A practical guide to the management of the teeth ...

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Contents

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Dedication . ..... iii

Introduction 3

Preface

In submitting the following sheets to the attention of the Public, the Author feels it necessary to apologize for occasional inaccuracies of style \ which the circumstance of his being a foreigner, combined with his anxious desire and impatience to make known some important discoveries, has rendered it as difficult for him to avoid, as it has afforded him but little leisure to correct.

The teefrh, it is well known, are organs most important to the animal economy. Their use in conveying distinct articulation, in ministering to the comfort, or promoting the health, of the individual, is too obvious to be insisted on. Suffice it to observe, that when, from disease or accident, impediments arise to the discharge of their proper functions, calamities most mischievous to the

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PREFACE.

system ensue : every medical man knowing that imperfect mastication is a fruitful cause of many disorders the most distressing, dangerous, and even fatal to the human frame. Numerous have been the publications of able and skilful men, who have preceded the Author in this path of science. It is however melancholy to reflect how little that is really useful, has accrued from their labours. Experience evinces that all their instructions are but ill adapted to answer the intended purpose. Diseased gums, offensive breath, deficient and decayed teeth, are still objects of public notoriety. Conscious therefore how much remained to be accomplished, in every thing relating to the management of the teeth, the Author was induced to direct his attention very early to the subject: and the result of many years close application and study, has been attended by a discovery the most important that has yet been made in this branch

[PREFACE.

of physiology. Regulating his practice by the principles of his own system, he has now the pleasure of announcing to the public, the signal success that has marked his professional career in various parts of the world, and more particularly in this metropolis. Testimonies, as numerous as they are highly respectable, will satisfy the most incredulous, that these are not the pretensions of an empyric, and will convince those desirous of placing themselves under his care, of the decided superiority of his mode of treatment in every possible case of diseased dentition, and under every variety of age, constitution, and habit of his patients. He also undertakes to initiate the youth of both sexes, without any laborious process, in the dental art, so as to enable them to preserve these important organs in a perfectly sound and healthful state, to the most protracted period of life.

PHEFACE.

Wherever, in the following work, the Author has ventured to criticise either the opinions or practice of his predecessors, he can truly say, he has been influenced by no other motives, than a wish to promote the improvement of an art but too little studied, and to excite the attention of the public, and the minds of professional men in particular, to its importance. Where their sentiments appeared founded on just observation, he has willingly adopted them, and in doing so, he has not scrupled occasionally to borrow their language. Should what he has written, have the effect of rescuing only one individual from the sufferings incident to a neglect of the teeth, lie will not regret the time the present publication has cost him.

Buckingham Street, Melphi.

DESCRIPTION OF THE PLATE.

Figure 1. Rabbit Mouth.

2. Toothless Mouth.

3. Projecting Chin.

4. Mouth, without any deformity.

Number 5. Mouth, expanded to shew all the teeth.

No. 1. 1. Front Incisores, *)

V or Cutting* Teeth,

2. 2. Lateral Incisores, J

3. 3. Cuapidati, Canine, or Eye Teeth.

4. 4. 4. 4. Two pair of Bicuspides, or small Grinders. 5. 5. 5. 5. Molares, or large Grinders.

6. 6. Denies Sapientix, or Wisdom Teeth,

Introduction

THE division of surgery into various branches, has, in a particular manner, served to promote the advancement of the science, and thereby been productive of the happiest benefits to society.

In examining the progress of the improvements in its different branches, it is to be observed with regret, that the Dental Art has not kept pace with many others of less real utility. One cause of this slow progress of dental science is, that the subject has not hitherto been considered as forming an essential part of professional education. Hence, the practice of it has generally been considered in no higher light than a mecha-

IV nical occupation or trade. A great improvement of this department of surgery, will depend on pointing out to society the importance of preventing diseases of the Teeth ; and their connexion, in almost every instance, with the general state of the health, and preservation of the system.

Nothing can tend so much to accomplish this object, as an institution for the exclusive promotion of dentalogical science. The wants of society, as well as the disposition of the present enlightened period, so favourable to the universal diffusion of knowledge, demand such an institution; and such, we flatter ourselves, we are authorised shortly to anticipate, when this noble art will be rescued from that degraded state in which it has long remained in the hands of ignorant practitioners, or mercenary pretenders, who have in a great degree made it a monopoly. Within these few years, it must be admitted, that some attempts have been made at improvement; and the publication of the late Mr. Fox, joined with his regular course of •lectures on this branch of physiology, has done more for its promotion than the labours of any other individual, though occasionally some important errors occur, which it will be one object of the present treatise to notice and correct.

When we advert to the progress of medical and surgical science, during the last few years, we are struck with the rapid and beneficial changes which have taken place.

Medicine is now built on experimental science, and conducted by those enlightened principles which are the fruits of liberal education, and the peculiar spirit of the present times. The consequence of this has been, that the prejudices of the nurse, the mysteries of the empyric, and the pedantry of the schools, are completely done away.

In surgery, the same fortunate improvement is conspicuous ; the complicated practice of former times now yields to a mild and natural proceeding: and such is the advancement of this branch, that operations are daily performed of that bold and decisive nature, that at a former period, would

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VI have been deemed impracticable, and beyond the power of art to accomplish.

This general state of improvement in surgery gives great encouragement to the extention of the dental art. — Were mankind sufficiently acquainted with the many diseases and painful afflictions which originate from want of attention to cleanliness of the mouth; and were they convinced, that, from this cause alone, numbers drag out a life of distress, they would feel a greater curiosity, and take a more lively interest in obtaining information respecting an art, which the considerations of appearance, comfort, and health, render so essential. That such an interest has not been felt is the more astonishing, since we cannot but observe how anxiously solicitous the mind daily discovers itself to be on subjects of less importance* Indeed, mankind, in general, are not sufficiently impressed with the utility of improvements, till their own feelings convince them of their necessity. In the present instance, the truth of this observation is but too obvious; for, in most cases, it is either the loss

VIJ of Teeth, or the sensation of pain that induces people to pay attention to cleanliness of the mouth.

Though, at every time of life, an attention to the teeth is necessary, for their appearance and preservation ; yet there are certain critical periods at which we are irresistibly led to the contemplation of the subject. — Infancy is one of them: when the teeth successively appear, the constitution of the child suffers from their protrusive power, and a general irritative action pervades the system; the sleep is disturbed, the appetite suffers, the bowels are deranged, the muscular flesh decays, and marks of universal sympathy affect every part. The anxious day and watchful night then give importance, in the opinion of mothers and female attendants, to this part of the human structure; and it is then that the greatest mortality of infancy occurs. It is computed, that no less than one-fourth of the human race die under two years of age, and it is clearly connected with this source; for the enlarged state of the nervous and vascular system gives a predisposition, at this

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dawn of life* to inflammation and disease from the slightest causes. The next period that calls the attention to the teeth, is the time of shedding the temporary set. The habit now more firm, does not suffer the same general uneasiness as at the former period: but the process of nature, often imperfectly performed in the removal of the original set. requires to be assisted, in order to prevent that local deformity or disfiguration of countenance and features, winch is well known to arise from tins cause. Hence, this is a period to be earnestly watched bj parents and guardians, especially when entrusted with the care of females, if personal advantages are to be studied and a pleasing exterior preserved. The last period of particular attention to the teeth is, when they begin to decay; for not only do they give exquisite pain, as the feeling of tooth-ache convinces, but the cause which moulders them away, like other species of gangrene, affects the contiguous parts, taints the breath, and causes the fetor of the mouth to be disagreeablej even to the individual himself. Thus

IX daily experience proves, that the teeth are generally the subject of pain and disease; and the question to be considered is. whether this state be naturally entailed upon them, or results from our own imprudence and neglect.

From the moment that the teeth have protruded, and appear in their proper situation, they are liable to be acted upon by every article of aliment that remains upon them : to protect them against this action, they are covered with an exterior coat, termed the Cortejc Striatas, or enamel, different from other bone, and the structure of which constitutes their ornament as well as their defence. — While a strict attention is paid to cleanliness of the mouth, this enamel will be a sufficient protection against the operations of every external cause.

The teeth of the savage are generally sound and regular, and no accumulation forms to deface them. But this is different in civilized society; refinements in the culinary art give the food a greater tendency to acquire noxious powers, and form chemical combination.

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This is displayed by the formation of that extraneous matter, called tartar, which, as it accumulates, seperates the teeth from their chief support, the investing membrane of the gums, and thus loosening them in their sockets, exposes them, and produces inflammation.

But a more active cause of the premature loss of the teeth, is the accumulation or lodgment of food in their interstices. There the putrefactive process commences, acts upon the enamel and penetrates to the bone.* In this way the tooth becomes gradually destroyed, and the individual suffers successive inflammation and pain for a time, till this active monitor, that leads to attention in all

* The Author is aware, that most of his predecessors who have written on this subject, and among the rest, the celebrated Mr. Fox, have given a different Theory of Caries, supposing that it commences in the internal part of the tooth, and at length extends its ravages to the enamel.

For further information, however, on this subject^ the reader is referred to the chapter ,on Caries.

cases, speaks in a language not to be misunderstood, tlie mischief of neglect.

If cleanliness be essential to other parts of the body, it is peculiarly necessary with respect to the mouth, through which is the opening for carrying on the two great processes essential to continuance of animal life: the process of digestion, which gives nourishment and support to the system ; and the process of breathing, which conveys a principle from the air connected with vitality. If, then, the food, from uncleaniiness of the mouth, be tainted in the preparatory step of mastication, the process of digestion must introduce into the system a tainted chyle, pregnant with the seeds of putrefaction : if the air inhaled receive the same impregnation* which is the opinion of some of the most skilful of the faculty, it cannot animate the body or give vital energy in a proper degree. These effects, which are independent of its injury to the teeth, have never been sufficiently appreciated. Thus, in all cases of unclean teeth, a putrid matter is daily passing into the body, and acting as a slow and unseen xn

poison for months and years, on every part of the frame. When this is reflected on, can there be a stronger inducement to clean the teeth in a regular and proper manner, as a preventive of general disease ?

The more we examine the structure of the human body, however varied and multiplied its parts, the more we are struck with the intimate connexion of each part with the whole. Numerous as they are, to each is assigned some peculiar and needful office, and in a healthy state, the most perfect harmony subsists between them ; no one obstructs, but each assists, the operation of the other, and thus promotes the ultimate preservation of the whole. By this wise adjustment, there is no schism in the body, no separate or interfering ends are pursued by the multiplicity of members, but the safety and support of each are the undivided care of all. Hence, in this view, there is no part of the frame that is not of importance, however trifling or insignificant it may appear ; the most vital, as well as those on which the lesser energies

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of the system depend, are equally essential to life and its comforts.

On these considerations, the teeth certainly claim an important rank in the human structure: for —

1st. On them depends the proper expression of the countenance. By their removal the character and symmetry of the face is lost, and beauty is thus deprived of its chief attraction. The celebrated Lavater has paid particular attention to this subject in his work, and pointed out their effect and importance in delineating the features of the mind. From this effect on the features they call for more particular attention on the part of females ; for (to use a quaint expression) no woman can be beautiful " in spite of her teeth y- and when the mouth is deprived of this ornament, the countenance loses its principal charm.

2ndly. To the teeth also is assigned the chief power of enunciation. If the great and pre-eminent prerogative of man is the possession of speech, that speech can never be complete or perfect, without the teeth to mo-

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dulate the sound, and give proper utterance to the words. Hence, when the teeth are lost, the speech becomes imperfect and scarcely understood. This circumstance gives them additional value, particularly to a man in public life 5 and the preservation of the teeth ought to be one of the first objects to those who wish to shine either in the senate, at the bar, or in the pulpit. Without these instruments of utterance, the graces of their eloquence are lost, and the power of affecting the mind and convincing the understanding, if n6t taken away, is considerably diminished.

3dly. It is the loss of this part of the structure, that produces the leading mark of age, and occasions the contracted countenance, the wrinkles of the face, and those unseemly changes which youth and beauty ever wish to see placed at a distance.

4thly. When the teeth are neglected, they frequently assume a preternatural growth, which produces a disagreeable change on the countenance ; and this, of itself, should be a sufficient inducement to their frequent in-

XV spection, where external appearance is considered of any importance.

Jthly. But the most dangerous effect of neglect of the teeth, and their consequent Joss, is the imperfect mastication of the food, which occasions indigestion, and a variety of disorders depending on this cause. In order to a proper digestion, it is necessary that the food be sufficiently comminuted by the action of the teeth, while, during this action* it becomes blended with a certain quantity of saliva; thus' rendering its solution easier when it descends into the stomach to be mixed with the gastric juice. Where the teeth are wanting, the food can neither be properly divided or broken down, nor a due quantity of saliva elicited from the glands, to render its solution in the stomach complete for forming it into perfect chyle.

6thly, A disagreeable, though not a dangerous, effect from the neglect of the teeth. is an offensive breath : this fact is susceptible of demonstration by positive experiments, one is, that the breath, which is exhaled by the nostrils, is widely different from

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that which ia expired through the mouth of a person with diseased teeth and gums; foetid breath therefore is confined entirely to the state of the mouth, and has no connexion with that of the stomach, or the digestive organs, as is erroneously supposed :— eructatation or belching can only produce a temporary effect ; but, from uncleanliness of the mouth, we find the taint constant and habitual ; and, unless the cause be eradicated, all the spices and perfumes of the east, though they may conceal, cannot remove it.

7thly. Besides the reasons already assigned, for the necessity of a strict attention to the teeth and gums, may be added their great influence on the state of the general health.

The danger to the lungs from constantly inhaling a putrid effluvium, has been strongly commented upon by the faculty, as a leading cause of pulmonary consumption. When the great annual mortality from this disease is considered, we cannot doubt that this putrid matter may so change the nature of the fluid inhaled, as to cause that slow in-

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flammation of tlie lungs, productive of those tubercles which are the foundation of the disease.

The teeth may be considered, in some measure, as extraneous bodies ; and thus do not, like the other parts of the human frame. possess the power of freeing themselves from whatever is injurious. The importance therefore of an acquaintance with the dental art, as a part of education appears indispensable, is the only means by which this department of science can be enabled to take that rank, which its importance in promoting the health and comfort of mankind so imperiously demands. Nothing will be a source of greater satisfaction to the author, than that his humble efforts should be instrumental in effecting so desirable a purpose, by impressing on the minds of parents and guardians, the necessity of the care and management of the teeth as a primary duty, with a view to the entire prevention of dental disease and deformity. If begun in childhood, and continued in the regular manner recommended, no accumulation could be formed. — The prevention of dental disease is founded on an important discovery of the author: experience has satisfied him fully of its success; and this experience makes him more eager to impress the same conviction on others. If to vaccination we owe, of late years, a decrease of the annual mortality, a point clearly proved, the prevention of dental disease will add to this decrease ; for the constitution will not be worn out, and the health impaired, by sleepless nights and days of tormenting pain from dental irritation, as happens to too many who date the first symptoms of their ill -health from this cause.

It has been a common opinion, that the teeth are intended by nature to decay sooner than the other parts ; but this opinion is erroneous. Their premature decay is the consequence of neglect ; and neglect acts here in the same manner as in other cases, by sapping the vital energy of the part, if we may use the expression, and thus occasioning them to moulder awav.

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After these observations on the importance of the care of the teeth, and as a preliminary to the present work, it may be proper to take a general view of the organized structure of man.

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GENERAL VIEW

BODY.

THE body is composed of a solid and fluid part, mutually dependent on each other : the former gives it stability, form, and the powers of action ; the latter supplies the waste, which the solid parts necessarily undergo in the prosecution of their functions.

The solid part has been divided by anatomists into the head, chest, abdomen, and extremities : the first contains that organ, — the brain, which is the origin and seat of life and feeling; it is enclosed in a case of bone for its greater defence and security, and is thus equally c 2 screened from heat and defended from cold. This part is further covered and beautified by an extensive and constant growth of hair; and to the most prominent part of it, the face, is assigned the situation of the different senses which guide and regulate the actions of the body. The chest contains the principal organs which give to the nourishment the peculiar changes that make it pass from a fluid to a solid state, and convert it to supply the decay of the solid parts : of these organs, the principal are the heart, the lungs, and the liver.

The heart is that strong, indefatigable muscle, by which the blood or vital stream is conveyed to every part; it is enclosed in a membranous bag, the inner surface of which is lubricated by a thin exhalation to allow it its proper play : it possesses two separate cavities. Each cavity contains an auricle and a ventricle. — From the right ventricle the blood passes into the lungs by means of the pulmonary arteries, and is again returned to the left cavity of the heart by the pulmonary veins. From the left cavity it passes into the aorta, to be transmitted to every part of the system j after this, it is received into the cava, and returned to the heart to undergo the same process. Thus, the blood constantly circulates in an interchangeable tide, whether asleep or awake, and knows no intermission in its flow. Through the arteries it sallies briskly, and returns more slowly through the veins. The action of the arteries evolves the heat received by the lungs, and contained in the blood for the animation of the body : this heat we find increased by whatever augments the velocity of the circulation, and lessened by 'whatever renders it languid.

The lungs, the next important organ, receives the blood from the heart, to draw a new principle through them from the air, and to return this principle into the circulation, to be dispersed to every part, conveying increased animation and life : they consist of two divisions, one on each side the chest, and they open to the throat by the trachea, or wind-pipe.

The liver, the largest gland of the body, is situated in the abdomen. Through this gland all the blood circulates, in its return to the heart, after that principle is expended, which it receives from the lungs. This organ secretes a peculiar fluid, the bile, of great use in the animal economy ; and often, by its accumulation, its deficiency, or obstruction, is the source of numerous and serious maladies. The gall-bladder is appended to it as the reservoir of that secretion.

Besides these, some of the lesser or secondary organs may be notited. The kidneys, two small glands situated between the back and loins ; the spleen, for forming the red globules of the blood, or some other important use $ and the pancreas, secreting that fluid, termed saliva, which assists mastication, and moistens the mouth.

These divisions of the body are covered partly with bones and cartilage, forming a regular arch, gently moveable in respiration, which protects the chest, and partly with a fine membrane, the omentum, and with muscles, which enclose the contents of the abdomen: these parts are appended to the back bone, which sustains the weight of the whole structure, and serves also to form a conveyance to that elongation of the brain termed the spinal marrow, which gives out part of those fine cords or nervous filaments, that give sensibility to the system.

The last division of the body is the extremities, — the arms, the hands, the thighs, the legs, and feet. The arms are pendent on either side, proportioned to each other, being the guards which delend, and agents which serve, the whole frame; fitted, by their shape and structure, for the most diversified and extensive operations, and capable of performing, with singular expedition and ease, all manner of useful motions.

The hands consist of numberless small bones and muscles, forming a nice and varied mechanism, capable of assuming many shapes, and performing every useful service.

The lower extremities show the same peculiar adjustment of structure for the office intended by them. The thighs and legs are articulated in such a manner, that they administer most commodiously to the act of walking, and do not obstruct the easy posture of sitting. By assuming a gentle projection, they undergo a diminution of bulk, and acquire a more graceful form.

The feet, the last part of the extremities, compose a firm and neat pedestal, far beyond what statuary or architecture can ever accomplish. This pedes* tal is capable of altering its form, and extending its size, as different circumstances require. It contains a set of active springs, which tend to place the body in a variety of graceful attitudes, and qualify it for a multiplicity of advantageous motions. The undermost parts of the feet are covered with a sinewy substance, preventing that undue compression of the vessels which the weight of the body, in standing or walking, might otherwise occasion.

Such are the four principal divisions of the body ; but a part of the structure we have hitherto omitted : it is the one by which the aliment is received and prepared for being introduced into the body, to supply the waste that daily and hourly takes place.

This part begins with the mouth ; containing, first, the teeth set in alveolar processes formed on the jaw-bones : the upper jaw consists of six pair of bones, and one without a fellow, viz. ossamaxillaria, ossa malarum, ossa nasi, ossa lacrymalia, ossa spongiosa inferivra, and ossa palati ; of each of these there are two: the thirteenth is a single bone called the vomer.

Ossa maxillaria.~- -These bones constitute the greater part of the upper jaw, of the nose, and of the roof of the mouth. They have many processes and depressions, which render their figure extremely irregular; by the union of which, and other bones, are formed the cavities called the maxillary sinuses. These cavities are situated beneath the cheek-bones, and are lined with a continuation of the fine membrane which lines the cavities of the nostrils and frontal sinus : this membrane is called the Schneiderian, from the name of its discoverer; and upon it the olfactory nerves are distributed. The upper sides of the maxillary bones form the lower and internal circumference of the orbits ; and in their lower sides are the sockets for the teeth. They have several holes for the admission of nerves and vessels ; the principal of which, are the foramen orbit ale externum 9 the foramen incisivum, and the posterior palatine foramen^ which admits the maxillary nerve to pass to the teeth. These bones are joined to the os frontis and ossa laerijmalia at the great angles of the eyes, and to each other under the upper lip.

Ossa malarum. — These are the prominent bones which form the cheeks : their figure is nearly quadrangular; they jnin the os frontis at the little angles of the eyes, their upper sides forming the lower and external circumference of the orbits. They are smooth and convex on the surface, and unequal and concave within. The internal sides join the ossa maxularia ; and the external sides are joined by long processes to the temporal bones, which union forms an arch called the zygoma.

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Ossa nasi. — So named from their situation and use, forming the upper part or bridge of the nose : they are thin bones, of an irregular, oblong, square figure, externally convex and smooth, and internally concave and rough. They are joined above to the frontal bone — below, to the cartilages of the nose — behind, to the maxillary bones — in front, to each other — and are supported internally by the partition between the nostrils, called the septum narium.

Ossa unguis, or lacrymalia. — These bones bear some resemblance to the finger nail; from whence their name unguis : they are also called lacrymalia, from the water of the eye passing over them into the nose. Their situation is in the great angles of the eye, separating the orbit from the cavity of the nose. Their surface, next the eye, is concave, and forms part of the orbit on which the eye-ball moves. They join above with the os frontis — below, with the maxillary bones- — and, internally, with the ethmeid bone.

Ossa spongiosa inferiora, are so called from their spongy texture. — These bones form part of the nose, enlarge the surface, and extend the organ of smelling; they also assist in forming the under part of the lacrymal duct, the orifices of which into the nose are concealed by them.