A TREATISE [...] TEETH.
[Price Two Shillings unbound.]
A TREATISE ON THE TEETH.
Wherein an accurate Idea of their Structure is given, the Cause of their Decay pointed out, and their various Diseases enumerated: To which is added, The most effectual Method of treating the Disorders of the Teeth and Gums, established by a long and successful Practice.
By BARTH. RUSPINI, SURGEON DENTIST.
LONDON: Printed for the AUTHOR, and may be had at his House in Pall-Mall; at S. BLADON'S, in Pater-noster-Row; and at all the BOOKSELLERS, &c. in Town and Country. 1768.
TO THE PUBLIC.
IT is needless to usher in this performance to the world, by a preface in the common form, proving the importance of the subject to be treated of, and the necessity of taking it up at this time. Both are sufficiently felt, and acknowledged: it will therefore suffice, that I briefly expose my intention in the following sheets, submitting it to the candid and impartial publick, whether the execution is answerable to the design.
I proposed first, to give a distinct and accurate idea of the anatomy of the teeth, and the adjacent parts, to prevent as much as possible those accidents which arise from an ignorance in this point, in the practice of unskiful practitioners; who, unacquainted with the structure of the parts, never fail to expose their patients to unnecessary pain, and frequently to dangerous consequences.
Secondly; To point out the more immediate causes of the diseases of the teeth, and to shew how they may be mitigated, and in some measure prevented.
And thirdly; To introduce and recommend a more general attention than has hitherto prevailed, for the preservation of the teeth, so useful to the purposes of life, and so ornamental, in that part of the creation, where beauty seems to have fix'd her peculiar feat.
A long, extensive, and I believe I may say, successful practice, has enabled me to acquire the knowledge, which I here pretend to communicate to the world; the subject is in some degree new in this country; I therefore hope for indulgence, and claim no absolute merit but in my intention: whatever share I may be further entitled [Page iv]to from the performance itself, depends entirely upon the judgement of the reader to bestow, and to whom I submit it without reserve.
A TREATISE ON THE TEETH.
TEETH are bones of a particular kind, given by nature in order to cut, break, and grind the necessary aliments, and to give a stronger and more articulate sound to the voice.
What is chiefly to be considered in the teeth, is their texture, number and [Page 2] figure; their exact order, and arrangement, and the time they begin to appear.
In these bones we may distinguish three parts, namely, the body, or crown, of the tooth, which appears out of the gums, the middle comprehending the space covered by the gums, and called the neck of the tooth, and lastly the root, that lies buried in the socket.
We find in a tooth three different substances. The first surrounds, and covers the body or crown of the teeth; it is thin, but grows thicker by degrees, as it draws near to the extremity of the crown. This substance is so close, and so hard, that no impression, either with a file or any other sharp instrument can be made on it, but with the greatest difficulty and trouble, its colour is that of a pearl white peculiar to the teeth.
This substance is what we call the enamel, and forms itself before the tooth [Page 3]comes out; it grows stronger and finer till the age of about 20, after which time it begins to wear off, by continual use; and so liable it is to decay, that we often see persons of a middle age without the least enamel on their teeth: such a thing very frequently happens in old men; but altho' the enamel be lost, or destroyed, still the tooth is not so liable to decay as one may imagine, for we find many teeth firm and sound in their internal substance, notwithstanding they have been deprived of their outward coat for many years: but however, when once it is gone, the tooth lies more exposed to the impression of heat and cold, and to be acted upon by any thing acid and sharp.
The loss of the enamel can never be repaired.
The second substance is not so close as the former, and consequently less hard; 'tis of a dusky white colour, and [Page 4]of the same nature as that of all human bones, altho' somewhat harder; it begins immediately under the enamel in the body of the tooth, and covers the neck, together with the whole root.
The third is that, which forms the most internal part of the teeth, and is called the BULB; it is soft in regard to the former, but pretty close if we compare it to the marrow of the other bones.
The outward covering or enamel, and the bony part of the tooth are not susceptible of the least sensation. The reason why teeth are affected by something acid or sharp, is owing to a certain tremor that communicates, and as it were, thrills thro' the nerve in the inward part; if this nerve is left uncovered by a caries of the bony substance, then we are tormented by the most excruciating pains.
Men at 25 and about three years after, have generally 28 teeth, 14 in each mandible or jaw.
This number encreases to 32, when the four teeth called dentes sapientiae appear, but as these in some persons come out sooner, in others later, and in some never, we may justly say, that the true number of teeth is generally 32.
Some writers were formerly of opinion that men had 32 and women 28, but inspection may plainly evince the absurdity of this notion.
All the teeth that exceed the number of 32, may be reckoned as supernumerary. They generally push out between the incisores or fore teeth of the upper jaw, and in such a case the incisores are increased in their number.
These supernumerary teeth resemble very much the lateral incisores of the upper jaw.
And it happens that the incisores also of the lower jaw, and the molares themselves, have been multiplied by intervening supernumerary teeth.
Teeth are generally divided into three classes, viz. the incisores or cutting teeth; the canini or dog-teeth, and the molares or grinders.
The incisores are eight in number; four in the front of each mandible. They are called incisores, because their business is to cut the aliments, for which purpose their outward form at the extremities is peculiarly and wonderfully adapted. On the outer surface, next the lips, they are a little convex, and on that, next the palate, concave. The two incisores in the middle of the upper [Page 7]jaw are larger, and often longer than those on each side, or any of the other incisores, for indeed the lateral upper incisores exceed the lower in magnitude.
The two middle upper incisores may be called the greater, those on each side the lesser, and the four of the lower mandible the small incisores. These teeth describe a kind of semicircle.
The canini are four in number; they lie one at each side next the incisores, between them and the molares both jaws.
These teeth are rather longer, more round, and less cutting than the incisores.
Their use is to part things that are of a solid nature; in regard to their structure, they appear to be very proper, not only for cutting asunder any piece of solid food, but also for keeping [Page 8]it quite firm, while one endeavours to tear and separate it, as well as for gnawing bones, or any thing of that kind. They are called canini, because they are very like to the teeth of a dog. The upper canini are also known by the name of eye teeth, because it was anciently believed, that they had a kind of connection with the eyes, and that, by drawing any of them, the sight was supposed to be endangered; but daily experience has clearly demonstrated, that such a connection, and danger, are merely imaginary.
Immediately after these come the molares or grinders. They are 20 in number, five on each side of both jaws.
The two first in each row, that is to say the nearest to the canini, are the small grinders, the others the large.
They are so called because they are thicker, blunter, and more flat at their extremities, than the rest. They serve like so many milstones, to bruise and grind the food.
Their figures are almost square. The broad end, or top of each grinder, is divided into several little eminences and cavities, in such a manner, that when the jaws shut, the eminences of the upper grinders are Received into the cavities of the lower, and so vice versa.
We cannot help admiring with astonishment the works of Providence in the figure and exact disposition of these teeth, which can never be too closely examined.
In order therefore to form a better idea of this admirable contrivance, it will be necessary to observe, that the lower jaw is a kind of a leaver, resting [Page 10]itself at the extremity, where it joins by articulation to the temporal bones, the aliments are the resisting bodies, and the elevatory muscles are the acting powers to overcome that resistance by raising of the jaw.
The grinders which are rather blunt, stand nearer the center of motion, and consequently press more forcibly than the rest; and this is the reason, that when we would bite something remarkably hard, we generally place it between the molares; the canini and the incisores can never act with so much force, being farther removed from the centre of motion, but their want of power is sufficiently compensated by their form.
In speaking of the name and characteristical figure of the teeth, enough has been said concerning that part of the teeth, which appears out of the gums, viz. the crown, therefore we shall proceed to their neck.
Of the Neck of the TEETH.
The Neck is that part of the tooth covered by the gums, and a bony substance, which as we said before, is of a dusky white colour.
In this neck we find, in that part where it joins to the gums, some little enequalities, or rather wrinkles, that cause some small vessels belonging to the gums, to adhere more closely to the neck of the teeth; by this means, not only saline particles are prevented from getting into the sockets, but the tooth is also rendered so firm and strong, as to secure it from being shook or loosened.
Of the ROOT.
The root is that part which is buried in the socket, a continuation of the same substance and colour as that of the [Page 12]neck. It is covered by a membrane exactly similar to that which lines the socket.
The root of each tooth is generally longer than the body, and is thereby rendered more able to bear any strain or violent impression, occasioned sometimes by chewing, gnawing, or breaking bodies of a hard nature.
In every root we find, towards the extremity, a little hole which is a passage to the internal substance, that is to say, the bulb of the tooth.
There is also a little branch of an artery, a small vein, and a nervous filament. This hole is closed up in old age, and then teeth lose their sensation. Various are the figures of roots, and in each species of teeth, there is a particular one.
In all the incisores, there is but one root to each tooth, which decreases gradually, and ends at last in a point.
The canini likewise have generally but one root; but there are some with two, quite divided through all their extent, and others only at the extremities; such teeth however are very uncommon. The sides of the roots of the incisores, and the canini, are flat; and these rest upon the partition of each socket: in the same manner, the flat side of the contiguous tooth rests on the opposite side of the same partition; which mechanism fixes more firmly these teeth in their sockets, and as their necks and bodies are also flat laterally, where they are applied to the other teeth; thus they receive mutually a strong and considerable support by being so well adapted to each other.
The small grinders, namely, those that come immediately after the canini, on each side of both jaws, have generally but one root; some are found with two, and some even with three; but such a case is very rare. The small grinders [Page 14]that have but one root, have it always flat on the sides, and therefore it supports itself in the same manner as the incisorers and the canini.
The number of roots in the large molares, both in the upper and lower jaw, is very uncertain.
There are some large grinders, with one or two flat roots, and each root seems to be formed of two joined together, distinguished only by a kind of a little channel, which begins immediately after the crown of the teeth, and appears through all their extent, in order to mark out the division. There are in some large grinders, three, four, and sometimes five roots, quite separate from one another, extending themselves in a large compass; for which reason, such teeth are deeply rooted, and stick more closely to the socket.
Hence it happens, that the molares are not so easily drawn out of their [Page 15]socket whenever the adjoining tooth is wanting.
The last grinders, otherwise called dentes sapientiae have fewer roots, than the two teeth that precede them, and their body is not so thick. They have generally but two roots joined to each other, which very seldom appear separate in all their extent, or even at their extremities; there have been some notwithstanding, with three, four and even five roots, very plainly divided one from another; but this case is not so common.
The crown or body of these teeth, is almost all covered by the gums. Sometimes the roots of the large grinders are crookedly enclined towards the internal part of the socket, and sometimes towards the external. Some are in an undulating form, and some are bent one against the other, or laid across all together, and therefore [Page 16]it is a very difficult task to draw a tooth of this kind. For if ever one of these roots bends with a point quite opposite to another root that may be lodged in the little cell or the next socket, then these two roots will form, as it were, a pair of pinchers, and gripe with their extremities, the bony substance that parts one cell from another; and consequently in drawing a tooth with those roots, we are forced either to tear the bony partition of the cells, or if this should resist, then either one or the other, and sometimes both these crooked extremities must break, and in both cases it may be of very bad consequence. There is also great danger in drawing the upper molares, lest you should tear with the tooth, the bottom of the socket, together with a very thin bony lamina or scale that parts it from a cavity called the maxillary finus, for then the mucous membrane is unluckily torn, and this gives occasion for inflammations and ulcers in that membrane, and [Page 17]may even produce a cancerous ulcer, as it has happened in many cases.
Every root has a hole that communicates with the cavity in the middle of the crown, which cavity in the grinders, is divided into as many small sinuses as there are little eminences on the base, which is lined with a membrane that serves as a sheath to the small blood-vessels and nerves, that are included in the internal part of the tooth. At the extremity of each root there is, as we said before, one or more little holes that receive nerves, blood-vessels, and perhaps absorbent vessels, which by their connexion together, form what we call, the cord of the tooth; this cord passes through the cavity of the root, and conveys a proper nourishment to the substance of the tooth, and as it draws nearer the crown, it becomes thicker by means of the menbrane that lines the cavity.
The incisores and canini have their nerves from a branch of the fifth pair, called the upper maxillary, which insinuates itself into the orbital canal, from whence it comes out, to be distributed on the face, and in its way sends off filaments for all the roots of these teeth.
The molares likewise receive their nerves from the same branch through small holes, formed in the hinder part of the external lateral surface of the upper maxillary bone.
The veins and arteries, as they always join with the nerves, communicate themselves the same way to the teeth. These arteries are branches of the external carotids and the veins of the jugular.
The nerves of the lower jaw, are from another branch of the fifth pair, called the inferior maxillary, which [Page 19]enters into a canal on the inside of the angle of the lower jaw, and is continued on each side to the chin, a little below the roots of the teeth; in passing along this bony canal, the nerve sends off filaments to the roots of each of the molares and canini, and is then divided into two branches, one of which comes out of a hole of the bone in the chin, called the mental hole, to be then distributed to the chin and muscles of the under lip. The other branch passes on to the symphasis of the lower jaw, and is distributed to the roots of the incisores and deploe of the bone? The arteries which are sent to the teeth of this mandible, have their rise from the external carotid, and follow precisely the course of the nerve through this bony canal, and accompany it through the whole of its distribution. The veins arise from the external jugular.
It therefore appears from what has been saidon this subject, that a tooth ach in the molares or grinders, must be more exquisitely painful than in any of the other teeth; for as the molares are furnished with a greater number of roots, and each root having its artery, vein and nerve, it therefore follows that a tooth of five roots must have fifteen sensative bodies, which, if exposed to heat and cold, by a caries of the bony matter, will caeteris paribus produce a greater quantity of pain, than that of a tooth with a single root.
Of the SOCKETS.
The sockets are cavities formed in the jaw-bones, for the receiving and fixing the teeth, but these will be better understood, by giving a previous idea of the mandibles in general, which have so great a share in forming the countenance; for if the teeth be [Page 21]wanting in either jaw, the lower will be brought so much the nearer to the upper, by the strong action of the temporal muscles, as to make the chin and nose approximate one another, and spoil the beauty and symmetry of the face.
The mandibles may be considered as two bony arches lying parallel to eathother. The lower jaw moving on its condyles, and the upper, which is properly composed of two bones that are firmly united before, and along the palate, so as to form a considerable part of that bony arch; this mandible is firmly attached to the other bones of the face; it has a cavity on each side, directly above the roots of the grinders, which is sometimes opened by drawing teeth with long roots, that have pierced into it.
The lower jaw is likewise composed of two bones, especially in the infant [Page 22]state; which are firmly united at the symphasis of the chin, so as to make but one bone in adults; this bone is remarkably hard in the lower part, altho' somewhat spungy on its upper, in order to afford a more convenient bed for the teeth. This bone has no cavity, save the alveolary canal, which runs under the roots of the teeth, and transmits to them their blood-vessels and nerves.
After this general idea of the structure of the mandibles, we shall now treat of the sockets in particular, which are cavities formed by the teeth in the diploe, or spungy substance of the jaw bones, divided into as many little fossulae as there are roots of each tooth. These little cavities are lined with a thin elastic scaly substance, not so hard as the other parts of the bone, and sufficiently pliable, to become a perfect mould for the teeth, which in [Page 23]cases of violent compression or shocks, gives way, so as to prevent in some measure the teeth from being loosened or broke.
We do not find in the jaws of infants the sockets intirely form'd, at least they do not appear so, for there are but ten or twelve in each mandible, and these not deep; all the sockets in thickness are not alike, for each species of teeth have their particular ones.
The incisores of the upper jaw have their sockets thinner than those of other teeth, and the canini theirs stronger, consequently thicker than the incisores, or even the small molares. The first large grinder has its socket stronger than the second, and last grinder.
In the incisores of the lower jaw, we find their sockets thinner, than in all [Page 24]other teeth of that mandible, and this is the reason that those teeth are more liable to shocks, and it is likewise easier to draw them. The canini have their sockets thicker than the incisores, and the small grinders, but the small grinders have theirs thicker than the incisores of this jaw. The first large one of the molares, has not the socket so thick as the second and third, which last one has it thicker, because of the apophysis coronoide, and that is the reason why it proves generally very difficult to draw.
These sockets, when teeth are drawn, or naturally fail, are generally destroyed in a very short time, insomuch that it is almost impossible to perceive any marks of them, as we daily see in examining the mandibles. But if ever in drawing a tooth, some part of the [Page 25]socket was to be torn, then the sides would be found not quite so thick, nor so firmly joined in that place. The sockets are outwardly covered, and lined inwardly, with a membrane or periostium, common with the root of the tooth; it is a continuation of the periostium that covers the other bones, and of the same membrane that lines the internal part of the mouth.
Of the GUMS.
The fleshy part that surrounds the socket, is called the gums, these are made of a hard substance, rather fibrous than glandulous. They are penetrated and moistened by different vessels, namely, by veins, arteries and lymphaties. The texture, of the gums is of a coriaceous nature, with fibres interwoven like a hat's felt, very close and elastic, of a pale vermilion colour; all the border of the sockets in both the inward [Page 26]and outward side of the jaw, is covered by the gums which insinuate between all the teeth, and adhere so closely to the neck of each of them, that they prevent any thing acid or sharp from touching the socket. Before the teeth come out, the gums are all of a body, without the least separation; and as the teeth begin to shoot out, they pierce the gums and make so many holes as there are teeth in the mandible.
The gums are joined to the jaws by the periostium, which they every where cover. The outward covering of the gums extends itself from the crown or body of the teeth, over the cheeks and lips, and seems in every respect to be a continuation of the same membrane.
The inward gums of the upper jaw, go from the internal part of the neck of the teeth, as far as the circumference [Page 27]of the roof of the palate, and those of the lower mandible, as far as the circumference of the bansis of the tongue.
When a tooth happens to fail, the gum covers the orifice of the socket, which being soon shut up or destroyed, the external part of the gum joins with the internal one, and they unite themselves very closely together, becoming so hard and so firm a body, that we see men, who, after having lost all their teeth, bruise the aliment with their gums, altho' they cannot cut or mince with them; in this case the gums re-assume the very same figure they had before the teeth appeared.
The gums no doubt are the prefervers of the teeth, since they keep them quite firm in their sockets, and save them from being touched by any thing heterogeneous or pernicious, [Page 28]which might produce the most painful disorders in the teeth, and even a total destruction of them.
The gums when properly ranged, contribute very much to the ornament of the mouth, for as these are of a vermilion cast, and form a kind of a crescent, or half moon, around the enamel, of each tooth; they set off in a more elegant manner the whiteness of the teeth, when we have occasion to shew them by smiling, &c. Of the GENERATION of TEET II.
Nature in forming these bones, seems to deviate intirely from those laws that she has established in the production of all other bodies, and to chuse a peculiar uncommon method in this generation.
The greatest part of natural productions have their beginning in their [Page 29]roots, but a tooth on the contrary does not begin to form its root till the body is perfectly finished. The first substance that begins to appear in this body, is not the internal part, as one would imagine, but the external one, the farthest from the root, and what is called Enamel. This substance in its begining is nothing but a mucous soft paste, which acquires insensibly so much firmness, that it becomes at last a bony part, so hard and so white, that it excels all other bones, (as we have shewn in its proper place) in point of hardness and whiteness. When once this scale, or bony coat is formed, the tooth assumes directly a proper figure, and its inward part begins to be filled.
The germ of the teeth, like that of other bones before ossification, is composed of a tissulated mucus separated and divided into a number of little [Page 30]cells; which are afterwards filled up with calcareous or bony matter, and constitutes the solidity of the bone. This germ is contained in little lodges or cells of the sockets, which it stretches in proportion as the bulk of the tooth augments, and spreads; at the same time its membrane increases, and takes hold of the root, and forms the periostium that surrounds it.
The body of the tooth being quite finished, the root takes then its due form, and as it grows stronger, it lengthens by degrees till it becomes of a proper length, the extremities grow firm and bony, leaving however a free passage to the vessels, that run through the cavity of its root, and penetrate with their nourishing juices to the very inward body of the teeth. While the root grows thicker and stronger, finishing itself within the socket, the body of the tooth rises towards [Page 31]wards the gum, and attempts to come out. It begins by dilating the partitions of the socket, and being level with this bony border, it cuts immediately the membrane, in which it is inclosed, then the other membrane that covers the socket, and at last the gum; in this manner shoots forth the teeth.
The partition of the socket will lengthen in proportion as the tooth draws nearer the gum; but altho' in lengthening they are compressed and grow stronger, still they retain an elasticity, by which they render the tooth safer and stronger in case any accident should befall it.
The same oeconomy we find in the molares, that are furnished with more roots, and consequently have more cells in their sockets, which always multiply at the same time, when the roots appear, as was said before. It would be natural to think that in those teeth [Page 32]that have but one root, their sockets should be found greater in diameter than the root itself, as the socket has taken the form and figure of the body of the tooth, which is first of all formed in it, and is always of a larger diameter than the root, but it is never so, on account of the above mentioned clastic force belonging to the partition of the sockets, insomuch that as soon as the body of the tooth is out of the socket, the socket contracts, and adapts itself, by degrees, to the figure of the root, holding it so close and so firm as if it were fixed in a vice or screw.
Of the ERUPTION of the TEETH.
Children, when they are brought into the world, have generally no teeth; I say generally, because some have been found with two, three and even four incisores, two in the upper [Page 33]jaw and two in the lower one; but these cases are not to establish a rule, being only an exception.
Teeth appear sooner or later, according to the weaker or stronger constitution of the child; there have been some of them who have cut their teeth when they were two or three months old, and sometimes not before they were a year or fifteen months; but for the generality, in the fifth, sixth or eighth month after their birth the first tooth begins to appear. The two small incisores of the lower jaw are the first that come out, the one fifteen days after the other.
The large incisores of the upper jaw appear almost at the same time, then two appear in the lower jaw at the side of the former, and then other two in the upper jaw; this is the general order in which the incisores are seen. [Page 34]When the child is eleven months, or a year old, the lower canini appear almost always at the same time; and a few days after the upper canini likewise shoot forth together, and these cause greater pain than the former.
When children are about sixteen or twenty months old, the two small lower grinders come out, and in a few days after the other two of the upper jaw; the other four molares do not generally appear till the child is two years old, one at each side of the mandibles. These make twenty in number, and are called milk-teeth, the child remaining in this situation, till about the sixth year of its age.
The order we have described, is not always exact, for we often see the small grinders shoot forth sooner than the [Page 35] canini, and the canini quicker than the lateral incisores. At the age of five or six years, the other four molares appear next to those lately come out in each mandible. Towards the eleventh or twelveth year, four other molares come out in the same order, as do likewise four others in the 17th or 18th, which in all make 28, viz. eight incisores or fore teeth, four canini and 16 molares or grinders; with these teeth we generally continue till the four last molares, called dentes sapientiae appear; the exact time of which is very uncertain, tho' usually it happens at the age of 25, or even 28; nor are there instances wanting of their not appearing before the age of 50, when they are for the most part accompanied with tumours and fluxions on the neighbouring parts, which proceed from the pressure caused by the crown of the tooth, on the sides of the socket, and on the fleshy [Page 36]and membranous point of the gum, which at that time of life, is become more hard and obdurate. At the age of seven or eight years, the incisores, the canini, and the small molares, are shed in the same order as they did appear. When these are gone, as many stronger and more beautiful teeth take their place.
It is remarkable, that if one of the milk-teeth is drawn before it is loose, we find in it a root as firm as that of the second tooth; but on the contrary, if it is drawn when it is loose, there is no root at all: this has given rise to a variety of opinions, concerning the destination, or rather destruction of the roots of the milk-teeth: it is imagined by some, that they are entirely consumed by a flux of acid humours, which absorb the calcareous matter of the roots, and so [Page 37]decompose the constituent parts; while others suppose, that these roots are incorporated into the substance of the second teeth. But as these suggestions are not supported by the least appearance, of fact, we shall not therefore take up the time of the reader, to prove the contrary of them, but shall only observe, such an acid humour could not exist without destroying all the teeth, and that such an incorporation into the substance of the second tooth, has never yet been found. It appears by several of the later discoveries made in anatomy, that many parts necessary to the body, in the embrio and infant state, are totally lost and obliterated in that of adults, and that those parts which are become useless and redundant in the system, are absorbed, and taken up the lymphatic vessels to be afterwards thrown out at the different emunctories of the body, that this is [Page 38]in reality the case with the roots of the milk-teeth, may be fully ascertained by a variety of similar facts, that the nature of this work won't admit to enumerate.
Sometimes, tho' seldom, the large molares, and even the dentes sapientiae, will shed, as happened lately to a lady, who was tortured with a most exquisite pain in one of the dentes sapientiae, on the right side of the lower jaw. I felt the tooth quite loose, which I drew with my fingers, but found no root to it: this I concluded to be owing to another tooth lying under it, which I soon perceived on further examining of the socket: as the excruciating pain still continued, the lady could not be persuaded that there was another tooth to come out, but that the root of the former was left behind; however, the appearance of the new tooth, not long [Page 39]after, fully convinced her, that the pain was entirely owing to the. smallness and firmness of the socket, which retarded the egress of the young tooth, and obliged it in a manner to grind its passage out.
There is an opinion prevails, that there is a very great risque in drawing milk-teeth before they are loose, but in reality, there is not the smallest. danger, and indeed, when they are careous, or any other way painful, it is absolutely necessary to draw them, to prevent as much as possible an inflammation of the gums, and adjoining parts, which might destroy the germ of the second tooth.
It is sometimes necessary to draw those teeth that lie across, or ride upon one another, (a very disagreeable sight) in order to give a more exact and uniform arrangement to the rest. This [Page 40]defect of order in the canini and incisores, in general proceeds from an extreme narrowness of the jaws. But the operator must be very circumspect in examining every circumstance relative to the tooth and socket before he draws a milk-tooth, for if a part of the socket should be broke and give way, the second tooth will always come out in an irregular and ununiform manner.
Disorders incident to Children in teething, and the manner of treating them.
The eruption of teeth in children, is often attended with the most fatal consequences, by exciting fevers, convulsions, gripes in the intestines, acidities in the stomach, attended with the worst consequences, and finally by [Page 41]introducing a great degree of irritability in their tender constitutions, so that they become more liable to a greater variety of disorders.
Children suffer in teething, first in proportion to the delicacy and sensibility of their constitutions. Secondly, to the number and figure of their teeth that push out at the same time. Thirdly, to the state of the gums, which in some children is found to be more tense and liable to inflammation than in others.
Children who are originally of a delicate habit, or who have been rendered so by milk of an improper quality, or by any other cause that impairs their digestion, and produces acidities in their stomachs and intestines, are extremely liable to convulsions in teething; on [Page 42]the contrary, children of a strong robust make, whose food is converted into proper nourishment, are less subject to convulsive disorders, but are liable often to a degree of fever, which in some measure facilitates the eruption of the teeth. Secondly, the number and figure of the teeth that shoot out at once, will greatly increase the pain, for the blunt flat molares, will meet with a much greater resistance, and a greater degree of laceration, than the sharp pointed incisores or canini.
At the same time the canini will prolong the pain from their wedge like figure, which is continually delating the socket and gum, till the tooth has compleated its growth.
From this great difficulty, that teeth have to cut the gums, a great [Page 43]many mischiefs are frequently produced, for as inflammation is always the consequence of laceration and pressure, this by going too far, occasions frequently swelled glands about the throat and neck, which sometimes suppurate, and even ulcers in the gums, and neighbouring parts, have been produced. In order to mitigate, and in some measure prevent the disorders arising from teething, it will be necessary to consider well what has been already said in regard to the tendency of nature to inflammation in the strong and robust children, and to convulsions, gripes and looseness in the weak, tender and delicate; in the first case, the degree of fever and inflammation, may be lowered, by keeping the nurse upon a low diet, avoiding animal food, spices, or what ever tends to stimulate and encrease the circulation; frequent but small doses of rhubarb, [Page 44]ought to be administered to the nurse, which will gently purge the child, in the safest and most commodious manner; in the mean time, if the gums are much swelled, scarrifying them with the point of a lancet, so as to make them bleed at several parts, will empty the distended vessels, and remove the tension from the inflamed gums and where the fever runs high, even bleeding with leeches or the lancet, will be of great service.
In the other case, where convulsions are so often the consequence, we must endeavour to prevent these frightful symptoms by every method that may tend to strengthen and confirm their constitutions, such as having a strong and healthy nurse, taking care that she lives on the most simple and nourishing food, giving the child a wholesome country air, with a good deal of exercise, and exhibiting small doses of aromatick infusions of the bark, powder of tin, or such like.
Where a looseness and gripes prevail, it would be necessary to take every method to prevent that tendency to acidity which mostly takes place in infants, whenever digestion is any way disturbed; this is best done by giving frequent, but small doses of the absorbent powders, conjoined with aromaticks; and perhaps rhubarb, or more astringent simples, with opiates, may be found necessary.
In children of relaxed habits, whose gums are loose and flabby, there is very little tendency to inflammation, in that case applying mild astringents (such as a decoction of rose buds in vinegar) to the gums by the nurse's finger, will help greatly to brace up and facilitate the eruption of the tooth. But in all cases, where the symptoms are troublesome, and the tooth tardy in coming out, the only effectual means is to make a free exit for it by incision, and to cut the gum quit down to the tooth; and indeed wherever a [Page 46]tooth seems ready to appear, and the child is pining and suffering much, we ought to recur immediately to incision, and in that way remove the pain that is occasioned by the distraction of such sensative parts.
Sometimes where the gum has been already cut, and the teeth very slow in growing, the parts unite, and a cicatrix is formed above it; here we should again cut the gum and periostium, so as to lay the tooth quite bare.
In some of the strong and healthy children, a number of teeth will push out at the same time, by which means the symptoms are greatly aggravated; here also we should give a free exit by incision, then gentle emollients should be applied to the gums, and every thing that is irritating be avoided.
Particular attention should be paid to the least sore or ulcer that maybe formed [Page 47]about these parts, lest they destroy the germ of the subsequent tooth.
Of the DISORDERS of the TEETH.
The teeth are subject to a variety of disorders, which may be divided into those arising from internal or external causes. The first have their rise from the juices being contaminated by scurvy, scrophula, venereal infection, or whatever induces a cahexy of the humours.
Also it is observed, that women are more liable to tooth-achs and fluxions upon the gums, during the time of pregnancy, than at any other; perhaps from the particular sympathy of nerves, that is so peculiarly shewn upon the stomach, &c. at that period.
All disorders in the gums, infect the teeth, and are the cause of long and painful sufferings. Teeth generally fail by some of the above causes.
The external causes are also many. The general ones are, the use of aliments too hot, or too cold, the different impressions of air, all shocks given to the teeth, which affect the nerves, the vapours that arise from the stomach and lungs, and leave a noxious and disagreeable slime on the teeth; any particles of food that stick betwixt the teeth and putrify; keeping the head uncovered and exposed to the air; sleeping bareheaded, as likewise the excessive use of smoking and chewing tobacco; the many improper remedies also that are made use of to keep the teeth clean, and the caustics applied in order to mitigate the pain, are always sure to destroy those they unluckily touch; hence we may see, of what importance it is never to make use of any remedies, but what are approved of by a skilful person. Sugar, when used immoderately, is another enemy to the teeth; but one of the most [Page 49]dreadful destroyers is mercury. One ought therefore to be extremely cautious in using it. All mineral exhalations are also very pernicious, as we see it by daily experience in all those persons that work in any of the quick-silver, lead, or copper mines, &c. such people generally have their teeth coroded, divested of their enamel, and sometimes entirely wasted away by the corrosive particles exhaling from those minerals. Among the external causes however, negligence may be reckoned the first; for let the lymph be ever so pure, and digestion ever so regular, there are always some viscid exhalations that are apt to settle upon the teeth; these can easily be removed, but if neglected, may prove the cause of many mischievous disorders, as we shall shew hereafter.
It is not my intention to give my readers a list, (as many have done) of the various disorders incident to the teeth, but to comprehend them under [Page 50]two single articles, namely, erosion and caries; and we shall take notice likewise of what is commonly called the tartar. Erosion is a disorder that renders the teeth rough, and as if worm-eaten.
It affects only children, either when the first teeth shoot forth, or when the second ones appear. The original causes of these disorders are the small pox, the measles, and all those disorders that contaminate the juices. It penetrates more or less, according o the hardness and firmness of the teeth; and therefore if the disease should seize the child, when his teeth are not sufficiently firm and ossified, it must be attended with bad consequences, meeting with little ressistance in the parts not sufficiently ossified.
But if it should come on when the milk teeth are shedding, and the new [Page 51]ones appear, it will be of no harm to the tooth that has not as yet come out. The enamel of the tooth can never be hurt, but when wrapt up in its membrane, as it is then nothing else but in the state of a soft mucus, which being rendered acrid by the same cause, the enamel will be intirely consumed. Whenever this disorder appears, it can be of no detriment, but to the parts that are not sufficiently firm and ossified. Children that are infected in utero, with the scurvy, the venereal disease, &c. will bring along with them the seeds of those disorders, so pernicious to the teeth, if proper means are not made use of to prevent it. But if the original causes shall be thoroughly eradicated, the milk teeth will only suffer, and those that succeed them will be found quite untouched.
In order to purify the constitutions of such children, it will be necessary [Page 52]to make use of those means proper to produce a good chyle, and to correct the state of the juices, which is the province of the physician.
It is necessary likewise to chuse a good nurse, whose milk is not thick, for then it is not so easily assimilated by the inflantile powers, nor too serous, for then it wants the proper substance, so necessary to form a good nutritious juice, the want of which prevents bones from growing in their natural form.
The child should be kept in a good and pure air, and all occasions taken to give it due exercise in the arms of the nurse, &c. These are precautions that will prevent this disorder from affecting children. It is worth observing, that if the erosion happens to come after the child is wained, that is to say, when he is from two to six years of [Page 53]age, a methodical way of living, proper food and good air, will be the means to prevent it. Many have thought, without reason, that this disorder could affect nothing but the body of the tooth, and that the root was not susceptible of it. It is true that the roots do not appear so rough and worm-eaten, as the body of the tooth, but still they are shorter, more crooked, and of an imperfect form, which they could never get but from this tendency of the humours to erosion, or from the rickets, which is a disease so fatal to children, and proceeds from the same causes as the erosion; it also proves very pernicious to the teeth, and all other bones.
Of the CARIES.
As soon as the teeth make their appearance, the caries begin to attack them, and consequently they stand in need [Page 54]of proper assistance. One should think that their hardness would render them less susceptible of it, but they are even more subject to a caries than all other bones; it is easy however to trace the causes of it. As teeth are of a closer texture, their vessels are more compressed, and therefore obstructions are easier occasioned, and also when cold happens to strike them to a certain degree, or when the bony fibres suffer by some extraordinary effort. If the juices that circulate through the small channels of the teeth, are too thick, or are any way vitiated, the teeth will therefore be more liable to be contaminated, but always in proportion to the impressions they shall receive.
Teeth that have been affected with the erosion, at the same time they were forming, are more subject to be [Page 55]carious, on account of the bad condition of their vessels, and therefore are more difficultly preserved.
Various are the species of caries; almost every part of the teeth are affected by it, and both internal and external causes produce it. A caries may be divided into soft, superficial, deep, and dry; it attacks the root, the neck or the crown of the teeth. The caries, that proceeds from internal causes, namely, the scurvy, &c. generally affects the root of the tooth, often the internal surface, sometimes the external, and even the inward cavity of the body.
Such a caries is more difficult to be known, than that which proceeds from external causes, chiefly when it attacks the root or neck of the tooth; for as the former is buried in the [Page 56]socket, and the latter is covered by the gums, one cannot perceive it, and therefore we can only conjecture, that there is a caries from the torturing pains that are produced; but these conjectures are often false; for the pain may proceed from some irritation affecting the cord of the tooth or the periostium, that covers and lines the root; the consquences therefore arising from this sort of caries are very bad, for it is mostly necessary to draw the tooth itself.
The caries that proceeds from external causes, is visible, and consequently by admitting of the necessary operations, more easily removed. A caries, the longer it is allowed to run on, the deeper it goes, and therefore the more difficult to cure.
the soft and dry caries are not dangerous, if their progress is quickly and properly stopt.
Every kind of caries is more difficult to be eradicated according to the place it affects in the tooth, as that renders the operation more or less difficult.
Although teeth begin to be affected with the caries, as soon as they appear, still it must be allowed, that the time in which they are more subject to it, is from 25 to 50 yeare of age.
It is wroth remarking, that when a tooth is affected by the caries on that side which rests on another tooth, it also infects the contiguous one; for experience daily shews, that when the spot begins to appear in one tooth, it is also seen, although not so large on the next in the very same place; from which we may argue, that the particles [Page 58]exhaling from the carious tooth must be corrosive; this happens, not only in the lateral, but also in the opposite teeth; for when a caries appears on the upper surface of a tooth, it is then applied to the surface of the opposite, and in the same manner affects it, as is particularly seen in the molares.
The caries sometimes proceed from fractures in the teeth; but these are generally caused by falls, and from violent efforts in breaking something of a hard nature with the teeth.
The fractured tooth can never be repaired, but however it ought not to be neglected, but carefully examined, as it requires the greatest assistance of art, for the tooth has sometimes in the fractured part small cutting points, that will be of great detriment to the tongue, and be the cause of very painful and dangerous wounds; therefore [Page 59]they must be immediately taken off, to prevent mischief to the tender parts that they touch.
Whenever the caries appears, it must be opened by a masterly hand to the very bottom; if in so doing, the cord of the tooth is discovered, the operation will prove very painful; but still it must be destroyed, either with an instrument, the actual cautery, or some caustic liquor.
We ought to be very attentive in the operation; for if we do not utterly destroy the said cord, but only prick it, the most raging pains will succeed, together with an inflammation, and the inevitable necessity of drawing the tooth.
Such a cure cannot but be very torturing, for not only the sensitive parts of the tooth are to be exposed to the impression of the air, but also to be [Page 60]touched with an instrument, so as to be entirely destroyed. The skilful operator must endeavour to asswage the pain of his patient by the assistance of medicines.
When a tooth by the loss of its cord is become insensible, it must be filled with lead or gold, in order to prevent any acid or saline particles from getting (through the hole, where the cord went) into the socket, to hurt its delicate membranes, for then there could be no means of redress, but by drawing the tooth; hence all the care that has been taken, and all the pain that had been endured to render the tooth insensible, would then be of no avail.
Of the TARTAR.
Now we shall proceed to treat of what is commonly called the Tartar. From whatever occasional or secondary cause the tartar proceeds, the principal [Page 61]one is certainly negligence. It hath been called by some a cancer, because it corrodes the gums, and the socket in suck a manner that the teeth will fall out for want of support. It is generated by the fragments of aliments that stick to the teeth, by a vitiated saliva, or by an imperfect digestion, &c.
Whenever this viscid matter is allowed to stick to the teeth, it grows hard, and becomes the tartar, and it will augment by degrees, from new particles of aliments continually joining the old ones; but this would never happen if they were carefully cleaned every morning with something proper for that purpose.
This tartar is a kind of a crust, not only disagreeable to the eyes, but also productive of very foetid exhalations.
There are various sorts of tartar, viz. The yellow, the whitish, the black, and even the green tartar, which is the most pernicious, as it often destroys the enamel. The lower incisores are more subject to the tartar, chiefly in their internal side, because of their vicinity to the tongue, and of the saliva which runs mostly that way; although persons grown in years are generally more liable to be troubled with the tartar; still we frequently see young people with their teeth all covered with it.
Whatever is the cause that produces this tartar, or whatever the time of its appearance, it ought to be removed as soon as possible, otherwise the gums, by the compression, will swell, and obstruct the regular course of the fluids through the lymphatic and blood-vessels, which will therefore be liable to putrify, and destroy, [Page 63]in a short time, the gum, the socket and periostium of the root.
This is the reason why teeth grow loose and painful; at that time, if you were even then to cut off this heterogenous body, it would be too late to hinder the loss of the tooth, which is now left without any support from the gums, the periostium and the socket.
The tartar sometimes is even thicker than the body of the tooth, to which it sticks so close, that it seems to form one single body; therefore requires a dextrous and skilful hand to remove it; in such a case we must endeavour to render the course of the humours free again to the gums, by restoring them with proper astringent and antiscorbutic medicines.
Some teeth, after having been freed of their tartar, will shew a very beautiful enamel, which makes it evident that such a tartar is not of an acrid or corosive nature as the green kind generally is.
Of the DISORDERS The Sockets are liable to.
The sockets are also subject to caries as well as the teeth, although not so often. The causes that produce such an effect in them, are the very same with these formerly delivered as the internal cause of caries in the teeth.
The sockets are also liable to be destroyed by degrees, in the same manner as the roots of the milk-teeth.
This fatal disorder proceeds from a stagnation of humours in the gums, where they putrify, or from any sharp [Page 65]and corrosive particles, that may penetrate and corrode them insensibly, Also from a stagnation of the fluids in the serous or blood-vessels of the gums; the sockets and their partitions will sometimes grow soft and become entirely of a fleshy consistence, which therefore leaves the tooth without support. Old men generally lose their sockets entirely, because the nutritious juices that formerly served to nourish the gums are now no longer distributed to them.
It is worth observing however, that persons of a robust constitution are not so liable to lose their sockets, and consequently their teeth; for we see people extremely old with all their teeth, their gums quite perfect, and therefore their sockets must be sound and well.
There is no other way to prevent those disorders, hut by taking a particular care in cleaning the gums, never letting any corrosive particles, or any viscid matter, that is likely to putrify, enter into the socket, so that the gums may become strong and apply themselves closely round the necks of the teeth.
Of the Disorders of the GUMS.
Whenever the gums are affected, they generally lose their colour, their firmness, and consequently their adherence to the teeth; they will at different times appear pale, flabby, relaxed, rough, corroded, inflamed and wrinkled. The lividity of the gums proceeds from some defect in the circulation of the blood through them.
To remedy as much as possible so disagreeable a circumstance, it will be proper to rub the gums pretty often [Page 67]in the morning, and likewise to scarify them in order to let out some blood, and in that way promote the circulation.
If after these means have been used, the complaint remains the same, it will be the necessary to have the physician's assistance, as the fault must be rooted in the constitution.
The gums grow often so thick that they in some measure resemble pincushions, and by communicating their swelling to the lips, they will greatly deform the mouth and face.
This disorder proceeds either from the compression of the tartar, or a local plethora. If it proceeds from the first of these, the tartar must be removed immediately, then scarify or prick the gums, and administer proper antiscorbutic and astringent medicines fit to brace them up.
But if the swelling proceeds from a plethora, which is easily known, a proper method must be-taken to evacuate the vitiated humours, and to diminish the thickness of the gums, in the points that run in betwixt each tooth, where the swelling more manifestly appears; then proper astringents should also be applied to prevent the complaint from recurring; the patient must live on a proper regimen, and submit to the necessary ablutions.
A swelling often as big as a strawberry, sometimes appears in the gums of young people, which is more unsightly than dangerous; but it is necessary to discuss it as soon as possible. The same causes that swell the gums, will also produce excrescences upon them.
If these proceed from an external cause, the effect will cease when once it is removed; but where the cause is [Page 69]internal, till once that is entirely removed, all outward applications will be useless; sometimes these excrescences will be greater than at other times.
When they begin, they are never dangerous, but if they are neglected and increase, the tooth becomes soon loose, and of course is soon lost. Absorbent remedies are to be applied in the beginning, but when the excrescence is arrived to a certain size, then it can't be destroyed, but either by carefully cutting off the redundant part of the gum, or by consuming it some other way.
The substance of the gums may be diminished either for want of sufficient nourishment, or by being too tense and firm; for then they are apt to hinder the fluids from circulating properly; hence it happens that the teeth are deprived of their necessary support, and [Page 70]the gums become a very disagreeable sight to the eye. The want of juices, and the contracted state of the vessels (which are the chief causes) may be removed, by means of proper emolients, &c. which by relaxing the parts that were too tense and firm, will promote the dilatation of the vessels, and consequently the course of the humours will be more free, and their quantity augmented.
We must not however delay the cure too long, for sometimes art comes too late. The paleness of the gums proceeds from a deficiency of the globular part of the blood, which may be occasioned likewise by the narrowness of the vessels. It is easy, by rubbing the gums pretty often, to recall the blood, and consequently restore to them their natural colour.
Whenever the gums are relaxed, and want that tensity and firmness which [Page 71]is so absolutely necessary for their being in a sound state, various complaints are generally the consequence, and therefore proper antiscorbutic astringents must be made use of in time, to prevent and remedy such fatal disorders.
The gums are sometimes rough, as if spread all over with little grains, like millet seeds, under the skin. These little tumours are hard and ugly, sometimes will come to a suppuration, and render the gums very painful; these are therefore to be prevented by applying very strong resolvents, then we must make use of detergents, and come by degrees to astringents.
Children who eat too much sugar, or sweetmeats, generally have their gums corroded: Confectioners and Chymists are subject to this disorder, because the saline and corrosive particles, that fly from the sugar and minerals, [Page 72]affect their gums: This disease should by no means be neglected; and first of all, the cause must be removed; then the proper astringent and sweetning medicines must be administered, to purify the mass of the blood; and it is very necessary to abstain from every thing too salt, spicy, high seasoned, or what else may render the blood acrid or sharp.
The inflammation of the gums proceeds, for the most part, from the impression of cold air: The belt remedy therefore is to keep them warm.
That the gums are also subject to cancerous tumours, from the above causes, evidently appears; and they should always be speedily extirpated. Such a disorder must be considered as a local affection that has proceeded from some glandular, or vascular part of the gums being vitiated, together [Page 73]with an internal or praedisposing cause in the habit; it requires, therefore, a very serious and mature consideration before such a cure is undertaken, lest we should hurry on to the operation too precipitately.
Sometimes ulcers will affect the gums, their external causes are rotten teeth, the tartar, violent falls, blows, vitiated saliva, or any other injury offered to them.
The scurvy and vitiated humours are the internal causes, and therefore a radical cure of the ulcers will never take place, except these are entirely got the better of.
They are sometimes more, sometimes less deep in the gums; when they are not deep, astringents and antiscorbuties may be of use; but when they are deep, they will even produce a swelling, and [Page 74]an excrescence in the gums; and therefore we must take care to cut off the superfluity, and follow the method that was mentioned when we spoke of tumours and excrescences.
Ulcers are of different sorts, and vary greatly in their appearance, but as they always proceed from the above causes, (and the nature of this work will not allow of prolixity) it will be unnecessary to describe them.
The abcesses or imposthumes, that are formed in the gums, proceed, for the most part, from some bad tooth, or from some tooth not drawn in time. Or they may proceed from the intemperature of air, from some violent blow, &c. as also from the extraction [Page 75]of a tooth difficult to draw. When the cord of the tooth is left uncovered, either by a caries, or some other cause, it swells and inflames, communicating the inflammation to the periostium that covers the root, and lines the socket and substance of the maxillary bones, then proceeds to the socket, and so to the gums, where the abcess is formed, from its being a much softer part: we must not neglect to examine the tooth, and if we find it to be the cause, it must be drawn immediately, even if there was a fluxion of humours upon the gums; for the corrupted matters that are stagnated in that place, might be very pernicious to the contiguous bony substance: then we must make use of those remedies that are prescribed in such cases, in order to make a perfect cure; for if it was not speedily done, it would prove destructive to the gums, the sockets, and contiguous teeth.
The same causes also will produce fistulas in the gums, which are more or less of a malignant nature.
In order to remove them, it will be proper to make use of the same things that were prescribed for the abcesses, or of any thing else that the skilful practitioner will find necessary.
Little Cancers that appear sometimes in the gums may destroyed by a caustic: those that arise from some internal cause, are more malignant and stubborn, sometimes they are very numerous and small, of colour different from other cancers, and almost always accompanied by ulcers somewhere else.
Those that proceed from the fluids being tainted by the venereal disease, are distinguished from those that arise [Page 77]from a scorbutic humour; for the former ones are deeper, more painful, and full of blood, yielding a greater quantity of foetid matter, and have their lips greatly swelled.
The second ones are of a milder nature, and are not so much inflamed. Without purifying the vitiated humours internally, as was formerly hinted, all outward applications will be quite useless.
The gums are also subject to suppuration, and in this way, not only the gums may be destroyed, but also the teeth. I have remarked that fat persons are more subject to this disorder than those of a meagre constitution, on account of their having a greater quantity of humours; the fore parts of the incisores, canini, and small grinders, [Page 78]towards the root, are most liable to be affected with it; they grow of a brownish colour, and in proportion as the disorder increases or decreases, they assume a different appearance.
Suppuration frequently happens in those gums where the sockets are wanting; the gum being, as well as the socket, divested of the periostium, and consequently not able to adhere, is, by being left to itself, and exposed to the air, or filled with some little ulcers that will soon occasion suppuration; and therefore it becomes necessary (in order to avoid more dangerous consequences) to cut off that piece of the gum which is left unattached, and likewise to remove all other causes, such as the surcharge of humours, &c. by exhibiting medicines that may be thoroughly adapted to answer that end.