influence upon tooth -structure. Another 
 argument in favor of thorough mastication is to be 
 found in its directly beneficial effects upon the teeth ; 
 for, although these organs serve the purposes of vo- 
 calization, ornamentation, etc., there can be no doubt 
 that their chief office is the mastication of food. 
 Neither can there be any doubt that the neglect to 
 exercise this special function impairs their vitality, 
 as the disuse of any organ, sense, or structare of the 
 body results in its degeneration and gradual loss of 
 power. A tooth having lost its antagonist — that is, 
 the tooth which opposed it in mastication — will gen- 
 erally elongate or rise beyond the line of its fellows, 
 as though in search of an opposing force ; from which 
 it appears that the pressure exerted upon the teeth 
 during use in mastication is essential to their retention 
 
THE MOUTH. 3 I 
 
 in a healthy condition in the jaws. The teeth are 
 strengthened in their attachments and in their vital 
 relations to the jaws by exercise. There is, therefore, 
 in the case of teeth not properly exercised, a lessened 
 nutritive supply, both through the pulp and through 
 the membrane which gives vitality to the roots. 
 Nor can the use of the brush and powder compen- 
 sate for the important service which the habitual, 
 thorough mastication of food accomplishes in secur- 
 ing cleanliness of the surfaces of the teeth ; the tritu- 
 ration of food effecting that which one is utterly 
 unable to do with the brush. In addition to the of- 
 fices of the teeth in ornamentation, in their mechan- 
 ical functions, in their relation to the articulation 
 and- modulation of sound, they serve another and 
 important purpose as conservators of the lungs and 
 the organs of voice, preventing the breath in the act 
 of speaking from being exhausted too rapidly. Per- 
 sons who have lost their teeth find continued speak- 
 ing, as in conversation, difficult, because each utter- 
 ance empties the mouth of air, and more rapid 
 breathing is required to keep up the supply. This 
 effort soon becomes fatiguing ; causes a feeling of 
 weakness and distress, and is apt to produce an irrita- 
 tion of the larynx and a chronic cough. The cough 
 in turn increases the irritation, and thus a vicious 
 circle is established which may involve the bron- 
 chial tubes and the lungs, and result in serious dis- 
 comfort and even in dangerous complications. 
 
CHAPTER III. 
 
 ANATOMY OF THE TEETH. 
 
 THE animal kingdom exhibits a wonderful diver- 
 sity in the dental structures of its various classes, 
 corresponding to an equal diversity in the uses re- 
 quired of them by the instincts and necessities of 
 the animal. Their conformation indicates so defi- 
 nitely the species in which they are found that they 
 are accepted as one of the best means of classifica- 
 tion, showing the distinguishing peculiarities of the 
 animals to which they respectively belong. 
 
 The teeth in man are hard, bone-like structures 
 implanted in sockets along the jaws, and are in- 
 tended to fulfil various useful purposes. Two sets of 
 teeth are developed in the human mouth — the first 
 called the deciduous, temporary, or milk teeth; the 
 second, the permanent set. 
 
 A tooth consists of enamel, cementum, dentine, and 
 
 dental pulp. The exposed part — that above the gum 
 
 — is called the croivn ; that wliich is held within the 
 
 socket, the root ; and the narrow part between the 
 
 crown and the root, the neck. 
 
 32 
 
ANATOMY OF THE TEETH. 33 
 
 The enamel is the cap or covering of the crown. 
 It is the hardest tissue of the body. It is thickest 
 on the cutting edges and masticating surfaces, gradu- 
 ally becoming thinner towards the neck, at which 
 point it is met or slightly overlapped by the cementum. 
 The enamel is possessed of very slight if 
 of any sensibility. It contains not more \ 
 than four per cent, of animal matter, and 
 is almost entirely soluble in acids. Under 
 the microscope it is found to consist of 
 parallel fibres or rods lying side by side ^^§^' ^' 
 — generally hexagonal, but some nearly circular, and 
 others nearly square. A transverse section of enamel 
 fibres is shown in Fig. V. 
 
 The cementum is a layer of hard tissue covering the 
 roots of the teeth. It is intermediate in hardness 
 between dentine and bone, resembling the latter more 
 than either of the other hard tissues found in a tooth. 
 It is thickest at the terminus of the root, gradually 
 diminishing until it seems to unite with or slightly 
 overlap the enamel at the neck of the tooth. 
 
 The dentine, or so-called ivory, constitutes the bulk 
 of the tooth. It is, so to speak, its framework, giving 
 each tooth its size and shape. If the enamel and 
 cementum were removed, the dentine would still pre- 
 serve the general form of the tooth. It is commonly 
 but erroneously called tooth-bone. It contains over 
 one-fourth of animal matter, and when subjected to 
 
 C 
 
34 THE MOUTH AND THE TEETH. 
 
 the action of acids the earthy matter is dissolved out, 
 leaving a cartilage-like mass retaining the form of the 
 tooth. Examined microscopically, it is found to con- 
 sist of innumerable tubes of a diameter of about 45^0 
 of an inch. It is usually highly sensitive both to 
 variations of temperature and to contact with foreign 
 substances, making the excavation of a cavity in a 
 tooth, preparatory to filling, more or less painful. It 
 is more sensitive just beneath the enamel than in its 
 deeper portions. It owes nearly all its sensitiveness, 
 however, to the pulp of the tooth, and when the pulp 
 dies the dentine loses almost all, if not all, of its 
 sensibility. 
 
 The pulp, commonly but incorrectly called the 
 nerve, occupies a cavity in the centre of the tooth and 
 corresponds to its general form. This pulp is the 
 uncalcified portion of the original germ of the tooth. 
 From this the dentine was developed, the pulp being 
 gradually converted into that substance up to a certain 
 point, when the process of calcification or deposit of 
 earthy matter ceased, leaving a cavity occupied by 
 what was left of the pulp. The pulp is a mass com- 
 posed of nerves and blood-vessels held together by 
 a cobweb-like connective tissue. It is acutely sensi- 
 tive not only to contact with foreign substances, but 
 to variations of temperature. The pulp supplies nour- 
 ishment to the tooth. When it dies the tooth loses 
 its translucency, the dentine loses its sensibility and 
 
ANATOMY OF THE TEETH. 
 
 35 
 
 gradually changes in color. Nerves and blood-vessels 
 enter through the minute opening at the extremity of 
 the root, and pass through the small canal in the root 
 to the pulp cavity. With the exception of this small 
 aperture, the pulp is entirely surrounded by solid den- 
 
 Fig. VI. Fig. VII. Fig. VIII. 
 
 tine. Figs. VI. and VII. represent a central incisor 
 and a molar, split vertically so as to show their various 
 parts. A is the cutting edge or grinding surface, 
 covered, as is the entire crown, with enamel ; B, 
 the cementum covering the roots ; C, the dentine ; 
 D, the pulp cavity. Fig. VIII. shows a transverse 
 section of a molar, of natural size, in which i is the 
 dentine ; 2, the enamel ; 3, the pulp cavity. 
 
 The teeth do not change in shape or increase in 
 size after they are erupted, though their tissues gradu- 
 ally become denser and harder. The crowns are 
 completed as to size and form before their eruption. 
 The roots, however, are not completed at that time, 
 and, instead of a conical termination with a minute 
 
36 THE MOUTH AND THE TEETH. 
 
 opening at the end of the root, the aperture is quite 
 large. The enamel, which when fully hardened will 
 strike sparks with steel, is still comparatively soft. 
 It undergoes a gradual process of hardening after the 
 eruption of the tooth; but this is the only change 
 except that of decay — for, although it contains a 
 small proportion of animal matter, and is therefore 
 of necessity nourished, there is not a sufficient nutri- 
 tive supply for its repair or renewal, and consequently 
 when once destroyed, either by disease or accident, 
 it cannot be restored. 
 
 Classification of the Teeth. — The permanent 
 set of teeth consists of thirty-two — sixteen in each 
 jaw. Those in the upper jaw are called the supe- 
 rior; those in the lower, the inferior. They are 
 divided into four classes, viz., incisors, cuspids, bi- 
 cuspids, and molars. Fig. IX. represents the per- 
 manent teeth — superior and inferior — of the left 
 side. The incisors — four in each jaw — are so called 
 from the Latin word incidere (to cut), on account of 
 their sharp edges. This class is subdivided into cen- 
 tral incisors, because of their position in the centre of 
 the arch, and lateral incisors, because they stand on 
 either side of the centrals. The second class com- 
 prises four teeth — two in each jaw — called cuspids or 
 cuspidati (singular, cuspidatus), from the Latin word 
 cuspis (a spear), because they terminate in a point. 
 They are comrhonly known by the name of canines. 
 
ANATOMY OF THE TEETH. 37 
 
 Fig. IX. — Permanent Teeth of the Left Side. 
 4 
 
38 THE MOUTH AND THE TEETH, 
 
 or those of the upper jaw as eye teeth, and those of 
 the lower jaw as stomach teeth. They are situated on 
 the outer side of each lateral incisor. The third class 
 comprises eight teeth — four in each jaw — called bi- 
 cuspids or bicuspidati (singular, bicuspidaius), from 
 the Latin words bis (twice) and cuspis (a spear) — 
 double-pointed. They are sometimes designated as 
 pre-molars or half-molars. They are situated imme- 
 diately behind the cuspids, holding an intermediate 
 relation to them and the molars, and are known 
 as the first and second bicuspids. The fourth class 
 consists of twelve teeth — six in each jaw. They are 
 called molars — Latin, molares (singular, 7nolaris) — 
 from molere (to grind, as in a mill). They are situ- 
 ated back of the bicuspids, and are known as the 
 first, second, and third molars. The first, because 
 of the time of their eruption, are called the sixth- 
 year molars ; the second, for the same reason, are 
 known as the twelfth-year molars ; and the third, for 
 a like reason, are denominated the dentes sapiential 
 (singular, dens sapientiae), or wisdom teeth — from 
 the Latin words dens (a tooth) and sapientia (knowl- 
 edge or wisdom), the teeth of wisdom — because they 
 are not erupted until the individual has reached ma- 
 turity. 
 
 The incisors are double-wedge shape — widest at 
 the cutting edge, thickest at the neck, slightly con- 
 cave on the inner and slightly convex on the outer 
 
ANATOMY OF THE TEETH. 39 
 
 surface. The superior or upper are larger than the 
 inferior or lower incisors, and the central incisors are 
 wider than the lateral. In the case of the inferior 
 incisors, the laterals are wider than the centrals. The 
 incisors, both superior and inferior, have each but one 
 root. The use of these teeth in eating is to '' bite " 
 or cut off a portion of food, operating on the same 
 principle as a pair of scissors. The cuspids are less 
 concave on the inner surface, and more conv^ex on the 
 outer surface than the incisors, and terminate in a 
 point. They have but one root, but this is longer 
 and stronger than that of any other tooth in the 
 mouth. The superior cuspids are larger and have 
 longer roots than the inferior. The use of the cuspids 
 is to seize and tear or lacerate obstinate substances 
 preparatory to mastication. It is an interesting fact 
 that these teeth are more prominent in proportion 
 as the animal approaches the purely carnivorous or 
 flesh-eating class, and are never found in an animal 
 having horns. The bicuspids are smaller than the 
 cuspids, convex on both outer and inner surfaces, and 
 flattened on the sides. Their long diameter is across 
 the jaw. The roots are conical. Tlie inferior have 
 but one root; the superior sometimes a single root, 
 often deeply grooved, and sometimes entirely divided 
 — bifid. The molars have large grinding surfaces, 
 divided by grooves into cusps or points. The crowns 
 of the inferior are larger than those of the superior. 
 
40 THE MOUTH AXD THE TEETH. 
 
 In each jaw they decrease in size from before back- 
 ward. The superior first and second molars have as a 
 rule three roots each. The inferior first and second 
 molars have each two roots, which are often deeply 
 grooved, and sometimes bifid. The third molars or 
 wisdom teeth of both jaws have but a single root 
 
 each, though this is sometimes divided into three in 
 the upper jaw and two in the lower. The inferior 
 third molar is larger than the superior. 
 
 The deciduous or temporary teeth are much smaller 
 than the permanent, although the roots are generally 
 larger and longer in proportion to the size of the 
 
ANATOMY OF THE TEETH. 4 1 
 
 crowns than those of the adult set. There are only- 
 twenty teeth in the deciduous set — four incisors, two 
 cuspids, and four molars in each jaw. Fig. X. rep- 
 resents the temporary teeth — superior and inferior — 
 of the left side. There are no bicuspids and no third 
 molars or wisdom teeth in the temporary set. Four 
 bicuspids and two wisdom teeth in each jaw — twelve 
 in all — which are not in the deciduous or temporary 
 set, make the permanent set to consist of thirty-two 
 teeth. 
 
 The surfaces of the teeth which are towards the 
 lips are called "labial; " towards the cheeks, "buc- 
 cal; " towards the tongue on the lower jaw, "lin- 
 gual," and towards the roof of the mouth on the 
 upper jaw, "palatal." The surfaces next to each 
 other are called " proximate ; " those looking towards 
 the centre, "mesial," and those looking from the 
 centre, "distal." The parts of the six front teeth 
 of both jaws which come in contact with each other 
 are called the "cutting edges," and the broad sur- 
 faces of the bicuspids and molars which are brought 
 in contact in the act of masticating are called the 
 "grinding or articulating surfaces." 
 
 Arrangement of the Teeth. — The teeth in man 
 are arranged in close contact, without intervening 
 spaces, affording each other mutual support after the 
 manner of staves in a barrel. Being set without in- 
 terspaces on a curved line, it follows that their outer 
 4* 
 
42 THE MOUTH AND THE TEETH. 
 
 surfaces are wider than the inner. The upper arch 
 is larger than the lower, and from this fact the in- 
 cisors and cuspids of the upper jaw, when the mouth 
 is closed, overhang or shut in front of the lower teeth. 
 The upper central incisors are broader than the lower, 
 during occlusion causing the teeth on either side 
 
 of them to be thrown out of exact correspondence 
 with those of the lower jaw occupying the same rela- 
 tive positions, thus bringing about an irregularity of 
 opposition, like that called by bricklayers "breaking 
 joints" — so that each tooth, instead of being antag- 
 onized by a single tooth, is met by portions of the 
 
ANATOMY OF THE TEETH. 43 
 
 surfaces of two teeth, as illustrated in Fig. XI, Further 
 back in the arch the difference is harmonized by an 
 increase in the size of the molars of the lower jaw 
 beyond that of the upper, which brings the arches out 
 even. This irregularity of opposition of the upper 
 and lower sets is a valuable feature, as when a tooth 
 is lost from the arch in either jaw the opposing tooth 
 is not rendered useless, as it would be if the teeth 
 were in perfect opposition with one another, because 
 it is brought at least partially into contact, during 
 mastication, with the tooth which adjoined the miss- 
 ing one. 
 
 In rabbits and other ''Rodents" the teeth grow 
 constantly in length, in order to repair the waste due 
 to their use in gnawing. A curious result follows the 
 loss of one of the incisor teeth in these animals. 
 The opposite remaining tooth not being worn away, 
 grows to such a length as to prevent gnawing, and so 
 causes the death of the animal by starvation. 
 
CHAPTER IV. 
 
 DEVELOPiMENT OF THE TEETH. 
 
 THE development of the teeth is one of the most 
 curious and interesting of the processes of growth 
 in the body. At about the seventh week of fetal life, 
 small gelatinous bodies, which are the tooth pulps, are 
 distinguishable in the jaws ; and at about the tenth 
 week the germs or developing pulps of all the tem- 
 porary teeth — twenty in number — are in position. 
 These germs gradually increase in size, assuming the 
 shapes of the teeth which they are to form. Mean- 
 while, the enamel and the cementum are being formed, 
 each from a separate matrix or mother: the alveolar 
 processes are being built along and across the jaws, 
 dividing the pulp of each tooth from its fellow, and 
 providing a separate socket for each root, so that 
 when matured they will afford firm support to the 
 teeth. At the same time, the different membranes 
 which are to line the sockets and cover the roots of 
 the future teeth, those which are to cover the jaw- 
 bones, and those to cover the gums externally, are 
 also developing. 
 
 44 
 
DEVELOPMENT OF THE TEETH. 45 
 
 When the pulps have attained proper dimensions, 
 representing the forms of the future teeth, they are 
 gradually, by a process known as calcification, par- 
 tially converted into the dentine, which forms the 
 largest portion of the bulk of each tooth ; the enamel 
 which is to protect the crowns and the cementum to 
 cover the roots continuing to be deposited. At 
 birth the forms of the crowns have been fully de- 
 veloped, though the roots are as yet but partially 
 formed ; these latter being the result of the elongation 
 of the pulps and the deposit of dentine and cementum. 
 The alveolar processes are gradually built up, and, 
 after they have reached a sufficient height above the 
 crowns of the teeth, their edges approximate so as 
 to partially close them in and form bony cells, within 
 which the further development of the teeth is con- 
 tinued. 
 
 During the development of the deciduous or tem- 
 porary teeth there appears, at about the fourth month of 
 fetal life, a second set of little gelatinous bodies, which 
 are the germs of the second or permanent teeth. Of 
 these, first in order of appearance are those of the 
 first or sixth-year molars (to be erupted when the child 
 is about six years of age) ; next, those of the central 
 and lateral incisors (to be erupted at about the eighth 
 year of age) ; then those of the cuspids (canines or 
 eye teeth) ; then the first and the second half-molars 
 (bicuspids). Thus, at birth we find in the jaws the 
 
46 THE MOUTH AND THE TEETH. 
 
 twenty deciduous or temporary teeth all in a state of 
 forwardness, and also the germs of twenty-four of the 
 permanent set in various stages of development. The 
 germs of the second or twelfth-year molars do not 
 make their appearance until three months after birth, 
 and those of the third molars (wisdom teeth) not un- 
 til the child is about three years of age. The process 
 of calcification of the twelfth-year molars does not 
 commence until the child is about three years of age, 
 and that of the wisdom teeth not until about the 
 twelfth year. 
 
CHAPTER V. 
 
 ERUPTION OF THE TEMPORARY TEETH. 
 
 AT about the fifth month after birth the process 
 known as the eruption of the teeth begins — a 
 double process, consisting of the gradual elongation 
 and rising of the teeth, and the coincident absorp- 
 tion of the hard and soft tissues overlying them. The 
 alveolar borders are the first to show signs of the 
 absorptive process by a dissolution or melting of their 
 approximated edges, thus gradually making a wider 
 space for the advancing teeth. These, rising in their 
 sockets — the roots meanwhile lengthening — press 
 upon the overlying gums, which, becoming thinner 
 and thinner, finally allow the escape of the imprisoned 
 teeth. It is not, therefore, as the common expression 
 of *' cutting the teeth " would indicate, a process of 
 laceration, tearing, or cutting, but of removal of im- 
 peding tissue by absorption, which allows the passage 
 of the teeth through the gums. There is no absolute 
 uniformity either as to the time or the order of erup- 
 tion. The rule is that the lower teeth precede the 
 upper of the same class two or three months ; but 
 
 47 
 
48 
 
 THE MOUTH AND THE TEETH. 
 
 not infrequently the upper precede the lower by the 
 iame difference in time. Again, the rule is that 
 the teeth are erupted in pairs, with an interval 
 between the different pairs; but occasionally a 
 
 single tooth will 
 
 3 _ ^/r^^^^^^i. ^ appear a con- 
 
 * ^^ siderable time 
 
 before its fel- 
 low, and in 
 other cases two 
 or three pairs 
 will erupt coin- 
 cidently. Fig. 
 XII. illustrates 
 an upper de- 
 Fig. XII. ciduous or tem- 
 porary set of 
 teeth, of which five are on each side. The usual order 
 of their eruption is as follows : — 
 
 2 Central incisors (Nos. i) between the 5th and 8th months. 
 
 2 Lateral incisors ( " 2) " " 7th " loth ** 
 
 2 Canines ( " 3) " *' 12th " i6th " 
 
 2 First molars ( " 4) " " 14th " 20th " 
 
 2 Second molars ( " 5) " " 20th " 36th " 
 
 The lower set consists of the same number of teeth, 
 known by the same names. They appear, as a rule, 
 in the same order as the upper teeth, generally pre- 
 
ERUPTION OF THE TEMPORARY TEETH. 
 
 49 
 
 ceding the latter by a few weeks. Fig. XIII. is a side 
 view of a child's lower jaw. The teeth in Fis;s. XII. 
 
 Fi-. xin. 
 
 and XIII marked 6 do not belong to the temporary 
 set. They will be treated of in a separate chapter — 
 "The Sixth-Year Molars." 
 5 I> 
 
CHAPTER VL 
 
 DIFFICULT DENTITION. 
 
 THE eruption of the teeth is a natural process 
 which, under conditions in every way favorable, 
 may take place with little or no disturbance or dis- 
 comfort to the child. When the growth of the teeth 
 and absorption of the guras proceed in perfect accord, 
 the teeth may be erupted without attracting the atten- 
 tion of even a watchful mother. But comparatively 
 few such instances occur. It is rare for a child to 
 pass through the period of dentition without more or 
 less manifestation of suffering, and frequently there 
 are serious and alarming disturbances of its health. 
 It is a well-known fact that this is the period of great- 
 est mortality among children. It is true that during 
 the same period other and important changes are 
 taking place in the organization of the child, especially 
 in the stomach and intestinal tract, which are intended 
 to prepare them to receive and digest solid food — 
 changes which may be said to be concordant with the 
 development of the masticatory apparatus. Doubt- 
 less, these concurrent changes exercise their full share 
 
 50 
 
DIFFICULT DENTITION. 5 1 
 
 in producing constitutional disturbances at this epoch. 
 This, however, makes it only more imperative that 
 the child shall have even more than usual hygienic 
 care and freedom from all avoidable disturbing in- 
 fluences j for whatever tends, by modifying the gen- 
 eral health unfavorably, to lower the resisting power 
 of the organism, may readily convert the natural and 
 otherwise easy course of dentition into one of pain 
 and danger. 
 
 There is certainly during the period of dentition 
 an increased susceptibility to nervous and digestive 
 troubles, requiring more than ordinary watchfulness 
 of the child on the part of the mother. Causes which 
 at other times have no appreciable effect may then be 
 fraught with danger. An exposure to cold, an attack 
 of indigestion — anything which introduces inhar- 
 mony into the functions of the animal life — may 
 result in a disturbance of the processes of dentition. 
 
 Difficult dentition may therefore be charged with 
 causing or aggravating various disorders, as these on 
 the other hand may be reasonably suspected of inter- 
 fering with the natural eruption of the teeth. It is 
 certainly unsafe to ignore the complications possibly 
 due to dentition, if any derangement of the health 
 of the child occur during the period when the teeth 
 are erupting. 
 
 As a rule the amount of irritation holds a relation 
 to the number of teeth advancing simultaneously; but, 
 
52 THE MOUTH AND THE TEETH. 
 
 owing to the varying susceptibility of individuals, a 
 single tooth may cause more disturbance in one case 
 than a half dozen will in another. 
 
 At the commencement of the eruption of the teeth 
 there is generally an increased flow of saliva, which 
 keeps the mouth moist and cool. When the irrita- 
 tion increases, and the mouth becomes hot and dry, 
 other derangements are likely to follow : the child 
 becomes feverish ; constipation or diarrhea ensues — 
 the latter, if not too severe or too protracted, being 
 beneficial, however, rather than hurtful, but requir- 
 ing nevertheless great care that it does not itself be- 
 come a source of danger. An unusual redness of one 
 or both cheeks, sometimes changing from one to the 
 other, is a frequent symptom of nervous disturbance. 
 Eruptions are apt to appear, usually on the cheeks, 
 but sometimes on the head, or even over the whole 
 body, and ulcerations on the tongue, gums, lips, or 
 on the inside of the cheeks. Itching of the nose, 
 twitching of the muscles, dilatation of the pupils, 
 uneasiness and fretfulness, restless sleep or wakeful- 
 ness, thirst and loss of appetite, are evidences of in- 
 creasing irritation, which, if not relieved, will be 
 followed by more active manifestations. The child 
 becomes cross, resentful, moans when asleep, cries 
 persistently when awake, or, if quiet for an instant, 
 will be found chewing its thumb or fingers, which 
 operation seems to afford a momentary cessation of 
 
DIFFICULT DENTITION. 53 
 
 anguish — but only momentary. It throws down its 
 toys as though in a passion, refuses to be amused, and 
 treats all effort to divert it as an indignity ; com- 
 presses its lips, corrugates its brow, shows an intoler- 
 ance of light, pulls at its hair or ears, slaps or scratches 
 its nurse, refuses its food, or vomits it as soon as swal- 
 lowed. Further manifestations of increased consti- 
 tutional disturbance are likely to appear in persistent 
 and copious diarrhea, nausea, high fever, and not 
 infrequently convulsions. 
 
 There is reason to believe that earache is often as- 
 sociated with and dependent upon the difficult erup- 
 tion of one or more teeth, and that, apart from the 
 aggravation of the fever and the increased liability 
 to convulsions incident to this added anguish, there 
 is also the possibility of the loss of hearing (entail- 
 ing in young children the loss of speech), from the 
 congestion and inflammation which result. But this 
 is not the only, indeed not the chief, danger; the 
 inflammation is liable to extend to the membranes of 
 the brain ^nd end in death. The facility with which 
 an irritation originating in the mouth may be con- 
 tinued to the ear, and thence to the brain, can only 
 be understood by a recognition of the intimate rela- 
 tions w^iich exist — especially in the infant — between 
 the parts concerned, and of their elaborate nervous 
 connections ; but the danger is a real one, and should 
 5* 
 
54 THE MOUTH AND THE TEETH. 
 
 never be lost sight of in the treatment of a child suffer- 
 ing from teething. 
 
 The usual indications in the mouth of the advance- 
 ment of the teeth are increased heat, redness, swelling 
 and hardness of the gum, and later the peculiar white- 
 ness caused by the pressure of the coming tooth. 
 Sometimes the swelling takes the form of a little 
 tumor, like a boil, on the edge of the gum ; in other 
 cases an ulceration will form over the presenting tooth. 
 In all such conditions the gums are very tender, so 
 sensitive that the lightest touch will cause pain, and 
 the child, on attempting to take the breast, will jerk 
 back its head — a maneuver which is frequently mis- 
 taken as an evidence of colic. A little watchfulness 
 on the part of the nurse will enable her to distinguish 
 the difference between the indications of the two 
 troubles. 
 
 Sometimes, however, the irritation of dentition 
 may produce the most serious constitutional derange- 
 ments without any local manifestations. That such 
 may be the case is apparent when the conditions of 
 the parts concerned are understood. The troubles of 
 dentition are caused to some extent, doubtless, by the 
 direct pressure of the advancing teeth, and the conse- 
 quent irritation of the nerves of the gums ; but this 
 is not the only, nor, it is believed, the principal fac- 
 tor in the disturbance. It must be borne in mind that 
 at the time of eruption the roots of the teeth are not 
 
DIFFICULT DENTITION. 55 
 
 yet complete ; that, instead of the conical termi- 
 nation and minute opening which characterize the 
 root of the perfected tooth, the aperture is quite 
 large, and its edges thin and sharp. In estimating, 
 therefore, the mischief which may result because 
 of a lack of accordance between the eruption of 
 a tooth and the absorption of the tissues which 
 impede it, we may imagine the sensitive nerve — 
 which, when exposed by decay, is so intolerant of 
 contact even with the atmospheric air — held be- 
 tween the bony socket and the sharp edge of the in- 
 complete root by the backward pressure of the re- 
 sisting gums, thus giving rise to a true toothache, 
 comparable only to that exquisite torture which is 
 experienced in after-life from an exposed and irri- 
 tated pulp. It is not difficult to comprehend that 
 a free division of the gum over the tooth or teeth thus 
 situated may, by removal of the pressure, give imme- 
 diate and complete relief. This simple operation of 
 dividing the gum over the teeth which are next in 
 the order of eruption is surely justified by local mani- 
 festations such as have been specified ; it is also sug- 
 gested by the occurrence of the usual symptoms of 
 difficult dentition, even when there does not exist a 
 single local indication in the mouth. Under such 
 circumstances it would seem proper to give the child 
 the benefit of the doubt by free incisions over the teeth 
 whose eruption is, in accordance with general expe- 
 
56' THE MOUTH AND THE TEETH 
 
 rience, to be anticipated — especially as the operation 
 causes only a trifling amount of pain, inflicts no in- 
 jury, and is practically free from danger. 
 
 The objections which are generally made against 
 lancing may be summed up as follows : That it is un- 
 necessary because of the comparative insensibility of 
 the gum tissue, and because the progression by growth 
 of a tooth is inadequate to make pressure sufficient to 
 cause serious discomfort ; that it inflicts pain upon 
 the child ; that it is liable to injure the developing 
 tooth ; that there is danger of serious hemorrhage 
 following ; that there is an increased resistance to the 
 eruption of the tooth by the cicatrix or scar which 
 results, and that a repetition of the operation is often 
 necessary. 
 
 The first objection named finds answer in the im- 
 mediate, manifest, and complete relief to the infant 
 which so often follows the operation that the rela- 
 tion of cause and effect is apparent to every observer ; 
 finds answer, also, in the testimony of every adult 
 who has experienced the comfort resulting from the 
 employment of the lancet in the case of difficult erup- 
 tion of a wisdom tooth. That the amount of pain 
 inflicted is of the most trifling character, may be in- 
 ferred from the readiness with which a child, old 
 enough to appreciate conditions, submits to the oper- 
 ation after it has once realized its benefits. Only an 
 ignorance of the anatomy of the mouth entirely 
 
DIFFICULT DENTITION. 5/ 
 
 inexcusable in any dentist or physician could lead to 
 the infliction of permanent injury. The liability to 
 serious bleeding from such use of the lancet is so 
 small that it is not worth considering as a danger in 
 comparison with the vastly greater risk incurred by its 
 non-employment when indicated. The assumed in- 
 creased resistance of the cicatricial or scar tissue is as 
 unfounded as it is common. Even though the wound 
 made by the lancet should heal completely before the 
 eruption of the tooth, the scar tissue is less instead of 
 more resistant than the original structure, and is easier 
 of absorption. This fact is illustrated by the readi- 
 ness with which a ''cracked lip" in winter cracks 
 again in the same place, although seeming to have 
 been perfectly healed. That a more or less frequent 
 repetition of lancing for the relief of the same tooth 
 is sometimes necessary, is because of a persistence of 
 the conditions which required the first incision. 
 
 The reasons for the methods of lancing which are 
 considered to promise the best results are easy of com- 
 prehension. Premising that the object of lancing is 
 not merely nor chiefly to induce a flow of blood, but 
 to remove tension, it follows that the cuts should ex- 
 tend through the gum to the presenting surface, and 
 should be made with special reference to the form of 
 the coming tooth. The incisors need only a divi- 
 sion of the gum in the line of the arch. The molars 
 
S8 
 
 THE MOUTH AND THE TEETH. 
 
 require a crucial incision, as shown in Fig. XIV. In 
 the case of either of the incisors, supe- 
 rior or inferior, owing to their straight 
 edges, the slightest appearance of 
 the tooth through the gum gives en- 
 Fig. XIV. ^|j.g relief so far as that particular 
 tooth is concerned. Not so, however, with the cus- 
 pids and molars. The cuspids, it will be remem- 
 bered, have cone-shaped crowns, and therefore, even 
 after the eruption of the points, still keep up the 
 pressure by reason of the inclosing ring of gum, as 
 shown in Fig. XV. A complete severance of this 
 ring on the lateral sur- 
 faces, as well as on the an- 
 terior and posterior faces, 
 as shown in Fig. XVI., is 
 necessary to relieve the 
 tension. So, all the cusps 
 or points of a molar tootli 
 may have erupted, and yet bands of gum tissue around 
 and between them, as shown in Fig. XVII. , maintain a 
 resistance as decided 
 as before their ap- 
 pearance, but which 
 is entirely overcome 
 by cuts as shown in 
 Fig. XVIII. If, after lancing, the cuts should heal be- 
 fore the tooth is fairly through the gum, the operation 
 
 Fig. XV. 
 
 Fig. XVI. 
 
 Fig. XVII. 
 
 Fig. XVIII. 
 
DIFFICULT DENTITION. 59 
 
 should be repeated as often as is necessary. Some- 
 times, but not often, there is a little too much bleed- 
 ing, generally caused by the child sucking the gums, 
 incited thereto by the taste of the blood. In such 
 case the substitution of the breast of the nurse will 
 give the infant better employment. The extent of 
 the bleeding can be ascertained by touching the 
 wound occasionally with a napkin-covered finger, and 
 when it continues longer than seems desirable, a little 
 very finely-powdered alum, rubbed into the incisions, 
 almost certainly controls it. If this fails, and the 
 case should require the attention of the physician or 
 dentist, the trouble is still quite amenable to treat- 
 ment. 
 
CHAPTER VII. 
 
 CARE OF THE TEMPORARY TEETH. 
 
 THERE is a marked structural difference, consist- 
 ent with the length of service required, between 
 the temporary and the permanent teeth — a modifica- 
 tion in the proportions of their constituents. The 
 temporary teeth contain a much larger amount of 
 animal matter than the permanent ; are consequently 
 of a less dense texture, and therefore more liable to 
 rapid decay. The pulps of the deciduous teeth are 
 relatively larger than those of the permanent set, and 
 when nearly or quite exposed by decay are more sus- 
 ceptible to the action of irritating agents, and are 
 more likely to lose their vitality under untoward in- 
 fluences. For these reasons they need even more 
 care and attention than the permanent teeth. The 
 temporary teeth are intended to perform important 
 offices, and their retention in the mouth in a healthy 
 condition until their successors are ready to appear 
 is very desirable. Besides their value in the mastica- 
 tion of food, they probably assist in the development 
 of the jaws ; certainly their too early loss may result 
 
 60 
 
CARE OF THE TEMPORARY TEETH. 6 1 
 
 in an irregular condition of the second or permanent 
 set, producing a disfiguration of the mouth and in- 
 terfering with the comeliness of the face throughout 
 life. The premature extraction of the temporary- 
 molars is fraught with danger to the bicuspids. 
 These latter, as will be seen by reference to Fig. 
 XIX. (see p. 69), are located, during development, 
 in the crotches of the roots of the former, the ex- 
 traction of which may inflict permanent injury upon 
 them. 
 
 It is a mistake to suppose that the temporary teeth 
 may be extracted at any time without injury. The 
 domestic dentistry which watches for the first evidence 
 of their loosening in order that they may be promptly 
 removed, is generally a mischievous interference. 
 Another mistaken notion is that the temporary teeth 
 were intended to be lost by decay, and in this manner 
 to make room for their successors. Under favorable 
 conditions they ought not to decay at all, but after 
 they have fulfilled their mission they should drop 
 out as white and clean as when they first appeared. 
 If allowed to decay, their pulps become exposed, 
 giving rise to pain, leading generally to extraction 
 of the teeth ; or, if the pulps die because of the expo- 
 sure, gum-boils form and interfere with mastication. 
 Moreover, when the pulp of a temporary tooth dies, 
 absorption of the roots is arrested, and the tooth re- 
 mains to cause soreness, inflammation, and suppura- 
 6 
 
62 THE MOUTH AND THE TEETH. 
 
 tion — sometimes to be a mechanical obstacle to the 
 advance of the succeeding tooth, which, as a result, 
 may assume a position inside or outside instead of in 
 the line of the arch. Though the premature loss of 
 the temporary teeth is, as a rule, to be deplored, there 
 are cases in which the extraction of one or more of 
 them at the opportune time will save much trouble in 
 securing a regular alignment of the permanent set. 
 
 The exemption of children from the suffering caused 
 by dental decay, and the immunity of the parent from 
 the consequent inconvenience, will be best secured by 
 constant attention to the teeth from their first appear- 
 ance. The general health of the child will also be 
 promoted by keeping them in such a condition that 
 mastication can be performed without pain ; other- 
 wise the child will soon learn to avoid that which is 
 troublesome or painful, and, by swallowing its food 
 without proper mastication, will bring upon itself all 
 the evils of indigestion. In infancy the mother should 
 make it a part of her daily care of the child to secure 
 perfect cleanliness of its teeth. Becoming thus accus- 
 tomed to it, the child when old enough to rinse the 
 mouth properly or to use the brush will find it impos- 
 sible to feel comfortable after a meal until the teeth 
 have been cleansed ; the habit thus early formed is 
 almost sure to be continued through life. Small, soft 
 tooth-brushes and pleasant dentifrices are now manu- 
 factured exactly suited for children's use. In cases 
 
CARE OF THE TEMPORARY TEETH. 63 
 
 where, in spite of all the care given them, the tem- 
 porary teeth show symptoms of decay, equal or even 
 greater care than would be given, to the permanent 
 teeth under similar conditions should be taken to 
 prevent its extension, and cavities of decay, particu- 
 larly in the molars, should be filled with some one of 
 the various preparations now in the hands of the 
 dental profession. A good rule is to have a dentist 
 examine the mouth of the child, after it is two and 
 a half years old, at least twice a year, or oftener if 
 necessary. 
 
CHAPTER VIII. 
 
 SIXTH-YEAR MOLARS. 
 
 IT must not be forgotten that the eruption of the 
 second set begins before any of the first teeth are 
 shed. Thus, between five and a half and six and a 
 half years of age the first permanent molars, four in 
 number — one on each side of the upper and lower 
 jaws — make their appearance. These are commonly 
 supposed by parents to belong to the first set, and 
 therefore, if found decayed shortly after their erup- 
 tion, no attention is paid to them, because it is 
 thought that they will soon have to make room for 
 their successors, and before the error is discovered the 
 mischief is irreparable. Although, as already stated, 
 the crowns of the teeth are fully formed before their 
 eruption through the gum, the structures of the tooth 
 have not then attained the compactness and hardness 
 which subsequently characterize them, and do not 
 acquire their maximum density for months, or even 
 years. Consequently decay makes greater ravages in 
 a given time in youth than at any subsequent period, 
 except probably during sickness. There is, for reasons 
 
 64 
 
SIXTH-YEAR MOLARS. 65 
 
 not perhaps fully understood, a great liability in the 
 sixth-year molars to deep fissures with imperfect union 
 of the enamel edges, and from this and other causes a 
 special tendency to caries, so that these teeth are 
 quite frequently decayed before they are fully erupted. 
 This fact shows the importance of extra care and more 
 prompt attention to them ; for, if they can be pre- 
 served until they become thoroughly solidified, their 
 liability to decay is very much lessened, and the 
 chances of retaining them throughout life are cor- 
 respondingly increased. The sixth-year molars are 
 the largest teeth in the mouth. In Figs. XII. and 
 XIII. (pp. 48, 49) they are shown in their relation 
 to the temporary set — in a child of about six years 
 of age. In Figs. XX. and XXI. (pp. 71, 72), these 
 same teeth are illustrated in their relation to the per- 
 manent set. They are very important teeth in many 
 respects, and should never be allowed to suffer from 
 decay if by any possibility it can be avoided. Even 
 if they cannot be permanently saved, there are good 
 reasons, with reference to the preservation of the integ- 
 rity of the arch, why they should be retained up to a 
 certain period, viz., to that between the tenth and 
 twelfth years — the time when the twelfth-year molars 
 are aboiit to appear ; there are equally good reasons 
 why, if they cannot be retained with a fair prospect of 
 their permanent preservation, they should be extracted 
 at that particular time. Another fact which should 
 6 -"■ T^ 
 
66 THE MOUTH AND THE TEETH 
 
 make each one of these teeth the object of special 
 anxiety on the part of the parent is that, in the opin- 
 ion of many practitioners of ripe experience, the loss 
 of one frequently necessitates the removal of all four, 
 in order to preserve the harmonies of articulation. 
 It has been stated in a previous chapter that the teeth 
 give each other mutual support, after the manner of 
 staves in a barrel, and that the teeth of the two jaws 
 are so adapted to each other that the elevations and 
 depressions upon their surfaces articulate so as to pro- 
 duce the most effective results in mastication. After 
 the extraction of a tooth the adjoining teeth generally 
 change their positions more or less, and the natural 
 occlusion is thereby interfered with, and to a greater 
 or less extent impaired. But, unless the tooth is re- 
 moved at the proper time, this is the least of the evils 
 likely to ensue. If too early, the adjacent teeth close 
 up, causing irregularity when the other teeth erupt ; 
 if a little too late, the space is never perfectly closed, 
 and the teeth on either side, lacking their natural sup- 
 port, lean towards the vacant space — tipping over, so 
 that the occlusion in mastication is constantly forcing 
 them further out of position. As a result the gums 
 recede on the sides next to the vacancy, the alveolar 
 processes are absorbed, the unsupported teeth be- 
 come tender, painful, and loose, and are consequently 
 lost ; those next adjoining are similarly affected and 
 lost in turn ; and so, as a consequence of the extrac- 
 
SIXTH -YEAR MOLARS. 6/ 
 
 tion of a sixth-year molar after the eruption of the 
 bicuspids and the twelfth-year molar, the side of the 
 mouth from which it was taken is ruined before mid- 
 dle life is reached ; and, if the same condition exists 
 on the other side, the function of mastication is prac- 
 tically destroyed. Are not these sufficient reasons why 
 parents should feel the necessity for constant super- 
 vision of the sixth-year molars? 
 
 It is a good rule for parents to count their children's 
 teeth occasionally after the fifth year, and, when more 
 than five are found on either side of either jaw, they 
 may know that the sixth or last one belongs to the 
 second or permanent set, and if lost will never be re- 
 placed ; that if extracted except at the exact time 
 when the conditions are most favorable, the results may 
 be disastrous to the entire denture, more or less inter- 
 fering with comfort and health, and, by the consequent 
 prevention of perfect mastication, leading to dyspeptic 
 and intestinal derangements tending to shorten life. 
 The want of a proper appreciation and proper treat- 
 ment of these sixth-year molars is, it is safe to say, 
 one of the most fruitful causes of the defective masti- 
 catory apparatus of a vast majority of people at and 
 beyond forty years of age. 
 
CHAPTER IX. 
 
 SHEDDING OF THE TEMPORARY AND ERUPTION OF 
 THE PERMANENT TEETH. 
 
 WHEN the small size and delicate structure of the 
 jaws of an infant, and the fact that the teeth 
 correspond to them in size, are considered, it will be 
 apparent that the provision of a second set, large and 
 strong in proportion to the increased size and strength 
 of the adult jaw, is a necessity. Almost coincidently, 
 therefore, with the development of the germ of each 
 temporary tooth, and in what may be termed an ap- 
 pendage to the sac in which it is inclosed, appears 
 the germ of its successor. The germ of the first per- 
 manent (sixth-year) molar is formed independently, 
 like those of the temporary teeth, but gives off an 
 appendage in which is formed the second or twelfth- 
 year molar, which in turn supplies an appendage for 
 the production of the third molar or wisdom tooth. 
 While, therefore, the development of the temporary 
 teeth is advancing, the germs of the second or perma- 
 nent set are also progressing. When the former erupt, 
 the latter are in various, stages of development. 
 
 68 
 
SHEDDING OF THE TEMPORARY, ETC. 69 
 
 Fig, XIX. illustrates the jaws of a child about six 
 years of age, in which the relations of the two sets of 
 teeth are shown — the temporary teeth still in position, 
 and the sixth-year molars just erupting. The perma- 
 nent incisors, both upper and lower — which after the 
 
 Fig. XIX. 
 
 sixth-year molars are the next to erupt — are the most 
 advanced, both as to completeness of form and as to 
 position. The canines, which are not due until the 
 child is between eleven and thirteen years of age, are 
 not nearly so complete in form, nor so far advanced 
 towards eruption. 
 
JO THE MOUTH AND THE TEETH. 
 
 As the permanent teeth approach their full develop- 
 ment, a process called *' absorption " is set up, by 
 which the roots of the temporary set are gradually 
 removed. Little by little the roots are dissolved, 
 and the particles composing them are carried away, 
 until only the crowns remain. This absorptive pro- 
 cess does not begin upon the roots of all the tempo- 
 rary teeth at once, but in the order corresponding to 
 their development and eruption. The lower central 
 incisors are the first to become loose and fall out ; 
 then the upper central incisors ; then the laterals, and 
 so on in the order in which they appeared. Deprived 
 of their support in the sockets, and retaining only a 
 slight attachment to the gums, the crowns are pushed 
 out by the movements of the tongue, cheeks, or lips 
 during mastication, or are picked out with the fingers. 
 
 The second or permanent teeth are thirty-two in 
 number, including twelve not found in the temporary 
 set, viz., eight bicuspids and four wisdom teeth — 
 the sixth-year molars constituting a part of this set. 
 The following table gives the average time and order 
 of eruption of the permanent teeth, liable, however, 
 both as to time and order, to very considerable varia- 
 tion in exceptional cases : — 
 
 First molars, 
 
 Central incisors, . 
 
 Lateral "... 
 
 First bicuspids, 
 
 5 to 
 
 6 years, 
 
 6 " 
 
 8 " 
 
 7 " 
 
 9 " 
 
 9 " 
 
 lO « 
 
SHEDDING OF THE TEMPORARY, ETC. 
 
 71 
 
 Second bicuspids, . 
 
 Canines, 
 Second molars, 
 Wisdom teeth, 
 
 10 to II years. 
 
 11 " 13 " 
 
 12 " 14 " 
 17 " 21 " 
 
 Fig. XX. illustrates an upper permanent or adult 
 set of teeth, in which Nos. i are the central incisors \ 
 
 1 1 
 
 Fig. XX. 
 
 Nos. 2, the lateral incisors ; Nos. 3, the canines ; Nos. 
 4, the first bicuspids; Nos. 5, the second bicuspids; 
 Nos. 6, the first (sixth-year) molars ; Nos. 7, the sec- 
 ond (twelfth-year) molars ; and Nos. 8, the third mo- 
 lars, or wisdom teeth. 
 
72 
 
 THE MOUTH AND THE TEETH. 
 
 Fig. XXI. — Side View of an Adult Lower Jaw. 
 
SHEDDING OF THE TEMPORARY, ETC. 73 
 
 Fig. XXI. is a side view of the adult lower jaw. 
 The lower teeth are known by the same names as the 
 corresponding teeth of the upper jaw. 
 
 The cutting edges of the incisor teeth are, when 
 first erupted, divided into little cusps or points (prob- 
 ably intended to facilitate their eruption), giving them 
 a saw-like appearance. These points, after the teeth 
 have been put into active service, are soon worn down, 
 leaving smooth and straight edges. 
 
 The period included between the sixth and the 
 twelfth or fourteenth year of the child's life is an ex- 
 ceptionally important one with reference to the care 
 of the teeth ; their subsequent condition for life de- 
 pending largely upon their treatment during this 
 period — whether they shall be useful, comfortable, 
 and ornamental, or the reverse. Suitable attention 
 given to the condition of the mouth during this pe- 
 riod will, as a rule, in a great measure prevent the 
 necessity of treatment in after life. This attention 
 on the part of the parent or guardian should consist 
 not only in advising or directing th^ habitual, thor- 
 ough cleansing of the teeth by the child, but should in- 
 clude a personal supervision of the operation, in order 
 that senous omissions as to time or manner may not 
 occur. In addition, a systematic examination of the 
 mouth by a competent dentist should be made at 
 frequent intervals. It will not do to wait until the 
 child makes complaint of toothache, or until the 
 7 
 
74 I'HE MOUTH AND THE TEETH. 
 
 ravages of decay make themselves visible to the un- 
 professional eye. Long before this mischief — irre- 
 mediable mischief — may have been done. 
 
 There is usually but little trouble attending the sec- 
 ond dentition ; but occasionally there are consider- 
 able pain and swelling, and sometimes sore throat, 
 difficulty in swallowing, earache, and even severe 
 constitutional disturbance. Various distressing and 
 obscure nervous affections have been found to depend 
 upon the eruption of a sixth- or twelfth-year molar. 
 The third molars or wisdom teeth of the upper jaw 
 are generally erupted without special trouble, except 
 that which is the result of their contact, by misdirec- 
 tion, with the cheek, causing ulceration. The erup- 
 tion of the wisdom teeth of the lower jaw generally 
 causes considerable inconvenience and suffering, ow- 
 ing to their being crowded between the second molar 
 and the ramus (the upright portion) of the jaw. The 
 space being insufficient, the gum is pressed between 
 the distal (rear) surface of the tooth and the ramus ; 
 the irritation produces swelling, and this is aggra- 
 vated by the bruising of the gum — in mastication 
 or by the teeth of the upper jaw. Inflammati^iT 
 is thus set up, which extends to the soft tissues 
 of the adjoining parts, making the act of swallow- 
 ing difficult and painful, and mastication impossible. 
 Sometimes the inflammation results in suppuration, 
 the pus finding exit at points more or less remote, 
 
SHEDDING OF THE TEMPORARY, ETC. 75 
 
 internal or external. The trouble in such cases is 
 generally of short duration, and ceases upon the com- 
 plete eruption of the tooth. Other cases require 
 lancing of the gum, or the removal of the overlying 
 portion of gum ; sometimes the extraction of the tooth 
 or of the one in front of it. No general rule for the 
 treatment of these cases can be given. It will depend 
 upon the space in the jaw and the eruption of the 
 tooth in a natural or unnatural position ; if the latter, 
 upon the form of the deviation. The nervous suscep- 
 tibility and constitutional condition of the individual 
 must also be taken into account. The record of 
 troubles caused by the eruption of a wisdom tooth 
 into a crowded arch shows cases of ulceration and 
 sloughing of the adjacent tissues, disordered vision, 
 earache, deafness, headache, neuralgia, hysteria, St. 
 Vitus' s dance, epilepsy, lockjaw, and various other se- 
 rious disorders — some exceptionally severe cases end- 
 ing in death. 
 
 At six, at twelve, and at seventeen years of age, 
 or until the wisdom teeth have been fully erupted, it 
 is well for patients suffering from eye or ear troubles, 
 or from any deranged condition not otherwise ac- 
 counted for, to seek the opinion of a competent den- 
 tist, in order to learn whether or not an explanation 
 is to be found in the mouth. 
 
fi I ■\. I- 
 
 CHAPTER X. 
 
 THE NUTRITION OF THE TEETH. 
 
 NUTRITION is the process by which the various 
 tissues of the body are nourished. The source 
 of nutrition is the blood, essential to the life of every 
 portion of the body, in order that it may obtain the 
 materials required for development, and subsequently 
 for maintenance. The teeth are no exception to this 
 rule, depending for their vitality upon the blood. 
 One of the large vessels which supplies the external 
 parts of the head gives off branches which are called 
 the dental arteries. From these smaller branches are 
 given off, which pass through openings at the bottom 
 of the sockets, and then through the hair-like aper- 
 ture (the foramen) at the extremity of each root ; 
 through the canals of the roots, and into the cavity 
 in the centre of each tooth. 
 
 But all use implies wear or waste, and wherever an 
 artery carries new material for the building or repair 
 of any tissue, it is accompanied by a vein to bear away 
 the waste products, and thus from birth to death every 
 portion of the body is continually undergoing change 
 — waste and renewal. The pulp of a tooth is com- 
 
 76 
 
THE NUTRITION OF THE TEETH. // 
 
 posed of nerves and blood-vessels ; from the nerves 
 pass out on every side minute fibrils which penetrate 
 the dentine ; from the blood nutriment is supplied to 
 every portion of the tooth, maintaining its vitality. 
 In addition to this provision for sustaining the life 
 of the tooth, the root is covered by a membrane (the 
 pericementum), from which nerves and blood-vessels 
 pass into the cementum. Thus, after the dentine and 
 enamel (which, as has been previously stated, are de- 
 pendent upon the pulp for their nutrition) die in con- 
 sequence of the death of the pulp, the tooth still re- 
 tains a semi- vitality by means of its root-membrane, 
 and may remain in the mouth without discomfort, 
 sometimes for many years. Although the death of 
 the pulp involves the loss of vitality to so large a por- 
 tion of the tooth, and should therefore be guarded 
 against with all possible care ; yet it should be known 
 that even then, even after the crown is lost through de- 
 cay, the root is still valuable, and may serve as a base 
 for an artificial crown, or may at least assist in main- 
 taining the adjoining teeth in position and prevent- 
 ing the absorption of their alveolar processes. Even a 
 tooth that has been dislodged by accident or purposely 
 extracted may be successfully replanted in its socket, 
 and, being held in position by ligatures or other me- 
 chanical device for a few days, will become firm by 
 virtue of the re-attachment of the pericementum and 
 the re-cstablishment of a vital relation therewith. 
 
CHAPTER XL 
 
 FOOD IN ITS RELATIONS TO THE TEETH. 
 
 THE blood, which as has been said is the source of 
 nutrition to every part of the body, would speed- 
 ily become impoverished if the materials which it dis- 
 tributes to all the various tissues were not re-supplied 
 to it. The elements required for the development, 
 repair, and maintenance of the muscular, nervous, 
 and bony systems do not originate in the blood, but 
 must be furnished from without. These elements are 
 derived from the food. There is no permanent source 
 of strength but in food. All food, however, is not 
 alike nutritious, and the different parts of the body 
 require different materials for their formation and 
 sustenance. Each organ and each tissue selects from 
 the blood that which is akin to its own structure — like 
 appropriating like. The bones and the teeth require 
 certain earthy matters. These abound in some vari- 
 eties of food, but are deficient or absent in other 
 varieties. If, therefore, the quality of the blood, 
 which distributes the elements of nutrition, depends 
 primarily upon the food, it follows that if food defec- 
 
 78 
 
/ 
 
 FOOD IN ITS RELATIOXS TO THE TEETH, yg 
 
 tive in quality or deficient in quantity be supplied to 
 the mother during gestation, the child will have an 
 imperfect organization of the teeth. So, if the food 
 of the nursing mother be wanting in the materials of 
 which the teeth are formed, there must result a de- 
 ficiency in the child's dental organs, just as, when the 
 food of the child at a later period is lacking in the 
 bone-producing elements, the later erupted teeth will 
 be defective. In a word, if the food of the mother 
 before the birth of the child, or during the period 
 when it depends upon her for its supply, does not 
 contain the elements to meet the demands, healthy 
 tissues will not be formed. It is believed that in 
 those cases where child-bearing and nursing women 
 fail to supply themselves with food containing the 
 earthy elements, which are then especially needed, 
 there is a drain upon their own organizations by 
 which the child is, to some extent, at least, provided 
 for at their expense. Their own teeth show the ef- 
 fects of the starvation by an increased sensitiveness 
 and rapid decay. A popular apprehension of this fact 
 has crystallized into the proverb, '' For every child a 
 tooth." During pregnancy and while nursing, more 
 than usual attention should be given to the teeth, 
 whose increased tendency to decay should be com- 
 bated by unremitting effort and watchfulness, in or- 
 der that the future comfort and health of the mother 
 
8o THE MOUTH AND THE TEETH. 
 
 may not be endangered or her personal attractions be 
 lessened by the loss of teeth. 
 
 But the advantages of proper food — that is, of 
 food containing the earthy materials of which the 
 teeth are constructed — are not confined to the devel- 
 opmental period. While such food is of special value 
 in furnishing the necessary constituents for building 
 solid structures during the time when the teeth are 
 developing, it is also required to sustain them in a 
 healthy condition through life. Well-organized teeth 
 are composed mainly of mineral substances, and there 
 is no power in the human organism to create them 
 out of materials which do not contain them. It is, 
 therefore, evident that if these elements are lacking 
 in the materials furnished as food, the teeth, which in 
 large part should be composed of them, must suffer 
 by reason of the deficiency; for observation shows 
 that upon the greater or less amount of their mineral 
 constituents largely depends the ability of the teeth 
 to resist destructive agencies. 
 
 For infants there is no other food equal to that 
 supplied by the breast of the healthy mother, and 
 for young children no other food so well suited to 
 the digestive organs, and so capable of supplying all 
 the materials for the growth of the various tissues of 
 the body, as milk. Up to the age of fourteen or six- 
 teen years a liberal use of milk is desirable. 
 
 An abundance of the necessary mineral constituents 
 
FOOD IN ITS RELATIONS TO THE TEETH. 8 1 
 
 is found in certain grains, or rather in certain parts 
 of these grains. Whole wheat probably contains 
 more of the essential elements of food than any 
 other grain. Next in value is oats. But it is chiefly 
 the outer portions of the grain which contain the 
 bone-forming material, and these are generally dis- 
 carded in the manufacture of flour so as to produce 
 a whiter article. That which is discarded is full of 
 nutriment for the bones and teeth ; that which is 
 retained is little more nutritious than starch. It is 
 apparent, therefore, that the liability of the teeth to 
 decay depends largely, first, upon their original or- 
 ganiza'tion, and that th^ character of the organization 
 depends upon the supply by the mother or nurse of 
 the mineral constituents which ought to enter into 
 their composition ; second, upon the regular supply 
 — especially in early life — of food containing these 
 constituents. The use of oatmeal, of wheaten grits, 
 or of bread made from unbolted flour, as a part of 
 the daily diet from childhood up to middle life, 
 would go very far towards preventing dental caries. 
 Alimentary substances, according to their character, 
 furnish fat, produce heat, or supply muscle, brain, 
 nerve, bone, and tooth material. It is evident that 
 food which does not contain the required elements 
 will not sustain the body in a healthy state. With 
 the single exception of milk, no one article of food 
 supplies all the various requisites. Milk should 
 
 F 
 
82 THE MOUTH AND THE TEETH. 
 
 form the exclusive diet of the child until at least 
 nine months of age, and the principal diet for the 
 first three years of life. Arrow-root, corn-starch, 
 and other farinaceous foods, are positively injurious 
 to a child under three months of age. The secre- 
 tion of saliva before that period is scant, and is, 
 moreover, deficient in a peculiar fermentative prop- 
 erty which is essential to produce the change required 
 upon starchy foods to fit them for digestion. This 
 fermentative power is not fully developed in the 
 saliva until the child is about a year old. Starchy 
 foods should not, even at a later period, be made a 
 staple, because, though they «iay create fat, they do 
 not contain the elements of which muscle, bone, and 
 tooth-structure are built. After the child is nine 
 months of age, if weaned, milk should still be made 
 the staple ; but the diet may be varied by the addi- 
 tion of oatmeal (boiled to a jelly), wheaten grits, 
 barley flour, rice, farina, sago, bread-crumbs, the 
 yolk of ^gg with milk, chicken or mutton broth. 
 After one year of age, bread and butter, baked pota- 
 toes, and ripe fruits may be gradually added. While 
 on the one hand confinement to any one article of 
 food (unless it be pure, rich milk) should be avoided, 
 and a varied diet allowed, care should be taken, on 
 the other hand, to exclude those substances which 
 contain but little nutriment or are difficult of diges- 
 tion, such as pastry, confectionery (unless of the 
 
FOOD IN ITS RELATIONS TO THE TEETH. 83 
 
 simplest forms), cabbage, turnips, the skins or rinds 
 of fruit, etc. The course which is calculated to best 
 subserve the general interests of the child is that 
 which is also calculated to produce the best results 
 in the dental structures. 
 
 It may be remarked that any food, however well 
 adapted to the development, nourishment, and repair 
 of the various parts of the animal organism, can 
 contribute to these results only in proportion to its 
 transformation through vital processes. It is there- 
 fore necessary not only that a varied and intelli- 
 gently selected diet be supplied, but that the system 
 be kept in condition to appropriate the materials 
 furnished for its sustenance. Nutrition comprehends 
 digestion, absorption, respiration, circulation, and as- 
 similation, and is that change in nutritive matters 
 by which they assume the characteristics of the dif- 
 ferent living tissues of the body. How much to eat, 
 and what and when, in order that *'good digestion 
 wait on appetite and health on both," are therefore 
 topics worthy of careful study. 
 
CHAPTER XII. 
 
 NERVOUS RELATIONS OF THE TEETH. 
 
 THE cause of so-called reflex (reflected) troubles 
 and the circle of sympathies between the mouth 
 and other portions of the animal system can only be 
 thoroughly understood through a familiarity with the 
 origin, distribution, and relation of the nerves. The 
 limits of this volume permit only a brief statement 
 of the facts that the nerves are tubular cords of the 
 same general substance or structure as the two great 
 nervous centres, the brain and spinal marrow ; orig- 
 inating in one or other of these, they extend to every 
 part of the body, communicating frequently with one 
 another, and having at such points of contact knot- 
 like enlargements known as ''ganglia," in which the 
 nerves from the brain and those from the spinal cord 
 unite, and which have been called "small brains," 
 — centres of nervous action, as they send out the 
 influence of both these nervous centres to the parts 
 which they supply with nerves. In addition to the 
 nerves proceeding from the brain and spinal marrow, 
 there is a distinct nervous system — called ''the great 
 
 84 
 
NERVOUS RELATIONS OF THE TEETH. 85 
 
 sympathetic" — which, though communicating with 
 both brain and spinal marrow, does not seem to be 
 immediately under the control of either. Its special 
 function is understood to be the supply of nerve-force 
 to what are called the muscles of involuntary motion 
 
 — those not under the domination of the will — such 
 as the muscles of the heart, stomach, intestines, etc. 
 
 Impressions are conveyed from the nervous centres 
 
 — the brain and spinal marrow — to the surface of 
 the body, as well as from the surface to the nervous 
 centres. 
 
 The different nerves have various functions. Thus, 
 there are nerves of special sense, as those concerned 
 in hearing, seeing, smelling, tasting ; nerves of sen- 
 sation ; nerves of motion ; nerves combining sensa- 
 tion and motion ; nerves belonging to the voluntary 
 muscles, as those of the arms and legs ; and nerves 
 distributed to the so-called involuntary muscles. The 
 irritation of a nerve of sensation causes pain; of a 
 nerve of motion, muscular contraction \ of the nerve 
 of the retina, the sensation of light ; of the auditory 
 nerve, the sensation of sound. 
 
 "Sympathy" depends upon the connection that 
 exists between two organs more or less distant from 
 each other, so that an affection of one is transmitted 
 to the other. The sympathy may be that of con- 
 tiguity (nearness) or that of continuity. The former 
 is illustrated by the earache, which is frequently asso- 
 8 
 
S6 THE MOUTH AND THE TEETH 
 
 ciated with an aching tooth ; the latter by the exten- 
 sion of an irritation or inflammation throughout a 
 membrane that is continuous — as, for instance, in 
 the sore mouth sometimes associated with a disor- 
 dered stomach. By "reflex" is meant the peculiar 
 phenomenon of an impression which originated at 
 one point and was transmitted to the nervous centres, 
 and then referred to another point more or less dis- 
 tant from the source of the irritation ; illustrated by 
 the angle described by an elastic ball when thrown 
 obliquely against a wall. The ball does not return 
 as when it is thrown at right angles to the wall, but 
 flies off at an angle corresponding to that at which 
 it was impelled. This reflex action is constantly ex- 
 emplified in the complaint of pain in a tooth in one 
 jaw when the irritation originates in the other. 
 
 There are twelve pairs of nerves originating in the 
 brain, and thirty-one in the spine. The fifth nerve, 
 having its origin in the brain, and diagramatically rep- 
 resented in Fig. XXII., is the largest of the cranial 
 nerves. Its functions are various. It is the great 
 sensitive nerve of the head and face, the nerve of the 
 special sense of taste, the nutrient nerve of the teeth, 
 and the motor nerve of the muscles of mastication. 
 It is called the ''trifacial," because it is divided into 
 three main branches known as the "ophthalmic," 
 the "superior maxillary," and the " inferior maxil- 
 lary." These main divisions again subdivide, and 
 
NERVOUS RELATIONS OF THE TEETH. 
 
 87 
 
 give off branches to the eye and eyelids, the nose, the 
 ears, the forehead, the scalp, the upper and lower lips, 
 the chin, the gums, the tongue, and the teeth of the 
 upper and lower jaws ; filaments of the maxillary 
 
 Fig. XXII. 
 
88 THE MOUTH AND THE TEETH. 
 
 branches again join the ophthalmic branch and the 
 seventh nerve — the nerve to the muscles of the face. 
 The fifth pair of nerves is remarkable on account of 
 its frequent communication with the sympathetic ner- 
 vous system, as well as its numerous ganglia and its 
 varied functions. It is this nerve which is spe- 
 cially affected during the eruption of the teeth, 
 whether of the primary or permanent set. It is the 
 irritation of this nerve during dentition which causes 
 convulsions in children. It is this nerve which is 
 the seat of facial neuralgia. It is the relation which 
 this nerve bears to the head and face which is the 
 cause of the various ''sympathetic" affections of the 
 eye, ear, etc., so commonly associated with dental 
 disorders. Painful sensations resulting from irri- 
 tation of one of the branches of this nerve in the 
 mouth are reflected not only to neighboring but to 
 remote organs. Attention is naturally called to the 
 teeth in those cases in which pain is experienced in one 
 or more of them; but frequently dental derangements, 
 which have subsequently been proved to be the ex- 
 citing cause either of constitutional disturbance or 
 of pain in other organs or of interference with their 
 functions, have failed to attract attention by reason 
 of the absence of any decided tokens of irritation in 
 the teeth. In such instances the announcement to 
 the patient that pain outside of the mouth is in any 
 way related to the teeth is generally received with 
 
NERVOUS RELATIONS OF THE TEETH. 89 
 
 distrust of the opinion, if not of the practitioner who 
 ventures the statement. Many cases are recorded, il- 
 lustrating how variously such reflected troubles may 
 express themselves, and how little reason there fre- 
 quently may be to suspect the origin of the difficulty. 
 There may be no cavity of decay, no pain, no sore- 
 ness, no external sign of trouble, but, from an enlarge- 
 ment of the roots, — a disease called exostosis, — or 
 from deposits in the pulp cavity of a tooth, there may 
 be a disturbance, from pressure, which will be reflected 
 to the eye, the ear, or other organs, or may even cause 
 general derangement of the health. 
 
 General systemic disturbances, resulting from dis- 
 eased dental organs, might be considered as impossi- 
 ble, were it not for the instances with which every den- 
 tal practitioner is familiar, in which debility, sleepless- 
 ness, nervous derangements, mental depression, pal- 
 pitation, etc., after resisting constitutional medica- 
 tion, have yielded promptly to such treatment as w^as 
 found necessary to restore a healthy condition of the 
 mouth. Indeed, so frequently have fretful, nervous, 
 irritable, despondent conditions been found to de- 
 pend upon dental troubles, that it would appear to 
 be a plain duty, in the event of failure to discover 
 other causes for such manifestations, to have the 
 mouth and teeth carefully examined by a competent 
 practitioner. So many and so varied are the disturb- 
 ances radiated or reflected to other organs, or depend- 
 8* 
 
90 THE MOUTH AND THE TEETH. 
 
 ent upon constitutional irritation from dental affec- 
 tions, that their enumeration in detail would be 
 tedious; but the inharmonies thus set up may range 
 from a mere sense of discomfort up to and include 
 the gravest and most formidable derangements, in- 
 volving even life itself. 
 
 But the sympathetic or reflex disturbances of har- 
 mony, caused by dental irritation, are not more inter- 
 esting or instructive than are the converse manifes- 
 tations of pain or discomfort experienced in the teeth 
 but originating elsewhere. A curious and familiar 
 illustration, which will help to an understanding of 
 these, is found in the effect produced on many, if 
 not most, people through an irritation of the auditory 
 nerves by discordant or peculiar sounds, such as those 
 produced by the sharpening of a saw, the cutting of 
 cork, etc., which not only "set the teeth on edge," 
 but send a thrill through the system which is described 
 as '' making the blood run cold." Similar effects are 
 produced on impressible organizations by the contact 
 of the hand or fingers with certain substances. Many 
 persons have their teeth set on edge and their blood 
 made to run cold by touching velvet. Even those 
 who have lost all their natural teeth and wear artificial 
 substitutes assert that discordant sounds, as well as 
 the taste, even the smell, or sometimes merely the 
 mention, of sour fruits or drinks, will cause their 
 teeth to feel " on edge ; " just as those who have lost 
 
NERVOUS RELATIONS OF THE TEETH. 9 1 
 
 a limb by amputation complain that they still suffer at 
 times from itching, pain, or uncomfortable sensations 
 in the missing member. Many of the instances of 
 painful affections of the fifth nerve are well-marked 
 examples of reflected sensations, the primary irri- 
 tation being in the stomach or intestinal canal. The 
 pain over the eyes so commonly associated with de- 
 rangement of digestion, and which may frequently at 
 once be relieved by correcting the acidity of the 
 stomach, is a familiar instance. The condition 
 popularly known as "biliousness," among numerous 
 other manifestations, not seldom reveals itself to 
 the observing sufferer by a peculiar discomfort pro- 
 duced in the teeth, which, variously described, may 
 be summed up under the general phrase, "exalted 
 sensibility. ' ' An attack of dyspepsia is by many more 
 quickly recognized through disagreeable sensations 
 in the teeth than by any special stomach disturbance. 
 In sea-sickness and in sick headache the nausea is 
 sometimes preceded by intense neuralgia in the teeth 
 and jaws, promptly disappearing if vomiting be in- 
 duced. In some people hunger will excite markedly 
 disagreeable sensations in the teeth. A case in point 
 is that of a gentleman who, while convalescing from 
 typhoid fever, was seriously annoyed by painful sen- 
 sations in two of his molars whenever he became 
 hungry. These uncomfortable sensations would rouse 
 him from sleep, and could not be allayed except by 
 
92 THE MOUTH AND THE TEETH. 
 
 the introduction of food into the stomach, when in- 
 stant relief followed. In another curious case of ner- 
 vous debility the approach of a thunder-storm or a 
 marked atmospheric variation always produced a most 
 tantalizing sensation of discomfort in the teeth, caus- 
 ing them to feel as though they were denuded of 
 enamel. The singular affection known as ''brow 
 ague" or malarial neuralgia — which, by yielding to 
 quinia, reveals its malarial origin — is frequently 
 alternated or is associated with periodical pain in 
 perfectly sound teeth. Neuralgia (nerve pain) fur- 
 nishes various illustrations of reflex or radiated pain, 
 the cause being in a nerve centre in the brain, in the 
 trunk of a nerve or in its extremity, or, by exchange 
 of communication, in the sympathetic nervous sys- 
 tem. Thus, a neuralgia originating in a diseased 
 tooth may express itself in the face, scalp, eyes or 
 ears, or in more remote parts, while by the same 
 methods of radiation or reflection, reversed, a neu- 
 ralgia having a general or constitutional cause, as 
 malaria, or a local cause in the stomach or else- 
 where, may manifest itself in one or more teeth. 
 There is a form of toothache, not inappropriately 
 termed ''hysteric toothache," which seems to de- 
 pend upon emotional rather than physical excitants, 
 and is more amenable to mental impressions than 
 to local or general medication. Rheumatism some- 
 times produces agonizing pain in the jaws, and either 
 
NERVOUS RELATIONS OF THE TEETH. 93 
 
 by direct influence, by the sympathy of contiguity, 
 or by radiation, may so powerfully affect an indi- 
 vidual tooth that the patient can hardly be persuaded 
 that instant and complete relief would not follow its 
 extraction. It is apparent, therefore, that many severe, 
 remote, sympathetic, and reflex derangements may 
 be associated with and dependent upon affections of 
 the teeth. It is a sad mistake for either the dentist, 
 the physician, or the patient to consider the teeth as 
 mere mechanical organs, requiring only mechanical 
 treatment, and to therefore ignore their nervous rela- 
 tions to the entire organism. 
 
CHAPTER XIII. 
 
 CONSTITUTIONAL PECULIARITIES, VARIETIES, AND 
 DEFECTS OF THE TEETH. 
 
 CONSTITUTIONAL peculiarities, or differences 
 existing between individuals, which are desig- 
 nated as temperaments, and which are variously 
 manifested in height, weight, build, complexion, 
 color of eyes and hair, etc., are nowhere more dis- 
 tinctly observable than in the mouth. The size, 
 form, color, and density of the teeth ; the time and 
 order of their eruption ; the character of the enamel 
 — its perfect or imperfect continuity ; the shape of 
 the roof of the mouth — a broad and flat or narrow 
 and high arch; proportion or disproportion of the 
 jaws relatively to the head and face or to each other ; 
 the length and size of the tongue ; the thickness and 
 muscular power of the lips; the character of the 
 mucous membrane of the lips, cheeks, and gums — 
 these and various other distinctive differences are 
 marked evidences of constitutional peculiarities. 
 The teeth, in their physical characteristics, con- 
 sidered individually or relatively to each other and 
 
 94 
 
CONSTITUTIONAL PECULIARITIES, ETC, 95 
 
 to the arch of the jasv, exemplify hereditary trans- 
 mission, as well as the impressions made upon them 
 during their formative stage. The former is illus- 
 trated by the reproduction in the children of pecu- 
 liarities in the teeth of their parents ; the latter, by 
 the constant proneness of the teeth to decay in pairs, 
 showing that the unfavorable impression which caused 
 their defective structure was made upon both alike. 
 Hare-lip and cleft-palate are examples of defects de- 
 pendent upon some arrest of development of the child 
 before birth, and show also the tendency to hered- 
 itary transmission of physical imperfections. The 
 differences between individuals in the physical char- 
 acter of the teeth (differences in their organization, 
 ossification, and density, and consequently in their 
 healthfulness, usefulness, and durability) are gen- 
 erally in harmony with other constitutional peculi- 
 arities. The size, shape, and structure of the teeth in- 
 dicate also their liability to decay or their power of 
 resistance to unfavorable conditions. The character 
 and progress of decay vary also in the several temper- 
 aments not less than does the original structure — 
 liability to decay and its character and progress be- 
 ing, however, much modified by the state of the 
 general health. Teeth poorly organized may, by 
 reason of favorable systemic conditions, and intelli- 
 gent, persistent care, be made to outlast those of 
 vastly superior original structure, but which succumb 
 
96 THE MOUTH AXD THE TEETH. 
 
 to unfavorable constitutional conditions, or to neg- 
 lect. 
 
 Teeth regular in their positions, of large size, of a rich 
 yellow or yellowish-brown color, with dentine dense 
 as ivory, and enamel (perfect in its crystallization 
 and in smoothness and hardness like glass) thickly 
 and evenly deposited, represent a vigorous, healthy 
 constitution. Those irregular in their positions, small, 
 stumpy, and incongruous both individually and rel- 
 atively; opaque and chalky, with enamel only semi- 
 crystallized, deficient in quantity, and irregularly de- 
 posited j the dentine soft or friable, represent con- 
 stitutional poverty. Teeth of the first class exhibit 
 ability to resist unfavorable local and systemic in- 
 fluences, in keeping with the vitality inherent in them; 
 while those of the other class have feeble power of re- 
 sistance to unhealthy conditions, in consonance with 
 the defective organization with which they are asso- 
 .ciated. Modifications of every possible variety, in 
 physical outline, in elementary constitution, and in 
 size, color, and density, show the relative wealth or 
 poverty of the organization ; show not infrequently 
 the blending of the characteristics of the parents — 
 in some respects indicating the organization of one 
 parent, and in some the peculiarities of the other. 
 
 Even in the same mouth some teeth are more sus- 
 ceptible to decay than the rest, owing to constitutional 
 conditions at the time of their formation, resulting 
 in different degrees of density in their texture, and 
 
CONSTITUTIONAL PECULIARITIES, ETC. 9/ 
 
 consequently of capability to resist the action of de- 
 structive agents. The deciduous teeth show by dif- 
 ferences of organization the varying health of the 
 mother during their development, as the permanent 
 teeth exhibit disturbances occurring during their for- 
 mative stage. The temporary interruption of nu- 
 trition by acute infantile diseases, such as measles 
 and scarlet-fever, is generally recorded distinctly in 
 the dental organs. 
 
 In addition to the imperfections described as re- 
 sulting from systemic conditions (either of the parent 
 or child), during the formative period of the teeth, 
 it is important to note another variety of defects not 
 infrequently associated with otherwise perfect dental 
 structures, viz., that resulting from incomplete union 
 of the enamel at various points in the depressions 
 found on the grinding surfaces of the molars and 
 bicuspids. These flaws in the continuity of the 
 enamel favor the lodgment and retention of food and 
 of the secretions of the mouth. 
 At such points decay is almost sure 
 to occur, frequently extending un- 
 suspected underneath the enamel 
 until the integrity of the tooth is 
 seriously impaired. Fig. XXIII. 
 represents a vertical section of a Fig* XXIII. 
 molar magnified, in which a is the fissure caused by 
 a failure of the enamel edges to unite. 
 9 G 
 
CHAPTER XIV. 
 
 IRREGULARITIES OF THE TEETH. 
 
 THE value of the teeth, not only for ornamentation 
 and vocalization but also for utility in mastica- 
 tion, depends very much upon their regular position 
 in the arches of the jaws and upon their perfect oc- 
 clusion. In a faultless denture the upper and lower 
 teeth come together in such a manner that the ele- 
 vations and depressions upon the opposing surfaces fit 
 into each other so as to produce the most effective re- 
 sults in mastication. When from any cause this per- 
 fect occlusion is prevented, their usefulness is more or 
 less impaired. The deviations from regular position 
 and occlusion are various and numerous. The disad- 
 vantages resulting include imperfect mastication with 
 its consequent derangements, faulty pronunciation, in- 
 terference with the thorough cleansing of the teeth, 
 thus increasing their liability to decay ; irritation of 
 the gums, tongue, lips, or cheeks, and disfiguration 
 of the countenance. The inconvenience is more or 
 less serious, and the deformity more or less conspicu- 
 ous, according to the character and extent of the 
 
IRREGULARITIES OF THE TEETH. 99 
 
 deviation. The irregularity may be limited to a false 
 position of one or more teeth, or may involve the 
 entire denture; may be the result of some extrinsic 
 cause, or of an incongruity of size between the teeth 
 and the jaws. A single tooth is sometimes twisted 
 upon its axis, overlaps the adjoining tooth, or erupts 
 inside or outside of the arch. The latter occurrence 
 — a frequent one with the canines — is generally a 
 source of great annoyance, interfering seriously with 
 the symmetry of the face. Sometimes the upper front 
 teeth shut edge to edge against the lower, instead of 
 overlapping them, causing a rapid wearing away of 
 the edges of both. In other instances the upper teeth 
 shut so far outside of the lower ones that they rest 
 upon the lower lip ; or they protrude so that the upper 
 lip fails to cover them. Another variety of irregularity 
 is that in which the teeth of the lower jaw close in front 
 of the upper teeth — an inversion of order which in 
 the dog is known by the name of ''underhung." 
 Another but rarer form of irregularity is that in which 
 the molars alone come in contact when the mouth is 
 closed, causing the front teeth to stand apart. 
 
 Irregularities of the teeth proceed from a variety 
 of causes, among which may be mentioned mechan- 
 ical injuries, such as blows upon the mouth ; the pres- 
 ence of supernumerary or extra teeth ; a steady press- 
 ure, such as is kept up during the habit of sucking the 
 thumb or fingers, tongue or lip^ during childhood \ a 
 
lOO THE MOUTH AND THE TEETH. 
 
 too early extraction of some of the temporary teeth, 
 especially of the molars and canines ; a wrong direc- 
 tion given to one or more teeth by a mechanical 
 impediment, such as the retention in the mouth of 
 temporary teeth, or even roots of temporary teeth, 
 after the time when they should have been removed ; 
 hereditary transmission of dental peculiarities ; the 
 incongruous association of large teeth with small 
 jaws, — a mixing without blending of differing pa- 
 rental characteristics, — as, for instance, large jaws and 
 large teeth in one parent, and small jaws and small 
 teeth in the other ; if the small jaws of one and the 
 large teeth of the other be associated in the offspring, 
 the result will be an overcrowded denture. 
 
 Children with enlarged tonsils are liable to an 
 irregular disposition of the teeth as a result of the 
 habitually open mouth caused by the difficulty of 
 breathing through the nose. 
 
 Fig. XXIV. illustrates the type of deformity result- 
 ing from the habit of thumb-sucking. A similar pro- 
 trusion of the teeth of the lower jaw is produced by 
 the habit of sucking the first and second fingers, the 
 weight of the hand and arm gradually forcing the 
 teeth out of position. 
 
 In many instances children are allowed to retain 
 the bottle from which they have nursed, or are sup- 
 plied with a sugar-teat, or are permitted to suck the 
 thumb or fingers, because of the quieting effect which 
 
IRREGULARITIES OF THE TEETH. lOI 
 
 this occupation seems to produce. The resulting de- 
 formity of the jaws, and the consequent irregularity 
 of the teeth (crowding, overlapping, or protruding), 
 produces disfiguration and causes disabilities and dis- 
 comforts which remain throughout life. 
 
 Fig. XXIV. 
 
 It is much easier to prevent these habits or to break 
 them up in their incipiency than after they have been 
 fully formed, although in some cases the sucking in- 
 stincts of the child make their prevention or early 
 correction no easy task to the anxious parent. The 
 sugar-teat can be denied ; the nursing-bottle may be 
 removed as soon as used ; but the fingers and thumbs 
 are not so easily disposed of, and probably the absolute 
 imprisonment of the hands will in many instances be 
 required. Watchfulness by the mother or attendant 
 during the child's waking hours will be sufficient to pre- 
 vent the indulgence ; but during sleep extra precau- 
 tions are necessary. A plan which has been success- 
 9* 
 
102 THE MOUTH AND THE TEETH. 
 
 fully resorted to^ and which is commended for its 
 simplicity and efficiency, is to have the child's night- 
 dress made without sleeves, like a pillow-case, and 
 fastened by a drawing-string about the neck. Cer- 
 tainly no pains which are necessary to save the child 
 from the evil effects of the pernicious habit of fruit- 
 less sucking should be considered onerous. 
 
 Chief in importance in the list of causes of irreg- 
 ularity is defective growth of the jaws during the 
 development of the permanent teeth. In a perfectly 
 healthy person the teeth and the jaws would develop 
 harmoniously ; but it is quite possible for one or the 
 other, or both, to suffer in development, according to 
 the character of the disturbing influence. 
 
 That the operation of some of the causes named 
 may be clearly understood^ it must be remembered 
 that previous to the eruption of the teeth their roots 
 are not closely embraced by the bony sockets, as they 
 are after they have erupted. During the develop- 
 ment of a tooth the socket is necessarily large enough 
 to contain the crown, which is comparatively so much 
 larger than the root that, after the former has emerged 
 from the socket, the tooth is surrounded only by soft 
 and yielding tissues, and hence is readily diverted 
 from its course by even a very slight impediment. It 
 must also be remembered that the size of the crowns 
 of the permanent teeth is determined long before 
 their eruption, and is not subject to subsequent modi- 
 
IRREGULARITIES OF THE TEETH. IO3 
 
 fications; that the development of the teeth and that 
 of the jaws proceed independently of each other, and 
 that the teeth erupt according to their original for- 
 mation, even though the jaws be hindered in their 
 growth. Bearing in mind these facts, it is easily 
 understood that any subsequent interruption or inter- 
 ference with the development of the jaws must neces- 
 sarily result in a crowded condition of the teeth. It 
 is to such interruption, it is believed, that many of 
 the irregularities witnessed in the mouths of the pres- 
 ent generation are directly traceable. If the brain 
 and nervous system be unduly stimulated ; if more 
 attention be bestowed upon the child's manifesta- 
 tions of intelligence than upon the growth of the 
 body and the general vigor of the system, the mus- 
 cular and bony structures must suffer. An undue or 
 precocious mental development is attained at the ex- 
 pense of the rest of the organism. An indoor life, • 
 late hours, stimulating food, overheated sleeping apart- 
 ments, surroundings which in any way invite and 
 encourage mental precocity, can result only in a 
 disturbance of the proper balance or symmetry of de- 
 velopment — the bony and muscular systems and the 
 functions of animal life being sacrificed for the sake 
 of a brilliant but probably brief intellectual ascend- 
 ency. During the first seven years of a child's life, 
 the brain and nervous system, far from being stim- 
 ulated, should be carefully, persistently, earnestly. 
 
I04 THE MOUTH AND THE TEETH. 
 
 anxiously guarded, and their development repressed 
 instead of favored. There is no necessity to teach a 
 child under seven years of age anything but morals 
 and manners. Whatever is added to these in the way 
 of education tends to inharmony of development — a 
 nervous and mental precocity at the expense of the 
 physical organism ; tends not only to a crowded 
 denture, to imperfect organization of the teeth, and 
 to their early decay, but to a general physical imper- 
 fection, and too often in addition to subsequent men- 
 tal incapacity or aberration. Out-door life, childish 
 pursuits, plain and wholesome food, long periods of 
 repose — all things, in fact, which favor the health 
 and growth of the physical organism — promote the 
 health ■and growth of the jaws and teeth, and at the 
 same time favor a mental development which, though 
 of slower growth, is likely to be symmetrical, vigor- 
 ous, and permanent. 
 
 It is much easier to avoid decided irregularities of 
 the teeth by attention at the proper time than to cor- 
 rect them at a later period. The nutritive functions 
 are more vigorous and the processes of absorption 
 and reconstruction more active in early life than sub- 
 sequently. If, therefore, changes of position of one 
 or more teeth are necessary to the correction of 
 an irregularity, an easy adjustment is permitted in 
 childhood, which a few years later would be tedious, 
 difficult, and uncertain. One of the reasons for in- 
 
IRREGULARITIES OF THE TEETH. I05 
 
 terference at an early period, when a tendency to 
 irregularity is to be combated, is because of the fact 
 that false positions of the teeth are made difficult of 
 correction when those of the opposite jaw in closing 
 prevent them from assuming their correct relation to 
 the arch of the jaw. 
 
 The causes and forms of irregularity are so numer- 
 ous and various that no rules can be laid down for 
 treatment. The natural expansion of the jaw up to 
 a certain period, the extent of the irregularity, the 
 character and condition of the teeth, the age of the 
 patient, and various other considerations, will deter- 
 mine the judgment of the dentist. Under the care 
 of a competent adviser, the prevention or correction 
 of most forms of irregularity is neither difficult nor 
 problematical, if the proper effort be made in time. 
 
CHAPTER XV. 
 
 TARTAR, OR SALIVARY CALCULUS. 
 
 THE liquid (saliva) found in the mouth is, as has 
 been heretofore explained, the product of various 
 glands. It contains in solution animal and earthy 
 matters which are liable to be precipitated upon 
 coming in contact with the atmosphere, or by reason 
 of the changes of temperature to which it (the saliva) 
 is subjected in the mouth. These precipitates, com- 
 posed as stated of both animal (organic) and earthy 
 (inorganic) matters, mixed with mucus and with va- 
 rious accidental substances (alimentary debris) found 
 in the mouth, are deposited upon the teeth. This 
 deposit is called ''tartar" because of its resemblance 
 to the article so named which is precipitated from 
 wines and adheres to the sides of the casks in the 
 form of a hard crust. 
 
 The quantity of tartar deposited varies in different 
 persons and at different periods, as do also its chemical 
 and physical characteristics. It is sometimes com- 
 posed almost entirely of earthy or inorganic ingredi- 
 ents ; sometimes it is largely made up of animal mat- 
 
 io6 
 
TARTAR, OR SALIVARY CALCULUS. 10/ 
 
 ters ; sometimes it is of almost flinty hardness, and 
 in other cases so soft that it can be scraped off with 
 the finger-nail. Its color is not uniform, but may be 
 black, brown, green, yellow, or nearly white. 
 
 The amount and character of the injury caused to 
 the teeth, gums, and sockets by the different forms 
 of tartar vary as greatly as the quantity, composition, 
 density, and color of the deposit. Some varieties form 
 in thin, hard scales, which can be chipped off with 
 an instrument. Other forms are characterized by a 
 rough, uneven surface and an exceedingly tenacious 
 adherence to the teeth. In other cases it has a con- 
 sistence more like that of cheese. Some forms are 
 more correctly described as stains than as deposits. 
 Some kinds of tartar are inodorous, while others are 
 insufferably fetid and offensive. Some act chiefly as 
 mechanical irritants to the gums and to the edges of 
 the alveolar processes ; others possess an acrid char- 
 acter, corroding the surfaces of the teeth on which 
 they are deposited, and causing rapid decay. 
 
 Tartar is deposited most rapidly upon such teeth 
 and such parts of the teeth as are nearest the open- 
 ings of the salivary ducts, and is likely to remain 
 upon the surfaces which are least exposed to the 
 friction of mastication. The inner surfaces of the 
 lower incisors and the outer surfaces of the upper 
 molars are, for both of the reasons stated, most likely 
 to suffer. Gravity also favors its lodgment on the 
 
I08 THE MOUTH AND THE TEETH. 
 
 teeth of the lower jaw. The greatest accumulation 
 takes place during the night, because, the teeth not 
 being used in mastication, and the fluids of the mouth 
 not being kept in motion by the movements of the 
 tongue, lips, and cheeks, there is nothing to interfere 
 with its attachment. 
 
 In certain cases the mischief occasioned by the 
 presence of tartar seems out of all proportion to the 
 amount of the deposit, which insinuates itself around 
 the necks of the teeth, beneath the free edge of the 
 gums, working its way insidiously towards the roots, 
 thus separating the gums from the teeth and the roots 
 from their enveloping alveolar processes ; producing 
 inflammation, sponginess, and suppuration of the mar- 
 gins of the gums, and causing them to bleed at the 
 slightest touch ; making the use of the brush exceed- 
 ingly painful ; interfering with mastication ; making 
 the breath offensive ; vitiating the fluids of the mouth, 
 and thus creating irritation of the throat and bron- 
 chial tubes, indigestion, and general derangement of 
 the health. The early stages of this condition are 
 manageable, but the only treatment available is the 
 thorough removal of the tartar by a competent den- 
 tist ; scoring the gums and the use of astringent washes 
 being worse than useless. After the removal its 
 re-accumulation must be guarded against with the 
 utmost care. 
 
 There is a variety of deposit or stain which is 
 
TARTAR, OR SALIVARY CALCULUS. lOQ 
 
 exceedingly deleterious. It is of a greenish -brown 
 color, and is frequently to be found on the front 
 surfaces of the upper permanent incisors of children. 
 Owing to its position beneath the lip, it is undisturbed 
 by the act of mastication, by the fluids of the mouth, 
 or by the movements of the muscles in speech. It is 
 very tenacious, and has an offensive odor, or at least 
 accompanies a vitiated mucous secretion, which ren- 
 ders the breath offensive. Its destructive effects are 
 made manifest by furrows eaten through the enamel 
 across the teeth just below the margin of the gums. 
 The teeth of young people are frequently ruined by 
 this variety of deposit. The affection seems to de- 
 pend upon a diseased condition of the mucous glands, 
 the deposit recurring quickly after removal. Treat- 
 ment should be directed to a correctioji of the cause, 
 as the mere removal of the deposit will not result in 
 any permanent benefit. 
 
 lO 
 
CHAPTER XVI. 
 
 DECAY OF THE TEETH, OR CARIES. 
 
 DECAY of the teeth is an affection which is almost 
 universal. It may be defined as a disintegration 
 of the tooth-structure, affecting the enamel, the den- 
 tine, and sometimes, though rarely, the cementum. 
 It always commences on the exterior of a tooth, and 
 is dependent chiefly upon external influences, though 
 it may be modified by constitutional conditions. 
 
 The causes of decay are predisposing and exciting. 
 The predisposing causes are imperfect structure, ir- 
 regularity of position, and mechanical injuries. Con- 
 ditions inherent in the teeth by virtue of their original 
 structure, determined before birth or during infancy, 
 establish in many cases a predisposition to decay. 
 Owing either to imperfect health of the mother dur- 
 ing the development of the teeth, or to disturbances 
 of the health of the child during their formative stage, 
 the various processes of organization are liable to be 
 so interrupted and deranged as to result in defective 
 dental structures. The dentine is soft and friable ; 
 the enamel semi-crystallized and deficient in quantity 
 
 no 
 
DECAY OF THE TEETH, OR CARIES. Ill 
 
 or quality — a heterogeneous mixture of animal and 
 earthy materials. Teeth thus imperfect in their tex- 
 ture are necessarily not fitted to resist the action of 
 destructive agents. The same may be said of those 
 with deep fissures whose edges are imperfectly joined. 
 
 Irregularity of position, from whatever cause, 
 renders the teeth liable to decay. When they lap 
 over one another, or touch at points other than those 
 which are intended to come in contact in a natural 
 and orderly arrangement, decay at such points is apt 
 to occur. The difficulty of keeping irregular teeth 
 clean is another fruitful cause of decay, the retention 
 of food being favored by their positions. 
 
 Mechanical injuries — falls, blows, and improper 
 use of the teeth, destroying the continuity of the 
 enamel — also predispose to decay. 
 
 The exciting causes of decay are chiefly different 
 forms of chemical action, which may either follow from 
 the use of acids as food or medicine, or be caused by 
 improper tooth-powders or washes ; or may result from 
 a vitiation of the secretions of the mouth, either from 
 a general systemic derangement or from a local cause, 
 such as mumps, sore throat, or the presence of tartar 
 about the necks of the teeth causing an irritation of 
 the gums and inducing an acid secretion ; or from the 
 fermentation and decomposition of food about and 
 between the teeth. This latter is beyond question the 
 chief cause of caries. It is well known that in the fer- 
 
112 THE MOUTH AND THE TEETH. 
 
 mentation or decomposition of animal or vegetable 
 substances acids are generated. Every housekeeper is 
 aware of the liability of milk, catsup, and various 
 other household supplies to turn sour — a result caused 
 by the development of a microscopic vegetation called 
 the "yeast plant," the change taking place more read- 
 ily in warm weather than in cold. Under favoring 
 circumstances a like growth (facilitated by the heat 
 and moisture) takes place in the mouth, and acts 
 upon the mucus and saliva as a ferment. The little 
 masses of food impacted in the crevices and between 
 the adjoining surfaces of the teeth thus become so 
 many heaps of decomposing or fermenting material, 
 generating acids which attack and destroy, particle 
 by particle, the tooth-structure. The effect of a 
 weak acid upon a substance which, like the teeth, is 
 largely composed of a form of lime, may be seen by 
 the submersion of an ^gg in vinegar. In a few days 
 the ^gg will be entirely deprived of its shell. This 
 exemplifies the manner in which the acid, generated 
 by fermentation of food, mixed with the secretions 
 of the mouth, attacks, disintegrates, and dissolves 
 the lime of the tooth. Decay never begins on the 
 smooth surfaces of teeth — those which are exposed 
 to the friction of mastication — but always com- 
 mences at points which, owing to their structure or 
 to their arrangement, furnish convenient receptacles 
 for decay-producing agents. The points most favor- 
 
DECAY OF THE TEETH, OR CARTES. II3 
 
 able to such retention are the deep fissures of the 
 bicuspids and molars and the approximate surfaces 
 of the teeth. In these crevices, and at the surfaces 
 which the teeth present to each other, and which 
 favor the lodgment and retention of food and mucus, 
 decay is most likely to begin, and once begun to 
 continue. It proceeds slowly, perhaps, so far as the 
 enamel is concerned, but when it reaches the den- 
 tine, either through a fissure in the enamel or a 
 breach made through its walls, it progresses more 
 rapidly until the pulp is reached, and its vitality 
 and the strength and substance of the tooth are 
 destroyed. Decay proceeds much faster when once 
 a cavity has been formed in a tooth because the de- 
 structive materials are there held in constant contact 
 with the tooth-structure; not, as is generally supposed, 
 because the dentine is so much more susceptible to 
 their action than the enamel. Smooth, well-polished 
 dentine, such as is left by careful operators after 
 making what is called a permanent separation be- 
 tween adjoining teeth, resists decay in many cases 
 almost as well as the enamel itself. 
 
 The character of the disintegration to which the 
 teeth are liable differs, as does their original forma- 
 tion, in different individuals, the decay being dark, 
 white, dry, moist, horny, soft, chalky, or cartilagi- 
 nous, according to the quality of the original struct- 
 ure and the strength and activity of the solvent ; 
 10* II 
 
114 ^^-^ MOUTH AND THE TEETH. 
 
 also somewhat according to the systemic conditions 
 of the individual. The teeth are a part, and an 
 exquisitely organized part, of the animal economy. 
 They must, therefore, be more or less influenced by 
 the state of the general health. They are liable to 
 considerable modification of their texture by varying 
 constitutional conditions, becoming softer at times, 
 and therefore more likely to be injuriously affected 
 by decay-producing agents. Moreover, morbid se- 
 cretions of the mouth in deranged systemic condi- 
 tions tend markedly to the production of caries. 
 Slight irritation of the mucous membrane, such as is 
 caused by the presence of tartar which has insinuated 
 itself between the gums and the necks of the teeth, 
 will provoke a mucous secretion decidedly acid, and 
 as decidedly destructive to tooth-structure. Derange- 
 ments of the alimentary canal are generally accompa- 
 nied by acidity of the saliva. During pregnancy the 
 saliva is generally acid in character, which fact, in 
 addition to the softened condition of the teeth them- 
 selves previously alluded to, accounts for the rapid 
 decay which is undoubtedly apt to take place at such 
 times. In all acute inflammatory diseases, and in 
 all chronic affections of the digestive tract, there is 
 increased viscidity of the mqcous secretions of the 
 mouth with a marked diminution of the saliva, tend- 
 ing to the production of caries. In dyspeptic trou- 
 bles there is generally an acid condition of the diges- 
 
DECAY OF THE TEETH, OR CARIES. II5 
 
 tive fluids, which are regurgitated from the stomach 
 to the mouth and act directly upon the lime of the 
 teeth. 
 
 In addition to the acids, resulting from derange- 
 ments of the stomach and alimentary tract, or from 
 the mucous and salivary glands, or from the fermen- 
 tation or decomposition of food about the teeth, 
 there is another agent which is supposed to play an 
 important part in the extension of caries, viz., a vege- 
 table parasite — a fungus — found in the interstices, 
 furrows, and depressions of neglected teeth, but most 
 abundantly in cavities of decay. It is not claimed 
 that this fungus originates decay, but that it becomes 
 an active agent in the destructive process when once 
 a loss of substance has been caused in the enamel — 
 its filaments penetrating the minute chinks, excava- 
 tions, and orifices caused by disintegration, and 
 opening the way for the entrance of chemically 
 destructive agents. The development of this fungus 
 seems to be favored by an acid condition of the 
 mouth. Treatment, therefore, which corrects the 
 acidity lessens the danger. Antacid washes, espe- 
 cially washes or powders containing soap, hinder the 
 development of the parasitic vegetation. 
 
 Whatever may be said of the deleterious efi"ects of 
 tobacco upon the general system, it has not been 
 proved to have any influence in the production of 
 caries, although the discoloration which results from 
 
Il6 THE MOUTH AND THE T^ETH. 
 
 its continued use detracts markedly from the appear- 
 ance of the teeth. In this connection it may be men- 
 tioned that the use of a clay pipe produces a rapid 
 abrasion of the teeth between which it is held, and 
 that short pipes are charged with the development 
 of cancerous affections of the tongue and lips. 
 
 Sugar and confections exercise no directly injurious 
 effects upon the teeth, but when taken in excess do 
 produce an acid condition of the stomach unfavor- 
 able to the health of the mouth, and when left in the 
 interstices of the teeth rapidly undergo an acid fer- 
 mentation, resulting in a product capable of acting 
 very injuriously upon tooth-structure. Particles of 
 candy remaining between the teeth will, in a single 
 night, produce demonstrable mischief. 
 
 The progress of decay of the teeth is as varied in 
 different individuals and at different times as is the 
 character of the disintegration. It proceeds some- 
 times insidiously and slowly, and again with wonder- 
 ful rapidity; sometimes announcing its ravages by a 
 sensitiveness of the exposed dentine to sweets and 
 acids and to changes of temperature, and at other 
 times giving no notice of its presence until a com- 
 plete exposure of the pulp has been made. 
 
CHAPTER XVII. 
 
 TOOTHACHE EXTRACTION — HEMORRHAGE. 
 
 PAIN or discomfort in or about a tooth may arise 
 from a variety of causes. In perfectly sound 
 teeth rhciumatism sometimes causes distressing pain, 
 which may be located in one or two teeth, or involve 
 half of a jaw, or even the entire jaw. Neuralgia, 
 originating as it does very frequently in diseased 
 teeth, may have its origin elsewhere and manifest it- 
 self in teeth which are perfectly sound. Valuable 
 teeth are often sacrificed from this cause. Pain 
 is frequently experienced in a tooth which is only 
 sympathetically affected. These facts have been ex- 
 plained in the chapter on "The Nervous Relations 
 of the Teeth." A recession of the gums and alve- 
 olar process from about the neck of a tooth, ex- 
 posing the cementum, gives rise in some cases to a 
 dull and annoying ache. Particles of tartar which 
 have found their way between the gum and the alve- 
 olar process may occasion soreness and distress, if not 
 acute pain. The disease known as exostosis^ which 
 may be described as an unnatural enlargement of the 
 
 117 
 
Il8 THE MOUTH AND THE TEETH. 
 
 root of a tooth, is often the cause of constant un- 
 easiness, and sometimes of distressing pain. In some 
 cases there is a peculiar deposit in the palp of a 
 tooth of granules of bone-like material which causes 
 severe neuralgic, generally paroxysmal, pain, some- 
 times located in the tooth (which yet gives no evi- 
 dence of trouble, either by soreness, discoloration, 
 or decay), and sometimes reflected to the eye, ear, 
 scalp, or elsewhere. The death of the pulp in a tooth — 
 the result of a fall, blow, or other accidental or vol- 
 untary violence, or from some unexplained cause — 
 becomes the occasion of unbearable pain when the 
 products of its decomposition are confined in the pulp 
 cavity. Some teeth, in which a cavity of decay has 
 exposed the dentine, become exceedingly sensitive to 
 the influence of irritating agents. In such cases sweets 
 or acids taken into the mouth, or cold or hot drinks, 
 or even the secretions of the mouth, will occasion 
 pain. 
 
 Chief in frequency, however, of the causes of pain 
 in a tooth is the absolute or approximate exposure 
 of the pulp, which, as has been previously explained, 
 is located in a cavity having the general form of 
 the tooth and protected on all sides by its walls. 
 When by the agency of decay the overlying floor of 
 the cavity becomes so thin as to be permeable, the 
 result is an irritation of the delicate and exquisitely 
 organized pulp, and consequently acute pain. When 
 
TO O THA CHE — EXTRA CTION— HEMORRHA QE. 1 1 9 
 
 the protecting wall of dentine has been so far disin- 
 tegrated as to expose the pulp, the latter is liable to 
 constant irritation by contact with food or drinks, 
 with the secretions of the mouth, or even with the 
 atmospheric air. A small defect in the continuity of 
 the dentine is likely to result in greater distress 
 than would ensue from a complete exposure, for the 
 reason that in the latter case the swollen pulp has room 
 for its enlargement, while in the former the unyielding 
 walls of the tooth confine it. The pressure makes 
 manifest every pulsation of the heart, causing that form 
 of anguish known as "jumping toothache." Those 
 who have experienced this pain need no description of 
 it ; those who have not, would do well to avoid a prac- 
 tical acquaintance with it. 
 
 Still another form of pain in connection with teeth 
 is that which is occasioned by an inflammation of the 
 membrane surrounding the roots and investing the 
 sockets. This affection is known by the name oi peri- 
 odontitis — inflammation about a tooth. The con- 
 dition may be either acute or chronic, and may be 
 the result of the continued influence of neuralgia, gout, 
 or rheumatism ; of the irritation of deposits of tartar 
 between a tooth and its socket \ of mercurial poison- 
 ing, or of one of the eruptive fevers (measles, scarlet- 
 fever, small-pox, etc.); of an attack of scurvy; of de- 
 generative changes from age or other causes, either in 
 the membrane itself or in the roots of the teeth ; of 
 
I20 THE MOUTH AND THE TEETH. 
 
 false (premature) occlusion of a tooth in mastication, 
 either because of its position or of an undue promi- 
 nence of a filling on a crown surface, and of mechan- 
 ical violence — accidental, voluntary, or from the in- 
 judicious use of the mallet in filling, or from exces- 
 sive wedging to separate the teeth for examination or 
 operation. 
 
 The acute or active form may be the result of **a 
 cold settling in the jaws," as it is commonly expressed, 
 and generally subsides after a few hours or days of 
 discomfort. The most common and the most severe 
 form of periodontitis, however, is that which is as- 
 sociated with disease or death of the pulp in a tooth. 
 Teeth in which an unsuccessful attempt has been made 
 to save an exposed pulp by "capping," as well as 
 those in which the pulp has been devitalized but its 
 complete removal not accomplished, are liable to peri- 
 odontitis, especially during sudden changes in the 
 weather, or as a result of a disturbance of health in 
 the individual. Periodontitis usually commences 
 with a scarcely noticeable uneasiness in the tooth, 
 but deepens into a dull, heavy, sometimes throb- 
 bing, persistent pain. From the swelling of its in- 
 vesting membrane, the tooth projects beyond its 
 fellows, compelling a discontinuance of all masticatory 
 efforts for the time being. The pain increases in in- 
 tensity, and is accompanied by more or less swelling 
 of the face. Unless the diseased action be arrested by 
 
TO O THA CHE — EXTRA CTION— HE MORE HA GE. 121 
 
 treatment, an abscess forms at the root of the tooth, 
 the resulting pus generally finding its way to the sur- 
 face of the gum opposite the abscess, or at some other 
 point in the mouth, forming what is popularly known 
 as " gum-boil." After the discharge of the pus the 
 pain subsides, and the swelling gradually disappears. 
 But the disease is not cured, and after a longer or 
 shorter period, depending on various circumstances — 
 notably on the good or the ill health of the individual 
 — there will be a recurrence of the abscess. If this is 
 repeated too often, the bony socket of the tooth be- 
 comes affected, the sockets of adjoining teeth partici- 
 pate in the trouble, the teeth lose their vitality and 
 drop out, and sometimes necrosis (death) of a portion 
 of the jaw follows. Sometimes the pus, instead of find- 
 ing exit near the affected tooth, burrows among the 
 tissues, and makes an outlet (called a "sinus") for 
 itself at a distant point inside or outside of the mouth, 
 not infrequently producing disfiguring scars on the 
 face. When the symptoms indicate periodontitis, 
 treatment should be instituted with a view to pre- 
 vent the formation of an abscess, or, if this effort fails, 
 to influence it to open at a desirable point — inside 
 of the mouth, and not upon the face. Domestic treat- 
 ment of this affection is usually wrongly directed, and 
 that prescribed by the average general practitioner of 
 medicine is almost equally at fault. The best pos- 
 sible advice which can be given here is to consult an 
 II 
 
122 THE MOUTH AND THE TEETH. 
 
 intelligent practitioner of dentistry at an early stage 
 of the trouble, at which time it can frequently be 
 aborted. 
 
 For the relief of toothache from approximate or 
 actual exposure of the pulp, an application to the 
 cavity of decay of a little ball of cotton saturated with 
 oil of cloves, oil of peppermint, or phenol sodique 
 in full strength, is perhaps the best amateur treatment 
 where the cavity is easily reached. In other cases, 
 holding in the mouth phenol sodique diluted with 
 from three to six times its bulk of water will frequently 
 alleviate the pain. But it must be remembered that, 
 if the pulp is nearly or quite exposed, a recurrence of 
 the pain is probable at any moment. For permanent 
 relief the only efficient plan is to secure the services 
 of a dentist. In the case of a child suffering from 
 toothache in a temporary tooth, the difficulty of ap- 
 plying local sedatives directly to the cavity of decay is 
 vastly increased by the fear (often well founded) that 
 the affection will be aggravated by the lack of skill in 
 the amateur operator, and by the exceeding amount 
 of the salivary secretion, making it difficult even for 
 an expert to operate satisfactorily. The disinclination 
 to have in the mouth anything which tastes or smells 
 unpleasant, or which produces any disagreeable sen- 
 sation upon the mucous membrane, is a difficulty in 
 the way of using such remedies as have been sug- 
 gested. In these cases holding warm milk, or even 
 
TO O THA CHE — EXTRA CTION— HEMORRHA GE. 1 2 3 
 
 warm water, in the mouth will frequently give tem- 
 porary relief. 
 
 It should be remembered that a tooth which has 
 ached once will be likely to ache again, and an en- 
 deavor should be made to prevent a second attack in 
 the same tooth by securing professional advice. 
 
 It is seldom that the extraction of a tooth becomes 
 a necessity. Thousands of teeth are sacrificed through 
 impatience, the result of the pain which ought to have 
 been avoided by timely attention, and which might 
 have been alleviated and the teeth preserved. 
 
 The facility afforded for the painless extraction of 
 teeth by the use of nitrous oxide gas leads to the need- 
 less, wanton, wicked sacrifice of useful organs — to 
 losses which can never be made good. The willing- 
 ness of many persons to part with valuable teeth rather 
 than take a little trouble and incur a small expense 
 for their preservation, is an evidence of ignorance and 
 of a readiness to submit to mutilation of the mouth 
 as remarkable as general. 
 
 There is urgent need of a popular awakening to 
 the fact that wilful neglect of the health of any por- 
 tion of the body is criminal ; that such neglect differs 
 only in degree from suicide. The preservation of the 
 integrity of the physical organism and of the vital 
 forces, and the restoration of diseased or wounded 
 members whenever possible, may be said to be the 
 leading principle alike of surgery, of medicine, and 
 
of dentistry. It should be the ambition of every in- 
 dividual to retain as long as possible each organ and 
 faculty of body and of mind. But when it becomes 
 desirable as a choice of evils to sacrifice a tooth, it is 
 a weakness and a folly to allow it to remain through 
 dread of the brief pain accompanying extraction. 
 If its room is better than its company, and its dis- 
 placement is demanded for conservative reasons, the 
 sooner it is removed the better, both for the health of 
 its neighbors and for the comfort of its owner. 
 
 The bleeding which follows the extraction of a 
 tooth is usually of short duration and ceases without 
 requiring any attention. In very exceptional cases it 
 may be so profuse and long-continued as to demand 
 treatment. The anxiety of the patient to have it 
 cease leads sometimes to such constant interference 
 as to effectually prevent natural cessation by the clot 
 which would otherwise form in the socket. The first 
 injunction, therefore, in such cases is, do not disturb 
 the clot. If, in spite of such negative attention, the 
 bleeding continues, resort may be had to the applica- 
 tion of astringents or styptics, such as alum, tannin, 
 catechu, kino, krameria, phenol sodique, or remedies 
 which act mechanically, such as powdered resin, burnt 
 cork, spider' s-web, etc. Of the various astringents, 
 tannin is perhaps the most efficacious. Either that or 
 powdered alum may be applied to the socket of the 
 tooth on a small pledget of cotton. If these remedies 
 
TO O THA CHE — EXTRA CTION— HEMORRHA GE. 125 
 
 are not available, cobweb, which can generally be pro- 
 cured without much difficulty, may be rolled into a 
 small pellet or ball and carried into the bleeding sccket 
 by a match-stick or piece of stout broom-corn. If 
 the case be a stubborn one, and refuses to yield to 
 such applications, pressure may be added. The little 
 pledget of cotton carrying the tannin or other styptic 
 should be dropped into the socket, which may then 
 be compressed by a V-shaped saddle (made of cork or 
 wood) so as to clamp the margins of the gum, and be 
 held in place by the opposing teeth or jaw, assisted, 
 if need be, by a bandage holding the jaws together. 
 To divert the circulation to other parts of the body, 
 hot foot-baths may be resorted to, and a sitting in- 
 stead of a recumbent posture assumed, that the law 
 of gravitation may also conduce to the desired result. 
 In exceptionally extreme cases, when such measures 
 as have been indicated fail, further treatment should 
 be instituted by the dentist or physician, and should 
 include systemic medication. 
 II* 
 
 -1. o^A nA^-^^ 
 
CHAPTER XVIII. 
 
 HYGIENE OF THE MOUTH. 
 
 THE comfort of a pure breath and wholesome saliva, 
 the agreeable effect produced upon others by the 
 exhibition of a clean and healthy mouth, the advan- 
 tage of the teeth in vocalization, the favorable im- 
 pression made upon the general health by the ability 
 thoroughly to masticate the food, exemption from the 
 suffering which would be caused by diseased organs, 
 and the possibility of the preservation and usefulness 
 of the teeth till advanced life, are reasons sufficient, 
 it would be thought, to induce every one to pay that 
 attention to the health of the mouth which would 
 secure such results. As far as the teeth are concerned, 
 their liability to decay and the fact that, unlike other 
 portions of the body, they are not endowed with the 
 power to repair injury or replace lost tissue, so that 
 when decay has destroyed any portion of their struct- 
 ure there is no possibility of its restoration, are most 
 urgent reasons why they should receive intelligent and 
 earnest care. 
 
 In the chapters on " Salivary Calculus " and " De- 
 
 126 
 
HYGIENE OF THE MOUTH. 12/ 
 
 cay of the Teeth" it has been shown that the accu- 
 mulation of tartar about the necks of the teeth and 
 the retention of food and other matters in their de- 
 pressions and between their contiguous surfaces, there 
 to undergo fermentation and decomposition, are the 
 principal exciting causes of diseased gums, loosened 
 teeth, and decay. It follows, therefore, that such de- 
 posits should be removed before they have had an 
 opportunity to work mischief. There is no ques- 
 tion that the one great essential to a healthy mouth is 
 cleanliness. In fact, few even of those who pride 
 themselves upon the care which they bestow upon 
 their dental organs give to them the attention which 
 their value would justify. Many otherwise intelligent 
 people fail to appreciate the importance of taking 
 due care of their teeth until compelled by suffering 
 to do so. Then, when the demand has become im- 
 perative, their chief thought seems to be not how best 
 to prevent further mischief and to retain what is left of 
 their dental organs in as perfect a condition as pos- 
 sible, but how imm.ediate relief can be secured, or else 
 how painless extraction can be effected. It must not 
 be forgotten that decay is not the only enemy of the 
 teeth. The absorption of the gums and sockets caused 
 by the presence of tartar is a liability which, though 
 not absolutely confined to teeth which are neglected, 
 is yet a danger specially threatening such. This re- 
 sult might in a majority of instances be prevented by 
 
128 THE MOUTH AND THE TEETH. 
 
 intelligent care — recession of the gums or absorpjtion 
 of the sockets rarely occurring in mouths that are 
 habitually kept pure. 
 
 On the other hand, many scrupulously careful people 
 bring about the evils which they seek to avert, by im- 
 proper methods and appliances. Much mischief is 
 wrought by the use of unsuitable brushes and injudi- 
 cious brushing; by the use of tooth-powders and 
 mouth-washes made in ignorance of the purposes to 
 be subserved by their employment, and likely to do 
 harm, either because of their chemical action upon 
 tooth-substance, their unfavorable influence upon the 
 health of the gums, or because of their containing 
 ingredients likely to be deposited about the necks of 
 the teeth and thus cause the absorption of the gums 
 and alveolar processes. Simple measures regularly 
 employed are sufficient for healthy mouths. In dis- 
 eased conditions the wash or powder to be employed 
 should be prescribed by an intelligent dentist. Patent 
 nostrums and advertised powders and washes should 
 be avoided. Any wash that is recommended for 
 whitening the teeth is either incapable of accom- 
 plishing what is claimed for it or does so at the 
 expense of the integrity of the enamel. The ha- 
 bitual use of astringent washes or powders, so far 
 from being conducive to the health of the gums, is 
 injurious. For certain purposes such dentifrices are 
 of service, but their use should be discontinued as 
 
HYGIENE OF THE MOUTH. 1 29 
 
 soon as the object for which they are employed has 
 been accomplished. Strongly alkaline washes are also 
 injurious. Washes or powders containing alum, cream 
 of tartar, charcoal, ground barks, or acids of any de- 
 scription, are injurious either because of a chemical 
 action upon the teeth or because their insoluble in- 
 gredients are apt to insinuate themselves under the 
 margins of the gums. Tooth-powders containing 
 excessively gritty or abrasive ingredients, or even 
 those of ordinary abrasive power not sufficiently fine, 
 do injury by roughening instead of polishing the en- 
 amel surfaces of the teeth. Perhaps there is no agent 
 in common use for cleansing the teeth worthy of such 
 utter condemnation as powdered charcoal. The re- 
 sults of its employment are exceedingly pernicious; 
 the harsh, insoluble particles force themselves between 
 the gums and the teeth, creating irritation, soreness, 
 and inflammation of the tissues, and form nuclei for 
 the dej)osit of tartar, resulting in the absorption of 
 the alveolar processes, and in the loosening and loss 
 of the teeth. Its continued use also causes the gums 
 to assume a tattooed appearance, like that whick 
 India-ink produces when pricked into the flesh. 
 
 A mouth-wash may be anodyne, astringent, disin- 
 fectant, stimulant, or tonic, according to the indica- 
 tions ; but, if the secretions are natural and the gums 
 healthy, the wash should merely be pleasant to the 
 taste, agreeable in odor, and slightly antacid or sapo- 
 
 I 
 
130 THE MOUTH AND THE TEETH. 
 
 naceous — not astringent. A tooth-powder, for a 
 healthy condition of the mouth and teeth, should be 
 merely a mechanical agent, possessing a hardness suf- 
 ficient for the removal, without liability to injure the 
 enamel, of slight accumulations of food and tartar. 
 It should be soluble in the fluids of the mouth, and 
 for most persons antacid. In mouths that are already 
 alkaline — most likely to occur after middle life — the 
 antacid ingredients may advantageously be omitted, 
 and a powder employed possessing only mechanical 
 qualities. 
 
 It is safe to affirm that a very large majority of 
 persons err in the selection of a tooth-brush. Most of 
 the brushes in the market are too stiff and too large. 
 The habitual use of such brushes is attended with ill 
 results. Again, those who are most solicitous to secure 
 perfect cleanliness of the teeth are apt to err decidedly 
 in a too vigorous use of the brush. Many sets of teeth 
 have been ruined by too much or injudicious brush- 
 ing. Skill and not force, faithfulness and not muscle, 
 are required to secure the best results. Most persons 
 scrub the outer surfaces of the teeth, as if to clean by 
 scouring or friction were the object in using a brush. 
 A very 7)ioderate application of a proper brush with a 
 gentle frictional powder is sufficient for the external 
 surfaces of the teeth, and is desirable in order to pre- 
 vent the tendency to unsightly discolorations, but as a 
 prevention of decay is the least useful mode of brush- 
 
HYGIENE OF THE MOUTH. 131 
 
 ing. Indeed, if the cleansing process is carried no 
 further, this style of brushing does perhaps more harm 
 than good, as it rubs particles of food and stringy mucus 
 in between the teeth, and allows them to remain just 
 where they are capable of producing the greatest mis- 
 chief. The surfaces of the teeth which are exposed 
 to the movements of the tongue, lips, and cheeks, 
 being thereby protected, do not especially need brush- 
 ing, except to remove stains, while the interstices, 
 interspaces, fissures, depressions, and cavities are ex- 
 posed to the deleterious action of the fermenting 
 materials which naturally lodge there, to which are 
 added the reinforcements carried by crosswise brush- 
 ing. It should be remembered that the removal of 
 accumulations of food or mucus from the depressions 
 in the bicuspids and molars and from between the 
 teeth is the essential. The brush should be mod- 
 erately soft, the bristles long and elastic and of 
 uneven lengths, so as to facilitate their introduction 
 between the teeth. The upper teeth should be 
 brushed downward and the lower teeth upward, both 
 on the outer and inner surfaces, thus avoiding crowd- 
 ing the gums from off the necks of the teeth while 
 tending to the dislodgment of any deposits between 
 them. The articulating faces of the teeth should be 
 brushed with the same care as the ©ther surfaces — 
 backward and forward and from side to side over the 
 
132 THE MOUTH AND THE TEETH. 
 
 grinding surfaces of the molars, so as to cleanse all 
 the depressions. 
 
 Once daily is quite often enough to use a powder, 
 and the best time is just before retiring. During the 
 waking hours the various movements of the tongue 
 and muscles of the mouth in speech and otherwise, 
 the constant salivary secretion and the mastication of 
 food, all tend to prevent the chemical changes which 
 during sleep take place without hindrance. The 
 morning cleansing may be properly performed with 
 the aid of a little pure, mild soap, such as old Castile, 
 or a reliable tooth-soap made expressly for the pur- 
 pose; the latter will be all the more efficient if it 
 contain an antiseptic such as creasote, carbolic acid, 
 or salicylic acid. After meals it will be sufficient to 
 use tepid water to which has been added a few drops 
 of spirit of ammonia, or a little bicarbonate of soda, 
 or lime-water — simply to neutralize any acidity. 
 These after-meal cleansings should not involve a too 
 vigorous use of the brush — merely a skilful dislodg- 
 ment of adhering or impacted food is required. In 
 fact, if the use of the brush leads to the scrubbing 
 process, it would better be dispensed with, substi- 
 tuting a thorough rinsing of the mouth with tepid 
 water, made slightly antacid, as suggested above. 
 A muscular styk of brushing five times daily will be 
 injurious to the gums, if not to the teeth. 
 
 During the period occupied by the shedding and 
 
HYGIENE OF THE MOUTH. 1 33 
 
 replacement of the temporary teeth — say from five 
 to fifteen years of age — it is difficult to keep the 
 teeth clean or the mouth sweet and healthy. It is 
 advantageous during this time, indeed at any period 
 of life when an acid condition of the mouth is recog- 
 nized, to use after the evening brushing a small quan- 
 tity of precipitated chalk, nibbing it into the inter- 
 stices of the teeth with the finger and allowing it to 
 remain. The quantity need not be enough to be 
 unpleasant ; as much as would adhere to the end of 
 a moistened finger is sufficient to counteract any 
 acidity during the night. 
 
 The use of a quill toothpick after meals to dislodge 
 particles of food from between the teeth is advisable, 
 as is also the use of a strand of waxed floss silk passed 
 between them at least once daily. 
 
 Such is the care suggested by the inestimable value 
 of the teeth, and by their increasing tendency to 
 early decay ; but such care can hardly be hoped for 
 until the public realize that to lose a tooth is a real 
 misfortune, to extract one unnecessarily a crime. A 
 perfect denture ! How few understand the signifi- 
 cance of the term ! A set of thirty-two teeth in two 
 unbroken arches — not one missing, not even one de- 
 cayed tooth — the beau ideal of dental perfection. 
 But the loss of a tooth, except in the front of the 
 mouth, is not considered a serious matter by most 
 persons, and the extent of the disaster is not appre- 
 12 
 
134 THE MOUTH AND THE TEETH. 
 
 ciated perhaps for years afterwards. Unquestionably, 
 if all the various offices of the teeth were fully com- 
 prehended, the really small amount of attention which 
 is required would be cheerfully bestowed. 
 
 As a frictional powder, precipitated chalk is a safe 
 and generally efficient agent. Where this is found 
 insufficient to prevent the staining or discoloration 
 of the teeth, it may properly be combined in various 
 1 proportions with the inside of the cuttle-fish bone, or 
 with a smaller quantity of very fine ly-powdered "^Mvaico. 
 stone. In case the mouth is habitually alkaline, pow- 
 dered orris-root combined with the cuttle-fish bone or 
 pumice as above may be substituted for the chalk. 
 
 Mouth-washes should be used with reference to the 
 existing conditions. Lime-water is recommended, 
 in full strength, or more or less diluted where the 
 mucous secretions are viscid or fetid ; where the ani- 
 mal constituents are in excess of the earthy in the 
 composition of the teeth ; where there is special sen- 
 sitiveness either of the dentine or of denuded roots, 
 and where an antacid is needed to neutralize the 
 action of acid medicines upon the teeth. In those 
 cases where there is an evident tendency to rapid 
 disintegration of tooth-structure, the daily use of 
 lime-water as a mouth-wash is attended with bene- 
 ficial results. Its unpleasant taste can be disguised 
 by the addition of a small quantity of bruised licorice- 
 root. The addition of a few drops of spirit of am- 
 
 \ 
 
HYGIEXE OF THE MOUTH. 1 35 
 
 monia to a tumblerful of water makes a convenient 
 and efficient remedy for use on the brush, or as a 
 mouth-wash where an antacid is indicated. For like 
 purposes a half- teaspoon ful or less of bicarbonate of 
 soda to a glass of water is also efficient. 
 
 The injurious action of acid medicines upon the 
 teeth should be counteracted by rinsing the mouth 
 thoroughly with either of the foregoing washes imme- 
 diately after swallowing the medicine. This immedi- 
 ate neutralization of the acid is much more trustworthy 
 than the use of a tube, through which the medicine is 
 often directed to be taken, and is advisable even in 
 addition to the use of the tube. 
 
 The peculiarly disagreeable sensation described as 
 having the teeth *' set on edge," which results from 
 taking acid fruits, foods, drinks, or medicines into 
 the mouth, is caused by the action of the acid upon 
 the enamel, perceptibly roughening its surface. This 
 effect is injurious, and if frequently induced cannot 
 but prove destructive even to perfectly sound teeth; 
 being, however, specially objectionable in the case 
 of teeth which have been filled, destroying the in- 
 tegrity of fillings by eroding the tooth-substance 
 around their margins. 
 
 The tincture of krameria, mixed with an equal 
 quantity of good eau de Cologne and diluted with 
 water, makes an elegant and delightful astringent 
 mouth-wash. Tincture of myrrh, so often pre- 
 
136 THE MOUTH AND THE TEETH. 
 
 scribed, is of questionable value as a mouth-wash, 
 from the fact that the dilution of the tincture occa- 
 sions a precipitation of the resin of which it is made 
 about the necks of the teeth, aggravating rather than 
 alleviating spongy conditions of the nwgins of the 
 gums. An excellent mouth-wash for^^ongy and 
 bleeding gums, to be used after the remd3^al of the 
 exciting causes, is made by combining one drachm 
 of tannin, two drachms of chlorate of potash, and a 
 
 - pint of boiling water. A teaspoonful of the tincture 
 of calendula to a goblet of water makes a pleasant 
 and efficient mouth-wash for use after the removal 
 of deposits about the teeth, or after extraction of teeth. 
 Perhaps no single article is more useful as a wash 
 in various conditions of the mouth than phenol 
 sodique — a preparation made from tar. It is an 
 antacid, an astringent, a sedative, a styptic, an anti- 
 septic, and a disinfectant. As a wash for the mouth 
 ■J it is highly useful (when there are no local exciting 
 
 ^ mechanical causes) in that class of cases of soft, 
 spongy, swollen gums which bleed at the slightest 
 touch. It checks excessive bleeding after extrac- 
 tion, and relieves the subsequent soreness of the 
 gums. It gives prompt relief to the distressing pains 
 which sometimes follow extraction; corrects unpleas- 
 antness of the breath caused by decayed teeth or by 
 unhealthy secretions of the mouth, while its antacid 
 and antiseptic properties make it a valuable agent in 
 
HYGIENE OF THE MOUTH. 1 37 
 
 correcting acidity and preventing putrefaction. It 
 may be used, to meet varying indications, diluted 
 more or less from half a teaspoonful to a tablespoon- 
 ful in a tumblerful of water. 
 
 These suggestions are not intended to encourage a 
 dependence upon any of the articles specified so much 
 as to discourage the use of unsuitable dentifrices and 
 washes, and especially of all advertised or secret prep- 
 arations ''warranted to harden the gums and whiten 
 the teeth." 
 
 As suggested in previous chapters/ more than usual 
 care of the mouth is required during sickness. It will 
 also be recognized that teeth need care in proportion 
 as they are poorly organized or irregularly arranged. 
 
 The treatment of unhealthy conditions of the mouth, 
 as shown in a predisposition to decay of the teeth, 
 must, to be successful, be systemic as well as local ; 
 but, fortunately, that treatment is found most effec- 
 tive which is also indicated for the general good of 
 the patient. It should include nutritious food, sun- 
 shine, sleep, change, tonics, etc., as are required alike 
 for constitutional and local derangements. 
 12 * 
 
CHAPTER XIX. 
 
 REPARATIVE TREATMENT. 
 
 THE first effort in the treatment of caries should be 
 directed to tlie predisposing and exciting causes, 
 constitutional and local. The object of treatment is 
 the arrest of the destructive action, and the repair of 
 the damage in the manner best calculated to preserve 
 the tooth or teeth in a serviceable condition, and 
 to protect them against a recurrence of the decay. 
 It is, of course, desirable that the treatment be begun 
 as soon as possible after the attack occurs, and before 
 any considerable progress in the disintegration of the 
 tooth-structure has been made. Very often a small 
 orifice leads to an unexpectedly large interior cavity, 
 and when the dentist is consulted the preservation of 
 the tooth is almost or quite impossible. Sometimes 
 a tendency to disintegration is manifested in all of 
 the teeth, showing systemic derangement ; sometimes 
 it is limited to a pair of teeth, showing that constitu- 
 tional conditions at the time of their formation have 
 resulted in an imperfect texture, and consequently in 
 a lessened capability of resisting tlie action of destruc- 
 
 138 
 
REPARATIVE TREATMENT. 1 39 
 
 tive agents ; sometimes it is confined to a single tooth, 
 in which case the explanation is probably to be found 
 in its relations to the adjoining teeth. 
 
 When, owing to the character and progress of de- 
 cay, and its appearance about the same time in teeth 
 formed at different periods, there is reason to believe 
 that it is an expression of constitutional disturbance, 
 such systemic treatment should be adopted as will 
 promote a healthy condition of the secretions of the 
 mouth and of the soft tissues about the teeth. All 
 deposits and accumulations of whatever character 
 about the teeth should be carefully and thoroughly re- 
 moved, and such local correctives employed as may 
 be indicated, conjoined with the utmost care as to 
 constant cleanliness. Any merely mechanical treat- 
 ment of carious teeth which ignores their original 
 organization, their special condition, and the tempera- 
 ment, age, and constitutional condition of the patient, 
 is not likely to be successful. These are considera- 
 tions which must always enter into the calculation in 
 reference to methods of treatment. There is no greater 
 folly than to demand the following of stated formulae, 
 prescribed manipulations, and an unvarying routine 
 for every operation without regard to varieties of struct- 
 ure and character of decay. Whether to fill or file, 
 with what and how much, must be determined by 
 the dentist chiefly by the peculiarities of each case. 
 Until the influence of such considerations is better 
 
140 THE MOUTH AND THE TEETH. 
 
 understood by the community unjust prejudices and 
 conclusions will prevail. The relative cost of differ- 
 ent materials and methods must also be considered, 
 though the most costly operations are by no means 
 always the best so far as the salvation of the teeth is 
 concerned. 
 
 It is not proposed, however, to discuss here the rela- 
 tive value of special materials or methods. Though 
 in one respect all who are worthy the name of dentist 
 agree — viz., that their mission is not to remove and 
 substitute, but to preserve and repair, yet, all the facts 
 of experience which have been gathered, all the im- 
 proved modes of practice which the best men in the 
 profession have thus far developed, have not sufficed 
 to establish a system the practice of which will in- 
 fallibly prevent or arrest the progress of decay in 
 human teeth. The most earnest and conscientious, 
 the most experienced and accomplished operators 
 disagree notably in their conceptions of what con- 
 stitutes the best practice ; and with all the advantages 
 of modern instruments, appliances, apparatuses, ma- 
 terials, and methods, they find their best efforts at times 
 unsatisfactory alike to them and to their patients. It 
 is, therefore, apparent that no rules can be laid down 
 which will be applicable alike in all cases. The gen- 
 eral reader cannot be expected to judge intelligently 
 of questions on which the ablest and most observing 
 practitioners of dentistry differ diametrically. The 
 
REPARATIVE TREATMENT. I4I 
 
 practice of anticipating and so preventing, or of re- 
 moving, superficial caries by so-called judicious sepa- 
 ration of the teeth is ably and earnestly advocated, 
 and also ably and earnestly denounced. Gold is gen- 
 erally considered the best material for permanent 
 fillings — those intended to be permanent ; though 
 in many cases it is admitted that other materials are 
 to be preferred. There are, however, many prepara- 
 tions of gold, having distinct and different qualities, 
 and many methods of manipulating them, so that 
 there are more differences even in gold fillings than 
 would be conceived by those not familiar with the 
 subject. Amalgam, gutta-percha, and various other 
 plastic fillings have undoubted claims to consideration 
 in many cases. The same is true of tin-foil. But 
 patients are not ordinarily qualified to judge of the 
 relative merits of the various materials and methods, 
 nor of their special applicability in individual cases, 
 and cannot do otherwise than to select an earnest, 
 conscientious, intelligent dentist, and submit to his 
 judgment — very certain to be better than their own 
 — and having done so, to give him all the help in 
 their power to secure the good results desired by both. 
 Good operations of any and all classes fail often 
 because of a want of cleanliness on the part of the 
 patient. If the teeth decay because of unhealthy 
 conditions of the mouth, produced either by consti- 
 tutional causes or from want of cleanliness, a contin- 
 
142 THE MOUTH AND THE TEETH. 
 
 uance of the same influences will produce like results 
 after the most thorough and most conservative treat- 
 ment according to any system. A tooth that has 
 been filled or filed is not therefore to be supposed 
 invulnerable to the attacks of destructive agents, 
 and the dentist should not be held responsible for 
 the patient's neglect. As a sick man requires more 
 care than a well one, so a damaged tooth, even 
 though repaired, needs more attention than a sound 
 one. 
 
CHAPTER XX. 
 
 SUBSTITUTION ARTIFICIAL DENTURES. 
 
 WHEN the natural teeth have been lost, the defi- 
 ciency should be supplied by substitutes. The 
 comfort, the health, the speech, and the personal ap- 
 pearance of the individual will be promoted thereby, 
 provided that the substitution is skilfully and artisti- 
 cally accomplished. Those who have parted with 
 some of their teeth are inclined to set a higher value 
 on those which remain, and supplying the place of 
 the missing ones is often the best means of preserv- 
 ing the rest — preventing their elongation and irregu- 
 larity. When the molars and bicuspids have been 
 removed the front teeth are apt to project, present- 
 ing an unsightly appearance. This may to a great 
 extent be prevented by supplying artificial masticating 
 surfaces. 
 
 There are various bases for artificial dentures — 
 gold, platinum, porcelain, silver, rubber, celluloid, 
 etc. Which of these materials is the best in a given 
 case depends upon a variety of circumstances — the 
 extent and character of the loss to be supplied, the 
 
 143 
 
144 ^-^^ MOUTH AND THE TEETH. 
 
 age and ph^ysical characteristics of the patient, the 
 condition of the mouth, the special qualifications of 
 the dentist, and the length of the patient's purse. 
 No one of the bases named is always the best ; each 
 of them has peculiar fitness for special cases. No 
 authoritative opinion governing all cases can there- 
 fore be given. As a general rule, however, it may- 
 be affirmed that a gold base has more advantages 
 and fewer disadvantages, certainly for partial sets, 
 than any other material. 
 
 The time most favorable for the insertion of artifi- 
 cial teeth is as soon after the loss of the natural ones 
 as the state of the mouth will allow, and before the 
 muscles of expression have been suffered to lose their 
 natural action. It is the modification which these 
 muscles undergo after the extraction of the teeth 
 which causes the changed and unnatural appearance 
 of the mouth and face when a considerable time 
 elapses before the natural teeth are substituted by 
 others. Their prompt replacement will also tend 
 greatly to prevent the elongation or protrusion from 
 their sockets of the teeth which formerly occluded 
 with the missing ones. 
 
 The most important office of artificial teeth, as well 
 as of natural ones, is the mastication of food. The 
 proper performance of this function is indeed essen- 
 tial, and frequently the skill of the dentist is re- 
 warded by a restoration to health of those whose 
 
SUBSTITUTION— ARTIFICIAL DENTURES. 1 45 
 
 imperfect mastication previous to the insertion of 
 artificial teeth had entailed upon them all the evils 
 of indigestion. 
 
 The sense of fatigue in the jaws and muscles of the 
 face, caused by inability to close the mouth properly, 
 in the absence of opposing or occluding teeth, is also 
 overcome by the skilful substitution of artificial teeth. 
 The enunciation is likewise improved, in many cases 
 being made as perfect as before. 
 
 Sometimes, in the case of elderly people who have 
 lost their teeth, there is a modification of the lower 
 jaw which causes it to interfere with the auditory ap- 
 paratus in such a manner as to produce partial or ab- 
 solute deafness, which the insertion of a properly 
 constructed denture promptly relieves. Another ad- 
 vantage gained by the wearing of artificial teeth is 
 that they act as a dam in preventing the sudden emp- 
 tying of the column of air in the mouth in speaking 
 — explained in the chapter on ''The Mouth." 
 
 The modification of the features caused by the re- 
 moval of the supports of the lips and cheeks is, of 
 course, changed by the insertion of artificial teeth ; 
 but whether the change is an improvement or other- 
 wise depends upon the artistic perceptions of the 
 dentist. It is unquestionable that the majority of 
 the dental profession have given more thought and 
 labor to the best methods of restoring impaired func- 
 tions — securing comfort, usefulness, and durability 
 13 K 
 
146 THE MOUTH AND THE TEETH. 
 
 in artificial dentures — than to the important ques- 
 tion of correlation of the substitutes with the general 
 physical characteristics of the patient. To this ac- 
 count is to be charged the unseemly incongruities 
 constantly staring the observer in the face from 
 mouths whose natural organs have been replaced in 
 disregard of the universal law of correspondence. 
 No matter how anatomically correct or how skilfully 
 adapted for speech and mastication an artificial den- 
 ture may be, if it does not bear the relation demanded 
 by age, temperament, facial contour, etc., its artifi- 
 ciality will be apparent to every beholder. This law 
 of correlation running through nature attracts and 
 enchants us in an infinite diversity of manifestations. 
 The failure in art to recognize its demands is cor- 
 respondingly abhorrent to our sensibilities. This law 
 of correspondence, apparent throughout the organism, 
 establishes a harmony between the teeth and other 
 physical characteristics by which we are led to infer 
 their size, shape, color, and structure. A broad and 
 square or an oval face ; a large, coarse-featured man, 
 or a delicately organized woman ; a miss of eighteen, 
 or a matron of fifty; a brunette or a blonde — these 
 and other varieties present as many differing types, 
 with teeth corresponding in size, shape, color, and 
 density. If, then, teeth correlated in their charac- 
 teristics to those which nature assigns to one class 
 be inserted in the mouth of one whose physical or- 
 
SUBSTITUTION— ARTIFICIAL DENTURES. 1 4/ 
 
 ganization demands a different style, the effect can- 
 not be otherwise than displeasing to the eye, whether 
 the observer be skilled in perception or only intui- 
 tively recognizes inharmony without understanding 
 the cause. It is entirely possible, by the study of 
 aesthetic anatomy, for the skilled dental mechanician 
 to adapt teeth to the great varieties of facial expres- 
 sion, to avoid offending the eye trained to observe 
 nature, and to add to usefulness the charm of beauty. 
 Incongruity or want of proper expression in a set of 
 teeth shows either malpractice in him by whom they 
 were selected and arranged, or dictation on the part 
 of the patient. 
 
 But, important as are the aesthetics of substitution, 
 use and comfort are mainly to be considered. An 
 artificial denture must be properly constructed and 
 skilfully adapted, or it will be worse than useless. 
 Badly-fitting plates cause serious affections not only 
 of the soft tissues of the mouth, but frequently of 
 the hard palate and of the jaws. However correct 
 artificial teeth may be in their aesthetic relations, 
 however comfortable and useful, let no one be be- 
 guiled into a willing sacrifice of the natural teeth 
 for the sake of the greater comeliness of substitutes, 
 or because the latter cannot ache. The best set of 
 artificial teeth that ever was made is so far inferior 
 to an average natural denture that the two can only 
 be contrasted, not compared. 
 
INDEX. 
 
 PAGE 
 
 Acid medicines, injurious action 
 
 of, upon the teeth iii, 135 
 
 Alveolar processes, description 
 
 of. 26 
 
 Anatomy of the teeth 32 
 
 Antrum 24 
 
 Artificial dentures 143 
 
 Bleeding following extraction, 
 treatment of. 124 
 
 following lancing, treatment 
 
 of. 59 
 
 Caries no 
 
 Cementum, description of. 33 
 
 Cleft-palate 25, 95 
 
 Correspondence, law of. 146 
 
 Decay of the teeth, causes of... no 
 
 varieties of 113 
 
 relations of, to systemic con- 
 ditions 114 
 
 Defects of teeth, constitutional.. 94 
 
 of enamel 96, 97 
 
 Dentine, description of. 33 
 
 Diet proper for children 82 
 
 DifEcuIt dentition, symptoms 
 
 of. 50, 74 
 
 earache from 53 
 
 page 
 
 Enamel, description of. 33 
 
 Epiglottis 16 
 
 Eruption of the teeth, indications 
 of. 54 
 
 Fifth nerve 86 
 
 Food containing mineral ele- 
 ments 81 
 
 importance of, during ges- 
 tation 79 
 
 importance of, while nurs- 
 ing 79 
 
 relations of the teeth to .. 78, 80 
 
 starchy, injurious to young 
 
 children 82 
 
 Glands, mucou"? 14, 19 
 
 salivary 17 
 
 Gum-boil 121 
 
 Gum, description of 23 
 
 Hare-lip 25, 95 
 
 Hygiene of the mouth 126 
 
 Irregularities of the teeth, 
 
 causes of. 98 
 
 correction of 104 
 
 148 
 
INDEX. 
 
 149 
 
 PAGE 
 
 Jaw, angles of the, at various 
 
 ages 25 
 
 articulation or jointing of 
 
 the lower 26 
 
 description of the lower 25 
 
 " " " upper 24 
 
 Lancing, hemorrhage from 59 
 
 methods of. 57 
 
 objections against 56 
 
 reasons for 54 
 
 Law of correspondence 146 
 
 Lips, description of. 14 
 
 Mastication 28 
 
 beneficial effects of, upon the 
 
 teeth 30 
 
 effects of improved facilities 
 
 for 30 
 
 results of imperfect 29 
 
 Mouth, anatomy of the 13 
 
 Mouth-washes 128 
 
 Nerves, functions of. 85 
 
 Neuralgia 92, 117 
 
 Palate, hard and soft 14 
 
 Pericementum 27 
 
 Periodontitis 119 
 
 Pharynx 15 
 
 Precocious mental development, 
 
 cause of irregularity 103 
 
 Pulp, description of. 34 
 
 exposure of n8 
 
 13* 
 
 page 
 
 Ranula, how produced 23 
 
 Reparative treatment 138 
 
 Rheumatism, toothache from. 92,119 
 Roots, importance of the reten- 
 tion of. 77 
 
 Saliva, description of. 19 
 
 effects of, on starchy food.. 20, 82 
 
 modification of, in disease 
 
 21, 114 
 
 relation of, to the sense of 
 
 hearing 20 
 
 Salivary calculus 106 
 
 Shedding of the temporary teeth.. 68 
 
 Sixth-year molars 64 
 
 Sugar, effects of, upon the teeth.. 116 
 
 Tartar, sources of 106 
 
 treatment of. 108 
 
 varieties of 107 
 
 Teeth, absorption of the roots of 
 
 the temporary 70 
 
 anatomy of. 32 
 
 arrangement of 41 
 
 as conservators of the lungs.. 31 
 
 brushes 62, 130 
 
 care of the temporary 60 
 
 circumstances demanding 
 
 extra care of 22, 73, 79, 137 
 
 classification of. 36 
 
 danger of the premature ex- 
 traction of the temporary' 61 
 
 description of 38 
 
 development of. 44 
 
 difficult eruption of the wis- 
 dom 74 
 
 eruption of the permanent.. 63 
 
 " " " temporary.. 47 
 
ISO 
 
 INDEX. 
 
 PAGE 
 
 Teeth, evils from decay of the 
 
 temporary 6i 
 
 • in classification of animals.. 32 
 
 irregularities of. 98 
 
 names of their surfaces 41 
 
 nervous relations of. 84 
 
 nutrition of 76 
 
 peculiarities, varieties, and 
 
 defects of. 94 
 
 reflex pain in and from.. 86,89,90 
 
 shedding of the tempo- 
 rary 68 
 
 special care of the, in sick- 
 ness 22 
 
 sympathetic affections of... 90 
 
 PAGE 
 
 Teeth, systemic disturbances 
 
 from 89 
 
 Thumb-sucking, results of 100 
 
 Tongue, functions of. 15 
 
 in disease 16 
 
 ulcers of the, caused by ca- 
 rious teeth 16 
 
 Toothache, causes of 92, 117 
 
 treatment of 122 
 
 Tooth-powders 129, 134 
 
 Tooth-soap 132 
 
 Wisdom teeth, difficult eruption 
 of. 74 
 
 The End. 
 
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