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UNC 
 
 HEALTH SCIENCES LIBRARY 
 
 The Sheldon Peck Collection 
 on the History of Orthodontics 
 and Dental Medicine 
 
 Gift of 
 
 Sheldon Peck, DDS 1966 
 
 and 
 
 Leena Peck, DMD 
 
M % 
 
PARENTS’ DENTAL GUIDE. 
 
THE 
 
 PARENTS’ DENTAL GUIDE; 
 
 A TREATISE ON THE DISEASES 
 
 OF THE 
 
 TEETH AND GUMS, 
 
 FROM 
 
 INFANCY TO OLD AGE; 
 
 WITH 
 
 OBSERVATIONS ON AMALGAMS, CEMENTS, &c. 
 
 AND REMARKS ON THE CONSTRUCTION OF 
 
 ARTIFICIAL TEETH. 
 
 By william IMRIE, Surgeon-Dentist. 
 
 LONDON: 
 
 PRINTED FOR JOHN CHURCHILL, 
 ^etiical iSoofeeellec anl» 
 
 16, PRINCES STREET, SOHO. 
 
 1834. 
 
yoo 
 
 HOWLETT AND BRIMMER, PRINTERS, 10 , FRITH STREET, SOHO. 
 
CONTENTS. 
 
 Page 
 
 Introduction . i 
 
 Attention of Mothers directed to Tooth-ache in Children . iii 
 Improvement in the Construction of Artificial Teeth. iv 
 
 CHAPTER I. 
 
 DENTITION IN INFANTS. 
 
 Effects of Constitution on the Teeth. 5 
 
 Defective Organization of the Teeth. 7 
 
 Symptoms of Dentition. 9 - 
 
 Danger attending Dentition. 10 
 
 Order and Protrusion of the Milk Teeth. 11 
 
 SECTION I. 
 
 Of Convulsions and Treatment required. 13 
 
 Groundless Objections against Scarifying the Gums. 14 
 
 Repetition of the Operation sometimes necessary. 15 
 
 Bad Effects of Coral and-Bone Rings. 16 
 
 Utility of Indian Rubber. 16 
 
 b 
 
VI 
 
 CHAPTER II. 
 
 DENTITION IN CHILDREN. 
 
 Page 
 
 Decay in Milk Teeth, how produced... 18 
 
 Teeth Decaying by Pairs in both Jaws . 18 
 
 Necessity for Brushing Children's Teeth .. 19 
 
 Care required in extracting Shedding Teeth. 24 
 
 Irregularity induced by Premature Extraction. 25 
 
 Removal of Tartar from the Milk Teeth. 27 
 
 Preserving the Teeth by Plugs. 28 
 
 Of the Rabbit-mouth and Under-hung Jaw. 31 
 
 Bandage described. 81 
 
 CHAPTER III. 
 
 OF PERMANENT TEETH. 
 
 Irregularities produced by a want of Development of the 
 
 Jaws. 83 
 
 Eruption of the Permanent Teeth. 35 
 
 Utility of preserving the Shedding Teeth. 37 
 
 Examination of a Perfect Set. 39 
 
 Irregularities of the Front Teeth...... 41 
 
 Danger of Extraction. 42 
 
 SECTION I. 
 
 Of the Mechanical Means used in obviating Irregularities . 43 
 
 Effects of the Constitution on the Development of the Jaw 
 
 Bones. 
 
 Danger of Filing the Teeth. 45 
 
 Cases of Irregularity and Description of the Treatment... 46 
 
VII 
 
 CHAPTER IV. 
 
 DECAY OF THE TEETH. 
 
 Page 
 
 Preservation preferred to Extraction. 61 
 
 Loss of the Front Teeth following Extraction of the Grinders 63 
 
 Mastication—how Performed. 64 
 
 Remarks on Extraction, addressed to the Medical Profession 66 
 
 SECTION I. 
 
 Defective Organization, a Cause of Decay... 67 
 
 Lateral Pressure, a Cause. 70 
 
 Accidental Causes. 72 
 
 Injurious Effects of Acids on the Teeth. 72 
 
 Effects of Acid Saliva,... ... 73 
 
 SECTION II. 
 
 Rapid Decay of Primary Teeth. 76 
 
 Remedies to Relieve Tooth-ache. 78 
 
 Plugging Decayed Teeth.. 80 
 
 Prevention of Decay in Teeth, denominated Chalky. 81 
 
 SECTION III. 
 
 Predisposition of some Persons to collect Tartar. 84 
 
 Symptoms and Effects of Tartar. 85 
 
 Removal of Tartar. 86 
 
 .SECTION IV. 
 
 Instructions for Preserving the Teeth. 89 
 
 b2 
 
VIII 
 
 SECTION V. 
 
 Page 
 
 Observations on Amalgams, Cements, &c. 91 
 
 « 
 
 CHAPTER V. 
 
 OF ARTIFICIAL TEETH. 
 
 Introductory Remarks. 96 
 
 Necessity for the Medical Profession to become acquainted 
 
 with Diseases of the Teeth... 97 
 
 Consequences of the Want of Teeth. 98 
 
 SECTION I. 
 
 Grafting or Pivoting Teeth.;. 101 
 
 Operation described... 102 
 
 Case of Mal-practice . 103 
 
 SECTION II. 
 
 Utility,of. Gold Caps.. 
 
 Case in Illustration. 
 
 SECTION III. 
 
 State of the Gums in adapting Artificial Teeth 
 
 Extraction not to be submitted to. 
 
 Bad Effects of Improper Fastenings. 
 
 Necessity for Back Teeth. 
 
 Loose and Painful State of the Front Teeth .. 
 Use of Gold Plates.. 
 
 105 
 
 107 
 
 109 
 
 110 
 111 
 
 114 
 
 115 
 117 
 
 
 « 9 
 
PREFACE. 
 
 A WORK, which shall have for its design the 
 alleviation of pain, the improvement of personal 
 appearance, and the preservation of health, may 
 reasonably claim the notice of the public, and 
 its indulgence ’ for whatever imperfections may 
 be found in the Author^s execution of his task. 
 The present volume has been written with a 
 view of directing the attention of individuals of 
 both sexes, and of all conditions, to the impor¬ 
 tance of a watchful care of their teeth, in which 
 is involved more of human comfort than might, 
 at first sight, be conceived ; while their neglect is 
 attended by inconvenience and pain, and followed 
 by ill health and the appearance of premature 
 old age. Of these truths, it is necessary that all 
 persons should be seriously convinced, especially 
 those of that sex to whom a pleasing exterior is 
 
X 
 
 PREFACE. 
 
 all-important; and who, from the comparative 
 delicacy of their structure, are rendered more 
 liable to the ravages originating in neglect and 
 disease. What, indeed, can be more melan¬ 
 choly than to see the attractions of youth and 
 beauty disfigured and marred by loss of teeth, 
 or by teeth in a bad and discoloured state ? And 
 yet what sight is less uncommon ? That a female 
 so situated should be reluctant to smile lest she 
 should reveal an uncomely mouth, is to be de¬ 
 prived of one of the most charming graces of her 
 sex; not to mention the more lamentable and 
 permanent injuries she is doomed to suffer. 
 
 Were it possible to ascertain the amount of 
 accurate information possessed by persons who 
 have arrived at the middle period of life, regard¬ 
 ing the nature and diseases of the teeth, and of 
 the alterations which the mouth is daily under¬ 
 going, it would be found to be so little and so 
 erroneous, as to convince every one that such a 
 work as the present is, at least, not superfluous. 
 It is a fatal error in the subject now under treat¬ 
 ment, to believe, that Nature is in herself compe- 
 
PREFACE. 
 
 XI 
 
 tent in all cases to fulfil her intention of arranging 
 the teeth in perfect order in the jaw ; the pre¬ 
 sent artificial mode of living has a tendency to 
 frustrate her; and unfortunately the great bulk 
 of the medical profession (which ought to be the 
 guide in this matter,) appears to be as unac¬ 
 quainted with dental diseases as the public at 
 large; and a patient is too often subjected to a 
 long course of medicine in the hope of relieving 
 a malady, which might be better and more 
 speedily remedied, by restoring to the teeth 
 their power of mastication, on which the comfort 
 of the stomach mainly depends. Were medical 
 gentlemen more observant of this, the teeth, by 
 the timely assistance of the dentist, might be 
 perserved to a very late time of life, and the 
 phrase “old age^^ would cease to be synony¬ 
 mous with “ a toothless person.^^ 
 
 The Author of the following work hopes, 
 therefore, to effect some good by what he now 
 ventures to lay before his readers. He has not 
 confined his observations solely to the means of 
 preserving the teeth, but has endeavoured to 
 
XII 
 
 PREFACE. 
 
 demonstrate the method of supplying them when 
 lost; and to show what may be obtained by 
 mechanical skill in ensuring the health and com¬ 
 fort of society in relation to that particular part 
 of the human structure of which he treats. 
 
 10, WOBURN PLACE, RUSSELL SQUARE. 
 January 1, 1834. 
 
 ERRATA. 
 
 Contents, page vi. for^> re«d 37. 
 
 Page 45, Le 17,/or page ^ 5 , read page 59. 
 
 Pale 55, line 10,/or page 44, read page 48. 
 
 Pa|e 59, line 20 ,/or page ^ 1 , read page . 
 
 Page 107, line 4,/or page 
 
 Page 110, line 5, for page 103, read page 99. 
 
I 
 
 INTRODUCTION. 
 
 Sensible of the importance of every design 
 having for its object the alleviation of pain, the 
 author feels it incumbent on him to lay before 
 the public his particular views respecting Den¬ 
 tal Surgery, and earnestly to direct the atten¬ 
 tion of parents and guardians to the beneficial 
 results arising from the methods he employs in 
 removing the causes which so frequently pre¬ 
 vent a due development of the jaw-bones of 
 young persons, occasion irregular positions of the 
 
 teeth, and, in consequence, deviations from 
 
 / 
 
 regularity of features. These defects are still 
 more conspicuous and lamentable when they 
 occur in the female branches of a family. 
 
 The foundation of irregularities, and other 
 
 I 
 
 unfavourable affections of the teeth is laid at a 
 much earlier period than parents imagine. For¬ 
 tunately, however, these diseases are easily 
 
 B 
 
11 
 
 INTRODUCTION. 
 
 prevented, if proper attention be directed to them 
 at the right time; though when neglected until 
 a late period, they admit of successful treatment 
 only with great difficulty and perseverance. 
 
 The experience of the author for a series of 
 years in regulating the teeth of young persons, 
 has been extensive. A long period is indeed 
 necessary, to make observations in this depart¬ 
 ment of the dental art. When it is remembered 
 that the interval from the age of six or seven 
 years to that of fifteen is required by nature for 
 the full development of the beauty of the per¬ 
 manent teeth, the effects of judicious treatment, 
 and the utility of early attention, become ap¬ 
 parent. It will be evident, therefore, that deep 
 study, combined with extensive opportunities 
 for observation, during a number of years, are 
 requisite to perfect the dental practitioner. 
 
 During the above period the author has too 
 frequently been accustomed to witness cases of 
 irregularity of the teeth arising from neglect, 
 sufficient to convince him of the necessity of 
 early attention. 
 
INTRODUCTION. 
 
 Ill 
 
 Mothers should keep , a strict watch during 
 the time of shedding the teeth, and occasional 
 examinations should be made by the scrutinizing 
 eye of the experienced dentist, or the little pa¬ 
 tient is doomed to suffer to an unlimited extent. 
 Tooth-ache and tenderness of the teeth in chil¬ 
 dren at the early age of four years, is an occur¬ 
 rence more frequent than parents are disposed 
 to believe. True it is that pain is not the only 
 consequence of neglect of the teeth at this age; 
 such neglect may, and frequently does, produce 
 diseases of which, with few exceptions, the 
 medical profession would not conjecture the 
 cause.* 
 
 Considerable improvements have lately been 
 made in the construction of artificial teeth; but 
 it may be remarked that there are many persons 
 in possession of artificial teeth which are ill 
 adapted to answer the intention of natural ones, 
 
 * Very foul ulcers on the lips of children are frequently 
 dependent on the projection of a sharp rough tooth against 
 the parts. The most common cause of suppuration in the 
 antrum, is a caries of some of the molar teeth in the upper 
 jaw.—C ooper’s First Lines. 
 
 B 2 
 
IV 
 
 INTRODUCTION. 
 
 and cannot be worn without producing pain and 
 inconvenience. Others fancy factitious teeth 
 cannot be constructed without the few remain¬ 
 ing natural ones are extracted, to which they 
 feel a repugnance. They therefore wait until 
 deprived of them by a process of nature. Such 
 persons are referred to the part of this work 
 wherein the best methods of constructing artifi¬ 
 cial teeth are considered. 
 
 « 
 
 These remarks cannot be better concluded 
 than by the following insertion from the valuable 
 treatise on the teeth, by the celebrated John 
 Hunter. “ The importance of the teeth is such 
 that they deserve our utmost attention, as well 
 with respect to the preservation of them, when 
 in a healthy state, as to the methods of curing 
 them when diseased. They require this atten¬ 
 tion, not only for the preservation of themselves, 
 as instruments useful to the body, but also on 
 account of other parts with which they are 
 connected; for diseases in the teeth are apt to 
 produce diseases in the neighbouring parts, 
 frequently of very serious consequences.” 
 
PARENTS^ DENTAL GUIDE. 
 
 CHAPTER 1. 
 
 OF DENTITION IN INFANTS. 
 
 EFFECTS OF CONSTITUTION ON THE TEETH- 
 
 SYMPTOMS OF DENTITION—DANGER TO 
 WHICH INFANTS ARE EXPOSED. 
 
 In this division, the dentition of infants will be 
 considered. It is obvious, from the great num¬ 
 ber of little sufferers carried off yearly by this 
 process, that some remarks should be addressed 
 to parents. 
 
 There can be little doubt that the causes of 
 difficult dentition may indirectly lead to, or lay 
 the foundation for, that want of development of 
 the jaws, so apparent at the adult age. The 
 inflammatory state of the gums at this period 
 
6 
 
 DENTITION IN INFANTS. 
 
 may interrupt the course of nature during the 
 
 secretion of the osseous particles of the per¬ 
 manent teeth, before they emerge from their 
 bony cells in the jaw. It is a fact admitted 
 by physiologists, that the disturbance of the 
 general health of infants usually frustrates se¬ 
 cretion, and may affect the several parts com¬ 
 posing the teeth equally with other portions of 
 the body. 
 
 The principal cause, then, of a faulty state of 
 the teeth is the primitive one, namely, a want of 
 vigour and energy of the constitution. 
 
 This want of development of the teeth is 
 induced in the same way as is occasionally 
 seen in persons with one limb (generally the 
 arm) shorter than its fellow, as though the arm 
 of a child had grown on the body of a man. 
 
 Parmly observes, ‘‘ In the teeth of all animals 
 in a state of nature, we discover no diseased 
 structure or deformity, and therefore we ascribe 
 it in the human subject to fortuitous, not con¬ 
 stitutional, or hereditary causes.’’ • 
 
 The term fortuitous,” in this instance, 
 amounts to causes unknown to the above 
 
DENTITION IN INFANTS. 
 
 7 
 
 writer, yet he rejects those of the constitu¬ 
 tion, which will readily explain the matter, 
 especially when it is considered, that the 
 human subject is very far removed from a 
 state of nature, and that art has effected alte¬ 
 rations prejudicial to the animal economy suffi¬ 
 cient to account for defects observed in the 
 human teeth. The same author also states, 
 
 That their premature loss or decay cannot 
 arise from any defects of original organization, 
 but it is to be ascribed solely to the action of 
 impure matter; the result of uncleanliness-on a 
 part incapable of freeing itself from extraneous 
 accretions, as in the other parts of the living 
 body; and to supply that want of natural 
 power, the interference of art appears indis¬ 
 pensable.” 
 
 The above quotation is replete with erroneous 
 information, as the very reverse of the opinion 
 therein expressed would be more correct; viz., 
 that defect in original organization, and not the 
 action of impure matter, is the primary cause 
 of decay of the teeth. That this defect of 
 
8 
 
 DENTITION IN INFANTS. 
 
 original organization is a cause of decay cannot 
 be disputed, from the simple fact that impure 
 matter applied to a well-organized tooth, will 
 not affect it in the least, though if applied to 
 one of defective structure, decay will ensue. 
 
 i 
 
 That impure matter is not the only cause of 
 decay, may be inferred from the food'of carni¬ 
 vorous animals being generally filled with this 
 pretended destructive solvent. 
 
 It was a remark of John Hunter, ‘‘ that decay 
 of the teeth does not seem to be so entirely the 
 effect of accident as might be imagined; for it 
 sometimes takes place in them by pairs, in 
 which case we may suppose it owing to an 
 original cause coming into action at a stated 
 period.” Here it plainly appears that the word 
 “ original” conveys the idea of a constitutional 
 defect, and tends very strongly to bear upon 
 the conclusion which the author has arrived at, 
 namely, that want of vigour in the body is the 
 original cause of decay and deformities in the 
 positions of the teeth. Other causes are also 
 in operation at different periods of life, the 
 
DENTITION IN INFANTS. 
 
 9 
 
 effects of which are fully exemplified in their 
 respective places in other divisions of this pub¬ 
 lication. 
 
 When the time arrives at which the four in¬ 
 cisors (front teeth) in the jaws begin to force 
 their way through the gums, the infant becomes 
 restless and irritable. Among the first symptoms 
 of dentition, little white spots will appear about 
 the point of the tongue, extend to the gums, 
 and the lining membrane of the mouth, known 
 as the thrush; the gums in a few days com¬ 
 mence swelling, and the salivary organs at the * 
 same time have their action increased, as is 
 perceived from the dribbling of a limpid fluid 
 from the corners of the mouth; nausea and 
 frequent vomiting are more or less urgent; the 
 skin is dry, and the face .alternately pallid or 
 flushed; the functions of the stomach become 
 deranged, a state with which the bowels fre¬ 
 quently sympathise ; and the intestinal secretions 
 are unhealthy, as is apparent from the clay 
 colour and sour foetid odour. Even in the most 
 favourable states of dentition, the action of the 
 intestines is generally irregular. 
 
10 
 
 DENTITION IN INFANTS. 
 
 The danger to which infants are exposed 
 during the period of dentition, arises from 
 pressure of the teeth against the gums, irri¬ 
 tating them, and exciting pain and inflam¬ 
 mation. 
 
 Nature sets up this process to cause a separa¬ 
 tion of the gums ; for at the time of birth there 
 is a very perceptible line, or seam, situated at 
 the edge of the gums, which may be traced 
 from one extremity of the jaw to the other. 
 
 The presence of this white line is thus ac¬ 
 counted for: during the growth of the infant, 
 some weeks previous to birth, the gums are in 
 two portions, one situated on the outside, the 
 other inside the jaw bones. In proportion as 
 the body of the infant increases, so the two 
 parts of the gums continue to grow, and at last 
 unite; the white line marks the place of union, 
 and the object to be attained previous to the 
 protrusion of the teeth, is a division of the 
 gums. ^ 
 
 The effect therefore of pain and irritation is, 
 that the gum wastes, becomes gradually thinner, 
 and at length the tooth protrudes. 
 
DENTITION IN INFANTS. 11 
 
 While the roots of the teeth are forming, the 
 upper parts or crowns are constantly projected 
 outward; and from this continued action, it 
 occurs about the sixth or eighth month after 
 birth, that the incisors, being the first secreted 
 and perfected in the Jaw bones, begin to pass 
 through the gums. The incisors of the lower 
 jaw generally appear first; the canine (eye¬ 
 teeth), and molares (grinders) not being per¬ 
 fected so quickly as the incisors, remain in the 
 gums until the twentieth or twenty-fourth month. 
 Sometimes one of the canine, but more fre¬ 
 quently a molar tooth, follows the eruption of 
 the incisors. 
 
 About this period the mother’s anxious fears 
 for the health and safety of her infant are strongly 
 excited; the most alarming symptoms rapidly 
 ensue, and from great tenderness and extreme 
 delicacy of construction, connected with a dis¬ 
 position to an increase of any inflammatory 
 action, the termination is generally more fatal 
 than favourable. " " 
 
 The irritation caused by the sharp edge of a 
 tooth against the gum produces derangement 
 
12 
 
 DENTITION IN INFANTS. 
 
 of the nervous and circulating systems, to which 
 inflammation extends its baneful effects, laying 
 the foundation of, or calling into action, com¬ 
 plaints of an incurable nature; convulsions, 
 diseases of the intestines, or water in the head. 
 
 It should be borne in mind that the nerves 
 and blood vessels of infants are larger in propor¬ 
 tion to the body than at any future period of life; 
 their fragile constitutions are not so well calcu¬ 
 lated to resist, and less able to overcome, dis- 
 ease when it has once fairly manifested itself. 
 
 SECTION I. 
 
 TREATMENT OF DENTITION IN INFANTS. 
 
 Of Convulsions; how remedied—Groundless objections against 
 
 scarifying—Injurious effects of Corals^ Bone-Rings, ^c _ 
 
 Utility of India Rubber. 
 
 The unexpected appearance of "two central 
 incisors in the mouth, without the mother having 
 observed her offspring to experience any pain or 
 indisposition, is a very rare occurrence; more 
 
DENTITION IN INFANTS. 
 
 13 
 
 frequently some of the symptoms already de¬ 
 tailed announce this operation of nature. 
 
 Healthy robust children generally suffer very 
 little pain, nor do those living in an open atmos¬ 
 phere ; while such as are of a weak habit or 
 nervous and vascular temperament, and confined 
 in large towns, do not so readily overcome the 
 difficulties and irritation attending the cutting of 
 the teeth. The process of dentition is sluggish, 
 and the life of the child in considerable jeopardy. 
 
 It is unnecessary to have the assistance of art 
 in every case, yet whenever the pain and indis¬ 
 position arise to a certain height, and convul¬ 
 sions begin to manifest themselves—as may be 
 foretold by the thumbs twisting into the palms 
 of the hands, accompanied by slight twitchings 
 of the muscles of the mouth, with a dark ap¬ 
 pearance about the lips,—the infant should be 
 immediately immersed in a warm bath, or a foot¬ 
 bath used while the other is being made ready, 
 and the gums freely scarified. This operation 
 is attended with very trifling pain; the gums 
 possess little sensibility, and they are often 
 
14 
 
 DENTITION IN INFANTS. 
 
 accidentally wounded without the least painful 
 sensation being induced.* • , *= ^ 
 
 ^.*Many persons object to a division of the 
 gums, supposing the admission of the tooth 
 will be more difficult than before, should it 
 not protrude after the first incision; this objec- 
 
 * The gum, in substance, has something of a cartilagenous 
 hardness and elasticity, and is very vascular, but seems not 
 to have any degree of sensibility ; for though we often wound 
 it in eating, and in picking our teeth, yet we do not feel 
 much pain upon these occasions. In infants and old people, 
 where there are no, teeth, the gums bear a very considerable 
 pressure without pain. 
 
 The advantage arising from this degree of insensibility in 
 the gums is obvious ; for till the child cuts its teeth, the gums 
 are to do the business of teeth, and are therefore formed for 
 this purpose, having a hard ridge running through their 
 whole length. As, therefore, the gums are not easily irritated 
 by being wounded, they are not so liable to inflammation as 
 other parts, and soon heal. 
 
 A vulgar prejudice prevails against this practice, from an 
 objection that if the gum is lanced so early as to admit of a 
 reunion, the cicatrised part will be harder than the original 
 gum, and therefore the teeth will find more difficulty in 
 passing, and give more pain. This is contrary to fact; for 
 we find that all parts which have been the seat either of wounds 
 or sores, are always more ready to give way to pressure, or 
 any other disease, which attacks either the part itself or the 
 constitution. Therefore each operation tends to make the 
 passing of the teeth easier.— John Hunter. 
 
DENTITION IN INFANTS. 
 
 15 
 
 tion is not founded on truth, and its fallacy 
 may be detected by referring to the part of the 
 publication which treats of the formation and 
 growth of the gums. 
 
 When a front tooth is a cause of irritation 
 and other bad symptoms, a complete division 
 of the gum should be effected, by an incision 
 made in a longitudinal direction, and suffi¬ 
 ciently deep for the operator to feel the edge 
 of the tooth ; a crucial incision becomes neces¬ 
 sary when a molar tooth is about emerging 
 from the gums.”* 
 
 Other diseases have their origin in difficult 
 dentition; they, however, do not come under 
 the cognizance of the dentist; the services of 
 the medical attendant are generally required 
 in these cases. 
 
 If the tooth do not protrude after the first 
 division, and the symptoms return, a repetition 
 of the operation must be persisted in until the 
 edge of the tooth has cleared the gum. 
 
 * As far as my experience has taught me, to cut the gum 
 down to the teeth appears to be the only method of cure. 
 It acts either by taking off the tension upon the gum, arising 
 from the growth of the tooth, or by preventing the ulcerati- n 
 whicli must otherwise take place.—H unter. 
 
16 
 
 DENTITION IN INFANTS. 
 
 The use (or rather abuse) of corals, bone- 
 rings, and other hard substances, so commonly 
 placed in the hands of infants, cannot be too 
 severely reprobated; they bruise and irritate 
 the gums, producing the very disease intended 
 to be obviated; and in every instance of difficult 
 dentition the symptoms are aggravated. 
 
 The best substances are of a soft, elastic, or 
 gristly nature. Rings formed of india-rubber, ^ 
 made expressly for the use of infants, are most 
 excellent of their kind, and are the only articles 
 that should in this way be allowed to enter the 
 tender mouth of a child. 
 
 Particular mention is therefore made of the 
 evil consequences where corals and similar 
 substances are used; the author has witnessed 
 in many cases very deplorable results. 
 
CHAPTER II. 
 
 OF DENTITION IN CHILDREN, AND OF DIS¬ 
 EASES TO WHICH THE FIRST, OR MILK, 
 TEETH ARE LIABLE. 
 
 The opinions formerly entertained by various 
 writers, medical and anatomical, upon the 
 formation and protrusion of the milk-teeth, 
 were at the best speculative, though in many 
 instances of an ingenious nature; equally erro¬ 
 neous opinions were formed concerning the 
 permanent teeth. A knowledge of these sub¬ 
 jects has advanced so rapidly, that at the 
 present period they are well understood. 
 
 The milk-teeth consist of ten in each jaw; 
 those of the lower front appear about the sixth 
 month (as already observed), and, between the 
 second and third year, primary dentition may be 
 considered as completed; it may be also ob¬ 
 served that no alteration of the mouth ensues 
 
 c 
 
 t 
 
18 DENTITION IN CHILDREN. 
 
 * 
 
 up to the sixth year, when some of the perma¬ 
 nent teeth begin to protrude. 
 
 The good or ill effects of possessing either a 
 vigorous or weakly constitution will be manifest,, 
 at the time the shedding grinders are appearing 
 through the gums. The author has, in nume¬ 
 rous cases, observed the correctness of this 
 remark. 
 
 Very frequently it happens that soon after a 
 molar tooth has cut the gums, many indenta¬ 
 tions and cracks are seen to exist on the 
 grinding surface; on further examination it is 
 perceived that the enamel is deficient, or that 
 there is a want of union at several parts, through 
 which a finely-pointed instrument may be passed 
 into the body of the tooth; these are certain 
 indications of defective organization, and will 
 account for the rapid decay of such teeth. 
 
 These appearances are not confined to a 
 solitary tooth; but it always happens that its 
 fellow in the other side of the jaw is equally 
 faulty in construction. Similar affections also 
 exist in the crowns of the teeth which are 
 opponents in the opposite jaw. 
 
DENTITION IN CHILDREN. 
 
 19 
 
 The destructive influence of particles of food 
 deposited in these irregular surfaces of the 
 molar teeth, coupled with'the constant appli¬ 
 cation of moisture, tend to hasten the pro¬ 
 cess of-decay. The neglect, therefore, of fre¬ 
 quently brushing and washing the teeth and 
 gums, calculated to remove foreign or extra¬ 
 neous matters that occasionally insinuate them¬ 
 selves between the teeth, is always accompanied 
 with serious consequences, whereby premature 
 decay and subsequent loss of the teeth are much 
 facilitated. 
 
 A caries of the teeth may be considered as 
 much a casualty in children as in adults.* 
 
 Whenever the teeth are in a state as above 
 
 I 
 
 described, considerable detriment to the child’s 
 health speedily ensues; for, when we consider 
 the numerous substances to be broken down in 
 the process of mastication, it becomes obvious 
 that, unless the masticatory organs are perfect, 
 
 * “ This disease and its consequences seem to be peculiar 
 to youth and middle age ; the shedding teeth are as subject 
 to it, if not more so, than those intended to last through life ; 
 and we seldom or ever see any person whose teeth begin to 
 rot after the age of fifty years.”— Hunter. 
 
 c 2 
 
20 
 
 DENTITION IN CHILDREN. 
 
 the food must pass into the stomach in a very 
 unfit state for digestion, and must be equally 
 imperfect for the absorption of those nutritive 
 particles which are to supply the growth, and 
 keep up the healthy condition of the body. 
 Hence, children with their mouths filled with 
 teeth more or less decayed, are generally of a 
 weakly and languid constitution. 
 
 To counteract these effects, it is of the ut-: 
 most importance that the child’s mouth should 
 be examined by the dentist soon after the pri- - 
 mary molar teeth have appeared, to discover if 
 any are defective in organization or are passing 
 into decay; if this period should be neglected, 
 the teeth become so much and so quickly di¬ 
 seased, that no alternative is left but extraction. 
 
 The occurrence of pain in a tooth is fre¬ 
 quently the first inducement to a parent to 
 have the child’s teeth examined, when perhaps 
 one or more are found so much diseased as to 
 be useless for the purposes of mastication. 
 
 Regularity of features and full development 
 of the jaws depend so much upon the manage¬ 
 ment of the shedding teeth, that the character 
 
DENTITION IN CHILDREN. 
 
 21 
 
 and expression of the adult face will correspond 
 with the judicious or injudicious treatment of 
 the child’s mouth. 
 
 The preservation of the temporary, teeth 
 during the formation of the permanent ones, 
 is of great importance.* 
 
 Many persons suppose that decay of temporary 
 
 % 
 
 teeth is an operation ordained by nature to 
 
 * At the early periods of the formation of the permanent 
 teeth, the connexion between their rudiments and the tempo¬ 
 rary teeth still exists, and the structure of the former would 
 be probably injured by the too early destruction of that con¬ 
 nexion ; in addition to which, the loss of the temporary teeth 
 before the permanent ones are ready to fall into their proper 
 situations in the maxillary arch, has been shown to lead to 
 the probable contraction of its span, and subsequent irre¬ 
 gularity of the teeth. 
 
 ** The temporary teeth, as long as they remain in the 
 sockets, from being arranged in a continuous and even 
 series around the arch of the jaw, tend to preserve its 
 form, and prevent its contracting during the growth of the 
 child, when every part of the body is undergoing continual 
 alteration in form as well as in size.”— Thomas Bell. 
 
 ‘‘ The shedding teeth are, however, equally liable with 
 the permanent ones to be affected by external caries, and for 
 that reason they should be objects of equal care, as on their 
 timely and proper shedding must depend much of the good 
 
22 
 
 DENTITION IN CHILDREN. 
 
 allow the permanent ones to protrude; it has 
 however been remarked, that the shedding teeth, 
 either from constitutional weakness, from their 
 shape, or other accidental causes, suffer from 
 external decay in the same‘manner as perma¬ 
 nent ones in the adult.* . 
 
 Whenever extensive decay has involved the 
 shedding, or even the permanent teeth, they do 
 not perform their functions with accuracy and 
 precision; where the alimentary substances are 
 soft, and admit of being easily broken down, 
 a few masticatory movements of the front teeth 
 divide what is contained in the mouth; but 
 
 or ill which will attend their successors i and although in 
 some instances it may be improper to delay the extraction of 
 a shedding tooth, more mischief has certainly arisen from 
 premature extraction than from cautious delay. 
 
 • Patterson Clark. 
 
 * ‘Mt is certain that children’s teeth are often affected 
 
 i 
 
 with caries at-the time of shedding, but it is as certain that 
 this is not a means taken by nature for their expulsion. If 
 the contrary opinions were adopted it might be attended 
 with serious consequences ; for the commencement of a 
 dangerous disease might then be neglected or improperly 
 treated, from a supposition that it were only a natural de¬ 
 fect.”—M urphy. 
 
DENTITION IN CHILDREN. 23 
 
 when, on the contrary, the substances are of a 
 fibrous or tough nature, the molar teeth must 
 be employed, and a longer continuance of mas¬ 
 ticatory movements becomes necessary in pro¬ 
 portion to the hardness of the food.* 
 
 In children whose molar teeth are extensively 
 decayed and painful, mastication is imperfectly 
 performed by the front teeth, which are not com¬ 
 petent to bear such action, and either sponta¬ 
 neously drop out, or are improperly removed 
 when they become loose. 
 
 At the same time, it not unfrequently occurs, 
 during the operation of extracting the decayed 
 temporary teeth, that one or more of the perma- 
 
 “ The teeth, during mastication, have sometimes very 
 considerable efforts to support, which would inevitably loosen, 
 or even detach them, were it not for the great solidity of 
 their articulation with the jaws. The root of each tooth acts 
 like a wedge, and transmits the force with which it is pressed 
 to the parietes of the alveolar process. The molar teeth hav* 
 ing the greatest efforts to support, have either several roots^ 
 or one very large single root. The incisors and canine have 
 but one very slender root, and are not subjected to any very 
 considerable pressure.” — Majendie’s Elements of Phy¬ 
 
 siology. 
 
24 
 
 DENTITION IN CHILDREN. 
 
 nent ones, wherein decay has commenced early, 
 are removed; the irremediable consequences of 
 such mal-practice are want of development of 
 the jaw, and irregularity of the adult teeth to an 
 indefinite extent.* This error is not perhaps dis¬ 
 covered until the unfortunate patient arrives at 
 maturity; for the permanent molar teeth, at the 
 sixth year, resemble the shedding ones, both 
 having their roots defective—those of the former 
 not being fully formed, while the latter are un¬ 
 dergoing absorption. 
 
 Temporary teeth occasionally remain in the 
 mouth. The author has, in several instances, 
 observed them in people of fifty years of age; 
 then, whenever they drop out of the jaw, their 
 
 *** A mouth thus cleared looks clean, and is calculated to 
 please parents who know no better; but experience will in¬ 
 form them that the second teeth do not come on so early as 
 was expected after the extraction of the shedding ones ; for 
 the process of absorption of the roots of the first teeth, seems 
 to open the way for the easier advance of their successors. 
 Besides, young persons are thus often prematurely deprived 
 of the use of their masticatory apparatus, to the detriment of 
 their general health.”—P atterson Clark. 
 
DENTITION IN CHILDREN. 
 
 25 
 
 places are not filled up by permanent teeth: 
 this is a deviation of nature, and may originate 
 in want of vigour of the constitution. 
 
 From the above observations, it behoves pa¬ 
 rents and others to be careful in the selection of 
 an experienced and judicious operator, whose 
 practiced eye will readily recognize the different"' 
 teeth. 
 
 It sometimes happens that the permanent 
 front teeth make their appearance inside the 
 temporary ones, without the roots of the latter 
 being absorbed; they do not therefore loosen, or 
 become detached from their sockets, and a 
 double row of teeth is thus formed, which if 
 permitted to remain in the jaw for any length 
 of time, occasion a departure, more or less, of 
 the permanent teeth from natural and regular 
 positions. 
 
 The mischief arising from ill-timed extraction 
 has been fairly shown, with the exception of ap¬ 
 pearances so conspicuous when the person has 
 arrived at maturity. These, however, are fully 
 considered in the third chapter. 
 
 1 
 
26 
 
 .DENTITION IN CHILDREN. 
 
 SECTION I. 
 
 % 
 
 TREATMENT OF THE SHEDDING OR MILK-TEETH. 
 
 Of Tartar; how remedied—Of Plugging—Care requisite in 
 Extraction — Mal-practices—Of Under-hung Jaw, and 
 '■ bandage for. 
 
 Defective organization, or structure of the 
 teeth, has been pointed out as a cause of decay; 
 indentations and the numerous cracks visible 
 on their grinding surfaces, indicate a want of 
 union of the enamel at those parts. Teeth thus 
 situated will be sure to decay, with the interven¬ 
 tion of moisture, &c.; this, however, is denied 
 by some authors.”* 
 
 That dec^ay of teeth with injured or defective 
 enamel is not universally the result, the author 
 freely admits; he however maintains, that in 
 every case of defective enamel decay will en¬ 
 sue, unless that portion of the tooth is freely ex¬ 
 posed to the friction produced by the frequent 
 use of a tooth-brush. Where the enamel be- 
 
 * Vide Murphy’s Natural History of the Human Teeth, p. 60. 
 
DENTITION IN CHILDREN. 
 
 27 
 
 comes injured in a part not within the action 
 of a brush, or to which it is not applied, caries 
 will most certainly attach itself. This more 
 particularly applies to the teeth of young per¬ 
 sons, as those of elderly ones receive injuries 
 of the enamel with impunity. 
 
 The collection of tartar about the necks of the 
 shedding teeth frequently occurs; there is also 
 occasionally deposited a greenish matter, of a 
 destructive and pernicious nature, the immediate 
 
 effects of which are decomposition of the enamel, 
 
 ■ 
 
 and rapid decay of the teeth. 
 
 The effects of tartar on the gums,^ render 
 them liable to assume a soft and spongy appear¬ 
 ance, inclined to bleed upon the slightest pres¬ 
 sure ; it moreover imparts to the breath a most 
 unpleasant and unwholesome odour. 
 
 * The gums being furnished with a smooth surface, and 
 dense texture, and placed around the neck of the teeth, fill 
 up the space between them; they are in consequence liable 
 every moment to laceration, for in masticating hard and uneven 
 substances, they are forcibly pressed upon by the edges and 
 angles which these often present. This inconvenience always 
 happens whenever their texture becomes soft, as in scorbutic 
 affections ''-— Majendie’s Elements of Physiology. 
 
28 
 
 DENTITION IN CHILDREN. 
 
 ■ In all cases the removal of tartar is the only 
 effectual remedy. The quantity that is some¬ 
 times found adhering to primary teeth is surpris¬ 
 ing; but as the operation is unattended with 
 pain, children readily submit. 
 
 So prone are the shedding teeth to collect 
 tartar, that it requires, in some cases, more than 
 one removal during the period they remain in the 
 jaws; wherever a repetition of the operation is 
 necessary, a want of cleanliness, and neglect in 
 the use of a brush, were the principal causes of 
 its re-appearance. The utility and necessity, 
 then, of frequent brushing of the teeth is suf¬ 
 ficiently manifest. By this is prevented de¬ 
 cay in teeth whose defective enamel is favourable 
 for the development of such disease; the fric¬ 
 tion of a brush, a soft towel, or even the finger, 
 induces and preserves a healthy state of the 
 gums, while the absence of tartar renders the 
 breath pure and wholesome. 
 
 The only effectual preservative of temporary 
 teeth, when decayed or defective in structure, 
 is filling the cavity with a stopping. 
 
 The materials for this operation should be a 
 
DENTITION IN CHILDREN. 
 
 29 
 
 substance whose insertion can be effected with¬ 
 out much force or pressure, as the primary set of 
 teeth are, more or less, without stumps, and the 
 stopping is only to continue a short time, unlike 
 the permanent plugs necessary in decay of the 
 second teeth. 
 
 Juvenile patients are proverbially restless 
 and fidgety; the saliva is with the greatest 
 difficulty prevented not only from filling the 
 mouth, but entering the cavity of the tooth, 
 thereby frustrating to a certain extent the object 
 of the operator. 
 
 Tin-foil is the best material for plugging the 
 shedding teeth; it is introduced with facility, 
 requiring much less force than gold to enable 
 it to accommodate itself to the decayed parts, 
 and generally resists oxizidation until the per¬ 
 manent ones are ready to appear. 
 
 Gold is of less use in these cases, as consi¬ 
 derable pressure must be used to insert it into 
 the carious tooth; more indeed than can con¬ 
 sistently be used upon the jaws of young 
 people, and therefore the folds of the gold leaf 
 do not form a compact and solid substance. 
 
 When the permanent teeth are making their 
 
30 
 
 DENTITION IN CHILDREN. 
 
 appearance, being of larger dimensions than 
 the temporary ones, they naturally require a 
 greater space in the jaw; and if the jaw bones 
 are not properly developed to allow sufficient 
 room for the forthcoming teeth, it often be¬ 
 comes necessary to remove four of the shedding 
 teeth to admit two of the permanent, and 
 thereby prevent irregularities; the extraction of 
 three teeth might afford ample space, but when 
 this is practised the front teeth are apt to take 
 erroneous positions. 
 
 It is at this time that the attention of parents 
 ought to be directed to some habits which 
 children frequently imbibe, and which should 
 be corrected; if the child continue to keep the 
 thumb in the mouth for hours during sleep, the 
 front upper teeth must be naturally forced out¬ 
 wards, and the lower front ones inclined in¬ 
 wards, more than nature intended; the result 
 is, that the upper lip projects beyond the under 
 one, and thus injures the appearance and 
 natural contour of the mouth. This is deno¬ 
 minated the receding chin or rabbit mouth. 
 The thumb employed in the above way becomes 
 
DENTITION IN CHILDREN. 
 
 31 
 
 a complete lever, and being affixed to the hand 
 is used at pleasure. 
 
 Another habit is the turning the tip of the 
 tongue to the roof of the mouth, or, as it is 
 usually called, sucking the tongue;” this 
 action is effected by throwing out the under 
 jaw bone from its articulations^ The result will 
 be an under-hung jaw, and the* lower front teeth 
 will consequently shut outside the upper ones. 
 
 A similar state of the teeth and jaw bones is 
 induced when attempts are made by the inex¬ 
 perienced to regulate them, ,by the extraction of 
 teeth in the upper Jaw, and neglecting to re¬ 
 move an equal number in the lower. 
 
 The author has frequently suspected these 
 habits in persons when the teeth are under ex¬ 
 amination. It may be almost' superfluous to 
 mention that the cure and prevention of the 
 receding or projecting chin, are to be effected 
 by a discontinuance of the causes. 
 
 In young subjects a bandage (such as is used 
 in cases of fractured jaw bone) applied around 
 the chin, and fastened at the crown of the head 
 and back of the neck, prevents the jaw being 
 thrust fprwards. . 
 
32 
 
 CHAPTER III. 
 
 OF PERMANENT TEETH — NECESSITY FOR 
 EARLY ATTENTION—OF IRREGULARITIES, 
 AND OF MEANS USED FOR REMEDYING 
 THEM—CASES, &C. 
 
 In comparing the teeth in the lower animals 
 with those in the human subject, remarkable 
 differences present themselves, from which the 
 following facts may be deducted:—that irre¬ 
 gularities are very rare in the inferior animals, 
 while in the human race nothing is more com¬ 
 mon ; and that decay, and other diseases con¬ 
 nected with the teeth, are rarely observed in the 
 brute creation. 
 
 Irregularities not only detract from personal 
 beauty, but also from the beauty and durability 
 of the teeth; for in cases wherein one or more 
 front teeth in the lower jaw shut outside the 
 upper, the entire shock of the jaws during mas¬ 
 tication is received by three or four incisors. 
 
OF PERMANENT TEETH. 
 
 33 
 
 and considerable injury is also occasioned by 
 too much compression of the nerves and blood¬ 
 vessels supplying the teeth. 
 
 The causes of decay in the human teeth, are 
 probably identical with those which subject 
 their possessor to a much longer train of dis¬ 
 eases, and it is impossible to say but that par¬ 
 ticular complaints of the teeth may be inherited. 
 Premature decay may thus be induced, from an 
 unhealthy or deficient organization, and occasion 
 irregularities from a want of development in 
 the jaw-bones. 
 
 Intemperance of various kinds, combined with 
 artificial modes of living, introduced by civiliza¬ 
 tion, and the sudden transitions from heat to 
 cold to which the teeth are subjected, have un¬ 
 doubtedly a tendency to prevent development 
 of the bones, thus contracting the space for 
 due arrangement of the teeth, and inviting 
 decay. 
 
 Nations in northern latitudes are observed to 
 have the teeth much distorted; these decay very 
 rapidly; while others, in southern latitudes, 
 particularly those who eat their food cold, as the 
 
 D 
 
 \ 
 
34 
 
 OF PERMANENT TEETH 
 
 original inhabitants of New South Wales and 
 New Zealand, have the jaws filled with teeth 
 of a beautiful shape and colour, and remain 
 exempt from disease up to extreme old age. 
 
 All the above causes, as well as those already 
 enumerated in the preceding chapters, are in 
 operation, and combine in producing the several 
 states of disease to be considered in the following 
 pages. 
 
 About the sixth year the milk-teeth loosen, 
 and soon afterwards drop out, and the perma¬ 
 nent ones take their places. This process com¬ 
 mences in some persons at the fifth year, while 
 in others it is delayed until they arrive at seven 
 or eight years of age. Considerable importance 
 ought to be attached to this period of dentition; 
 the teeth should be frequently inspected, so 
 that .any incipient distortions may be corrected; 
 ‘‘ for as the twig is bent, so the tree’s inclined.” 
 The teeth bear indeed a remarkable similitude 
 to young trees, and may, like them, be made to 
 assume any shape which utility requires. Should, 
 however, this period be suffered to pass by, they 
 rigidly adhere to their unnatural situations, until 
 
AND IRREGULARITY. 
 
 35 
 
 brought back by energetic measures, applied 
 for a considerable period.^ 
 
 When the time has arrived for the shedding 
 of the primary set, the jaws have become consi¬ 
 derably enlarged, and the permanent teeth being 
 ready to appear, the gums must of necessity 
 occupy and form a dental circle of larger dimen¬ 
 sions than their predecessors; to this may be 
 attributed the several unnatural positions which 
 the permanent set occasionally take, the eight 
 molars excepted. 
 
 The order of dentition of the permanent teeth 
 takes place generally in the following manner. 
 
 About the time at which the lower central 
 incisors protrude from the gums, four large 
 grinders, situated at the back of the jaw, may 
 be expected; soon afterwards the upper central 
 incisors make their appearance, followed by the 
 lateral lower and lateral upper ones; next in 
 
 * “ The time to effect any material alteration in the position 
 of the teeth, is before thirteen or fourteen years of age ; for 
 after that time the sockets acquire a greater degree of strength; 
 and if the irregularity be left to a much later period, it be¬ 
 comes a great deal more difficult, and frequently all attempts 
 are fruitless.”—Fox. 
 
 D 2 
 
36 
 
 OF PERMANENT TEETH 
 
 succession are the bicuspides, and the lower 
 canine teeth; the remaining molars then succeed 
 each other. When these last-mentioned teeth 
 have protruded, considerable prominences may 
 be seen and felt in the gums, where the upper 
 canine teeth are situated; these are the last 
 which appear, until the coming of the “ wisdom 
 teeth.” 
 
 These occurrences generally occupy a period 
 extending from seven to eight years. 
 
 From various causes, especially those referred 
 to when treating of the milk-teeth, the perma¬ 
 nent ones appear in positions deviating more or 
 less from the natural 
 
 Much depends on the judgment and skill of 
 the dentist in regulating the extraction of the 
 primary teeth, and in preserving them in the 
 mouth to a proper period. In cases where they 
 have been improperly and prematurely removed, 
 the gums and alveolar processes shrink back to 
 the permanent ones, which are not yet suffi¬ 
 ciently advanced to occupy the places of the 
 temporary set, so that the space naturally be¬ 
 comes diminished. An attempt is made by 
 
AND IRREGULARITY. 
 
 37 
 
 nature to fill up the opening by inducing the 
 adjacent teeth to approximate in such a manner 
 as to prevent the jaw enlarging in proportion 
 to the increased number and size of the perma¬ 
 nent set; .the inevitable result is, that, when 
 the second set have protruded, they are forced 
 into irregular positions, deteriorating much from 
 the form and beauty of the face. 
 
 The permanent teeth are in every way of 
 larger dimensions, and require the jaws to be 
 of greater magnitude, than was necessary for 
 their predecessors. Hence arises the propriety 
 of bringing to aid all such means, as have a 
 tendency to promote ample and full develop¬ 
 ment of the jaw bones. 
 
 To satisfy the minds of parents upon the 
 accuracy of the above observations, let the 
 mouth of a healthy child be examined, whose 
 teeth are perfect in every respect; at the age 
 of three years, the teeth will be discovered 
 nearly touching each other at their sides; if 
 the mouth be examined at the fifth year, or a 
 few months previously to the commencement of 
 shedding, the teeth will be perceived to have 
 
38 
 
 OF PERMANENT TEETH 
 
 separated themselves to a considerable extent; 
 this is effected by expansion of the jaw bones, 
 an. operation of nature to allow the per¬ 
 manent and larger teeth to assume correct 
 positions.* 
 
 Irregularities in the teeth of the upper jaw 
 are of frequent occurrence; in some instances 
 one or both of the front central incisors project 
 much beyond the dental circle. This prominency 
 is usually denominated ‘‘ the rahhit mouth; '' 
 occasionally a front tooth is found widely sepa¬ 
 rated from its fellow ; the four front teeth may, 
 from a want of space, have uneven positions, so 
 as to shut partly inside and partly outside the 
 teeth of the lower jaw. The incisors, canine, 
 
 ^ “ The expansion of the jaw (the consequence of the 
 proportionable growth of the animal, and of its skull) neces¬ 
 sarily separates the teeth of the first set, however compactly 
 disposed, to a distance from oire another, which would be 
 very inconvenient. In due time, therefore, i. e. when the 
 jaw has attained a great part of its dimensions, a new set of 
 teeth springs up (loosening and pushing out the old ones be¬ 
 fore them), more exactly fitted to the space which they are 
 to occupy, and rising also in such close ranks, as to allow 
 for any extension of line wliich the subsequent enlargement 
 of the head may occasion.”— Paley’s Natural Theology. 
 
AND IRREGULARITY. 
 
 39 
 
 and bicuspid teeth often appear in erroneous 
 positions. - 
 
 ' Departures from the natural position of the 
 teeth are as frequent, though not so apparent, 
 in the lower as in the upper jaw; they however 
 differ in some respects, principally by the 
 defects being confined to the six front teeth, 
 though it sometimes occurs that the bicuspides 
 are affected. The four incisors are generally 
 very regular when they first protrude, and 
 maintain their positions until the time arrives 
 for the appearance of the canine teeth, when, 
 if the jaw bone is of confined dimensions, they 
 have the effect of forcing the incisors behind 
 one another, so as to resemble a double row of 
 front teeth. 
 
 The 'projecting chin' is also a consequence 
 of deformities of the teeth, commonly the lower, 
 though irregularities of the upper ones may 
 produce it. 
 
 The projection of the lower front teeth pre¬ 
 vents the upper taking their natural places; in 
 those cases wherein the teeth of both jaws come 
 in contact at their edges, the upper gradually 
 
40 
 
 OF PERMANENT TEETH 
 
 incline inwards; the lower teeth have an in¬ 
 clination outwards, and, as the teeth protrude 
 themselves further through the gums, this de¬ 
 formity is at length confirmed.^ This is readily 
 accounted for by the canine teeth in the lower 
 jaw protruding through the gums at a time when 
 there is not sufficient space to admit them in a 
 line with the incisors, and it is at this period 
 that the under-hung jaw becomes manifest. 
 
 * “ It is about the time of the completion of the first teeth 
 that the projecting under jaw begins to show itself, and 
 shortly before the appearance of the second set from the sur¬ 
 face of the gums. At the first commencement it occurs that 
 one or both of the first eye-teeth in the under jaw, are some¬ 
 what longer than the rest and are pointed on the top, so that 
 in shutting the mouth the under jaw is thus prevented taking 
 its proper direction. The child not being aware of the per¬ 
 nicious consequences, stretches out the lower jaw, attempts in 
 that manner to overcome the free action of the teeth, and 
 constantly is seen in the act of pushing the lower jaw out¬ 
 wards ; this unobserved or neglected at first, grows into a 
 determined habit; and a mischief at first easily controlled 
 becomes the foundation of this defect; for the jaw gradually 
 lengthens itself out from the articulation on each side, to 
 relieve itself from the bad position in which it was placed, and 
 thus the jaw becomes completely under-hung. The remedy 
 in the very early stage of the deformity is very easy, simple^ 
 and satisfactory.”— Sigmond. 
 
AND IRREGULARITY. 
 
 41 
 
 The generality of cases of irregularities of the 
 teeth may very readily be obviated by mecha¬ 
 nical pressure, though if no attention be paid 
 until after the period of puberty, relief is only 
 obtained with considerable difficulty by the 
 dentist and a corresponding perseverance on the 
 part of the patient. 
 
 The means resorted to by different practi¬ 
 tioners in regulating distortions of the teeth are 
 various. A knowledge of the principles con¬ 
 nected with the teeth is only to be gained by 
 long experience; and the dentist, however inge¬ 
 nious he may be, who is not acquainted with 
 these principles, will be constantly foiled in his 
 endeavours to rectify deformities, while the pa¬ 
 tient meets with nothing but disappointment, 
 and, in many cases, an increase of the malady. 
 
 The principal methods in use are—extraction 
 of one or more of the irregular teeth ; pressure 
 by means of springs attached at their extremities 
 to other teeth, assisted by ligatures of strong 
 silk; a variety of gags ; there is also the wedge, 
 a simple and effective instrument. All these 
 mechanical contrivances can be applied without 
 
42 
 
 OF PERMANENT TEETH 
 
 inducing pain, and are. attended with little in¬ 
 convenience to the patient. 
 
 • With reference to the extraction of irregular 
 teeth, the operation should never be attempted 
 but by those who have acquired considerable 
 experience and dexterity, and have in their 
 possession numerous instruments well adapted 
 to individual cases. Cases are constantly brought 
 before the' author’s notice, wherein fruitless at¬ 
 tempts do extract irregular teeth were followed 
 by detaching portions of enamel from a neigh¬ 
 bouring tooth and loosening adjacent ones. 
 Besides, it has sometimes occurred, not only in 
 extracting irregular teeth in the front of the 
 mouth, but also in teeth painful and decayed, 
 that a< sound one at the same time slips from its 
 alveolar cavity ; this untoward event arises from 
 a want of skill or nerve in the operator. It 
 may, however, be great consolation to the suf¬ 
 fering patient to be informed that, in cases of 
 this description, the sound tooth will, if re-ad¬ 
 justed in its socket, become securely and per¬ 
 manently fastened. 
 
AND IRREGULARITY. 
 
 43 
 
 SECTION I. 
 
 TREATMENT OF IRREGULARITIES. 
 
 Mechanical Means employed in obviating Irregularities — 
 
 Of Extraction and Regulation of the Teeth, 
 
 There is probably no part of a dentist’s prac¬ 
 tice which has given rise to such discrepancies 
 of opinion, and varieties of method, as the 
 treatment and modification of irregularities. 
 
 The consequences arising from the mal-prac¬ 
 tice of extracting the temporary teeth have 
 already been mentioned, as tending in a consi¬ 
 derable degree to prevent the natural develop¬ 
 ment of the jaws, and to predispose the 
 permanent set to assume improper and unfa¬ 
 vourable situations. 
 
 The front teeth in the upper jaw being larger 
 than those in the lower, led John Hunter and 
 other writers to suppose, that irregularities ^ 
 occur more frequently among the upper teeth.* 
 
 * ‘‘ This irregularity happens much oftener in the upper 
 jaw than in the lower, because the difference of the size of 
 the two sets is much greater in that jaw.” —Hunter, p. 198. 
 
44 
 
 OF PERMANENT TEETH 
 
 It should, however, be recollected that the 
 dental circle of the upper jaw is proportionally 
 .larger than the lower; and it will be found by 
 observation, that the teeth in both jaws are 
 equally liable to derangement; for the same 
 cause which operated in the production of these 
 derangements in the one will be just as effec¬ 
 tual in the other jaw. 
 
 Although mal-treatment of the temporary 
 teeth is occasionally a cause of irregularity, yet 
 disproportion between the jaw and the teeth is 
 the most frequent, arising from a want of deve¬ 
 lopment of the bones. The size of the teeth 
 are determined on at an early age, while the 
 jaw bones do not attain their full growth until 
 a much later period; the constitution may be 
 vigorous and healthy during the formation of 
 the permanent teeth, and, from a variety of 
 causes, become unhealthy and debilitated at 
 the time the jaws are acquiring their greatest 
 dimensions. As the proper growth of the 
 body depends upon the constitution being 
 healthy, so also must it determine the magni¬ 
 tude of the jaw bones. 
 
AND IRREGULARITY. 
 
 45 
 
 When only a crowded state of the teeth is 
 perceived about the age of puberty, or when 
 irregularity is partial and in its incipient form, 
 Mr. Bejl, in his publication on the teeth, (page 
 94) recommends a very thin file to be passed 
 between each tooth, so as to remove the slightest 
 possible stratum of enamel. The author depre¬ 
 cates this method as dangerous in the extreme; 
 a slight derangement may be thus regulated, 
 but it will have the effect of causing the teeth 
 to approach each other more closely, and, 
 being deprived of a portion of enamel by the 
 file, they are less able to resist the destructive 
 effects of lateral pressure, which will hereafter 
 be shown to be a cause of decay. 
 
 The correct treatment of teeth thus situated 
 is related at page 55. 
 
 In young persons, when one or both central 
 or lateral incisors have deviated from natural 
 positions, with their edges standing obliquely 
 in the jaw, they admit of being brought back 
 to their proper places in a very satisfactory and 
 expeditious manner. The following Case is an 
 example. 
 
46 
 
 OF PERMANENT TEETH 
 
 Case. — Master T-, aged seven years, 
 
 had the left central incisor in the upper jaw 
 turned. This was a confirmed deformity, as it 
 had come in contact with the lower teeth; and 
 on looking into the mouth, the side of the 
 tooth presented itself, one half projecting out¬ 
 side, while the other had a direction inside the 
 lower teeth. The outer edge became a source 
 pf irritation to the inside of the upper lip, and 
 had produced an unhealthy sore. 
 
 There was a sufficient space to allow the 
 tooth to be brought into a natural position, and 
 in a line with the edges of the adjacent teeth, 
 which was accomplished with an appropriate 
 pair of forceps, and the tooth detained in that 
 position by means of a ligature fastened to its 
 fellow; the tooth having become firm in a few 
 days after the operation, the ligature was re-* 
 moved, and it remains at the present period 
 even in the dental circle.* 
 
 * “ As neither the bodies nor the fangs of the teeth are 
 perfectly round, we find that this circumstance often becomes 
 a cause of their taking a twist; for, while growing, tliey 
 may press with one edge only on the completely formed 
 
AND IRREGULARITY. 
 
 47 
 
 This treatment is only applicable at an early 
 age, as the sockets are at that period compara¬ 
 tively soft and yielding. When it is deferred 
 until the body has obtained its full growth, 
 there is a liability of their being injured by 
 twisting the tooth round, and it does not so 
 readily fasten. The case is however one of in¬ 
 terest, inasmuch as the necessity for early 
 attention to these deformities becomes obvious. 
 
 Considerable mischief arises from allowing the 
 first set of teeth to remain in .the jaws too long; 
 the second set, in consequence, frequently take 
 erroneous positions, as is illustrated in the fol¬ 
 lowing :— 
 
 tooth; by which means^ they will be turned a little upon 
 their centre. 
 
 “ The alteration of these is more difficult than that of 
 the former; for it is in general impossible to apply, so long 
 and constantly as is necessary for such an operation, any 
 pressure that has the power of turning the tooth upon the 
 centre. However, in the incisors, it may be done by the 
 same powers which produce the lateral motion; but where 
 these cannot be applied, as is frequently the case, the 
 tooth may be pulled out entirely, and put in again even, 
 or it may be twisted round sufficiently to bring it into a 
 proper position.’^—H unter. 
 
48 
 
 OF PERMANENT TEETH 
 
 Case. —Miss B—, aged ten years, daughter 
 of Mr. B—, M.P., had the two upper central 
 incisors within the line of the dental arch, as was 
 manifest when the teeth were closed, these 
 being inside those of the lower jaw; the remain¬ 
 ing upper ones were in natural positions, viz. 
 shutting outside the lower teeth. Neglect in 
 removing the temporary teeth at the right period 
 was the cause in this instance. 
 
 A brief description of the mechanical contri¬ 
 vance had recourse to, in rectifying this defor¬ 
 mity, is subjoined; it is also applicable to a 
 variety of cases. An impression of the lower 
 front teeth was taken in wax, and modelled to 
 an inclined plane, resembling a wedge; this was 
 covered on all sides with plaster of Paris, leaving 
 a small opening at the top, through which the 
 wax was removed (having been previously im¬ 
 mersed in hot water), the plaster then became 
 a perfect mould, which, being thoroughly dried 
 and hardened, was completely filled up with 
 melted block-tin; on breaking away the plaster, 
 the tin was found to correspond precisely with 
 the wax impression, and fitted on the lower teeth 
 
AND IRREGULARITY. 
 
 49 
 
 with accuracy, maintaining its situation as 
 firmly as a rock. No ligatures were required, 
 nor was there occasion for caps to prevent the 
 back teeth coming in contact during mastication. 
 
 In a few days the irregular teeth were thrown 
 so far forwards as to shut outside the lower ones; 
 the use of the instrument therefore became un¬ 
 necessary : nature perfected the cure. 
 
 The author has been the more minute in 
 giving a description of the mechanical means 
 employed in the above case, on account of its 
 simplicity and great utility, and because it 
 differs so much from those used by many dentists 
 for similar distortions. 
 
 Mr. Bell, in his work on the teeth, has in¬ 
 troduced an improvement on the instrument 
 described by Mr. Fox. He mentions (page 99), 
 that Fox used a gold bar;” and also says, 
 “ that, instead of its being quite regular and 
 plane, it should be accurately stamped to a 
 brass cast of the upper teeth, so as to accom¬ 
 modate itself to all the depressions and ele¬ 
 vations presented by the series of the teeth, 
 excepting that it should stand a little for- 
 
 E 
 
50 
 
 OF PERMANENT TEETH 
 
 wards opposite the irregular tooth. It should 
 be so long as to extend just beyond the first 
 bicuspis in each side; two small holes are drilled 
 through it at the part corresponding to each of 
 those teeth, to the irregular one, and, if neces¬ 
 sary, to any other to which it may be thought 
 desirable to fasten it for greater security. Li¬ 
 gatures, consisting of strong silk twist, are passed 
 through these holes, the ends of each being 
 brought in front, and the bar is thus fastened, 
 first of all to the bicuspides, and then to the 
 irregular tooth. It is necessary that the liga¬ 
 tures should be applied quite up to the necks of 
 the teeth, or they will slip off. The closing of 
 the jaws is to be prevented by a method less 
 complicated, and less liable to derangement, as 
 well as firmer and more comfortable to the pa¬ 
 tient than the one formerly in use. It consists 
 of a simple cap of gold, made to fit very accu¬ 
 rately to a molar tooth, either of the upper or 
 lower jaw; I have usually found the former the 
 most eligible. The thickness of its surface must 
 be sufficient to prevent the lower front teeth from 
 interfering with the operation of bringing the 
 
AND IRREGULARITY. 
 
 51 
 
 irregular upper one forwards by means of the 
 bar.” 
 
 The ligature should be replaced about every 
 other day, and the bar should be wholly removed 
 whenever this is done, in order to cleanse it, as 
 it otherwise becomes offensive^ and irritates the 
 edge of the gum.” 
 
 The author presumes that, upon a re-perusal of 
 the means used in the case at page 44, itwill be suf¬ 
 ficiently obvious that the simplicity of the method 
 there made use of, and which so easily eifected 
 a cure, is a much less complex and inconvenient 
 instrument than the improved one of Mr, Bell. 
 In his, there is a band of gold to be fastened to 
 the teeth by three ligatures, and gold caps made 
 to fit other teeth, so as to prevent the lower front 
 teeth coming in contact with the irregular upper 
 ones, which they had done heretofore; the liga¬ 
 tures also required changing every other day, 
 to prevent unpleasant consequences. 
 
 Now the instrument used by the author was 
 a piece of block-tin, cast in a mould of the lower 
 teeth, which fitted with accuracy. Neither pain 
 nor inconvenience was produced; that portion 
 
52 
 
 OF PERMANENT TEETH 
 
 which projected above the lower teeth was filed 
 so as to resemble a wedge (hence its name), 
 with its plane inclining inwards; and when the 
 jaws were closed, the inner edge of the irregular 
 teeth touched the wedge, and were thus gra¬ 
 dually pressed forwards to the line occupied by 
 the other front teeth. 
 
 A great improvement may, however, be ef¬ 
 fected on the instrument described by Mr. Bell, 
 so as to render two out of three ligatures unneces¬ 
 sary. This may be accomplished by attaching 
 caps to the extremities of the gold hand, and 
 placing them on those teeth to which the two 
 end ligatures were fastened. The caps may vary 
 in number, in order to give a more extensive 
 grinding surface for mastication; then, the only 
 ligature to be used is the one which surrounds 
 the tooth requiring to be drawn into the dental 
 line. 
 
 The following case will readily illustrate the 
 difficulties in the management of children’s 
 teeth, with which a dentist has frequently to 
 contend, and which may be successfully over¬ 
 come, provided the parent or guardian is reason- 
 
AND IRREGULARITY. 
 
 53 
 
 ably patient and persevering. The mere removal 
 of a tooth, may be easily performed by any 
 operator; but to remove a tooth or teeth, which 
 shall lead to a happy and natural appearance, 
 requires both discrimination and decision on 
 the part of the dentist, and a confiding perse¬ 
 verance on the part of the parent. As, for ex¬ 
 ample, to obtain sufficient room for an eye-tooth 
 (they usually come late) to correspond exactly 
 with the eye-tooth in the opposite side of the 
 jaw, if an incisor (one of the four front teeth) 
 be extracted, to make way for a permanent eye¬ 
 tooth, there will then be an eye-tooth on one 
 side, awkwardly corresponding with a lateral 
 incisor on the other side. It frequently happens 
 that when a small grinder is removed, the late- 
 coming eye-tooth will naturally and easily take 
 its place, and appear to a superficial observer to 
 be quite natural. This is the proper treatment of 
 such a case. If, however, the eye-tooth pre¬ 
 sent itself more to the front of the mouth, the 
 removal of an incisor will permit the new eye¬ 
 tooth to slip quietly into its place, and produce 
 
54 
 
 OF PERMANENT TEETH 
 
 the deformity hinted at above. These cases 
 are common; they are readily performed, and the 
 parents are easily satisfied, because informed 
 there is no better way. 
 
 If the operator should propose any thing that 
 would require time, (some months,) the parent 
 will probably leave him for another and another 
 dentist, and that too after a step has been taken 
 by the first, which could only by him be carried 
 to a successful issue; and thus the young person 
 becomes the permanent victim of the unreason¬ 
 able impatience or niggardliness of the parent. 
 
 Case. —Without adverting here to the want 
 of development of the jaw, it will be suf¬ 
 ficient to state that the Hon. Miss G— had 
 arrived at an age when the shedding of the first 
 teeth was complete, and permanent successors 
 had supplied their places. The upper jaw was 
 as full of teeth as it could contain, and yet only 
 one of the eye-teeth had made its appearance. 
 At a periodical examination of the young lady’s 
 mouth, the point of a tooth was seen protruding 
 from the roof in the rear of the left lateral in- 
 
AND IRREGULARITY. 
 
 55 
 
 cisor. This was the deficient eye-tooth. The 
 appearance in such a place was unusual, and, as 
 it gradually descended, it pushed out the adja¬ 
 cent incisor. Had the incisor been extracted, 
 the new tooth would readily have fallen into its 
 place, only meeting the under jaw within the 
 teeth, while all the others closed outside in the 
 usual way. This state of affairs is easily reme¬ 
 died by the use of the wedge (described at page 
 44). Had this course been pursued, the young 
 lady’s mouth would have been so far deformed 
 that an eye-tooth would have to correspond 
 with a small lateral incisor on the other side of 
 the two handsome central front teeth. It was 
 determined to extract the first small grinder in¬ 
 stead, and, with much trouble on the part of the 
 patient and operator, the new eye-tooth was 
 trained to attain its proper place. The process 
 of cure occupied several months, during which 
 period the young lady visited the dentist 
 about half a dozen times, to have the little ap¬ 
 paratus that was employed altered. The teeth 
 are fully worthy of the trouble, and the fair 
 patient has now as uniform and beautiful a set of 
 
56 
 
 OF PERMANENT TEETH 
 
 teeth as can reasonably be desired. None but 
 those who try the experiment can appreciate 
 the difficulties of this case. 
 
 The eye-teeth are also frequently seen occu¬ 
 pying situations more or less removed from the 
 natural; these teeth, equally with the incisors, 
 are much larger than their predecessors. The 
 eye-teeth seldom appear before those on either 
 side have obtained fixed positions in the jaw; so 
 that in all cases wherein there exists a dispro¬ 
 portion between the teeth and the jaw, the eye¬ 
 teeth, from their lateness of appearance, must 
 deviate from the dental circle, shooting inwards 
 or outwards, or lapping over the lateral incisors. 
 The following case is in exemplification. 
 
 Case. —Master H—, aged fourteen, had the 
 eye teeth on either side in both jaws projecting 
 and forcing the lips outwards; the whole of the 
 teeth appeared crowded, and no space existed 
 for their falling into natural positions; the first 
 small grinders were removed in both jaws, and 
 in a short time the eye-teeth gradually fell into 
 the dental line occupied by the others. 
 
 This treatment may originate the annexed 
 
AND IRREGULARITY. 
 
 57 
 
 question. Why was one tooth removed to make 
 room for another ? or for what reason is a small 
 grinder to be extracted to preserve an eye-tooth? 
 The loss of an eye-tooth will detract more from 
 the beauty of the teeth; the small grinders 
 will much sooner decay, while the former are in 
 every way stronger and more valuable when 
 artificial teeth are required to supply the place 
 of natural ones. 
 
 When the jaw bones are too narrow from side 
 to side near their anterior parts which support 
 the front teeth, then the following irregularities 
 are produced:—the incisors in the lower jaw 
 generally slide past each other, while those in 
 the upper jaw more commonly project outwards; 
 this, however, occurs generally in the upper 
 central incisors, and materially affects the ex¬ 
 pression of the face. The following is an in¬ 
 stance. 
 
 Case. —Master D—, aged fifteen, had two 
 central incisors in the upper jaw, projecting in a 
 frightful degree, with their edges turned in ob¬ 
 lique and contrary directions. As the two first 
 permanent molars (or six-years-old teeth,) were 
 
1 
 
 58 OF PERMANENT TEETH 
 
 in this instance very much decayed, their removal 
 was determined on. This operation relieved 
 the teeth generally from lateral pressure, and 
 room was thus procured for the two irregular 
 teeth to obtain less objectionable situations, with 
 the assistance of the mechanical contrivances 
 about to be described. A model of the mouth 
 was taken in the usual manner, and a plate was 
 made to extend across the roof of the mouth to 
 the small grinders on each side; these were co¬ 
 vered with caps, fastened to the ends of the plate, 
 so constructed as to press against the inner edges 
 of the irregular front teeth; a band was formed 
 and soldered to the outside of the caps, and, 
 when applied, pressure was directed against 
 the outer edges of the oblique teeth, and kept 
 up by a ligature being passed through a hole in 
 the plate, and tied over the band in front; this 
 was renewed daily. In a few days it was found 
 necessary (from the gradual receding and turn¬ 
 ing of the teeth into natural situations,) to have 
 the band cut; a small piece was taken out, again 
 soldered, and re-adjusted to the teeth, so as to 
 maintain a considerable degree of pressure on 
 
AND IRREGULARITY. 
 
 59 
 
 their projecting edges. Several small pieces of 
 the band were from time to time removed, as 
 often as the teeth inclined towards proper posi¬ 
 tions, which was accomplished in about three 
 months,—the projection being diminished by 
 one-fourth of an inch. This case gave great 
 satisfaction to all concerned, having resisted the 
 treatment of an eminent dentist, and being 
 given up by him as incurable. 
 
 The subjoined case is one of slight irregu¬ 
 larity. 
 
 Case. —Miss D—, aged sixteen, daughter 
 of the Hon. Mr. D—, had several of the front 
 teeth in both jaws slightly irregular, which could 
 have been seemingly remedied by passing a thin 
 file between them; but whenever the wisdom- 
 teeth had protruded through the gums, the result 
 was a close approximation of the front teeth, 
 and ultimate destruction by lateral pressure, 
 as already illustrated, (page 41.) 
 
 In this case the posterior bicuspides in each 
 jaw were removed; the vacancies soon filled up, 
 by the front teeth inclining backwards, and the 
 molars coming forward.—There being ample 
 
60 
 
 OF PERMANENT TEETH. 
 
 space in the jaws, the wisdom-teeth appeared in 
 regular and upright positions. 
 
 Whenever the six-years-old teeth are affected 
 with caries (as they frequently are) they should 
 be extracted; care must also be taken to remove 
 an equal number of teeth in both jaws, or the 
 dental circle will be decreased in the one, while 
 that of the other jaw would not be diminished 
 in proportion. 
 
 In the foregoing cases are described the prin¬ 
 cipal irregularities to which the teeth are liable. 
 They are selected from a number of similar ones. 
 The mechanical means also admit of alterations, 
 
 and can be adapted to every variety of dis¬ 
 tortion. 
 
61 
 
 CHAPTER IV. 
 
 OF CARIES, AND OTHER DISEASES OF THE 
 TEETH-OF THEIR DEFECTIVE ORGANIZA¬ 
 
 TION—EFFECT OF LATERAL PRESSURE, AND 
 
 ACCIDENTAL CAUSES OF DECAY-OF THE 
 
 TREATMENT—STOPPING AND SCALING OF 
 TEETH. 
 
 Within the last few years the subject of 
 decay in the teeth has occupied a considerable 
 share of public attention. It was at all times 
 considered to be a desideratum among the pro¬ 
 fession to discover means whereby decay might 
 be best prevented,* and when incurred, to be 
 
 * However useful the improvements in medical science 
 have been to society, in the alleviation and cure of diseases 
 incident to the mouth and teeth, the preventive means, which 
 Mr. Fox termed ‘‘ the delightful secret,” will, if prosecuted 
 and brought forward, supercede the necessity of every other ; 
 since the want of preventive means has been one great cause 
 of human misery, and the only reason why mankind do no 
 longer retain these important organs for masticating their 
 food, and preserving a perfect voice, the functions of which 
 apparatus constitute, in some degree, a main spring of life.”— 
 L. S. Parmly. 
 
62 
 
 DISEASES OF THE TEETH. 
 
 able, by the application of suitable remedies, to 
 arrest its progress, and thus preserve the teeth 
 • in the jaws to the latest period of life. 
 
 The extraction of molar teeth involves a prin¬ 
 ciple of much greater importance to the commu¬ 
 nity at large, than, from a superficial view of the 
 subject, it would be likely to obtain. 
 
 The very construction of the teeth should 
 make it manifest that they were originally de¬ 
 signed by nature to last equally with the living 
 body. By various causes incident to civilization 
 and society, the operations of nature have been 
 frustrated, and destruction of the teeth has re¬ 
 sulted. 
 
 There are few teeth, when decay has once 
 attacked them, that gradually moulder away 
 without the patient being tormented with pain, 
 in some instances of an aggravated nature; 
 and from the great inclination existing in the 
 human mind to free itself from every inconve¬ 
 nience and painful feeling, extraction is resorted 
 to, as the most common and certain means of 
 obtaining relief. 
 
 How few people arrive at the age of twenty 
 
DISEASES OF THE TEETH. 
 
 63 
 
 without experiencing the effects of extraction! 
 But the infliction of pain is trifling in importance, 
 when compared with the almost irremediable 
 injury arising from the loss of large grinding 
 teeth. A tooth perhaps but slightly affected 
 with caries, which, if attended to in time, 
 would answer every purpose of mastication 
 to an indefinite period, is, whenever pain 
 supervenes, subjected to the operation of 
 extraction. Is the pain inflicted by the in¬ 
 strument used the only evil to be dreaded? 
 Certainly not. When the mouth is filled with 
 the proper complement of teeth, and the dental 
 circles are perfect, it will be seen, as the jaws 
 close with a slight force, that the back teeth 
 come in contact on their grinding surfaces, 
 and alone receive the shock; and moreover, that 
 the front teeth of each jaw scarcely touch each 
 other, (when the molar teeth are fairly brought 
 together) as the front teeth of the upper pass out¬ 
 side those of the under jaw. 
 
 Now, whenever a large grinder is extracted, 
 its opponent in the other jaw becomes, to a cer¬ 
 tain extent, useless. Mastication is performed 
 
64 
 
 DISEASES OF THE TEETH. 
 
 by bringing two opposite surfaces into contact, 
 accompanied by the rotatory motion of the jaws; 
 the extraction therefore of a tooth deprives its 
 antagonist of its grinding property, and in the 
 course of time this tooth advances higher or 
 lower (in whichever jaw it is situated) than the 
 neighbouring ones; this is an effort of nature to 
 fill up the space left by the extracted tooth. 
 
 It has been already remarked, that the molar 
 teeth generally decay in pairs, and it will also 
 be found that the corresponding teeth in the 
 other jaw are liable to similar affections pro¬ 
 duced by the same causes. 
 
 Whenever a certain number of molar teeth 
 have been extracted, the remaining ones are de¬ 
 prived of their antagonists, and mastication must 
 then be performed with the front teeth. Persons 
 in this situation will discover, upon shutting the 
 jaws with some force, that the shock is received 
 by the front, instead of falling on the back teeth, 
 as was the case heretofore. They may then pre¬ 
 pare for very speedily being deprived of all the 
 remaining teeth, which either decay rapidly, 
 from having their posterior surfaces ground away 
 
DISEASES OF THE TEETH. 
 
 65 
 
 by the sharp edges of those in the lower jaw, 
 or become loose in consequence of the sockets 
 being absorbed by incessant irritation, and ulti¬ 
 mately drop out. These are inevitable conse¬ 
 quences, though sometimes effected in a very 
 gradual manner, and by insidious means.* The 
 
 * The loss, however, of a tooth is of more serious impor¬ 
 tance than we may probably imagine; there is always a dis¬ 
 position in the anterior and posterior, as well as the lateral 
 sides of the socket, to approximate, and the pressure which 
 the extracted tooth bore is thrown upon those contiguous to 
 it; they have consequently to support an additional pressure, 
 and become much sooner weakened than if the mouth had 
 remained in its original state. A regular pressure on all 
 the teeth is necessary, however, to their economy, and we 
 will again consider another reason why the extraction of a 
 tooth should not be resorted to without it is indispensably 
 requisite. There is in the sockets a disposition to fill up, and 
 thus the pressure of the two jaws against each other tends to 
 counteract.”—G. Waite. 
 
 “ It will be readily understood how, in absence of double 
 teeth, an unusual pressure falls on the front, or single ones, 
 every time the mouth is shut, the front teeth of the under 
 jaw rubbing forcibly against those of the upper, grind down 
 by attrition, or loosen each other. The proper remedy for 
 this state of affairs is to fill up by artificial means the ravages 
 of time, of heedlessness, and tooth-drawing, thereby restoring 
 in a great degree, and in the proper quarter, the usual powers 
 of mastication.”— Patterson Clark. 
 
 F 
 
66 
 
 DISEASES OF THE TEETH. 
 
 cheeks fall in, the voice changes, the nose and 
 chin approach each other, and the countenance 
 strongly indicates and characterizes premature 
 old age. 
 
 Such are the daily melancholy consequences 
 arising from the too common practice of indis¬ 
 criminately extracting molar teeth, however 
 much or slightly decayed. 
 
 The author cannot conclude this part of the 
 subject without directing the attention of the 
 medical profession, their assistants, and pupils, 
 who are engaged occasionally in extracting 
 teeth, to the above remarks, and he trusts 
 that they will ponder well before depriving 
 even the most humble individual of a tooth, 
 as (in nineteen ca^es out of twenty) it could 
 have been relieved of pain, permanently plugged, 
 and would have remained in the jaw answering 
 all the purposes of its office to extreme old age. 
 
 The principle involved in extraction is the 
 following, that when the jaws are closed and 
 the teeth are perfect, the molares of each jaw 
 touch at the grinding surfaces, and the front 
 upper ones pass over those in the lower jaw; 
 
DISEASES OF THE TEETH. 
 
 67 
 
 but, when the back teeth are extracted or 
 worn down, the pressure in mastication is thrown 
 upon the front ones, which not being intended 
 by nature for masticating or grinding down 
 hard substances, (as is apparent from their shape 
 and situation) loosen by attrition, and one after 
 another become ejected from the sockets. 
 
 There is certainly very little knowledge ex¬ 
 tant concerning the causes of decay, and also 
 of the means by which the teeth, especially 
 the front ones, are lost; a deprivation always 
 to be regretted, but the more so when it occurs 
 prematurely, or about the middle period of life. 
 
 SECTION I. 
 
 CAUSES OF DECAY. 
 
 I.—It has been shown that incipient decay was 
 in some instances perceived in the primary teeth 
 a few days after emerging from the gums, 
 caused by defective organization, or by a super¬ 
 ficial covering of enamel, which in many in¬ 
 stances was altogether wanting in the centre of 
 
 F 2 
 
68 
 
 CAUSES OF DECAY. 
 
 the masticating surfaces. The same defects 
 frequently exist in the permanent teeth. In 
 some instances, several cracks are visible in 
 the enamel, indicating imperfect union. 
 
 It is, during the formation and growth of the 
 teeth, and previous to their appearance in the 
 mouth, that the imperfect covering of enamel 
 is produced; the ^‘ six-years-old'’ teeth appear 
 to suffer more from this cause than any of the 
 others. If particles of food are allowed to re¬ 
 main upon the surface of a tooth having a 
 pitted enamel, they will in time insinuate them¬ 
 selves between the cracks, and decomposition 
 rapidly follows. Before this event can take 
 place, there must necessarily exist defective 
 enamel favourable for the development of caries, 
 and likewise the constant or occasional pre¬ 
 sence of extraneous and adventitious matter.’’ * 
 
 * “ Were it possible to keep every part of a tooth at all 
 times perfectly clean, it is presumed that decay would be 
 as slow to commence in the hollow as in the prominent 
 parts. The reason why this species of decay seldom appears 
 in front teeth, is, that they have but single pointed wedge¬ 
 like shapes, on whose surfaces few indentations exist, as in 
 the double teeth, for the lodgment and decomposition of 
 food and moisture.”— Patterson Clark. 
 
CAUSES OF DECAY. 
 
 69 
 
 The enamel of the front teeth is sometimes 
 pitted or honey-combed, and when moisture 
 gains admittance, they become discolored, and 
 decay ensues; this, however, is not so frequent 
 as in the grinders.* 
 
 II.—Another and very common cause of 
 decay, applicable alike to temporary and 
 permanent teeth, is an over-crowded state of 
 the mouth, described as lateral pressure'' 
 
 Even in the young subject the injurious ten¬ 
 dency of a crowded state of the teeth is as 
 perceptible as in the adult. As a general rule 
 it may be remarked, that in all cases where the 
 teeth touch one another at the sides decay may 
 be expected. 
 
 * Though this disease attacks all the teeth without 
 distinction, yet it may be considered as a general rule, that 
 the grinding teeth more frequently suffer from this malady 
 than the incisors and cuspidati; and that the bicuspides or 
 small grinders, incisors, and cuspidati of the upper, are 
 generally much more subject to caries than the same teeth 
 in the under jaw. The large grinders are affected with this 
 disease, most commonly on the grinding surfaces, whereas 
 the small grinders, and front teeth generally, suffer from it 
 on those sides which are in contact with the adjoining teeth.”— 
 Leonard Koecker. 
 
70 
 
 CAUSES OF DECAY. 
 
 The evils arising from premature extraction of 
 the temporary teeth have been shown to retard 
 the growth of the jaw and arrest its develop¬ 
 ment; these defects will, however, be more 
 apparent where the permanent set are only with 
 great difficulty able to attain upright positions. 
 The lateral pressure against each other is in¬ 
 creased, while the unyielding substance com¬ 
 posing enamel becomes injured; and upon the 
 admission of moisture and lodgment of impuri¬ 
 ties, a black speck will be manifest, indicative 
 of decay having commenced. Continued pres¬ 
 sure is attended with precisely the same effects 
 on the teeth as in every other part of the human 
 frame, producing either absorption, or depriva¬ 
 tion of vitality. This latter affection, when it 
 occurs in the teeth, assumes the primary appear¬ 
 ance of a dark speck,^ and upon the admission 
 
 * “This speck gradually enlarges as the enamel becomes 
 decomposed by the agency of the impure matter which con¬ 
 stantly lodges there : it also makes its way to the bone, which 
 from exposure to air and moisture, soon becomes soft and 
 spongy, and is consequently well adapted for retaining the 
 noxious principle that destroys teeth.”— Patterson Clark. 
 
CAUSES OF DECAY. 
 
 71 
 
 of moisture becomes more discoloured and ulti¬ 
 mately decayed. 
 
 Nature occasionally obviates this disposition 
 to decay from lateral pressure, when the jaws 
 are contracted, by causing the front teeth to 
 slide past each other; thus preferring irregu¬ 
 larity to painful decay and ultimate destruction. 
 However, if particles of food are allowed to 
 decompose between these teeth, decay will often 
 be the result. 
 
 The same rule that is applicable to molar 
 teeth wherein decay commences by affecting 
 them by pairs, from defective organization, is 
 equally so from lateral pressure; for, as the 
 same tooth in both sides of each jaw is formed 
 at the same time, so the causes of decay, (what¬ 
 ever they may be,) will operate in an equal 
 degree, and in a similar manner. 
 
 III.—The following causes may be said to be 
 accidental and of an indirect character. They 
 have influence only upon a single tooth, such 
 as is evinced by an accident, fracture by external 
 violence, or a tooth coming in contact with a 
 stone mixed with particles of food. 
 
72 
 
 CAUSES OF DECAY. 
 
 The injurious tendency of acids to combine 
 with and ultimately destroy the enamel, more 
 particularly when it is not of the usual charac¬ 
 teristic hardness, has the effect of denuding 
 the teeth, and facilitates the wasting away of 
 the bony substance or internal texture. This 
 description of decay commences at the neck 
 of the tooth, close to the edge of the gum; the 
 former is, therefore, extremely tender when 
 touched with any hard substance. Hence arises 
 the necessity of avoiding the frequent use of 
 liquids possessing acid qualities ; and, in those 
 instances where the enamel is known to be of 
 a preternatural softness this circumstance cannot 
 be too rigorously attended to. Ripe fruit, how¬ 
 ever, should not be avoided, as a moderate use 
 of it rids the teeth of incipient depositions of 
 tartar, which is the reason why they are whiter 
 in the fruit season than in any other; when, 
 however, it produces unpleasant sensations it 
 may naturally be concluded that a defective state 
 "of the enamel exists. 
 
 There are some persons whose saliva appears 
 
CAUSES OF DECAY. 
 
 73 
 
 of a contrary nature to that generally secreted.* 
 It is known by being of a thick, viscid, and 
 stringy appearance, flowing into the mouth in 
 small quantities, and producing an odour of its 
 own kind; it is in these persons that a denuded 
 
 * Acid saliva .—The case is that of a patient. On visit¬ 
 ing him to-day he complained of having pain in all his joints; 
 he has also an ulcerating sore on the posterior and upper part 
 of the right thigh. Mr. Brodie tested his saliva and found it 
 acid. ^ It ought to have been alkaline.^ Mr. Brodie also 
 observed, ‘ It is a very singular fact, but Dr. Prout in¬ 
 formed me that he has met with a great many persons who 
 have acid saliva, and since he has named it to me, I have 
 remarked the same circumstance myself in several of my own 
 private patients. Now this is a very extraordinary fact, and 
 should only be met with in cases where there is very great 
 disorder of the system.’ ”—Report of Hospital Cases .— 
 Lancet, 1832, Vol. ii. 
 
 ‘‘ The fluid of a salivary gland has never been directly 
 analysed; it is always the fluid found in the mouth, which, 
 in fact, is invariably found to be entirely composed of saliva. 
 It has been found limpid, viscous, without colour or smell, of 
 a sweet taste and a little heavier than water. 
 
 ‘‘ M. Berzelius states it to be formed in the following 
 manner:—water 992*9; a peculiar animal matter 2*9; 
 mucus 1*4; muriate of potash and soda 0*7 ; tartrate of 
 soda and animal matter 0*9; soda 0*2. It is probable that 
 this composition of the saliva varies, for under certain cir¬ 
 cumstances it possesses a sensibly acid taste.”— Majendie’s 
 Elements of Physiology. 
 
74 
 
 CAUSES OF DECAY. 
 
 state of the teeth is so frequently detected, from 
 its attacking them indiscrimately. 
 
 . How far the use of a variety of tooth-powdey^s, 
 tinctures^ lotions, ^c, may injure the teeth, it is 
 impossible to state. All person should be mind¬ 
 ful of the quackery connected with advertise¬ 
 ments, and should also confine themselves to 
 substances recommended only by respectable 
 dentists. 
 
 Considerable injury is inflicted on the teeth 
 by the vicissitudes of cold and heat. The che¬ 
 mical changes produced by these causes deserve 
 mention. The teeth of savage nations, as has 
 been remarked, who partake of food and liquids 
 only in a cold state, are generally exempt from 
 the effects of decay. 
 
 Certain organic diseases appear to affect the 
 teeth in various ways; for instance, those of 
 consumptive people are frequently of a pearly 
 whiteness, indicative of a want of vascularity, or 
 debility of the circulating system. 
 
 There are other causes of decay which have 
 their origin primarily in the alveolar processes, 
 diseases of the roots of teeth, gumboils, affec- 
 
TREATMENT OF DECAY. 
 
 75 
 
 tions of the lining membrance of the sockets or 
 of the fangs, and many other maladies, some 
 of which owe their origin to a want of clean¬ 
 liness. 
 
 SECTION 11. 
 
 TREATMENT OF DECAY, &c. 
 
 Necessity of early Attention—Remedies to relieve Pain and 
 Inflammation—Utility of Plugs—Of Chalky Teeth. 
 
 When decay has commenced, either in a tem¬ 
 porary or a permanent tooth just protruded 
 through the gum, it is remarkable in how short 
 a period a large cavity is formed; so rapid in¬ 
 deed is the process of decomposition, that in 
 some instances a few months will be sufficient 
 to form a larger decayed cavity than can be 
 effected in old teeth after many years have 
 elapsed from the first appearance of disease. 
 The six years old molar teeth are frequently 
 attacked with disease, and become the victims 
 of extensive and rapid decay, in consequence of 
 their being frequently mistaken for shedding 
 teeth. 
 
76 
 
 TREATMENT OF DECAY. 
 
 To understand how such extensive caries can 
 be so speedily produced, attention must be 
 directed to the difference of structure existing 
 between the teeth of young persons and those of 
 mature age. A young tooth has a large cavity, 
 and its vascular, or living principle, is abundantly 
 furnished. This very active condition of the 
 vascular portion of a tooth is 
 with other parts of the body of a child. The 
 bony structure is not of the usual denseness, nor 
 is its substance so compact as in an old tooth; 
 the absorption of moisture is therefore facili¬ 
 tated, and decomposition quickly induced. 
 
 On the contrary, an aged tooth has very fre¬ 
 quently its cavity obliterated by depositions of 
 ossific particles, while its structure becomes 
 hard; so much so, that when accident has re¬ 
 moved the enamel, the bone assumes an ap¬ 
 pearance resembling the primitive covering. If 
 the mouth of an old person be examined, wherein 
 teeth have resisted decay, they will be found to 
 possess qualities hard and brittle, as a piece of 
 rock or crystal. 
 
 Incipient decay of the teeth may be detected 
 
 strictly in unison 
 
TREATMENT OF DECAY. 
 
 77 
 
 by a speck or line of a dark brown colour, in 
 one or more of the depressions on their grinding 
 surfaces; at other times it appears on the side 
 of a tooth. This discoloured speck, sooner or 
 later, breaks down, from an extension of the 
 caries, and the bone becoming soft and spongy, 
 an opening is made into the cavity, and by 
 exposure to air and the admission of foreign sub¬ 
 stances, pain is induced. 
 
 It is always a duty on the part of the parent, 
 therefore, to have the teeth inspected at short 
 intervals, in order to discover decay, and to have 
 the disease early eradicated. The places of such 
 portions as are taken away should be filled up 
 with a stopping of gold or tin leaf, introduced in 
 an efficient manner. This operation is frequently 
 performed at one sitting, and if decay be thus 
 arrested in due time, with proper attention paid 
 to cleansing the tooth, and no unforeseen ac¬ 
 cident occurs, it will endure to extreme old age. 
 
 Should a tooth wherein decay, from various 
 circumstances, has been permitted to continue 
 until it is extremely tender and painful, and 
 
78 
 
 TREATMENT OF DECAY. 
 
 the cavity be exposed, the inflammatory symp¬ 
 toms must be relieved, and the tooth brought into 
 a state fit for the reception of a plug ; to answer 
 this purpose, a piece of cotton-wool, dipped in 
 mastic varnish, and gently introduced into the 
 cavity, so as effectually to prevent the admission 
 of air and moisture, will, in almost all cases, 
 be attended with relief from pain, and a sub¬ 
 sidence of other inflammatory symptoms. 
 
 Relief will be more certain, if precaution be 
 taken to cleanse out the cavity of adventitious 
 matter, and if a small quantity of camphorated- 
 spirit on cotton be applied previously^to using 
 the mastic. 
 
 The cessation of inflammatory action is indi¬ 
 cated, not only by the absence of pain, but it 
 allows of the diseased portions being cleared 
 out, and afterwards permanently stopped in the 
 usual way. In some cases, several applications 
 of the mastic are necessary, at intervals of a 
 week each. It should, however, be recollected 
 that in no instance can a tooth be preserved, or 
 decay arrested, unless the cavity is hermeti- 
 
TREATMENT OF DECAY. 
 
 79 
 
 cally sealed by the plug, to the utter and com¬ 
 plete exclusion of air and moisture, which are 
 the principal causes of decay. 
 
 Whenever a plug is prematurely introduced 
 into a decayed cavity, or before the tooth is 
 brought to a healthy condition, pain is liable 
 to return, and on removing the stopping, matter 
 and blood will sometimes flow. 
 
 A tooth wherein decay has made considerable 
 havoc, and reduced it to a mere shell, is not 
 unlike a worm-eaten " nut, having a tiny hole 
 only visible. This will break down by its in¬ 
 ability to bear pressure of the opposite tooth, 
 when hard substances are to be encountered. 
 Many persons suppose (from the absence of 
 pain and uneasiness), that the breaking in of 
 a tooth was entirely the effect of accident at 
 the time, and are not aware that decay of an 
 insidious nature had existed some time pre¬ 
 viously. Now, although a tooth so situated 
 may be permanently plugged, yet it is of little 
 use for the purposes of mastication, if its grind¬ 
 ing surface be lower than the neighbouring teeth. 
 If there already exist a deficiency of molar 
 
80 
 
 TREATMENT OF DECAY. 
 
 teeth (the result of extraction or neglect), so 
 as to threaten the safety of the front ones by 
 frequent collision in mastication, it often be¬ 
 comes necessary to lengthen the grinding 
 surface of the decayed, and worn-down tooth 
 to its original level, that it may come in contact 
 with the opponent tooth, when the jaws meet 
 each other, and thus be enabled to take its 
 share in performing the office of mastication; 
 the treatment for remedying this and similar 
 defects are mentioned in the chapter on arti¬ 
 ficial teeth. Section 11. 
 
 When a front tooth is slightly decayed, or when 
 only a dark spot is to be seen, it may be eradi¬ 
 cated by appropriate instruments ; and, if kept 
 perfectly clean, decay will make no further 
 progress. If the disease have advanced to the 
 interior of the tooth, the treatment must be the 
 same as that recommended for the molares. The 
 cause of decay in the front teeth arises from a 
 crowded state of the mouth and neglect of 
 cleanliness, as has been already indicated. 
 
 In considering the treatment of temporary 
 teeth it was mentioned that the best stopping 
 
TREATMENT OF DECAY. 
 
 81 
 
 is tin-foil; this substance corrodes by the action 
 of air and moisture. The process, however, is 
 the work of severaFyears, and by the time this 
 is accomplished, the permanent teeth protrude 
 through the gums and supply the places of the 
 first set; should the stopping be within the range 
 of the tooth brush it will remain unoxidized. 
 In some peculiar cases of decay, it is advisable 
 first to use a certain quantity of tin-foil, and to 
 fill up the remainder of the cavity with a layer 
 of gold leaf. 
 
 Great attention must be paid that the stopping 
 does not rest upon the gum, especially in cases 
 where decay is situated at the side of the tooth. 
 
 When a portion of enamel has become de¬ 
 tached close to the edge of the gum, decay 
 spreads very rapidly to the centre of the tooth; 
 when touched with a hard substance a thril¬ 
 ling pain is experienced. On removing the dis¬ 
 ease, the tooth will be found to be of a character 
 denominated “ chalky,and in a short period it 
 crumbles away to the stumps, unless the cavity 
 be discovered in due time, and prompt measures 
 are used for preservation 
 
 G 
 
82 
 
 TREATMENT OF DECAY. 
 
 The application of camphorated-spirit ap¬ 
 pears to retard, in some measure, the progress 
 of decay in these teeth, and prepares them for 
 receiving a permanent stopping. It is a custom 
 with many persons to wash the mouth after 
 using the spirit, which should never be done, 
 as its beneficial effects are thereby frustrated. 
 
 The structure of the wisdom-teeth is occa¬ 
 sionally detected as being of a soft and chalky 
 nature; they are the last that appear in the 
 jaws, and are frequently the first affected by 
 decay; their defective construction always pre¬ 
 disposes to disease, which generally proceeds 
 with great rapidity; it is also a common occur¬ 
 rence to find teeth similarly organized in various 
 parts of the mouth. 
 
 For a tooth very much decayed and reduced 
 to a mere shell, so that no stopping can be 
 retained on account of pain or tenderness, and 
 which is necessary to be preserved for purposes 
 of mastication, a gold cap, as is mentioned in 
 the fifth chapter, should be so constructed as to 
 fulfil this intention. 
 
OF TARTAR. 
 
 83 
 
 SECTION III. 
 
 OF TARTAR. 
 
 How produced—Symptoms of—Effects of Uncleanliness — 
 Treatment required—Causes of Scurvy. 
 
 The gums and sockets of the teeth are subject 
 to a variety of diseases. It is, however, not 
 improbable, that peculiarity of constitution may 
 be, to a certain extent, considered a cause. 
 The saliva of many persons has been shown to 
 be marked by qualities differing from those pos¬ 
 sessed by mankind in general. Earthy particles 
 are more abundantly deposited around the necks 
 of the teeth of such persons, and concretions are 
 formed, resembling in every respect, those 
 produced by tartar, and attended by similar 
 consequences. 
 
 These concretions increase rapidly when fric¬ 
 tion with a tooth-brush is sparingly used. 
 
 Some authors have imagined, that tartar and 
 other accretions collect principally in those parts 
 of the mouth where the tongue is less frequently 
 applied to the teeth. But it will be found that 
 these substances are generally attached in 
 
 G 2 
 
84 
 
 OF TARTAR. 
 
 greater quantities to the outside of the molar 
 teeth in the upper, and on the inside of the front 
 ones in the lower jaw. To account for this, it 
 must be mentioned that the ducts of the salivary 
 glands, through which the saliva flows into the 
 mouth, are opposite these situations ; and there¬ 
 fore it is that tartar collects about the teeth 
 nearest the terminations of these ducts. 
 
 The presence of tartar is always known by 
 the gums being red, painful, swollen, and bleed¬ 
 ing freely whenever a tooth-brush is applied, 
 attended with a state of the breath exceeding the 
 odour arising from the most putrescent sub¬ 
 stances, and contaminating the air around. The 
 shock given to persons who unfortunately come 
 near a mouth so situated, is better imagined 
 than described; but so it is, that tartar has 
 been suffered to remain for years unbroken, while 
 particles of food which lodge about the teeth 
 after every meal, pass into putrefaction, until 
 the whole line of gums become diseased and 
 detached from the teeth; the sockets are at 
 length involved in the diseased action, become 
 slowly, but surely, absorbed; the teeth appear 
 
OF TARTAR. 
 
 85 
 
 to have elongated, are found chattering and 
 unsupported in the ja^vs, and are finally ejected 
 from their positions at irregular and distant in¬ 
 tervals. The mouth is thus left a complete 
 wreck, and the constitution participates in the 
 consequences.* 
 
 It is proper here to remark, although it will 
 increase the chagrin of persons concerned, that 
 
 * ‘‘ When it has increased so much as to touch the 
 gums, (which very soon happens, especially in the angle 
 between the teeth), it produces ulceration of that part, and 
 a train of bad consequences. Often the gums receding from 
 this matter, become very tender and subject to hoemorrhage. 
 
 “ The disposition of the juices of the mouth to abound 
 so much with earth, seems to be peculiar to some people, 
 perhaps to some constitutions; but I have not been able to 
 ascertain what these are. We find persons who seem to 
 have nothing particular either in constitution or way of life, 
 so subject to this accumulation, that the common methods of 
 prevention, such as washing and brushing the teeth, have not 
 the desired effect. 
 
 “ It is very apt to accumulate on a tooth, the opposite of 
 which is lost. 
 
 ‘‘ I once saw a case of this kind, where the accumulation, 
 which was on a grinder, appeared like a tumour on the 
 inside of the mouth, and made a rising in the cheek, which 
 was supposed by every one that felt it, to be a scirrhous 
 tumour forming on the cheek ; but it broke off, and dis¬ 
 covered what it was.”— John Hunter. 
 
86 
 
 OF TARTAR. 
 
 teeth so lost, are generally of the densest texture, 
 and free from decay. 
 
 ' Such are the deplorable effects arising from 
 the presence of tartar and other concretions. 
 
 Whenever the gums put on an appearance of 
 redness, and bleed when touched, tartar will be 
 found under their edges, (although the teeth 
 look tolerably clean to a casual observer) and if 
 removed by appropriate instruments, little more 
 requires to be done; the gums return to a healthy 
 state, and by the frequent application of a brush, 
 and friction with a towel, the collection of tartar 
 will be retarded. 
 
 It must, however, be remembered, that the 
 removal of these incrustations can only be safely 
 effected by the dentist’s instruments, and per¬ 
 sons should be careful of the bad effects attending 
 the use of various tooth-powders advertised to 
 remove tartar and whiten the teeth; that they 
 do so, is true enough; but at the same time 
 they injure the enamel, when decay, with its 
 train of distressing symptoms, is ai inevitable 
 result. 
 
 The author wishes to direct the attention of 
 
OF TARTAR. 
 
 87 
 
 the medical profession to the condition of the 
 gums, as described above, and recommends them 
 to institute an inquiry into the state of the teeth, 
 and to examine minutely the gums, in order to 
 detect the cause of scurvy,"' as it has hitherto 
 been erroneously called, in preference to pre¬ 
 scribing various useless lotions. 
 
 When the teeth are surrounded by tartar in 
 considerable quantities, it appears improper to 
 remove it completely at the first operation; some 
 days should be allowed to intervene between the 
 removal of certain portions. In aggravated 
 cases, wherein some of the teeth were loose 
 in both jaws, the above method had the effect 
 of restoring them to their natural firmness, and 
 quickly eradicating the fanciful disease ascribed 
 to scurvy," 
 
88 
 
 INSTRUCTIONS FOR 
 
 SECTION IV. 
 
 INSTRUCTIONS FOR PRESERVING TEETH. 
 
 Necessity of Brushing—Hard Brushes—Prevention of 
 Tartar—Of Tooth-powdersy and of Tooth-picks. 
 
 A FEW general directions for preventing decay 
 of the teeth, and preserving the gums in a 
 healthy state appear to be necessary, and, it is 
 presumed, will be found useful. 
 
 Care should be taken to keep the teeth free of 
 all adventitious and extraneous substances. 
 The grinding surfaces of molar teeth are the 
 parts most favorable for the development of 
 cariesy while in the interstices between the 
 front ones tartar is abundantly deposited. The 
 teeth ought, therefore, to be well brushed night 
 and morning, effectually removing all particles 
 of food, which are so apt to insinuate them¬ 
 selves into irregular surfaces. 
 
 Teeth with defective enamel, especially those 
 where dark coloured spots are visible, require 
 to be indefatigably attended, and kept free of 
 
PRESERVING TEETH. 
 
 89 
 
 substances already enumerated as likely to 
 induce decay. 
 
 In the generality of cases hard brushes should 
 be preferred. The great secret, however, lies 
 in keeping every part of a tooth at all times 
 perfectly clean. After the use of a brush, fric¬ 
 tion should be freely applied to the gums with 
 a towel, when (if they be relaxed) a whitish 
 matter will be pressed out, which, if allowed to 
 remain, would probably become a foundation for 
 tartar. 
 
 Vicissitudes of cold and heat are injurious to 
 the teeth, therefore water used for cleansing the 
 mouth should be only tepid ; in summer it is 
 sufficiently so, in winter it requires to be made 
 warm. 
 
 Prepared Chalk is, of all substances, the 
 safest as a tooth-powder, and it may be applied 
 at pleasure. Its use is particularly indicated 
 when the saliva possesses acid qualities, or after 
 partaking of sub-acid fruits; it also effects the 
 neutralization of particles of food lodged in 
 cavities in and about the teeth, thus in a great 
 measure rendering them harmless. 
 
90 
 
 OF AMALGAMS AND CEMENTS. 
 
 Tooth-picks are of service in removing ex¬ 
 traneous matter, dislodging and preventing the 
 formation of tartar between the teeth. The 
 most useful are made of steel; a piece of watch- 
 spring answers every purpose. It should be 
 about an inch in length, pointed, and fixed in 
 a neat ivory handle ; the great elasticity of this 
 substance is much in its favour. The author 
 has observed that the teeth of person s who use 
 tooth-picks as above described, are remarkably 
 free of tartar, and are not much afflicted with 
 decay. 
 
 SECTION V. 
 
 OBSERVATIONS upon the DESTRUCTIVE EFFECTS 
 or AMALGAMS, SPURIOUS CEMENTS, &c. 
 
 The word ‘‘ cement,’’ as applied to the teeth, 
 was first introduced by Mr. Patterson Clark, 
 some time in the year 1825. He also affixed 
 to it the term “ anodyne,” from its well-known 
 efficacy in relieving the most aggravated cases 
 of tooth-ache. 
 
 The ‘‘ anodyne cement ” is applied in a soft 
 
OF AMALGAMS AND CEMENTS. 
 
 91 
 
 state to a decayed tooth; air and other causes of 
 pain are excluded; but it never becomes so hard 
 as to supply the place of a permanent stopping-, 
 nor was it ever intended to do so ; for when the 
 inflammatory symptoms have subsided, which 
 they generally do after one or more applications, 
 it is removed, and the tooth, formerly so painful 
 that the touch of an instrument could not be 
 endured, now admits of the decay being cleared 
 out, and the cavity permanently plugged. 
 
 From the success v/hich attended this dis¬ 
 covery, many imitators of the above method 
 appeared, and the public prints teemed with 
 their advertisements. Unfortunately for them 
 and the public, the modus operandi of the “ ano¬ 
 dyne cement ” was not understood sufficiently; 
 the greater number supposed that it was simply 
 inserted into a decayed tooth, there to remain 
 permanently, and thus effect a cure by arresting 
 the progress of decay, in the same way as a per¬ 
 manent gold stopping; others had the sagacity 
 and honesty to clear away the decay (when it 
 would admit it) previously to its application ; the 
 cements, therefore, were various in their compo- 
 
92 
 
 OF AMALGAMS AND CEMENTS. 
 
 sition, and in their effect. Some were to become 
 instantaneously equal in hardness and dura¬ 
 bility to the original enamel—others were to fill 
 up the decayed portion with so much precision, 
 that the tooth would be restored to its primitive 
 state; and in all cases the relief afforded was to 
 be unbounded and permanent. 
 
 A little reflection upon the nature of decay 
 and the causes, would very soon convince even 
 the most quackish and credulous of the impos¬ 
 sibility of preserving teeth from decay by any 
 composition, which does not in the completest 
 manner effectually keep out air and moisture. 
 
 In cases treated by the introduction of amal¬ 
 gams of mercury, &c. pain generally re-com- 
 mences a few days afterwards ; they are inserted 
 into hollow teeth in a soft state, and the metal 
 adapts itself to all the cracks and crannies of the 
 decayed surfaces with great nicety; air and 
 moisture are thus deprived of admission for a 
 time, while the patient, relieved of pain, ex¬ 
 presses considerable satisfaction. But, alas! 
 a few days scarcely elapse before pain of an 
 aggravated nature occurs, and if a sharp-pointed 
 
OF AMALGAMS AND CEMENTS. 
 
 93 
 
 instrument be applied, the stopping will be dis¬ 
 covered to be loose, and to admit of being moved 
 in various directions : the amalgam, in harden¬ 
 ing, had contracted, according to its nature, 
 while air, moisture, &c. had free ingress in the 
 space left between the metal and the sides of 
 the carious cavity. 
 
 In other instances pain does not occur, but 
 the composition of amalgams being like the re¬ 
 fuse, or cineritious part of melted metals, the 
 particles break down piece by piece, and are 
 washed out of the cavity by the liquid part of 
 our food. 
 
 In particular cases wherein the pulpy portion 
 of the nerve has, by a process of nature, become 
 destroyed, and the tooth rendered insensible, 
 these metals appear to a superficial observer to 
 answer exceedingly well; no pain is experi¬ 
 enced and the tooth performs its office. Sooner 
 or later it invariably happens that when an extra 
 pressure, or increased force is necessary to be 
 used in breaking a substance more than usually 
 hard, to the very great surprise and suffering of 
 the unfortunate patient, the tooth also breaks 
 
94 
 
 OF AMALGAMS AND CEMENTS. 
 
 away, the metal drops out, and pain of an ag¬ 
 gravated character ensues; this is a certain 
 result arising from the decay not having been 
 previously cleared away; or, if removed, the 
 metal is very unfit to arrest the progress of 
 decay by its inaptitude to hermetically seal up 
 the cavity; such a result should have been 
 anticipated, as caries was proceeding in an in¬ 
 sidious and insensible manner. 
 
 A tooth thus loaded, even in favorable cases, 
 quickly loses its natural and beautifully trans¬ 
 parent colour, acquires a blackish hue, very like 
 the dark teeth of incorrigible smokers and 
 chewers of tobacco. So destructive are amal¬ 
 gams, that if introduced in a cavity made in a 
 a healthy tooth, blackness and decay speedily 
 ensue. Teeth thus treated are rendered very 
 brittle, and are not able to resist even a com¬ 
 mon degree of pressure. 
 
 The author has had many opportunities of 
 witnessing the direful effects of these amalgams, 
 having to remove them frequently from the 
 mouths of suffering individuals in consequence 
 of a recurrence of pain, or the formation of 
 
OF AMALGAMS AND CEMENTS. 
 
 95 
 
 gum-boils, abscesses, See. Such are only a few 
 of the evils arising from the use of spurious 
 cements; and it is hoped that sufficient has 
 been said to deter persons from submitting to 
 such practices in future. 
 
96 
 
 CHAPTER V. 
 
 OF ARTIFICIAL TEETH. 
 
 INTRODUCTORY REMARKS. 
 
 It would be superfluous to give a lengthened 
 account of the causes which lead to the necessity 
 of constructing artificial teeth, or to enlarge 
 upon their utility; the beneficial influence they 
 have on the digestive organs, the general effect 
 on the constitution, and the improvement and 
 expression given to the face, are advantages 
 which, at the present time, are very properly 
 appreciated by society in general. 
 
 It is to be regretted that there is no work 
 upon the construction of artificial teeth, con¬ 
 taining a complete system for the guidance and 
 information of those who are anxious to attain 
 some degree of respectability in their profession. 
 
 Many and able are the publications treating 
 of the natural history of the teeth, among which 
 the celebrated work of John Hunter will ever 
 
OF ARTIFICIAL TEETH. 
 
 97 
 
 remain one of reference and study to experienced 
 dentists, and if perused more frequently by 
 gentlemen of the medical profession, the pain 
 and sufferings inflicted by carious teeth would 
 be mitigated. A correct knowledge of the phy¬ 
 siology and diseases of the teeth would enable 
 them to advise their patients respecting the best 
 means of remedying defects in the mouth, which 
 from time to time appear; not to mention that 
 practitioners of medicine are the proper media 
 between the public and the dentists. A know¬ 
 ledge of this branch of the animal economy 
 enables them to give the necessary information 
 to persons having defects in the mouth, or 
 diseases in the teeth (perhaps unknown to the 
 patient); such intelligence offered, even by 
 an intimate friend, might be construed into 
 officiousness, or a want of politeness. This ob¬ 
 jection could not be raised against the medical 
 profession. 
 
 Other circumstances tend to circumscribe the 
 utility of dentists, especially when artificial teeth 
 are required; one is the secrecy with which 
 
 H 
 
98 OF ARTIFICIAL TEETH. 
 
 they are worn, and the manifest attempts made 
 by patients to conceal from their most intimate 
 friends and even from their family, that they 
 possess such teeth. This prevents the beneficial 
 comparison between teeth properly and impro¬ 
 perly constructed; the public consequently suf¬ 
 fer, while the unskilful escape detection. If com¬ 
 munications were oftener made, they who suffer 
 from wearing teeth badly constructed, and 
 improperly secured, would discover they had 
 not that in the mouth which adds to their com¬ 
 fort or affords pleasure. 
 
 It is a custom with some dentists to supply 
 patients with front teeth only, and with these 
 mastication must be performed; with front 
 teeth the important office of mastication can be 
 but imperfectly executed, and large masses of 
 food are swallowed in a half-broken state; 
 irritation of the stomach ensues, or, more fre¬ 
 quently, spasms of that organ, and obstinate or 
 habitual constipation. Now, all these evils 
 are to be remedied by having artificial grinders 
 fitted accurately, so that every part of the gums 
 
OF ARTIFICIAL TEETH. 99 
 
 receive equal pressure and the teeth feel like 
 part and parcel of the jaw-bones. 
 
 There is another remark applicable to those 
 who are compelled to wear artificial teeth: the 
 extraction of the few remaining natural ones is, 
 an operation which some dentists deem it expe 
 dient to perform previously to the model being 
 taken on which the artificial set is to be con¬ 
 structed. The public should be informed that 
 by the present improved methods, teeth are 
 adapted with so much accuracy and precision, 
 that where persons fortunately possess one tooth 
 or more in a jaw, or even a few healthy stumps, 
 they are of the most essential service in assisting 
 to steady the plates, and are of advantage in 
 other respects; therefore they should never be 
 extracted. 
 
 When all the teeth in one or both jaws are 
 lost, the alveolar processes or sockets become 
 absorbed, and a change takes place in the con¬ 
 tour of the face which is familiar to every one. 
 The features are shortened, the nose and chin 
 approach each other, the cavity of the mouth 
 
 H 2 
 
100 
 
 OF ARTIFICIAL TEETH. 
 
 is reduced, and articulation becomes difficult and 
 
 * ** The too great extent of the lips, which, as soon as 
 the incisors are lost, are longer than is necessary to go 
 from one jaw to the other, and which touching each other 
 internally, instead of meeting at the edges, are no longer 
 capable of retaining the saliva* The want of teeth reduces 
 them to the necessity of chewing with the lips constantly in 
 contact, which again gives a peculiar character to mastica¬ 
 tion. 
 
 “ The saliva is one of the most useful of the fluids 
 concerned in the process of digestion; it favours the tritu¬ 
 ration and division of the food; it assists in its deglutition 
 and transformation into chime; it also renders the motion 
 of the tongue^ in speaking and singing, more easy. The 
 greater part of the fluid is carried into the stomach by the 
 motions of deglutition; another part flies off in the form of 
 vapour, and escapes with the air expired as it passes through 
 the mouth.”— Majendie’s Elements of Physiology. 
 
OF GRAFTING OR PIVOTING. 
 
 101 
 
 SECTION I. 
 
 OF GRAFTING, OR PIVOTING. 
 
 When young persons require artificial teeth 
 they are generally confined to the front of the 
 mouth, and in the upper jaw. 
 
 The front upper teeth are liable to decay 
 principally from lateral pressure, and occasion¬ 
 ally from their shape, and they are more subject 
 to decay than those of the lower jaw. 
 
 Whenever a front tooth has been injured by 
 a blow or fall, or when decay has made such 
 havoc as to deprive it of its transparent appear¬ 
 ance ; or, being deprived of enamel, it assumes 
 a blackish hue and becomes a blemish, the 
 remedy is safe and easy, and is obtained by per¬ 
 forming the operation of grafting, about to be 
 described. 
 
 The decayed tooth is taken between the fin¬ 
 ger and thumb of the left hand, and a very fine 
 saw applied in the most gentle manner to its 
 neck. By a succession of quick, light strokes 
 of the saw, the decayed portion is cut away, 
 
102 OF GRAFTING OR PIVOTING. 
 
 and the stump left in the socket; no uneasy 
 sensation is produced. The decayed crown 
 is sometimes cut off with a pair of excising 
 forceps, but if the stump be brittle it may be 
 splintered. The saw is therefore the safest 
 instrument for this operation. 
 
 In the centre of every stump there is a little 
 canal running to its extremity, which is occupied 
 by the blood-vessels and nerves of the tooth. 
 This canal sometimes requires to be enlarged, 
 which is easily effected by a fine drill. A tooth 
 of faultless shape and colour is now to be chosen, 
 and, by the application of a file and other in¬ 
 struments, is made to fit with extreme nicety to 
 the stump left in the jaw. 
 
 A piece of gold wire is used, one end of which 
 is screwed into the body of the artificial tooth, 
 while the other end is left of sufficient length to 
 pass nearly to the termination of the canal in the 
 stump. Much attention is required in regulat¬ 
 ing the length of the wire, for if too long it 
 presses upon the nerve, thereby causing pain. 
 The pivot requires a little fine silk passed a few 
 times round it; it should then be dipt in mastic 
 
OF GRAFTING OR PIVOTING. 
 
 103 
 
 varnish, and being introduced into the stump it 
 becomes fixed. If this operation be properly 
 performed, the edge of the gum will so cover 
 the line of union as to defy detection by the 
 keenest observer. 
 
 A tooth thus attached to a stump, will answer 
 all the purposes for which it was intended, and 
 will remain permanently fixed for many years. 
 The following exemplifies mal-treatment. 
 
 Case. —Miss F— had her two front central 
 upper teeth decayed, from mismanagement and 
 neglect; a practitioner had fitted two artificial 
 ones, by means of gold pivots, to their stumps, 
 the decayed crowns being previously filed to a 
 level with the gums. A short period only 
 elapsed after this operation was performed, when 
 the young lady became a great sufferer from 
 pain in the stumps and front of the mouth: 
 on applying to her dentist, "^patience” was 
 recommended. At length the pain became un¬ 
 bearable ; her health suffered; and ' her friends 
 resolved to take her to London for advice. ^ 
 
 An experienced dentist was consulted, and 
 after an examination, recommended extraction 
 of the stumps as the only remedy. The friends 
 
104 
 
 OF GRAFTING OR PIVOTING. 
 
 hesitated, and requested time for consideration. 
 During this period, they consulted the author, 
 who judged that the pain experienced for so 
 many months, was caused by the pivots pressing 
 upon the nerves. The removal of the pivots was 
 attended with a discontinuance of pain; the 
 gums were spongy and tumid; they were there¬ 
 fore scarified, and friction being applied for a 
 few days, they assumed a healthy appearance. 
 
 The pivots were shortened, and again intro¬ 
 duced into the stumps. The lady continued in 
 town about a month, regained her former health, 
 and, although three years have gone by, there 
 has been no return of pain or uneasiness. 
 
 When the operation of ‘‘grafting” is per¬ 
 formed on one or more of the front teeth, a 
 careful examination should be made, so as to 
 ascertain if any of the front lower touch the 
 upper teeth, during mastication; should this be 
 the case, the grafted teeth would soon loosen, 
 and become a constant annoyance to the patient. 
 The probable cause of this is, that the back teeth 
 have been lost, either by caries or extraction, or 
 
OF GOLD CAPS. 
 
 105 
 
 worn shorter by attrition.* This is a common 
 occurrence, especially when the grinders are 
 not of the usual and characteristic hardness. 
 
 SECTION II. 
 
 OF GOLD CAPS. 
 
 When the back teeth have become shortened, 
 and do not touch their opponents in the oppo¬ 
 site jaw, one or more of them on each side of 
 either jaw, as may be found most suitable and 
 convenient, should be covered with gold caps,'\ 
 
 * Old people are often found to have very good sets of 
 teeth, only pretty much worn down. The reason of this is, 
 that such people never had any disorder in their teeth, or 
 alveolar processes, sufficient to occasion the falling of one 
 tooth. For, if by accident one tooth is lost, the rest will 
 necessarily fail in some degree, even though they are sound, 
 and likely to remain so, had not this accident happened; 
 and this weakening cause is greater in proportion to the 
 number that are lost. From this observation, we see that 
 the teeth support one another.— John Hunter. 
 
 t “ The proper remedy when an under pressure of the 
 front teeth of one jaw is exerted against those of the other, 
 is to cap the remaining teeth with gold.’’— Patterson Clark. 
 
106 
 
 OF GOLD CAPS. 
 
 Indentations should be formed on the grind¬ 
 ing surface of the caps, to correspond with 
 those of the teeth; and for this purpose they 
 require to be raised on a brass model of the 
 grinders, a process well known to dentists of 
 ability and skill. 
 
 From the same cause, namely, the shortening 
 of molar teeth, the whole shock of the jaws, 
 when brought into contact, is received by the 
 front ones, which, by this incessant action, 
 loosen, and one after another drop out of their 
 sockets. When the front teeth become loose, 
 they also appear elongated. It is a bad, though 
 not an uncommon practice, to reduce them to 
 the level of the neighbouring teeth with a file; 
 this, however, affords but temporary relief; in a 
 short period they again become lengthened, for 
 inflammation had attacked the lining membrane 
 of the sockets, and ejectment of the teeth from 
 their cavity is a process set up by nature to 
 relieve herself of the troublesome occupants. 
 
 When only a few molar teeth remain in the 
 mouth, although they may be extensively de¬ 
 cayed, it is essential to preserve them, for pur- 
 
OF GOLD CAPS. 
 
 107 
 
 poses of mastication, and also to prevent the 
 front ones falling a sacrifice to undue pressure; 
 for this purpose the decayed molares should be 
 plugged in the manner described in page 76, and 
 afterwards restored to their original dimensions, 
 by means of gold caps; this is an effectual way, 
 and may be recommended to persons who have 
 an antipathy to artificial teeth. 
 
 In some cases it is also necessary to lengthen 
 the grinding surface of the back teeth, (although 
 none have been extracted, but are worn away 
 by a long course of attrition, through original 
 defective organization,) or the front ones will be 
 lost; and this is foretold by pain being occasion¬ 
 ally experienced in front of the mouth, attended 
 with other symptoms, indicating the commence¬ 
 ment or presence of inflammation of the mem¬ 
 brane lining their sockets. 
 
 The following case illustrates the utility and 
 advantage of gold caps. 
 
 The Earl of D— had experienced consider¬ 
 able pain in the upper front-teeth; they were 
 especially affected by whatever was taken into 
 
108 
 
 OF GOLD CAPS. 
 
 the mouth, above or below a certain tempera¬ 
 ture. 
 
 • The teeth were apparently perfect, none had 
 ever been extracted, and, until of late years, he 
 had never consulted a dentist, except to have 
 them occasionally cleaned. 
 
 Upon examination, it was discovered that the 
 inner surface of the upper front teeth were so 
 worn away, as nearly to expose the nerves. 
 
 The above state of the teeth was occasioned by 
 the grinding surfaces of the molares being worn 
 down which allowed the points of the lower front 
 teeth to come into too close contact with the 
 inner surfaces of the upper front ones. 
 
 The remedy had recourse to was easy and 
 simple ; it consisted of covering with gold caps 
 the whole of the double teeth on each side of 
 the lower jaw. In some instances, the upper 
 jaw is to be preferred, as the gold is not so 
 readily observed. 
 
 The effect of this treatment is obvious; no 
 further waste of the front teeth occurred, while 
 the pain and other bad symptoms gradually 
 subsided. 
 
OF GOLD PLATES. 
 
 109 
 
 SECTION III. 
 
 OF THE ADAPTATION AND CONSTRUCTION OF 
 ARTIFICIAL TEETH AND GOLD PLATES. 
 
 Much depends on the state of the gums in 
 adapting artificial teeth. In some cases it is 
 requisite to have a piece of sea-horse tusk fitted 
 to the gums, into which teeth are to be inserted.^ 
 In other instances an advantage will be gained 
 by using a gold plate. 
 
 When the front and some of the molar teeth 
 are lost, the construction of artificial ones be¬ 
 comes more complicated and difficult than when 
 the patient is deprived of the whole of the teeth. 
 
 * A principal consideration with those who wear 
 artificial teeth, is to have them appear perfectly natural^ 
 and no way of attaining this desirable object has yet been 
 discovered, but by placing in human teeth of the same 
 description as those whose places they are intended to 
 supply. Teeth made of any other material are easily 
 discovered to be artificial, especially when placed beside 
 those formed by nature. 
 
 “No reasonable objection can be made to the wearing of 
 human teeth in the manner they are now used, any more 
 than the wearing of human hair in head-dresses.”— Murphy. 
 
iia 
 
 OF ARTIFICIAL TEETH 
 
 It was heretofore the practice, and by the un¬ 
 skilful is yet followed, to clear the mouth of the 
 remaining teeth or stumps, whether sound or 
 decayed; this error has already been pointed 
 out at page 103. For, it is obviously the more 
 correct method to fill up with artificial teeth 
 the spaces between those remaining in the 
 mouth, than have recourse to the destructive 
 and unnatural measure of extraction. It is 
 most undoubtedly the duty of the dentist to 
 preserve and not to destroy. 
 
 It is the practice of some dentists to fasten 
 artificial teeth by means of strong silk ligatures; 
 there is, therefore, very little nicety required in 
 fitting them,* consequently the teeth round 
 which the ligatures are fastened will loosen and 
 be dragged from their sockets, when a larger 
 piece is required, and if secured as before will 
 be follow’ed by similar results, until the poor 
 sufferer is deprived of every tooth. 
 
 * “ Some teeth are so ill made and unskilfully adapted, 
 that they are troublesome to the wearer, and an impediment 
 to speech and mastication, and even a greater blemish to the 
 countenance > than the want of teeth; those that are well 
 adapted are;qn the contrary, easy,[useful, and ornamental.'’— 
 Murphy. 
 
AND GOLD PLATES. 
 
 Ill 
 
 The following illustrates the consequences* of 
 mal-practice, and is worthy of perusal. 
 
 Case. —A young lady had a front upper 
 permanent tooth unfortunately removed by 
 mistaking it for a shedding one; the dentist 
 endeavoured to fill up the space by drawing the 
 adjoining teeth together with silk ligatures, 
 this was followed by the destruction of its 
 fellow, and also a lateral incisor; the next 
 step was to put in three artificial teeth, they 
 were also fastened to the adjacent ones with 
 silk ligatures, and the result was (as might 
 have been anticipated), the loss of two more 
 teeth. The young lady, before she was 
 eighteen years of age, had thus been deprived 
 of Jive front upper teeth, and had the same 
 system been continued a few more years, not 
 a tooth would have remained in the upper jaw. 
 
 Ligatures should never be used to fasten 
 artificial teeth; they should be so constructed 
 as to be removed as easily as a glove. 
 
 When the front teeth are destroyed, and the 
 gums have not much receded, a thin gold-plate 
 should be accurately fitted to the mouth, and 
 
112 
 
 OF ARTIFICIAL TEETH 
 
 extend as far back inside as the small grinders; 
 one or more of which being capped, is sufficient 
 to make all secure. To the gold-plate natural 
 front teeth should be fixed; much care and 
 attention are required in their adjustment, so 
 that the lower front ones do not come in contact 
 with the upper when the jaws are closed. 
 
 When the alveolar processes are absorbed 
 the features become shortened; the teeth must 
 therefore be set in a bone-plate, so as to form 
 an artificial gum. In all these cases, whether 
 bone, or gold plates are required, they are to 
 be accurately adapted to the mouth; fastenings 
 with clasps or ligatures are thus rendered un¬ 
 necessary. 
 
 It has been remarked, that the eye-teeth 
 generally are the last remaining in the mouth. 
 Persons so situated frequently suppose that 
 front artificial teeth only are necessary. This 
 is easily aecomplished, by placing front ones on 
 a plate of gold or ivory, and securing them 
 with claws or ligatures embracing the eye-teeth; 
 it should, however, be remembered, that they 
 
AND GOLD PLATES. 
 
 113 
 
 will loosen, and be dragged from their sockets, ' 
 and the artificial ones rendered useless. 
 
 To remedy the defects above enumerated, 
 the following method may be advantageously 
 adopted. Let it be supposed that the molar 
 teeth on each side of the lower jaw are des¬ 
 troyed, the front ones alone remain. In such a 
 ca'se artificial grinders should be supplied, made 
 of the tusk of the hippopotamus, formed on a 
 model of the mouth taken in the usual way, and 
 fitted to the gums with much precision, so as 
 to bear equally at all points; or a gold plate 
 might be used, raised with equal care and at¬ 
 tention, on which back te’eth are to be properly 
 secured. 
 
 It is a bad practice’ to form* the teeth of two 
 pieces, (as is sometimes done,) which are con¬ 
 nected by means of a gold bar passing behind 
 the front ones; it is impossible to unite the 
 two pieces by a band, so as to afford comfort to 
 the wearer, or a feeling of security in the mouth, 
 and generally while masticating on one side, 
 the other will be raised from the gums. 
 
 i 
 
114 
 
 OF ARTIFICIAL TEETH 
 
 CoLsiderable care is requisite in forming the 
 grinders of such a length as to come in contact 
 with their opponents, and that without the front 
 teeth touching; if they were in a loose state, as 
 they generally are, previously to the application 
 of artificial grinders, they will then be restored 
 to their original firmness. Should the above 
 circumstance be overlooked the loss of the 
 remaining front teeth will follow. 
 
 Case. —Lady L—, had lost all the grinders 
 of the upper jaw, the two wisdom-teeth ex¬ 
 cepted ; their opponents had been attacked with 
 early decay, and were removed. The remaining 
 lower grinders were therefore useless, and mas¬ 
 tication was imperfectly performed with the 
 front teeth, which had become loose by the 
 points of the lower front ones constantly striking 
 against their inner surface. The gums of the 
 upper jaw were spongy and painful, and pus 
 Dccasionally oozed from their sockets, indicating 
 a dislodgment of the whole upper front teeth. 
 The case was remedied in the following manner. 
 A plate of gold was fitted inside the upper front 
 
AND GOLD PLATES. 
 
 115 
 
 teeth, and extended as far as the wisdom ones/ 
 which were covered with caps connected with 
 the plate. The vacant spaces were then filled up 
 with artificial grinders adjusted to the bite of 
 their opponents in the lower jaw, so as to prevent 
 the front teeth touching during mastication. 
 Thus the irritating cause was removed, the 
 gums became healthy, and the teeth regained 
 their former stability. 
 
 Whenever a partial loss of ^molar teeth has 
 occurred, painful, or perhaps only uneasy sen¬ 
 sations are experienced near the front teeth; 
 these are warnings of the destruction about to 
 ensue. The front teeth first separate, after¬ 
 wards take irregular positions, projecting out¬ 
 wards or inclining inwards, and soon become 
 loose. 
 
 By filling up the spaces left by the lost molar 
 teeth with artificial ones, and lengthening the 
 grinding surfaces of those remaining in the mouth, 
 such defects are obviated. To ensure this, much 
 labour and skill are required; and the dentist 
 
116 
 
 OF ARTIFICIAL TEETH 
 
 who ban accomplish a piece of work, which 
 will bring a mouth thus affected to a state equal 
 to the natural one, and render the patient easy 
 and comfortable, ranks with the most eminent 
 in this department of his profession. 
 
 Here are two objects to be attained: First, 
 to supply artificial teeth where, perhaps, every 
 second or third natural one has been extracted, 
 and those that remain are decayed or worn to 
 stumps. Second, To lengthen the grinding 
 surface of the remaining back teeth by means of 
 gold caps, and thus render these decayed teeth 
 or stumps of essential service in supporting and 
 steadying the apparently complicated structure 
 of artificial ones. 
 
 Bone in these instances would be useless with¬ 
 out the assistance of gold plates ; unless, indeed, 
 the remaining back teeth were extracted, a 
 mode of proceeding always to be deprecated, 
 and very properly met by the generality of 
 persons with aversion, frequently deterring them 
 from having artificial ones. 
 
 An impression of the mouth is taken with 
 wax; from this a plaster model is made and 
 
AND GOLD PLATES. 
 
 117 
 
 afterwards cast in brass. A plate of gold is 
 raised on one or more of the brass casts, so 
 as to be a perfect stamp, and is extended over 
 the decayed teeth or stumps, forming caps. 
 Then between these caps, and having the gold 
 plate for a foundation, are fitted molar teeth, 
 and secured to the plate by means of gold pivots. 
 Much care is necessary in fitting gold plates, 
 that they may bear equally at all points. 
 
 When one or more double teeth are slightly 
 decayed, but very tender, they should be capped 
 with gold and thus preserved, as they give great 
 security to artificial ones; adventitious substances 
 are thereby prevented coming in contact with the 
 tender teeth ; they quickly return to a healthy 
 state, and decay makes no further progress. 
 
 This is illustrated by the following 
 
 Case. —A gentleman, a member of a learned 
 profession, had lost nearly all the grinders in the 
 lower jaw; one of those that remained was a 
 wisdom-tooth, slightly affected with decay, ten¬ 
 der at the neck, and very susceptible of atmos¬ 
 pherical changes. The front teeth came in 
 contact at the cutting edges, and were much 
 
118 
 
 OF ARTIFICIAL TEETH. 
 
 worn down; nearly all the upper double teeth 
 had become useless for want of opponents. To 
 remedy these evils a gold plate was accurately 
 fitted to the gums, and extended so as to cover 
 the remaining double teeth, including the tender 
 wisdom one, and excluding air and all irritating 
 substances. Thus protected it became easy and 
 useful. The spaces were filled with artificial 
 grinders, so adjusted as to prevent the front 
 teeth touching, and consequently no further 
 waste ensued by attrition. 
 
 FINIS. 
 
 Hewlett and Brimmer, Printers, 10, Frith Street, Soho. 
 

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