Siism^^^' RK61 H55^^^'*°^^303 Dental physiology an RECAP ':-':^'^'^:l;::^|>,i-:;>x^': ' mu Est COLLEGE OF PHYSICIANS AND SURGEONS LIBRARY Gift of Drnt 1 st s ' SuDply Co. DENTAL PHYSIOLOGY AND ORAL HYGIENE I3y DAVID STANLEY HILL, D. D. S. Eflangham, Illinois. FIRST EDITION Illustrated. The LeCrone Press Effingham, 111. 1917. Copyright 1917 by DAVID STANLEY HILL, D. D. S. All Riehts Reserved. DEDICATED TO MY MOTHER, MRS. MARGARET HILL, whose example has been an inspiration to me;; AND TO MY SISTER, VIOLA HILL, whose loyal assistance has contributed much to any success I may attain. PREFACE. Modern dentistry is devoting much effort toward- preventing and removing the cause of disease, as well- as repairing damage after bad habits have caused de- cay of the teeth. Medical' men assert that many of the infectious and contagious diseases find their begin- ning in unclean oral conditions. Disease contributes toward poverty and crime. In any community where right living conditions are- practiced, poverty and disease decrease. People are very much interested in their own wel-- fare, and are anxious to know of anything that will aid them in preserving their health and good appearance. Unfortunately, many people neglect or avoid seeking dental advice and aid until pain prompts them to call on the dentist. Often serious damage has been done, which it may/ be too late to remedy. The time to begin the care of the teeth is in infancy. : The children are not responsible for the neglected state of their teeth. The careless or ignorant parent, is to blame for the condition. Diseased conditions put a handicap on the child, re- tarding mental and physical development. School teachers are doing a good work in teaching.: —7— PREFACE. habits of personal cleanliness; but parents must co- operate. Many children are injured by bad oral hab- its long before the school age. In a period of ten years' practice, I have often been asked questions relative to the care of the teeth. People of otherwise high intelligence show a very lim- ited understanding when it comes to a knowledge of the Tteeth, especially the care and preservation of the tem- porary teeth. This is the most vital time of the child's life, and mis- takes made here may leave their mark throughout life. Start the child right and keep him right the first ^even years of his life, and he will take care of himself afterward. If you neglect your child while he is young and unable to care for himself, he will feel a resent- ment when he grows old enough to realize your neglect. Repeatedly and methodically going over a subject is the best known method of teaching, so that facts sink in and are digested by the reader. For this very Teason of emphasis the author has purposely repeated some subjects. In this little book I have tried to convey informa- tion which will be of service and promote better care of the teeth, which means better health to the individ- ual. If I have succeeded I shall feel well rewarded. In writing this little book, I have read many books and magazine articles. An effort has been made to give credit to those who have aided. Dr. Victor C. Bell's ''Topular Essays on the Care of the Teeth an^ Mouth," —8— PREFACE. have given me some excellent ideas. From The Dental Cosmos and The Dental Digest many helpful ideas have been used. If proper credit has not been given here, the author will be glad to rectify the mistake in: the next edition, if the book should merit one. I desire here to express my thanks to those wha have helped me in the preparation of this little book; to Doctors Otto U. King, Henry L. Whipple, Hermann Prinz, W. A. Evans, L. C. Burgard, William W. Belcher, William G. Ebersole, George T. Weber, and F. B. 01 win, and to Doctors Thomas B. Hartzell and E. A. Bogue, for the use of their illustrations and assist- ance; also to the Columbus Dental Manufacturing Co., The S. S. White Dental Manufacturing Co., P. Blakiston's Son & Co., The Blue Island Specialty Co.,. and The National Mouth Hygiene Association, for the use of illustrations. Also to Superintendent 0. C. Bailey and Professor W. B. Bunn, of Effingham, for their kindly assistance- in reading proof. David Stanley Hill, D. D. S., Effingham, III., May 1, 1917. —9- TABLE OF CONTENTS. CHAPTER PAGE I. The Digestive System 13 II. The Temporary Teeth 30 III. Children's Teeth 43 IV. Oral Hygiene, and Dental and Medical Examination of School Children 55 V. Orthodontia, or Straightening Irregular Teeth 72 VI. Filling and Treating Teeth ... 85 VII. Crown and Bridge Work .... 99 VIH. Care OF the Teeth and Mouth . . . 110 IX. Extracting Teeth and Oral Surgery . 122 X. Artificial Teeth 133 XI. Diseases of the Mouth, and First Aid Remedies 144 XII. Some Information About Dentistry . 156 Glossary . 165 —10— LIST OF ILLUSTRATIONS. FIGURE PAGE I. The Digestive System 16 II. The Appendix .25 III. The Temporary Teeth at Age Two Years (upper) . 30 IV. Irregular Teeth . . ... . . '3^ V. The First Permanent Molars . . . . 43 VI. The Ten Upper Deciduous Teeth, Age Five Years 72: VII. Models of Irregular Teeth . ... 74 VIII. Case of V Shaped Upper Arch . . . 75- IX. A Mouth Breather (front view) ... 81 X. A Mouth Breather (side view) . . . . 8L XI. A Mouth Breather. After Widening OF THE Arches and Straightening THE Teeth (front view) .... 82 XII. A Mouth Breather. x4fter Widening of the Arches and Straightening the Teeth (side view) .... 82: XIII. Cuspid Teeth, Ground Down, Show- ing Enamel, Dentine, Pulp Cham- ber, AND Roots of Teeth . . . . 87 XIV. Decayed Teeth 93 XV. Decayed Teeth, Restored by Filling . 94 XVI. Root Canals in Teeth, Filled . . .95 XVII. Bad Eyes, From Abscessed Teeth . . 9^ XVIII. Diseased Heart, From Abscessed Teeth 97 —11— LIST OF ILLUSTRATIONS. FIGURE PAGE •XIX. Defoemed Hand, From Dental Abscesses 98 XX. Tooth Which Needs Crowning . . . 101 XXI. Tooth Root Prepared for Crown . . 101 XXII. Porcelain Crown Completed .... 102 XXIII. A Richmond Crown 104 XXIV. A Gold Shell Crown . . . , . 104 XXV. Teeth Needing Crown and Bridge Work 107 XXVI. Teeth Prepared for Crowns . . . 107 XXVII. Crown and Caps for Bridge Work . 108 XXVIII. Spaces Filled in, for Bridge Teeth 108 XXIX. Bridge Soldered Together ... 108 XXX. Bridge, Porcelain Teeth Attached . 108 XXXI. A Three-Tooth Bridge .... 109 XXXII. A Tongue Scraper 114 XXXIII. Brushes^Adult's, Youth's, Child'« 119 XXXIV-A-B. How TO Brush the Teeth . . 120 XXXIV.-C. How TO Brush the Teeth . . .121 XXXV. Irregular Teeth, Caused by Removing One Tooth 12.3 X^XXVI. Artificial Upper Teeth .... 134 XXXVII. Artificial Lower Teeth . . . 135 XXXVIII. Full Upper and Lower Plates 137 XXXIX. A Plate Brush 142 XL. Nerves of Head and Face .... 151 —12- THE DIGESTIVE SYSTEM. CHAPTER I. The apparatus for the digestion of the food consists of the ALIMENTARY CANAL and certain ACCES- SORY ORGANS. The Alimentary Canal (Fig. 1), commencing with the mouth, lies in the neck, in front of the spine, passes through the thoracic cavity, pierc- ing the diaphragm, and continues in a tortuous course through the abdomen and a straighter course through the pelvis. It is about thirty feet long, and varies in diameter. Its principal parts are the MOUTH, PHARYNX, OESOPHAGUS, STOMACH, SMALL INTESTINE, and LARGE INTESTINE. Its lining, mucous membrane, is modified in each section according to the function of the particular part, and is continuous at both extremities with the skin. The muscular fibres of the canal are mostly of the UNSTRIPED variety, and are arranged length- wise and circularly in the tubular portions. Its layers, serous, muscular, areolar, and mucous, are well sup- plied with blood vessels. The tube has nerve ganglia, and receives fibres from the central and sympathetic systems. For convenience in the study of the Alimentary Canal, it may be divided into its various parts as follows : —13— The Salivary Glands DENTAL PHYSIOLOGY AND ORAL HYGIENE THE ALIMENTARY CANAL. The Mouth, The Stomach, The Pharynx, The Small Intestine, The Oesophagus, The Large Intestine. ACCESSORY ORGANS. [Deciduous, or Baby Teeth, 20 in Number, The Teeth [The Permanent Teeth, 32 in Number. fThe Parotid Glands, The Submaxillary Glands, The Sublingual Glands. The Liver, The Pancreas. THE MOUTH. — The Alimentary Canal commences with the mouth. It is bounded by the lips in front and the soft palate behind. Between the anterior and posterior arches of the soft palate are situated the TONSILS, one on each side. A Tonsil consists of an elevation of the mucous membrane, presenting several openings which lead into recesses, in the walls of which are placed nodules of lymphoid tissue. The Tonsils will be mentioned again in a following chapter. The mouth is bounded above by the hard palate, below by soft structures, and on the sides by the cheeks, and is lined with mucous membrane. It con- tains the tongue and the teeth. When closed the cavity is completely filled. The mouth is the main entrance to the alimentary canal, and with its appendages, is of great service in speech. —14— THE DIGESTIVE SYSTEM Opening into the mouth are a large number of little mucous glands. The salivary glands also pour their secretions into the mouth. The Tongue is a muscular organ, covered with mucous membrane. The muscles which form the great- er part of the tongue (intrinsic muscles), are termed Unguals; and by these, which are attached to the mucous membrane, its smaller and more delicate move- ments are perform.ed. By other muscles (extrinsic muscles), the tongue is fixed to the surrounding parts, and by these its larger movements are controlled. The mucous membrane of the tongue resembles other mucous membranes in essential points of struc- ture, but in addition, contains PAPILLAE, peculiar to itself. The tongue is also beset with numerous mu- cous glands and lymphoid nodules. The Papillae give the characteristic roughness to the tongue. The Peripheral Organs of the sense of taste consist of groups of modified epithelial cells, termed TASTE BUDS, which are found on certain parts of the tongue and its immediate neighborhood. The mouth contains the teeth, which are used in masticating the food. The human subject is provid- ed with two sets of teeth, which make their appear- ance at different periods of life. The first set appear in childhood, and are called the TEMPORARY, DE- CIDUOUS, or MILK TEETH, of which there are twenty, ten in the lower and ten in the upper jaw. The second set appear later in life, and are called —15— DENTAL PHYSIOLOGY AND ORAL HYGIENE the PERMANENT TEETH. There are thirty-two of these. The Teeth will be taken up in a separate chapter and more fully discussed. THE PHARYNX.— The Pharynx is the enlarged upper part of the alimentary canal, which lies behind the mouth. It is a musculo-membranous open sac,. Nasal Cavity Palate Tongue: OESOPHAGUS Gall Bladder LivEa — Duodenum Small Intestine Appendik Pylorus Stomach Pancreas Large Intestine Figure I. The Digestive System. (Photograph of pen drawing,) —16— THE DIGESTIVE SYSTEM wider above than below, and is that part of the ali- mentary canal which intervenes between the mouth and the oesophagus. In the middle portion it is com- mon to both food and air, conveying food to the oesophagus, and air to the larynx, and thence into the lungs. The Pharynx has seven openings through which it communicates with neighboring cavities. These are the two posterior nares, opening into the nasal cavity in front; the two Eustachian Tubes on the sides, opening to the ears; the opening into the mouth ; the opening into the larynx ; and the opening, at the lower end, into the Oesophagus. The OESOPHAGUS.— The Oesophagus or Gullet, is the portion of the digestive canal which intervenes be- tween the pharynx, above, and the stomach, below. With the exception of the pylorus, it is the narrowest part of the alimentary canal. It is also the most muscu- lar part. It is a muscular tube, nine or ten inches in length. Its breadth varies from a half inch in its empty contracted state, to an inch or more in its fully distend- ed state. The Oesophagus is made up of three proper coats, — the outer or muscular, the middle or sub-mucous, and the inner or mucous. In addition it is surrounded by an outer covering of areolar tissue, by which it is loosely connected to the various structures related to it in its course. This loose covering permits of its free movements and of its increase in size, or of its contraction during the act of swallowing. The MUS- CULAR coat is composed of two planes or layers of —17— DENTAL PHYSIOLOGY AND ORAL HYGIENE fibres, of considerable thickness, an outer or a longi- tudinal, and an inner of circular fibres. The SUB-MUCOUS or areolar coat connects loosely the mucous and muscular coats. It is composed of areolar tissue, and is of considerable thickness, in or- der to allow of the expansion of the tube during swal- lowing. By loosely connecting the mucous membrane to the muscular coat, it permits the mucous coat to be thrown into folds when empty. The sub-mucous coat contains blood vessels, nerves, and oesophageal glands. These glands are mucous glands. The MUCOUS coat is 'thick, and is disposed in longitudinal folds, which disappear when the tube is distended. This coat has numerous glands which dif- fer from the mucous glands of the sub-mucous tissue. "They are branched and tubular, and are called super- ficial glands. The muscular coat also contains glands, which dif- fer from the mucous glands of the sub-mucous tissue. Swallowing, or Deglutition, is divided into three stages: (1) . The mass of food is forced by the tongue through the fauces into the pharynx. This is under the control of the will. (2). In this stage the bolus must pass through that part of the pharynx common to food and air, and hence it must be quickly performed. This is done by a series of contractions controlled by the reflex centers, and not by the will. (3). The passage of the food through the oesophagus is performed by progressive muscular contractions, from above down- wards, and is independent of the will, and which act —18— THE DIGESTIVE SYSTEM carries the food into the stomach, which is the next part of the Alimentary Canal. The STOMACH.— The Stomach is the principal or- gan of digestion. It is the most dilated part of the alimentary canal, and is placed on the left side of the abdomen, and under the DIAPHRAGM, between the terminus of the oesophagus and the commencement of the small intestine. The form and size of the stomach varies because of varied conditions, but as a rule, when distended, it assumes the form of an irregular pear. Probably no organ in the body varies more in size, within the limits of health, than the stomach. Its length, in its fulljr distended condition, is about ten to eleven inches, and its greatest diameter not more than four to four and a half inches ; whilst its greatest capacity in the aver- age state rarely exceeds five pints. The DIAPHRAGM is a thin musculo-fibrous sep- tum, which separates the thorax from the abdomen, forming the floor of the thorax and the roof of the abdomen. The Diaphragm is the muscle involved in hiccough. Hiccough is an ijivoluntary sudden contrac- tion of the diaphragm, causing an inspiration, which is suddenly arrested by the closing of the glottis, causing a characteristic sound. It arises from gastric and re- flex irritation. (Note 1 ). The Oesophagus pierces the Diaphragm in its downward course to the stomach. Note 1. The true Glottis is the apparatus for producing tone^ and is formed by the true vocal cords. —19— DENTAL PHYSIOLOGY AND ORAL HYGIENE STRUCTURE OF THE STOMACH. The Stomach is composed of four coats. (1) . The outer or serous lay- er — ^thin, transparent and smooth — is a part of the peritoneal lining of the abdomen, and is also called the external or peritoneal coat, (2). The muscular, whose fibres are arranged lengthwise, circularly, and ob- liquely, making three separate sets of layers of fibres. The churning motions of these muscles cause the con- tents of the stomach to be well mixed up. The action of these muscles is called peristalsis. (3). The areolar or sub-mucous coat consists of a layer of strong but loose connective tissue, which lies between, and unites the muscular and mucous coats. It is more loosely attached to the former and more closely to the latter coat, and forms a bed in which the vessels and nerves break up before entering the mucous membrane. (4). The mucous or inner layer is thick. Its surface is smooth, soft and velvety. In the fresh state it is of a pinkish tinge at the pyloric end, and of a red or red- dish brown color over the rest of the surface. During the contracted state of the stomach, the membrane is thrown into numerous plaits or rugae, caused by the contraction of the three outer coats, which are ex- tensile, while the inextensile mucous coat, as a result of its lack of elasticity, is thrown into numerous promi- nent folds, or rugae, which project into the interior, and, as it were, occupy the cavity of the contracted organ. They disappear when the stomach is distended. A constant fold exists at the pylorus. It is called the PYLORIC VALVE, and is produced by the presence —20— THE DIGESTIVE SYSTEM beneath it of the Sphincter muscle. This mucous layer is composed of a corium of fine connective tissue, which approaches closely in structure to adenoid tissue. This tissue supports the tubular glands, of which the superficial and chief part of the mucous membrane is composed, and assists in binding them together. The glands are separated from the rest of the mucous membrane by a very fine homogenous basement membrane. The corium is covered with a layer of columnar epithelium, which passes down in- to the mouths of the glands. At the deepest part of the mucous membrane are two thin layers (circular and longitudinal) of unstriped muscular fibres, called the MUSCULARIUS MUCOSAE, which separate the miucous membrane from the scanty sub-mucous tissue. FUNCTION OF THE STOMACH. The mucous or inner layer of the stomach is provided with a multitude of glands, which secrete GASTRIC JUICE. This fluid is colorless and watery, and has a sour taste and odor. It contains free hydro- chloric acid, and a ferment body called pepsin. The €ASTRIC GLANDS are of three kinds : the TRUE CASTRIC GLANDS, the PYLORIC GLANDS and the CARDIAC GLANDS. The True Gastric Glands are also called PEPTIC GLANDS. They are distributed throughout the entire fundus, or main body of the stomach, and may even be found at the pylorus. These gastric glands secrete pepsin. Between these glands and the basement membrane are the PARIETAL or —21— DENTAL PHYSIOLOGY AND ORAL HYGIENE OXYNTIC CELLS. The parietal cells secrete the acid of the gastric juice. The PYLORIC GLANDS are branched tubular glands, and secrete mucus. They are placed most plentifully about the pylorus. The CARDIAC GLANDS are found about the Oesophageal orifice. They resemble the pyloric glands. The secretion of these glands, the GASTRIC JUICE, has the power of changing the insoluble proteids, (beef, eggs, legumes), into soluble and diffusible substances, called PEP- TONES. The muscular contractions churn the con- tents of the stomach and thoroughly mix the food with mucus and juice. The motions are independent of the will. When a portion of the food is reduced to a soft pulp, it is called CHYME. The Chyme, as it i& formed, is allowed to escape intermittently through the pylorus into the small intestine, where the digest- ive processes are continued. By a reference to Figure 1, the course of the food may be traced and an idea obtained of the various parts of the digestive tract, which will enable the reader to better understand the following chapters. The INTESTINES.— The Intestinal canal is divided into two chief parts, named, from their differences, in diameter, the SMALL and LARGE INTESTINE. These are continuous with each other, and communi-^ cate with each other by means of an opening guarded by a valve, called the ILEO-CAECAL VALVE, which allows the passage of the products of digestion from the small into the large intestine, but not, under ordi-^ —22— THE DIGESTIVE SYSTEM nary conditions, in the opposite direction. The SMALL INTESTINE.— The average lengi:h of the small intestine, in the adult, is about twenty feet. It commences at the PYLORIC ORIFICE or PYLORUS, the opening through which the stomach communicates with the Duodenum, which is the name of the first part of the small intestine. The DUODENUM extends for eight or ten inches beyond the pylorus. The JUJUNUM is the next divis- ion, and forms about two-fifths of the whole, and the ILEUM the other three-fifths of the canal. The wall of the intestine, like that of the stomach, is made up of four coats, namely, the serous, muscular, sub- mucous, and mucous. The small intestine lies in coils in the middle and lower part of the abdomen. It is from one to one and three-fourths of an inch in diam- eter. It is supported and held in place by a broad, double fold of the peritoneum, enclosing blood-vessels and nerves, called the messentery. The ducts of the liver and pancreas empty into the first part of the small intestine, the Duodenum. The interior of the small intestine shows many transverse projections, extending half or two-thirds around the tube, called the valvulae conniventes, and .an immense number of threadlike processes, the VILLI. When immersed in water, these villi stand up, ^nd they then resemble the ''pile" of velvet. There are many glands in the mucous membrane layer. • The movements forward of the contents of the in- testine depend upon the longitudinal and circular mus- —23— DENTAL PHYSIOLOGY AND ORAL HYGIENE cular fibres of the tube. This peristaltic action consists of slow, successive, wavelike contractions, chiefly of the circular fibres, extending from the upper part gradually to the lower part of the canal. However, these contractions or rythmic segmentations may com- mence at any point of the intestine, and extend in a wavelike manner along the tube. The series of con^ tractions force the intestinal contents along. These contractions may occur independently of the central nervous system. Their essential stimuli arise in the nerve ganglia seated in the intestional walls, but the movements are modified by influences passing over the sympathetic nerves. Peyer's patches are found only in the small intes- tine. They consist of aggregated groups of lymphoid nodules. They vary from one to three inches in length, and are about half an inch in width, chiefly of an oval form, their long axes being parallel with the intes- tine. The chief bowel lesion in typhoid fever is found in Peyer's patches and the solitary glands, and it is from their ulceration and perforation that hem- orrhage results. . The LARGE INTESTINE.~The Large Intestine is from five to six feet long, being about one-fifth of the whole extent of the intestinal canal. It is from one and a half to two and a half inches wide, and has a wrinkled and saculated appearance. Its mucous membrane is smooth, and has, in depressions, a few glands. There are no villi. Like the small intestine, the large intestine is con- —24— THE DIGESTIVE SYSTEM structed of four coats — the serous, muscular, sub- mucous and mucous. The ileo-caecal valve is situated at the place of junction of the small with the large intestine, and guards against any influx of the con- tents of the latter back into the small intestine. The Caecum, the commencement of the large intes- tine, is the large blind pouch, or cul-de-sac, situated below the ileo-caecal valve. Its name is derived from OAECUS, meaning blind. The Appendix, (appendix Small ntestine C/\e:cum Figure II. The first part of the large intestine, show- ing the appendix. (Photograph from a pen drawing.) —25— DENTAL PHYSIOLOGY AND ORAL HYGIENE vermiformis) , is a long, narrow, worm-shaped, muscu- lo-membranous tube, which starts from what was origi- nally the apex of the Caecum. The canal of the Ap- pendix is small and extends throughout the length of the tube. (Figure 2.) The Appendix is very susceptible to inflamation, the condition being known as appendicitis. The large intestine differs from the small intestine in its greater size, its more fixed position, its saculat- ed form, and certain peritoneal pouches containing fat. There are three divisions of the large intestine, but in a work which primarily concerns dental subjects, they will not be fully discussed. The LIVER and PANCREAS.— The Liver is the largest gland in the body, and is situated in the up- per and right part of the abdominal cavity. In the male it weighs from fifty to sixty ounces ; in the fe- male from forty to fifty ounces. The liver is an ex- tremely vascular organ, and receives its supply of blood from two distinct sources, — ^namely, from the PORTAL VEIN and from the HEPATIC ARTERY, while the blood is returned from it into the ven^, cava inferior by the Hepatic Veins. Its secretion, the bile, is conveyed from it by the hepatic duct, either directly into the intestine, or, when digestion is not going on, into the Cystic duct, and thence into the gall bladder, where it accumulates until needed. In addition to the secretion of the bile, the liver plays an important part in the metabolism of both carbohydrates and nitrogenous materials. Bile —26— THE DIGESTIVE SYSTEM is being continually forced into the intestines, but there is an increased discharge immediately upon the arrival of food in the duodenum. The PANCREAS is a long, narrow, pinkish gland. It is found behind the lower border of the stomach. In structure it resembles the salivary glands. Its duct discharges into the duodenum. Its secretion is viscid, colorless, odorless, and of an alkaline reaction. The Pancreatic Juice "contains a ferment which breaks up fat, a ferment which converts starch into sugar, a fer- ment which curdles milk, and a ferment which digests proteid material." * The SALIVARY GLANDS.— Numerous glands exist in the lips, cheeks, palate and tongue. They are mostly mucous glands, but by the term Salivary Glands are usually understood the three chief glandular masses on each side of the face. These are the principal salivary glands. They communicate with the mouth, pour their secretion into its cavity, and are named, respectively, the PAROTID, SUBMAXILLARY, and SUB-LINGUAL GLANDS. The PAROTID GLANDS, so called from being placed near the ears, are the largest of the three sali- vary glands, varying in weight from half an ounce to an ounce each. They lie one upon each side of the face immediately below and in front of the external ear. Their outer surface is covered by the integument and parotid fascia. The ducts of the parotid glands (or Stenson's Ducts), are about two inches and a half in length. They open upon the inner surfaces of the — — 27. *Grav's Anatomy. •" DENTAL PHYSIOLOGY AND ORAL HYGIENE cheeks by small orifices opposite the second molar teeth of the upper jaw. The SUBMAXILLARY GLAND is situated below the jaw, in the anterior part of the submaxillary tri- angle of the neck. It is irregular in form and weighs- about two drachms. The duet of the submaxillary^ gland, or Wharton's Duct, is about two inches long, and opens by a narrow orifice on the summit of a small papillae at the side of the fraenum linguae, and close to its fellow on the opposite side. The SUBLINGUAL GLAND is the smallest of the salivary glands. It is situated beneath the mucous membrane of the floor of the mouth, at the side of the fraenum linguae, in contact with the inner surface of the lower jaw. It is narrow, flattened, and shaped somewhat like an almond, and weighs about a drachm. Its excretory ducts are from eight to twenty^ in number. They open separately into the mouth back of Wharton's Duct, and upon a fold of the mucous membrane. One or more ducts sometimes join to form a tube which opens into the duct of Wharton, or re-^ mains independent, opening close to Wharton's duct. This duct is called the DUCT OF BARTHOLIN. MUCOUS GLANDS.— Besides the salivary glands proper, numerous other glands are found in the mouth. They appear to secrete mucus only, which serves ta keep the mouth moist during the intervals of the salivary secretion, and which is mixed with that secretion in swallowing. DIGESTION. — ^By a careful study of the digestive —28— THE DIGESTIVE SYSTEM system a better idea may be had of the effects diseased teeth have on the general health. Good health depends to a great extent on a healthy alimentary tract. Good^ teeth permit the food to be well masticated. A clean mouth will not contaminate the food eaten. This pro- motes good digestion. The mouth is the entrance to the alimentary canal, and here all food taken receives the first preparation in the process of digestion. It is therefore important that this preparation be thor- ough, and that the mouth be free from disease, to- avoid infecting the food supply. A clean mouth and a good set of teeth to properly masticate the food wili do much to insure a healthy body and a longer life. --29— THE TEMPORARY TEETH. CHAPTER II. The mouth of the infant at birth contains no teeth, although a number, partly developed, lie embedded in the jaws beneath the gums. About five or six months later teeth begin to appear, and by the end of the second year a set, known as the MILK TEETH, have been ''cut", or come in. The teeth may pierce the gum without any local manifestations. Very frequently, however, just before a tooth comes through, there is noticed a little swelling and redness of the mucous membrane overlying it. This condition may be accom- panied by f retf ulness and an increase of saliva, but the symptons disappear when the tooth has pierced the gum. These teeth are the tem- porary or de- ciduous teeth, more common- ly known as the milk teeth. This set con- sists of twenty teeth, ten in the upper jaw Fi.aiire III. Model of child's month, age and ten in the two years, showing the ten temporary teeth , in tlie upper Jaw. lOWer jaVf. —30— THE TEMPORARY TEETH The following table will give an idea of the time each temporary tooth comes into place : * Central Incisors, Fifth to Ninth Month. Lateral Incisors, Seventh to Ninth Month, First Molars, Fourteenth to Fifteenth Month. Cuspids, Seventeenth to Eighteenth Month- Second Molars, . . Eighteenth to Twenty -fourth Month. The above table gives the average time of eruption of the upper teeth; as a usual thing, the lower teetk erupt about one month earlier than the upper teeth. However, the limits of normal variations are com- paratively wide. Some forward children may get their teeth earlier, while others may run over the normal two year period a few weeks or months. Various diseases of childhood affect the teeth, an example of which is Rickets, a disease that affects the bony structures and the teeth. The Temporary teeth last but a short time, or until they are replaced by the Permanent teeth. This fact leads many people to the conclusion that the Tem^ porary teeth are not of much importance. This, how- ever, is a mistaken idea. THE TEMPORARY TEETH ARE VERY IMPORTANT TO THE GROWTH AND DEVELOPMENT OF THE CHILD. The idea that the Temporary teeth should not be taken care of, and that they should be taken out as soon as they ache, is a mistake, and does harm to the growing child. CLEAN TEETH DO NOT DECAY.— Therefore, the child's teeth should be kept clean. As soon as the teeth * Compiled. -31- DENTAL PHYSIOLOGY AND ORAL HYGIENE appear, they should be carefully watched, for they easily begin to decay at this time. They should be cleaned every day with a piece of soft linen or cotton cloth. The mother can do this each day. Begin when the first teeth appear. Watch each tooth as it comes in, and keep all stain or any deposit from forming on th^ teeth. This can be done by gently wiping the surface of the tooth with a soft piece of linen cloth, removing any stain or other accumulation that may be on the teeth. When all of the twenty teeth are erupted, a soft brush should be used. Brush the baby's teeth regu- larly, and do the work of cleaning until the child be- comes old enough to brush his own teeth. By that time he will have formed the habit of having his mouth clean, and most children will be willing to Thrush their own teeth as soon as they are old enough to handle the brush for themselves. Once a child learns the physical comfort derived from a clean mouth, he will tolerate no other condition, and no one will have to coax him to brush his teeth. DECAYED TEETH.— Should the teeth have been neglected, and decay and toothache result, they should not be extracted if it is possible to save them. Nature provides a time for the Temporary teeth to be re- moved. This is indicated by the absorption of the roots, and the loosening of the crowns in preparation for the permanent teeth. Until these roots are ab- sorbed, and the crowns loosened, the teeth should re- main in place. First; because the child's jaws are im- —32— THE TEMPORARY TEETH perfectly developed and very frail, and are liable to fracture or be damaged otherwise by bruising. An injury may be done at this time that the child ma:^^ carry through life. Second ; if these teeth are extracted before the permanent teeth are ready to come in and replace them, the permanent teeth are interfered with. They will not grow in their natural positions, which makes them irregular and distorts the mouth, and sometimes the facial expression. It also hinders the work of mastication. This is harmful to the child, and should be prevented. Teeth that do not come out in time to permit the permanent teeth to come through, may be extracted, but this should be left to the dentist to decide. FILLING CHILDREN'S TEETH.— Children's teetn should be examined at regular intervals — at least twice a year, sometimes oftener — and any small de- cayed place should be cleaned out and filled. If this is commenced early the child will not mind the little work necessary to properly fill the tooth and prevent further decay. When this is done early the child is not hurt by the dentist, and consequently is not afraid to come back at another time and have more teeth filled. Perhaps the dentist is able to ''make up" with his little patient, and by ''jolly talk" make this first visit to the dentist a pleasure. If this is done the little patient will have had a "nice time" at the dentist's, and when it comes time to return for another examination, will be ready and willing to return and have more work done if it is necessary. In order that children may be —33— DENTAL PHYSIOLOGY AND ORAL HYGIENE willing to visit the dentist -it is necessary that parents and others use a little common sense in their talk be- fore the little ones. NEVER tell a child that he will be hurt if he goes to the dentist. This instills a dread of the dentist in the child's mind, and may make it difficult or impossible to get him to the dentist's office. If taken there, he may be so frightened that it is impossible for the dentist to render any service to him, or even to make an examination to see what needs to be done, or to give him proper relief, if he is suffering pain from neglected teeth. If there should be pain given when attending the little patient, let the dentist alone. He will usually be able to gain the patient's confidence, and if he hurts- the child, he will usually be forgiven by his patient, provided the child has not been frightened beforehand. Therefore, '*grown-ups" should refrain from talking of their dental experiences before children. If the child has not been told things and frightened, he usually becomes a pliant and willing patient at the hands of a careful and friendly dentist. On the other hand, take the child who has had its teeth neglected, and has teeth that ache badly, perhaps decayed so far that abscesses or '*gum-boils" have form.ed. He has been told how it ''hurts to go to the dentist". He has suffered all night or day with the worst kind of toothache, frightened so that toothache is endured rather than go to the dentist. Finally the parents, in desperation, having been kept up all night by a suffering child, take him to the dentist. Perhaps- —34— THE TEMPORARY TEETH the child is forced to go, carried into the office, crying and resisting. How much chance has any dentist to get the confidence and attention of this child, and render him any service? Usually, if anything is accomplished, it is because the child is held down while the dentist pulls open the mouth and extracts an aching tooth, while the patient protests with cries and struggles. Yes, the tooth was extracted, but was not something else extracted along with the tooth? The confidence and good-will of the child, and perhaps of the parents also, and a fear instilled into the child's mind that will prevent a return to the dentist, perhaps for many years to come, or until prolonged suffering compels a return to get relief from pain which can no longer be endured. Is it any wonder that many dentists dislike to work for children under these circumstances? Children who have been spoiled at home, or have been taught to look with fear upon a visit to the dentist, are usually hopeless as patients. And how about the den- tist, who, from a sense of duty, has struggled through a fruitless appointment with such a patient ? Often after such a scene, he is ready to close up his office and go fishing, or somewhere else to forget his troubles. Then the story that this patient can tell to other children may prevent many other little patients from making a much needed visit to the dentist. All this fear can be avoided if the mother will give a little time and care to cleaning her baby's teeth, and see that they are kept clean. —35— DENTAL PHYSIOLOGY AND ORAL HYGIENE Frequent examination will prevent decay getting a start, and should there be a small decayed place it can easily be filled, and filled without pain, and without fear of being hurt, on the part of the child. Refrain from talk of pain before the child and there will be no fear in visiting the dentist. This co-opera- tion, on the part of the parents and the ''grown-ups," with the efforts of a careful dentist, will do much to promote the good health of the growing child, insure a good set of teeth to masticate the food, and thus pro- mote proper digestion. For a good digestive system is required in order that the child may develop in a. healthy and normal way. HABITS. — While the mother should use great care in keeping her baby's teeth clean, she should also watch and guard him against bad habits, which many children acquire in early life, and which may result in deformity of the teeth, and even of the face. SUCKING THUMB OR FINGER.— This is a very common habit of infants, and during the first few months it is seen to some degree in most of them. If they are carefully watched, the habit is easily stopped. If the mother or nurse is careless, the habit may con- tinue indefinitely. Young infants usually suck the finger when hungry, and while this may seem natural, it should be prevented, lest the habit become a regular one. The feeding time of the infant should be so regu- lated that it never gets hungry. Two forms of sucking are of interest, from a dental standpoint. Sucking of the thumb or finger, and suck- —36— THE TEMPORARY TEETH ing or nursing the lip. In thumb sucking, pressure is made on the lower teeth, causing them to be crowded inward, while the upper teeth are forced outward. The tissues of the infant are very tender, and a little pressure will soon make a change in the form of the mouth. Lip sucking causes the same effect. The lower teeth being pressed inward, causes a contracted lower arch, which will lessen the room for the permanent teeth, if the habit be persisted in until the permanent teeth appear. If not prevented before the permanent teeth appear, the result will be disfiguring. The teeth, will be irregular, and speech and mastication will be impaired. The result of finger sucking may be serious deformity of the mouth, and finger also. Deformities of the teeth, lips, and even the jaws, are sometimes, produced. Habitual sucking of one hand or finger may" lead to spinal curvature. Babies sucking the thumb,, often bend the body sidewise, in their efforts to keep the thumb in the mouth. If persisted in, sometimes the spine is curved to one side, besides causing de- formity of the mouth. These cases are best managed by the early arrest of the habit before it becomes fixed. Very often the thumb sucking is encouraged by the mother or nurse, to induce a temporary quiet in the child when it is restless. This should not be done under any circumstances. Find out the cause of the child's restlessness, and remedy that cause, and there will be no need of thumb sucking or the use of a, "pacifier." Once the habit is formed, the only successful treat— —37— DENTAL PHYSIOLOGY AND ORAL HYGIENE ment with infants is mechanical restraint. Bitter solu- tions on the fingers are useless. They are soon sucked off and the habit continues. With infants the hands may be covered with mittens, or with the long sleeves of the night-gown, which are pinned to the bed, so that the part sucked cannot be put into the mouth. Or a splint may be made to fit the elbow, so that the arm cannot be bent and allow the fingers near the mouth. In mild cases the habit may be voluntarily discontin- ued, but when indulged in until the child is four or five years old, it has become a chronic affair and difficult to stop. As a rule, punishment does not avail in the late ■cases. Sometimes a child may be shamed into quitting the habit, but more often rewards are more successful. Xip sucking may be difficult to prevent. This habit is Tisually formed in connection with thumb sucking. Lip sucking seldom becomes a permanent habit, although a case presents now and then that persists. MOUTH BREATHING.— The habit of breathing through the mouth will, if persisted in, lead to a nar- rowing of the upper arch, and cause the mouth to be deformed and the teeth to be irregular. This habit, is nearly always due to obstructions in the nasal passages. These obstructions are gener- :.ally adenoid vegetations of the vault of the naso- pharynx, and are the source of much discomfort, and the origin of more minor ailments than any other pathological condition of childhood. Growths, large enough to produce pronounced nasal obstructions, will —38— THE TEMPORARY TEETH cause changes in the facial bones, causing a V shaped arch and irregularity of the teeth, such as illustrated in the figure below. Deformities of the thorax will be caused if the breath- ing conditions are not cor- rected. The symptoms o f adenoid growths are usually no- ticed in child- ren from a Figure lY. Model of a girl's mouth, age nine years, showing irregular teeth. year and a half old to three years old, the symptoms increasing in severity with advance of age up to the sixth or seventh year, the conditions being better in summer, and v»^orse in winter, when weather condi- tions are worse in the temperate zones. The chief symptoms are chronic catarrh, nasal ob- structions, deafness, anemia, and nervous disturb- ances. The obstructive symptomis are of chief interest from a dental standpoint, because, by this condition, the mouth breathing is induced. The child being unable to breathe freely through the nose, forms the habit of breathing through the mouth. The mouth being —39— DENTAL PHYSIOLOGY AND ORAL HYGIENE held open, draws the strong muscles of the side of the face against the upper arch and teeth, and causes con- stant pressure there, which tends to make the arch narrow and of a V shape. Obstructions of the nasal passages cause the child to sleep in all kinds of posi- tions, in an endeavor to find some position in which breathing may be easy. These attacks of difficult breathing are doubtless often the explanation of many of the night-terrors from which many children suffer. Sometimes it is possible that the adenoid growths may disappear by absorption, but this will occur only when the growths are very small. The physician may assist by treating the growths, or the patient may be removed to a warm, dry climate during the wiiiter season. Removal of adenoid growths is necessary when they cause mouth breathing, disturbed sleep, or nasal discharges. The family physician should be consulted and his advice followed. If the parent will form the habit of having the child's teeth examined at regular intervals, many early oral conditions will be discov- ered and treated before they become serious. A child two or three years old is not too young to have regular appointments witb the dentist. Thus, early decay may be attended to, and if enlarged ton- sils or adenoid growths are present, they will be no- ticed by the dentist, and the attention of the parent called to the condition, and an early viijit to the physi- cian can be made, thus avoiding more serious trouble. CRACKING NUTS.— The teeth and bones of child- —40— THE TEMPORARY TEETH ren in early life are not as strong as they are in later life. The child's teeth are small and frail, and should not be used as nut crackers. Cracking nuts will soon result in their destruction, for they are not con- structed to stand such violent service. When the child is old enough to eat nuts, he should be taught never to use his teeth on such hard objects as nut shells. EATING CANDY.— Most children crave sweets, and most of them get more or less candy. Good, clean candy will do no harm to the teeth, if eaten in moder- ation, and the teeth are properly brushed and cleaned after eating the candy. Hard candies should never be eaten, for they may cause the teeth to be broken^ Under our pure food laws, less adulterated candy is- sold than formerly, yet the parent will do well to see that only good, clean candy is used by the child. In former years cheap candies were frequently mixed with acid, and arsenic used as coloring matter. Such candy is very destructive to the teeth of the growing child. EATING HABITS.— Children should be taught tO' eat their food slowly, chewing it well before swallow- ing. They should also be taught not to eat food that is. very hot. Sometimes a child will eat food that is hot and immediately take a drink of cold water^ perhaps ice-water. This combination of hot and cold on the teeth is very injurious to them, and also to the stomach. The food should contain a generous supply of tooth building materials. Too much fine white flour bread, sugar and pastries, are not good for the —41— DENTAL PHYSIOLOGY AND ORAL HYGIENE child. The food should be plain and substantial, not too fat or too rich. SUMMARY. — As soon as the temporary teeth appear, great care should be taken to keep them clean. Twice a year the teeth should be examined by the dentist, and any small decayed place cleaned out and filled. The child should not have any of the temporary teeth extracted but should preserve them until the time for the permanent teeth to erupt. Sound tem- porary teeth are the foundation for sound permanent teeth. By proper care of the first set of teeth, the mother may be assured that her child will have a set of sound permanent teeth, which with proper care will last for his life-time, and do much toward building up a good, sound physical condition, which is essential to the proper development of the child, mentally and morally, as well as physically. 42 — CHILDREN'S TEETH. CHAPTER III. By the end of the second year, the child has the com- plete set of temporary or milk teeth, twenty in num- ber, ten below and ten above. Now there follows a pause of about four years, during which time little perceptible change takes place in the mouth. How- ever, there is an active change going on beneath the gums ; a further development for the production of the adult conditions. ABOUT THE SIXTH YEAR FOUR NEW TEETH APPEAR. THESE ARE THE FIRST PERMANENT MOLARS, ONE ON EACH SIDE,. Figure V. A lower set of teeth, showing tlie first jjermanent molars in place, which come in at six years of age. The two central incisors in front are permanent teeth, and come in at seven years of age.. Courtesv, Blue Island Specialty Co. —43—^ DENTAL PHYSIOLOGY AND ORAL HYGIENE I ABOVE AND BELOW, JUST BEHIND THE SET ' OF MILK TEETH. Heretofore the mother has been able to count only ten teeth in each jaw. Now there are twelve. So the child^ will have in all, twenty-four teeth. This is a most critical period in the dental life of the child. If the temporary teeth have been well cared for, and are I clean and free from decay, then the new teeth will be in ' a favorable environment, and not exposed to decay. By ' proper attention these new teeth need never decay. Let us suppose that the temporary teeth have not received good care, between the ages of two and six years, when the first permanent molars appear. I The temporary teeth will have large decayed places, I and perhaps the pulps of some of the teeth have died, and caused abscesses or ''gum-boils" to form. The teeth \ will contain decay, and some of it will naturally float around and become lodged on the new teeth, and before f very long these new teeth will commence to decay. i These six year molars should have special attention, for they are often confused with the temporary set of teeth, and the parent allows the decay to go on until the I teeth ache, and perhaps have to be taken out. The I reason for this confusion is that these six year molars f make their appearance before any of the temporary [ teeth are shed. f When eleven or twelve teeth can be counted in each j jaw, that is, as soon as there are more than twenty j teeth in all, one can be assured that the last molars on each side belong to the permanent set. : —44— : CHILDREN'S TEETH The following table will show the average age at which the milk teeth are shed: * Central Incisors Seventh Year. Lateral Incisors Eighth year. First Molars Tenth year. Cuspids Twelfth year. Second Molars . . Eleventh to Twelfth year. As soon as the temporary teeth are shed, the crowns of the permanent teeth begin to push their way through the gums, and make their appearance in the following order: PERMANENT TEETH. *First Molars . . Five and a half to Seven years. Central Incisors Seven to Eight years. Lateral Incisors Eight to Nine years. First Bicuspids Ten to Eleven years. Second Bicuspids .... Eleven to Twelve years. Cuspids, the lotver usually preceding by a year or more . . . .Twelve to Fourteen years. Second Molars. . . .Twelve to Fourteen years. Third Molars. .Sixteen to Twenty years and indefinitely beyond. Most parents look upon any special care of the temporary teeth as useless, since they believe that these teeth are to last only a little while. This is due to an utter lack of appreciation of the purpose of the temporary set of teeth. Each adult person is provided with two sets of teeth, which make their appearance at different periods of life. The child, being small, is "^Burcharcl's Dental Pathologv. —45— DENTAL PHYSIOLOGY AND ORAL HYGIENE provided with a set of small teeth. As these teeth themselves cannot increase in size to keep up with the growing maxillae (jaws), this small set is gradually replaced by a larger and stronger set of teeth, in pro- portion to the stronger and larger jaws. If this replacement takes place in a normal manner, the child will be provided with a continuous masticating ap- paratus. This temporary set is, therefore, intended to perform the work of their permanent successors until replaced by the latter. If the temporary teeth are properly taken care of, the replacement of the temporary teeth goes on with- out any trouble; but if any of these are lost pre- maturely, or are destroyed by decay, and abscesses are allowed to form from dead pulps, then things have gone wrong, and the child suffers, not only the tempor- ary pain from aching teeth, but may also suffer in later life from conditions caused by early dental troubles. One such condition is infected tonsils, from the pus of abscessed teeth. This often causes throat and ear infec- tion, which, if not properly treated, will in later life re- sult in partial deafness, or in extreme cases, in total deafness. Should it become necessary to extract decayed and abscessed teeth, the second teeth will often not erupt,, or come in, properly, and will grow out of their re- gular places. The mouth will be distorted, and the work of mastication be impaired. Should the child also have adenoids, he will become a mouth breather,, and this often results in defective breathing. —46— CHILDREN'S TEETH Such cases are a familiar sight in every school. Such :a child is stoop-shouldered, listless, dull mentally, and below the average in school work. Sometimes such re-, suits make the child vicious and incorrigible. Often the removal of the adenoid growths, and proper dental attention, will make a new child out of the dull, list- less, or vicious one. He becomes more alert, and more orderly in work and conduct. BOLTING FOOD.— Teeth which have decay in them are generally sensitive when used to masticate the food. If part of the teeth have been extracted, and some of them are tender, the food is not properly cut up and mixed with saliva. This causes the child to "bolt its food", namely, to swallow it before it is properly masticated and mixed with saliva. Thus bad eating habits are established early in life, which may affect the health of the growing child, and affect him even in later life. In the first chapter, a brief outline has been given of the digestive system. The effects of diseased teeth fall, in the first place, on the whole of the alimentary tract, from the tonsils downward. The effects include tonsilitis, pharyngitis, gastric troubles, and other troubles in adjacent parts, an example of which is appendicitis, the origin of which may be the chronic abscesses or "gum boils" of childhood. The germs of these diseases lodge in the decayed places of the teeth, and may later be absorbed into the body. Consider for a m.oment the effect of this daily 'dose of poison" upon the system of the growing child. This —47— DENTAL PHYSIOLOGY AND ORAL HYGIENE infected material, constantly being conveyed to the tonsils and throat, must be taken care of some way. Much of it is swallowed, and some of it infecting the tonsils and throat. The up-to-date surgeon, when a pa- tient requires an operation for appendicitis, examines, the throat for infected tonsils, especially if the patient is a young person. He does this because experience teaches him that most of the appendix cases have diseased tonsils, and these have probably become in- fected in early youth, from neglected teeth. Thus the effect of diseased teeth should not be underestimated^ as they vitally affect the normal development of the child; and we know that among the great army of children with neglected and diseased mouths, there is in all of them an incredible amount of infection and fermentation. The effect of harboring this poison is that the glands in and near the oral cavity are in- fected. Absorption takes place from these infected areas, and the influence of this is felt, not only in the neighboring glands, but also results in a group of con- ditions which might be referred to as anemic, or a low state of vitality. To avoid such conditions, we should start the child out in life with a clean mouth, and as soon as he is old enough to learn, he should be taught to keep his mouth clean. Children are responsive to the delicious sensation produced by a clean mouth, as are older people, and if the child's mouth is kept clean during the time that duty should be performed by the mother or nurse, the —48— CHILDREN'S TEETH habit of having a clean mouth will be formed and con- tinued by him without much coaxing. If the child has a set of teeth free from inherited defects, this care will preserve them until they are replaced by the per- manent ones. Thus the permanent teeth will come in, and be in good clean company, and will not be exposed to decay from other infected teeth. This problem is an important one for the dental and the medical profession, and its proper solution will be in the interest of public health, and particularly of our school children. From thirty to fifty percent suffer from dental and oral sepsis and their after-defects. Further, about seventy to ninety percent need some dental attention to avert the more severe defects. FILLING CHILDREN'S TEETH.— Unfortunately few children are given this care to insure them a clean mouth and good teeth. Few mothers have the incli- nation or a proper conception of the importance of such service to their little ones. Thus it happens that the first view the dentist has of the average child's mouth, brought to him for attention, is rather discouraging. A large majority of parents have never thought it necessary to clean their children's teeth, or to teach them to do so themselves, as they grow up. The problem for the dentist here is, first to relieve the present pain, and later to get the mouth of the little patient in a healthy condition. When such cases come to the dentist for the first time, the usual request i& that he extract the tooth. Before extracting an aching tooth, would it not be better to see if the tooth —49— DENTAL PHYSIOLOGY AND ORAL HYGIENE could be saved and made useful? This may not be possible, if it is badly decayed, and broken down, and has an abscess or "gum-boil" developed on the gum. No doubt if the destructive work has reached this stage, it will be well to extract the tooth, and remove this source of infection from the throat and tonsils. Perhaps the toothache has been caused only by a simple decayed place, in which some food, or candy, has lodged. In this case it will be far better to treat the tooth, relieving the present pain, and permit the little patient to return at another time and have the tooth filled. To extract the tooth will destroy the reg- ularity of the temporary set of teeth, and perhaps of the second set also. « Suppose the patient had a sore or festered finger, and went to the doctor and told him to cut it off, be- cause it was sore. Do you think that the doctor would do such a thing? No. He would say: *'The finger is useful to the child. I can cure the sore place, and make it a useful finger." The little temporary tooth, that has a hole in it and aches, was put into the mouth for a useful pur- pose, and should remain there until nature provides a new tooth to take its place. It is useful, and can be saved if filled and properly taken care of. FILLING TEETH.— To fill any tooth properly, ALL the decay should be removed from the cavity. However, in children, this cannot always be done, and in the temporary teeth it may not be necessary. If the child will allow enough decay to be scraped out so —50— CHILDREN'S TEETH that a copper cement filling can be inserted, the tooth can be repaired and made useful. The reason copper cement is used in children's teeth, is because they will not tolerate having all of the decay removed. The copper cement is very sticky, and will ad- here or stick in shallow cavities where no other material will. It is a germicide, and will sterilize what little decay is left, and thus arrest the further progress of the decay. The copper salts contained in a good copper cement sterilize the cavity, while the body of the cement pre- vents contact of the food with the sensitive part of the tooth. Objection may be made by some to copper cement, because it is black. This is not to be considered first; because most of these fillings are placed in the back teeth, and do not show ; and second ; the results from the use of this cement are better than that of any other known material. However, there is a white copper cement that can be used if the filling shows, and that objection is overcome by using this kind. Sometimes in removing the decay, the pulp, or "nerve", will be exposed. Even in such cases these temporary teeth can be treated, the pulp removed, the root canals filled, and a filling made to restore the crown of the tooth. Children from six to ten years old will usually allow such work to be done. If the cavity is in a front tooth, and a small one, enamel cement can be used. This is a hard cement, and much resembles the enamel of the teeth. It comes in various shades or colors to match different shades —51— DENTAL PHYSIOLOGY AND ORAL HYGIENE of teeth, and restores the teeth to their normal appear- ance. It is sometimes called artificial enamel. If the front teeth are very badly decayed, some other way must be found to restore them to usefulness. If the pulps are not forming abscesses, the tooth can often be trimmed down a little, and a small gold jack- et of very thin gold can be molded over the tooth, and after soldering the joints together, this jacket or crown can be cemented over the tooth with white cop- per cement, and the tooth preserved and made useful, until the time it should come out and be replaced by the permanent one. FILLING THE FIRST PERMANENT MOLARS.— Due to the fact that the first permanent molars eru^t before any of the temporary teeth are shed, they are often confused with the temporary teeth, and are allowed to decay. Often the dentist does not see the young patient until decaj^ has done considerable dam- age to these permanent teeth. The child complains of a toothache, and often requests are made by the par- ents that the tooth be extracted. The first permanent molar should be retained, if it is at all possible. The age of the child, and the extent of the decay, will have a great deal to do with the case. The roots of these teeth are usually formed by the end of the tenth year, but should the pulp be exposed, it may be difficult or impossible to treat such a tooth, because the opening at the end of the root is overlarge at this time. Twelve years is a safer age for root treatment, as —52— CHILDREN'S TEETft the openings are usually closed properly at that time. If the pulp is exposed, an effort should be made to treat the tooth and plug the root canals, after which a filling may be placed in the crown of the tooth, and the tooth will then become useful. Should the tooth have to be extracted, there would be an open space left which would impede mastication. If several teeth were lost, the child would be unable to chew his food properly, and would learn bad habits of mastication. The food would be ''bolted", namely, swallowed, with- out being properly chewed and mixed with saliva. This throws extra work upon the stomach, and interferes with the progress of digestion, which is bad for the health of the growing child. But many of these teeth can be filled without treat- ing them. Usually the decay can be removed with a Iiand instrument. If the cavity is large, a copper cement filling can be made to protect the tooth. It will last for a year a two, and can be replaced if it comes out; or a permanent ''silver" filling can be inserted, as soon as the child is a little older and will allow all the decay to be removed. Often the cavity is small, and all the decay can be removed the first time. In that case a permanent "sil- ver" filling may be inserted at once, and the tooth made safe. If the child is sent to the dentist from the time he is three or four years old, and makes a practice of having the teeth examined twice a year, decay will be controlled. Should little cavities form, they are easily taken care of, and can be filled without pain to —53— DENTAL PHYSIOLOGY AND ORAL HYGIENE the patient. If at the same time proper instruction be given in the care of cleaning the teeth, and the parents see to it that the instructions are carried out, the child will have a clean mouth, clean teeth, and will not be troubled with toothache from decayed teeth. Clean teeth do not decay. 54— ORAL HYGIENE, AND DENTAL AND MEDICAL EXAMINATION OF SCHOOL CHILDREN. CHAPTER IV. The trend of all modern health work is in the direc- tion of prevention. To cure disease is a great achieve- ment, but to prevent it is a greater. Every year the people of this country are taking more interest along educational lines, and dental education is making great progress, wherever dental publicity is encouraged through dental societies. Newspapers and magazines realize and acknowledge their mission in promoting health clubs, giving pub- licity to mouth hygiene work and the teachings set forth by the dental and medical professions. We spend each year millions of dollars for education. The young men and women who graduate from our public schools and colleges are a credit to the nation. We do not graduate enough of the boys and girls who enter our schools. Many of them attend for a few years, and as soon as they reach the age of school ex- emption, quit and hunt a job, or become idlers. There may be some excuse for the boy who quits school to support a widowed mother, or to care for little broth- ers and sisters. But there is another class of boys who do not have this excuse. They quit school as soon as they pass the age when they do not have to avoid the truant officer and these are the ones who give the most trouble. While in school they are indifferent pupils,' absent themselves whenever they have an opportunity, —55— DENTAL PHYSIOLOGY AND ORAL HYGIENE are backward in their studies, often in trouble with their teachers, always restless, and many develop vicious habits. There must be a reason why these pupils, both boys and girls, resent the confinement and discipline of school. Normal children go to school, study, adapt themselves to discipline, and complete the school course; while they may be inclined to mischief at times, they are usually model pupils. If a pupil is rest- less, backward in classes, often absent from sessions, or develops habits or an attitude of mind that pre- vents good school work, it will usually be found that such a pupil is defective in a physical way. Dental and medical examinations of our school children will discover these defects, and allow of most of them be- ing corrected before serious harm is done. Wherever dental examinations have been conducted by dentists, the statistics show about ninety-five percent of the children's mouths contain defective teeth. This may seem an exaggeration, but let anyone who is skeptical, examine the mouths of a few school children, between the ages of seven and fifteen, and the conditions found will soon convince him of the truth of the statement. It is an acknowledged fact, by both the medical and dental professions, that there is no part of the body so closely associated with general health conditions as the mouth. It has been said that the mouth is the gateway of the human body. This being true, what must be the effect of a mouth full of decaying teeth, perhaps abscesses formed, discharging pus, which —56— ORAL HYGIENE, DENTAL AND MEDICAL EXAMINATION affects the tonsils, nose and throat, and other parts of the body? Such a mouth becomes an incubator for disease germs that may be carried directly into the system. We have here conditions to which we have paid little attention in the past years, considering them of minor importance. But of late they have been recognized as having a great influence on the development of the growing child. These conditions create toxins, or pathological organisms, which are constantly absorbed, and lower the vitality of the body, and lay the foundations for more serious troubles. If the child is not taught to keep his mouth clean, the result will be oral sepsis, which will soon result in dental troubles; then follows gastro-intestinal disturbances, and the result will be an ill-nourished body. The systemic disturbances produced will lower the bodily resistance, rendering it more susceptible to contractible diseases. Children are congregated in the school-room, and spend much of their time in contact with each other. Contagious diseases are thus easily spread. Many people do not appreciate the fact that one unclean mouth may contaminate the air in a school-room, and become the means of spreading disease to other child- ren. When a child comes to school with dirty hands and face, the teacher usually takes prompt measures to introduce him to a liberal supply of soap, water and a towel ; which results in at least an outward appear- ance of cleanliness for that particular offender. Most —57— DENTAL PHYSIOLOGY AND ORAL HYGIENE of our states have laws which regulate the construc- tion of public school buildings, whereby there is plenty of light, air space, and a proper temperature. These are only partial measures. The majority receive pupils with diseased m^ouths, infected tonsils, many with inherited defects, and other disorders; and also children who may have been exposed to in- fectious diseases like diphtheria, mumps, scarlet fever, measles, tonsilitis, whooping-cough or chicken- pox. These children mingle with their playmates for awhile before outward signs of some of these diseases make their appearance, and the entire school is thus exposed to the infection. If the state finds it advis- able to provide clean, sanitary buildings for edu- cational purposes, properly lighted and ventilated, and that the children have clean hands, faces and clothing; would it not seem reasonable that every child should also be required to have a clean mouth, and be free from disease which endangers his own and the health of others with whom he is so closely asso- ciated ? Dental and medical inspection, with the establish- ment of free dental clinics for those who are unable to pay, will do much to promote public health, and especially the health of the children in our schools. Many people may object to such examinations, and say that this will cost more money, and that our taxes are already high enough, without adding extra burdens. Let us see whether this is true, and con- sider the problem from a business standpoint. If a —58— ORAL HYGIENE, DENTAL AND MEDICAL EXAMINATION business man wants to engage in any enterprise, his first thought is, Will it pay? Will it be profitable? The taxpayers may be pardoned if they are skeptical at first, and hesitate to encourage such work in the schools. If they can be convinced that it pays they will be eager to encourage the work, for nothing ap- peals more to the average business man than some- thing that will conserve his pocket-book. To get a proper understanding of this subject, it might be well to give facts in regard to dental conditions which pre- vail in our public schools, their retarding effect on the pupils, the benefits to be derived by preventing and correcting such conditions; also, what benefits are to be derived from a combined dental and medical inspection of our schools, the cost of this service, and the ultimate benefits that will result to the community at large. DENTAL CONDITIONS IN OUR PUBLIC SCHOOLS. — The need of dental work and instruction in oral hygiene among the public school children is well known to dentists, and those who have been en- gaged in school work, but is not so well known to the public at large. Cleveland, Chicago, Boston, New York, and other large cities have conducted dental examinations of school children, and the records made show that over ninety-five percent have defective teeth. This looks like poor dental conditions, and it really is poor. It demonstrates that the family cannot be relied upon to prevent these conditions ; therefore the school and —59— DENTAL PHYSIOLOGY AND ORAL HYGIENE family should co-operate, and teach the principles of oral hygiene. The percentage of dental defects given above are for large cities, where there is a great mixture of different races and classes of people. However, the smaller cities and towns have about the same dental conditions, and even the people of the agricultural regions suffer to nearly the same extent. These children enter school at about the age of six years ; many at this early age have decayed teeth, and mouth and throat infection. Few have been properly taught to care for their teeth, and the result is that many soon have dental conditions that begin to give trouble. The degree of trouble ranges all the way from an occasional toothache to more serious dis- orders, where decayed teeth have caused abscesses, or '*gum.-boils," which discharge pus into the mouth ; and .food is left upon and between decayed teeth; all of which is mixed with the saliva, which is swal- lowed, carrying infection into the stomach; w^hile mouth-breathing, from which many suffer, permits in- fection to be carried directly into the lungs. Some of this infected saliva is spread through the air in cough- ing and talking, and some deposited on the ground in spitting ; all of which becomes a further source of in- fection to the children in the room and on the play- grounds. The mouth is a warm, moist, cavity and where there are decayed teeth it becomes an ideal incubator for disease germs. In these cavities of decay, they find an —60— ORAL HYGIENE, DENTAL AND MEDICAL EXAMINATION: ideal field in which to develop. Is it any wonder that tuberculosis, pneumonia, diphtheria, infantile paral- ysis, influenza and other diseases, are so prevalent among school children? The wonder is that so many^ escape. THE RETARDING EFFECTS OF BAD ORAL CONDITIONS ON THE CHILD.— The effects of bad oral conditions may be seen in any school-room. They are a familiar sight in the schools of every city, village and hamlet. Doctors and dentists know the im- portance of the mouth as an entry-way and harboring place for germs of disease, and many authorities claim that seventy-five to eighty percent, of all infectious diseases make their entry into the body by way of the mouth. If this be true, and it can easily be demon-- strated, the mouth becomes an important part of the body, in relation to disease. When a child is fortun- ate in inheriting a healthy, normal physical consti- tution, and the habits of cleanliness are practiced, there will be a considerable amount of natural immun- ity from ordinary childhood diseases, which protects the child, where other less fortunate children suffer. Where the teeth are allowed to become unclean, decay soon begins, and if not promptly checked, tooth- ache results. A child with an aching tooth will not do good school work, and besides, may miss several ses- sions of school on that account. A decayed tooth will sometimes cause an earache, or trouble with the eyes, on account of the interrelation of the nerves of the teeth and eyes. This is a detri- —61— DENTAL PHYSIOLOGY AND ORAL HYGIENE ment to the child, and holds him back in his school work, if the conditions are not corrected. The interrelation of the tri-facial nerve over the face, including the teeth, eye, ear, nose and throat, cause many cases of pain that are referred to a differ- ent part from where the trouble really arises. Thus a child will often suffer from an earache when the ear is entirely normal. A decayed tooth sends a message of pain, which is transferred to the ear, or even to the eye. This is shown to be true, when the carious tooth is treated, by an immediate disappearance of the earache or eye trouble. This also works both ways, for an inflamed ear will sometimes cause a sensation of pain in the teeth. (See figure 40, page 151) . Attention has been called, in a previous chaptei*, to mouth-breathing in children. Children breathe through the mouth only when the nasal passages are obstructed. This obstruction is usually from adenoids. It is safe to say that first there was a septic mouth to begin infection. These mouth breathers have con- tracted dental arches, usually of a V shape in the up- per arch (Fig. 4). They have irregular teeth, which prevents proper mastication. If they have a few badly decayed teeth, as they do in many cases, which harbor decayed food and disease germs, often abscesses on the gums discharging pus, the food eaten is infected and the air taken into the lungs contaminated. Our schools contain many such children. They are anemic, continually suffer in the winter months from coughs and colds, and are not only physically below the —62— ORAL HYGIENE, DENTAL AND MEDICAL EXAMINATION average, but usually behind in their classes. Many contract consumption, and become a burden on their family or the State. BENEFITS DERIVED FROM PREVENTION AND CORRECTION OF BAD ORAL CONDITIONS. — It is the duty of the parents to see that their child- ren have a heritage of good health, and given this, it is due these children that they be properly taught how to preserve their good health. This is the duty of the parents, but experience teaches us that they often fail to give proper care and instruction to the children ; not always from lack of desire for their welfare, but more often from a lack of knowledge of what is needed. The State recognizes this, in regard to the educa- tion of the children of this country. If the common school education of their children were left entirely to the parents, many of them would fail to give their children the benefit of an education. Therefore, the State steps in, and says that they must educate their children. If the parents are too poor to provide the necessary books for their children, the school board furnishes them books. The State further provides shoes and clothing, ,and even food, so that a child may be able to go to school and receive an education. Would it not be good policy to go a step farther, and see that these children were in a proper physical con-^ dition to profit by their attendance at school, and were free from disease that might be communicated to other- children ? —63— DENTAL PHYSIOLOGY AND ORAL HYGIENE These children are the ones who need most the teachings of oral hygiene, and medical and dental care, to prevent disease. They live in poverty ; their homes are poorly warmed and ventilated; they are not as well fed as they should be, and are more liable to disease from being in a sub-normal condition. Tuber- culosis is only dangerous to people with weakened constitutions, and it is well known that the chief ob- ject of its treatment is to improve the general health of the patient. Many children contract tuberculosis during infancy^ but most of them recover, or never manifest any seri- ous form of the disease. This is due to the normal means of defense against disease, possessed by a nor- mal body. The children of the better classes of people have better living conditions, better medical and dental care and escape or recover from diseases more readily. It has been said that "we have the poor with us al- ways". While this is true, it is to our shame, as a civilized people, and a discredit to our civilization. There is no doubt that disease contributes much toward poverty conditions in this country. The place to attack these conditions is to begin with the children. Teach them to live clean and to keep clean, so they may be healthy and able to work, and become useful citizens. Healthy men and women usually earn their own living, and do not become public charges. Wherever right living conditions are established in a community, there poverty and disease decrease. Is —64— ORAL HYGIENE, DENTAL AND MEDICAL EXAMINATION this not a benefit? The place to begin is in the public schools. BENEFIT OF DENTAL AND MEDICAL IN- SPECTION OF PUBLIC SCHOOL CHILDREN.— The children of the better classes often suffer from bad dental, nose, and throat conditions. This is not because the parents of these children do not care, but they are not informed, or are too much occupied with the cares of social and business matters, to give proper attention, and they let these conditions go until the child calls their attention to an aching tooth. Often serious harm has resulted. Dental inspection in the schools would call the attention of the parents to early dental decay. In these cases a card is given to the child, who takes it home to the parents, just as the monthly grade cards are taken home. On this card the work needed is marked out. The parents are free to go anywhere, and have any dentist do the work for the child, and while this is not obligatory on the part of the parents, that they must have the work done, few of them but are ready and willing to give this service to their children, and glad to have this need called to their attention, at a time when it can be done cheaply and without pain to the child. Medical inspection of our school children will do much for the health of the community. At the com- mencement of the school term, each child should be examined to see that he is free from any disease that may be communicated to other children, and for any defects that may prevent him doing good school work. ^65— DENTAL PHYSIOLOGY AND ORAL HYGIENE Many schools in the larger cities even go so far as to apply tests to determine the mental development of the child, so that he may be properly provided for. Medical inspection will often disclose early throat troubles or nose affections, which, treated early, may be removed ; while if left to develop, they call for am operation a few years later. An example of such is diseased tonsils, and adenoids in the nasal passages. COST OF DENTAL AND MEDICAL INSPEC- TION, AND THE BENEFIT TO THE COMMUNITY AT LARGE. — ^The exact cost of medical and dental inspection for any given school is determined by con- ditions. Conditions in one community may make liv^ ing expenses higher than in some other communities. These same conditions will have their effect on the cost of everything else, medical and dental services included. This is a measure to benefit public health, and can be purchased like any other community want. The size of the school or the size of the city, or town, the local conditions, the degree of efficiency and the thoroughness with which the work is done will govern, to a great extent, the cost. In small towns the work could be done by having the children go to the local dentist and have their teeth examined. In most cases this can be done without any expense, for most dentists are willing to make these examinations for a reason- able number of school children. New work which comes to them repays them for the time devoted to examinations. Where the schools are larger, the cost —66— ORAL HYGIENE, DENTAL AND MEDICAL EXAMINATION of having the examinations made by specially em- ployed dentists is not great. Some of the larger cities have free dental clinics, where those unable to pay for dental work may have their teeth taken care of at public expense, or at a nominal cost, where they are able to pay something, and this has proved to be money well invested. If public money is used to furnish these destitute children with books, shoes and clothing, and some- times even food, would it not be good policy to see- that their physical condition is also good, so that these children may profit by their work in school ? In many places the oral hygiene work and public dental clinics have been started by public spirited citizens, who have contributed directly to the cause, and by dentists who have given their time to the work. This has been done in several cities, and the work later taken over by the public health department. At first small appropriations were made for this work, and increased as the scope of the work enlarged. In the larger cities, where dentists are regularly em- ployed in the school dental clinics, the salary ranges from $1200 to $1500 per annum, for each dentist em- ployed. In smaller cities or towns it may not be possible to establish dental clinics. However, it is an easy matter to teach oral hygiene in these schools. Physiology is taught, and a course in oral hygiene can be taught along with this subject. Tooth-brush drills, teaching the children how to clean and care for the teeth, will add little if anything to the cost of the school course. —67— DENTAL PHYSIOLOGY AND ORAL HYGIENE In cities which have a properly organized health department, the medical inspection can be conducted with little more expense. In smaller communities^ without a good health department, the school board should employ a physician to examine the children at the commencement of the school year, and none but healthy children should be admitted to the schools. Those who are in ill health should be required to take proper measures to remedy their ill health so that they may enter school. If these children are too poor to pay for their own care, the State should provide proper medical attendance, to set them on the road to health, and enable them to grow up into healthy men and women. With good health and an education, these children will become useful citizens, able to support themselves. Then they are not apt to become a burden on society. On the other hand, many of these defective children,, if their infirmities be not corrected, become a prey to disease and an early death, or they drag along through life, a burden on society, unable to acquire an educa- tion, and too weak physically to compete in life's battles. Therefore, they meet defeat. Our alms- houses are full of such wrecks. This makes a further burden of tax upon our people ; a burden which could be avoided in many instances by teaching habits of cleanliness, and remedying hereditary or acquired de- fects, before serious damage is done to the growing child. We have also another type of boys and girls who are- —68— ORAL HYGIENE, DENTAL AND MEDICAL EXAMINATION' seemingly not weak physically. They appear to be normal, healthy, strong children. They seem to get along as well as other children at first. They may be leaders of their particular set ; adepts in all the sports of childhood and one might say that they are all right, that there is nothing the matter with them. This is. true of most of them, but of some it is not. When these children enter school, some of them find it their first stumbling-block. These are the children with de- fective eyesight, hearing, or some of the various de- fects which may have begun at birth, or may have been acquired from bad oral conditions. As long as they are engaged in outdoor exercises, they get along all right. As soon as they are confined within the school they become restless ; study becomes an impleas- ant task, and the physical sense of uneasiness often, becomes unbearable. Unless these conditions are discovered and correct-- ed, the result will be that these pupils will study as little as possible. They will stay away from school whenever they have the opportunity. When in school^ they will be more apt to be engaged in mischief, which soon gets them into trouble with their teacher. The lack of study results in failure to get promotions, and ; with the tendency to mischief, soon causes these child- ren to be looked upon as delinquent. Punishment and failure to receive promotion give these pupils a dis- taste for school, which often results in giving them a resentful attitude toward society, which is here repre- sented by the school. —69— E DENTAL PHYSIOLOGY AND ORAL HYGIENE On the playground these children are the recipients of the admiration of their playmates ; in school they are the objects of reproach and ridicule. Is it any wonder that some of these unfortunates are truants from school, or if they go to school for a time, that they quit as soon as they reach the age of school ex- emption ? Some of these may go to work, but others become idlers, and soon get into trouble; these youngsters, the boys especially, are very liable to take up with other boys whose associations have led them into various crimes. The story is a familiar one in any of our large cities, and to a great extent in the smaller cities and towns. They soon meet with society i^ an- other combat. This time it is the jpolice. They are ar- rested, imprisoned and given a term in the reform or training school. Some of these boys and girls may be reformed by their training while detained in these in- stitutions. Many are not. Their resentment toward society continues, and they become criminals for the remainder of their lives. Criminals are just ordinary human beings, the greater percent, of whom are suifering from some pre- ventable or remediable defect. The others are prob- ably insane, and should be treated as insane. Medical and dental inspection of these defectives in early life will enable society to discover, and remedy or prevent many of these defects, and save a great Inany boys and girls for a useful and productive life. The cost of this prevention is little in comparison to —70— ORAL HYGIENE, DENTAL AND MEDICAL EXAMINATION the cost of building and maintaining prisons in which to confine these unfortunates after they have become a menace to society. What we spend in court costs on preventable crime would more than pay for all the school inspection we will ever need. One of our great American surgeons recently said that the next great step in preventive medicine should come from the dentists, and asked: 'Will they do it?" He might have added, crime prevention. The medical and dental men of this country are ready and willing to do their part. Are you, Mr. Taxpayer, ready to help them ? -^71— ORTHODONTIA, OR STRAIGHTENING IRREGULAR TEETH. CHAPTER V. The average healthy child who has had proper care of the mouth, who has been taught to keep it clean, whose teeth are free from decay, and who has been fortunate in escaping early colds, adenoids or infected tonsils, and has not formed wrong feeding habits, or other vicious habits, such as mouth-breathing or thumb-sucking, will have a regular, well formed set of temporary teeth. Usually the temporary teeth will be close together until about four years of age, after which they should begin to separate a little, because of the growing arch enlarging. When this separation does not take place it denotes that the child has suf- fered an arrest of development, which he cannot over- come unaided. By the age of six years this separa- tion should be wide enough so that when the temporary teeth are shed there will b e room for the wider perman- Figure VI. The ten upper deciduous teeth. ^^it teeth tO ^72— ORTHODONTIA. OR STRAIGHTENING IRREGULAR TEETH come in without crowding. If this separation takes place normally, the new teeth will come in straight; if it does not, the new teeth will be ''crooked" or over- lap each other. (Fig. 4, Chap. II.). In Figure 6, a photograph of a plaster model of a child's upper teeth, age five years ; notice the separa- tion of the teeth on the right side of the model. (Left side of the face.) This separation should give room for the eruption of the larger permanent teeth. How- ever, there is no separation on the opposite side, or be- tween the central incisors, and unless this defect is cor- rected, that is, the separation made the same on botk sides, the teeth will be crowded and irregular. Figure 4 is that of a girl, age 9 years, showing the crowded condition which will result unless this defect is cor- rected. When the bones of the face develop normally, and the temporary teeth are shed at the proper time, the permanent teeth erupt in order, and the new set of teeth are at least approximately even. When decay attacks the teeth, causing too early a loss, or the ton- sils become infected, adenoids form, and breathing- through the mouth is practiced, the dental arches are forced into an abnormal shape, or they are prevented from growing and developing as they should. Then the permanent teeth come in ''crooked." They are in all sorts of positions, growing inside the regular line of the arch, toward the roof of the mouth, or out to- ward the cheek, turned half way around in their sockets, or some of them overlapping each other^ —73— DENTAL PHYSIOLOGY AND ORAL HYGIENE Sometimes the upper teeth may close inside the lower, when normally the upper teeth should close over the lower teeth. The first six or seven years of a child's life are said to be the formative period of his life. What the child learns now and the habits he forms, will influence his entire after life. This is t r u e* i n both the physic- al and the mental life Figure VII. Models of irre.u'ular teeth. Where the ^ ^ t n e teeth are very irre.u'ular the bones of tlie head and child. One face Will be out of shape. .t, , Will surely influence the other. If the physical development is g'ood, the child will have a m.uch better chance for a normal mental development. The avera-^e child is born healthy, but all children do not remain so. By unclean oral (mouth) habits, early colds, bad feeding habits, or vicious practices, the normal growthi may be perverted. Adenoids, diseased teeth and tonsils, soon exert their harmful —74— ORTHODONTIA. OR STRAIGHTENING IRREGULAR TEETH effects. The first effect will be in regard to breathing. The air passages through the nose are reduced in size by enlargement of the adenoids. This causes the child to hold the mouth open for breathing, and causes the cheeks to be drawn down until they press against the outside of the arches and push them out of shape. The bony frame work of the faces of young children is very easily changed m shape, because these bones are not solidified. The tongue and lips also help shape the dental arch- es. When the mouth is held open, the tongue is drawn away from the teeth, and does not press against them Fi.aiire VIII. Case of Y shaped upper arc?!. Diie to jnoutli-breathing and tliunili-sucliing. Courtesy, lilue Island Specialty Co. —75— DENTAL PHYSIOLOGY AND ORAL HYGIENE normally. Neither do the lips. This pressure of the cheeks and lips on the outside of the arches, with the lack of the tongue pressure on the inside, which norm- ally gives shape to the dental arches, causes the arch to grow in a V shape. This causes a restriction of the breathing, affecting the supply of oxygen, which soon affects the lung de- velopment, and retards the development of the entire body. These teeth being irregular, the child is not able to properly masticate the food, and as irregular teeth are more liable to decay, because of the difficulty in properly cleaning them, there will usually be found a certain amount of decay and f ermentaton ; the pro- ducts of which are mixed with the food and saliva and taken into the digestive system, and produce disorders of digestion. If this influence is continued, it will •often affect the mentalitj^ of the child, because an ill- nourished child will not have the ambition to work and study that a well-nourished and vigorous one will liave. The early discovery of any condition that will Tetard the growth of the child is very desirable, and if faulty conditions are found, it becomes much more de- sirable to correct these conditions before serious harm is done. These conditions develop early, and should be attended to promptly, before the formative period of childhood ends, which is by the end of the sixth or seventh year. This is the duty of the parents, for few children are in school before six years of age. A child two or —76— ORTHODONTIA. OR STRAIGHTENING IRREGULAR TEETH three years old is not too young to visit the dentist twice a year, and have examinations made to discover defects of faulty development of head and face, nose and dental arches, or decay in the teeth. Children who *'just grow up", and do not have their dental defects corrected by the time they enter school, which is usually at six or seven years of age, will suf- fer in various ways. Some will be stoop-shouldered, have a curved spine, or a badly developed thoracic cavity. Others are anemic. We call them backward pupils. The least that usually happens is irregular and decayed teeth, which annoy them more or less in their work and play. If a child does not breathe freely it cannot develop right. After these deformities have occurred, the next question is how to correct them. In young child- ren this is usuall}^ a simple matter. The tissues are soft and easily molded into place. If the child has adenoids or diseased tonsils, and is a mouth-breather, the arch will usually be found compressed or V shaped, and the vault or roof of the mouth high. The raising or arching of the vault of the mouth restricts the space in the nasal passages. Spreading this V shaped arch out to the form nature intended it, will separate or spread the temporary teeth so that the permanent teeth will tend to come in straight. At the same time the nasal passages above will be spread, and the vault or roof of the mouth will take its proper shape. This allows the nasal septum to grow straight, and this, with the removal of the adenoids, allows re- —77— DENTAL PHYSIOLOGY AND ORAL HYGIENE sumption of proper breathing. If the tonsils are diseased, they should be looked after, in order that the throat passage may be cleared up and made healthy. The correction of these defects is best done early. Some operators are able to get good results for child- ren three and a half or four years old. These defects should, however, be corrected by the time the child is six or seven years old. The arches are easily spread at these ages; generally only a few weeks — ^ten or twelve — are required for the spreading process. If the child is under six years of age, the arch will not need much spreading to allow regular eruption of the permanent teeth, and a correction of the nasal ob- structions. Less than one-fourth of an inch will usu- ally be sufficient spreading for children six years of age or less. Very slight pressure is all that is necessary to effect the movement, and this can be applied by means of a small gold arch spring attached to the teeth. After the arches are spread a retaining appliance should be worn, until the first permanent molars erupt, to pre- vent the arch returning to the former contracted po- sition. In order to impress the importance of the need to- correct early dental irregularities, let us briefly re- view what happens to most children with bad oral conditions. These irregularities begin with some obstruction of the nasal passages. This causes the child to hold —78— ORTHODONTIA. OR STRAIGHTENING IRREGULAR TEETH the mouth open, and the breathing is done through the mouth. The air thus enters the lungs without being cleansed of impurities, which would not happen if breathing was through the nose, where the fine hairs of the nostrils catch and prevent dust, etc., from en- tering the lungs. This mouth breathing results in malformed arches, which crowd the roof of the mouth up and contract the nasal space. For it should be noted that the roof of the mouth is also the floor of the nasal cavity. The question may here be asked why the child can- not receive as much air into the lungs through the mouth as he could through the nose, were the passages in the nose opened ; for instance by the removal of the adenoids. Most of them do not, because they also have diseased tonsils to help stop up the air passages in the throat. The results of these bad conditions are that impure air is taken into the lungs, and the lungs are infected with disease germs. The influence of such conditions reduces the vital force, and the child is anemic. Frequently these children are undersized, and backward mentally as well as physically. In many cases a renewal of normal development and bodily vigor will be accomplished by a correction of these ab- normal conditions. MANAGING YOUNG PATIENTS.— Many people, and some dentists, have an idea that work cannot be done successfully for very young patients. But this is not true, for almost any dentist can gain the confidence of these little patients, provided the ''grown-ups" at —79— DENTAL PHYSIOLOGY AND ORAL HYGIENE home have not previously instilled a dread into the mind of the little one. If any dentist says the child i& too young, it will usually be because he has not the knack or the patience to work with these little ones. In such cases it will be wise to consult another dentist, one who will have the patience to gain the friendship af these little ones, and do what is needed to correct these defects at a time when it will do the most good. There is an old saying to this effect: "As the twig is bent, so will the tree grow." Why not apply this prin- ciple to the growing child ? Accompanying are photographs of an early case, as it appeared before operation, and the after appear- ance. "Case E. O'D". Child seven years old. Notice the two portraits taken before widening of the arches was be- gun. Note the position in Figure 9 — mouth open, head leaning forward, the stoop-shouldered position. In Figure 10 the same is shown with side view. Note the listless appearance of the face. Note the erect appearance, after operation, in Figure 11 — the head held up, neck straight, mouth closed. Also Fig- ure 12, with side view. The little boy here shown has had the dental arches widened. This also widened the nasal space, giving plenty of breath- ing space in the nose. Plenty of oxygen is taken into the lungs, and by the normal manner of breathing. The teeth were put in a normal position, which en- abled him to masticate his food properly. He was starving for oxygen, and as soon as he received a gen- —80— DENTAL PHYSIOLOGY AND ORAL HYGIENE -i. < —81— DENTAL PHYSIOLOGY AND ORAL HYGIENE y. fee - c —82- ORTHODONTIA. OR STRAIGHTENING IRREGULAR TEETR erous supply, and was able to chew his food properly, he began to develop in a normal manner. REGULATION OF THE PERMANENT TEETH. — While it is very desirable that the temporary set of teeth be cared for, so that the permanent teeth will ^come in even, this care is not always given, and re-^ suits in many cases of irregular permanent teeth. Patients of all ages consult dentists in regard to their irregular teeth, and most of them have the idea, that they should wait until they are grown before this work is attempted. Most dentists who do Orthodon- tia, would prefer to have their patients under nine years of age, or not over ten. From six to nine years is a very good time to have this work done. The tis- sues are more easily molded into place than when the work is done after the teeth are all in place and have their full root development, and the bony parts of the face become set. However, if the child has grown up with an irregular set of teeth, and desires to have them straightened, it may still be done, but it takes longer, and more work is required to get results. The general health of the patient, and the amount of school work required of him, should govern the time. For some this can be done at twelve to fifteen years. It should be done earlier, if possible. Before &ix years is better. During the age of puberty, it might not be well to attempt this kind of work for some patients, especial- ly girls. However, that should be left to the discre- tion of the dentist. , —83— DENTAL PHYSIOLOGY AND ORAL HYGIENE The work should begin so that it can be finished by the time the patient is fifteen or sixteen years old, twenty at the latest. For after these ages the tissues have become set and require a longer time to accomplish the regulation, and work a greater hard- .sjiip on the patient. • — ^,4- FILLING AND TREATING TEETH. CHAPTER VI. Few people have clear ideas in regard to filling teeth. Most of them think, that after a tooth has ached, is soon enough to have it filled. But this not true, for then it is often coo late, or the decay has progressed so far that filling will not restore the tooth as well as if it had been done sooner. The time to fill a tooth is just as soon as decay begins. If this is done it takes little cutting, causes little or no pain, and takes very little time to do the work. When the work is done this way, it can be done well, and restores the tooth to usefulness, and the filling will stay in and give no trouble. Besides it costs less to have the work done at this time. On the other hand, if the teeth are let go until they ache, it may take several trips to the dentist to have the work completed. It is also likely to hurt some, will cost a great deal more money, and does not give as good service after it is filled as work done early. The child who has had good care of the mouth until seven years of age, and is taught to keep the mouth clean, will not be liable to have trouble with decay. Making regular visits to the dentist, having every little decayed spot taken care of, will avoid trouble with decayed teeth. If the teeth are preserved until adult age, the chance is good to keep them throughout life, for there is really —85— DENTAL PHYSIOLOGY AND ORAL HYGIENE no physical reason why the teeth should not be retained until old age, and be useful during all that time. CAUSE OF DECAY.— The causes which lead to decay of the teeth are numerous, especially in highly civilized countries. One of the princi- pal causes is uncleanliness. Food lodged be- tween the teeth, and in the pits or depressions, if left, soon ferments. The mouth is moist and warm, and fermentation and chemical changes take place. The bacteria form an acid, which dissolves the enamel. If there are defects in the teeth like deep fissures, the decay forms faster and the small cavity soon becomes a large one. If not filled it will soon reach the pulp (or nerve) of the tooth, and cause it to ache. The pulp may then have to be removed, or even the tooth may be lost by the neglect. Another cause which makes the teeth decay, is sick- ness, which lowers the vitality of the body. Those who are ill should take special precaution to keep the mouth clean and the teeth free from deposits. Excessive study or worry, without exercise, may weaken the system, and the teeth may suffer as a con- sequence. Irregular teeth are hard to keep clean and show a tendency on this account to decay. Various diseases of childhood affect the teeth, and they may not develop evenly. Fissures are often found in the teeth, which harbor decay germs, and these teeth de- cay easily. The one great cause of decayed teeth among civilized peoples of today, is because so many live on luxuries, the prepared breakfast foods, and fine —86— FILLING AND TREATING TEETH white bolted flour, from which three fourths of the qualities, which are bone and tooth builders, are re- moved. The Vitamines are also removed. FORM OF TEETH.— The teeth are made of enamel, cementum, and the pulp or nerve. The root is covered by the peridental mem- brane, and set in the Alveolar pro- cess, the bony support of the teeth over the jaw bone. Cer- tain diseases in- jure this mem- Figure XITL Cuspid teeth, ground down, b r a U e, CaUSing" showing enameh dentine, pulp chamber, and .i^ teeth tO loOS- roots of teetii. (Enlarged.) en, or be lost. THE ENAMEL. — This is the hard, white, outer cov- ering of the tooth, and is the hardest substance in the body. It is clear, lustrous and translucent. The color varies in different people. Children usually have white teeth, and the second set of teeth may be white in color, or may be of a yellowish or bluish cast. Young people's teeth are usually whiter than those of older people. Teeth may change color. This is due to the changes in the teeth caused by foods, the —87— DENTAL PHYSIOLOGY AND ORAL HYGIENE changes of age, use of tobacco in chewing or smoking, and sometimes medicines taken into the mouth. Real hot food or drinks, or real cold things against the enamel, will often cause checks or cracks to come in the enamel. Especially is this true of sudden changes from hot to cold, or cold to hot substances. The enamel is formed of little enamel rods of a wavy or gnarled appearance. These rods are closely bound together, and run lengthwise from the dentine to the outside of the crown of the tooth. The entire tooth above the gum line is covered with enamel. THE DENTINE.— The dentine forms the greater bulk of the hard tissues of the tooth, and is covered by the enamel. The hollow space in the middle of the tooth contains the pulp or **nerve." The dentine contains a great number of minute tubules or canals which connect with the pulp of the tooth. The dentine is a hard, elastic substance, has a yellowish tinge, and is very sensitive. When the enamel covering is injured by decay, and cavities form, the exposed dentine becomes sensitive to heat or cold, or sweets, and to pressure of food particles, and toothache results. If decay goes on the pulp is exposed, and serious pain results. THE PULP. — The pulp is the soft vascular tissue contained within the hollow part of the crown of the tooth and root. It contains blood vessels and nerves, which enter at the small open end of the root. When decay destroys the enamel and dentine, the pulp be- —88— FILLING AND TREATING TEETH comes exposed, and it then becomes necessary to de- stroy this pulp or *'nerve", and clean the root canal out, and fill it with some inert substance which will completely fill the interior of this cavity, and prevent any moisture entering from the end of the root. After this is done the tooth can be filled or crowned. THE CEMENTUM.— The cementum is a modified bone, covering the root or fang of the tooth. It meets the enamel edge to edge, and is covered by a thin membrane called the Pericementum, or Peridental membrane, which forms a cushion around the root of the tooth, which is set firmly in the Alveolar pro- cess. The Alveolar process is that part of bone which is continuous with the body of the maxillae, or jaws, and supports the teeth. PREPARATION OF TEETH FOR FILLING.— The preparation that the cavity receives will deter- mine the usefulness of the filling in the tooth. All the decay should be removed and the tooth cut down until healthy dentine is reached, and all overlying enamel removed from the cavity. The margins of the cavity should be cut back so that when the filling is put in, the joint will not come against the adjoining tooth. If it does the tooth is very liable to decay again, for food will lodge there, and a brush will not clean and polish the margin of the filling as it should. Where decay is between the teeth, the cavity should be extended below the gum to prevent a recurrence of the decay. All grooves in the top of the tooth should —89— DENTAL PHYSIOLOGY AND ORAL HYGIENE be cut out to the rounding cusps of the teeth, so decay germs cannot lodge there. When decay is thoroughly removed, and the cavity cut out properly, a filling can be placed which will give long service, and it is worth the time and discom- fort endured. However, it is not always possible to do such thor- ough work. The age, the health, or the sensitiveness- of the patient will often prevent doing all that should be done. Young, or sensitive people, will not always al- low the dentist to cut into sensitive dentine and extend the cavity as it should be. Sometimes it may not be pos- sible to remove all decay, but it should be removed by all means, or the tooth will decay under the filling. Work that is half done will have to be done over some day. The dentist is often asked if it is safe to fill teeth for women in delicate health. Usually this can be done with perfect safety and comfort for these patients^ but the dentist should be informed of the condition. Temporary work at least can be done, which will pre- serve the teeth until such time when permanent work can be done. If teeth are let go, and toothache and abscesses result, the discomfort and danger will be greater than that from any dental operation that may be done at this time. Teeth may even be extracted with safety, and it is much better to have this done, if the tooth cannot be saved, than to endure prolonged suffering from diseased teeth. FILLING MATERIALS.— A good many materials —90— FILLING AND TREATING TEETH have been tried for filling the teeth, but gold, amalgam, and the different cements, are the principal ones used. GOLD.^Gold has long been a favorite filling ma- terial, with both patients and dentists. Its color is good, and if anything is used that will show at all, gold is chosen by the patient because of its appear- ance. The dentist uses it because it is malleable and a good filling can be made of it, and one that will not be apt to leak and expose the tooth to decay. Gold can be worked over little margins or edges of a cavity, and will stay without breaking off. In other words it has edge strength, and is adapted for filling cavities peculiar to front teeth. GOLD INLAYS. — During recent years a form of gold filling has been perfected which does away with long operations. This is the gold inlay. The cavity is prepared without any undercuts or mortices, so that it may be filled with wax, which is shaped up as the filling is desired. This wax is removed and invested in a cast, and the wax melted out, after which gold is melted and cast in this mold. This reproduces the wax filling in gold. This is set in the cavity and polished up, after which it is cemented into place. This makes a nice filling and does away with long opera- tions and the pounding necessary in working the gold foil fillings. AMALGAM. — Amalgam, or ''silver fillings," are used principally for the back teeth, those hidden from sight, in the mouth. Gold is sometimes used in these back teeth, but usually amalgam fillings are used. —91— DENTAL PHYSIOLOGY AND ORAL HYGIENE They preserve the teeth just as well, and are easier and cheaper to put in. It is very hard to put in a good gold filling in a com- pound or double cavity in the back teeth. It is hard to get the margins or edges of the filling so that no septic matter can seep in and cause decay, and it may not be advisable to try a gold inlay. Besides the work is very tiresome on the patient where the gold filling is very large. Amalgam can be placed much easier, and will preserve the tooth from decay, and patient and dentist will both be better' off. A good amalgam filling is worth more than any number of bad gold fillings. After the cavity is properly prepared, much depends on properly mixing and inserting a "silver" filling. The cavity should be dry, and the amalgam tightly packed in and shaped up with the tooth. After the amalgam has hardened the filling should be polished, so that no rough surfaces are left to catch food particles. CEMENT FILLINGS.— Cement fillings are used mostly for temporary work, and in children's teeth where permanent work cannot be done. Many people speak of these fillings as ''bone" fill- ings, but such is not the case. However, there are many places where a cement filling is preferable to any other, and often it is used for a permanent filling. Where decay is extensive, and all the decay cannot be removed, often a copper cement is used, because of its germicidal effect on decay left in the tooth. Or an or- —92— FILLING AND TREATING TEETH dinaiy cement filling may be used because the tooth wall not tolerate a metal filling. Metal is a conductor of heat and cold, especially the silver metal used in filling teeth, and the pulp may die from the repeated shocks, from heat and cold, caused by hot or very cold food taken into the mouth. Cement does not conduct heat or cold as well, and is often used where the tooth is very sensitive. If the cement dissolves it can be replaced. This is better than to have the pulp die and to have the root canals filled. The principal objection to cement is that it may dissolve from the cavity. Cement will stay in cavities in one patient's mouth for long periods of time, and in some other person's mouth will last only a short time. This is not entirely due to the cement, but to the conditions in the mouth. SYNTHETICS.- Among the re- cent cements put on the market are the so called Syn- thetic porcelains, 'ma or artificial enamel ™ cements. These are made in many shades or colors to Figure XIV. Photograph of child's teeth, match the differ- aa:e 13 vears. The dark spots show where x i j -e ., 1 " , , 4. / 1 ^ ^,1- ent shades ot the decay lias been cut out ready for Tilling. teeth. These cements are more permanent, and have to a great extent replaced the use of gold fillings and —93— DENTAL PHYSIOLOGY AND ORAL HYGIENE porcelain inlays in the front teeth. Cavities can Be filled with this Synthetic porcelain, and the fillings matched up with the color of the tooth so that the filling cannot be detected, except by very close exam- ination. This is also used in the teeth furth- Figure XV. The teeth shown in Figure 14 ^^ ^^^^^ ^^^^ makes iilled with a material like the enamel of the natural teeth. This looks better than ^^ ideal filling ^old, and restores the natural appearance, where it Can be properly placed, and does away with unsightly metal fillings in the mouth. TREATING TEETH.— When a tooth has decayed so that the pulp is exposed, the pulp will have to be removed, and the root canals cleaned, sterilized and filled, so that no moisture or septic matter can enter from the root end of the tooth. The vitality of the pulp or nerve may be destroyed by applying a devital- izing paste to it, and sealing the opening of the cavity with cement. In a few days the treatment can be re- moved, and the pulp taken out of the root canal without -any pain. Or a rubber cloth may be placed over the tooth, and a local anesthetic applied by means of pressure, and within a few minutes the pulp can be removed without hurting. If plenty of time is taken for the treatment there will be no pain. Pain is gen- —94— FILLING AND TREATING TEETH erally the result of too much hurry. The proper treat- ment and fining of the root canals in teeth is one of the most important parts of dental work. The good health of the tooth treated depends on the stability of the root, and if the work is well done the tooth will be useful. If it is not well done an alveolar abscess, or *'gum-boil," will result, which will very likely cause the loss of the tooth, and may cause more serious trouble. After the pulp has been removed, the canals cleaned and sterilized, some inert substance is introduced into the canals and worked up to the end of the root, com- pletely sealing the opening against the entrance of anjr moisture or infection from the tissues at the end of the root. A tooth with a live pulp is more durable than one in which the pulp has been destroyed. Therefore, it is best to have all decayed places repaired before the decay gets too deep and exposes the pulp, but after it is exposed it must be treated, and too much care and skill cannot be used ia the operation. Many people think that all that is necessary is to *'kill the nerve", and let it go with- Fig. XVI. Left tooth o^t fliij^g the root, but if this is perfectly filled root. i • i Right tooth imper- done, an abscess will result which fectiy filled root. forms pus, and this is absorbed into the system, and may set up a more serious disturbance. If a faulty root canal filling is made, an —95— '-#^r Pigure X^^II. Shows eyes of patient with severe iritis due to a dental abscess. Courtesy Dr. Thomas B. Plartzell, College of Dentistry, University of Minnesota. DENTAL PHYSIOLOGY AND ORAL HYGIENE abscess will form. Abscesses, or ''g u m- boils," dis- charge pus which is mixed with food and saHva and swallowed, produc- ing digest- i V e d i s- turbances. This pus is also taken up by the blood current and lymphatics, and carried to remote parts of the body, where inflamatory lesions are caused, such as in the joints, muscles, eyes or appendix. Abscesses on the gums constantly discharge pus. This not only causes the mouth to have a foul odor, but allows the food to be mixed with this pus and swallow- ed, thus affecting the entire digestive system, as well as carrying infection to other organs. Such people usually suffer from neuralgia, rheumatism and like diseases. Figure 17 shows a severe case of iritis caused by a Cental abscess involving the left antrum. Extraction of the tooth and cleaning of the tooth sockets resulted —96— FILLING AND TREATING TEETH in a rapid imp rove- m e n t of the inflam- mation o f the eyes. M Figure 18 shows veg- etation on the valves of the heart of a patient who had a Fiaure X\'III. Sliows veuetation on tlie mitral „ valves of Iieart. I'atient who liad several dental number 01 abscesses. Courtesy Dr. Tlionias l?. Hartzell, Colleiie of Dentistry, l^niversit\' of Minnesota. dental ab- scesses. In Figure 19 an X-Ray picture is shown of a man's hand, who suffered from a form of rheu- matism, called arthiitis deformans, caused by dental abscesses. The infection was carried to the joints, resulting in the deformity. These pictures have been presented to show the danger which may result from neglected ab- scesses. Too much care cannot be given to the filling of the root canals of treated teeth. Besides the danger of ab- scesses from badly treated teeth, the person will have a very foul breath, and become disagreeable to others —97— DENTAL PHYSIOLOGY AND ORAL HYGIENE in social and business in- terco u r s e, B us i nes s- and social success de- pend much on good health, and a good per- s n a 1 a p- p e a r a n c e c o n t r i b- utes greatly to a favor- able impression in any walk of life. Unsightly teeth often spoil the looks of an otherwise good looking per- son, while in some other, the even, well cared for teetk give that individual a pleasant appearance, that often creates the favorable impression which insures success in business and social undertakings. Bad teeth are a. source of ill health and retard the individual in any work. Figure XIX. Shows X-Ray of hand of man suffering from arthritis deformans, a form of rlieumatism due to dental abscesses. Courtesy Dr. Thomas B. Hartzell, College of Dentistry, University of Minnesota. —98— CROWN AND BRIDGE WORK. CHAPTER VII. When teeth become so badly decayed, or are broken off, so that they cannot be filled, it becomes necessary lo crown them in order that their usefulness may be Testored. Often teeth have been extracted and a space left, giving- an unsightly appearance, and de- stroying the continuous chewing surface necessary to good mastication of the food. In such cases these spaces are often filled in by bridge work, the appear- ance bettered, and the masticating surface of the teeth Testored. Sometimes, in bridge work, it is necessary to use a sound tooth for the attachment of the support crown. In such cases it is usually best to preserve the vitality of the tooth. The pulp should not be removed from such a tooth if there is any way to avoid it, but where j^ront teeth are to be crowned, it is usually best to re- move the pulp or "nerve", and restore the appearance by the use of a porcelian faced crown, because gold crowns do not make a good appearance where they show in the front of the mouth. Teeth, in which it becomes necessary to remove the pulp, should be carefully treated, to prevent abscesses forming later and causing the loss of the teeth. —99— DENTAL PHYSIOLOGY AND ORAL HYGIENE Should this happen, the entire bridge might be lost. If the supporting teeth become diseased, the crowns- will have to be removed. It can readily be seen that the teeth must have sound, healthy roots, in order to support crowns or pieces of bridge work. If the foundation fails, the top structure will also fail. The X-Ray is of great use to the dentist, for by it he can tell how well a root canal has been filled. Wherever possible, an X-Ray of the treated tooth, whether for crown or bridge work, or for ordinary filling, should be taken. A root canal is a blind pass- age, and hard to fill under the best conditions. Single rooted teeth are comparatively easy of access, but mul- tiple rooted teeth, like the molars, are very difficult to fill. After the root treatment has been properly done, the next step is to see that the crown is properly pre- pared, and that in this preparation no injury be done the gum and delicate membrane surrounding the tooth root, which, if injured, may cause disease in this deli- cate tissue, and the previous good work lost. It is the purpose of modern artificial crown and bridge work to restore the broken teeth to usefulness, and to make them as near indistinguishable from natural teeth as possible. To do this, as little gold should be exposed to view as possible. There are vari- ous ways to restore broken down teeth by crowns, some of which will be briefly described. THE PORCELAIN CROWN.— Porcelain ready- —100— CROWN AND BRIDGE WORK is- o P-i O l-H tj i^ o r "1 «<-i X v-> a; (U ^ !h — cS _CJJ c^ ip crowns are fastened or fused together with gold solder. Figure 30 shows the bridge Fig^ure XXIX. ^.-^j^ ^^^ facings attached Courtesy ot Columbus Dental Manufacturing Co. and Cemented to place. These facings are easily replaced if any of them should be- come broken, and the repairs can be made in a few min- utes, without having to re- move or damage the bridge. Figure XXX. By Courtesy of the Columbus Dental Manufacturing Co. —108— CROWN AND BRIDGE WORK Figure 31 shows a three tooth bridge in place, in the mouth. This makes an ideal piece of work to re- place missing teeth. It is clean and sanitary, re- stores the masticating surface of the missing teeth, and improves the personal appearance. It restores the teeth without the use of a plate, and aids in restoring speech, for where teeth are miss- ,_ , ' ing speech is often in- Fiiiurc xxxT. terferred with. THE CARE OF CROWNS AND BRIDGE WORK. — Where bridge work or crowns are worn, careful at- tention should bo given the mouth to keep it clean, and the artificial parts free from food particles which tend to lodge there, and which decay and cause the breath to be foul. After every meal the teeth should be well l3rushed and rinsed with water. It must be remembered that the tissues of the mouth, •especially the delicate gums around the teeth, are easily injured. If filth is allowed to accumulate, the gums will recede or pull back from the crowns, the roots of the teeth becom.e diseased and loosened, and the den- tal work will be lost. The foundations of the parts must be kept healthy to insure the permanence of the work. —109— CARE OF THE TEETH AND MOUTH. CHAPTER VIII. The care of the mouth should begin when the child is young. The mother should, as soon as the first teeth appear, cleanse each tooth with a piece of soft linen or cotton cloth, wiping off all accumulations, keeping- the teeth polished well at all times. By the time the child is two or three years old he should be able to use a tooth brush and keep his own teeth clean. A child will soon learn the pleasure of a clean mouthy and will usually be willing to continue cleaning his teeth. If neglectful in doing this, often rewards will stimulate renewed effort. The health of the child is greatly influenced by con- ditions in the mouth during the first five or six years- of life, and if conditions are very bad, the influence will be felt throughout the life of the adult. There- fore, the importance of keeping the mouth clean and free from food remnants and tartar, should be learned by every one, and the earlier this is learned the better for the individual. Practically all dental troubles come from uncleanli- ness. Children attending school eat candies and sweets^ and leave the teeth covered with particles of it, whick soon ferment when lodged in the pits of the crowns- —110— CARE OF THE TEETH AND MOUTH and between the teeth. Perhaps food, such as cakes and sandwiches, are taken to school for kincheon, and the food remnants are also left on the teeth. Besides decay being caused, the food accumulating around the teeth will cause bad odors, and the mouth will be in a filthy condition. If the teeth are brushed clean after eating candy, or after each time food is €aten, no harm will result. TARTAR. — Tartar is composed of mineral and ani- mal matter, deposited from the saliva and food. Sometimes the teeth are entirely covered with and stained by it. In young children it may commence as a green stain. In older persons it may be dark, yellow, or sometimes of a whitish color, depending on the con- ditions causing it. These deposits press against the gums and crowd "them away from the roots of the teeth, and soon bac- teria enter and pus pockets form. Pyorrhea has now begun, and if let go on, the teeth are soon loosened, and in time lost. EFFECTS OF TARTAR.— It causes the gums to be- come soft and spongy, and they bleed at every little injury. Pus is also formed, as stated before, and the food eaten is mixed with this pus, which, passing in- to the stomach, impairs the entire digestive system. Not only remote parts of the body are affected di- 2'ectly, but the parts adjacent to the mouth — the ton- sils, nose, the ears, through the Eustachian tube, and even the eyes, as shown in a previous chapter. The way to avoid all this discomfort and danger is to —111— DENTAL PHYSIOLOGY AND ORAL HYGIENE keep the mouth scrupulously clean and free from de^ caying food, thus preventing all deposits from forming on the teeth. This demands the most constant attention.. In one who has practiced keeping the mouth clean,, it is comparatively easy to keep all deposits brushed from the teeth. If deposist are once allowed to form on the teeth, no one but the dentist can ckan them thoroughly. This is because no one can see just where the deposits are, or be able to use the proper in- struments to remove them from his own mouth with- out doing some injury to the soft tissues. After deposits are removed from the teeth, patients often complain that the teeth are very sensitive, es- pecially to hot and cold substances. This is natural, for the tartar has crowded the gum back from the roots of the teeth, and replaced the natural gum cov- ering the root. The root of the tooth has no enamel to protect it, and when the tartar is removed, the sensi- tive root is exposed, and is easily irritated by hot and cold foods. This will not last long, however, for the gums will partly return over the roots, and the teeth- will soon adjust themselves to the clean condition. Teeth which are allowed to become very foul usual- ly have more or less decay, and when these deposits are removed the decayed places are exposed, and are noticed by the patient. The dentist has not '"picked"' these holes in the teeth. He has only cleaned the teeth so that the decayed places can be found. No dentist would do such a thing, nor would a responsible dentist; use medicine or instruments that would do any^ —112— CARE OF THE TEETH AND MOUTH damage to the teeth. Enamel is too hard to be easily damaged by the fine instruments used to clean teeth. It is difficult to penetrate enamel, sometimes, with a dental bur ; therefore, the delicate dental instruments will do no damage. THE EFFECT OF FOOD ON THE TEETH.— The different kinds of food and drink have their effect on the teeth. Very hot foods are liable to injure the enamel, as also are very cold ones. Many people will take very hot food into the mouth, and then take a drink of cold water or iced tea. This rapid change from hot to cold often causes the enamel to crack. Heat expands and cold contracts. The hot food will expand the tooth substance, and if cold is applied sud- denly the contraction is too rapid, and causes the tiny little fractures often seen in the teeth, especially in the front teeth. This is also true of sudden changes from cold to hot foods. The principle on which this damage is done can easily be shown by placing a glass tumbler in cold water, and then quickly placing it in hot water. The rapid change in expansion will crack the glass. This is what happens to the enamel of the tooth. Often these little cracks may be caused by blows on the teeth, but usually it is from the abuse of hot and cold substances in the mouth. 'The prepared foods, much in use to-day, help cause many dental troubles. The great amount of white bread eaten is a factor in dental decay. Soft food, requiring little chewing, is swallowed without being properly chewed. The teeth and gums do not get enough exercise. —113— DENTAL PHYSIOLOGY AND ORAL HYGIENE Whole wheat bread and some of the other coarse breads are good for the teeth, because they require more chewing to prepare them for swallowing. Thus the teeth and gums are given more exercise, and are cleaned better. Apples and fibrous vegetables cleanse the teeth well and give plenty of exercise. Chewing gum helps clean the teeth and keep the gums in good condition. Unsweetened gum is the best to use. If a sweetened gum is used, the teeth should be well brushed afterward. However, the place to chew gum is not in public places, but rather in the privacy of the home. If any deposits are allowed to collect, chewing rough foods and gum will not remove the deposits. The teeth should be brushed after each meal, and the gums thoroughly massaged, and the tongue should not be neglected in this cleaning process. When a person's tongue is inclined to be coated, a tongue scraper may be used to clean the tongue and help keep the mouth in clean condition. —114— Figure No. XXXII. A Tongue Scraper. CARE OF THE TEETH AND MOUTH CLEANING THE TEETH.— The teeth should be brushed frequently, and the mouth kept free from debris at all times. The ideal way to care for the teeth is to brush them with a suitable brush and luke warm water, in the morning before eating breakfast. This cleans the mouth, so that the food eaten will be mixed with clean saliva, and there will be no secretions from over night left on the teeth to be mixed with the food, As soon as the meal is over, the teeth should be brushed again, to remove food particles. At this time a tooth powder may be used, or luke warm water. Some people like to use a little salt in the water when brushing the teeth, which helps harden the gums and imparts a sense of cleanliness to the mouth. Others make a practice of cleaning the mouth and teeth before and after each meal, and this might be called the ideal way. Few of them ever suffer from disease of the mouth or decay of the teeth, provided, of course, that cleanly habits were practiced before decay began. Dental floss should be run between the teeth occasionally, to keep the spaces between the teeth clean. This can be purchased at the drug store, or your dentist will supply you. A piece about six inches long is held taut and passed between the teeth. Care should be used not to let it slip down on the gum and cut it. Hold the piece of silk floss taut, one end in each hand, and gently work it between the teeth, taking them in rotation. The silk floss is waxed, and will easi- ly pass between the teeth without cutting, except where there is a cavity between the teeth. If there is a —115— DENTAL PHYSIOLOGY AND ORAL HYGIENE cavity the floss will be frayed or cut. Even when decay has begun it will be retarded and kept from spreading as much as it would do if the mouth were unclean. A good tooth powder should be used once a day. Some teeth are even and regular, and so set in the arches that it is an easy matter to keep them clean. People with such teeth have little trouble keeping them in good condition. On the other hand, there are others who have irregular teeth, or have some of them miss- ing ; there may be crowns or bridge work, or a partial plate. These patients have more or less trouble keep- ing the mouth clean and wholesome. Each person should consult his dentist, and get ad- vice in regard to cleaning the teeth; how often to do this; the kind of powder or dentrifice to use; and the best way to do the brushing. A doctor does not give the same kind of medicine to all his patients. He finds out what the trouble is, and prescribes for each case. This is more or less true of the dentist. The individ- ual needs and desires of each patient are to be con- sidered, and your family dentist will be the one to ad- vise you best. It will be time and money saved to seek this advice. Few people have the knowledge to select proper brushes and cleaning agents for themselves. There are many kinds of tooth brushes, powders, pastes and mouth washes on the market, and while many of them are good, there are also many of them that are not good, and some of them are worse than useless, because they injure the teeth and the tissues of the mouth. Some of these powders, pastes or washes —116— CARE OF THE TEETH AND MOUTH contain acids. Acids have a great affinity for the mineral salts, which make up a great part of the tooth substance, and abrade or roughen the teeth, and make them an easy prey to decay. Many of the dental preparations are put up in attractive packages, the contents sweetened or colored to make them pleasing to the palate or eye. This makes the use of sugars and dyes necessary in their manufacture. Sugars left in the mouth undergo chem- ical changes, and an acid is formed. As for the color- ing agents used in some pastes and powders, it has been found that they often have a bad influence on the teeth and tissues of the mouth. As a rule a good tooth powder is better to use than any other cleansing agent. Pastes and mouth washes are of doubtful value, for they impart a sense of cleanliness when in reality the mouth is riot clean. If a paste is used occasionally, the mouth should be well brushed and rinsed with water to remove all remnants of the tooth paste. This may be advised also where powder is used. Many of the tooth powders and creams are made of cheap, coarse and gritty materials, and these are un- desirable agents to clean the teeth, for they scratch and wear down the enamel. The United States Gov- ernment, through one of its Departments, perhaps the Bureau of Chemistry, should supervise the manufac- ture of these mouth preparations, and compel all manufacturers to come up to a certain standard. Such a law will compel many manufacturers to improve their products. —117— DENTAL PHYSIOLOGY AND ORAL HYGIENE MOUTH WASHES. — There are many preparations made and sold as mouth washes. The best one, how- ever, is the one provided by nature. Under normal conditions the saliva is the best mouth wash. The teeth are constantly bathed in it, and if the teeth are kept free from food debris, bacteria cannot act on food particles between the teeth and in the pits and grooves, and cause acids to be formed, which destroy the teeth. The saliva is present in the mouth at all times, and if the digestive system is kept in good shape the general health will be good, and the saliva secre- tions will be normal. Man has not yet succeeded in producing a mouth v/ash as good as the saliva pro- vided by nature. Water conies the nearest, and in sur- gical operations sterilized water is about as usefu> as many of the germicides and antiseptics employed. Should it become necessary to use a mouth wash, your dentist or physician will advise you what to use. CARE OF THE TEETH.— The baby's first tooth brush is usually a homemade one. A piece of soft cot- ton or linen cloth, or dental cotton, may be wrapped around a small stick or wooden toothpick, or the finger, and wet with a solution of boric acid, or bicarbonate of soda. The little tooth can be gently cleaned ; also the gums. When two or more teeth have come in, a small soft brush can be used to clean the teeth and keep food particles from between the teeth. As soon as all the teeth are in, the mother should have them examined by the dentist. Often there are fissures in the enamel surfaces, which will decay if not —118— CARE OF THE TEETH AND MOUTH Fiffure XXXIII. Three sizes of Tooth Bruslies. Adult's. Youth's. —119— Child's. DENTAL PHYSIOLOGY AND ORAL HYGIENE attended to promptly. Usually the teeth are protected from decay if the surfaces are kept clean. During and after the time the adult teeth appear, they should be given daily attention, to prevent decay and tartar forming. The teeth should be brushed at least once each day; once after each meal is better. After meals a soft quill toothpick may be used to dislodge particles of food from between the teeth ; or dental floss may be passed between the teeth, to keep the surfaces between them polished and free from food particles and stains. Toothpicks should be used in private, not public places. If the teeth are kept clean they will not decay. The best preventative is cleanliness. Twice a year is not too often to see your dentist and have an exanyn- ation made for decay. *"HOW TO BRUSH THE TEETH.— Comparatively few people know how to brush the teeth. Many people brush their teeth this way, passing the brush crosswise over the surface of the teeth, thus: This is incorrect. Quite a number of people have been taught to brush their teeth this way, passing the bristles lengthwise of the teeth, thus : —120- Fiffure XXXIV A. Figure XXXIV B. cleanse the teeth better than either 1m^^^^ after a little practice the user of this^V^ i3 CARE OF THE TEETH AND MOUTH This method is a great improvement over the first, but is not thoroughly efficacious. In the light of recent investigation conducted at the hands of some of the leading students of Mouth Hygiene, the most effective way to use the tooth brush is to place the bristles of the brush firmly against the teeth, applying firm pressure, as though trying to force the bristles between the teeth, using a slight rotary or scrubbing motion, thus : This movement will be found to of the above methods of brushing, and method will be surprised at the results obtained. Care should be used to go Fig.xxxiv c. over all the surfaces of the teeth in this manner. WATER CLEANSING IS MOST IMPORTANT.— When the brushing is finished, the user should take in the mouth luke-warm water, and with the use of the lips, cheek and tongue, using all the force that the indi- vidual can bring to bear, force the water in between and around the teeth, repeating this cleansing process several times. This is as important a part of the correct tooth toilet as is the use of tooth brush and tooth paste. After a short time the power to force the water be- tween and around the teeth will be increased until one who uses this method will be astonished at how much debris can be washed out this way, after a careful use of the dental cream and the brush." * By Courtesy of The National Mouth Hygiene Association. —121— EXTRACTING TEETH AND ORAL SURGERY. CHAPTER IX. In this day and age of the world it should be unnec- essary to extract teeth. Unfortunately there are a great many lost because many people neglect their teeth until extraction is the only remedy. In children the temporary teeth are often lost before it is time for these little teeth to be shed. Through neglect the teeth of the little ones often are allowed to decay, and "gum- boils" are formed, which make extraction necessary. THESE LITTLE TEETH SHOULD BE RETAINED UNTIL TIME FOR THEM TO BE REPLACED BY THE PERMANENT TEETH, IN ORDER THAT THE BONES OF THE FACE AND JAW MAY DE- VELOP PROPERLY. However, cases happen where these temporary teeth are retained over the normal time, and the permanent teeth begin to come in under or beside them. In such cases these teeth should be removed, in order to allow the permanent teeth to erupt evenly. Should it be necessary to extract teeth for these little ones it can be done painlessly, PROVIDED THE CHILD HAS NOT BEEN FRIGHTENED BEFORE- HAND, by parents or others telling the child he will be hurt when the tooth is ''pulled". Never frighten —122— EXTRACTING TEETH AND ORAL SURGERY children or punish them by telling them buga- boo stories, or theaten them with having their teeth **pulled". The punishment will return ten fold to the one who gave it, the first time that person takes one of these ''frightened kids" to the dental office, or perhaps has to sit up all night with one who has the toothache, and is afraid to have anj^hing done to the tooth. Often children, in playing, may fall or run against something, and knock a tooth loose. These teeth should not be extracted. A speedy trip to the dentist may save the tooth. The loosened tooth can be anchored solid, and will usually grow back firm. If let go without treatment the tooth may be lost. Teeth knocked entirely out of the socket can sometimes be replaced, and will grow firm again if properly fast- ened until healing takes place. The tooth should be kept from getting dirty if possible, especially dirt from the ground. After adult life is reached it should not be necessary to have teeth ex- tracted; but older people neglect their teeth as well Figure XXXV. Irreaiilar teeth caused bv extraction of one tooth. ' aS yOUUgCr OnCS, and often have to —123— DENTAL PHYSIOLOGY AND ORAL HYGIENE have them removed. Sometimes a patient comes in with the toothache and insists that the tooth be extracted. On examining the tooth, the dentist finds that it can be treated, saved, and made useful. Usually the patient will be willing to have this done. Occasionally a patient will insist on having the tooth removed, say- ing one less will not make any difference. It does make a difference, and the dentist is justified if he re- fuses to extract a good tooth. One tooth out may dis- arrange the entire masticating apparatus on that side. When one tooth is extracted from a full set it means damage to five other teeth adjacent to it. (Fig. 35). Abscessed teeth, as a rule, should be extracted, un- less they can be readily cured. Teeth that have once been treated and afterward abscess are difficult to save. They are usually chronic cases, and the' al- veolar process is diseased to some extent, and the teeth loosened. Where teeth are crowded it may be necessary to extract one or more, but usually they can be straightened by the orthodontist without extract- ing any of them. Teeth which are badly neglected and are covered by deposits, often have to be removed, because of their loosened condition and the diseased gums. This condi- tion is called pyorrhea, and pus will be found around the teeth. Such teeth should be removed at once, if it is not possible to quickly cure them. Pus around the teeth will, if left, cause more serious affections in the throat, ears, eyes, or more distant parts of the body. After the teeth are removed, flow of pus stops and the gums heal. —124— EXTRACTING TEETH AND ORAL SURGERY Teeth can usually be extracted without pain, if there are no unusual diseased conditions to prevent the ab- sorption of the anesthetic into the gum. The bad re- pute that extracting of teeth bears, is due to th6 fact that formerly nothing was used to anesthetize or deaden the gums. Teeth were taken out with- out an effort being made to relieve the pain, and the experiences some of these people had, especially those who would have fifteen or twenty teeth removed at one time, are told even to- day. By the use of local anesthetics the gum may be deadened, and a tooth, or several teeth, removed, and not the least bit of pain be experienced. Some people have an idea that where a tooth is ab- scessed, it should not be extracted until the abscess gets well. This is a mistaken idea, for the abscess will not heal of its own accord. It may break and let some of the pus out, and become less painful, but it is not well. If one has a splinter in the flesh, and it is fester- ing, it would be very foolish to leave the splinter in, expecting the festered place to get well. The physi- cian would pull the splinter out, and clean the wound so that it could heal quickly. And this is what should be done with the abscessed tooth. Formerly it was thought to be dangerous to extract an abscessed tooth, but there is no more danger than in extracting any other tooth, and by an early extraction much needless suffering may be avoided. Sometimes teeth that are diseased are neglected until they are very difficult to extract, or other diseased con- —125— DENTAL PHYSIOLOGY AND ORAL HYGIENE ditions may be present. The patient delays until the suffering can be borne no longer. Then he goes to the dentist and has the diseased tooth extracted. This 'does not always cure the abscess, because in- fection may enter the wound from other infected teeth, or the patient may carry infection to the wound with the finger. Keep the fingers away from the mouth, after having a tooth extracted. The hands easily carry infection from things they come in contact with, and the patient himself may infect the wound and after- ^svard may want to blame the dentist. Sometimes the tissues continue to swell and hurt; or the patient may perhaps be getting along all right, and disobeys instructions, by going to work or to places of amusement sooner than he should and ag- gravates his condition. Then when his sufferings continue he wants to abuse the dentist, and blame him for his condition. Sometimes legal proceedings are brought against a dentist in such cases, but they are seldom successful. Sometimes an unprincipled rival dentist may encourage a patient to sue his dentist, to get revenge for some fancied wrong; but when he gets on the witness stand, this other dentist has to tell the truth and exonerate the man he has tried to wrong. There are few men in the profession, and few pa- tients, who will give or listen to such unprincipled ad- vice, for every one recognizes the fact that no profes- sional man would jeopardize his reputation by inten- tionally injuring a patient, or be careless with his treatment. L.aiy decayed teeth should be extracted EXTRACTING TEETH AND ORAL SURGERY early, and bad results will seldom follow, and the den- tist and patient will both be better oft*. LOCAL ANESTHESIA.— Local anesthesia is the local injection or application of medicinal agents, in a circumscribed area, to render that part insensible to pain. The elimination of pain from surgical opera- tions is very much to be desired, and can be accom- plished with a local anesthetic in minor operations^ and thus avoid a general anesthetic. Cocaine was formerly much employed as an anesthetic agent, but there are drugs much safer than cocaine, and these are used almost exclusively now in preference to cocaine. Among the latter drugs is novocaine. It is one of the safest, if not the safest, drug that can be used as a local anesthetic. Applied locally it has no after effects,, and is not irritating to the soft tissues. Secret prepa- rations should be avoided, and any one who adver- tises that he possesses a secret drug that no one else can get, is misrepresenting things to his patients. Dr. Hermann Prinz, of Philadelphia, one of the best authorities on drugs in the United States, has made a very complete study of anesthetics, and has given the result of his studies to the professions, and any legally qualified person may avail himself of this knowledge and the use of these drugs. Dentistry is a branch of the medical profession, and physicians, from time immemorial, have given freely of their knowledge to their medical brethren, in order to relieve the sufferings of humanity. To do otherwise —127— DENTAL PHYSIOLOGY AND ORAL HYGIENE is to practice the methods of the charletan or quack. Another local anesthetic sometimes used is the Ethyl Chloride Spray. For the extraction of teeth, or opening of abscesses, the spray is directed against the gums until they are covered with ice crystals and have turned white. This is often referred to by patients as ''freezing" the gums. GENERAL ANESTHETICS.— General anesthetics are drugs which, when inhaled into the lungs, act on the central nervous system, and cause the pa- tient to be insensible to pain or any other sensation. The principal general anesthetic, and the safest one used in dental operations, is a combination of nitrous oxide and oxygen. It is sometimes called ''laughing gas." This is due to the fact that nitrous oxide produces exhilarating effects on some pa- tients, causing them to laugh or cry, or have "funny dreams." These effects are mostly due to the use of the gas in a pure form. When used with oxygen these exhilarating effects are nut noticeable. Formerly, when nitrous oxide alone was used, the period of anesthesia was very short, but prolonged an- esthesia, by means of a mixture of nitrous oxide and oxygen, is now possible, and is used in hospitals for some of the larger operations. A patient may be kept under the influence of this an- ■esthetic long enough to remove one tooth, or to open a painful abscess, and no knowledge or sensation of pain will be experienced by the patient. Within a few —128— ■EXTRACTING TEETH AND ORAL SURGERY aninutes after the anesthetic is discontinued the pa- tient returns to a normal condition, and will be able to get up from the chair and return home, or go about Ihis business, without feeling any ill effects. The only people who will have any difficulty taking nitrous oxide are those who have recently indulged in a full meal or intoxicating liquor. No one should take ^ general anesthetic on a full stomach, because it will cause nausea. Nitrous oxide with oxygen is the safest general an- esthetic, and is not unpleasant to take. Many thou- sands of administrations of this anesthetic have been recorded and death has never resulted from its use. Some few deaths have been charged to nitrous oxide in former years where the gas has been used alone. But . impartial investigations have shown that these deaths were not due to nitrous oxide, but from fright affecting a diseased heart. The few deaths recorded would have happened with any anesthetic, or even v^ithout any. But where oxygen is given with the ni- trous oxide, there is no more danger than with a local anesthetic. Neither chloroform or ether should be used for an anesthetic in minor dental operations, except by the advice and aid of the family physician. SURCxERY OF THE MOUTH AND JAWS.— Many people still think only of the dentist as one who is able to relieve an aching tooth, or extract or fill teeth, and make artificial substitutes to replace the teeth that are lost. This may have been a good conception of den- —129— DENTAL PHYSIOLOGY AND ORAL HYGIENE tistry in the past, but is not of the dentistry of to-day. Dentistry has rapidly advanced along with the rest of the world, and has attained a high place as a healing art^ retaining, but improving the mere mechanical part of dentistry, and has become skilled in the therapeutical and surgical department of the profession. This has resulted in many of the diseases and accidents, for- merly treated by surgeons and physicians, being re- ferred to the dentist or oral surgeon, who makes a specialty of treating these diseases and accidents to the face and mouth. This is so well recognized that prac- titioners in medicine and surgery refer such cases to the dentist, or call him in to co-operate in the treat- ment of oral diseases, and especially in fractures of the jaw. The war in Europe has given the dentists of the world an opportunity to prove their worth as members of the healing art. Here most of the wounds re- ceived are of the head and face, and many of these are disfiguring, making the person repulsive to look upon. Dental surgeons have done much to relieve these suf- ferers, and by mechanical means, to replace lost teeth and bones of the face : and by plastic operations, to re- shape the disfigured features back into a semblance of human form. FRACTURES OF THE JAW.— The lower jaw, be- cause of its prominence, is often injured or frac- tured, because it is more frequently exposed to vio- lence than other parts of the face. The lower jaw is a piece of bone, bent at the chin, and at the angles of the jaw, and loosely attached to the base of the skulL —130— EXTRACTING TEETH AND ORAL SURGERY by ligaments. The tooth sockets make it rather frail in the most important part, and easily broken. When the jaw is fractured, the displacement of the parts is made worse by the action of the muscles which are at- tached to the jaw. Fractures of the lower jaw are usually between the cuspid and first bicuspid, the jaw being weakest here because of the long root of the cus- pid, or "stomach tooth." Such fractures may be on one or both sides of the jaw, although fractures occur at other parts of the jaw. The lower jaw is the most prominent of the bones of the face, and if not properly set, the deformity resulting is more noticeable than that of any other part, unless it is that of the nose. TREATMENT.— Treatment consists of caring for the tissues of the mouth and keeping them in clean condition, placing the broken parts together, and in the attachment of a suitable appliance to retain them in position until healing takes place, so that no de- formity may result. This retention may be done by means of wires to tie and hold the bones in position, or by the use of sutures which are absorbable, by metal plates, or by dental splints. The dental profession has devised many of the appliances which enable fractures of the jaw to be treated successfully. As soon as the jaw is fractured, treatment should be begun, as soon as professional help can be procured, for the earlier the parts are put together the lesser the chance for in- fection of the mouth tissues, or deformity of the jaw. In the European War, the method of trench war- --131— DENTAL PHYSIOLOGY AND ORAL HYGIENE fare exposes mostly the head and upper part of the' body, and wounds of the head and face are more usual than of other parts of the body. Here the general surgeon and the dental surgeon work together. Some years ago contract dental surgeons were appoint- ed to serve with the United States Army, and care for the soldiers' teeth, for it was recognized that the soldier must have a good masticating apparatus in order to keep in good fighting trim. Recently Con- gress has enacted new army dental legislation, doing away with the old contract system, and granting a commissioned standing to these dentists, with a cer- tain amount of promotion provided for. The number of dentists in the Army has also been increased in proportion to the increase in the Army. The American dentist has always stood at the head of his profession throughout the world, and the new army dental bill provisions will draw the best of the young dentists of the country into the dental corps, and provide a good dental service for our Army. The United States Government also provides for dental service to the men in the navy. This is anoth- er means of raising the efficiency of the navy to the highest standard in the world, by improving the health and physical comfort of the men. Thus our govern- ment recognizes that good teeth are requisite for the making of a good soldier or sailor. —132- ARTIFICIAL TEETH. CHAPTER X. When the natural teeth are lost, they should be re- placed by substitutes, to restore the jaws to their proper position, preserve the natural facial appear- ance, and restore speech and mastication. For the teeth are not only necessary to mastication and good appearance, but also to speech. When any of the teeth are missing, speech is more or less interfered with, and if all the teeth are gone it is impossible to articulate many words properly, and speech becomes badly impeded and distorted. Speakers and singers realize this more than any oth- er class of people. The food must be properly masticat- ed if it is to be digested properly, and if the teeth are out, this becomes impossible, and the general health suffers. The gastric juice cannot act properly on unchewed food, and the body, as a result, cannot receive all the nourishment which is in the food. Elderly people need all the nourishment they can obtain from their food, and these people usually are the ones who are without their natural teeth, although younger people are sometimes unfortunate enough to have all their teeth extracted, and to have plates made. Good —133— DENTAL PHYSIOLOGY AND ORAL HYGIENE liealth requires good digestion and assimilation of the food taken into the body. This is not possible without a good masticating apparatus. Modern dentistry is able to replace the natural teeth with artificial dentures, so good that the natural ap- pearance is restored to the features, and speech and mastication are made normal. Artificial plates are made to replace a few teeth that are missing, as, for instance, the four or six upper front teeth, oj to re- place the entire set of teeth in either one or both jaws. Plates are usually made of two parts — the teeth; which ara made of porcelain, and the plate, which may be mads of rubber or metal, to conform to the shape of the. gums and hard palate, and retain the ientures in place. Rub- b e r Tilate*^^ Figure XXXVI. An artificial upper denture. ^ ^ ^ more usually employed, because they are less expensive, and rubber makes a serviceable plate, which, with proper care, will last for years. Partial dentures are often made to replace a few teeth that are missing, especially the four or six up- per front teeth, and give good service, and restore the appearance anti the masticating surface. However, if the remainder of the teeth are sound, and the gums —134— ARTIFICIAL TEETH healthy, it may be better to use bridge work to re- place these teeth. A partial plate is apt to wear against the necks of the remaining teeth, and cause abrasion, and the gums will sometimes recede away from the teeth. This does not happen where bridge work is used. Be- sides the palate will not be covered over where bridge work is used. In the use of any plate in the upper jaw, the palate is covered by the plate, and food is not tasted so well as when the tongue is allowed ta come in contact with the rugae of the palate. A full upper denture is usually easier to fit than a partial denture. There are no teeth to trim around to make a fit, and the form of the upper gum ridge makes the task easier, because there are definite lines, to be followed in trimming down the plate. The rugae should be reproduced in the part of the^ plate that comes next to the tongue and aids in tast- i n g the food. Figure XXXVII. An Artificial Lower Denture. The loWCF teeth are som.etimes more difficult to replace, because the lower gum ridge is only a narrow band of tissue, and in some cases has been allowed to shrink away until there is very little tissue left to support the plate in position. —135— DENTAL PHYSIOLOGY AND ORAL HYGIENE Usually, however, a lower plate can be made to stay in, and if the gum has not shrunken too much there will be no trouble. Most plate failures are caused by the patient waiting too long before having the plate made. Many people will *'hang on" to a few old diseased snags or teeth, with pus around the roots, and wait until the teeth cannot be retained any longer. By this time the articulation has been disarranged and they have developed an abnormal bite. They cannot place the jaws together, in the same position, two times in succession. Then some others will have all the teeth removed, and wait six months or a year before they have their plates made. By this time the jaw, having nothing to support it, has become a little unhinged from its attachment to the upper jaw, and drops down and a little forward. This causes the lower ridge to advance in a line ahead of the ridge in the upper jaw, and throws the bite out of line. This can be avoided if the impressions are taken soon after the teeth are extracted, and temporary plates made. This protects the tender gums from in- jury, the alveolar process does not absorb so quickly, and there is not so much gum shrinkage. This gives more holding surface to retain the plate when the permanent set is made, six months or a year later. Then the jaws are left in a normal position by the temporary set of teeth, and the *'bite" or articulation is not disarranged. The pleasure of being able to eat and enjoy food during these months of waiting, together with the —136— ARTIFICIAL TEETH better appearance and ability to speak well, will more than pay for any little discomfort endured in get- ting used to a temporary set, and the extra expense it may cost. The same porcelain teeth used in the tempor- ary teeth may be detached and used in the permanent set of teeth. It is usually easier to make a complete set of teeth, a full upper and lower, than a partial set, or to make an artificial lower to fit against the natural up- per teeth, or vice versa. In making a complete set of upper and lower artifi- c i a 1 teeth, the teeth come match- ed, and fit one to the other set more per- fectly. COLORS OF THE TEETH.— Color plays a great part in making up a set of artificial teeth, and colors or shades should be selected that will harmonize with the physical appearance of the face, in order that the appearance may be made natural and harmonious with the general complexion. If the color is wrong, the artificial restoration can be detected at once. It" —137— Figure XXXVIII. Full upper and lower dentures. Gum section teeth are used, and reproduce tlie appearance of tlie natural gum. DENTAL PHYSIOLOGY AND ORAL HYGIENE would be foolish for a person sixty years of age to se- lect the milk white color of teeth like the child of =eight or nine years old. Middle aged people and even younger people complain of their natural teeth not being as white as they would like them. Our teeth wear and change as we grow older. Gray hair and wrinkles come with advancing age. Our teeth are subject to the same ageing process, and if the color of the teeth changes from the milk white color usual in childhood to the ''yellow tooth" of old age, it should be accepted as the mark left by advancing time. Neglect and abuse may discolor the natural teeth prematurely, but each decade in the life of the indi- vidual will show a slight change in the teeth, as well as of the general appearance. So when you • go to your dentist for your ''new teeth," let him select the color suitable to your age and complexion and your general appearance. Your dentist has made a study of tooth color, and will select a color more suitable than you are likely to do for yourself. If you should be unfortunate enough to impose your will on the dentist, and select a tooth color suit- able to the sixteen year old girl, do not go back and blame the dentist for the ghastly appearance of your teeth. Take a color natural to your age and appear- ance, and the result will be more harmonious. KINDS OF TEETH.— Teeth come in various molds or shapes to suit the various types of patients. The form and shape of the mouth, as well as the facial appearance, will determine the shape of tooth to use. —138— ARTIFICIAL TEETH The up-to-date dentist often uses a photograph of his patient to aid him in the selection of teeth which will harmonize with the appearance of his patient. The distance the jaws are apart, and their shape, aid the dentist in selecting teeth as to length, size, etc. Teeth are made in sets of fourteen upper and fourteen lower. The natural set has thirty-two teeth, but in a full set of artificial teeth only twenty-eight are used, four- teen in each plate. Some of the teeth are made sep- arate, fourteen separate teeth to the set, and are called plain plate teeth. Others are made in sections of two or three teeth to the section, and have a porcelain gum at the top to reproduce the natural appearance of the gums. The gum part of the section is colored to imi- tate the natural gums. Others are made in sec- tions without the artificial gum baked on. All these teeth have either pins attached or grooves cut in the teeth, to secure them to the plate which holds the denture in the mouth. PLATE MATERIALS.— Various materials are used to make the plates on which the teeth are set. . Rubber, being moderate in price and very serviceable, is much used, and is within the means of the average person. For those who demand the best service and materials,, some of the precious metals are used as a base. Gold, platinum and aluminum are the ones usually used, and give the best results. An impression is taken of the mouth, and a model is made, usually of metal, over which the gold or platinum is swaged into shape to fit the mouth; after which the teeth are fastened to —139— DENTAL PHYSIOLOGY AND ORAL HYGIENE the metal plate. Gold or aluminum may be melted and cast to the form of the plate desired. The metal plate is light in weight, and. has the added quality of being a conductor of heat and cold. Rubber is a non- conductor of heat and cold, and sometimes the tissues of the mouth become tender or swollen from contact with the rubber. However, few people are troubled in this way. The physical comfort of a plate made from gold or platinum is so much more pleasant than that of rubber, that one who has worn both kinds would never go back to the rubber plate. Platinum fuses at a very high temperature, and on this account it makes a very desirable base for a denture. The teeth are attached, and a porcelain gum fused direct- ly to the platinum plate, and the natural appearance of the gums restored. There are no joints left to be- come filled with odors, and on this account makes the most sanitary denture, as well as a beautiful work of restoration. This work, however, is very expensive, and within the reach of few people. CLEANING ARTIFICIAL TEETH. — Artificial teeth should be cared for and kept clean just the same as the natural set of teeth. Some people get the idea that their troubles are over when they get their ''store teeth". Such, however, is not the case, as many have learned by experience. Few things, man-made, are perfect, and artificial teeth lack some things of being perfect, and yet if carefully made they are ser- viceable and comfortable, and a boon to thousands who would be doomed to a ''toothless old age" with- —140— ARTIFICIAL TEETH out them. Any mechanical contrivance, to be useful and give a reasonable amount of service, must have care. An artificial denture is no exception to this Tule. Artificial dentures are constructed upon models tak- en from impressions of the mouth, and they are made to fit gums and hard palate perfectly. If anything happens to distort this fit the plate does not stay in the mouth perfectly. If the plate fits accurately it sticks firmly, and the wearer speaks, eats, and goes about his work without any difficulty. Take two pieces of glass, as an example, and wet i:hem with water, and press them tightly together. It ^11 be found that one adheres firmly to the other, and they are pulled apart with difficulty. If the plate is made to fit accurately it adheres to the gum and palate in the same way. The wet plate, coming in con- tact with the moist palate and gums, and being pressed lip close until all the air is expelled from between the tissues and plate, is held firmly in place. AS LONG AS THE PLATE IS CLEAN IT IS EASILY HELD IN PLACE. Going back to the experiment with the two flat pieces of glass. They are now taken apart, and a few grains of sand or dirt scattered over the surface. Now Iry to make them stick together. It will be found that they do not stick very well. So it is with the artificial plate. If berry seeds, bread crumbs, and other food particles, are allowed to encumber the plate, it will not fit and stick to the mouth as well as if clean. —141— DENTAL PHYSIOLOGY AND ORAL HYGIENE The plates should be brushed, and all stain and food removed from the surface of the teeth and plate. Regular plate brushes are made for this work, and it is easy to keep the plates clean and sweet if a little care is given them each day. After each meal the plates should be removed from the mouth, rinsed and well cleaned with water. Usually all that is needed is brush and water. A powder is not necessary. Sometimes a deposit, similar to tartar on the natural teeth, will collect on the ar- tificial teeth. This should be scraped off. If the plates become foul, they should be taken to the dentist, and have the de- posits removed and the dentures cleaned and polished. Artificial teeth do not give the wearer a foul breath unless food is left on the plates to decay and become foul, and they do not destroy the sense of taste. If the plate is ever broken it can usually be quickly repaired. If a small break or crack is made by accidentally dropping Figure XXXIX. the plate, which sometimes happens, it A plate i)ru.sh. gj^Q^j^ ^^ repaired before the break be- Artificial den- tures should be comes larger and perhaps beyond re- kept clean. pair. Many people have two sets of —142— ARTIFICIAL TEETH teeth made. If one set is broken, the extra set is always ready for use. Busy people or travelers find this extra set of teeth a good investment. In conclusion, remember that the comfort and usefulness of your artificial dentures depend much upon keeping them clean. It is just as reasonable to expect a foul plate to be serviceable and comfortable, as it is to expect a pair of shoes to be comfortable when they contain a few grains of sand to tickle the feet -143- DISEASES OF THE MOUTH, AND FIRST AID REMEDIES, CHAPTER XL Bacteria are present in all mouths ; even in the- best cared for mouths conditions are favorable for their growth. The mouth, being a warm, moist place,, is a natural incubator. If bacteria grow in cleart mouths, they will surely thrive in unclean mouths, where food debris, decay, pus, and other conditions are so favorable for their development. Children with unclean mouths are more subject to infections, such as diphtheria, scarlet fever, and other diseases incident to childhood. Children with clean mouths have a much better chance of escaping these diseases than children with unclean mouths. The cleaner the mouth the less i& the danger of disease. There are many diseases and conditions that affect the human mouth, but in a short work of this kind all of them cannot be men- tioned. Toothache and a few diseases will be men- tioned, and advice given on some home remedies. TOOTHACHE. — This is one of the common sources of pain, as many of us have found from experience. People often have an attack of toothache when it is not possible to visit the dentist, and resort to home reme- —144— DISEASES OF THE MOUTH, AND FIRST AID REMEDIES dies is the only chance for relief . Often ''carbolic acid", liniments, etc., are resorted to for relief. These reme- dies might be all right if they were applied in the right spot. Unfortunately they are not usually put where they will do the most good, but are smeared aroun-d the tooth and on the gum, and as a conse- quence, when the patient seeks professional aid, the tissues of the mouth are blistered and burned, and the mouth is so inflamed that very little can be done for permanent relief until the burns heal. ''Carbolic acid" and liniments, as usually applied by the home remedy friend, are about as effective for re- lieving toothache as grease smeared on the spokes of a squeaky wheel. When the teamster or the automo- bilist discovers a squeaky wheel, he takes it off and applies the grease on the spindle and inside the hub, where the friction is, and the bearings then cease their squeaking. So it is with the toothache, the remedy must be applied at the seat of pain. To do this, locate the decayed cavity, and with a tooth-pick or small darning needle, pick out all the food debris which clogs up the hole, and wash the cavity out with warm water. If the tooth has a live pulp, the ache can us- ually be relieved by the application of oil of cloves. Take a tooth-pick or small piece of soft wood with a small pointed end, and a small pledget of cotton satur- ated with the oil, and apply the cotton directly into the cavity of the tooth, using the wooden pick to place the cotton in position. If the cavity has been cleaned out well, so food does not press against the live nerve, —145— DENTAL PHYSIOLOGY AND ORAL HYGIENE the ache should be relieved within a few minutes. If oil of cloves cannot be secured, use some chloroform or camphor, and apply it in the same way. Over this pellet of cotton containing the medicine, insert another dry pellet of cotton, to help confine the medicine in the cavity and protect the pulp from sud- den changes of temperature or pressure from food when eating. The above directions are for aching teeth with live pulps. Phenol (carbolic acid) is some- times used ; it is dangerous, and the best advice is not to use it. If an acid is used care must be taken to ap- ply the cotton containing it in such a way that none escapes from the cavity to the mouth. If it does, a burn will result. Alcohol or whiskey is an antidote for "carbolic acid" burn, and if the mouth is burned, apply the alcohol to the place that the acid touches. This must be done quickly, for acid burns quickly. To find out whether a tooth has a live or a dead pulp, take some very cold water in the mouth, and bring it into contact with the aching tooth. If the pulp is alive, the pain will become greater. Apply warm water to the tooth and the pain will quiet down. Another way to find out whether the pulp is alive, is to gently press a tooth-pick or needle against the cavity. If the pain is increased, the pulp will be found to be alive. In teeth with live pulps any sweet substance in the cavity will cause the tooth to ache. TEETH WITH DEAD PULPS.— Teeth with dead pulps are sore to the touch, and feel longer than the rest of the teeth, so that when the mouth is closed the —146— DISEASES OF THE MOITTH, AND FIRST AID REMEDIES sore tooth is struck first, and pain results. When the pulp dies putrefaction takes place, and a gas is formed, which, confined within the pulp chamber of the tooth, tries to find some way of escape. This it usually does from the end of the root. The effect of this gas pressing upon the delicate tissues around the tooth, is to inflame them, and they get sore, swell up, and an abscess or "gum-boil" forms, which is very painful as well as dangerous. Another way teeth with dead pulps may be dis- covered, is by their discolored appearance and foul odor. The treatment for these teeth is to clean out the cavity, and with a large needle or a small sharp pointed instrument, puncture a hole into the pulp chamber. The gas will then escape from the tooth and relieve the pressure within. However, these cases progress so far sometimes that the effects of the in- fection cannot be checked, and the abscess gets worse. The gum around the tooth swells up and is very pain- ful. Within a few days pus will form, and the ab- scess should be lanced, or the ''gum.-boir' may break out on the outside of the gum, and the pain subsides. Sometimes, when these abscesses begin, the dentist can check them, and sometimes he will not be able to do so. A hot water bottle held to the cheek will often give temporary relief, or the water may be ice cold. Sometimes alternating between hot and cold applica- tions will give temporary relief. Care must be taken when these abscesses have swollen out the cheek, in applying heat to the outside of the face, because the —147— DENTAL PHYSIOLOGY AND ORAL HYGIENE abscess may be drawn out and break outside, and leave an ugly scar. If unable to reach a dentist at once, apply a mixture of iodine, or better still, of aconite and iodine, over the gums. Pull back the lip and dry the gum with a piece of cotton, and then apply the remedy with a small camel's hair brush, or a piece of cotton wound on the end of a tooth-pick or stick. Allow the aconite and iodine to dry before releasing the lip. Treating an abscess at home is one of the most unsatisfactory home treatments. The abscess should receive treat- ment at the hands of one who has the proper instru- ments to reach the seat of trouble, which is usually far up in the gum out of reach of ordinary remedies. Sometimes people endure these abscesses until they swell, and the pus breaks out of its own accord, and the patient thinks it is all right. Right here is where the dangerous stage is reached. The abscess is easy, but there is a constant discharge of pus, car- rying infection to the throat. The food is mixed with the pus, and carries infection to the stomach and bowels, and often to the appendix. Many cases of ap- pendicitis, or cases of eye or ear trouble, or of rheuma- tism, may be traced to abscesses in the mouth. Delay in treating these conditions is dangerous. The sooner they are attended to the better it is for the health of the individual. Where the tooth has formerly been treated and the root canal filled, and an abscess forms, it is difficult to cure. Usually it is necessary to extract such a tooth, but an effort should be made to save it. —148— DISEASES OF THE MOUTH, AND FIRST AID REMEDIES CANKER SORES.— This affection is a common one, and is usually referred to as canker sore mouth. Children with catarrhal stomatitis frequently have little sores in the mouth during or after dentition. The most common is the single sore in the mouth of the adult. These sores usually come where two mu- cous membranes meet, as the gums with the lips or cheek, or the tongue or the gum with the floor of the mouth. The local pain is annoying. There is a little swelling and redness around the sore spot, which is somewhat hardened. This place breaks down, and a raw surface is formed with a yellowish white coating. These sores are then very painful. In children these ulcerations are treat- ed by giving a laxative. As a mouth wash, a solution of potassium chlorate may be used. In treating canker sore in adults, calomel should be given at night, fol- lowed in the morning by a saline laxative. If one does not like calomel, some other cathartic may be substi- tuted for the calomel. The local sore should be dried and pure ''carbolic acid" applied to the sore and the reddened area just around it. After a moment the acid will have cauterized the sore, and pure alcohol should be applied, the dead flesh cleaned away, and a little iodine applied. Healing should take place within a few days, and the pain should be relieved within a few minutes after cauter- izing. The administration of milk of magnesia will often help the gastric conditions unless of long stand- ing. The eating habits should be regulated, care be- —149— DENTAL PHYSIOLOGY AND ORAL HYGIENE ing taken not to eat foods which cause digestive dis- turbances. NEURALGIA. — Pain referred to some other part of the body other than its origin is characteristic of dis- eases of the pulp. This is more true of chronic diseases of the teeth than those that are acute or just beginning. In people subject to neuralgia, any chronic disease of the teeth may cause pain in other parts of the body or head. Due to some systemic condition, pulp nodules may form in teeth that are apparently sound, and cause reflex pains in some other part of the body. There may be no definite location of pain in these cases, but tenderness of the eye when pressed against, pain in the temple, or ears, or other parts of the head, and pain even as far as the shoulder. # When teeth have decay, all cavities should be filled, teeth treated where needed, and all diseased roots ex- tracted. Where root canals are filled, they should be X-Rayed to find out if the canals are properly filled. Many of these cases of neuralgia are treated by the family physician for temporary relief from pain, but the patient should have the source of trouble corrected. Often the X-Ray will reveal conditions in obscure cases of neuralgia, which, if taken as soon as neuralgia begins, will enable the physician or dentist to locate tne cause and apply a remedy. Crowded teeth sometimes cause neuralgia pains. The lower third molars are the teeth which more often cause trouble, because of the close relation of theii: roots to the inferior dental nerve. —150— DISEASES OF THE MOUTH, AND FIRST AID REMEDIES Third molars are often impacted, that is, the crowns grow forward toward the back part of the tooth just in front, preventing full eruption, which jams the The Cranial Nerves. 5^> Nervc-Trigeminus iotter.del Figure XL. Showing" connection of nerves of teeth to other nerves of head and face. Permission of P. Blakiston's Son & Co., Philadelphia. tooth, between the tissues and the tooth in front, —151— DENTAL PHYSIOLOGY AND ORAL HYGIENE causing a painful condition, and sometimes a swelling or abscess and a ''stiff jaw." In impacted third molars, or those whose eruption is slow or delayed, the crowded condition may cause reflected pain to any organ of the head, because the nerves which supply the ear, eyes, teeth and face, are mter-related to each other, and pain in one set of nerves may be reflected to another set, and cause pain some distance from the source of trouble. Disease in some other part of the body may cause neuralgia pains in sound teeth or the tissues surrounding the teeth. Chronic malaria, syphilis, diseases of the ear, or dis- orders of the lower bowels, causing constipation, may cause neuralgia pains in the teeth. Another cause of pain in the teeth is pregnancy, and is very common even when no trace of dental disease can be found. HARELIP AND CLEFT PALATE.— Cleft palate may be either congenital or acquired. When a child is born with a cleft in the palate, there is usually also a cleft lip which is called harelip. Thanks to surgery, most, if not all these early clefts may be closed by an operation. This can be done the first twenty-four hours after birth, and if done at this time the defect is soon healed, and the functional results are better. The infant is able to take nourishment better, and much heartache and embarrassment saved the par- ents by early operation and cure. If left until a later age, or until the child learns to speak, the defects of faulty speech are hard to correct. If there has beea —152— DISEASES OF THE MOUTH, AND FIRST AID REMEDIES no operation to close the cleft in infancy, the person so deformed will be unable to articulate words prop- erly, becaus-e of the defective palate. Thus they are deprived of distinct speech, and do not properly per- form the work of mastication and the swallowing of food. An operation in adult life seldom fully restores speech, although, if the defect be not too great, an op- eration will often do much good. Dentists have de- vised an appliance to close these openings and re- store speech and function of the parts. This is done by means of an artificial plate, with attachments to replace the lost parts of the hard palate or soft palate. These appliances are called obturators. If the hard palate only is perforated, it is a very easy matter to close the cleft by means of an artificial plate to cover up the opening, preventing communica- tion between the mouth and nose. Where the hard and soft palate are both involved, the construction is very difficult. In such cases an ar- tificial soft palate also has to be constructed and at- tached to the plate to restore the lost part. After the ''cleft palate speech" has been developed, it is neces- sary to teach the patient to use proper speech. This takes time and patience, both on the part of the dentist and the patient. Sometimes the hard palate is perforated by disease. These perforations are nearly always the result of syphilis. They may be all the way from a single hole through the hard palate, the size of a pea, to the loss of —153— DENTAL PHYSIOLOGY AND ORAL HYGIENE most of the palate process and the surrounding tis- sues. The first care should be thorough constitution- al treatment, to prevent further destruction of tissue, and prevent the patient from carrying infection to other people. This is the physician's work. Perforation of the hard palate may be remedied by the use of a plate to cover up the opening and prevent communication between the mouth and nose. This will restore the speech, and the food can be mas- ticated properly and swallowing not interfered with. PYORRHEA. — Pyorrhea will probably never de- velop in the mouth if all the tooth surfaces have always been kept clean. When teeth are allowed to become covered with deposits, the gums are irritated from contact with the deposits, and fall an easy prey to the invasion of infection, which soon causes a flow of pus from around the teeth. Pyorrhea is then made possible by injury to the gums, and infection gets an entrance to the tissues around the teeth. The first condition usually noted by patients is a softening of the gums, and they complain of the gums bleeding when the teeth are brushed. These deposits usually form around the necks of the teeth, just at the gum margin, and if left, gradually push back the gum from the roots of the teeth, as the deposits become heavier, for these deposits have a tendency to increase in the direction of the roots. No systemic treatment alone is able to arrest this process. Removal of the deposits and prophylactic treatment to prevent recurrence of the condition usu- —154— DISEASES OF THE MOUTH, AND FIRST AID REMEDIES ally give good results. Emetine Hydrochloride is often used in the treatment of pyorrhea. In connection with the mechanical removal of the deposits and prophylactic measures, there may be remedies given to build up the general health, if this be run down. Medicine alone will not cure pyorrhea, and to secure good results the mouth must be kept clean. If deposits are allowed to accumulate again, the disease will return. If disease has progressed so far that the teeth are loose, and the alveolar process eaten away, the best thing to do is to extract the teeth. If pyorrhea con- tinues long, there will be infection carried to some other organ of the body. Surgeons find that most of their gall-stone patients have pyorrhea. Pyorrhea can be cured if treatment is begun in time, and when cured it takes constant care to prevent its return. Daily massaging of the gums with a brush, with the use of a good tooth powder, will keep the gums firm and the teeth free from deposits. -155— SOME INFORMATION ABOUT DENTISTRY. CHAPTER XII. The people of a country constitute society. Laws are made to govern conduct in social and business affairs, so that people may live in peace, follow their occupations, and justice be done to the individual. Bankers and business men form associations and make rules for the conduct of their business. Laboring men form unions, in order to secure a just compen- sation for their work, and to better their living -con- ditions. Thus the banker has a legal rate of interest on loans, above which he does not go, while the loan shark fleeces his victims, and is therefore held in bad repute. The business man recognizes that when he makes a sale the purchaser has certain rights, and is entitled to receive a fair value in merchandise in re- turn for his money. Thus both purchaser and mer- chant are benefited by the trade. The union man looks with disfavor upon the ''scab'', because he takes an unfair advantage of the union man in labor dis- putes. The dentist, like the rest of his fellow men, has his societies, where he meets with his brother dentists to discuss dental problems and improve himself in a —156— SOME INFORMATION ABOUT DENTISTRY. professional way. In any profession, trade or calling^ there will be found men who abuse the privileges given them. Dentistry is not exempt from this rule, and deception and ignorance may impose upon the layman who is not well informed. Dental societies make rules to govern the conduct of their members toward each other, and the conduct of dentists toward their patients. One of the principal rules is in regard to advertising. ADVERTISING. — Reputable dentists class the "advertising quack" with the loan shark, the cut-rate man, and the *'scab". Bankers, business men, and the public, sometimes have difficulty in understanding why a reputable dentist, or a physician, considers it wrong to advertise. The banker and business man prospers by advertising. Why not the professional man ? The professional man may and does profit by adver- tising, but it must be legitimate advertising. To bet- ter understand what is legitimate advertising, and what is not, let us quote four rules from the code of ethics which govern the practice of reputable dentists. Code of Ethics. As unanimously adopted by the Illinois State Dental Society, 1909. From the Dental Review, 1909. ''Section I. In his dealings with patients and with the profession, the conduct of the dentist should be in accordance with the Golden Rule, both in its letter and its spirit. Section II. It is unprofessional for a dentist to ad- —157— DENTAL PHYSIOLOGY AND ORAL HYGIENE vertise by hand bills, posters, circulars, cards, signs, or in newspapers, or in other publications, calling at- tention to special methods of practice, or claiming excellence over other practitioners, or to use display advertisements of any kind. This does not exclude a practitioner from using professional cards of a suitable size, with name, titles, address and telephone number, printed in modest type, nor having the same Mnd of a card in a newspaper. Neither does it pre- vent a practitioner, who confines himself to a special- ty, from merely announcing his specialty on his pro- fessional card. Section III. It is unprofessional for dentists to pay or accept commissions on fees for professional services, or on prescriptions or other articles supplied to patients by pharmacists or others. Section IV. One dentist should not disparage the services of another to a patient. Criticism of work v^hich is apparently defective may be unjust, through a lack of knowledge of the conditions under which the work was performed. The duty of the dentist is to remedy any defect without comment." The dentist who conscientiously follows this code cannot go far wrong, and if he makes mistakes he will profit by them, and not make the same mistake a second time. The patients of such a dentist are given good service and fair treatment. He will not need to advertise, for his patients will be his best advertisement, and success will come through their friendship. —158— SOME INFORMATION ABOUT DENTISTRY. On the other hand, there is a class of dentists who seek to draw their patients by "boasting" superiority and ''catch bait bargain prices." Many of you are familiar with the gaudy signs and alluring adver- tisements of these quacks, for they cannot be called by any other name. Often the owners of these of-^ fices, or dental parlors, are not dentists themselves, but use the office solely as a commercial venture, and employ students or recent graduates to do the work. These are usually without ready money, or are in debt. Some of them drift into the advertising par- lors in order to earn some ready money, and to get some experience. They see quick work in the dental parlors, and become speedy workmen themselves.. They advertise low prices, and have to work quickly, for time is money. Let us note some of their advertisements. Gold crowns, $3.00; Cleaning teeth, 50 cents; Silver fill- ings, 50 cents; Plates $5.00. These are only a few of the ''catch bait" advertisements. CROWNS FOR $3.00.~How can a reputable dentist make a crown for $3.00? The time taken for a proper preparation of the root for the crown is worth that much, aside from the material used, and the extra time to make and fit the crown. The quack makes up for this by rapid work, and bj^ the use of cheaper material. As a consequence, the crown does not fit properly. Often the gold band is crowded up under the gum so far that soreness re- sults. In a few years the tooth is lost because of pyorrhea, which develops because of the injury done —159— DENTAL PHYSIOLOGY AND ORAL HYGIENE \ to the gums, and because the crown collects filth j around the tooth. ; TEETH CLEANED FOR FIFTY CENTS.— No dentist can, on the average, clean a set of teeth in less ] than an hour. When the deposits are very bad, it may j take two or three hours, or several trips, to have the ■ work done properly. No dentist can work for fifty cents an hour and exist. i How can the quack clean teeth for fifty cents? By the use of strong acids and bleaches the work of hours may be done in a few minutes. These acids and i bleaches also destroy the teeth, and do more damage j than good. The teeth may look nice for a short time, j but they will soon show the effects of acid and bleach, i turn yellow, and the destruction wrought is greater ! i than that which years of wear will cause. ■ SILVER FILLINGS FOR FIFTY CENTS.— Can a \ reputable dentist fill teeth for fifty cents, and do i justice to himself and his patient? He can not. The ^ conscientious dentist will cut out the decay, trim the ; cavity so that when the filling is in place it will be ; cleaned by the act of chewing food. He will protect ; the tender tooth by insulating material, so that the tooth will not have a mass of metal close to the pulp or ''nerve" to cause it to ache. A tooth filled in this ] manner will be comfortable and endure. This work ! takes time; but the reputable dentist will not charge any more for this filling than the quack who bores ; three or four little holes in the tooth, and charges for that many fillings at fifty cents per filling. The first j —160— i SOME INFORMATION ABOUT DENTISTRY. class work will endure, while the other kind will al- low decay to come, and the tooth soon needs a new filling. Poor work will have to be done over again, and is dear at any price. PLATES FOR FIVE DOLLARS.— With the usual care the expert dentist will need a day or two to make a set of artificial teeth. He cannot devote this much time to the work and make teeth for $5.00 per "plate." Work and good material cost more than that. The work requires time to select teeth that will have a natural appearance. It requires skill in order to se- cure an accurate fit. The result must be such that the wearer will be able to masticate his food and speak distinctly. All this time and skill costs money. Dental plates are made over models, from impres- sions of the mouth. They may be made of wax, plaster of paris, or modeling compound. The wax impressions are easily and quickly taken, but they are not accurate. Those of modeling compound and plaster of paris are hard to make, but they are accurate. The man who makes plates for $5.00 will use the quick, cheap way, but the results will not be satisfactory. The material used will be inferior. Our clothing may be of a fine grade, or it may be of shoddy material. This is true of the porcelain used in making the artificial teeth. There are two classes of porcelain, a high grade and a low grade. The better grade fuses or melts at a high heat. It is dense and not easily broken, and has a vital or lifelike appearance. The low grade is less dense and breaks —161— DENTAL PHYSIOLOGY AND ORAL HYGIENE easily. It is dull and lifeless in appearance. The reason that the quack works for such low prices is because he employs poor workmanship and uses poor materials. The quack works a few hours where the careful dentist works days. Teeth are not luxuries. They are necessities. It is therefore poor policy to buy an inferior article for the sake of saving a few dollars. The saving is not real, for the poor teeth are worthless in every respect. The greatest sufferers are the poorer people, and the people of only moderate means. Many of these are at- tracted by the cheap prices and promises of quick work. The poor deserve our sympathy. However, the poor man has no reason for resorting to the quack. Any good dentist expects to do some charity work, and some work for much less than his usual fee, for those who cannot afford to pay the regular prices. In many places free dental clinics are estab- lished for those who are unable to pay. Here he may receive careful work and treatment on the same basis that he would receive medical or surgical care from our medical brethren. To those who have the means to paj^ for good dental service, experience should teach them that anything abnormally cheap will be worthless. For these there is no excuse. For poverty and ignorance there may be an excuse, but there is none for greed. FEES. — Conditions which regulate the cost of living in a community will have their effect on the cost of dental services. It is generally conceded that —162— SOME INFORMATION ABOUT DENTISTRY. a professional man is entitled to fees which will en- able him to live in comfort, and lay up a com^petency against the day that he will be unable to work, the proverbial "'rainy day." His income should be suffi- cient to permit him to live on an equality with those he serves, and with the people with whom he asso- ciates. If prices are so low that a dentist can barely make a living he has to overwork to make ends meet. Worry over the grocer's bill, the meat bill, and a hundred other little worries, impair the health and the efficiency of the dentist, and lowers the grade of service to his patients. Thus they all suffer. On the other hand, the dentist who charges enough for his services to enable him to live in comfort, meet his expenses, and lay up something for the "rainy day", will be free from these petty worries. He can devote all his energies to the service of his patients, and they will receive a higher grade of ser- vice. The relations between such a dentist and his patients are congenial. He establishes a family prac- tice, patients who return to him year after year. These patients may pay a little more perhaps than the cheap advertisers would charge them, but they willingly pay it, for they know that the service they receive will be the best their dentist can give, re- gardless of any remuneration they may paj^ him. I have endeavored, in this chapter, to tell of the delusion of cheap prices, and the harm one may suffer from cheap dentistry. Prices should not be exorbi- tant; neither should they be so low that the dentist —163— DENTAL PHYSIOLOGY AND ORAL HYGIENE cannot make a decent living. For then the quahty of the service will be lowered, and the patient will be the principal one to suffer. The health of the body depends to a great extent on the health of the mouth. The best dental service should be employed in order to maintain good health. It has been said, "There is nothing new under the sun." This is especially true of the information contained within this little book, most of which has been written many times, and is known to all well informed dentists, but not so well to the laity. There- fore the author does not claim any originalitj^ except perhaps, in the form this information is presented to the reader. —164— GLOSSARY Abscess. A localized collec- tion of pus. Adenoid. 1. Resembling a gland. 2. In the plural, hy- pertrophy of the adenoid tissue that normally exists in the naso-pharynx of children and is known as pharyngeal, tonsils. Adenoid- Vegetation. Fungus like growths of lymphoid tissue in the nasal pharynx. Aluminum. A white metal with a bluish tinge resem- bling silver but inferior to it. Alveolar-Abscess. Pertaining to an inflammation of the alveolar-process. Alveolar-Process. Pertaining to the process which sup- ports the teeth. Anemia. A condition in which blood is deficient, either in quantity or quality. Anesthetic. A drug that pro- duces a condition without the sense of touch or pain. Anesthetize. To render in- sensible. Appendicitis. Inflamation of the appendix vermiformis. Areolar. Containing minute interspaces or lacunae. Bacteria. Disease germs. Microscopic vegetable or- ganisms. Bite. The position of the teeth or jaws when the mouth is closed. Refers to the articulation of the teeth. Bolus. A ball of food ready to swallow. Canker. Ulceration of the mouth or lips. Carbohydrates. A compound made up of carbon in groups of six atoms and of hydrogen and oxygen in the proportion to form water. Catarrh. Inflamation of a mucous membrane with a free discharge. Catarrhal Stomatis. Simple and uncomplicated inflam- mation and redness of the mouth. Cathartic. Purgative. Cauterize. To burn or sear with caustics or a hot iron. Cementum. The layer or bony tissue covering the root of a tooth. Cleft Palate. A palate hav- ing a congenital fissure in the median line. Cocaine. A crystalline alka- loid used as a local anes- thetic. Congenital. Existing at or before birth. Corium. The true skin, or dermis; the vascular layer beneath the epidermis. Crown. The portion of the tooth above the gum. Chystic-Duct. The excretory duct of the gall bladder. Debris. Rubbish. (Fragments of food.) Decay. The gradual decom- position of dead organic matter. Dentine. The chief substance or tissue of the tooth which surrounds the tooth pulp. —165— GLOSSARY Dentition. The cutting of the teeth. Devitalizing;-. Depriving of vi- tality or of life. Emetine. A white, powdery alkaloid, made from ipecac. Emetine Hydrochloride. A salt of emetine employed in - medicine. Enamel. The white compact, hard substance that covers the crown of the tooth. Ethics. Relating to rules of professional conduct. Ethyl Chloride. A colorless liquid used as a local anesthetic and stimulant. Eiactachian Tube. The pas- sage from the nasal pharynx to the tympanum. The mid- dle ear cavity. Fauces. Tlie passage from the mouth to the pharynx. Fermentation. The chemical change induced by a fer- ment. Fissure. Any cleft or groove, normal or other. Frenulum. Is a fold of the mucous membrane that lim- its tlie movement of an or- gan in part. Gall-stone. A calculus from the gall-bladder, or one of its afferent ducts. Gastro-Intestinal. Pertaining to the stomach and intes- tines. Germicide. An agent that destroys germs. Hy;;5ien.e. Relating to the health or the mode of pre- serving the health. Inert. Inactive. Infection. The implantation of disease from witliout. Infectious. Easily spread from person to person. —166 Inflammation. A redness and swelling of any part of an animal body. Integument. The covering of the bod^^ Kaolin. A fine variety of clay used in making porce- lain teeth. Layman. Not belonging to, or emanating from, a par- ticular profession. Lymph. A t r a n s p a r e nt, slightly yellow liquid of alkaline reaction which fills • lymphatic vessels. Malaria. A febrile disease caused by a blood parasite. Malleable. Capable of being- shaped or beaten. Massage. A systematic ther- apeutic friction, stroking, and kneading of the body. Mastication. A chewing of food. Metabolism. The process by which living cells or organ- isms incorporate the matter obtained from food into a part of their own bodies. Mucus. The viscid, watery secretion of the mucous glands. It is con.posed of water, mucin, inorganic salts, epithelial cells, leu- cocjdes and granular mat- ter. Mucous. Pertaining to or re- sembling mucus. Naris. A nostril (pi. nares). Uecrc-i".. A molecular death of t'ssue. Neural jia. Pain in a nerve or radiating along the cburse of a nerve, of a severe darting character. Ni-jht terrors. Night frights. Nitrogenous. Containing ni- trogen. Nitrous Oxide. A non-as- phyxial anesthetic agent. GLOSSARY Node. A swelling or pro- tuberance. Nodules. A small boss or node. Novocaine. A local anesthe- tic. Oral Hygiene. Pertaining to the health of the mouth. Organism. Any individual plant or animal. Orthodontia. The correction of dental irregularities. Oxygen. A gaseous element existing free in the air. Papilla. Any small nipple- shaped elevation. Pathological. Pertaining to the causes and symptoms of diseases. Peridental. Situated or oc- curring around a tooth. Pericementum. The me m- brane or tissue which oc- cupys the space between the root of a tooth, and the alveolus of the jaw. Platinum, A metal resem- bling silver, very ductile and malleable, and fuses only at a very high tem- perature. Porcelain. A composition of feldsnar, silica, kaolin. Prophylactic. A remedy to ward off disease. Pulp. The soft vascular tis- sue occupying the center of the tooth. Pus. A liquid inflammation. The matter of a sore. Putrofacticn. The decompo- sition of vegetable and ani- mal matter. Pyorrhea. A discharge of pus, with progressive nec- rosis of the aveoli and loose- ness of the teeth. Quack. An ignorant or fraudulent empiric. Remuneration. Compensation given for services. Rheumatism. An inflamma- tion of the connective-tissue structures of the body. Rickets. A disease of child- hood in which the bones be- come soft and flexible. Ruga. A ridge, wrinkle, or fold. Saline Laxative. A laxative of salts. Sanitary. Promoting or per- taining to the health. Scab. A non-union worker. Sepsis. Poisoning by the pro- ducts of putrefactive pro- cess. Synthetic. Artificial. Syphilis. A contagious and hereditary venereal disease. Tartar. The incrustations formed on neglected teeth. Taut. Tight. Not slack. Tonsils. A small mass be- tween the pillars of the fauces on either side. Ulceration. The formation of an open sore other than a wound. Vitally. That which is essen- tial to life. Vitamines. Substances exist- ing in foods which are necessary to proper meta- bolism, and absence of which produce deficiency, diseases such as beriberi. ^167- COLUMBIA UNIVERSITY LIBRARIES This book is due on the date indicated below, or at the expiration of a definite period after the date of borrowing, as provided by the rules of the Library or by special ar- rangement with the Librarian in charge. DATE BORROWED DATE DUE DATE BORROWED DATE DUE X^i»' ^,jXH "^ ?. .: M V -;, !■'■ ,i n ' C28(1 140)M100 H55 1 COLUMBIA UNIVERSITY LIBRARIES (hsl,stx) RK 61 H55 C.1 Dental physiology and oral hygiene 2002337584 W^y.