ESSAY 
ON 
U L C E R A T I O N 
OF 
THE FANGS OF THE TEETH 
AND THE 
BEST METHOD OF CURE. 
PREPARED FOR, AND APPROVED BY, THE PUBLISHING COMMITTEE OF 
THE AMERICAN SOCIETY OF DENTAL SURGEONS. 
BY ELISHA BAKER, M. D. 
PUBLISHED BY THE AMERICAN SOCIETY OF DENTAL SURGEONS 
STEREOTYPED BY J. S. REDFIELD, NEW YORK. 
1S41. Entered, according to Act of Congress, in the year 1841, Iiy 
SOLYMAN BROWN, 
In Ibc Clerk's Office of the District Court of the Southern District of New York ESSAY 
ON 
ULCERATION OF THE FANGS 
OF 
THE TEETH. 
Having been appointed by the 11 American Soci- 
ety of Dental Surgeons," to prepare an essay on 
abscesses from diseased teeth, and the method of 
treatment, I shall be happy, if in my power, to suggest 
a manner of treatment, that will lead to more suc- 
cessful results, than have hitherto been experienced. 
A curative treatment, except by extracting the 
teeth so diseased, has not received much attention 
by any author who has written on the subject. Al- 
though most who have written on Dental Surgery 
have given a more or less correct description of the 
disease and have recommended a practice which 
might serve in some degree, to moderate the symp- 4 
toms, but by no means such a one as would be 
likely to cure it. 
Mr. Fox gave, perhaps, about as correct diagnostic 
and pathologic description of the disease sixty years 
since as has been given since that period. It has 
been called by several names, such as gum-boil, al- 
veolar abscess. Perhaps epulis or rather parulis 
would be a more appropriate name for it. It may 
be rather difficult to give it a specific name as a 
number of distinct parts are involved in the disease, 
viz, the nerve primarily, the alveolus process and 
its periostums, and the gum. In this, as in all dis- 
eases, it is necessary that a correct description of 
the origin and progress of it should be given. 
The human body is said to be sympathetically 
connected together, and dependant, the one part 
upon the rest, constituting a genera] sympathy. But 
there are particular parts more intimately dependant 
upon each other than upon the rest of the body, 
constituting a particular sympathy. When the dis- 
ease is sympathetic, the local affection is nearly co- 
eval with the part first affected; for instance, the 
stomach with the brain, the one extremity of the 
bone with the other, the body of a muscle with its 5 
insertion, the skin with the parts below it, and in the 
same manner the gum with the inflammation in a 
tooth. The gum is sympathetically affected, when 
the nerve and the investing membranes of a tooth 
first become inflamed, notwithstanding the alveolar 
process intervenes; the tissue of which is quite po- 
rous and as action cannot be greatly increased in 
any one organ without being diminished in some 
other, it follows that the tooth is relieved at the 
time the swelling commences in the gum and ends 
in resolution. Although the nerve dies at this time, 
yet no permanent abscess forms and which follows 
generally from neglect. 
After the death of the nerve, its place and the for- 
amen through the fang is filled with a morbid secre- 
tion, which is a source of irritation to the investing 
membranes, which at length take on a diseased ac- 
tion and in process of time a permanent abscess is 
formed at the end of the fang not in the alveolar 
process or the gum. After a permanent abscess is 
formed the alveolar process is soon absorbed by the 
pressure of the abscess and the icherous discharged 
from it. 
As it has been observed the nerve always dies 6 
during the first inflammation ; at the termination of 
which, immediate measures should be taken to pre- 
vent a recurrence of it. This is accomplished by- 
re moving all the foul matter, consequent after the 
death of the nerve and filling the canal of the tooth 
to the extremity of the fang. If the operation is 
performed at this stage and with skill, a recurrence 
of the inflammation seldom or never happens. 
For the sake of illustration, it is necessary to re- 
fer to cases in point, by which will be seen the al- 
most entire certainty of preventing inflammations, 
which often repeated occasion at length confirmed 
abscesses. " An ounce of prevention is worth a 
pound of cure," is an old adage and should always 
be acted upon, if possible. 
A young gentleman, Mr. Alston, of Halifax coun- 
ty, N. C., had been troubled for several months by 
pain in one of his superior inci sores, and without 
any external appearance of decay. The gum for 
some distance around appeared slightly inflamed 
with very little enlargement. No suppuration had 
ever taken place. On close observation, the tooth af- 
fected had though hardly perceptible, that dull opaque 
appearance, always observed when the nerve is dead. 7 
It was treated as above, after drilling through the 
posterior part of the tooth to the canal, and in four 
days all signs of inflammation or feeling of soreness 
had disappeared. 
Frequent inflammations and resolutions may hap- 
pen to a tooth, and yet no confirmed and continual 
abscess be formed. 
To prove the truth of this opinion I will cite the 
case of a Miss C. This young lady, about a year 
previous to my seeing her, had a front toothfilledin 
Boston, where she then resided. Soon afterward 
the nerve became irritated, inflammation and resolu- 
tion followed, and a succession of inflammations and 
resolutions followed up to the time I saw her. In 
the interims there was no discharge, and but a slight 
degree of inflammation. Her case was treated as be- 
fore mentioned, and no recurrence of disease has 
happened since, which is five years. 
When the disease has so far progressed as to oc- 
casion a constant discharge, a permanent abscess is 
formed, and it then becomes much more difficult 
to effect a cure. The treatment should then be to 
open a free communication to the internal cavity or 
canal, which should be carefully and repeatedly 8 
cleaned out, thereby removing the morbid secretion, 
which undoubtedly is the primary cause of the ab- 
scess ; and exteriorly an incision should be made 
from the mouth of the ulcer extending to the end of 
the fang of the diseased tooth. This is performed 
without any difficulty, as the intervening bone at 
this stage of the disease, is absorbed. A tent should 
be introduced, penetrating to the bottom of this in- 
cision. As the cure, if it be possible to effect it, is 
accomplished by keeping the parts open and clean 
both internally and externally, it is of very little 
consequence that any other means or applications be 
used. 
Mr Fox states that " abscesses happen from a dis- 
eased socket or jaw having no communication with 
a tooth, and only affecting it secondarily." This 
may be considered as very doubtful. He also says, 
" it is common for abscesses to skin over and in all 
appearance heal." When the gum heals up entire- 
ly we believe there is no permanent abscess formed. 
In proportion to the age of the person and excita- 
bility of the system, depends in a greater or less 
degree, the sympathetic affection. Thus the gums 
of children are much sooner affected sympathetical- 9 
ly than those of adults. And when inflammation 
takes place, occasioned by decay in the deciduous 
teeth, abscesses are soon formed. 
From the circumstance, that the temporary teeth 
of children are soon and gradually lost and their 
places supplied by permanent ones, it is not very 
desirable, if it indeed be possible, to adopt any oth- 
er course than that of a paliative one, or if there is 
much pain and inflammation, extraction may be re- 
sorted to. 
A very fruitful cause of abscesses, is the imper- 
fect, and, at present, common manner of inserting 
teeth with wooden pivots on the stumps of teeth. 
The usual practice is to bore a large hole, from an 
eighth to a quarter of an inch in depth and about a 
line in diameter, leaving the canal above filled with 
foul matter, which soon produces disease. This 
manner of inserting teeth is very objectionable. 
First, the loss of substance in the stump by making 
the hole so large. Secondly, if the tooth so insert- 
ed comes in contact with an opposing one it soon 
gets loose. Thirdly, from the elasticity of the 
wood, matter gets in between the stump and arti- 
ficial tooth, producing a rapid decay of the stump. 10 
Stumps seldom last more than three or four years 
when wood alone is made use of. 
The way formerly of inserting teeth with gold 
pivots, is vastly preferable. The hole in the stump 
should be made no larger than to admit the pivot, 
and which should be a half-inch in length at least; if 
the hole is a trifle larger than the pivot a little gold 
foil may be wrapped around it, and if considerably 
larger, a plug of soft pine wood may be introduced, 
through which insert the pivot. That portion of the 
canal above the pivot should be carefully cleaned 
out and filled up. Teeth inserted in this way have 
been known to last eighteen or twenty years, and 
not to require refastening for ten years, and all this 
time remain without occasioning any inflammation or 
parulis. 
Writing on the manner of inserting teeth, may be 
thought by some as a digression from my subject; 
but I consider the objectionable way of inserting 
teeth with wood alone, and its liability to produce 
disease, a sufficient warranty for having mentioned 
the subject; and I appeal to all experienced prac- 
titioners whether gold pivots are not vastly prefera- 
ble to those of wood ; preferable, as being less liable 11 
to produce disease; preferable, as the tooth is more 
perfectly placed and retained in its proper position ; 
and still more preferable as it respects cleanliness, 
durability, and usefulness.