^71! tt:^.; >- 1>^ L2< i^='¥ii MP TREATISE ON DENTISTRY, TREATISE ON DENTISTRY THE CARE AND PRESERVATION €\t Ceet|. BY SAMUEL FOWELL, DENTIST. $mn^ ^Htinn. LONDON : J. MITCHELL, BOOKSELLER AND PUBLISHER TO THE QUEEN, AND, BY SPECIAL APPOINTMENT, TO THE EMPEROR NAPOLEON III, ROYAL LIBRARY, 3 3, OLD BOND STREET. LONDON: ADLARI), BARTHOLOMEW CI.OSK. 113 THOMAS HAWKSLEY, ESQ., M.D. ETC., ETC., ETC. Dear Sir, The recognition of great personal kindness, as well as of high professional talent, points you out as the person to whom, pre-eminently, the Second Edition of the following Treatise should be addressed. How- ever trifling it may be in itself, it at least presents the opportunity, of which I eagerly avail myself, of attesting my gratitude for your friendship and esteem for your character and ability. I am, dear Sir, Yours most sincerely, SAMUEL FOWELL. New Bond Street, 1859. W.xthtt, "lie who pays no attention to liis teeth, by this single nealeot l)ctrays vulorar sentiments." — Lavater. To trouble the general reader of a Treatise on Den- tistry with minute details of the anatomical structure of the Teeth, or to introduce therein unnecessarily any technical terms, would be superfluous, and will there- fore, as far as practicable, be avoided. Yet as some de- scription of the l^eeth is requisite, in order that their incidental diseases may be understood, a o-eneral view VIU PREFACE. of these important organs will be given, with such practical observations only, as Avill effect the purpose summarily but clearly. The teeth, then, must be considered as members of a distinct class, which Nature, with her ever judicious care, has constructed to assist the digestive organs in the proper performance of their functions. This they effect by comminuting, dividing, and, Avith the aid of the sahva, blending food into such consistency and form, as will enable it to undergo with perfect facihty the future process of digestion. Since, then, these members assist in one of the most arduous and important offices of our vital mechanism, they cannot be too highly valued, and provided as most of us have been with an equal gift, it must be confessed that it is mainly attributable to our own carelessness if we lose their services ; for the diseases and consequent suffering to which tlie teeth are lia[)le, with the sacrifice of PREFAOE. IX health, comfort, and appearance entailed by their loss, are caused solely by negligence and want of proper care. Indeed, it is not sufficiently considered until too late that detriment to the teeth, by casting undue exertion on the digestive organs, unprepared to encounter and un- able to support, such additional work, and consequently overloading their individually allotted duties, already amply taxed, originate serious maladies ; though all are ready to admit the disparagement entailed by dental disease on personal grace in those who, careless of health and comfort, neglect the preservation of this important feature. How truly Rousseau tells us — " Avec des mauvaises deuts jamais femme n'etait belle, Avec des jolis dents jamais femme n'etait laide." Having thus briefly pointed out the importance of the Teeth, we sincerely hope the hints hereafter given for their care, together with the treatment to be resorted X PREFACE. to when they are attacked, will be adopted by the readers of this Treatise, who may satisfy themselves that nothing is lost in tending to the well-being of snch useful and valuable servants. It is the desire that the following pages may advance this object, which has induced the Author to offer them to the Public. New Bond Street. Conknts, PAGE General remarks on the Teeth . . . .1 Temporary (Shedding Teeth) . ... 4 Permanent teeth . . . . . .9 Ibee&tjlaiiities : Protrusion . . . . . . . 13 Recession . . . . . . .17 Torsion . . . . . . . . 20 Crowding . . . . . . .23 Tartar . . . . . . 26 Diseases of the Teeth : Caries . . . . . .35 Odontalgia (Toothache), Nervous . . . . 42 „ „ Inflammatory . . .47 Greneral Remarks on Odontalgia . . . . . 51 Alveolar Abscess (Grum-boil) . . . .54 Necrosis, or Death of the Tooth . . . . 56 Scurvy (or Spongy) G-ums . . . . .59 General Remarks on the Diseases . . . . 61 Extraction . . . . .68 Abtificial Teeth . . . . . 73 TREATISE ON DENTISTRY, GENERAL REMARKS ON THE TEETH. And is creation not a work of skill ? In its grand outline, in its parts minute — That we should mark its movements, trace its laws, Observe its fine consenting harmonies, Yet feel no prompt of reason to infer The being of a great intelligence ?" Every classical reader will remember the conversation of Socrates with Aristodemus, recorded by Xenophon, relative to the conclusive proof of Divine wisdom de- rivable fi'om the admirable organization of man. In that celebrated colloquy the dental structure is specially 1 2 TREATISE ON DENTISTRY. alluded to, and indeed, when we examine tlie human mouth we are immediately struck with the beautiful and perfect manner in which the Teeth, from their position, shape, and texture, are adapted to carry out, in every way and under every circumstance, the separate duties allotted to them. First, then, if we remark their position in the mouth, we shall observe that the Incisores (or Cutting Teeth) are placed in the front, most conveniently for cutting and dividing food, previous to its undergoing further comminution. If, from toughness or any similar cause, these cannot accomplish that object, we are provided with the Canine {Bog-teeth), situated next to them, to tear it. The BicuspiDES [Small Grinders), their neighbours, then take up the work, and, by rending and partially mastica- ting the food, prepare it for the Molares {Grinders), which complete the process by triturating it with the saliva, until it is fit to be swallowed. In the second place, we may observe their various shape. How beautifully adapted, how perfectly are they modelled, for their different functions. How admirably constructed GENERAL REMARKS ON THE TEETH. 3 is their attachment to the jaw, supphed as they are with roots varying in number, size, and position, according to the requisite degree of solidity required to accompKsh with safety the performance of their individual object. And lastly, their texture, so hard and durable as to be able to resist the injmies and wear to which, from tlie considerable amount of mechanical violence, they are constantly exposed, and yet their almost fleshy sensi- tiveness, so that a Tooth may be defined an osseous finger. The union of these two, presents not only con- structive perfection, but the most exquisite adaptation of means to end, and whether we regard it as one of the myriad proofs of Almighty wisdom or as merely a provi- sion for human support, nothing can be conceived more completely beautiful than this beneficent arrangement of Nature. THE TEMPOUARY (SHEDDING) TEETH. " Our liabits are like our teeth, one set displaces the other, and inatten- tion in childliood bequeaths a legacy of irregularity to old age." O. Freire Owen. In the numerous proofs of design exemplified by the bodies of animals, " the human teeth/' observes Dr. Paley, " afford an instance not only of prospective contri- vance, but of the completion of the contrivance being designedly suspended. They are formed within the gums, and there they stop ; their further advance to maturity would be not only useless to the new-born animal, but extremely in its way." Before entering, therefore, upon the subject of permanent teeth, to which I intend principally to confine myself TEMPORARY TEETH. 5 in the following pages, I will offer some slight description and remark upon the shedding teeth ; not so much on account of their individual importance, as because upon their proper treatment mainly depends the perfect deve- lopment of their successors. These teeth are twenty in number (ten in each jaw), and make their first appearance when the child has attained the age of between six and nine months. This, however, is not an invariable rule, for some children often cut them much earlier ; in fact, it not unfrequently occurs that when making their own debut they are prematurely gifted. Still this is an exception to the usual law of nature, " that when some particular purpose is to be accomplished, a provision is made." Hence, at the above stated age (viz., between six and nine months), the child being supposed capable of taking and to require a different diet to that previously derived from the breast, these temporary aids to its sustenance appear. In order, then, that the fond mother, who ever looks with anxiety to the appearance of the first tooth, may know when to expect it, I shall give a brief classification TREATISE ON DENTISTRY. of these teeth, with the time of their relative develop- ment. The first spot whereon they become manifest is the front of the lower jaw, and they are followed by the corresponding teeth of the upper. Next the lateral or side-cutting teeth are put forth ; then come the first grinders, followed by the canine (or dog-teeth) ; and, lastly, the posterior or back grinders. It may be observed, as a general rule, that the teeth of the lower jaw precede their fellows of the upper. The annexed Table,* containing their numerical order, will easily show their classification, though, we repeat, their succession is frequently departed from. Upper Jaw. 2(1 Molar. 1st Mol. Cau. Lat. Cent. Inc. Inc. Cent. Inc. 2 Lat. Inc. Can. 1st Mol. 2(1 Molar. 10 6 8 4 ■ 2 3 1 4 8 6 10 9 5 7 1 3 7 5 '■< Lower Jaw. The temporary teeth are much smaller, Init ni shape TEMPORAUY TEETH. 7 nearly resemble the permanent. These indicate their emancipation by a loosening, which is caused by the ab- sorption of the roots upon the approaching development of their successors ; still the permanent teeth will occa- sionally appear out of place, either at the back or front of the temporary ones, whilst yet these last remain perfectly firm. It will be advisable, in such instances, to hasten their expulsion ; but, as a general rule, temporary teeth, however loose, should, when practicable, be retained until the permanent appear, unless^ indeed, as before remarked, they come through the gums irregularly. This observation is important, since parents are too often anxious to rid their children of these shedding teeth, under the erroneous impression that, as soon as the slightest loosening is perceptible, their riddance must be precipitated, lest the permanent teeth be injiu-ed by these being allowed longer to remain. Such practice cannot be too highly deprecated, for this simple reason, that as long as we retain the temporary teeth the arch of the mouth will be correct. Remove a temporary tooth before the permanent successor has appeared, and a depression 8 TREATISE ON DENTISTRY. is immediately caused ; the tooth that is to replace it may be months before it is developed, Avheii it will take its place on an uneven Une. To illustrate this fact, hovir often do we see a permanent tooth, in an uncrowded mouth, depressed and out of the proper line, a misfortune invariably occasioned by the too early removal of the predecessor. Thus, then, we should always take time when the temporary teeth are in good condition, and not too hastily remove them. Nature will instruct us when to act, and, in fact, will often operate herself, by casting off the tooth at the proper season. There are, of course, exceptions which should be considered, as if decay, attended with pain, attack these little organs, for the comfort of the child necessarily infers the removal of the inconvenience. But the foregoing remarks apply to cases where no pain or discomfort is felt ; so that, according to circumstances, we shall do well to observe them. Having thus pointed out the course most advisable for general adoption, we shall proceed to discuss the more important subject of — the pekmanent teeth. THE PERMANENT TEETH. Order is Nature's beauty." — Anon. The total number of permanent teeth to be developed in each person, is thirty-two : but whether from loss of some of the earlier by disease, or, on account of having been removed in cases of irregularity, that number is seldom found to exist together. The following Table will show the order of their classification in the develop- ment, and the ages at which they individually appear. Order of Appearance. Character. Xumber. Age of Development. 1st. 2d. 3d. 4th. 5th. 6th. 7th. 8th. The first Molares (Large Grinders) . The Central Incisores The Lateral ditto First Bicuspides (Small Grinders) . Second ditto Canine (or Dog-teeth) Second Molares Third Molares (or Wisdom Teeth) uncertain, but usually between . 4 4 4 4 4 4 4 4 6 years. 7 » 1 8 „ 9 „ 10 „ 11—12 „ 12-14 „ 18—25 „ 10 TREATISE ON DENTISTRY. 1 — Crown. 2— Neck. 3— Fang. Teeth are anatomically divided into the crown (the enamel), the neck, and root (fang). Of these the crown may be considered as di- rectly the most important part, since it alone performs all the duties for which these organs are intended, the fangs being merely for the purpose of attach- ment to that portion of the jaw {the alveolar process, or socket) in which they are imbedded; and the neck as a line of demarcation between the two. Each tooth has a cavity corresponding, in a great measure, with its form, being larger at the crown, and Section of a Molar Tooth, magnified to show n-varlnQllAT- rlimin-ioVn'-nrv +rv the pulp-cavity and foramen. graQUaUy QimmiSUmg tO the extreme end of the root, or roots, where it terminates in a small /or<3;- rnen, or passage for the transmission of the nerve and small blood-vessel. PERMANENT TEETH. 11 which, communicatmg with the highly vascular substance, termed the puljp, which it contains, gives nutriment and vitality. The drawing on the preceding page illus- trates the cavity and nerve communicating mth the pulp. The roots articulate with the sockets enveloped in a membrane which entirely covers them, terminating at the necks of the teeth ; this membrane is called the Peri- dental, or Periosteum. The composition of the teeth is of two distinct sub- stances, the one organized or vital, the other crystalline. The former, termed the dentine, or true bone, is the basis of the tooth, which, like other bones, is composed of earthy and cartilaginous portions ; the latter, called " the enamel," or shield, covers the upper portion or crown, is more dense, and from its excessive hardness admirably suited for the purpose of protecting (its office) this den- tine from the action of chemical agency and injuries likely to arise from friction or wear. It is deposited in greater abundance and is thicker on those parts where such injmies, if they attack, must arise, viz., the mastica- 12 TREATISE ON DENTISTRY. ting surfaces of the teeth ; hence this extra provision is adapted to accompHsh effectually the desired result. The .permanent teeth being subject, during their deve- lopment, to many irregularities, affecting their position, shape, or texture, it will be necessary to describe the most frequent of these, together with the best treatment for their rectification; since, doubtlessly, being causes (although remote) of many diseases to which the teeth are subject, they cannot be too soon attended to. The irregularities of shape and textm'e are incurable; but those most frequent of malposition, which I purpose to consider, are generally within the reach of remedy, and may be considered only temporary. They may, indeed, from malformation of the jaw, or even from procrastination, become permanently fixed in the unnatural position, but when treated in the early stages, it is seldom that the present advanced state of mechanical science and ingenuity fails to alter, if not to rectify them considerably. I will therefore describe the most common irregularities, viz., " Protrusion, Recession , and Torsion'' PROTRUSION. " Prevention is the best bridle." — Feltham. This irregularity is characterised, as its name denotes, by the teeth presenting the appearance of being thrust outwards, an evil caused in most cases either by crowd- ing or by malformation of the jaw itself. In the first instance, the remedy is very simple, and generally suc- cessful, when effected by the following means. If the patient has developed all the teeth, but from growth, and consequent expansion of the jaw, sufficient room cannot ultimately be expected for the return of the protruding teeth to their proper position, it will be necessary, at first, to sacrifice some less important tooth in the same range, since the protruding ones are usually either inci- 14 TllEATISE ON DENTISTRY. sores or canine of the upper jaw, pre-eminently affect- ing the general appearance of the mouth. It often happens, however, that those in the lower jaw are subject to a like irregularity ; but in either case a tooth must be sacrificed, and the least important one to be chosen for this unceremonious treatment, " expul- sion," will be one of the bicuspides. Still, should a decayed molar offer, it will be worth the trial to call for its resignation, although its position is remote, for in all cases, however important a tooth may be in its indi- vidual character, unless indeed implicating appearance, yet if attacked by disease, it should always give place to a sound one, upon the principle of Martial, that — " Life is not to live, but to be well." Nevertheless we must not sacrifice everything even to personableness, an evil which those commit who seem to think — " Appearances to save, their only care ; So things seem right, no matter what they are." Space having been thus provided for the yielding of PERMANENT TEETH. 15 teeth, an elastic band of vulcanized india-rubber is passed over the tooth next to the protruding one, on the side of the space, and then back over the tooth, or teeth, beyond it ; by which means, from the constant tension, these will approximate, and consequently free the malposed tooth from the crowding to which it had previously been subject. The remedy is then completed by what is called the bar. This contrivance is a bar of gold passed along the inner surface of the teeth, as low down near the necks as possible ; it should be slightly separated from the arch, resting only against those teeth to which it is attached. Elastic bands are then passed over the protruding teeth under treatment, and attached to the bar, the contrac- tion of which will gradually draw the teeth towards their proper position. There is another method sometimes adopted to re- duce this irregularity, which is by capping with gold the antagonist teeth to those malposed, in such a manner as to bring their edge within the inner surface of the cap. The pressure produced when the mouth is closed, and these teeth come in contact, will, by the protruding tooth 16 TREATISE ON DENTISTRY. sliding as it were on the inner surface of this apparatus, constructed in the form of a plane, force them inwardly. The bar is perhaps the preferable of these two modes, on account of its more gradual action, and being likewise less conspicuous when worn. RECESSION. " No evil propensity is so powerful that it may not be subdued by discipline." — Seneca. In this defect the teeth are forced inwards, forming a dip or depression in the arch. The irregularity is pro- duced by the same causes as protrusion, and the remedy is in a great measure similar, only that it requires an expansive instead of a contracting pressure for its reduc- tion. Room must be obtained for the teeth to yield and to diminish crowding, between the bar, similarly applied as in protrusion, and the receding teeth, small wedges of Jdckory or dog-ioood are introduced, which, swelling when moistened by the saliva of the mouth, enlarge, and by expansion, force the teeth outwards. 3 18 TREATISE ON DENTISTRY. We must observe that this process requires more con- stant attention during its operation, as the wedges have to be altered and enlarged at short intervals, perhaps every second or third day, in order to maintain the requisite pressure. Another plan for the treatment of this irregularity is to have a plate accurately fitted to the molar teeth on the side of the malposed one, to which a small spring is attached, and so passed along the inner surface of the arch as to press against the receding tooth. This is more simple than the former plan, and perhaps in the gene- rality of cases preferable ; yet, in choosing oiu- tnodus operandi, we must be guided by circumstances, " those whippers-in of the human pack," since although the desired object be the same, the means to be resorted to are often necessarily different. A particular treatment can never be adopted for the reduction of either physical or moral irregularities, the forms of either being so various as to preclude the possibility of following any given rule. The adaptation of the means to the end characterises both the true man of science and the philosopher, though RECESSION, 19 the efforts of either are frequently baffled by the endless variety of case and constitution. As Otway remarks — " Clocks will go as they are set ; but man — Irregular man — is never constant, never certain." TORSION. Errors, like straws, upon the surface flow — He who would search for pearls must dive below. Torsion occurs when teeth are twisted or turned in the socket so as to present a lateral or side surface. A full description of the very complicated means and numerous contrivances required for the cure of this irregularity it would be almost impossible to introduce here ; yet we may state that the most frequent method is to encase the twisted teeth with gold in such a way that the cap may not slip round, which may be effected by accurately stamping these caps to the shape of the teeth. Spiral or stretching springs are then attached to these caps, and the former running in different directions, pull the teeth round TORSION. 21 towards their proper position. These springs being stretched, are fixed at their other extremities to such teeth, also capped — the molares, for instance — which, from their position and firmness, are best able to afford '^ points d''a2)j)ui'' and safely to resist the considerable stress to which they will be liable. In all mechanical contrivances for the reduction of irregularities, the adaptation should always be such as to permit of removal at pleasure, for the purpose of cleansing, a precaution which should invariably be taken, as imperatively necessary to the health of the mouth and personal comfort. No food should be allowed to remain hidden about the teeth, there to undergo decomposition, affecting the breath, and otherwise producing most un- pleasant results. The mechanism ought to be likewise so formed as to prevent the teeth under treatment being interfered with by their antagonists, and this can be easily effected by allowing the caps used in such con- trivances to be thicker or more raised on the surface of the teeth wherever they are placed. Moreover, after the irregularities have been reduced, it is always advisable to 22 TREATISE ON DENTISTRY. continue the means that have been used, at least until the teeth have assumed perfect solidity in their new position, since they are liable from the slightest causes to return to their former state. In very early protrusion or recession, or vrhere teeth appear slightly diverging from their proper position in the arch, a cure may be effected by occasional pressure of the finger on the tooth, or by some equally simple means. The irregularities caused by malformation of the jaw itself are, as before remarked, incurable ; yet even here means are often found to considerably improve their state. We should never despair, but give every chance a trial. Nature is ever indulgent and generous, and it does not unfrequently occur that we find ourselves happily sur- prised at what patience and perseverance have effected ; '' A falling drop,*' says Lucretius, *' at last will hollow a stone." CROWDING. To all men freedom solace gives — He lives at ease who freely lives." — Barbour. Crowding, the usual cause of the foregoing irregulari- ties is itself produced either by want of concurrence in the temporary teeth w4th the development of the permanent, by incapacity in the arch to accommodate teeth of unusual size, or by narrowness of the jaw itself. In the first instance, the removal of any temporary teeth found to interfere with the regular development of their successors should be adopted immediately ; in the last, the sacra- fice, before recommended, of any unimportant tooth or teeth in the same range, so as to supply the requisite room ; but in all cases it is advisable not to decide upon 24 TREATISE ON DENTISTRY. them until every other chance is gone, as by growth of the jaw, or any similar natural course, a remedy may be ultimately effected. It frequently happens that teeth appear entirely out of the arch, as through the palate, under the tongue, through the side of the gum under the cheek, and in other remote and unnatural positions ; here nothing but removal will avail; yet it is some consolation to know, that we sustain no loss in getting rid of such malposed teeth, which, being usually supernumerary, are real intruders. The canine teeth, however, often take their place high up under the lip, and, as they seldom yield, should be ex- tracted as soon as possible. It would be superfluous as well as useless to describe minutely the almost innumerable deformities which occur, or to point out the different means required for their reduction, as it will be seen, by the remarks already offered, that mechanical contrivance, in almost every case, is the only suitable application, and, conse- quently, that nothing can be done beyond following the suggestions of good sense. The hints, therefore, I have CROWDIxNTG. 25 endeavoured to convey, will at least teach those who may require such treatment what they may fairly expect from their dentist, and when to consult him ; and with this remark I will close the present portion of my subject, viz., that the sufferer who exercises jciatience is sure to arrive at a satisfactory result, while the dentist who succeeds by simple means, deserves the greatest com- mendation. The motto of the one should be, that "Patience conquers all:" the recollection of the other, that as " simplicity is of all things the hardest to be copied, so it is the concomitant of the greatest power. " TARTAR. ** Even from the body's purity the mind Receives a secret sympathetic aid." — Thomson. Before considering the diseases of the teeth, it may be as well to animadvert on tartarous de- posit, which although not an actual cause of the maladies to which the teeth are subject individually, is yet an assignable reason of their being generally affected. Tartar is a substance consisting of concrete or har- dened saliva, dried by its OAvn earthy materials, and TARTAR. 27 found to be deposited in the greatest abundance on those parts of the teeth situated near the salivary glands, e.^., on the outer surfaces of the upper molares, and on the inner of the lower cutting teeth. This deposit on the teeth may be considered ''generaV,' as it is engendered in the mouths of most persons ; never- theless, in some individuals it exists much more than in others, and, in fact, is collected so quickly from the excessive quantity of earthy matter contained in their saliva, that it is with great difficulty, even with the most unremitting care, the teeth are kept from being entirely encased in it ; whereas, in other instances, with very little trouble, its appearance is altogether avoided. When tartar is first deposited, it is of a yellow, creamy appearance, and is easily removed with the brush ; but when unheeded, it speedily assumes its calcareous form, adhering to the teeth so tenaciously, as to require con- siderable mechanical force for its dislodgment. This substance cannot be too soon got rid of, since it is an assignable cause of dental disease ; yet it is a singular 28 TREATISE ON DENTISTRY. fact, that although undoubtedly giving rise indirectly to almost every dental malady, it is, locally, a pre- ventive of their most frequent enemy, ''decay'' which can be at once proved, if we observe that decay seldom, if ever, occurs on those surfaces where tartar is most frequently deposited, viz., on the exterior of the upper molares, and the inside of the lower cutting teeth, 'i'his circumstance, I am of opinion, must be attributed to the shield tartar forms against mechanical injury and other casualties. The diseases which this deposit originates are spongi- ness or scurvy of the gums, through the irritability caused by its contact with them; inflammation at the roots of teeth, through the detachment of the gums from the necks, by its insinuating itself under the gums, and thus exposing the living portion of the tooth to the action of irritating substances taken into the mouth ; and general loosening of the teeth through the same cause, by removing their natural support. We should obviate all these maladies, did we generally adopt the simplest of all courses — " cleanliness!' TARTAR. 29 When tartar has assumed its calcareous form, the operation necessary for its removal is termed " scaling ^^ which when performed with care is safe ; but, on the con- trary, if any undue violence is used, or unless proper caution is exercised in the application of the instruments, the enamel becomes abraded or chipped, producing a very serious evil, that of exposing the dentine, or true bone. The greatest care is therefore necessary in apply- ing the instruments, as where the tartar is found, namely, about the necks of the teeth, the enamel is very thin, and the slightest violence will remove it. The great preventive, then, is cleanhness, by adopting a habit of washing out the mouth frequently with water, to which a little spirit, such as eau de Cologne, or even simple spirit of mne, has been added. The use of dentifrices is of much benefit, but those containing camphor or myrrh should be avoided. I name these ingredients in particular, as they are very extensively used, and a prejudice in their favour is entertained, but as it would be unjust to censure without offering a reason, I will here state the grounds on which I condemn them. In 30 TEEATISE ON DENTISTKY. my observation of discoloration of the teeth I have invariably found, on inquiring what tooth-powder or other preparation had been habitually used, that, ''Mi/rrh" " Camj)horated chalk," or some article in which one or both of these ingredients had been contained, was the favorite nostrum. Both these are resinous gums, inso- luble in water, of a sticky, tenacious nature, and, being deposited on the enamel, there remain undissolved, form- ing a nucleus, to which adheres any discolouring agent that may be taken into the mouth. This is particularly the case when the surfaces of the teeth are uneven, or have depressions ; here they lodge, and nothing will touch them. It is true that both these drugs are highly grateful, and particularly refreshing to the mouth; but as to their cleansing properties, or their giving, as supposed, a tone to the gums, it is a fallacy ; they do more harm than good, for the reasons I have stated, and so far from preserving the healthy state of the mouth, I feel convinced they produce quite a contrary effect. I here subjoin a recipe for a dentifrice, which I think will prove more beneficial : TARTAR. 31 Take of Orris-root, powdered, Rhatany-root, powdered, of each ^ ounce ; Precipitated Chalk, 1 ounce ; Cuttle-fish, finely powdered, Cloves, powdered, of each 2 drachms. Mix. The rhatany root* {Kramaria Triandria Peru), when powdered, forms an invaluable ingredient, for its astrin- gent principle, being unaccompanied with any stimulant, has the veiy great advantage over myrrh of strengthening the gums without producing irritation. In the formula here given, the rhatany powder mixed with the cuttle- fish I have ascertained by long experience to be far superior to any advertised recipes, the majority of which, consisting of acids, destroy the dental structure. Certain quack pastes also, besides the acid they contain, are blended with honey, and thus become more destructive from the action of saccharine matter. The active principle of the rhatany is soluble in proof spirit, forming the tincture of rhatany ; with this the * Excellent preparations of this root, which I strongly recommend to be used for the care and preservation of the teeth, are made by Reece & Co., Medical Hall, 168, Piccadilly. 32 TREATISE ON DENTISTRY. teeth may be brushed every night, by which process the progress of decay is often greatly delayed, from the exposed nerves of the tooth becoming hardened by the action of the astringent, and the dentist is not prevented by tenderness of the pulp from removing the decayed portion and applying the stopping. In the preceding prescription we have a combination which contains every desirable requisite for cleansing the teeth, refreshing the mouth, and giving tone to the gums. The chalk, from its alkaline properties, will correct the acid secretions of the mouth ; the cuttle-fish will cleanse ; the orris-root and rhatany (astringents) will give tone to the gums ; and the clove impart to the whole composition a grateful and most agreeable flavour. Let it be however remembered, that all dentifrices, or other preparations, containing acids, adopted for the care of the teeth, should be most determinedly avoided. It is true that for a very brief time they afford a fal- lacious promise from the brilliant appearance the teeth temporarily assume, but this briUiancy is owing to the surface of the enamel being removed through decom- TARTAR. 33 position, brought on by the chemical action of the acid on the alkahne of the enamel. If the acid appHcation be continued, the enamel will be entirely re- moved, and the dentine, deprived of its safeguard, will then be subject to chemical decomposition and mechani- cal injury, to which, being too weak to resist them, it will ultimately fall a sacrifice, The aromatic tincture of rhatany with borax, used in water as an astringent lotion, in cases where, through tartar, the gums have become spongy and irritable, will be found very useful, and is, therefore, highly to be recommended. DISEASES OF THE TEETH. " Sickness, the mother of Modesty, puts as in mind of our mortality, and while we drive on heedlessly in the full career of worldly pomp and jollity, kindly pulls us by the ear, and brings us to a proper sense of our duly."— Burton. The diseases to which the teeth are most frequently subject are Caries (decay), Odontalgia (toothache), Gum- boil (abscess in the socket), and Necrosis (death of the tooth). CARIES. This affection, commonly called " decay," is the most general of dental maladies, and is, in fact, the exciting cause of all the others. It is a disorganization or decomposition of the dentine, or true bone, produced by its exposure to the action of chemical agency, contiguity 36 TREATISE ON DENTISTRY. of food, or contact with any other foreign substance. This exposure of the bone may arise from the shghtest mechanical injuries, by which its shield, the enamel, is removed, or from want of precaution and cleanliness in suffering food and other sub- stances taken into the mouth to remain and undergo there their natural course of decomposition, whence injury is produced,consequent on the acrid secretion generated by such decomposition. Decay, therefore, usually occurs on those pouits where wearing away of enamel is most proba- ble, from the retention of food ; thus, on the masticating surfaces of the molares, the necks of teeth, or between such as, slightly separated from each other at the necks, are quite close at the top. It invariably commences at the outer surface, gradually spreading its ravages towards the interior of the tooth, the bone softens, and assumes a dark brown colour ; the disorganization increases in rapidity as it proceeds, until at length it completely excavates the tooth, leaving but a thin wall of enamel, which, deprived of its natural support, crumbles away, and discloses the cavernous space. When so far extended CAUIES. 37 as to expose the pulp to the access of air, or pressure of food, &c., pain is produced, but it often happens, never- theless, that caries is accompanied during its progress by absorption of the pulp, in such case occasioning the total destmction of the tooth, without any painful in- convenience being experienced, unless indeed, as an extraneous body, the diseased tooth produces irritation to the surrounding parts. The treatment indicated is to check the malady as soon as possible, by shielding the dentine from the irritation to which it has been exposed, and this is effected by the operation of stopping, or filling up the cavity, or, more properly speaking, by replacing the lost substance with such an agent as will, from its power of resisting chemical action and its applicability, suit the purpose ; best stopping being made of metals in foil, and the amalgams of metals with mercury. Of the first, gold is undoubtedly preferable, from its general purity, and should always be applied, when practicable ; but there are cases, and these unfortunately but too frequent, when decay has been so long unheeded, that its 38 TREATISE ON DENTISTRY. ravages have left but a very thin wall of tooth for the attachment of any stopping, especially such as gold leaf, which requires considerable pressure for its applica- tion, and ought to be packed, too, so tightly as to assume almost a solid body, and even to ring when struck. In such instances, therefore, the gold leaf, or, indeed, any metals in foil, will be utterly unsuitable, from the danger they may occasion to the teeth by fracturing them under treatment, for which reason the amalgams must be then substituted. As a general rule, however, these last should not be indiscriminately employed, unless under the circumstances I have described, or when, from tenderness of a tooth, extreme pressure would create pain, in short, unless as a " dernier ressort'' for the mercury contained in amalgams has a tendency in some mouths to oxidize and discolour, which, when in sight, is always objectionable. Still this is not usual, as the amalgams now prepared rarely change, but when properly used and blended, they are equally durable in a tooth as gold leaf, and have the advantage of being much more easily applied. The best amalgams are those of palladium CARIES. 39 and gold, or of precipitated silver fused after the mercury has been added. For successful stopping, it is absolutely necessary that every particle of decay should be removed, as well as all rough edges of enamel round the orifice of the cavity, before plugging the tooth is attempted, for decay, if suffered to remain, will from its own action on the bone extend, and after the lapse of some short time, if the operation has been performed without this pre- caution, it will be found to have failed, the stopping will loosen and ultimately drop out, not only casting discredit on the dentist, but, perhaps, which will be still more unfortunate, deterring the patient from ever again having recourse to a remedy, which, when carried out with only common precaution and care, is unexceptionable. This reluctance would, of course, arise from the convic- tion that stopping is useless. Now, I particularly press these remarks, as many persons will not permit their teeth to be excavated under any circumstances, and I do so in justification of my profession, that a line may be drawn between the inclination and desire, if not command, 40 TREATISE ON DENTISTRY. of the patient, and the modus operandi of the prac- titioner. Occasionally also decay is left uncared for, from the erroneous idea that, so long as a tooth does not cause pain, caries is of no consequence ; or that, when it does exist, relief is immediately attainable by stopping. Such notions are in every sense wrong ; for in the former case we should save the ultimate certain loss of the tooth by prompt and early measures, and in the latter, the pulp being exposed, and the nerve consequently in an irritable state, it is quite impossible to bear the operation ; in fact, it would be highly injudicious to attempt it, as will be explained when hereafter treating of Odontalgia (toothache). It will be unnecessary, I am sure, to impress this important fact on my readers, for their good sense must naturally point out the absolute necessity cf early treatment, since after the reasons already given, which must be too clear and palpable to admit even of a doubt, we must be convinced that delay only entails aggravated suffering, if not much more serious mischief, and that when neglected or uncared for, we risk the ultimate loss CAUIES. 41 of the tooth. Well has Shakespeare remarked, and the observation is as true of physical as of moral evils — " That we would do We should do when we would ; for this would changes. And hath abatements and delays as many As there are tongues, are hands, are accidents ; And then this should is like a spendthrift sigh, That hurts by easing." I will now proceed to treat of that painful malady, Odontalgia. ODONTALGIA. " There was never yet philosopher That could endure the toothache patiently ; However they have writ the style of gods, And made a pish at chauce and suffering." — Shakespeare. '' This affection, commonly called " toothache," is, I am sorry to say, too acutely understood to require much description ; yet, as it is caused by two separate agencies, namely, irritation of the nerve from foreign invasion, and inflammation of the pulp, it may be useful to point out their individual symptoms, in order that the treatment, also different, may be distinguished and adopted ac- cordingly. The neuralgic odontalgia, or nervous toothache, attacks, then, in such severe paroxysms as to have been knovi^n, in its excess, to temporarily deprive the suiferer of reason. ODONTALOIA. 43 These attacks last for various periods, coining on sud- denly, relaxing at inteiTals, and again retiu-ning with more or less violence. The fits are often accompanied with spasm of the neighbouring muscles, and with pain extending to parts where the nerves in connexion take their course; for instance, in the region of the eye, tlie temple, neck, and even as low down as the chest, frequently also affecting the sight. The nervous irritation is produced, as before stated, by contact with some foreign body, hence the natural treatment is to guard against such intrusion by stopping ; but, previous to this course, it is requisite to reduce the existing irritability by some local sedative. The following drops will be found most serviceable for the purpose : Take of Laudanum, Sulphuric Ether, Camphorated Spirit, of equal parts. Mix. The preparation should be applied to the affected nerve on cotton wool. If it fail to produce the desired 44 TREATISE ON DENTISTRY. relief, the following may be tried, which, not evaporating so speedily as the above, may be more fortunate in keeping up a longer effect. Take of Opium powdered, Camphor, of each equal parts ; Spirit Solution of Gum Mastich, a sufficiency to blend them into a mass. This should be well triturated in the hand, and applied while yet soft from the warmth of friction, but if it like- wise fail, the Tincture of Fyrethrum may be tried on cotton wool. This acts by producing profuse salivary secretion, thereby reducing local irritability. We often find, I am sorry to say, these and all other similar applications unsuccessful in procuring the least alleviation, in short, that no treatment of the kind will avail. When such is the case, however averse I am to the loss of a tooth, I have nothing to recommend but its removal, yet as a last resource to those who experience an ungovernable dread of submitting to the operation, I will add the method adopted for the total destruction of ODONTALGIA. 45 the nerve, namely, the cautery. This is effected by two means, the one by the heated needle, the other by the application of caustic. In the first, the cavity having been cleaned out carefully wnith cotton wool or fine lint, and dried, a red-hot needle is introduced into its ex- tremity, where the nen^e is to be found. In the second, the cavity is similarly cleaned out and dried, and lunar caustic, powdered, is placed in proximity with the nerve, over which is carefully lodged a piece of dry wool ; the remaining vacuum is then entirely filled with wool, saturated with a solution of gum juniper or mastich, which, after a lapse of a few moments, hardens to the consistence of putty, and may be retained for some short time. It is necessary to renew the application at brief inten^als, until the desired effect is obtained; but should any inflammatory symptoms appear during the process, or if pain does not speedily subside, we must at once desist, for in many cases, from inflammatory habit or other causes, the treatment may be seriously detri- mental. Here, therefore, again we must be guided by circumstances, and, when we find we fail, must sacrifice 46 TREATISE ON DENTISTRY. the tooth. It will be time, however, to decide on the momentous question when Nature points the way. It is a soiiy remedy either to destroy the vitality of a tooth or to lose such an important member; and, as before remarked, every trial should be made before we have recourse to the ultimatum. I repeat this, as numerous persons, as soon as the least pain in a tooth is felt, hasten to the dentist or sm^geon to have it removed, under an impression that nothing is to be done but to submit to its extirpation at once. The practitioners applied to, under the idea, perhaps, that the patient has tried every remedy, operate without making inquiries, and the tooth is lost, when most probably, by some simple application of a sedative nature, suffering would have been reheved, and the tooth ultimately stopped and saved. INFLAMMATORY ODONTALGIA. ' The heaving sighs through straiter passes blow, And scorch the painful palate as they go ; The parch' d, rough tongue night's humid vapour draws, And restless rolls within the clammy jaws." — Rowe. This kind of toothache may be always distinguished by the dull throbbing and continued pain^ It frequently comes on Hkewise in paroxysms, yet a line may never- theless be drawn between these and such as are attendant on neuralgia, as they attack much more gradually and are free from the muscular spasm. Inflammatory dental affection is usually considered the most painfrd, for, surrounded as the pulp is by a hard, unyielding wall, which allows of no expansion, suffering of the most dis- tressing description is produced, often, indeed, so severe as 48 TREATISE ON DENTISTRY. to call for the immediate removal of the torturing tooth. Yet some patients will bear any amount of pain sooner than lose a tooth ; and for such brave martyrs the free apphcation of cold water or ice to the region of the in- flamed membrane will, perhaps, produce alleviation. The general treatment is first to reduce the vascu- larity of the part, by the application of leeches to the gum; they must be placed as near the extremities of the roots as possible. Considerable pain being often experienced from the leech-glass, whenever the hard edge of this little machine presses on the gum, it may be as well to hint that such edge, if guarded by a roll of lint^or small band of vulcanized india-rubber, and allowed to extend slightly beyond the end, will remove inconvenience, and prove most grateful to the patient. I cannot refrain from recommending the mechanical leech invented by Kidston for the use of the gums, a contrivance admirable in every respect, not only on account of its easy accommoda- tion to the mouth, but as fulfilling its ofiice without pain or trouble. Free lancing of the gum is like- INFLAMMATORY ODONTALGIA. 49 wise resorted to. In the chronic inflammatory odon- talgia a guarded regimen must be observed, and the occasional use of some cooling or laxative medicine adopted. Anodyne fomentations will also be found use- ful. From the sympathetic effect these inflammatory cases have on the adjoining teeth, very careful treatment and prompt measures are necessary, as abscess in the socket, with loosening of the adjoining teeth, often results if proper precautions are not taken. When such accom- panying evils happen, it will be advisable at once to re- move the original offender. This will in most cases effect a cure ; but if, after a tooth has been removed, the inflammation does not subside, or fungous growth or disorganisation of the living substance appears at the edge of the socket, we may conclude that there exists dead matter in the latter, on account of the extended in- flammation. We must then examine the part carefully and remove any loose portions which may be met with, for the dead substances generally found will be exfoliated parts of the alveolar process itself. The removal of these must be followed up by the free use of astringents. When 7 50 TREATISE ON DENTISTRY. fungus, or what is generally better understood as " proud flesh/* appears, it should be excised with the lancet or by means of the cautery ; the former will be found the most eiFectual. With these remedies the general health of the patient must be most particularly studied, as the treatment will mainly depend on following the dictates of the constitution, by observing which we may rely on a satisfactory result. GENERAL REMARKS ON ODONTALGIA. "What avails Valour or strength, though matchless, quell'd with pain. Which all subdues, and makes remiss the hands Of mightiest men ? Pain is perfect misery, the worst Of evils ; and excessive, overturns All patience." — Milton. There is no affliction of the human subject so ex- cruciating as toothache, either nervous or inflammatory, the former from its acute nature, the latter from its con- tinued and ungovernable character. The first, it will be seen, may generally be remedied by removing the exciting cause (exposure of the nerve) ; and, should this fail, we have a sure cure, in the loss of the tooth. If, however, by injudicious treatment, such means are not properly applied, serious evils arise. 52 TREATISE ON DENTISTRY. In stopping, for instance, where such would have been successful had necessary precautions been taken, it frequently happens that, after the operation has been performed, we are compelled to sacrifice the tooth at last, through the careless manipulation that has been exer- cised in allowing the material used to press on the nerve, or otherwise to irritate it. Often, also, during the per- formance of the stopping process, the operator is com- pelled to desist, when the preliminary measure already mentioned, reducing the existing irritability, has not been observed. The end of all this is, that we place directly in contact with a vital object a foreign body, which, from its constant proximity, will continue to irritate, until at length inflammation arising, the tooth is hurriedly expelled or the work in progress undone : meanwhile the patient suffers to an almost intolerable degree. On the other hand, suppose that, in the first in- stance, a tooth must be extracted, and that, from im- proper management, or by the use of barbarous and inapplicable instruments, the operation fails, further mis- GENERAL REMARKS ON ODONTALGIA. 53 chief is naturally excited, either by injury to the sur- rounding parts or by placing, on account of fracture of the tooth, our only remedy more distant. In inflammatory odontalgia, when the symptoms are so severe as to defy ordinary treatment, the only resource consists in extracting the tooth ; and this must be re- sorted to sometimes immediately, to prevent ulterior mischief. ALVEOLAR ABSCESS (GUM-BOIL) "Prolonged endurance tames the bold." — Byron. This is the next malady we come to. The ailment commonly called '' Gum-boil," although not an actual dental disease, so closely appertains to it that I have preferred to introduce its discussion here. It arises either from neglected inflammation or the ills accruing from unsuccessful attempt at extraction, by which stumps are left in the gum or the socket splintered, causing, like foreign substances, constant irritation, whereupon inflammation supervening, the secretion of matter is formed. To remedy this effectually, the extraneous sub- stances must be removed, and the operation followed up by copious fomentations. If the gum-boil has attained ALVEOLAR ABSCESS. 55 maturity, a temporary relief may be obtained by lancing, in order to liberate the pent-up matter ; but the abscess may be reproduced on any attack of cold, derangement of stomach, or indeed any cause likely to create heat of body and feverish action. Hence, as before stated, the only permanent cure will be the removal of the extraneous substances which are the actual cause of ex- istent irritation. NECROSIS, OH DEATH OF THE TOOTH. "Death is the liberator of him whom freedom cannot release, the ph^/si- cian of him whom medicine cannot cure, and the comforter of him whom time cannot console." — Colton. " If thou and nature can so gently part, The stroke of death is as a lover's pinch, Which hurts and is desired." — Shakespeare. This subject is the next to be considered. Cessation of vitaUty results either from severe inflammation, by which the membrane covering the fangs of the teeth has been destroyed, or the pulp disorganized; or even from me- chanical violence, as a blow, for instance, by which the vessel supplying nutriment has been cut ofl". Before proceeding further, I will here quote an old-fashioned remedy for toothache, which was effected, or more pro- NECEOSIS, OR DEATH OF THE TOOTH. 57 perly supposed to be so, by the following means. The tooth was partially drawn out of the socket, in order to snap the nerve and vessel, when it was again replaced in its previous position. I have myself seen the aAvful results of this most erroneous practice. The pain may be subdued for a time, perhaps, by the destruction of the vitality of a tooth, but the latter, by remaining as an extraneous substance in the jaw, will eventually give rise to serious results, inflammation of the lining membrane of the socket, followed by abscess and its attendant in- convenience. I mention this to deter those who might be advised to adopt this kind of treatment, from undergoing it ; for nothing can be more serious than its results, nor more mistaken than the idea that a remedy is thereby effected. We only get rid, and that very doubtfully, of one evil, at the price of a far greater one, which will at once be understood, when referring to the comparative symptoms and results of neuralgic with in- flammatory toothache. To proceed ; a necrosed tooth will be known by its dark bluish colour, and the absence of neuralgic pain. In many constitutions, a necrosed 8 58 TREATISE ON DENTISTRY. tooth may be retained for a considerable time without any inconvenience yet, in most instances, it occasions those irritating symptoms already referred to as attendant on extraneous bodies in the socket ; and to obviate the chance of such consequences, it should be removed. When suffering from distinct neuralgic toothache, and a necrosed tooth is present, it would be useless to remove it with the idea of obtaining reHef. Necrosed teeth never have connexion with nervous toothache ; hence the fallacy of this general impression. There are many other diseases to which the teeth are subject, or directly give rise, such as fungous growth of the pulp, abscess in the substance of the bone, sympa- thetic inflammations, ' nervous affections, scurvy of the gums, &c. ; but these are cured by preventing or removing the maladies occasioning them. It will be needless, therefore, to describe them separately, if we ex- cept the last, I am obliged to add, a very frequent visitant to uncleanly mouths. I will, therefore, describe this affection, in order to complete the catalogue of the ills most generally affecting the mouth. SCURVY (OR SPONGY) GUMS. " So great is the effect of eleanliuess upon mau that it extends even to his moral character. . . Virtue never dwelt long with filth ; nor do I believe there ever was a person scrupulously attentive to cleanliness who was a consummate villain." — Count Rumiord. This is produced either by constitutional derangement, causing the saliva to become impregnated with an acrid secretion, or by the deposit of tartar at the necks of the teeth, which, by coming in contact with the gums, causes considerable irritation, surcharging the blood-vessels in connection. This malady may be distinguished by the general tenderness of the gums, their frequent bleeding from the shghtest cause, and by the thickening of their edges. The remedy is, first, to overcome any consti= 60 TREATISE ON DENTISTBY. tutional ailment ; next to remove any exciting cause, such as tarta", or foreign substance ; then free lancing to reduce the vascularity ; and, lastly, the use of astringents to restore the tone. GENERAL REMARKS ON THE DISEASES. " The pain is in my head ; 'tis in my heart ; 'Tis everywhere ; it rages like a madness, And I most wonder how my reason holds." — Otwat. " Our bodies are at all times like the fire which was shown to the hero of the ' Pilgrim's Progress,' in Interpreter's house, which had water poured on one side of the wall against which it blazed, and oil on the other. Here one tissue is burning like fuel, and there another is becoming the depository of combustible matter. We have, as it were, millions of microscopic wind- furnaces converting into carbonic acid, water, vapour, and other products of combustion, all the combustible elements of the body ; and millions of blast-furnaces, reducing the starch and sugar of the food, and the sulphates and phosphates of the body, into inflammable oils and other fuels, which are finally transferred to the wind-furnaces and burned there. Burning, and, what we must call in contradistinction, unburning, thus proceed together ; the flame of life, like a blow-pipe flame, exhibiting an oxidizing and a reducing action at points not far distant from each other. Such is the human body, ever changing, ever abiding ; a temple always complete, and yet always under repair; a mansion which quite contents its possessor, and yet has its plans and materials altered each moment ; a machine which never stops working, and yet is taken to pieces in the one twinkling of an eye, and put together in the other ; a cloth of gold, to which the needle is ever adding on one side of a line, and from which the scissors are ever (32 TREATISE ON DENTISTRY. cutting away on the other. Yes ; Life, like Penelope of old, is ever weaving and unweaving the same web, whilst her grim suitors, Disease and Death, watch for her halting ; only for her there is no Ulysses who will one day in triumph return." — Dr. George Wilson. Having now pointed out tlie most frequent dental diseases, let me, before closing the subject, offer a few general remarks on their character and consequences. We must class, then, " Alveolar abscess," (gum-boil,) exfolia- tion of the socket, and such other serious and painful affections, as results of inflammatory odontalgia ; loss of teeth, the derangement of the mechanism of digestion, as the consequences of odontalgia generally. Tartar excrescences, with their evils ; viz., detachment of the gums from the teeth, giving rise to inflammation of the membrane lining the socket, decay below the necks, scurvy of the gums, &c., as attendant upon the irritability naturally produced by foreign substances retained in contiguity with the teeth. Now, when we consider for a moment, these truly serious ills, as arising, which they undoubtedly do, from the most simple causes, through GENERAL REMARKS ON THE DISEASES. 63 neglect, and producing not only constitutional derange- ment and intense suffering, but incapacitating us for the performance of our occupations, or enjoyment of our pleasures, can we deny the fact, that we debar ourselves of the comfort we should otherwise experience through hfe, had we adopted those simple precautions I have endeavoured, in this treatise, to point out. We should entirely prevent, not only pain to ourselves, but we should free our friends from the strain upon those sympathies naturally excited at witnessing our torture, knowing, as all well do, its extent ; indeed, nothing so greatly checks the flow of general enjoyment, as the spectacle of a martyr to any physical anguish. Sm^ely then should we not, if we have no feeling for our- selves, at least consider that of our sympathisers ? and when I repeat, that all these unpleasant results may be obviated by cleanhness in the first instance, I feel convinced that the assertion will cause so necessary a course to be more generally followed.* In the hope that * I may here observe that the subject appeared to me of such vast importance in connexion with our military and naval services, that the fol- 64^ TREATISE ON DENTISTRY. the foregoing hints will induce those, either anticipating anj dental malady, actually suffering, or even free from lowing letters were inserted, some years back, in the Morning Post, and led to some, though I fear but temporary, improvement. I now republish them for the benefit of the general reader. " Dental Surgery, the Necessity of Army and Naval Surgeons BEING instructed IN IT. " To the Editor of the ' Morning Post.' " Sir, — The melancholy scenes in the late war having forcibly directed the public attention to the state of our army and navy, it will not, perhaps, be out of place to notice the subject of dental surgery, to point out its im- portance, and to show how, in this respect, the well-being of the British soldier has hitherto been neglected. Where not a single medical authority is opposed to me, it would be useless to quote the many eminent authorities upon the vital importance of the teeth to the preservation of health. Now the great majority of our soldiers enlist at the age of twenty, when caries usually commences in the molar or masticating teeth ; if the caries is then cut out, and the tooth stopped, the tooth is preserved for years, if not, the enamel soon breaks in, the food enters and rots, the caries extends, the nerve is exposed, and the tooth is lost, the pain from the necessary expo- sure to the night air whilst on duty being most severe. The loss of a tooth weakens that support the teeth give one to another. The tooth in oppo- sition to that extracted is immediately compromised, and the decay of the molar teeth being thus unchecked, all the strain is thrown on the incisors, or front teeth, so indispensable to the soldier in preparing his cartridge for the rifle. These once loosened speedily fall away, he is discharged, and the services of an experienced soldier are thus lost to his country. Even before GENERAL REMARKS ON THE DISEASES. 65 the present infliction of such, to follow the plain truths I have written, and thus escape torments, become that last step, whilst on severe service, like the late disastrous war, he was incapable of masticating the hard biscuit and tough salted meat, which, being swallowed in lumps, not only gave no nourishment, but, by producing mechanical irritation in the intestines, gave rise to fatal dysentery — the cause, as I am assured by a surgeon of a regiment, of the death of many of his bravest and most experienced soldiers, whose places were filled with raw recruits. The advantage of the trained soldier over the recruit has been too clearly shown in the victories of the Alma, Inkermann, and the Redan, for me to dwell upon the subject, and it is clearly our best interest to retain the services of the former at any cost. The army medical depart- ment is being now revised. The rank of the surgeon is to be raised, his pay is to be increased, the commissions to be thrown open to competition, and among the points of examination the practical acquaintance with dental surgery should be rigorously insisted on. In time of peace there is neces- sarily great leisure, and the surgeon could easily devote himself to the regular inspection of the soldiers' teeth ; nor would this kind attention be thrown away ; on the contrary, another and a stronger link would bind the soldier to his surgeon and his country. This evidence of his country's care of her soldiers would enlist many a brave recruit ; nor would the nation hesitate before a trifling expense to employ professional dentists for the troops whilst on home service, and thus give, at the same time, the best advice and assistance to our soldiers and instruction to their surgeons. At Chelsea there are hundreds of boys in training for our army, not one of whom probably receives the slightest attention to his teeth. The child of wealth does ; of the members of the Legislature, it is probable that in nineteen out of twenty some teeth will be found to have been stopped ; of 9 66 TllEATISE ON DENTISTRY. through neglect, alas ! too general, I have been induced to offer these hmts. Yet, before closing the subject, it the thousands of our soldiers at Aldershot it is probable that not one could be fouud where the caries has beeu arrested. Now I am certain I can speak for the profession to which I belong, when I say that there is not one who would hesitate to offer his gratuitous services to our gallant soldiers. So great is the evil, and so clear and easy the remedy, that I feel, if honoured by inser- tion in your widely -circulated columns, this letter will receive the attention of that enlightened and able officer who now commands those troops, whose services he has seen and of whose value he is aware, and that amidst the reforms now being introduced this most important point will not be longer overlooked. The Admiralty authorities would naturally not hesitate to follow the example thus shown them, for, if the necessity exists for our soldiers, the sailors, whose daily food is the hard biscuit and the salted meat, require it, if possible, even more. — Yours, " Dentist. '' New Bond Street:' "The Necessity of Attention to the Teeth of the Soldier and THE Sailor. " To the Editor of the 'Morning Post: " Sir, — May I beg the favour of you to insert the following observations on the necessity of our army and navy surgeons being instructed in the surgery of the teeth. Even at present the great importance of the teeth is acknowledged at the War Office, for the surgeons are directed to reject those volunteers whose teeth are either carious or have been extracted ; but when once enlisted into the service, though at an age when, from expe- rience, decay is generally found to commence in the teeth, and, when com- GENERAL EEMAEKS ON THE DISEASES. 67 may console many unfortunate individuals who are compelled to part with a tooth, to offer a few remarks on menced, to make its most rapid progress, we find almost universally the teeth of the soldier are left without stopping. These teeth at an early stage being stopped, would be preserved for many years ; but when decayed they are soon lost, and with them the services of the soldier. Before the caries has even made much progress, toothache sets in — of all pains nearly the most acute — and in the soldier aggravated to its utmost extent by exposure to the air whilst on duty, in all seasons and at all hours, ren- dering the extraction of the tooth necessary. This is an operation requiring various instruments to suit the case, with none of which is the army sur- geon probably provided, a knowledge of the teeth, which he cannot be expected to have, and great care, or the adjoining healthy teeth may be injured by the splintering of the socket. " When the knowledge of dental surgery is one of the qualifications re- quired of the array surgeons, in certainly ninety-nine cases out of a hundred these sufferings will be prevented by the examination of the soldiers' teeth by their surgeons at stated times, and the extra trouble to the surgeon would be amply repaid to him by the diminished sick lists from indigestion and other diseases, caused in many cases, and aggravated in all, by deficient masticating powers. Some time must necessarily elapse before this desi- rable change can be effected, but during the delay this neglect need not continue. A college of dentists has been formed, comprising amongst its members the most skilful professors of the art, and I can state confidently that a sufficient number of these are willing, gratuitously, if required, to devote each, one day in the week to assist our soldiers, and at the same time to instruct their surgeons ; and from the ample field at Aldershot, the London barracks, and the military schools, the most rapid progress would 68 TREATISE ON DENTISTRY. the improvement of the instruments used for their ex- traction. Those now adopted^ I sincerely hope by every dental practitioner, are constructed to operate with comparatively Kttle pain to the patient, and infinite ease to the operator. It would be absurd to say, that the extraction of a tooth can be effected totally without pain ; but when we remember the suffering experienced under the operation performed with the instrument of former days, I think the small amount of inconve- nience now felt will justify my observation. Before the introduction of the instruments I allude to, the patient was often subjected to numerous trials, ere the be made in the iustruction of the army surgeons in the prevention of the sufTerings of our soldiers. " If this plan should be adopted by the Commander-in-Chief — and it would appear impossible to raise any objection to it worthy of attention — the officer as well as the soldier would be benefited ; for though, whilst on home service, the surgeon is always welcomed by the dentist, and the officer can pay for his services — the soldier only being neglected — abroad and at sea all must equally suffer ; and I feel confident the subject has but to meet the attention of the Duke of Cambridge to receive at his hands a speedy and satisfactory conclusion. — Your obedient servant, " Samuel Eowell. " 120, New Bond Street, Bee. 24, 1856.*' GENERAL REMARKS ON THE DISEASES. 69 extraction of the tooth was accomplished, intense pain was experienced, and after the tooth was removed evils arose from the rough performance, even more serious than if the diseased tooth had been suffered to remain, for the means then applied were for universal use, and the instruments not as now adapted to the various shapes and different positions of the teeth ; in short, one contrivance had to do the duty of all, and the issue was left to chance. The instrument now generally adopted is the self- lancing forceps, adapted to each tooth individually. This is so constructed as to effect its object by a single move- ment, doing away with that unnecessary distinct operation of lancing the gum, which gave so much additional pain to the patient. It must be attributed to carelessness indeed, or want of proper precaution, if teeth are broken off, stumps left in, or socket removed with the teeth, under the instrument as at present constructed ; and as to any of the after inconveniences, felt under the ancien regime, such as a bruised gum from the pressure of the key, then used, at the point of resistance from which its action takes place, these are now never experienced, the action 70 TREATISE ON DENTISTRY. being on the tooth itself. There may be exceptions touching the expert extraction of a broken tooth, occurrent in certain formations, such as one in the subjoined illustra- tion, which cannot be extracted without fracture, yet we have forceps for the removal of the part that may be left. Some persons, I am sorry to say, have become so enamoured of chloroform or ether, to alleviate the suffering anticipated in extraction, as to refuse to permit the operation without its assistance. I will not deny that in extensive opera- tions such determination may be right, but when it extends to the mere removal of a tooth, which is an act simple in its execution and quick in its eflPect, I must confess I think it most indiscreet, and calculated to do probably more harm than good, by inducing the expec- tation of excessive pain, to prevent which anaesthesia is deemed necessary, but which, if it fails to produce the desired end, only deters the patient from submitting to the operation altogether. The same remark applies to THE OPEUATION OP EXTRACTION. 71 electricity and congelation, both of which I have tried without success, and have failed to produce the desired insensibility. From the complication of the whole pro- cess, and the display of alarming paraphernalia, the patient is agitated by direful anticipations, which, as is well known, are always more grave than the simple process. Why then create this evil, and foster the erroneous idea that such pain is to be endured, that we must have stupifying agents to alleviate it? Why make a prominent operation of the most simple of the whole index of surgery ? Moreover, we know the result of simple extraction, but we do not know that of those agents, which, in constitutions of a certain class, may create unpleasant and even dangerous effects. We cannot look into the future, nor prognosticate events ; why then wander, without occasion, from the beaten path into an unknown track, which may lead to danger, when by the familiar road we are sure to reach the desired goal ? These remarks will, I hope, induce my readers to abandon such infatuation. T have witnessed the issue 72 TREATISE ON DENTISTRY. of this erroneous course, and if my advice may have any weight, they will avoid it; for in the present day all instruments for dental operations are so beautifully adapted to perform their individual offices, that little, if any, inconvenience is felt by those who are compelled to have recourse to them, and failure seldom, if ever, occurs. Having now concluded this portion of the subject, and given the necessary hints on diseases of the teeth, with their remedies, pointing out those cases where we can retain sUch useful members, and those when we must lose them, I will explain the method of replacing their loss by artificial means, which, thanks to the present advanced state of aiechanical ingenuity, we can, under every circumstance, satisfactorily accomplish. It is, indeed, no small comfort to know that the loss of teeth can now always be remedied. ARTIFICIAL TEETH, "Art surpasses strength; and patience and reflection make those things possible which in the first instance appear almost insurmountable."— ^^'ow. In the selection of mechanical substitutes, care must invariably be taken that the material used be such as is unaffected by chemical agency, and so durable as, when adapted, not to require alteration or readjustment from wear. These desirable ends may almost always be achieved, if gold be employed for the framework of our contrivance and the crystalline teeth for dental duty; the former on account of its purity and capabihty of resisting decomposition, the latter from their extreme hardness and beautifid imitation of nature. Many persons, for economy, will wear a case of impure mate- rial and inferior adaptation, and as long as Something 10 74 TREATISE ON DENTISTllY. approaching a lit is secured they are content. Such a practice can never be permanently beneficial, and is therefore totally at variance with the idea of thriftiness. In the first place, inferior material, silver or palladium, is used, which metals, through acrid secretions of the mouth, oxidize and blacken, ulcerate the gums, produce most offensive breath, and otherwise destroy the health of the mouth ; and hence, not only become a source of discomfort to the wearer, but invariably shock those with whom they converse, an effect they are invariably themselves ignorant of producing. In the second, an ill-adapted or imperfectly fitting case must naturally be uncomfortable, and a constant worry to the mouth, the tongue being much too sensitive a member to be fidgeted ; besides, such cases must be fixed in order to keep place at all. A case, to act with perfect comfort to the wearer, nuist be removeable at pleasure : this is imperative in a sanatory sense. Now, when cases are fixtures, what results? Food insinuates itself between the plate on which the teeth are fitted and the gum, and there undergoes its chemical changes. Acrid and ARTIFICIAL TEETH. 75 offensive secretions ai'e generated, tlie gums become sore and irritable, the taste is lost, and the wearer cannot help himself, being unable to remove his teeth, and so must either suffer on or discard his case altogether, these effects being of daily recurrence. This brief and true explanation will suffice to point out the error. A case, to act well, must be composed, as before stated, of gold and mineral teeth ; the plate most accurately fitted to the roof of the mouth, and also tlie teeth correctly adapted to the bite of the antagonist contact. Wire attachments should never be used, since, from their cutting tendency, they too often wear through the enamel over which they are placed, and destroy the only attachment for the adhesion of the apparatus. It will then be advisable that all the clasps should be hands, or collars ; these are flat, and pass over the teeth with smoothness, and are not only more easily removed from the teeth, but may be so without causing the least chance of abrasion. Circumstances will alter the plans, in accordance with the numerous and different kinds of cases, but we may be always guided by these rules. If 76 TREATISE. ON DENTISTHY. there exist natural teeth for attachment, let bands be used ; if none, either let our case be fixed on the prin- ciple of suction, or by counter-pressure by means of the spiral springs. Pivoting teeth I do not recommend, since it too often induces painful results. The stump to which the arti- ficial tooth has to be grafted is drilled, in order to receive the pivot by which it is attached. This operation irritates the pulpy cavity, and frequently causes great pain. We can always adapt a plate even to carry a single tooth, so that the risk is really unnecessary. Whenever artificial teeth are to be worn, all stumps that may be located where the plate has to go should be removed, as a soft pillow is then obtained, on which it will press with equal force throughout, and yield evenly to any pressure. However, a plate can be well adapted over stumps, especially if it is lined with the prepared gutta-percha, which, yielding slightly on the pressure of biting, prevents them being irritated ; yet, as a general rule, I advise the former plan. In every case, too, where stumps or diseased teeth have to be removed, it is most ARTIFICIAL TEETH. 11 essential that ample time be given for the gmn to heal, and recede as far as it may be likely to do ; for nothing is so unsatisfactoiy to the honest dentist as, when a plate has been fitted and so considered completed, to hear, after the lapse of a short time, that his work is no longer in proper form. In hurried cases this will always occur, for when the gums recede, the pillow on which the plate formerly adjusted itself perfectly, having shrunken, the case will naturally be too large, and the then overlapping edges of plate either cut the cheek, or the whole case be so loose as to be displaced on every occasion, and thus con- tinually annoy the wearer, until at last it is altogether discarded, and the dentist of course condemned. We cannot, therefore, be too careful how we proceed, in the construction of artificial teeth. Time for healing the gums, when teeth or stumps are extracted, should be given ; the material of the cases carefully considered, and none employed that will not entirely resist chemical action and decay ; the adaptation be rendered so perfect that no pain in wearing is experienced, no deficiency in the firmness felt, no rough edges to worry 78 TREATISE ON DENTISTRY. the tongue or otherwise irritate the mouth ; the whole to be appUed or removed with ease; and, lastly, the substitute to be substantial and durable. Attention to these particulars will ensure such admirable comfort in the contrivance as cannot fail to reflect credit on the maker and give perfect satisfaction to the patient. THE END. Printed by J. E. Adlaxd, Bartholomew Close. >/ JL.OS /*.llgClC» This book is DUE on the last date stamped below. 1