A treatise on the disorders and deformities of the teeth and gums : explaining the most rational methods of treating their diseases : illustrated with cases and experiments

Preface

TO THE AMERICAN EDITION.

POLIO

ALTHOUGH since the time of the publication of the Treatise which we now offer to our readers, (1770,) the science of Dental Surgery has made great advances, we — nevertheless think it a work well worthy of a place in the Library part of our Journal. Mr. Berdmore, during the period of his professional career, ranked deservedly high asa Dentist. No English practitioner, in this department of the curative art, at this time, enjoyed as high a reputation for skill and professional knowledge, and although his work has been scarcely noticed by subsequent writers, it is unequalled, in point of merit, by any previous British publication ; and in thus rescuing it, as it were, almost from oblivion, we believe we shall receive the thanks of our brethren generally. We had at first intended to append notes to it, descriptive of the present established principles and practice of the art, but upon reflection we came to the conclusion, that, inasmuch as that if we were ‘to do this, the annotations would be more copious than the text, it would be as well to publish it as itis, without comments. The work, therefore, is principally valuable only as a book of reference. It is not offered as a practical guide to the student.

EDITORS AMER. JOUR. OF DENTAL SCIENCE.

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PREFACE.

WueEn first I resolved to devote my whole time and attention to that part of Surgery which concerns the Dentist’s art, I observed, with regret, that no material instructions were to be derived from the writers of this

_country who have touched on the subject; therefore I endeavored, for my own improvement, to collect carefully, from my predecessors in business, and from practice, whatever I thought conducive to the advancement of it.

After a few years thus employed, I found, or I thoughtI - had found, my observations and discoveries in some measure worthy of being communicated to those who practice in this business, to the parents who are solicitous for the health and beauty of their children, and to the patients who are affected with disorders or deformities of the teeth. I therefore endeavored to reduce them to some order, and at last resolved to commit them to the press.

The work being originally designed for artists, who are not much given to reading, and for patients who do not love too much trouble, I purposely avoided quotations. Indeed, without departing from the subject, I could only have quoted a few French authors, who have written to make their names known, and one or two English, who have translated very injudiciously.

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TREATISE ON THE TEETH.

CHAPTER I. The Design of this Treatise

To preserve the teeth, to regulate their growth, and to remove the vast variety of disorders. and deformities to which they are exposed, are matters of greater importance than is generally imagined, and of such universal concern as justly claims the attention of the public; for disorders or deficiencies of the teeth, however slightly regarded by some people, are inevitably attended with evils which affect the whole system; and deformities of them are often remarkably hurtful in common life.

Whatever renders mastication painful or imperfect, not only lessens our relish and enjoyment of food, but also prevents that perfect comminution and mixture of it with the salivary liquor, which is necessary towards digestion; and thence gives rise to an endless train of diseases of the stomach and bowels, at the same time that the body is deprived of its wonted nourishment.

Disorders of the teeth also frequently bring on the most excruciating pains and dangerous inflammations, sometimes deep seated abscesses, which destroy the neighboring parts, and affect the whole system by sympathy, or by infecting the blood with corrupted matter; and it is well known, that cutting the teeth carries off an immense number of children, who by due assistance might easily be saved.

Deformities of the teeth, as they generally tend to disease, are objects of serious attention; but. setting apart a consideration which appears so distant, it is well known that they are often as. formidable as disease itself.

In common life, we every day observe, how a slight deformity caricatures every gesture of some worthy people ; whilst beauty and th ove soften the foibles of others, and grace the few accomplishments they are possessed of.

4 Pert 8 TREATISE ON THE TEETH.

The oratory of the pulpit and the bar, and above all the art of pleasing in conversation and social life, are matters of the highest concern to individuals. But in these no one can excel whose loss of teeth, or rotten livid stumps, and fallen lips and hollow cheeks, destroy articulation, and the happy expression of the countenance; whose voice has lost its native tone, and whose laugh, instead of painting joy and merriment, expresses only defect and disease.

A foulness of the teeth is by some people as little regarded as it is easily removed; but with the fair sex, with the polite and elegant part of the world, it is Jooked on as a certain mark of nastiness and sloth; not only because it disfigures one of the greatest ornaments of the countenance, but also because the smell imparted to the breath by dirty rotting teeth, is generally disagreeable to the patients themselves, and sometimes extremely offensive to others in close conversation.

The design of this short treatise then, is to obviate and remove these evils; to render the art which I profess of more extensive utility ; to communicate to the public the advances I have made in it ; and lastly, to rescue it from the indifference and unmerited contempt with which it has hitherto been treated, by those especially who are pleased to comprehend under the idea of tooth-drawing or tooth-scraping all that is necessary to be known or advanced on the subject; and therefore place on an equal footing with the surgeon dentist, the tooth-drawing barber and itinerant mountebank.

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CHAPTER II. The Method of this Treatise

For the sake of brevity and precision, I shall divide this little work into three parts.

In the first, the teeth and the parts with which they are immediately connected, shall be considered and described in their natural and sound state. ;

In the second, I shall treat of the teeth and contiguous parts, in their diseased state, and annexed to each disease I shall give the methods of cure.

In the last part, I shall teach all the various means which prevent disorders of the teeth, and which have been found, by long experience, conducive to their soundness, regularity, good color, smoothness, and firmness in the sockets, and to the lasting preservation of them in old age.

This last part, although it will contain instructions for every age, I must beg leave to address particularly to the ladies who have young children, and to the governesses who have the care of them, and who are studious to cultivate in them whatever is admired in society, and useful in itself.

For in the early periods of life, whilst the teeth are forcing a passage through the gums, and afterwards when the time of shedding approaches, it rests more with the mother and the nurse to make them good or bad than is generally imagined: then nature can be cherished where she is kind, assisted when feeble, and easily directed or restrained when irregular or luxuriant.

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Chapter III

Anatomy and Physiology of the Teeth, and parts adjacent.

_A perrect knowledge of the structure of the teeth, and of the parts to which they are immediately connected, is the basis of all rational practice, as well in diseases as in superficial deformities of them.

I wish, therefore, for the sake of those who practise drawing, cleaning, and other operations on the teeth, that this necessary instruction could be imparted by writing: but that is impossible ; for a regular study of anatomy, under proper professors, ocular demonstrations, and judicious dissections, often repeated, are absolutely necessary.

I would have it understood, therefore, that I do not attempt to teach the anatomy of the teeth in this manner; but that I mean only to give such a general idea of these parts in their natural and sound state, as to enable every person, however slightly conversant in these matters, to comprehend whatever shall be said hereafter concerning the disordered condition of them, and to determine, in some measure, how far the practice which I adopt, is rational, or likely to succeed.

The teeth, in grown people, are small bones, of various figures and sizes, fixed immoveably in their sockets, by a species of articulation, by the anatomist called gomphosis.

That part of them which is sunk in the socket, is called the — root ; that which is exposed to view, the body or crown ; and the circular ridge or line, which limits and distinguishes these two parts, is called the neck or collar of the tooth.

The substance of the teeth is extremely different from that of other bones, being denser, whiter, and not apparently laminated, nor subject to exfoliation.

The body of the tooth is crusted over with a very white, smooth polished substance, called ename/, which only extends as far as the collar, whatever some anatomists may have said to the contrary; it differs in many circumstances from the bony part underneath, as shall be related more at large hereafter, and it is so hard as to strike fire with steel like flint; viewed with a microscope, it appears to be composed of short radiated fibres, proceeding perpendicular to the plain or surface of the part from which they arise, and its thickness seldom exceeds half a line, or the twenty-fourth part of an inch.

This enamel is formed before the tooth appears above the gums; it thickens, hardens, and polishes, until the age of twenty or twenty-five, and afterwards is repaired no longer, but gradually wears by continued use.

The roots of the teeth consist of one uniform substance; they are only covered by a periosteum, or thin membrane, which follows them to the bottom of the sockets, and helps to connect them with the diploe, or spungy osseous substance, which forms the inside of each socket. .

The collar of the tooth, all round, is firmly connected to the

membrane of the gums, which, in this place, seems to unite with the periosteum above mentioned. _ The substance of the gums is compact, elastic, and in some measure resembling the texture of leather; it is fixed to the jaw bones by means of their periosteum ; it covers the whole alveolary border of both jaws; insinuates itself between the teeth; encompasses the collar of each, and is firmly connected with it. The gums, therefore, on the outer and inner sides of the teeth, are one continued piece, containing as many openings as there are teeth ; and the membrane which covers them seems to be a continuation of that which goes to the lips, cheeks, and tongue.

The teeth, considering their size, are plentifully supplied with nerves and blood-vessels, which enter through a small hole at the points of their roots, and after passing through a straight channel as far as the crown, are divided and diffused all over their substance: this hole lessens as we advance in years, and at last is totally obliterated. ,

The arteries proceed from the internal carotids, the veins return to the jugulars, and the nerves are branches of the fifth pair.

The nerves of the upper and lower gums are branches of the maxillaris superior and inferior, which come from the fifth pair ; they also receive branches from the portio dura of the auditory nerve, which inosculate with the former in a singular manner, and give rise to certain sympathetic affections related in the second part of this work.

‘The use of the gums is to support the teeth, to fill up their interstices to keep them firm, and to protect their roots from the injuries of external air, of the salivary liquor, and of acrid food.

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The number of the teeth varies in different periods of life, as shall be shown hereafter ; at present, we shall only consider them in their most perfect state.

After the dentes sapienti@ have appeared, there are sixteen teeth in each jaw, which are divided into three classes; the first including the four anterior teeth, called incisores or cutting teeth ; the second including the two next, one on each side, called canini or dog teeth ; and the third including the other ten, five on each side, named molares or grinders.

The incisors of the upper jaw are larger and broader than those of the lower; and of the upper ones, the two in the middle are the largest.

The roots of the incisors are long, pointed, and: single; the bodies are wedge-like, convex on the outer side, a little concave within, flatted on the sides, and so disposed that their sharp edges lie all in a line, making one uniform edge. e

The dentes canini, so called from their prominence and similitude to the teeth of dogs, and also eye-teeth, on account of their situation, stand on either side of the incisors. a

Their bodies are thicker, more prominent, pointed, and rounder on the outside, than those of the incisors; and their roots are thicker, longer, and more pointed. Sometimes they are so long as to perforate the bottom of the maxillary sinus. .

Of the dentes molares, or grinders, the two first in each row are small, the two next larger, as are the last also, called the wise-teeth.

Their bodies are generally short, very thick, irregularly cylindrical, or rather with four sides a little rounded, and terminated by a broad end, more or less filled with obtuse points, cut in some measure like so many diamonds; whence the name of crown is most frequently given to the bodies of the molares, because the resemblance is greater than in the others,

The crowns of the two small molares are often less than the bodies of the canini, and seldom have above two points, or three. at most.

In the two large molares the crown is of much greater extent, and the points are three, four, and often five in number.

The fifth grinder, or dens sapientize, has a crown much like the two former, but often more rounded and with fewer points. We sometimes find it, even in advanced age, wholly hid in its socket.

_ The roots of the molares are long, more or Jess flatted, single in some of them, in others two, three, or four, but rarely five in number. Sometimes all these roots are distinct, sometimes wholly united, and often united only in part. They are generally straight, and more distant from each other at the extremity than

- TREATISE ON THE TEETH.

at the neck of the tooth, because they taper to a point; but in some instances these points are bent inwards, outwards, and in other directions.

The roots of the small grinders often appear single, without being so in reality; for, on examining them narrowly, we find they have two roots united, or as it were soldered together. Sometimes the only distinction that appears consists in a slight separation at the point.

The great molares have several roots; in the upper jaw three or four, but in the lower jaw only two in general.

The fifth molaris, or dens sapientie, has often only one root, but more commonly two, which are conical and seldom long; thence it happens that this tooth is generally lost.in old age before any of the other grinders.

It appears then, that the grinding teeth of the upper jaw have more roots than those of the lower; and in mastication, or when the mouth is shut, the upper row, especially in the fore part, advances beyond and slides over the lower, instead of meeting it. In some people, however, they do meet, but seldom fail, in that case, to destroy each other, or to be worn down very early in life by their constant rubbing and pressure.

It is perhaps unnecessary to add, that the teeth serve for mastication, for the distinct articulation of sounds and for ornament.

CHAPTER IV. The Formation, Growth, and Shedding of the Teeth

In dissecting the alveolary arch of either jaw-bone, in infants newly born, we observe, in each socket, a collection of soft, white, glairy matter, contained in a small membranous sack, pierced on that side which corresponds with the bottom of the socket, by a nervous and vascular cord, whose vessels presently divide, and are branched all over the membrane and contained substance.

This is the tooth in embryo, whose future nourishment, growth, and ossification is to be derived from the matter conveyed by these vessels.

_ The first sprouting of the teeth through the gums happens sooner or later, according to the health or vigor of the child, and is called the first dentition.

It begins in the second, third, fourth, fifth, or sixth month after birth, is seldom finished before the second or third year, and proceeds in the following order, pretty nearly.

- Within the first three or six months, appears one of the front incisors of the lower jaw; then, after a little time, the other; a few months afterwards the great incisors of the upper jaw come

forth, both nearly at the same time; then come the two, lateral

incisors of the lower jaw, and the two small ones of the upper one,

in some little time after the other; then appear the two canini of

both jaws; and in some months more, or about the second year,

the small molares shoot forth successively: so that at the end of | the second year, in general, a child is furnished with ten teeth in

each jaw, which are called milk-teeth.

The second dentition is in the sixth or seventh year, or thereabouts, and produces the four first great dentes molares, one at either extremity of both jaws. ;

The third dentition happens in the tenth, twelfth, fourteenth, or fifteenth year, and furnishes four other great molarés, one close by each of the former. . a3

Finally, about the twentieth year, and in some people long after, comes the /ast dentition, which gives the four extreme — dentes molares, called dentes sapientie, from their coming after puberty. ce

It is to be observed, however, that this order varies considerably in different people and different constitutions. Instances are recorded of children born with their teeth already cut; others, particularly those who are ricketty, do not cut their teeth before the fifteenth month or later; and we-every day observe that the dentes sapientize in some people come very late, or never come at all. ‘Some have more than the ordinary number of teeth in one row, others have the supernumerary ones in a double row, or standing apart without any order, owing to a circumstance which we shall touch on hereafter.

The first twenty teeth, or milk-teeth mentioned above, generally last till the sixth or seventh year; after that, until the fourteenth or fifteenth year, they fall successively, and are succeeded by others, most commonly without any considerable pain, and almost in the same order which they observed in coming forth at first.

The shedding of the teeth is wisely intended, and brought about ina singular manner. Their extremely hard enamel, and the rigidity, of their bony substance, will not admit of distension and free growth, like other parts of the body. After an enlargement of the jaw-bone, the original teeth are no longer sufficient to fill up the extended alveolary space; they must stand single and unsupported by each other, and leave interstices remarkably hurtful to mastication, to speech, and the symmetry of the countenance ; the enamel also is not regenerated when once lost, and that coat, cn was given in infancy, would be too slender for the uses of ong life. se rieay?

Nature, therefore, has kindly placed under the milk-teeth the ea of another set, which, in due time, acquires a greater and solidity than the former, and by their constant pressure on the roots of the milk-teeth, rob them of their nourishment. ‘and hold, and finally push them entirely out of the sockets. _ Hence, in children of two or three years, we find ten grown teeth in each jaw, ten stamina under them, and also the stamina of the six molares which come forth afterwards. Before we conclude this part, I think it necessary to relate an observation, which, although unsupported by the evidence of any other writer, [am convinced is perfectly true, and applicable to ood purposes in practice; that is, the molares of the second tition are considerably smaller than the milk-molares to which bo have succeeded, notwithstanding the increased size of the jaw-bones ; therefore, what we have said above of the increased size of the teeth, applies only to the incisors and canini. —

PARE T:.. EI,

Of Diseases of the Teeth and Gums.

To treat minutely of all the diseases of the teeth, and to follow them through all the varieties and subdivisions which occur in practice, would alone furnish matter for a large volume, and the method would be equally tiresome and unprofitable to the reader.

I shall therefore rank them under general heads, placing together all those which agree pretty nearly in their general symptoms and indications of cure.

CHAPTER I. Of the Tooth-ache

Or all the diseases to which the human body is exposed, the tooth-ache is perhaps the most frequent, and the most commonly mistaken as to its-causes and methods of cure; because the disorders that give rise to it are extremely numerous; because they are not easily detected or traced; and because the people who are generally applied to on this occasion are very ignorant. For taking out the tooth, which the patient complains of, is their universal cure, without considering that the pain may often be removed by gentler methods, or that it may arise from disorders which never fail to be exasperated by such treatment, or that it may be owing to sympathy, which I have often observed to produce a sensation of exquisite pain in the sound tooth on one side, whilst a rotten one on the other was the sole cause. Nay, sometimes, a cariated tooth has produced violent pain in the corresponding one of the opposite jaw.

Indeed, the tooth-ache cannot be treated with any certainty of success, unless we trace the causes of it, and pay close attention to them in the cure; for, although in its progress it often becomes a violent disease, producing inflammations, restlessness at night, head-aches, glandular swellings, hysteric fits, delirium, abortions, fevers, and a variety of dangerous diseases; yet, in its rise, it is merely a symptom of disease in the teeth, gums, periosteum, or sockets, the removal of which will remove the tooth-ache of course.

._ Whether we consider it asa violent disease, or as a troublesome

ee" ity we are necessarily involved in the investigation and

removal of its causes, as much as in the pursuit of means to alleviate

or suppress the pain for the instant; and hence it happens that

the tooth-ache cannot be treated apart from the disorders which

usually produce it, without omitting what should be chiefly

insisted on, or without giving rise to endless repetitions, prolixity, and confusion.

7 We shall, therefore, in this place, only enumerate the various

disorders which occasion the tooth-ache, leaving the diagnestic

and curative part to be more fully considered under each head

respectively.

1. A tooth-ache often arises from defluxions falling on the gums, the neighboring periosteum, and bone, particularly after catching cold. 2. From obstruction or inflammation of the nerves and vascular parts of the tooth itself. 8. From purulent or acrid matter, generated in any of these parts, in consequence of inflammation, extravasation, or acrimony of the fluids. 4. From fungi, excrescences, and ulcers of the gums. 5. From a recess of the gums, occasioned by scorbutic, venereal, or putrid disorders, whereby the roots of the teeth are exposed to external air and injury. 6. From tartar of the teeth, extending itself along the roots, and injuring the gums. 7. From looseness of one or more teeth, occasioned by violence, loss of gums, salivation, or putrid disease. 8. From injudicious extraction, whereby the tooth is frequently broken low down, the gums are bruised and torn away,

the neighboring teeth exposed at their roots, the external side of _ the socket very often considerably injured, and splinters raised _ which produce lasting pains and inflammation. 9. From sudden alternations of heat and cold. 10. From sympathy with the neighboring affected parts. 11. From collections of matter form- ‘ed in the mazillary sinuses, and in the cancellated parts of the lower jaw. 12. From caries or exostosis of the bones which form the sockets. 13. From caries of the tooth itself. 14. From loss of enamel, whereby the sensible, irritable part of the tooth is exposed. 15. From a fracture of the tooth. 16. From dentition. 17. And lastly, from the affection called tooth-edge.

a nif: CHAPTER IL. ) Of Defluxions falling on the Gums, and the Tooth-ache arising lie: 2s therefrom.

_ Tux lentor of the fluids, the spasmodic affections of the solids, -and the tension and overcharge of the vessels which are observed to take place, in consequence of catching cold, are apt to generate obstructions and inflammation; and the tender parts which are most exposed to the influence of external air, generally suffer first. Hence, heaviness of the head, inflammation of the pituitary membrane, irritation and increased action of its glands, &c. hence, also, an uncommon tension and repletion of the vessels of the gums, periosteum, teeth, and neighboring glands, the increased flow of the saliva, and the sensation of pain on these occasions.

But those who have catched cold are not the only people that are subject to this disorder; for the same genera] causes, which produce extraordinary repletion and irritability in other parts, produce them here also; and it is observable that women who are not regular, and also women with child, are remarkably subject to a tooth-ache of this kind, for reasons easily deducible from what has been said above.

This sort of tooth-ache is distinguished from others, by observing that some of the general causes which we have just now mentioned have preceded ; that a sense of fullness in the gums, and an uneasiness about the sockets of several teeth, have been succeeded by an uncommon flow of saliva, and a swelling of the. gums, extending itself more or less to the muscles of the cheek and face, on the affected side; and lastly, that the pain is not confined so much to one tooth, as happens in other cases; or if it be that the tooth so affected appears perfectly sound. em

This tooth-ache is extremely common in the winter season, and the barbers are indebted to it, beyond all others, for the plentiful supply of beautiful sound teeth, which it furnishes to ornament their windows and signs withal. For the people, distracted with pain, run to the first barber-dentist’s shop that presents itself; and the operator instantly applies the universal cure, the instrument, without wasting time with observations and questions.

If this absurd practice were only attended with the loss of a sound tooth, it would not, perhaps, in the opinion of some people, deserve to be considered in a serious light; but that is not all. The extraction of a sound tooth, whilst the gums and periosteum are swelled and inflamed, is not performed without tearing and wounding them in such a manner as increases the evil, renews and exasperates the irritability, disposes the parts to inflammation, and uncovers the roots of the neighboring teeth, when they are most susceptible of pain, obstruction, and decay; and hence it appears that the loss of the neighboring teeth, which so constantly follows the extraction of a sound one, in defluxions, is occasioned by the operation, and not by any contagion, or communication of putrid matter, as pretended on these occasions.

The common method also of giving acrid, aromatic substances a won? eee a A i > ao A vo i i i ee A es ye We aa ee, ee . 4 : ¢ x 5 & to be chewed, such as ginger, galangal, Florentine orris root, cloves, allspice, mace, camphor, orange peel, peppermint leaves, caraway seeds, and many other stimulating applications, in various forms, is often productive of very dangerous consequences, notwithstanding the discharge which they occasion. For it is to be considered that the liquor of the salivary glands, and not the contents of the distended, obstructed vessels, comes forth on this occasion; and since there is no real direct evacuation of the latter, stimulating medicines, applied to the very seat of inflammation, to the distracted irritable fibres, must increase the repletion, tension, and pain.

' The true and rational method of cure is comprehended under four general indications:

1. To lessen the velocity, quantity, and inflammatory disposition of the blood. 2. To relax the affected parts by topical applications, and sometimes by scarifications. 3. To make a revulsion by means of irritation, and by discharge from a neighboring part. 4. And lastly, to lessen the sensibility of the pained parts by the use of external and internal sedatives.

1. The first indication is answered by bleeding and purging, and frequent repetitions of nitrous draughts.

_ 2. -The second, by keeping the mouth constantly moistened with emollient, attenuating liquors, such as decoction of marshmallows, comfrey, or satirion roots, or of columbine, or quince seeds, with a little nitre; by applying poultices of bread and milk to the affected cheek externally, and boiled or roasted figs internally, and also by scarification of the gums; but this last should only be practised when the inflammation is very violent, and where the obstruction has lasted so long as to leave no hopes of resolution.