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THE TEETH
AND
HOW TO SAVE THEM.
L. P. MEREDITH, M.D., D.D.S.
   i •'
1 KM sens, tibi metis."
    PHILADELPHIA:
J. B. LIPPINCOTT & CO.
       1871. 
                 wu
                 M55vi
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Entered according to act of Congress, in the year 1871, Dy
           L. P.  MEEEDITH,
In the office of the Librarian of Congress, at Washington. 
CONTENTS.
                                                   l'age.
Preface.............................................   7
Introductory Chapter.................................   9
History of Dentistry................................  13
Food  in Relation to the Teeth.......................  21
Origin and Formation of the Teeth...................  34
Eruption of the  Temporary Teeth.....................  40
The Troubles  of First Dentition......................  43
Lancing the Gums During First Dentition.............  49
Preservation of Temporary Teeth.....................  55
The Permanent  Teeth...............................  5P
The Troubles  of Second  Dentition....................  64
Description of the  Permanent Teeth...................  66
Irregularity of the Teeth.............................  71
Dental Caries, or Decay........  ....................  77
Filling, or Plugging.................................  93
Mallet Filling....................................... 122
The File............................................ 125
Separating........................................... 127
Coffer Dam Rubber.................................. 130
Bleaching the  Teeth................................ 131
Salivary Calculus, or  Tartar......................... 133
Odontalgia, or Toothache............................. 138
Miscellaneous Diseases. ............................. 167
Third Dentition...................................... 183
Supernumerary Teeth................................ 186
United Teeth....................................... 1S8 
6
COJVTEJVTS.
                                                      Page.
Extracting..........................................  1S9
Anaesthesia  .........................................  2!i0
Nitrous Oxide  Gas..................................  203
Dentifrices, Brushes, etc.............................  226
Tobacco............................................   229
Artificial Teeth......................................  233
Defects of the  Palate...............................   256
Quackery...........................................  258
Index...............................................  269 
FREFACE.
T^HE  profession of Dentistry after a period
    of  infancy,  longer, perhaps, than  that of
any other profession, dating from the earliest
history of man to within a comparatively re-
cent day, has taken the prominent position
that it now occupies.  Beginning its strife for
eminence cotemporaneously with the science
of medicine, it has been  compelled for  cen-
turies  to remain almost unnoticed, while its
more fortunate and more needed brother has
ever pressed forward into the foremost ranks
of notice and honor.
  But  its seclusion  has not been passed in
idleness; while waiting in silence and abiding
its time, it has been gathering the crumbs that
have fallen from the  tables of knowledge, and
today, when the urgent need of humanity calls
it forth, it comes  bearing its  unlimited gath-
erings  from the treasures of Philosophy, Chem-
istry, Medicine  and Art, and claiming equal
right to contribute to the wants of the suffer-
ing race.
  But while the profession of Dentistry stands
thus ready and  willing to  bestow its favora 
8
PREFACE.
upon  all who desire  them, the  fact is never-
theless  too  evident  that  few, comparatively,
avail themselves of their opportunity.
  Then, again, many who  profess a desire for
its services  are ushered in at the wrong door
by the seductive wiles of  empiricism, and ob-
tain instructions so  corrupted  and so abused
by unscientific handling,  that  injury follows
more often than benefit.
  The great cause of the success of Charla-
tanism is, that the true profession has stood
back  too much on its dignity, and has waited
to be sought  rather  than to seek;  however
well it  deserves this mark  of respect, it is
nevertheless true  that it has not been prop-
erly appreciated because the people have been
denied the right kind of information.
  It is with  the intention, therefore, of open-
ing the doors of dental knowledge to  the peo-
ple; of explaining its fundamental principles
to the  best of his moderate ability, and of
giving such suggestions and information rela-
tive to its uses and  abuses as  may awaken a
better appreciation, that the author, a humble
votary of Dentistry, offers this little volume
to the public.
  Cincinnati, O., July, 1871. 
INTRODUCTORY  CHAPTER.
TT has often  been a matter of wonder  to me that
■*- many books of the nature of tMs have not been
written.  Numerous subjects of far less  importance
than the human  teeth have been again and  again
treated of in books intended for domestic use.  Peo-
ple have been instructed how to  take care of their
flowers, trees and gardens;  their bees, birds and cat-
tle ; their hair, eyes and complexion.  Volume after
volume of "domestic medicine" has been published.
In short,  nearly  every subject, excepting dentistry,
that has been  considered of importance  to the com-
fort, well-being or profit of mankind, has been brought
by means of books into the family circle for familiar
contemplation.  This is  not because  the profession
of dentistry has  not the  material  from which  to
furnish such instruction.  Dental colleges are flour-
ishing  all  over the land;  associations are meeting
almost daily, where the thousands of their membeis
are engaged in discussing subjects of infinite interest
to themselves and the people; standard dental works
occupy their places in the library of the practitioner,
while the  dental journals, containing the thoughts 
10        IJVTR 01) UCTOE T CJSA 2>TJS&.
 and experience of the brightest lights  in the profes-
 sion, are so numerous and so  replete  with informa-
 tion, that no one can find time or opportunity to read
 them all.   But from this great storehouse of knowl-
 edge the  dentists   alone  procure instruction;  the
 public is not at all  educated in  proportion to  the ad-
 vancement of the profession.
   Considering these facts, may I not then be* excused
 for endeavoring, even in my imperfect way, to bridge
 over  this stream of ignorance that lies between the
 profession and the masses?
   In undertaking this labor,  I  am considerably per-
 plexed at the start in deciding how to  condense  the
 greatest  amount of useful matter in the  smallest pos-
 sible  compass; for such  condensation is necessary in
 order not to exceed the limits  of an ordinary sized
 volume.
   If I should attempt to describe all of the anatomy
 of the teeth and surrounding parts—the bones, mus-
 cles, tissues, arteries, veins, nerves, glands, etc.—all
 of which would  be  necessary to give a  complete idea
 of the anatomical relations, those things alone would
 take up  a good-sized volume.   The same  might be
 said if I should propose  to speak particularly of  the
 physiological action  of these different parts; the uses
 and repair of the osseous portions; the actions of the
 muscles; the conveyance of nutritive material through
 the arterial system, and the removal of waste through
the veins and  absorbents; the secretions of the sali-
vary and mucous glands, and the direct and sym- 
          IJVTIiODUCTOlir CHAPTER.        11

pathetic pain and other nervous impressions occurring
in abnormal conditions.   All  of these  subjects and
various points in chemistry, philosophy and medicine
would have to be  explained in order to convey any-
thing like thorough instruction in dental knowledge.
  While it would  be  impossible  to treat of  these
subjects  in  the  present work, yet  the  information
alluded to can be readily and pleasantly acquired by
any  one  who  so wishes,  upon reference to  one  or
more of the dental text-books of the present time.
  With these hints as to the  sources and  usefulness
of a good general  dental  education, and with an
earnest wish that my readers  may have  their appre-
ciation awakened  sufficiently  to spend  a few leisure
hours in acquiring such  knowledge,  I proceed to the
accomplishment of my design, which is to  lay before
my readers something of the history of  dentistry •
the origin, formation and eruption of the teeth;  the
methods  of securing their regular  arrangement and
healthy constitution; the causes of the diseases  of
the teeth and mouth, and their prevention and cure,
and  the  restoration by artificial appliances of parts
that have been lost by disease, accident or negligence.
  In the consideration  of these and  various inci-
dental topics calculated  to promote  the advancement
of dental knowledge among the people,  my efforts
shall be  applied.
  That the state  of the times  requires earnest and
successful  labors  in this direction,  we have but to
look around us  to see.   Thousands of people, tolera- 
12        IJVTRODUCTORr CHAPTER.
bly well-informed on  other  subjects,  patronize  the
dentist only to have teeth extracted, and believe filling
to be injurious and promotive of decay.  With num-
bers to clean  the  teeth is the exception and not the
rule; tartar and decomposing food thus accumulating
and injuring the gums  and teeth, vitiating the saliva,
producing  impure breath, impure  blood, dyspepsia,
and ills without number.  Thousands of sickly parents
are begetting  sickly children with sickly teeth,  and
instead of feeding them with such food as is calcu-
lated to counterbalance the inherited predisposition,
are doing just the opposite.  And thousands more
through fear of a little discomfort in the dental chair,
or through pecuniary closeness, are permitting them-
selves to be lulled into sweet oblivion by anaesthetic
influence, and sacrifice their  own  nature's  teeth for
the "beautiful teeth" of the cheap charlatan.
   If these and many  other evils connected with the
times do not call for reformation,  then indeed is the
mission of the dentist  a mistaken  one.
   In  offering this volume as a  companion for the
household, I would beg leave to state that the  teach-
ings herein contained are not mere dogmas of my
own, but are truths deduced, either from my actual
experience or from the  best authorities,  and may,
therefore, be  taken as reliable  guides as far as the
present status of dental  science is concerned. 
HISTORY  OF  DENTISTRY.
 TN tracing any business, art or profession, back to
    its beginning, one naturally turns to the Old Testa-
 ment to see what is recorded in its  truthful pages in
 reference to it.   But concerning the subject of den-
 tistry, the data  are so few that we are led to believe
 the teeth, in those days, were remarkably good, and
 subject to no disease of sufficient moment to  call into
 life a special  profession for their treatment.  There
 is  no doubt that the teeth were appreciated on  ac-
 count of  their service and adornment, and that their
 loss was considered a serious misfortune; for in the
 Mosaic law we  find: "If a man smite out his man-
 servant's  tooth or his maid-servant's tooth,  he shall
 let him go free for his tooth's sake."   Then  in Solo-
 mon's Song, setting forth the graces of the Church in
 the  most beautiful figures, we  see : "Thy teeth  are
 like a flock of sheep that are even shorn, which came
 up from the washing;  whereof every one  beareth
 twins, and there is not one barren among them."   It
 does not take much stretch of the imagination to see
the allusion to the evenness, the  whiteness, the two of
each kind, the presence of all, which are embodied  in 
14        HIS TORT OF DEJVTISTRT.
a beautiful set of teeth to-day as well as then.  That
the effects of certain chemical  agents were known in
those days, we conclude from  the passage  in  Prov-
erbs: "As vinegar to the teeth, and as smoke  to the
eyes, so is the sluggard to them that send  him.'
And again,  in Jeremiah: "Every man that  eateth
the sour grape, his teeth shall be set on edge."
   In enforcing the penalty of the law,  "Eye for eye,
tooth for tooth," it is probable that if the loss  of the
complainant was not atoned for by some  pecuniary
satisfaction,  it was the duty of some officer to extract
a  similar  tooth  from the offender, and he was cer-
tainly a dentist for the time being.
   Although  the  explanations  of the  commentaries
are so unsatisfactory concerning the exclamation of
Job in  his groanings: "I am  escaped with the skin
of my teeth;" yet it hardly seems possible that he
could  have   been acquainted  with  their  delicate
anatomy.  It seems strange, however, that his  lan-
guage  should anticipate  the  discovery, more than
three thousand  years later, of the "cuticle of the
enamel."  Any  one waggishly inclined might force
a  resemblance between Job and the untutored quack
of modern times, when  he said, alluding to his past
days of prosperity :  "And I brake the jaws  of the
■wicked, and plucked the spoil  out of his teeth."
   When we  come, however, to search the  annals of
profane history, we do not find such a scanty  supply
of material  connected with the  profession of den-
tistry; hut the truths are so few and so  mixed up with 
HISTORY OF SEJVTISTRr.        15
ignorance and  superstition, that it  is a matter  of
curiosity rather than  of  benefit to  refer  to  them.
From the writings of  Herodotus (about 450 B. C),
we learn that the treatment of the teeth constituted
a separate branch of practice  among the Egyptians,
and the truth of this is corroborated by the testimony
of the celebrated Giovanni Belzoni, noted for his dis-
coveries in Egypt. He informs us that  in the ancient
tombs artificial teeth of ivory and wood were found,
some  fastened  on gold plates.   Gold  fillings, also,
have been found  in the teeth of mummies.   Horace,
Ovid, and other ancient poets allude to artificial teeth.
In  those  early days charms and amulets  were em-
ployed  for  the  relief of the  toothache, and  little
knowledge appeared to exist  concerning its  causes,
as we would judge from such teachings as that offered
by Aretoeus, a Greek  physician of the first century,
who gave it as his learned opinion that "the  cause
of toothache was known only to God."  Galen, in  the
second  century, considered  that  the teeth  possessed
the power of taste as well as the tongue, on account
of the nerves that entered their roots.  Leaping over
a space of about  fourteen hundred years to the time
of the  eminent Lord  Bacon (1560  to 1626 A. D.),
■we are disappointed in any hopes of considerable  ad-
vancement of dental knowledge; which, if existing,
we  might  reasonably  expect  to  see in one of such
versatile genius, and so learned in the literature of
all nations.  He appears to have devoted much atten-
tion to  the teeth,  and says that the points to be con- 
16        HISTORY OF DENTISTRY.
sidered regarding them  are:  "The  preserving  of
them;  the keeping of them white; the drawing of
them with the least pain; the  staying and easing of
the toothache; the binding in  of artificial teeth, and
the great  one of restoring teeth in  old age."
  In a book, published not much later, "The Works
of that Learned  and Renowned Doctor Lazarus Riv-
erius, sometimes  Councillor and  Physitian  to  the
King of France," we find  such  instructions as the
following: Charles  Piso  being troubled with  the
toothache many  days, " half an hour after he  had
taken purging medicine, vomited up  above a pint of
clear water with such success  that ten years after he
was never troubled with it."   He was led to believe
that a surplus of  some humor in  the body was the
cause of it, because  he observed  that persons that
"have the toothache  do continually spet."
  Further on, Riverius mentions worms in the cavity
of decay as one of the causes of toothache and says :
" If worms are the cause  of pain it will be  intermit-
ting, coming  and going  often,  and  sometimes the
motion  of the worm will be  felt."   Afterward  he
judiciously prescribes a bitter  application to kill the
worms.   Again we read :   " And  because the small
veins by which nourishment is carried to the  teeth
do run by the ears, you may put medicine into  them
for the  cure  of  toothache."  He then gives  some
kind advice to the patients, whose  interest he has so
much at  heart, in case that they are obliged to  pre-
sent a  tooth  for  extraction to some of the  skillful 
          HISTORY OF DENTISTRY.        17

operators of the day:   " And the Chirurgeon is to be
admonished  that  he pull it not out violently at one
pull, lest the brain  be too much shaken and the jaw-
bone broken, from whence comes a great flux of blood,
afeaver and sometimes death.'"   After proposing dif-
ferent  remedies  for the  toothache, he says:  "But
the leaf of  Elleboraster rubbed upon the tooth is
best; but you must not  touch  the others, lest  they
also fall out."
  In the  experiment  of Leuwenhoeck,  in 1678, we
perceive an  important step toward  the correct anato-
my of  the teeth.  He drew out one of his own teeth
for observation, and discovered with the  aid of his
glass that "the whole tooth was  made up of  very
sn:all, straight and  transparent  pipes.  600 or 700 of
these pipes put together exceed not the thickness of
one hair of  a man's beard."  But Dr. Hugh Todd, a
well educated man of the same  times, in examining a
disinterred skeleton twenty-two feet long, atCorbridge,
on  the Tyne, did not know whether the teeth, three
or  four  inches  in compass,  were  human  or  not.
About a hundred years later than  this, which brings
us  to  the door  of  the nineteenth century,  the re-
nowned Hufeland, in the "Art of  Prolonging Life"
gave this  advice:   "As  soon as you observe that a
tooth  is decayed,  have  it immediately pulled  out,
otherwise it will  infect the rest."  At the  beginning
of  the nineteenth  century there was, comparatively
speaking, but  little diffusion of dental  knowledge,
even among professional  men; although from the
          2 
18        HISTORY OF DENTISTRY.

labors of such men as  Fallopius  and Eustachius, of
Italy, and Pare, of France, in the sixteenth century;
Martin, in the seventeenth; Fauchard and Bourdet,
of France, in the middle of the eighteenth century,
and  Hunter and Fox, of England, some  years later ;
there had resulted  such an accumulation of general
principles and such a sifting of truth from error, that
a' sure foundation stone  was laid upon which to erect
the imposing structure of the present times.
   It is not worth while to weary the reader with the
successive steps in the advancement of dental science,
when once the hindrances being removed from its path,
it made its rapid strides toward perfection.   It is its
present condition that most interests us, and of  this
it is the object of  the subsequent pages of this work
to treat.
   It may not be amiss,  however, to give some general
idea of the work that has  been accomplished  in  dif-
 ferent departments within a little more  than half  a
 century.   Incorruptible porcelain artificial teeth have
 taken the place of transplanted human teeth and teeth
 Carved from those of sheep and other animals, and
 from bone and ivory.   Pure gold  in  various  forms,
 unchangeable and  so admirably adapted for the pres-
 ervation of decayed teeth, by filling, has superseded
 the inferior and less durable metals.  Artificial teeth
 on  plates secured by atmospheric pressure  have  done
 away with the old methods of fastening them by lig-
  atures, clasps and springs.  Aching teeth  that a few
  years ago used to  be lost, almost invariably, are now 
HISTORY OF DENTISTRY.         19
 often saved and  made  permanently useful.  The ex-
 traction of teeth that used  to  be an operation of so
 much pain to all and agony  to many, is now rendered
 almost pleasant by means of anaesthetics.  Fissures
 and openings into the  palate, ca*used  by disease and
 wounds, that used so much  to  interfere with speech
 and deglutition as to make life miserable, are now rem-
 edied to such an extent as to cause but little inconve-
 nience.   A  number  of dental  colleges  has  been
 established,  having  centered in them all the talent
 and facilities to educate those choosing  the  dental
 profession, in  a  manner  that  a lifetime of practice
 would scarcely equal.  Dental magazines,  filled with
 all of  the  extracts from the  fields of science and art
 that can  in  any way benefit the dentist  and  better
 prepare him to practice his profession, have multiplied
 to  a number almost too  great  for perusal.   Dental
 societies,  to  the  profession,  have almost  become as
 prayer-meetings  to  the  churches.  The  number of
 dentists in the United States  alone has increased from
 less than  a  dozen,  in  1800, to more than 10,000;
 while there is not a suffering mortal in  the  smallest
village anywhere in the civilized world that does not
have more or less convenient access to  some one de-
voted to the practice of  dentistry.  Of course very
•many of these are uneducated men and unworthy of
the name of  dentists  in the  true acceptation  of the
word;  but if the people  can be educated  up to the
 point of being able to discern what ought to be the
acquirements of  the  dentist, and  of refusing  their 
20        HISTORY OF DENTISTRY.
patronnge to charlatans—thus compelling them to
enlighten themselves—then will the dental profession
have shaken off its last reproach.
 
FOOD IN RELATION  TO  THE  TEETn.
 IF the  builders of a house are  supplied with poor
    brick and poor stone, bad timber and bad mortar,
 the workmen, no  matter  how skillful they are, can
 erect nothing but a weak and insubstantial edifice.
 So Nature, in building the human fabric, approaches
 perfection more or less nearly, according to  the mate-
 rials furnished.   From the food taken into the body
 are all the different parts of that body formed and
 maintained.  If the food eaten during  the  time of
 formation is deficient in certain constituents essential
 to different parts, those portions  are  imperfectly or-
 ganized and rendered  incapable of fulfilling the ob-
 jects of their creation.
   Of the sixty-four elements to which all the various
 substances  in the world have been reduced, fourteen
 enter into  the composition of the human organism.
 Chemical  analysis  has shown these to be  carbon,
 nitrogen,  hydrogen, oxygen,  phosphorus,   calcium,
 sulphur,  fluorine,  chlorine, sodium, iron, potassium,
 magnesium and  silicon.   These  are  introduced by
 solid food,  liquids and air into the system, and arc
foand there in the form  of proximate principles  or 
22   FOOD IN RE LA TION TO THE TEETH.

substances  composed of two  or  more ultimate ele-
ments, as shown in the following  examples:
  Water,  composed of  hydrogen  and  oxygen, is
found in all the solids and fluids  of  the body and
constitutes  about three-fourths of it by weight.
  Chloride of sodium (common salt) is composed
of chlorine  and sodium, and is detected in all parts of
the body, except the enamel of the teeth.
  Phosphate  of lime, formed of  phosphorus, oxy-
gen and calcium, is the principal ingredient in  the
earthy matter of the bones.
  Fats, composed  of  carbon, hydrogen  and oxy-
gen.
  Besides these  are found, albumen fibrin, osteine,
globuline,  carbonate of  lime, fluoride of  calcium,
phosphates of soda, potash and  magnesia, sulphate
and carbonate  of soda, peroxide  of iron, silica and
other proximate principles.  Chemical analysis again
has shown just what articles of food contain these dif-
ferent constituents.  Physiology has  classified  ali-
mentary substances under three principal heads : those
which produce  fat and furnish  heat to the body; those
which supply muscle,  etc.; and those which  supply
bone, brain and nerves.  The body can not  be sus-
tained by any one of these classes.  As Dr.  Dalton
says in  his Treatise on Human  Physiology:  "In
order that the  animal tissues and  fluids remain in  a
healthy  condition and take their  proper part  in  the
functions of life, they must be supplied with all  the
ingredients necessary to their constitution, and a man 
      FOOD IN RELATION TO THE TEETH.   23

may be starved to death at  last by depriving him of
chloride of sodium or phosphate of lime just as sure-
ly, though not so rapidly, as if he were deprived of
albumen or oil."
   It will not be in  accordance with the design of this
work to enter into a minute consideration of the dif-
ferent alimentary principles and their relation to the
well-being of the body, however closely  this subject
may be connected with  the condition of the mouth as
a part of the  whole, or  with the  support of health
and vital power during  the process of dentition ; but
there are a few points that demand some  attention.

               phosphate  of lime.
   This substance is of great interest to us as regards
the teeth.   It constitutes the greater portion of them,
and is what gives them their extreme hardness.  The
importance of phosphate of  lime to the osseous struc-
ture is well proven by the oft-tried  experiment  of
placing  a  bone in  dilute muriatic acid, when  the
phosphate  is dissolved, and the animal matter remain-
ing behind, and retaining the form of the bone, be-
comes so pliable that it can  be bent in any direction,
or even tied in a knot.   Other earthy matters enter
into the  construction of the teeth, but  they are in
small quantities and not sufficient to preserve their
integrity.  Nature  forms the teeth of such  material
as is present in the  blood.  If from any  cause there
is a deficient supply of  the phosphate, they are more
or less imperfectly constructed, and come forth either 
24    FOOD IN RELATION TO THE TEETH.

with fissures, or so soft  in  structure as to be soon
affected by the various causes of decay.
  Parallel  instances in the operations of nature are
seen in the softening of the bones (osteomalacia) of
adults, and the rickets of children, diseases caused by
a deficiency of the phosphate of lime.   The same is
seen in the formation of  the egg, the yolk of  which
passes through the oviduct having albuminous sub-
stance secreted around  it, then a  firm fibrous  cover-
ing, and finally in  the  last  part of the oviduct has
calcareous  salts  crystallized in the substance  of the
fibrous membrane, forming the shell.  If the fowl is
denied access to  material for shell  the eggs are laid
without them.  Now there is no doubt that the bad
teeth of the youth of the  present day are attributable
more to the imperfect  supply of phosphate of lime,
than to any  other cause.  This  insufficiency  exists
before birth in the blood of the mother,  and after
birth in the milk and  food  given to  the  child.  In
this connection the bread, pastry, cake, etc., so much
in use and made of  superfine  flour, have received
more blame than anything else.
  The distribution of the elements in wheat answers
the wants of the human system better than any other
grain ; but in the ordinary method of preparing, it is
ascertained that  the most essential constituents  are
removed.   The outer portions of the grain contain-
ing the material  for bone, muscle  and brain, being
tenacious and flaky, are mostly sifted  off, leaving
hardly anything in the flour  but starch.   Many 
      FO OD IN RE LA TION TO THE TEETH.    2 5

parents eat no other kind of flour than this, and many
children after  weaning  are almost brought up  on
such  flour, with sugar  and butter added.   Add  to
this cause the degenerated physical condition of the
mother of the present times, inherited imperfections,
unhealthy milk, the cultivated taste for fancy dishes,
and the wonder is, not that children have bad teeth, but
that they have any teeth at all.   It is stated  that "an
insufficient supply of phosphate of lime is supposed
to account for the well known fact that women, when
pregnant, suffer unduly from toothache, the tooth sub-
stance of the mother being attacked in order to supply
material for  that of the offspring."  Bran  contains
fourteen times as much material for bone and muscle as
fine flour does ; therefore the use of unbolted flour and
cracked wheat is indicated for both mother and child.
The condition of the teeth is not bettered to any
appreciable extent by food taken into the system
after  they are formed;  so the  time  to  furnish the
necessary  constituents  is  while  they are developing.
   If  the first set is poor, let it be the care that the
second shall not be so.   Young  children should not
be allowed to acquire a  taste solely for white  bread,
pastry, butter, sugar and confectioneries,  but they
should be accustomed to use  broiled beefsteak and
the gravy therefrom, other  meats, barley, oatmeal,
vegetables, sweet  potatoes  especially, eggs, and  al-
lowed to drink plenty of pure milk ; or when nursing
and too young to take these things, the mother should
be plentifully supplied with them.  If some of these
         3 
26   FOOD IN RELATION TO THE TEETH.

articles should not agree with the child others should
be tried.   Mucilage of rice  has often been  recom-
mended as being  soothing,  somewhat constipating)
and containing a useful quantity of phosphate of lime
in solution.   It is  made by boiling rice well in a sur-
plus of water.
                      MILK.

   Through the  wisdom of the Creator, who always
intends in his works that the means shall be adequate
to the end, the healthy human milk from the healthy
mother is sufficient for all the requirements of  the
infant, at least until  the  teeth  begin to come,  the
very appearance of which seems to indicate that  the
child needs, in addition to the mother's supply, some
solid food which requires mastication.  In the human
milk are found casein, the albuminous substance  for
the formation of muscle ;  sugar and butter for heat
and fat; and mineral matter for bones,  teeth,  etc.
But for many reasons, which it is not worth  while to
mention here, it is a  lamentable  truth that a great
number  of the  mothers of the present times are not
able to supply their children with milk of the proper
quality or in sufficient quantity.
   This  makes  it necessary to seek a supply from
 some other source; and it is  this compulsory change,
 occurring at a time when  the delicate constitution of
 the child will  bear so little tampering  with,  that
 causes a large share of the  mortality of infancy.  A
 wet-nurse is without doubt the best substitute,  if a 
      FOOD IN RELATION TO THE TEETH.    27

suitable one can be obtained, but it is seldom indeed
that  such a one  can be  secured.   The case is so
urgent and  the time  for inquiry into the  history of
the nurse is so short, that generally the first  one that
offers is taken,  and it is more a matter of chance than
choice.   The nurse's age should not be far from that
of the mother, and her confinement should have taken
place at about  the same  time;  she should be in good
health, with no inherited or other constitutional  dis-
ease lurking in her system; her moral conduct during
the time  of her services should be above  reproach ;
she should be of kind disposition and should be will-
ing to yield to sensible dictation in regard to  her
cleanliness,  exercise, diet,  etc.   How  rarely all of
these things can be expected from one who gives her
services for wages  to the highest bidder, with  no
parental love for the little  being, not  her own, at her
breast, can be imagined.   Sudden emotions, as anger
and fear, sometimes  produce diarrhoea,  convulsions,
etc., in  the infant.   Salivation may  occur from  the
milk of a nurse who is under  the influence  of mer-
cury; and ail unhealthy conditions of the milk more
or less affect the child.
  Unless  every serious doubt could be dismissed from
the mind  of the parent,  I  would have  no  hesitation
iu advising bottle-feeding in preference to  the wet-
nurse.   But here also, especially in cities, great diffi-
culties are encountered.  Very little pure  milk can
be obtained in spite of municipal regulations  and
official inspection.   The art of milk adulteration has 
28    FOOD IN 7iELATION TO THE TEETH.

become a science almost.   The most common method
is to remove a portion of the cream and add water ;
and then, to improve the  color of the impoverished
milk, different substances are mixed with it.  Obser-
vation of the amount of cream furnished  by a small
quantity of  milk, compared with some  known to be
pure,  is  the best method of detecting this  fraud.
Gum, flour, starch, chalk and  emulsion of sheep's   «
brains, are  other substances used for  adulteration.
The granules of starch can be detected by the micro-
scope; or solution of iodine will turn them blue.
Chalk will settle to the bottom of the vessel, and  may
be recognized by muriatic acid causing it to effervesce.
Shreds of nerve substance from the brain may  be de-
tected by  the microscope.  Milk  is  often  furnished
that is derived from an unhealthy or improperly fed
animal; it is generally characterized by some  unnat-
ural odor or taste, or by its containing pus or mucus.
Considering the great interest at stake,  it is certainly
a duty to have  milk that is offered for the sustenance
of the child, and represented to be pure, occasionally
examined by a practical  chemist.  Supposing,  how-
ever,  that after due care,  pure milk  from  a healthy
cow is secured, it must be remembered that it is  rich-
er in casein, butter and phosphates than human milk,
but poorer in sugar ;  therefore it should be diluted
with about  one-third water and  have a little  sugar
added.  Asses' milk is much better  than cow's milk
if  it  can be procured.  Two  parts  of  it  should  be
added to one part of cow's milk.   An artificial asses' 
FOOD IN RELATION TO THE TEETH.    29
milk is made by adding two ounces of sugar of milk,
or unniedicated homoeopathic  globules,  to  a  pint  of
skimmed cow's milk.   Arrowroot, flour  and other
starch pastes, with sugar and butter, should not alone
be  employed  to  sustain  the  child,  as  often done.
Starch, butter and sugar give fat and  make it  plump
and round, but they don't furnish a fibre of muscle
or a granule of bone or tooth substance.

                      SUGAR.
   No article  of food  is mentioned, in  reference  to
effects upon  the teeth after  their eruption, as fre-
quently as sugar.  The popular belief is that it causes
decay.  If a child's temporary teeth break down  at
an early age  from  imperfect  organization,  lack  of
cleanliness or what  not, the parent  attributes it  to
sugar.  If the permanent teeth, from  the before men-
tioned causes, or from  irregular position, or lack  of
understanding in their management, are presented to
the dentist gone  almost beyond  remedy at  an age
when they should be perfect, the parent begins with
a tirade against sugar.  In short, sugar  is the "scape-
goat" for  nearly  all the  ignorance  and negligence
concerning the  teeth and  their requirements.   It is
one of that class of words so often used by habit,
more than through any knowledge of their significa-
tion, sounding well but meaning nothing, like "cold"
and "neuralgia."   A  person  has  the toothache and
he ventures the opinion that it is caused by "cold ;"
the listener  knowingly nods  his head  in assent, yet 
30    FOOD IN RELATION TO THE TEETH.

neither of them knows anything about how cold pro-
duces change in the circulation of a part, or how that
change causes irritation  of the nerves;  and,  in  the
majority of instances, "cold" is innocent of the charge.
If one has an attack of sharp, flitting pain  that he can
not at once trace to its origin, he calls it "neuralgia,"
and he is right about once in a hundred times.   Nine-
teen out of twenty that abuse sugar as the  agent of
so much mischief, can not give one reason for its pro-
ducing such  effects.   This prejudice  against sugar
originated in  olden times, and has been handed down
to posterity, with no more testimony in substantiation
of the charge then, than now.  In Paul Heintzners
Travels, 1598, Queen  Elizabeth is said to have "her
teeth black  from eating  too much sugar."   I don't
doubt from what  history says of her  that her teeth
were  bad, but I suppose  it was only a case of dental
caries, no worse  than we  see nowadays  in   ladies
that are not queens.  Lord Bacon, in his  discourse in
praise of  the Queen,  describes her gait,  hair, voice,
eyes, etc., but keeps silent in regard to her teeth, from
which I infer that the appearance of her mouth  was
not as prepossessing as it ought to be in  a lady who
supported so much style.  But my  respect for roy-
alty has caused me to digress.   Let us see what  evi-
dence can be found in favor of sugar.  History tells
us that "Henry, Duke of Beaufort, who  died about
1702, ate  nearly a  pound  of sugar daily for forty
years. He died of fever  in the seventieth year of his
age.  He was never troubled with  cough, his teeth 
      FOOD IN RELATION TO THE TEETH.    31

were firm, and  all his viscera were found, after death,
quite sound."   In Cleland's  Institutes of  Health,
Mallory is  described as a great lover and eater of
sugar, and  is said  to have lived to be about one hun-
dred years  of age, and  to have had good teeth until
fourscore, when he cut a new set.
  Sir John  Sinclair, in  his  work  on Health  and
Longevity, repeats what was affirmed  by Dr. Slare,
in the latter part  of the  seventeenth  century, that
his grandfather, who lived to be  one hundred  years
old, had all his teeth strong and firm at eighty; that
he remained  in good  health and  strength  till  his
death, and  died in consequence of fullness of blood.
These circumstances were attributed by Dr.  Slare to
the  frequent  use of sugar, of which his grandfather
was a great eater, taking it on his  bread and butter,
in ale and beer, and adding it to all the sauces used
on his meats.   These are a few of the many instances
furnished by men of repute to establish the fact that
sugar is not  injurious to the teeth.  The  negroes of
su"-ar countries are remarkable for their white  and
sound teeth,  although they eat great quantities  of
sugar, and  grow fat on it during  the season for mak-
ing  it.  Teeth have been immersed for a  year or
more  in a syrup of sugar and water, and when taken
out  have not  been affected in the least degree.  Xow,
a few words to show that saccharine  matter as food is
absolutely necessary for  the growing  child.  The pro-
portion of phosphate of lime required by the child is
greater  than  in the adult, for, in the first instance, 
32    FO OD IN RE LA TION TO THE TEETH.

the bones  are increasing in size, while in the adult
they only  have to  be maintained.  The lactic acid,
that is formed from the sugar, dissolves the  phos-
phate of lime in other articles of food, and thus pre-
pares it to readily enter the circulation.
  Then, again, circulation and respiration being more
active  in  the growing  being than in one who has
ceased to grow, some especial food is required to be
consumed  in the lungs, and protect the parts already
organized from the  action of oxygen.   Children have
an instinctive  desire for  some such food; the colder
the climate the  richer  must the  substance  be  in
hydrogen  and carbon for furnishing heat.  Accord-
ingly we would naturally expect that the  children in
the frigid  zone would  crave some richer material.
Such we find  to be the case.  Sir  Anthony  Carlisle
says : "In  one of those late  extravagant  voyages  to
discover a northwest passage,  the most northern races
of mankind were  found to  be unacquainted with the
taste of sweets, and their infants made very wry faces,
and sputtered out sugar with disgust; but the little
urchins grinned with ecstasy at the sight of  a bit  of
whale's blubber."
  Now, in conclusion, I do  not wish to be  understood
that sugar  can not be made a source of evil.   Biting
into rock  and other hard candies is certainly a very
reprehensible  practice, and will  injure a set of teeth
as much as cracking nuts with them or biting other
hard substances.   Then, sugar should not be allowed
to the point of producing  stomach disturbances and 
FOOD IN RE LA TION TO THE TEETH.   33
diarrhoea.  Sour  regurgitations  are injurious  to the
teeth, but no more so when arising from a stomach
made sour by too much sugar,  than from the same
condition caused by any other article of food.
 
ORIGIN AND FORMATION OF  THE  TEETH.
   THE teeth are generally  classed,  as  regards  the
   method of their formation, with such  substances
as horn, hair and  nails.  Being  partially  external
and  increasing  in  size  by successive  deposits of
formative material,  there are certainly striking simi-
larities.
   Many scientific men have devoted much valuable
time to the study of this wonderful process of nature,
and, as in every other study connected with minute
microscopical  examination,  their conclusions  have
been various and conflicting.  To mention their dif-
ferent ideas in  regard to the growth of the  enamel,
dentine and cementum, the different membranes from
which they are formed, etc., would  greatly  extend
this article, and prove, I fear, very uninteresting to
the general reader.
   Certainly the most simple and comprehensible ex-
planation I  have ever seen,  is that given by Dr. Jas.
E. Garrctson, in his  "Diseases  and  Surgery  of the
Jtlouih, Jaws and  Associate  Parts."   And  as sim-
plicity is what  is desired in  the  present work, I shall
give  his thoughts with a few omissions, and possibly 
FORMATION OF THE TEETH.       35
some slight  alterations.  Wherein his opinions con-
flict with the views of others, he will  have to fight
his own  battles, which he is doubtless  able and will-
ing  to do.   They  arc certainly reasonable and con-
sistent, and worthy of acceptation  until they can be
proven erroneous.
   At the sixth week of intra-uterine existence there
is a groove  observable  in the gums of the fcetus—
"lined by a  delicate membrane continuous with the
mucous membrane, and perhaps a part of it.  * *  *
This membrane, at  points  corresponding with  the
position  of the future teeth, is elevated into  papillae
or  little hills.  A section  through  the  membrane,
over any of the bulbs, exposes a papilla.  *  *  *
This papilla is the rudiment of the future tooth, as
observation  of its development proves.  *  *  *
The papilla, thus  understood, is seen  to lie beneath
the mucous membrane, and in this membrane resides
a certain amount  of elasticity.  As the papilla en-
larges and projects  itself, it becomes inclosed to all
the  extent  possible with  this  mucous  membrane
contracted about the  body,  so as to constitute a sac
or  cell  wall.  *   *  '*"   This sac enveloping  the
papilla  has its  continuation, as is seen,  necessarily
over the sides of the groove; as then this  groove en-
larges and deepens, and  finally envelopes the  pap;lla,
it  is seen that the  body or  tooth-germ gets a second
sac.  *   *  *  At this  period, the pulp or original
papilla, having attained the size of the tooth it repre-
sents, commences  the process of the  formation  of 
36       FORMATION OF THE TEETH.
dentine.   Before the attainment  to full size of the
papilla there existed between it and its sac proper a
fluid.  This  fluid is now replaced by a more highly
endowed secretion, the work of matured cells,   llns
secretion,  deposited against the inner sac, or  between
it and the pulp, contains the elements of the  dentinal
structure, is, indeed, the dentine,  and  deposits  layer
after layer, supported  by and  molded into form by
the  sac.  As this  deposit  intrudes on  the  pulp, so
this  body contracts within  itself, until, finally, by
some law of nature, it  stops  at  that certain  point
which  maintains within  the tooth a canal or cavity,
and  a vascular and nervous  pulp  to occupy  it,—this
pulp being  the  contracted original papilla;  the ves-
sels  of this papilla being vessels entirely analagous to
any  one of the ordinary  papilla of touch, so  supplied
and  so maintained.  Why this secretion, in its organ-
ization, should assume the position of the elongated
tubular cells which pertains to the structure of den-
tine, I have, of course, no idea, and it is quite enough
for our purpose to say that it is a law of life perhaps
never to be comprehended  this side of eternity, and
the  discovery of which  would, at any rate,  have but
little practical signification to us."
   [The cause of this tubular structure of the dentine
is doubtless a matter more  of curiosity than practical
interest, but a thought has sometimes suggested itself
to me which it may not be amiss  to state.  Taking as
texts the statements of Kolliker, of Wiirzburg, that
 "according to their more or less frequent ramification, 
          FORMATION OF 2'HE TEE'EH.       37

are the ends of the dentinal canals more or less fine;
frequently appearing merely as excessively fine, pale
lines, like fibrils of connective tissue," and that ''the
dental sacs consist of connective tissue in which ves-
sels  and  nerves are  distributed,"  I would  ask  if
there may not be such connective tissue between the
papilla and  the sac, which  being stretched in lines,
while the papilla and the sac are being separated, are
fixed in  position by the deposition  of  the dentine,
To illustrate, by a homely comparison, let us suppose
that two  solid substances  are  placed against  each
other with a layer of glue between them;  before the
glue  is hardened draw them apart  and  numerous
strings of connection will be seen, and  if plaster of
Paris  is poured  in, there will be  a solid substance
formed full  of delicate tubes corresponding with the
direction  of the partial separation.]
   "The formation of the dentine completed, the cov-
ering of it with enamel begins, or rather this  deposit
is, to a degree, coincident with  the dentinal  forma-
tion.   Secreted  by the same pulp which formed the
dentine, the  same secretion, some portion  of  it finds
its way into and through  the primary sac.  As it
passes through this  sac  it  is modified, receives new
elements,  perhaps, which  as it  is received into  the
second space, or  the space between the first and sec-
ond caps,  and its calcification  commences, impresses
upon  it the  arrangement of its particles  after  the
hexagonal order of the enamel.  Between the  enamel
thus  formed and the dentine, exists the primary sac; 
38       FORMATION OF THE TEETH.
simply the  originally  modified mucous  membrane
which  we first saw as overlying the papilla.   This
membrane continues its existence between these two
hard bodies, and receives and modifies for the support
of the enamel, the  liquor sanguinis sucked out from
the dentinal tubules and intertubular structure.  It
may be called the enamel  membrane.  It has, of
course, been much modified, and it is from it that we
receive the impressions of pain when it is exposed by
a break in the continuity of the enamel.  The growth
of the root of the  tooth,  as far as its dentine is  con-
cerned, has precisely the  history of the body.   It is
associated with the pyramidal  elongation of  the pa-
pilla or  pulp, which,  pushing  upward1 the crown,
elongates  upon  itself the enamel  membrane.   This
elongation, with a greater  vascularity and  vitality
assumed by the membrane as it approaches the base-
ment vessels, modifies again  the result obtained by
the secretion passing through  it from  the  dentinal
pulp, the result being a nearer approach to true bone
in the  production of cementum.  The periodonteum
is  simply  the  modified external sac, lost, of  course,
above the  neck as the  tooth has  emerged  through
it.   *   *   *   About the fourth  month (of  foetal
life) these papillaj are all in their sacular envelopes,
and  forming behind the lids of the sacs are  little
crescentic depressions, called cavities of reserve, lined
with mucous  membrane  and  containing  the germs
of the papillae of the second set of teeth.   *   *   *
The position of the permanent papillae, which are at 
FORMATION OF THE TEETH.       39
first situated between  the sacs of the deciduous and
the  gum, gradually recedes behind, falling  deeper
and  deeper, at  least,  relatively so, as the  milk  set
elongates, until, on the completion  of growth in the
deciduous, the germs of the permanent set are found
in a  common alveolus (or  socket) at the apices of
these cavities, occupying, indeed, almost  the position
and physiological relations of the original papillae."
   "The first molar of  the permanent set is markedly
related  to  the  deciduous set, by having a common
origin from and in the primitive dental groove; and
from  sacs,  secondary to the capsule of this tooth,
spring the  reserve cavities of the second and third
molars of the second set."
   I would  only add that there  is also formed  a deli-
cate  membrane  covering the  enamel  of the tooth,
called sometimes "Nasmyth's  membrane" (from the
discoverer), and by Kolliker termed the "cuticle of
the enamel," and described by him as being an "exu-
dation secreted  from  the enamel organ immediately
after  the ossification of the  last enamel  cells, which
glues together and protects the ends of the prisms of
the enamel."  Having thus  followed the  method by
which nature forms the teeth, we are ready  in the
next chapter to study the periods of their eruption. 
ERUPTION OF  THE TEMPORARY TEETH.
T^HE temporary teeth having begun to assume their
    form and dimensions at  the fifth month,  all of
them  have begun to  calcify at about  the  seventh
month of fcetal  life.  This  hardening process con-
tinues, the crowns of the teeth being  first completed,
afterward  the roots.   The  divisions  between  the
dental sacs  also  begin to  ossify  and commence to
form the alveoli or sockets,  intended as a strong sup-
port for the  necks and roots.
  At  that time of the child's life when  its growing
energies  imperatively  demand a  solid  and  more
strengthening food, the deciduous teeth, which have
been forming and calcifying before and  since  birth,
make  their appearance.
  There are twenty teeth in the temporary set—ten
in each jaw.  The order and time of their eruption
are  subject to frequent variation, so that no table can
be given which will invariably designate  them,  but 
2'EM'l'ORA li T TEETH.           41
 the  following may be  received  as  nearly correct in
 the majority of instances:
   4 Central Incisors from  5 to  7  months after birth.
   4 Lateral Incisors   "   7 to  10    "
•  4 First Molars      "  12 to 15    "     "    "
   4 Cuspids          "   14 to 20   "     "    "
   4 Second Molars    "   18 to 36   "     "    "
Temporary Teeth of Onk Side.
 I. Outral Incisors. 2. Lateral Incisors. 3. Cuspids. 4. First Molar3.
5. Second Molars.
  The cuspids are called also the canine  teeth ;  the
upper cuspids are called sometimes the "eye-teeth,"
and the lower ones the  "stomach-teeth."  The molars
are vulgarly called "jaw-teeth" and grinders.   Gen-
erally the  lower teeth erupt  sooner  than the corre-
sponding teeth of the upper jaw.
  There have been  many theories given as to  the
manner in  which  nature effects the  eruption  of  the
teeth, but it will probably be  idle to  more than men-
tion them.    The longitudinal  growth of the pulp for
         4 
42
TEMPO RA R Y TEETH.
the formation of the root, thus causing pressure to-
ward the surface;  the  adaptation of the alveolus  to
the forming root, also causing pressure; and the con-
traction of the dental sac attached to the gum at one ,
extremity and to the neck of  the tooth at the other,
thus drawing it through the  gum,—are the different
supported opinions.
  The opening  of tne gum for  the  passage of the
tooth is caused  by the pressure of the sharpest por-
tion of the crowns, and the process of absorption.
  As before alluded to, there are many variations  in
the order  and period  of the appearance of  the tem-
porary teeth, and  it would be well for parents to bear
the  fact  in mind.  They often begin  to erupt very
early ; some even have been born with  teeth.  Louis
the Fourteenth is a noted example.  I have  met with
some cases in which two teeth have been in the mouth
at birth.   Then again the temporary teeth occasion-
ally appear very  late, being  delayed for months, and
in some cases on record, for years.
  It has been my experience that, in children of any-
thing like  healthy constitution, the teeth are more
backward  where  the children are more forward  in
crawling, walking, etc., and vice versa. 
THE TROUBLES OF FIRST DENTITION.
T'HE period from the  beginning to the completion
    of the eruption of the deciduous teeth has long
been justly considered as full of mortal danger.
  From the bills of mortality collected by Dr. Hufc-
land, physician to  the King of Prussia, in the latter
part of the last century, it was  estimated that out of
every one  thousand children born, fifty died during
the time of teething, and  two hundred  and seventy-
seven from  convulsions and other diseases during the
first two years.  Now, considering with good reason
that many of those cases of "convulsions and other
diseases" were either caused  or  aggravated by the
process of dentition (a fact not so well  understood in
those days as now), the associated mortality of the
period would come near the estimate of more modern
times.  In France, out of  one million  of  children
born, two  hundred and fifty thousand,  or one-fourth,
are said to die before the end of twelve months.  In
England the  statistics tell nearly  the same story.
  Of course there  are many frequently fatal diseases
incident to early  childhood that are  not caused by
the irritation of teething, and allowance should be 
44
FIRST DE~\ TITION.
made for  them in viewing this immense  mortality;
but on the other hand this proportion of other causes
should not be  overrated.   Many able men have made
too great  an allowance,  in  their argument,  that so
large a number of infants die before the age of six or
seven months, the period when dentition generally
begins: for  it has been  shown  oftentimes that the
teeth at a  very early period of their development may
produce such irritation and sympathetic derangement
of the system,  as to terminate fatally in some obscure
disease, which post-mortem examination has removed
the mystery from.  Deaths so occurring have been de-
monstrated to have happened at two or three  months
after birth.  Then, when we consider that post-mortem
examinations are  so seldom permitted in these infan-
tile cases, we are  ready to believe that, in many in-
stances, if such examinations  should be allowed, we
would find that very many deaths before the sixth or
ceventh month could be  traced to dentition as the
direct or indirect cause.
   Writers of our  day calculate that of children horn,
from one-twelfth  to one-sixth die during the  time of
teething.  Of those whose vital  power  enables them
to withstand for the time the depressing influence of
the period, but whose constitutions are affected there-
by to such a degree as to cause  them to readily suc-
cumb  to  attacks of disease  a few years  later, it is
impossible to  estimate a  probable  proportion; but it
is no doubt a considerable one.
   Considering  the frail and impressible structure of 
FIRST DEN2TTI0N.
45
the new being, its  frequently  inherited weaknesses,
the improper care taken of it by those intrusted with
it.* nursing, dress, exercise, food and cleanliness; the
unhealthy influences of the bad air and contagion of
crowded cities, etc., it  hardly  appears strange that
the period of teething should be considered the most
critical  of life.
  To describe in anything like a particular manner
all of the diseases which from time to time have been
found to arise from the  irritation of dentition, would
require a special volume;  therefore, in  this work, I
shall confine myself to a simple  enumeration of the
more frequent troubles associated with  the period.
And this  for  the purpose of  causing the parent to
remember  and to  be  ever  watchful for  the  many
enemies that linger around the threshold of his dear
child's existence, rather than to offer any suggestions
as to the means of baffling them : for this is the duty
of the  intelligent physician, who should  always be
summoned at  the slightest cause of alarm.
   Inflammation  of the mouth, ulcerative or  not, is
probably  the  most readily recognized trouble con-
nected with teething:  it  may  be  seen  in all stages
from that  which is simple and localized  about an
erupting tooth,   to the  threatening, extending  and
destructive  inflammation,  encouraged  by  constitu-
tional  conditions.  On  account of the mucous  mem-
brane  extending from the mouth,  back  over the
tonouc, palate, tonsils, etc., into  the nose, ear  and
cavity of  the eye  by  certain  passages;  down the 
46
FIRST DENTITION.
throat into the stomach  and intestines ; we are pre-
pared  to trace back  to  the  irritating teeth  certain
inflammations, ulcerations and enlargements of parts
about the mouth, discharges from the nose, eyes and
ears, diseases of the throat, and vomiting, diarrhoea
and constipation.
  Less obvious to the common observer, but equally
obvious to  the medically educated  man, are  other
diseases connected  with  dentition;  such as  fever,
convulsions, skin  diseases, hydrocephalus (dropsy of
the brain),  spurious croup, cough, etc.
  Then again there are many diseases, which, though
not caused by the constitutional excitement of teeth-
ing, yet when occurring at the same  time, are aggra-
vated,  maintained  and often rendered  fatal by it.
Hooping-cough and lung  complaints  are well-marked
examples.  All  of these and  other morbid effects
may result  from the efforts of a little tooth to  burst
from its confinement.
  Were  it  not for some  violated  laws of nature, I
doubt  not that the irritation of the period of den-
tition, instead of producing such serious consequences,
would serve rather as a  healthy stimulation ;  for it
does not seem in accordance with the wisdom of  the
works of the Almighty, that He should oppress  the
little, tender infant with a burden so disproportion-
ate to its capacity.  As a proof of this we have  but
to notice the difference of the effects of this  process
of nature upon the robust children of healthy, com-
patible parents, surrounded by the invigorating  influ- 
FIRST DENTITION.
47
 ences of pure air, pure milk, pure water, etc., com-
 pared with those of opposite constitution, surrounded
 by opposite influences.   The whole subject demands
 the close, attentive study of both  parent and practi-
 tioner.   It  must be remembered that the  nerves
 supplying the  parts in proximity to the teeth  are
 sensitive  beyond measure, and  moreover  that  the
 nervous system  of the child is remarkably developed.
 It should be recollected that the forward pressure of
 erupting  teeth  upon sensitive  gums, and the back-
 ward pressure  upon   exquisitely sensitive  pulps,
 irritate  those nerves.  And then it should be remem-
 bered that the infant being has no spoken  language
 by which it can express its  feelings of discomfort,
 pain or agony,  but  that it has another language, no
 less expressive to those who understand it, the "lan-
 guage of  signs  and  symptoms."  How important to
 comprehend that the variations of the appetite, rest-
 lessness, drowsiness, movements of the little hands
 and feet,  knitting of  the  brows,  twitchings of  the
 muscles, movements  of the eyes, grinding of the teeth,
 different kinds of crying, manner of lying, and many
 other appearances  are  the forerunners  of certain
 dangerous diseases.
  How  important to understand that the  diarrhoea,
 or the disagreeable eruption are  often connected with
the process of teething,  and are salutary rather than
hurtful, and that to check is to kill.
  As I said before, the management  of most of  the
ailments of childhood,  during the eruption of  the 
48
FIRST DENTITION.
teeth, should be intrusted to the careful  physician ;
but there is one method of treatment about which the
dentist is so often  consulted  and which  is  so  often
resorted  to by the parent;  and which,  though  so
simple and so manifestly beneficial, is yet  so  often
unwarrantably abused and objected  to,—that I con-
sider it necessary to say something about it,  and will
therefore make it the subject of the following chapter.
 
LANCING  THE GUMS DURING  FIRST DEN-
                    TITION.
TF any individual should  argue that a hot, painful,
X throbbing boil, tense with irritating matter and
producing  much  systemic excitement, should not be
opened ;  that the operation would be uncalled for and
productive of injury instead of benefit, he would not
receive much credit for good sense.   To the dentist
who so often sees the immediate beneficial  results of
lancing hot, congested gums, the argument that it is
an unnecessary operation, productive of irritation and
attended  with many peculiar dangers, seems  just as
senseless.
  Indeed,  when  one considers  the  vast amount of
overpowering testimony, accumulated through centu-
ries, in favor of the operation of lancing, as compared
with the  shallow or  imaginary evidence to the con-
trary, it  seems strange that any person  should  be
willing to risk his reputation by arguing in  opposi-
tion ;  unless he  happens to be of that class hit £0
well by Goldsmith when he says:
     " In arguing too, the parson owned his skill,
       For even tho' vanquished, he could argue still."
  The operation  has beeu  objected to by some on
        5 
50
LANCING THE GUMS.
account of a supposed danger  of fatal  hemorrhage.
Doubtless  such accidents  have occurred,  but  how
rarely 1   As many people  have bled to death from
the extraction of teeth, probably; but so seldom has
this occurred that extraction is certainly not consid-
ered a dangerous operation.  Of ten  thousand chil-
dren in  such condition as would indicate the cutting
of the  gums  as a  remedial measure, probably one
thousand  would die if the  operation should  be re-
frained  from during the whole period  of teething ;
whereas if the gums of the entire ten thousand were
lanced one might die.  No  operation should  be  con-
sidered  unsafe which exhibits such  an infinite num-
ber of benefits and such a  small proportion of acci-
dents.   Considerable hemorrhage no doubt frequently
occurs, but it yields readily to the proper astringents
and appliances.
  It has been asserted by others that the  enamel of
the tooth just before eruption is in a soft state, and is
liable to injury from  the lance.  But this assertion
is too absurd to dwell upon, for it  is well  known  to
the contrary.
   Then, again, some  object  to incising the gums of
the child on account of the  pain, fright,  stru«-«din<r
and resistance occasioned.   Well, I can imagine that
a  bear   in  human  costume, seizing  a  young child
roughly, forcing open  its mouth and tearing  a  hole
in the sensitive gum with an instrument more like a
saw than a knife, might produce all of these effects.
I know, however, that by the use of great gentleness 
               LANCING THE GUMS.           51

 the many little playful artifices by which the confi-
 dence of the child may be secured, a very sharp lance,
 a dextrous hand and above all patience, the operation
 can be  performed with very little  trouble,  mostly,
 and often will be gladly submitted to.
   A very common objection is  that  the scar formed
 by the healing of the  incision  is tougher and more
 difficult for the tooth  to advance  through than the
 untouched gum.  In answer to  this, all I have to say
 is, that  in many cases that require lancing, the gum
 being already on the  stretch,  the  parts open and
 gradually fall around the advancing tooth; but where
 a  cicatrix is formed,  it  is a fact  too well known to be
 disputed, that  scar  tissue  breaks  down  much more
 readily before  irritating causes than tissue that has
 always retained its integrity.   The objects aimed at
 in scarification are  to  remove  the  pressure  of  the
 advancing tooth, and to relieve the congestion by the
 abstraction  of blood.
   In corroboration  of  the  ideas herein advanced as
 to the usefulness of the operation, I will quote a few
 passages from  excellent authorities.  Dr. Chapin A.
 Harris, in his celebrated work, "The Principles  and
 Practice  of  Dental  Surgery," says:  "This  simple
 operation often succeeds after all  other  attempts Ao
afford relief have failed.  We have  frequently known
children  after having suffered  the greatest agony for
 days and weeks, and until they  had become reduced
 to  mere  skeletons, obtain immediate relief without
auy  other  treatment.  This  at once  removes  the 
52
LANCING THE GUMS.
cause; whereas, other remedies  only counteract the
effects of the suffering, and can only he considered as
palliatives that may assist nature in  her struggles
with disease, but  can  not, always prevent her from
sinking in the contest."
  Sir Marshall Hall says: "Better scarify the gums
a hundred times unnecessarily than allow the acces-
sion of one fit of convulsions from the neglect of this
operation.  *  *   *  Now,  while there  is fever or
restlessuess, or tendency to spasm or convulsion, this
local blood-letting should be repeated daily, and, in
urgent cases,  even twice  a  day.  A skillful  person
does it in a minute, and in a minute often prevents  a
serious  attack ;  an attack which may  cripple the
mind, or the limbs, or even  take the life of the little
patient, if frequently repeated.   There is, in fact, no
comparison between the means and the end—the one
is so trifling, and  the other  so momentous."
  But, on the other haud, there  is no doubt that this
useful means  of  treatment  may be abused.  Every
ailment of early childhood should not  be attributed
to the irritation of dentition, and the child's mouth
continually  hacked  by  indiscriminating   persons.
Judgment is necessary  and certain things should be
talcen into consideration.  The operator should have
a knowledge of the time and order of the eruption  of
the teeth, for  although  such a knowledge  is not  an
infallible guide,  yet  it is generally  of  importance,
especially where  the  local  manifestations  are  not
sufficiently marked to indicate the exact spot to which
 the knife should be applied. 
LANCING THE GUMS.
53
   Then where there  is supposed  to be a hereditary
tendency  to  hemorrhage,  great  caution should  be
used, and a course of constitutional  treatment would
be advisable.   It being a well known fact that some-
times erysipelas  is developed  by  small, superficial
wounds where  there is a predisposition to it, the pos-
sibility of its  occurrence  in some cases should  be
made the subject of medical advice.   If  there are  no
contra-indicating circumstances, and the operation is
decided  upon, it is  easily  performed.   Much has
been written  as to the position  of operator, assistant
and patient and the method of doing it; but a few
simple directions are  all  that  are  necessary.   The
operator  must have  good  eyes  and a steady hand:
the assistant  must be strong and reliable.  If force is
deemed requisite, the child should  be  placed  upon
its back across the  lap of  the assistant,  who should
secure its hands and  feet.  The head of the  child
should be steadied  upon the knees of the operator,
who should be in the sitting posture.  This  method
of course frightens the child and produces more  or
less mental distress, but should  be adopted without
hesitation in  case of necessity.
  Often,  however,  the operation can be performed
with the child in any  posture, by the  alternate exhi-
bitions of candy and the lance, or in some other way,
and without provoking aery of alarm or pain.   The
blade being wrapped  nearly to its point,  there is no
danger of a  serious wound  being given in  case  of
sudden starting, if ordinary care  is used.  For each 
54
LANCING THE GUMS.
of the six front teeth in either jaw, there should be
made a single incision  corresponding with the  long
diameter of the erupting portiou of  the tooth.  For
the  cuspids a short incision intersecting this at right
angles is of advantage.  For each of the others (the
molars) incisions  forming the letter X are required,
and these must extend fully to the circumference  of
the   tooth, or even a  little beyond.   If doubtful  as
to the exact position of the tooth, a preliminary ex-
amination with a sharp needle is useful.   The smooth
unyielding surface of enamel is readily distinguished
from the penetrable bone.
 
PRESERVATION OF TEMPORARY TEETH.
rPHE temporary teeth are liable to the same causes
-*-  of decay as the permanent ones, and equal care
should  be taken of them.   It is really astonishing
how little attention is  generally paid to them, the
prevailing idea being  that as they are destined soon
to be lost and give place  to  the second set, it is un-
necessary to attempt to preserve them.
  This  argument as to their loss and replacement is
indeed  true, but other things of great importance
should  be taken into  consideration.  The  hopes of
the parent are that the anticipated  second set shall
be placed evenly and beautifully in the dental arches,
so that  no deformity may exist, that no crowded teeth
shall  have to be extracted, that no tedious operation
for regulating shall be necessary,  and that there may
be no unusual liability to  decay.
  Well, then, I give my word for it, the surest way
to secure the disappointment of all these commenda-
ble hopes, is to be negligent in  regard  to  the pre-
servation of the deciduous  teeth.   It is not the design
of nature that the first set  shall be  lost by the de-
struction of  the crowns, but by the destruction of the 
56
TEMPORARY TEETH.
roots.   Take  care  of the crowns and the roots will
take care of themselves.   It is intended  that simul-
taneously with  the advance of the permanent  tooth,
the absorption  of the root of the temporary should
occur ;  so  that when the  temporary tooth is thus
loosened, the  permanent one  is  generally close at
hand to occupy its place.  Thus no loss of space re-
sults, while it would be  different if the milk  teeth
should  be  extracted months or years  too soon;  for
any one, who has examined at all, has  noticed that
when a tooth has  been lost and nothing has occupied
the space, there has been an absorption of the alveo-
lar processes, and a leaning toward each other  of the
teeth  on the  sides of the vacancy.   Where,  then,
there is this diminution of space, it is impossible for
the second  teeth to arrange  themselves regularly;
there is barely  enough room  under the  most favora-
ble circumstances.  Irregularly placed teeth are unu-
sually  liable to decay, both from the great difficulty
of properly cleaning  them, and  from  the  fact that
when such portions of enamel touch each  other as
are not intended to be  in  antagonism, injury results.
How  then  can the  temporary teeth  be preserved?
The teeth  should be cleaned several times daily by
the parent when the child is too young to do it, and
by either when the child is old enough.  Biting into
hard candy and holding hard substances in the mouth
should be prohibited.
   The  teeth should be frequently examined  by the
dentist, and if decay or  such imperfections  in the 
TE.If/'O'ltA li V TEETH.
57
enamel as would lead to decay, should be found, the
places should be filled.   If  the  child should  be too
young to undergo the more tedious operation of filling
with  gold, there are various fillings which are put in
in a soft state and subsequently harden, that preserve
the t cth sufficiently well, although they more fre-
quently have to be replaced.   Besides the advantages,
before alluded  to, accruing  from the preservation of
the deciduous teeth, it seems to me that it is  not the
height of parental kindness to allow children to suffer
the agonies  of toothache when  it  can  be so easily
avoided; nor is it wise to allow their early visits to
dental offices to be for the  purpose of having their
teeth  extracted, for often  such a lasting  unpleasant,
impression is made that in after years  they will suffer
their  teeth to go to destruction rather than go near
the places that are surrounded with such  unpleasant
associations.
   In  conclusion, I would  state that occasionally there
are cases in which the instructions  herein given will
not hold good, but their occurrence is so seldom that
they may be  regarded  only as exceptions.   For in-
stance, sometimes the process  of absorption  in the
roots  of the  temporary  teeth  fails to  be brought
about, and the permanent teeth erupt in front of or
behind  them;  in which  case, of  course,  the  solid
temporary teeth must be extracted.  Then, iu certain
instances, there is even too much room for the tem-
porary teeth, and a  straggling  appearance results;
when  the  deformity is  considerable, it  sometimes 
58           TEMPO RA R T TEETH.

becomes  a question whether it is not advisable  to
extract some of the sound temporary teeth, so as to
allow the  alveolar border to contract, and  thus  pre
vent a similar separation in the second teeth.   Other
anomalies connected with the relationship of teeth to
the jaws,  and of the jaws  to one  another, occasion-
ally  present  themselves, which should be  made  the
subjects of careful study and good  advice before de-
termining what course to pursue.
 
THE PERMANENT TEETH.
 TMIERE are thirty-two teeth in the permanent set,
    sixteen in each jaw; whereas in the temporary
 set there were but twenty, ten  in each jaw, which
 completely filled the arches.
   In  order to make room for  the greater number,
 and larger size of the  teeth of the  second set, the
 jaws  undergo a process of elongation.  By the time
 that the first permanent molars are  ready to erupt
 (about the sixth year) the jaws have increased in size
 so as  to allow these teeth to take their  places imme-
 diately behind the temporary teeth.  In the portion
 of the arch, then,  in front of these  molars are ten
 temporary teeth ;  which space  is also to be occupied
 by ten permanent  teeth.   If all of these second teeth
 should  be larger  than  the first ones there evidently
 would not be room for them ;  but the  four incisors
 and  two cuspids  are all that  are larger—the four
 bicuspids being smaller than the four molars they
 take the place of.   This, however, will  hardly give
 room  enough, and  additional space is gained by the
 crowns of the permanent teeth standing out more in
the arch.  Many claim that there is also an elongation 
60         THE PERMANENT 2'EETH

of the anterior portion of the jaws by the pressure of
the advancing teeth.   This again  has been disputed
by just as good authority; but if there is any increase
it is certainly  a very slight one.
  At about the twelfth year the jaws are still further
increased  in length, so as to permit the second per-
manent  molars to occupy their position just back of
the six-year molars.  Sometime between the seven-
teenth and the twenty-first year, generally,  the third
molars, or "wisdom teeth," erupt in  the back part of
the arches.
  The  permanent  teeth,  beginning to calcify shortly
before birth, and continuing  to do so for some years,
more or less rapidly,  and more or less perfectly, ac-
cording to the state  of  the  general  health  and the
amount of formative  material  furnished  by  the
food,—erupt about as follows :
First Molars, from	5	to 7	years	after	birth.
Central Incisors, "	G	to 8	"		"
Lateral Incisors, "	6 J	to 9	«		K
First Bicuspids, "	9	to 10	d		ii
Second Bicuspids, "	9J	to 12	a		"
Cuspids, "	11	to 12	u		11
Second Molars, "	12	to iy	a		It
Third Molars,	17	to 21	a		11
  The incisors  are  called often in common parlance
the "front teeth;"  the  upper  cuspids,  canine  and
'•eye'' teeth ; the lower cuspids, canine and "stomach"
teeth; the bicuspids, "small grinders;" the molars,
as a  class, "large grinders," and the third molars,
particularly, "wisdom teeth" or dentes sup lent ice.  The
above table is only  an approximation, as many varia- 
THE PERMANENT TEETH,         61
tions occur.   Not only are the period and the order
frequently irregular, but in some cases  the teeth fail
to appear at all—the temporary teeth being occasion-
ally retained till advanced life, and sometimes lost.
             Pi:rmank.\t Teeth of Bight Side.
 T  On W line. 1. Central Incisors.  2.  Lateral Inp'sors. 3.  Oiif.pi'ls.
I  1 i st 1! cuspids.  5. Second Bicuspids.   6. 1- irst Molars.  7. Second
Molars.  S. Third Molars or Wisdom  'Aeelh.
  The wisdom teeth occasionally erupt as late as the
fortieth or fiftieth year, and  sometimes never appear. 
 62        THE PERMANENT TEETH.

   Lord  Bacon, who  lived  in  Shakespeare's time,
 Eccmed to marvel  at  the  peculiarities of "wisdom
 teeth."  In his writings we find: "But divers have
 backward teeth come forth at twenty, jca, some at
 thirty and forty.   Query of the manner of the coming
 of them forth."
   Persons have been known in very rare instances to
 retain certain  temporary  teeth till thirty or forty
 years of age, and  then have them give way to  per-
 manent ones.  There is one subject standing mid-way
 between  the first and  second  dentitions of such  im-
 portance that I deem it  advisable to  call  particular
 attention to it.   The first permanent molars, four in
 number,  come in  most  frequently without causing
 any irritation,  and  often without the knowledge  of
 the parent.  Their time  of eruption,  as  has been
 seen,  is about the sixth year, and their position, back
 of the second molars of the temporary set.  It more
often  happens  than otherwise,  that within  two  or
three  years after their eruption they decay on account
of the bad condition of the fluids of the mouth, caused
by the giving  away of the temporary teeth and  the
little attention paid to  cleanliness.
  In very many cases  these teeth  arc  presented  for
extraction, and it is sometimes impossible to convince
the parent  that  they belong to  the second set;  the
belief being that they are the first teeth because no
teeth  have been shed  to  give them place.   There is
 no excuse for such ignorance, and yet it appears that
 not one parent in a hundred is aware of the truth. I 
           THE PERMANENT TEETH.         63

had  almost said  that  not one parent in a thousand
knows it, and  it is possible  that this estimate would
be a  closer one.   It is very essential to save these
teeth, and  one simple rule will be all sufficient.
  Remember that the temporary set consists of twenty
teeth, ten  in each jaw.  Occasionally count them after
the  fifth  year, and when there are twelve teeth in
either jaw, know that the back ones  belong  to  the
second  set.  Keep them  well brushed, and if decay
should chance to show itself, have the decayed places
substantially filled while  the operation can be per-
formed painlessly.
 
THE TROUBLES OF SECOND DENTITION.
rPHERE is usually little  or no pain or inconveni-
    ence attending the eruption of the second set of
teeth, as the system by this time has acquired such a
degree of vigor and endurance that it is not readily
affected as is the feeble constitution of the infant.
  Sometimes when the  teeth are  crowded,  there  is
more or less irritation.   And  in case that there is not
sufficient room for the easy eruption of the wisdom
teeth, we have a remarkable exception to this gener-
ally easy process  of dentition.  When this  crowded
condition  exists, and  the time comes for nature to
endeavor to erupt the tooth, the  resistance  of some
part of the bone or of the adjoining tooth may cause
it to take various irregular directions.  Violent pain,
swelling,  throbbing, sore-throat, difficult deglutition,
contraction  of the  muscles,  closure of  the mouth,
periodontitis, alveolar abscess, and general sympa-
thetic excitement are among the minor results ; while
in some severe cases, lock-jaw, death of  the  bone and
tumors occur.
  The treatment that would  naturally present itself
to the  mind would be to extract  the offendiug tooth 
               SECOND DENTITION.           G5

 if it could be reached, or else the one immediately in
 advance;  but sometimes this is exceedingly difficult
 of execution, owing  to the fact that the jaws are too
 nearly closed  to allow the  introduction of an instru-
 ment.  I  call to  mind one  case in which  a youno-
 nian, afflicted  with several of the ailments mentioned
 above,  had been suffering  great disturbance off and
 on for  some time;  he had been treated for neurahna
 and several of the local manifestations, without ben-
 efit.  Finally, he met some one who had  shrewdness
 enough to suspect  that it might be a tooth complica-
 tion, and he was sent to me with  his jaws  so nearly
 closed  that I could barely insert the  handle of a lance
 between his teeth.   By frequently  inserting wed-es
 of gradually  increasing sizes, I finally succeeded' in
 opening his mouth sufficiently to extract  the second
 molar of the lower jaw.  With the  probe J  then de-
 tected  that  the wisdom  tooth  had  been   growin-
 squarely against the tooth extracted, and, indeed, the
 form of the crown was somewhat marked on  the'root
 it  had pressed against.
   The  dentist should be  consulted  about the time
that the wisdom  teeth maybe reasonably supposed
to  be advancing, and preparation made for their erup-
tion, if  there evidently should be no room  for them.
A  little timely attention will  often prevent a low
train of evils. 
DESCRIPTION  OF  THE  PERMANENT
                 TEETH.
TTAVINGr now reached the point at which the per-
-*--*- manent teeth are supposed to have taken their
places in the jaws, some description of them  will be
in order.
  The four incisors and  two cuspid,  or canine teeth
of each jaw are  single-rooted  teeth.  Of these  the
root of the cuspid is the broadest and longest, and
generally has  a  slight  furrow running  its length,
seeming as if nature had  made  an attempt at two
roots.  I have never  seen but one cuspid in which
there  were two well formed roots.  The incisors are
so called from their broad, cutting edges.   The cuspid
is named  from  its having a  pointed extremity  or
cusp.
  The  bicuspid  is also generally a  single-rooted
tooth, but has a deeper groove, which quite frequent-
ly divides  it into  two distinct roots.   It is named
from the two sharp extremities or cusps on its orind-
ing surface.  The  upper molars  have  three roots
each,  two toward the  outer  surface of the  jaw and
one toward the inner.  There  are two roots  to  each
of  the lower molars, one presenting behind  and the 
            THE PERMANENT TEETH.         67

 other toward  the tooth in  front.   The wisdom-teeth,
 or third molars,  of each jaw have shorter roots than
 the other molars, and they generally approach nearer
 together, frequently forming but one.   The roots of
 these teeth are liable to many deformities on account
 of their crowded position.
   The above  description applies  to the human teeth
 in  the  vast  majority of  instances, but  occasional
 anomalies occur.  I have in my possession a bicuspid
 with three roots, a wisdom-tooth with four, and a
 lower molar  with three.   Upper  molars  have beeu
 seen with four and even five roots.
   Concerning  the anatomical description of the teeth,
 that of a simple case, the central incisor for instance,
 will answer for all; it being remembered  that when
 several roots  exist,  each  one  is supplied with blood
 vessels and nerves,  which  unite in a common  pulp
 chamber.  The hard parts of a tooth are the enamel,
 the  dentine, and  the  cementum  or  crusta  petrosa.
 These, as  seen in the plate, are  so arranged as to
 leave in  the  interior of the tooth a pulp cavity con-
 taining connective tissue,  vessels and nerves.
   Enamkl.—The enamel covers  the  crown  of the
 tooth, or  that  portion which is visible upon  looking
 into  the  mouth.  Its substance  is arranged  in  the
 form of five or six sided prisms;  the inner ends face
 the dentine; the outer are covered and cemented, as it
were, by that exceedingly fine but  dense membrane,
mentioned in  the  chapter on  the  Formation  of  the
Teeth.  The depth of the enamel is greatest on those 
68          THE PERMANENT  TEE2H.

           Central I>cisor Divided and Magxijied.

  E. Enamil.   D.  Dentine.  C. Cementum.  V. Pulp.  Q. Peridental
membrane turned  back.  A. V. N. Arteries, veins  and nerves enter-
ing root.  1. Cavity of decay affecting enamel only.  2. Decay reaching
sensitive dentine.  3. Decay exposing pulp. 
THE PERMANENT TEETH.        69
  parts exposed  to  antagonism.  It is  the hardest of
  all substances found in living  beings,  even  givin"
  sparks when struck by steel.  According to Berzel-
  ius, it is made of
       Phosphate of lime........................gr> 3
       Filiate of lime.......................     3 2
       Carbonate of lime........................  g.fj
       Phosphate of magnesia ...................  ] .5
       Soda and muriate of soda.................  1.0
       Animal matter and water..................  ].0
                                            100 parts.
    Dentine.—The dentine  is never exposed  where
  everything is in a healthy condition, as  it is covered
  in the crown of the  tooth by the enamel, and  in the
  root by the cementum.  It is not so hard as enamel,
  but harder  than  bone or cementum.   The greater
 portion  of the tooth is composed of it.   Its substance
 is traversed by innumerable delicate tubes or canals,
 running  from the pulp cavity to  the  outer  surface,
 conveying fluid and nerve fibrils.   It is composed of
      Phosphate of lime........................6:2 0
      Fluate  of lime...........................  i> 0
      Carbonate of lime.......................  5 ,"5
      Phosphate of magnesia  ...................  1.0
      Soda and muriate of soda.................. 1 ,">
      Gelatin aud water........................28 0
                                          K!0 parts.
   It is thus  seen that dentine  has considerably less
earthy matter than enamel, and a  greater amount  of
animal substance; which accounts  for the rapid  pro-
gress of  decay when it is exposed.   Its nerve fibrils
account for its sensitiveness when it is  uncovered by
caries  and irritated by different  substances, or by
dental  manipulations. 
70         THE PERMANENT TEETH.
   Cementum.—This covers the root of the  tooth,
commencing at the termination  of the enamel  cover-
ing.   It is thickest at the end of the root.  It is not
so dense as  the dentine, and  approaches true bone in
its character:  indeed it must to be  tolerated by the
living parts in contact with it.  Were it otherwise it
would act as an irritant.   Its composition is:
Phosphate of  lime and fluoride of calcium............. 5^.73
Carbonate of lime...............................  1 :?Si
Phosphate of  magnesia.............................  0 09
Salts...........  ..................................  0S2
Cartilage.......................................... 31 31
Fat...!...........................................  0 93
                       v                     10.000
  Cementum, having a still greater amount of animal
matter than dentine, is considerably more sensitive,
as is experienced when the gums are removed by cer-
tain causes,  leaving it exposed.
  Pulp.—To this are distributed several small arte-
ries,  nerves  and veins, which  enter at the small open-
ing at the  apex of the root.   The tubules of the
dentine, although too small to allow the entrance of
the corpuscles  of  the blood, yet suck in a certain
amount of nutritive fluid.   The  branches of the pulp
nerves  divide into the fibrils  that enter the tubes.
  In addition to the parts of the  tooth herein de-
scribed, we  have  the peridental  membrane  which
covers  the root of the tooth and is  attached  to the
cementum by fibrous prolongations  and numbers of
vessels.  A delicate,  structureless membrane has also
been detected surrounding the pulp. 
IRREGULARITY OF THE TEETH.
  A  PERFECTLY regular  set of  teeth is one  in
 -*-■*-which the teeth of both upper and lower jaws are
 arranged in well formed arches, the upper arch being
 somewhat larger, permitting the upper teeth to shut a
 little over or iu advance  of the  lower ones.   The
 cutting and  grinding surfaces are about on a line.
 The cusps and  prominences of one set fit  into the
 depressions of the  other, so  that when  the jaws are
 closed, no  important  space between them is observ-
 able.  The incisors and cuspids of the  superior jaw
 are broader than the same teeth of the inferior.  This
 secures an arrangement of the teeth which is of con-
 siderable  importance in their preservation  and  in
 mastication;  for the upper central  incisors  strikiug
 against the lower centrals  and half of the laterals,
 and  the same relation being  observed  between the
 laterals and  cuspids,—each  of  the upper  teeth  is
thereby caused to cover a portion of the correspond-
in"  tooth and a  part  of the  next.  Thus it will  be
seen that each tooth, with the exception of the upper
third molars and the lower central incisors, is opposed
 to two in mastication; and  that if  any tooth  is  lost, 
72      IRREGULARITY OF THE TEETH:

the corresponding one on the other jaw is not entirely
useless, as  it  still  antagonizes with  a  portion of
another.  This arrangement of the teeth also  oper-
ates against that effort of nature to expel teeth which
have uo antagonism.  From the regular position of
the teeth,  above described, there are numerous varia-
tions.  The irregularity may be so slight as to result
in no hindrance to their usefulness, and even be desir-
able as taking away the  suspicion of their being arti-
ficial ; while, on the other  hand,  it may be so  great
as to make the appearance of the person unpleasant
or even  disgusting.   There are various causes for the
irregular  arrangement  of the  second  teeth, but
among the most common are the removal of the tem-
porary teeth  too soon, or  suffering them to remain
too  long ;  hereditary transmission ; illness or consti-
tutional disturbance preventing the jaws from grow-
ing with a rapidity proportionate to the development
of the teeth; suffering the early permanent teeth to
be lost; the  presence of supernumerary teeth ; and
the  failure to erupt of certain permanent teeth.   The
teeth of the upper jaw often shut much too far out-
side of the lower ones, sometimes  allowing  the  front
teeth to touch  the lower lip, and  at  other  times to
come down nearly or quite to the lower  gums, com-
pletely hiding the lower front teeth  when the jaws
are  closed.   Frequently  the  cutting  edges  of the
upper teeth shut squarely on those of the lower, caus-
ing a wearing  away and  straight edges.  In  other
instances the lower jaw protrudes and the teeth are 
IRREGULARITY OF THE TEETH.
 thrown far in advance of the upper ones, giving
 a " bull-dog"' appearance that is anything but agree-
 able.  Occasionally the back teeth alone antagonize,
 while  there remains a considerable space  between
 the other teeth, which can not be closed by any effort.
 The  incisors, cuspids  and  bicuspids are  frequently
 seen  to  have a portion of their number  crowded
 outside of the arch, while others  are  pushed inside,
 some  of  the teeth  of the  opposite jaw  shutting
 among them in such a way  as to lock  them  in  their
 irregular  positions.   The same teeth are often turned
 partially around, lapping over one  another, or having
 their sides presented where the fronts ought to be.
 In some cases the teeth change places,—the cuspid
 exchanging positions with the  lateral, or the lateral
 with the central, etc.   The  failure of certain teeth to
 erupt, after the loss of the temporary  ones, allows
 their unfilled  spaces to be  encroached upon by the
 neighboring teeth, causing  a  straggling appearance.
 The same condition  often  occurs from the  loss of
 teeth by decay or accident,  where there  is  no  arti-
 ficial substitute.  Teeth sometimes erupt in the  roof
 of the mouth, and deformed  and supernumerary teeth
 appear in different parts of the arch.
  I have confined  my remarks  to irregularities of the
 second dentition, for the  teeth of the deciduous set
are very rarely misplaced.   The evil results of these
irregularities are many, but I will  mention only a
few of the most common : imperfect mastication, fol-
lowed by dyspepsia and other  disorders; inability to 
74     IRREGULARITY OF THE TEETH.

properly clean the teeth,  thus encouraging  decay ;
irritation of the lips, tongue and cheeks;  slavering;
imperfect speech;  inflamed  gums ;  tumors, and disa-
greeable expressions of countenance.   The treatment
of the different cases  extends all  the way from the
simple one of letting them alone and trusting  to na-
ture, to the most complicated  mechanical appliances,
assisted by great assiduity on  the part of the patient.
   Judicious  extraction to  give room, filing, plates,
ligatures, screws, caps, inclined planes,  etc., are the
means  generally employed  to correct irregularities ;
but it will  be impossible to lay down any directions
which will  be  applicable to  all cases, as there are
hardly any two precisely alike.
  It can be received as a general truth however, that
any case  of irregularity of the  teeth can  be  either
completely corrected, or very materially improved by
use of the proper means.  The patient should be
neither  too young nor too old.  If too young, the
subsequent changes of the growing jaws  may operate
against permanent benefit;  and a lack of the appre-
ciation of the  good  results would  prevent the dili-
gence demanded from the patient in wearing  the
appliances, keeping them cleaned,  etc.  If too old,
the teeth are  so firmly set  that it  requires a  much
greater amount of time in which to accomplish  a cer-
tain result.  For anything  like a complicated case,  I
have found from twelve to fifteen years of a»e to be
the best time.  Slight  irregularities, such as one or
two teeth presenting  anteriorly or posteriorly, may 
IRREGULARITY OF THE TEETH.
75
be undertaken at  any time when  the child possesses
reason and is  obedient—the sooner  the better.
  Probably there  is no operation in dentistry that so
little attention is paid to, and which  the  dentist dis-
likes as much, as  correcting the irregularities of the
teeth.   The  objection of the dentist  arises from in-
sufficient remuneration,  and from the fact  that he is
often not gratified in the result of his labors on ac-
count of  the patient failing to co-operate  with  him,
for the patient can not be under the eyes of the den-
tist at all times, and much attention is  necessary in
cleanliness, changing ligatures, etc.  Then, again,
great patience is required in  keeping the plate or
other appliance constantly in the mouth.   Sometimes
it has to be worn  for months  after the  deformity is
rectified in order  to retain  the  teeth in position  until
the  partially  new sockets are well solidified  by bone
deposit.  The dentist being aware of the tediousuess
of the operation,  and the probability that the patient
will not perform  a  proper share of the labor, feels
like asking a pretty good fee  for  taking  charge of
the  case and promising a proper   result;  whereas
the  parent, placing too much  confidence  in the  co-
operation of  the  child  and himself, and not appre-
ciating the dentist's position,  is unwilling to pay so
laro-e "i price.  The proper way to  do would be  for
the° dentist to view the case, form  his opinion  as to
how Ion- it would take under the most favorable cir-
cumstances to correct the irregularity, and charge so
much for that  amount  of time, without  any positive 
76     IRREGULARITY OF THE TEETH.

promises as to the result.   The charge would thus
be exactly proportioned to the amount of labor, and
the parent, to whom money is an  object, would be
stimulated to see that everything should be done that
might secure the best results in the limited space of
time.
  There is  another matter connected with the treat-
ment of irregular teeth that demands consideration.
Rubber rings are much used  around the  teeth, and
any one who  has  had any experience, is  aware how
liable they are to slip  under the gums and become
hidden.  Many a tooth has been lost by a ring slip-
ping from all the teeth  but one, and following up the
tapering root of that, irritating  and loosening it to
such a degree  that it  has  been extracted with the
cause unsuspected, until the ring has been found far
up the root.
 
DENTAL CARIES, OR  DECAY.
    /"HEX. at an interesting period in youth, we look
      admiringly upon a well  arranged, clean, sound
and  beautiful set of teeth, so intimately  associated
with  comeliness  of  countenance, and  contrast their
appearance
    " Before  decay's effacing fingers
      Have swept the  lines  where beauty lingers,"
with  that presented  a  few years  later, when from
negligence or heedlessness the pearly whiteness  has
been  succeeded  by the blackness of decomposition,
and the beauty of symmetry has given way to hideous
disorder,—we can not but wonder at  the  unfaithful
stewardship  of those who  so lightly esteem the treas-
ures intrusted to their care.
  It  is as doubtless the design of nature that  the
teeth shall endure through life, and perform without
material injury all of the  labors for which they are
created, as it is that the eye, the ear, or any of the
members or  appendages of the body, shall  be able to
execute their particular offices until the end of exist-
ence.  Were the laws relating to the formation  and
development of  the  teeth, and their subsequent re-
AA 
78       DENTAL CARIES, OR DECAY.
quirements,  fully  comprehended and  obeyed, they
would  certainly meet with fewer injuries  than any
other parts of the  body.
  The human teeth  have  doubtless  been  subject
through all time to occasional  disease; but it is only
of late  years that their condition has become such as
to cause alarm, and to demand earnest efforts to dis-
cover wherein the  laws of nature are violated.   Let
us look at some references  to the  condition of the
teeth in other times.   Sir John Sinclair, in his  work
elsewhere referred to, says:  "Former  generations
seem to  have enjoyed a great superiority over the
present in regard to the duration of their teeth.  A
place of  interment was lately opened  at Scone, near
Perth,  in Scotland, which had remained untouched
for above 200 years, and  yet to the  astonishment of
every one, among a great number of skeletons which
were discovered, there was hardly any of them whose
teeth were not  entire and  sound.   This  is  to be
ascribed, probably, to  a greater simplicity of diet."
  John Taylor, a  miner  at  Leadhills, who died in
1770, at  132 years of age,  had excellent  teeth till
within six years of his death.   Petrarch Czartan, a
Hungarian,  who  died January  5,  1724, aged  185
years, had  some of his  teeth remaining.  "In Mis-
cellanea Curiosa there is an account of an old  man,
one hundred and twenty years of age, without the loss
of a tooth."   Hufeland gives  an account of "a lady
past seventy years  of age, remarkable for the fineness
of her teeth, who  ascribed their preservation to her 
DENTAL CARIES, OR DECAY.        79
having laid  it  down  as  a rule to clean  them after
•very meal."  These  are but a few of the many in-
stances  that could be quoted  to  show that  even in
days  not long past,  the teeth  were far superior to
those of this century; and  it is certainly not unrea-
sonable to suppose that  those of our times could, by
proper attention, be rendered capable of withstanding
the wear and tear of an ordinary lifetime.   Numer-
ous travelers among various other nations of the globe
describe the teeth, even of the  now existing genera-
tions, as seldom  afflicted  by disease in those cases
where the people  live in accordance with the laws of
nature,  surrounded by healthy influences.   In  our
own country we often hear allusion made to immediate
ancestors who retained  their teeth to advanced  age,
and "never knew what the toothache was."  In tracing
such  instances back,  we  find that  the constitution of
their bodies was the same as the constitution of their
teeth, and  that they  sprang from robust stock,  and
remained aloof from the follies  of fashionable living.
But it is useless  to follow these thoughts further; it
is our duty  to deal with the condition of the teeth as
we find it  at the present day, and it is a fact  that
dental caries is generally prevalent, but few sets of
teeth escaping its ravages.  Teeth have their outward
indications of health  as  well as people, and an expe-
rienced  observer  can tell  by certain characteristics
their inherent soundness or weakness, and their capa-
bility of resisting the various antagonistic influences
to which they are liable.  The best constructed, most 
80       DENTAL CARIES,  OR DECAY.
solid  and most durable  teeth are of a color just re-
moved from white, with a faint yellowish border near
the margin  of the gums, gradually  shading off into
the rest of the crowns,  not very  large,  being  of
medium  width and length;  their longitudinal sur-
faces  are perfectly regular  on  all sides, with  no
grooves or depressions; their cusps  and prominences
are not  strongly  marked;  their  grinding surfaces
have  no  deep, narrow depressions, and their enamel
exhibits no delicate fractures upon the closest exam-
ination.  Such teeth are seldom attacked with caries,
and with ordinary cleanliness and care in  their use
would rarely have to be taken to  the dentist.   If all
people possessed  such teeth, one dentist would  be
able to perform what  a thousand  do now, and the
other nine hundred and ninety-nine would have  to
benefit society in  some other way.
  Teeth of the next best quality are those that ex-
hibit the characteristics of these, with the exception
that they have deep  depressions  or fissures  in the
grinding surfaces; for  though these places are almost
certain to decay, they can  be substantially filled if
taken in  time, and  the teeth made about as good as
those first mentioned.  The  further the departure
from these kinds and the nearer the approach  to the
pearly white, the  chalky, the bluish, or  the grayish
tinge;  to imperfect shape,  to length and  delicacj-  of
form, to  very large or very small  size,  to  pits and
grooves on  other  surfaces than  the grinding ones
the more  readily are the teeth affected  by external
influences. 
          DFATAL CARIES, OR DECAY.        81

  Now, notwithstanding  the many different grades
of teeth, it has bceu found  by experience that it is a
rare thing for teeth to be  so poor in quality that they
can  not be  made to last  till late  iu life,  by paying
proper attention  to cleanliness, to the condition of
the fluids of the  mouth,  to the  general health, and
by  visiting  the dentist for the purpose  of having
them examined, and to have them  filled at the com-
mencement of decay.
  Decay of the  teeth is the destruction of  their
earthy salts  from the action  of certain  corrosive
agents.   It exhibits different appearances according
to the attending circumstances.  If the teeth  are of
solid construction, the  decay is darker, and  slower in
its  progress; if soft in texture, the decay is  lighter
aud more  rapid in its action.   The color varies from
nearly  black to cream-colored  and white.  It may
attack  the teeth   at any  point, but  is  much  more
commonly confined to  the grinding surfaces, and the
sides or  approximal surfaces.  I would distinguish
decay further  by the terms apparent aud concealed ;
the first applying to  that  which  is readily  visible,
whether  deep  or  shallow;  and the  second to that
which presents an almost imperceptible opening ex-
ternally, while inside its ravages extend rapidly, just
as a worm eats out the inside of a nut. while only a
minute orifice exists in the shell.   As will be seen
by reference  to the  plate  exhibiting the anatomical
structure  of the  tooth, superficial  decay is confined
to the enamel  covering, or dips but slightly into the 
82
THE CA USES OF DECA Y.
dentine.  As its depth increases the sensitiveness is
heightened  on  account  of  the nerve  fibrils,  and
finally the pulp chamber is opened.   The sensitive-
ness aud the distance from  the  pulp depend  also
upon the position of the decay.
$<*:<
             THE CAUSES OP DECAY.

  After  numerous  speculations  concerning  the
manner in which the  teeth  decay,  scientific men
have generally come to the conclusion that there is
but one essential direct cause, and that is the action
of acids.  The  power  of  acid to destroy the earthy
matter of  the teeth may be inferred by reference to
the chapter on Phosphate of Lime.  The enamel, on
account of its extreme compactness, is slowly acted
upon;  the dentine much more rapidly.  If the teeth
were always well constructed, with no imperfections
in the  enamel, it would be safe to say that from acids
of such strength as those  to which they are exposed,
decay  would rarely occur,  especially as  the  acids
would be  so often diluted and washed away by sub-
stances taken as drink, and by the continued flow of
saliva.  But fractures and imperfections of the en-
amel exist  so generally on  account of iijuries  aud
disease, that the  dentine  is readily  exposed to the 
THE CA USES OF DECA Y.
83
 action  of acids  found in the mouth, and from that
 formed by the decomposition and fermentation of  its
 own organic matter.   1 probably can not make better
 use of my time  than to quote  the interesting and
 convincing experiments of Dr. A.  Westcott, in refer-
 ence  to the effects of acids, etc., on the teeth.
   "Both vegetable  and  mineral  acids  act readily
 upon the bone, and  enamel of the teeth.
   'Salts whose acids  have a stronger affinity for the
 lime  of the tooth than for the basis with which they
 are combined, are decomposed, the acids acting upon
 the teeth."
   [A salt  is the  union of an acid with  a substance
 called a base,  each  neutraliz'ng the  other more  or
 less perfectly, and forming a compound of altogether
 different properties  than  those possessed  by  cither
 constituent.  Sometimes  the base  does not entirely
 neutralize  the  acid, in which case  the compound  is
 called an acid-salt.   Such substances are used fre-
 quently as medicines.]
   "Vegetable  substances  have no effect upon the
 teeth  till after fermentation  takes place, but all such
 as are capable of acetic fermentation, act readily after
 this acid is formed.
   "Acetic and citric acids so corroded the enamel  in
 forty-eight hours that much of it was easily removed
 by the finger nail.  Acetic acid, or common vinegar,
 is  not only iu  common use as a condiment, but  is
formed in the mouth whenever substances, liable  to
fermentation, are suffered to remain about the  teeth
for any considerable length of time." 
84
THE CA USES OF DECA Y.
  [Strictly speaking, vinegar is a much diluted solu-
tion of acetic acid.  Much of the made-up vinegar is
very injurious on account of the sulphuric acid con-
tained  to increase sourness.   The government  of
England, recognizing this fact, allows the admixture
of one-thousandth part only of sulphuric  acid.]
  "Citric acid, or lemon juice, though less frequently
brought into contact with  the teeth, acts upon them
still more readily.
  "Malic acid, or the  acid  of apples, in  its  concen-
trated state, also  acts promptly upon the  teeth.
  "Muriatic, sulphuric and nitric acids, though large-
ly diluted, soon  decompose the  teeth—these are in
common use as tonics."
  [In taking any such medicines the teeth should be
protected.   The method often advised of taking thein
through a quill is almost  useless, as there is always
some  regurgitation.   The proper way is to  have a
bottle filled with water in which some bicarbonate of
soda has been dissolved,  and rinse the mouth with
some of it before and after  taking  the medicine.  A
table-spoonful of soda to a quart of water will be a
suitable mixture.  Many  a set of teeth has been per-
manently damaged by  neglect of such precautions.]
  " Sulphuric and nitric  ethers have a similar  dele-
terious effect, as also spirits of nitre—these are com-
mon diffusible stimulants in sickness.
  " Super-tartrate of  potash (cream of tartar) de-
stroyed the enamel very readily.   This article is fre-
quently used to  form an acidulated beverage. 
THE CA USES OF DECA Y.
85
  " Raisins so corroded the enamel in  twenty-four
hours, that its surface presented  the appearance and
was of the consistency of chalk.
  " Sugar had no effect  till  after acetous acid wa3
formed, but then the  effect was the same as from this
acid  when directly applied."
  Be.-ides  the acids  introduced into the mouth as
medicines and condiments, and those formed  there
by the fermentation of food, the fluids of the mouth
are  frequently a  source, aud  often there are  acid
regurgitations from the stomach.
  The saliva in  its normal state is slightly alkaline,
but from certain  diseased conditions of the mouth
and of the general system, it becomes so acid  as  to
be capable of corroding the teeth  with  rapidity;  as
is seen to happen  from diseased  gums and  mucous
membrane,  disorders  of the stomach aud  bowels,
fevers, etc.
  It is also  subject to other changes which render it
liable to putrefy  with rapidity and  communicate  the
same  tendency to  particles of food left in the mouth.
This is noticed iu bilious, albuminous and puriform
saliva, etc.
  The thick, tenacious secretion  of  the  mucous fol-
licles of the mouth often produces the same effect.
  These facts point  out the necessity of having  the
fluids of the mouth carefully examined iu all cases
where the  teeth  appear to disintegrate  rapidly and
good  fillings fail  to arrest  the  decay.  Certain tests
in the bauds of the dentist detect the  abnormal con- 
86          THE CA USES OF DECA Y.
ditions of the oral secretions, and often a simple pre-
scription will correct them.
  Acids, then, being  the  direct cause of decay, the
various  indirect  causes may be  spoken  of as  those
that injure the texture of  the teeth in any way, so as
to render  them  susceptible to  corrosion, and  those
that interfere with  the cleaning of them.   Besides
those that interfere with the healthy formation  and
development of the teeth,  which have been sufficient-
ly considered elsewhere, I  will mention the following:
  1. Inherited peculiarities. It is well  known that
certain irregular positions, abnormal shapes, fissures,
etc., giving origin  to  decay, are  often  transmitted
from parent to child.
  2. Fractures of the enamel.  Cracking nuts,  biting
threads,  falls, blows,  the  crowding  of  the teeth iu
the arch,  and many other  habits and  accidents cause
fractures, frequently too minute to  be  observed  by
the naked eye, but  they nevertheless exist  and give
entrance  to the destructive  agent.
  3. Roughening and wearing  away of the enamel.
Picking with  metallic tooth-picks, holding pins in
the mouth, the pressure of artificial plates and clasps,
the use of powders  containing too  much grit, all  pro-
duce a scratched  or worn  condition of the enamel.
  4. Swollen  gums.   Old  roots  of teeth  and tlw3
sharp edges of large cavities  of decay  frequently
irritate the gums, causing  them  to  rise up on the
sides of  sound  teeth, thus forming  a  place for the
lodgment of food  and acids;  they  also vitiate the 
THE CA USE,S OF DECA Y.
87
fluids of the mouth generally by their contaminating
influence.  Accumulations of  tartar often act  in the
same way.  Swollen and inflamed gums moreover
commonly prevent the use of the brush on account of
pain and  bleeding.   Connected  with this subject, it
may be mentioned that the wisdom teeth, on account
of deficiency of room, are often only partially erupted,
the gum forming a lid over a portion of  the crown.
   5. Badly performed dental operations.   Sometimes
in filled  teeth, the metal instead  of just filling the
cavity and beiug continuous with  its exterior mar-
gin, overlaps and forms a crevice  in which injurious
agents secrete themselves.  At  other times the Cav-
 es
ity is not full  enough or  the metal is uot well con-
solidated.  Occasionally,  through  indiscreet  use  of
the mallet, the enamel at  the margin of the filling is
fractured and  subsequently disintegrates.  After the
use of the file in separating,  finishing fillings, etc.,
the scratched surfaces are often not sufficiently pol-
ished.   The same remark will apply to the condition
of the enamel  sometimes observed  after  the removal
of tartar by scaling instruments.
   This enumeration includes the most common causes
of decay, but before  closing I will  mention  two
others that have  been  the occasion of considerable
discussion of  late years—galvanic  action and infu-
soria and  fungi.   That a small  galvanic  battery may
sometimes be formed  in the mouth from the presence
of two different metals, one of them being acted upon
by the oral fluids, no one  can deny.  As  a proof of 
88          THE CA USES OF DECA Y.
this is given the  familiar experiment  of Sulzer,  a
century old, of placing a silver coin above the tongue
and a piece of zinc beneath it; a little electric shock
and  peculiar taste occurring when the  metals  are
pressed into contact.  But that such galvanic action
generally  exists,  and that it causes the wholesale
destruction of the teeth  that the extremists claim,  1
have  not  the courage to assert; especially when  I
consider the fact  that such claims could be so well
refuted by many  whose teeth have  remained in  a
comparatively good condition for a quarter of a cen-
tury, notwithstanding the juxtaposition of different
kinds of metallic fillings.  I have no doubt, however,
that in many cases slow, and,  sometimes, rapid injury
results when the position of the fillings, the acidity
of the fluids and  the  quality  of  the tooth substance
combine in the  most  favorable manner  for galvauic
action and decomposition.
  Concerning  the  infusoria  and  fungi  there is no
doubt of what the  microscope  has proven to exist in
abundance in the human mouth.   In fact, cavities of
decay have been spoken  of as minute aquaria, teem-
ing with animal and vegetable parasites.  Whether
they cause  decay or  not has  never been definitely
settled by disputants.  My opinion is  that they do
exert some influence, and I  am  led  to believe this
from consideration of the fact that they possess  the
power of destroying organic matter, as  is seen in the
occasional destruction of gold-fish and  the tails of
reptiles to which they attach themselves. 
PREVENTION OF CARIES.         89
       THE  PREVENTION AND CURE OF CARIES.
    The great  method  of  prevention  is to keep  the
  teeth clean.   To secure proper cleanliness, pleasant
  taste and  purity of  breath, the  teeth ought to be
  cleansed five times a day;  once  after each  meal, once
  before retiring and once  during the  morning ablu-
  tions.   In  the morning the bru.-h and good  powder
  should  be  used and  the mouth rinsed.  After each
  meal  all particles of  food  should be picked from
  between the teeth, and then the  brush and clean water
 will be sufficient.  At night the brush and water  will
 answer, occasionally using a little  good Castile soap
 and then rinsing the mouth.  The best toothpick is
 one made from a quill, but after using it should not
 be kept in the mouth the balance of the day, till it is
 mashed into a ragged brush.  The tooth-brush should
 be applied  so as  to reach every  accessible surface of
 the teeth and so as to brush the food from between
 them;  therefore  it should  be  used  backward aud
 forward and from side to side on the  grinding sur-
 faces to clean out all the  depressions ; aud upward
 aud downward  in the divisions  between the teeth,
 inside and outside.   Once or twice a week, or oftener,
 a silk thread armed  with  powder should be  drawn
 between all of the teeth.  So well do people generally
appreciate the necessity of keeping  the teeth  clean,
that about one  in  ten thousand  takes  such care  of
them.   One  of a thousand, probably,  goes  through
the form of cleaning them three  times a day.   A
         8 
 90        PREVENTION OF CARIES.

 greater number clean them once a day, and that in
 the morning, allowing the food from three  meals to
 accumulate,  putrefy  aud  ferment  all day and  all
 night  till the  next morning again.  But the great
 majority of people don't clean them at all  aud—glory
 in it  often.   Many that do pretend to  brush  tho
 teeth,  rattle the brush along the row, just as a  boy
 rattles his stick along the palings; this  docs about
 as much harm  as good, packing the particles of food
 and  decomposing  mucus  nicely away between  the
%teeth,  and leaving untouched the grinding surfaces.
 It would be just as sensible  to attempt to paint a
 fence by rubbing the brush across the pickets instead
 of up aud down.   Many who have  been careless with
 their teeth will doubtless think  that to follow these
 directions will  be an arduous duty, but the attention
 here advised will not require in the aggregate more
 than ten minutes of each day; and after a little while
 it will assume  the form of a habit and will be natu-
 rally added to the ordinary routine of daily duties.
 The dentist should be seen occasionally, that he  mav
 remove  deposits  of tartar, see that the gums  and
 fluids  of the mouth are in a healthy condition,  and
 that there is sufficieut  room  between the teeth to
 allow  them to  be cleaned ; also that he may examine
 the conditiou of the teeth in places that  the  patient
 can  not see.
   When from  any cause, decay does occur, the means
 of cure are filing, burring and  filling, operatious that
 will be spoken of in full hereafter. 
            PREVEN1 JON OF CA1HES.        91

   Finally, if people would fully realize the truth of
that aphorism given to us by Shakespeare:
    " A little fire is quickly trodden out,
      Which, being suffered, rivers can not quench,"
and would  p;iy more  frequent visits  to  the  dentist,
we would seldom see those cases of aggravated decay,
agonizing  toothache,  offensive breath, early  loss of
the teeth, etc., that have  become so  common.   The
majority of people will  wait uutil pain drives them
in desperation  to the  dentist to have  teeth extracted
that  could  have  been  saved without peradventure
and without pain, if they had been filled  in the early
stages of decay.
   It is sufficiently  near the truth  to lay it down as  a
rule that a small  spot of  decay, unattended to, is as
sure to end iu the destruction of the tooth, as a small
fire is sure to  end in the destruction of the building.
   A decayed tooth never repairs itself, and to save it
the dentist must be patronized.  One  great populai
mistake is  that the teeth  are not decayed as long aa
they give no pain ;  whereas pain comes from the ad-
vanced stages  of decay.   It is a common thing for  a
patient to go into a dental office confidently asserting
that there is only one decayed tooth  in  ihe mouth,
when examination  will detect a dozen.  It is  utterly
impossible for  patients to examine properly their own
teeth; to do it requires  delicate  mirrors  and fine in-
struments  that  the uuinstructed can not use, aud an
angle of vision that can not be employed.
  Expense, which  is  such an  object to  many, and 
92         PREVENTION OF CARIES.

which  is so much increased by delay, ought to be a
strong  appeal for the necessity of early attention.
  Ten  dollars will often do at one  period what will
require a hundred dollars a year later.
  "An ounce of  prevention  is worth a pound  of
cure;"  "Great  ends from  small  beginnings grow;"
"A stitch in time saves  nine;" and a whole volley of
proverbs and maxims  could be hurled at the unbe-
lieving and indifferent.  "-Time is money," and  an
hour or two in the early stages of  decay is only con-
sumed, instead of days at a  later period.  Pain is the
dread  of mortals, and  early operations  are painless
where  later ones  are painful.  Beauty and comfort
are preserved at one period; whereas they are lost at
another.   Then besides, it should be remembered that
bad teeth are often attributed to a lack of cleanliness,
and
  "Cleanliness is indeed next to godliness." 
FILLING,  OR PLUGGING.
 A  FTER the removal of the decomposed matter from
■^-*- a  cavity of decay, the  operation of introducing
metal,  or some other  substance, for the purpose of
arresting  the further progress of the  disease,  is
called  filling.  Considering the countless instances
in which good fillings have preserved  the teeth  in
excellent condition ever since they were put in  many
years  before, it  is really astonishing that so  many
persons still live in ignorance of the usefulness of
the operation.   Many there are who through  igno-
rance or prejudice suffer their teeth  to go, one by one,
suffering meantime the agonizing  tortures of tooth-
ache, most offensive  breath, vitiated saliva, impaired
digestion, impure blood, and numerous  other  evils,
and are  at  last left  toothless  and with general de-
rangement of the system.   In  some cases the preju-
dice has arisen  from their own,  or their parents'
experience  in early days, when  the operation was
not.so well understood, and good dentists were scarce;
makin"- no allowance for the great improvements that
have taken  place in  materials  and in the qualifica-
tions of the  operators.  Many through parsimony or 
94          FILLING, OR PLUGGING.

poverty have had their teeth poorly filled with cheap
materials, and  by cheap dentists, and are unwilling
to believe that fine fillings, inserted by skillful hands,
will give  better satisfaction.  Others again have  al-
lowed their teeth to proceed to exposure of the nerve
or ulceration of the root, before  having them filled,
and because they did  not turn out well, condemn  all
filling as useless.  It would be just as sensible to call
in a physician  in the  last  stages of some  fever, and
because the patient does  not recover, refuse to believe
in the  healing  power of medicine; or to let a house
burn nearly to  the ground, and because the engines
can not save the property at  that  late hour,  declare
them incapable of ever  accomplishing good.   Some
won't have their teeth  touched because their first ex-
perience gave them so  much pain,—not realizing that
small cavities are generally not painful, or that means
have been discovered  to allay sensitiveness.  And a
great number, after having had their teeth filled once,
have since had no regard to cleanliness, suffering
their teeth to decay around the plugs and  elsewhere,
and blame the dentist for what is attributable to their
own  negligence.
  Filling the  teeth with the right material, in the
right manner, and at  the right time, will  almost  in-
variably save  them, if the  patient co-operates with
the dentist by doing  his  part of the work  afterward.
In any case, it is more  certain  than  any remedial
operation that can be  performed upon any  other por-
tion of the body.  A person  may be treated for any 
           FILLING, OR PLUGGING.         95

disease and restored to perfect health, but there is no
certainty that he will not be attacked by another the
next day or the next week; whereas good fillings at
the proper time are almost sure to preserve the teeth
from any disease for a number of  years.  Every one
should know what is essential in  a good  filling, that
he may be able to judge whether the work is well or
poorly  executed,  and know whether to blame the
dentist or not,  should the operation prove unsuccess-
ful.   All  decomposed  and soft substance should  be
removed  from  the  cavity.  The cavity should  be
shaped so as to be but slightly wider internally than
at the entrance, no  matter how much  cutting  away
has to be  done, for it  is impossible to introduce the
instruments so as  to thoroughly condense a filling iu
a cavity that has a large area of  decay inside, while
the external margin describes a very much smaller
circumference.  Besides, the  thin  plate of enamel
which, under such circumstances, would  be left over
the filling, would  be very liable  to  subsequent frac-
ture.   Teeth very often  decay iu the manner spoken
of, for  the  hard enamel is slowly acted  upon, while
the softer dentine is  eaten  away rapidly, and many
such  teeth arc improperly filled by timid dentists,
who dare not  cut away the enamel for fear of being
accused of unnecessarily enlarging the cavity iu order
to secure  a greater fee.
   The work ought to be done well, even if the  future
patronage of a susp:eious patient should be lost,
   The mar»ius of the enamel should be smooth and 
 96         FILLING, OR PLUGGING.

 firm, so as not to crumble under the necessary pres-
 sure.   After syringing all the debris from the cavity
 and  making it completely dry, the filling  material
 should be pressed  into every inequality, and the en-
 tire filling thoroughly condensed,  so  as to perfectly
 exclude the atmosphere, fluids and particles of food.
 The filling should  then be  dressed down so that its
 edges may be  exactly even with the  surface of  the
 enamel, being  neither  too  low,  too high, nor  over-
 lapping.   It  should  then  be  well  smoothed and
 polished.
   If the filling is on the masticating surfaces it must
 not be felt when  the jaws are closed tightly together;
 if on the approximal surfaces, enough space must be
 left between the  teeth to allow cleaning. When  the
 work is finished the patient must do his  part  by keep-
 ing the filling clean, otherwise it will  be liable to
 have decay renewed around it.
   A  finely polished  steel  blade, if left in  a  damp
 cellar,  will become  covered with and  damaged by
 rust;  it may be taken out and by proper labor have
 its brilliancy restored, but it would  be  foolish to place
i it right back where  it would be subject to the same
 damaging influences.
   The dentist should be called upon every few months
 that he may examine his fillings, aud see whether the
 fluids of the mouth, the  care  of the patient, and all
 the surrounding  conditions  and  circumstances  are
 favorable to their  preservation ; for every honorable
 practitioner  takes  a pride  in  his  operations, and is 
            FILLING,  OR PLUGGING.         97

anxious that his work shall be perfectly done.   But
how can he take an interest in his labors for a patient
who remains away for a long time, taking no care of
his teeth, and finally comes  back growling about his
fillings coming out, and wanting him to do them  over
again for nothing, when he has given  his dentist no
chance for observing the quality of his work ?  Many
people keep  away from the  dentist because they are
afraid that he will  find something  to do, never  con-
sidering that they  ought to be  glad if he does ; for
time, pain and expense are saved by early operations.
Dentists do  not charge  for examinations and consul-
tations, although  there is.no reason why they should
not be remunerated for  time occupied in  professional
advice, as well as physicians or lawyers.
   Various materials are used in filling teeth, each of
which possesses some advantages  that the others do
not, and neither of them answering every requirement
necessary to constitute a perfect filling  iu all respects;
perfect adaptation, natural  color, hardness,  lack of
shrinkage,  non-conduction of  heat  and cold, unin-
juriousness  to the teeth, mouth or general system,
and unchangeableness  in mastication, or from  ex-
posure to anything with  which it may come in con-
tact.   I will mention these  different  materials  sepa-
rately, and give my opinions as to the relative merits
and advisability  of each, untrammeled by any  per-
sonal  preference, and  regardless  of  the  prejudices
of others.
9 
98
GOLD.
                      GOLD.
  The preparation of gold for the use of the dentist
has become a distiuct branch of business.   It comes
to us in the form of leaves  of various degrees  of
thickness, being adhesive or non-adhesive;  also, in
soft spongy masses called on account of slight differ-
ences in  appearance and  manner  of preparation,
crystalline or sponge, plastic and shred  gold, all of
which are very adhesive.  Adhesiveness  is the name
given to that quality of  gold, by which one portion,
by pressure, becomes so incorporated with  another
as to make a mass almost as solid as coin; but some-
times this  property  is objectionable, as in deep  and
narrow and irregular cavities difficult of access, for
the gold becomes  consolidated  before  it is pressed
into all  the  iuequalities.  Adhesive  gold  foil  and
sponge  gold  arc  peculiarly  applicable for  contour
fillings, or those in which a lost portion of the tooth
has  to be  built up  to  its  original shape; but it is
much more tedious  to use them than the soft gold,
and great  care has  to be used to keep  them from
getting wet, as the least moisture ruins their adhesive
properties.
   The fillings  made of them, when propcr7y done,
are the perfection of skill and  beauty, as any shape
can  be imitated and a most lustrous finish  can be
given.  Non-adhesive gold  answers  well  in  many
.caces, especially in the  masticating  surfaces of  the
bicuspids and  molars where  there  is no building up 
                       GOLD.                    99

 to do, and it is much easier of introduction ; but it is
 not susceptible of so fine a finish, and is more apt to
 crumble out when once started from any cause, as  by
 picking, and by fracture of the  enamel at the edge  of
 the filling.
   Gold is unquestionably the  best  material that has
 ever been  employed  for filling  the  teeth,  and  may
 always be considered the most appropriate in cavities
 sufficiently  easy of access where  the  pulp is not too
 nearly exposed, and where the walls are firm enough
 to allow the pressure necessary for perfect consolida-
 tion.  It can be adapted to every minute  portion of
 the  cavity,  resists perfectly the force of mastication,
 exerts no evil influence upon the teeth or any other
 part, and remains entirely unchanged from any agen-
 cy with Avliich  it is liable to come  in contact.  This
 is more than can be said of any other material.
   Pure gold  put  in  the  teeth to-day, will be pure
 gold in the  grave a thousand years  hence.   Its color
 in front teeth is very  objectionable  to some  whose
 tastes are such that they prefer to  have tooth-color
 fillings many times renewed, or even to have artificial
 teeth, rather than  to show the  burnished gold every
time they move their lips.  Its power of conducting
Bcnsations of heat  and  cold to a sensitive pulp  is
sometimes a serious disadvantage, the continued irri-
tation occasionally producing in it inflammation,  loss
of vitality and  suppuration;  but  proper medication,
and  the interposition  of some  non-conducting sub-
stance between the filling and  the location of sensi-
tiveness, will generally  prevent  such occurrences. 
100
GOLD.
  In filling very large cavities  requiring a great deal
of pressure and malleting,  there  is no  doubt that
occasionally the perideutium is  thereby  injuriously
excited, especially in people of great susceptibility to
irritating  influences.   Another objection  that  some-
times exists to the use of gold is, where the walls of
the cavity are so thin and brittle as to make it ques-
tionable whether or not they are  able to withstand
the required pressure, for  it  will  not  do to com-
promise matters and insert an imperfect, half-consoli-
dated filling, just for  the name of  having gold in it.
Finally, the expense of well  executed gold fillings is
an impassable barrier  to many who fully appreciate
their teeth, and would have  their work  done in the
best manner if they could afford it.   The question,
what  to do in such cases, constantly presents  itself
to the mind of the dentist.   I can not but condemn
the practice  of  those  operators who, clinging  obsti-
nately to  their  theory of "gold or nothing," drive
away  such patients and compel them to  go  to  the
cheap  charlatan for  cheap  fillings, poorly inserted.
Other  fillings  than gold, well  put in by a skillful
dentist, and well taken  care  of by the  patient, will
often save the teeth for a considerable time, perhaps
until the days of prosperity.
   Of course, it  is  difficult  sometimes for the dentist
to know whether the patient is poor or penurious, but
he should have the benefit of the doubt, and whether
he is unable or unwilling to pay  the price of gold,
he should have the  dentist's  best services in some- 
          TIN FOIL-FUSIBLE ALL 0 2^.       101

thing else; especially as the  patient is the one who
has to suffer iu case of any misrepresentation.


                     TIN FOIL.
  TniS is probably the  next best metal {or preserving
the teeth in anything like simple cavities with strong
walls.   Its color is much less agreeable  than that of
gold,  even when  first put in;  but in many months it
is  soon  chemically affected,  turns black  and  dis-
integrates.  Its  softness is  such  that  it is readily
conformed to the shape of a cavity and makes, there-
fore, at first a  good filling, and very often  lasts as
well as gold.  It is better than gold as far as its con-
duction of thermal  changes is  concerned.  Its lack
of adhesiveness renders it unserviceable for any but
the simpler kinds of cavities.

                 FUSIBLE  ALLOYS.

  Tin, cadmium, lead  and bismuth melted together
in certain  proportions  form a compound  looking
much  like lead, and is  fusible  at a very low degree
of heat.   For  instance, when placed  on  paper  and
held  over  over a flame it melts without the paper
being  scorched.   The  cavity being  kept  perfectly
dry, is filled by piece being added  to piece by means
of warm  instruments.   Unless  through  mismanage-
ment, the heat  is not sufficient to cause any unpleas-
ant sensation.   It preserves  its color  well, cau  be 
102         0X2- CHL OR IDE OF ZINC.

built up  to any shape, and where a good foundation
is secured it makes a fair  filling.  As it is not much
used, I have  never felt sufficient interest to examine
particularly,  but there is doubtless  some  little con-
traction of the filling on cooling, which makes it liable
to have decay started around it.  It is used generally
as one of the dernier resorts in the worst cases of
carious  teeth.  It possesses some  advantages  over
amalgam, in  that  it is not  suspected of evil  effects,
can be entirely dressed and  polished at one  sitting,
and is easily  removed in case  after  trouble renders it
necessary.  Such fillings sometimes  last many years.

                  GUTTA PERCIIA.

  Gutta perciia alone, and in combination with
feldspar, quicklime, etc., is  frequently used for tem-
porary fillings, and as  a non-conductor beneath metal
fillings.  It is applied with warm instruments in the
manner described  for  fusible alloy.   Hill's stopping
and White's  preparations are  those  most commonly
used.  Such  fillings are soft and unirritating,  and are
excellent for temporary purposes, and sometimes, in-
deed, last for several years.


       OXY-CHLORIDE OF ZINC PREPARATIONS.

   Os-artificiel, osteo-clentine, bone-filling,  white-
filling, osteo-plastic, cemeut-plombe,  Guillois'cement,
etc., are some of the names applied  to a certain class 
OXY-CHLORIDE OF ZINC.         103
of compounds consisting essentially of oxide of zinc
combined with silex, borax  and titanium and  other
coloring matters, made into a paste with chloride of
zinc just before  using;  and  which  hardeus in a
few minutes.
   The number of these compounds indicates the great
longing for a perfect material for filling teeth, or one
which combines the natural color of these  prepara-
tions  with the many good properties of gold.  These
plastic materials are superior to gold in some respects.
They match  very nearly the  different shades  of the
teeth, so as not  to  be  distinguishable at  a  little dis-
tance.   They adhere to the  walls of  the  cavity so
firmly,  that  its shape makes  but  little difference.
They allay the sensitiveness of the teeth by the pain-
obtunding  action  of the  chloride  of zinc, which  is
often used by itself for that purpose; for this reason
os-artificiel  is  often  happily used  in  those  cases,
especially among females, where the sensitiveness of
the teeth is excessive  from  sympathetic association,
and where the existing condition makes it unadvisable
to "-o through a long and  tedious operation of gold
filling.   What it  lacks is the durability of gold, for
it is gradually, within  a variable  time, removed by
the fluids of the mouth.   It is much  used as a cover-
ing for  exposed pulps, the permanent filling  being
placed over it.  It is  this application of it that has
caused such a great amount of discussion in our cm-
ventionsaud associations for several years; one raity
arguing that it invariably devitalizes the pulp, while 
104
AMALGAM.
the other declares it to be harmless.  As for myself,
I believe that it will  nearly always destroy it if ap-
plied in immediate proximity to it, sometimes when
the pulp is separated  from the  filling by but a small
amount of tooth substance, and hardly ever when the
pulp is  well protected.  Excellent fillings are made
in certain kinds of cavities by filling the  greater por-
tion of  them with oxy-chloride of zinc and finishing
with gold, being in  all respects  as good  as  when
made entirely of gold.  Numerous cases  are reported
of oxy-chloride of zinc fillings  being perfect  at  the
end  of  from  five to ten years.  Doubtless there is
difference in the quality of different lots of the mate-
rial, but I think the main cause  of its early failure
in the hands of many dentists, is  in not keeping it
perfectly dry for several days by covering the  filling
with some impervious coating.  I consider it a valu-
able acquisition to  the dental profession, and  more
advisable than any other filling in front teeth much
disfigured by decay,  and where  doubts exist  as to
the permanency of gold.

                    amalgam.

  As connected with  dentistry, this  name is applied
to a paste made of silver and tin filings and mercury.
It has for years been the  subject of more discussion
than any other  material used by the profession.   To
represent fairly the opinions of its enemies and advo-
cates would consume a volume.  Saying nothing of 
AMALGAM.
105
its injurious local and systemic effects, it is certainly
the greatest  curse  that ever has beeu  visited  upon
the dental profession.   Being easily mixed, readily
plastered in some fashion into a cavity and setting in
spite of moisture, it has long been used wherever  the
laziness or incompetency of the dentist, the poverty
or illiberality of  the patient, the pressure of time
or the difficulty or  impossibility  of using gold  has
caused a decision against the latter  metal.  It pos-
sesses one superiority over gold or anything else, and
that is  hardness, being harder often than the con-
sciences of those who unreservedly use  it.  Many of
the effects of mercury manifested  so  distinctly in  the
coppery taste, swelling, tenderness, and  ulceration of
the gums and tongue, profuse flow of saliva, loosen-
ing of the teeth, gangrene, sloughing  of the soft parts,
death of the bone, etc.;  or  seen  in  mercurial palsy,
characterized by convulsive agitation, difficult speech,
mastication,  locomotion and  vision,  debility, black-
eniug aud decay of the teeth, etc. (which effects  so
frequently have arisen from the administration of the
medicinal preparations of mercury and from exposure
to its fumes), have so often  been traced to the  pres-
ence of large quantities of amalgam in  the  mouth,
that it  is  folly to  deny its power  for  evil.   It is
a worthless  argument that the quantity of mercury
absorbed  from  fillings  is  too  small and extended
through  too  long  a time  to produce  its  peculiar
effects;  for searchers after  the truth are well aware
that this gradual  accumulation of  mercury in  the 
106
AMAL GAM.
system is what  produces the serious effects so often
noticed  in  the  cases of button  and other  gilders,
looking-glass makers and other workmen.
  There is frequently a much greater amount of mer-
cury put into the mouth in the shape of fillings, than
often is required  to  produce injurious  effects when
administered iu medicines or used  in ointments  for
skin diseases.   Some persons are peculiarly suscepti-
ble to the effects of mercury, not being  able  to bear
small doses of it, while others can  take much larger
quantities with impunity.   It is  generally conceded
that more cases  of root troubles, as abscess, periodon-
titis, etc., occur in teeth filled with amalgam than in
those filled with  any  other material;  but the fact
that a much larger proportion of badly decayed teeth
are filled with amalgam than with other substances,
interferes with the value of this testimony.   Galvanic
action from the presence of different metals in  the
mouth,  has been alluded to in another article.  With
amalgam fillings and  the  fluids of the  mouth, we
have the requisites of a miniature battery.
   The power of voltaic electricity to decompose com-
pound substances is  exemplified in  the experiment of
the decomposition of water: the current being sent
through this liquid,  hydrogen is given off at  oue pole
aud oxygen at the other.
   Of course the power of the mouth battery is very
feeble in comparison with that used for chemical ex-
periments, but  when  the  associated conditions are
favorable, it is no less certain.  It is not  difficult to 
AMAL GAM.
107
  imagine how acids may be formed from the union of
  elements set  free by this process of decomposition.
  Hydrogen and oxygen being liberated from combina-
  tion in the water of the fluids, the hydrogen combin-
  ing with the chlorine from chloride of sodium in the
  saliva, forms hydrochloric acid.  Nitrogen, from de-
  composing food  uniting  with  the oxygen from the
  water, forms  nitric  acid.   Besides the  formation of
  acids destructive to tooth substance, other effects may
  occur.   The chlorine of the chloride of sodium of the
,  saliva and of the chloride of potassium of the mucus,
  uniting  with  the tin and mercury of the amalgam,
.  forms chlorides of these metals, which, being soluble,
  are washed out, thus accounting for the porosity often
  observed in old amalgam fillings.  This porous con-
  dition, and the shrinkage from the walls of the cavity
  that  occurs during the  hardening of the amalgam,
  open the way for further decay.
    One of the great objections to amalgam is its un-
  seemly  appearauce when it becomes very  much dis-
  colored, as happens in the majority of mouths.  This
  discoloration is attributable not only to the action of
  agents formed within  the mouth, but also to certain
  kinds of food.  Mustard, eggs  and some kinds of
  game discolor the amalgam just as they discolor  silver
  spoons and forks, owing  to the action of the sulphur
  contained in them.  I have thus endeavored to  point
  out the  worst effects that may happen from the use of
  amalgam, especially from a common article; the best.
  qualities are made from chemically pure materials aud 
108               AMALGAM.
contain less mercury than the others.   But the most
violent opposers of  amalgam have no  doubt allowed
their zeal to carry them to too great an extreme.  To
say that the use of amalgam,  even in  considerable
quantities, is always productive of  great injury and
fails to preserve the teeth, is  asserting too  much.
While writing upon the present subject, I  have had
occasion to examine the mouth  of a  gentleman whose
teeth are in a most excellent state of preservation, and
yet he has  more than a  dozen good  sized amalgam
fillings that were inserted as many years ago by some
dentist in whom he had great confidence, and who
imposed upon his credulity by telling him that amal-
gam was much better than gold.   Considering that
the amalgams of that time were so  much inferior to
the best of the present day; that they are now hardly
discolored at all; that he has had gold fillings put in
his mouth since, which ought to increase the galvanic
action ;  and that his health has always been remark-
ably good,  and his  teeth  have  never  given him any
trouble;  it is  certainly  a well marked instance to
prove that  amalgam fillings sometimes do  good ser-
vice.  It is  no uncommon thing to meet persons with
a less number of such fillings, which  have  preserved
their  teeth  for  nearly double  the  time.   Upon the
whole, however, it is my firm conviction, considering
the idiosyncrasies  of  different individuals and the
effects that often do follow the use of amalgam, that
it should never be used except in moderate quantities,
as  a  last resort, or as temporary fillings; and  then 
             SENSITIVE DENTINE.         109

preferably for  persons that will  take  good care  to
keep their teeth clean and their mouths in good con-
dition, occasionally visiting their  dentists that they
may examine the condition of the fillings and remove
them if  need  be.   The amalgam  piste  should  be
thoroughly washed by working it  in a mortar with
soda, chloride of zinc or alcohol until all  impurities
are removed;  the surplus  mercury should  be well
squeezed out and then the same care should be taken
in shaping the cavity, putting in the filling and finish-
in"- when hard, as with gold.  A few words in refer-
ence to the removal  of old  amalgam fillings.   Their
hardness is proverbial, and  it is distressing to hear of
the tedious operations that have often been submitted
to in having them drilled and cut, if not blasted from
the cavities,  by dentists that did  not  know that  by
scratching the  filling so as to obtain a clean surface,
and then adding  some new soft amalgam paste, the
old plug will soou be so much softeued that it can be
readily cut out.

                SENSITIVE  DENTINE.

   TlIE varying decrees  of sensitiveness exhibited
during- operations upon the teeth of different indi-
viduals, have  long been a  matter  of surprise.  One
patient will take his seat in the  dental chair and have
his teeth  probed, drilled, burred, and  hammered  for
hours, retaining his composure with  stoical indiffer-
ence, and, possibly,  going to sleep;  while another 
110
SENSITIVE DENTINE.
whose  teeth  are  not nearly so badly decayed, will
wince at the slightest touch, and writhe with agony
at the  necessary  application of power, pronouncing
the pain unbearable and refusing to submit to further
manipulations.   It is not worth while to enter into
any speculations as to the causes of the peculiar sus-
ceptibility to impressions  existing iu  certain people;
it is no more to be wondered at that the  teeth should
possess such peculiarities, than it is that many other
parts of the body may,  in one  person, endure almost
pleasurably, sensations which would be very disagree-
able or insupportable to another.   The nerves which
supply the teeth (fifth pair) are the most sensitive of
any in the human body, and it has been previously
shown that  the terminal fibrils of these nerves are
the ones that  ramify through the substance of the
dentine.
  When such excessive sensibility occurs, no matter
how provoking it is to the dentist to have the patient
twist  and start at every touch, it is  useless to get
angry, or to attribute it  to affectation,  lack of self-
discipline or childishness;  the  loss of patience often
results in the loss of patients.\  Whether the person
can not or will not stand it, it is the duty of the den-
tist to endeavor  to relieve the hyper-sensitiveness,
and remove that  dread  of dental operations that ex-
ists in the minds of some people to such an extent,
that they can not be  induced  to  go near a dentist
except for that last resort—extraction, and even that
must be done under the influence of an anaesthetic. 
SENSITIVE DENTINE.          Ill
  If the patient can possibly summon the resolution
to allow the decayed matter to be cut away by a few
vigorous strokes, I believe it  to  be, generally, the
best way; but if  not, medication should be resorted
to.  Apropos  of  this subject, I would  mention how
dangerous is that habit, often indulged in by patients,
of suddenly and forcibly dashing their  hands against
that of the operator, as  an indication of unwillingness
to submit to further operations.  There is danger  of
making an unsightly wound, or of putting out an eye.
If they can not or will  not  submit to  the  pain, the
manly or the womanly way to do,  would be to slowly
and firmly take the hand of the dentist, interrupt his
work  aud decidedly refuse  to allow him  to proceed.
Different substances have been used as local applica-
tions  to sensitive  dentine.  Sometimes  it happens
that one fails  to answer the purpose in  some cases,
when it does admirably in others.
  The patient should not give up at the first  trial,
but experiment with all of the  recommended applica-
tions; for  it rarely happens that some one of  them
does not succeed.   The most of these act  by destroy-
ing the vitality of the  outer portions of the  animal
matter of the  dentine,  and forming  a  more or less
insoluble compound with it, which remains as a pelli-
cle  protecting the parts below.   Creasote and carbolic
acid (nearly the  same  preparations)  are  much  used
and are excellent.  The odor and  taste are objection-
able, but the idea th.it  they cause decay of the  teeth
is erroneous.  They only affect  the animal matter, and 
112          SENSITIVE DENTINE.
in reality preserve  it, as the creasote of smoke pre-
serves meat.  Chloride of zinc  is another.  It is in
general use, and  very  reliable.  The dangers of in-
flammation and destruction of the vitality of the pulp
have been spoken of before.   Nitrate of silver is often
applied.   Sometimes the  discoloration of the cavity,
which it  blackens  upon  the same principle  that it
does the skin, is an objection.   Tannic acid  is often
a good remedy, as is terchloride of gold.  Arsenic is
the surest agent, but many refrain from using it on
account of the danger of its  causing the death of the
pulp, even when left in but a little time ;  not at once,
but subsequently from  the  absorption of what fiuds
its way into the tubules.  If applied in  very minute
quantities, well secured in the cavity, and left in but
an hour or two, when the  nerve  is not too nearly ex-
posed, being  afterward well  syringed  out  and an
antidote applied, I believe that  injuries  of any kind
would happen so  seldom that they need not be taken
into consideration.   But on  account  of  the  careless
manner in which  it is often applied, and the neglect
of patients  to have it  removed at the proper time,
other means should  be  tried first.  Cobalt, which
owes its action  to the arsenic contained in it,  is con-
sidered safer.  Hydrate of chloral, perfectly harm-
less  and unirritating,  has been tried  with  consid-
erable success.   Instruments heated from warm to
red-hot have  been  found very  efficacious, but this
method has  never  been regarded very favorably by
the patient. 
         CA PPING EXPOSED NER VES.      113

  Sub-cutaneous  injections  and internal administra-
tion  of small quantities of morphia, have been found
to produce the  best results,  on account of their con-
trolling  influence over  the nervous  system.   The
remedies mentioned in this chapter should be applied
only by the dentist, as  great  care is  required in the
use of most of them.   The  condition  of the saliva
should be looked into, as this often  has much  to do
with the abnormal sensitiveness of exposed dentine.

            CAPPING  EXPOSED NERVES.

  What is called  the nerve of a tooth, in common
parlance, is in reality  the  pulp,  consisting, as  has
been  previously  seen,  of  several  minute arterial,
venous and  nerve branches; but for  the sake of be-
ing better understood, I will adopt the  erroneous
term  for  a caption,  rather than insist on correct
nomenclature.  Destroying  the nerve,  bleeding the
nerve, etc., are errors of the  same kind.  Not  many
years ago the majority of the members of the profes-
sion believed and taught that when decay had  once
encroached upon  the pulp, it was  impossible to pre-
serve it  alive, and  that, before filling the tooth, the
exposed  pulp had to be devitalized.   I am sorry to
admit that many believe, or at least teach the same
thing nowadays;  whether they lack the patience, the
knowledge, or the skill requisite for saving the  pulps
alive  I will not decide.  To secure success, a knowl-
edge of the anatomical structure of  the teeth, their
         10 
114      CAPPING EXPOSED NERVES.
physiology, and the treatment applicable to their dis-
eased  conditions,  is  certainly required;  and  often,
moreover, great patience and skillful, precise,  and
delicate manipulations are demanded.
  It is certainly no exaggeration  to  assert that the
majority of teeth  that have had their pulp cavities
recently  exposed by decay,  or have been opened  into
while doing the necessary amount of excavating pre-
paratory to  filling, and have not settled  down  into
cases of chronic toothache, may be  preserved with
undiminished vitality.   Further than this, a fair pro-
portion of the most unfavorable cases can be restored
by proper medication to a condition healthy enough
to justify permanent filling.  It will probably be
unnecessary to  urge  the importance  of  saving the
pulp.
  The tooth is nourished in two ways ; partly by the
sustenance it receives from  the membrane covering
the  root, but  mostly from that derived  from  the
vessels  circulating in  the  interior.   If  the supply
from the latter is cut  off,  the  outer membrane  is
stimulated to  increased  action, and will often main-
tain the  vitality of the tooth  for some time, but fre-
quently it fails; the tooth is then necrosed, or dead,
and  becomes a  source of irritation.   A living tooth
is just as much better than a dying one, as a livin"-
tree is  better  than a  dying tree; the latter, after
girdling, fails  to  bear foliage  or  fruit, although  it
may continue to rear aloft  its lifeless and decaying
branches for some time. 
CA PPING EXPO SED NER VES.      115
   The  principle invoVed in preserving the life of
the pulp, is the protection of its sensitive  structure,
by placing over it some non-conducting, unirritating
substance  to  prevent  the access of air, food, heat,
cold, or any of the exciting  influences to which it is
exposed,—and then filling the cavity in a substantial
manner.  The pulp  then often co-operates  in this
design of protection, by going to work in the  privacy
of its little chamber, now protected from the intru-
sion of impertinent visitors, and repairing the breach
in the dentine by the deposition  of new bony matter,
just as  it deposited it during the  periud of the forma-
tion of the teeth.
   The  pulp  being free from pain and  hemorrhage,
and  the surrounding associated  parts in  a  healthy
condition,  there  are various methods  of  operation
that promise  success.  After touching  the exposed
point with a  little  creasote, a lead, gutta  percha, or
gold cap, having a concavity that prevents  its touch-
ing,  may be placed over it.   Then the cavity  may be
filled with either a  permanent or temporary filling;
the latter is  generally  preferred, as it  is less irrita-
ting by not requiring  as  much   time or labor, and
if there is no trouble  after a reasonable  length of
time, it may be removed to give place to the  per-
manent filling.  A properly shaped piece  of  quill,
or a drop of collodion  from  which the  ether evapo-
rates  instantly, leaving a pellicle, are excellent non-
conducting substances to interpose.
   A small  piece of letter  paper  saturated with crea- 
116      CA PPING EXPO SED NER VES.
sote,  over  which is placed a  little asbestos, is an-
other.
   In  case of threatened inflammation after the opera-
tion,  often  a little judicious treatment will counteract
such  tendency.  Lancing the gum around the tooth
to relieve the fullness of the vessels; lying with the
head  a little higher than usual at night, and taking a
warm foot-bath, to promote the flow of  blood  from
the head; holding a piece  of pencil rubber, or some
other substance between the jaws at a distance  from
the seat of trouble, so as  to  prevent the irritation
of antagonizing teeth;  are remedial measures  that
should not be  neglected.  Besides  these, it is often
very beneficial  to have  an application made by the
dentist  of  the  tincture of  iodine  and  aconite.  A
saline cathartic,  as  epsom salts, is often invalu-
able.
   An  appreciation of  the  value  of a living  tooth
should prompt a person to endeavor by every effort
to retain it in that condition; but if after reasonable
trial  the hope  has to  be abandoned, then the  pulp
may be devitalized and  removed, and the tooth filled
with  a fair  prospect of preservation for  a sufficient
length of time  to fully justify the operation.
   Another method sometimes adopted  to preserve
the pulp from inflammation  and  suppuration  after
filling, is to drill a small hole  at  the margin of the
gum  into the root as  far  as  the  canal, care  being
taken not to wound the lining membrane of the pulp;
but the  success  attending  the operation is  not suf- 
ROOT FILLING.
117
ficient to recommend it  as  a remedial measure  of
much value.


                  ROOT filling.

  It sometimes happens that the pulp is so exquisitely
sensitive that it will  not tolerate the presence of the
most  unirritating caps or non-conductors; at other
times when presented to the  dentist, it is already
dead,  having lost its vitality spontaneously, from the
irritation of a previous filling, from frequent medica-
tion to  cure toothache,  or  from some other cause.
In  such  cases shall the tooth be extracted or shall  an
attempt be made to save it?   A few years ago extrac-
tion would have been advised  in nearly  every instance.
Some can be  found who advise the  same thing  in
these days.  But the experience of the  best operators,
throughout  the world now, teaches that the percent-
age of success attending rightly performed root-filling
operations  is so great,  that  it is good  practice  to
attempt  to save almost every tooth with a dead  pulp
that presents itself.   If alveolar abscess has resulted
and continued for a long time, the case is much more
complicated, but  even then it is  often astonishing
what nature will do  when  assisted by proper  local
and general treatment.
  It is  very much a  matter of the appreciation  of
the  natural  teeth  by the patient,  aud  the manner
in which the work is  done by the dentist.   The vast
majority of  failures is doubtless attributable to the 
118
ROOT FILLING.
imperfect  manner in which  the operation is per-
formed, the patient frequently  not  being  willing
to cousume the time or put himself  to  the  incon-
veuieDce of making a number of visits to  the dentist
for the  necessary dental  treatment; or if willing  to
do these he is often not willing to give the dentist
sufficieut compensation.   The following is a descrip-
tion of the manner in which  the work is ordinarily
done.  The patient  through neglect  suffers  a tooth
to decay until  the pulp is exposed and  the  tooth
aches;  he  then  goes  to his  dcutist to  have  the
tooth extracted, but is informed by him that there is
a probability of saving it.  This the patieut is desi-
rous of doing, if it does  not take much time from his
business and does not cost much.   So an arsenical
preparation is applied and he comes back in a day  or
two to have it  removed  and the tooth filled.  The
pain is entirely gone and everything looks favorably;
perhaps the nerve and vessels  are partially removed
from the canal, perhaps  not; the cavity is then filled
either perfectly or imperfectly,  and the patient goes
on his way pleased with the result.   In the majority
of such cases,  at  some  subsequent  period, varying
from a few days to several months, root trouble man-
ifests itself, either from not having the tooth  and
membranes restored to a healthy condition, or from
allowing more or less of the dead pulp to remain  in
the canal to putrefy aud irritate the investing mem-
brane of the root.   Even at this period a removal
of the filling and proper treatment  would probably 
ROOT FILLING.
119
 succeed, but the patient is not willing to risk it again
 and the tooth is sacrificed to the forceps.  Now let
 us  take a case in which both operator and patient do
 their whole duty to secure the best prospects of suc-
 cess; the one possessing  the requisite skill, patience
 and appliances', the other willing to take the necessary
 time, and able and willing to make  a reasonable re-
 muneration.   Let  the suppositional  case  be that of
 an  upper molar  which has decayed in such a manner
 as to expose the orifice of only one of the  root canals.
 The  paste of arseuious acid and  morphia, which is
 the agent  generally  used, placed in the cavity will
 destroy the vitality of the pulp in all of  the canals;
 but when the time comes for removing the paste and
 the dead pulp, the three  canals can  not  be reached
 from the original  cavity; it must  be much enlarged,
 or  a  new cavity drilled into the  grinding surface.
 The canals, always small, are  sometimes  so minute
 that the finest instrument can not be made to enter
 them; but they must be enlarged and the contents
 entirely removed to the end of the roots.   Medicines
 must then be applied until any irritation caused by
 the tedious labor is  allayed.  Frequently, applica-
 tions are required to correct the putrefaction of small
 portions of decomposing matter that are unavoidably
 left in the curves of the most tortuous canals.
  After everything is brought to a healthy condition,
the three  roots, one  by  one,  must  be  thoroughly
filled with gold, or some other material, and after-
ward  the  cavity in the crown.   It is  not always 
120
ROOT FILLING.
advisable to do the filling at one long sitting, but to
divide it into  several sittings.  It is  often a better
plan  to  put  temporary fillings in both roots  and
crown for several months, and  then  if  no trouble
arises, to remove  them for permanent fillings. Many
dentists prefer to make  the permanent fillings in the
roots of cotton and creasote, claiming  that they pre-
serve the tooth just  as  well, while they possess  the
great advantage of being readily  removed in case of
after trouble, thus giving another trial for the pres-
ervation of the tooth.   The great difficulty and some-
times the  impossibility  of removing well  condensed
gold fillings from such  narrow canals,  can be readily
imagined.   The above  remarks  apply of course as
well to teeth, the pulps of which are dead  at  the
time they are presented before the dentist, only they
generally  require  a longer  course of  preparatory
treatment; especially if alveolar abscess exists.   See-
ing then  the much greater amount of  skill, time and
labor required in such a complicated case, compared
with the  filling  of an  ordinary cavity, and that  the
dentist ought  to be better paid for an  operation per-
fect in all its details than one that is not,—the ques-
tion arises  whether or not the dentist is justifiable in
putting in  the filling in the crown, and slighting the
root, in those  cases where the patient is unable or
unwilling to pay for the best services.   Dental  sta-
tistics seem to show  that  he is, for  some teeth so
filled never give any trouble,  and when the others do
there is yet a chance for filling them properly; or if 
ROOT FILLING.
121
it is decided upon to extract them, it is no more than
would have been done in the first place; besides,  the
fillings  strengthen the teeth  and render them les3
liable to fracture under the pressure  of the  forceps.
Before leaving this subject, I  would say a few words
as to the propriety of filling roots, the crowns of
which have been-broken off or have decayed  entirely
away.   If left in  their ragged or decayed condition,
they are a constant source  of evil to the fluids of  the
mouth,  to the soft parts and  to the adjoining  teeth.
If the roots are in front and are solid  enough, they
should be made the supports of pivot teeth.   If  the
other teeth are crowded and irregular, or if artificial
teeth are advisable, they should be extracted.  Other-
wise,  much good  often results  from  smoothing  and
polishing them and filling the  canals;  they can be
thus  kept  perfectly clean  and maintain the  position
of the other  teeth. 
MALLET FILLING.
 A MONG the many recent improvements in den-
    tistry, which render the competent operator able
and even anxious to undertake complicated cases of.
gold fillings, which a few years ago the best dentists
would have given up as impossible, the mallet occu-
pies  a prominent  place.  There are two  kinds  of
mallets, the  hand  and the automatic.  The first  is
shaped  somewhat  like an  ordinary hammer,  and  is
used by an assistant to strike  against an instrument
held by the operator,  the  force of the blow bein<*
transmitted to the filling, and condensing it  better
and more expeditiously than  hand pressure.   They
are constructed of either wood, lead, ivory, or  other
material, but which is best has not yet been decided
to the satisfaction of all parties, although  the mem-
bers of different dental conventions have  spent sev-
eral years iu trying to mallet into each other's heads
the superiority of  certain kinds  of mallets.  The
automatic mallet consists of  an instrument with a
hollow handle,  in which  is  placed machinery for
striking against a movable point inserted in the end of
the instrument.  Certain screws  and slides graduate 
MALLET FILLING.
123
 the force of  the  blow.    This instrument  is  used
 by one hand of the operator, and requires no assist-
 ant.   It possesses some  advantages over the hand-
 mallet;  it can be used in some positions where the
 other  can not; there is  no liability to accident from
 a mis-stroke; and it is more comfortable to the pa-
 tient, as-there is  perfect  regularity in the  strokes
 and there is  no worry of mind as to whether  the next
 blow is  going to  be harder or lighter.  But iu the
 majority of cases  it  does  not  do its work as well as
 the hand-mallet, on account of the quivering nature
 of  the blow;  it  is very useful, however, in certain
 places.  The  hand-mallet gives that  sure and  solid
 blow, when properly used, that is calculated to per-
 fectly  condense  a  filling;  but  it must be wielded by
 an experienced hand; an accidental sidelong blow on
 the end  of the plugger  may throw the  point to one
 side or the other,  aud break  off or crack a portion of
 the tooth, as may  a blow before the  operator is quite
 ready.  The employment of mere children to use the
 mallet has always  appeared to me reprehensible.  No
 dentist can perfectly signify to  another person before
 each blow just what kind he  wishes, whether hard or
 light, quick or slow, lingering or rebounding; there-
 fore, the mallctcr  should see  the cavity and have had
 some  experience  iu filling teeth.   The mallet, al-
though such a valuable adjunct, is nevertheless liable
to abuses.   It may be used so indiscreetly as to frac-
ture the walls of the cavity; it may occasionally by
 its jarring irritate  the membranes connected with the 
124
MALLET FILLING.
tooth; but the principal injury arising from its use
is that which  often  occurs  in  the  last part of con-
densing,  where  care  is not taken to avoid  minute
fractures  of the  enamel at the  edge of the filling.
As  before mentioned, in speaking of the causes of
decay, the fractures may be too small to be observa-
ble to the eye, but exist to a sufficient extent to admit
destructive agents, which in  the course of time under-
mine the fillings.
  It is true  that this same injury  may arise from
violent and misdirected hand pressure, but it is not
nearly so liable to occur.
 
THE FILE.
  "DROBABLY  there  is no  operation  in  dentistry
    that encounters  so much opposition as the use of
 the file.
   Patients generally consent to its use very reluct-
 antly, while  many  have their aversion  so strongly
 set, that no reasoning will cause them to yield.
   There is no doubt that a great amount of mischief
 may result if the operation is performed  in  a bun-
 gling and imperfect manner, but that is true of filling,
 extracting, or any other  operation in dentistry.   On
 the  other hand, however, there is no better preventive
 or curative means within reach  of the dentist, than
 the  file used  in  the proper  cases, and in the  proper
 manner.  The prevailing opinion is that when a por-
 tion of the enamel is  removed,  decay is certain  to
 occur;  this is controverted by too many facts.  Many
 barbarous  nations  file their  front  teeth  to  sharp
 points for the purpose of better tearing their food to
 pieces,  and also, as  they think, of adding  to their
 beauty;  yet these very  people  are remarkable  for
the souuduess of their  teeth.  The enamel  is thick
enough  to bear considerable cutting without exposing 
126
THE FILE.
the underlying dentine, but even if the latter should
be uncovered there  is not nearly so much danger of
decay as is generally believed, if the surface  is kept
clean.   Every dentist of much experience has seen
numerous  instances in which  all  of the teeth sepa-
rated by the file have remained  entirely unaffected
by caries, while all of the corresponding teeth in the
same mouth that were not so separated, have decayed
in a few years, although they were perfectly sound
at the time of the filing of the others.  The sides of
the teeth would probably not decay once, where now
they decay a thousand  times, if they were  separated
early by the file, and the surfaces frequently cleansed.
When  the  teeth  are  crowded  too  closely together,
they not only wear  one another in  the slight move-
ment that  all teeth have in  mastication,  but  they
prevent the passage of anything  between  them for
the purpose of removing the destructive agents which
work unmolested on  the affected  enamel.   A very
small space is all that is required—just sufficient to
pass a thread through with comfort.  The practice
of filing the teeth heroically away, seemingly to  show
defiance to  the unfounded  prejudices of the opponents
of filing, is censurable, both  because it is unneces-
sary, and because of the disfigurement.  The separa-
tion should not be  made clear through to the  gum,
the  teeth   being  allowed  to touch  there;  otherwise
they would come  together again.   The work should
be  done with fine  files,  and  the  enamel  afterward
made as smooth as possible with powders, burnisher, 
SEPA RA TING.
127
etc.   Rubber,  wooden  wedges, etc., are  frequently
used to separate the teeth for  the purpose of filling
them, but the file should be used also to prevent, sub-
sequent touching.   Superficial  decay can often be re-
moved by the file, and it should always be  done where
disfigurement of the tooth will not follow.  The burr-
drill is but a modification of the file, being an instru-
ment with a small ball-end, which  is file-cut;  it is
useful in removing incipient decay, where the result-
ing concavity would not be so  deep as to be difficult
to clean.  Natural teeth that are too long for correct
articulation with  artificial  ones, and elongated teeth
that have  no antagonists, have] to  be shortened by
files; roots are also dressed down  by them for the
insertion  of  pivot teeth.   Excessive local and  gen-
eral sensitiveness  can  generally be  controlled by
medicines.

                   SEPARATING.

   When  decay occurs in the approximal surfaces of
teeth which are  crowded  very close  together,  it is
necessary to separate them before the cavities can be
cleaned out and filled  properly.  There are  different
methods of procuring this necessary separation.
   Some prefer  to quickly  force the  teeth  apart  with
wooden wedges;  oihers, to do  it slowly by inserting
from day  to  day, wedges, or pieces of rubber or cot-
ton  of gradually  increasing sizes.  Mauy  consider
the use of the  file the best method. 
128
SEPA RA TING.
  Each has among its advocates  some of the best
operators of the day.   Patients also have their pref-
erences and prejudices.   It is not my intention to
contest these different views, but I can not refrain from
giving my opinion as to the best means of separating
the teeth, based upon my own experience in practice,
and upon examination  into the results of the methods
adopted by others.
  Each has its objectionable features,  but I  believe
that the judicious use of the file,  generally gives
better satisfaction to both  dentist  and patient, than
either  slow or quick wedging.  There is no doubt
that wedging very often produces inflammation of the
peridental membrane,  sometimes  inflammation and
death of the pulp, and occasionally permanent dis-
placement of the teeth.  These  results never follow
the right employment  of the file.  Teeth  that have
decayed on account of  their crowded condition, com-
ing back to their original  position after the  removal
of the wedge, are just as liable again  to decay around
the fillings;  unless the latter are left convex  to pre-
vent the teeth from comiug  together, which often
occasions the  disagreeable  sensation of  something
crowded between the teeth and  constant picking to
remove it.  If the file is not  used as it  should be,
far  greater  injury arises than  from the employment
of wedges, and it is doubtless  from such faulty oper-
ations  that most of the prejudice against this useful
instrument has arisen. 
SEPARATING.
129
   The accompanying figure represents how the teeth
 should  be separated by the file and how they should
 not be.   If the cut is made clear through  below  the
 margin of  the gum as at No. 1, the teeth  will come
 together, and further decay will almost iufallibly re-
 sult.  The  separation should be made as  at .No. 2,
 where a slight shoulder prevents the teeth  from com-
 ing  in  complete contact,  although the points will
 probably touch.  No. 3 represents a still better form
 where the decay has not extended too near  the points
 of the teeth.  Often slight wedging in conjunction is
 advisable.  It is surprising to  see the inconsistency
 somet'mes  exhibited  by the champions  of wedgin^
 when they denounce  the use of the file in  all cases,
 and yet separate the  teeth by wedges, and  then  file
 the filling  down  even with the enamel, roughening
 the tooth just as much as if they had  filed  it in the
 first  place,  and yet not  securing sufficient space  to
 prevent  further decay.    When approximal cavities
 exist  in  the  front  teeth with no anterior  disfigure-
 ment, many operators prefer to cut away a large V
 shaped space at  the back of the teeth  and  fill them
at that point.  This is doubtless the best method,  as
it causes no division in front and forms a space behind 
130         COFFER DAM RUBBER.

that is almost self-cleansing.  The following figure
represents the rear view.
COFFER DAM RUBBER
  Various instruments and appliances for facilitating
operations, and adding to the comfort of patients, have
been invented for the use of dentists.  It seems use-
less to mention  them, as every operator should  be
supposed to have all improvements that are calculated
to make his work better in quality and easier to him-
self  and patients.  But there is  one improvement,
comparatively recent, that deserves particular atten-
tion, both because it is not universally used by dentists,
and  because  in many cases it  is so  very essential to
the comfort of the patient.  This is the  rubber-dam,
introduced by Dr. S. C.  Barnum.   The  difficulty of
controlling the flow of saliva used to canstitute one
of the greatest  objections against  tedious  and com-
plicated fillings.   Stuffing the mouth with napkins,
and holding down the tongue and closing the salivary
ducts with compressors, have always been  regarded
as very disagreeable.   Even these failed to check the
oozing of moisture from  the gums about  the necks of 
BLEACHING THE TEETH.
131
 the teeth, and many fillings have been ruined by be-
 coming thus wet before completion.  In the majority
 of cases, by the use of the rubber-dam, inconvenience
 and unsuccessful operations may be avoided.
  It  is but right  that the patient should know of
 and demand the employment  of any appliance that
 does so much toward the removal of the dread  of
 dental operations.  The first of the accompanying fig-
 ures shows a sheet of the rubber with holes punched
 in it for allowing the teeth to  slip through, and  the
second gives a representation of the teeth with rubber-
dam applied.
  It will be seen that the contraction of the rubber
around each tooth effectually precludes the access of
moisture into the cavities of decay, while at the same
time the patient is  not  bothered with  napkins and
has the liberty of moving the jaws and swallowing.

              BLEACHING THE TEETH.
  Teeth  which  have become discolored from  the
chemical  decomposition  of  amalgam  fillings, from 
132        BLEACHING THE TEETH.
the infiltration of dead pulp  substance, or from the
stains of certain topical applications, can  generally
be restored to  their original color by the use of
bleaching agents.
  These operate by uniting with some element of the
coloring compound, thus decomposing it.
  Solution of chloride of soda and diluted nitric acid
are the  agents generally employed.  Oxalic acid  is
peculiarly applicable where the discoloration is attrib-
utable to the salts of iron.   Cyanide of potassium has
also been used for bleaching.   All of these substances
require great  care in their use, and  as some of them
are very destructive to tooth substance if their effects
are not counteracted, and also injurious  to  surround-
ing parts, they should never be applied  except  by a
dentist.
 
SALIVARY CALCULUS, OR  TARTAR.
 /CALCULUS, derived from the word calx, a stone,
    is the  name applied to solid concretions appear-
 ing in any  part  of  the  body.   Tartar is the name
 given to hard deposits  in casks  containing fermented
 wines.   Thus  is  seen  the  origin of the terms used
 in  dentistry to designate  those  earthy  depositions
 around and on the teeth.   The source of tartar,  and
 the cause of its being  deposited, have been the sub-
 jects of much inquiry, aud have never yet been so
 satisfactorily  settled  as  to  hush  discussion.   The
 theory  supported by the large majority  is that it
 comes from the true salivary secretions, and in  proof
 of  this we have the  fact  that it is most abundantly
 deposited upon the outer surfaces of the upper molars
 aud upon the inner surfaces of the lower front teeth,
 close  to which the ducts of the parotid, and  of  the
 submaxillary  and  sublingual   glands, respectively,
 enter  the cavity of the mouth.  Some claim  that its
 deposition  is  due to the  fact that the saliva  being
alkaline, and containing the phosphate and carbonate
of lime, these are  precipitated when the saliva corned
in contact with the acid mucous secretion. 
134   SALIVARY CALCULUS, OR TARTAR.

  Others assert that in certain conditions of the sys-
tem  there  is a superabundance of earthy matters in
the saliva, which  mechanically settle upon any sur-
face  to which they can attach themselves.   Dr. Gar-
retsou believes that "when the salivary secretions are
sluggish, the inorganic material, not being held in
solution until fairly ejected iuto the mouth, becomes
deposited about  the roughened and inviting surfaces
of immediately neighboring teeth."  This theory
seems unreasonable  to  me, both because I have ob-
served that often, in  the worst cases, the salivary flow
is  considerably  augmented,  and  because  if  it were
remarkably sluggish, and  deposition resulted  there-
from, stoppage of the ducts would be very liable to
occur, which,  comparatively speaking,  seldom  hap-
pens.  Other authorities abandon altogether the idea
that salivary calculus proceeds  from the saliva, and
claim that it owes its origin to the secretion of the
mucous membrane, or from small  glands whose par-
ticular  office  it  is  to  secrete  the  substance.  Dr.
Schrott, a celebrated German  dentist and micros-
copist, ascribes the origin of tartar to the presence
of the infusoria; of the mouth; and after speaking
of the locations where the deposit is most abundant,
he says: "These  places  are also  the true  places of
meeting for  the  infusoria;;  here they  remain the
longest  time, obtain  their  highest age, die, and their
living remnants interlace  with epithelial cells, para-
sites, remains  of food, slime, and  secretion of saliva,
and  form,  in this manner, the tartar of the teeth." 
       SALIVARY CALCULUS, OR TARTAR.   135

But leaving these probable and improbable theories,
let us  come to the subject of tartar  as  it exists, its
effects and its treatment.   Iu the mouths of different
individuals, it differs much in regard  to  quantity,
effects, rapidity  of  accumulation and appearance.
On one extreme, the deposition may be so slight as to
be  scarcely noticeable; on the other, it maybe so
great as to completely hide several of the teeth, flying
off in  large masses  when  disturbed  by instruments.
It varies  in  color,  being black, several  shades of
brown and yellow, and whitish.  That which is black
in color is the hardest and most tenacious; the lighter
it is in color the softer it is.   The white tartar, aud
a certain  green stain found generally on the outer
face of the upper  front teeth, are the most injurious
to the teeth  themselves,  corroding  the enamel  and
causing speedy decay.  The  other  varieties  cause
little or no injury to the enamel, but are very injuri-
ous in many other respects.
  Salivary calculus, even when not directly affecting
the teeth,  is very injurious  to  the  gums,  sockets,
breath, secretions of the mouth, the  general health,
etc.   The first deposit  irritates the  gums;  they
inflame, suppurate and withdraw; here they would
stop and heal  if it were not for the continued addi-
tion of tartar which  causes the gums to recede more
and more.   This deposition also eucroaches upon the
vessels which  supply the membrane affording vitality
to the  alveolar processes and  the roots of the teeth;
the devitalized processes are gradually absorbed, and 
136   SALIVARY CALCULUS, OR TARTAR.

finally when  they and the gums are both gone, the
teeth are past saving, and are ready to drop out.  So
intolerably offensive  does  the  breath become from
some kinds of porous tartar which give lodgment to
decomposing inucus and food, that it is almost insuf-
ferable by any one but the happy owner.   The fluids
of the mouth becoming vitiated are taken into the
stomach, which rebels at such a condiment; the blood
becomes  full of impurities, the system suffers, and
often the best efforts of the physician fail while the
cause exists   Dr. Harris, in  his work  on  dental
surgery, further  enumerates the effects of salivary
calculus as follows : "Tumors and spongy excrescences
of the gums of various kinds;  necrosis and exfolia-
tion  of the alveolar processes,  and of portions of the
maxillary bones; hemorrhage  of the  gums; loss of
appetite, derangement of the whole  digestive appa-
ratus ; foul breath; catarrh, cough,  diarrhoea;  dis-
eases of various  kinds in the maxillary antra and
nose; pain in the ear; headache; melancholy, etc."
Add to these, closure of the salivary ducts, periodon-
titis, alveolar abscess, and various sympathetic pains;
think a little—and  then resolve to  keep the  teeth
clean.  There is one great means of present cure, and
that is  the operation of  scaling performed by the
dentist.  The common inquiry put to the dentist is:
"Does it not injure the teeth  to scrape them?"  Of
course it does—a little;  so  it does to  clean the rust
from a knife, but it  is certainly far  better to  do it
than to allow the rust to remain till  there is nothing 
      SALIVARY CALCULUS, OR TARTAR.   137

left to clean.  Much  depends also  upon the manner
in which the scraping is done; just as a man might
be shaved  by having hair, skin and  all scraped off,
while a  more gentle tonsor might be kind enough to
leave the skin.
  Some of the deposits  have so little attachment to
the enamel that a slight touch with the  scaler de-
taches the  mass in a single piece, leaving the enamel
smooth  underneath;  other  kinds   so  corrode  and
become  incorporated with the teeth, that they lose a
part of  their substance in cleaning.  Every particle
of tartar must  be removed, and if the enamel  is at
all scratched jt must  be polished with  powders aud
burnished.   If the gums have become inflamed and
cover the lower margins of the deposit, several  sit-
tings may be required before the gums have sufficient-
ly healed to allow all of it to be visible.   After  the
tartar is removed, and  between the sittings, a healing
wash should be used.  There  is one great  means to
prevent the rcaccumulation, and  that is to keep  the
teeth  clean.  There is no disguising the fact  that
excessive deposits  of tartar  proceed from negligence
in this  respect; it is  at first creamy in consistence,
but afterward hardens if not removed.   Explicit di-
rections  as  to  the  manner of cleaning the  teeth are
given elsewhere.   Slight accumulations may occur in
certain locations in spite of care; the deutist should
then be visited.
12 
ODONTALGIA, OR TOOTHACHE.
H^HE term toothache is generally  used to denote
   any kind of pain which arises from a morbid con-
dition of the teeth, or of the  membranes connected
with them.
   The causes of pain connected with the teeth are so
various, and the remedial measures' for  each so dif-
ferent, that scientific exactness calls for some system-
atic  classification;  consequently, professional men
have distinct names for the different diseased condi-
tions which produce tooth-pain.   The peculiarities of
nature are  nowhere  noticeable to a greater extent
than they are  in  the different  effects  produced  by
irritation of the parts associated with the teeth.   In
some cases, almost imperceptible causes produce un-
endurable agony, banishing sleep and appetite, occa-
sioning various constitutional disturbances, and often,
doubtless, so debilitating the system that the entrance
of disease is rendered easy.  In other instances, con-
ditions may exist which would be considered capable
of producing the most serious  effects, and yet only
slight discomfort,  or none at all arises.  The pain
may proceed from only one tooth, or from several at 
ODONTALGIA, OR TOOTHACHE.     139
 the same time ; or it may flit from one to the other.
 It may last for a long  time almost without intermis-
 sion, prompting the sufferer to resort to all kinds of
 positions and  all kinds of applications,  in  the vain
 effort to  obtain relief; or it may come  periodically
 and go away of itself,  or yield when  a certain  posi-
 tion of the  body is assumed or when a certain local
 application is made.   It seems  that  the vocabulary
 of adjectives  has  been exhausted  in searching for
 names to express the different  kinds of toothache ;
 digging, shooting,  boring, cutting, throbbing, jump-
 ing, thumping, tearing,  gnawing  and  pulling,  are
 some of them.  Odontalgia arises mainly from sensi-
 tive dentine, irritation of the pulp by external agents,
 pulp nodules, periodontitis, alveolar abscess,  decom-
 position  in the pulp  cavity, fungous pulp, fungous
 gum, exostosis, exposed cementum, necrosis, and sym-
 pathy.
   Sensitive dentine has already been treated of at
 some length in a previous article connected with the
 operation of filling  the teeth.  It is only necessary to
 add that  the dentine may become exposed in other
 ways than by  decay or  by the excavation  of a cavity
 for filling ; thus fractures may occur in which a piece
 of the enamel is chipped off, or it may be exposed by
 denudation and abrasion,  affections which will  be
 mentioned hereafter.   Too much filing may also ex-
pose the dentinf.  Though often  not sensitive when
laid bare,  yet at other times it is exceedingly  so, aud
the contact of hot  and cold  substances,  sweet and 
140      IRRITATION OF THE PULP.
sour things, the  atmosphere, etc., produce  consider-
able pain.

  IRRITATION OF THE PULP BY EXTERNAL AGENTS.

  In the anatomical description  that  hasV>een given
of  the pulp, it  has been seen  that  it is  composed
principally of delicate  arteries, veins and  nerves.
Various causes may occasion an increase of the blood
which is  distributed to it,  just as a greater flow may
be brought to the skin or other parts  by irritating
causes.   The walls of the pulp cavity  being solid and
unyielding, expansion is prevented and pressure is
made upon  the  nerves, which  produces pain.  The
amount of this pain depends upon the  size of the
opening  at the  apex  of  the  root and the  calibre
of  the vessels which enter,  the  extent  to  which
the circulation of the blood is  augmented, the nerv-
ous  susceptibility  of  the  patient, etc.    The  pulp
may be irritated  in many ways.   Particles of food,
hot  and  cold  fluids, draughts of air,  etc., may come
in contact with it in cavities of decay.   Even if pro-
tected from the direct contact of these by a consider-
able amount  of  decayed matter, the  decomposed
dentine may irritate by actual impingement and  by
conduction, or  it  may' allow  the ingress of  acids.
Metallic fillings may convey impressions of heat and
cold to it, or they may be  inserted with so much force
as to bulge in or break thin walls of  protective den-
tine.  The occasional  action of the chloride  of zinc 
         IRRITATION  OF THE PULP.      141

in os-artificiel fillings, has been  already alluded to.
The progress of the spontaneous or mechanical wear-
ing away of the teeth, beyond the point of exposure
of sensitive dentine, may produce inflammation of the
pulp.   Blows and falls, and fractures in attempts to
extract teeth, often expose the pulp.   Exposure to
cold and wet may, by contracting the superficial ves-
sels, produce an increased circulation in it.
   The same means that are used to  combat determi-
nation, congestion and inflammation in  other parts of
the body, are equally applicable to the treatment of
the dental  pulp in the same  conditions.   Anything
that diminishes the quantity of  blood in its vessels,
will often be immediately beneficial: thus the warm
foot-bath draws  blood to the opposite  part  of the
body;  counter-irritation by blisters, etc., answer the
same  purpose; or the blood  may be directly drawn
by frequent lancing of the gums, pricking the pulp,
application of  leeches, etc.   Cathartic medicines, by
producing liquid discharges from the bowels,  reduce
also the amount  of blood in the system.   Applica-
tions  of cold  by constringing  the vessels, force out
the surplus of blood when the diseased condition has
not progressed  so far as to iuterfere  with the free
movement  of the fluid.   The  position of the body
has much  to do with the circulation, as  has often
been experienced by those who have had to pace the
floor at night,  or sleep in the sitting posture, posi-
tions which favor  the  reduction of the circulation in
the vessels  of the head.   Concerning the local appli- 
142      IRRITATION  OF  THE PULP.
cations  to cavities of  decay encroaching  upon  the
pulp, the list  is almost endless.   From the  many
remedies may be selected spirits of  camphor, turpen-
tine, laudanum, ether, chloroform, tincture  of aconite
root, oil  of  cloves,  creasote, and  acetate  of morphia.
Dr. Harris gives in his work a good prescription:
'*R. Sulphuric ether,.....1 fluid  ounce.
     Powdered camphor,  ....     2 drachms.
     Powdered alum,  .    .    .   .    .2 drachms.
     Sulphate of morphia,   ...     2 grains.
  "The alum should be very finely powdered, and all
the ingredients well mixed before use.   After remov-
ing all foreign matter and carefully drying the cavity
of the tooth, a small  bit of cotton or  lint  dipped in
the above mixture may be applied, and renewed sev-
eral times a day if necessary."  The same directions
are appropriate for  the application of  the other rem-
edies.  Another useful prescription, that may be put
up for family use, is this :
R.  Oii of cloves,.....1  fluid drachm.
    Sweet spirits of nitre,  ...     1  fluid drachm.
    Acetate of morphia,  .    .    .     .10  grains.
  The mere removal of the irritating decayed matter,
and stopping the cavity with wax or cotton, will often
relieve  the  toothache; or where  the  irritation  is
caused by the acid  contents of the cavity, the appli-
cation of  a little bicarbonate of soda, or  some  other
alkali to neutralize  it,  is frequently all that is neces-
sary.   The application  of anything but  the simplest
remedies  should rarely be attempted by  the  patient,
for to secure  good results, the cavity ought  to  be 
IRRITATION OF THE PULP.      143
 well  dried, and the tongue  and cheeks kept out of
 the way ; the medicine should then be protected from
 the entrance of saliva by some  impervious substance.
 The  tincture of  aconite root is very  poisonous,  and
 a few drops  taken into the  stomach  may  produce
 alarming results.
   It  is  distressing to see the  injury that  patients
 sometimes do themselves by the careless use of crea-
 sote,  badly burning the lips,  cheeks and tongue.  If
 such  accident should occur, sweet oil should be imme-
 diately applied.  A drop  or  less is all that is needed
 for any tooth, and  it should  be well  secured in the
 cavity;  the  shape of this is often such  that it i3
 impossible for the patient . to  properly  apply  the
 medicine.
   The remedies  mentioned generally give only tem-
 porary  relief, and  it is  no uncommon thing  for a
 patient, before going to the dentist, to suffer off and
 on for  weeks, trying  meanwhile  every conceivable
 remedy, passing many sleepless nights, and at last
 desperately calling for extraction.   He is then often
 in such  a frame  of mind  that he will listen to no
 promises of saving the tooth ; his spite has accumu-
 lated  to such a degree that it can only be pacified by
having  the  blood of the  offending  member.  The
right  course  to pursue would be to go to the dentist
at first,  and  have  the pulp  capped  and  the tooth
filled.    The  simplicity  of the  treatment depends
 much upon the length of time that has elapsed since
 the commencement of trouble, whether  or not the 
 144      IRRITATION OF THE  PULP.

 peridentium is affected, and  upon the condition of
 the general system; but it is safe to say that a great
 number of pulps  can be saved alive even after expos-
 ure, while in  the great  majority of cases, extraction
 is certainly rendered unnecessary by the ability of
 the dentist  to devitalize  the pulps and fill the teeth.
 Devitalization of the  pulp, or destroying the  nerve,
 as it is commonly called, can be performed in  differ-
 ent ways.
   The actual  cautery, or the rapid insertion of the
 red-hot point of an instrument, has  generally been
 abandoned.   Excision  of the  pulp by insinuating a
 delicate smooth instrument with a sharp  and slightly
 bent point, between the  pulp and the wall of the
 canal up to the point where the vessels enter, and then
 making a revolving cut, is the  most speedy method.
 If the operation  is performed  dextrously, there is
 little  or  no pain given; but persons  so often object
 to it that  the  methods of destroying  the pulp gen-
 erally adopted, are those of applying either cobalt or
arsenious  acid.   Of these two methods  the latter is
 most in vogue.  For this purpose the  arsenious acid,
 or white  arsenic,  is generally mixed into a paste with
acetate  of  morphia and creasote     The  arsenious
acid in its  action  irritates and increases the circula-
tion  of the pulp to the point of strangulation and
stagnation.  Its dilution and  thorough effect  is ac-
complished by means of  the morphia,  while both the
 morphia and the  creasote obtund  the sensibility of
 the nervous matter which would otherwise be greatly 
IRBITATION OF THE  PULP      145
 exalted by the pressure of the  increased circulation.
 Quite a number  of deutists oppose the use of arse-
 nious acid on the  ground of the danger of its being
 absorbed and destroying  the investing membrane of
 the tooth  and  parts beyond, and use cobalt instead,
 claiming that it is not so dangerous an agent, although
 its efficacy depends upon the arsenic contained.
   For my part,  I do not admit  the liability of the
 occurrence of  such  accidents where  proper  care  is
 used iu its introduction and in  securing the paste in
 the cavity; although there is no doubt that such re-
 sults might  happen  from mismanagement.  Certain
 it is that  I never  have seen  a case of injury to sur-
 rounding parts occurring from its use when properly
 applied,  and many others of many years' experience
 testify to  the same  thing.   The cavity should  be
 thoroughly dry and a portion of the paste on cotton
 applied directly to the  point, and the whole covered
 with some substance to preclude the possibility  of
 its escape.  Amalgam, or oxy-chloride of zinc filling,
 I have found the best.   A  filling of cotton dipped
 in sandarac varnish is also much used.  The quan-
 tity of paste used need  not be larger in size  than
 half a mustard-seed, and it is safer to remove it in
 twenty-four hours, although some of the best dentists
 have experimented by leaving it in a cavity for weeks
 without any bad  result.   Frequently the arsenical
 paste can  be pricked gradually into the pulp, and
the contents of  the canal  removed without  pain,
while the patient remains  in the  dental chair.
         13 
146
PULP NODULES.
   Much judgment  is often required in deciding as
 to the propriety of making such an application to
 the temporary teeth.   As  has  been seen, at certain
 periods the roots are  more  or less absorbed to allow
 the advance  of  the permanent teeth.   The applica-
 tion at these periods would be very injudicious, as
 the absorption  of  the arsenious acid  through  the
 wide ends of the canals might produce all the  evil
 results that the  worst enemies of arsenic  claim.  To
 relieve the pain  of  exposed pulps in temporary teeth
 at these  times,  and to  avoid the evils  following too
 early extraction, every remedy should be resorted to.
 Dr. Garretson gives an excellent formula, which may
 be copied and sent  to an apothecary:
 "R   Creasotum,   ....     gtt. vi.
       Tinct. Iodinii,   .     .     .     .   f jj.
       Aqua Plumbi,                      f 3ss.
       Chloroform, .....
       Tinct.  Opii, aa.....f 3-"

                   PULP NODULES.

    From some   derangement of the function of the
 dental pulp,  either  during  the formation of the teeth,
 or  on  account  of subsequent irritation, irregular,
 detached masses of deutine are  occasionally formed
/ and occupy various positions in the pulp chamber.
    They are  generally nodular,  kidney  shaped, or
 spicular.  Frequently they are productive of no  irri-
 tation, while at  other times they give rise to the most
 violent  kind of toothache, which  is  mistaken  for 
                PERIODONTITIS.            117

neuralgia on account of the flitting  character of the
pain, and the different  parts affected.   It  is a very
hard matter to decide whether pulp nodules exist or
not, the teeth being of perfectly healthy appearance
as far as  the influence of their presence is concerned;
but it is  warrantable to drill  into the teeth for them,
in cases of aggravated  odontalgia,  which  the  most
complete  investigation  can not trace to any other
cause.   It has been said that teeth so affected have a
peculiarly  uneasy sensation  upon scratching then
with the finger nail, and give  no pain upon  pressure,
but do ljpon  striking them.   If the nodules prevent
the access of arsenical  paste to the pulp, when ap-
plied in the opening made  in the crown,  a small hole
can be drilled through  the root into the pulp canal.

                  PERIODONTITIS.

   Tins \:\ inflammation of the periodontcum or the
enveloping membrane of the root, and constitutes one
of the most excruciating forms of toothache, as can
be  imagined when we  consider  that the  inflamed
membrane is confined closely between the hard tooth
on one side and  the  unyielding alveolar process  on
the other.  The sympathetic pain  is far  greater than
that arising  from an exposed  pulp; other parts  of
the mouth, the face, eyes, ears, temples, etc.,  and even
the neck and arms being sometimes affected to such
an extent, that the real  source of the trouble is over-
looked.  Constitutional  disturbances, such  as head- 
148
PERIOD ONTITIS.
ache,  feverVmess,  and  constipation,  are  common.
The inflammation  sometimes  extends  to the tonsils
and the muscles of the  throat and neck.   Lock-jaw
has been known to result, and the death of consider-
able portions  of the jaws.  The disease begins  by
dull pain about the  root of the  tooth, with a desire
to work it with the finger or with the opposite teeth.
Afterward the  pain becomes acute and pulsating; the
tooth  becomes elongated  by the membrane  becoming
engorged, and  pushing it partly from its socket; the v
striking of the tooth, or the pressure of the opposite
teeth gives intense pain.   The gum becomes red and
more or less swollen.  The  most common  causes of
periodontitis  are those  which  follow.  Blows, etc.,
accumulation  of tartar,  irritation   of badly  fitted
clasps  or plates, loose roots, crowded  and  irregular
teeth, inflammation of the pulp,  dead and decompos-
ing pulp, arsenic escaping from a cavity, and inflam-
mation of neighboring parts may produce it.  It may
result  from dental manipulations; as from too hard
malleting,  the  pushing  of filling material through
the opening at the apex of the root,  the breaking off
of probes in the root canal, from  putting so  much fill-
ing in  cavities that correct articulation is prevented
and the tooth receives too much pressure, from hasti-
ly wedging apart the teeth preparatory to filling, and
from rubber rings, used in regulating, slipping under
the gum and remaining unseen.
   The action  of  mercury taken internally, or  ab-
sorbed from large amalgam  fillings,  may  cause  it. 
                PERIODONTITIS.            119

Recession of the gums exposing the cementum, or the
sharp  edges of cavities  of decay  beneath the  gum,
may induce periodontitis.  Unnatural antagonism of
the teeth caused by the irregularity resulting from
extraction,  or  no antagonism  at  all,  may cause it.
Dr. Watson, in his Practice of Physic, relates a case
of blindness in an eye and suppuration of the parts
around it,  attributable  to inflammation  of  the  in-
vesting membrane of the root of a tooth.
  The patient  after much suffering presented him-
self to a surgeon for the purpose of having  the eye
cut out,  but he quickly recovered  after the extrac-
tion of a molar tooth, in one  root of which a wooden
tooth-pick had  been broken off and extended a little
distance  beyond the apex of  the root.   I  once saw a
violent  case  of  periodontitis that was  caused  by a
portion of  the  septa  of an apple core  becoming
buried in the alveolus  of a  molar tooth  and firmly
wedged between one of its  roots and  the alveolar  .
process.
  The methods of treatment are of course various,
and mostly come in the province of the dental phy-
sician;  but it  will not be amiss to allude to  their
general character.  Removing the cause, lancing the
gums,  and painting them with  equal parts of tinc-
ture  of iodine and aconite root, is generally the first
treatment employed.  Then counter-irritation, leech-
es, hot foot-baths, purgation, quiet, elevation of the
head  aud the retention  of  something  between the
other  teeth  to  prevent  antagonism,  are   indicated. 
150
ALVEOLAR ABSCESS.
Cooling mouth-washes  are very beneficial.  Chlorate
of potash, one part to  sixteen of water,  is excellent
for holding iu the mouth, and a teaspoonful  may be
swallowed every hour or so.   If it happens that it is
impossible to allay the  inflammation after a fair trial,
then suppuration  should be encouraged  by painting
the gums frequently with capsicum and  chloroform,
or  with  cantharidal  collodion, or  by  applying  a
roasted fig  or raisin.   Poultices should never be ap-
plied to  the  outside of the  face, for  if the  abscess
should point and break there-, a permanent and un-
sightly scar might result.

               ALVEOLAR ABSCESS.

  If the inflammation of periodontitis  is not sub-
dued by proper treatment, it passes on to the form-
ation  of pus, which lifts the  membrane from the
root, and thus  forms  the  sac so  often  seen  when
teeth so affected arc extracted.  As the matter  accu-
mulates,  the  pressure  produces absorption  of  that
portion of the bone and the enveloping soft  parts
which  offer the least  resistance, until there is an
opening made for the escape of the pus.
   This  opening,  when formed in the  gum,  cs  it
usually is,  is  called a gum-boil;  but it sometimes
happens that it is made at some distant point, in the
nasal cavity, through the roof of the mouth, through
the cheek, underneath the lower  jaw, low  down  in
the neck, or at some other point. 
ALVEOLAR ABSCESS.          151
   Openings  discharging pus, occurring in such re-
mote localities,  are  often very confusing and lead to
great mistakes  in treatment; especially as a casual
examination  of the  mouth frequently  detects noth-
ing wrong with  the  teeth.   But it  must be remem-
bered that dead pulps, a prominent cause of alveolar
abscess,  sometimes exist without any external decay
or any noticeable  discoloration of  the teeth.   In
such  cases, by  holding a  small mirror back of the
tooth and  reflecting light  against it, an opaque ap-
pearance is observable that does not exist in a tooth
with a living pulp.
  A wisdom-tooth  that does not erupt for want of
room  may be the cause.    A broken piece  of root
left in the socket at a previous extraction, hidden
by the gum and not known by the patient, may be
the cause  of  such  purulent discharge.  The  other
causes of  alveolar  abscess have  been  sufficiently
noticed in  the enumeration of those which are capa-
ble of producing an attack of periodontitis.   The
throbbing  pain  that accompanies the  formation  of
alveolar abscess, is  often  of the most agonizing na-
ture  until  the  escape of  the matter,  when sudden
relief  comes; therefore  the propriety  of  hastening
suppuration by   the applications mentioned in  the
last chapter, as soon as ultimate abscess is found to
be inevitable.   After the pus has escaped, the open-
ing generally heals in a  few days, but abscess is
very liable to recur at some future  time, unless the
tooth is  properly treated  and filled; and even then 
152
ALVEOLAR ATiSCESS.
its prevention  is  not certain, although  a well-per-
formed operation  is  very often successful.   Some-
times  the abscess settles down into a chronic form,
and there is a slight but continued oozing of  pus,
iu which case longer  treatment is required.
   Teeth that have no  antagonists  are occasionally
pushed from their sockets sufficiently to allow the
escape  of the  matter around their necks.  Among
the worst effects of  alveolar  abscess  may be men-
tioned  necrosis of the  teeth, and loss  of  several
neighboring  processes,  or even of considerable  por-
tions of the  jaw.  Abscesses connected  with chil-
dren's temporary teeth are peculiarly  dangerous in
this respect.   Chronic  abscess,  by the constant  dis-
charge of pus into the mouth, vitiates its fluids, thus
injuring the teeth and deranging the general system.
In  the  treatment  of  alveolar abscess  the  value of
the affected tooth should  be  considered;  if  an old
root or au isolated tooth it should be  extracted.   If
it is desirable to save it,  the  pulp canal should be
cleaned out,  and  the  fistulous opening  continuous
with it injected with diluted creasote,  iodine, phenol
sodique, or  some other curative   agent.   Cutting
through the  gum  and  alveolar process to the root,
and destroying the sac, is a method  often resorted to
with success.   In depraved conditions  of the system
general medical treatment is often necessary.
   After the tooth  is brought  to a healthy condition,
the root and the crown cavity should be filled as al-
ready described.  As before mentioned, the abscess 
   DECOMPOSITION IJ\ ' THE PULP CA VIT2.  153

should never be allowed to break  anywhere  on  the
face, even if it can not be prevented except by very
free lancing on the inside of the  cheeks.  Otherwise
a  permanent  fistulous  opening and disfigurement
might result.  Of course if such an accident  should
occur,  the dental or the general surgeon would  be
able to restore the parts partially or entirely, but it is
best to avoid the necessity of a surgical operation.

       DECOMPOSITION IN THE PULP CAVITY.

   Occasionally  ;t happens  that  a greater  or less
portion of the pulp loses its vitality, the inflammation
stopping short of periodontitis and  alveolar abscess.
   The dead  portion decomposes,  forming  pus and
mephitic gas; if these are prevented from escaping by
a sound crown, a  filling, impervious dentine  or  im-
pacted food, they irritate the  portion of living pulp
at the extremity of the canal.  The  odontalgia  arising
is usually very severe and  assumes a neuralgic form.
   The gas arising  from  the  putrefaction of food
which becomes condensed iu the  first portion  of  the
canal  while there  is some vitality in the other part,
produces the same  effect.  This  condition of affairs
often comes about when an old filling, that has caused
by its presence the destruction of a part of the pulp,
drops out and the patient fails to  have it renewed;
also, where the frequent application of creasote for
the relief of toothache has caused such partial devi-
talization, and the  tooth has not been filled afterward. 
154          FUNGOUS PULP, ETC.

The treatment is to clean out the pulp cavity to the
point of vitality, aud fill after all inflammation is sub-
dued.  When such cases are taken in time, the oper-
ation is  more  than ordinarily successful compared
with other pulp complications, on account of the dis-
tance existing  between  the  body of the filling and
the  point of sensitiveness.   Sometimes  the decom-
posed matter is absorbed into the tubules of  the den-
tine, discoloring the tooth, and trouble is prevented
for a long time.

               FUNGOUS PULP, ETC.

  In very large cavities of decay, involving  the ex-
posure of the pulp, it sometimes occurs that the pulp
fails to take on acute inflammation, the irritation of
external agents only succeeding in exciting  enlarge-
ment.  The fungous growth may  be so large as to
fill  the cavity;  the larger it is the less sensitiveness
and the more hemorrhage upon pricking.
  The smaller  growths are  often very  sensitive.
Sometimes when severely wounded by the contact of
food in mastication, pain occurs of greater or less
duration.  The rational treatment would be to re-
lieve sensitiveness by creasote, promote absorption by
iodine, or cut out the growth aud destroy the pulp in
the canal, and afterward fill ; but I have succeeded in
effecting a cure by cutting away the tumor, stopping
the bleeding in a  few minutes, capping and  perma-
nently filling.   At times, what  appears to be a fun- 
DENTAL EX0S20SIS.
155
gous pulp, will  be found on close investigation to be
a fungous growth of the gum, entering an opening in
the neck of the tooth, the sharp edges  of which cause
the irrritation that produces the enlargement.
   The application of arsenical  paste  in such a case
would  be very  injurious, so  great care should  be
observed iu ascertaining  of what the  growth really
consists.
   If the tumor proceeds from the investing membrane
of the root,  extraction is generally necessary.

                DENTAL  EXOSTOSIS.

   Tins is the name given to the enlargement of the
roots of the  teeth, produced by the deposit of new
osseous material.  The extraneous substance may be
deposited with some regularity about  the circumfer-
ence of the  roots; but generally it is  in the form of
bulbs or protuberances of various sizes.  The deposit
is  occasionally so  abundant that the  alveolar parti-
tions are  absorbed,  and  the roots of  different teeth
inseparably joined.
   This  abnormal growth may result from  various
causes  which irritate the membrane  sufficiently  to
cause it to throw out more osseous matter, or it may
occur on account of  some inexplicable constitutional
peculiarity.   The disease is not  confined to any par-
ticular condition of the affected teeth,  for the crowns
may be  perfectly sound,  decayed slight'y or  much,
or  entirely  gone.  The  irritating causes to  which 
156
DENTAL EXOSTOSIS.
exostosis has generally been traced are: unnatural
antagonism of the teeth; mechanical  injuries from
accidents; hard  usage,  such as cracking  nuts, etc.;
deposition of tartar ;  protruding fillings; the conduc-
tion  of hot  and  cold  impressions  by fillings; frac-
tures  in attempts to extract; loose teeth; grinding
of the teeth;  imperfectly fitted  clasps aud  plates;
cavities encroaching on the cementum,  etc.
  The disease is generally very slow in its develop-
ment, the  pain  at first being slight, or only an un-
comfortable  feeling about  the roots being present;
in the latter  stages, however, the suffering is often
unbearable and  peculiarly aggravating on  account of
its neuralgic character disguising its real  location
  In  Harris' Dental Surgery allusion  is made to the
case of dental exostosis which  came under  the ob-
servation  of  the celebrated Fox.   The subject,  a
young lady, at the time she  presented herself to him,
"had  suffered so much and so long, that the palpebral
of one eye had  been closed for near two months, and
the secretion of saliva had, for  some time,  been  so
copious that it  flowed from her  mouth whenever
opened.   She had  tried every remedy science and
skill  could  suggest, without experiencing any per-
manent benefit, and was only relieved from  her suf-
fering by the extraction of every one of  her teeth."
The only remedy in the advanced stages is  extrac-
tion; but there is no doubt  that if the disease should
be suspected in its incipient state, it  could often  be
prevented by the treatment applicable to periodon- 
              EXPOSED CEMENTUM.          157

 titis.   Even when  extraction is decided upon, it  is
 often  a  matter of great difficulty, depending  upon
 the manner in which  the osseous material  has been
 deposited.  Sometimes it is an absolute impossibility
 without first cutting away the alveolar process to the
 extremity of the root.

                EXPOSED CEMENTUM.
   The cementum when divested of its natural cov-
 erings, the  alveolar process, and the superimposed
 gum,   is  exquisit^y  sensitive.   There  are  several
 methods  whereby  this  exposure may be produced:
 Inflammation,  and  subsequent  recession  of  the
 gums,  occasioned by vitiated fluids, or any  local or
 constitutional cause;  deposits of  different  kinds  of
 tartar; loose or irregularly placed  teeth,  and the
 pressing away of the g^ims by artificial partial plates.
 When  teeth have lost their antagonists, there is usu-
 ally an effort of nature to remove  them from their
 sockets, thus lifting the cementum from its protective
 surroundings.  Where  no particular cause  is found
 to exist, many attribute the recession of the  gums to
premature old age exhibiting itself in this one loca-
tion at least, recognizing the fact  that the  teeth of
aged people are generally gotten rid of in this way.
Such a supposition does  not seem any more unrea-
sonable than  to attribute the  early appearance of
gray hairs to the same cause.
  The  success attending the treatment of  exposed
cementum arising from the  effects of the saliva, or 
158
DENTAL NECROSIS.
from  constitutional causes, is  not  very encouraging
as far as permanent  relief from annoyance is  con-
cerned.  Acids and alkalies are used respectively to
correct alkalinity and  acidity.   Elongating  teeth
require artificial antagonists.   Pressing  plates should
be discarded for those raised a little  from the gums
where they surround  the teeth.  Loose teeth should
be supported  and irregular ones regulated.   Tartar
should be removed and  kept from  again  accumulat-
ing.   Conjointly, various  obtunding  agents  may be
used.

                DENTAL NECROSIS.

  When  from  any cause both  the pulp and  the
pcrideutium of the  tooth  are  destroyed, or in other
words, when  both the  external  and  the  internal
sustenance are cut off, the tooth  is said to be en-
tirely dead or  necrosed.   Its color  then changes, the
discoloration varying  from a yellowish hue to nearly
black, depending much upon the manner of its death,
the capacity of absorption  of the decomposed matter
by the dentinal tubes, and whether or  not a cavity
exists in  the tooth.
  A necrosed  tooth is  further distinguished by its
being  more or less elongated, and  by the gums not
clinging  to it  when it is worked  back and forth  by
the fingers.
  When any  of the other osseous  structures of the
body  are affected with necrosis, nature  refuses  to 
DENTAL NECROSIS.
159
 tolerate  the dead portions, and  they are thrown off,
 or exfoliated; but necrosed teeth are often, where the
 constitutional conditions  are  favorable, permitted to
 remain in position a long time.  This is accounted
 for by the fact that the teeth  are not really part and
 parcel of the surrounding bone, but are  held some-
 what separated from it by sockets so shaped as to
 mechanically retain  the teeth in position until any
 inflammation arising from their presence, if  not too
 violent, has exhausted itself.
  During the activity of the causes that produce the
 necrosis, and during  the efforts of  nature to rid her-
 self of the offending tooth, various degrees of pain
 are  felt, from  very slight to  very  severe.  Necrosis
 of the teeth may be produced by anything that has
 elsewhere been seen  to be capable of causing  inflam-
 mation  and  death  of the pulp, these extending to
 the peridentium; by the action of  certain medicinal
 agents, and  through  lack of  sufficient nutrition, as
 occurs sometimes  in  the  debilitated conditions  fol-
 lowing wasting fevers, etc.
  Threatened necrosis is to be combated by the same
general and local treatment that has been  advised for
inflammation of the  pulp and periodontitis.   After
it has occurred, the  discolored  teeth can often  be
bleached and filled, with the prospect of saving them
for  a considerable  time.
  Before  leaving  this  subject,  it  may  be well  to
bestow passing  notice upon those  forms  of necrosis
involving  the alveolar processes, or more or  less of 
160        SYMPATHY-NEURALGIA.

the jaw bones ; but the general surgeon is more fre-
quently consulted about these cases than  the dentist.
The death of the periosteum, or the membrane which
affords vitality to the bones, causes the death of those
portions which  are  nourished  by it.  Such necrosis
often happens from  accidents of various  kinds ; from
the extent of inflammation from diseased teeth; from
crowded wisdom-teeth; from attacks of such diseases
as small-pox, measles and scarlet-fever;  from the ad-
ministration of mercury and exposure to phosphorus ;
from scrofulous and other taints of the system.   The
symptoms at first are  hardly  distinguishable from
those attending inflammation about the roots  of the
teeth, but as  the disease  manifests  itself,  there is no
mistaking the extent, the purple, glazed  appearance
and pain of the swelling, the fistulous openings and
the fetid discharge.
   The treatment  essentially consists of the removal
of the dead bone, the  administration of tonic medi-
cines, and the local application of washes for  stimu-
lation and purification.

             SYMPATHY—NEURALGIA.

   No matter what lines of demarkation may be drawn
by scientific men  between ordinary, sympathetic and
neuralgic pains, it is evident that these  distinctions
are not comprehended by the people nor generally
observed by the physiologically educated.   Probably
the simplest definitions that  can be given are the 
            SYMPATH1-NEURALGIA.        161

following.   Ordinary pain proceeds from local irrita-
tion, being readily traced to its seat and causing dis-
agreeable sensations nowhere else.  The  term sym-
pathetic  pain  should probably  be confined  to  that
which  experience  teaches, exists in certain  parts
while other parts are the ones really irritated, so fre-
quently as to be regarded a symptom of the distant
irritation;  thus  pain  in   the  shoulder  generally
accompanies irritation of the  liver; pain  in  the left
arm is associated with certain diseases of  the heart;
and pain in sound teeth may  occur from  pregnancy,
rheumatism, gout, or from other teeth  that  are dis-
eased.
  Neuralgia, properly speaking,  means an affection of
the trunk of a nerve, the pain appearing  to  proceed
along its course and into its branches  of termination.
  Even  the names themselves  are very  unsatisfac-
tory,  for neuralgia  is  derived  from Greek words
meaning nerve-pain; therefore  any  pain might  bo
called  neuralgia, as it is irritation  of  the nerves  that
produces the  sensation.  Then  it is  not  very com-
forting to  the patient  who has been suffering  the
racing pain of toothache,  rendered somewhat more
bearable by the sympathy of kind friends at home, to
"•o to the sympathetic dentist  aud  there be informed
that sympathy is the cause  of all  his troubles.   He
might naturally conclude that  he had received enough
of it, and be excused for becoming irritable at any
further sympathy being evinced  by commiserating
friends.
         14 
 162        SYMPATHY—NEURALGIA.

   The phenomena connected with the nervous s}-stem
 arc more wonderful  and incomprehensible  than any
 others observed in the animal organism, and but few
 of them are  fully explained by the various theories
 concerning the nature of nervous substance and the
 manner of the transmission of nervous impressions.
 It will be most suitable  for our purpose to consider
 the brain and the spinal marrow as batteries gener-
 ating animal  electricity ; then to  regard the twelve
 cranial and the thirty-one spinal nerves as conduct-
 ing wires by  which motion aud sensation are respect-
 ively conveyed to and from every part of the body;
 and lastly to  consider  the  great  sympathetic nerve,
with its independent generating ganglia and various
cords, as the  means of establishing  nervous commu-
nication betweeu all  of the  different portions of the
body.
  By this theory the possibility of the conveyance of
sympathetic  and  neuralgic  painful  impressions is
made manifest; but  why the impressions should  be
so conveyed  to the various  parts  of this intricately
woven web of nervous tissue, interfering with  their
harmonious action,  is a mystery  never to  be ex-
plained.
         " Like warp and woof,  *  *  *   «
           Are woven fast,
           Linked in sympathy like the keys
           Of an orgiin vast;
           Pluck one thread and the web ye mar,
           Break but one
           Ot a thousand keys, and the paining jap
           Through all will run." 
            SYMPATHY—NEURALGIA.        163

   Only those that have tried know the difficulty that
the dentist  often has in persuading people that are
not aware of the peculiarities of the nervous system,
that certain teeth are the  cause  of violent pains that
they  locate  elsewhere.   Many persons  have had
tooth after tooth extracted that could  have been
saved, without experiencing any relief until  finally
the  right  one has  feci  reached,  possibly on  the
other side  of  the same jaw, or even in the opposite
jaw.
   Let us look at  the few of the many recorded in-
stances  of  sympathetic  affections connected with dis-
eased conditions of the teeth.
   Dr. Watson, in his Practice  of  Physic, quotes  a
case of  severe tic douloureux  of ten years' standing,
which was  at last completely cured by the  extraction
of a decayed tooth.
   Dr.  Harris gives  a case  of a gentleman afflicted
with the gout for many  years, and  who  was fore-
warned  of  the approach of the attacks by  the occur-
rence of toothache which came on regularly  ten or
twelve days  before,  and which  ceased as  the gout
symptoms  came on,  but returned and continued for
two weeks, when these subsided.  From Dr. Garret-
son's work, I  take the following cases:
  A young lady had  suffered for some time with neu-
ralgia of the face, ear and scalp ;  her agony was some-
times so great that she  had to resort for temporary
relief to the  inhalation  of chloroform ; she had ex-
perienced no pain in  any of her  teeth, but all of her 
164        S YMPA THY—NEURAL GIA.

pain instantly  disappeared upon the extraction of a
carious bicuspid with an exposed pulp.
  A lady aged thirty had suffered for ten years from
severe  neuralgia, affecting  the left eyeball and left
side  of  the head  and  face, the iris of the affecled
eye having changed  from a deep and bright hazel to
a dull gray.   Upon  the extraction  of an  exostosed
tooth the pain  left.
  A woman affected with facial neuralgia was cured
by the extraction of  a central incisor that was sound,
but somewhat  elongated and slightly  loose.  Upon
opening  the tooth,  an  excrescence  of dentine was
found encroaching on the pulp.
  A lady was  afflicted  with neuralgia of  the  left
fore-arm from  the  pressure of a badly fitted lower
set of artificial teeth.
  A young woman sjffering with wry-neck for more
than six months, and whose head  was drawn down
nearly to the shoulder, was cured by the removal of
some teeth.
  A young lady suffered with  neuralgic pains,  first
of the face and afterward of the arms, legs aud nearly
the whole body.   Exostosed teeth  were the cause ;
the crowns were entirely sound.
  Dr. Hyde Salter  was afflicted with neuralgia of
the neck and  arm,  from  a carious molar.   There
was no actual  pain in the tooth itself, nor any ten-
derness in  it  or the adjacent  gum, nor any appear-
ance of inflammation,  lie  was cured  by the extrac-
tion of this tooth. 
           SYMPATHY-NEURALGIA.        165

  A lady of rank and a nun are mentioned as being
attacked by facial neuralgia and toothache, owing to
menstrual irregularities.
  Epilepsy, catalepsy, blindness,  deafness, lock jaw,
convulsions, St.  Vitus' dance, etc., have been caused
by diseased and  crowded teeth.
  It is useless to make further mention of particular
cases;  from those quoted  it is  obvious  that it is not
improbable that serious disturbances in  almost any
part of  the body may arise from tooth irritation as a
primary cause,  and yet the teeth  not be suspected;
and  on  the other  hand, that  the teeth  may suffer
from disturbances in other parts of the  system.
  It will be superfluous to make any remarks  con-
cerning the treatment of such sympathetic and  neu-
ralgic pains, as that applicable  to the  diseases  of
the teeth causing  such  disturbances, is  mentioned
under the  proper headings;  while  the  treatment  of
the systemic conditions lies  within  the province  of
the general physician.
  Such attacks are  often  invited by anything which
debilitates  the vital powers, as disease, debauchery,
etc.; by anything which causes the  accumulation  of
impurities  in the blood, as bad atmosphere, miasmatic
influences,  etc.;  and  by  exhausting  emotions aud
passions.
  S. D.  Gross,  M. D.,  Professor of Surgery  in the
Jefferson Medical College of Philadelphia, mentions
a form of neuralgia of  the jaw-bones which has not
been described  by  others.   The pain  is located in 
166        SYMPA THY—NEURAL GIA.

the alveolar processes and  OArerlying  gum of jaws
from which the  teeth have  been for  some time  ex-
tracted;  and it  is  described as being  very  severe,
coming  on in  paroxysms often  from  slight  causes,
such as talking,  masticating, the contact of hot and
cold food, mental excitement, etc.  The disease  ap-
pears  to  arise  from  the  compression  of the  minute
nerves distributed through  the wasted  alveolar pro-
cess, dependent  upon the encroachment of  osseous
matter upon tho walls of the canals in which they
are naturally inclosed.
   He considers  that the only effectual remedy is to
cut cut the affected alveolar process.
 
MISCELLANEOUS  DISEASES.
                     ATROPHY.

rpiIIS word,  meaning  defective  nourishment,  al-
    though not strictly appropriate  as applied to the
disease we arc about to  consider,  is probably more
nearl}r correct than any technical name we have; but
the plain English, tooth-marks, conveys the meaning
iu a plainer  manner.  Atrophy is  generally applied
to a wasting  away of any portion of the body, after
being fully formed, on account of deficient nutrition;
thus we say, "atrophy of the  heart," or "atrophy of
a limb," when  these  become dwindled in size, which
is certainly not the  idea to be conveyed concerning
the teeth.  We have seen, in a previous place, that
the teeth, in reference to their formation and growth,
are classed  with  such  productions as nails.  This
similarity is nowhere more evident  than in the pres-
ent disease.   The term atrophy, in  dentistry, is used
to denote certain marks which form abrupt contrast
with the general color of the tooth,  or which destroy
the general evenness of the enamel  by the formation
of little pits, indentations, or grooves on its surface.
   White, yellow, or brown spots of various sizes and
irregular shapes may exist on the  outer surfaces of 
168                ATROPHY.
the teeth; these do not interfere with the smoothness
of the enamel, and although the teeth at these points
are of soft structure  and easily cut away, yet  the
places rarely decay if unmolested, on account of  the
lips keeping them constantly clean.
  The little pits or  depressions maybe scattered here
and there over the surface, or they may run together
so as to  form grooves.  They may be shallow, affect-
ing only the  enamel, or deep, going through  to  the
dentine.  The incisors are  the only teeth  attacked
in the great majority of cases, but occasionally others
are also.  Sometimes several of the teeth in one or
both jaws may be so affected as to scarcely look like
teeth, appearing as  if they had been badly eaten  and
discolored by some  corrosive agent.
  Dental atrophy is  doubtless produced by causes
that interfere with  the nutrition of the teeth during
their  formation;  thus  it  frequently lesults from
attacks   of  scarlet-fever,  measles,  small-pox,  etc.,
just as  the nails exhibit  grooves of  imperfect devel-
opment  from the same causes.  The white and brown
cpots may  result from slighter disturbances,  as  the
irregular white spots  in the nails do.  External  vio-
lence may sometimes cause them before the teeth are
erupted, just as a blow over  the root of the nail below
the scarf-skin shows its effect afterward when  the in
jured part, as  a purple  spot, is pushed  forward by
the growing  nail.
   Concerning the treatment, little need be said.   If
the pits are  shallow and  easily kept clean, no harm 
            ABRASION OF THE TEETH.        169

 will arise.   If they are deep, they ought to be filled
 as cavities  of decay; if near the cutting edge of the
 tooth, they can often be removed by the file.   In the
 worst cases, where  filling would be impossible,  and
 the disfigurement of the personal appearance is so
 great as to be  a source of mortification, it is certainly
 justifiable  to advise extraction and the insertion of
 artificial teeth.

             ABRASION OF  THE  TEETH.

   By this  term is  meant the wearing  away of  the
 cutting and grinding surfaces of  the  teeth.   The
 front teeth are much more affected  than the  back
 ones, the former being sometimes worn away,  even to
 the gums.   The pulps of the teeth would, of course,
 be exposed in the early stages of the disease, were it
 not  for a  wonderful provision of nature  by which
 they are stimulated to throw out new dentinal sub-
 stance for  their  protection,  while  they   gradually
 retire before the  advance of the enemy.   But there
 is a limit  to this  self-protection, and the  pulps are
 generally so nearly uncovered at some period in the
 progress of the abrasion, that  they become  much
 irritated from  mastication, hot and cold food, acids,
 etc.  Several  causes have  been  assigned for  this
wasting of the  substance of the teeth;  the manner
of their shutting  together; very hard food; acidity
of some of  the secretions;  imperfect texture of the
teeth, and excessive power of the masticatory muscles.
         15 
170       ABRASION OF THE TEETH.
But I can not see that either of these is always suf-
ficient.  It is true  that in the majority of cases of
abrasion, the  upper  front teeth shut squarely upon
the lower ones instead of over them; but this ought
to cause the  wearing away of the  front  teeth  only
until  the  back teeth receive all of the  strain upon
themselves.   Although  old  sailors who  have  used
hard biscuits for a great many years,  usually  have
the crowns of their teeth much worn down, yet many
persons who  live  on land and  eat  easily masticated
food, have their teeth affected in the same way.  If
it depends upon the fluids of the mouth exerting  a
corrosive influence, all of the teeth ought to be affect-
ed similarly, and all parts  of the  teeth should be
more or less acted upon.
  Abraded teeth generally  have the  external evi-
dences of being solidly constructed, and are compara-
tively  free from decay.   Excessive muscular power
appears to be a very common feature, but  many in-
dividuals  who have just as  much, and whose  teeth
shut properly, have no abrasion.
  The treatment  depends upon the existing circum-
ctanccs.   If  several teeth have been lost and undue
force is exerted upon the others, artificial teeth can
be inserted  so as  to  sustain the greater portion of
the  pressure.  Sensitive dentine  may receive the
treatment that has been  advised in another part of
this  work.  Exposed, or  nearly exposed pulps, may
be devitalized and tho root canals filled.  Where the
abraded front teeth have to  be extracted, the inser« 
         DENUDATION OF THE TEETH.      171

tion of artificial  teeth  is often a matter of peculiar
difficulty if the other teeth are left in;  for the plate
and teeth require frequently so much space that the
jaws are opened somewhat, which prevents the back
teeth of one jaw from touching those of  the opposite.
Rubber plates will hardly ever do; gold or silver ones
often answer well, if the teeth  can be set without dis-
figurement so as to allow the  opposite  natural teeth
to strike the plate only.  If filing the natural teeth
docs not give sufficient room, it is  often necessary to
extract  the balance of the teeth on the same jaw
with the abraded ones, and insert an entire half set
which can be arranged  to suit any irregularities.
   There is another wasting of  the points of the front
teeth,  which leaves a  space between  them and the
teeth of  the opposite  jaw,  instead  of being followed
up and worn still further by them.   Writers have in-
correctly termed this " spontaneous abrasion."   Abra-
sion means wearing  away  by  rubbing  with  a  suf-
ficiently hard substance,  and  there  is  certainly no
such mechanical  action  here.   The disease doubtless
arises from defective tooth material and  acid fluids.

           DENUDATION OF THE  TEETH.

   This is the name given  to a slow corrosion  of the
enamel, and ultimately of the dentine, on the anterior
faces of  the teeth.  It differs from pitted atrophy in
that it occurs long  after the eruption of  the  teeth,
and  instead of being  rough in  appearance, is per- 
172      DISEA SES OF THE ANTR UM.

fectly smooth and  highly  polished.   It sometimes
forms a  continuous groove  across  several  of the
teeth near the gum, just as if made by a half round
file and then  polished.  As has been seen in the
chapter  on Sensitive Dentine,  pain  may arise after
the enamel  has been  removed.  It is probably the
same thing  as "spontaneous abrasion," only in a
different  locality.   The  avoidance  of brushes with
stiff bristles,  and the use of  antacid washes, are the
best means to delay its progress, with the exception
of  filling.   The latter is  generally  objected to on
account of the number and  conspicuousness of the
fillings, but the good dental operator might  not*ob-
ject to thus posting up a modest advertisement.

  DISEASES OF THE  ANTRUM, OR MAXILLARY  SINUS.

   When we  consider the fact that those best ac-
quainted with the anatomy of the human body, were,
three hundred years ago, ignorant of the existence
of the maxillary sinus, and that its uses have never
yet been discovered, it is not so surprising  that the
majority of the people do not  know  that there is a
large cavity of that name  in  each  side of the upper
 jaw.
   It  is  situated above the back teeth,  the roots of
 the bicuspids and molars either entering it or being
 only slightly separated by a thin layer of bone.   The
 floor of  the orbit forms its roof, and all of its walls
 are quite thin.   It  communicates with the cavity of 
DISEA SES OF THE ANTR UM.       173
the nose by a small opening, and is everywhere lined
by a  continuation of  its  mucous membrane,  which
has its proper secretion.   It is liable  to  the same
diseases, that  mucous  membranes are  generally, aud
to some others depending upon its peculiar situation.
Its diseases range from those of the simplest  nature
that readily submit to treatment, to those of such a
complicated and  violent character that  death  aione
stops  their ravages.
  Some simple diseases that could readily he  cured
by  the proper early attention, may be  neglected or
mistreated until they baffle the skill  of  the dentist
and physician.
  Debilitated  and depraved conditions of the system
resulting  from exhausting diseases,  vicious habits,
scrofulous and other taints, etc., have much to do with
the character  and violence of the diseases of the an-
trum.  The presence of diseased teeth  is a more com-
mon cause of  trouble than  all other causes combined.
Inflammation  often extends from  diseased roots  to the
mucous membraue of this cavity; the character of its
secretion  is changed, it becomes irritating and  emits
au exceedingly disagreeable odor.  Occasionally the
passage iuto the nose  becomes closed  and the  accu-
mulated  secretiou distends the cavity, breaks  down
the weakest wall, pushing  out the eye, turning aside
the nose,  depressing the palate, elevating the check,
or closing  the  nostril.  Abscesses  may be formed
with fistulous  openings through  the cheek, into the
orbit, nose,  etc.   Ulcerations, innocent or dangerous, 
174      DISEA SES OF THE ANTR UM.
 may occur.  Tumors, from the simple and  curable
 kind to the malignant and incurable, may grow to
 various  sizes.   Cases  are recorded where  they have
 produced death by pressing  upon the brain, crowding
 into the throat,  or by exhausting the system.  Caries
 and necrosis may attack the walls of the cavity and
 associated parts, causing exfoliation  of the dead por-
 tions and great disfigurement of the  soft parts.
   Most of the diseases of  the antrum have a similar
 general  character, such as deep-seated pain iu the
 upper jaw,  flushed cheek, offensive  discharge  from
 the nostril when the position of the head  favors its
 gravitation  into the noce, and  sympathetic  pain in
 other parts  of the  head.  Nearly every disease has
 some symptom different from the rest,  by which the
 experienced observer  may distinguish  it  to a cer-
 tainty.   When some  other cause is  not known, the
 teeth ought to  be carefully examined.   Old  roots
 may remain, unknown  to the patient, the gums being
 closed over them.  Teeth  may have dead and putres-
 cent pulps, and the external appearance of the  tooth
 not be affected.  But the  hidden causes of the dis-
eases of the teeth, and the  methods of their detection,
have  been considered in another place.  Diseases of
the antrum occasionally are caused otherwise than by
bad teeth; thus affections  of the nasal passages may
close the opening, and foreign  substances may find
entrance into the cavity.  The  treatment of its dis-
eases is  the same that is applicable to conditions of a
similar nature occurring  in  other   parts.   Tumors 
DISEASES OF THE ANTRUM.       175
 must be cut out and dead bone removed.   An open-
 ing for the escape of accumulated secretion and  for
 the purpose  of injection, is  generally made by  the
 extraction of one or more  teeth and enlarging  tic
 alveoli.  Of  the many cases that have been placed on
 record, in which obscure troubles have been traced to
 diseased teeth as their origin, I select the following :
   Harris gives an account  of a young lady from  the
 West Indies who was afflicted for many months with a
 fistulous opening under the right eye.   Medical treat-
 ment availed nothing, and finally a carious molar was
 extracted.  The operation was followed by the imme-
 diate  discharge of a large quantity  of thick,  muddy
 and greenish  matter, and a  cure was accomplished
 without further treatment.
   In a case reported for the Dental Cosmos by Hor-
 ace Meredith White, M. D., the patient was troubled
 for some time by a fetid discharge from the right
 nostril, and heat and sense  of tension in the same
 side of the jaw.  After the extraction of a decayed
 molar  and the escape of pus, the disease was cured.
   Garretson quotes a case from Baron Ilallcr in which
 a  large tumor of the cheek  existed.   The external
 wall was much distended and softened, and yielded
 to pressure, upon the removal of  which  it  gave a
sound resembling the crushing of an egg-shell.  Tho
nose was turned to one side and  the nostril was  ob-
structed, yet the patient suffered no pain.   The case
was cured by the extraction of some bicuspid aud
molar roots  and  some after  treatment. 
176
RANULA.
  In another case, a young woman had  complained
of a dull aching pain under the orbit for three or four
months ; this was attended by a gradual elevation of
the  plate of bone between the  antrum aud  the eye.
Blindness and a discharge from the nostril  followed.
Recovery took place after the removal  of three roots
affected with periodontitis.

                    RANULA.

  The  ducts  of the  submaxillary and sublingual
salivary glands enter the floor of the mouth beneath
the  anterior portion of  the tongue.   Occasionally
one of  these becomes closed  and the secretion accu-
mulates, distending  the duct  and forming a tumor of
a smaller or larger size.  The contents may be either
fluid in the early stages, or solid at  a  later period
from the  absorption of  the watery  portions,  the
mineral matter being left and forming  a mass similar
in consistency to the salivary calculus  found on the
teeth.   Such swellings are sometimes  so large as  to
push the tongue back into the throat, interfering with
mastication, swallowing and enunciation.
  They are at times very rapid in growth, as shown
by the  following case:
  The  patient " stated that the enlargement occurred
while eating his  breakfast, and that in five minutes
it attained the size  of  ' a walnut with its  bark on,'
and  that it  prevented his opening his mouth freely.
After leaving the table he  rubbed it for some time, 
        INFLAMMATION OF THE GUMS.     177

and in  half  an hour  it was reduced to its  present
size.  From  that  time  the same  enlargement oc-
curred  every time  he ate, and without  reference
to what he ate.  It enlarged most, however, while
eating his first meal in the morning.   By rubbing
alone  could it be reduced.   Chewing tobacco seemed
rather to diminish  than to increase  its  size.   It
was not tender nor red,  but when enlarged to its
utmost, it caused a severe pain, which extended to his
ear."   The treatment generally  adopted is to punc-
ture the sac,  let out the contents and insert into the
opening  a short tube with expanded ends,  so as to
hold it in position;  or else to cut out with the  scis-
sors a portion of the sac, and follow with astringent
lotions.  The term ranula is not usually applied to
an  enlargement resulting  from   the closure of the
duct of the parotid gland, which opens opposite the
second molar tooth of the upper jaw ; but I will men-
tion that  condition here, although its  occurrence is
rare.   In the British  Journal of Dental Science a
case is  reported of closure of the  parotid duct and
swelling of  the cheek,  caused  by inflammation re-
sulting from  the ragged edge of  the second molar.

          INFLAMMATION OF THE  GUMS.

  The  gums, in a healthy condition of the mouth
and the general system, present a pale  pink  appear
ance; their margins taper down to  thin edges, form-
ing regular  festoons around the necks  of the teeth, 
178     INFLAMMATION OF THE GUMS.
which they embrace so closely as to aid materially in
retaining  them  in position; their texture is quite
tough, enabling  them to withstand the pressure  and
friction  of mastication,  aud vigorous rubbing with
the brush without any pain, bleeding or injury.   But
from various  local and constitutional causes their
normal characteristics are so changed, that in  fact it
is  quite  rare  to see  a  person  possessing  perfectly
healthy gums.
  All grades of inflammation may occur, from a slight
swelling  around one tooth to a  tumefaction so great
as to nearly cover all of them.    With the different
degrees, may be  associated suppuration, sensitiveness
so great as to prevent  the  mastication of anything
but  soft food, and hemorrhage upon the slightest
touch of a tooth-pick or tooth-brush.  The usual
local  causes of inflammation are: the  use of  irri-
tating  brushes,  picks  and powders; poorly  fitting
plates  and  clasps;   the  accumulation  of  decom-
posing food under unremoved  artificial plates  and
between  the natural  teeth; collections of tartar  or
salivary calculus; irregularly placed, loose and dead
teeth; irritating edges of roots and cavities of decay;
ligatures and  rings around the  teeth for regulating,
etc.; wedges placed between the teeth for separating;
substances  crowded underneath  the gums, such  as
portions of metal fillings and the septa of the cores
 of fruit; the unskillful  use of creasote, chloride  of
 cine, and other powerful medicines;  periodontitis and
 several diseases of the teeth and jaws; teeth  without 
INFLAMMATION OF THE GUMS.     179
antagonists; erupting teeth; irritating substances that
sometimes exist in tobacco and in various articles of
food.  The most of these combine to form one great
cause, which does the mischief in nineteen cases out
of twenty, and that is,—lack of cleanliness and care
about the mouth.
   The main treatment is to remove and  keep away
the  cause, which alone will generally effect a cure;
but various healing  washes may be used also.
   Phenol sodique, two teaspoonsful or more to a glass
of water; two  drachms each of chlorate of potash and
borax to four ounces of water;  two teaspoonsful of
chlorinated soda to a glass of water;  white oak bark
and water  boiled  together;  are  a few of the many
washes employed  for  ordinary  inflammation  of the
gums.
   Dr. Harris  gives two good prescriptions for "in-
flamed, spongy and ulcerated gums :
"R.   Powdered nutgalls,  ....  2 drachms.
      Powdered Peruvian bark,   .    .    2 drachms.
      Powdered orris root, .   ...  1 drachm.
      Infusion of roses, ....    4 fluid ounces.
   "The infusion  to stand for a day  or so  upon the
powders, with  frequent stirring, then decant and filter.
UR.   Borax,......2 scruples.
      Honey,  ......    1 fluid ounce.
      Sage tea,   .    .    .   .    .    .4 fluid ounces.
  "This is a favorite and very general domestic rem-
edy,  and will  be  found very soothing and  healing."
A solution of  nitrate of silver, to be applied  by the
dentist to  the margins  of the gums, is certaiu and
rapid in its effect. 
180
TUMORS.
  For the inflamed gums attending periodontitis, one
of the best washes is:
R.   Chlorate of potash,    .    .    •  4 drachms.
     Water     .    ...    *    8 fluid ounces.
     Laudanum,'.....2 fluid drachms.
  A teaspoonful  of  this should be  taken into the
mouth every half hour and held for some minutes so
as to submerge the inflamed gum, and then spit out.
Certain  morbid growths of the gums should be re-
moved by the knife.
  Different diseases, affecting  the system  generally,
but having an especial local  manifestation in the
gums,  should receive  general  medical treatment;
among these may be  mentioned  scurvy and the mer-
curial disease.  Local treatment in conjunction should
not be omitted, however.
  More might be said concerning the different affec-
tions of the gums, but they are  mentioned  incident-
ally in other places in this volume.

                     TUMORS.
  The maxillary bones  and  the parts in  immediate
connection with  them, are peculiarly liable to these
morbid  enlargements.    They may be  like bone, flesh
or cartilage in consistence; of small or immense pro-
portions; of slow or  rapid growth;  painless  or ex-
cessively painful;  of various shades  of color, from
pale to  purple.   They may be smooth and of sym-
metrical proportions,  or they may be  rough and of
very irregular form; attached by either a broad or  a 
TUMORS.
181
stem-like base.  Some occur only at  certain periods
of life, others at any time.  The state of the patient's
health may be not at all affected for years, or it may
be disturbed at the earliest periods.  Some are readily
cured  by removal and treatment, while others per-
sistently return and ultimately carry  the sufferer to
the grave.   To give a  description  of  the various
kinds  of  tumors  and their symptoms would be a
task too tedious.   Some  are so complicated that the
most experienced doctors find themselves bewildered.
This  advice is always good, however:   the patient
should  never permit a tumor to exist without pre-
senting himself to  a physician, dentist or  surgeon,
not being indifferent on  account of its slow progress
and mild appearance;  on the other  hand he should
not be greatly  frightened at more alarming symptoms.
  Frequently  it happens that  small  tumors,  which
at first  could be readily removed by a simple opera-
tion,  are neglected until  a  considerable portion  of
the jaw has to  be lost.  Tumors of the  jaws  and
gums are  more  frequently traced to diseased teeth
than any other cause,  their magnitude and  character
depending much of course upon constitutional pecu-
liarities.
  The sharp edges of a  decayed place, or  ot a root,
may irritate the gums or  the membrane covering the
root or the  alveolar process to an increased action,
that results in a morbid growth.
  Crowded teeth and salivary calculus may exert the
same  influence.   Unerupted teeth may remain  for 
182
TUMORS.
some time incased somewhere in  the bony structure
of the jaws without producing trouble, and then be-
come the cause  of a tumor.   The simple extraction
of a tooth will sometimes result in a cure;  at others,
more or less of  the jaw  has  to be removed.   Many
simple  tumors of  the gums  can be  removed by a
simple cut of the knife, or  by the gradual contraction
of ligatures;  the  latter  method is preferable, when
they°can be made to operate  sufficiently low,  on ac-
count of the lessened hemorrhage.
 
THIRD  DENTITION.
 "IV/TORE for the sake of gratifying the curiosity of
     those who may take  an interest  in anomalies
 than for any practical good, I will mention  the fact
 that nature does occasionally, late  in life, supply the
 toothless  mouth  with a new set  of teeth.   Many
 writers,  who  had not  themselves  seen such cases,
 have refused to believe them possible,  but evidence
 from  different sources  has accumulated  to  such an
 extent, that there can no longer be any doubt.   Not
 stopping  to refer to the reported cases  of  remote
 times, which we might justly hesitate to believe, we
 will confine  ourselves  to the consideration of a few
 of the well-authenticated modern instances.   Sinclair
 says:  "I  once saw an old man, named James Donald,
 who had got new teeth, which I had  an opportunity
 personally of examining.   They appeared  to  be
 much softer than teeth usually are and not fit to do
the same service; and, on the whole, I was disposed
to consider them as an imperfect substitute."
  In Harris' Dental Surgery is an extract of  a letter
from a professional  friend, Dr. J. D. McCabe: 
184
THIRD DENTITION.
   " I have just seen a case of third dentition.   The
 subject of this 'playful freak of nature,' as Dr. Good
 styles it, is  now in his seventy-eighth year, and, as
 he  playfully remarked, 'is  just cutting  his  teeth.'
 There  are  eleven  cut, five  in the upper, and six in
 the lower jaw.  Their appearance is that of  bone,
 extremely rough, without any coating or enamel, and
 of a dingy brown color."
  "Sometimes these teeth are produced with wonder-
 ful  rapidity;  but  in  such  cases,  with very  great
 pain, from the callosity of the gums,  through which
 they have  to  force  themselves.   The  Edinburgh
 Medical Commentaries supply us with an instance of
 this kind.    The  individual was  in  his sixty-first
 year and  altogether  toothless.   At  this  time  his
 gums and jaw-bones became  painful, and the pain was
 at  length excruciating.  But, within the space of
 twenty-one days from its commencement, both jaws
 were furnished with a new set of teeth, complete in
 number."
  Such teeth are generally of poor quality, and often
without well-formed roots and without sockets to re-
 tain them.   In  Harris' work, I find the following
 passage: "It is said that the efforts made by nature,
for  the production  of a third complete set of teeth,
are  so great that they exhaust the remaining energies
 of the  system; and, as a consequence,  that occur-
 rences  of this  kind are  generally soon followed by
 death." But the third dentition of the grandfather of
 Dr. Slare (mentioned elsewhere), appears  to present 
              THIRD DENTITION.            185

quite an exception to this rule  of failing energy; he
got his third set at eighty-five  years of age and "re-
mained in good health and  strength to the one huu-
dreth year of his age, and  even then died in conse-
quence of fullness of blood."
  The teeth  must have been of fair quality, also, to
have lasted him  fifteen years.   Numerous  instances
have occurred in which one or two particular teeth
of the second set have been replaced with new ones,
and  Harris even gives  a case  in which  there were
four eruptions of a certain central incisor.
16 
SUPERNUMERARY TEETH.
TT is not very uncommon to see in the  mouth  a
-L certain little tooth of  stunted growth,  over  and
above the number usually found in the jaws.  Most
frequently such teeth are in the front part of  the
upper jaw, between and rather back of the central in-
cisors, and have cone shaped  crowns.   When they
are found back in the jaw, they generally appear  like
dwarf bicuspids or stunted wisdom teeth.   Dr. Har-
ris says, however, that he has seen cases, in both jaws,
in which  there were too many incisors, and yet the
supernumerary ones could not be distinguished, so
close  was their similarity to  the others.   Supernu-
merary teeth should always be extracted, when they
occasion any disfigurement or irregularity.   The fol-
lowing is a case of my own:  A lad aged  seventeen
presented himself with five teeth in the space between
the two  eye-teeth.   Four of these were the proper
central and lateral incisors, and  the other was a  con-
ical supernumerary.  He informed me that  a short
time  before he had a similar conical tooth extracted
from the same space. 
SUPERNUMERARY TEETH.       187
  His incisors being decayed nearly away, they were
extracted for the purpose of inserting artificial teeth.
Soon  after  this, a peculiarly  dwarfed  and  twisted
tooth erupted and was extracted.   On its root was a
notch where the root of the lateral incisor had caught
it, keeping it from erupting sooner.   Thus  it is seen
that there were  seven teeth in the space  intended for
four.
 
UNITED TEETH.
   AR back in history we have accounts of the occa-
    sional union of the teeth.  Herodotus  says that
there was found on the field of the battle  of Plataea
" a skull without any seam, made entirely of a single
bone; likewise a jaw, both the upper bone  and the
under, wherein all the  teeth front  and back, were
joined together and made  of one bone."   Pyrrhus,
king of Epirus, and a son of Prusias, king of Bithyn-
ia, are said  to have had teeth of the same description.
   When we  consider that no such  case of  general
union of the teeth has  been found in modern times,
we can be excused  for  incredulity  concerning the
statements; but  the union of two of the  teeth has
been seen so  frequently as  to almost take  away the
novelty.  Within the last month, I saw a case of the
osseous union of the crowns of the lower right lateral
and cuspid.  Anteriorly there was presented  a broad
surface without division; while posteriorly  there was
the mark of separation.   Cases have  occurred in ex-
tracting teeth, in which adjoining teeth have been un-
intentionally removed, the  roots being united while
the crowns were separated.
F 
EXTRACTING.
QO many allusions have been made incidentally to
    the circumstances which render the  extraction of
teeth advisable or necessary, that it will be useless to
particularize here.
  With the  exception  of  temporary teeth that re-
quire removal, irregular teeth, supernumerary teeth,
aud crowded wisdom-teeth, cases calling  for  extrac-
tion, would be very rare indeed, if people would learn
to  take care of their mouths  and  have the  proper
preservative  dental operations performed.   But  as
people will neglect  their teeth until  they have become
affected with incurable diseases,—or if  curable,  they
are not able or not  willing to have  them treated and
filled,—extraction  is such a  commonly performed
operation, that it will be well to speak  of it further.
  It is an operation that is almost universally dread-
ed,  aud many will  suffer weeks of pain, lose night
after ni°-ht  of sleep and hour after hour from busi-
ness, rather  than  submit  to  it.   I have  seen  the
scair^d hero of many battles cry like a child when
called upon  to have a tooth extracted. 
190
EXTRA CTING.
  Considering the  prevailing aversion  to  the opera-
tion and the many  accidents that  happen when it  is
intrusted  to rough and  inexperienced hands, it  is
truly surprising  to see the class of  operators  fre-
quently allowed to perform it.   The extraction of a
tooth is often so simple an  operation, it is true, that
one that has never had a forceps in his hand before,
can accomplish it;  but cases are constantly present-
inc themselves that require intelligent employment
of properly shaped instruments,  the  application of
the necessary  power  in the right direction, an inti-
mate knowledge  of the anatomy of the parts and the
anomalous shapes  frequently occurring in the teeth.
Strength is not the only thing  necessary.  A large,
muscular  man may  seize  a forceps iu both hands,
shut his eyes,  and  snap off the crown  of a firmly set
molar at a single jerk ; whereas a man of much less
brute strength, might with  one hand, open eyes, care-
ful motions and skillful management, bring the entire
tooth safely away.
   In Harris' Dental  Surgery are quoted two cases to
show  how serious  a  thing  the extraction  of a tooth
may turn  out  to be.   They arc so similar  that it will
be sufficient to mention one of them.   The roots of
tho  tooth (a  molar) " were greatly  bifurcated and
dove-tailed into  the jaw, aud would not pass perpen-
dicularly  out,  though a slight lateral  motion would
have  moved them instantly.  The jaw proved  too
weak  to  support  the monstrous pull upon it, and
gave  way between the second and first molars, and 
EXTRACTING.
191
with  it came both  the anterior and  posterior plates
of  the antrum.   The broken portion  extended to
the spongy bones of the nose, and terminated  at the
lower edge of the socket of the left front incisor, con-
taining six  sound teeth.  The soft  parts were cut
away with a  knife.   A severe hemorrhage  ensued,
but the patient soon recovered, though with excessive
deformity of his face and mouth."
  Few  people  of our times consider how thankful
they ought to be for the many improvements in in-
struments and the skill in  their management, that
have  taken place.   Ambrose Pare,  "the  father  of
French surgery," was so much afraid of accidents in
extracting, that he  always separated  the tooth to he
operated  upon from the  rest with  a file.  And in
enjoining care  in the use of the  "tooth-mullets," or
pincers, of the period, he said :  "Unless  the person
knows readily  and  cunningly how to use them, he
can scarcely  so carry himself but that he will force
out three teeth at once."   The  most of the serious
accidents in extracting that  have occurred in recent
times, have  been from  the  use of the "tooth-key,"
which may be described as an instrument capable of
exerting  power enough  to  tear  out the side of a
house, but wkich is often applied to the  extraction
of a tooth, which it is fully competent  to  remove
together with any neighboring teeth, or large por-
tions of jaw that may stand  in the way.   The tooth-
key was used almost exclusively for about fifty years,
but has fortunately been entirely abandoned, except 
192
EXTRA CTING.
by a few old fogy operators  that  still  cling to the
friend of their youth.  In its  place we  have forceps
of various  shapes,  and screws  and  elevators for
roots ;  but accidents still occur frequently enough  to
make it advisable to intrust  the  extraction of teeth
only to competent hands.  A glance at the chapter
describing the permanent teeth will show the  com-
parative ease and difficulty attending the extraction
of each.   Generally,  the wisdom-teeth,  or  third
molars,  are  the  easiest  pulled;  next, the incisors
above and below; then, the bicuspids above and the
cuspids and  bicuspids below ; next, the cuspids,  or
eye-teeth, above; then, the first aud  second molars
below; and  lastly, the first and second molars above.
But there are many exceptions; the roots of any  of
the teeth  may be curved or exostosed;  the  roots  of
the molars may approach one  another  so as to grasp
a portion of the bony process, or diverge  to such  an
extent as to not admit of passage between the adjoin-
ing teeth.
  In such cases it is sometimes impossible to extract
them without breaking, and the  dentist is accused 
EX2RA CTING,
193
 unjustly of awkwardness.  There are several errone-
 ous ideas  engrafted  in  the  minds of many people,
 that  never can be eradicated  until they are better
 educated.   Some  hold on tenaciously to old "eye-
 teeth," although they may disfigure them, or render
 the nice  adjustment of artificial teeth impossible,
 because they think that to remove them will injure
 the eyes.   I would inform those having such crotchets
 that these  teeth are so named because the  roots are
 long and point toward the eye, and not because there
 is any connection;  it would  be just as sensible to
 object to  having "wisdom-teeth" extracted  through
 fear of losing wisdom,  or the  "stomach-teeth" on
 account of injuring the  stomach. Many think  that
 the extraction of old  roots is far more painful than
 any others, and suffer their  mouths to remain in a
 disgusting condition for years, rather than have them
 removed.   They are  generally very  easy to  extract
 when they emerge  from the  gums enough to allow
 taking hold of  them, and often are not difficult, when
 entirely covered by the gums.   There is always an
 effort of nature to get rid of such old roots, and gen-
 erally the  process of absorption has progressed so
 far, that the  dentist is met more  than half way.
 Many patients,  ignorant of the anatomy of the mouth,
 make unpleasant scenes  in a  dental office by declar-
 ing that roots  have  been  left  in, when the  dentist
 knows he has removed them.
  The mistake  arises from feeling the bony sockets
and the septa between them.  The dentist ought to
         17 
194
EXTRA CTING.
know, because he is aware when he has extracted the
proper number of roots, and knows by the appear-
ance of each  root whether  it is entire or not; but
occasionally no argument will succeed in convincing
the patient, and he goes to some less honorable den-
tist, who humors his notion for  the sake of a fee or
to gain his  influence, and  takes  out  a  piece  of the
process and calls it a root.
  The patient should be properly educated concern-
ing the anatomy of the  teeth, and in case of doubt
should see  the extracted teeth himself; thus  all
trouble would be avoided.
  Lancing the gums  is an  operation  that  should
always precede that of extracting the teeth.  A great
many individuals refuse to have it done, believing it
to be more painful than pulling.
  If the lance is sharp,  it generally does not hurt at
all.  It facilitates the labor of extraction by severing
the attachment to  the gums, and to  the reflected
fibrous  portion of  the membrane  of the root  that
embraces the neck of the tooth.   Sometimes  severe
laceration of the gums occurs from neglect to lance.
  Frequently patients  circulate a report that  a cer-
tain dentist  has broken the jaw, when  in  fact there
has only been a portion of the alveolar process that
has given away.   It  is sometimes unavoidable, and
generally  results  in no  harm, only anticipating,  iu
reality, the operation of nature in removing the pro-
cesses  by absorption.   It is this absorption  of the
processes  that causes the falling away of the gums 
HEMORRHA GE.
195
 after extraction.  The  question  is often  asked as to
 the advisabi.ity of extracting teeth during  the latter
 months of pregnancy.  It is certainly not good prac-
 tice, and  every means should  be tried to allay pain
 without resorting to it.  The system at such times is
 peculiarly susceptible to  the influence of shocks of
 various kinds;  besides  miscarriage, etc., are liable
 enough to happen  at any time, and although the ex-
 traction of a tooth might not really be the cause of
 the trouble, yet there would be  a distressing uncer-
 tainty.  AVhere the agony of toothache is long con-
 tinued and unendurable, refusing to submit to treat-
 ment, there is no doubt that the fear of the prostrated
 condition  of the body for the final trial, is a sufficient
 reason for running the risk of having teeth extracted.
   In cases of violent inflammation about the teeth,
 abscess threatened or forming, it  is often advisable to
 reduce the inflammation before extracting, on account
 of the danger of hemorrhage, or  of taking cold.   In
 greatly debilitated  states of the  system, or  in states
 of violent excitement, extraction  of teeth is not to bo
 recommended.

                   HEMORRHAGE.

   Eleedtng inside of the mouth ordinarily r.risca
from  only four  causes: from brushing and  picking
the teeth, or spontaneously, when  the gums are in-
flamed,  and following the  operations of removing
tartar, lancing  the  gums, and  extraction.   The first 
196
HEM O R RHA G E.
two of these have been  sufficiently noticed under
"Inflammation of the Gums," and "Salivary Calculus,
or Tartar."  As  we have seen,  excessive  bleeding
may sometimes happen after cutting children's gums
during first dentition.
  In such cases, a piece of muslin, half an inch square
or less, may be moistened and dipped into pulverized
alum or tannin, and then held for some time against
the incision by the finger of the  parent;  or a little
clean cobweb may be retained in position by pressure.
  If such simple means  do not succeed, either from
the unmanageability of the child, or the failure of
the application, a dentist  should be consulted.  Some-
times  a bandage  has to  be  applied, which requires
considerable skill  in its  adjustment.  If the case is
at all obstinate, internal treatment should be resorted
to.  In the great majority of cases there is  but little
hemorrhage after  extraction; in  fact, it is generally
preferable to encourage bleeding by using warm water
in the mouth, rather than to arrest it.
   But occasionally it happens that the hemorrhage
is alarming, and demands energetic treatment to con-
trol it, and in a few instances persons  have bled to
death.   The object is to  form a firm clot in  the torn
extremities of the bleeding  vessels.
   This can nearly always be accomplished by an ob
servance of the following directions.  Several small
pledgets of cotton should be saturated with solution
of persulphate of iron or  tincture of nut-galls, or
moistened and dipped into powdered alum or tannin. 
HEMORRHA GE.
197
and then pressed tightly into the socket of the extract-
ed tooth, so as to fill it up to the margin of the gum.
Over  this  quite a large piece  of  cotton  should be
placed, so  that the jaws will  press  tightly upon  it
when  approximated, and yet remain separated euough
to allow the saliva to run out.   It  should then be
held iu this position for an hour or more.  No mus-
cular  effort should be  made to spit, but the saliva
should be  allowed to escape by simply holding the
mouth over the  spittoon.   When the  bleeding has
been stopped for some time  the large piece of  cotton
should be removed, but that in the  alveolus should
not be disturbed for a day or more.
  Active exercise should be ayoided, and the head
kept elevated.  A warm foot-bath is  valuable in con-
junction, as it invites blood  to the lower extremities.
Compression is the main thing, and will often stop
hemorrhage without  the  use of  astringents,  but  it
makes it more certain to add them.  Various other
applications are in the hands of the dentist, but the
above mentioned are about the most  available for the
patient to use himself.   Pledgets of cobweb applied
in the manner described for the cotton pledgets, I
have never known to fail.
  If a tendency to hemorrhage is known to exist by
previous experience, or  suspected from its occurrence
in other members of  the same  family, constitutional
treatment should be employed for  some days previous
to the operation of extracting. 
198   DISL O CA TION OF THE L O WER JA W.

        DISLOCATION OF THE LOWER JAW.

  Tins is an accident that occurs occasionally from
opening  the  mouth too wide  in gaping, during the
extraction of teeth, from forcing large bodies into the
mouth, and from blows  received when the mouth is
open, etc.
  A  glance at any book of  anatomy, showing the
articulation of the jaws, will explain how  the  acci-
dent may occur by the condyles slipping out of the
depression  in  which they play.   The dislocation is
readily recognized by the protrusion of the jaw either
directly forward or partially to one side, according to
whether one or both, condyles have slipped out; the
mouth furthermore remains wide open, and  there is
much pain.
  As the accident might happen  at a time when pro-
fessional help  could not  be readily obtained, I will
mention the manner in which the  jaw is generally
easily returned to its place. The patient should take
both hands, and placing  the  fingers upon  the  back
teeth of each side, pull with force the jaw downward
and  backward, while an  assistant should push the
chin  upward, and at the  same time hold a  block, or
the back of a book, between the front teeth to save
the fingers on  the back  teeth.  Or the assistant may
place his thumbs upon  the back teeth and  push the
jaw downward  and backward, while  he  elevates the
chin with his  fingers,  the same care being  observed
about the sudden closure of the teeth, which always 
      DISL OCA TION OF THE L O WER JAW.   199

occurs with a snap  and great power when  the  jaw
slides into  its place.  Enveloping  the  thumbs with
several thicknesses of a napkin serves as an addi-
tional  protection and allows greater pressure to be
made.  After the  jaw has  once been dislocated, the
accident is  liable to occur again ; so it should be held
while yawning,  and while  having dental operations
performed.
 
ANAESTHESIA.
rPHIS word  is applied to that condition  in which
    there is a loss of sensation either in a part or the
whole of the body.  Any agent that is  used to pro-
duce that state is called an  anaesthetic;  the latter
word is also  used as an  adjective to designate the
class.   Chloroform,  ether, nitrous oxide,  bichloride
of methylene, etc., are agents used to produce general
ana3sthesia.   Of these chloroform, ether,  or a mix-
ture of the two, are most commonly used  for exten-
sive surgical operations; although  occasionally used
in the  extraction of teeth,  they are  so seldom  em-
ployed that it will be an unnecessary consumption of
space to treat  of them particularly.
   Nitrous oxide is, par excellence, applicable to the
extraction  of teeth, on  account of the speedy pro-
duction and  the short duration  of  the anaesthetic
state  produced  by it.  A separate chapter  will be
devoted to its consideration.
   Various applications also  have been  made to the
parts about the teeth  for  the production  of local
anaesthesia,  with  more  or  less  successful  results.
Pouuded  ice and  salt contained in a small bag and 
ANAESTHESIA.              201
held  in  contact  with the teeth and gums until the
parts are benumbed;  and the production of cold by
pumping on  a spray  of ether  or rhigolene, are
means that have  frequently succeeded well in re-
moving  the  pain  of extraction.   Applications  of
equal parts of chloroform  and  tincture of aconite
root, and of a  mixture of camphor and ether,  have
resulted  very  satisfactorily in  obtunding sensibility.
It must be recollected that the  tincture  of aconite  is
very poisonous, and should be used with great care.
   Another method which  has probably been  more
successful than any other, with the exception of gen-
eral anaesthesia, consists in the passage of an electric
current through the tooth at the time of extraction.
Any one who  has  felt the  "shock" of an ordinary
electro-galvanic battery, can  appreciate  how  that
sensation might overcome the pain  of tooth-drawing.
Occasionally persons  are found, however, that object
to the " needles  arid pins" feeling so much,  that
they would rather suffer the pain of extraction.
   The advantage of these agents for producing  local
anaesthesia, is that they are  safe, without regard to
age, sex, or conditions of the mind or body.   Objec-
tions to the use of the ether spray have been made on
the ground that intense cold sometimes causes slough-
ing of the gums   I  do not recognize  any danger
from this unless the application should be  prolonged
to an unnecessary extent.  Dr. Garretson, than whom
there is probably no better authority in  matters con-
nected with surgery, says:  "An objection urged to 
202
ANESTHESIA.
the use  of  extreme  cold  as  thus induced, is, that
injury is done  to  the  soft parts, as it  is  thought
will be manifested in  inability to  unite wounds hap-
pily and easily.   That  such  objection is,  however,
not valid,  I have  satisfactorily  proven,  for, if any  v
thing, parts thus operated  on  have united better and
with  less inflammatory  reaction  than  has  obtained
where the spray has  not been  used."  There is no
circumstance in  life which  exhibits in a more marked
manner  the differences between people than  the vary-
ing degrees  of ability or willingness to bear the ex-
traction  of  teeth.  A small  and sickly  person, on
the one  hand, may laugh at the idea of any  body not
having  manhood or womanhood enough  to bear it,
while on the other,  a person  almost  giant-like in
strength and stature may faint at the thoughts of the
operation and suffer for years  all the ills arising from
diseased teeth,  rather  than  submit  to  it.    Others
again, and  not a few, think it sinful to tamper with
human life by taking anaesthetics for such  a  trivial
operation as the extraction of  teeth.
17 
NITROUS OXIDE GAS.
VTITROUS OXIDE,  Protoxide  of  Nitrogen  or
    "Laughing Gas," was discovered in 1776 by the
celebrated English chemist, Dr. Priestley.  For more
than twenty years it excited very little interest, until
Sir Humphrey Davy, in 1799, began his celebrated
"Researches."
   One volume of his works is almost entirely devoted
to his investigations, and in  one of his  note-books
kept at the  time is the following allusion to them:
"These experiments have  been  made  since April,
1799, the period when I first breathed nitrous oxide.
Ten months of  incessant  labor were  employed  in
making them,  three mouths in  detailing  them."
This  gas, composed of nitrogen and  oxygen,  one
equivalent of each, is but one of the many instances
of the wonders of  chemical combination as compared
with  mechanical mixture.   A  measure  of  salt  or
su^ar mixed with one, two, three or more measures
of water, makes only a compound more or  less salt
or sweet, without affecting its nature; but in chem-
ical combination, a measure more or less makes  the
difference  between a solid  and  a fluid, or a  gas—an
inert substance, or  a deadly poison. 
204          NITROUS OXIDE GAS.
  Thus, five equivalents of oxygen and one of nitro-
gen give us  nitric acid,  or  aqua fortis, an intensely
sour, colorless and powerfully corrosive liquid; four
equivalents  of oxygen and  one  of  nitrogen form
hyponitric acid, an orange-colored liquid with cherry-
red vapor, boiling at 82° and solidifying at 8° ; three
of oxygen and one of nitrogen yield nitrous acid, an
orange-red vapor, a poor supporter of combustion aud
very destructive to  life; two of oxygen and one of
nitrogen form  nitric oxide,  or deutoxide of nitrogen,
a colorless gas that extinguishes  burning substances
and is fatal to  animal life;  one equivalent of nitrogen
and one of oxygen furnish  us with nitrous oxide, the
subject of our study; while a mechanical  mixture of
four parts  nitrogen  and one  of oxygen,  constitutes
the air we breathe.
  Nitrous oxide is a  colorless gas  of  sweetish odor
and taste, heavier than the  air, almost as vigorous a
supporter of combustion as pure  oxygen,  and can be
breathed not only without injury in the vast majority
of cases, but often with real benefit.
  To make it, nitrate of ammonia is  placed in  a
retort and exposed to the heat of a flame, which de-
composes it  iuto water and nitrous  oxide ; the latter
passing through the wash-jars and  being collected in
the gasometer. Nitrate of ammonia is the salt pro-
duced  by the combination  of nitric  acid  and am-
monia.  Nitric acid, we have seen, is  composed of
nitrogen and  oxygen; aud  ammonia  is  formed of
hydrogen and nitrogen.   By decomposing  at  the 
NITROUS OXIDE GAS.
205
 proper heat, the elements  choose to combine in an-
 other  manner; some of the oxygen uniting with hy-
 drogen to  form water, and the rest with nitrogen to
 form the  gas.  Great care is required in keeping the
 heat at the proper point during the generation of the
 gas, as a  temperature  a little too high  causes the
 formation of poisonous vapors.
   It is  a responsibility that  few dentists ought to
 take upon themselves,  especially since the invention,
 by Mr. Sprague, of Boston, of an attachment which
 automatically  regulates  the  heat upon  principles
 philosophically certain.  Then the nitrate of ammo-
 nia  should be perfectly  pure, and a series of wash-
 bottles interposed between the retort and the gasom-
 eter, should contain the requisite purifying chemicals
 to arrest  the  slight impurities that  arise, no matter
 how carefully the operation is conducted.   The  gas
 should then stand over water from eight to ten hours,
 —or a day or two would even be better.  " Fresh
 gas every day," sounds well to those who associate
 freshness  with excellence, but some things are better
 for being a little old.   Epicures  would hardly  pat-
 ronize the vender  who advertised  fresh  whisky,
 fresh wines, fresh cigars,  fresh pickles, fresh cheese,
 etc.   But  operators  that admiuister the gas much,
 have not time to let it stand, so people that object to
 old gas need not be afraid of getting it.   Although
absolute freshness is not an advantage, absolute puri-
ty is; and the way  to secure pure  gas is to have the
best apparatus, the  purest chemicals, sufficient chem-
ical knowledge and careful manipulation. 
206
NITR O US OXIDE GA S.
  The gas should be inhaled through a mouth-piece
which  has the valves arranged so that what is expired
from the lungs can not re-enter the vessel containing
the gas.  This method is far superior to the old one
of breathing from and  into a rubber bag, the con-
tents of which became more and more poisoned with
carbonic acid from the patient's lungs at each succeed-
ing breath.   In  that  way  the  person was  often as
much smothered by the carbonic acid, as influenced
by the nitrous oxide ; but  because consciousness of
pain was lost, the end  was supposed to be gained.
So it could have been  gained about as well by lower-
ing the patient into the choke-damp of a well, until
unconsciousness  was produced.
  Before inhaling the gas,  the mind should  be free
from all  fear either in  regard  to the possibility of
pain or of dangerous consequences from the inhala-
tion ;  not that the imagination of  evil effects will
cause them  to occur,  but  it may make a  very un-
pleasant and disagreeable operation of what otherwise
would  be a delightful  one.
  There should be a perfect willingness or even anx-
iety to inhale it,  and  the thoughts should  be fixed
as  much as  possible  upon  some pleasing subject,
such as music, scenery, travel,  etc.  In nine out of
ten of those cases where persons fail  to  become per-
fectly unconscious, or where they express themselves
as  being  disagreeably affected, the cause  is  to be
found  in some dread or fear that impressed  itself
firmly in the mind at the outset.   One common cause,
/ 
NITROUS OXIDE GAS.
207
 especially with ladies, is the determination not to say
 anything  while  under the influence  that may cause
 them embarrassment.  Such anxiety  I  believe to  be
 perfectly unjustifiable, for in daily administrations of
 the gas for six years, I never had a patient make use
 of an indelicate  remark, or do or say anything that
 would cause regret.  It is very rare indeed that a
 person who takes nitrous oxide for the purpose  of
 having teeth extracted, says a word.   It is not  as it
 is in  its administration at  humorous exhibitions, for
 then the gas is taken away just as soon as the period
 of excitement is reached; those  who dance, sing,
 laugh, fight, speak,  etc., would  keep  perfectly quiet
 and pass into the anaesthetic state, just  as in  having
 teeth  extracted, if not prevented.
   The power of studied resolves to interfere with tho
 usual effects  of anaesthetic  agents has  long been
 known.   Bouisson gives the case of a  young  soldier
 that feigned disease to avoid military service; he was
 placed under the influence of ether, it being supposed
 that his answers  to  questions would betray him, but
 " he  played his part so well as a dissimulator, as
 never to respond to  any question in  such a way as to
 compromise himself."  In detailing the effects of an
 administration of ether  to  himself,  M. Gerdy says :
 " My  lids seemed  heavy.  I wished  to sleep,  and
 above  all to abandon myself to the charm which in-
 toxicated me ; nevertheless, because / wished abso-
 lutely to observe myself to  the last moment, I did  not
abandon myself to the seduction which was fascinating 
208
NITROUS OXIDE GAS.
 me, and I did not sleep.  I  remarked  immediately,
 that  with the exception  of certain  vibratory  sen-
 sations which generalized  my sense of  touch and
 blunted the sense of pain, and with the  exception of
 a roaring in my ears which prevented my clearly dis-
 tinguishing what  I heard, my perceptions and my
 thoughts were very clear and my intelligence perfect-
 ly free."   In the majority of cases, the  gas is taken
 with  pleasant  feelings,  the anaesthesia is produced
 without trouble, several  teeth are  extracted without
 the patient's knowledge or resistance, and on awaking
 the operation is declared pleasant, or at least not dis-
 agreeable.  About a minute  may be considered the
 average time for producing the anaesthetic state, and
 its continuance may be estimated at three-quarters of
 a minute.  But sometimes persons are met with who
 take longer  to get under  the influence and  remain
 anaesthetized for a greater time; others  declare that
 they knew everything that was going on, but felt no
 pain and could not resist.  Others knew  nothing nor
 felt nothing,  but the general  sensation was very dis-
 agreeable ; and occasionally individuals are met with
who appear not to be affected by the gas at all, even
after breathing large quantities of it.
  The sensations existing during  the  operation, are
expressed iu various ways, and it seems in fact  that no
two persons are affected  in all respects exactly alike,
with  the exception of those who have no recollection
at all  of their impressions.   It may not be uninter-
 esting  to give a few instances of remarkable  varia- 
NITROUS OXIDE GAS.
209
 tions from the usual  experience had in the adminis-
 tration.   A young  lady, accompauied by her father,
 came into the office to have an upper molar extracted.
 She inhaled the gas properly, but just as the mouth-
 piece was removed, she closed  her teeth firmly to-
 gether and held them so until  she opened her  eyea
 and began, apparently, to awake.   She  had  con-
 sumed the contents of the gasometer, so her father
 told her to have it pulled without gas.   She  obedi-
 ently opened  her  mouth and turned her  head  far
 around for the light  to  fall  upon the  tooth, which
 was then extracted ; but in reply to our  inquiries,
 she informed us that she did  not know when tho
 tooth was extracted,  and had  nothing  but  most
 pleasant sensations.
   In another  case, a  young  lady who  had inhaled
 the gas at several offices without being  put to sleep,
 as she said, wished to  have a couple of badly decayed
 front teeth extracted.   She  inhaled two  or three
 times the amount  of gas usually required,  and kept
 shaking  her head  negatively during the whole time,
 to signify that she  was not  under the influence.  I
 took  the inhaler from  her mouth and  she at once
 began to cry out aud  to repeat: "Don't you dare to
 pull my  teeth; I am just as conscious as you are!"
 In accordance  with  the directions of her elder sister,
 however, who  previously told me to extract them in
any manner that was possible,  I proceeded to apply
the forceps, regardless  of  her  remonstrances,  and
succeeded in  removing the teeth.  We  were greatly
         18 
210
NITROUS OXIDE GAS.
surprised afterward to find that she  possessed  no
recollection  of what  had occurred.   She  probably
had been in  the same peculiar  coudition at  the other
dental offices, but they did  not feel  justified in pull-
in<' her teeth, which I certainly would not have done,
if  I had not received the instructions I did from her
sister.
   Another case was that of a girl of very nervous
temperament.   While  the  preparations  were being
made to administer  the gas,  she  fainted  through
fright.  I extracted  her teeth while she  was thus
unconscious and  then  brought her to by sprinkling
water on her face and arms.  She appeared to know
that she had fainted, but  not knowing of her teeth
beinf drawn, she began to  prepare  herself to inhale
the gas.
   Another  case is that  of a gentleman, who came
into the office to have some filling done.  Seeing  the
gasometer and  the inhaling tube before him, he re-
quested a breath or two of the gas, observing at  the
same time that he had  a carious wisdom-tooth that
he wished extracted  some  day,  but wanted to  see
somebody inhale  the gas before he ventured to take
it to the point of  unconsciousness.   He took only  two
or three  breaths, when  he let the  inhaler slip from
his mouth.  Seeing that he was  in  the anaesthetic
state, I  seized the  opportunity and  extracted  his
tooth.  Almost immediately he came  to, expressing
liis belief that it would be  impossible to anaesthetize
him.  It is  needless to depict his astonishment when 
NITROUS OXIDE GAS.
211
 the tooth was shown him.  The sight  of  blood was
 insufficient to convince him, mirrors and touch having
 to be employed in addition.
   All things considered, I have certainly had by far
 the  happiest results  when nitrous  oxide  has been
 administered to people of intellectual  culture, who
 have read or heard  of the delightful experience of
 others of the same class, and who possessing poetical
 imaginations, or  longings to  partake of  the  same
 spiritual feasts, are   anxious  to  enter  the dreamy,
 blissful  state that generally follows the inhalation of
 pure gas, when  the mind is untrammeled with dread
 or fear.
   People of the grosser kinds without refinement or
 mental  culture, and  those without any appreciation
 of the exalting  influences  of this exhilarating agent,
 may  be  either pleasantly  or unpleasantly affected as
 it happens; just as a man  may get drunk and enjoy
 it, or get drunk  and be sick.  What certainty is there
 in pleasant results from the administration of nitrous
 oxide to rough,  ignorant persons  that call  for "gas"
 which they know  by no other  name, and wonder that
 it conies from a  special gasometer, instead of the tube
 for illuminating gas; or want to know, when water
 is handed them  in a glass,  if that's "the stuff?"
   I have in mind a case connected with just such an
 individual.  He couldn't or wouldn't understand; he
 wouldn't  keep  his lips tightly closed  around the
 mouth-piece;  he either breathed as quick aud short
as a worried  cat, or with  the  labor of an asthmatic 
212          NITROUS OXIDE GAS.
patient; he persisted in keeping his  eyes  open; he
said the gas was sweet or not, pleasant or not, just as
he imagined you wanted him to.
  Finally he got his eyes shut and refused  to answer
questions.  My patieuce gave  out,  and I concluded
that his habitual lack  of sensibility was anaesthesia
enough  for  him; so I told him he was asleep  now
and asked him  if I  should  pull  his teeth.   He gave
his consent, and I wrenched out a large molar; he
wanted to spit, but  as I feared  he would pass out of
the anaesthetic state, I told him to hold on  till I got
the other  two out.  He stood it manfully,  and when
I got through he jumped up, slapped me on the back
and said:  "Gas iss  the best ding—I never  have him
pull  no oder vay."   He  had  not inhaled  a particle
of the  gas, but was immensely satisfied, and I don't
know how many patients his recommendation brought
me.
  In order to acquaint those who have not had their
attention  called to  the subject, with some  of  the
effects  of nitrous oxide, I  will give  some extracts
from the  recorded evidence of Sir Humphrey Davy,
and others who lent him  their aid in  his researches:
  "The first  inspirations occasioned a slight  degree
of giddiness, succeeded by a sensation  analogous to
gentle  pressure  on  all the muscles,  attended by a
highly pleasurable thrilling, particularly in the chest
and the extremities.  The objects around me became
dazzling, and my hearing more acute.  Toward  the
last inspirations, the thrilling increased, the sense of 
NI2-U0US OXIDE GAS.
213
muscular power became greater, and at last an irre-
sistible propensity to  action was indulged  in:  I
recollect but indistinctly what followed ; I know that
my motions were various and violent."
   "By  degrees,  as  the pleasurable  sensations  in-
creased, I lost  all connection with external  things;
trains of vivid  visible images rapidly passed through
my mind, and were connected with words in such a
manner, as  to  produce perceptions perfectly novel.
I existed  in a world of newly connected and newly
modified ideas.  I theorized—I imagined that I made
discoveries.   When I was awakened from this semi-
delirious trance by Dr. Kingslake, who took  the bag
from my mouth, indignation and  pride were the first
feelings produced by the sight of the persons around
me.   My  emotions  were enthusiastic  and sublime;
aud for a minute  I walked round  the room, perfectly
regardless of what was said to me.  As I recovered
my former state of mind, I felt an inclination to com-
municate  the  discoveries I had  made  during the
experiment.  I endeavored  to recall the ideas, they
were  feeble and  indistinct;  one collection of terms,
however, presented itself; and with the most intense
belief  and  prophetic  manner, I  exclaimed  to Dr.
Kingslake, 'Nothing exists  but  thoughts 1 the uni-
verse  is composed  of impressions, ideas,  pleasures
and pains.' "
   "On May  5, at night, after walking  for  an hour
amid the scenery  of the Avon, at this period rendered
exquisitely beautiful by bright moonshine; my mind 
214
NITROUS OXIDE GAS.
being in a state of agreeable  feeling, I respired  six
quarts of  newly prepared nitrous oxide.  The thrill-
ing was  very rapidly produced. * * *  The pleasura-
ble sensation was  at first local, and perceived iu  the
lips and about the cheeks.  It gradually, however,
diffused itself over the whole body, and iu the middle
of the experiment was for  a moment  so intense and
pure as to absorb existence.  At this moment, and not
before, I lost consciousness. * * * The thrilling and
the pleasurable feeling continued for many minutes;
I  felt, two hours  afterward, a slight recurrence of
them in the intermediate state between sleeping and
waking, and I  had during the whole of the  night
vivid and  agreeable dreams."
   "Of two paralytic patients  who were  asked what
they felt after breathing nitrous oxide, the first an-
swered: 'I do  not know how, but very queer.'   The
second said: 'I felt like the sound of a harp.' "
   The above extracts are  taken from several of Sir
Humphrey  Davy's experiments.   His  friend, Mr.
Tobin, thus expressed himself after inhalation of the
gas:
   "It is not easy  to describe my sensations; they
were superior to anything I ever before experienced.
My step was firm, and  all  my muscular powers in-
creased.   My senses were  more alive  to  every sur-
rounding  impression;  I threw  myself into several
theatrical attitudes, aud  traversed the laboratory with
a quick step;  my mind was elevated  to a most sub-
lime height.  It is giving but a faint  idea of  the 
NITROUS OXIDE GAS.           215
feelings  to  say that they resembled those produced
by a representation of an heroic  scene on the stage,
or by reading a  sublime passage in poetry, when
circumstances  contribute to awaken the finest sym-
pathies of the soul.  In a few minutes the usual state
of mind returned.  I continued  in  good spirits  for
the rest  of the day and slept soundly."
   Mr. Wm.  Clayfield  said:  "I  was for  some time
unconscious  of existence, but at no period  of  the
experiment experienced agreeable sensations; a mo-
mentary nausea  followed it,  but unconnected with
languor  or headache."
   The poet, Southey,  thus expressed himself: "In
breathing the nitrous oxide, I could not distinguish
between  the first feelings it occasioned and an appre-
hension  of which I was unable to divest myself.  My
first definite sensation was  a dizziness, a fullness  in
the head, such as  to  induce a fear of falling.  This
was  momentary.   When  I took  the bag from  my
mouth,  I immediately laughed.   The  laugh  was
involuntary but highly pleasurable,  accompanied  by
a thrill  all  through  me, and  a tingling in my toes
and fingers, a sensation perfectly  new and delightful.
I felt a fulluess in my chest afterward;  and during
the remainder of the  day, imagined that my taste and
hearing were more than commonly quick.  Certain I
am that I felt myself more  than  usually strong and
cheerful. * * * Now after an interval  of some months,
during which  my health  has  been  materially im-
paired, the nitrous oxide produces an effect upon  me 
216          NITROUS OXIDE GAS.
totally different.   Half the quantity affects me,  and
its operation is more violent, a slight laughter is first
induced, aud  a desire  to continue  the  inhalation,
which  is counteracted by fear from the  rapidity of
respiration; indeed, my breath becomes so short and
quick,  that I have no doubt  that the quantity which
I formerly  breathed  would  now  destroy me.   The
sensation is not painful, neither is it in the slightest
degree pleasurable."
  [After this letter was written, he again had pleas-
ant effects.]
  Coleridge, the   poet,  said:  " My sensations were
highly pleasurable, not so  intense or apparently local,
but of  more unmingled  pleasure than I had ever be-
fore experienced."
  Mr. Wansey thus expressed  himself:  "The effect
was gradual, and I at first  experienced fullness of the
head, and afterward sensations so delightful that I
can compare them to no  others,  except  those which
I felt (being a lover of music) about five years since
in Westminster Abbey, in  some of the grand choruses
in the Messiah, from the united power of seven hun-
dred instruments."
  Mr. Coates wrote in a letter to Mr. Davy:  " During
the rest of the day, I experienced a degree of hilar-
ity altogether new to me.  For  six or  seven  days
afterward, I seemed to feel most exquisitely at every
nerve,  and  was much  indisposed  to my sedentary
pursuits;  this  acute sensibility has  been gradually
diminishing; but  I still feel somewhat of the effects
of this novel agent." 
NITROUS OXIDE GAS.          217
   " Joseph  Priestley,  from breathing nitrous oxide,
generally had unpleasant fullness  of the head aud
throbbing of the arteries, which prevented him from
continuing the respiration."
   It. Boulton aud G. Watt  were less affected than
any.  These quotations  are  enough to  show what
pleasurable  feelings generally  attend the inhalation
of nitrous oxide ; by them  we see  also  that people
were affected in  different ways and degrees, then as
well as  now.  The gas being inhaled from a bag, if
it had been  taken to the state of profound anaesthesia
often, as it is now, unpleasant sensations would have
been more frequent, on account of the complete ex-
haustion of  the   nitrous  oxide and  the  substitution
of carbonic  acid from the lungs.
   Certain it is that with the  improved facilities of
recent  times, safety and pleasure ought to exist to
even a greater degree.   If they do  not,  it  must  be
attributable  to the fact that  in those days there was
no previous  unsettling of the mind  by the suffering
of toothache and  the  dread  of extraction.   Those
who  inhale  the   gas  for  curiosity  alone nowadays,
seem to experience even greater pleasure  than exper-
imenters did in  the time of Davy.   I know that in
my own  case  language is too tame to describe the
brilliant conceptions,  bright visions  and  glorious
imagery that fill my mind at  those times  when
every external influence is removed  and my soul ap-
pears to float away through space ; although I im-
agine while  in that state that it will be my pleasure
         19 
218          NITROUS OXIDE GAS.
and duty to  communicate my thoughts, and that I
shall be  able to do  so without  any of that embar-
rassment that so often mortifies me in speaking.
  With Sir  Humphrey Davy originated the idea of
using nitrous  oxide to prevent pain  during short
surgical operations.  Says he: " As nitrous oxide in
its extensive operation appears capable of destroying
physical  pain, it may probably be  used with advan-
tage during surgical operations in which no great
effusion of blood takes place."
  In another place:  "The power of  the  immediate
operation of the gas in  removing  intense  physical
pain, I had a very good opportunity of ascertaining.
In cutting one of the unlucky teeth called dentes
sapientice, I  experienced  an  extensive inflammation
of the gum, accompanied  with great pain,  which
equally destroyed the power  of repose, and  of con-
sistent action.  On the day  when the inflammation
was most troublesome,  I  breathed  three  large doses
of nitrous oxide.   The pain  always diminished after
the first four or five  inspirations; the thrilling came
on  as  usual, and  uneasiness was  for a few minutes
swallowed up in pleasure."   It would be  impossible
for any man to have such thoughts,  without having
at once forced upon his mind the idea of the painless
extraction of teeth by the use of nitrous  oxide.  If
Sir Humphrey  Davy or  any one of the friends  that
experimented with him had  been a  dentist,  there is
no doubt that it would have been so applied  at once;
but when we consider that dentistry was  almost un- 
NITROUS OXIDE GAS.
219
known and that the manufacture of gas in its purity
was difficult and the knowledge  confined to practical
chemists, it is not be wondered at that its application
for dental purposes was deferred  until a recent period.
The advantageous  use of  nitrous  oxide for certain
bodily complaints  began to be  noticed at the same
time.   For the later  investigations concerning its
medical uses  in asthma, consumption and other dis-
eases, the reader is  referred to an excellent work on
Nitrous Oxide, by Dr. George J. Ziegler, of Phila-
delphia.
  No matter what ignorance may exist in regard to
the gas and  its physiological  effects, there  are very
few that doubt its  power to speedily and certainly
place them in such a condition that operations may be
painlessly performed;  but  a vast number of people
have serious  doubts as to its safety, and the question
is  constantly heard,  " Is it dangerous  to take  tho
gas?"   The  correctness of the answer  "No,"  de-
pends upon the conception  of the meaning of "dan-
gerous."  My  opinion is that the  only true way of
answering the  question to  each  one's satisfaction is
by  comparing the number  of  accidents resulting
from the inhalation of gas  with  those resulting from
a thousand and one other things that people are  con-
stantly doing, and  yet do  not  consider  them espe-
cially " dangerous."
  Let a hundred thousand  people go carriage-riding
go gunning, cross  the  Atlantic,  take a long  railroad
journey, or take medicine, and far more fatality would 
220
NITROUS OXIDE GAS.
result than if the same people inhaled  nitrous oxide
to unconsciousness.  Yet people are constantly doing
these things  voluntarily and gladly, and when fatal
accidents  occur  no one is  blamed and  the survivors
straightway do the same things again.   But  if  one
death should occur in twice a hundred  thousand ad-
ministrations of  nitrous  oxide, I doubt not that the
public would become greatly alarmed and  gas would
grow stale in the gasometer, unless the dentist  should
happen to have  a grain of confidence left  and use it
up himself for fun.
  The subjoined statistical report,  based  upon  the
impartial examination of a number of cases by Prof.
E. Andrews, and published in the Chicago Medical
Examiner, speaks a volume in favor of  the safety of
nitrous oxide compared with other anaesthetics:
Ether,  .    .        .  1 death to 23.204 administrations.
Chloroform,    .    .   1   "  "  2.7*>3      "
Mixed  Chloroform  and
   Ether,              1   "  "  5 5S8      "
Bichloride of Methylene, .  1   "  ««  7.(00      ««
Nitrous Oxide,  .    .    No  "  " 75.000      "
  Mr. Sprague,  of Boston,  well known in connection
with nitrous oxide  and  the improved apparatus for
generating it, reports  that he has  taken  the gas to
insensibility "nearly two hundred  times within  the
last three  years,  with beneficial rather than injurious
results."   There have been only three  or four fatal
cases that have been attributed to the use  of  nitrous
oxide, and those  have been attended with extenuating
circumstances.   One was that of a gentleman  in New 
NITROUS OXIDE GAS.
221
York, nearly dead of consumption, who died a few
hours afterward.   Another was that of a young lady
of Vermont, suffering with a disease of the membranes
of the brain and  spinal  cord, who died several days
after inhaling the  gas for amusement.  Another case
was that of  a gentleman who died in  Philadelphia
before leaving the dental office, and whose death was
supposed to result from a tooth or piece of cork, that
was known  to have entered  his  windpipe.   Some
four years ago, a woman  died on the street not long
after  inhaling the gas  at some office in Cincinnati;
but the Coroner attributed her death to another cause
altogether.   Numerous reports have been made, how-
ever, of serious and enduring systemic injury result-
ing from notably  impure gas, or even  from purer gas
indiscreetly administered without  regard  to  certain
mental and bodily conditions.  From all the evidence
that has been adduced, it may be  argued that pure
nitrous oxide, administered with discretion in proper
cases, is safe.   Such administrations as that  noticed
in Sprague's treatise, are  hardly safe.  "At this time,
a lady acquaintance in  delicate  health applied to one
of those 'Pure Gas' offices, to have an offending molar
removed  by gas.   While she  waited, a  furious heat
was applied  to a  pint retort charged with  a crude
salt, and the gas forced rapidly  through a  single
small  washing-bottle into a four-gallon bag.   Soon
the bloated  bag  was brought out, the  lady gagged
with a cork, the   mouth-piece forced  between  her
jaws,  and she left, nolens volens, to breathe this com- 
222          Nil ROUS OXIDE GAS.
pound of corruption.   Insensibility from some cause
soon followed, and the tooth was drawn.   Upon  re-
covering consciousness,  she  experienced  a  violent
headache, nausea, and a sore  mouth.  The irritation
of her lungs was also increased, and for  weeks she
was a severe  sufferer.  Her experience  assured her,
and the wliole community, that nitrous oxide was not
safe.  Friends  and neighbors, and 'all  the doctors'
of the village, joined in condemning the use of such
a dangerous agent as nitrous oxide, while  not a sus-
picion rested upon  the knowledge  aud  skill of the
'excellent dentist.' "
   In  regard  to  the poisonous vapors  that may be
formed by fluctuations  of heat, Prof. Geo. Watt says:
"No man can give such attention to the  process, with
ordinary apparatus, as  will  enable him to  know that
he has not a mixture of nitrous and nitric oxyds in
his gasometer instead of pure nitrous oxyd.   With the
uncertainty of the ordinary processes of decomposing
nitrate of ammonia it is not  strange that  congestion
and soreness of the air-passages are so  frequently
observed after the use  of the nitrous oxyd. Defect-
ive apparatus in the hands  of the inexperienced, and
those without chemical education, is  likely to result
imperfectly.  *  *   *   Though a teacher of chem-
istry for nearly a quarter of a century, I never would,
never did, and never will use a nitrous oxyd appa-
ratus, even for amusement,  without the  ability abso-
lutely to control the temperature at which the gas is
generated." 
NITROUS OXIDE GAS.
223
   But even where the gas is  perfectly pure  there
 should much judgmeut be used before its adminstra-
 tion is decided upon.   In cases where  the increased
 force of the circulation, arising from its use, might be
 of serious disadvantage, great caution should always
 be observed, and sometimes it should not be adminis-
 tered at all.
   It is  not good policy to give  it in bad cases of
 heart  disease or far advanced  pulmonary  consump-
 tion, or to very old people.  Such persons  are liable
 to leave the world any day, and if death should hap-
 pen not long after the inhalation, there would  be  a
 distressing state of doubt, as to the cause, existing in
 both the minds of the patient's  friends and the den-
 tist.  It is well  known that " the pattern of  body
 which  is most prone to apoplexy is denoted by a  large
 head and red face,  shortness and thickness  of the
 neck, and a short,  stout, squat build."  Great care
 should  be used in giving the gas to such persons,
 especially after  excitement, exercise or full  meals;
 and if  they have had any of the premonitory symp-
 toms of apop'exy, or previous attacks, it should never
 be administered.  Various  temporary derangements
 of the body, and certain periodical and other condi-
 tions of females, should be made the subjects of con-
 sultation in order to insure  against results of a more
 or less unpleasant nature.   One of the greatest supe-
riorities  that nitrous oxide  has over ether and chlo-
roform, is in the rapidity  with which the patient
arouses from its influence upon the admission of air 
224          NITROUS OXIDE  GAS.
 into the lungs, if dangerous symptoms present them-
 selves.  There is no cumulative action to render the
 anaesthetic state  more profound after  the agent is
 withdrawn.   Were it otherwise, fatal accidents would
 frequently occur,  for  nitrous  oxide possesses  the
 power of destroying  life in a short time, if its inhala-
 tion should be continued much  too long.  But this
 should  be the  occasion of no alarm, for there is no
 more danger  of inhaling the gas to that point, than
 there is of making anything in common use a means
 of death.  A person may drown  himself in a basin of
 water if he will hold his head  under long enough.
 A cat confined in pure  nitrous oxide gives up its
 "nine lives" in three or four  minutes.   A  mouse
 dies in about a minute.  Dr. J. J. Colton, of Phila-
 delphia, says in a treatise recently published :   "Man,
judging from the  appearance of persons in the third
 stage of anaesthesia, which is effected in from thirty
 seconds to two minutes, could not survive its inhala-
 tion for a  longer period than from three to five min-
 utes, depending upon the age, condition of health  and
 susceptibilities to anaesthesia."
  In conclusion, I would ask pardon if I have  ex-
 tended  my remarks  on  nitrous  oxide to  a tiresome
 degree ; but  the  subject is  one of peculiar  interest
 and  one upon which the public generally needs in-
 formation, more  than  upon any other  subject  con-
 nected with dentistry.   Consider what has been said
 and  then " look here upon this  picture, and on this."
 An educated dentist, after spending much money and 
NITROUS OXIDE GAS.
225
years of time and labor in acquiring knowledge  of
the subjects connected with his profession, feelingly
responds to the entreaties of suffering humauity to
save them from pain; regardless of expense, he pro-
cures the best apparatus in the  market  and supplies
himself with the purest material; with sleepless eyes
he sits hour  after hour at  night watching  his retort
and seeing that the slowly bubbling gas on its way
to the gasometer through purifying chemicals, carries
with it no poisonous vapors.   Then when the morn-
ing conies  aud brings his  suffering brother  to his
door, he gives  him to drink of this delightful  fount
from  which poets  quaff inspiration;  leads  him  with
tender hand and watchful  care nearly to the " valley
of the shadow of death;" relieves him of his suffering,
and carefully conducts him back to happy conscious-
ness ; and then for  all these valuable  services, the
grateful  patient  thiuks,  because  some  uneducated
quack has so advertised, that  a sufficient  remunera-
tion is " fifty cents."  Do not the bones of Priest-
ley, Davy and Wells upheave in indignation the sod
that lies over their graves ? 
DENTIFRICES, BRUSHES, ETC.
 TV/TANY people who profess to be very careful of
 -^their teeth,  do them  more harm than good  by
 using injurious preparations.   Some depend altogeth-
 er upon soap as a dentifrice.   While  it is doubtless
 useful to destroy the animalcules of the mouth and to
 facilitate the removal of tenacious mucus, it is gener-
 ally conceded that its frequent use is injurious to  the
 gums on account of its alkalinity.  It does not  an-
 swer the purpose of a powder nor does a powder that
 of a soap.  It should be used occasionally, care beino-
 taken  to  rinse  the mouth  thoroughly  afterward.
Nothing but the purest Castile, or the best cocoa-nut
oil soap should be employed.
  Charcoal, as usually applied,  is  very  injurious.
Many persons are  attracted  by the  readiness with
which it removes the stains upon  the  teeth, and use
it freely in its simple pulverized state  and combined
in  the form of paste.   Its gritty, insoluble particles
insinuate themselves between the teeth and the '-urns
and destroy their  connection,  frequently  producing
inflammation of the gums and of the peridental mem- 
DENTIFRICES, BRUSHES, ETC.     227
 brane.   The finer  the charcoal  is  pulverized  the
 worse it is.
   Pumice stone may be spoken of in the same way.
 The injury arising from these substances may be cou-
 sidcred hardly appreciable, where  they are employed
 only occasionally  and applied with a pointed  stick,
 care being taken not to lodge them under the gums,
 and to rinse the mouth thoroughly.  Nothing is bet-
 ter in  the way of a simple grit  than  cigar ashes; it
 does  its work well and is soluble.  One of the best
 tooth powders for general use is the following:
 " Precipitated carbonate of lime,    .   .     .4 ounces.
  Pulverized  orris  root,    ....     f ounce.
      "      white sugar,    .    .   .     .  \\ ounce.
             slippery elm bark, ...     \ ounce.
      "      cuttle-fish bone,  .    .     .    •  \ ounce." .
 Color with carmine and flavor with oil of wintergreen
 or rose.   Persons making the powder for themselves,
 should  be provided with  a mortar and  pestle with
 which to  incorporate the  ingredients,  and a very fine
 sieve to rub the powder through when finished.
   In  coloring, the carmine and  cuttle-fish bone  are
 first ground together, and the other ingredients then
 added.
   Another is made thus:
 " Precipitated carhonate of lime,   .   .     .4 ounces.
  Pulverized orris root,.....2 ounces.
  Prepared oyster shell,.....2 ounces."
  Color and flavor if desirable.
  A good and very simple powder is made by mixing
equal parts  of prepared  chalk and powdered  orris
root, and  adding a little of the scrapings of fine  soap. 
228     DENTIFRICES, BRUSHES, ETC.

  These powders are all that are necessary where the
teeth and mouth are in a healthy condition ; if tartar
or diseased gums exist,  the  dentist should be con-
sulted.  The objects of the use of the powders are
to counteract acidity of the mouth, and to prevent the
accumulation  of tartar after  the  teeth  have  been
cleaned.   It  can be  laid  down as a  rule  that any
advertised preparation that whitens  the teeth speed-
ily, is injurious to the substance of the teeth,  and, in
fact, it is unsafe to resort to them anyhow.   The den-
tist can furnish preparations that will do all the good
possible, and  at the same  be harmless,  although he
may not get  them up in  such  handsome bottles or
boxes, nor with  such pretentious labels.
  A good and pleasant mouth wash, in cases of fetid
breath, inflamed gums, etc., is made thus.
Tincture of krameria,    ...    *   3 fluid ounces.
Eau de Cologne,.....6 fluid ounces
Oil of wintergreen,.....10 drops.
  Of this mixture add a teaspoonful or two to a wine-
glass of water.
  The best brushes are those which have the  bristles
pointed instead  of being cut with square ends; they
enter between the teeth  better.   The stiffness of the
bristles must  depend upon the condition of the gums.
If they bleed easily, a soft brush  must be first used,
but  perfectly healthy gums ought to  bear  without
injury the stiffest brush.
   The proper method of cleaning the teeth is partic-
ularly noticed in the chapter on Prevention of Caries. 
TOBACCO.
 rPHOSE who are addicted to the habits of smoking
 •*~  and chewing to excess, generally attribute to them
 whatever bad teeth they may have, aud are  contin-
 ually asking the dentist, "Is tobacco injurious to the
 teeth?"  Not that an answer confirming their sus-
 picion would cause them to  free themselves  from
 their bondage, but they appear curious  to know the
 full extent of their sufferings from their self-inflicted
 martyrdom.
  I believe that the direct effect of tobacco upon the
 substance  of the teeth  is not  injurious—possibly
 slightly beneficial from  its pain  allaying and saliva
 increasing  properties;  but this  is no argument in
 favor of its use, for when used to any great  extent,
 its  indirect evil  effects  are too evident.  Whatever
 lessens the nutrition, health and vigor of the system,
 injures the parts  associated intimately  with the teeth,
 their susceptibility to certain diseases being increased
 and their recuperative  power  decreased.  Anything
 that deranges the digestive organs, and causes  acidity
 of the stomach and sour regurgitations, produces a
condition very unfavorable to  the preservation of the
teeth.   These, tobacco is certainly capable of doing, 
230
TOBACCO.
and besides, it is  a notorious  fact, that the  greater
slaves  people  become to tobacco, the more uncleanly
do they become iu regard to their teeth.   Many den-
tists give it as their experience, that a larger propor-
tion of cases  of  periodontitis, abscess, abrasion  and
recession, occur in tobacco  users  than others,  and
that they  are  less  amenable  to  treatment.   That
severe  constitutional disorders  should follow the un-
restrained  use of  such  a powerful  agent as  tobacco,
can not be wondered at when  we  consider the viru-
lence of its poisonous  principle, and the number of
its  poisonous  adulterations.   A single drop of this
principle, nicotin, will   kill  a  good-sized  dog, and
birds  die at the approach, only, of a vial containing
it.  Antimony, lead, copper, copperas, corrosive sub-
limate, etc., are some of the  adulterations.   Indiges-
tion, emaciation, neuralgia,  paralysis, insanity, heart
disease, and a disorder  much like  delirium  tremens,
have been  ascribed to the abuse of tobacco.
   In  France, of  late  years, a  commission was "ap-
pointed to inquire into the influence of tobacco  in
the schools and  colleges."  It was ascertained  that
those who did not use it were so much better physi-
cally,  morally and intellectually, that "an edict was
issued, prohibiting the use   of  tobacco  in  these
national institutions, by which thirty thousand per-
sons were  at once forced to abandon it."
   Dr.  Willard Parker, of New York, says:  "Cigar-
makers, snuff manufacturers,  etc., have  come uuder
my care in hospitals and in private practice, and such 
TOBACCO.
231
persons never recover soon and in a healthy manner,
from any case of injury  or  fever.  They are  more
apt to die in epidemics, and  are more prone to apo-
plexy and  paralysis.   The same is true also, of all
who chew and smoke much."   Bearing these facts in
mind, it is easy to believe  that diseases about  the
mouths  of tobacco-chewers are more violent and less
easily cured, than those of other persons.
   It would of course be vain to expect that  the  de-
votees of  tobacco  would  sacrifice  the habit that
enthralls them, for  the sake of their teeth, when  the
most powerful arguments  that  are  prompted by  the
fear of mental and  bodily diseases fail to break  the
spell; but it may not be unreasonable to hope that a
compromise may be effected  by which the pleasures
of the habit will not  be detracted from, and yet  the
injurious effects  will be lessened, and the demands of
cleanliness and decency better answered.  After every
smoke or chew, brush the  teeth thoroughly, rinse  the
mouth and gargle the throat; thus the absorption of
much poison, and  the waste  of much  saliva will  be
prevented.   Afterward, especially  before going into
society, use some fragrant  tooth-powder, and I prom-
ise you that your teeth will  be  better preserved, and
you  will cease to be disgusting to your friends that
are  not  tobacco users.   No person  of refinement,
whether  patient or dentist, should give  or  receive
the offense of a breath  impregnated with the odor of
tobacco, which is always disagreeable  in close quar-
ters.  Many that find it beyond their  power to give 
232
TOBACCO.
up tobacco entirely find very little trouble in reduc-
ing the number of "chews" or "smokes,"  and the
quantity used each time.  The more  saliva saved,
and the less  poison of tobacco and adulterations ab-
sorbed, the better for health and teeth.
 
ARTIFICIAL TEETH.
  A FTER the loss of a few or all  of the teeth by
  ■^ negligence, accident or disease, it becomes the
 duty of the dentist to insert artificial substitutes.
   Such has been the advancement of this art during
 the last few years that now any number of teeth from
 one to a full set can be inserted, and in the majority
 of  cases can be made to resemble the  natural  teeth
 so nearly in appearance  and usefulness, that the loss
 is scarcely felt.   Considering  how essential the  teeth
 are to  good  looks,  mastication,  enunciation,  good
 health and enjoyment of life,  it is fortunate that the
 dentist  possesses such skill.  Yet  it is to be lamented
 that so  many thousands  of  people appreciate the
 natural  teeth so slightly, that they suffer them to go
 by  default and would rather have artificial teeth than
 submit to some  inconvenience and a little more ex-
 pense in  preserving  those  that  nature  gave them.
 Such  a course is certainly a violation of natural laws
 and doubtless brings its  punishment, for I believe it
 to be  a fact that the average duration of life in those
 that lose their teeth early and  resort to artificial ones,
is not so great as  in those that preserve  their  own
         20 
234
ARTIFICIAL TEETH.
teeth to late in life.  But after the natural teeth are
lost, of course the health is improved and life  pro-
longed to a greater extent by having artificial substi-
tutes, than by going without them.
  There  is no branch of dentistry that requires more
skill and general knowledge than the proper insertion
of artificial teeth.  The plates should  fit  the mouth
well and  be so applied as to exert  no injurious influ-
ence upon the soft parts or upon the natural teeth, if
any should remain.  The  articulation of the teeth
should imitate nature as nearly  as  possible,—the
cusps and prominences of one set being received into
the depressions of the  other so as  to  secure perfect
antagonism and occlusion ; this is so  important for
mastication and enunciation.   They should  not be
cumbersome  on  account of their  bulk,  while  they
should be of sufficient strength  to withstand all legit-
imate usage.   The color should be suitable  for the
age, sex  and complexion  of the patient, or should
correspond perfectly with remaining natural  teeth.
  The size and shape should be appropriate for  each
individual case.  The  material of  which the plates
are composed, should be of such recognized purity as
to preclude the possibility of injurious local  or  sys-
temic effects.
  The arrangement of the teeth and the perfection of
the work should be such that they  would not be sus-
pected to be artificial.  The teeth and plate should
be so accurately joined as to prevent the insinuation
of  particles  of food.   The dentist should  possess 
ARTIFICIAL TEETH.
235
 enough of the talent of the portrait artist to restore
 the  natural  facial expression ;  and, finally,  realizing
 that no two cases are precisely alike, he should  be
 endowed  with  that  versatility which enables  the
 skillful dentist to accommodate all of those  little pe-
 culiarities that are constantly presenting themselves.
 There is no doubt that first-class dentists everywhere
 are fast losing their interest in  mechanical dentistry,
 and  the  people  are to blame for the  change.   The
 dentist knows what judgment, skill  and labor are
 required ;  but the people, not having a just apprecia-
 tion, are often unwilling to half pay him for  his serv-
 ices, and rush with eagerness to the cheap charlatan,
 who gives them a mouthful of something to shout his
 praise and make  excuse for their own  penuriousness
 by abusing the extravagant charges of those dentists
 who can not consistently sacrifice  their consciences
 and the last vestige of their professional  dignity by
 descending to the level of the quack in recommend-
 ing cheap  materials, cheaply  put  together without
 regard to the patient's welfare.
  From what has been written in the previous pages,
 it will be  understood  that  the preservation of the
 natural teeth is to be advised in nearly all  cases,  in
 preference to resorting to artificial  ones.   An excep-
 tion exists  sometimes in the  case of deforming, irre-
mediable irregularity.  After one or more  teeth have
been lost, it is nearly always advisable to insert arti-
ficial  ones, unless  the natural teeth are so  crowded
that  the space  is  of advantage.    A  natural tooth 
236     PR EPA RA TION OF THE MO UTH.

should not be left without an antagonist, on account
of its subsequent elongation and loss.   If an artificial
tooth should not be needed for appearance or speech,
nor particularly for mastication, it is often required to
prevent the adjoining teeth from becoming irregular.

          PREPARATION OF  THE MOUTH.

  To secure the best satisfaction from a full or  par-
tial set of artificial teeth, care should be taken to put
the mouth in  a proper condition before  inserting
them.  Deposits of tartar about any remaining teeth
should be removed; decayed teeth  should be filled;
diseased  gums should  be cured;  and  all diseased
teeth that can not be  restored to a healthy condition
should be extracted.  It is  very bad policy to  have
a plate inserted  over old roots, and  yet there are
numbers of people that insist on having  it done, and
will go from dentist to  dentist that discountenances
the idea, until  they find one that to  humor them is
willing to sacrifice his better judgment  and convic-
tions of duty.
  The pressure of the plate upon the roots produces
inflammation of  the  surrounding  membranes and
gums;  diseased secretions  result  which injure the
sound teeth, taint  the breath and affect the general
health.   Besides, the  resistance of the roots prevents
that adaptation of the plate to the mucous membrane
which is necessary to keep  out particles of food, or
to make perfect suction. 
        PR EPA RA TION OF THE MO UTH.    237

   When a very few, only, of the natural teeth remain,
it is often best to have them removed, even if perfect-
ly sound.  This is especially the case where only a
few of the front teeth remain, for besides the diffi-
culty of  so perfectly joining  the  artificial to the nat-
ural gums that they will not be detected, the plate is
apt to press  away the gums from the necks of the
teeth,  loosening them and exposing the  cementum.
This usually  involves the trouble and expense of a
new plate, for it generally  makes a  patched job  to
add new  teeth to such plates.
   One or two sound  molars  on each side, can often
be left with advantage, especially if they  have antag-
onizing teeth to  keep them  from being pushed  by
nature from their sockets.
   After  the extraction of the teeth, if there are any
hanging  pieces  of  gum,  they  should  be  cut off.
Sharp or projecting portions of bone should  be clip-
ped off at the time and the dentist should be called
upon  occasionally that he may keep them trimmed.
If these portions of alveolar  process are  suffered  to
remain, they often make the gums very sore, and con-
siderably  retard their healing.   Tincture of arnica,
tincture  of calendula, and tincture of myrrh, some-
what diluted, or a decoction  of white-oak bark, are
excellent for  riusing the mouth to promote the heal-
ing of the gums.  Rinsing  the  mouth  alternately
with warm water and ice-cold water  for a number of
times as soon as possible after  extraction, aud after-
ward using several  times a day a wash composed of 
238          TEMPORA R Y PLA TES.
one-third  tincture of arnica and  two-thirds water, I
have found very successful.   It is a good plan to
change  the washes every few  days.   The  time re-
quired  for complete healing of the gums of different
individuals is quite variable.  It depends much upon
the number of teeth or  roots extracted and  their size
and firmness in the jaws, the thickness of the alveo-
lar processes, the power of nature to heal wounds in
other parts of the  body, the attention of the patient,
exposure and other circumstances.

               TEMPORARY PLATES.
  As a general thing  it is not  advisable  to insert
temporary sets of artificial teeth;  that is those which
are usually so-called—teeth  without  gums, put in
within  a few days  after extraction.   The impression
of the  mouth being taken at that time, the artificial
plate has all the  irregularities of the alveolar ridge
stamped upon  it, and  besides  irritating the  tender
gums, is apt to prevent them  from healing in that
smooth and regular manner which  is required for a
permanent set of teeth, satisfactory in all  respects.
It is a  risk that  often has to be  run,  however, by
public  speakers, and others who are in such positions
that they can not do without their teeth till the mouth
is well.  Many who have such sets just for appear-
ance sake, are often soon disappointed ; for although
the teeth may fit accurately into the  gums  aud look
naturally at first,  the  gums in a short  time  shrink
away, leaving a space between them and the teeth. 
TEMPORA R Y PLA TES.         239
   It is best to wait until the gums have shrunk, at
 least  sufficiently to allow gum-teeth to be inserted
 without  being too prominent; further shrinkage is
 then  not observed, as  it is hidden  behind  the  artifi-
 cial gums,  and after it is sure that there will  be no
 further contraction, the same  teeth may be taken off
 and  remounted on a  new plate.   In those cases in
 which the  natural  gums are so prominent that, even
 when  entirely healed,  they can not  have artificial
 gums  placed over them, it  is often very hard to tell
 what course to pursue ; if teeth are inserted while any
 doubts exist as to future contraction, they should be
 made to  press well into the gums, so that a little sub-
 sequent shrinkage will not cause a space.  But  while
 artificial teeth should not be inserted too soon, on the
 other  hand it is wrong to leave them out too long.
 Where all  the teeth on either or both jaws have been
 removed, the lips and cheeks  are  apt  to lose  their
 natural expression, and the  lower jaw often becomes
 partially dislocated and inclined to project; the gums
 moreover, having become callous by long usage, it ia
 much more difficult to  adapt plates  to them.  If nat-
 ural teeth are  left in either  jaw without antagonists,
 they become much elongated in course of time, some-
 times  coming so near to the opposite gum  that arti-
 ficial teeth  can not be inserted without cutting  away
a great deal of the natural teeth. 
240      SUCTION AND CLA SP PLA TES.
           SUCTION AND CLASP PLATES.

  Entire sets of artificial teeth used to be kept in
the mouth by the constant  pressure  of springs, ex-
tending from the upper  to the lower plates;  but it
was found that often after the breaking of the springs,
the lower plate would remain in  position by its own
weight, and that the upper one would stay on account
of the complete exhaustion of air between it and the
mucous membrane.  From  this  it was  ascertained
that the  springs might be abandoned altogether  by
having the upper plates larger and perfectly adapted.
Upper plates, either full  or partial,  are, nowadays,
hardly ever inserted any other way.  A good fit to
the roof  of  the mouth  is  generally sufficient, but
usually there is an air-chamber in  addition carved
out of the plate next to  the  palate, for the purpose
of exhausting more air.   If suction  plates are prop-
erly made, much less injury arises  from  their use
than from clasp  plates.   They should fit the mouth
perfectly, the edges of the  air-chamber should not
injure  the palate, the border of the plate, next to the
teeth, should not press the gums unduly so as to irri-
tate them, or cause  them to  recede, and the pressure
against the natural teeth should not be so great as to
move them much out of their position.   Where they
are crowded, a slight expansion of the arch is advan-
tageous.   Clasp plates have  the  advantage of small
bulk and perfect fixation, but no matter how accur-
ately the clasps  may be adapted, they are almost sure 
PORCELAIN TEETH.
241
in the course of a few years  to seriously injure  the
teeth they are thrown around, if they do not destroy
them altogether.

                PORCELAIN TEETH.

   Dental substitutes were formerly made from bone,
ivory, human teeth, teeth of cattle, etc.; but of late
years these have been  entirely superseded  by porce-
lain  teeth.
   The bulk of the latter is composed chiefly of silex,
felspar and a fine variety of white clay, called kaolin;
over  the  surface of  the  body is melted the  enamel,
consisting chiefly  of felspar.   Differeut  substances
are added to  imitate  the various shades of color seen
in the teeth and gums; thus oxide of titanium gives
yellow; platina  sponge and filings, a  grayish  blue;
and oxide of gold, a  rose red color.  While the teeth
are in a  soft state, platina pins  are sunk into  the
backs of them and become immovably fixed  by sub-
sequent baking at an intense heat.
   When well made they are almost perfect imitations
of nature, suffer no damage  during the process of
mounting them  on  plates, and are unchangeable in
the mouth.  As with  every  other article  manufac-
tured on so large a scale, the  market is flooded with
cheap porcelain  teeth, poorly made and composed of
poor materials.
21 
242
CONTINUOUS GUM.
          EirFERENT KINDS  OF PLATES.
  It would be quite a task to enumerate the different
bases which have been  employed  from time to time
for  the purpose  of mounting artificial teeth,  even
without attempting to give a description of them, or
to discuss their  relative  merits.  Scarcely a  year
passes without the discovery of several new bases or
methods,  which,  of course, for the  interest  of the
patentees, must be advertised in the most flattering
manner.   Some die  out  about as quickly  as  they
spring into existence, others more  slowly, but no less
surely; while a few, after a lengthy period of proba-
tion, succeed  in establishing  their claims of excel-
lence.   I  do  not propose to mention particularly any
of the bases for artificial teeth, excepting those which
are  either in  general use or have been tested so long
that their merits  are generally acknowledged; not
intending, by so doing, to disparage any of  those
that are struggling  for public  recognition, for  it is
only by such continual  experimentation that we can
hope to obtain what we never  have as yet succeeded
in discovering—a base for artificial  teeth, perfect  in
all respects.

                 CONTINUOUS GUM.
  Although but little used,  I mention  this style  of
work  first, because  it  surpasses  everything  else  in
answering most of the requirements of a perfect set
of artificial teeth. 
CONTINUOUS GUM.
243
  A platina plate is first made to fit the mouth, and
then plain teeth, or teeth without gums, are soldered
to it.  Every portion of the plate, except the surface
which is adapted to the mouth, is then coated with a
mineral compound like that of which  porcelain teeth
are  made.
  Finally,  over this  coating is melted gum-colored
enamel, which joins  gums, palate and  teeth  in one
continuous piece without joint or crevice.  Both the
platina plate and the  mineral matter being perfectly
pure and unaffected by any agent they may come  in
contact  with, the work is clean, tasteless and durable.
As  regards its natural appearance, it can be made  to
defy the closest scrutiny.  The teeth can be made  to
lap  over, project, or imitate any little irregularity  of
the  previous natural set; which can not be done with
gum teeth  mounted  on  other plates on account  of
interfering with the joiuting of the gums.  No matter
how much a person may show his  gums iu laughing
or talking, there  is no seam shown.  The elevation
and depression of the  natural gums over and between
the  roots of the teeth, may be perfectly imitated.
  Continuous gum work is especially applicable for
full  upper and  lower sets;  there are some  partial
cases in which it can  not be used.
  The objections urged against it are its weight, lia-
bility to fracture, and  expensiveness.  It certainly
weighs much more than any other kind of work, but
this is of real advantage iu lower sets, and  of no dis-
advantage in upper sets, if the  fit is perfect; for  if 
244              GOLD PLATES.
the plate  is perfectly adapted to the mucous mem-
brane there is enough atmospheric pressure to sus-
tain  many times  the  weight of the  heaviest set of
continuous gum teeth.
  If it falls on hard places it is more liable to break
than other kinds  of work, and is  more expensive to
repair, but it  should  not be allowed to fall.   Fine
watches will break in the same way, but I never heard
of anybody refusing  one  on  that  account.    The
expensiveness  can not be avoided, for the platina is
worth nearly as  much  as  gold, and such  skill and
ingenuity  are required that the cheap dentist  dares
not attempt it.
  Mineral  plate  is  but a modification of the above;
the platina plate is discarded, and the whole denture
is made of the mineral matter.  It is superior to the
other in lightness, but it can not be made  to fit the
mouth so well, and it  is very liable to fracture.

                  GOLD PLATES.

  For general use, gold  plate as a base for artificial
teeth, has  always  held the  first place in the estima-
tion of the dentist.  It combines  great strength with
medium weight and slight bulk.  It is pure, healthy
and unchangeable.  One or any number of teeth can
be mounted upon it.  No  matter how often  the set
may  be  broken it can be  mended  again and  again
without injury to the plate, can be  remodeled as
often as  necessary, and if finally abandoned  for 
GOLD PLATES.              245
another plate, it brings  its cash market value.   The
skillful  dentist loves to work with this  metal, for he
has no  better  opportunity to  show his superiority
over the rubber  charlatan.  In gold plates there is
no limit to the display  of  artistic workmanship, and
if the quack  ever  acquires the  necessary skill, he
gains such an appreciation  of his own labors that he
ceases to be a quack.
  The objections  to gold are these:  the  fluids of the
mouth and portions of food work their way between
the teeth and the plate;  the teeth are apt to be sprung
more or less out of place in  the course of time, de-
pending of  course  much upon the  strength of the
backings and the power of the masticatory muscles;
and the gum of each tooth being ground up to the
other, there  are a great number of joints made, which
are objectionable when  persons show their  gums.
Most of these  defects can be  remedied by riveting
on  block teeth, and all  of them by attaching block
teeth with rubber;  but with  the exception of the
part covering  the  palate,  the  set  is thereby made
about as bulky as a rubber plate.
  The expense of gold plates prevents many persons
from getting them  that  prefer them, but where this
obstacle can be  overcome, a well  made  gold  plate
will generally give better satisfaction than anything
else, excepting continuous  gum. 
246
CHE 0 PLA STIC METAL.
                 SILVER PLATES.

  A few years ago silver was used nearly altogether
in those cases where the patient could not afford gold,
but since the introduction of rubber, it is fast going
into disuse.  It makes a strong plate, weighs less
than gold, and  takes  but little room  in the mouth.
If it would remain as  when first put in the mouth, it
would  still  rank next  to  gold, but  it is  liable  to
objectionable changes.  The sulphuretted  hydrogen
of the  atmosphere discolors  it, as does the sulphur
of eggs, mustard, different kinds of game, etc.
  It is so acted upon  in some mouths,  that  the plate
is corroded through  in a few years;  occasionally,
where  kept well cleaned, it is worn for a long  time
without important change.   Silver in  its pure  state
is  too  soft  for dental purposes, and  it is generally
alloyed with a  small  portion of copper; many prac-
titioners  will not use plate  so alloyed, claiming that
it  often  produces serious local and general  effects.
Platina is the best alloy, preserving the purity of the
silver,  and remedying the liability  to tarnish.   Such
plates  r.re  generally far  more durable   than the
cheaper kinds of work.

               CHEOPLASTIC  metal.

  This is an alloy of tin, silver and  bismuth with a
small  amount of antimony.   A trial  plate is  made
upon which to  arrange the teeth to suit  the  case; 
              ALU. UINU. V PLA TES.           247

 this plate is afterward removed from  the interior of
 a flask in which it and the teeth have been incased,
 and into the vacuum is poured the melted metal.  A
 strong  set of teeth  is made  composed of block or
 single teeth and a continuous piece of metal holding
 them in position.   The access of fluids and  food, and
 displacement of the teeth are  prevented.   This is a
 method but little used, but I have taken it as a repre-
 sentative  of  several  kinds of alloy that are molded
 into plates in about the same manner.   No particular
 objection is  urged against the construction of arti-
 ficial dentures by such methods,  but for some reason
 or  other  no one  of them has  ever been  generally
 adopted, and it is  probable it never will.  Soire of
 them, however, seem to be  preferable to rubber for
 cheap substitutes.

                aluminum plates.

  Among the many recently introduced  bases strug-
 gling for precedency, no one presents such auspicious
 claims as aluminum.  It is lighter than any metal
 used in deutistry, weighing only  one-eighth as much
 as platinum,  one-seventh  as much  as  gold, and one-
 fourth as  much  as  silver.  Although  it was discov-
 ered as long ago as 1S27, it is only of late years that
it has been produced in sufficient quantities to be of
service.  Even after the supply became abundant, it
was for a long time  impossible to either pour a dental
plate of it, or to solder teeth to it.  Both of the obsta- 
248
"ROSE PEARL.
 cles have been  surmounted, and all  that  aluminum
 needs  to  establish  its claims of superiority over all
 of the cheaper bases, is to stand a few years more of
 trial as successfully as it has done thus far.
  It resembles silver somewhat in color, is about as
 hard, and more tenacious.  It neither changes color
 nor corrodes, and is tasteless.  Plain, single gum, or
 block  teeth can be used,  and whether  the plate is
 poured, or has the  teeth soldered to it, the crevices
 and joints are  filled so as to  keep out fluids and
 food.

                 "rose pearl."

  This romantic name is given to a base of compara-
 tively recent introduction.  It is intended as a sub-
 stitute  for  continuous  gum,  and  it  claims  some
 advantages over that kind of work in  that it is by
 far lighter in weight and much less expensive.  The
 teeth used are single and without gums, so that they
 can be arranged on  a swaged rose-pearl plate, to
imitate  any irregularity of nature.   The material in
a plastic state is afterward  added to secure the teeth
to the  plate, and to build  out the gums to  the re-
quired thickness, so that when the work is done, the
gums and  the plate are united in a continuous piece
without any seams showing.  The color of the plate,
though  not a perfect imitation  of  nature  like  con-
tinuous gum, is  tolerably near to it, and much more
natural looking than pink  rubber. 
"ROSE PEARL."             249
  It has its earnest advocates and its violent opposers.
The opposition  to it is  mainly on the ground that
there is so much shrinkage of the material in drying
that it is  impossible  to make a perfect fit.   This is
doubtless  a specious  argument, for the added mate-
rial, spoken of above, is  more than half ether, all of
which must evaporate, leaving an alveolar border of
one-half of the bulk of the original plastic mass.
The plate covering  the  palate, being well  seasoned
beforehand, may be clamped  firmly to the cast while
the set is  being  dried in  the  oven, but I regard it as
simply impossible  to  prevent the parts of the base
under the teeth and next to the gums, from drawing
away from the cast of the mouth.
  Besides, there are  always some  crevices left about
the teeth, which allow the entrance of the  fluids of
the mouth and fine particles of food.  These crevices
are only  imperfectly closed  by  pressing  down the
edges of the material with heated instruments.
  Rose-pearl,  then, falls  short of continuous gum  in
being not  so cleanly,  not of such a natural color, and
in not being a perfect fit; yet there  is no doubt that
the perfect adaptation of the plate over  the roof of
the mouth may be sufficient,  in the majority of cases,
to retain the plate in position.  Some have objected
to rose pearl on account  of the taste of its ether  in
the mouth, and its warping in use.  I hardly believe
that these things occur, when the plate is thoroughly
evaporated before it  is inserted.   Pyroxyline, a still
later  base, is,  like rose-pearl, a compound of  collo- 
250         VULCANIZED RUBBER.
  dion, or gun-cotton.  It is open to some of the same
  objections, while  it is  not  intended to imitate con-
  tinuous gum at all.

                vulcanized  rubber.

    For some years rubber has been more commonly
  used than any other  base for artificial teeth.   Like
  everything  else it has  its  merits  and its demerits,
  but, as generally used, the latter certainly outnumber
  tho former.
    The best features that it possesses are the perfect-
  ness of its adaptation to the mouth, and its cleanliness.
    The soft rubber being shaped and hardened upon
  the original east of the mouth, a perfect fit is secured:
  and as all spaces behind and between  the  teeth  are
  filled up with the base, all fluids and particles of
  food are excluded.  Though not nearly so  strong as
  well made metal  plates, it  is strong enough for all
  ordinary purposes; but even this  degree of strength
. can  only be secured by  a  great   increase of bulk.
  Rubber  plates, in their  thinnest portions, are  gener-
  ally from six to  ten  times  as  thick as gold,  and in
  other places from twenty to  forty times  as  thick.
  Teeth in blocks of three  and two generally have to
  be used, and they can not like single teeth be  set in
  and out  to correspond with all the little irregularities
  of the opposite teeth;  as a result, therefore,  in  the
  majority of eases, correct articulation is sacrificed for
  the sake of an evenness, generally unnatural,  of  the 
VULCANIZED  RUBBER.         251
 external arch.   The joints have to be perfectly made,
 and care  has to be used in pressing  the  rubber, to
 prevent the blocks from separating, or cracking, and
 the rubber from showing.
   Rubber plates do not allow frequent repairing as
 metal  plates do; for new rubber having to be added
 and baked  each  time, the  original  plate becomes
 darker, harder and finally so brittle as  to be useless.
   They are often much objected to  on  account of
 their causing a disagreeable sensation  of heat  in the
 mouth;  for being  such  poor conductors, cooling
 drinks and draughts of air have little effect in lessen-
 ing  the  temperature under  the  plates.  From this
 cause,  it is generally conceded that sore, spongy and
 Bcalded gums frequently arise.  The  distressing ef-
 fects of mercury upon the system have at times been
 attributed to the use of rubber plates. It  has been
 the subject of much discussion for years, some claim-
 ing that mercury as  incorporated in the coloring
 matter of the rubber  is inert, and others  asserting
 that it is capable of exercising all of its  poisonous
 properties.  The subject of mercurial  poisoning has
 been noticed in the article on Amalgam.
  Reputable dentists, everywhere, are opposed to the
 use of rubber, although they  have  to employ it to
 meet the public  demand; for it has done  much to-
 ward detracting from  the  dignity of  the profession
and interfering with its advancement.   The process
of fitting a rubber plate to the mouth, and attaching
teeth to  it in some way or other, is so simple that 
252         VULCANIZED RUBBER.
any quack can acquire a knowledge of it in a few
weeks and start out as a dentist.
  And dental education among the  people being  at
such  a low stand, the rubber  charlatan can always
find numbers that eagerly accept his offer to pull out
all their teeth and insert  new ones at about the cost
of shoeing a horse decently.   But the best qualities
of rubber, in  the hands of good dentists, often sub-
serve  a  useful  purpose,  where  the  best  teeth are
selected with judgment, fitted with care, and  all the
skill possible  is put upon the work.   In  attaching
teeth  to rubber by means of  gold supports or block
teeth  by rubber to gold plates, and  in various other
combinations of gold  and rubber, there  is  room for
great  display of talent; but the dentist must be fair-
ly remunerated for such  work.  Rubber for dental
purposes is of various colors, white, brown, red, black,
pink,  etc.   Black is the strongest, but  very few can
be persuaded to take it.   Red is  the color generally
used as it is less objectionable than black and  strong-
er than pink.  But pink  rubber  is  preferable when
properly strengthened with gold, or when  used  as a
coating over red rubber at the more exposed portions
of the plate; by hardening at the right  temperature
and by certain means  employed afterward, it  can  be
made  to approach gum-color so nearly as  to escape
detection in most cases. 
PIVOT TEETH.
253
                  pivot teeth.

  There is no  artificial  substitute  that  imitates
nature so completely  and,  in  favorable cases,  pro-
duces so little discomfort to the patient.   A pivot
tooth consists of  an artificial crown, in which there
is a hole which comes opposite that in the center of
the natural  root; the root is filed  off  even with the
gum, or a trifle below,  the canal is  enlarged, and the
crown is fitted to it and ingrafted upon it  by means
of a pivot of wood or metal.   The six front roots
above and below, especially  the former, are the only
ones upon which it  is  advisable  to  ingraft  pivot
teeth.   The roots should be  solid and  free from dis-
ease.  As the requisite drilling and filing sometimes
excites peridental inflammation, it is generally advis-
able to extend the operation through several sittings,
and  then to have  a  temporary pivot  fitted  rather
loosely for a few  days.
  Well-seasoned  hickory is  generally used for per-
manent   pivots,   but  commonly they  have  to be
changed  every few  years at furthest;  besides, teeth
so inserted are not so cleanly on account of the insin-
uation of fluids and particles of food into  the space
between crown and root.   The better, but more ex-
pensive  way, is to have a gold tube inserted into the
root, into which  a gold  pivot extending  from the
crown, fits tightly enough to  retain  it in position, but
not so firmly as to prevent  the frequent removal of
it for the purpose of cleaning. 
254          REPLANTING, ETC.

   Pivot  teeth in the mouths of very careful  people
sometimes last a great many years without injurious
effects; but generally they are worn much too long
by those that  hold on to them after  the roots  decay,
become loose, or have abscesses formed at the extrem-
ities, regardless  of bad breath, inflamed  gums, and
the injury to the other teeth by vitiated fluids.

                replanting,  etc.

   Numerous  cases have  been recorded in  which
natural teeth removed by accident or mistake have
been replaced  in their sockets, and have  grown firm
in their places again.  Encouraged by these instances
of tolerance on  the part of nature, it has become a
common  practice with some dentists to  experiment
by replanting extracted teeth, not too badly decayed,
which  have refused to submit  to treatment, or which
the patients would  not have treated.
   Success attends the operation frequently enough to
justify the trial, and it would be performed  much
oftener were it not that many patients object,  think-
ing that there would be a recurrence of their troubles
if the offending member should be replaced.   This is
not a valid objection, at  least as far  as any present
trouble is concerned, for if the forbearance of  nature
is not secured, the tooth may be very easily extracted
again, generally by the fingers  of the patient.   Teeth
affected with decay and abscess have been extracted,
and after the  sac  has been cut off and the  decayed 
REPLANTING, ETC.           255
place filled, have been replaced, afterward doing good
service.
  Operations still  more singular have been success-
ful.   Dr. Garretson, of Philadelphia,  gives the fol-
lowing case:
  "I  once, as an experiment, replaced in the mouth
a central  incisor  tooth, which  had  been  extracted
twelve hours before, and  although it had been car-
ried in the pocket, enveloped in the usual  collection
of dust, tobacco, keys,  knife, etc., the whole inter-
vening time, I  kept it in its socket  until  the parts
became reconciled.  Many years have since passed,
and  it seemed  to me, when last  I saw it, about  as
useful as in its  palmiest days."
  In  my own  practice I recently  had the  following
case: A youth  having been kicked in the face by a
horse a few days before, was brought to me with one
of his upper incisors broken entirely off at the margin
of the gum. As an experimeut, I extracted the root,
joined the crown to it by a gold pivot and Guillois'
cement, and three hours afterward  replaced it into its
socket.  No trouble of any kind  followed, and  now
alter a lapse of four months, the tooth is as firm and
useful as any in the mouth. 
DEFECTS OF THE PALATE.
T7ROM  malformation, accident,  or  disease, various
■*-  defects of the palate  may result, which interfere
to a less or greater extent with mastication, swallow-
ing, speech and comfort.
  The inconvenience may at times be so great as to
take away all  pleasure of life until it  is remedied.
There  may be a simple perforation of the  palate
only, which the patient  readily  learns to close  by
seme  home-made appliance ; or  a large portion  of
the palate  and bones may be missing, requiring the
most complicated apparatus.
  It would be  consuming space  unnecessarily to
mention  the different kinds of palatine defects, and
the method of remedying each, as the cases  are gen-
erally so urgent that patients need no solicitation to
avail themselves of the best surgical or dental skill.
Suffice it to say that by  the operation of staphylor-
aphy, by  the insertion of obturators to close  open-
ings or artificial palates  to restore lost portions, the
majority of palatine defects may be perfectly cured,
or  much improved.   The operation of staphyloraphy
consists  in paring  the  borders  of  the cleft  palate, 
DEFECTS OF THE PALA TE.        257
stitching  the raw edges  together, and trusting  to
nature to  unite them.  The adaptation of obturators
and  artificial palates, requires  more  ingenuity and
skillful workmanship than any other branch of me-
chanical dentistry.
^P
22 
QUACKERY.
HHHE American people have long enjoyed the unen-
-L viable reputation of being the most easily huin-
buo-"-ed of anv nation  in  the world.  In  no other
  CO         •/
country do  cheap auctions,  dollar stores,  traveling
impostors,  catch-penny advertisements, quack doc-
tors, etc., find so many dupes.
  But in  nothing is this  trait exhibited to such a
remarkable degree as in the love the people  have for
"cheap dentistry."  On this account, many good men
who have striven  hard to elevate the  profession, and
to cultivate  the appreciation of the people, have re-
tired in disgust, and many more would do likewise if
opportunities should offer for them to gain a better
livelihood in some other way.
   A still  larger  number, equally disgusted, yet love
their profession so dearly that they cling to it, hoping
for the day to come when the scales shall  fall  from
the eyes of the people, although they can not but see
that  dental  quackery becomes  more rampant  from
day to day.  Thousands of persons that would scorn-
fully refuse  the  attendance of a quack physician, or
 who would be ashamed to wear imitation  jewelry or 
DENTAL QUALIFICATIONS.        259
 cheap clothing, think it no disgrace  to patronize the
 lowest dental charlatan.
   Numbers of people that spend their  thousands in
 their summer travels, horses, carriages and diamonds,
        " And sacrifice to dress,
          Till household joys and comforts cease,"
 become  strangely economical in their dental expen-
 ditures.
   This state of affairs is  to be attributed mainly to
 two causes—the lack of that  dental information that
 I have endeavored  to lay before my readers in the
 preceding pages of this volume, and the failure to
 discern the distinguishing marks  between the true
 profession of dentistry aud dental empiricism.
   With  a few remarks upon the latter and some
 kindred subjects, I shall conclude.

             dental  qualifications.

   Webster defines a quack  to be "one who boast-
 fully pretends  to knowledge not possessed; an igno-
 rant and  pretentious practitioner in  any branch of
 knowledge."  In dentistry the  meaning of the term
 is extended to embrace those that have not served the
 term of pupilage and tuition that is required before
 they are deemed worthy of college diplomas, together
with those,  still  lower  in reputation, who, having
graduated, are unwilling  to  labor for  respect and
reputable patronage, and disgrace their Alma Mater,
and  detract from  the dignity of the  profession by 
260        DENTAL QUALIFICATIONS.
resorting to cheap advertisements and unprofessional
trickery.  What a state of society is that when intel-
ligent people in an  enlightened  country, lost  to all
appreciation of one  of nature's most valuable gifts,
cast  their  pearls  before  swine  by patronizing  the
laboratory student of a few weeks'  experience, who
flaunts  his banners  proclaiming "cheap dentistry,"
rather than pay a little  more  for the services of the
worthy  practitioner who  has spent  years of his life
and much of his means in properly qualifying him-
self!  When a man makes a quack dentist of himself,
he could not by words more  plainly express the fact
that he is  not  qualified  to command a first-class
patronage.  If he  could, he  would certainly  prefer
it, but knowing his  inability,  his only hope  is to get
up  an extensive  practice among the ignorant, poor
and penurious.
  A dental diploma does not of itself, however, make
a competent dentist; but it shows that he has  appre-
ciated the importance of his calling enough to place
himself in  the  proper  position for acquiring the
requisite knowledge, and it is a letter of introduction
to public notice from an experienced faculty,  assert
ing that the graduate is master of the theory of den-
tistry, and has passed a creditable examination.  The
start being right, the most of the requisite knowledge
and skill  is to be acquired by study and  experience
afterward.  No professional men are more exposed to
criticism  than dentists, and people  are  constantly
taking  them to task for failings that often have noth- 
DENTAL QUALIFICATIONS.       261
ing to do with their competency.  Some prefer an
old man to a younger one on account of his  greater
experience; others  prefer the latter  because they
think that the sight  of the former is not so good, or
that he  is an old fogy, or that he has become too
independent  or  indifferent.    Other   things  being
equal, a dentist ought to improve as he grows older,
within certain limits; but  some men can learn more
in five years than others can in  a lifetime.
  One dentist may make so many grammatical errors,
mispronounce  so  many words of his own language,
and murder  his Latin so extensively, that he causes
his refined and educated patients to  leave him iu  dis-
gust, and yet  he  may be a skillful  operator  and an
excellent mechanic.   His  manner may be harsh, his
dress  may  be out of style,  he may  hold opposite
political  and  religious  views,  he may be  of very
homely  appearance,  he  may  be poorly educated in
general matters, and  a poor conversationalist, and yet
his dental work may be of the best quality.   But no
dentist is worthy  of  reputable  patronage that is not
master of his profession, a gentleman in his manners,
cleanly about his office, free from demoraliz ng habits,
honest in his dealings with his  patients, aud  of good
character;  while  he may  reasonably  expect  to  be
more and more successful, the  more nearly he meets
the requirements  of  modern, refined, intellectual  and
religious society. 
262           ADVERTISING, ETC.
                ADVERTISING, ETC.

  The prevailing feeling among dentists of repute in
regard to dental advertisements is about the same as
that expressed in the Code of Dental Ethics:
  "It is unprofessional to resort to public advertise-
ments, cards, handbills,  posters, or  signs, calling at-
tention to peculiar  styles of work, lowness of prices,
special modes of operating;  or  to claim  superiority
over neighboring  practitioners;  to publish reports
of cases  or certificates in the  public  prints;  to go
from house to house to solicit or perform operations;
to circulate  or recommend nostrums; or  to perform
any other similar acts."
  No dentist  is ever censured for  putting  up  neat
signs with his name  and  title, or for issuing  any
number  of  similar  cards or  advertisements  to  call
attention to  his  place of business, and invite  the
public patronage;   but  how  far  he can  transgress
these bounds and maintain his professional  standing,
has been a subject of much discussion.  On the one
hand, those who after years of effort have established
a large practice, are often, doubtless, too stringent;
while, on the other,  those who have  not been success-
ful, or those who are just  beginning to practice, are
often too  liberal  in  their views.  In  many cases,
where the  striving dentist keeps  anywhere near the
bounds of propriety, more leniency ought to be exer-
cised by his professional  brethren;  for domestic
wants, unpaid  bills  and empty pockets are  strong 
CHARGES.
263
incentives  for  a  man  to do  many  things  to  court
patronage,  that he would scorn  to do  in  better cir-
cumstances.  But when  a man openly disregards all
claims of professional  decorum, and resorts  to paid
puffs, advertisements of cheap rates, or work superior
to that of others, be becomes a quack, no matter what
his standing may  have  been previously.

                    CHARGES.

   There is  such a wide  range  between  the fees
asked by different dentists, that confusion often  re-
sults among patients in  estimating what is and what
is not an equivalent for  prices paid.  There are two
extremes—that of extortion on one side, and that of
empiricism on the other.  It seems to me  that  the
fair deutist ought to avoid both extremes, and require
only a reasonable remuneration; but every one has  a
right to place his own  estimate  upon his  services,
provided that  the  patient  is informed of the price
before the work is done.  It is certainly poor policy
for a dentist  to overcharge  his patient because he
knows that he possesses abundant means;  it is like
killing  the goose that laid the golden egg.  It is  a
question to  be decided  by  one's  own  conscience,
whether or not it is  right for a professional man,
standing as a public benefactor, to exact such fees
that the wealthy alone can secure  his services.  One
thing  is   certain,  however,  that  a  dentist whose
charges  are  high, is  rarely guilty of doing poor 
264
JTA RRANTIES.
work, and the latter is a more disgraceful accusation
than the former.
  The same truth, that a dentist has a right to  set
his  own value upon his  services, holds good  even in
the  business of the charlatan.  If he finds his duties
so pleasing to his  tastes that he considers five or  ten
dollars, and the inhalation of a  fetid breath, a suf-
ficient remuneration for a  protracted operation upon
a diseased mouth, extracting old  roots and inserting
a set of his inimitable  teeth, well  and good,—no one
envies him his  job.

                   WARRANTIES.

  The  most  reputable  practitioners ot  dentistry
never warrant their work;  quacks, without a dollar
in their pockets, and whose promises are worth even
less, will guarantee against all accidents, possible and
impossible, for all  time to come.  It is deemed unpro-
fessional to give warranties.  In  taking  this stand it
is intended to teach the  people  that dentistry is a
branch of medicine just as much as is the profession
of the oculist or the aurist, and that its practitioners
are  entitled to the same respect.
  What  person afflicted with a disease of the  eye or
ear, would  insult  his  physician  by asking  him to
warrant that he should  be cured  and should remain
so?  No one engaged in any business or profession,
has as much responsibility expected of him as  the
dentist. 
1VA RRANTIES.
265
   When persons are  sick they send for a physician
 in whom they have confidence, ask no guarantees, and
 trust altogether  to his honor and professional repu-
 tation.   If after a certain  length of time he fails to
 do them any good,  they may dismiss him and send
 for another; yet they pay him for every visit without
 grumbling, just  as if  they had recovered under his
 care.   The lawyer receives  pay for  his  services,
 whether he loses or gains his suit.
   People buy watches and jewelry that are subjected
 to far easier  usage  than the teeth are, and though
 they break again and  again, they expect to  pay for
 repairing.  A fine vehicle  bought to-day, may have
 a wheel  knocked off to-morrow, and an extra charge
 is made for repairing.  The shoemaker gets paid for
 patching, and the tailor for mending.
  Even  the works of nature give way;  trees  blow
 down,  aud  living things die unexpectedly, but the
 work of^he dentist is often expected to be infallible.
 It is not an uncommon thing  for a person to wear a
 set for  five or ten years with  every satisfaction, and
 then if a tooth comes off, demand that it shall be put
 on again without charge.  Others, with  mouths  so
 unfavorable that it is  impossible  to  adapt a  set of
 teeth  to  them, although  the dentist tries again and
 again to  do it, generously  offer  not to trouble him
 any more if he will refund  their money.
  To those  that are acquainted with the good profes-
sional standing  of a dentist, his promise to  serve
 them to the best of his capacity should be enough.
         23 
266           DENTAL HARMONY.

  To transient patients that know nothing of his repu-
tation, there is nothing  unprofessional iu warranting
that the  materials used shall be of the  quality con-
tracted for, and  that  he and his assistants will exert
themselves to the best of their  ability to make good
all representations.   But it is unprofessional and one-
sided for a dentist to  warrant fillings to last a certain
number of years for those that may make no effort to
preserve them, or to  warrant artificial sets  of  teeth
not to break for those that may  fracture them by  the
roughest usage, or  by accident, and  then  attempt to
impose upon the dentist by asserting that they broke
without any strain whatever.  Every dentist knows
that it is to his interest to do all he can, consistently
with duty, to satisfy his patients; and there are very
few practitioners indeed, that will  not go to the full
limit of their  obligations  in re-filling, re-inserting
plates, or  in correcting  any errors, to retain  their
patients.  But if any  misunderstanding as to the den-
tist's responsibility should arise, the patient should
not  make  the  deutal office  the  scene of  unpleasant
wrangling, but should exercise  his liberty of leaving
his dentist just as he would a physician that treated
him unsuccessfully.

                DENTAL  harmony.

   Dentists, like other professional  men, have their
piques, cliques, jealousies, disputes aud  prejudices,
which, however  much  they may be deprecated,  can 
DENTAL HARMONY.          267
hardly be wondered at as long  as  human nature is
what it  is, and different schools, sectional peculiari-
ties, and individual rivalries exist.   Those animated
discussions that take place at dental societies and con-
ventions, and in the different periodicals, doubtless
result in great good by eliciting the various views of
the  combatants, and  starting an energy of  thought
that would not be aroused in any other way.
   But when  the dentists of any  one  locality can not
agree among themselves, and descend to petty quar-
rels  and personal envy and  abuse, they certainly
thereby much hinder the advancement of the profes-
sion; for its  progress depending  upon the estimation
of the people, it is not natural that  they can have the
greatest respect for those that on account of  private
envy, or  mercenary motives, endeavor"to injure one
another.
   Travelers through various sections of the country
have  noticed great difference in  the amount of har-
monious  feeling existing  among dentists.  In  some
locations, the dentists, bound by  the strongest bonds
of fraternal feeling, crowd  their offices together in
the same building, meet often  in social intercourse,
shield one  another's faults, attend to one another's
practices during absence, and extend  the hand  of
welcome  to all worthy incoming practitioners.   In
other places, they scatter their offices far apart, sel-
dom or never hold meetings, make  mole-hill failings
into mountain faults, would rather drop at their chairs
than trust  their practices to oue another, and  turn 
268          DENTAL HARMONY.
the cold shoulder to those that are striving to advance
themselves, till they are  driven away from the place,
or become quacks through desperation.
  No  honorable  dentist, however, can refrain from
treating the charlatan as he  deserves, for such  a man
is the avowed enemy of the  profession, and makes it
his whole object to degrade it.  And all dentists being
open to public criticism, if  they depart so far from
propriety in their professional labors or social rela-
tions as to make their  faults  notorious, their most
forgiving brethren can  not  help being occasionally
drawn  into conversations that may be disparaging to
them.


  In placing this volume  before the public, I would
only say in conclusion, that  if my endeavor to give
the people useful information  concerning the  teeth,
and to call attention to various subjects  of mutual
interest to the dentist  aud the public, have been suc-
cessful  in awakening a  better  appreciation of the
teeth and of the profession that  makes the preserva-
tion of  them a specialty, I am abundantly rewarded.
  But if I have failed in my object, and  the reader
feels like saying:
        ' I pray thee, cease thy counsel,
         Which falls into my ears as profitless
         As water  in a  sieve,"
I shall at least take  comfort in thinking with Byron:
  " 'Tis pleasant sure to see one's name in print;
   A book's a book, although there's nothing in't." 
INDEX.
                            PAGE.
Abrasion of the teeth............... 169
Abscess, alveolar....................... 150
Acids, effects upon the teeth.....  83
Advertising, etc....................... 262
Alloys, fusible.......................... 101
Aluminum plates..................... 247
Alveolar abscess....................... 150
Amalgam................................. 104
Aiuesthesia.............................. 20)
Anesthetics, local and general.. 200;
    relative safety of................. 220
Antrum, diseases of the............ 172
Arseuic, for  devitaliaing  the
      pulp, and the dangers of.. 145
Artificial teeth......................... 233
    preparation of the  mouth
      for................................... 23!i
Atrophy................................... 167

Battery, electro-galvanic........... 201
Reaching discolored teeth......... 131
Bleeding, and how to control it.. 19-r>
Brushes for the teeth................ 228

Capping exposed nerves............ 113
Caries.......................................  77
    causes of.............................  82
    prevention of.....................  89
Cemjntum,  description of.........  70
    exposed.............................. 157
Charges for dentil services........ 263
Charlatanism........................... 25S
Cheopl istic metal..................... 216
Cla-p plates.............................. 240
Cleaning the teetu...................  89
Cleft palate, etc........................ 2~>6
Cofferdam rubber.................... 130
Continuous gum plates............. 242
Creasote, care in the use of........ 143
Crowded wisdom-teeth.............  CI
Crusta petrosa, description of....  7U
                            PAGE.
Decay......................................  77
    causes of.............................  82
    prevention of.....................  89
Decomposition in the pulp cav-
      ity.................................. 153
Dental harmony....................... 266
Dental pulp, desci iption of........  70
Dentifrices............................... 226
Dentine, description of..............  69
Dentine, sensitive.................... 109
    remedies for....................... ill
Dentistry, history of.................  13
Dentition, first.........................  40
    troubles of..........................  43
    second................................  60
    troubles of.........................  64
    third.................................. 183
Denudation of the teeth........... 171
Destroying the.nerve............... 144
Discolored teeth................ 131, 158
Diseases of first dentition.........  46
Dislocation of the jaw............... 198

Empiricism.............................. 253
Enamel, description of the........  67
Eruption of the permanent teeth  60
    of the temporary teeth........  4'J
Ether spray.............................. 201
Exostosis................................. i55
Exposed nerves, capping of....... 113
Extracting............................... 1S9
    dangers of. ......................... 193
    difficulties of...................... 192
    during pregnancy............... 195

7ile, thenseofthe............ 125, 128
tilling the teeth.......................  S>3
Killing  roots............................. 117
First dentition, diseases of........  46
    lancing the gums during.....  49
    mortality during................  44 
270
INDEX.
                            PAGE.
Formation of the teeth..............  34
Food in relation to the teeth.....  21
Fungous gum...........................  l->^
    pulp...................................  15J
Fusible alloys...........................  101

Galvanic battery......................  201
Gas, nitrous oxide.....................  203
    safety of..............................  219
Gold fillings..............................  S>8
    plates.................................  244
Guarantees...............................  264
Guillois' cement.......................  102
Gum-boils................................  1=°
Gums,  diseased,  prescriptions
      for........................... 179,  180
Gums, inflammation of.............  177
Gutta percha...........................  1°2

Harmony among dentists.........  266
Hemorrhage.............................  19o
    treatment of.......................  190
Hill's stopping..........................  1( 2
History of dentistry..................   13

Inflammation of the gums........  177
Irregularity of the teeth...........   71
Irritation of the pulp................  14J

Jaw, dislocation of the.............. 198

Key instrument for extracting..  191
                            PAGE.
Odontalgia...............................  138
    different forms of...............  139
    treatment of.......................  142
Origin of the  teeth....................  31
Os-artilieiel..............................  102
Osseous union of the teeth........  188
Oxy-chloride of zinc.................  102

Palate, defects of the................  256
Periodontitis............................  147
Permanent first molars.............  62
    teeth..................................  59
    teeth, description of...........  66
Phosphate of lime.....................  23
Pivot teeth..............................  253
Plate of magnified tooth............  68
    of the permanent teeth.......  61
    of the temporary teeth........  41
Plates, aluminum.....................  247
    cheoplastic.........................  246
    clasp.................................  210
    continuous gum..................  242
    gold....................................  244
    mineral..............................  244
    rose-pearl...........................  248
    rubber...............................  250
    silver.................................  216
    suction..............................  240
    temporary..........................  238
Plugging..................................   93
Porcelain teeth........................  241
Powders for the teeth...............  227
Pregnancy, toothache of............  19a
Lancing the gums.............. 49,  194

Laugningi^'.::::::::::::::::::::::::  -m\preservation «f the temporary
    safetvof            .........  219       teeth..............................  5o
Lime, phosphateof...'................  23 Prevention of decay....  ....
lJl   ' i'""0*'                      Pulp, decomposition ot the
Magnified tooth, plate of...........  68
Mallet filling............................  122
Maxillary sinus, diseases of the..  172
Milk........................................  26
    adulterations of..................  28
Mineral plates..........................  214
Molirs, first p rmanent............  62!Q"ackery........
Mortality during first dentition  ^Qualifications ot the demist...... 2o9
Mouth, preparation of the, for
      art'"
Mouth-w«-».....         . —,  — |Keplantil]

Necrosis...................................  158  Rhigolene.
                           153
description of the...............  70
devitalization of the........... 144
fungous.............................. 154
irritation........................... 140
nodules............................... 146

                           258
:tificial teeth..........'....... 236 Eanula ................................... 176
washes................... 179, 228 Regulating..............................  -4
                           Replanting teeth...................... 2o4
                                                  ...................... 201
Meuralgia.................................  160'Root fining.............................. 117
Mitrousoxide...........................  203]Roots,  extraction of.................. 193
    dangers of...........................  223     preservation of................... 121
    experiments with...............  212 "Rose-pearl"............................ 248
    how to inhale.....................  206 Rubber dam............................. 130
    generation of......................  204J    plates................................. 250
    safety of.............................  219;    rings in regulating..............  76 
INDEX.
271
                            PAGE.
Salivary calculus...................... 133
    effects of............................. 136
    removal of.......................... 137
    ducts, closure of the............ 176
Second dentition, tioubles of.....  64
Sensitive dentine..................... It 9
    remedies for....................... Ill
Separating................................ 127
Silver plaies............................. 246
Spray of ether.......................... 201
Suction plates........................... 240
Sugar.......................................  29
Supernumerary teeth............... ISO
Sympathetic pain..................... 160

Tartar...................................... 133
    effects of............................. 136
    removal of.......................... 137
Teeth, brushes for the............... 228
    classes of............................  80
    artificial............................. 233
    artificial, preparation of the
      mouth for........................ 236
    effects of  acids, etc., upon
      the.................................  83
    eruption of the temporary...  40
    eruption of the permanent...  60
    food in relation to the.........  21
    how to clean the.................  89
    irregularity ot the...............  71
    origin and  formation of......  34
    permanent..........................  59
    permanent,  description of
      the..................................  66
                            PAGE.
Teeth, permanent, plate of the..  61
    pivot.................................. 253
    porcelain............................ 241
    powdecs.............................. 227
    supernumerary................... 1S6
Temporary plates...................... 238
    teeth, plate of the...............  41
    teeth, preservation of the...  55
Third dentition........................ 183
Tin foil.................................... 101
Tobacco, effects of..................... 229
Toothache............................... 133
    different forms of................ 139
    treatment of....................... 142
    of children.......................... 146
    prescription for.................. 146
Tooth-key................................. 191
Tooth-marks............................. 167
Troubles of first dentition.........  43
    of second dentition.............  61
Tumors of the mouth............... 180

United teeth............................. 188

Vulcanized rubber plates.......... 250

Warranties.............................. 201
Washes for the mouth........ 179, 223
Wearing away of the teeth........ 169
Wedging.................................. 128
Wet-nurse................................  27
White filling.......................... 102
Wisdom-teeth, crowded............  64 
 
 
 
 
 
 
Jli