. et * i** ARMED FORCES MEDICAL LIBRARY Washington, D. C. S-. ' A PRACTICAL GUIDE TO THE MANAGEMENT OF THE TEETH; • COMPRISING A DISCOVERY OF THE ORIGIN OF CARIES, on DECAY OF THE TEETH; WITH ITS PREVENTION AND CCHt. BY L. S. PARMLY, DE5TAL PllOFESSOB. " The great distress which usually accompanies, and the inconvenience which always follows the loss of the Teeth, makes the discovery of some mode of prevention of curies very desirable." Fox. PHILADELPHIA; PUBLISHED BY COLLINS & CROFT, NO. 73, MARKET STREET. J. R. A. Skerrett, Printer. ll ^Atyll' •.• To BENJAMIN WEST, Esq. President of the Royal Academy of Arts, $c. $c. $c. DEAR SIB, In addressing this small performance to you, my intention is less to congratu- late you on the fame your unrivalled ta- lents have secured to you in a depart- ment of the Arts, demanding all the finer powers of taste and genius, than to mark my high esteem for your private charac- ter as a man, in which the union of those virtues that diffuse happiness in the va- rious relations of domestic life are so eminently conspicuous. I have the honour to be, Dear Sir, Your very obliged humble Servant, .., 1. S. PARMJ4Y. 5* BUCKINGHAM STREET, m. ADELPHI. CONTENTS. PAGE Dedication ..... . iii 3 General view of the body . 21 Formation and structure of the teeth . 44 Shedding of the teeth 60 66 Diseased teeth and gums . 74 76 86 91 Occasional effects of diseased teeth . 96 Structure of the gums 100 Structure of the alveolar processes . 106 Management of the teeth 111 OPERATIONS ON THE TEETH. 123 127 Mending or capping diseased teeth . 132 Transplanting of teeth 142 Irregularities of the teeth . 145 Fractures of the teeth . 151 Cracks of the enamel .... . 155 Denuding process..... 157 Wearing of the teeth .... . 159 Morbid growth of the gums 161 Artificial palates . . .' . 165 Ligatures of the teeth . . . . 167 Antrum Maxillare .... . 170 Physiognomy of the teeth 174 Domestic Advice .... . 183 PREFACE. In submitting the following sheets to the attention of the Public, the Author feels it necessary to apologize for occa- sional inaccuracies of style; which the circumstance of his being a foreigner, combined with his anxious desire and impatience to make known some import- ant discoveries, has rendered it as diffi- cult for him to avoid, as it has afforded him but little leisure to correct. The teeth, it is well known, are or- gans most important to the animal eco- nomy. Their use in conveying distinct articulation, in ministering to the com- fort, or promoting the health, of the in- dividual, is jtoo obvious to be insisted on. Suffice it to observe, that when, from disease or accident, impediments arise to the discharge of their proper func- tions, calamities most mischievous to the PREFACE. system ensue; every medical man know- ing that imperfect mastication is a fruit- ful cause of many disorders the most distressing, dangerous, and even fatal to the human frame. Numerous have been the publications of able and skilful men, Avho have preceded the Author in this path of science. It is however me- lancholy to reflect how little that is really useful, has accrued from their la- bours. Experience evinces that all their instructions are but ill adapted to an- swer the intended purpose. Diseased gums, offensive breath, deficient and de- cayed teeth, are still objects of public notoriety. Conscious therefore how much remained to be accomplished, in every thing relating to the management of the teeth, the Author was induced to direct his attention very early to the subject; and the result of many years close application and study, has been at- tended by a discovery the most import- ant that has yet been made in this brauch PREFACE. of physiology. Regulating his practice by the principles of his own system, he has now the pleasure of announcing to the public, the signal success that has marked his professional career in vari- ous parts of the world, and more parti- cularly in this metropolis. Testimonies, as numerous as they are highly respecta- ble, will satisfy the most incredulous, that these are not the pretensions of an empyric, and will convince those desir- ous of placing themselves under his care, of the decided superiority of his mode of treatment in every possible case of dis- eased dentition, and under.every variety of age, constitution, and habit of his pa- tients. He also undertakes to initiate the youth of both sexes, without any la- borious process, in the dental art, so as to enable them to preserve these im- portant organs in a perfectly sound and healthful state, to the most protracted period of life. A.m.; PREFACE. Wherever, in the following work, the Author has ventured to criticise either the opinions or practice of his prede- cessors, he can truly say, he has been influenced by no other motives, than a wish to promote the improvement of an art but too little studied, and to excite the attention of the public, and the minds of professional men in particular, to its importance. Where their sentiments ap- peared founded on just observation, he has willingly adopted them, and in do- ing so, he has not scrupled occasionally to borroAV their language. Should what he has written, have the effect of rescu- ing only one individual from the suffer- ings incident to a neglect of the teeth, he will not regret the time the present publication has cost him. Buckingham Street, Adelphi. DESCRIPTION OF THE PLATE. Figure 1. Rabbit Mouth. 2. Toothless Mouth. 3. Projecting Chin. 4. Mouth, without any deformity. Number 5. Mouth, expanded to shew all the teeth, No. 1. 1. Front Incisores, ") J. or Cutting Teeth. 2. 2. Lateral Incisores, J 3. 3. Cuspidati, Canine, or Eye Teeth. 4.4.4.4. Two pair of Bicuspides, or small Grin- ders. 5. 5. 5. 5. Molares, or large Grinders. 6. 6. Dentes Sapientice, or AVisdom Teeth INTRODUCTION. THE division of surgery into various branches, has, in a particular manner, served to promote the advancement of the science, and thereby been productive of the happiest benefits to society. In examining the progress of the improve- ments in its different branches, it is to be observed with regret, that the Dental Art has not kept pace with many others of less real utility. One cause of this slow pro- gress of dental science is, that the subject has not hitherto been considered as forming an essential part of professional education. Hence, the practice of it has generally been considered in no higher light than a media- IV uical occupation or trade. A great improve- ment of this department of surgery, will de- pend on pointing out to society the import- ance of preventing diseases of the Teeth; and their connexion, in almost every instance, with the general state of the health, and pre- servation of the system. Nothing can tend so much to accomplish this object, as an institution for the exclusive promotion of dentalogical science. The wants of society, as well as the disposition of the present enlightened period, so favoura- ble to the universal diffusion of knowledge, demand such an institution; and such, we flatter ourselves, we are authorised shortly to anticipate, when this noble art will be rescued from that degraded state in which it has long remained in the hands of ignorant practitioners, or mercenary pretenders, who have in a great degree made it a monopoly. Within these few years, it must be admitted, that some attempts have been made at im- provement; and the publication of the late Mr. Fox, joined with his regular course of lectures on this branch of physiology, lias V done more for its promotion than the labours, of any other individual, though occasionally some important errors occur, which it will be one object of the present treatise to no- tice and correct. When we advert to the progress of medical and surgical science, during the last few years, we are struck with the rapid and beneficial changes which have taken place. Medicine is now built on experimental science, and conducted by those enlightened principles which are the fruits of liberal edu- cation, and the peculiar spirit of the present times. The consequence of this has been, that the prejudices of the nurse, the mysteries of the empyric, and the pedantry of the schools, are completely done away. In surgery, the same fortunate improve- ment is conspicuous; the complicated prac- tice of former times now yields to a mild and natural proceeding: and such is the ad- vancement of this branch, that operations are daily performed of that bold and deci- sive nature, that at a former period, would B VI have been deemed impracticable, and beyond the power of art to accomplish. This general state of improvement in sur- gery gives great encouragement to the ex- tention of the dental art.—Were mankind sufficiently acquainted with the many dis- eases and painful afflictions which originate from want of attention to cleanliness of the mouth; and were they convinced, that, from this cause alone, numbers drag out a life of distress, they would feel a greater curiosity, and take a more lively interest in obtain- ing information respecting an art, which the considerations of appearance, comfort, and health, render so essential. That such an in- terest has not been felt is the more astonish- ing, since we cannot but observe how anxi- ously solicitous the mind daily discovers itself to be on subjects of less importance. In- deed, mankind, in general, are not sufficient- ly impressed with the utility of improve- ments, till their own feelings convince them of their necessity. In the present instance, the truth of this observation is but too obvi- ous ; for, in most cases, it is either the loss Vll of Teeth, or the sensation of pain that in- duces people to pay attention to cleanliness of the mouth. Though, at every time of life, an attention to the teeth is necessary, for their appearance and preservation; yet there are certain criti- cal periods at which we are irresistibly led to the contemplation of the subject.—In- fancy is one of them: when the teeth suc- cessively appear, the constitution of the child suffers from their protrusive power, and a general irritative action pervades the system; the sleep is disturbed, the appetite suffers, the bowels are deranged, the muscular flesh de- cays, and marks of universal sympathy affect every part. The anxious day and watchful night then give importance, in the opinion of mothers and female attendants, to this part of the human structure; and it is then that the greatest mortality of infancy occurs. It is computed, that no less than one-fourth of the human race die under two years of age, and it is clearly connected with this source; for the enlarged state of the nervous and vascular system gives a predisposition, at this V1U dawn of life, to inflammation and disease from the slightest causes. The next period ' that calls the attention to the teeth, is the time of shedding the temporary set. The habit now more firm, does not suffer the same general uneasiness as at the former pe- riod; but the process of nature, often imper- fectly performed in the removal of the origi- nal set, requires to be assisted, in order to prevent that local deformity or disfiguration of countenance and features, which is well known to arise from this cause. Hence, this is a period to be earnestly watched by parents and guardians, especially when en- trusted with the care of females, if personal advantages are to be studied and a pleasing exterior preserved. The last period of par- ticular attention to the teeth is, when they begin to decay; for not only do they give ex- quisite pain, as the feeling of tooth-ache con- vinces, but the cause which moulders them away, like other species of gangrene, affects the contiguous parts, taints the breath, and causes the fetor of the mouth to be disagree- able, even to the individual himself. Thus IX daily experience proves, that the teetli are generally the subject of pain and disease; and the question to be considered is. whether this state be naturally entailed upon them, or results from our own imprudence and neglect. From the moment that the teeth have pro- truded, and appear in their proper situation, they are liable to be acted upon by every ar- ticle of aliment that remains upon them : to protect them against this action, they are covered with an exterior coat, termed the Cor- tex Striatus, or enamel, different from other bone, and the structure of which constitutes their ornament as well as their defence.— While a strict attention is paid to cleanli- ness of the mouth, this enamel will be a suf- ficient protection against the operations of every external cause. The teeth of the savage are generally sound and regular, and no accumulation forms to deface them. But this is different in civilized society; refinements in the culi- nary art give the food a greater tendency to acquire noxious powers, and form chemical combination. b2 X This is displayed by the formation of that extraneous matter, called tartar, which, as it accumulates, seperates the teeth from their chief support, the investing membrane of the gums, and thus loosening them in their sock- ets, exposes them, and produces inflamma- tion. But a more active cause of the premature loss of the teeth, is the accumulation or lodg- ment of food in their interstices. There the putrefactive process commences, acts upon the enamel and penetrates to the bone.* In this way the tooth becomes gradually des- troyed, and the individual suffers successive inflammation and pain for a time, till this active monitor, that leads to attention in all * The Author is aware, that most of his prede- cessors who have written on this subject, and among the rest, the celebrated Mr. Fox, have given a different Theory of Caries, supposing that it com- mences in the internal part of the tooth, and at length extends its ravages to the enamel. For further information, however, on this subject, the reader is referred to the chapter on Caries. XI cases, speaks in a language not to be misun- derstood, the mischief of neglect. If cleanliness be essential to other parts of the body, it is peculiarly necessary with respect to the mouth, through which is the opening for carrying on the two great pro- cesses essential to continuance of animal life; the process of digestion, which gives nourish- ment and support to the system; and the process of breathing, which conveys a princi- ple from the air connected with vitality. If, then, the food, from uncleanliness of the mouth, be tainted in the preparatory step of mastication, the process of digestion must in- troduce into the system a tainted chyle, preg- nant with the seeds of putrefaction; if the air inhaled receive the same impregnation, which is the opinion of some of the most skilful of the faculty, it cannot animate the body or give vital energy in a proper degree. These effects, which are independent of its injury to the teeth, have never been sufficient- ly appreciated. Thus, in all cases of unclean teeth, a putrid matter is daily passing into the body, and acting as a slow and unseen Xll poison for months and years, on every part of the frame. When this is reflected on, can there be a stronger inducement to clean the teeth in a regular and proper manner, as a preventive of general disease ? The more we examine the structure of the human body, however varied and multiplied its parts, the more we are struck with the in- timate connexion of each part with the whole. Numerous as they are, to each is assigned some peculiar and needful office, and in a healthy state, the most perfect harmony sub- sists between them; no one obstructs, but each assists, the operation of the other, and thus promotes the ultimate preservation of the whole. By this wise adjustment, there is no schism in the body, no separate or in- terfering ends are pursued by the multiplicity of members, but the safety and support of each are the undivided care of all. Hence in this view, there is no part of the frame that is not of importance, however trifling or insignificant it may appear; the most vital, as well as those on which the lesser energies Xlll ef the system depend, are equally essential to life and its comforts. On these considerations, the teeth certain- ly claim an important rank in the human structure: for— 1st. On them depends the proper expres- sion of the countenance. By their removal the character and symmetry of the face is lost, and beauty is thus deprived of its chief attraction. The celebrated Lavater has paid particular attention to this subject in his work, and pointed out their effect and im- portance in delineating the features of the mind. From this effect on the features they call for more particular attention on the part of females; for (to use a quaint expression) no woman can be beautiful " in spite of her teeth;" and when the mouth is deprived of this ornament, the countenance loses its principal charm. 2ndly. To the teeth also is assigned the chief power of enunciation. If the great and pre-eminent prerogative of man is the pos- session of speech, that speech can never be complete or perfect, without the teeth to mo- XIV dulate the sound, and give proper utterance to the words. Hence, when the teeth are lost, the speech becomes imperfect and scarcely understood. This circumstance gives them additional value, particularly to a man in public life; and the preservation of the teeth ought to be one of the first objects to those who wish to shine either in the se- nate, at the bar, or in the pulpit. Without these instruments of utterance, the graces of their eloquence are lost, and the power of af- fecting the mind and convincing the under- standing, if not taken away, is considerably diminished. 3dly. It is the loss of this part of the structure, that produces the leading mark of age, and occasions the contracted counte- nance, the wrinkles of the face, and those unseemly changes which youth and beauty ever wish to see placed at a distance. 4thly. When the teeth are neglected, they frequently assume a preternatural growth, which produces a disagreeable change on the countenance; and this, of itself, should be a sufficient inducement to their frequent in- XV spection, where external appearance is con- sidered of any importance. 5thly. But the most dangerous effect of neglect of the teeth, and their consequent loss, is the imperfect mastication of the food, which occasions indigestion, and a variety of disorders depending on this cause. In order to a proper digestion, it is necessary that the food be sufficiently comminuted by the action of the teeth, while, during this action, it be- comes blended with a certain quantity of saliva; thus rendering its solution easier when it descends into the stomach to be mix- ed with the gastric juice. Where the teeth are wanting, the food can neither be proper- ly divided or broken down, nor a due quanti- ty of saliva elicited from the glands, to ren- der its solution in the stomach complete for forming it into perfect chyle. 6thly. A disagreeable, though not a dan- gerous, effect from the neglect of the teeth, is an offensive breath: this fact is suscepti- ble of demonstration by positive experi- ments, one is, that the breath, which is exhal- ed by the nostrils, is widely different from XVI that which is expired through the mouth of a person with diseased teeth and gums; foetid breath therefore is confined entirely to the state of the mouth, and has no connexion with that of the stomach, or the digestive or- gans, as is erroneously supposed:—eructa- tation or belching can only produce a tem- porary effect; but, from uncleanliness of the mouth, we find the taint constant and habi- tual ; and, unless the cause be eradicated, all the spices and perfumes of the east, though they may conceal, cannot remove it. 7thly. Besides the reasons already assign- ed, for the necessity of a strict attention to the teeth and gums, may be added their great influence on the state of the general health. The danger to the lungs from constantly inhaling a putrid effluvium, has been strong- ly commented upon by the faculty, as a leading cause of pulmonary consumption. When the great annual mortality from this disease is considered, we cannot doubt that this putrid matter may so change the nature of the fluid inhaled, as to cause that slow in- xvii (lamination of the lungs, productive of those tubercles which are the foundation of the dis- ease. The teeth may be considered, in some measure, as extraneous bodies; and thus do not, like the other parts of the human frame, possess the power of freeing themselves from whatever is injurious. The importance therefore of an acquaintance with the den- tal art, as a part of education appears indis- pensable, is the only means by which this de- partment of science can be enabled to take that rank, which its importance in promoting the health and comfort of mankind so impe- riously demands. Nothing will be a source of greater satisfaction to the author, than that his humble efforts should be instrumental in effecting so desirable a purpose, by impress- ing on the minds of parents and guardians, the necessity of the care and management of the teeth as a primary duty, with a view to the entire prevention of dental disease and deformity. If begun in childhood, and con- tinued in the regular manner recommended, no accumulation could be formed.—The pre- o XV 111 vention of dental disease is founded on an important discovery of the author: expe- rience has satisfied him fully of its success; and this experience makes him more eager to impress the same conviction on others. If to vaccination we owe, of late years, a decrease of the annual mortality, a point clearly proved, the prevention of dental disease will add to this decrease; for the constitution will not be worn out, and the health impaired, by sleepless nights and days of tormenting pain from dental irrita- tion, as happens to too many who date the first symptoms of their ill-health from this Cause. It has been a common opinion, that the teeth are intended by nature to decay sooner than the other parts; but this opinion is erro- neous. Their premature decay is the con- sequence of neglect; and neglect acts here in the same manner as in other cases, by sapping the vital energy of the part, if we may use the expression, and thus occasioning them to moulder awav. XIX After these observations on the importance of the care of the teeth, and as a preliminary to the present work, it may be proper to take a general view of the organized structure of man. A GENERAL VIEW OF THE BODY. THE body is composed of a solid and fluid part, mutually dependent on each other: the former gives it stability, form, and the powers of action; the latter sup- plies the waste, which the solid parts necessarily undergo in the prosecution of their functions. The solid part has been divided by anatomists into the head, chest, abdomen, and extremities: the first contains that organ,—the brain, which is the origin and seat of life and feeling; it is en- closed in a case of bone for its greater defence and security, and is thus equally r 2 22 screened from heat and defended from cold. This part is further covered and beautified by an extensive and constant growth of hair; and to the most promi- nent part of it, the face, is assigned the situation of the different senses Avhich guide and regulate the actions of the body. The chest contains the principal organs which give to the nourishment the peculiar changes that make it pass from a fluid to a solid state, and convert it to supply the decay of the solid parts: of these organs, the principal are the heart, the lungs, and the liver. The heart is that strong, indefatigable muscle, by which the blood or vital stream is conveyed to every part; it is enclosed in a membranous bag, the inner surface of which is lubricated by a thin exhalation to allow it its proper play : it possesses two separate cavities. Each cavity contains an auricle and a ventri- cle.—From the right ventricle the blood passes into the lungs by means of the 83 pulmonary arteries, and is again return- ed to the left cavity of the heart by the pulmonary veins. From the left cavity it passes into the aorta, to be transmit- ted to every part of the system; after this, it is received into the cava, and re- turned to the heart to undergo the same process. Thus, the blood constantly cir- culates in an interchangeable tide, whe- ther asleep or awake, and knows no in- termission in its flow. Through the ar- teries it sallies briskly, and returns more slowly through the veins. The action of the arteries evolves the heat received by the lungs, and contained in the blood for the animation of the body: this heat we find increased by whatever augments the velocity of the circulation, and les- sened by whatever renders it languid. The lungs, the next important organ, receives the blood from the heart, to draw a new principle through them from the air, and to return this principle intp 2± the circulation, to be dispersed to every part, conveying increased animation and life: they consist of two divisions, one on each side the chest, and they open to the throat by the trachea, or wind-pipe. The liver, the largest gland of the body, is situated in the abdomen. Through this gland all the blood circulates, in its return to the heart, after that principle is expended, which it receives from the lungs. This organ secretes a peculiar fluid, the bile, of great use in the animal economy ; and often, by its accumula- tion, its deficiency, or obstruction, is the source of numerous and serious maladies. The gall-bladder is appended to it as the reservoir of that secretion. Besides these, some of the lesser or secondary organs may be noticed. The kidneys, two small glands situated be- tween the back and loins ; the spleen, for forming the red globules of the blood, or some other important use; and the 25 pancreas, secreting that fluid, termed saliva, Avhich assists mastication, and moistens the mouth. These divisions of the body are cover- ed partly with bones and cartilage, form- ing a regular arch, gently moveable in respiration, which protects the chest, and partly with a fine membrane, the omentum, and with muscles, which en- close the contents of the abdomen: these parts are appended to the back bone, which sustains the weight of the whole structure, and serves also to form a con- veyance to that elongation of the brain termed the spinal marrow, which gives out part of those fine cords or nervous filaments, that give sensibility to the system. The last division of the body is the extremities,—the arms, the hands, the thighs, the legs, and feet. The arms are pendent on either side, proportioned to each other, being the guards which de- 26 fend, and agents which serve, the whole frame; fitted, by their shape and struc- ture, for the most diversified and exten- sive operations, and capable of perform- ing, with singular expedition and case, all manner of useful motions. The hands consist of numberless small bones and muscles, forming a nice and varied mechanism, capable of assuming many shapes, and performing every use- ful service. The lower extremities show the same peculiar adjustment of structure for the office intended by them. The thighs and legs are articulated in such a manner, that they administer most commodiously to the act of walking, and do not ob- struct the easy posture of sitting. By as- suming a gentle projection, they under- go a diminution of bulk, and acquire a more graceful form. The feet, the last part of the extre- j mities, compose a firm and neat pedestal, far beyond Avhat statuary or architec- 27 ture can ever accomplish. This pedes- tal is capable of altering its form, and extending its size, as different circum- stances require. It contains a set of active springs, which tend to place the body in a variety of graceful attitudes, and qualify it for a multiplicity of ad- vantageous motions. The undermost parts of the feet are covered with a sinewy substance, preventing that undue compression of the vessels which the weight of the body, in standing or Avalking, might otherwise occasion. Such are the four principal divisions of the body ; but a part of the structure we have hitherto omitted: it is the one by which the aliment is received and prepared for being introduced into the body, to supply the waste that daily and hourly takes place. This part begins with the mouth; con- taining, first, the teeth set in alveolar processes formed on the jaw-bones: the upper jaw consists of six pair of bones. 28 and one without a fellow, viz. ossa max- illaria, ossa malarum, ossa nasi, ossa lacrymalia, ossa spongiosa inferiora, and ossa palati; of each of these there arc two: the thirteenth is a single bone called the vomer. Ossa maxillaria.—These bones con- stitute the greater part of the upper jaw, of the nose, and of the roof of the mouth. They have many processes and depressions, which render their figure extremely irregular; by the union of which, and other bones, are formed the cavities called the maxillary sinuses. These cavities are situated beneath the cheek-bones, and are lined with a con- tinuation of the fine membrane which lines the cavities of the nostrils and frontal sinus: this membrane is called the Schneiderian, from the name of its discoverer; and upon it the olfactory nerves are distributed. The upper sides of the maxillary bones form the lower and internal circumference of the or- 29 bits; and in their lower sides are the sockets for the teeth. They have several holes for the admission of nerves and vessels; the principal of which, are the foramen orbitale externum, the foramen incisivum, and the posterior palatine foramen, which admits the maxillary nerve to pass to the teeth. These bones are joined to the os frontis and ossa la- crymalia at the great angles of the eyes, and to each other under the upper lip. Ossa malarum.—Tfiese are the pro- minent bones which form the cheeks: their figure is nearly quadrangular; they join the os frontis at the little an- gles of the eyes, their upper sides form- ing the lower and external circumference of the orbits. They are smooth and convex on the surface, and unequal and concave within. The internal sides join the ossa maxillaria; and the external sides are joined by long processes to the temporal bones, which union forms an arch called the zygoma. n 30 Ossa nasi.—So named from their situ- ation and use, forming the upper part or bridge of the nose : they are thin bones, \ of an irregular, oblong, square figure, externally convex and smooth, and in- ternally concave and rough. They are joined above to the frontal bone—below, to the cartilages of the nose—behind, to the maxillary bones—in front, to each other—and are supported internally by the partition between the nostrils, called the septum narium. Ossa unguis, or lacrymalia.—These bones bear some resemblance to the finger nail; from whence their name unguis: they are also called lacrymalia, from the water of the eye passing over them into the nose. Their situation is in the great angles of the eye, separating the orbit from the cavity of the nose. Their surface, next the eye, is concave, ( and forms part of the orbit on which the eye-ball moves. They join above with the os frontis—below, with the 31 maxillary bones—and, internally, with the ethmeid bone. Ossa spongiosa inferiora, are so called from their spongy texture.—These bones form part of the nose, enlarge the sur- face, and extend the organ of smelling 5 they also assist in forming the under part of the lacrymal duct, the orifices of which into the nose are concealed by them. Ossa palati are bones of a very irre- gular figure.—They form part of the roof of the mouth, of the nose, and of the orbits. The portions which form part of the palate are irregularly square and concave; and, though thin, are firm and strong :—they have many pro- cesses which joins the other bones of the face. The vomer has its name from the re- semblance it bears to the ancient plough- share : its situation is in the middle of the lower part of the nose, of which it forms the partition. This bone is smooth, 32 thin, and of a solid substance; it en- larges the organ of smelling, by allow- ing space for expanding the membrane of the nose. The lower jaw is admirably adapted to the necessity which exists for a great va- riety of motions, combined with strength of action; it is, at first, composed of two bones,—the ossific fibres of which unite with each other at the chin, soon after birth, and, by complete ossifica- cation, become one bone; this union is called symphysis. This jaw is formed of two lamina, whose surface is hard and smooth; its internal substance is cellular: its base thick, compact, and hard, particularly at the chin, where it is most exposed to injury. It has two processes on each side ; the anterior of which, called the coronoid processes, end in points which pass under the zygomatic arches. The temporal muscles are inserted into these processes. The posterior processes, call- 33 ed condyloid, or articulatory processes, are thicker and less elevated than the coronoid processes ; they terminate in oblong, smooth condyles, or heads, sup- ported by a cervix. To each condyle is attached a strong moveable cartilage, which is also attached to the cavity and eminence, which arc for that purpose in the temporal bones; they are further strengthened in their situation by a strong ligament attached to the temporal bones, and to the cervix of the condyles on each side. Thus, the under jaw is firmly united to the skull; the loose intervening cartilage greatly facilitates its lateral motion, so necessary in mastication. The lower edge of this jaw is called its base, and the end of its base is its angles. In this bone are four holes; two inter- nal, near the processes; and two exter- nal, near the chin: by the internal holes enters a branch of the fifth pair of nerves, an artery from the carotids and vein t'romthejuglares, branches of which d 2 34 pass into the fangs of the teeth; these \ressels emerge again by the external holes, and spread upon the chin. That part of the bone in both jaws, which immediately surrounds the fangs of the teeth, is called the alveolar process. The growth of this process commen- ces with that of the teeth, and advances with them to maturity. The existence of the teeth and alveoli, so entirely depend on each other, that the loss of the former, is inevitably fol- lowed by the waste and absorption of the latter. Thus, the jaw bones of persons become toothless through age, have no sockets for teeth, but have a smooth and solid surface. The teeth are so formed as either to tear or grind, according to the nature of the aliment presented to them; which be- ing masticated, is received on the tongue, that, without the assistance of either bone or joint, adapts itself to every shape and posture, for the purpose of introducing 35 the food. This important organ also renders our thoughts vocal, enables us to communicate our sentiments, and by this faculty of speech, qualifies us for all the comforts and benefits of society. The tongue is terminated by the throat, con- taining the passage to the lungs, through which we breathe; and the passage to the stomach, or gullet, by which we re- ceive food. The stomach, the reservoir of the food, may be considered as its di- latation. In its figure, it resembles the pouch of a bagpipe, and has two ori- fices ; the one which receives the crude aliment from the mouth, and the other which conveys the digested food, or chyle, to the upper part of the intestines. The food on being received into the sto- mach, undergoes an important chemical change: the solvent fluid of the stomach, secreted from its coats, termed the gas- tric juice, acts upon it; and by the fur- ther assistance of heat, it is converted into chyle. This chyle is drawn off by 36 all the secretory orifices of the lacteal vessels, spread on the surface of the in- testines ; and the useless part separated, and receiving an admixture Avith the bile and other active fluids, is discharged un- der the form of feculent matter, after passing through the long and intricate convolutions of the cavity of the intes- tines. Thus, is the body supplied witli food, and its waste repaired. For the choice of this food we are indebted to the senses, which are five in number, viz. the sight, the hearing, the smell, the taste, and the feeling. The eyes, which are the or- gans of vision, are placed in the upper part of the face, are of a globular struc- ture, and consist of simple fluids enclo- sed in thin tunicles. These tunicles are furnished with an apparatus of muscles, enabling them to perform all the varied motions of which they are susceptible. This power, combined with its elevated position, renders the sight 37 the most extensive of all the senses. It is through this sense only, that we are made capable of enjoying the sublime and most beautiful in nature and art. In sleep, its exercise is suspended, and the lids, those natural curtains, spon- ' taneously close for its protection, till the light of day again calls forth its active powers. Next to the sight is the hearing; and the organ subservient to this, consists of an outward porch, the external ear, and an internal apparatus of the most admirable contrivance and workman- ship. The hammer, the anvil, the stir- rup, and the drum, are the names of its parts ; the winding labarynths, and the rounding galleries, with other pieces of its mechanism, are all formed to increase the power of hearing, in a*manner cu- rious and intricate beyond description. It is through this sense the charms of music are enjoyed, and social inter- course maintained. While the eye is 38 watchful only in our waking hours, the ear is expanded to receive impressions at all times, and to warn us of danger before its approach. So important are the organs of sight and hearing in the estimation of nature, that she has shewn her anxiety of guarding against their ac- cidental loss, by bestowing duplicates of each. Smell, the next sense, is one through which also we receive much enjoyment. It has its seat, a fine set of nervous con- geries, spread every where on the inter- nal surface of the nose. Through this sense we inhale the flowery breath of Spring, the scent of autumnal fruits, the delights of the hay-field, the fragrance of the orchard, and the more delicious odours of the garden-rose. Taste, the next sense, has its resi- dence in the tongue and palate. Like a friendly monitor, it apprises us of the safety or mischief of what we eat or drink, and, with the vigilance of a sen- 39 Unci refuses admission to any article of food till its qualities have been subject- ed to its scrutinizing test. The last sense, the touch, is seated in the skin, or that covering which envelopes the whole body; it possesses, therefore, a wide range, and is not circumscribed to a particular place, as the others are. The skin is formed of the most delicate net work, whose texture is exceedingly minute, and whose threads are multi- plied even to a prodigy: they are so minute, that nothing passes them which is discernible by the eye, though they discharge every moment what con- stitutes insensible perspiration. The threads, indeed, are so multiplied, that the point of the smallest needle cannot pierce a single part without causing an uneasy sensation. The outermost co- vering of the skin is that soft whitish tegument, raised by a blister, termed the cuticle or scarf-skin. The true is that reddish and exquisitely tender part 40 which appears beneath the blister when broken. The former is void of sense, and intended to screen the true skin from the impressions of the air, and the effect of injuries. The colour of the cuticle is white. The apparent black or brown it acquires in the Ne- gro or Indian, is entirely owing to the mucous substance lying under it. The functions of the skin are exten- sive and important. It is the seat, as observed, of the sense of touch ; it is the channel of perspiration, and it ob- serves a sympathy with the internal parts; so that an intimate relation sub- sists between them, and a derangement of the internal organs is always mani- ^ tested by the state of the skin: hence the countenance is a sure index of disease; and nature has intended this change, in order to give us alarm in the first instance, and warn us of dan- ger: but the sense of touch is more ex- quisite in the points of the fingers than 41 any other part. Both the fingers and toes are furnished with the defence of nails, which are now considered as a continuation of the cuticle, as they are removed with it by boiling Avater or maceration. Like the cuticle, they are insensible, are renewable when separat- ed, and have no evident vessels: but they differ from the cuticle in structure, being formed of plates with longitudinal fibres, closely compacted; they begin by a square root, a little before the last joint of the fingers and toes; in their appearance, when separated, they are transparent as horn; but in the living body are coloured by the vessels of the skin, to which they adhere, and from which they derive nourishment:—they are fixed at their root to a semilunar fold of the skin, and are there covered by a reflexion of the cuticle, which firm- ly adheres to them. Their growth pro- ceeds from the roots, not the points : by them the ends of the fingers and toes are E 42 strengthened and defended. In the lin- gers they increase the power of appre- hension, particularly in laying hold of , minute bodies. The skin is also adorned in certain parts with a foliage of hairs: they arise by roots or bulbs from the cellular sub- stance under them. The bulbs are of various shapes in different parts of the body, and have blood-vessels dispersed upon them for their nourishment. Each of the bulbs has two membranous cap- sules, containing an oily fluid between them, which gives colour to the hair; for want of this in age, or under certain V diseases, the hair changes its colour* Each hair consists of smaller hairs in- ti closed in a membrane, and is somewhat like the nature of the nails. Like them, it grows from the roots. Though all the uses of the hair are not yet known, it evidently serves for the warmth, pro- tection, and ornament of those parts, on or near which it is placed. 43 Such is a general view of the compli- cated and varied structure of man. When we contemplate the nicety and art with which every part is constructed, we should suppose it was intended to last for ages: experience, however, daily teaches us the reverse; and that certain parts giving way, and falling into decay, occasion the destruction of the whole ' machine. The teeth, though the hardest parts of the human frame, and intended by nature to survive every other, are, through ne- glect and mismanagement, the soonest Avhich give way. The nature and dis- eases of these organs are what we are now to consider as the subject of the present volume. 41 OF THE FORMATION AND STRUCTURE OF THE TEETH. THE teeth consist of two parts: osse- ous matter, the same as other bone; and enamel, their peculiar covering, which •■< gives them their whiteness and polish of surface. Each tooth may be properly divided into three parts. First,—The crown, or that part which projects from the gum, and is the only division which possesses the covering of the enamel. Secondly,—The neck, or that part where the enamel immediately termi- 45 nates, and to Avhich the gum is closely attached. Thirdly,—The fang, enclosed by the socket, and inserted deeply into the jaw. At the point of the fang there is a small opening, placed for the passage of nerves and vessels, which are ramified or spread out on the lining of the opening within the tooth. In this manner the circulation and sensation of each tooth are supplied. The fang is, therefore, an important part, and of the same value as the root to vegetables; preserving the tooth in its due position, and, at the same time, conveying to it the proper degree of nourishment. Man differs from other animals in be- ing provided with two sets of teeth: the first intended for the period of in- fancy, and consequently limited in their duration ; the second intended for the remainder of life, and, therefore, of a stronger and more compact texture. The e 2 46 teeth, in their first formation, unlike other bone, instead of having for their base cartilage or membranous substance, are formed from a soft pulpy matter resembling their shapes, and may be distinctly seen at the time of birth. As soon as they have attained their shape, grooves are formed, into Avhich the sur- rounding vessels deposit the pulpy mat- ter, constituting the rudiments of the fu- ture teeth. At the age of five or six months, this pulpy matter has a regular arrangement, and is enclosed in membranous sacs or bags, ten in number, in each jaw, cor- responding to the number of the tempo- rary teeth. This first appearance is succeeded by ossific fibres shooting across, and dividing the sacs into their respective compartments, which are the commencements of the future sockets. About the seventh month, the ossifica- tion commences, both on the cutting edges of the first teeth, and on the pro- 47 minent points of those situated further back in the jaw. At birth, the bodies of all the first set appear distinctly formed in each jaw; but, at this time, they are ossified only on the external parts, and the unossified pulp within is merely covered with a shallow bone. As the teeth proceed in their ossification and shape, the invest- ing membranes adhere more closely to their necks; and by this attachment they secrete and deposit over the crowns of the teeth a fluid, from which a very Avhite substance is deposited upon the bone. This is the enamel, which is at first of a consistence not harder than chalk; but in age it acquires such a hardness, that a file in cutting it, is soon worn smooth. After birth, the growth of the teeth is rapid, and cannot, therefore, be confined long within the alveolar cavity or socket; they lengthen chiefly from the bodies; those of the under jaAv downwards, and 48 those of the upper jaw upwards. Thc^ parts that first lengthen are shaped into ' fangs; and, as this takes place, the sockets grorv round, and more closely invest them. On the progressive ossification of the teeth, their original membranous cover- ings undergo the process of absorption, and are carried out of the system, having completed their original and destined purpose. In the progress of this growth y of the teeth, a corresponding growth takes place in the sockets or alveolar plates; at first, they grow much faster than the teeth themselves, which are consequently, but loosely, contained in them; and this rapidity of growth is necessary, both to render the soft gum capable of sustaining pressure, as well as to protect the embryo teeth from injury. Hence, in the mode of their growth, it may be observed, that the ' outer edges of the sockets or plates grow higher, and turn a little over in order to approach each other ; the gum then 49 hardens over;—and thus the teeth are fully protected, and the gums rendered sufficiently firm to undergo every neces- sary degree of pressure. The protrusion of the first set of teeth begins as early as at the end of four or five, months after birth, though in this there is a considerable variation; nor does this variation depend on the strength or delicacy of the child; for we often find that delicate children commence dentition very early; while, on the other hand, strong children are very slow in acquiring their teeth: nay, there arc some instances where children have shewn no appearance of teething until the fourteenth or fifteeth month. The general rule, hoAvever, is, that their protrusion begins from the sixth to the eighth month after birth: the mode in Avhich they affect a passage through the gums, is by the process of ulceration. The teeth pres^huraf^h^^ which encloso^Wem, occasions ws 50 i sorption; and the pressure being next comimied on the gum, causes that also to give way. The order in which the teeth succes- sively make their appearance, may be thus described: first, the two front in- cisores, or cutting teeth, of the under jaw,—one generally appearing a few days before the other; for, though form- \ ed in pairs, they seldom protrude at the same time. In about a month after, those are succeeded by the front incisores of the upper jaw. Next follow the lateral incisores of the under jaw, and soon after those of the upper jaw. A deviation "V from the order, hitherto observed, then$ takes place; and, instead of the cnspidati,9',; or canine teeth, which are next in sue-J cession, the anterior molares, or double I teeth, appear in the under jaw ; and * these are soon after succeeded by those y of the upper jaw. Then follow the large molares which completes the first or temporary set. The' whole process 51 generally occupies a period of about two years and a half. Though this is the .regular course observed by nature, there are, at times, ' exceptions to this order of protrusion; i for, instead of the front incisores, the lateral incisores are discovered first through the gums, and the small molares hefore the lateral incisores. It may be remarked, also, that children have been born with the two front incisores of the under jaw through the gum, but such premature birth is always imperfect; these teeth possess no fangs, and are attached chiefly to the gum, which oc- casions pain and irritation to the child; on which account it is generally found necessary to extract them. The period of dentition is often highly critical to the constitution of the child, as it not only occasions disease, but generally aggravates any other disorder Avhich may occur at the time; yet, it is well known, that this period sometimes 5a! elapses unaccompanied by any particu- lar symptoms of pain or uneasiness. The appearance of the teeth is clearly an effort of nature, in which she effects the absorption of the investing mem- brane, the alveolar process, and the gums, to make way for their passage ; but the teeth sometimes advancing too \ rapidly, occasion a strong tension and pressure on the vessels of the gums, ., which produces pain and irritation in the surrounding parts. Hence, the gums appear swelled and inflamed, a constant discharge of saliva takes place from the mouth, and often a general sympathetic fever prevails over the whole system. At this stage of the fever, which fre- quently proves fatal, the treatment of u the child, both as respects the parts affected, and the system in general, de- mands particular attention. It is commonly recommended to allow the child some hard substance to press against the gums, which, though it may 53 afford a temporary relief, generally in- creases the inflammation and uneasiness. A more effectual means of relief would be afforded by producing a gentle fric- tion on the gum, with the finger and a little fine salt; which, by exciting a co- f pious flow of saliva, and thus reducing I the action of the vessels, would tend to m alleviate the inflammatory symptoms. FBut an early recourse to the lancet is the safest expedient, and the only one that is to be depended on. An incision made with this instrument over the tooth that is the cause of irritation, either in a linear or cruciate form, as the tooth is single or double, would not only ad- minister instantaneous ease to the little sufferer, but would prevent or remove every distressing and dangerous symp- tom with which dentition is often at- tended. But little skill is required in performing so simple and safe an opera- tion, particularly if the lancet, the au- thor has invented for the purpose, be F 54 employed. The operator must see that his instrument reaches the seat of the mischief; and not be satisfied with barely dividing the gum, but, also, the membrane below the gum, that is in im- mediate contact with the tooth. The division of this membrane, from its tougher texture, will acquire some little pressure of the lancet, (and, with the instrument commonly used, a conside- rable one,) from which it need not be apprehended the tooth can sustain the slightest injury. And here I cannot but seize the pre- sent opportunity of combating the preju- dice that so generally prevails in the minds of parents against the use of the lancet. Let them be assured, it is ab- solutely impossible the slightest harm can arise from its use, even when the \ operation is discovered to have been un- necessarily performed. When parents are even convinced of its necessity, their fears frequently induce them to postpone 55 the operation till fatal symptoms of convulsion appear, which frequently prove fatal, and in one moment awfully reproach their indecision, by hurrying their infant offspring to another world. But let not the most threatening symp- toms of danger deprive the afflicted mother of her presence of mind, but let her apply immediately to the lancet; for the author has known many a child snatched, as it were, from the arms of death, when the delay of its application, even for a few seconds, he has the strongest reason to suppose, would have terminated their existence. The general irritation of the system which attends teething, is marked by the following leading symptoms: Flushings of the check and fever, which is generally sudden in its attack. The eyes of the child first become heavy; he is hot and restless, putting his hand often into his mouth. The tongue be- comes white, the skin dry, and the ap- 56 petite and rest are disturbed. These * symptoms become often so aggravated, - that delirium succeeds, convulsions su- , pervene, and a fatal termination takes , place. Where fever is not so predominant, diarrhoea is a common symptom, which, if gentle, is attended with beneficial ^ effects, and assists in taking off the irri- tation ; but when, on the contrary, it is violent, of a green colour, and attended Avith much griping, the child becomes exhausted, its rest is constantly disturb- ed, startings and convulsions supervene, and the termination is often fatal. Another symptom of general irrita- tion at this period is, the appearance of.. different eruptions on the skin. These are attended with considerable variety, * and are often thought to arise from a ' different cause than that of teething; but the period of their occurrence marks their origin, and every remedy is found ineffectual, till the irritation of teeth- 57 ing is past.—Such are the symptoms which the protrusion of the first set oc- casions. The permanent set, on the contrary, occasions no uneasiness or pain. These, like the others, are formed before birth; but, in the formation and perfection of this set, we may observe, a very impor- tant part of life is occupied; twenty years being necessary for their complete evolution. They consist, generally, of thirty-two in number; being twelve more than the primary set, and are divided into four classes, namely, eight incisores, four cuspidati, eight bicuspides, eight mo- lares, and four denies sapiential: if more, they are termed supernumerary teeth. The formation of both sets of teeth correspond to the elongation or growth of the jaws, and the changes are exhibit- ed in the following order : the tempora- ry incisores and cuspidati of the child, are succeeded by larger ones of a similar form; while those which succeed the f2 58 \ A temporary molares, are much smaller, } and, being divided or irregular on their grinding surfaces, are called bicuspides. j The adult molares, which succeed each | other as the jaws advance in growth, all ] differ in the number and shape of their fangs. The size of the teeth is originally de- termined by the deposition of ossific matter assigned them, so that, on their appearance beyond the gum, their growth may be considered as completed, for they neither increase in size nor alter in shape. The first set, or temporary teeth, hav- ing answered their purpose, the perma- if nent teeth, formed in sockets behind ' them, and Avhich have been gradually | proceeding in growth, by pressing for- I ward, possess the situation of the others: and in this, they are often impeded by the roots of the temporary set, which have never been absorbed. This effort, Avhich facilitates the re- 59 moval of the temporary set, is one of the most curious operations of nature. The absorption takes place in the in- cisores about the fifth or sixth year, and proceeds in rotation, as the teeth origi- nally protrude through the gums. The absorption is retarded by uncleanliness, and disease of the teeth and gums, which occasion irregularity in the permanent set. 60 SHEDDING OF THE TEETH. THE changes which the teeth under- go form a very interesting part of Na- tural History; and is absolutely requisite to be known by every parent, to enable them to render such assistance, during the progress of the second dentition, as may prevent the permanent teeth from acquiring that irregularity which occa- sions so much deformity of the face, and often destroys correct enunciation. The period when the temporary teeth begin to shed, is usually between the fifth and seventh year. On the removal ', of the front incisores of the under jaw, the permanent ones immediately succeed, and next the four first permanent molares appear; and then the permanent inci- sores of the upper jaw, which are sue- 61 ceeded by the lateral incisores of the un- der jaw, and soon after by those of the upper. The bicuspides are the next in order : first, the anterior one's of both jaws, and soon after the posterior ones; the cuspidati of the under jaw next ap- pear ; then the corresponding ones of the upper; and, near the same time, the middle molares make their appearance in both jaws, which is, generally, be- tween the eleventh and thirteenth year; and, lastly, the posterior molares, termed dentes sapientiae, or wisdom teeth. The time of their protrusion is more uncer- tain than the others; sometimes they appear as early as the eighteenth year, and at other times not before the fortieth year. Such is the time occupied by na- ture in the perfection of the permanent set of teeth; and such is the order in which they generally appear. Though the number of the second set is found to be thirty-two in all, yet a natural defi- ciency of them often occurs; but these 62 aberrations of nature are very rare: in- v stances are even stated of persons not having any teeth; in such cases the gums are found sufficiently callous, and competent to every purpose of mastica- tion. Having thus described the two sets of teeth, it will be further necessary to con- sider, that part of their structure which is peculiar to these organs, and which qualifies them for the proper discharge of their office. This part is the cortex striatus, or enamel, which consists of a crystallization, formed by a soft earthy matter, deposited by the investing mem- branes on the bony layers of the crowns of the teeth. Its appearance, at first, is in fibres or streaks, running from the circumference to the centre of the teeth. ' As it hardens, these fibres arrange I themselves into arches over the bodies of the teeth. Hence, by this mode of ar- rangement, arises its durability and strength, to resist, without injury, the 63 frequent actions to which it is exposed. The enamel, though thus so hard and strong, is not above half a line in thick- ness; but this thickness is increased on / the cutting edges and grinding surface of the teeth; its hardness may be consi- dered as tempered steel, and when struck againstthe latter it will emit sparks. The enamel, in many cases, appears imper- fect ; and where indented spots are seen on its surface, they may generally be attri- buted to uncleanliness of the mouth dur- ing the growth of the teeth. The ena- mel consists of three principles, viz. phosphate of lime, carbonate of lime, and gelatine, in different proportions. It is, at first, of a consistence not harder than chalk; though, when the teeth appear through the gums, it has acquired the firmer texture of bone ; yet it is often so acted upon by particles of food and dis- ease of the gums, as to assume a honey- comb appearance. Having considered the formation and 64 progress of the teeth, to the complete / i evolution of the permanent set, it w ill now be proper to examine, not only the , diseases to which, as organized bodies, they are exposed, in common with other bone, but also the disorders to which they become liable, from the peculiarity of their situation. As diseases of the teeth not only injure the gums and taint the breath, but also affect the alveolar processes, their treat- » ment should be undertaken only by an operator that is thoroughly acquainted with the principles of surgery. Whatever affects the teeth, is readily communicated to their appendages ; and hence, the alveolar processes and sock- ets, from their intimate connection, in- variably become more or less diseased. The teeth, from the compactness of their structure, do not, like other bone, pos- sess sufficient power to effect exfoliation, or the natural removal of disease; neither is it in their power to bring on the pro- 65 cess of suppuration, which nature em- ploys as a salutary change to carry off the morbid effect that takes place; and when inflammation commences, if not speedily removed, occasions gangrene, or a death of the affected parts. 66 THE ADULT TEETH. THE teeth may be viewed, in some degree, as extraneous bodies, not liable to those diseases which affect the rest of the system. This has not been duly con- sidered by preceding writers, who have generally supposed these substances to be affected by all those circumstances which influence the rest of the body, and which are here, on the contrary, from the nature of their composition, of no effect whatever. The diseases of the teeth are simple; and they are only changed by that chemical agency which is immediately applied to them, and which never fails, when exposed for any length of time to its influence, to produce an erosion of their enamel. The adult, on the discovery of a carious 67 tooth, may date the mischief even as far back as the period of childhood, when the means of prevention should have been administered. Numerous are the causes of diseased teeth and gums, stated by writers; but these causes may be considered, for the most part, as ideal. It has been assert- ed, that climate has a considerable in- fluence in this respect; that the inhabi- tants of warm countries have sound teeth, while those in the colder regions have diseased teeth. But this is contra- dicted by plain fact; for we find persons both with sound and diseased teeth in every climate, Avhich shews it is not to that cause the disease is to be attributed. The same may be said of the luxuries of the table, in respect to sauces, acids, sweetmeats, &c. For the teeth,, the hard- est substance of the animal machine, can never be acted upon by the transient passage of certain articles of food and beverage into the stomach. The same 68 s observation will apply to heat and cold, and to the temperature of substances taken into the mouth. This temporary influence can never, of itself, produce disease in the teeth. To what then are the disorders of the teeth to be attributed ? This is an inter- esting question ; and one whose solution escaped even the penetration of those ce- lebrated physiologists, Hunter and Fox. I esteem it, indeed, a most fortunate circumstance, that my attention was so early and closely engaged by an enquiry of such general importance : and I can now assure my readers, that the result of my labours, founded on the successful prosecution of a series of the most nu- merous and satisfactory experiments, few have had even an opportunity of making is, that the relics of what we eat or drink, (without regard to its quality) being allowed to acwimulate, stagnate, and putrefy, either in the interstices of the teeth, as is most commonly the case, or else in 69 these indentures on their surface, favour able for the lodgement of food, is univer- sally the cause of their decay, and general- I ly of most other disorders, to which they are exposed. The great and leading cause, there- fore, of the diseases of the teeth and gums, is to be sought for in the exercise of their functions. Being the agents of introducing the supplies to the system, they must act on these supplies mechani- cally, and fit them for passing into the stomach; and, in doing so, part of that matter, of which the supplies consist, must adhere, and receive, if allowed to remain, that change which enables it to act upon, and erode their enamel and bone ; and to contribute to that peculiar secretion on the teeth, known by the name of tartar, which is another cause. of inflammation and disease of the gums. This is the true source of 'caries, or decay of the teeth, which the two late eminent writers before-mentioned, find so difficult G 2 70 \ te account for; and of which discovery I cannot help feeling a pride and pleasure in avowing myself the author; for I can, with confidence, assert, that if the teeth and gums are regularly cleaned with the dentifric apparatus, recommended by the author, no caries can possibly take place. This then is a simple and clear view of the subject, and the grand desideratum for retaining these important organs in a sound and healthy state, to the latest period of existence. The mode of clean- ing the teeth, as usually performed, is to rub them with a brush and a prepara- tion of tooth powder, or tinctures, (to which some great quality is ascribed;) but, in whatever way it is employed, ^ the source of the evil still remains; for the interstices and irregularities of the teeth afford a lodgement for whatever is taken into the mouth; and no contrivance hitherto discovered can, from these parts, remove the accumulation. After much experience and reflection 71 on the subject, I found it necessary to construct a dentifric apparatus, which is found to answer every purpose, and i to obviate the defects in common prac- | tice. This apparatus consists of three r parts, contained in a small case, with a ' dental mirror, fit for the toilet or the pocket. The first part to be used is the brush.* It is made hollow in the middle, to em- brace every part of the teeth, except the interstices; and thus, at one operation, the top, (a part hitherto entirely ne- glected) the outer and inner surfaces are completely freed from all extraneous * As public utility, more than emolument, is the object of Mr. Parmly, he has resisted the advice of his friends, in declining to take out a patent for his brush; he cannot, however, but submit it to the feelings of a well known Dentist, at the west-end of this Metropolis, how far sentiments of candour or justice can warrant him in affixing his name to this article, and assuming to himself the credit of the invention. 72 „ matter. The second part is the dentifric polisher, for removing roughness, stains, &c. from the enamel, and restoring to the teeth their natural smoothness and colour. The third part is the waxed silken thread, which, though simple, is the most important. It is to be passed through the interstices of the teeth, be- tween their necks and the arches of the gums, to dislodge that irritating matter which no brush can remove, and which is the real source of disease. With this apparatus, thus regularly and daily used, the teeth and gums will be preserved! free from disease ; the use of powders, tinctures, &c. will be superseded; and the breath will not be loaded with that putrid effluvium, which, besides its pub- lic annoyance, is the cause of numerous disorders. Indeed, were persons suf- ficiently attentive to cleanliness of the mouth, diseases of the teeth and gums might be prevented, without the neces- sity of any painful operation, Avhich 1 73 would contribute no less to the improve- ment of the features of the countenance, than to the promotion of general health and comfort. Having thus pointed out 't the simple and successful method of jj preserving the teeth and gums, and I rendering the breath agreeable, we will now consider their treatment when in f a diseased state, and rectify the practice I of former dentists. 74 TREATMENT OF DISEASED TEETH AND GUMS. THE means of prevention, pointed out in the preceding part of the work, ap- pear at first sight, interesting only to those whose teeth are not yet attacked by disease. Where, however, it has actually commenced, and undergone the specific treatment adapted to its cure, the means of prevention, already insist- ed on, will be equally efficacious against any future attack. The treatment of the diseases of the teeth constitutes an important branch of surgery; and it is proper and almost indispensable, that every person, and particularly parents, should have some acquaintance with the operations be- 75 longing to this branch, that they may form some idea themselves of what is proper to be done, and what may be reasonably expected from the person | who denominates himself a professor of the dental art; individuals will thus be ,' guarded against the exaggerated pro- ! mises of empyrics, and form just expec- f tations for themselves of what can be r done for their relief and improvement. For, whatever experience and manual • dexterity the dentist may profess, he can never perform miracles, or effect any thing more than is rendered practicable by the laws of nature, and a knowledge of the structure of the teeth and their appendages. 76 CARIES. CARIES, or the decay of part of the teeth, arising from uncleanliness of the mouth, is the most frequent disease to which they are liable. It commences* generally, in the interstices and irregu- larities of the teeth, in the form of a small dark spot on the enamel, which, eating it away, passes inwards, and oc- casions a still more rapid decay of the bone, till the tooth is entirely destroyed. It has been a grand mistake with authors on this subject, that caries commences internally, and acts on the bony sub- stance of a tooth. The enamel, how- ever, may be considered at all times, the first seat of attack; though, on the bone, from its softer texture, it makes a greater and quicker havock than on the f 77 outer crystallized covering, Avhich, to the eye, appears oftentimes scarcely perforated. The wasting of the bone thus deprives the enamel of its support, so that the J least pressure, on masticating hard sub- I stances, causes it to break away, Avhich exposes it to the action of every external 1 substance; and then a cavity is disco- vered in a tooth which had been sup- posed, previously to this, perfectly sound. Mr. Fox, and other Avriters, observed, that one part of a tooth is not more lia- ble to disease than another; but the very nature of the cause which produces ca- ries, viz. the relics of the food lodging in the interstices, proves, that those are the parts in which diseases generally commence. The molares are usually more decayed than any other of the teeth. This arises not only from their being more neglected than those placed in the prominent part of the mouth, but, from their indented surface, affording easier u 78 lodgements for food than the other teeth; and for the removal of which, my new- invented brush is so well adapted. The j caries, or decay often begins on those I sides of the teeth which are placed in j apposition to each other ; and, from the j nature of the cause, which acts by a ! putrefactive process, there is no doubt, that, among the sound teeth, any one which is contiguous to a tooth that is decayed, is the most liable to diseased action. The incisores of the upper jaw, are, also, very frequently affected in this way, while those of the under jaw are very seldom known to decay. Their preservation arises from the under jaw being more exposed to the action of the saliva, the solvent powers of which pre- vent the relics of the food from injuring the teeth. The first appearance of ca- , ries, in every instance, is, by a disco- 1 louration, as before noticed, of the af- fected part; and, when a decayed tooth is examined, the diseased part appears to be disposed in strata, the external 79 layers of which are most decayed, as- suming a blacker appearance, and are rendered so soft as easily to be cut away. The next are of a harder nature, less discoloured, and gradually exhibiting a firmer texture, till we reach the part that is perfectly sound. When the opaque- ness of the enamel indicates the attack of caries, if the tooth is sawn through, a brown mark will be discovered, ex- tending towards the natural cavity.—It is in this direction the disease proceeds, and, on the cavity being exposed, the investing membrane, and its ramifying nerves and blood-vessels, discover inflam- mation, which is the cause of tooth ache. During the progress of caries, the inter- nal part of the crown, from its softer texture, suffers most, and is, therefore, soonest removed, which causes the inside to appear excavated. When the whole crown is destroyed, the progress of dis- ease seems somewhat suspended; and the fangs will often remain, for many years, 80 \ V with little alteration, from the cause ot ft the disease not having the same field to act upon as it had on the crown, which is always an exposed part; and the fangs will even continue firmly attached i to the socket, without the least incon- venience. Hence, persons seldom experience the pain of tooth ache, from what are termed stumps; for, by the disease destroying the body of the teeth, the investing mem- brane, and its blood-vessels, are remov- ed, and the circulation to the fang is thus cut off. Pain, therefore, from stumps, arises from their acting as extraneous bodies on the sockets; and thus exciting in- flammation, which often terminates in suppuration. It is surprising, that the cause of caries should have been so much misunderstood. Mr. Hunter goes so far as to say, that it does not arise from external injury, or from menstrua, which have the power 81 of dissolving part of a tooth, and that we may reasonably suppose that it is a disease originally arising in the tooth itself. This idea is acceded to by Mr. jl Fox, who expresses the same doubt and j obscurity respecting it. But if we at- f tend to the commencement and progress » of the disease, it appears evident, that the cause is of an extraneous nature, as before-mentioned; that it first affects the enamel in one point, and that this point is in a situation most liable to be acted upon, by the relics of the food and beverage which, from heat and stagna- tion, undergoing a putrefactive fermen- tation, acquire a sufficient solvent power to produce disease. The proof that this is the true cause of caries, is evident from the fact, that those who daily and regularly clean their teeth, even in the common method, are not so subject to this disease, because less lodgement can then take place in the interstices, or else- where to act upon them. h 2 82 \ Mr. Fox, therefore, following his pre-' decessors, has bewildered himself on this subject, and lost sight of the true cause. He ascribes it, in the first place, to a state of ill health, during the formation of the teeth, which renders thein unable to resist the causes of disease. But this cause would extend equally to all the teeth, if it arose from a general weak- ness of the system. He next attempts to account for it, from a state of constitu- tion connected with dyspeptic symp- toms, or stomachic complaints. But this cause, like the other, could only act by depriving the body of its due portion of nourishment, and the teeth of course as a part: to this must be ascribed, the pearly white appearance, he remarks on them: but it never could induce a specific action on particular teeth, the leading point contended for. Certain kinds of diet, he next resorts to, as the source of caries; but whatever we eat or drink, can only act on the 83 teeth while it remains in the mouth: yet 60 far we agree with him, that the relics of any diet, allowed to stagnate in the interstices, as we have already pointed out, will be sufficient to produce the dis- i ease, without the aliment being of any | particular kind. The same objections apply to the influence of temperature of the atmosphere ; for in all countries teeth are found sound and healthy. This is a proof, that the cause is entirely of a local nature, and confined to that part where the disease first appears. Caries, it is clear, can never arise from irregularity of the teeth, nor yet from their being placed too close to each other, or improperly situated in any part of the mouth; excepting, so far, as such circumstances may afford a more convenient lodgement for food and other matter, to act upon them chemically. On the subject of caries, from the above facts, Ave are led to conclude, that no one part of the teeth is more liable to 84 disease than another; and that caries is not peculiar to them at any certain pe- ' riod of life: but, when the cause is ap- ' plied, the decay is more rapid in child- | hood than in the adult; which has given rise to the common expression of " bad teeth, so young, I am surprised." This surprise instantly ceases, when it is con- sidered, that the teeth of young children )! are very little harder than wood. In dismissing this subject on caries, it may not be amiss to state, that the calamities of war have afforded the author an op- portunity, with which few, perhaps, of < his profession, have been favoured, of in- vestigating the true cause of caries; and of satisfying himself, in regard to the accuracy' of his own theory. He has now, in his possession, thousands of teeth, extracted from bodies, of all ages, that have fallen in battle, inflicted with caries from its first commencement to the last stage of the disease; and he will undertake to satisfy the most seep- r 85 tical on this point, that caries univer- sally commences externally. What has, in all probability, given rise to a con- trary opinion is, that the aperture in the enamel, through which this disease finds its admission, is, in many cases, so j exceedingly minute, as to escape the de- I tection of all, but those who are aware : of its true cause. 86 TARTAR. EXCEPTING the disease of caries, nothing is so destructive of the healthy condition of the mouth, or of the dura- bility of the teeth, as the accumulation of tartar. This is an earthy substance, held in solution by the saliva, and is deposited on the teeth as the saliva undergoes decomposition. Almost every person is subject to the formation of it, in a greater or less degree; in some, the deposit is so habitual and copious, that, without unremitting attention, there is no guarding against its accumulation; whereas in others, it is so small in quan- tity, that the least degree of care is suf- ficient to keep the teeth perfectly free from it. Similar concretions are known to be deposited in other parts of the 87 body, of a nature corresponding with the fluids that pervade those parts of the system. In some, the tartar is deposited in greater quantities, during disorders of i the alimentary canal. It is also in- | creased by an inactive and obstructed perspiration. Hence, its accumulation, during sleep, is greater than at any other time. It soon acquires a hard con- sistence, insinuates itself under the gums, and detaches them from the necks of the teeth. Thus the gums become subject to inflammation and pain, gradu- ally recede from the teeth, and produce an absorption of the alveolar process. So, in proportion to the increase of tar- tar, and its adhesion to the teeth, their natural support is destroyed, they be- come loosened in their sockets, and at last fall out. This happens to one tooth after another, until the whole are lost. When the teeth come out in this man- ner, they appear, on inspection, perfectly 88 sound, and betray no mark of caries or other disease; for the tartar acts as an artificial covering to the natural enamel; and while it loosens them in their sockets and detaches them from their situation, it protects them from the action of other external agents, whenever it covers them. When it is allowed to accumulate, it thickens, and becomes hard on the parts which do not undergo friction, parti- cularly between the teeth, and at the base of their crowns next the gums, as well as about those teeth situated near the openings of the salivary ducts. Hence the incisores of the under jaw, and the molares of the upper, are most covered » by it. Where any of the teeth are wanting, so that friction does not take place in the act of mastication, the tooth corres- ponding to the one lost, very rapidly be- comes encrusted with tartar. The colour of tartar is various, as well as its consistence; when soft, it has 89 a yellowish appearance, but, as it thick- ens it becomes of a dark brown or of a blackish colour. Its accumulation gives always to the teeth, a disgusting and uncleanly appearance, and though in f itself inodorous, yet from its effect in f producing diseased gums, the breath re- ceives a disagreeable taint. As it forms, it deposits itself in layers, acquiring often such an extraordinary magnitude, as to equal the size of the teeth themselves. In some cases, the tartar has been known to acquire a pe- culiar corroding nature : in this case, its colour differs from common tartar, being of a dark green, and it is more of a fluid than of an earthy nature, having little tendency to incrustate. It is perhaps this species of tartar, which is mention- ed by Dr. Armstrong, of St. Vincent, when he states the fatal diseases which often follow the bite of the negro there, ' and which he attributes to the noxious 90 qualities contained in the tartar of their teeth. The analysis of tartar has been made by several chemists, and it seems chief- ly made up of phosphate of lime—its earthy part; the remainder, consisting ofjibrina, the foundation of the animal solid, and a proportion of oil or fat. Of these materials, the phosphate of lime is by far the most abundant. r 91 TOOTH ACHE. THE ultimate effect of caries, is, by denuding the internal structure of the teeth, to produce that unpleasant and painful sensation, termed tooth ache. The pain attending it, is, in various de- grees, according to the influence of ex- ternal agents, on the denuded part. Often it is so acute, as to produce deli- rium and convulsions. At other times it is moderate, and rather a gnawing than an acute pain. The caries has ge- nerally made some progress before tooth ache commences. The pain is com- monly sudden in its attack, darting from the tooth through the head, and affecting the whole jaw. Where fits of tooth ache frequently occur, they be- come so violent and constant, that the rest is disturbed, the appetite fails, and the person is unable to pursue his usual I vocations. The original scat of tooth ache is always confined to the cavity 3 of the teeth, and not to the investing membrane, as erroneously supposed. In the progress of the disease, the mem- brane, and all the contiguous parts, be- ' come inflamed, occasioning considerable swelling, which having attained a cer-^|; tain height, the pain often, in some de- gree, subsides, though in other cases it becomes more acute, and ends in suppu- ration of the surrounding parts. In se- vere cases of tooth ache, the swelling i and inflammation of the surrounding parts is so great, that the mouth cannot be opened, and the eye often becomes nearly closed. The swelling has even . been known to extend down the neck, and to be productive of general irrita- tion. When this is the case before its termination, suppuration ensues, and the alveolar processes in consequence of 93 their inflamed state, are removed by the process of absorption. Where matter repeatedly forms about the fangs of the teeth, the sockets be- come so much absorbed as to loosen the teeth ; and even the jaw bone occasion- ally suffers from this inflammation, and its partial mortification at times is known to ensue. When this misfortune happens, it can only be remedied by the process of ex- foliation, which is slow in its progress, and occasions a greater or less deformity for the remainder of life. The pain of the teeth is often peculiar to the situ- ation of the tooth affected. Thus, when it attacks the dentes sapiential, or wisdom teeth, of the lower jaw, it is not felt so much in the teeth themselves as in the ear. When it affects those of the upper jaw, it seems to shoot more directly up to the temple. In all cases, a remarkable sympathy seems to prevail between the affections of the teeth and the ear; for 94< pains in the teeth cause a similar suffering | in the ear, and, in like manner, harsh and discordant sounds produce an unpleasant I sensation, known by the term of the teeth being set on edge. But the most alarm- ing disease, connected with the state of the teeth, is that affection, known by the name of Tic Douloureux. This disease- consists in the irritation of certain nerves, the commencement of this irri- tation is connected with the teeth, and is of a most alarming nature. The pain is most excruciating, and recurs in fits on the slightest agitation, produced by mas- •» tication, speaking, walking, riding, &c. l The nature, however, of this disease is * but little understood, and is fortunately but of rare occurrence. Indeed, such is the sympathy of the teeth with each other, and the diffusion of pain from one to another, that the pa- tient has often a difficulty to point out the original tooth from which the pain proceeds. Hence, it is not uncommon 95 for a person to feel a pain in the teeth of the upper jaw, when the disease ori- ginated in a tooth of the under jaw7. But, independent of their sympathy with t each other, the teeth have a remarkable I one with other parts of the system. f Thus tooth ache is often one of the ac- companying symptoms of pregnancy during the first months; though, when the teeth are examined, they discover no apparent marks of disease. The treat- ment of tooth ache is a subject of much importance, and must be varied accord- ing to the circumstances of the case ; it is, therefore, necessary to ascertain, whether it arises from caries, tartar, cold, or sympathetic affections. 96 OCCASIONAL EFFECTS OF DISEASED TEETH. DISEASED teeth often occasion that affection of the gum termed epulis, or gum boil: the inflammation of the tooth extending to the vessels at the point of the fang, and thence to the periosteum and sockets; the circulation becomes necessarily impeded, and the inflamma- tory action thus begun, ends in the for- mation of matter within the alveolar processes. While this matter is confined, it excites considerable pain; the face is swelled and inflamed, which continues till the collected matter escapes. This it does, by eroding the socket on the outer | 97 J side, where a natural opening or ulcera- tion takes place; the sore occasions a perpetual discharge, and the skin rises and becomes fungous, with a red spongy , appearance. If the diseased tooth, which F is the source of the evil, be removed, if the discharge then gradually diminishes, 1 and the sore heals externally : but, in ■ healing, the former destruction of the T parts, occasions a contraction of the I skin, and a deep scar is formed, which to a female cannot fail to- be highly disa- greeable, and a source of great uneasi- ness. When, under these circumstances, carious teeth are extracted, a fleshy substance appears to cover their fangs, which extends to the bottom of the socket; and is that method which nature employs by means of granulation, (the effect of the healing process,) to fill up the cavity, occasioned by the loss of sub- stance, during the inflammatory action. Where the disease is entirely ne- glected, the inflammation often extends 98 I deep into the jaw bone, and the conse- quence is, that a part of it separates, and mortification ensues. Before this happens, and exfoliation is accomplish- ed, a continual uneasiness prevails, and a constant discharge takes place in the mouth. As the process of mortification, or separation, of the parts proceeds, the alveolar processes are gradually left by the gums, and the bone, separating and gradually loosening, should as soon as the separation is completed, be taken away. When a gum boil forms with any of the temporary teeth, it requires very particular management; for, if allowed to proceed so far as to cause an exfolia- tion of the jaw bone, the teeth may be entirely destroyed. These circumstances point out the ne- cessity of early care, to prevent a malady of this kind. But, sometimes, instead of matter forming, the inflammation at- tending a carious tooth is of an indolent 99 ! nature, producing, at the bottom of the socket, a hard lump, about the size of a nutmeg. This appearance will continue without any change for months, ex- cept when some active irritation occurs Jfrom cold or other causes, which pro- I duces considerable uneasiness and pain i- of the parts. Such tumours are always F to be considered dangerous; for there is no dependence on their continuing in an indolent state. From the view taken in the preceding pages of the teeth, and their diseases, we are led to notice the parts which support them; namely, the gums and the alveolar processes. 100 STRUCTURE OF THE GUMS. THE gums, when in a healthy state* are of a vermillion colour, of a semi- cartilaginous consistence, and highly vascular. They adhere firmly to the necks of the teeth, passing between them and attaching to the bony divisions of the alveolar processes, (which connect the inner and outer gums) and their ex- treme edges lie upon the enamel. The gums, which arc between the teeth in the upper jaw, descend lower, and in the under jaw, are situated higher than the other parts. Hence, at the necks of the teeth they form an arched appearance. In their natural state they possess little sensibility; but, from accumulations about the teeth, they acquire such an extreme degree of it, that the least pres- 101 sure occasions pain : they are liable to bleed, and become considerably disco- loured, thickened, and enlarged. In in- fancy, during ,the progress of dentition, should there be inflammation of the • gums, the slightest touch produces so much suffering, that children will even J refuse the breast, on account of the pain f attending the necessary pressure of the f nipple. On the contrary, where there is no inflammation, the gums are so in- sensible, that infants are pleased with sucking or biting a hard crust. In old age, when there are no teeth, the gums possess so, little sensibility, that the chewing or bruising of food is attended with no pain; and it is well known, that those who have lost all their teeth, enjoy their food much more than those who have diseased ones. It is clear, therefore, that all diseases of the gums, at every period of life, originate either from dentition, or from uncleanliness of the mouth, and are not peculiar to the K 102 gums themselves, as erroneously assert- ed by authors on this subject. The most ' frequent disease, which has been sup- , posed peculiar to the gums, is what is commonly, but erroneously, called scur- vy, from their assuming an appearance similar to that of the scurvy at sea; a complaint always proceeding from un- cleanly teeth. The disorder is marked by the gums becoming redder than ordi-, nary, spongy, discoloured, and bleeding from the slightest touch, caused by the fulness of the vessels. This disease of < 3 the gums is entirely of a local nature, ;'{ and when neglected, is productive of * much uneasiness and distress; for, be- sides their being soft and spongy, the mouth becomes very painful and sore, •; and the teeth so tender as scarcely to allow the mastication of food. Matter forms and oozes out near the necks or lower parts of the teeth, in consequence of the ulceration, forming between them ; and the gums. The natural arch of the 103 gums is thus destroyed; they become uniformly straight, recede from the ena- mel, and thus expose the fangs of the teeth to whatever is taken into the mouth. This affection next attacks the alveolar processes, where absorption taking place, they are gradually destroy- ed, and thus the teeth, losing their sup- port, become loose, and successively drop out at intervals, until the person is rendered toothless. Persons who lose teeth from this cause, complain that they come away perfectly sound, not consi- dering it as the effect of uncleanliness. Scurvy of the gums, is a disease with which most individuals are more or less affected, under the usual method of managing the teeth. It is, as before stated, local; and, from the very nature of the cause, will affect the gum on one side of the tooth, and not on the other. In its early stage, this disease is easily cured by the use of the dentifric appa- ratus. The habitual application of this 104 apparatus will produce a healthy action II in the vessels, and keep the teeth clean; ■ thus preventing any recurrence of the 1 cause which produced it. The brush, 1 when first used, should be employed u rather delicately, as also the waxed silk, .< until the gums harden and regain their | arched appearance. Although the gums may at first become subject to a slight bleeding, yet in a few days, by a perse- verance in the treatment recommended, this bleeding will cease; nor will the slightest pain be experienced. When the disease has proceeded to such a length, that matter oozes from the gums, and the teeth feel tender and painful, a dental operation is the only remedy. After the operation, the above treat- ment will have all its influence, in pro- ducing the desired effect; but there is an ultimate stage of this disease, where | it does not prove altogether effectual, in j consequence of a death taking place in 105 the periosteum, which covers the fangs of the teeth. Persons occasionally subject to inflam- mation of the gums, should clean their teeth often with the waxed silk; when f a new and healthy action will be com- municated to the gums, and they will be restored, in a short time, to their na- turally firm and adhesive state. By this uniform proceeding, the interstices will be kept clean, and the teeth will become more firmly attached in their situation. K 2 106 STRUCTURE OF THE ALVEOLAR PROCESSES. THE alveolar processes, though origi- nally elongations of the jaw bones, do not belong to them, but are considered as appendages to the teeth. In these parts, j as we have shewn, are deposited the first rudiments of the teeth, which they con- tinue to retain in all the stages of their growth, and to the fangs of which, their shape is gradually accommodated. Like \ the periosteum in other bones, they are invested with a vascular membrane, which is attached to the fangs of the teeth, and by which the latter are fixed in their sockets. The destruction of the 107 membranous lining loosens the teeth, and from this circumstance the single fanged ones drop out, whilst those that are double and irregularly fanged are retained. This dependence of the teeth on the membrane for their attachment, allows them a certain motion, intended by nature, in some degree to prevent injury, as it enables them to yield to the resistance occasioned by hard sub- stances, during the process of mastica- tion. This motion is most sensible where the fangs are inflamed; and from the increased sensibility of the periosteum, the teeth appear as if loose to the pa- tient, and he is led to suppose, that the extraction may be performed without difficulty or pain, which has too often been proved to be a complete mistake. In all cases of diseased teeth and gums, the alveolar processes, from their intimate connexion with them, are more or less exposed to injury. The inflam- mation of the former extends to the 1 108 V latter, which, from increased action of their absorbent vessels, undergo a re- moval of their substance. Thus their absorption constantly attends the loss of the permanent teeth, under every variety of age, from whatever cause that loss may proceed. Where all the teeth are lost, it may be observed, that the upper jaw is dimi- nished in length, the roof of the mouth loses its arch and becomes flat, and the under jaw is a mere piece of bone covered by the gums. Thus the face loses an inch and a half, of its former M extent; and, from the muscles of the \ lower jaw, being obliged to act more forcibly to draw it against the other, are : produced those striking and well known | marks of old age, the deformed features, the hollow cheeks, the wrinkled face, and projection of the chin. Some authors, particularly Mr. Fox, have considered the alveolar processes as subject to peculiar diseases, inde- 109 i pendent of the teeth and gums: but these I have never been able to trace; and wherever their absorption takes place, at any period of life, it will be found to 1,1[ have proceeded from an affection of the T primary parts. Whenever the alveolar if processes become diseased, the gums V will be detached from the teeth, and will m recede in proportion as the alveolar pro- f cess is destroyed, the absorption gradu- ally advances, the necks of the teeth t and the fangs become more and more f exposed, and seem to those unacquainted • with their structure, as if increased in length. The causes of alveolar absorp- tion are, continued inflammation of the teeth or gums, an accumulation of tar- tar, that affection of the gums called scurvy, and their diseased state arising from an excessive use of mercury. The symptoms of this state of the al- veolar process having commenced, are, the length of the teeth, the wider space between them, and a difficulty in chew- 110 \ ing hard substances. The teeth next be- come loose, and mastication is alto- gether impracticable. Besides absorption of the alveolar pro- cesses, an opposite affection may be no- ticed. The bottom of the socket fills up, or becomes contracted, by which it is proportionally shorter, and the teeth are forced out, while the gum undergoes no change, but still retains its place; and the teeth continuing to advance, gradually lose their support, and in the end drop out. < In many persons, the loss of a tooth ' is hastened by being longer and striking against the others; this may be easily rectified, by shortening the tooth with a new dental instrument I have invent- 3 ed for the purpose. I Ill MANAGEMENT OF THE TEETH. t } THE first and most important object, is cleanliness of the mouth, which is the only preventive of disease. Of the va- rious causes of diseases of the teeth and alveolar processes, we have found that the greater part as enumerated by writers, are merely theoretical, and are built on no solid facts. The only true cause of all the diseases to which they are liable, is, the contact of the accumulation, and the action of that matter upon them, which forms the re- lics of our food and beverage, and which operates by undergoing the putrefactive process, as a deleterious poison, or cor- roding agent to their structure. Where the teeth are kept clean and free from such matter, no disease will 112 ever arise. Their structure will equally stand against the summer's heat, and winter's cold; against the changes of climate, the variations of diet, and even the diseases to which the other parts of the system may be constitutionally sub- ject. This being the case, the means of prevention are clear and simple ; name- ly, to avoid the accumulation of matter which injures their substance ; and it is in the mode of cleaning them, that the whole secret of avoiding disease consists. The means commonly resorted to, are the use of the brush, joined with the friction of tooth powder; but, that both brushes and dentifrices, as they are at present used, however ingeniously con- trived or often employed, are insuffi- cient for the purposes of effectual cleans- ing, is obvious from this circumstance, that the teeth and gums are still left in a diseased state. Tooth powders, being generally composed of insoluble sub- 113 stances are acid ingredients, and evi- dently hurtful, both by their mechanical and chemical agency. The brushes and powders are gene- rally applied to the outside only of the 1 teeth; and to shew the injury of these F applications, we shall make some obser- ' vations on their composition and nature. The sulphuric acid, or oil of vitriol, from its peculiar and well known pro- perty, of giving a beautiful white appear- ance to the teeth, forms a principal ingre- dient in all those ruinous compositions, sold under the title of tooth powders, tinctures, or pastes. In tinctures and lotions, it is combined with some spiri- tuous or watery infusion, of an aromatic nature, variously coloured and scented, according to the taste of the composer. In the paste it is united with some gritty powder, to which a light vegetable mat- ter is added, when the whole is made of a proper consistence with honey, or other glutinous substance. The powders, 114 also, not admitting the acid in its natural form, have corrosive salts substituted, such as cream of tarter, alum, &c. &c. united with powder, which often consists of brick-dust, blended with some other ingredient, to colour and conceal it. But, besides these compositions, which are expressly sold for the purpose, many arc in the habit of using substances at their own option for cleaning the teeth, with- out having recourse to these advertised specifics. Of this kind, soot is one; to Avhich I see no other objection, than that it is a dirty, disagreeable, and indelicate substance. Its use has, perhaps, arisen from the observation, that chimney sweepers have white teeth. This is gene- rally more in appearance than in reality: when examined, it is found to be oc- casioned by the contrast of the face with the natural colour of the teeth. Another substance in much greater use of late years, for the purpose of cleaning teeth, is charcoal pulverized: but highly as it 115 is celebrated for its antiseptic qualities, it is very improper as a dentifrice; for, however fine may be the powder to which it is reduced, every chemist knows, that the substance continues perfectly inso- luble. The finer indeed it is pulverized, the easier is the admission it finds be- tween the teeth and gums, where its insinuation, like every other extraneous matter, is a perpetual source of irrita- tion and disease; and its constant fric- tion may injure the health and beauty of the gums; its effect also, as a purifier of the breath, is very transient. Denti- frices similar to charcoal, are formed by the burning of bread, leather, betle nut, peruvian bark, &c.; in their effects, however, they all differ little from com- mon charcoal: gunpowder and iron rust, is another composition in use, but it owes its quality entirely to the charcoal, as the nitre it contains is in too small a quantity tQ be of any use. Prepared alum, is another substance used for the 116 same purpose; but, being a combination of sulphuric acid and clay, when it comes in contact with the teeth, it undergoes a decomposition, and they are conse- quently exposed to the action of the acid. The same injury arises from the use of cream of tartar, which, though it Avhitens the teeth, acts powerfully on the enamel. The best dentifrice that can be used, is common table salt: it is perfectly inno- cent, as it completely dissolves in the saliva, and produces all the friction that is necessary for cleansing the teeth. Nitre, is also a valuable application, both as it reduces the inflammation of the gums, and removes the tough viscid slime, which is then apt to collect in the mouth. But the cleaning of the teeth and gums, in order to preserve them in health, and prevent the attack of disease, can only, as we have before stated, be done in a proper manner, by using the dentifric apparatus already described. This is as simple in its construction 117 as it is easy in its application ; and its use, if persevered in, will preserve the teeth, gums, and sockets, in a healthy state, and render them less subject to disease than any other part of the body. The idea, that the teeth are more de- structible than any other part of the sys- tem, is founded on a mistaken opinion, of which we find evidence every day, in bodies, which have been buried for years, where the teeth have been found entire and sound, while the other bones were decayed and mouldered to dust. This is a sufficient proof that disease is not naturally entailed upon their structure, but the effect of carelessness, inatten- tion, or the want of cleanliness. It is in the power, therefore, of every individual to preserve the teeth and gums in perfect health, when once instructed in the proper method of cleaning them. What a world of pain and distress are we thus enabled to avoid by a little trou- 12 118 blcand care!—the attack of serious dis- eases, sapping the foundation of health, arising from this cause, might be en- tirely prevented; and the stomach and digestive organs would also be preserved in their natural and regular state. By perfect mastication, the process of as- similation would be greatly facilitated, and the nourishment would enter the system in that complete form capable of transmitting its benefits to the most minute recesses of the body; and thus dyspeptic complaints, which begin at an early period, and are the bane of those past the meridian of life, would not he so frequent as at present, nor call for the aid of the physican, or the constant use of the stomachic tincture and pill. When the teeth and gums are capable of performing their proper offices, the food is always relished, and health, that greatest of blessings, uninterruptedly preserved. It may, perhaps, be neces- sary to give some directions for clean- 119 ing the teeth, adapted to the varieties of age. In childhood, before the loss of the temporary teeth, the mouth should be regularly cleaned every evening, the relics of the food, which have been all the day accumulating, are thus prevented from committing their ravages during the night; and the habit of cleanliness will become fixed, from being so essentially connected with personal comfort. The brush should at first be but gently ap- plied, and then particular care taken to pass the waxed silk in the interstices, and round the necks of the teeth, where lodgements of the food (the causes of disease) are usually formed. Warm water is always preferable to cold for cleaning the mouth, from its being a better solvent of the usual articles of their diet. But when the permanent teeth begin to make their appearance, then is the time that the greatest attention to •ieanliness is particularly necessary. ISO \ It is a common practice with most peo- ple after meals, to make use of a tooth- pick, to remove whatever may be lodged between the teeth. This practice, how- ever, is highly to be reprobated: the constant use of a tooth-pick cannot fail to make improper openings between the teeth; and when once that part of the gum which forms the arch, is removed from their interstices, a small hollow is made for the reception of accumulating , matter, which, if neglected to be remov- ed, will, from its immediate action on the bone, rapidly excavate a tooth, and pro- duce early pain, that woidd never have | existed, but for the use of so improper an instrument. ■ Some popular writers have objected I entirely to the use of hard brushes, and considered the finger as sufficient for ' cleaning the teeth, on account of its soft pliancy, and the gentle roughness of its papillary vessels. But, if this were sufficient, the tongue would answer yet 121 better; for its papillary vessels are still more numerous, and it possesses also greater sensibility, softness, and pliancy; yet, with all these advantages, it does not prevent the accumulation of tartar, j which is always more abundant on the inside of the teeth, where the action of fthe tongue is most powerful. The same objection may be applied to cleaning the teeth with a cloth, which, though it may partially remove what is on the surface, cannot, from their inaccessible situation, act on those parts that it is of the most importance should be kept clean. Many people suppose that the gums cannot be preserved in a healthy state, unless they are exposed to the daily fric- tion of the brush. This, however, is a mistaken opinion; and, indeed, if the friction is constantly applied in a per- pendicular direction, it will, by forcing them from the teeth, be highly injurious. If the gums are actually diseased, the application of a composition of salt and 12S alum, in the proportion of one of the lat- ter to four of the former, either in a state of solution, or used as a powder, will, in the course of two or three days, effect a temporary cure ; when if the tartar is immediately removed, and the interstices of the teeth kept clean, no other means will be necessary to keep them perfect- ly pure and wholesome for the remain- der of life. 123 OPERATIONS ON THE TEETH. SCALING. THE first and simplest operation on the teeth, is the removal of the tartar, termed scaling. The instruments for this purpose are made of various forms, and so constructed as to be applied easily to the different parts of the teeth. It is an operation which is not attended with pain; and, for its utility, we may refer to the observations already made on the accumulation of tartar, as one cause of disease. In employing the instruments, I can with confidence say, I have never found a patient complain of the slightest 124 pain, nor even perceive the smallest scratch on the enamel, after the tartar had been removed. This is prevented from the lightness of hand, with which the instrument is conducted over the sur- face of the teeth; a dexterity acquired only by practice and experience. Instead of performing this operation by means of instruments, some dentists, from a desire to make the teeth appear white, have employed chemical solvents. But, as the tartar contains the same principle of solidity, as the teeth them- selves,—namely, phosphate of lime and fihrina, whatever acts in destroying the tartar, must also act in injuring the teeth : such means, therefore, are to be strongly condemned, and will never be employed by an operator of any re- spectability. The benefit derived from the removal of tartar, is not to be esti- mated according to its quantity, but ac- cording to the situation in which it is ' - 125 placed; for, if a very small quantity has insinuated itself in the interstices, or round the neck of a tooth under the gums, the removal of it, is of more importance I to the patient, than a greater quantity on the crown. This fact is proved by daily observation; for teeth become loose, and fall out early, with very little tartar upon them. A popular prejudice prevails against scaling the teeth, from its having been observed, that, after such an operation, they tend more rapidly to decay; a cir- cumstance easily explained. For, while tartar is confined to the crown of the teeth, so as not to interfere with the gums, however disagreeable in appear- ance, it acts as a complete preservative against the attack of caries. This na- tural protection, therefore, being re- moved, it will be easily seen why, if the teeth are again neglected, their liability to decay should be increased. This ef- M 126 feet, hoAvever, is completely prevented, by the constant use of the dentifric ap- paratus, which will also supersede the necessity of future scaling. 127 EXTRACTION OF TEETH. THIS is an operation which always creates some little alarm to the patient, and is sometimes attended with difficulty and danger; but, in this, as in many sur- gical operations, the ease and safety with which it is executed, will depend on the skill of the operator; though, for the consolation of patients, my ex- perience warrants me in asserting, that extraction is much oftener resorted to than is necessary. Whenever a tooth is painful, it is advisable to have it ex- amined, and an endeavour should be made to remove the malady by palliative means; but, if it prove carious, the dis- eased part should be removed, and the tooth repaired. Indeed there is no ne- cessity for having recourse to this dan- 128 gerous expedient, even if the crown be entirely decayed ; for the fangs of the teeth will always admit of engrafting, on a plan I have for years so success- fully practised. Extraction therefore can only be necessary, either to prevent, or remedy, irregularity in the arrange- ment of the permanent teeth of children, or, in some diseases of rare occurrence in the adult, as in neglected cases of the antrum maxillare, as well as, where the diseased state of their fangs has, from neglect, terminated in what is called an ulcerated tooth. In all other cases it is to be opposed, and is a wanton outrage on the unhappy individual, who, from the effect of pain, is brought to submit to this harsh and often unavailing mea- sure. But, independent of the little ne- cessity for such an operation, we know that it has sometimes been attended with the most serious and fatal conse- quences. 129 Even in the most favourable case, there must be a fracture of that part of the socket where the fangs are situated; and if the alveolar process is firmer than usual, and does not yield to the power of the instrument, the fracture may be extended through the alveolar processes of several teeth, and the jaAV bone be exposed to a most serious injury, the effects of which the patient may re- tain for life; and the formation of matter taking place, several of the contiguous teeth will be rendered useless. But, though the operation may be success- fully performed, a dangerous hemorr- hage often follows. Some patients have suffered a continued bleeding for twenty- four hours, and their lives have been with difficulty preserved, while other cases have ended fatally from this cause alone, in spite of all the boasted powers of styptics. This alarming effect of extraction arises from the artery not always con- M2 130 trading after the removal of the tooth, either from the injury done to the parts, or from its being of a larger size than usual, and the coagulum that is formed not being sufficient to prevent the effusion of blood. As these consequences cannot be foreseen, the operation is a more serious one than is commonly imagined; and should, therefore, never be trusted to the rash or ignorant. Much likewise depends on the state of the patient's con- stitution at the time of extraction. In some persons we find so strong a dispo- sition to gangrene or mortification, that the slightest scratch or cut will produce a tendency to it. In such habits the ex- traction of a tooth, aided by the putre- factive process arising from a diseased state of the gums, will easily excite in- flammation, when either a tedious ulce- ration and exfoliation of the parts will ensue, or else the patient will be cut off by a mortification rapidly extending its effects to the jaws, face, and throat. 131 A dreadful instance of which lately oc« curred in Guy's Hospital, where a pa- tient died solely in consequence of the extraction of a tooth. For these reasons I strongly object to the extraction of teeth in all cases, but those specified in the preceding observa- tions ; where extraction, however, is ad- visable, I employ an instrument similar to that of an engraver's tool. In this I differ from all other operators; for they uniformly prefer the key instrument, so long in use. It is true, that it has un- dergone several alterations, and has re-r ceived some improvements; but the prin- ciple of it, even in its most improved state, remains the same, and cannot h% too strongly reprobated. 132 MENDING OR CAPPING DISEASED TEETH. THIS is an operation which is rarely attempted by dentists; and it must give no little satisfaction to those having ca- rious teeth, to know they can be com- pletely repaired by a new mode of ope- rating peculiar to myself. The carious teeth are thus rendered ornamental and useful through life, and every complaint prevented which arises from imperfect mastication. An acci- v dental circumstance first convinced me that a part of a tooth might be supplied, and that in so perfect a manner as com- pletely to escape detection. The frequent performance of this ope- ration has enabled me to execute it with 133 success, in situations where I did not at first conceive it practicable. It is at: tended with scarcely any pain ; and the discovery will, in most cases, supersede the necessity of extraction. A knowledge of the evils which may result from a carious tooth, even if un- accompanied by pain, should influence every person, on its first discovery, to seek the proper remedy; for by cap- ping the diseased tooth, the lodgement of food, occasioning the putrefactive process, is prevented, and the conse- quent taint of breath removed; the pro- gress of decay is arrested, and the pain arising from tooth ache, or any other cause, completely done away. But where the teeth are painful, and attended by inflammation of the gums and sockets, this operation should be suspended till the painful symptoms subside; for the cavity of an inflamed tooth is then so sensible, that the accidental introduction of any substance will excite the most 134 acute pain: it is therefore advisable, first to diminish the increased action, which may be done by filling the carious tooth with cotton, dipped in an infusion of oil of cinnamon and gum camphor; and, as soon as the tenderness or pain is removed, then should the operation of capping be performed. In cases where the crown of a tooth is entirely decayed, I have found means of supplying the deficiency without having recourse to metallic aid, or ligatures. 135 ARTIFICIAL TEETH. THE utility and importance of this invention may be fully appreciated, when we consider, that by the loss of teeth, the youthful countenance acquires all the character and deformity of age; the natural expression of the features is changed, mastication impeded, and the power of correct enunciation entirely destroyed. My mode of supplying teeth is as dif- ferent from any employed by my prede- cessors, as it is far superior to all that are at present known. They are formed from a substance warranted not to change its colour, are rendered perfectly durable, contrived so as to baffle detection, com- bining ease with beauty, and are, in all 136 respects, as efficient as those of the na- tural set. On this branch of the dental art much labour and ingenuity have been bestow- ed ; and it is the exactness with which artificial teeth are adapted to the mouth, and the ease with which they can be worn, that constitutes their chief excel- lence. The mode of supporting teeth, by means of ligatures, round the con- tiguous ones, I very early found suffi- cient reason to discontinue in my own practice; nor is the other method of fixing the artificial crown by means of a gold or silver pivot, as was recom- mended and practised by Mr. Fox, lia- ble to less objection; as, on this plan, the pivit soon wears away the fang, the artificial crown becomes loose, and will at last drop out. This has been gene- rally considered as the fault of the ope- rator, in not adapting such teeth with sufficient nicety to the fangs; but the blame attaches rather to the principle than to the dentist; for it is impossible that a pivot, made from a harder substance than the bone of a tooth, can be used with- out the latter sustaining injury from the constant friction. The same objection may be applied to the fastening artificial teeth by clasps, or springs, round the necks of the natural teeth, or securing them by means of fine Avire, or Indian grass; for, in whatever way it is appli- ed, it tends to destroy the periosteum. But, besides these inconveniences aris- ing from the use of artificial teeth, se- cured by ligatures, pivots, clasps or wire, a still greater objection is the taint the breath receives from the particles of food, which remain about the teeth, and which, from the nature of these contriv- ances, appears to be unavoidable. The author has long abandoned this destructive practice, and is able to per- form the operations in such a manner, as to render artificial teeth completely secure, without either of the above me- N 138 > t'hods. This, he has no doubt, will be a matter of astonishment to those, who arc acquainted only with the common mode of operating; but he is ready to convince the most sceptical on this sub- ject. Incredible as it may appear, the witnesses of his practice, both abroad and in this country, will prove the de- cided superiority of the Parmlyan Sys- tem. His method, he is satisfied, is entirely new in this country, and is con- sidered one of the greatest improvements in the dental art. Where the teeth are mostly gone, in both or in either of the jaws, the method is to form an artificial set, by first taking a mould of the risings and de- pressions of every point along the sur- face of the jaw, and then making a cor- responding artificial socket for the whole. If this be accurately fitted, it will, in most cases, retain itself sufficiently firm, by its adhesion to the gums, for every 139 purpose of speech and mastication. If this adhesion cannot be rendered suffi- ciently complete, from the irregular form of the jaw, then it must be supported by springs. On its first application, such a mechanical apparatus feels unpleasant, but habit soon reconciles the Avearer to its use. The gums become hard, and the sensibility of them nearly oblitera- ted, so that at last the person feels un- easy without them. Artificial teeth are commonly made from the tusk of the hippopotamus or sea horse, which has been preferred for its whiteness, durability, and fine ena- mel. The chief objection to its use, is, that it does not resemble the human teeth in colour. Thi& difference is more apparent, when placed by the side of a natural tooth, than when the entire set is made from the same substance. Artificial teeth have likewise been formed of a paste, termed mineral teeth; they are composed of baked earth, 140 covered with an enamelled flux, and co- loured to imitate nature. This sub- stance is best suited to entire sets, but objections arise to such teeth, as they are easily broken, and do not assume the healthy appearance of the human teeth. Neither have they everbeen formed so as exactly to imitate nature, but are easily discovered to be artificial machi- nery ; and many improvements are still wanting to render them complete. Hav- ing succeeded in supplying the loss of teeth, as already stated, without the aid of ligature or any metallic substance, and, aware of the prejudice prevailing against the use of natural teeth for this operation, I succeeded in discovering a substitute, possessing all their advan- tages of form, durability, and colour, in the teeth of certain quadrupeds smaller than the sea horse; the beauty of whose enamel is superior, and whose form re- quires little or no alteration. This in- vention I have now successfully employ- 144 ed for years ; and my practice requires only a comparison witli the operations of other dentists, to estimate fully the importance of such an improvement. In all cases of artificial teeth, an at- tention to cleanliness is indispensably necessary; for they, as well as the hu- man teeth, unavoidably accumulate tar- tar ; and from the particles of food ad- hering to them, they become highly dis- agreeable. They should be frequently cleaned with warm water; and, by means of the dentifric apparatus, they may be rendered equal in appearance, wholesomeness, and durability to the na- tural set. jr 2 142 TRANSPLANTING OF TEETH. THIS is a painful operation, and not often attended with the desired success. It was once a popular practice; and is performed by completely extracting the diseased tooth, in whose place another is to be introduced. The tooth to be substituted, is then to be removed from the mouth of a person, previously pro- vided for this purpose, and instantly transferred to its intended situation, where it is properly fixed till it unite firmly to the socket. This operation is, at best, but limited, being confined to the front teeth, or those having single roots. The practice was first suggested, and acted upon, by the late Mr. John Hun- ter; it continued a few years after his 143 death, but is now, for strong reasons, entirely given up; for, first, it did not alwrays succeed, nor could it be expected; facts proving that when teeth are ex- tracted by mistake, they do not'always become firm again, even when immedi- ately replaced. Much less can a tooth, belonging to another person be expected to become fixed, when inserted in a socket of unsuitable dimensions. Besides, after submitting to the ope- ration, and undergoing, for weeks, all the penance of a fluid regimen, and even where a transplanted tooth, under the most favourable circumstances, has fast- ened, experience has shewn that its du- Cation is limited to a very few years. To this may be added the turpitude of disfiguring one person for the sake of another; and the danger of introducing disease, which Mr. Hunter has laboured so strongly, but unsuccessfully, to op- pose. He admits, however, that this operation has occasionally produced dan- 144 gerous symptoms; but that these arise from the principle of irritation alone, ex- citing deranged sympathies. But what- ever may be the cause, the consequences have been, in many instances, unplea- sant and alarming; and, if the mere ir- ritation of a foreign body, applied in this way, is sufficient to produce them, it is a strong reason for laying the prac- tice aside, whether it is capable of intro- ducing infection and general disease into the system or not. 145 IRREGULARITIES. OF THE TEETH. IN all cases of irregularities, during the shedding of the teeth, the treatment to be observed, is to remove the obstruct- ing temporary teeth, and then to ap- ply pressure, in the most convenient manner, upon the irregular tooth, in order to direct it into its proper situa- tion. But parents, unfortunately, do not in genertil, perceive the necessity of having recourse to professional aid, until the irregular growth of their childrens teeth, is so far increased as to amount to a manifest deformity. Where suffi- cient room is not made for the perma- 146 neiit teeth, by the timely removal of the temporary set, irregularities of the for- mer are often met with; and where these irregularities are allowed to pro- ceed and become fixed, it is often a mat- ter of difficulty, and sometimes of im- possibility, to rectify them. Thus, where the permanent teeth are large, and the jaw bones have not grown sufficient to admit of their enlargement, in a regular manner, they crowd and over-lap each other. In the same man- ner the central incisores of the upper jaw are often pressed forward, and ren- dered so prominent, as somewhat to re- semble in shape the mouth of a rabbit. When the space of the jaw is not suffi- cient for the regular arrangement of the teeth, some must then be considered as superfluous; and it will be necessary to remove one or more of the bicuspides from each side of the jaw, before the fangs are formed, to, give room to the rest; the incisores must then be gradu- 147 ally forced into their proper situation. The occasional pressure of the finger and thumb, if attended to, before age has given too much firmness to the jaw, will invariably bring the teeth into their proper places, without the necessity of having recourse to continued pressure by means of instruments adapted to the arch of the mouth, as recommended by Mr. Fox. But, in some cases, the cause of irre- gularity arises not from the Avant of space in the jaw, but from the protru- sion of supernumerary teeth, which are generally of a deformed shape, and some- what resembling the cuspidati. These protrusions usually take place in the upper jaw, and if inside, they are in front of the jaw, or when without, near the molares; and are always very conspicu- ous, and should, as soon as their growth will admit of it, be extracted. But the most frequent irregularity, which occurs in the appearance of the 148 teeth, is, where one is longer than the other, or where they have ragged edges. This often takes place in the edges of the front teeth, which are so irregular as to resemble a saw. These irregularities, in order to avoid inflammation in those parts of the mouth that come in contact with them, it will be necessary to remove, which is easily effected by the improved dental instru- ments, which cut much faster than the file, without producing any unpleasant sensation. No injury will attend this operation; on the contrary, it will improve the shape, and prevent any further crack- ing, or separation of the enamel. The application of the file has been consider- ed injurious, by those who suppose the removal of part of the enamel, to occa- sion the decay of the teeth. But a partial loss of the enamel, or even a larger por- tion of the tooth, while the cavity re- mains untouched, will never occasion 149 its decay. This is confirmed in those eases where the enamel is broken by accident, as well as by the operation of filing, for the purpose of removing the carious part, which preserves the rest of the tooth entire. The truth of this observation will further appear from a practice that obtains among savages; j for, it is Avell known, that the Abyssinian negroes remove the corners of the cutting i edges of the incisores, so as to give them a pointed appearance; and, by not interfering with their cavities, such teeth receive no injury whatever, from the operation of the file: the Malay Indians likewise file the incisores of the upper jaw, in a direction across their anterior surface, giving them the ap- pearance of being fluted; but, by this operation, the cavities of the teeth be- come exposed, and caries accordingly soon takes place. The chief objection, however, of patients, to the operation of filing arises from the unpleasant sen- o 150 sation it produces :—but here the fault attaches rather to the dentist, than to the instrument; and I have the satisfaction to state, that, in the method invariably adopted by myself in the use of this in- strument, but little inconvenience is ex- perienced, much less any excitement of pain. 151 FRACTURES OF THE TEETH. THE teeth are as liable to injury from accidents as other bones, and the incisores of the upper jaw are, from their situation the most exposed to them. Boys, in their quarrels or amusements with each other, frequently have their front teeth fractured by blows received on the mouth. Falling on the face has been attended with the same effect, as also the attempt to catch a cricket ball, and many other circumstances of the same kind. Even the mastication of hard substances, when the muscles of the jaw are in strong action, will produce the fracture of a sound tooth. In such accidents, the treatment must be regulated by the extent of the injury. If the fracture is confined to the point of 152 the tooth, nothing more will be required, than to make it smooth and equal with the other surface, by a fine file; and, as the tooth has not previously been in a state of disease, there will be no dan- ger of the attack of caries. But, if the injury extend into the cavity of the tooth, it will then become tender, and for some time become subject to occa- sional fits of pain ; but nature generally repairs this mischief by a fresh deposit of bone, in the cavity which defends the nerve, and often prevents any further trouble for the remainder of life. Where fractures are of a more serious nature, and the cavity is completely ex- posed, then the age, and other circum- stances, must regulate the treatment. If it occur at so early a period of life as fifteen years, the best plan is, to extract the fractured tooth ; and, at the age of maturity, the teeth will be found to have approached so near to each "ther, as to render the loss scarcely perceptible. 153 This treatment applies only to fractures of the permanent teeth; for such acci- dents happening to the primary set, are, ^ from their temporary duration, of little * consequence ; when the injury occurs at an advanced period of life, the loss is very serious, not only from its unseemly appearance, but also from its occasion- ing a defect in the speech. If assistance, '.. however, can be procured before inflam- ' mation has commenced, the tooth may be easily repaired. If a tooth is completely knocked out, and the alveolar process is not injured, it should be immediately returned to its place, and secured to the adjoining teeth, when it will fasten in a very short time. Where a fracture is of a very serious nature, and the person is anxious about the future appearance, the remainder of the crown may be cut away, and a new one fixed to the fang. If the blow or accident only loosen the tooth, it will in a young subject, o 2 \ 154 readily fasten again, though it is apt to lose its colour, and so assume a bluish tinge; but, where a tooth is thus loosen- ed in more advanced life, it rarely fas- tens, for the fang becomes deceased, which communicates to the socket, and then the tooth becomes so loose as to re- quire extraction. But, in all cases, of accidents, where the alveolar processes have suffered, the fastening of the tooth or teeth can never be depended on; for inflammation is apt to arise, matter forms in the socket, and nothing but extraction will give ease to the patient. 155 CRACKS OF THE ENAMEL. THESE are confined to the incisores, and are mostly caused by the too fre- quent or violent action of their cutting edges against each other. This arises in a great measure, from the loss of the back teeth, when the incisores are not only more frequently used in the act of mastication, but are necessarily brought into contact by a stronger muscular power. This action upon each other, oc- casions them to assume an appearance something like caries; but the teeth do not, as in caries, become softer, nor does it commence with inflammation, but it consists solely in the enamel part- ing from the bone, and it proceeds no further than to effect the exterior sur- face of the teeth. 156 Whenever such cracks or separation of the enamel appears, it is advisable, in order to stop its progress, to cut and file away the part that appears thus dis- figured, taking particular care to leave the cutting edges somewhat rounded. 157 DENUDING PROCESS. THIS disease, at first, begins by a Avasting of the enamel, by which a small portion appears as if scooped out, or filed away. This wasting continues to increase till the bone is exposed, during which time the tooth becomes discolour- ed, assumes a brownish hue, is smooth and polished, and will often continue so for years. In some teeth the anterior part of the enamel has, in this way, been entirely removed, but without any exposure of the natural cavity, and the bony part has remained prominent as before. It is not unfrequent for the teeth in this state to be very tender, and susceptible of the slightest application of heat or cold. In the whole extent of 158 my practice, I never met with this dis- order, whose cause I could not safely attribute to the use of acids in the den- tifrices that w7ere employed. 159 WEARING OF THE TEETH, THE natural effect of mastication is, to wear the teeth by the friction and at- trition with which it is accompanied.— Thus, where the incisores, when the mouth is closed, are so situated, that they meet each other at the cutting edges, instead of those of the upper jaw over-lapping the corresponding ones of the under set, mastication cannot be performed without a more extensive la- teral motion of the jaws, which, of course, occasions a greater friction, by which the teeth gradually wear away. This circumstance always takes place in the front teeth, where the back ones have been lost in the early part of life, and often the whole crowns have been removed. The effect of this process i« 160 to render the teeth tender, and occasion- ally subject to pain; this tenderness and sensibility of the fangs, however, are gradually lessened by the ossific matter that is deposited by the vessels, until the whole cavity is completely ob- literated. This deposit of ossific matter led Mr. Hunter erroneously to believe, that the teeth were extraneous bodies, with respect to a circulation through their substances; but, he justly observes, that they rarely decay after a person has passed fifty years of age; because the bony or osseous matter of the tooth has then acquired a degree of firmness of texture, nearly equal to the enamel itself. 161 MORBID GROWTH OF THB GUMS. THE irritation produced by decayed teeth, on the circulation of the gum-ves- sels,' is often the cause of a preternatural growth of the gums, by which excrescen- ces or tumours form on them of various sizes. Carious stumps, are the most frequent source of this morbid growth ; for, if the socket is not close at the bot- tom, a protrusion takes place, which makes the edges of the gums grow irre- gularly over it, and thus, by the pres- sure of the sharp edges of the stumps, a constant soreness and inflammation is kept up; the soft parts assume a diseased p 162 action, and the gums rapidly increase in size. An enlargement of this kind, will often equal the size of a walnut, and no cure can take place, till the cause or ir- ritating edges be removed; on this being accomplished, and the fang repaired, the fulness of the vessels is taken off by the hemorrhage accompanying this opera- tion, while the morbid growth, or en- largement from its fungus nature, soon decays, and the gum is reduced. At other times, tumours form on the gums without any evident cause, and uncon- nected with the state of the teeth. This is the cause, also, in other parts of the body, wherever a soft vascular stricture prevails. Such tumours are of a firmer consistence than where they arise from decayed teeth, resembling the gum in its healthiest state. When troublesome, their removal should be attempted either by excision or ligature. Wherever a ligature can be applied, it is the safest method; for, 163 in performing excision, the operation from the vascular nature of the tumour is always attended with danger, on ac- count of the great loss of blood, which ensues from the impossibility of taking up the vessels, or of employing any other means of stopping the effusion, than the actual cautery. Other tumours of a different nature form on the gums, which are distinguished by their parti- cular softness and disposition to bleed. Such tumours are generally the conse- quence of a diseased jaw bone; and, as no cure can take place without the re- moval of the cause, the operation above mentioned, either by excision or liga- ture, has, in these cases, generally fail- ed. If however, they arise only from the fangs of the tooth being in so very diseased a state as to have occasioned a destruction of part of the alveolar pro- cess, then a cure can be effected only by extracting the diseased tooth; and if, on examining the socket, it be found 164 i Works, <§*c. by Collins Sf Croft. SCIENCES. 3 vols. 4to. with 140 Engrav- ings. Price in boards g 37 50, bound 843 50. 6. WALKER'S CRITICAL PRONOUNC- ING DICTIONARY, to which is annexed, A Key to the Classical Pronunciation of Greek, Latin and Scripture Proper Names. Stereotype Edition. In 1 vol. royal 8vo. Price bound, g 3 50. 7. THE MODERN PRACTICE OF FAR- RIERY ; or, Complete Horse Doctor. 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