THE complaint which generally attends the execution of a work of this kind seems to be, that the author, being puffed up with a vain conceit and opinion of his own abilities and consequence, takes too frequent and unnecessary occasions of introducing in his writings technical terms, and obscure expressions of the art; making that, which professedly undertakes in a clear and simple manner to treat of the disorders incidental to the teeth, and the remedial applications necessary in such a case, a work of laborious inquiry, and a mere display of anatomical [Page 10]knowledge. This error I will endeavour cautiously to avoid; as well, because the natural history and anatomical structure of the teeth have been explained and amply treated of in some late very ingenious and elaborate treatises (those I mean written by Mr. John Hunter, F. R. S. and surgeon to St. George's Hospital; and Mr. Beard­more, surgeon dentist in ordinary to his Majesty) as because I should be too circum­scribed in such an attempt by the limits of these pages: such an attempt requiring more time and leisure thoroughly to finish than I could be able to secure from my ne­cessary avocations of business. I therefore beg leave to recommend the treatises above mentioned, from the perusal of which I have received great pleasure and satisfaction, to those, whose curiosity or profession lead them to attend to the minutiae of the subject.

My design is merely to give a plain and brief account of the teeth, the compaints they are subject to, and the methods of cure; omitting nothing, I hope, which is [Page 11]necessary to be known, and avoiding all obscurities of stile and meaning. The sub­ject has been already amply and copiously treated of, and I have not the vanity to think that I shall be able to set it, or any branch of it, in a new or more instructive point of view.

The teeth are hard substances of bone and enamel growing in the cavities of the upper and lower jaw. These cavities anatomists call the alveoli, which have circular pro­cesses embracing the body of the tooth with great closeness, and thereby are to be con­sidered as principal supports of the teeth.

These alveolar processes are covered by a compact elastic substance or fleshy cove­ring, called the gums; which covering ad­hering firmly to the alveolar processes invests and contains the teeth firm in their sock­ets: and are besides an admirable protec­tion for them against the injuries they might receive from an exposure to the air and cold, and from the occasional pressure of our food against the thin membrane which covers them. The circular ridge [Page 12]which separates and distinguishes the body and roots, or fangs of the teeth, and to which the gums grow up, and are closely attached, is called the neck or collar of the tooth. The fangs or roots are those parts which are hid from our sight in the sockets: they are covered with a thin vascular membrane, called the periostaeum, which unites them firmly to the jaw. The inner substance of the tooth is the bone, having an internal cavity, which extends nearly the whole length of the tooth; be­ginning at the point of the root or fang, and ending in the body of the tooth. This cavity is well supplied with nerves and blood vessels, which nourish the teeth, pro­mote their growth; and when subject to any disorder or obstruction, are the seat of the most exquisite sensations of pain. The enamel grows only on, and surrounds the body of the tooth. It is a very white and smoothly polished substance, of a degree of hardness so great, as to be impenetrable to our keenest instruments: in cutting or di­viding it therefore, we are obliged to use files, and even those must be skilfully used [Page 13]by the operators, to prevent any damage being given to the remaining polish of the enamel.

The shape of the teeth being within the immediate extent of every one's own knowledge, I shall not here make mention of it. Their number is uncertain; though I believe they rarely exceed thirty. Mr. Hunter says, that he once saw only twenty­seven, but never more than thirty-two; and makes thereupon this very sensible re­mark, "That where the number is less than thirty-two, the deficiency is in the last grinder."—This is, however (I mean the number of teeth in a full subject) a point of mere curiosity; since during the course of my practice, I never could discover any difference in the formation or structure of them, whether more or less in number: but they all equally as well perform their usual functions, and answer the purposes for which they are designed. The number is not certain, I think, for this reason, viz. that if it were, when the jaw bone [Page 14]of a man is enlarged, and grows in propor­tion to the increase of his age, we do not find any difference in the alveolar spaces, either with regard to their number or ex­tension, which would otherwise undoub­tedly happen in the case between a man, who in his perfect state, had thirty two teeth, and of another, who had only thirty.

The above is a brief description of the situation and structure of the teeth: the formation of them is curious and particular, which I will endeavour to give as satis­factory and concise an account of, as the limits of this work will permit.

The contents of the alveoli, or cavities in the jaw, in which the teeth grow; are at almost the earliest state of infancy, some little soft pulpy substances which are attached to the bottom of the sockets by a nervous filament, whose vessels diffuse themselves through the pulpy substances, and the thin membrane that covers them. [Page 15]Nourishment is hereby conveyed to these pulpy substances, which, as the child in­creases in age, begin gradually to ossify, and advance higher and higher from the sockets. The tooth is yet imperfectly formed, not having gained any degree of strength and rigidity. By degrees they begin to press against the gums, which, by constant attrition are inflamed and affected with redness and swelling, and occasion great pain and uneasiness to the infant. What is called the cutting of the teeth now begins, which is a violent effort of nature to pierce through the confinement of the gums, where the teeth have undergone the state of formation and ossification, and to appear above the sockets. As this opera­tion of nature is attended with great and continued pain to the child, and frequently not finished without the hazard of much danger, it has been a matter of surprize to some gentlemen of eminence in surgery. that a new and more expeditious method has not been introduced to assist the cutting of the teeth, and that the efforts and endea­vours [Page 16]of nature have not been, as in almost all other cases, promoted by the assistance of art. Those gentlemen have thought, and with great appearance of reason and good sense, that no danger or inconvenience would attend the opening of the gums at the particular time of the first appearance of dentition, with an instrument, and thereby, by making a way for the teeth to raise themselves from the sockets to pre­vent the slow advances of nature. The in­strument certainly must be managed with a nice and skilful hand; or it may, by pene­trating too deep, do much harm and da­mage to the tooth itself, not yet sufficiently hardened. I cannot suggest to myself any plausible objection to the propriety and ex­pediency of this plan; however, I willingly submit this opinion to the judgments of those gentlemen, who claim a superior knowledge in this point, from their atten­dance upon children in their infancy; my practice having been chiefly confined to the care of the teeth in their full grown and perfect state.

Anatomists divide the teeth into three classes; viz. The incisores, or cutting teeth, the canini, or canine teeth, and the molares or Grinders: the first class including the four anterior teeth; the second including the two next, one on each side, called the canine teeth, from the similarity and resem­blance they bear to the teeth of dogs; and the third including the rest. For a particular description of which, I beg leave to refer the curious reader to Mr. Hunter's late treatise, which I mentioned before, where he will receive every degree of intelligence and satisfaction to his inquiries. I do not here take so much notice of them, as perhaps some people may think I ought; as their situation and parts are pretty universally marked out to every one's knowledge, and all that could be said would amount only to some comparative remarks on their diffe­rent degrees of prominence, thickness, or other inherent properties.

Having thus briefly treated of the forma­tion and structure of the teeth, the third [Page 18]proposed point, viz. their use, comes under our consideration. This, though already apppearing sufficiently clear and compre­hensive, may be thought to stand in need of no farther explanatory elucidation; but really the preservation and care of the teeth being a matter of no small consequence, indeed of much greater importance than the generality of mankind seem from their indolence and inattention to them to sus­pect, I beg leave to be indulged in a few words. The teeth are parts which will sooner decay and become disordered through neglect, than any other parts of our Frame; and, when disordered, occasion greater pain, and introduce a greater variety of other complaints than can be conjectured upon casual consideration. An enumera­tion of the benefits arising from their perfect state may therefore make us more attentive to them, and more desirous of avoiding the numerous train of inconveniences and disor­ders we shall feel upon their decay and im­perfect state.

The most common and principal uses which we find to result from the growth and perfection of the teeth, are the assistances they give us in mastication, and in speech. I speak from the common experience which every one must be presumed to be in posses­sion of, when I mention the painful and unpleasant operation of chewing our food, at a time when any accident or disorder has deprived us of the temporary or entire loss of our teeth, not to mention any phy­sical reasons of the harm it may do our constitution, when the necessary assistance which the food we eat requires to promote its speedy mixture with the salivary liquor, facilitating thereby its passage into the stomach, and occasioning a pleasant and safe digestion, is lost or impaired. Another inconvenience will arise in this case, from the continual pressure of our food against the gums, which may irritate and inflame them; occasioning, thereby, soreness and swellings.

In speech, we all know the well timed, and regular aid, which the teeth in their perfect state give to our voice and pronuncia­tion; and, by consequence, the essential service they are of to the study and practice of oratory in public life; where the form of the English government and constitution, the elevated rank and esteem in which the liberal professions are held, and the reputa­tion and fashionable celebrity which public speaking claims, give the happiest opportu­nities for eloquence to display her powers, and engage and captivate the attention of the largest assemblies: and in private life, where a graceful and elegant address are no less necessary to attach us to the good opinion and favour of our neighbours, who would not be susceptible of so favourable an im­pression in our behalf, by an imperfect and broken voice, and a difficulty of expressing our sentiments with fluency, and facility; which I affirm, will be the case in a disor­dered and rotten state of the teeth. The tongue, indeed, modifies the voice, and gives it different forms, but I cannot help [Page 21]being seriously of opinion, that the various graces of pronunciation arise from the assist­ance of the teeth; I mean according to the propulsion of the tongue against the teeth, which detains or transmits the sounds at pleasure. This is, indeed, too curious, and indeed too philosophical an argument to be attended too in this short treatise, nor is it at all of consequence in common obser­vations. The easiness wherewith we speak, and the pleasure we take in hearing an harangue gracefully, and well pronounced are, I am sure, not superficial or trifling recommendations to us to keep, when in our power, the organs of speech perfect and unimpaired; of which organs I by no means reckon the teeth in an inferior class.

A collateral advantage arising from the care and preservation of the teeth, is the grace and symmetry they give to the coun­tenance, keeping the complexion in a state of youthful bloom, and preventing all wrinkles about the face; which the de­pression of the jaws, in consequence of the [Page 22]loss of our teeth, would inevitably occasion. It is, I am told by my own and other peo­ple's observations, a prevailing fashion in the present age to keep the face and the complexion as delicate and smooth as art can make them: (I speak not here of our English ladies, whose care in this particular is laudable, graceful, and characteristic of that amiable part of the creation) but, without meaning any offence to that part of mankind, whom the uncouth rusticity and unpoliteness of some amongst us think they disgrace by giving them the appella­tion of Beaus, I beg leave to remind the younger part of my readers, that though they may possibly take too much pains in adorning their persons, and thereby incur the charge of effeminacy, and the want of a decent and proper manliness, yet I think they may oftentimes take too little care in this particular; and none can be attended with more disagreable and offensive sensa­tions, both to themselves and their friends, than the neglect of the teeth.—Excuses may be made frequently for any neglect of [Page 23] Dress—slovenly apparel—or unpowdered curls, which may be occasioned by a want of time to undergo the various processes of dressing, or the avocations of business. But no excuses can be made, or taken for a dirty and foul set of teeth, which argue an habitual neglect of them, and either a wilful or (what is just as bad in this case) an unintentional omission of the employ­ment of cleaning them; which employ­ment, when rightly understood, and fre­quently practised, is attended with no length of time, nor the least trouble.

The disorders to which the teeth are sub­ject, either simply from the neglect of them, or from an ill habit and state of body, are numerous. Suffice it here to mention a few; a perfect knowledge of which will, I am persuaded, give weight to my opinion and advice, relative to the care of them. The tooth ache, is a pain, which, as it arises from various causes, I suppose, there are few amongst us, who have at all times been totally exempt from. The pain and [Page 24]anguish are more violent and excruciating than the visitation of diseases to other parts of the body. Shakespear, the immortal poet of the English nation says,

Meaning certainly thereby, that with what­ever great fortitude, and philosophical pa­tience, other disorders might be born and combated with.—The pain of the tooth ache surpassed all human resolution and cou­rage. The anguish is frequently so insup­portable that it forces us to use violent means to obtain some kind of temporary ease, which means occasion, not a long time after, a greater and more afflicting return of the disorder.—Such are, I think unnecessary extraction of the teeth, which, according to some modern operators, is the universal method of cure; without considering that the pain may be oftentimes alleviated by gentle methods, and the tooth preserved entire. It frequently happens that the pain is severely felt in sound teeth, [Page 25]owing to ulcers and excrescencies on the gums, sudden colds, from sympathy with the neighbouring affected parts, or other causes. Can the extraction of those sound teeth be therefore in such cases deemed ne­cessary, or even expedient? common expe­rience and sense shew the contrary.—We cannot perform the operation without in­creasing the evil which it is intended to di­minish or remove. By uncovering the roots, and baring the sockets of the neigh­bouring teeth, we make them loose, and susceptible of pain, and cause frequent in­flammations in their nerves and vascular parts. I have known not a few instances where the extraction of one of the molares or grinders has considerably weakened the jaw, though performed in a skilful manner, and by a violent distension of the muscles of the jaw, brought on a great soreness and inflammation of them. I am, however, a great friend to extraction when [Page 26]the circumstances of the case positively demand it. Another method no less in­judicious of expelling the pain, and gaining a temporary relief, is the filling the mouth with acrid and hot spices and substances, and burning spirituous liquors; which deaden all sensation for a while, but when their influence is at an end the pain returns with redoubled strength and severity: ex­clusive of the harm which such applications certainly do the gums by disposing them to inflammations, and occasioning sorenesses, and external swellings.

The tooth ache is frequently occasioned by acrid humours being lodged in the sock­ets of the teeth, and purulent matter, which affects the roots of the teeth, and is always attended with a foul and offensive smell of the breath. In this case, if the cure be not speedily undertaken, the whole [Page 27]tooth becomes quite rotten and carious: the nerves and vessels are corrupted, and ulcerations of the parts will ensue. Of this kind is the scurvy, that most inveterate enemy to the soundness of the teeth, which is however very effectually dissodged by lan­cing the gums, and extracting the coagula­ted blood and matter. The tartar of the teeth is another cause of their destruction, which is a yellowish substance formed on the teeth, which hardens in time, and forms a compleat incrustation over them: deforming and discolouring them, and by secretly and imperceptibly insinuating itself in the interstices of the teeth, open too great a passage between them, prevent the growth of the gums by an inconvenient pressure of them, and are productive of a numerous train of disorders. This tartar, however, when early discovered, is very easily removed, being at first of a soft pulpy nature, and may be rubbed off the teeth by [Page 28]washing the mouth with clean water, and afterwards gently rubbing the teeth with a soft spungy brush, or by using any common tooth powder. When however it has for­med an incrustation too hard to be rubbed off in that manner, having acquired a strong adhesion to the teeth, the operator's instru­ment must be used, but great care is ne­cessary to be taken in the use of it, so as not to damage the enamel. Some kind of an inflammation in the gums generally attends this operation, which inflammation may however be reduced with gentle means.

Venereal complaints, and the great quan­tities of mercury which are generally admi­nistered, in such cases, affect the teeth and gums in a violent degree: destroy the nou­rishment which the teeth should receive from the nerves and blood vessels, impove­rish and render the gums pale and flaccid, loosen the teeth from their sockets, and oc­casion [Page 29]putrid disorders, attended with foul­nesses of breath. I am not versed in surgery enough to be able to declare what methods, to prevent such complaints and evils, should be taken, during the continuance of that venereal disorder to which they owe their rise, but certainly would recommend at the re-establishment of the patient's health, that he should have his teeth thorougly cleaned, his gums lanced, and all the other necessary processes performed, whereby the gums will regain their former redness and firmness, and adhere, as originally, closely to the teeth; the teeth will be cleared from all foul discolorations, all the coagu­lated blood will be removed from the sockets, and every part be braced a new and strengthened.

The tooth-ache is frequently communi­cated by sympathy, from one tooth to ano­ther. This may seem surprizing, but I find [Page 30]all writers on the subject I have consulted, agree in the opinion, though without assigning any cause for so extraordinary a phaenomenon. We must not, however, carry our notions of sympathetic affections so far as I remember one writer of my own country has done. I mean one Durlach Cosel, who was a German and lived I think in the year 1558 under Ferdinand the First. In a treatise of his writing upon surgery, (which I remember to have seen in manu­script in Leipsic) he positively affirms, that sympathy may be communicated by contact to other animals: and mentions some instances where he has known the tooth-ache transferred from a man to a cat, by applying the man's cheek for a consider­able time together, to that of the cat. The tooth-ache left the man, and the ani­mal was seized with the violence of the pain, as was supposed, by the agony she seemed to labour under, and the squalling [Page 31]she made. This will, I make no doubt, be looked upon by all serious and sensible people as a foolish notion, and not founded in fact; and indeed I am greatly surprized that that writer should so warmly insist on the reality of it, as he was undoubtedly, by several works which he left behind him, a man of great wisdom and learning.

I will now just mention a few cases, in which extraction of the teeth may be expe­dient or necessary, which will introduce some observations upon artificial teeth, and the practice of filling up hollow teeth with gold or lead.

When the scurvy, or other putrid hu­mour, lies preying upon the roots or fangs of the teeth, removed beyond the reach of those instruments that can extract it from the gums by lancing them; when it destroys the nerves, and corrupts the foun­dation [Page 32]of the tooth; in such cases, I must deem extraction necessary, and that it is so, will incontestibly appear, since we find the root or fang of the tooth quite covered with the corrupted matter, when we have pul­led it out: which corrupted matter there is no possibility of reaching with our in­struments, or expelling by any other means than extirpation, as it lies so close and con­cealed. Were the tooth to continue in the head, the corrupted matter would eat the tooth gradually upwards, and occasion a putrid decay of the gums. Stumps or por­tions of the roots of teeth which have either been broken off, or injudiciously ex­tracted, ought certainly to be drawn. There is not much pain in this operation, when skilfully performed, in a comparative sense with regard to whole teeth being extracted. Mr. Beardmore's opinion is, that ‘"when any tooth-ache arises from a portion of the root left behind, if the [Page 33]patient is unwilling to try this second operation, the pain may be sometimes removed by burning the nerve, or by applying a very small bit of lint dipped in essential oil of cinnamon, over the hollow part of the stump, or by intro­ducing a bit of paste made of opium, camphor, and essential oil of pepper mint."’ But with all possible deference to his opinion, I should certainly prefer the extraction of the stump, and recommend it in such strong terms to the patient, as would, I think induce him to submit to the opera­tion. Palliative applications may give ease, though Mr. Beardmore seems him­self to own the case to be uncertain, by making use of the word "sometimes;" but I think the pain will return in a short time, or the gums will grow over these stumps, and being constantly wounded by them, will be exposed to frequent inflammations, and extremities of pain. I am happy in [Page 34]having Mr. Beardmore's authority to sanction my opinion, that ‘"The stump or root of a tooth is at all times easily taken out, unless it grows to the jaw bone, which is a very rare case; and nothing is more erroneous than the popular notion that stumps are very difficult to be remo­ved, and that digging and punching (as they call it) are absolutely necessary."’

Stopping the teeth, or filling them with gold, or lead, is a very useful practice, and attended with no inconveniences. This is necessary when the internal part of the tooth is destroyed, or wasted away, and something must be put in the cavity, to prevent the air from piercing to the fang, or root of it, and occasioning the tooth­ache, or a further decay; as also for hin­dering loose bits of our food, &c. from lod­ging in the said cavity. The cavity then, in which the nerve formerly lodged, must [Page 35]be well filled up with gold or lead, and, if occasion be, may be fastened by a wire or thread to the neighbouring teeth: how­ever, after it has been well pressed down in the hole, there will be no danger of its falling out.

When there is a real necessity of extract­ing teeth, or they grow loose from any venereal or putrid disorder in the blood, I am a great friend to the practice of supply­ing their places with artificial teeth. After a little use, they equally as well perform the different offices of real teeth, in masti­cation, in speech, and in appearance. In­deed to such a pitch of greatness has the art and ingenuity of modern times arrived, that operators can make them, and fit them in the sockets in such a manner as not to be discernible from our natural teeth. Af­ter washing the mouth constantly for some time afterwards with some astringent liquors, [Page 36]we find that the gums will closely adhere to these artificial teeth. I have frequently made and set whole rows of artificial teeth, which have looked very ornamental, and have given an healthy air to the coun­tenance. The general objection seems to be that they do not fit firm and easy in the sockets, but are apt to fall out. This ob­jection I flatter myself, in the course of my practice as a dentist, I can wholly obviate: for without meaning or wishing to be my own paneygrist, or desirous of arrogating any credit to extravagant professions which some modern operators for the teeth among us do, I can safely pronounce that this branch of the profession has employed greatly my time and attention, and I have, in consequence of that attention, discovered a method of setting and fixing them almost immoveably in the sockets, without the great number of wires and ligatures which are commonly used.

It remains for me now to say something of the care and treatment of the teeth and gums, to prevent diseases and complaints in them,—the methods of cure, and the ne­cessary instructions for cleaning them, and preserving their polish and whiteness.—But I here perceive a difficulty which I was not aware of at first, which is, the impos­sibility of all the rules and directions I mean to propose being equally salutary and efficacious in all cases.— Different modes of treatment must be prescribed in different cases;—and as it would be morally im­possible for me now to know the different state of the teeth in all my different readers, the various complaints they labour under, and whether they have ever taken care of their teeth or not, it is equally as impossible to advance any directions which would be of necessary assistance to all, in all cases; I shall however be exceedingly happy when any persons approve so far of the sentiments [Page 38]and opinions advanced in the above pages, and think the contents of this work of con­sequence enough to let me have the honour of attending them; whereby I shall be able upon a personal and direct view of the case to decide with some degree of certainty, and to found my advice upon ocular proofs.—The scurvy must certainly be removed from the gums, and all tartareous concretions separated from the teeth, and all putrid matter dislodged from the sock­ets, before we can think of using any ex­ternal application to make the teeth white and clean: for otherwise, might they not be compared, with great plausibility, to sepulchres and monuments, which are painted and adorned with pure and splen­did marble on the outside, but within con­tain nothing but rotteness and corruption? [Page 39]—I think it therefore necessary, as I said before, to have the scurvy removed from the gums; all tartareous concretions sepa­rated from the teeth; and all putrid matter dislodged from the sockets first; and then external applications may be used to make the teeth white, and free them from all discolorations.

I cannot help thinking, (notwithstanding what I am going to say opposes the opi­nions and advice of some of our modern writers on the subject, though I believe that Hoffman and Heister, two German writers of eminence on physic and surgery, have introduced their approbation of the point in question) that the occasional use of tooth-picks is necessary in an high de­gree to remove what scraps of our food have lodged between the interstices of our [Page 40]teeth, and to give a salutary stimulus to the gums. The objections I hear, are certainly levelled against too constant an application of tooth-picks; but to argue against a practice and use in general terms, because it is frequently abused, and carried to too great extremities in particular instances, is absurd and ridiculous. The custom of washing the mouth with clear water, after the use of tooth-picks, is certainly judi­cious, and the custom of using occasionally cool emollient gargles.

I could willingly indulge my pen in a further prolixity, but am fearful of enga­ging the attention of my readers longer than their patience will countenance: and likewise of making this a work of labo­rious and diligent investigations, which is only a short collection of a few casual ob­servations [Page 41]and loose remarks, which I have hastily thrown together, and now venture to solicit the patronage and protection of the Gentlemen of the University of Oxford, as this publication is in consequence of the desire of many of them, founded upon too favourable an opinion of the author's merit.