^ $* ■>*, H (im fi >»J A ON THE STRUCTURE, DISEASES, AND MANAGEMENT OF THE HUMAN TEETH. BY EAeazer Gi&ney, Dentist.. " The teeth are worthy objects of the anato- mist, the physiologist, (he chemist, the naturalist, and the practical surgeon."—Dr. Hare. r. FIRST EDITION. UTICA : PRINTED FOR THE AUTHOR, BX AtTGCSTINE G. DAUBY, Franklin-Street. 1824. Northern District of New-York.—To wit: Be it remembered, thai on the fourteenth day of May, in the forty-eighth year of the Indepen- dence of the United States of America, A. D.1824, Eleazer Gidney, of the said District, has deposit- ed in this office the title of a Book, the right where- of he claims as Author and Proprietor, in the words following, to wit : A Treatiit on the Struc- ture, diseases and managemen t of the Human Teeth. By Eleazer Gidney, Dentist. " The Teeth are worthy objects of the Anatomist, the Physiologist, the Chemist, the Naturalist, and the Practical Sur- geon."—Dr. Hare—First Edition. In conformity to the act of the Congress of the United States, entitled "an act for the encouragement of learn- ing, by securing the copies of Maps, Charts, and Books, to the authors and proprietors of such co- pies, during the times therein mentioned ;" and also to the act, entitled " An . act supplementary to an act, entitled 'An act tor the encouragement of learning, by securing the copies of Maps,Charts and Books, to the authors and proprietors of such copies, during the times therein mentioned, and extending the benefits thereof to the arts of De- signing, Engraving and Etching historical and other prints." R.R.LANSING, Clerk of the Northern District of Neiv-Yorlfr ERRATA. Page 7, line 9, for artieles read articles, p. 8, I. 8, for tempory r. temporary, p. 11, I. 16, tor the safety r. that safety, p. 17, 1. 8, for the decay r. their decay, p. 19, 1. 1, for tempory r. tempora- ry, p. 21, 1. 18, for thus becoming r. this becom- ing, do. 1. 19, dele at. p. 23, 1. 11, for tempo- ry r. temporary, p. 24, 1. 26, for with the r. with a. p. 27, 1. 13, for designated r. designed, p. 28, 1. 8, for at the r. at their, do. I. 17, for nitche r. niche, do. 1. 19, for of a r. of the. do. 1. 28, for forty r forty-eight, p. 30, 1. 28, for crystilization r. crystallization, p. 31,1. 6, for too r. two. do. I. 9, for yery r. very do. 1.20, dele the word and. do. I. 22, for internal r. external, p. 32, I. 5, for for the fifth pair r. arise from the fifth pair. do. I. 13, for form the infra orbiter r. forms the infra orbiter nerve, do. 1. 25, for gustutory r. gusta- tory, p. 33,1. 2, for tooth r. teeth, p. 35, I. 23, for like bones r. like other bones, p. 41, 1. 16, dele the word from. p. 45, 1. 27, for permament r. permanent, p. 57, 1. 11, for above r. about. p. 66, 1. 5, for the teeth r. the permanent teeth. p. 80. 1. 7, for and produce that r. and thus pro- ducing that. p. 86, 1. 7, for to brought r. to be brought, p. 88, 1. 18, for the teeth r. several of the permanent teeth, p. 94, I. 7, for the teeth r. these teeth, p. 96, 1. 2-1, for has been r. have been. p. 119, I. 9, for progress r. process. Dentifrice, in several places is spelled dentri- frice, &c. CONTENTS. —©©©— Paa-e. INTRODUCTION. 7 Chap. 1. Formation of the temporary teeth, 19 2 Formation of the permanent teeth, 25 3. Formation 6c structure of the teeth in general (and their analysis) 29 4. Sheddinir of the teeth, 38 5. Irregularities of the teeth, 43 6. Diseases attending dentition, 48 7. Caries or decay of the teeth, 52 8. Of the structure and diseases of the gums, 61 9. Morbid growth of the gums, 66 10. Alveolar processes, and their dis- eases, 68 11. Diseases of the antrum maxillare, 71 12. Exostosis of the fangs, 73 13. Denuding process, necrosis and spina ventosa, affecting the teeth. 76 14. Tooth-ache, 80 15. Wearing & fractures of the teetli, 83 CONTENTS, Chap. Page. 16. Occasional effects of diseased teeth, 86 17. Tartar (and its analys s ) 89 18. Cleaning, scaling, or removing the tartar from the teeth, 92 19. Filing or separating the teeth, 94 2o. Filling, or stopping the teeth, 98 21. Ext action of the teeth, 100 22. Remedying the irregularities of the teeth, 105 23. netting artificial teeth, 107 (A dtsc ■ ptton of the Hippopotamus, or .Vn Horse.) 109 24. Importance of cleanliness of teeth, 115 25, Importance attached to the teeth, 128 26, Conclusion, 138 Among- the many letters received, recommen- datory of this work, the author has selected the following':— From the Hon. Joseph White, M. D. Presi- dent of the College of Physicians and Surgeons of the Western District, located at Fairfield, state of New- York. Cherry Valley, June 9th, 1824. SIR—I have read with much pleasure your " Treatise on the structure, diseases, and man- agement of the human teeth." A work of this kind has long been called for. Your little Trea- tise ought to be in the hands of every family and read with attention—especially by those who have the direction and management of our youth. I firmly believe that a strict compliance with the directions given in your work, would wipe off the opprobrium cast upon our climate as being unfriendly to the preservation of the human teeth. Accept, sir, of my best wishes for the success of your laudable endeavour to ameliorate the con- dition of your fellow beings. Respectfullv, J. WHITE. E. Gidney, Dentist, Utica. From Henry Davis, D. D. President of Hamil- ton College. The subscriber has read, with much interest, - A Treatise on the structure, diseases and iaan- Kgemant of the human teeth, by Eleazer Gir> kev, Dentist;" and judging from his Treatise and from information otherwise received respecting him, he has no hesitation in saying that Mr. Gid- ney is, in his opinion, entitled to the thanks, and highly deserving the patronage of the public. H. DAVIS. Hamilton College, ) 18th June, 1824. \ From Alexander Coventry, M. D. Presi- dent of the Medical Society of the State of New- York. Mr. Eleazer Gidney, SIR—I have perused your Treatise on the structure and diseases of the human teeth with much satisfaction, and can truly say that I have very seldom found so much useful information comprized in so small a compass. Your little volume is worthy the perusal of every individual of competent age to understand its contents; would make a valuable addition to every private library ; and the Parent who regards the future comfort of his children would do well to furnish himself with one of your treatise. Respectfully yours. ALEXANDER COVENTRY. TJtica, July 7,1824. PREFACE. In presenting the following work to the perusal of the public, the author has been influenced by a desire to promote the knowledge of a science, which, at the present time, is little understood in this country. Among the various diseases which are incident to the human system, none, he believes, are less attended to, either as to the means of their preven- tion or cure, than those of the teeth.— Yet the painful consequences which are attendant on the disorders of these im- portant organs, certainly afford a suffi- cient inducement to pursue that know- ledge,by which we maybe enabled with proper care and attention, to preserve the teeth in a healthy state. Every one 4 who has ever experienced the excrucia- ting pains of the tooth ache, or the incon- veniences which result from a loss of the teeth, must be fully sensible of the ef- fects of inattention to this subject. Pre- judices, indeed, have long existed in the minds of many persons, against any op- erations on the teeth. But this preju- dice arises wholly from ignorance, and from the fatal consequences which such persons have often seen resulting from the operations of empirics, and of mere pretenders to skill in dental science. In the following work, the formation and structure of the human teeth, as well as the causes by which diseases of these important organs are produced, and the mode by which those diseases may be prevented or remedied, have been illustrated in such a manner as can- not fail to be useful to every person who may find leisure to peruse it, and the 5 author doubts not but that it may prove of singular advantage to practical phy- sicians, surgeons and dentists. INTRODUCTION. It is an uniform law of nature, that the operation of the living functions of all animal bodies, has a constant tendency to consume the substance of which they are composed. A certain and regular provi- sion is therefore necessary for the repara- tion of those losses which the body has sustained. The animal and vegetable king- doms are abundantly stored with artiel«s of food which by a bountiful Providence are adapted to the tastes and instincts of all his creatures. But before these arti- cles of food can become nutriment for the body, they must undergo certain proces- ses. The first is that by which they are broken down into small particles, which by being mingled with the fluids of the mouth, are comminuted into a fine mass, and thus prepared for the action of the stomach, in the process of digestion. The teeth are the organs provided by nature for the mastication of food, which is an operation so essential to health, that 8 without its due performance, the digestion must be always more or less deranged. Those teeth which appear in the early part of life, are adapted to the state of childhood, and at a certain period are suc- ceeded by a second set, which are design- ed to continue during the remainder of life. The first, or tempory set of teeth, are very liable to become diseased, and in the majority of cases, do not of them- selves, fall out in sufficient time for the permanent or second set of teeth to ar- range themselves in their proper order. A knowledge of the change which the teeth undergo, is a very interesting part of natural history, and is absolutely re- quisite to enable a practitioner of the den- tal art, to render such assistance during the progress of the second dentition, as may preserve the permanent teeth from being injured by the diseases of the tem- porary ones, or from acquiring that irreg- ularity which always occasions much de- formity, and often prevents correct pro- nunciation. Attention to the appearance and pre- servation of the teeth is an object of much importance. When we take into consideration the advantages which have 9 arisen from the separation of the differ- ent branches of surgery, no one, it is pre- sumed, will hesitate to acknowledge the great benefits which have thus been pro- duced to mankind. But while examining the progress of improvements in the different branches of this science-, it is to be observed with regret, that the dental art has not kept pace with many others of less real utility. And we believe that one great cause which has retarded its pro- gress, is that the subject hitherto has been considered as not forming an essential part of professional education, but the practice of it has generally been regarded in no other estimation than that of a me- chanical occupation or trade. Although many valuable publications from able and skillful Dentists have preceded this trea- tise, yet it is melancholy to reflect how limited has been the usefulness of their la- bors. Experience evinces that all their instructions are but ill adapted to answer the extensive calls for information on this subject. C onscious, therefore, how much remained to be done in every thing rela- ting to the management of the teeth, I was induced to direct, my attention very early to the subject j and from experience 10 have generally found it necessary to regu- late my practice by the principles of my own system. How far it has been satis- factory, must be decided by those who have experienced its effects. Whenever, in the following treatise, I shall take the liberty to differ from the opinions or practice of my predecessors, I can truly say, that I am influenced only by a desire of improvement, founded in experimental knowledge. But where their sentiments have appeared to be founded on just observation, I willingly adopt them, and in doing so, I shall not scruple occa- sionally, to borrow their language. A great improvement in this depart- ment of surgery, will depend on pointing out to society the importance and means of preventing diseases of the teeth, and their connexion, in almost every instance, with the general state of the health and preservation of the system. By no means could this object be so effectually accom- plished as by the establishment of an in- stitution for the exclusive promotion of Dentalogical science. The wants of so- ciety, as well as the disposition of the present enlightened period, so favorable to the universal diffusion of knowledge, 11 demand such an institution, and such, we flatter ourselves, we are authorized short- ly to anticipate. Then will this useful art be rescued from the undue degradation to which it has been exposed in the hands of ignorant practitioners, or of mercenary pretenders, who by the monopoly which they have established, have prejudiced those who have spared no pains or ex- pense in obtaining a scientific knowledge from the best professors in this depart- ment of surgery, without regard to the sufferings of mankind or disgrace of the profession. A want of that knowledge which is indispensably requisite to enable an operator to act with the safety and suc- cess which so delicate and valuable an or- gan as the teeth demands, will readily ac- count for the low estimation in which our profession is held by a large part of the community. Numerous, indeed, are the injuries caused to society, by these pre- tenders, and it is heartily wished that they had more information, or less patronage from an enlighted people ; a patronage which is the bane, and almost total ruin of our profession, and for which we have »uch frequent cause of complaint. 12 Very different, indeed, is the reputation of our profession in Europe. The servi- ces of a Dentist are there considered in- dispensable in almost every family, and in public seminaries, which are regularly vis- ited from two to four times a year, or oft- ener if necessary, that the teeth of the family or pupils may be inspected so that timely assistance and directions may be given ; und in this manner almost every deformity and decay of the teeth may be prevented with a trifling expense. I am happy to state that a similar practice is coming into fashion in our large cities, and which I have no doubt will produce the happiest effects. But here I would re- mark, that there are many important con- siderations which should induce those who wish the professional assistance of a Den- tist, to pause before they proceed to em- ploy a person with whose character or a- bilities they are unacquainted ; for in the hands of Charlatans or quacks is general- ly some powerful medicine, the efficacy of which profers some miraculous cure of the tooth ache, or some remarkable quality of whitening the teeth, or some other preten- ded valuable properties. Therefore these remedies are frequently applied by the 13 unwary, on recommendations of a person wholly destitute of a knowledge of their qualities, and perhaps of the pernicious effects which they are liable to produce : But they answer his purpose. The reme- dy is applied ; he gets his money, and is soon beyond the reach of his unfortunate patient, and of the protecting power of justice. But too soon the fatal decep- tion is discovered ; an invaluable set of teeth are wholly ruined, and many pain- ful consequences ensue. But if the im- postor has placed in the hands of the unwa- ry, some powerful pretended specifics for the tooth ache,what has experience proved to be the result of its application ? Not less than five fatal occurrences from this source have fallen under my own observation, be- sides almost innumerable instances of much pain and danger. I would therefore recommend the public to consider all med- icines dangerous in the hands of the igno- rant, and as they value life, to reject from their hands every preparation for the teeth, with the properties of which they them- selves are unacquainted. Those who wish to extend their inqui- ries further on this important subject, I would refer to the justly celebrated publi- 14 cation on the teeth, by Mr. John Hunter This was/the first scientific treatise that was ever published on this subject, and as an anatomical work, must ever stand high in the estimation of every professional Dentist. It was this gentleman who first tendered the fostering hand to this noble art. His opportunity, from being fre- quently consulted on the subject, by Den- tists of his day, gave him a complete in- sight into the miserable condition in which this brancli of physiology then existed.— His views were accordingly given to the public in a manner which soon procured gentlemen of elevated talents and respec- tability to embark in its cause, and from these gentlemen light and knowledge in this science have been promulgated to a very considerable extent, and which have tended much to put down those practices of imposition which I have already men- tioned, and have established a permanent foundation for the further elevation of this science, which I fondly trust will not be easily shaken. Dr. Blake's disserta- tion, published in Edinburgh,in 1798, con- tains many correct and valuable observa- tions. Mr. Rosini's work on this subject is filled with interesting matter, and may 15 be perused with advantage by all who re- gard the preservation of their teeth as an object of any importance. The late Mr. J. Fox, it is presumed, has done more for the elevation of this science than any other man. Several courses of lectures on this subject were delivered by him at Guy's Hospital, from 179y to 1814. The first volume of which, containing the natural history of the human teeth, &c. was published in 18u3, and a second vol- ume on the diseases of the teeth, &c. was published in 1806. And both volumes, with further improvements and illustra- tions, with twenty-three copper plate en- gravings were republished in 18,4, under the title of the "Natural History and Dis- eases of the Human Teeth." This work contains a comprehensive view of the origin, rise, progress, and all the various deformities and diseases of the teeth. It is executed in a manner which shows very accurate observation, and I presume it will ever be regarded as a work of great merit. It is not, however, without some imper- fections, which, in the course of this trea- tise, I shall notice, and, as far as possible, correct. There are many other smaller works in the hands of the public, of differ- 16 ent degrees of merit. In fact, within these few years, in this country, as well as in Europe, it must be admitted that con- siderable improvement in dentalogical science has been made, and especially in our large cities. It is generally establish- ed on a respectable footing, and conduct- ed by those enlightened principles which are the fruits of a liberal education and practical experience. Such are the im- provements in this branch that the compli- cated diseases of former times now yield to a mild and natural treatment, and by the skilful Dentist, operations are daily performed, of that bold and decisive char- acter, which, at a former period, would have been thought impracticable and be- yond the power of art to accomplish.— Indeed, if mankind in general, could be suitably impressed with the utility of the many improvements in the der.tal art, and timely application made for relief, much Buffering would be prevented. That much may be done for the preser- vation of the teeth by the individuals them- selves, is a fact which needs no proof; but that every person is not acquainted with the most approved or necessary means, to effectually guard their teeth from all dis- 17 ease, is also a fact, which, it is presumed, will not be contested. Therefore, when teeth are sound, the advice and directions of a skilful dentist, if strictly adhered to, will generally preserve them so, to the most protracted period of life ; but if they have already began to decay, and especial- ly if the decay is produced from external causes, which five times out of six is the case, a proper dental operation will not only stop its further progress, but by filling the decayed cavities with gold, suitably pre- pared for the purpose, will render them artificially sound, and in every respect as good and likely to be durable as ever. But here let me observe that this is an opera- tion which can only be expected to prove effectual, or in fact of any particular ben- efit where it is well done and that with the best materials. A word, it is presum- ed, will be sufficient to convince every one that this operation, particularly, should be attempted by none, but those who are pos- sessed of the necessary knowledge, manu- al dexterity, suitable instruments and the best materials. The want of some one or all of these qualifications in those who have attempted this operation,is the cause of the want of success, and consequently id «f the low estimation in which this useful branch of our art is held by so large a class of community. I could wish the public might be induced to correct this erroneous opinion ; as it is a fact that very many, and even almost every decayed tooth, if taken seasonably, may be so effectually stopped that it will be in every respect nearly as serviceable and durable as if no disease had ever effected it. CHAPTER t Formation of the tempory Teeth. At a very early period we may per- ceive the preparatory steps for the forma- tion of the teeth. As soon as ossific or bo- ny deposits commence, both jaws are fil- led with small membraneous sacs, which are the rudiments of the teeth. The blood vessels and nerves belonging to the teeth run along at the bottom of the cavity, in which these pulps are contained*; but after- wards a distinct canal is formed, through which the principal blood vessels and nerves pass, separate filaments being sent off to the several teeth. The alveolar processes or sockets, soon become distinct; for the bony partitions, which divide the longitudinal cavity in the jaw, rise to the upper margin, and thus those membraneous processes, now enlar- ged, become more evolved and begin to be contained in separate cells. Upon ex- amining those sacs or substances found in 20 TREATISE, &c. the jaws, they are seen to be soft or pulpy bodies, bearing a resemblance to the figure of the body of the tooth to be formed, and each of them is contained in a membrane proper to itself. For some time during the formation of the teeth, the alveoli grow much faster than the teeth them- selves, which are consequently but loose- ly contained within them, and so as near- ly to enclose or cover the teetli, and thus giving a firmer support to the gums, and enabling the infant to make the necessary pressure in taking nourishment without injury to the parts going on underneath. The ossification of the teeth begins to take place very early; it is first visibleupon the tips of the front teeth, next the cuspi- dati or canine teeth, and soon the mo- lares or grinders. This gradually advan- ces and extends itself over the pulps. At the time of birth the bodies of twenty teeth are distinctly formed, ten in each jaw. These are the teeth designed to serve during the years of childhood, and are commonly called the temporary, shed- ding or milk-teeth. They are divided in- to three classes, incisores, cuspidati, and anolares. In each jaw there are four in- cisores or front teeth, two cuspidati or ca- TREATISE, &c. 21 nine teeth, and four molares, two on each side—the teeth on one side of the mouth corresponding in figure with those of the other, so that they are situated in pairs. Besides these twenty teeth, there are in a very early stage of their formation the ru- diments of some other teeth which are to form part of the permanent or adult set. As the growth of these teeth goes on they become too long to be contained within the alveolar cavity. They therefore begin to make pressure upon those parts, which cover them. This produces the process of absorption, which proceeds with the en- largement of the tooth, first removing the membranes which enveloped it, and after- wards the thick gum with which it is cov ered, thus becoming thinner and thinner, till, at at length, the tooth is suffered to pass through. Sometimes children have one or tw« teeth at the time of birth. These prema- ture teeth have no fangs and are only at- tached to the gums. They soon get loose and produce inflammation in the mouth, & are inconvenient to the mother. It is therefore advisable to extract them imme- diately. In general, children begin to have their teetli about the sixth, seventh or 22 TREATISE, &c. eighth month. Those which correspond with each other generally appearing about the same time, first in the under jaw and then in the upper. The first set of teeth is generally complete at the age of two and a half or three years ; but this frequently depends on the health and vigor of the child. Among the robust, it is not un- common to see the teeth begin to protrude as early as the fourth or fifth month, while those of more delicate and weakly consti- tutions will require from ten to fifteen months before any teeth make their ap- pearance. It some times however hap- pens that the teeth seem not to be influen- ced by the state of the health. The following is the order in which the teeth of a child generally appear. The first teeth are the central incisores of the under jaw, one generally coming a few days before the other, then in the course of a month the two central incisores of the upper jaw. These are succeeded in a few weeks by the lateral incisores of the under jaw, and then soon after by the lat- eral incisores of the upper jaw. The cuspidati are generally slower in completing their growth than the molaree. They are placed deeper in TREATISE, &c. 2S the jaw, and therefore are preceded by the first molares of the underjaw which us- ually come before those of the upper. They commonly appear about the fourteenth or sixteenth month, & are soon met by those of the upper jaw. After these the cuspi- dati come through, first in the lower jaw and then in the upper. At sometime be- tween two years or two years and a half, the second molares make their appearance, and thus complete the tempory set of teeth. Though this is the regular course observed by nature, there are at times ex- ceptions to this order of protrusion for in- stead of the front incisores, the lateral in- cisores are sometimes discovered first, through the gums, and the small molares before the lateral incisores. The period of dentition is often highly critical to the constitution of the child, as it not only occasions disease, but general- ly aggravates any other disorder which may occur at the time. Yet it is well known that this period sometimes elapses unaccompanied by any particular symp- toms of pain or uneasiness. The appear- ance of the teeth is clearly an effort of nature, in which she affects the absorption of the investing membrane, the alveolar 24 TREATISE, &c. process, and the gums to make way for their passage. But the teeth somtimes advancing too rapidly occasion a strong ten- sion and pressure on the vessels of the gums, which produce pain and irritation in the surrounding parts. Hence the gums appear swelled and inflamed, a constant discharge of saliva takes place from the mouth, and often a general sympathetic fe- ver prevails over the whole system. At this period the mode of treatment de- mands our particular attention. The child is frequently indulged with some hard sub- stance to bite or press upon the already in- flamed gums. This practice is highly per- nicious, as it tends much to increase the inflammation and uneasiness of the parts. Some recommend the use of salt with a gentle friction on the gums with the finger. But experience has proved this mode of treatment to be highly improper. A gentle cathartic or any other means by which the increased action of the system may be re- duced, will prove useful. But nothing will so effectually and safely relieve the little suffeier, as an incision made with the lancet, over the tooth which is the cause of irritation. This would not only adminis- ter instantaneous relief to the child, but TREATISE, &c. 25 will prevent or remove every distressing and dangerous symptom, with which denti- tion is often attended. Little skill is re- quired in the performance of this simple and safe operation. The operator should be certain that the instrument reaches the seat of the mischief. Not only the gum, but the membrane immediately over the tooth, must be effectually divided. No mischief can ensue from the lancet being pressed sufficiently hard upon the tooth as to leave no doubt of the entire division of its covering. —e©^- CHAPTER II. Formation of the permanent set of Teeth. In the management of the teeth of chil- dren, it is highly necessary that the sur- geon, or whoever may have the care of them, should have a perfect knowledge of the order in which the teeth of the perma- nent set are formed, and of the time when each tooth is expected to pass through the gums. The formation and perfection of this set of teeth occupy a very important portion of our limited existence. No less 26r TREATISE, &c. than twenty years, and often more being necessary to their complete evolution. Na- ture begins to attend to the production of these permanent instruments of mastication at a very early period, and in many instan- ces they are not wholly completed before the twenty-fifth, thirtieth, and somtimes the fiftieth year. The permanent set of teeth are much larger, differing essen* tially in figure from the temporary set, and are twelve more in number, making, in the whole, thirty-two. This set of teeth may be divided into two classes. Those which are to succeed the temporary, and those which are superadded. The formation of both these divisions begins nearly about the same time, & the progress furnishes one of the most curious changes the animal econ- omy can exhibit. The incisores and cus- pidati of the child are succeeded by teeth similar in form, but larger in size. But the teeth which take the places of the temporary molares are much smaller & being divided at their grinding surfaces into two points are called bicuspides. The molares of the adult, are the teeth which are super- added, and these succeed one another as the jaw advances in giowth. The perma- nent set of teeth are subdivided into four TREATISE, &c. 27 classes, viz. the incisores, cuspidati, bicus- pides and molares. There are in each jaw four of the first class, two of the second, one on each side, four of the third, two on each side, and sixth of the fourth class, three on each side. The front teeth of the upper jaw are much broader and lar- ger than those of the under jaw. The cuspidati are more conical, and have much longer and larger fangs than any of the oth- er teeth, and are of a middle nature be- tween the incisores and bicuspides. They seem to be particularly designated for the laying hold of and tearing substances. The bicuspides have an intermediate re- semblance between the last described teeth and the molares. Those in the upper jaw generally have but one fang, those in the un- der jaw, two. The molares are the three back teeth on each side of the jaw, making twelve in the whole. Their crowns are much larger than those of the other teeth. Their grinding surface is furnished with several points, which fit them for their of- fice. The upper molares generally have three fangs, and those of the under but two. The third or last grinder is called dens sa- pientiae. The fangs of these teeth are of- ten so much curved as to render their ex- 28 TREATISE, &c. traction extremely difficult. They sel- dom appear before the twentieth or thirti- eth, and sometimes even the fiftieth or six- tieth year of age- At the time of birth, on examining the membranes of the temporary teeth, small membraneous sacs or pulps con- taining a jelly-like substance, will be found attached to them at the posterior and up- per part. These are the early rudiments of the permanent molares. At the age of two or three years the position of the teeth is much altered. At first the permanent teeth are contained in the same socket as the temporary. But as the formation of both sets advances, the permanent teeth by the growth of the alveolar processes become placed in a kind of nitche. There is also a small bony process shooting across the bottom of a commonsocket, which gradual- ly increases, till at length, nearly a com- plete separation is produced, and the per- manent teeth are contained in sockets of their own. At about six years of age those teeth designed to succeed the temporary ones and the first and second molares are in considerable forwardness; and if none of the first set have yet been removed, there are at this time in the head forty- teeth, twenty in sight; and within the jaws TREATISE, &c. 29 beneath the gums in the progress of forma- tion, twenty eight. At about the ninth or tenth year the formation of the the third molares or dens sapientiae, begins. This description differs considerably from Mr. Hunter's treatise, for by some means, in- accuracies have been suffered to creep in- to his work. But the above is the order in which the formation generally takes place. - ■ oOQ CHAPTER III. Formation and structure of the Teeth in general. The teeth are formed in a manner pe- culiar to themselves, differing materially from the formation of other bones. They are formed from a soft pulpy substance, which possesses the shape of the body of the tooth to be produced. Each pulp is> covered by a membrane strongly attached to the gum and to the pulp at its base, and is slightly connected with the socket. These pulps and membranes, on examimv 30 TREATISE, &c. tion, are found to be vascular. The mem- branes derive their vessels from the gums, and the pulps receive theirs from the artery which passes through the jaw. We are indebted to Doct. Blake for the discovery of the manner in which the per- manent teeth derive their origin. We have observed that from the mem- branes of the temporary teeth are given off small sacs from which the permanent set are produced. The second and third mo- lares are in like manner formed from the first. A tooth is composed of two substances, one of which, called enamel, is spread over that part which is not covered by the gums. The other substance is bone. It consists of the fang and all the body of the tooth situated within the enamel. The bone of the tooth is formed from the pulp, and the enamel from the investing mem- brane. This membrane secretes a fluid, from which a very white soft substance is deposited upon the bony part of the crown of the tooth. This at first is of a consis- tence not harder than chalk, but after- wards seems to undergo a process similar to crystilization. The deposit of the en- amel coatinues nearly as long as the tooth TREATISE &c. 3i is contained within the membrane, but re- ceives no addition after it has protruded. This enamel when perfect is so hard as to elicit fire, if struck with steel. Sometimes in the formation of the teeth, too pulps unit e, and upon their serfices appear as two distinct teeth, but on at- tempting to remove one it is discovered to be united to the next. Yery often the fangs of the teeth become crooked from some obstruction to their growth, and teeth having two or three fangs are now and then met with, so much bent at their points as to occasion them to be very firm- ly placed in the jaw. When these cir- cumstances occur, the extraction of the jteeth is unavoidably an operation of the utmost difficulty. The arteries which supply the teeth with blood, are called the dental; and they are branches of the internal maxilia- ry artery, which arises from the internal carotid. It sends off numerous branches to the parts belonging to both jaws, and to the teeth of the upper jaw. it then gives off one brmich to the lower jaw, called, by some, the inferior maxillary, and by oth- ters, the dental. This enters the posterior maxillary foramen of the jaw bone, passes 32 TREATISE, &c. through the maxillary canal and gives off branches to the fangs of each tooth, and also supplies the substance of the bone. The nerves which are distributed to the teeth for the fifth pair, the trigemini.-— This pair -of nerves divides into three branches ; the opthalmic ; the superior maxiliary, and the inferior maxillary.— The opthalmic branch is distributed to the parts in the neighbourhood of the eye. Branches from the superior maxillary nerve enter the canal under the orbit, and form the infra orbiUr. At the pos- terior part small filaments of nerves, ac- companying branches of arteries, enter the superior maxillary bone by the fora- mina which lead to the molares, and whilst in the canal it sends oft" branches to the other teeth in the upper jaw. The inferior maxillary nerve passes through the foramen ovale of the sphenoid bone, and is distributed to the muscles of the lower jaw: It sends off a large branch, the lingual, which goes to the tongue, which is the true gustutory, or that nerve which produces the sense of taste ; it then enters the maxillary canal of the lower jaw, passes through the bone under the al- veoli and gives off branches which enter- TREATISE, &c. jj ing the fangs, ramify upon the membrane within the cavities of the tooth ; it passes out at the anterior maxillary foramen and is spent about the chin and lip. There is another set of vessels called absorbents, of the existence of which in the structure of common bone there can be no doubt: and on account of certain effects produced upon the teeth, we have reason to conclude that they are not des- titute of them. During the progress of the second den- tition the fangs of the temporary teeth are absorbed ; and even the permanent teeth, when diseased, often loose a considerable portion of their fangs. Some suppose that these vessels are seated in the socket, but from frequent ulcerative processes oc- curring in the cavity of a tooth, by which a considerable portion of its infernal struc- ture is destroyed, we may reasonably conclude, that absorbents alsoaccovipany the other vessels into the internal cavities of the teeth. The teeth are fixed in their sockets by that species of articulation called gom- phosis. They are attached to the alveolar cavity, by a strong periosteum, which is 34 TREATISE, &c. extended over the fangs, and which also lines the socket. It is connected with the gums at the neck of the tooth. Mr. Hun- ter considered the teeth devoid of internal circulation, and destitute of a living prin- ciple. But Mr. Fox very justly supports an opposite theory. He considers that the blood sent to the teeth is designed for their nourishment and support. That blood does circulate in the inter- nal cavities of the teeth, it is presumed no one will attempt to deny, and as blood carries with it the principles of nutrition, and is sent to those parts only where re- novation is necessary, it is but reasonable to suppose, that the blood imparts nour- ishment to the teeth, the same as it does to other bones. It is always observed, that as persons advance in life, their teeth lose that whiteness which they possess in the time of youth. This change seems to de- pend on one which takes place in their cavities, by which the vessels entering them are gradually destroyed and the sup- ply of blood proportionally -diminished. In the teeth of persons advanced in years, the cavity is very frequently obliterated, in consequence of a deposit of bony mat* TREATISE &c. 35 ter, which destroys the internal organiza- tion. VN hen a tooth has once been com- pletely loosened, by accident or other- wise, and remains in the socket, it will beco ;.e of a darker colour, on account of the loss of its nourishmeut from the de- struction of its blood vessels. The teeth being similar i<» their con- struction to other bones, are governed by somewhat the same laws, and are liable to like diseases ; .nd like then, they are af- fected by the various causes of inflamma- tion, and when diseased, are subject to similar appearances. In bones the power of resisting the ef- fects of disease, is in an inverse propor- tion to their density. The teeth being the most compact and solid bones in the sys- tem, possess the least power of resisting disease, and in these, the general result of inflammation, is gangrene. The teeth have not the power of exfoli- ation like bones, and it is not necessary they should, for the system in general, sustains no injury by the loss of a tooth, and no one would have sufficient patience to endure the pain at ending upon, or wait the completion of so slow a process.— 36 TREATISE, &c. Like other bones, the teeth are subject t# that inflammation called the ossific, by which they become enlarged by an addi- tional deposit of bony matter, and exhibit all the appearances of exostosis. It may not perhaps be uninteresting to know the substances which enter into the composition of the human teeth. I will here enumerate them, and give the pro- portions in which they are respectively found, as ascertained by Mr. Pepys. One hundred grains of the enamel of the human teeth (carefully rasped) being decomposed by a chemical process, was found to consist of the following sub- stances : Phosphate of lime 78 Carbonate of lime 6 84 Water of composition & loss 16 100 A loss of sixteen grainshere takes place, which is easily accounted for, from the ii» possibility of directly ascertaining the state of dryness in which the ingredients existed originally ia the enamel. TREATISE, &c. 37 Bone or roots of teeth yielded by anal- ysis, in 100 grains, Phosphate of lime 58 Carbonate of lime- 4 Gelatine 28 90 Water of composition &, loss 10 100 The teeth of adults yielded on analysis in 100 grains, Phosphate of line 64 Carbonate of lime 6 Gelatine 20 90 Water of composition Sf loss 10 100 The specific gravity of adults' teeth is found to be 2.2727. The shedding or primary teeth of chil- dren yielded, on analysis, in 100 grains. Phosphate of lime 62 Carbonate of lime 6 Gelatine 20 38 TREATISE, &c. Water of composition Sf loss 12 100 The specific gravity of children's teeth is 2.0833. —©©©— CHAPTER IV. Shedding of the Teeth. The falling out of the temporary teeth, to give room for those which are designed to be permanent, is usually termed, the shedding of the teeth. It is the effect of one of the most curious operations of na- ture, and is of great importance to man- kind, since the beauty of the face, and the proper articulation of sounds, depend in a great measure upon the regularity with which this process is accomplished. The necessity of teeth for the mastica- tion of food, commences as soon as the time of support from the mother ceases, and therefore a set is provided at a very early age, which occupies but a few months TREATISE, &c. 39 in formation, and continues without decay only a few years. These teeth are only proportioned to the size of the mouth dur- ing childhood, and would consequently be too small and too few in number, for the extended state of the jaws in the adult.— This renders the formation of a new set indispensable, and agreeable to the man- ner already mentioned, a set of teeth is formed of a magnitude and number pro- portioned to the mature state of the body, and designed from their very dense struc- ture, to last through life. It is during the formation of the per- manent teeth, that the very curious pro- cess of absorption takes place in the tem- porary ones, which quickens their remov- al from tiie socket, and opens a free p is- sage to the permanent teeth. The pulps of the new teeth are placed behind the temporary ones, and thus situated they are very much crouded, and fill but a small space. Now it is evident, that as they advance in size, they will require an in- crease of room, to obtain which, they must ceme forward so as to form a larger circle. This effort first produces a pres- sure against the bony partition situated 40 TREATISE, &c. between the temporary and permanent teeth. This pressure causes an absorp- tion of those parts upon which the pres- sure acts, and as the new teeth augment, the fore pirtof the socket, which contains the pulp and separates it from the shed- ding tooth, is taken up by the absorbents and carried out of the system. This process of absorption gives to the !V.!;.^s the appearance of being broken, but when compared with a fracture, will be seen to differ very essentially. While the absorption of the frngsof the tempo- rary set of teeth seems to depend so much on the pressure <»f the rising permanent ones, it is often found to go on without such pressure, for in some cases the tem- porary teeth v ill drop out long before the new teeth appear, and some times the same effect is produced where a new tooth does.not rise to fill the place of the one that h;i<5 fallen out. Cases of deficiency of the permanent teeth are frequently known to occur.. The appearance of the teeth when ab- sorbed, has frequently given rise to a pop- ular but erroneous opinion, that the first teeth have no fangs. It has also been er- TREATISE, &c. 41 roneously conceived, that the temporary teeth are pushed out by the permanent — Now, that this is incorrect, will appear obvious, by observing the state of the two sets of teeth. The temporary are firmly fixed in sockets, whilst the new teeth, during their growth, are contained in cav- ities larger than themselves, and can only make such pressure as their gradual in- crease will permit. Hence, if the absorp- tion of the old teeth be retarded, or the formation of the new ones takes place too quickly, the latter will take an improper direction, when they come through the gums, and form partially a second row of teeth, from the temporary ones still re- maining. Further, if the old teeth were crowded out by the new, we should always find those teeth about to be displaced, forc- ed out of the line of the others, a circum- stance which never occurs. Children generally begin to shed their teeth between the sixth and seventh year. The teeth of the permanent set which usu- ally appear first, are the anterior molares, which being so newhat earlier in their formation,generally precede the incisores, and soon after the cutting of one or the 42 TREATISE, &c, other of these teeth we may expect that the shedding of the temporary teeth will begin. Soon after the first permanent molares have appeared, the two central incisores of the under jaw become loose, and when they are but slightly attached to the gum, easily come away. ; he permanent cen- tral incisores soon after appear, one com- ing a little before the other In about two or three months the central temporary in- cisores of the upper jaw become loose and fall out,and the permanent central incisores succeed them. In about three or four months more, the under lateral incisores having 'ost their fangs, come away, and the permanent lat- eral incisores succeed them The latte- ral incisores of the upper jaw are the next that drop out. and the permanent ones ap- pear shortly afterwards. In about six or ei"-ht months more, the tern] orury molares begin to loosen ; they generally come out before the cuspidati ; the long fangs of which take a much longer time to be ab- sorbed. The first b'cuund the names of Hunter, Fox and Blake. Mr. Hunter observes "that it does nota- rise from external injury or from n enstrua which have a power of dissolving part of a tooth. But we may reasonably suppose that it is a disease arising in the tooth itself." Mr Fox, on this subject, remarks, uAt first It has its origin in the bony part of lie crown of the tooth, the structure of which is grad- ually destroyed ;''thus, continues he, 4kit is that in the first instance caries originate." Mr Blake's opinion on this subject con- curs precisely with the above. In support of the latter theory are found the names ©f TREATISE, &c. 55 Messrs, L. S. and E. and J. Parmly. Mr. L. S. Parmly, mentions, (speaking on this subject) 'that relics of what we eat or drink (without regard to its quality) being allow- ed to accumulate, stagnate and putrify ei- ther in the intersticies of the teeth, as is most co-nmonly the case, or else iu those indentures on their surface, favorable for the lodgement of the food, is universally the cause of their decay and generally of most other disorders to which they are ex- posed.' Mr. E. Parmly, in his essay on teeth, speaking .f caries, says, "from my own observations, I am induced to believe that caries is universally caused, by the action of external agents, and therefore cleanli- ness after the proper offices of the Dentist is performed, is the only safeguard against it." Here seems to be two diametrically opposite opinions as to the true cause of this destructive malady. From this di- versity of senti nent and the importance of the subject, I have been induced to give it my careful attenton, the result of which, I can say, has in this point proved, to me, satisfactory. Fro ly liable to cause the other teeth to be- come diseased, but they often produce gum-boils and diseases of the socket.— The decay of the teeth does not appear to be peculiar to any age, temperamei t, or state of health. The teeth of children are ve- ry subject to this disease, and those of the robust and healthy, are equally liable to caries as the delicate and less healthy. TREATISE, &c. 61 CHAPTER VIII. Of the structure and diseases of the Gums. The gums, in a healthy state, are of a red colour, of a semi-cartilaginous con- sistence, and considerably vascular. They are attached firmly to the necks of the teeth, passing between them, and attach- ing to the bony divisions of the alveolar processes (which connect the inner and outer gums,) and their extreme edges lie upon the enamel In their natural state they possess little sensibility, but from accumulations about the teeth, they ac- quire such an extreme degree of it, that the least pressure occasions pain. They are liable to bleed and become considera- bly discoloured, thickened and enlarged, which proves exceeding troublesome in infancy, during the progress of the first dentition, but which, in a healthy state, are so insensible, that children are pleased with sucking or biting a hard crust. In old age, when there are no teeth, the gums " 62 TREATISE, &c. possess so little sensibility, that the chew- ing of food is attended with no pain, and it is well known, that those who have lost all their teeth, enjoy their food much more than those who have diseased ones. It is clear, therefore, that all diseases of the gums, at every period of life, originate either from dentition or from uncleanli- ness of the mouth, and are not peculiar to the gums themselves, as many authors have supposed. That common disease termed by some the scurvy in the gums, from their assum- ing an appearance similar to that of the scurvy at sea, unquestionably proceeds from uncleanly teeth. The disorder is marked by the gums becoming redder than ordinary, spongy, discoloured, and bleed- ing from the slightest touch, caused by the fulness of the vessels. I consider this disease entirely of a local nature, and when neglected is productive of much un- easiness and distress, for besides their be- ing soft and spongy, the mouth becomes very painful and sore, and the teeth so tender as scarcely to allow the mastica- tion of food. Matter forms and oozes out near the necks or lower part of the teeth TREATISE, kc. 63 in consequence of ulceration taking place between them and the gums. The natural arch of the gums is thus destroyed ; they become uniformly straight, recede from the enamel, and thus exposing the fangs of the teeth to whatever is taken into the mouth. This affection next attacks the alveolar process, wiiere absorption taking place, the teeth are gradually destroyed, and thus loosing their support, become loose and successively drop out, until the person is rendered toothless. Persons who loose their teeth from this cause, complain that their teeth came away perfectly sound, not considering it the effect of uncleanli- ness. When the disease has proceeded to such a length, a dental operation is the on- ly remedy, which will generally restore them to healthiness in a short time. Where unhealthy or decayed teeth or fangs are suffered to remain in the mouth, they are liable, from slight colds and the action of foul matter which remain in and about them, to produce an inflammation in the membrane lining the socket, which frequently terminates in suppuration.-— Thus matter is accumulated as in a sac at the extremity of the fang, the pressure of 64 TREATISE, kc, which produces the process of absorption in that part of the alveolar process situa- ted on the outside of the teeth. This ul- ceration continues until the gum bursts, nearly opposite to the place where the point of the fangs is situated, and thus the matter escapes from the opening.— These are termed gum-boils, or abscesses. The inflammation or fungous appearance. will sometimes subside after the discharge of matter, but an opening generally re- mains for a length of time, through which matter continues to be discharged. As this is caused by diseased teeth, it is sel- dom cured without their removal. But as extraction will not always be submitted to, it is highly necessary, that means should be employed to render them as lit- tle injurious as possible. This may be ac- complished by making a puncture with a lancet, as soon as the swollen condition,. soft feeling and throbbing sensation indi- cate that matter is formed. But where the tooth has become loose and sore, this operation can never be serviceable, but its extraction should be strongly recommend- ed, as its extraction will prove a cure te the gum-boil. Some suppose it danger- TREATISE, kc. 65 ous to extract a tooth, when the gum is inflamed, but this opinion can only arise from ignorance. It may cause a little more pain for the instant, but as the dis- eased tooth is the cause of the excitement, its removal will prove a certain cure,, and the discharge of blood, by unloading the vessels, will afford almost instantaneous relief. When the influence of fear has so completely overcome the unhappy patient, that neither acute pain or protracted suf- fering, will produce submission to the ex- traction of the diseased tooth, the inflam- mation of the jaw bene is often so great as to result in mortification of a large piece of its substance, thus unavoidably giving rise to the tedious process of exfoliation, accompanied with a considerable discharge of offensive matter, and often the loss of several teeth. Poulticing and fermenta- tion, as is usually the practice in such ca- ses, is highly improper, as it is likely to produce ulceration in the cheek These are often with great difficulty healed, and generally leave a scar near the center of the cheek, which will ever prove a source of mortification to a person of delicate feelings. 66 TREATISE, &c. When abscesses form in the mouths of children, from diseases of the temporary teeth, the greatest care should be taken, as by an exfoliation of a piece of the jaw bone the teeth may be destroyed. A knowledge of the evils which may result from a carious tooth, ought to influence all persons who may be afflicted with this malady, to take such steps for its prevention as prudence shall dictate. CHAPTER IX. Morbid growth of the Gums. The irritation produced by decayed teeth, on the circulation of the vessels which pass through the gums, often cau- ses a preternatural growth, by which ex- cressences or tumours of various sizes are formed. Carious stumps are the most fre- quent source of this morbid growth, by producing inflammation in various waj's, and no cure can be expected to take place, TREATISE, &c. 07 till the cause be removed. As this disease is generally caused from back teeth that are much decayed, I would always recom- mend their extraction ; but if it proceeds from a front tooth, especially if desirous to save the fang, for the purpose of en- grafting an artificial crown, other means are to be resorted to. In this case bleeding will prove highly beneficial. Sometimes tumours of different sizes form on the gums, of various degrees of hard- ness, and which sometimes also showacan- ceroup disposition. These are at first whol- ly local, and may be removed by excission or ligatures. Tumours of this kind, if neg- lected, may become carcinomatious, 4- con- taminate the system with a dangerous virus. But there is nothing from which the gums are more apt to suffer, by changing their consistence and texture, than the use of mercury, administered in various diseases 68 TREATISE, kc. CHAPTER X. Alveo7ar processes and their Diseases. The alveolar processes are to be con- sidered as necessarily belonging to the teeth, and not essential to the formation of the jaw-bones. They are elongations of the external and intei na! tables of the maxilla-. ry bones, which being united by transverse processes, are divided into cavities, called alveoli or sockets, for containing the fangs of the teeth, and acquire a form exactly suitable to the shape of the fang. Their cavities are lined with a vascular mem- brane, bearing a near resemblance to the periosteum in other bones. This mem-: brane also attaches the f mgs of the teetli to the socket. These alveoli are larger than the frigs of the teeth, which allows them a certain degree of motion which is of immence importance in mastication, by preventing their injury when coming in contact with hard substances. This mo- tion is more evident during inflammation in TREATISE, &c. 69 the teeth and gums. The al eoli are lia- ble to be sympathetically affected by all diseases of the teeth and gums, by produ- cing an increased action of the absorbents, which causes their substance to be taken up. The loss of the teeth from any cause, unavoidably produces the absorption of the greater part of the alveoli immediately con- tiguous on each side. The alveolar processes have certain dig- eases peculiar to themselves, independent of affections arising from the teeth or gums. The most frequent disease to which they are subject, is the absorption of their sub- stance, by which the teeth lose their sup- port, and by degrees come away. At the age of between forty and fifty this disease usually makes its appearance, andgeneraly when the teeth are apparently sound. The causes of the alveolar absorption are continued inflammation of the gums ; an accumulation of tartar ; that affection of the gums called scurvy, and diseases arising from an excessive use of mercury. The symptoms of this diseased state of the alveolar processes having commenced, are the length of the teeth ; a wider space between them, and a difficulty in mustica- 70 TREATISE, &c. tion. There is also an opposite affection of the alveoli. Sometimes deposits of os- sific matter take place in the bottom of the socket, by which it becomes filled, and is proportionably shorter, forcing the teeth out of their natural situations, while the gums seldom undergo any change, but the teeth continuing to advance, gradually lose their support, and finally drop out. When a number of contiguous teeth have become loose, as often happens with the incisores^ they may be strengthened in an artificial manner by tying them with a fine gold wire, or sea grass prepared for the purpose, to those neighboring teeth which happen to be firm. By this treatment the loose teeth are supported, not only giving comfort to the patient, but also arresting the progress of the disease, by removing that irritation which is kept up in the gums and sockets by the looseness of the teeth. The treatment found to be most success- ful in stopping the progress of this disease, is the removal of that which appears to be the exciting cause. If this be tartar, it should be removed, and if there be a ten- dency to a habitual deposit, the person should be careful, by frequent attention, t«j TREATISE, &c, 71 prevent its accumulation. In some cases this disease is accompanied with inflamma- tion, extending along the fangs of the teeth) giving the sensation of tension, and occa- sioning great uneasiness. This is reliev- ed by scarifying the gums, a practice which should always be had recourse to, as the loss of blood, by abating the inflammation, relieves the pain and checks the progress of the disease. CHAPTER XI. Diseases of the Antrum Maxillare. The Antrum Maxillare is a large cav- ity in the superior maxillary bone. It is situated over the molares and under the orbiter plates. It is lined with a mem- brane, and has communication with the cavity ©f the nose, by a small aperture in that part of the antrum which is membra- nous, and which is situated between the superior and inferior turbinated bones. 72 TREATISE, &c. Diseases of the antrum proceed from inflammation of the teeth and gums of the upper jaw. When considerable and long continued, it often communicates to the n«embrane lining the maxillare cavity, which terminates in suppuration. This matter in the cavity having no vent or pas- sage, destroys by its corroding effects and pressure, the contiguous bone. As soon as the symptoms of this disease are dis- covered, (a fact very difficult to ascertain till matter is actually formed) the great point is to give it a free opening or dis- charge. The readiest manner of doing this, is to extract the middle grinder, or molaris, the situation of which is immedi- ately under the antrum, and thus perforate through the socket from which the tooth was extracted, into the antrum, and by suitable injections the disease may soon be cured. The commencement of this disease is sometimes distinguished by a deep throb- bing pain, which appears to be seated at the roots of the molares of the upper jaw. In its progress it affects the eye, noseand ear. During inflammation in the antrum, the patient at first conceive the pain to TREATISE, &c. 73 proceed from the tooth-ache, but if the teeth should not be diseased, a more accu- rate observation is made upon the peculiar sensations excited. The pain usually ex- tends towards the forehead, in the direc- tion of the frontal sinus, and a sensation of tightness and pressure, with throbbing, is felt on the side of the face. In a short time the cheek becomes red, and appears as if swollen : It feels very hard, and on raising the lip, a considerable fulness above the fangs of the teeth may be ob- served. CHAPTER XII. Exostosis of the Fangs. This is an enlargement of the fang of the tooth, produced by a deposit of bony matter, so dense in its structure as very much to resemble ivory. The cause which produces this disease, says Mr. Fox, is obscure, and the slow increase in the size 74 TREATISE, &c. of the fang, is the reason why pain is not produced ui>til a considerable augmenta- tion of its bulk has taken place. It some- times appears to arise from indolent in- flammation, produced by caries in the bo- dy of the tooth, and extending to the fang; and at other times it is found to exist where the crowns of the teeth remain per- fectly sound. Suppuration is not produced by this kind of disease. The gum cominues quite healthy ; but whenever pain occurs, as no permanent relief can be obtained without the extraction of the tooth, it becomes ne- cessary when the teeth are sound, to be very attentive to distinguish this disease from mere rheumatic affections of the jaw- bones. Where this disease occurs in teeth already decayed, the patients are not af- flicted with extreme tuoth-ache, but have occasional uneasiness, which gradually be- comes more uninterrupted, and the tooth projects to a certain degree from the sock- et, so that in-closing the mouth, it feels as if out of its natural situation, thus ren- dering mastication very painful. When extracted, the fangs are found enlarged. Some persons will refer this appearance TREATISE, &c. 75 upon the fangs of the teeth, to an original mal-formation ; but so unlike is it in ap- pearance from the smooth structure of any ill-formed, crooked or undiseased tooth; and when extracted, so much whiter than any other part of the fang, that it can only be referred to diseased action, produ- cing a deposit of bony matter, as in oth- er cases of exostosis. CHAPTER XIII. Denuding process, Necrosis affecting the Teeth and Spina Ventosa. The denuding process is a disease causing a change in the teeth, by which they receive an appearance different from that of caries, but attended with a loss of substance. The tooth does not, as in cases of caries, grow softer, nor like that disease, does it originate in inflammation, but it consists in a removal of the enamel from the bone 76 TREATISE, &c. of the tooth, as if by solution and gradual abrasion. The incisores are affected by it much more than any other teeth, and in all cas- es its operation is limited to the exterior surface of the teeth. In its incipient stages its appearance is discovered by one or more of the inciso- res, becoming thinner, and appearing as if a small portion had been scooped or filed out, occasioning a slight depression. Thus the enamel wastes, until so much of it is removed as to leave the bone exposed, as this process advances, the tooth changes its colour, gradually becoming yellower as the bony part is more exposed. When the whole of the enamel is destroyed, part of the bone is also removed ; the remain- der acquires a brownish hue and will of- ten continue in this state for a number of years. Sometimes teeth affected with this dis- ease, become very tender, sensible in an unusual degree to the application of heat or cold. The cause of this disease, by some, is attributed to the use of acids en- tering into the composition of Dentrifices, that are employed in cleaning the teeth ; TREATISE, &c. 77 but there certainly must be some other cause, as it not unfrequently happens, that only one or two teeth in the mouth are af- fected by it, and even sometimes I have known artificial teeth to lose a portion of their substance, from the same cause.—■ From these circumstance, I think it not improbable that the denuding process is caused by an acrimonious discharge from some salivary gland contiguous to the tooth affetced. Necrosis affecting the Teeth. This disease proceeds from a destruc- tion of-the vessels which supply the teeth with nourishment, by which the tooth los- es its living principle. It then, like other dead pieces of bone, becomes an extrane- ous body. When this takes place the sock- et becomes inflamed and matter forms within it; the gum loses its natural tex- ture and appears of a darkish red colour, and the matter sometimes discharges itself through the gum by several orifices, but generally it escapes between the necks of the teeth and the gums. It is attended with considerable pain and a. discharge of offensive matter. This disease is gene- rally confined to the front teetli, and 78 TREATISE, &e. those which are wholly free from caries. Often considerable portions of the alve- olar processes are abs >rbed, and the teeth become loosened and productive of much inconvenience. In this disease the most common reme- dy is the extraction of the tooth affected. The scarification of the gums in the early stage of this disease, by abating the in- flammation, often affords a temporary relief. Spina Ventosa. This is an abcess formed in the cavity of the tooth. The ulcerative process re- moving a portion of the bone from the in- side, whilst there is a corresponding in- crease on the outside, forming an irregu- lar, bony tumour on the extremity of the fang. It is generally confined to the up- per front teeth. This disease proceeds from an inflam- mation of the membrane lining the cavity of the tooth, by which matter is formed, and which discharged itself at the point of the fang, into the alveolar cavity. During the progress of the disease, the gum contiguous becomes inflamed, and acquires a spongy texture, and the matter TREATISE, kc. 79 generally makes its escape from the sock- et imo the mouth, by a number of open- ings through the gum, which is thus kept in a constant state of irritation. The dis- charge produces great fetor of the breath, the taste is constantly affected, and the socket is gradually absorbed until the tooth becomes quite loose. During the progress of this disease, the body of the tooth assumes a different ap- pearance, and gradually acquires a dark colour ; the internal part of the fang is much enlarged, and the external part has a rough, scaly appearance. The bestpal- iative treatment of this disease, is occa- sional scarification of the gums, and fre- quent washing of the mouth with astrin- gents. The infusion of roses and tincture of myrrh is useful for this purpose. As no cure of this disease can be expected, the extractiion of the tooth should always be recommended, as soon as the gums have acquired a truly diseased appearance ; for if the disease be permitted to proceed in its natural course, the gums become so ex- tensively affected as to induce absorption of the alveolar processes belonging to the neighboring teeth, which is fodowed by their consequent loss. 80 TREATISE, 8rc. CHAPTER XIV. Tooth-Ache. The ultimate effect of caries or decay of the teeth, is to denude or remove a por- tion of the crown of the tooth, and thus exposing to the air and to every species of matter taken into the mouth, that delicate and sensible nerve situated in the cavity of the tooth, & produce that very unpleas- ant and painful sensation, termed tooth- ache. The pain attending it is various, according to the influence of external a- gents on the parts. The decay has gene- rally made considerable progress before the tooth-ache commences. The pain is commonly sudden in its attacks, darting from the tooth through the head, and af- fecting the whole jaw. When fits of tooth- ache frequently occur, they often become so violent and constant that the rest is disturbed, the appetite fails, and the per- son is unable to pursue his usual avoca- tions, In the progress of the disease, the TREATISE, &c, 81 membrane and all the contiguous parts be- come inflamed, occasioning considerable swelling, which sometimes terminates in suppuration, and frequently produces the tedious process of exfoliation of a piece of the alveola. When it proceeds from a tooth in the upper jaw, it seems to shoot more directly up to the temple. In all cases a remarkable sympathy seems to prevail between the affections of the teetli and those of the ear, for pains in the teeth of- ten cause a similar suffering in the ear, and in like manner harsh and discordant sounds produce an unpleasant sensation, known by the teeth being set on edge.— These sympathetic pains probably proceed from the intimate connection which exists between the branches of the fifth and those of the seventh pair of nerves. The pain in the ear is therefore sympathetic, arising most frequently from disease in the dens sapiential. It is caused by an union of a branch of the seventh pair of nerves with the lingual branch of the fifth pair. Another disease, which is generally-sup- posed to have its seat in the teeth, is an affection of the nerves ; called Tic dou- loureux. It is confined principally to the 7 i& TREATISE, kc. fifth and seventh pair of nerves. The pain is most excruciating, and occurs in fits, on the slightest agitation. It is for- tunately but of rare occurrence. I have met with but four cases in the course of my practice. A cure is sometimes effect- ed by completely separating the nerves, but should only be attempted by a skilful hand. Sometimes, in cases of tooth-ache, it is extremely difficult to fix upon the tooth from which the pain proceeds, and it is not uncommon for those who are affected with it, to suppose that a tootlfnot in the least diseased, is the seat of the pain ; it also often happens that the pain is con- ceived to originate from a tooth of the up- per jaw, instead of one of the under jaw, and vice versa. When any doubt is manifested, great caution should be used previously to the extraction of the tooth. The teeth may be examined by striking them with the end of some instrument, in order to discern that jvhich is most tender, as it usually happens that a t >oth in a state of inflam- mation is so sensible, that it will not bear to be struck without pain. TREATISE, &c. ttt If this mode of examination be not satis- factory, and there should be more than one decayed tooth, they should be carefully examined, by picking the hollow part with the point of a probe, or other small pointed instrument, bent in the form of a hook. By doing this the nerve that is ex- posed, ami which has caused the pain may be touched, which will immediately ass'.re the pati-Mit and the operator, of the tooth from which the pain proceeds. CHAPTER XV "Wearing and Fractures of the Ted:.* Wearing of the teeth is the natural effect of mastication, by the friction and attrition with which it is accompanied.— Thus when the front teeth of the upper jaw are so situated that they overlap the corresponding ones of the under set mas- \\ax'\ >n can be performed with much lesc lateral motion of the jaws, and cause less 84 TREATISE, &c. friction than where they meet each other at the cutting edges. Wearing of the teeth generally happens in the front,ones when the molares have bee n lost, in the early part of life and often the whole crowns have been removed. The effect of this process is to render the teeth ten- der and occasionally subject them to pain by the application of cold or acids. But1 this soon subsides, for during the time that the teeth are Wearing away by their action upon each other, a process is going on in ■ the cavity, by which their sensibility ;s destroyed. The vessels take on a new' action, and deposit ossific matter, until the whole cavity is completely filled. This circumstance also happens very frequently in the teeth of old people, which accounts for their not being so- liable to the tooth- ache. Fractures of the teeth, frequently occur from injuries,from accidents, or blows re- ceived in quarrels, or otherwise. Masti- cation of hard substances sometimes will produce the same effect. In accidents of - this kind, the treatment must be regulated by the extent of the injury done. If the fcacture be confined to the point of the TREATISE, kc. 85 tooth, nothing more will be necessary than to remove the unequal surface with a fine file, and no caries will be likely to proceed from this operation. But if the injury ex- tend into the cavity of the tooth, it will then become tender, and for some time be subject to occasional fits of pain ; but na- ture often repairs this mischief by a fresh deposit of bone in the cavity, which de- fends the nerve. When fractures are of a more serious nature, and the cavity is completely exposed, the remainder of the crown may be taken away, and an artifi- cial one engrafted. Sometimes, where the tooth is completely knocked out, and not broken nor the socket injured, it should be immediately returned to its.place, and se- cured by ligatures around the adjoining teeth, when it will be likely to become firm, but its colour will be changed to a dark hue. But when the alveolar proces- ses have been essentially injured or frac- tured, the teeth seldom become perfectly fast, inflammation arises and nothing but their entire removal will effect a cure. Fractures of the Enamel. The enamel of the front teeth becomes Sometimes fractured or cracked and sep.aV 86 TREATISE, kc. rated from the tooth, caused by the too frequent or violent action of the cutting edges against each, other. This circum- stance arises in a great measure from the loss of the back teeth, which causes the front ones to be used more frequently in mastication, and to brought together with greater muscular power Whenever such cracks or separation of the enamel appear, it is advisable, in or- der to stop its progress, to file away the part that appears thus disfigured. CHAPTER XVI. Occasional effects of Diseased Teeth. Diseased teeth often communicate dis- eases to the contiguous parts, and espe- cially to the gum immediately surrounding the tooth. That affection of the gun* termed by Dentists epulis, or gum-boil, arises from this cause. The inflammation of the diseased tooth extending to the ves- TREATISE, kc. 87 sets at the point of the fang, and thence to the periosteum and sockets ; the circu- lation becomes necessarily impeded, and the inflammatory action thus begun, ends in the formation of matter within the al- veolar cavity. While this matter is con- fined, it excites considerable pain ; the face is swelled and inflamed, which con- tinues till the collected matter escapes.— This it does by corroding the socket on the outer side, where a natural opening or ulceration takes place. The sore occa- sions a constant discharge, and the skin rises and becomes fungous, with a red spon- gy appearance. If the diseased tooth which is the source of the evil, be remov- ed, the discharge then gradually diminish- es, and the sore heals externally, but in healing, the former destruction of the parts occasions a contraction of the skin, and a deep scar is formed, which (as has already been observed) to many persons, cannot fail to be a source of great uneasi- ness. When under these circumstances decayed teeth are extracted, a fleshy sub- stance appears to cover their fangs, which extends to the bottom of the alveolar Cavity. 83 TREATISE, &c. Where this disease is entirely neglected, the inflammation often extends deep into the jaw bone, and the consequence is, that a part of it suppurates, and exfoliation takes place. Before this exfoliation is accomplished, a constant uneasiness prevails, and a con- tinual discharge takes place in the mouth. As this disease progresses, the gums grad- ually recede from the alveolar processes, and the bone separating and gradually loosening, should, as soon as the suppura- tion is completed, be taken away. When a gum-boil forms from any of the temporary teeth, it requires very particu- lar management, for if allowed to proceed so far as to cause an exfoliation of a piece of the jaw-bone, the teeth may be entirely destroyed. These circumstances show the necessity of early attention, to prevent a malady of this kind. At other times hard lumps form on the gums, from the same cause, which often prove trouble- some, and sometimes dangerous, for there is no dependence on their continuing in an indolent state. TREATISE, &c. S9 CHAPTER XVII. Tartar. This is an earthy substance held in so- lution by the saliva and is deposited on the teeth during its decomposition. No- thing, except caries, is so injurious to the healthy condition of the mouth, or dura- bility of the teeth, as a deposit of this substance. The teeth of all persons are liable to a formation of it, in a greater or less degree. In some the quantity is so small, that little care is sufficient to keep the teeth perfectly clear from it, while in other* the deposit is so constant and co- pious, that the teeth can only be preserv- ed in a decent state, by the most unremit- ted attention. The state of health has considerable in- fluence in the formation of this substance, for in febrile complaints, in which the se- cretions of the whole alimentary canal are disordered, the teeth are covered with a thick mucus, hence there is usually a ve- ry large deposit. The same effect is also observed during confinement, from any cause whatever, 90 TREATISE, kc. when the teeth cannot be constantly cleans ed. And it is remarkable, that the teeth after sleep are found covered with a vicid yellowish mucus, which, if not removed by a tooth brush or washing, gradually ac- cumulates, depositing itself in layers un-, til it acquires a hard consistence and firm- ly adheres to the teeth. When the tartar is soft, it has a yellow- ish appearance, but as it grows harder, it changes to a dark brown or black colour. The tartar, after it has accumulated about the teeth, insinuates itself under the gums, and causes them to recede from the necks of the teeth, thus producing diseas- es of the gums, and causes absorption of the alveolar processes, by which the teeth lose their support, and at length, by sime accident, a large piece of tartar is broken off, when the tooth, deprived of its artifi- cial support, drops out Persons who lose their teeth from this cause, complain that they came away per- fectly sound, not considering it the effect of their own negligence, and it is but too commonly the case that nothing less than a commencement of the loss of teeth in- duces them to pay attention either to their cleanliness or preservation. TREATISE, kc. 9i These accumulations are greatest about those teeth situated near the openings of the salivary ducts, and those least used in mastication. There is another species of tartar, pe- culiar to the teeth of young persons ; it is of a dark green col ur, rather resembling a stain, than an earthy concretion. It is, very injurious in its effects upon the teeth, by corroding the enamel, and disposing them to become carious. The deposition of tartar is an unavoid- able circumstance, depending upon the ef- fusion and decomposition of saliva. But it is in the power of most persons to keep their teeth free from an injurious deposit, after the accumulation has been properly removed, by carefully washing and brush- ing the teeth. Fifty grains of this species of tartar, when submitted to a chemical process,was found to yield, by analysis, Phosphate of lime 35 Fibrina or c rtilage 9 Animal fat or oil 3 Loss 3 50 92 TREATISE, &c. CHAPTER XVIII. Cleaning, Scaling, or Bemoving the Tar- tar from the Teeth. This operation is generally termed sca- ling of the teeth. It is nothing more than removing the incrustations of the tartar, the qualities of which, and its pernicious effects upon the teeth, have already been described in the preceding chapter. In performing this operation, much care and judgment is required in selecting suit- able instruments, as well as in the manner of using them, in order to completely re- move every particle of tartar from the inside and between the teeth, as well as from the indentures on the grinding sur- faces, with facility and ease to the patient., without any injury to the enamel or gums. A description of the shape of the differ- ent instruments necessary in performing this operation will be unnecessary, as it is presumed no one will attempt it, but a Dentist. The common notion, that this operation of cleaning the teeth, proves injurious to TREATISE, &c. m them, can only arise from ignorance, or the injudicious operations of unskilful Dentists, as no unpleasant or pernicious consequences can possibly result, if it be performed in a skilful and proper manner. And I consider it one of so much impor- tance, that I cannot too strongly recom- mend it, for I have no doubt, that a very large proportion of decayed teeth is pro- duced by the accumulations of tartar and other foul matter being permitted to re- main for a considerable length of time on the teeth. The benefit which results from the seal- ing of the teeth, depends on judiciously conducting the instruments over the sur- face of the teeth, with no greater force than is necessary to remove the tartar, and so as not to injure the enamel, a dexterity which can only be acquired by practice and experience. No acids or chemical solvents of any kind, should ever be employed to remove tartar from the teeth, as the same substan- ces which will act on the tartar, will al- ways injure the enamel. 94 TREATISE, kc. CHAPTER XIX. Filing or separating the Teeth. Separating the teeth, especially the front and side ones, is an operation of the greatest utility ; which, if seasonably and properly performed, and a due degree of attention to cleanliness is preserved, will generally prove a sovereign remedy against every disease of the teeth. This is evi- dent, from the fact that may be noticed by every one, that where teetli stand a little distance from each other, and especially where they have been kept clean very sel- dom, if ever, any disease affects them.— The reason is obvious. Where the teeth are so closely situated that the ed«es or points encroach on e..ch other, a space betweeu them, near the gum may in al- most every case be noticed, which is an effectual lodgement for every kind of f od or substance taken into the mouth, which being there retained a considerable time, subject to the natural warmth and mois- ture of the mouth, soon undergoes the pu- trefactive process, and at length acquires" TREATISE, kc. 9a an acrimonious quality, which commences its ravages on the side of the tooth with which it comes in contact. These remarks, with common observa- tion, will readily prove this to be a very fruitful source of the diseases of the teeth, which may easily be prevented, at a tri- fling expence and without pain, by simply passing between them a very fine, thin file, made expressly for the purpose ; or if the decay has just commenced, this operation will remove the decayed portion, and at the same trme thye cause of it; but where the disease has already penetrated deep into the tooth, it may be observed that there is another operation which, if time- ly and properly performed, will restore them to their former usefulness and dura- bility, by rendering them artificially sound, This is called pluging or stopping the teeth, which will be treated of hereafter. There is no prejudice more common than the very deep rooted one against the ap- plication of a file to teeth. It is consid- ered, by ti.any, one of the most fatal ope- rations which can be performed, as it is supposed that the decay of the tooth will inevitably follow t'*e removal of the lec^t 96 TREATISE, &c. portion of the enamel. These opinions have been disseminated by certain empy- rics, who have considered diseases of the teeth as a source of profit, and have there- fore paid no regard to the correctness of their statements, provided they could ac- quire gain. In those cases where filing or separa- ting the teeth has been recommended, ei- ther to prevent, remedy or retard the pro- gress of disease, it is defensible on the most correct principles. It is a therory justified by uniform suc- cess, wherever it is practiced by a man of skill and integrity, especially if it is re- sorted to before the caries has reached the internal cavity of the tooth. Th* decay of a tooth is never caused by the removal of a part of the enamel or bony portion of the tooth, provided it is superficial and does not enter the cavity. This may frequently be observed in those cases where considerable portions of a tooth has been broken oft", and no caries has been produced. In like manner, says Mr Fox, " a considerable portion of a tooth may be filed away and the remainder will continue perfectly sound." TREATISE, &c, 97 fcTpon the effects of filing the teeth, the Abyssinian negroes and the Malay In- dians furnish striking examples. The Abyssinian negroes have a custom of cut- ting or filing off the corners of the cutting edges of all the front teeth, in order to make them all into a serrated form. This operation they perform without penetra- ting the cavity of the tooth. The teeth thus filed, are not thereby in the least ren- dered carious ; a most convincing proof that the mere filing of a tooth does not cause it to decay. The custom of the Malay Indians dif- fers from that of the Abyssinian negroes. It consists in filing the incisores of the up- per jaw, in a direction across the upper part of the anterior surface, so as to give them the appearance of being fluted. But if those modes of filing be carried so deep as to reach the cavities of the teeth, caries will soon ensue. No person acquainted with the teeth, would, in the least, endanger them in this operation. 8 38 TREATISE, kc CHAPTER XX. Filling, or Stopping the Teeth. This operation is productive of so ma- ny beneficial effects, that I cannot too strongly recommend it to the public. By stopping a tooth in a proper time and man- ner, it will be rendered artificially sound, In this manner many teeth which are now prematurely sacrificed to extraction, might be preserved for many years, and probably for the remainder be desired, that some person may be fortunate enough to discover a substance, from which artificial teeth may be composed, that will possess all the ne- cessary properties to render them natural and not subject to tarnish or decay. . The great inconvenience generally at- tending the loss of teeth, in respect to mastication, enunciation,- and deformity in the features, renders the introduction of some substitutes highly desirable. US TREATISE, kc. In all cases of artificial teeth, strict ob servance to cleanliness is indispensable, for they, as well as natural teeth, unavoid- ably accumulate tartar, and from particles of food adhering to them, they become very disagreeable; but the daily use of a tooth brush, with warm water, will gene- rally be found sufficient to keep them clean, wholesome, and in a considerable measure, as pleasant as natural teeth. The manner by which artificial teeth are secured in their intended situation, is so various, depending on such a variety of circumstances, that a minute description would be tedious and uninteresting, nor will the ingenious Dentist need the description, as his judgment will most readily dictate the best mode, from taking a view of the intended location. My direction shall therefore be gen- eral, and subject to such variations as prudence and circumstances may dic- tate. If it is a front tooth to be supplied, and the fang still remains in the socket, so much of its ragged or carious surface should be filed away, as to leave it as low as the gum. The natural cavity in the TREATISE, &c, 113 fang is then to be made of a suitable size and depth. A similar hole is then to be drilled in the artificial crown, and a pivot of the toughest wood inserted, so prepar- ed as to enter each cavity without much force, where it will soon swell and make the tooth very permanent and durable.— This pivot may be renewed by the patient when necessary. In cases where no fang remains, by which the artificial teeth may be fastened as above, the crown may be so fitted as to set easy on the gum, and if there be more than one, they should be neatly and firm- ly connected ; and at each side, adjoining the standing teeth, a clasp, or spring of pure gold, should be permanently fasten- ed, the ends of which should extend par- tially around the permanent teeth, which if properly done, will often be sufficient to keep them in their place. But if neces,- sary, small holes may be drilled through each end of these clasps, and a ligature of silk, or India grass, passed through them and around the teeth and secured by a knot on the inside, which can easily be renewed as occasion requires. Any number of teeth from one to 3 9 114 TREATISE, kc. dozen, may be supplied in this way, ij there be but one remaining on each side by which they can be secured. Should there be but one fang remaining, where a number of teeth are to be supplied in this way, great steadiness may be given to them all, by connecting them with a piv- ot to this fang. Should there be no teeth or fangs remaining in one or both of the jaws, an entire set may be made and kept steadily in their place by means of springs. In a short time, they will become so fitted to the gums, that they can be worn with pleasure, and all the common duties of the teeth be performed with considerable ease and satisfaction; nor is there the least pain attending the setting of teeth in this way, as they are wholly unconnected with any part of the mouth or jaw, and may be tak- en out and returned at pleasure. Much prejudice exists in the minds of many, against setting teeth in any manner, on account of great pain which they fancy must be experienced in the performance ©f this operation. But in no case is any con- siderable pain caused in this operation, ex- cept where the nerve remains sensible in the fang, and in such cases, it is always but momentary. TREATISE, kc. 115 CHAPTER XXIV. Importance of cleanliness of teeth. The importance of a due regard to cleanliness of-the teeth would appear,were mankind sufficiently acquainted with the diseases and painful afflictions, which or- iginate from want of attention to this im- portant duty, and were they convinced that from this cause alone numbers drag out a life of distress, they would feel e that is not of importance, however trifling, or iiisignificai.t it way appear.— The most vital, as well as those on which the lesser energies of the system d-.pend, are ;•„!! equally essential to life, and its comforts. On these considerations, the teeth certainly cliim an important rank in the human structure. To then is as- signed the chief power of enunciation.— lf the great and preeminent prerogative of man, is the possession of sneech, 'hat speech-can never be a-i^.'.eu or t.^i< ict, TREATISE, kc. 121 without the teeth to modulate the sound, and give proper utterance to the words.— This circumstance, gives them additional value, particularly to a man in public life. Certainly the preservation of the teetli ought to be one of the first objects to those who wish to shine, either in the senate, at the bar, or in the pulpit. Without these instruments of utterance, the graces of their eloquence are lost, and the power of affecting the mind, and convincing the un- derstanding if not wholly taken away, is considerably diminished. Another consideration which demands attention, is, that the loss of this part of the structure produces the leading mark of age, and occasions the contracied coun- tenance, the wrinkles of the face, and those unseemly changes, which }Outh, and be u- ty, ever wish to see placed at a distance. But the most dangerous effect, of neglect of the teeth, and their consequent loss, is the imperfect mastication of food, which produces indigestion, and a variety ofdis orders, resulting from this cause. Another disagreeable eii'°ct, arising from the neglect of the teeth, is an offer .-:v» breath. This fact is bi^ceptible of i.v.m- 122 TREATISE, kc. onstration, by actual experiment. One is. that the breath which is exhaled by the nostrils, is widely different from that which is expired through the mouth of a person, having diseased teeth and gums.— Fceted breath arises entirely, from the sta;e of the mouth, and has no connexion with that of the stomach or the digestive organs, as is erroneously supposed. E- ructation can •'mly produce a temporay ef- fect, from uneleanlinessof the mouth—we find the taint constant and habitual, and unless the cause be eradicated, all the spi- ces and perfumes of the east, though they may conceal, cannot remove it. Besides the reasons already assigned for the necessity of a sti ict attention to the teeth and gums, may be added their great influence on the state of the general health. The danger to the lungs, says Air. L. S. Parmly, " has been strongly commented on by the faculty, as a leading cause of pulmonary consumption." The import- ance, therefore, of an acquaintance with the dental art, as a part of education, ap- pears indispensable,; as it is the only means, by which this department of sci- ence cau.be enabled to take that rank> its TREATISE, ko. 123 importance in promoting the health and comfort of mankind, so imperiously de- mands. Nothing will be a source of great- er satisfaction to the author, than that his humble endeavors should in any degree be instrumental in effecting so desirable an object, by impressing on the minds of those into whose hands the care of chil- dren may be intrusted, the necessity of the care and management of the teeth, as a primary duty, with a view, as far as possi- ble, to prevent those unhappy occurrences of dental diseases, and consequent de- formity, which so often occur. While the teeth are kept clear and free from foul matter, seldom will disease af- fect them. Their structure will equally stand against the summer's heat, ami win- ter's cold, against the changes of climate, the variations of diet, and even the diseas- es, to which the other parts of the system is subject. From these observations, we may infer the necessity, of guarding the teeth against every foul accumulation.— But where such accumulations have, thro' negligence, been suffered to take place, they can only be properly removed, bjr suitable instruments, in the hands of a 124 TREATISE, &c. dentist. When this operation has been performed, and the spaces between the teeth sufficiently widened, they may gen- erally be kept in a clean and healthy state, for any length of time, by the daily use of the tooth brush. But should the removal of such accumulations be attempted by the use of any dentrific substance, that will accomplish the object, its powerful quali- ties will not fail, essentially to injure, if not wholly to ruin the finest set of teeth. In order to be able to form something of a correct idea of the pernicious conse- quences of the dentrifices in general use, it will be proper to take a view of the in- gredients which enter into their composi- tion. Tooth powders being generally com- posed of insoluble or gritty substances, and acid ingredients, are evidently hurt- ful both by their mechanical and chemical agency. And to shew the injury of these applications, I shall make some observa- tions on their composition and nature. Sulphuric acid, from its peculiar and well known property of giving a beautiful white appearance to the teeth, forms a principal ingredient, in all those ruinous compositions, sold under the title of tooth- TREATISE, &c. 125 dowders, tinctures or pastes. In tinct- ures and lotions, it is combined with some spirituous or watery infusion, of an aro- matic nature,variously coloured and scent- ed, according to the taste of the composer. In the paste, it is generally united with some gritty powder, to which a light veget- able matter is added, when the whole is made of a proper consistence with honey or other glutinous substance. The pow- ders, not admitting the acid in its natural or liquid form, have corrosive salts substi- tuted, as cream of tatar, alum, See. &c. u- nited with powder which often consists of brick dust blended with some other ingre- dient to colour and conceal it. But besides these compositions which are expressly sold for the purpose^ many are in the habit of using substances at their own option, for cleaning the teeth, without having recourse to these specifics. Of this kind, soot is one : which I think a very improper, disagreeable and indelicate substance. Its use cannot be justified on any reasonable principle. Another substance in much greater use, of late years, for the purpose of cleaning the teeth, is pulverised charcoal; but high- 1S6 TREATISE, kc. ly as it is celebrated for its anticep.- tic qualities, it is very improper as a dent- rifrice, for however fine may be the pow- der to which it is reduced, every person, I presume, knows that it continues perfect- ly insoluble. The finer, indeed, it is pul- verised, the easier is the admission it finds between the teeth and gums, where its in- sinuation, like every other extraneous matter, is a perpetual source of irritation and disease: and its constant friction may injure the health and beauty of the gums. Its effect also, as a purifier of the breath, is very transient. Dentrifices similar to charcoal, are formed, by the burning of bread, leather, betle-nut, &c. In their ef- fects, however, they all differ little from common charcoal. Gunpowder and iron rust, is another composition in use. Pre- pared alum, is another substance, used for the same purpose; but being a combina- tion of sulphuric acid and clay, when ex- posed to the moisture of the mouth, it un- dergoes decomposition, and consequently, the teeth are exposed to the action of the acid. The same injury is produced by cream of tartar, which though it whitens the teeth, acts powerfully on the enamel. TREATISE, &c. 127 Salt is another article highly spoken of by some who profess knowledge in this sci- ence, but I consider it too powerful to be used as a dentrifrice with the least sha- dow of safety. Nitre, as generally used, is equally pernicious. In fact, the indiscriminate use of any dentrifrice, will be found ultimately to do much harm. I approve of them in a very limited degree. There may be cases,which seem to require something to cooperate with the friction pf the brush, in order to keep the teeth from all extraneous matter, especially tartar, but these cases will be found to be very few, after the teeth have been put in complete order, by a skilful dentist. It is a common practice with most peo- ple after meals, to make use of a tooth- pick, to remove whatever may be lodged between the teeth. This practice, how- ever, is highly to be reprobated. The con- stant use of a tooth-pick cannot fail to make improper openings between the teeth; and, when once that part of the gum, which forms the arch, is removed from their interstices, a small hollow is made, for the reeeption of accumulating 128 TREATISE, &c. matter, which if neglected to be removed, will, soon commence its action on the tooth, and rapidly excavate it, and pro- duce early pain, that never would have existed, but for the use of so improper an instrument. If the teeth be properly sepa- rated, a silk thread, a strip of a fine rag, or the edge of a handkerchief may be drawn between them, which will more ef- fectually clear them without any injury. CHAPTER XXV. Importance attached to the teeth. The importance of the teeth, seems to be equally appreciated by all nations. In civilized society, their care is regarded, as a matter of fashion and ornament, and a- mong ruder nations, their preservation and cleanliness, is regarded as a religious duty, and their value so highly rated, as even at times, to be offered in sacrifice to their deities. It may not be uninteresting to some of my readers, to briefly state some of the customs and ceremonies of TREATISE, kc. liS different barbarous nations, respecting the teeth. In the East Indies, particularly in Hin- dostan, the care of the teeth among the Bramins, is made a part of their religious rites. As soon as they rise in the morn- ing, their teeth are rubbed for an hour, with a twig of a fig tree; During this op- eration, their prayers are fervently ad- dressed to the sun, invoking the blessing of heaven on themselves and families.— This practice it is presumed, is coeval with their religion and government. And cer- tainly, nothing can more shew their high regard for cleanliness, and particularly for the purity and beauty of the mouth, til an their making this custom both a law, and religious duty. In some places of In- dia, the teeth are made of a redish cast, by the constant use of betel and areca nut, whilst in other parts they are made- yellow by chewing madder. But not content with changing the nat- ural form and colour of the teeth, many savage tribes try to make an alteration in the very shape of their mouths; and by this means the inhabitants of Prince Wil- Uam's Island, in the south seas, appear at 10 130 TREATISE, &c. a distance to have two mouths. In order to do this, an incision is made in the un- der lip, in a line with the mouth, suffi- cient to admit the tongue to pass through it, which after being healed continues to have all the appearance of lips. This artificial mouth is adorned with a shell, which is so cut as to resemble a row of teeth. In one of the tribes of New Zealand, the queen is distinguished by having a piece of gold substituted for her two front teeth. Amongst other savage tribes black is prefered in order to make them differ from the brute creation. Thus the wo- men of the Marian Islands blacken their teeth. The s; me is done by the Ton- quinese and Siamese, and by the inhabi- tants of Sumatra and Malacca. In Java, this distinction is onfined to the married women as a mark of great respect; while in the other parts of the East India islands the two central incisores or front teeth of the upper jaw, are often gilded, and the adjoining ones made of a black, colour. In New Holland, the beating out of the front teeth is performed by the priests TREATISE, &c. 131 when a youth has gone through the various ceremonies previous to his being introdu- ced into the class of warriors. Such are a few of the customs of some savage nations in respect to their teeth. The importance of the teeth in speech, mastication and in giving symmetry and ex- pression to the countenance, has been al- ready sufficiently insisted on. But it has been attempted to carry their importance further, in supposing these organs to ex- ert an intluence in the formation of the human character, and for this doctrine there exists perhaps some slight founda- tion, but certainly not to that ridiculous extent contended for by some authors— the vivacity of whose imagination on their favorite subject appears to have com- pletely misled their judgment. That the state of the mind is often discovered in the countenance, it is presumed every one will admit, but the countenance is made up of parts in a high degree flexible which vary their motions and expressions with every changing influence of the soul. When the mind broods over any partic^ ular passion, or yields to one continued train of thoughts or feeling, the expres- 132 TREATISE, #c. sion of such mental affection may remaiu fixed in the countenance, and give a de- termined and decided character to the features. The teeth on the contrary are fixed bodies, they can receive no change from the influence of the mind, and they merely fill up or give that finish to the countenance, which can admit of no oth- er change as far as these organs are con- cerned, than what will arise from their loss. In the ingenious system of Lavater they liave met particular notice, and from the appearance of the teeth and projecting chin, he has drawn many plausible conclu- sions. " Thus small short teeth have been con- sidered as denoting a weakness of charac- ter and constitution, and, though such have been observed in many persons of extraordinary strength, yet, in those per- sons they are seldom of a pure white.— Long teeth are considered as sure signs of weakness and pusillanimity. White clean well arranged teeth, visible on ope- ning the mouth, not always seen, have •>een esteemed marks of good, accute, honest, candid, ami faithful men. Whore TREATISE, &c. 133 in some persons they appear otherwise, or are foul, uneven and ugly, it is either the effect of sickness or some mental im- erfection which has changed them.— hort, broad teeth, standing close togeth- er are the characteristics of tranquillity* firmness and strength. Persons of a mel- ancholy habit have seldom teeth well arranged clean and white." Such are the maxims laid down by La- vater, but they are not founded in truth.— The size and shape of the teeth, we have seen, are originally developed and arrive at perfection long before the mental qualities are established, and the mind acquires its character. But though the teeth can have no ap- parent influence on the mental qualities of individuals, yet, a considerable differ- ence is visible in their appearance, in the inhabitants of different countries, and in this point of view they may be considered indicative of the character of nations.— Thus the Spaniards are distinguished in general for their well arranged teeth, and the Hottentots for their extremely white ones. Lavater has carried his whimsical svs- I 134 TREATISE, kc. tern so far, as even to form from the teeth ideas of character in the brute creation.— To the sea-horse from the structure of his teeth, he attributes the disposition of fool- ish self-distructive malignity. To the sheep he gives the character of little or no wildness, from the line of the mouth, or form and position of the teeth. But, as we have already stated, it is not in the teeth, but on the countenance the great lines of character are exhibited. This is the theatre on which the soul delineates itself, and where the muscles of the face give it the expression of the inward work- ings of the mind. That countenance which can at one moment display the most savage ferocity or the greatest stupidity, will on other occasions exhibit the greatest meekness and placidity, and in all these circumstances the teeth suffer no change. How unjust then to characterise all those who have irregular teeth as possessing the most malignant passions, or to exclude from our friendship all who have long and separated teeth lest they should rob and murder us. But though the teeth can have no influence in the elucidation of character, yet in regard to appearance TREATISE, kc. 135 their influence is great. No face can be considered as truly beautiful which is dis- figured by foul, unsound, irregular teeth. The laugh which is the test of good humour and openness, excites only disgust where the mouth exhibits foulness and de- formity. A pleasing countenance, natur- ally preposseses but it never can be com- plete, unless beauty and regularity of the teeth unite in the attraction; so that where a person wishes to please, the care of the teeth forms an essential consideration and hence, withjustice, Lavater observes "the form, position, and cleanliness of the teeth so far as depends on the individual him- self, is a certain proof of his taste in other matters." With the following quotation from the Dictionary of Medical Science, published at Paris, 1 shall conclude the present chapter. "The teeth are the most lovely arna- ment of the human countenance ; their re- gularity and their whiteness constitute that ornament; these qualities rivet our regard, and add new charms to the beauty of the countenance. " It the mouth exceeds in size its ordi- na ry proportions, fine teeth serve to dis- 136 TREAT lSE,&c. guise this natural error in its formation. and often, even the illusion which results from the perfection of their arrangement is such, that we imagine the mouth would not have looked so well if it had been smaller. " Observe that lady smile whose mouth discloses the perfection of their arrange- ment ; you will never think of remarking the extent of the diameter of her mouth ; all your attention will be fixed upon the beauty of her teeth, and upon the gracious smile which so generously exposes them. " The ornament is equally attractive in both sexes ; it distinguishes the elegant from the slovenly gentleman, and diffuses amiability over the countenance, by soft- ening the features. But, it is more partic- ularly to women, that fine teeth are ne- cessary, since it is her destiny first to grat- ify our eyes, before she captivates and en- slaves our hearts. " The influence which the teeth exer- cise over beauty,justifies the pre-eminence which 1 attribute to them over all other attractions of the countenance. Let a wo- man have fine eyes, a pretty mouth, a handsome noes, a well turned forehead. TREATISE, kc. 137 elegant hair, a charming complexion, but let her also have bad teeth, teeth blacken- ed by caries, or covered with thick tartar, or a viscid concretion, in a word let her ex- hale a contaminated breath, (which discov- ers her approach before herself appears,) we should cease to think her beautiful the moment she opens her mouth ; she herself aware of the unhappy effects of her smile, .constrains it into a grimace to conceal the ravages which disease has made on her teeth. On the contrary, if she has a large nose or small eyes, if she is even ugly, provided her teeth be regularly planted, that they are white and above all, that she possesses the whole of them, or at least those which are visible, this woman's coun- tenance however frightful she is, will ap- pear agreeable, the moment that a smile comes to her aid, and she will hear whis- pered around her, these words so consol- ing to her vanity ; what beautiful teeth she has. " When nature sparing of her gifts, has failed to bestow them on the teeth, making them defective in form and tarnished in colour, care and extreme cleanliness must be resorted to to supply the imperfections 138 TREATISE, kc. and hide the faults ; in this case, at least if the teeth do not attract our regard, they do not effect us disagreeably." CHAPTER XXVI. Conclusion. it is a fact well known, and which every ones experience daily confirms, that few persons pass through life, without at some period, being subjected to more or less inconvenience and pain from diseases of the teeth. In infancy, we have seen that their for- mation and growth is the source of great and constant anxiety to the fond parents, and that they produce devia- tions from health, which often continue for the remainder of life: for, at that ear- ly period constitutional diseases are called into action by the irritation of dentition, which would otherwise have remained dormant. That period of childhood; at which the temporary teeth begin to shed, TREATISE, &c, 139 is the critical time that calls for the assis- tance of parents,for by neglect at that time, irregularities are, as we have seen, apt to arise which might easily have been pre- vented, by proper care and attention. The chief deformities caused by irregular teeth are the rabbit mouth and projecting chin. But these and all other defects may be prevented by timely attention. In proportion as the teeth grow the de- formity becomes increased and more con- spicuous. These disagreeable deformities are al- ways in the power of the dentist to recti- fy, and what parent who has a regard for the personal appearance of their offspring would allow such a deformity to exist. Nothing therefore is required to render this part of the human structure less de- structible than others; but the same atten- tion which from personal delicacy and fashion, is paid to cleanliness of the'face and arrangement of the hair. In selecting a tooth brush much care and judgement is necessary in order that it may be of proper dimensions and a suit- able degree of stiffness. This must be regulated by the size of the mouth and 140 TREATISE, kc. state of the gums and other circumstan- ces. A great advantage will therefore be- derived by referring the choice of a brush to a dentist, if convenient. When children begin to shed their teeth, if irregularities form in their arrangement by one laping over the other, a frequent inspection should be made, for all deform- ity can at that time be easily rectified, nor indeed should a cure of any deformity be despaired of under the age of twenty. The most frequent and destructive dis- ease of the teeth we have stated to be ca- ries, this affects them at a very early pe- riod ; indeed it is coeval with their first appearance, particularly when dentition is slow, for then the accumulated matter is apt to lodge on their edges, and, unless carefully removed, disease is entailed for life. * Among the popular prejudices, which have been propagated in the world is, that of bad teeth being hereditary,or running in families. This is a most erroneous idea, <§' ought to be strongly combated, as under such a prepossession, the teeth will gen- erally be neglected, parents supposing that every means used for prevention of disease will prove fruitless. TREATISE, kc. < 141 I have no hesitation in affirming, that bad teeth are five times out of six, acciden- tal and are to be considered either as the consequences of neglect or improper management, and in fact, a large share of caries proceeding from internal causes, may be prevented with seasonable direc- tions and care But the management here depends on such a variety of circum- stances, that it would be exceeding diffi- cult, if not impracticable to give such di- rections as would safely lead to a favora- ble result. It will be found highly prudent in all cases of inflammation or, soreness in the gums or about the teeth, to consult a den- tist immediately, so that the inflammation may be reduced as speedily as possible and thus prevent a gangrenou affections in the cavity of the tooth, which if suffered by neglect to take place will inevitably prove the destruction of the tooth. The first stages of diseases affecting the teeth, are seldom considered of sufficient importance to merit attention, and thus these important organs are neglected till the inroads of caries, or the agonizing pain of the tooth ache, admonishes us, in a larr- 142 TREATISE, &c. guage not to be misunderstood, and hence diseases which could have been wholly ar- rested by seasonable application are placed beyond the reach of any remedy ; extrac- tion or some paliative being the only means then left in our power. The first traces of disease in the teeth, are generally unobserved by the patient. Caries in particular, is so insidious in its attacks, that its existence often requires the most minute inspection to detect it. It will readily be perceived from the foregoing observations, that there is no in- dividual branch of practice of more uni- versal utility, than the one I have endeav- ored to illustrate ; and, at the same time I am well aware, that in this part of the country none has been so much abused.— "If says Dr. Hare,Dentists would content themselves with enterprises, no greater than are sanctioned by the dictates of rea- son and experience, they would enhance a firmness of reputation, more lasting than the affectation and presumption of doing impossibilities could ever establish, and ac- knowledge the limitation of their art in common with that of the more weighty branches of chirurgical science." TREATISE, &c. 145 *' The teeth," continues he " are worthy objects of the anatomist, the physiologist the chemist, the naturalist, and the prac- tical surgeon, for it is dreadful to reflect upon the injuries to health, and the actual causes of mortality, which are daily lev- elled upon the unwary, by buffoons and chatterers—by quacks and mountebanks, and by the most illiterate mechanics in med- dling with disorderd teeth." Dr. Brown, of Edinburgh, observes, in his remarks on the subdivision of surgery, " if surgery has need of being subdivided in order to its advancement and perfection, such subdivision is in a particular man- ner applicable to the branches which re- quire great manual address ; and perhaps there is no one which demands more hab- it and dexterity than the dentist. If he who embraces it, joins to the knowledge of his art, that which is required of medi- cal men, he will not fail to hold a distin- guished rank in science, and to contribute to the elevation of a branch of the heal- ing art, which has been too long usurped and degraded by ignorance and presump- tion. Without being duly qualified no one ought ever to command the confidence of the world, or induce patients to trust with U-l TREATISE, kc. security to his care the remedying of affec- tions inorgans so precious as the teeth." In making these quotations, I hope t shall not be misunderstood in regard to this science^ as forming a distinct profession; The occupation of a dentist certainly u- nites as great a variety of practice as in justice ought to be attended to by one per- son, and therefore, it is my decided opin- ion thatrthis science should be made a sep- arate profession, in order that by the ex- clusive attention of its professor it may be brought to that perfection which its impor- tance so justly demands. FINIS, w '(4/ ^n ■'* 4P 3-. .f* ■w, i&~Wi£J ► Pjj<^j HJs&aMBHr? '3g| SeSh fe^t!lM| Cy(j; ^=m " ' T^L^^^tf it '• * ^Jt,** ^wB fltt^-JaS^lo j^Hk*Sw| > $r BwS* ^fef^Pt,^ ■'■■ sf^'i'ia "j> IN>| J.'T 1 T'-^v