ODONTALGIA. ODONTALGIA, 
COMMONLY CALLED 
TOOTHACHE; 
ITS CAUSES, PREVENTION, AND CURE. 
BY 
S. PARSONS SHAW. 
Necesse habeo scribeye, ct dicam ut sentio. 
PHILADELPHIA : 
J. B. LIPPINCOTT & Co. 
London : TRUBNER <fc Co. Manchester : PALMER & HOWE. 
1868. CONTENTS. 
PAGE. 
Introduction 1 
The Teeth 26 
Organisation oe the Teeth 28 
The Trifacial Nerve 34 
Decay of the Teeth 50 
Exposure of the Pulp 67 
Odontitis 70 
Periodontitis 84 
Alveolar Abscess 89 
Sympathetic Tooth-ache 95 
Diagnosis of Tooth-ache 112 
Tartar 125 
The Prevention of Tooth-ache 131 
The Cure of Tooth-ache 196 
Disease in the Antrum 228 
Neuralgia, Tic-douloureux, &c. • 226 PREFACE. 
object in the present work has been 
to offer a treatise which shall be so 
clear and precise that the physician, the 
surgeon, and the dentist may alike be able 
to detect the symptoms of one of the most 
painful of all maladies, and to correctly 
estimate the many absurd theories which 
prevail in regard to the various forms of 
facial pain. VIII 
Preface. 
I have endeavoured also to indicate the 
methods employed by the intelligent dentist 
for the prevention of tooth-ache, and inci- 
dentally to expose some of the barbarous 
and harmful practices of quackery. 
Furthermore, I have pointed out the 
means to be adopted with a view to the 
cure of tooth-ache, so that in cases of ne- 
A 
cessity, the physician and surgeon may be 
enabled to effect at least temporary relief 
in a scientific manner; and when a perma- 
nent cure is entrusted to the dentist, how 
the former class of practitioners-and the 
more intelligent portion of the public-may 
enable themselves to obtain some idea as to 
whether the latter is basing his treatment 
upon scientific principles, or otherwise. 
To have treated the various subjects which 
legitimately come under the general head or 
idea of tooth-ache, in a manner that would Preface. 
IX 
leave absolutely no more to be said, would 
have given the volume greater dimensions 
than in many respects was desirable. I 
regarded it as of primary importance that 
the subjects which were to be most definitely 
presented, should not be obscured by the 
introduction of too great a quantity of ac- 
cessary matter. What Horace recommends 
to the ."gentle craft" in the Ars Podica, I 
have considered it discreet to observe in a 
sober treatise on Odontalgia. On the other 
hand, it was equally important that nothing 
should be omitted which would assist in the 
elucidation of those more special subjects; 
though I cannot but acknowledge that to 
make at all times a judicious selection, has 
required, I fear, more ability than I possess. 
That in this respect, and indeed in every 
other, my work will but imperfectly meet 
the just demands of the profession,-which X 
Preface. 
are, of course, for a treatise based both upon 
learning and personal experience,-I am quite 
conscious. 
I have not hesitated to refer, when neces- 
sary, to the incompetence of so many 
of those who practice dentistry. No 
slight task is imposed on the dentist who 
strives to emancipate a noble profession 
from error and charlatanerie, in daily meet- 
ing and combating the foolish notions which 
patients derive from the persons referred to. 
The course,-disagreeable as it is-which I 
have felt constrained to adopt, will be appre- 
ciated by those who practice dentistry as a 
science. 
I have much pleasure in acknowledging 
my obligations to my friend, Mr. Samuel 
Le Resche, for his patience in the applica- 
tion of his artistic skill to the production of 
the illustrative drawings. These the reader Preface. 
XI 
will perceive to be of the highest useful- 
ness, not regretting that they have added 
materially to the cost of the volume. 
S. P. Shaw. 
Exmouth Place, 
188, Oxford Road, 
Manchester, January, 1868. TOOTH-ACHE. 
INTRODUCTION. 
f | THE difficulties which, prevent the practice 
of dentistry on scientific principles are 
alike numerous and embarrassing. The man who 
addresses himself to this art may have become 
possessed of such an amount of anatomical and 
pathological knowledge as involves an acquaint- 
ance with the structures of the human body, and 
with the causes and development of disease:- 
in addition to this general knowledge he may 
be especially familiar with the structure of the 
parts, and with the peculiarities of the diseases, 2 
Introduction. 
he is to treat; and of those parts likewise which, 
from their proximity to the others, are liable to 
become the seat of pain if not of positive disease 
when the former enter on a pathetic career. 
Possessing this knowledge, he ■will be enabled 
to correctly diagnose these affections when they 
appear; and, comprehending the cause of each 
symptom, be able also to determine the disease it 
indicates, and to apply the appropriate remedy. 
Nevertheless, although he may have these 
powers at command, he is constantly hindered in 
the performance of that higher degree of useful- 
ness of which he alone is capable, by the general 
prevalence of numerous strange, inconsistent, 
and misleading opinions as to the causes and the 
character of the diseases he is daily treating. 
These opinions appear to be authenticated in 
text-books otherwise possessing high authority; 
and they are so often repeated, and with such 
confidence in their correctness, that however well 
a dentist may understand his profession, and Introduction. 
3 
however well he may know those opinions to 
be erroneous, the alternative is often presented 
to him of either retiring in mortified silence, 
or of risking the appearance of over-confidence 
in his own opinions; and perhaps, also, of 
impugning the intelligence of those general 
practitioners whose mistakes have been honestly 
and conscientiously, though unwittingly, derived 
from the only sources of information which lie 
open to them. 
Were these opinions confined to patients, 
they could be met and easily eradicated by 
sound advice. But the origin of the fallacies 
in question, and the means through which they 
prevail, are of such a nature, and they serve so 
convenient a purpose in hiding or excusing the 
ignorance or incompetence of the great mass 
of those persons who, with little or no qualifica- 
tion, have assumed the duties of a profession 
demanding, in many respects, a very high order 
of capacity and a great range of acquirements; 4 
Introduction. 
that while much progress may be made in the 
desired direction, it will be impossible to eradi- 
cate them entirely until the science of dentistry 
has become more advanced, and until sufficient 
intelligence is found among at least the most 
prominent of its professors, to comprehend that 
they are fallacies, and to combat them. At 
present, however, such is the general deficiency, 
not only of the great mass of those who practice 
dentistry, but of those also who from one cause 
or another have obtained lucrative practices, 
that a recent medical writer iff constrained to 
say, "the ignorance, the gross ignorance of 
many dentists, even of those with a high name, 
is truly astonishing." So long as this continues, 
the science of dentistry will make no advance 
beyond the merely mechanical character which 
it now possesses in such hands; and the medical 
profession and the public will continue, with 
every justification, to expect no medical know- 
ledge in this quarter; nor will they regard as Introduction. 
5 
worthy of more than little, if any, respect, any 
opinions proceeding therefrom which are con- 
trary to those usually affirmed. Patients, conse- 
quently, finding the dentist almost universally 
a mere artificer, with no higher attainments 
than the ability to indifferently "stuff" or 
extract a tooth, or to construct an artificial 
set of teeth when the natural ones have been 
lost, will continue to resort to the general 
practitioner for advice and treatment when 
suffering from disease in the mouth or con- 
tiguous parts; and the physician, whose know- 
ledge of these diseases (unless he has had the 
clinical experience of a long practice, and has 
been a close observer), must needs be limited 
in comparison to what a dentist ought to possess 
(whether he does so or not), when thus called 
upon to act, can only resort to his text-book 
for information and guidance; and, taking for 
granted (as he is fully justified in doing) that 
what he finds in standard works is correct, he 6 
Introduction. 
is as likely as not, in perfect integrity and great 
confidence, not infrequently to adopt the most 
erroneous theories of practice, and to base a 
treatment thereupon which becomes the most 
complete empiricism. If these • sources of in- 
formation be searched, it will be almost vain to 
hope either for an intelligent idea respecting the 
diseases of the teeth, their causes, progress, 
symptoms, or effects upon the mouth;-or for 
any intimation, that has sufficient force to arrest- 
attention to the fact, that they are the almost 
invariable cause of certain pains seated in other 
parts of the face. 
That so much error should prevail in medical 
literature in regard to these diseases, and their 
effects upon parts of the body distinct from 
those immediately affected, and also upon the 
general health, occasions a good deal of surprise 
when it is remembered what a large amount of 
information has been given to the profession by 
writers some of whose names are of the highest Introduction. 
7 
eminence. The statements of Hunter, Fox, 
Kocker, Deschamps, Harris, Toms, and others 
are unquestioned ; the importance of their 
investigations, and their imperative claims to 
consideration, are undeniable; and yet, such is 
the extent to which they are neglected, that 
Dr. Bond, in his work on il Dental Medicine,"* 
is constrained to say :- 
" That the diseased conditions of the teeth 
and the structures adjacent to them do exert 
a most pernicious influence upon the general 
health, is a fact as well established as any 
other medical observation; yet the medical 
profession seem as yet, with very few excep- 
tions, entirely careless of it. We are not 
apprised that the subject is ever alluded to 
by lecturers on the practice of physic when 
recapitulating to their classes the cause of func- 
tional disturbance and constitutional suffering. 
* "Dental Medicine as connected with Dental Sur- 
gery." By Thos. E. Bond, A.M., M.D. p. 217. 8 
Introduction. 
It is not noticed in the many text-books in 
practice; and certainly, however frequently the 
physician may look into the mouths of his 
patients, it is very rarely that his comprehensive 
glance perceives anything worthy of note in the 
decaying organs of mastication." 
In view of this condition of things, ho 
continues :- 
" It is full time that practitioners of medicine 
should perceive the importance of the teeth and 
of their diseases ; but until they do so, it is the 
more important that the dentist should be able 
to point out the causes of obscure disease, which 
the physician has in vain endeavoured to dis- 
cover simply because he has sought for it every- 
where but in the right place." 
While the effects produced by diseased teeth 
remain unknown to the majority of medical 
writers, it can occasion no stirprise to find their 
treatises on tooth-ache rendered in a vague and 
most unsatisfactory manner. Nor need we be Introduction. 
9 
astonished that those writers appear, so far as 
any definite meaning can be extracted from their 
circumlocutory style, to be impressed with the 
idea that this pain is not by any means always 
caused by a diseased tooth; but that it is often 
a strange, inexplicable, idiopathic disorder of 
most uncertain origin. 
But we have some right to wonder when 
we find these same writers pretty accurately 
describing the symptoms of tooth-ache; and 
then, instead of recognising the true origin of 
these symptoms, or entertaining, it would appear, 
the remotest suspicion of their cause, not only 
proceeding to assume that they are the mani- 
festations of purely idiopathic nervous diseases, 
to which they apply the terms " tic," " tio 
douloureux," "prosopalgia" " rheumatism in the 
teeth," and "facial neuralgia" (of which latter 
there will often be named several varieties, 
according to its seat, or the peculiarity of its 
symptoms, or both)j but giving the reader to 10 
Introduction. 
understand, from the freedom with which these 
terms are used, that it would be presumption to 
doubt, and worse than idle to deny, that they 
are precise, scientific, and, to all intelligent 
medical men, perfectly intelligible designations 
of the pains so common to mouth, face, and 
head. 
After thus transposing the proper relations of 
cause and effect, and substituting the one for the 
other, it is inevitable that when an attempt is 
made to elucidate the meaning of these terms, 
there shall be found in the place of a record of 
that properly directed observation which leads 
to clearly established facts and the deductions 
which are legitimately drawn therefrom, a total 
want of all clearness of expression. Instead 
of general principles, we find only crude state- 
ments and illogical conclusions based upon 
observations not extended beyond the first 
appearance,-which is almost always delusive. 
From these, in turn, are evolved erroneous Introduction. 
11 
and bewildering theories, which cannot fail 
to lead the practitioner who may be so un- 
fortunate as to accept them, into absurdities 
of diagnosis and serious mistakes in treatment; 
and if he be a dentist (unless his learning and 
experience enable him to estimate the correct- 
ness of what he reads), not only so, but to 
disregard the plain and palpable teaching of 
his own daily observations. 
These attempts at description are frequently 
followed by a statement of the remedy sup- 
posed to be applicable to the case, which is 
usually found to be some powerful general 
anodyne, such as quinine, morphia, or bella- 
donna, often in company with a purgative to 
alter the condition of the stomach. 
It is true that these anodynes, by blunting 
the sensibility of the encephalon, will arrest for a 
time almost any pain; but they have no especial 
bearing upon the affections under considera- 
tion; and very little reflection will convince Introduction. 
12 
the thoughtful therapeutist that medical science 
would be in a position bordering upon pauperism 
if it should really appear that it had only these 
general palliatives for the relief of some of the 
most frequent and severe pains to which hu- 
manity is liable. 
It is proper, however, to observe, and somewhat curious 
that a recent American writer on Homoeopathy (Guern- 
sey, p. 298) names quinine in potent doses, from a half 
to one grain, as one of the. specifics of the " similia 
similibus curantur " theory of medical treatment for 
facial neuralgia. Whether this may be regarded as the 
mountain coming to Mahomet or Mahomet going to the 
mountain, certain it is that the author has found this 
drug, in this and larger-in short the ordinary-doses, 
to generally lact in a more direct manner on tooth-ache 
than any other medicine, and in many instances to act 
directly upon and cure it in a manner most surprising. 
It is not to be denied, however, that much 
as we may deplore this paucity of information 
respecting diseases of the teeth in medical 
works of a general character, there is found, 
on looking deeply into the subject, as usual in Introduction. 
13 
such cases, an extenuating, if not a good and 
sufficient explanation of the want of it. Let us 
see in what this consists. 
All, or very nearly all, of the real progress 
that has been made in a knowledge of the 
affections of the teeth has been founded upon 
the old system of studying disease; in which the 
science of pathology was little else than a 
collection of clinical experiences, the result of 
long and patient observations upon the living 
subject, not recorded until the mind had become 
matured. 
Now, however, that the attention of medical 
men is necessarily so much directed to the 
disclosures of the microscope, the investigations 
made with this instrument so engross both 
writers and readers, that the old system is for 
the time almost displaced by one which it is 
well, for the present, to pursue independently 
of all past methods. 
While, however, through the constant and 14 
Introduction. 
energetic use of the microscope, we are daily 
obtaining new facts, facts moreover, which are 
fitting the practitioners of all branches of 
medicine, as nothing else could, for extended 
and more accurate observations in the future, 
we are for the present not only not getting so 
much of the old-fashioned clinical experience, 
but even that which has been recorded is much 
neglected. When our present keen interest in 
these new and wonderful developments shall be 
a little abated, it is to be hoped that we shall 
have a return to the observations of the old 
writers, which possess a value at present in- 
sufficiently appreciated, and to a more careful 
record of daily experience; which, qualified and 
guided by the microscopical discoveries, will 
ultimately develope a system of medicine that 
will stand the severest criticisms. 
These explanations of what we must regret, 
suggest no particular fault in procedure, and no 
blame to persons; but there is another demerit Introduction. 
15 
of which, this cannot altogether be said, not- 
withstanding that very great allowance must be 
made for the natural desire of the educated 
dentist to keep up as intimate a relation as 
possible with the general department of the 
science of which he is conscious of being a 
most important member; and we are not to 
forget that the learning, and even the prejudices 
of school, for both good and evil, remain with 
us for life, and consciously or unconsciously 
sway our minds at all points. 
Those dental writers to whom we are most 
indebted for information, have failed to make 
the impression their writings deserve, either 
because they did not possess the independence 
of thought which would have enabled them to 
treat, from a thoroughly original point of view, 
the diseases with which they were so familiar, or 
because they were unwilling to do so ; and they 
have too often lapsed into a display of erudition, 
which, incorporated with their own observations 16 
Introduction. 
and qualifying them, has unfortunately served to 
greatly mislead all those not prepared to sift 
the wheat from the chaff. 
Even so eminent a writer as Dr. Chapin Harris 
-whose work supplies abundant evidence that 
he could both observe and think, and who was 
well informed in every branch of his profes- 
sion-instead of abiding by his own accurate 
observations, and those of his equally eminent 
professional brethren, commences his remarks 
upon tooth-ache by saying, that it is "a symptom 
of some functional or structural disturbance 
either of the organ in which the pain is seated, 
or in some other part or parts of the body, 
but more frequently of the former than the 
latter."* And of the causes of tooth-ache, he 
says, they " are almost as numerous as the 
varieties of character which it exhibits. Irrita- 
tion and inflammation of the pulp, and inflamma- 
* "Harris's Principles and Practice of Dental Sur- 
gery." p. 345. Introduction. 
17 
tion of the investing membrane, are among 
the most frequent, but it is sometimes re- 
ferable to a morbid condition of the nerve 
or nerves going to a single tooth, or of the 
trunk from which several teeth are supplied; 
also to derangements of the digestive organs, 
and to certain diathesis of the general sys- 
tem," and so forth. Further on he quotes 
Dr. Good, (as if he were an authority!) 
who says of tooth-ache, that "this is often 
an idiopathic affection dependent upon a pe- 
culiar irritability (from a cause we cannot 
easily trace) of the nerves subservient to the 
aching tooth, or of the tunics by which it is 
covered, or of the periosteum or fine membrane 
which lines the interior of the alveoli. But 
it is more frequently a disease of sympathy, 
produced by pregnancy, or chronic rheumatism, 
or acrimony of the stomach in persons of irri- 
table habits. It is still less to be wondered at 
that nerves of the teeth should often associate 18 
Introduction. 
in tlio modern pain of facial neuralgia or tic- 
douleureux, as the French writers sometimes 
term it, for here the connection is both direct 
and immediate. In consequence of this the 
patient in most instances regards the teeth 
themselves as the salient points of pain (as they 
unquestionably may be in some cases), and 
rests his only hope of relief upon extraction, 
but when he applies to the operator he is 
at a loss to fix upon any particular tooth. 
Mr. Fox gives a striking example of this 
in a person from whom he extracted a stump 
which afforded him little or no relief, in 
consequence of which his patient applied to 
him only two days afterwards, and requested 
the removal of several adjoining teeth which 
were perfectly sound. This he objected to; 
and, suspecting the real nature of the disease, 
he immediately took him to Sir Astley Cooper, 
who by dividing the affected nerve produced 
a radical cure in a few days." Introduction. 
19 
By referring to Mr. Fox/' it will be seen that 
Dr. Good rather overstates the case; and it will 
be evident to anyone acquainted with the symp- 
toms of odontitis, that his patient was suffering 
from that pain; and that, instead of its being a 
case of "tic" he had simply failed to discover 
its seat. What Mr. Fox would have us suppose 
when ho says that "Sir Astley Cooper divided the 
suborbitar branch of the fifth pair of nerves," is 
not readily determined; but what was really 
done, any anatomist may pretty easily settle, 
for he says, " The nerve was completely divided, 
as the power of raising that side of the lip 
ceased, and it remained in a state of paraly- 
sisshowing that it was a motor nerve, and 
not a sensory, which was severed, and that it 
was not possible for this to effect a cure. 
The preface which Mr. Fox makes to his record 
of this case shows how he was induced to suppose 
*"The History and. Treatment of Diseases of the 
Teeth." By Joseph Fox. p. 32. 20 
Introduction. 
that 11 tic^loideureux" was an idiopathic disease 
of the nerves, chiefly affecting the fifth and 
seventh pairs; hnt if he had relied upon his 
own good sense and learning (which, on diseases 
of the teeth and mouth, and the pains arising 
therefrom, was altogether more than that pos- 
sessed either by Sir Astley Cooper or Dr. 
Houghton); and had he, instead of allowing 
himself to be misled by the empiricisms of popu- 
lar authorities, based his diagnosis on the accu- 
rate observations he has so very clearly recorded 
in other sentences, he would not have omitted 
those proper inquiries and investigations -which 
show the seat of this pain; nor would he have 
made himself a party to disfiguring his patient 
by an operation which after all could not have 
been what it was supposed to be. 
Interspersed with such remarks and extracts 
as have been quoted, Dr. Harris, in other para- 
graphs, very clearly and carefully indicates the 
symptoms of tooth-ache. This renders it so Introduction. 
21 
much the more to be regretted that he has not 
let us see more of the intelligent dental prac- 
titioner ; making room for such matter by 
omitting whatever had emanated from those 
who could not write intelligently upon this 
subject, and who thought to compensate de- 
ficiency of learning by verbosity of style, which, 
instead of instructing the enquiring student, 
• 
stands between him and the truth he is seeking. 
There is abundant evidence that Dr. Harris 
might have done so had he been disposed. 
Greatly, then, as we have a right to lament 
the errors constantly met with in general medical 
literature, in respect of matters relating to the 
diseases of the teeth and the pains induced 
by them, what blame may be deserved cannot 
rest with these writers alone. Tor so long as 
there, is found in the writings of the most 
eminent dental authors, incorporated with pre- 
cise and definite teaching, the same vague and 
unsatisfactory treatment of a subject upon which 22 
Introduction. 
the reader expects, from their position, exact 
statement and positive information, the former 
class of writers must not be exclusively censured 
for deficiency in that minuteness of information 
which the specialist is most certainly bound 
to afford. That the vague and unsatisfactory 
should occur in the writings of those who could 
not possibly have hourly opportunities for obse*-. 
vation, such as a dentist must needs possess, is 
unquestionably a great defect; but how much 
greater is it when manifested in •writers by 
whom the requisite opportunities for observation 
had been fully enjoyed! 
Again, in microscopical investigations, the 
teeth have assumed a speciality which in itself 
has laid the foundation for the practice of den- 
tistry, as a distinct branch of medicine, much 
deeper than is generally supposed. Yet there 
is evidently a consciousness of this, and the 
task of demonstrating these diseases, and of 
explaining their influence upon the general Introduction. 
23 
system, is now expected of the dentist to a 
degree more than is expressed. He ought there- 
fore to be able to intelligently comprehend the 
phenomena daily presented to his observation; 
and to thoroughly understand the diseases of the 
teeth, and those other diseases to which they 
give rise; and to be able to think and speak of 
them with a clearness correspondent to the 
speciality of his practice, and to his superior 
opportunities for investigation. 
But until more members of the dental pro- 
fession, than at present is the case, become aware 
of what is expected from them, and of the 
position they ought to occupy; and until they 
are stimulated by ambition to become qualified 
for the task they undertake, this branch of 
medicine must needs languish. 
When, however, by the accomplishments of 
its professors, dentistry assumes its rightful 
position, we may expect an accumidation of 
instructive observations from a variety of minds 24 
Introduction. 
cultivated in all the branches of this science. 
These observations will become, from their 
transparent truthfulness, the recognised authority 
in relation to the diseases which at present are 
so little understood, and to the pains which 
are at present so mysterious; and when this 
desirable result is attained, the facts which 
dental science alone can teach, will make their 
way (to the entire exclusion of the prevailing 
speculations) into general, as well as special 
medical literature. 
Although the assumption that tooth-ache is 
ever a disease arising from a variety of causes, 
(many of them of a strictly constitutional 
character); or the other assumption, that its 
symptoms are idiopathic affections of the nerves, 
could not be defended,-even if nothing more 
were known of the structure and the diseases of 
the teeth than what is obvious to any intelligent 
practitioner who considers the pains they are 
well known to be capable of producing, and who Introduction. 
25 
looks into the mouth and sees the destruction 
of their organisation;-with the light now before 
us, the proper mode of studying these diseases 
is first to attain a knowledge of tooth-structure, 
as disclosed by the microscope, and of the agents 
which influence and destroy it. In this enquiry 
we shall find that so far from tooth-ache origin- 
ating in " tic? " neuralgia? or any idiopathic 
disease of the nerves, or proceeding from any 
disorder of the stomach; we shall find, we 
say, that it is a malady confined to the teeth 
and their integuments; and that it is the 
source, almost without exception, of the pains 
which so much perplex enquirers who persist 
in looking for their origin in every direction 
but the right one. THE TEETH. 
r | ]HE permanent teeth are thirty-two in num- 
ber, and are arranged in pairs, and as an- 
tagonists. They consist of a pair, to each jaw, 
of front incisors {cutters); of lateral incisors; of 
cuspids {spear-heads); of first bicuspids {double 
spear-heads); of second ditto; of first, or an- 
terior molars {grinders); of second or middle 
ditto; and of posterior molars, generally called 
the wisdom-teeth. 
Without further explanation, by reference 
to Fig. 4, a general idea of the antagonism of 
the teeth will be obtained; while Fig. 1 gives a 
front view, •with the teeth seen as far back as the 
first molars. The Teeth. 
27 
Fig. 1. 
a. a. Front incisors. 5. 5. Lateral ditto, c. c. Cus- 
pids. d. d. First bicuspids, e. e. Second ditto, f. f 
First molars. 
As the prime organs of mastication, the teeth 
are the hardest portions of the human body, 
and present an organisation, which, although 
somewhat analogous to bone, is, nevertheless, 
distinct from it, and peculiar to themselves. ORGANISATION OF THE TEETH. 
TOOTH consists of three portions: the 
crown (Fig. 2, a), which is all that pro- 
trudes beyond the gums, and 
is exposed in the mouth; the 
root, or roots (c), the portion 
surrounded by the socket, and 
immediately enveloped by the 
periosteum ; and the neck (bJ, 
or the portion covered only by 
the gum. It is composed of 
four distinct structures, called 
respectively the enamel, the 
dentine, the cementum, and 
.the pulp. 
The enamel (Fig. 3, a) is 
that hard and dense covering 
which extends over the crown, 
Fig. 2. 
Front view of 
a superior cuspid 
(eye) tooth. 
a, The crown. 
b. The neck. 
C. The root. Organisation of the Teeth. 
29 
and protects it from corrosive 
agents and mechanical injury. 
The enamel is itself covered 
with a still finer shield, called 
the enamel cuticle, a calcified 
structureless membrane, which, 
from its great power of resisting 
chemical re-agents, is especially 
adapted to aid the enamel in 
preserving the tooth from de- 
cay. 
The dentine (b) constitutes 
the greater portion of the sub- 
stance of the tooth. It is 
less dense than the enamel, yet 
it is far more dense than bone; 
and is so formed as to present 
the greatest amount of resist- 
ance to force. The dentine is traversed by numer- 
ous microscopic tubes, which commence in the 
wall of the pulp-cavity, and run through its entire 
Fig. 3. 
Section of a 
superior cuspid, 
tooth. 
a. The enamel. 
I. The dentine. 
c. Thecementum. 
d. The pulp-cavi- 
ty. 30 
Tooth-ache. 
thickness, penetrating the enamel in the crown, 
and the cementum in the roots. These tubes 
are without doubt traversed by nerve-filaments, 
which give sensation, and probably by vessels, 
which give vascularity to the tooth. 
The cementum (c) is the external structure 
of the root, as the enamel is that of the 
crown. It commences on the neck, where the 
enamel ceases, as a thin layer, becoming 
thicker as it descends into the socket, and 
attaining its greatest dimensions upon the ex- 
tremities of the roots. In character, the cemen- 
tum is more like bone than the other hard parts 
of the tooth; it possesses, also, much greater 
vascularity. On the inner surface it enters into 
intimate union with the dentine, no intermediate 
substance intervening; while the outer surface 
is covered by the dental periosteum, which is 
firmly attached to it on the one side, and to the 
alveolus, or tooth-socket, upon the other. 
In the body of the dentine is the pulp-cavity Organisation of the Teeth. 
31 
(d), which commences at the apex of the root, 
and gradually enlarges until it assumes, in the 
upper parts of the root, and in the lower part 
of the crown, dimensions quite important. 
The pulp is that portion of the tooth so often 
called the il nerve." It is an exceedingly sensi- 
tive and highly vascular mass, composed of 
delicately organised capillaries, blood-vessels, 
and nerves, rising at the apex of the root, and 
filling the entire pulp-cavity. According to 
Kolliker,* "from three to ten small arteries 
pass into the pulp of a single tooth, which, at 
length, produce both in the interior and upon 
the surface of the pulp, a somewhat loose net- 
work of capillaries, from which the veins arise; 
at the surface these capillaries here and there 
present evident loops. The tooth-pulp does not 
appear to possess any lymphatics, but its nerves 
are extremely well developed. Arising from the 
* " Manual of Human Microscopic Anatomy." p. 300. 32 
Tooth-ache. 
well-known nervi dentales, there passes into each 
fang a trunk, and, together with it, as many as 
six or even more fine twigs, which ascend 
into the cavity without, at first, forming any 
considerable anastomosis, but giving off separate 
fibrils, and in the thicker part of the pulp 
form a richer and richer plexus, with elongated 
meshes and collections of nerve-tubes, and thus 
gradually break up into fine primitive fibres." 
This mass is connected with the dentine by 
means of the lining membrane of the tooth;- 
a delicate structureless substance which spreads 
over the entire surface of the pulp-cavity, and 
thereby completely envelopes the pulp. The 
lining membrane is also the medium of commu- 
nication for those nerves of the pulp which pass 
into the dental tubules. It finally merges, at 
the apex of the root, into the dental periosteum 
or investing membrane. 
The dental periosteum is a white and fibrous 
membrane, resembling, in general character, Organisation of the Teeth. 
33 
other structures of the same kind, except that 
it is softer, much more sensitive, and non-elastic. 
It is quite uniform in thickness; and enveloping 
the roots of the teeth, is attached to them upon 
its inner surface by means of small fibrous 
prolongations and a quantity of vessels which 
penetrate the cementum; and its outer surface 
unites in much the same way with the alveolar 
processes or sockets of the teeth. Hence it 
becomes the medium of the vital connection 
of the teeth with the general systemand per- 
forms all the other offices required by the 
indispensable soft structure which must needs 
exist, in the living organisation, between two 
such hard bodies. The cementum is therefore 
a wise provision of nature-indeed an impera- 
tive necessity, since it allows of that mem- 
branous adhesion which would be impossible 
were not the outer surface of the roots of the 
tooth composed of some substance much more 
porous than the dentine. THE TRIFACIAL NERVE. 
rpiIE teeth, are supplied with sensation from 
branches of the fifth pair, which is the 
largest of the cranial series of nerves. This is 
sometimes called the trifacial nerve, and also the 
trigeminus, because while within the cranium 
it divides into three portions, which are ulti- 
mately distributed to the superior, the inferior, 
and the middle parts of the face. 
The trifacial (Fig. 4) is the sensory nerve of 
the face, a nerve of the special sense of taste, 
and also the motor nerve of the muscles of 
mastication. 
It is somewhat analogous to a spinal nerve 
in its origin by two roots, a sensory (1) and a Fig. 4. The Trifacial Nerve. 
35 
motor (2), by which one of its divisions is a 
compound nerve. 
Explanation of Fig. 4; showing the hoots, 
GANGLIA, AND BRANCHES OF THE TRIFACIAL NERVE. 
1. Sensory root. 2. Motor root. 3. Gasserian gang- 
lion. 4. Ophthalmic ganglion. 5. Otic ganglion. 6. 
Spheno-palatine ganglion. 
A. Ophthalmic division, which is entirely sensory. 
B. Superior maxillary division, which is also entirely 
sensory. C. Inferior maxillary division; this 
receives the motor root, the greater part of which is 
distributed, by means of (p) the anterior trunk, to the 
muscles of mastication. D. D. D. Portion of the 
facial, or motor nerve of the face, and its branches (cut). 
Chief trunks of the ophthalmic division.-a. Lachrymal 
nerve, b. Nasal nerve, c. Frontal nerve, (d. Supra- 
orbital foramen.) 
Chief trunks of the superior 'maxillary division.- 
e. Orbital nerve, f. Malar, and g, Temporal branches of 
orbital nerve, h. Ganglionic nerves, i. Posterior dental 
nerve, j. Anterior portion of ditto (cut), k. Anterior 
dental nerve. (1. Infra-orbital foramen, where the supe- 
rior maxillary nerve emerges from the infra-orbital canal 
upon the face.) m. Palpebral nerve, n. Nasal nerve, 
o. Labial nerve. 
Chief trunks of the inferior maxillary division.- 
p. Anterior trunk, which receives nearly all of the motor 
filaments (cut), q. Posterior trank, which is mostly 36 
Tooth-ache. 
sensory, and is the continuation of this division, r. 
Gustatory nerve (cut). s. Aurieulo-tcmporal nerve, 
t. Temporal branches of auriculo-temporal nerve (cut), 
u. Auricular ditto (cut), v. Inferior dental nerve, 
branches of which ascend to supply the inferior teeth, 
w. Mylo-hyoid nerve, (x. Dental foramen, where the 
inferior dental nerve enters the dental canal in the 
inferior maxillary bone.) y. Petrosal branch of vidian 
nerve, z. Branch from otic ganglion to tensor tympani 
muscle (cut), {a. Mental foramen, where the mental 
branch of the inferior dental nerve emerges upon the 
face.) 
Besides being distributed to every part of the 
face, its branches and ganglionic communications 
extend to portions of the head; and to the 
external ear, the middle ear or tympanum; and 
so forth: it also forms frequent anastomosis 
with the motor nerve of the face-the facial 
nerve, or portio dura of the seventh pair-and 
occasional connections with the other cranial 
nerves. 
Its real origin is deep within the brain; but 
the superficial origin of the principal or sensory 
root is in the Gasserian ganglion, while the The Trifacial Nerve. 
37 
smaller and motor root passes beneath this 
structure, without establishing any connection 
with it, and joins the inferior maxillary division 
of the sensory root just outside the cranium. 
The Gasserian ganglion (3) is lodged in a 
depression on the inner surface of the temporal 
bone, near the apex of its petrous portion. It 
receives filaments also from the carotid plexus 
of the sympathetic, and gives off minute branches 
to portions of the encephalon. 
Immediately on leaving the Gasserian gang- 
lion, the sensory portion of the trifacial nerve 
breaks up into three principal divisions; the 
ophthalmic and superior maxillary, which are 
sensory nerves exclusively, and the inferior 
maxillary, which receives, as before stated, the 
filaments of the motor root, and becomes thereby 
the compound portion of the nerve. 
The ophthalmic (A) is the smallest division 
of the fifth pair, enters the orbit through the 
sphenoidal fissure, and is subdivided into three 38 
Tooth-ache. 
principal nerves; namely, the lachrymal (a), 
which is distributed to the lachrymal gland, 
the conjunctiva, and the integument of the 
upper eyelid, where it joins 'with filaments of 
the seventh pair; the nasal (b), which is more 
deeply placed than the other branches of the 
ophthalmic, and after entering the orbit, gives 
off three branches which go to the ophthalmic 
ganglion, the ciliary muscle and iris, the orbicu- 
lar muscle, the integument of the eyelids, the 
side of the nose, the conjunctiva, caruncula 
lachrymalis, and lachrymal sac; it then passes 
through the anterior ethmoidal foramen, into 
the cavity of the cranium, which it traverses 
to the nasal slit, where it passes into the nose, 
terminating in branches which severally supply 
the neighbouring mucous membrane, the integu- 
ment of the lips, the mucous membrane near 
the fore part of the septum, and joins with 
filaments of the facial nerve ; the frontal (c), 
which is again divided into two branches, one The Trifacial Nerve. 
39 
of which escapes from the orbit, and is finally 
lost in the integument of the forehead, while 
the other passes through the supra-orbital fora- 
men (d), and after giving off filaments to the 
upper eyelid, ascends to the forehead, termi- 
nating in muscular, cutaneous, and pericranial 
branches, which are severally distributed to 
the muscles of the forehead, the integument of 
the cranium as far back as the occiput, and 
the pericranium over the frontal and parietal 
bones. 
The superior maxillary division (B) is also 
entirely sensory. It commences at the Gasserian 
ganglion, and passes forward over the greater 
wing of the sphenoid bone and through the 
foramen rotunda, where it leaves the cranium, 
and crosses the spheno-maxillary fossa, in which 
it gives off three nerves, the orbital, the gang- 
lionic, and the posterior dental. It then passes 
through the spheno-maxillary fissure to the 
infra-orbital canal, where it gives off the anterior 40 
Tooth-ache. 
dental nerve, and then continues forwards 
until it emerges through the (1) infra-orbital fora- 
men upon the face, where it is distributed by 
means of the palpebral, the nasal, and the 
labial branches. 
The orbital nerve (e) divides into two main 
branches, the malar (f) and the temporal (g); 
the first of which emerges upon the face and 
joins with the facial nerve; while the other is 
eventually distributed in the integument cover- 
ing the temple and the side of the forehead, 
communicating with the facial and the tem- 
poral branches of the auriculo-temporal nerve. 
The ganglionic (h) or spheno-palatine nerves 
descend to the spheno-palatine ganglion. The 
posterior dental nerve instantly breaks into two 
portions; one of which (i) pierces the tuberosity 
of the superior maxillary bone, and, after giving 
off numerous filaments which form, in the 
wall of this bone above the alveolus, a minute 
plexus from which filaments are distributed The Trifacial Nerve. 
41 
to the molar and bicuspid teeth and the lining 
membrane of the antrum or maxillary sinus, 
• 
is finally lost in the anterior dental nerve. 
The other portion of the posterior dental nerve 
(j) supplies the gums and buccinator muscle. 
The interior dental (k), which is the largest 
nerve given off from the superior maxillary 
division, enters a special canal in the anterior 
face of the maxillary sinus, and unites with 
the posterior dental nerve, after giving off 
filaments to the incisor, cuspid, and bicuspid 
teeth. 
The palpebral (m), the nasal (n), and the labial 
(o), are the facial branches of the superior max- 
illary division, and are its terminal filaments. 
The first supplies the orbicularis palpebrarum, 
the integument and conjunctiva of the lower 
eyelid; the second supplies the muscles and 
integument of the side of the nose, joining with 
the nasal branch of the ophthalmic division ; 
and the third supplies the muscles of the upper 42 
Tooth-ache. 
lip, the mucous membrane of the mouth, and 
the labial glands. They are all joined, imme- 
diately beneath the orbit, with filaments of the 
facial nerve, whereby is formed an intricate 
plexus,-the infra-orbital. 
The inferior maxillary (C) is the ^rgest 
division of the fifth pair, and the only one 
which possesses a truly compound character. It 
consists of two parts, the larger and sensory 
proceeding from the Gasserian ganglion, and 
the smaller and motor part, which is the 
motor root of the fifth pair before mentioned. 
These, after union, form a single cord and one 
nerve made up of filaments of motion and 
filaments of sensation. At the point of junction 
is the small otic ganglion. Immediately beneath 
the base of the skull, it divides into two 
trunks, anterior and posterior. The anterior (p) 
receives nearly the whole of the motor portion, 
and subdivides into five branches, which supply 
the muscles of mastication. The posterior por- The Trifacial Nerve. 
43 
tion (q) and larger trunk also receives a few 
filaments from the motor root, and is divided 
into three branches, the gustatory, the auriculo- 
temporal, and the inferior dental. 
The gustatory (r), or lingual nerve, is a 
special nerve of the sense of taste, deeply 
placed throughout the whole of its course ; and 
has its terminal filaments distributed to the 
papilke and mucous membrane of the tongue. 
It has also a few branches of distribution sup- 
plying the mucous membrane of the mouth, the 
gums, the sub-lingual gland, &c. 
The aunculo-temporal nerve (s) distributes 
branches to the temporal region, the external 
ear, and parotid gland. This nerve has also 
branches of communication with the facial 
nerve and the otic ganglion; and the one 
which joins the facial forms one of the 
principal branches of communication between 
this nerve and the fifth pair. Arising by 
two roots, it passes backwards to the inner 44 
Tooth-ache. 
side of the articulation of the lower jaw, and 
then turns upwards, with the temporal artery, 
between the external ear and condyle of the 
jaw, and finally divides into two temporal 
branches (t), the posterior and anterior; the 
first and smaller of which supplies the attrahens 
aurem muscle, and is distributed to the upper 
part of the pinna and the neighbouring integu- 
ment, while the other accompanies the temporal 
artery to the vertex of the skull, and sup- 
plies the integument of the temporal region. 
There are also two auricular branches (u), the 
superior and inferior; the first supplying the 
integument covering the tragus and pinna; the 
second being distributed to the ear below the 
external meatus, -with other filaments twining 
around the internal maxillary artery, some 
of which communicate with the sympathetic. 
Two other branches of the auriculo-temporal 
nerve are distributed to the auditory canal; and 
the parotid branches supply the parotid gland. The Trifacial Nerve. 
45 
The inferior dental nerve (v) is the largest of 
the inferior maxillary divison. It passes down- 
wards, giving off the mylo-hyoid (w) branch; and 
at the dental foramen (x) enters the dental canal 
lying beneath the teeth in the inferior maxillary 
bone, and, passing forwards in this canal, gives 
off branches to the inferior molar and bicuspid 
teeth as far as the mental foramen (a), where 
it divides into two terminal branches; one of 
which continues within the bone to the middle 
line, and supplies the cuspid and incisor teeth, 
while the other emerges from the bone at the 
mental foramen, and divides into numerous 
branches which are distributed to the lower lip 
and surrounding parts. 
It is not merely in tracing the branches of 
the trifacial nerve, as they spread out from 
their roots to the regions where they are finally 
distributed, that we get a full idea of their 
intricate ramifications, extensive as these are; 
for by means of the extension of the ganglionic 46 
Tooth-ache. 
structure to this nerve, it is found that its 
different branches are in more intimate connec- 
tion with each other; and the whole nerve by 
means of this wonderful system of inter-commu- 
nication, is brought into more or less connection 
with other cranial and spinal nerves. 
Besides the Gasserian ganglion, there are 
connected with the fifth pair of nerves, the 
ophthalmic, the otic, the spheno-palatine, and 
the sub-maxillary ganglion; and these form 
the cephalic portion of the sympathetic. 
The exact character and functions of these 
organisations are not as yet well understood; 
but that they serve to form a sympathetic con- 
nection between those nerves with which they 
communicate, is obvious; and much interesting 
speculation might be indulged in as to the 
action of the ganglia in distributing tooth- 
ache to various regions; but we really know so 
little of nerve-action that at best it could 
not be more than enlightened hypothesis. The Trifacial Nerve. 
47 
Very nearly all that we know for a certainty 
is, that by the nerves pain is experienced. 
They are, however, so extensively ramified as 
to suggest a rational mode of enquiry as to 
the origin of the pains we find shooting 
through the parts which are traversed by the 
fifth pair and its ganglia, and to point out 
a more definite diagnosis than to say it is 
neuralgia. 
Regarding, as do most anatomists, the ganglia 
as so many small brains or semi-independent 
nerve-centres concerned in the accumulation and 
distribution of nerve-power, the nerves by which 
they are supplied are properly their roots; and 
the nerves running from them are their branches 
of distribution. 
The cranial ganglia have a sensory, a motor, 
and a sympathetic root. 
The (4) ophthalmic ganglion is found in the 
orbit, and derives its sensory root from the 
nasal nerve (b,) its sympathetic root from the 48 
Tooth-achc. 
cavernous plexus, and its motor root from the 
third nerve. Its "branches are distributed to 
the ciliary muscle and iris. 
The (5) otic ganglion is found on the inferior 
maxillary division just after its emergence from 
the cranium. Its sensory root is from the 
auriculo-temporal nerve; its motor root from 
the inferior maxillary nerve; and its sympa- 
thetic communication is by a filament from the 
plexus surrounding the middle meningeal artery. 
Its branches of distribution are a filament (z) to 
the tensor tympani, and one to the tensor palati 
muscles. 
The (6) sphenopalatine is the largest of the 
cranial ganglia, and derives its sensory root 
from the ganglionic branches of the superior 
maxillary nerve; its motor root from the facial, 
through the petrosal filament (y) of the vidian 
nerve; and its sympathetic root from the carotid 
plexus. It is divided into numerous branches, 
which are distributed to the orbital periosteum, The Trifacial Nerve. 
49 
the nose, the hard and soft palates, the tonsil, 
the pharynx, and so forth. 
The sub^namllary ganglion receives its sensory 
root from the gustatory nerve; its motor root 
from the facial; and its sympathetic hy fila- 
ments from the plexus of the nervi molies. Its 
branches are distributed to the duct of the 
gland and mucous membrane of the floor of the 
mouth. DECAY OF THE TEETH. 
all their structures are unaffected, 
the teeth perform their office without 
pain or inconvenience; and very consider- 
able progress may be made towards disease 
before they give any indication of the tor- 
turing agony they are capable of affording. 
But when disease has obtained control of the 
teeth, we may expect, if we do not always 
experience, all the pains they are capable of 
giving. 
As the office and general character of these 
organs are unlike those of other parts of the 
body, their diseases are peculiar to themselves, Decay of the Teeth. 
51 
and must be studied as a special branch of 
medical science. When the pathologist con- 
founds the maladies of the teeth with those 
found in bones, he is at once astray, and cannot 
suggest the proper treatment. 
The teeth are never attacked, as the bones 
are, by spontaneous necrosis; and the im- 
mense vitality which centres in the pulp seems 
sufficient to resist all of those general influences 
to which the bones sometimes succumb. Those 
theories, accordingly, which refer these diseases 
to vital action, consequent upon any general 
disorganisation, do not, since they cannot, 
suggest the proper remedy. 
That even in structures so dense as the 
enamel and the dentine, the condition of the 
general system may have some infinitesimal effect, 
can easily be imagined. But no organic lesion 
is capable of producing disturbance in any of 
the structures of the teeth sufficient to result 
in their destruction; or even in perceptibly 52 
Tooth-ache. 
weakening their vital powers; notwithstand- 
ing that there are a few cases recorded of the 
spontaneous disorganisation of the pulp through 
a general deficiency of vital energy. And that 
such disturbance ever causes them to present 
less appreciable resistance to the forces which 
produce decay, is a proposition which does 
not accord with the plainest experience of the 
dental practitioner who is successful in arresting 
its progress; however plausible, and even 
indisputable it must often appear to the mere 
theorist, and to those whose only opportunity 
of observing the results of the mode of arresting 
tliis disease has been confined to the miserable 
attempts usually met with. 
If it be assumed that these attempts are all 
that can be effected, and that they serve, as far 
as possible, to arrest the external action; then, 
in view of their constant failure, it would be 
proper to attribute the further progress of disease 
in these organs to an incurable predisposition Decay of the Teeth. 
53 
having its origin in the weakness or in the 
entire loss of their vitality. But it is fortunate 
that ordinary "tooth-stuffing" is not all that 
can be accomplished in arresting decay in teeth ; 
and we know that when all the requirements 
of a filling are met, as in almost all cases they 
may be, by the properly qualified dentist, 
he succeeds in arresting decay; and the suc- 
cess, or the failure, is not to be attributed 
to any condition absolutely beyond surgical 
control. 
Nor will the proposition of Mr. Tomes,-who 
undertakes the advocacy of a chemico-vital theory 
of decay,-namely, that the vitality of the dentine 
"must have been lost before the tissues undergo 
decomposition,"* be found to accord any better 
with the facts which are presented to the dentist. 
One of these is well stated by Dr. Harris, who 
says, in referring to the theory in question, 
* "A System of Dental Surgery." By John Tomes, 
F.R.S. p. 321. 54 
Tooth-ache. 
" that this opinion is erroneous is proven by the 
fact, that the animal framework of the affected 
part, after the complete decomposition of the 
earthy salts, is often so exceedingly sensitive, 
that the slightest touch of an instrument is pro- 
ductive of severe pain, thus demonstrating 
conclusively the existence of remaining vi- 
tality."* To this may be added that if decay 
were dependent upon the loss of vitality in 
the dentine, there would be only the very 
slightest pain, if any, in excavating the tooth 
preparatory to filling. 
The well-known fact stated by Dr. Harris, 
receives some explanation from Professor Kolli- 
ker, who says, "the organic basis of the teeth 
may be readily obtained by treating them with 
hydrochloric acid. This tooth-cartilage, as it is 
termed, completely retains the form of the 
dentine, and, except that the tubes are with 
* Op. cit. p. 248. Decay of the Teeth, 
55 
difficulty visible, even its internal structure. 
If it be macerated in acid or alkalies until it 
is quite soft, the matrix is found in the act 
of disintegration, but the dentinal tubes, with 
their walls, are still preserved, and may be 
isolated in large quantities. When still longer 
macerated, everything is dissolved."* 
This would seem to show that even after the 
complete destruction of its earthy salts, not 
only may the animal substance of the tooth 
remain, at least for a time, but that the dentinal 
tubes, through which vitality is conveyed to the 
dentine, constitute the very last part of the 
tooth to be destroyed. 
It thus appears incontestible that, so far from 
the decay being dependent on the loss of 
vitality, nature has made provision, in the tena- 
cious character of the walls of the dentinal 
tubes, for life to linger even after decay has 
* Op. cit. p. 292. 56 
Tooth-ache. 
ceased its ravages; although neither experience 
nor reason show that it is long able to survive 
the effects of the fluids which saturate the 
tooth-cartilage. 
Again, if this theory of decay were correct, 
we should find that a tooth that was devitalised, 
or had had "the nerve destroyed," would decay 
more rapidly, in the same mouth, than one still 
possessed of vitality; and that a tooth possessing 
great sensitiveness would resist decay. But 
instead of this, we find a filling quite as success- 
ful in arresting decay in a dead tooth as in one 
not devitalised; and that so far from sensitive 
teeth resisting decay, they are as liable to 
disease as any others; indeed it sometimes 
appears as if they were more liable. 
But although Mr. Tomes insists upon the 
absence of vitality as a primary stage of disease 
in the tooth, he says further: "There cannot be 
any difference of opinion as to the merely chemi- 
cal character of the processes by which the Decay of the Teeth. 
57 
enamel and. the dentine are softened by the re- 
moval of the earthy matter, and ultimately dis- 
integrated." * And his microscopical researches 
in this direction are most interesting and 
instructive. 
When decay is attempted to be accounted for upon 
any supposed analog}' to caries in bones, it should be 
remembered, first, that the teeth have an organisation 
different from these structures; second, that unlike 
these organs, they are exposed to external action; and, 
third, that in disease they present altogether different 
painful symptoms. 
There is another theory which would not have 
been noticed but that it is advanced by some 
recent German writers, and repeated in works 
which in other respects possess great worth and 
authority. The theory referred to is thus stated 
by Kblliker in his work above quoted :t "Caries 
is not merely a solution of the teeth by 
the fluids of the mouth, for a putrefactive 
*0p. cit. p. 318. bp. 310. 58 
Tooth-ache. 
decomposition of the organic parts of the tooth, 
which is accompanied by the development of 
infusoria and fungi, goes on at the same time; 
nay, the latter, according to the statements 
of Ficinus, appear to play the chief part in this 
process, inasmuch as caries proceeds princi- 
pally from those parts of the tooth where the 
organisms in question may grow undisturbed, as 
the fissures and small pits of the enamel, the 
depressions on the crowns of the molars, and the 
crevices between the teeth; hut not in other 
places where the dentine may have been exposed, 
as upon the masticating surface, on filed parts, 
etc." The surprise we feel that a clever writer 
should have adopted and should assist in the 
promulgation of this absurdity, is increased when 
we find him giving, at the same time, such an 
accurate description of the appearance of decay 
as shows much patient investigation. He says, 
"In caries, the discoloured enamel-cuticle, which 
is beset with the growing organisms (an in* Decay of the Teeth. 
59 
fusarium, similar to vibrio, which Ficinus calls 
denticola, also fungi, leptothrix buccalis), first 
loses its calcareous salts, and then breaks up into 
angular, cell-like particles, as if it had been 
treated with hydrochloric acid. The same pro- 
cess then advances through the enamel to the 
dentine, always softening it first, so that it con- 
tains only ten per cent of ashes (Ficinus), and 
then disintegrating it. The dentine suffers more 
than the enamel; and its tubes become filled with 
the fluid arising from the decomposition," and so 
forth. "Subsequently, a brownish matter is 
deposited in the tubes, and then the intermediate 
substance breaks down completely. In this 
manner, the process of destruction advances 
further and further, until, at length, the crown 
breaks down, and the fang also loosens and falls 
out." 
So far as these statements profess to assign the 
cause of decay, they claim nothing beyond an 
expression of astonishment that such anti- 60 
Tooth-ache. 
quated and absurd notions should find a place in 
any modern writings. Those which relate to the 
appearance of decay will be pretty well under- 
stood when the true theory is stated. 
The true cause of decay may be seen in the 
composition of the hard structures of the tooth, 
and of the fluids of the mouth. The hard part 
of the tooth is made up, to a great extent, of 
earthy salts; namely, phosphate, fluate, and car- 
bonate of lime ; phosphate of magnesia, soda, 
and so forth. In the enamel these form from 
95 to 98 per cent., and in the dentine 70 to 
75 per cent, of the whole. The remainder 
consists of an organic framework called the 
tooth-cartilage. 
When it is known that there may be acids in 
the mouth of sufficient strength to act upon 
these salts, the cause of decay is at once sug- 
gested ; and the undoubted, and now universally 
acknowledged, process by which the hard struc- 
ture of the tooth is broken down, is the dissolu- Decay of the Teeth. 
61 
tion of its earthy salts "by means of acids; the 
only questions that are raised being those we 
have already answered. 
It was in the year 1821 that the Drs. Parmley, 
of New York, for the first time distinctly ad- 
vanced the doctrine that not to vital phenomena 
at all, but to external corrosive action alone, are 
we to look for the cause of decay. The idea had 
been previously suggested in the writings of the 
French dentists and anatomists, and in England 
it was not unknown, but this was the period 
and the manner of its first distinct promulga- 
tion. The advancement of this doctrine not 
only suggested the sole possible mode of arrest- 
ing this malady; and furnished a sound reason 
for the success of the operation of filling the 
teeth (which had then begun to attract great 
attention through the labours of Hudson, Har- 
wood, Koecker, Rodgers, the Parmleys, and 
others); but it also gave the hope for that yet 
higher progress in this art, which, with those 62 
Tooth-aclic. 
among whom the true doctrine of decay has 
since prevailed, has been realised to an extent 
scarcely conceived, by even the best and most 
sanguine operators of forty years since. And 
it can occasion no surprise that, with those who 
have clung to erroneous theories of decay, little 
or no advance has been made in arresting its 
progress, beyond the clumsy attempts of the 
earliest practitioners. 
Acids exist in the oral fluids, to some slight 
extent, in health. Then, however, they are 
not usually of sufficient strength to act upon 
the teeth, even when the latter are of a very 
frail character. But they are liable to be in- 
creased, although how this is altogether effected, 
is uncertain. Dr. Harris thinks it is through 
the mucous fluids, which become viscid by 
means of the disturbance of some functional 
operation of the body; and that, if all of these 
operations were healthily performed, decay would 
seldom occur. Be that as it may, that the oral Decay of the, Teeth. 
63 
fluids become viscid in some manner, is easily- 
shown ; and that acids are found in the mouth 
which are capable of disorganising the teeth, 
is a fact beyond all doubt. 
It is certain, also, that the formation of these 
acids is often indirectly promoted, if not always 
caused, by functional operation, as suggested by 
.Dr. Harris. It is equally certain that they are 
directly formed by the action of the oral fluids 
upon relics of food lodged between and around 
the teeth; upon certain condiments which are 
taken into the mouth (especially when held there 
for any length of time); upon the tooth-cartilage, 
after the salts have been removed; and upon the 
pus which exudes from the gums v'hen they are 
inflamed. 
Acids capable of destroying the teeth are also 
introduced into the mouth directly, viz., by 
certain medicines; and in various other ways. 
The smooth and polished surface of the 
enamel, and the great density of this structure, Tooth-ache. 
64 
combine to resist any of the agents that bear 
destructively upon the teeth; and they could 
be bathed in extremely viscid oral fluids with- 
out much fear of harm, if there were not, 
occasionally, certain places in the enamel which 
are weak or defective, and at which points the 
acids prove too powerful. When an opening 
has been made through the enamel, as the den- 
tine possesses less power of resistance, and the 
cavity affords greater opportunity for the accu- 
mulation of debris of food and other substances 
which promote the formation of acid and thereby 
increase the destructive force, the disease goes 
on, with constantly accumulating energy, until 
the tooth is destroyed. 
Decay is more or less rapid according to the 
strength of the acids on the one hand, and to 
the constitutional quality of the tooth and its 
consequent power of resistance, on the other. 
This constitutional character of the teeth, when 
they arc once formed, will not vary; and their Decay of the Teeth. 
65 
power of resisting decay will remain, so far as 
we are able to discover, neither impaired by 
disease, nor improved by health. On the other 
hand, the strength and energy of the acids very 
much alter, depending considerably upon the 
general health, the cleanliness of the teeth, 
the healthy or diseased state of all the struc- 
tures of the mouth, and upon what direct 
addition is made to them. Decay, accordingly, in 
the same mouth, or even in the same tooth, may 
be much greater at one period than another. 
Sometimes it will be years in destroying a 
tooth; in other instances a few months will 
suffice. It is obvious, however, that in youth 
the teeth decay more rapidly than in after 
years, when they acquire a greater degree of 
density. 
Even dental authors who maintain the correct 
theory of decay are apt to lend an indirect and 
unintended sanction to what is erroneous in the 
use of the term " caries which word, after Tooth-achc. 
66 
all, if applied to no other disease, would 
be perhaps the most appropriate that could 
be found; but which, as it is used in all 
medical writings to designate a disease in 
the bones in no way akin to dental decay, 
must have a constant tendency to perplex the 
mind, leading to confusion of things quite 
distinct. This is an error which should be 
especially avoided. How to steer clear of it 
does not appear to have been suggested; and 
until medical philologists have settled to which 
of the two diseases the term is to be applied, it 
would be well for dentists to avoid it altogether, 
and to employ only the equivalent word "decay," 
which is in general use even among medical 
men. EXPOSURE OF THE PULP. 
decay is ravaging a tooth, there 
may be unpleasant sensations, and 
occasionally a sharp twinge; and the removal 
of the disorganised dentine, preparatory to 
fdling, may, as the numerous nerve-filaments 
traversing the dentinal tubes are severed, some- 
times occasion much suffering. But there will 
be no decided or continuous pain, and the pulp 
will remain unaffected until the dentine is 
destroyed down to the wall of the pulp-cavity, 
and the lining membrane of the tooth is by this 
means exposed. 
When, however, the lining membrane is 
reached, not only those agents which act upon 
the dentine, but the pressure of food, hot and 68 
Tooth-ache. 
cold liquids, salt, and other substances, begin to 
irritate this structure; and then ensues pain of 
a character much more continuous and intense. 
This may at once develope into the severest 
tooth-ache, but this is more likely to be retarded 
until the enamel is broken down. This structure, 
being thick and very strong upon the parts 
of the tooth which receive the force of mastica- 
tion, will often remain unaffected (except, per- 
haps, at the small orifice where the decay com- 
menced) for a long time after the dentine 
beneath it has been destroyed; when having no 
longer any support, it gives way, and the debris 
of hard and soft substances is crowded upon 
the now exposed lining membrane and pulp 
with such force as seriously to impair the 
organisation of these delicate structures, whereby 
agonizing pain of necessity ensues. 
While exposure of the pulp is usually caused 
by decay of the dentine, this result is sometimes 
induced by other means. Exposure, of the Pulp. 
69 
There is an unexplained denuding process 
which occasionally attacks the teeth, whereby 
the dentine is gradually wasted away. It is not 
especially confined to any teeth; nor does it 
commence, as stated by Harris, with the central 
incisors or any other particular teeth. The 
author has also seen the pulp exposed at the 
apex of the root from the effects of inflamma- 
tion of the gums and alveolus, and causing 
severe tooth-ache. ODONTITIS. 
in consequence of injury, the pres- 
sure of an irritating substance, altered 
nutrition, or any other cause, any portion of 
that network of fine vessels known as the 
capillaries is closed for the time being; or 
is contracted, or semi-paralysed; the free cir- 
culation of the blood, which should find its 
way through these vessels from the arteries 
to the veins, is arrested. Thus deprived of its 
natural outlet, the blood accumulates in the 
arteries and capillaries, producing in almost every 
instance mpre or less heat, or inflammation. 
This accumulation of blood which should be 
passing onwards causes great pressure upon the Odontitis. 
71 
capillaries and the elastic tunics of the arteries; 
and if the situation of the obstruction be favour- 
able, these structures, especially the capillaries, 
swell, and relieve much of the pressure upon the 
nerves which ramify through the affected parts. 
The pain which ensues is consequently much 
abated. The blood also, which comes rushing 
along the arteries, turns off into the numerous 
branches which are unaffected, leaving the 
diseased portion to be restored to health by the 
action of the absorbents, by suppuration, and 
by such other curative processes as nature sets 
in operation. 
But as the pulp is destitute of lymphatics, 
and is in the greater portion composed of fine 
blood-vessels and nerves with a very loose and 
fragile system of capillaries, it is apparently not 
able to put forth any amount of restorative 
power when once the circulation through it is 
decidedly interrupted. The capillaries, more- 
over, being too weak to resist the pressure of 72 
Tooth-ache. 
the arterial engorgement, are speedily broken 
down; and then the whole of this structure is 
soon reduced to a state of suppuration. 
During this process, as the pulp is confined 
in a bony cell which prevents any expansion, 
its vessels, as they become distended with blood, 
press with such force upon the ramifying nerve- 
filaments everywhere traversing it as to produce 
one of the most agonizing pains to which the 
human subject is exposed. 
This is the first form of tooth-ache; and being 
a pain caused by lesion in the structure of the 
tooth, it is called odontitis. 
It occasionally happens, however, that teeth 
decay and lose the pulp -without causing pain. 
If we take ordinary medical writings for our 
guide (particularly the authorities of the symp- 
tomologists), we shall be led to believe that 
tooth-ache presents a wonderful and almost 
infinite variety of symptoms. A long list might 
be given of those which unmistakeably point to Odontitis. 
73 
odontitis, the most familiar being the pains 
which are described in the language of common 
life as boring, tearing, shooting, bounding, 
digging, thumping, jumping, throbbing, drawing, 
and so oir. But when we enquire into the mean- 
ing of these terms, we find that they are simply 
the various modes of expression adopted by 
different sufferers to emphasize the great severity 
of the pain, and to indicate its peculiarity. 
This peculiarity is derived from the inability 
of the pulp to expand, whereby the pain is 
found exactly to harmonise with the pulsion 
of the blood into this structure, and there is a 
steady and regular repetition of the severer pang 
at the moment when the vessels of the pulp are 
the fullest, and the pressure is greatest on the 
nerve-fibres. If the decay has exposed the pidp 
for a considerable distance, and it can at all 
expand, just so far as it does expand, the pain 
loses its peculiar characteristic and becomes more 
like any other. 74 
Tooth-achc. 
Ill precisely the same manner that these terms 
have originated with ourselves have French 
writers applied "tic-douloureux" to the symptoms 
of odontitis; although under the impression that 
they are the indications of a purely nervous 
affection. And this term has thereby got trans- 
planted into our own language, where it has 
acquired a range of application that is quite 
absurd. 
The etymology of the word tic, as used by the 
French, is rather obscure, although it is not 
difficult to imagine how it became applied to a 
rhythmical movement. Nor is it important that 
the etymology should be determined. It is 
sufficient for our purpose to find that the word 
is now regarded in all its applications, save to 
facial pains, as half slang; and has especial 
reference, under all circumstances, to a repeated 
movement, as applied in English to the swinging 
of a pendulum. 
In colloquial French its particular use is to Odontitis. 
75 
characterise the habit which some horses have 
of throwing up their heads and snorting, as 
this movement recurs with a good deal of 
regularity. 
Starting, as it appears from all that can be 
gathered, from this as its primary signification, 
the word is often extended in a half jocular and 
a half depreciating manner to ftny absurd Tidbit, 
because of its regular repetition, for the purpose 
of ridiculing or condemning it; such as biting 
the nails; repeating a certain w5rd; unusual 
winking of the eyes, or of one eye; twitching 
the face; throwing the hand about in a certain 
manner, &c. 
When the character of odontitis is understood, 
and the meaning of tic is ascertained, it is not 
difficult to imagine how some French stable- 
boy, when his tooth was aching from an inflamed 
pulp, and he was goaded into the use of some 
word expressive of its character, naturally 
adopted a horsey phrase from his limited 76 
Tooth-achc. 
vocabulary, which idiomatically expressed that 
he had an excruciating pain 11 that had the 
tic," or, which repeated itself at regular inter- 
vals. Nor is it surprising that those who 
understood the peculiar significance of the 
phrase, and had also experienced the extreme 
poverty of all such words as convulsif and so 
forth to express the pain, should have recognised 
this keen and truthful portraiture of it; and, 
notwithstanding its origin, have adopted the 
term into medical literature. If the origin of 
the pain so well described had been at the 
same time ascertained, the application of tic 
would have resulted in throwing light upon the 
character of tooth-ache. Failing to do that, an 
erroneous conclusion was adopted which has had 
just the contrary effect. 
As odontitis is occasioned in the manner 
described, this pain is apt to come all at once, 
and with such severity that the agony seems to 
shoot through every part of the face. When Odontitis. 
77 
it has assumed a more settled character, the 
pulsation of the blood will promote the throb- 
bing sensation. The pain from an inflamed 
pulp will continue for a longer or shorter 
period, when it will cease, to be renewed after 
an uncertain interval. It sometimes assumes a 
regularly intermittent character, especially when 
the patient is weak, or is suffering from any fe- 
brile affection that has a tendency to periodicity. 
There is much of nature's mercy in this arrangement. 
Otherwise, the steady continuance of the pain until the 
pulp was entirely destroyed, would, in many instances, 
seriously, if not fatally, exhaust the patient. 
It is to be noticed, however, that there is 
■ usually but one very severe paroxysm of pain 
in the same tooth, and the paroxysms which 
follow are much less severe. 
As a rule, the pain will be confined to the 
aching tooth, or only in its wildest paroxysm 
will it be felt extending to other parts of the 
mouth. And the firmer the structure of the 78 
Tooth-ache. 
diseased teeth, and the less disease there is in 
the other teeth, and the better, too, the general 
health of the patient, the more local and severe 
will be the pain. 
On the other hand, in a poorly organised 
tooth, and in a mouth full of diseased teeth, 
or where the general health is indifferent, the 
pain is more diffused and less agonizing, though 
it generally lasts longer. In a patient of low 
vital powers there seems to be a less amount 
of vitality in the teeth to act and to be acted 
upon; while in dentine of an inferior quality 
decay spreads over a greater surface as it pro- 
ceeds. Hence, when the pulp is reached, instead 
of there being only a very small point over the- 
lining membrane where the dentine is decayed, 
as. in a tooth of denser structure, the side of 
the pulp-cavity may be softened for some dis- 
tance before the pulp is inflamed. In this case 
there may be some opportunity for its expansion, 
whereby partial relief is afforded. Odontitis. 
79 
Sometimes the pain shoots through the mouth 
and face, causing involuntary twitchings, and 
is finally lost in some remote part; but 
this symptom must be largely attributed to the 
imagination of the patient, who is very apt to 
think, because of the decided pulsation, that 
there really is a movement, though none what- 
ever takes place. 
While it is true that odontitis may sometimes slightly 
affect the motor nerve of the face, this symptom is by 
no means as frequent as we might be led to expect from 
the constant inosculation of the terminal filaments of 
this nerve with those of the trifacial. Did this really 
establish intercommunication of nerve force, as would 
at first be supposed, we should find that painful 
twitchings and other involuntary motions in different 
parts of the face, and more especially in the numerous 
plexuses formed by the combined interwoven filaments 
of the two nerves, were almost invariably a marked 
symptom of odontitis. But so far from this being the 
case, the involuntary spasmodic symptom is, as we say, 
rarely noticed ; and when it does occur, and we cannot 
trace it to the imagination, we must look to some cause 
as yet unknown for its solution. 
Owing in part to the error that formerly prevailed as 
to the character of the facial nerve, when it was supposed 80 
Tooth-ache. 
to preside over the sensibility of the face, and was con- 
sequently thought to be the seat of tic-doulourevx ; and 
in part, perhaps, to premature conclusions as to the 
effect on the nerves of the anastomosis referred to, we 
are constantly finding in writings on "facial neuralgia," 
and so forth, the impression that "tic" has reference to 
some combined action of the motor and sensitive nerves 
of the face. We have already given the origin and exact 
limit of this term, and it will still further help to dissi- 
pate the cloud of errors which has over-shadowed the 
subject of facial pains, to add some remarks of Todd and 
Bowman* on the sympathetic action of one set of nerves 
on another. They say,- 
"We learn from anatomical investigation, that, 
although nerves anastomose with each other in their 
distribution, this anastomosis is by no means of that 
kind which would justify the supposition that an irrita- 
tion could be communicated from one to the other in 
their course. The nerve-fibres only lie in juxtaposition, 
but do not communicate; and there is an evident pro- 
vision in the tubular membrane and white substance of 
Schwann for the insulation of the central axis, which is 
probably the effective substance in the nervous action. 
We must seek, therefore, in the nerve centres for such a 
communication between these nerves as may explain the 
excitability of one by the other. 
*"The Physiological Anatomy and Physiology of 
Man." By Robert Bently Todd, M.D., and William 
Bowman, F.R.S. Vol. I., p. 391. Odontitis. 
81 
In the present state of our knowledge we can do no 
more than state it as in the highest degree probable 
that nerves implanted in the centre immediately con- 
tiguous to each other can exert an influence upon the 
vesicular matter of the centre, and upon each other. 
But there are certain facts which demonstrate beyond 
all doubt, that, in such actions as we refer to, the in- 
tegrity of the centre forms a necessary condition. First, 
in many of the instances, it is plain that there can be no 
connexion between the affected nerves elsewhere than in 
the centre, for they are so distinct from each other that 
there is not even that apparent connexion which results 
from the anastomosis of a fasciculus of fibres of the one 
with a portion of the other. Secondly, the removal of 
the portion of the nervous centre with which any one of 
the nerves concerned in the sympathetic action is con- 
nected, will prevent the development of the phenomenon, 
although the nerves themselves remain uninjured in 
their peripheral distribution, or in their connexion with 
each other. Thirdly, if there were any peripheral com- 
munication between nerves, it would be most likely to 
take place in the plexuses. Experiments, however, upon 
the nerves which lead to these show that each nerve- 
tube, in its passage through them, retains its isolation as 
distinctly as in any other part of its course. 
In applying these principles to the explanation of the 
instances which we have quoted, we shall find it difficult 
to determine the central connection in some, although in 
others such a connexion is highly probable. It remains, 
therefore, for future anatomical research to ascertain what 82 
Tooth-ache. 
that connexion is which enables one nerve to sympathise 
with another." 
And yet further, Beal's and other experiments seem 
to unmistakeably show that, in reality, there are no 
nerve ends ; and that,-as stated by Dr. B. K. Brown, 
of New York, in a paper on "The ultimate distribution 
of the nerves of gustation,"*-■"They demonstrate that 
no part of the sensitive structure of mammalian 
animals forms organs of special sense by a terminal 
arrangement. They show that the nervous tissue is an 
undivided continuation from centre to periphery and back. 
And finally, they force upon us the conclusion, adverse 
to all our present theories of sensation, that neither 
sensation nor motion are physiological phenomena, 
beginning at a nerve terminus on the one hand and 
ending at a nerve terminus on the other." 
Again, the pain concentrates in some other 
tooth, generally a diseased one, and is felt in 
it exclusively, with no painful indication of 
the actual origin. Patients suffering from odon- 
titis also very frequently complain of pains in 
the head, the neck, and even in the extremities; 
such pains being sometimes accompanied, too, 
by numbness. 
* Dental Cosmos. Vol. viii. p. 585. Odontitis. 
83 
When the pulps of two or more teeth are 
exposed and inflamed at the same time, the 
pain is almost invariably felt in only one tooth. 
And sometimes, when a single pulp is inflamed, 
the pain may be experienced wholly in a tooth 
that is decayed, but not to the lining membrane. 
Less frequently, but often enough to occasion no 
surprise, pain arising from a diseased tooth is 
felt in one that is perfectly sound. PERIODONTITIS. 
^^LTHOUGH a very skilful dentist may 
occasionally prevent irritation of the pulp 
even after decay lias reached the lining mem- 
brane, yet that delicate structure being once 
inflamed, while it may give more or less pain 
and may be a longer or shorter time in becoming 
entirely destroyed, its death is so certain to 
follow inflammation that the exceptions are not 
worth consideration. As the vitality of the 
dentine and of the enamel is wholly derived 
from the pulp, the disorganisation of this struc- 
ture is equivalent to the entire devitalisation of 
the others. And when this takes place, what- 
ever may be the cause, in common parlance Periodontitis. 
85 
the condition of the tooth is described as "dead," 
or it is said that "the nerve has been destroyed." 
It is a common impression that when a tooth 
has reached this state, it will not again ache. 
In a strictly literal sense this is nearly true, and 
the pains which follow are only occasioned by it. 
But tooth-ache, properly so called, includes all 
pains either in the teeth, or occasioned by the 
teeth. 
The prevalence of this opinion is quite as much due 
to the ignorance of dentists as to the very natural mis- 
conception of patients ; since it is by no means uncom- 
mon to find the former destroying the vitality of a tooth, 
and after "stuffing" it, assuring the patient that never 
again will there be pain felt in it. When the disturb- 
ance which is inevitable comes to pass, being unable 
to divine the cause, this operator falls back upon the 
unfathomable statement that it is "tic," or something 
of that kind; and it is vexing to find this mistake by 
no means confined to those practitioners whom the public 
regard as inferior. 
When the prdp is disorganised it is resolved 
into pus, and in that form it is discharged into 
the cavity in the tooth, where it becomes 86 
Tooth-ache. 
mingled with the fluids of the mouth and 
other accumulations. The dentinal tubes also, 
no longer supplied with healthy nutriment from 
the pulp, become saturated with the combined 
fluids and pus; and the tooth, instead of its 
previous brilliant life-like aspect, presents a 
dull, dead, and sometimes quite dark appearance. 
The inflammation of the pulp will not extend, 
to an appreciable degree, beyond this structure ; 
and for just so long as it retains any vitality, it 
is the pulp alone which is affected; and the 
tooth, through the unimpaired periosteum, will 
continue to maintain a healthy action in the 
cementum, and a firm and painless adhesion to 
the sockets. But when the pulp has become 
disorganised, the purulent matter that has 
thereby accumulated in the pulp-cavity will 
cause inflammation of the vessels of the cemen- 
tum, which finally extends to the periosteum, 
or investing membrane of the tooth, and a dull, 
uneasy sensation begins to be experienced. At Periodontitis. 
87 
first this sensation is rather undefined, and of a 
more continuous character than odontitis, but 
eventually it is developed into a pain which 
may not be less severe. The inflammation caused 
by the purulent matter is much the greatest at 
the apex of the root where this accumulation 
comes into direct contact with the cementum; 
but it is by no means insignificant throughout 
the whole of this structure, as the matter also 
reaches it through the dentinal tubes. 
As the periosteum lies between two hard 
structures, it has little power of expansion, 
though more than is possessed by the pulp. 
Hence there is the same pressure upon its nerve- 
filaments; and although this may not produce so 
sharp and acute a pain as that which accom- 
panies inflammation of the soft structures of the 
tooth, there ensues a pain as difficult to be 
endured. This is the second form of tooth-ache; 
and being an inflammation around the tooth, is 
called periodontitis. 88 
Tooth-ache. 
If the pains occasioned by inflammation in 
the pulp (or "an exposed nerve") are often 
extended to other parts, their sympathetic action 
is trifling when compared with periodontitis. 
It is seldom that this pain is entirely confined 
to the place of its origin ; and it frequently ex- 
tends not only to other parts of the mouth and 
to the cheeks, but to the eyes, the forehead, the 
nose, the temporal regions, the ear, and even to 
the neck, back, and arms. Indeed, its force is 
sometimes expended in so emphatic a manner in 
more remote parts, as entirely to prevent sus- 
picion, on the part of anyone not familiar with 
its eccentricities, that it is tooth-ache at all. 
As the irritation of the periosteum extends, 
the vessels of this membrane become engorged, 
and it somewhat thickens; whereby the tooth is 
slightly raised out of its socket. Hence, when 
the teeth are closed, the affected one is the first 
to receive the pressure, and the pain is in conse- 
quence increased. ALVEOLAE ABSCESS. 
1 A THEN" inflammation in the periosteum has 
continued so long that any portion of 
the especially affected part of this structure has 
lost its organisation, so much of it is resolved 
into pus, which is deposited around the apex of 
the root of the tooth : and such is the irritating 
character of this secretion, that the inflammation 
already existing, is so greatly increased that 
the pain becomes still more aggravated. When 
the pus has accumulated in the socket, the 
inflammation has developed an alveolar abscess. 90 
Tooth-ache. 
The progress of this disease 
is much as follows. Beginning 
at the apex of the root, the 
periosteum gradually "becomes 
detached from the cementum 
and forms a sort of sac, in 
which the pus accumulates 
and surrounds the point of 
the affected root. This effu- 
sion, which is not only in- 
creasing but requires a greater space than the 
structure it displaces, is consequently pressing 
upon the walls of the socket with such force 
that the pain becomes deep-seated and steady, 
and often most excruciating; and, instead of 
being confined to the aching tooth, may be 
extended, and in the most erratic manner, as 
before mentioned. Meanwhile, by the inflam- 
mation in the socket and the cementum, the 
organisation of these structures also begins to 
be lost, and more pus is thereby secreted. 
Fig. 5. 
Inferior molar 
tooth, with ab- 
scess on its pos- 
terior root. Alveolar Abscess. 
91 
This process goes on, and the abscess increases 
in extent, until, at last, by the combined vital 
action of the inflammation and the chemical 
action of the pus, the wall of the socket is so 
far destroyed that an opening is made in it. 
Through this opening the.pus is discharged, and 
usually against the soft structures by which the 
socket is invested; these structures swell in 
consequence, and the pain is thereby speedily 
reduced, if not altogether removed. 
Sometimes the inflammation is so very con- 
siderable that swelling in the gums and other 
parts takes place before the opening into the 
socket is formed. Sometimes also (owing, in all 
likelihood, to the extreme thinness of the socket 
over the affected part), an opening is made 
which is preceded by little or no pain. Occa- 
sionally the pus escapes by the side of the tooth, 
and at the edges of the gums. When this 
happens, it is generally owing to the tooth 
having no antagonist, whereby it can be raised 92 
Tooth-ache. 
in the socket by the swelling of the periosteum, 
to a greater extent than is usual. Sometimes, 
on the other hand, it is the result of the use of a 
sialagogue for the relief of the pain caused by 
the abscess, or of previous mercurial salivation. 
During the rage for mercurial medicines, happily now 
past, this last-mentioned phenomenon was much more 
frequent than now. 
When the pus comes in contact with the soft 
parts, it rapidly forms a passage through these 
structures, whereby whatever portion is not 
taken up in the meantime by the absorbents is 
discharged, usually into the mouth, forming 
what is called a gum-boil. 
But the discharge of the pus will not always 
be through the gum, or into the mouth. It may 
work an opening through the cheek, or the base 
of the lower jaw, forming a discharging fistula 
upon the face. It may also discharge into the 
maxillary sinus, causing inflammation of the 
lining membrane of this cavity. Alveolar Abscess. 
93 
The swellings developed by an alveolar ab- 
scess may not only affect the whole side of the 
face, but extend beyond the mouth to the tonsils, 
and the muscles of the neck; and even beyond 
these last-named structures. 
When inflammation has commenced in and 
about the roots of a tooth, in addition to decay, 
a new force begins to hasten its destruction. 
Indeed, it may be said that inflammation in the 
periosteum and alveolus is the orderly effort of 
nature to expel a substance which, whatever 
may have been its previous relation to the rest 
of the economy, is now, by the extinction of its 
vitality, only to be regarded as a foreign body. 
And this process goes on with more or less in- 
flammation and pain, until all these irritants are 
expelled from the mouth. But after one severe 
attack of periodontitis, there is not likely to be 
a recurrence of it equally severe; for although 
on the subsidence of the inflammation, the gum- 
boil may entirely close, the orifice in the socket 94 
Tooth-ache. 
remains; and when pus again secretes, it finds a 
more ready 'exit, by means of the old channel, 
than before that channel was formed. SYMPATHETIC TOOTH-ACHE. 
OTHING more misleads the practitioner, 
unless he he a dentist who is exceedingly 
well informed, than the disposition of tooth-ache 
tb be felt in other parts than its actual seat. 
For it will be found so eccentric that the opinion 
of the patient as to which tooth is the real 
offender, or whether it is a tooth at all that is 
in fault, will be quite as likely to vitiate as to 
assist the diagnosis. Often, too, he will declare, 
and with perfect sincerity of belief, that the 
pain is wholly felt in the very opposite part of 
the mouth to that in which the disease is 
situated; and not infrequently he is quite 
positive that it cannot be tooth-ache, as the 96 
Tooth-aclw. 
pain is not felt, in any degree, in the teeth 
themselves. * 
The means by which the pains of odontitis 
are transferred to other parts, and by which 
other kindred sympathetic nervous action is 
produced, constitute one of those mysteries 
which have not yet been fathomed. Nor will 
it, nor indeed can it be fathomed so long as 
merely sympathetic pains are treated as indica- 
tions of idiopathic disorders. 
Instead of looking to tooth-ache for an ex- 
planation of the origin of facial pains, we find 
enquiry taking a wrong direction at the very 
outset; and, without liny such justification as 
the scientific mind has a right to plead, the 
facts upon which all conclusions must rest, are 
quite perverted in the assumption, not only that 
these pains are, at most, only occasionally the 
result of tooth-ache, but that they quite as often 
hold to it the relation of cause to effect. 
In thus blinding the eyes to the true cause Sympathetic Tooth-achc. 
97 
of facial pains, and, still worse, in directing 
the student to look to them for the frequent 
origin of affections of which they are, almost 
without exception, in reality the symptoms, 
enquiry is at once committed to a phantom ship 
of the imagination, to sail for ever through 
never-ending nothingness, fruitlessly searching 
for that which does not exist. It is not sur- 
prising, therefore, that the mind seeks relief, 
although it may be in vain, in the pernicious 
conclusion that they are the indications of a 
purely nervous disorder, of which no more is 
known than the pains which they occasion. 
We shall not be far wrong in looking to the 
action of the ganglionic structure of the sensitive 
nerve of the face, for the exhibition of tooth- 
pains in other parts than those of their origin. 
What seems to justify this is the frequent 
extension of tooth-ache in the line of the arteries; 
and the character of odontitis so well described 
by all the popular terms in use; and also in 98 
Tooth-ache. 
the French stable slang, " tic," which we have 
borrowed from that language; all of which terms 
signify a rhythmical pain of great severity. 
There is no sensation that presents more of all the 
peculiarities of pain than odontitis; and in studying the 
character- of pain, this malady affords the best field for 
investigation. Sharp and intense, the inflammation of 
the pulp never extending, it would seem, into the 
adjacent structures, its peculiar features are distinctly 
presented. Much of the vagueness found in treatises 
on pain is attributable to mistakes as to the character 
of odontitis, being made the groundwork of an elaborate 
system of error, which vitiates all that is thought or said 
on the subject of pain, and especially of sympathetic pain, 
Some reference to the anatomy and functions 
of the so-called sympathetic nerve may aid in 
suggesting an elucidation of the phenomenon we 
have noticed. 
The sympathetic nerve* "consists of a series 
of ganglia, connected together by intervening 
chords extending from each side of the vertebral 
*" Anatomy, Descriptive and Surgical." By Henry 
Gray, F.R.S. p. 564. Sympathetic Tooth-ache. 
99 
column from the base of the skull to coccyx.. 
It may, moreover, be traced up into the head, 
where the ganglia (which are all in connection 
with the fifth cranial nerve) occupy spaces 
between the cranial and facial bones. 
Each ganglion may be regarded as a distinct 
centre, from or to which branches pass in 
various directions. These branches may be 
thus arranged :-1. Branches of communication 
between the ganglia. 2. Branches of communi- 
cation with the cerebral or spinal nerves. 3. 
Primary branches passing to be distributed to 
the arteries in the vicinity of the ganglia, and to 
the viscera, or proceeding to other ganglia placed 
in the thorax, abdomen, or pelvis. 
The primary branches of distribution have a 
remarkable tendency to form intricate plexuses, 
which encircle the blood-vessels, and are con- 
ducted by them to the viscera. The greater 
number of these branches pass to a series of 
visceral ganglia : these are ganglionic masses, of 100 
Tooth-ache. 
variable size, situated in the large cavities of the 
trunk, the thorax, and abdomen; and are con- 
nected with the roots of the great arteries of the 
viscera. From these visceral ganglia numerous 
plexuses of nerves are derived, which entwine 
round the blood-vessels, and are conducted by 
them to the viscera." 
A further and more especial description of 
the sympathetic nerve, other than has been 
given in connection with the description of 
the trifacial, of such parts of it as are found 
in the head, is not necessary; and we pass 
on to Messrs. Todd and Bowman's remarks on 
its functions; quoting only such portions of 
their able article as seem to bear on the 
enquiry we are now pursuing. 
They say,* " Two questions are to be solved 
in reference to the sympathetic. 1. Is the sym- 
pathetic a distinct and independent portion of 
*0p. cit. Vol. ii., p. 141. Sympathetic Tooth-ache. 
101 
the nervous system ? or is it merely an off-shoot 
from the brain and spinal cord, exhibiting 
certain peculiarities of arrangement? 2. Do 
its fibres exhibit the same power as those of 
cerebro-spinal nerves ? that is, are they sensitive 
and motor?" In reply to the first question, 
they arrive at the conclusion that this is a com- 
pound nerve, and continue : " Adopting this 
view of the compound nature of the sympathetic, 
it is obviously impossible to regard it either as 
independent of the cerebro-spinal centres, or 
wholly depending on them. And it may be 
stated that the views of anatomy which we hold 
to be correct, justify us in affirming that the 
sympathetic exhibits marked indications if not 
of independence, yet of great peculiarity, in its 
mode of distribution. Clinging to the coats of the 
arteries, it follows them for the most part in 
their ramifications, and attaches itself to them 
somewhat as ivy does to a tree. The proper 
mode, -then, of stating the reply to this question 102 
Tooth-ache. 
seems to us to be: that the sympathetic, taken 
as a whole, is not in itself a special and inde- 
pendent nervous system, but a portion of the 
nervous system peculiar in its composition, 
having, as regards some of its constituent fibres, 
a special relation to blood-vessels, particularly 
arteries, (and these are the fibres which are 
independent of the cerebro-spinal qpntres, having 
distinct centres of their own), but being by 
others of its fibres connected, as all other nerves 
are, with the cerebro-spinal centres." 
In answer to the second question, they con- 
clude that the sympathetic must have both 
motor and sensitive fibres, although the latter 
are not very numerous; and that the motor 
fibres are at most to a very trifling extent under 
the influence of the will. They then proceed 
to notice the very striking peculiarity of this 
nerve, which " consists in the rhythmical 
nature of the movements of parts which derive 
their supply of nerves from this source, of which Sympathetic Tooth-ache. 
103 
the movements of the heart and the intestinal 
canal afford good examples. This peculiarity 
seems to be referable to a double cause; first, 
the disposition of the muscular fibres themselves, 
which is such that a contraction cannot take 
place at one part without affecting the adjacent 
fibres, so that the contraction of one set of fibres 
appears to stimulate those in their immediate 
vicinity. This progressive contraction is well 
seen in the intestines. Secondly, the frequent 
occurrence of small ganglia, not only among 
plexuses of the sympathetic, but also, as in the 
heart, upon or among the muscular fibres them- 
selves. These ganglia, it is reasonable to sup- 
pose, are so many little magazines of nervous 
force, which, by their intimate connection with 
the muscrdar fibres themselves, render them 
capable of repeating their action at intervals, 
after their disconnection from the main trunk 
of the sympathetic system. Much, however, 
in the peristaltic actions is perhaps due to the 104 
Tooth-achc. 
peculiar constitution of the unstriped muscular 
fibre itself; a constitution which gives it a slow 
and enduring, rather than a quick, energetic, 
and fleeting contraction." 
They conclude thus : " The sympathetic thus 
appears to exercise a three-fold office: first, 
that of a sensitive nerve to the parts to which 
it is distributed; secondly, that of a motor 
nerve for certain muscular parts; and, thirdly, 
that of a nerve to the blood-vessels. It is 
almost certain that blood-vessels enjoy in their 
coats a power of contractility; and it seems 
highly probable that these nerve-fibres exercise 
an influence upon that contractility." 
These writers object to the term sympathetic, 
because, say they, " Our improved know- 
ledge of the anatomical distribution of the 
nerves, and of their physiological anatomy, and 
of their endowments, clearly shows that the 
phenomena of sympathy are explicable, by the 
known laws of action of the great nervous Sympathetic Tooth-ache. 
105 
centres, and that the sympathetic nerve can take 
no more part in it than any other nerve." 
That improved anatomical knowledge has 
dissipated the undefined idea of sympathetic 
action which referred everything to sympathy, is 
alike undoubted and gratifying; and immense 
progress has indeed been made in knowledge of 
nerve organisation. Yet, with all deference to 
such high authority, it must be stated that no 
facts or theories have been presented which 
account for the sympathetic action of tooth-ache. 
Nor can the proposition, that the known laws 
of action of the great nerve-centres show that 
the sympathetic nerve is no more concerned 
in sympathetic action than any other nerve, be 
readily accepted. The connection of the ganglia 
one with another forming thereby a series, at 
once suggests a sympathetic union not found in 
nerves that simply spread out into branches and 
terminal filaments, which, whatever becomes of 
them, certainly do not communicate with each 106 
Tooth-achc. 
other. Without attempting to suggest any theory 
of sympathetic nerve-action, even in the face, 
we will point out a few facts and offer a few 
suggestions. 
1. This phenomenon cannot be accounted for 
by any communication of the nerves at their 
peripheral filaments, or by any direct com- 
munication between one nerve-filament and 
another by means of the sympathetic; for no 
such communication appears to take place ; nor 
have we a right to imply by the name we give 
the ganglionic series that such a communication 
is the cause of the sympathetic action of pain. 
Nevertheless, this nerve may be, and in all 
probability is the cause of sympathetic pain. 
2. The so-called sympathetic nerve is dis- 
tributed to the heart and the arteries, and 
where ganglia are found their branches sup- 
ply these latter structures. Kolliker says,* that 
*0p. cit. p. 485. Sympathetic Tooth-ache. 
107 
many arteries are completely destitute of 
nerves, which, may account for any peculiarity 
observable in the vicinity of those which 
are so possessed. Referring back to the descrip- 
tion of tooth-ache we are reminded, by every 
popular phrase used to express this pain, of its 
pulsating character. Perhaps this is fully ac- 
counted for by the heart's systole and diastole 
(which are certainly perceived in the pulp when 
inflamed); and we cannot fasten upon the 
sympathetic any certain connection with tooth- 
ache ; yet the intimate relation of this nerve to 
the blood-vessels, and the rhythmical character 
of its action suggest, when we find precisely 
the same peculiarity in odontitis, as highly 
probable, that it must have some more direct 
effect'upon this pain than through the heart's 
action. 
3. We have seen that the pressure of the en- 
gorged arteries upon nerves ramifying through the 
pulp causes the pain of odontitis; and if 11 at 108 
Tooth-ache. 
whatever point a sentient nerve be stimulated, 
a sensation will be produced, which will be 
referred to those parts, and to those only, to 
which the fibres irritated are distributed,"* the 
pain caused by this pressure must, so far as 
the direct branches of the trifacial nerve are 
concerned, be confined to the tooth. But, how 
far back does the influence of this engorgement 
extend? It is not communicated to the peri- 
osteum, yet it is hardly probable that the effects 
of so severe an inflammation can be wholly con- 
fined to the pulp. If it extends beyond the 
pulp it must be communicated to the coats of 
the arteries, and, so far as these have in them 
the terminal filaments of sensitive nerves, the 
pain may be experienced. But, from what we 
know of nerve force, it would be difficult to 
trace the effects of the inflammation of the 
pulp direct to the facial ganglia without sup- 
* Todd, and Bowman. Vol. i., p. 231. Sympathetic Tooth-ache. 
109 
posing an arterial engorgement beyond anything 
we have a right to assume. If it can be shown, 
however (as the arteries are entwined as the tree 
by the ivy by filaments from the ganglia), that 
these filaments transmit pain to the ganglia, 
we have only to imagine the disturbance to 
extend but slightly beyond the tooth to*account 
for the sympathetic action of tooth-ache. 
4. The greater number of the fibres of the 
sympathetic are motor, and these we find 
concerned in repeating the peristaltic move- 
ments. It certainly has some sensitive fibres, 
and probably there are a goodly number pro- 
ceeding from the facial ganglia. It would be 
in strict analogy with the action of the motor 
fibres to say, that when irritated, the office 
of the sensitive fibres is to communicate the 
sensation to these little brains or nerve-centres, 
whereby it is by them progressively repeated. 
5. Sympathetic pain will sometimes be accom- 
panied by tenderness in the parts where the 110 
Tooth-ache. 
pain is seated. This fact does not harmonise 
with the prevalent ideas of sympathetic action. 
6. At no point is sympathetic tooth-ache more 
frequently found seated, than near where the 
posterior branches of the trifacial nerve and the 
facial ganglia send off filaments that entwine 
around * or proceed in company with, the great 
trunks of the ascending arteries and their 
branches. From this vicinity a pulsating pain 
often extends in the line of the arteries upwards 
upon the temple, and posteriorly in and around 
the ear. 
7. Certain affections of the stomach, cause 
pulsating head-ache: and, lastly, a severe case 
of ranula produced a very decided pain in an 
inferior tooth. 
Many other pertinent facts could be given; 
but, after all, neither in dental nor in general 
practice is it necessary that we should obtain 
knowledge how sympathetic pain originates. 
The great fact wliich we have to learn is Sympathetic Tooth-ache. 
111 
this-that tooth-ache very frequently is sym- 
pathetic, and thereby the cause of almost every 
facial pain. When this truth becomes recog- 
nised, the reduction of all these pains may be 
easily and effectually accomplished. DIAGNOSIS OF TOOTH-ACHE. 
A THEN a patient is suffering from tooth- 
' ache which has led to other disorders, 
it is not uncommon to attribute the pain in the 
mouth and face to these disorders; and to regard 
the facial pains as an exhibition of what is sup- 
posed to be purely sympathetic nervous action. 
So far from attributing tooth-ache to constitu- 
tional disorders, the physician will always act 
wisely, when there is pain in the teeth or face, 
in regarding it, not as the effect, but as a 
powerful aggravator, if not the sole cause, of 
these disorders. 
The effects of tooth-ache, besides those 
before-mentioned, are general febrile symptoms, Diagnosis of Tooth-ache. 
113 
constipation, and a general prostration of the 
system. The exhaustion alone caused by so 
severe a pain, especially when accompanied 
by loss of sleep, will often be so great as 
to require many days and even weeks to be 
repaired. 
Nature works out her laws with such wonderful wis- 
dom and precision ; and, so far as we have been able to 
apprehend them, with such an unmistakeable intention 
to reduce as much as possible the evils resulting from 
derangements in the animal economy; that when we 
find certain conditions invariably accompanying any par- 
ticular derangement, it must be apparent to all reflecting 
minds, that they are the least of the evils, and, under the 
circumstances, the very best for the patient. Without 
going out of the range of the subject under consideration, 
or entering upon any general proposition not pertinent 
to it, but confining the enquiry strictly within the limits 
of dental science, it is proper to suggest that the effects 
of tooth-ache should not always be looked upon as so 
many positive evils demanding eradication ; but as the 
natural attendants, for some wise and merciful end, upon 
other diseases: and that, instead of administering cura- 
tives which are intended to arrest only these attendant 
symptoms, the attention of the medical adviser, whether 
he be physician or dentist, should be primarily directed, 
either to the eradication of the predisposing local causes 114 
Tooth-ache. 
as soon as possible, or to the assistance of nature in 
carrying out her processes. This being done, the pains, 
inflammation, swelling, fever, constipation, and other 
attendant evils, will subside, as they arose, in a natural 
and orderly manner. 
While tooth-ache produces many derange- 
ments of the general system, such derangements 
do not, in turn, directly cause tooth-ache. 
There are, however, many constitutional in- 
fluences which promote the course of tooth- 
ache, and which thus indirectly produce it. 
It will be apparent, for example, that whatever 
tends to increased acidity of the oral fluids will 
in this manner eventually produce first, decay, 
and then this pain. And this tendency will be 
found in connection with almost any functional 
disturbance, and more especially with disturb- 
ances of the stomach. 
It is customary to refer a diseased condition of the 
teeth to derangements of the stomach. This is reversing 
the facts ; and it will be found, on the contrary, that 
while disease of the stomach affects the teeth but Diagnosis of Tooth-ache. 
115 
slightly? and never directly causes tooth-ache, the 
teeth in all their stages of disease both directly and 
indirectly affect the stomach. 
There are also many influences which excite 
tooth-ache when the predisposition has prepared 
the way. When the periosteum of a tooth is in 
a state of chronic inflammation, many things 
will aggravate it; especially such as produce 
debility. The pressure of food, as before men- 
tioned, upon the exposed pulp; the action of 
the oral fluids; hot and cold drinks, or other 
liquids taken into the mouth; and many other 
agents will directly excite odontitis. And both 
this pain and that of periodontitis will also be 
directly and indirectly produced by a cold ; and 
sometimes by indigestion and other causes, the 
most notable among which is pregnancy. 
During this period the tendency to tooth-ache 
is so great as to be, with some, almost its first 
indication; and it has a greater tendency than 
at any other time, not only to become erratic 116 
Tooth-ache. 
and sympathetic, but to be more keenly felt. 
When it is remembered how almost universally 
this state is accompanied by increased acidity 
of the oral fluids, it occasions no surprise 
when decay and the pain that ensues from an ex- 
posed nerve is produced. For with this increased 
viscidity we are to expect the destruction of 
the teeth; and even in a pulp that was before 
exposed, but had not become inflamed, that 
immediate irritation which would have been 
postponed for a time had these fluids remained 
in their normal condition. Nor is it surprising 
that the pain from an inflamed pulp should be 
more severe while it was excited by an irritant 
of unusual strength. But why the periosteum 
of a dead tooth, which would have remained in a 
chronic state, for a time at least, should be so 
easily excited by this condition, is not clear; and 
the pertinacity of both kinds of tooth-ache pains, 
and other peculiarities which they exhibit, 
is not so easy of solution. For instance, the Diagnosis of Tooth-ache. 
117 
prevalence at this period, of the short and. stab- 
bing, but not so often continuous, pain, which 
so usually precedes a severe attack of odontitis; 
as if the pressure of the arterial and capillary 
vessels upon the nerves were quick and severe, 
and were then as suddenly withdrawn. It can- 
not be attributed to hypersesthesis, for this is 
not especially noticed to accompany pregnancy. 
Observations suggest that an occasionally ex- 
alted arterial action (more frequent at this than 
at any other time) which suddenly propels more 
blood into the capillaries of the pulp or the peri- 
osteum than can be readily transmitted through 
its impaired organisation, may possibly be at 
least one cause of the peculiarity. But this 
suggestion, even if correct, does not explain the 
cause of the unusual sympathetic action of 
tooth-ache during pregnancy, which still remains 
somewhat obscure. 
When continuous pains arise in any part of 
the face or head which cannot be directly traced 118 
Tooth-ache. 
to some lesion other than in the teeth, these may- 
be examined with the greatest confidence as to 
their being the cause of the malady. And if 
not immediately found, the conclusion must not 
be that the pain does not so originate, but 
that the examination has not been thorough. 
In examining the teeth, a small mouth-mirror and a few 
fine dental instruments, such as are readily obtainable at 
any of the dental depSts, will be found indispensable. 
When the mouth is looked into, although the 
presence of a decayed tooth is at once apparent, 
it by no means follows, nor is it to be assumed 
without father investigation, that it is the one 
from which pain proceeds. For the pain may 
arise from some other tooth, and the extraction 
of the one apparently offending will thus furnish 
no relief; and in some cases it may even aggra- 
vate the pain; and the erroneous conclusion may 
in this manner be come to, that it is not tooth- 
ache, but an unmistakeable nervous affection. 
No matter how many decayed teeth there may be Diagnosis of Tooth-ache. 
119 
in the month, although the retention of any- 
one of them will he the worse for its health, 
the particular offender, when there is pain, 
should be searched out. 
Some idea of the character of the pain may 
be gathered from the symptoms. But when 
the' symptoms are not clearly defined, and the 
teeth have to be examined in order that the 
malady may be determined and treated, it is 
best to first press with the finger upon such, if 
there be any, as appear to be decayed; and if 
there are none in which disease is visible, then 
upon all of the the teeth; since if upon the 
application of pressure to any one, the pain 
is increased, this is the unmistakeable offender, 
and it is a case of periodontitis. The same 
conclusion may just as safely be come to when 
/ 
any tooth begins to feel too long, and gives 
pain whenever the teeth are closed. If, however, 
no teeth that appear to be decayed respond to 
the pressure, it may be applied to all the teeth 120 
Tooth-ache. 
in succession; whereby the disease will not in- 
frequently be found in a tooth that is quite 
unaffected by decay. This mode of testing for 
periodontitis so certainly reveals the presence 
of the disease, when it exists, that it may be 
assumed as pretty clear that when no tooth or 
root is sore to the touch, the pain arises from an 
inflamed pulp : although when the inflammation 
of the periosteum is sudden and severe, there 
may be much pain before this test reveals its 
locality. The seat, however, will be determined 
in the course of a short time. 
If pressure does not detect the aching tooth, 
and there are several teeth decayed; then, 
(commencing with that which from appearances 
is most likely to be the one that is aching), 
by cutting away the decayed dentine near the 
orifice, so as not to disturb the pulp more 
than is necessary, if it should be exposed and 
inflamed, it can soon be determined if that 
tooth has lost its vitality. If there is no sensa- Diagnosis of Tooth-ache. 
121 
tion in the dentine, and further excavation of 
the tooth reveals that it is not aching by reason 
of an exposed pulp, but is devitalised, the 
absence of pressure shows that the inflamma- 
tion has not yet reached the periosteum, and 
that, therefore, the cause of the pain is to be 
looked for in some other tooth; and every 
affected one may be examined in like manner 
until the seat of the pain is determined. 
Even if a case of periodontitis is discovered, 
it by no means follows that this is the sole 
cause of the pain. For it is frequently found 
that more than one tooth is so affected when 
there are many badly diseased teeth; and that 
it is often accompanied by odontitis. The 
combination of these two pains results in such 
severe and unusual suffering (which is almost 
certain to extend far beyond the mouth), that 
it often gives rise, from its complicated charac- 
ter, to what seems to be the most incontestible 
proof of the neuralgic theory. 122 
Tooth-ache. 
While periodontitis is usually soon dis- 
covered and located, it must be remembered 
that odontitis is often most obscure. And 
when after one examination, or even repeated 
examinations, the pain continues, instead of 
concluding that it is not tooth-ache, the search 
for the cause should be renewed. 
Sometimes the pulps of two or even more 
teeth will be exposed at the same time; and 
if only one is discovered, although it may be 
destroyed, the other will continue to ache. 
When it is found that the suffering is not 
from periodontitis, the removal of the decayed 
dentine will soon determine in which of the 
decayed teeth the disease has so far progressed 
as to reach and inflame the pulp. 
It frequently happens that, although the pain 
is intense, all the teeth appear to be sound ; or 
none that are seen to be decayed are found to 
be the seat of the pain. When this occurs, it is 
first to be observed if there be any appearance Diagnosis of Tooth-ache. 
123 
of discolouration through the enamel, at or near 
the approximate surface of any tooth, when a 
powerful light is thrown upon it by the aid of 
the mouth-mirror. Oftentimes, when there is 
decay in the sides of the teeth, it "will in this 
way be apparent to anyone; but as a rule, this 
test is not of much use to any but the most 
experienced and keen-eyed dentist. If no dis- 
colouration is observed, the teeth should be 
probed with a fine instrument, when the 
decay will often be discovered in the most 
unexpected place. 
If the surgeon or dentist is unable to discover 
the seat of the pain, he must not (as is more 
frequently done than acknowledged), extract 
any tooth at random ; for he runs but a small 
chance of affording relief, and may remove a 
valuable tooth which ought to be retained. 
Nor, either before or after this operation, 
when the pain continues, because he cannot 
locate it, must he conclude that he has dis- 124 
Tooth-ache. 
covered a case of tic. He must be satisfied to 
know that he has failed to discover the decayed 
spot or other cause of the suffering. 
Very frequently also there will be no disease 
in the mouth except in some very small and 
apparently insignificant root, and even that one 
only very slightly sore to the touch. And yet 
this may be the sole cause of very severe pains 
in the face. TABTAR. 
r | THIS is a deposit almost wholly composed 
of lime and animal matter in various 
proportions, frequently found upon the teeth. 
Its source and mode of deposit are uncertain. 
Dr. Harris gives an excellent summary of what is 
known on this subject, and declares that,* "the 
conclusion appears to us irresistible that this 
earthy matter is chiefly a salivary deposit, and 
takes place in the following manner : It is pre- 
cipitated from the saliva, as this fluid enters the 
mouth, upon the surface of the teeth, opposite 
the openings in the ducts, from which it is 
* Op. cit. p. 451. 126 
Tooth-ache. 
poured. To these its particles become aggluti- 
nated by the mucus always found, in greater or 
less quantity, upon them. Particle after particle 
is deposited, until it sometimes accumulates in 
such quantities that nearly all the teeth are 
almost entirely encrusted with it." When first 
deposited, tartar is soft and creamy in its appear- 
ance; but if allowed to remain, it loses apportion 
of its animal matter and water, and, as the 
lime predominates in its composition, becomes 
harder, and clings with great tenacity to the 
teeth. 
The adhesion of the tartar to the teeth does not 
directly induce decay; but indirectly, through 
the irritation of the gums which it occasions, it 
greatly promotes this malady. The deposit of 
tartar usually commences on the teeth at the 
edges of the gums. While soft, it does not 
much interfere with these structures; but as it 
gets harder the gums are irritated and become 
inflamed. Tartar. 
127 
There may be remote constitutional causes 
which favour the irritability of the gums, but 
a local irritant is necessary for its active de- 
velopment. Tartar is the agent which almost 
always causes this disease; although it is not 
infrequently owing to the presence of dead 
teeth, badly-inserted artificial teeth, improper 
fillings, and other causes. Koecker, whose 
practical good sense is almost unrivalled among 
dental writers, says that he has not observed 
the devastation of the gums and sockets of the 
teeth without the presence of tartar; and the 
author's observations go to show that he is 
very much nearer the truth than is generally 
supposed. 
The effects of the inflammation of the gums 
by tartar is to cause them to swell, become sore 
to the touch, easily bleed, and finally suppu- 
rate; whereby foetid matter is discharged, first 
polluting the breath, and then mixing with 
and vitiating the oral fluids. As the suppura- 128 
Tooth-ache. 
tion continues, the gums recede; and in this 
manner they would clear themselves from 
the tartar and resume their healthy condition, 
were not new deposits made upon the previous 
accumulation, whereby its advance is constantly 
pressing upon the retreating gums. 
This has not long to continue before the 
sockets of the teeth also become involved; and 
the result, if the tartar be not removed, is 
that gums and sockets are destroyed, the teeth 
are devitalised and become loose, periodontitis 
and sometimes odontitis ensues, and finally the 
teeth drop out. 
When tartar is in its soft state it is easily 
removed with a brush; but when it has become 
hard it can only be removed with instruments. 
The operation of removing the tartar should be 
performed, even by the ordinary dentist, at the 
cost of little or no pain, and without much 
fear of the slightest injury to the teeth. 
As this deposit from the saliva is composed Tartar. 
129 
chiefly of lime, and is readily soluble in acids, 
it is customary to introduce some agent of the 
acidulous character into tooth-washes and tooth- 
powders, alike for this purpose and for the use 
hereafter mentioned. But whatever will act 
chemically upon tartar will also destroy the 
teeth; and any attempt to remove the tartar in 
this manner will directly induce decay. 
The common operation of " scaling the teeth," 
while in the right direction, is one which sel- 
dom if ever meets the requirements of the case 
because of its lack of thoroughness. By this 
operation, the greater portion of the deposit is 
often removed; but that is of little real 
advantage if, as usually happens, nothing more 
is accomplished. It is the small particles which 
remain embedded under the gums and between 
the teeth, and which are not seen until after the 
first or second sitting, that do the greater part 
of the mischief. These, in the ordinary ope- 
ration of scaling, are not reached; since to 130 
Tooth-ache. 
reach them is impossible previously to the 
removal of the bulk of the tartar, and until 
the bleeding of the gums has ceased, and the 
swelling has subsided. They are consequently 
left, in almost all attempts to clean the teeth, 
to act, not only as insidious and potent irri- 
tants, but as nuclei for renewed deposits. 
After the excitement and the bleeding of the 
gums, consequent upon the first operation, has 
subsided, which will not be until some days 
have elapsed, the process of removing the tar- 
tar should be continued and repeated until 
not a particle remains. THE PREVENTION OF TOOTH-ACHE. 
r 11HIS is a subject which, it will be well to 
consider before that of Cure. 
If treated in an exhaustive manner, it is one 
that would extend quite beyond the limits 
of such a treatise as this; for it would lead to 
the consideration, not only of the best means 
of preventing the derangements which ulti- 
mately induce tooth-ache, but would carry our 
enquiry back to the hereditary tendencies in 
general; and to a particular consideration of 
the regimen necessary to the mother as well 
as to the child, at the period when the food 
and health of both had powerful influence 
upon the organisation of the teeth. It 132 
Tootli-ache. 
would lead also to other extended questions. 
Our enquiries must be limited accordingly, to 
the prevention, as far as possible, of those 
diseases of the teeth which arise after they 
have emerged. 
It has been seen that tooth-ache is the result of 
the exposure and the consequent inflammation of 
the pulp through decay; and of the devitalisation 
of the tooth through this action, the effects 
of tartar, injuries, and so forth. To arrest and 
prevent further decay is to leave, accordingly, 
but little opportunity for the exhibition of tooth- 
ache ; and to remove and to prevent the accu- 
mulation of tartar is to leave scarcely any. 
Inasmuch as when the teeth are once formed, 
their vitality and strength of character are fixed; 
and, so far as their innate organisation is con- 
cerned, they are not liable to vary in their 
tendency to disease; all efforts for the pre- 
vention of decay are utterly useless which 
aim at any supposed possible increase in their The Prevention of Tooth-ache. 
133 
vitality that would give them greater power 
to resist the attacking forces. 
The first efforts of the dentist, which have 
for their end the prevention of disease in 
the teeth, will be directed to the teeth of 
the child; and especially at that period of its 
life when the permanent teeth are assuming 
their positions. These efforts consist in aiding 
nature, when necessary and possible, in the 
arrangement of the teeth after the manner she 
designs : for when they are uneven, the 
accumulation of food about them is much 
greater than when they arc regular; and when 
they are crowded, the constant attrition wears 
away the enamel upon their approximate 
surfaces. 
It is also matter of observation that, how- 
ever sound and clean the teeth may he, the 
gums about a tooth that is not in its proper 
place will always present an angry appearance. 
, This is not the place for an elaborate dis- 134 
Tooth-ache. 
quisition upon the mode of regulating the 
position of the teeth: there are, however, a few 
general propositions to be made, which are per- 
tinent to the present subject, and which can be 
comprehended, and will be readily appreciated, 
by any mind of ordinary intelligence. 
It is in "regulating the teeth" that dentists so fre- 
quently exhibit to the anatomist, if not to patients, the 
entire and almost universal absence of the anatomical 
knowledge so essential to those who have to deal with 
the human fabric ; and efforts in this direction are often 
made, not only in ignorance of the wonderfully wise 
arangements of nature, but in utter defiance of their 
provisions. 
When we consider how wonderfully perfect is 
the progress of the formation of the teeth from 
the rudimentary pulp ;-when we consider, more- 
over, the growth of the two sets, the displace- 
ment of the first by a portion of the second, and 
the perfection and beauty of the final arrange- 
ment of the latter in the mouth-whereby order 
is brought, in the most wonderful manner, out of The Prevention of Tooth-ache. 
135 
what seemed to be hopeless chaos,-it must 
needs be obvious to the dentist who reflects, that 
his paramount duty is to prevent any interference 
with the orderly operations of nature. To 
perform this duty effectually, he must first 
acquire so thorough a knowledge of dentition as 
to learn, what so many seem ignorant of, that 
this is his line of duty: and he must be 
possessed not only of intelligence but of a 
conscientious and child-loving spirit. 
The little patient will then perceive that the efforts 
are all made for its good, and that the trouble and 
annoyance are not more than are absolutely necessary. 
Convinced of this, it is often astonishing what children 
will submit to, and easily get through. 
Much decision, with those who have the charge of 
children, will also be often found necessary ; since 
nothing is more common than for parents and others to 
become alarmed at the peculiar and ragged appearance of 
the mouth during second dentition, and to think that 
something must be done to the teeth, and that they are 
becoming displaced, when the progress of the replace- 
ment of one set by another is exactly what is desirable. 
It often happens indeed, that the most favourable indi- 
cations are regarded with the most alarm. 136 
Tooth-ache. 
Very frequently also, children are taken to the dentist 
for the purpose of obliging them, whether they will or 
no, to have different kinds of operations performed. 
No man-that is fit to be called a man-will become a 
party to such undignified scenes as are sometimes 
enacted. Nor will any gentleman fail to resent the 
request that he shall assist in deceiving a child, as a 
gratuitous insult. What is really necessary almost 
any child can be reasoned into having performed; and 
operations attempted against its will throws it into such 
a state of terror that they cannot be properly, if at all, 
accomplished : so that deception and coercion are with- 
out excuse. Moreover, while a child will submit to 
almost anything from those in whom it has confidence, 
once deceived and tortured, its dread of the dentist 
remains throughout life; and other effects are also 
produced which it is the end of all good education to 
prevent. 
The first set of teeth consists of twenty, ten 
to each jaw; and these are displaced by the same 
number of somewhat larger permanent teeth. 
The second, or permanent set, as shown above, 
consists of thirty-two teeth, sixteen to each 
jaw. 
The space for the additional number, and the 
increased size of the permanent set, is attained in The Prevention of Tooth-ache. 
137 
various, and in some respects, peculiar ways. 
All that portion of the jaw where the first 
teeth are placed-which, until the molar teeth 
begin to arrive, is indeed, the whole of the 
jaw-may be regarded as having very nearly 
attained its normal growth when the first teeth 
have emerged. Nevertheless, there is a very 
perceptible increase at the middle line and in 
the vicinity of the cuspid teeth, and a slight 
general increase, by the time the permanent 
teeth begin to appear. Most, however, of the 
additional space required for the permanent teeth 
which displace temporary ones, is attained by 
the new position they assume. 
The temporary teeth are ar- 
ranged in a vertical position, 
as shown in Fig. 6 ; the effect 
being to bring their crowns 
together, while the roots will 
be wide apart, leaving some 
unoccupied space, so to speak, 
Fig. 6. 
Lateral or side 
view of temporary 
superior front in- 
cisor. 138 
Tooth-ache. 
m the jaw. The new teeth, on the contrary, 
assume a somewhat oblique position, as shown 
in Fig. 7 ; the consequence of 
which is that the crowns are 
thrown further out, and the 
arch formed by the cutting 
edges of the teeth is larger 
than the jaw; while the arch 
marked out by the roots cor- 
responds to the jaw and is 
not much greater than before, if at all so. In 
✓ 
this manner the larger crowns of the new teeth 
find the room which would otherwise not have 
been possible. 
It will also be observed that the new teeth arc 
so shaped in the crown as to preserve the same 
appearance as if their roots were vertical. 
While the new teeth arc forming in the jaws, 
the lateral incisiors and the first bicuspids lie 
pretty close together, and the cuspids stand out- 
side of the necessarily contracted arch described 
Fig. 7. 
Lateral view of 
permanent supe- 
rior front incisor. The Prevention of Tooth-ache. 
139 
by the other teeth. It appears, accordingly, that 
space amounting to almost the whole width 
of these latter teeth must be obtained for them. 
Some space is got by the slight general increase in 
the jaws and the particular increase at the middle 
Une; and more yet, than to the best of the 
author's belief has been pointed out by previous 
writers, by a decided increase in the jaws at the 
point of the emergence of the cuspids. 
When watching the progress of dentition, it 
should not be overlooked, however, that not 
quite so much room is needed as would be the case 
were the cuspid teeth so placed that the front 
teeth would form a rounded, arch. When 
it is observed that the permanent cuspids, in a 
well-arranged set of teeth, are a little more promi- 
nent than the others, thereby giving a somewhat 
flat appearance to the arch described by the front 
teeth, it will become evident that their position 
while forming, was but preparatory towards 
the arrangement, which, on their emergence, 140 
Tooth-ache. 
culminates in giving the whole of the teeth, and 
the face 'likewise, that greater prominency at 
the point the cuspids occupy, which is essential 
not only to the conversion of the juvenile mouth 
into the adult one, but to the conferring of that 
character upon the face which is indispensable 
to the expression alike of force and beauty. It 
is because this is not observed, that so many 
extractions and other mistakes in treatment take 
place. It will also account, to a great extent, 
for the peculiar and unnatural expression given 
to the mouth by almost all artificial teeth. The 
emergence of the cuspid teeth slightly upon the 
outside of the arch formed by the other teeth, is 
also one great cause of the increase of the jaw at 
that point. 
So far then, from the appearance of the cuspid 
teeth on the extreme outside of the jaw, which 
usually excites so much alarm in parents and 
dentists, being an unfavourable indication; in 
almost all cases it is just so much evidence that The Prevention of Tooth-ache. 
141 
the teeth are emerging in a way to give plenty 
of room : and from this it follows that not only 
are they more likely to become regular in ar- 
rangement, but that decay will be less likely 
to arise. 
The space for the whole twelve additional 
molar, and largest teeth, is obtained by positive 
growth in the posterior portion of the jaw. And 
the great increase of the jaws in this direction 
completes the conversion of the child's mouth 
and face into the adult's,-a change which was 
commenced as above described. 
The jaws, then, from the beginning of growth 
to the completion of dentition, are at one point 
or another constantly increasing in size so as to 
accommodate the teeth which have been formed 
in their remote parts. And as the increase is 
effected for this purpose, it will be found pro- 
gressing under the influence of the development 
of the teeth; and in conjunction and harmony 
with that development. When the said in- 142 
Tooth-ache. 
fluence ceases, so, in great measure, does the 
growth of the jaws. 
It is evident that when there is irregularity of 
the teeth, it is owing to the disparity between 
the space they require and that which is pro- 
vided for them. This disparity must necessarily 
arise either from the teeth being too many or too 
large, or else from the jaw not having sufficiently 
grown to receive them. As it is only in ex- 
tremely rare instances that the teeth exceed the 
normal number; and, as it can never be con- 
sistently said that they are too large, it is to 
deficiency in the size of the jaw alone that we 
must look for the cause of irregularity. It is 
clear, therefore, that the entire efforts of the 
dentist should be primarily directed to such 
treatment as will not in any way impede the 
natural growth of the jaws; and when there is a 
tendency to irregularity, to such treatment as 
will, as far as possible, promote their growth. 
As, therefore, the jaws are forced, as it were, The Prevention of Tooth-ache. 
143 
to grow by the crowding forwards of the teeth 
which have been formed in their remote parts; 
under no circumstances, except as a very last 
resort and an indispensable necessity, should a 
tooth be extracted until the jaw has developed 
to its full size: for it must be evident that the 
growth of the jaw is thereby impeded, that the 
room for the teeth is lessened, and that liability 
to irregularity and to decay are just in the same 
measure increased. 
A most remarkable case of "regulating the teeth" 
was one where the temporary teeth of the lower jaw had 
been extracted by an ignorant fellow for ' ' tic " (!) So 
much had this retarded the growth of this jaw that it 
was much smaller than the upper one ; and the second 
teeth were not only crowded, but even the bicuspids 
shut inside the upper teeth. The effect was to give the 
patient a most unsightly appearance. 
The importance, indeed, of retaining not only 
all the temporary teeth, but also the permanent 
ones while dentition is in progress, or at least 
until the second or middle molars have acquired 144 
Tooth-ache. 
a firm position* in the mouth,-say until 
about the fifteenth year, or a little later,-should 
never be let slip from the minds either of 
parents or dentists. To this end, when the first 
teeth decay and the child will allow them to be 
filled, they should be so treated before the pulp 
becomes exposed. Tin-foil, and in perfectly 
healthy patients even amalgam, may be used. 
But the time required for gold is too tedious for 
the child. If the pulp is exposed, it may be 
destroyed and as far as possible removed; and 
the tooth afterwards filled. Should periodon- 
titis at any time after this set in, the removal of 
the filling will in general relieve the pain a good 
deal. If not relieved by this, and the patient 
will allow the operation, an opening may be 
made into the abscess through the root, whereby 
the pus will be discharged into the tooth. If no 
relief to the pain is thus obtained, then a tenth 
to one-half a grain of quinine every hour, a few 
times repeated, will have the desired effect. The Prevention of Tooth-ache. 
145 
It is, however, when the new teeth begin to 
appear, that if anything be required, most can 
be accomplished towards assisting them into 
their proper positions, and preventing liability 
to decay. It is at this period also that mischief 
is so often inflicted. 
In reference to this matter Dr. Koecker 
pertinently remarks* that " Irregularity of the 
teeth is one of the chief predisposing causes of 
their diseases, and never fails, even in the most, 
healthy constitution, to destroy, sooner or later, 
the strongest and best of teeth, unless properly 
attended to." 
And Harris t as emphatically declares that 
" It is important that the mouth during second 
dentition, should be properly cared for; and 
so thoroughly convinced is the author of this, 
that he does not hesitate to say, that if timely 
precaution were used, there would not be one 
* " Principles of Dental Surgery." p. 188. 
+ Op. cit. p. 138. 146 
Tooth-achc. 
decayed tooth where there are now a dozen. 
Much harm, it is true, may be done by im- 
proper meddling with the teeth during this 
period, but this so far from inducing a total 
neglect, should only make those having the 
care of children more solicitous in securing the 
services of scientific, accomplished practitioners." 
With a laudable desire to have all that is practic- 
able done for their children, parents are very naturally 
inclined to consult a dentist at this period. The 
practitioner called upon will generally find that his 
sole duty, when intelligently performed, is the pleasing 
one of calming the fears of the parent; and of pointing 
ortt that the progress of dentition is going on in the 
way that could be wished ; or, if there be only a slight 
defect apparent, that nature, in her wise and curious 
ways, will do much more towards curing it than the 
dentist can, however skilful. He will also feel it his 
duty to impress upon parents how imprudent-and it 
is not too much to say how wicked-it would be to 
interfere, except under the most imperative necessity, 
with an arrangement so wonderfully perfect. 
From a variety of causes, such as protracted 
illness, and so forth, it is not infrequently The, Prevention of Tooth-ache. 
147 
found that the growth of the jaws has not kept 
pace with the development of the teeth; and that 
they begin to emerge from the gums rather 
crowded and out of place. In most cases time 
will give the jaw opportunity to develope to a 
sufficient size; and it should not at once be con- 
cluded, that because the jaws are not large 
enough when the teeth begin to appear, they 
will not become so, in due course, provided 
they be left to themselves. 
But in some cases, owing to the above causes, 
to hereditary tendencies, and so forth, the jaws 
are not inclined to grow to a sufficient size. Here 
the aim of the dentist should be to induce or 
stimulate the necessary development. In so 
doing, he is but assisting nature; such develop- 
ment, as we have seen, being what she is 
employed upon when the teeth are pressing 
forward into their respective positions. And 
he must take great care to render this assistance 
at the proper time and in the proper place. 148 
^Tooth-ache. 
Instead of so doing, however, the usual 
practice is at once to extract a tooth or teeth, 
so as to 11 make room." Such a course, instead 
of promoting the desired end, retards the growth 
of the jaw; and this too where, if the teeth 
were left alone, in a majority of instances they 
would have come as they ought. 
In this mania for " making room," the tooth 
sacrificed is generally one of the bicuspids; 
which, even when extraction must be resorted 
to, are not the teeth to lose if it be possible to 
save them. And even a cuspid tooth is not 
infrequently remove^; the teeth subsequently 
presenting the appearance exhibited in Fig. 10, 
on page 152, where the cuspid has not yet 
shown itself on the right side of the mouth. 
A glance at the figure will show that this is the height 
of charlatanerie : and it is proper to add that the den- 
tist who has no clearer perception of his duty than lets 
him disfigure a mouth in this way, is unfit to be en- 
trusted with a juvenile, if indeed with any patient. 
Yet it is mortifying to have to say that this is by no The Prevention of Tooth-ache. 
149 
means an uncommon occurrence. The author possesses 
models of several mouths which have been treated in 
this manner; and drawings of which would have 
been inserted had not the one referred to sufficed to 
show the appearance of the deformity, so far as 
the teeth are concerned. But the effect of the 
extraction of the cuspid tooth is not confined to the 
appearance of the teeth ; it is also very marked in 
that of the face when the mouth is closed. 
The points where the jaws are deficient, vary; 
and although always attributable to a similar 
cause, the peculiarities of irregularity are con- 
siderable. For example:-the whole of the 
Fig. 8. 
front upper teeth sometimes take a more vertical 
direction than nature designs they should, and 
shut inside the lower teeth, as seen in Fig. 8. 
The jaw is then said to be " underhung." 150 
Tooth-achc. 
More frequently only one or two superior 
front teeth take this direction. When the 
upper front teeth once shut inside of the lower 
ones, they are crowded inwards each time the 
jaw closes. The lower teeth are at the same 
time forced outwards, whereby the deformity 
is increased and rendered permanent. 
That the lower jaw should be underhung, is by no 
means so much owing to abnormity in shape or size as 
most dental writers seem to consider. Rather is it that 
the upper teeth, having at first just barely caught inside 
the lower front ones, press these teeth out at each 
occlusion of the jaws, whereby they are caused to project 
more than is natural; and generally also, the under-jaw , 
has to be thrown unnaturally forwards so as to allow of 
the meeting of the molar teeth. In this manner, not 
only do the front under-teeth project beyond their usual 
position and cause protrusion of the lip; but the 
proper relation of the under-jaw, not only to the upper 
one but to the whole face, is abnormal; whereby the un- 
natural projection causes that greater size of the lower 
part of the face which appears to be owing to an 
increase in the size of the lower jaw. That after the 
front teeth have been thus forced out (and the other 
lower teeth antagonise with, and shut outside of, the 
upper teeth that were intended to meet those of the The Prevention of Tooth-ache. 
151 
lower jaw which are situated further forward), the 
under jaw is sometimes found increased in size, is 
true enough. But the appearance of unnatural size is 
always owing very much more to the unnatural position 
it has been compelled to assume than to an actual 
growth. 
The remedy for such an irregularity is to 
insert in the mouth a plate made of vulcanised 
india-rubber securely tied to the other teeth, 
between which and the teeth a wooden wedge 
is inserted. The expansion of the wood by 
moisture will force the teeth into place. A 
metal plate, provided with an inclined plane for 
the irregular teeth to stride upon, will in some 
cases also conduce to the desired result; and 
then, the upper teeth being once made to shut 
outside the lower ones, as is natural to them, 
both upper and lower teeth will in a short time 
assume their normal positions. The case repre- 
sented in Fig. 8 was so treated; and in nine or 
ten days the upper teeth were got to shut over 
the lower ones. In a few weeks the irregularity Tooth-ache. 
152 
had been so far remedied as to present the 
appearance seen in Fig. 9. 
Fig. 9. 
Another excellent illustration of the occasional 
necessity for forcing the growth of the jaw, is 
shown in Fig. 10. Here, all the temporary 
Fig. 10. The Prevention of Tooth-ache. 
153 
teeth have been shed ; and the permanent 
teeth have emerged as far back as the first 
molars; excepting the right superior cuspid, 
which has not yet shown itself through the 
gums, although the increase of the jaw indicates 
that it is coming forwards. Left to itself, this 
cuspid tooth would emerge upon the outside of 
the arch, and present a tusk-like and extremely 
unsightly appearance. The cause of the ir- 
regularity was evident, and the remedy was 
the increase of the jaw. 
Fig. 11. 154 
Tooth-ache. 
This was effected by means of a vulcanite 
plate and wedges. The first bicuspid teeth on 
both sides were first brought out; then the 
right front incisor; and lastly, the right lateral 
incisor. This gave the appearance and the space 
seen in Fig. 11; and here, at the time of writing 
these words, the case rests. When (as far as 
is possible in the present condition of affairs) 
the right superior cuspid shall have come into 
place; and the jaw, under the stimulus it has 
received, has increased all that it will by natural 
growth, still further progress will be made. 
Great care was of course taken to preserve the 
first molars. 
At about the sixteenth year, when the second 
molars shall have become well fixed, the first 
molars will be extracted. The teeth in front of 
them will then fall into order and regularity. 
It is seldom that we find so difficult a case as 
the one here presented; and regulating is 
usually a much simpler affair; and as in the The Prevention of Tooth-ache. 
155 
other case illustrated, more easily managed. It 
shows what can he acomplished, and that ex- 
traction of any sort, while the jaw is yet growing, 
is unnecessary and improper. 
In irregularity, some slight assistance to 
nature in arranging the teeth in position will 
usually he all that is required; and for this 
purpose, no teeth need he removed, except in 
very rare instances. For where no teeth have 
heen extracted to " make room " and the jaws 
have heen thereby allowed to grow in the pro- 
per manner; and, when necessary, judicious 
I 
appliances have heen put into the mouth to 
assist the teeth into place, space will almost 
always be found quite, or, at all events, very 
nearly sufficient for all the teeth. 
But when all the teeth have emerged, except 
the posterior molars, and the jaws have ceased, 
or have nearly ceased, growing; and notwith- 
standing all efforts to the contrary, they are 
then found to be irregular, a new view of the 156 
Tooth-ache. 
matter is to be taken. The cause of the 
irregularity as we have shown, is invariably the 
smallness of the jaws; and not the space de- 
manded by the teeth. And just so long as 
either nature or art can promote the growth of 
the jaws, this is the only course to pursue in 
order to remedy the defect. 
But when the jaws will no longer grow, and 
all available space for the teeth has been pro- 
cured, should the jaws still not be sufficiently 
large, and should the teeth still require more 
room, then, but not until then, the only plan is 
to reduce the space which the teeth demand to 
the dimensions which it is now found that the 
jaws are able to present. 
In entering upon an explanation of the proper 
manner of adjusting the space required for the 
teeth to the dimensions presented by a con- 
tracted jaw, it is first proper to observe that it 
is not the new front teeth that are usually the 
first of the permanent set to appear as is by The Prevention of Tooth-ache. 
157 
parents generally supposed. Before, as a rule, 
any of the old teeth have been shed, the first 
molars of the permanent set-the posterior 
teeth seen in Figs, 10 and 11-have emerged. 
This fact is one that should be more noticed by sur- 
geons and parents (not forgetting many dentists). The 
first molars appear about the sixth year ; and the parent 
may always suspect that the child has got these teeth 
when there are indications that the old ones are begin- 
ning to depart. If there be any doubt as to whether or 
not they have yet appeared, the question may be settled 
by simply counting those that are in the mouth. As 
there are ten temporary teeth in each jaw, there are five 
upon each side of the jaw. If, on either side of 
either jaw, in addition to these a sixth tooth is found, 
the last is certainly a permanent one. 
These are frequently mistaken for temporary 
teeth; and are allowed to decay-and are even 
extracted-without any suspicion being enter- 
ained of their true character. 
It is also proper to observe that while the 
second dentition is in progress, the oral fluids are 
in a somewhat more viscid condition than usual; 
indeed, under the circumstances, it cannot be 158 
Tooth-ache. 
otherwise. And as the first molars are not only 
formed at an earlier age than the other perma- 
nent teeth, but occupy their places in the mouth 
during the whole period of the second dentition, 
they must needs be much more liable to decay 
than any other teeth. Statistics prove, in fact, 
that of all the permanent teeth the first molars 
are by far the most liable to decay. If there be 
tendency to decay, these teeth accordingly will 
be found to be affected by the time that the old 
teeth are lost and new ones are in their places ; 
especially if the permanent set be crowded and 
irregular: and in this manner they give un- 
mistakeable indications that if any teeth are to 
be lost, it will be themselves. 
When, accordingly, it is found, after all the 
efforts to increase the jaws have ceased, that 
irregularity still exists, and that resort must be 
had to the plan of reducing the spaces required, 
these teeth, and no others, are, almost without 
exception, the proper ones to be extracted. The. Prevention of Tooth-ache, 
159 
And furthermore, the extraction of the first 
molars (as these teeth are of large size), will, 
in almost every case, be all that is required, 
alike to bring the teeth in general into place, 
and to obviate the pressure which would other- 
wise eventually produce decay. 
There is no excuse for the great ignorance displayed 
by dentists as to the importance of looking to the first 
molars when it is necessary to make extractions in a 
mouth where the teeth are irregular; since from the 
time of Koecker (by whom attention was first drawn 
to the subject) it has been a clearly established rule of 
practice. 
Such facts as that the first molars are so much 
more liable to decay than the other teeth ; the 
tendency to decay produced by attrition when 
the teeth are crowded ; and the insidious and 
destructive progress of decay when it commences 
on the contiguous surfaces, especially of the 
back teeth, leads also to the consideration of 
some conditions which may not always be ac- 
companied by positive irregularity, but which 160 
Tooth-ache. 
bear quite as directly upon the subject under 
review. 
If, when all the teeth excepting the last 
molars are in the mouth, they are crowded,- 
although there may not be much irregularity,- 
this will induce in teeth that are not very strong, 
for the reasons above named, a decided tendency 
to decay upon their contiguous surfaces. 
It is comparatively easy to fill the teeth upon their 
grinding surfaces, even with gold ; but it requires more 
skill than is usually exhibited, to successfully arrest 
decay when this begins upon the contiguous surface. 
For this reason, and because not so readily seen in this 
part of the tooth as when occurring upon the grinding 
surface, decay is often overlooked until the cavity has 
become very large ; and then it is usually "stuffed" 
with amalgam. It is no uncommon thing to see very 
fair gold fillings on the grinding surface of the teeth, 
inserted in a mouth where there had been no effort to 
arrest decay on their contiguous surfaces ; or where, 
if attempted, it had been a wretched failure. 
When the jaws have ceased growing, and no 
more is to be gained by delay, should the first The Prevention of Tooth-ache. 
161 
molars be found much decayed, and the other 
teeth be inclined to decay upon their contiguous 
surfaces, the mouth should be treated in such 
a manner as will ensure the preservation of 
the greatest number of teeth for the longest 
period of time; and this must be done with 
as little trouble and pain to the patient as 
possible. 
The increase in the tendency to decay which 
♦ 
will be promoted by the crowded condition of 
the teeth; and the actual beginning of decay 
such as will generally be found, when the teeth 
are crowded, to have taken place in the first 
molars-and not infrequently upon the con- 
tiguous surfaces of the other teeth-by the time 
that the second dentition is about completed ; 
shows at once that, if left to the ordinary course 
of events, many of the teeth will certainly be 
soon lost. And even when fillings of the most 
perfect kind have been inserted, the loss of the 
teeth will not be altogether prevented'; for it 162 
Tooth,-ache. 
will be found almost impossible to completely 
arrest decay upon the contiguous sides of 
teeth which, however large the intervening space 
at the time of the operation, will, in a few 
weeks or months, be found again closely 
crowded. 
Looking forward then to the ultimate preser- 
vation of the greatest possible number of teeth, 
-having persistently retained the first molars 
while the jaws were increasing and thereby 
secured sufficient room for at least the re- 
maining teeth;-it will be found that when 
there are evident tendencies to decay upon the 
contiguous surfaces of the teeth, the removal of 
the first molars will allow those which remain 
to spread out over the jaws; thereby relieving 
their crowded condition, and thus reducing 
this tendency in a most decided manner: and, 
in ridding the mouth of these diseased teeth, 
which, through the effects of the decay, are 
powerfully aiding the viscidity of the oral fluids, The Prevention of Tooth-ache. 
163 
the tendency to decay in the remaining teeth is 
still further reduced. 
In short, if the principles of this treatment 
are understood, and it is carried out in a firm 
and intelligent manner; in most of the cases 
in which the teeth have a tendency to decay, 
it will suffice so far to counteract the tendency 
in question that the prospective loss of the 
teeth will be reduced from a certainty to a 
contingency. 
In order to be successful, however, from the 
beginning there must be neither mistakes nor 
deviations. This granted, it is not too much to 
say, that in the mouth where decay is a cer- 
tainty. the dentist thereby lays a broad 
foundation for the future health of the teeth 
and mouth; and he does more to preserve the 
remaining teeth, than, in many cases would 
result from all his other efforts (allowing even 
that he be most skilful) in a mouth in which 
the first molars were either extracted at ran- Tooth-ache. 
164 
dom, or were allowed to remain and keep 
the teeth in their crowded condition. 
And the dentist, however skilful he may be 
in filling the teeth, achieves his highest useful- 
ness, and to the greatest possible extent 
prevents decay, -when he so well understands 
the mode in which the teeth develope and the 
causes that must lead to their decay, that he is 
prepared to properly treat the mouth up to the 
point when the jaws cease to increase. And 
however desirable may be all other acquirements, 
it is in preventing disease that the highest are 
most needed; and where his practice is most 
scientific and most satisfactory. 
Because also of the treatment we have de- 
scribed, the fillings inserted on the contiguous 
surfaces of the teeth will be found to preserve 
them very nearly as well as in any other part; 
which is not possible when the teeth are so 
much crowded that they cannot be kept 
clean. The Prevention of Tooth-ache. 
165 
It is often extremely difficult to convince a 
person of the danger he has escaped, or of the 
serious contingencies he has avoided ; or to show 
a patient, especially where immediate pain is 
involved, that a preventative is the best treat- 
ment. Although this is of the first importance, 
it becomes, therefore, exceedingly difficult to 
pursue any systematic plan in extractions, 
owing to the natural reluctance of the patient 
to suffer except to relieve present pain. 
Tooth-extraction has been rendered much less painful 
since the introduction of Mr. Richardson's most ad- 
mirable ether-spray apparatus. Patients who previously 
were unable to endure this operation, are now able to 
sustain it. For if not altogether relieved of pain, the 
suffering is so much mitigated as to be quite bearable. 
It is not, however, altogether owing to the 
patient that teeth are so commonly extracted 
only under the impulse of severe pain; or that 
it becomes so difficult to pursue a systematic 
plan in extraction. It is to be largely attributed 
to the general ignorance of dentists. 166 
Tooth-ache. 
An excellent illustration of the difficulty of pursuing 
any such plan as has been above specified, or indeed of 
any arrangement based on the principles of common 
sense, so long as dentistry remains in its present con- 
dition, occurred to the author while this work was going 
through the press. A juvenile patient had been under 
his care for some years, and the first molars were carefully 
retained ; although one of them was much decayed and 
devitalised, and had given decided indication of perio- 
dontitis. But in order that the jaw should grow, this 
was left until it must be removed. When this time 
arrived, the patient happened to be near London, and 
was taken to a person who has a high name and a great 
practice. He not only removed this tooth, but the 
adjoining second bicuspid, which was perfectly sound ; 
assuring the patient, after it was extracted, that it had 
an ulceration at the root, although this tooth could not 
possibly be devitalised ! 
Thus, in a moment's time, was all the care that had 
extended over years, rendered useless ! 
Had the upper first molar been removed, no more 
than two teeth, as now, would have been lost ; and in 
time the remaining teeth -would have spread over the 
jaw, and relieved all the pressure and attrition, as seen 
in Fig. 13 ; whereas there is now the space of two teeth 
vacant on the lower jaw,-one more than in Fig. 12-the 
crowding of the upper teeth is increased, and rapid 
decay will be the inevitable result. Had this mortifying 
blunder occurred in the hands of some village druggist 
it would have excited in the author's mind no surprise, The Prevention of Tooth-ache. 
167 
and no more vexation of spirit than what came from the 
thought of his patient's loss. But when it is known to 
be a fair representation of the ignorance of so many of 
those whom-because they may perchance through some 
means attain a practice-the credulous and uninformed 
public are led to regard as leaders in a noble profession, 
it is sickening to think that there are yet no means 
whereby the intelligent dentist may be known from the 
empiric. 
In treating a mouth, whatever is done, the 
future condition of the teeth is a consideration 
that should never be lost sight of for a moment 
by the dentist; and hence, whenever extraction 
is resorted to, it should be practised with the 
view of removing as few teeth, and saving as 
many useful ones as possible; and of avoiding 
to the last moment, the necessity for artificial 
teeth. 
While the unlearned dentist is ever ready to extract 
the temporary teeth; and also the new ones-even when 
quite sound-while they are emerging and just at 
the time when he should leave them alone ; on the other 
hand, he is ever afterwards found just as persistently 
wrong in allowing, and even advising, the retention of 
the decaying teeth and of their roots. 168 
Tooth-ache. 
It is by no means uncommon to find a mouth in which 
either the first or second bicuspids have been lost, and 
the first molar teeth (which are some four times more 
liable to decay) "stuffed" with immense quantities of 
amalgam. And this when it is evident that had 
the bicuspids been retained and the molars lost, this 
treatment would have taken from the mouth, if not- the 
whole, certainly almost all, of the decay. 
Some illustration of the effects of extracting 
teeth at random will show the pernicious results; 
whatever may be thought of any other course. 
It should be remembered that the teeth are 
useful for mastication only in the degree that 
they antagonise one another ; and that when a 
tooth is lost, the antagonist is as useless as a 
single glove or the half of a pair of scissors. 
It is common to find a mouth in which one 
of the first molars has been extracted and the 
other left; see Fig. 12. There is no even 
balance between good and evil, and what has 
lost its power for good must have become a 
power for harm. No clearer illustration of this 
truth is presented than in these cases. If the The Prevention of Tooth-ache. 
169 
antagonist be allowed to remain, the space in 
the jaw covered by the lost tooth is also 
likely to remain, as here seen; whereby not only 
Fig. 12. 
is that amount of masticating-space lost, hut 
much inconvenience and annoyance often arise 
from the pressure of the food. Contrariwise', if 
the antagonist is removed, as is seen in Fig. 13, 
Fig. 13. 170 
Tooth-achc. 
the teeth spread out over the jaw and the space 
is closed up; and although some masticating 
space is lost, nevertheless some is gained over 
and above what would have remained if but 
one tooth had been removed. 
But the greatest gain is to the remaining 
teeth. For the health of these there can scarcely 
be too much intervening space; and that which 
will be gained in this manner will, in a mouth 
where the teeth decay rapidly, more than com- 
pensate the loss of both molars, even had they 
been sound. But in such a mouth they will not 
be sound; and if the folly of attempting to per-' 
manently retain the first molars, when there is a 
tendency to decay, is so great, how much greater 
is the folly of retaining a tooth rendered entirely 
useless by the loss of its antagonist, as we so 
often see is the case; and in mouths, too, where 
the other teeth are nearly all decaying on their 
contiguous surfaces 1 These mistakes result in 
producing just the opposite effect to what is The Prevention of Tooth-ache. 
171 
intended, and the result is clearly seen in 
after years. 
It should be understood that filling the teeth is a 
purely surgical operation; depending for success not only 
upon the way in which it is performed, but upon all the 
attendant circumstances ; and that one of the most 
desirable conditions for a filling is that, the patient can 
keep both it and the tooth clean. 
When the teeth are liable to decay, in mouths 
where the jaw has been prevented from ex- 
panding by injudicious extractions, or where 
the first molars are not extracted when decayed, 
or only one of them is lost, there will be 
presented a great variety of peculiarities; but 
all will exemplify the principles here advanced. 
For an example, refer to Fig. 14; which 
illustrates a case where instead of removing 
the first superior molar with the inferior 
antagonist, it was retained, and very greatly 
promoted the loss of the first bicuspid and 
second molar; whereby while only three teeth 172 
Tooth-achc. 
are gone, as regards power of mastication, that 
side of the mouth is almost ruined. It is also 
seen that, as the superior bicuspid locks upon 
the inferior bicuspid, and the superior molar 
upon the inferior molar, the spaces cannot close 
up,-although the cuspid tooth may move some- 
what backwards. Furthermore, as the pressure 
and attrition of the superior bicuspid and of the 
Fig. 14. 
remaining molar are necessarily greater than ever, 
decay upon their contiguous surfaces is certain 
to end in their loss, in spite of the most careful 
fillings. Had the proper course been pursued, 
decay would have been rendered so unlikely 
by the removal of the pressure and attrition, The Prevention of Tooth-ache. 
173 
that with little expense, and less extractions 
than have already taken place, the • teeth 
would have presented the appearance shown in 
Fig. 13. 
This could have been' accomplished with 
avoidance also of all the pain from the decay 
of the first bicuspid and the superior second 
molar; for even if decay had begun, it could 
have been arrested by fillings that would have 
secured the desired end, inasmuch as both they 
and the tooth could have been kept clean. 
Some years ago the author had a patient whose mouth 
had been treated (not by design, but accidentally) in a 
proper manner upon one side, but not so upon the other. 
Where the teeth had been properly removed, the/e was 
no decay ; but on the side where the extractions had 
been improperly made, all the teeth in the upper jaw- 
commencing with the front incisor-and also all the pos- 
terior teeth in the inferior jaw, were decayed on their 
contiguous surfaces. These the author filled, making 
in all nearly or quite a dozen fillings ; the whole, or 
nearly the whole of which, there is every reason to 
believe, could have been avoided had the previous treat- 
ment been right. 174 
Tooth-ache. 
Having reduced, as far as lies in his power, 
the opportunities for the action of the corrosive 
agents which decay the teeth, the next efforts of 
the dentist should be directed to such treatment 
as will bring down the strength of these agents, 
and keep them at their minimum. While the 
best of teeth will decay if these acids reach 
their maximum strength, very poor teeth may 
be preserved sound, if not acted upon by an 
external agent. 
Viscidity of the mucus may arise from such 
remote constitutional causes that it defies all 
control. It is almost certain to be perceptible 
during the prevalence of many disorders. And 
as above noticed, it is notorious how powerful 
it is during pregnancy, and how rapidly teeth 
decay during this period. 
But the most powerful acids which destroy 
the teeth may be said to be either of local 
origin, or to have been directly introduced into 
the mouth in the form of strongly acrid medi- The, Prevention of Tooth-ache. 
175 
cines, and so forth. Whether the oral fluids 
are acrid or not when first secreted in the mouth, 
if long retained there they will become so. The 
increase of the viscidity of these fluids is created 
by their chemical action upon the food and 
other deposits about the teeth; also upon the de- 
caying dentine, or whatever else is lodged in 
the cavity of the tooth ; and upon the pus 
which is immediately incorporated into them 
when discharging from gums inflamed by tartar 
or from an abscess. To reduce, accordingly, as 
much as possible, not only the tendency to 
decay, but its progress, when once begun, it is 
imperative with the patient not to allow any 
substance to accumulate in the mouth with 
which these fluids can unite and thereby in- 
crease their viscidity; or to introduce any direct 
addition to this viscidity. 
Thoroughly to accomplish this end, it is in 
the first place necessary that all Viose dis- 
organised substances which can be saturated by 176 
Tooth-ache. 
the oral fluids, and all such as are irritants that 
promote the secretion of pus, should be removed 
from the mouth. In short, all disease existing 
in the mouth should be eradicated. 
The first step in this direction is to remove all 
the tartar which has accumulated upon the teeth. 
While in a soft state the tartar is not much of 
an irritant; but when it has become hard the 
effects are most destructive. 
Dead teeth and roots also greatly irritate the 
gums; and should not be allowed to remain in 
the mouth except in cases to be mentioned, 
where they are so treated as to prevent alveolar 
abscess. It has been shown that when a tooth 
is devitalised, in time it becomes an irritant to 
the gums and alveolus; and that the matter 
which is discharged mixes with and vitiates the 
oral fluids, whereby decay is directly induced. 
These fluids also saturate the dead and softening 
dentine, find in this manner become still more 
viscid. Unless, therefore, these teeth are so treated The Prevention of Tooth-ache. 
177 
as to prevent alveolar abscess, and are also filled 
in a manner that will prevent further decay, the 
retention of them can only produce harm in the 
mouth. In view then of the health of the 
mouth and of the remaining teeth, those which 
are devitalised should either be so treated or 
removed. 
Dead teeth and roots are frequently kept in the mouth 
under the impression that they prevent the cheek 
falling. When the front teeth are lost the lip falls ; 
but it would be impossible to detect from the appearance 
of the face that a posterior tooth had been removed. 
This objection to the removal of a tooth or roots is 
therefore no less puerile than mistaken :-it may serve 
for an excuse, but it never can constitute an intelligent 
reason. And for a patient to endure the pain and bane- 
ful contingencies of diseased teeth on this account, is 
folly in the extreme. 
Even if the loss of a diseased tooth were slightly ap- 
parent, the author thinks that its deleterious effects on 
the health would, in many cases, give the face a more 
sunken appearance than would result from its loss. 
When several of the posterior teeth have been lost, 
there may possibly be some appearance of it in the 
face ; but this is nothing in comparison to the evils 
resulting from the presence of so many decaying and 
dead teeth in the mouth. 178 
Tooth-ache. 
Although the unavoidable pain experienced in 
extraction generally prevents any systematic 
plan of removing the teeth, the good effects of 
such a practice have been made obvious. Instead 
of pursuing such a plan however, we find the 
natural repugnance to pain frequently catered 
to by dentists; and what should be only allowed 
under protest, is often advised as the best. 
Under no circumstances whatever is the reten- 
tion of a tooth, after it has become an irritant 
to the gums, an advantage to the patient. In 
a majority of instances it will be utterly useless; 
or if at all useful, this will be trifling in com- 
parison to the harmful effects. 
It is a common practice to retain the natural 
roots when inserting a set of artificial teeth. 
The reason given for this practice is that they 
prevent the mouth losing its natural expression. 
It is quite true that artificial teeth as usually inserted 
are easily detected ; and especially when the roots have 
been removed does the mouth wear an unnatural, and The Prevention of Tooth-ache. 
179 
often a most disagreeable expression. But the patient 
should understand that this is not because of the loss of 
the decayed teeth and roots; but because of the unskil- 
ful manner in which the false teeth are constructed. 
Where the alveolus has much absorbed, the skilful den- 
tist, instead of inserting artificial teeth nearly an inch in 
length, as is sometimes seen,-thereby giving the mouth a 
most unnatural appearance,-will also insert an artificial 
gum, which will quite restore the natural contour of the 
face ;-except perhaps in the vicinity of the upper cus- 
pids. In so doing, he will not, however, be obliged (in 
those cases where the lip is sufficiently raised in speak- 
ing to show the gums) to resort to the miscalled gum- 
coloured vulcanite which has of late become common ; 
but will replace the lost gum with porcelain substitutes 
so naturally coloured as to defy detection. 
While the excuse for retaining the roots of the natural 
teeth has not the slightest justification, the patient 
should also understand that the pain of cutting off and 
filing down these roots is often quite as painful as 
their extraction would be. 
From what has been said on the subject of 
decay and the formation of those corrosive 
agents which cause it, the condition of the 
roots and gums under such a case of artificial 
teeth, and how immensely the viscidity of the 
oral fluids is increased, and how rapidly 180 
Tooth-ache. 
decay in the remaining teeth must progress, can 
easily be imagined. Professor Richardson has 
well stated the results of this practice.* 
"Every experienced dentist is familiar with 
the fact, that an artificial substitute resting 
upon diseased roots of teeth, and impinging 
continually upon gums already irritable and 
inflamed, soon becomes a source not only of 
annoyance and discomfort to the patient, but is 
rendered, in a great degree, inefficient in the 
performance of some of its more important 
offices. There is, besides, a perpetual and 
cumulative aggravation of the morbid conditions, 
and sooner or later irretrievable destruction of 
the remaining natural organs will be induced. 
It may be stated as a general rule of practice, 
that all the remaining natural teeth that are 
* "Practical Treatise on Mechanical Dentistry." 
By Joseph Bichardson, D.D.S., M.D., Professor of 
Mechanical Dentistry in the Ohio College of Dental 
Surgery, &c. p. 111. The Prevention of Tooth-ache. 
181 
not susceptible of being restored to a state of 
comparative health and usefulness, should be 
removed before inserting an artificial substitute. 
Especially should this course be pursued when- 
ever the remaining roots are found partially or 
wholly necrosed, and the peridental membranes 
and surrounding tissues inflamed and suppu- 
rating. Such should be extracted if for no 
other reason than that they are offensive in the 
mouth, and tend, in a greater or less degree, to 
compromise the general health. In respect to 
the utility, comfort, and permanence of a dental 
appliance, the expediency of removing the roots 
of teeth prior to the introduction of the former, 
is apparent. If a dental substitute is adapted 
with necessary accuracy to all the parts which 
it covers, it will be plainly seen that the forces 
applied to the base at every occlusion of the 
jaws in the act of mastication, instead of being 
equalised or diffused, will be expended mainly 
on the fangs, inasmuch as they afford so many 182 
Tooth-ache. 
fixed points of resistance, whilst the adjacent 
soft tissues, yielding to the pressure, permit the 
artificial piece to bear with undue and unequal 
force upon the roots. The consequences of 
this action are inevitably pernicious. In a 
comparatively short time, inflammation and 
suppuration are induced about the fangs, which 
ultimately become loosened and painfully sen- 
sitive to the slightest pressure; the secretions 
of the mouth, becoming more and more acri- 
monious, act persistently and with increasing 
energy upon the remaining natural teeth, in- 
duce rapid and general decay; contiguous 
parts, through their immediate connection or 
sympathetic relations with the structures of the 
mouth, respond to the local disturbances, and 
the case, in time, becomes complicated with 
those various distressing maladies about the 
head and face so commonly associated with 
diseased conditions of the buccal cavity. At 
last, the patient, no longer able to endure the The, Prevention of Tooth-ache. 
183 
offensiveness and distress arising from the pre- 
sence of the substitute in the mouth, or to 
properly masticate his food, is compelled to 
have the offending organs removed." 
This statement is clear and explicit: and it 
leaves no room to doubt the course to be 
pursued when artificial teeth are about to be 
inserted. 
It is difficult to conceive that even the most ignorant 
person can be long engaged in inserting artificial teeth 
over the natural roots without obtaining some idea of 
the deleterious effects of such a practice; and that it 
would not ere this have met with more opposition and 
protest on the part of dentists, were there not some 
supposed self-interest in the matter. Patients are more 
easily persuaded to have artificial teeth if they can be 
made to believe that such substitutes can be inserted 
without pain ; and they are led to think that the den- 
tist who promises to insert them without pain is both 
kindlier and more clever than he who advises the pro- 
per preparation of the mouth, although the intelligence, 
the integrity, and the charity are entirely with the latter. 
Moreover, in thus misleading the patient, the case is at 
once secured ; whereas if the mouth is properly treated, 
there must be a temporary, and afterwards (when the 
absorption of the sockets has ceased) also a permanent 184 
Tooth-ache. 
case constructed: otherwise there ensues a delay which 
involves some uncertainty. The motive, however, 
which induces dentists so readily to acquiesce in and even 
advise this inexcusable quackery, must be left to the 
conscience : we can only deal with the facts which such 
a practice presents. These facts have been clearly 
stated. And the patient, so far from listening to any 
intimation that such a course of procedure could be 
otherwise than against his interest, must regard any 
success that appears to attend it as a very7 rare ex- 
ception, and only a postponement of the inevitable evil. 
Indeed it is not too much to say that he may regard any 
person, whatever may be his position or reputation with 
the public, w'ho advises, under any circumstances, the 
retention of dead roots (unless in some rare instance, 
and then only when he proposes to treat and fill them 
as hereafter described) when about to insert artificial 
teeth, as one whose ignorance or cupidity, or both, are 
too great to allow any confidence to be placed in him. 
For so far from proffering any such advice, the dentist 
who has any regard for his patients (especially if they 
are of the humbler class, and expense is a consideration) 
and who has any respect for his profession,-or even the 
self-respect which no man should be without,-will give 
advice to the very contrary effect; and point out the 
consequences that, sooner or later, must inevitably 
follow. Moreover, as artificial teeth in a mouth that 
has not been properly prepared for their reception must, 
in almost all cases, do more harm than good, a con- 
scientious, dentist will not be content to insert what he The Prevention of Tooth-ache. 
185 
knows his patient had better be without: although a 
rigid adherence to his duty in this matter will certainly 
result in his seeing much of this sort of practice (other- 
wise coming to himself) pass into the hands of his 
less intelligent, or it may be less scrupulous neighbours. 
When the tartar and the other irritants of 
the gums have been completely removed, and 
the gums are thereby restored to health, much 
of the decay that may have commenced will 
be revealed. And the restoration of the gums to 
health will allow of the teeth being operated 
upon with a far greater degree of comfort to 
the patient, and of success on the part of the 
dentist, than was possible before this restoration 
is effected. 
If decay has commenced, the aid of a dentist 
is indispensable; and the disease should be 
entirely removed. In the first stages of decay 
it will be confined to the enamel, and is so 
superficial that this will be all that is required, 
except to thoroughly polish the surface of the 
tooth; after which, care upon the part of the 186 
Tooth-ache. 
patient in keeping it clean, will generally pre- 
vent further progress of the disease. But if in 
removing the decayed portion of the tooth a 
cavity is either found or formed, both it and the 
tooth should be so shaped as to receive a proper 
filling, which may then be introduced. And if 
this operation be performed in a skilful man- 
ner, so as to meet all the requirements of the 
case, decay will be arrested. Cases may occur 
which will defy the skill of the best dentist, 
but they will be very few indeed ; and in the 
hands of an accomplished operator, this process 
will prevent the irritation and death of the 
pulp,-provided it be not already exposed by 
decay,-and the train of destructive and painful 
consequences which are otherwise almost in- 
evitable. 
Easily as this may be stated in general terms, 
and easily as it is by many thought to be 
accomplished, it involves an amount of ability 
such as, at present, is seldom met with in the The, Prevention of Tooth-ache. 
187 
dentist. But when he does unite the requisite 
learning and surgical skill, the result aimed at 
is secured in a manner which still remains, even 
to those most familiar with it, a marvel of 
human success. 
It is proper to observe that it is not ordinary 
"tooth stopping" as practised by the great majority 
of dentists, that is here indicated ; for this has little 
effect for good, and is often productive of much harm ; 
the usual result in the end being that, after all 
the pain and the trouble, instead of finding the natural 
teeth preserved, the patient is at last brought to the 
necessity of ai-tificial substitutes. 
Dentistry, when rightly practiced, has passed far 
beyond the daily exhibition of charlatanerie seen not 
only in the mass of its practitioners, but almost as fre- 
quently in many, who, through influences foreign to 
merit, have secured a name and a position with the 
public. And patients have a right to demand, if not 
the highest degree of skill, at least some approach to it 
on the part of those who assume to be learned and skil- 
ful in an art, compared with which, there is not one that 
demands a greater amount of either of these qualities. 
Although when disease has got control of the 
mouth the aid of the dentist is indispensable 188 
Tooth-ache. 
to its restoration to health, not only before this 
condition has been reached, bnt at all times 
after the disease has been arrested or removed 
by the dentist, the health of the teeth and 
gums rests much more in the hands of the 
patient than is generally supposed. 
If decay or the accumulation of tartar is 
to be prevented, either before disease has com- 
menced, or after it has been reduced, it is 
indispensable that the strictest attention should 
be paid at all times to the cleanliness of the 
teeth. 
The food which accumulates between them 
should be carefully removed after every meal by 
means of a soft tooth-pick made either of quill 
or wood, or by means of floss-silk thread, or 
any other substance that is not hard and 
which will reach all the points where the food is 
lodged. 
The absurd idea is held by many that to use a tooth- 
pick is improper. Proper it certainly is not, any more The Prevention of Tooth-ache. 
189 
than it would, be to use a tooth-brush, at the table, or in 
any public place. But altogether to eschew the use of 
the most valuable agent in preserving the teeth from decay, 
simply because vulgar people use it at inappropriate 
times, is to emulate their folly. 
When all the accumulated foreign substances 
have been removed, as far as possible, with the 
tooth-pick, the teeth should be so thoroughly 
brushed with a soft tooth-brush and water of a 
pleasant temperature, that the newly deposited 
and still soft tartar shall be entirely removed,- 
especially at the edges of the gums,-and that 
nothing whatever of an extraneous nature shall 
be left in contact with them. 
It is a great mistake to use a hard brush ; for if the 
gums be tender, either the brush will not be allowed to 
touch them-as is usually the case-and hence the teeth 
will not be cleansed at the edges of the gums (the very 
places where cleansing is most important), or else the 
gums will be unnecessarily lacerated and inflamed. 
Besides, quite contiary to the popular belief, a soft 
brush in any case cleans better than a hard one. In 
using the brush, it should be applied to the lingual as 
well as to the labial surfaces of the teeth ; and it should 
' also be carried over them lengthwise as well as crosswise. 190 
Tooth-ache. 
Generally speaking, a tooth-powder is a de- 
sirable, and in many cases it is an indispensable, 
addition. But the powder must be a compound 
prepared solely with a view to assist the brush 
in its mechanical action ; for when such a pre- 
paration acts medicinally upon the gums and 
mucous membranes,-as do all those tooth- 
powders and washes into which myrrh, Peru- 
vian bark, quinine, chalk, camphor, and so 
forth, more or less enter,-it promotes an 
irritation of these structures which leads to 
increased viscidity of the oral fluids, whereby 
decay is indirectly induced; and when it acts 
chemically upon the teeth,-as do all those 
powders which contain acids to whiten the 
teeth,-it directly destroys them. 
It is amazing to find what nauseating, and not only 
useless but greatly injurious compounds are sold by 
apothecaries, and even recommended by medical prac- 
titioners, as tooth-washes and tooth-powders. A tooth- 
wash may at once be disposed of by saying that under 
no circumstances can it be of service ; since it can neither The, Prevention of Tooth-ache. 
191 
clean the teeth, nor remove the tartar without injuring 
them. Nor, as the inflammation of the gums is caused 
by a local irritant, can any astringent introduced into 
the mouth be other than either useless or harmful; for, 
so far as it has any effect it will induce the irritation 
it was introduced to allay. Many objectionable medicines 
are used in tooth-powders and washes ; and the most 
pernicious are perhaps the most common-namely, myrrh 
and camphor. The irritation of the mucous membrane 
which these drugs cause, when in any strength, is always 
considerable and sometimes very great. 
So strongly are some tooth-preparations medicated 
that medicines in potent doses are often interfered 
with, and the physician is perplexed by witnessing a 
result he did not expect. 
Without entering upon that interesting field of inves- 
tigation,-namely, the particular effects upon medicines 
which come of the diseased condition of the mouth,-it 
is well to invite attention to it. And it is proper also to 
make some suggestions to the disciples of Hahnemann. 
Admitting all that its advocates claim for the in- 
finitesimal dose when administered upon the tongue 
in a healthy mouth, it must be apparent to every 
intelligent mind, on reflection, that the action of such a 
quantity of medicine must depend, not only on the com- 
plete purity of the oral secretions but on the entire absence 
of all, even the slightest, opposing medicinal action. 
We are told by those who follow Hahnemann that no 
drug must come in contact with their medicines ; even 
flowers being forbidden the sick room on account of 192 
Tooth-ack^ 
their perfume. Camphor is expressly forbidden as being 
an antidote to almost all homoeopathic remedies. It is 
easy enough to perceive that all this is in strict accord- 
ance with the infinitesimal dose theory. But let it be 
answered by those who contend that when two drugs 
are given together, no one knows what the patient has 
received,-what has one of these infinitesimal doses be- 
come after mixing with the oral fluids when they contain 
acids powerful enough to destroy the dentine ; or when 
it floats in these fluids after they have become impreg- 
nated with the mercury constantly given off-granted, 
in the most infinitesimal of quantities-from a large 
number of amalgam fillings inserted in the usual man- 
ner of dental operations? Let it be answered likewise,- 
how many million times a millionth part of a grain of 
medicine will be antidoted by the daily use of a cam- 
phorated tooth-powder ! 
The truth is, that before even the primary question 
raised by the infinitesimal dose theory can be satisfac- 
torily answered, dentistry, as practised by the majority 
of those who attempt it, must become far more elevated 
than at present is the case-save with the rarest excep- 
tions-even among the few wrho have managed to secure 
the better kind of reputation. In short, before the 
homoeopathic practitioner can reasonably feel any degree 
of confidence that his medicines will have, in general 
practice, the effects which he attributes to them, the time 
must come when for a dentist to put all the structures of 
the mouth into a healthy condition, and then to instruc 
his patient how to keep it so, shall be the rule of prac- The Prevention of Tooth-ache, 
193 
tice ; instead of being, as now, apparently an unheard of 
proposition among dentists. The American writers on 
homoeopathy have the advantage over their European 
friends, in constantly coming in contact with a more 
advanced condition of dental science ; and have evidently 
had these suggestions forced upon them, since their 
later writings contain allusions to the necessity of the 
purity of the mouth. But even the American writers 
indicate little knowledge of the absolute necessity for 
this. They also emulate their European compeers in 
adopting the most extravagant theories on facial pains. 
While the agency of sugar, condiments, and 
so forth, in destroying the teeth is by most 
people immensely over-estimated, under no cir- 
cumstances should saccharine substances be long 
held in the mouth. Nor should any of the 
dentifrices formed into a paste by means of 
honey or any similar substance ever be used. 
It is necessary also that when acid or other 
medicines injurious to the teeth are taken, they 
should not only be administered through a tube 
and with the greatest care so as not to touch 
the teeth, but that the mouth should imme- 
diately be rinsed with water that is slightly 194 
Tooth-ache. 
alkaline, and the teeth thoroughly cleaned 
with the brush. 
Furthermore, none of the quack nostrums 
recommended for tooth-ache should ever be 
resorted to; since these almost invariably contain 
some powerful acids which can never be bene- 
ficially used by the sufferer, or by anyone else 
except in the manner to be described. 
At nearly all chemists' shops, especially those of an 
inferior character, remedies for tooth-ache are sold. 
These nostrums are _ often sulphuric acid, and sometimes 
one of the others hereafter named. These acids are usually 
deposited in large quantities in the cavity of the tooth, 
without any attempt being made to remove the debris 
or to protect such teeth as are sound. By this means 
not only is the pain not arrested but it is often increased; 
since the aching pulp is not reached, and the pressure of 
the agent by which the preparation is introduced forces 
the decayed dentine and other accumulations existing in 
the cavity upon the pulp, whence increased inflammation 
of this structure is nearly certain to ensue. The acid, 
also, not being confined, burns the cheeks and gums 
wherever it comes in contact with them; and be- 
coming almost immediately mingled with the saliva, 
is carried thereby to the other parts of the mouth, 
destroying the teeth in the most direct and rapid manner. The Prevention of Tooth-ache. 
195 
There cannot be a doubt that the frightful loss of teeth 
noticeable among the poor is very largely attributable 
to- the indiscreet use of these pernicious preparations. 
Almost all of the lower class-especially the advertising- 
dentists have also for sale some tooth-ache compound. 
Both these and the chemists, it is cWritablc to suppose, 
are not aware how much injury they inflict upon the 
poor. 
The treatment of devitalised teeth is, strictly 
speaking, for the purpose of preventing tooth- 
ache ; but it will be found much more convenient 
to explain it when treating of Cure. THE CURE OF TOOTH-ACHE. 
0VEREIGN remedies for this pain are not 
only dispensed as above intimated, but 
are also named with great confidence in almost 
every domestic .circle. But the simple fact that 
there is not the slightest approach to agreement 
in them, is sufficient evidence that they are not 
selected upon any sound principle; and an 
enumeration of the domestic remedies would be 
found more fitting for insertion in an illustrated 
comic periodical than in a sober treatise like the 
present. 
The cure of tooth-ache, or the success which 
may attend efforts in this direction, depends very 
much upon its character. Odontitis is easily The Cure of Tooth-ache. 
197 
managed; "but periodontitis is frequently beyond 
remedy, and is to be removed only with the 
tooth itself. 
When the pulp has become exposed and the 
tooth aches, it sometimes happens that it had 
better be at once extracted. But if undesirable 
to remove the tooth, this pain may be relieved 
by the application of a local anodyne. Oil of 
cloves, carbolic acid, and many similar prepa- 
rations will act as anodynes to the pain in 
question; but the application of creasote will be 
found the most efficacious, and it will almost 
instantly relieve the pain of odontitis. 
Whenever a tooth-ache remedy is introduced 
into the cavity of a tooth,-being necessarily a 
powerful acid,-it must be so well protected that 
it will remain where placed; and thereby not 
only fulfil the intended use, but produce no 
injurious effect upon the other teeth. Wax, 
gutta-percha, and similar substances are used 
for this purpose; but the liability of these to 198 
Tooth-ache. 
create pressure upon the already inflamed pulp 
is too great, and they do not sufficiently confine 
the remedy to its place. 
The proper substance to use is finely-ground 
plaster of Paris mixed with sufficient water to 
form a soft paste. The simple and harmless 
application of creasote is accomplished by care- 
fully removing,-so as if possible not to touch 
the pulp and thereby increase the pain,-all the 
debris, such as food and decayed dentine, which 
has accumulated in the cavity of the tooth. 
When this has been accomplished and the 
pulp is laid bare, so that the medicament may 
come in direct contact with it, the cavity may 
be dried out with paper or cotton; and after 
arrangements have been made to keep it dry 
for a sufficient length of time, a small pledget 
of cotton containing from a tenth to half a 
drop of creasote may be introduced directly 
upon the pulp. The remainder of the cavity 
may then be filled with the soft plaster, which The Cure of Tooth-ache. 
199 
must be protected from the saliva until it has 
" set." An immediate, and afterwards, an 
occasional rinsing of the mouth with water will 
prevent any deleterious effects. 
The plaster will not remain where deposited 
more than a few days; and as the creasote is 
only a palliative, the application of this anodyne 
by itself is advisable only when the pain is 
severe, and the immediate destruction of the 
vitality of the tooth by artificial means would 
be likely to prolong, and perhaps to increase 
the pain. 
As the irritation of the pulp, when once it is 
excited, is certain in the course of time to cause 
its devitalisation, it is best at once to accom- 
plish an end which cannot be prevented: so 
that the suffering which is almost certain to 
follow the exposure of this structure, may be 
thereby curtailed. It is incumbent on the 
operator that this result should be accomplished 
with as little pain as possible. 200 
Tooth-ache. 
The destruction of the vitality of the tooth is 
what dentists call " destroying the nerve; " a 
term which, although indefinite, is not altogether 
inappropriate. 
The pulp is medicinally devitalised by the 
application to the tooth of a minute quantity 
of arsenic,-say from one-fiftieth to one-thirtieth 
of a grain. The application of the arsenic must be a 
little different, however, from that of the creasote. 
While the medicinal devitalisation of the pulp 
should always be brought about in a harmless 
manner, and should seldom excite pain, great 
and unnecessary agony and much injury are 
often the result of this process. 
The chief mistake made in applying arsenic to a 
tooth, is the excessive use of it, -so much as three or 
four grains being sometimes placed in the cavity,-which 
causes very great irritation, not only in the pulp, but 
in the periosteum. Other mistakes are not first removing 
the decayed dentine so that the arsenic may be applied 
upon a sound spot; also in applying it directly upon 
the exposed pulp ; and more especially, in crowding the 
material used for a covering so hard .upon the pulp or The Cure of Tooth-ache. 
201 
the dentine lying above it as to cause excessive inflam- 
mation and excruciating pain in this structure. 
As the mineral is used to destroy the tissues 
of the pulp, if applied in too great quan- 
tities or directly to this structure, it will 
create extensive engorgement of its vessels, and 
consequently for a time severe pain. It is 
a common practice with the more intelligent 
dentists to unite with the arsenic about the 
same quantity of morphine; and this, to some 
extent, certainly counteracts the painful effects 
of the mineral. Others go further and make 
a paste of morphia, creasote, and arsenic ; or 
what amounts to the same thing, they take up 
on a pledget of cotton previously saturated 
with creasote, a mixture of the two dry 
substances. 
A small quantity of aconitine added to the 
arsenic will also have a powerfully anodyne 
influence upon the pulp : but this preparation 
is not to be used by any one unacquainted with Tooth-ache. 
202 
its potency, as the fiftieth part of a grain has 
been known to endanger life. 
If the tooth be aching, it is best to first 
subdue the pain with creasote alone. In order 
to accomplish this, the creasote may have to 
remain in the cavity covered with plaster of Paris 
for twenty-four hours; but the pain can usually 
be so thoroughly reduced in a few moments,-by 
removing the debris, drying out the cavity, 
applying the remedy and protecting it with dry 
cotton and a mouth-napkin held by the finger 
of the operator over the cavity,-that the appli- 
cation of the arsenic may be immediately made. 
If it has been necessary to use the plaster, at 
the end of the time named it should be care- 
fully removed so as not to disturb the pulp. 
When the tooth no longer aches, a pledget 
of cotton containing creasote alone should be 
placed directly over the pulp; and another, 
containing a mixture of arsenic and morphia, 
may then be placed against the sound dentine The Cure of Tooth-ache. 
203 
at a point which, has been laid bare for that 
purpose, and the whole, as directed, be covered 
with plaster of Paris. The creasote, acting 
directly upon the exposed pulp, will prevent a 
recurrence of the pain; while the arsenic will 
gradually penetrate the dentine, destroy its vi- 
tality, and eventually the vitality of the pulp also. 
If the pulp be certainly exposed and yet 
there is no pain, it is best to remove a portion 
of the decayed dentine so as to expose a sound 
spot at a point remote from the pulp, taking 
great care not to irritate this structure. The 
arsenical preparation may then be applied, and 
covered with plaster. 
The arsenic should not be allowed to remain 
in any tooth more than twenty-four hours; and 
in some teeth retention for only a few hours is 
prudent, as this mineral, if too long retained, 
causes the permeating fluids of the dentinal 
tubes to assume a pinkish colour, and that hue 
becomes imparted to the tooth. 204 
Tooth-ache. 
The pulp will generally be found so much 
disorganised in from four to five hours after the 
introduction of the arsenic, that it will not 
again ache continuously. But there will be so 
much vitality remaining in the root for some 
days, and in some instances even for weeks, 
that it is usually best to remove the decayed 
dentine and a portion only of the pulp, and 
then to fill the cavity temporarily; waiting, 
before anything further is attempted, until the 
root can be operated upon without pain. 
There is another mode of destroying the pulp 
much in vogue; namely, suddenly thrusting 
into it some sharp instrument. This is' usually 
done without any warning to the patient of what 
may be expected; and even some practitioners 
are found so lax in their ethics that it is 
preceded with a solemn assurance-intended to 
deceive, lest the patient should exhibit the 
decided unwillingness, natural, when asked' to 
undergo such torture-that no pain need be The Cure of Tooth-ache. 
205 
feared. The effectual puncture of the pulp will 
certainly accomplish the intended result; but the 
agony is so frightful and the shock to the 
nervous system is so severe that the patient 
will be found, after having once been deceived 
and tortured in this manner, never again willing, 
and in many cases utterly unable ever again to 
submit to dental operations. 
Cruel and unnecessary as is this mode of 
destroying the vitality of the tooth, there are 
dentists who-seemingly ignorant that owing to 
the delicate structure of the pulp, a single 
thrust of a needle is certain to destroy it-add 
to this unspeakable horror by an arrangement 
whereby, while the needle is held in the pulp 
an electric spark is communicated to it and the 
pulp is exterminated by cauterisation ! 
Considering the utterly painless manner by 
which this structure is usually devitalised, these 
practices have not the slightest excuse. 
As in more or less time, unless the tooth be 206 
Tooth-ache, 
treated and filled into the roots, periodontitis 
is certain to follow the death of the pulp, to 
fill at once permanently and only into the 
crown,-as, it may be said, is universally done,- 
is to make no provision against this pain; 
which may commence in all its severity within a 
few weeks after the tooth is dead. In view of 
this fact, in almost every case it would be far 
better to remove the tooth at once, rather than 
to follow the empirical course so very generally 
adopted. 
The pulp being the centre of vitality in 
a tooth, the death of this part, instead of 
preventing future tooth-ache,-as is too often 
imagined will be the case,-is, as has been shown, 
only the beginning of the end; and it is but 
another step in nature's progress towards the 
expulsion of the tooth from the mouth. 
As periodontitis is certain to follow the de- 
vitalisation of the tooth, it becomes a serious 
question what is to be done with it under these The Cure of Tooth-ache. 
207 
circumstances. When a tooth was reduced to 
this condition, it is but within comparatively 
recent times that all that could be accomplished 
was either to extract it at once, or else,-if 
it was thought it might be retained for a short 
time,-to fill it; at the same time perforating 
the tooth from the side into the pulp cavity,- 
as recommended by Dr. Flagg, of Boston, 
Mass.,-thus forming a passage by which the 
pus could be discharged. The condition of the 
tooth was then explained to the patient; and he 
was given to understand not only what might 
always be expected, but what was certain to 
follow in time; and this was supplemented with 
advice to have the tooth removed as soon as 
the pain became unbearable. 
Fortunately, however, dental science has ad- 
vanced to such an extent, that not only in almost 
every instance where the pulp has been only 
recently destroyed is it possible to prevent this 
painful affection,-but in a large majority of 208 
Tooth-ache. 
cases the alveolar abscess can even be healed, 
and its recurrence prevented. 
In describing the organisation of the teeth, it 
was shown that it is only the enamel and the 
dentine which entirely depend upon the pulp for 
vitality; and that to a considerable extent the 
vitality of the cementum is derived through the 
periosteum. Hence it follows that, while the 
inflammation of the pulp necessarily involves 
its own devitalisation and likewise the devi- 
talisation of the enamel and the dentine, the 
death of the cementum is not necessarily 
included. The last-named structure in fact, is 
able to exist in a comparatively healthy con- 
dition so long as the mere devitalisation of the 
other structures of the tooth is all that follows 
the death of the pulp. But as this condition of 
the cementum cannot long continue, and inflam- 
mation in this structure is sure to be set up in 
the course of time if it is left to be acted upon 
by exciting agents, the problem is presented to The Cure of Tooth-ache. 
209 
the dentist how to prevent it, and thereby retain 
the tooth in the mouth without disease or 
pain. 
This desirable end is accomplished by first 
removing the entire pulp, when it has become 
devitalised throughout its whole extent, with 
delicate instruments expressly shaped and 
tempered for the purpose; and then filling the 
pulp-cavity either with gold or tin-foil, thereby 
preventing the action of any irritating agent 
upon such living organisation of the tooth as 
remains. To arrest further decay, the tooth 
should afterwards be filled in the crown in the 
ordinary manner. 
When the principles of this elegant operation 
are correctly conceived, and it is performed with 
the skill which it indispensably demands, suc- 
cess is almost certain. 
The mode of filling a dead tooth into the roots has 
frequently been described. Yet we find very few den- 
tists undertaking it, even rarely, and still fewer who 210 
Tooth-ache. 
are successful in the performance. The reason of this 
is not difficult to discern. The very nature of the 
operation demands an intimate acquaintance with the 
anatomy of the tooth, and all the conditions of its 
several structures alike in health and disease. With- 
out this there can be only guess work ; and failure 
from one cause or another is almost inevitable. It is 
true that in rare instances the operation is successfully 
accomplished by dentists of the average standard. But 
when this happens, the success is attributable rather to 
good fortune than to skill ; and failure among this 
class of dentists whenever the operation is undertaken, 
is so general that it has engendered with them, if 
not absolute disbelief in its efficacy, at all events very 
grave doubts. 
Not comprehending the principle of the process which 
they address themselves to, they do not know when they 
possess or are unprovided with the suitable instru- 
ments. They cannot determine when they have 
penetrated to a sufficient depth in the root; they are 
very apt to force the instrument through the side of the 
root, thereby irritating the periosteum and inducing 
inflammation in the structure that should be pro- 
tected ; and various other mishaps combine to render 
the attempt abortive. 
When the tooth has been so long devitalised 
that periodontitis has become developed, it 
should be at once extracted, unless it be one The Cure of Tooth-ache. 
211 
particularly desirable to retain, and 'which, 
can be restored to a healthy condition. 
Since the inflammation which causes the pain 
of periodontitis is not, except to a very slight 
degree, in 'any of the structures of the teeth as 
in odontitis,-but is rather an inflammation in 
other structures residting from the death of the 
tooth,-while the removal of the irritating agent 
■will eventually relieve the pain, the suffering 
will not always cease on the instant. Indeed, 
for a time, it will in some instances be much 
increased. When, therefore, it is discovered that 
the extraction of the tooth for periodontitis 
does not afford instant relief (as it will in 
cases of odontitis), it is not to be assumed that 
there has been a mistake in the diagnosis and 
that the pain was not tooth-ache, but " tic" or 
" neuralgia." 
If the tooth be one that should not be parted 
with, about the only relief for this malady is 
nature's own process, above described; for, owing 212 
Tooth-ache. 
to its locality and character, little can be effected 
by the dentist, except sometimes in mitigation of 
the pain or to promote the discharge of the 
pus in the right direction. 
It is always very much easier to offer sound advice than 
to combat errors in opinion and practice ; and it is 
exceedingly difficult to get proper advice adopted when 
it happens to be of a negative character. Many patients 
seem to think that when there is disease nature does 
nothing, or next to nothing, towards the cure ; and that 
this is wholly effected by medical treatment; and when 
they consult a medical practitioner, they appear to take 
it for granted that he will at least do something. It is 
also curious to observe that almost anything will 
pacify such patients, if it possess the one quality of 
action, even though it may be quackery the most 
ridiculous. Hence, if the medical man suggests that 
nothing should be done, and recommends that the dis- 
ease should be left for nature to work out her beneficent 
ends, not only is the proposition incomprehensible, but 
the adviser ceases to be regarded as a competent phy- 
sician : and the patient too often feels,-whether he 
expresses it or not, -that it was not for this that the 
medical man was sought. So determined will a certain 
class of persons often be found that something shall be 
administered, that when the doctor has advised them 
to trust to nature,-although necessarily quite ignorant 
of the disease and of the effects of remedial agents,- The (Jure of Tooth-ache. 
213 
they will nevertheless not infrequently themselves apply 
some supposed remedy which has been suggested by one 
as ignorant perhaps as themselves, and which not only 
aggravates the disease, but removes it beyond the 
control of any properly applied agent. 
This class of patients is so numerous that the prac- 
titioner whose only aim is success in getting a prac- 
tice, at once falls into their view of his duties ; and 
even the most conscientious, from the pertinacity of the 
patient, is apt to be sometimes unconsciously misled. 
It is almost entirely in consequence of this idea,- 
though it may not be expressed in words,-namely, that 
a remedy of some sort must necessarily be applied, what- 
ever may be the affection or its character, that it is 
found so difficult to indicate the proper course to be 
pursued when an alveolar abscess is threatened. 
It would seem an axiom in therapeutics too plain to 
be mistaken, that the use of a remedy is to assist and 
in no way to' interfere with nature ; and that an 
intended remedy should never be applied until there is 
a pretty clear perception of what it is that obstructs 
nature's processes, and that the action of the agent 
selected should be so well understood that it will be 
known to produce the specific end in view. 
Yet the intelligent dentist finds that his greatest 
difficulty in dealing with periodontitis is to prevent the 
adoption of advice tendered by persons who can have 
no idea whatever of the nature of the disease beyond 
the fact that there is pain in the face ; and to prevent 
also, the application of agents which, so far as they 214 
Tooth-ache. 
have any influence, can only produce effects the very 
opposite to what are desired. 
The first remark to be made, accordingly, with refer- 
ence to the cure of this disease, is that the patient 
should do nothing except in accordance with the very 
best professional advice, since the supposed remedies 
which are usually applied will be almost certain to prove 
more hurtful than beneficial; and further, that in seek- 
ing advice, in this and in all other cases, instead of 
doing so with a preconceived notion that active medi- 
cinal effort should at once be commenced, the patient 
should remember that the primary, and often the most 
important consideration in the physician's mind is the 
question thus foreclosed ; and that it is one which the 
medical man alone must decide. 
The second remark is that the practitioner would 
accomplish results more useful by doing nothing, and 
leaving the progress of the disease to nature, than 
by applying anything which had not a direct reference 
to some specific end ; a clearer comprehension of which 
had been obtained through some better channel of 
information, on this and kindred subjects, than ordinary 
text-books. 
The efficacy of an antiphlogistic treatment 
based upon general depletion, which has been 
suggested, is more than questionable. It can do 
no good, and may be productive of much harm, The Cure of Tooth-ache. 
215 
as we find this pain generally arises when the 
system is in an exhausted condition. Local 
bleeding, so much relied upon, while open to no 
very serious objection, is seldom found of use; 
and the good effects of sialagogues, which have 
also been named, are very doubtful. 
What, however, is especially to be avoided 
when pain is felt in the teeth or in the face, is 
the application to the cheek of emollients, such 
as linseed, bread and milk, hot mustard, and so 
forth. For these, so far as they act upon the 
disease, directly increase the danger of the dis- 
charge being made through the face or into the 
antrum instead of into the mouth. They also 
promote the spread of the inflammation, which 
should be confined as much as possible rather 
than be allowed to extend. 
The pus from an alveolar abscess is not infrequently 
discharged upon the face. The author once met a 
young lady who had no less than three scars upon her 
face, which her physician informed him had been pro- 216 
Tooth-ache. 
duced by the application of emollients when suffering 
from face-ache caused by alveolar abscess. By the 
advice of her physician, another young lady applied to 
the author some few years since with a running sore at 
the base of the lower jaw, which, after vain attempts to 
cure it, extending over three years time, a country prac- 
titioner had pronounced to be scrofula ! The removal 
of an inferior molar tooth, which was the cause of an 
abscess, not only cured the disease, but took from this 
lady the weight of a supposition which had greatly 
depressed her spirits and thereby seriously affected her 
health. 
Nothing of a local character can be much 
relied upon. But a roasted fig or raisin, or 
anything that, will act as an emollient, applied 
to the gums over the affected root, will generally 
hasten suppuration; and also help to cause the 
pus to be discharged in the right place. 
The application to the face of cold water,- 
and sometimes warm water,-frequently renewed, 
or of a fomentation of poppy heads with either 
chamomille, calendula, or a small quantity of 
aconite leaves, will generally assuage the pain. 
But if the pain be very severe, and no relief The Cure of Tooth-ache. 
217 
is obtained by the application of any of these 
remedies,-then from half a grain to a grain ot 
quinine (repeated if necessary in an hour) will 
be almost certain to afford at least temporary if 
not always permanent relief; especially when the 
pain is periodic, and accompanied by febrile 
symptoms. 
Several experiments very recently made by the author 
go to show, as has been stated, that this drug is a 
specific for periodontitis. It has been observed in 
several instances to assume so direct and immediate a 
control over it, that the acute pain was relieved in a 
very short time,-even when it had continued for some 
weeks,-and to leave the seat of the pain sore to the 
touch, showing thereby that the inflammation had 
not subsided: after a time this has also disappeared 
without a recurrence of the pain. 
Before resorting to quinine, however, the other remedies 
had better be tested, and this one be adopted only 
as a last resort. Nor should it ever be given simply 
because there is tooth-ache - but for periodontitis 
only. 
When the abscess has progressed so far that 
the pus is ready to burst through the gum, the 218 
Tooih-achc. 
application of the lancet in the right place will 
relieve it. 
Sometimes, notwithstanding all the efforts 
for relief, the inflammation is very great, and the 
pain is so severe that it cannot be endured; 
and although the tooth be ever so valuable, 
extraction must be resorted to. When the tooth 
is thus valuable, if able to retain it until the 
abscess has subsided, the patient should im- 
mediately seek a dentist,-if such a one is to be 
found,-who will prevent its recurrence. 
It is unfortunate that so many dentists,-and even 
dentists with lucrative practices,-seem as unconscious as 
the public of any other cause of tooth-ache than an 
" exposed nerve ; " and that they should imagine when 
a tooth is the unmistakeable seat of pain, that such 
agents as creasote, carbolic acid, arsenic, &c., will 
give relief. Strange as it may seem, these agents are 
often applied in great quantities to the tooth in cases of 
periodontitis,-with what result it is easy for any 
reader of these pages to determine. 
A gentleman applied to the author while suffering 
from the pain occasioned by a devitalised tooth, which he 
was recommended to lose. Not feeling able to endure The Cure of Tooth-ache. 
219 
the pain of extraction, he declined to have it removed. 
In a day or two afterwards he accompanied a friend on 
a visit to a dentist; and the fact that he was suffering 
from tooth-ache becoming known to this person, he at 
once proposed the application of carbolic acid. He was 
promptly told that the patient had been advised that no 
local application could be of any service, as the tooth 
was aching because the nerve was dead. This statement 
seemed so far beyond his comprehension that it was 
treated with contempt, and he declared that no tooth 
could ache except from an exposed nerve. The patient,- 
only too anxious to be relieved from pain,-submitted, 
accordingly, to the application of this person's cure-all, 
which it is needless to say afforded no relief. Such cases 
as this are by no means uncommon ; and in nothing has 
the author found more difficulty than in combating the 
idea that where there is a dead tooth there cannot be 
tooth-ache. 
Although it is best that periodontitis should 
be prevented, even when there is inflammation 
in the cementum and periosteum resulting in 
alveolar abscess the tooth is not yet beyond the 
reach of the highest dental skill. If the tooth 
can be retained until the pain has ceased, the pus 
has been discharged, and the swelling and inflam- 220 
Tooth-ache. 
mation have subsided, the parts return to their 
former chronic condition. 
While in this state,-after all the decayed den- 
tine, the secretions, pus, and other accumulations 
in the tooth, which arc the irritants whereby 
inflammation is excited, are removed to the very 
apex of the roots,-the renewed application of a 
powerful antiseptic to each root, will, in time, 
overcome the putrescence; and a comparatively 
healthy action will be restored to the periosteum 
and cementum. This, if continued, is all that 
is required to retain the tooth with comfort in 
its position. 
As soon as this condition is reached,-but not 
until it is entirely accomplished,-the roots may 
be filled ; and after a few days, the crown also, 
as above directed: and if the treatment and 
operation have been correct and thorough, the 
retention of the tooth may with much confidence 
be relied upon. We may however conclude that 
its liability to disease must be greater than that The Cure of Tooth-ache. 
221 
of a tooth in which the pulp remains unaffected.; 
and that when the system is greatly prostrated, 
or the patient is suffering from a severe attack of 
any disease which excites undue cerebral action, 
it may be expected in a greater or less degree, 
despite all preventive treatment. 
If the operation of filling a dead tooth prior 
to the inflammation of the periosteum be one 
requiring the highest dental skill, the treatment 
of abscess and subsequent root-filling requires 
no less. And it would be difficult to find in the 
whole range of surgery, an operation in which 
the conception is finer, or in which the treatment 
is based upon principles more scientific. 
It is to be observed that this treatment and the sub- 
sequent filling of a dead tooth is a painless operation. 
When the treatment for the prevention and 
cure of the different forms of tooth-ache cannot 
for any reason be adopted, the offending tooth 
should be removed; since even if it were of any 222 
Tooth-ache. 
use, this could not be sufficient to compensate 
the injury to the structures of the mouth, the 
stomach, and other parts, which is caused by 
a decaying, dead, and ulcer-forming tooth; and 
it invariably more or less (and in many cases 
entirely) prevents the otherwise efficient use of 
the remaining sound teeth, which if the diseased 
ones were removed, would be equal to the pur- 
poses of mastication. DISEASE IN THE ANTRUM. 
ELUSION has been made to the Maxillary 
Sinus, or Antrum Highmorianum. 
This cavity is situated in the body of the 
superior maxillary bone, and communicates with 
the middle meatus of the nose. It is some- 
times perforated by a root of one of the pos- 
terior teeth. So long as such a tooth retains 
its vitality, a healthy condition of all the parts 
subsists. But if one of these teeth becomes devi- 
talised, the inflammation of its periosteum is 
certain to extend to the lining membrane of 
the antrum. The wall between the floor of 
the antrum and the root of a tooth that is 224 
Tooth-ache. 
causing an alveolar abscess, may also be so 
thin that the pus is discharged into this 
cavity. Other influences cause disorders in the 
antrum which will sometimes produce alarm- 
ing and even fatal results. It does not come 
within the scope of this work to give any 
details of these diseases. The fact to which 
we wish -to draw attention is that such diseases 
are by no means infrequent, and that severe 
pain ensues. Of these cases many, and in all 
probability a large majority, are relieved and 
cured by the extraction of the offending tooth 
without any knowledge on the part of either 
patient or physician of their existence. But 
tooth extraction will not always give relief; and 
the case is then by far too apt, because of the 
obscurity of the origin of the pain, to be 
regarded as an instance of facial neuralgia, and 
is allowed to prevail perhaps for years, without 
any knowledge of its existence or attempt to 
relieve it. Disease in the Antrum. 
225 
A highly respectable lady of this city was afflicted 
for many years with inflammation in the lining mem- 
brane of the antrum. When the true character of 
her complaint became known, an injection of warm 
water a few times repeated produced a cure. The author 
was applied to by a servant girl who had wandered 
for some years among the medical charities, to obtain 
relief for a pain in her face and a discharge in her 
mouth. She also was suffering from inflammation in the 
lining membrane of the antrum ; and an injection, 
three or four times repeated, of water slightly impreg- 
nated with creasote produced a complete cure. 
For the best authority on disease of the maxillary sinus 
the student is referred to Dr. Chapin Harris. NEURALGIA, TIC-DOULOUREUX, &c. 
~J~N pointing out the origin and the symptoms 
of tooth-ache, enough must have been 
shown to suggest-at all events to the thoughtful 
mind-the seat of those facial pains which we 
find so generally regarded as idiopathic 
affections, and to expose the inappropriateness 
of the terms by which they are known. 
As these terms,-except " tic " and " tic-dou- 
loureux," the origin of which has already been 
explained, and which we have seen to apply most 
unmistakably to odontitis,-are really so indefi- 
nite, it will be well to point out that they by no 
means describe or even suggest any particular 
disease; and that they give no sort of intimation Neuralgia, Tic-douloureux, &c. 
227 
as to the cause of these pains. When translated, 
into plain English they are found to express 
only the fact that there is suffering. Eor 
instance, "neuralgia" is simply "nerve-pain." 
Can any pain be felt except by means of the 
nerves? Is there any other than nerve pain? 
So with " facial neuralgia " (nerve pain in the 
face), " prosopalgia " (face-pain), and so forth; 
The patient knows well enough when he 
consults his medical adviser regarding the 
symptoms which go under these names, that 
he has pain / It is not to be assured of this in 
language which he does not clearly understand,- 
even if he comprehends it at all-and which can 
be no clearer to the practitioner himself, that 
he seeks his opinion and aid; but that the 
appropriate remedy may be applied. So the 
student, if his ethics be up to the proper 
standard, does not consult Iris text-books that 
he may learn how to employ these empty phrases 
dexterously; but that' he may be able, when 228 
Tooth-ache. 
called upon, to perform the uses to which he 
proposes to devote his life in a scientific and 
effective manner. 
So long as the origin of these pains is sought 
in a wrong direction, it is not surprising that 
their character should become more and more 
mysterious; on the contrary, it increases in ac- 
cordance with the wanderings of investigation 
away from the truth. 
Neither is it to be wondered at that,-not 
knowing their origin, and, for the satisfaction of 
many patients who would not otherwise rest 
contented, obliged to give these pains "a local 
habitation and a name," we find in such 
general use phrases which are exceedingly con- 
venient,-sounding, as they do, in the ears of 
those patients as if, instead of representing in 
diagnosis an "airy nothing," they were the 
embodiment of the most extensive erudition,- 
for concealing the absence of any real in- 
formation on these diseases, and as allow- Neuralgia, Tic-douloureux, &c. 
229 
ing scope likewise for the assumption of the 
profoundest intelligence, by many who, if 
constrained to express themselves in intelligible 
language, would at once reveal their complete 
ignorance of the whole subject. 
But however strongly some such terms may 
be demanded by many patients when suffering 
from tooth-ache, and however useful these phrases 
may be to some practitioners on the ground 
referred to, it would be difficult to account for 
the ready acquiescence in them and adoption by 
the patient, did it not sometimes unmistakably 
seem as if human nature is really so constituted 
that, in many people, the spirit excoriated by 
Thackeray is so great that they actually feel more 
reconciled-and in some cases even feel flattered 
-if their disease can have attached to it some 
pompous and far-fetched, and-what appears to 
them-a genteel and high-sounding name, which 
implies that they are not even sick as other 
people are; and as if they were dissatisfied both 230 
Tooth-ache. 
with themselves and with the doctor, when the 
malady is found to be, after all, only common- 
place and undignifying, and such as anybody 
might suffer from. 
There is nothing so difficult to eradicate as 
what has become fashionable, however absurd it 
may be; for the simple reason that it is based, 
not upon the judgment, but upon vanity or 
supposed convenience, neither of which are 
amenable to the laws of common-sense. There 
will always be a large number of persons, 
accordingly, who will not listen with any 
patience to suggestions which may interfere 
with what they would have appear to be true, 
and with whom anything like argument and 
philosophical reasoning is a mere waste of 
words. 
But it is a happy and a proud matter for 
congratulation that most of those who practice 
the healing art are influenced by the highest 
and purest motives; and that there are, after Neuralgia, Tic-doulourcux, &c. 
231 
all, comparatively few patients who are really 
willing dupes to ignorance and pretence. So 
that it is not so difficult as those who are 
pursuing a mere crotchet would sometimes have 
us believe, to establish a truth when once it has 
been discovered. 
The indiscriminate application of meaningless 
terms to pains which cannot be readily accounted 
for, has led to some of the most curious as well 
as the most erroneous speculations upon nervous 
action which it would be possible to find. 
To rehearse them would be idle, since they 
end as they begin-in nothing! When a 
pain arises, it is the duty of the medical man 
to ascertain its origin by patient investigation; 
not to build up a fabric of absurdities through 
attempting to account for it by the exercise of 
that tendency of the human mind to make 
discoveries independently of facts; and which 
has its foundation in indolence and conceit. 
Especially has the term "neuralgia," become 232 
Tooth-ache. 
such a very common designation for almost all 
painful affections of uncertain origin, that other 
than dental writers find it necessary to inquire 
into its use and meaning. 
Dr. Barclay says,* "The term neuralgia is 
one which only serves to remind us of the limited 
range of our knowledge: had we attained to a 
perfect pathology, it would find no place in a 
systematic classification of disease, except as a 
symptom. In itself a mere sensation dependent 
on a variety of causes, we are yet forced very 
often to rest satisfied with the knowledge of its 
existence, without being able to trace it back- 
ward to its true source in the causality of 
disease; and at the same time its very vagueness 
too often serves as a cloak for ignorance, or fur- 
nishes a ground for deception. It is exposed to 
all the difficulties in investigation which are 
inseparable from merely subjective phenomena, 
* "A Manual of Medical Diagnosis.'' By A. W. 
Barclay, M.D. p. 249. Neuralgia, Tic-douloureux, dec. 
233 
and. there are few indications by which we can 
correct an opinion wo are driven to form merely 
upon the patient's own statement: even when 
convinced that there is no exaggeration or de- 
ception, we are still so ignorant of the changes 
in nervous structure, that if we be able to prove 
by post-mortem evidence that there has been no 
other cause for the pain, we must still rest 
satisfied with the fact that it has been felt, and 
with the expression that it was neuralgia." 
Having thus defined this term as a vague 
expression, this author continues: " One point is 
perhaps not sufficiently attended to in the em- 
ployment of the term, that while in truth all 
pain is perceived by the nerves, and in that 
sense is seated in the nerve, yet all pain ought 
not to be called neuralgia. 
u The true distinction between the two is that 
in the one instance the sensation is produced by 
some irritation acting locally on the terminal 
filaments of the nerves which are the normal 234 
Tooth-ache. 
recipients of it, while in the other it is caused by 
something affecting the trunk of the nerve,- 
that bundle of fibres, large or small, lying within 
the neurilemma, which in a state of health 
does not receive but transmit the sensation: con- 
sequently, neuralgia properly so-called affects all 
the sensitive branches uniting to form the 
trunk on which the irritation acts, and pain is 
felt sometimes distinctly to the terminal fila- 
ments, sometimes vaguely in the course of the 
ramifying fibres." 
While this description of pain is pretty clear, 
when we consider the difficulty in determining 
what this something actually is-or indeed if 
there be anytliing-affecting the trunk of the 
nerve, we find that we are no nearer than before 
to any clear definition of neuralgia: and we 
can after all only regard it as designating a 
mere sensation, the cause of which it is our 
duty to look for until found; not appearing as 
if we knew all about it, and thereby deceiving Neuralgia, Tic-doidoureux, &c. 
235 
ourselves as well as our patients with a few 
empty sounds. 
Proceeding to a further description of local 
pain, Dr. Barclay says that it "is either direct or 
sympathetic: when accompanied by a febrile 
state, it is always referrible to some congestion 
or inflammation; without fever, it is either de- 
pendent on some chronic ailment of the part, or 
it must be regarded simply as neuralgia. The 
first inquiry, therefore, is whether there be any 
alteration in the function, normal condition, or 
nutrition of the part in which pain is complained 
of; next, whether any ailment exists elsewhere 
of which such pain is known to be sympathetic. 
Should careful inquiry reveal no definite cause 
for local pain, we must be content with the 
terms neuralgia and irritation; not that they are 
in themselves satisfactory, but they serve to 
distinguish conditions beyond which we cannot 
at present penetrate." 
So far from placing too much restriction upon 236 
Tooth-ache. 
the use of the term neuralgia, this writer errs, if 
he err at all, in allowing it so large a place as 
he does. 
That in the present condition of medical 
diagnosis there are many pains felt in different 
parts of the body, as to the origin of which it 
would not be safe to hazard even a guess,-and, 
in the rarest instances, even in the mouth and 
face, which cannot be positively accounted for,- 
there is abundance evidence. And while we are 
in this uninformed state, the application of the 
term neuralgia, if never allowed to extend beyond 
the limits prescribed by the clever authority 
above quoted, and used merely to designate a 
symptom, and intending thereby to express 
only that it is pain of which we at present 
know no more than that it exists, is cer- 
tainly permissible. Nevertheless, the enquiry 
may still be legitimately raised,-If from its 
liability to be abused, is it desirable to use the 
word at all? And it is past doubt that any Neuralgia, Tic-douloureux, &c. 
237 
further extension of its meaning, or to use it 
without a proper explanation that it is a 
purely negative expression, must be open to 
the severest criticism, as being calculated both 
to confuse and to deceive. 
When the true meaning of this term has been 
defined, and we have established the utmost 
limits to which its range can be legitimately 
extended, we see that there is not the slightest 
justification for its indiscriminate application to 
the every-day pains of the face. 
And when the character of tooth-ache be- 
comes well understood, the mind is prepared to 
emerge from the sea of mysticism into which it 
has been plunged, and to look for the cause of 
this malady in the right direction. When this 
is done, there will be no difficulty in perceiving 
that tooth-ache is never dependent upon any 
of the supposed idiopathic diseases to which 
it has been attributed ; and for this best of 
all reasons, namely, that instead of being 238 
Tootk-achc. 
primary diseases, these affections are merely the 
symptoms of tooth-ache; and that the cause 
cannot depend upon the effect. 
Indeed, when the symptoms and effects of 
tooth-ache are well understood, it will be found 
that, while the precise operation by which this 
malady becomes sympathetic and gives rise to 
pains in the face (although many suggestions 
having an air of great probability may be offered) 
cannot be altogether explained, enough has been 
learned to show that no pains have a more 
clearly defined origin: and that medical science 
has reached a point when, in reference to 
them, " the expression that it was neu- 
ralgia" not only may, but should be entirely 
dispensed with: and also that a case of facial 
pain to which we may, with any degree of 
propriety, apply the term neuralgia would be 
the greatest of rarities, and not, as we are 
led to suppose, the almost daily experience of 
every practitioner. Neuralgia, Tic-douloureux, &c. 
239 
In most cases of so-called facial neuralgia, 
well-directed examination of the teeth will so 
quickly show to the most superficial observer 
that in these organs there is sufficient cause 
for*the pain,-even if the patient cannot locate 
it, and the particular offender is not at once 
detected,-as to dissipate almost all the illusions 
that have been prevalent upon this subject, and 
excite surprise that its origin could ever have 
been in doubt. 
It must be remembered, however, that unless 
the mind be thoroughly convinced that the 
origin of the pain is in the teeth, and enquiry 
is pursued with the greatest confidence, and 
sometimes even with pertinacity, it will often 
be completely foiled through the inability-and 
sometimes through the unwillingness-of the 
patient to render any assistance. Hence there 
will seem to be no other conclusion than that, 
whatever may be the general facts, the par- 
ticular case under consideration must be an ex- 240 
Tootli-aclie. 
ception, and one that has no connection with 
these organs; and that it proves, accordingly, 
that it is not only justifiable but highly proper 
sometimes to regard facial pains as an idiopathic 
affection of the trifacial nerve. 
Enquiry will also not infrequently fail from 
the obscurity of the disease, .unless conducted 
by a most intelligent dentist, who is tho- 
roughly familiar with all the peculiarities and 
symptoms of tooth-ache; and wrho is also 
able to make such a minute investigation as 
shall disclose the facts. 
While the general causes which have led to 
error in the diagnosis of facial pain are found 
in the prevalent want of information on the 
character and symptoms of tooth-ache, the par- 
ticular causes which have misled those who are 
disposed to pursue proper enquiry, are numerous. 
Some of these have been already incidentally 
named, and we will now mention a few others. 
It is difficult for the patient to conceive that Neuralgia, Tic-douloureux, &c. 
241 
such excruciating pains can originate in any 
other part than that in which they are felt; and 
although it may he known that there are decayed 
teeth in the mouth, the patient is apt to be so 
very positive that it is not tooth-ache that 
the enquiry in that direction is dropped; and 
the assumption that it is some other affection is 
too readily adopted. Or it may be that a tooth 
has decayed into the pulp without any suspicion 
being awakened that it is decayed at all; and then, 
when the pain comes and is felt in another place 
it is, naturally enough, not likely to be suspected. 
* As sometimes happens, when a tooth decays 
into the pulp and this structure dies without 
pain, periodontitis may be set up without any 
previous intimation that there had been disease 
in that part. In such a case, the replies of the 
patient may be given in the most perfect good 
faith and with the most earnest wish to get at 
the facts, and yet be entirely wrong. 
After a pulp has become devitalised by 242 
Tootli-achc. 
irritation or by some artificial means, not in- 
frequently the tooth is "stopped" without the 
dentist having even so much as removed the 
disorganised mass: and the patient, who has 
been led-as is almost universally the case-to 
suppose that the tooth would " never ache 
after the nerve was dead," cuts off all further 
enquiry on the part of one not thoroughly up 
to all this charlatanerie, by the statement that 
it cannot be the tooth which aches, since it 
has been "stuffed;" while all the time the 
whole trouble is in the inevitable abscess at 
the root which is sure to ensue upon thiS 
treatment. 
A tooth is frequently filled by the unskilful 
dentist without his discovering that decay has 
reached the lining membrane; when, if pain 
does not accompany the inflammation of the 
pulp, it is certain to ensue upon the death of 
that structure. In either case, as the tooth 
appears to superficial observation to be in pro- Neuralgia, Tic-douloureux, &c. 
243 
per condition, it is not suspected to be the 
cause of the pain. 
It is also an occurrence by no means uncom- 
mon, for the sockets of the teeth to be so much 
absorbed through the irritation caused by tartar 
and other causes, that the periosteum is destroyed. 
The vital supply to the pulp through the apex 
of the root is thereby cut off, the tooth becomes 
devitalised, and periodontitis ensues: the same 
result may also be induced by a blow upon 
the tooth. 
When a tooth has in this manner begun to 
be the cause of pain, so preposterous is the 
idea that it can arise from a sound tooth to 
those not informed in these matters, that it is 
at once discarded; and there seems to such 
persons no possible way of accounting for the 
pain, except on the neuralgic theory. 
It is sometimes observable in teeth which 
have more than one root, that the sockets are 
destroyed to the apex of one of these roots, 244 
Tooth-ache, 
and that the pulp at this point becomes quite 
exposed while it continues to receive a healthy 
supply of blood and nerves through the other 
root or roots. In such cases true odontitis 
has been seen to result: and it is easy to 
imagine how one who does not perceive that 
the pulp is exposed at this point,-the tooth 
being perhaps perfectly sound,-naturally enough 
comes to the erroneous conclusion that it cannot 
possibly be tooth-ache. 
While endeavouring to arrive at a proper 
diagnosis of facial pain, it is not to be forgotten 
how very flattering it is to those who dislike 
to admit that their teeth are decayed,-either 
from that foolish vanity which some have in 
being thought not to possess any decayed teeth, 
or the fear of an operation,-to refer all these 
pains to any cause but to that which will reveal 
the truth. And in many cases of tooth-ache, 
enquiry will be met with the positive assurance 
that there is not any disease in the mouth : and Neuralgia, Tic-douloureiix, &c. 
245 
this is not infrequently the case when the 
difficulty would be rather to determine which 
were the sound teeth. 
With this class of patients,-who are more 
than willing dupes of deception, and whose 
opinions are based upon their inclinations and 
not upon reason,-little or no progress will be 
made by mere enquiry pushed contrary to their 
cherished opinions; they will be disposed to 
treat the assumption that they can be suffering 
from tooth-ache with so much levity and dis- 
dain that their answers will become evasive, 
unpolite, and incorrect; and unless they are 
plied with leading questions, and are well 
cross-examined, and the mouth is also ex- 
amined, the facts will not appear. And even 
when the facts have become apparent, and 
proper advice has been tendered, the physician, 
-or the dentist, as it may* be,-will often 
have the mortification, (or perhaps, and not 
infrequently, the satisfaction!) of seeing his 246 
Tooth-ache. 
patient seeking some one whose ignorance or 
accommodating disposition,-or, what is more 
probable, whose mixture of both,-will re-assure 
him in his conceit. This, however, is one of 
the penalties of intelligence and integrity which 
the honourable practitioner can always well 
afford to pay. 
The difficulty, however, of obtaining in- 
formation by means of enquiry alone, is not 
confined to the vain or th® timid patient. It is 
also experienced with the most sensible, and 
with those who are really anxious to render 
aid to the utmost of their power. 
From the common prevalence of erroneous 
theories, many of the latter class of patients will 
be indisposed for a time to render much assist- 
ance in any enquiry, from an idea of its utter 
uselessness; since it will be so extremely difficult 
for them to realise the fact that-after all they 
have heard of "tic," "neuralgia," &c.,-the pain 
was really tooth-ache. But with this class, the Neuralgia, Tic-douloureux, 
247 
confidence arising from intelligence will soon 
overcome all obstacles, and the enquiry will 
become as successful as the patient can render it. 
But while a casual investigation or a few 
leading questions may reveal the unmistakable 
fact that the seat of the pain is in the teeth, 
when it is to be located, so that the wrong tooth 
shall not be extracted and the proper one be 
treated, the whole subject is often so obscure 
to even the most intelligent patient that, after 
all the facts-so far as he is able to supply them 
-have been presented, his liability to be wholly 
mistaken as to which tooth is diseased-or which 
teeth, if there be more than one-is so great, that 
any information he may afford on that point is 
scarcely worth the asking. 
It is only by examining the teeth,-always 
carefully, and often most minutely-that these 
facts can be ascertained. And even then, so 
obscure will the disease sometimes be found, 
that it will baffle the most experienced dentist. 248 
Tooth-ache, 
Indeed, so long as there is an exposed pulp 
or even the very least remains of dead teeth in 
the mouth, no other cause for tooth-ache or 
any other pain in the mouth or in the face is, 
for a moment, to be suspected. 
And if the pain continues, not until there is 
neither an exposed pulp in the teeth -which still 
retain vitality or a dead tooth in the mouth, 
will it he time to so much as think of looking 
for the origin of facial pain out of the mouth 
And even then, the first suspicion must be 
that the pains arise, as they sometimes do, 
from inflammation in the lining membrane of 
the antrum or maxillary sinus. 
When facial pains exist which are not traceable 
to disease either in the teeth or in the antrum, 
it will be found that, instead of attributing them 
to some slight disturbance in the nerve cords, 
the physician may begin to look for disorder 
much deeper seated than this; and he should 
regard the patient as requiring his greatest Neuralgia, Tic-douloureux, &c. 
249 
anxiety, since in such, symptoms there is cer- 
tainly indicated derangement in the cerebro- 
spinal axis itself. 
Little fear, however, need be entertained that, 
almost without exception, the pains will be 
found, and can be properly treated and easily 
cured, when they are looked for in the mouth. 
After a careful study of the symptoms of 
tooth-ache, it cannot fail to be a matter of 
much surprise that so many of the commonest 
symptoms of this malady could be so often 
exhibited to the general as well as to the 
dental practitioner, and should also with such 
frequency be so clearly enumerated in medical 
writings, without-notwithstanding some of the 
fanciful symptoms which are often given in 
connection with the genuine ones-their cha- 
racter being discovered. And when we find 
these pains so frequently referred to almost 
any other cause than the true one, surprise at 
once deepens into wonder: and the reflections 250 
Tooth-ache, 
of the thoughtful mind lose hold of that 
subject, to lapse into contemplation of the 
absolute bewilderment which pertains to mental 
efforts having no foundation in facts, or which 
are leavened by a false theory. INDEX. 
Acid Medicines, how taken 193 
Acids for tooth-ache 194 
,, to remove tartar 129 
,, to " whiten " teeth 190 
Alveolar abscess 89, 208 
,, ,, discharge on the face . 92,215 
Alveolus 30, 33, 86, 90, 93, 128 
Antrum 41, 92, 215, 223, 248 
Antagonism of the teeth 26, 168 
Arsenical preparations 201 
Artificial teeth over natural roots 178 
,, ,, why unnatural 179 
Astringents in the mouth 191 
Barclay, Dr., quoted 232 
Bicuspid teeth 26 
Bond, Dr., quoted 7 
Brown, Dr. R. K., quoted 82 
Camphor in the mouth 191 
"Caries" , 65 
Cementum 30, 86, 208 
Cheeks falling 177 252 
Index. 
Children, mode of dealing with 135 
Cleanliness of the teeth 65, 188 
Constitutional character of the teeth 64 
Corrosive agents 174 
Creasote for tooth-ache 197, 202 
Crowded teeth 160 
Crown of tooth 28 
Cuspids 26 
,, appearance on the outside of jaw 140 
,, prominence of 139 
Cure of tooth-ache 196 
"Dead tooth" 85 
Decay of the teeth 50 
,, chemico-vital theory of 53 
,, during pregnancy 174 
,, first stages of 185 
,, fungi theory of 57 
,, increased by attrition < 159 
,, true cause of 60 
Decaying teeth, injury of 222 
Dental periosteum See periosteum. 
Dentinal tubes 29, 55, 86 
Dentine 29 
Denuding of the teeth 69 
" Destroying the nerve " 200 
Diagnosis of tooth-ache 112 
Effects of dead teeth and roots 176, 222 
,, inflammation of the gums 127 
,, , tooth-ache 112, 114 
Emollients to the face 215 
,, ,, gums 216 Index. 
253 
Enamel 28 
Enamel-cuticle 29, 58 
Ether-spray in extractions 165 
" Exposed nerve" 88, 218 
Exposure of the pulp 67 
Extracting at random 123,168 
,, before the jaw is grown 143 
,, on systematic plans 165 
"to make room" 148 
" Facial neuralgia," 9, 18, 80, 224, 239 
,, ,, meaning of term 227 
,, pains, cause of , 117, 248 
,, ,, errors in diagnosis of 240 
Filling devitalised teeth into roots 209, 220 
,, contiguous surfaces of the teeth 160 
„ the teeth 53, 61, 171, 186 
Fomentation to the face 216 
Fox, Mr. Joseph, quoted 19 
Ganglia, the cranial 46, 99 
Good, Dr., quoted 17. 
Gray, Mr. Henry, quoted 98 
Gum-boil 92 
Gums, how they recede 128 
,, swelling in 91 
Hahnemann, suggestions to disciples of 191 
Harris, Dr., quoted 16, 54, 125, 145 
Hard tooth-brushes 189 
Incisors 26 
Infinitesimal doses t 192 254 
Index. 
Investing membrane of the tooth 32 
Irregularity of the teeth 142 
,, ,, a cause of decay 145 
Irritability of mucous membrane 191 
Jaws, deficiency in size of 142 
,, how growth of is impeded 143, 148 
,, how stimulated to grow 154 
,, lower one " underhung " 149 
,, natural growth of 137, 141 
,, tardy growth of 147 
,, shape caused by cuspid teeth 140 
Koecker, Mr. quoted 145 
Kolliker, Prof., quoted 31, 54, 57 
Lancet to abscess 218 
Lining membrane of tooth 32, 68 
,, of antrum, how irritated 223 
Loss of teeth among the poor 195 
Maxillary sinus See antrum. 
Molar teeth 26 
Molars, the first 157 
,, ,, liability to decay 158 
,, ,, when to be extracted 162 
Myrrh in the mouth 191 
Natural contour of the face 179 
Neck of the tooth 28 
Nerve-ends 82 
Nerve, facial 36 
,, sympathetic <<. 98 Index. 
255 
Nerve, sympathetic, its functions 100, 104 
,, ,, its peculiarity 102 
" Nerve has been destroyed" 56,85 
Nerve, the trifacial 34 
Nerves, branches of the trifacial 34 to 45 
"Neuralgia" 25, 211, 226, 231, 236, 239, 246 
Odontitis 70 
,, character of 73, 77, 97, 107 
,, how produced 68, 72, 244 
,, its symptoms 73 
,, how relieved 197 
,, how cured 200 
,, increased by pregnancy 115 
Pain, description of 233 
,, peculiarity of 98 
Parmley, Drs., cited 61 
Periodontitis 84 
,, symptoms of 87 
,, to detect 119 
,, excited by pregnancy 116 
,, to treat 211 to 221 
,, to prevent 209 
Periosteum, the dental 32 
,, inflammation in 87, 89, 115, 220 
Prevention of tooth-ache 131 
"Prosopalgia" 9, 227 
Pulp-cavity 30 
Pulp of the tooth 31 
,, how exposed 67, 244 
,, inflammation of 68, 71 
,, how devitalised by arsenic 200 256 
Index. 
Pulp, how devitalised with a needle 204 
,, ,, by cauterisation 205 
,, pulsion of blood into 73 
Pus, chemical action of 91 
,, discharge of into antrum 92, 215 
Quack nostrums for tooth-ache 194 
Quinine 12, 144, 190, 217 
Rhythmical character of sympathetic nerve... 102, 107 
Richardson, Prof., quoted 180 
Roots of teeth 28 
,, abscess at apex 90 
,, under artificial teeth 183 
" Scaling the teeth" 129 
Space for front permanent teeth 139 
,, permanent molars 141 
"Spearing" the pulp 204 
Sockets of the teeth See alveolus. 
Sympathetic nerve See nerve. 
,, nerve-action 106 
Tartar 125 
,, effects of 127, 243 
,, how deposited 126 
,, how to remove 128 
Teeth, the 26 
,, attrition of 133, 159 
,, composition of hard part 60 
,, constitutional character of 64 
,, effects of crowding 133 
,, first of the permanent set to appear 157 Index. 
257 
Teeth, how arranged 26 
,, how to clean 188 
,, improper extraction of 148 
,, in-infancy 133 
,, medicinally devitalised 200 
,, number of 26, 136 
,, organic basis of 54 
,, organisation of 28 
,, painful when closed 88 
,, peculiarity of disease 50 
,, preservation of greatest number 161 
,, prevention of disease 133 
,, space between 170 
,, the temporary, how displaced 136 
,, ,, importance of retaining 143 
,, ,, how to treat 144 
,, when uneven 133 
"Tic" 9, 19, 25, 80, 85, 98, 124, 211, 226, 246 
" Tic-douloureux " 9, 18, 20, 74, 80, 226 
,, true meaning of 74,76 
Todd and Bowman quoted 80, 100, 108 
Tomes, Mr. John, quoted 53 
Tooth-ache, cure of 196 
,, diagnosis of 112 
,, extending to ear 110 
,, first form of 72 
,, how produced 68, 72, 86 
,, second form of 87 
,, sympathetic 79, 88, 95 
,, true sense of the term 85 
Tooth-brushes 189 
,, ,, how to use 190 
Tooth-cartilage 54, 60 258 
Index. 
Tootli-pieks 188 
Tooth-powders and tooth-washes 190 
Tooth, structures of 28 
,, "the nerve" of 31 
Viscidity of the oral fluids 60, 62, 65 
,, ,, when increased ... 114,116 
127, 157, 162, 174, 179, 190, 194 
Wisdom teeth 26 
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