A treatise on second dentition, and the natural method of directing it : followed by a summary of stomatic semeology

Front matter

Spe Library of Dental Science.]

Sn on nan etn ey ts etn nen et ete s ones e ee

A TREATISE

Preface

Few writers on odontology, occupy a higher position, or have contributed more largely to the advancement of this branch of medical science, than the author of the Treatise which we now present to the public for the first time, in our own noble and widely extended language.

It is true that his great abilities and excellent judgment, did not preserve him entirely from error, yet we hazard nothing in saying, that, for general correctness of opinion, extensive information and practical good sense, this work will compare favorably with any other on the same subject.

We have thought that a good treatise on Second Dentition, was much needed by the profession in this country. ‘The position of the dental art, so rapidly rising in usefulness and respectability, demands more iv PREFACE.

extensive reading, and greater collateral information, than has heretofore been considered necessary for successful and reputable practice. We wish to contribute every facility in our power, to the attainment of an end so desirable ; and we do not doubt that this treatise will be read with pleasure and profit, by those who love their profession sufficiently well, to desire to see it improved and elevated to its proper place in the medical sciences.— Balt. Ed.

SECOND DENTITION.

Ne eee se

Chapter I. General Considerations

Wuitst the various branches of the healing art are fast advancing to perfection, and the light of pathological research now lends its aid to practitioners, in the most complicated diseases ; dental surgery by no means keeps pace with these improvements. It does not receive from our public schools, that attention which its importance demands; and although we have many exprofesso works on the structure and diseases of the teeth, how much do they not leave to be desired. ‘The authors of nosology and physiology devote even some lines to them, but they appear to mention them only to complete the plan of their works, and thus they have treated them very superficially. Many indeed, though freely confessing the great want of knowledge, of the expansion, growth and diseases of the teeth, are nevertheless, by reason of their numerous engagements, unable to devote themselves to their study.

Formerly, these bones were regarded, indeed, as mere ornaments of the face, and consequently their preservation was rather the province of the perfumer than the regular physician.

Modern physiologists, however, in lecturing on the phenomena of digestion, have very clearly shown in what manner the teeth are necessary to the performance of one of those functions on which life depends. ‘The alimentary canal it is now well known, is charged with those substances designed for the accre-

tion and preservation of the individual, and that it must be aid-

ed in its operations, by mechanical means. The, stomach of

man cannot act with ease unless the destined aliment, has first 2.

*~ sergnenn

Sd” sh otiie | te ol Th we ea br passed through a previous state of preservation. Our food, accordingly, is first roasted or boiled, and seasoned in various ways, before it is committed to the mouth, in order that it may the better be prepared to be submitted to the action of the stomach, by being penetrated with saliva; the secretion of which, is called forth by the presence of the food and by mastication. But how can this last be performed with jaws unfurnished with teeth ?

In those animals which have a membranous stomach, the teeth are designed as auxiliaries to facilitate its operations, and as it has pleased the Creator to use an endless variety of means to produce the same results, those species, whose stomachs are of a weak texture, are supplied with teeth, while those supplied with great muscular power are unfurnished with them.

‘The stomach, in animals of the ruminating kind, whose dental arch is incomplete, generally supply the want of those bones, and the food is brought again to the mouth, there to be masticated anew and to be submitted again to insalivation.

Physicians of the present day, in other respects, better appreciate the importance of dentistry than those of a former age; they recommend it to our attention, they do not neglect to examine the habitual healthy state of the mouth, and are hence frequently enabled to make indications, which are useful to them in cases of disease.*

The phenomena exhibited in the development of these small bones, which now engage our notice, have attracted the attention of some and excited their curiosity ; but to speak freely, this part of the science is too much neglected and too little understood, it demands from those who devote themselves to the honorable task of instructing pupils in all the branches of the great medical art,a less superficial study.

Although there have been a great many very interesting works on first dentition ; still all the phenomena of which it is composed, have not yet been fully enumerated; it is for time and

* Notwithstanding the excellence of the most modern treatises on semiology, there are a number of important symptoms connected with the jaws, the saliva, the tartar, &c. which have not yet been mentioned.

é experience to supply these deficiences ; and happy will he be who shall diminish their number.*

Men of approved medical knowledge, however, have had first dentition under their inspection, but it is not thus with the branch we are now considering. This has been left to the observation and sagacity of dentists possessing not the requisite physiological knowledge.

The laws that govern the expansion, growth, and arrangement of the teeth, are properly the patrimony of the physician, who should understand them, in order to direct the dentist whenever (which unfortunately is too frequently the case) he is not furnished with sufficient information on all the duties of his profession.

It is very desirable that there should be a class of physicians who would give their attention to the practice for the diseases of the mouth; this is the only means of preventing so interesting a part of our art, from falling into the hands of mere practitioners, or from becoming the prey of the vilest charlatans. Such persons cannot practice any part of surgery without detriment to society.

He that is nothing more than a mechanician, ought not to be admitted into the sanctuary of Esculapius, his duty here should be confined to those machines, with which alone he has the right to interfere.

I repeat it, the knowledge of true dentistry is not sufficiently diffused, and it never will be, until it shall have been made as much a portion of public instruction, as the various other parts

* The work of Professor Baumes on First Dentition, should, nevertheless, be well studied, it is justly placed in the first rank.

+I have not room here to express my regret that goldsmiths, jewellers, watch makers and workers of ivory, having labored only as such in the laboratories of dentists, without having studied, without having ever assisted at their operations, should obtain permission to practice. Let us, however, hope, that under the wise regulations that are proposed for the practice of medicine, those sorts of admissions, will no longer occur, and that with them will also disappear those great teeth of varnished ivory that indicate the abodes of those dentists, and which to the shame of the art, are also seen at the doors of some more respectable personages.

of the art. Then and then only will it be cultivated by educacated men, and will advance with the same vigor as the other branches of medicine.

The management of second dentition is a stumbling-block to dentists of moderate abilities; they have for this a certain routine, which, I say it with regret, is sustained by writings of authority with those, who find in these books of ready made opinions, food for their minds, and foundation for their practice, without giving themselves the trouble to inquire into their value.

It is in order to eradicate these errors, that I have determined to publish this work. It is not my intention to establish any new system; the natural method which I here explain, has been followed by many distinguished dentists, but they have either not made public the results of their experience, or have done it in a very brief manner. I here show that which enlightened men practice daily with success, and I only add some free reflections drawn from my own practice, and from anatomical examinations of the human jaw, considered from the first moment the adult teeth appear, until the period they take their place in that circle which after their growth they are destined to occupy. Thus, submitting my observations to the just criticism of professional men, I leave it to them to decide upon a subject of so much importance as to interest every class of the community.

Among the numerous authors, both native and foreign, that I have been obliged to consult before writing,* I have not found any, who did not seemingly present some system founded on their own personal observation ; they abandon themselves to reasonings more or less specious, forsaking the paths of experience to follow the vagaries of their imaginations. Others do not fully explain themselves on this point; they elude the subject and seem afraid to grapple with it.

_ Sprengel has justly remarked, that the road to experience is

*I have employed some moments of my leisure to translate the works of Hunter and F'ox upon the human teeth. My intention, at first, was to publish them, but having found in them so many opinions,and so many things which do not accord with our actual knowledge of physiology, that 1 regard them only as good sources from which to derive information, but whose engravings constitute their greatest value.

hard to tread, for it is easier to follow the suggestions of fancy, and by an unvaried routine, to acquire a certain amount of practical skill, than to confine oneself to the narrow and thorny path of observation.

These principles may be applied to the treatment of second dentition ; it is much easier to extract the teeth, than to determine whether it is absolutely necessary. The extraction of a tooth requires nothing more, on the part of the practitioner, than a certain degree of facility in the use of the instruments that are usually employed in this operation; whilst the knowledge necessary to appreciate the consequences can only be acquired by time and study.

Fauchard, Jourdain, Bourdet, and other writers of a more modern date, have treated this point with a sort of indifference unfortunate for the profession, and painful to him who expects to find in the works of these learned dentists something which will at least instruct him.

In his Dentiste de la Jeunisse,so finely written, M. Duval has" shown great literary talents; but his work seems rather to be designed for the public at large than for men of the profession. The author, believing that his professional brethren were as learned as himself, has not taught them precisely what he should have known so well how to teach; he has not mentioned how very necessary it is in order to assist dentition, that the means should be varied according to circumstances.

In another work excellent in many respects, he has not reckoned among the dangers of extraction the imperfect configuration of the dental arch, and the destruction of the germs of the adult teeth, the common result of improper extraction, and which a practitioner of his merit could not have failed to observe.

Dionis Bunon, l’Ecluse, Bourdet, and many that have written since their time, have adopted a system entirely opposed to the tendency of nature.

There are, nevertheless, two modern authors to whom we are indebted for some excellent articles on this point, these writers are Messieurs La Forgue and Gariot, still they have but touched upon a subject that should have occupied a much greater space in their works.

Hunter has not said any thing about it. Fox, professor of dentistry in the London hospital, has left. us a very fine treatise upon his profession ; but, forgetful of the manner in which he has followed the expansion of the teeth at every period of life, instead of making a judicious application of what he has said, in order to establish some useful system to aid dentition, he aii votes himself entirely to a theory that involves himself in error.

In a little work, embellished with colored engravings, which I published in 1816. I have thrown out a few suggestions on the best method to be pursued in the management of the teeth ; but as this pamphlet was rather designed for the general reader, and as I was desirous to be otherwise employed in so small a volume, I have been content to confine myself to principles without entering into details.

Finally, the last French anatomist that knew what he wrote, has entitled his work Nouvelle Theorie de la Dentition; but he has not said one word about the means that should be employed to regulate the denture. ‘The title of his work gives us a right to expect this information ; there are,without doubt, many excellent passages ; but we perceive with regret, various discoveries, both national and foreign, ancient as well as modern, announced as his own. And often absurd hypotheses, and the most ridiculous stories palmed off for truth on the good faith of the world.*

Although the utility of a work,in which the different opinions of these authors should be impartially discussed, has, for many years, appeared incontestible, and although I have collected many notes on this subject, yet believing the task was too great for me, I have for a long time hesitated to arrange them. Nevertheless the necessity of instructing our young practitioners on the choice of means to regulate second dentition, has triumphed over the repugnance I have felt to attack received opinions, and a mode of treatment sanctioned by time and supported by the most celebrated authors.

In order, therefore, to contend with success against so great authorities, 1 must be read without prejudice, and by those who

*M. Miel, surgeon dentist, justly thinks, that the work of M. Serres is filled with errors and mere suppositions, which he proposes to notice.

SECOND DENTITION. ll will be disposed to examine the physiological facts that I oppose to those theories which I think proper to controvert. I ought, accordingly, before presenting the natural method for aiding the arrangement of the dental arch at the time of molting the primitive or temporary teeth, to review the phenomena displayed in the formation of the second teeth, as well as in the progressive enlargement of the jaw, until the termination of the second dentition.

In no country has the anatomy of the teeth met with so much care and attention as in England. Hunter, Blake, Monroe and Fox are those to whom the profession is under the greatest obligations on this subject. ‘Their works abound in excellent engravings; the examination of which shows how much the manner of nourishing and tending the infant, in the very beginning of life, influences the health of the second teeth.

Hippocrates has said, that the health of the child, depends on the health of the mother. In truth the physical part of man resembles the vegetables that assimilate to themselves the juices of extraneous substances. If, at the period of development, the foetus is possessed of the right principles, it will increase with ease, and all its parts will be harmoniously arranged. If, on the contrary, the pregnant female has been weakened by disease, or if she is of a naturally weak constitution, her offspring will almost assuredly have a delicate complexion; and all its organs will be rather half formed than well made, and they will need in a manner, to be renewed, during life, by nutrition.

Unfortunately the teeth when they are once formed, are, by reason of their compactness, of all the parts of our body, the most slow to obey the general laws of vital decomposition and recomposition ; especially the enamel, which, although it is nourished, and may be hardened while life remains, yet it can never be reproduced, when once it has been either wholly or in part destroyed. Hence it results, that, if the juices which have been furnished these small bones, during their formation, are of an unwholesome nature; they will for a long time have a tendency to decay ; still the individual who has been born with a weak constitution may become strong during his accretion.— Jourdain.

The dissections made by various anatomists, have demonstrated, that the first or milk teeth are generally formed at the period of birth.— Hippocrates.

If, on the little stranger coming into the world, its fluids do not contain a sufficient quantity of the calcareous materials which are designed to form the solid parts of the milk teeth, these will be liable to decay during the early periods of life.

If the case is the same with the teeth of the second dentition; if the child continues feeble during the expansion of the teeth that belong to this class, they will contain a great quantity of gelatine, and be exposed to odonto-malavia.

But if, during the ossification of the second teeth, the child is robust, if it does not experience those diseases that impair the qualities of its fluids, or if born feeble, it afterwards becomes strong, it will most undoubtedly have good teeth; the contrary will be the case with the child, which having been born strong, afterwards becomes diseased. ‘These observations are suflicient to shake the faith of those who are persuaded that the daily cleaning of the teeth causes them to decay, as well as that of those, who, on the other hand, believe that the observance of this will invariably prevent the teeth from becoming affected with caries.

This question, with the knowledge of these phenomena which these organs exhibit, during their development, can be very easily resolved ; and it can be established on sound principles, that continued cleansing, preserves the teeth that are naturally good, whilst the most assiduous care will not prevent caries attacking those, whose very nature is vitiated by the calcareous material. Happy in this case, will it be, if the subject be aware of the bad quality of his teeth, and has recourse in time, to professional aid, which alone can retard the decay.

Consequently, the physician, by inspecting the teeth, can, in a certain degree, judge of the natural constitution of the individual, and the knowledge thus acquired may influence him with advantage, as to the mode of treatment he will adopt in the various cases of disease. |

In fine, teeth originally good, may in the course of time decay ; but with a little practice, the physician will easily be enabled to distinguish between those that are naturally bad and those that have become so.

The same great changes and superficial marks which we observe on the teeth of those who have been attacked with violent disease, are also frequently seen on the mucous membranes during the periods of youth ; these spots constitute what are called atrophy and erosion of the enamel, and their situation more or less removed from the cutting edges, indicate the time of life at which the disease has deranged the operations of nature.

The dentist, it is true, is sometimes able, when the disease is slight and the crowns of the teeth are above the sockets, to remedy these disorders; but this is only when he perceives them ; it belongs to the physician alone to foresee and to prescribe the necessary means to be used by mothers and nurses to prevent these decays. |

Bunon, page 61, thinks that erosion proceeds from a humor that insinuates itself into the alveolus and diseases the enamel of the tooth. The physiology of his time admits this explana- | tion, which, if not strictly correct, approaches very near the truth. ;

This article of his work, is enriched with many just observations on the method of discovering by an inspection of the teeth affected with erosion, at what age the child was affected with the disorder that corroded these organs. But Bourdet, who wrote after him, has explained the mechanism of erosion much better; he says, “that the liquor contained in the dental sac or matrix, in some cases of violent disease, acidulates, and that in consequence, the teeth are affected with erosion.” —Bourdet, page 79, ed. 1758. Experience demonstrates the truth of this exposition.

M. Duval: has substituted the name of atrophy for that of erosion, (Bulletin de 1’Ecole de Medecine,) but this is only a change of names ; it appears to me that either one is admissible, not to designate one and the same affection, but to distinguish two very different diseases that may appear either at different

periods or at the same time on the same individual.

_ Kach of these present various characteristics, that do not permit them to be confounded.

Congenital atrophy is very frequently seen on only one tooth, whilst all the rest are sound.

Congenital erosion always lights on a series of teeth, and this kind of decay is quite common. Atrophy is more rarely observed.

Notwithstanding what Hunter and other learned men, among whom is M. Cuvier, have written on this subject, I have intimated my conviction, that the enamel forms an integral part of the tooth, that it proceeds from the dental embryo, and that consequently, does not result from a superposed crystallization, nor does it remain in suspension in the liquor which is enclosed in the dental matrix.

It is certain, that a very small quantity of vascular tissue enters into the composition of the enamel; its presence may easily be demonstrated by a well conducted analysis.

I suppose, therefore, that the dental embryo is placed in the part where the enamel must be formed, and that there is an immense quantity of small exhalent vessels, forming a sort of imperceptible velvet. By degrees, these small tubes receive the phosphate of lime, that fills them without destroying the organic sensibility, which they fora long time retain and do not lose until their place is usurped by the terreous substance that is continually conveyed to them during life; but, before the enamel is formed, a bony coat, somewhat like mother of pearl, developes itself, which is of remarkable density, and is found only on the crown of the tooth; this then receives the sulphate of lime that passes over its surface, and which at the same time perhaps undergoes some preparation. This coat, by reason of its hardness and the closeness of the tissue, may appear to be impermable, but do not the animal and vegetable kingdoms furnish us with numerous examples, where the circulation is carried on, although our nicest instruments cannot detect any vessels.

Will any one, for example, assert that there is no room for the circulation of sap in the iron tree, whose hardness is proverbial, or even in the knots of our indigenous trees, whose hard surface blunts the steely edge with which we strike them? Now, if circulation is proved to exist in the most compact vege-

Be a> ear tables, why may it not also be supposed to exist in the teeth, that have the advantage of belonging to the animal kingdom?

Such is the formation of this pearly covering, whose hardness is so remarkable as to have induced Hunter to suppose that the enamel was deposited by the internal membrane of the dental capsule.

As to the rest, Jourdain, in his essay, observes, that the enamel and the layer of which I have been speaking are simultaneously formed.

If we admit the mode of formation that I have just described, we can account for the changes of color, consistence and sensibility that are observed in the enamel, and which are nothing more than the result of nutrition. By this, too, we may explain its diseases. In truth, the caries to which it is exposed, and which isa sort of ulcer on the tooth, can only commit its ravages on organized parts; its being set on edge; its being often worn half away, and its being subject to accidental erosion, all go to prove vital sensibility to be here. This every surgeon dentist fully comprehends, and can here triumphantly refute those merely scientific reasonings which must ever fall before impartial experience. |

Atrophy to me appears to be the result of nutrition, or of a vicious development of the small exhalent tubes just mentioned, and which constitutes an organic defect.

There is another sort different from this; it is the partial and casual destruction of some crystals in the enamel, which were primitively very well organized.

I will here state what I myself have frequently seen, and what surgeon dentists also every day observe. ‘They are consulted first in behalf of children whose enamel on one tooth or more, although very smooth and polished, is of a brown or pale color, and perfectly insensible to the action of the instrument that breaks it. This is congenital atrophy.

Again, they are called upon by persons who have received a blow on a sound tooth, which, in consequence, has caused a part | of the enamel to change its color, and upon it is found a white spot of greater or less extent. This is accidental atrophy.

If we examine the relative hardness of the enamel thus described, we shall find it much softer in the places diseased having there been reduced to the state of carbonate of lime by the interior absorption of the small quantity of gelatin that enters into the composition of its crystals. 'Thus absorption acts on the enamel and on the teeth, as on the other bones; and in proof of which, I might adduce other arguments equally convincing.

Erosion should not be confounded with atrophy, which is occasioned by the death of a greater or less number of the exhalents that furnish the enamel, and the destruction of which may have happened before or after birth.

The other is the destruction of the enamel after it is formed.

This is the result of the corroding action of the mucous fluids, in the midst of which the crown of the tooth unfolds itself, and whose quality varies according to the various states of health and disease.

On opening the jaws of children that have died of vermicular, mucous or mesenteric diseases, I have generally found the teeth affected with atrophy, not only on the enamel, but also on some part of the osseous substance ; some of the germs were also so disordered as would lead one to suppose that they were no longer able to be charged with the calcareous phosphate.

I have sometimes seen the enamel unequally distributed over the crowns of several teeth; this constitutes those gibbosities

- that should of right be classed under atrophy.

Erosion confines itself to the enamel, and as I have before remarked, it ordinarily shows itself on a series of teeth; it is frequently seen in the cases of those who, during the time of enamelling, have been attacked by small-pox or some other violent

disease, or whose mucous membranes have been affected. In cases of children that have been sick, the part of the tooth that has been formed before the disease is frequently sound, though situated in the midst of disordered fluids, whence I have concluded that the action of this fluid is the more fatal to the enamel as the enamel is the more recent, so that its dissolution may gradually happen, as it is deposited by the vessels of the ’ germ in astate of disease, and consequently before it has acquired that degree of aggregation and consistence which is necessary in

SECOND DENTITION. a7 order to resist the acidulated mucus that surrounds it. ‘To assure myself of the acidity, I placed this mucus upon blue paper died with the turnsole, the color of which, on touching the mucus, was immediately changed to a red, the more marked as the teeth appeared to be the more strongly corroded.*

The experiments which I have made present the following results. Whenever an infant has been sick of a disease by which the mucous system is principally affected, and whose progress has been rapid, the erosion will engrave a horizontal line upon the enamel of the teeth. If there have been relapses, several lines may be observed. If the malady has been of very long continuance, the enamel will be destroyed in different places, or pierced through in small holes. In the last case, the depth of the enamel will vary according to the length of time the cause may have continued.

If we now examine the differences between erosion and atrophy in the case of an infant that has been freed from a disease that has so sadly marked its teeth, we shall find that the part atrophied is deformed and deprived of the enamel; that the teeth are yellow and sensitive, and that the touch of the finger upon the part affected is very painful.

If the erosion has not wholly destroyed the crystals of the enamel, the bottom of it is of a white color, and on its being touched, causes no disagreeable sensation; if, on the contrary, the crystals are destroyed down to the tooth, the part thus denuded is irritable. In fine, congenital atrophy and erosion are very painful at first, but they gradually cease to be so as age comes on.

Erosion demonstrates that the enamel is an emanation of the tooth, for were we to suppose that the membrane secretes it, we should be compelled to admit that, if sickness for a time disturbed its functions, the act of enamelling would only be suspended, and that when the malady ceased, the membrane would produce anew the calcareous material.