Popular Essays i txii i LIBRARY OF CONGRESS. Shelf. JB>4r_<_£> <%^ UNITED STATES OF AMERICA. r POPULAR ESSAYS THE CARE OF THE TEETH and MOUTH By VICTOH C. BELL, A. B., D. D. S. Director of the Special Prosthetic Department of the New York College of Dentistry. Late Dental Surgeon to the German Polyclinic. ^•; ? *YRiG^ PUBLISHED BY THE AUTHOR. 1894. \ -N Copyrighted 1894. BAKER, JONES & CO., PRINTERS AND BINDERS. BUFFALO, N. Y. TABLE OF CONTENTS. PAGE. Chapter I — Introductory, . . . . .7 Chapter II — Cleanliness, . . . . .13 Chapter III — Filling the Teeth, . . . .20 Chapter IV — Extraction op Diseased Teeth, . . 29 Chapter V — Artificial Teeth, .... 37 Chapter VI — Advice to Mothers, . . . .44 Chapter VII — Children's Teeth, .... 56 Chapter VIII — Crown and Bridge Work, ... 64 Chapter IX — Fractured Jaws, . . . . .68 Chapter X — Cleft Palate, ..... 74 Chapter XI — Hints on Home Remedies, . . .81 Chapter XII— Quackery, .... 96 PREFACE. This work is the outgrowth of the observations made in daily practice. For years the author has noted and deplored the lack of information upon dental subjects that is displayed by people of otherwise great general intelligence. This is the more to be lamented, because the subject is a vital one, and the consequences of igno- rance must be felt during the whole life. He candidly believes that were the information contained in this little book generally diffused, and its teachings well followed, not only would very much of pain and suf- fering be prevented, but the general term of human life would be perceptibly lengthened. This book has, therefore, been prepared in the hope that it may in some way be used to spread a knowledge of the importance of the dental organs among the people, especially the young, through the medium of the schools. It has not been Avritten especially for VI PREFACE. dentists, and hence simplicity of language has been cultivated, and technical terms have been avoided. But at the same time the hope is indulged that professional men may find it useful for the purposes indicated, and it is therefore dedicated to dental prac- titioners and their patients. The author desires to acknowledge the great obliga- tions under which he rests to Dr. William Carr, and Professors W. C. Barrett, Frank Abbott and J. B. Littig, for valuable suggestions and assistance. New York, Jan. 1, 1894. CARE OF THE TEETH AND MOUTH. CHAPTER I. INTRODUCTORY. " Doctor, does not the cleaning of the teeth by dental instruments ruin them ? " " In filling the teeth are not their nerves killed, and their vitality thus destroyed ? " "Can aching teeth be made serviceable ? " " Is not the gas that is administered for extraction very dangerous in its action % " " Are not false teeth taken from the dead ? " "Is not food tasteless to the wearer of artificial teeth % " Questions such as these are constantly asked the practicing dentist. "Miss A., why do you not attend to your teeth? " " O ! I am so afraid of the dentist and his torturing instruments." 8 CARE OF THE TEETH AND MOUTH. "Mr. B., why do you not have your teeth put in order?" " Well, I'm too busy, and just now they do not bother me." Thus it is that Miss A. and Mr. B. neglect these es- sential organs, until decay and disease have so far pro- gressed that they are beyond the skill of the dentist, and irretrievably lost. Hoav often do patients present themselves to the den- tist with teeth so filthy that one recoils with disgust and aversion at beholding them. Add to this a number of ulcerated roots, or decayed teeth with large cavities in which decomposing food remains for weeks and months, and you will no longer wonder why sometimes the breath of an individual is so offensive and foul that his presence is unbearable. Wherever there is de- composition of organic matter, there innumerable col- onies of microbes, the germs of disease, are generated. Through a mouth thus infected, can any individual pass his food and yet wonder why he suffers from indi- gestion ? An eminent writer, speaking upon this sub- ject, says : " The stomach may be compared to a stove; the food to the fuel consumed by the stove, and life to the heat given off by the glowing coals. The stomach is an ex- cellent stove, and will burn much bad fuel. But have a care lest it rebel, and the fire be extinguished." To INTRODUCTORY CHAPTER. 9 maintain a vigorous and sustained vital glow, the food taken into the stomach must be thoroughly ground by the teeth, and mixed with the saliva, and it must not be mingled with any deleterious accumulations in the mouth. Good health demands thorough digestion ; thorough digestion demands thorough mastication, and thorough mastication demands sound and healthy teeth. Ulcer- ated roots and decayed teeth, an inflamed mouth and vitiated saliva, are poorly fitted to supply the stomach with food that can be properly digested and assimilated. Abscesses with agonizing pains, necrosed jaws and probable disfigurement of the face, with tumors and foreign growths of varying character, frequently result from a neglected mouth. Many other diseases, as of the eye, ear, and the cavi- ties of the head, often the most difficult to diagnose, may be traced directly to an unhealthy condition of the teeth. But a short time ago, I was visited by a young lady whose eyes were so badly affected that she could only see with great difficulty. Medical treatment had failed to relieve her. Having trouble with her teeth, she found it necessary to consult the dentist, and with the curing of her dental troubles her eyesight was restored. I have seen the most robust patients shattered in health by dental troubles. Who is not familiar with 10 CARE OF THE TEETH AND MOUTH. the acute suffering with which the development of an abscess, or swelling on the gums or face, is accom- panied ? The pain is not only agonizing, but the gen- eral health is affected. Surgeons and dentists are daily called upon to perform operations for the removal of necrosed portions of bones, and tumors of the most formidable character, and sometimes even for the removal of the entire jaw. There is not a disease to which the human body is liable that is not aggravated by an unhealthy condition of the teeth. It is marvelous to observe how men will spend money in the most extravagant manner for outward show, or will wear away the best part of their lives in the ac- cumulation of wealth, and yet never give a thought or a penny to the preservation of health. But there will come a day when disease shall have so wasted their system as to place its recovery beyond all medical skill, and then they will realize the full consequences of their neglect. It is in the comprehension of these facts that I have written this book. In it I shall discuss the following topics : 1. Cleanliness. 2. Filling the teeth. 3. Extraction of diseased teeth. 4. Artificial teeth. INTRODUCTORY CHAPTER. 11 5. Advice to mothers. 6. Children's teeth. 7. Crown and bridge work. 8. Fractured jaws. 9. Cleft palate. 10. Hints on home remedies. 1 1 . Quackery. I have adopted this system of division because I think it not only the most logical, but that which is best calculated to give the reader a knowledge of the dangers incurred by neglect of the teeth, and of the best remedial measures to be employed when suffering from such a course. Before concluding this chapter, I may say that the lack of knowledge displayed by the popular mind on these subjects, has aroused in me the desire to place before my readers, in a concise form, such information as will be of service to them in all dental emergencies, and which, if carefully followed, will add to their health and strength, and to their consequent happiness. In preparing these pages, I have had primarily before me the fact that just such a book is needed, to throw some light upon a common subject that is not suffi- ciently considered in the ordinary courses of school instruction. I have endeavored to avoid the use of technical terms, L2 CAKE OF THE TEETH AND MOUTH. and to study simplicity in the language employed, as it is my sole intention to interest the popular mind with matters which are familiar to the medical and dental professions. CHAPTER II. CLEANLINESS. The importance of keeping the mouth free from rem- nants of food and masses of tartar cannot be too strongly impressed upon the reader. It is no exaggeration to say that ninety-five per cent, of all dental troubles are the direct outcome of uncleanliness. When particles of food are allowed to accumulate upon and between the teeth, fermentation, which will be subsequently explained, takes place, and decay is the result. Or putrefaction may en- sue, and the mouth become a very center of disease and infection. If the mouth could be kept perfectly clean and pure, teeth would never decay, but as this is impos- sible, it only remains for us to clean the teeth thoroughly after each meal, that the particles of food may be as perfectly removed as is practicable. Tartar. — This is a deposit of animal and mineral matter, precipitated from the fluids of the mouth upon the teeth. Sometimes it accumulates in such large quantities as completely to incrust them. It imparts to the teeth a greenish, yellowish, darkish, and sometimes a white color. Its effects upon the teeth are : 14: CARE OF THE TEETH AND MOUTH. 1. It makes the gums spongy and sloughy, and causes them to bleed at the slightest irritation. 2. It produces suppuration of the gums, and pus accumulates, sometimes in considerable quantities, mak- ing the mouth exceedingly unwholesome. 3. It forces the gums from the teeth, and working its way between them produces such an absorption of the bony sockets as to cause the latter either to fall out of their own account, or to be taken out at the least exhibition of any force. 4. It vitiates the saliva, and as this fluid is essential to digestion, the digestive apparatus is deranged and the entire system is disturbed. 5. It imparts a disagreeable odor to the breath. This is one of the most disgusting features of a filthy mouth, and makes the sufferer obnoxious to all. If, then, one would preserve his teeth and avoid these diseases, he should keep them free from deca}ang food and tartar, by the most unremitting attention. This cannot be done by merely polishing the exposed surfaces. When once allowed to become encrusted with tartar, no one can thoroughly clean his own teeth, because he can neither see where the masses are, nor can he use the proper instruments for their removal. The work can only be well done by the dentist. Everyone, then, should visit his dentist at least twice each year, for cleaning and examination of his teeth. CLEANLINESS. 15 We often hear the question asked, if cleaning the teeth with instruments does not injure the enamel, or if they are not so irritated as to cause disease, and per- haps instances are cited in which the teeth of a friend have, in their imagination, been led to decay because of the work done upon them by some dentist in cleaning. It is undoubtedly true, that when teeth are cleaned cavities of decay that were masked by tartar are un- covered, but in such instances the cause existed before professional aid was sought. Neither the medicines nor the instruments employed by a good dentist will, in any case, injure the teeth. In the first place, no respectable practitioner would employ any remedies that could be harmful. In the next place, the instruments are of the finest make, while the enamel is too hard to be abraded by them. The pain com- plained of is caused by the removal of the tartar that has been allowed to accumulate beneath the gums, and which had forced them from the necks of the teeth, leaving that portion bare and exposed. A few days will accustom them to the changed condition, when the irritation will subside. The decay of which the patient complains was not caused, but revealed, by the cleaning. Sooner or later it would have manifested itself, as the coatings of filth and tartar had been silently doing their work of destruction, and the cleaning, far from inducing the 16 CARE OF THE TEETH AND MOUTH. decay, simply exposed its existence, and warned the patient to check its further progress. After the teeth have been thoroughly cleaned by the dentist, to preserve them in this condition the patient should wash them with lukewarm water, and polish frequently with a powder or mouth-wash, using a soft brush. Lukewarm water should be used, because it cleanses much more effectively than either that which is very cold or very warm, and because, even if the cold and warm water could clean as perfectly, they should still be avoided, as they act injuriously upon the teeth. Every layman has no doubt observed for himself the physical law that heat expands, while cold contracts bodies. No one would think of removing a glass tumbler from a basin of very cold to very hot water, or vice versa, because he knows that the rapid expansion or contraction which would follow might break the glass. It is in a similar manner that the enamel of the teeth may be cracked, when very cold or very warm substances succeed each other in the mouth. In choosing a brush, select a soft rather than a harsh one, as the latter irritates and abrades the gums. Brush from the gums toward the summits of the teeth, or longitudinally, and not transversely. By brushing across them, particles of food are forced between the teeth, where they may become centers of decay. After using CLEANLINESS. 17 the brush, wash it carefully, that all de- composable matter which may have been caught by the bristles may be removed. In the absence of a brush, a silk thread is an excellent substitute. By forcing it between the teeth, all matter which may have lodged there is removed. Indeed, floss silk, prepared for this purpose, is an excellent thing with which to supplement the tooth brush. Powders and mouth- washes, when free from acid, should be employed in clean- ing the teeth. Great care and judgment should, however, be exercised in their se- lection, and only those recommended by some reputable dentist should be used. The fact that a certain powder or mouth- wash is extensively advertised, does not add to its value. As a rule, avoid such preparations, for they may contain acids* which, while they clean rapidly, are very destructive. The teeth are chiefly composed of mineral salts. Acids have a great affinity for these, and when brought in contact with the teeth corrode or dissolve them, and in this way make their surfaces rough, and bring about their destruction. A toothbrush of proper form. 18 CARE OF THE TEETH AND MOUTH. The following powder, containing nothing deleteri- ous, will excellently answer the purpose for which it is intended : Bicarbonate of Soda, - - half ounce. Precipitated Chalk, - - - two ounces. Pulverized Orris Eoot, - - one ounce. Pulverized Castile Soap, - - one ounce. Flavor with Peppermint or Wintergreen. It is sufficient to employ a powder every other day. Its too frequent use may abrade the teeth, and wear them away. In the intervals, the brush and water will suffice. After the teeth have been carefully brushed, the mouth should be daily rinsed with a mouth-wash. Lime water is excellent for this purpose, and should be freely used. Its peculiar virtue consists in the fact that it is an alkali — that is, it neutralizes the effects of acids. Food ma}^ contain acids, or the saliva may be acid, a condition that frequently exists when the patient is in a debilitated condition. Those who object to lime water because of its un- pleasant taste, may remove this objectionable feature by using with it a few drops of oil of rose, or cologne. The following mouth-wash is a most excellent one, as it is antiseptic, sweet to the taste, and is also alkaline in its reaction : CLEANLINESS. 19 Bicarbonate of Soda - - half ounce. Simple Elixir - two ounces. Distilled Water - - - ten ounces. Tinct. Cochineal - - - q. s. Kinse the mouth with this solution twice daily, in the morning after cleaning the teeth, and in the evening before retiring. If the directions here given are carefully followed, the result will be a clean and sweet mouth, a pure breath, hard, firm gums and sound teeth. CHAPTER III. FILLING THE TEETH. Judging from the questions constantly asked the dentist, it is no exaggeration to say that very few peo- ple have a clear conception of the causes which lead to decay of the teeth. Experiments and observation have shown that these are numerous. Chief among them is the fermentation of particles of food lodged between the teeth, or in their pits or depressions, during mastication. When, through carelessness or indifference, these deposits are not removed, under the influence of the warmth, mois- ture and the microbes present, fermentation, or chem- ical change takes place and an acid is generated, and this dissolves the enamel and dentine, leaving a cavity, which constantly grows larger and deeper. The dentine is of a tubular structure, and into these tubules the microbes which constantly exist in the mouth penetrate, where they continue their destructive effect until the tooth is completely destro} T ed. Microbes are minute vegetable organisms, some of the many species of which are so small that they are FILLING THE TEETH. 21 only visible under the highest powers of the microscope. They are the cause of a large class of infectious or contagious diseases, and between them and the body there is a constant struggle. The process of fermentation is of itself but the growth and multiplication of these minute organisms, and in this process of their life-history they produce the •Vm mm> % v •* „ # ?/» n Microbes, micro-organisms or bacteria, greatly enlarged. acids and other poisonous material which make them so fatal to mankind. Their number is inconceivable. These are the direct causes of decay of the teeth. But there also exist indirect, or contributing causes, and these may be anything which will lower the general tone of the system, and make it less able to resist the action of deleterious agents. Among these secondary causes producing decay, may be mentioned any protracted sickness, the lack of out- door exercise, excessive study, anxiety or worry, which W2i CAKE OF THE TEETH AND MOUTH. undermine and weaken the system. When the body is ill, no one organ can be said to be perfectly sound. The teeth may be crowded or depressed, or there may be fissures which offer a ready means for lodge- ment of food. The walls of the teeth may not be dense, and their power of resisting decay may be very weak, or the food may not contain the necessary ele- MM $.0 •" Other forms of Microbes, greatly enlarged. ments for nourishing the teeth, and hence the work of repairing the wear and tear of daily use may be but poorly accomplished. Again, there may be a hereditary tendency to decay. That our ancestors suffered from any special ailment does not necessarily demonstrate that it will be repro- duced in us, but it is probable that the same debilitating conditions will be inherited. Their consequences can, however, be avoided by proper and unremitting care. These causes are constantly at work, producing decay of the teeth and forming minute cavities, through FILLING THE TEETH 23 which the decay rapidly progresses until the living- matter of the tooth is reached. Unless this is checked, the tooth will be totally wrecked ; even if it be not wholly destroyed, it will be so badly decayed that it will threaten the welfare of the entire dentition, and therefore it may become necessary to extract it. Many, fearing that the filling of a tooth will be pain- ful, refuse to have this done. But when the proper manipulation is employed, the operation is accompanied by very little of acute pain, and if the decay is of re- cent formation, by none at all. Every consideration, then, whether the ultimate welfare of the tooth is con- cerned or the desire be to avoid suffering and discom- fort, prompts the patient to early attention to his teeth, before decay shall have proceeded so far as to cause toothache. The teeth are composed of four principal parts, — Enamel, Dentine, Cementum and Pulp. Enamel. — This constitutes the cap, outer covering, or occluding surface of the tooth. It is the hardest tissue in the animal body. Its great density admirably adapts it to the purposes of mastication of hard substances. The enamel is easily distinguishable from the dentine with the naked eye, by its clear, lustrous, and somewhat translucent appearance. Dentine. — The dentine forms the principal constitu- ent of the tooth. It is situated under the enamel, and 24 CARE OF THE TEETH AND MOUTH. is permeated by a great number of minute canals, which connect with the pulp chamber. It is a hard, elastic substance, with a yellowish tinge, and is slightly translucent. Cementum. — This forms a thin covering for the sur- face of the fang, or root of the tooth, and extends from its neck to the apex. Pulp. — The pulp is' a soft tissue, occupying the pulp chamber, which is an elongated "canal, wide at the crown, and narrow at the root. It runs longitudinally through the center of the dentine. The pulp contains the nerves and blood vessels of the tooth. It is the vital part, and sends forth minute fibers of living mat- ter through the microscopic canals of the dentine, to nourish and endow the tooth with sensation. As soon as the enamel is decayed through, the sensi- tive dentine rapidly disappears under the action of the acids produced by fermentation, and the pulp soon be- comes exposed. Frequently the decay of the sixteenth part of an inch is sufficient to lay bare the pulp. This is extremely sensitive, and the contact of any foreign matter causes the most exquisite suffering. The least change of tem- perature, or the exertion of any undue pressure upon it, will so irritate its nerve filaments as to produce se- vere toothache, and affect the entire nervous system of the head. FILLING THE TEETH. 25 Before the pulp lias become exposed, the operation of filling the teeth is comparatively painless. The filling lasts, and the tooth remains strong, because the vital portions of the pulp have not been affected. It is easy to discover when the dentine alone is ex- posed. This may be sensitive to the touch, to cold and to heat, but the pain is dull, and passes away when the irritating agent is removed. When, however, the pulp is exposed, the pain is acute, constant, severe and ago- nizing. Thus the degree and character of the pain will indicate the amount of the decay. Should the tooth be neglected when the pulp has become exposed, the latter becomes inflamed, and the work of filling the teeth is very painful, and perhaps impossible, and if the neglect be persisted in, the pulp dies. Thus at the outset the dentist is confronted with three classes of diseased teeth — those in which the dentine alone is affected, those in which the pulp has been but recently exposed, and those in which, because of prolonged exposure, the pulp is either dead or dying. Of the first class I have already spoken. In a tooth of the second class, the pulp can be cured by the applica- tion of soothing medicines, which may remove the irri- tation and subdue the inflammation, and enable it to bear a filling.. If, after being thus treated, the tooth be filled, a covering of secondary dentine may be formed by nature underneath the filling, for the better 26 CARE OF THE TEETH AND MOUTH. protection of the pulp, and soon the tooth may become as sound as ever. Concerning the third class of decayed teeth, there are three kinds. Those in which the pulp has recently died, those in which there is more or less of infection and inflammation, and those with a fistulous opening, with a more or less constant discharge of pus. The first can be cured with comparative ease. The second may be relieved if judicious means are employed, while the third may require a considerable time, and the exer- cise of much patience and skill on the part of the den- tist. The pulp chamber and canals must be thoroughly cleaned and disinfected, and this work is sometimes performed with great difficulty, as the canals are often crooked and difficult of access. Should the dentist fill such a tooth, leaving within it particles of infected matter in the pulp canal, they may putrefy and generate gases, which, having no es- cape except through the opening at the apex of the tooth, press against the surrounding tissues, and produce abscesses and swellings, with their accompanying pains. After the whole territory has been thoroughly disinfect- ed, the canals must be effectually filled. It is sometimes advisable to insert a temporary filling to last for sev- eral weeks, and only after this experimental stopping- has been sufficiently tried, and no unfavorable symptoms have supervened, should a permanent filling be substi- FILLING THE TEETH. 27 tuted for the temporary one. If, however, the tooth becomes sore, it is an indication that inflammation is again active, and that unless it be reduced an abscess may follow. The filling must then be removed, and the tedious work of disinfection resumed. It is apparent, then, that to postpone the work of filling a decayed tooth only increases the danger and > ///// *\ * Different forms of microbes, very much enlarged. suffering, while the result, when accomplished, is much less satisfactory. There are some dentists who promptly apply an ar- senical paste to sensitive cavities, whether the pulp be exposed or not, and patients have been led to approve this, thinking thereby to avoid pain during the filling. But it is very bad practice, and the more reputable portion of American dentists condemn it earnestly, and for some of the following reasons : 28 CAKE OF THE TEETH AND MOUTH. First, because when devitalized, there is always the liability to putrefaction and the formation of an abscess. Second, because it is much easier to fill a live tooth than a dead one. Third, because a dead tooth is liable to many diseases, and is not as permanent or as useful as a live one. To destroy the pulp quickly, arsenic is employed. Unless this be carefully and skillfully used, there may be intense pain. The cavity must be carefully and deli- cately cleaned of all foreign material, the irritability of the pulp must be allayed, and then the proper devitaliz- ing agent must be so inserted that no pressure will be exerted. When this is skillfully done no pain will ensue. But it is much better if the pulp can be saved alive, and the honest dentist will therefore put forth every exer- tion to do this. A few words as to the materials to be used in filling the teeth. Gold and tin possess all the requisite quali- ties for beautiful and lasting fillings. Silver is only used in the form of an amalgam, with mercury. Gutta percha and cement form excellent temporary fillings for teeth so decayed that they cannot stand the strain incident to the filling with gold or tin foils. The choice of materials should, however, be left to the dentist, as he best knows the peculiar conditions, and what they demand. CIIAPTEE IV. EXTRACTION OF DISEASED TEETH. Extraction is an ultimate remedy, and should be resorted to in extreme cases only. If people would give to their teeth the attention that is their due, there would be no occasion for the forceps, except in very rare and exceptional instances. It is because of ignorance, or inexcusable carelessness, or the uncon- querable dread of dental operations, that the necessity for the removal of teeth arises. Timely care might preserve even those which are naturally weak and bad. But, through neglect, cases arise which imperatively demand extraction. Let us consider some of the conse- quences of a refusal to have this done. The most common of these are abscesses. Abscesses, or gumboils, are collections of pus, or putrid matter, clue to infection and inflammation of the tissues surrounding the roots of diseased teeth. These may produce many dangerous results, among which are those that follow : Locked Jaw.— Sometimes a severe abscess is caused by diseased molars or wisdom teeth of the lower jaw. 30 CARE OF THE TEETH AND MOUTH. The nerves become so irritated that they are finally paralyzed, and the muscles remain in a contracted con- dition. They cannot perform their office, and the sufferer is unable to open or close his mouth. When this happens, the patient is said to suffer from locked jaw. It should be understood that by this term is not meant tetanus, or spasmodic contractions. Neuralgia. — Intense neuralgia of the eye, the ear, or the entire side of the face, is frequently produced by the pressure of an abscess and the irritation due to a diseased tooth. All the nerves which supply the e} T e, the ear, the face and the teeth, are intimately connected through their terminal filaments, and any special irrita- tion of one may be communicated to and affect any of the others. The oculist and aurist recognize that the eye and ear may be affected by diseased teeth, and so, very often, before proceeding with their work, insist that the patient have his teeth put in good condition. Necrosis. — Death of the bone frequently results from an abscess. When pus is allowed to accumulate in large quantities, it may burrow between the bone and the periosteum, or membrane which envelops the bone, and which gives to it nutrition and vitality. This membrane being severed from the bone, the latter dies from lack of nutrition, and from the violent inflamma- tion caused by the abscess. EXTRACTION OF DISEASED TEETH. 31 Eye, Ear and Nose. — These organs are very often affected by diseased teeth. Over the molars, in each side of the upper jaw bone, there exists a cavity, the roof of which is formed by the floor of the orbit, its inner boundary being the wall of the nose, and through which there is an opening into the nostril. The floor of this cavit}?" is formed by that portion of the jaw bone which holds the roots of the molars, and into which one of them occasionally penetrates. The walls of the cavity are thiu, and are lined by a very sensitive mem- brane. Any serious disease of these penetrating mo- lars, such as inflammation and suppuration, may extend into this cavity. Pus may accumulate in such large quantities that it will ooze out through the opening that communicates with the nose. Thus may be seen why, when one suffers from a con- stant discharge from the nose, it may be due to a neg- lected tooth. Again, if the accumulation of pus is very large, it may press against the floor of the eye-ball, and either displace the eye or cause partial or complete blindness, or it may break through the bone and dis- charge upon the face, leaving an ugly scar. At the very least, the continued discharge, even though it may not find its way to the surface, makes the patient a con- stant source of offense, both to himself and those who surround him. Cases are reported in which tumors caused by dis- 32 CARE OF THE TEETH AND MOUTH. Undeveloped Teeth. eased teeth have developed to such enormous size that they plugged up the nose, dislodged the eye, and even broke down the wall of the cavity and penetrated into the brain. Again, whenever a decayed tooth is in close proxim- ity to a sound one, the latter will ultimately be affect- eel, for wherever there is decay, there we find acids and microbes, which in their action are very de- structive to the teeth. Every day that these teeth are permitted to remain in the mouth but aggravates the condition, and renders their inevit- able fate, extraction, more and more difficult. This is particularly the case with regard to the molars, which, as a rule, have several roots, all connected by the crown. "When decay has destroyed the crown, the roots become separated, and must be ex- tracted singly. Sometimes the patient attributes this difficulty to lack of skill on the part of the dentist, and perhaps even institutes legal proceedings for malpractice against men of acknowledged skill. These suits, though almost invariably unsuccess- ful, have in many cases blighted the reputation of the practitioner, for suspicion easily attaches to EXTRACTION OF DISEASED TEETH. 3'S professional men, and clings to them with fatal tenacity. We may thus see the importance of an early extrac- tion of such badly decayed teeth. But many people shrink from the operation, either by reason of their ignorance, or because of the misrepresentations of their friends, or through a fear of the pain. Let me illustrate a case of very frequent occurrence. "A" is suffering from an abscess developed from irri- tation produced by a dead tooth. He is about to visit the dentist to have the tooth extracted, when some officious, though well-meaning friend, informs him that it is dangerous to extract the tooth before the abscess has broken, and "A" will suffer many days and nights of intense agony, waiting for the abscess to heal, and after this has taken place and he no longer suffers tor- ture, he undergoes the additional pain of having the tooth extracted. As a matter of fact, there is no dan- ger in extracting a tooth about which an abscess is de- veloping. There was a time when it was thought hazardous to do so, it is true, but this theory has long since been exploded. Moreover, the pain of extracting such a tooth is entirely lost in the far greater pain suf- fered from the abscess, for when one suffers from pains of varying intensity, the sensation of the lesser pain is, to a greater or less extent, lost in that of the greater. There are many who fear to have a tooth removed 34 CARE OF THE TEETH AND MOUTH. because of the accompanying suffering. In realhy, there is little pain in the extraction of a tooth. The sleeplessness, anxiety, and lack of proper food which precede the extraction, weaken the body, arfd hence the nerves are very susceptible to irritation. The pain of extraction principally results from these causes, and not from the extraction itself. Fortunately for the sufferer, however, by the use of nitrous oxide gas, the extraction of teeth may be made absolutely painless. This gas is obtained by heating a substance techni- cally called ammonium-nitrate in a retort. This salt is composed of hydrogen, nitrogen and oxygen. The last two gases are the chief constituents of the air we breathe, and in differing proportions compose nitrous oxide gas. Though odorless and colorless, the gas is sweet to the taste ; through its action upon the nerves there is an entire loss of consciousness, and with that of course all sensation and volition. This lasts but a few moments. There is naturally considerable shrinking from it on the part of those who are unacquainted with its char- acter. But statistics, carefully collected, show that it is by far the safest of the anaesthetics, and when properly administered that there is less risk from it than from the operation itself. It is given daily by many who possess no special medical knowledge, and who take no precautions as to examination before administering it. EXTRACTION OF DISEASED TEETH. 35 Yet rarely has any harm resulted, even though patients were suffering from diseases which are of themselves dangerous. I may add that in many cases nitrous oxide has proven a remedial agent, and where other remedies have failed it has afforded relief. It may even be adminis- tered to women in the later stages of pregnancy. The shock experienced by the nervous system from extract- ing a tooth without the gas, is far more dangerous and more likely to produce evil results than would the same operation be with it. While it is true that during this period women should not have their teeth extracted unless it becomes absolutely necessary, it is equally true that expectant mothers should not be permitted to suf- fer from protracted pain. The effect of that upon both the mother and babe may prove a lasting injury to each, during all the years of their subsequent life. Let the patient take the gas on an empty stomach, and be perfectly calm ; then its inhalation will be safe, and it will relieve the dreaded extraction of ail its horrors. In conclusion, let me add that if people have badly decayed teeth or roots that do not ache, they should at once be put in a sanitary condition. If this cannot be done, they should be extracted, for if allowed to remain they may bring in their train any one of a long list of diseases. 36 CARE OF THE TEETH AND MOUTH. With the badly decayed teeth removed, and the re- maining ones cleaned, filled, capped or crowned, as the case may demand, the mouth will be in a thoroughly healthy condition, and if any reasonable degree of care be bestowed upon it, will probably remain so for many years. CHAPTEK V. ARTIFICIAL TEETH. Teeth are subservient to three great functions — beauty, speech, and digestion. Beauty. — From the remotest ages, the poet and the novelist have found in the teeth a fruitful theme for song. How they revel in painting their charms ! no face, however rich in beauty, color, or regularity of its features, is a finished conception with an incomplete denture. Nay, if the denture be imperfect in the front of the mouth, the charms of the face but heighten the inharmony into repellent incongruity. We are all ambitious to please, by conforming to the laws of the beautiful. In society, one who understands the laws of harmony delights the eye by her tasty attire. Another, though more richly dressed, having failed to harmonize her costume, attracts attention only by the impression of absurdity. In the purchase of any article of clothing, we all recognize that something besides the mere fit or adapta- tion must be observed. However excellent the material 38 CARE OF THE TEETH AND MOUTH. or the workmanship, a certain law of harmony must be observed, or the wearer will appear ludicrous. I make but a mild statement, then, when I say that it is extremely unpleasant to behold a pair of ripe, cherry lips, open but to disclose an incomplete denture. The contrast with what was expected becomes very jarring. Speech. — Teeth are necessary, not only to beauty, but to speech. When any of them are missing, the power of speech is more or less impaired, because they are necessary to the proper formation of articulate sounds, and unless all of the teeth are present in the mouth, the result is an incomplete and discordant utterance. There is a certain relation between the physical form and the voice, from which we infer in advance the char- acter of the tones which may be expected from any individual, and if instead of the expected bass a falsetto greets us, the result is very unpleasant. Speakers and singers recognize this fact so well, that the instant the denture becomes incomplete they have it repaired. Digestion. — The most important function of the teeth is to assist in digestion, by masticating and insali- vating the food. Mastication is the process of reducing the food to a pasty condition, by grinding it into small particles and mixing it with saliva. If before passing the food into the stomach this work of mastication is thoroughly performed, the food is ARTIFICIAL TEETH. 39 rendered easily susceptible to the action of the fluid secreted by the stomach — the gastric juice. This reduces the food to a liquid state, and so prepares it for absorp- tion into the system. "When, however, the food is swallowed without being thoroughly masticated — that Artificial lower Denture. is, in mass, or in a dry condition— the action of the gastric juice is very slow, and to a considerable extent ineffective. It moreover fails to yield all the nourish- ing essence of which it is possessed, and causes in addi- tion those intense agonies of indigestion, which a cele- brated writer once so forcibly described as " a hundred rats gnawing in the stomach." Good health requires good digestion, and good diges- tion requires good mastication ; but so long as any of the teeth are missing this is impossible, for nature, economical in all things, teaches that unless all the 40 CARE OF THE TEETH AND MOUTH. teeth were necessary, some of them would not be found in the mouth. As the functions of the teeth are of such paramount importance, it is necessary that they be kept in constant repair, and if any of them are missing they should be immediately replaced. The modern dentist has reduced this art to a science, and artistically constructs artificial dentures, crowns and bridges. Artificial Teeth or Dentures. — There are two parts in a set of artificial teeth. The plate and the teeth. The Plate. — This is a thin sheet of rubber or metal, corresponding in shape to the hard palate or roof of the mouth. The rubber base is in most common use, as it is cheap and serviceable. Eub- ber is the coagulated milky juice of certain trees, that grow in South America and other An Artificial upper Denture. . , „, .. warm countries. After under- going many chemical changes, this is manufactured into rubber of various grades. Only the best is used by the reputable dentist, after it has been subjected to many delicate manipulations and processes. Among some of the metals used in the manufacture of dental bases are gold, silver, platinum and aluminum. These are the precious metals, and only such are fit for use in dentistry. ARTIFICIAL TEETH. 41 Teeth. — The teeth are attached to the plate so as to correspond exactly to the natural denture, in size, shape and order of arrangement. They are manufac- tured from porcelain, which is a compound of silex, feldspar and kaolin. Silex is a white mineral, found in sands, rocks, crystals and flint. Feldspar is generally found as an ingredient of granite and other volcanic rocks. Kaolin is a fine clay, found in many parts of the world. From these minerals, together with the use of color- ing matter, artificial teeth are manufactured. From various fancies or prejudices, none of which have any foundation in fact, many people object to the use of any artificial appliance in the mouth. Some, because they are ashamed to wear artificial teeth, or because they are under the impression that they taint the breath, and destroy the sense of taste. Others, because they believe that artificial teeth are taken from the dead, or that an artificial denture cannot be held securely in the mouth. No false sentiment should be allowed to interfere with the laws of health or proper hygiene. Beauty, speech and mastication are primary considerations, and no mere affectation has the right to negative their demands. 42 CARE OF THE TEETH AND MOUTH. Artificial teeth neither destroy the sense of taste nor contaminate the breath. The sense of taste is located in the tongue, and there is not a single ingredient entering into the composition of the rubber or teeth which can infect the breath. Nor are artificial teeth ever taken from the dead. Their very name shows that they are the product of man's handiwork; they are manufactured from the pure materials that I have already enumerated. To those who fear that a denture cannot be held firmly in the mouth, let me say that their apprehen- sions are groundless. To secure the plate in the mouth it is necessary to utilize two forces of nature — adhesion and atmospheric pressure. Adhesion. — Adhesion is that force by virtue of which the molecules of different bodies cling together. A remarkable instance of this is found when we press together two smooth or occluding surfaces. Adhesion is so strong that they will cling together with great tenacity. If we press together two perfectly level sur- faces of glass, it will be found very difficult to separate them. Atmospheric Pressure. — The air presses in every direction with a force of about 15 lbs. to the square inch. A little computation demonstrates that the human body, for instance, is subjected to a constant pressure of from 20,000 to 30,000 pounds. This would ARTIFICIAL TEETH. 43 be sufficient to crush us to the earth, were it not that the air presses equally in all directions. Hence the downward pressure is counter-balanced by an equal up- ward pressure. This may be proven by an actual experiment. Take a glass jar, the mouth of which is accurately fitted to a smooth metal surface, and by means of an air pump exhaust the air within it. Now try to lift the jar, and it will be found that it adheres with great tenacity. There is no air within to counteract the down- ward pressure of that without. But if the air be al- lowed to re-enter the jar, it can be raised as easily as ever. Children playing with the familiar leather soakers, unconsciously take advantage of adhesion and atmos- pheric pressure. "When the soaker is pressed down upon the stone, the air is forced out, and they are enabled to lift the stone, whirl it in the air, or carry it about. Artificial plates are constructed upon a model taken from an impression of the mouth, and it is thus made accurately to fit the hard palate and gums. There are two perfectly occluding surfaces, the palate and the plate. When these are brought into contact the air is driven from between them, and adhesion and atmospheric pressure are called into play. Hence the plate is held in the mouth by the action of natural forces, and the patient need not worry himself by con- juring up imaginary difficulties. CHAPTER VI. ADVICE TO MOTHERS. Were one to say to the mother, as she lovingly fondles her young, " ninety per cent of the diseases from which your child will suffer in after life are directly traceable to your treatment of it," would she not deny the assertion with unbounded indignation % And yet, the charge is true, for it must be apparent even to a superficial observer, that women, as a rule, possess such an imperfect knowledge of the laws of hygiene as to be but poorly equipped for a thorough training of their young. There was a time when diseases were regarded as the manifestations of the wrath of an offended Deity, who could only be appeased by offering up sacrifices on the altars of the Gods, and as men thought it hopeless to struggle against the Deity, they paid little, if any, at- tention to the laws of hygiene. Those times, however, have passed. Our higher culture has swept away these idle superstitions, and has revealed to us the universal reign of inexorable laws. This should teach us that health is the reward of obedience to these laws ; disease, ADVICE TO MOTHERS. 45 the penalty of their infraction. They are easily ascer- tainable, and readily followed. Indeed, such progress has been made in their systemization and comprehen- sion, that we can almost choose between health and disease, but to secure the full measure of advantage which must result from an adherence to these laws, their study should not be postponed to mature life. It must begin in early infancy, and be made to form part of the home and school training, for knowledge and impressions received in childhood are the most lasting, and are readily developed into fixed habits. The training of the child during this early period of its life is peculiarly the work of the mother, and not all the study and thought of after life can thoroughly erad- icate the ideas and habits which she can impress upon its young mind. To perforin the work of education efficiently, the mother must be as familiar with the laws of the child's physical existence as she is with the laws of its moral well being. Yet, while we realize that without an intimate ac- quaintance with the principles of good health immunity from disease is impossible, we have made no united effort to instruct our women so that they can perform this duty. Nay, if some woman, more intelligent and enterprising than the rest of her sex, makes a thorough study of hygiene and of kindred topics, she too often becomes a subject for ridicule among her acquaintances. 46 CARE OF THE TEETH AND MOUTH. They seem to think, as did women of yore, that the circle of woman's attainments is bounded by the hori- zon of man's pleasures, and that if she has acquired a knowledge of dancing, singing, music, courtly manners, and a little understanding of household management, she is equipped for the duties of life, of marriage, and of maternity. To dispel this delusion, and awaken in wo- men a sincere desire to familiarize themselves with the laws of health, which is the object of my present chapter, is, therefore, of the utmost importance. The evils which result from disobedience of these laws are not confined to women alone, but are transmitted to their offspring, and in this way are perpetuated. Truly, "The evil which men do, lives after them." How forcibly did Henry Ward Beecher realize this, when, in answer to the question "When should a child's educa- tion begin," he said, " With its grandfather." It is my province, however, only to consider those hygienic laws which are intimately connected with the welfare of the teeth. A discussion of the remaining principles is not the office of the dentist, but of the general physician. For the sake of clearness and logical arrangement, I shall divide this chapter into two topics : First, " Hints to Women in General." Second, "Hints to Pregnant Women." ADVICE TO MOTHERS. 47 Hints to Women in General. Lack of cleanliness and of proper dieting are undoubt- edly the main causes which contribute to the destruction of the teeth. As the subject of cleanliness has already been discussed at length, I shall now proceed to consider the subject of proper diet, by which I mean not only what to eat, but also how to eat. What to Eat. — This is a question that must be solved differently for different indi- viduals. The food which is proper for one man may not agree with another. The stu- dent, or the brain worker, could not long subsist on that re- quired by the laborer, or the out-door toiler. Time, age and occupation must all be consid- ered before it may be said to any man, " Eat this or that kind of food." Yet, in spite of this difficulty, there are certain foods of which it may be said that they are safe to all. The human body is composed of seventeen elements, Upper and Lower Permanent Teeth in Outline. 48 CARE OF THE TEETH AND MOUTH. the chief of which are hydrogen, nitrogen, carbon, and the salts of lime. The various organs of the body are formed by varying combinations of a certain number of these elements, and these organs sustain and nourish themselves by extracting from the blood a sufficient quantity of the elements which enter into their forma- tion, so that if the food is deficient in any one element, some one organ of the body is destined to suffer. As no foods, except milk and eggs, contain all the elements which enter into the structure of the body, it is appar- ent that to properly nourish all our organs, recourse must be had to a diversified diet. In this way the abundance of a certain element in one food may supply its deficiency in another. Teeth strongly resemble bone in their composition. They are composed of animal and mineral elements. The mineral matter is the more abundant of the two, and consists principally of lime salts, such as phosphate of lime, carbonate of lime, fluoride of calcium, and phosphate of magnesia. These elements give to the teeth their strength and hardness. If they are absent to any marked extent, the teeth are weak, frail and soft. By careful experiment, it has been found that the following foods contain these elements in greatest abun- dance : Milk. — This is the representative food, as it contains every element which enters into the structure of the ADVICE TO MOTHERS. 49 body; but as it is a ready absorbent of microbes, it should be boiled before it is given to children. The boiling kills the microbes. Buttermilk. — This is valuable as a food, except when it is churned from very sour milk, or has become cheesy by age. Cheese. — This should be eaten sparingly, as it is indi- gestible ; a little, however, may aid digestion. The Cereals. — Wheat, maize, rye, oats and rice, are very valuable foods, because they contain so many of the constituents needed for life and health. Fine flour, however, should be sparingly used, because in its preparation the lime salts and phosphates are extracted. Thus, it has been estimated that five hun- dred pounds of Graham flour contain seventy-five pounds of muscle, and eighty -five pounds of bone ma- terial, while an equal quantity of white flour contains only sixty-five pounds of muscle, and but fifty pounds of bone material. Eggs. — These are highly nourishing. They should be used "soft-boiled," and not hard-boiled, as the latter are less digestible. Eggs should always be eaten with a little bread and salt, as this renders them more whole- some. Meat. — Of all meats, beef and mutton are the best regular foods. If rightly prepared, meat is very nour- ishing and digestible. Among other nourishing meats 50 CARE OF THE TEETH AND MOUTH. might be mentioned pork, veal and poultry. Meat, however, should not be eaten excessively, and should never be used unless carefully prepared. Fish. — When fresh and well cooked, fish are very nourishing. Beans. — The nutritive value of beans is higher than that of any other vegetable. Among the most valuable varieties may be mentioned the kidney, the haricot and the lima. Peas. — Peas have qualities similar to beans, but not in the same degree. Potatoes.- — If properly cooked, these make a valuable food. When cold they are indigestible. They are best when boiled with the skin on, or when roasted. Pota- toes contain valuable potash salts, which are lost in boiling without the skins, but are retained in baking and stewing. Vegetables. — Cabbage, parsnips, carrots, onions, to- matoes and beets are good foods when eaten moderately, but if taken in large quantities are indigestible. These are but a few of the many valuable foods which a bountiful nature has placed at man's disposal. Only those are enumerated in the above list which are important from the standpoint of the teeth. They are equally valuable, however, in building up the rest of the body. For a more extended discussion of food, I refer the reader to some work on hygiene. In our ADVICE TO MOTHERS. 51 libraries may be found many books treating of this topic most exhaustively and explicitly. Their perusal will repay the reader with compound interest. The consequences which result from a neglect to use proper food cannot be overstated. It is because of this neglect that so many of our boys and girls, while yet in the full bloom of youth, are compelled to wear arti- ficial dentures. One eminent writer has even said, " We are becoming a toothless people." Of course he did not imply that our ancestors did not suffer from decayed teeth. They certainly did, but through an ex- amination of their remains, we must conclude that they did not suffer from dental troubles to the extent that we do. Our inventions and discoveries have revolutionized science and art. They have even changed the character of our food. The tables of the rich are to-day loaded with delicate, dainty viands, from which have been ex- tracted the phosphates and lime salts, the elements that build up the bones and the teeth. It is because he eats such food that the child of riches often has weak, ill- formed teeth, and because the child of poverty subsists on coarse flour, he enjoys a wealth of teeth that money cannot buy. Having now learned " What to eat," we have yet to learn what few, indeed, understand, " How to eat," for the evils resulting from a neglect of the latter will 52 CAKE OF THE TEETH AND MOUTH. more than balance the good derived from an observance of the former. How to Eat. — However nourishing may be the food one eats, it can yield little benefit unless it is properly eaten. 1. It is to be thoroughly masticated. 2. It should not be taken in excess, nor the maxim forgotten, " We eat to live, and do not live to eat." 3. It is not to be taken too hot or too cold. 4. The stomach must be allowed freedom of move- ment. It is self-evident that if the stomach is overloaded by excessive eating, or if the food is bolted and not thoroughly masticated, the work of digestion will be poorly performed, the stomach become disordered, and the saliva acidified. The acid saliva, as already shown, destroys the teeth. It is equally evident that since the food digests most readily at a temperature of about 98° F., if that which is very cold or warm is taken into the stomach, its tem- perature is materially lowered or raised, and to that extent the work of digestion is checked. Nor need I add that if the free movement of the stomach is restrained by stays or tight corsets, it can- not perform its functions properly. No doubt a slender waist gives to a woman an elegant form, but a ADVICE TO MOTHERS. 53 gracefulness purchased at the price of health is a charm far too costly. Hints to Pregnant Women. Women at this time must be particularly careful to observe hygienic laws, because upon their obedience to them depends not only their own health, but also that of the unborn child. The food, especially, should be highly nourishing, because only a part of it is em- ployed in building up her own body, the remainder going to lay a foundation for the organs of her child. If, for instance, her food is deficient in lime salts and phosphates, not only will her own teeth be underfed, but she will give but a poor structure to the teeth of her young. Every married woman should have her teeth care- fully attended to, for any trouble with which they may be affected will be intensified by her pregnancy. At no other period of a woman's life do her teeth decay more rapidly. At no other time is she so suscep- tible to disease, so frequently indisposed, so neglectful of herself. She is a constant sufferer from disorders of the stomach, and in particular from morning sickness, or inability to retain food. As a result, her saliva is generally acid, and hence her teeth are rapidly de- stroyed. As I can only treat of the laws of health in so far as 54 CAKE OF THE TEETH AND MOUTH. they directly affect the teeth, I must stop here, for a more extended discussion would take me from the field of the dentist into the domain of the physician. Let me close, therefore, by recapitulating the various points suggested in this chapter. 1. Let the mouth be always clean. 2. Masticate the food thoroughly. 3. Eat moderately ; avoid excess. 4. We eat to live ; we do not live to eat. 5. Eat substantial, well-cooked food. 6. Avoid pastr} 7 and superfine flour. 7. Do not eat very cold or very warm food. 8. Do not restrict the action of the stomach by corsets or stays. 9. To neutralize the acidity of the mouth use lime water. 10. To relieve morning sickness, use Lacto-Phosphate of Lime. This last named remedy, used in the form of the syrup, should be freely employed by expectant mothers, unless otherwise ordered by their physician. It should be taken in teaspoonf ul doses, three times daily. It is especially valuable because : 1. It assists in retaining the food on the stomach. 2. It relieves the morning sickness, or vomiting, to which women are so subject at this critical period of their lives. ADVICE TO MOTHERS. 5:> 3. It strengthens the mother's teeth, and contributes to the perfect development of those of her unborn child. It is particularly useful in those cases in which the food is deficient in lime salts. Lime water, taken in moderate doses, is another remedy very efficient in hardening the teeth. It may also be used as a mouth wash, after each meal. A solution of bicarbonate of soda makes another ex- cellent mouth wash, using a teaspoon ful in a glass of water after each meal. Both will neutralize the acidity of the mouth, which is so common at this period of the life of woman. A case of irregularity of the teeth. CHAPTEK VII. CHILDREN S TEETH. By a natural progression we are brought to the con- sideration of children's teeth. After the mother has secured to her child a solid foundation, her work has but begun. As soon as the teeth appear they must be carefully watched, for as they take some time to solidify, they easily decay ; as to the best means for preserving these organs, there is much misunderstanding and lack of knowledge, and hence many a child's teeth are un- wittingly permitted to decay. The following sugges- tions on the care of infant's teeth will, therefore, I think, be of some service to the reader. Children grow two sets of teeth. The milk teeth, twenty in number, and the permanent ones, thirty-two in number. The milk teeth generally appear as follows : Central incisor, 5th to 6th month. Lateral incisor, 7th to 8th month. First molars. 12th to 16th month. Canines, 14th to 20th month. Second molars 21st to 36th month. children's teeth. 57 The eruption of the lower teeth usually takes place before those of the upper. The permanent teeth appear in the following order: First molars, . 5th to 6th year. Central incisors, lower jaw, . . . 6th to 7th year. Central incisors, upper jaw, . . . 7th to 8th year. Lateral incisors, 7th to 9 th year. First bicuspids, 9th to 10th year. Second bicuspids, 10th to 11th year. Canines, 11th to 13th year. Second molars, 12th to 15th year. Third molars, or wisdom teeth, . 17th to 23d year. As the milk teeth last but a short time, or until they are displaced by the permanent teeth, very little atten- tion is generally paid to their preservation. Tartar and filth are allowed to accumulate, and as soon as they become troublesome they are extracted. The idea that the milk or deciduous teeth should be taken out as soon as they ache, is not only erroneous but harmful. So long as they can be saved, they should not be removed, as serious injury is inflicted on the child. If these are extracted the incoming permanent ones are seriously interfered with; they grow out of their allotted space, or grow in an irregular manner, distort the mouth and impede the work of mastication. Nature indicates the time for their removal by absorb- 58 CARE OF THE TEETH AND MOUTH. ing their roots and loosening their crowns, preparatory to the appearance of the permanent teeth. Moreover, it is somewhat dangerous to extract any of the milk teeth, because the jaw is not }^et perfectly developed, and is, therefore, very frail and liable to fracture. It of a child at about six years of age. The deciduous teeth and the first per- manent molars are in place. The outer plate of the bone is removed to show the advancing germs of the permanent teeth. is because of this belief and the consequent neglect that the milk teeth decay so rapidly. As soon as they appear, they should be cleaned every day with soft linen, and when all the teeth are erupted, a soft brush should be used. Tartar, easily distinguishable by the children's teeth. 59 dark or green stain which it imparts, should not be per- mitted to accumulate. From the tables already given, it appears that at the age of six the child has four, and at the age of twelve it has twenty-eight of the permanent teeth. The sixth-year molars deserve a special notice, because they are so frequently confounded with the first set of teeth. The reason of this is, that those back teeth of the upper and lower jaw on either side make their ap- pearance before any of the first teeth are shed. If neglected, as they too often are, they are early lost, and can never be replaced, except artificially. When you are able to count a row of eleven or twelve in each jaw, that is, as soon as there are more than twenty teeth in all, you may be sure that the last molars on either side belong to the second set. During the eruption of the milk teeth, children fre- quently suffer from stomatitis, or inflammation of the soft parts of the mouth, due to the irritation produced by the teeth forcing their way to the surface. The mucous membrane, or lining of the mouth, becomes very red, there is an increased flow of saliva, the parts are irritable and sore, the child is in a feverish state, it is disinclined to put anything in its mouth, or to take food either from the spoon or nipple, because of the pain which it experiences. The irritation and swelling may be so extensive that the entire nervous system 60 CAEE OF THE TEETH AND MOUTH. becomes affected, and the child is thrown into convul- sions. Relief may frequently be obtained by lancing the gums, and thus mitigating the irritating pressure of the incoming teeth, and by spraying the mouth with a solution of fifteen grains of borax, or chlorate of potas- sium, dissolved in a tumbler full of water, or by paint- ing the cheeks and lips with linseed. Of course, during dentition children may suffer from many other diseases, none of which are within the prov- ince of the dentist. In such cases the physician should be consulted, and much unnecessary pain, if not serious consequences, may be avoided by a timely call. Very early in life children may acquire bad habits, which shall result in deformity of the teeth, and hence parents should make a strong effort to correct them. Thumb, ok Finger Sucking. — By this habit the lower teeth are forced inwards and the upper teeth outwards. These results are due to the peculiar way in which the fingers rest upon the teeth during the act of sucking. Unless this habit is checked before the permanent teeth appear, it will result in disfiguring them, and speech and mastication will be impaired. The habit may be broken by wrapping the finger with muslin saturated with some harmless preparation, disagreeable to the taste. Lip Sucking. — This is another habit which may result in depression of the lower teeth. The child, b} T drawing nNILDKKN S TEETH. 61 the lower lip into the mouth, exerts a pressure upon the teeth, and they are forced inward to such an extent that deformity results. The space for the back teeth is An irregular dentition due to thumb sucking. greatly contracted, and extraction of one or more is required to make room for all the teeth in the arch. If the child cannot be broken of this habit in any other way, a fixture similar to a splint ought to be made and put between its teeth and lips, so as to make it im- possible to draw the lips into the mouth. Mouth Breathing. — Mouth breathing also produces irregularity of the teeth. This habit, most commonly indulged during sleep, is frequently due to some nasal obstruction of the air passages. In these cases surgical operations are often necessary. Sometimes the habit is acquired when no organic trouble exists. The most effective way of breaking this habit is that employed 62 CAEE OF THE TEETH AND MOUTH. by the Indian mother, who bandages the mouth of the child, and in this way forces it to breathe through the nostrils, or not to breathe at all. Rubber appliances, working on the same principle, are in use to-day, only they are free from the barbarous character of the Indian method ; that is, they work on the principle of inducing nose breathing, by making it so difficult to breathe through the mouth that the child readily accustoms itself to breathe through its nostrils. Cracking Nuts, Etc. — Teeth must not be used as nut-crackers. Like the bones, they are not solidified in early life. Even if they are, cracking nuts with them will soon result in their destruction, as they were not intended for such violent work. Candies. — Children should be advised to abstain from candies. I mean cheap candies ; that of the best qual- ity is harmless enough, but the cheap candies are fre- quently mixed with acids and arsenic, the latter being used as coloring material. We need hardly add that these foreign substances are most destructive in their action on the teeth. Eating. — Children should be prevented from drinking very cold water after partaking of a warm meal. With Americans the use of ice water is very common. Yery often after drinking hot coffee or tea, a large quantity of cold water is drunk. This mixture of the warm and cold is very injurious, not only to the stomach, but also children's teeth. 63 to the teeth. The habit should be broken in childhood, because when once formed it is difficult to overcome. But unless the food contains a generous supply of tooth- building material, no amount of cleanliness or correc- tion of bad habits will suffice to preserve the teeth. An eminent physician, speaking on the subject of food, says, " our pale-faced boys and girls are brought to this condition by living on butter, sugar and super- fine flour. To prepare these articles, the very elements that make bone and tissue are extracted." The child must be fed on plain, substantial food ; it must not be too fat, or too rich, all pastries being avoided. A tea- spoonful of lacto-phosphate of lime, or lime water, ad- ministered three times a day, will add greatly to the strength of the child's teeth. To conclude, let me say that as soon as the milk teeth appear the utmost care should be taken of them. The child should be examined by a dentist at regular intervals, say of six months. It should not have any of the temporary teeth extracted, but have them filled wherever necessary, and so preserve them until the permanent teeth are erupted. By following these suggestions and bringing to their aid good common sense, mothers may secure to their children a set of strong, healthy teeth, which, with proper care, will last a life-time. CHAPTER VIII. CROWN AND BRIDGE WORK. Although this department of dental practice offers to humanity one of the most useful and ornamental devices yet discovered, very little, as yet, is known of it among the people. By its employment, teeth that it would otherwise be necessary to extract are pre- served, and artificial plates are dispensed with. It is certainly more expensive than artificial dentures, but the comfort and convenience af- forded, to say nothing of durability, amply repay the outlay. Crown Work.^ — This is the process of attaching artificial crowns to badly decayed teeth, or to roots. There are a number of kinds of crowns used. Those intended for part of the mouth are of Crowns for front teeth. teeth in the porcelain, or anterior have porcelain facings, while those CROWN AND BRIDGE WORK. 65 employed for back teeth alone are commonly made of gold only. The latter class are caps of gold, which completely envelop and enclose the crown of the tooth, and they are used in those cases in which decay has so wrecked them that a filling will fail to preserve them in a satis- factory condition. Surrounded by its gold cap, the tooth cannot come into contact with foreign substances, so that it is almost impossible for decay to recur. For front teeth, crowns with porcelain facings are employed, to prevent the unsightly appearance of such an apparent mass of metal. The porcelain facing gives to the tooth a natural appearance. Formerly, the work of crowning, which demands Crowns for back teeth. great skill and discrimination, was confined mainly to the back teeth; but the modern dentist, having im- proved methods of manipulation, successfully operates 66 CARE OF THE TEETH AND MOUTH. on any tooth, if it have but roots which are firmly imbedded in the jaw. Bridge Work. — When there are two or more sound roots or teeth, with spaces from which teeth have been lost between them, it is possible to supply the missing teeth by constructing a bridge of crowns across the vacancy. The crowns are soldered to each other, the terminal ones being firmly attached to the sound teeth or roots, in such manner that each of the intermediate crowns occupies the space of a missing tooth. They may be constructed with a porcelain firu facing, so that the whole work shall present [ , ] to the observer a most natural appearance. There are a variety of methods for construct- ing these bridges, each excellent in itself, and each specially adapted to some particular class crown, of cases. Bridge work has been condemned by many dentists of high standing, because it has been so much abused through its improper use. Some practitioners, either because of a mistaken enthusiasm or from some less worthy motive, have inserted bridges upon insecure or diseased roots, with the natural consequence, of their early failure. Others have not hesitated to sacrifice good and serviceable teeth for the purpose of putting in bridges. All these possible abuses do not excuse the CliOWN AND I51MDGE Wo UK. 67 wholesale denunciations of that which is proper and correct practice. As well might one condemn the fill- ing of teeth, because poor work is sometimes done. One of the most attractive features of this kind of A piece of Bridge Work. work is, that when properly made and inserted, the patient soon loses all consciousness of its artificiality. The crowns and teeth being attached to natural roots and immovable, approach more nearly to the natural organs, and the patient suffers less discomfort than from any other artificial substitutes. OHAPTEE IX. FRACTURED JAWS. To the great majority of people, the word " dentist " conveys but one idea — that of a tooth puller. It is true that in the past, dentistry was practised to a large extent by persons engaged in some other pursuit, and without any professional education whatever. The blacksmith, barber, watchmaker, and others of the same class, were the dentists of every village and town. Even in some of our largest cities, dentists of this kind were, until quite lately, found practising under the very shadows of the Universities and Medical schools. The explanation of this seems to be that mere tooth drawing constituted the surgical dentistry of those days, and as the operation of extraction is one requiring muscular strength and manual dexterity, rather than anatomical knowledge and surgical skill, and was performed as successfully by the irregular as by the regular practi- tioner, it had not many attractions for medical men. Dentistry was, accordingly, assigned to the uneducated and the charlatan. To-day, however, the province of dentistry embraces FRACTURED .JAWS. t>tf the art of treating the diseases and lesions of the teeth, and supplying artificial substitutes for these organs when lost. Diseases of the teeth and mouth are not always local affections, but may, and very frequently do, arise from constitutional causes ; hence the dentist who is thoroughly qualified to heal, as well as to repair and ameliorate, must be both a surgeon and a physi- cian. He must be skilled, not only in the mechanical, but also in the therapeutical department of his profes- sion. As a result, many affections of the teeth and the various portions of the mouth, for the treatment of which people in former Interdental Splint. ^^ j^ recourse to ^g physician or the surgeon, to-day more properly are rel- egated to the dentist, who, making a specialty of these parts, is thoroughly familiar with them, and can prop- erly be termed a specialist in diseases of the mouth. This fact is so well appreciated by the general prac- titioners in medicine and surgery, that they have no hesitancy in referring their patients to the dentist in every case of oral disease, independent of any affection of the teeth, and particularly is this the case in frac- tures. 70 CARE OF THE TEETH AND MOUTH. Fractured Jaws. — In discussing this subject, I wish at the outset to mention the fact that they are most frequently clue to direct manual blows received in fights. They may also be the result of kicks, falls and other forms of violence. Fractures of the lower jaw are most frequent, those of the upper jaw being rarely en- countered. The lower jaw has its weakest place between the canine and bicuspid teeth, owing to the long roots of the former, and it is at this point that fractures are most often met, although they may occur in any other part of the bone. Out of a great number of fractured jaws that have been under my treatment, four-fifths were due to violent blows received during quarrels, the remaining one-fifth occurring through accidents. In most of these cases the jaw was fractured between the canine and bicuspid _teeth. In newly fractured jaws there is a slight movement of the broken parts, which can be felt by pressing them with the fingers. The simplest method of detecting a fracture is as follows : Grasp the jaw with both hands, applied on each side of the apparent seat of injury, so as to hold the bone between the thumb and index fingers ; then, by slight opposite movements directed both upward and down- ward, a positive conclusion may be reached through the mobility of the parts. In badly fractured jaws the FKACTUEED JAWS. 71 teeth are irregular, owing to the alteration of the level of the fractured parts, and when the jaws are brought together they do not meet as formerly, while very fre- quently the jaws cannot be closed at all. On the slight- est pressure or movement severe pain is felt, and inflam- mation, and usually suppuration, succeed. The jaw should be kept at rest, and all irritation of the fractured parts through movements caused by con- versation, eating, etc., should be carefully avoided. No Interdental Splint. View of upper Interdental Splint. View of under surface. surface. time should be lost in visiting the dentist, for the more recent the fracture the more readily can it be reduced, and the more rapid will be the healing process. For the treatment of fractured jaws the interdental splint has been devised, by the aid of which they are quickly and easily healed. This splint is made in the shape of a horseshoe, so as to correspond precisely to the arches of both the upper 72 CARE OF THE TEETH AND MOUTH. and lower jaws. The two wide surfaces have depres- sions into which, when it is placed between the two arches, the crowns of the upper and lower teeth fit ac- curately. That is, the crowns of the superior teeth fit into depressions in the upper surface of the splint, while the crowns of the inferior teeth are in the same manner received by the lower surface of this appli- ance. Thus, when the splint is placed in the mouth, the teeth and jaws become locked and immovable. In the centre of the splint there is an opening for the reception of fluid food. Nature unites the fractured bone by the formation of new bone around and be- tween the broken parts, when they are brought into accurate coaptation and kept immovable for a certain time, and preserved in good hygienic con- dition. In compliance with these principles, all interdental splints are constructed to fit the mouth as though no fracture had occurred. When such a splint is applied to the mouth, the fractured parts must, of necessity, by a Splint retained by a skull cap. FRACTURED JAWS. 73 slight pressure, resume their original position, and then nature does the rest. It usually takes from three to six weeks for a perfect union to be effected. I have dwelt at some length on fractures and splints, because I wish, first, to show how easily a fractured jaw can be healed through the aid of a splint, and secondly, to dissipate the distrust with which some people are apt to regard those dental sur- geons who undertake to perform such operations. To illustrate the second point more forcibly, I will relate the following case : A short time ago a lad, four or five years of age, was kicked by a horse, and his lower jaw was broken. I was called in as consulting dentist, and suggested the use of the splint. As the parents had never heard of this device, they immediately became distrustful, and by their misgivings and fretfulness greatly interfered with the work of fitting the splint. Even after it had been introduced into the child's mouth, it was with the ut- most difficulty that they were prevented from removing it. In the course of a few weeks the fracture was com- pletely healed, and I may add that the parents were thoroughly cured of their distrust. CHAPTEK X. CLEFT PALATES. Nature's freaks are so numerous and unlooked for that her infallibility becomes a matter of grave suspi- cion. The deaf, the mute, the lame and the afflicted, daily born into the world, are examples of her many whims and caprices. Were it not for the unwearied efforts of science, these unfor- tunate victims would find life well nigh intolerable. Thanks, however, to a broad philanthropy, the blind can be taught to read and to write, the deaf and dumb to communicate with those about them, while the deformed are enabled in a great measure to overcome their natural defects and to be placed upon the same level with their neighbors. Few, if any, are more entitled to our sympathy and our best efforts for relief than those unfortunate ones who are born into the world with a defective palate, for Jaw with double cleft. CLEFT PALATES. 75 they are thereby deprived of one of the greatest bless- ings bestowed upon man, the faculty of distinct speech, as well as the power properly to perform the functions of mastication and deglutition. The palate is the roof of the mouth. It consists of two parts, the hard and the soft palate. The former is of bony, while the latter of muscular tissue. The hard palate serves not only as the roof of the mouth, but also as the floor of the nose. The soft palate is sus- pended like a curtain from the posterior edge of the hard palate. Its function is very important, and consists, during deglutition, in closing the passage from the pharynx into the "posterior nares, so that food may not get into the nose. Each palate is, moreover, divided into two parts, which are united in the median line of the mouth. The union of these parts generally occurs during the third week of embryonic life. Sometimes, however, this does not take place, and the child is born with a perfor- ated palate. Such an one is technically called a con- genital cleft palate. There are also accidental cleft palates, due to disease resulting from an irregular and debauched life. Cleft palates of the latter class are much more numerous than those of the former. Congenital cleft palates vary in size and form. Sometimes both hard and soft palates 76 CAKE OF THE TEETH AND MOUTH. are perforated. In such cases the interior of the nose and the bones of the skull are exposed, and the whole presents a very ghastly appearance. Accidental, or acquired, cleft palates also vary, and either the soft or hard tissues, or both, may be affected. Cleft through the hard and soft palates. In congenital cases the sufferer does not experience any great inconvenience during the process of degluti- tion, as the instinct of self-preservation has from child- hood taught the sufferer to close the cleft with the tongue. Then, by placing the food under that organ, CLEFT PALATES. 77 it is shifted from side to side until forced into the pharynx. This process is a very curious and compli- cated one. None of us, try as hard as he may, could imitate it. For this reason, if one becomes afflicted with such a palate in adult life, he can in no way accus- tom himself to close the opening with his tongue, and, therefore, whenever he at- tempts to eat, a portion of the food is invariably forced into the nose. The patient thus not only suffers great inconvenience, but it be- comes the source of con- stant humiliation. But by far the greatest embarrassment to which these sufferers are subject- ed, whether the cleft be con- genital or acquired, arises from their inability to speak clearly and distinctly. For a distinct utterance of vocal sounds every part of the mouth is essential. In many cases, indeed, the cleft makes speech utterly impossible. Formerly, to remedy these evils recourse was had to surgical operation. Staphylorraphy, which means Upper denture with artificial soft palate. 78 CARE OF THE TEETH AND MOUTH. suturing or sewing together, was the most common remedial measure. But this operation in many cases proved unsuccessful. It consisted in paring the edges of the cleft, and then sewing them together. This necessitated the stretching of the soft parts to such a degree that they would eventually rupture. Dentistry has succeeded in con- structing an appliance which, by taking the place of the lost parts, enables the palate properly to perform its functions. These contrivances are known under the name of obturators. Where the hard palate alone is perforated, the obtur- ator is very simple. It consists of an ordinary artificial plate, extending over the cleft. But where the soft palate is involved, it is very com- plicated and difficult of construction. In such cases the obturator consists of an artificial plate, to the posterior edge of which is attached a pendulous body, cor- responding in size and shape to the miss- ing soft palate, and fitting exactly in its Plate ready for attachment of the obturator part. „]„„„ In some cases this pendulous body is given a hinge movement, the muscles of the mouth enabling it to CLEFT PALATES. 79 perform all the functions of the soft palate. The obtur- ators are held in position by means of clasps or rings, which embrace the natural teeth, as it is impossible, owing to the cleft, to utilize the forces of adhesion and atmospheric pressure, as would be done in the case of artificial dentures. The use of the obturator has never failed to restore clearness and distinctness to speech, or the power properly to perform the process of deglutition. Of course, in congenital clefts, the sufferer has never known how to utter the proper sounds, and for this reason it requires a great deal of patience and perseverance on his part be- fore he is able to do so. He must learn just like a young child. But in the case of acquired clefts, the patient still retains the knowledge of the former method of utterance ; he only needs some contrivance to close up the cleft, to restore to him the power of speech. So it can readily be seen that when the palates, or either of them, is perforated, the plate and the pendulous body 80 CARE OF THE TEETH AND MOUTH. thereto attached, if properly made, will completely close the entrance to the nose and prevent the food from being forced into it. The obturator is an excellent example of the many benefits modern dentistry has conferred upon mankind. By its means men are restored to society, who, either through the misfortune of birth or from wantonness, have become to others an object of pity — to themselves, one of disgust. CHAPTER XI. HINTS ON HOME REMEDIES. People are frequently seized with toothache at times when it is almost impossible to visit the dentist. On such occasions they listen eagerly to the advice of kind and sympathetic friends, each of whom has some pet medicine to recommend that he is convinced will prove efficacious ; these remedies too often are only active in burning the patient's mouth, so when one of these self- doctored sufferers obtains professional advice, the tissues are so inflamed that before the teeth can be treated the work of home doctoring must be undone. Recognizing the difficulties under which one labors who is thus suddenly attacked, I have determined in this chapter to lay down a few suggestions, which, if properly followed, will enable patients to treat them- selves in an intelligent and effective manner until they can reach the dentist. Of course, in a book such as this, it is impossible to speak of every disease that may affect the teeth. To attempt it would result in producing a work not only very voluminous, but also very confusing, as the distinctions between many of 82 CAKE OF THE TEETH AND MOUTH. the disorders are very subtle, and comprehensible only to the dentist. There are others, however, whose cause even a layman can readily ascertain, and to which some simple remedy may be temporarily ap- plied with good effect. I shall treat in this chapter of the following maladies : I. Aching teeth, with a cavity caused by deca}^ Of these there are two classes : A. When the pulp within the cavity is living. B. When the pulp within the cavity is dead. II. Filled teeth that ache. Of these there are two classes : A. When the pulp is living. B. When the pulp is dead. III. Aching gums. These are usually due to one of the following causes : A. Tartar. B. A cold. C. Recent cleaning of teeth. D. Extraction of teeth. IV. Hemorrhage. V. Neuralgia. YI. Foul breath. HINTS ON HOME REMEDIES. 83 VII. Dislocated jaw. VIII. Faintness after extraction. IX. Food to be used in place of solid food. When suffering from toothache, find out if any of the teeth have a cavity"; you can do this by probing the teeth with an ordinary tooth-pick, or some similar instrument. If you discover a cavity, determine whether the pulp within the cavity is living or dead. I. Aching Teeth with a Cavity of Decay. A. WHEN THE PULP IS LIVING. Diagnosis. — To determine whether the pulp is living or dead, take some very warm or very cold water in the mouth, and bring it in contact with the pulp. If the pain is thereby increased, the pulp is living. Another very simple method for determining whether the pulp is living or not, is to insert a tooth-pick into the cavity and press upon the pulp. If the pain thereby is intensified, the pulp is living. In fact, living pulps are so sensitive that the introduction of any foreign material into the cavity will greatly increase the suffering. Treatment. — Wash out the cavity, either by rinsing the mouth with lukewarm water, or by employing a syringe, if one is at hand. After the cavity is 84 CARE OF THE TEETH AND MOUTH. thoroughly cleaned, insert into it a pellet, or little ball of cotton, saturated with spirits of camphor, oil of cloves or laudanum. Over the pellet insert a piece of dry cotton, so as completely to fill the cavity, and thus protect the pulp from sudden changes of tempera- ture, or the intrusion of foreign substances. B. ACHING TEETH, WHEN THE PULP IS DEAD. Diagnosis. — Of these teeth there are two kinds ; in the first, the patient suffers from mere inflammation of the lining membrane between the root and the socket ; in the second, the inflammation has developed an abscess or gumboil. Prompt treatment in the first stage of the disease may prevent the second. The symptoms of the two stages are alike, except that in the second there is a swelling of the gums around the tooth. The teeth are elongated above the level of the surrounding ones, and are very sore, so that on closing the mouth they are struck first and a painful shock is experienced. They are also discolored, or somewhat darker than the surrounding teeth ; a bad odor also sometimes issues from them. Treatment. — For the first stage, or that in which there is mere inflammation of the lining membrane : 1st. Apply a dental plaster to the gums. It may be obtained at almost any drug store. Or, 2d. Rub iodine and aconite in equal parts around HINTS ON HOME REMEDIES. 85 the gums with cotton, or a camel's hair brush ; before the mixture is applied, dry the gums thoroughly. The iodine and aconite induce a healthy flow of the blood, and facilitate the removal of the waste material. Be careful not to swallow the remedies, as they are poison- ous. Or, 3d. Apply a leech to the gums, through a tube. Or, 4th. Employ a cathartic ; it will reduce the quantity of water in the blood, and by limiting the blood pressure afford relief. Treatment. — For the second stage, or that in which the inflammation has developed an abscess : 1st. Apply warm poultices of capsicum, or flaxseed, or raisins. Capsicum Poultice. — Place in a small cotton bag a mixture consisting of three parts of flour and one of red-pepper or capsicum. Warm this and apply it over the head of the abscess within the mouth. It should be changed every three hours. Flaxseed Poultices. — These may be made by wrap- ping flaxseed in strips of linen, two by three inches ; after heating them, apply them around the abscessed gum ; as soon as the poultice becomes cool, remove it and substitute a warm one. The abscess is thus brought to a head and prepared for the lance of the dentist. Patients should never attempt to do their own lancing, lest they induce blood poisoning. 86 CARE OF THE TEETH AND MOUTH. Raisin Poultice. — This may be made by cutting a number of large raisins into halves, taking out the seeds and heating them. One of these should be applied to the gums, directly above the abscess. As soon as it becomes cool, change it for a warm one. Con- tinue this treatment for several hours. As the breath is feverish and foul during the develop- ment of an abscess, the patient should use either of the following mouth-washes several times a day : 1st. Rinse the mouth with a solution made from a teaspoonful of bicarbonate of soda in a glass of warm water. 2d. Or, Listerine, either pure or diluted with from three to five parts of water. 3d. Or, the following : Carbolic acid, two drams ; glycerine, four drams ; rose water, ten ounces. Sometimes the abscess is so large that the cheek is swollen. In such cases apply cold applications to the face, in addition to the warm applications to the gums. Never apply heat externally, lest the abscess burst there and leave behind it an ugly scar. II. Teeth that Ache After Being Filled. Diagnosis. — Sometimes a tooth is prematurely filled by the dentist ; that is to say, he fills the tooth before he has thoroughly quieted the nerve, in a case in which the pulp is living ; or in one in which the pulp is dead, HINTS ON HOME REMEDIES. 87 he fills the tooth before he has thoroughly disinfected the pulp chamber and removed the dead pulp. It may also happen that after the cavity has been filled, in spite of all precautions, the pulp dies beneath the filling ; hence arise two classes of these diseased teeth — those with living pulps, and those with dead pulps. When the pulp is alive beneath the filling, the patient may suffer from jumping, or intermittent toothache. Treatment. — Any one of the following measures may be employed : 1st. Take a hot foot bath ; this will equalize the circulation, and by relieving the blood pressure will relieve the pain. 2d. Take a saline cathartic, like magnesia or epsom salts ; this will diminish the quantity of water in the blood, and so will relieve the blood pressure on the pulp. B. WHEN THE PULP IS DEAD BENEATH THE FILLING. Diagnosis. — The same as in the case of unfilled teeth with dead pulps. Treatment. — Also the same. (See disease I, sub- division B.) III. Aching Gums. This may be clue to an accumulation of tartar under- neath them, to colds, to laceration due to extraction, or 08 CARE OF THE TEETH AND MOUTH. to the irritation produced by a recent cleaning of the teeth. A. ACCUMULATION OF TARTAR. Diagnosis. — The gums have receded from the necks of the teeth, the teeth are loose, the breath is foul, and pus oozes from the gums. Treatment.— Rinse the mouth with tepid water, in which one or two teaspoonfuls of bicarbonate of soda have been dissolved. Use the solution at intervals of an hour. B. COLDS. Diagnosis. — The pain results from the inflammation caused by exposure to currents of air below the normal temperature of the body. Treatment. — Paint or rub the gums with a mixture of equal parts of aconite and iodine, or rinse the mouth with a solution of one dram of borax, or chlorate of potash, in a glass of water. C PAINFUL SENSATION FROM RECENT CLEANING. Diagnosis. — After the teeth have been cleaned by the dentist, they ache for a day or two, and are some- what sensitive. Treatment. — Rinse the mouth with either of the following mouth- washes : 1st. Dissolve a teaspoonful of common salt in a glass of warm water ; to be used every half hour. HINTS ON HOME REMEDIES. 89 2d. Rinse the mouth with Listerine, either in full strength or diluted with water. D. LACERATED GUMS AFTER EXTRACTION. Diagnosis. — After the teeth have been extracted, if the gums are lacerated and torn the patient will suffer considerable pain. The breath may also be foul, because of consequent sloughing. Treatment. — Use tincture of calendula, dilute it with an equal quantity of water, as a mouth-wash every three hours. It hardens the gums, soothes the pain, and sweetens the breath. IV. Hemorrhage. Diagnosis. — It sometimes happens that the extrac- tion of a tooth is followed by excessive hemorrhage or bleeding, due to a lack of coagulation or thickening property in the blood, or to a hereditary tendency to hemorrhage. There are two stages of hemorrhage — the primary and the secondary. The primary occurs at the extrac- tion of a tooth, and is normal ; the second hemorrhage may occur several hours, or even a day or two after the teeth have been extracted. Treatment. — Place the patient in a reclining posi- tion, with his head higher than the rest of his body, and 90 CARE OF THE TEETH AND MOUTH. apply bags of hot water to his feet. His position will prevent a determination to the head, and the water bags will draw the blood to the lower extremities. Before applying any remedy to the cavity, wash it very carefully with warm water, or the remedy will not prove as effective. Make a firm plug of styptic cotton and force it into the cavity ; cut a notch in a cork of suitable size, so that it may sit astride the gum ; then close the mouth firmly upon it, and bandage. By this means the cotton will be forced far into the cavity, and thus check the flow of blood. Hold in the mouth, until bleeding has stopped, a portion of a solution of two drams of borax in a glass of warm water. The bleeding cavity ma}^ also be plugged with leather scrapings, alum, cob-webs, or pieces of sponge satur- ated in nut-galls. Any one of these will usually suffice to check the hemorrhage. While these remedies are being employed, the physician or dentist should be sent for without delay. V. Neuralgia. Diagnosis. — Neuralgia is usually due to a bad con- dition of the teeth, but it may arise from some general disease, for the teeth may be perfectly sound and yet the patient suffer from intense neuralgia. HINTS ON HOME REMEDIES. 91 Here let me say that I shall dismiss the neuralgias due to constitutional conditions from consideration, as their treatment lies within the province of the physician. The nerves of the face are very numerous and closely connected. The}^ form a complex net work, which is instantly aroused if any of the filaments are irritated. In the sensitiveness and rapidity of their transmis- sions, nerves are like electric wires ; an aching tooth may thus cause intense neuralgia, by inducing sympa- thetic pain among the nerves of the face and the head. Such pain, of course, can only be assuaged by allaying the pain in the tooth. Hence, to check neuralgia due to any of the teeth, the patient need only ascertain what particular ailment — as cold, tartar, recent extrac- tion, a dead or a living pulp — causes the pain, and apply the proper remedy. VI. Foul Breath. This is one of the most offensive and annoying features accompanying decayed or filthy teeth. It makes its victim a nuisance in society, as he becomes absolutely repulsive, and yet it is rarely referred to, from mistaken notions of delicacy. As a rule, the patient is quite unaware of his condition. Sometimes it arises from a disordered stomach, catarrhal troubles, 92 CARE OF THE TEETH AND MOUTH. or some general disease. If this be the case, the care lies with the physician, but if it arises from bad or filthy teeth, he should see the dentist, and in the mean- time take internally a half teaspoonful of Listerine after each meal, at the same time rinsing the mouth two or three times a day with tepid water, in which two or three grains of permanganate of potash have been dissolved. VII. Artificial Teeth. Diagnosis. — Before becoming accustomed to artificial teeth, the wearer generally suffers from soreness of the palate. It may be clue to the fact that the plate is not accurately fitted, or that the gums have not suf- ficiently healed, but more often it may be attributed to the novelty of having an artificial contrivance in the mouth. Treatment. — Remove the teeth for a few days, to allow the mouth to resume its normal condition. If there is considerable soreness, use the following wash : Take a lump of alum, the size of a black- walnut, and place it in a half glass of water. Keep it there for five minutes ; then rinse the mouth with the solution. With a camels-hair brush paint the sore places of the mouth, or the corresponding positions on the plate, with the following : Into a two-ounce bottle, with a wide mouth, put an HINTS ON HOME REMEDIES. 93 ounce of glycerine, place it in a hot bath, and stir in slowly two ounces of tannic acid. This will also be found an excellent remedy for the lips when chapped or made sore by dental operations. If these do not afford relief, see the dentist. Here let me say that much unnecessary suffering is the result of persistently removing the plate and allowing it to remain out of the mouth for a greater or less period of time, while the patient is becoming habituated to it. In spite of some pain and inconvenience he should persevere, and only when the intensity of his suffering becomes unbearable should the plate be re- moved, and the treatment above outlined be employed. VIII. Dislocated Jaws. Diagnosis. — Sometimes during laughing, vomiting, etc., the lower jaw is dislocated ; that is to say, the joints or condyles are forced out of the sockets. When this is the case it will be found impossible to close the mouth, or to move the lower jaw. Treatment. — I. Let the patient sit in a low chair that is tilted backward so that the head rests firmly against the wall. Next let some friend wrap his thumbs in a napkin, or some other material that will protect them against being bitten, and grasping the sufferer's chin, so that the thumbs rest upon the upper surface of the lower back teeth, while the remaining fingers 94 CARE OF THE TEETH AND MOUTH. encircle the outside of the chin, let him exert a quick downward and back- ward pressure, and the jaw will be forced into place. II. Take a stick of convenient size and about a foot long, and apply one end of it to the upper surface of the lower back teeth on one side ; raise the free end of it upward, thus using it as a lever, and exerting great down- ward and backward pressure, when the jaw will be sprung into place on that side. Do precisely the same thing on the other side, and this will also assume its proper position. IX. Gas Exteaction. Diagnosis. — Sometimes after gas has been adminis- tered, a strong feeling of drowsiness seizes the patient. Treatment. — Let him get into the fresh air, and in- hale large draughts of it, also taking a little brandy to A dislocated jaw. HINTS ON HOME REMEDIES. 95 stimulate the action of the heart. If the desire for sleep be not gratified, the drowsiness will soon pass away. X. When the gums are lacerated after extraction, it is sometimes impossible to eat solid food. Make a mixture consisting of a glass of boiled milk, two soft boiled eggs, and some sugar ; drink this and it will prove as nourishing as a good sized steak. In conclusion, let me say that these remedies are but make-shifts ; they may afford temporary relief from pain, but they do not remove the cause of it. This remains, and with every recurrence of the pain the efficacy of the remedies becomes less and less, until finally it is reduced to nothing. Hence there can be but one source of permanent relief, and that is to strike at the root of the trouble ; thus, if you suffer from the accumulation of tartar, let the dentist remove it; if you suffer from aching filled teeth, have him either extract them, or take out the fillings and prepare them again for fresh filling. Let the patient remember, too, that it is not sufficient to have only the aching teeth attended to ; wherever it is necessary, let them be clean, filled or capped, for thus only can every source of disease be removed and the mouth be restored to a healthy condition. CHAPTER XII. QUACKERY. Every family has its black sheep, all professions their quacks, and dentistry is no exception to the gen- eral rule. Here, much more easily than in any other profession, deceit and ignorance may be palmed off upon the layman for a considerable length of time, with little fear of detection or exposure. You are all familiar with his quackship, who may be recognized by his gaudy signs and alluring advertisements. Here are some of them : " Teeth cleaned for 50 cents ! " " Teeth filled for 50 cents ! " "Teeth extracted with pain for 25 cents; without pain for 50 cents ! " " Artificial teeth made for $5.00 while you wait ! " Enticing signs, these, are they not? " Teeth cleaned for 50 cents ! " How can a reputable dentist clean a set of teeth for this sum? How can any professional man live as befits his station, and meet the current expenses of his office, and work for 50 cents an hour? ]STo dentist, however QUACKERY. 97 skilled and ingenious he may be, can on an average thoroughly clean a set of teeth in less than an hour, and how often, when the mouth is very filthy, must he work even two and three hours. It requires this length of time to clean a set of teeth, because, as I have shown in a preceding chapter, cleaning the teeth does not consist in merely giving to exposed surfaces a bright polish, but in thoroughly removing the tartar from beneath the gums, where it has accumulated in thick, incrusting cakes. How then, you will ask, can the quack clean the teeth for 50 cents? How? Through the use of de- structive agents. By the application of a powerful acid he can do the work of hours in a few moments. But for the reasons that I have already explained, in those few minutes the action of the acid has wrought greater destruction than many years of wear and tear could effect. This is how the quack works, and that is why he can work cheaply. " Teeth filled for fifty cents ! " How can any reputable dentist afford to fill a tooth for that sum ? How ? Listen to the experience of Mr. A., which is that of hundreds of others : " I had my teeth filled by the dentist, and the pain was intensified a thousand fold. I suffered from jump- ing toothache, and from abscesses, until I was almost driven wild. It was not until the filling fell out of the 98 CAEE OF THE TEETH AND MOUTH. tooth (thanks to bad workmanship) that I obtained any relief from the severity of my sufferings." Upon carefully questioning the indignant complainant, it leaked out that he had been enticed into the parlors of the 50-cent dentist. Good filling requires that the dentist should carefully examine the tooth before he undertakes to fill it, so that he may discover whether it is alive or dead. If it is living, before he can fill it the pulp must be soothed ; and if it is dead, the pulp-chamber and canals must be thoroughly cleaned and disinfected. This preliminary work is laborious and difficult, and no dentist can undertake it for the mere pittance my complaining friend so generously paid. If he suffered from jumping toothache, it was because the dentist worked the filling into the tooth before the inflamed pulp was quieted, and so aggravated its irritated con- dition. If he suffered from abscesses and swellings, it was because his tooth was filled before the pulp- chamber and canals were properly disinfected. If the filling'fell out shortly after it was put in, it was because the dentist had not spent a sufficient and necessary length of time in shaping the cavity for its retention. " Teeth extracted with pain for 25 cents ; without pain for 50 cents ! " The quack excels in one department of dentistry — extraction. He takes out everything that comes in his QUACKERY. 99 way. Extraction is a joy to his heart. He glories and revels in it. Never by any chance does he advise his patient to have a tooth filled, capped, or crowned, or to employ any one of the numerous excellent con- trivances which modern dentistry has invented. He always urges that it be pulled. The task of extraction is brief, and the remuneration comparatively high, when one considers that he charges the same price for the more difficult work of filling or cleaning. The harm thus worked by the quack is incalculable. Many a tooth thus ruthlessly removed might have been saved by the reputable dentist. The majority of decaying teeth are not so far gone but that the skill- ful practitioner can, by some one of the many ingenious means in vogue, manage to preserve them. "Artificial teeth made for $5.00 while you wait! " How absurd. No one, be he ever so clever, can make a set of teeth in less than a day or two, nor can any dentist, without sacrificing the welfare of his patient, afford to make teeth at such ridiculously low figures. Two elements enter into determining the value of a set of artificial teeth — workmanship and material. Workmanship. — This includes : 1st, natural appear- ance ; 2d, accurate fit ; 3d, such adaptation as will enable the possessor to perform mastication and articu- lation. 100 CARE OF THE TEETH AND MOUTH. Natural Appearance. — The teeth must be so con- structed as to preserve all the characteristics of the natural organs, and conform to the physiognomy of the patient. Shall they be large and powerful, small and dainty, or shall they be of medium size ? "What hue and shade shall be selected ? These are questions that the dentist can only answer after careful study of each individual case, for the patient can readily perceive that a set of teeth may be of very fine material, and yet may mar his appearance, because they are not in harmony with his general facial expression. Accuracy of Fit. — Perfect adaptability of the denture to the tissues is necessary, in order that it may set firmly in the mouth. This adaptability can only be obtained at a great expenditure of time, which the quack cannot afford, since he must compensate his cheapness of price by rapidity of work. Dental plates are manufactured on models made from impressions of the mouth. These impressions may be taken in wax, or some similar compound, or in plaster of paris. The former are taken easily, but they are inaccurate. The latter are obtained with difficulty, but they are exact. It is needless to say that our friends of the flourishing advertisements always dabble with wax and similar materials. Mastication and Articulation.— -I need hardly tell the reader that unless the teeth are well constructed. QUACKERY. 101 mastication and articulation can only be performed with great difficulty and inconvenience. Material. — Many people labor under the impression that artificial teeth are all of the same grade of material. This view is erroneous. Just as our clothing may be of inferior or superior quality, so it is with the porcelain from which artificial teeth are manu- factured. There are two classes of porcelain teeth. One pos- sesses such a remarkably vital appearance, that when put alongside of the natural teeth the most critical eye will often fail to distinguish between them. This close imitation results from study, and refined, artistic taste. The other class has a dull, opaque and lifeless appear- ance. It lacks all those essential characteristic features which make the former kind of porcelain in- valuable in dental art. The reason, therefore, why the quack works at such low figures is, that he employs poor workmanship and poor material. The better class of porcelain is worth fully three times as much as the inferior kind, and as to the relative values of good and bad workmanship, there can be no comparison whatever. The quack works minutes, while the painstaking dentist works hours. Poor teeth are injurious physically, aesthetically and financially. 102 CARE OF THE TEETH AND MOUTH. Physically, because they are a source of discomfort to the patient. JEsthetically, because they mar his appearance, and financially, because they are not durable. Teeth are necessities, not luxuries. Bad is the policy, and worse the intelligence that will, for the sake of apparently saving a few dollars, buy ugly trash instead of valuable and durable material. The few dollars' dif- ference in the price between good and bad teeth are, I said, only seemingly saved. This is true, because the poorer class of teeth are worthless in every respect, whether as masticators, articulators, or beautifiers, and they must soon be discarded for something better. As usual, the greatest sufferers at the hands of the quack are the poorer people, who are readily attracted by the cheap prices and the golden promises of speedy benefits. For them we may have sympathy. There is, however, a class of people who have the means wherewith to pay for good dental work, and whom experience should have taught that whatever is abnor- mally cheap is worthless. For them there is no excuse. If they have been deceived, they have only obtained their just deserts. Poverty may be offered as an extenuation, but for greed there is no excuse. In the long run it will pay rich and poor alike to select a dentist, not from the standpoint of cheapness, but of ability. It is true that he may charge what QUACKERY. 103 appears to be large prices, but the patient will have the satisfaction of knowing that he has had faithful work, and that he has been given the benefit of the best fruits of great industry and knowledge. As a matter of fact, however, not even the poor man has any reason for resorting to the quack, for every good dentist is imbued with such a love for his profes- sion that he considers not alone the financial side, but is always ready to make due allowance for those who cannot afford to pay him his regular fees. Nothing then, save a false sentiment of pride which may make him ashamed to ask for the reduction, need drive the poor patient from the doors of the skilled practitioner to the quack. I have sought, in this chapter, to point out the delu- sion of cheap prices, and the danger and menace that the quack is to society. If I have succeeded, I shall have rendered an important service to every one who is obliged to seek the services of the dentist. LIBRARY OF CONGRESS DDQ5bD73SD c 3