XeV-' ON 
T E E T I: . REMARKS 
ow 
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Liverpool . . J. Cornish, Lord Street REMARKS 
UPON 
ARTIFICIAL TEETH 
AND UPON THE STATES OF 
THE MOUTH IN WHICH THEY SHOULD 
AND SHOULD NOT BE USED 
WITH A DESCRIPTION OP THE MATERIAL BEST SUITED TO PARTICULAR CASES 
AND 
%n 
SHOWING THE SECONDARY DISEASES PRODUCED BY DECAYED TEETH 
BY 
SAMUEL ADAMS PARKER 
Licentiate in Dental Surgery of the Royal College of Surgeons of England, Surgeon-Dentist 
to the Queen’s Hospital and to the Birmingham Dental Dispensary, 
Member of the Odontologies! Society, &c. &c. 
BIRMINGHAM 
CORNISH BROTHERS, 37 NEW STREET 
LONDON: LONGMAN, GREEN, LONGMAN, AND ROBERTS 
1862 TO 
JOHN TOMES, ESQ., F.R.S. 
SURGEON-DENTIST TO THE MIDDLESEX HOSPITAL AND THE DENTAL 
HOSPITAL OF LONDON. 
My dear Sir, 
You have permitted me to dedicate this 
little work to you; and to whom could I so properly 
offer this fruit of my labour as to one who holds 
the first place amongst British Dental Pathologists, 
and who has laboured so hard and so successfully to 
place Dentists in the rank they now occupy, and to 
give them a status and a position they did not before 
possess ? 
Believe me, with every sentiment of esteem and 
respect, to remain 
Your obliged and faithful former Pupil, 
SAMUEL ADAMS PARKER. PREFACE. 
When I consider the very rapid progress that 
has been made within the last few years, and, 
indeed, within the last few months, in the in- 
vention of materials of which artificial teeth 
are composed, and in the mode of their con- 
struction and adaptation, it seemed to me pos- 
sible to glean out of the large field of valuable 
knowledge thus opened some few remarks for 
the especial benefit of those who are about 
to adopt the use of such appliances. 
It has been my desire to put before my 
readers in a popular form, as many of the 
most important particulars relative to the art 
of mechanical dentistry as may best serve to 
guide them in their choice of the material 
most suitable to their own cases. It will be 
observed that I have directed particular atten- VIII 
PREFACE. 
tion to the proper preparation of the mouth 
previous to the insertion of artificial teeth. 
My remarks will be found to bear mainly 
on the defects produced by the loss of the teeth 
and on the best means to be adopted in order 
to repair such loss, and it is hoped that the 
illustrations at the end will tend to throw some 
additional fight upon the subject. 
In the Appendix following the remarks 
upon artificial teeth, will be found considered 
one of the most important subjects in dental 
surgery, viz. the evil effects produced by re- 
taining diseased teeth and stumps in the jaws. 
The cases illustrating this portion of my 
work, have been carefully selected from up- 
wards of 9,000 patients in Hospital, Dispensary, 
and private practice; and in order that the 
subject may be more fully illustrated, I have 
selected some few cases of interest from other 
valuable sources. 
18 Colmobe Row, Birmingham. CONTENTS. 
CHAPTER I. 
PAGE 
Defects arising from the Loss of the Teeth . . 1 
Reasons for inserting Artificial Teeth as soon as the 
Natural ones are lost ...... 4 
CHAPTER II. 
Effects produced by the Loss of the Natural Teeth . 8 
Treatment of the Mouth previous to inserting Arti- 
ficial Teeth ....... 10 
CHAPTER III. 
Materials employed in the Construction of Artificial 
Teeth ........ 20 
Use and Abuse of Clasps round Sound Teeth for the 
Purpose of retaining Artificial Teeth in their Place 23 
The Application of a Single Tooth on a Gold Plate, 
its Fastenings, &c. . . . . .30 
The Application of Four Teeth mounted on a Gold 
Plate, their Fastenings, &c. ..... 32 
The Application of several Teeth mounted on a Vul- 
canized Indiarubber Base, for restoring the general 
Contour of the Face and assisting Mastication . 33 
The Application of Teeth for the purpose of Mastica- 
tion, their Fastenings, &c. ..... 34 X 
CONTENTS. 
PAGE 
Artificial Teeth retained in the Mouth by Atmospheric 
Pressure ........ 36 
Complete Sets of Artificial Teeth and their Fasten- 
ings 39 
CHAPTER IV. 
Vulcanized Indiarubber as a Material for the Base of 
Artificial Teeth ....... 40 
Its Superiority over Bone and Ivory, &c. . . 42 
Other Advantages to be obtained by using Vulcanized 
Indiarubber ....... 44 
Advice to those wearing Artificial Teeth . . .49 
Advice to those about to adopt Artificial Teeth . 53 
Concluding Remarks ...... 54 
Explanation of Plates . . . . . .57 
Plates ........ ib. 
Appendix, showing the Secondary Diseases produced 
by decayed Teeth 58 
Cases .66 ON 
ARTIFICIAL TEETH. 
CHAPTER I. 
DEFECTS ARISING FROM THE LOSS OF THE 
TEETH. 
I intend in the following pages to direct the 
attention of my readers to a minute portion 
only of the wonderful mechanism by which 
life is supported, and upon the harmony or 
breaking up of whose constituent parts either 
healthy or morbid conditions of the body 
depend. 
And yet, though these observations will 
apply to a very small portion only of the body, 
few will be bold enough to deny that this sub- 
ject is not one of very great importance, 2 
DEFECTS ARISING FROM 
whether it be considered in reference either to 
personal appearance, personal comfort, or even 
to the health of the individual. 
It is well known that the dental organs are 
given for the purpose of distinct articulation, 
of perfect mastication, as well as for the agree- 
able expression of the countenance. If the 
teeth be lost, either partly or wholly, the de- 
fects arising from such a misfortune soon make 
themselves painfully evident. For instance, in 
the loss of the front teeth articulation becomes 
difficult, and the face loses its distinctive cha- 
racter. By the loss of the back or molar 
teeth, the general health and strength become 
more or less affected; for the food, which is 
their allotted part to triturate and prepare for 
the stomach, is carried imperfectly masticated 
into that organ, and the function of diges- 
tion consequently becomes much impaired and 
weakened. If the machinery of the mouth, so 
to speak, loses its healthy play, it is impos- 
sible to foresee the inconveniences and disorder THE LOSS OP THE TEETH. 
3 
which may result. And in proportion as the 
art of dentistry can furnish mechanical means 
to prevent these evils when impending, or to 
cure them when present, it is entitled to the 
serious attention of the patient. 
It should be borne in mind that the per- 
manent, or second set of teeth, are not like the 
temporary, or first set. They are intended to 
perform the part given to them during the 
whole period of fife ; and here let me urge it 
upon those who are so happy as to possess a 
fine, healthy set of permanent teeth to adopt 
all prudent measures for their preservation in 
that state. 
Mechanical contrivances may be, in some 
respects, no mean imitators of nature; but in 
dentistry, as in other things, the former cannot 
be accepted as an all-sufficient substitute for 
the latter; yet it is an indisputable fact that the 
dentist can fashion teeth capable of answering 
most purposes the bodily health may require. 
He has materials at hand which enable him to 4 
REASONS FOR INSERTING ARTIFICIAL TEETH 
take the model of the mouth so accurately, and 
to adapt his substitutes so faultlessly, that the 
patient may frequently forget he has artificial 
teeth in his mouth. 
REASONS FOR INSERTING ARTIFICIAL TEETH AS 
SOON AS THE NATURAL ONES ARE LOST. 
I cannot too strongly insist on the absolute 
necessity of cleanliness as the one great pre- 
servative of teeth that are in a sound and 
healthy state. But when the least symptoms of 
decay present themselves in the teeth, let it be 
arrested without delay by stopping, or by the 
removal of the disease, or the tooth or teeth 
affected. In this latter case, so soon as the 
gums shall have closed, let the absent teeth be 
replaced by artificial ones. I have always 
deemed it successful practice to replace im- 
mediately the loss occasioned by the extraction 
of a natural tooth. 
I am convinced there is everything in my 
favour when advocating such a procedure ; for AS SOON AS THE NATURAL ONES ARE LOST. 
5 
when a tooth has been drawn, the teeth on 
the right and on the left of it have also lost their 
former support. It should be remembered, 
that in the dental organisation one tooth can- 
not act independently of its fellows, without 
risk to the perfect and healthy performance of 
its functions. Time finds out and weakens the 
teeth on either side of the one removed; there- 
fore it is the wisest plan to replace the lost 
tooth or teeth before any serious mischief takes 
place in those which are left. 
Again the antagonising tooth or teeth be- 
come partially disabled, when its opposite 
tooth or teeth have been taken away; for it 
must be borne in mind that the permanent 
teeth are so distributed that they close in the 
following manner; — the central incisors of the 
upper jaw close over the same class of teeth in 
the lower jaw, and also one half of the adjoining 
teeth on either side, and so on through the whole 
set, so that when one tooth is gone, its fellow- 
worker has partially lost its occupation. The 6 
REASONS FOR INSERTING ARTIFICIAL TEETH 
parts external too, such as are the cheeks, fall 
in, and the countenance consequently acquires 
a false expression, and an appearance of age, 
and the greater the number of teeth lost, the 
more extensive and observable will be the de- 
fect created. The late Professor Harris, of the 
Baltimore College of Dental Surgery, noticed a 
peculiarity in the mouth which may not be 
generally known (in a popular sense), and 
thence he deduces the necessity of supplying 
the loss of teeth as soon as possible after it has 
occurred. He remarks : 4 the loss of a tooth 
in one jaw is generally followed by the gradual 
protrusion from its socket of the one with which 
it antagonised in the other; so that if the loss 
of the former be replaced with a substitute of 
equal size, it will strike against the latter at 
each occlusion of the mouth, and prevent the 
other teeth from coming together. This ten- 
dency of the teeth in one jaw to protrude, is 
always in proportion to the number lost in the 
other; and if not soon counteracted by the re- 7 
AS SOON AS THE NATURAL ONES ARE LOST. 
placement of the latter with artificial substitutes, 
it often gives rise to an obstacle to their proper 
application, which will require no little in- 
genuity and tact to overcome.’ 
This may all be avoided if the teeth are 
replaced, as I have before stated, immediately 
they are lost. 8 
CHAPTER II. 
EFFECTS PRODUCED BY THE LOSS OF THE 
NATURAL TEETH. 
Only a brief glimpse at the process of diges- 
tion will serve to show the disorder caused 
in the general system by the absence of teeth, 
natural or artificial. It is true that the 
teeth are not the solvents of our food, but 
it is their function to fit it for the action 
of the gastric juice, by triturating and pre- 
paring it for the digestive process to work 
upon. 
The food when conveyed into the stomach is 
reduced by the action of its juices into a pulta- 
ceous mass termed ‘ chyme.’ ‘ Substances taken 
as food, irrespective of their relative solubility, EFFECTS OF LOSS OF THE NATURAL TEETH. 
9 
are dissolved by the gastric fluid quickly or 
slowly in proportion to their degree of permea- 
bility or comminution, or, in other words, ac- 
cording to the surface exposed to the action of 
the solvent. So it happens that a solid morsel, 
swallowed whole, may remain in a healthy 
stomach many hours before it is dissolved; while 
had the same morsel been crushed or broken up 
into many pieces, and in that process mixed with 
the saliva, and then swallowed, it would have 
been reduced to pulp in an hour. In the one 
instance the function of digestion, so far as the 
production of chyme is concerned, is duly per- 
formed ; in the other it is retarded. Hence it 
is of paramount importance that the food, be- 
fore it is introduced into the stomach, should 
be properly crushed, divided, and thus ren- 
dered pervious to the gastric juice; in other 
words, perfect mastication is necessary to per- 
fect digestion. To effect this purpose we are 
provided with a special apparatus with suit- 
able crushers, — with teeth. To the dentist is 10 
TREATMENT OF THE MOUTH 
entrusted the care of these important organs, 
to keep them in repair, and to replace them 
when lost.’ * 
TREATMENT OF THE MOUTH PEEVI0US TO 
INSERTING AETIFICIAL TEETH. 
We not unfrequently meet with individuals 
who will suffer extreme agonies rather than 
knock at the dentist’s door, for the cure which 
they would receive at the cost of an almost 
infinitesimal part of their previous pain. And 
when at last the alternative of tooth extraction 
has to be considered, the patient will meet his 
coming cure considerably more than half way, 
if instead of fancying all sorts of unreal miseries, 
he places himself in ordinarily skilful hands, 
when no doubt in nine cases out of ten his 
fears will prove to be the creations of an over- 
sensitive mind. Not so with the applicant for 
artificial teeth; he enters the dentist’s ope- 
* Tomes on Artificial Teeth, p. 12. PREVIOUS TO INSERTING ARTIFICIAL TEETH. 
11 
rating room with a light and easy mind, think- 
ing nothing more has to be done than an im- 
pression taken of the mouth (an operation 
unattended with pain), when, in due time, 
he receives his artificial substitutes. The pa- 
tient finds himself disappointed when told that 
his mouth is not in a fit state to receive the 
artificial teeth he asks for. His manner and 
conversation will frequently show that he has 
been led away by quack advertisements, such 
as it is scarcely credible any sober-minded 
person would believe. The dentist perceives 
that his patient, in this case, possesses a smaller 
or greater number of loose stumps; he ex- 
amines the gums and finds them inflamed, 
and in a soft spongy condition. He is ex- 
pected to place the clasps of the new teeth 
round those which are decayed and loose; 
and, as an honest practitioner, he avows at once 
his inability to perform impossibilities. Better 
far to say this than to deceive the patient, and 
to let him go on believing in the truth and 12 
TREATMENT OF THE MOUTH 
infallibility of the advertisements; to take his 
fee, and send him home with teeth which can 
only plague and distress him. 
I not only, however, complain of the absurd 
inducements held out by these advertisements, 
in the way I have already mentioned, but 
they tend greatly to injure the dental pro- 
fession in another way. Through their agency 
a false impression gains ground that artificial 
teeth are useless, uncomfortable, and painful 
appendages. It will naturally be no easy 
matter for the scientific dentist to convince 
people who come to him full of the virtues of 
Mr. So-and-So’s method of supplying artificial 
teeth, that their common sense has been tam- 
pered with. Let there be never so many loose 
stumps and decayed teeth, let the gums be 
never so much inflamed, and the breath, as a 
natural consequence of all this, very offensive, 
they will, in too many cases, adhere obstinately 
to their first hallucination. The breath is to be 
rendered pleasant, disease in the gums and in PREVIOUS TO INSERTING ARTIFICIAL TEETH. 
13 
the jaws to be arrested, say rather buried, under 
the smart-looking artificial teeth they covet so 
much. Some will perchance have their own 
way, and return home from the empiric to eat 
their food with ever renewed irritability, to un- 
happy days, and restless nights; all of which 
might have been avoided had they only learned 
in time that, whatever quack advertisements 
may assert to the contrary, impossibilities can- 
not be performed. Let the opinion of the late 
Dr. Koecker give its due weight to the preceding 
remarks. 4 There is, perhaps,’ he says, 4 not one 
case in a hundred requiring artificial teeth, in 
which the other teeth are not more or less dis- 
eased, and the gums and alveoli also either 
primarily or secondarily affected. The mechan- 
ical and chemical bearing of artificial teeth upon 
such diseased structures naturally becomes an 
additional powerful aggravating cause of disease, 
already in a sufficient state of excitement, even 
if the teeth are mechanically well constructed 
and inserted; if, however, they are not well 14 
TREATMENT OF THE MOUTH 
constructed, and are inserted with undue means 
or force, or held by too great or undue pressure, 
or by ligatures or other pernicious means for 
their attachment, the morbid effects are still 
more aggravated, and a general state of inflam- 
mation in the gums and sockets, and particu- 
larly in the periosteum, very rapidly follows. 
The patient, moreover, finds it impossible to 
preserve the cleanliness of his mouth; and his 
natural teeth, as well as the artificial apparatus, 
in combination with the disease of the structures, 
becomes a source of pain and trouble, and the 
whole mouth is rendered highly offensive and 
disgusting to the patient himself as well as to 
others.’ * 
These facts are brought forward as witnesses 
against chicanery in artificial dentistry, which 
the most special pleading cannot controvert; 
and it must be obvious to every candid judg- 
ment, that the state of the mouth demands 
* Essay on Artificial Teeth, pp. 27, 28. PREVIOUS TO INSERTING ARTIFICIAL TEETH. 
15 
most serious attention, if the dentist cares to 
confer comfort and assistance upon his patients 
and to reflect credit upon himself. 
Anything calculated to irritate and inflame 
the gums should be removed; and under the 
head of substances most injurious to these, will 
come dead and loose teeth, stumps, and salivary 
calculus, or tartar. Many eminent and expe- 
rienced men have long debated amongst them- 
selves as to the immediate cause of the last 
named substance; but, various as are the con- 
clusions arrived at by them, all must be agreed 
that tartar plays a very prominent part in keep- 
ing up a diseased condition of the mouth, and 
he is a wise man who makes it a point of im- 
portance that the healthy preparation of his 
mouth should be attended to, though, as is 
sometimes the case, he may be obliged to wait 
several weeks or even months before the arti- 
ficial teeth can safely or pleasantly be inserted. 
As a general matter of experience, however, 
not a little persuasion on the part of the 16 
TREATMENT OF THE MOUTH 
practitioner is necessary to induce patients to 
submit to an operation unjustly dreaded at this 
stage. 
4 It may be stated, as a general rule of prac- 
tice, that all the remaining natural teeth that 
are not susceptible of being restored to a state 
of comparative health and usefulness, should 
be removed before inserting an artificial sub- 
stitute ; especially should this course be pur- 
sued whenever the remaining roots are found 
partially or wholly necrosed, and the peridental 
membranes and surrounding tissues inflamed 
and suppurating. Such should be extracted, if 
for no other reason than that they are offensive 
in the mouth, and tend, in a greater or less de- 
gree, to compromise the general health. An 
additional reason why they should be extracted, 
is, that their presence prevents, in some degree, 
an accurate and uniform adaptation of the me- 
chanical appliance to all the parts on which it is 
designed to rest, and this is particularly true of 
those cases where atmospheric pressure is made PREVIOUS TO INSERTING ARTIFICIAL TEETH. 
17 
available in the retention of the substitute.’ * 
When the dentist has concluded his examina- 
tion of the patient’s mouth and has determined 
what teeth or stumps ought to come out, this 
most necessary preliminary to the insertion of 
artificial dentures should be accomplished if 
possible at one sitting. The parts will then 
absorb uniformly, and the desired substitutes 
may be inserted at a much earlier date than 
if several sittings had previously been taken. 
Occasions will, however, 'arise, in which the 
condition of the patient’s health will not admit 
of the removal of more than one tooth or stump 
at a time, and such cases the experienced prac- 
titioner will not be slow to discover. 
Let me here guard my readers against mis- 
conception of the foregoing remarks. Let them 
not suppose that I am advocating the removal 
of sound healthy stumps, such as cause no 
irritation. It is desirable that such should be 
retained, unless some circumstance should arise 
* Mechanical Dentistry : J. Richardson, pp. 112, 114. 18 
TREATMENT OF THE MOUTH 
upon examination which may render their re- 
moval necessary. 
If, for instance, the shut of the mouth be 
rendered very close, gum almost touching gum, 
by the presence of stumps, they should .be re- 
moved, and the new teeth would then receive 
a much greater depth. 
Salivary calculus deposited round the necks 
of the teeth should be carefully removed. If 
the teeth are encumbered to a great extent with 
this earthy matter (which is not unfrequently 
the case) the patient should be recommended 
to give more than one sitting for its removal, 
since it would be highly injudicious practice to 
expose the necks of the teeth to a sudden 
change of temperature. Sometimes, too, tartar 
will have accumulated in a quantity so large 
that the gums, the alveolar process, and the 
surrounding tissues, are involved in the mis- 
chief, and under such circumstances great skill 
and judgment must be called into play for the 
restoration of the affected parts to health. PREVIOUS TO INSERTING ARTIFICIAL TEETH. 
19 
If the operation of tooth-extraction is to be 
extended over the space of two or three sit- 
tings, the mouth should in the mean time be 
kept scrupulously clean, and an astringent lo- 
tion composed of tincture of myrrh and com- 
pound infusion of roses, or some other such 
suitable gargle, may be used with much advan- 
tage. When the parts have regained their 
healthy condition, when the gums have become 
firm, and the surrounding teeth are rendered 
sound, the model of the mouth may be taken 
in the usual way, and the substitute proceeded 
with. 20 
CHAPTEK III. 
MATERIALS EMPLOYED IN THE CONSTRUCTION OF 
ARTIFICIAL TEETH. 
We now arrive at thej inquiry as to the best 
and most suitable material to be used in the 
construction of artificial dentures. These, as 
may be supposed, are various : gold, silver, pla- 
tina, dental alloy, rubber, &c., are some of the 
substances most frequently used as a basis for 
new teeth ; but as I rarely use in my own prac- 
tice any other material than gold and vulcanized 
indiarubber, I may be allowed to confine my 
remarks exclusively to them. 
It is highly important that in the construction 
of a gold substitute, the plate selected should be 
one of a suitable thickness, so that it may bear 
the various manipulations necessary for its con- MATERIALS EMPLOYED, ETC. 
21 
struetion and adaptation without bending, and 
may give a firm basis for the teeth. It ought 
never to be less than 18 carats in quality. When 
clasps are used for the purpose of retaining the 
substitute in the mouth, the standard should be 
somewhat lower (say perhaps 16 carats), because 
it is requisite they should possess a certain degree 
of elasticity about them, so that they may be 
made to fit the more firmly and comfortably in 
the mouth. It would be out of place here to en- 
ter upon the consideration of many of the details 
in the construction of the artificial dentures, nor, 
indeed, would it be necessary, since any remarks 
on these points could only be useful in class- 
books, but a few practical observations, as to 
their general purpose and adaptation, may be 
found useful. The great objects to be gained 
by those who are about to adopt the use of false 
teeth, are non-detection, perfect articulation, 
and comfort and assistance in masticating their 
food. These points can only be properly car- 
ried out by the practitioner who has a thorough 22 
MATERIALS EMPLOYED IX THE 
practical acquaintance with all the details con- 
nected with mechanical dentistry. When a se- 
lection has been made as to the material of 
which the basis for the teeth shall be composed, 
very particular care is required with a view to 
its exactly even position on the gums : continual 
pain and discomfort will be the result if this 
point is not strictly adhered to. It must be 
recollected that from this basis or foundation 
the crowns of the false teeth are made to rise. 
Mr. Tomes has some very useful remarks on this 
point; he says: ‘ The base is an essential part 
of all artificial teeth, whether they be fewer many; 
and upon the accuracy with which this fits the 
gums, will the usefulness of the imposed teeth 
depend. Indeed, unless it fits tolerably, the 
teeth cannot be worn, and for this obvious rea- 
son, that the pressure of mastication will be 
communicated to those parts only of the gums 
on which the base bears. If the area of these 
be small, the parts will be bruised; if they be 
still smaller, they will be cut. The greater the CONSTRUCTION OF ARTIFICIAL TEETH. 
23 
area over which the pressure is diffused, the less 
will it be felt, the smaller the more. We all 
know what would be the consequence if the 
area were reduced to an edge or a point; yet 
there are not wanting instances where, from in- 
attention to these simple facts, the bases of false 
teeth are so badly constructed that the gums 
are bruised or cut the first time they are worn, 
and this from the ill-fitting or insufficient size 
of the base. ’ * 
USE AND ABUSE OF CLASPS BOUND SOUND TEETH 
FOE THE PURPOSE OF RETAINING ARTIFICIAL 
TEETH IN THEIR PLACE. 
When the plate has been struck up, it should 
be carried as far back as the case will permit, 
and should be made to fit closely to the necks 
of the teeth inside, for be it remembered that 
the more closely the plate is fitted to the palate, 
the less is the requirement for clasps to retain 
* Tomea’sUse and Management of Artificial Teeth, p. 18. 24 
USE AND ABUSE OP CLASPS 
it in position. It has been observed that ‘ the 
method of applying artificial teeth with clasps is, 
with perhaps the single exception of placing them 
on natural roots, the best that can be adopted.’ * 
I am inclined to think the former, when the va- 
rious manipulations are well carried out, the 
more valuable of the two processes: it is one ca- 
pable of more general application; and it is truly 
added by the author just quoted, ‘ that a plate 
may be so fitted to an aperture in the dental 
circle, and secured with clasps to the other teeth, 
as to afford a firm support to six, eight, ten, or 
even twelve artificial teeth.’ And yet it should 
be observed that clasps or any other fastenings 
round the teeth ought to be fitted with unerring 
accuracy, and the majority of writers on Dental 
Mechanics recommend that extra models of the 
teeth round which the clasps are to be fastened, 
should be taken. Such a proceeding, however, 
is only necessary in some few cases. 
* Harris’s Principles and Practice of Dental Surgery, 
p. 594. ROUND SOUND TEETH. 
25 
Sound teeth are being constantly sacrificed by 
the careless and injudicious adjustment of clasps. 
The injury done to the teeth round which they 
are placed does not proceed from the constant 
friction of the two substances against each other, 
but from the fact that they are often so inaccu- 
rately fitted, that all kinds of extraneous matter 
habitually collect between the clasp and tooth, 
which, in the course of time, becomes putrid, 
and acrid. Hence arises decomposition of the 
enamel, and ultimately the total destruction of 
the tooth supervenes. 
‘ The most usual seat of decay in these cases 
is at the neck of the tooth, where the enamel is 
thinnest, and it is sometimes limited to a circum- 
scribed spot, but often extends on a line with the 
gum involving nearly or quite all of that part 
of the neck of the tooth embraced by the clasp. 
At first the enamel becomes bleached and 
softened as though macerated, and is ordinarily 
very sensitive to both chemical and mechanical 
irritants. With a continuance of the cause, the 26 
USE AND ABUSE OF CLASPS 
superficial portions of the affected, parts become 
more and more thoroughly disintegrated, and 
sooner or later assume the open form and cha- 
racteristics of ordinary decay. If, as was for- 
merly supposed, decay or solution of tooth bone 
in these cases resulted from mechanical attrition, 
or wearing away of the enamel, the injury would 
be inflicted at points distant from the neck of 
the tooth, where the clasp lies in more direct 
and immediate contact with the protuberant 
portions of the crown; but we find that decay, 
from this cause, is not only of unfrequent 
occurrence at such points, but that, on the 
contrary, the enamel is frequently found con- 
densed and polished by the mechanical action 
of the clasp.’* 
But one more quotation upon this valuable 
point in mechanical dentistry, before passing 
on to another portion of our subject. ‘The 
effects resulting from the presence of corrosive 
* Richardson’s Mechanical Dentistry, p. 200. ROUND SOUND TEETH. 
27 
agents are not the only deleterious ones liable 
to be produced by clasps. They are often 
fitted and applied in such a manner as to force 
themselves up upon the necks of the teeth and 
gums, causing inflammation of the latter, as well 
as that of the alveolo-dental membranes, and, 
ultimately, the destruction of the alveoli and 
loss of the teeth. Hence the necessity of 
guarding against such effect, by a proper adjust- 
ment of the clasps in the construction of the 
piece.’ * 
The chemical history of a tooth shows its 
natural predisposition to suffer decay from con- 
tact with any one of the irritating causes just 
mentioned. 
To the eye of the inexperienced observer 
the tooth presents an appearance of solid den- 
sity which is disproved by minute examination. 
It has indeed a superficial coating of enamel, 
and this is one of the hardest substances known, 
* Harris, p. 687. 28 
USE AND ABUSE OF CLASPS 
and it is a substance that retains its healthy 
aspect much longer in some mouths than in 
others; but underneath the enamel is the body 
of the tooth, made up of a substance known as 
dentine, and it possesses peculiarities that only 
show themselves with more or less distinctness 
when assisted by the aid of the microscope. 
When seen by the aid of this instrument, it is 
composed of numerous delicate tubes, branching 
from the pulp cavity to the border. It is sup- 
posed that a minute nerve fibre passes through 
each tube; and from the fact of many teeth 
being remarkably sensitive and even painful 
long before the proper nerve cavity is exposed, 
I am rather inclined to lean towards the theory 
advocated. These tubes have each parietes 
or walls of a suitable thickness, and some idea 
may be formed as to the unspeakable skill 
manifested in the construction of these tubes, 
when it is stated that ‘ measured by the micro- 
meter, the internal diameter of the largest tube 
is about the To(T?tty °f an inch, and the dia- ROUND SOUND TEETII. 
29 
meter, including the parietes, of an 
inch.’ * 
As a proof of the danger of allowing fluids to 
remain an unnecessary length of time in the 
mouth, particularly those of an acid nature, if 
any one will place a section of dentine under the 
microscope, in a few drops of water, the instru- 
ment’s magnifying power will presently show 
him the little globules passing into the tubes 
that traverse the body of the tooth. Hence we 
may understand with what ease draughts of 
cold air find their way into these little passages, 
and cause great pain to the parts so exposed. 
A tooth is found upon analysing it to be 
composed of phosphate, fluate, carbonate of 
lime, phosphate of magnesia, salts, cartilage, 
and fat, and hence it may be seen that these 
substances cannot long bear the contact with 
matter prejudicial to their continuance and co- 
hesion in a sound, healthy condition, without 
* Tomes’s Dental Physiology and Surgery, p. 39. 30 
THE APPLICATION OF A SINGLE TOOTH 
giving way, or causing offensive odours in the 
mouth. But to continue the subject of selecting 
teeth to which clasps ought to be attached; — 
they should be selected according to their po- 
sition, shape, and condition, and, above all 
things, loose or decayed teeth, if any have been 
allowed to remain in the mouth, should be free 
from any irritation of clasp or plate. 
The molar and bicuspid teeth, when circum- 
stances permit, are the most useful for the at- 
tachment of clasps. They should be sound, 
firmly imbedded in the socket, and the sur- 
rounding gum and parts healthy. The clasps 
should be carried no farther than just to the 
margin of the gum, lest inflammation should 
ensue. 
THE APPLICATION OF A SINGLE TOOTH ON A 
GOLD PLATE: ITS FASTENINGS, ETC. 
It is necessary when one tooth only has to be 
inserted (as, for instance, one of the central in- ON A GOLD PLATE : ITS FASTENINGS, ETC. 
31 
cisors), (see Plate 1, Figs. 1 and 2), that two 
teeth, on whichever side may be most suit- 
able, should be separated in order to admit the 
passage of the clasp, and as I have before stated, 
the bicuspids may be selected with much ad- 
vantage. 
This is an operation that requires the utmost 
care and judgment, and one, be it observed, 
that should not under any circumstances be 
resorted to unless absolute need exists for it. 
It must be understood that I am now al- 
luding to cases in which all the teeth are in the 
jaws, minus one of the incisors, and that no 
other way of inserting it without detection can 
be resorted to except by filing. 
Where, however, this process is resorted to, 
and cannot be avoided, the importance of 
keeping the inside of the clasp clean ought to 
be strongly impressed upon the mind of the 
patient. And after the separation has been 
made, the sides of each tooth should be 
carefully burnished, to prevent the lodgment 32 
THE APPLICATION OF FOUR TEETH MOUNTED 
of even fluids, for reasons only lately ad- 
verted to. 
THE APPLICATION OF FOUR TEETH MOUNTED ON 
A GOLD PLATE : THEIR FASTENINGS, ETC. 
The same method of attachment may be 
adopted in most cases with reference to the 
four front teeth. If, however, the teeth to be 
replaced are divided by natural teeth from 
each other, a somewhat different process will 
be required as regards the application of the 
clasps. If, for instance, two front and one or 
two back teeth require replacing (the re- 
maining teeth being perfectly healthy, and an 
accurate model of the mouth having been ob- 
tained), the plate may be struck up in the 
usual way, and will require nothing more than 
the adjustment of the clasps. In this case re- 
ference to Plate 2, Figs. 1 and 2, will show 
that the clasps are fastened round the first 
molar on the one side, and the first bicus- ON A GOLD PLATE : THEIR FASTENINGS, ETC. 
33 
pid on the other, by which means the piece is 
held firmly in its place; the teeth may then be 
adjusted to the bite, and the piece finished in 
the ordinary way. 
THE APPLICATION OF SEVERAL TEETH MOUNTED 
ON A VULCANIZED INDIARUBBER BASE, FOR RE- 
STORING THE GENERAL CONTOUR OF THE FACE, 
AND ASSISTING MASTICATION. 
The next modification represents a case sup- 
plied with artificial teeth, for the purposes of 
mastication, and of restoring symmetry to the 
appearance of the mouth. This piece referred 
to in Plate 3, Pigs. 1 and 2, was made in vul- 
canized indiarubber, of which special notice 
will be taken in due course. The patient, when 
speaking or laughing, gave considerable pro- 
minence to the front teeth, and to obviate 
detection in this instance, the denture was 
kept up in its place partly by suction, and 
partly by clasps round the two first permanent 
molars. 34 
THE APPLICATION OF TEETH 
THE APPLICATION OF TEETH FOR THE PURPOSE OF 
MASTICATION ONLY, THEIR FASTENINGS, ETC. 
We now come to the consideration of those 
cases in which patients desire to be supplied 
with teeth with a view to the maintenance or 
the restoration of their health. It will be 
obvious that this part of our subject is more 
important than any other, and that the teeth 
sought for require much careful manipulation. 
These are classed under the heads of partial 
and complete sets. The very obvious fact 
should be borne in mind, that the front teeth 
are thin and wedge-shaped, whilst the back 
teeth are flat and broad, and that these latter 
teeth are furnished with several cusps, and with 
depressions on the antagonising surfaces cor- 
responding to each other, in order that the 
food may be bruised preparatory to its being 
carried into the stomach. 
When these back teeth are lost, the front FOR MASTICATION, ETC. 
35 
ones are brought into contact with each other; 
a circumstance that does not take place when 
the back teeth are present. The whole of the 
masticating process is thus thrown upon the 
front teeth, which, naturally, having another 
office assigned to them, are unable to bear the 
continual work and strain upon them. In order, 
therefore, that the mischief created by the 
absence of the whole of the back teeth may be 
averted, artificial dentures are supplied, cor- 
responding to those represented in Plates 4 
and 5, Figs. 1 and 2. These may be fast- 
ened in, either by means of spiral springs, or 
by small clasps round the bicuspid teeth, or 
by atmospheric pressure. I may be allowed 
here to remark that for my own part I prefer 
spiral springs as agents of attachment, since by 
this means clasps are entirely dispensed with; 
and I am informed by patients, that dentures 
when made upon this plan fit with the greatest 
ease and comfort. 36 
ARTIFICIAL TEETH RETAINED IN THE MOUTH 
ARTIFICIAL TEETH RETAINED IN THE MOUTH BY 
ATMOSPHERIC PRESSURE. 
When partial sets are retained in the mouth by 
means of suction or atmospheric pressure, and 
are mechanically well made, they are productive 
of great comfort to the patient. The manner 
in which atmospheric pressure plates are ge- 
nerally constructed, is by the formation in the 
plate of what are termed air cavities or cham- 
bers ; they may be made with one in the centre 
or one on either side. 
‘ With a cavity plate the loss of a single 
tooth, or any number of teeth, may, in most 
cases, be replaced without the aid of clasps, and 
when this last means of support for artificial 
teeth can be dispensed with, it is important 
that it should be done.’ * 
It has already been explained, that clasps 
* Harris’s Principles and Practice of Dental Surgery, 
p. 701. BY ATMOSPHERIC PRESSURE. 
37 
are apt to exercise deleterious effects on the 
teeth to which they are adapted. It should be 
noticed, however, that there are cases in which 
this mode of inserting artificial teeth by suction 
or atmospheric pressure, cannot be resorted to 
without the risk of causing some little discom- 
fort to the wearer. And in any case the follow- 
ing disadvantages have been noticed as resulting 
from its use, granting the plate has been made 
with cavities, or what are called air chambers. 
‘ In the first place, the protuberance on the 
lower part of the plate interferes, in some 
degree, with the movements of the tongue, and 
with the articulation of words, but it becomes 
less and less manifest the longer the piece is 
worn, until ultimately the individual almost 
ceases to be conscious of the presence of any 
foreign body in his mouth. But there is an- 
other and more serious objection, and it is this : 
there is a constant tendency of the mucous 
membrane over the cavity to thicken, and come 
down into it, assuming a sort of hypertrophied 38 
ARTIFICIAL TEETH RETAINED IN THE MOUTH 
condition, and in some cases it has ulcerated. 
We have, however,’ adds this author, ‘ met with 
but two cases in our practice in which this 
has happened. But this morbid tendency may, 
in nearly every case, be prevented by leaving 
the piece out of the mouth every night; and 
the shallower the cavity the less will be the 
liability to it.’* 
Mouths most suitable for plates upon the 
suction plan are those that are not flat, but 
deep, having a prominent alveolar ridge, and 
the rugse of the palate well defined. 
Provided that the model of the mouth be 
perfectly correct, and that the various mani- 
pulations be carried out in a skilful manner, 
this is a most comfortable method of wearing 
false teeth. It is one that dispenses not only 
with clasps, as already noticed, but with spiral 
springs likewise. These at least have only to 
be called in as agents for fastening in arti- 
ficial teeth, whenever the construction of the 
* Harris, p. 702. • BY ATMOSPHERIC PRESSURE. 
39 
atmospheric pressure plate is defective. It is 
above all things necessary that the mouth 
should be perfectly healthy, since the amount 
of pressure is very great, and unless the gums 
are in a sound condition injurious effects are 
likely to arise. 
COMPLETE SETS OF ARTIFICIAL TEETH, AND THEIR 
FASTENINGS. 
Only one more class of artificial dentures 
remain to be noticed, viz. complete sets of 
them. And here it will be sufficient to remark 
that the same process is carried out in making 
a complete set, as in making a few teeth, the 
only difference being that the plates are mounted 
in full, and that they are retained in the mouth, 
(as may be seen upon reference to Plate 6, 
Fig. 1), by means of spiral springs. 40 
CHAPTER IV. 
ON VULCANIZED INDIARUBBER AS A MATERIAL 
FOR THE BASE OF ARTIFICIAL TEETH. 
It is now time to discuss the subject of an- 
other most important material used in mecha- 
nical dentistry. I allude to vulcanized india- 
rubber, which has in great measure superseded 
gold, platina, and other substances, as a base 
for artificial teeth. This material, the original 
invention of Mr. Putman, of New York, upon 
which many and great improvements have 
taken place, is in almost universal request, and 
may fairly be considered one of the greatest 
modern acquisitions that the dental art has yet 
gained. 
The vulcanite base possesses an advantage 
over gold in one very important feature—a gold VULCANIZED INDIARUBBER, ETC. 
41 
plate must be swaged between what is com- 
monly known as a cast and die, and it not un- 
frequently happens that the rugge or irregular 
surface of the palate becomes obliterated, the 
plate fitting as on a flat surface. In the mani- 
pulation of a vulcanite denture, the material is 
subjected for about four hours to a great heat, 
by means of a steam apparatus, when it melts 
into and between all irregularities, so that, sup- 
posing the model of the mouth to be correct, a 
more accurate, and, if well made, complete fit 
it is impossible to obtain. 
From one tooth to a complete set can be as 
readily made in rubber as in gold, but it is un- 
deniable that cases come under notice in which 
it may be injudicious to use it. 
It is capable of receiving a finish equal to 
that of gold, and is repaired with the utmost 
facility. In all cases in which it has been 
previously the custom to use bone as a base for 
artificial dentures, the vulcanite has taken its 
place. 42 
VULCANIZED INDIARUBBER 
ITS SUPERIORITY OVER BONE AND IVORY, AND 
REASONS WHY IT SHOULD ALWAYS HAVE THE 
PREFERENCE. 
One or two out of the many reasons in favour 
of this substitution may be given. Bone is 
liable to decay; through the action of the fluids 
of the mouth upon it, it becomes highly offen- 
sive ; owing to this cause it requires replace- 
ment at the expiration of at least every three or 
four years, and sometimes more frequently still. 
Bone, however sound, cannot stand the wear 
and tear of time and of constant use so well as 
the vulcanite ; and, as to solidity or density of 
material, the mineralised vegetable has an ad- 
vantage over the animal substance. Vulcanite 
rubber, in short, is indestructible, and not liable 
to suffer from the action of anything that may 
enter the mouth, and, if for this reason alone, 
it is superior to bone. No argument can be 
brought forward in favour of either the hippo- 
potamus or the walrus tooth, as materials in AS A BASE FOR ARTIFICIAL TEETII. 
43 
mechanical dentistry. They are virtually aban- 
doned by those who wish to do credit to them- 
selves, and to confer comfort upon their patients. 
Let it suffice to adduce in support of these opi- 
nions the following remarks of the late Dr. C. 
Harris:—‘These teeth (i.e. those made from the 
tooth of the hippopotamus) soon change their 
colour, assuming first a yellow then a dingy or 
bluish hue. They are also very hable to decay. 
We have in our possession a number of blocks 
of this sort, taken from the mouths of different 
individuals, some of which are nearly half de- 
stroyed. But there is another objection to 
teeth made of this article, which, even were 
there no other, would be sufficient to condemn 
its use. It is that they, like those formed from 
elephant ivory, give to the air retained from 
the lungs an insufferable offensive odour, which 
cannot be corrected or prevented. They may 
be washed half a dozen times a day, and taken 
out and cleaned again at night, but it will be 
grossly perceptible, and although it may be 44 
VULCANIZED INDIARUBBER 
much worse in some mouths than others, no 
one who wears teeth formed from this sub- 
stance is entirely free from it. To one whose 
attention has never been directed to the subject, 
it would be astonishing to observe the effects 
produced upon the breath from wearing two or 
three of these teeth.’ 
OTHER ADVANTAGES TO BE OBTAINED BY USING 
VULCANIZED RUBBER. 
Eubber has another advantage over gold or 
any other material, in being so made that spaces 
between the teeth are dispensed with. Hence 
no substances can collect to become putrid or 
offensive. This renders it a most cleanly article, 
which is a great desideratum in artificial teeth. 
At a meeting of the Odontological Society, held 
in April 1859, at the Society’s rooms in Soho 
Square, Mr. Saunders, in the course of a terse 
and clever speech, made the following re- 
marks on the advantages, in another respect, AS A BASE FOR ARTIFICIAL TEETII. 
45 
possessed by vulcanite over other materials used 
in mechanical dentistry. ‘ Its lightness,’ he 
said, 4 was a great advantage, and in this respect 
it was an improvement upon anything they 
had hitherto met with. He might mention the 
case of an old clergyman, in somewhere about 
his eightieth year, who was greatly tormented, 
and who told him very pathetically, that at the 
end of the first half hour of his sermon, his 
teeth made his jaws ache, and he became in- 
distinct, so that the congregation could not 
hear the end of the discourse. He resolved to 
see if he could not make the old gentleman 
happier, and he gave him a vulcanite set, which 
answered every purpose equally well, and saved 
upwards of an ounce in weight. The original 
set was extremely well made, weighing two 
and a half ounces or rather more, but the new 
set weighed within an ounce and a half.’ An- 
other speaker mentioned that the vulcanite 
‘ was perfectly non-absorbent, so that if they 
took a piece out of the mouth, and laid it upon a 46 
VULCANIZED INDIARUBBER 
table, it was perfectly dry within a minute after- 
wards. In numerous cases in which he had 
tried it it had been marvellously successful.’ 
And again, too, at the American Dental Con- 
vention, held at Newhaven, Connecticut, in 
August 1861, the subject for discussion was 
4 the relative merit of the various materials used 
as a base for artificial dentures, and the method 
of mounting them.’ Some members preferred 
metals, others vulcanite, and the following are 
some of the opinions with respect to india- 
rubber. 
Dr. Whitney said that 4 his experience had 
been formed by many years’ use of silver, gold, 
continuous gum and vulcanite. Of all these he 
preferred the last-named substance, th hiking it 
superior to anything else. If the impression is 
perfect, we could be sure of a fit in every in- 
stance. The twang, which was so much an 
objection in other materials, was in this obviated, 
and besides this the cost was not so much to 
the patient. Dr. Mallett said : 4 He had been AS A BASE FOR ARTIFICIAL TEETH. 
47 
the first to try experiments with rubber for 
artificial teeth in the United States, having per- 
fected and used it for six years. The longer he 
used the vulcanite work, the better he was 
pleased with it; and this was also the testimony 
of his patients, many of whom had worn other 
materials.’ Dr. Franklin observed that the re- 
lative value of different kinds of work could 
t 
only be determined by the amount of good that 
could be accomplished by each, and then added 
that his own preference was for vulcanite; and 
that he considered time had proved its purity 
and indestructibility, but that it was necessary 
(for the vulcanite to preserve its superiority 
over other materials), that the utmost care 
should be used, with a view to the attainment 
of perfect results. 
These conventions are held annually in dif- 
ferent cities and towns throughout the United 
States, for the purpose of discussing the relative 
merit of all things connected with dentistry. 
They are visited by all the dental practitioners 48 
VULCANIZED INDIARUBBER. 
of eminence throughout the country, who take 
part in the discussions, and give to the world 
in this way their experience — the fruit of years 
spent in toil and study. 
To these remarks on the vulcanite rubber as 
a base for artificial dentures, I will only add that 
my own experience fully corroborates the 
truth of the statements made. I have had but 
one case in which it failed to answer the pur- 
poses for which it was intended, and in this 
instance a gold plate was substituted with suc- 
cess. 
Many more pages might well be filled in no- 
ticing the various processes that are carried on 
in the manipulation of a piece from this mate- 
rial; but to undertake such a task is quite 
foreign to my purpose. My only object is to 
point out to those who are about to adopt arti- 
ficial teeth the material that is likely to be of 
the greatest service to them. I would remind 
such readers that the substance used should be 
indestructible, that the teeth employed should ARTIFICIAL TEETH. 
49 
be of a quality likely to last, that they should be 
perfectly clean and easy in the mouth, and not 
to be detected by the closest observer. The 
vulcanite patent answers all these purposes, and 
the teeth made expressly for it have undergone 
great improvements, both in shape and colour, 
so that it is almost impossible to injure them un- 
less violence is used. 
ADVICE TO THOSE WEARING ARTIFICIAL TEETH. 
I shall offer in conclusion some few words of 
advice to those who wear artificial teeth, as well 
as to those who are about to adopt them. 
To those who wear artificial teeth, whether 
small pieces, or partial sets retained in the 
mouth by means of clasps disposed round the 
remaining teeth, or complete sets held in by 
spiral springs, I would say, — be particularly 
careful when you take them out of the mouth 
to cleanse them from every particle of matter, 
and especially between the clasps. Patients are 50 
ADVICE TO THOSE WEARING 
too apt to neglect this simple rule, and as a con- 
sequence of this, the natural teeth round which 
the clasps are fitted become destroyed, and not 
unfrequently, though most unjustly, these care- 
less wearers proceed to blame the dentist, as 
though the clasps had produced the mischief, 
and not the retention of acid substances between 
the clasp and the tooth. 
And again, remove false teeth from the 
mouth every night on retiring to bed, and place 
them in a tumbler of clean water. In the 
morning cleanse the teeth that remain in the 
mouth, then brush the artificial teeth, and when 
they are placed in the mouth they will be found 
comfortable, clean, and sweet. Unless you are 
careful in cleaning them regularly, they will 
become very offensive, and will act as an irritant 
to the gums. 
The manner in which artificial teeth act upon 
the gums when not taken out and well cleansed 
every day, has been so admirably described by 
Mr. Tomes, that I feel justified in quoting his ARTIFICIAL TEETH. 
51 
remarks : —‘ It is of great importance that you 
should know how to preserve false teeth, for in 
the absence of proper attention they are soon 
destroyed, and still sooner become offensive. 
The wearer often seems singularly unconscious 
of the offensive odour which arises from ne- 
glected breath. Not so, however, the by- 
stander ; he is almost poisoned by the offensive 
breath of his neighbour. Artificial teeth cannot 
be too well kept, but they can be very easily, 
and frequently are, kept too ill. If the base be 
gold and the teeth mineral, still they should be 
well cleansed every day. If the base be gold 
and the teeth dentine, there is greater need of 
frequent and careful cleaning; if the base be of 
dentine and the teeth natural teeth, the piece 
will soon be destroyed if cleaning be neglected.’ 
‘ Nothing short of never removing artificial 
teeth from the mouth should be more strongly 
deprecated, than the habit some people have of 
taking them out only once or twice a week, 
and at other times cleaning them in the mouth. 52 
ADVICE TO THOSE WEARING 
They cannot be well cleaned in the mouth, and 
the surface of the month cannot remain healthy 
when perpetually covered. For it must be 
borne in mind that the gums are covered with 
epithelium, and that it is the nature of this 
tissue to be perpetually forming below, while it 
is suffering perpetual loss from its surface. 
The scales are rubbed off by the tongue and 
food. Now if the epithelium be perpetually 
covered by a base of artificial teeth, the for- 
mation will still go on, but the loss from the 
surface will be retarded. The outer epithelium 
scales may separate, but cannot escape from the 
surface; they, therefore, accumulate under the 
base of the teeth, and then become highly 
offensive. After a while the mucous membrane 
inflames, and the development of epithelium is 
suspended or vitiated; the scales no longer 
adhere to each other to form a membrane. If 
the teeth be removed after the mouth has got 
into this condition, the surface which has been 
covered will be found red and vascular, and ARTIFICIAL TEETH. 
53 
will bleed on the slightest touch. The fitting 
surface of the teeth will be coated with a white 
sebaceous matter, highly offensive.’ * 
ADVICE TO THOSE ABOUT TO ADOPT ARTIFICIAL 
TEETH. 
To those about to adopt artificial teeth, I 
would say, do not be led away by inducements 
that can never be accomplished. Cheap false 
teeth are always dear in the end, and the 
mouth is not to be practised upon by char- 
latans with impunity. It is too valuable a part 
of the human frame to be subjected to ill-usage 
in the shape of never fitting artificial teeth, and 
of rough edges that will cut and inflame the 
gums. But, on the other hand, be not uneasy 
and disposed to quarrel with your dentist if he 
provide you with teeth that do not all at once 
seem to give you pleasure. Be patient, and 
* Use and Management of Artificial Teeth: J. Tomes, 
pp. 86, 87. 54 
CONCLUDING REMARKS. 
allow art to come up with nature slowly but 
surely in this matter. ‘ Artificial teeth must 
be regarded by the wearer as tools, the use of 
which have to be learned by patient trials. 
The first time you take up a joiner’s plane 
you cannot work it, nor would you expect to 
do so without previous practice ; so with arti- 
ficial teeth : you have no right to expect to 
masticate effectively with them until by prac- 
tice you have learned their use. I would re- 
commend that patients, before they wear arti- 
ficial teeth, should carefully examine them in 
their several parts and actions, and thus learn 
how they should be used, and what is to be 
expected of the teeth, and what is to be ex- 
pected of themselves, in acquiring the art of 
artificial mastication.’* 
CONCLUDING REMARKS, 
A patient places himself in our hands and 
expects just and fair treatment. His health 
* Tomes, pp. 370, 371. CONCLUDING REMARKS. 
55 
depends upon our skill and judgment, and our 
reputation will be increased or lessened accord- 
ing to the treatment he receives. The patient 
demands from us a straightforward statement 
of his case; he asks us to tell him what he re- 
quires, and to name the most suitable and last- 
ing material, and this at a moderate cost. 
Whether our patients place in our hands a 
liberal or a small fee, as may be proportioned to 
their circumstances, we must deal with one and 
all in the same manner. Let our work be as 
lasting and as well finished for the one as for 
the other. 
The time has now arrived when it is no dif- 
ficult matter to discover who are competent to 
carry out work intrusted to them, and who are 
not. The College of Surgeons has stepped into 
the arena, and has rescued a noble branch of 
medical science, that was fast sinking into dis- 
repute through the inefficiency of too many who 
had taken upon themselves the onerous duties of 
dental practitioners, with little or no preparatory 56 
CONCLUDING REMARKS. 
knowledge or training. They have instituted an 
examination, to which those will readily sub- 
mit themselves who are competent to enter the 
lists. So have they recognised that which was 
once looked upon with suspicion. And none 
could blame the man who would hesitate be- 
fore allowing his tooth to be extracted by a 
person whose credentials might not be such as 
to entitle him to public confidence. The re- 
sult of this salutary interposition is, that at the 
present time few hospitals in the United King- 
dom have not a legally qualified dentist upon 
their medical staff.  
F / G . I 
FI G. 2 jPlcutes 2 
FIG. I. 
FIG 2 F I G . I 
7ya te 3. 
FIG 2 Plate Jr. 
F I G I 
FIG 2. Bafo5. 
FIG I 
FIG 2. T!ate/ 6 
A JruUa/ jRubber 
B Tuna Gold/ Wa ff 57 
EXPLANATION OF THE PLATES. 
PLATE 1. 
Figure 1. —Drawing taken from the model of a mouth requiring 
one single front tooth. 
Fig. 2. — Artificial piece corresponding to the above drawing, 
made in gold, and mounted with a mineral gum tooth, having its 
principal attachment round the left bicuspid. 
PLATE 2. 
Fig. 1.—Drawing taken from the model of a mouth requiring 
four teeth, two anterior and two posterior. 
Fig. 2. — Artificial substitute corresponding to the above drawing. 
Mineral teeth mounted on a gold plate, and retained in the mouth 
by a clasp round the first left superior molar and second right supe- 
rior bicuspid. 
PLATE 3. 
Fig. 1. — Drawing taken from the model of the mouth of a lady 
requiring six teeth, partly for personal appearance, and partly for 
the purpose of assisting mastication. 
In this case the denture was made in vulcanized Indiarubber, 
and was retained in the mouth in a manner somewhat similar to the 
last case. The patient had previously worn a metal plate, but de- 
rived more comfort from the Indiarubber one, on account of its 
extreme lightness and cleanliness. Mounted with mineral teeth. 
Fig. 2.—Artificial piece corresponding to the above drawing. 
PLATE 4. 
Fig. 1. — Drawing taken from the model of the upper jaw of a 
lady who had lost all the posterior teeth from the first bicuspid. 
The case was made in gold and mounted with ivory blocks, being 
made previous to the recent introduction of Indiarubber, and it 
was retained in the mouth by means of a clasp round each bicuspid. 
This was a case in which the application of artificial teeth had be- 
come an absolute necessity, since the whole of the mastication was 
thrown upon the front teeth, and had caused them to project to a 
considerable extent, and the patient had also begun to suffer con- 
siderably from the want of her food being properly masticated. 
Fig. 2. — Artificial denture corresponding to above drawing. 
PLATE 5. 
Fig. 1. — Drawing taken from the model of the lower jaw of the 
same case as the last, fitted with a gold plate, mounted in the same 
manner, and held in situ by the same means as the upper piece. 
Fig. 2.—Artificial denture corresponding to above drawing. 
PLATE 6. 
Fig. 1. — Complete set of artificial teeth. Mineral teeth mounted 
on an Indiarubber base, having a gold palate let into the rubber. 
Retained in the mouth by means of spiral springs. 58 
APPENDIX 
SHOWING THE SECONDARY DISEASES 
PRODUCED BY DECAYED TEETH. 
To the eye of the unprofessional observer, there 
would appear to be nothing very serious and little 
prejudicial to the general health in a carious or 
otherwise diseased tooth. 
He will suppose too frequently that pain, in- 
convenience, or a temporary cessation from business, 
and at the most only a little derangement in health, 
are likely to be the most troublesome consequences 
of a diseased state of the dental organs. 
But, could the record of cases be placed before 
him in detail,— could the beginning, and the slow 
development of such diseases be known which have 
broken up so many constitutions,— it would readily 
be seen that in many instances they arose from that 
apparently trivial object,— a diseased tooth. 
Why should there be any difficulty in inducing 
individuals to see that such is the case ? SECONDARY DISEASES. 
59 
A tooth is not a thing detached from and foreign 
to the rest of the system,— it is not an unimportant 
part of the body that will keep its decay to itself. 
Is it denied the sympathy with the rest of the human 
frame in which it works ? No ; we have seen in a 
former part of this work that a tooth is a member 
as beautifully and wonderfully made as any other that 
is formed to subserve the purposes of the animal 
economy. 
We have seen that it is traversed through its 
entire body by infinitesimal tubuli; that the nerves, 
those electric channels of intercourse between the 
various parts of the frame, reach and enter into its 
solid substance, and that blood-vessels penetrate them 
for the purpose of supplying them with vitality. 
If such were not the case, we should not have it 
on record, that a man of Padua, having had a tooth 
shortened for the purpose of correcting an irre- 
gularity, died immediately afterwards in an epileptic 
convulsion, ‘and that a short fragment of nerve was 
found in the section of the tooth.’ * 
Diseases of the teeth, as the cases which follow 
these remarks will show, have occasionally been the 
sole origin and cause of many very serious affec- 
tions. 
* Bond’s Dental Medicine, p. 197. 60 
SECONDARY DISEASES PRODUCED 
Tiodoloreux, neuralgia, headache, earache, nervous 
depressions, abscesses of the face and jaw, fistulous 
openings, the most distressing symptoms of dys- 
pepsia, &c., are amongst some of the more frequent 
disorders that have arisen from a neglected state of the 
teeth. A common cause of the dyspepsia has already 
been alluded to in my remarks upon artificial teeth, 
and if more conclusive evidence were wanted, I refer 
my readers to cases which will be found at the end. 
Headache, earache, faceache, neuralgia, and tic, 
are the more common results of carious teeth; 
hut it by no means follows that because a per- 
son has a number of decayed teeth and stumps 
which happen not to be painful, that secondary dis- 
eases like those alluded to may not arise from such 
a state of things. 
Again, the teeth are the organs of mastication, by 
which our food is prepared for the stomach; conse- 
quently, if they are deficient in their work, the food 
cafinot enter that organ in a fit state for the di- 
gestive organs to act upon. 
Acrid or purulent matter is secreted and formed 
from the irritation set up by diseased teeth in the 
surrounding structures; this during the process of 
mastication is mixed with the saliva and swal- 
lowed; by this the secretions of the stomach are more BY DECAYED TEETH. 
61 
or less vitiated; and thus the foundation of various 
forms of indigestion is laid. 
Dr. Bond, of the Baltimore Dental College, re- 
lating a case in which nearly all the teeth were de- 
cayed to the edge of the gums, says: — 4 The food is 
no longer chewed, and everything which passes 
through the mouth is mixed with a vitiated compound 
of mucus, pus, and blood, which descends into the 
stomach to mingle with the gastric juice, and de- 
teriorate the quality of that most important fluid.’ * 
Thus we see by what means the nervous powers 
become weakened, why appetite fails, and why di- 
gestion becomes impaired. 
Need I make any further remarks to point out the 
importance of careful and early attention to the 
teeth ? It is natural for persons in advanced age to 
lose their teeth, but not so in the young. The cases 
I have selected from my own practice will show that 
the mouth and teeth are deserving of more atten- 
tion than they generally meet with. 
In saying this let me not be misunderstood : my 
only object being to show that, as the teeth are un- 
doubtedly the source of many and serious-complaints, 
and are frequently much neglected and overlooked, 
* Bond’s Dental Medicine. 62 
SECONDARY DISEASES PRODUCED 
I have put before my readers in strong terms 
the claims the teeth have to frequent and careful 
attention. 
Dental surgery is something more than knowing 
how to manufacture artificial teeth, or how to ex- 
tract a natural tooth when decayed, or to stop them 
for the purpose of preservation. The dental surgeon 
must be well acquainted with all the various parts 
of the head, and every structure appertaining to the 
teeth; he must know the seat and connection of the 
nerves supplying them, or how shall he correctly 
trace pain in any part of the head to its frequent 
origin in the teeth ? 
If I might refer to any one class of cases more 
than another in which secondary diseases are pro- 
duced by decayed teeth, I should unhesitatingly 
point to those in which patients suffer from head- 
ache, earache, faceache, and pains in the temples. 
These cases are of daily occurrence in practice; 
and it is surprising how readily they yield upon the 
removal of any decayed teeth or stumps that may 
be found setting up irritation in the mouth. 
The pain is of a very different character to tooth- 
ache ; hence the reason why such pains are not com- 
monly referred to the teeth generally being dull and 
heavy rather than sharp and lancinating, moving BY DECAYED TEETH. 
63 
about from place to place, sometimes situated in the 
temples, at another time on the top of the head, 
again in the ears, and along the jaws: it frequently 
comes on at stated periods, lasting several hours at a 
time, frequently disappears without cause, to com- 
mence in the same manner, and is always more 
violent when the patient becomes warm in bed. 
These pains have all the character of pure neu- 
ralgia; and it is on this account, coupled with the 
fact of the teeth not being painful, that the mistake 
so frequently occurs, that the pains are neuralgic, 
and totally unconnected with the teeth, when, in 
fact, they arose altogether from disease in these 
organs. 
£An immense amount of accumulated suffering 
has occurred which otherwise might have been pre- 
vented ; the true character and seat of many diseases 
have remained undetected, and their successful treat- 
ment, as a necessary consequence, an utter failure. 
It is known to every well-informed physician and 
dentist, that cases have occurred and are recorded 
where patients have, year after year, taken medicine 
of every kind, and from the hands of the greatest 
variety of physicians, and all without avail; that 
such class of patients have, further, by the advice of 
their medical practitioners, gone in pursuit of health 64 
SECONDARY DISEASES PRODUCED 
and for the removal of their diseases, pronounced to 
be beyond the reach of medical and surgical skill — 
we say have gone, by the best medical advice, for the 
cure of their several cases, to distant regions, cross- 
ing seas, scaling mountains, visiting springs, taking 
every kind of exercise, and every variety of diet, and 
yet all of no avail, as they have severally returned 
home with little or no improvement in their disease, 
which still exhibits the same character and un- 
manageableness as when they started on their tour. 
By some lucky or accidental suggestion, the teeth 
are suspected as the probable cause of the whole 
mischief, and with some degree of plausibility, as 
everything else had failed to give relief. The sug- 
gestion thus is acted upon, skilful dentists are em- 
ployed, and by correcting the diseased condition of 
the mouth and teeth, the before incurable disease of 
each becomes readily curable. The general health is 
speedily restored, and the whole of this wonderful 
change is brought about simply by the application of 
a little dental skill. 
‘In other words, disease had commenced in the 
teeth and extended to other parts of the system, the 
general relations of the body became disturbed, and 
the physician attending solely to these latter, whose 
disturbance was only secondary, and overlooking the BY DECAYED TEETH. 
65 
special relations of the mouth, which was the source 
and cause of all the mischief. We say by thus dis- 
regarding this law of connection established between 
these two classes of relations, and not giving proper 
estimate of the reciprocal amount of influence which 
each exerts upon the other when diseased, is the 
only explanation we think which can fairly be given 
for the failure in the diseases under notice ; for when 
the cause was discovered, and the laws of patho- 
logical relationship obeyed, they were found to be 
perfectly manageable.’ * 
Cases in support of the arguments just referred 
to my readers will find at the end of this appendix; 
and, in most instances, it will be found, that the 
mischief had existed for a considerable length of 
time, and that an ultimate cure had beer effected by 
the extraction of a few teeth or stumps or, perhaps, 
in the removal of only one. The severe pains in 
the ear previously alluded to may, nearly every 
case, be attributed to a diseased condition of one of 
the inferior wisdom-teeth, upon the emoval of which 
such pains quickly disappear. I might adduce a 
long list of arguments to show Jow intimate are 
the connection between the teetl and the economy 
* American Journal of Dental Science 1849. “Handyon Patho- 
logical Relation of the Mouth.” 66 
CASES. 
generally, but I think enough has been said to 
prove how frequently the teeth are the source of 
secondary diseases in other parts, which, in many 
instances, are attributed to causes of a different 
nature to those to which they are really due. 
CASES. 
NEERALGIC AFFECTION OF THE FACE, ARISING FROM A 
CARIOUS WISDOM-TOOTH — REMOVAL OF THE TOOTH 
— CURE OF THE NEURALGIA. 
Case 1. —A young lady consulted me, in the month 
of April 1S58, respecting violent periodical pains on 
the left she of the face, shooting through the ear, 
the temple, md along the side of the lower jaw; but 
the root of fee tongue was the seat of such violent 
pain, that for two or three hours together the head 
was completely drawn downwards. These paroxysms 
lasted at times tome six or eight hours, and nothing 
relieved them bit strong narcotics. 
Upon an exanination of the mouth, I found the 
left lower wisdomtooth decayed to the edge of the 
gum, and the surounding parts highly inflamed. 
Although the tootL was not painful in itself, I felt 
persuaded it was tin sole cause of all the patient’s 
suffering. CASES. 
67 
I advised the immediate removal of the tooth, 
together with one or two decayed stumps in another 
part of the mouth. The patient readily consented to 
the operation, but at the same time was very un- 
willing to believe that the pains had any origin in 
her teeth. I extracted the tooth and stumps, since 
which time the patient has been quite free from 
pain. 
FISTULOUS OPENING IN THE LOWER JAW, ARISING FROM 
A DECAYED LOWER MOLAR STUMP - REMOVAL OF 
THE STUMP, AND CURE OF THE FISTULOUS OPENING. 
Case 2. — Harriet E , aged fifteen, applied for 
relief at the Dental Dispensary, in the month of 
December 1858, respecting a fistulous opening in 
the lower jaw, and also a small abscess underneath 
the chin, both of which were discharging very pro- 
fusely at the time I saw her. The patient was in a 
very weak and exhausted state from the continual 
discharge, which had lasted for a period of nine 
months. Various remedies had been resorted to in 
order to check the flow of pus; but so long as the 
irritant remained, so long was the mischief likely to 
continue. Upon passing a probe through the open- 
ing, it came in contact with the stump of the first 
permanent lower molar, the crown of which had 
been fractured in an attempt to extract the tooth. I 
removed the stump with Thomson’s elevator, an 68 
CASES. 
admirable instrument in such cases; a considerable 
quantity of pus followed the operation, and the pa- 
tient experienced immediate relief. 
Dec. 16, 1858.—Very little discharge; health 
much improved. 
Jan. 1859.—Cured. 
NEURALGIC AFFECTION OF THE FACE CAUSED BY DE- 
CAYED STUMPS — REMOVAL OF THE STUMPS, AND 
RECOVERY. 
Case 3. — A young woman consulted me respect- 
ing some artificial teeth she required to replace the 
central and lateral incisors, canines, and first bicus- 
pids of the upper jaw. The natural teeth had de- 
cayed away and broken off, without giving any pain, 
leaving the stumps in the jaw. She had been subject 
to most violent pains in the face, principally in the 
temples; could assign no cause for the pains, never 
having had any toothache; could get no sleep at 
nights, unless induced by strong narcotics; was 
totally unfit to follow any occupation; and, from 
continual suffering night and day, her life was 
rendered perfectly miserable. I advised the re- 
moval of all the stumps before inserting any arti- 
ficial teeth. Moreover, I refused to furnish any new 
ones unless she had undergone the operation, well 
knowing they would he perfectly useless to her. 
After some hesitation, she consented to have them CASES. 
69 
removed, which was done in three sittings. Since 
the first were taken out a decided improvement had 
set in, which continued daily until she was quite 
free from pain. My patient now enjoys excellent 
health, sleeps well, and follows a light occupation. 
The artificial teeth have been inserted, and are a 
source of great comfort as regards mastication, arti- 
culation, and personal appearance. 
Cases like these show the importance of carefully 
examining the mouth previously to inserting arti- 
ficial substitutes, and the removal of all teeth and 
stumps likely to cause irritation. 
ABSCESS IN THE PALATE CUBED BY THE REMOVAL OF 
A CARIOUS STUMP. 
Case 4. —A iiian about fifty years of age con- 
sulted me respecting a large abscess occupying a 
considerable portion of the left half of the palate, 
which was at the time he consulted me discharging, 
and had been for a considerable time, the pus exud- 
ing between the central incisors in large quantities 
whenever the abscess was pressed with the finger or 
tongue. The teeth that remained in the jaws ap- 
peared perfectly healthy; tapping each gently gave 
no evidence of sensitiveness. The stump of the left 
superior canine remained firmly embedded in the jaw, 
which I immediately suspected to be the cause of 
the mischief. My opinion was further strengthened 70 
CASES. 
by the information I obtained, that the patient had 
been in the habit of trying silver coins between 
his teeth for the purpose of testing their genuine- 
ness, his occupation being one in which a consider- 
able amount of money passed through his hands. 
This habit no doubt brought on periostitis and its 
resulting suppuration. The canine tooth ultimately 
decayed and broke off, and the abscess appeared very 
shortly afterwards. 
The patient consented to the removal of the stump, 
and although from its deep-seated position, the ope- 
ration • was attended with some little difficulty, it 
readily yielded to the forceps generally used in such 
cases. Very little pus followed the operation, but a 
considerable quantity of blood was lost. At the 
apex of the stump I found a small sac, clearly indi- 
cating that the stump was the irritant that caused so 
much annoyance to the patient. 
Since the operation I have heard that the abscess 
has entirely disappeared, and the patient’s mouth 
has resumed its natural healthy condition. 
PALATINE ABSCESS CAUSED BY A DECAYED MOLAR 
REMOVAL OP THE TOOTH, AND CURE OF THE ABSCESS. 
Case 5.—A young woman consulted me in the 
month of August 1858, respecting an abscess si- 
tuated on the left half of the palate, which, when 
pressed, discharged round the necks of the teeth on CASES. 
71 
that side of the face. This case was very similar to 
the last, and the disease had its origin in the first 
permanent molar, which was considerably decayed. 
There was no pain whatever in the tooth. The sur- 
rounding parts were slightly inflamed, and the con- 
tinual discharge caused the patient great uneasiness, 
and rendered the breath offensive. I immediately 
removed the tooth, when a considerable quantity 
of pus followed. I saw the patient again in the 
following month, when the abscess had entirely 
disappeared. The remaining teeth are healthy, 
well-formed, and very regular. 
MORBID GROWTH OF THE GUMS, CAUSED BY DECAYED 
STUMPS — REMOVAL OF THE STUMPS, AND DISAPPEAR- 
ANCE OF THE MORBID GROWTH. 
Case 6.—A boy, twelve years of age, was brought 
to me for advice respecting bis gums, which I found, 
upon examination, to be swollen so much as to hide 
a greater part of the teeth; in some places the tips 
of them alone could be seen. A slight discharge 
oozed from the necks of the teeth. They bled pro- 
fusely upon the slightest touch, and were so sensitive 
that the softest substances coming in contact with 
them gave great pain. He was unable to take any 
food, and had for some time lived upon beef-tea and 
fluids. A minute examination pointed out to me the 
cause. Several loose stumps could be distinctly felt, 72 
CASES. 
which were acting as powerful irritants. These I 
managed to remove, but not without some difficulty, 
on account of the extreme pain caused by any in- 
strument coming in contact with the gums. I freely 
scarified the gums, and ordered an astringent gargle, 
composed of half an ounce of tincture of myrrh, and 
seven ounces and a half of compound infusion of. 
roses, to be used several times a day ; and the teeth 
to be carefully cleaned as soon as the gums had as- 
sumed a more healthy appearance. 
In about a fortnight, I had the satisfaction of see- 
ing that, by carefully following out my instructions, 
the mouth was very comfortable. I removed two 
more loose stumps, and also the first permanent 
molar in the upper jaw, which was decayed to the 
edge of the gum, and ordered the patient to con- 
tinue the gargle. In the course of two or three 
weeks the lad was perfectly well. 
FISTULOUS OPENING IN THE LOWER JAW, ATTENDED BY 
SWELLING AND INFLAMMATION OF THE SUBMAXIL- 
LARY GLAND, CAUSED BY A DISEASED WISDOM-TOOTH 
— REMOVAL OF THE TOOTH, AND CURE OF THE 
DISEASE. 
Case 7.—In December 1859, a gentleman con- 
sulted me respecting a fistulous opening in the lower 
jaw, near the angle, which was accompanied by a 
considerable amount of inflammation in the sub- CASES. 
73 
maxillary gland on the left side. He stated that this 
evil had been in existence during nearly eight 
weeks; that it had gradually become worse, and had 
yielded to none of the usual remedies. He com- 
plained that it had deprived him of rest night and 
day, that the pain had been incessant, and the dis- 
charge from the opening continuous. The jaw had 
become fixed, so that little or no food could be 
taken, and the patient, when I saw him, was reduced 
to a state of great weakness. 
Having examined the mouth to the best of my 
ability under the circumstances, I found that the 
dens sapientise on the same side as that on which the 
disease was situated was considerably decayed, and 
very loose and tender to the touch. The patient, 
having an important engagement to fulfil on the day 
on which I saw him, deferred the extraction of the 
tooth till the morrow. In the meantime I recom- 
mended that he should use a fomentation of poppy- 
heads as frequently as possible until he should call 
the next day. 
Dec. 11. — The mouth could be opened with 
somewhat more ease, so that I was the better able to 
reach the tooth. Still the jaw was closed sufficiently 
to prevent the entrance of a pair of forceps. I, how- 
ever, removed the tooth by means of an elevator, 
and a considerable quantity of discharge followed 
the operation. Renewed fomentations were then 
advised. 74 
CASES. 
27. —The fistulous opening had quite closed up, 
and the surrounding inflammation had abated. The 
patient could open his mouth as he had been accus- 
tomed to do before it became diseased. 
This was a very successful case, and one in which 
the cure was rapid. 
FISTULOUS OPENING IN THE LOWER JAW, CAUSED BY A 
DECAYED MOLAR STUMP — REMOVAL OF THE STUMP, 
AND CURE OF THE FISTULA. 
Case 8.—In February 1861, Eliza P , aged 
twelve years, a patient in the Dental Dispensary, 
sought relief respecting a fistulous opening in the 
cheek, which had been discharging matter for nearly 
two years, and which was supposed to have originated 
from the stump of the first lower molar on the left 
side. The crown of this tooth had been fractured in 
an attempt to extract it. Some few days after it 
had been broken, the surrounding parts became 
swollen, inflammation of the periosteum set in, fol- 
lowed by suppuration, and this finally ended in the 
formation of an abscess, which had broken exter- 
nally, and had continued to discharge up to the 
time when I saw her. She had been a patient at 
the General Hospital during a long time, and here 
the usual remedies had been resorted to without 
benefit. 
I removed the stumps with Thomson’s elevator. CASES. 
75 
They had been broken in so low as to preclude all 
possibility of easy application of the forceps, and the 
operation was rendered somewhat difficult. By the 
aid, however, of the elevator, and by a moderate 
steady pressure, they were soon extracted; and at 
the end of each fang I found a large sac, which 
proved beyond a doubt that the cause of the mischief 
had now been removed. A free discharge continued 
for about forty-eight hours after the operation, and 
in about three weeks the opening externally could 
scarcely be seen. The gums inside were nearly 
closed up. 
In the month of April, the patient having occasion 
to come again to the dispensary to undergo some 
other operations, I had an opportunity of seeing her, 
and found that the external mark was entirely ob- 
literated, and that the second molar was gradually 
filling up the space caused by the removal of the 
first molar. 
NEURALGIC AFFECTION OF THE FACE, CAUSED BY A 
NUMBER OF DECAYED AND LOOSE STUMPS — REMOVAL 
OF THE STUMPS, AND SUBSEQUENT CURE OF THE 
NEURALGIA. 
Case 9.—A young woman, thirty-one years of age, 
consulted me at the commencement of January 
1860, under the following circumstances:—For 
many months she had been suffering from pain in 76 
CASES, 
the jaws, face, ears, temples, and from great depres- 
sion of spirits. She had no enjoyment in taking 
food, and suffered from constant indigestion and 
other unpleasant symptoms. She had been under 
medical treatment for a considerable length of time 
without any benefit, and the state of her mouth had 
never been inquired into ; and thinking herself that 
the teeth might possibly give rise to some of her 
maladies, she consulted me upon the subject. 
Upon examination, I found the teeth in such a 
state as to warrant me in concluding that the cause 
of her illness was to be attributed in a great measure 
to their condition. There was not one tooth that 
was not partially or wholly destroyed by caries, and 
but one alternative suggested itself, which was that 
she should have extracted all that could not by the 
usual means be restored to usefulness. The patient, 
however, was reluctant to have so formidable an 
operation performed ; but feeling somewhat con- 
vinced on her own part that it might lead to her 
recovery, and being assured that the operation 
should extend over several sittings, she consented 
to a beginning. 
In due course of time the stumps of the molar 
teeth, both superior and inferior, together with 
several others, were removed, and some of the front 
teeth that were not in so bad a condition were filled 
and rendered serviceable. The pains in the head, 
&c., have, since the operation, gradually diminished, CASES. 
77 
and in the May following she was quite free from 
any inconvenience. Her appetite is good, she sleeps 
well, and her food, which she enjoys, although, for 
want of grinders, it is not masticated as it ought to 
be, does not produce that irritation in the stomach 
which it formerly did. 
Nearly all the stumps had a bony deposit upon 
them, and one or two presented that condition men- 
tioned by the late Mr. Sheely, in a paper read before 
the Odontological Society* in March 1857. 
NEURALGIC AFFECTION OF THE FACE, CAUSED BY DE- 
CAYED WISDOM-TEETH — REMOVAL OF THE TEETH, 
AND CURE OF THE DISEASE. 
Case 10.— Harriet F , aged twenty-six, ap- 
plied to the Dental Dispensary in April 1860, for 
relief under the following circumstances:—She had 
suffered for a length of time from violent pains in 
the inferior maxilla, shooting through the ear, and 
up to the temples; had no sleep at night, nor rest by 
day; could take nothing but soft food, on account of 
the pain produced when eating anything hard. No 
pain could be detected in any one particular tooth ; 
* Extract from Transactions of the Odontological Society, Yol. i. 
p. 37 :—‘A very common appearance of exostosis, and one which is 
frequently ascribed to absorption is a nipple-like projection of the 
apex of the fang.’ 78 
CASES. 
the gums were slightly inflamed, and upon the lower 
front teeth a small quantity of tartar was deposited. 
I found that the stumps of several teeth remained in 
the jaws, and as both the wisdom-teeth in the lower 
jaw were decayed to the edge of the gum, the pains 
in the ear were easily accounted for. 
I recommended the stumps to be removed, to 
which the patient consented, and on the 26th I ex- 
tracted the second bicuspid stumps, right and left 
side, in the lower jaw. 
April 28.—No improvement. Removed first su- 
perior molar, left side, decayed to the edge of the 
gum. 
May 3. — Pain not quite so bad, but still suffi- 
cient to prevent the patient from following her daily 
occupation. Removed both the inferior wisdom 
stumps. 
12.— Pain entirely ceased upon the removal of 
the wisdom stumps. 
29.—Cured. 
PAINFUL AFFECTION OF THE RIGHT MALAR BONE, PRO- 
DUCED BY A CARIOUS WISDOM-TOOTH REMOVAL OF 
THE TOOTH, AND CURE OF THE DISEASE. 
Case 11.— On March 28, 1861, a young man, a 
patient at the Dental Dispensary, applied for relief 
for what he thought was a tumour in the mouth. 
For nearly twelve months he had suffered intense 79 
CASES. 
pain in the right malar bone, the cheek swelling at 
times to a considerable size, and the eye becoming 
quite black. Inside the mouth, between the cheek 
and the gums, was a hard substance, which was 
situated close to the right superior''wisdom-tooth. 
This tooth was decayed to the edge of the gum, and 
painful when touched. I removed the tooth, and had 
the satisfaction of finding all the painful symptoms 
subside in the course of a fortnight, and the swelling 
in the mouth entirely gone. 
FISTULOUS OPENING IN THE LOWER JAW, ACCOM- 
PANIED WITH TWELVE ABSCESSES, CUBED BY THE 
REMOVAL OF DISEASED STUMPS. 
Case 12.—Thomas aged 23, was sent to the 
Dental Dispensary respecting a fistulous opening in 
the lower part of the jaw, which had discharged for 
seven years. The history of the case was as fol- 
lows : — 
In the early part of November 1850, the crown of 
the first right lower molar was broken off in attempt- 
ing to extract the tooth, and the fangs were allowed 
to remain in the sockets. Considerable pain was 
experienced for several days, which ultimately led to 
the formation of an abscess, which broke externally. 
Six months had scarcely elapsed when several other 
abscesses made their appearance in various parts 
of the neck, numbering in all thirteen. Several 80 
CASES. 
attempts had been made to remove the fangs of the 
tooth broken, but without success: his health began 
to fail, and he became very weak from the continual 
discharge. The first time I saw him was on No- 
vember 23, 1857, when with a pair of ordinary stump 
forceps I removed both the fangs, which were much 
necrosed. 
December 6. — Has had no more discharge exter- 
nally, but a little comes through the opening inside. 
20 — Discharge entirely ceased, the original opening 
in the cheek gradually closing up, and the marks 
upon the neck from the other abscesses wearing 
away. 
January 13, 1858.—By this time a perfect cure 
had been effected. 
Bemarks.—The case just quoted presents two very 
remarkable features, first the unusual number of 
thirteen abscesses, arising from a diseased condition 
of the molar stumps, and secondly, the great length 
of time the openings continued discharging. 
Cases are on record in which similar diseases had 
existed for two or three years, but this is the only 
case I am acquainted with where it had extended 
over a period of seven years. The patient informed 
me that the opening in immediate connection with 
the diseased fangs had never ceased discharging, more 
or less, since the first day it broke out. The other 
abscesses had ceased to discharge about eighteen 
months previous to my seeing him. Various remedies CASES. 
81 
had been resorted to, which, so long as the stumps 
remained, failed to produce any beneficial results. 
Several cases of fistulous openings in the cheek 
will be found recorded in this work, all of which 
have been permanently cured upon the removal of 
the exciting cause, viz., diseased teeth or stumps. 
PAINFUL AFFECTION OF THE EYE, CURED BY THE RE- 
MOVAL OF A DISEASED TOOTH. 
In the ‘ Dublin Medical Free Press,’ Dr. Emmeuch 
relates the following case :— 
Case 13.—A man consulted him on account of a 
painful affection of one of his eyes, which had lasted 
fourteen years, and occasioned great suffering. There 
was considerable vascularity of the conjunctiva and 
sclerotica, especially round the cornea, which structure 
itself was somewhat opaque and spotted. There was 
a continual flow of tears, with pain, and intolerance 
of light. 
All these symptoms were greatly aggravated by 
any indiscretion in diet, and the use of the slightest 
stimulus, such as a single glass of wine. All kinds 
of remedies had been tried in vain, at different times, 
and the affection seemed incurable. On examination 
of the upper jaw, Dr. Emmeuch found a carious tooth 
in the side corresponding to that of the affected eye. 
The portion of the jaw around the tooth was pain- 
ful, and very sensitive to the touch. The patient 
thought that the affection of the tooth had begun 82 
CASES. 
simultaneously with that of the eye. The tooth was 
drawn, and almost immediately afterwards the symp- 
toms relating to the eye began to subside, and soon 
entirely disappeared. The affection of the eye was 
evidently the result of sympathy between the second 
and third branches of the fifth pair of nerves. 
DYSPEPSIA, CAUSED BY DISEASED TEETH, AND CURED 
BY THEIR REMOVAL. 
Case 14.—Dr. Koecker relates the following 
case: — 
Mrs. P , a lady of great respectability, under 
the medical care of Dr. Jule Rucca, of Leicester 
Square, had some years since continually suffered 
from dyspepsia. This judicious physician had for a 
Jong time suspected the cause, and frequently pro- 
posed to consult me. By the wish of the lady, how- 
ever, the dentist of the family was at last sent for, 
and three or four teeth and roots were extracted, 
which, according to the assertion of the dental atten- 
dant, were all that could be removed. The disease, 
however, was only aggravated by this interference, 
and the sufferings of the patient increased more and 
more. 
About six months after the doctor again urged a 
meeting with me on the subject, and at last I was 
sent for. I found the lady labouring under a com- 
plete salivation from an extraordinary sympathy of 
all the glands in any way connected with the teeth. CASES. 
83 
On the previous night, and, indeed, for many nights 
preceding, she had been suffering such violent fits of 
convulsions as to alarm the whole family. The face 
was affected with acute erysipelatous inflammation, 
accompanied with headache, as also with considerable 
derangement of the digestive functions, such as sick- 
ness, vomiting, loss of appetite, &c. By examining 
the mouth, I found that the previous dental treat- 
ment had been but partial, and I proposed the 
removal of every tooth and root that produced 
irritation. The lady consented immediately to my 
proposal, and the necessary operations were performed, 
when nine decayed teeth, some of them mere roots, 
were removed. The patient was requested to rince 
her mouth frequently with a diluted astringent tonic. 
By this simple local treatment, and by further 
medical care, she was perfectly cured in about a week 
after the operation. 
INDIGESTION, ACCOMPANIED WITH SEVERE HEADACHE, 
VOMITING, ETC., CAUSED BY DECAYED TEETH AND 
STUMPS REMOVAL OF THE TEETH, AND CURE OF 
the disease.—(Dr. G. A. Harris.) 
Case 15. — In September 1830,1 was consulted bj 
Mr. , at that time a resident in New York. Before 
I examined his teeth, he informed me that his general 
health had been very bad for four or five years past, 
and that he had applied to some of the most eminent 84 
CASES. 
physicians in New York, Troy, and Albany, but had 
not obtained any permanent relief from his suf- 
ferings. 
The character of the symptoms that prevailed at 
this time were very peculiar. His digestive powers 
were so much deranged, that he was obliged to 
observe the strictest regimen, and confine himself to 
the simplest kind of vegetable food. Besides the 
dyspeptic affection with which he was troubled, he 
had severe paroxysms of headache and vomiting, 
that recurred at regular intervals of from four to five 
weeks. These were always preceded by numbness, 
which commenced in his tongue, and extended 
thence throughout the whole system. This sensa- 
tion continued usually for about two hours, when it 
was succeeded by a violent pain in the head and 
partial vertigo, from which, in about ten hours, he 
was relieved by vomiting. The effects of these pa- 
roxysms lasted about ten days, and the other 
symptoms had continued, without much mitigation, 
for three years. On examining his mouth, I gave it 
as my opinion that the diseased state of his teeth was 
the cause of his affliction. 
This idea, though entirely novel to him, he was 
disposed to believe correct, and therefore readily 
consented to the treatment I prescribed. Many of 
his teeth were much decayed, and nearly all of 
them covered with tartar. The roots of some were 
denuded of the gums, the alveolar processes more or CASES. 
85 
less absorbed, the gums turgescent, fungoid, bleed- 
ing on the slightest touch, and of a dark red colour. 
The secretions of the mouth were viscid, and their 
exhalations exceedingly offensive. Such of his teeth 
as could not be perfectly restored were extracted, 
and as much tartar was taken away as could be con- 
veniently removed at one time, and the rest at subse- 
quent sittings. His gums were freely scarified, and 
a tonic astringent and detergent wash directed to be 
used three or four times every day. Under this 
treatment the local affection of the mouth rapidly 
disappeared, and in about four or five weeks his teeth 
and gums became perfectly healthy. His general 
health also began to improve, and in about two 
months it was perfectly restored, and has so con- 
tinued. 
SEVERE NEURALGIA CURED BY THE REMOVAL OF 
diseased teeth. — {Dr. C. A. Harris.) 
Case 16. — The following (says Professor Harris) 
is one of the many cases of tic doloreux or neuralgia 
faciei, produced by disordered teeth, that have come 
under my own observation. The subject of it was 
a lady about forty years, of sedentary habits, and 
naturally of rather a nervous temperament. For 
several years she had been afflicted at times with a 
most distressing and painful affection of her face, 
which was pronounced by her physician to be tic 86 
CASES. 
doloreux. The pain was sometimes so acute and 
lancinating that it almost deprived her of reason. It 
generally commenced near or a little anterior to the 
angle of the superior maxillary bone; thence it 
darted across the face to the alse of the nose and 
thence to the temple, forehead, and angle of the eye, 
accompanied with frequent and sudden transitions 
from one side to the other, twitching and tremors of 
the muscles of the affected parts, and with a preter- 
natural flow of saliva. 
Her face, and sometimes the whole of her head, 
were rendered so sore by these paroxysms, that the 
slightest touch would produce pain. These pa- 
roxysms, although they were generally of short du- 
ration, frequently recurred as often as ten or fifteen 
times in twenty-four hours, and sometimes lasted 
ten, sixteen, and even twenty days, after which they 
would gradually subside, having subjected her during 
their continuance to the greatest misery, and leaving, 
after their subsidence, a dull heavy pain in one or 
both jaws. A sensation similar to this was always 
(especially in the right side of the upper) expe- 
rienced several days before one of these attacks, 
which often enabled her physician to ward them off, 
and finally led to the detection of their cause. These 
spasms were more severe and occurred more fre- 
quently in cold, damp, and wet, than in warm and 
dry weather. 
Bark, quinine, carb. ferri, stramonium, belladonna, CASES. 
87 
and various other tonics and antispasmodics were 
prescribed, but without any apparent beneficial 
effect. Leeching, sinapisms, and epispastics were 
also of no avail. As a last resort, it was determined 
to divide the affected nerve, but before the operation 
the physician was induced, by the pain in the jaws 
always preceding these paroxysms, to examine the 
condition of the patient’s teeth. The examination 
proved the teeth to be in a very unhealthy condition. 
The molars, generally, and especially those on the 
right side, were involved in complicated caries. The 
gums were much tumefied, inflamed, and very sensi- 
tive. 
Her teeth and gums, from the diseased condition 
in which they were found, were immediately sup- 
posed to have some agency in producing the affec- 
tions of the face. 
A consultation with me was therefore proposed, 
and I was requested to visit her. 
On examining her teeth, I found that eleven were 
so much decayed as to render their restoration im- 
practicable. It was therefore determined to remove 
these immediately, but it was not thought proper, 
owing to her extreme debility and the state of her 
nervous system, that more than two or three should 
be extracted at one time. 
So great was her agitation at the mere thought 
of the operation, that,’ notwithstanding the agony 
she suffered, she could not, on my first visit, be 88 
CASES. 
persuaded to have even a single tooth extracted, but 
requested me to call on the next day, when she pro- 
mised she would submit to the removal of as many 
as she possibly could. 
I accordingly called on the following day, and to 
the astonishment of her friends, she allowed all her 
teeth that were carious, eleven in number, to be at 
once extracted. The operation at once revealed the 
cause of her disease. The roots of three of these 
teeth were very much enlarged by bony depositions; 
one of the fangs was, at its extremity, about the size 
of a pea. Those of the other two were not quite so 
large, but a disposition to exostosis was manifested 
by all. 
With the removal of these teeth, all symptoms 
of pain entirely vanished, nor have they, to my 
knowledge, returned. 
EARACHE, CURED BY THE REMOVAL OF A DECAYED 
wisdom-tooth. — (Jourdain.) 
Case 17.—A lady had long suffered with severe 
pains in the right ear. All the ordinary remedies 
were used without effect. At length she was asked 
if she had any carious teeth. She replied that she 
had not, that all her teeth were good, and never 
gave her any pain. Nevertheless, her mouth was 
carefully examined. At first sight all seemed right, 
but a close inspection showed external caries of the 
dens sapientige. As the pain of the ear extended to CASES. 
the angle of the jaw, and even a little along its base, 
I persuaded the lady to permit me to extract this 
tooth, which I suspected to be the real cause of the 
mischief. Three days afterwards the lady was per- 
fectly and permanently relieved. 
NEURALGIA CAUSED BY DECAYED TEETH, AND CURED 
by their removal.—(Dr. Shepherd.) 
Case 18. — Miss C W of delicate con- 
stitution, was attacked with severe pain in the right 
side of the head, neck, and shoulders, and from the 
severity of the pain, and other circumstances attending 
it, she came to the conclusion that it was neuralgia; 
and by concurrence with her medical adviser, her 
opinion was confirmed. 
She used, therefore, all possible remedies for that 
disease, but without success. In the meantime her 
attacks were growing more frequent, and more severe; 
and for the latter period of the time she suffered, 
they occurred daily, at precisely five o’clock in the 
afternoon, and continued with the most intense 
severity until midnight, when the pain would begin 
gradually to subside, growing less and less until she 
was perfectly easy. 
These daily attacks came on with such perfect 
regularity, that, to use her own words, five o’clock 
was a terror fo her before it came. At this stage of 
the disease she was in Baltimore, whether in search 
of medical advice or not I do not know; but while 90 
CASES. 
there, she consulted an eminent physician of that 
city; and he advised her to have her teeth examined, 
intimating that they might be involved ; he gave her, 
at the same time, a prescription for neuralgia, to be 
used in case the teeth were not at fault. With this 
advice she returned home, and sent for me (Dr. 
Shepherd), and related substantially what I have 
stated above. I examined her teeth, and found the 
inferior wisdom-tooth of the right side decayed to 
the nerve, and I gave it as my opinion that all her 
‘ neuralgia ’ originated there; I therefore advised its 
immediate extraction, to which she assented. The 
first day after the tooth was extracted she had very 
little pain, the next still less, and the third none at 
all. Thus a perfect cure was effected, of what perhaps 
nineteen out of twenty of our very best physicians 
would have pronounced neuralgia, without once 
thinking of the teeth, by the simple extraction of a 
bad tooth. 
NEURALGIA CURED RY THE REMOVAL OF A DECAYED 
stump.—(Pro/. Bell, F.R:8.) 
Case 19.—In May 1827, Mr. D , a gentleman 
about fifty years of age, applied to me in consequence 
of severe pain occurring in irregular paroxysms, first 
attacking the ear, and from thence darting down the 
neck and shoulder, and through the whole length 
of the arm, so as considerably to diminish the power 
of the hand and fingers. CASES. 
91 
He had been for more than a year the subject of 
this affection ; and had, latterly, consulted a physician 
of the highest character, who, finding that the 
medical treatment which he recommended had failed 
to produce the slightest relief, requested me to see him. 
I was informed that the second inferior molar tooth 
had been broken about two years before, in an attempt 
to extract it, and the roots were now remaining in the 
jaw; the anterior one having been partially thrust 
out of the alveolus and lying obliquely upon the gum, 
the posterior still remaining firmly fixed, but evi- 
dently producing considerable irritation in the sur- 
rounding parts, with increased pain on pressure, 
which in some degree assumed the character of those 
paroxysms which he had so long been suffering. I 
therefore removed both the roots, and had the satis- 
faction of hearing some time afterwards thatthe com- 
plaint had entirely ceased. 
PAINFUL AFFECTION OF THE JAWS CAUSED BY TEETH, 
SOUND TO ALL APPEARANCE EXTERNALLY, BUT HAYING 
A BONY DEPOSIT UPON THE FANGS — REMOVAL OF 
THE TEETH, AND SUBSEQUENT CURE OF THE DISEASE. 
—(Joseph Fox, M.R.C.S.) 
Case 20.—Mr. Fox relates a case in which he ex- 
tracted the first molars of each side of the lower jaw 
from a lady, who had suffered for a considerable length 
of time from pain on both sides of her face, arising 92 
CASES. 
from each of these teeth. She described her symptoms 
to be, a constant uneasiness like the gnawing sensation 
of rheumatism, 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 con- 
tinued 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 com- 
plaint 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 distension 
of the alveolar cavity, and kept up a constant uneasi- 
ness. The lady was immediately relieved, and reco- 
vered her health and spirits, to the great joy of the 
family, who were nearly deprived of her society by 
reason of her excessive nervous irritability. 
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