A practical treatise on the human teeth: showing the causes of their destruction, and the means of their preservation

Preface

TO THE FIRST EDITION.

In tlie course of a long and extensive practice, my attention lias been often forcibly drawn to the great and too frequently irreparable mischief which has arisen from the want of a correct know¬ ledge on the subject of caries, or decay of the teeth. It is generally assumed, that the structure of the teeth is similar to that of the other parts of the body ; and consequently, that in the former as in the latter, the commencement of disease will necessarily be attended with pain, and that it will be time enough to apply for advice when pain has occurred. I have, however, in the pages of this treatise shown the fallacy and danger of this mode of viewing the subject, and pointed out the incura¬ ble mischief which will be its inevitable result. I have been anxious to remove another popular error, relative to the period of life when the teetb a

VI

PREFACE TO - are the most subject to caries ; 1 have, therefore, shown that in youth, the time when it is least sus¬ pected, the liability to caries is greatest, and that its approaches are then to he the most attentively guarded against.

The few works of authority hitherto published, on the diseases of the teeth, are almost exclusively intended for the instruction of the medical student ; and are necessarily, on that very account, but little adapted to afford information to the general reader. I trust that a careful perusal of the following pages will show how important it is that the latter, even more than the former, should possess an accurate knowledge of this subject. The evils resulting from a want of this knowledge may, in general terms, he considered of two kinds. In the first place, patients ignorant of the predisposing and exciting causes of caries, are not able to detect its presence until its destructive progress has placed the case beyond the means of remedy ; and, secondly, it renders a large portion of the commu¬ nity the dupes of a class of practitioners, who can only he designated by their proper title of charla¬ tans, and whose absurd pretensions and promises of relief might well he thought too extravagant for

THE FIRST EDITION.

vii

the present age, if the instances of mischief pro¬ duced by their nostrums were not so numerous.

As one of my objects, indeed the chief one, has been to make the 11011-professional reader ac¬ quainted with the nature and progress of caries, and with the preventive and remedial measures which it is necessary to adopt, I have entered no farther into the consideration of the anatomical structure of the teeth and of the parts connected with them, than appeared to me absolutely neces¬ sary in order to make that part of the subject, which is by far the most important, clear and in¬ telligible ; and this course I have pursued without hesitation, since the works of Hunter, Fox, and Bell, will furnish the most ample information on anatomical details, to those whose tastes or pur¬ suits would lead them to enter more deeply into this inquiry.

The theories hitherto brought forward to explain the origin and progress of caries, and which have possessed most weight and influence both with the profession and with the public, I have considered it right to submit to a free though not uncourteous criticism ; because they arc not only inadequate to explain the phenomena of caries, but are essen-

a 2 viii

Preface To The First Edition

dally fallacious, and have a tendency to lead their readers, in imaginary security, to wait till pain lias been produced.

The theory, however, which I have advanced explains all the phenomena of caries, and accounts for all those circumstances which previous authors regarded as inexplicable anomalies. It is strictly the legitimate deduction from facts which every person can examine for himself ; and it possesses this advantage over the explanations hitherto given, that it shows how caries may, in a great majority of cases, he altogether prevented. It explains to us the reason why a tooth cannot he saved after decay has arrived at a certain stage ; and teaches us how to detect the mischief at its early commencement, to arrest its progress, and to prevent its recurrence.

Preface To The Second Edition

l\

PREFACE

TO THE SECOND EDITION.

The former edition of this work appeared in 1835. The subject was not laid before the public without mature consideration. The opinions then advanced were necessarily in direct opposition to the most popular treatises upon the diseases of the teeth ; but they were grounded upon facts col¬ lected during sixteen years of extensive practice and minute observation, — facts which I felt per¬ suaded could not he contradicted. Subsequent experience has produced no change in my former views. The numerous cases which have come under my notice since the first edition was pub¬ lished, have only confirmed my previous state¬ ments, and afforded me an opportunity of furnish¬ ing the reader with additional facts in support of their truth and importance.

X

PI1KFACE TO

Tlic second edition is considerably enlarged, and differently arranged from the former one. It is divided into two parts, and subdivided into chapters ; a mode of arrangement, perhaps, better adapted for the general reader, and more convenient for the purpose of reference.

In the first division of the work, I have proved from facts connected with the character of caries of the teeth, that decay in these organs is the result of chemical, and not of inflammatory action, as it has hitherto been supposed.

The great error into which the most popular writers upon the diseases of the teeth have fallen, and from which many other mistakes have origin¬ ated, is, their having overlooked the peculiarity of their structure and organization. They have assumed that the structure of the teeth is similar to that of the other parts of the body, and have naturally enough concluded that the excitingcause of disease in the former is the same as in the latter. The public have, therefore, been led to believe that decay of the teeth is the result of inflammatory action, originating in the internal structure of the tooth, either in the membrane or in the bony substance of the organ, and that the

THE SECOND EDITION.

commencement of decay must necessarily be at¬ tended with pain ; — and so it would, if inflam¬ mation were the exciting cause of caries. lu consequence of these misconceptions, the teeth, in the absence of pain, are neglected, because they are supposed to he in a sound and healthy condi¬ tion ; and ^The dentist is scarcely j ever consulted before pain has been experienced, and the evil has become irremediable. This is the svstem which

t /

lias constantly been acted upon; and it is from the want of a correct knowledge of the character of caries, and its exciting cause, that all the evil originates*. _

I have, however, shown that the teeth are differently constituted from the other parts of the body ; that they are neither formed after the same manner, nor governed by the same laws ; that the enamel and bone of the teeth are, strictly speak¬ ing, inorganic substances ; and that their destruc¬ tion is effected by chemical and not by inflamma¬ tory-action. I have proved, from the partiality of caries in attacking particular teeth, and particular parts of them ; — from decay never commencing upon the plain and smooth surfaces of the teeth, but always in pits, Assures, and interstices, pro-

XII

PREFACE TO tluced by the irregular structure and arrangement of these organs, where the food is retained, and undergoes decomposition ; — from these facts I have proved that decay of the teeth is the result of chemical action. Also from the greater frequency of decay in youth than in the after periods of life ;

— from the liability of the teeth to decay in pairs ;

— from the hereditary predisposition to it often observed in the teeth of different families ; — from the absence of pain so long as decay is confined to the enamel and bone ; — from caries always com¬ mencing upon the surfaces of the teeth, and never internally ; — from the fangs of the teeth being entirely exempted from caries, so long as they are embedded in their sockets, and protected from the influence of external agency ; — from the circum¬ stance of decay attacking artificial teeth in a simi¬ lar manner, as it does those naturally connected with their sockets ; — from the teeth of the lower animals being almost in every instance exempted from caries ; — from the nature and success of the operations performed in dental surgery, such as permanently arresting the progress of decay by filling and filing the teeth ; — from these and various other circumstances connected with the

THE SECOND EDITION.

Xlll character of caries of the teeth, I have proved that the theory which I have advanced must be correct, and that those grounded upon inflam¬ matory action must be fallacious. A correct view of the cause of the destruction of the teeth, has necessarily led to a different mode of treatment from that formerly adopted for their preservation. I have accordingly, in the second part of the work, laid down rules for the general management of the teeth, which, if acted upon, will, I feel per¬ suaded, be the means of preserving these organs in ninety-nine cases out of a hundred where they are now lost.

It has been my endeavour, as much as possible, to avoid the use of technical terms, and to convey my ideas in familiar language ; and, if I have succeeded in making myself clearly understood, and in convincing the public of the necessity o( having recourse to the means which 1 have recom¬ mended, much inconvenience and suffering will be prevented, and my object will be fully attained.

Old Square, Birmingham, b

PART I. Page

Object of the treatise . . . . . . . . . . . . .. ib.

The teeth more subject to disease than any of the other parts of

The investigation of the diseases of the teeth of very recent date.

Mr. John Hunter the first writer of eminence on the subject . . 2

Succeeding authors, Mr. Fox and Mr. Bell .. .. .. 3

Mistaken notions advanced on the cause of caries, or decay of the teeth ; their effects upon the public ; importance of a correct knowledge upon the subject .. .. .. .. .. 4

Chapter I

BRIEF DESCRIPTION OF THE STRUCTURE, ORGAN¬ IZATION, AND ARRANGEMENT, OF THE TEETH 7

CHAPTER IE

THEORIES OF CARIES ADVANCED BY MR. FOX AND

MR. BELL . 9

Arguments against these theories . . . . . . . . . . 12

b 2

XVI

CONTENTS.

CHAPTER III. Tage

PROOFS THAT THE DESTRUCTION OF THE TEETH IS THE RESULT OF CHEMICAL AND NOT OF INFLAMMATORY ACTION, AS ERRONEOUSLY SUP¬ POSED . 17

The bone and enamel of (lie teeth differently constituted from the

other parts of the body . . . . . . . . . . ib.

Misconceptions which have arisen from overlooking the peculiar structure of the teeth. Caries, mortification, etc., terms not applicable to that process which effects the destruction of the teeth . . . . . . . . . . . . . . ..18

Notice and explanation of the pits and fissures formed in the structure of the enamel, and the mischief which results from their harbouring the food . . . . . . . . . . 19

The structure of the enamel completed before the tooth appears

above the gum; the enamel undergoes no after- change .. 21

Rone of the teeth ; its mode of formation ; its resemblance, in this respect, to inorganic bodies ; formed by depositions of layers, not like unto other bones, by depositions taking place from circumference to centre . . . . . . . . . . 22

Sole office of the internal membrane of the tooth to secrete new

boue, not to nourish that which has been already formed . . 24

Chapter IV

THE DISPOSING CAUSES OF CARIES TO BE DIS¬ COVERED IN THE EXTERNAL FORM, CONFIGURA¬ TION, AND JUXTA POSITION OF THE TEETH .. 27

Parts of the teeth where decay commences pointed out. Partiality

of caries in attacking particular classes of teeth explained ib.

The molar teeth the most subject to decay : The cause of this explained

CONTENTS.

XV1L l’iigo.

Tlie bicuspides the next in liability, and after them the incisorcs

Why the incisores of the lower jaw are less liable to decay than any

of the other teeth . . . . . . . . . . . . 30

Explanation why the wisdom teeth are more subject to decay than

any of the other teeth . . . . . . . . . . . . 31

Summary of evidence which proves that the destruction of the teeth is effected by the corrosive or chemical action of the solid particles of the food, which have been retained, and have under¬ gone a process of putrefaction or fermentation, in the several parts of the teeth best adapted for their reception . . . . 32

Chapter V

LIABILITY OF THE TEETH TO DECAY IN PAIRS— THE RARE OCCURRENCE OF DECAY OF THE TEETH IN THE AFTER PERIODS OF LTFE, AS COMPARED WITH ITS FREQUENCY IN YOUTH— THE GREAT SUSCEPTIBILITY TO CARIES IN THE TEETH OF PARTICULAR FAMILIES— THESE FACTS ACCOUNTED FOR AND EXPLAINED .. 34

The above facts noticed by Mr. Hunter, but not explained . . ib.

Explanation why the teeth are more liable to decay in youth than

in the after periods of life .. .. .. .. ..37

Great susceptibility to caries in the teeth of particular families : The

cause of this explained . . . . . . . . . . 39

Mr. Hunter, in his inquiry into the origin of caries of the teeth, is shown to have approached nearer to its primary seat and nature than either Mr. Fox or Mr. Bell .. .. ..41

Chapter VI

DESCRIPTION OF THE PROGRESS OF CARIES THROUGH ITS DIFFERENT STAGES TO THE PERIOD WHEN TOOTHACHE IS PRODUCED .. 45

XVlll

CONTENTS.

Page.

Notice of the insidious character of caries .. .. 47

Evils which result from the want of a correct knowledge of the

cause and progress of decay of the teeth . . . . . . 48

Mischievous consequences of neglecting the teeth in the absence of

Chapter VII

THE NATURE OF THE OPERATIONS WHICH ARE PERFORMED UPON THE TEETH, AND WHICH ARE ATTENDED WITH SO MUCH SUCCESS IN PRESERVING THEM, ARE STRONG PROOFS THAT THEIR DESTRUCTION TS THE RESULT OF CHE

MICAL ACTION . 51

Decay in hones a rare occurrence compared with its frequency in

Comparison between the teeth and other bones: The parts of the body the most highly organized the most subject to inflam¬ mation : The bone of the teeth, (according to Mr. Bell,) of the lowest grade of organization, and ought to be the least subject to decay . . . . . . . . . . . . . . . . 52

Inflammation of the internal membrane of the tooth the result of previous decay of the tooth, not the cause of it, as has been supposed: No instance to be found of inflammation of the internal membrane in the absence of decay . . . . . . ib.

Inflammation of the periosteum of the tooth a common occurrence:

This not to be mistaken for, or confounded with, inflammation of the internal membrane . . . . . . . . . . 53

Difficulties insurmountable to be encountered by authors who have founded their theories of decay of the teeth upon inflam¬ matory action . . . . . . . . . . . . . . ib.

Conclusive proofs that decay does not commence within the tooth, but externally, and is the result of chemical action

CONTENTS.

XIX

Page.

Decay permanently arrested by tilling up the cavity, a proof of the

The progress of caries permanently arrested by filing out the decayed portion, and by giving a plain and smooth surface to the side of the tooth, another proof that decay is the result of chemical action . . . . . . . . . . . . 57

Inconsistency of individuals who suppose caries of the teeth to be the result of inflammatory action having recourse to the opera¬ tions of filling and filing as the means of arresting decay of the teeth. The system which they ought to adopt to be consistent . . . . . . . . . . . . . . . . ib.

Inorganic nature of the bone of the teeth illustrated by the occur¬ rence of caries in them after they have been removed and attached to a gold plate and fixed artificially in the mouth, or when ingrafted upon fangs naturally attached to their sockets 59 The various circumstances connected with caries of the teeth capable of being explained in conformity with the theory advanced . . . . . . . . . . . . . . 60

Chapter VIII

WHY THE HUMAN TEETH ARE SO LIABLE TO DECAY, AND THE TEETH OF THE LOWER ANIMALS ALMOST TN EVERY INSTANCE EX¬ EMPTED FROM IT . 62

The teeth of apes and monkeys, which bear the greatest resemblance to the teeth of man, not subject to decay : The cause of this exemption .. .. .. .. .. .. .. ib.

The teeth of our common domesticated animals, the horse, cow,

sheep, etc., likewise exempted from caries . . . . . . 64

The teeth of the human race who live in a state of nature, not so

subject to decay as the teeth of those who live an artificial life 65 Not the solid fibres of food retained in the interstices of the teeth,

XX

CONTENTS.

Tage.

and which excite irritation in the gums, the cause of caries; hut tlie portions which have undergone decomposition, and a fiord no evidence of their presence . . . . . . 66

Remarks on the artificial state of man, and the evils to which he is

The cause of irregularity in the arrangement of the teeth hinted at 70 A defective deposit and an irregular distribution of the enamel upon the teeth, traced to a deranged state of the health during infancy, the period when the teeth are being formed , . 71

Chapter IX

THE BONE OF THE TEETH; ITS INORGANIC NATURE 73 Opinion of Mr. Lawrence on this subject .. . . . . . . 74

Facts connected with the character of caries of the teeth, in direct

opposition to Mr. Bell’s theory of inflammatory action . . 77

Mr. Hunter's experiments to show the inorganic nature of the bone

Evidence of the inorganic nature of the teeth, from the office which

they are destined to perform . . . . . . . . SO

Chapter I

RULES FOR THE MANAGEMENT OF THE TEMPO¬ RARY TEETH, AND FOR REGULATING THE

PERMANENT ONES . 83

Importance of preserving the temporary teeth until the permanent ones are ready to appear ; means to be employed for this purpose

CONTEXTS.

XXI

Page.

Form of tire jaw bones at the period when the temporary teeth are

Change which takes place in the formation of the jaws, to make

room for the permanent set of teeth . . . . . . . . 86

Formation of the maxillary arch ; in different individuals exceed¬ ingly various . . . . . . . . . . . . . . 87

The temporary teeth to be removed to make room for the permanent

The permanent teeth which ought to be removed when the set is

crowded. The evil which results from removing the cuspidati 89 Projection of the lower part of the face occasioned by the upper front teeth closing within the lower ones. How to remedy this deformity . . . • . . . . . . . . . . . . 90

Chapter II

THE MEANS WHICH ARE TO BE EMPLOYED FOR PREVENTING DECAY IN THE PERMANENT TEETH. FILLING TO BE HAD RECOURSE TO FOR THE PURPOSE OF PERMANENTLY ARRESTING CARIES

OF THE TEETH . 92

Decay of the teeth most frequent in the early periods of life, and its progress the most rapid in effecting their destruction: The cause of this explained . . . . . . . . . . 93

Importance of keeping the teeth clean. The most effectual method of

removing particles of food from the pits and interstices of the teeth 9-1 The bone of the tooth, that portion of it (the fang) which is imbed¬ ded in the socket, and protected from the influence of foreign bodies, exempted from caries, a proof that decay of the teeth is the result of chemical and not of inflammatory action . . 96

Necessity for early and constant watchfulness of the teeth . . 97

The object and advantages proposed by the system of constant

C xxu

CONTENTS.

Page.

watchfulness and regular inspection of tlie teetli. Explanation of the object and principle of stopping and tiling the teeth . . 98

Stage of caries the most favourable for stopping the teeth . . 99

The mode in which this operation ought to be performed . . . . 101

Explanation why a tooth often requires filling in more places than

Injudicious mode of filling the teeth by inexperienced practitioners,

and the mischief which it occasions .. .. .. ..101

Stage of caries when filling is no longer practicable . . . . 105

Chapter III

FILING THE TEETH. THE ADVANTAGES WHICH

RESULT FROM THIS OPERATION . 107

Prejudices against filing the teeth refuted .. .. 108

Advantages of having recourse to this operation in the early stages

Mistaken notions advanced regarding the true nature of caries, have

led to premature treatment in filing the teeth . . . . 112

Unpleasant sensation, sometimes a painful one, produced by filing the teeth accounted for, without supposing (as some persons would have it) the bone of the tooth to be an organized substance . . . . . . . . . . . . . . ..114

A correct knowledge of the nature and character of caries of the teeth, shown to be necessary for the successful performance of the operations of filling and filing .. .. .. .. llfi

Chapter IV. Stage Of Caries When It Becomes Necessary

TO EXTRACT THE TEETH . 122

Explanation why the internal membrane of a tooth, in a state of inflammation, produces more acute pain than the other parts of the body in a similar state . . . . . . . . 123

CONTENTS.

-Will

Page

The destruction of the teeth occasionally affected in the absence of

Great uncertainty of success from stopping a tooth after the internal

membrane becomes exposed ; the cause of this explained . . ib. The grafting of an artificial tooth upon a fang, how it sometimes

produces inflammation of the periosteum . . . . . . 125

False and delusive promises to cure toothache held out by the

The art of extracting a tooth with the least possible degree of suffer¬ ing to the patient ; how it is to be acquired . . . . . . 130

Defects of the instruments in general use .. .. .. 131

An improved instrument for extracting the teeth . . . . . . 132

Chapter V

BAD EFFECTS WHICH RESULT FROM RETAINING DISEASED TEETH, WHICH ARE BEYOND THE

POWER OF REMEDIAL MEASURES . 134

Exfoliation of large portions of the alveolar process occasioned by diseased teeth. Abscesses externally at the underedge and angle of the jaw arising from diseased teeth . . . . 186

Mistaken prejudice that injury is sustained by the removal of a

tooth before inflammation has subsided .. .. .. ..137

Important that the physician and surgeon should be acquainted with the cause of the destruction of tho teeth, and the nature of their diseases. Pain proceeding from the teeth often con¬ founded with and mistaken for other complaints . . . . 138

Many supposed cases of tic douloureux ; few genuine ones; the pain

generally found to proceed from the teeth . . . . ..139

Effect of the imagination in procuring temporary relief from tooth¬ ache. The judgment of the patient not to be relied upon in selecting the tooth from which the pain proceeds; a case in point . . . . . . . . . . , . , , . . I 10

c 2

XXIV

CONTENTS.

Page.

How a tooth which occasions pain may be detected . . . . . . 143

Popular mistake, that the greater the destruction of the tooth by

caries, the more likely to produce pain .. .. .. 145

Stage of caries when the pain is most acute .. .. .. ..146

Supposition, that the extraction of a carious tooth occasions injury

to the remaining teeth, examined and refuted . . . . 147

Chapter VI

LOSS OF THE TEETH FROM TARTAR, AND FROM INFLAMMATION OF THE PERIOSTEUM .. ..151

A healthy state ef the gums necessary for the preservation of the

The connexion and sympathy which exists between the gums, the

sockets, and the periosteum . . . . . . . . ..152

The mischief which is occasioned by neglecting to keep the gums

in a healthy condition . . . . . . . . . . . . ib.

Loss of the teeth from inflammation of the periosteum . . . . 153

Loss of the teeth from absorption of the gums . . . . . . 154

Tartar and its effects upon the teeth . . . . . . . . .. ib.

The parts where the deposit first takes place, and how it accumulates 155 Application of acids to the teeth reprobated . . . . . . 157

Effect of acids upon the teeth . . . . . . . . . . . . 158

Tartar to be removed from the teeth . . . . . . . . ib.

Treatment necessary to preserve the gums in a healthy condition, and to prevent tartar from accumulating. Mistaken notion regarding the treatment of the gums . . . . . . ..159

Prejudices against the removal of tartar from the teeth traced to the

untimely performance of the operation .. .. .. 161

General remarks as to the cause of the loss of the teeth . . . . 163

Chapter VII

POPULAR BUT ERRONEOUS NOTIONS CONCERNING THE CAUSE OF THE DESTRUCTION- OF THE

CONTENTS.

XXV

Page.

TEETH ALLUDED TO, FOR THE PURPOSE OF

CORRECTION . 165

Great error into which the most popular writers upon the diseases of

the teeth have fallen .. .. .. .. .. .. ib.

Erroneous supposition that the teeth continue to grow after they

have appeared. Circumstances which have led to this mistake 166 The destruction of the teeth not attributable to bodily indisposition,

as is generally supposed .. .. .. .. .. ..167

Why the teeth become carious at different periods of life . . 168

Supposition that the teeth are of a brittle nature, and liable to be broken in masticating the more solid kinds of our food, examined and refuted. The cause of the apparently sudden fracture of a tooth explained .. .. .. .. .. .. ..170

Mistaken notion that sweetmeats occasion decay of the teeth . . 172

Decay of the teeth often supposed to be the result of mercurial

medicine. Facts which prove this notion to be incorrect .. 173 The bone of the teeth not subject to mercurial action, a proof that

it is not liable to inflammatory action . . . . . . 174

Remarks upon the erroneous notions generally entertained regarding the teeth, and the evils which result from the want of a correct knowledge of the subject .. .. .. .. ..175

Chapter VIII

A FEW BRIEF HINTS ON THE GENERAL MANAGE¬ MENT OF THE TEETH . 178

The coming through of the temporary teeth, the most critical and

dangerous state of a child’s existence: Treatment to be adopted 179 First set of teeth when completed : Treatment necessary for preserv¬ ing them .. .. .. .. .. .. 181

The period of life when the teeth require the greatest attention.

The shedding of the teeth. The treatment necessary to insure the regular arrangement of the permanent teeth . . . . 182

XXVI

CONTENTS.

Page.

Treatment necessary for the preservation of tire permanent teeth . . 187 Necessity for persons making themselves familiar with the form and

arrangement of their teeth .. .. .. .. .. 191

Difficulty of impressing upon the minds of people the necessity of

attention to the teeth in the absence of pain . . . . . . 192

Part The First. A Practical Treatise

ON

THE HUMAN TEETH.

INTRODUCTORY REMARKS.

The object of the present work, is to make the general reader acquainted with the insidious nature of the diseases to which the teeth are liable, to explain to him their causes and progress, and to show that a knowledge of these is absolutely necessary, either, by early attention, entirely to prevent their occurrence, or, by timely application, to counteract the mischief before it has become irremediable.

It may be safely asserted, that none of the organs of the human body are so often the subjects of disease as the teeth ; none, the diseases of which are so little understood, and yet, when rightly comprehended, none, more completely under individual control. When we reflect how few persons there are who have not experienced some of the ill effects of diseased teeth,