Surgeon General's Office Kf mi ) ^w <£® mmK„.fr6%4c « * <0 Ci> Cj! t^s-r-^ EDICINE NATIONAL LIBRARY OF MEDICINE NATI NOI1VN 3N ID 10 3W JO AlVia II IVNOIIVN 3NI3II \ r*' ^resrtbatton of tjje Seetj): A FAMILY GUIDE, BEING Familiar Observations oa their Structure and Diseases; WITH PRACTICAL ILLUSTRATIONS AND ENGRAVINGS; EMBRACING THE MODERN IMPROVEMENTS IN DENTISTRY. r - BY DAVID K. HII*G»CQ€lf,v\ Surgeon j K. HII*G»CQ€lf, jN i Dtnust, fcoston. "^- <" w~\ / . - %'\ BOSTON; *- yV^j IVES AND DENNET, --' 1 114 Washington street. . J NEW TORK : GOULD, NEWMAN AND SAXTOTST-" 1840. VIU Entered according to Act of Congress, in the year 1840, BY IVES & DENNET, in the Clerk's office of the District Court of Mass. BOSTON: Henry P. Lewis, Printer, 2 Water streti THIS WORK IS RESPECTFULLY DEDICATED TO AMASA WALKER, ESQ. AS A TOKEN OF RESPECT FOR HIS LONG-TRIED FRIENDSHIP, BY THE AUTHOR. PREFACE. Others as well as myself have thought that a plain system of dental instruction would be well received by the community. Nearly all the books upon the subject are too voluminous and scientific for general reading ; but no such objection can with propriety be urged against thi3. If it accomplishes the design of the au- thor, he will have the satisfaction of having contrib- uted something towards the general good. ON THE TEETH. CHAPTER I. THE TEETH. In all countries and in every age, the teeth, those organs on which facial expres- sion and health depend, have been regarded with undiminished interest. It is one of the tendencies of civilization, owing to the arbi- trary customs of society, to bring premature decay upon these necessary and almost in- dispensable instruments. They were intend- ed, in the constitution of our physical struc- ture, to endure£as long1 as other parts of the living machinery of the human body; but the heats and colds to which we are subject- ed, both in diet from day to day, and in the temperature of the apartments we inhabit, be- 8 side a multitude of incidental causes which it were useless to enumerate in a treatise like this, designed for a plain guide in the management of the teeth, particularly in this section of the continent, predisposes them to a premature decay. A principal object, therefore, of the author, is to present an intelligent community, ex- posed to the now common misfortune of defective teeth, with a plain statement, based on a scientific knowledge of the anatomical organization of the manducating apparatus, and show, clearly, the only methods discov- ered by experienced dental operators, how they may be preserved to old age, in all their original effectiveness and beauty. Such is the general effect which well-form- ed or a forbidding set of teeth produce on others, in respect to personal appearance, that were no other object gained by them than securing the admiration of those with whom we associate, it would be a compensa- tion for any extra care bestowed upon them in attaining even that desirable object. 9 Aside from any considerations of beauty, or even symmetry, our health is very inti- mately concerned with the varying condition of the teeth. So universally is this fact ad- mitted, that no argument can be necessary to enforce its truth upon the understanding of the reader. " If the teeth, being sound, white and clean, prepare the food properly for the stomach, the individual certainly is less liable than I hose who have carious ones, a diminished number or spongy gums and their concomi- tants, to maladies that are alike uncomfort- able to bear, and, in the sequel, destructive in their tendency to life itself. In the course of this treatise, I shall par- ticularly advert to those vices of the age which operate with exceeding power in bring- ing on a rapid decay of the teeth in youth, and suggest the proper antidotes. It is need- less to remark, that the seeds of premature destruction in them is laid in the constitution of some families, and they are developed generation after generation. Under this mis- 10 fortune, the advice of the dentist becomes in- dispensable, and it is the province of his art to arrest the progress of disease, or supply the loss which local disease has occasioned. CHAPTER II. ANATOMICAL STRUCTURE. Our teeth are constructed of particles of lime, held in contact by animal glue. Those parts which are exposed to the atmospheric air, and consequently liable to injuries from attrition against each other, are covered over with an exceedingly thin, delicate coat of en- amel, bearing some slight resemblance in its chemical composition to highly glazed porce- lain. The fangs are lodged in deep sockets in either jaw, which are spongy beds, raised on a ridge, and above the hard bone of the jaw. These sockets are lined with a thin vascular membrane, in which the blood cir- culates freely. From the bottom of each pit, 11 an artery, vein and nerve, lying side by side, run into the very extremity of each root, through a minute hole, traversing the entire length of it, till they reach the centre of the body of the tooth. At that point there is a small cavity in which the nerve enlarges itself into the form of a pad. This is the seat of the tooth's vitality, and the point to which sensation is referable in all forms of toothache, in the incipient stages of disorgan- ization. Explanation of the Engraving. Here is the inside of a molar or double-tooth. A shows the enamel composing the surface of the tooth, which is the hardest production of the animal Lody. B represents the bone of the tooth. C the cavity in the body of the tooth, for the lodgment of the nerve. The gums are a mass of compact, con- densed substance, unlike any other tissue of the body, abundantly supplied with blood, which serve to box up the teeth on all sides, —standing, as it were, between the place where the enamel is discontinued, and the margin of the socket. The same membrane, which dips into the socket between their 12 walls and the roots of the tooth, also passes over the margin and is the common cover- ing and protecting skin of the whole body of the gums. By this simple anatomical description, which contains the essence of all that is known in the most elaborate works upon the subject, we are enabled to explain, with fa- cility, the cause of very many complaints in which the teeth are involved. We are also, by the same guidance, directed in the suc- cessful application of remedies. If by accident, or the gradual approach of an insidious constitutional cause, the enamel is injured, the soft, bony part of the tooth becomes exposed to the agents of its rapid destruction. These are the air, a variety of articles in food, hot drinks as well as cold, and, lastly, our own instinctive mechanical agency. For no sooner is there a sense of fullness or inconvenience by the lodgment of particles, after eating, than we endeavor to dislodge them with pins or picks, and thus 13 increase the difficulty, permanently, in the act of securing a little temporary relief. Should the lining membrane, in conse- quence of some unnatural violence, arising, for example, by a sudden pressure, as in cracking a nut, inflame and thicken it, sup- puration would follow, and perhaps the de- struction of the tooth, owing to the injury inflicted on the nerve at the extremity of the fang. If by any event the circulation of blood in the root is destroyed, the tooth, to all intents and purposes, becomes a foreign body—for its vitality can only be maintained by its im- mediate connexion through the nerve, with the system. "When the cavity containing the pulp or nervous expansion in the body of the tooth becomes exposed, the simple atmos- pheric air is a prolific source of pain. Un- less the cavity made by a fracture of the enamel, is filled before an inflammation en- sues, the death of the tooth cannot be pre- vented. "Whatever has a tendency to effect unfavor- 14 ably the chemical composition of the tooth, is prejudicial to its permanency. Acids, if highly concentrated, are amongst the most active agents of destruction, because they produce a separation of the particles of lime, and thus break down the structure. On the other hand, if by the formation of abscesses in or near the alveolar sockets, or the surrounding bone is fractured or splin- tered by the unskillfulness of an operator in extracting a neighboring tooth, there is a liability to a suppurative inflammation that may so far extend itself as to effect the cir- culation of the next tooth, and thus the foun- dation of subsequent pain and positive loss is laid. A multitude of evils resulting from the ig- norance of those who make pretensions to scientific dentistry, are continually taking place, which are often referred to causes which do not exist. Hence the importance of employing those only, who are known by their success in a wide circle of practice, to be deserving of public confidence. 15 CHAPTER III. IRREGULARITY IN DENTITION. Parents should watch the whole process of dentition m their children with vigilance. However irregular some of the teeth may appear when their cutting edges protrude above the gum, by the resources of the den- tal art, now reduced to a beautiful system, they may be turned from the course of their deformed position, and adjusted with the ut- most exactness. Explanation of the Engraving. This is a correct representation of 'irregular teeth,* which I took from the mouth of a young lady for whom I extracted a tooth. The canine or eye-teeth, it will be perceived, project so much that they stand outside of the others, thereby producing a most repulsive and deformed mouth. It is a forcible exhibition of the most unpardonable parental neglect; for had a little watchfulness been exercised by the parents, and a competent operator consulted, a perfect and even set of teeth would have been secured. To accomplish a point so essential to the future good looks of the child, the dentist 16 must be frequently consulted. It is utterly useless to trust too much or too long to na- ture, where the tendency to malformation or malposition is early manifested. Again, the modulation of the voice, and the distinct ar- ticulation of words are intimately connected with the position and arrangement even of the deciduous, or first set. Should the milk teeth show themselves di- vergent from the curved line of the jaw, rid- ing one upon the other, or forced out of their apparent place of destination, it is prelty certain that the second or permanent set will follow the same departure. No one, there- fore, thus warned of this law of contingency, should rest satisfied a moment till the best advice has been obtained. A common distortion, and one exceedingly neglected, too, is the protrusion of the eye teeth, high up on the side of the gum, so as to lie actually over one of the incisors. The deformity is very striking, especially in laughing. In a majority of instances, the lodgment of food between the two, lays the 17 foundation of premature decay in one or both of them. Explanation of the Engraving. The most common irregularity of the teeth is here shown. It will be so»n tint one of the first incisors or front teeth lips over the oth-r, while the seconJ incisors on either side are similarly displaced. Nothing is more simple than to remedy this lamentable state of the young teeth. But to accomplish it effectually, unless the patient is placed under the care of the den- tist seasonably, the perfect restoration of the aberrating tooth is almost hopeless. Even in adult life, it is always worth while to take advice, for such are the resources of modern art in combination with the discoveries of science, that extraordinary cases are met most, happily by extraordinary means. Cases not unfrequently present, especially in young female children, where the front under teeth shut over the front upper teeth, instead of passing in behind ihem, wlien the mouth is closed. This malformation calls for immediate relief. 2 IS By neglect, as soon as the teeth are fairly developed, the chance for their restoration to their proper position is greatly lessened. There is the appearance of a lengthened un- der jaw, which by and by really becomes longer than nature originally intended. By constantly shutting outside the upper incis- ors, they act upon the principle of a wedge, constantly forcing the jaw furiher and fur- ther outward, till the articulating surfaces at the joint are dragged considerably forward, out of the shallow depression in which they play. An instrument of very simple construction can be worn by the child, if seasonably ap- plied, which gradually and without pain, and almost without inconvenience, directs the w?anderers under the upper' ones. After a while, they begin to shut their edges over those which were once outside. No sooner is so much of the labor accomplished, than the perfect and complete restoration is effect- ed. Each day the lower teeth are pressed a little further by the common exercise of the 19 muscles, and finally close completely, and all the grinders meet at every point. An ingenious device of springs, of difficult description, is applied to a single awry tooth, to force it into place, which is equally deserving the consideration of all persons even remotely concerned in the appearance and physical welfare of children. These are a few of a countless variety of defects and liabilities of the teeth of children and youth, for which the counsel of the scien- tific dentist should be in constant requisition, till his further services become unnecessary, from the stability and success of the opera- tion he may have performed. CHAPTER IV. FILLING TEETH. One of the discoveries of modern times, which has conferred a lasting benefit on k mankind, is that of filling decayed teeth. At 20 first view it seems like a trifling affair that such importance should be attached to an operation apparently so trivial. Still, it is the concurrent opinion of those most compe- tent to decide, that nothing pertaining to the manipulations of dentistry, is of more im- portance. Perhaps there are about as many teeth posiiively destroyed as there are saved in this way; but it arises from the criminal ignorance of those base pretenders whose only object is to profit by the misfortune and misplaced confidence of their fellow beings. It involves the highest attainments in the whole range of practical dentistry, to fill a carious tooth as it may and always should be executed. If the operator is ignorant of the minute anatomy of the organs of the ad- jacent parts, how can he appreciate the value of the operation ? Should he inflict a wound upon the nerve in consequence of not know- ing its contiguity to any particular division of the tooth, where he is about to use his in- struments, he may not only create disease, 21 but prodigiously aggravate that for which he pretends to apply a remedy. Scarcely one in ten enjoy a reputation worth coveting, in this department of the arts ;—and the reason is obvious—they are adventurers and not dentists. Impositions are without number which are practiced in this branch of the profession. Base metals are sometimes introduced, but in the end they are detected, when it is too late to obviate the difficulty resulting from them. Amalgams of metals, too, the basis of which is quicksilver, under the specious name of lithodeon, or tooth-stone, it is pretended will crystalize or harden in the cavity, and thus become as resisting as the tooth in its best estate. The imposition, however, is certain. Gold, of the purest kind, can only be advanta- geously used. The excavation for the re- moval of every carious roughness—the in- troduction of the gold foil—the subsequent management in securing it in place, can only 22 be accomplished by a most adroit and expe- rienced hand. In view of the transcendent advantages to be realised by this curious invention, every person, even those with beautiful, sound, regular teeth, should have them examined as often as every six months, to ascertain their exact condition. It is a neglect of this pre- caution that many apparently sound teeth are undermined by disease, and the remedy applied too late. My injunction cannot be misapprehended —especially by ladies. Consult your dentist as frequently as you would your physician when in danger of some malady of a serious character, which is menacing you with its pa- roxysms. CHAPTER V. DENTIFRICES. Although great good may be accomplish- ed by the habitual use of dentifrices, lotions, 23 and various astringent washes, many evils are produced. "Whilst some act chemically and destroy the integrity of the tooth, others, from their corrosive character, operate equally de- structively on the tender gums. Hence it is of vastly more consequence to be particular in the choice of an article for cleansing the teeth, as it is familiarly called, than might at first be supposed. Ingenious, unprincipled men are not want- ing, who avail themselves of this prolific source of profit, the necessities of their fellow creatures, to enrich themselves, without con- ferring a corresponding benefit. In the first place, in regard to dentifrice powders, an essential recommendation is— that there is no grit: it must be an impalpa- ble dust, so finely should it be levigated. Secondly, nothing should enter into the com- position that might even remotely affect a chemical action on the lime of the tooth; and, thirdly, no abrasion should be made on the shining surface of the gums. One of the bad effects arising from the 24 constant resort to a coarse powder, of any sort, is a recession of the gum from the neck of the tooth, so that, in process of time, it seems and in fact actually does stand out un- naturally long. It is quite observable in ladies at about the age of thirty, who have long been accustomed to cleansing the teeth with pulverized charcoal, that both the upper and under front teeth have become unsym- metrically long. This is brought about, usu- ally, by the forcing of particles down by the si'le of the tooth, till it overcomes the adhe- sion of the shining membrane that is reflect- ed from the gum to the tooth. By degrees the whole border of the gum lessens in volume, becomes smaller, and the teeth seem to protrude unnaturally. Per- haps the continued violence of a stiff, harsh brush, may be partly instrumental in bring- ing about this disastrous result. Cold water, it will be admitted by every candid dentist, where no disease has appeared, is decidedly the best of all applications. Very many fine teeth are worn out by the 25 attrition of coarse tooth powders ; the enamel is positively rubbed so thin that the bony texture of the tooth is made susceptible to impressions even from the air. Whenever a fetid breath, ulcerated teeth, or gums, small abscesses, discharged from the root of some old, long neglected stump, require a remedy, consult the dentist again, and be sure to follow his prescriptions with undeviating exactness. He, of all men, is most competent to decide what remedy, un- der any peculiarity of circumstances, is in- dicated. Let this be kept constantly in mind, that since this class of professional men ex- clusively devote their lives to this one de- partment, it is reasonable to believe that they must, consequently, be the best qualified to judge and to sit in judgement upon the rem- edies that may be indicated. 26 CHAPTER VI. CLEANSING TEETH WITH INSTRUMENTS. Before entering upon the consideration of topics no less important than we have al- ready been treating, I feel it incumbent on me to make reference, at least, to an evil of considerable magnitude, within the pale of dentistry, of which there seems to be insuf- ficient popular inlormation. Very commonly, individuals have the up- per half of the upper front teeth considerably discolored,—sometimes there is a disagree- able, dark, yellowish hue. In another in- stance, on the margin of the gum, there is a dark line, like a stain produced by the juices of wild berries. Others present the appear- ance of being partially coated with charcoal. All sorts of shades are noticeable in a company of persons, who may happen to be the subjects of observation—varying from a deep, dingy, yellowish incrustation, to the deep, black stain, which runs in the form of rays quite down to the cutting edge. 27 When one for the first lime is informed that this appearance is fraught with danger to the teeth, in the excitement of alarm at information altogether new to him, he some- times seeks a remedy in the moment of alarm, and as often as otherwise, makes bad worse, and thus hastens an event which he is solicitous to avoid. Formerly it was more the custom than at present to remove these discolorations by scraping the whole front surface. To effect the entire removal, particularly when the enamel was stained considerably deep, the operator did not hesitate to carry his excava- tions unpardonably deep, till the tooth's cas- ing was nearly all scraped off. Those itiner- ant dentists, who travel about from town to town—whose whole object is to get as much money in as little time as possible,—feel- ing no kind of responsibility,—for, being strangers, they fully intend to remain so, spoil teeth without mercy. They are the operators who make white teeth almost in- stantly, but they are nearly destroying them 28 at the same time. When the enamel is made preternaturally thin, by this abomin- able process, the defect is not spontaneously repaired again. It ever after remains too thin for the protection of the inside bony sub- stance of the tooth :—ever after, the teeth, thus injured, have a bluish tinge,—crumble, or present very small patches, here and there, over the front surface, where the enamel is abraded or scales off entirely. In the latter case, minute pits are discoverable in a favorable light. When a dentist of competent abilities and judgement uses an instrument in cleansing, it is for the express purpose of removing extra- neous matter, but never to grind down the enamel—any attempt at so doing is presump- tive evidence of the ignorance, recklessness and irresponsibility of the operator, who pro- poses it. Even the passing of a file or saw between two teeth, if the enamel or the prox- imal edges are injure'd, is the precursor of subsequent decay at that point. It is because there are such numbers of 29 strolling quack dentists here at the North, that I have been thus particular. A little pulverised pumice stone, taken up on the moistened extremity of a pine splinter, may be rubbed over the face of a tooth, slightly, with impunity ; this is, perhaps, a practice by no means rare with some of the best oper- ators in New-England, to whiten a tooth that does not precisely correspond in color with its fellows. Still, I regard it as a decidedly bad practice, if too frequently repeated. It is in fact equivalent to scraping with an in- strument, only it is attended with less parade and less violence. A conscientious operator, endeavors to assist nature in a majority of his labors, and this constitutes the science of the pro- fession. No one can detail with an exact- ness that may be comprehended at once, by a written description;—it is sufficient here to put the reader on his guard against the wiles of those who have done and I fear are still doing an immense deal of injury. Perhaps these discolorations, from the fre- 30 quency and the anxiety generally expressed to restore the teeth to their pristine appear- ance, demands further attention; but I have given a warning voice, and now trust to the intelligence of the reader to avoid the evil. Still, without consulting a regular dentist, which is the only safe way, the individual should on no account attempt to operate upon himself—under such circumstances he might very much aggravate the malady. Every well instructed dentist is fitted by his acquire- ments to give opinions which should com- mand implicit respect. CHAPTER VII. TARTAR. Nothing is more familiar than the fact, that there is a most singular disposition in our organization to accumulate a foreign matter about the teeth, which is called tartar. Now this is a common name for a kind of calcare- 31 ous deposition that no one precisely under- stands, and yet we all talk about the destruc- tive tendency of this singular accumulation, because it really produces most lamentable effects. Specimens are occasionally met with in cabinets, to illustrate the excessive injuries this tartar occasions. By little and Utile,— and it may by the work of successive years. this semi-stony incrustation fastens, perhaps more generally, on the inside of the teeth, just at the union of the gum with the neck, like a thin wedge—additions seems to be made at the base—which drive it further and further, whilst it gradually insinuates itself down into the socket. To get there, the periosteum, or lining membrane of the socket, which is also a covering of the roots, is pealed off, as it were, and this denidation constitutes a disease,—a homely name for which is tartared teeth. As my object is instruction, I shall not discuss the question—how the tartar is form- ed, nor suggest a theory :—suffice it,—the 32 disease exists, and there is a positive remedy for it. One of the evils growing out of this aggre- gation of particles of lime round the teeth, beside the one just adverted to—is this : the tooth is loosened—the gum at the same time, if it does not ulcerate, by no means rare in extreme cases, is kept constantly in- flamed. It is not only always turgid with blood, so that it bleeds at the slightest touch of the brush, but the breath is excessively fetid. In a ward, there are a score of in- tolerable inconveniences attending the accu- mulation and presence of tartar, that cannot be readily described. But, in addition to them all, the mouth cannot be opened in the presence of another without disclosing an appearance that is forbidding. In those who habitually use a brush, if the tendency to an accumulation of tartar exists at all, it is kept off tolerably well in front, but it hides itself deep down behind the front under teeth, and the sides of the 33 back grinders, quite out of the reach of the brush. Wherever it is, by close inspection with a mouth glass, it will be seen that the gum is a little pressed off from the tooth, thicken- ed a trifle on its margin, and quite red and inclined to inflammation. Some persons have constitutionally, or in other words, inherit sound teeth, in whom this predisposition to a deposition of tartar is so strong, that they are wholly bereft of them by the time they are forty five years of age, solely by its intrusive agency. Thus the teeth, one by one, as it were, are lifted out of their beds—and with the fingers they are finally plucked from their slender hold, perfectly sound, but sadly crusted and rough- ened by a load of tartar. Further, in extreme cases, a distortion of the mouth is brought about by this same sad and unfortunate tendency. Those powders and washes with which the shops teem, are not specifics, as often represented, for this 34 difficulty:—nor are they beneficial in re- moving the complaint. Perhaps the chronic inflammation of which I have spoken, may be partially subdued by a topical application of an astringent lotion ; but that is the ex- tent of the operation of such alleged rem- edies. As this subject is one of deep concern to those who are the subjects of its ravages, I have devoted more than usual attention to it in this place, with a hope of inducing those who may examine these pages, to ward off the danger. In connexion with this topic, the question may naturally arise,—.what should be done ? As in a former chapter, I am obliged to say, consult a skillful dentist. His knowledge embraces this complaint, as it does every other belonging to the domain of the teeth: with a carefulness—nay, more, with a dex- terity that is encouraging, he will remove every particle of this extraneous matter;— in detaching it from the neck of the tooth, 35 where it adheres with extreme tenacity, a steady hand is required, not to wound the the turgid vessels. Instruments of singular forms, nicely fit- ted to the convexities and depressions of the teeth, are expressly made for the purpose of dislodging tartar. If by any indiscreetness in the operator, the enamel is injured, then the foundation is laid, deep and abiding, for the ultimate destruction of the tooth. A dentist,—an experienced one, and no other, should be trusted in the management of this department of the art. Since it is a well established point that the tendency to the formation of the tartar exists in many-persons, parents should once or twice a year subject their children to the strict scrutiny of a dentist,—upon the well known principle that " a stitch in time, saves nine." 36 CHAPTER VIII. INFLUENCE OF TOBACCO ON THE TEETH. Europeans are astonished, in traveling over this country, at the legion of tobacco chewers;—and well they may be, since it surprises ourselves to look into the statistics of this abominable custom. Thousands are habitual tobacco chewers, who cannot assign one rational excuse for it:—even small boys are often seen, sadly addicted to this vice. Others find an apology for it, in supposing that it keeps off some- thing else, in the form of a distemper. Yet this is all idle: it is not so. When the habit is fairly established, all moral effort to ab- stain is quite hopeless. It is even worse than opium eating, so far as uncontroled dominion is concerned over the mind. But I have no disposition to declare war against a great army;—let them grind their quids in quietness,—trusting that after ages will correct this monstrous evil in civil- 37 ization. Aside from a host of miseries con- sequent upon chewing tobacco, I am con- cerned only in relating the consequences that follow to the teeth—which is bad enough to discourage a veteran consumer. Tobacco, when used in the very best man- ner, contains considerable grit, or sand, which grinds down the face of the teeth, in process of time, prodigiously. A few chewers out of a hundred, wear their teeth down evenly. Such is not always the state of things. If a tooth has been extracted, it produces an irregularity in the lateral grind- ing movement of the jaw, that ultimately makes an unevenness some where on the line. Not uncommonly, half of the lower part of the teeth, on the side particularly where the tobacco is chewed, are actually worn off down to the gum. On the other side, the equal pressure having been taken off, they are too long—so it is in respect to the molars. Let this pass however. The essential oil of the tobacco stains the 38 teeth a deep, filthy yellow,—too permanent for removal by the ordinary process—they cannot be bleached out in inveterate chewers. This same oil, too, undermines the enamel, the protecting shield of the teeth, in some in- dividuals, hence they crumble, and are lost without redemption. Both of these agents are positively de- structive to the teeth, habitually used. Last- ly, it is notorious in New-England that to- bacco chewers, as a distinct body of men, have proverbially bad teeth. Smoking is a vice too—and a national one, of such magnitude that railroad corporations throughout all their routes in the United States, have a special command in large letters, conspicuously placed at depots and inside of the cars—" No smoking allowed here ^rj\ •" Less injury is inflicted on the teeth by smoke than by chewing, of the two, though the last is bad enough. An inces- sant current of hot smoke, saturated with that same essential oil, plays destruction 39 also;—but the process is much slower, hence no one stops to reflect upon it. A quantity of saliva is poured out by the salivary glands in the act of smoking, which collects copiously round the whole circuit of the under teeth, that consequently protects them:—they are the last to suffer, whilst the upper front incisors, in some extreme cases, are lamentably injured and defaced. Such are some of the effects to be appre- hended by tobacco chewers. Therefore, it being easier to warn one of approaching danger, than to extricate him when surround- ed by it,—I say, emphatically, never allow your son to chew tobacco under any pretext whatever. Ladies require no "admonitions in this respect. 40 CHAPTER IX. DENTISTS. Before entering upon an important di- vision of this work, viz: the extraction of the teeth and the insertion of artificial ones, I am disposed to devote a page to the profes- sion of dentistry,—distinctly. In this, as in medicine, there are quacks. Still, there is another grade of imposters, equally obnoxious, better known to dentists themselves than to others. They are the praters, or alarmists, who are continually crying out to beware of their neighbors,—as though none but themselves or the numbers of their immediate clique, could possibly be qualified either to advise or operate. They harp however about the science of the profes- sion, as though that enabled a man to work miracles. Dentistry is an art;—yes—actually a busi- ness that requires the use of one's hands,— if he is not a mechanic, the whole matter 41 turning on that one pirot, a dentist cannot succeed:—with a scientific knowledge of the general anatomy of the parts concerned in his vocation, together with a nice develop- ment of his constructiveness, he becomes all that can be desired in an operator. Dentistry is acquired, with us, slowly and cautiously, under the instruction of compe- tent and deserving teachers ; therefore, there are not so many poor dentists about as form- erly :—common ambition prompts those who might perhaps have been indifferent artists or operators, in these days of competition, to labor incessantly, to be competent to all exigencies, and in our cities they are so. Extensive experience gives the individual a higher claim; and his patronage depends upon the success of an application of his knowledge and ingenuity in benefiting those who resort to him for counsel and mechani- cal aid. 42 CHAPTER X. extraction of teeth. »■ Previous to discussing the details of this painful, yet very necessary operation, much might be advanced advantageously, perhaps, upon the subject of tooth-ache, as denominat- ed in common parlance. Since it is quite impossible to embody all the'practical re- marks that might be concentrated here, without defeating the original intention of constructing a compact pocket, manual, I shall at least defer a consideration of the painful diseases of the nerve, till a more fit- ting opportunity. To extract a well formed, tolerably well located tooth, if not far gone by caries, in- volves no great effort of mechanical ingenu- ity :—any one who can fit on a hook, and turn the bar of an instrument upon its own axis, can twist it out. But there is a wide difference between this twisting and lifting a tooth from its bed. By the former, the 43 alveolar is crushed, the gums bruised, and i the offending tooth as often as otherwise ' broken off in the middle. This is vulgarly called tooth pulling. There are all kinds of contrivances for re- moving diseased teeth,—but, after all, they are only modifications of a primitive inven- tion, the lever—for all of them act upon that principle, with a few exceptions. One lever may be better than another, and succeed well or indifferently, in different hands : all this depends on the good judg- ment and experience of the operator. Some men never succeed in extraction, without mangling the jaw, splintering the bone or inflicting some gross injury that is about as intolerable as the misery that was to have been cured. This results from an utter ignorance of the manner of adapting the in- strument. Physicians, as a general rule, have but one key, which answers for all cases, through an entire professional life. The dentist can- 44 not, without degrading the craft, practice on such an economical system. He must have very many instruments, of various sizes and shapes—and it is in being thus prepared, that he possesses such a manifest advantage over ordinary practitioners of medicine. It is inexcusable in a dentist of any pre- tentions to experience, not to extract a tooth with adroitness. Since great pain, tedious and protracted suffering frequently arises from the very miserable mode of drawing teeth, that I feel it a duty to warn the reader against these unnecessary torments. If there is any one branch of operative dentistry in which I excel more than another, it is in this. From the commencement of my practice, the number extracted yearly, has been almost incredible ;—hence, without wishing to misrepresent in any manner whatever, I do not hesitate to say that an ex- tensive experience, justifies me in speaking here very decisively. All surgeons study the same leading authorities, and provide them- 45 selves with knives and forceps from celebra- ted manufactories,—yet something more is requisite to constitute an operator. One of a thousand monopolizes all the surgery,— : while the nine hundred and ninety-nine, ap- parently equally well qualified, never get a « chance to splinter a broken finger. How does this happen ? One man possesses l«the happy tact of applying his knowledge to conduce to the well being of his fellow crea-J tures; whilst others, educated to the same pursuits, cannot succeed. Such too is the fact in the practice of medicine. There are invariably some two or three persons in every city, town and village, who are al- ways sought after, to the entire neglect of others who think themselves fully equal to their more fortunate competitors. How is this ? ' As it is with them, so it is with dentists : some obtain all the patronage of the public worth having—and others, equally eager in the pursuit of fees or food, perhaps both, 46 lead a life of disappointment.-—hope defer- red No one can deny, therefore, that some are^ better constituted than others, to conduct the unpleasant manipulations of dentistry. Gen- ius, united with experience and judgment, 1 in connexion with philosophically constitut-I ed tools, must all meet in the person who! can extract a simple tooth as it should bje Siiy wn | .—_—— ' Here, too, is involved the consideration of painful affections of the face, arising from a wide circle of nervous sympathies, having their immediate rise in the extremity, per- haps, of a tooth apparently sound. Collec- tions of pus in the antrum, a cavity in the upper jaw, under either eye. extremely form- idable, at times, are also associated with this apparently trifling affair of extraction. In the course of my observations, the faixlt chiefly to be dreaded in unskilful hands, is a fracture of a root,—a portion of which may be left in the socket to be a source of exces- 47 sive irritation and subsequent pain. Ordi- nary instruments are not fitted for exigen- cies, and the patient, therefore, is tortured unnecessarily. Were people to reflect with t more care upon the hazard of allowing any • and every one to extract their teeth, or those ■of their young children, it is certain they would have fewer to be drawn. A mishap, lays the foundation for an extension of dis- eased action,—and thus the evil keeps ex- tending itself, to be developed in full, per- haps, at some remote period. Allow me again to caution the reader with regard to the proficiency and judgment of the dentist who is permitted to extract his teeth. We before stated that some physicians, , who pretend to great experience in extract- ing, have but one instrument—and that, per- haps, may be one of the most objectionable kind, which is used indiscriminately in all cases. But the general medical practitioner is not always successful in this labor of all work, and they have generally the frankness 48 to acknowledge the superior qualifications of the dentist. Not long since, one of our most intelligent . and influential physicians, residing in a pop- ulous village in the neighborhood of Boston, called upon me with one of his students, and emphatically inquired—" Can you extract that tooth, Sir?" showing one of a formidable • character, it would seem, to himself. It struck me that I could, and without produc- ing much suffering. The young gentleman took a seat in the operating chair, and with one of the improved instruments, it was re- moved with comparative ease, by a slight effort of strength on my part. The physician involuntarily exclaimed, " that was well done —for, to be candid with you, I must acknowl- edge that I tried on that same tooth, and was fearful of breaking the jaw, and therefore abandoned it. It was given up to a physi- cian of the next town, and he also gave up the removal as impracticable." Now the physician was not unsuccessful because he 49 was lacking in muscular power: no—for he possessed vastly more strength than myself: his difficulty proceeded from a defective in- strument, together with a knowledge of its use. Again, one of the most esteemed clergy- men, who has been for a long while a settled preacher in this city, called on and desired me to remove an aching tooth. Having re- resorted to the gum lancet, as a preparatory step, I placed the instrument on the tooth, and took it out instanter. I then asked him if the pain was very intense ? " Bui you have not got it out, Sir !" He could hardly credit the fact of its removal, even when shown to him in my hand, and he manifested his embarrass- ment. He then remarked, that one of the most expert dentists of the city had broken off a tooth for him—and, furthermore, advised him never to submit to another trial. These facts, selected from many marked cases, are cited simply to illustrate the im- 4 50 portance of resorting to operators who are provided with instruments constructed for meeting all emergencies. CHAPTER XI. artificial teeth. Improvements have been so rapid in the art of manufacturing artificial teeth, within the last few years, that, in appearance, nature is certainly rivaled. Several articles are substituted for the orig- inal teeth, and each has its advocates. I shall advert to them in rotation, but confine my remarks especially to the consideration of the superior advantages of porcelain or mineral teeth, to all others known to dentists. One of the earliest, and in this country most familiar substance for making teeth, was the enameled side of the tusk of the sea- horse. It is still in very considerable de- 51 mand with second rate workmen. We fre- quently notice these teeth in persons who have had the misfortune to require one or two. They may always be detected by their bluish hue, after remaining long enough in the mouth to imbibe the saliva, which they do very speedily. Another criterion of the sea-horse tooth, is its uncommonly smooth face,—which never corresponds with the un- even faces of the natural ones by the side of it. When a vacancy of three or four incisors is to be filled, the space, for example, between the eye-teeth, it has usually been customary to make them in one block, in using this material. The exact curve is ascertained by frequently trying in the piece, and carefully fitting it in all its relations to those of the under jaw which shut against or within the line. If the stumps of the old teeth happen- ed in this case to be still remaining, they are dressed down to a level, or perhaps ex- cavated down below the gum. This done, 52 the whole block, made to resemble as much as possible, or rather as far as practicable, those which had formerly been there, it is confined by pivots, dowels, or wires. A row of teeth, all united in one piece, are much firmer than if—provided there were stumps enough—each division were separat- ed into an independent tooth, unconnected with others. After a while, even with ex- ceedingly careful usage, from the imbibation of the saliva, and its action on the gelatin of the ivory, these teeth become offensive to the wearer. They are sometimes intolerably so to those who are obliged to inhale the breath of the individual who has them. I have sometimes thought the sea-horse teeth were even more objectionable on this account, for ladies, than for men. Even frequent washing does not overcome the peculiarly disagree- able breath belonging to these otherwise tole- rably good substitutes. Were it not quite cer- tain that the public sentiment has set strong- ly against the sea-horse tooth, so that, with 53 other causes, dentists of any reputation will wholly abandon the article, I should dwell with far greater interest on the disadvanta- ges just enumerated, and illustrate my posi- tion by a sufficient number of cases to estab- lish all that might be said, clearly and con- vincingly. Another substitute which has also had its advocates, was the tooth of a calf. It could be set very well by being ground at the lat- eral edges, and from the top, downward to- wards the cutting part. The value of this, over and above the sea-horse, arose from the fact, that the color of the enamel, as well as the surface, corresponded exceedingly well with those by the side of which it was to be inserted. All the workmanship, therefore, was necessarily expended on the base, and widthwise sides. An ingenious dentist some- times succeeded admirably with one solitary tooth, fixed to a pivot. If several were re- quired, then the artificial character of the operation could not be concealed. This plan, 54 like the other, is now scarcely practised in the Atlantic cities. Not satisfied with either of these, it was thought that the insertion of human teeth could not fail to achieve all that was desirable in point of effect. At one time, within the recollection ol those of middle age, it was a common object with some dentists to procure all the finely shapen, sound front teeth from the dead, in alms houses and other public institutions, to which they or those who conducted the enterprise, could gain ac- cess. Notwithstanding the natural appearance, these teeth were difficult to set. The aper- ture of the nerve did not always exactly cor- respond with the one in the stump to which it was to be joined. If it were too thick, the enamel must necessarily be sacrificed on some part of it, before the body could be fitted in place. Beside these objections, a belief seems to have been entertained that loathsome diseases were introduced into the system, as it were, by inoculation, through 00 the instrumentality of these dead men's teeth. Some of the journals of medicine have re- corded strange accounts of the misery inflict- ed in this way on ladies. Perhaps there was some truth in the stories, and perhaps not. In a word, the dead teeth mania has entirely subsided : I doubt whether they are now used at all. However successfully transplantation may have been conducted in Europe, in this coun- try it never became a favorite operation. Accounts may be found of the extraction of a sound tooth from one perst in, which being inserted into the socket of another the instant a defective one had been drawn, adapted it- self to its new location, and established a vital connexion,—lasting for years,—being both beautiful and useful. Occasionally an aching tooth may be extracted and instantly forced back again :—an adhesion will appar- ently follow, to the periosteum, but the cir- culation and nervous communication being cut off, the tooth will always be sore, the 56 jaw tender and inflamed, and therefore an imperfect organ, inferior to an artificial one. The last, best, and I fully believe most ex- cellent substitute for the natural, are the comparatively new discovery of mineral, or incorruptible teeth, of the present day. ,It seems impossible that they should ever be superseded by any subsequent invention. They are made of any dimensions or suppos- able shape, to match the natural ones retain- ed in the jaw. It matters not what may be the condition of the niche in which it is to be set—for a model is constructed, from which the tooth is made, so that the color, exact length, breadth, aad whole physical aspect, is precisely like the one whose place is to be supplied. Here is an advantage which the dentist of the present day holds over those of the olden time, that is not sufficiently prized. A revo- lution has been effected in the whole busi- ness in less than twenty years. Since the art of making the teeth as they are required, Explanation of the Engraving. The above represents an upper and under set of Artificial Teeth. When persons have lost all of their teeth, it is expedient to insert whole sets. They have been brought to such perfection, that they can be worn without any inconvenience, and are of the greatest utility both in speaking and mastication, as well as adding greatly to one's peisonal ap- pearance. Sometimes it is necessary to use Artificial Gums, which, like the Teeth, are correct representations of Nature. 57 to suit in all cases, is clearly understood, it is certain that no dentists in the world are superior to those in the United States. There cannot be better or more beautiful work produced any where than in Philadel- phia, New York, and Boston. Without wish- ing to appear egotistcal, I shall not attempt to conceal my opinion that no more perfect specimens of highly finished artificial teeth can be found, any where, than in Boston. In comparing Paris work, London, &c. with that produced in this city, I am sure it cannot be better, more enduring, or a closer imitation of nature. My object has been in this chapter, to present a chart of the past and present estimation of the various ele- mentary material used in making artificial teeth, before treating of the intrinsic value of silver, gold, platina, wooden dowels, &c. and gold plate foundations. 58 CHAPTER XII. MECHANISM OF ARTIFICIAL TEETH. When an artificial tooth is to be set, the question naturally arises as to the partic- ular advantages or disadvantages of the general methods adopted by dentists. At one time, if the pivot were made of any metal less valuable than gold, however perfectly adjusted and enduring the work might be, there was a seeming inferiority about it, not at all agreeable to the patient. It will be perceived, by these remarks, that the value was an imaginary one, mechanically, or even philosophically considered. If the new tooth is fitted with such exact- ness to the prepared end of the stump, as characterises the workmanship of every re- sponsible, conscientious dentist, it is scarcely possible for food to be forced in laterally. Even the atmospheric air is pretty nearly ex- cluded. No injury will be sustained to the pivot, or, more properly, dowel, from either 59 of these sources. Then why is gold prefera- ble to wood ? Surely, it cannot be. A metalic pivot cannot be so introduced into the central canal of the stump, as to fill it perfectly and keep its hold. By use, the tooth becomes loose, and drops out, if in the upper jaw, by its own gravity, if the mouth happens to be unguardedly opened. Various schemes have been devised to re- tain the pin, but all of them equally unsatis- factory, because the tooth would become infirm. By first filling the canal of the stump with wood, the dowel driven into it with con- siderable force, would swell and thus hold on with greater energy. This, all the while, was unnecessarily multiplying the mechanism. Triangular, square, hexagonal, and other shapes have been quite as unsuccessful. With a wooden dowel, all the vexations . here recounted, are at once obviated. It im- bibes saliva that swells it to fit the canal, and the new tooth is h^ld with a tenacity that cannot be brought about by any other means. 60 It is also economical, and therefore an impor- tant consideration—all persons cannot afford the expense of gold ; but all who require the assistance of art in this respect, wish for something serviceable. My observations here are by no means new to dentists: they are introduced with , reference to those who may have occasion to ask their assistance, that they may not har- bor the idea of being wronged or turned away with inferior workmanship, should the wood- en pivots be recommended above gold.— Again, should it be necessary to alter the dowel, or put in a new one, in consequence of any alteration in the condition of the stump, the repair is neither attended with a heavy expense or loss of time to the patient. One of the reprehensible practices of this particular dental epoch, when new teeth are to be inserted, is taking out the stumps. They never should be removed if it is possible to save them ; no, even if they are retained but a few years, it is far better to keep them 61 than to allow their extraction. I am now referring to spaces in which two or more arti- ficial teeth are to be placed. Some dentists make formidable prepara- tions, even beginning whole months before hand, to get what they consider the jaw in order. The roots are drawn, and as a matter of course, absorption of the walls of the alve- olar margin follows slowly. When the heal- ing process is complete, and the prominent ridge of bone is absorbed,—a cast is then taken of the space, in plaster, and subse- quently a metalic model. On this a gold plate is beaten into the exact shape, the teeth are rivetted to it, and generally by the air- pump principle, or pressure of the atmos- phere, the whole is kept in place. A slight assistance, at any rate, is all that is usually required. Now I object to the extraction of the stumps. Fill them well with foil, and file them down to a level with the gum, as circumstances require. Finally fit the plate 62 to the stumps. The teeth are only separated from them by the thickness of the plate. Such teeth may be used advantageously as very tolerable substitutes for nature's handy work. Those which bear directly on the gum cannot be firm and resisting. Mas- tication is never complete, because there is a tenderness, never wholly overcome. Beside, in such cases, something more than the teeth are wanted to perfect the imitation of nature. Artificial gums are to be appended, to meet the deficiency induced by absorption of the dental ridge. Thus, weight is added to inconvenience; the more ponderous, the less adhesive power, —or in other words, gravity fairly overcomes the suction, and down they drop on the tongue, if they pertain to the superior jaw. These remarks will apply with equal force and truth to whole sets. It is an imaginary hindrance to the proper performance of the functions of the artificial teeth, if stumps re- main. Save them, and that invariably—nor 63 should any one be argued out of them, when about submitting to toil through life with artificial teeth. A whole upper or lower set will hold on, based upon the stumps, just as well and securely as though none were there. Thus the contour of the mouth is neither in- jured or lost. CHAPTER XIII. TOOTH-ACHE. How dreadful are the sufferings produced by an aching tooth! Those who have been spared that severest of all distracting pains, cannot conceive of the intensity of the misery. Some are so injuriously affected and pros- trated by suffering from this source, that the digestive powers are seriously impaired, and perhaps death may have been induced by it, in feeble, delicately organized females, or young children. 64 Unless there should be an ulcer at the ex- tremity of a root, by no means uncommon, the pain is in consequence of an exposure of the bulbous portion of the nerve in the cen- tral part of the diseased tooth. An inflam- mation ensues,—and those applications which act either as patritives, being mostly ano- dynes, cannot be relied upon. They are but temporary comforters. Nothing short of the actual cautery is worth attempting—pro- vided that extraction will not be submitted to. Opium, ground pepper, pearlashes, salt, cajaput oil, kreosote, &c.