' " 4 
ORAL HYGIENE. 
By MEYER L. RHEIN, M. D„ D. D. S. 
NEW YORK. 
Read before the First District Denta! Society, State of New York,- 
May 6, 1884. 
Heprinteil from The \NeW England Journal Of Dentistry,October, 1884. o wv t nt e-w to. 
ORAL HYGIENE. 
BY MEYER L. RHEIN, M. D„ D. D. S. 
NEW YORK. 
Read before the First District Dental Society, State of New York, 
May 6, 1884, 
Reprinted from The New England Journal of Dentistry, October, 1884. ORAL HYGIENE. 
This evening I propose to say a few words not concerning some 
new disease or remedy, but rather to illustrate and enforce that old 
adage, " an ounce of prevention is worth a pound of cure," in its 
application to oral hygiene, the subject to which I desire to call 
your attention. 
The greatest difficulty is that we consider this a hackneyed subject, 
and feel that every one understands all about it. I grant you that 
we all have very fair views as to the manner of maintaining the sani- 
tary relations of the component parts of the oral cavity, but do the 
public at large understand any of the principles of oral hygiene ? 
Aye, I may even ask how many of our patients have well defined 
ideas as to how the healthy condition of their mouth is to be main- 
tained. Those few who have any knowledge on this subject are only 
notable examples of exceptions to the rule. 
This subject, commonly considered so simple as to deserve only a 
passing notice, assumes, in my eyes, a position of vital importance ; 
and the frequency with which it has been considered in other socie- 
ties during the past year indicates that we are at least awakening to 
the value of prophylaxis in our department of medicine, with the full 
hope and expectation of avoiding many dreaded diseased conditions. 
Oral Hygiene may be summed up in one word, cleanliness. Keep 
the mouth in a perfectly clean condition, and the number of those 
terrible diseases would decrease; maintain the normal condition of 
the secretions, and the number would be still further reduced. How 
much rarer the cases of pyorrhoea alveolaris and pericementitis we 
would meet if people would keep their teeth as clean as their faces I 
How rare would be the cases of exposed pulp if food was never per- 
mitted to ferment between the teeth ! I shall not, however, consume 
time by repeating all the evils that can be either prevented or at least 
alleviated by this seemingly simple prescription. To keep the teeth 4 
ORAL HYGIENE. 
clean sounds like such a simple thing that it often deceives doctors as 
well as patients. 
When we consider the close juxtaposition of the teeth to each 
other, ofttimes the irregular position they assume in the arch and, 
most important of all, the frequency of taking food or other articles 
into the mouth which may become lodged around the teeth, and the 
resulting fermentation proceeding upon its work of destruction-then 
we see that the rule is not so very easy to follow, and sooner or later 
the patient must have his prescription amended, to read, Keep your 
teeth as clean as possible. 
It is our duty, then, to take some of our valuable time and show 
people by careful manipulation, how very little they know about this 
sanitary measure. How many of us do this, and if we do it for some 
patients, why do we not the same duty for all who intrust themselves 
to our care? Too often, in the hurry and strife of our daily life, do 
we neglect this all-important duty. The principal article necessary, 
and the one for which we have not yet discovered a substitute, is the 
tooth brush. 
At a discussion of this subject before the Odontological Society 
last October, one of the members said {Dental Cosmos'); " Every- 
body knows more or less about brushing the teeth; every person 
understands it; it is an established thing, like washing your face and 
brushing your hair." My experience, and it has been substantiated 
by that of much older men, is, that however established may be the 
practice, everybody knows less about brushing the teeth correctly and 
more about brushing them improperly. 
Upon making a careful and extensive examination of the brushes 
retailed in the largest stores in New York city, a feeling of dismay 
came over me at the ignorance displayed by the general public in 
their choice of this most necessary adjunct to the paraphernalia of 
the toilet. Wherever I asked which was the most popular brush, I 
was shown brushes of such huge dimensions that, before they were 
shown to me, I supposed they were intended for cleaning the hands 
and nails. Some of you may doubt this, but you only have to go, 
ascertain and be convinced. One of this class of brushes is " Dr. 
Scott's Electric Tooth Brush," the dimensions of which are simply 
immense. The cross motion is the only one that can be made with a 
brush of such magnitude. To quote from Dr. Abbott on this sub- 
ject : " The consequence is, the gums are irritated and recede, the 
necks of the teeth become cut or grooved, and sometimes even the ORAL HYGIENE. 
5 
enamel is brushed off; besides, when the brush gets half way back in 
the mouth, its excessive size prevents it from going further, and the 
back molars are not touched at all." 
So the first thing necessary is to prescribe a suitable brush for your 
patient. Concerning this, I will speak later; but supposing we have 
the proper brush, it should be passed in every direction across the 
grinding surfaces or crowns of the teeth to insure the bristles reach- 
ing every depressed surface or fissure, and upon the inside and out- 
side of the arches, passing it in the direction of the length of the 
teeth from the gum toward their cutting edges, by slightly turning 
the hand upon the wrist so as to cause the brush to move from side 
to side. The necessity of brushing behind the wisdom teeth and the 
insides of all the teeth should be given careful attention. The brush- 
ing should never be severe, but always a delicate operation-to 
merely remove the effete material of a few hours' standing. The 
dentifrice used should be of the finest quality, so as to produce the 
least possible amount of friction. The time to brush the teeth is 
after every meal and before retiring, so as to always leave a clean and 
polished surface, with no opportunity for fermentation to be instituted 
in food entrapped between or around the teeth during each meal. 
To remove what remains between the teeth after the brushing, 
nothing surpasses the waxed dental floss-, and occasionally a little 
powder can be carried on it between the teeth. If these directions 
are followed out to the letter, the patient is keeping himself from 
many hours of dental torment under our hands. 
Of course, there are a large number of patients, business men 
more especially, who will not follow our instructions very closely. 
My motto in such cases is, "A half loaf is better than none." If 
they will not cleanse them after the noon meal, why, insist on their 
attention to this matter subsequent to breakfast and the evening meal. 
Nothing is more instructive to the patient than for the dentist, having 
first handed him a hand-mirror, to carefully brush the patient's teeth 
for him, explaining at each change of position the method and direc- 
tion in which the force is applied. 
One of the most difficult things of accomplishment for the human 
race is the formation either of a new habit or the breaking of an old 
one. It is for this reason that the inculcation on the mind of a child 
of this practice of cleanliness cannot be commenced too early. As 
soon as their first teeth appear, make the cleansing thereof part of 
their regularly recurring duties. They will soon grow to like it, and 6 
ORAL HYGIENE. 
will be proportionately uncomfortable until it has received attention ; 
and thus, when the child is still very young, a habit of the greatest 
benefit is being formed-one which will grow firmer as the child 
grows older, and prove a boon and blessing to them in later life. 
For a long time I sought in vain for a tooth brush that came up to 
my ideas on this subject. In turn, I discarded the Windsor and Pal- 
mer brushes. About this time, Dr. T. J. Thomas, of Paris, presented 
me with a few of the style of brushes he had been using. They 
suited me better than any I had yet met, and I concluded that, with 
certain modifications and improvements, it could be transformed into 
the model tooth brush. In setting out to improve the brush, three 
facts were impressed upon me : 
Figs. 1 and 2. Brush received from Dr. T. J. Thomas. 
Figs. 3 and 4. The Prophylactic Tooth Brush. 
First, A brush that would reach every exposed portion of the 
teeth, in small mouths as well as large ones. 
Second, One that would accomplish its work as automatically as 
possible. 
Third, If possible, construct the brush so as to prevent the 
patient passing it across the teeth. 
The brush that has been evolved from these three principles I have 
named The Prophylactic Tooth Brush. (Figs. 3 and 4.) The 
slab of bone is curved, with the bristles on the concave side. On the 
brush, as presented by Dr. Thomas (Figs. 1 and 2), the bristles were 
divided into three rows, running in parallel lines to the end of the 
brush. They are widely separated and trimmed to different lengths, 
to pass as far as practicable between the teeth. The bristles were ORAL HYGIENE. 
7 
very high next to the handle and gradually decreased in size, until at 
the end they were very short. The head of the brush was one-half 
inch wide at any point (Fig. 2, a). My first step was to give the 
brush a decided taper, so that while the bone next to the handle was 
one-half inch wide (Fig. 4, b), at the apex it was less than one- 
fourth inch in width (Fig. 4, c), and the bristles at the apex are not 
more than one-eighth inch wide (Fig. 3, d.) The next step was to 
change the concavity of the bristles. Instead of having them very 
short at the apex, after passing the center of the brush, the bristles 
commence to rise in height, and at the apex there are three con- 
verging rows of bristles forming one narrow tuft (Fig. 3, d). The 
trimming and separation of the bristles were left the same. 
On the original lot of brushes, and on every brush that I have ever 
seen, the bristles are set back some distance from the end of the 
brush, leaving a projecting piece of bone from one-sixteenth to one- 
eighth inch in length (Fig. 1, e). In a great many mouths this por- 
tion of bone prevents the proper brushing of the wisdom teeth, as in 
attempting to cleanse them it is poked into the soft parts of the 
mouth. In my brush, this protruding portion of bone terminates 
close to the bristles (Fig. 3, f), the apex at the back being beveled 
off, so that the brush passes with the greatest ease around all portions 
of the wisdom teeth, even in the smallest mouths. 
♦ 
Another improvement in the brush consists in an aperture near the 
end of the handle large enough to pass over an ordinary tack (Fig. 
4, g). The idea of drilling a small hole in the handle of a brush and 
passing a string through it was one I received from Dr. F. M. Odell 
some years ago, but the enlarging of the aperture so as to do away 
with the string is a considerable improvement. The advantages to 
be derived from hanging up a brush after using, are a more speedy 
drying of the bristles and additional ventilation, and consequently 
the brush remains much sweeter and cleaner than by a number of 
other methods. 
Each brush comes enclosed in an envelope, upon which are printed 
directions for the intelligent use thereof, and the following caution : 
" Never pass the brush across the teeth, as this movement destroys 
the delicate membrane which attaches the gum to the teeth, causing 
recession of the gum, and ultimate loosening and loss of the teeth." 
The brush has been used by a number of our best known dentists 
in New York, Philadelphia, Chicago and Boston during the past few 
weeks, and it has received the heartiest endorsement of all of them. 8 
ORAL HYGIENE. 
Having reached the conclusion that The Prophylactic Tooth 
Brush comes nearer to the general approval of the profession than 
any other brush, I determined to present the brush to the general 
public through the regular channels of trade, not as Dr. Rhein's 
brush, but merely as The Prophylactic Tooth Brush. For some 
time the question of professional dignity harassed me, and I was 
averse to entering into any commercial relations ; but a careful con- 
sideration of the premises showed me that the fact of my presenting 
this article to the public need bear no relations to my professional 
calling. Public hygiene has been a factor of discussion in every 
medical society, and for the same reason I deem the subject of dental 
hygiene as relating to the general public a fit subject for us to consider. 
Any efforts that we make for improving the general sanitary condition 
of mouths, and for instilling some useful knowledge on this subject, 
will certainly tend to nothing less than the elevation of our profes- 
sional standing.