mm impMimm m i fill "i m vmmm 0& j '/%-;3''-> - '^-:irr'- '~:-'^-»- ■L.,J'C:-"'J -..(■" A." 'iM I V Surgeon General's Office i y A\ N.NKV r* ^ \ ' ,4,1 ~^l /f/f/tf/r/f //tfjt/' of nu ---TEETH -— • •- ByJ3 k n.fami;* Jawe s M.M.S.S. 1 i'f?r?? Ji O S T O X. '/„„StKet..l8l4. District of Massachusetts, to nit: District Clerk's Office. BE IT REMEMBERED, that on the fifteenth day of December, A. D. i8i3,andin the thirty-eighth year of the Independence of the United States of America, Benjamin James, of the said district, ha9 deposited in this office the title of a book, the right whereof he claims as author, in the words following, A Treatise on the Management of the Teeth. By Benjamin James, M. M. S. S. " Solatium Afflictis.3 In conformity to the act of the congress of the United States, intitled, "An act for the encouragement of learning, by securing the copies of maps, charts, and books, to the authors and proprietors of such copies, during the times there- in mentioned ;"* and also to an act intitled, " an act supplementary to an act, intitled, An act for 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 designing, engraving, and etching historical and other prints" WILLIAM S. SHAwJ^jJ.i****' CONTENTS. To the Reader pages Cleanliness 11 Cold Water IS Dentifrice 17 Tooth-Ache 25 Sympathetic Tooth-Ache 39 Rheumatic or Nervous Tooth-Ache 41 Quack Remedies 47 Filling, or Stopping Teeth 53 Filing, or Separating Teeth 57 Transplanting 63 Artificial Teeth 67 Extraction of the Teeth 81 Tartar 93 Irregularity of the Teeth 97 Dentition 103 Shedding the Teeth 111 Occasional Effects of Diseased Teeth 115 Pepys's Analysis of Teeth 129 5 TO THE READER. The utility of popular treatises on the teeth may be inferred from the success, they have met with in many parts of Europe. As the same causes exist here, which, in the old world, destroy the human teeth, it may not be amiss to make an attempt to dissemminate information on a subject of such universal importance. Had it been taken up by any other per- B 6 son, the public would not now experi- ence this intrusion upon their patience. Whatever may be the fate of this publi- cation, it will be a cause of gratification, if it do but lead to a more finished pro- duction from some abler hand. In a treatise of this nature, calculated for general information, it is not proper to enter into a minute detail of the ana- tomical structure of the teeth : a previ- ous knowledge of anatomy and physiol- ogy would then be necessary, to enable the reader to keep pace with us. We shall, therefore, only give descriptions, which, to be generally understood, will need, neither the aid of technical phrase- ology, nor the prior acquaintance -with any preliminary science. 7 The teeth are so important, in divid- ing our food, as well as in conversation, and are, besides, so highly ornamental, as to render it a positive duty, with eve- ry one, to study the causes, which lead to their premature destruction. When, through negligence, many of them have decayed, and the remainder are rapidly falling into the same condi- tion ; it is pleasant to learn, that the dis- ease may be stayed ; that the places of the absent teeth may be supplied with others, both useful and ornamental ; and that those, which have become partially diseased, may be rendered of service to us, as long as we continue our attentions. The hollow cheek, the putrid saliva, which contaminates the whole system, the foul breath, and days and nights of 8 agony, are not the worst consequences of our neglect ; the unpitying and mur- derous hand of the dentist is, alone, a sufficient punishment for our careless- ness. The great impositions, which have been practised by some, who call them- selves dentists, render it necessary, that every one, who values his teeth, should be able to distinguish the impostor from him, who understands his business. To communicate the information, necessary to enable all to make this distinction, is one of the objects of this work. Most people may be deceived at the time of an operation ; though woful ex- perience in a few months unfolds the de- ception. The impostor is sought for to make reparation, or to receive merited 9 punishment ; but the bird has flown ; he is gone to practise his tricks and decep- tions among those, who know not his character ; until prudence drives him in- to another seclusion from revenge, into another shoal of gudgeons. In all occupations, it is safer to employ those only, whose permanent residence enables us, at all times, to call them to account for negligence or deception. The itinerant dentist ought, therefore, never to be trusted. 11 CLEANLINESS. The first and most important object is the cleanliness of the teeth. Without attention to this necessary duty, it is use- less to think of preventing disease, or of keeping them in a sound state, when the skill of the dentist has been put in requi- sition. In making choice of a brush, we should not choose one so soft as to pass over the interstices of the teeth, nor one so hard as to tear the tender gum from 12 its connection with the tooth. When we are satisfied that the brush possesses a suitable degree of stiffness, we should be careful not to carry it too long in a horizontal direction, for fear of produc- ing the evil just mentioned. A direc- tion from the root to the crown serves to elongate, and spread the gum more ele- gantly upon the enamel. The tops of the teeth, as well as their inner surfaces, require the visitation of the brush- Though we should be care- ful to clean the teeth after every meal, it is more particularly necessary before re- tiring to rest; the foulness, which has been all day accumulating, is thus pre- vented from committing its ravages dur- ing the night. 13 When the gums are spungy, and liable to bleed, from the slightest touch, a hard brush, though apt to occasion much bleed- ing at first, eventually gives them much firmness, and in a short time effects a cure. 15 COLD WATER. When we consider the opposite ef- fects, produced by cold and warm water; and that cold water braces, and strength- ens parts, with which it comes in con- tact ; while warm water relaxes and de- bilitates, we are naturally induced to pre- fer the former, for the teeth and gums. If we attend to the process used in the manufacture of glue, we may obtain a just idea of the evil consequences re- sulting from the use of warm liquids. 16 By boiling bones, either rasped, or entire, they give out their jelly, or gelatinous part, to which they are indebted for their solidity and cohesion. A moderate degree of heat, such as the mouth can bear, produces the same effect as boiling water, if it be applied for a length of time. Vi DENTIFRICE. It is safer to trust to a brush, and cold water, altogether, than to use den- tifrices, of the composition of which we are doubtful. Those powders, which are extolled for immediately whitening the teeth, are all pernicious, as they produce their effect by a decomposition and removal of the surface of the enamel ; and, if often us- ed, they rob the teeth of their elegant covering, and eventually leave a row of « c Id decaying, brown, and offensive stumps, which ruin the health, and disgust the nose and eye of the observer. Cream of tartar is a very common, in- gredient, in these noxious dentifrices, which, like acids of all kinds, ought to be avoided by those, who do not wish to sacrifice their teeth to a temporary el- egance of appearance. The ashes of wood, or tobacco, are hurtful, from the large portion of alkali, or pot-ash, which they contain. It is from ashes that we obtain caustic, the most powerful substance for the decom- position of animal bodies. The lapis- infernalis, or infernal stone, owes its chief activity to the principle, with which ashes abounds j it is capable of destroy- . ing the soft parts of the body, in a short 19 time, and, though slower in its operation upon the teeth, its effects are as certain in the end. Every economical house-wife, who makes her own soap, knows, that bones contain a large portion of fat ;■ and that, by boiling them in lye, the fat is extract- ed, and the texture of the bones destroy- ed, in a few hours. Alum, table-salt, and all other saline articles, are improper to be used alone, or to enter into the composition of dent- ifrice. The acids, which make a part of such substances, are generally of the most powerful kinds. When the gums are relaxed, or spun- gy, and liable to bleed, some bracing powder, such as the Peruvian bark, ys useful. Powdered charcoal, under vari- 20 ous names, has been in very common use ; but, we feel convinced, from the ex- periments of a friend, whose acquaint- ance with the subjects we are treating of, is very extensive, that its grinding pow- ers are not exceeded by any other denti- frice, with which we are acquainted. Many dentifrices contain so large a proportion of grinding substances, viz. coral, pumice-stone, emery, &c. that one hour's steady application of them, with a brush, has removed the enamel from a tooth, placed in a vice for the experi- ment. « From this fact we may ascertain, pret- ty nearly, the time required for the de- struction of the enamel, under the daily •u*e of the powder. Suppose such dsnt- ifrice to be used for ten seconds each 21 day ; by this calculation, we see, that it requires but one year's perseverance in its use, to ruin the teeth. When we have a dentifrice, the quali- ties of which we are desirous to ascer- tain, it may be mixed with water. If there be any acid* in its composition, an effervescence will be produced by put- ting into it a small quantity of salt of tartar, or pearl-ash. When an alkaline ingredient is present, a similar effect is produced by the mixture of vinegar, or other acid. After washing away all the light, and colouring parts of the dentifrice, we find, at the bottom of the vessel, the sand, em- ery, pumice-stone, &c. It is to acids, generally, that all prepa- rations for the teeth owe their activity, C 2 22 whether in the form of electuaries, bal- sams, tinctures, or powders. There are, at this time, in Boston, sev- eral persons, known to the writer, who have been so indiscreet as to use a lotion of vitriolic acid, and water, for whiten- ing the teeth. The effect, at first, sur- passed their most sanguine expectations ; they have now only the mortifying con- viction, that neither art, nor time, can ever remove the filthy discolouration, which has ensued. The omission of an easy precaution, when directing for patients the elixir of vitriol, has laid the foundation for much unhappiness. In the common mode of drinking this medicine, every tooth is exposed to its destructive influence. By sucking it through a tube it may be taken 23 without touching the teeth, and with perfect safety. To obtain an idea of the injury sus- tained from the frequent use of vinegar, (and all vegetable acids have the same ef- fect ;) a sound, and well-enamelled tooth, may be placed in a wine glass full of vin- egar ; on taking it out, eighteen or twen- ty hours after, hollows may be noticed in the enamel, and erosions on its sur- face, similar to iron, when pitted with rust. If we put a tooth in any of the mine- ral acids, an immediate alteration may be perceived; in a few hours' time, the enamel is entirely destroyed. By diluting these acids with water, their solvent pow- er is, not proportionally weakened. 24 From what has been said, we may perceive the great necessity of caution in selecting a dentifrice for the teeth ; having obtained one, which contains nei- ther acid, nor saline articles, we have much discretion to exercise, in its use. Once or twice a week is sufficiently oft- en ; if any discolourations remain not- withstanding, we had better let them alone. 25 TOOTH-ACHE. The external crust, or covering of the teeth, is so hard, as to strike fire with steel. This substance, which is call- ed enamel, entirely covers all that part of the tooth, that is not included in the jaw and gums. Within the enamel is a bony sub- stance, which is the immediate covering of the marrow, nerve, or sensible part of the tooth. The enamel is rarely thicker than the twenty-fourth part of an inch. 26 It is so thin, and, as has been shown, is so easily destroyed, by a variety of causes, that breaches are often taking place, and exposing the bony part of the tooth. In this state of the disease, there is a remedy, which will be noticed, when we come to the subject of filling or stopping the teeth. Very few are fortunate e- nough to discover the decay, until it has proceeded to the nerve itself, exposing that exquisitely sensible part to the vio- lence of every thing entering the mouth, and producing tooth-ache. We know of no certain remedy, in this disease, but extraction. Palliative applications are very numerous, and are sometimes successful. The effect of fear, in suspending the tooth-ache, is very striking. The pres- 27 ence of the operator, or "the sight of his extracting instruments, is generally suffi- cient to lull, or suspend the pain for hours ; and has, not unfrequently, re- moved it altogether. It is probably up- on this principle, upon this excitation of fear, that dentists depend, when they un- dertake to cure the tooth-ache by burn- ing the ears. Who has not heard of the practice of London mountebanks, who, with their charms, as they call them, have so often amused, deceived, and cheated the populace ? The whole secret consists in artfully creating an emotion of the mind, suffi- ciently powerful to withdraw its atten- tion from the tooth. As soon as this i new feeling has subsided, the pain re- turns with its usual violence ; having 28 kept off just long enough for the jug- gler to receive his fee," and disappear. A drop of laudanum on lint, placed in the hollow of the tooth, oil of mint, of cloves, or any of the essential oils, do sometimes suspend the pain. The caje- put oil is declared to be almost a certain remedy in this affection, whether from a rotten tooth, rheumatic acrimony, ca- tarrh, &c. though it be only applied to the gums. See the American Dispen- satory, by Dr. Thacher. Good effects have been known from opium and camphor, in equal parts, formed into a paste, and placed in the hollow of the tooth on a little lint, and repeated several times. Not more than half a grain of opiurn is necessary in such an experiment; 29 when used without regard to its quan- tity, serious and even fatal consequences have ensued. We have met with cases of violent pain, proceeding from the irritation of teeth, which have become dead by be- ing closely jammed in a crowded jaw. These teeth were literally squeezed to death ; their' superficial discolouration is an undeniable proof of their destruction, and as they irritate the jaw as foreign substances, extraction becomes necessary. This kind of irritation, and consequent ulceration, are very common consequenc- es of dead stumps. The roots of the front teeth are rendered less troublesome, and are generally cured, by placing arti- ficial crowns upon them, to be hereafter described. D 30 The teeth are often subject to great uneasiness from the accumulation of tar- tar about their necks, which gradually displaces the gums, and not unfrequent- ly renders them so loose, that they drop out. An early removal of the tartar would have obviated this difficulty. Mercury and the mineral acids, which are now in such common use, have de- stroyed many an elegant set of teeth ; a misfortune unhappily attended with as much pain as any other mode of de- struction. It is common to meet with severe pain in the ear, arising from one or more de- fective teeth on the same side ; the man- ner of relieving it is obvious. 31 It frequently happens that pain, swell- ing, and inflammation, extend very rap- idly over the whole jaw, from the diffi- culty which the wisdom teeth experience in their protrusion ; sometimes from the firm resistance of the gum, but oft- ener from want of room. It now be- comes necessary to divide the gum upon the teeth, with some cutting instrument, that will reach the part. If they do not advance, nor the pain subside in a day or two, we must extract a tooth as near as convenient, and thus make room for them. When the throat and contiguous parts have been much inflamed from this cause, and have resisted all other means, for several weeks, this operation has giv- en immediate relief. The wisdom teeth 32 do not often make their appearance, un- till the age of twenty, and, in some per- sons; not till many years after. In instances of considerable inflam- mation of the jaw and face, nice judge- ment is required to ascertain, whether we shall perform our operation directly, or defer it until this severe symptom has subsided. There is but one direction in this case, that may be considered as generally ap- plicable ; which is, if the inflammation be rapidly extending itself over the face, and throat, much danger is threatened, and an immediate operation is required. If, on the other hand, the inflammation give us any encouragement of its early subsidence, we avoid operating for the present, and with soft, warm, and emol- 33 lient applications, bring the parts into that state of ease, which will render our operation safe, and easy. Some authors, as if fearful that the dentists may not have sufficient employ- ment, endeavour to encourage inatten- tion to the teeth. Instead of acknowl- edging that disease arises from external means, they impute its origin to internal causes ; and thereby inculcate a theory, which bears the same relation to our teeth, that the doctrine of election* does to our souls ; for if every thing go by predestination, of what consequence is it, to one or the other, to soul or body, whether we give them a moment's atten- tion, or carelessly let them shift for them- selves ? D 2 34 Mr. Fox observes, that: " Caries has " its origin in the bony part of the " crown of the tooth, the structure of " which becomes gradually destroyed, " &c." He further observes : " when " caries has made some progress inter- " nally, a small opaque spot appears upon " the enamel, where it covers that part " of the tooth which is diseased, and " the bony part of the tooth situated " underneath this spot will be found of " a dark brown colour ; when the decay "has advanced so far as to destroy the " texture of part of the bone of the " tooth, the enamel loses its support, " then breaks away, and a cavity is dis- " covered in the tooth. It is in this way " that caries first originates ; and it is by " no means uncommon for a person, in 35 " a very short space of time, to discover " cavities in several teeth which had " been supposed perfectly sound. " In the mastication of hard sub- " stances, pieces of the enamel are brok- " en off, on account of the texture of " the bony part being destroyed by the " caries, which had previously gone on " internally." We may suppose from Mr. Fox's fre- quent repetition of the same ideas, that he is determined to make converts Of his readers. Let us see what he has to say further : " The proximate cause of ca- " ries appears to be an inflammation in " the bone of the crown of the tooth, " which, on account of its peculiar struo- " ture, terminates in mortification." Jb If Mr. Fox's theory be true,* why do we not suffer pain from this inflammation of a part, in which, its presence proves the existence of organs of sensation, of vessels and nerves ? on the contrary, we feel no great uneasiness, until the disease has exposed the very centre of the crown. Richerand tells us that a bone, when inflamed, manifests the most exquisite feeling. It would be absurd for believ- ers in Mr. Fox, to attempt to explain how it is, that disease so often happens * Indeed we might call it Hunter's theory. In speaking of caries, Mr. Hunter says: « It does not " arise from external injury, or from menstrua, " which have a power of dissolving part of a tooth ; " but we may reasonably suppose that it is a disease " arising originally in the tooth itself." in the corresponding sides of two teeth, at the same time. There are but few, whose experience does not teach the fallacy of this doc- trine. There may be, without doubt, diseases of the teeth originating within ; but they furnish no suitable reason for neglecting all attention to the teeth, es- pecially when we know, that in most in- stances, disease is the inevitable conse- quence of neglect. There are various improper practices, which bring on decay of the teeth, and consequent tooth-ache, such as raising heavy weights with them, cracking nuts, using metal tootn-picks, &c. &c. That kind of tooth-ache, which hap- pens in sound teeth, is often aggravated by extraction. When a tooth is pain- 38 ful, and does not appear to be defective, we have many circumstances to take into consideration : We should learn whether it arises from sympathy, from cold, from tartar, or other causes. 39 SYMPATHETIC TOOTH- ACHE. When the painful tooth appears sound, and the opposite of the other jaw, or its fellow on the other side, is defective, there is a strong presumption that the pain is a consequence of that sympathy, which so often displays itself in diseases of Other parts. Here the mode of proceeding is ob- vious ; the extraction of the diseased tooth relieves its sympathizing fellow. 40 If the rotten tooth be not removed, it is remarkable that the sound tooth short- ly becomes affected. A gentleman, suffering from this spe- cies of tooth-ache, was advised to have the rotten tooth extracted; as it did not ache, and it being difficult to con- vince him of the existence of sympa- thetic pain, he insisted on the removal of the sound tooth, which, for judicious reasons, was refused. Another person, less scrupulous, ex- tracted it for him, and thereby occasion- ed an immediate aggravation of the complaint; the pain remaining in the socket of the extracted tooth, until his senses convinced him of the necessity of removing the original aggressor up- on his quiet. 41 RHEUMATIC OR NERVOUS TOOTH-ACHE. There is another species of tooth- ache, for which it would be rash to at- tempt a cure, in the usual way. What- ever impropriety there may be in call- ing it rheumatic, or nervous, is of little consequence, provided we can make our- selves understood. That spasmodic tension, increased ac- tion, and fullness of the vessels, accom- E 42 panied with heat, and extreme pain, which so frequendy result from check- ed perspiration, or, as it is commonly called, a cold, are apt to sieze the gums, teeth, neighbouring glands, &c. giving the disease a resemblance to tooth-ache, and appearing to require extraction for its relief. The attentive observer, having ascer- tained the nature of this case, will avoid irritating, by extraction, parts already violently inflamed. He will rather en- deavour to restore the healthy action of the skin; to guard the body from any fresh cold, or damp air, and, if necessary, he will apply bread and milk, or onion poultices, on the cheek, or irritating or blistering plasters on the back of the heck, or behind the ears. 43 A liniment, composed of spirits of hartshorn (aqua carbonatis ammonite) one part, and of sweet oil two parts, makes an excellent application for the face and throat. In these cases, the disease often ex- tends along the jaw, producing in many of the teeth, that sensation, which, in tooth-ache, is generally confined to one. There is a symptomatic disorder of the teeth, which is produced by various de- rangements of the health. vVe ought, in none of these instances, to adopt the common method of applying hot'and stimulating articles to the gums, such as rum, brandy, ginger, &c. for, like ex- traction, they add to the violence of the disease. 44 In addition to the remedies mentioned above for these affections, it will be ad- visable to take cooling purges, to keep the mouth moistened with warm decoc- tion of marsh-mallows, comfrey-roots, or chamomile; to take opium with moder- ation, or to bleed, according to the ur- gency of the case, until the original af- fection, on which it depends, has sub- sided. Having pointed out the most com- mon occasions of the tooth-ache, it is unnececsary to perplex the reader with a confused account of other causes, which can be understood only by the experienced practitioner. Our task will be performed, if we do but convince our readers, how absurd it is, whenever they are in pain, to run to the first person, 45 who will take out their teeth, imthout asking any questions. 3 2 *;-' QUACK REMEDIES, The absttrd fears, which many people entertain respecting the extraction of a tooth, often make them dupes to merce- nary empirics ; a few observations, how- ever, will show the absurdity of throwing away money for nostrums. There are three very evident means, by which tooth-ache, or other pain, may be removed, or alleviated. The first is by sedatives. The second, by lessening the quantity of fluids in the inflamed 48 part. The third, by a diversion, or re- moval of the disease, from one place to another. The first purpose is answered by the internal use, or external application of opium, or its tincture, called laudanum. This drug, variously disguised, forms the basis of nearly all the quack-remedies for the tooth-ache, of the present day. The ill consequences, which follow the use of such applications, might be prevented by a knowledge of their component parts ; but such information cannot be given with the nostrum; the secret of its com- position would thus be disclosed, and the quack would put it out of his power to benefit himself any further by the decep- tion. Every thing essentially necessary to be known, in the use of opium, has 49 been communicated in a previous article. The second purpose is answered by the use of purgatives ; by smoking, or chewing such substances as occasion a flow of saliva ; or by exciting perspira- tion from the skin, by warm fomenta- tions, or poultices. The third purpose is effected by a meth- od, which is successful in a variety of complaints ; we attempt to cure the dis- ease by exciting a new one, and seem to give the old complaint an opportunity to get well, while the attention of the sys- tem is withdrawn to the new disease. Irritating applications, of every degree of power, from that which simply raises pimples on the skin, to those which pro- duce a complete blister, answer the third intention. 50 So far as these three intentions can be answered by nostrums, they ma;- -^ use- ful ; but it would be absurd to apply them except for the first, and as we are totally ignorant of their strength, it is ever un- wise to have recourse to them. Much credit has often been attached to quack medicines, from their application being made, when the inflammation and pain have begun to subside. The dura- tion of tooth-ache very rarely exceeds three, or four days, and the bug-bear ap- prehensions, which are entertained about extraction, prevent the sufferer from ob- taining a speedy relief; he bears the pain with some fortitude, for the first day; the want of sleep, during the night, and the aggravation of his complaint, leads him on the following day to try many 51 remedies, as simple as they are useless. Worn out at last by the violence of his sufferings, he seeks relief in the use of tooth-ache drops, which are so ridiculous- ly puffed in the papers of every day. Either by a subsidence of the inflamma- tion, or by a discharge of matter from the jaw, he is relieved ; he extols the nos- trum last used, and unwittingly leads oth- ers into the same deception. When again afflicted with the tooth- ache, if the patient will suffer the com- plaint to proceed, unmolested, he will be sensible, that we have not been guilty of exaggeration. FILLING, OR STOPPING TEETH. If people were more generally ac- quainted with this excellent mode of stopping decay, but few teeth would re- quire extraction. The first appearance of disease is a brown, or yellowish discolouration of the enamel. Teeth, in this state, should not be meddled with ; a proper attention to cleanliness is sufficient to prevent their going any further; but when the enam- 54 el is eaten through, and the disease be- gins to take hold of the bony part of the tooth, immediate recourse must be had to plugging, or filling it. When the disease takes place between the teeth, filling them is generally imprac- ticable ; they have then no chance of be- ing saved but by filing, or separating them, as hereafter described. Some writ- ers have made a distinction between wet and dry caries ; the former chiefly affect- ing the upper surface, rapid in its pro- gress, and requiring immediate attention ; the latter, attacking the sides, proceeding slowly to destroy the teeth, and requiring no attention, for several years. We, however, feel justified in filling a tooth, whenever there is a sufficient breach, or loss of substance to ad mit of it. 55 When the disease has not proceeded so far as the nerve, we may always venture to put in a suitable filling. If the nerve be uncovered, or alive, it must be de- stroyed before we proceed any further. To answer this intention, it is common to introduce into the diseased cavity, either the caustic, or hot iron ; the strong- mineral acids, or essential oils. The sensibility of the nerve being de- stroyed by any of the means just men- tioned, we next proceed to the removal of the diseased parts, and having wiped the cavity dry, a filling of gold, silver, or other proper metallic substance, may be firmly crowded into the tooth. Though the teeth may be so far de- cayed, as to be of no service in chewing the food, filling them, when practicable, 56 prevents their getting worse, and cures the fetor of the breath, which invariably arises from foul teeth. Roots may be cut, or filed down to the gum, and filled with the same materials, or wood, with the same beneficial results. When filled in this way, they are not so liable to at- tacks of tenderness and inflammation. Lead is often used as a filling, but as it is a substance so easily corroded by the acids, which are washing its surface every day, no suitable dependance can be placed in it. When we have filled a tooth, and great uneasiness has followed the operation, we must remove the filling, and substitute some resinous substance, until the cavity possess less sensibility. FILING, OR SEPARATING THE TEETH. The greatest part of those, who have occasion for artificial teeth, owe their mis- fortune to neglect, usually arising from ignorance, and which might have been prevented by very little trouble in the commencement of the disease. Who- ever suffers many days to pass, without removing the foulness from the gums, and teeth, harbours a powerful enemy in his mouth—a mass of putrifying matter, F 2- 58 which lies undisturbed, until it has effect- ed breaches in the enamel. As the lower teeth are constantly washed by the saliva, and drink, this ac- cident does not so often happen with them ; it is chiefly in the upper jaw, where the teeth are too high to be affect- ed by the same causes, that the greatest ravages are committed. The dissimilar- ity of form in the upper and lower teeth, contributes very much towards producing this difference of effect. The sides of the upper teeth lie closely together, while the crowns of the under teeth touch only at that point, which is most distant from the gum. For this reason, noxious ac- cumulations, between the upper teeth, cannot be so easily removed, as between the lower teeth. It is therefore in ths 5S power of the file to destroy the greatei aptness of the upper teeth to decay. Collections of foul matter, when suf- fered to remain for a certain time between the teeth, produce an effect, which is of- ten discovered too late. When disease has happened from this cause, it is gen- erally near the gum, and affects the cor- responding sides of two teeth, at the same time. To prevent the disease from proceed- ing further, we make an immediate sep- aration of the two crowns, by a thin, flat, file ; thus removing the parts already af- fected, and preventing injury from future collections. By this process the teeth are saved, or at the worst, they last longer than would have been the case, if the fila had not been used. 60 The practice of filing has often fallen mto disrepute, from the unsuccessful op- erations of unskilful hands. There is an unjust prejudice against separating the teeth, arising from a plausible appear- ance ; for instance, a person's teeth have been for some time falling into decay; the disease has made small external open- ings in the enamel, while the bony part within has become extensively diseased ; the teeth are nearly ruined, and a few days, whether the operation be performed, or let alone, produces their entire destruc- tion. At this period, separation can do but little good, and we are sure to hazard some reputation, if we operate under such circumstances. 61 The use of the file is likewise necessa- ry, when the tongue, lips, or cheeks, are wounded by broken, or jagged parts of teeth. As soon as wounds have arisen from these causes, and the file cannot be so applied as to remove the offending part of the tooth, the whole of it ought to be extracted. 63 TRANSPLANTING. The transplanting of teeth from one head to another is an operation, the suc- cess of which is very doubtful. Teeth, which have been drawn by mistake, do not always become firm when replaced in the jaw ; how much less should we expect a tooth belonging to another person, to become firm, when crowded into a socket of unsuitable di- mensions. 64 The uncertainty of success is a strong argument against transplanting; besides, we must pay dear for the experiment, and procure several persons to have teeth extracted from corresponding parts of their jaws, until we can get one that will fit ; or the transplanted tooth must be cut and filed very much to make it an- swer at all. When we have succeeded in fixing it tolerably well in the jaw, it is tied as we wish it to adhere ; and upon most ex- aminations afterwards, we have the mor- tification to see the borrowed tooth as loose as our worst enemies could wish. In unsuccessful transplanting, there is not only a sufferance of pain, a loss of time and money, but there is a further loss to our patient of a valuable root, on 65 which might have been fixed, a hand- some, firm, and durable artificial tooth. If transplanting were successful oftener than it is, the communication and pro- duction of disease, which frequently en- sue from this practice, render it a trouble- some and hazardous operation ; so that it is now thought better to pursue any other mode of filling the mouth with teeth, than by that of transplanting. 67 ARTIFICIAL TEETH. A few years only have elapsed, since it was considered a disgraceful violation of propriety, to wear an artificial tooth. The more correct reasoning of the pres- ent day justifies the use of them, when- ever they can be serviceable. Divines, lawyers, and statesmen, whose sedentary habits have made them more subject to decayed teeth, than other classes of peo- ple, are not now ashamed to wear these 68 auxiliaries to their elocution ; and the ladies are no longer averse to call to their assistance these ornamental aids to con- versation. The further we depart from nature, or the more we indulge in the luxuries of the table, in the same proportion do our teeth suffer. That curse to civilized man, the tooth-ache, has not even a nominal existence in savage life. No animal but himself is tormented by it, and though he is too proud to take les- sons from the monkey, or Hottentot, he has humiliating reasons for envying them, their exemption from the disease. Among the various tribes of animals, we cannot discover any instances of rot- ten teeth, except when arising from frac- ture. The alternations of heat and cold, 6V experienced in our drinks, (for we are so whimsical, that some articles cannot be swallowed, without the assistance of ice ; and our broth, tea, and coffee must be almost scalding hot;) the violent ac- tion of vegetable acids, which are in such common use ; pearl-ash, and sweetening in our puddings, and pastry ; and pow- erful spices with every thing we eat, are so many destroying engines of the teeth,. and stomach, This being the age of the greatest refinement in cooker)', there are consequently more rotten teeth than were ever known before ; the number of dent- ists have necessarily increased, and, as in other trades, we have workmen of all consciences, from ten dollar operators to six shilling botchers in bone and ivory. People should be able to form an idea of G a 70 the operation of setting a tooth, that they may become judges respecting the ade- quate fee. For setting an artificial tooth, in this town, some pay ten dollars ; oth- ers pay five, or three, according to the person employed. It would be difficult to point out any other difference, than the price, in most instances. In setting artificial teeth, there is room for considerable imposition. It is chiefly in the country, that itinerant, self-styled dentists carry on their deceptions. Many of these honest folks do not know what enamel is ; they are therefore in the hab- it of working up bare bone, or ivory into teeth, and the deluded patient, being as ignorant as the person he employs, most cheerfully pockets, we might rather say. mouths, the deception. If these travell- 71 ing gentry did not commence their ope- rations by extracting the roots, to which the new crowns ought to be attached, we could feel more charity for their igno-- ranee. There are, in certain towns in the vi- cinity of Boston, many young ladies, whose mouths have been filled with ivo- ry teeth, which now look more like for- tifications of tobacco quids, than like any thing human. When caries has proceeded so far as to occasion any considerable deformity of any of the teeth, which have a single root, they then become suitable objects for this branch of our art. An instrument, that will cut off the diseased crown, at once, nearly even with 72 the gum, is preferable to the file, not on- ly because the file requires more time, but because it occasions much more un- easiness. The crown being cut down to the gum, the half round file, which tapers to a point, must produce that degree of con- cavity at the top of the root, which will make a suitable lodgement for the crown, and enable it to come close to the gum. If we find that the application of the file produces pain, except when the root is tender from disease, it is occasioned by the exposure of the nerve, which must be destroyed before we proceed further.^ To effect this purpose, an instrument, about the size of a brown thread needle, is introduced into the natural canal of the root, and carried as far as it will go ; 73 the remainder of the operation is now rendered free from pain. Dentists pursue very different methods of fastening the new crown upon the root j some drive the wire, which is at- tached to the crown, into the canal of the root, with cotton wrapped round it, to make it tight; while others previously place a piece of wood in the root, and attach the crown to this substance. As the cotton, of the former method, absorbs and retains the saliva, which, from stagnation, becomes offensive ; and as teeth, set in this way, are sooner loos- ened, we are induced to prefer the latter manner of setting them. When the root is filed down upon a level with the gum, we enlarge the cavity, or canal of the root, so as to remove the diseased parts, * 74 and produce a sound and even caliber to receive the wood, which is previously drilled through its whole length, and shaped to fit in its place. A trifling en- largement of the canal is necessary, when wood is used, though there may be no diseased parts to remove. Well seasoned walnut will last many years, and give a surprising degree of firmness to the arti- ficial crown. As the root is now prepared, we are able to fit upon it, very perfectly, the new crown, which exactly resembles that part of the tooth, which was seen above the gum, before it had undergone any alteration from disease. We next drill a hole in the under part of the crown, sc that it »may precisely correspond with the opening of the root. A screw is now 75 matte of gold, and screwed into the crown. That part of the screw, which does not enter the artificial tooth, is squared, and driven into the hole pre- pared to receive it. When we engraft, it being the term applied to this operation, a preference is given to golden screws, as they are more durable than silver. There is another mode of engrafting, which is sometimes eligible; a hole is drilled into the crown, a piece of walnut driven into it, and so shaped as to fit the enlarged cavity of the root. There is, in this case, merely a substitution of wood for the gold wire of the former method. When artificial crowns are formed from the large teeth of animals, such as 76 the hippopotamus,* or sea horse, setting them in wood is more practicable. Small teeth are so brittle, that they cannot part with more of their substance than is suf- ficient to admit the wire, without being very liable to break. We are often obliged to form several teeth in one piece, particularly when there are not corresponding roots for each crown. If a person have lost from three to six teeth, or more, from the front of the mouth, and there be only two roots remaining, the whole block may be very conveniently attached to these roots by the screw and wood, or wood alone, as already described. * The artist, who designed the vignette at the be- ginning of this volume, has given a distant view of the hippopotamus. 77 It is not eligible, perhaps, to set an en- tire block of teeth, when the roots are all good ; for it should be remembered, that when the crowns are set separately, and one of them decays, it does not affect the others ; but if they be set in one entire piece, an injury happening to one crown, from rot, or fracture, can be repaired only by a new set. The tooth of the sea horse, which must be used, when several teeth are to be made in one set, does not generally look so well, after wearing for some time, as the teeth which are used Separately. If there be no roots, to which the crown can be fastened, it is necessary to drill holes in it, and secure it by liga- tures of thread to a tooth on each side. The wires, which are used for tying in 78 teeth, are improper, as they wear deeply into the teeth they surround. After setting an artificial tooth, it is not uncommon for the face to swell, and occasion uneasiness. No blame, how- ever, can justly fall upon the dentist, un- less his operation be roughly performed, or the root be inflamed, or ulcerated, when he begins his work. Artificial teeth, of a French inven- tion, have been preferred in Europe, from their being made of earthy sub- stances, and because they neither decay, nor affect the breath ; they are, however, more brittle, less natural, and more ex- pensive, than the kind in common use ; and indeed nothing is necessary but cleanliness, and frequent rinsing the 79 mouth, to render the common artificial teeth, as sweet, and as durable as any others. 81 EXTRACTION OF THE TEETH. The extraction of teeth is considered by some as a simple operation. When the tooth is but little diseased, the roots neither diverging, nor locking so as to include a portion of the jaw, and being superficially set, a tooth may be extract- ed in any direction, by any body who merely knows how to get at it. To extract with the least possible in- jury, (for every extraction is an act of H % 82 violence,) it is indispensably necessary, that the operator should be perfectly ac- quainted with the anatomy of the jaw, ahd contiguous parts. A deficiency of anatomical knowledge often leads to serious injuries. How is it possible for those, who are ignorant of the existence of the large cavities of the upper jaw, towards which the roots of some of the grinders approach so nearly, to know how to avoid breaking open their thin floorings, or external walls ? The quackery of those, who pretend to draw teeth with such sudden despatch, as to give the patient no time for pain, and before he knows where he is, is too ridiculous to deserve a serious notice. Those, who think, that he is the best operator, who jerks out a tooth in the 83, twinkling of an eye, must suppose so from prejudices, which nothing short of sad experience can do away. Teeth, ex- tracted so suddenly, almost invariably bring away with them the alveolary pro- cesses, (the sides of the sockets) which supported them ; loosen the processes of the teeth on either side, and two sound teeth shortly fall a sacrifice to quackish despatch. These evil consequences, as well as those of a more serious nature, eventually make many of the advocates of jerking become proselytes to correct practice. The celebrated anatomist, John Bell, observes, that : " The teeth are so close- " ly embraced by their sockets, and we " are so far from being possessed of any " instrument, by which they can be pull- 84 " ed perpendicularly out, that the sock- " ets can seldom escape ; they are brok- " en or splintered in perhaps one of four " extractions, even by the most dexter- " ous artists in that line." Repeated experience convinces us, that Mr. Bell did not devote his usual atten- tion to the subject, before he hazarded these expressions. To break, or splin- ter the socket, in one of twenty extrac- tions, is not necessary. The sockets are so elastic, that a tooth may almost always be pulled without apprehension, provid- ed an eye be kept on the tooth, when it is starting from the jaw. If we see it moving altogether in a lateral direction, we take off the instrument, apply such forceps as will most conveniently take hold, and raise the tooth from its place ; 85 a method which gives the least pain, and insures a safe extraction. The gum should always be separated from the tooth, as low as the thin edge of the socket, before the extractor is ap- plied. Though this precaution be not always supposed necessary, it is safe ; for after repeated inflammation of the gum, it is often converted into a firm, tough substance of a cartilaginous nature, which, if it be not separated, follows the tooth, carrying along with it large strips of the gum, and leaving a part of the jaw divested of its natural covering. Disease of the jawbone is a necessary consequence of such unpardonable neg- lect. The gum being separated from the tooth, a soft cushion should cover the 86 fulcrum of the extractor, to protect the gum. Some have preferred turning the teeth outwards, under the impression that less force is required than when turned inwards. The former method we conceive to be unjustifiable, except when the tooth, to be extracted, is wedged in like the key stone of an arch. When the teeth are extracted out- wardly, they bear upon the concave side of the external alveolary arch; when extracted inwardly they bear upon the the convex side of the internal arch. Every one knows that the least force ap- plied on the concave side of an arch is sufficient to break it; on the contrary, the convex side is capable of bearing an immense weight. 87 Hence we may venture to assert, that there is a greater risk of tearing away the sides of the socket, by an extrac- tion outwardly, than in the opposite direction. Another important reason for extracting inwardly is, that the external side of the tooth furnishes a more deep and secure hold for the claw of the in- strument. The outward processes of the wisdom teeth of the lower jaw are so thick and unyielding, as to endanger a longitudinal fracture of the jaw, if the extraction be outwards. We wish it to be kept in mind, that it is not our intention to point out the most dexterous manner of extracting a tooth. We had rather ascertain how to perform it with the most safety. We 1 88 therefore place the fulcrum of the ex- tractor on the inside, and the claw on the outside, of the tooth, with the ex- ceptions above mentioned : the fulcrum now rests on the edge of the inner gum, the claw is pressed down, with a finger, under the enamel, until it meets i with the resistance of the thin edge of the socket. We next apply the necessa- ry degree offeree to the instrument, re- collecting as we turn the tooth out, that we must endeavour to raise it up as much as possible. We thus obtain a motion, which is composed of the hori- j zontal and perpendicular direction ; mak- ing, in this combination, an ascent of j forty-five degrees, subject to some little ! allowance. 89 The force must not be suddenly ap- plied ; it must be so slow as to give time to see the tooth move. The moment it has started, we decide whether the pro- cess be in danger of fracture, or not. If the process be likely to suffer, we with- draw the instrument, apply forceps of a suitable construction, turn the tooth into its natural position, and then raise it with little pain, or difficulty from the jaw. In speaking of extraction, the terms up and down apply only to the teeth of the lower jaw ; it is therefore evident, that the reverse is meant, when the upper teeth are to be extracted. Whenever the thin edge of the socket is splintered, or broken, we had better remove the fractured pieces immediately, and thus prevent future uneasiness. 90 The removal of roots is generally more simple, and less painful than the extrac- tion of teeth. Those roots, which con- tinue to receive the pressure of the teeth of the opposite jaw, are firmer than oth- ers, which are not pressed upon. These last become more and more loose, until they fall out, or are extracted with great ease. The chief difficulty, in extracting roots, proceeds from their having de- cayed so low down in the jaw, or from the inconvenience of their situation. Force, applied to any part of them, u- sually turns them out; there is a pre- caution, however, which must be attend- ed to, whenever the punch is used : it is absolutely necessary that the arm of the operator should be pressed firmly against his side. When attempting to extract 91 with this instrument, and with the arm elevated, if the punch slip, it is liable to plunge into the tongue, or roof of the mouth, or to occasion other considerable injuries, which are not unknown in this town. We are so fond of novelty, in all the indigencies, whether of necessity, or caprice, that we cease to wonder at the preference given to new operations over those, whose utility have been tested by time and experience. Were it not for this propensity to indulge in every thing new, we should express our astonish- ment, that the method of punching out teeth, in all cases, had ever found advo- cates in this place ; and that every petty innovation upon the established practice 92 of the best dentists should obtain so much attention and encouragement. There are some rare instances, after extraction, of profuse bleeding, which may be easily stopped by crowding, with a probe, a little lint into the socket, upon which are placed cushions of rags, suffic- ient to fill up the vacancy between the crowns of the teeth on each side, so that, by closing the jaws, the dressing is kept firmly in its place. •Ji> TARTAR, To explain the process by which tar- tar is formed, would be as difficult as it is uninteresting. It is sufficient that we know how to obviate its effects, when it adheres to the teeth, and how to prevent it doing any future injury. Before the formation of tartar, we ob- serve a yellowish viscid matter collecting around the teeth, which, if not removed, is eventually converted into a hard, grit- 94 ty, or stony substance of various shades of colour, from black to a light brown ; becoming more firm and extensive, the longer it is suffered to remain ; discol- ouring the enamel, and forcing itself be- tween the teeth and gums, and, in the end, producing pain and inflammation ; ulcers and recession of the gums ; foul breath, caries, and looseness of the teeth, until they are entirely destroyed. In removing the tartar, attention must be paid to the hardness, or temper of the instrument. An untempered instrument scarcely makes any impression upon the tartar, while one, that is tempered very highly, is liable to take hold of, and cut away the teeth themselves. Ignorance, or inattention to this fact, is the reason that teeth have been either 95 not benefited, or much injured by the operation. The instrument, which re- moves the tartar, should be applied to that edge of it, which is insinuating it- self under the gum, so as to raise it in layers, and render it unnecessary to have recourse to tedious and ineffectual scrap- ing. It is necessary to distinguish accurately between tartar, and discolouration of the enamel ; for from mistakes in this re- spect, the enamel has been entirely scraped off, and the teeth ruined. The quantity of tartar, which collects about the teeth, is occasionally so enor- mous, that cases are known of persons, who have had all the teeth of each jaw enveloped in one continued coat of it; a circumstance, which has given rise to 96 those stories propagated by the wonder- ful magazine, and by those, who love to deal in the wonderful, of people who have only one tooth in each jaw, ex- tending from ear to ear ! Tartar should not be removed by den- tifrice ; for whatever dissolves, or grinds it away, will have an effect upon the enamel, proportionate to the hardness of the tartar. When it is removed, the teeth may be brushed with some suit- able powder, until the remaining discol- ouring matters are removed. From this time, more dependance should be placed on the use of the brush, and cold water,. than on any dentifrice whatever, •■•7 IRREGULARITY OF THE TEETH. The milk teeth are seldom subject to any irregularity ; thefe are, however, in- stances of their coming in such an un- natural position as to do an injury to the cheeks, or tongue ; an injury, which ex- traction obviates. The same irregulari- ty may operate as an impediment to the speech, or as a cause of derangement in the order of the second set of teeth. 98 A few years since, Mr. Fennell, the tragedian, whose success in the instruc- tion of youth, particularly of the deaf and dumb, is well known, brought to me a dumb girl, who was not deaf, of six, or seven years of age : her dumbness, as Mr. Fennell supposed, arose from the extreme irregularity of all the milk teeth ; some of them pointing outwards to the cheek, others turning in towards the tongue, and wounding it, exhibiting every variety of position except the nat- ural. I extracted the whole of the teeth for the little girl, whose courage, and submission to such frequent operations, gave proof of her intelligence, as well as her ambition to acquire the use of her tongue. Every day or two, a tooth was taken out, and it was very evident 99 that each operation removed an obstacle to her articulation. With the assistance1 of Mr. Fennell, she increased her vocab- ulary of single words, as the number of her teeth decreased, so that by the time the whole were removed, she was able to deal out a few short sentences, which were well pronounced. With proper attention paid to the re- moval of the first set of teeth, the regu- larity of the second may be anticipated ; and this attention must be kept up, un- til the first set are wholly supplanted by the permanent teeth ; an event, whichj as before mentioned, does not complete itself, until the child has attained his twelfth, or fourteenth year. We are oftener called upon to cure irregularity, than to prevent it ; we shall 100 therefore make a few remarks on those modes of proceeding, which appear best suited to our purpose. When the permanent teeth have dis- placed the first set, the former are often observed to be so much crowded, and deranged, as to produce the appearance of unnecessary profusion in their num- ber. The deformity thus occasioned, and the greater aptness of the teeth to decay, from the collection of foul matters in their numerous interstices, render it nec- essary to restore them as nearly to a state of perfect regularity as possible. The jaw of a person very young is so soft and yielding, that a tooth, taken out at a considerable distance from a deranged tooth, makes room fof it ; the teeth on each side of the one extracted crowding 101 in to fill up the vacancy. But when the jaw has become more hard, and unyield- ing, we can make room for deranged teeth only by drawing those in imme- diate contact with them. Then, by gen- tle compression of the finger applied dai- ly for several weeks to the deranged tooth, we see it come into its proper place as effectually as from ligatures, springs, or violence. The most common, and the most un- pleasant irregularity happens in the eye teeth, and those included between them. Young people of courage have submitted, when the teeth have been much crowd- ed, to have one of the grinders extracted from both sides of each jaw, and in this way, have secured to themselves a set of handsome, useful, and lasting teeth. K. 102 Compression of the finger will usually bring teeth into their proper places, if ■i-ooni le made for them, and if attended to before age has given too much firm- ness to the jaw. This operation is ex- tremely easy in children ; quite difficult in those who have all their teeth, (thirty- two in number;) and not at all practi- cable with those, whose ages are far ad- vanced. 103 DENTITION. In that important period of infancy, when the gums are inflamed and swoll- en j when various parts of the body sympathize with the unyielding mem- brane, which resists the passage of the teeth ; we are called upon to bestow nu- merous attentions upon the little sufferer. Considerably more than one third of the whole number of deaths happens a- jo; mong children, who have not attained their second year; and as the greater prat of their diseases is in some way con- nected with teething, we may consider a very large portion of their deaths as aris- ing from this complaint. In London, during one year, seven thousand two hundred and sixty-one children have died under two years of age. A melan- choly consideration, and a proof either of neglect in medical treatment, or of the fatality of the disease ! The teeth of the child just born are as yet only small membranous bags, con- taining a white matter of a soft consist- ence, into which enter the nerve, and vessels, from which the nourishment and / growth of the embryo teeth are to be derived. In a few months some of them 105 are forward enough to pierce their way through the membrane and gum. The two front teeth of the lower jaw appear first, and with their sharp edges help along their more deeply seated fel- lows of the upper jaw. Next come the the two lateral incisors, or cutting teeth of the lower jaw ; the corresponding ones of the upper jaw soon follow. We now have four cutting teeth in the front of each jaw; next to these, two grind- ers, on each side of both jaws, make their appearance. The dog teeth of the lower jaw next come into sight ; and the last of all, are the two eye teeth, making, in the whole, twenty temporary or milk teeth. Though liable to exceptions, this- is the most usual manner in which the teeth K 2 106 make their appearance. The first denti- tion is generally completed between the second and third year. About the sixth or seventh year, one permanent grinder makes its appearance at each end of the two ranges of milk teeth, making four in the whole. From the twelfth to the six- teenth year appear four more, next be- yond those last mentioned. About the twentieth year, come the four last grind- ers, commonly called wisdom teeth from the age in which they appear. Instances have been recorded of chil- dren born with one or more teeth, al- ready in a state of protrusion through the gum ; while in some subjects, twen- ty-two months have elapsed before the first tooth has been seen. 107 Were we to attempt to give an ac- count of all the appearances, which at- tend upon, or which are the consequences of, severe teething, the reader would hardly pardon us for drawing up so long a catalogue. We shall therefore only give such a view of the subject, as we conceive will be generally interesting. If an uncommon degree of restless- ness, or fretfulness, take place in the child, about the time the teeth are expected to make their appearance, we may general- ly place it to the account of teething. When we observe that the child slavers at the mouth ; that its gums are swollen, and its little head tossed from side to side, as if seeking relief from pain ; but more particularly, if considerable fever, startings in the sleep, profuse discharges 108 from the bowels, spasms of particular parts, or general convulsions take place, our remedy must be promptly applied. With the gum lancet, or other suitable instrument, we make a free division of the gum, which we know to be deep enough by the grating sensation commu- nicated to the hand from the tooth. By dividing the gum, the highly sen- sible membrane beneath it is laid open, and the former is sometimes known to close and grow together again. The cause of irritation is, however, removed, and the gum, from its elasticity, yields to the pressure of the tooth, which some- time afterwards passes through without producing any of those symptoms occa- sioned by the irritation of the membrane. If the first division of the gums be not 109 attended with success, subsequent opera- tions become necessary. Though there be no division of opin- ion respecting the use of the gum lancet, still, authors disagree as to the propriety of putting hard things into the mouths of children to bite, rubbing the gums with the fingers, &c. The great degree of pleasure, with some exceptions, com- municated to children, and the evident advantage occasionally arising from such practices, do, notwithstanding, evince their utility. Ill SHEDDING THE TEETH. The teeth, when perfectly formed, are such hard and compact bodies, that it would be absurd to expect the growth of the first set to keep pace with the in- creasing dimensions of the jaw ; the sec- ond set are therefore forming in the jaw, so as to take their places when it is suf- ficiently extended to receive them. To facilitate the passage of the perma* nent teeth to their proper places, the 112 roots of the first teeth are gradually re- moved by machinery, which nature has formed for the purpose, constituting a process known by the name of absorp- tion. The absorption begins at the extrem- ity of the root, and proceeds towards the crown just fast enough for the perma- nent tooth to advance, until no support being left for the old crown it falls from the gum, and the new tooth soon sup- plies its place. The permanent teeth pursue nearly the same order in rising from the jaw, which was observed in the milk teeth ; beginning to make their appearance a- bout the age of six years. They do not dislodge all the first set until the twelfth or fourteenth year. 113 When the permanent teeth do not press into the situations occupied by the corresponding milk teeth, the latter do not suffer the absorption of their roots mentioned above, but retain their orig- inal places, and become what are called supernumerary teeth. The teeth, which are intended by na- ture to be permanent, having made their appearance, require the assiduous atten- tion of the parent, until the faculties of the child are sufficiently matured to ena- ble him to attend the task himself. The importance of attention to the teeth should be inculcated with his ear- liest lessons, and an impression thereby made, that will not be forgotten in man- hood, and which will secure to him a 114 sound set of teeth, until, with the body. they decay in the grave. 115 OCCASIONAL EFFECTS OF DISEASED TEETH. It may appear strange to most per- sons, to hear it asserted, that any condi- tion of the teeth may contribute to the production of that fatal disease, which rages so generally in this country, and which occasions nearly one half the deaths recorded in the bills of mortality ! It must be plain to every one that we mean consumption. Were this com- 116 plaint more rare, it might be less worthy of our attention ; but it is present every where, in every town, and in almost ev- ery family. When a disorder has become so com- mon, we are compelled to suspect a cause of its production even in our pleasures, and necessary enjoyments. It is, how- ever, more rational to place its preva- lence to the account of irregularity and neglect; and we shall endeavour to as- certain, whether it may not be consid- ered as one of the miserable consequences of bad teeth. In a climate like ours, diseases so of- ten terminate in hectic fever, that there are but few, who have not had an op- portunity of observing its progress, or its most remarkable symptoms. 117 After extensive ulceration, or accumu- lation of matter, in any part of the body, an absorption of the matter takes place. It is thus carried into the circulation, contaminating and undermining thewhole system ; producing a quickened pulse, debility, loss of appetite, and very irreg- ular attacks of heat, cold, and sweating, with uncertain intervals and duration, until the victim to the disease finds re- lief only in death. When hectic symp- toms appear, and none of the well known causes of the disease exists ; and especially if the patient have long been troubled with rotten, or ulcerated teeth, or with long continued collections of matter in and about the jaw, have we not just reasons for supposing that the hectic appearances are occasioned by the L 2 118 neglected cdndition of the teeth ? We therefore have another inducement to preserve our teeth, and to have them re- moved when defective ; an inducement, which arises from the certainty of pos- sessing an additional security against that deadly disease, consumption. On each side of the face, above the roots of the grinders, there is a cavity, called the antrum maxillare, which com- municates with the cavity of the nose by a small opening. Its use, in conjunc- tion with other cavities, appears to be, to render the voice more sonorous, as the cavities of stringed instruments magnify the sound communicated to them by the vibration of their strings. The antrum is lined by a membrane, which is so nearly in contact with the 119 roots of the large grinders, that inflam- mation is' readily communicated to it from the teeth. When the inflamma- tion has continued for some time, an ab- scess is formed in the cavity, and as the opening into the nose is rendered imper- t vious by the disease, the matter is com- pelled to work its way through the jaw- bone, and muscles of the face. From the apparently trifling neglect of a diseased tooth, and the consequent in- flammation and formation of matter in the antrum, the bones of the whole face have been involved in general destruc- tion. In a patient troubled in this way, the disease has occasioned the entire destruc- tion of the right upper jaw, the palate, and cheek bones, and the articulating 120 portions of the lower jaw, of the same side of the face ; the bones, which form the orbit of the eye and forehead, were considerably affected. The symptoms, which indicate the ex- \ istence of this complaint, are not often so strongly marked as to enable us to judge of its nature correctly. We should therefore be upon our guard, so as not to mistake common affections of the teeth for this dreadful disease, as well as to se- cure us from the consequences of over- sight, when it actually exists. During the existence of inflammation in the antrum, a sensation of tightness and weight, with throbbing, is felt in the cheek, and considerable pain is expe- rienced, extending, from the part first af- fected, to the forehead. The cheek short- 121 ly becomes hard, red, and swollen, and a considerable fulness may be perceived within the cheek, above the roots of the teeth. If we do not succeed in removing the inflammation, matter very soon forms, and an outlet must be made for it as ear- ly as possible. With this view, we ex- tract the first or second large grinder, on the same side of the upper jaw, and make a perforation into the cavity, through the bottom of the socket. The second grinder appears to be more cen- trally inserted into the antrum, and gen- erally has the preference given to it by operators. Some authors recommend making a perforation within the cheek, above the roots of the teeth ; but as such an open- 122 ing appears to be too high to produce a complete discharge of the matter, it should not be attempted, except when the patient will not suffer a tooth to be extracted. As soon as the matter is dis- charged, deeoction of bark, or diluted tincture of myrrh is to be frequently in- jected with a syringe into the cavity. If the bones be sound, the cure is soon completed, but if they have become dis- eased, the face does not get well until they come away, or are removed. The formation of bony matter is not an uncommon consequence of disease in the antrum. In such cases, a bony tu- mor makes its appearance in the cheek, and increases in size, until the distortion of the features become frightful. Un- fortunately it admits of no remedy ; the 123 tumor increases in size, and the diseased action does not stop, till all the animal functions have ceased. Though the probability of suffering from such a dreadful complaint be very small, the possibility of our being visited with it is another strong incentive to the pre- servation of good teeth, and the remov- al of those that are bad. A formation of bony matter about the roots of sound as well as diseased teeth, sometimes occasions so great a pro- trusion of their crowns, that the jaws cannot be brought together. This exos- tosis of the roots admits of no remedy but extraction. The cause of the dis- ease appears to be a long continued in- flammation, which is variously produced and communicated to the roots. 124 We have heretofore been noticing either the destruction of sound, or the formation of diseased parts, which are alike inconvenient and distressing. It is with pleasure that we bring our atten- tion to a beautiful process, which has for its object the formation of new bone, when the teeth have been ground away by long continued use. When the teeth are worn down by mastication, and the nerve has become nearly bare, by a peculiar action of the vessels, new bone is formed, and the nerve absorbed, until the cavity which contained it is entirely obliterated. Were it not for this contrivance of nature, persons far advanced in life would experience much misery in one of their greatest enjoyments, for they 125 would suffer torture even in the indul- gence of their appetite. THIS ANALYSIS OF HUMAI TJEETH, BY W. H. PEPYS, JUN- As this treatise will probably fall into the hands of many, who will be pleased to meet with some re- marks on the composition of the teeth, the writer of- fers no otliev apology for adding to his work Pepys's Analysis of Human Teeth. 129 ANALYSIS, Mr. Charles Hatchet, in his valuable paper on shell and bone, [Phil. Transact. 1799] enumerated the several substances which enter into the composi- tion of the human teeth ; it is to be re- gretted that the nature of his subject did not render it necessary for him to as- certain the proportions in which they are respectively found, as it could not have failed to have proved highly useful, and M 2 130 his known accuracy would have preclud- ed the necessity of any other person un- dertaking such a labour. Several good analyses of bone have been published, but I believe no accurate analysis of the teeth has yet been offered. Bone, it has been observed, when ex- posed to the action of acid menstrua, be- comes dissolved ; that is to say, the solid or constituent substance of them is.ab- stracted, and a gelatinous matter is left of the form of the original bone. Nitric, muriatic, and acetic acids are capable of producing this change, which is accompanied with a liberation of an aeriform fluid, that precipitates lime in lime water, changes vegetable blues red, and by its gravity is known to be car- bonic acid gas. These acid solutions 131 yield a copious precipitate with pure am- monia, which is again soluble in either of the acids. After the precipitation by pure ammonia, the solution of the car- bonate of ammonia will still produce a new precipitate. The precipitate of the first solution, by pure ammonia, as noticed above, is soluble again in the acids before men- tioned ; these solutions yield, with a so- lution of acetite of lead, a copious pre- cipitate, proving the presence of phos- phoric acid. The precipitate obtained by the car- bonate of ammonia is also soluble in either of the above acids, but with effer- vescence ; and these solutions are not precipitated by acetite of lead ; they fall, however, with, oxalate of ammonia, car- 132 bonate of ammonia, or any precipitant of lime. The great solubility of the phosphate of lime, in even the weakest of the acids, is very extraordinary. Phosphate of lime, mechanically suspended in water, is speedily and completely dissolved by passing a copious stream of carbonic acid gas through it. With these facts before me, I havft ventured to examine the several speci- mens of the human teeth ; as the en- amel, the bone, or roots, the teeth of a- dults, and the shedding teeth of chil- dren. Previous to an account of the analy- sis, it may not be uninteresting to notice the action of some of the articles of the. materia chemica on the teeth. 133 Sulphuric acid of the specific gravity 1*83, appears at first to have no action ; in the course of an hour small bubbles are perceived, the roots become black- ened, and in twelve hours the enamelled part busts, cracks, and separates, accom- panied with an evident formation of sel- enite, by the action of the acid on the lime, which enters into the composition of the teeth. Nitric and muriatic acids of the spe- cific gravity of i • 12, act instantly on the tooth, accompanied with an evolution of a quantity of small air bubbles from the whole of the surface ; about eight times their weight of these acids are sufficient for the solution of the solidifying princi- ples of the teeth. The mass left undis- solved has nearly the original form of 134 the tooth, is flexible, semitransparent, and easily divided by the nail. The dilute acetous acid (distilled vine- gar) has a very trifling action, but when concentrated, acts both on the phosphate and carbonate of lime. Boiling nitric acid acts strongly on a tooth, with the evolution of carbonic acid, and a considerable quantity of azot- ic gas. The gelatine and solid substance are dissolved as the surfaces present themselves; but the operation being stopped at any part of the process, the residuum is firm and hard, but reduced in size proportioned to the time the tooth has been acted upon. 135 ANALYSIS OF THE ENAMEL. One hundred grains of the enamel of human teeth, (carefully rasped) were placed in 600 grains of nitric acid of the specific gravity 1*12. Slight efferves- cence ensued, and after twelve hours 200 grains more of the acid were added. Allowing for the loss by evaporation in a corresponding vessel, after thirty-six hours it was found to have lost four grains and a half. It was then diluted with four ounces of distilled water, precipitated by pure ammonia, and then filtered. 136 The precipitate obtained being dried in a water bath, at 212% weighed 102 grains. It was then ignited, after which it was found to weigh 78 grains. The filtered solution was then precip- itated by carbonate of ammonia in solu- tion, and filtered: The separated precipitate being dried in a heat of 212°, weighed six grains. Enamel then consists of Phosphate of lime - 78 Carbonate of liine - 6 84 Water of composition and loss 16 100 137 A loss of 16 grains here takes place, which is easily accounted for, from the impossibility of directly ascertaining the State of dryness in which the ingredients existed originally in the enamel j for we have seen, that by drying the phosphate of lime in a heat of 212°, (after which it had the appearance of being as dry as possible) it yet contained so much mois- ture, as to yield a gain of 8 grains in the analysis. On the other hand, when ignited, its state is driven to the opposite extreme, and there is a loss of 16 grains. It is impossible, however, that the materials could exist in the teeth, in a state of dry- ness to be compared with that produced by exposing them to such a high tem- perature. And it appears but reasona- 138 ble to conclude, that the real quantity of moisture lies nearer to that given by the heat of 212°, than to that given by ig- nition, and consequently, that the 16 grains, lost by exposure to such a high temperature, were chiefly water. Bone, or roots of teeth, yielded by analysis in ioo grains, Phosphate of lime - 58 Carbonate of lime - 4 Gelatine - - 28 90 Water of composition and loss 10 100 139 The teeth of adults yielded on analy- sis in ioo grains, Phosphate of lime - 64 Carbonate of lime - 6 Gelatine - - 20 90 Water of composition and loss 10 100 Specific gravity of adults' teeth 2'2727 140 The shedding, or primary teeth of children, yielded an analysis in ioo grains, Phosphate of lime - 62 Carbonate of lime - 6 Gelatine - 20 88 Water of composition and loss 12 100 Specific gravity of childrens' teeth 2-0833 In these analyses, as in the former, the phosphate of lime was also exposed to a red heat, and consequently was re- duced to a greater degree of dryness than that in which it existed in the tooth. 141 In all of them the carbonate of lime was dried in a heat of 212° (above which it would have been liable to decomposi- tion) and the gelatine of the three last in the same temperature. %\z <£nJ, [?/f