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NATURAL HISTORY 
 
 AND 
 
 DISEASES 
 
 OF THE 
 
 HUMAN TEETH. 
 
J)r. Q. Evans, 
 55 We#t H'Mh 8L 
 the j$ ew York. 
 
 NATURAL HISTORY 
 
 AND 
 
 DISEASES 
 
 OF 
 
 THE HUMAN TEETH, 
 
 BY 
 
 JOSEPH FOX, M. R. C. S. L,, 
 
 MEMBER OF THE SOCIETY OF MEDICINE, PARIS; LECTURER ON THE STRUCTURE AND DISEASES OF THE TEETH, 
 
 AT guy's hospital; AND SURGEON DENTIST TO THEIR ROYAL HIGHNESSES 
 
 THE DUKES OF KENT AND SUSSEX. 
 
 FIRST AMERICAN FROM THE THIRD LONDON EDITION. 
 
 REMODELED, WITH AN INTRODUCTION AND NUMEROUS ADDITIONS, BY 
 
 CHAPIN A. HARRIS, M.D., D.D.S., 
 
 PROFESSOR OF PRACTICAL DENTISTRY AND DENTAL PATHOLOGY IN THE BALTIMORE COLLEGE OF DENTAL 
 
 SURGERY ; FELLOW OF THE AMERICAN SOCIETY OF DENTAL SURGEONS ; MEMBER OF THE 
 
 MEDICO-CHIRURG1CAL FACULTY OF MARYLAND ; AUTHOR OF PRINCIPLES 
 
 AND PRACTICE OF DENTAL SURGERY, ETC. ETC. 
 
 ILLUSTRATED WITH THIRTY PLATES. 
 
 PHILADELPHIA: 
 ED. BARRING TON AND GEO. D. HAS WELL. 
 
 1846. 
 
iCAl COLLECTION 
 
 C 1 
 
 Entered according to act of Congress, in the year one thousand eight hundred and forty-six, 
 
 By Ed. Barrington and Geo. D. Haswell, 
 
 In the Clerk's Office of the District Court of the Eastern District of Pennsylvania. 
 
 .I011N D. TOY, PRINTER. 
 
TO 
 
 HENRY CLINE, Esq. 
 
 lecturer on anatomy, and surgeon of st. thomas' hospital. 
 
 Dear Sir: 
 
 The numerous and continued marks of friendship 
 and attention which I have received from you, demand 
 my most grateful acknowledgments. 
 
 When at a very early age I was deprived of my father, 
 you kindly stepped forward with your advice, and, by 
 your countenance, and the sanction of your name, trans- 
 ferred to me the confidence of his friends, and secured 
 the continuance of a respectable practice. 
 
 To the knowledge I obtained from you when your 
 pupil, and the opportunities of information I have since 
 derived from the easy access with which you have always 
 favoured me, I attribute, in a very considerable degree, 
 the success which has attended my practice in that 
 particular branch of the profession to which I have 
 applied. 
 2 
 
VI DEDICATION. 
 
 Your having been pleased to speak favourably respect- 
 ing the utility of the present Work, is a great encourage- 
 ment to me in submitting it to the Public; and, in 
 permitting me to inscribe it to you, I feel another flattering 
 mark of attention conferred on. 
 
 Dear Sir, 
 
 Your faithful and obedient servant, 
 
 Joseph Fox. 
 
 No. 54 Lombard Street, 
 April 20, 1803. 
 
PRE FAC E 
 
 TO THE AMERICAN EDITION 
 
 The first complete edition of this Work was published 
 in 1806; and, notwithstanding the rapid progress which 
 Dental Surgery has made subsequently to that period, it 
 still occupies a high place in the literature of this depart- 
 ment of medicine. It has been more extensively quoted 
 than any other Treatise upon the same subject, and has 
 passed through three editions in England. The last of 
 which was published in 1833. There is still, both in 
 Europe and America, a steady demand for it. 
 
 The Author, during his professional career, enjoyed a 
 high reputation as a practitioner of Dental Surgery; and 
 for many years previously to his death was a lecturer on 
 this branch of medicine in Guy's Hospital. Although he 
 has passed from among the living, he has left behind him 
 a memorial which will perpetuate his name to the latest 
 period of time. Wherever, and so long, as this branch 
 of Surgery shall be practiced by educated men, will the 
 name of Fox be held in grateful remembrance. 
 
 In preparing the work for republication in this country, 
 the editor has found it necessary to make numerous and 
 
Vlii PREFACE TO THE AMERICAN EDITION. 
 
 extensive additions, in order to adapt it to the present 
 state of dental practice. These are designated [by brack- 
 ets,] and are about equal to three-fourths of the original 
 text. He has also added seven plates, remodeled the 
 arrangement of the subjects, and placed over each an 
 appropriate caption. 
 
 The English editions are divided into two parts. This 
 has three. The last is devoted to artificial teeth, obtura- 
 tors and palates, and with the exception of four or five 
 pages, consists of additions furnished by the editor. 
 
 Although it has been deemed necessary to change the 
 arrangement of some of the subjects of the Treatise, the 
 whole of the original text, with the exception of some 
 ten or twelve pages, will be found in the present edition 
 of the work. These were left out, because they related 
 to treatment of affections of the teeth which at present is 
 never adopted. 
 
 It will be found that the scope of the work has not 
 been materially enlarged — the chief aim of the editor 
 having been, to supply such details of subsequent im- 
 provements in practice, as the present state of the science 
 and art seemed to demand. If the manner in which he 
 has done this shall prove satisfactory to his professional 
 brethren, his object will have been accomplished, and he 
 will not regret having consented to assume the task. 
 
 CHAPIN A. HARRIS. 
 
 Baltimore, Md. 
 Jan. 1, 1846. 
 
PREFACE 
 
 TO THE THIRD LONDON EDITION. 
 
 GtG -o, _ •• 
 
 49 Wesi byiii oi M w. Y. City, uL<Jhu^ l. mbj 
 
 49 West 39th St, N.Y. City, 
 
 Since the appearance of the Second Edition of this 
 work; the profession have lost the personal services of its 
 respected Author; but, notwithstanding twenty years 
 have clasped since he gave his last attention to the sub- 
 ject, it is the opinion of good authorities that neither 
 alterations nor additions are required. 
 
 The importance of duly attending to the diseases of 
 the teeth, and the motives which induced the Author to 
 publish, cannot be better explained than by making the 
 following reprint of his own preface. 
 
 " The operations of the living functions of all animal 
 bodies having a constant tendency to consume the sub- 
 stance of which the general frame consists, a certain and 
 regular prpvision is required for the repairs of those in- 
 juries which the body commits upon itself. 
 
 "Abundant supplies for the production of new cor- 
 poreal matter exist, as articles of food, in the animal and 
 vegetable kingdoms; and, by a bountiful Providence, are 
 adapted to the taste and instincts of all his creatures. 
 
X PREFACE TO THE 
 
 But before these articles of food can become nutriment 
 for the body, they must undergo certain processes. The 
 first is, that whereby it is broken down into small par- 
 ticles, and, being mingled with the fluids of the mouth, is 
 comminuted into a fine mass, and prepared for the action 
 of the stomach, in the process of digestion. 
 
 "The teeth are the organs provided by nature for 
 the mastication of food, which is an operation so essen- 
 tial to health, that without a due preparation of the 
 aliments, the digestion must always be more or less 
 deranged. 
 
 "The teeth which appear in the early part of life are 
 adapted to the state of childhood; and at a certain period 
 are succeeded by a second set, which are designed to 
 continue during the remainder of life. 
 
 "'The first, or temporary set of teeth, are very liable to 
 become diseased; and in the majority of cases they do 
 not naturally fall out in sufficient time to permit the 
 second, or permanent, set of teeth to arrange themselves 
 in their proper order. 
 
 "A knowledge of the changes which the teeth un- 
 dergo, is a very interesting part of natural history, and is 
 absolutely requisite to enable a practitioner in surgery to 
 render such assistance during the progress of the second 
 dentition, as may preserve the permanent teeth from 
 being injured by the diseases of the temporary teeth; or, 
 from acquiring that irregularity which always occasions 
 so much deformity, and often destroys correct pronun- 
 ciation. 
 
THIRD LONDON EDITION. xi 
 
 "An attention to the appearance of the teeth; — a de- 
 sire to preserve them in a healthy state; — and the neces- 
 sity which exists of procuring relief when affected by 
 disease, are sources of considerable occupation. In the 
 metropolis and large towns, professional men, as dentists, 
 are enabled to confine their practice to this department 
 alone; but in those situations where surgeons are obliged 
 to undertake medicine and surgery in all their branches, 
 it is very necessary that they should be as well acquainted 
 with the structure and diseases of the teeth, as of any 
 other part of practice whatsoever. 
 
 " Mr. Hunter's publication on the teeth was the first 
 scientific book ever published upon this subject; and, as 
 an anatomical work, must ever enjoy great celebrity; 
 but not having practically devoted much of his attention 
 to the operations upon the teeth, there can be no re- 
 flection upon Mr. Hunter's merit in stating, that in many 
 essential points he was wholly, but unavoidably, deficient ; 
 particularly in regard to the right management of the 
 teeth during the second dentition." 
 
 Further it appears that during the time the Author 
 was engaged as a dresser with Mr. Cline, he found 
 amongst the pupils of St. Thomas' and Guy's Hospitals a 
 great desire to obtain particular information concerning 
 the diseases of the teeth. Frequent conversation on 
 these subjects, and descriptions of the modes of per- 
 forming some operations, led to the delivery of a Course 
 of Lectures on the Structure and Diseases of the Teeth. 
 In this undertaking, much assistance was rendered by 
 
Xii PREFACE TO THE THIRD LONDON EDITION. 
 
 Mr. (now Sir Astley) Cooper. The first Course was 
 given in the Spring of 1799, after which they were con- 
 tinued as one of the Spring Courses of Lectures delivered 
 at Guy's Hospital^ and finally gave origin to the present 
 work. 
 
 London, 
 Oct. 15, 1833. 
 
CONTENTS. 
 
 Introduction, . . . . . . . . .21 
 
 PART FIRST. 
 
 The Natural History of the Formation and Structure 
 
 of the Teeth, &c. &c, 27 
 
 CHAPTER FIRST. 
 Of the Formation of the Temporary Teeth, . . .29 
 
 CHAPTER SECOND. 
 Of the Formation of the Permanent Teeth, . . 35 
 
 CHAPTER THIRD. 
 
 Of the Manner in which the Teeth are Formed, . . 44 
 
 Manner of the formation of the Enamel, .... 52 
 
 Arteries of the Teeth, 59 
 
 Nerves of the Teeth, 60 
 
 Absorbents of the Teeth, 61 
 
 Articulation of the Teeth, 62 
 
 Structure of the Teeth, .... . ib. 
 
 CHAPTER FOURTH. 
 
 Of the Shedding of the Teeth, ..... 66 
 
 3 
 
xiv CONTENTS. 
 
 CHAPTER FIFTH. 
 
 Of the Irregularity of the Teeth, 7ti 
 
 Accretion of the Jaws, 78 
 
 CHAPTER SIXTH. 
 
 Of the Treatment to Prevent Irregularity of the Teeth, 83 
 
 CHAPTER SEVENTH. 
 
 Of the Treatment to Remedy Irregularity of the Teeth, 87 
 
 CHAPTER EIGHTH. 
 
 Of Supernumerary Teeth, 103 
 
 CHAPTER NINTH. 
 
 Of the Decay of the Temporary Teeth, . . . 105 
 
 CHAPTER TENTH. 
 
 Of the Diseases which attend Dentition, . . . 108 
 
 CHAPTER ELEVENTH. 
 
 The Analysis of the Human Teeth, .... 123 
 
 Analysis of the Enamel, 125 
 
 EXPLANATION OF PLATES TO PART FIRST. 
 
 Plate One, 131 
 
 Plate Two, 132 
 
 Plate Three, 134 
 
 Plate Four, 135 
 
 Plate Five, 136 
 
 Plate Six, 136 
 
 Plate Seven, 137 
 
 Plate Eight, 140 
 
 Plate Nine, 141 
 
CONTENTS. XV 
 
 Plate Ten, 143 
 
 Plate Eleven, 145 
 
 Plate Twelve, 147 
 
 Plate Thirteen, 148 
 
 Plate Fourteen, 149 
 
 Plate Fifteen, 150 
 
 PART SECOND. 
 
 The History and Treatment of the Diseases of the 
 
 Teeth, Gums, &.c. &c, 151 
 
 Introduction, 153 
 
 CHAPTER FIRST. 
 
 Of Caries, 157 
 
 Proximate Cause of Caries, ...... 160 
 
 Predisposing Cause of Caries, 166 
 
 Prevention of Caries, . . . . . . . 172 
 
 Treatment of Caries, . . . . . . . 1 76 
 
 CHAPTER SECOND. 
 
 Of Filing the Teeth, 179 
 
 CHAPTER THIRD. 
 
 Of Stopping the Teeth, 185 
 
 CHAPTER FOURTH. 
 
 Tooth-Ache, 197 
 
 Treatment of Tooth- Ache, 198 
 
 CHAPTER FIFTH. 
 
 Of the Extraction of the Teeth, .... 209 
 
 Instruments Employed in the Operation, . . . .210 
 
 The Key Instrument, ...... ib. 
 
Xvi CONTENTS. 
 
 The Paces, 212 
 
 The Perpendicular Extractor, ..... 213 
 
 Of the Forceps, ........ ib. 
 
 Forceps for the Extraction of the Superior Incisores and 
 
 Cuspidati, 215 
 
 Forceps for the Extraction of the Superior Molares, . . 216 
 
 Forceps for the Extraction of the Superior Dentes Sapientia?, 217 
 Forceps for the Extraction of the Bicuspides of both Jaws and 
 
 the Inferior Cuspidati and Dentes Sapientiac, . . ib. 
 Forceps for the Extraction of the Inferior Incisores, . .218 
 
 Forceps for the Extraction of the Inferior lYFolares, . . ib. 
 
 Manner of Extracting Teeth, 219 
 
 Directions for the Extraction of the Incisores and Cuspidati, 220 
 
 Directions for the Extraction of the Bicuspides and Molares, 222 
 
 Directions for the Extraction of Roots of Teeth, . . 229 
 
 Particular Directions for the use of the Key Instrument, . 233 
 
 Hemorrhage after Extraction, .*.... 237 
 
 CHAPTER SIXTH. 
 
 Of Exostosis of the Fangs of the Teeth, . . . 238 
 
 CHAPTER SEVENTH. 
 
 Of Necrosis affecting the Fangs of the Teeth, . . 245 
 
 CHAPTER EIGHTH. 
 
 Of the Disease resembling Spina-Ventosa, . . . 247 
 
 CHAPTER NINTH. 
 
 Of the Removal of the Enamel by the Denuding Process, 249 
 
 CHAPTER TENTH. 
 
 Of the Wearing of the Teeth by Mastication, . . 252 
 
 CHAPTER ELEVENTH. 
 
 Of Fractures of the Teeth, 254 
 
CONTENTS. XV11 
 
 CHAPTER TWELFTH. 
 
 Of the Diseases of the Gums, ...... 260 
 
 Of the Scurvy in the Gums, ...... 261 
 
 Of Preternatural Growth of the Gums, .... 265 
 
 CHAPTER THIRTEENTH. 
 Of Gum-Boil and Abscess, 275 
 
 CHAPTER FOURTEENTH. 
 
 Of the Diseases of the Alveolar Processes, . . . 286 
 
 CHAPTER FIFTEENTH. 
 
 Of Tartar (Salivary Calculus) of the Teeth, . . 296 
 Analysis of the Tartar, ....... 302 
 
 Analysis, 303 
 
 CHAPTER SIXTEENTH. 
 Of Scaling (Removing the Tartar) of the Teeth, . 306 
 
 CHAPTER SEVENTEENTH. 
 Of the Effects of Mercury upon the Teeth, . . 309 
 
 CHAPTER EIGHTEENTH. 
 Of the Diseases of the Antrum Maxillare, . . . 317 
 
 CHAPTER NINETEENTH. 
 Of Luxation of the Lower Jaw, 325 
 
 EXPLANATION OF PLATES TO PART SECOND. 
 
 Plate Sixteen, 353 
 
 Plate Seventeen, ......... 337 
 
 Plate Eighteen, 338 
 
 Plate Nineteen, . 339 
 
Will CONTENTS. 
 
 Plate Twenty, 340 
 
 Plate Twenty-one, 341 
 
 Plate Twenty-two, 342 
 
 Plate Twenty-three, 343 
 
 Plate Twenty -four, 344 
 
 Plate Twenty-five, 345 
 
 Plate Twenty-six, 346 
 
 Plate Twenty-seven, 347 
 
 Dissection of Tumour, 349 
 
 PART THIRD. 
 
 Artificial Teeth, Obturators and Palates, . . . 351 
 
 CHAPTER FIRST. 
 Artificial Teeth, ........ 353 
 
 CHAPTER SECOND. 
 
 Of the Manner of Inserting a Pivot Tooth, . . . 370 
 Manner of Preparing the Root, ..... 371 
 
 Of the Manner of Fitting and Attaching a Tooth to the Root, 376 
 
 CHAPTER THIRD. 
 
 Of the Manner of Fitting and Adapting a Plate, and At- 
 taching Clasps and Artificial Teeth to it, . . 380 
 Of the Manner of taking a Wax Impression, . . . .381 
 
 Of the Manner of obtaining a Plaster and Metallic Model and 
 
 Counter Model, 382 
 
 Of the manner of Fitting and Stamping a Plate and attaching 
 
 Clasps to it, 384 
 
 Of the manner of Fitting and Antagonizing the Teeth, at- 
 taching them to the Plate, and finishing the work, . 387 
 
CONTENTS. XIX 
 
 CHAPTER FOURTH. 
 
 Of the Teeth to which it is most proper to apply Clasp*, 
 and the manner of counteracting the injury liable 
 to result from such application, 395 
 
 CHAPTER FIFTH. 
 
 OF THE CoNSTRUCTIOxN OF A DOUBLE SET OF ARTIFICIAL TEETH 
 
 MOUNTED ON PLATES WITH SPIRAL SPRINGS, . . . 399 
 
 CHAPTER SIXTH. 
 
 Of the Construction of Plates for Artificial Teeth in 
 
 particular cases, 404 
 
 CHAPTER SEVENTH. 
 
 Of Artificial Obturators and Palates, .... 408 
 Absence of a Portion of the Palatine Organs, . . . ib. 
 
 Of the Construction of Obturators, 412 
 
 Of Obturators and Palates complicated with Artificial Teeth, 417 
 Of the Construction of a complete Palate with a Set of Artificial 
 
 Teeth, 419 
 
 Artificial Palate and Nose, 421 
 
 EXPLANATION OF PLATES TO PART THIRD. 
 
 Plate Twenty-eight, 429 
 
 Plate Twenty-nine, 430 
 
 Plate Thirty, 431 
 
INTRODUCTION BY THE EDITOR, 
 fifci & 4v • '#& 
 
 49 Wt .y.ci v&Wtfxm 
 
 The teeth are not only among the most useful and 
 important organs of the human body, but they are also 
 among the most ornamental. They play an important 
 part in the animal economy, and form an essential por- 
 tion of the organism of man — contributing, when sound, 
 to the health of the whole body, and when diseased, to 
 the impairment of many, and often of all its functional 
 operations. Planted deeply in the alveolar border of 
 each jaw, they are important both in an anatomical and 
 in a physiological point of view. They sustain, through 
 the medium of the fifth pair of nerves, an intimate re- 
 lation with the brain and whole nervous system, as well 
 as with all the parts dependent on them. They are the 
 prime organs of mastication — an operation which consti- 
 tutes the first stage of digestion, and which, if impro- 
 perly performed, necessarily vitiates the whole process 
 of assimilation. They contribute too, in an eminent 
 degree, to distinct enunciation, and by preventing the 
 jaws from coming together, they give rotundity and 
 symmetry to the face. Therefore, in whatever light 
 they may be viewed, they are of priceless importance 
 to the well-being and comfort of every individual. 
 4 
 
22 I N T It O D U C T I N . 
 
 But notwithstanding the value and importance of the 
 teeth, they, like other parts of the body, are liable to 
 disease, and are often destroyed by it at a very early 
 period of life. Unlike other parts of the body, how- 
 ever, these organs are not endowed with recuperative 
 powers. When attacked by disease, art only can stop 
 its progress, and repair the injury which it has inflicted ; 
 and happily her resources, when applied in time, have 
 been found amply sufficient, both for the one and the 
 other. Skilful, however, must be the hand, and perfect 
 the knowledge of the operator, who deals with organs, 
 the diseases of which can only be arrested by mechani- 
 cal means; and, it is greatly to be regretted, that so few 
 of the practitioners of dental surgery, possess these in- 
 dispensable qualifications. The numerous unsuccessful 
 operations on the teeth, daily performed, and the last- 
 ing, and often irreparable injury resulting therefrom, are 
 all attributable to the want of a sufficiently thorough, 
 theoretical and practical knowledge of this branch of 
 the curative art. 
 
 But the treatment of the diseases of the teeth and the 
 replacement of their loss with artificial substitutes, do not 
 comprise all the duties of the surgeon dentist. The 
 treatment of the various affections of the gums, alveolar 
 processes, and their contiguous parts, as well as the man- 
 agement of second dentition, when effected in a faulty 
 or improper manner, and the correction of irregularity 
 in the arrangement of these organs, all come legitimately 
 within his province. He therefore who would be a suc- 
 cessful practitioner of the dental branch of medicine, 
 should not only be thoroughly skilled in the various 
 mechanical manipulations which belong to it, but he 
 should also have a knowledge of anatomy, physiology, 
 pathology, and the therapeutical indications of disease 
 
INTRODUCTION. 23 
 
 generally. Without this knowledge, no one should take 
 upon himself the responsibility of practising the profes- 
 sion, and to obtain it, requires much time and close and 
 persevering application. Neither mechanical ability nor 
 the highest medical attainments, nor both combined, 
 without a thorough knowledge of the diseases of the 
 dental apparatus and their treatment, can make a skilful 
 practitioner of this branch of the healing art. 
 
 That any one, therefore, should be guilty of the egre- 
 gious folly of committing the treatment of the diseases of 
 organs so valuable as the teeth, to an individual totally 
 destitute of all qualifications, and having no other claim 
 to skill in their management, than the mere assumption 
 of the name of dentist, is almost incredible; and yet it 
 is done every day, and by persons who would not think 
 of putting a watch, or any common jewelry for repair 
 into the hands of a man not known to be well skilled in 
 such matters. Such inconsistency, might seem paradox- 
 ical, if it were not constantly observed in individuals 
 moving in the most learned and polished walks of so- 
 ciety, and manifesting in most matters great prudence, 
 shrewdness and judgment. But this is not so culpable 
 in others, when medical men, eminent for erudition and 
 skill in their profession, have been known to employ and 
 recommend practitioners of this description. Thus en- 
 couraged they have multiplied with most astonishing 
 rapidity, and if it were not that some men of education, 
 talent and ingenuity are engaged in this field of practice, 
 they would, long before now, have destroyed all confi- 
 dence in the alleviatory resources of the profession. But 
 thanks to the efforts and unwearied labour of such men, 
 notwithstanding the multiplication of empirics, the pro- 
 gress of the science and art of dental surgery has been 
 rapid; it has outstripped the most ardent flights of imagi- 
 
24 INTRODUCTION. 
 
 nation ; and has already attained a degree of excellence; 
 which a few years ago was supposed impossible. 
 
 The importance of a higher standard of qualification 
 for practitioners in this department is beginning to be 
 felt every where ; and it is gratifying to perceive that 
 efforts are now making for the accomplishment of this 
 important object. That it has not been previously done; 
 is not at all surprising; for until recently; the practice had 
 not assumed the importance it now possesses; nor had 
 any public or ample private facilities been furnished for 
 the acquisition of a thorough and comprehensive know- 
 ledge of the art. Therefore; it was only by the appli- 
 cation of rare abilities and the most untiring efforts; that 
 those who have attained to eminence and skill in it ; were 
 enabled to do so. 
 
 But the dawn of a brighter day has begun. Ample 
 facilities are now furnished by the Baltimore and Cin- 
 cinnati Colleges of Dental Surgery; for obtaining a tho- 
 rough medico-dental education. The former was char- 
 tered by the Legislature of Maryland in 1840; and has 
 been in successful operation five years; the latter was 
 chartered about twelve months since ; by the Legislature 
 of Ohio; and commenced operation in November last. 
 
 The advantages of collegiate over private instruction 
 are as great in dental surgery as they are in medicine 
 and general surgery. Few private teachers are provided 
 with the means and necessary facilities for imparting a 
 thorough knowledge of the various branches that should 
 enter into the professional education of an accomplished 
 dentist; and most of those who commenced practice with 
 no other information upon the subject; than that which 
 they obtained from private instructors; did so with ex- 
 ceedingly limited qualifications; and soon found that they 
 had still much to learn. 
 
INTRODUCTION. 25 
 
 The study of dental surgery is now invested with 
 peculiar interest. A revolution has commenced in the 
 ranks of the profession, which must before long result in 
 an entire change in the character of the pursuit and its 
 relation to the liberal sciences. The number of edu- 
 cated men engaged in it is rapidly increasing, and they 
 are uniting their energies to accomplish this change. 
 
 They have already done much toward effecting it, and 
 the result of their past labours encourages, nay warrants, 
 the belief that the day is not distant, when none but men 
 capable of practising the art upon scientific principles, 
 and of enriching it by the result of enlightened observa- 
 tion and critical research, shall be permitted to exercise 
 its duties. Then, and not till then, w T ill the malign influ- 
 ence of dental empiricism cease, and the sanatary and 
 restorative resources of this branch of medicine be pro- 
 perly appreciated and acknowledged. 
 
PART I, 
 
 THE HISTORY OF THE FORMATION AND STRUCTURE OF THE 
 
 TEETH. 
 
 THE SYMPTOMATIC DISEASES INCIDENTAL TO THE FIRST 
 
 DENTITION. 
 
 THE CHANGES WHICH TAKE PLACE DURING THE SECOND 
 
 DENTITION; 
 
 AND 
 
 THE TREATMENT TO PREVENT AND REMEDY IRREGULARITIES 
 IN THE ARRANGEMENT OF THE TEETH. 
 
PART FIRST 
 
 CHAPTER FIRST. 
 
 OF THE FORMATION OF THE TEMPORARY SET OF TEETH. 
 
 When the foetus has advanced so far in the organiza- 
 tion of its different parts, as to take some determinate 
 form or figure, we may perceive a considerable progress 
 in the preparatory steps for the formation of the teeth. 
 
 As soon as the ossific deposit commences in the cartil- 
 aginous parts of the embryo, both jaws are filled with 
 small membranous sacs; and, in the anterior parts, we 
 may perceive the rudiments of alveolar processes. 
 
 In a foetus of about four months, the jaw bones are 
 distinctly formed; but at this time they only consist of 
 thin grooved bones, having a cavity extending through 
 their whole length.* In the under jaw, anteriorly, this 
 cavity is narrower and deeper; but, posteriorly, it becomes 
 wider and more shallow. At this time, if the mem- 
 branous parts be removed, small processes of bone may 
 be perceived shooting across from each side; which as 
 
 * The description of what takes place in one jaw, will completely exhibit what con- 
 cerns the formation of the teeth in both ; therefore, in order to avoid confusion, I shall 
 refer to the under jaw only. 
 
 5 
 
30 OF THE FORMATION OF THE 
 
 the foetus increases in growth, gradually acquire more 
 distinctness, and at length form separate sockets for the 
 teeth.* 
 
 During the foetal state, and also for some months after 
 birth, the blood vessels and nerves belonging to the teeth, 
 run along at the bottom of this cavity, immediately below 
 the pulps of the teeth; but afterwards a distinct canal is 
 formed, through which the principal vessels and nerves 
 pass; separate filaments being sent off to the several teeth. 
 When the gum which covers the alveolar groove of a 
 foetus of the age above-mentioned, is stript off from the 
 bone, small processes or elongations from the inner surface 
 of the gums may be distinctly perceived; these are the 
 first appearances of the pulps from which the teeth are 
 formed, f 
 
 The alveolar processes soon become perfectly distinct; 
 for, the bony partitions w^hich divide the longitudinal 
 cavity in the jaw, rise to the upper margin; and thus 
 those membranous processes, now enlarged and become 
 more evolved, begin to be contained in separate cells. J 
 
 In a foetus of about four months old, the rudiments of 
 the teeth may be very distinctly seen; upon examining 
 those substances found in the jaws, they are seen to be 
 soft, or pulpy bodies, bearing a resemblance to the figure 
 of the body of the tooth to be formed, and each of them 
 is contained in a membrane proper to itself. || 
 
 For some time during the formation of the teeth, the 
 alveoli grow much faster than the teeth themselves, which 
 are consequently but loosely contained within them. At 
 the time of birth, the alveolar processes have increased so 
 much, that they almost enclose or cover the teeth ; thus a 
 firm support is given to the gums, and the infant is 
 enabled to make considerable pressure in sucking, &c. 
 
 * Plate I. Fig. 1. \ Plate I. Fig. 2. \ Plate I. Fig. 3, 5. || Plate I. Fig. 4. 
 
TEMPORARY SET OF TEETH. 31 
 
 without injury to the progress which is going on under- 
 neath. 
 
 The ossification of the teeth begins to take place very 
 early; it is first visible upon the tips of the incisores. In 
 a fetus of about five or six months, ossification has com- 
 menced upon the pulps of the incisores and cuspidati, and 
 on the points of the molares; this gradually advances and 
 extends itself, over the pulp, down to the neck of the 
 tooth, from the cutting edges or highest points ; where it 
 had first commenced. 
 
 At the time of birth, the bodies of ten teeth are distinct- 
 ly formed in each jaw; these are the teeth designed to 
 serve during the years of childhood, and are commonly 
 called the temporary, shedding, or milk teeth.* 
 
 These temporary teeth, which constitute the first set, 
 are twenty in number, and are divided into three classes, 
 incisores, cuspidati and molares. In each jaw there are 
 four incisores, two cuspidati, and four molares, and the 
 teeth on one side of the mouth correspond in figure with 
 those of the other, so that they are situated in pairs. 
 
 Besides these twenty teeth, there are in a very early 
 stage of their formation, the rudiments of some other 
 teeth, which are to form part of the permanent or adult 
 set.f 
 
 [At birth, the jaws contain the rudiments of fifty-two 
 teeth — twenty temporary and thirty-two permanent.] 
 
 After birth, as the ossification goes on, the teeth be- 
 come too long to be contained within the alveolar cavity, 
 they therefore begin to make pressure upon those parts 
 which cover them; this produces the process of absorp- 
 tion, which proceeds with the enlargement of the tooth, 
 first removing the membranes which enveloped the teeth, 
 and afterwards the thick gum which covered them, this 
 
 * Hate II. Fig. 1. f Plate II. Fig. 1. a. b. 
 
32 OF THE FORMATION OF THE 
 
 gradually becoming thinner and thinner, till at length the 
 teeth are suffered to pass through. 
 
 There is considerable variety as to the precise time 
 when the teeth begin to make their appearance. This 
 frequently seems to depend upon the health and vigour 
 of the child: for sometimes the first tooth comes as early 
 as four or five months, while on the contrary, in those of 
 more delicate and weakly constitutions, no tooth makes 
 its appearance until the child is ten or twelve months old: 
 and it is not very uncommon for a child to be turned of 
 fourteen months before any tooth appears. 
 
 It may be expected that the formation of the teeth will 
 go on more rapidly in the healthy, and proceed more 
 slowly in the weak and delicate : Yet there are excep- 
 tions to this, for often the teeth seem not to be influenced 
 by any state of health. Those of a weakly child will 
 sometimes arise in rapid succession, while those of one 
 more robust will often come forward but slowly. 
 
 In general; children begin to have their teeth about the 
 sixth, seventh, or eighth month after birth:" those which 
 correspond with each other generally appearing about 
 the same time, first in the under jaw, and then in the 
 upper. 
 
 The following is the order in which the teeth of a child 
 
 * Sometimes a child is born having one or two teeth : these are generally the cen- 
 tral incisores of the under jaw: In such cases the socket for the forming tooth has not 
 been sufficiently deep, and therefore the tooth has passed through the gum premature- 
 ly. These early productions are only the upper parte 
 
 having yet been formed. And as they have only a weak attachment to the gums, 
 they soon get loose, prodv. -Merable inflammation in the mouth of the child, 
 
 u well as occasioning inconvenience to the mother. It is therefore advisable to 
 tract them immediately, for they can never come to perfection. 
 
 :h. which appear through the gums at birth, had as the raft - . Jways 
 
 a weak attachment, and soon get loose, it would be proper to adopt the practice which 
 
 he recommends. But having met with cases where they were firmly articulated, and 
 
 productive of no unpleasant en ot join with him in recommending 
 
 their immediate removal ; this operation should only be resorted to when they give 
 
 • J irritation of the gor 
 
TEMPORARY SET OF TEETT1. 33 
 
 generally appear. — The first teeth are the central incisores 
 of the under jaw, one generally coming a few days before 
 the other; then, in the course of a month, the two central 
 incisores of the upper jaw. These are succeeded in a 
 few weeks by the lateral incisores of the under jaw, and 
 then soon after by the lateral incisores of the upper jaw. 
 The cuspidati are generally slower in completing their 
 growth than the molares, they are placed deeper in the 
 jaw, and therefore are preceded by the first molares. 
 The small molares of the under jaw usually come before 
 those of the upper; they commonly appear about the 
 fourteenth or sixteenth month, and are soon met by those 
 of the upper jaw. After these, the cuspidati come 
 through, first in the lower jaw, and then in the upper. 
 At some time between two years and two years and half, 
 the second molares make their appearance, and thus 
 complete the temporary set of teeth. * 
 
 The obtaining of the temporary teeth usually occupies 
 a child from about the sixth or eighth month until be- 
 tween two or three years of age. The teeth most com- 
 monly follow the order above-mentioned; but this is not 
 always to be expected : there are often great irregulari- 
 ties; sometimes the upper teeth appear before the under; 
 now and then the lateral incisores precede the central. 
 I once saw an instance of the first molares of the under 
 jaw appearing before the lateral incisores; and sometimes 
 more teeth come about the same time than ought natural- 
 ly to be expected. These cases of irregular succession 
 of the teeth are often attended with considerable derange- 
 ment of health, and alarming symptoms of irritation. 
 
 [The periods for the eruption of the temporary teeth 
 are stated by Mr. Thomas Bell, to be, for the four central 
 incisores, from the fifth to the eighth month ; for the four 
 
 •Platell. Fis. 2,3, 4. 
 
34 FORMATION OF TEMPORARY TEETH. 
 
 lateral^ from the seventh to the tenth; for the four anterior 
 molares, from the twelfth to the sixteenth; for the cus- 
 pidate from the fourteenth to the twentieth; and for the 
 posterior molares, from the eighteenth to the twentieth. 
 I am however of the opinion, that he is somewhat in 
 error with regard to that of the last. The second 
 temporary molares seldom appear before the twenty- 
 fourth month.] 
 
CHAPTER SECOND. 
 
 OF THE FORMATION OF THE PERMANENT SET OF TEETH. 
 
 In the management of the teeth of children, it is 
 highly necessary that the surgeon should have a perfect 
 knowledge of the order in which the teeth of the perma- 
 nent set are formed, and of the time when each tooth is 
 expected to pass through the gums. 
 
 The formation and perfection of this set of teeth, 
 occupy a very important portion of our limited exist- 
 ence ; no less than twenty years, and often more, being- 
 necessary for their complete evolution. Nature begins 
 to attend to the production of these permanent instru- 
 ments of mastication, even before birth, and in many 
 instances, they are not wholly completed before the 
 twenty-fifth, or thirtieth year. 
 
 The permanent set of teeth vary much from the tem- 
 porary set, some of the teeth being much larger, and 
 others differing much in figure; they are in number 
 thirty-two, and therefore consist of twelve teeth more 
 than the temporary set. 
 
 This set of teeth may be divided into two distinct 
 classes; those which are to succeed the temporary, and 
 those which are superadded; the formation of both these 
 divisions begins nearly about the same time, and the 
 progress furnishes one of the most curious changes the 
 animal frame can exhibit. — The incisores and cuspidati of 
 
36 OF THE FORMATION OF THE 
 
 the child are succeeded by teeth similar in form ; but 
 larger in size, and they have the same appellation; but 
 the teeth, which take the places of the temporary mo- 
 lares, are much smaller, and being divided at their grind- 
 ing surfaces into two points, are called bicuspides. The 
 molares of the adult are the teeth which are superadded, 
 and these succeed one another as the jaws advance in 
 growth.* 
 
 The teeth of the adult are divided into four classes: 
 incisores, cuspidati, bicuspides, and molares. 
 
 The teeth differ very much in the figure of their 
 bodies, and in the number and shape of their fangs. 
 The cuspidati are of a middle nature between the inci- 
 sores and the bicuspides; as are the latter between the 
 cuspidati and the molares. 
 
 The incisores, or cutting teeth, are situated in the ante- 
 rior part of the jaw, and form the front of the mouth. 
 In each jaw they are four in number, and are so placed, 
 that the two central stand somewhat more advanced than 
 the lateral. 
 
 The bodies of the incisores are broad, and rather flat. 
 The anterior surface is convex, the posterior concave; 
 they both go off from the neck of the tooth somewhat 
 sloping: the two surfaces terminate in a cutting edge, 
 w r hich is placed in a direct line with the apex of the fang. 
 When viewed in front, the cutting edge is seen to be the 
 broadest part of the tooth, but gradually becomes smaller 
 as we approach to the neck. When viewed laterally, 
 the cutting edge is the thinnest, and the tooth, to the 
 neck of it, increases in thickness. This gives to the 
 body of the tooth the form of a wedge, which is its true 
 office, it being used to cut or divide soft substances. 
 
 The enamel is continued farther, and is thicker on the 
 
 * Plate VII. 
 
PERMANENT SET OF TEETH. 37 
 
 anterior and posterior surfaces than on the sides; it is 
 even thicker on the fore part than on the back part of the 
 tooth. The fangs are conical, and are shorter than those 
 of the cuspidati. 
 
 In the upper jaw, the central incisores are much 
 broader and larger than the lateral; in the lower jaw 
 they are all nearly of the same size, but much smaller 
 than those of the upper jaw. 
 
 The cuspidati are four in number, one of them being 
 placed on the outer side of each of the lateral incisores. 
 
 The shape of the crown of a cuspidatus is like that of 
 an incisor, with its corners rubbed off, so as to end in a 
 point, instead of a broad edge. The fang is thicker and 
 larger, and is more depressed at the sides, which causes 
 it to appear considerably broader, when viewed laterally, 
 than when seen in front. The fang, which is the largest 
 of any of the teeth, may be felt with the finger, running 
 up a considerable length, and projecting beyond those of 
 the other teeth. 
 
 The cuspidati of the lower jaw very much resemble 
 those of the upper, both in figure and in length. The 
 enamel covers more of the lateral parts of these teeth 
 than of the incisores : When they are first formed they 
 are pointed, but by the friction of each upon the other in 
 mastication, they become rounded, and sometimes ac- 
 quire a flat edge. 
 
 The use of the cuspidati is not like that of the inci- 
 sores, to cut and divide substances, nor like the molares 
 for mastication ; but they are similar to the canine teeth 
 of carnivorous animals, and seem to be designed for the 
 laying hold of and tearing of substances. 
 
 The bicuspides are situated immediately behind the 
 cuspidati. They were formerly called the first and sec- 
 ond grinders, but as they do not possess the true figure 
 f> 
 
38 OF THE FORMATION OF THE 
 
 of grinders, and only have an intermediate resemblance 
 between those teeth and the cuspidati, Mr. Hunter con- 
 sidered them as a particular class. 
 
 These teeth are very much like each other, and when 
 viewed as they are situated in the mouth, are not unlike 
 the cuspidati. They are eight in number; those belong- 
 ing to the upper jaw have the body divided into two 
 points, one external, the other internal. Their fangs ap- 
 pear as if compressed at the sides, and resemble two 
 fangs united, with a depression running between them : 
 commonly the first bicuspis has two small fangs, the sec- 
 ond has seldom more than one; but in this they are sub- 
 ject to variety. 
 
 [The editor has several superior bicuspides in his ana- 
 tomical cabinet, each of which has three fangs.] 
 
 The bicuspides of the under jaw are smaller than those 
 of the upper; the points upon their surfaces are not so 
 distinct, and they have only one fang. The enamel is 
 distributed nearly equally around the crown, and they 
 stand in the jaw almost perpendicularly, but have a slight 
 inclination inwards. 
 
 The molares, or grinders, are placed behind the bicus- 
 pides; there are three on each side of the jaw, making 
 twelve in the whole. The first and second molares are 
 so much alike in every particular, that the description of 
 one will convey a perfect idea of the other. The third 
 grinder has several peculiarities, and therefore must be 
 described separately. The molares are the largest teeth ; 
 they have a broad base, furnished with several points, 
 which fits them for their office in grinding of food, and 
 they have several fangs. 
 
 The molares of the under jaw have an inclination in- 
 wards, while those of the upper jaw are placed nearly 
 perpendicularly with respect to the jaw. 
 
PERMANENT SET OF TEETH. 39 
 
 The upper grinders have commonly three fangs, two 
 situated on the outer part of the tooth, and one on the in- 
 ner; the inner fang is very oblique in its direction, and is 
 larger and rounder than the others. Those of the under 
 jaw have two fangs, one placed forwards, the other back- 
 wards; they are rather flat, and continue broad all down 
 their length. 
 
 Sometimes molares of the upper jaw are met with hav- 
 ing four distinct fangs.* I have one with five fangs, 
 which is the only one I ever saw.f The molares of the 
 under jaw now and then have three fangs. J 
 
 The third molaris is called dens sapientiae; it is smaller 
 than the others, its body is rather rounder, and the fangs 
 are not so regular and distinct : they often appear as if 
 squeezed together, and sometimes there is but one fang. 
 The dentes sapientiae of the lower jaw often have their 
 fangs curved, and sometimes they are so much inclined 
 inwards, as scarcely to rise above the ridge of the coro- 
 noid process. 
 
 The incisores of the upper jaw being much broader 
 than the same teeth in the under jaw, cause the other 
 teeth to be placed farther back in the circle than the cor- 
 responding teeth of the lower jaw ; hence in a well-formed 
 mouth, when the teeth are shut close, the central inci- 
 sores of the upper jaw come over the central and half of 
 the lateral incisores of the lower jaw : The lateral incisor 
 of the upper jaw covers the half of the lateral incisor, and 
 more than half of the cuspidatus of the under jaw. The 
 cuspidatus of the upper jaw falls between and projects a 
 little over the cuspidatus and first bicuspis of the under 
 jaw. The first bicuspis of the upper jaw falls partly upon 
 the two bicuspides in the lower jaw: The second bicus- 
 pis shuts upon the second bicuspis and the first molaris: 
 
 •Plate IX. Fig 11. f Fig. IS. fFig.6. 
 
40 OF THE FORMATION OF THE 
 
 The first upper molaris covers two-thirds of the first and 
 part of the second molaris of the under jaw: The second 
 upper molaris shuts upon the remainder of the second 
 and part of the third; and the third molaris of the upper 
 jaw, being smaller than that in the under jaw ; shuts even 
 upon it.* 
 
 From this mechanism of the teeth their power in mas- 
 tication is increased, and if one tooth be extracted, the 
 antagonist tooth does not become useless, since it can in 
 part act upon another. 
 
 [When this is not the case, as often happens, it be- 
 comes elongated, or is gradually forced from its socket 
 by a deposition of bony matter at the bottom of the alveo- 
 lus; and from this it would seem, that when a tooth has 
 lost its antagonist, it becomes, in some degree, obnoxious 
 to the system, and an effort is made by the economy to 
 expel it from the jaw. In accordance with this indica- 
 tion of nature, Dr. Koecker recommends the removal of 
 such teeth. But as this tendency can in many cases, by 
 constant attention to the cleanliness of the tooth, be mea- 
 surably counteracted, the operation should be resorted to 
 only in those cases where it is absolutely required.] 
 
 The permanent incisores and cuspidati are formed 
 behind the temporary incisores and cuspidati; the bicus- 
 picles underneath the temporary molares, and they are 
 contained in sockets of their own. 
 
 The molares are, one after the other, formed in par- 
 ticular parts of the jaws: In the upper jaw, that posterior 
 part called the tubercle, is the place for the formation of 
 the upper molares; and the molares of the under jaw are 
 formed in that part situated beneath the coronoid process, 
 one succeeding the other, as the jaws in their growth 
 carry the teeth forwards. 
 
PERMANENT SET OF TEETH. 41 
 
 Those teeth of the permanent set which first begin to 
 be formed are the anterior molares, the pulps of which 
 may be found in a foetus a short time previous to birth, 
 when they are situated quite at the posterior parts of the 
 jaws. At the time of birth ossification has commenced 
 upon their highest points; at this time also, on examining 
 the membranes of the temporary incisores, small mem- 
 branous sacs, containing a jelly-like substance, will be 
 found attached to them at the posterior and upper part. 
 These are the early rudiments of the permanent molares ; 
 ossification commences upon their tips soon after birth, 
 but always first in the lower jaw. 
 
 When an infant has cut the central incisores of the 
 upper jaw, and the four incisores of the under jaw, a con- 
 siderable progress has been made in the ossification of the 
 permanent incisores and first molares; in the under jaw 
 it has begun on the points of the cuspidati, and in the 
 upper jaw, pulps for cuspidati have become distinct, the 
 ossification of which usually commences when a child is 
 aged about sixteen months.* 
 
 Between two and three years, when all the temporary 
 teeth have appeared through the gums, the size of those 
 permanent teeth already mentioned is much increased, 
 and ossification has commenced upon the points of the 
 bicuspides of the under jaw.f 
 
 After this time the teeth very much alter their position : 
 At first the permanent teeth are contained in the same 
 sockets as the temporary; but as the formation of both 
 sets advances, the permanent teeth, by the growth of the 
 alveolar processes, become placed in a kind of niche; 
 there is also a small bony process, shooting across the 
 bottom of the common socket, which gradually increases, 
 till at length nearly a complete separation is produced, 
 
 * Plate II. Fig. 2 and 3. t Plate II. Fig. 4. 
 
42 OF THE FORMATION OF THE 
 
 and the permanent teeth are contained in sockets of their 
 own. This may be very well observed in the head of a 
 child of about four years of age; at this time the jaws 
 have become deeper, in consequence of the complete for- 
 mation of the temporary teeth and their alveolar proces- 
 ses, and the permanent set may be presented to view, 
 upon removing the external plate of the jaws.* 
 
 About this age the ossification of the incisores, cuspi- 
 dati, first bicuspides, and first molares, is much advanced, 
 some progress has been made in the formation of the 
 second molares, and soon after, the ossification of the 
 second bicuspides commences. 
 
 At about six years of age those teeth designed to suc- 
 ceed the temporary ones, and the first and second molares, 
 are in considerable forwardness, and if none of the tem- 
 porary teeth have yet heen removed, there are at this 
 time in the head, forty-eight teeth, twenty in situ, and 
 within the jaws beneath the gums, in the progress of for- 
 mation, twenty-eight, f 
 
 In the eighth or ninth year the formation of the third 
 molares, or dentes sapientise begins, by this time some of 
 the front teeth have been shed, and all the others are 
 much advanced in growth. J 
 
 [The rudiments of the dentes sapientiae have been dis- 
 covered at birth, but at this period they exist only as 
 mucus papillae.] 
 
 The permanent incisores and cuspidati, during their 
 formation, are all situated on the inner side of the tempo- 
 rary teeth, consequently they are contained within the 
 segment of a circle, smaller than that which holds the 
 temporary teeth ; they are also much larger, and therefore 
 very much crowded and forced into irregular order. 
 The lateral incisores are placed sometimes crossways, and 
 
 * Plate III. f Plate IV. \ Plate V. 
 
PERMANENT SET OF TEETH. 43 
 
 always behind, in the space between the central incisores 
 and cuspidati. In the upper jaw the cuspidati are placed 
 so high as only to be just underneath the suborbitar 
 process, and in the lower jaw they are placed almost as 
 deep as the under margin. 
 
 This description which has been given of the progres- 
 sive steps taken by nature in the formation of the teeth, 
 may not exactly agree with that given by some respecta- 
 ble writers. Into Mr. Hunter's treatise, for want of closer 
 attention, many inaccuracies have been suffered to creep. 
 Besides, descriptions of this kind are liable to disagree, 
 because the formation of teeth in children of the same age 
 may be in a more or less advanced state. But from 
 various preparations and observations I have made, the 
 above is the order in which the formation generally takes 
 place. 
 
CHAPTER THIRD. 
 
 OF THE MANNER IN WHICH THE TEETH ARE FORMED. 
 
 The teeth are formed in a manner peculiar to them- 
 selves, differing from the mode observed in the formation 
 of bones in general; instead of having for their basis car- 
 tilage or membranous substance, as the cylindrical and 
 flat bones have, they are formed from a soft pulpy sub- 
 stance, which possesses the shape of the body of the 
 tooth to be produced. 
 
 [The pulp of a tooth, according to Mr. Nasmyth, is of 
 a cellular structure, having the aspect when examined 
 under a microscope, of small vesicles— varying in size 
 from the smallest perceptible microscopic appearance, to 
 an eighth of an inch in diameter. These are arranged 
 in layers " throughout the body of the pulp." When 
 macerated, these layers, says Mr. N. " present an irregu- 
 lar reticular appearance," and are ei interspersed with 
 granules."] 
 
 Each pulp is covered by a membrane strongly attached 
 to the gum, and to the pulp at its base, so that the pulp 
 at its edge is loosely contained within the membrane, 
 which is only reflected over it; at the base the pulp is 
 weakly connected with the alveolar cavity in the jaw. 
 
 When a jaw has been minutely injected, we find that 
 the pulps are vascular, and also the membranes by which 
 they are enveloped These membranes may with care 
 
MANNER IN WHICH TEETH ARE FORMED. 45 
 
 be separated into two lamella?., the external of which is 
 rather of a loose and spongy texture, and possessed of 
 vascularity; the internal lamella is more smooth, and is 
 also vascular: the membranes derive their vessels from 
 their gums, and the pulps receive theirs from the artery 
 which passes through the jaw. 
 
 Some preparations, in the injection of which I have 
 very happily succeeded, fully warrant the above state- 
 ment in all its variations from those of Mr. Hunter or Dr. 
 Blake the author of an inaugural dissertation, published 
 in Edinburg in 1798, containing many excellent physio- 
 logical remarks on the formation of the teeth. Mr. Hun- 
 ter observes, that the external membrane is soft and 
 spongy, without vessels, the other much firmer, and 
 extremely vascular. Dr. Blake says, "they (the mem- 
 branes) can easily be separated into two lamellae, the 
 external of which is spongy and full of vessels; the inter- 
 nal one is more tender and delicate, and seems to contain 
 no vessels capable of conveying red blood. " In several 
 preparations which are minutely injected, taken from the 
 human subject, and also from the foetal calf, I have found 
 both the lamellae to be very vascular.* 
 
 The manner in which the permanent teeth derive their 
 origin, w r as never properly understood until described by 
 Dr. Blake, and is a discovery which shews very accurate 
 observation. 
 
 [The supposed discovery of Dr. Blake with regard to 
 the manner of the formation of the permanent teeth, is 
 said to have been made twenty years before, by a French 
 dentist by the name of Herbert.] 
 
 When the rudiments of the temporary teeth are some- 
 what advanced, a new sac is given off at the upper and 
 posterior part of their membranes. These sacs are at 
 
 4 Plate X. Fig. }, 2, 3, 1. 
 
46 OF THE MANNER IN WHICH 
 
 first contained in the same socket, and are so intimately 
 connected with the membranes of the temporary teeth, 
 that they cannot be separated without tearing one or 
 both.* As the sacs of the permanent teeth advance, the 
 sockets of the temporary ones become enlarged, and little 
 niches are formed in the internal plate of the alveolar 
 processes; these increase in proportion with the size of 
 the permanent sacs, and gradually form a distinct socket 
 round each of them. 
 
 There is however an opening left immediately under 
 the gum, through which the membranes of both sets of 
 teeth continue to be connected.! When the temporary 
 teeth have risen in the socket, the membranes are much 
 elongated, and remain attached to the gum at the neck of 
 the tooth, small foramina being left in the jaw for them to 
 pass through; thus they continue to derive their vessels 
 from the gums. J 
 
 The second and third permanent molares are in like 
 manner formed from the first : a small process or sac is 
 sent off posteriorly, which is at first contained in the 
 same socket as the pulp of the first molaris; by degrees 
 a new socket is formed in which the pulp of the second 
 molaris becomes perfect: this then sends off another pro- 
 cess, which forms the third molaris. || 
 
 [The recent researches of Arnold and Goodsir have 
 thrown much new and valuable light on the manner of 
 the formation of the teeth. Their progress, almost from 
 the moment of their appearance, as simple mucous papil- 
 la?, until the completion of both sets, has been minutely 
 and accurately traced, by the last named gentleman, and 
 his observations go to prove many of the views of Dr. 
 Blake upon this subject to be incorrect. § 
 
 * Plate X. Fig. 5. f Fig. 10. \ Fig. 6. || Fig. 9. 
 
 $ Vide Edinburg Medical and Surgical Journal for January, 1839. 
 
THE TEETH ARE FORMED. 47 
 
 Without entering into a minute or detailed description 
 of the result of the researches of Mr. Goodsir, it will be 
 sufficient to state, that the formation of the temporary 
 teeth, commences as early as the seventh week after con- 
 ception. At this period, the germ of the first temporary 
 molaris of the upper jaw, may be seen rising up from the 
 mucous membrane lining the floor, of what he denomi- 
 nates the primitive dental groove, in the form of a " simple 
 free granular papilla," of an "ovoidal" shape — "the 
 long diameter of w 7 hich is anterio-posterior." Another 
 papilla, of a rounded and granular form, between the 
 "middle and anterior" curve of the jaw, on the floor of 
 the same groove, is observable about the eighth week. 
 This is the rudiment of the temporary cuspid atus. The 
 germs of the incisores — the central first and then the 
 lateral, make their appearance in the form of mucous pa- 
 pillae, during the ninth week. During the tenth week, 
 the sides of the groove before and behind the first molar 
 papilla, gradually approach each other, sending off pro- 
 cesses from each side, which meet, and enclose it in a 
 follicle. A similar follicle, in the mean time, is gradually 
 forming around the germ of the cuspidatus. The papilla 
 of the second temporary molaris, makes its appearance 
 during the latter part of the tenth week. 
 
 The incisor follicles are formed during the eleventh 
 and twelfth weeks, and during the thirteenth week, a 
 follicle is formed for the papilla of the second temporary 
 molaris. Each papilla now begins to assume a particular 
 shape, the incisores that of the 'future teeth/ the cuspi- 
 dati that of 'simple cones/ the molares 'become flattened 
 transversely.' About this time, the papillae begin to grow 
 faster than the follicles, and soon protrude from their 
 mouths. The depth of the follicles varies to correspond 
 with the length of the fangs of the future teeth; and their 
 
48 OF THE MANNER IN WHICH 
 
 mouths as they become more developed, are formed into 
 opercula, which, in some measure, correspond with the 
 crowns of the future teeth. The incisor follicles have 
 two opercula — one anterior and one posterior — the first 
 larger than the latter; the follicles which contain the cus- 
 pidati papillae, have three — one external and two inter- 
 nal, and the molar follicles, as many as there are tubercles 
 on the masticating surfaces of these teeth. 
 
 During the fourteenth week, the lips of the primitive 
 dental groove meet in a valvular manner, giving to the 
 papillae the appearance of having receded back into the 
 follicles, in w T hich they are nearly hid by the closing 
 of the opercula. 
 
 The germs and follicles of the lower teeth do not ap- 
 pear quite so soon as those of the upper, but in every 
 other respect the manner of their formation and their 
 progress are almost precisely similar. 
 
 At about the last mentioned period, provision is made 
 for the production of the teeth of replacement, consisting 
 in the formation of a crescent-shaped depression, imme- 
 diately behind the inner opercula of each follicle — first of 
 the central incisores, next of the lateral, then of the cus- 
 pidati, and lastly of the first and second molares. These 
 cresent-shaped depressions, are soon formed into what 
 Mr. Goodsir calls "cavities of reserve," and from which 
 the sacs and pulps of the ten anterior permanent teeth 
 are produced. 
 
 The primitive dental groove has by this time attained 
 a higher level, and is now very properly denominated, 
 by Mr. Goodsir, the secondary dental groove. It has 
 now extended itself back of the second temporary mola- 
 ris, and from the floor of which, about the sixteenth or 
 seventeenth week, the papilla and follicle of the first per- 
 manent molaris begins to be developed. 
 
THE TEETH ARE FORMED. 49 
 
 As the papillae of the temporary teeth increase in size, 
 they gradually assume the shape of the teeth they are 
 respectively destined to form. The pulps of the upper 
 molares are perforated by three canals, which penetrate 
 to their centres, and the lower by two. The primary 
 base is divided into an equal number of secondary bases. 
 From these, the roots of the future teeth are formed. 
 The sacs of the teeth now grow more rapidly than the 
 pulps, so that a space is formed between them. There 
 is deposited in this, a gelatinous granular substance. 
 This, at first, is small in quantity, and adheres only to 
 the proximal surfaces of the sacs, but about the fifth 
 month, it becomes closely and intimately attached to the 
 whole of the interior of these organs, except for a small 
 space of equal breadth, all around the base of the pulps, 
 and as these become perforated by the canals just men- 
 tioned, the granular matter sends processes into them, 
 which adhering, reserve the narrow space described 
 above, between themselves and the secondary bases. 
 These processes of granular matter disappear near the 
 point of junction of the canals which enter the pulp. 
 The granular matter does not adhere to the pulps, but 
 is accurately moulded to all their depressions and 
 prominences. 
 
 The cavities of reserve gradually recede and assume a 
 position behind the temporary teeth, and about the fifth 
 month the distal extremities of the anterior ones begin to 
 distend, and give rise to the germs of the replacing 
 teeth, which soon acquire the appearance of dental pulps. 
 About a month later, bony septa are thrown across the 
 alveolar groove, and niches formed in the posterior walls 
 of the alveoli for the sacs of the permanent teeth. Up 
 to the eighth, and sometimes even up to the ninth month, 
 the sacs of the permanent molares are embedded in the 
 
50 OF THE MANNER IN WHICH 
 
 maxillary tuberosity. In the formation of the roots of 
 the temporary incisores, "three cotemporaneous actions/ 5 
 says Mr. Goodsir, "are employed, viz: the lengthening 
 of the pulp ; the deposition of tooth substance upon it ; 
 and the adhesion to the latter of that portion of the inner 
 sac which is opposite to it." The sacs of the permanent 
 .teeth continue to recede during the advance of the tem- 
 porary teeth and "their sockets to their perfect state/' 
 and to "insinuate themselves" "between the sacs of the 
 former" until "they are only connected by their proximal 
 extremities" through the alveolo-dental canals or itinera 
 dentium, as they are termed by M. Delabarre. 
 
 From the foregoing brief summary of the result of the 
 researches of Mr. Goodsir ; as given at length by himself, 
 it will be perceived, that the germs of the permanent 
 teeth, although like those of the temporary, originating 
 from mucus membrane, are nevertheless of distinct origin, 
 and have no connection with them. Their origin and 
 progress, however, as well as those of the temporary, 
 will be more readily and better understood by an exami- 
 nation of plate VII. copied from the diagram given by the 
 author of the paper in question.] 
 
 A tooth is composed of two substances, one of which, 
 called the enamel, is spread over that part which is not 
 covered by the gums. The other substance is bone; it 
 consists of the fang and all the body of the tooth situated 
 within the enamel. [To these may be added the pulp 
 and crusta petrosa, or cementum.] 
 
 [The pulp is soft, gelatinous, and has a semi-transpa- 
 rent appearance; its surface is covered by an extremely 
 thin and vascular membrane, designated by Raschkow, 
 the praeformative membrane. This membrane constitutes 
 the bond of union between the enamel and the bone of 
 the tooth.] 
 
THE TEETH A 11 E FORMED. 51 
 
 The bone of the tooth is formed from the pulp, and 
 the enamel from the investing membrane. The bony 
 part of the tooth is begun to be formed before the enam- 
 el. i When the ossification of a tooth is commencing, 
 bone is deposited from the vessels of the pulp upon its 
 extreme points. In the incisores it begins upon their 
 edges, and in the molares, upon the points of their grind- 
 ing surfaces. The ossification usually begins in the in- 
 cisores in three spots; these increase, soon unite and pro- 
 duce the cutting edge of the tooth : In the molares it be- 
 gins in as many spots as there are grinding points, which 
 in the lower jaw are commonly four, and in the upper, 
 five : These soon unite and form one thin layer of bone 
 of the upper surface of the pulp. The ossification soon 
 extends to the sides of the pulp, and a thin shell of bone 
 is spread over its whole surface. * 
 
 If this shell be removed, the pulp, when uncovered, 
 will be found very vascular. This is extremely well seen 
 in the teeth of large animals, when in a state of formation. 
 Some time ago I had the opportunity of examining the 
 pulps of the teeth of a young elephant, which was dis- 
 sected by Mr. Astley Cooper. Upon removing the ossi- 
 fication which had taken place upon the pulps, I found 
 the vessels to be exceedingly full of blood : There was 
 also a considerable degree of force required to separate 
 the bone from the pulp, and this strength of union be- 
 tween the pulp and the ossified part, I have always found 
 to be in proportion to the size of the tooth. 
 
 In the formation of the bone of a tooth the ossific mat- 
 ter is deposited in strata, one within the other; thus a 
 tooth is formed from the outer part to the inner, and this 
 deposition of bone continues until the tooth becomes 
 complete. When the body of the tooth is formed, the 
 pulp elongates, and takes that form of the fang proper to 
 
52 MANNER OF THE 
 
 each particular tooth, and bone is deposited upon it: It 
 then becomes gradually smaller, until it terminates in a 
 point. If a tooth have two or more fangs, the pulp 
 divides, and the ossification proceeds accordingly. The 
 cavity within a tooth, as it is forming, is at first very 
 considerable; it becomes less as the formation advances, 
 until it arrives at a certain point, when a cavity is left in 
 it extending nearly through the whole length, and re- 
 taining the shape of the tooth. * 
 
 In the crown of the tooth, the cavity is of the same 
 figure, and it divides into as many canals as there are 
 fangs to the teeth, a canal extends through each fang 
 connected with the cavity in the body of the tooth : Into 
 this cavity the nerves and blood-vessels enter and ramify 
 upon the membrane of the pulp, which remains to line 
 the cavity after the formation of the teeth. In this man- 
 ner the nerves give sensation to the teeth, and the inter- 
 nal parts of them are nourished. 
 
 [MANNER OF THE FORMATION OF THE ENAMEL.] 
 
 The enamel is situated upon all that part of a tooth 
 which in the healthy state of the gums is not covered by 
 them. This portion of the tooth is called the body, or 
 crown. It is formed by the membrane which invests 
 the pulp : When a shell of bone has been formed upon 
 the pulp, this membrane secretes a fluid, from which a 
 very white soft substance is deposited upon the bone; 
 this at first is of a consistence not harder than chalk, for 
 it may be scratched or scraped off by the nail; it how- 
 ever soon grows hard, and seems to undergo a process 
 similar to that of crystalization, for it takes a regular and 
 peculiar form. 
 
 * Plate IX. Fig. 4. 
 
FORMATION OF THE ENAMEL. 53 
 
 The deposition of the enamel continues nearly as long 
 as a tooth is contained within the membrane; it is always 
 most in quantity upon those parts where its formation 
 first began; it is thicker upon the edges and grinding sur- 
 faces of the teeth than upon the sides, and it gradually 
 becomes thinner as it approaches the necks of the teeth. 
 A tooth, when sawn through, shews the arrangement of 
 the enamel; and as it requires more heat to blacken and 
 burn this hardest part of the animal frame than the bony 
 part of the tooth, we can, by exposing it to the effects of 
 fire, obtain a still more distinct exhibition of it.* By the 
 time the enamel is completely formed, the tooth has risen 
 so much in the socket, that by its pressure it occasions an 
 absorption of the membrane, which completely prevents 
 any further addition of enamel. 
 
 When perfect, the enamel of the teeth is so hard, that 
 a file in cutting it is soon worn smooth ; and when struck 
 with it, sparks of fire will be elicited; an effect I have 
 several times produced with human teeth, and which 
 may be very readily seen by striking the teeth of large 
 animals with steel, particularly those of the Hippopo- 
 tamus. 
 
 The enamel, when broken, appears to be composed of 
 a great number of small fibres, all of which are so ar- 
 ranged as to pass in a direction from the centre to the 
 circumference of the tooth, or to form a sort of radii 
 round the body of the tooth. This is the crystalized 
 form it acquires some time after its deposit; by this dis- 
 position of its fibres, the enamel acquires a great degree 
 of strength, and thus it is not so readily worn down in 
 mastication, nor so easily fractured by violent action of 
 the teeth. f 
 
 ♦Plate IX. Fig. 1. t Plate IX. Fig. 2, 3. 
 
 8 
 
54 MANNER OF THE 
 
 [The foregoing explanation of the manner of the for- 
 mation of the enamel, has, until recently, been regarded 
 by anatomists and most writers on odontology, as correct, 
 but the recent researches of Raschkow and others, have 
 very conclusively proven it to be erroneous. In fact a 
 different theory was promulgated as early as 1819, by 
 M. Delabarre, in his treatise on Second Dentition. This 
 writer contends that the enamel is an integral part of the 
 tooth, that it proceeds from the dental embryo, and is 
 produced by an immense number of small exhalent 
 vessels, which form a sort of imperceptible velvet. Into 
 these, he supposes the calcareous ingredients are de- 
 posited, and in such a way as not to destroy their organic 
 sensibility. 
 
 According to Raschkow, the gelatinous granular sub- 
 stance, spoken of by Goodsir, and situated between the 
 follicle and germ of the tooth, is the organ destined for 
 the formation of the enamel. Raschkow calls it the ada- 
 mantine organ, and says it forms a 'globular nucleus' be- 
 tween the follicle and dental germ, at a very early period 
 of the growth of the latter, with a bulging externally, 
 and presenting internally a parenchymatous appearance, 
 gradually exhibiting angular granulations, which are con- 
 nected with each other, by 'filaments of cellular tissue, 5 
 resembling 'a kind of actinenchyma, such as may be seen 
 in plants.' The editor has frequently had opportunities, 
 in dissecting the jaws of young animals, of demonstrating 
 the existence of this granular substance, and it was the 
 discovery of this, that induced him to believe the gene- 
 rally received opinion of the manner of the formation of 
 the enamel, to be erroneous. This granular substance is 
 surrounded by a limpid fluid resembling the liquor amnii, 
 and as ossification commences on the pulp of the tooth, 
 it is gradually transformed into a membrane, attaches 
 
FORMATION OF THE ENAMEL. 55 
 
 itself to it, and to which it adheres with considerable 
 tenacity. 
 
 Raschkow says, 'the dental germ, in advancing further 
 and further into the dental follicle, makes first only a 
 slight impression on the globular mass of the enamel 
 organ, but this impress is rendered gradually deeper as 
 the growth of the germ proceeds. When the germ has 
 penetrated further into the hollow thus made, it appears 
 narrower towards the base, and thicker under the apex, 
 and is enclosed around on every side by the parenchyma 
 of the enamel organ, which thus assumes the appearance 
 of a hood, covering the dental germ when advanced in 
 its development.' It is disconnected from the dental 
 capsule, except at the coronal part, where it is apparently 
 united by some loose vessels, which supplies the paren- 
 chyma of the enamel organ with the numerous capilla- 
 ries that pervade it ; and from this, our author assumes, 
 that while the tooth germ originates from the extremity 
 of the sac next the fang, the enamel organ has its origin 
 from the opposite extremity, and thus, 'arising at opposite 
 points' they 'approach each other, are adapted together, 
 and both contribute' to the production of the tooth. He 
 also describes a peculiar organ on the inner surface of 
 this granular substance, 'consisting of short uniform fibres, 
 placed perpendicularly' 'to the cavity, and forming as it 
 were, a silky lining to it, which may readily be distin- 
 guished in a transverse section of the enamel organ, from 
 the stellated parenchyma' of this substance, which he 
 calls the pulp. 
 
 This stratum of fibres, he represents, as originating in 
 the transformation of the enamel pulp, with which it is 
 for a time connected, but from which it afterwards sepa- 
 rates, so as only to adhere by a f few filaments of cellular 
 tissue, and becomes a genuine membrane.' which he 
 
56 MANNER OF THE 
 
 styles, 'the enamel membrane.' The inner surface of 
 this membrane, he says, 'consists of hexangular, nearly 
 uniform corpuscules, visible only through a magnifying 
 glass, towards the centre of each of which, is a round 
 eminence. These corpuscules are nothing more than the 
 ends of short fibres, of which the whole membrane is 
 composed, and which being pressed together, assume 
 freely the hexangular form.' They are disposed in regu- 
 lar series, and correspond with the arrangement of the 
 fibres of the enamel. 
 
 These corpuscules, he regards as secretory ducts, 
 whose peculiar office is to secrete the enamel fibres which 
 correspond to them. This process begins immediately 
 after the commencement of the ossification of the pulp of 
 the tooth, and while it is going on, Raschkow thinks an 
 organic lymph is secreted from the parenchyma of the 
 enamel membrane, which diffuses itself between the fibres, 
 rendering the whole substance soft, but which afterwards, 
 by means of a kind of chemico-organic process, combines 
 with the earthy substances, and forms the animal base of 
 the enamel. 
 
 The membrane covering the pulp of the tooth, he calls 
 the praeformative, and this, no doubt, as has been before 
 intimated, constitutes the bond of union between the 
 enamel and bone of the tooth. 
 
 Little is known with regard to the manner of the for- 
 mation of the cementum, or fourth substance entering 
 into the composition of the tooth. Raschkow thinks that 
 it may be produced by the remains of the enamel pulp. 
 I am of the opinion, however, that it is secreted by the 
 dental periosteum, and the more so, as it cannot be de- 
 tected on the crowns of the human teeth.] 
 
 While some eminent physiologists have contended, 
 that the teeth, when they have attained their full growth, 
 
FORMATION OF THE ENAMEL. 57 
 
 are to be considered as extraneous bodies, and that they 
 no longer receive nutriment, like the other bones of the 
 body; others have supposed, that even the enamel is 
 kept up in future life by continued deposit : but that this 
 cannot be the case will be obvious, when it is considered, 
 that the membrane which invested the pulp and entirely 
 produced the enamel is destroyed before the tooth can 
 appear. When a tooth first appears, the enamel is thick- 
 er than at any other period of life, and from that time it 
 begins to decrease; this may be remarked in some of 
 the permanent teeth. The incisores, when they first 
 pass through the gum, have their edges notched; the 
 cuspidati are sharp at their points, and the grinding sur- 
 face of the molares is always irregular. This sharpness 
 of the points of the teeth is occasioned by a larger de- 
 posit upon those parts where ossification had first com- 
 menced. By the friction of the teeth against each other, 
 and against the food in mastication, the teeth are worn 
 smooth, the notches upon the incisores disappear, the 
 points of the cuspidati are rounded, or in many cases en- 
 tirely removed, and the surfaces of the molares become 
 much smoother. 
 
 The case is quite the reverse with the bony part, for 
 when a tooth is first seen through the gum, scarcely more 
 than two-thirds of the fangs are formed, but the ossifica- 
 tion continues for a considerable time afterwards. 
 
 The enamel upon some teeth has a very defective for- 
 mation; instead of being a hard white substance, having 
 a smooth polished surface, it is frequently met with of a 
 yellow colour, and having a great number of indentations 
 upon its surfaces. This occasions the teeth to resemble 
 the exterior of sponge, and gives them what has been 
 termed a honey-combed appearance. 
 
 Sometimes this appearance of the enamel is only met 
 
58 MANNER OF FORMATION OF ENAMEL. 
 
 with on the front teeth, near the cutting edge; at others 
 it extends nearly over half of the tooth, the remaining 
 parts being perfect. When the roughness is near the 
 edge, it often wears out in a few years, or at the age of 
 maturity it may be filed out. In some, one, two, or three 
 indented lines pass across the front of the teeth.* 
 
 [The affection under consideration may result from the 
 destruction of a portion of the praeformative membrane or 
 some one or more of the enamel fibres, caused by disease 
 of the general system, and some writers are of the opinion 
 that it is wholly referable to the occurrence of eruptive 
 diseases during the formation of the enamel. M. Duval 
 has given to the disease the name of atrophy.] 
 
 This defective formation of the enamel is usually 
 confined to the incisores, cuspidati, and first permanent 
 molares: it is rarely met with on the bicuspides, or second 
 and third molares. — No certain reason can be assigned 
 why the membrane secreting the enamel should so often 
 deviate from its natural action. It can only be referred 
 to some peculiarity of constitution, occasioning an irregu- 
 lar action in the membranes of the pulps, during the first 
 months; for this appearance is only met with on those 
 teeth, the formation of which commences about the time 
 of birth : and even upon them, in those parts only which 
 are first formed. In a few months after, the membranes 
 acquire a healthy action, and the teeth which are formed 
 later, rarely have defective enamel. 
 
 It is very remarkable that this circumstance often 
 occurs in several children of the same family ; indeed there 
 is scarcely any part in which they resemble each other 
 more, than in the appearance and arrangement of the 
 teeth. I have however constantly observed that these 
 kind of teeth are not so liable to decay, as those which 
 
 * Plate IX. Fiff. 14. 
 
ARTERIES OF THE TEETH. 59 
 
 have the enamel very beautiful and transparent. We 
 here find nature, as she does in many other particulars 
 common to humanity, making up for defects in one part 
 of her work, by bestowing greater perfection upon an- 
 other. 
 
 [The editor's observations upon this subject do not 
 exactly accord with the opinion of Mr. Fox. He has 
 seldom known more than one or two of the same family 
 to have their teeth thus affected, and he has found that 
 atrophied teeth were just as liable to decay as any other, 
 but the parts marked by the disease are the portions 
 least liable to be attacked by caries.] 
 
 Sometimes in the formation of the teeth two pulps 
 unite, and upon their surfaces, appear as two distinct 
 teeth, but upon attempting to remove one, it is discovered 
 to be united to the next. In Plate IX. are figures of 
 several teeth of this kind, which must be regarded as 
 lusus naturae.* 
 
 Very often the fangs of the teeth become crooked, from 
 some obstruction to their growth; and teeth having two 
 or three fangs, are now and then met with, so much bent 
 at their points as to occasion them to be very firmly placed 
 in the jaw. When these circumstances occur, the ex- 
 traction of the teeth is unavoidably an operation of the 
 utmost difficulty. 
 
 [ARTERIES OF THE TEETH.] 
 
 The arteries which supply the teeth with blood, are 
 called the dental ; they are branches of the internal max- 
 illary artery, which arises from the external carotid, at 
 that part where it is covered by the parotid gland, and 
 lies behind the middle of the upright plate of the lower 
 
 ♦Plate IX. Fig. 8, 9, 10. 
 
60 NERVES OF THE TEETH. 
 
 jaw, where it divides into the condyloid and coronoid 
 processes. It passes first between the jaw and the ex- 
 ternal pterygoid muscle, and afterwards runs in a very 
 winding direction towards the back part of the antrum 
 maxillare; it here sends numerous branches to the parts 
 belonging to both jaws, and to the teeth of the upper jaw. 
 It then gives off one branch to the lower jaw, called by 
 some, the inferior maxillary, and by others, the dental. 
 This enters the jaw-bone at the posterior maxillary fora- 
 men, passes through the maxillary canal, and gives off 
 branches to the fangs of each tooth, and also supplies the 
 substance of the bone: This vessel having sent a branch 
 to the incisores, passes out at the anterior maxillary fora- 
 men; it is distributed to the gums, and communicates 
 upon the chin with branches of the facial artery. 
 
 [NERVES OF THE TEETH.] 
 
 The nerves, which are distributed to the teeth, arise 
 from the fifth pair, the trigemini. This pair of nerves 
 divides into three branches; the opthalmic, the superior 
 maxillary, and the inferior maxillary. The opthalmic 
 branch passes through the foramen lacerum of the orbit, 
 and is distributed to the parts in the neighbourhood of 
 the eye; the superior maxillary nerve goes out at the 
 foramen rotundum of the sphenoid bone, and divides into 
 several branches, being continued to the posterior part of 
 the nose, the palate, velum palati, and contiguous parts. 
 At the posterior part, small filaments of nerves, accom- 
 panying branches of arteries, enter the superior maxillary 
 bone by foramina which lead to the molares, and also to 
 the membrane lining the antrum maxillare: The nerve 
 then goes into the canal under the orbit, and forms the 
 infra orbitar nerve. Whilst in the canal, it sends off 
 
ABSORBENTS OF THE TEETH. 61 
 
 branches to the bicuspides, cuspidati, and incisores; it 
 afterwards passes out at the foramen infra orbitarium, 
 and is distributed upon the cheek, under eyelid, upper 
 lip, and side of the nose. 
 
 The inferior maxillary nerve passes through the fora- 
 men ovale of the sphenoid bone, and is distributed to the 
 muscles of the lower jaw : it sends off a large branch, the 
 lingual, which goes to the tongue, which is the true 
 gustatory nerve; it then enters the maxillary canal of the 
 lower jaw, passes through the bone under the alveoli, 
 and gives off branches, which entering the fangs, ramify 
 upon the membrane within the cavities of the teeth; it 
 passes out at the anterior maxillary foramen, and is spent 
 about the chin and lip.* 
 
 [ABSORBENTS OF THE TEETH.] 
 
 There is another set of vessels, called absorbents, of 
 the existence of which, in the structure of common bone, 
 I believe there is no doubt; and on account of certain 
 effects produced upon the teeth, we must conclude that 
 they are not destitute of them. 
 
 During the progress of the second dentition, the fangs 
 of the temporary teeth are absorbed; and even the per- 
 manent teeth, when diseased, often lose a considerable 
 portion of the fangs. It may be argued, that in these 
 cases the absorbent vessels are situated in the socket, and 
 act upon the tooth as if it were an extraneous body. 
 But in some cases, we find the teeth undergo the ulcera- 
 tive process, and a considerable quantity of the inner part 
 is removed, a circumstance w r hich could not happen un- 
 less there were absorbents entering into the cavities of 
 the teeth, and properly belonging to them. 
 
 * Plate IX. Fig. 5. 
 
 9 
 
62 STRUCTURE OF THE TEETH. 
 
 Besides these instances, the effects of absorption in the 
 tusks of elephants are often seen; sometimes in sawing 
 these bodies, iron balls, spear heads, &,c. are met with, 
 which have been forced into them in attempting to kill 
 these animals. These extraneous substances are always 
 found loose, having a space in which they can be moved. 
 This could never happen, unless there were some action 
 going on, by which part of the bone could be removed, 
 and there is no other mode in which it can be effected, 
 but through the medium of the absorbent vessels. 
 
 [As the editor will have occasion in the chapter treat- 
 ing of the destruction of the roots of the temporary teeth, 
 to make some remarks concerning the phenomenon here 
 alluded to, it will not be necessary, in this place, to enter 
 upon its further explanation.] 
 
 [ARTICULATION OF THE TEETH.] 
 
 The teeth are fixed in their sockets by that species of 
 articulation called gomphosis. They are attached to the 
 alveolar cavity by a strong periosteum, which is extended 
 over the fangs, and which also lines the socket; it is 
 connected to the gums at the neck of the tooth, and it is 
 vascular, like the periosteum in other parts of the body. 
 
 [STRUCTURE OF THE TEETH.] 
 
 It is very extraordinary that Mr. Hunter should have 
 considered the teeth as devoid of internal circulation, and 
 destitute of the living principle. The structure of the 
 teeth is similar to that of any other bone, and differs only 
 in having a covering which is called enamel, for the 
 exposed surface, and in the bony part being more dense. 
 There are several parts of the body in which we cannot 
 
STRUCTURE OF THE TEETH. 63 
 
 by injections demonstrate the existence of blood-vessels, 
 of the vascularity of which no one can entertain a doubt; 
 and as bones in general are continually receiving nourish- 
 ment from the vessels which enter into their substance, 
 it may be justly inferred that the blood sent to the teeth 
 affords a similar supply, especially as a considerable 
 portion of animal matter enters into their composition. 
 
 A large quantity of blood is distributed to the teeth ; 
 this may frequently be seen in performing some opera- 
 tions. In cutting off the crown of a tooth, in which the 
 caries had not spread to the fang, for the purpose of en- 
 grafting a new tooth, I have several times seen a dis- 
 charge of blood from the internal cavity. This blood 
 came from the vessels of the membrane in the cavity, 
 which I have also several times seen injected. Blood 
 carries with it the basis of nutrition, and is sent to those 
 parts only where renovation is necessary. For what 
 other reason then, but to impart some principle of nutri- 
 tion, can so much blood flow into the teeth? If the teeth, 
 after their first formation, received no supply from vessels, 
 or did not require any nourishment, it would have been 
 better if they had been destitute of an internal cavity, and 
 of regular organization. 
 
 [The vascularity of the teeth is now too well estab- 
 lished to leave any room for doubt. The editor has, in 
 his anatomical cabinet, sections of two human teeth, in 
 which, by the aid of a microscope, vessels injected with 
 red blood can be distinctly traced. A microscopic view 
 of one of these is given in the second volume of the 
 American Journal of Dental Science. The existence of 
 vessels in tooth bone has also been subsequently demon- 
 strated by Dr. Maynard of Washington City, and Mr. 
 Norton of New York.] 
 
 It is always observed, that as persons advance in life, 
 
64 STRUCTURE OF THE TEETH. 
 
 their teeth lose that whiteness which they possessed in 
 the time of youth. This change in the appearance of 
 the teeth seems to depend upon one which takes place in 
 their cavities, by which the vessels entering them are 
 gradually destroyed, and the supply of blood is propor- 
 tionably diminished. In the teeth of persons advanced 
 in years, the cavity is very frequently obliterated, in con- 
 sequence of a deposit of bony matter, which entirely de- 
 stroys the internal organization. When this happens, 
 the teeth always lose their colour, and become very 
 yellow, their texture also becomes more brittle, and they 
 acquire a horny transparency. 
 
 When a tooth has been loosened by a blow, and has 
 afterwards fastened in its socket, a great alteration in its 
 colour is the consequence ; it gradually loses its white- 
 ness, and acquires a darker hue; this proceeds from the 
 vessels which enter the teeth, being destroyed, and the 
 teeth consequently losing their supply of blood. 
 
 The teeth being constructed like common bones, are 
 governed by the same laws, and are liable to be affected 
 by similar diseases; like them, they are affected by the 
 various causes of inflammation, and have the same dis- 
 eased appearances produced upon them. 
 
 [That all of the diseases of the teeth are identical with 
 those which attack other bones, is obviously erroneous. 
 With the exception of exostosis and necrosis, they do not 
 bear the slightest resemblance to them. Neither are 
 they produced by the same causes nor can they be cured 
 by the same remedies.] 
 
 In bones, the power of resisting the effects of disease 
 is in an inverse proportion to their density. The living 
 principle is always less in the close textured cylindrical 
 bones, and greater in those which are flat and spongy. 
 The teeth being the most dense bones in the body, have 
 
STRUCTURE OF THE TEETH. 65 
 
 the least power of resisting disease, and, in them, the 
 general termination of inflammation is in mortification. 
 
 The teeth do not possess the power of exfoliation, it is 
 not necessary they should, for the system suffers no in- 
 jury by the loss of a tooth : and no person would have 
 sufficient patience to bear the pain attending upon, or 
 w T ait the progress of so slow a process. Like other bones, 
 the teeth are subject to that species of inflammation called 
 the ossific, by which the fangs become increased in size, 
 acquire an additional quantity of bone, and exhibit all the 
 appearances of exostosis. They are also liable to inflam- 
 mation of the membrane lining the cavity, and to its sup- 
 puration, during the progress of which the inner part of 
 the tooth is removed by the absorbents, and an appear- 
 ance is produced like that disease of bones called spina 
 ventosa. 
 
CHAPTER FOURTH. 
 
 OF THE SHEDDING OF THE TEETH. 
 
 The falling out of the temporary teeth, to make way 
 for those which are to be permanent, is commonly called 
 the shedding of the teeth. It is the consequence of one 
 of the most curious actions of nature, and is of great im- 
 portance to our comfort, since the beauty of the face, and 
 the proper articulation of speech in a considerable degree 
 depend upon the regularity with which this part of her 
 work is accomplished. 
 
 The necessity of teeth for the mastication of food com- 
 mences as soon as the time of support from the mother 
 ceases, and therefore a set is provided at a very early 
 period, which occupies but a few months in formation, 
 and only continues a few years without falling into a state 
 of decay. These teeth are only proportioned to the size 
 of the mouth during childhood, and would consequently 
 be too small and too few in number, for the extended 
 state of the jaws in the adult; hence the formation of new 
 teeth becomes indispensable, and according to the man- 
 ner already described, a set of teeth is formed, of a mag- 
 nitude and number proportioned to the mature state of 
 the body, and intended, from their compact structure to 
 continue through life.* 
 
 * The same circumstances take place in all animals : They, like the human sub- 
 ject, shed their teeth, and obtain a new set. But in some animals there is a variety 
 in the mode, arising from the peculiar structure of their teeth and jaws. This is 
 
OF THE SHEDDING OF THE TEETH. 67 
 
 It is during the growth of the permanent teeth that the 
 very curious process of absorption is going on in the tem- 
 porary ones, which facilitates their removal from the 
 socket^ and affords a free passage to the permanent teeth. 
 
 It has been observed, that the pulps of the new teeth 
 are placed behind the temporary ones, and in that situa- 
 tion they are very much crowded, and occupy but a small 
 space. Now it is evident that as they advance in growth, 
 they will require an increase of room, to obtain which 
 they must come forward, so as to form a larger circle. 
 
 This effort first produces a considerable pressure 
 against the bony partition, placed between the temporary 
 and permanent teeth, and then upon the posterior part of 
 the fangs of the shedding teeth. The pressure in this 
 instance acts precisely in the same manner as it generally 
 does in other cases where it is applied. It induces an 
 absorption of the parts pressed against; and as the new 
 teeth augment, the fore part of the socket which was 
 formed around the pulp, and separated it from the tempo- 
 rary tooth, is removed by the process of absorption. * 
 The second teeth still continuing to protrude, press 
 against the fangs of the temporary teeth, at which place 
 their substance begins to be taken up: The absorption 
 goes on until the greater part, or the whole, of the fangs 
 are removed; at the same time the new teeth come for- 
 ward, underneath the temporary ones, which soon drop 
 out, when the edges of the new teeth may generally be 
 distinctly felt. 
 
 particularly and very curiously the case in the elephant, which animal, instead of 
 having its new teeth formed under the temporary ones, they are formed in sockets 
 beyond those to be shed, which in due time advance from the back to the front part 
 of the jaw. This is very accurately described by Mr. Corse, in his paper in the Phil- 
 osophical Transactions. A similar mode is observed to take place in one grinder of 
 the Sus Ethiopicus, as described by Mr. Home, whose paper, with that of Mr. Corse, 
 are in the Transactions for 1799. 
 *Plate II. Fig. 1,2,3,4. 
 
68 OF THE SHEDDING OF THE TEETH. 
 
 The absorption gives to the fangs of the teeth an ap- 
 pearance of being broken, but this, when compared with 
 a fracture, will be found to differ from it very materially. 
 While the absorption of the fangs of the temporary teeth 
 seems to depend so much on the pressure of the rising 
 permanent ones, it is often found to go on without such 
 pressure; for in some children the temporary teeth will 
 loosen and drop out many months before new teeth ap- 
 pear, and in many cases the same effect takes place where 
 a new tooth does not rise to replace the one which has 
 been shed. 
 
 These circumstances seem to prove that the absorption 
 of the fangs of the temporary teeth is an action of nature, 
 sometimes independent of pressure: and it is a very 
 singular circumstance, that at a time of life when so great 
 a quantity of ossific matter is poured forth from all the 
 arteries concerned in the formation of bone, in one par- 
 ticular part, there should thus be an absorption of this 
 substance taking place. 
 
 In many instances, however, absorption of the fangs of 
 the temporary teeth never takes place; and it is by no 
 means uncommon to find one, two, or sometimes more of 
 them, remain in their sockets for a great number of years. 
 When this happens to be the case with several teeth, it is 
 found that no permanent teeth had been formed : which 
 shews that the absorption of temporary teeth, although a 
 regular action in the animal oeconomy, is very considera- 
 bly influenced by the pressure of forming teeth. This 
 defect always produces an unseemly appearance, from 
 the small size of the old teeth, when compared with the 
 new. 
 
 Cases of deficiency of the permanent teeth are by no 
 means unfrequent. I have seen a young lady of about 
 twenty years of age, who had never shed the two central 
 
OF THE SHEDDING OF THE TEETH. G9 
 
 incisores of the under jaw ; and in the upper jaw, all the 
 temporary incisores remained, except one of the lateral, 
 which had been shed. 
 
 [The editor cannot believe, that this curious and sin- 
 gular operation of the animal economy is the result, 
 wholly, of the action of the absorbents. Bourdet, ob- 
 serving a carneous substance behind the root of the 
 temporary tooth, ascribed to it the agency of its destruc- 
 tion, which he believed to be effected by means of a sol- 
 vent fluid which it exhales. Laforgue gives to this 
 substance the name of absorbing apparel, believing its 
 function to be the removal of the root of the temporary 
 tooth, and in this opinion M. Delabarre concurs. 
 
 Having given a brief exposition of the last named au- 
 thor's views upon this subject, in his Principles and 
 Practice of Dental Surgery, accompanied by his own, 
 he will here repeat what he there stated. 'While the 
 crown of the tooth of replacement,' says Delabarre, 'is 
 only in formation, the exterior membrane of the matrix 
 is simply crossed by some blood vessels; but as soon as it 
 is completed, the capillaries are then developed in a very 
 peculiar manner, and form a tissue as fine as cob-web; 
 from this tissue the internal membrane, instead of con- 
 tinuing to be very delicate, and of a pale-red colour, 
 increases in thickness and assumes a redder hue. As was 
 before said, it is at the instant in which commences the 
 reaction of the coats of the matrix, that are conveyed 
 from the gum to the neck of the tooth, that the plaiting 
 of the vessels, that enter into their tissue, compose a 
 body of a carneous appearance, whose absorbents extend 
 their empire over all the surrounding parts; it is, there- 
 fore, the dental matrix itself, that, after being dilated to 
 serve as a protecting envelope to the tooth, is contracted 
 to form not only this bud-like body which we find imme- 
 10 
 
70 OF THE SHEDDING OF THE TEETH. 
 
 diately below the milk tooth, at the instant in which it 
 naturally falls out, and whose volume is necessarily aug- 
 mented as odontocia gradually goes on; but also a car- 
 neous mass by which the whole is surrounded and whose 
 thickness is the more remarkable as the organ that it 
 envelopes is nearer its orifice.' 
 
 After giving this description he asks, 'is there a dis- 
 solving fluid that acts chemically on the surrounding 
 parts, or do the absorbents, without any intermedial, 
 destroy every thing that would obstruct the shooting up 
 of the tooth?' In reply to this, he says, 'Not possessing 
 positive proof, suitable to guide me in the decision of 
 this question, and finding those of others of little import- 
 ance, I shall not attempt to answer them.' 
 
 In pursuing the subject further, he states that the ves- 
 sels of the temporary tooth often remain entire in the 
 midst of this carneous substance, and continue to convey 
 their fluids to the central part of the tooth, whilst the cal- 
 careous ingredients and the gelatine have been removed, 
 and that at other times they too are destroyed. And the 
 conclusion to which he arrives, after a careful examina- 
 tion of the whole subject, is, that whether the earthy 
 and animal parts of the root are removed by the absorb- 
 ents of the carneous tubercle in question, without any 
 previous change, or whether they are decomposed by 
 the chemical action of a fluid exhaled from it, they are 
 ultimately carried back into the general circulating system. 
 
 In proof of the agency of the fleshy tubercle in the 
 destruction of the roots of the temporary teeth, he men- 
 tions one fact that goes very far to establish it, and if his 
 views be correct, will account for those cases which are 
 occasionally met with, where one or more of the perma- 
 nent teeth fail to appear. It is this: if this substance 
 fails to be developed, or is destroyed by an injurious 
 
OF THE SHEDDING OF THE TEETH. 71 
 
 operation, the tooth often remains in its socket, and 
 never makes its appearance. Cases of this kind have 
 fallen under the notice of almost every practitioner. 
 
 In as few words as possible, I have given the views of 
 this ingenious writer, on the subject under consideration, 
 and although they do not seem to have attracted much 
 attention from English writers, and are rejected by Mr. 
 Bell, on the ground, as he says, but which I have never 
 known to be the case, that the destruction of the root of 
 the temporary frequently commences on a part Hhe most 
 remote from the sac of the permanent tooth,' I am dis- 
 posed to believe them, for the most part, correct. As to 
 the existence of the fleshy tubercle, there can be no 
 question, and that it is through the agency of these that 
 the roots of the temporary teeth are destroyed, seems 
 more than probable. But whether it is through the 
 agency of their absorbent vessels or a chemical fluid ex- 
 haled for the purpose, may not, as Delabarre says, be so 
 easy to determine. 
 
 The change that takes place in the external membrane 
 of the dental sac, as noticed by Delabarre, is observable 
 first on the peduncle or chord leading from it to the gum 
 behind the temporary tooth. It here becomes thickened 
 about the time the root of the new tooth begins to form, 
 and assumes a fleshy appearance, and it is here that the 
 destruction of the surrounding bone commences, enlarg- 
 ing the alveolo-dental canal, and gradually removing the 
 intervening long partition, and finally the root of the 
 temporary tooth. The agency of this thickened and 
 fleshy condition of the exterior membrane of the dental 
 capsules, in the removal of the roots of the temporary 
 teeth, is rendered more conclusive by the fact, that, in 
 those cases where the roots of the permanent teeth have 
 become partially destroyed, the alveolo-dental periosteum 
 
72 OF THE SHEDDING OF THE TEETH. 
 
 had assumed a similar appearance. In the formation too 
 of alveolar abscess, the tubercle at the extremity of the 
 root presents a like aspect. 
 
 It oftentimes happens, that the root of a temporary 
 tooth fails to be destroyed, and that the crown of the 
 replacing organ comes through the gum in a wrong 
 place. Whenever this happens, the carneous body is 
 developed only beneath the parts through the opening of 
 which the new has appeared, and is not brought in con- 
 tact with the bony partition between it and the root of 
 the temporary. 
 
 The manner of the destruction of the roots of the 
 temporary teeth has been a subject of close and critical 
 enquiry with me for several years, and the more I have 
 examined it, the more fully have I become convinced, 
 that it is the result of the action of this fleshy tubercle 
 upon them, and while its formation seems to be the 
 result of the contraction of the dental sac and its appen- 
 dage, for the purpose of effecting the eruption of the 
 tooth, it is especially charged with the removal of every 
 thing that would obstruct its passage. 
 
 In conclusion, it is only necessary to observe, that the 
 temporary teeth are shed in the same order in which 
 they at first appear. After one pair has been shed, a 
 sufficient time usually elapses before the shedding of 
 another, for those of the same class of the permanent set 
 to come forward and take their place. Thus, the jaws 
 are never deprived, unless from some other cause than 
 the destruction of the roots of the temporary teeth, of 
 more than two teeth in each jaw at any one time.] 
 
 It frequently happens in the upper jaw, that the per- 
 manent central incisores only are formed, the lateral ones 
 never appearing. Many persons are deficient in one or 
 more of the bicuspides. I know a gentleman who re- 
 
OF THE SHEDDING OF THE TEETH. 73 
 
 sides at Bath, who has never had the incisores of the 
 under jaw ; and it is remarkable, that two other persons 
 of his family are in the same situation. I have seen a 
 lady who had only four teeth of the permanent set in 
 each jaw. Mr. Taunton, Surgeon of the City Dispen- 
 sary, has the preparation of a child's head, in the upper 
 jaw of which only one incisor was forming.* These de- 
 viations often occur in the human subject; but so far as 
 I have observed, they are very rare in animals, yet I 
 once saw a horse rising between eight and nine years, 
 which still retained one of the milk incisores. 
 
 The appearance of the fangs of the teeth, when ab- 
 sorbed, has given rise to a popular but erroneous opinion, 
 that the first teeth have no fangs, and this was even 
 taught by some of the old anatomists. It has also been 
 erroneously conceived that the temporary teeth are 
 pushed out by the permanent: Now that this cannot take 
 place, will be seen by observing the state of the two sets 
 of teeth. The temporary ones are firmly placed in sock- 
 ets, whilst the new teeth, during their formation, are con- 
 tained in cavities larger than themselves, and can only 
 make such pressure as their gradual growth will permit. 
 On this account, if the absorption of the old tooth be re- 
 tarded, or the formation of the new tooth proceed too 
 quickly, the latter will take an improper direction when 
 they come through the gums, and form a second row of 
 teeth, from the temporary teeth still remaining. More- 
 over, if the old teeth were pushed out by the new, we 
 should always find those teeth about to be displaced, 
 forced out the line of the others, a circumstance which 
 never occurs. 
 
 The period at which children begin to shed their teeth 
 varies considerably. In some, the teeth become loose as 
 
 •Plate XI. Fiff. 6. 
 
74 OF THE SHEDDING OF THE TEETH. 
 
 early as five or six years of age; in others, this process 
 does not begin until the eighth year: about six or seven 
 years of age may be taken as the standard time. 
 
 The teeth of the permanent set, which usually appear 
 first, are the anterior molares, which being somewhat 
 more early in their formation, generally precede the in- 
 cisores; and we must always expect, soon after the cut- 
 ting of one or other of these teeth, that the shedding of 
 the temporary teeth will begin. 
 
 Soon after the first permanent molares have appeared, 
 the two central incisores of the under jaw become loose, 
 and when they are but slightly attached to the gum, 
 easily come away; the permanent central incisores soon 
 after appear, one coming a little time before the other; in 
 about two or three months the central permanent inci- 
 sores of the upper jaw become loose, and having dropt 
 out, the permanent central incisores succeed them. 
 
 In about three or four months more, the under lateral 
 incisores, having lost their fangs, come away, and the 
 permanent lateral incisores succeed them. The lateral 
 incisores of the upper jaw are the next which drop out, 
 and the permanent ones appear shortly afterwards. In 
 about six or twelve months more, the temporary molares 
 begin to loosen ; they generally come out before the cus- 
 pidati, the long fangs of which take a much longer time 
 in being absorbed. 
 
 The first bicuspides take the place of the first molares, 
 and about the time they appear, the second temporary 
 molares, and the temporary cuspidati, become loose, and 
 having been shed, are succeeded by the permanent cus- 
 pidati, and the second bicuspides. 
 
 The shedding of the teeth, commencing at six or seven 
 years of age, is commonly completed in about hve or six 
 years, w T hen all the temporary have come out, and those 
 
OF THE SHEDDING OF THE TEETH. 75 
 
 of the permanent set as far as the second molares, have 
 taken their stations. There yet remain, to complete the 
 set, the third molares, or dentes sapientiae, and these usu- 
 ally appear between eighteen and twenty-one years of 
 age, but sometimes they do not come till much later; not 
 before twenty-seven or thirty years; and I once was con- 
 sulted by a gentleman, fifty years of age, who had great 
 pain cutting one of these teeth. 
 
 [The periods for the eruption of the permanent teeth 
 are, like those of the temporary, exceedingly variable. 
 The following, however, may be regarded as very nearly 
 correct. The first molares usually come through the 
 gums between the fifth and sixth year; the central inci- 
 sores, between the sixth and eighth ; the lateral incisores, 
 between the seventh and ninth; the first bicuspides, be- 
 tween the ninth and tenth; the second, between the tenth 
 and eleventh, or eleventh and a half; the cuspidati, be- 
 tween the eleventh and twelfth ; the second molares, be- 
 tween the twelfth and fourteenth; and the dentes sapi- 
 ential, between the eighteenth and twentieth.] 
 
CHAPTER FIFTH. 
 
 OF THE IRREGULARITY OF THE TEETH. 
 
 During the shedding of the teeth there are several 
 circumstances which prevent the permanent teeth from 
 acquiring a regular position, and often give rise to very 
 great irregularity in their arrangement. 
 
 The most frequent cause is a want of simultaneous 
 action between the increase of the permanent teeth, and 
 the decrease of the temporary ones, by the absorption of 
 their fangs. It rarely happens that so much of the fang 
 of a temporary tooth is absorbed as to permit its removal 
 by the efforts of the child, before the permanent tooth is 
 ready to pass through : on which account the new tooth 
 takes an improper direction, and generally comes through 
 on the inside. 
 
 Cases are very frequent in which scarcely any absorp- 
 tion of the fangs of the temporary teeth had taken place 
 previous to the appearance of several of the permanent 
 teeth ; and it often happens, that upon the removal of the 
 shedding teeth to give room for the permanent ones, that 
 no absorption of the fangs of the temporary teeth has 
 taken place. 
 
 Irregularity of the permanent teeth is most commonly 
 occasioned by the resistance made by the nearest tempo- 
 rary teeth ; this is always the case if the temporary teeth 
 are small and close set, for as the permanent incisores are 
 
OF THE IRREGULARITY OF THE TEETH. 77 
 
 much larger than the temporary, they require more room ; 
 but as the space left by the shedding of the temporary 
 teeth is too small for the regular position of the permanent, 
 they are exposed to the pressure of the next tooth, and 
 hence are frequently turned out of their right direction. 
 
 Another cause of the irregularity of the teeth arises 
 from the permanent teeth being too large for the space 
 occupied by the temporary ones; those parts of the jaws 
 not being sufficiently extended to permit a regular posi- 
 tion of the new teeth — in this case the irregularity is con- 
 siderable, and occasions great deformity in the appearance 
 of the mouth. The incisores and cuspidati being much 
 larger than those of the child, require more room, for 
 want of which they are turned out of their proper positions. 
 The central incisores overlap each other — the lateral in- 
 cisores are either placed obliquely with their edges turned 
 forwards, or they are pushed back, and stand between 
 and behind the central incisores and the cuspidati; the 
 cuspidati are projected, occasioning the lip to stand out 
 with considerable prominence, and the bicuspides are 
 placed very irregularly. 
 
 [Malconformation of the jaws may be mentioned as 
 another cause of irregularity. The superior alveolar 
 arch is sometimes too narrow — having a compressed ap- 
 pearance, and projecting so as to prevent the upper lip 
 from covering the front teeth. The arch at other times is 
 too broad, giving to the roof of the mouth a flattened ap- 
 pearance, and causing the teeth to be separated from each 
 other. The effect upon the appearance of the individual 
 in either of these cases, is bad, but worse in the first 
 than the last. The lower jaw is liable to similar faulty 
 configurations. 
 
 The disposition to defects such as these, is observable 
 in early childhood, and is regarded by most of those who 
 11 
 
78 ACCRETION OF THE JAWS 
 
 have treated of it, as hereditary, and more peculiar to 
 the people of some countries than others. Some at- 
 tribute it to a rickety diathesis of the general system, but 
 this opinion is gratuitous, as is shown by the fact, that 
 most persons labouring under this affection, have good 
 palates and well developed jaws. It cannot, therefore, 
 with any degree of propriety be regarded as having any 
 agency in the production of a faulty configuration of the 
 jaws. 
 
 There is also another species of deformity sometimes 
 met with in the upper jaw, equally difficult of explana- 
 tion. It is characterized by one or more divisions of the 
 upper lip, alveolar border, and palatine arch, always giv- 
 ing rise to irregularity in the arrangement of the teeth. 
 This description of malconfiguration is congenital. 
 
 Supernumerary teeth too, may be reckoned among the 
 causes of irregularity. But examples of this are of com- 
 paratively rare occurrence.] 
 
 It will be proper, in this place, to observe the manner 
 in which the jaw bones grow, (the under one being 
 taken as the example) and to point out the difference 
 between the temporary and permanent teeth. 
 
 [ACCRETION OF THE JAWS.] 
 
 After a child has obtained all the temporary teeth, the 
 jaw in general grows very little, in the part which they 
 occupy. In those children who are an exception to this 
 rule, the temporary teeth become a good deal separated 
 from each other, and these are the cases in which the 
 shedding of the teeth is effected without any assistance 
 of art. 
 
 When the jaw of a child is compared with that of an 
 adult, very striking difference is observed; that of a child 
 
ACCRETION OF THE JAWS. 79 
 
 forms nearly the half of a circle, while that of an adult 
 is the half of a long ellipsis. This comparison clearly 
 points out the part in which the jaw receives its greatest 
 increase, to be between the second temporary molaris 
 and the coronoid process; and this lengthened part of 
 the jaw is destined to be the situation of the permanent 
 molares. 
 
 By the elongation of the jaw a great change in the 
 form of the face is produced; that of a child is round, 
 the cheeks are plump and the chin flat; in an adult the 
 face is more prominent, with a flatness of cheek and a 
 considerable length of chin. 
 
 The temporary incisores and cuspidati are much smaller 
 than the permanent, while the molares of the temporary 
 set are larger than the bicuspides which succeed them. 
 Hence it is, that the incisores and cuspidati are so fre- 
 quently irregular, and they never could be otherwise 
 were it not that some space were gained from the mo- 
 lares, in consequence of the bicuspides being much 
 smaller. 
 
 This circumstance is rendered intelligible, by exam- 
 ining jaws at various ages, and observing in w T hat particu- 
 lars they differ from each other. 
 
 Until about twelve months after birth, the jaw grows 
 uniformly in all its parts, and at that time as far as the 
 teeth extend, it approaches nearly to a semicircle; at 
 about three years of age, w T hen all the temporary teeth 
 have appeared, it begins to lose its semicircular form, and 
 become somewhat elongated; an extension takes place 
 between the last temporary molaris and the coronoid pro- 
 cess; and in that part, in an advanced state of formation, 
 the first permanent molaris will be found. 
 
 At about seven or eight years of age, the jaw is more 
 extended, the first permanent molaris has grown up, and 
 
80 ACCRETION OF THE JAWS. 
 
 the second is advancing in formation. At about eleven 
 or twelve years of age it will be found still longer; the 
 second molaris is ready to come through the gum ; and 
 the third molaris has begun to form. 
 
 The jaw acquires its full proportion, at about eighteen 
 or twenty years of age, when the third molaris makes its 
 appearance, and the teeth are seen in the figure of their 
 arrangement to form part of an ellipsis. 
 
 The growth of the jaw being nearly confined to the 
 part situated behind the temporary teeth, where the per- 
 manent molares are placed, the anterior part of the jaw 
 undergoes little more than an alteration in form ; it adapts 
 itself to the permanent teeth there situated, and scarcely 
 receives any increase of size. 
 
 The same comparison of jaws exhibits the cause of ir- 
 regularity in the permanent incisores and cuspidati. 
 When a child is about to shed its teeth, the first perma- 
 nent molares come through the gums behind the tempo- 
 rary molares, and therefore the teeth which are situated 
 anteriorly to the permanent molares, can obtain no ad- 
 ditional space. 
 
 The permanent incisores occupy the space of the tem- 
 porary incisores, and half of that of the cuspidati. It 
 commonly happens that the bicuspides are earlier in their 
 appearance than the cuspidati ; therefore, when the first 
 temporary molares are shed, a little room is gained, as 
 the teeth which succeed them are smaller. When the 
 second molares are shed, still more room is gained; the 
 two bicuspides go back against the first permanent 
 molares, and thereby give sufficient room for the cuspi- 
 dati. Thus, by the change of the molares of the child, 
 which are large, for the bicuspides of the adult, which 
 are small, room is obtained for the increased size of the 
 permanent incisores and cuspidati. 
 
ACCRETION OF THE JAWS. 81 
 
 [There exists considerable diversity of opinion with 
 regard to the increase of that portion of the jaw occu- 
 pied by the temporary teeth. Some writers contend 
 that it continues to grow until these teeth are replaced 
 by the permanent ones, while others assert that the in- 
 crease, after the completion of first dentition, is wholly 
 confined to the back part of the jaw, between the second 
 molares and the coronoid processes, and that the ante- 
 rior portion undergoes no increase whatever. Among 
 the former is M. Delabarre. This writer endeavours to 
 prove that a very considerable increase takes place in this 
 part of the jaw, but Mr. Fox entertains a different opin- 
 ion, as may be perceived from what he has said upon the 
 subject, and he endeavours to establish the correctness of 
 his views by the measurement of several jaws, as may be 
 seen by reference to Plate XI. Fig. 5. But the only way 
 to arrive at the truth of the matter is, to measure the 
 same jaw at different ages, as proposed by Mr. Thomas 
 Bell. For example, let that portion of the jaw of a 
 child, containing the temporary teeth, be measured im- 
 mediately after the completion of this dentition, or say 
 the third year, and then after they are replaced with the 
 permanent teeth. If this be done, the portion of the 
 jaw occupied by these teeth will be found to have in- 
 creased a little, but not as much as Delabarre supposes. 
 I allude to the change which takes place in the span 
 or extent of the circle of the arch, not to the trans- 
 verse or perpendicular dimensions of the bone. These 
 continue to augment until the sixteenth or twentieth 
 year. The premature loss of a temporary tooth, may, 
 by the approximation of the adjoining teeth, cause a 
 diminution of the span of the anterior portion of the 
 jaw. For this reason the temporary teeth should never 
 be extracted, except when called for by urgent necessity. 
 
82 ACCRETION OF THE JAWS. 
 
 The popular opinion, that inasmuch as the temporary 
 teeth are soon to be replaced, it is of little consequence 
 whether they be retained in the jaw until they are re- 
 moved by the operations of the economy, or are lost a 
 few years earlier, is erroneous, and has been productive 
 of a vast amount of injury.] 
 
 This change of small teeth for larger, and of larger for 
 smaller, points out the necessity of giving some assistance 
 to nature in one of her processes, viz : that of throwing 
 out the temporary teeth before the permanent teeth ap- 
 pear: if this be done at a proper time, the teeth will 
 always take a regular position, and every deformity 
 arising from irregularity be prevented. 
 
 During the progress of the second dentition, an oppor- 
 tunity presents itself for effecting this desirable object; 
 but every thing depends upon a correct knowledge of the 
 time when a tooth requires to be extracted, and also of 
 the particular tooth; for often more injury is occasioned 
 by the removal of a tooth too early, than if it be left a 
 little too long; because a new tooth, which has too much 
 room long before it is required, will sometimes take a di- 
 rection more difficult to alter, than a slight irregularity 
 occasioned by an obstruction of short duration. If an im- 
 proper tooth be extracted irreparable mischief will ensue; 
 as in the case where young permanent teeth have been 
 removed, instead of the obstructing temporary ones, which 
 I have several times know r n to have been done. 
 
CHAPTER SIXTH. 
 
 OF THE TREATMENT TO PREVENT IRREGULARITY OF THE TEETH. 
 
 The advantage which attends the removing the teeth 
 of children, depends upon its being done at the precise 
 time when nature is tardy in effecting the absorption of 
 the fangs of the temporary teeth. The performance of 
 any improper operation will be prevented by a knowledge 
 of the progress of the formation of the teeth, combined 
 with observations upon the appearance of the gums, which 
 become full when a tooth is about to pass through them. 
 
 To assist the permanent teeth in acquiring their proper 
 arrangement, the mouth should be examined from time to 
 time, that the operation be performed at the time re- 
 quired; for it is not sufficient to remove an obstructing 
 tooth, when the new one is perceived to be coming irreg- 
 ularly, because it always requires a considerable time to 
 bring the latter into its proper place, and often the ir- 
 regularity remains unaltered. 
 
 The shedding of the teeth commonly begins at about 
 seven years of age : sometimes it may be earlier, and at 
 others rather later; however, it is about this time that a 
 child's mouth begins to require frequent inspection. 
 
 There are two circumstances, the presence of either of 
 which always denotes that the shedding of the teeth is 
 about to commence. The first permanent molares of the 
 under jaw make their appearance; or one or both of the 
 central incisores in the under jaw begin to loosen. 
 
84 OF THE TREATMENT TO PREVENT 
 
 Sometimes the absorption of the fangs of the temporary 
 teeth goes on so slowly, that they do not get loose pre- 
 vious to the passing of the new tooth through the gums 
 behind them. If then the permanent molares have been 
 cut for some time, and there be a fulness of the gums be- 
 hind the under permanent incisores, it will be expedient 
 that the two central incisores be extracted immediately 3 
 although not yet loose. It most commonly happens that 
 the under central incisores, by the early absorption of 
 their fangs, becomes loose, and are taken out by the child 
 some time previous to the appearance of the new teeth; 
 but it often occurs, that although they have got somewhat 
 loose, they are not sufficiently so, to come out of them- 
 selves before the new teeth are ready to pass through. 
 When in this state, the temporary central incisores should 
 be removed, and this will permit the permanent central 
 incisores to take their proper place. It will soon be seen, 
 as the new teeth arise, whether they have sufficient room; 
 if not, it will be necessary to remove the temporary lateral 
 incisores. 
 
 In two or three months afterwards, or sometimes later, 
 attention must be paid to the central incisores of the up- 
 per jaw. If they have got loose they should be taken 
 out, or if not, and there be the least fulness of the gums 
 behind them, they must be extracted, or else one or both 
 of the permanent incisores will come through, and pro- 
 duce one of the most unseemly cases of irregularity, as 
 well as one of the most difficult to treat. 
 
 When the permanent central incisores are passing 
 through the gum, there is seldom sufficient room for 
 them, and it will be proper to extract the temporary 
 lateral incisores. 
 
 [The author seems to have overlooked the fact, that, 
 by the time the upper permanent central incisores are 
 
IRREGULARITY OF THE TEETH. 85 
 
 ready to come through the gums, the temporary lateral 
 incisores have become so much loosened by the wasting 
 of their roots, as to yield sufficiently to the pressure of 
 the former to permit these teeth to take their proper 
 place in the arch. But when this is not the case, the 
 temporary lateral incisores should be extracted.] 
 
 The attention is next to be turned to the under jaw, 
 for in three^ or six months time, the lateral permanent 
 incisores may be expected to appear, and if there be any 
 fulness of the gum, where those teeth are to pass, the 
 temporary cuspidati must be taken out. In two or three 
 months more the same observations should be made upon 
 the upper jaw, and as soon as the permanent lateral in- 
 cisores exhibit signs of approach, by a fulness of the 
 gums, the temporary cuspidati should be extracted. 
 
 When the teeth are in this state, they may often re- 
 main without farther attention for near a twelve-month, 
 during which time the incisores will be acquiring their 
 complete growth; and the cuspidati and the bicuspides 
 be ready to come through. Care must now be taken 
 that the permanent cuspidati do not take an improper 
 direction; the gums should be examined, and if any 
 prominence be felt, the first temporary molares must be 
 extracted. It frequently happens that the first tempo- 
 rary molares get loose previous to any appearance of the 
 cuspidati, and that when they are removed, the bicus- 
 pides soon appear. 
 
 [The shedding of the first, and often the second tempo- 
 rary molares, takes place previous to that of the temporary 
 cuspidati, so that when it becomes necessary to procure 
 room for the permanent cuspidati, it has to be obtained 
 by the removal of the first or second bicuspides, or when 
 the first permanent molares are decayed, by the extrac- 
 tion of these teeth, instead of the first temporary molares 
 12 
 
86 TREATMENT TO PREVENT IRREGULARITY. 
 
 as recommended by Mr. Fox. But it is only in the 
 fewer number of cases that the resources of art are re- 
 quired in the dentition of the secondary teeth. Nature 
 in most instances, is amply sufficient to manage her own 
 work. Irregularity of the teeth more frequently results 
 from the premature removal of the temporary teeth, than 
 from their retention too long in the jaws.] 
 
 After this, the treatment must be guided by circum- 
 stances. If either of the cuspidati exhibit signs of early 
 approach, and there be scarcely room between the latter 
 incisor and the bicuspis already in its place, it will be 
 proper to take out the second temporary molaris, the first 
 bicuspis will then go somewhat back and the cuspidatus 
 will get more room. 
 
 When the second temporary molares have been re- 
 moved, there remain no other obstacles in the way of the 
 completion of the second dentition. The second bicus- 
 pides will come properly into their places, and the mo- 
 lares having no obstruction, will progressively occupy 
 their proper stations. 
 
 Though the shedding of the teeth generally requires a 
 period of four or five years, it sometimes occupies nearly 
 six years. In some children the changes take place 
 quickly, and in others slowly. I have seen a child of 
 only seven years of age more advanced in the process of 
 dentition, than another of the same family when near 
 eleven. 
 
CHAPTER SEVENTH. 
 
 THE TREATMENT TO REMEDY IRREGULARITIES OF THE TEETH- 
 
 [There is no truth in surgery, more fully established, 
 than is that of the practicability of altering the position 
 of a tooth in the mouth, after the completion of its 
 growth; and yet there is no branch of practice in den- 
 tistry more neglected than the treatment of irregularity 
 in the arrangement of these organs. Notwithstanding 
 the acknowledged importance of regularity in the ar- 
 rangement of the teeth, not only to an agreeable expres- 
 sion of the countenance, but also to the health and 
 durability of the whole dental apparatus — hardly one 
 practitioner in twenty ever gives the subject a thought. 
 Their manipulations are almost wholly confined to filing 
 and plugging the natural teeth and the substitution of ar- 
 tificial ones for their loss. The attention of a few of the 
 more scientific and skilful practitioners, however, have 
 been directed to the treatment of irregularity, and the 
 results of their labour in this department of physical alle- 
 viation, have been as gratifying to their own feelings as 
 they have been beneficial to their patients. 
 
 The cases of irregularity of the teeth are so various 
 and sometimes complicated in their nature, that the skill, 
 patience and ingenuity of the operator are often put to 
 the severest test. Different cases require to be treated 
 differently. To construct the appliance best calculated 
 
88 VARIETIES OF IRREGULARITIES 
 
 to overcome the difficulty in every case, requires no small 
 amount of tact and inventive ingenuity. It often too, 
 becomes necessary to vary the means employed in the 
 same case, or to use different fixtures in different parts of 
 the operation; and the length of time required for its 
 accomplishment, is sometimes such as to call for a greater 
 amount of patience and perseverance on the part of both 
 practitioner and patient, than every one can be prevailed 
 upon to exercise. A deviating tooth cannot always be 
 moved to the place which it should occupy in a day or a 
 week. Months are oftentimes required to do it, and 
 during the whole progress of the operation, the most 
 constant attention is necessary.] 
 
 The mode of treatment described in the preceding 
 chapter, is not always had recourse to, at a time when 
 every irregularity might be easily obviated. Parents 
 most commonly wait, until, by an irregular growth of 
 their children's teeth, a manifest deformity is produced, 
 ere they perceive the necessity of advice. 
 
 In all cases of irregularity during the shedding of the 
 teeth, the treatment to be observed is to remove the ob- 
 structing temporary teeth, and then to apply pressure in 
 the most convenient manner upon the irregular tooth, in 
 order to direct it into its proper situation. 
 
 [VARIETIES OF IRREGULARITIES OF THE TEETH.] 
 
 I will now describe the different states of irregularity, 
 and to avoid confusion, take each jaw separately. 
 
 In the under jaw, when the growth of the permanent 
 central incisores has exceeded the absorption of the tem- 
 porary ones, they grow T up immediately behind them, in 
 a direction towards the tongue. These two new teeth 
 are generally so broad as nearly to cover the inner sur- 
 
OF THE TEETH. 89 
 
 face of the four temporary incisores. It will therefore 
 be necessary, in order to obtain room for these teeth, that 
 the four temporary incisores be extracted. The new 
 teeth will then gradually come forward, in which they 
 will naturally be assisted by the pressure of the tongue 
 of the child, and may be occasionally helped by the 
 finger of the parent or nurse.* 
 
 If the temporary central incisores have loosened, and 
 come out previous to the appearance of the permanent 
 teeth, the space is seldom sufficiently wide, and the new 
 teeth will either grow up with their sides turned forward, 
 or one will be placed before the other. In this case the 
 two lateral incisores must be taken out.f 
 
 When the permanent central incisores have completely 
 grown up, they occupy full two-thirds of the space, 
 which contained the four temporary incisores; therefore, 
 when the permanent lateral incisores appear, they are 
 placed partly behind the centrals and the temporary cus- 
 pidati ; or they grow up with one corner turned forwards 
 and the other pointing backwards. In either of these 
 cases the temporary cuspidati must be removed to give 
 room. J 
 
 [This arrangement, is often, though not always, forced 
 upon the lateral incisores by want of room between the 
 centrals and cuspidati. The space between the last men- 
 tioned teeth is often amply sufficient for the four inci- 
 sores.] 
 
 The four permanent incisores take up nearly the whole 
 of the space of the temporary incisores and cuspidati. 
 The permanent cuspidati are large teeth, and when they 
 have not sufficient room, they occasion very great irregu- 
 larity. Sometimes they come through on the inside, but 
 most commonly they cut the gum on the outside, and 
 
 •Plate XII. Fig. 1. f Fig. 2. JFig.3,4. 
 
90 VARIETIES OF IRREGULARITIES 
 
 project very much out of the circular line from the tem- 
 porary incisores to the temporary molares. In this case 
 the necessity of the removal of the first temporary molares 
 is obvious.* 
 
 [The author here has evidently mistaken the order of 
 the eruption of the permanent teeth. The first tempo- 
 rary molares and oftentimes the second are replaced with 
 bicuspides before the cuspidati appear, so that if the re- 
 moval of any teeth becomes necessary to make room for 
 the last mentioned organs, it will be the first or second 
 bicuspides, but as these are much smaller than their pre- 
 decessors, it is comparatively seldom that the sacrifice of 
 any is called for.] 
 
 It is not very common that the bicuspides of the lower 
 jaw are irregular, because the temporary molares are gen- 
 erally removed before they appear; but when this is not 
 the case, they always come through the gums on the in- 
 side, pointing towards the tongue, in which case the tem- 
 porary molares must be removed, that the bicuspides may 
 rise into their proper situations.! 
 
 In the upper jaw the permanent central incisores some- 
 times pass through the gums behind the temporary ones; 
 when this happens, the four temporary incisores must be 
 extracted, [if the wrong direction taken by the former 
 has resulted from want of room between the latter,] and 
 frequent pressure by the thumb should be applied to the 
 new teeth, in order to bring them forward as soon as 
 possible, and prevent one of the cases of irregularity most 
 difficult to be remedied. 
 
 When the temporary central incisores have come out, 
 the space is generally too narrow for the permanent ones, 
 and hence they are pressed into some shape of distortion. 
 Their edges do not assume the regular curve, but stand 
 
 * Plate XII. Fig. 5. f Fig. 6. 
 
OF THE TEETH. 91 
 
 obliquely, or even sometimes one before the other. Ca- 
 ses of this kind require the removal of the temporary 
 lateral incisores.* 
 
 [The practice recommended in the last paragraph, is 
 based upon the erroneous belief that the anterior part of 
 the jaw acquires no increase of dimensions after the den- 
 tition of the temporary teeth. But by the slight increase 
 which takes place in this part of the alveolar border and 
 the yielding of the temporary lateral incisores, to the 
 pressure of the permanent centrals, the latter, in the ma- 
 jority of cases, acquire their proper position between the 
 former. Therefore, it is only when they are forced to 
 take a wrong direction in their growth, by want of room 
 between the temporary lateral incisores, that these last 
 should be extracted.] 
 
 The permanent central incisores are very broad; they 
 occupy the greater part of the space of the four temporary 
 ones, and leave scarcely any room for the permanent late- 
 ral incisores; on which account these latter teeth must 
 grow very irregularly; they generally pass through be- 
 hind, being forced considerably backwards by the resist- 
 ance of the central incisores and the temporary cuspidati. 
 Some times they pass through edgeways, and now and 
 then they project forwards. In any of these cases the re- 
 moval of the temporary cuspidati is absolutely necessary, 
 and unless the operation be timely performed, the irregu- 
 larity is with difficulty remedied. f 
 
 [As has been intimated in a preceding place, a tempo- 
 rary tooth should not be extracted, except to make room 
 for a permanent one, or when called for by some other 
 special necessity. The practice in the preceding para- 
 graph, as that in the one noticed before it, is based upon 
 a false theory.] 
 
 * Plate XII. Fig. 7. | Fig. 3, 9. 
 
92 VARIETIES OF IRREGULARITIES 
 
 The greatest deformity is generally occasioned by the 
 want of room for the lateral incisores and the cuspidati, 
 and when too long neglected usually becomes permanent. 
 
 When the permanent cuspidati make their appearance, 
 [in an improper place] they generally project very much 
 forwards, and not only disfigure the mouth, but are very 
 dangerous. I have known several instances, where, from 
 the accident of a blow, the upper lip has been cut through. 
 Whenever the cuspidati are growing thus, the first tem- 
 porary molares ought to be extracted.* 
 
 When the bicuspides appear before the temporary 
 molares have been [removed by the destruction of their 
 roots or] extracted, they pierce the gums above the shed- 
 ding teeth, and may be seen by raising the cheek and 
 upper lip. The removal of the temporary molares im- 
 mediately permits them to come down into their right 
 situation.! [Irregularity in the arrangement of these 
 teeth is, however, of comparatively rare occurrence.] 
 
 In almost all the cases of irregularity which occur in 
 the under jaw, nothing more is necessary after the re- 
 moval of the obstructing tooth, than to apply the frequent 
 pressure of the finger, in such a manner as to direct the 
 irregular tooth into its proper place. It will assist the 
 natural tendency of the teeth to form a regular circle, and 
 to take up as large a space as possible. But in the upper 
 jaw, when the irregularity has been suffered to remain 
 for any length of time, it cannot be obviated without 
 having recourse to other assistance. 
 
 Irregularity is often occasioned by the teeth being 
 much too large for the space allotted them, and then it 
 will be necessary to remove one or more of the perma- 
 nent teeth. 
 
 When the incisores are perfectly regular, and the 
 
 •Plate XII. Fig. 10. t Fig. ll. 
 
OF THE TEETH. 93 
 
 bicuspides have appeared before the cuspidati, there is 
 so little space left, that the cuspidati are thrust forward.* 
 
 It has been the common practice to admit the cuspidati 
 to grow down to a certain length, and then to extract 
 them. This operation certainly removes the deformity 
 of projecting teeth, but it destroys the symmetry of the 
 mouth, and takes away two teeth of great importance. 
 The cuspidati are exceedingly strong; they form the 
 support of the front of the mouth, and in the advanced 
 periods of life, to those persons who have the misfortune 
 to lose the incisores, they furnish an excellent means of 
 fixing artificial teeth. [The practice, formerly so com- 
 mon, of attaching artificial teeth to the cuspidati, is, at the 
 present time, seldom adopted, when there are other teeth 
 in the mouth further back, to which a support for artificial 
 ones can be attached.] 
 
 On these accounts [or more properly for the reason first 
 stated,] they should be preserved, and therefore it will be 
 right to extract the first bicuspis on each side. The 
 cuspidati will then fall into the circle, and if there should 
 be any vacant space, it will be so far back, that no defect 
 will be perceived. This is often the case in the under 
 jaw, as well as in the upper, and the same practice ought 
 to be adopted. 
 
 [The better practice, in cases of this sort, is, to extract 
 the second, instead of the first bicuspis, as recommended 
 above, except when the space between the first and the 
 lateral incisor, is very narrow, say not more than equal to 
 one-third the w T idth of the cuspidatus, and in which case 
 the first should be removed instead of the second, for 
 although after the extraction of the other, it might be 
 made to take its place, and the deviating tooth brought 
 within the circle, yet still there would be such an over- 
 
 * Plate XII. Fig. 12. 
 
94 VARIETIES OF IRREGULARITIES 
 
 taping of the roots of the two within their sockets, as 
 would occasion a considerable prominence on the anterior 
 part of the alveolar border, which would be likely to give 
 rise to an unhealthy action in the investing soft tissues.] 
 
 The first permanent molares often become carious soon 
 after they appear; when this is the case, and the other 
 teeth have not sufficient room, considerable advantage 
 always attends their extraction. Their removal permits 
 the bicuspides to fall back, and gives way for the regular 
 position of the cuspidati. 
 
 The removal of these teeth when decayed ought always 
 to be recommended, although they may not occasion pain, 
 or there be no irregularity in the front teeth; diseased 
 teeth always affect others, and therefore ought never to 
 remain in the mouths of children. 
 
 If they be extracted before the second permanent 
 molares appear, in a short time they will not be missed, 
 because the bicuspides will go back, and the second and 
 third molares will come forward, so that no space will be 
 left. 
 
 [When there is irregularity in the front teeth, or good 
 reason for believing there will be, or that they will be 
 crowded unless some of the permanent teeth are removed, 
 the extraction of the first permanent molares when de- 
 cayed, is unquestionably advisable, but under any other 
 circumstances, the decision of the practitioner, should be 
 determined by the situation and extent of the disease. 
 If the decay has commenced on the grinding surface of 
 the tooth, and has not invaded a very considerable portion 
 of the organ, the better practice would be to remove the 
 diseased part, and fill the cavity with gold.] 
 
 The front teeth may even derive much benefit from 
 this gain of room, as there will probably be left a small 
 space between them, which will tend to their preserva- 
 
OF THE TEETH. 95 
 
 tion; for it is observed, when teeth are situated so close 
 as to press hard upon each other, they almost always fall 
 into a state of decay. 
 
 Sometimes the upper jaw is too narrow from side to 
 side, the teeth in the fore part are thrown forwards, and 
 project very much over the teeth of the lower jaw : they 
 also push out the upper lip. In this case the first bicuspis 
 on each side should be extracted, which will permit the 
 teeth to fall into a more regular curve. [But should they 
 fail to do so, they should be brought back by means of 
 ligatures attached to one or more of the molares, and so 
 applied to them, that a constant and regular pressure shall 
 be kept upon them in the direction they require to be 
 moved, only one tooth, however, on each side should be 
 moved at a time.] 
 
 When the permanent incisores of the upper jaw have 
 cut the gum behind the temporary teeth, and have been 
 suffered to remain until considerably advanced in growth, 
 they always stand so much inwards, that when the mouth 
 is shut, the incisores of the under jaw stand before them, 
 which is always an obstacle to their acquiring regularity, 
 and occasions a great deformity. 
 
 There are four states of this kind of irregularity. The 
 first, when one central incisor is turned in, and the 
 under teeth come before it, whilst the other central incisor 
 keeps its proper place, standing before the under teeth.* 
 
 The second is, when both the central incisores are 
 turned inj and go behind the under teeth; but the lateral 
 incisores stand out before the under teeth. f 
 
 The third variety is, when the central incisores are 
 placed properly, but the lateral incisores stand very much 
 in; and when the mouth is shut, the under teeth project 
 before them and keep them backward. J 
 
 * Plate XTII. Fig. 1. tFig. 2. J Fig. 3. 
 
96 VARIETIES OF IRREGULARITIES 
 
 The fourth is, when all the incisores of the upper jaw 
 are turned in, and those of the under jaw shut before 
 them. This is sometimes occasioned by too great a 
 length of the under jaw, in consequence of which it 
 projects considerably more forward than the upper jaw.* 
 But the majority of such cases originate entirely from 
 neglect, and may be completely remedied by early as- 
 sistance. 
 
 [It is also proper to state that the cuspidati as well as 
 the incisores sometimes come out behind the dental arch, 
 so as at each occlusion of the jaws, to strike behind the 
 lower teeth. But this variety of irregularity with these 
 teeth is less frequent than with the incisores. The 
 editor has, however, treated several cases within the 
 last four years, and he has one case at this time under 
 treatment. Plate XIV. Fig. 8, represents an inclined 
 plane which he employed for the purpose of bringing 
 a deviating cuspidatus forward to its proper place in the 
 dental circle.] 
 
 The time to affect any material alteration in the posi- 
 tion of the teeth, is before thirteen or fourteen years of 
 age, and as much earlier as possible; for after that time 
 the sockets of the teeth acquire a great degree of 
 strength, and the teeth are so fixed that they cannot be 
 moved without much difficulty. If the irregularity be left 
 to a much later period, it becomes a great deal more dif- 
 ficult to produce any alteration, and frequently all attempts 
 are fruitless. 
 
 [Not only is the difficulty increased by delaying to a 
 later period, and especially after the twentieth or twenty- 
 first year, but an increased susceptibility to morbid im- 
 pressions will be induced in the sockets of the teeth, 
 whose position has been changed, which will ever after 
 
 •Plate XIII. Fig. 4. 
 
OF THE TEETH. 97 
 
 remain, and render them more liable to the attacks of 
 disease.] 
 
 To remove the kind of irregularity above mentioned, 
 two objects must be accomplished ; one, to apply a force 
 which shall act constantly upon the irregular tooth, and 
 bring it forward; the other, to remove that obstruction 
 which the under teeth, by coming before the upper, 
 always occasion. 
 
 The first of these objects may be attained by the appli- 
 cation of an instrument adapted to the arch of the mouth, 
 which, being attached to some strong teeth on each side, 
 will furnish a fixed point in front, to which a ligature 
 previously fastened on the irregular tooth may be applied, 
 and thus, by occasionally renewing it, a constant pressure 
 is preserved, and the tooth may be drawn forward. 
 
 The second object, that of removing the resistance of 
 the under teeth, must be attained by placing some inter- 
 vening substance between the teeth of the upper and 
 under jaws, so as to prevent them from completely 
 closing, and be an obstruction to the coming forwards 
 of the irregular tooth. 
 
 The instrument may be made of gold or silver; it 
 should be so strong as not easily to bend; if about the 
 sixteenth of an inch in breadth, and of a proportionate 
 thickness, it will be sufficiently firm. This bar of gold 
 must be bent to the form of the mouth, and should be 
 long enough to reach to the temporary [or first perma- 
 nent] molares, which are the teeth to which it is to be 
 tied. Holes are to be drilled in it at those places where 
 ligatures are required, which will be on the parts op- 
 posed to the teeth designed to be the fixed points, and 
 also at the parts opposite to the place where the irreg- 
 ular tooth or teeth are situated. Then to the bar a 
 small square piece of ivory is to be connected, by means 
 
98 VARIETIES OF 1 RR E G UL A RI T IE S 
 
 of a little piece of gold, which may be fastened to the 
 ivory and the bar by two rivets. This piece of ivory 
 passes under the grinding surfaces of the upper teeth, is 
 kept there fixed, and prevents the teeth from closing, 
 and consequently takes off all obstruction in front.* 
 
 [Gold caps are now pretty generally employed instead 
 of blocks of ivory. These, when well adapted to the 
 teeth over which they are placed, are far preferable, as 
 they are less annoying to the patient, and can conse- 
 quently be worn with less inconvenience. The first per- 
 manent molares are the most suitable teeth to be em- 
 ployed for the purpose. The second temporary molares, 
 may, however, be used, or if they have been molted and 
 replaced with bicuspides, these will answer, though less 
 suitable than either of the others. When caps are used, 
 it is not necessary to attach them to the gold bar passing 
 round the front teeth.] 
 
 The bar is to be attached by a strong silk ligature to 
 the teeth at the sides, so that if possible, it may remain 
 tight as long as it is required; a ligature is then to be 
 tied around the irregular tooth, and the ends, being 
 brought through the holes in the bar, are to be tied in a 
 firm knot. In two or three days this ligature must be 
 removed and a new one applied; the tooth will soon be 
 perceived to move. A fresh ligature must be used every 
 three or four days, in order to keep up a constant pres- 
 sure, sufficiently powerful to bring the tooth into a line 
 with the others. f 
 
 The same mode of treatment is to be observed whether 
 there be one, two, or three teeth growing in a similar 
 manner. The teeth are usually brought forwards in 
 about a month or five weeks, and as soon as they are so 
 
 * Plate XIII. Fig. 5. f Fig. G, 7. 
 
OF THE TEETH. 99 
 
 much advanced as to allow the under teeth to pass on the 
 inside, the piece of ivory may be removed, and the bar 
 only be retained for a few days, until the teeth are per- 
 fectly firm, which will prevent the accident of the teeth 
 again receding. 
 
 [The gold bar and caps should be removed, and the 
 teeth thoroughly cleansed, every time the ligatures are 
 removed. This is necessary to prevent the teeth from 
 being injured by the chemical action of the corrosive 
 matter that forms between them and the gold bar, caps 
 and ligatures.] 
 
 In cases where the irregularity has been suffered to 
 continue too long, no success can be expected to follow 
 attempts to remove it; we must content ourselves in the 
 treatment of these cases in adults, with taking away the 
 most irregular teeth, and thus, as much as possible, lessen 
 the deformity. 
 
 [Various other methods have been proposed and 
 adopted for the purpose of remedying irregularity of the 
 teeth. M. Delabarre recommends the employment of 
 ligatures, so applied, as to keep up a constant action 
 upon the deviating teeth. Instead of using blocks of 
 ivory or gold to prevent the teeth from coming together 
 and forming a permanent obstacle to the adjustment of 
 a tooth which has come out so far back of the dental 
 circle, as to fall behind the lower teeth every time the 
 mouth is closed, he employs wire caps or grates placed 
 upon two of the lower molares. (See Plate XIV. Fig. 
 5.) This treatment, if it were the most efficient, would 
 for several reasons be objectionable. In the first place, 
 the ligatures, when applied so as to act upon a deviating 
 tooth, acts with equal force upon the adjoining teeth, and 
 moves them just as far from their place, as it does the 
 other toward the place it should occupy. In the second 
 
100 VARIETIES OF IRREGULARITIES 
 
 place, it is difficult to apply it so as to prevent it from 
 coming in contact with and irritating the gums. Thirdly, 
 it cannot be made to act with as much force when thus 
 applied as when used in connection with the gold bar. 
 The fourth and last objection, applies to the w T ire grates. 
 These cannot be fixed to the teeth as readily as either 
 the ivory blocks or gold caps, and such as could be 
 conveniently employed for the purpose, would not inter- 
 pose a barrier sufficiently thick in all cases to prevent the 
 front teeth from coming together. 
 
 For remedying the description of irregularity under 
 consideration, M. Catalan proposes the employment of 
 an inclined plane, which may be made either of gold or 
 silver, but the former is preferable, as the latter is liable 
 to corrode in the mouth, fixed upon the lower teeth, in 
 such a way that it shall strike behind the deviating tooth, 
 at each occlusion of the jaws, and press it forward 
 toward the place it should occupy. When several of the 
 upper front teeth had come out behind the arch so as to 
 fall behind the lower incisores, Catalan employed as 
 many inclined planes as there were deviating teeth. See 
 Plate XIV. Figs. 1, 2, for a copy of the engraving of his 
 instrument, taken from the Journal General de Medec)ne, 
 de Chirurgie et de Pharmacie, for January, 1814, and 
 the representation here given will supercede the neces- 
 sity of any other description. When only one tooth 
 strikes behind the circle of the lower teeth, a single in- 
 clined plane will be all that is necessary, as in the case 
 represented in Plate XIV. Figs. 6, 7, 8. 
 
 The gold frame or case applied to the lower teeth, and 
 to which the inclined plane is attached, should be fitted 
 with the nicest accuracy, and made to enclose one or 
 both of the bicuspides on each side. The cutting edges 
 of the incisores and points of the cuspidati need not be 
 
OF THE TEETH. 101 
 
 covered with it. Its adaptation, when applied, should be 
 such as to hold it firmly and securely in its place, and 
 prevent the action of the deviating tooth upon the in- 
 clined plane from jostling or moving it in the least. It 
 will be necessary too in adjusting the inclined planes to 
 this frame, so that they shall act upon the right points on 
 the deviating teeth, to have a plaster antagonizing model. 
 The manner of obtaining this will be described in another 
 part of this work. 
 
 When this instrument is employed, it of course is not 
 necessary to interpose any substance between the back 
 teeth, and it is unquestionably the most efficient and pow- 
 erful agent that has ever been used for remedying this 
 description of irregularity. But before it is applied, it 
 should be ascertained whether there be a sufficient aper- 
 ture in the dental circle for the reception of the deviating 
 tooth, or teeth, if there be more than one, and if there is 
 not, more room should be obtained by the removal of one 
 of the bicuspides on each side, or the first molaris, if that 
 be decayed. The tooth too, which is to be brought for- 
 ward, should always be opposite the aperture it is in- 
 tended it should occupy, before it is submitted to the 
 action of the inclined plane. Therefore, when it is situ- 
 ated at either side, as is often the case, it should be 
 moved with ligatures, to a point directly behind the va- 
 cuity, in which it is intended it should be forced, by the 
 inclined plane, before that is applied. 
 
 It often happens, that one or more of the teeth, though 
 situated in the circle, stands obliquely or transversely 
 across it, so that its anterior and posterior surfaces, pre- 
 sent laterally. All that is necessary in cases of this sort, 
 is simply to turn the tooth or teeth, if there be more than 
 one, partially round, in their sockets. To do this, M. 
 Delabarre applies a gold cap to the twisted tooth, with 
 14 
 
\ 
 
 102 IRREGULARITIES OF THE TEETH. 
 
 ligatures attached to each side, which he passes round 
 the adjoining teeth and secures to the temporary molares 
 or bicuspides on either side, in such a manner as to make 
 them act constantly in the direction the tooth is to be 
 turned, upon it.* I have found a gold ring, properly 
 fitted to the tooth, to answer better than a cap, for the 
 reason that it is less annoying to the patient. The object 
 may sometimes be accomplished with ligatures alone.] 
 
 ♦Plate XIV. Fig. 3,4. 
 
 
CHAPTER EIGHTH. 
 
 OF SUPERNUMERARY TEETH. 
 
 The growth of more teeth than the natural number 
 frequently occurs, and is always the cause of great irregu- 
 larity of the teeth. It most commonly happens that 
 supernumerary teeth are met with in the upper jaw, and 
 they are chiefly placed in some part about the incisores 
 and cuspidati. They are only rarely met at the posterior 
 part of the mouth, and then they resemble small dentes 
 sapiential being placed on one side or other of those 
 teeth. 
 
 The form of supernumerary is very different from that 
 of any of the other classes of teeth; they are generally 
 small round teeth, resembling the point of a quill,* and 
 sometimes they are not much unlike a broad bicuspis of 
 the under jaw.y 
 
 When these teeth appear, they always create a con- 
 siderable deformity; commonly there is only one of them, 
 and that is placed either between the central incisores, or 
 projecting over them, or between the central and the 
 lateral incisores, or behind, turning towards the roof of 
 the mouth. J 
 
 When there are two supernumerary teeth, the fore 
 part of the mouth is so filled as to occasion the incisores 
 and cuspidati to be placed in a double row. I have seen 
 
 ♦Plate XIII. Fig. 1. t Fig. 2. {Kg. 4,5. 
 
104 OF SUPERNUMERARY TEETH. 
 
 three remarkable instances of this kind: in one, there 
 were two supernumerary teeth, of the conical kind, which 
 were placed together, and had come behind and between 
 the central incisores, which they had thrust forwards. 
 The lateral incisores grew in a line even with the super- 
 numerary teeth, behind the central incisores and cuspidati, 
 and so formed a second row. This was the most con- 
 spicuous deformity of the teeth I ever saw, for the mouth 
 could not be opened to speak, without completely pre- 
 senting them to view.* 
 
 In the other two cases the supernumerary teeth re- 
 sembled bicuspides of the lower jaw; they had large 
 crowns, with depressions at their bases, and, by thrusting 
 the other teeth into very improper situations, produced 
 an appearance of a double row.f 
 
 [Supernumerary teeth are sometimes met with which 
 bear so close a resemblance to the others, that it is impossi- 
 ble to distinguish the one from the other. I have met with 
 several examples of this sort, both in the upper and lower 
 jaws.] 
 
 These supernumerary teeth should always be extracted 
 as soon as they are perceived; and if they have occasioned 
 the other teeth to turn out of their right direction, the 
 application of a ligature will soon bring them again into 
 their regular situation. 
 
 * Plate XV. Fig. 6. t Fig. 7. 
 
CHAPTER NINTH. 
 
 OF THE DECAY OF THE TEMPORARY TEETH. 
 
 The temporary teeth are very liable to become carious, 
 and generally cause a great deal of pain. Sometimes 
 this disposition to decay shews itself very early ; and in 
 two or three cases I have seen every tooth in a diseased 
 state at so early a period as three years. The little pa- 
 tients are generally dreadfully afflicted, and by their rest 
 being disturbed, and their being unable to masticate food 
 with comfort, the health is often much impaired. These 
 circumstances render the extraction of these decayed 
 teeth highly necessary. 
 
 Sometimes abscesses of considerable extent form about 
 the sockets and gums of these carious teeth, and produce 
 considerable mischief. I have seen the gums acquire a 
 sloughy appearance, discharging a quantity of fetid mat- 
 ter; and sometimes so much injury is done as to occasion 
 the death and exfoliation of portions of the jaw bones; 
 when this happens it usually extends so far as to include 
 the sockets containing the forming permanent teeth, 
 which I have seen come away with the diseased tempo- 
 rary ones.* 
 
 On these accounts it should always be recommended, 
 when a child's teeth have become carious, and occasion 
 pain, gum-boils, or abscesses, to extract them, as they not 
 
 * Plate XVI. Fig. 12. 
 
J06 OF THE DECAY OF THE TEMPORARY TEETH. 
 
 only very materially injure the health, but also are liable 
 to prevent the formation of the permanent teeth. 
 
 [The preservation of the temporary, as has been stated 
 in a preceding place, until they are removed by the ope- 
 rations of the economy, to give place to the secondary or 
 permanent ones, or until the latter are about to appear, 
 is of the utmost importance, and this, in the majority of 
 cases, might be effected by timely and proper attention. 
 The temporary teeth should be cleansed with a brush 
 and waxed floss silk, three or four times every day, and 
 if this were done from the time they make their appear- 
 ance, there would not be one decayed deciduous tooth 
 where there are now twenty. But when from neglect or 
 any other cause, they do decay, such treatment should 
 be instituted, as may be best calculated to arrest the pro- 
 gress of the disease. This, however, should be had re- 
 course to, before the teeth have become much loosened 
 from the wasting of their roots, for then, the use of the 
 file upon them, and plugging, which are the proper reme- 
 dies for caries, might, by shaking them in their sockets, 
 cause injury to the new teeth beneath. But previously 
 to this time, the treatment may be applied with impunity 
 and it will be found as successful in the preservation of 
 these as the permanent teeth. For arresting the pro- 
 gress of caries on the approximal surfaces of the tempo- 
 rary teeth, and especially the incisores, filing is preferable 
 to plugging, but when the decay is in the grinding sur- 
 face of the molares, the last operation is the proper 
 remedy. 
 
 Sound teeth are as desirable and just as necessary to 
 the comfort and health of a child as they are to an adult, 
 and therefore they should not be permitted, from neglect 
 of the means of their preservation, to decay, and the 
 temporary teeth require as much care as do the perma- 
 
OF THE DECAY OF THE TEMPORARY TEETH. 107 
 
 nent ones, and they should never be extracted except for 
 the relief of pain, that cannot be removed by any other 
 means, or the cure of an alveolar abscess, or, as has been 
 before stated, to make room for a permanent tooth. The 
 popular opinion, that inasmuch as these teeth are to be 
 replaced with others, it is of little importance whether 
 they remain in the mouth until they are removed by na- 
 ture to make room for their successors, or are lost a year 
 or two earlier, is erroneous, and has been productive of 
 much injury.] 
 
CHAPTER TENTH. 
 
 OF THE DISEASES WHICH ATTEND DENTITION. 
 
 The period of dentition in children is generally con- 
 sidered as one of the most critical in life. In infancy the 
 animal frame is so delicate, that the least local irritation 
 produces a sudden and universal sympathy throughout 
 the whole body. Hence the excitement occasioned by 
 the passage of the teeth through the gums often gives 
 rise to the most alarming constitutional symptoms, which 
 are always with difficulty alleviated, and not unfrequently 
 terminate in death. 
 
 The mode in which the teeth pass through the gums is 
 very much misunderstood ; the prevailing opinion is, that 
 as the teeth advance in growth, they find their way 
 through the gums by their own mechanical pressure. 
 The idea has given rise to the common expression of 
 cutting the teeth, and the pain during dentition has been 
 considered as being produced by a laceration of the 
 membrane and gum covering the tooth. 
 
 That this is an erroneous opinion will be perceived, 
 when the state of the teeth and gums at that time is con- 
 sidered. During its formation a tooth is loosely con- 
 tained in the socket, and can exert no force sufficient to 
 perforate so firm a substance as the gums. The gums 
 also possess a certain degree of elasticity, and could by 
 the gradual pressure of the rising teeth, be stretched so 
 
DISEASES WHICH ATTEND DENTITION. 109 
 
 as to become elongated with the progress of the teeth, 
 and would continue to cover them. 
 
 A passage for the teeth is opened by the process of 
 ulceration. By the pressure of any extraneous substance 
 upon a sound part, or by a diseased enlargement of some 
 part within the body, an absorption of the parts subjected 
 to the pressure will take place. This, in a very remark- 
 able degree, is seen in cases of aneurism, in which, by 
 the pressure of a soft tumour, bones of the most compact 
 structure are removed by the process* of absorption, and 
 that unattended with any secretion of pus. 
 
 [The foregoing explanation of the mechanism of den- 
 tition is too general to be very clearly or w r ell understood. 
 The most ingenious, and at the same time most plausible 
 theory that has been advanced upon this subject, is given 
 by M. Delabarre. This writer is of the opinion that the 
 escape of a tooth from its matrix or sac, and passage 
 through the gum is analogous, if not identical with that 
 of the birth of a child. He regards the sac in connec- 
 tion with its neck or chord which passes from it to the 
 surface of the gum, as the prime agent in this operation 
 of the economy. It is by the retraction of this upon the 
 neck of the tooth to which it is attached, that the tooth 
 is raised from its socket towards the mouth or orifice of 
 the matrix, and ultimately brought to a level with the 
 gums. The peduncle or chord leading from the sac to 
 the surface of the gum, is said by Goodsir to be solid, 
 but Delabarre has demonstrated conclusively, that it is 
 hollow, and there is reason for believing that as the tooth 
 advances, it dilates so as to give egress to the tooth, and 
 ultimately becomes the margin or free edge of the gum 
 around its neck. 
 
 This is the only theory that explains upon any thing 
 like sound philosophical principles, this most curious and 
 15 
 
110 OF THE DISEASES 
 
 singular operation of nature. As the Editor has stated in 
 another place, he repeats, it is difficult to imagine how the 
 elongation of the pulp, or the moulding of the alveolar 
 walls to it, can have any agency in raising or depressing 
 a tooth through the gums. If the elongation of the pulp 
 commenced before the crown of the tooth had made any 
 progress toward the gums, it would at once come in con- 
 tact with the floor of the alveolus, and in its soft and 
 yielding condition, be caused to assume a configuration 
 different from that presented by the root of a naturally 
 developed tooth. The crown of the tooth must there- 
 fore make some progress toward the gums, before the 
 elongation of its pulp can commence, and it is difficult to 
 conceive how this can be effected, if it is not, as Dela- 
 barre supposes, by the contraction of the fibres of its 
 sac] 
 
 When the teeth have advanced so much in their for- 
 mation as to be too long to be contained in the socket, 
 under the gum, they press upon the membranes which 
 enclose them; these become absorbed, and then the pres- 
 sure being applied against the gum, that also is removed, 
 and the teeth make their appearance. When the absorp- 
 tion of the membrane and gum takes place early, the 
 child suffers no inconvenience during the progress of 
 dentition. The teeth advance without any trouble, and 
 their appearance is discovered by the mother or nurse 
 with some degree of surprise: but when the growth of 
 the teeth is too rapid for the absorption of the gums, 
 dentition is often attended with much pain and derange- 
 ment of the whole system. At this early period of life, 
 as I have already observed, the constitution is so delicate, 
 and the irritability so great, that the least cause of irrita- 
 tion produces an universal sympathy throughout the 
 whole system. It is well known to many adults, that the 
 
WHICH ATTEND DENTITION. HI 
 
 pain attending the protruding of the dentes sapientiae is 
 very great, and it therefore cannot excite surprise that 
 this cause of irritation should in children produce so 
 many distressing symptoms, and even be the cause of 
 destroying so many. 
 
 When the formation of the tooth goes on very rapidly, 
 and the absorption of the parts which cover it does not 
 proceed in proportion, it becomes confined; this pro- 
 duces a distension of the membrane, and occasions pres- 
 sure upon the pulp, nerves and vessels at the bottom of 
 the socket. The tooth continues to grow, and the in- 
 creased pressure, which is occasioned by this augmenta- 
 tion, produces inflammation, and a variety of symptoms 
 of general irritation. 
 
 [If the theory advanced, just before, with regard to 
 the mechanism of dentition be correct, and that it is, 
 seems more than probable, the irritation produced by it 
 cannot be caused by pressure of the tooth upon the 'pulp, 
 nerves and vessels at the bottom of the socket,' but must 
 result from inflammation produced by the pressure of the 
 tooth against the sac and superincumbent gums.] 
 
 Few children obtain all their teeth without undergoing 
 some degree of suffering: in many, the symptoms are 
 merely local, in others they often arise to a very alarming 
 height, and not unfrequently terminate fatally. 
 
 When the symptoms are merely local, the gums be- 
 come very tender, and look redder than ordinary, the 
 child is restless, and rather fretful: these symptoms with 
 some children are of short duration, and always go off 
 as soon as the tooth appears. Nature operates in a very 
 salutary manner for their relief, by occasioning an in- 
 crease in the secretion of the saliva, which generally is 
 discharged in large quantities, and thus diminishes the 
 action of vessels. In other cases a gentle diarrhoea takes 
 
112 OF THE DISEASES 
 
 place, which also reduces the state of irritability. They 
 also find relief from rubbing or pressing the gums, which 
 is best done by themselves. The coral, though used as a 
 common appendage to a child's dress, is a very injurious 
 and a very improper substance: children ought to have 
 nothing hard; they will put their fingers into the mouth 
 and bite upon them; or they may have a soft crust of 
 bread; this slight pressure will expedite the absorption 
 of the gum, and consequently the passage of the tooth ; 
 while that produced by a harder substance will increase 
 the irritation and inflammation. 
 
 When the constitution becomes affected, all the symp- 
 toms of general irritation occur, and there is scarcely any 
 affection we do not meet with in one case or other of 
 difficult dentition. 
 
 Fever is a frequent attendant, and it often comes on 
 very suddenly; at first there is a heaviness about the 
 eyes, the child then becomes hot, having the skin dry 
 and tongue white; it gets very restless, putting the hand 
 into the mouth, and can neither eat nor sleep. Some- 
 times these symptoms are so much aggravated that de- 
 lirium will take place, and convulsions supervene. 
 
 In other children, the skin is more particularly affected; 
 a little fever arises, which is soon followed by some kind 
 of eruption. There are several appearances seen upon 
 the skin during childhood, and which are the conse- 
 quence of irritation during the time of dentition. 
 
 A very common eruption is a rash, which resembles 
 the measles, and which appears in spots about the face 
 and neck, sometimes extending over other parts of the 
 body. This rash is like an aggregate of small pimples, 
 so that when the finger is pressed over the red part, from 
 the skin which is healthy, a small rising may be felt. 
 This has been called the red gum, and is very common 
 
WHICH ATTEND DENTITION. 113 
 
 to children during the early months. It may in general 
 be esteemed beneficial; for the blood being carried to the 
 skin, takes off any improper determination to important 
 parts, and prevents more serious disease. 
 
 Sometimes postules arise in different parts of the body; 
 they are at first transparent, from being filled with a 
 limpid fluid, which afterwards becomes purulent, a scab 
 forms, and the changes afford an appearance not unlike a 
 mild small-pox. 
 
 There are other eruptions which form very unpleasant 
 and extensive scabs; they break out upon the corners of 
 the mouth, or on the cheek. Sometimes they begin 
 upon the forehead, and spread over part of the scalp; 
 they form large loose scabs, which drop off, but are soon 
 succeeded by others. These scabs, however, leave no 
 scar, and therefore are to be considered only as trouble- 
 some, and not dangerous. 
 
 Other children are subject to an inflammation, and a 
 discharge from behind the ears; this may always be re- 
 garded as salutary, since from its contiguity to the teeth, 
 it tends to divert the inflammation. 
 
 A gentle diarrhoea, during teething, is a beneficial effort 
 of nature; it takes off the excitement from the constitution^ 
 and diminishes the febrile symptoms. But sometimes it 
 becomes so excessive as to produce the most alarming 
 symptoms; the discharges are of a green colour, very 
 frequent, and attended with excessive griping; the rest 
 is so much disturbed that no strength is gained by it; 
 the child is continually starting, and spasms of various 
 parts are occasionally seen; at length the whole system 
 becomes so reduced that convulsions of the whole body 
 take place, which continue until nature becomes com- 
 pletely exhausted. 
 
 In some children, the irritability of the nervous system 
 
114 OF THE DISEASES 
 
 is so great, that convulsions supervene in a very short 
 time after the appearance of any febrile symptom, and 
 this is constantly the case with the cutting of every tooth. 
 Besides these different affections, there are so many other 
 anomalous symptoms, that it may be truly said, that every 
 symptom of general irritation which can be mentioned, 
 may be met with during the time of dentition. In some 
 children the lungs are much affected, and they are 
 troubled with difficult breathing; in others, the continual 
 derangement of health is often the cause of scrofula, 
 rickets, or consumption. Mr. Hunter mentions a remark- 
 able sympathetic affection in a child, which arose from 
 the irritation excited by teething. Formerly children 
 were often placed under most dangerous circumstances, 
 when they happened to be attacked with the small-pox at 
 the same time as they suffered from dentition ; but happily 
 now, they may be defended from that dreadful malady, 
 by the shield which has been raised by the admirable 
 discovery of Dr. Jenner; and we have the certain pros- 
 pect, that this most horrible, of human maladies is about 
 to withdraw its pestilential influence from the world for 
 ever. 
 
 In the treatment of any affection incident to children 
 during the progress of dentition, if the teeth are at all 
 suspected to be concerned, the removal of the cause of 
 irritation ought to be first attended to. This must be 
 done by opening the gum, so as to take off the confine- 
 ment from the tooth, and enable it to pass through. This 
 operation ought always to be had recourse to in the first 
 instance, and then other remedies should be applied ac- 
 cording to the various symptoms which may appear. 
 
 When there is fever, the antiphlogistic regimen must 
 be adopted. The bowels should be evacuated. The 
 best medicine for children is calomel, which may be 
 
WHICH ATTEND DENTITION. H5 
 
 combined with rhubarb or scammony; or some of the 
 neutral salts may be exhibited. 
 
 After these, saline draughts or gentle antimonials should 
 be administered, in order to produce a determination to 
 the skin. If the head should be much affected, a blister 
 to the nape of the neck would be very useful. In all 
 cases of rash, or eruptions, the child should be kept warm, 
 and be particularly preserved from taking cold, as great 
 danger often follows the sudden disappearance of any af- 
 fection of the skin. If this should happen, the child 
 should be put into the warm bath, and some medicines 
 administered to produce diaphoresis; also attention is to 
 be paid to the bowels, that no costiveness be suffered. 
 In general, slight eruptions are to be regarded as bene- 
 ficial, and particularly those occurring behind the ears, at- 
 tended with moderate discharge. In cases of difficult 
 dentition, when no sore ear has arisen spontaneously, 
 much benefit has followed the practice of rubbing a small 
 quantity of blister ointment behind the ears, and thus 
 inducing a slight discharge. 
 
 If scabs are extensive and become dry and hard, they 
 may be w r ashed with warm milk and water, and touched 
 with a little oil. They also may occasionally be wetted 
 with the hydrargyria muriatus, in aqua calcis, in the 
 proportion of 1 gr. to 1 oz.: the scabs should never be 
 picked off, but left to separate of themselves. When 
 they extend over the head and are moist, much trouble 
 and pain is occasioned by the sticking of the cap; they 
 should then be dusted with a little powder, or some fine 
 fuller's earth, and a singed rag should be laid over them. 
 In these cases much good has been seen to attend the 
 use of an oiled silk cap, or a piece of oiled silk laid over 
 the part, this prevents evaporation, and the scabs do not 
 dry and become so troublesome. 
 
116 OF THE DISEASES 
 
 All eruptions are to be regarded as salutary, for so 
 great a sympathetic connection exists between the skin 
 and the stomach ; that it often happens, that the repelling 
 of any eruption from the skin, immediately produces 
 considerable derangement of that organ, which ought to 
 be regarded as a sort of centre of sympathetic action. 
 This is very strikingly seen in a variety of diseases in 
 which the stomach sympathizes with the other parts of 
 the body, and therefore during dentition it is of conse- 
 quence not to check any mild eruption which may appear. 
 
 If a diarrhoea be only moderate, it should not be 
 checked; it tends to diminish fever, and takes off the 
 excitement from the constitution. As it is usually con- 
 nected with acidity, a little magnesia, or some of the tes- 
 taceous powders may be exhibited; but when the diar- 
 rhoea runs on for a great length of time, and seems to be 
 causing weakness, which threatens fatal atrophy, serious 
 endeavours must be made to subdue it. 
 
 The treatment of this complaint is attended with many 
 difficulties, and medicines which succeed in some cases 
 will totally fail in others. If the abdomen be much en- 
 larged, two grains of calomel every night, purged off in 
 the morning with ten grains of rhubarb and half the 
 quantity of magnesia, will generally be found beneficial. 
 This should not be persevered in more than three or four 
 days successively, and should be succeeded by eight 
 grains of the pulvis cretce comp. cum opio, and four or five 
 grains of columba root. The patient should be warmly 
 clothed, especially on the abdomen and lower extremi- 
 ties. On some occasions the pulv. trag. comp. appears 
 preferable to the pulv. cretce comp.; and the syrup, or 
 decoct. althcBy with 20 drops of paregoric elixir, have suc- 
 ceeded when the other usual means have failed. The 
 warm bath may be considered as another perfect species 
 
WHICH ATTEND DENTITION. 117 
 
 of warm clothing, and is attended w T ith good effects, by 
 relaxing the pores of the skin and relieving the bowels. 
 If the above mentioned remedies cannot be taken by the 
 patient, opiate frictions of the abdomen or back should be 
 used, and the following formula will answer very conve- 
 niently. R. Ung. hydr. fort. 5i. — pulv. opii pur i. Gi. 
 old oliv. 3 iij. fiat linimentum bis terve in hebdomade in- 
 fric; but the quantity and repetition must be regulated 
 by the judgment of the practitioner. If the patient is 
 much distressed by tenesmus and stools streaked with 
 blood, clysters of starch, with 20 drops of tr. opii, and 
 twice that number of tr. catechu or kino, should be given 
 every evening. 
 
 When convulsions have taken place, we must endea- 
 vour to remove what appears to be the exciting cause. 
 If the stomach have been overloaded with improper food ; 
 or there be signs of indigestion, a gentle emetic should 
 be given. If there is costiveness, or the bowels are af- 
 fected, they should be cleansed by a clyster: when the 
 stools are offensive, or the breathing at all affected, a few 
 grains of calomel and scammony may be given with ad- 
 vantage. If those medicines do not succeed, antispas- 
 modics should be administered. It often happens that 
 the deglutition is much affected, then it will be right to 
 give an enema with asafoetida: or if not, in a draught, a 
 drop or two of tinct. opii should be given. The back 
 may be rubbed with oil of amber, or aqua ammonias. — 
 During the fit it is always proper to put the lower parts 
 of the body into warm water, which by exciting a greater 
 flow of blood to the legs, takes off too great a determina- 
 tion to the head; a blister should be applied to the back 
 of the neck, and leeches may be applied to the temple. 
 
 Other symptoms which arise, must be met according to 
 their urgency; but we ought never to lose sight of what 
 16 
 
118 OF THE DISEASES 
 
 may appear to be the principal exciting cause, viz. the 
 inability of some teeth to pass through the gums. 
 
 Under every circumstance of indisposition, arising from 
 dentition, the lancing of the gums ought never to be omit- 
 ted. The benefit which attends the operation is so sud- 
 den, and if performed sufficiently early, is so certain, that 
 it ought never to be neglected. As soon as the gum is 
 lanced and the membrane is divided, the tooth obtains an 
 increase of room, the pressure is immediately taken off 
 from the socket, and the cause of irritation is removed. 
 
 It is very surprising that, notwithstanding the manifest 
 advantage which attends the lancing of the gums, in cases 
 of painful dentition, there are persons who entertain strange 
 prejudices against this safe and important source of relief. 
 But the uniform experience of its good effects, and no in- 
 stance of its doing harm ever having occurred, should 
 produce an unanimous consent for adopting it. Some 
 persons object to the operation on account of the pain 
 which it will occasion to the child, not considering that 
 the inflammation produced by the resistance of the gum 
 to the tooth, is far more acute than dividing the gum with 
 a sharp instrument. Others suppose that the formation 
 of the teeth is injured, and that they are more liable to 
 decay; but neither of these circumstances can occur; for 
 at the time that the teeth is about to pass through, the 
 enamel is completely formed, and no injury can be done 
 to the formation of the fang, which is always continued 
 for some time after the appearance of the crown. 
 
 When it is necessary to lance the gums some time be- 
 fore the teeth are quite ready to appear, they unite, and 
 in this case the cicatrix has been said to impede the pro- 
 gress of the tooth, presenting a greater resistance than the 
 gums in their natural state; but it is now certainly known 
 that a newly formed part always gives way sooner to the 
 
WHICH ATTEND DENTITION. 119 
 
 process of absorption than the surrounding parts, and 
 hence the passage of the tooth is facilitated. 
 
 The haemorrhage which is occasioned by the operation 
 is never considerable, but is always beneficial; the vessels 
 become unloaded, and the inflammation is always soon 
 diminished. 
 
 The most convenient instrument for this purpose is a 
 round edged gum lancet; this cuts much easier than a 
 pointed one. It is necessary that the tooth be felt with 
 the edge of the instrument, else the membrane may still 
 be left upon the stretch, and no other benefit be derived 
 than that which proceeds from the topical bleeding. In 
 lancing the incisores it will be proper, in dividing the 
 gum, to pass the lancet down on the anterior part of the 
 tooth : for if it be carried deep on the posterior part ol 
 the tooth, there may be a danger of dividing the membrane 
 which connects the pulps of the permanent teeth to those 
 of the temporary, and the formation of the former may 
 be injured.* [When the incision is made directly through 
 the summit of the gums covering the alveolar ridge, the 
 lancet passes behind the teeth, and to prevent which it 
 should be made about the twelfth or sixteenth part of 
 an inch anterior to it.] 
 
 When the gums of the molares are to be lanced, a 
 crucial incision may be made, or two semilunar incisions, 
 the gums soon separate, and the tooth shortly makes its 
 appearance. The symptoms which usually precede any 
 indisposition arising from teething ought to be universally 
 known, because then the certain remedy may be applied 
 in time, and a great deal of suffering be spared to the 
 child. If the nurse be attentive, she will find the child 
 does not take the nipple with the same degree of force 
 as ordinary, or it holds it only for a short time, and soon 
 
 * Plate IX. Fie. 5. 
 
120 OF THE DISEASES 
 
 lets it go; the gums feel hot, and are redder than usual; 
 the cheeks appear flushed, the eyes look heavy, and the 
 child is uneasy. When these symptoms appear, the 
 mouth should be examined, and if there be any fulness 
 of the gums, or they have the appearance of inflammation, 
 they should be lanced at that part. The order in which 
 the teeth appear should always be kept in mind, and then 
 there will be little probability of mistake, as to the spot 
 where the cause of irritation is seated. 
 
 As a child increases in strength, the symptoms arising 
 from dentition diminish, and often become merely local; 
 but the diseases to which infants are liable, frequently 
 keep them in weak health, and much disposed to be af- 
 fected by any exciting cause of irritation. 
 
 To delicate children there is often danger attending 
 the cutting of the cuspidati and the first molares. These 
 teeth advance in growth nearly at the same time, so that 
 there are eight teeth making pressure upon the mem- 
 branes and the gums at the same period. If at this time 
 a child should be at all indisposed, one or other of these 
 teeth may be the cause of convulsions, or some other se- 
 rious disease; therefore, when any of these teeth appear 
 to be in a state of forwardness, the gum should be lanced. 
 This is the only method of treatment to be relied on to 
 bring a weakly child through this period. 
 
 During the second dentition, with one exception, 
 scarcely any pain is felt; the constitution has acquired such 
 a degree of strength that the sympathetic action is with 
 more difficulty excited, and the only inconvenience ever 
 experienced is, when the permanent teeth, which are 
 placed at the base of the temporary ones, by the increase 
 of their growth make pressure against them; this more 
 particularly happens when the bicuspides are endeavouring 
 to come forward, and being resisted, by the continuance 
 
WHICH ATTEND DENTITION. ]21 
 
 of the temporary molares, a tenderness and pain are occa- 
 sioned, which can only be relieved by extracting the tem- 
 porary teeth, and thus giving way for the passage of the 
 permanent. 
 
 The exception to which I have alluded with respect to 
 pain during the second dentition, is in the clentes sapien- 
 tiae; very often a great deal of pain attends the progress 
 of these teeth. When there is scarcely sufficient space 
 for them to grow, or the gum being very thick is firmly 
 bound over them, considerable inflammation, and some- 
 times swelling of the face takes place. In many cases the 
 pain is so severe as to excite a considerable degree of fe- 
 ver and indisposition. I have known persons confined 
 from this cause only, during several weeks. If the clen- 
 tes sapientioe of the upper jaw pass through first, it very 
 much increases the inflammation, because whenever the 
 mouth is closed, the gums which cover the teeth in the 
 under jaw are bitten upon by the upper, and being con- 
 tinually pinched, the patient suffers extremely. 
 
 Generally it is only necessary to lance the gums with a 
 crucial incision; there is often a good deal of hemorrhage, 
 which is very useful in reducing the inflammation; the 
 gum soon retracts, and the tooth gradually passes through. 
 When the upper clentes sapientiae appear first, it is some- 
 times necessary to cut off the piece of gum which covers 
 the under tooth. 
 
 In many cases the gum is very thick, and will often 
 close and unite again after the operation; this produces a 
 necessity for repeating it; but which might always be pre- 
 vented, by inserting a small piece of lint between the 
 edges of the divided gum, which then cannot unite; they 
 remain separated, and gradually receding, the tooth has 
 no longer any obstruction. 
 
 Sometimes, in these cases the gum is exceedingly 
 
122 DISEASES WHICH ATTEND DENTITION. 
 
 swelled over the toothy and when divided by the lancet, 
 a considerable quantity of glairy fluid escapes; in some 
 instances I have met with considerable quantity of matter, 
 and in one case the gum was ulcerated to a great extent. 
 [But neither lancing the gums nor cutting out a piece 
 from over the tooth, will always afford relief, the extrac- 
 tion of the tooth itself is often necessary, or the antagoniz- 
 ing one in the other jaw, which, having made its appear- 
 ance first, strikes the gums covering this, at each occlusion 
 of the mouth, causing it to inflame and swell and often- 
 times to become exceedingly painful. The extraction of 
 the second molaris w r ill generally give relief, and when 
 this is very much decayed, it is better to remove it, than 
 the dens sapientiae. So great is the irritation sometimes 
 produced by the dentition of these teeth, that trismus has 
 been known to result from it. Two cases of this sort 
 have fallen under my own observation. In cases of this 
 sort, the treatment should be addressed to the general 
 system. Copious bleeding, warm bath and small doses of 
 emetic tartar should be had recourse to, for the purpose 
 of inducing a relaxation of the muscles of the jaw, and 
 so soon as this is accomplished, the tooth should be ex- 
 tracted.] 
 
CHAPTER ELEVENTH. 
 
 Being desirous to render this work as complete as 
 possible, I requested the favour of my friend, Mr. Pepys, 
 to make a chemical analysis of the teeth, and from the 
 accuracy with which all his experiments are conducted, 
 I flatter myself that the following observations will not 
 a little enhance the value of the publication. 
 
 THE ANALYSIS OF HUMAN TEETH. 
 
 BY W. H. PEPYS, JR. 
 
 Mr. Charles Hatchet, in his valuable paper on shell and 
 bone, [Phil. Transact, for 1799] enumerated the several 
 substances which enter into the composition of the human 
 teeth; it is to be regretted that the nature of his subject 
 did not render it necessary for him to ascertain the pro- 
 portions in which they are respectively found, as it could 
 not have failed to have proved highly useful, and his 
 known accuracy would have precluded the necessity of 
 any other person undertaking such a labour. Several 
 good analyses of bone have been published, but I believe 
 no accurate analysis of the teeth has yet been offered. 
 
 Bone, it has been observed, when exposed to the ac- 
 tion of acid menstrua, becomes dissolved; that is to say, 
 the solid or constituent substance of them is abstracted, 
 and a gelatinous matter is left of the form of the original 
 bone. 
 
124 THE ANALYSIS OF HUMAN TEETH. 
 
 Nitric, muriatic, and acetic acids are capable of produ- 
 cing this change, which is accompanied with a liberation 
 of an aeriform fluid, that precipitates lime in lime water, 
 changes vegetable blues red, and by its gravity is known 
 to be carbonic acid gas. These acid solutions yield a co- 
 pious precipitate with pure ammonia, which is again solu- 
 ble in either of the acids. After the precipitation by pure 
 ammonia, the solution of the carbonate of ammonia will 
 still produce a new precipitate. 
 
 The precipitate of the first solution, by pure ammonia, 
 as noticed above, is soluble again in the acids before men- 
 tioned; these solutions yield, with a solution of acetite of 
 lead, a copious precipitate, proving the presence of phos- 
 phoric acid. 
 
 The precipitate obtained by the carbonate of ammonia 
 is also soluble in either of the above acids, but with effer- 
 vescence; and these solutions are not precipitated by ace- 
 tite of lead; they fall, however, with oxalate of ammonia, 
 carbonate of ammonia, or any precipitant of lime. 
 
 The great solubility of the phosphate of lime, in even 
 the weakest of the acids, is very extraordinary. Phos- 
 phate of lime mechanically suspended in water, is speedily 
 and completely dissolved by passing a copious stream of 
 carbonic acid gas through it. 
 
 With these facts before me, I have ventured to exam- 
 ine the several specimens of the human teeth; as the 
 enamel, the bone, or roots, the teeth of adults, and the 
 shedding teeth of children. 
 
 Previous to an account of the analysis, it may not be 
 uninteresting to notice the action of some of the articles 
 of the materia chemica on the teeth. 
 
 Sulphuric acid, of the specific gravity 1.83, appears at 
 first to have no action; in the course of an hour small 
 bubbles are perceived, the roots become blackened, and 
 
ANALYSIS OF THE ENAMEL. 125 
 
 in twelve hours the enamelled part bursts, cracks, and 
 separates, accompanied with an evident formation of sele- 
 nite, by the action of the acid on the lime, which enters 
 into the composition of the teeth. 
 
 Nitric and muriatic acids of the specific gravity of 1.12, 
 act instantly on the tooth, accompanied with an evolution 
 of a quantity of small air bubbles from the wdiole of the 
 surface; about eight times their weight of these acids are 
 sufficient for the solution of the solidifying principles of 
 the teeth. The mass left undissolved has nearly the ori- 
 ginal form of the tooth, is flexible, semi-transparent, and 
 easily divided by the nail. 
 
 The dilute acetous acid (distilled vinegar) has a very 
 trifling action, but when concentrated, acts both on the 
 phosphate and carbonate of lime. 
 
 Boiling nitric acid acts strongly on a tooth, with the 
 evolution of carbonic acid, and a considerable quantity of 
 azotic gas. The gelatine and solid substance are dis- 
 solved as the surfaces present themselves; but the opera- 
 tion being stopped at any part of the process, the resi- 
 duum is firm and hard, but reduced in size proportioned 
 to the time the tooth has been acted upon. 
 
 ANALYSIS OF THE ENAMEL. 
 
 One hundred grains of the enamel of human teeth, 
 (carefully rasped) were placed in 600 grains of nitric 
 acid of the specific gravity of 1.12. Slight effervescence 
 ensued, and after twelve hours 200 grains more of the 
 acid were added. Allowing for the loss by evaporation 
 in a corresponding vessel, after thirty-six hours it was 
 found to have lost four grains and a half. 
 17 
 
126 ANALYSIS OF THE ENAMEL. 
 
 It was then diluted with four ounces of distilled water, 
 precipitated by pure ammonia, and then filtered. 
 
 The precipitate obtained being dried in a water bath, 
 at 212°, weighed 102 grains. It was then ignited, after 
 w T hich it was found to weigh 78 grains. 
 
 The filtered solution was then precipitated by carbo- 
 nate of ammonia in solution, and filtered : 
 
 The separated precipitate being dried in a heat of 212°, 
 weighed six grains. Enamel then consists of 
 
 Phosphate of lime, ... 78 
 Carbonate of lime, ... 6 
 
 ~84 
 Water of composition and loss, . 16 
 
 100 
 A loss of 16 grains here takes place, which is easily ac- 
 counted for, from the impossibility of directly ascertaining 
 the state of dryness in which the ingredients existed 
 originally in the enamel; for we have seen, that by drying 
 the phosphate of lime in a heat of 212°, (after which it 
 had the appearance of being as dry as possible) it yet 
 contained so much moisture, as to yield a gain of 8 grains 
 in the analysis. 
 
 On the other hand, when ignited, its state is driven to 
 the opposite extreme, and there is a loss of 16 grains. It 
 is impossible, however, that the materials could exist in 
 the teeth, in a state of dryness to be compared with that 
 produced by exposing them to such a high temperature. 
 And it appears but reasonable to conclude, that the real 
 quantity of moisture lies nearer to that given by the heat 
 of 212°, than to that given by ignition, and consequently 
 that the 16 grains lost by exposure to such a high tem- 
 perature, were chiefly water. 
 
ANALYSIS OF THE ENAMEL. 127 
 
 Bone, or roots of teeth, yielded by analysis in 100 grs. ; 
 Phosphate of lime, ... 58 
 Carbonate of lime, ... 4 
 
 Gelatine, ..... 28 
 
 90 
 Water of composition and loss, . 10 
 
 100 
 
 The teeth of adults yielded on analysis in 100 grains, 
 
 Phosphate of lime, ... 64 
 
 Carbonate of lime, ... 6 
 
 Gelatine, 20 
 
 90 
 
 Water of composition and loss, . 10 
 
 100 
 Specific gravity of adults' teeth, . 2.2727. 
 The shedding, or primary teeth of children, yielded on 
 analysis in 100 grains, 
 
 Phosphate of lime, ... 62 
 Carbonate of lime, ... 6 
 
 Gelatine, 20 
 
 88^- 
 Water of composition and loss, . 12 
 
 100 
 Specific gravity of children's teeth, . 2.0833. 
 
 In these analyses, as in the former, the phosphate of 
 lime was also exposed to a red heat, and consequently 
 was reduced to a greater degree of dryness than that in 
 which it existed in the tooth. 
 
 In all of them the carbonate of lime was dried in a heat 
 of 212° (above which it would have been liable to de- 
 composition) and the gelatine of the three last in the 
 same temperature. 
 
EXPLANATION OE PLATES 
 
 TO 
 
 PART FIRST. 
 
PLATE I 
 
 THE RUDIMENTS OF THE ALVEOLAR PROCESSES AND THE 
 PULPS OF THE TEETH. 
 
 Fig. 1. The under jaw of a foetus at three or four 
 months. In the anterior part, processes of 
 bone are shooting across to form the alveoli 
 for the incisores. 
 
 Fig. 2. The gums removed from the same jaw bone, 
 exhibiting the first appearance of the pulps, 
 those of the incisores being the most distinct. 
 
 Fig. 3. The under jaw of a fetus at six months, in 
 which the alveolar processes are seen more 
 advanced. 
 
 Fig. 4. The pulps removed from the same jaw, dis- 
 tinctly formed, each contained within its pro- 
 per membrane. 
 
 Fig. 5, 6. The upper jaws of fetuses of the same age, 
 as in Fig. 1, 2; exhibiting the alveolar pro- 
 cesses and pulps. 
 
PLATE II. 
 
 THE PROGRESS IN THE FORMATION OF THE TEETH FROM THE 
 TIME OF BIRTH, UNTIL BETWEEN TWO AND THREE YEARS 
 OF AGE. 
 
 * # * The figures on the left side of the plate represent 
 the teeth as naturally situated ; those on the right side as 
 taken out from the sockets; the dotted lines represent 
 the gums. 
 Fig. 1. The teeth at the time of birth, when they are 
 
 only shells, having the form of the crowns of 
 
 teeth. 
 
 a. The central incisores. 
 
 b. The lateral incisores. 
 
 c. The cuspidati. 
 
 d. The first molares. 
 
 e. The second molares. 
 
 A. Points of ossification upon the tips of the pulps 
 
 of the permanent incisores. 
 
 B. Points of ossification upon the points of the per- 
 
 manent molares. 
 Fig. 2. The teeth of a child about six or eight months 
 after birth. At this time the central incisores 
 of the upper jaw, and the central and lateral 
 incisores of the lower jaw, have made their 
 appearance; the other teeth are considerably 
 advanced in growth. 
 
PLATE II. 133 
 
 a b c d e. The temporary teeth. 
 
 A. The permanent central incisores. 
 
 B. The permanent lateral incisores. 
 
 C. The permanent cuspidatus of the lower jaw. 
 
 D. The first permanent molares. 
 
 Fig. 3. The teeth of a child at sixteen months. The 
 incisores in each jaw, and the first molares, 
 have passed through the gums. 
 
 A. The permanent incisores much increased. 
 
 B. The cuspidati. 
 
 C. The first permanent molares. 
 
 Fig. 4. The temporary set of teeth have all passed 
 through the gums ; and in addition to the per- 
 manent teeth already described are ; 
 A A. The points of the first bicuspides. 
 
 18 
 
PLATE III.* 
 
 THE TEETH OF A CHILD BETWEEN FOUR AND FIVE YEARS 
 
 OF AGE. 
 
 Fig. 1. A side view. Fig. 2. A front view. 
 
 Of the temporary set. 
 acta a. The central incisores. 
 bbbb. The lateral incisores. 
 c c c c. The cuspidati. 
 dd dd. The molares. 
 
 Of the permanent set. 
 e e e e. The central incisores. 
 ffff The lateral incisores. 
 g g g g. The cuspidati. 
 hhhh. The first bicuspides. 
 iiii. The first molares. 
 k k. The second molares. 
 
 The formation of the second bicuspides has not yet 
 commenced. 
 
 * For the references to this Plate, and Plates IV. and V. see the outline Plate VI. 
 
PLATE IV. 
 
 THE TWO SETS OF TEETH AT SIX YEARS OF AGE. 
 
 Fig. 3. of Plate VI. 
 
 Of the temporary set. 
 aaaa. The central incisores. 
 bbbb. The lateral incisores. 
 c c c c. The cuspidati. 
 dddd. The molares. 
 
 Of the permanent set. 
 e e e e. The central incisores. 
 ff. The lateral incisores. 
 g g g g. The cuspidati. 
 hhhh. The first and second bicuspides. 
 i i. The first molares. 
 k k. The second molares. 
 
PLATE V. 
 
 THE TEETH AT EIGHT OR NINE YEARS OF AGE. THE INCI- 
 SORES HAVE BEEN CHANGED, AND THE FIRST PERMANENT 
 MOLARES HAVE APPEARED. 
 
 Fig. 4. of Plate VI. 
 
 Of the temporary set. 
 a a. The cuspidati. 
 bbbb. The molares. 
 
 Of the permanent set. 
 c c c c. The central incisores. 
 dddd. The lateral incisores. 
 
 e e. The cuspidati. 
 ffff The bicuspides. 
 g g. The first molares. 
 h h. The second molares. 
 i i. The third molares, or dentes sapien- 
 tiae ; beginning to form. 
 
HATE VII. 
 
 (FROM GOODSIR.) 
 
 Fig. 1. Mucus membrane. 
 
 Fig. 2. Mucus membrane with a granular mass rising up 
 from it. 
 
 Fig. 3. Primitive dental groove. 
 
 Fig. 4. A papilla on the floor of the groove. 
 
 Fig. 5. The papilla enclosed in a follicle, and the se- 
 condary dental groove forming. 
 
 Fig. 6. The papilla assuming the shape of a pulp, the 
 opercula forming and a depression for a cavity 
 of reserve behind the inner operculum. 
 
 Fig. 7. The papilla after it has become a pulp, the follicle 
 a sac by the adhesion of the lips of the oper- 
 cula, and the secondary dental groove in the 
 act of closing. 
 
 Fig. 8. The secondary groove adherent, except behind 
 the inner operculum, where there remains a 
 shut cavity of reserve for the formation of the 
 pulp and sac of the permanent tooth. 
 
 Fig. 9. The last change more complete by the deposition 
 of the granular body, deposition of tooth-bone 
 commencing. 
 
 Fig. 10. The cavity of reserve receding, its bottom in 
 which the pulp is forming dilating. 
 
 Fig. 11. The cavity of reserve becoming a ^ac with a 
 
138 PLATE VII. 
 
 pulp at its bottom, and further removed from 
 the surface of the gum; the temporary tooth 
 covered with a layer of bone, and the granular 
 substance absorbed. 
 
 Fig. 12. The temporary tooth getting its fang, and ap- 
 proaching the surface of the gum. 
 
 Fig. 13. Root of the temporary tooth longer, and its sac 
 touching the surface of the gum. 
 
 Fig. 14. Eruption of the temporary tooth; its sac again 
 a follicle, and the permanent receding further 
 from the surface of the gum. 
 
 Fig. 15. Completion of the temporary tooth; free portion 
 of the sac become the vascular margin of the 
 gum, and the permanent sac connected by a 
 chord passing through the alveolo-dental canal 
 or foramen. 
 
 Fig. 16. Lengthening of the root of the permanent tooth, 
 the crown approaching the gum, and the root 
 of the temporary tooth partly destroyed. 
 
 Fig. 17. The changes last described more advanced. 
 
 Fig. 18. The eruption of the permanent tooth, and the 
 molting of the temporary. 
 
 Fig. 19. The permanent tooth perfected. 
 
 Fig. 20. The primitive dental groove in its non-adherent 
 state. 
 
 Fig. 21. The papilla and follicle of the first molaris on 
 the floor of the non-adherent portion of the 
 groove, now become the secondary groove. 
 
 Fig. 22. The papilla a pulp, and the follicle a sac, and 
 the lips of the secondary groove adhering, so 
 that the latter has become the posterior or 
 great cavity of reserve. 
 
 Fig. 23. The sac of the first molar increased in size, ad- 
 vancing into the coronoid process or maxillary 
 
PLATE VII. 139 
 
 tuberosity, and the cavity of reserve length- 
 ened. 
 Fig. 24. The sac of the first molaris returning by the 
 
 same path to its former position, and the cavity 
 
 of reserve shortening. 
 Fig. 25. The cavity of reserve sending backwards the 
 
 sac of the second molaris. 
 Fig. 26. The sac of the second molaris passing into the 
 
 coronoid process or maxillary tuberosity. 
 Fig. 27. The second molar sac returned, and the cavity 
 
 of reserve shortened. 
 Fig. 28. The cavity of reserve sending off the sac and 
 
 pulp of the wisdom tooth. 
 Fig. 29. The sac of the wisdom tooth advanced into the 
 
 coronoid process or maxillary tuberosity. 
 Fig. 30. The sac of the wisdom tooth returned to the 
 
 extremity of the dental range. 
 
PLATE VIII. 
 
 Fig. 1. The permanent set of teeth complete. 
 Row 1. The temporary teeth of the upper jaw. 
 Row 2. The permanent teeth of the upper jaw, 
 Row 3. The permanent teeth of the lower jaw. 
 Row 4. The temporary teeth of the lower jaw. 
 
PLATE IX. 
 
 Fig. 1. Longitudinal sections of teeth, the bony part 
 of which has been burnt, to render the distri- 
 bution of the enamel more conspicuous. 
 
 Fig. 2. The transverse section of a molaris. 
 
 Fig. 3. A tooth magnified, to exhibit the striated ap- 
 pearance of the enamel. 
 
 Fig. 4. An under jaw, the fore part of which, and of 
 the teeth, have been sawn away to shew the 
 cavities in the teeth. 
 
 Fig. 5. A section of the under jaw; the nerve is seen 
 giving off branches which enter the cavities 
 of the teeth. 
 
 Fig. 6. A molaris of the under jaw, having three fangs. 
 
 Fig. 7. A molaris having on its side a deposit of enam- 
 el like a pearl. 
 
 Fig. 8. The central incisores of the under jaw united 
 at the sides. 
 
 Fig. 9. Two views of the second and third molares of 
 the upper jaw, which are united by the 
 inner fangs. 
 
 Fig. 10. A molaris of the under jaw, having the crown 
 of a bicuspis growing out of its side. 
 
 Fig. 1 1. A molaris of the under jaw, having four fangs. 
 
 Fig. 12. The permanent central incisores of the under 
 jaw, having an exceedingly deformed appear- 
 ance. 
 19 
 
142 PLATE IX. 
 
 Fig. 13. A molaris of the upper jaw ; having five fangs. 
 
 Fig. 14. Several teeth, shewing the appearance of the 
 enamel when defective in quantity, the sur- 
 face of the teeth being covered with small 
 indentations. 
 
PLATE X. 
 
 ALL THE FIGURES OF THIS PLATE ARE FROM INJECTED 
 PREPARATIONS. 
 
 Fig. 1. The under jaw of a child at the time of birth; the 
 fore part has been removed, and the membranes 
 inclosing the teeth are seen to be vascular. 
 
 Fig. 2. The teeth have been turned out of the sockets, 
 and the inner membranes are also seen to be 
 vascular. 
 
 Fig. 3. The lower jaw of a foetal calf, in which the vas- 
 cularity of both membranes is seen. The 
 membrane belonging to one tooth has been 
 turned down to exhibit the vascularity on the 
 inner side. 
 
 Fig. 4. Half of the upper jaw of a boy about eight years 
 of age. Part of the central incisor, the cuspi- 
 datus, the first molaris and the second molaris, 
 (not yet completely formed) has been cut 
 away to show the vascularity of the membrane 
 within the cavities of the teeth. The lateral 
 incisor and the bicuspides are contained within 
 the membranes. 
 
 Figs. 5, 6, 7, 8, and 9, represent the manner in which 
 permanent teeth are formed. 
 
 Fig. 5. Half the under jaw of a child soon after birth. 
 The membranes of the teeth are seen, and over 
 the bristle the membranes of the pulps of the 
 incisores and the cuspidatus of the permanent 
 
144 PLATE X. 
 
 set, which are firmly attached to the membranes 
 of the temporary teeth. 
 
 Fig. 6. Part of the jaw of a child about three years of 
 age. The permanent teeth are placed deep 
 in the jaw, and their membranes remain at- 
 tached to the gams. The vessels of the mem- 
 branes are derived from the gums. The 
 artery which passes through the jaws sends off 
 branches to the pulps of the teeth. 
 
 Fig. 7. Teeth which have been removed from the sockets 
 to explain the attachments of the permanent to 
 the temporary teeth. 
 
 a. The pulp of the temporary teeth inclosed within 
 
 its membrane. 
 
 b. The pulp of the permanent teeth attached by its 
 
 membrane to that of the temporary. 
 
 c. The temporary tooth completely grown. 
 
 d. The permanent tooth attached to the gum, the 
 
 membrane beins: elongated into a sort of 
 pedicle. 
 
 Fig. 8. A section of the lower jaw, showing the tempo- 
 rary tooth, with the manner of the situation 
 and attachment of the permanent tooth. 
 
 Fig. 9. Exhibits the manner in which the pulps of the 
 permanent molares are produced. 
 
 a. The first permanent molaris inclosed in its mem- 
 
 brane. 
 
 b. A small membranous substance given off from 
 
 the membrane of the first, and which becomes 
 the pulp of the second permanent molaris. 
 Fig. 10. Half of a young jaw, showing the foramina 
 through which the membranes of the perma- 
 nent teeth pass, to be attached to the gums. 
 A bristle is placed in one, and is seen going 
 into the socket of the new tooth. 
 
PLATE XI. 
 
 Fig. 1. The progress of absorption in several of the 
 
 temporary cuspidati. 
 Fig. 2. The same circumstance exemplified in several of 
 
 the temporary molares. 
 Figs. 3 and 4. Sections of the lower jaw exhibiting the 
 
 progress in the formation of the permanent 
 
 teeth, and the absorption of the fangs of the 
 
 temporary teeth. 
 Fig. 5. Exemplifies the changes which take place in the 
 
 teeth at different periods. 
 
 A. Part of the under jaw of a child at six years, 
 
 when the temporary teeth only are visible. 
 
 B. Part of the jaw of a child about eight or nine 
 
 years of age. The temporary incisores and 
 cuspidatus have been removed; the permanent 
 incisores and the first permanent molaris have 
 grown up. 
 
 C. In this jaw the first temporary molaris has been re- 
 
 moved, and is succeeded by the first bicuspis ; 
 the cuspidatus and the second permanent 
 molaris are appearing. 
 
 D. Part of a jaw in the adult state. The second 
 
 temporary molaris has been succeeded by the 
 second bicuspis. The third molaris, or dens 
 sapientiae, has made its appearance. In this 
 series of jaws, the change of the temporary 
 
J 46 PLATE XI. 
 
 teeth for the permanent, and the addition of 
 the permanent molares are clearly elucidated. 
 The teeth which succeed the temporary inci- 
 sores and cuspidati are larger, and those which 
 succeed the temporary molares are smaller. 
 Fig. 6. The upper jaw of a foetus, in which only one 
 incisor had formed, 
 a. The incisor. 
 
 b. b. The cuspidati. 
 
 c. c. The first molares. 
 
PLATE XII. 
 
 EXAMPLES OF IRREGULARITY SOMETIMES OCCURRING DURING 
 THE SECOND DENTITION. 
 
 Those permanent teeth which are acquiring an irregu- 
 lar position, are sufficiently obvious. Those marked a a, 
 are the temporary teeth which ought to be extracted. 
 
PLATE XIII. 
 
 Fig. 1. One central incisor turned in, being placed 
 
 when the mouth is elosed ; behind the under 
 
 teeth. 
 
 a a. The temporary lateral incisores. 
 Fig. 2. The same circumstance occurring in both the 
 
 central incisores. The lateral incisores being 
 
 placed properly. 
 
 a a. The temporary cuspidati. 
 Fig. 3. The central permanent incisores rightly situa- 
 ted, the lateral ones turned in. 
 
 a a. The temporary cuspidati. 
 Fig. 4. The four permanent incisores, having the same 
 
 improper situation. 
 Fig. 5. The bar to be fixed on the teeth, in order to 
 
 remedy this kind of irregularity. 
 Fig. 6. Represents the bar as fixed in order to bring 
 
 one of the central incisores forward. 
 Fig. 7. The bar fixed; with ligatures applied to the 
 
 four permanent incisores, which are to be 
 
 drawn forward. 
 
PLATE XIV. 
 
 (FROM CATALAN, DELABARRE, ROBERTSON AND NATURE.) 
 
 Fig. 1. An apparatus invented by M. Catalan to be 
 placed upon the lower teeth, with four in- 
 clined planes fixed to it, and designed to act 
 upon the four incisores of the upper jaw. 
 
 Fig. 2. The apparatus applied with a view to exhibit 
 the principle upon which it acts. 
 
 Fig. 3. In this figure, copied from Delabarre, an incisor 
 tooth with one of its approximal surfaces pre- 
 senting anteriorly, is represented. 
 
 Fig. 4. A cap applied to the deviating incisor with liga- 
 tures attached to it, for the purpose of turning 
 the tooth in its socket until the front surface 
 shall present anteriorly. This figure is also 
 copied from M. Delabarre. 
 
 Fig. 5. The manner of correcting irregularity of the 
 teeth by means of ligatures and a metallic 
 grate, as proposed by M. Delabarre. 
 
 Fig. 6. This figure, representing an apparatus applied to 
 the lower teeth with an inclined plane acting 
 upon a central incisor, is copied from Mr. 
 Robertson's Treatise on the Teeth. 
 
 Fig. 7. The last named apparatus before being applied 
 to the teeth. 
 
 Fig. 8. A gold case fitted to the lower teeth with an in- 
 clined plane to act upon a deviating cuspidatus, 
 constructed by the editor. 
 20 
 
Fig. 
 
 1. 
 
 Fig. 
 
 2. 
 
 Fig. 
 
 3. 
 
 PLATE XV. 
 
 CASES OF IRREGULARITY FROM SUPERNUMERARY TEETH, be. 
 
 Supernumerary teeth of the conical form. 
 Supernumerary teeth resembling bicuspides. 
 A tooth which acquired a distorted shape 
 during its formation, from the resistance 
 of the temporary tooth. 
 Fig. 4. A supernumerary tooth placed between the 
 
 central incisores. 
 Fig. 5. A supernumerary tooth growing above the 
 
 central and the lateral incisor. 
 Fig. 6. A remarkable case of irregularity, occasioned 
 by the growth of two supernumerary teeth. 
 Fig. 7. A similar case, the supernumerary resembled 
 
 bicuspides of the lower jaw. 
 Fig. 8. A case of two lateral incisores on the same side. 
 
 irregularity at an advanced period. 
 
 Fig. 9. The lateral permanent incisores to be ex- 
 tracted. 
 
 Fig. 10. The most irregular tooth must be removed, 
 when the others will approximate. 
 
 Fig. 11. A cuspidatus left projecting until a late pe- 
 riod; this being removed, the teeth will 
 appear regular, as the lateral incisor and 
 the first bicuspis are close to each other. 
 
 Fig. 12. An exfoliation from the upper jaw, containing 
 the temporary molares, and (a a) the bi- 
 cuspides advancing in formation, b. The 
 socket for the permanent cuspidatus. 
 

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PART II. 
 
 THE HISTORY AND TREATMENT OF THE DISEASES OF THE 
 TEETH, THE GUMS, AND THE ALVEOLAR PROCESSES, 
 
 THE OPERATIONS WHICH THEY RESPECTIVELY REQUIRE: 
 
 TO WHICH ARE ADDED 
 
 OBSERVATIONS ON OTHER DISEASES OF THE MOUTH, 
 
INTRODUCTION. 
 
 In the former part, I endeavoured to prove that the 
 teeth are organized in a similar manner to other bones, 
 and that, as possessing life, they are connected with, and 
 form an integral part of, the system. 
 
 I have now the satisfaction to find that the same opinion 
 is entertained by almost all the enlightened members of 
 the surgical profession. 
 
 Mr. Hunter, who made many experiments, by feeding 
 animals with madder, in order to ascertain the effect it 
 would produce in colouring the different bones of the 
 body, having observed that the teeth did not become 
 tinged so speedily as the other bones, or, when tinged, 
 that they retained their colour longer, hence concluded, 
 that "they are to be considered as extraneous bodies, 
 with respect to a circulation through their substance." 
 
 The consequence of having formed this opinion was, 
 that he could not, in any satisfactory manner, assign a 
 cause for the different diseases of the teeth. It must, 
 however, appear extraordinary that Mr. Hunter, who 
 was so accurate an observer of the phenomena of nature, 
 should have published this opinion, when he immediately 
 added, that "they (the teeth) have most certainly a 
 
154 INTRODUCTION. 
 
 Jiving principle, by which means they make part of the 
 body, and are capable of uniting with any part of a living 
 body." 
 
 The diseases which affect the mouth, and which are 
 commonly considered as cases on which the surgeon-den- 
 tist is to be consulted, arise from affections of the teeth, 
 the gums, and the alveolar processes. 
 
 The teeth are the organs of mastication ; they are 
 placed in sockets called alveoli, which are formed upon 
 and make a part of the jaw bones, and are there firmly 
 held by a periosteum, which lines the socket, and is also 
 reflected over the fangs of the teeth. The alveolar pro- 
 cesses are covered with a continuation of the gums, which 
 are firm, but very vascular substances. 
 
 These parts have such an intimate connection with each 
 other, that, when diseases originate in one, the others al- 
 ways become more or less affected. It is therefore abso- 
 lutely necessary that an accurate knowledge should be 
 had of all the diseases of those parts connected with the 
 teeth; for, as the loss of the teeth is the ultimate conse- 
 quence of disease in any of the contiguous parts, we can 
 only expect to preserve instruments, so important to our 
 comfort and welfare, by speedily applying such remedies 
 as will restore the parts with which they are connected 
 to healthy action. 
 
 The diseases to which the teeth are subject are similar 
 to those which affect bones in general, and in like manner 
 they have their origin in inflammation.* The teeth differ 
 only from bones in not possessing sufficient living power to 
 effect the process of exfoliation. 
 
 These different kind of diseases affect various parts of 
 
 [*To this error, we alluded in the first part of the work, and our reasons Tor reject- 
 in;; this hypothesis, we shall presently state at length.] 
 
INTRODUCTION. 155 
 
 the teeth. A death of any part of the crown of a tooth 
 constitutes caries. 
 
 The fangs are occasionally enlarged, as in exostosis. 
 
 The membrane contained within the cavity of a tooth 
 sometimes inflames and suppurates, and the matter, being 
 discharged at the extremity of the fang, causes that part 
 of the tooth to acquire an appearance of a bone affected 
 with spina ventosa. 
 
 A death of the fangs of the teeth often takes place, and 
 presents a disease resembling that which in bones is 
 called necrosis. 
 
 Besides these diseases, there are changes produced by 
 a removal of the enamel from the bone of the tooth, called 
 by Mr. Hunter, decay by denudation. Also very disa- 
 greeable and painful affections resulting from accidents, 
 such as fractures or luxations of teeth. 
 
 The gums are subject to several diseases peculiar to 
 themselves, and to others which proceed from those of 
 the teeth, or alveolar processes, beside other affections, 
 which may be considered as the index of constitutional 
 derangement. 
 
 The alveoli of the teeth have also their distinct dis- 
 eases, as well as others in common with the teeth and 
 gums, and are liable to be affected by diseases of the consti- 
 tution. 
 
 In addition to these various diseased actions, there is 
 an earthy deposit, called tartar, which, in a greater or less 
 degree, accumulates about the teeth of most persons; this, 
 if suffered to increase to any quantity, causes a separation 
 of the gums from the necks of the teeth, and a consequent 
 absorption of the alveolar processes. 
 
 There are also diseases requiring surgical aid to which 
 the antrum maxillare is liable; and different imperfections 
 of the palate or roof of the mouth, arising either from 
 
156 INTRODUCTION. 
 
 natural malformation, or the consequence of disease. — 
 When these have been considered, the mode of supplying 
 the loss of teeth, by means of artificial ones, will be de- 
 scribed : and the work concluded with an account of the 
 method of performing the several operations which the 
 diseases of the teeth require. 
 
PART SECOND 
 
 CHAPTER FIRST. 
 
 OF CARIES. 
 
 Caries, or, as it is commonly called, decay, is the dis- 
 ease with which the teeth are most frequently affected. 
 At first it has its origin in the bony part of the crown of 
 the tooth, the structure of which is gradually destroyed, 
 and the disease proceeds until the whole of the crown of 
 the tooth, both the enamel and bone, is entirely removed. 
 [The enamel, though less frequently, is nevertheless some- 
 times, first attacked.] 
 
 When caries has made some progress internally, a small, 
 opaque spot appears upon the enamel, where it covers 
 that part of the tooth which is diseased, and the bony part 
 of the tooth situated underneath this spot will be found of 
 a dark brown [black, light brown or white] colour: when 
 the decay has advanced so far as to destroy the texture of 
 part of the bone of the tooth, the enamel loses its support, 
 then breaks away, and a cavity is discovered in the tooth.* 
 Thus it is that in the first instance, caries originates; and 
 
 * Plate XVI. Fig. 1, 2. 
 
 21 
 
158 OF CARIES. 
 
 it is by no means uncommon for a person, in a very short 
 space of time, to discover cavities in several teeth, which 
 had been supposed perfectly sound. In the mastication 
 of hard substances, pieces of the enamel are broken off, 
 on account of the texture of the bony part being destroyed 
 by the caries, which had previously gone on internally. 
 
 [The first manifestation of the disease, is in some] in 
 the irregularities of the grinding surfaces of the molares, 
 and resembles a crack filled with a black substance, which 
 at length breaks into a cavity in the centre of the tooth ; 
 in others, it commences in the side of the tooth next the 
 cheek; and sometimes at the neck of the tooth, the de- 
 cay extending into the body of the tooth underneath the 
 enamel. 
 
 The decay very often commences on those sides of the 
 teeth which are placed in opposition to each other; this 
 is the worst possible situation for the disease, because it 
 often makes considerable progress without being disco- 
 vered, and is much less conveniently placed for the per- 
 formance of an operation to arrest its progress. 
 
 In the incisores, the caries most commonly begins at the 
 sides, between the teeth; in some, it appears near the 
 neck, the cavity extending across the tooth and the dis- 
 ease proceeds until the tooth is nearly divided in two ; in 
 this case, w T hilst biting something hard, the lower part 
 of the tooth usually breaks off, leaving the fang in the 
 socket, and a small portion of the body of the tooth. 
 
 The molares are more subject to this disease than any 
 of the other teeth: the incisores of the upper jaw r are 
 very frequently affected by it, whilst the incisores of the 
 lower jaw very seldom become decayed. 
 
 When a decayed tooth is examined, the carious part 
 appears to be disposed in strata, the external is the most 
 decayed, is black, and so soft that it may be easily picked 
 
OF CARIES. 159 
 
 away.* The next stratum will be found of a harder 
 texture, and not so black in colour, and as the substance 
 of the tooth is less decayed it becomes more dense, until 
 we arrive at the sound part. Whenever a decay has 
 taken place in a tooth, and the enamel, by becoming 
 opaque, begins to exhibit the appearances of this disease 
 as having gone on underneath, if the tooth be sawn 
 through, a brown mark will be found extending into the 
 natural cavity of the tooth : it is in this direction the de- 
 cay always proceeds, and, when the cavity is exposed, 
 the membrane which lines it, and upon which the nerve 
 and the blood-vessels ramify, most commonly becomes 
 inflamed, and causes pain. 
 
 During the progress of caries in a tooth, it is the inter- 
 nal part of the crown which is the soonest removed, 
 causing the tooth to appear as if the inside had been 
 scooped out. The enamel, being much harder than the 
 bone, remains, and only breaks away as it loses its sup- 
 port, from the bony part becoming dissolved and re- 
 moved, f 
 
 The progress of caries seems to be retarded when it 
 has destroyed the whole crown of a tooth ; for although 
 the decay may have gone on in the body of the tooth 
 with great rapidity, yet the fangs will often remain for 
 many years with scarcely any alteration, and they often 
 continue for a considerable length of time firmly attached 
 to the socket, without occasioning any inconvenience. 
 Persons rarely experience the tooth-ache, properly so 
 called, from stumps; for, when the caries has destroyed 
 the whole of the body of the tooth, the membrane which 
 
 [* The consistence of the carious part of a tooth is exceedingly variable, — depend- 
 ing upon the density of the organ. In some teeth, it is almost as hard as the tooth 
 itself throughout every part of it; in others, it is very soft, and the colour is gene- 
 rally dark in proportion to the density of the affected organ.] 
 
 f Plate XVI. Fig. 4, 5. 
 
160 PROXIMATE CAUSE OF CARIES. 
 
 lines the cavity is also removed, and the blood-vessels 
 and nerves, which pass through the canal in the fangs, 
 generally likewise perish; on which account, whenever 
 pain proceeds from decayed stumps, it usually is the con- 
 sequence of inflammation taking place in the sockets, 
 whereby the attachment of the periosteum is destroyed, 
 and the stump becomes an extraneous body, causing 
 great inflammation in the socket and the gums, which 
 often terminates in suppuration. 
 
 It very frequently happens, when a tooth has become 
 so decayed as to leave only the stumps, that nature, as if 
 conscious they were no longer useful, makes an effort to 
 thrust them out; the socket gradually closes at the bot- 
 tom, and thus the stumps are protruded, until they only 
 adhere to the gum, thus they become loose, and occasion 
 soreness and slight inflammation. The attachment being 
 very weak, they are with great ease taken away.* 
 
 [PROXIMATE CAUSE OF CARIES.] 
 
 The cause of caries has not been satisfactorily ex- 
 plained, from the structure of the teeth not having been 
 duly considered. Mr. Hunter says, "It does not arise 
 from external injury, or from menstrua, which have a 
 power of dissolving part of a tooth; but we may reason- 
 ably suppose that it is a disease arising originally in the 
 tooth itself." It is surprising that, although Mr. Hunter 
 went thus far, he gave no correct idea of the manner in 
 which the disease can alone originate. 
 
 The proximate cause of caries appears to be an inflam- 
 mation in the bone of the crown of the tooth, which, on 
 account of its peculiar structure, terminates in mortifica- 
 tion. 
 
 * Plate XVI. Fig. 6, a. 
 
PROXIMATE CAUSE OF CARIES. 161 
 
 [The author's opinion with regard to the cause and 
 nature of dental caries is, as the editor has shown in 
 another place, evidently incorrect.* If it were the result 
 of inflammation, as he asserts, none but living teeth 
 would be attacked by it, but so far from this being the 
 fact, it is well known that teeth after having been de- 
 prived of their vitality are as liable to be affected with it 
 as the living organs. Artificial teeth too, of bone or 
 ivory, decay as readily as the natural ones. 
 
 Caries of the teeth is the result of the action of chemi- 
 cal agents, and not that of any operation of the animal 
 economy, and it consists simply in the decomposition of 
 the calcareous molecules of the organs. The fluids of 
 the mouth, especially the mucous, when in a vitiated 
 condition, contain an acid, namely, the septic (nitrous,) 
 which has a strong affinity for the earthy ingredients of 
 these organs, and it is by the action of the former upon 
 the latter, that the affection is produced. Inflammation 
 may influence the progress and perhaps the appearance 
 of the diseased part, but it cannot of itself produce it. 
 
 If inflammation were the cause of caries, the opera- 
 tions of filing and plugging, would tend rather to increase 
 than arrest its progress, inasmuch as they augment, for a 
 time at least, the susceptibility of the organs to impres- 
 sions from heat and cold, and as a consequence to inflam- 
 mation. They do not, however, when properly per- 
 formed, give rise to the disease in question. On the 
 contrary, they completely arrest it. 
 
 A series of experiments were instituted about three 
 years since, by Amos Westcott, M. D. of Syracuse, N. Y. 
 who is well known to the profession as an accomplished 
 writer and able practitioner, for the purpose of ascertain- 
 
 * Vide, Principles and Practice of Dental Surgery ; also, Characteristics of the 
 Teeth, &c. fee. by the Editor. 
 
162 PROXIMATE CAUSE OF CARIES. 
 
 ing the effect certain aliments produced upon the teeth, 
 after having underwent chemical decomposition, and the 
 result proves conclusively, that caries of the teeth is pro- 
 duced by the action of external corrosive agents. For a 
 detailed account of these experiments, the reader is re- 
 ferred to a Dissertation delivered by Dr. W. before the 
 fourth annual meeting of the American Society of Dental 
 Surgeons, and published in the 3d vol. Amer. Jour. 
 Dental Science. 
 
 The term mortification, or gangrene, as used by a later 
 writer, if at all applicable to any morbid condition of the 
 teeth, would be more so to that of necrosis, than the 
 affection under consideration. But to neither of which, 
 according to its usual signification, can it with any degree 
 of propriety be applied, it being a term used to signify 
 the death of a soft, not that of a solid tissue. Nor does 
 caries convey a correct idea of the true nature of the 
 affection, yet because of its almost universal adoption, it 
 may, perhaps, be as well to continue it.] 
 
 The membrane which is contained within the cavity of 
 a tooth is very vascular, and possesses a high degree of 
 nervous sensibility: an inflammation of this membrane is 
 liable to be occasioned by any excitement which produces 
 irregular action; and as the bone of the tooth is very 
 dense, and possesses little living power, a death of some 
 part of it may speedily follow an inflammation of the ves- 
 sels of the membrane which are contained within the 
 cavity.* 
 
 * Some time ago, I was applied to by a gentleman, who complained of an acute 
 pain arising from one of the molares of the under jaw: as I could discover no appear- 
 ance of caries in it, I advised the loss of blood from the gums, with a view to remove 
 the inflammation in the socket, or other parts connected with the tooth. This treat- 
 ment was by no means effectual, for the pain continued with scarcely any intermis- 
 sion: the gentleman therefore determined to have the tooth extracted. In attempting 
 this operation, the tooth broke off at the neck, and completely exposed the internal 
 cavity. Fortunately, this accident proved to be satisfactory, as it afforded an oppor- 
 
PROXIMATE CAUSE OF CARIES. 163 
 
 If a sound tooth, that has been recently extracted, be 
 broken, the membrane will be found to be firmly attached 
 to the bone of the tooth, forming the inner cavity. But 
 when this membrane becomes inflamed, it separates from 
 the bone, and the death of the tooth is the consequence. 
 
 That this is the proximate cause of caries, appears to 
 be highly probable, by remarking that a caries of other 
 bones is caused by a separation of those membranes which 
 cover them, and which are attached to them. Thus a 
 separation of the periosteum will cause a death of part of 
 the tibia, or that of the pericranium, a caries of some part 
 of the bones of the head. 
 
 This opinion is also confirmed by comparing the 
 symptoms which accompany inflammation in a bone with 
 those which are occasionally felt by persons in their teeth, 
 previously to any appearance of caries. 
 
 During the inflammation of a bone, there is an obtuse, 
 rather than an acute pain; the parts which surround or 
 cover it feel sore, and cannot bear pressure; and, when 
 there is the opportunity of making the comparison, an 
 inflamed bone is found to have a darker appearance than 
 a healthy one. 
 
 Very similar to these are the symptoms which are ob- 
 served by every one when their teeth have been affected 
 by what is commonly termed a cold. At this time a dull, 
 uneasy pain is felt extending along the jaw, the teeth are 
 tender, and cannot be pressed together with the ordinary 
 degree of force; and it may almost always be observed, 
 
 tunity of ascertaining the cause of the pain. The membrane lining the cavity of the 
 tooth had become so highly inflamed, that it had proceeded to suppuration, and the 
 cavity of the tooth was filled with pus. Immediately after the operation, the gentle- 
 man was perfectly relieved, and had no return of pain. In a similar case, instead of 
 extracting the tooth, I should recommend the drilling a hole, at the neck of the tooth, 
 into the cavity, in order to make an opening by which the matter might escape. 
 [But this operation, while it will generally afford relief from pain, seldom effects a 
 radical cure. Therefore, it is better in most instances to remove it at once.] 
 
164 PROXIMATE CAUSE OF CARIES. 
 
 that the teeth thus affected have a darker appearance than 
 those which are perfectly free from pain. 
 
 When these inflammatory symptoms subside, the pain 
 in the teeth goes off; but as inflammation may have caused 
 a death of some part of one or more teeth, the decomposi- 
 tion of the internal part of the tooth goes on, until the 
 enamel is broken away, and a caries is discovered. 
 
 I could mention many cases in corroboration of this 
 statement, and produce several examples of teeth with 
 the decay extending through the internal part ; whilst the 
 enamel remained perfectly sound. 
 
 In Plate XVI. Fig. 4 a, is the representation of a tooth 
 which I extracted for a lady, who complained of having 
 suffered great pain from it for a length of time; the tooth 
 appeared to be perfectly sound, but, on sawing it asunder, 
 a considerable caries was discovered in the centre. 
 
 Fig. 5 a represents the perfect enamel of a tooth that 
 separated from the bony part, which, by caries, had be- 
 come quite soft and black. 
 
 Fig. 3 a shows the dark line which may be seen pass- 
 ing through the bone of a tooth from the external part to 
 the cavity, in the centre, as described in page 159. 
 
 [Inflammation of the lining membrane of a tooth often 
 terminates in suppuration and the death of the crown and 
 inner walls of the root, or roots, if it have more than one, 
 of the organ — gives rise, in the majority of cases, to the 
 formation of alveolar abscess, but the only indication of 
 caries resulting therefrom, is the softening of the inner 
 w r alls of the tooth, caused by the chemical action of the 
 matter therein contained. But examples of this sort, are 
 comparatively rare, and between the pulp cavity and ex- 
 ternal surface of the bone of a tooth, within its substance 
 caries never commences. 
 
 The symptoms mentioned by the author, as being an 
 
PROXIMATE CAUSE OF CARIES. 165 
 
 accompaniment of inflammation, are rarely present during 
 the progress of caries, or not until the lining membrane 
 has become exposed. The disease, until this time, is 
 seldom attended with pain, and it oftentimes happens, that 
 tooth after tooth, until not a sound one remains, is de- 
 stroyed by it, without giving rise to any unpleasant symp- 
 toms whatever. Again, the membranes of the teeth often 
 become inflamed, causing pain and soreness in the teeth 
 for weeks and even months, without being accompanied 
 or followed by caries. 
 
 The decomposition of the internal part of a tooth, as 
 spoken of by Mr. Fox, is caused, not by inflammation, 
 but by the acrimonious qualities of the fluids which ac- 
 cumulate in the pulp cavity after the destruction of the 
 lining membrane, and not only do they break down the 
 solid basis of the parts of the organ with which they are 
 in immediate contact, but they give to the whole of the 
 crown of the tooth, a dark brown, muddy or purple ap- 
 pearance. If the tooth be permitted to remain in the 
 mouth, and no outlet made for the escape of the matter, 
 nor means used to prevent its re-accumulation, the de- 
 struction of its interior walls goes on, until ultimately, in 
 biting some hard substance, the crown is broken in, when 
 the ravages of the disease becomes manifest. 
 
 Caries almost always commences on the exterior surface 
 of the tooth, beneath the enamel, and at points where this 
 outer casing has sustained some injury, or is imperfect, as 
 for example, within the indentations on the grinding faces 
 of the molares and bicuspides or the approximal sides of 
 the organs, and proceeds interiorly toward the centre.] 
 
 22 
 
166 PREDISPOSING CAUSE OF CARIES. 
 
 [PREDISPOSING CAUSE OF CARIES.] 
 
 The chief predisposition to this disease consists in a 
 defective formation of either the enamel or the bony part 
 of the teeth. 
 
 The teeth of many persons are formed with a less 
 quantity of earthy matter than of animal substance, on 
 which account they do not acquire such a density as is 
 necessary to make them durable, and resist those various 
 causes of decay to which the teeth are constantly ex- 
 posed. Teeth thus formed are at first very white, and 
 have a certain transparency; but they soon begin to 
 decay, and frequently, in a very few years, the disease 
 extends through the greater part of them. 
 
 Sometimes the enamel does not acquire a proper 
 degree of hardness, its attraction of cohesion being defec- 
 tive, in which case it has a dead yellowish tinge, and is of 
 a chalky consistence. 
 
 When either of the above states of formation of the 
 teeth occur, they very soon fall into a state of disease; be- 
 cause the enamel is not sufficiently dense to resist the 
 force applied to the teeth, in the mastication of hard sub- 
 stances, without being broken; and the bone is of too 
 soft a texture to continue long without being affected by 
 some cause of inflammation. [The author should have 
 said to the action of the chemical agents, to which all teeth 
 are more or less constantly exposed.] 
 
 This original defect in the structure of the teeth must 
 depend upon a want of healthy action in the pulps, during 
 the time of the formation of the teeth. It is impossible 
 to conjecture what can be the cause of this imperfection, 
 but it is very singular, and also very certain, that the same 
 kind of structure may be observed in the teeth of many 
 individuals in the same family, who, in all other respects, 
 are very healthy. 
 
PREDISPOSING CAUSE OF CARIES. 167 
 
 That the teeth acquire this disposition to decay from 
 some want of healthy action, during their formation, seems 
 to be proved by the common observation, that they be- 
 come decayed in pairs; that is, those teeth which are 
 formed at the same time being in a similar state of imper- 
 fection, have not the power to resist the causes of disease, 
 and, therefore, nearly about the same period, they exhibit 
 signs of decay, while those teeth which have been formed 
 at another time, when a more healthy action has existed, 
 have remained perfectly sound to the end of life. 
 
 Decay of the teeth is often the consequence of certain 
 states of the constitution, in which the functions of the 
 body are performed irregularly, inducing various dys- 
 peptic symptoms. [Just in proportion, as any functional 
 disturbance of the body deteriorates the healthy qualities 
 of the fluids of the mouth, does it contribute to the decay 
 of the teeth.] 
 
 In these cases, the caries affects many teeth at the 
 same time, and often proceeds so quickly as, in a short 
 period, to destroy the crowns of the teeth, leaving only 
 the fangs. [This is more especially the case when all the 
 teeth are equally susceptible to the action of those causes 
 upon the presence of which, the decay of the teeth is 
 dependent.] 
 
 It is remarkable that the caries, arising from these con- 
 stitutional affections, has often a whitish appearance, and 
 the bone of the tooth is then much softer than when it 
 proceeds from simple inflammation. [The density of the 
 tooth has more to do with the colour of the caries than 
 any constitutional causes which may be concerned in its 
 production. Generally, in proportion to the softness of a 
 tooth is the colour of the caries light, and to its density is 
 it dark.] 
 
 I have also often had occasion to observe that great; 
 
168 PREDISPOSING CAUSE OF CARIES. 
 
 changes take place in the economy of the teeth, in conse- 
 quence of continued fever: however sound the teeth of 
 such persons may have been, previously to the disease, 
 they have shortly afterwards discovered marks of caries, 
 by which, in a few years, many of the teeth have been 
 injured or destroyed. [This however is to be accounted 
 for by the fact, that such diseases always vitiate the secre- 
 tions of the mouth, especially the mucous, and impart to 
 them a corrosive quality, which they do not, when in 
 health, possess. At such times too, little or no attention is 
 paid to keeping the teeth clean, and in consequence they 
 become coated with clammy acidulated mucus, and which 
 by its long contact, causes a more general and rapid decay.] 
 
 Caries has been very commonly attributed to the use 
 of certain articles of diet, and animal food has been sup- 
 posed very much to contribute to this disease. In sup- 
 port of this opinion, it is observed that persons in the 
 country, who live on plain fare, and those of Indian na- 
 tions, who live on vegetable food, have their teeth per- 
 fectly sound and free from disease. That these persons 
 are very often found to possess perfect sets of teeth, is in- 
 controvertible; but it is also to be observed that, amongst 
 the same classes of mankind, there are great numbers 
 whose teeth are very much diseased. 
 
 But why should animal food, more than any other kind, 
 produce disease in the teeth? In a chemical way, it can- 
 not act upon them; and, if in itself it had any injurious 
 action upon the teeth, then all carnivorous animals, whose 
 teeth are of the same structure as the human, ought 
 equally to be liable to caries. 
 
 The various articles of our food can only produce a 
 diseased action in the teeth, in consequence of their being 
 taken at a temperature either much above or below the 
 natural heat of the bod v. 
 
PREDISPOSING CAUSE OF CARIES. 169 
 
 The experience of every one teaches, by the effects, 
 that extremes of heat or cold are injurious, because the 
 sudden application of either, generally occasions a very 
 unpleasant sensation in the teeth; this painful feeling 
 arises from irregularity being produced in the circulation 
 within the cavities of the teeth, and also the application 
 of an unnatural degree of heat affecting the nerves of the 
 teeth, and producing that painful sensation consequent on 
 such application. 
 
 The reason therefore why persons, who live in a less 
 luxurious state, have their teeth less liable to caries is, 
 that, their food being all of a moderate temperature, they 
 are not injured by that frequent stimulus which is pro- 
 duced by the use of very hot or cold substances. This 
 statement seems to be confirmed by the observations I 
 have been enabled to make upon the teeth of persons 
 inhabiting different situations. 
 
 As a general rule, I think it may be asserted that the 
 inhabitants of warm inland countries have teeth free from 
 disease, and that those who dwell in colder regions, and 
 also in seaports and large towns, have bad sets of teeth. 
 For, in all warm countries, the refreshment which always 
 accompanies the application of whatever is cool, induces 
 persons to make use of their culinary preparations at a 
 moderate degree of heat, and their drink consists of such 
 articles as are proper to allay thirst, and produce but little 
 stimulus. 
 
 In cold countries, on the contrary, where the applica- 
 tion of heat is congenial to the feelings, the food is taken 
 very hot; also in these regions, and likewise in seaports 
 and places of great commercial intercourse, strong spiritu- 
 ous and fermented liquors are very constantly made use 
 of, which, in addition to the injury arising from the use 
 of the food at a high degree of temperature, keep the 
 
170 PREDISPOSING CAUSE OF CARIES. 
 
 mouth in constant heat, and produce all the injurious 
 effects which arise from the accidental occurrence of 
 fever. 
 
 [Neither the variations of temperature, nor food, nor 
 drinks, has any agency in the production of caries, for if it 
 had, teeth whose susceptibility to the action of heat and 
 cold, as has been before stated, has been increased by dental 
 operations, would be more liable to decay than others. 
 But this is not the fact, and hence the inference is incor- 
 rect. The supposition too, that particular sorts of diet 
 exert a more deleterious influence upon the teeth than 
 others, is equally gratuitous. They can do this only as 
 they prejudicially affect the health of the body and impair 
 the healthy qualities of its fluids. The same may also be 
 said with regard to climate. As a general rule, those 
 who have good innate constitutions and have enjoyed 
 good health during infancy and childhood have well- 
 formed and regularly arranged teeth — teeth not easily 
 acted upon by the causes that produce caries; and as their 
 constitutions are otherwise, will their teeth be susceptible 
 to the action of such cause.] 
 
 The destruction of a tooth, which has become carious 
 in the manner above described, is not the extent of the 
 mischief, for the disease is generally communicated to 
 those teeth which are in contact with the decayed part. 
 Cases occasionally occur which appear to militate against 
 this opinion; as, for instance, a tooth may become de- 
 cayed, and be entirely broken away without causing any 
 disease in the neighbouring ones. Such examples, how- 
 ever, are rare; and it may be asserted, as a general rule, 
 that caries in one tooth will produce disease in that which 
 is contiguous. 
 
 When the caries is communicated by contact, it proba- 
 bly arises from the action of some acrimonious discharge 
 
PREDISPOSING CAUSE OF CARIES. 171 
 
 from the decaying tooth, which, in the first place, oc- 
 casions a decomposition of the enamel, and afterwards 
 the destruction of the tooth. But there is this peculiar 
 difference, that, in the one, the decay proceeds from the 
 interior to the exterior part; whilst, in the other, it com- 
 mences on the surface, and extends towards the cavity. 
 [If this cause is capable of producing it in the one case it 
 is fair to conclude it is in the other.] 
 
 Caries is also very frequently the consequence of the 
 teeth being crowded so much together, as to cause them 
 to be pressed too closely against each other. This is the 
 most common cause of the decay of the incisores in the 
 upper jaw, on which account, in the earlier part of life, 
 means should be made use of to give more room, which 
 would permit the teeth to separate, and press with less 
 force on each other.* If the person be more advanced 
 in years, then a small space should be made by passing a 
 thin file between all the front teeth. 
 
 [Filing teeth to gain room for the purpose of correcting 
 a slight irregularity is a practice which has been produc- 
 tive of incalculable injury. The editor has frequently in 
 other places, expressed his disapproval of it, and he is 
 happy to believe, that, at present, it is seldom resorted to 
 for this purpose. For the removal of caries on the ap- 
 proximal surfaces of the teeth, the file, in the hands of a 
 skilful practitioner, is one of the most valuable resources 
 of the dental art, but in the hands of an ignorant and 
 inexperienced operator, it is an unsafe and dangerous 
 instrument. 
 
 When the file is employed for the above mentioned 
 purpose, the filed surfaces soon come together, and give 
 lodgment to the mucous secretions of the mouth and other 
 extraneous matter, which by being retained there soon be- 
 
 * Vide Natural History of the Teeth, page 62. 
 
172 PREVENTION OF CARIES. 
 
 come vitiated, and act chemically upon the rough denuded 
 sides of the teeth. Thousands of teeth have in this way 
 been sacrificed. I will not however, in this place, dwell 
 longer upon this subject, as I shall have occasion hereafter 
 to advert to it more at length.] 
 
 To these various causes of decay of the teeth, may be 
 added, want of cleanliness in the mouth, and a diseased 
 state of the gums. When the teeth are not regularly 
 cleansed from the tartar which constantly gathers about 
 them, and also particles of food which may lodge between 
 them, a putrefactive fermentation takes place, which (not 
 to speak of the offensive fetor it produces) always injures 
 the gums, and disposes the teeth to fall into a state of 
 decay. 
 
 [PREVENTION OF CARIES.] 
 
 The great distress which usually accompanies, and the 
 inconvenience which always follows, the loss of the teeth, 
 makes the discovery of some mode of prevention of caries 
 very desirable. 
 
 This delightful secret, although it is pretended to in the 
 advertisements of every quack, we can only expect to 
 acquire when the philosopher's stone and the grand 
 panacea have been obtained. It is not in our power to 
 alter the laws of nature, or change the natural constitution 
 of man; we can only obviate evils by attending to the 
 causes which produce them, and it is in this manner we 
 can, in a very great measure, preserve the teeth from 
 disease. 
 
 The principle means of preserving the teeth from 
 decay consist in paying such a degree of attention to them 
 in early life, during the period of the second dentition, as 
 to allow the permanent teeth to acquire a proper regular- 
 ity, without pressing too much upon each other; and, at 
 
PREVENTION OF CARIES. ] 73 
 
 the same time, if the temporary teeth should become 
 decayed, and be in contact with any of the new teeth, 
 they should be removed. [The better practice, when 
 practicable, is to remove the decayed surfaces of the 
 temporary teeth with a file.] 
 
 When these circumstances have been observed, young 
 persons should be urged to keep their teeth very clean, 
 and the daily use of a tooth brush, with water only, will 
 in most cases be quite sufficient. In addition to cleanli- 
 ness, the habitual use of all kinds of food at a moderate 
 temperature will almost certainly prevent any disease 
 from taking place, unless there be any radical defect in 
 the teeth themselves. 
 
 [In addition to the use of the brush, great advantage 
 may be derived from the employment of waxed floss silk, 
 as recommended by Dr. L. S. Parmly. This is used 
 by passing it between the teeth or around a single tooth 
 at a time and drawing the ends backwards and forwards 
 some ten or a dozen times. In this way the impurities 
 that cannot be reached with a brush, are removed from 
 between the teeth, and which, when permitted to re- 
 main, cause their decay. If it were possible to keep the 
 teeth thoroughly and constantly clean, they would never 
 decay. 
 
 With regard to the influence the temperature of food 
 exercises on the teeth, I have before alluded; it is not 
 necessary therefore, to say more upon that subject.] 
 
 If, in persons more advanced in years, any of the teeth 
 should have become decayed, and be in contact with 
 sound ones, and they are not sufficiently injured to make 
 it necessary that they should be extracted, so much of 
 them should be filed away, as to separate them from 
 those teeth which are sound : this will prevent the decay 
 from being communicated. 
 23 
 
174 PREVENTION OF CARIES. 
 
 If the teeth have become so much decayed as to leave 
 only stumps, then they should be extracted, because they 
 are not only liable to cause the other teeth to become 
 diseased, but they often produce gum-boils and other dis- 
 eases of the sockets. [They also exert a deleterious in- 
 fluence on the general health, giving rise not unfrequently 
 to dyspepsia, neuralgia of the face and a multitude of other 
 diseases, so that the importance of their removal cannot 
 be too strongly impressed upon all who have such teeth 
 in their mouth.] 
 
 The decay of the teeth, as far as I have been able to 
 judge, does not appear to be peculiar to any age, tempe- 
 rament, or state of health. The teeth of children are 
 very subject to this disease. I have frequently seen 
 nearly all the temporary set of teeth decayed; and, in 
 two or three instances, I have attended children who 
 have been so constantly tormented with the tooth-ache as 
 to make it necessary to extract almost all their teeth 
 before they have arrived at five years of age. 
 
 The teeth of robust and healthy persons seem to be 
 equally liable to caries as those of the delicate and less 
 healthy. Nosologists mention, as one of the characteristic 
 marks of predisposition to phthisis, sound teeth of a beau- 
 tiful transparent whiteness. This must only be considered 
 as an accidental circumstance, and not as a general rule ; 
 for great numbers of the persons, and especially those 
 rather more advanced in years, who fall victims to this 
 disease, have lost many of their teeth. The observation 
 applies only to those delicately-formed persons who, un- 
 happily, in our climate, so frequently fall victims to con- 
 sumption. In the teeth of these persons, there is too 
 small a quantity of earthy matter in proportion to that of 
 the animal substance, on which account they have that 
 fine transparent appearance. 
 
PREVENTION OF CARIES. 175 
 
 [If the author had studied closely the physical character- 
 istics of the teeth of different individuals, he would have 
 discovered that temperament, and the state of the consti- 
 tutional health at the time of their ossification, had much 
 to do in determining their susceptibility to the action of the 
 causes that produce decay, and these are influenced in a 
 great degree, by residence in certain localities and modes 
 of living. But for a full exposition of the editor's views 
 upon this subject, the reader is referred to Part Second, 
 Chapter Second, of his Principles and Practice of Dental 
 Surgery.] 
 
 Mr. Hunter thought that teeth did not decay after a 
 person had passed fifty years of age; but I have had many 
 opportunities of observing that, even on this head, no 
 certain opinion can be formed ; for I have met with sev- 
 eral persons who have not only passed fifty years without 
 having caries in their teeth, but who have arrived at sixty 
 without having felt the tooth-ache, and, after that period, 
 have been obliged to have several teeth extracted on 
 account of the extreme pain, which the inflammation 
 arising from caries had occasioned. 
 
 [As a general rule, teeth which escape the attacks of 
 caries until the fortieth or fiftieth year of age, rarely suffer 
 much from this disease, except in those cases where the 
 healthy qualities of the fluids of the mouth, from general 
 disease, or some change in the state of the constitutional 
 health, become impaired, and are thereby rendered cor- 
 rosive.] 
 
 The early loss of teeth, however, cannot be considered, 
 in itself, as a mark of short life, for there are many 
 persons enjoying the most healthy old age, who have lost 
 all their teeth before they had attained thirty or forty 
 years of age. [This remark however, applies only to 
 those whose general health has suffered from the presence 
 
176 TREATMENT OF CARIES. 
 
 of diseased teeth and gums; and the improvement of 
 health in such cases, which follows the loss of the teeth, 
 is oftentimes very surprising.] 
 
 TREATMENT OF CARIES. 
 
 I shall now proceed to state the mode of treatments 
 necessary to be adopted in the different stages of caries. 
 In the preceding pages, I have shown that the progress 
 of caries may be retarded, and the patient be preserved 
 from pain by keeping the cavity of the tooth constantly 
 and completely stopped. Beneficial as this practice really 
 is, there are some cases in which it cannot be adopted ; 
 such are, an unfavourable situation of the decay, or its 
 being so superficial as not to afford depth sufficient to 
 retain the gold leaf. 
 
 When the decay is situated on that side of a tooh which 
 is in opposition to another, so that persons say, the decay 
 is between two teeth, it is always difficult, and frequently 
 impossible, to retain the stopping, in which case, great 
 inconvenience arises from the food lodging in those 
 cavities, whence it is not easily removed; great benefit 
 will here be derived from passing a file between the teeth, 
 in which operation the opening should be so much 
 enlarged as to allow a quill tooth-pick to be used with 
 ease. If the caries has affected one tooth only, the next 
 to it will be preserved by filing away as much of the 
 decay as possible, and, should it not have made such pro- 
 gress into the body of the tooth, the remainder may be 
 preserved for a number of years by the removal of the 
 more carious part. 
 
 [When the decayed part cannot be removed without 
 filing away so much of the tooth as greatly to injure its 
 appearance, after having formed a sufficiently wide aper- 
 
TREATMENT OF CARIES. 177 
 
 ture to enable the operator to get at the diseased portion, 
 this should be removed and the cavity filled with gold in 
 the manner to be hereafter described.] 
 
 The success of the operation of filing away a decayed 
 portion of a tooth must not always be regarded as certain, 
 the decay proceeds so rapidly, that it cannot be checked 
 by any means, likewise the file cannot at all times be used, 
 the position of the teeth rendering its application not only 
 inconvenient but impracticable. 
 
 [Experience, however, has proven, that this is one of 
 the most valuable operations in dental surgery, but in 
 order to be successful, it is necessary that the whole of 
 the diseased part of the tooth should be removed. In 
 another place, the manner in which the operation should 
 be performed w T ill be fully described.] 
 
 In the Natural History of the Human Teeth, p. 95, I 
 have described the ill effects which usually arise from the 
 incisores being too closely placed against each other, and I 
 there stated the mode of obviating them. If the teeth, in 
 this state, have been neglected until persons have arrived 
 to adult age, considerable advantage will be obtained from 
 separating them by a very thin file, as it is on the sides of 
 these teeth that the caries commences in the form of 
 black spots. [It has been already stated, that this opera- 
 tion should be resorted to only in treatment of caries.] 
 
 If caries has proceeded in the manner delineated in 
 Plate XVII. Fig. 1, a file rather thicker may be used, so 
 as to separate the teeth as in Fig. 2. If one tooth only be 
 injured, the file should be smooth on one side, in order 
 that no part of the enamel of the sound one may be re- 
 moved. 
 
 When the decay has considerably advanced, a small 
 round, or half-round file may be used, and it should be 
 carried into the mouth in an oblique direction, so as to 
 
178 TREATMENT OF CARIES. 
 
 preserve as much as possible of the front part of the tooth ; 
 should the filing cause much pain, from the great sensi- 
 bility of the tooth ; the operation ought not to be continued, 
 as it may render the patient liable to future tooth-ache, 
 by causing an exposure of the nerve. In these cases we 
 may file a little at a time until the decay has been nearly 
 or quite eradicated, recommending during the intervals 
 the application of spirits of wine to the decayed parts, 
 which tends to harden the carious substance of the tooth 
 and to diminish its sensibility. [A flat file should always 
 be preferred for the front teeth, and experience has de- 
 monstrated that it is better to complete the operation at 
 one sitting, even though the tooth be sensitive, and no 
 advantage whatever is derived from the application of 
 spirits of wine as recommended by the author.] Sup- 
 posing the decay to have extended into the cavity of the 
 tooth, it will be better to omit the filing altogether, and 
 endeavour to stop it with gold leaf. [In many cases 
 where the decay has extended thus far, neither filing nor 
 plugging will save the tooth.] 
 
 [It will be seen from the foregoing remarks, that the 
 treatment of caries is comprised in two operations, namely 
 filing and plugging, and the manner of performing which 
 will now be described.] 
 
CHAPTER SECOND. 
 
 OF FILING THE TEETH. 
 
 The application of a file to the teeth is considered by 
 some persons, as one of the most injurious practices 
 which can be performed; and they think that the decay 
 of the tooth will certainly follow the removal of the least 
 portion of enamel. These opinions have been dissemi- 
 nated by certain empirics, who have considered diseases 
 of the teeth as a source of profit, and have therefore, paid 
 no regard to the correctness of their statements, provided 
 that they could acquire gain. 
 
 In those cases of caries where filing has been recom- 
 mended to retard its progress, the most decided advan- 
 tages were promised; and it is a practice defensible on 
 the most just principles. Caries is a disease which it is 
 not in our power entirely to arrest by any remedy what- 
 soever: its progress is gradual, but certain, until the de- 
 struction of the tooth is effected. The only plan that 
 promises success, is to remove the carious part from that 
 which is sound, with the expectation that the disease 
 will thereby be stopped. This theory is justified by the 
 success of the practice, whenever it is adopted before the 
 caries have reached the internal cavity of the tooth. 
 
 The decay of a tooth is never occasioned by the loss of 
 a part of the enamel, provided it be superficial, and not 
 entering the cavity : this is frequently seen in those cases 
 
180 OF FILING THE TEETH. 
 
 where a piece of a tooth has been broken off, and caries 
 has not been produced. In like manner, a considerable 
 portion of a tooth may be filed away and the remainder 
 will continue perfectly sound. 
 
 These facts may be well illustrated by stating the cus- 
 toms of some savage nations; these people have many 
 customs, in which doing something to the teeth forms an 
 essential part of the ceremony. In New Holland, the 
 beating out one of the lateral incisores is performed by 
 the priest, when a youth has gone through various cere- 
 monies previous to his being introduced into the class of 
 warriors. In one of the tribes of New Zealand, the 
 queen is distinguished by having a piece of gold substi- 
 tuted for her two front teeth. Upon the effects of filing 
 the teeth, the Abyssinian Negroes and the Malay Indians 
 furnish striking examples. The Abyssinian Negroes 
 have a method of cutting off the corners of the cutting 
 edges of the incisores in both jaws, in order to make them 
 all into pointed teeth; this operation they perform with- 
 out entering any part of the cavity.* Mr. Cline was in 
 possession of a scull of one of these Negroes, in which, 
 although it bore the marks of having belonged to a man 
 who had been somewhat advanced in years, the teeth, 
 thus filed, were not in the least rendered carious. A 
 most convincing proof that the mere filing of a tooth does 
 not cause it to decay. The other example in the custom 
 of the Malay Indians, consists in filing the incisores of the 
 upper jaw, in a direction across the upper part of the 
 anterior surface, so as to give them the appearance of 
 being fluted. By this mode of filing the teeth, the enamel 
 is not only removed, but the cavities in the teeth are 
 more or less exposed: the consequence of this is, that 
 the teeth soon become carious. I had an opportunity, 
 
 •Plate XXII. Fi?. 5 . 
 
OF FILING THE TEETH. 181 
 
 some time back, of examining the teeth of three of these 
 men: they were all filed as represented in Plate XXII, 
 Fig. 4. In those teeth which had the cavities exposed, 
 caries had taken place, and those remained sound from 
 which little more than the enamel had been taken off. 
 These facts demonstrate that the teeth are not rendered 
 carious by filing, excepting when any part of the cavity 
 is exposed. 
 
 The incisores of the upper jaw, as I have already shown, 
 are very liable to become carious, in consequence of being 
 crowded, or pressed much against each other. To 
 prevent this disease from taking place, it is advisable to 
 make a separation between each tooth with a very thin 
 file; and the space ought not to be wider than to allow a 
 piece of paper, or fine linen, to be passed between the 
 teeth. If the teeth have begun to be carious, a wider 
 space should be made. In case one tooth should be 
 carious, and the next to it perfectly sound, then the file 
 should be smooth on one side, which will save the sound 
 tooth from being injured. 
 
 Sometimes there is so much sensibility in the teeth, 
 that filing causes pain; here it will be proper to file but a 
 little at a time, until the decayed part is removed. If the 
 decay appear to have entered the cavity of a tooth, it 
 will be advisable not to touch it with the file. In that 
 disease of the alveolar processes, where the teeth are 
 protruded from the socket, the tooth should be made firm 
 to the side teeth, by means of a ligature, previous to 
 making use of the file; the projecting piece may then be 
 filed off without causing any disagreeable jar or shaking 
 of the tooth. In filing off the ragged points of broken 
 teeth, no other direction is required than not to make use 
 of a coarse file ; fine Lancashire files are the most proper 
 for all these purposes, 
 21 
 
182 OF FILING THE TEETH. 
 
 [It is sometimes necessary, from the peculiar nature of 
 the decay to file away a considerable portion of the tooth, 
 and in doing which, it is important that the symmetry of 
 the organ, as far as practicable, should be preserved. 
 Anteriorly, the aperture should be no wider than is neces- 
 sary to admit of a sufficiently oblique motion, of a safe- 
 sided separating file, for the removal of the caries. A 
 third, on even more, of a tooth, may, in this way, be re- 
 moved without materially injuring the appearance of the 
 organ anteriorly. 
 
 It has been before remarked, that in filing the teeth, it 
 should be done in such manner as to prevent the filed 
 surfaces from coming together. To prevent which, a 
 projection should be left on each tooth near the gum. 
 Where the approximal sides of two incisores are decayed, 
 an equal portion, as nearly as the circumstances of the 
 case will permit, should be removed from each tooth. 
 
 During the operation, the file should be frequently 
 dipped in water, lukewarm, if cold causes an unpleasant 
 sensation. After the removal of the caries, the filed sur- 
 faces should be made smooth with a very fine half-worn 
 file and burnisher. The edges and sharp corners should 
 next be removed and made smooth to prevent annoyance 
 to the tongue and lips of the patient. 
 
 The operator, in filing the front teeth and those of the 
 right side of the mouth, should stand at the right and 
 a little behind the patient, steadying his head with his 
 left arm, while with the fingers of the same hand he 
 raises and retracts his lips and properly exposes his teeth 
 for the operation. Then w r ith the file firmly grasped 
 between the thumb and middle finger of the right hand, 
 with the end of the fore-finger resting on its edge near 
 the extremity, the operation should be commenced by 
 moving it backwards and forwards in a straight line. 
 
OF FILING THE TEETH. 183 
 
 When both teeth are affected with caries, a file cut on 
 both sides of about half a line in thickness, should first be 
 used, and after having passed this between them, the 
 balance of the operation should be completed with a safe- 
 sided file of about the same thickness. If only one tooth 
 is affected, the operation should be commenced and com- 
 pleted with a file of the description last named. 
 
 For the bicuspides, a file shaped like the pinion-file of 
 a clock, or one that is oval on one side and flat on the 
 other, will be found the best adapted for the operation, as 
 the aperture to be formed should be made to resemble 
 somewhat the letter V, except that the angle at the gum 
 where it should terminate, should be less acute. The ap- 
 proximation of the teeth will be prevented by an aperture 
 between them of this shape, and should plugging become 
 necessary, the dentist will, without difficulty, be enabled 
 to perform the operation in the most perfect manner. 
 
 When it becomes necessary to separate the molares, a 
 similar shaped aperture should be formed, but as these 
 teeth are situated farther back in the mouth, it cannot 
 always be clone with a straight file. To obviate this diffi- 
 culty, operators have been in the habit of employing an 
 instrument, with which every dentist is familiar, denomi- 
 nated, a file-carrier, but as this, for many reasons, is not 
 very well suited to the purpose, the editor has used for 
 several years files which he had made expressly for these 
 teeth. They are in pairs, or rights and lefts, about an 
 inch and a half in length and shaped something like the 
 pinion-file of a clock, with a handle to each, bent so 
 that they may be used without interfering with the corners 
 of the mouth. These files, together with others of a 
 somewhat similar construction, are now used by many 
 dentists, and are highly approved. 
 
 To many, the sensation produced by the action of the 
 
]84 OF FILING THE TEETH. 
 
 file on the teeth is exceedingly disagreeable, and to some 
 quite painful, but the operation should never be suspended 
 on this account. The teeth too, after having been filed, 
 are often exceedingly susceptible to heat and cold, so 
 much so, in fact, as to be more or less painful when any 
 thing hot or cold is taken into the mouth. But this sus- 
 ceptibility soon subsides, generally in a few days, without 
 causing any other inconvenience. 
 
 After the operation has been completed the patient 
 should be directed to keep the filed surfaces of the teeth 
 constantly clean. The observance of this precaution is 
 absolutely necessary to prevent a recurrence of the dis- 
 ease for which it was performed.] 
 
CHAPTER THIRD. 
 
 OF STOPPING [PLUGGING] THE TEETH. 
 
 Jt frequently happens that persons apply to have this 
 operation performed, with an expectation that it will 
 relieve the tooth-ache : the error of this opinion will ap- 
 pear, when it is considered that tooth-ache, being a con- 
 sequence of inflammation, can only be relieved by such 
 applications as diminish increased action. 
 
 The cavity of an inflamed tooth is commonly so very 
 sensible, that even the accidental entrance of any substance 
 will cause the most acute pain; hence an endeavour to 
 fill up the cavity of a tender tooth, with any material that 
 requires pressure, would increase all those sufferings from 
 which it is the desire of the patient to be relieved. A 
 tooth then can only be stopped when it is perfectly free 
 from pain or tenderness. 
 
 By stopping a tooth, it is rendered artificially sound 
 again. The carious cavity being completely filled up, 
 the introduction of particles of food, and that taint of the 
 breath which arises from their becoming putrid, are pre- 
 vented; the nervous membrane, in the natural cavity, is 
 preserved from being irritated, and is rendered less sus- 
 ceptible of changes of temperature in the articles of food : 
 and, if care be taken to keep the stopping in a complete 
 state, the progress of decay is very retarded, and the 
 tooth-ache almost prevented. I am acquainted with per 
 
186 OF STOPPING THE TEETH. 
 
 sons who have had carious teeth for several years, but 
 who have never felt the tooth-ache, from keeping the 
 cavities in their teeth constantly stopped. 
 
 [The value of the operation however, depends upon 
 its being well performed, and with an indestructable ma- 
 terial. When thus performed, and with such material, 
 the preservation of the tooth, unless it be attacked by 
 caries in some other place and no means used to arrest 
 its progress there, may be regarded, in almost every in- 
 stance, as certain; but when performed by an unskilful 
 hand, or with a bad material, it has a contrary effect — it 
 often hastens, rather than arrests, the progress of the dis- 
 ease. Although to one inexperienced in this branch of 
 manual medicine, the operation may appear very simple, 
 yet it is the most difficult one in dental surgery. It, in 
 fact, requires so great an amount of mechanical aptitude 
 and practical skill, that hardly one in fifty, engaged in 
 this department of physical alleviation, have acquired an 
 eminent degree of excellence in it. At the time of the 
 publication of the first edition of this work, it was but 
 little understood, and consequently, the directions given 
 by the author for its performance are too brief, and inex- 
 plicit to serve as a proper guide to the student. There- 
 fore, the editor has thought it best to omit them alto- 
 gether. 
 
 As a general rule, the operation should be performed 
 before the pulp cavity of the tooth has been reached by 
 the disease, for after the lining membrane has become ex- 
 posed, its success, especially on a molaris, in at least four 
 cases out of five is rendered hopeless. A filling may often 
 be introduced into a cavity in the side of a bicuspis, cus- 
 pidatus or incisor, which extends in to the lining mem- 
 brane, without touching it, and in such a manner as to 
 secure the preservation of the tooth. But to do this, 
 
OF STOPPING THE TEETH. 187 
 
 much mechanical tact and practical experience is re- 
 quired^ for if the filling touch the lining membrane, the 
 pain and inflammation it will excite will render its remo- 
 val indispensable. 
 
 It is seldom proper to plug a tooth after the destruction 
 of its lining membrane, except it be an incisor or cuspi- 
 datus, and even then the success of the operation is very 
 doubtful. A tooth after being deprived of the greater 
 portion of its vitality, becomes more or less obnoxious to 
 the periosteal tissue of its socket. It causes it to become 
 thickened about the extremity of its root or roots, if it 
 have more than one, and a morbid secretion, which is con- 
 stantly discharged through the tooth, so long as the cavity 
 remains open. If this be closed by a filling, the matter 
 accumulates, and ultimately in the majority of cases, 
 makes a passage for its escape through the alveolus and 
 gum or into the antrum. This, however, is not so fre- 
 quently the case with the incisores and cuspidati, as with 
 the bicuspides and molares, and probably, for the reason 
 that the roots of the former derive a greater amount of 
 vitality from their investing membrane than do the latter, 
 and are hence, after the destruction of their lining mem- 
 brane, productive of less irritation to the surrounding 
 parts. 
 
 The accumulation of matter, however, secreted at the 
 extremity of the root, may be prevented, by leaving an 
 opening through the filling, as proposed by Dr. L. S. 
 Parmly, which is done by introducing the foil round a 
 small probe or wire, with one end resting on the bottom 
 of the pulp cavity, and which, after the operation is com- 
 pleted, is to be withdrawn. But while the decay of the 
 tooth immediately around the filling is thus prevented, it 
 is constantly going on interiorly, and ultimately destroys 
 the tooth. The practice, therefore, of filling the bicus- 
 
188 OF STOPPING THE TEETH. 
 
 pides and molares after the destruction of their lining 
 membrane, whether by the process of inflammation and 
 suppuration, or by arsenic or any other means, is, to 
 say the least of it, unscientific, and should never be 
 adopted, except when called for by some peculiar neces- 
 sity. Nor should a front tooth, from the root of which 
 fetid matter is discharged, ever be filled. 
 
 In cases of exposure and inflammation of the lining 
 membrane, Dr. Koecker recommends the application of 
 leaf lead, previously to the introduction of the gold, sup- 
 posing the former is less irritating to the animal fibre 
 than the latter, but the contact of any hard substance 
 with as sensitive a tissue as is this membrane, would of 
 necessity increase the disturbance. The practice recom- 
 mended by Dr. Fitch, which consists in covering the 
 exposed nerve with a gold plate, and in such a way that 
 it shall not come in contact with it, is altogether pre- 
 ferable. The plate, however, should be so fitted to the 
 walls of the cavity as to prevent it from touching the 
 bottom or from becoming displaced by the introduction of 
 the filling. But when the lining membrane is inflamed, 
 Dr. F. recommends the application of Aleppo galls to 
 it, for the purpose of reducing the inflammation, pre- 
 viously to filling the tooth. The editor, however, has 
 seldom derived any advantage from the application of this 
 remedy. Some benefit may occasionally be derived from 
 the application of leeches to the gum, but neither by this 
 nor any other treatment that has ever been adopted, can 
 inflammation of this tissue be always reduced. In fact, it 
 is only in the fewest number of cases that it can be. 
 
 It oftentimes happens that a tooth is very sensitive 
 when the decay has penetrated but a short distance into 
 its osseous structure. This, however, need never prevent 
 the dentist from proceeding with the operation, provided 
 
OF STOPPING THE TEETH. \gg 
 
 the patient can be prevailed upon to endure the pain con- 
 sequent upon the removal of the diseased part, for, after 
 he has accomplished this, it is seldom that any other in- 
 convenience will afterwards be experienced. 
 
 From the foregoing remarks, it will be perceived, that 
 the plugging of teeth is advisable only under certain 
 circumstances, and to which reference should always be 
 had in the performance of the operation. And now, 
 having premised these few general observations on the 
 subject, it may be well, before describing the manner of 
 performing the operation, to say a few words concerning 
 the materials employed for the purpose, and upon this 
 point, we shall be brief. 
 
 Various articles and preparations have been employed 
 for filling teeth, and hardly a month passes, that we do 
 not hear of the discovery of some new material or nos- 
 trum, recommended by the discoverer as being superior 
 to anything previously used for the purpose. But pure 
 gold or platina is the only material capable, under all 
 circumstances, of resisting the action of the secretions of 
 the mouth, and is the only one that should ever be em- 
 ployed for filling teeth. Gold is softer and can be more 
 easily introduced into the cavity of a tooth than platina, 
 and for which reason, is altogether and by far preferable 
 to that metal. This, when properly prepared in leaves 
 of from four to ten or twelve grains, can be so packed in 
 the cavity of a tooth as to exclude every particle of mois- 
 ture, which is indispensable to the preservation of the 
 organ. With this metal, the object for which the opera- 
 tion is performed, may with certainty be secured. It is 
 therefore good enough; no better material is wanted, and 
 indeed, none better can be had. 
 
 Tin is the next best material. This metal is very soft, 
 and can be easily and compactly introduced in the cavity 
 25 
 
190 OF STOPPING THE TEETH. 
 
 of a tooth ; but in consequence of its being more easily 
 acted upon by the secretions of the mouthy it is of a less 
 durable nature; though in the mouth of a healthy person, 
 it will often last for many years, and sometimes through 
 life. But inasmuch as it cannot be depended on in all 
 cases, and under all circumstances, we are of the opinion 
 that it should never be employed. 
 
 Silver is even more objectionable than tin. It is much 
 harder and cannot be so firmly packed, and besides it 
 oxydizes more readily; consequently, it is at present little 
 used for filling teeth : Lead, a few years ago was much 
 employed for this purpose, but in consequence of its being 
 easily decomposed by the septic (nitrous) acid of the 
 mouth, its use has been almost wholly abandoned. An 
 alloy of bismuth, tin, and lead, in consequence of its fusi- 
 bility at the temperature of boiling water, was at one 
 time recommended. This, however, was never much 
 used, as it was found, that the temperature at which it had 
 to be used, caused inflammation in the lining membrane of 
 the tooth, and that when it cooled, it shrunk and admitted 
 the fluids of the mouth around it into the cavity of the 
 organ. 
 
 The most objectionable and pernicious article that has 
 ever been employed for filling a tooth, is an amalgum of 
 mercury and silver, known by the various names of 
 lithodeon, mineral cement, &lc. &lc. This preparation not 
 only readily oxydizes in the mouth, but it also turns the 
 teeth black, causes them to decay more rapidly than they 
 would do if let alone. It moreover, exerts a hurtful 
 influence upon the alveolo-dental periosteal tissue, gums, 
 and in fact the whole body. A number of clearly marked 
 cases of silivation produced by the use of this amalgum 
 have fallen under the observation of the editor, yet it 
 has been most extravagantly eulogized by a few unscru- 
 
OF STOPPING THE TEETH. 191 
 
 pulous empirics, during the last six or seven years, and 
 thousands of teeth both in America and Europe have 
 been destroyed by it. 
 
 Having said thus much concerning the materials em- 
 ployed for filling teeth; we shall now proceed to offer a 
 few remarks on the instruments for and manner of pre- 
 paring the cavity, and for this part of the operation, a 
 variety of delicately, different shaped, and well tempered 
 instruments are required, which are designated by the 
 name of excavators. They should be so curved and 
 shaped at their points as to be easily applied to any part 
 of the tooth, and each one should have a sharp cutting 
 edge, which may be made to act with facility upon 
 every part of the caries and walls of the cavity, it may be 
 necessary to form for the retention of the filling. Each 
 may have a separate handle or be made to fit in a socket 
 fixed to one common handle. It would be well however 
 for every operator to be provided with a good supply 
 of both kinds, and in case of necessity he should be 
 able to make them himself; for without such as are 
 exactly suited to each individual case, he will not only 
 labour under great inconvenience, but oftentimes be un- 
 able to form the cavity in the best and most proper 
 manner. 
 
 In addition to the foregoing instruments, cherry-headed 
 and flat drills are oftentimes exceedingly useful in some 
 portions of this part of the operation. They may be used 
 either in a socket handle or drill-stock. The latter may 
 be turned with the thumb and forefinger or a string and 
 bow. Some practitioners, without reason, but on the 
 alleged ground that the more rapid motion which is thus 
 given to the instrument, causes a greater amount of ir- 
 ritation to the bone of the tooth, object to the latter 
 method of using it. In the hands of a skilful operator it 
 
192 OF STOPPING THE TEETH. 
 
 may be used in this way with impunity, and frequently 
 with great advantage, especially in opening a cavity on 
 the grinding or outer surface of a molaris. But for this, 
 the cherry-headed drill should be employed. The flat- 
 drill too, in many cases is very useful. A cavity in a tooth 
 however, can, without the aid of other instruments, seldom 
 be properly formed with either of these. They are chiefly 
 useful for opening and enlarging the orifice, and this 
 done, its formation should be completed with properly 
 shaped excavators, and in the majority of cases, the 
 whole of this part of the operation should be performed 
 with these instruments. When the drill is used, the 
 precaution of dipping it frequently in water, to prevent 
 it from becoming heated, should never be neglected. 
 
 The forming of a properly shaped cavity, preparatory 
 to plugging a tooth, is an important part of the operation; 
 and though generally the easiest, is nevertheless sometimes 
 attended with difficulty. The removal of every portion 
 of the caries, is not all that is required in the formation of 
 the cavity — it often becomes necessary to cut away some 
 of the sound part of the tooth, to give to it the proper 
 shape for the retention of the gold. It should always, 
 if possible, be as large at the bottom as at the orifice, 
 and if there be any difference, it should be rather larger 
 here than there, though the dimensions of the former 
 should never greatly exceed that of the latter. The walls 
 of the cavity too, surrounding the orifice should be strong 
 and smooth, presenting no unequal or brittle edges. It 
 sometimes happens however, that the extent and peculiar 
 limits of the decay is such, as to render it impracticable to 
 make the bottom of the cavity as large as the orifice. In 
 this case, a firm support should be secured for the filling, 
 by cutting several circular grooves in the w r alls of the 
 cavity. This precaution, if properly attended to, will 
 prevent the filling from becoming displaced. 
 
OF STOPPING THE TEETH. 193 
 
 It is generally much easier to form a cavity in the 
 grinding surface of a molaris or bicuspis, than in any 
 other part of these, or any of the other teeth. But there 
 are cases, in which, the formation of a properly-shaped 
 cavity, even in the grinding surface of a molaris is very 
 difficult, especially when the caries, having attacked the 
 centre of the tooth, follows the various indentations or 
 depressions which leads out in various directions from 
 it. The caries, after having attacked the tooth, spreads 
 as it penetrates it, and it is necessary to cut away the 
 points at least, of the intermediary converging portions of 
 the enamel, in order to make a sufficiently large orifice, 
 and these are often very thick and hard, requiring consid- 
 erable time to do it. When the caries is situated in the 
 approximal side of a tooth or sides, as is most frequently 
 the case, it should first be exposed by filing a space 
 between the organs in the manner as before described, 
 and this should always be wide enough to enable the 
 operator to remove with facility the caries and fill the 
 cavity. 
 
 To fill a tooth well when the cavity is situated in its 
 side next an adjoining tooth is often a very nice and 
 exceedingly difficult operation. It was formerly regarded 
 as impracticable, but its practicability is now fully estab- 
 lished. An experienced and skilful practitioner can put 
 in, under favourable circumstances, as substantial and 
 durable a filling here, as in any other part of a tooth. 
 
 After the formation of the cavity is completed, it should 
 be wiped out and freed from all loose particles of matter, 
 before the introduction of the filling. 
 
 The next step in the operation is the introduction of 
 the gold, and this is by far the most difficult part, requir- 
 ing ordinarily more time and mechanical skill in its exe- 
 cution. A number of instruments are required for the 
 
194 OF STOPPING THE TEETH. 
 
 purpose. Some dentists employ more than others, and 
 the majority of practitioners have more than is absolutely 
 necessary. With from twelve to fifteen, properly con- 
 structed, a good operator will be able to fill any cavity in 
 any tooth. Those generally employed, are illy suited to 
 the purpose. Filling instruments should be made of the 
 best of steel, have a spring temper and be strong enough 
 to bear all the pressure the operator is capable of putting 
 on them. Their points should be shaped so that they may 
 be applied to any cavity in any tooth — some should be 
 curved slightly, others to an angle of ninety degrees, and 
 others again should be straight. Most of them should be 
 shaped like a thin wedge, especially those that are to be 
 used for the introduction of the foil. A few should have 
 blunt and some oval points, and they should vary in size 
 to suit the cavity in the tooth, and they should be se- 
 curely fixed in strong octangular handles. 
 
 Being provided with a sufficient number of properly 
 shaped instruments, the operator should cut his gold foil 
 in strips of from half an inch to an inch in width. These 
 should be loosely rolled or folded lengthwise, and begin- 
 ning at one end, it should be introduced, with a wedge- 
 pointed instrument, in folds, commencing on the side of 
 the cavity, making one end of each of which, press on 
 the bottom while the other projects a short distance out 
 of the orifice. Thus fold after fold, and piece after piece 
 should be introduced until it is tolerable tightly filled. 
 This done the point of the instrument should be forced 
 down through the centre of the filling and the gold firmly 
 pressed out against the walls of the cavity. The opening 
 thus made should next be filled in the manner as first 
 described. Every part of the filling should now be tried 
 with a tolerably sharp wedge-pointed instrument, and 
 an opening effected similar to the first, and filled as before 
 
OF STOPPING THE TEETH. 195 
 
 described^ whenever it can be made to penetrate the 
 gold. After having put in as much foil as can possibly be 
 introduced^ the part projecting out of the cavity should 
 be packed, if it be in any part, except the approximal 
 surfaces of the teeth, with a blunt-pointed instrument, 
 and if here with the side of a wedge-pointed one, with 
 as much force as can be applied, or as the tooth will bear. 
 
 If the filling be in the grinding, labial or lingual surface 
 of the tooth, so much of it as still protrudes should be 
 scraped or cut away, leaving it however flush with every 
 part of the cavity, and the surface highly polished. If 
 the filling be on the approximal surface of the tooth the 
 extruding portion should be removed with a very fine or 
 half worn file, and polished as before stated. 
 
 Too much labour and pains cannot be bestowed on the 
 introduction and finishing of the filling. The gold should 
 be thoroughly packed, and inserted in folds as just de- 
 scribed to prevent the liability of its crumbling. If in 
 finishing the filling, any small particle should crumble or 
 be displaced next the wall of the cavity, an opening 
 should be made here, deep enough for the introduction 
 of more gold, so that when the operation is completed, 
 it shall present a firm, uniform, unbroken and highly 
 polished surface. 
 
 When the lining membrane is exposed, the folds of the 
 foil should not be carried to the bottom of the cavity, and 
 in packing it, the instrument should be forced down at 
 the side, instead of through the centre of the filling, as 
 before described. It is seldom, however, that any other 
 tooth than a bicuspis, cuspiclatus or incisor can be filled 
 under such circumstances, and even then it cannot always 
 be done, and never, except by a very skilful operator.] 
 
 Having stated, in the preceding pages, the causes of 
 caries, and described its progress in destroying the teeth, 
 
196 OF STOPPING THE TEETH. 
 
 it now becomes necessary to treat of the symptoms of 
 inflammation, which usually attend this disease, and the 
 occasional consequent affections of the contiguous parts. 
 [As the symptoms to which the author refers, belong 
 strictly to tooth-ache, and are comparatively seldom an 
 accompaniment of caries, we shall head his remarks upon 
 the subject with the name of that disease, and arrange 
 them in a separate chapter.] 
 
CHAPTER FOURTH. 
 [tooth-ache.] 
 
 The pain commonly termed the tooth-ache, is one of 
 the most excruciating to which we are liable. It is 
 caused by an inflammation of the membrane lining the 
 cavity. 
 
 In inflammation, one of the usual consequences is a 
 swelling of the part, which is generally followed by a 
 diminution of the pain, the degree of which seems to be 
 regulated by the resistance and compression which the 
 inflamed vessels suffer from the surrounding parts; hence 
 we see inflammation of a part, which may be easily 
 distended, is not so painful as that of one situated under 
 a tense membrane, or fascia. In the former case, the 
 symptoms of general irritation are scarcely perceptible, 
 whilst, in the latter, the constitution always becomes con- 
 siderably affected. 
 
 These remarks sufficiently demonstrate, that in conse- 
 quence of the membrane of the tooth being contained 
 within a bony cavity, which is incapable of distension, 
 there must necessarily exist an insurmountable obstacle 
 to the swelling of the membrane, and this it is which ren- 
 ders the pain so extremely acute. 
 
 In some few instances, caries will proceed without 
 being accompanied by any painful sensations : the tooth 
 gradually breaks away, until the whole of it is removed; 
 26 
 
198 TREATMENT OF TOOTH-ACHE. 
 
 after which, the gum becomes perfectly smooth, and 
 appears as if the tooth had been extracted. [Its appear- 
 ance, however, is of a deeper red; sometimes it is almost 
 purple, and bleeds from the slightest injury.] 
 
 Generally, no tooth-ache is experienced until the caries 
 has made some progress. It is impossible accurately 
 to describe an attack of tooth-ache, as persons are so 
 variously affected by this malady. Some are suddenly 
 seized with a pain darting from the tooth, through the 
 head, so acute as almost to induce fainting. A few 
 instances of this mode of attack I have witnessed where 
 the patients have endured the pain for a short period, 
 and, alarmed at a return, have been so importunate to 
 have the tooth extracted, as scarcely to allow sufficient 
 time for preparing the instrument, and, after the opera- 
 tion, they have exclaimed that the pain could not in the 
 least be compared with the sufferings attendant upon the 
 attack. 
 
 [Tooth-ache is often induced by a cold, w r hich causes 
 inflammation and pain in the investing and alveolar mem- 
 branes; in this case the teeth are slightly raised from 
 their sockets and exceedingly sensitive to the touch — at 
 other times it is sympathetic, being the result of disease 
 in some other part. Females during gestation are very 
 subject to it] 
 
 [TREATMENT OF TOOTH-ACHE] 
 
 More commonly, at first, the pain of the tooth-ache is 
 slight, and occurs at intervals, being occasioned by expo- 
 sure to cold, or the accidental pressure of some adven- 
 titious substance, such as a piece of crust, the seed of 
 some fruit, or any thing sweet: either of these getting 
 into a tooth, partially decayed, generally causes some 
 uneasiness. This kind of pain may almost always be 
 
TREATMENT OF TOOTH-ACHE. 199 
 
 relieved by a little tinctura opii, or it may subside of itself. 
 In either case, a recurrence may generally be prevented, 
 by filling up the cavity of the tooth with some substance 
 sufficiently hard and durable to keep out particles of 
 food, and not liable to be acted upon by the moisture or 
 heat of the mouth. [But whenever they are applied, the 
 operator should be careful not to touch the pulp of the 
 tooth if it be exposed.] 
 
 For this purpose wax, gum mastic, &c. have been 
 employed, but they are soon dissolved and destroyed, 
 therefore are improper. Formerly it was very much the 
 practice to stop teeth with lead leaf, but the use of this 
 substance ought to be forbidden, as it becomes corroded 
 by the saliva, and the introduction of a very small quantity 
 of this metal into the body is found to be productive of 
 deleterious consequences : there is indeed reason to be- 
 lieve that, being dissolved by the menstrua contained in 
 the saliva, it may occasion pains in the stomach, or other 
 uneasy sensations. 
 
 On this account, nothing ought to be used but what is 
 insoluble, or, if soluble, innoxious. Gold leaf is the most 
 proper substance : also pure tin, beaten into leaves, may 
 be used with nearly equal advantage : it is not so durable 
 as the gold, as the saliva gradually acts upon it, but it 
 cannot do any injury to the constitution. [But the 
 plugging of a tooth with a metallic substance after it has 
 ached, is seldom advisable. This operation has been 
 treated of in another place.] 
 
 By thus excluding the air, and preventing any particles 
 of food from lodging in the cavity, the progress of decay 
 may be greatly retarded, the pain prevented, and the 
 teeth preserved for many years. 
 
 If no means have been used to prevent the recurrence 
 of the tooth-ache, it usually becomes so violent and con- 
 
200 TREATxMENT OF TOOTH-ACHE. 
 
 stant; that rest is disturbed, and persons are incapacitated 
 from pursuing their accustomed avocations: when this 
 is the case, the tooth should be extracted. 
 
 There is scarcely any thing occasions so much fear as 
 the idea of the extraction of a tooth, and this very dread 
 is often the cause of most unpleasant consequences. 
 
 The inflammation proceeds from the tooth, and affects 
 the contiguous parts, the gums and the integuments of 
 the face swell, and become much inflamed. The swelling 
 is often so great, that the mouth cannot be opened, and 
 the eye becomes closed: in other cases, the swelling 
 extends down the neck, and the constitution is affected 
 with the symptoms of general irritation. 
 
 Sometimes the inflammation and swelling will subside^ 
 and resolution take place^ but most frequently it termi- 
 nates in suppuration. Now and then, after the matter 
 has been discharged, the pain will cease; but, as the 
 diseased tooth remains, the symptoms are liable to recur 
 Upon every exposure to cold. Whenever the gums are 
 inflamed, the alveolar processes are also affected, and 
 they are removed by the process of absorption. If a 
 person should have had formation of matter two or three 
 times about the fangs of a tooth, the sockets will be so 
 much absorbed [or rather wasted] that the tooth will 
 become loosened: in this state, it causes so much trouble, 
 that the patient is obliged to have it extracted, and a cure 
 is thus obtained. 
 
 The inflammation is sometimes so great as to extend to 
 the substance of the jaw bone, and even to occasion its 
 partial mortification. 
 
 The distress attending the process of exfoliation, and 
 the consequent deformity, should warn all persons against 
 exposing themselves to the hazard of such an occurrence. 
 
 The pain proceeding from the inflammation of the 
 
TREATMENT OF TOOTH-ACHE. 201 
 
 membrane of a carious tooth is not of the same kind in all 
 persons, arising probably from some peculiarities of con- 
 stitution, for it not only varies in its intensity, but likewise 
 the sensation excited. 
 
 Some describe it as a gnawing kind of pain, not 
 amounting toacuteness, but being constant, and admitting 
 of no continued relief, it renders them unfit for either 
 mental or bodily exertion. In others, it comes on sud- 
 denly, occasioning an acute pain, as if an instrument had 
 been passed through the jaw: this occurs at intervals, 
 and the expectation of an attack often causes as much 
 anxiety and distress as the pain itself. In others, the 
 pain is periodical, there being an intermission of some 
 hours. In these cases, bark has been sometimes exhibited 
 with a degree of success; but, at length, patience being 
 exhausted by the continuance of the pain, extraction of the 
 tooth has been the only remedy. [When it is the result 
 of a disordered state of the stomach an emetic or cathartic 
 will often give relief. When it occurs during pregnancy, 
 a dovers powder and pelclilurum on going to bed has 
 been found beneficial.] 
 
 The pain often follows the course of the nerves, being 
 diffused all over the cheek, shooting up to the temple, 
 and affecting the head generally. 
 
 It frequently happens, that, when either of the dentes 
 sapientiae of the under jaw occasions pain, the patient 
 does not suffer so much in the tooth itself as in the ear. 
 
 I have also frequently observed that the last tooth of 
 the upper jaw, when diseased, has occasioned many 
 confused sensations, the pain most commonly has been 
 referred to the first or second molares, and with the 
 greatest difficulty could patients be persuaded to have the 
 dens sapientiae extracted. 
 
 These sympathetic pains, arising from carious teeth, 
 
202 TREATMENT OF TOOTH-ACHE. 
 
 proceed from the intimate connection which subsists 
 between the branches of the fifth and those of the seventh 
 pair of nerves. The pain in the ear is therefore sympa- 
 thetic, arising from disease in the dens sapientiae; it is 
 caused by a union of a branch of the seventh pair of 
 nerves with the lingual branch of the fifth pair; this 
 nervous filament enters the cavity of the tympanum, 
 passes on the inner side of the membrana tympani, and is 
 called the corda tympani. 
 
 From the connection which subsists between these two 
 pairs of nerves, it happens that not only inflammation in 
 the teeth causes a sympathetic pain in the ears, but dis- 
 agreeable and unharmonious sounds produce a sympathetic 
 effect upon the teeth, and occasion that unpleasant sen- 
 sation called the teeth being set on edge. 
 
 In that disease of the nerves called tic douloureux, the 
 teeth are generally suspected to be the seat of the pain. 
 
 In the Medical Records and Researches is a very 
 excellent paper on this subject, by Dr. Haighton. The 
 disease is there described as chiefly affecting the fifth and 
 the seventh pair of nerves, and the doctor relates several 
 cases of persons, affected with this disease, having sub- 
 mitted to the extraction of a great number of teeth, before 
 the true cause of the pain had been ascertained. I have 
 had the opportunity of observing a few of these cases, 
 one of which I shall relate, on account of the remarkable 
 benefit which followed the operation, as recommended by 
 Dr. Haighton. An elderly gentleman applied to me for 
 the purpose of having some stumps extracted from the 
 upper jaw, stating that he suffered considerable pain from 
 them : without further enquiry, 1 performed the operation. 
 Two days afterwards, he came to me again, and expressed 
 a wish that I would extract the teeth which were remain- 
 ing on that side of the upper jaw. The teeth to which 
 
TREATMENT OF TOOTH-ACHE. 203 
 
 he directed my attention were two molares, both of 
 which appeared to be perfectly sound. I then enquired 
 what his particular kind of pain was: he described it as 
 a pain which had come on at intervals for nearly two or 
 three months past ; at first it was slight, but had gradually 
 arisen to such a degree of acuteness as almost to cause 
 fainting : whilst he sat still he was easy ; but, if he spoke 
 quickly, or ate any thing which required mastication, or 
 walked hastily, or was shaken by riding in a carriage, the 
 pain returned, shooting through his cheek, and affecting 
 his teeth and all the side of his face, as if he had received 
 an electric shock. I had the opportunity of seeing him 
 during two or three of these painful attacks. Whilst he 
 was relating to me the above statement, he was seized 
 with so much pain, that he suddenly stopped, and the 
 water streamed from his eyes. On comparing his de- 
 scription with what I then saw, I immediately conceived 
 that his complaint was caused by a disease of the sub- 
 orbitar branch of the fifth pair of nerves, and offered to 
 accompany him to Mr. Astley Cooper, in orde^r to take 
 his opinion. As I went with him in the coach, a sudden 
 jolt caused another attack. Mr. Cooper, after having 
 heard the above statement, concurred in the opinion I 
 had given, but was more particularly confirmed in it by 
 producing another attack, by only rubbing the hair of his 
 beard contrary to its natural direction. 
 
 The gentleman assented to the operation, which Mr. 
 Cooper performed immediately. The nerve was com- 
 pletely divided, as the power of raising that side of the 
 lip ceased, and it remained as in a state of paralysis. The 
 wound healed in a few days, after which the pain entirely 
 left him, he could eat with comfort and take exercise 
 without fear. His joy was so great at the deliverance 
 which he had experienced from so much suffering, that 
 
204 TREATMENT OF TOOTH-ACHE. 
 
 he could not afterwards speak of it without shedding 
 tears. 
 
 Sometimes when persons suffer extremely with the 
 tooth-ache, they find a great difficulty in fixing upon the 
 tooth from which the pain proceeds; and it is not un- 
 common for them to refer it to a tooth not in the least 
 connected with the seat of the disease : frequently they 
 will Hx upon a sound tooth, and it often happens that the 
 pain is conceived to originate from a tooth of the upper 
 jaw, instead of one of the under jaw, and vice versa. 
 
 Whenever any doubt is expressed, great caution should 
 be observed previously to the extraction of the tooth. 
 The teeth may be examined by striking them with the 
 end of a pair of forceps, in order to discover that which 
 is the most tender; as it usually happens that a tooth in 
 a state of inflammation is so sensible that it will not bear 
 to be struck without pain. If this mode of examination 
 be not satisfactory, and there should be more than one 
 carious tooth, they should be carefully examined by 
 picking the hollow part with the point of a probe, or 
 other small pointed instrument, bent in the form of a 
 hook; by doing this the exposed nerve of the tooth, that 
 has caused the pain may be touched, which will im- 
 mediately assure the patient and the surgeon of the tooth 
 from which the pain proceeds. [The seat of the disease 
 may, in the majority of cases, be ascertained in this way, 
 but not in all.] 
 
 The means which have been employed to relieve the 
 pain arising from inflammation of the membrane of a tooth, 
 are attended with very different success; some persons 
 deriving benefit from one application, and others from 
 another. 
 
 Whenever tooth-ache exists, without any sympathetic 
 affection of the gums or socket, those medicines which 
 
TREATMENT OF TOOTH-ACHE. 205 
 
 tend to diminish nervous sensibility, afford relief; opium 
 conveyed into the tooth, either in the form of tincture, or 
 solid opium, frequently succeeds. Camphor, the smoking 
 of tobacco, essential oils of cloves or of thyme, the con- 
 centrated acids, &,c. are also recommended, and with 
 occasional effect. 
 
 It is most extraordinary, but not less true, that there is 
 scarcely any pain to which the human body is subject, 
 that is so much under the influence of the passions of fear 
 or hope, as the tooth-ache; this is experienced by almost 
 every patient, and as constantly observed by every sur- 
 geon, by the pain generally leaving that individual who 
 is under the immediate expectation of having the tooth 
 extracted. 
 
 Empirics are not wanting who take advantage of this 
 circumstance, and pretend to cure tooth-ache by certain 
 charms and nostrums : indeed, at the moment they often 
 appear to be successful, from the passions of fear or hope 
 causing a temporary suspension of pain. 
 
 The burning of the antihelix of the ear, in order to 
 relieve this complaint, must be ranked amongst the above 
 methods of cure; it is one not worthy of notice, had it 
 not been formerly a very popular remedy, and lately re- 
 commended in a periodical publication. The slightest 
 knowledge of the distribution of the nerves to the teeth 
 must convince every one, that a division of any part of 
 the ear cannot separate the connection which subsists 
 between the teeth and the principal branches which go to 
 the brain, and therefore no more benefit can be derived 
 from this formidable operation, than may be attributed to 
 the influence of fear. 
 
 When the carious part of a tooth is very sensitive the 
 pain not being constant, but only excited by some cause 
 of irritation, it is much in the same state as an irritable 
 27 
 
206 TREATMENT OF TOOTH- A CHE. 
 
 ulcer, and the pain may be relieved in a similar manner, 
 viz. by destroying its surface with caustic. This method 
 of treatment was first mentioned to me by Mr. Abernethy, 
 as one that he had tried with great success, and which I 
 have also found to be very beneficial. 
 
 The cavity of the tooth is first to be wiped dry with a 
 small piece of lint, or cotton, then some lunar caustic, in 
 solution, may be introduced on the point of a camel's hair 
 pencil, spreading it over the whole of the carious surface. 
 This should be repeated two or three times, after which, 
 if the tenderness be removed, the tooth may be stopped 
 with gold leaf, and thus be preserved. 
 
 [The application of lunar caustic to the carious part of 
 a tooth will sometimes, but not always, allay the sensi- 
 tiveness of the diseased portion, and in consequence of 
 the uncertainty of its effects, its employment for this 
 purpose is, at present, seldom resorted to.] 
 
 Attempts have been sometimes made to destroy the 
 nerve with the actual cautery, by introducing a red-hot 
 wire; but I have scarcely ever found this plan to be 
 effectual; and, as it always gives great pain, and some- 
 times produces an increase of inflammation, I think it is 
 better never to recommend it. Indeed, all applications 
 are very uncertain, and therefore, if relief be not speedily 
 obtained, it is advisable to suffer pain once for all, by 
 having the tooth extracted. 
 
 [It was ascertained by Mr. Spooner of Montreal some 
 years ago, that the nerve of a tooth might always be 
 destroyed in a few hours by the application of a small 
 quantity of arseneous acid. This discovery was pub- 
 lished to the profession shortly after by his brother Dr. S. 
 Spooner of New York, in a popular treatise on the man- 
 agement of the teeth. At first the discovery promised to 
 be of great value, but it was soon ascertained, that, 
 
TREATMENT OF TOOTH-ACHE. 207 
 
 though the nerve could with certainty be destroyed by it, 
 and the tooth afterwards plugged, alveolar abscess was 
 almost sure to result. The use of it therefore, has been 
 almost altogether abandoned by the more skilful and 
 experienced of the profession.] 
 
 Some years since I attempted a mode of destroying 
 the nerve, which at first promised to be very successful. 
 I knew that a nerve once divided did not re-unite for a 
 considerable length of time, and therefore concluded, that 
 if I could separate the nerve going into the tooth from 
 the principal branch, that the pain would be prevented, 
 and useful teeth might be thus preserved. 
 
 The method which I adopted, was to raise the tooth, 
 by the common operation of extraction, so high in the 
 socket as certainly to break the nerve and vessels which 
 enter the extremities of the fangs; then, on withdrawing 
 the force, to press the tooth back again into its former 
 situation. I not only recommended this operation, but 
 also performed it upon a great number of persons, and for 
 a short time nattered myself with very sanguine expec- 
 tations; these, however, were quickly destroyed, for 
 some of my patients, in about three or four weeks after- 
 wards, came complaining of pain, and were anxious to 
 have the tooth completely removed. They did not suffer 
 the tooth-ache so acutely as before, but the tooth had 
 become sore, and was protruded from the socket, so that, 
 whenever the mouth was closed, the pressure of the teeth 
 in the other jaw against the tender one occasioned great 
 pain. 
 
 On extracting these teeth, I found the fangs covered 
 with a considerable quantity of coagulated lymph; which 
 circumstance led me to believe, that this operation could 
 not be recommended with any certainty, as it only suc- 
 ceeded in those cases in which union of the fangs to the 
 
208 TREATMENT OF TOOTH-ACHE. 
 
 socket took place, as it were, by the first intention; but 
 if any inflammation followed, so as to produce an effusion 
 of lymph, it caused a thickening of the periosteum, and a 
 consequent protrusion of the tooth, which induced a 
 necessity for its complete removal. Since that time, I 
 have only followed this practice in cases where a tooth 
 has been but slightly decayed, and the patient has been 
 very desirous to suffer any experiment for its preservation. 
 In a great number of cases it has perfectly succeeded; 
 but I have always represented the possibility of its failure. 
 
 The incisores of the upper jaw, although very liable to 
 become carious, do not often occasion the tooth-ache; but 
 when this is the case, I always recommended the extrac- 
 tion of the tooth before any inflammation has affected the 
 gum; the decayed part of the tooth may then be removed, 
 or the cavity be very perfectly stopped with gold leaf, 
 and it is then to be returned into the socket. The fangs 
 of these teeth being straight and conical, renders this 
 operation almost always successful; the tooth soon be- 
 comes perfectly fixed, and may remain many years useful 
 for the articulation of sounds, as well as ornamental to 
 the sight. 
 
 [The practice here recommended, even under the 
 most favourable circumstances, is objectionable. A tooth 
 being thus deprived of its vitality, is more or less ob- 
 noxious to the surrounding parts. The removal alto- 
 gether of the tooth and the substitution of an artificial one 
 is far preferable.] 
 
CHAPTER FIFTH. 
 
 OF EXTRACTION OF THE TEETH. 
 
 Few operations in the ordinary practice of medical 
 men, are more repugnant to their own feelings, as well 
 as to those of their patients, than the extraction of a tooth. 
 In this operation, both surgeon and patient are frequently 
 alike influenced, as it often happens that the former is 
 quite as much averse from performing the operation, as 
 the latter is from suffering it. This reluctance in the 
 surgeon can only arise from deficiency of confidence in 
 his own abilities, producing fear lest he should perform 
 the operation unsuccessfully. I shall, therefore, offer a 
 few hints, which may tend to remove distrust, and, in 
 this way, increase the fortitude of a timid operator. 
 
 The various conditions of the teeth, which may create 
 necessity for their extraction, produce equally great va- 
 riety in the difficulty or ease with which the operation 
 may be performed. In some, the teeth are so loose, that 
 they may almost be taken away by the fingers; in others 
 from the carious state of the teeth, or from the direction 
 and strength of the fangs, it is impossible to succeed, 
 notwithstanding the greatest care or ability. [This, no 
 doubt was true, at the time of the publication of the first 
 edition of this work, but it is not at present. Any tooth 
 may now, with proper instruments, be removed, with 
 safety, by a skilful operator.] 
 
210 THE KEY INSTRUMENT. 
 
 Extraction of the teeth is required for the following 
 reasons: in children, to prevent or remedy irregularity 
 in the arrangement of the permanent teeth, and on ac- 
 count of tooth-ache arising from caries of the molares, 
 which is a very common circumstance. In adults, from 
 the teeth having become loosened from an absorption of 
 the alveolar processes ; or from some other cause, as the 
 effects of caries. 
 
 [INSTRUMENTS EMPLOYED IN THE OPERATION.] 
 
 It would be useless to mention the great variety of 
 forms in which instruments for extracting the teeth have 
 been made : I shall only describe such as are really use- 
 ful, and make a few remarks on some that have been 
 strongly recommended. 
 
 [THE KEY INSTRUMENT.] 
 
 The key instrument, or, as it has been commonly 
 called, the German key, is the most useful : it has under- 
 gone several alterations in form, and has received some 
 improvements, which, I think, have brought it as near to 
 perfection as possible. The first material improvement 
 in this instrument w T as made by Mr. Spence : it consisted 
 in adding a projecting part at the end of the bolster, 
 through which the screw is passed. This addition was 
 made for the purpose of fixing a claw, in an advanced 
 position, beyond the bolster, which was found extremely 
 useful in the extraction of the dentes sapientiae. 
 
 Mr. Savigny introduced his improved key with a 
 round bolster, and a raised form in the stem of the in- 
 strument, which is very convenient for avoiding injury to 
 the. front teeth, when it may be required to extract a 
 
THE KEY INSTRUMENT. 211 
 
 tooth, by fixing the bolster on the inner side of the jaw. 
 It occurred to me that another addition was still requisite 
 to make it complete, and that was, to be able to fix a 
 claw behind the bolster, that it might act on a principle 
 similar to Mr. Spence's improvement, which is, to have 
 the fulcrum of the instrument applied at a different place 
 from the carious tooth to be extracted. In Mr. Spence's 
 instrument, the claw is placed before the fulcrum, in 
 mine, the fulcrum is placed before the claw. This im- 
 provement I have found of very essential service in ex- 
 tracting the bicuspides of the lower jaw, and also in cases 
 where a large gum-boil, of extreme sensibility, happened 
 to be situated at the part where the fulcrum of the com- 
 mon instrument would have been placed; a circumstance 
 of great utility, as the pressure may be made upon an 
 insensible, rather than upon an inflamed part. The de- 
 scriptions in Plate XXII. will clearly illustrate the above 
 statement. The alterations in this instrument, from Mr. 
 Savigny's improved key, which had the advantage of 
 Mr. Spence's improvement, consist in a place for fixing 
 the claw behind the fulcrum, and in having the bolster of 
 an oval form instead of a round one, as the latter occupies 
 too much room in the mouth. This instrument is appli- 
 cable to the extraction of the bicuspides and molares. 
 
 For the removal of the molares of children, a small 
 spring key instrument is very requisite. In operating 
 upon a child, nothing ought to be exhibited that might 
 occasion alarm : a very small instrument may be hidden 
 in the hand, which, by preventing terror in the child, 
 will produce submission to the operation : this small key 
 instrument may be accommodated to the handle of the 
 large one. 
 
 Sometimes it happens that a molaris on each side of 
 the mouth occasions tooth-ache at the same moment, in 
 
212 THE PACES. 
 
 which case, it is desirable to remove both of them ; but 
 there is great difficulty, after a child has felt the pain 
 from the extraction of one tooth, to persuade it to submit 
 to a second operation ; on this account we must always 
 endeavour to be as quick as possible. It is very easy, 
 when the mouth is open, to extract more than one tooth, 
 as the claw of a spring key can be turned in so short a 
 time that the little patient scarcely knows any thing about 
 it. Parents are too solicitous to prepare the minds of 
 their children for undergoing the extraction of a tooth, by 
 talking of it, and assuring them that they will not be hurt, 
 &,c. &c. but I have usually observed that attempts of this 
 kind are often unsuccessful, and the contrary disposition 
 is more generally excited. The best plan is not to men- 
 tion to the child any intention of having its tooth extracted, ' 
 but only to allow the time for performing the operation 
 to be the moment of deliberation. Children are often 
 tortured with the anticipation for several days together, 
 and, when the moment arrives, they have lost all their 
 fortitude. 
 
 THE PACES. 
 
 For the extraction of the incisores in the adult, and 
 the incisores and loose molares in children, an instru- 
 ment is used, called the paces: this instrument is an 
 improvement upon the crowVbill, formerly used. The 
 form recommended by Dr. Blake, of Dublin, is the best; 
 they are made straight and curved. The instrument for 
 adult teeth should be larger and stronger than that for 
 the temporary teeth. For the extraction of a stump, the 
 instrument commonly called a punch is employed. Be- 
 sides these instruments, a pair of forceps, like the common 
 dressing forceps, but rather stronger, are required for the 
 purpose of removing a loosened stump, or any small 
 splinter. 
 
OF THE FORCEPS. 213 
 
 THE PERPENDICULAR EXTRACTOR. 
 
 Some persons have very strongly recommended instru- 
 ments adapted for the perpendicular extraction of teeth : 
 much ingenuity, indeed, has been exercised in the con- 
 struction of all these; but they are not applicable to 
 general use. The principle on which they all act is this; 
 that, after having fixed the extracting instrument on the 
 carious tooth, a powerful action is made with it, and the 
 tooth is removed, just on the same principle as that by 
 which a cork is drawn from a bottle by the patent cork- 
 screw. There are several insurmountable objections to 
 this mode of extraction : in the first place, the instruments 
 being of complicated structure, they cannot be used 
 quickly, a circumstance of the greatest importance: sec- 
 ondly, it not unfrequently happens that the tooth to be 
 extracted is much stronger than the tooth on which the 
 counter pressure is to be made; here the sound tooth is 
 much injured, and the carious one cannot be extracted: 
 thirdly, the fangs of some teeth being very divergent, it 
 is not possible to extract them in a perpendicular direc- 
 tion, any more than a piece of wood, dove-tailed in a 
 mortise, can be removed in any other way than in a 
 lateral direction : fourthly, there may be no teeth remain- 
 ing on which the counter pressure can be made. In 
 trying these instruments, I have met with all these various 
 difficulties, and, therefore, think them inapplicable to 
 general use. 
 
 [OF THE FORCEPS.] 
 
 [It is not surprising that the author should have given 
 a decided preference to the key instrument, for, during 
 his time, the forceps employed for the extraction of teeth, 
 were so awkward in their construction and illy adapted 
 
 28 
 
214 OF THE FORCEPS. 
 
 to the operation, as to render them not only inefficient in 
 their use, but also inconvenient in their application. But 
 the objections to their use, that existed at that time, 
 cannot now be urged. They have been so improved 
 during the last twelve or fifteen years, that, at present, 
 they are the safest, most convenient, and efficient instru- 
 ments that can be employed. Any tooth that can be 
 removed with the key, can be extracted with a properly 
 constructed pair of forceps, and in the majority of cases 
 with greater ease and convenience to the operator, and 
 less pain and injury to the patient; besides, many teeth 
 which cannot be removed with that instrument can be 
 extracted with ease and safety with these. 
 
 In discussing the relative merits of the key instrument 
 and forceps, the editor can speak advisedly upon the 
 subject, having used both for many years, the former for 
 more than eight and the latter for about twelve years. 
 He is happy too, to believe, that in giving his preference 
 to properly constructed forceps, he expresses the opinion 
 of all who have given both instruments a fair trial. There 
 may be some, who, having been accustomed to the use of 
 the key instrument for many years, — have only occasion- 
 ally employed forceps, and which perhaps were not of the 
 best construction, still persist in giving a preference to 
 that instrument. But this constitutes no argument what- 
 ever in its favour. To form a correct opinion of the 
 relative merits of the two instruments, it is necessary to 
 use each for a length of time, say three or four months, 
 to the entire exclusion of the other. All who have done 
 this, give a decided preference to the forceps. The 
 author himself acknowledges that frequent injuries to 
 the alveoli are unavoidable in the use of the key, which, 
 with forceps properly adapted to the operation, need 
 seldom if ever be inflicted. 
 
INCISOR FORCEPS. 215 
 
 But notwithstanding the great improvements which 
 have been made in the shape and form of forceps, not 
 one dentist in five, of those who use them, have such as 
 are best suited to the operation. Many too, have four 
 times as many as are really requisite, believing from their 
 number, they will always be able to select one, adapted 
 to the peculiarity of any case which may come up in 
 their practice, seemingly ignorant of the fact, that effi- 
 ciency of their action depends more on their shape and 
 construction than on their multiplicity. Seven pair are 
 all that are required for the operation. The beak of each 
 of these should be so adapted to the necks of the teeth to 
 which it is intended to be applied, as to secure a firm hold ; 
 the handles should be no longer than is absolutely neces- 
 sary to accommodate the hand of the operator, to which, 
 they should be accurately fitted and so bent as not to 
 interfere with the teeth in the opposite jaw. But in 
 describing them, it will be better to do it, under the 
 names of the teeth, intended to be extracted by each. I 
 will commence with those to be used on the teeth in the 
 upper jaw. 
 
 FORCEPS FOR THE EXTRACTION OF THE SUPERIOR INCISOR 
 AND CUSPIDATI. 
 
 For the extraction of the upper incisores and cuspidati, 
 but one pair of forceps is required. These should be 
 straight, with the nibs of their beak hollowed out on the 
 inside so as not to press upon the crown of the tooth 
 during the operation. The extremity of each nib, too, 
 should be sufficiently hollowed on the inside to fit the 
 neck of an incisor or cuspidati tooth. They should also 
 be slightly notched to prevent them from turning on it, 
 when a rotary motion is given to the instrument: the 
 
216 UPPER MOLAR FORCEPS. 
 
 handles should be broad and about five or five and a half 
 inches in length; one should be bent near the end so as 
 to form a hook to pass round the little finger of the hand 
 of the operator. The extremities of the beak should be 
 thin, in order to admit of being forced high up on the 
 tooth under the gums. But a better idea may be formed 
 of the instrument by an examination of Fig. 1, Plate 
 XXIV. where it is represented. These forceps, besides 
 being specially adapted to the extraction of the superior 
 incisores and cuspidati, are in many cases the best that 
 can be employed for the removal of the upper bicuspides. 
 
 FORCEPS FOR THE EXTRACTION OF THE SUPERIOR MOLARES. 
 
 The above named teeth, having three roots each, two 
 outer and one inner, require for their removal two pair 
 of forceps, one for the right and one for the left side of 
 the mouth. The beaks of these forceps should be bent 
 sufficiently to clear the tooth, anterior to the one on which 
 it is to be applied without depressing the handles so much 
 as to throw them in contact with the teeth in the lower 
 jaw. The outer nib of the beak of each pair, should 
 have two grooves filed in its extremity, with a fine point 
 between them, to fit in the depression on the side of the 
 neck of the tooth, just below the bifurcation of its outer 
 roots. The inner nib or blade, should be grooved to fit 
 the neck of the tooth on the palatine side. The handles 
 should be broad and strong enough to prevent them from 
 springing under the grasp of the hand of the operator. 
 The handle of each instrument toward the operator, 
 when applied to the tooth, should have a hook on the 
 end of it to pass round the little finger, in order to pre- 
 vent it from slipping in the hand when it is moist with 
 perspiration. These forceps are represented in Figs. 2 
 
BICUSPID AND DENTES SAPIENTIjE FORCEPS. 217 
 
 and 3, Plate XXV. Their handles should be about the 
 length of the incisor and cuspidati forceps. 
 
 FORCEPS FOR THE EXTRACTION OF THE SUPERIOR DENTES 
 
 SAPIENTLE. 
 
 Although in most cases, the forceps to be hereafter 
 described for the extraction of the bicuspides of both jaws 
 and the cuspidati of the lower, are the most convenient 
 and best instrument that can be used for the removal of 
 the superior dentes sapientiae: it sometimes happens, that 
 one of a different shape is necessary, these should be 
 bent in the beak above the joint so as to form two right 
 angles. The object of this is to clear the second molaris, 
 when the dens-sapientiae is considerably shorter than this 
 tooth. Each blade or nib of the beak of these forceps, 
 should be grooved on the inside, to make them fit the 
 necks of these teeth. The handles should be broad and 
 one bent at the end in the manner as before described. 
 
 These forceps are also useful for the extraction of the 
 root of a tooth situated close behind another tooth. Fig. 
 4, Plate XXIV. is an accurate representation of them. 
 
 FORCEPS FOR THE EXTRACTION OF THE BICUSPIDES OF BOTH 
 JAWS AND THE INFERIOR CUSPIDATI AND DENTES SAPIENTIJE. 
 
 But one pair of forceps are required for the extraction 
 of these teeth. The handles of these should be straight 
 and broad, without a hook on either. Each nib should 
 be grooved on the inside, and both bent so as to form 
 an angle of twenty-five or thirty degrees with the han- 
 dles. They should also be narrow to prevent interfering 
 with the adjoining teeth, and thin so as to admit of being 
 slipped under the gums to the e(\^e of the alveolus. 
 
218 INFERIOR MOLAR FORCEPS. 
 
 With a forcep of this description, a bicuspis in either 
 jaw can readily be extracted. They are also better suited 
 to the extraction of the inferior cuspidati and dentes 
 sapiential than any other instrument. In the majority of 
 cases too, they are the best for the removal of the upper 
 dentes sapientiae. These forceps are represented in 
 Fig. 2, Plate XXIV. 
 
 FORCEPS FOR THE EXTRACTION OF THE INFERIOR INCISORES. 
 
 The only difference between the forceps now under 
 consideration and those last described, is, that the beak 
 of the latter should not be more than one-third the width 
 of those of the former. The handles should be of the 
 same width and length, and the beak have the same cur- 
 vature. And while forceps of this description are admi- 
 rably adapted to the extraction of the lower incisores, 
 they are the most efficient instrument that can be em- 
 ployed for the removal of the roots of the bicuspides and 
 molares, for it often happens that the former are so much 
 funneled out by caries as to prevent their walls from 
 affording a sufficiently firm support to any other forceps 
 for their extraction. But with these a portion of the 
 alveolus may be included between the nibs, and cut 
 through and the root grasped and removed at once. 
 This, therefore, may be regarded as one of the most 
 valuable extracting instruments that has ever been em- 
 ployed. A view of it is exhibited in Fig. 4, Plate XXV. 
 
 FORCEPS FOR THE EXTRACTION OF THE INFERIOR MOLARES. 
 
 The lower molares having two roots, one anterior and 
 one posterior, require for their removal, forceps of a 
 different construction from any which have yet been de- 
 
MANNER OF EXTRACTING TEETH. 219 
 
 scribed. Each blade or nib of the beak should have two 
 grooves with a point in the centre, so constructed as to 
 fit the depression on each side, just above the bifurcation 
 of the roots. The beak should be curved just enough to 
 make the instrument clear the tooth immediately before 
 the one to which the instrument is applied. Mr. Snell, 
 the inventor of the beak of these forceps, as well as those 
 for the extraction of the upper molares, employs two pair 
 for the removal of the teeth in question. But by an 
 improvement made by the editor, one pair will answer 
 the purpose better than two. The improvement consists 
 in having the handles bent so that the instrument may be 
 applied with equal convenience to a tooth on either side 
 of the mouth, while the operator always occupies the 
 same position and has his left arm and hand to control his 
 patient's head and lower jaw, which he can do better 
 than any assistant. But a better idea may be formed of 
 the shape and peculiar construction of these forceps, as 
 improved by the editor, from an examination of Fig. 1, 
 Plate XXV. than from any description which can be 
 given of them. The handles it will be perceived are bent 
 towards the operator, with a hook on the inner one, to 
 pass round the little finger like some of the others which 
 have been before described. 
 
 The manner of using these forceps will be described in 
 connection with the parts of the work which treats on the 
 extraction of the different classes of teeth.] 
 
 [MANNER OF EXTRACTING TEETH.] 
 
 I shall now state the manner of extracting the different 
 classes of teeth, accompanied with cautions necessary to 
 be observed under different circumstances. 
 
 Previously to the extraction of a tooth, it is very 
 
220 EXTRACTION OF INCISORES AND CUSPIDATI. 
 
 necessary that the gum should be separated as much as 
 possible from the neck of the tooth and the edges of the 
 alveolar processes. This is to be done with a gum lancet, 
 and a round edged one is to be preferred to a pointed 
 one. The lancing the gum saves it from being torn by 
 the raising of the tooth, and the claw of the instrument 
 can be pushed so much under the gum as to obtain a 
 firmer hold upon the neck of the tooth. In young chil- 
 dren, we may dispense with the lancing of the gum, on 
 account of their extreme timidity; beside, as their teeth 
 are commonly not very strong in the sockets, there is 
 very little danger of injuring the gums. 
 
 [DIRECTIONS FOR THE EXTRACTION OF THE INCISORES AND 
 
 CUSPIDATI.] 
 
 The incisores and cuspidati, although very subject to 
 caries, are not frequently affected with tooth-ache, there- 
 fore it is not often required to extract them on that 
 account. In the loose state, they are easily removed, 
 and the paces have commonly been used ; but, when firm 
 in the head, it has been usual to employ the key instru- 
 ment. There are two or three objections, however, to 
 this practice: it must be recollected that the fangs of 
 these teeth are long, and the alveolar processes thin ; it 
 is, therefore, almost impossible to extract an incisor or 
 a cuspidatus with a key instrument, without splitting up 
 the alveolar processes. This accident, together with the 
 unavoidable contusion of the gum, occasioned by the 
 pressure of the instrument, leaves an unpleasant ulcer, 
 which, being in the front of the mouth, is very percep- 
 tible, and as it is a considerable time in healing, the 
 patient often expresses much dissatisfaction; there is also 
 a danger of breaking the tooth in the middle of the fang, 
 
EXTRACTION OF INCISORES AND CUSPIDATI. 221 
 
 especially in the case of the cuspidati. These accidents 
 are avoided by making use of the paces; and, as these 
 teeth are straight, and have conical fangs, they may be 
 extracted in the direction of the socket, which will pre- 
 vent its fracture, as well as the contusion of the gum. 
 
 The manner of using the paces is this: the tooth is to 
 be laid hold of, upon the fang, as far as possible under 
 the gum. The instrument is then to be grasped with a 
 force just sufficient to hold the tooth tight, but not to 
 pinch so hard as to crush it. The attachment of the 
 periosteum of the fang to that of the socket is then to be 
 separated by moving the tooth from side to side, by a 
 gentle but steady motion of the wrist. When the tooth 
 has thus been moved in its socket, it may be drawn 
 straight out. Sometimes it will be requisite to use efforts 
 for some time to loosen the tooth ; for it must be remarked, 
 that scarcely any man has sufficient strength to extract 
 one of these teeth by direct force; but if a tooth be first 
 loosened in the socket, by moving it from side to side, it 
 may then be extracted successfully. The teeth of chil- 
 dren are always removed with facility; the only impedi- 
 ment being the resistance induced by their fears. 
 
 [It is not to be wondered that the extraction of the 
 incisores should have been regarded both as a difficult 
 and rather dangerous operation, when for the want of a 
 more suitable instrument, it often became necessary to 
 have recourse to the key for their removal. The injuries 
 of which the author speaks, as being, in many cases 
 unavoidable, need never be inflicted in the extraction of 
 these teeth. With forceps such as have been described 
 by the editor, they can always be removed with both 
 ease to the operator and safety to the patient. 
 
 For the extraction of an upper incisor or cuspidatus, 
 the forceps first described and represented in Fig. 1. 
 29 
 
222 EXTRACTION OF THE 
 
 Plate XXIV. should be employed. With these, after 
 having separated the gum from the neck of the tooth, it 
 should be grasped as high up as possible, and just tight 
 enough to prevent the instrument from slipping. This 
 done, it should be moved several times in quick succes- 
 sion, backwards and forwards, and then with a rotary mo- 
 tion, the tooth may be pulled from the socket. The root 
 of an upper cuspidatus being rather more flattened than 
 that of an incisor, will not admit of as much rotary mo- 
 tion, in its extraction. This, the operator should bear in 
 mind in the removal of these teeth. It is also longer, 
 and oftentimes requires considerable more force for its 
 removal. 
 
 The lower incisores are generally less firmly articulated 
 than the upper, and as might readily be supposed, are, in 
 the majority of cases, more easily removed. The forceps 
 represented in Fig. 4, Plate XXV. should be employed 
 for their extraction. They should be applied as low down 
 on the neck of the tooth as possible, and after moving it 
 several times backwards and forwards, giving at the same 
 time, a slight rotary movement to the instrument, it should 
 be raised from the socket. When the tooth to be extrac- 
 ted is situated behind the arch, as is often the case, a 
 rotary motion only should be given to the instrument, 
 previously to the removal of the organ. 
 
 The inferior cuspidati may also be removed with the 
 forceps recommended for the extraction of the lower 
 incisores, but it is better to use a pair having wider 
 beaks.] 
 
 [DIRECTIONS FOR THE EXTRACTION OF THE BICUSPIDES AND 
 
 MOLARES.] 
 
 The biscuspides and molares should be extracted with 
 the key instrument which must be always furnished with 
 
BICUSPIDES AND MOLARES. 223 
 
 three claws, adapted to the different sizes of the crowns 
 of the teeth. The smallest claw is designed for the bi- 
 cuspides; the next in size for the molares of the under 
 jaw, and the dentes sapientise of the upper jaw ; and the 
 largest size for the first and second molares of the upper 
 jaw. The bicuspides of the upper jaw may be extracted 
 with the claw placed in the usual mode, as little difficulty 
 attends their removal; but the bicuspides of the lower jaw 
 being very long and slender, the fangs are liable to be 
 broken off at about two-thirds of their length, leaving a 
 piece in the socket; this circumstance arises from the 
 pressure of the bolster of the instrument against the exte- 
 rior part of the middle of the fang, and the resistance to 
 the extraction of the fang made by the inner and lower 
 part of the socket. 
 
 These accidents are certainly avoided by fixing the 
 claw behind the bolster, as in Fig. 8, Plate XXII. and in 
 Plate XXIII. Fig. 2. The instrument, in this way, acts 
 upon the tooth only in the place were the claw is fixed, 
 and, by the fulcrum being applied beyond the tooth, no 
 resistance is made against the side of the alveolus; thus 
 the tooth is usually extracted perfectly whole, and with 
 great ease. 
 
 The molares are extracted with claws proportioned to 
 their size, which are to be fixed even with the bolster.* 
 
 Much diversity of opinion has existed as to the precise 
 direction in which the teeth should be drawn: it has been 
 recommended by some, to draw the second and third 
 molares of the under jaw inwardly, and all the others out- 
 wardly. The reason assigned for this rule is, that those 
 teeth naturally incline inwardly, and the alveolar proces- 
 ses, being thin on that side, yield with greater ease, by 
 which the extraction of the tooth is facilitated. 
 
 * Plato XXII. Fig. 7, and Plate XXIII. Fig. & 
 
224 extka(Tio.\ or Tin: 
 
 From much experience, however, I have found that 
 this plan cannot be practised without incurring difficulty 
 and danger; when these teeth incline much inwards, they 
 are situated out of the perpendicular with respect to the 
 jaw, and hang considerably over the base. When the 
 instrument is fixed, the claw taking hold of the tooth at 
 the outer side, the bolster presses upon the jaw in a part 
 relative to the tooth, in a line so much out of the perpen- 
 dicular, that the force applied acts upon the tooth in a 
 diagonal line from the outer part, at the neck, to about 
 the middle of the inner part of the fangs : hence there is 
 great danger, if the fangs are very strong, that the tooth 
 will be broken off, and leave a part of the fangs in the 
 socket. There is also danger lest the extraction of the 
 tooth should be attended with a fracture of the alveolar 
 processes, for it is very liable to extend considerably.* 
 
 Much soreness is likewise occasioned by the pressure 
 of the instrument against the soft parts under the side of 
 the tongue, which causes a swelling and a tenderness that 
 continue for some time. Extraction, in this manner, is 
 frequently rendered impracticable, by the caries being 
 situated at the side where the claw should be fixed: this 
 is very commonly the case with the dentes sapientiae, 
 w T hich would render the removal of these teeth an impos- 
 sibility, without using the instrument according to Mr. 
 Spence's improvement.! For these reasons, a general 
 rule may be given, that the key instrument should ahvays 
 be applied in such a manner, as to extract the tooth out- 
 wardly, except in those cases where the state of the decay 
 renders it impossible. 
 
 The extraction of the dentes sapientiae of the under 
 jaw is attended with more difficulty than that of any other 
 of the teeth. The jaw T -bone begins to rise on the outer 
 
 * Plate XXIII. Fi ? . 5. \ Plate XXII. Fi?. <i. 
 
BICUSPIDES AND MOLARES. 225 
 
 side of the dentes sapiential, in order to form the coronoid 
 process; and, in some persons, the rise of the bone is 
 nearly as high as the tooth. Hence there is not sufficient 
 depth for the bolster of the instrument to be applied on 
 the outside of the tooth, and there would always be a 
 necessity for drawing the tooth inwardly, if we did not 
 possess a safe method of extracting it outwardly. It was 
 with this view that the improvement of Mr. Spence was 
 introduced. A dens sapiential which is much decayed 
 on the outer side, could not be drawn inwardly, because 
 the decayed state of the tooth would prevent proper hold 
 for the instrument. Likewise, with a common key in- 
 strument, it would not be possible to draw it outwardly, 
 because the rise of the jaw-bone would render it imprac- 
 ticable. These difficulties are entirely obviated by 
 advancing the claw beyond the bolster; a fulcrum is then 
 conveniently obtained by applying the bolster upon the 
 jaw at the outer side of the second molaris, and the claw 
 being fixed on the inner side of the tooth, it may be 
 drawn outwardly with great safety. By operating in 
 this manner, much difficulty is obviated, and the danger of 
 breaking away large portions of the alveolar processes is 
 prevented.* 
 
 [The bicuspides and molares, as has been before stated, 
 can be extracted with more ease and less danger of in- 
 jury to the alveolar processes, with forceps than with the 
 key instrument, and as the directions given by the author 
 upon the subject apply exclusively to the latter, the editor 
 will add such as he deems necessary for the former. But 
 before he does this, he will advert briefly to the directions 
 given by the author, with regard to the manner of apply- 
 ing the key to the second and third inferior molares. In 
 the application of the instrument to these teeth, he recom- 
 
 * Plate XXIII. Fig. 1. 
 
226 EXTRACTION OF THE 
 
 mends placing the bolster or fulcrum on the outside of 
 the tooth, and the reasons which he offers for so doing 
 should at once, determine the application of it on the 
 other side. As these teeth incline inwardly, the direction 
 of the force exerted by the key when the fulcrum is 
 placed on the outside, is on a line which forms a more 
 abrupt angle with the tooth than when it is applied on 
 the inside, and consequently requires a much greater 
 amount of power for its removal, and in proportion to 
 which, is the danger of injury to the alveolus increased. 
 When, therefore, the key instrument is used for the 
 extraction either of the second, third, or first molaris or 
 bicuspides of the lower jaw, the fulcrum of the instrument 
 should be placed on the inside of the tooth. And as a 
 general rule, it should be placed on the inside in the 
 extraction of the upper molares or bicuspides. 
 
 For the extraction of the bicuspides of either jaw, and 
 the inferior cuspidati, the forceps represented in Fig. 2, 
 Plate XXIV. should be used. The gum having been 
 perfectly separated from the neck of the tooth, the for- 
 ceps should be placed on it as high up or low down as it 
 may happen to be, in the upper or lower jaw, as possi- 
 ble, grasping it sufficiently tight to prevent the instru- 
 ment from slipping and not tight enough to fracture the 
 tooth, it should be quickly pressed outwards and inwards 
 until it begins to yield or give way in the socket, when it 
 should be raised with a very slight rotary motion from 
 the alveolus. But if the tooth above the alveolus, is so 
 much weakened by caries as to be unable to bear the 
 pressure of the instrument, the gum should be laid open 
 vertically with a sharp lancet, for an eight of an inch or 
 more if necessary on the alveolus, and this grasped suffi- 
 ciently high up, if the tooth be in the upper jaw, and 
 low down, if it be in the lower, to reach a sound part of 
 
B1CUSPIDES AND MOLARES. 227 
 
 the root, with the narrow-beaked forceps represented in 
 Fig. 4, Plate XXV., which, by a little pressure, on the 
 handles, will be cut through, when the affected organ 
 may be easily removed. 
 
 The lower cuspidati should be extracted in nearly the 
 same manner, when similarly circumstanced, but when 
 their roots are not funneled out by caries, the forceps 
 represented in Fig. 2, Plate XXIV. should be employed 
 for their removal. 
 
 It may be as well to observe here, that it often happens, 
 when a tooth decays on the side next to an adjoining 
 tooth, the last, by the approximation of the two, infringes 
 upon the first in such a manner, as to oppose a formidable 
 obstacle to its removal — one which can only be overcome 
 by filing away a portion of the encroaching organ. In a 
 case of this description, no attempt should be made to 
 extract the carious tooth, until so much of the adjoining 
 one as has impinged upon it, has been removed with a 
 file. If this precaution be neglected, two teeth, if no 
 more serious injury should result, will be removed instead 
 of one. 
 
 The directions given for the extraction of the bicuspides 
 and lower cuspidati, will, in most instances, be found ap- 
 plicable for the removal of the dentes sapientiae. It 
 sometimes happens however, that when the lower dentes 
 sapientiae are situated far back under the coronoid pro- 
 cesses they are somewhat difficult of removal, but with 
 forceps, such as represented in Fig. 2, Plate XXIV. and 
 a little tact, on the part of the dentist, they may be 
 grasped and removed. If the crown be decayed off 
 down to the alveolus, the narrow-beaked forceps should 
 be used, and in their application, the upper edge of the 
 socket should be included between the nibs of the beak 
 of the instrument. It sometimes happens too, that the 
 
228 EXTRACTION OF THE 
 
 roots of these teeth are bent in such a way as to consti- 
 tute a considerable obstacle to their removal, but a little 
 patience and management on the part of the operator 
 will enable him to extricate them. When the crowns 
 of the second molares in the upper jaw are very much 
 longer than those of the dentes sapientiae, the forceps 
 represented in Fig. 4, Plate XXIV. should be employed 
 for the removal of the last named teeth, instead of the 
 ones last referred to. 
 
 The superior molares having three roots are generally 
 more firmly articulated than any of the other teeth, and 
 as a consequence, usually require more force for their 
 removal. When therefore, one of these teeth is to be 
 extracted, it should be firmly grasped high up under the 
 gums, with one of the forceps represented in Figs. 2 and 
 3, Plate XXV. and pressed outwards and inwards, until 
 it begins to yield in the socket, then by depressing the 
 instrument it should be removed. The forceps for the 
 removal of the upper molares should be strong and accu- 
 rately fitted to the teeth, and when of the proper shape 
 and construction they are the safest and best instruments 
 that can be used for their extraction. 
 
 Although the inferior molares have but two roots, they 
 are often very firmly articulated, and require considerable 
 force for their removal; yet with forceps such as repre- 
 sented in Fig. 1, Plate XXV. in the hands of a good 
 operator, they can usually be extracted without difficulty. 
 The points on the ends of the nibs of the beak, should, 
 in the application of the instrument, be forced down 
 between the roots of the tooth, which being firmly grasped 
 should be forced several times, outwards and inwards, 
 and as soon as it begins to move freely in the socket, it 
 should be raised from it. When the crown of the tooth 
 has decayed otf, a portion of the alveolus on each side 
 
ROOTS OF TEETH. 229 
 
 should be included between the points of the nibs of the 
 forceps, and cut through in the manner as before de- 
 scribed. This done, a firm hold is obtained upon the 
 tooth, which now may easily be removed. 
 
 The position of the operator, while extracting a tooth, 
 whether in the upper or lower jaw, or on the right or 
 left side, should always be at the right and a little behind 
 the patient. This position gives him an opportunity of 
 controlling his head, and guarding the instrument more 
 effectually than he could do were he to occupy any other 
 position. And as a general rule, the instrument should 
 rest upon the palm of his hand, while he is using it.] 
 
 DIRECTIONS FOR THE EXTRACTION OF ROOTS OF TEETH. 
 
 Stumps are often extracted with much ease; they are 
 sometimes so much thrust out by the socket as to require 
 very little force for their removal; but in other instances, 
 there is great difficulty, from the depth at which they are 
 placed in the jaw, and the very decayed state of the 
 exposed part. Stumps can rarely be extracted with the 
 key instrument, as a sufficient purchase for the claw can 
 scarcely be obtained, they must therefore be extracted 
 with the punch. The mode of using this instrument is 
 as follows; the gum should be well separated with the 
 lancet, that the instrument may be applied to a sound 
 part of the stump; it is then to be pushed with a steady 
 force, sufficient to displace the stump from the socket. 
 As there is danger that the punch may slip, and tear 
 some part of the mouth, care should be taken to avoid 
 such an accident, by wrapping a cloth around the fore- 
 finger of the left hand, which, being introduced into the 
 mouth, will receive the point of the instrument, should it 
 slip, and prevent any injury from being inflicted. 
 30 
 
230 EXTRACTION OF THE 
 
 [In addition to the punch, an elevator, hook and 
 screw, instruments too well known by every dentist at the 
 present day to need description, are now used in the 
 extraction of roots of teeth. The punch, elevator and 
 hook, are used chiefly for the extraction of the roots of 
 the bicuspides and molares. The two former for the 
 removal of roots on the right side of the mouth, and the 
 latter, for the removal of roots on the left side. 
 
 In using the punch or elevator, care is necessary to 
 prevent the instrument from slipping and inflicting injury 
 on the soft parts of the mouth. With the hook there is 
 not so much danger. The manner of using the elevator, 
 is to force the instrument between two roots or one root 
 and a sound tooth, and then by turning it, the edge 
 against the root to be removed, and the back against the 
 adjoining tooth or root, the root to be removed, is lifted 
 from the socket. The hook acts upon pretty much the 
 same principle as the punch. 
 
 The narrow-beaked forceps, however, previously de- 
 scribed, are much better adapted for the removal of the 
 roots of the bicuspid and molar teeth than either the 
 punch, elevator or hook, and in the hands of those who 
 have made trial of them, it has superceded their use 
 almost altogether. It can be more easily used, and is a 
 much safer and more efficient instrument. 
 
 The screw employed for the extraction of roots of 
 teeth, is of a conical shape, somewhat like that of the 
 roots of the incisores and cuspidati, and for the removal 
 of which, it is especially designed. After the loss of the 
 crown of one of these teeth, the caries oftentimes extends 
 up the roots, tunneling it out, and leaving only a thin 
 exterior shell, which is too weak to bear the requisite 
 amount of pressure from forceps for its removal. But 
 after removing the softened, decomposed bone from the 
 
ROOTS OF TEETH. 231 
 
 interior, with a screw like the one here described, firmly 
 introduced, it may easily be removed. 
 
 On the conical screw which has been in use for a long 
 time, Dr. Hullihen of Wheeling, Va. has made a highly 
 valuable improvement, consisting of a combination of this 
 with a pair of forceps, which he designates " Compound 
 Root Forceps." A representation of them is exhibited in 
 Fig. 3, Plate XXIV. and the editor will here quote the 
 description which he has given of them. 
 
 He says, "the above named forceps, were contrived 
 some time since, for the purpose of extracting hollow 
 roots of teeth, with more expedition and at the same 
 time, with less pain to the patient than was possible with 
 the instrument in general use, and as the forceps have 
 fully answered the purpose for which they were intended, 
 I have thought them of sufficient importance to lay them 
 before the profession. 
 
 The compound root forceps are about nine inches in 
 length, and like the common straight forceps with the 
 exception that the beak is much longer, and much nar- 
 rower and thinner at the point. Lengthwise, within and 
 between the blades of the beak is a steel tube, one end of 
 which is open; the other solid and flat and jointed in a 
 mortise in the male part of the forcep's joint. When the 
 forceps are opened, this joint permits the tube to fall 
 backwards and forwards from one blade of the beak to 
 the other, without any lateral motion. Within this tube 
 is a spiral spring, which forces up the shaft, two-thirds of 
 the length of the shaft is rounded and fitted neatly into 
 the tube, the other part is a well tapered or conical screw. 
 The shaft is retained in the tube by a small screw, that is 
 fixed into the shaft through a notch half an inch long in 
 one side of the tube. The shaft and tube are so fitted 
 together, and to the beak of the forceps, that one-half of 
 
232 EXTRACTION OF THE ROOTS OF TEETH. 
 
 the rounded part of the shaft projects beyond the end of 
 the tube; so that the shaft may play up and down upon 
 the spring, the length of the notch; and the screw part pro- 
 jecting beyond the point of the forceps ; so that the shaft 
 may be embraced between its blades^ just behind the base 
 of the screw. A full sided view of the beak of the 
 forceps with its tube and shaft is well represented in the 
 cut ; — for a copy of which see Fig. 3 ; Plate XXIV. 
 
 The forceps are used; by first embracing the shaft 
 between the blades. Then screwing it gently and as 
 deeply into the root as possible; the blades are opened and 
 pushed up upon the root; which is then seized in either 
 of the ways as the case may require. 
 
 The screw thus combined with the forceps; prevents 
 the root from being crushed. It acts as a powerful lever 
 when a lateral motion is given ; it is likewise of advantage 
 when a rotary motion is made; as it prevents the forceps 
 from slipping; or of their action being lost; should even 
 one side of the root give way in the act of extracting it; 
 and is used with equal advantage where one side of the 
 root is entirely gone. In short, this combination of the 
 screw and forceps forms an instrument which fulfils every 
 indication that can be desired in the extraction of hollow 
 roots. 
 
 The shaft of the compound forceps is easily changed ; 
 a number of different sized screws may therefore be used 
 in the same pair of forceps. " 
 
 In conclusion; the editor would remark; that he has 
 tested the merits of this instrument; and can recommend 
 it to the profession as one of great value.] 
 
USE OF THE KEY INSTRUMENT. ' 233 
 
 [PARTICULAR DIRECTIONS FOR THE USE OF THE KEY 
 INSTRUMENT.] 
 
 In extracting a toothy the first thing to be considered, 
 is the choice of a claw adapted to the size of a tooth : it 
 should neither be too large, nor too small: if it be too 
 large, there is great danger of breaking away a large 
 portion of the alveolar process; and, if it be too small, as 
 it can only act upon the crown of the tooth, there will be 
 almost a certainty of breaking it off, and leaving the fangs 
 in the socket. 
 
 In Plate XXIII. are too examples of the dangerous 
 consequences of attempting to use an instrument with too 
 large a claw, Fig. 7 is the representation of all the mo- 
 lares of the upper jaw that were torn from the mouth of 
 a gentleman, by an injudicious operator, in attempting to 
 extract one of them, which was decayed. 
 
 Fig. 8, represents the dens sapiential of the lower jaw, 
 of a lady, which was attempted to be extracted inwardly 
 with too large an instrument; the consequence was, the 
 bringing away a large piece of the jaw with the tooth, as 
 described. 
 
 The fixing an instrument upon the tooth is a circum- 
 stance which ought particularly to be attended to, as 
 many teeth have been broken for want of regarding this 
 circumstance. 
 
 The key instrument, in the extraction of a tooth, acts 
 precisely upon the principle of a lever of the first kind. 
 It is an improvement upon the very ancient instrument 
 called the pelican, which consisted of a claw laying hold 
 of the tooth, a fulcrum to press upon the jaw, and a 
 straight handle by which to exert the power. In the 
 present form of the instrument, the claw, or hook, forms 
 the point of the lever, the bolster the fulcrum, and the 
 
234 PARTICULAR DIRECTIONS FOR THE 
 
 handle, which is now placed at a right angle with respect 
 to the claw, is the part with which to exert the power. 
 
 The point of the claw should always be fixed as far as 
 possible on the neck of the tooth, that the power may act 
 upon the fangs ; and the bolster should be fixed on the 
 opposite side, rather below the point of the claw. When 
 an instrument is thus fixed, and power is applied by turn- 
 ing the handle, it immediately acts, by raising the tooth.* 
 But, if the point of the claw 7 and the fulcrum be in direct 
 opposition to each other, the increasing of the power only 
 pinches the crown of the tooth, and does not act so as to 
 raise the fangs. In this case, the crown of the tooth 
 must be broken off, without moving the fangs, or the 
 claw 7 will be broken in the centre of its curve. f 
 
 When the instrument has been fixed in a proper man- 
 ner, the next thing to be regarded is the best mode of 
 using it. 
 
 There is one method of using the instrument which 
 cannot be too strongly reprobated, as it is sometimes 
 attended with the most mischievous consequences; this 
 is, the attempting to extract a tooth quickly, by turning 
 the instrument in a sudden, violent manner. I have 
 known many accidents result from this practice, and 
 therefore cannot but condemn it in the strongest terms. 
 No tooth can be extracted safely, unless its attachment to 
 the jaw be overcome by a force, which being gradu- 
 ally increased, will cause the parts concerned to yield 
 with safety. For want of attending to this principle, 
 various distressing accidents have been occasioned ; com- 
 monly the teeth are broken in the socket, and sometimes 
 part of the jaw itself; and often the alveolar processes 
 are extensively fractured. About six years ago, I atten- 
 ded a lady who suffered most dreadfully, for a great 
 
 * Plate XXlUFi?. f. t Fig. 6. 
 
USE OF THE KEY INSTRUMENT. 235 
 
 length of time, from having a tooth extracted in this sud- 
 den manner. The gentleman who performed the opera- 
 tion, removed the tooth, the second bicuspis in the lower 
 jaw, with a very sudden jerk of the instrument; two or 
 three days afterwards, the face became much swollen, and 
 a considerable quantity of matter formed; this was dis- 
 charged at the socket from which the tooth had been 
 drawn. The lady was in this state when I saw her; the 
 discharge of matter w 7 as very considerable, and the other 
 bicuspis was somewhat loosened; it was very tender to 
 the touch, and appeared to be a cause of irritation: it 
 was, therefore, judged expedient to remove it. The pain 
 and discharge of matter still continued, and small pieces 
 of bone worked out of the gum; at length the abscess 
 extended to the socket of the first molaris, and it became 
 so tender as to make it necessary to extract that tooth. 
 Shortly after this had been drawn, some very large pieces 
 of the jaw exfoliated; but still the lady was not relieved 
 from pain, nor did the abscess appear to be disposed to 
 heal : in a little time afterwards, the second molaris be- 
 came sore, and was affected by the abscess as the other 
 teeth had been; and, therefore, it w T as determined upon, 
 that this also should be extracted. The removal of this 
 tooth permitted a piece of bone, more than two inches in 
 length, to come away; soon after which the discharge of 
 matter ceased, and the parts became perfectly healed. 
 This is an instance in which three teeth were lost, besides 
 the originally diseased one, with extensive exfoliation of 
 the jaw, and six months excessive pain ; all this resulting 
 from extracting a tooth with a violent jerk 
 
 To be able to extract a tooth well, the surgeon should 
 act with firmness and self-possession: having these quali- 
 fications, he will not be so confused as to place the instru- 
 ment upon a wrong tooth, nor act with so much precipi- 
 tation as to endanger the safety of the patient. 
 
236 USE OF THE KEY INSTRUMENT. 
 
 The observation of a most distinguished anatomical 
 lecturer, that all operations are performed sufficiently 
 quick, which are performed well, is very applicable to 
 the extraction of a tooth 
 
 The plan that I have always adopted, with the great- 
 est success, is gradually to increase the power of the 
 instrument until the tooth be moved; and then, by raising 
 the hand, endeavour to draw the tooth in a direction as 
 nearly perpendicular as possible. 
 
 Sometimes, although the utmost care has been taken 
 in the extraction of a tooth, a portion of the alveolar pro- 
 cess will be broken off: it may either come away adhering 
 to the tooth, or it may remain loose in the socket: it is, 
 therefore, highly proper that the gum should be cautiously 
 examined, and, if any loose splinter be felt, it must be 
 taken away: for this purpose it is always right to be pre- 
 pared with a pair of forceps. If any splinter should be 
 left in the gum, it will be productive of future inconve- 
 nience, as the gum remains very sore, and is kept from 
 healing until the piece of bone has come away. This 
 examination may always be made at the time of closing 
 the gums, without exciting any alarm in the mind of the 
 patient. 
 
 When the crown of a tooth is much decayed, success 
 does not always attend an attempt to extract it: the 
 whole, or a part of the fangs may remain: sometimes the 
 gum will grow- over such portions of the fangs, and then 
 they can no longer be the cause of uneasiness : or the 
 socket, by closing at the bottom, will gradually thrust 
 them forwards, until they may readily be taken hold of, 
 and extracted. The pain of the tooth-ache is usually 
 removed by the destruction of part of the nervous mem- 
 brane, or the hemorrhage caused by the operation; and, 
 if the stumps should afterwards become troublesome, they 
 mav, in a few months, be easily removed. 
 
HEMORRHAGE AFTER EXTRACTION. 237 
 
 HEMORRHAGE AFTER EXTRACTION. 
 
 Sometimes, after the extraction of a tooth, a consid- 
 erable hemorrhage continues; the artery which belonged 
 to the tooth does not contract; or, from being of large 
 size, a coagulum sufficiently strong to restrain the flow of 
 blood is not formed. Hence a great quantity of blood 
 may be lost. The best mode of stopping this hemorrhage 
 is by the application of pressure. A piece of very fine 
 lint, or cotton, dipped in spirits of turpentine, should be 
 pressed into the socket, over which a large compress of 
 lint should be laid, which may either be pressed firmly 
 with the finger, or, in closing the mouth, by the teeth of 
 the other jaw. In this manner, a hemorrhage may soon 
 be restrained; little or no benefit is ever derived from 
 washing the gums with styptic remedies, as they cannot 
 act upon the mouth of the bleeding vessel, and therefore 
 are ineffectual. 
 
 31 
 
CHAPTER SIXTH. 
 
 OF EXOSTOSIS OF THE FANGS [OF THE TEETH.J 
 
 Oxe of the species of exostosis in bones, is an enlarge- 
 ment arising from a deposit of bony matter, so compact 
 in its structure as very much to resemble ivory. This is 
 that kind of enlargement to which the fangs of the teeth 
 of some persons are liable. 
 
 The cause of this disease is obscure, and the slow- 
 increase in the size of the fang is the reason why pain 
 does not occur until a considerable augmentation of its 
 bulk has taken place. 
 
 It is sometimes found to exist where the crow T ns of the 
 teeth remain perfectly sound; in other cases, it appears 
 to be the effect of indolent inflammation, arising from 
 caries in the body of the tooth, and extending to the fang. 
 This kind of disease does not produce suppuration; the 
 gum continues quite healthy; but, whenever pain occurs, 
 as no permanent relief can be obtained without the ex- 
 traction of the tooth, it becomes necessary, when the teeth 
 are sound, to be very attentive to distinguish this disease 
 from mere rheumatic affections of the jaw bones. 
 
 In Plate XVI. Fig. 12, are two teeth, the first molaris 
 of each side of the lower jaw, which 1 extracted from a 
 lady, who had complained, for a considerable length of 
 time, of pain on both sides of the face, arising from each 
 of these teeth. She described her symptoms to be, a 
 
OF EXOSTOSIS OF THE FANGS OF TEETH. 239 
 
 constant uneasiness, like the gnawing sensation of rheu- 
 matism, which, continuing almost without intermission, 
 exhausted her health and spirits. The teeth and gums 
 were quite free from any diseased appearance, the pain 
 therefore was considered as rheumatic: she had taken 
 much medicine, and continued under the care of an 
 eminent practitioner, for a considerable length of time, 
 without receiving any benefit. The gums were lanced, 
 blisters were applied behind the ears, but all means were 
 ineffectual : she at length determined to have both of the 
 teeth extracted. This was reluctantly performed, because 
 they appeared to be perfectly free from disease. 
 
 When one tooth was removed, the cause of her 
 complaint became evident, for the whole surface of the 
 fangs was increased in size by the irregular addition of a 
 quantity of bony matter. This induced me to comply 
 with her wish of removing the other, which had precisely 
 the same appearance. The cause of her pain now became 
 certain; the increase in the size of the fangs necessarily 
 occasioned a distention of the alveolar cavity, and kept 
 up a constant uneasiness. The lady was immediately 
 relieved, and recovered her health and spirits, to the 
 great joy of her family, who were nearly deprived of her 
 society, by reason of her excessive nervous irritability. 
 
 Where this disease has occurred in teeth already 
 carious, the persons have not been afflicted with extreme 
 tooth-ache, but they have had occasional uneasiness, 
 which at length has become more uninterrupted, and the 
 tooth has projected to a certain degree from the socket, so 
 that in closing the mouth the tooth felt as if out of its 
 natural situation, thus rendering mastication painful. 
 When extracted, the fangs have been found enlarged as 
 in the teeth represented in Fig. 13, Plate XVI. 
 
 Some persons will refer this appearance upon the fangs 
 
240 OF EXOSTOSIS OF THE FANGS OF TEETH. 
 
 of the teeth to an original mal-formation ; but so different 
 is it in appearance from the smooth structure of any ill- 
 formed; crooked ; or undiseased tooth; and when extrac- 
 ted; so much whiter than any other part of the fang; that 
 it can only be referred to diseased action; occasioning a 
 deposit of bony matter; as in other cases of exostosis. 
 
 Of this disease of the teeth; the most extraordinary 
 case on record occurred to a young lady scarcely twenty 
 years of age. The following letter, from the surgeon 
 who had attended the lady; and by whom she was intro- 
 duced to me ; presents a full narrative of the case. 
 
 Sir; 9th JYov. 1809. 
 
 Miss ; the young lady who will deliver this to 
 
 you; has been under my care for near twelve months ; 
 with a very extraordinary complaint in her face ; teeth 
 and gums. It commenced with a deep-seated pain in 
 the face ; confined principally to one side ; returning most 
 mornings at about eleven o'clock; and continuing several 
 hours. This had gone on for near three months; before 
 she, or her friends, thought it sufficiently serious to call 
 in any medical assistance. When first I saw her; she 
 had suffered great pain all that day; from the teeth; gums, 
 and face : on one side the gums were rather swollen and 
 inflamed ; and as one of the teeth was slightly decayed; I 
 thought it most advisable to extract it; which gave relief 
 till the next day, when the pain returned with still greater 
 violence; so much so, that she was desirous of having 
 the adjoining tooth taken out, which she fancied gave her 
 more pain than the rest. This had the same effect as the 
 other, only giving relief till the next day, when the pain 
 returned with equal violence. I then tried scarifying the 
 gums, cold lotion to the face, giving at the same time a 
 brisk purgative ; and afterwards an opiate. This was 
 
OF EXOSTOSIS OF THE FANGS OF TEETH. 241 
 
 continued for a short time without abating the pain; I 
 then changed the plan for the more soothing one of fo- 
 mentation and poultice, applying a fig to the gums, occa- 
 sionally changing it for a crust of bread soaked in warm 
 milk; taking at the same time a saline and opiate draught 
 every four hours; but with just the same effect as the 
 preceding remedies. In short, the pain in the teeth and 
 face continued, the gums became partially ulcerated, and 
 in the course of six months, I was under the necessity of 
 extracting, at different times, all the teeth in the lower 
 jaw, excepting the four incisores, which very soon became 
 affected in a similar way to the rest: these her friends 
 would not allow to be drawn; nor was I desirous of per- 
 forming the operation, as the removal of the others did 
 not appear to have given any permanent relief, excepting 
 that the gums healed, and remained well where the teeth 
 had been extracted. During this time almost every re- 
 medy that could be thought of was tried, such as frequent 
 scarifying of the gums, leeches, permanent blisters to the 
 lower jaw and behind the ears, astringent lotions, as the 
 infusion of roses with the tincture of myrrh, decoctions of 
 bark, oak bark, infusion of galls, solutions of alum, argen- 
 tum nitratum, salt and water, lemon-juice, oxymel aeru- 
 ginis, borax, charcoal and soda, tepid bath, artificial sea 
 bath, and afterwards sea bathing, seton in the neck, issue 
 in the arm, &lc. &lc. with a great many other applications 
 which it would be useless to name. Internally she has 
 taken strong purgatives, calomel combined with antimony, 
 and afterwards continued alone in small doses to saliva- 
 tion, solutio mineral, solut. calc. muriat. bark, with nitrous 
 acid, steel, lemon-juice in large quantity, tinct. opii. to 
 the amount of gut. 60 at bed time, and repeated in small 
 doses during the day at short intervals, cicuta, &c. &,c. 
 prescribed by an eminent physician of this place, without 
 
242 OF EXOSTOSIS OF THE FANGS OF TEETH. 
 
 receiving little more than slight temporary relief from any 
 one medicine prescribed. She has now all the teeth of 
 the upper jaw affected in a similar way to the lower; the 
 palpebral of one eye have been closed for near two 
 months, and, when opened, can discern objects but very 
 imperfectly; the secretion of saliva has for some time 
 been so copious as to flow from the mouth whenever 
 opened. She is now come to London, purposely for ad- 
 vice, and I have recommended that she should call upon 
 you. 
 
 I remain, Sir, 
 
 Your obedient servant, 
 T. S. 
 
 This letter not only fully describes the very afflicting 
 case, but also shows that medicine under every form had 
 altogether failed : of course no benefit could be expected 
 from a repetition of any similar treatment. 
 
 At the time I saw the lady, she was only able to take 
 fluid nutriment, for the teeth of the upper jaw were so 
 very tender that the slightest touch caused extreme pain. 
 As described by Mr. S. the flow of saliva was so consid- 
 erable that there was a continual necessity of discharging 
 it. The lady herself said she was assured she should 
 never get well, unless all her teeth were extracted. It 
 was however desired if possible to seek such relief as 
 should prevent so painful an expedient which could only 
 be regarded as the last resort. 
 
 Dr. Babington and Mr. Cline were consulted, who 
 prescribed a blister on the head, to be kept open by the 
 application of the ceratum sabina?. This was tried with- 
 out success. The pain in the mouth, the soreness of the 
 teeth, and the general irritation on the constitution, all 
 combined to render the extraction of the most painful 
 
OF EXOSTOSIS OF THE FANGS OF TEETH. 243 
 
 tooth advisable. This was the first molaris of the upper 
 jaw, situated under that eye, the palpebral of which had 
 become closed. 
 
 The fangs of this tooth were much enlarged; and from 
 the periosteum being greatly thickened, the fangs had the 
 appearance of being cartilaginous. The removal of this 
 tooth was attended with great benefit; as, in two days 
 after the operation, the affected eyelids so much recover- 
 ed, as to open simultaneously with those of the other eye. 
 This relief unhappily was of short duration: and as the 
 other teeth remained very sore, the lady determined to 
 have them extracted one after the other. She submitted 
 to this operation, every two or three days. The fangs of 
 those teeth which had caused the most pain, were the 
 most enlarged; but each partook of the disposition to 
 exostosis. 
 
 The relief from pain which was experienced by the 
 loss of the teeth was so great, that with the utmost reso- 
 lution this afflicted lady persevered until every tooth was 
 extracted. After the loss of the teeth, from time to time, 
 portions of the alveolar processes exfoliated, which ren- 
 dered it necessary to scarify the gums. I am happy to 
 say that a material improvement has taken place in the 
 general health, although not so perfectly as could be de- 
 sired. One most important benefit resulted from the 
 removal of the teeth, in arresting the progress of the 
 other diseased actions : for the other eye had begun to be 
 affected; and sometimes was so dim, as scarcely to enable 
 the lady to guide herself about the house. In point of 
 appearance, how T ever, I had the satisfaction of completely 
 restoring the lady, the teeth which had been extracted 
 were replaced, as an artificial set; which, with the great- 
 est comfort she has now used for more than twelve 
 months. 
 
244 OF EXOSTOSIS OF THE FANGS OF TEETH. 
 
 [To the foregoing highly interesting and very remark- 
 able case, the editor could add several others, but as 
 most of them have been elsewhere noticed, he does not 
 think it necessary to extend the limits of this work by 
 their introduction here. With the exception of necrosis, 
 this is the only disease of the teeth which bears the least 
 analogy to any of the morbid affections that are met with 
 in the other osseous structures of the body. The cause 
 of exostosis, has never been satisfactorily explained. 
 Some writers suppose it to be the result of inflammation 
 of the dental periosteum, but as it often attacks the roots 
 of sound teeth, it is most likely dependent on some pecu- 
 liar constitutional idiosyncrasy.] 
 
CHAPTER SEVENTH. 
 
 Or NECROSIS AFFECTING THE TEETH. 
 
 When a bone, or part of a bone, has completely lost 
 its living principle, it is precisely in the same state as soft 
 parts when affected by gangrene: no restoration of the 
 part can be effected, the surrounding parts become in- 
 llamed, and an action takes place, which has for its object 
 the separation of the dead from the living part. When 
 the fang of a tooth has lost its life, the whole of the tooth 
 becomes, in consequence, an extraneous body; and, as in 
 bones, the cure of necrosis depends upon the exfoliation 
 of the dead piece; so, in the case of the tooth, the cure 
 can alone be effected by its entire removal. 
 
 This disease usually affects teeth which are perfectly 
 free from caries.* And it is more particularly confined 
 to the front teeth, the others being rarely affected in this 
 way. When the fang of a tooth has lost its living prin- 
 ciple, the socket becomes inflamed, the gum appears of a 
 darkish red colour, loose in its texture, and matter begins 
 to be discharged. In some, the discharge is from two or 
 three orifices through the gums, opposite to the extremity, 
 or the middle of the fang of the tooth ; in other cases the 
 matter passes out at the neck of the tooth. In all, there 
 is an uneasy pain, and the discharge of the matter is very 
 disagreeable. 
 
 'Although teeth which in other respects are sound, are frequently deprived of 
 vitality, it is by no means uncommon for carious teeth to be affected by necrosis. 
 
 32 
 
246 OF NECROSIS AFFECTING THE TEETH. 
 
 During the progress of this disease, the alveolar pro- 
 cesses are absorbed, [wasted] and the teeth are loosened, 
 from which great inconvenience arises. 
 
 In the early stage of this disease, considerable benefit 
 attends the scarification of the gums; the loss of blood 
 abates the inflammation; and, as it is very unpleasant to 
 lose a front tooth, we may, by repeatedly lancing the 
 gums, arrest the progress of the disease for a considerable 
 time; but, when it has proceeded so far as to loosen the 
 tooth, it is better to extract it, especially as the whole of 
 the uneasiness arises from the tooth being an extraneous 
 body; the discharge then ceases, and the gum becomes 
 perfectly healed in a short time. After extraction, the 
 fang of the tooth is always found to be very rough; in 
 most cases it is dark coloured, being of a deep green, 
 brown, or black colour. In Plate XVII. are several 
 teeth illustrative of this appearance. [The cause of this 
 affection, as has been before stated, is inflammation and 
 suppuration of the lining membrane.] 
 
CHAPTER EIGHTH. 
 
 OF THE DISEASE RESEMBLING SPINA VENTOSA. 
 
 Spina Ventosa is the term usually given to that 
 species of tumor in bone, which is originally an abscess 
 forming in the centre : the ulcerative process removing 
 the bone from the inside, whilst there is a correspondent 
 increase on the outside. 
 
 This disease, according to my observation, is confined to 
 the incisores and cuspidati of the upper jaw; it produces 
 upon the gum and socket similar effects to the disease 
 last described. The seat of the malady is in the cavity of 
 the tooth ; the vessels ramifying on its membrane acquire 
 a diseased action, by which the membrane becomes 
 thickened, absorption of some of the internal part of the 
 tooth takes place, and the opening at the extremity of 
 the fang also becomes enlarged. This disease of the 
 membrane is attended with the formation of matter dis- 
 charging itself at the point of the fang into the alveolar 
 cavity, which, being rendered more porous by the process 
 of absorption, affords an easy exit. During the progress 
 of the disease, the gum covering the alveolar process 
 becomes inflamed, and acquires a spongy texture; the 
 matter passing from the socket makes its escape into the 
 mouth by several openings through the gum, which is 
 thus kept in a constant state of disease. The discharge, 
 which is generally considerable, produces great fetor of 
 
248 DISEASE RESEMBLING SPINA VENTOSA. 
 
 the breath, the taste is constantly affected, and the socket 
 is gradually absorbed until the tooth becomes quite loose. 
 [This affection simply consists of inflammation and sup- 
 puration of the lining membrane of a tooth affected with 
 exostoses, and the enlargement of the canal passing 
 through its root by the corrosive action of the fluids 
 therein contained.] 
 
 When the tooth has been extracted, I have usually 
 found the membrane sprouting at the end of the fang, the 
 internal part of which is much enlarged, and the external 
 part has a rough, scaly appearance; also, during the 
 progress of this disease, the body of the tooth changes in 
 appearance, and gradually acquires a dark colour. 
 
 The only treatment which can be observed here, is to 
 scarify the gums occasionally, and to wash the mouth 
 frequently with an astringent lotion : for this purpose, the 
 infusion of roses with tincture of myrrh is very beneficial. 
 As no cure of this complaint can be expected, the extrac- 
 tion of the tooth should be recommended as soon as the 
 gums have acquired a truly diseased appearance; for, if 
 the disease be allowed to take its natural course, the 
 gums become so extensively affected as to induce absorp- 
 tion of the alveolar processes belonging to the neighbour- 
 ing teeth, which is followed by their consequent loss. 
 
CHAPTER NINTH. 
 
 OF THE REMOVAL OF THE ENAMEL BY THE DENUDING PROCESS. 
 
 This is a disease producing a change in the teeth, by 
 which they acquire an appearance unlike that of caries, 
 but attended with a loss of substance. 
 
 The tooth does not, as in caries, become softer, nor, 
 like that disease, does it originate in inflammation, but it 
 consists in a removal of the enamel from the bone of the 
 tooth, as if by solution and gradual abrasion. 
 
 It affects the incisores much more frequently than any 
 other teeth, and, in all the cases which I have seen, its 
 operation is limited to the exterior surface of the teeth. 
 
 The first appearance is in the enamel of one or more of 
 the incisores becoming thinner, and appearing as if a 
 small portion had been scooped or filed out, occasioning 
 a slight depression. This removal of the enamel con- 
 tinues until so much is taken away as to leave the bone 
 exposed: as this denuding process, according to Mr. 
 Hunter's term, advances, the tooth changes in its colour, 
 gradually becoming yellower, as the bony part is more 
 exposed. When the whole of the enamel is destroyed, 
 part of the bone is also removed : the remainder acquires 
 a brownish hue, is very highly polished, and will often 
 remain in this state for a number of years. 
 
 T have seen a few cases in which the teeth have been 
 so much wasted, as to have all the anterior part removed ; 
 
250 OF THE REMOVAL OF THE ENAMEL 
 
 but yet the natural cavity has not been exposed, for the 
 bone has remained in a prominent line, as it were defend- 
 ing that particular part, and thus preventing pain. 
 
 Sometimes teeth thus affected become tender, very 
 susceptible of cold, and are made uneasy by. the use of 
 acids. 
 
 It is difficult to make a very good engraving of this 
 disease. Fig. 3, Plate XVII. is designed to show the 
 common and early appearance of it. In other cases there 
 is an appearance as if a small round file had been applied 
 to the anterior surface of the teeth, close to the gums, 
 removing a considerable portion of them, but leaving the 
 surface exceedingly smooth. 
 
 Fig. 4, is intended to describe this appearance as 
 extending across the necks of all the incisores of both 
 jaws. In these cases the molares participate in the dis- 
 ease. 
 
 Fig. 5, are two cuspidati, in which are very great 
 depressions, as if made by a round file. 
 
 I am not able to assign any cause for this loss of the 
 enamel and part of the substance of the tooth, especially 
 as it is confined to that portion of the teeth which could 
 not be acted upon by the friction of one tooth against 
 another. I have observed it both in healthy and delicate 
 persons. As it appears to be connected with some cause 
 which may produce a solution of the enamel, it is very 
 possible that the saliva may have some influence, and that 
 the friction of the lips may contribute to the removal of 
 the enamel. [The editor is of the opinion that it is the 
 result of the action of the mucous secretions of the mouth, 
 which, in some persons, are found to contain more septic 
 acid than in others.] 
 
 The only means to prevent a rapid progress of this 
 disease, is to avoid whatever may contribute to it; there- 
 
BY THE DENUNDING PROCESS. 251 
 
 fore, as all acids act powerfully upon the teeth, their use 
 as an article of diet should be forbidden : and, whenever 
 there is any necessity for employing a medicine which 
 contains an acid, persons should be extremely careful to 
 rinse the mouth, and wipe the teeth immediately after- 
 wards w T ith a cloth. [The affection may oftentimes, after 
 it has made some progress, be arrested by plugging the 
 diseased part. Whenever it is possible to form a suitable 
 cavity for the retention of the filling, this can always be 
 done.] 
 
CHAPTER TENTH. 
 
 OF THE WEARING OF THE TEETH BY MASTICATION. 
 
 The mouths of some persons are so constructed, and 
 the teeth so placed, that, when the jaws are closed, the 
 incisores, not being so long as they usually are, meet each 
 other at the cutting edges. Thus a variety is formed 
 from the usual mode, which is for the incisores of the 
 upper jaw, when the mouth is closed, partially to overlap 
 those of the under jaw. 
 
 When the teeth meet in the manner above described, 
 they all act upon each other, and the jaw has a much 
 more extensive lateral motion. This occasions greater 
 friction in mastication, by which the teeth gradually wear 
 away a part of each other. In some persons they become 
 worn dow r n equally all around the mouth, w hilst in others, 
 who have acquired a habit of masticating their food on 
 one side only, the teeth which have been in constant use 
 are worn down, the others remaining quite perfect. The 
 same circumstance also happens, if persons, by reason of 
 caries, have lost several teeth in the early part of life: 
 those which have remained have become very much 
 worn away. I have seen a gentleman whose teeth were 
 so much worn down as to have the whole of the crowns 
 removed, leaving only the fangs in the jaws even with the 
 edges of the gums. 
 
 It is not unfrequent for teeth in this state to become 
 
WEARING OF THE TEETH BY MASTICATION. 253 
 
 tender; the application of cold or acids excites consider- 
 able pain, but this generally soon subsides; for, during 
 the time that the teeth are wearing away by their action 
 upon each other, a process goes on in the cavity, by 
 which their sensibility is destroyed ; the vessels take on 
 a new action, and deposit ossific matter until the whole 
 cavity is completely obliterated. This circumstance also 
 happens very frequently in the teeth of old people, w r hich 
 accounts for their not being so liable to the tooth-ache. 
 
 33 
 
CHAPTER ELEVENTH. 
 
 I 
 
 OF FRACTURES OF THE TEETH. 
 
 The teeth are liable to be fractured by blows, which 
 may be inflicted either by accidents, or from malicious 
 intentions. The incisores of the upper jaw are the most 
 exposed to these accidents: boys, in their various amuse- 
 ments, occasionally receive blows in the mouth, which 
 not unfrequently occasion fractures of the front teeth. 
 
 In falling upon the face, the teeth are sometimes struck 
 against a stone; in throwing of stones at each other, one 
 may be received against the teeth ; in an incautious at- 
 tempt to catch a cricket ball, the force of which is not 
 sufficiently spent, it may come with violence against the 
 mouth: in these, and other similar ways, persons are 
 subjected to fractures of the teeth; also, in the mastication 
 of food, hard substances, such as splinter of bone, or a 
 small stone, or a shot in game, may unexpectedly be 
 bitten upon, at which time the muscles of the lower jaw, 
 being in very strong action, exert a force sufficiently pow- 
 erful to fracture a perfectly sound tooth. 
 
 The treatment of these cases will depend much upon 
 the extent of the injury. If a small piece be broken off 
 from the point of a tooth, nothing more w r ill be necessary 
 than with a fine file to make the rough edge smooth. 
 
 A tooth rarely becomes carious in consequence of an 
 accident of this kind; for, if there be no predisposition in 
 
OF FRACTURES OF THE TEETH. 255 
 
 a tooth to decay, the mere removal of a small portion of 
 it will not cause caries. 
 
 A fracture of a tooth occasions inconvenience in pro- 
 portion to the injury done to the cavity of the tooth. If 
 it should extend nearly into the cavity, having left only a 
 thin piece of bone to cover it, the person will be subject 
 for some time to pain on exposure to cold air; this, how- 
 ever, is generally cured by a deposit of bone taking place 
 within the cavity, by which the nerve is defended, and 
 the tooth may remain during life without exciting further 
 trouble. 
 
 If the fracture should extend into the cavity, the mem- 
 brane will immediately be exposed, and inflammation will 
 follow. In this case the treatment must be regulated by 
 the age and peculiar circumstances of the patient. If the 
 accident should have happened to a youth under fifteen 
 or sixteen years of age, it would be better to extract the 
 tooth, because the teeth on each side will gradually 
 approach each other, so that when he is arrived at matu- 
 rity the loss may never be observed. 
 
 It is to be understood that I am speaking of accidents 
 occurring to the permanent teeth; blows received by chil- 
 dren under five or six years of age can only injure the 
 temporary teeth; sometimes by accidents one or more of 
 these are beaten out: this never fails to produce alarm in 
 the minds of the parents; but, as in a short time a remo- 
 val of those teeth must have been affected by nature, or 
 performed by art, it cannot be considered as a permanent 
 injury. 
 
 If the case be neglected for some time, the inflamma- 
 tion extends to the fang and socket, and produces a con- 
 siderable gum-boil, which can only be cured by the 
 extraction of the tooth. 
 
 When an accident of this kind occurs to a person more 
 
256 OF FRACTURES OF THE TEETH. 
 
 advanced in years, the loss is very considerable, as the 
 appearance of the mouth and also the speech becomes 
 thereby much affected. 
 
 In Plate XVIII. Fig. 9, is a representation of two cen- 
 tral incisores which were broken by a fall. Fig. 10, is the 
 posterior view of these teeth, the fracture of which will 
 be seen extending into the cavity. 
 
 In an accident of this kind affecting either one or both 
 teeth, if the person should apply for assistance immedi- 
 ately after the accident, and before any inflammation has 
 supervened, I should recommend that the tooth or teeth 
 be extracted with great care. When this has been done, 
 the cavity in the tooth should be cleared out as much as 
 possible, and some gold-leaf be introduced, so as com- 
 pletely to fill it up. 
 
 After the cavity has been thus stopped, the teeth are 
 to be restored to their sockets, and there to be confined 
 by a ligature; they will soon fix, and in a few days be as 
 secure as ever, and may afterwards remain without incon- 
 venience for a great number of years. [The editor has 
 found this treatment to succeed only in the fewest number 
 of cases. Teeth after having been removed and placed 
 back in their sockets, are, in the majority of instances, at 
 times, more or less troublesome.] 
 
 If the fracture of a tooth should be so great as in Fig. 
 1 1, the patient must submit to extraction: or, if he should 
 be desirous to preserve the appearance of his mouth, he 
 may be recommended to have the remainder of the tooth 
 filed away, so as to make the fang even with the gums, 
 and, in the manner hereafter to be described, have a tooth 
 fixed to the fang by means of a pivot. [The concussion 
 of a blow sufficiently severe to fracture a tooth, generally 
 induces inflammation in the alveolo-dental periosteal tis- 
 sue and renders the root unfit to support an artificial 
 
OF FRACTURES OF THE TEETH. 257 
 
 crown; it should therefore be removed, and the loss of the 
 tooth supplied with a substitute on gold plate in the man- 
 ner to be hereafter described. The application of an arti- 
 ficial crown to such a root has been known to be produc- 
 tive of very hurtful consequences. The practice, to say 
 the least of it, is unscientific, and should never be adopted, 
 except in cases of the most absolute necessity.] 
 
 When a blow has been received upon a tooth so as to 
 loosen it, if the person be young, it will become fast 
 again; but it gradually loses the whiteness of its colour, 
 and at length acquires a bluish tinge. [This is owing to 
 the destruction of the vitality of the organ, resulting from 
 inflammation and suppuration of the lining membranes.] 
 
 When the like accident occurs to a person rather 
 advanced in life, a disease usually takes place about the 
 fang, which eventually affects the socket; the tooth then 
 becomes very loose, and must be extracted. 
 
 A young gentleman had the central incisores broken by 
 a cricket ball, as represented in Fig. 9. The fracture did 
 not extend into the cavity. In this case the teeth were 
 filed so as to remove the irregular portion, and bring 
 them as nearly as possible into a line with the other teeth. 
 
 Fig. 10 represents a posterior view of the central inci- 
 sores of a young gentleman, who, falling on his face, 
 struck his mouth against a stone. So much of the teeth 
 were broken off as to uncover the membrane; the en- 
 trance into the cavity is described by the dark spots, a a. 
 Immediately after the accident, the mere touch of the 
 tongue passing over the exposed part of the membrane 
 occasioned extreme pain; in a short time, inflamma- 
 tion extended to the socket, the lip became very much 
 swollen, and a considerable quantity of matter was formed. 
 The parents, being very desirous to preserve the teeth, 
 made use of every means to abate the inflammation; but, 
 
258 OF FRAC TURKS OF THE TEETH. 
 
 as the gums remained thickened, and the discharge of 
 matter continued, they were at length obliged to consent 
 to the extraction of the teeth: on examining the fangs, 
 they were found covered with a considerable quantity of 
 lymph, which is a common consequence of a neglected 
 accident of this description. 
 
 In Fig. 1 1 is the representation of the teeth of a young 
 gentleman who had the central incisores broken by a 
 blow of a stick: being anxious to have the deformity 
 removed in the best possible manner, he was willing to 
 submit to any means that should be recommended. J 
 stated to him the necessity of preserving the fangs for the 
 purpose of fixing other teeth in a permanent manner; 
 but, perceiving that the sensibility of the exposed mem- 
 brane was very great, I concluded that he would not be 
 able to endure the pain attendant on the common mode 
 of destroying the nerve, therefore determined to extract 
 the teeth partially, and return them back into the socket; 
 after which I introduced an instrument, and passed it up 
 to the extremities of the fangs, without occasioning the 
 least painful sensation. Union of the fangs to the socket 
 took place in a few days, when the remainder of the 
 crowns of the teeth was filed away, and other teeth fixed. 
 
 If a blow be inflicted with sufficient violence to remove 
 a tooth from its socket, it may be returned again; and, if 
 secured to the other teeth by a ligature, it will become 
 fast in a few days. I have known a case in which a 
 tooth had remained out of the socket for six hours, and 
 yet, when returned, became again perfectly united. It 
 will be necessary when a tooth has been out of the socket 
 for some time, to introduce a probe, and remove, the 
 coagulated blood; the fang may then be inserted with 
 ease, and inflammation will be avoided. But when the 
 teeth have been loosened or beaten out by a blow, and 
 
OF FRACTURES OF THE TEETH. 259 
 
 the alveolar processes have been injured, or fractured, 
 the teeth will never become perfectly fast; inflammation 
 arises, and nothing but extraction will effect the cure. 
 
 [We think it doubtful whether the replacement of a 
 tooth, which has been fo:cibly thrust from its socket, is 
 strictly proper under any circumstances, yet necessity 
 may sometimes seem to justify it. We have never known 
 a tooth thus replaced to become so perfectly re-united as 
 not, occasionally, to be productive of disturbance to the 
 surrounding parts, and ultimately to cause a thickening of 
 the periosteum of the alveolus.] 
 
CHAPTER TWELFTH. 
 
 OF THE DISEASES OF THE GUMS. 
 
 The alveolar processes of both jaws are covered by a 
 substance which is called the gums. They have a semi- 
 cartilaginous hardness, are very vascular, and possess 
 considerable contractability. Under slight inflammation, 
 occasioned by cold, they become thickened, enlarged, and 
 swollen, and of a loose, spongy texture. 
 
 The gums adhere to the necks of the teeth, and pass 
 between each of them, being attached to the bony parti- 
 tions of the alveolar processes, by which the inner and 
 outer gums are connected together. 
 
 When the gums are in a healthy state, they are firmly 
 attached to those parts of the teeth which are not contained 
 in the sockets, and their extreme edges lie upon the 
 enamel. The gums, which are between the teeth in the 
 upper jaw, descend lower; and, in the under jaw T , are 
 situated higher than the other parts: hence, at the necks 
 of the teeth, they form an arched appearance. Naturally, 
 they do not possess much sensibility, and therefore are 
 not injured by the friction which is unavoidably occa- 
 sioned by the mastication of hard substances; but, when 
 inflamed, they acquire such extreme sensibility, that 
 even the pressure of the cheek causes pain. 
 
 In infancy, during the progress of dentition, should 
 there be inflammation of the gums, the slightest touch 
 
OF THE SCURVY IN THE GUMS. 261 
 
 produces so much suffering, that children will even refuse 
 the breast, on account of the pain attending the necessary 
 pressure of the nipple. On the contrary, when there is 
 no inflammation, the gums are so insensible, that they 
 are pleased with sucking or biting a hard crust. In old 
 age, when there are no teeth, the gums possess so little 
 sensibility, that the biting or bruising of food is attended 
 with no pain ; and it is remarkable, that those who have 
 lost all their teeth enjoy their food much more than those 
 who have only a few weak ones left. 
 
 Several affections of the gums originate from diseases 
 of the teeth, but there are others peculiar to the gums 
 themselves: I shall first describe those diseases which 
 arise from the teeth. 
 
 OF THE SCURVY IN THE GUMS. 
 
 The most common disease of the gums, is that which 
 has been usually called scurvy in the gums, thus denomi- 
 nated from assuming an appearance similar to that which 
 happens to persons afflicted with the sea-scurvy. 
 
 [But this affection is wholly unlike that, and although 
 favoured and aggravated by a scorbutic diathesis of the 
 general system, it often occurs in individuals, in whom 
 there exists not the slightest tendency to that disease.] 
 
 This disease is generally marked by the gums becom- 
 ing redder than ordinary, and enlarged from a tumes- 
 cence of the vessels, which are made to bleed by the 
 slightest causes, such as the use of a tooth-brush, the 
 biting of a crust, or even by only sucking them. 
 
 If the complaint be not attended to in this stage, the 
 gums become very soft and spongy, and shortly after- 
 wards they are affected with considerable soreness, being 
 so tender as scarcely to allow the mastication of food; 
 34 
 
262 OF THE SCURVY IN THE GUMS. 
 
 this is often followed by a discharge of matter at the 
 necks of the teeth ; and an exulceration may be observed 
 on the edges of the gums between the teeth; also those 
 parts which form the arched appearance are soon de- 
 stroyed, so that the gums have a uniform straightness, 
 and the necks of the teeth are consequently uncovered. 
 
 This disease next proceeds to the alveolar processes, 
 the substances of which are destroyed by absorption; at 
 length the teeth become loose, and, in a few years, drop 
 out, one after the other, at short intervals, until the per- 
 son is rendered toothless. 
 
 It is from this complaint that many persons lose their 
 teeth at a very early period of life; indeed, most individ- 
 uals are more or less subject to it, as the gums, in some 
 part or other, although there be no disease of the teeth, 
 are liable to become preternaturally red, enlarged, or 
 tender: whenever, therefore, a tendency to this disease 
 is observed, great care should be taken to apply such 
 means as will arrest its progress. At its commencement 
 it is very manageable, and may always be relieved by 
 puncturing, with the point of a lancet, those parts which 
 appear unnaturally red or distended. The loss of blood 
 affords immediate relief; and whenever the slightest 
 soreness, or an increased fulness of the gums is perceived, 
 the above plan of scarifying the vessels will be found 
 highly beneficial. Suppose the disease to have proceed- 
 ed to that stage in which the gums become spongy or 
 loose in texture the lancet should be then used with 
 greater freedom. Essential service is always derived 
 from the loss of blood: in some cases the use of leeches, 
 as drawing away a larger quantity of blood, is attended 
 with the best effects. Frequent recourse should be had 
 to this treatment, which may be accompanied with the 
 use of astringent lotions, such as the infusion of roses 
 
OF THE SCURVY IN THE GUMS. 263 
 
 with the tincture of myrrh, decoction of bark, solutions of 
 alum, arquebusade water, &c. In these cases great 
 benefit is derived from the use of sea-water, and there- 
 fore I always recommend it, whenever it can be pro- 
 cured; adding, that, if the gums be tender, it should be 
 used warm. In all cases where there is a tendency to 
 inflammation of the gums, arising from this disease, much 
 is to be expected from the free use of a tooth-brush; at 
 first the gums are apt to bleed a little, by which the same 
 benefit is obtained as from the lancet: by degrees, the 
 gums become more firm, and at length a hard brush may 
 be used without causing any loss of blood, or giving the 
 slightest pain. 
 
 When the gums are exceedingly tender, and have the 
 smallest tendency to exulceration, the patient should be 
 directed to wash the mouth very frequently with barley 
 water sweetened with honey : in two or three days, if the 
 soreness should be diminished, the lancet should be 
 cautiously used, accompanied with diluted tincture of 
 myrrh, as a wash. 
 
 If the edges of the gums do not heal under this treat- 
 ment, and if they should hang loosely about the necks of 
 the teeth, much good will be derived from the use of the 
 argentum nitratum in solution. If the disease be only 
 partial, the caustic should be applied with a camePs hair 
 pencil dipped in the solution. This remedy appears to 
 communicate a new action to the gums, and they generally 
 get well in a short time. Indeed, whenever the gums 
 are very full, and discharge a good deal of offensive mat- 
 ter, washing the mouth with a solution of lunar caustic is 
 a very excellent remedy for rendering the mouth sweet 
 and comfortable. 
 
 When this is applied to the sore edges of the gums 
 with the hair pencil, it may be used as strong as in the 
 
264 OF THE SCURVY IN THE GUMS. 
 
 proportion of a drachm to an ounce of water; but, if the 
 mouth be rinsed with it, it ought not to exceed the pro- 
 portion of one grain to two ounces of water; because, if 
 it get into the fauces, it is liable to produce an unpleasant 
 nausea. 
 
 Persons who are subject to inflammation of the gums, 
 should have them scarified whenever they become painful, 
 or are more turgid than usual. By the loss of a little 
 blood, they are instantly relieved, and the disease is thus 
 prevented from proceeding to the extent which has been 
 described. 
 
 In scarifying the gums, the lancet should be applied 
 longitudinally to those parts which are situated between 
 the te^eth, because, if the gums are cut in those parts 
 where they cover the fangs, they will, in healing, retire, 
 and leave the necks of the teeth exposed; whereas, if 
 they are lanced in the angles, between the teeth, they 
 will in healing be drawn tighter, and the teeth will even- 
 tually be strengthened. 
 
 [Although favoured by certain constitutional tendencies, 
 the immediate cause of inflammation, and sponginess of 
 the gums, is local irritation, and the removal therefore of 
 every thing from the mouth which can act as irritants 
 upon this structure, constitutes the first curative indica- 
 tion. If there be any dead teeth in the mouth, or roots 
 of teeth, or teeth which from their peculiar position act 
 as irritants to the gums or alveolar periosteal tissues, 
 they should be removed; also all loose teeth which from 
 the partial destruction of their sockets cannot regain their 
 lost firmness, as well as all tartar or other extraneous 
 matter that may have collected around or on the teeth. 
 This should constitute the first step in the treatment of 
 spongy and inflamed gums, and in addition to which, the 
 gums should be lanced in the manner as directed by the 
 
PRETERNATURAL GROWTH OF THE GUMS. 265 
 
 author, the mouth too, should be gargled several times a 
 day with some astringent lotion. In the mean time the 
 most constant attention should be paid to the cleanliness 
 of the teeth. They should be thoroughly cleansed with a 
 good brush and waxed floss-silk, four or five times every 
 day. The observance of this last is indispensable, and if 
 it be neglected, no matter how appropriate the other 
 treatment may be, it will be found inefficient and fail to 
 accomplish a cure. 
 
 As a gargle, the editor has found nothing better than a 
 strong decoction of the inner bark of young green white 
 oak prepared as directed by Dr. Fitch, by taking two 
 pounds, putting it into six quarts of water and boiling it 
 down, until it becomes strongly impregnated with the 
 bark, which last is then to be taken out, and the water 
 boiled down to two quarts, strained, and put in a bottle 
 for use. The following, recommended by Dr. Koecker, 
 is also a very excellent gargle. Take of honey and the 
 tincture of rhattania two ounces each, mix and dilute in 
 the proportion of three table-spoonfuls to a pint of warm 
 sage tea or water, to be used frequently through the day. 
 
 But should matter be discharged from between the 
 gums and necks of the teeth, notwithstanding the use of 
 the foregoing remedies, a solution of the nitrate of silver, 
 as recommended by the author, should be employed. It 
 is also sometimes necessary to have recourse to constitu- 
 tional treatment, which should accord with the peculiar 
 indications of the case.] 
 
 OF PRETERNATURAL GROWTH OF THE GUMS. 
 
 Decayed teeth are sometimes the cause of deranged 
 action in the arteries of the gums, by which they become 
 so enlarged a§Lto form excrescences or tumours of con- 
 
266 PRETERNATURAL GROWTH OF THE GUMS. 
 
 siderable size. These are frequently the consequence of 
 carious stumps, and are produced in the following manner. 
 The crown of a tooth having been removed by caries, 
 and the stump remaining in the socket, even with the 
 gums, if the socket do not close at the bottom, so as to 
 cause a protrusion of the stump, it is so much wasted 
 away, that the edges of the gums have a tendency to 
 grow over it. When the gum has thus partially grown 
 over a ragged stump, it is liable to become very sore and 
 inflamed, from the constant irritation which the gum suf- 
 fers from being pressed upon the sharp edge of the 
 stump. Hence a diseased action is caused, and the gum 
 very rapidly increases in size. I have seen an enlarge- 
 ment of this kind, surrounding some stumps in the lower 
 jaw, equal to the size of a walnut. In these cases no 
 cure can be expected whilst the cause is permitted to 
 continue; the first thing, therefore, to be done is, to 
 extract the stumps, which in general effects all that can be 
 desired; the enlargement of the gums being of a soft, 
 spongy, and fungous nature, is always reduced by the 
 hemorrhage which attends this operation, after which, the 
 cause of irritation being removed, the vessels contract, 
 and the gums acquire their natural state. 
 
 Some time since, Mr. Cooper was applied to, by a 
 lady who had an enlargement of the gums in the lower 
 jaw, which nearly filled up one side of the mouth; there 
 were several decayed stumps remaining, around which 
 this enlargement of the gums had taken place. Mr. 
 Cooper sent her to me for the purpose of extracting the 
 stumps, intending, when these had been removed, to 
 extirpate the tumour. The stumps being imbedded in 
 the gums, the operation was unavoidably attended with 
 laceration of the excrescence, and consequently a con- 
 siderable hemorrhage. A few days afterwards the tumour 
 
PRETERNATURAL GROWTH OF THE GUMS. 267 
 
 became very flaccid and dark coloured, it then sloughed 
 away in large pieces, so that a cure was effected without 
 any other operation. 
 
 Sometimes tumours arise from the gums without there 
 being any diseased tooth, or any evident cause: these 
 are of a much firmer texture than those above described, 
 frequently being of the same consistence as the gums, 
 when in a healthy state. 
 
 They are very vascular, and the treatment has always 
 been considered as extremely troublesome: the usual 
 mode adopted for removing them has been that of exci- 
 sion; this operation has generally been attended with a 
 great loss of blood, to stop which, as Mr. Hunter observes, 
 "it is often necessary to apply the actual cautery, for 
 arteries going to increased parts are themselves increased, 
 and also become diseased, and have not the contractile 
 power of a sound artery." A great hemorrhage from 
 the gums, or any part of the mouth, must always be 
 regarded as alarming, on account of the impossibility of 
 discovering and securing any principal branch of the 
 artery; or, if the bleeding should be from a number of 
 small vessels, the difficulty of applying pressure with 
 advantage is so very great, that recourse must always be 
 had to more powerful agents. Mr. Hunter also remarks, 
 that these excrescences are liable to grow again, after the 
 operation of excision; and mentions, that they have been 
 removed six times, and have as often been reproduced ; 
 which he attributes to a cancerous disposition. On these 
 accounts, I determined some years since, that, if any 
 cases of this kind should ever come under my care, I 
 would attempt their removal by means of ligatures. The 
 first case, in which I was consulted, was a lady of about 
 forty years of age, who had several of the teeth on the 
 right side of the upper jaw extracted when she w r as a 
 
268 PRETERNATURAL GROWTH OF THE GUMS. 
 
 young woman: about five years before I saw her, the 
 gums, covering the jaw where the teeth had been situated, 
 appeared to be thicker than before; they gradually 
 increased in size until a very large tumour was formed: 
 it had now become so large as to affect the speech, and 
 in other ways was extremely troublesome. 
 
 The lady was very desirous to have it removed; to 
 effect which, without incurring the danger of hemorrhage, 
 I employed ligatures. The basis being very broad, I 
 passed a needle, with two ligatures, close to the jaw 
 bone, through the substance of the tumour, half of which 
 was then included in each ligature. The ligatures were 
 tied just tight enough to stop the circulation; the next 
 day there was a great deal of inflammation, which sub- 
 sided in proportion as the ligatures began to produce 
 ulceration, which on the fourth day was very considera- 
 ble: new ligatures were then applied; on the sixth day 
 these were removed and others introduced; on the eighth, 
 one ligature came away, leaving the tumour hanging only 
 by a small pedicle; this being cut through with a lancet, 
 the whole was removed; the surface was then touched 
 w 7 ith some diluted nitrous acid, and the gums have ever 
 since continued in a perfectly healthy state. 
 
 Subsequent experience has furnished me with many 
 opportunities of removing several excrescences of a simi- 
 lar nature. The basis of these are generally very broad, 
 and therefore cannot be included in a single ligature; on 
 this account, I have commonly passed a needle, armed 
 with two ligatures, through the middle part of the tumour, 
 as close to the bone as possible, and then have included 
 half of the substance in each of the ligatures. The ulce- 
 rated process goes on here very quickly; in some cases 
 the application of a second ligature has been quite suffi- 
 cient, and in most cases it has not been necessary to make 
 use of more than three or four ligatures. 
 
PRETERNATURAL GROWTH OF THE GUMS. 269 
 
 Last summer, a lady applied to Mr. Cline, having an 
 enlargement of the gums on one side of the upper jaw; 
 a tumour of very large size was formed, which pressed 
 the cheek so much out as to give the appearance of a 
 swelled face. The teeth were still remaining, and not 
 decayed; but the molares were so surrounded with the 
 excrescence of the gums, that no successful attempt could 
 be made to extirpate it until they had been removed. 
 Mr. Cline sent the lady to me for that purpose, I ex- 
 tracted the farthest tooth; the hemorrhage being rather 
 profuse, the extraction of the second was deferred; two 
 or three weeks afterwards, I removed the second molaris; 
 at the time the excrescence had become completely altered 
 in form, being more dependant, and after the second 
 tooth was extracted, it contracted at the basis and ac- 
 quired a pyriform shape; this afforded a very favourable 
 opportunity for its removal by ligature, which Mr. Cline 
 performed. 
 
 There are other excrescences which sometimes form 
 upon the gums, differing in appearance from either of the 
 former; they are soft, exceedingly red, and very liable to 
 bleed. These originate from some diseased state of the 
 jaw bone, and can only be cured by the removal of such 
 disease. It has most commonly happened that surgeons 
 have not sufficiently regarded the cause of the disease; 
 for, simply attending to the state of the gums, they have 
 cut off these fungous excrescences with the knife, or 
 burnt them with caustic; but having been foiled in their 
 various attempts, by their speedy renewal, they have 
 considered them as cancerous, and the patient has been 
 rendered extremely unhappy by having been thus in- 
 formed. 
 
 Sometimes these fungi of the gums arise from a dis- 
 eased state of the fangs of a tooth, which fangs have 
 35 
 
270 PRETERNATURAL GROWTH OF THE GUMS. 
 
 caused a death of part of the alveolar processes, and a 
 consequent diseased state of the gums. In these cases, 
 the first thing to be done is to extract the tooth more 
 particularly connected with the disease of the gums, an 
 opportunity is then given to examine the state of the 
 alveolar processes; if these are found to be in any way 
 diseased, means must be used to hasten the process of 
 exfoliation. If, on examining with a probe, the socket 
 should be found to be rough, or in any way denuded of 
 its periosteum, then a dossil of lint, dipped in a weak 
 solution of nitrous acid, should be applied two or three 
 times a day; this will hasten the exfoliation of the bone, 
 and produce a cure of the gums. 
 
 The strength of this lotion should be one drop of ni- 
 trous acid to an ounce of water. 
 
 A very extraordinary case of tumour arising from the 
 lower jaw, was admitted into Guy's Hospital on the 9th 
 of April, 1812. The patient's name Sarah Dulwich, aged 
 13, of a scrofulous constitution. The tumour was situated 
 under the left cheek. It appeared first about twelve 
 months ago as a small tumour from the gums of the lower 
 jaw. At the time of her admission into the Hospital, the 
 tumour was globular, and occupied the whole of the left 
 cheek. Under the integuments it was irregular, and 
 projected below the jaw; it extended to the cuspidatus 
 of the right side irregularly under the tongue, which it 
 thrust close to the right cheek. The surface was very 
 irregular, and it felt hard in substance. 
 
 The pressure of the teeth of the upper jaw had caused 
 a superficial ulceration, from whence there was occa- 
 sionally an offensive discharge. Viewed externally it 
 reached from the fore part of the chin, passing up by the 
 side of the left nostril, to the edge of the left orbit, and 
 thence round to the ear. The nose was pushed consid- 
 
PRETERNATURAL GROWTH OF THE GUMS. 271 
 
 erably to the right side, thereby occasioning a great 
 distortion of the countenance. In size it was nearly half 
 that of the head. The skin over the whole surface had 
 a slight blush on it, and the veins appeared to be con- 
 siderably enlarged. She complained of pain at the back 
 part of the tumour, and there was some suppuration from 
 the right ear. Mastication had become very difficult and 
 painful, in consequence of the pressure of the teeth on 
 the left side of the upper jaw upon the tumour as it arose 
 from the lower jaw. From the pressure of the tumour, 
 the teeth of the left side of the upper jaw were pushed 
 towards the opposite side of the mouth, as were also the 
 teeth of the lower jaw. In other respects this poor girl 
 was in good health, and had a good appetite. 
 
 Before the disease appeared, she was subject for some 
 months to the tooth-ache in the two molares of the lower 
 jaw, which were exceedingly carious, and from the gums 
 of which teeth this tumour sprang. 
 
 When she was first received into the Hospital the jaws 
 were separated nearly an inch from each other by reason 
 of the projection of the tumour from the back to the fore 
 part of the mouth. It was with difficulty the lips could 
 be brought together, but in the common state they sepa- 
 rated to at least an inch and a half distance. 
 
 The tumour continues to increase rapidly, and by 
 degrees it becomes more protruded from the mouth. 
 The ulceration on the surface becomes much more exten- 
 sive. In about six months from her admission, it had 
 become so exceedingly enlarged as to project considera- 
 bly beyond the lips, which were extended to an almost 
 incredible degree. At this time her only mode of taking 
 nourishment is by sucking fluids through a tube, and she 
 is gradually becoming exceedingly emaciated. 
 
 Besides these various affections of the gums, they are 
 
272 PRETERNATURAL GROWTH OF THE GUMS. 
 
 subject to diseased appearances, symptomatic of constitu- 
 tional disease. Children of scrofulous habits are more 
 particularly liable to a spongy state of the gums, accom- 
 panied with great fetor of the breath; they become ulcer- 
 ated so as to cause the alveolar processes and fangs of the 
 teeth to be exposed. When this disease occurs to chil- 
 dren^ the teeth which are thus affected are only the tem- 
 porary teeth, and therefore the removal of these is not 
 attended with any permanent disadvantage. I have 
 always considered it right, whenever any ulceration has 
 taken place about the gums of children, to extract the 
 teeth, and I have usually found that this plan has com- 
 pletely arrested the progress of the disease : at the same 
 time the general health of the patient should not be 
 neglected, and the appearance of the gums must only be 
 considered as indicative of constitutional derangement. 
 
 Fig. 1, Plate XX. represents all the alveolar processes 
 of the under jaw, which exfoliated in consequence of a 
 neglected disease of the gums, in a child of scrofulous 
 habit. It was given me by Mr. Goldston, surgeon, of 
 Bath. Similar exfoliations sometimes take place in con- 
 sequence of fever. 
 
 In more advanced age, the gums are also symptomat- 
 ically affected : I once saw a lady, who laboured under 
 general weakness, whose gums were so relaxed and 
 devoid of vital energy, as to be perfectly soft, of a livid 
 colour, and apparently quite dead. I pared off a great 
 quantity of them, and ordered a stimulating lotion; which 
 with attention to the general health, and change of situ- 
 ation, sea air, &,c. effected a cure. 
 
 [The whole substance of the gums all the way round, 
 and of both jaws, are sometimes affected with a morbid 
 growth, by which the crowns of the teeth become com- 
 pletely imbedded in them. When in this condition they 
 
PRETERNATURAL GROWTH OF THE GUMS. 273 
 
 are exceedingly sensitive to the touch and bleed from the 
 slightest injury. This peculiar affection, although first 
 excited by local irritation, is determined by a bad habit 
 of body. Scorbutic and scrofulous dispositions are 
 more subject to it than any other. 
 
 The proper treatment in cases of this sort, consists in 
 removing all that portion which has grown over the 
 crowns of the teeth, and all dead and loose teeth, roots 
 of teeth, and teeth so badly affected with caries as to 
 render their restoration to health impossible. The mouth 
 should be gargled several times every day, with a decoc- 
 tion of oak bark, prepared as before directed ; also with a 
 solution of the chloride of soda, for the purpose of cor- 
 recting the fetor of the mouth. The margins of the 
 gums should at the same time be occasionally touched 
 with a solution of the nitrate of silver. In addition to 
 which, such general treatment should be adopted, as may 
 be indicated by the state of the constitutional health. 
 
 Temporizing treatment in this form of diseased gums 
 will never answer. To be successful, a decided impres- 
 sion must be made at once. The treatment must be 
 thorough. It is not sufficient to remove all dead and loose 
 teeth, and the roots of decayed teeth. The morbid 
 growth of the gums which encase, as it w T ere, the crowns 
 of the teeth, should be removed by means of a horizontal 
 incision on a line near the termination of the enamel; in 
 addition to this, they should be frequently scarified with 
 a sharp lancet. This should be passed through them 
 between the teeth, so as to make a complete section. It 
 is only in connection with this treatment, that gargles will 
 prove at all beneficial. 
 
 Another important item in the local treatment of the 
 disease, consists in cleansing the teeth frequently and 
 thoroughly, with a soft and elastic brush. This should 
 
274 PRETERNATURAL GROWTH OF THE GUMS. 
 
 be done, at least, five times a day; namely, immediately 
 after getting up in the morning, after each meal, and at 
 night before going to bed. If any relics of food, or ex- 
 traneous matter of any sort, or clammy mucus, be per- 
 mitted to collect between or around the teeth or along 
 the margins of the gums, the cure will be retarded, if not 
 wholly defeated.] 
 
CHAPTER THIRTEENTH. 
 
 OF GUM-BOIL AND ABSCESS [ALVEOLAR ABSCESS.] 
 
 [Inasmuch as the seat of the above named disease is 
 always within the alveolus, the gum being only secon- 
 darily affected, it would be more proper to term it, as 
 Mr. Thomas Bell justly remarks, alveolar abscess, and 
 should be treated of under the head of diseases of the 
 alveolar process.] 
 
 Carious teeth frequently become inflamed at the root, 
 and suppuration takes place in the socket, attended with 
 swelling and soreness of the gums. In these cases, the 
 same laws are observed for the exit of matter as in 
 abscess in general, viz. ulceration takes place in some 
 part of its surface, so as to make an outlet for the matter 
 in the best possible situation. When matter forms at the 
 root of a tooth, the periosteum which covers its fang 
 thickens, and in some cases becomes detached from it; 
 the matter is accumulated as in a bag, by the extension 
 of which, considerable pressure is made against the sides 
 of the socket, the consequence of which is, that that part 
 of the alveolar process, situated on the outside, becomes 
 absorbed, [wasted] rather than that within the mouth.* 
 
 The ulcerative process continues until the gum bursts, 
 nearly opposite to the place where the point of the fang 
 is situated, and thus the matter escapes from this natural 
 
 'Plate XVI. Fig. 10,11. 
 
276 ALVEOLAR ABSCESS. 
 
 opening : the edges of the opening are generally raised, 
 having the appearance of a small, red fungus; sometimes, 
 after the discharge of the matter, the inflammation will 
 subside; but the gum-boil rarely disappears, and a small 
 fistulous opening remains, at which, matter continues to 
 be discharged; or, upon taking cold, persons are liable to 
 a recurrence of inflammation, occasioning a reaccumula- 
 tion of matter; but which is seldom attended with much 
 pain. These gum-boils, being occasioned by diseased 
 teeth, are seldom cured without their removal; but, as 
 the operation of extraction cannot always be submitted 
 to, means must be employed to render them as little 
 injurious as possible. 
 
 [The matter does not always make for itself a passage 
 through the alveolus and gum; it sometimes escapes into 
 the maxillary sinus, but this rarely happens except the 
 abscess has formed in the socket of a superior molaris, 
 which is situated immediately beneath this cavity, where 
 its floor is often very thin and sometimes even penetrated 
 by one or more of the roots of the subjacent teeth. 
 Diseases of the antrum of a very serious nature have been 
 produced in this way. But the extraction of the affected 
 tooth in this, as in the other case, is generally soon fol- 
 lowed by a subsidence of every unpleasant symptom.] 
 
 At the first appearance of a gum-boil, that is, as soon 
 as the gums, by their swollen condition and soft feeling, 
 together with the sensation of throbbing pain, indicate 
 that matter is already formed, a puncture should be made 
 with a lancet, in order to suffer it to escape: this will 
 relieve the pain, and prevent any extensive effusion. 
 
 Sometimes the tooth becomes very sore, and rather 
 loose, in which case, as it will never be serviceable, it 
 would be far better to extract it, which will prove a cure 
 to the gum-boil. 
 
ALVEOLAR ABSCESS. 277 
 
 When the inflammation occasioned by a carious tooth 
 is very great, we should be particularly careful to guard 
 against its effects. The formation of matter is often so 
 considerable, as to produce an abscess of no small extent. 
 In some cases the matter is contained within a cavity, 
 extending through the length of one side of the jaw. 
 The teeth which produce the most distressing symptoms 
 are the dentes sapiential of the under jaw; when inflam- 
 mation extends from either of those teeth to the contig- 
 uous parts, the swelling is speedily diffused over all the 
 cheek, so as to close the eye, and cause a considerable 
 hardness at the upper part of the neck, near to the angle 
 of the jaw. 
 
 The muscles of the jaw are also affected by the adhe- 
 sive inflammation, and they become so rigid that it is 
 with great difficulty the mouth can be opened. 
 
 These cases require the utmost attention, for a large 
 abscess is usually formed, which, if left to itself, generally 
 points externally; the ulceration extends through the 
 substance of the cheek, there producing a most trouble- 
 some sore, which, when healed, leaves a deforming scar. 
 To prevent these sad consequences, when the matter is 
 formed, a free opening should be made, on the inside of 
 the cheek, into the softest part of the tumour. [The 
 immediate extraction of the tooth however, would be 
 preferable, as the matter in this case, if already formed, 
 would escape through the alveolus into the mouth.] 
 
 A common notion exists, that it is extremely dangerous 
 to extract a tooth at the time the gum is inflamed; but 
 this is erroneous. Certainly, at this time, the opera- 
 tion is attended with rather more pain than at another; 
 but, as the carious tooth is the cause of all disease, the 
 removal of it is the most certain, and always the most 
 speedy, mode of cure. 
 * 36 
 
278 ALVEOLAR ABSCESS. 
 
 In those cases where the mouth is closed , as this prac- 
 tice cannot be adopted; we must wait until the inflamma- 
 tion be sufficiently subsided for the mouth to be opened. 
 
 When inflammation and swelling of the gums and face 
 arise from a carious tooth, they seldom subside without 
 going into the suppurative stage. I have frequently 
 attempted by leeches, cold applications, &c. to prevent 
 suppuration, but have rarely succeeded : the progress of 
 inflammation having been by these means only retarded, 
 not prevented ; for, after a certain time, it has come on 
 with redoubled violence, and has gone through its pro- 
 gress : on this account, whenever there is any considerable 
 swelling, and the patient too timid to submit to the 
 extraction of the tooth, or if the mouth be so much con- 
 tracted that the instrument cannot be conveyed into it, I 
 think it advisable to hasten the suppurative process by 
 fomentations, &c. and as soon as a soft place can be felt 
 on the inside of the cheek, to introduce a lancet, and dis- 
 charge the matter. People very often continue poulticing 
 a swelling of this kind, in order, as they term it, to bring it 
 to a head; in so doing, they cause ulceration to take 
 place through the substance of the cheek. If the tooth 
 producing the abscess be situated in the upper jaw, it 
 will discharge in the middle of the cheek; if in the lower 
 jaw, the opening will be at the lower part of the jaw, 
 either near the angle or at the edge of its base. 
 
 These abscesses are rarely healed; the painful symp- 
 toms may subside, but the opening remains fistulous, 
 attended with a consequent discharge of matter. 
 
 I have known persons persist in their attempts to heal 
 these kinds of abscesses for some months. One lady 
 continued the application of dressings and lotions to a sore 
 of this kind for two years, but with no benefit. 
 
 In all these cases, the fangs of the teeth become very 
 
ALVEOLAR ABSCESS. 279 
 
 much diseased, and are the cause of the perpetual dis- 
 charge; therefore, no cure of these abscesses can be 
 expected without the extraction of the tooth. 
 
 In these cases, at the opening where the matter was 
 discharged, the skin rises and acquires a sort of fungous 
 appearance, being very red, and of a loose, spongy tex- 
 ture; when the tooth has been extracted, the discharge 
 gradually diminishes, and the external opening closes; 
 but, as the inner part of the integuments have been 
 destroyed by the ulcerative process, in healing the skin 
 becomes contracted, and a deep scar or pit remains. 
 
 From the situation and appearance of these scars, they 
 are liable to be attributed, by superficial observers, to the 
 effects of scrofula, which, to a female, or a person of nice 
 feelings, is always a source of uneasiness. 
 
 [When the matter from the abscess has been permitted 
 to escape, for a considerable length of time, from a fistu- 
 lous opening through the cheek, or lower part of the face 
 beneath the inferior maxillary, the removal of the tooth, 
 though it cures the abscess, is not always followed by the 
 closure of the opening exteriorly. A diseased action 
 having been set up here is often continued after the cure 
 of the primary affection. Although this rarely happens, 
 examples are on record. Mr. Thos. Bell, in his treatise 
 on the Anatomy, Physiology, and Diseases of the Teeth, 
 gives a very interesting case. The plan of treatment 
 which he instituted, and which might in like cases be 
 adopted, was, after the extraction of the tooth, the remo- 
 val of a circular portion of the parietes of the tube to- 
 wards the gum, and the bringing of the integuments 
 together as a simple wound.] 
 
 When teeth, which have caused abscesses of this kind, 
 are extracted, the fangs are found covered with a fleshy 
 substance, which are granulations extending to the bottom 
 
280 ALVEOLAR ABSCESS. 
 
 of the socket; this being only an effort of nature to effect 
 the healing process, and to fill up the cavity occasioned 
 by that absorption of substance, which always attends the 
 formation of matter. 
 
 When unfortunately the patient is so much under the 
 influence of fear, that neither acute pain nor protracted 
 suffering is sufficient to induce submission to the extrac- 
 tion of the tooth, the inflammation of the jaw bone is often 
 so great as to terminate in the mortification of a large 
 portion of its substance. 
 
 The process of exfoliation is necessarily a tedious one> 
 the patient is in a continual state of uneasiness, and the 
 mouth is constantly filled with an offensive discharge. 
 As the process of separating the dead portion of the jaw 
 from the living advances, the gums gradually recede from 
 the alveolar processes; at length the dead bone begins to 
 separate, it gradually becomes loose, and, when it is com- 
 pletely separated from the bony attachment, it may be 
 taken away. 
 
 In Plate XVI. are two specimens of the mortification 
 of portions of the jaw bone, in consequence of carious 
 teeth. 
 
 Fig. 8 represents a portion of the superior maxillary 
 bone, containing a central and lateral incisor, and the 
 cuspidatus of the left side : this case occurred to a gentle- 
 man whose lateral incisor was decayed, he had pain for 
 a day or two, when his gums and lip became swollen ; in 
 this state, instead of taking proper advice, he poulticed 
 and fomented his face for several days in succession : a 
 considerable quantity of matter formed, and discharged 
 itself under the lip: in this state it continued for some 
 time; when he applied to me, I found that not only the 
 diseased tooth was loose, but also the one on each side. 
 I extracted the carious tooth, but found the socket quite 
 
ALVEOLARABSCESS. 281 
 
 rough, arising from the destruction of the periosteum. I 
 told him I expected that the socket of this tooth would 
 exfoliate; a short time afterwards I saw him again, when 
 on touching the other teeth, I perceived a motion under 
 the gums, through the extent of the three teeth. 
 
 Some weeks after, the whole became so loose, that a 
 slight force brought it away. The parts then healed, but 
 not without leaving an immense cavity. 
 
 Fig. 9 exhibits a similar case, which occurred to a 
 young lady, a patient of Mr. Williams, in the Borough of 
 Southwark. 
 
 This lady was tormented by the tooth-ache for a long 
 period, her face swelled, and matter formed; but all the 
 entreaties of Mr. Williams, and the dreadful consequences 
 which he taught her to expect, could not raise in her 
 mind sufficient courage to permit the tooth to be extrac- 
 ted. The consequence was, that a large piece of the jaw 
 mortified, the bicuspides, in consequence of their attach- 
 ment to the bone being destroyed by the ulcerative pro- 
 cess, became loose, and, being single-fanged teeth, were 
 easily taken away; at length the piece of bone was so 
 completely detached, as to allow of its removal, bringing 
 away with it the diseased tooth: at this time, the second 
 molaris, having lost almost the whole of its support, was 
 found to be so loose as to render it necessary to be ex- 
 tracted. Here is an instance where a person lost four 
 teeth, and a large portion of the jaw, through an obstinate 
 determination of not submitting to the extraction of the 
 originally-diseased tooth. 
 
 I saw also a woman in Bartholomew's Hospital, who, 
 from a similar cause, lost all the teeth with the alveolar 
 processes of the anterior part of the lower jaw. 
 
 When abscesses form in the mouths of children, from 
 diseases of the temporary teeth, the greatest care should 
 
282 ALVEOLAR ABSCESS. 
 
 be taken, as, by an exfoliation of part of the jaw bone, 
 the teeth may be destroyed.* 
 
 A knowledge of the evils which may result from a 
 carious tooth, ought to influence all persons, who may be 
 affected with this malady, to take such early steps for 
 their prevention as prudence shall dictate. 
 
 Sometimes an indolent kind of inflammation will exist 
 at the bottom of the socket of a carious tooth, occasioning 
 a hard lump, or small tumour, of the size of half a nutmeg. 
 In this state it will continue for months, with no other 
 alteration than being rather sore, when, in consequence 
 of a cold, a little active inflammation may arise. 
 
 These hard swellings should always be regarded as 
 very dangerous, because, as during their indolent exis- 
 tence they have caused a certain degree of absorption of 
 the inner part of the integuments of the face, if any active 
 inflammation occur, it very speedily runs on to suppura- 
 tion ; and, as the skin has already become thin, ulceration 
 to the external part takes place so rapidly, that I have 
 known an opening formed through the cheek in a very 
 few days. On these accounts I always endeavour to 
 persuade patients to have any tooth extracted, which may 
 be accompanied with any hardness or swelling. It is also 
 much better to submit to the extraction of any carious 
 tooth which has produced an abscess; for it will be 
 always a source of trouble, as well as occasion an offen- 
 sive state of the breath. 
 
 [A very singular case of alveolar abscess fell under the 
 observation of the editor about four years ago. The 
 subject of which was a lady about thirty years of age. 
 She had been troubled with a dripping of pus from 
 behind the curtain of her palate for near twelve months, 
 and becoming somewhat alarmed at its long continuance, 
 
 * Vide Natural History of the Teeth, page 105. 
 
ALVEOLAR ABSCESS. 283 
 
 called the attention of her family physician, Professor 
 Bond ; to it, who after having carefully examined the case, 
 endeavoured to trace it to its origin. He soon came to 
 the conclusion that it come from the socket of a diseased 
 tooth, and after passing his finger around on the gums 
 covering the alveolar border, discovered a protuberence 
 over the extremity of the root of each superior central 
 incisor, nearly the size of a hazelnut. This tended to 
 confirm the opinion which he had formed with regard to 
 the place whence the matter came, and he requested 
 us to visit the lady with him, which we did, and on 
 examining the case advised the immediate removal of the 
 affected teeth, and the more strongly, as they were 
 found to be in a necrosed condition. 
 
 The lady readily consented to the operation, which 
 was performed on the following day. The discharge 
 behind the curtain of the palate immediately ceased, and 
 thus the patient was relieved from an affection that had 
 proved a source of great annoyance to her. The pus 
 from the abscess in this case, instead of passing out 
 through the alveolus and gum, had effected a passage 
 through the nasal plates of the superior maxilla, passed 
 back over the roof of the mouth and escaped in the 
 manner as described. 
 
 The following highly interesting case of alveolar ab- 
 scess, described by Dr. I. I. Greenwood of New York, 
 is quoted from the American Journal of Dental Science.* 
 
 "Some few years past a foreign gentleman applied to 
 me for professional aid, who had been treated by an 
 eminent surgeon dentist for several years for a diseased 
 dens sapientiae. On examining the case, the malady was 
 found to be seated in the alveolus of the tooth on the 
 right labial side of the dracranian maxillary at the base of 
 
 * Vide Vol. II. page 291. 
 
284 ALVEOLAR ABSCESS. 
 
 the coronoid process, where it forms a conjunction and 
 continuation of the alveoli. In the first instance it had 
 been formed by an erosive exposure of the medulla of 
 that organ. The patient being of a timid disposition, and 
 the surgeon not determined in extracting the tooth, an 
 abscess had formed, and the pus passing off from the 
 weight of the matter aslantwise, and through the base of 
 the alveolus of the tooth, had perforated the Levator, af- 
 fecting the rotary muscles opposite the orifice, and through 
 the anterior surface of the skin, immediately under the 
 centre of the belly of the digastricus, where it pierces the 
 meatus auditoriusexternus, forming a considerable orifice; 
 which issue he was in the habit of probing with a silver 
 instrument, about six inches in length, and cleansing with 
 lint, &lc. It was found that in making use of this instru- 
 ment and forcing it in the whole length of the canal, 
 which was straight and considerably indurated, the rigidity 
 being such that the digastricus could not have its full 
 force of expansion, and the masseter muscle of that side 
 at its lower portion was affected as well as the pterygoi- 
 deus externus in such a manner, that the patient was not 
 enabled to open his mouth more than half an inch. 
 
 By further probing the wound the instrument was 
 found to strike upon a hard substance at the base, which 
 by the sound was known to be the fangs of the diseased 
 organ. The alveolus being destroyed on that side of the 
 diacranian opposite, and on the labial section of the 
 surface of the tooth; from the continuous issue of matter, 
 the tooth irritating and acting as an extraneous body, and 
 causing this flow, it was determined at once to perform 
 the operation of extraction. No worse result could take 
 place when the member was removed. The cutting was 
 carefully yet fearlessly made, and the operation performed. 
 The patient immediately feeling relief, the sanguineous 
 
ALVEOLAR ABSCESS. 285 
 
 discharge which followed was somewhat free, and con- 
 sidered as favourable. Yet still the indurated canal re- 
 mained, and the rigidity of the parts not remedied. The 
 patient was advised when the wound healed in a measure, 
 to lubricate the parts externally with emollients, such as 
 had been prescribed by his physician and were of a 
 mercurial nature, to cause a pliantness and relaxation of 
 the muscles. The advice was concurred in, and a resti- 
 tution of the parts was the effect of the application."] 
 
 37 
 
CHAPTER FOURTEENTH. 
 
 DISEASES OF THE ALVEOLAR PROCESSES. 
 
 The alveolar processes are elongations of the external 
 and internal tables of the maxillary bones, which, being 
 united by transverse processes, are divided into cavities 
 called alveoli, or sockets, for containing the fangs of the 
 teeth. 
 
 The alveolar processes are to be considered as neces- 
 sarily belonging to the teeth, and not essential to the 
 formation of the jaw bones. In the earlier part of life, 
 they contain the rudiments of the teeth, which they 
 accompany in their growth, and when the teeth are 
 completely formed, they acquire a form exactly suitable 
 to the shape of the fangs. 
 
 The alveolar cavities are lined with a vascular mem- 
 brane, analogous to the periosteum in other bones; this 
 membrane is also attached to the fangs of the teeth, and 
 by it the teeth are fixed in their sockets: the alveoli 
 are larger than the fangs of the teeth they are meant to 
 contain, as may be seen by examining a skull that has 
 been macerated; where the membranous parts being 
 destroyed, those teeth which have single fangs drop out, 
 whilst the others are retained by the irregular shape of 
 their fangs. On this account it is, that the teeth have a 
 certain degree of motion, which is of great benefit in 
 mastication, thereby preventing that injury which might 
 
DISEASES OF THE ALVEOLAR PROCESSES. 287 
 
 arise from the concussion consequent on the breaking of 
 hard substances. This motion of the teeth in their 
 sockets, is made evident to all persons when the fangs of 
 a tooth are inflamed ; hence, many expect that the opera- 
 tion of extraction will be attended with little pain, and no 
 difficulty; an error which we cannot be too careful to 
 correct, by explaining that the looseness of the tooth is 
 only its natural motion, now become more observable 
 from the increased sensibility of the periosteum. This 
 explanation leads the patient to abandon those delusive 
 expectations, and preserves the surgeon from the imputa- 
 tions, of having given unnecessary pain. [Not only is 
 the motion of a tooth more perceptible when its alveolar 
 membranes are inflamed, but it is actually looser, and this 
 results from its being slightly raised from its socket by 
 the swollen and thickened condition of the periosteal tissue 
 which surrounds its root, or roots, if it have more than 
 one.] 
 
 The alveolar processes are always sympathetically 
 affected by all the diseases of the teeth and gums. When 
 inflammation affects either the teeth or gums, it shortly 
 extends to the alveolar processes; in consequence of 
 which, an increased action of the absorbents is induced, 
 and the substance is removed. An absorption of the 
 alveolar processes invariably follows a loss of the teeth, 
 occasioned by any cause whatsoever. This may be 
 noticed in very old persons, who have lost all their teeth; 
 the upper jaw becomes much diminished in extent, and 
 the roof of the mouth, instead of being arched, is ren- 
 dered nearly flat; the under jaw becomes simply a thin 
 bone covered by the gums. Thus, by the removal of 
 the teeth and alveolar processes, a loss of substance is 
 sustained nearly equal to an inch and a half in depth ; 
 and, when this is the case, the muscles of the lower jaw, 
 
288 DISEASES OF THE ALVEOLAR PROCESSES. 
 
 in the endeavour to draw it against the upper, produce 
 those characteristic marks of old age, the shortened face, 
 the wrinkled cheek, and the projecting chin. 
 
 The alveolar processes have certain diseases peculiar 
 to themselves, independent of affections arising from the 
 teeth and gums. The most common disease to which 
 they are subject, is a gradual absorption of their sub- 
 stance, whereby the teeth lose their support, become 
 weak, and at length are so loosened as to drop out. This 
 disease usually begins to show itself in persons between 
 forty and fifty years of age; and, from its frequent occur- 
 rence without any evident cause, it would seem to be a 
 consequence of having passed the middle period of life. 
 In the majority of cases in which this disease occurs, 
 the teeth are perfectly sound, and, from numerous obser- 
 vations, I think I may venture to assert, that persons who 
 have had several of their teeth affected with caries in the 
 early part of life, are not liable to lose, by an absorption 
 of the sockets, those which remain sound ; but where the 
 teeth have not been affected with caries in the early part 
 of life, persons, as they approach fifty years of age, and 
 often much earlier, have their teeth become loose from 
 absorption, or a wasting of the alveolar processes. 
 
 When the alveolar processes are removed by the action 
 of the absorbents, the gums which are supported by the 
 alveolar processes, partake also of the disease; thus, in 
 the progress of the disease, as the absorption of the bony 
 matter advances, the gums lose their attachment to the 
 teeth, and recede in proportion to the wasting of the sock- 
 ets. Hence when an absorption of the socket is taking 
 place, the necks of the teeth become exposed, and the 
 teeth appear to increase in length; which circumstance 
 has caused many persons to imagine that they are actual- 
 ly extended by natural growth. In this opinion, how- 
 
DISEASES OF THE ALVEOLAR PROCESSES. 289 
 
 ever, they are soon undeceived; for, as the disease 
 increases, the teeth become weak, and at length, by 
 losing their natural support, are rendered so exceedingly 
 loose, that, in a short time, they drop out. 
 
 Sometimes this disease proceeds without the appear- 
 ance of any assignable cause, the gums retain a very 
 healthy aspect, are quite free from pain or inflammation, 
 and yet will gradually recede, until the teeth become 
 very loose. 
 
 The causes which more particularly produce this affec- 
 tion are such as occasion any continued or considerable 
 inflammation of the gums. These are an accumulation 
 of the tartar about the teeth, an habitual predisposition in 
 the gums to inflammation, as happens in that disease com- 
 monly called the scurvy in the gums, or that state of them 
 which is produced by the action of mercury. 
 
 When this disease attacks the alveolar processes in 
 both jaws, it is generally discovered by all the teeth 
 appearing longer, and having larger spaces between them 
 than formerly, accompanied also with a difficulty of mas- 
 ticating hard substances. Soon after a person has made 
 these remarks, he finds some one tooth become loose, 
 occasioning much uneasiness, by preventing the use of 
 that side of the mouth in which it is situated, and there- 
 fore its removal is determined upon. Shortly afterwards 
 another tooth fails, and so in succession, until, in the 
 course of eight or ten years, most of the teeth are lost* 
 
 In some cases of absorption of the alveolar processes, 
 and removal of the gums, the disease causes a very pecu- 
 liar appearance; the gums are very much swelled 
 between the teeth, the fangs are uncovered irregularly, 
 and are also quite black. f 
 
 *Plate XVIII. Fig. 5. fFig- •• 
 
290 DISEASES OF THE ALVEOLAR PROCESSES. 
 
 Sometimes the alveolar processes are affected only par- 
 tially, the absorption being confined to the sockets of two 
 or three teeth only, after the loss of which there may be 
 no appearance of the disease for a great length of time.* 
 
 When several teeth together have become loose, as is 
 often the case with the incisores, they may be strength- 
 ened in an artificial manner, by tying or fixing them with 
 a silk ligature, or a fine gold wire, to those neighbouring 
 teeth, which may happen to be firm. By this operation, 
 the loose teeth are supported and kept steady, not only 
 giving comfort to the patient, but also arresting the pro- 
 gress of the disease, by removing that irritation which is 
 kept up in the gums and sockets by the looseness of the 
 teeth. 
 
 [The destruction of the alveoli is not the result, as sup- 
 posed by the author, of the direct action of the absorbents, 
 but of that of the corrosive matter secreted by the gums on 
 their inner edge and the periosteal tissue. The wasting 
 of the alveoli is always preceded and accompanied by a 
 diseased action in the gums, and sometimes by a morbid 
 diathesis of the alveolo-dental membranes. And disease 
 in these tissues, may result from the presence of diseased 
 teeth, tartar or other extraneous matter, or a vitiated or 
 morbid condition of the fluids of the mouth. 
 
 If the wasting of the alveolar processes were the result 
 of a spontaneous action of the absorbents, independently 
 of local irritation, they would all be attacked at about the 
 same time, but inasmuch as they are not, and as some are 
 more liable to be destroyed than others, and especially 
 those, the teeth of which are most liable to accumulations 
 of tartar, the inference that the author's opinion is incor- 
 rect, seems irresistible. Moreover, the matter secreted 
 
 *Plate XVIII. Fie. 7, 8. 
 
DISEASES OF THE ALVEOLAR PROCESSES. 291 
 
 by the inner edge of the gums, around the necks of the 
 teeth; is known to be possessed of corrosive qualities, and 
 capable of breaking down the calcarious molecules of bone, 
 and the parts of the alveoli first destroyed are their edges, 
 which are in contact with this matter. 
 
 The affection is not a necessary consequence of old age, 
 as the author seems to imagine. Many persons retain all 
 their teeth firmly in their sockets to extreme old age, but 
 that it should frequently occur, after the middle period of 
 life, is not to be wondered, when we take into considera- 
 tion the fact, that as the healthful energies of the body 
 begin to decline, all its fluids begin gradually to deterio- 
 rate, those of the mouth as well as those of other parts of 
 the organism, and hence the morbid action in the gums 
 which about this period oftentimes manifests itself, and the 
 consequent gradual wasting of the alveoli, and especially 
 when no means are used to counteract it — such for exam- 
 ple, as the observance of thorough and constant cleanli- 
 ness of the dental apparatus. 
 
 The lower teeth are by far more liable to loosen and 
 drop out from the destruction of their sockets than the 
 upper. As soon as they begin to loosen, they, by their 
 increased motion in their sockets, become a source of 
 irritation to the gums and alveolo-dental periosteum, and 
 hence it is, that the loss of three or four loosened teeth, 
 often, for a time at least, arrests the progress of the 
 disease. 
 
 The employment of an artificial support, such as liga- 
 tures or wires, for teeth which are loose, is decidedly 
 improper, for the reason, that though it may steady the 
 teeth for a short period, it prevents them from being pro- 
 perly cleansed, and affords a lodgment to extraneous 
 matter, and will thus ultimately increase the evil.] 
 
 The treatment found to be most successful in arresting 
 
292 DISEASES OF THE ALVEOLAR PROCESSES. 
 
 the progress of this disease, is the removal of that which 
 may appear to be the exciting cause. If this be tartar, 
 it should be removed; and, if there be a tendency to an 
 habitual deposit, the person should be careful, by frequent 
 attention, to prevent its accumulation. In some cases, 
 this disease is accompanied with inflammation extending 
 along the fangs of the teeth, giving the sensation of ten- 
 sion, and occasioning great uneasiness; this is relieved by 
 scarifying the gums, a practice which should always be 
 had recourse to, as the loss of blood, by abating the 
 inflammation, relieves the pain, and checks the progress 
 of the disease. 
 
 Sometimes the absorption of the alveolar processes is 
 attended with a considerable secretion of pus, which 
 oozes out from under the gums, at the necks of the teeth. 
 This discharge is not only very disagreeable, but often 
 renders the patient very unhappy. Persons thus affect- 
 ed, from observing, when they squeeze the gums with 
 the finger, that matter passes out at the necks of the 
 teeth, form an opinion, that it must produce injurious 
 effects upon the sockets of the teeth, as well as render 
 the breath offensive; on these accounts, they frequently 
 squeeze the edges of the gums, and wipe the teeth, in 
 order to remove what they consider to be so offensive 
 and injurious. This practice, however, cannot be too 
 strongly reprobated, as it tends to promote the very ef- 
 fects they so much fear. By frequently squeezing the 
 gums, a constant irritation is kept up on the secreting 
 surface, by which the discharge is not only rendered 
 more copious, but also more acrid. 
 
 In these cases, nothing more should be done than to 
 use a soft tooth-brush, night and morning, and cleanse 
 the mouth by rinsing it with some lotion, such as a decoc- 
 tion of Peruvian bark, the infusion of roses with tincture 
 
DISEASES OF THE ALVEOLAR PROCESSES. 293 
 
 of myrrh or tincture of catechu, diluted arquebusade 
 water, &c. By attending to these rules, the discharge 
 will be moderated, and the mouth become much more 
 comfortable. [In addition to the foregoing, the ulcerated 
 edges should be touched with a solution of nitrate of 
 silver.] 
 
 An extraordinary change in the position of the teeth is 
 sometimes produced by a slow and peculiar absorption of 
 the alveolar processes. The teeth advance from the pos- 
 terior to the anterior part of the mouth, and cause the 
 incisores to become irregular; this irregularity sometimes 
 increases, even to the entire projection of one tooth : and, 
 if the projected tooth should become loose, and be ex- 
 tracted, the loss will not be perceived, as the tooth on 
 each side has approached so near to each other. In this 
 manner I have seen the cuspidati advance so much to- 
 wards the symphysis of the jaw as not to leave sufficient 
 space for more than two teeth. [The loss however of 
 two of the front teeth, even though the space between 
 the cuspidati be filled, gives to the teeth a disagreeable 
 appearance.] 
 
 This alteration in the position of the teeth arises from 
 an absorption of the transverse alveolar processes, and the 
 irregularity from the difference which exists in the form 
 of the fangs and the crowns of the teeth; the former 
 being much thinner than the latter, necessarily occasion, 
 when the fangs are approximated, a considerable irregu- 
 larity in the position of the teeth. When this kind of 
 change takes place in the teeth of the upper jaw, the in- 
 cisores project so much as to be placed one over the 
 other, and produce very great deformity.* 
 
 There is another disease of the alveolar processes 
 
 •Plate XVIII. Fig. 4. 
 
 38 
 
294 DISEASES OF THE ALVEOLAR PROCESSES. 
 
 frequently occurring, but which diners from the appear- 
 ances already described. It rarely affects more than one 
 tooth at the same time, and, instead of being an absorption 
 of the socket, it is a filling up or contraction of the bottom 
 of it, by which it becomes shortened, and the tooth 
 consequently pushed out. 
 
 The appearance produced is an increase in the length 
 of the tooth : the gum is not affected, but retains its 
 natural situation. As the disease in the socket advances, 
 the tooth continues to be protruded, until it loses so much 
 of its support as to become loose, after which it soon 
 drops out. The loss of the tooth is much hastened by 
 occasionally striking against the teeth in the other jaw: a 
 disagreeable effect is also produced in the symmetry of 
 the mouth, by one tooth being much longer than the 
 others. In this case, all that can be done, is to file away 
 a portion of the lengthened tooth, so as to make it even 
 with the others. This operation should be performed 
 from time to time, as the tooth continues to be protruded, 
 which will save it from being struck by the other teeth, 
 and obviate the deformity arising from the otherwise 
 unavoidable irregularity.* 
 
 The alveolar processes occasionally become enlarged 
 by exostosis. This sometimes takes place at that part 
 formed by the union of the superior maxillary bones; 
 the central incisores, from being closely situated together, 
 become so much separated as to appear as if a tooth had 
 been extracted. The same circumstance also sometimes 
 occurs at the symphysis in the lower jaw.f 
 
 I once met with a case of considerable enlargement of 
 the alveolar processes at the posterior part of the upper 
 jaw, in which the molares were still remaining; great 
 deformity was occasioned by the projection of the cheek. 
 
 * Plate XVIII. Fig. 1,2. tFig. 3. 
 
DISEASES OF THE ALVEOLAR PROCESSES. 295 
 
 The practice adopted was to extract the teeth with the 
 view of producing a decrease in the size of the tumour 
 by that absorption of the alveolar processes which always 
 follows the removal of a tooth. This proved very suc- 
 cessful, for the tumour was not only diminished in size, 
 but the progress of the disease was arrested. 
 
CHAPTER FIFTEENTH. 
 
 OF THE TARTAR [SALIVARY CALCULUS] OF THE TEETH. 
 
 Excepting the disease of caries, nothing is so de- 
 structive of the healthy condition of the mouth, or of the 
 duration of the teeth, as the accumulation of tartar. This 
 is an earthy substance held in solution by the saliva, and 
 is deposited upon the teeth, as the saliva undergoes de- 
 composition. Almost every person is subject to a forma- 
 tion of it in a greater or less degree ; in some, the deposit 
 is so habitual and copious, that without unremitted atten- 
 tion, their teeth cannot be preserved in a decent state; 
 whereas, in others, it is so small in quantity that the least 
 degree of care is sufficient to keep the teeth perfectly 
 clean. 
 
 The formation of tartar is much influenced by the state 
 of the health; for, during the continuance of any febrile 
 complaint, in which the secretions of the whole alimen- 
 tary canal are disordered, the mouth and teeth are loaded 
 with a thick mucus; hence there is commonly a very 
 large accumulation: the same also is observed during 
 confinement from any cause whatever, when there is not 
 an opportunity of constantly cleansing the teeth : it is 
 remarkably so in the confinement attendant on partu- 
 rition. [Some temperaments too are more favourable to 
 depositions of this substance than others, and the relative 
 proportion of the earthy and animal constituents of 
 
SALIVARY CALCULUS. 297 
 
 tartar varies in different dispositions, but for a descrip- 
 tion of its physical characteristics the reader is referred 
 to Part Second of the editor's Principles and Practice 
 of Dental Surgery.] 
 
 After sleep., the teeth are usually found covered with a 
 viscid, yellowish mucus, which, if not entirely removed 
 by the use of a tooth-brush and washing, adheres to the 
 teeth in those parts not subject to friction during masti- 
 cation. Through neglect, this viscid mucus gradually 
 accumulates, depositing itself in layers until it acquires a 
 hard consistence, and sometimes a magnitude equal to 
 that of the teeth themselves. 
 
 When the tartar is soft, it has a yellowish [or whitish] 
 appearance: but as it becomes harder, it changes to a 
 dark brown, or a black colour; in this way the teeth are 
 rendered very disgusting to the eye, and, by its effects 
 on the gums, a very disagreeable fetor is communicated 
 to the breath. 
 
 In the formation of tartar about the teeth, it insinuates 
 itself under the gums, and detaches them from the necks 
 of the teeth; the gums are thus brought into a diseased 
 state, are subject to inflammation and pain, and at last 
 gradually recede from the teeth. This state of the gums 
 soon causes the alveolar processes to become affected, and 
 absorption in them is induced; so that, in proportion to 
 the increase and accumulation of tartar about the teeth, 
 their natural support is destroyed, they become loose, and 
 at length, by some accident, a large piece of tartar is 
 broken off, when the tooth, being deprived of its artificial 
 support, drops out. In like manner, the other teeth give 
 way one after the other, until in a few years the greater 
 number are entirely lost. Persons who lose teeth from 
 this cause, complain that they came away perfectly sound, 
 not considering it as the effect of their negligence; and it 
 
298 SALIVARY CALCULUS. 
 
 is but too commonly the the case that nothing less than 
 commencement of the loss of teeth induces them to pay 
 attention either to their cleanliness or preservation. 
 
 The tartar always accumulates in greater quantity about 
 those teeth situated near to the openings of the salivary 
 ducts; and ; in some few instances ; it has been found, in 
 no inconsiderable quantity, in the ducts themselves: 
 hence, the inner side of the incisores in the under jaw, 
 and the external sides of the molares in the upper jaw, 
 are the most covered by it. If, on account of a carious 
 tooth that may be tender, only one side of the mouth be 
 used in eating, the teeth on the other side usually become 
 very much incrusted; which circumstance demonstrates 
 that the friction of the food in mastication very much 
 tends to cleanse the teeth. 
 
 There is another kind of tartar which collects chiefly 
 about the teeth of young persons : it is of a dark green 
 colour, rather resembling a stain than an earthy con- 
 cretion: it is very injurious in its effects upon the teeth, 
 as it corrodes the enamel, and disposes the teeth to be- 
 come carious. 
 
 In Plate XIX. are a variety of examples of accumu- 
 lated tartar, showing also the manner in which it pro- 
 duces its injurious effects. 
 
 The deposition of tartar is an unavoidable circumstance, 
 depending upon the effusion and decomposition of saliva; 
 but it is in the power of most persons to keep their teeth 
 free from an injurious accumulation, by carefully washing 
 and brushing the teeth every morning, to remove that 
 soft matter which is deposited during the night, and also 
 by rinsing the mouth after meals, to cleanse them from 
 those particles of food that may lodge about them, and 
 which, being left in the intermediate spaces of the teeth, 
 become changed during the night, and not only contribute 
 
SALIVARY CALCULUS. 299 
 
 much to the formation of tartar, but also produce a tainted 
 breath [and caries of the teeth.] 
 
 If the constant use of a tooth-brush and water be not 
 sufficient to keep the teeth perfectly clean, a tooth-pow- 
 der may be used, composed of some substance not pos- 
 sessing any chemical property which can act on the 
 enamel, or of too hard a quality, by which it would grind 
 it away. [The use of waxed-floss silk as before directed 
 will also be found a valuable auxiliary to the brush.] 
 
 Powders for this purpose may be composed of any of 
 the finely powdered earths, or boles, or any of the 
 testaceous powders; charcoal, finely levigated, has been 
 recommended and much approved by many. In the 
 formation of a tooth-powder, no ingredient ought to be 
 used that can have any chemical action upon the enamel 
 of the teeth; nothing more is desirable than something 
 which will mechanically act with the brush, in taking 
 from the teeth that inspissated mucus which forms [or 
 rather mixes with and agglutinates the particles of the 
 tartar together,] nor should any acid be introduced into 
 washes, tinctures, essences, or dentifrices, for diseases of 
 the gums, as, by their power in decomposing the enamel, 
 the greatest injury is done to the teeth. In cases of 
 disease, where acid remedies are necessary, persons 
 should be careful to wash and wipe their teeth im- 
 mediately after their exhibition, to prevent future injury 
 of the teeth; for whatever renders the enamel thinner 
 necessarily tends to the destruction of the teeth. 
 
 [The editor is of the opinion that neither charcoal nor 
 bark should enter into the composition of dentifrices, for 
 the reason that it gets between the edges of the gums and 
 necks of the teeth, where it oftentimes remains for years, 
 giving to the margin of the former a blackish or reddish 
 brown appearance. It moreover is a constant source of 
 
300 SALIVARY CALCULUS. 
 
 irritation. Equal parts of prepared chalk; oris root and 
 castile soap, finely pulverized and passed through a fine 
 sieve, constitute a much better dentifrice, but no powder 
 should be employed when the gums are in an inflamed 
 and spongy condition.] 
 
 When tartar has collected about the teeth, it is to 
 be taken off by means of instruments; this operation is 
 called scaling of the teeth, which is one of the most 
 useful and necessary for their preservation. Much pre- 
 judice has been excited against this operation by the very 
 injurious practice of some dentists, who apply the muriatic 
 or vitriolic acid for the purpose either of softening the 
 tartar, or whitening the teeth : the effect of these agents 
 upon the teeth, is to remove the external coat of enamel 
 by its solution, and to give to the teeth a beautiful white 
 appearance immediately after its application. The natural 
 polish of the enamel being thus destroyed, the surface is 
 left rough, and the teeth soon afterwards become dark 
 coloured from the adhesion of the colouring matter 
 contained in the food. But, if this practice of applying 
 the acid be not adopted, and the tartar, as it may accu- 
 mulate, from time to time, be carefully removed from all 
 parts of the teeth, the gums will be preserved in a healthy 
 state, and absorption of the alveolar processes be entirely 
 prevented. 
 
 The tartar, when it has been suffered to accumulate in 
 large quantities, should be taken off cautiously, otherwise 
 the sudden exposure of the necks of the teeth will be a 
 cause of tenderness and pain. In such cases, a small 
 portion of tartar should be removed at a time, beginning 
 at the edges of the gums, which will permit them to 
 grow up about the necks of the teeth; by this gradual 
 procedure, a week or fortnight intervening between each 
 operation, a very large quantity of tartar may be removed 
 
SALIVARY CALCULUS. 301 
 
 without occasioning the slightest inconvenience: in the 
 interim, the gums should be frequently washed with an 
 astringent lotion. 
 
 [It would be preferable, if it could be done, to remove 
 the whole at one time, but from the turgid condition of 
 the gums, this is not always possible, hence it becomes 
 necessary to resume the operation, at intervals of two or 
 three days, or a week, until it is completed.] 
 
 I have seen many cases of great soreness and extensive 
 ulceration of parts of the mouth, arising from large accu- 
 mulations of tartar. A lady from the country applied to 
 me, complaining of a sore mouth, which had baffled all 
 the attempts made by a very skilful surgeon to heal it. 
 The inside of her cheek was in an ulcerated state, and 
 under the tongue, at the fraenum, there was a considera- 
 ble thickening, with a line of ulcerated surface. She had 
 been in this state for more than twelve months, and could 
 only obtain temporary relief from any application. Her 
 teeth were covered with an immense quantity of tartar, 
 such as described in Figures 14, 15 and 16 of Plate XIX. 
 The edges of this substance, being very ragged and sharp, 
 were continually cutting into the soft parts, that pressed 
 against them. Sometimes a small portion would break 
 off, when, from the new edge being very sharp, much 
 irritation immediately ensued. I removed the tartar at 
 intervals, in the manner above described, the sore places 
 healed, and since that period, by an occasional removal 
 of newly formed tartar, her mouth has continued per- 
 fectly well. 
 
 In scaling the teeth, care should be taken to use the 
 instruments with no greater force than is necessary to 
 remove the tartar, lest the enamel be scratched or injured ; 
 attention is also required to distinguish an .irregular- 
 formed tooth from the distorted shape, which accumulated 
 39 
 
302 ANALYSIS OF THE TARTAR. 
 
 tartar frequently assumes; and, in teeth that are naturally 
 yellow, not to mistake the body of the tooth for the extra- 
 neous matter upon it, a discrimination highly important, 
 when applied to those yellow teeth, with very rough sur- 
 faces, described in the Natural History of the Teeth, 
 page 57. 
 
 ANALYSIS OF THE TARTAR. 
 
 Dear Sir, — The specimens of the Tartar of the 
 Teeth, which I received from you, I have examined 
 chemically. Previous to their analysis, I subjected a por- 
 tion of them to the following experiments. I am, 
 
 Dear Sir, 
 Jlrtillery Place, Finsbury y truly yours, 
 
 Dec. 1, 1805. W. H. Pepys. 
 
 To Mr. Fox. 
 
 Tartar of the teeth, of a dirty white colour, inclining to 
 brown stained in parts yellow and green; spongy, porous 
 texture, yet considerably hard; when it is detached in 
 large pieces, exhibits the impression of the teeth on which 
 it was deposited. The pieces which were examined 
 were dry and free from smell. Specific gravity 1.5714. 
 
 Sulphuric acid 1.85 is immediately blackened, the sub- 
 stance becomes spongy and soft, but no complete solution 
 takes place. 
 
 Nitric acid 1.12 acts in nearly a similar manner on this 
 substance as on the teeth. * A gas which has the nega- 
 tive properties of nitrogen, is evolved in small bubbles, 
 and a flocculent mass, of the form of the piece immersed, 
 is left. 
 
 *See Natural History of the Teeth, page 123. 
 
ANALYSIS. 303 
 
 Solution of potash, boiled for some time upon it, had 
 but little action; the tartar became whiter, the solution 
 yellow ; upon the addition of nitric acid to the separated 
 solution, the colour nearly disappeared without any pre- 
 cipitate being formed: ammonia reproduced the yellow 
 colour. 
 
 The flocculent substance left by dilute nitric acid, after 
 washing off the acid, being boiled with solution of potash, 
 was not wholly dissolved; the solution became yellow. 
 Nitric acid being added, discharged the colour, which 
 ammonia reproduced. 
 
 Water boiled for some time upon tartar gave no pre- 
 cipitate or turbid appearance on the addition of solution 
 of tannin. 
 
 Tartar exposed to a red heat, in a silver crucible, 
 smokes, accompanied with a greasy smell, is blackened in 
 a similar manner to bone, and becomes more easily solu- 
 ble in nitric acid, leaving a carbonaceous residuum. 
 
 The solutions of potash which have been boiled on tar- 
 tar, being neutralized with nitric acid, gave no precipitate 
 with solution of nitrate of barytes. 
 
 ANALYSIS. 
 
 Fifty grains of tartar of the teeth were placed in 400 
 grains of nitric 1.12; nitrogen gas was slightly liberated: 
 in twenty-four hours it was diluted with two ounces of 
 distilled water, and then filtered. 
 
 The solution w r as then precipitated by ammonia, and 
 filtered; and, upon the addition of carbonate of ammonia, 
 remained clear; the precipitate produced, being dried at 
 212°, weighed 40 grains, and, when ignited, it weighed 
 35, which were again soluble in dilute nitric acid, giving 
 a copious precipitate with solution of acetate of lead: this 
 
301 ANALYSIS. 
 
 precipitate, washed, dried, and exposed to a flame, urged 
 by a blow-pipe, fused in a globule, accompanied with a 
 bright phosphorescent appearance, and was therefore 
 phosphate of lead. 
 
 The substance not soluble in nitric acid, was washed 
 and dried at 212°, weighed 15 grains, and adhered firmly 
 to the filter. 
 
 The 15 grains of the last experiment were boiled in a 
 solution of potash for a quarter of an hour; being sepa- 
 rated, washed and dried at 212°, weighed 9 grains. 
 
 The separated solution was of a yellow colour, the 
 addition of nitric acid produced no precipitate, but lost 
 colour, which was recovered by ammonia. 
 
 The 9 grains of residuum after treatment of the potash, 
 were placed in boiling concentrated nitric acid, by which 
 they were completely dissolved; and, by the test of 
 tannin, proved the cartilage to have been gelatinized. 
 
 Tartar of the teeth consists of 
 
 Phosphate of lime, ... 35 
 Fibrina, or cartilage, ... 9 
 
 Animal fat, or oil, ... 3 
 
 Loss, 3 
 
 50 
 [The following is the result of an analysis by Berzelius. 
 One hundred parts contained, 
 
 Phosphate of lime and magnesia, 79.0 
 
 Salivary mucus and salavine, . 13.5 
 Animal matter, . . . 7.5 
 
 100. 
 
ANALYSIS. 305 
 
 In an analysis made by Mr. Dwindle, a scientilic dentist 
 of Cazenovia, N. Y. One hundred parts yielded, 
 Phosphate of lime, ... 60 
 Carbonate of lime, . . . 14 
 
 Animal matter and mucus, . . 16 
 Water and loss, . . . . 10 
 
 100 
 It is probale that no two analyses could be made to 
 give the same result for the reason as before stated, that 
 the relative proportions of its constituents vary in different 
 individuals.] 
 
CHAPTER SIXTEENTH. 
 
 OF SCALING [REMOVING THE TARTAR FROM] THE TEETH. 
 
 By the term scaling the teeth, nothing more is meant 
 than the removal of the tartar; though, through preju- 
 dice, a popular notion prevails, that, by scaling the teeth, 
 a removal of the enamel is intended. The instruments 
 for performing this operation are made of various forms, 
 so adapted, as to be easily used on the different parts of 
 the teeth. The most conveniently formed set of instru- 
 ments consists of, one having the shape of a chisel, a 
 straight and a curved spear-pointed instrument; one like 
 a rugine, being three pointed, and adapted for scraping ; 
 and another form for scraping, but smooth at the back. 
 In some sets, there may be one or more instruments of 
 different shapes; but this depends more upon caprice 
 than real utility, as it is not so much the form of an in- 
 strument that is of consequence, as the proper manner of 
 using it. [The form of the instruments, however, should 
 be such that they may be readily applied to every part of 
 the teeth, for it is important that every particle of tartar 
 be removed from them.] 
 
 The patient should be seated in a chair, having a high 
 back, that the head may rest conveniently ; and, by being 
 kept steady allow the operation to be performed with 
 convenience to the surgeon, and ease to the patient. 
 Endeavours should be made to acquire a habit of taking 
 
OF SCALING THE TEETH. 307 
 
 off the tartar without violence, operating with as light a 
 hand as possible. 
 
 The chisel-formed and straight spear-pointed instru- 
 ments are designed for the anterior surface of the under 
 incisores; the curved spear-pointed and the scraping 
 instrument with a smooth back, for the outer side of the 
 molares and other teeth; and the three-pointed instru- 
 ment, or other scraping instruments, for the posterior sur- 
 faces of the teeth. By attending to these hints, with a 
 little practice, a habit may soon be acquired of removing 
 the tartar without leaning heavily upon the mouth, or 
 jarring the teeth, which are two circumstances of con- 
 siderable importance. 
 
 [In the removal of the tartar from the lower front 
 teeth, when they are loose, the thumb of the left hand 
 of the operator should be placed on them in such a man- 
 ner as to prevent them from being jarred or shaken in 
 the operation. The patient should be directed to wash 
 his mouth from time to time, during the operation, to free 
 it from blood and the small particles of tartar that lodge 
 along the edges of the gums. 
 
 For the removal of the tartar on the approximal sur- 
 faces of the teeth, a thin-bladed instrument like that of a 
 knife should be employed, and the operator should be 
 careful not to injure the periosteum. When the gums 
 are very much swollen and inflamed, and the accumula- 
 tion very considerable, several sittings will be required to 
 complete the operation. After which the patient should 
 be directed to cleanse his teeth several times a day with 
 a soft elastic brush and waxed-floss silk, to prevent a 
 re-accumulation. If any small particles be left upon the 
 teeth, they will constitute nuclei for its re-accumulation, 
 and thus, in a measure, counteract the means employed to 
 prevent it. It is important therefore, that the operation 
 
308 OF SCALING THE TEETH. 
 
 be thorough^ that not a particle be left upon the teeth ; 
 and as the presence of this substance, gives rise to disease 
 in the gums, it is also important that such other treatment 
 be instituted; as the nature of the morbid condition in this 
 structure may seem to require. But, as this has been 
 described in a preceding chapter, it will not be neces- 
 sary to recapitulate what has been said upon the subject. 
 Some writers recommend for the removal of this sub- 
 stance from the teeth, chemical agents, — such for exam- 
 ple, as diluted muriatic and even sulphuric acids, but the 
 employment of either of these, or any acid, for this pur- 
 pose, is highly improper. Any chemical agent which 
 will decompose the tartar of the teeth, will act upon the 
 teeth, therefore, mechanical, is the only means that 
 should be employed for its removal.] 
 
CHAPTER SEVENTEENTH. 
 
 THE EFFECTS OF MERCURY UPON THE TEETH. 
 
 When mercury has been introduced into the system, 
 certain circumstances occur which are usually regarded 
 as criteria of its specific and constitutional action. The 
 most evident of these are an increased discharge from the 
 salivary glands, soreness of the mouth, and fetor of the 
 breath. The gums become tumid and spongy, are very 
 tender, and liable to bleed; the teeth also become loose, 
 and cannot bear the pressure necessary for the mastication 
 of hard substances : this loosened state of the teeth arises 
 from the thickening of the periosteum which covers the 
 fangs, and by which the teeth are held in the sockets; 
 the soreness of the gums is probably occasioned by that 
 fulness of the vessels which the peculiar action of the 
 mercury induces. These affections of the teeth and 
 gums generally subside soon after the use of mercury is 
 discontinued, the teeth again become fast, and the gums 
 acquire their natural firmness. 
 
 A common consequence of the use of mercury is, an 
 increased action of the absorbent vessels, and there is no 
 part on which this action is more evident than the alveolar 
 processes. On examining these parts in persons who 
 have died during the use of mercury, they will be found 
 much less dense, and of a more porous texture than the 
 bone ought to be in its sound or natural state. The use 
 40 
 
310 EFFECTS OF MERCURY UPON THE TEETH. 
 
 of mercury is therefore no uncommon cause of premature 
 loss of the teeth ; by inducing absorption [wasting] of the 
 alveolar processes; this injurious consequence, arising 
 from the use of this remedy, is now greatly obviated by 
 the improvement adopted in its exhibition; namely, by 
 keeping up a longer but slighter action of it upon the 
 system, rather than that violent one which accompanied 
 the old practice of salivation. 
 
 Where the use of mercury is carried very far, the 
 teeth, even during its exhibition, often become so loose 
 as to drop out: in other constitutions, still greater mischief 
 is experienced; there is a considerable inflammation of 
 all the parts of the mouth, attended with great swelling 
 and ulceration. This sometimes extends even to morti- 
 fication of parts of the jaw-bones. It would not be 
 difficult to collect cases of extensive mischief following an 
 injudicious use of this valuable medicine; several striking 
 examples of which have been presented to me by various 
 surgeons of my acquaintance. In Plate XX. Fig. 2, is 
 the representation of a large piece of the anterior part of 
 the under jaw, containing the incisores and cuspidati, 
 which exfoliated, in consequence of a long-continued 
 salivation. 
 
 Fig. 3 represents nearly the whole of the under jaw, 
 which mortified and exfoliated; this person also lost 
 almost every tooth of the upper jaw, which became loose, 
 and dropped out. 
 
 A very similar case occurred to a patient in Guy's 
 Hospital, who applied for advice on account of great dis- 
 ease in his mouth, as the consequence of a late salivation. 
 He had an exfoliation nearly similar to the last case, and 
 it was surprising to observe how small a deformity at- 
 tended the loss of so great a part of the jaw. During 
 the progress of the exfoliation, so large a deposit of new 
 
EFFECTS OF MERCURY UPON THE TEETH. 311 
 
 bone took place, around the dead portion, that it became, 
 as it were, inclosed in a case; and, after it came away, 
 the new bone was rounded, and the gums healed over 
 very perfectly. 
 
 Last year I saw a most dreadful instance of the inju- 
 rious consequences of an improper use of mercury, in a 
 lady, a patient of Mr. Norris, who had just arrived from 
 the East Indies, where she had been salivated on account 
 of a liver complaint. She had been advised to employ 
 so much mercury, that she was literally poisoned, her 
 mouth became completely ulcerated, and the w 7 hole con- 
 stitution Was so much affected, that she lay for some time 
 in a state of insensibility. As she recovered, the sore- 
 ness of the mouth rendered the opening of it painful and 
 difficult; and, as the ulcers healed, so much adhesion and 
 contraction took place at the posterior part of the mouth, 
 that it could scarcely be opened even to admit a tea- 
 spoon; at length, the contraction increased to that degree 
 that she completely lost the power of opening it. On 
 this account, she was under the necessity of receiving 
 nutriment in the form of thick milk, soups, &c. intro- 
 duced into the mouth by a large syringe, the pipe of 
 which, being curved, was passed into the mouth through 
 an opening formed by the loss of one of the molares. In 
 addition to these calamities, the great inflammation which 
 had been excited, caused the mortification of nearly the 
 whole of the alveolar processes of both jaws. On sepa- 
 rating the lips, a most dreadful appearance presented 
 itself, the gums had retired from the teeth, leaving the 
 alveolar processes uncovered, and quite black. I re- 
 moved several teeth which had become loose, and in two 
 or three places exfoliation was beginning to take place. 
 
 The constant discharge of matter made a very frequent 
 syringing of the mouth with tincture of myrrh and water 
 
312 EFFECTS OF MERCURY UPON THE TEETH. 
 
 absolutely necessary, and had she not possessed a most 
 exemplary patience and composure of mind, she must 
 have been completely miserable. 
 
 Some time since a man became a patient in Guy's 
 Hospital, who had been so injudiciously treated in a 
 course of mercury as to cause a complete ulceration of the 
 gums and the inner surface of the cheeks and lips. The 
 consequence of which was, that, as the process of healing 
 advanced, so much adhesion of those parts took place, 
 that the mouth could scarcely be opened. The man 
 could only be relieved from this distressing situation by 
 the dissection of the lips and part of the cheeks from the 
 gums, which was performed by Mr. Cooper, the parts 
 were then preserved from re-uniting by the interposition 
 of lint, until they had perfectly healed. 
 
 During the use of mercury, when the mouth becomes 
 affected, it should be frequently washed with a mild 
 astringent lotion: for this purpose I have usually recom- 
 mended the infusion of roses with a small quantity of 
 alum; and, if the soreness of the mouth be very consider- 
 able, some tincture of myrrh may be added. During the 
 exhibition of mercury, there is usually a considerable 
 deposition of tartar about the teeth; to obviate the ill 
 effects of which, it should always be removed, as soon as 
 the medicine is discontinued; the gum will then soon 
 recover their healthy state, and material injury to the 
 teeth be prevented. [If it were requisite the editor could 
 give the particulars of several very interesting cases of 
 the pernicious effects resulting from an imprudent use of 
 this medicine, but he does not deem it necessary to extend 
 the limits of this work by so doing.] 
 
 Effects similar to those arising from the injudicious use 
 of mercury sometimes attend that dreadful disorder, the 
 small-pox. In the excellent museum of Mr. Heaviside 
 
EFFECTS OF MERCURY UPON THE TEETH. 313 
 
 are several specimens of exfoliations which have been 
 occasioned by the deadly operation of that loathsome 
 pestilence. The preparations which the Figures 4 and 
 5 of Plate XX. represent, have the following statement 
 affixed to them. "This very curious exfoliation is from 
 the under jaw of a little boy about four years old, from 
 matter formed between the gums and the bone, after 
 the small-pox. As soon as it became pretty loose, the 
 whole was carefully removed, which shows itself to be 
 the substance of the lower jaw, with some teeth in it. A 
 small portion of the anterior part of the upper jaw also 
 exfoliated with two of the incisor teeth and two secondary 
 teeth." 
 
 A similar case has for some time past been under the 
 care of Mr. Dorratt, of Bruton Street. A child had the 
 small-pox about Christmas last: soon after the fever had 
 abated, the mother found a tooth upon the child's pillow; 
 other teeth soon afterwards became loose, and dropped 
 out. After this, great swelling of the integuments cover- 
 ing the face and chin, succeeded; this inflammation soon 
 proceeded to suppuration, a great quantity of matter was 
 discharged from the gums, which then began to retire 
 from the jaw bones. 
 
 A large piece of bone, with several teeth, exfoliated 
 from the upper jaw, and another piece from the under 
 jaw; and when Mr. Dorratt gave me the account of the 
 case, he informed me that he expected the exfoliation of 
 another large piece.* 
 
 In page 114 of Part First, I could not refrain from 
 expressing the hope that this scourge of mankind would 
 soon be driven from the world by the mild, but powerful, 
 influence of vaccine inoculation; a triumph for humanity, 
 which might have been achieved in our country as well 
 
 ♦Plate XX. Fig. 6, 7. 
 
314 EFFECTS OF MERCURY UPON THE TEETH. 
 
 as in some of the stales and cities on the continent. It 
 is a lamentable fact, that, in the country that gave birth 
 to this glorious discovery, there should be found persons 
 capable of taking every method to alarm the fears and 
 excite the prejudices of the careful, but uninformed, 
 parent; and who instead of uniting in the benevolent 
 effort to preserve human life, have exulted at every unfa- 
 vourable circumstance; and have taken advantage of 
 those accidents which have resulted from negligence or 
 want of information ; and have unremittingly attempted 
 to destroy the confidence of the public in this most salu- 
 tary gift of Providence. 
 
 But the attempts of these persons have only tended to 
 confirm the success of the practice; for, while by the 
 industrious but malignant attempt to render the small- 
 pox epidemical, by extending its inoculation, the atmos- 
 phere of the metropolis has been for some time past 
 impregnated with the infection, the thousands who have 
 been satisfactorily inoculated with the vaccine have re- 
 mained in perfect health, although surrounded by the 
 most active and virulent contagion. I cannot but express 
 the hope that the legislature will wisely interfere, and, by 
 restricting the inoculation of the small-pox, effectually 
 prevent these gentlemen from indulging themselves in 
 experiments so fatal to the public welfare; but which 
 they openly endeavour to turn to their own private emol- 
 ument. 
 
 This wonderful discovery was announced in the year 
 1798. From our favoured isle, it was soon carried to the 
 other nations of Europe, and to America. In Russia, by 
 the order of the emperor, it has been diffused through his 
 vast empire. From Vienna, it was conveyed through 
 Persia to our possessions in the East, where it was 
 received with enthusiasm, not only by the European 
 
EFFECTS OF MERCURY UPON THE TEETH. 315 
 
 settler, but by the Hindoo, it was regarded as an im- 
 mediate gift from Heaven. Through the exertions of 
 Mr. Ring, whose zeal in this cause must render him esti- 
 mable to every philanthropist, it has been successfully 
 conveyed to our settlements in New Holland, and there is 
 reason to believe that it has been introduced into Africa. 
 
 Thus, like the sun, has this discovery extended its 
 benign and life-preserving influence around the globe. 
 What gratitude to the Almighty ought to possess the 
 mind of him, on whom has been conferred the happiness 
 of communicating so great a blessing to man ! Long may 
 he live, — and may the name of Jenjver ever be revered 
 as one of the great benefactors of the human race! 
 
 [Mercury does not, as many suppose, exercise any 
 direct action upon the teeth. It is only by vitiating the 
 fluids of the mouth, inducing inflammation and sponginess 
 of the gums and the destruction of the alveolar process, 
 that the teeth are prejudicially affected by it. By vitia- 
 ting the juices of the mouth, it increases their corrosive 
 qualities and renders them more hurtful to these organs, 
 and by its effects upon the gums and sockets of the teeth, 
 it often causes them, as stated by the author, to loosen 
 and drop out. 
 
 In the treatment of sponginess of the gums, originating 
 from a mercurial diatheses of the general system, whether 
 accompanied with ulceration or not, it is important that 
 the use of this medicine be first discontinued, as no bene- 
 ficial effect will be obtained during its employment. The 
 mouth should be frequently gargled with some astringent 
 lotion, such, for example, as a decoction of sage and 
 honey, with a little suborate of soda. For correcting the 
 fetor of the breath, a wash of the chloruret of soda, well 
 diluted, to prevent injury to the teeth, will be found very 
 
316 EFFECTS OF MERCURY UPON THE TEETH. 
 
 serviceable. The bowels should, at the same time, be 
 kept open with some gentle aperient. 
 
 Scarification of the gums is recommended by some 
 practitioners, but no advantage will be derived from it 
 during the action of the medicine, and even after it has 
 ceased to act, its effects are much less salutary, than in 
 sponginess of the gums which has been produced by 
 other causes. It may however, sometimes, after the dis- 
 ease has assumed a chronic form, be attended with bene- 
 ficial results. 
 
 Disease in the gums, produced by a mercurial action of 
 the general system, however perfectly it may have sub- 
 sided, increases their susceptibility to morbid impressions. 
 Hence, they are ever after more liable to disease.] 
 
CHAPTER EIGHTEENTH. 
 
 OF THE DISEASES OF THE ANTRUM MAX1LLARE. 
 
 The antrum maxillare is a large sinus or cavity in the 
 superior maxillary bone. It is situated over the molares, 
 and under the orbitar plates: it is lined with a mem- 
 brane, and has communication with the cavity of the nose 
 by a small aperture in that part of the side of the sinus 
 which is membranous, and which is placed between the 
 superior and inferior turbinated bones. 
 
 Inflammation in the antrum is often occasioned by dis- 
 eases of the teeth, but it also occurs when the teeth are 
 quite sound. Sometimes, in examining the prepared 
 bones of the head, one or more fangs of the large molares 
 may be found passing into the cavity. In such a case, 
 inflammation, excited by a diseased tooth would speedily 
 communicate to the membrane lining the cavity, and 
 cause suppuration. [It however more frequently causes 
 an obliteration of the nasal opening, and a consequent 
 engorgement of the cavity.] 
 
 Much mischief usually follows the neglect of an abscess 
 of the antrum. The natural opening from the cavity is 
 usually rendered impervious, hence the matter is obliged 
 to make its exit by an ulceration through one of its sides, 
 which most frequently is that situated under the cheek. 
 It is common to membranes, under inflammation, to 
 become thickened, and as the opening into the nose is 
 41 
 
318 DISEASES OF THE ANTRUM MAXILLARE. 
 
 through a membranous part, it is probable that when in- 
 flammation takes place, it is in consequence of the thicken- 
 ing of this membrane that the opening of the antrum into 
 the nose becomes closed. 
 
 During inflammation in the antrum, the patient at first 
 conceives the pain to proceed from the tooth-ache; but, 
 if the teeth should not be diseased, a more accurate 
 observation is made upon the peculiar sensations excited. 
 The pain usually extends towards the forehead, in the 
 direction of the frontal sinus, and a sensation of tightness 
 and weight, with throbbing, is felt on the side of the face. 
 In a short time, the cheek becomes red, and appears as 
 if swollen; it feels very hard, and, on raising the lip, a 
 considerable fulness above the fangs of the teeth may be 
 observed. 
 
 If the disease be not attended to in this stage, as the 
 matter rarely passes out at that side leading into the nose, 
 an absorption of the bone above the molares takes place, 
 and the matter discharges itself through the gum; but this 
 does not cure the abscess,* the formation of matter still 
 continues, and the ulcerative process goes on, until so 
 great a destruction of the bone is caused as to render the 
 disease incurable. 
 
 This case requires the same kind of treatment as 
 abscesses in general, viz. an outlet to be made for the 
 matter: the best mode of effecting this is by extracting 
 one of the molares, and making a perforation into the 
 antrum, through the socket of one of the fangs. If it 
 should happen that either the first or second molaris be 
 carious, it will be proper to extract it; but, when the 
 teeth are perfectly sound, the second molaris is to be 
 
 [* Abscess, according to the true definition of the term, rarely occurs in the 
 maxillary sinus. Therefore, it is improper to term an altered condition of its secre- 
 tions and engorgement by that name.] 
 
DISEASES OF THE ANTRUM MAXILLARE. 319 
 
 preferred^ as the antrum descends the most at that part, 
 and it is desirable to have the opening in the most de- 
 pending situation. 
 
 When the matter has been discharged, the object must 
 be to restore the parts to their former condition ; with this 
 view, a solution of tincture of myrrh is to be frequently 
 injected, with a syringe, through the opening. As the 
 inilammation subsides, the natural opening usually be- 
 comes pervious, and the injection will pass into the nose: 
 when this opening is restored, the discharge gradually 
 diminishes, the gum may then be suffered to heal over 
 the artificial opening, and a cure is effected. As there is 
 always a disposition in the gum to close over the part 
 from whence a tooth has been extracted, it may be kept 
 open, where the socket has been perforated, by introduc- 
 ing a piece of bougie, which sticking at the upper part of 
 the socket, and hanging just low enough to be taken hold 
 off, may be withdrawn at the time of syringing, and then 
 be again returned. 
 
 [The diseases of this cavity being caused in a large 
 majority of the cases, by irritation produced by diseased 
 teeth, it is seldom necessary to do any thing more than 
 remove the affected teeth and provide an outlet for the 
 escape of the matter by perforating the floor of the sinus 
 through one of the alveoli.] 
 
 If the natural opening into the nose has become per- 
 fectly obliterated, it will be requisite to preserve an arti- 
 ficial one; this may be accomplished by wearing a silver 
 tube in the perforated part, through which the mucus 
 will constantly pass into the mouth, and future accumu- 
 lations be prevented. 
 
 I have met with several cases of disease in the antrum, 
 occasioned by carious stumps, in which a considerable 
 enlargement, with absorption of some of the anterior part 
 
320 DISEASES OF THE ANTRUM MAXILLA RE. 
 
 of the bone had taken place. The extraction of these 
 stumps has been followed by a great discharge of a gla- 
 reous fluid : from the socket the discharge continues for 
 some time, but it gradually diminishes until the part ac- 
 quires a healthy state. 
 
 The antrum is sometimes the seat of formidable dis- 
 eases^ but these cases are not common. That which 
 most frequently occurs is the formation of a polypus, or 
 fungous tumour, within the cavity. The usual progress 
 of this malady is, that the tumour having acquired a cer- 
 tain size, an absorption of the bone is induced by the 
 pressure, this absorption commences in the internal part 
 of the cavity, which is gradually rendered thin, until the 
 whole is completely removed. The alveolar processes 
 and even part of the fangs of the teeth are absorbed, 
 when the remainder of the teeth, becoming loose, irritate 
 the gum, and must be extracted.* The tumour contin- 
 uing to increase, the cheek becomes much enlarged, and, 
 instead of bone or fungous substance, occupies the whole 
 side of the face; at length ulceration takes place in some 
 part, which, as it increases, is attended with so consid- 
 erable a discharge of matter, that the strength of the 
 patient is gradually diminished, and at length the disease 
 terminates fatally. 
 
 The antrum is sometimes most dreadfully affected with 
 cancerous disease. Happily these cases are very rare; 
 the only specimens that I have seen are in the possession 
 of Mr. Heaviside and Mr. Taunton. The histories of 
 these cases are very similar, the patients were both el- 
 derly women; at first they complained of pain in the side 
 of the face, extending up to the forehead and the eye, 
 and back to the ear; these symptoms continued for about 
 four months, when a tumour formed near the ear, from 
 
 * Plate XVII. Fig. 17. 
 
DISEASES OF THE ANTRUM MAXILLARE. 321 
 
 which, shortly afterwards, there was a discharge of a very 
 fetid, dark-coloured fluid. Ulceration then began in the 
 cheek, over the maxillary bone, by which, after great 
 ravages had been committed, their strength was gradu- 
 ally exhausted, until death terminated their sufferings. 
 These cases were about fourteen months in their pro- 
 gress. 
 
 In the patient under Mr. Taunton's care, the disease, 
 which was on the right side, occasioned the absorption of 
 the os maxillare superius, the os palati, the os malae, the 
 os unguis, and the condyloid and coronoid processes of 
 the os maxillare inferius; also there w r as an opening of 
 communication from the orbit to the dura mater by an 
 absorption of part of the os sphenoides and of the os 
 frontis; but the dura mater was not injured. 
 
 In Mr. Heaviside's museum is the scull of a woman 
 who had a disease of the antrum, attended with a very 
 great enlargement : in the course of the disease, an ossifi- 
 cation in the substance of the tumour took place. Mr. 
 Heaviside, w T ho very kindly favoured me with drawings 
 from which the Plate XXI. and Fig. 1, Plate XXII. 
 were engraved, is not in possession of any accurate histo- 
 ry of the case. It occupied, in its progress, about five 
 years. When it had existed about four years, matter 
 began to form under the skin of the face, w T hich, ulcera- 
 ting, was attended with a great discharge, under which 
 the patient finally sunk. 
 
 A few years since I had the opportunity of observing 
 the progress of an antrum case, in a respectable gentle- 
 man, Mr. W. The disease first exhibited itself as a 
 tumour above the molares, occasioning a slight promi- 
 nence of the cheek. By the direction of Mr. Cline, 
 about once a fortnight I made an incision with a lancet 
 into the tumour, which being attended with a considera- 
 
322 DISEASES OF THE ANTRUM MAXILLARE. 
 
 ble hemorrhage, greatly diminished the tension which 
 arose from the fulness of the vessels. 
 
 As the tumour increased, an absorption of the maxil- 
 lary bone took place, together with the fangs of the 
 teeth,* which becoming loose, were extracted. At length 
 the tumour became so enlarged as nearly to fill the mouth, 
 and by its projecting of the cheek, greatly deformed the 
 countenance. By adhering to the occasional use of the 
 lancet, the disease was retarded in its progress for about 
 five years, when ulceration commenced, by the distress- 
 ing effects of which the life of the sufferer w r as termi- 
 nated in a few months. 
 
 Mr. Cooper is in possession of a remarkable case of 
 ossification from both antra: a tumour projected from each 
 antrum, which, by their gradual enlargement, effected 
 such a change in the structure of the orbits, that the eyes 
 considerably projected ; at length the ossification pro- 
 ceeded upwards, and produced so much pressure upon 
 the brain as to be the cause of the death of the patient. 
 
 [The character which the disease assumes is doubt- 
 less always determined by the state of the general sys- 
 tem, but whatever may be the particular tendency of 
 this, it would probably never manifest itself in disease 
 here, were it not for local irritation, and there is no 
 source of irritation to which this cavity is so much 
 exposed as that which arises from an unhealthy condition 
 of the teeth, gums and alveolar processes. Therefore, 
 where a morbid condition of these organs or the parts 
 with which they are connected, are the suspected cause 
 of disease in this cavity, the treatment should be first 
 directed to the mouth. If any of the teeth in the upper 
 jaw beneath the affected sinus are carious, or in any way 
 productive of irritation to the alveolar membranes, they 
 
 * Plate XVII. Fk. 17. 
 
DISEASES OF THE ANTRUM MAXILLARE. 323 
 
 should be removed at once, and such other treatment 
 afterwards instituted as the nature of the case may 
 indicate. 
 
 Disease of this cavity should never be neglected, as it 
 is impossible to determine the character which it may 
 assume, until it has made considerable progress, and 
 involved to some extent, at least, the surrounding struc- 
 tures, when, if it has not taken on a malignant or danger- 
 ous form, its cure will be more difficult and tedious. 
 When taken in the incipient stage, almost every form of 
 disease to which the maxillary sinus is subject, may, in 
 the majority of cases, be easily cured. But there are 
 some which, if permitted to continue until the neighbour- 
 ing parts have become involved, bid defiance to the skill 
 both of the medical and surgical practitioner. 
 
 Inflammation of the pituitary or lining membrane, is 
 the simplest and most common form of disease to which 
 the antrum is liable, and often subsides spontaneously, 
 but when it continues for a long time, it not unfrequently 
 becomes chronic, giving rise to other and often more 
 aggravated affections. Among the most common of these 
 is a purulent condition and accumulation of its fluids, and 
 sometimes ulceration of the lining membrane, caries of its 
 osseous parieties, fungous and other varieties of tumour. 
 
 The symptoms indicative of inflammation of the lining 
 membrane, is often similar to those of some forms of 
 tooth-ache. For the most part, they consist of a fixed 
 and deep-seated pain in the substance of the maxillary 
 bone, under the cheek, extending from the alveolar ridge 
 to the orbit. This is sometimes very severe and lancina- 
 ting; at other times it is dull and heavy. A purulent 
 condition of the secretions of this cavity, is sometimes 
 indicated by the escape of offensive matter from the 
 nostril of the affected side when the patient inclines his 
 
324 DISEASES OF THE ANTRUM MAXILLARE. 
 
 head to the opposite side. Engorgement may generally 
 be suspected from the formation of a soft tumour on 
 the cheek accompanied by a sense of fulness., weight, 
 redness and tumefaction of the integuments covering the 
 antrum. The tumour generally first makes its appearance 
 below the molar bone, this being the point which generally 
 but not always first gives way. 
 
 The symptoms of abscess are very similar to tooth-ache, 
 and ulceration of the lining membrane, is usually accom- 
 panied with constant pain, and when the patient inclines 
 his head to the opposite side, an occasional escape of fetid 
 matter through the nasal opening, which sometimes has 
 flocculi mixed with it. These not unfrequently choke 
 up the natural opening and cause an accumulation of the 
 matter and a consequent distension of the walls of the 
 cavity. If the ulcer be of a fungous nature, the matter 
 will be mixed with blood and of a dark brown or blackish 
 colour. If it be of a cancerous character, the pain will be 
 sharp and lancinating and the matter serous, very offen- 
 sive, and streaked with blood. 
 
 Caries and necrosis may be detected by perforating 
 the cavity and exposing the diseased bone. When it 
 occurs in the alveolar ridge, the gums assume a livid 
 appearance, and separate from the alveoli and slough. 
 Tumours of the maxillary sinus, cannot be prognosticated 
 during their early stage. It is not until after they have 
 attained sufficient size to distend the cheek or depress 
 the roof of the mouth, that their existence can be 
 ascertained. 
 
 But we will not enlarge upon the subject. For a 
 fuller and more detailed description of the diseases of 
 this cavity and their treatment, the reader is referred to 
 Part Third, of the editor's "Principles and Practice of 
 Dental Surgery."] 
 
CHAPTER NINETEENTH. 
 
 OF LUXATION OF THE LOWER JAW. 
 
 When I commenced the present work, I had no inten- 
 tion of introducing this subject, as it was then one upon 
 which I had not had any experience; but, having since 
 had an opportunity of attending a case, I think there is a 
 propriety in making some remarks upon this very disa- 
 greeable accident. The object I have chiefly in view, is 
 to take notice of a mode of reduction, which, although it 
 has been long recommended, is not sufficiently known; 
 but which is much more expeditious, and less painful to 
 the patient than the one commonly adopted. 
 
 The structure of the articulation of the lower jaw, and 
 the nature of its dislocation, have been treated with great 
 minuteness, by several distinguished anatomists. Dr. 
 Monro's excellent dissertation, first inserted in the Edin- 
 burgh Medical Essays, and afterwards published in the 
 complete edition of his works, is not only comprehensive 
 in its anatomical description, but contains the most ac- 
 curate rules for the reduction. 
 
 The condyloid processes of the lower jaw are con- 
 nected with those parts of the temporal bones which are 
 situated just under the beginning of the zygomatic arch, 
 and before the meatus auditorius externus. In this part 
 of each of the temporal bones, there is a cavity adapted 
 for the reception of the condyles, and a tubercle, or 
 42 
 
326 LUXATION OF THE LOWER JAW. 
 
 eminence, which, with the cavity, forms the articulatory 
 surface.* The condyles of the jaw, and the cavities and 
 eminences of the temporal bones, are covered with a 
 smooth cartilage; there is also interposed between the 
 condyles and the temporal bones a cartilage, which is 
 movable, and which contributes greatly to the steadiness 
 of the jaw in all its motions. These parts are united by 
 a ligament, which rises from the circumference of the 
 articulatory surface of the temporal bone, is attached to 
 the edge of the movable cartilage, and then surrounds 
 the condyle of the jaw, and is inserted into the neck of 
 that bone.f 
 
 The structure of this joint is admirably adapted to the 
 necessity which exists for a great variety of motions, 
 combined w r ith strength of action; it is peculiar to the 
 human subject; all animals possess the movable car- 
 tilage, as it is of essential service in diminishing the ef- 
 fects of friction. Graminivorous animals, which require 
 an apparatus suited to the grinding and minutely dividing 
 of their food, possess considerable lateral motion of the 
 jaw, whereby they can move it from side to side, as in 
 chewing the cud; and they reduce their food to an im- 
 palpable mass. For this purpose the articulatory surfaces 
 on the temporal bones are very large, and permit the 
 condyles of the jaw to perform the necessary lateral mo- 
 tion. Carnivorous animals, which only tear or cut their 
 food, and require no grinding, have their jaw confined to 
 the simple hinge-formed joint, and therefore possess only 
 the power of depressing and elevating the jaw. 
 
 Man, being an inhabitant of every clime, is provided 
 with digestive organs suited to every kind of food; the 
 articulation of his jaw, therefore partakes of the structure 
 both of the graminivorous and carnivorous animal : it can 
 
 * Plate XXVI. Fig. 4. fFig.3. 
 
LUXATION OF THE LOWER JAW. 327 
 
 perform lateral motion, and be confined to mere elevation 
 and depression. 
 
 When the mouth is closed, the condyles of the jaw are 
 placed back in the cavities; when the jaw is brought 
 horizontally forwards, the condyles slide forward upon 
 the eminences : this action may be performed by the con- 
 dyles alternately, one being brought forward and the 
 other held back, so that the jaw may be turned from side 
 to side, as in the action of grinding. In opening the 
 mouth, the condyles slide forward upon the eminences; 
 when it is required to open it very wide, the condyles 
 are brought forward to the extremity of the articulatory 
 surface, and rise a little, by passing over the convexity. 
 In all these motions of the jaw, the movable cartilage is 
 of very great service: it is doubly concave, and, by 
 adapting itself to the rounded head of the condyle, and 
 that part of the articulatory surface which forms the emi- 
 nence, it gives steadiness to the jaw in all its motions; 
 without this cartilage, the jaw would have been very 
 liable to accident. As convex surfaces can only touch at 
 one point, the condyles would have been liable to slip 
 back into the cavity, or too much forward and cause a 
 dislocation. 
 
 The motion of the lower jaw is produced by five pairs 
 of muscles; these are, the masseter, temporalis, ptery- 
 goidaeus externus, pterygoidaeus internus, and digastricus. 
 The masseter, temporalis, and pterygoidaeus internus, act 
 in raising the jaw, and in bringing it back. The ptery- 
 goids externi act in bringing the jaw forward; when 
 one only of these muscles acts, a lateral motion is pro- 
 duced, one condyle is brought forward, while the other 
 is kept back; this alternate action of the muscles causes 
 the jaw to be moved from side to side, and produces the 
 
328 LUXATION OF THE LOWER JAW. 
 
 action of grinding. The digastric muscles are employed 
 to depress the jaw. 
 
 The luxation of the jaw is commonly occasioned by an 
 excessive opening of the mouth; as in yawning, or from 
 a spasmodic action of the muscles affecting them at the 
 time of opening the mouth. When the jaw is luxated, it 
 remains wide open, and the patient cannot shut it by any 
 muscular exertion. The nature of this accident will be 
 made very plain, by observing that, when the jaw is lux- 
 ated, the condyles are advanced so much upon the ante- 
 rior part of the eminence, that they quit the proper place 
 of their articulation; the muscles then cannot draw the 
 jaw back on account of the posterior edges of the condy- 
 loid processes being fixed against that part of the emi- 
 nence where it goes to form the zygomatic process.* 
 
 A person, to whom this accident has once happened, 
 is liable to a recurrence, whenever the mouth is opened 
 very widely; a circumstance which renders the caution 
 necessary, of supporting the jaw, in order to prevent too 
 great an extension in yawning, &,c. On this account 
 also, those who have been subject to luxation of the jaw 
 are in danger, if under the necessity of submitting to the 
 extraction of a tooth, as at this time the mouth must be 
 opened widely, and the muscles are then liable to be 
 spasmodically affected. 
 
 The mode of reduction that has been commonly re- 
 commended is, to wrap linen about the two thumbs, which 
 are to be introduced between the posterior molares; the 
 base of the jaw is to be held firmly by the fingers, and 
 the palms of the hands are to be applied to the chin. 
 The extension is made by pressing the jaw down at the 
 posterior part with the thumbs, when also it may be 
 pulled a little forward by the fingers: at this time, if the 
 
 •Plate XXVI. Fig. 2. 
 
LUXATION OF THE LOWER JAW. 329 
 
 muscles appear to yield, the chin is to be raised by 
 pressing it upwards with the palms, when the condyles 
 become disengaged from the zygoma, and they slide 
 backward into their proper situation. 
 
 Dr. Monro observes, "that when the thumbs have not 
 force enough to make this reduction, his friend Dr. 
 Simpson, professor of medicine at St. Andrew's, makes 
 use of a round piece of wood, eight or nine inches long, 
 one end of which is cut into the form of a wedge, to in- 
 troduce it between the teeth of the luxated side, with the 
 thinnest part, as far back as the posterior grinders : w r hen, 
 having the head secured, and raising the chin, he pushes 
 the other end of the wood upwards, to depress the back 
 part of the jaw with the thin end, by which the force is 
 much greater than the thumbs can exert." 
 
 It was in attempting to extract a tooth that I had an 
 opportunity of attending to this accident. Last summer, 
 in passing through Dorchester, I called to see a gentle- 
 man, who, after the customary salutations, informed me 
 there was a lady of his acquaintance who wished to have 
 a tooth extracted, and was at that instant upon the point 
 of going to Weymouth, to consult a dentist from London, 
 who was on a visit there. He immediately introduced 
 me to her. I found that this lady had several times been 
 the subject of luxation of the jaw, and she was in fear lest 
 that accident should again be occasioned by the opera- 
 tion. The tooth she wished to be extracted was one of 
 the dentes sapientiae of the lower jaw. I consented to 
 attempt the operation, but wished that Mr. Arden, the 
 surgeon, who had reduced her jaw two or three times 
 before, should be present. I had scarcely fixed the in- 
 strument upon the tooth, when, by a spasmodic action of 
 the muscles, the jaw slipt forward, and became luxated. 
 Attempts were immediately made, first by Mr. Arden, 
 
330 LUXATION OF THE LOWER JAW. 
 
 and then by myself, to reduce the jaw by the usual 
 method of pressing down the back part of the jaw with 
 the thumbs, and raising the chin w T ith the palms of the 
 hands: but neither of us could succeed, although very 
 considerable efforts were made. I then happened to re- 
 collect a statement once made to me by M. de Chemant, 
 of his having been frequently applied to by a person at 
 Paris, who was subject to this accident, and that he 
 always succeeded in reducing the luxation immediately, 
 by making use of a lever of wood, as recommended by 
 Dr. Monro. I then inquired for a piece of wood, which 
 I could employ in this way, and was so fortunate as to be 
 furnished with a piece of about an inch square, and ten or 
 twelve inches long, which was used as a flat ruler. I 
 introduced this into the mouth, so that the extremity lay 
 upon the under molares, and then, by raising the other 
 end with my hand, the teeth in the upper jaw became 
 the fulcrum. The jaw on that side was then depressed 
 at the posterior part, when the condyle immediately passed 
 over the edge of the eminence. I then applied the lever 
 to the other side of the jaw, and disengaged that in like 
 manner, when the muscles instantly drew the jaw back 
 into its proper situation. 
 
 The quickness with which the reduction was performed, 
 by this means, gave great pleasure, as the lady had 
 sometimes been a very long time before reduction in the 
 common mode could be effected. Once, when at a 
 distance from home, this accident happened to her, and 
 she was nearly two hours submitting to attempts, before 
 reduction could be effected. 
 
 In addition to this case, I have been informed by Mr. 
 Heaviside, that he was lately sent for to reduce a luxation 
 of the jaw, which had occurred to a lady, from merely 
 opening her mouth widely, to have her teeth scaled. 
 
LUXATION OF THE LOWER JAW. 331 
 
 To prevent this accident from happening in the extrac- 
 tion of a tooth ; to persons who have previously been 
 subject to a luxation of the jaw, I have contrived a band- 
 age, which will insure the safety of the patient during the 
 operation. This bandage consists of a piece of leather, 
 formed so as to receive the chin, and a strong cap, that 
 may be placed upon the top of the head, which are con- 
 nected by two straps on each side : it is to be fixed when 
 the mouth is opened to a certain degree, with the condyles 
 as far back as possible : the cap is then to be put on the 
 posterior part of the crown of the head, and the leather 
 being applied to the chin, the straps are to be buckled 
 tight, when it will not be possible, by any effort, to 
 advance the jaw so much as to endanger its luxation, and 
 the tooth may be extracted with safety.* 
 
 * Plate XXVI. Fig. 5. 
 
EXPLANATION OF PLATES 
 
 PART SECOND. 
 
 43 
 
PLATE XVI. 
 
 Figs. 1, 2, 3, 4, 5, 6. Represent the progress of caries. 
 On the side of Fig. 1, is a dark appearance, 
 resembling an opaque spot upon the enamel: 
 in Fig. 2, the caries has produced a cavity: 
 Fig. 3, is the section of a molaris, to show that 
 the caries proceeds to the natural cavity in the 
 tooth: Fig. 4, a molaris with caries in the 
 centre : Fig. 5, the decay much increased : and 
 Fig. 6, the whole of the crown being removed, 
 the fangs only are left. 
 
 Fig. 3 a. The section of a molaris, in which there was 
 a superficial decay; a dark mark is seen extend- 
 ing from the caries to the cavity in the tooth, 
 showing the direction of the death of the bone 
 of the tooth. 
 
 Fig. 4 a. A molaris apparently quite sound; but, on 
 being sawn into, a considerable caries was 
 formed in the body of the tooth. 
 
 Fig. 5 a. The enamel of a molaris which separated from 
 the tooth, in consequence of the bony part 
 being destroyed by caries. 
 
 Fig. 6 a. A stump protruded by the closing of the 
 socket, until it was held only by the gum. 
 
 Fig. 7. The incisores of a child decayed, the points of 
 the fangs ulcerated through the gums. 
 
336 PLATE XVI 
 
 Fig. 8. An exfoliation from the upper jaw, containing 
 
 two incisores and a cuspidatus: the disease was 
 
 caused by the inflammation attendant on the 
 
 decay in the lateral incisor. 
 Fig. 9. An exfoliation from the under jaw, from the 
 
 effects of caries in a molaris. 
 Fig. 10. The effects of an abscess at the point of a 
 
 stump. A considerable portion of the alveolar 
 
 process is absorbed. 
 Fig. 11. The point of a stump with a membranous bag 
 
 attached to it ; in which matter was contained. 
 Fig. 12. Two molares extracted on account of exostosis 
 
 of the fangs. 
 Fig. 13. Examples of exostosis of the fangs in several 
 
 teeth. 
 
Fig. 
 
 1. 
 
 Fig. 
 
 2. 
 
 Fig. 
 
 3. 
 
 PLATE XVII. 
 
 Caries on the sides of the incisores. 
 Represents the teeth with the caries filed out. 
 The appearance of the teeth when denuded of 
 
 the enamel. 
 Fig. 4. A deep notch formed at the necks of the teeth 
 
 by the denuding process. 
 Fig. 5. Two cuspidati, with deep notches, from the 
 
 same cause. 
 Fig. 6. Examples of diseases in the fang, resembling 
 
 spina ventosa. 
 Figs. 7, 8, 9, 10, 11, 12, 13, 14, 15, 16. Diseases of 
 
 the fang, resembling necrosis in bones. 
 Figs. 17, 17. Two molares, the fangs of which were 
 
 absorbed in consequence of a tumour formed 
 
 in the antrum. 
 Fig. 18. A tooth which had been transplanted, the 
 
 fang of which was absorbed in a most cu- 
 rious manner. 
 Fig. 19. Two incisores of the under jaw, the fangs of 
 
 which were absorbed, in consequence of 
 
 disease in the socket. 
 
PLATE XVIII. 
 
 Fig. 1. A central incisor protruded by the closing of 
 the socket at the extremity of the fans;. 
 
 Fig. 2. The two lateral incisores protruded from the 
 same cause. 
 
 Fig. 3. A great separation of the central incisores 
 from an exostosis of the transverse alveolar 
 process. 
 
 Fig. 4. Irregularity of the teeth arising from disease 
 of the sockets. 
 
 Fig. 5. The appearance of the teeth under absorption 
 of the gums and alveolar processes. 
 
 Fig. 6. Absorption of the gums and sockets, leaving 
 the fangs of the teeth uncovered and black. 
 
 Fig. 7. Absorption of the gums and sockets of two 
 teeth in the under jaw. 
 
 Fig. 8. The same disease in the gums and sockets of 
 three teeth in the upper jaw. 
 
 Fig. 9. Two teeth fractured at the points; the frac- 
 ture not having extended into the cavities, 
 the dotted lines show how much may be 
 filed off to make them even. 
 
 Fig. 10. Two teeth fractured by a blow; the cavities 
 in each were exposed, and caused great in- 
 flammation; a points to the cavities. 
 
 Ftg. 11. Two central incisores fractured by a blow; 
 the remainder of the crowns were filed off, 
 and the teeth pivoted to the fangs. 
 
PLATE XIX. 
 
 Fig. 1. Blacky hard tartar, collected about the necks 
 of the teeth. 
 
 Fig. 2. Represents the yellowish coloured tartar, and 
 the teeth much stained. 
 
 Fig. 3. The manner in which the progressive accu- 
 mulation of tartar causes the loss of teeth. 
 
 Figs. 4, 5, 7, 8, 9, 10, 11, 12, 13. Examples of consid- 
 erable accumulation of tartar about different 
 teeth. 
 
 Fig. 6. A piece containing six artificial teeth, about 
 which a most prodigious quantity of tartar 
 was suffered to accumulate, also a larg3 
 mass about the cuspidatus; the whole, when 
 quite dry, weighed three drachms and a 
 half. 
 
 Fig. 14. A large accumulation on the side of the mo- 
 lares. 
 
 Fig. 15. A large quantity collected on the posterior 
 surface of the under incisores. 
 
 Fig. 16. A similar accumulation on the anterior surface 
 of the incisores. 
 
PLATE XX. 
 
 Fiu. 1 An exfoliation of the alveolar processes . : the 
 
 temporary tec::.. g rom a scro- 
 
 fulous disease in the gums. 
 
 Fig. 2. An exfoliation c: r-bone and teeth, in con- 
 
 the exhibition of too much 
 mercury. 
 
 Fig. 3. The greatej part oi the under jaw. which ex- 
 foliated in con- fk lent salivation. 
 
 Figs. 4. 5. Exfoliations oi nearly the whole of the m 
 
 ". and a piece of the uj ei aw. pro- 
 duce., by ;he small-pox. 
 
 Fk..-. •.'■. 7. Exfoliations from the 
 
 cans : sm 
 
 Fig. B. An Los a£ 
 
PLATE XXI. 
 
 The skull of a female who had a disease of the antrum, 
 which produced an ossific tumour, in the possession of 
 John Heaviside, Esq. 
 
 a. The cartilage of the nose unaffected by the 
 disease. 
 bbbbb. The extent of the bony tumour. 
 
 c. The bony matter that filled up the roof of 
 the mouth. 
 ddddddd. Several teeth pushed out of their proper 
 situations; the sockets of which are 
 greatly absorbed. The dark parts on the 
 surface of the tumour are chasms made 
 by the matter under the integuments. 
 
 44 
 
PLATE XXII. 
 
 Fig. 1. The appearance of the face of the person who 
 
 was the subject of the antrum case, described 
 
 in Plate XXI. before any ulceration took 
 
 place. 
 Fig. 1. The profile of the face of a young gentleman 
 
 who had a distorted growth of the upper jaw, 
 
 combined with harelip. 
 Fig. 2. The piece of bone, with three teeth, which was 
 
 sawn off. 
 Fig. 3. The appearance of the face after the operation 
 
 was completed. 
 Fig. 4. Represents the teeth of a Malay Indian, which 
 
 are filed on the anterior surface; the central 
 
 incisores were filed so nearly into the cavities, 
 
 as to be the cause of caries. 
 Fig. 5. Represents the teeth of an Abyssinian Negro, 
 
 filed into a pointed form. 
 Fig. 6. The key instrument, having three places in 
 
 which the claw may be fixed: in this figure, 
 
 the claw is placed beyond the bolster. 
 Fig. 7. The claw is placed in the usual position. 
 Fig. 8. The claw is placed before the bolster. 
 
PLATE XXIII. 
 
 Fig. 1. The key instrument, with the claw beyond the 
 bolster, and fixed as in the extraction of the 
 dens sapientiae in the lower jaw. 
 
 Fig. 2. The key instrument, with the claw before the 
 bolster, and fixed as in the extraction of a 
 bicuspis in the lower jaw. 
 
 Fig. 3. The key instrument, with the claw opposite to 
 the bolster, and fixed as in the extraction of 
 the molares. 
 
 Fig. 4. The key instrument as fixed in the most proper 
 manner. 
 
 Fig. 5. Represents the possible consequence of using 
 too large a claw, or of placing the bolster too 
 low; the tooth is liable to be broken in the 
 direction of the dotted line. 
 
 Fig. 6. Represents the possible consequence of using 
 too small a claw; the tooth is liable to be 
 broken in the direction of the dotted line, 
 across the neck of the tooth, or the claw will 
 be broken in the centre of the curve. 
 
 Fig. 7 The molares of the upper jaw, which were torn 
 away by an improper mode of attempting to 
 extract one which was decayed. 
 
 Fig. 8. A dens sapientiae, with a large piece of jaw- 
 bone, broken away by an unskilful application 
 of the instrument. 
 
 Fig. 9. Represents the manner in which teeth incline 
 towards each other, after an intermediate one 
 has been extracted. 
 
PLATE XXIV 
 
 FORCEPS FOR THE EXTRACTION OF THE TEETH, AS IMPROVED 
 BY THE EDITOR. 
 
 Fig. 1. Straight forceps for the extraction of the su- 
 perior incisores and cuspidati. 
 
 Fig. 2. Forceps for the extraction of the bicuspides 
 and dentes sapiential. 
 
 Fig. 3. Dr. S. P. Hullihen's compound screw-forceps, 
 for the extraction of the roots of the superior 
 incisores and cuspidati. 
 
 Fig. 4. Forceps for the extraction of the dentes sapi- 
 ential of the upper jaw. 
 
PLATE XXV. 
 
 FORCEPS FOR THE EXTRACTION OF THE TEETH, AS IMPROVED 
 BY THE EDITOR. 
 
 Fig. 1. Forceps for the extraction of the inferior mo- 
 lares. They will apply with equal facility to 
 either side of the mouth. 
 
 Fig. 2. Forceps for the extraction of the right superior 
 molares. 
 
 Fig. 3. Forceps for the extraction of the left superior 
 molares. 
 
 Fig. 4. Forceps for the extraction of the roots of teeth 
 and the lower incisores. 
 
PLATE XXVI. 
 
 Fig. 1. The appearance of the jaw-bones when the 
 whole of the alveolar processes have been 
 absorbed. 
 
 Fig. 2. The position of the lower jaw when luxated; the 
 condyloid processes are advanced so much 
 over the articulatory eminence, that it is pre- 
 vented from returning, by resting against the 
 lower part of the zygomatic arch. 
 
 Fig. 3. A section of the temporal bone with the con- 
 dyloid process of the lower jaw, representing 
 the ligament and movable cartilage. 
 
 Fig. 4. A section of the temporal bone and part of the 
 lower jaw, representing the head of the 
 condyloid process in the cavity; the articula- 
 tory eminence, or tubercle, being before the 
 condyle. 
 
 Fig. 5. Represents a mouth opened, and a bandage 
 applied to keep the jaw back, and prevent 
 luxation during the extraction of a tooth. 
 
PLATE XXVII. 
 
 Represents the case of Sarah Dulwich. 
 Fig. 1. The appearance of her face when first admitted 
 
 into Guy's Hospital. 
 Fig. 2. The appearance about two months after her 
 admission, when the tumour began to pro- 
 trude from the mouth, having the surface 
 ulcerated. 
 Figs. 3, 4. The appearance a short time before her de- 
 cease, viewed laterally and in front. 
 * # * The unfortunate sufferer was alive when the former 
 account of her case, as before inserted, was in the 
 press, rendering it impossible in the body of the work 
 to detail all the particulars. The following account is 
 taken from the notes of Mr. Astley Cooper, who pos- 
 sesses the preparation of this most extraordinary dis- 
 ease. 
 
 Sarah Dulwich, set. 13, scrofulous constitution, was 
 admitted into Guy's Hospital on April 8, 1812, with a 
 large tumour under the left cheek, which first made its 
 appearance twelve months previously, in the form of a 
 small tumour of the gum upon the lower jaw, and at that 
 time not painful. 
 
348 PLATL XXVII 
 
 At the time of her admission, the tumour occupied the 
 whole of the left cheek; it was globular; it felt irregular 
 under the integuments; it projected below the jaw, and 
 extended from the cuspidatus of the lower jaw on the 
 right side, irregularly under the tongue, which it had 
 thrust close to the right cheek, and consequently ren- 
 dering speech difficult and indistinct; internally its sur- 
 face was irregular, hard, and unyielding; it was in a 
 superficial state of ulceration from the pressure of the 
 teeth of the upper jaw on the left side. For six months 
 previously from its rising above the teeth of the lower 
 jaw it prevented the approximation of the jaws, the lips 
 remaining an inch and a half or two inches apart. The 
 discharge from the ulcerated surface was sometimes 
 bloody and offensive to the smell. 
 
 Upon viewing the tumour externally it reached from 
 under the edge of the orbit, extending by the side, and 
 pushing up the left nostril, and around to the ear, forming 
 an immense extended tumour even down to the fore part 
 of the chin; it was at least half the size of the head, the 
 skin in some places had a slight blush on it, and here and 
 there the veins were seen of considerable size running 
 over its surface. 
 
 Deglutition was extremely difficult and painful in con- 
 sequence of the pressure of the tumour against the teeth 
 of the upper jaw. 
 
 Half the upper jaw T , together with the teeth, from the 
 pressure of the tumour, were pushed towards the oppo- 
 site side. 
 
 The only cause she can assign for the disease is, that 
 she was subject to constant tooth-ache in the two molar 
 teeth of the lower jaw, for two or three months previous 
 to the appearance of the tumour on the gum. In other 
 respects her health is good. 
 
PLATE XXVII. 349 
 
 The tumour continued increasing in size, and dis- 
 torting the countenance. About two or three months 
 after admission, it began to press forward and to hang 
 out of the mouth, and about this time she began to be 
 troubled with a constant discharge of saliva over the 
 tumour, together with a profuse discharge of fetid bloody 
 matter. 
 
 About five or six months after her admission the tu- 
 mour and lower jaw became extremely painful, and small 
 pieces of the jaw began to exfoliate from under the tu- 
 mour, and from that time to her demise about ten or 
 twelve pieces of bone exfoliated. 
 
 She died in about eleven months after admission. 
 
 DISSECTION. 
 
 The tumour was found to be growing from the inner 
 and left side of the lower jaw. 
 
 It had thrust the tongue backwards and to the right 
 side, so that its apex reached only to the cuspidatus 
 tooth. 
 
 The upper edge of the lower jaw was thrust forwards, 
 and the teeth, instead of being opposed to those of the 
 upper jaw, had their points thrust forwards and out- 
 wards. 
 
 One of the molares on the left side was carried by the 
 tumour in which it was imbedded to the right side under 
 the apex of the tongue. 
 
 On cutting into the disease it was found white in 
 colour, firm, and of a consistence approaching to the 
 nature of cartilage, but not quite so firm; but under this 
 45 
 
350 PLATE XXVII. 
 
 cartilage, and close to the jaw, the basis of the tumour 
 was composed of large masses of bone. 
 
 The periosteum of the jaw covered the tumour. 
 
 This disease was therefore an exostosis of the lower 
 jaw, but its surface remained cartilaginous whilst its basis 
 was composed of bone. 
 
 Astley Cooper. 
 
 October 31, 1813. 
 
Plan 16. 
 
 \ r 
 
 3 
 
 3 a 
 
 fa. 
 
 \jJ 
 
 i !bi 
 
 10. 
 
 13 
 
 *fc- 
 
 ^^y| 
 
 £M % 
 
 P. S. Dwral's Lith, rhicul 
 
Plate, 17. 
 
 70 
 
 16 
 
 ? 
 
 17 
 
 <J 
 
 17 
 
 *. 
 
 Wf» 
 
 
 12. 
 
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PART III. 
 
 ARTIFICIAL TEETH, OBTURATORS AND PALATES. 
 
PART THIRD 
 
 CHAPTER FIRST. 
 
 ARTIFICIAL TEETH. 
 
 [Greater improvements have been made in the con- 
 struction and application of artificial teeth, during the 
 last quarter of a century, than in any other branch of 
 dentistry. Previously to this time, and even down to a 
 much later period, artificial teeth, for the most part, were 
 carved from blocks of ivory and fastened in the mouth by 
 ligatures to the adjoining teeth, or by springs constructed 
 in the awkwardest and most bungling manner. It is 
 true, the invention of porcelain teeth, had, at a much 
 earlier date been made, but their manufacture had not 
 been brought to a sufficient degree of perfection, to ren- 
 der them at all desirable as substitutes for the loss of the 
 natural organs. Some idea may be formed of the state 
 of this department of practice, at the time of the publi- 
 cation of this work, by the remarks of the author upon 
 the subject, which the editor, in order to preserve the 
 whole of the original work, will give entire. 
 
354 ARTIFICIAL TEETH. 
 
 He says] "upon this subject, 1 cannot attempt to do 
 more than give a very general statement, it being impos- 
 sible to teach a mechanical art, in any other way than by 
 manual practice. 
 
 The inconvenience which attends the loss of teeth, in 
 respect to enunciation, as well as mastication, renders the 
 introduction of some substitute very desirable. For this 
 purpose artificial teeth are invented, which not only 
 remedy the effects above-mentioned, but also preserve 
 the symmetry of the mouth. 
 
 Artificial teeth are most commonly formed from the 
 tooth of the hippopotamus, which is the most dense os- 
 seous substance with which we are acquainted. Of late 
 years, they have also been made of a porcelain compo- 
 sition, which has been introduced by M. de Chemant: 
 this gentleman's invention merits much commendation, 
 as it affords a more durable substance for those, who, 
 from acidity, or some peculiar property in the fluids of 
 the mouth, destroy artificial teeth, made of osseous sub- 
 stances. However, these teeth do not sufficiently re- 
 semble nature, and considerable allowance must be given 
 to the statements of an author disposed to regard his own 
 invention as meriting a decided preference. 
 
 The manufacture of artificial teeth require a profi- 
 ciency in mechanical art which can only be acquired by 
 much patient labour, and it is the exactness with which 
 they are adapted to the mouth, and the ease with which 
 they can be worn, that constitute their chief excellence. 
 In order to be able to prepare an artificial tooth, a model 
 of the space to be filled up must be taken in wax; from 
 which a cast in plaster of Paris may be made. The 
 impression of the mouth in the wax being the reverse, 
 will cause the plaster of Paris to acquire the exact repre- 
 sentation of the person's mouth. Having thus obtained a 
 
ARTIFICIAL TEETH. 355 
 
 model, the substance designed to be the artificial tooth 
 must be fitted with great nicety, and be so formed as to 
 correspond with the other teeth. The same general di- 
 rections apply to the formation of more teeth than one, 
 and so even to a complete set. 
 
 Artificial teeth are made secure by fastening them to 
 the adjoining teeth by ligatures of silk, Indian weed, 
 commonly called silk-worm gut, or fine gold wire. If 
 the teeth are made to fit very correctly, a slight fasten- 
 ing will be sufficient; and, in all cases, persons should 
 avoid tying ligatures very tightly, as then they are very 
 liable to create pain, and do mischief. In other instances, 
 they are fastened by means of gold springs. 
 
 The foregoing remarks apply only to those cases in 
 which the teeth have been extracted, or being loose, 
 have dropped out: but, when teeth are lost by caries, 
 another mode of inserting artificial teeth is adopted. 
 
 The incisores and cuspidati of the upper jaw are very 
 frequently affected with caries, and the crowns of the 
 teeth decay, so as to leave little more than the fangs in 
 the sockets. When the teeth are in this situation, if 
 there be no disease in the socket, new teeth may be fixed 
 to the fangs of the decayed ones, without any attachment 
 to the other teeth being required. This operation is to 
 be performed as follows: All the ragged or carious re- 
 mains of the crown of the tooth are to be filed away 
 close to the gum; the hole in the fang, which forms the 
 natural cavity, is then to be prepared for receiving the 
 pivot, by which the new tooth is to be fastened ; this is 
 done by passing a small instrument, called a broach, into 
 the cavity, and drilling it into a smooth round hole. — 
 The fang being thus prepared, the crown of a human 
 tooth, corresponding with the one that has been filed off, 
 is to be fitted to .he fang, a hole is then to be drilled, 
 
3dG artificial teeth 
 
 and a piece of gold wire screwed firmly into it; the wire 
 being left of a length equal to the hole in the fang, and 
 filed to the exact size, is to be introduced, and, being 
 made tight, it may continue for many years without occa- 
 sioning any trouble, or requiring any repair. In this 
 mode, several teeth belonging to the same person may 
 be replaced, which cannot be discerned upon the most 
 minute inspection. 
 
 Much prejudice has been excited, without foundation, 
 against the use of human teeth, in the manner as above 
 described, on account of various alarming symptoms hav- 
 ing attended the former practice of transplanting. No 
 person can be a greater enemy to that operation than 
 myself, but there is a most essential difference between 
 the two modes of practice; for, in that which is recom- 
 mended, we only use a piece of tooth, which may be 
 considered precisely in the same condition as any com- 
 mon piece of bone. No tooth formed by art can be 
 compared to a natural tooth, fixed in this manner; as 
 artificial teeth must differ, in some degree, from human 
 teeth, both in colour and form. 
 
 Natural teeth connected to a plate of gold, or a base 
 made of the tooth of the hippopotamus, may be fixed in 
 the same manner as artificial teeth. This is a very neat 
 mode of supplying the loss of teeth, and cannot be de- 
 tected, by any difference in their colour or form, from the 
 natural set. 
 
 It was Mr. Hunter who introduced and recommended 
 the practice of transplanting teeth; and, under his imme- 
 diate inspection, it was carried on to a great extent. In 
 his treatise on the diseases of the teeth, he goes into the 
 subject at great length, and he admits it to be a difficult, 
 uncertain, and often an unsuccessful operation. 
 
 In the course of the practice many very disagreeable 
 
ARTIFICIAL TEETH. 357 
 
 and alarming symptoms attended some of the cases. In 
 a later work, Mr. Hunter endeavoured to diminish the 
 disrepute into which a practice had fallen that he was 
 naturally partial to, from its being of his own inven- 
 tion, by accounting for all the symptoms which occurred, 
 on the principal of irritation exciting deranged sympa- 
 thies. That the mere irritation of a foreign body, as the 
 tooth of one person inserted into the alveolus of another, 
 will occasion many extraordinary sympathies, independent 
 of any infection, may readily be conceived. I have been 
 informed by Dr. Jenner of a person who had blotches on 
 the skin, from the irritation which followed the replacing 
 of a tooth into the same socket from which it had been 
 extracted. 
 
 However, the ill success and unfortunate consequences 
 that sometimes occurred, have caused the practice to be 
 abandoned for many years past. The other modes of 
 supplying the loss of teeth are so unexceptionable, and 
 invariably successful, that we have no reason to regret 
 the failure of the practice of transplanting. I might 
 indeed have observed, that this operation involved in it a 
 defect of the moral principle, as one person is injured 
 and disfigured, in orde'r to contribute to the luxury and 
 convenience of another. 
 
 In Plate XVII. Fig. 18, is the representation of a 
 transplanted tooth, which was worn by a gentleman 
 eleven years; it had never been quite fast, but, during 
 the last two or three years, it had become very loose, at 
 length the crown broke off, and left the fang in the gum : 
 on extracting it I found it to have been absorbed all 
 around in the most curious manner, and contrary to the 
 common mode in which the absorbents act upon the 
 fangs of teeth, which is to begin at the point, and extend 
 towards the neck. In this way the absorbents, as if con- 
 46 
 
358 ARTIFICIAL TEETH. 
 
 scious that this tooth was an intruder, exerted their 
 utmost power to eat it out, rather than permit its con- 
 tinuance." 
 
 [The materials used for and the manner of applying 
 artificial teeth at the time this work was written, were, 
 for many reasons, exceedingly objectionable. To be both 
 serviceable and desirable, they should not only be ap- 
 plied in such a manner as not to exert an unhealthy 
 influence upon the parts on which they rest, or be, in 
 any w r ay, productive of injury to the remaining natural 
 teeth, if there be any, but they should also correspond in 
 shape and appearance with those which they replace, 
 and be incapable of being acted upon by the fluids of 
 the mouth, whether in a healthy or diseased condition. 
 When badly applied or of an improper material, they are 
 not only both an annoyance and nuisance, but are pro- 
 ductive of vastly more injury than benefit, and notwith- 
 standing the high comparative state of perfection to which 
 this department of the art has been brought, and is at 
 present practiced by a few, nineteen-twentieths of the 
 artificial teeth worn, are of this description, or at least, 
 so far as it regards the manner of their application. 
 
 The demand for artificial teeth has become so general, 
 since the improved manner of their construction and ap- 
 plication, has so fully established their utility, that every 
 one having the most meagre pretensions to a knowledge 
 of dentistry, is now called upon for them, when, in reality, 
 not more than one in twenty possesses either the judg- 
 ment or skill, never having been properly instructed in 
 the art, to construct or execute, in a proper manner, a 
 piece of dental mechanism. Neither mechanical ability 
 to execute nor a judgment sufficiently enlightened to 
 design the plan most proper for the construction and 
 application of artificial teeth in the various cases which 
 
ARTIFICIAL TEETH. 359 
 
 are constantly presenting themselves, separately, consti- 
 tutes the qualifications requisite for a practitioner in this 
 department. Both should unite in the same person, and 
 in addition to which, a correct knowledge of the reme- 
 dial indications of the various morbid conditions of the 
 several parts and structures of the mouth, is indispensa- 
 ble; for, it is never strictly proper, to apply artificial 
 teeth when the remaining teeth, gums, or alveolar pro- 
 cesses are in a diseased condition. 
 
 And as indispensable as are these various branches of 
 knowledge even to a mechanical dentist, there are hun- 
 dreds of practitioners in the country, who have made but 
 little, if any proficiency in either; and it is to the very 
 limited professional acquirements of most of those en- 
 gaged in the exercise of the duties of the art, that so few 
 of the artificial teeth worn even at the present day, are 
 not only worth nothing at all, but a source of constant 
 annoyance and actual injury to those who wear them. 
 
 Of the various materials which have been employed 
 for artificial teeth, the porcelain is almost the only sort, at 
 present, used. The perfection in w T hich these have been 
 manufactured during the last ten years, and especially in 
 the United States, has secured for them a decided pre- 
 ference over every other description of artificial teeth. 
 They are now made to resemble so closely the natural 
 organs, as to render their detection when placed in the 
 mouth, exceedingly difficult. But resemblance to the 
 natural teeth, is not their only merit. Unlike all osseous 
 substances, they never change in colour, or not mate- 
 rially, nor are they liable to be acted upon by the secre- 
 tions of the mouth. They can also be more neatly and 
 firmly secured in the mouth than any other dental sub- 
 stitute. 
 
 Although there are many dentists engaged in the manu- 
 
360 ARTIFICIAL TEETH. 
 
 facture of porcelain teeth, it does not necessarily consti- 
 tute any part of his duties. It is a distinct business, and 
 it is one which has been carried on for the last ten or 
 twelve years, in the United States, very extensively. 
 During this period, one establishment, the editor has 
 been informed, has sold annually, from ten to twenty-five 
 thousand dollars worth. 
 
 So much more highly esteemed are the American por- 
 celain teeth than the European, that they are now exten- 
 sively used both in Great Britain and France, as well as 
 in other foreign countries. It is but just, however, to 
 say, that these teeth so far as it regards shape and resem- 
 blance to the natural organs, are at present manufactured 
 in very great perfection in London. The editor has seen 
 some very beautiful specimens manufactured by Mr. Ash, 
 of that city. 
 
 The porcelain teeth manufactured in France, although 
 very strong, and seldom break under the blow-pipe, ap- 
 proach less nearly in resemblance, so far as the editor has 
 had an opportunity of examining them, to the natural teeth, 
 than do those of either England or America, consequently 
 they are not employed as much at present as formerly. 
 
 Teeth constructed from the ivory of the tusk either of 
 the hippopotamus or elephant, are, at present, but little 
 used, and it is a matter of astonishment that they should 
 ever have been employed, to the extent they once were, 
 for certainly they are more objectionable than any other 
 description of artificial teeth ever worn, except those 
 made from common bone. In the first place, they read- 
 ily absorb the fluids of the mouth, and in consequence, 
 in a very short time, exhale an exceedingly fetid odour, 
 contaminating the breath, and rendering the air expired 
 not only offensive to those who wear them, but also to 
 others. In the second place, they are less durable than 
 
ARTIFICIAL TEETH. 361 
 
 other kinds of artificial teeth, being in the majority of 
 cases, soon decomposed by the fluids of the mouth, which 
 they vitiate and render unfit for the purposes for which 
 they are designed. In the third and last place, they bear 
 but a very slight resemblance to the natural teeth, assum- 
 ing in a short time a blue or yellowish appearance, and 
 eventually they become almost black. 
 
 But notwithstanding the foregoing objections, these 
 were for many centuries almost the only kind of artificial 
 teeth used. In fact, twenty-five years ago, they were 
 more frequently inserted than any other, and there are 
 some dentists, even at present, who use them. 
 
 Of the two descriptions of ivory, that of the teeth of the 
 hippopotamus is preferable, and in the construction of 
 artificial teeth from this, the enamel, after filing off the 
 outer rough surface, is, when practicable, usually left, and 
 the teeth cut out in such a way as that it shall cover their 
 front or labial surfaces. 
 
 But, for a number of years, previously to the intro- 
 duction of porcelain teeth in general use, the crowns of 
 human teeth, were much employed, and next to these, 
 they are altogether and by far preferable, to any other, as 
 artificial substitutes for the living organs. When prop- 
 erly and accurately applied, their detection is rendered 
 almost impossible. They are, however, liable to decay, 
 and a portion of their bony structure being necessarily 
 exposed to the action of the fluids of the mouth, they 
 generally, after one or two years, assume a dark brown 
 appearance. 
 
 The manner in which they are usually procured is 
 from individuals who supply dissection rooms of medical 
 colleges with subjects, and the demand for them among 
 dentists, was so great, that it was difficult to supply it, 
 although the most exorbitant price was offered for them. 
 
362 ARTIFICIAL TEETH. 
 
 The teeth of various animals have been used for arti- 
 ficial teeth, but those which have been found to answer 
 the best purpose, are those of neat cattle. They are 
 usually procured from slaughter yards, and from beeves 
 of from seven to nine years old, after the pulp cavities of 
 their teeth have become nearly filled with bony matter. 
 By filing the lateral and posterior surfaces of these teeth, 
 they may be made to resemble very nearly in shape, the 
 human incisores, and when used as substitutes for them, 
 oftentimes last for several years. They are only suitable, 
 however, for engrafting to the natural roots, though they 
 have often been attached to plate and secured in the 
 mouth to the adjoining teeth by means of clasps. They 
 are usually much whiter than human teeth, and have 
 apparently a smoother and more glossy surface, which 
 renders their detection, when used as substitutes for 
 these, almost certain, even by the most casual observer. 
 They are, however, preferable to artificial teeth made of 
 ivory, though by no means equal to human teeth, and 
 since the manufacture of the porcelain teeth has been 
 brought to its present comparative perfection, they are 
 seldom, if at all used. 
 
 It will be perceived from the forgoing remarks con- 
 cerning the relative merits of the various kinds of arti- 
 ficial teeth, that the porcelain is preferable to any which 
 have ever been employed. Having said thus much upon 
 this branch of the subject, it will be proper to offer a few- 
 observations on the different methods of applying dental 
 substitutes. 
 
 In the insertion of artificial teeth, it frequently becomes 
 necessary to adopt different methods, in different cases, in 
 order to meet the peculiarities of each. A method which 
 is applicable, and would be most proper in one, often- 
 times is not in another. But different methods have been 
 
ARTIFICIAL TEETH. 363 
 
 adopted in the same description of cases, and where one 
 is far preferable to any other. The advantages and dis- 
 advantages of each will be noticed in the proper place. 
 
 The pivoting method of inserting artificial teeth, under 
 certain circumstances, is the best that has ever been 
 adopted, and under all others, is one of the worst. 
 It consists in placing an artificial crown upon a natural 
 root, made fast by means of a pivot or tenon fixed to the 
 former and introduced into the latter; which, when it is 
 in a healthy living condition, will oftentimes remain firmly 
 and securely in its place, from five to twenty years. But 
 from the simplicity of the operation, and the ease with 
 which it can be performed, it has been greatly abused, 
 having been practiced under all circumstances; and hence, 
 the worst and most lamentable consequences have fre- 
 quently resulted from it. Not only should the root be 
 possessed of vitality and free from disease, but the parts 
 also which surround it, should be in a healthy condition. 
 Under any other circumstances, the application of an 
 artificial tooth upon this principle, is not only unscientific 
 and improper, but is always, to a greater or less extent, 
 productive of bad effects. There are some cases, it is 
 true, where these, to some extent, may be counteracted, 
 and where, from some very peculiar necessity, a dentist 
 may be justifiable in inserting an artificial crown upon the 
 root of a tooth partially deprived of its vitality, provided 
 the contiguous parts are in a healthy state. But under 
 no circumstances, when these are diseased, should the 
 operation be performed. 
 
 Thus, it will be perceived, that the pivoting method of 
 inserting artificial teeth is applicable only in the fewest 
 number of cases which require such substitutes. JYor is 
 it applicable under any circumstance for the replacement 
 of the molar or bicuspid teeth, and very seldom for that 
 
364 ARTIFICIAL TEETH. 
 
 of the inferior incisores and cuspidati. As a general 
 rule, the roots of the superior incisores and cuspidati are 
 the only ones capable of affording a firm and secure sup- 
 port to artificial teeth. 
 
 The next method, which the editor proposes to notice, 
 consists in the application of artificial teeth on plates se- 
 cured in the mouth, to one or more of the remaining teeth, 
 by means of clasps. This method is applicable to a much 
 greater variety of cases, and in the replacement of the 
 bicuspides, the first and even second molares, as well as 
 the incisores and cuspidati, when there are not healthy 
 sound roots to engraft these last to, if the second or even 
 third molares are free from disease, and firmly articulated, 
 it is the best and most proper method that can be adopted. 
 It has this advantage too, over all others, in supplying the 
 loss of part of the teeth in either jaw; the teeth may be 
 removed by the patient and cleansed, as often as necessary, 
 and replaced with perfect ease and without the slightest 
 difficulty. This should always be done two or three times 
 every day, and the teeth left out every night, to prevent 
 the secretions of the mouth from remaining between the 
 plate and the parts on which it rests until they become 
 vitiated, and from between the clasps and the teeth round 
 which they pass, until they become acidulated and cause 
 the decay of the latter, which they will do, if this pre- 
 caution be neglected. 
 
 Artificial teeth applied upon this principle, if done cor- 
 rectly, may be worn as long as the teeth lasts, to which 
 they are attached, and they are useful in the division 
 and mastication of food, in proportion to the number in 
 immediate contact with each other. But this description 
 of dental mechanism, to subserve the purposes just men- 
 tioned, as well as all others for which such apparatus is 
 designed, and can be made capable of doing, should be 
 
ARTIFICIAL TEETH. 365 
 
 neat in its execution, perfect in its adaptation to the sub- 
 jacent parts and the teeth to which it is attached, and 
 be sufficiently strong to prevent the liability of injury 
 from the force to be exerted upon it by the antagonizing 
 teeth. The plate should be three-fourths of an inch in 
 width, and sufficiently thick to give to it the necessary 
 strength; the clasps should be as wide as the length of 
 the teeth to which they are applied will admit of their 
 being made, and about one-third or half thicker than the 
 plate. They should both be made of gold, the former of 
 from twenty to twenty-two carots fine, and the latter of 
 from eighteen to nineteen. Gold less pure than the 
 above-mentioned, should never be used for any purposes 
 in the mouth, as it is liable to oxydize and turn dark. 
 Silver is often used by a certain class of practitioners, but 
 it is objectionable for the reason just stated. 
 
 The application of artificial teeth with spiral springs, is 
 never called for, except, for supplying the loss of all, or 
 the greater part of the teeth in both jaws, and when no 
 other method for their retention in the mouth can be 
 adopted. The springs being attached on each side to 
 each piece, work with the jaws and hold both, when of 
 sufficient strength and fixed in the proper manner and at 
 the right points, firmly and securely in their place. 
 
 The lower plate should be fully double the thickness 
 of the upper, and both should be accurately adapted to 
 all the inequalities of the parts on which they are to rest, 
 so as not to be productive of the least irritation. The 
 teeth should be so antagonized that all shall come to- 
 gether, when the mouth is closed, at the same instant. 
 
 The difficulty which so frequently attends the insertion 
 
 of double sets of teeth, or teeth applied with spiral 
 
 springs, results from the thinness and want of correct 
 
 adaptation of the plates, and the improper manner in 
 
 17 
 
366 ARTIFICIAL TEETH. 
 
 which the teeth are antagonized. Much judgment and 
 mechanical skill is required to design and construct in a 
 proper manner, a double set of artificial teeth, but when 
 put up in this manner, they may be worn with ease, and 
 in most instances, will subserve to a considerable extent, 
 the purposes of the natural teeth. 
 
 But, it is not always necessary in the application of a 
 double set of artificial teeth to have recourse to spiral 
 springs for their retention in the mouth. Under favour- 
 able circumstances, they may be confined in the mouth 
 by the pressure of the atmosphere and capillary attrac- 
 tion, and when the springs can be dispensed with, it is 
 always better that they should be. The editor has suc- 
 ceeded, in applying them without springs, during the last 
 two or three years, in a number of cases. When they 
 can be made to adhere sufficiently tight, without springs, 
 they are worn with much more comfort and satisfaction 
 by the patient, and the want of success which has so fre- 
 quently resulted from attempts to apply them upon this 
 principle, has been owing to the w r ant of perfect adap- 
 tation of the plates to the parts which they cover. 
 This is indispensable, and in order to which the wax 
 impressions of the alveolar ridges must be perfectly true 
 and correct. 
 
 It is much easier to apply a dental substitute to the 
 upper than to the lower jaw upon this principle, as the 
 upper usually presents a much smoother and more prom- 
 inent ridge. It is also much easier to obtain a correct 
 impression of the upper than of the lower jaw, and be- 
 sides, a wider plate, for the atmosphere to act upon, can 
 be employed, which is a matter of no small momenf in 
 applying teeth upon this principle — yet it is not neces- 
 sary to have the plate in any case more than an inch and 
 an eighth or an inch and a quarter in width, for in pro- 
 
ARTIFICIAL TEETH. 367 
 
 portion as it is wider than this, the greater will be the 
 difficulty of obtaining a perfect fit. A plate of the width 
 just mentioned presents a sufficient amount of surface for 
 the atmosphere to act upon, and if one wider than this 
 be employed, there will, in nine cases out of ten, be some 
 places on the back part of the ridge or palatine arch to 
 which it will not be closely fitted, and where the air will 
 be admitted and weaken the attachment of the whole. 
 For a long time, the editor was unable to discover the 
 cause of the difficulty he sometimes met with in the ap- 
 plication of teeth upon the suction or atmospheric pres- 
 sure principle, and it was only by accident that he at last 
 did do it. Since which time he has employed narrower 
 plates, and his success has been more uniform and perfect. 
 
 As the lower plate can never be very wide, in conse- 
 quence of the narrowness of the jnferior alveolar ridge, it 
 should be extended, when it is designed to apply one 
 upon this principle, as far back, on each side, as possible. 
 They should be made to reach up, a short distance, on the 
 coronoid processes. It was for a long time thought im- 
 possible, to apply a lower plate upon this principle, but 
 the editor has demonstrated its practicability in a number 
 of cases, and now he adopts in all, where the circum- 
 stances are at all favourable, and he has succeeded in 
 some, where, from the great irritability of the integu- 
 ments covering the alveolar ridge, the individuals were 
 unable to bear the pressure of spiral springs. But for a 
 fuller exposition of the merits of this principle, in the 
 application of artificial teeth, the reader is referred to his 
 Principles and Practice of Dental Surgery. He would, 
 however, remark, before he dismisses this part of the 
 subject, that it is seldom applicable except for a full 
 upper or under set. 
 
 The next method which he will notice, is one which 
 
368 ARTIFICIAL TEETH 
 
 was much in vogue during the period of the professional 
 career of the author, and although it is now never adopted 
 by scientific practitioners, it may nevertheless be proper 
 to notice it. It consists in fastening artificial teeth in the 
 mouth by ligatures, of silk or sea grass, or with gold or 
 silver wire to the adjoining natural teeth. This affords 
 not only a weak and insecure support, but it is productive 
 of injury to the teeth to which the ligatures are attached. 
 It often pulls them from their sockets, or rather by the 
 continual pressure which they exert upon the teeth, they 
 cause the destruction of the sockets and a gradual loosen- 
 ing and ultimate loss of the teeth. But this is not the 
 only effect which results from fastening teeth in the mouth 
 by this means. They afford a lodgement for extraneous 
 matter around the teeth to which they are attached, 
 which, by being retained there, soon cause them to decay. 
 Teeth too, inserted in this way, not being easily removed 
 by the patient, are often retained in the mouth for weeks 
 and months, without being taken out and cleansed, im- 
 parting to the breath, the most disagreeable fetor, and so 
 vitiate the fluids of the mouth as to render them unfit to 
 be taken into the stomach. Fortunately, however, this 
 method of inserting artificial teeth, is seldom resorted to 
 at the present day. 
 
 That barbarous practice of transplanting a tooth from 
 the mouth of one person into the socket of that of 
 another, as practiced by that celebrated French Surgeon 
 Ambrose Pare and recommended by John Hunter, is 
 very justly condemned by the author. It rarely suc- 
 ceeded even under the most favourable circumstances, 
 and was oftentimes instrumental in communicating to the 
 patient disease, which in some instances proved fatal. 
 A case of this sort given by Dr. Watson, is contained in 
 "The Medical Transactions of the College of Physicians" 
 
ARTIFICIAL TEETH. 369 
 
 and copied by the editor in his Principles and Practice oi* 
 Dental Surgery. But it is unnecessary to say more con- 
 cerning this method of inserting artificial teeth, opposed 
 as it is, both to the laws of the animal economy and to 
 common sense. Happily, it is now never practiced. 
 
 In conclusion, it may be proper to say a few words 
 concerning the condition of the mouth at the time of the 
 application of artificial teeth, and especially as this is a 
 matter which has been too little regarded by the majority 
 of dental practitioners. Hence, in many instances, the 
 bad effects which so frequently result from their insertion. 
 
 Every part of the njputh should be in a perfectly 
 healthy condition at the time of their application, to 
 ensure the advantages capable of being derived from 
 them. If the gums are swollen or inflamed, or there be 
 dead, loose or decayed teeth, or tartar, or any other ex- 
 traneous matter on the remaining organs in the mouth, 
 such preparatory treatment should be first instituted as may 
 be necessary to their restoration, else, the morbid action 
 already existing in the parts, will be aggravated by the 
 presence of any substitute for teeth, which have been lost, 
 that can be applied, however perfect, may be its con- 
 struction. For the completion of the changes in the 
 alveolar ridge, which follows the loss of any of the teeth, 
 from three to nine months are oftentimes required. If 
 artificial teeth be inserted before these have taken place, 
 the plate to which they are fixed, will lose its adaptation 
 to the gums, press upon them unequally, and in conse- 
 quence of which, be a constant source of irritation. 
 
 To obviate the difficulty and inconvenience which 
 some persons experience from the loss of the natural 
 teeth, a temporary substitute may be applied and worn 
 when absolutely necessary, until a permanent one can be 
 inserted. The material, however, employed for this, 
 should be as pure and incorruptible as that for the other. 
 
CHAPTER SECOND. 
 
 OF THE MANNER OF INSERTING A PIVOT TOOTH. 
 
 As it regards the mere manipulations, the insertion of 
 a pivot tooth, ordinarily, is one erf the simplest and most 
 easily performed operations in dental surgery. But cases 
 are, nevertheless, occasionally met with, presenting diffi- 
 culties which require all the judgment, tact and skill, of 
 the operator, to overcome. For example, when the root 
 has an oblique position in the jaw, or is situated behind 
 the circle of the teeth, so as to render it necessary, in 
 order to the proper position of the artificial crown to be 
 placed upon it, to employ a crooked pivot, or a plate with 
 a pivot or tenon and plate tooth. In either of the above 
 cases, much difficulty is oftentimes experienced in the 
 proper adjustment and insertion of the artificial tooth. 
 But the manner of overcoming the peculiar difficulties 
 presented by each, will be presently described. When 
 the root of the tooth does not deviate from a vertical 
 direction in the jaw, requiring merely a straight pivot, 
 the only skill called for in the insertion of the tooth, is, to 
 fit it accurately to the fang, except in those cases where 
 the pivot hole in one is not in exact opposition to that in 
 the other, or when one of the adjoining teeth impinges 
 on the vacuity occasioned by the loss of the one which is 
 to be replaced. The first of the last-mentioned difficul- 
 ties can usually be overcome by the selection of a suitable 
 
MANNER OF PREPARING THE ROOT. 371 
 
 toothy and the last may be obviated by filing off a portion 
 of the side of the tooth that impinges upon the aperture, 
 or even by grinding the artificial crown. 
 
 MANNER OF PREPARING THE ROOT. 
 
 In the majority of the cases in which it is proper to 
 adopt the pivoting method for the insertion of an artificial 
 tooth ; a portion of the crown of the natural tooth that is 
 to be replaced^ is still remaining; so that the first step to 
 be taken in the operation; is ; its removal. This is done 
 by some practitioners; at once ; with a pair of strong ex- 
 cising forceps; while others prefer cutting it partly off; 
 with a file; and afterwards completing the operation with 
 that instrument. By the first method the root is often- 
 times fractured and so much injured as to render it unfit 
 to sustain a tooth; and even when this does not happen, 
 the concussion is frequently so great as to induce violent 
 inflammation in the alveolo-dental membranes; which not 
 unfrequently terminates in suppuration and necrosis of the 
 socket of the tooth. By the second method; such effects 
 are rarely produced; and on which account, it is preferable 
 to the other. 
 
 The process of filing should be commenced with a 
 safe-sided separating file; which should be passed be- 
 tween the tooth to be removed and one of the adjoining 
 ones; the smooth side of the file towards the latter; nearly 
 up to the apex of the gum ; where the upper edge of it 
 should be turned to the pulp cavity; and the operation 
 continued until it has nearly reached it. The other side 
 of the tooth should next be filed in the same manner, and 
 then a deep horizontal notch filed across its front surface, 
 when it should be suddenly snapped off with a pair of 
 excising forceps. The crown of the tooth should never ; 
 
372 MANNER OF PREPARING THE ROOT. 
 
 when the nerve is alive, be entirely cut off with a file, as 
 the pain which would be produced by the contact of the 
 instrument with the lining membrane and pulp, would be 
 too protracted to be endured by the patient. 
 
 After the removal of the crown of one tooth, if there 
 be another to be taken off, the operation for the removal 
 of the second will be greatly facilitated by the increase of 
 room, gained; for the movement of the file, and besides, 
 an oval or half round file may be employed instead of 
 a flat one, which is not so liable to become choked up and 
 stick in the tooth. 
 
 Having proceeded thus far with the operation, the next 
 thing to be done, is the destruction of the nerve. This 
 is effected by most French, as well as by some English 
 and American practitioners, by passing a fine iron or 
 steel wire, heated until it is white, suddenly up the canal 
 of the root. The destruction of the nerve by this means, 
 is exceedingly painful, several applications of the heated 
 wire often being necessary, and besides, it is very apt to 
 excite inflammation in the surrounding parts, and in some 
 instances has been known to produce very alarming con- 
 sequences. But notwithstanding, it is strongly recom- 
 mended and advocated as preferable to any other method 
 by many very respectable dentists. The editor has, in 
 many cases, tested the relative merits of this with other 
 modes of destroying the nerve, and so much more ob- 
 jectionable is this than any other which he has ever tried, 
 that for nearly seventeen years, he has not resorted to it 
 in a single instance. 
 
 Since the employment of arsenic was recommended for 
 the destruction of nerves in teeth, this article has been 
 much used for this purpose. But it is objectionable for 
 the reason, that it not only destroys the whole of the lining 
 membrane of the tooth, but it also induces an unhealthy 
 
MANNER OF PREPARING THE ROOT. 373 
 
 action in the investing membrane, which, generally, in the 
 course of a few months, terminates in alveolar abscess, 
 thereby rendering the root unfit for the support of an 
 artificial crown as well as obnoxious to the surrounding 
 living parts. It is important, therefore, that as much of 
 the vitality of the root as possible, should be preserved. 
 
 The best method of destroying the nerve, is, to do it 
 with a small iron or silver wire with the point brought to 
 an edge and left rough, or with a small flat untempered 
 drill or broach. Either will answer equally well. The 
 manner of performing the operation, is to introduce the 
 instrument into the canal of the root, about half or 
 five-eighths of an inch, giving it at the same time a quick 
 rotary motion, which will extirpate the nerve as far up as 
 the drill or broach extends, leaving the remaining por- 
 tion, and lining membrane to supply the inner walls of 
 the fang with vitality and nutriment, which they will of- 
 tentimes do for years. But before a wire can be suc- 
 cessfully used, it is necessary that the nerve cavity should 
 be completely exposed, to prevent the operation from 
 being too protracted. With the broach or drill, the 
 cavity, even though it be covered with a thin layer of 
 bone, can be readily and at once reached. 
 
 But whatever instrument the operator may determine 
 to employ, it is necessary to use the same precaution 
 to prevent it from being broken off in the root, by any 
 sudden motion which the patient may give to his head. 
 This, however, in most instances, will be prevented by 
 informing him beforehand, that the operation will be at- 
 tended with considerable pain, but which, will be of but 
 two or three seconds duration, if he remain perfectly 
 quiet. This is usually long enough for its completion. 
 
 This part of the operation having been completed, the 
 operator should next proceed to file the root off, with a 
 48 
 
374 MANNER OF PREPARING THE ROOT. 
 
 round or half round file, up to the gum, and a little above 
 its free edge, so that when the artificial tooth is fitted to 
 it, the point of connection between the two, may be 
 wholly concealed. The common rat-tail file was formerly 
 used for this purpose, but files are now made expressly 
 for the operation which may be had in most of the larger 
 cities. 
 
 In filing the root above the free edge of the gums, the 
 file, as it is moved backward and forward, should be held 
 firmly against it, and made to act upon it, all the way 
 across, to prevent wounding the latter structure, which 
 will be done, if the instrument be used in any other 
 manner. 
 
 Having filed the root in the manner as just described, 
 it only remains to enlarge the canal in it, as far up as it is 
 necessary for the pivot or tenon to extend, which may be 
 done either with a broach or a burr or cherry-headed 
 drill. The enlargement of the canal, when a wood or a 
 w r ood-cased pivot is to be employed, should extend about 
 three-eighths of an inch up into the root, and should be 
 about the sixteenth or twentieth of an inch in diameter. 
 No advantage whatever is gained by making the canal 
 any larger, and when it is done, as it frequently is, the 
 w r alls of the root are weakened, and a much larger sur- 
 face presented to the action of the secretions of the 
 mouth, — consequently its destruction is thereby greatly 
 hastened. When a metallic pivot is to be employed, the 
 enlargement of the canal should extend up about half an 
 inch. 
 
 When the canal has been enlarged by caries, so as to 
 give the root a funneled appearance, after the removal of 
 the diseased part, it should be tightly filled with some 
 soft wood, and red cedar is perhaps as good as any that 
 can be employed, with a perforation through the centre, 
 
MANNER OF PREPARING THE ROOT. 375 
 
 sufficiently large for the metallic pivot. But the better 
 practice in cases of this sort, is, to introduce a hollow 
 gold tube, with a screw cut on so much of the upper 
 extremity as will occupy the upper part of the canal 
 which is of uniform dimensions. This done, the open- 
 ing around the lower part of the tube, should be firmly 
 and compactly filled with gold foil, which will not only 
 hold it securely in its place, but will at the same time 
 protect the inner walls of the root against the action of 
 the secretions of the mouth. The opening in the tube, 
 which is intended for the reception of the pivot, should 
 be about the sixteenth of an inch in diameter. 
 
 This method of preparing a root is more troublesome, 
 but by far preferable to any other, and as it is very sel- 
 dom, when a root is so much decayed as to call for it, 
 that there is sufficient vitality in it to prevent it from 
 being a source of irritation to the contiguous parts, it is 
 not often necessary to resort to it for the purpose of ob- 
 taining a hold for the pivot. After having secured it in 
 the manner as above described, so much of it as projects 
 below the root, together with the filling around it, should 
 be removed with a fine oval or half round file. 
 
 The introduction of a hollow gold screw into the canal 
 in any case, after having sufficiently enlarged it, would 
 contribute greatly to the preservation of the root, and if 
 dentists would provide themselves with hollow gold wire 
 of the proper size, and a screw plate and taps, the ope- 
 ration would not be attended with much more trouble 
 than is consequent upon the ordinary method of inserting 
 a pivot tooth. 
 
 The balance of the operation consists in selecting, fit- 
 ing, and attaching the artificial crown to the root, which 
 the editor will now proceed to describe. 
 
376 OF THE MANNER OF FITTING 
 
 OF THE MANNER OF FITTING AND ATTACHING A TOOTH TO 
 
 THE ROOT. 
 
 In the selection of the toothy the operator should be 
 careful to procure one of the right size and colour, so 
 that in neither, it shall differ sufficiently from the corres- 
 ponding natural tooth, to render its detection easy by a 
 striking contrast; for in that case, the effect that would 
 be produced on the observer, would be worse than that 
 caused by the loss of the original organ. The base too, 
 of the artificial tooth, should be large enough to cover the 
 root, and the pivot-hole in it deep, and exactly in the 
 centre, and as large at the bottom as it is at the orifice. 
 In many of the porcelain teeth, the pivot-hole is faulty 
 in all of these respects, and therefore, it is a matter that 
 should never be overlooked by the dentist. If it is 
 smaller at the bottom than at the orifice, the swelling of 
 the pivot, if a wood one be employed, will force the 
 tooth off from the pivot, or if it be a little to one side, or 
 have an oblique direction, as they oftentimes have, the 
 proper adjustment of it on the root, will be attended with 
 great difficulty. 
 
 It is often necessary in fitting an artificial crown to the 
 root, to alter its original shape, which is done by means 
 of a grinding apparatus. This may consist of an emery 
 wheel or stone fixed on an axle, and turned either with 
 the hand or foot. The most convenient and portable 
 kind are turned by a small crank with the hand of the 
 operator, and the emery wheel, when properly prepared, 
 is preferable to almost any stone which can be procured. 
 It cuts more rapidly, and is less liable to injury from use. 
 
 After the tooth has been ground so as to fit the root 
 accurately, it should be fixed to it with a temporary pivot, 
 and if it deviates in the least from the exact position it 
 
AND ATTACHING A TOOTH TO THE ROOT. 377 
 
 should occupy on the root, or if the teeth with which it is 
 to antagonize, strike it in closing the mouth, such altera- 
 tion should be made in the pivot or tooth, as the peculiar 
 nature of the case may require. When the upper teeth 
 close over the lower, it is often necessary to make the 
 tooth very thin by grinding it away on the inside. As a 
 general rule, the artificial tooth should not touch any of 
 the teeth in the under jaw. 
 
 After having accurately fitted the tooth to the root, the 
 operator should then proceed to arm it with a pivot. 
 Wood is most commonly employed, and in most cases is 
 preferable to any metallic substance, inasmuch as by the 
 swelling of it in the root, it becomes very tight, and will 
 often hold the tooth securely in its place for many years. 
 The kind generally used, is close-grained, well seasoned 
 young hickory. This is now prepared especially for the 
 purpose, by being made of the right size and firmly com- 
 pressed, and may be had at the principal establishments 
 in the country for the sale of porcelain teeth. When the 
 piece is larger than the hole in the tooth, one end should 
 be reduced to the right size and firmly forced up into it. 
 It should then be cut off about a fourth of an inch, or a 
 little more, from the tooth, and the projecting part 
 trimmed down until it will tightly fit the canal in the 
 root, into which, after having been wiped out, it should 
 be introduced. No more pressure will be required for 
 this purpose than can be exerted with the thumb and 
 forefinger of the hand of the operator. Some practition- 
 ers are in the habit of driving the pivot into the root, by 
 striking on the tooth with a hammer, but this is wholly 
 unnecessary, as the moisture of the mouth will cause the 
 pivot to swell sufficiently to prevent it from loosening or 
 coming out. 
 
 It sometimes happens that the antagonizing tooth can- 
 
378 OF THE MANNER OF FITTING 
 
 not be prevented from striking the artificial tooth, and 
 they occasionally do it in such a way as to act with great 
 force against the pivot, causing it as it becomes saturated 
 with the fluids of the mouth, to bend, and the tooth to 
 project. To prevent which, the editor some ten or 
 twelve years ago, adopted the plan of passing a gold 
 screw through the wood previously to reducing it to the 
 proper size, and he has derived much benefit from it. 
 This description of pivot, especially in cases where the 
 lower teeth strike the artificial, is perhaps the best that 
 can be employed. The simplest way of making one, is 
 to drill a hole, about three-fourths of an inch long, of the 
 size of a small knitting-needle, lengthwise into a piece of 
 well-seasoned hickory of about an eighth of an inch in 
 diameter. This done, a screw is cut on a piece of gold 
 wire, large enough to fill the hole. The wood around 
 the gold wire is then reduced to the proper size, fixed 
 in the tooth, cut off a little more than an eighth of an 
 inch from it and the projecting part introduced into the 
 canal in the root, in the manner as before described. 
 
 For a metallic pivot, gold is the proper metal to be em- 
 ployed. It should be fully eighteen carots fine, and is 
 prepared for use by being made into wire of about the 
 sixteenth part of an inch in diameter. A piece of about 
 five-eighths or three-fourths of an inch is cut off, the 
 cavity in the tooth is filled with pulverized borax, (sub 
 borate of soda) and water, one end of the wire inserted 
 around which several pieces of gold solder is placed, the 
 tooth is then fixed in a piece of charcoal, and a flame 
 from a lamp thrown on it until the solder fuses and runs 
 down into it around the wire. By this simple process 
 the wire is made fast in the tooth, and after this has been 
 done, it is made sharp at the point with a file, and several 
 small beards cut on it, so that when it is introduced into 
 
AND ATTACHING A TOOTH TO THE ROOT. 379 
 
 the canal in the root, which should be previously filled 
 with some soft wood, pierced through the centre, it will 
 not be liable to loosen and come out. Artificial teeth are 
 often securely retained by this description of pivot for 
 many years. 
 
 When an artificial tooth is engrafted to a root from 
 which there is a fetid discharge, an outlet should be pro- 
 vided for the escape of the matter. This may be done 
 by cutting a groove on the side of the pivot as recom- 
 mended by Dr. L. S. Parmly, or by the employment of 
 a tubed pivot with an opening through the crown of the 
 tooth opposite to the pivot-hole as proposed by Dr. E. H. 
 Elliott. Either method, by giving egress to the matter, 
 will prevent its accumulation in the root, and the conse- 
 quent formation of an alveolar abscess. 
 
 That it is unscientific to apply an artificial crown to the 
 root of a tooth under such circumstances, every one must 
 admit, but there are cases, in which, from some peculiar 
 necessity, the practice may, perhaps be justifiable, and by 
 adopting the plan just described, the hurtful effects that 
 would otherwise inevitably result, may be measurably 
 counteracted. But even the presence of a dead root of 
 a tooth, or that of one from which fetid matter is con- 
 stantly being discharged, must of necessity be productive 
 of injury to the patient, and therefore, under all ordinary 
 circumstances, a dentist would be exceedingly remiss in 
 the discharge of his duty, if he fails to urge upon him 
 the importance of its immediate removal. 
 
CHAPTER THIRD. 
 
 OF THE MANNER OF FITTING AND ADAPTING A PLATE, AND 
 ATTACHING CLASPS AND ARTIFICIAL TEETH TO IT. 
 
 In the construction of a dental substitute to be held in 
 the mouth by means of a gold plate and clasps, fixed to 
 some of the remaining natural teeth, it is necessary that 
 it should be adapted with the most perfect accuracy, to 
 the parts on which it is to rest, and that it antagonize 
 correctly with the teeth, with which it should come in 
 contact when the mouth is closed, or that it does not 
 strike these before the others meet, provided there be 
 teeth back of it in both jaws. It should be so contrived 
 too, as to restore the symmetry of the face, which is 
 always more or less injured by the loss of several teeth. 
 The operation of constructing a dental substitute of the 
 description now under consideration, may be properly 
 divided into four parts. 
 
 The first consists in taking an impression of the parts 
 on which the substitute is to rest, and with which it is to 
 be connected, in wax. The second, in procuring from 
 the wax impression, first, a plaster, and second, a metallic 
 model and counter model. The third, in swedging up 
 the plate and attaching clasps to it. The fourth and last, 
 in taking an articulating model, in fitting, antagonizing, 
 and attaching the teeth, and finishing the work. 
 
 In describing these several parts of the operation, the 
 order just mentioned will be followed. 
 
MANNER OF TAKING A WAX IMPRESSION. 381 
 
 OF THE MANNER OF TAKING A WAX IMPRESSION. 
 
 Although the taking of an impression of the mouth, is 
 a very simple operation, it is nevertheless often attended 
 with great difficulty, for if this be incorrect, it will be 
 impossible to make a plate to fit the parts on which it is 
 to rest and the natural teeth to which it is to be attached. 
 Different dentists employ different preparations of wax 
 for this purpose, but there is nothing better than the 
 common beeswax. But whether this or any other prep- 
 aration be used, it should be previously softened, until 
 it is of about the consistence of soft putty, in warm 
 water. It should then be placed in a semi-circular box 
 or frame, made of tin or silver, large enough to encase 
 or cover the whole, or so much of the alveolar ridge, as 
 an impression from which, may be required, and leave a 
 small space on each side. The wax thus enclosed, 
 should be placed in the mouth, and pressed against the 
 jaw until a deep impression is made in it by the parts to 
 which it is intended to apply the artificial teeth, and to 
 the adjoining natural teeth as far back as it may be neces- 
 sary to extend the plate, and to which, the clasps are to 
 be fixed. This done, the wax which has escaped from 
 the frame, should be pressed against the alveolar ridge, all 
 round, and on each side, by the forefinger of the hand of 
 the operator; and after being well assured a correct 
 impression has been made, the whole should be carefully 
 removed from the mouth. In doing this, the greatest 
 care is necessary to prevent the wax above the outer 
 edges of the frame from being bent by the corners of 
 the mouth. This is oftentimes attended with great diffi- 
 culty, and sometimes it is necessary to take several im- 
 pressions before a perfect one can be obtained. 
 49 
 
382 MANNER OF OBTAINING A PLASTER AND 
 
 The wax-holder or frame, should have a handle at- 
 tached to the front part of it, of about an inch and a half 
 or two inches in length. Every dentist should be pro- 
 vided with from ten to fifteen frames of this description, 
 varying both in shape and size. Dr. Elliott of Platts- 
 burg, N. Y. recommends that they be " formed by being 
 swedged between a model and counter model, in the 
 same manner that a gum plate is fitted to the mouth." 
 This description of wax-holder, is certainly preferable to 
 those commonly used, and in one instance the editor 
 found it absolutely necessary to have one made, in order 
 to obtain a correct impression. But in all cases where 
 the mouth is of the ordinary size, the others will answer. 
 
 OF THE MANNER OF OBTAINING A PLASTER AND A METALLIC 
 MODEL AND COUNTER MODEL. 
 
 Previous to filling the wax impression with plaster, 
 every part of it should be smeared with oil. The best 
 way of applying this, is, with a small camel's hair pencil. 
 If there are any teeth in the jaw, a pin or short piece 
 of small iron wire should be stuck in the bottom of the 
 impression made by each, for the purpose of strengthen- 
 ing those which will be formed on the plaster model, and 
 to prevent their liability to break. 
 
 As it will be necessary to raise the plaster above the 
 wax impression, a rim or border of pasteboard or folded 
 paper, an inch wide, may be passed around it and made 
 fast by pinning. The connection of this to the wax im- 
 pression should be sufficiently close to prevent the plaster 
 from escaping. 
 
 The plaster should be of the best quality. That used 
 for making busts is generally superior to any other that 
 can be obtained, and when this can be had, it should be 
 
A METALLIC MODEL AND COUNTER MODEL. 383 
 
 preferred. It should be prepared by stirring it in water 
 until a batter is formed, which should not be too thick to 
 prevent it from descending readily into all the depres- 
 sions in the wax. The plaster being thus prepared, the 
 impression should be slowly filled, putting on a sufficient 
 quantity of the batter, which by this time will have be- 
 come much thicker, to raise the model nearly to a level 
 with the paper border. 
 
 From two to four hours should elapse, after filling the 
 impression, for the plaster to harden, before it is taken 
 from the wax, which, in most instances, is easily done, 
 but when from the number, great length, or peculiar 
 shape of the teeth, it cannot be easily separated, the wax 
 should be placed in warm water and allowed to remain, 
 until it has become a little softened, when the plaster 
 may be readily removed. 
 
 It should now be trimmed in such a manner that the 
 metallic model which will be shaped exactly like it, may 
 be removed without difficulty from the counter metallic 
 model. This is sometimes neglected, and in consequence 
 of which, the two become locked together, so that they 
 cannot be separated. 
 
 Brass, zinc, lead, and tin, are the metals usually em- 
 ployed for the metallic models. The last is more easily 
 fused than either of the others, and in the majority 
 of cases, answers equally well. The plan which the edi- 
 tor, in common with many other dentists, adopts, for the 
 procurement of a metallic model, is, to fuse some four or 
 five pounds of lead in a strong round sheet iron box or 
 ladle, about three inches deep, and at the bottom, about 
 three inches in diameter, but a little larger at the top; then 
 to immerse as much of the plaster model in it as was 
 formed in the wax impression, and holding it there, until 
 the metal chills around it. When the lead gets cold, 
 
384 MANNER OF FITTING AND STAMPING A PLATE 
 
 which process may be hastened by pouring cold water on 
 it, the plaster may then be broken to pieces and taken 
 out. The counter model thus formed should be covered 
 with a little whiting mixed with water, put on with a 
 camel's hair pencil, or smoked over a lamp. This done, 
 three or four pounds of tin should be fused in another 
 ladle, and at a temperature which will not char or dis- 
 colour white paper, poured in this while still in the ladle 
 first employed. When cold both may be taken out and 
 separated from each other. 
 
 This is the simplest way in which a metallic model and 
 counter model can be obtained. It is also the most per- 
 fect. Some dentists, however, are in the habit of making 
 the model first, which is done by making an impression 
 with the plaster cast in sand, such as is used at brass and 
 iron foundries; then fusing the tin or brass, or zinc and 
 lead, whichever may be employed, and pouring it into the 
 impression thus made, and afterwards obtaining a counter 
 model from the model thus procured. The first method 
 is the best, for the reason that it ensures a much smoother 
 and more perfect model. But it is necessary when taken 
 in that way to have a duplicate plaster model, which, 
 however, may generally be obtained from the wax im- 
 pression in which the first was formed. Should this, 
 however, be injured, in the removal of the first plaster 
 model, it will be necessary to take a second wax impres- 
 sion. 
 
 OF THE MANNER OF FITTING AND STAMPING A PLATE AND 
 ATTACHING CLASPS TO IT. 
 
 The plate in the first place should be got out to the 
 proper size and shape, from a sheet lead pattern, pre- 
 viouslv obtained from the model, which should be from 
 
AND ATTACHING CLASPS TO IT. 385 
 
 three-fourths of an inch, to an inch in width. And it 
 may be well to remark here, that the plate should be 
 thick enough to prevent it from being easily bent or 
 broken, and the best way to secure a uniform thickness, 
 is to have it always got out by a gage, such as is used by 
 watch casers, which are numbered. The plate usually 
 used by the editor for the upper jaw, and he does not 
 think it at all too thick, fits tightly in number twenty-six, 
 and that which he employ for clasps, in twenty-four or 
 five. 
 
 After having cut out a plate of the right size and 
 shape, and fitted it as closely to the model as possible 
 with a pair of plate forceps and a small round-faced 
 hammer, it should be annealed, by heating it on a piece 
 of charcoal with a lamp and blow-pipe. This done, it 
 should be swedged up between the model and counter 
 model, with a heavy hammer, until it fits with the most 
 perfect accuracy, every part which it covers. And 
 during the process, it is often necessary to take it out 
 once or twice, and re-anneal it. 
 
 The posterior extremities of the plate should fit up 
 closely to the teeth to which the clasps are to be applied, 
 and if there be any anterior to these, a space of an eighth 
 or twelfth of an inch between it and them should be 
 left uncovered, to prevent irritating the margins and 
 apices of the gums, which is almost certain to result 
 from contact with the plate. 
 
 The plate should now be placed on the plaster model, 
 and clasps accurately fitted to the teeth, one on each side, 
 when practicable, if two be employed. But when the 
 teeth on one side have all been lost, and there be good 
 teeth to clasp to on the other, two may be used on that 
 side, and which, when properly applied, may be made to 
 support a plate with artificial substitutes for all the other 
 
386 MANNER OF FITTING AND STAMPING A PLATE. 
 
 teeth. In fact, one has oftentimes been made to do this 
 for years, without having been attended with any un- 
 pleasant effects whatever, and in the insertion of a single 
 tooth in the front part, or two or even three on the side, 
 of the mouth, it is seldom necessary to apply more than 
 one clasp. But in this case, the clasp should be fixed to 
 a bicuspis or first or second molaris. 
 
 After the clasps have been fitted to the teeth, they 
 should be connected to the plate, while on the model, by 
 means of two pieces of wax, softened until they are about 
 the consistence of putty. The plate and clasps should 
 now be taken off, without altering in the least their rela- 
 tive position, and placed on a piece of paper with the 
 concave side of the plate upwards, then plaster of Paris, 
 prepared in the manner as before described, poured over 
 it and the clasps. As soon as this becomes hard, the 
 piece may be lifted from the paper, and the w T ax taken 
 off, when, if there be any apertures between the clasps 
 and plates, they should be filled either with gold foil or 
 small pieces of plate. Finely ground borax (sub borate 
 of soda) mixed with water, until it is of the consistence 
 of cream, should now be applied with a camel's hair 
 pencil, to the parts to be united, and after which, several 
 small pieces of fine gold solder. It should next be 
 placed on a piece of charcoal and the flame of a spirit 
 or oil lamp be thrown upon it with a blow-pipe, until the 
 solder fuses and unites the clasps to the plate. 
 
 It is much better to solder the clasps to the plate in 
 this manner than to do it on the plaster model, as that 
 will be afterwards needed, and is liable to be injured by 
 the intense heat necessary to be applied to fuse the solder. 
 
 The clasps having been soldered to the plate, the piece 
 should be placed in diluted sulphuric acid, and allowed 
 to remain about twenty or thirty minutes for the purpose 
 
ATTACHING THE TEETH TO THE PLATE. 387 
 
 of decomposing the borax which remains on the part of 
 the plate and clasps to which it was applied, and by the 
 action of the heat has become almost as hard as glass. 
 This done, the work should be cleansed for the reception 
 of the teeth. 
 
 When it is necessary to supply the loss of several 
 teeth, in different parts of the mouth, but in the same 
 jaw, by means of one plate, the teeth on the plaster model 
 should be cut off, before the metallic model is made, and 
 a plate covering the whole of the alveolar ridge, or ex- 
 tending back as far as the teeth to which it is to be 
 clasped, should be sweclged up, and the places of the 
 natural teeth afterwards filed out. A plate can be made 
 to fit more perfectly in this way than by cutting out the 
 places for these teeth before it is stamped up, as in this 
 process, it is liable to draw off from them. 
 
 OF THE MANNER OF FITTING AND ANTAGONIZING THE TEETH, 
 ATTACHING THEM TO THE PLATE, AND FINISHING THE 
 WORK. 
 
 After having selected such teeth as correspond in class 
 with those which have been lost, and in colour with the 
 adjoining natural teeth, the operator should proceed to 
 fit them to the plate, and in doing this, it will be neces- 
 sary, in the majority of cases, to grind them more or less 
 on the base. No apertures should be left between the 
 teeth and plate, as they would become receptacles of ex- 
 traneous matter, exceedingly difficult to clean, and to 
 prevent which, great care is requisite, especially in those 
 cases where the alveolar ridge is very rough and uneven. 
 
 As the teeth are selected and arranged on the plate, 
 they should be held in their place by a rim of softened 
 wax behind them, such as recommended to be used in 
 
388 ATTACHING THE TEETH TO THE PLATE 
 
 taking impressions, and it will be proper to remark in 
 this place, that when the alveolar ridge is exposed in 
 laughing, the plate should not cover the anterior part of 
 it. The anterior portion of the base of the artificial 
 teeth, in this case, should cover the edge of the plate and 
 be accurately fitted to the gums, but when the alveolar 
 ridge is not exposed in laughing, a much larger portion 
 of it may be covered by the plate. 
 
 It sometimes happens that the whole of the alveolar 
 ridge has been wasted by disease in the gums and alve- 
 olo-dental membranes, or destroyed by necrosis and ex- 
 foliation. To supply this loss of substance, it becomes 
 necessary to make a raised or box plate, or to employ 
 what is commonly termed gum teeth, and in some cases 
 both can be advantageously applied. The most conve- 
 nient and best manner of making a box plate, is, to fit up 
 a plate first in the usual manner, then to put on a paste, 
 or thick batter, made of plaster of Paris, which should 
 be raised to the proper height and afterwards trimmed to 
 the proper shape, leaving about an eighth of an inch of 
 the plate on each side exposed — with this a metallic 
 model and counter model should be obtained in the man- 
 ner as before described, and between which another plate 
 should be swedged. This last is to be filed until it fits 
 the first, and then soldered to it. But previously to this, 
 a small hole should be pierced for the escape of the air, 
 which becomes expanded by the heat employed in solder- 
 ing, and after the teeth have been soldered on, it should 
 be closed by the introduction of a small gold screw, 
 which, in finishing the piece, should be cut off close to 
 the plate. . . 
 
 In arranging the teeth on the plate, it is better, in 
 most cases, to have an antagonizing model, which may be 
 obtained in the following manner. Place a rim of soft- 
 
AND FINISHING THE WORK. 389 
 
 €ned wax, three-fourths of an inch in width, on the 
 convex side of the plate, after it has been fitted and the 
 clasps attached to it; let the plate now be put in the 
 mouth, and the patient be directed to close his jaw nat- 
 urally, until his back teeth come together, or if he has 
 none which antagonize with each other, pass a wedge of 
 wood, of a width equal to the length required for the 
 artificial teeth, through the wax, with one edge in con- 
 tact with the plate, and then let him be directed to close 
 his mouth until the teeth which are to antagonize with 
 the artificial ones, come in contact with the other. The 
 wax should now, while the jaws are thus closed, be 
 pressed around the natural teeth; this done, the mouth 
 may be opened, and the plate with the wax removed, 
 using the precaution at the time, not to bend or alter the 
 shape of the latter. 
 
 Let the concave side of the plate, and the wax which 
 has received the impression of the teeth, be now lightly 
 smeared with olive oil, in the manner as previously de- 
 scribed; next place it on a piece of paper, some six or 
 eight inches square, and fill one side with a thick batter 
 made of plaster, letting it extend back of the wax impres- 
 sion, or plate, as the case may be, on the paper, about two 
 inches, adding to it from time to time, as it becomes 
 stiffer, until it is about an inch in thickness. As soon as 
 the plaster has solidified sufficiently, the edges and sides 
 may be trimmed with a sharp knife, and about half an inch 
 of the under surface extending behind the wax and plate 
 cut away, and two or three deep grooves formed across 
 it, and crossing each other at right angles. These should 
 now be oiled and the whole of the surface of the plaster 
 on the same side, together with the wax impression or 
 plate in front of it, if it were not done at the time the 
 oil was applied to the side previously filled. This done, 
 50 
 
390 ATTACHING THE TEETH TO THE PLATE 
 
 let a batter of plaster be put on this side in the manner 
 as directed for putting it on the other, and when it has 
 hardened sufficiently, it may be trimmed, and the two 
 
 taken apart and the wax removed. 
 
 In a model of this description, the teeth may be ar- 
 ranged, fitted and so antagonized that all shall meet the 
 teeth in the other jaw at the same instant. But when 
 only one or two teeth are to be inserted, it will not be 
 necessary to incur the trouble consequent upon the pro- 
 curement of such a model. 
 
 The teeth being fitted to the plate, and antagonized, 
 the next thing to be done, is, to put on gold backings. 
 For this purpose two platina rivets are fixed in the 
 palatine or lingual surface of each, about the twelfth of 
 an inch long. They are fixed in the teeth while they are 
 being manufactured before they are baked. The backings 
 are made from a strip of gold plate, a little thicker than that 
 to which the teeth are applied. The manner of putting 
 a backing on a tooth, is to punch a hole through the strip 
 of gold plate near one end, with a pair of punch forceps 
 made expressly for the purpose, to insert one of the pla- 
 tina rivets into it, and by moving the other end of the 
 plate two or three times backwards and forwards, over 
 the other rivet, to mark its distance from it, then to 
 punch another hole through the plate at the point thus 
 indicated, immediately below the first; afterwards to en- 
 large the holes on the outer side of the plate with a sharp 
 triangular pointed instrument, called a counter sink, then 
 put the plate on the tooth, file off the protruding ends of 
 the platina pins nearly down to the plate, which should 
 now be made fast by riveting. This done, the plate should 
 be cut off close up to the tooth, which should now with 
 its gold back be refitted to the plate it is to be attached to, 
 the rim of wax on the inside behind it, still supporting 
 
AND FINISHING THE WORK. 391 
 
 and keeping it in its proper place. The backing, how- 
 ever, should be filed and made to fit closely to the plate. 
 It should also fit up closely to the tooth, and have its 
 edges neatly bevelled off. It should cover the whole of 
 the back of the tooth to within about a sixteenth of an 
 inch of its cutting extremity. 
 
 Some dentists are in the habit of putting on a raised 
 back, giving as a reason for so doing, that it gives to the 
 tooth a firmer support, but the editor has never been able 
 to perceive that any advantage whatever was derived 
 from it. Others again, after fitting the teeth to the plate, 
 cover their anterior surfaces and cutting edges with 
 plaster, and take off the rim of wax from behind, before 
 they put on the backings, believing that they can in this 
 way fit them more closely to the plate. They may, 
 however, be fitted to it as accurately in the manner first 
 described, as by this method, and in one-half the time. 
 
 When the backings are all fitted to the teeth, the plate 
 with the teeth and wax should be taken from the model 
 and placed on a large piece of charcoal, and then covered 
 with a batter of plaster. When this becomes hard, the 
 wax should be removed, and if there be any openings 
 between the backings and the plate, they should be 
 closed with small pieces of gold plate or foil. This done, 
 borax, prepared in the manner as before described, should 
 be freely applied, where it is intended the solder should 
 take effect, namely, at the points of connection between 
 the backings and the plate and around each platina rivet. 
 At each of these places, several small pieces of fine gold 
 solder should be placed, except over the rivets, — one 
 being sufficient for each of these. 
 
 The solder employed for this purpose, as well as that 
 for uniting any description of mechanism to be worn in 
 the mouth, should, if possible, be fine enough to resist 
 
392 ATTACHING THE TEETH TO THE PLATE 
 
 the action of the secretions of this cavity. The following 
 recipe, copied from the editor's Principles and Practice 
 of Dental Surgery, will perhaps be found as well adapted 
 to dental purposes, as any that can be employed. It 
 makes an excellent fine flowing solder. 
 
 2 dwt. 22 car. gold. 
 16 grs. fine silver. 
 12 grs. roset copper. 
 
 Previous to use, it should be rolled out in a thin strip, 
 and cut into very small pieces. It fuses more readily 
 and flows more freely when the pieces are small. 
 
 The soldering on of the teeth, is a nice and somewhat 
 difficult part of the operation, and although greatly facili- 
 tated by a good lamp and blow-pipe, a thorough know- 
 ledge of it can only be acquired by practice. The lamps 
 most frequently employed, and which answer very well, 
 are similar to those used by silver and goldsmiths, and 
 spirits of wine (alcohol) is now generally preferred to 
 oil. It makes a clearer and purer flame, and gives out 
 about the same quantity of heat. When this is used, the 
 lamp should hold fully a pint, and have a spout from 
 three to four inches in length, and three-fourths of an 
 inch in diameter, which should be filled with wick, to 
 prevent the flame from extending down into the lamp 
 and causing an explosion. This has sometimes happened, 
 when the above precaution has been neglected. 
 
 Hook's self-acting blow-pipe is thought much of 
 by some practitioners, and as improved by Dr. Jahial 
 Parmly of New York, is certainly very valuable for den- 
 tal purposes. Dr. Elliott of Plattsburg, has also added 
 to this blow-pipe and lamp a very important improve- 
 ment, which consists in feeding the flame with atmos- 
 
AND FINISHING THE WORK. 393 
 
 pheric air, by means of a bellows worked by the foot. 
 But Dr. Somerby's furnace and blow-pipe is the best 
 instrument of the kind which the editor has ever em- 
 ployed. An engraving of this, as well as Dr. Elliott's 
 self-acting blow-pipe, may be seen in the editor's Princi- 
 ples and Practice of Dental Surgery, to which, for a 
 more minute description of each, the reader is referred. 
 
 If the common blow-pipe be used, it should be from 
 fifteen to eighteen inches in length, and have a tolerably 
 large orifice, to enable the operator to control as much of 
 the flame of the lamp as possible. The blow-pipes ordi- 
 narily employed by silversmiths are too short. They 
 bring the eyes of the operator so near the flame of the 
 lamp, that they are oftentimes injured by the intensity of 
 the heat and light. 
 
 The work being ready for soldering, the lamp should 
 be lit, and as much of the flame as possible, thrown with 
 the blow-pipe, on, first, the plaster, and kept there until 
 this has attained a red heat, then on the point of connec- 
 tion between the backing of one of the teeth and the 
 plate, and as soon as the solder flows well here and 
 around the two platina rivets, it should be passed to 
 another and another, until the whole process is com- 
 pleted. After the solder has flowed freely at the first 
 point, it will be comparatively easy to fuse it at all the 
 others, as the temperature of the whole piece will be 
 raised so high by this time, that little additional heat will 
 be necessary to fuse the solder at the various other points 
 where it is required. The flame, how r ever, when it is 
 directed to a single point, for the purpose of fusing the 
 solder there, should be brought to a smaller focus, than 
 when first thrown upon the work w T ith a view of heating 
 the plaster. 
 
 Should the solder flow in a wrong direction, as it often 
 
394 ATTACHING THE TEETH TO THE PLATE. 
 
 does, when the heat is not concentrated upon the right 
 place, the focus of the flame of the lamp, should be 
 directed upon the point where it is desired it should take 
 effect, when it will immediately flow in that direction. 
 When the solder is only partially fused it is apt to run 
 together and form a lump or small ball, which is fused 
 with great difficulty, or to leave a rough uneven surface, 
 and thus render the process of finishing both tedious and 
 troublesome. 
 
 When the soldering is completed, the plaster, after it 
 has cooled, should be removed, and the work immersed 
 in a mixture of equal parts of sulphuric acid and water, 
 for the purpose as before stated, of decomposing the 
 borax and cleansing the plate. From fifteen to thirty 
 minutes are required for this, and when it is completed, 
 the work should be taken out, washed in water, and all 
 rough portions carefully removed with suitable scorpers 
 (scrapers) and a smooth neat finish given to it. This 
 done, it is ready to be applied to the mouth, but in its 
 insertion it is often necessary to bend and file the clasps 
 a little to complete their adaptation to the teeth which 
 they are intended to encircle. 
 
CHAPTER FOURTH. 
 
 OF THE TEETH TO WHICH IT IS MOST PROPER TO APPLY CLASPS, 
 AND THE MANNER OF COUNTERACTING THE INJURY LIABLE 
 TO RESULT FROM SUCH APPLICATION. 
 
 The utility of artificial teeth applied on plate, when 
 retained in the mouth by clasps to some of the natural 
 teeth, depends very much upon the teeth to which they 
 are clasped. The first molares, when sound and firmly 
 articulated, offer a better means of support to a dental 
 substitute than any of the other teeth, and when they 
 can be as conveniently employed for this purpose, they 
 should certainly be preferred. Next to these, the second 
 molares are the best, and next to these the second bicus- 
 pides, then the first, and lastly the dentes sapientiae. But 
 no loose tooth, nor one within whose socket there is a 
 diseased action, or which is so much affected w T ith caries, 
 that it cannot be restored to health, should ever, when it 
 can be avoided, be made a means of support to artificial 
 teeth. When none but such can be had, the proper 
 course to pursue, is, to extract every tooth in the jaw, 
 and replace the loss of the whole, with artificial substi- 
 tutes, as the application of clasps to diseased or loose 
 teeth, always aggravates the diseased action, and causes 
 them to become a source of increased annoyance to the 
 patient, as well as a cause of disease to the adjacent and 
 contiguous parts. This, at any rate, would have to be 
 
396 TEETH TO WHICH IT IS 
 
 done, in two or three years, and it is better to do it at 
 once, than to subject him to the increased trouble and 
 expense consequent upon a double operation. More- 
 over, when the clasps are applied to loose teeth, the arti- 
 ficial ones not being held firmly in their place, move up 
 and down with the motions of the lip, and thus render 
 their detection by every observer, almost inevitable. 
 
 A plate with artificial teeth, when properly fitted and 
 constructed, exerts but little mechanical force upon the 
 teeth to which it is applied. Therefore, w T ith the proper 
 care and attention, a dental substitute of this description, 
 may, under favourable circumstances, be worn, without 
 being altered or replaced by another, from ten to twenty 
 years. But it is important in every case, that the clasps 
 be accurately adapted, and applied in such a manner as 
 not to strain or exert any undue pressure upon the teeth 
 to which they are fixed. 
 
 The cuspidati, being of a conical shape, and wholly 
 unsuited to the application of clasps for the retention 
 of artificial teeth, should never, when it can possibly be 
 avoided, be used for that purpose. It is true, they are 
 oftentimes fixed to them, but the practice is nevertheless 
 objectionable. But when from peculiar necessity, it 
 becomes absolutely requisite to use these teeth, the clasps 
 should be adapted with great accuracy, and in such a 
 manner as to prevent their presence from being detected, 
 which can only be done, by making them very short and 
 narrow. They should only reach a little more than half 
 way round the teeth, and, applied very near to the gum. 
 
 As a means of support for artificial teeth, the incisores 
 are worse than the cuspidati. It is almost impossible to 
 apply clasps to these teeth so as to hold even a single 
 artificial tooth securely and firmly in the mouth, still 
 when others cannot be had, it is sometimes necessary to 
 
MOST PROPER TO APPLY CLASPS. 397 
 
 use these, but they should only be had recourse to as 
 a dernier resort. 
 
 Having now mentioned the teeth to which it is most 
 proper to apply clasps, it will be proper to say a few 
 words concerning the means necessary for the prevention 
 of the effects liable to result from their application. It is 
 well known, not only to practitioners of dentistry, but 
 also to most persons who have worn artificial teeth, ap- 
 plied upon the principle under consideration, that the 
 liability of the teeth to decay, to which the clasps are 
 applied, is always increased by their application. The 
 reason of this, has often very erroneously been ascribed, 
 to the mechanical action of the clasps. It is a common 
 remark, even among dentists, that when teeth, to which 
 clasps or ligatures, have been applied, have decayed; 
 they have been worn off; when in reality, the loss of sub- 
 stance which they had sustained, was wholly attributable 
 to another cause, to the action of chemical, not to that of 
 mechanical agents. By the retention of the secretions of 
 the mouth and other extraneous matter, between the 
 clasps and the teeth to which they are applied, they soon 
 become putrid and acidulated, decomposing, first the 
 enamel, and afterwards the bony structure of the organs. 
 
 This being the cause of the injury sustained by teeth, 
 to which clasps are applied, the means for its prevention, 
 must, at once, suggest themselves to every reflecting 
 mind. They consist in the frequent removal of the 
 artificial teeth, and the cleansing of the natural ones, to 
 which the clasps have been applied. This should be done 
 every morning and night, immediately after rising, and 
 before going to bed, and after each meal. For which 
 purpose, both a brush and waxed floss silk should be 
 employed, and the teeth rubbed until every particle of 
 vitiated mucus and foreign matter is removed. 
 51 
 
398 TEETH MOST PROPER TO APPLY CLASPS TO. 
 
 By the constant and regular observance of these means, 
 the decay of the teeth may be prevented : but if neglected, 
 their destruction, will, in most cases, be both speedy and 
 inevitable. Therefore, the importance of attending to 
 them, should always be strongly impressed upon the mind 
 of the patient, who, at the same time, should be properly 
 instructed in the manner of removing and replacing the 
 artificial teeth, and the plate and clasps should be so con- 
 structed, that this may be done with the most perfect 
 ease and convenience. 
 
 But the decay of the teeth caused by the presence of 
 corrosive agents, is not the only injury liable to be pro- 
 duced by the application of clasps. They are oftentimes 
 so fitted, that when applied, they force themselves down 
 between the necks of the teeth and gums, giving rise to 
 inflammation in the last-mentioned structure and the al- 
 veolo-dental membranes, and ultimately to the destruction 
 of the alveolar processes, and the gradual loosening and 
 loss of the teeth. It is always necessary, therefore, to 
 guard against these effects, by so adapting the clasps to 
 the teeth as to prevent them from pressing too much 
 upon the gums. 
 
CHAPTER FIFTH. 
 
 OF THE CONSTRUCTION OF A DOUBLE SET OF ARTIFICIAL TEETH 
 MOUNTED ON PLATES WITH SPIRAL SPRINGS. 
 
 The mouth being in a fit condition, an impression of 
 each alveolar ridge should be taken in wax, from which 
 plaster and metallic models and counter models should be 
 obtained., in the manner as before described. Between 
 the latter, a plate for each jaw, of the thickness and 
 width before mentioned, should be swedged and properly 
 fitted. Having proceeded thus far, the next thing to be 
 done, is, to make an antagonizing model, which may 
 be obtained in the following manner. First, take a thin 
 piece of soft w r ood, trim off its edges until its width shall 
 be equal to the length it is intended the front teeth in 
 both jaws shall be, then fix a rim of softened wax about 
 an inch or an inch and a quarter in width, between the 
 convex surfaces of the two plates ; next pass one end of 
 the wood through the frame part of this about on the 
 medial line; put the whole in the mouth, adjust the plates, 
 each to its proper place, then direct the patient to close 
 his jaws naturally until they come in contact with the 
 edges of the wood, when his mouth should be opened 
 and the plates and wax removed, without, in the least, 
 changing their relative position. The concave surfaces 
 of the plates should now be oiled, and a batter of plaster 
 of Paris, put first on one side and then on the other, in 
 
400 DOUBLE SET OF ARTIFICIAL TEETH 
 
 the manner as directed for obtaining an antagonizing 
 model when a dental substitute is required for only one 
 of the jaws. 
 
 When the plaster has become sufficiently hard, the 
 two pieces may be separated, and the wax removed. 
 This done, let a narrow rim of wax be put around the 
 convex surface of each plate, which is supposed to be 
 still connected with its own part of the model. The two 
 parts of the model may now be put together, and the 
 teeth selected and arranged on the w 7 ax, beginning with 
 the superior central incisores, then with the inferior, and 
 so on; first, with two in the upper and then with two in 
 the lower jaw, until all are selected and arranged. 
 
 As a general rule, the upper incisores and cuspidati 
 should overlap the lower, and the superior centrals 
 should cover the inferior centrals and about one-half of 
 the laterals. The upper lateral incisores should cover 
 the lower laterals, and about one-half of the inferior cus- 
 pidati, and the superior cuspidati should cover the re- 
 maining half of the lower and about one-half of the first 
 inferior bicuspides. The first superior bicuspides should 
 cover the remaining half of the first inferior and about one- 
 half of the second, and the second superior bicuspides 
 should cover the remaining half of the second inferior 
 and about one-third of the first molares. The first upper 
 molares should cover the remaining two-thirds of the first 
 lower and about one-third of the second ; and lastly, the 
 second superior molares should cover the remaining two- 
 thirds of the second inferior. The third molares, or 
 dentes sapientiae, are usually dispensed with in a set of 
 artificial teeth. 
 
 The foregoing arrangement being about that of the 
 natural teeth, should always be observed in the con- 
 struction of an artificial set, for the reason, that it adds to 
 
WITH SPIRAL SPRINGS. 401 
 
 their strength as well as to the beauty of their ap- 
 pearance. 
 
 In fitting, arranging, and antagonizing a double, as well 
 as a part of a set of artificial teeth, it is almost always 
 necessary to alter the shape of their base or the part 
 which is to be fitted to the plate, and this can only be 
 done by means of an emery wheel or grind stone. 
 
 The teeth being all properly adjusted and antagonized, 
 the operator should next proceed to make suitable sup- 
 ports for the springs. These are differently constructed 
 by different dentists, but the simplest, and if not the best, 
 that have ever been employed, consist of strips of gold 
 about an eighth of an inch in width, the sixteenth or twen- 
 tieth of an inch in thickness, and about a fourth or three- 
 eighths of an inch in length, with a shallow open socket 
 on the outside of the end towards the coronal extremities 
 of the teeth, for the head of the eyelet, perforated in the 
 centre for the reception of a screw, or simply with a very 
 narrow strip of gold, a little thicker than the head of the 
 eyelet, soldered, transversely across, a little below the 
 perforation for the screw, to prevent the spring from com- 
 ing in contact with the gums. The other extremities of 
 these supports are soldered to the plate, one on each side 
 on the outside of the teeth, at a proper point between the 
 medial line and the posterior extremities, which, in most, 
 if not in all cases, will be found to be between the second 
 bicuspides and first molares. The screw-heads should 
 be a little larger than the heads of the eyelets, which last 
 should be about a twelfth of an inch in diameter. The 
 screws need not be larger than a small knitting-needle. 
 The object of having large heads to them is to prevent 
 the springs from coming in contact with the walls of the 
 cheek. 
 
 The arm of the eyelet or the part intended to enter the 
 
402 DOUBLE SET OF ARTIFICIAL TEETH 
 
 spring should be about half an inch long, and the size of 
 the spindle or wire around which the spring is wound. 
 
 The springs should be made from eighteen carot gold 
 wire, which should be no larger than is necessary to 
 give to them a sufficient degree of power. Their diame- 
 ter should not exceed a tenth or at most an eighth of an 
 inch. Their length should be varied from an inch and a 
 half to two inches, according to the distance of the jaws 
 from each other when the mouth is opened to its greatest 
 extent. 
 
 The manner of winding the wire is very simple. It is 
 sometimes done by means of a small crank, but the sim- 
 plest way of doing it is to grasp it between two blocks of 
 wood in a small bench-vice. This done, let the upper 
 end be grasped with the wire or spindle on which it is 
 to be wound, which should not exceed, in size, a small 
 knitting-needle, by a pair of sliding tongs or a small 
 hand-vice. This then, with the end of the spindle rest- 
 ing on the blocks of wood, should be made to revolve by 
 turning it in the hand, until a coil of sufficient length 
 shall have been firmly and closely wound on the spindle. 
 
 But the construction, both of the springs and sup- 
 ports, will be better understood by the student, by an 
 examination of Plate XXIX. Fig. 8, where they are 
 represented, than by any description which can be given. 
 
 It is often necessary to employ spiral springs for the 
 support of an upper and part of a lower set of artificial 
 teeth; as for example, where only three or four teeth are 
 required on each side of the back part of the inferior 
 maxillary — six or eight of the natural teeth in the front 
 part of the mouth being present and firmly articulated. 
 The lower plate, in a case of this sort, should pass behind 
 the natural teeth which remain, and cover the alveolar 
 ridge posteriorly where they are wanting. But the part 
 
WITH SPIRAL SPRINGS. 403 
 
 of the plate which passes behind the natural teeth should 
 be thickened, by soldering another piece over it, to give 
 it the necessary degree of stiffness and prevent it from 
 bending. It is seldom, however, that a set of teeth con- 
 structed in this manner, is worn with as much comfort 
 and satisfaction as a full set, and where only five or six 
 teeth remain, it would be better to extract them and in- 
 sert a complete set at once; or if there be eight good 
 teeth, or even six, in the front part of the mouth in the 
 lower jaw, to dispense with a substitute for the others, 
 and apply only an upper set. 
 
CHAPTER SIXTH. 
 
 OF THE CONSTRUCTION OF PLATES FOR ARTIFICIAL TEETH IN 
 PARTICULAR CASES. 
 
 As the stability of artificial teeth, applied on plate, 
 greatly depends on the construction o£ the plate, it may 
 be well to describe the shape that should be given to it ; 
 in a few different cases. But the reader will be able to 
 form a more correct idea of their shape and the manner 
 of their application, from the representations given in 
 Plates XXVIII. and XXIX., than from any description 
 which can be given. To these, therefore, he is referred. 
 
 It is seldom necessary, in the application of a single 
 incisor to attach to the plate more than one clasp. If 
 this be applied to a suitable tooth, it will give to the plate 
 and artificial organ sufficient stability for all the purposes 
 to which a substitute for a single tooth can be made sub- 
 servient. The plate should be about a quarter of an 
 inch in width and carried back on the palatine side of the 
 alveolar ridge, to the second bicuspis or first molares, of 
 the same side, if either of these are remaining^ and are 
 in a suitable condition to be employed for its support. 
 But when these teeth are wanting, and no other suitable 
 tooth on this side of the mouth can be had, the plate 
 should be carried across to a bicuspis or molaris on the 
 other side, to which it should be clasped. In either case, 
 however, the plate should not be fitted up close to the 
 
PLATES FOR TEETH IN PARTICULAR CASES. 405 
 
 teeth by which it passes. A space of a twelfth or an 
 eighth of an inch should be left between it and them, so 
 that it may not become a cause of irritation to the apices 
 and margin of the gums. The anterior edge of the plate 
 should not ordinarily come so far forward over the alveo- 
 lar ridge, as to prevent the anterior part of the base of 
 the tooth from covering it. 
 
 But when from any peculiarity in the shape of the 
 bicuspides and molares, one cannot be found capable of 
 affording a sufficiently firm support for a clasp, or that 
 will not admit of the application of one sufficiently wide 
 to do this, then the plate should be extended back on 
 each side, to the second bicuspides or first molares, or to 
 the teeth which it is to be clasped. 
 
 The foregoing general directions with regard to the 
 construction of a plate for an artificial incisor, will, in 
 most instances, serve as a sufficient guide to the student 
 or young practitioner, yet cases will occasionally present 
 themselves, in which his judgment alone, will have to 
 suggest the description of plate that it will be most proper 
 to employ. 
 
 When two or more incisores of the superior maxillary 
 are to be replaced with artificial teeth applied on a metal- 
 lic base, the part of the plate to which the teeth are to be 
 attached should be from three-fourths of an inch to an 
 inch in width, and extend back on each side of the al- 
 veolar ridge to the second bicuspides, or first or second 
 molares, or whichever may afford the best means of sup- 
 port to the artificial piece to be placed in the mouth. 
 And, as in the case of the plate for a single tooth, it 
 should come as far forward over the alveolar ridge, as 
 the anterior portion of the base of the artificial teeth will 
 admit. This part of the plate, except in those cases in 
 which the gums are never exposed in laughing, should 
 52 
 
406 PLATES FOR TEETH IN PARTICULAR CASES. 
 
 be covered by the artificial teeth to prevent its presence 
 from being detected. 
 
 A plate of this description when firmly secured by a 
 clasp to a bicuspis or molaris on each side of the mouth, 
 will afford a secure support to substitutes for all of the 
 incisores and even the cuspidati; and artificial teeth thus 
 applied, may be made to subserve to a very great extent, 
 all the purposes of the natural organs whose loss they 
 supply. 
 
 In constructing a metallic base for the incisores, cuspi- 
 dati and bicuspides, the plate should be shaped very much 
 like the one last described, except that it should be about 
 the same width all the way round. It should be accu- 
 rately fitted to the teeth to which the clasps are to be 
 applied, and be fully one inch in width. The loss of all 
 the teeth in the upper jaw as far back even as the dentes 
 sapientiae, may be replaced with artificial teeth attached 
 to a plate of this description. But when it is to be clasped 
 to the second molares, if the third be wanting or have 
 been removed, it should be extended back to the maxillary 
 tuberosity on each side, to prevent its weight, together 
 with that of the artificial teeth, from acting unequally and 
 prejudicially on the organs that sustain it. 
 
 It frequently becomes necessary to supply the loss of 
 one or more upper incisores as well as the bicuspides and 
 sometimes one or two molares on one side of the mouth, 
 by means of a plate secured by clasps to teeth on the 
 other side. In cases of this sort, the plate should be 
 made to cover such parts of the alveolar ridge as are to 
 be supplied with artificial teeth, and to fit up closely to 
 the teeth to which it is to be applied, and when practica- 
 ble, the second bicuspis and second molaris should be 
 selected for this purpose. By attaching clasps to the 
 plate at points a little distant from each other, greater 
 stability will be secured to the piece. 
 
PLATES FOR TEETH IN PARTICULAR CASES. 407 
 
 It is seldom necessary, in the application of substitutes 
 for one or two bicuspides on each side of the mouth, to 
 extend a plate across from one side to the other. Two 
 separate plates may be employed, and each made fast to 
 a molaris. When thus applied, they are worn with more 
 comfort and satisfaction by the patient, than when the 
 plate is extended all the way across the mouth, however 
 accurately it may be fitted. 
 
 In constructing a plate for artificial substitutes to sup- 
 ply the place of all the natural teeth in the upper jaw, 
 except a single molaris, it should be about one inch in 
 width, and made to cover as much of the alveolar ridge 
 as possible, and to all the inequalities of which, it should be 
 accurately fitted. It should extend back of the remain- 
 ing natural tooth to the tuberosity of the bone, which it 
 should cover. The clasp should be wide and applied in 
 such a manner as to keep the plate in its proper place. 
 A single molaris may oftentimes be made the means of 
 support to a plate with twelve or thirteen artificial teeth 
 for a number of years, but as a general rule, when there 
 is only a single tooth remaining, it is better to extract it 
 and apply a whole upper set upon the atmospheric pres- 
 sure or suction principle ; for the reason, that the opera- 
 tion can be made more perfect and durable. 
 
 Most dentists are in the habit, in the application of 
 artificial teeth upon the last-mentioned principle, to make 
 the plate wide enough to cover the whole of the roof of 
 the mouth, but in doing this, it is impossible to fit it with 
 as much accuracy to the various inequalities of the parts 
 as can be done, when a narrower one is employed. A 
 plate, an inch or an inch and a fourth in width can, for 
 this reason, be made to adhere more firmly than a much 
 wider one. 
 
CHAPTER SEVENTH. 
 
 OF ARTIFICIAL OBTURATIONS AND PALATES. 
 
 Before giving a description of the mechanical contri- 
 vances most proper to be employed for remedying the 
 various defects met with in the palatine organs, it will be 
 proper to offer a few general remarks concerning the 
 nature and extent of the injury to which these parts are 
 liable. 
 
 ABSENCE OF A PORTION OF THE PALATINE ORGANS. 
 
 Imperfections in the palatine arch, involving a loss of 
 substance, always interferes, in proportion to their nature 
 and extent, with the functions of mastication and deglu- 
 tition, and this difficulty is greatly aggravated, when the 
 defects here, are accompanied by malformation of the 
 jaws. But notwithstanding the inconvenience to w T hich 
 an individual, labouring under an affection so distressing 
 as that of the absence of the whole of the palatine arch, 
 and even a portion of the anterior part of the alveolar 
 border, together with a fissure of the upper lip, they do, 
 nevertheless, manage to perform these functions; and it is 
 curious to see how readily an infant, thus affected, draws 
 from the breast of its mother or nurse, the aliment which 
 it requires for its sustenance and growth. The plan 
 which it adopts to effect this process, is very curious. 
 
ABSENCE OF A PART OF PALATINE ORGANS. 409 
 
 The nipple, instead of being taken upon the top of the 
 tongue, is carried beneath it, and this organ, as is ob- 
 served by M. Delabarre, is thus made to perform the 
 office of an obturator, by being applied to the roof of the 
 mouth and closing the opening through it. It now, by 
 the contraction of its lips and depression of its tongue, 
 draws the milk from the breast. 
 
 Unconscious of the imperfection in its palate, it does 
 not perceive, as is observed by the author just mentioned, 
 until the period approaches, when it should begin to 
 make its wants known by words, the great importance of 
 a distinct articulate voice. This function, in conse- 
 quence of which, is little cultivated. Every word being 
 badly articulated, it <e makes no effort to render itself in- 
 telligible. All the sounds are nasal, and resemble a dull 
 murmur, difficult to understand, and disagreeable." Nor 
 can age enable the unfortunate individual to give a much 
 more distinct utterance to words. 
 
 Imperfections of the palatine arch are sometimes con- 
 genital; at other times they are the result of disease, or 
 of mechanical violence. The former are seldom unac- 
 companied by a fissure of the upper lip, and sometimes 
 two, and the division or perforation of the palate, is 
 always along the median line. This description of 
 defective formation, extends both to the bones and soft 
 parts, causing the cavities of the nose to communicate with 
 that of the mouth.] There is much variety in them, in 
 some, there is deficiency of the velum pendulum palati, 
 or soft palate; in others, there is a fissure extending 
 through the whole roof of the mouth, both the bony and 
 soft parts being divided. 
 
 [There is sometimes too, a complete division of the al- 
 veolar border, oftentimes accompanied, by great distortion 
 of the jaw-bone. Mr. Fox, describes a most extraordi- 
 
410 ABSENCE OF A PART OF PALATINE ORGANS. 
 
 nary case, which came under the care of Mr. Heaviside.* 
 He says.] It was in a young gentleman born with a 
 double harelip; the upper jaw bone projected considerably 
 under the nose. When the time of dentition arrived, 
 three teeth came in this projecting piece, and the ap- 
 pearance of the mouth was as in Plate XXII. Fig. 1. 
 At the time that Mr. Heaviside was first consulted, he 
 advised that no operation should be attempted until the 
 young gentleman had arrived at an age when the success 
 of the operation would have no chance of defeat from 
 childish resistance. When he was about six years of 
 age, Mr. Heaviside began to perform the operation ; at 
 that time he dissected from the bone a piece of skin 
 which grew upon the upper surface; he then sawed off 
 the projecting piece, with three teeth in it, Fig. 2. Twelve 
 months afterwards, he performed the operation for hare- 
 lip on one side. He then left his patient for another 
 year, when he performed the like operation on the other 
 side. The piece of skin that had been attached to the 
 upper surface of the bone, formed the central portion of 
 the lip; and when the cure was completed, the face ap- 
 peared as in Fig. 3, having a most perfect symmetry, and 
 free from any deformity. 
 
 [It is to be regretted, that the extent of the imperfection 
 in the palatine arch in the foregoing case, is not described. 
 Nor does it appear from the history which the author has 
 given of it, that any surgical operation was performed, or 
 mechanical contrivance applied to remedy this part of the 
 defect. But when recourse is had to mechanical means 
 as a substitute for the absence of any portion of the roof 
 of the mouth, or palate, it should not be, until after the 
 completion of the growth of the jaws, and it may be, that 
 the employment of means for remedying the defect in 
 
 * Vide Plate XXII. 
 
ABSENCE OF A PART OF PALATINE ORGANS. 411 
 
 these parts, was for this reason deferred to a later period 
 of life, which may not have been until after the publica- 
 tion of this work. 
 
 M. Delabarre, who in his work on mechanical dentis- 
 try, treats of the subject in question at some length, 
 divides accidental leisons of the palatine organs, into 
 three species. The first is circumscribed by the osseous 
 substance. The second consists of a perforation of 
 the velum of the palate only; and the third, in the 
 destruction of the entire vault of the palate, or at least, a 
 great part of it; and to these ravages, is sometimes added, 
 says the author just named, the loss of the inferior portion 
 of the vomer and the cornets. 
 
 "The two first," says Delabarre, "are most frequently 
 situated on the side of the palatine raphe, thus penetrating 
 only a single nostril." He then adds, that, whatever be 
 the extent, form and position of these accidental leisons 
 the victims of them have not the advantage of the young 
 infant; for having acquired the habit of eating by placing 
 their food on the tongue, they always force a certain 
 quantity of it up into the nose. The natural tone of the 
 voice is destroyed, articulation of words, in some cases, 
 where the loss of substance is very considerable, is wholly 
 prevented. They also affect deglutition as well as the 
 voice. The case of a young man, is mentioned by the 
 above named writer, who, suffering from a division of 
 the velum palati, could swallow no fluids, "without a 
 part of them being returned by the nose." He however 
 managed to remedy to some extent, this difficulty, by 
 throwing his head back, and letting them run into the 
 oesophagus. Similar examples of effects resulting from a 
 loss of a portion of the palatine organs have fallen under 
 the observation of the editor. 
 
 In the destruction of the solid tissues which enter into 
 
412 CONSTRUCTION OF OBTURATORS. 
 
 the formation of the roof of the mouth, the soft parts 
 participate. Nor does the injury always stop here. It 
 frequently extends to the nose, lips and cheeks; the 
 greater portion of which, are sometimes destroyed, giving 
 to the unhappy sufferer, the most hideous and frightful 
 appearance, but as it constitutes no part of the design of 
 the editor to treat of the means employed for remedying 
 defects in these parts, although the aid of art is often 
 invoked, and has in many instances supplied the loss 
 with useful and ingenious mechanical contrivances, he 
 will not in this place, attempt to give a minute description 
 of them. 
 
 Imperfections of the palate may oftentimes be remedied 
 by surgical means — by an operation, denominated staphy- 
 loraphy, said to have been first instituted by a French 
 dentist by the name of La Monnier, and who first per- 
 formed it about the year 1764. M. Roux, a French 
 surgeon, is the author of an excellent memoir on this 
 operation, which was published in 1825. It is also 
 minutely described by Dr. Hullihen of Wheeling, Va. 
 in a well written paper in the fifth volume of the Ameri- 
 can Journal of Dental Science. But with the surgical 
 treatment of leisons of the palatine organs, the editor at 
 present, has nothing to do; his object being merely to 
 describe the mechanical means employed for remedying 
 them. 
 
 OF THE CONSTRUCTION OF OBTURATORS. 
 
 The employment of obturators to supply the abscence 
 or replace the loss of a portion of the palatine arch, was 
 resorted to, many centuries ago, but their construction, 
 for a long time, was exceedingly faulty, and as a conse- 
 quence, the wearing of them was not only attended with 
 
CONSTRUCTION OF OBTURATORS. 413 
 
 inconvenience, but was also productive of actual injury. 
 They were retained by means of a piece of sponge. 
 This instrument, according to Guillemean, was applied 
 by the Greek physicians, who called it hiperari. But as 
 the disease to which the destruction of the palatine 
 organs were supposed to be only attributable, was not 
 known at so early a period, some have questioned the 
 correctness of the above statement. On the other hand, 
 it has been shown, that dental abscesses have been known 
 to give rise to necrosis and exfoliation of the bones of the 
 palate, and that hence it is rendered very probable. 
 
 The celebrated French surgeon, Ambrose Pare, gives 
 an engraving of an obturator which he had constructed in 
 1585, which consisted of a plate, probably of gold or 
 silver, applied to the opening in the palatine arch, and 
 retained by means of a piece of sponge, secured with a 
 screw to an upright attached to the upper surface of the 
 plate. The sponge, by absorbing the moisture in the 
 nostrils, swelled sufficiently to prevent the plate from 
 falling. But this description of obturator is the most 
 objectionable of any that has ever been employed. By 
 the stagnation of the fluid in the sponge, we are told, and 
 as any one might readily suppose, it soon becomes so 
 insufferably offensive, as to render the approach of an indi- 
 vidual almost impossible. Besides, the sponge not only 
 counteracts the efforts made by nature to effect a cure, 
 but it has been found, that it gradually enlarges the 
 opening. The following case, quoted from Lefoulon, 
 and by this author, from a memoir upon obturators, by 
 M. Baillif, a dentist of Berlin, is in point. 
 
 "The 1st of November, 1824," he says, "Dr. Siedmo- 
 grodzki presented himself to me with M. de ***, who 
 had had the misfortune to lose his nose, and part of the 
 
 53 
 
414 CONSTRUCTION OF OBTURATORS. 
 
 vault of the palate ; by a siphilitic malady, in the years 
 1807, 1808. 
 
 The hole formed in the anterior of the palate was ten 
 millimetres long and eight wide. 
 
 To remedy these accidents, an artificial nose had been 
 made for him, and an obturator formed of a plate of fine 
 silver, furnished with a sponge, such as recommended by 
 Ambrose Pare, Gariot and other practitioners of our 
 days. The compression which the sponge of the said 
 obturator had caused upon the maxillary and palatine 
 bones, during the period extending between the years 
 1808 and 1824, has so dilated the parts, that all the max- 
 illary and palatine vault is consumed entirely, without 
 any sign of disease, and in an imperceptible manner, 
 leaving nothing but the velum and uvula at the posterior 
 part. The anterior part of the maxillary bones is so thin 
 that they are separated at their suture, in such a way that 
 the obturator could no longer be applied. 
 
 In short, the opening, which was only twelve milli- 
 metres long and fourteen broad, to day presents the 
 enormous extent of ten inches long and an inch and a 
 half broad. Such was the deplorable situation of this 
 patient, who could not articulate a single syllable. All 
 the sounds that she could utter by any effort, amounted 
 to no more than a kind of bellowing. 
 
 This fact proves incontestibly, that we should banish 
 from use, obturators sustained upon the lateral parts by 
 the compression of sponges; also, those w T ith wings, 
 plates and flat springs, because they dilate and destroy 
 every part which they touch either by compression or 
 friction." 
 
 In speaking of the application of any appliance which 
 may interfere with the curative efforts of the economy, 
 Bourdet, thus judiciously remarks. " Before considering 
 
CONSTRUCTION OF OBTURATORS. 415 
 
 the cicatrized perforations of the palate as being of a 
 nature incapable of diminishing in diameter, practitioners 
 should satisfy themselves properly and beyond doubt that 
 such is the case. I do not think so, for positive facts 
 attest the contrary, and as holes made in the cranium 
 with the trepan, close almost entirely, in like manner, 
 those of the palate constantly diminish." The juxta- 
 posed obturator proposed by Bourdet, and as improved by 
 Delabarre, is free from the objections of those fastened 
 with sponge, or lateral wings or slides, which, for a 
 long time, were employed. The obturator contrived by 
 Bourdet consists of a metallic plate, large enough to cover 
 the opening in the palate, accurately fitted, with two 
 lateral prolongations extending to the teeth and to which 
 they were fastened by means of ligatures. But as the 
 ligatures were productive of irritation to the gums, and 
 did not hold the plate sufficiently tight to prevent it from 
 moving, it found but little favour among dentists. Both of 
 these objections, however, were obviated by the improve- 
 ment made by Delabarre, which consisted in the em- 
 ployment of clasps, attached to the lateral branches of 
 the plate, instead of ligatures, for fastening it to the teeth. 
 And to prevent these from slipping, he attached to each a 
 small metallic spur, which, descending between the teeth, 
 was bent below over its grinding surface. To this im- 
 provement he made another equally valuable, not only 
 for the purpose for which he applied it in a case he 
 relates, in connection with the description he gives of it, 
 viz. to supply the loss of substance and prevent an accu- 
 mulation of mucus in the cul de sac, resulting from the 
 wound being closed only on the side of the mouth, but 
 also, to prevent fluids in swallowing, from passing be- 
 tween the obturator and soft parts, through the opening 
 into the nostrils, which by the contraction of the muscles 
 of the palate are sometimes slightly raised. 
 
416 CONSTRUCTION OF OBTURATORS. 
 
 This last improvement consists in the application of a 
 drum to the top of the plate, which, to use the author's 
 own words, " resembles a man's hat, the crown of which 
 is very low and enters the opening." It is fastened to the 
 plate by means of two screws. He supplied his patient 
 with several of these, gradually diminishing in size, so 
 that as the opening closes, a smaller one may be put on. 
 
 A copy of the engraving of the obturator just de- 
 scribed, as given by M. Delabarre in his Treatise on 
 Mechanical Dentistry, may be seen in Plate XXX. 
 Fig. 5. 
 
 The manner of constructing an obturator after the 
 above plan is very simple. First, let an impression be 
 taken in wax of the palatine vault, and alveolar ridge, 
 then procure a plaster and metallic model and counter 
 model, in the manner as before described. Between the 
 last, let a gold plate be stamped, large enough to cover 
 the opening in the palate, with an arm on each side ex- 
 tending to a bicuspis or molar tooth to which a broad 
 clasp should be soldered. Second, let an impression of the 
 opening be now taken, and from this another plaster and 
 metallic model and counter model obtained, and a plate 
 smaller than the first stamped — to the upper surface of 
 which, it should be fitted and made fast by soldering. 
 But the drum should never be so large as to press against 
 the walls of the opening. But this last, should never be 
 applied, except absolutely required, to prevent the pas- 
 sage of fluids into the nostrils. 
 
 Every part of the mechanism should fit with the most 
 perfect accuracy, and in such a manner as not to be pro- 
 ductive of the slightest irritation to the soft parts, and as 
 in the case of the insertion of artificial teeth, the health 
 of the natural teeth and their relative and contiguous 
 parts should be previously secured. This should never 
 
OBTURATORS AND PALATES WITH TEETH. 417 
 
 be lost sight of, as the success and durability of the ope- 
 ration will greatly depend on it. The obturator too, 
 should be removed and thoroughly cleansed two or three 
 times every day, as also the teeth to which the clasps are 
 applied. 
 
 A plate of gold replacing nearly the whole of the loss 
 of the entire palate, may be applied in the manner as 
 just described. 
 
 OF OBTURATORS AND PALATES COMPLICATED WITH ARTIFI- 
 CIAL TEETH. 
 
 The loss of one or more teeth oftentimes accompanies 
 the destruction of the palate, and when this happens, the 
 substitute for the latter should be connected with that for 
 the former, and the idea of complicating the two with 
 each other, was first suggested by Fouchard. When 
 there are healthy and firmly articulated natural teeth re- 
 maining in the upper jaw, such substitutes may be ad- 
 vantageously connected, but the mechanism, as intimated 
 by Delabarre, would be too heavy to be sustained by 
 lateral wings. 
 
 "But we find," says the author just mentioned, "in vol. 
 50, page 386, of the Journal of General Medicine, the 
 description of a dental obturator, presented to the So- 
 ciety of Medicine, by M. Touchard, surgeon dentist, of 
 Paris, similar to the one he had applied for a man who 
 had lost the two medial incisores, the lateral incisores, 
 the canine and the first bicuspis of the right side, and all 
 the part of the maxillary bone, in which these teeth were 
 situated, as w r ell as a portion of the ascending apophysis 
 of the same side, and finally nearly the anterior half of 
 the bony plate which forms the palatine arch. Notwith- 
 standing the loss of osseous substance, the opening which 
 
418 OBTURATORS AND PALATES WITH TEETH. 
 
 formed the accidental communication between the nose 
 and the mouth, was only an inch in diameter, and round. 
 M. Touchard thought that in perfecting the obturator 
 described by M. Fouchard, he might apply it advan- 
 tageously in the case in question. Consequently, he 
 made it of two distinct parts, one of which was an obtu- 
 rator of gold, the lower side concave, and the upper pre- 
 sented a round elevation, destined to be inserted in the 
 opening of the palatine arch. The other was a piece of 
 hippopotamus, to which he gave the form of the missing 
 portion destroyed by the disease, and into this human 
 teeth were inserted. 
 
 The obturator and teeth were firmly united by means 
 of a metallic staff, dove-tailed, in the posterior part of the 
 latter. Two elastic plates of gold proceeding from the 
 sides of the instrument and pierced with holes, passed 
 behind the remaining teeth on each, and by their ten- 
 dency to separate from one another, served to maintain 
 the apparatus in its place.' 5 
 
 After giving the foregoing description, M. Delabarre 
 remarks, '-'the learned dentist entrusted with the report 
 of this obturator, has judiciously observed, that the pro- 
 longed action of the elastic plates, would result in the 
 loosening and displacement of the supporting teeth. Not 
 only am I of this opinion, but I have had occasion to test 
 that machines, however wanting in elasticity, always ope- 
 rated to the detriment of the organs against which they 
 acted. " 
 
 Again, he says, " M. de Chamant has engraved in his 
 opusculi on mineral paste teeth, a dental obturator, which 
 occupied the place of the incisores, the coronoids and the 
 four bicuspides; and he has shown me another mode 
 after the same plan, and supported by lateral ligatures. 
 We perceive all the advantage resulting from the employ- 
 
COMPLETE PALATE WITH ARTIFICIAL TEETH. 419 
 
 nient of porcelain, whenever there is occasion to replace 
 the loss of substance when it is as considerable as in the 
 case just mentioned. Finally, as it is essential to take 
 care of the supports, it is not proper to make use of the 
 elastic plates advised by M. Touchard, nor the ligatures 
 used by Fouchard and M. de Chemant, but the elastic 
 compressors (clasps) may be applied with more advan- 
 tage." 
 
 When the loss of substance is very great, instead of 
 having recourse to porcelain block teeth, the better plan 
 is, to make a raised or box plate, as the latter would be 
 much lighter, and as a matter of course much less cum- 
 bersome than the former. The plate should be made of 
 twenty-one or two carot gold, and be no thicker than is 
 absolutely necessary. Plate XXX. Figs. 3 and 4 rep- 
 resents an obturator and plate complicated with artificial 
 teeth. 
 
 But in the construction of a dental obturator, the den- 
 tist will always have to be governed by the circumstances 
 of the case, and therefore, no rules can be laid down from 
 which it will not be necessary occasionally to devaite. 
 By reference, however, to the illustrations given in Plate 
 XXX. the reader will be able to obtain such general 
 knowledge of the subject, as will enable him to give the 
 proper construction to the mechanism for any case in 
 which his aid may be sought. 
 
 OF THE CONSTRUCTION OF A COMPLETE PALATE WITH A SET 
 OF ARTIFICIAL TEETH. 
 
 The following is a description of a most ingenious con- 
 trivance planned by M. Delabarre for replacing the loss 
 of the palate, together with most of the teeth in the su- 
 
420 COMPLETE PALATE WITH ARTIFICIAL TEETH. 
 
 perior maxillary. He says "the most serious case which 
 can be presented is that which I am about to relate. An 
 individual had lost, in consequence of siphilis, all the 
 bony and membranous arch of the mouth, and also the 
 greater part of the upper teeth, among which were the 
 lateral ones, which would have been the most favourable 
 to be embraced by the hooks, (clasps.) I thought of 
 constructing a mineral set of teeth, surmounted by an 
 arch and velum of platinum, bearing upon sides of the 
 cavities a circle surrounding the parts to be supplied. 
 Inside of this circle was encased a very light box, 
 though representing the thickness and figure of the naso- 
 palatine floor, so that by this means, I restored to each of 
 the cavities the form it had before. This being done, I 
 supported the obturator by springs which took their in- 
 sertion upon a metallic case which enclosed the lower 
 dental arch. 
 
 The machine subserved a part of the object; that is to 
 say, the nose and the mouth were separated by it; the 
 patient however still spoke through his nose, because the 
 soft portion of the palate w T as wanting. It was then ne- 
 cessary to replace this. I could have constructed a cover 
 and a movable plate in metal, as the goldsmith Cadot, of 
 whom Cullerier speaks, has done. But I preferred gum 
 elastic. I wished to employ the mechanism of degluti- 
 tion for my purposes, which w r ere that the artificial cover 
 should raise and fall every time the passage of food, and 
 even that of saliva, should be effected from the mouth 
 into the pharynx. Consequently the tongue became the 
 means of putting the mechanism in motion, and this lat- 
 ter was disposed of to this effect, in the following manner. 
 
 I made an oval window in the fore part of the plate; I 
 then placed a valve which clasped itself hermetrically and 
 which was held in place by means of an axis and a small 
 
ARTIFICIAL PALATE AND NOSE. 421 
 
 very soft spring. To this plate was soldered a lever 
 which passing backward, rested on another which was 
 held in a see-saw position by an axis. This last lever 
 was enough to reach the extremity of the principal plate, 
 and it was flattened, so as to fasten to the movable ve- 
 lum, which itself was attached to the pharyngeal border 
 of the instrument. 
 
 During deglutition, the point of the tongue, applying 
 itself, pressed upon the valve, which transmitted to all the 
 other parts the movement impressed upon it. Thus the 
 velum was raised, and from a vertical, assumed nearly a 
 horizontal position ; in such a way that neither solid food 
 nor drinks could escape into the nasal, cavities. This 
 plate, complicated with the artificial teeth, was yet by no 
 means heavy, for the plates were of very thin platina, 
 soldered with fine gold. The patient derived great ad- 
 vantage from it, both in mastication and deglutition, and 
 in the articulation of words." 
 
 It is possible that a piece of mechanism, such as the 
 one just described, might be made to answer, to some ex- 
 tent, the purposes for which that was designed, but hap- 
 pily, cases seldom occur which call for so complicated an 
 apparatus. A copy of the engraving which the author 
 has given of it may be seen in Plate XXX. Fig. 6. 
 
 Although constituting no part of the design of the edi- 
 tor, to treat, in this place, of the prosthesis of any other 
 organs than the palatine and maxillary, he will, in conclu- 
 sion, subjoin the following description of an artificial palate 
 complicated with an artificial nose, as well as with artificial 
 teeth, furnished at his request, by his brother Dr. John 
 Harris, formerly of Georgetown, Ky, The subject of 
 54 
 
422 ARTIFICIAL PALATE AND NOSE. 
 
 which ; a young lady, the editor had an opportunity of 
 seeing about twelve months since, and so neatly was the 
 mechanism constructed and applied, that none but a very 
 close and critical observer, would suspect it to be the work 
 of art. 
 
 Annapolis, July 28, 1845. 
 
 Dear Brother, — Your letter of this morning requesting 
 me to send you by return of mail a description of the arti- 
 ficial nose and palate which I made for the young lady of 
 Scott County, Kentucky, is now before me, but received 
 too late to enable me to comply with your request, but I 
 will endeavour to do so by the next succeeding mail. 
 
 I very much regret, from the novelty and importance of 
 the case, that you had not allowed me more time, but I 
 will endeavour to do the best I can. 
 
 The subject of the affliction requiring the artificial ap- 
 purtenances referred to, is, Miss A. C, now about twenty 
 years of age, of high personal and family respectability. 
 
 When but little past infancy, she lost her nose and the 
 central portion of the soft and bony palate, about three- 
 fourths of an inch in length and three-eighths in width, 
 commencing about five-eighths of an inch in rear of the 
 front teeth and extending backwards. 
 
 I have no knowledge of the cause that led to the af- 
 fliction, only that it was preceded by inflammation, 
 ulceration, and general constitutional derangement. 
 
 When about twelve years of age she submitted herself to 
 be operated on for an artificial nose, in Cincinnati, Ohio, 
 by Dr. M. The design of which was to supply the 
 defect by the transfer of integument from the arm, over 
 the deltoid muscle, called the rhynoplastic or telecopeon 
 operation. 
 
 To say nothing of the expense, pain and suffering 
 consequent upon the operation, and the jeopardy her life 
 
ARTIFICIAL PALATE AND NOSE 423 
 
 was placed in, as soon as her health would admit, she 
 returned to her home, in a much worse condition than 
 when she left it. 
 
 To add to her misfortune, before she left the city, or 
 had fairly recovered from the effects of the first operation, 
 mortified with her now aggravated condition, as a last 
 alternative, she had a nose manufactured of wood by a 
 Mr. Rostang, resident dentist of the same city, and con- 
 fined in its position by means of spectacles, and an artificial 
 palate, to which the nose was connected by intermediate 
 fixtures, passing through the palatine fissure. 
 
 As might have been expected, the subsequent devel- 
 opment of the maxilla and other parts soon rendered the 
 whole apparatus useless, though not until it had destroyed 
 the three teeth, which had been selected as a support to 
 the palate, by means of as many rough, badly constructed 
 and arranged clasps. 
 
 About four years ago, at which time I was consulted in 
 her case, her teeth and relative parts exhibited the fol- 
 lowing appearance, viz. several of her teeth besides the 
 three irrecoverably injured by the clasps, were more or 
 less decayed: some of which quite loose; the gums and 
 adjacent soft parts much inflamed, tumefied and spongy, 
 the dental arch and general dimensions of the mouth, 
 (whatever it might ever have been) was evidently very 
 much collapsed or contracted, say to nearly one-half of the 
 usual size, as was evidenced by the position of the 
 superior cuspidati, now standing parallel to each other 
 and nearly in contact, between which there had been the 
 usual number of incisores and of the ordinary dimensions, 
 and which were lost when she was about ten or eleven 
 years of age. 
 
 Although the design and plan of the apparatus was a 
 good one, for the accomplishment of the purpose for 
 
424 ARTIFICIAL PALATE AND NOSE. 
 
 which it was intended, its premature application was 
 unquestionably productive of the worst of consequences, 
 and to which the contraction of the mouth may principally 
 be ascribed. 
 
 Her timidity arising, no doubt, from the recollection of 
 her previous suffering, gave me no little trouble in obtain- 
 ing her consent, to the course of practice which I recom- 
 mended, but after explaining what must soon be her 
 condition, she reluctantly yielded her assent and permitted 
 me the full exercise of my judgment in the management 
 of her case. 
 
 The removal of the three teeth previously referred to, 
 was immediately effected, as also all deposits of salivary 
 calculus. 
 
 In about eight weeks, with the usual treatment, the 
 soft parts of her mouth were restored to health. The 
 local maladies of her teeth were next attended to, and in 
 some four weeks, thirteen carious places, after the usual 
 preparatory treatment, were filled with gold foil. 
 
 With the mouth thus restored to health, but one ques- 
 tion could arise as to the propriety of supplying my 
 patient with another palate, &c, that was, if the max- 
 illary organs have not attained their full development, 
 the same destructive consequences might be produced, 
 as was from the other palate. 
 
 From the circumstance of her advanced age, I did not 
 much fear this would be the case, though, had I been 
 governed entirely by my own inclination, I should have 
 deferred all further proceedings to some more remote 
 period, but in this I was overruled, by not only my fair 
 patient herself, but by all her family connections, and 
 as yet, I have not had cause to regret the course I took. 
 
 I therefore constructed a palate of fine gold upon the 
 usual plan, with only two clasps, made broad and heavy, 
 
ARTIFICIAL PALATE AND NOSE. 425 
 
 one on the left and one on the right margins of the palate, 
 embracing two of the soundest and most suitable teeth. 
 
 To the convex or superior surface of the palate one 
 end of a piece of gold wire three-fourths of an inch long, 
 was soldered at a point corresponding with the fissure — 
 from front to rear, and on a line extending between the 
 two teeth embraced by the clasps, describing the centre of 
 action; the wire or upright was then bent forward and 
 upwards so as to pass through the fissure and present the 
 upper end parallel with, and at a convenient distance 
 from, the anterior opening of the naries, — this place of 
 attachment I found necessary, that no unequal or undue 
 pressure might result from the weight and action of the 
 superincumbent parts upon the palate. 
 
 A screw was now cut on a platina wire, for one-half 
 inch, made to fit in a corresponding one, made through 
 the upper end of the upright wire, on a level with the 
 external opening of the nose; upon the other or anterior 
 extremity of the horizontal platina wire, a hook or catch 
 was made as a support to the nose by means of a gold 
 loop attached to the septum of the artificial nose, the 
 tightness of the nose to be regulated by screwing the hori- 
 zontal wire in or out, and its position by bending the up- 
 right backwards or forwards. 
 
 The length of the horizontal wire is one inch, the size 
 or strength needs no further description. 
 
 It is now about four years since the operation was com- 
 pleted, and thus far, I have heard no complaint. 
 Yours, affectionately, 
 
 John Harris. 
 
 The dentist, although seldom called upon to replace 
 the loss of the nose with an artificial substitute, yet the 
 manner of doing it should be understood by him.] 
 
EXPLANATION OF PLATES 
 
 TO 
 
 PART THIRD. 
 
 \ 
 
A 
 
PLATE XXVIII 
 
 FROM SUBJECTS FURNISHED BY THE EDITOR. 
 
 Fig. 1. A front and side view of a porcelain tooth with 
 a wood pivot or tenon, for the replacement of 
 the crown of a superior central incisor. 
 
 Fig. 2. A front view of a porcelain tooth with a metallic 
 pivot for the replacement of the crown of a 
 superior central incisor, with a representation 
 of the pivot before it is fixed in the tooth. 
 
 Fig. 3. A wax holder made of tin for taking an impres- 
 sion of the upper jaw. 
 
 Fig. 4. A wax holder for taking an impression of the 
 front and right side of the upper jaw. A sim- 
 ilar one should be employed for taking an 
 impression of the front and left side. 
 
 Fig. 5. A wax holder for taking an impression of the 
 lower jaw. 
 
 Fig. 6. A porcelain substitute for the left central incisor 
 of the upper jaw, mounted on plate, to be 
 clasped to the first molaris of same side. 
 
 Fig. 7. A porcelain substitute for the left central incisor 
 of the upper jaw, mounted on plate, to be 
 clasped to the first molaris on each side. 
 
 55 
 
 \ 
 
PLATE XXIX. 
 
 FROM SUBJECTS FURNISHED BY THE EDITOR. 
 
 Fig. 1. Porcelain substitutes for the two central incisores 
 of the upper jaw, mounted on plate, to be 
 clasped to the second bicuspides. 
 
 Pig. 2. Porcelain substitutes for the upper incisores and 
 cuspidati, mounted on plate, to be clasped to 
 the first molares. 
 
 Fig. 3. Porcelain substitutes for the upper incisores, cus- 
 pidati and the left bicuspides, and first molaris, 
 mounted on plate, to be clasped to the first 
 bicuspis and first molaris on the right side. 
 
 Fig. 4. Porcelain substitutes for the upper incisores, 
 cuspidati and bicuspides, mounted on plate, to 
 be clasped to the first molares. 
 
 Ftg. 5. Porcelain substitutes for the upper incisores, 
 cuspidati, bicuspides and first and second left 
 molaris, mounted on plate, to be clasped to 
 the first right molaris. 
 
 Fig. 6. Porcelain substitutes for all the upper teeth, ex- 
 cept the dentes sapientiae, which are generally 
 omitted in an artificial set, mounted on plate, 
 to be applied upon the atmospheric pressure 
 and suction principle. 
 Fig. 7. Porcelain substitutes for all the teeth of both 
 jaws, except the dentes sapientiae, which are 
 omitted, mounted on plates with spiral springs. 
 Fig. 8. A spiral spring, with its attachments, before be- 
 ing fixed to the plates. 
 
PLATE XXX. 
 
 Figures 1, 2, 3, and 4, are from original subjects, fur- 
 nished by the editor, the others are copied from Fouchard 
 and Delabarre. 
 
 Fig. 1. An obturator, for an opening of about half an 
 inch in diameter through the palatine arch, to 
 be clasped to the first molares. 
 Fig. 2. An obturator similar to the last, but for covering 
 
 a much larger opening. 
 Fig. 3. An obturator complicated with the two central 
 
 incisores. 
 Fig. 4. An obturator complicated with the incisores, cus- 
 piclati, bicuspides, and the first and second 
 molares of the left side of the mouth, clasped 
 to the dentes sapientiae, which were sound and 
 firmly articulated. The original of this was 
 constructed after the plan adopted by Dr. 
 Koecker, for restoring a similar defect. On 
 the left side of the mouth, the alveolar border 
 had been destroyed, and there was a large 
 opening into the antrum as well as through 
 the roof of the mouth. 
 Fig. 5. A representation of an obturator constructed by 
 Delabarre with a drum on its upper surface. 
 Fig. 6. A representation of a complete palate, w r ith four- 
 teen teeth, constructed by M. Delabarre. 
 
 s 
 
432 PLATE XXX. 
 
 Fig. 7. A representation of a palate obturator with 
 the uvula, to be held up by wings, copied 
 from M. Delabarre's Mechanical Dentistry, 
 but constructed by Cadet. 
 
 Fig. 8. Represents an obturator constructed by M. 
 Delabarre, to be retained in the mouth by 
 elastic compressors. This instrument is an 
 improvement on one invented by Bourdet, 
 which was held up by means of ligatures 
 applied to a tooth on each side of the 
 mouth. 
 
 Fig. 9. Represents a winged obturator, invented by 
 Fouchard, the wings turning on a pivot. 
 This obturator is inserted by placing one 
 wing above the other, and when put in 
 place, the wings are turned by means of a 
 key in opposite directions, which prevents 
 it from falling. 
 
 Fig. 10. Represents another winged obturator invented 
 by Fouchard and applied by means of a 
 key. It is held in its place, by means of a 
 piece of sponge in connection with the 
 wings. 
 
Flat*. ZS. 
 
 f^ / 
 
 Fig.Z. 
 
 94 
 
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INDEX. 
 
 A. 
 
 Abrasion of the teeth, mechanical, 252. 
 Abscess, alveolar, remarks on, 275. 
 
 fomentations to cheek, for the relief of, 278. 
 remarkable cases of, 282, 283. 
 seldom cured, except by removal of tooth, 276. 
 treatment of, extraction when the gums are inflamed 
 
 recommended, 277. 
 when produced by dentes sapientiae most painful, 277. 
 Abscesses, formation of, 105. 
 Acids, their deleterious effects on the teeth, 300. 
 
 used in analysis of the teeth, 124. 
 Adhesion of the lips and cheeks from excessive use of mercury, 312. 
 Adjustment and adaptation of artificial teeth to gold plate, 388. 
 Alveoli, description of, 286. 
 
 absorption of, not independent of local irritation, 290. 
 diseases of, 288. 
 growth of, 30. 
 Anatomists, former views of, on the destruction of temporary roots, 73. 
 Antrum maxillary, description of, 317. 
 diseases of, 318. 
 effects of diseased teeth on, 319. 
 polypus in, and cancerous affections of, 320. 
 treatment of, 322. 
 Apparatus for grinding artificial teeth, 376. 
 Arch, palatine, imperfections of, 408. 
 Arnold's view of dental germs, 47. 
 Arteries, dental, 59. 
 
 distribution of, 60. 
 Atrophy of the teeth, 58. 
 
 B. 
 Backings for artificial teeth, 390. 
 
 56 
 
 \ 
 
434 INDEX. 
 
 c. 
 
 Calculus, salivary, description of, 296. 
 
 formation of, and pathological condition of the general 
 
 system, favourable to its production, 296. 
 its effects, 297. 
 
 meaus necessary to prevent its accumulation, 298, 299. 
 Canal, dental, formation of, 30. 
 
 preparation of, for reception of pivot, 374. 
 Care necessary on the part of those who wear artificial teeth, 398. 
 Caries, dental, arresting progress of, in temporary teeth, 106. 
 
 agency of diet in its production, considered, 168. 
 
 constitutional causes, 167. 
 
 dependent on hereditary predisposition, 170. 
 
 first manifestation of, 158. 
 
 frequently caused from defective formation of the teeth 
 only, 166. 
 
 internal, doctrines of, refuted, 165. 
 
 of permanent teeth, 157. 
 
 predisposing causes of, 166. 
 
 prevention of, 172. 
 
 produced by pressure, 171. 
 
 progress of, 157. 
 
 proximate cause of, 160. 
 
 results from chemical agents, 161. 
 
 treatment of, 176. 
 Cementum of the teeth, and formation of, 56. 
 Clasps for holding artificial teeth, their construction, 365. 
 Climate, its influence in producing caries of the teeth, considered, 169. 
 Constitutional effects of dentition, 112. 
 Convulsions, causes of, in children, 113. 
 
 Cooper's, Mr. Astley, observations on vascularity of dental pulps, 51. 
 Crowns of teeth, manner of excising, 371. 
 
 D. 
 
 Decay of temporary teeth, 105. 
 
 Dentes sapientiae, formation of, 42. 
 
 Dentifrices, description of, for the prevention of tartar, 299. 
 
 Dentition, diseases of, 108. 
 
 erroneous notions of, 108. 
 
 mechanism of, by M. Delabarre, 109. 
 
 symptoms of, 110. 
 Diarrhcea, causes of, in children, 113. 
 
 treatment of, 1 14, 1 15. 
 
 i 
 
INDEX. 435 
 
 E. 
 
 Effects of clasps on the teeth considered, 397. 
 Enamel, analysis of, 125. 
 
 removal of, by denuding process, 249. 
 defective formation of, 57. 
 
 formation, hardness, and composition of, 52, 53. 
 Eruption, cutaneous from dentition, 112. 
 
 Excavating caries, its importance, and the difficulty attending it, 192. 
 Excavators, dental, description of, 191. 
 Excrescences of the gums, removal of, by ligatures, 268. 
 Exostosis of the teeth, 238. 
 
 case of, 242. 
 probable causes of, 244. 
 symptoms of, 239. 
 Experiments with chemical agents, their effects on the teeth, 162. 
 Extraction of teeth, remarks on, 209. 
 
 directions for those of the incisores and cuspidati, 220. 
 manner of, 219. 
 
 objects of, and reasons for, 210. 
 of bicuspides and molares, 222. 
 of roots of teeth, 229. 
 
 F. 
 
 Fangs of teeth, formation of, 39. 
 ossification of, 57. 
 temporary, absorption of, 61, 67. 
 Files for teeth, best shape of, &x., best manner of using them, 183. 
 Filing, its bad effects in the regulation of teeth, 171. 
 custom of savage nations in relation to, 180. 
 for removal of caries, highly beneficial, 171. 
 manner of, in order to prevent reapproximation of teeth, 182. 
 root of tooth for the reception of artificial crown, 374. 
 Foil for filling teeth, proper manner of introducing it into, 194. 
 Fomentations to face, when necessary, 278. 
 Forceps for extraction of teeth, remarks on their superiority, 214. 
 
 for extraction of bicuspides of both jaws, inferior cuspidati, and 
 
 inferior dentes sapientiae, 217. 
 for inferior incisores, 218. 
 for inferior molares, 218. 
 for superior dentes sapientiae, 217. 
 for superior incisores and cuspidati, 215. 
 for superior molares, 216. 
 
 \ 
 
436 INDEX. 
 
 Forceps, number requisite, 215. 
 
 their formation described, 215, 218. 
 compound root, description of, 231. 
 
 G. 
 
 Goodsir's views of the formation of dental germs, 47. 
 Gumboils, produced by decayed stumps, 174. 
 
 influence on the general health, 174. 
 Gums, diseases of, 260. 
 
 preternatural growth of, and treatment, 265, 266. 
 
 lancing of, in difficult dentition, 118. 
 
 H. 
 
 Hemorrhage after extraction of teeth, 237. 
 
 mode of arresting it, 237. 
 Hunter's, John, views on structure of the teeth, 62. 
 
 I. 
 
 Impressions of the mouth, how taken, 354, 381. 
 
 Incisores, ossification of, 50. 
 
 Inflammation of membrane in nervous cavity, 162. 
 
 Instruments for extraction of roots of teeth, directions for the use of the 
 
 elevator, hook and screw, 230. 
 Irregularity of teeth, the treatments necessary to remedy, 87, 93. 
 
 caused by cuspidati, 93. 
 
 construction of appliances for the remedying of, 88. 
 
 four states of, 95. 
 
 time most suitable for its correction, 96. 
 
 varieties of, 88. 
 Irritation, consequent upon dentition, 111. 
 
 J. 
 
 Jaw-bone, exfoliation of, caused by diseased tooth, 280. 
 
 exfoliation of, caused by use of mercury and by small-pox, 312. 
 articulation of, 326. 
 
 its movements resembling that, both of the graminivorous and 
 carnivorous animals, 326. 
 Jaw, inferior, alveoli of, more liable to absorption than superior, 292. 
 
 its motion produced by five pair of muscles, 327. 
 Jaws, mal-conformation of, 77. 
 accretion of, 78. 
 diversity of opinion concerning their increase, 81. 
 
INDEX. 437 
 
 K. 
 
 Key instrument, remarks on, 210. 
 
 directions for the use of, 233. 
 
 L. 
 
 Lancing the gums, beneiits of, in dentition, 118. 
 
 Lancet, gum, description of, and the parts necessary to be lanced, 120. 
 
 Luxation of lower jaw, reduction of, 325. 
 
 how produced, and liability of its recurrence, 328. 
 
 manner of relieving, various means spoken of, 330. 
 
 prevention of, 331. 
 
 M. 
 
 Matrix, dental, transformation of, 69. 
 Maxilla, foetal, development of, 29. 
 Membrane, dental, preformative, 56. 
 
 destruction of, 58. 
 Membranes, dental, vascularity of, 45. 
 Mercury, its effects on the teeth, 309. 
 
 deleterious, and fatal effects of, as exhibited in the case of a 
 
 patient in Guy's Hospital, 311. 
 its influence on the gums ; renders them more susceptible to 
 
 future morbid affections, 316. 
 produces no direct effect on the teeth, 315. 
 symptoms of its presence ; manifested by looseness of teeth 
 and soreness of the gums, 309. 
 Models, metallic, how obtained, and metals necessary for, 382, 383. 
 
 antagonizing, how obtained, 388, 399. 
 Molares, first, their liability to decay, 94. 
 
 permanent, anterior, formation of, 41. 
 ossification of, 41, 51. 
 Mouth, its healthy condition necessary for reception of artificial 
 teeth, 369. 
 
 N. 
 Nasal and palatine apparatus, constructed by Dr. John Harris, 422, 425. 
 Necrosis, dental, remarks on, 245. 
 causes of, 246. 
 
 confined particularly to the front teeth, 245. 
 treatment in the early stages of, 246. 
 Nerves, dental, distribution of, 60. 
 
 method of destroying, 207, 208, 373. 
 
438 INDEX. 
 
 o. 
 
 Obturators, artificial, 408. 
 
 complicated with artificial teeth, 417, 418. 
 construction of, their former imperfection and con- 
 sequences, 412 — 415. 
 improvements on, by M. Delabarre, 416. 
 
 P. 
 
 Paces, its use in the extraction of teeth, 212. 
 Palates, artificial, 408. 
 
 with sets of artificial teeth, 419. 
 Peduncle of dental sac, observations on, 109. 
 Perpendicular extractor, 213, 
 
 Phthisis pulmonalis, indicated by transparency of the teeeth, 174. 
 Pivoting method of inserting artificial teeth, manner of, 356. 
 Pivot teeth, mannner of inserting, 370. 
 
 Pivots, suitable materials for, and manner of preparing them, 377. 
 tubed, for escape of pus, with holes in artificial crown, 379. 
 with gold in centre, 378. 
 with groove on side for egress of matter, 379. 
 Plate, gold, for artificial teeth, its thickness and purity, 365. 
 
 box, recommended, in some cases, 388. 
 confined by atmospheric pressure, 366. 
 manner of stamping, fitting and attaching 
 clasps to, 384. 
 Plates, construction of, in particular cases, 404 — 407. 
 Plugging the teeth, when indicated, 186. 
 
 as recommended in case of exposed nerve, 188. 
 in such way as to admit the escape of pus, 188. 
 so as to prevent pressure on exposed nerve, 188. 
 suitable instrument for, 191, 194. 
 the difficulties of, 193. 
 the proper material for, 189. 
 when improper, 187. 
 Porcelain, its use in the manufacture of teeth, 359. 
 Processes, alveolar, description of, 286. 
 
 absorption of, not independent of local irritation, 290. 
 diseases of, 288 293. 
 Pulps, dental, first appearance of, 30. 
 elongation of, 52. 
 union of, 59. 
 vascularity of, 44 — 51. 
 
 i 
 
INDEX. 439 
 
 Processes, alveolar, rudiments of, 29. 
 Punch for the removal of roots of teeth, 212. 
 Pustules, formation of, during dentition, 113. 
 
 R. 
 
 Raschow and others, researches of, on the formation of the teeth, 54. 
 Roots of teeth, temporary, destruction of, 72. 
 
 manner of attaching an artificial crown to, 376. 
 
 manner of preparation of, for artificial teeth, 371. 
 
 temporary, non-absorption of, 68. 
 
 the condition necessary for the reception of artificial 
 crowns, 363. 
 
 S. 
 Sacs, dental, their appearance when given off, 45. 
 Scaling the teeth, manner of applying the instruments, 306. 
 
 description of instruments necessary for its performance, 307. 
 Scrofulous habits in children, and their consequent liability to tumours 
 
 and excrescences of the gums, 272. 
 Scurvy of the gums, 261. 
 
 how marked, 261. 
 
 treatment of, in the more advanced stages, 263. 
 treatment of, in the incipient stages, 262. 
 Sockets of teeth, inflammation of, indolent kind, 282. 
 
 formation of, 41. 
 Soldering teeth to plate, preparation for and manner of, 391. 
 
 apparatus necessary for, 392. 
 Spina Ventosa, confined to the incisores and cuspidati of upper jaw, 247. 
 
 what it consists of, its effects and treatment, 248. 
 Springs, spiral, when used, 365. 
 Stumps of teeth, generally cause inflammation, 160. 
 Substance, granular, transformation of, 54. 
 
 carneous, remarks on, 70. 
 Substitutes, dental, temporary, 369. 
 Symptoms of dentition, 111. 
 
 T. 
 Teeth, temporary, ossification, number and division of, 31. 
 articulation of, 39. 
 composition of, 50. 
 description of, 36. 
 discoloration of, 64. 
 eruption and completion of, 32, 33, 34. 
 
 s 
 
440 INDEX. 
 
 Teeth, fractures of, and treatment for, 2-54. 
 human, analysis of, 123. 
 irregularity of, causes of, 76, 78. 
 irregularity of, prevention of, 83. 
 most suitable for the attachment of clasps, 395. 
 permanent, formation of, 35. 
 permanent, irregularity of, 76. 
 supernumerary, 103. 
 
 temporary, importance of their removal at a proper time, 82. 
 temporary, shedding of, 66, 74. 
 temporary, shedding of, time required for, 84, 86. 
 temporary, time and manner of replacement, 74. 
 artificial, arrangement of, and how antagonized, 400. 
 demand for, 357. 
 
 great improvement in their manufacture, 353. 
 insertion of, 3(32. 
 
 insertion of, on plate, and secured by clasps, 364. 
 manner of confinement in the mouth, 355. 
 Tic douloureux, description of, 202. 
 
 case of, recorded by Dr. Haighton, 202, 203. 
 Tooth-ache, arising from sympathetic affections of gums or sockets, 204. 
 remarks on, 197, 198. 
 its frequent results, 202. 
 remedies for, 201. 
 treatment of, 199, 200. 
 Tooth, carious, removal of sensitiveness for purpose of filling, 205. 
 Transplanting teeth, former practice of, 356. 
 
 immoral tendency, and baneful effects of, 357. 
 Treatment of first dentition, 104. 
 Trismus produced by dentition of molar teeth, 122. 
 Tube, gold, for pivoting when it is necessary, 375. 
 Tubercle, carneous, proofs of, 70. 
 first appearance of, 71. 
 
 V. 
 
 Vaccination, its importance, and happy influence in the prevention of 
 
 small-pox, 314, 315. 
 Vascularity of the teeth, 63. 
 
 W. 
 Wax-holder, description of, 382. 
 
 THE END. 
 
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