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[American Library of Dental Science.]
CRITICAL   INQUIRY
                FEW   FACTS

                    CONNECTED WITH


            THE   TEETH.


                 .__£___.....-
      BY GEORGE WAITE, Esq., Surgeon Dentist,
MEMBER LONDON ROYAL COL. OF SURGEONS; LECTURER ON THE PHYSIOLOGY
    OF THE TEETH; AUTHOR OF THE "SURGEON DENTIST'S MANUAL."
"Tout* d a pot. J^f*] ozzivottv.   Qf/so. IXiao.
T^
                BALTIMORE:        ^-*
PUBLISHED BY THE AMERICAN SOCIETY OF DtfvTAL SURGEOAS.
          JOHN  W. WOODS, PRINTER.

                      1846. 
 
PREFACE.
  The author has deemed it necessary to institute the present
inquiry from various theories which have been given out to the
public, these  not only  differing from the opinions of his  late
father, but also from those which he still'upholds.
  Any candid discussion of what will be herein found stated,
will  always give him satisfaction;  and he  will maintain his
doctrines no longer, if he be once convinced' that they are not
founded on physiological facts and laws of the animal economy.
          A  CRITICAL  INQUIRY.


  The  enamel of teeth, in  its proper  crystallized state, is of
extreme hardness, and affords an appropriate covering to  parts
beneath it;  but it  is nevertheless subject  to morbid changes,
these being frequently produced by neglect and by the tenor of
nature, which  formed it of extreme durability ? not being pro-
perly appreciated.                     ;                  •'
  If teeth, like substances of the mineral kingdom, had ho
vitality existing in  them, if they  were  brute productions, not
capable of interesting changes, not subservient to the principles
of life, and not under the influence of the  circulating fluids, I
would then say every thing connected with them is uninterest-
ing: but when we  see them, as the age of a child advances,
adapting themselves to the exigencies of life, and  exhibiting  a
succession of  wonderful phenomena, we cannot  but confess
that every thing relating to them is  worthy of notice, nor pay
too  much attention to those doctrines which tend towards their 
4                CRITICAL INQUIRY.

preservation, this  being a circumstance much connected  with
the comforts of life, with  a healthy temperament and a proper
digestion.
  If this be not sufficient to recommend them  to our  notice,
we may consider the sympathy which exists between teeth and
other parts of the body; the excruciating anguish which attends
a decay, where the cavity in the interior of the tooth is exposed,
swellings of the face, rheumatic affections, pain mistaken for
tic douloureux, which  is frequently produced, as well as great
constitutional irritation, fever, and other bad consequences.
  Before we proceed any further, as various misconceived ideas
may be entertained as to  the manner in which the teeth are
deposited and grow, it will be necessary to explain a few osteo-
logical points, in order that the reader may fully comprehend
the subject.
  Ossification commences  by  a determined action of the  arte-
ries to deposite ossific  matter;  and before the period of birth,
instead of bone, we only find cartilages assuming the respective
positions of the future bones;  but as the age  of the  child ad-
vances, the cartilage begins to appear red, as if blood were cir
culating in it, it grows opaque, and a small nucleus of ossifica-
tion begins and increases, according to the length and shape of
the bone.
  While  bone is being deposited, the  absorbent vessels  are  in
action, gradually removing the cartilage, and at the same  time
they give the bone its  shape, and form the cancelli and cavities,
through which vessels are abundantly distributed.  In the mid-
dle of long bones a canal is in general  perceptible, and through
this an artery is seen to pass, sending  its branches  to the  can-
celli and  towards the extremities of the bone, uniting with other
branches from the  periosteum, which  surrounds the bone, and
depositing ossific matter.
  The bones of the skull are deposited  between two membranes,
■and the bony part of a tooth on a pulp or vascular bed, while the
enamel, the external covering of a tooth, is formed from a juice
which is thrown out from the internal  lamina of  the  capsule
which invests  the pulp.
  Nothing can be more interesting  than an  inquiry into the 
CRITICAL
INQUIRY.
5
growth of teeth at an early period of life; and as the bone of a
tooth has  peculiarities  relating to  it, which are not found to
exist in common bone, there is additional reason  for making a
distinct research into every thing which presents itself at the
time of its formation.
   If we examine the jaws of a foetus prematurely born, we find
in them several  substances which are placed in the situation of
future teeth.  These substances, like sacs in appearance, are
found to consist of a membrane, enclosing a pulp, which is the
rudiments of a future tooth; as yet there is no bone on the pulp,
but  it is similar in shape to the tooth which is about to be form-
ed.  In a short time the pulps increase in size and  get firm,
and  in the course of a few weeks a blood-vessel  shoots across
the surface of that one which is to appear first above the gums.
Its vascularity increases, and a thin shell of bone is found to have
been deposited on its extreme point.  In the incisor teeth, ossi-
fication commences at  three points;  and in the other teeth, at
points corresponding to the number of future  points which are
to be found on the tooth.   Ossification still advances, and that
part  of the pulp is most vascular which is covered with bone;
the small osseous portions increase in size, gradually unite and
form one thin layer of bone, which spreads itself over the surface
of the pulp, and downwards towards the neck of the  tooth.
The bone increases in  thickness, and  a further  examination
leads us to conclude that it is formed of successive layers of
matter thrown out from the pulp.
   When the bony part of the tooth advances towards its perfect
form, from the internal lamina of the capsule, a juice exudes,
which is afterwards found to form the enamel.   The fluid is at
first  thin, but quickly  thickens, crystallizes, and becomes  the
enamel.  As to the manner in which it crystallizes, and becomes
united to the bony part  of the  tooth, various arguments might
be deduced, but the minute arteries of the capsule are the agents
instrumental in its deposition, and it may itself be considered as
a gland from which the fluid is secreted.
  It  might perhaps be well to consider the different appearances
displayed in fractured bones, the manner in which an exudation
comes from the extremities of their arteries, gets hardened, and 
e
CRITICAL  INQUIRY.
unites the two portions inseparably together; but in the enamel
of a tooth, an additional, quantity of hardening  matter is con-
tained, which gives  it its peculiarity.  The manner in which
the enamel is deposited may now be- perceived; all. solids of the
human body are formed, by the fluids, hence its cprnponent.parts
were originally in the blood, but have been separated from it. •
  No instance is on-record of the enamel of a tooth being twice
generated; this it was almost useless to  mention,.for no -parts
are left to concur in the action, the Toots of the  teeth have all
been formed, the tooth itself has taken-the situation in  the
mouth that  nature  intended it should,  and in so  doing has
forced its way through the capsule, which membrane, having
performed the function  that nature allotted to  it, shrinks  and
becomes connected to the adjacent gum. '*
  The enamel of teeth is the hardest part of the animal  body,
neither are there many material substances to  which it  will
yield.  It may be compared  to polished  steel,  being scarcely
acted on by the saw or file; but the laminated structure which
it is well known  to have, renders it more" easily affected by
chemical means.
  The strength of the enamel depends very much on the state
of the constitution at the time  of its formation., and it was then
entirely under the influence of the circulating  fluids.  In  the
mouths of weak and delicate children, although the teeth are
sometimes large and apparently good, yet  the arteries-had not
the power of forming a sufficient deposition, and  the covering to
the bony part is thin and soon decays.  Very often in the mouths
of children who have suffered considerably during the time of
teething, the .enamel is deposited in great scarcity, it being here
and .there altogether wanting, and putting on an appearance com-
monly known by the name of the honeycomb disease.  This is
by the same cause, the constitution being in a weakened state,
and the arteries having to perform functions indispensable to
existence, deposit the enamel but scantily.   This would appear
to be during only a certain space/of time, so long as  the debili-
tated state continued, for if we examine the teeth individually,
we  see on each that was being formed about the same time,- the.
peculiar appearance which I have  mentioned;  but  the part of 
CRITICAL  INQUIRY.
7
the enamel corresponding to  the neck  of the tooth which was
afterwards being formed, is in general good ; hence, when the
tooth has arrived at its proper growth, a portion of the edge may
be removed and  made smooth, and  the beauty of the mouth
considerably, enhanced.
  The  color of the enamel  likewise varies very much, some-
times white specks are discernible on it, and at other times it is
of a deep fleshy color, as if much animal matter was contained
in it.
  These peculiarities depend upon the greater or less quantity
of lime that was-separated from the blood at the time when the
enamel was being deposited,  in a similar manner as the  honey-
comb disease depends upon debility of the constitution.
  Having so far proceeded, we may now inquire into the different
causes  of decays of teeth; these may be classed as follows:—
first, a weak enamel; secondly, a peculiar formation of the tooth
itself, and a too close apposition of one to the other; fourthly, a
constitutional predisposition and neglect.
  It is worthy of notice, that  there is an appearance about the
enamel of teeth, by which a correct eye may judge of their tex-
ture, as well as their disposition or tendency to decay; and a
physiologist, well acquainted  with the nature of disease, may,
by a person's look, nearly judge as to the state of the  teeth, by
the same rule, as a child's face affords a good criterion whether
or not scrofula exists in the constitution ;  this requiring, how-
ever, a knowledge of disease and long attention.
  When teeth are in too close opposition, if their sides are fiat
and broad, and the constitution in an  unhealthy state, a decay
frequently commences between  the front upper  teeth, arising
partly from the continued  pressure, but principally from a pecu-
liarity of the saliva and mucus of the mouth, which acts on the
enamel, and causes it to lose its regular crystallized texture;
here, from the peculiar formation of the teeth, no tooth  powder
or brush can touch the diseased part, and  thus  it becomes ne-
cessary  to file down to it, and then, by  friction and the use of a
tooth powder or spirits, it  may be brought  to a hardened and
polished state.-
  Having arrived at this part  of the inquiry, it will be necessary 
8                CRITICAL  INQUIRY.

to point out a few facts which will show the injudicious method,
lately much adopted, of not brushing the teeth with an appro-
priate tooth powder; but previously to this, I  must explain the
manner in which decays commence, which  could not have
been understood by those who have spoken against their use.
  A decay almost always commences  in  some obscure part of
the mouth, where part of the tooth is not exposed to friction, by
different substances there lodging and acting on the enamel.
  It is well known that by chemical means we can dissolve
the whole of a tooth; if, therefore, there is  contained in the sa-
liva, in the mucus which we find in the morning in the mouth,
or in substances which we put into the mouth, any such ingre-
dient, even in a small quantity, it must in some measure soften
the texture of the enamel.   A  decay in its primary  or incipient
state, is no more than a roughness ; but this affords a convenient
lodgment to substances very deleterious  to the enamel.  In a
short time the part of the enamel most exposed to the action we
have considered, is  much softened and  discolored, the decay
points inwards, increases and soon attacks the bony part of the
tooth, which, being of a softer texture  than  the  former sub-
stance, is more  easily eaten  away.   The caries  still further
continuing its progress, exposes  the nerve in the interior of the
tooth, and causes pain  and inflammation.   Such is  the manner
in which  I have, with an  unbiassed judgment, observed  the
progress of a decay. I took as much care as possible in making
my experiments, not to try them to prove any favorite hypothe-
sis, but to be able conscientiously  to assert  facts, as deduced
from miscroscopic observations, and my  theories I  hope always
to be able to support.
   The necessity of putting a polish and preventing the lodgment
of offensive matter on the part where the decay is about  to be-
gin, must evidently be seen;  but  a  brush  itself is insufficient
to do this, and  a tooth powder must be resorted to.  It is  here
necessary to  make a  selection—the powder must contain no
acidity, it must be hard enough  to remove  any  adventitious
substance from the surface  of the tooth, but much softer  than
the enamel.
   A very wide difference exists in the mouths  of different per- 
CRITICAL  INQUIRY.
9
sons; some mouths collect very  little  tartar, insomuch  so, that
a brush alone, or merely wiping the teeth with a towel, is suffi-
cient to keep them  clean ;  whilst  in  others it collects in such
abundance, that even by tooth powders it is impossible to brush
it off; and the accumulation goes  on  increasing, sometimes in
an incredible manner, and eats its way down between the edge
of the gum, which is loose round the tooth and the root, causing
considerable irritation.   The use of the tooth powder is  here
however very serviceable, and it  must  be remembered that the
accumulation is principally behind  the front teeth of the lower
jaw, which, from their  situation  and shape  are with difficulty
got  at;  but were they differently shaped, and as great  care
taken of them at their back  as well as  their front part, they
would present as cleanly an appearance as in any other part of
the mouth.
  To ascertain the utility of a tooth powder, I have repeatedly
made experiments:  I have found decays commencing on the
outside  of a tooth, and  have made the  part smooth, and advised
it  to be continually brushed with a tooth  powder,  and the
caries has altogether ceased.  It  is a curious but well known
fact, that if a tooth  on one side of the mouth commences to
decay, the corresponding one on  the opposite side is in general
soon attacked.   This  has  hitherto appeared inexplicable, but
may be ascribed to the  similarity of conformation that one tooth
has  to  its corresponding one in the  opposite jaw, and to the
same cause which affects the one being likely to do so to the
other.    When operating  upon  a tooth,  I  invariably expect
something to be wrong in its corresponding one, and  have fre-
quently perceived, by means of the microscope, a decay in its
commencement, and by the  practice  I have mentioned, have
very often seen its progress arrested.
  Decays of teeth very frequently commence on the tables or
upper surfaces of the grinding teeth, owing to depressions formed
in them ; at the bottom of these depressions are small sulci, and
in these, injurious substances  easily lodge.   It was  owing to
this  that my father  so strongly  recommended the use of very
hard brushes to this part of the tooth, in order to put  a proper
polish on it;  and the enamel being  of a very firm  texture,
brushes of the  hardest bristle will not rub it away.
      2 
10
CRITICAL  INQUIRY.
  Many misconceived ideas as to hard tooth brushes, have been
deduced, owing to the attrition which goes on by one set closing
against the other; by this we frequently see  the  teeth much
worn down, and I have often observed the  back of the upper
incisors worn in a similar manner to those of the glires  or  ro-
dentia, whose teeth are adapted for gnawing—hence the mouth
of man ought to be compared to  that of three  different genera
of quadrupeds.  I deny that the brush effects this change  on
the teeth, and as  a proof of it, I refer my readers to any teeth in
their own mouth, on which much pressure falls.   It  is well
known to  those who study comparative anatomy, that the ena-
mel pervades perpendicularly the teeth of graminivorous quad-
rupeds, and that attrition still goes  on.  It  is  likewise  known
that the front teeth of the rodentia are  worn down and  left
with a  sharp edge, by the under  ones closing behind them,
and 1 need scarcely say  that this is not caused by the use of
tooth brushes.
  We may draw an analogy between the offices of the grinding
teeth of graminivorous mammalia and those of man ;  and as I
see the surfaces of the teeth worn as much in the mouth of those
who do not use hard brushes as in the mouths of those who do,
for the sake of cleanliness, and the  preservation of the  teeth, I
adhere to my late father's system, and universally  recommend
them.
  We may now  inquire  whether decays of  teeth, commence
from external or internal causes, or whether on the external or
internal part of the tooth.
  Decays  of teeth  commence both from internal and external
causes; but here a confusion has arisen, for the decay, although
arising sometimes from  constitutional causes, commences on
the external  part of the tooth.  The external  causes of decay-
are  substances which soften the enamel taken  into the  mouth,
as food or medicine.  Although decays of teeth seldom com-
mence internally, yet instances of it come under our notice,
here a blue color of the bony part is perceptible under the  ena-
mel, and the decay may be easily found by cutting down to it.
  I have  hereinbefore mentioned. that  there is a peculiarity
about the  enamel of all teeth subject to decay; but the teeth 
CRITICAL INQUIRY,
11
 which I have most frequently found attacked by  it, are those
 on which the enamel is  deficient.  Their surfaces present a
 rugged appearance, several points are seen  sticking up  on  the
 surface of the tooth, and in the depressions  where  a layer of
 enamel is most wanting to protect the parts beneath, it is found
 not to have  been deposited, the result must unfortunately be
 anticipated.  When the tooth has its  original and appropriate
 covering, it is  frequently incapable of resisting the action of
 substances which lodge on  its  upper surface; then, as  this is
 the case, how will the bone, which is  soft  and porous, be able
 to resist that which the enamel could  not? a wide  difference
 exists between there being no enamel  corresponding to these
 depressions, and when we deprive  a tooth of part of it by the
 file, in order  to prevent a  decay from increasing.   The  follow-
 ing cases, relating to teeth subject to decay, it may be  worth
 while noticing:'—
   In the mouth of a young lady, aged fourteen, of  a delicate
 habit, the enamel was deficient in all the  teeth, (the  dentes
 sapientias were not yet formed ;) before I attended her, she had
 lost the  second bicuspis, the two  grinding teeth of the upper
 jaw on  the left side, and the  first grinder of the lower jaw;
 every remaining tooth in her head, except those  in  front, were
 attacked by decay, and some of them in a serious manner.
   Another case, almost similar, presented itself, where all of the
 teeth, except those in front, were attacked by decay; but in this
 mouth there was a slight peculiarity, the two front incisors were
 large and perfect, but the lateral ones were wanting;  and it ap-
 peared as if nature had been making an effort to  add  a little
 beauty to the mouth, and that the juice destined to form the one
 had been wasted on  the other.
  A third case was in the mouth of a  young nobleman, of an
 illustrious family:  on all of  the teeth the enamel  was deficient,
 great care had been taken  of his  mouth, the bicuspides being
 near the  front of the  mouth, were easily cleaned  and remained
 sound, the first grinders had been filled with gold and preserved,
 and as  soon  as the  second appeared  they required a  similar
 treatment.  I might relate numerous cases,  but an operator will
 not have much difficulty in practically observing them.   This
will benefit him much more than any narration that can be given. 
12
CRlTiOAL  INQUIRY.
                      PART  II.

   I purpose now mentioning a disease or process which  is one
of the most curious to which the human frame is incident, and
its intricacies and peculiarities have  rendered it  hitherto inex-
plicable.
   I do not profess herein to lay down theories which I say must
be correct, or to unravel mysteries  which  other authors have
not done; but I wish to prove, contrary to the statements of the
present dentists, that the process of denudation, as it has been
called, and a receding of the gums from the necks of the  teeth,
depends either on a peculiar state of the system, or some  consti-
tutional cause.
  At a certain time of life, or after the administration of certain
medicines, which  act principally upon  the  absorbent system,
the gums  frequently recede, owing to the thin prominent edges
of the sockets being exposed to  its action ;  and here sometimes
a  curious  appearance presents itself, this,  however, varying
greatly.   The  most  frequent  appearance  of the disease is  a
groove, which is  formed at  the neck of the  tooth, extending
round it.   This  is sometimes  of a semi-elliptical shape, and
sometimes triangular,  having the exact appearance as if a  file
had passed round it;  and I have seen  it in the triangular state,
extending in such a  direct line along all  the teeth, from  the
canine backwards, that it would be almost impossible for any
one, not versed in the laws of nature, to imagine  but that it was
the work of art.
  Owing to an improper conception  which most  dentists have
of the power of absorption peculiar to  vessels destined for this
office, as well as an incorrect idea of the deposition in early life
from the arteries, absurd and unscientific statements have been
given out, endeavoring to prove  that this disease  and an absorp-
tion of the sockets, a process unavoidable as we advance in years
and approach old age, perfectly  natural to the animal  economy,
and incident to the   human race in every  climate, should be
caused by the accident of a simple tooth brush ;  but the fallacy
of these representations may  easily be  conceived  by those who 
CRITICAL  INQUIRY.
13
have paid attention to the immortal works of the late Mr. John
Hunter.  Although the cause of the denuding process appeared
to him intricate, yet, from circumstances, he states  it to be an
original disease of the tooth.  If he had attributed it  to the ac-
tion of the absorbents, he must then have recalled theories, and
made many of his experiments appear  by no means  compli-
cated.  It is well known that he denied the existence of vascular
action  in the bony part of a tooth ; he allowed that it possessed
life, but that was  a vitality peculiar to itself and independent of
circulation;  he  made various experiments—he transplanted
teeth into the combs of cocks, and they fastened.  At the result
of these experiments he  was well  pleased, for his conception of
the bony part made this appear  improbable  to him.  After his
opinions were given out to  the  world, he  repeated his experi-
ments, and was always highly gratified at the manner in which
the teeth fastened.
  But if, with an unbiassed judgment, we  examine the succes-
sive changes of a tooth, from an early period of utero gestation
til? its fall, we see circumstances which induce us to conclude
mat it possesses a degree of life,  and that  a circulating fluid
exists  in it necessary for its  nutrition.  It is well known  that a
vascular action is more  perceptible  in young bones than old
ones;  but in the  bony part of a tooth there  is a difference, for
in adolescence this substance is of a  white color;  but in old age
it becomes red, as if blood was contained in it.
  When the bony part of a tooth  is  first deposited, the perios-
teum is not attached to it;  but whether or  not it  throws out a
juice which unites with and forms part of the bone, might per-
haps be doubted; suffice it  to say, that it becomes united to the
bone, as may clearly  be  seen  by maceration.  Little  change
takes place, generally speaking, till after  middle age, when the
waste of the body, by the  action  of the absorbents, begins to
exceed the deposition from the arteries.
  The ends of the sockets  are  thin  and  protrude, they  are ex-
posed  to the action of  the absorbents, and  are more  easily laid
hold of than other parts; the teeth all bear the  same  or addi-
tional  pressure to what they originally did, and a  part  of the
socket being removed, they are much less firm than they were. 
14
CRITICAL  I NQUIRY.
 The  result is  as  follows:—they  are  loose  and move  in  the
 sockets, the periosteum becomes irritated, and by the consequent
 determination of blood to it and the surrounding parts, they ap-
 pear much more vascular than they originally did.   Thus may
 the red appearance of the root at this time of life  be accounted
 for, but it is evident that some circulation exists in it.
   The discoloration which occurs when the vessels in the inte-
 rior of a tooth are destroyed, affords us likewise an ample proof
 of its vitality depending on a circulating fluid, for as long as it
 is nourished it retains its white color;  but when the vessels in
 the interior are destroyed, it becomes dark  and discolored, it
 adheres, however, to the socket, for vessels pass from the  perios-
 teum, serving to retain it in situ.
  Many other circumstances might be brought forward to prove
 that the vitality of a tooth depends on vascular action, but these
 it is trusted will be  sufficient.   We must now consider 4he
 denuding process;  but I think it previously necessary  to say
 something respecting the absorbent system.
  Among the phenomena of life, absorption is a process  neces-
 sary to be understood  by the medical practitioner, as the reno-
 vation, growth, and decay of parts, depend greatly on its action.
  The absorbents are  small delicate pellucid tubes, which exist
 in all  parts of the human body, in the external and internal sur-
 face of our organs, and their office is to carry into the circulation
substances adapted to the exigencies of life, as well as that
coming  away in the continued destruction of parts.
  In the intestines the lacteals take up  the  nutritious  part of
 the food, and convey it into the blood ; and in the infant, while
the process of ossification is  going on, and bone is being de-
posited  in  the  bed of cartilage, that, pro  tempore, occupied  its
place, the absorbent vessels are in strong  action, take away the
cartilage into the blood,  and make  room  for the deposition of
bone.   This is the nature of these vessels ;  but here is an om-
nipotent and admirable  contrivance, illustrative of  intent and
mechanism, plainly seen in them.
  Absorption, although less active on the external  part  of the
body,  is continually going on, notwithstanding the  epidermis,
which is perhaps insensible and inorganic, and naturally, by its' 
CRITICAL  INQUIRY.
15
thickness, rendering the process difficult.   The origin of these
vessels is thus explained in Richerand's Physiology:—
  "The radicles from whence they arise have orifices so very
minute, that they are imperceptible to the naked eye; a tolera-
bly accurate notion may be formed of them, by comparing them
to the puncta lachrymalia, which are  larger and  more easily
discovered.   Each orifice endowed with sensibility and  with a
peculiar power of contraction, dilates and contracts, absorbs or
rejects, according as it  is affected  by the  substances which are
applied to it.  The variations of the absorbing power, according
to the age,  the sex, the constitution, and different periods of
the day, show that it cannot  be compared, as several physiolo-
gists have done, to that principle which  makes fluids  ascend
contrary  to  the laws  of gravitation  in capillary tubes.   If
absorption were a process merely mechanical, it would in no
case  be accelerated or retarded, and  would  proceed  with a
regularity never observed in  the vital functions.   The mouth
of every lymphatic, when about to  absorb, erects itself, draws
towards itself, and raises the surrounding  membranous parts,
and  thus forms a small tubercle, similar to the puncta lachry-
 malia."
   In  the above allusions, I  have but slightly mentioned the
 power of the absorbents, but  it is well known that there  is a
 continued renovation  and decay going on in all  parts  of the
 system.  The thymous gland, so' perceptible, in  children, be-
 comes absorbed as they advance in age, the absorption carrying
 on decomposition with a force not to be resisted, and frequently
 producing erosions of living solids,  of which ulceration is the
 consequence..  When a sharp spicula of bone protrudes  from
 any point and causes irritation, the absorbents act on it, remove
 the irritating edges, and render it smooth, so as the  parts  heal
 over it.   We now see that not only  are soft  parts  taken up by
 these vessels, but  that bone itself yields to their action.  We
 have, in the extraction of teeth, an  appropriate  fact  connected
 with  the absorbent system;  the edges of the sockets have a
 disposition to approximate, and at the same time an absorption
 is going on, removing the part no longer useful;  so when we
 examine a cleansed lower jaw, we find only a ridge of bone in 
16
CRITICAL  INQU IRY.
the space formerly occupied by a tooth.  That the process of
denudation is by some remote cause connected with  the  ab-
sorption which takes place in the sockets, seems  highly proba-
ble, on account of the waste that exists  in the parts around.   I
have  never  yet  seen the  disease without an alteration in  the
parts around;  I  have seen it at different ages,  but most  fre-
quently after middle age, the  period at which the body  begins
to waste.  When it occurs in early  life, the  patient's constitu-
tion has in general been debilitated, and as debility is known to
be favorable to absorption, we may easily account  for the gums
receding at that period ;  for it must be noticed, that they do  not
recede at this period but  in  the mouths of those of delicate
health, or who have taken much medicine.
  Independently  of what  has been already  mentioned,  the
denuding process puts on other appearances; it sometimes  de-
prives the whole anterior surface of the teeth of their enamel,
and consequently leaves them yellow  and  unseemly;  this is
the disease in its worst state:  it generally commences from a
corner of the  tooth, and takes a slanting direction upwards.
This the late Mr. John Hunter has noticed, and its nature may
be considered very intricate.
  I have sometimes known the disease to commence, form  an
oval cavity in the tooth, and then  stop  altogether; it also fre-
quently commences on the sides of the  necks of the teeth, and
appears to cut through them with as great precision as if a saw
had been used for the purpose.  This I have seen  in  such a
situation as the brush could not touch.
  I have in my possession  several very curious specimens of
the disease;  the one most worthy of attention is, where it  has
commenced  at the  inner side of a tooth, a groove has been
formed, which takes a spiral direction, making rather more than
a turn round the  tooth, and at the bottom of this groove there
is another one, which is much smaller, appearing  as if a worm
had eaten its  way  round it.   The vascularity of the  root is
greatly increased, for it appears red as if blood were contained
in it.  I once showed this specimen to  an eminent anatomist,
and at first  appearance  he felt convinced that it was caused
either by the periosteum or the gum. 
CRITICAL  INQUIRY.
17
  I believe that 1 was the  first person who observed the peri-
osteum  at  the neck of the tooth, being with the gum more
firmly there connected  to the root than at any other part; and
it appeared probable to me, that  as  the gum receded, if  the
absorbents were in very strong action, they could easily remove
a part  of the bony part  of a tooth;  I have since seen cases
which made my suppositions appear  more probable, and these
have been strengthened by  assertions from persons affected.
  A dyspeptic patient  last  year applied to  me  to clean  his
mouth.   The gums were rather in an unhealthy  state, all  the
back teeth  were much decayed, and the mouth exhibited  a
disagreeable appearance.  I saw the  same person a few days
ago, he had been very unwell  in Edinburgh, shortly  after  his
first visit to me, and  it was  thought necessary  to administer
mercury to him ; his gums  were much affected by it, and they
now had a scorbutic appearance;  they had also  receded from
some of his front teeth, and where the recession was worst, the
denuding process had  commenced.  It had eaten  away  part of
the enamel and bone corresponding to the necks of one of the
upper and lower incisors, and on the others  there  was a rough
ragged appearance, as  if it  had been  broken down and decom-
posed.   I named the  peculiar appearance  to  my  patient, and
the  opinion of some  dentists  as  to the  brush  effecting  the
change.  He told me  that since the exhibition of mercury his
gums had been in such a very tender  state, that it had been
almost impossible for him to use the tooth  brush; but he said
he  thought it was caused by the medicine which he had taken.
I have been told the same by other patients.
   I was. applied to by a person of rank to examine  his teeth
and gums, which presented  the  following appearance:—The
gums had receded  very much  from the  necks of the  teeth, es-
pecially  on the left side of the mouth,  so  much so, that  the
division of the roots  could plainly  be  seen.  The denuding
process had commenced  on all the teeth, and had taken  the
slanting, direction from their corners ; much of the enamel  had
been removed, and the gums  had so far receded from the necks
of the teeth  internally, as  to  leave only the tips of the roots
covered   He had been told that the  loss of enamel was occa-
       3 
18
CRITICAL  INQUIRY.
sioned by repeated friction, and it was  by that, I believe, dis-
continued.   The gums became  spongy, as no  method  was
adopted to allay the irritability ensuing from one set striking
against the other, when the roots had no sockets  to support
them.  The  consequence was suppuration of the periosteum,
occasioned by the continued jar, and the blood no longer circu-
lated freely through the gums, but they became spongy, and
the teeth loosened.
   Having explained the leading points connected with the dis-
ease, we may consider  whether it  is caused by mechanical or
constitutional effects.   It commences often at a certain  time,
and then, when the health improves, stops.   We find it in situ-
ations on the teeth which the brush has difficulty  in  touching,
as well as on the  teeth of persons who seldom  brush them.  It
has a peculiar shape, which it would not have if caused by the
brush; and I have never seen it without observing a change in
the parts all around : I mean an absorption of the sockets, which
has caused the gums to recede.
   That the disease  is curious, every one must allow; for the
enamel of teeth, although originally in  the mass of blood cir-
culating through the system, has become hard and crystallized.
The power of the  absorbents is wonderful; so is  that of the
gastric juice in the stomach.   When  a sharp  spicula of bone
protrudes from any one point, it at  first  causes considerable in-
flammation, but in process of time the absorbent vessels remove
its sharp edge ; and when the waste of the body  exceeds the
deposition  from the arteries, the  absorbent vessels  easily lay
hold of the thin prominent edges of the sockets, and convey
them into  the blood.  Thus  it will  be perceived that  a change
can be produced on bone, and we may account for the disease
commencing at the neck of the tooth.   But doubt  may  arise
whether these vessels can so far carry on decomposition as to
take away the enamel; this I do not altogether pretend to de-
cide ; but I certainly must deny that  the change  is  produced
by the action of a tooth brush.
  Another misrepresentation has been given out, the  absurdity
of which 1 must mention, namely, that a receding of  the  gums
is likewise occasioned  by the use of tooth brushes.  In the 
CRITICAL  INQUIRY.
19
mouths of people of every nation, and of every class of society
we see it; many of these never use tooth brushes ;  the absorp-
tion commences when it is to be expected,  after  middle age, or
after the exhibition of medicines which rouse  the absorbents
into action.  If we examine the lower jaws of indentulous indi-
viduals, we  see  the  sockets of the teeth completely  removed,
the depth of the bone is considerably shortened, the chin  pro-
jects, and a deposition of osseous matter has been going on in
the bottom of the sockets, so that they are quite unperceived.  If
the gums  were worn  down by the action of the  brush, the tips
of the sockets  would  be left protruding.
  For the last  ten years of my life, I have perhaps brushed my
teeth and gums harder than  any person in England.  I may
say that I have endeavored to rub them  away, but  in  vain;  I
have  sometimes gone so  far as to make  them sore,  but the
result I find is this, that  the  soreness heals in  an almost in-
credible manner, that the next morning there is a somewhat
cartilaginous deposit on  them, exuded  from  the  openings of
vessels  on their surface, sometimes  perceptible to the naked
eye, and that when healed there  is an increase rather than  a
decrease.
  The structure of the gums is certainly parenchymatous, and
from  the  vessels principally composing  it, other minor ones
pass, which open on their surface by minute orifices.  This
renders a  free circulation  through them particularly necessary,
for the small  vessels become easily choked up, and the blood
remains coagulated in them.   Nothing is more adapted to giving
them strength and a  healthy appearance than repeated friction.
I see no justifiable reason for speaking against it, but my sincere
wish  is that every  doctrine which can tend to the benefit of
mankind  may be  promulgated.  If those  who  assert  that the
gums are  rubbed away by the brush, instead of receding as the
socket absorbs, can  give me any physiological  reason why  it
should  be so, I will then be tenacious about  recommending
friction to them; at the same time I trust that  I  have scientific
principles and  common sense to hold me out;  and  am embol-
dened by an  additional  reason, viz.  that these principles were
at an early age held out to me by my late father. 
 
SUPPLEMENT.
                   EXCISION.

  At the present period nothing is aimed at but novelty, nor do
many productions succeed which follow the regular line of going
on;  and while men of science pursue honorable and just means
to bring themselves into notice, their  reputation is frequently
surpassed by contemporaries brought forward by  some lucky
coincidence.
  The operation which we are about to notice, consists simply
in laying hold of a tooth with a large pair of cutting forceps, as
high up as possible  towards the  extremity of the roots, and
pressing the handles firmly together ;  it must however be no-
ticed, that different instruments are required, each adapted  to
the shape of the neck of the tooth that is painful.
  If we take a tooth and split it, or saw it across corresponding
to its neck, we find in the middle of it a cavity, which contains
a portion of the pulp still remaining.  It was the pulp that ori-
ginally deposited the  bony part  of the teeth, and it is found
greater or less, according to the age of the patient.  In young
people it is large, and in old ones much less perceptible.
  If we look at the bottom  of the root of a tooth, we find a small
hole through which vessels  pass ;  but the root of a  tooth is
formed later than the crown; and if we examine a tooth extract-
ed from the mouth of a young person, we find a large passage
through the root to the internal cavity.
  It will be seen that the operation of excision  must  be most
successful when performed in the mouth of an elderly person,
the internal cavity is more filled up, and  there is  not so much
danger of cutting directly through  the  extremely  sensible part
contained in it.
  The operation  points out  no new facts  to  London  dentists. 
22
EXCISION.
 All hospital pupils are well aware that when by an  unskilful
 extraction they leave the roots of a tooth in a patient's jaw, the
 part of the  tooth is no longer so liable to pain as it was, and
 they endeavor to console the poor sufferer  with this fact.  But
 if the vitality of the root  be destroyed  by the operation, it re-
 mains in  the jaw as an obtrusive and dead part, and finally pro-
 duces an  abscess in the gums.
   The principal advantage gained by  breaking  or cutting off
 the crown of teeth is, that the stumps remain in the socket and
 prevent its sides from approximating; and I have heard an emi-
 nent continental dentist with whom I resided, propose the ope-
 ration in question, when  a female has  wished to preserve her
 teeth, that her good looks might not be impaired.
   We have pointed out an inconvenience from stumps deprived
 of life remaining in the  jaw.   I recollect continually hearing
 my foreign friend say, " Ces chicbts nefont jamais du bien  dans
 la bouche."  I am perhaps a little biassed to his opinion, but
 have, under peculiar circumstances, both recommended and per-
 formed the operation now called excision.
   We  will now suppose the remaining part of the tooth to have
 much life left in it; the nerve which passed up originally to the
 internal cavity, and which was  furnished with a  covering, is
 exposed, and pain and a susceptibility  to inflammation is the
 consequence;  this however  is much less  when the tooth has
 been cut  off high  up.   The operation, however,  like  filing a
 tooth, leaves behind it some sensibility, but  this becomes di-
 minished  by a frequency  of impressions.
  With respect to the  expansion of the  nerve of a tooth, a mis-
 take has certainly arisen; a nervous ganglion  or plexus would
 have been better applicable to the seat of pain, more especially
 in the grinding teeth, where  two or more  filaments pass up
 through the roots, and become united in the pulp.   The cavity
 is for  containing the  remains of the pulp, and this  becomes
 diminished in size as we  approach our dissolution.
  The subject would be unexplained, did  I not make some re-
marks respecting tooth-drawing.   For this purpose, a large pair
of forceps, instead of a claw, has  been  lately brought  into use
by an eminent dentist, who after my father's death came  to re- 
EXCISION.
23
side as my opposite  neighbor.  But when surgeons attempted
to use these instruments, generally, instead of extracting the
tooth, they severed it into two parts, consequently performed the
operation for excision, but without much nicety;  they were not
cautious enough about getting hold of the tooth high up towards
the roots, and cut directly through the gum and internal vascu-
lar part, putting their patient  to  great  torture.  The circum-
stances which led them into error were as follow: they went to
instrument  makers, and indiscriminately  purchased forceps
more  adapted for  excision than any other purpose.  I should
therefore feel gratified  if, by these  hints, I  have thrown  any
light on their use; their edges  ought neither to  be sharp nor
turned too much inwards.   This I had at an  early period of life
explained to me, and during my stay on the continent, and at
the London hospitals, have always preferred using them.   I
must lastly give my readers  one caution, that is, to draw.a defi-
nition between cutting and extracting forceps. 
 
 
i