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1^ 



A SYSTEM 



or 



DENTAL SUEGEE 



DT 



JOHN I0ME3, FJl.S. 



owmtwnnta nanam or tui mn.*iiuj-itijh &cttiinit or vatckal 

LtT> SCITTtt. mntitaH TO THI MIDDLHKX 1)CI> l>e«TAL niXTTlU 
AXD 

CHAltLES a TOMRfl. M.k. 

uxTCRu OS DRXTAL AXAT-mt Ax» Piiiiiounr 

■xxT ot^nAu lOBitBf^K to THI ocmk iiu«i>tT«t. or tMfVj* 



8EC0XD KDITfOtr 




THE 
OPBRT 

OP THE 

33!il^ 363 llluslrattons 



LONDON 

J. A A, CHURCHILL, NEW BURLINGTON STREEl 
1S73 



I 










CONTENTS. 



TKErillNG. 

navELOPitKST of jaws axi> XEtrrii ....... 3 

KRUPTtOJI'OP TKMPOnABV TEETH 17 

IRKIMUL&IUTIKS OP TEMPORARY TEETH .i7 

IRREGULARITIES OF POSITIOS OF TEETH 6iS 

KRUPTIOS Oy PERUAHKTiT TEETir 84 

IRREGULARITY OF PER3IANEST TEETH 117 

THE DENTAL TISSUES. 

I-:XA1IKL 'J44 

DESTISB 23S 

niS}j:A.SES OF THF. TKKTII. 

CAIUES *_'9Jl 

TREATMENT OP CARIES iJOS 

UE:rrAL exootobis -i'-i'^ 

SECBOSIS OF THE TEETH -tUI 

ABSORPTION OF PERMAMElfT TEKTII 44C 

EB0610X OB" THE TEETH 4jU 

IRRITATION OP THE PULP ■*jt' 

ACUTE INPLAHUATIOX OF THE PULP 4tia 

CIIROKIC INKLAMMATIOH OF THE PBLP *GG 



vr otaenxn. 

rtam 

IXri.UIHATION OF ALVKOLAa rEKtOffrKUK ..... 478 

VBoaosra OF the jaws 465 

kMOOmON or tiii: alv^-Oli ......... 509 

I UVrCBTUUJ'UY M- AJ.YiiX>L<Ut UOKIIlUt MS 

nrPEBOSTOSQ 533. 

■TOiuTmi SS9 

uunnuTios or hie loimri: 643 

Timouns OP tiir atrmt 545 

KALirA AXD SALIVAKr CALCULI'S AM' 

ODOVTAUIU 661 

KCUEAUUA 5£7 

■KOONDAXir AVriXnOXS due to DUEISKD TCKTtl . 5S7 

ODOJiTOMBS Sfl& 

DCxneEROtra cms 6W 

vmuaa or Ajtrtii-u 634 

CtMCUt or TiTE jAVft 044 

nuoTUEB or the TEcra 449 

nni/KUTum of tiie Tinrrit 465 

QtJUUES OF THE 1AW9 659 

nvoTiya TWH'U 6*8 

EXTttACnOS OF TEETH 670 

ajatoaRaAOB aftes cxTEAcrioy 70<> 

Mtxntaottk 7tl 

Arrcicoix OS dcxtal ojuueb 7IS 



TI 



PB SPACE. 



from other wriurs liave kmeu imt Iimii<Kl. I miiitt, Iiowever, 
cxpresM nty uMigntiun to niaiiy of tlir>«> who imvc writun 
upoa UntUl Eurfft^ry, auil I caitool Itiava umnculioDcd tha 
imiiira of Mr. IV-ll, Mr. Stn-Hc« liuip, Mr. SnmiK'l Cariwright, 
Mr. ChApin IImtis, »ni Mr. AnLur. Hcfercnco is not 
iltifraquently tuaie b> a raries of )(<ctor«4 piililiF<hed in 1H48. 
Many utibja-tft Imt im(ierr«tly toiich*cl iijioij in these pftgM^ 
Aro mom fully tr«tu<«l in that wurli, and inauy s])eciDienf^ 
ftre then* figUKtl wkiub illiwtnitc )HibJraT& dUcussfiil in xhi» 

Tbe demands of aa luitivo jcactico Wve but little loisarr 
for n-rillni, find tltkt little him luxn serionHly int(^rnifjt«d bfj 
cugaifeittcutJi ruiiitetiueut upoii the (;radual ur^uizaticn wtucb. 
the denial jirufcssiuD lioa nxwiily uiHicirgonx.'. Fruui tUiMc, 
and from causn less coatrulUHis tko pre«enc wurk luifJ 
(nnsei) vo-y (ihrnly ihroiigK tlie prenK, Tunny ol tho earlieri 
sbwtH liaving ln^m in print upwardft of eighteen montliB, 

To Mr. Timif, I ain greatly indebted for tho bighly artistic 
illtiBtrutiouit wliioh be bau priMltii-'ed from ppocinicus in my 
wWQ cwllectioii, and from other* which have boon Ubciilly 
uiiutnbuted by uiy pmfs&sirtiial friends. 

JOHN TOMEa 



37, ClTEXDiml Sqi-ARC. 



PREFACE 

TO THE SECOND EDITION. 



The material jirogress which has Iwcii ninde ty the science 
of DentBl Surgery since the publication of the first edition of 
this work, has necessitated large additions to the text; the 
balk of the volume has, howevL-r, been kept within con- 
venient limits by a slight induction in the size of the pinnt. 
Those portions of the book which are devoted to the 
description of neuralgia, dentigerous cysts, odontomes, 
secondary affections resultinij from the irritation set up by 
dental disease, as well as many other shorter sections, are 
entirely new ; and nearly sixty fresh illustrations have been 
added, of which a few have been, by permission of Mrtsrs. 
Lon^ao, borrowed from my father's earlier work, the 
lectures on dental physiology and surgery; others have 
been, with the consent of the Council, rejirinted from the 
Transactions of the Odontological Society ; to the kindness 
of Mr. Christopher Heath also i am much indebted for the 
use of several figures, which have been reproduced from his 
valuable work on the " Diseases and Injuries of the Jaws," 
to which frequent reference will be found in these pages ; 
whilst a considerable number of woodcuts have been specially 
executed for this edition by Mr. W. H. Wesley. 



'^KW * 



viii 



PaSFAOE. 



Tic desrription nf dental cxrics. wil>i tlio (■sccption of 
soma ftlijzbt addiMoiis iin<l ultcnttionti. remnins much the 
suae as iu tli« first iidition ; but n fitllcr diKcuHston or tbt' 
ivhole snl^cct lias been a/iiei ia tltc fomi of an np[>endix, in 
which a siimiuary of Ihc conclusions ui 1« ilniwn from recent 
inventigaiioTiB will lie fniiiid. 

Id tb« seL'lioii iclatiu;; loUierlijaUvl tisKiii>s(lufi |iroiuiiieucc! 
hout becii gtT«u to tbe opinions of conlimintal ob«crvcr», anil 
references to the more important works consulted liavo >>f*n 
inaertod, though it would be imiiractitTiblo, ewa WBre it dt- 
Kirable, to encumber a text-book hy traolni; evtiry RtAtetneut 
to its source. But I cHnnut refraiu from ackuixi-ltxlgiDg ibe 
awristance which I have dorivcJ from Prof. Wt-dl's recent 
work, ** Did P&cliolo^^ic der Ziiliut-," as well aa from iho atlas 
^niblialicd jointly by )*rofi;ftior3 Meider mid Wall. 

CHARLES S. TOMKS. 



37, ClVKKniBIE SqUAR];, 

Jmmm-y, 1873. 



A SYSTEM 



or 



DENTAL SUEGEEY. 



TEETHING. 

Thb term teetMag might be omploy cd to cxpieta Xhc dovelop- 
ment of the t««tb from the oammoncriscnt tu the comptcttnn 
^of lij« fbniutjve ootiuii; but custom Las limited it« nm to 
lie exprtadoD of » singtv pbsM of the process— that is, to 
the eruption or cutliitg of the temporary teeth. AUhuui^h 
this, neuly the hit in a Miies of dtfTelopmeutuI actiiniP^ iiiay 
tie ragaided in humj retipcots as the inriHt interesting, unit the 
ooeirhich the inedic^ pnctttioti«r is luaally required to iratch, 
yet ifobaemiticn wt-re reatricit-d to the eni|itirm of the tev(| 
without toKtitutJD}; on imiuiiy Utto the preceding condttionc,^ 
our knowled^ of th« subjt'Ct wonltl be very imperrect It is 
fnopomd, tbercfoni, iu the prowat iiistatu:«, to doKiribe lbs 
eonditioiu of the tc«th and Jaw« at the tine of binh, sod to] 
traoe the changes oDwarda until the temporary t«eth ba^'a 
arriTod at loatuhty . 

At the time 1 undertook to write the preeeat -volnnie, the 

nitMeonu in which aa ext«adiMl aoriva of yotiag aknlb wotUd 

Ulnly In be found wvn risitod, bnt withoat sooocm. So i 

U I ooQld learn, oo snch sertM existed. It tlifiiofora 

nceeaaarj to make n coUccticn, taking c«ro tbiit tbo 

I of mA qieeimen ihould, if poteibLe, be aeccrtAJned. Thin 

ibeendooe, and the proparationa comprised in ttic collection 

^Sre stiffioentl; numooiis to allow of Uuductions bcio^ made 



A aTSTOf 09 D£MTAL SCsnERT. 



from tile chttmctcrs they present. But should the csonclnsious 
tlre^ii froiu the stiuiy of tbusu uUimalcly pruvu in mjum 
res{>ect« iiiconvct, ihtt want of accuiucy can only be i(\it«uin- 
tiatal by tho sludy at a still mum 03iteuilL<(l surii's. But uutil 
fucb R oollectioii is made, it will bo eafcr to adopt the doq' 
ditioiu of tie pn-pnratiunB nt pruiwnt at my (liRiNinal, as fujr 
example* of the sute* of the Jenial ap^iarfttus at t1te kcvctaI 
■ges, tliuii to mttraine that the opinions gcrvtrally <'.xtAiit,when 
■t Tarituice with tliiMu, an.' in all cowui correct. Feeling that 
Uiis course i» thu more UkHy od« Ui luiid to a oorrect 
knowlwlgo of the mibjiict, 1 Hhji.tl, in the foUouiiif; [nf^es, 
describe ihQ conditions presented by individual specimens. 
■Meeting mich oa npjioar miwt typiakl of the agcw choMs for 
dcscriptioiL 

If two p«rfeotly ht^althy L-hildrun, whose n^BS are similHT, 
b« wlcct«d. for exaiuinalion, we shall nreljr find that they 
preaent procisciy similar cuuililiuua aa ropnlti tbo rate uf 
Mclhing ; yot ih^ero will prob«bly be do great <li*p*riiy in the 
coudilioDfl o[ thu two. Each will imss throU|^h thv same 
, pbuei, although, until the procoas of dcatition is compMod, 
'one may be a few wt-eko, or even months, in i«Iviuu-e of the 
other. 

There i», however, another aourcc of fallacy to be guarded 
■gainaL The specimertB uhtatned oru oecnaarily takmi from 
I ibdiriduaU who hare been the subjecta of diacaao ; and mj^ 
' insuig the fatal illDe<s to bare been of Inng standing the jawi 
may have beeo modified. That eucb has occurred to 
mcuibcni of the aeries ia suQicicntly obvloiin, but Uie di 
action appoaratoliareintlupticeil th^ growth of thL<jaw«lheni> 
velTea, rathLT than the rate of development of thv teeth. 
IIe[ico,eveu these epeeiiueos may cerve to oonfinn theresuV 
obtainoil from an examination of healthy jaws so far as thfl 
teeth are concerood. 

Thoas minor diffcr«ncce in size and fonn which conatitnte 
iodividuaJity, by which wu are enabled to distinguiah ons 
perwm Irom another, though in all essential chotocten they 




TBKTHINO. 



I 



itn pTK ! ir, muAt bo U>ni« in nund vrhea iave&tiga- 

liotu of u;r are undttrUlcoii. 

It woaU periupa bo difficult to find B more iatercstitig 
niliject for inviutigattoa, than the iirogrcssivo changm in fonn 
*ai ill Tvlative [impcirtiun bctwcvo tbe v&riiKis parts of the 
jjiira daring inCuicy which occur u necasary oonmxiuuiu-tui 
gf thnr itHak of firowtJi, anil »n omnccted with the ilevcloii- 
meat aad ftmnj^irmont vf Iho Icetb. 

lltn fact tlinL tlic durvlupinetit of th« bard tissues vt a 
tooth b pnccdod by the I'onnAtioa of soft tina«, or tooth- 
pnlp^ of aqtul s!«! anil fonu Ui the futuro t<x>th, uiubI at uU 
times bo kept in vww. Xot that the pulp assume* tito 
diBHWDoas (if a pt-rfectnl tiNith IxifoTc the develojuuL-itl uf the 
kard liMOM ootimivocva, bat tbat each part of the Ep«dually 
dvvakpping tootb is lirst rnrmed in toft lissne of it« full siu\ 
and then eald&et. Far exaiopW, tbu cufps of the moUmaiul 
tb« «d^ of ttie front trath Onl ateaiuQ lJi«ir full duo«iuion« 
in Ihii fbriD of pulp^ and then calcify ; tlte procesa of gradual 
dcwlopoiait aod snbMqtMOt cnlcilication proceeding until 
th* tMth are perfccied. In iluutiiit.', which furnis the ^n»t 
balk of ukcb lAoth, wn haTe tw nicb thing or iMitwnrd growth ; 
ao nddilioD tti ths uitcmol sorbOR of the fonnod tiuuc tivfr 
Ukai place, excepting by th^^uf-crjx^UioD of tbd enamel, and 
cammtiim, which m(jurttvp|y»iiiL thp crown and the root of 
Ifav tooth; liutthoaeaildcotnponitively little to ihu uizo of tha 
or^^iu Hesoe it follown ttiat both thu (onus and diniensiuiis 
tt tbe erowna of the ti.<ctlt ore iinaltorahly lised long before 
Ih* ^w« are HifScicnlly enhirgod to admit of their ultioiatu 
and aonoal ananKenmaL 

If tbe nuuillw of a fttlt-fjrown /(rtut \« fxaminwl, it will 
b* fonnd Ihat tliir iiniuu t>f tht^ two lialve.s both uf Iho upper 
»ad lower )aw>i U elTecu-d by the int«rirf*itiun of fibro-tAr- 
tilttgn, which allows a cjrnAiu uinouut of motion between 
tb« part* ttioa oomuKtod. Thu atnolat margina are deeply 
Indcnlad with large open erypu, moru or l^aa perfecdy Ibnned. 
TTw d(T*h of tbeip bon/ etHs la ouly tuBclmi to cnuuVn l^<i 

B 1 




STflTIU or DEKTAI. SUIIQEBT. 



Uereloping teetli ukI Ivelb-piiljjA, (h« furtner rising to tlie 
level of the alveolar margitm of the jawH. At thii^ pi!n(>d 
the crypts or alveoli ar« uot arraa^etl in a perfectly unifonn 
line, aeltbcr are thry all n^ually complete. H'he eeptA, wliich 
divitle into a Miritw uf ccUji that wtiicb at aD earlier age was 
but s continuous groove, are Lms |)crfoct nt tho back than At 
tho fmnt part of tbv uioullu Tlic alreoU vt tUu central in- 
ciaor* both of tjje npper ami lower jaws arc a little larger within 
than lU Ibe ori&ce, and tbis diderence in inade »Lill greater 
by a depression npon the liagua) val I of each for tJic receptioa 
oftUu pulp uf tbc ofirrcapomiiTic imrnianeHt tooth. Tbeyare 
dtvldecl from tbo crypt« of the lateral JDcisorv by A septum, 
wbicb nuiit obliquely backwards, and a little iowarda towards 
tb« tui'<diaD line. Th« sockets of the lateral incisors occupy 
S pontion sligbtly posteriur to tbuse fur tlie ocmtrnl tvt'th, aiid 
are divided Cruui the cnniiio alruuli by a iteptDm whicli pro- 
ceeds obliquely backwards, and in tlie lower jaw (as rcgimii 
the median line uf Lbc tiioutb) outwards (Fi^. 2). By the 
arraagetDcnt of those divisioiis, tbe nlvcnli oi the c^^ntral in- 
cisors are rondercd broader iu fruut than btfiJndt »dA the 
relative tUmvtiHious of tlie sockets of the latcnl teeth are re- 
versed, as showu in ITgurea 1 a:ul 2. Tbu cry[ilB tif the 
caniue teeth an placed a little anterior to tboeo of the 
latenls, and ni'nriy in a line with tbe coDtral incisor Mtckets, 
givinj; to the jaws a somewhat flattened anterior sorfaceu 
The Kptoiu dividing the caiuue from the &r»l temporary 
molar crypt is not subject to tbe obliquity obeorred in. the 
two preceding cxaiuples, but proceods directly acroes from 
tbe outer to tho imner alveolar marg;in, giving to tbe socket 
lor tht canine a Ktveter breadth in front than behind, which 
liGCiiliiirity is still furtlier iiicrea5e<l by ibti anterior w&ll being 
Iwlged outwards. In thrse alveoli we have at present no 
dopreflsinn [iruvidud fur ilie pulps of tbe permaDent teeth. 

The socluU for the 6nft temporary molars are placed in tbe 
median line of tbe HlvitiUr ridge ; iuivu a miiuewbat square 
fnnu, with tlK- outer margins inverted; and in tbe lower 




TUTniNa. • 

niAxUla are marked on th«ir floor* by a vligbt groove, iu 
which tbv tnHirior dtuLil nvrvc ttoi artary lis. .Tbo reiy 
doH aj^iroximatioD of tb« nerv« to the developing teeth may 
aorvs in some tueasuro lo explain the liahiUty of t:lulilren tu 
reflex DOTVooB dutarbaDccs dependent oa the t«eth. The 
oervG and artery enter the alvooliifi on rithrr iridp tltroiigh hu 
aperture in the baae of the Mptam, which dindes impn-fiectly 
the fiKt fmiti tb« aecoud tenipomry iti«>Ur, and pM> out to 
tha external surrace of the jaw through au orifice m the 
aeptum dividiug tlw cauiuv from die former tooUt. 

Posterior to the alveoli for the Gnt temporary molam we 
have a large open sockot, which, iu the upjier ntaxilla, has 
hat a very imperfect pueterior wall. Projecting iiiwardu (W>iii 
the free edge of the oater and inner alreolor walls, we may 
obMxvD mnall epk'uhk, the rudimcuU of septa which are 
deatiueJ to divide the cavity into two dinlinct nockota, and 
thxu Mponte the pulps of the .second temporary and firaC 
permanoDt molar teeth, bolh of which at i>rc8cul occupy oue 
large alveolus. The divinon Tunalty takes place a little carlJor 
ID the lower than the nppi^r jaw. Tlio groove which murks 
the pusagc of the nerve and artery in the floor of the socket 
of the first temporary molar, is cDutiiiuod thn)ii<;U Llii' »lvuoIi 
of the two posterior teeth, having entered the jaw by Ibe 
inferior dental foramcu, which ia hitnateil midway betwe4?Ti 
the angle of the jaw and tike edge of the inner wall of the 
alveolus of the first permanent molar, a little below the lloor 
of the posterior part of the last alveolus. 

At this period the articular process of the lower jew is 
scarcely raised above the level of the alveotar oilge, while the 
angle ia projected downwards a little below the gejieral level 
of tb« inforitfr mari:\D of the jaw. The ooronoiil {irooees riaea 
»t an angle of fort^'-Sve degrees from the alveolar edge, it« 
sscL'al commeiioins; at the anierior Iionndnry of the f^ooket 
of the lint pennanent molar. In the upper jaw the zygo- 
roatie process prooceda outwards fn>m tlie outcrkir mitrgin uf 
the large open socket of the secoad (cmporary molir. 




(i; Tlw ap|vf Ja« at « titnuBmtM teW m yrt vrt or the tan jmU. 
iriiMtag Uw rdUlTf poaltlotu uail AUnmriDn of Hit klvMli Uv iMnty itoro- 
lopMI Meili Iikv1<uc hmi mn'n'pl Irooi tlv •ackro oa Uw T1(hi tUl* of th* 
Jaw. a, the tockHof lb« UVt*! lodior ; ^. Ui«Liy ihccanlM: r, ibr ahiMlM 
or tti« Mrand ttnipaniry mulu-. Uw iHuunor nalt m ihia ag« htinii ntMmi. 
Thk aad IlwaalNiqaMllifnr«*kn<lwij-lMT>l>lir/-Mie. 

(*) Ttw kwnr Itwol ft nliir-mmUu' tanJa. ntioinuK itif coDdlHun of Ife 
■IVMlL a, Ibe •DclcfU of IbB UukI ladMn: fr, thue uf Ibt cuiint lortft; 
e, U»* aIvmU of Uv •rmM MpwM j awt lint iimuftntBl iiMdut A bflfUo 
to pUmt la ItK tufcrlur dMUU aautL 



TKKTUIKO, 



^ 
* 



I 



Bi a-iwr y to luriioe. with sotrui degjK* of mcxancy, the 
tvhtivc jiQiiliiMi oflbeM poiou, as in tracing tlw (crowtb of 
the Jawi:, dungca oocur wbicli oan be rcoogouei) ouly by a 
kniiwlsl{[o of tb« pivoedliig condilitiiiA. 

The inferior oigo of the lower jaw in tlio iiinv-monthtt* 
fotoa is aDdaUted; the otkglo and Xho point wbent the aockela 
of tbv fint and wootid tosponry molan join being the lowest 
toinli, while tlie intennnliale parts o( the margin are curved 
npwarda. Viewed in prattle, it will be seen ihnt the alveolar 
BMUfpa pnjects over, and tliereforu forms a botder curve than 
tlia inforior bonlert of the }aw. At the jauctioD of the two 
l»lr«a CMcb portion is exfjaiided, rtirming on the anterior 
ntrfiwi % vertical procna. which extends from tbe alveolar to 
t]ie inferior nuu^u of tha maxilla, the gnaleHt prooiinence 
hoD'' atuibcd in the middle port of ita course. (Fig. 4.) 

Tlte ptaitJon of the zygomatie proom baa been alread}* 
noticed, but the funeral pecnUoritioa of the alveoli remain to he 
(leacritwd. lu the Upper ja<v the inner alveolar ridge deaceoda 
hot little bdow tba level of the hard pdato, althouglt the 
■oefceta have aitajoed a ooaBidenble depth. At this age the 
antrum ie rvproent«d by a depreaaion on the outer wall of the 
nasi cavity, while the alveolar csvHtea extend to the baac of 
the rjr>iilT froui which tbejr ore ae]ianitcd b; a tliin pktv nf 
bona : ainiilar rcIaUooa being m&iDiaiiwd with r^anl to thv 
antcrrinr |iirl of the naaal cavity. 

Tht leoiporary te«th at thin period are partly tomied. The 
oenlitU incwira are calcifivd tbroogh ihe greater length of the 
cvDwnj biit the lateral lectli are less mlranoed. The lonninAl 
pc^ta only of the cnnineH are calcified, while the maMiiaiting 
•nrlkoeii of the first lemiKmuy molars are completed, exoepciog 
tbe anatnel. which at thia stage has not attained mora than 
liaif ita thickiiiM, a mndition oomroon alao to the more 
antjrrt-r terth. The Kcond temporary molar ia reiffeseoted 
liy raUntidl nihjm, which are united in a circle, the centml 
(MTt of tlic crown being u Tut uocalciBed. Thi-M conditions 
are ahowa in Ki^ I and 2: If exnmined in the iweiA 



8 




A 8T8TE11 UF DEMTAI. BtnOSBT. 



ooodUion, tt will be noea Ihat m tbu front t4Mth calcifioHtioD 
has advuoed ne^Ijr (o thu base of the tooUi pulp, which Gods 




H0.4.^ 




in a brood ikl mirlaoe ; whil« ia the cmaines luid moUrs tho 
pulp extends a short distarkoo helow the terminal line of 

By di riding the tn neons memhmnoiuid nibjncent ]>erio«totiQi 

a ittllo iwluw Uic- u]>|K-r margin of tlm ulfe<jti, butl] on the 

rlalnal wd Ungual 8iirraci<s of the jaw, in a spcclmea which • 

fhu beOD kopt 0, fihort limo iu s^'inl, nud tlitiu ciintfally rising 

the membmnc from the sarraco of tbo bone, we bMI bo 



(■) Hw wppei J*V of k nluivmiialhi' fa-tnd, the aofl iNLtU barlns fatcn 
[momd, >bo«rlli|{ ihs uutw muttix et Uk alvcobr pncnwa. c^ tbt ilrprciMCit 
I otmBpotidlnc lo Uk poridun oi ibc kural lodnor. 
(*) llui low»r Jaw of a nlii»>nonllui' (catua, tlumnc tba nbttlTo iIm and 
piMliMD of |]ie Mviml pans ol tlie bonir »l chta ^i% 



TEKTUinO. 



9 



r enabled to witiulnw from Uieir BockeU the ilvnbiptllf tSBth 
«uclo»ed ID their sacs, wbich will lemam firmly altadied to 
the gum. The relative positiOQ of the deutal sacs will be 
nea to oorrespoQd with ibo UTBtigDmi'iit of tlie alveoli 
alrrady deacHhed. The union of tho external coat of the 
aac with tbc tissaes of tba gum, and of the lowor portion of 
^m thv pulp irith the baw of the sue, may bo demonstrated. 
^P At the ago of tteo Tnont/ii hut litU« change frotn Lhti fistal 

1^ chuactcn baa taken place in the upper jaw. The mRxitla is, 
howorer, ^nvrnlly a Uttlu larger, and Uio Kockcrts slightly 
deeper and nwre prominent at tho anteriof free margins, than 

I at tlie tima of lurth ; tho relative position of tlio tiiith being 
nnchaDged. Id the lover jaw tho differences arc much more 
itrongly muri^ed. In oddition to a gcnenti iDcrenge of iii»e, 
growth haa advanced rapidly in tho ramui, and the angle 
boc<»no loas obtuao. Tbc articular process rises above the 
genaral lerel of the alveolar ridge, an iodicatioD that during 
the eariy weelcs of infancy growth tg more active in the 
■acendiDg ramus than in any other ^nrt uf the lower jaw. At 
tlie point of junction of ilie two halve)), tncreaae in the depth 
of tliu J3W luuy bo obacTved. ThJii htu beoD in great part 
effected by addition* to tho .free edge of the alvaJi, which 
have been extended anteriorly into a aomewbat Urger curve. 
But in addition to growth in the positioos mentioned, develo)>- 
ment has gone oo from the u|>posod RUrfnocB of tbc two halvce 
encTUOchiug u|x»i thu fibru-ccilulsr tissue which oonneota 
, thcio. The Rmctaral character of thia dcvclopmenc wilt be 

Kubeoquently conaidered. Similar changes occur in tho 
^B totora ooflDCCting tbc two halve* of the upper jaw. Growth 
^H prOoeeds in the line of junction of the two halves, and indi-td 
^V at each of thoae poiuta vliere tlie bone i$ at present conTiect<.<l 
^1 cmly by soft tianie to tho adjointn;; booea. Increase of bone 
in the luediaa linu would uecenarily lead to soparaliou of th* 
ocotral inctaors ; this is, bowever, prevented liy tlio teeth un 
•Jlbirr aide inclining towards tho centre, and tLa sockata 
portalic in a simitar change of direction, the frc« edges of 



10 

which ai« clowly approximalod, while the deeper pflrts become 
Kp«nt«il from Bacii uihor. 




At the i^e nC two mouikt, thf> toelh are morv nilvationl in 
dtrvelopineiit ibaii At the timo or birth, hut the change is Dot 
ao strongly nutrlceid in them as in the maxillnr. The crypt 
uf the pulp of the Qnt permanent uiular n yi-t withuuL n 
pofteriw wnll in l!i« iii>|it'r jaw; and in llic kmiT jiiw, tin- 

(i>TtMD|)|xr>wof a imI« iwo tnHiiitlia oM. •'binrlnf ika pnml Lnmav 
of aUflMniiuranil ttltb U>r t^Ut^w, and Ibc IniCrniMd dtpth uf \ht alvtotu 
linMMMa. 

(t) Tb! Icr«*rjkiir of a BBole ■■■> monlfa* «il,iliow1n||tb> laniMi*rd ibr *• 
aaniarad wi>b iLr laitA >« Klvm In Itg. 4, and ibe chanfw rn Ifan mlai<t# 
poMhn of tbe \kAj anil afinllpg mmita ilurtng Ibr two mumlut nocrattnK 
Uitti. 



h. 



TRBTHlHa. 



II 



KptQiD i^Tidia^ this frcm Utc Kcket o( the iccand tetDporary 
niaUr ia ioeiiui|>let«. 

What tbo third nontA bfts hetn nttained, tbe tnixilla* sliow 

«*t. (1) 




nt.9H>i 




t*\ TW ii|>pn >>» nf a malvlw HMmba oU. thowtof ibt «>mlll>i>n of tki 
(t)TI»lM*T>>^ ■ ■>lalMiiMHMb«U.alM*tn| lla omdUivD << \bl 




18 



A BTSTEU OF OBITTAL SCROERT. 



• further derclopmoot hi the directions BlrnOy indicated^ 
Tbe an^ uf tliu lowar jkw in mon proDOODoed, and tbo boae 
naehinoreinltd. Thoa]Tcoli,how«T«r,nhibttB tx>on<ierubl« 
ohougu in clioisctOT ; tbcir depth lias iucruieL-d ; luid tho bee 
ed)^ which vers before opeo, so that la a niAccmtcd pre- 
paration tha b?cth rmiVily fall nut, are nuw turned inwnrds 
towards the m«diaa liuo of the alveolar ridge, thereby con- 
tracting the oriflco", and affoiding protection to the encloBojJ 
fteetb, which ans no lunger liaMc to fall out whoa thu bouc ia 
diuud. The dir«otion of the rami is bill littlv chaii^'tHl, 




Jl^. IB. (I) 




(■> Thr UpTWf- J*<r of ft Boir ibfw tnonlha oh). Iwn-thln]!i llfr-id«r. 
<*>'rWlo«wJ*v<if aoMIe tbrKiiiaMlMfia. In tfaerpfclHimAwB wllldi 
I aaimii Ukn Uv UUt»l mdaxi arc wuitlnf. 




bot ooDnd«nlil0 additloa of booe at the lower bort)«r or Iba 

kogle will be obsenrsd, the aigmoid notch at the auaa timu 
being widened. The Bfnii>byeu is itill ttron^j tuarkfn) tu 

Pi0- It CI 




I'if.VLm 




(!) TiMDpp?r>« 04 aiMlf thrM noathf oU. ahowinf tlte (dvran4 ««■• 
moaani lb" 4lfMll. ind ttw bTtntod of ih« rt|a cf Mck inebct. tofaUMr 
««b o«mple<Mi qT tbe poatmor wall of Uw Mclun «blcb cnabdn tfa* ««and 
M^ofUT niobr ml Uu palji <rf ibm tint pmunMl a»tar. 

(I) T&r t-.WT >1WC< * tHleUlffv tnomba old. rimwlBg |1)F iDTCIliM) «< 
•l«t<l>r ^<l|t>^< Mul tii C I X^ iWII I CiiMnuUuti oT Utt 4pirrlnn«. Tb* Ul'nl 



14 




eaefa half of Uia bone, and viewed in prafile the curved oat- 

line IB Btil! prwerveiL Ttie figures Uliiatratiitg Ike t^un-iiiiuiu 
pEvultar to this age are xingulRrfrom th{> nluicncc of Ulcnl 
iuciaoni in tbu lower jaw, awl m tlie vriuit of & trypt fur tlie 
first pcnnancQt molar on ouc side of the uppor Jaw. In other 
mijcicttt tlwjr pRMtint the chumcttTs cuiiiniuii lu jawa of ciitnilar 
a^e. 

Faaiing front a snbjcct of three to one of nr mmtha aid, 
the differenoea are uot at find wj;ht very sinkiug. The 
SDjlle formed by Ibc bonlcK of ttiv hody And rumun of the 
ItfwdT jav does uot a[>pcar to bo Icm obtuae thiui in ynnnoer 
ikulls. Hila is, bowin'cr, duo to a ooDadcraMe increase 
of bono on the lower border, cejiecially near and a1x>ut 
the symph^Bis, at the same time that the mi?ntiil promi* . 
uouoe is bttginiuDg to ai^pmr oud occupy a mora fun 
I posittuD tbau the margiu of tlie alveolar rid^i^. The socket 
'■re gBOPralLy incniiaed in ilpptli, hut in a gnyitc.r dogrw tftl 
thi! UitcriuT tljAD at the |K>Htcnor jKtrt uf tlio liue. The 
posterior wnll of the cryyt of the first }>«rninQeut molar in 
the ap{i>--r maxilla is still ini|K;rrL'Ct ; atid Llio SL-pluiu biriwcm 
' tbe second t«ni]x>rary and firrt pcmiaDcnt molan iu the lower 
[jaw is incomplete. Ilie teeth at. th(> n^fi nf nix montha arsj 
jDora advancvd than at the ag«s previously dcachbvd ; but tb«1 
IdiffcretKu is tiiucli more marliod in the iociwira than in thai 
other teeth. TIic caoiuca and itecond moliLra arxi more forward, ' 
'bat the rate of projireud lias bu-L-u slower than in tlie other I 
teeth. 

The jnTenion of the edges of the alveoli, and congequeQt 
^Bflnowiug of the aperturoA described as iH.'rt.iiiiin;r to ths^ 
iwa of thi'ee monihs old, id less pr>oci()uuc«d at six months,' 
Ithough »H yet the teeth lie bvluw tlio free nlges of the 
okcta. The iitcrewod sixc of the* alveolar orifices must bo 
irded on the first of tboou cliaiigea which precede the 
"eniptiou of the teeth. 

The relative ponitiotL of (he tootli ia hut little ctisngnl ; iho 
caninrft of the upi>er jaw are even more out of llio regular 



TmTBINO. 



15 



tli«o brmvrly, beitts ptsced at tliU period ulinoet external 
Id Oio bUvml U'«(h, tbtniby [iruduciug gmit promtneooe in 
the jaw at these iwIqu. 

Tbe bony cells Cor the jvrmanent oenlnU iticimra are nciv 
well nurkfd. pmdncm;; a jffoiiiinence on tlio palatiae surfikco 
of the alvQfdar prncMn, hot ihey iiRiially cnmmiiiticntv wth 
CfTpta cpf tbe teminruy teolh by a Urge orifioe. 1'hv n>tls Tor 
the iiennaiieot lalvnil incison are at [trcMiit inrlicfttcd only by 
ft doFTHeioQ un tlic Ungual surrooe uT lh« cr]-]:tii occupiod by 
tb« uvnporary IcetJi. 

At tbo a^ Df tight faontha we may ace indication« of 
farther prvgreca. lu the spocimeo fi^iired, thnt of a m«ld 
iiioe months old, the oondi^nns of Uitt alvi-ulnr riAtiu aro 
bvcomin); mpidly cbHo^d. At the front pnrt of the mouth, 
tlie alveoli, whicli have hiihfrto develiijwd more rapidly 
thfto tboK siiuattKl further back, now bocome the scat of 
Bbeorplion ; white the mere poBt«rtor nuee as^umo a greater 
acttrity of growth. Tlie central incimra of the upper jnw, 
althouf^b they do not dMccini below Cho jzcnpral Wcl of the 
ftlveol*r ridge, are exposed oo llteir aotcrior nuifiicot by the 
■hsorptioa of (pvat part of thfi outer wall of the socketa, «c 
like sun* time that the teeth li&vemovL'd boilily a little forward. 
The oater tdfso* of tbe ceatml teeth are in front of the latemi 
tMtb, the latter bring still plnced in a liuo intcruul to tim 
cuiinea, >o that if the teeth were cut iL their present pon- 
liouH, tbe arran|feitient w-oulil Iw extremely irregular. Itulica- 
ltOD> of the removal of the atitcinor watU of tlie wcketa of the 
lateral indion are sbonTi in their i!ii\ar^nnU'<l cdgcji, while thu 
alreoli uf the other txjeth still pmwrvti their tuvvrtml mari^ins. 

Tlic eTyi>ta of the pcrroancut central incison aro ht^coming 
iepaniL«l frntn thoee of the temporary teeth by the growth 
of Mpta, which rii>e towarda the Borfaoe from tbe deeper part 
uf ihe sockulu ; ami growth in oontimed in thin diroction unlil 
the opening becomes level, or nearly so, with the free margia 
of tlie sockets of the temporary toutb. 

The locketa of tLo luoUr teeth, vrhicli iu the fcctua ex- 




BTSTSH or DKirTAL STTBaSBT. 



iendud to tlic floor of the orbit, nre dow t;iL-p(Lmt«l frota it by 
the antmm, 'which at this time u rcijrcsenlod by « deep 

tig. 13. (i> 




At.u.m 




depretrioa, exteiuUng ander the orbit id Ita inner two-thildt. 
The Mptuin Iwtweoo th« socket of the second temponrj* 

(I) Tha >p|MT>if of k raale ulna tnoatht old, tliovliic olvorpifan of tbi< 
antcrtar w^lla of Ibe Mckx4a af tho oHilnl Indton prrpantory lo Uw «Ki^ 
a(tlipeniwB(orilie tcrtliinn tbrtr alvnJI. 

(1) Tbr tower )«w at • nwh) bIm ■wntha old, aiwtrlt^ abMtpUca «r Om 
oour wKtIa -M the i»ch*l 4it Uw lactw^ pfT^ifat»r7 to thu m|itioa tf lh«w 
trrtll. I <ro-Uura« UfF-Mlrv 



d 




TBBTHIKO. 



n 



I 
I 

I 



awl Gnt penDanciil Dtular in still imperfect, niul the pi»- 
terioi nr«ll of t)te crypt of the latter tooth, altLoagfa iacum- 
pWtC 19 \u pr^gmm of d£Te1«;pmcnt. 

Id the luwcr jftw the i^httoged fntiu the cartior ooDditiuiifi 
are mure striking. The two halvoi, which in the upper arc 
still Mparfiblc, uru ia the iufi-riur m&xiUa iwH-uming untied, 
and no lon^r pftrt under maceration. The sympbpib and 
tEtentAl pmuiitiL-tioo am fitnia;i;ty niarkoi), the bone behind 
the fruot iccth is ibickoned, and at ibc alveolar mnrpn 
tunied oatwards, girtug; a cuttinI surface, the canvexity 
being directed towards the tongue, — a ftirin altogether dir- 
foeut from that of the curmNpondini; jmrt in iJie niaturu 
foetne, 'when the line of the symphyMH at the (vst^rior *itr- 
face of the jaw is atraight. It wiu .ihon-n tlial in the fivtal 
jaw the |>oint of the iulerior border com-spoiKUaj; to the 
peention of the first and second tenipomry molars, descend*) 
to a lower lerel than the parts anterior en* posterior tn 
it. In the ntn^y month h' jaw, the rebtivc heights of the 
three parte indicatMl are cliungn), the middle |i:>rtitin insvj 
being the highoet. The remoral of the anterior wall of thv 
alveoli of the central inci8<in>, aixl [lortly alau of llutt uf the 
tatCEral tcclh,hiuhc#n efTecieil in the hmcr afiin tlic iipj«r jaw. 

Taking the jaw ti^utvd a8 a fair standard uf tlie cun- 
dilioDS peculiar tu thie .ige, it will be seen, on comparison 
with the preceding figures, that tlie bone has amlergnne 
great changi-, not only id Hize, hut alw in form, and tliat 
the changes in furm ara more remarkable in some parttt of 
the )aw tluia in ethei^ 

In order to iiiHtitut« n eoTn|4iri)Kin of the relative changes 
which mark Ihu ^>wlli of a bunc, it ig ncooaeary to liml 
souic hxni points In.im which to take nxsamrcmeulK; this, 
ttowever, ia no easy tiiattrr, aeeing that processes for the 
ftUachlticnt of muscles, or foramina, change their puaitiou 
InfiD lime to time. To illiislTate what is nu-ant by i\m 
change uf iMwition, sappoee that a pnxen for Ute attach- 
ment of a muiwle u situated at a pvint one-third of the way 

o 



1£ 




8T8TEM or DENTAL irSOSRY. 



ilnwn a long bone of a f<et»3. Now ir this bane grow enu 
M ito two eads by il«[M>itiun in it« effipbyms, eventnul 
the jiroowe (if jt ri'mftiiieil slill) wvulii oome to he vi 
a«arly ia tbe middle of tlie boni'. for tlmt approximatioo 
lovf'arls una end which iiindu a grrat diffuTcnco in a smiUl. 
fcctat botiA would tuake ooly an inappreciable dtlTerence fid 
KD adult liono six or seven titneei the let^h of tlie fonne^ 
Biit AA A iiiatlcr of fact sitcli \» not the okm: A prooegn 
riltuited ai n point disUmt from one end c*T a long bone by 
uiie-tiiird of its U'n^h prcson'ux that pn>]K)rliouati*dietnuce, na 
matlvr liow much the bon« nwyaTow; obviousiy this cwi 
ouly wine alx>ut by tlio pntcess Khifliti;; its |i(j«itiuii,' awl 
as il were gliding alona; the surface of the botic. Now if 
ihc jaw-bonp weris in all renpects o^niiuimble to a Imig bone, 
ihis foot would offer aa inaupemblc objifction to thv choice 
of any mumilar |irocc8s or fomnipn wi a point of mmsnre* 
mmt. Fortuuatcly, however, for our presGot purpoeo, t]w 
lower jnw-bi»m stAmls in iinito a difr«rent potiiioii to chat 
of a long bone : if we draw n honKontal lino tbn>ugh the 
level »if the upper pair of Hpime meotales in an ailutt jaw 
wo nhAtl ftlHKit equully divide it; but the tifo hiHtory of that 
piirt which lit'8 nbu^'e the Unf? bikI that whicli lies below 
il is wtdoly tUfTi-rtiut. The Iowit portion i^ the JHw that 
supp«.trLS muiK;l(« of deglutitioa. of maelicalion, and th« 
hki» fitruoturcs essontial 1o the wcJl-beitig of thc! aiiinui), and 
is progr«BMVely devulupod from tlie earliest time of oiwilica- 
tiOQ until it has Attained its t'ltil -tin; without iutermisaion; 
Dot so howecer tbo porlirm of bi>nc nbovo our iiiui«iaary 
line. This is subservient to one purpose only ; that of sup- 
porting tho toetb whwn perfected, that of protecting thctii 
whiUt dovdopitifi. And «.i far from being itself gnwliially 
eUboratod and dev(>lop<?d without n olieck, it was built up 
an>uud the calcifying temporary tcolli, and then in port 
remoyed to allow of their enipliuu: built up aj^aiii around 
tbdr f.uigg. and yet odoo more abaorbod to give exit to tbo 
()) a. M UumpliKr, in Tnn*. ll*<l. OufmiUaa S<m<«^, vsL kIt, 






L 



TBKTHiau. 



19 



^^lemuwot taeth : tben dcrclopcd Afrtah wnmnd the n»ta of 

^HUiB penaauont set of tbo teeth, bo thst in ilia aiM^kiiU ni tin 

^^•permiavtit tc«U) pfobaWy not one rr^rocnt of the oriRJaal 

alveolnr pnrtkm of Lbo jaw remninii. And when the tectb 

are ibed for tbo last ttm« the alvtolir portion of the jaw 

is agiiii ninoTcd. Kvlfttivoly, tlien, to Uio changwble a(- 

viioUr ponioD wo may regard tbe Uxly of tha ramns ta flx«d 

and immutablo, and wo sliati uot be U'l) into noy envr of 

flODMqnenoe by taking muscuUr jirtwejuwi or foramina on 

the latter as prnntD of mcAsiiremcnt from which to mititoate 

the relotiva proiwrtions uf tbew> two imtIi of th« horuuintal 

^_ n.TDU8 M various ages. 

^ft Tho fommvn mentalo U (wrtivularly auitalilu aa a poiot 

^Bfrotu which to take relatire dimvnsioni, as ita position may 

^■be practically asaamed as Hstxl, nndorg-iing littJo ur uu 

i^ change afUn- birtlt. In the full-^rowu fioLua it i« situated 

at the point corresponding to the awptuni whicli dfviiica ibe 

aockota of tbo tempanvy canine and (irHt lcmp(irar>' mtikr, 

and on a [Jane with th« bottom of the alveoli. In the adult 

jaw, (be lamtnen is iti clfot: proximity with the extmiiiiy 

»of the root of the fint biciupid — that is, ou a Ivvel with 
the Ivtutin of the aockct of thv tuotb which Huccenhi tlio 
fint Ivinpuniry tnolnr. Xow, nsuming that the position 
ot ihc Utt«r tooth and ita mioccfleor nmiaina unchang^Hl 
dnriae gntwth, while otlier {arta undenco nltriatioM, wr 
hare a point from which tb« relative amount of JncreAM 
of difterent parte, and of the samv \mn nl diffpivat ii^m, ran 
be onimatcd. If thv terminal p»rtloii of tb« inferior dental 
canal Incxamiitcd iu Che fictim it^i urilicc will bo faiind to 
be ID th« direct Uoe of its course, upetiiiig forwanlx, but in 
an adult jaw it will be found u> look outwairU, upwards, 
and UickwaTda,ao that ita pouUou is slightly ]ioeturiur to 
I that which it would hart asntmed ha<l it remained iu 
the line of thn canal. This chan^ in pointiou ia dii« tu a 
l^nat incrooac Id the (hickucss of ttio boac from deposition 
ivD its oQler sarfacc, and Lu that tcodoncy to a pirservntion 

<■ A 



30 



A ITSTBll OF DIKTAL BUIUIERT. 



of iu ori^nttl jxMlioD reUtirely to the length of tho jaw 
nlicady alluded to (pCfct 18). Bui tnumtich as tb« growth 
of Ibfl jaw ditfirrs in niftn; im|)ortant particnlan; from that 
of the long Iuqps, the foruDCD does not fally preserrv iU 
nrigiiinl pOHition relatir<?ly to th« two cuds of tht Iwnoit 
but in the nduit is ]>ro|xiitionally farther from the ssccndiog 
lunus tlian in tho foetiil jaw. 

Am fXAtuiuation uf a sor'tos of }ewi KTres to ihow that 
almost the wholo change which is effected in the poKitioTi 
of tbfl fnmniMi is compIet(>d within tJie first few motitha 
after hirth ; after this time no marked change takes pliux, 
it baring the-n heoomc opponite to the middle of tlie socket 
of the lint temporary molar, and nmaLtiLiig in the adult 
opposite to the root of the flnt hiciLR|nd. 

On the inner nuiloco of the jaw the luberclM for the 
■ttaohiaent of the geuio-hyo-glosBus and gecio-hyoideiu 
nndflrgo biit little change daring the grovth of tlie jnw. 
In the fatus they are plncod opponte to und a little below 
the base of Hit- sockets of thu oontml iucisors; the Iwti 
upper toheroles hcing even at this early ape well marlwd. 
la the adult euhject the position, aa regards the [!ential 
incisors, i^ the same, excepting in those caseii in which tlio 
alreolar process is developed in an tinuBnal desroe, in which 
case the cxtiviuilin of the roots of tht> t4?vtli occupy a 
higiier level than the spiiuc me otaJw. The upper of the 
two |»irs of processes aru at all BgH nearly at tliu Karae level 
as the mcntAl fommina, though where the l&ttcr hiTc a dis- 
tinctly upward direction, lut is sometimtis the cose in the 
adult, they rise to a somewhat higher level. 

If, on the inner Burfao* of the jnw, tiie distance lictwoen 
the juDCtioQ of the septa between the sockets of the first and 
second temporary luLitara and the inner plate of the alveoli 
of either side bo meosored in the full-f^wn fcctus, and in 
jaws op to the bo^ of nine months, when obb^oos unlca 
betwt«n the two halvi? lumntly oommeDces, thin measure* 
meat being made on a level with the attAchnicnt c^ Um 




TEBTHIHQ. 



y] 



^ 



^ 



genio-hyo*g1oasu8 miuicks it will bo found, thai altbongh 
the i&ws bare with tgu gteatly increAMd to Biu, yet tho 
dist&ace betwceo theao points haa noi matfiriAlly fncre«se<L 
Agkln, if a line he irtretcliMl aoroes froui tliu aborc points, 
sod maisurcmpnt!) be mode fmm the ecotro of tba Ibe U> 
the iipfN-r of tlie two fairs of H])iiiffi msnlaltM, it will alan 
b« fonnd that the distonoG liiu not incrvued vith the agtiog 
of l}ie stil^t. But if the meaanremciii be made from the 
centre of the line to tho anterior alveolar ]>liite, it will bo 
aecn that the distonoo between these two points (Emdaally 
iucrcaMi with the age of the xubjeot, uod that tho front tci-th 
contempomneonaly assume a more forward position. The 
fltattnnsry cnmlitinn of the indnr, while the OQter alveolar 
pUle Kxi t««th are moved fDrward, allows the former to 
inenam in thiaknens, and aflbrd reoeptacles for ttit- ]nil{« 
of the Aaterim penuanent t««th. 

Three yean nller th« publication of the preceding state- 
■oents in the fint edition of this work, Dr. Humphrey read a 
paper before the Cbmbridgu Fhilosojihical Society ,(*) in which 
an identical ooTwliiMon was arrived as to the growth of the 
jaw by infereoces £rom a seriea of experimeots perfonned by 
inMrtio;* wires into tlio jaws of growiog autmals. 

TV following diagram m»y serre to render this point 
cleartT ; iu it u jaw from a ninct-months' fojtiiB i» placwi uvur 
an ndalt Jaw, the limits of whieh are marked by unshsdod 
lines. 

It will be seen that Uie arch of tho jaw in the frotiis is 
as wide and na large as in the ndnlt; the diCTereiiai bt'lwcuu 
tbam in this part bdng u'mply doe to additions lo its thick- 
nev, to a slight extent on the inside, but very much m<ire 
on the outside of the Jaw. It will also be stK-ri that the 
Increase in sfm In the adolt jaw is giined escluslrely by 
its prulnDgstion beckwarda, and not by anything lika inter- 
atMal growth. As expressed by Dr. Hnmpbrey, " Although 
ihe bonee of the alveolar arch are lengthened, and the areh 

t.t) - Britlib JooRMl of OtCFUl Bdmoe." laL Ti, pk MB. 




IB Tendered more ellipticaj, it iii not widened. The vridcning 
of tbe jaw, in ooneepoodenoe witb the iocicasing width o^ 
the baw of the skall, taks [)lacc twlitnd tlio alTcolar arch 
in Uie atccudiog portno, aad 'a effected by tbo programoD 
of a'b«orptioD od the inner ojid addition to tbe outer soTfAce 
ol thi« part." Bui witbcnit tho aid i>[ this inodt'llint* pra- 

Flt.lt. 




cotts, Uie mere prolongation baclcward* of tbe horns would 
give aonifaidumbli! Liicrvasu tii width. 

The growth of tho anlorior pan of the jaw by addition of 
booo proviuun to uuiuu ut thu fiyuii)by.siK, may be oomputed 
by rektire meoflurements of the fecial aad Dine-iooDlhs' jawb. 
An increase of diatancti between the Avniiibj'sis nml mental 
Ibmneii, amoiutmg to the eighth uf an iitab iu favuur of Uie 




TESTHUta. 



^2S 



I 



oUer jaw, if< shown. This intTcasc will bu fouiwl to ooftw- 
■potid iu amotiut with the grouler thicknew in iLd Atitrro- 
posterior directkin near tlie flytiijiliyiuii ot tliv uiiio-moiillui* jnw 
cou)]ARd with ih« fotnl bone. If a line be drawn tlje 
c^hth of ail iikcb in froDt of llit- HyiiijihytiiK of ilio firtut jaw, 
and the disUiuK tram tbe mental foramen tn tlut point of 
the line «arresponding to tbe eyiuiihysiH be tAkcn, it will bo 
ibtind to Agree with tbe nuamuvment of the nioe-inuutlis' 
Jaw betwpea the |Xiitit« aln«dy (l<.-«.-ri)]L'd. I'hv rcttrgninft 
laets sboir nifl)ci«ntly clearly that thv growth vf th« aoteriur 
parts of the luwrr jaw ix pnxiuciid by addiliuu of Ixiiii^ lu the* 
anterior mrfoce, ntbrr than by any luuterial increaw by 
the .durolopmuut of Imao ia thu fibro-ot^lukr ttwuc whirh, 
Up to thi« i>cricd, united tba two halves, Uevi'k>i>ui«iil in 
tbe liitter jiosiiiott ap|)cBra to have its t*(^rio(l of actiTtty 
limited to intra-titcriuu life. After birtli, tbi- (imccsh of 
growth in this dirrcliou is all bat Misixwlod ualil Ilio 
period arriTc» iat the aa>i(><nis union of the two hairoH of jau-, 
when the action is rraiimcd, the Abro-«ellulftr lisatic is ra- 
plfiCfsl by Ume, and all further tneroaar al ibis imint is tlien 
at AU end. Still keeping the iiKutal fomuifa iw Ibo point 
fnnn which to make tbe comjmlations of relative growth in 
diflvnut diructiona, it will bo found, by tizaniiuiug tbe »eriv« 
of jaws^ that additions have bocn tnado to the luwur Innlcr 
of the jawa, bat that there ban been relatively u much gn<<Uer 
activity ibown in the nlreoli, wliicb at the nge of nine 
iDontlis have ocqiiiiud their maximam height in the front 
part of tbe jaw. The K-ngth of the jaw i>Dsleri(.r to ibc 
ittmul foranieu ban su-iidily iucrcasul with the increa-ting 
age of the subject, lli« tlir«tion of the growth bt^ing indi- 
cated by a Juries of minute vaacuhu' grouvLtt wbich mark 
the bono nt uw^ucar iho angle of th« jaw. Between thc«e 
gjDores the bone risea into taJunte ridgai, many of which 
arfi Pfintinned to tbe preleriur bi>nicr of tiie raniua, and tlief".' 
teniunate in abort slcndor apicula, giving lo the burdi-r a 
nmgb ttirboe, wlm'h, although well marked in mAnr dry 



94 




svatKn Of DSSTAL tuBaxax. 



specimens, it much more Ktrongly pronoaDoed heton tb« 
hone is ftllowpd to dry, and the itnrtly-cnlcified apimila U> 
htxcme coaLrmcted by tbo km of uioiAuro. If these grooTSi 
are trtocd through a ncrics of upocimMis of progresive agoB, 
oomniiiicing with the fixtal jaw, it will be wen that thoM 
ftboat the roronoid ptYxsesa indicato tho course in which that 
part Jias ndvanceti; n line which, I Khali miVjniMiuvtitly be 
ftble tosliuw. Is {wruiiLiiciidy Diarkwl in ihu adult jaw ly the 
axtemal obli<}»r. line. 'V\wa, ai^iii, a «iinil)Lr line of gn^vea 
iodlc&tM the courM which hoa Imwd tak<jii by the orticulai 
proociM ill iui |>ru|^asivo ^niwth upwards and buckn-ards. 
Jodeixi, thiH line in aIiui imiicated by the Htirface bting 
flUghtly niBed, there \ie\ag a distinct ronndni eminence along 
the outer siu-racv of the Jaw, ending m the condyle, :iThich 
beoomea 1p«i marked in the adult. Below, and a little po^ 
tLfiur tti this line, we Imvo the engle of thci jnw, tbu mcrcMij^^B 
ia which hns bceu already noted. ^^| 

M. Kiilliker hiui ahnwii that th^ articular earti)a;;;;e is nf 
notiHuallhickQesxt'orcartilat^fio placed; nod that, inaddttioD 
to rlio nsiial hinctinnH of nriicnlar cartilage, it is here Biihser- 
vieiit to the fmrpoKCfi nf ilfrrclopment, itn ofiico in ont! respect 
boiag rimilar to tho cartilngD which in childhood is placed be- 
tween the epi|^)yf>i8 awl shaft of a long lune. It is not proposed 
to enter apoa the subject of osaeoug dorelopmcnt, untij tho 
obaugea of form and im^reoite of eiee of the maxilla; hnvv bet'ii 
tnuoi frcwii birth to manhood. But tho discovery finm re- 
corded by M. KolIiktT haa been mentionwi, in order to show 
that in whatever direction the jaw lias iiicLeased, tlie in- 
crease has been prodiiewi by ailiiitinnn to tho external sur- 
bce. There are an iiidications of inlerstitial (;rowth within 
and throughout tho whob siibHtarc-e of the Iwne. It is not 
unusual to find iucrcoeed size of a Ixmii desivibtxl aa cxpan- 
rion, but tbo term le not applicabte. Wo may have great 
incresae in the eize of Iho medullary cavity and of the cir- 
cunrcrenec of a long bono, aa seen in diaeaaed limb«: but in 
moll cun tho enlargemmt of the cavity U produced by pro- 




TCKTUINO. 



35 



P 



gresflve «}i«orptioo of iu parietw, and the eiiUrg«iiieDt of 
the oat«r dimsniiiisifl l^ davvlopmait of bone upon tUe 
Rur&K«. 

Tiiv (IcMniptioQ uf the jaws nf Urn nine-monthii' child has 
bcvn git'cn at greater length, in ODDwqueuce of the KixxzimcD 
baviuK attained that Bta^ nf dt-reloiinicnt which immediately 
precedes the ernplioo of th« t«etfa. 

The conditions of tlie itlvroii coinddmt lirith the firop-cc- 
UTs derelopiaenC of thv t(H.-th, do not appvaj to haw attracted 
that amount of alt«iitioiiwbicb the subject di'^M.Tveii : nndthe 
atage in which thr wall or wttlls n( tho nociiots. nn> [nrtially 
sbtofbed preiAratoty to the liossagc of the t«eih ihroti};h tbo 
gonw, ali]imi<^h lui iiu|iurmtii and neommry sciloa for the 
UbondoD of the crown of the tootfa ftom tbe socket, teenu, 
aotua»l know, to have eitcaped obwiraliim altogether. 

If tbo (eetb of tlto specimen which lias bocu under ood- 
nderatioD be rentored from tlioir i^>ck«tfl and examinod sepa- 
rately, it will be scvit that Ibu cn>n'»ti of tliu (ruutrftl iiicisuni 
irc |n>rfi<tei| to far aa ihcir usterior* are ccneetiieJ, aud tliat 
tilB jToductiua of tbu ueckB uf Uin troUi 1im commenoed. 
Tbe eaomel of these le«th presents t}ie characl«r which marks 
Ute CHtipletion of its dwelopiiient — oamely, the Bmuutb and 
polished earface n hlch snccc«ds to the dul], opaqao, and almost 
chslk-likc character maintained so Ions; aa the tiitKiie la incom- 
plete, The lateral iticitora present Hiuiilarappeamocu), excupt^ 
in; that rbo nwk ts less pronounced than in tbe ccabml tacih. 
Tlw cat)iu«a at preeeut aro phiocd deep in the socketa, tbe 
crowtu hcin^ incomplele, contnuling stroo^y with the teeth 
iaunediately U'biod them. ThcH.', tbv liriU. tempnnry molare, 
have the crownA nearly coiuploied. the maaticatory sur* 
tKm of which are on a level with the alveolar mar^c. The 
latter parta liave already been slightly rcluced by abEi>or[^itioii. 
and the ootet apcrturea of the sockets hav* been thereby cd- 
lar;^. Theaccuod tL'iupuniry and tbo final purinaiioiit molars 
although ooiuidorably advanced aa oomparod with thoM of 
the sis-moutha' subject, are stilt oonsidemtty leluw the level 




T^^^^^^ A 8Y8TE31 OF DBSTAI. SUBCERT. 

of the »h-colar margina, th« outer of which is ttiniftl very 
inucli iRnitrtltt, aud hi'iicc llie openiitKa of tlie snrkets arc 
contracted, an uruigemecit calculated to afford protectioQ to 
the dcvtlopinj? teeth. 

PuMiug from the nine to tlie fuWve-monfAs'subject, further 
cTiftiijEcs ill the dcntaJ apparatna will be olneired, iudicatiug 
that cluring thu iulfarveaiiig three tii'ODths tho ivncetss i>f toeth- 
ing, u the term is ccmmoDly iindcntood, htu fahly aet In, aiid 
at iba latter age is io fuLl activity, la the upper jaw the 
two halT«s of the bone are becoming united; aud although 
they may be se|)n.rLled after tnaoemiioii, yet it r«iuire« w>nie 
force 10 part them, a conditioa varj- difrreut Ut that wliioh 
obtains at an nrlior period, when th«y readily fal) aittrt. It 
was Htatcd tbnt tJic anli-rior wall nf the alvetili nf the crntrel 
incisor* in the niiiC-months' jaw hw! bwn dimiuiaLi.-d hy ab- 
■oi^itiflQ, exposing to riow the crowns of th« ifi'th, altbuuch 
tttew ccguu did not riw above thegencntl level of the alreolar 
ridge. At tho agp of twelve montha the crowns of tiiMtc tei'th 
hava escaped from the sockets to the «xtent of half tb«ir 
length, thv wIhiIc of the cnuitiH on the aut^rior mirfact* being 
viaible. Tlipy nxe jilaced ogaiust the anterior wall, and are 
aepantod hy a considcrabtc interval froio the posterior wall 
uf the alvfcli. The latter prwxtw at this age diwecuda helow 
tho level of the anterior wall of the itocketH, at tho aatne lime 
that aniucreiuicof thickuuaaof thehoneat this |arl is allowed 
hy the forward muveiiient of the inciiwr teoth. The cryirt* uf 
the iM^rmancnt teeth iHffiiiinB enlargud, occupying thi? spnco 
whicli has be^n piiueih The &t«rture8 hading; to thf pcr^ 
nmncut inciaors aic nnw «itwiit«vl nimr the nivmlar margin, 
but at iinwent ojien u|)uu tho ini:liij«d r^urfaoo which furuis 
the i<o8terior wall of the enlarged aockcta of the teij))iorary 
teeth. 

Thv alveoli of the caninea preserre tlieir depih, but tho 
opanli^ is somewhat larger than herotofore, indicating tba 
eaameaeemciit of tlie change which prccedi^ the eniptiun of 
thoee teeth. The lateral incisors have escaped from their 



TKBTHIXO. 



27 



Alveoli tothcut«ot of tvD-tliinbnf tbvircTDwns. Tbemiinc 
promitMQCM ou Ibe anterior mirfiioe of the jaw, whkb daring 
the earlier months of life rurtn m atning ■ featnre, arc now 
becotniti}; lout ; mA, huHr«v«T, by ibvir own tuWidcnce, but 
t^ic advucitig funvariU of Ihi* alveoli of the m-ighbuohog 




Fig. IT. (») 




(I) rppfr )aw of a oaLt tliMecti iuuiiUm old, •bcrtrlng Uio iattMi*,wlib 
ite (Mwna nopHi frnni Um alnoU, and lln lafglMllim of Um •ockn of 
(be Oni MDpamry nmbi. 

p] Hie paUUl nrftar iimI tk> •IvvnUi mArglu «t Iba «me aiRclDMB. 



98 



A SX8TEH or DBXTAL iUBOEnV. 



tMtti. Thft first teinparary mulan at tlita »f^^ Imvc passed j 
tbnragh tbe npcrtures of th^; sockets, ami tho cmorgiii 
of tlic cxtiTual )j)ati> is gmdiialLy bccnming loiA, tho 
of dcreloinncnl tuviag gucoee<lfld to that t>f absorplkuL 




rig. IB. {0 




()) Tbfi emullilMi oi tbc lo«rc) Jkw ud uetli ot a iliinocn monlbt' iim1« 
nl^Kt. In UilB cuunflc, tlw Dnt temporwr; Dolun oF tbc uppM ■>(■ nM 
i^l>i«r iBdrv ailmnnHi Umii (h> oprmpoDdlug toKh or Uas loirer t*w- * 



TVETHIXO. 



39 



The olreoliu of tiic first penuaneot moLir, which at au 
enriirr agi? wu draliiutfi of nny pnateriorwall, and had a lar^ 
open cdfioo, bus acm become more perfoot, aud LtnntnunicotAn 
witlt tbflRniboebyaRoinparatiTftly sniali npcnln^ ntnal«<1 on 
the alreolar ridge, and m n line with the njwnlngs uf Uio an- 
terior ftncket«. the lingua) margin of th'> wvket i» much more 
atrongljr dwelopml llina that of the onler atreubr pUto, and 
iaieed riaes into a fvorcM cootinoons with the camw ponding 
fart of thi> socketa of the mora aoterior tooth. Tb<> hase ia 
cootiaocd outward* so aa to arch orer tho inner part of the 
■]eveIo{>iiig toijth, a condition cnlcnlatfld to pmlmt the lall«r 
from meohanical injiiry. now that the month in becoming 
ninushsi with orgflua of ma8licatii.tn. 

l&icc\*\afi in a gnifral increnn of riKe, the Inver Jaw dnea 
not pmi'Ot any miuiidcrHblo cliougo in chamctor frani that 
uf th« Diop-monthn' nibject. The central indaoni have n»«Q 
not of the fujckcts, and tlte entatfhuition of the onter fklata 
(if l)i« al%'eoli of the latcnU iDctmri) and of the Grvt t«ni]iurary 
molars has eomnwnced : those teeth are, howerer, ecarcely 
nUM.'d alxiro the Icrul uf tliu alvculnr rid^ 

The tMXt «]MK!iinen in the series is that of a female subject, 
eightren nuxaM* of ago. ThU, an enm{>ared with the twelve- 
DWDiha* maxilUe, shows ait advance in the pioceca of deotitiou, 
bnt not to therxt<>nt lutiiallT anut^nod to the age. The cTowns 

^of the cfiUnd inciw'rs both of the iipiwr and lower jan-s, are 
Ihllf exposed ; hut; the fonga, although approachinf; the tiormnJ 
Ingth, are ii» yet inconipletc, tliu cxtrcniity oftach pruient- 
Bs a «harp Miin *tlffn, with a ]an:c npcrtnrp, instead of the 
conical tcnninalion, fxii'uratud h_v a minntc foramen, pcnUiar 
to perfected toeth. The lateral incisors have emerged from 
their nockets, but the cruwna hare not reached to the lerel 
of the central teeth, those of ihe upper bdng more forward 
than the oOTrvspondin^ teeth of the lower jaw. The oonical 
pointa of the canines hare become rielble abore tho emar- 
ginatetl edgpft of their alveoli; while Ihe first temporary 
mcdan hare bceo protruded in the upper to thcexteotof two- 



* 



I 



80 



A STSTKH OP DEKTAL SDUOBBr. 



thirds of their enjwaft, and bo one-thinl Id the lower Jaw. 
The rtrol* tixbibit L'orruBf'Oiidiiij^ BUif^nt vf iluvL-luijmviit, tbawr 
at the Tipper JAWS bvJng ncArlj- half their nltimn-tc iengUt, 
ttid ihs lowvr ooea about unv-lJiinL 'Hn' Kwuiid lempDmry 
moUr is At present whnlly within the aockrt, th« mnrKins of 
which arn archwl hvlt sn na to dimiiii&h the alveolnr aper- 
ture. And imAvct till' (Icvflofiiiip; tooth, an effect which u 
partly [jroducod l>y the cdgu uf tlia extumal alvoohir plate 
being more prwlucuiJ in height, and at the fume time more 
arched over tbo tooth tluin the liin«r edgu of the sockot. The 
tool» of LhuMi t«ct)L are Karcely indicated, cxoqjtiug by th« 
septum uf dentine wbiih in uich may bo iMD extending 
across tho base of the crvwn, and markiaj* the position fur 
thefnturv roots. The first iwrninnent molars lie deep within 
their respective socketti, tho orifices of wludi in the loner jaw 
are oontiactcU by tho inversion of the outer alvcolm- plate and 
thfi baao of tliecoronoid procKts, the i<^6th at thia time Ix-in;; 
placed with their jioaterior two-tfairda internal to and hcneath 
that portion of the jnw. The po!«t«rior olgo of Ibo socket in 
brought Rfivard uv«r Ui9 back i^art of tho c^u>^'n lo tho vit«&t 
of one*foarth nf ii» antero-po«tcriordiineuijiun». On ihc upper 
sur&ocnfthis, withinaliiieof itscd)?!, Bde]>rusBion in tho bone 
may be seen. This ii the oonunciicvnicut cf a crypt for the 
second i^Tdianent molar. (Fif;.UiO '^K:'cor^*plnuiin^! iwrltuf 
the Atijieriiir iiiaxill;^ occupy the tiilierniiity, tlio piwli-riiir |iart 
of whirh is estremely thin, and in the meiiian linp im]iorl'«t. 
Thin gives a iont; and curvivj 0|>etii»^ to tht' suckul, and a 
posterior direction to its ftinhtr half. In tho upper jaw we 
hare as yet no indication uf pruporatioas for tho lodf^nent of 
the second prrman<?nt molar. 

If the ni}>h(iH'U tnonths' luaxiihu ant cninjared with LhiiBc 
of twelve or thirtwn m<.inths, the relations of ^wth between 
th« teeth and snckcts may be seen. Tho enuupn&tion of the 
sockets of the central incisors, and conieiiaant »olargeaieut of 
the alveolar siicrtnrcH noceMRry for tlw ovohilion of Hw 
cn>wns of the»o teeth, baring been nooompUabed, and the 




I 



TBITBINQ. 



SI 



crowQB liaTiog pused Uuontch, absorption U tospCDilnl, and 
the sGTcnJ iklvcoli bccomini; ooniractwl, npl'ly themselves to 
the twth, derelopineDt &t Ibe matgins kcepiii:; jaco with the 
growth of tiiB roots of Ibe tpt-tit. The socket of sn Inciur, 
eo kioii w Ihs crown i* below the MlveuUr nwr/ii), is liirgvr at 
itfl hose thiui at ila more extenml honoiiMy ; Uu no sooner 
don thm onnrn Iobtb the aocbei, than tlie relatiTo dimensions 
nveivi theowelrea. The base contraots, b; Ibe derdopment 
of Dew buue, to (he dimensions of the laug. Tbo level of tlie 
socket in not, bowevw, at prestmt chansed. If tho com- 
psriBon of the two subjects tie continiml, it will Im) twn t.lmt 
ftUboagli tbe length of the iuc«n<lbg rami hno consdrnbly 
iDoreand io tlie older jaw, yet that tbta angle foimDd by the 
two portions rem&iits pretty mtioh the santo. 

Twentjf-one Mattiks, — The diffcrenooi observable between 
the prei«ratiuii lost described and tiie inaxilla< of n female 
subject lwiint>'-«iie months old, witb tbe exception of a iJi^bt 
general incrcaao m size, are ccnfined to the nmre advanced 
conlitivn of tbe teetb. Tbe fuur incisors of either jaw have 
oAHiiiitat tbe normal positioii ; the crowns beitif; fidly exposed, 
although the fftagi are not qailu (Xim[>leted, The eookelH 
have, howercr.cootraolod, and closely embrace the implauted 
|iarl4t>n8 of the teetit, at tbe mtne lime that they havi- grown 
Dp trilh the teeth aa the bitter line's iorrensed in length. 
'ITie canincH show only their tipe nlx>vp the aivrvilar mnr»in ; 
but Ibe &r»t t«m)>Drary uiulars in tbe ujipvr Jaw havu fully 
tf»orst<d, and are closely ernlimced at their iierkfi by the 
uiATgiuH of ihc sockets. Iti the hiwvr jaw, these teeth have 
.OHBped from their sockets, bnt a^ the thicker pan of the 
iwown U srarcely tlirrniRh tlie ajwrturo, tbti omarginatinu uf 
the eihie of the alveoli has not been oblitoml«d by dcvelup- 
ment of Ukiu at thr»i- ]i<.kinta. 

Tuvnltf-eiyht JUoitthi. — In a twenty -etghl-morilba' guhject, 
in addition tu tbo tcctli which have been dewrilnsfl as having 
taken their [wnnanent (Hwition in tlic youQ);er jaws, the crowns 
of the canlnos bat* fortly pcuaed out of their aiirkrts, thnsj 



inaccuracy uTtbiA conctoBitiii vili 1^.*] 
are ihe oiily t«ctk in wfaiclt Ujc faiigl 
TliQ caiiiupD are (k«titute of about oai 
nrj uuJais of s iifth, and the kccuiuI 
leut ODO-half, of tlit-ir itomisl lent.tlij 
At thU period a chuige lakes place| 
auditrmyberegutledaBtlienooQd i^[ 
shawi a mors tapid rale q( rlevcli)|inil 
iann. It was stated tbat n-itdin two 
bjrtb, the angle ot the \aiwT tiiaxilla 
in liacing th« wime point in jftws of 
bo mea that but littlu further trliiui^ii I 
to tb« angle mitil (be Bubjcct arrives at 
at tbJB age a iiianifrat allfration may b 
bu dtHw-D alo»^ the alveolar mai^, &xu 
FHTiili*, it will hp awn that tiio nn^le for 
\\iv Utter joirt 18 bctnct^u 6S\y and iix 
the articular aiid winiimid proce«8c» 
alvL-ular Vim. It in important to ob«fit 
bi-cu di)iiiiJt»li('d, aa the rHi>^niliuu of i 
will to a Dotisitli-rublu cxtuut clucklatc 
ibe adtili is nxluoe*! tu iIiq iiccuILj 



i_ » 1 .1 




TKKnnNO. 



88 



until ihty m lower thut tlio teeth. Tho crownx of the 

Utter Krndtikllv [oss tliri<u^ tbo wideoed ajwrtortn at thuir 

re&pectire 9Crclcet«. Whea tlis portions oT tlie trath which 

■re mre>l«d with enamel have paMcd the edgvs o( the 

1^^ bune, doreluiioiisit of the lAtter is rwiimrd, uid ki!e|s paca 

■■Vith the increasing length oS the teeth. Xow, if atteatkm 

Hdw direoteil to the menial ftiramen ftt the several Bgrs whidi 

^Btt.Te bMD uotioiKl, it will be aeen that frou liniC to last this 

a|ierturo Is in cl€#o ooi>ri«crioD with tho urminal portion of 

the hnt lDui|x>mry iiioLir; iiidicatiii); ihitL th« Kradually in- 

Icrauod depth of ihu JAwhubeen ohmitiiMlbyidditiotw to the 
plTflolar edge of the bono. If M]aal nddttiona bad boea madfl 
llo the lower border, the i-clftliona between the body and the 
rami would have been mainlained. Ihitgrowthnt that partis 
t«L>tive]y slight, henm thvaogh) funnvd by the Iwu diriJiiuus 
_-«[ the jaws has become chfluged oontenipor&neous'ty with 
^Kiapid gftiwlh of the olreolar inRrKin.(') Thu muii harn been 
gradually elongated. The rate of growth is aot^ however, 
suhji'ct (o sndilen aoceleraliou, as in ihv cml- of the ulvwtor 
border ; a oooditiun which is compcaaatcd by the tncnsaMd 
dejnh of the alreoli, uttll furtiiur by the protrusion of Ghooereral 
t««lh tftVing plac« at diffureut )^<eriodB in different parts of the 
JBwa. If, for iniitancc, tho whole of the lenii>orary ttwth were 
cat at the soioh tinio, and tlio frrowUi of Lht> alveoli 'were 
«qiial tbioaghoat the whole Une, the elongatjon of the rami 
must aasumo a sudden actinty,_othcrwi«.' the front pert uf 

I (he month ooold sot be c1c«cd. With deficient length of 
the rami, tb« tnohir loelh akin« wonld cxinie in cxmtaci, — an 
Abnormal oooditiofi not very rare in the adult, and to which 
J shall ffDhmqacntly advert. In the ohild, however, thf 
emptiou of tho frunt lot- tb, a»*l tho subsequeut rapid devcloi*- 
meut of their uIvl-uIi, |iruducv df|ir(asiou of the chin nhm 
the mouth ia clwied : at tlio latne timu the upper and luwer 
gomt, situated behind the front teeth, r.o loaxer come in 
iMhte contact. The rami steadily increase in leD'^Ui,iu)d after 
O CMapue dtacraau OD pan 101. 

D 




ft time the buck teeth Appear throu;;b Ihe gums, uid occupjr 
the sfjace which hnx Inmu gained, Unl l>y tltc w^wrHiiuu 
occasiuneil by liuf prior (levi'lupment at tlitt front put of tbo 
luoutU, aud afUTwuiilH iucn»ievd by Uu laogthaoiug oT tlu 
mini 

\iy Lbc UDmtcrmph'd but com|mrativDly slow olun^tioiiof 
tho rami, ftoti the rapid but succemT* growth of the froat 
Aud Imck ports ol the jaw», a relation of \mn» is bruught 
iibout by wliich the wholv series of t(^>Ch ure allowetl to be 
brought iu coiiUKt siuLulUiu-uunly. Jf it were Drceamry to 
lind K niUHin why the mini should nut br'subject to im-^Uar 
nitesof growtJi, siiuilar to, and in aworlanoe wiih, such aj 
are nen to ooctu' Id the alveolar [mrtions uf tbe ja\vt(, a 
wffident refttton might be UmnA in ihe. factlhat bono which is 
developed ui t4iii)i)unirycArLilB!;uuiidiTurdiuaTy ciicumstauum 
ftiereaoea steadDy, and that the articular prvcesaeaof the lower 
maxilla are incrcuscd ill li'njj^lb by dev(>la[)mcut in cartilage 
Mttiat«d iNrnvath the turfoco of Uie articular cartilo)^'; thu 
dflvelopinent in tltis sitiwtioa offering no exception to what 
apIKVLpi to ifc a ^(.-ucml law in relation to the dcvciupmuut uf 
bono in temporary cartila^o. On the other hand, bone may 
lid formed with c-omjiamtiTu rapidity upon a froo aurlace of 
pre-eiuiLiii^ hotie. 

Tlio uiorv ouuto anijlc formed by tli« alvoolar inar<:in and 
the aBcvuding rami in the jaw of the forly-moiilhe' siibjn't, 
as oomiMnHl wiih yoimgcr suhjoct», has boon nlnwiy mvn- 
Uoood. But if the Uui> fonned by tlie tower Wrder of the 
body of tho jaw Itc csatnincd in rolation to that bounding the 
posterior }HirtioiiR of tho rami, it will tte foimrl that the angles 
I'omi^l ar« raoro obto>ic, hottco preM-rvin^ at lhe!«c points a 
greater aiiuilartty to tliv youii);t:r javrs; and tho <:uiiditioii ta 
maintained so long a;< the jaw continnc^ to incrcaw) in length. 
Tbe deep jiortiou of tlio arlicuUir curlila{;(i is to thu urttvular 
portion of the jaw, tt» regard* growth, what llio cartilage intw- 
ixjisfd bctweini tjio cjiiphytJti and a]iopIiyisiif is to a loi^; bone. 
If, tlnrel'orc, the lines last referred lo were rcciangiular, as Is 




TEETawa. 



35 



the CUM in some fioelj-tlereloited adoU javrs, we might bava 
ft furtbET increaM in ti>» tingth «( the rnmi, niui \a th« ilnpth 
of the j»ws; but tt wuuKL bo ditlloult to >eu huvr Uio lcii};th 
oonid bfl {ttcreased ia the homootal directioo. 

At thii age aruler consideratiaQ, thu first pcrinamiit molar 
in ibe lower outxilla lies tbtemal to the «Qterii^ portiuu of tha 
base of tbi; caronoid procca ; that is, suppasing the jnw to be 
viewed from the outer side. The opening of tho soch«t it cou- 
'tractcd, of oval ronn.aml t)inx-tM upwards ami inwimU. Po»* 
T to thia opeaing vco have the depresaioii for thu nicttptioa 
«fthe pulp of thcMC4a<lpi«nnanentiiialAr, which nt present lies 
jwu thv Qppcr surfaou of tlie hinder part of tho procoM of bona 
verini; the first iw4ar, a uliglit t;roovo ptuisin]; from the new 
in the obiet docket. In the up)K.<r maxilla we find a similar 
conditinn as regards tlio fine [)ennaneDt molnr. Tho wollit of 
tho socket are •ilron*^; the opuriutv isMimll, aiidinuMnv with 
the alveoliir margin, being directt^l donnwarvis inntcaiL of 
duwuwanU aitil backwards, aa in tho younger examplev. Ou 
the])OAtoriorKUrliii:«of the tuberosity a ttli^hl (Iv[iT»Hiim may 
obnenred, connected, u in the lower jaw, by a shallow 
ijve with the tux-kel of the Rnst molar. In tliin depresiiiuu 
e liavo the wirlicsuiodicationof a crypt fi>r tho reception of 

iilpof the xodond jHirmant'Jit molar uf tlm U|i|ier jaw. 

Fuur TfartfUid 0n4 Month. — The next specimen iii my 

wa« taken from a Hi!h)c<:t who died at the .ig<! of fonr 

years and one month. In thcM jawti, the incisor teeth ar« 

the only onpj* which are niilly iMTD'cUii, Th.- Caug* cf ihu 

Othon areiilighilydeliciKnt iu length, and am hulluw at thtic 

extremities. Four or five additional months would probnhly 

ve Hervfid for tlieir conipletirm. At the ooninienct^ment of 

.0 sixth year tho temjxjrary teeth are all fuUy formed, a 

litiun which ia moKt Ukvty nttaiuul six moDtlia prior to 

{wrioti; hut I have not ijiccimvDK uf delvrDuuvd a(p« 

png h<.twwn ih« fourth ntMl fifth year suiiablu for the 

ucidatiija of the point. Seeing, however, that at tlio 

lination of the fourth year the dcrvlo^cul of tUo lir«t 





STSTEM OT DKKTAL HCItOEBT. 



aet of teclK is not completed' ami thnt at Liu comiitencenteot 
of the sixth year tlio«c teeth are perfnftly fonncd, it may h« 
assntncd that at four and a half yeara of ago the primary 
<l«QtitkiD ie completed. 

]f the tnaxilln of tbc forty-nine montJis* stihject bo cotn- 
[nred with lb« otw |>reriioii»ly tltacrilwd, it will be wen tint 
the 8lit;ht dq rtiwiiiiis which niarkeilihe K|tot8 destinol for tbs 
puipe of the second pennani'tit tDolan>.hav« now becomv larga 
crj'iitH wiih wdllHlcQiied xnarj^ns, tbeenjicrficiiil i-xltni belog 
proportiorifttt>ly much greater tlinu tho di.>pth. In the upper 
jaw thesn di?prej)inons hiok Vjarkwnn^ tow-ards the pteryjtoid 
plates of thu uphitnoid bono: iJi the lovrvr. U|iwardii and * 
littl* inwardB, thoir floors lying immt-dialelj- otct th* inferior 
tLeolal canal, near Ob commetHwment, Situiitod on the fluor. 
Dear tho pcmtcriur vmll of lhi.> crypt, ii a small furamen, trhlcb 
pMces through into the dtntal canal, and gives pasBoge to 
TBSsela which supply Uie d«vi>I«ping tooth. PiuwinK over llifl 
scpttiiri, diviiling ihe socket* of the permanent molars, is the 
groove which in the younger Bpecimen vras but filightly 
marked. In this nihjoct it ie brond mid strc'ii^ly pronounced, 
tho nmrfnoa bcinf; raised into two thin priircsses nf hone. 

HaTiDg tmocd tho progress of the temporary teeth from 
the time of birth up to thcporii^ of their onnipleiimi, and the 
comtcmporaneoaa conditifmii of the Jawa, the further changes 
in form of the jaws will be resumed in counuxlon with the 
development and eruiitiun o( the permanent tocth. 



In describini; the different pnrta of iodividaat te«th which 
may or may not hold tho noniial p<*itinn, there is sume Hitle 
diffieulty iu writing; intvlligibly witliuut first ik'tiuiug the 
praoiM meaning of the terras ii-«c^i. 'Ilic t«tli Iwing placed in 
an cUipm, Ih© teniis anterior and potlerii/r, if applieJ iudtf- 
ferently in describing the surCice of an inci»^r and a molar 
tooth, wonld indirate dilTf^rent pnrtn in the twotoeth.ond the 
confusion would be still gn-alet when Ihe teeth are altog«aber 
ant of the uaual pu«itio&. In order to avoid this diSiciilty, 



H ■U'bil 



TSETBIKa. 



37 



I 



urbitrBry termi muat be idopfed nud iwed without rer«n!Qc« 
to Xhe Actual ijltiAliuu \>t auy imltvidtutl tuoUi, una supposing 
it Iw mispliicQil. Tliuts tbo surface which Dormfttly U direcicd 
towsnla ibi! ttl» at obvobs will bu ileacribed as the lahitti,Kid 
tbmt directed towards the tongue a th« lingual, wiitmn. Tba 
8tirlin?« Mrbicb Ucsa»aituilanei);hbnnringtnoth, noil iBiiirecletl 
towortU tbepotQt ofjuoctioaof chetwohalveao[thealToolu' 
ritlge6, tritl Ixs Umted Ibe nututl mrfiM: while that wbich 
is directnl oulwardit in Ibc front, and Wckuarda iu the muiar 
tMtb, will be railed ttw tiubU suifiice, 

Irr^gtUnrUy w the jwtitum of the temporary teeth U K«n ia 
ohUdraa wb<i«e jaira have nut aojiurod the bize Duceuaj'; for 
the nomml UT«Q{;ement. Tbo d(.-f«ct U, »o far u 1 know, 
oonfiiied Iu the iiwLsore, and may be liiuiml to itlii^bt crowding 
ttml a oinaequeut want of unifr>miity nf jioi'itinn in tcvcral 
contiguous t«nlh. In thre^ chiUircn, momb^ni of a hirge 
Cuuily, uoe (if tltu ceutral iocinors i*f the lower jaw is iu (lath 
tunicd, ao that the nuxlian aidf of the tooth Htaods in the 
puailion which ahuuld be oocufijed by the antericr or labial 
sorface. The dcDlitiuo in itlher rospects is regular, both iu 
iheae and iu the brothers and eietera, aU}itiu<{b tlw jaw» iu 
each child am uousoally emolL A. transvenH secUon of a 
pennaiif nt central iociflor of tlw lower jaw, whoti tahi-o imuii<- 
diatoly bolciw tlio eiiaiuel, girea an Gton);atcd oral, the long 
axis of which corrGflponds in direction with the median line 
uf the uioulb. Iloucd the turning of Mudi a toolh in the jaw 
would only crowd to a giratuT dtf^rvu thr ronttjcuoriK ti-plh. 
Uiit thn fangs of Ilie temponuy lower mcisors aro cylindricnl, 
ao that theae iwth, when tum«d in tb« uiAnner described, 
gin grcnler rociin for those near ibein than would have b«en 
obuitkod bad the Donnal pMition bcca prwerved. Hence tfatH 
derUlioo frim the usual arniiiL;«tiii^ut inuat be re^uded aa a 
roeanii taken by nature to acoumiaodate the want of ctnootd- 
aiMP betWM'n iho tAjx uf the iruth aud tb« kizo of the jawa. 

Jmguliifity in the number iff the temporary ttcth.—Tihe 



38 



A BTSTEH or DBSTA.L fiUllGBIlT. 



iiutnlter, onlpr, aod poution of Ihc dcviduous tccih, »•* tixey 
nrine in the jawH wlicn the dcvdo[>inBiit in nuriiinl, }iiive b«eD 
ilejKTibcd. The dcviiititws tWnii tht^ac coinlitinns remain Cor 
consideration jirior to eiitwinf,' yjion Ihe eruirtion, or cutting 
of the toetli, as the procws ic coramntily callod. 

As regards tlie number, a child may have citlier morp or 
lew tliau tli«> twenty. Inslaccea are ciwd in which the j«wt 
liaro \nscn culircLy (■dciitnlniix. 1 ]iar« nfit liail an opjinrtuRity 
of exAminiii]; r case, citb«r in the living subject or in ■ pre- 
|«rRtton. R«;nitly I iunt willt a {>vutleinHri who hkfnrmed 
tuc tliflt n, nicin1>or of ht» family, a female, aUmt fifteen yt»n 
old, WTis then, hnd had hcon from iho time of Imr birth, entirely 
(^eijliiLoiitt, and that the lower part of Ui« face pmwrfed (ho 
■ppearancfl usually preiwnted by a child prior to the- pniption 
of libB twill. Sn«b cases, howerer, inum I* w\triiiiit.-ly rare. 
A diminutioD in tho ordmsry n»iu1>er of temporary teiith is, 
lifiWBver, not «> uiieoiiimuii. I have in my own collection two 
itiManceiin which the lateral incisors or© alwent — wne iu vhicU 
tliey are wanting in the Inwor [Fif^. 12), the other in which 
tboy arc ftb««nt in the npper, jaw (a view of vrliJuli will be 
feund in a subscqitt^nt {tpurc). TheM> casrx of dcRcicncy in 
the Dmnbiir of tlio firKi loetli poKsc^ but little imu-tical into* 
rat, aod, in n physiologicnl ]»int of view, we can do nothing 
norp than rc^^^ise th« bitrc iaci. We are aft little able to 
account for the alwonce of a t«m)<oraTy touth usually present, 
n» to dotflnnine why twenty, Hitlirr Ihati n ttmsllcr or greater 
nnmlMr, constitute tiie ni^rmal veHoK. 

The pnwence of twih in excow of the nnml number de- 
niandfi more attention, as we may in certain law-f. U> called 
upon to determine wiielher or not tliey should be allowed to 
remain. I am indebted to Ur. IbbctMon for n cast taken 
from n case under his diBi;gc, in which thore wrro fivo iucisont 
in the lower jaw. They wore utiifiiniily am>n|^<d, and thpro was 
rothiuK peculiar in the form of either: sofdniilar indeoil were 
they, tJiat it wa« diflicnlt to determine whiib sliouM l>n ««. 
(lardod as thd supernumerary tooth, la my own cuUectiou, 



TSKZWO. 



39 



ttiere IK an oppcr jaw, the age of which is fimlmlily five jrMnt, 
having two fliperniimcniry twtli. TL«y are plnced Ix-himl ili« 
central incioon. oeiir the mciiinn lin« nf tiiujow; iutvc i-uuical 
crowns am) roots, the Utt«r Wing a little short of coiaplelkm. 
iDiUcatiuna an prtawut of lluiir luiving jioiteiil tbruu;^! tlio 
gum, or rather tJu palate, for they are sitQatcd pceteriot to 
tJiat part which is UKually licsignatw) f*uni. The rircunislancr 
that the olhw' t«tDpfirary twth are fully fonaod, while thets 
are not quite completed, might lend u> the qiiCJiHon, whether 
tliqrabould not be reckontd aa siiperauinvninvy of Ihe pernia- 
nent tocth ; bitt examinntion of thr laltor itliowa that the 
MUDi«t of thv iiiDftt forwanl of thrtu is at |ifpn(.-iit iiK-un)))t«te, 
anA tliat the formation ^f the ro(it» ha« not oocinivDocd. 
Ilcni-0 it in tail ta conclude, that the pslutiil tMlJi are miper- 
nnmcrorics of lb« firat set of t«etb. In this case it ui qu)t« 
fiuwiihle tliiit articulation was to come extent interfered with, 
aimI if so, their ii&nieiliat« nmoval would havo boon desirable. 

Several ycwre »iii«% a child, aged fire y<!dni, was bnmght to 
mc, hanng a mipcnuinu'rary tonlh ttimilar in cliarnoter auA 
m j>o«)ition to those la»t dc-scribed. The tenth was removnt 
in consequence of a diOiciiUy in articuUliun, which arow con- 
lemf-jraneoufily with il# a|ip«irin.v in thf pakte. 

Another nse came under iriy tieatiiieiit, ptff.i$.V) 
in which tbeccuiral aad iaieral incis«>ni were 
unileil, and to these a third tuutii waa at- 
tached ; tliiii, the suj^-niumerarr, was tiaited 
thmntgh the grnit^r part i>f it« lenj^h tn ihe 
lateral. When the tints arrived for tha 
eruption of the permanent central inciaor, 
tha removal of Uie three bocftme nuccsaarj-. It wan then 
aeon that the root of the Nntial inciaor had been absorbed, 

(■} Tmpanrj ImUi. Tb« wMnl and Utml incMnn. Idl Miit of ib* upper 
Jiw, l<a»lbw wlUi a tap*inaRiiTar7 (oMli, nnltnl. Tb« root «f Ib* c*Mral 
tel t>>«o fttaMtwl, Ami ibt> p'^isMMfii tnui «"u rttAf lo |mh oat ot M* 
w«kt4: brno tiM itiimtmI ot Of Bnlim ihhh «*• nwaMUtoa. TIw 
l«mst, * Ermait, «H M|bi jrafi 9t acr. 'l'h» Dib«f MMk mn ttn tnm 
pcBlMrllka. 






40 



A eTBTBM or DKKT&L SUBaERT. 



hut that the canrMpoodiQg paru of tli« Dth«r two l««th 
reiaiiHKl ibcir full itimonsiuus. I liavo smii other inslanoM 
of to unuHUiil iiiiuiIkt nf U'liipomry teetU, \mt ihv excoii liH 
aIwav* been in ilie inctson thCttielTos, nr in lUeir nrighVioiir- 
fatxxl. BiuiiUr i>xai]i[j[L'8 BfV loeoirdtiil hy luuiiy writers oii the 
subject of <letit;iil Biirgpry. 

'Fbo k'in|wrary 3p|»car much more eiempt from inilivWnnI 
dt'formity than the [K-rnifliifnt tpoth, I have but one ('xainplc, 
In thin a »tr(iri^Ly-]>ronoiinrcid conimi cusp arises frcmi iha 
posterior jurfiice of a central inci»or. 

Another dnviati'mi from th« ordinary course of rlflvelopinent 
remaiiu fur coiuiil&ratioo, and wlikti. tike the precetliug 
insinDces ofiic'Eiartiireft fmiii the iwiml luwa, ennnot he tvm- 
elderad in coiLDe<:lioii with those coiuiitioDs which are atlrt- 
hiitAlilc to diMsAMi. The |<iili<» fur the dcvr-hipinent of the 
imliviUual woth are net only disiliRl from eath othur, hut are 
contained Mch one lu its own rrypt. Oroai«ioTially, h«Wf Tfr, 
the alvuuliu Bi'|i4uiu Ih Bb&eal, and two ln'comc luiGrnlly 
united, and the twtb produced from the adherent pulps fvrm 
one cuuH, dtHtingtiiBhablc fmm une anothur only by ih(? pra- 
Kiuw uf a uioro or Icm distinctly pronounceJ gnxive which 
mark)* the line of ontiMence, Hometinma the crowns nf the 
tcoth aru oiurti ur [vsn ditilinct, the nxjtit only htrinj^ iiniU'd; 
while in otht-r* the crowrw are united, and the fangs arc to 
B^nie pxttiit «e|iar!itwl. At tlin |ioiiitji o( iiniwi tho dentine 
in oommoa to the two teeth, the cementum or the enamel, aa 
ihe caae may be, forming n coranion inv<*stmeut. Thin con- 
dition wa« known to M. I>e*itftlK*lo, who say», "The wnion 
of the crown io a real fusion of ihe two teeth in which the 
ivory sub«tanC«s aTu common to Mich oth«r.''C') 

Ur. Sailer haa a paper in tho " Tnmmctious of the Medict^ 
Chirurgical Society ** upon this anbjcct, and givo« on iUott- 
tnlion conRrniatory of th(^ fact advaoccd by Oeairabodc, bat 
taken from two »irai!ttfly nnited jHTmnnetit t«eth.C) Mr. 

(■) AawMcaa JonnulatlMiUlSekM*, IMI. 
(*) )l<idlM-Clunu|lnl TTimanlfni. ml. xxxr, 




JEMTBDta. 



41 



Braokhoose, of MuduitAr, Mnt me two exam|iln of gemi- 
natwl r«!ib, Th<j Utcrab and coainU wc jwiwxl lawrally 
tlirtMigliuiit tbvtr liin)i^k, aiul bavn a pulp artty cuiuiuuu to 
the two ucth. ThU wu the more Bppanmt i& cnnwijiience 
of Uveir rcmoTal (oDoeesitatod by varivK) [irinr tu thu miu|)le* 
tioQ of thoir root«, tbiu kSbrding an opportunity for a com- 
plete einiainotinit. A tntnKvento sec^tion thn^ci^^h one of the 
^wcijuctiit, iiiailo iniiutfdixU'ly K-tuw the t<.Taii[iaLioii i>f the 
ernitov), exhibits the oonntiou puLp cavity ciui»trirl>-ii :tt ilie 
polDt rarri^iKiitiliiig tu thv Ijuo of jUQutiou, and dilutled at 
either extremity. 

Tho a'Ulrul uid laUval Jncixtrs, or the lateml incitsun and 
canine*, appear lo Iw tlie only teeth of the temporary net 
subject to jiEnniiiatioii. Tb43 uccoin|NUiyiog figunw itlustm* 
Uw appcarafKKe preaentvd l>y atilt«cl t«ctb. (Fig*. 21 and 22.) 



^.ii.(t} 



« 



«f »OT 



T^truptiou or cutting ^ temporary teeth. — HaviDg traced 
tlie growth of tbii («mi>>rary mt of t«etL in coitui^tioa 
with the jftws, from the tinia of birth up to the frerioti of 
tJicir ojuipk'tkui, upon a •erieit of prv^Kiratiooii fruiu vrliich the 
«i>ft pirt« htu) bc«n remurml, it is now necfss&ry to connidcr 

(t) MuiKi ih* rwinivirwfif ihr Ulm\ Inrlmr mA cuUm mnn ilm \m 
Mr iX Uir Dixlrr i%m. ntiiLd Ihptiigli-ini UMit miUta bncth, tiul wllb Uic 
ItiM iif Jandkin wHI niu-Kol, 1h« ap at wliitrli ibty ««ra nmovtit km 
»rin rein IIk CMmpondtag tocUi en Uw ujipoalu idtb «t U)»J»w «>» 
■laiiUrly nnlbil, 

(>} Shorn iIm rqmaM>4tt«B of ihc l«Mvl InelMif tad anliM frMB 1h< 
liCl Mdt b4 IIm tuwvr^w tJ k iwllail afnt aliif jmr^ In iliU rxiun|ile Vae 
Utm •! >oi)(tian t* !<•• difilMitr marked Uun la Uu jireooliiif UliutraUoDi 



43 



A ST8TRU OP DENTAL SrRGEBT. 



tbe OHidttions of llie Intter m &r m they &re conD«ct«d with 
llie •'inpliftn nf thn ti^th. 
U wc dciHilciry the lower jaw of a nin« moDtTiV f(vtn», nncl 



FiS.7i.O) 








iS^ 



nmlce a section throitfch 
th« gam and ]aw, yaiis^ 
in« through wje of the 
d(!vel«[riiig teetb, the tia- 
KUM vrill be cxpcMTd iQ 
tlio fitllowing order: — 
Firit, w(» "have a thick 
Iftver of ejiitlifliMTn, tbe 
ccUb nf which arc flat- 
''1 'lut ^rEuiiiBlly in« 

<<!-<' iu lliicknOM the 
fiiriher tlicy an? removed 
frrnii the eHrrac*-. and 
eventanlly terfninat^ in a 
MTies of aliglitlr clonyiUed 
crIU, (he long rxm of 
wliich nm plnred at. n right 
attg'e with thv siirracc of 
the (jum. Below the ej-i- 
thtlium comes a thick 
layer of BtcUiite ttreolar 

0) ShMrtflR Ih- t*?UflTP ]M>|. 

lion or 11)1^ tiJKiiir« fx|WMvi In ■ 
Tcrtkml bkKoh Uinxirli ilv |i/«rr 
Jnw nf a nln« toniil.Ki' frriQ*. 
n. »trtrii of tlon^W Cfll*. lorm- 
In^ lli« IiiK> ur Ibc rfiUMM 
UyiT; fc, «Irll*l^ nrroliu' I'Moe; 
C, tv-tidniard tWinr, fkimni|[ 
itmt«l ur. on ib« fnn«r nTfoe* 
crvilili-h la tli^ eiiRnicI pulp: d, 
UiF Ftnni'^l nrpui I r. the mnniri ; 
/,tli<r<lmilii(v«lth Il>» dpmUn*! 
piitp; g. ttie ln«ie rormloi tht 
\.-,wer ftjrdw cC Ute J«w; A. the 
)jvrli(«lc«uiL. 




Tunuuto. 



43 



titaat, tbc inestifis of wliidi ara comporativtilj krgQ And 
o|)ni. Nddei lire prcsrot in tlie ccntn«of the Btollolioas, 
whila otfaen majr be found in filvpE wiiidi havf! nut eon- 
fomted to tbe axiftl arrani;cm«nt, or which, in |)roigrcuive 
gruwUi, tjftTe nnl jret anivM at ihi> EU'lUte form. In tiw 
me«tiM of tbe areolar ti»«u« a few fne ct^lls mity I>« fonnd, 
Imt tlicf are r>nt ahnmiftnt. ItliXKl-vrsads trnvoTM* itiin 
tcxtun: in coiui<]cTalilc iiuiuWnt. . ^cai IhH lowtr boundAry 
more ftbnodaat, are of Urgcr m», nnd the 
itself becoones morf oondrosed. Tbe Abrcfl are 
plAc«d nearer each other, and assume colIcc4ivciy the form of 
All iU-dcfin«il fibrvita tnembraiie, which ilip« il»wn within the 
Bocicec in the form of a wtc — the aac or oatcr inrestment of 
Ibe developing tuotli. Blill proceeding from abuvi> dou'iiwanls, 
ttiar panit^ ibroagb tfa« appcr part of the *a£ w* come tn 
th« ** cnamd organ," then to the dentine and tlie dentinal 
which at it« baae mer^ into tbe lover purcii>n of the 
wilhuul. Hny dpfmitt! line of separation or iitructnrAl 
Uon between tbe two. Below thin, n^ain, we h«ve a 
ifl areiilAr ti^iio which connects, allhnugh hut fM>hly, 
with tbe Umy socket. Then voiiiea tlie bone, whieli 
forms the base of the socket on the one surftoe, and the 
lower tmrder of tba jaw on tha other; anocealod by tbe 
pniosteam, which on ttx cmtcal ffurCace !• in great [»rt turmed 
of nncleatcd ccih, tbe hulk of the tneinbrane being made up 
of filiroas tisvuev toodiitg iu diaracler rnllier towards the 
Ctelhite aroolar tiitaue, than to the filmnia tissue of older 
sabjaels. 

After Ibc crown )*f a tooth has bfien fomind, before it 
aui be cut, tbe apurttire of tbe anckct mniit be enlarged, the 
ooai of the sac inuncdinlcljr nhove tb« crown of tbe tooth 
ranored, toother with the Kiipprimiiond fibro-arcolar tlwne 
nd epttbelial layer. These pnrta — which aland in 'the way 
of the «ni|(tioii of a tooth — may, bowever, be remorod in 
flDcb strict accordatiee with the rate of growth and outwa^l 
pro g raw of the toutb~-gmwtb and waste may he so nicely 





flTfiTBM or DEKTAI. firKOZRT. 

tiaUacMl — tb«t the subject of thos^ rhnn^i^ji sufTers no io- 
cooTsnieiu-B. In m child whu vai^ \.'<>ii^tiiiuly umler my uwa 
notioe, tooUi after tooth ap[Karul wiiht>m iiiy [>reinonitory 
B>in|>loma. The period of Uwthtug cuiik.' aiui went, attracting 
att«iitiou only wltcn a new tooth wu di»covciud. Iiutuupcs of 
teething such ks Iho faregoitig are, 1 bnlicve, otMiiponitivply 
ram, ua<l can only wrcur in cbildKQ who are and h*v« heen 
in oU rcspwtA perfectly Jienltliy, the fulfilment of which 
IdvoIvw a sBiioe uf amditiuiia which our artL^ci*! elate ol 
living; docs not t«.-ad lu hriiii; abuut, or. it luay be «ud, 
cat! scan'tily allow. 

Ke«denc« in crowded cities, eroo in members of the middla 
clameH, seldom faiU to proiltiou wuue amount of injurious in- 
fluence npon childhood ; ood among ths working clasxea, 
LuHullidciut ur inipnj[A.-r food (^'Stly tends to iucicAHe thu 
evil which the wnut of a ^oi:>il aUuospliere has been sufficient 
to create. Among the agricultuml p-tptilnUnn we often find 
great crowding in tljt: iudividiiiil dnt-ilinj^K, a scarcity uf 
aniinal food, and, by way of making the mnttvr worse, a 
perfert indifference to Uio onnditiiiu of the jirociuctfi of tbu 
cottages. A stagiuiDt pond or a filthy ditch, into which is 
thrown tliP ref«i«^ from the house — one or ntJinr, or lioth, are 
fuund in moHt of our runil villages, wilhiu a few yards of the 
labourer's bovuw. The almu«t iiidvereal presence, in om; form 
or another, of thno disturbing causes. Is atteado>i witli a loss 
of that bulAnctt of tlu< nuiuus fimcticins of the body which 
constitutes perfect boalth. Hence wo find that but few 
childran jmsH thruu^^h tliL* t)oriiKl of U-L'thiu^ without Ruiertng. 
In some cnsos the attcndiuit ailment is slight and unimpor- 
tant ; in others, maUdies ariso which endanger life. To tlneso 
dcviatiunn from tionnal dtjitilion, attention Qiu»t now be 
directed ; bul in trviiting upon tliis ymt uf Uie subject, I 
most borrow liu-j^uly ipjta the ex(«erieucc of others. The 
managomcnt of cbildrvn during the eruption of the temiKtmry 
teeth is suldum eutrustvd Ui thosu wlio con5ue th^ir piaotice 
to dental surgor)*, and tlicri'fore ihclr ^owlcd^ of the ooin- 



^m eiAt 



TIBTIUNa. 



4!> 




I 



cidBal dianrders DSceBsarilj beaimes HmitAr) and exeoBad, • 
condition wliicli hM viteD withiti tbolutfitt^or stitjrycanh 
Manj of Uie wrlicr vrritera n|nn denial mirgery van eriAeatlj 
coiwutlvd ia caM« wb«re di«ew0 was su]>poeed, correctly or 
iw, (o ariae fruin obslriurtioD to tlia eraption of th« 
(Rjniry Uttth. 

IhniUivnaineaiaecf local anriconitUttti'tyitatttiitturlianix. — 
In eotinial-ing the amonnt of influcm^ tientition may liure in 
th» pcodactioo of diratM, tbose changes iq Che toeth, and in 
the parts conoeoted with tiietn, whi«h I have endtnvoared to 
dMcribfl ia tbe foregone pag«^ must be kept In the mind ; 
bat not thorn only. TbBro ar« other parta iu tlio alimentary 
tract which in tho healthy subjoct uodiTgo concordant cbaogea. 
Br. Went, in his valuable wnrk " On Diseases of Inljiocy and 
CbiUlhwHl," has broi^it lof^otfaer many of the &vtA which bear 
Upon this subject, and I cannot do better than avail myself 
of hiF wurda: 

" The shape of the human itloiniich in the Snt moatb of 
exitttmce approachee that which ii n-tAiiia through life in the 
i-arsirora, in whom the process of digestion ia more siiDple 
than in any nther nuunmulia. It is long, Init littlt^ curvfdf 
growiug narro«r«r toward either end, wh«re it pasMs into tba 
dBSopbagoa on the one band, and into tbe intcatinn on th* 
otbw. Its Email currature if* but Uttlu urcbed, and appfoachus 
nearly to a ^traiji^l line; thv lar^v cnrvaturo h but slightly 
dei'eloped, and runs almost parallel with the other, — charao- 
teriftics whidi are all founil in the stomnch of camirorous 
■i^inala. Compara with thin thn form ofthu stomnch in the 
adniL It is altogether more rounded: the oaaopluigua do 
looj^cr outers alite li'Ttexmniiity^ltut nearly midway between 
that point and th« pylurus. Th« pylwiu iUelf la drawn baok 
towards the c8Tdia,nDil the; two oriticna arolbus brought nc&r 
to farh other: hence the aiitali cur^-aturv is very sliort; the 
great rnrvflttim of coD»dprablo extent, forrainj; not merely 
tho whole luider part of the circumference of the atomacb, 
but likewiao bounding tlte whole of Ihnt pouch which is 




A 8TSTEH or DENTAL BmOIBT. 

xituatv)! bfyuad it* cardial.- unficc BeeMea tins, too, the 
cr&ncitioti from the pylonis to tbe intetttioe it gradual iu tlis 
child, while in Uie aA\x\t the demarcatiiui betwwn Momach 
ftDcl iutcstiuu IB well luiirked. Thv rL-milt of all tbis is, LhaC 
in the adult, wbo is nti omniTotous animal, the etoiuach 
proflents n fomi nut iinlika that which it has in oonio of the 
rodeatt— as the rat aud thi* rabbit ; and chat the food, lo tlio 
oourae (>r digestion, iintlergues somewhat of a rotatory tuotiun, 
not the sUn{>lG oDwoid movemeDi which is communicalod to 
it iu tho sLuuiuch of tlini aituivura. Tho sloiiuich of the 
adultf then, ii fnime<l to act U[)o]i mibst&aiMs which majr 
requirv Home txvac for thuirdi^ivtioii, whilo th«t of the infant 
is ill suited to ntaia mattt^rs lr>ug wilhiii it, and it^ sttuUI 
size iiniitA it for recdving nuich at once. If, therefore, th« 
foud '^nun to an iitf^mt he ttuch as can be dij;(t>(teO with 
(acility, it K-OQ [VLsaes out of the atoinacb, and tbo inbni 
8|w«lily aecks fur mure. Nivr ure theoc arm.ngRinent'ii, eaU 
culat«d for tlie rapid digntion of eutily-aMiiuilattid food, 
eonfincd to the Rtomach of th« infant, but the form and 
proportioua of the iuCestiiits TOirespond thereto : tht- Kniail 
intciittao in relatively Bhiittcr tliun in tlm adtilt: thv largi) 
intestine nftniialler calibre; the C(m:uiu less den<lo^ie>l ; whiUt 
the peristaltic action of the l)owcls i» inr>ix- m\n<i thus in later 
life; excreTrii>ntitii>U8 matters are quiclily e\|ifii!(Hi, ami the 
healthy infant pas»M three or fcmr emcunliotis in the twctity- 
loiir hoiirJt." 

Thus it ui sbown tliat while the organs of mastication are 
cumiu;; fLirn-uri] fur use, tlio alimoutary caual ta at the nune 
titno na»iuuiuj{ a fonn suitable foe the digestion of imhstaiicea 
that require to be masticated bofora Lticy are pai»e<] into the 
Btomach. And it may be assumed if the iioruinl mluiiuna 
existing l»tween thu dontxil mid disRstive njijMrfltiift, n.t rtgarda 
their reapective rates of deretoimtruE, be disturbed, that vhn 
ohiUl will beaMiio predisposed Iu disengie. 

The tables of mortality, imdur the licad nf death frnm 
tnlhJng, give over four per cent, of tho whole number of 



TEITHiyG. 



■17 



y dfifttbs utidcr tbo agfl of tweho moutlu; awl over iercn per 
ceoL IxtwixD the latter ago aud ibree yeam. Id UieM cuaes 
d«atb U Qut| 1 insume^ su])pui>ed to ariae tltrccU; ftvm dis- 
ordered dentition, bat from disease pcodoced bjr te«tbiDg. Uut 
bcloK full cftdcuco is giveu lo facta advoikced in tluou rotunu), 
it slwuld be sbowo that tli« diiHtrdortd dvtititioa is oot itself 
a aoouiidsry afft^ctinUf ur tfasL ila cmimi was iucapalilc of jiro- 
ducing tlie fatal disea^, I liavu uot be«n aUe to find any 
acooont uf careful poet^nwrtaa examtnations of die twili ami 
JAwt, ia c»M of death attritputed to abnonual dmititioa. ii 
shontd ^Je shown, tn iiidiviihin! cases Uid syinptKius of wliicli 
bad Iwen watcbAl, in wbal ^.articnliir tha jirucess ui t«ctluiig 

Iditfrrtd rroin the a^raial oourae — wliciiier tJio cmwus <.f tho 
tt<eth iMiiiig ready fur eruptiun, the ntugiiiH uf Uiu utvL-iili bad 
lH>t 1m«u stiflicieutly dilated by absorption of tbo booc to allow 
of tbcir [Uise^e towards tbo suilace ol Ilin guiiw, ur wbetlutr 
the jsunis only inip«dcd cho eraption of tlie teeth ; and mon- 
«vcr, lliat in the prctw-'noo of otbiT uinmlitral couditioua, the 
(iuutal was Lbe fdiniary aDuctiua — tbat iL was, iu truth, tbe 
jlrst link ill tbc chain of di»oi-doT>»J actionn. There can be 
iHit, Uttlo duubt tliai diflivuit dL-iitttJoii luui l>ocii ortrrnitcd, as 
a cauae of lAital diseaM occurring during the period of its 
presence, 'iliis has bcseii struu^ly felt by Dr. WchI, wbu 
cayx : 

" Tbo error which has been committed with rcfurt'iice to 
this mallur, uot UK-n-ly by '^o vulj^ar but by inviubvn of our 
lOvra jrrofvssion also, ootiaists, net inovormting the Itazaids of 
I tbo time wbeu cbongcs so iiupottaut an) boiug avcum|iluihed, 
filut En regaixiing only one of Uio manifestations — though t}iat, 
ibidecd, U the nioflt Htrikingone — of tho matiy imiiorUuit mda 
[which nature is ibeu labourijig to bring alKiut. A clilld in 
llMsrlcci biMltb UKuaUy cuts iu ueih at n ccrtuiii tiiiio aud Jii a 
ioertaiu order, justOBugrrlat a c«;rtuiu ui;« prciii-Dts ihv various 
ago* of api'KUchiDg pubiTly, and iit luti<;ili bi-j;ii;s to nivn- 
tniate. In Iter case we do uot lix our att«itiuu suk-ly ou 
tic meDSlrual flux ; nor, if it f&ll to appt-ar, do wu liavu ro* 




SySTBM or DBNT&L SCEUtERT. 



ooaraa to the empiricBl oinployinent uf ciametisgK^e medi- 
cines. We exnmtre iuto tho cuii)<« of iw absence ; try to 
uccruin whi-tbor it dopend^ on tho 8tnt« of the beallli in 
gvncnl, nr of the uterina aystcin in parttciilar, ttmi re^ulnte 
■ooordingly our iitt<>ini>Ui nt cxae. Tlio epoch of dt'QiitioQ is 
to be kiokwl at ytvsi in the siune wAy an that in which vc 
niganl tho epoch of i>u)i«rty. (Juiittiituti>.-Dal difiturl>aiice is 
more ooramon, mdA nrious diwMo more fnMjiient, at t)K>sc 
tbtMB than at otbera; but tlieir oiuc* l\v dec|wr Ujiui the 
tooth which irriut«8 the gum that it hu not >'«t pierced in 
the rme caw, ur tlian thu womh which has nut ;i<>ldi»l the due 
duchargo of Mood in the other. Ton might prodnce hanaoT- 
rhap; from Ih* uterine ve«»ei« in the Inttor riRtaiioe,or might 
cut through the gtini whii-h «[iclu«ed the teeth in the former, 
with no other effeat than that of aggravating the conditiou of 
jour jmtieut." 

Yet iho iihraae, " Bi-1 enfant jnfxjn'aiix dents 'gives ei- 
pression to a belief very widily opread, and nnfortunalely 
t<» weU grounded, that this is the ]>enod at which many & 
child hccoiueH sickly, and porhujiti ucvor again Kcorera 
strength. 

Dr. Copland gires the following deRnition of DiffltvU 
Dentition: — " Slow or retardecl evolutioa of the teeth, with 
signs of \oav\ imiation and cnnntitutiomtl diHturbance, often 
with disorder nmnife»ted eqieMally in tlie di-icstive oralis 
uid nervous Byslem, <Mx»irrtns; cliiiifiy in weak or ovcr-fcd 
ehildren." In duncnljiiif; tlic locflJ sympLums I tuu6t again 
bomiw fmri Or. West : 

" lliouj^h a j)crf«ctly natural proceHB, dentition in yet alraoet 
always att«nd«l wilh aonie dcKrct of suffpring. Many of us, 
no doubt, cau rvinember feeling much i>ain when we cut oiir 
wisdcim teeth, and children probably experience the same kind 
of annoyance. Thta, however, is not always Uio ca&e ; for 
•ometimes we discover that an iDfaot has cut a tooih. who 
had j-ot shown no sign of duiooinfort, nor any indication that 
AtatltkHL wu commencing; with the exception of an in- 



TKETHINO. 



49 




ftow at iaUvii. Mora frvqin^ntly, indeed, the mooUi 
itiieti hoi, unl lLc t^ums Im^k. Uiniitl, tcnae, uid Bliiniog, 
th« flXHct potitiun of c«:b Utoth is nurked, for totne 
,iniu beltira its afjpGaruicu, b; Uiu prutnitiuDca oliiia pxtai or 
ib« oraption of th« teeth ia prucvdMi or acoampanbd by a 
atimowhttt diSciviit cnaditian of cbo month, in which then are 
much beat, and rat«(i«e rcdaniA »f Ifae mucoua lUL-mbnaa, ao 
extremely oo]iioU8 flow t^ Uiin aiilivii, and a digpmition to titti 
fonutiouof nDallftplithotu QlcemtioDs uD thv li^oguv, at tho 
OQter Mirbce of the alveoUt, ur at ihu 4liipUcatun) of ihc lip, 
ifiiougb the gUDis thninwlTea nay not be |nrticularly ewullca 
IjaiDfu). Eiiber uf theae it«t«i is usually attended witli 
IS degree of febrile disturbanoo, aud apinreiitly vitli oun- 
.etaMe lufferiog to the infimt, who ia constsDtly fretful aud 
iah,or cries out oooasionally aa If Id pain. A third iDorbid 
<D(IitioD of do mouth ia aometimiia seen, which U Uiiually 
uahoroJ in or atttioded hy rory cooaidcrable ferw and (!!»• 
ordur of ibe chylopotetio Tiooeni. The gimis then bocumv 
extremely hot and awolLen, rq<1 unusually tender, capednlly 
cr soiite tooth or other tn partiutilar, tuid iu thai xituatiou 
ii&d ihe gum swollea up into a ):ind o( little tumi^nr. 
11 unhealthy u]oi'raUvu«,wit}ias!ou;'hy app^'Uiituv, ufieti 
ujwn the summit of the gum, ami cspeciaUy around any 
ilh which has portly pierc<«i through it. To (brn lUTuctiua, 
bicb U often very painful, anil uftun difficult of cure, the 
me of OdtmtUia It\fantum has been applied by some Oon- 
KDtal vrritera." 

Uuv of the most commoo diacaacs incident to Lhta period ia 
'diarrhcBB, attacks of which will come an aa oacb K^'oup of 
Imth coDics to the surface, and paas away in the intef rals : 
■omeiimi'^, hawe^-t>r, from the long oontinuauoe of the diar- 
rbot, the child will pass into the condition of marasmus. 
Uooy of these symptoma, ncconlhig to Dr. Ci>|ilaii<l, fre- 
itly preeede the appoanuice of thv teeth by sovural wveks, 
t do not alwayfl maintain a uniform aevurily. Indeed, iJiey 
y alto^ctba* subude aud reappear before the teeth are cut. 



50 



A BTiTIU or OKRTAt SDBOSBT. 



in Huo)i caMfl, the uld nursea tell :roQ tiut the teeth vera 
ling in the fint BtlAck, and ia the »ecoDil cutting Uw 
tiB. A more probablo explanation is, thAt ia tbo od« cub 
fl jmseiiig throa^h the alveolar upcoiog — in the other, 
m i Hlc tilfiT u-ay through Uie gums. It has be«n jx>iDt«d 
out hy TrouaseauC) that t.«cthin(;; ia not a cnntinmius pruocae 
which, oncu b«i;iin, is cAirifsi nn without inUjirupliou ttU Its 
oimplotion, but that it takpA place in well marlcod atagw. 
Till! Ufulh an.- tut in f;niups, and when one jCTt'up of 1«elli is 
feirly ernpted there i» a fwriod of real till It is, time for the 
nprt grou|i to appear. It will of tuunw be understood by 
ftvdry ooe who is faaQiliarioed with the Dncnerons irrcpiU* 
riuw ariiiinK in drntitinn, Ihat (hia definite sorial ordvr will 
in >(»]]« iimtnnces be de[>artwi froD), tbotigh the statemonl is 
none the leas very genemlty true 

At un a<^ Taryin^ fruai aix tu ainB mcuthi the lower 
i.-«utral iacison appear. th«ir eniption being rnpld, and being 
minplel«il in from tliree to len ilayfi ; then pomes a (leriocl of 
n-tit of two or three mouthx, at the end of which the four 
upiKtf iriniwrs cpinc down irifo pldce. Tlit-u again afl«r the 
Upfd of somc! monthB tho low^-r lalenl ineifiun and the four 
fint molars arc cut, their eruption being followed by a con* 
lidmiblo lapea of time, amountlog ofton to four or five 
inouths, vrhtm thi? four cuuiiiu8 rommencc to cnme throngh. 
lilt- eru|>tion of the caniiic leolh covens a very kmg period, 
taking perhnpH twu or ttiree nioutUs for its complolion, and 
it ia during the eniptioa of these u-oth (acoordiog to 
TniuKHuiiii) that a child Miffum riioi*t stver*ly, though a dif- 
ferent opinion has been l*t«ly eKpieesed by l>r. WvHt,(') who 
oHiaiderM that the four timi molam catiiw! the grcAteitt amount 
of cunAtiLiilii'iiul disturliatipv duriug their pro^csn fruui the 
alvpoli. Thi" pr**t*'r lime in.kf'n by the canine teeth, and the 
MveriT syinptotiiK uccasiouvd by them, uru acouunted ft^ by 
Trouweau, hy the fact that they are the only membors of the 

(■> CUatm LtduT**. TrouoaraQ. vol Iv. (laydefiliajii t-nirt? Bdliira). 
<■) On taait Karroiu UlMorden of CbRilbouO. \ij Ckurla Vti-wt, UJf. 



I 
I 

I 



■ * » *■' 




nmsniA. 



61 




toioporary H.-ri» which come into place between two other 
pnvioa*^ •nipt«d teeth, eo that tbey ure likely to meet 
vrith gnster nautauce in Uieir inui»it. But he appears lo 
bare iu boow d^ree iDiiiup]irt;hvt»Ied the couditioDa uuder 
which the ernption nf t«vth takes plnocs whvn he mcntious 
their length of f&Dg as being aiiollier difliculty in the way of 
Ibetr Msy tran^t ; for the fanf; i» nut fnUy fortoed until the 

wn 18 well a<ivimc«<l in its movemeal towards its final 
puiiiion. 

Tuhenile does not appear to intorfcro with the prognsa of 
deotition, bnt rioketa does so in a rery great drgrre ; in fact 
great delay in the appearanM of Uie teeth would alwuys lead 

■ awpieion of the exiatiaiM of rickou.(^) 

Among the coUocti<jQ of in^ulu maxillai which bsa been 
there are wvcral specimens of local <lii»rdfr whith may 
iced at this pmot of Ihc iuqiiiry. lu oiic uxaiuplr, Uken 
a anbject nearly nine montha old, the teeth prc^umt no 
IKCiiliarity either an roganls Htn]T.-tiiro vr furwardoees. 
The Jaws are, howerrr, small, and the bone U imiisuaUy porona, 
the alveoli being at taany points imperfect, leaving the fanning 
teoth partly exposed on their anterioir sarfacei. In a second 
epecimen, twenly-one months old, a similar coodition tif the 
uutxilhe exists. The iDcisora and first temporary inulaTS hATe 
been erupted, and appeur tol«t«bly well developed. Notbitig 
i» known of the history of these caaoi, bnt Borcly the uniinual 
condition of the bone of the alveolar procesaes must have 
been attended with local indicaUons of dtEWcder, In a Uiinl 
specimen we havi? the enlarged cranium peculiar to chroulc 
hydronephalus, sccominniiid with an abeeuoe of the outer 
alvcolur plate, ao that the lecth arc ezpovcd uver the whole 
of their anterior snrfacoa, Tho bono does not cjihibit any 

0) llwlUht n«UiMl(ialoekl9f over tiw inuHl* flsuml In (hto *> urk, Um 
ihr MUti 4K, In auof Irwincn, btnUf — Ur alTioonl m wddU te npMxa 
iraa ltii« asn of Um dilUl ; ihtt nmf te ^w M Uie bul Olima Iwrlai ben 
•f wMidmbIc dvraiiDa. bgt ibu vtatn cwUln Itaills ilu-rr U *aiin Ulila 
rutMVij. rfn in btwlUiy cbUdna. U lutlnud lir tM (h( Uut alBwsi t*trj 
Mttdor aMlpM B dlthrvnt pmcd u Uw mi])Uan vf lb* vitb. 



A BTBTRX or DENTAL BCBGE8T. 



unuaUAl puTwity, tlm defect being in qiuntity ooty, — & pecu* 
llsritjr whicb in cxu-nde*) tu th>i3 wbolu o( ibe bonca of th« 
hoe. (Fl^j:. 24.) I ww a fminnt soma innntbK sinco, who 
l«went«d sitcilBr coDditiooi. Itw aourior snrraces of the 
hMth ooald bo rdt thrait^li Ui« gunu. Tbe cfaiM wm 
tlio Iredtment of Dr. Wert, who tclU me that Ii« hua oVi 
in cues of this kind dentition in seldom nctendod with 
trritatiOQ or any increase of tlie pre-extatiog ooDsUtuiioiial 
dlBturbaace. If tliix l>e a cuiutADt Oiiiiditkin, it goes aome 
way towards Bhovring that tbe local irriUtioQ so commooly 
ubseTTod is ooiuwicincnt upon the ohfltraction oflTcrcd to tbe 
eroptitiu .of the t«etb liy tb« margins of tbe sockets, ratbi-i 
than to that aifurdcd by tho i^tni. Further obccrvatiuo is 




required before tbe qucatioD can Iw net at nsU IndBed. 
this ruiiuirk may be applied to the. wholft mbJMt. tloiiw 
[Ttaclitionera atlribut* almost every nilraeut of infancy U- 
dentition, without, however. Attempting to expkiu how su 
muoh iniacbief ti prodooed, oratcnting tfactnaelres with the 

nt VIM ot Iha laaM pNtlon at aknll of ttiO-l >lw had aaOsrad tRnn 
itj^nmfkalm, rtwvlat ib* **«kflar Icmpmry mu. mat tbe Miethe 
«iu«rii>r milt of ta* i 



TKiraixa 



53 



^I^^PH^^ant, without lelling an in what particalara tha 

^^•eru^r^^^ wbicfa oorampwiy Um eni]iiioii of the t«eth 

wore defectJTe. O^ier medical mtu cutMiain the opiuiouA so 

clearly tft furth hy Iir. West. 

^ Id Rddillon to ihe nrioos ch&mctcrs preseated by tUv 

^M ptnis which bavo bccu alreaiiy noticed, then u a oondition 

^^ which I bare kku in & tuw ciutm uiily. Tlie gum nver the 

cotnjug tooth in ettlur;^!, but the enlargement is circutn- 

scribed, hns a Itlne i>r jHirpIn colour, nnd yicMi to prenum 

^ ir aa ii>ci8ioD be made into it,a email quantity of ttansianat 

^H Duid will cscAfie, nnd we flhall find the Uwth at the bottom of 

^0 the em|)tin1 cy«t. In thuie caset, the vnlai^mcnt apparoat 

»TO the surface of the gum wa» obvidimly produced by this 

secretkiQ offlaid between the emrlace or the eiiamr-l nnd tlie 

BUperjacent eod ttwue. I was unable lo det«rmiae whvthvr 

^_ the linincof the eyet was compuHcd of the libroiu tissue which 

^H fomui the base of the eDamel-palp, or of the atellate arouUr 

^B liBsue which Mm oxiemid to the latter. 1'here appears lo be 

^H rwt connectittu knpt np between the enamel and tiw tooth hoc 

^^ whra oncff tho tomior is ooinpleted, and it i» oot Intprolmhlp 

that a alii:hi ainuuut t^if fluid niay be [inwi-ut ua a normal 

condition. Thv irici>nv«niebce cxperioDced by the patteiitB 

nppearc<d tu be very Hlij^hL, niul the uccumuice DrofliuiiMn in 

tlw Mc would merit little attection hnl tliat it offers a 

^_ probable explanation as to liie wiiirce of another diseaM 

^B which satnctiin<w oriao in counoction with tlie o%'olutiuTi of 

^K t««lh — a snbjoct which will be con^idemL in a future page. 

^H Hunter, alti'r staling that ibe tveth, in thfir adratice 

^^ toward)* the snrfiice of the gum, ewrt pressure upon the 

iinp£!nm[iiiieBd parts, thereby causing inflatnmatinn and ulcer- 

^Kntixn, i:o«a ou toray, " that ulircration which takea place iu 

^B dcolitiiHi is one of tbeflpccieii which .seldom or never produces 

auppaiatton; howt-ver, in Boine few caws I have found the 

glUM nlceralad, nnd the bcx]y of the tiKith xuntiundod with 

nuilter; but I bvlievo ihiH Midom bap[)ea» till the touth in 

Dear cutting the skin of the gums." The condition l]or« 




BTOTBH OP nCKTAI. fftmOBBT. 



<tol|gfl»d is probably s»)>«M.\}uont u> Uie inflltnitioii of wrous 
fluid within tliu cai|«iil(r iuvustiiif; (liu vtuiui'J. 

Thtr most oommciti msult of difficult dmlilioQ in a general 
fulirilr ouiidjtioti. UiiiiUir aays : 

"The fever in somctiiueB slight, and sometimes violent. It 
is vcrv riJiniu-kabln 1>oih for iU sudden rise and dioclonnun ; so 
Uut iL th« lirtl hour of this illni!«», the chili libaU be per- 
fectly cool ; Id tlM sooood, 6ushod und burning lioi ; lod in a 
third, tcmptirate ag&itt." 

UiAorders of the nervous syat«m frequently arise at ihU 
ppoch, varying iu intraiHity from elight inuecular twLdiing to 
violent con^-uUion*. The following case occurred in the 
family of a medical man : — A child, filaying round the dioiog- 
room table, suddenly fell down in a stale of insensibility. 
The father at tU« timo vae absent, and a iieighlMiiirin^ practt* 
tioiier was caltc-l iu, who, oii examiuiiiG; th« Tiiomh, fonind that 
thDgttm was raised, and in Biitau? of lonRinn over a tcipporary 
molar. Au iuoiaiou M/aa made down to the tt^otb, the child 
immediately recovered ita aonBibtlity, and in a few boars 
WAS perfectly wall. Now, aa uo muilicine wax givuu, and aa 
the inMnsIbility was ooutinncd noiil ihc ^m was divi'led, it 
would be too much to asaiimf tliat tliu opvraliou and the le- 
covery had no further relation than n»i*ro coincidence, espe> 
cially when it i» romf'niWn^ that the majority of tiioae 
mgaged iu ctt«iieive j^eucral pnu^tioe coald furnish caaes 
Kimilnr to thn one citivl above. On the other lianii, we may 
have coiivulsiunH when loctli axe about to be cut, and the 
gums may be lauotyl with tio apparent advaniagr, the disease 
running ita conrso lowm"ds recovery or death, uninfiuenci'd 
by the dental operation. (') 

Inatancro of epileptiforni convQlsions depondeni on the 
eniptiua of the teui[><irary teeth are far from uncommon 
and in aome few cases wh<>rc parlially cm[>t<^d t«mponuy 

(!) Twarqii4tt]riarllctiigei*«arcarinilBloiu«l(ti««twldiinb1rp]rr*xIolanat 
rtlhvnl lij UridiiK lumM n^Mi'iiPi] gniu wrrr nimmunloatrrl bj Mr. SLfv^kmi 
SnIIti loth* EdtaburytitJLwtiiitutlSuclrl;, anil Brrc|uuCiil in Uir IK'iiliiirwniua 
vol. XlL, ^ 20«. 



k 



THitTfrnta. 



55 



I 



t«cth hftVD nppAued to ho sourccii of initation, malit^l 
tDflOtC) nil other rcino(]i«a liai-ing loilcd, tuivv oxtnct«d 
thnn wiLfa tba elTvct uf at oooo relioving tlw convulnionfi. 
Hunter, wboM wurk on the teetb cannot be too often rvfcrrt^ 
to hy thoae engaged ia iho pnu:tico of d<>utal surgery, nr in 
llie trwtiDcDt of disorders coincident with an alinunuid ata't; 
^of the <]«ital nppRralus — Htales: " 1'he jmrtml ur IhchI voii- 
t*«qti«uti.\l iiym)jtouk« ar« tLe moat varied utd cuiupticated ; 
for Uio appoumtuM' they ]>ni tm i» in some degreo dutcrmioeil 
bf tht D&tara of th« parto thoy affect ; wherafon the? imttiiiv 
vvKnia difUMucR of ihc liumati body. These aymptoius we 
aliall doecribe in the onlor rff thnir moat freqiuint oocnrrauoi- : 
diarrhaa, costiveDfisa, loM of appetite ; eniptiona on the ikin, 
capecially on tbo hce and walp ; oougfa, vhurLnuw tif breath, 
with a kiud uf oooYutood KCpiration, aimilrr to that obwried 
in hoopinji-ooM^i ; sptunis of particular partii, either by intfr- 
vida or ooulinu«d ; au iiicnuuKx] K>CT«tioti of urines and eome- 
• diluiniition of that accretion ; a •iiwhargo of matter 
the pent!!, with a <liflivulty and pain in making water, 
litalinc exactly o vioIt>iit ^M^rrhaut." 
A caso IB givMi iu which tiiis dmiiiihaooo of the nrinary 
l-organs wan invariably coincidout vrith cutilDg of teeth, tht- 
otU! aa it were kci-pmg time with Die otiicr. Hiincer'H own 
wonla are : ** It wu obaerved at last, that they (the uriOM^- 

Ijyinptonift) relurued only upon hti* cutting a ni>w tooth; thi» 
ibnppcncd BO often, rej^ularly, and coDKtiuUy, that there vas 
DO rcsaoQ to io\iht bat that Jt wai owiii;; to tluit cause." 
I San, then, we have, on the highest authority, a long li«t 
of the maoy ailmcntu that may be conaequent upon diHrdcred 
dentition ; sDd it i« for tiie prnotilioner to distinguish iu in- 
^Bdividtud cabm, whetlier tha duiea»e prment during the time 
^Bbf teething is consequent upon some demngomcntof thio pro* 
^MM^ or T]|>on an abnonn&l oonditlon uf sonic other oryan ur 
^ orgvu,of which the dental difficulty iii but itself a symptom. 

O nwul. OtoervAfloBi aor I'^y^pak. p, 3», ub) ncntol Omoim vol. xil..« 
Sit, In wtiieh bllet omb Uk |atkBt wm Id a ■i«Cc or coUb^m^ 





£6 



A BmKM OF DBMT&L BCBOG&Y. 



In rorminR this distiactioD, tbe tlate of the jawB ntnil 
be tb« ]q4notp«l guicle. ir, in tli« prcwiico of tiyia| 
vbich miglit arino fnun teeth, we f^iid that lei-tli kre 
pressing forwanl townnle tli« sarfiKe of tbo paa», and tlwt 
the latter nuiinlain thnir nurtnol appeannoe, it will be uselen 
to have recourse to tlie gain lancet -, yvt, even in tbii cum, 
the disorder nmy lie riiic tn, m much intliiencpil by.thc teeth. 
They may bo ooufincd by tho sockets a difficaily beyond 
th« reach of niero divi«ion of tlio muu> It te not easy to 
80e bow wonruling the anperjaceat soft tissues ahauld promote 
•baorption of the osseous margins of the aockets ; yet then 
are those who, oa all oocaitiuna, have reoonrae to this praotiocb 

There are, however, rancs in which this irimple opmrat 
will at ooce either mitif-ate or eiUirely minnve inrist. nXt 
«yraptoinii; but in imch wo Bhall find the gnm pronJnviit, 
and ill a bUte of teiutJun uvts the ailvaucing toctb. Uuder 
these condttious thu ^uu should be divided down to the aar- 
Cnta of the tooth, aud nut at a pciat only, but across the 
whole breadth or length of the crown ; in fact, iha imiirUoQad 
organ chould be entirely *ct free. 

'Ilion, a^tn. there are rawH in which the giiina may he 
lanocd with advantage, for the sake of local depletiuu. with* 
mit roferonco to the liberation of the t«cth. Wbi^n we find 
tlio lATt iiiflitmed and jAioful, this measure tony l>c adopted: 
the incisiuTu should nut, however, be dt-ep, as in the fonDer 
case, bnt HtiixTficiftl only, ai»l iwhrfoniu'd with n Aharp instnt- 
ment, shaped like an ordituiry knoct, ami with an equally 
sharp edge. The iuiliscriminate okdoption of this treatment in 
all cases when the gums aro turgid and inflsmed will occa^ 
sionally lead to mischloroiu reKults. In ehiUlren who ait 
enfeebled, either fjrom disease or residence id a bod atmo- 
fiphore, ulceration of the wounded parts may follow as a 
consnqueDCO of the operatioo, or in some in.'^tances sevete 
ha^tnorrfaHge, which has been known tx) ]ir<ivc fatal. 

Trouffittau expreaaes a strong uj^inion adviTHo to scarifi* 
cation of the gum, which is, Qevcrtbcl«u« ondoabtedly of 




TBXTBJHO. 



57 



¥ 



great aerrkti in same caaca, anil it will bo lung before the 
practice is abendoiwd, if iodeod it ever will tx'. 

For a doUiled nccontit. nf tiie aym]>l<:iin3 luid titi&tni«iit of 
tliOM diM«w« whicL way l« occMion«<l vr aKgravated by 
Abnonnal lUntiliua, I tniut r^fer the reader to vorka UtAtiDg 
upun thtf diaouwK of infouoy anO cluldhood. Them an 
subjvctK w}iidi Ketilotn cumu aniivr the uottco of tfae d«iiul 
mrgc»n; hct, having his attvnlion conHtantly directed to Iha 
MfCADB of iDMticatk>a ill all their vnnod conditioiu, abootd 
be able to pifiDt out any dcvintioD fnnn the normal state of 
tbi tMtb and jaws with grenter precision than then whose 
pnusticc ran^ea over a wiiler fielil. The onnditinna neocnary 
to the aoquliiiLioi) of thin aiiecial knowle^ pv«clade t>>e 
poaibilily of bi« Raining aii amuunt of practical iofurmatiou 
u]iun the Eieneral siilijvct of dteewe sufficient to place bim 
upOQ AD oqufllity witl\ thoAc who devote tlietuEtelvea to the 
ittudy of tlio diMiu«ui of lafiuicy nod cbiKihood. 

Bfi'iiiont t/ the temporary to the developing pfrmtment treth 
at the fieruAl u/ien the former an faHy /vrtntd. — In foUuwiDg 
tbe plan which has bccQ adopted in armogiDg tb*.' maittr of 
Uw present Toiiimi', it will be necosfiary to puiat out tbe 
itornial reUtiou* uf the two itctv of teeth before ciitcrio^ 
Dpon the irrtfniiAritj' in tho arrartgement of the permarK^nt 
oritanii while still mtbin the alvi-uli. If we aelect fur eutuu* 
luttion perfectly well-fonned jaws frotn a 8abj«ct in which tbv 
finii [lermancnt molars hAre not apptunni thioogb the gtimK. 
bat in which the temporar>- teeth nre all perfect, we shall 
find Uiai each nii'iiilnT of tlt« latter set faaa become Rlli;)itly 
fl^wated from its fellow; a condition indJcatioi; tlmt tbe 
growth of thti jan-B haa been in all rudpeoU uormal, and cuu- 
aequently that a good and well-arrangod set of pennanent 
tMtb may reoaonably be expected. 

Tbe cnjwut of the permanent iuoiaors, both of the upper 
and lowor jliws, are perfected, «xcei)ting perhaps) at that part 
where the enamol terminatea There the dull and uhalk-Uke 
appeanuice which that tiiwuc presents when the develop-* 



S8 



A STBTKM OR DXNTAL SrROERT. 



meat is progratang, m*y be obMrv«d. Thu cnninei aro still 
leai ttdranrpd, while the prowni* of Hip first bic-u«pidB have 
Dot AttAincd to man than two^thirde, and tJioee uf the eieconcl 
bicnisptil not mow than * thiixl. of their ultimate I'?n?th8. 
The downs of thi> finit }>ermaiieDt moIuD an; us n-Kptrrtn 
thrir external surrace, fully developed; and tlie wpt* of 
clentliiu which extend acruSia the baw of t)io pulps marking 
out the MVflrnJ roole yet to he dKV{'|i>pe(! are fully pro- 
nouDoctl. The wcond pormanpnt miliars are iit i>rc«<«nt rept** 
iK-titod by ftbout two-ihirda of tUtnr crnwms aiid iDvestod 
with a thin Uyer of partial I y-devMopfiJ eDamol. I'hc posi- 
tions of ibo piilp of tho wisduin iut'th are but faintly indi- 
cated by elight depressions in the bone posterior to the 
•ockets, which conwin the roniiing spoond rnoliirs. These 
morlu may, hnwi^ver, nt thio jxtriiKl, be AlCut<cthc;r wanting. 

Th* position of the temporary toeth in the javra differa 
from that nf the pennancnt sat in being perrccUy rerlicB], 
Tha crowns do uot occupy & tuoro forward poeitinn ta thu 
dcotal circle thau tfaeir rcHpn-tivi; root.t; the crown of rach 
tontli is directly over ur under (aa thu case may bc>) its own 
root, the btter standing imnKidiatcly in front of one or other 
of the stiooecdiug teeth. 

The permanent t««th arc at this age contained within bony 
oella, which huvn Ivfoii aptly uii'iuf^h cotnpared to the den.v< 
layer of »h«U which surrouudii an almond, and whii.lt, ltk« 
the dental celle, is oonnect«i) with the cuntignonii tiuue by 
a cDm^raratively jioruus structun:. The alreular uells luay be 
mdily isolated by breakiug aw&y tb« poroiis bone by which 
they arw RurrtiuudDd, excu|)t at thoei? iwiutB whuro they wiino 
in contact, and blend with the dense bone which contribut4xl 
in fiirni either the oul«r cturfaoe of the jaw, or the dense wall 
uf a iivighbuuring cell. 

()n rcmoral of the hone frora the anterior surface of the 
msxiUa, it wilt be mod that the pcnnauent central tnrtHon 
arc placeO nearly jiaratlcl with each other, the culling edges 
in the upper teeth being incliuDd a Little forwaitls, while tbe 



k 



TEBTmKQ. 



59 



parts oarr wp ondipg to tJie hue at the crowns o( the two 
t^eth rMpecliTel> arc |>Iaoed immediately below tbe floor of 
the noae, from wbicb ravity they are nepanted by a thia 
li^rer of bone ouly. The tectb at ibtii «tago of growth ooin- 
ptetely fill tb» cells or crypto- The oorraepoiMHng lower 
louth fauld a similar pusitioa in tlie luwirr jaw, bat bavc a 
strictJy Tonksl po«itioi), aoJ abow a alight advBDCc in de- 
Teloptnant aa ccuipareil with tlio upptir centTBJa 

llie lateral incisors of the upper jaw have a alight ly oblique 
direction, the cutLing edgpA being more rnrwuni than the Imw 
of lb« crvwus, which are orarty on a Ivvel with Uie cum- 
spotidiog inriii of the cotitnil t«etb. Tim lahial surbioc uf uu-h 




i often Kligfatly turned, so that the mmial surfare wLirh lien 
tlw oculral inciwr Is directed out'»-ar<I«, wbllc th« 
KDgle of the tootJi ulandx in front, and a UUlo onsr thff 
eontigoouii [iorti<>ti of ihu cvutral iuclMir. Tbo jioiat at wlJch 

0t Skomt Uu ralMloM oT th* tUBpcnt; uatl pcnuaoDt Icwt at iIm 
fMlod wtan Iba bnaer arc pcrfwily landBil, U an WMUfita <r wdMom*^ 



80 



A BTBTEH OF DEVTAL BTBCEBT. 



tin one tooth orerUiw the otlier, corrwpuuils to tbe posllioa 
of the root of tbu temporary lateral iaeiaor. Tlmt biiIb nf the 
btenU which in th« pnrfmted teeth liee a^inst tho cauioft, 
here rwU s^oHt tbo ce\[ whicsb contains Hus 6tfii liiciiEtptd ; 
while ibe developing cantnc is at thi» pcriotl abov« die Utter 
tixith. In the lower javr tlie lateral ininaoTB nre placttl less 
rcftuUrlj, hulding a {iceiticn xtighlJy niore Wukwaal than 
tJio ccntniiif. ITio tooth of either side Is tamwl from tho 
meeua line, ami lint uhlii|uelx over the cacuutf, to the oxteut 
of about half of that touth. Thvy i\o not, liowover, a» to 
tbe ninier jaw, oome in contact with the oells that coDtain 
the flm biciupjds. 

11)0 iwruumeot canine t««Ui at thiA ataj;e of dentition are 
■itufttetl above th« line of the otlior teeth in the upi«r, and 
below it in the iafcrior niaxUla. TIimmi of tbe up|>er jim are 
directtd olinhtly fonvank and ontwards, while iu tho lower 
Jaw thesp tt«lh have a din:<ctiou iiF^wanU ami a little in- 
warda. Tbu bicuKpida an- plncul iu cbtU itiluatod between 
the roots of tho temporarr molani. 

In tbe ^perimen which 1 have chnaen far dceKTtption. and 
fruiii trliich the illiuitntaoD is taken, we have perfectly well- 
grown jawH, showing very oomjilctoly the relations in pcmition 
lof the firtil tn the Bocond net uf teeth, aud the reliittve piisi- 
tioQ of the several members of the latter to cftch other. It iit 
very d^'flimlile that tbe practitioner ahoold be well arqimtnted 
with the conditions which this, in comnion with mauy other 
Blinilar spi-ciiitenK, jtrescnU. We ^^e in it nil thu early ooti- 
ditions necessary to the development of a perfectly regular 
set of teeth fuldilpd. 

In aniUher »i<n.-iinvii (Fig. 2C>), tlie arrangenient is egnallj 
normal, hot diJTcrii in one respect frnm that which has been 
bdeecrihed. In this caw the mesial siJi's of the upper lateral 
r^Dcisors ai« placed behind the distal sides of the central 
teeth. The degree of overlapping is perhnits rnlhor in cjccenB 
of what may be rc};anletl as a ]M>rfect arrangvgneiii, an<l the 
lateral iiavu diisccnded nearer to Om alveolar margiu thaa 



TSBTHnOt 



61 



tbe cenu«l incinore; but still tlie apocimen will nerve for 
illiifitnitiDg the nUtivt pc«ition of tb« mttnl twtli nUudoil 
to, lit th« sMino time thiiL it oxliibiw im lrr«eulmrity In i)i« 
puaitioD of tbo ri^ lAtorol iucUor in the lowor Jaw. This 
tooth lies it« mvdiu) d^e turned oDtwanls lowanhi the lipe 
and IsaccoiDpanied witti»diminUh<wl Hizeof the utttoriar part 
of tbe j«w, M cnmpansd with m»nj othnr jiiwn of Mmilar age. 
Altentiun may aKain be (Uivctcd to Ihu fact thAt the t«ni- 
pormry tMth an placed vertically Id the j&w«, and that if their 




meoeisors wore mmilarly tmrJanted, there would Dot he nxia 

io tbe nppar jaw fur thu cantuo Uicth. Bat Uu< U|i(<ot iudaura 

in lite place of n v<,>rttcal haro aa oblique direction forwarda 

aod outwarla tuwards tltu lijie, while the vortica] line ix »t 

tliia afi:e fuUowed by the biciutpids. Now, if wc [inxttiou ati 

imaginary Hue through thn axt^ uf th« ufiper iucLiKtrs in 

their pruseuL aUUc, to Llio cxtvitt of pcrfoctt'd tueih, it will be 

(1) aMMns (h« raMv« rottUoo nr tk* t«4 «<u of w^h, wttb Ui« eppor 
laMvl tadMn daavBdUif lowar ibu ih« oeiitr4l tcdb, util ll>e rigbt \nmtr 
iManI wM W tUmti ^Igr lamal rami*, 



69 



A 8TIITBM or DRNTAi. Btntonr. 



teen that the difTennce iii tlifi (Unrctinn nr tliQ line of ftrowth 
between the ioclMn and the bicuHpidii will lend to a separa- 
tioB between tbcaa teeth suHioiciil to ndmit the caoiDfl into 
llie doiitat Ime. In order tbut tbis rmult sball Im attained, 
it is Decc«vary that the relative nit« of growth beCweon t)ic 
several leetli nliiUI rfinain undisLorbed. K, for instance, th« 
canJne advances tuo rapidly nptm the Utoral iaciaor, and 
nuik«a it» app(!iaraDLt> thrutiKli the f^m bcrnre tbe lat«ra] tooth 
baa advanced aufBcieutly furwaix^s and otitwiudH, botb teeth 
will be dlspboed : the lateml will he forced wilhin tbe prt^ief 
line, and th? canine will occupy a |tlAGe exteroal to it. 

Many cliiKlren, however, either fr'nn hereditary' tendency 
or from ill-hcaltli and coiiaoquent ciufiTlivc gruwtb in tli« 
jawH, have the i^rmonent teeth during their deve1oj<mcnt 
placed irregularly. Attention haa already been directed tc 
tim fact that the rise of the crouiui of the teelh is determined 
At an early age, and \» not capable of fnlweqwcnt alteration. 
Ir would appear, howcvur, tliut a want of pruper relalinn in 
nw|Kx:t of size between the teetii and the jawit may btmime 
a permanent hereditary charact^ir, (jnite R|Art fnnii the influ- 
enon of healtJ) uid diaeaae. In certain families wc may ece 
larRe teeth aaacxnated mth small jawn, t\w want of the requi- 
site siee ill tite Intttr pnrtx DecesnlAtiiig the rmnoval of two 
or more of the pernaanent teeth before the repilar arrange- 
ment of the rumaining ones can Iw aet^uiiied — and Uiia 
without any indication either of want uf ix>nstitutional vigour, 
OT of prediMpuBiiicu U» disrjiw?. It in, in fnct, n pwnliarily 
traDnmitted from y^ucal to child, and muKt bo regarded rather 
as an her»Ulury I'haraetvriitlic, than (u analmonnal cnndilion 
fwsulting from an arrett in thiC development of the maxiUa!, 
capable of ntnendment if thu pulient be xubjwted to treat- 
ment during the in-riml of childhood. It is very necessary 
tltat thic part of dental surgery fihonid recavc far more oun- 
aider^tiuu in an aiiatominal and physiologicul {mint of view 
than it has hitherto done. In the absence of precise know- 
ledge upon the subject, tbore is nwu fur great diHjxkrity 



TXETDUfG. 



63 



^D^ opinion m ragurd* tnfttncQt, le&Ting b wide &nd very pro- 
ductive field for th« onltivaUon uf tlio cluirlaiau, wliu Boot 
lo «Tety cue of irreguUr ditposition of the tMlb Uk oppor- 
^ tuiiity for mechanical inl«rferaioc, in some nuee eecuriog to 
H bim«elf a large fee for doing hy means of mechaniun tliat 
" which Natnre would have tffveted, had the opportnnity been 
allowed i and ia otb«i' coees siibiiJtliiig the palieot. lo a iDug 
coune of treataeat, which Mttaiia no luwfitl resulu 

In the subsequent pages, on attempt i* made to bring 
togettier a sctjes of oouditions connected with the subject of 
irregnlnrity nf the permaiieoc leeth, tAking up the inquiry at 
an earlior period thno ia usually dou«, and traciuf; the devia- 
tianfi onward until the teeth are niatnrcd. 

Fmyutarilt/ in Ihs pimtioH qf the permanent, tlannff the 
exiitatce of the tempomry, trtfth. — 'Ilie fint example wiectod 
for doscriptinii in tl lustra tinn of irrr^iilurity in i]w. [awitinn nl 
the ]ienuitiirDt t««lh. will be- that ul'a child who diinl vrbfn a. 
little orcr thtt &i;e of four ytwre. Thf tem|Kimr>' tet^lii in tlie 
front part of the month are crowded, the ni'PBial edges of the 
lateral inciBon of the upper jaw being directed forward, 
from ituiiifficient Kpnne for a more regular pottitiuD of these 
iMtli. The permiuicai ceutial incisors, although uniform u 
regards each other, hold an imuHiial i>OHition. The mumsl 
edgM are turned forward, and t-be cutting edges of the teeth, 
from the obliquity of thn rrowiw, are dinjcU^l tuwarda the 
mesial line. Tlie upper lateral iuclsora lie in front of the , 
dl«lAl edgni of thr rvnlral tuelli, and the canines are {itac»l 

PiinmedinlL'ly ovoi tlie rootH of the Qrst temporary muUrw, and 
conK-qocully iinmi-dlatrly over the developing cospa of the 
lirst tnciiA[uds. We have in this nun a deninjj^ed position 
which, until the te«th liave psaaed through thegimis, cannot 
be matemlLy changed. I'he development of thn teeth has 

■ been continued while the jaws have been comparatively 
atatioDary. The oblique and twisted position of the central 
incisora will be maintnnwl until tbey are acted ugion by the 
■aUgonistic loftb of titc lower jaw ; and the first bictispids, 



I 



. 



64 



A SrBTXK OF IHOtTAI. nnWBBT. 



which have been enrrnai^hed it)x>n and ratnixleil in ^ruwth bv 
tbe cauiutM, will Im cTxiuketl and niiMluped,&l thouune time 
ihmt tboy will bu furumi tnUt an irrvgulnr pontiun in common 
witb tho impinglDtc cauiniHs leaiHog irrulitbly to one or other 
of ibv iwrnianail- fornja of displicfltuciil of the later teeth. 

I>i0. IT. (1) 




ennsidered in a future pug«- In tbiH cue, tbo t«elh in the 
lower jaw8 ak dubjoct lu but slight iire'^ularity. 




haofifa* \aknh. 

(*} !Me vlev oT Uie him <v«diDea. ■hovlait ib« xtUltTr podU^ni of tb* 
wiiual Mid laUnJ IndBMI, tfaa ouiiitc Md Uie Otit UtaqMOa. tbc laUtr lootli 
b*li« liiurrasW to to di*«)(>pmait b/ ilia caalm 



TKEmiMO. 



C5 



^B In another BpecinMO, fmu a Biibjoct who died at the age 
I or four years atul thirty-itix dayn, tho lflt*ral iDcwoni of the 

upper jaw are plnctxl Itehirul itit- cvutmK tho iaIUtr tiMilh 

uitl cauinM balng separated only 1^ the common wall oT 

their raspcctiTe crypts. 

In a third «pucimen, the ineMa) siirfacf- of tlie l«(l up])er 

ceotral ia tnmed outwards, while th« ctirrestpondin^ {«rt of 



«»■».<') 




"Ife fellow tooth is tnmtd inwapda. The tmwiAl side vf the 
k'H Ut(.<ml iooiaur lies in frunl of the distal side of the cea* 
trul, nnd on lh<! opposite mdo of the jaw the mesial side uf 
the btcrul i» phtoal behind the distal side of its contiguous 
<-i>iiLrftl tooth. The cnoine and bicospid teeth bold the 
oorniiil poHitioiu 

In a fourth spacinMiii vc have an airangenutiit of leeth 
which may not nnfrequrntty be Bo.'n in the sdtitt. The 
devintinn from the nattual forui is but itUght, yet gives x very 
cbaraetetistic appearance to the uoiith. aud one which indi- 
cstca a want of actiTity in thu i,iDWtli of tbc jaw during; 

^1} tlbama OMi-ptnlUuD uf Uk IndaMa^ Tbe kfl crntnl hM tt> dihIImi 
•dfa tnTniJ «ntir4rdi. wtA the lucnt lytnf bi met ot tht dl«ut nt^. Tb* 
rl^t uraiiui IndMT kM lu dbul aide etottd. wllli Ui« bicrat pU«d 



'''•"iri^Bliw"'' 



T^^-r".)a*! 



68 



A STSTBM or OENTAI, flCBOBBT. 



chiMbood. In thin ths tlintal Ktdoi uf ifae upper oeDtraU arc 
BiigUUy eroted. wbilo the crown of ucb tooth, rtgarded m 
lt« Iflogtli, fllontA outuKnlA froiu tbe mraiao liue. UsaaU?, 
the upper and nnAll«r |Aru Kt wpanted bj a wider iQt«rT»1 
than tlio lowur purtiuDM ur tho civwd ; in ihu case the meaial 
■arfacffl ars parallel Uirougbout the wholo leni^tb ur the 
flrowna. fiuooe tho ercTHiun. 

ng.aa.0) 




Hitherto, the nilatioua of the ttsetb to each uthcrand to tfao 
jaws, havo boen ccosideted in csms where the nioxillB pccMDt 
the nonnnl ntnictiuml appearance, a* diBtingiiishKl frcrni caaea 
tn wbicii there are obTKnu Doatka of a, diseased coadilioQ of 
the l»i>c. In the Rpodtnen from which tha two succi'cding 
figures Rni tjikea, the boD« is defective both in the quautily 
aod in the quality of the tusu«. Tlio teniporarj' loiah are 
alnioet devoid of socketH, wbilo the devolupiag permanent 
teath — ia the afaaoiiM of stiKcieat bone to adtnit of tbi- 
exiatsDoe of Borntally-formed arypU — an covered at oert«n 
point* by »nft pnrta only. The suhjoct— a male — from wtiich 
the maxillip wi-re tAkcu, died cxhnustud bystnimoiwabcMse* 

(t) ShMn tbe ttavtia armtaFtiicall]' inMigtd, but nitb tbc dlMaJ tid* •! 
nab loM tarwd tll«)tUy Mtvardt, 




TBBTHIHO. 



67 



iSD bo wu Mid to bo six y«arfl did. Both iti tike upper and 
rcr jaw«, tlio tuctmrs and canines are almost without 
fkottf, and tho tiiotars have but imperrect ones. The 
■gencnU dimensions of th* jawa, even sn^^iottng th* age lo bo 
uvcrstatol tu tiuufnU'iii v( vii:,\\U.viimim%h^&.tetkthmi IwUrw 
tbo nonnal size. 'l*hu has l«d to the mal-poMtioii of th« 
pennsneul tenth. Tlie ceutral incisora of th« up|M.'r jaws are- 
of the DAial eizB and shape, alUiougb tho enamel is at 
pDinl« defective. 




The ixikinra lie with their mediaa sarfoces id cootact with 

the distal ndos of the oeutnil t««tli, leavitijf do Bpooe wbst- 

rer for the lateral incisors. Tliese are iilacod within tlio 

Dtital linn, brhind the tenipurBr}- ceniDe6(Kig. .12), lodged 

very iiiiitttfuct rryi't'S and placed at right atigltM bi their 

3pcr iKWttioa, tlio cutting edge of each tootii being directed 

itwsnb instuad tif downwards. Tlii^ tirKl[iiTmaii(riil mnlafs 

tve thvir crowns lutarly peri'i'cte<i, atul are ploccj wilb Ihe 

(1) Wnot Tk« of Ibe <ipprrja« ol a nul« ntjtt:! >tkO died at Um ■■• ef 
•U T*an> tlM>wl&B • ikf««ll'* cvndil/vii of Iht «alir «l*«elj» {i»U ani mi 
impnttti UnpUnUilDn vf tbr Inupurwr l«Vth. 



68 



1 •T8TEJI or DESTAL glTRQKBT. 



muticating surbceit diractfx] oliUquelT htckwardi, the bas« 
of the crown running over the fiingB of the nerond temporary 
molar, ttiid oucroschiiig ujxia tlie space whicb »houM be 
oocupiod hy the scooiid bicospids. 

Ths MGOnd permanent molar, the cnspe of whirh arc calci- 
HeA nmi unitoii the one to the other, ia altogetber vitbont an 
oeeeouH receptacle. 

In this upocimen we have a remarkibly good example of 




the eflectii produced froin thv dowluiuuvnt uf the mnxUllt! 
havin;; InwD i)us]>ended, wbil« that of the pennaneut tL'vtb 
was coutiuui^. We bere f<ee the ^reat iimount of diisplaco- 
iiioDt that may ariitc from the preiicQcc of loog-slanding 
coDstitutionnl diw-a.^. 

Lncsl disGuv tii the icmiwrnry Toay also afiTuct the pcrnw- 
neat t«oth; btit the efTecc will be- lim{t«d to those ia Uie 
immediate ueiy;hbnuibooO of tlm disK-ase. Caries, and oon- 
itequcDt alveolar abaceH, ari«iitg in a temporary tooth, eome- 
timos producBs injnrioun effects iiprm, and eveo displiicx'tueDt 
n{ the sut-ceediog tooth; and tide ia, 1 tliink, a mare fre- 
qacDt consequence when the disooKC is situated in the lint 

{!> Pkl«to] view ot the tpMlmen lUuMinW In Um lul Bguiv, vbowtog 
«n atinorDul eaaiUhn U ifae bout mkI Uw npugfc of Uw i^ntutiniC 




TWSTBXm. 



69 



[or »i>C0Dd umponry mol&rs, tban when th« front t«eth are 

' AETeoUMl, Ina propatation Bgurol ta illtutrate the cRIects of 

dead tMth, it may he seen that the derelopiug first 1>tcas{rid 

of the upper Jnw has been driren outwards by the miacbief 

anting from Has preaeooe of a ixai Ussnponry mular. 




Iq additJoa to thn causes aln^y enumnTa.t«d, Tnechanical 
injory of tbo nHnitiie or of th« temporary t««th, amy bo cit«d 
u producing displncemcDt uf tliu pernuuujnl ceeUi while 
lodged witbia the dental cryptK. 

Among modianiical causes, iha extraction of temporary 
tMtfa may ba placed. Wo hnve uxjst of us w«u ossmpU-s 
where reuonL of the secood tcoiporary molar bait been 

(t) Til* vvptt *ftd \ortr Jt«r* <t tti» i^ nbai the jwrauuiraiC htclMnt *ni 
•fant to apfnir Uircagli Uw goiUk abovittii; lh« MloUve poalllaD of Uw t*o 
■rtaof teoUL TV IcR Ul>^kl Ineinirof UiBa|>pcrJftwla tnparTMUrilnvclotwd, 
•nd idMid •xMTVal lA Ui" crnlnaioMbiUidUM) tint blcwpU of UiennM aide 
liH brao lliratd odtwanla T7 iMiwii. ud MbsaqjOMtt dMUt, •( Ui* fi«e*dUi| 
immf utM tj moUr. 




70 A BTSTRM or DBtTTAI. StntOKBY. 

accunipaninl hy that or tbr; parti y-formeri second bionspid, an 
aixiidont wliicli has uri&L'D «illi«r Iruiii tlw uau>tiui] converKPin:« 
of tlie rooW of the tcmporarr. or rrom the nlworption of the 
wiJIs of tlie rn'pt <if the [lernument tnotli. The laUur 
«)[Mlitiim u Dot, I think, «xtn>in«)y mniD those ca«e« where 
alveolar iboccw is ooiiMiiguonl upon (liwasiR in ttto temporary 
molar. A certain dcgrn.' ot inflamuuitory acliuu of Iho «oft 
parts in tbe iinine<liiiti.- vicinity uf huno leads Ui more or loss 
abHorption of the latter, and at the tamo time tlie fanner 
ooToc (;Iu«<l together by cfTtued lymiih. Supposing Ibese 
dilioiis (o provai], it will not be diffictdt to conceive haw, 
attvmpting tlie pxlmction uf one, biith teeth may lit- removed. 

Taking tiu: iiliiusiiw tjl dentitiitu in the ffrder i^f tlniroccur- 
rettce, the next \kAtxI which pre*cni* itself for ixmaidt-ratloa 
in thu nlvMjqjtiuu uf the rtxite uf thr ti-'iiipurury tiy.'LU. 

Shrdtliny of iht ttmp'orary tcctfi, — No souDcr w tlie tempo- 
rary »ct of tocth fully fomieti, tlum a proeowisK't tip for the 
remorol nf sumu uf it« membcra. WiLbio twolvu ur ci<;ht«eD 
mouthH of the completion of tbi- roots of the second molars 
attd canine*, thft fnngH of thi; inrisiini are attacked by 
abaorptiun. 

The de^triict ioTi may continetu.'t' on any port uf the ntot, or 
at Mivcral ti|>ot8 eimtiltaiiiKiuiily. Parlivlc after )iarticl« is by 
degreea wirricd away, until nothiiiK but iho crown of the tooth 
i« left, and cvc:i thin Ifl often ko much hollow^ out, that 
Uitlc ttTO the ctiatn'sl remaini, and sometimes not all of that. 

Although amongauumber of temporary teeth wv mnyfind 
that abtorplion ba« commenced at sercral and distant pointa, 
and not uitoomiiKinly uu Ihv labinl Kurfocfl uf tbo ruut ; yei, 
in tiie mnjorily of cosas, that part which lic« nearett to the 
growing tooth wilt Ite the first to fihow indications of waating, 
and upon which Ihu process will !« the tuont active. Tbo 
oppowd surfaces of the roots of the lower temporary molars, 
mnbcBcJng bic:iu|iidg, are at-tod upon, wbilo the outer mriJtoes 
usually escape. The liogtul siufaca of the fang of a front 
tooth is commonly attacked, the pruooM (xaununcing at 




-rarreiira. 



71 



or near Iha exlremity ■, bat the proximity of Uie ptmiflnent 
tooUi is not by aay meaoi a neocanry poioL 1 Iiilvc 
eiBxained many npefrimena, in which a portion or the Ubial 
ffur&M inidvay betwcon the neck and tlw point of the toot 
has booD carried away. 

Havii^! ktterly had oocuion to derate ooasiderabUi atten- 
tion to the pheoomena attending th? absorption of bono and 




the waiting of lh« lootn of the deciduous t«lh, aevoral con- 
ditiuoH rclutivft to abtwrpUon haw come under my notice, 
which, as applied to t«titb, had. I thinlc, tiilherto eKn[tod 
obscrvatinn. The wiucntuin is first attacfeixl, then tlw deurinc 
dinappuani, and tliu enamel at thtwc points whvn the doDtiiie 
ha« Uvn entirclr rcmoTcd suffers from the umc ootioD. But 

(1) A HOUoB tram a Utap^truj Inalb, to whkli th* il*at{M (A) Mid Ui> 
W bw boea Taiiov«d bj aliaDcptloii, InviaK Ui« tm t an m i oaU 



73 



A tenrtat of dbktal flunasBT. 



whiuhever ot tlio three tisauw » attacked, we me Uifl same 
chAncterixttc Mirfaceiu thatshomi liir booc when otvdcrgouij 
B Biuiilur action — namely a Rurfacc full oftlcpp indcatatiooB, u 
though they hjul been niadb by a sharp |)i«rc\ai: instnimeot, 
liaving a wtnkircular extremity. Tbe-ie minute hnlra or 
deinvMioiu imweed id various directions, *evera1 ulraovutg 
from ooiitnry poiDt« towsidc the §anie spot, not uofrcqtieotly 
isolabid inecos uf doitiuc If a wctiau bo taken through 
the sabfitanco of a tootli, w as to cut the wasting part 
ai a right angle, vrc nball find tba sorfaoe acted upon 




to have an tnvf^ular tostoonod ontlino, bo cbaracteriitie 
in appearance, that wlien onoa aeen it cannot fail to be agun 
reoogniaod. 

Cloacly applied to thiti aurlaoe a cellular tnass will be found, 
which in but xlifihtly odh^n^L, the wa«ti»g and groviog 
surtaoea muiily parting, nnl(»8 ihc two are held together by 
tbo trroi^ulaiities uu tLe surface uf the furnier. It witl eomo- 
timcs bflppcii that the a-Uolar mass penetrates into the 
dmtiae tlm>ut:ti a smalt opunin^ and Lh«re dilates, in wbiuh 
caee its wtlbdniv,-al becomes tnapeded. I'hiBoonditjon la now 
and then found in sectionn pre[«rcd for examination, and 

(■1 Sbon th« wmipoimil <slU *lilcli lorm Iba Mf&M oT ifca •Iwurtml 



TKin'HJJfO. 



78 



affordii B hTonmMo opportunjtf for examining the two tikSnes 
in aitv. Indffwi, wc uwy find n few oelk adlierimt to tin- but- 
EJKe of tha dentiae wboro lew deep burrovriag had occiimd. 
Dy tJio aid of tbe micrascape, the Btmctorn of tliin peciUiiir 
organ can be det«rniiQed. Tlie sutCmo is Diada uj> uf peculiar 
multifimn cells, each one being compoecd of sevenit BnalliT 
cell*, the uuuiber Voryiur; from two ur tiuoc to as mOBy as 
fnurtoen or flfi«cn. ITio form is nriablc, but c^shaped or 
spbericat Ggum arc found to prevail, aUhouKh souio few 
deriato iiom these forms, and offer a Teryatroogrcacmblanco 
to those cells descrilwd by M. Kijllikcr as luyeloid cells. 

Tb« toUtiMi thv more Bupurficiat of tJuuw c«Ux bear to tb« 
wastloK sDrfoco of the di-otal tisinca is pecuHarly InliirestinK- 
It has IncD already stated that th« enrlaoe of the poiiUU is 
closely uppliivl lo the wasting sttrface of the tooth ; and in 
favoutmble spoctmeas it may be idiuwn that lite iodividnal 
indcntatiooB corrc8|)ond to, aod are o<:cii|>ied by, these larga 
oell^. On si!VLinl (iccasioiu 1 have olitaiapd K|]«nmei)e !q 
which tlw two retaiuekl Lhvir natural |H«itioiut. I-Jtcb soni- 
cinnlar indentation in the dentine wa»i oconpied by a eon^* 
pouDd cell. Very possible in othvr covm wveral cells nuy 
take Ibe plooe of a sin^e colL IVlow tlio ituriace tiie 
papiUm is made up of urditiary iiuuleiLtud cvUh odiI Ukv nuclei, 
siniilar lo those contained in the saperfioial compound a-lU ; 
while at and near the \aso, tho tisstie asflninra the r.baia(!- 
teristicsof dereloping filirons tisaue. 

If a toDth which baa lest its fniig he earrAillv rcmnvcfl, we 
shall lirul rcmiiining iu it^ place thu gmwin); puiiillri, currc* 
cpoudiug exactly in bIm and fomi to the surfiice from which 
it has been scjuiated; and this Bejiaration may oftea bo 
effected with so littJo injnry, that no blood npjieats npon its 
surlore after the optTalion, althoutlli the organ ik highly Tas- 
cular and readily turu.(') The Hupvrticlalestvul of tlic papilla 

(■) lAforpu! ut<i Boonkt lyfcgnUed Uw fumtatem at (bt ■iMirlwnt argu), 
b«l tupponnl It csJmIhI > fltlii) n^paUt iirSI—ilila^ tlw raoU of Un tncjuntr 

iMItll. 



74 




A 8T8TKM OF OIXTAL BOBdEBt. 



will be equal lu ttutL port of tlic twuUi undvr^^uing wutc, but 
tliB extent, 08 rcgu<l« depth, Is slight ; for, as th« root of tbf 
tooth dixni^pnora, tha socket ta oontnctcd hy the deposition 
of Iwne, which fortna ftt the base of Ute ahsiirbcnt or^u as 
rapidly *» the eelLular sarfaco Gncroaclieji upon tJie tooth. 
Th« casus iu wbioh we find aa exception to this oouditioD an 
tbosf) in whii'h the iwrniniif iit ha&advanced do8c to the hngB 
of the tenipomry tooth, whnu the cnrpt contatoing the one 
oommunicattis with tho scK^kct of t)u< otJkcr, indicating that 
the rate of j^wth uf the fwrnuinonL, has been equal to if not 
greater tlian tli« fthsrirprion of tJie deciduona, organ. But 
oreu iu thuiw t^tistw wu may uccaxioaally obeerve some part 
in which the contraction of th« socket hu beco ooincidont 
with iho al)«niptiuo uf thtv ucciijmiit fan^. From the fotlow- 
Ing quotation, it does not appear that Mr. B(U observed thcw 
oonditinns : 

"It has lx>eu already Klahfd, that the permanent teeth 
during their formation are crowded togotbnr in tlm jow, by 
being placBil in a mnaller arch than they wtniltl occupy if 
regolArly placed side by side. As thp latter, however, is 
their dMtined situntion, wp find that aa soon as tbi^y an 
adraooed to & certain point of th«ir formation, snd can no 
longer be contained within the olTeuli, abiwrption takes place 
in the anterior |»riobcs of the cavitiea, hy which meniu the 
tee& are alluwod to uoine iu some tueasuro forward. In 
oooMqaencfl of tliis alMwrption it often hapiiena, that not 
only the socket of the corresponding tt-iniwrary tooth, but 
that of the tooth un each aide, is also opened to th« perma- 
nent one. Alisorption now romcnences in the root of the 
lempi>rary tooth, generally on that part ueacent its Duccessor, 
and thus goes on by de^es as the lutl«r advances, until the 
root is ctimpletoly reniovwl, the crown at length falls ofl, 
leaving room for the ^icrmaucnt tooth to unjiply iut plaoc" 

Mr. UclL, howerer, rejects the idea tlmt mere pressure of 
the one tooth against the other has anytliing to do with the 
absorption of the first set ; an opinkiQ that he would probaUf 



TKETIUKO. 



78 



l«ve expnwed even more atroojilj-, Imil be obwrrvcd the 
shallow but iivrfci't KockolH which nrv furiiii-d wbcti ttw 
tomponiy twtli aru shod lieforu ibeir suocaaBon are rewly 
to appMtr. Tliin, howevvr, mum be n rwy commoa condition, 

A*. MO) 




(!) T1>B nppCT Mid lo«(r>« of ■ tniui* (u1(|r;'< 'Ix jnr* M>1 (lit BoDlin 
«ld, ahttwlni Um laT«T of tmiv •rbkli ToniM tbo tolioat bT Lbe IwIm of tkc 
teniwmy ted m ti alto Uw fooU )u«t tmoi Bbwdied. 



rapidly as the ralhilu' surfaof i>nc| 
Tbo caws ia wliicli we doA uaaxwf 
thoie in which the pvrmancut buKuilj 
of the temporary kwlb, vhtta ths rn 
«aiiiininicat«8 with the iockci of thi 
iho nt« of "rowLb of thi* ]icrtiist]L-i]l, | 
greater tliAa tlw «li«i>rptioD of th« 

CTHIl in tbcKU CMOS W« KLOy 

in which Che ooatT»ction of the aocli 
vrith thu alisiirptlnn of thn occu|nnt 
iog (^uoULion, it dues not apiiear Uut I 
ooDditioRB : 

"It has b«ca uJruuly sUteii, thftli 
during th«ir formatinn are crowd«l I 
'beAofi |)lac«il in a BmalliH' arch than 
rc^iUtrly placed ride by ride. As 1 
their deittined sitnittion, wo find tba 
advuioed to a i-vrlkiti poiat of their 
longer be oontAincd within the nJvwili, 
in tb« anterior pftrious of the c&ritJi 
t«etb u« aUowed lu cuiuu in HOina 
oonteqaenco of thia abtorpUoa it of 
only tbo aocket of the oorn!«pondiii| 
that of the tooth on each side, in aluo 



TKBTHWO. 



75 



liflVB eipRMod even more utmnfiily, hud bo observed the 

ituUow bat iterftvt wckcU whii^li are formed when tb» 

fitempofmry hntli an nhctl licfnrr their racoctvurs »re rmiy 

lo ^jpear. Tbu>, however, miiHt be & very oomtnun cooditioD, 




- (t) ItaM^ Ml W«v>wrf •fcMMkMltfett. •(■}««■ ■nll*« HMbUM 
rBU.<ti»^*f *>>« ^•^^ •^ ^'^ '*'*^ *°'^ "*" ^>Mum a the MOkA (4 «b* 



76 




STBTBU or DBMTAL BtTBQEET. 



u I h&TD in mj own collection Mvcrnl tpocinions iUostntiog 
the point. 

The (act waa not overloiitked, 1 tlAnk, by lluntcr, altboii^ 
hia diutoriptiou is not very cIcat. He iUttea, at page 90 in 
bis " Natural liinlory of ibe Tvctb :" — " Tbo new altiooti rue 
with lh« new ivelli, and the old aiveoli Atmy in proportion 
u Oxe old tuctb tluuay ; &tid wb<m ihti first sol Ealb out, tho 
meoMding teeth are so br from b&ving destroyed by thvir 
proesuro tlic ports gainst which th^y might ho auppnsm) to 
poflh, tbat tbey are sEiU encloaed and cuverad by a complete 
bony anckct. Frnm thin we nee that tho rhango is oot 
produced by a uiecbani<:al pressure, but hy a particular 
proceu in tho ani»ml wwinjniy." 

But there is Htill a dispositioa on the part of many who are 
eotniitedwilh tho trvatmcai vf teeth, tu attribute tJieabKiriH 
tioD of the roots of the one tooth to pnuwuro ooMsloDnd by 
tba growtb of its guoocasor ; and th« deTelofanent of the 
iwrmiinetit ntay have mtikething to do with the shedding of 
the utbcr. But this does not offer a ntii^factory explanation 
^}t all the cia-utn!«tan(»ii attending tho alaturptiun of the fangs 
of tevth. In the &rBt place, we sometimes meet with cases in 
which tbe fangs of peirtianent teeth are HA coiiiplutcly ab- 
Borboi) as those of the t«iii[>orary organs. Then, t^ain, tbe 
fangR of t«ni]Kirary icH\\, wliich liav** no MicccHacim, are ah« 
abfforlxNl: and it mit uuciiuini»nly bfipiwns tbat absorption 
takes place at tcrpral points on tho fang, some of which are 
lar rciuuvcd from tlwi siiccoBBor, being ofteulinios ou the 
opposite side of tho root. Thew circumstancca*, taken with 
tbe bithcrtij ovcrlijokod lact, that with tbe waste of the torn- 
porary tooth w« have in many casei a comipondiiii; develop- 
meut (if kme within the snckot, to be removnd bofiire the 
permanent looth appears through the gum, render the pres- 
sare theory alto^t'thcr ontennble. Another condition may 
be a^ldiio»l, lending alHo ^^injit that opinion, — namely, tbat 
temporary teeth occasionally maintain thi'tr plow to the 
cselustou uf tbe puminueiit onus, which are then kept 



TKBTEINO. 



77 



withia tbe ffubstanM of the jaw, or «p{«ar in Botne lumnul 
■ition. 

lie rrUtJoiui w rcKanb time between the abw-rptkiu and 
ahcdiliiif; of lemporvy t«.«tli nmi the Bp|w«rnnc<> of tlio suc- 
ceeding prnoaoent teetli. are by tio luuans coDst«ut. In suine 
canes tlic Icmporary toeth ore thrown off two years before 
tbe oorrespcjodin}! penonnent ones cumo through the giiiti!*. 
Id otben, again, tbo octrwill replace tbcoldoQesui asmaoy 
weeks or tnn days. 

Befor* the lawa wblch regulate the abaorption of tho fangs 
of t«eth ran he fully rccognuied, a mara perfect knowledge of 
the coaditiuu attending the prooesa must be acquired. Itecent 
exanii nations hure enatiled tue to add tbe MluwitiR ajMitiitnal 
fauta huariii^ u]«a thbi Btibject to tliuse ;ilreaiiy kiiuwii. 
Wfaen the proven of absorption baft oncE! annmcTicetl, it 
appeara U> Iuitd been assumed that the aclioii wuuld he mn- 
tiuucd, with more or less rapidity, until the tix>th foils oat. 
Savb, however, ia nut constantly the case. Not only in tho 
actios of abeorption Buspcnd4.>d, bat one of development tolces 
ita |dac«. We Knii the cxcArntnd siirfaa^ wf the d4<^ntinc, 
cenMotnm, and eDauiel covered with cemeDtuni, thu Utter fol- 
lowing all tho irrejtulariticK of the former tixsucft, and eloscly 
unitm) lu tbem. (Fig. 37.) In caeca where Ibis derelupiuent is 
goiiig 00, or iu which the new lissoe is retHioed, th« tebth 
offer cnnsiderahle resititanoe when their rotnora] is attempted. 
In tboM initancei where the first leetb hare r^maiiiod, and 
tend to tlte diitpUiceDient »f the second set, thiif dupoak of 
cemcQtum will be found to exi^^t in comiderablo iiuantity. 

'iTiD dpvolopmeot (jf bone uitiu tiie uurfaco which had 
fonacrly been the uat of absDrplion, by no nioana indieBtes 
that tliD totvlli will not again be iiubject to destnictivo action. 
On the coutniry, specimens In my coUecliua aliow that the 
bone duposiud under the abuw circiimstanooa may itaelf 
become tho subject of alisotptioc, that (hiH (jruresK may bo 
■gain BHSpendod and devebjuneiit he rimowed, that the 
absorpUon uuiya/aiii take iJiv pincu ui di.'VclogimL>ut; in fact, 
wasting and reparation may altoniate until, by the 



7B 



A iTsreM OF nENTAi. smtaEST. 



pnponUpraace of tho formt^r, tLe tooth iti slicd. Id RKtion* 
of tertli dlinwing ihis pprnlinr romiilioii of devckijirnitrit, wo 
imj find upou the Kr<>witi); bune Qumiiroiu oetenl ciIIk, with 
btn ud thero H Ucimnl cull. A Hono Ucuna. sititAUKl vritli- 
in a Rsmi-circuUr iiideoULiuu iu t)i<i duDtiuv, )!^vEtt Lbu ■(>• 
pcaratKC of a Ucunal cell, and & Ucuna BtmiUrly situated in 

no. 31. (t) 




the oemeDtuiii (n elrcunistaocc of common «c<'iirn>nec), hu 
pginbly bi'cii 6U|I[kmk'iJ by &Ir. J. Salter Ut Ik.- what has been 
dMcrihfxl in l\w. paper U^fttrc rcfurrvd to u a lacuual wll.(*) 

The part ofatooth whirh haa the greateat power of resistioj; 
alnuriilifitiisthatwhiJiiAiti iratD«ltate contact with the piilp. 

(1) A KcOim Inm iba boc of * tootli in wMeli tbt dmUM (u) t^a bMU 
rvRMTHl, locclhtr frtift the eemenua (eX add u«ln nad« fixid by tb* Aep^ 
rilktt «f DeneDMiD. Tbe tppeuaaee prNfCiM at UKiuiMlciD t<f UmAhu 
Um •Md aRMMun, ikbere AtNoriKton ba* out «DavMcbod upon ilw llMnca 
U tbat pcdul, U thawji A (ft). Tba nrred invgnlkr llna In Ow nuwnWB 
taidlcato tlw rxlviA ut aliairpUon *I rarloiM pbrlodf^ uul Um hounduln of ill* 
tktaa Kbhb I m rrptsml lh<' l<Mt pUU. 

(Tt Tmnctkinaur tlivKthukj^citlHatirtr, ful ■!, p. 14). 



TKBTHntO. 



79 



rWe 6nd exAmplcs in which % thin shell of dentine encirclet 
tliAt orgAD. while »U uwuid it baa boea iu grv^t part tuXen 
Kway. 'litis i», liowsver, orentuaUy mnorert, and th« potp 
itiiuir cbangos iu clmnicUT, and bccomea mi ftbM)rbail or^au, 
or timb«a way fur that wliicli Is. la a fortuoaU MleotioD we 
Riayfind Mctioni showing in onepArt dcntin« which has been 




(■} A. MMltM tmn * UMfnry VnHb, lb* Cut^. ....icU bavn bero 

•bmtat, uitf Iba ooon b»Uu<rt<] out ; Uit dbumI k4vtn9 tiwii pwil; kamtvL 
Htl Mb tiMBn «BaM ■>>'* "''b ix^ (mirnlnm. a, Um dtniinei A, lk« 
ownrit e, Hie samwiu ; <t. it* JokUui of tfte «te>it«<l wrIbM of lk( 
wyt wil iii«ir cuBMUiUB. 



8D 



A 8T8TKX or DBTTAL flTItOBBT. 



but KoenUy fonn<^, wjtb iM nodular outline aucl ooutif^ious 
celli capable of dcTclopiiig dcotine; Iq nuother piirt, nUinrp- 
tion in acUvo pro^rcM; iiml in u thin], tlie deptuitioD or 
bone OQ the surface of tlie waslol ileiitine. In tio iosUnce, 
howpvpr, harp I seim dentine d(<posit<^ upon the 9Ur£u« of 
lliat which hm L^ea diniiaijiheJ by absur|>Liuti. 

It woiihl ap]>cJir ihat tl»e dentinal pulp, althcngh iU faac- 
tioa miLV Im cluiiii^iHi into that of iib*i<ir{itioti, or iU jilaoc be 
tekca by an abeorbcDl or|^, and this, again, changed to one 
for tfao liDVt'IwjjiDfiil (if iMUf, is iuca^ublG of msinuing nndflr 
any recognised circumstances its primary function of dtnlinal 
dirrelnptiK-'nt, In nthvr wtfnla, that a jK-rtion of li^-nttuc when 
removed by abaorptiou, cannot be replacenl; whilo in hone, 
or Cf-mcntiim, the renewal uf a lost portion la of Jre(]UCDt 
occurrence. 

It will he seen Hint the. foregoing facts bear n^wu the 
opiiiiouii advaaccd by Atr. De Morgiui and myRclf, in the 
pa]icr on tlio Ktructuro and development of bcme beforo cital ; 
that we have indicaiiniui in toetli, a» in bono, of altcmationg 
of removal and of depoHtion of liasut. In the yoiini subject, 
the devolopmciic of bouu tiwuu is in t^xcaa of absorption, 
allowiog the licnes tu increase iu sixe; iji uiiddle lif<^' the two 
powers, under ordinnry circumstanrca, bftbiDC« «ftCh other, 
and the \n>u&« preiwrvu their fidnlt diiuiiUBions ; wMls Iii old 
a^ ilis absorbent action api)e-ar!( to prrpoiitl«rate. Coa* 
ditjonft {wetty urarly jiartillcl olvut in Che dental tiHtae* after 
iho t«iiipf)rary tooth ha* bwn fully fomiwl; portions of ce> 
tueutum Are rciiiuvnl, and with Ihciii, in mntie oisps, a little 
dentino; tho lost porta are replaced by cemenlutn, and the 
UMth ih :ii:atn ]«rfec[. Whun the time upprnach^a for shed- 
ding the teeth, the ttro actions alternate; but the abeorpliL'u 
being ill iixceaa of the drnfelopTiicnt, tho tifsiiea disappear, 
oud the tooth is abed. After the foruintiun uf the {wnuantnt 
t«Cth wo have occasional alteruations of tho two actiotts ; but 
tiiey are balanced, and neichur incrmse mir diminution ia 
size ia obaervcd. But aa ago comes on, ft ofWn Lappeui that 



TBETHIKO. 



81 



^^I^^^^Bh h in eKcesK, the bngs iliminish in siuj, the tocih 
tMOUM loo*^ and eventa&lly f^ ouU 

The normal ■hedtling ol' orw or more of tho t«inpumry 

teeth is, liawever, RuneLinuw Bubjwt to iuIcrni|iiiou. Tlio 

^— abat>r{AicRi of tbe roots is suspeiKlnl, niid Ibc tvotli boliis i1« 

^M plica, while its mcccswir is nmlunxl witlitii Lliu juw in Eonio 

^ ucuftual positioQ ; or the iwrmADcnt tontli may be alto^tlief 

uauting. It ianot uiiontiitnnii tu Qml Uio tuinixirnry itHTJsiini 

finnly imi>lAnteid,wiU] thc[wnnaneQt teeth a[^«aring throai;h 

the ^m lK?ltiii(] thmn. In instamzeaof this kinil it is iliiE- 

«ult tu li^cvnutiie whether or not ttic permaiioDt t«oth vref« 

[dtnTioiml ill n ix.-rf<MLly Dorinal jxMtitinn, lunl Hu'ir pusiliun 

|<abMquoi)tly changed by Uw |#i>istL-nci! uf iLv milk uvrb 

i]H9(|tiijut on the Rrreat orabaKirittiuu.'jr wUt'ilirr thv R'lutivo 

l^iMitiuD of the two upls has been fmm Lbe fimt irregiihir. 

Jodgiag fcom thv oonditioDS pru«cQtctl in my own Bpecimena. 

I should iodine to the ornniaii that Uie prewDCO of ilit; 

^-fiB^lpOfV7 teeth ia in soch cases dus to aame extent tu 

rig^oal nmlpoHitiun of Uie developing permanent of>^iis. 

ay inatanoefl in which the second tflni|x>rary molar* have 

'Ixien retained tintil Uie middle perii^tl i>f life hoH ixuiiuh), liave 

come uiKivr my ooUoe. The second bicuspid has been uiuiU- 

Iing, tn.it he icraporary tooth has retained its origiiuil pwitiwu 
The inllueuoe of tliv TirKt luid sucoiid euta of teeth uixm 
4ach other at the time of replacement is ao constant, and so 
ivaricd in cliancter, tliat it li«oomcs iiupobsilile to tmt fnlly 
«r all that rehitca to the disaiipearauco of tho one, prior to 
entering upon the reUtions of tho other. It will iherefurc 
be couveiiicut to revert to sevi-ral points coanocled with thv 
. aheddins; of the temptjniT^' (and Cffpcctnlly those rclntiti^ to 
^^ trcatmfitt), in connection with the eruption audorraagoiuent 
^■of ilto pertnanent taetb. 

^H Before we dismiss the siiTij«ct of a1)sorption, n fuw lines 

^Fsnay be devoted to tho considemtion of the manner in which 

tfacahiKirbcDt nrfi;&a iftdcvuluped, and of lli« CiMiictt fioni wbich 

tU'iaes ; both are puinta of ffoit physiological interest. 





62 



A BTSTEM or DEBTTAL lUROEfiT. 



In a paper read before the Odtmtoh^ical Society, Mr. 
Stieoce bat« advanced the oiaiuod that the outer vurfaoe td 
the vnaniol organ uvomed an iocnewd degree of rasculanty, 
aod took u|xni itMir tbo uffico of afamrption. If oiir Dbserv»> 
tionK wer« ronricwd to the pheDorocoon as U i« nsunlly pre- 
MDtnl iu tbv tmipuTVT Diuliirs, this ujituiuD tuiglitf jicrluipe, 
he tnaintMinM ; but whcQ vp 6iid abaorptioR comaeocod uid 
ci>nliiiiHf) u(ion the liihial surfaces of the front leetli, when 
DO coamcl oi^an exists; and when wo find a number of 
appriioens in which a Inyer nf Imne nerpanited the (lerelo]4ng 
tooth from the one uodergoiiig abiorptioti, counderabte douH 
is thrown npon tlie acouincy of Ur, Hate's Tiewii. .Uc, bow'< 
ever, coniideri the forgoing u «xeei)tlaiial cut*, and rogiarda 
them as abDormal. Any vascular tisane, flU Bssiuuiug an 
inoraued degroe of Tascularity, may, he coofiden^ exardM 
the foDctioQ of aboorpiion. But the wasting (^ the fiuiga of 
permanent teeth, togellivr with the cUsa of oases cited aborek 
ho rti^iardfi an jnatancos of abaonaal action, tbe abeorptica 
beinjf perfunned by the peridental meiobmoo, the vascukrity 
of which has been Increased by irritation at the same tine 
that it lias beroiue detached frum the surface of the tooth. 
Tlic admimioQ of thia distinction into normal and abnormal 
abR>ri>tion, in respect to the rcmoral of the timaHS of tem- 
porary teeth, will not, I think, help us lo a better compre- 
hension of the subject ; for in the una case we caunol knrnv 
when the nctioo baa commeooed on a part distant ttom the 
enamet organ until the tooth hiui been rnnovnl, uid in th« 
other the septum i>( butiu cumiut be rvcugniaed but by 
disaection. Hut Ibu uui^t i»Ul ubjiiciiun of all to stich a far- 
fetched s:ippo«itlon Is, that at the period when absorption of 
the iku^ of the tempurur)' tooth is g^ng on with the ulniuet 
activity, tbe eniuuel organ «<f itA tnicoeiaor has not only Ic 
ceased to be vascular, biit lia-i in lurMi iiiAtanoea actually < 
to exist, the external epilliulm uf thu I'liamL'l organ hai 
becomo inseiiarably attached to the surface of the enameL 

AU recent obeervi-re will, I think, Bdiuil that the dental 




TEKmilK). 



88 



tissues are removed througli the Agency of a growiog 
fttpilln, ntul [ do not Uiink a tliJTcrence of strnc^nro or fimc- 
tion. nireraUa to the particaUr tissue trom which it may 
liAvr ariaeii, can bv e«t»lilisliwl, Wiivlhcr the (idviOoptnenC 
talies pUoe from the cnAmel capAulfi or from the peri^critnl 
DiembraiK, ibe strnctuK and thv function of tli« pnpilln will 
be the B&cia The pretuae iinlure of thu actioD hy wliirh 
the Cflts cat ftwny the hird tooth stnictnreN still reniains 
n nmltiT of i^rcal uiu.vrtaitity. Kehrer, htiviii<; olwcireil 
chalk granule's in the proto[i!iuiin of yowng cell*, bolieves 
that the anuehoid cells of the gratiiiUitinns dpHtrxiy the 
duutal tissue by i kind of niiniajt pniccMS olIect«d by clieir 
pwndopodia. (Waldcyer, in Strieker's Hoiotn ftod Com- 
parative Biatulcf^.) 

lu a paper published in the ** Philosophical TransactioDB," 
Mtne of tlte faregt^t^ hiclB are descrilwd in connection irith 
the absorption of booe, and aa optuioa v&n adruocvd, tn the 
effect thai the nlvinrlM'ot nrgan grow at the cxpmac of the 
vriutin){ bcmv ur dnitil tiHaui% atttho case may be. At tlint 
time the peculiar chanwrt^r cf the Bupi-rticial comfHinnd cells, 
and their cofTOSpondencu to aad lodgment in the niiiintti 
coDcaritiea of the woating tixinie, liad not been obwrred. 
B«t when it is considered thnt ihe dt^ntnt tiwiie i» dccreoslti]:^ 
wbU« Ibo oompouiid or mother cells (as they have bven 
call«l) ore iiicmsing, and that the convoxitics of the Uf tor 
are fitted int'> the concavitica of the former, we are irresi»liblr 
led, not only to the conclusion that the growiw-; ]iapilln is 
tiie absorbent or^au, hut aIxo to the lielief Uial iLl' ttujit'rfiL'ial 
COapODnd cells are the imm4><lintc ofsonts hV which the 
tiMOBS arc rnmoTtHl, and tlml the poculiar Eiirtare presented 
by either hone or dental tissues, is secondary to, and |*roducvd 
hy the ccIIh which form the aurface of tht> pipilln. 

Perhaps llr. Spencc Bate might be ri[;ht wltv he to aseert 
Ihat the outer Borlfict< of the cupmilo of the dcvclt^ing pcr- 
atanent tooth, may tjecome the «cat of thv vasaibir stnicl nre 
trbioh fulfils the office of Bb«or]>tion. Uut 1 am unwilling to 



81 



A BITBTCM VT DOTAL 8VR0RRT. 



SKlmit Uiftt & eiiiiUar titrucmrc arUi^j; in c>tber pAru and 
under other cinnmititiiticm, is h> be icRarded ae abiioniuU. 
Supposing the diBtinctioa to hold gfxA, ve must ngMiA the 
notion l>y whirl! Inne is !it all iHiriods of Win rerDovul, jinur 
to the deTciopmciit of new tineue, na tn abnomial process, 
and tilao tito correfl]M)n<Jing changes vhioh go on in Uio 
ceiuvutum ctotliiiig tlio ro<>t« of peruutaeat xveih. It wonid 
apjM'ar mtbiT, th«t wht'rever tlie neooolty for the reino%TU of 
iwttooiu tiasuo amcM, tlia Ktructurc ^afHible uf fiiliilliiis tlie 
o(B<Mi is (lurvln|)CiJ. anil in » vtut iitituL>or uf cawa (|uiie in- 
dopoideiitly a[ abnornuil aotion, and tliat tha Mat of Um 
developmout may be in any vswutar atmctnro. 

Th« oI'Mrratiuns at prownt at our tlUpoital are not suffi- 
citaitly nunioroiw and variad to ndcait of the deductjoa of 
aiiy genenl Iav, ah rcgfirdn the power hy whirJi alworption of 
one tiastw by another in effected. But I thinlt they point 
utitjiigly to the )<icu, titat u c^ull Ktruvluro in an M'live Btato 
of devclopntOQl, ia capable of appiopriatiug or removing oat 
uf ita way a mntured tUsuo. 

Vu truption o/the ftnnanent tffth. — Attention boa alnady 
beeo dirwtod to the cbaitgai In the cinulitioti uf thu alretdar 
prooQues antwudent to tbe eruptiou of the temporary teeth. 
Very timilar conditionK prornil when the pcrmaneat orgftna 
are about to nuike their appuorancu tbruugU tba K^uua. It 

^bax been ebown that absoqitiinii of the alreoUr margin of tbe 
BketH Qf the firel teeth is not neci'ssarily coincident with 

'tlie removftl of their roots, but that tho o])po»tte xundition 
reiy coinuiuiilyobtJiiaii; Lbat abeurption of tlio dental ti^mes 
may Iw accompanied by dcvelfipmont of osseoua stniotnie. 
Wiicn, howcTor, tbe permanent tooth U rcaily to cracigo 
Irom ita bony coll, absorption io ognin set up, and in tbia 
case the bone which lie* over the crown of the growing toaib 
is attacked. The coronal portion of tbe cn-pt Is ealai^«d, 
uad the outer nlreoUr plalc cmAC^inated in the manner 
wbicl) we bare swa [ntxviiai the evolution vi ttie len)[>uniry 
sooth. The apcrtoro becomes enlarged tmtil the cromi of 



TEETHIKO. 



B5 



he tooCli out nsdily p^u tltruiigli. The companUvel.r Inrxn 
or fli« ctowD $» compnfM with th* neck or tho root of a 
Itiwjtli, uocuBitatM & brculth of Mtckel, iliiriiij; ihv in-t^h) hiiili 
[or dr\-c1opiii«at aod of evolution, fur ]!n!iitcr than is requirod 
ifor tliD inifilHtilatiuQ vi tho fiilly-eiuiTgud or^an. Htiicw g 
Ab At ibi* »U3^> of its pTogna* am be rva^lily oiorcd from 
■iile to siilp hy mndernle prrMiire, hiuI very Blig;ht lucchniiJcnl 
JL-tiua will turn iL eitber into or out of iLs Dormal 
tttMK Th<' presence even of a stnaW portvm ot Ute root of 
inupnrftry tnolli will Iw siitBciuut to chunge ite direction; 
lii'I on the other han<l, tLu HctioQ of the tou^e on thu lip* 
' will suffice tu bring tJi« out-gronnng urgau iutu its natural 
)XMitu>i(, if thu Jmpedjmnii U- rrntovtrd during the \xn<A of 
>uti»« eruption. The cou'litioQ to which I biva alluded in 
3WU in the tuUrgod ulvrnlnr K])ertures of the first pcr- 
iiiau<-i)t rtidUr tctlh in I'ii.. itii, aikil will Uv teeu in ooudi-c- 
tioF). T-ilh other pemtanciit t4>*'ih tunning the subject of 
It illuKtmliuns. 
mioD Tor > tooth to t«ko it« proper ptseo, dtHplaye<1 
Uw grtttUy widcuod socket at the period of crtiptUm, 
)ld bowfver bo fnvuffident if tho whole of the front teeth 
nlmionl towards their allimaUi |»«itioii Biinulluuisonsly. It 
'hu been tbown that the crowua, while wiihia the jaw«, an 
I nwwMBrily placed in an uneven line, aii<i this im^ilarity 
H '' ' 'tno pemmnBDt if all were to make thoir appeamnce 

^^ I ' he iriinit at the mdm time. Bat, althotigh the jann 

^Lu Um afj;i' of &v» ur aix years do not alTord NtilltrienC spttCB 
^Ffjr the imif irni amngemoiit of the crowtu of the dorelopinj; 
teeih, yet there would bo ample roont for the roota oftbcfw 
^ieeth tu bo placed in an tma Uoo. It haa been Rlatn] that 
^■be emwiu of the rnmiinf; teelh are inclinol alifchtly uut- 
^HHdn, arui that tJie growth of the alveolar aivh is princiinlty 
^^HBbikl U) the free edge* and the ooter mirfncc. [lone is 
^ftCm vxteriinlly. while it is being reiitvrwl fmiu tho inner 
■rypl to all(jw*[iace for llie increasing tof*ih, 
it that the tuotb ia inuvud bodily ^tw&^i. 



B$ A BTBTXM or BBHTAL SUBOKftT. 

If adult spwimend in which the teeth kbA jaws urn wet 
fumityl, Ui L-xHiuiuHtl, tt will Im fouud tli&t gTX>wlh in thb 
(liri>ctu)n iadicAtcd baa Wen continued until the jnrts Jultq 
arrivud at maturity. In tlic ailult tbo crowtu vi itic fruut 
t«etb ore pUced in adTanoe of the baee of the dom ; in the 
chiLd they arc in a line vertiail to it : and if we mussiu-D the 
ellipso fomied hy the anterior nirboe of tha upper jav in * 
borlxonul Hue with the iBst'Dsrned point, ettandiog on 
either tudu t<; tlic Kcond bicuspids, luid Uieo api^y tho 
meuurc to the corresponding part in an stdult, or in mi 
edt-ntuluuH uM porsou, wo shall Had thu result tii each caso 
very nearly similar. In tracing the permanent t«etb as th«y 
are rcspectimly protraded and tako their poHtlioa in tho 
dental arch, it is desirable tii bear the foregoing points in 
jmni. In certain cases we shall find mischief arieea £rom 
want of growth in the facial hones at tha earlier periods of 
life, but in many inftaaccs the deriatious from the normal 
pOHitioo of tho teeth and &lv<jali aru iudupciideiit uf insutHneat 
size of the bodies of tbu uiuxillffi ; or iu other wordn, casett in 
which tlie haaal line ba» attainod its usual extent, while th* 
leetL are irregularly placed iu an irregnlarly-fumied arch. 

It it D«ce«8Jiry to draw a dUUnction between tho bodies of 
the maxillas and the nUcdar prooeoses, aii it will eubsixiuently 
be ibown that in cases of irregular dentition, tho irrcgubrity 
may depend upuii a want uf aucunlanui! bt-twnni tlie general 
dimeosions of the jaws and the determined size of the t«cth ; 
or the mal -arrangement may dojwnd uilely upon imperfect 
derelopment, io respect to ixwilion, of the teoCh and the 
alveoli. 

In dtwcribing the evolution of the tcvlb iudiridnally, and 
the coincident oonditlona, tho chroaolt^cal order iu which 
they osnally appuai will be followed. 

The firnt pennantmt molar of the upper not uncommonly 
preoedea by a few weeks the corr£«pondJii|{ tooth of the lo^rer 
Jaw; but I do not know that, tn respect to prinriCy, any |?n»t 
ontfurmity prcvatU. Tbo couditjons proacnted by these t«cth 




Tswrauta. 



87 



•t the K^ of Hryuin and fire mo»Oa,MTe abowD iu fig. 3ti. 
In th« iiptwr jaw, the bono which lay o%-or aoil (jn>t«cte4 tha 
tooth at ao earlier o^ in entirely roounred, nut only fmta tha 
oofunal ntrbce, b»t alao to a great exteni from tho bbial litle 
nf the crypt ; aod thi» bax taken place prior bo the tooth hcing 
raiwd aUiiro the gumral levfll of the alroolar maigiu. It is 
DOW, boweritT, in a condition for raplii (lav«lopDieDt of ihc 
fiuign, and two or threo inonlha would hare aerred to brtog 
it lo th« Hurfiwx of the goou. Ou removing odo of th« tec-th 
fniui Lbo ujiper jaw, tho routs, allhuugh vmy shurt ouil 
iiDperfccli aro accn to have their res|xctiTc positions dc&ncd, 
tbu noutt of tha tuoth l»ing perfectoL Hm enamel has al- 
i talned it0 maximDm UiickocM, and is deficient only tn dcusitj'. 
At the a^ onder crnifeidpfation, the Rrst. mniarB occupy 
tho poaterior part of th« alr«oUr arch, th« aeooDd molar in 
I the npper bring ooafiii«d to the back i«rt of tha tbbcroaily, 
mod in the lover jaw to an excavatioa benuath the base of 
thfl ooroDoid {Koceas, 

In a specimeo ohtAined from a female subject ^ed sevta 
yeitn, tbc firat mdan hare gained the lord of the temporary 
teeth, although the laugs are at {treaent very short and 
tniacai«d at their a« y«t iooompleto eikda ; each fang has ita 
owB well-deGoed aooket, lUu depth of which Is cqiuU Iu the 
length of the deroloping root. If a tooth be extracted before 
dacompoaitiuD has oiimiuencud, it will be found ttint tliD fur- 
iMtiTA palp Is contained within the large and open cavity 
kof the £utg, pcnJBctii^ only in a very di^bt degnse from the 
t Htrentity. It looks as though it had beeo cut off on a level 
[with tha Old of the mot, so abrupt aitd flat la the t«miina- 
Uon of the aoA ttasoe. Wer« it otherwise, prcasnre upon tho 
tnaniicating surface of the hwlh wmild produce ctim|ire(>fiioii 
uf tha pulp, as tbo socket luu oot yet cootnictfd to the 
4iliMMiooi of the tooth, and thi' septa of bone which cven- 
Uially riao batwecn the roota, kre not sufficiently developed 
to take the prDsmv, and thus relieve the roota from being 
dfitan agatiut tha bottom of the socktit. 



98 A srttTEU OF UKNTJIL BDBGBBT. 

In the acKMupanyinx figure (Fig. S9), Ihe nralv of Urt 
rizht IS in adruice oT the cormpdudiag tooth of the opi>oaite 
t,\dc of the jnw. On the ono side ths tooth batl appouvd 
thrciii(ih t!ie giim, whtlt* on theothor the surfiicc of the tuucooi 
lUbuihrauu bad not U*o piorcwl, Tlic iKwiliuD of the t<e«wl 
nolAT U iuUkatwl by tli« ut«n»k. In the sp«ciniOD prorioiul^ 
described, the Qnit mulurs tm-uiiiud the lannioKl purtian of 




tlic Alvfolltr arch; io the prc-ftcut ciuc n nmnll ninouiil of 
tpHcc [lOBlvriur tu them is gninvd. uu«:l the aecoaJ muhirs, 
jphich wort pUcwl nt the lack part of the tuhurosity and 
dincti-xl hackwardK, are ouw doec^oidiag iuto the dnital line, 
and iirv dircctnl ohli<}ticly downwArds luid InKku-ardi). 

In the 6)iu:uuiuiH which hnre \ieen dcRcriUed, thi> new teeth 
in thtir iiiipiantixl portivns arc finite oyBftl lo the depth of 
the 6»>okel.'i, tlie botttJins orwhk-h remh in the iipi>er jaw to 
the floor of the tintriim, and in the lower imixillii to the 
inferior donlAl cnnai. TLU Icuvus nu ruuiii fur ^[lowih iii thti 

(!) SiMwtiig ilie noMltitnn nt tlw itvmlnti uf t)v nm ptrmantnt ixiUrtt 
(tw lunr Uie tmifa is »l%«ndTi( i" tbe lurAice at ihr Runi. Tli* [ooth ca lb* 
rtflii tlil^ U * lltilr In wlvaDco rif iliU «d tbt Ml Mt of thf ntoeili. "Tba 
trjpt ol Uie toxoa |icniuanu UttUr. 



teethikq. 



B9 



dircrtion t( the deeper para. Tb« tDcrcfl«ine IcDpcti nf cacl) 
toolb iQiut tfaerelbn> be acc«nn|«ni«tl hr mi iiKTt-aevil dv|i(li 
of Hockei prodocwJ by atlJitioa of btme lo the free margin 
of the alveijltis. 

The devoIopmoQt pri>ct«<l8 r&pi<lljr UDtU Ibt oppDRiDg 
u»th come ui cunUict, when thv Butn^'m'*™ becomus (mJ- 
justc^l, a pTDccH vhich is rendered «»>' hj tbo cumparalirel; 
loi^o tmpUQlatioD vf lliv Iveth. 

Tlie Iceth whirK iiitually succeed the Gnt permanmt 




molsn ill ttie otAer of ctiKTgfnce, are llic central inc-iMirB oJT 
Ihft b3w*r jaw. After tho teropomry wntnil incitKirti hnvf 
I»en ilw<l, nl)«tr[itioa of the corrrajiondii^,' wlgtw of the 
alTOoli conun^ocM, and cotninoDly carries awuy the outer 

ft) 8h»w* tlie rrtttlw |iMllkaof (be t*ro*c(« of terih.uiil ibo A)M>rT>ilDTi 
ti ilu> loMfor jlMf if Um alvtvll of tb« Ivmr troiml latlMm BatMrfirMl 
lo tbri/ ettOigUiiM. la lh« Upp« >tw ilir roou ut Um Itin^jnrj UicIum 
b>rt bNH tvmvwL Mid •hwJTpUtiii <ir th« tiH» ot Iht aItk^us ot Uw left 
wntnl iBdfM- hM nKDBHDoMl. Il will te> m« Uwt ihn drpUi ut tint al^Mll 
41 flila join b fi|«I to ttit Ivngiii of ib* tovitapbif tMih. 



90 A STflTRW OP DBITTAL SUBOKBr. 

pl&te to a cnnsideraUe depth. Tlie condition it ehoinx in 
Pig. '10; in thii cose the wliote oi thti booo which lay in 
front of tho crowns of the aev t«eth has been absorbeil. In 
othvr umtUQcus the vrustu luay he nitliur lu^ire limited, but in 
all CUM the depth of the jaw becomes dimioULed at the 
points correx pan ding U* the toutb, which nra nlKiut to advanco 
from their obmuus crypts to th« eurlkce of the gtmin. Tho 
IKwtcriar alvoolur pliile, althouf^h diminished in height, 
usually imfferEi in a much Ivw drgroc thiin tlie outer surfaco 
cf the jaw, and conwuuenlly offers a lesu brokflii outline tlian 
that Khowu ill tJiu lii>it figure. If tho Rpociiuuu under con- 
xidcnitiou be corDpari.>l ^ith an ftdult jaw from which tho 
uutur alveulnr pinto iiiM Ik'cii removed, it will he seen that 
tho terminatioas of the two advancing inciMta hold the 
poBition which the endii of tho routa of the fully formed 
coiTMponding teeth occupy. 

The wnditians whicli have befin dGscribecI M pertaining to 
the erujition of th« lower ceutml iuL-isurs, will bo found u> 
accompany tho solution of the upper central teeth; tho 
amount of buae rtmovwl by ubsurptii>u varying with the 
fxiaitioQ and flize of tbo t««lh. It is, howv\-er, by no lucans 
easy to obtain sp«cimen.i of tho n^ roqnireii to iliustmU- the 
changes nttcndunt upou the eruption of the jteruiauont teitth. 
The dealers do cot npiKnr to regard thfin as aak-Me, and 
they can be acquired fraui other wjuicca only at uncertain 
imcrmJg. 

The sabjiact (a female) from which the following figure has 
been taktiiu died at the age of seven years and eight monthir. 
The central inciMjra Imve enwrgetl from the ulruuti to the 
extt-'ut of about two-thirds of ibt length of their cronns, tlie 
right being a little in advance of ita felluw ^Mth. The 
reepcclivo alvooUr apertures are grwtly enlarged, allowing 
Ibe teeth to be mored either outwards or inwardit. 

la this instance, the jaw ia rather coutracted in size, and 
the new teeth, in the abscnoe of the temporary latembi, tuivo 
their distal sides situatcl but a short diHiaaco from the 



I 



TErTBINO. 



91 



«uuaei, luvtBg ui«uffici«iit 8pac« t^a tlie penuaneDt Ut«Tal 
teetit, nijiporing the preaent }^i08itioD of the centrnta to he 
miifitftlnfpt. Bui tho provbiou aCTunled for oiljiuUueut by 
the «Bhrsed aockvt^, will olluw tlic crowas of the tceib lu 




uk« a man Cbrwvd pontioD, which, ae thi-.r deacend obli<iu«ly 
oatwartb, mil Iw ■till farther uK^reawMl when the te«ih have 
alUittoJ their full lougtli. And thus Uiv Biwce, at pKoent 
too limiied for th« ikvidaI trruigemeat of the iMigfabouring 
tMth, will arentnftUr boooDis lufikueatlir extended. 

Tbe pbcn um e D * whkh h«v« heea deacribed m 4tteQdii)g 
the erupUoQ of the ceutral inciaor, an repetted wfaeo the 
btenl teeth Are irotriided. Thtas ue, however, t>iibjocC to 
■B t&flueEioe u rcgwdi ih«ir poeilioD, from which the central 
inciean en ezompL The caninee ere at this perind far 
ttlvucod in development, and their Large, rounded. tn««ial 

(■} tlpywii'* ot> hmtlt witjtnl w<w jmw mi lifct ewnito pH. «hif Ing 
At aatnl ta*>n uktai iMr plaw la tkt ilvnlar anh. Tke rtRfet tuaili 
InrJI Hhn-il Inmlin Irfl h^ ■ imii tariTJ in in iiti Tlw tlVTaliw ofwdi 
h Imvv (bwi te wMilMe taod^ rf M«f (fMi fcr iki uath i» mbwm • 
tpuetfao. 



SiS 



A eVITEU or DEVTAL BTBOSBT. 



■idM aot uriffwjucntly inlcrfrrf with the nfpprtinn of lbs 
wot* of the latoral t<cth, awl thiis tend to turn the crowns uf 
the t««Lb i>nt of their natnral ^nsilion^an evil which is 
tuiully remixliod hy the further de»ccQt of the caninot 
toniudB tbfl alvccilnr tnarB^n. The iiontml [iDftitioQ vf the 
iaclhon htler falUog ioto Uae, ia Ehon-ti iti Fik- 42. 




Taking what may It regaixkii a* tlie tK-rmal order of 
eru[iiioD, the Hmt hii^usjiiiU will h»vcco<1 ilic latenU inctbors. 
If Fig. 40 be examined, it may bo seen tti&t the cuirn distal 
side of the crown of the uupcr canine Ues u|>uii the mvsial 
side of ihc neck of tlie finit l>iriiNi>iil, and ncccKxitativ the 
flattened or grooved Rurface whirb characterbcs that [nrt 
of the tonfh, whtio the ditslal oidi* of the tooth is oimilnrly 
luflui^ncftd (although in a lew degreff) by the wrond bi- 
cUKpid. 

AJler the fint Iwcniipid bu taken its position, the canine* 
are the next tu acipusir in the line of the crnptcd tevth. The 



I 



(0 Sfaowliit Uw |itniiAn«iit cmirml and LUrnI tadnn tn Ibrlr ngmwl 
ptitlMi la Uk ilonUJ anli, n LOt tlii: nnlne tad litcu*pld* wllliUi Uie Ji*. 



A 



k 



TEBTBinO. 



93 



Appeftnuces presented hj tlu t«eth in a fsToorable spednita 
on shuwn in Pig. 43. 




AAi-r iJio oaititMA, tho Rcconil bicaspfbt nppcwr thmiigh iho 
gnnui,Botl make up tht* fiill wtuplnncub of tixam whiuh huvn 
been preceded by t«rapor»ry Uxth. The preceding raay liB 

t looked upon as the natiiiul [irdcr in which thi< first pennaiicnL 
lOoUfs, and th« t4>elli anU-rior to them, apjicar; but this 
order a fr«iucntly suhveiuai, and in very many cnflc» witli- 
uut entuiUng any evil roui»«qucuc«s. It w-itl, howoi-cr, bu 
convenient to conxiilvr nil thv ilt-vLiOions froui iJiat which la 
Kgarded as the nonnal orlcr, under oua general lieading, 
aA«T the evolution of the Bt-caiid pemiaoent nurior has bean 
oonaidenx], and aft«r the ciiangcs in the rorm and siae (rf 

(I) faunrlDE itiE dmtlUnu td the fnwtnmi UwUi 4fter Uh cmfrtlan of 
UwcaDtun; Id Um! a))|Kr><r, t Ik woo nil blcuqad. 



94 



& 8YBTKM OF DENTAL SUBaBbT. 



Hu )tws coincident wttli tbe eniptiuu of the |wnnanent tsotb] 
have boeo trocod. 

S«twim tiu ag9 <^ htrlve and thirtttn yeart, the second 

permBnont moUrs adruice towanln the Riirfaco of th« Koms, 

their Advance being •ocompuucd by alveolar cbanecti liimilar 

..to thoM which hu'o been dcwribr^l in c-onneictinii with the 

noe of other t««!th. Ai tliU time the crypts for the 

third moIftTA hold tlie positiouB which thow.- for tbo wcond 

molar* held when the firet molars emerged from their bony 

celU, and occnpiwl tbo terminal portion of the nlviyjUir tmot. 

ir the luoutli U) exauiined iiumediiibely after the eruption 

of the second rnolnrs ttio dental arches will appear fully 

uccnpicd. In Lhu luwer jaw, a tuoth on either »tde will be 

placed close to the hoM of the coronold processes, nod in the 

upppr muxilla at the extremitiex of the alveolar portion of 

the ktiie. But by the time the patjcnl has reached the 

tixtetnth tir ttptmtitth yenr, tbe jnwi* will have Im^ened^ 

posteriorly to au extent ttuflicient for four newt«etli to' 

[jtake tlieir resiivctive positions in the drntal arches. Under 

ftTOurable circiimfitancps, the development nml eruption of 

iriadknn teeth is but a repetition uf those progrenire 

F(SuiDf!<m which have nlreody been dcKcribeii in respect to tbe 

St und second molars, and therefore need not be dwelt npoiu 

' Ho doubt these twth are seldom cut without creator inawi- 

venience to the patient than tlio anterior molars, and the 

perioii of emergence is loea deBned: hut we have liilhorto 

cirtiKiilereii the eruption of the jiexnianent teeth wlien the 

proecM h&» been perfectly normal, the deviations from which 

have yet to lie coiujdered. 

Tht poriods of eruption of the permancDt teeth ha\-e in 
the foregoing pafEee been tnice<) from prepamtiunB. But tbe 
object baa been examined statistically. 
In IflST, lilr. SaurtiliirB jiublbhnl n mono^ph, entitled, 
^Tbe Teeth a Te«t of Ape." About this time, the miseries 
entailed by employing yonnp children in factories were, not 
for the first time, forced ujiuu the attention of the Legtalature. 




TEST aura. 



95 



IDJl 

the: 
H nec' 

■ of I 

■^' 

■ «ru; 
^ Tin 



The Deo««rity of mtricting the hours of lalnur and o{ esla- 
blwliing Uvrit for definiiif; tli« period at which children should 
Ik allownl tu enter upun factory labuur, was atUnith-d. But 
a difficulty arose tm to (he priucij^les upou which thin period 
should be fixed. It was contended liy soTne that a certain 
state of phyeieal dorelo|inieut iliimld be taken aa the 
staodoid, while crfhent thought that the nge wnuld fom) a 
better cfiterioQ of thi> cajjahijitiox of cDdiiria)^ labour without 
injury. The etntemcais of [larents m respccbi the ages of 
their chiMron could not be defteudwi upuu ; hvnce it hucanic 
necessary that itome mcani should be found M-hercby the age 
of a child conld Iw detortainid indi?j)ciidently of the repro- 
Ultions of intcrcflted ]«rtic)i. With thin view, Ur. Saunders 
entercul iifirm nn inquiry rrfipccting thn relations of the 
eruption of the penuauenl teeth to the Age of the iudividual. 
Ho viBited many of the large mctroioittan Bchooltt, and 
nlecteil for examinatioa tfaoM cbildroo w}io hod reachei) the 
ninth and the tbirteeuth yenr, and published the renults in 
a serioA of tables, of which the follnwing oro charscterietic 
examplea: 



Of 457 Iwysof itiM 


Inrtoon. 
Oroi. Lfti. 


pid. 


BIciupM. 


Hclan. 


AM. 


IVxL 


Act. Port. 


Tears Moga — > 




















4 




,. 




4 


♦ 1 


77b«d 




» 








4 


«s 


91 ba4 




3 








4 


„ 






1 




„ 




4 


_*, 






, , 




,, 




4 


*■ 




3 


3 




,. 




4 






* 


" 








4 


■■ 


Of 327 bof s v( tiurt«Mt 
















y«u« of nge— 






















4 


4 


4 


4 


4 








S 


4 


4 


4 


8 






• 


3 


4 


3 


4 


2 








3 


4 


2 


A 1 




4 




S 


^ 


I 


4 1 .. 




66 



A STBTra OF DEKTAL 8URGEBT. 



Vf. fiuwnAers sams up the rcsuJU of hb invostigatknis in 
the i<AUtmng words : 

" TliU5, tb«ii, it appeiUH that of 706 children of iiine years 
of ag[% 3SQ would liare been pronounced, on an ajipUcatiua 
of thill test, to be near the vnin^tleticui of tlu: ninth jear; 
that is, they jiresGntod th« full itevelupnionl fur that itga. 
Uat on tbo principle already ntAted, that of reckoning the 
(otirih tnnth as pnseciDt wbvo tho thnw arc fully (levelaped. a 
atill larger majority would be obtained, and instead of SH'J, 
the proportion would \k as follows: of TOd children, no leae 
a number than 530 will be fully nine yeam of age. What, 
tbni, are the deviatiaus in the remaining 178? They arc ttie 
folloiriiii;: 126 wootd be pnmoancseid eight yoan and six 
months, and the rtrmaining 88 eight ycont of age, bo that the 
cxtnmte duvtaliooa are only twelve nirintlu, and thew unly 
in the inconsiderable proportion (when comporal with tb<> 
rusults ubtaiucd by other er\t«ri&) of 52 in 70B. 

" Again, of 338 cbildrei) under thirteen yean of age, oo 
leas than '2M might have Imni prunuunoud witli onBdenoe 
to be of that at!^- '^^^ reniaiiting 44 would luivu liuui 
considered u follows : 36 in their thirteenth and eight near 
the oampleUon of their twelfth year." 

More recently Mr. 8. Cartwright, jnu^ has publiBhod a 
Table which enibracei a mnoh luoro extended {leriodt oiid givoB 
reaults obtained &om 3074 caaoa. After describing the order 
and the poriixls of mnption of the permanent teeth, hi? mnkcs 
the following remark : 

"These pcriiHls t final fimn a Tii<Mlentt«ly fitir average. I 
have |Nbrticularisod thena for the i^ke of affor<liiig yun sumo 
idea of the times of replacriiwnt of the vuriouB clottacs of 
teeth ; but exceptions are eu frecpicnt, that it is not potwilJo 
to give with accuracy ttio exact time for their change. Thne 
tables will show yoa the times of apiworance of the teeth in 
the given number of eases — tipwanls of 300O— which I have 
collocted and wliicli have ctirae nnd«r my notice" 

The followingjs n reprint from hin fourtii locturo, published 
in the •* Britiub Journal of Dental Scieuue," May, Idol : 



TZBTHUra. 



97 



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a flVfiTElI Of DBHTAL srmaBBT. 



we enter upnn the fubject nf irregularities id tho 
ff^apmeat of tlic {^nnsnent tectli, luitl the variouH dis- 
turbing c«u«cs, it will be nilvnnlagcouB to give sonic further 
atteutioo tu Lbu coiiditii>ii8 unJur wbtcli tbo ijTwtl^tr pro- 
cesaes are fbrmi-d, and to the lawn which rcg\iUt« ihe growth 
or the jaws. 

Dexntlcpment of the atvtolar prcctstet in cvnnectwn wUh 
tecojid (ientUifm. — 1ti t!ie cjirlier )a}{ra, it was Htatcd tbat the 
alveolar proccascs arn foriuwl attvr the dentiil papilliD are 
developed, ami thftt at th« tir»« of birth they liave risen up 
to the levul of the developing teeth. ^Vtlbin two or three 
mcmtbn they arch over and iiKirly encloac the Itctb, thereby 
eriucitig a nrnre rapid ntte of growth tliiui the tveth tboni- 
aoWcji. \Vhf»n the t<wth are rraily for eruption, th* anterior 
wall of each alvcolun U aW)rbod to th« extent of about half 
its whole depth. 'line tt-eth emerge, and tlie fttvcc>lar pro- 
OBBiietl again ujuimeui-o to rtow; bat not aa iu tlie former 
eue§» more rapidly than the teetli. Tliuy now kwp face 
with the tcclh. At thu time the devclopinwit (»f the several 
teeth is couiinencetU the )«pilke ore placx^L at tlie ultiniate 
depth in the jaws. Thpy do not etow into, but up from the 
maxillm, und the alvroli ^'ruw with Ifavin. At the period of 
erujition tfa« lower end of the tntncatcd nod unfiQuihed root 
reaches to the bottom of the sockut, tlip position of which, oa 
rc^rdfl depth, is cot changed with the gradual leiigtheoiug 
of tho root oftlie tooth. After emergence, tlie depth i.>f Uie 
alveolus is equal to the Icii^tb i.>f thv root of the iuclovod 
tooth, the auli»e[|uent growth of tho root at its base being 
equalled by Ihi^ develuptnentof the alrpnhu at its free edgo. 
When the permanent teeth are ready to emerge, the pro- 
CO08 of absorption is a;nin railed into rnfiuisilion. and tho 
labial wall of each ftlvooluB is. in the anterior part of the jaws, 
rcinove<l, the knw of iKinv being (.-xletMicd to a point corre- 
dpoD^iui: to tho n«ck of the otncrgiag tooth. Tliii* coitdition 
ia shown iu FigH. 33 and 40; Intt the nceompatiying illustra- 
tioni exhibit in a r^niukablo mnntier tlie dependency of 




TIBTSUIO. 



99 



alvootar on dental defalopment The dentition is in many 
nspeett irrcgaUr; boi the piint w which I woulii draw 
attputiou is the Hxtrmnuly LtuIidd line deHoribed by thu 
alveolar tn«rg{b, holh in tli« npfier uid lower Jawm. It may 
be seen that tlie Uirminal algu of oach uickut corrcHpunils 




the neck of ihc contained tooth, however im^larly the 
Uttm may bo plnrod with roipect to itK felloirs, exception or 
courao being nude to tluve t««tb which hare not yet puMd 
ifarrMich tlio Rom. Oti the nglit »id« uf (liu lower jaw, the 
Ant (euforary miliar is retaiued ; and ou the lef^, th« second 

(■) Tb» upper and b«*(>va of • nl^ect abont fcnrtera J**n «f ■«»; 
«lmrtnK Um nUUoM of iU« iCTwiAr pracnna to ibe tMtli. In tfaa nppn 
>« Ok unparary ouUm mod Ibe KM ual *cciiik1 moUn are rfi«lorU. ■ A 
tmftn-naanry looih lux lAkni ibr pUo* of th« p«naMii^n( teumi towtanr, ihr 
lM0ml bUc fomtf budtmtxi lovaMi Um palMc. Tbe centril InrUor Iwi 
(•m olMrtKHd In lu ilMcain. aiid the nM ci»tMK|U(ii)lr rtirvni. Thf^ 
parmaarai canlnr U far advuKfd In It* dfnrelopmrnt. Nil in iltwmt b 
■Jb urort rt bjrUtr «iiprrainni>nvT Innlh uni the Ur'nl Itidapr. lBlliplo««r 
^w IAf ant Irmpiirtrj mnUr bo* Kwn rrlaUHd, tn" raltnl t» • littler U-td 
Umo iimm), and iHtli It ilv aIt^uIim. 




100 



A 8TBTEM OF DEKTAt. BCBOEBT. 



temporary molar is |ire«uiiU In uurh eane the tooth And lU 
alvoolus lit raised to a hijihirT level than b usually klUuiwd hj 
UiB tetii|Kir&rj' t«etk, ami Iii^^bcr than the luljaiiiiDK Aral 
pera>aD«ut Digkn ftiui tbcir suckeU. Thu (tlevfttiug procam 

rig. 4x (11 




h»» ao doubt 1)evn vfFdctcd after the tooth it«olf luul been 
nD4ture<1, and shuwii iu a renuLrkable niiuiner the relation of 
ulrLMilar dcvclorniieiit tci the ch&Qgce of j><:>«iitiuii iu tba teeth. 
It is nut uucomuion to tind tanix>nu-y mokra pretwQt, even 
in psUimt* of advanced age. I oocaaoDally see a geoUemkn, 
over fifty yean of ago, in whose tower jaw Iho nocood 
txaxfonry molara have been rotaioed. Thoy miige with 
the odjoitiing teeth, and perform tl^eir part in njasUcAtion. 

(I) Vkw of ibe left aid* of Um pp«ebD«o Spiral Ho. f I. tn Ibv vfftr 
J««, ib» tncgutiu Hm ilMcnbMl I7 U» Blvrubr niMxUi t* ttiuwu tn coanKtlaii 
wlib Uhf pcmMDHit i«Mli. In ih* lomr Jiw, ihe AtM «ul aocuid teinpMirjr 
OMUn m truUHid, ud both ibt taMb lod Otutt alrtUl an nlwd atovv 
ibr level nf tbn petmwKit Mrti ud UtdT MOkM*. Aaih (U« aiat Uw prv 
cmUdc nmrc nmnnt* irTrculwnis in tbe pnUtko ol iba pwiwatu iMlh, 
■lid mill br tvlrrKd ta In canoectlcin «1th Ux nlDNt vf IntfiUritj-. 



J 




rtnsrmsa. 



101 



The teeth generally ura of tJi<! uhua] mte, «nd the jaw ami 
ftlrenlar [wocoflKca luAlntoin the usual doptJi. In this caw 
the tcmpomiT Ictttli and their alreoll mnnt, at the period of 
Moonil dontitioo, hare been raued to ilia level of the adjoin- 
ing fmrta of the dental arch. Other instanoca pnMat tbem- 
aelreR to which the penrietcnt tfinxirtniry teeth do not gun 
the general levol. Tiio raufs* is, hoit-evcr, ueunlly rery appa- 
rent: tliR contiguouit teistft hail); orn-, aod as it were hold 
down tlie depfeased tooth ; and hero again the socket oorre- 
Bponrts to the level of the neck of the tooth. There is no 
dbpositjon on the part of the bone at this point to grow up 
tn the gencnl line of the alveolar proresxcB, independently of 
tlie tooth to which it gives implantation. In the one caae 
wo have a tooth raised above, and in the other hold down to, 
the normal height of a temporary tooth; aitd in oaoli the 
alveolar developocwnt bag strictly coDformed to the position 
of the tooUi. 

Tb« appreciation of the foregoing conditions will l>o found 
of great practical value in respect to llie travtrneut of irrvgu- 
laritles in the poaicion of the pennanent teeth. Diiiea«i>d 
aetioQ in the itructarex may, however, modify the rclatioiLS of 
the one part to tlie other. I have fieuii a cmo in which the 
alvet^ar pmcown) were e-nnmmiisly chickened, nnd so raised 
that the t*>elh lay iu ^roov<!8 ; And instaiioeft are not very un- 
oommoa in which development of tho omoom tiagae is arrested. 
Bat the resulla of normal action only have u yet boon ooo- 
ndered. The conae^aences entailed by disease upon the 
permanent teeth and their aockats, will be treated in n future 

OtoiM a^Ota maxiBat during aeeoud dmlition. — In parsn> 
injn thia inqniry, tho natural varintiim in absolute uze and in 
Ihe minor det^ls of form, which the jaw9, in common with 
other parts of the body, present in different indtvidunla, muMt 
be Icept in view. It will bo deairable, therefore, in repenting 
tlwa obaervBlioDEi, to seteot for examination 8(iecimena which 
prsttnt the arerogv couditioa of the part«. 



102 



A BYSTEU or DENTAL SUnOEDT. 



On comparing the jtws of a child in whom tlie first pcr- 
iiuineut luoUr? are aiWftDcing towards the tnifitce wilb th« 
maxillw in which tho wiwlom teeth have t«ken tbdr ultimiitc 
]iOHitioD, we arc al once Htnick with thp preal ilifference in 
lice, not only of the iM^th, but of thi^ jaws thomwlvcs; and 
it Beemiiat Jiretrnght wry ilillicult t<> «xfilatn how the nmaUei' 
ctm aakumo t!)e daracc^ni of tW older fpeclcuen. willtoat 
having R^'onrsc ti> ibc iind^Bnnl idea of general expntutioD 
by incerstttiol grovth throiighoiit the whole nibctaace of tkw 
bonca. 

It has been shown how the alveolar portions grow tip, ue 
partly removed. And again grow up ; how they ore iron time 
to time moulde<l u> the required forms; and it will not be 
difficnlt to point out how the ather ptirts af tho jaw are, by 
tbe ]>rogren of develnpmeat^ cbangea, gradually adranoed 
towards the ndult kirm. 

At a preceding ]stvip (pa^e 1S>) mention was made of certain 
points as convemcut for the purpos^a of measurement, as beiikg 
liable to little altemtinn during the growth of tbo mnxillie, tbe 
tubendee fur the aLtaohmont of the geuio-byu-glussuK wul 
th* mental foramen being selected ae the most suitable Ibr 
tlwparpoae. Wlien rightly interpreted, nteafiitrommts taken 
from these two points give identical resnlts ; but before pro- 
Ooeding fiirlhur it will be well tn explain that at tint ajght 
tneaaurctuunts takvii fruiu ih-i mental forameD will gire itaW' 
leading lesultfl, owing to on atirupt uhar^ in the direction of 
the canal at its anterior extremity. If thv uuttir eur&ce of 
the Uhh' be n'lnovwi so as to cxjuwc the whole length of the 
inferior dental rainal iu a noriefi of Hpccinienn of dilferent ogea, 
the QUaner in which the meotat forntncn bos become raised 
will be appon^nt. In the nine niouths' subject the mifico is 
on a level with the course of the canal and looks forwiirds : 
now the portiou of Hilt caiml alrcudy furnwl docs nut undergo 
any (uithtrr change, but, as the thickucsa of the bone is aag- 
mente'l by deiMwtion on its outer surface, the canal comca to 
lie at a {jrualvr di>ptb within the bone. 




TSBTHINO. 



103 



I 



Tlie DGOtaMvy adtlitiuD U> tba Icnvitb of tha canal befora il 
(xa rttftch the surftoc docs not, u might [lerhaps hi.ve been 
o&)ioct«(l, Uiko plaiM! til diract oontmuation »f itx previous 
courac; bur, ioobedicDcelo a law alwady alluded lo(iia^ 19), 
givus lu the added portion oT caoal an upward aod bodcward 
dii-cclioo. 

ThislKtifa addition to the cauaI tlierorurti forms within the 
thickoeat of the jaw »u aiiglii with that pn-viuusly cxlstiuji, 
and this aogW outchpoikIa in position with the opening or men* 
t&l ftjtiuueu in the fa'tal jaw. If tli«n we rasp ulf tho imrtace 
till w« reach tliu angle, and take our meiuuremcT.t5 from it 
Instead of from tlie Bxcernal opening, wh ithall have au un- 
obangiDg point, and the nwiiha of our inf^niry will ha con- 
ai«lQnt with tlkoao attatnod wbvu the tubcrcloa were choseu 
as the fi^Led points. In old agf nature performs tliis (^}eiatloiL 
for OS and remoTcs the bone till thia angle ia nearly, or quit«, 
roMbed — hcDCc the foraojeo ia bam^ht -iovm nearer to tlio 
lomr border of the jaw. Hut with thi' excciition of additionx 
to flitbor end during tbv }«riod <if growth and cunsotiuvut 
alteratioHB of the aperture, there is not the smallvat rcaooDto 
mppnw that tlir pusiticin of iha canal in in any n-ay cliangod 
at any period uf development. 

In the former edition of this work certain actual measitio- 
raenta of a particnhir series of jawn were 0ven ; but m I bare 
funnd that stGdcota have experienced some little dillicnlty In 
gratipiog tlin Qitnning of the paKSge when placed before thvm 
in Uiis form, it liaa seemed preferable to embody the ninilts 
of theec inveetif^tiona in tba accompanying dbgnms. 

As aoine Tariatknts, dnu to individiinl |JOCuli»rit)cs such as 
greator or less development of tlie rhin, exint between dif- 
farant ipecimeDS, these diagrsnu are drawn up according to 
avora^ dimeiiuunit taken from a conaideiuble number uf Juwh, 
and are drawn to «cale. 

The horizontal Uuo rcpreMjnts Ibo le\-«l of tho antt-riur 
portion of the infisrior dental canal in the Icetus, and the cor- 
iding portion in th« adult jaw, which may be taken as 



104 



A ISTHTEM nr IIKNTAI. STROKltY. 



eepuating the alreotar portion, ntriclly mlwcrvient to th« 
Lodgineot of tli« teetli, from the basal portion wltidt sul^crves 
other purposes. 




^yeart 



'*-«.m,' 




^flK&jQVitig tbo Jtw or tbo nine monthe* Tcetiu: with that 
cfftvA^^ryun' child it 18 Been that thnt p<^>rtiaii whi>h tiea 

(M rp. 4e, 4T, (!.— In UiTK iKum th* hnrlMntal 11m tnufct lb* com- 
•fnndlnii pirt* rf the MTft«l limit «p llut Hi* rvl«U>« Incrtaw ttwv* tad 
fario« II. Uwl It la skf. In tke tlnotar tad bual fwrtioos uT Uk Jaw, buj b« 
mdllj- Men. 




TBB'IHINO. 



105 



below the lino luu iiioru thAn itoubled in its depth ; but do 
looking at tbo idnlt and the aisoA jaw it is appanmt ibat tbU 
portion of the bone boa Rtiauicd ita TuU derelopmoat in 
depth, or v«ry' nearly bo, at tb« ag« of atrtva yeara, and that 
it remains comiiantlivitly nnchiuigad artf!r that titna until the 
dralL of lb« iudividu4l. 

Lookiii);, howcvor, at. the nlvpnlar portion above the hoii- 
zoatal tine, it la appamiit that ii dues aut attata to ita full 




It till nftrr the ponnanf nt u>cth are iii plnoe, and 
I so BOoa aa tbo tottth arc liMt, it di»ap|»ar8, so tlutt iii the 
aged jaw here 6gnrc(l it ia almost abacnt. 

Such ineasnrv»it:nt.s prove very conclusively tlie iliffrrvnee 
botw«cu tbe bDMl aud alveolar portioiu of the jaw, aiul bring 
promiueutly fum-ard the untlrv do|>cudouc« of the latter on 
tbfl teetbj a point which cannot be too Htron-ily insisted on, 
M it hae [•nctkal bearings to be alLiidixl to in a future page. 
In the nine tnunths' aubjcct, whrii the aiiturior tooth are 

(I> Tb* iWtal lino In tbto Bipit* i t p i iw U thn mitllne ittildi woaM hava 
ima pi c w Btod tif tb> maoe Jaw during ilie niiVll* pcrfud of ItTe. tht ftm 
tutm v^n^ut bM>*«n ibu lli>« anit ibt dnwlni bavtng bats nuxmi I7 
, fhNqpdai, rikw Uh kM Of llM latlk 



106 



A BTSTU OP DKKTAL SmoBST. 



oboat to be oat, tb« c&oal U iiMrlr Btmi^'ht from cud toeed, 
iu whole length cofTwpoiwUng tu that portion which in Ibe 
lulult lira under the bicuti]ii()8 and Gnt f<<>niiftrir>rit niolur, and 
fomtinjE 8CArc«l>' inoro than one*tliird of iu ontirff lon)*th in ttio 
adult, llif Btraitfhtiieas of tliis iwrtiuti i» |KTitiAnmilly ]ir(v 
Bervud iu all the spMiuiens I liikw cxaminml. The uiidi.Ue 
thirf is alightly ourved upwards, and the jxMtcrior porlioo t» 
Btill taon curved, tuid if prolonged, winild jaiw throu::b or im- 
mediaUly in fronL of iIk; articular procias. 'I'liv course of this 
pOBtorior tiiird trarcr^es the aacendiDg ramus of the adult 
jaw ntber obliquely, and in the ^reat majority of cases corre- 
EpiJiulE with tbi- dirocliuii of tlia condyle ratbcr 1)mii tbntof 
the ramus. Thoc points havr been entered npon with xntue 
dcgrev of ini»utciiit;««, in coii»n|uenc(i of their afTonling ftvi- 
dence h to tbf inAniicr in wiiich tbc jaw becomes leiigthcnud 
toMi great ail vjilctit Uy additicmit at its posterior portions. 

In tracing! the ^cmth oi tlie jaw backwards, we nuiy tnko 
the itifrrior dental i-aiml at> tnarking [iTvtty scoanitAly the line 
of growth lulli»t'vd by tbe ouodyle, and the external ohliiiue 
line u Ibat which liaa bt*n followed by the liawe of the curo- 
noid (irocewi. Forthc Hike o/ facilitating dcscriptioii, il may 
be oasiUDed that the l«ckward growth takva place at three 
poiata — Id the 8u)>-BrticuLn.r cartilage of the condyle, in thr 
periuflteum iuroatinf; the cnmnoid procMa, and in that in- 
re!itin}( t)ic )in;;k\ 

Tbe oundyle btanda with it* long axis directpd nearly lnn»- 
vcntely arr«Mii the muiUB, the one cxlruiiiity lyiug nwrly on 
a platto with the outer Burfnce of tbc boms while tbe other 
pvcrhang3 ton cnnsiderable extent the itiaer isiirfaro of Uic 
mmtu. Now, ifwe lake a thin %'crtical sectLon, miitahle for 
mkrrosoopic cxuminatioii, from a j^Tleclly IreHh yoiing jaw, it 
will be floru that now hone is derelujiiufj; iii the lenipotaiy 
sab-articular cartiiago— -uot, bownvcr, in tlie linear manner 
usual in the temporary cartilage of long bonus, b\tt by the 
«xtau8ioa of oaaificatioa among small groups of cells. A» tint 
actJDQ extern^ tbiuujjbout tbe articular extremity, the bone lo 




TBBTBIHQ. 



107 



Itroducctl wcrald, if prrmnnently retained, asmitnc the form of 
& bnml pruocw, niArkiux Hi" ouurse llirmigti wlituli Kruwth 
prooeed«l. Oii Ui« out«r Mirfac*' w« fnH(iit>iitly out diMwrn 
K t.\igb.t rid^ DXtcuiUng a ^ort distuiiL-e fruiii chc licad of 
the bODtf ; but if tlu: prouiiRcace n-«rc pr««*rr«<l on tlie iuncir 
xiirfAoe, the iiiferinr dental artery and noTYc w»uld Ik ttimnd 
from itH coonie toniudi> tbo cnnaL lI«noe the hard tiwue, 
alljiuugh pruduCTd, in at this point spwdilj renuiveil, hihI in 
tUu ]>iiux *>f a ridgp extcatUi^; from tho articular proci-st 
downwiu^s, fTc hare a ooncarity inuncdjately below the arti- 
outatiuti, and along it th« vtswU find ntirvcs [ns8 beforv 
Mitcring the bono. A section taken from ibis pert will nhow 
that the nowLy-furnvBd Wme has lieui ruinuvitl byabeurptinn. 

The ]iKigrrsaiTO growth of the coronoid |.rijcciM is cffoctfld 
in the usnal mannisr of iiub-{x;rioflteal ilcvoloiimnnt — thnt is, 
by iho oBi<i6cal)uu t^f cclU aiid couucuUvc blutwoa ; aiid hon», 
n^in, thu UKxlelUiif; procen cffectuJ by tlie stipeirenlion of 
alworption is called iato lequieition. If all the Iwn^ which is 
developed were retained, we should hare a breadth of nunus 
extending forwnnl nver half tl»e alveolar mnrgiii. U a traua- 
T«rw aectiOQ bo taken from the base of the r&uiu& of a growing 
jaw, it will Ix^ found llint indicaliomi uf nbttoriitiou ore fire- 
MDte'd at the anterior «dg« ; and at the point corrvspotiditig 
tn the puHterixir Ituakt of the jaw, evidences u( niweuiiei dere* 
lopuiout are pr««eut. llii.- fact, that Uie viilanittiiieQt of the 
Jaw takiw place by backwunl (j^wtli almost exclunivcly, hu 
becu already aUinlud tu ([i«f(V ^2) ; in Lliis FBSpect alsii Dr. 
Hamphniy'4 expe>rimciit« arc coufinnatory of the iufi3n>ijce 
biTt.' drawn. 

The correctDcai of the above vicwe, as to the devetopnient 
of the jaw, luLfi ruceivi-d a suniewhat iioexpected cmifirmaiiim 
from two examples of arrented dewlopmcut of tlio one nimus 
of the jaw whil^ tite other has attainnl its normal «ixc. The 
(int of tb«»e two spucimeon (') was brought befori! the Tatho- 

(>) nciu«daBdteeill»dlBhi^leflo*l!iiid£iy^TnBUfUeiDa,vol.KU.,ta6l, 

p.au. 



108 



A 8YBTKM OV PRSTAL BtTBOEBy. 



logical Socirtj- by Mr. Edwnrd Cantoc ; it oocuired in a giri 
of gBnemtly atnnif d growth, in whom the wtwlc left tiiilc of the 
lace wu fUtteti«>d, and itta exteroal mt wu almost abunu 
At tlie po&t-iiioru.-in exatniaation the i^'gomutic and auditof7 
proooBHSwcre found to be altt^tberabient, whilH ib« gleiiuid. 
cavity wr» n-pnuiciilod by a iwrfoctly nmnoth surfaLM.-, 

As IB tibcn iu ihe tii^ire, uq the left iridn of the jaw the 
Mccndin^ ramiu h h very nhnrt, narrow prooeM tenninaiing 
ia two poiiitM, which iiiuv ;k;Hib|ik niprcMMittbeeotDuinduikd 
ooodyloid i)roa«W8. But thero u nothing to be »*wi at all 
like aooudylc iit tho Etimnitt of this proooaa, and tburvforc, 
there being no articular Bur£»co, there can bo no articular 
eartila^ 

rtf.to. 




But it has jiut bccu {lointcd oat that tho bnckirard and 
ttpwird elongation of tho jaw tflkca place in grvst part by 
08»ification in this articular cartilago, jtut as a long bone 
grows by o<»ific«t!>i>n fT^ign-oHms in its epiphyact, ll^iico tho 
ftbMtira of the condjie arcniints perfflctly for tlio arr«sl iu 
the difveloptDent of tbiit portion of the jiiw ; it will however 
be noticwl tliat llio vertical drvdopmect of iby lioriEontat 
nuniu, which is entirely correlAtive with that of tlio tcetb, 
has not auQercd in a like degree : the teeth have been dere* 
loped, and conaoqun&tly the alvnilar portion of the jaw has 
attained to something apprcnching iu norinal depth and 
width. "Hie IfUKLh of ituM alxjrU-d side of the jaw doi« not 
exceed that attained by that of a child aged two yean and a 
half. 

The great clevatiun of tin inclsoc teeth >■ simply the con-* 



* 



TXETBIXO. 



109 



«q.iWUse of tmpirfect anUgonism, on explBDJitioii nmdered 
the own* certain by their wmtol edges, which hav« obviously 
not come iuto coutoct with tUe u}ipef t«oth. 

On tho inner Kiniitce of tha stiiniod firocmB, at a level cor- 
respuutliug to ttuit of the crown of the vecood molar tooth, is 
th« Inferior Pcntsl Foramen, which U much aiualler th&n 
that of tbw right siiie. TiiB niuDtal foramen is pntin-ly aliH-nt, 
the nen'es and vessels having been a[>paroatly wholly lued 
Up in the siihNtaace of the bone. 

The m-cood apeciineo, which is in the muKam of tbs 
Odoncological Society (^), pivseuta Bomcwlut Kiinitar rhn- 
nclttnt; of ita history ootLing wluttever U Jtnovrii, htit it 
appears lo bo the jaw of quit<> nii apii penon^ ukI the rIvcoIat 
portions of the jaw having brva for the most piirt ahwrbod 
after the Iom of tbe toctb, the fact of the entire depeiideim 
of the i;rowth of tbia rrgion of the jaw oa the presence of tfao 
teeth Is nut so strongly exemplified as was th« c&se in tlie 
UBt-mcntioiUHl specimeu. Ilul that iho aborted mmua hu 
atom time been of a dapth apparently disproportioDaU) tu 
its backward elongalion, is {irobable fmm the prpftcnce along 
ils upi>n inirrace of llie sharp ri<i^e which in usually b-ft after 
absorption of alveoU, consequent on the low* of tlio teeth. In 
tbe ftpinoua process which terminate this KtuuLeil mums, no 
■eporate represeotalives of ooronoid and condyloid procesacv 
can he traced : ll i« a simple Hpiuir, which from its relatiou 
with the exlemal oblique ridge would coirespoud mora iiooriy 
with the ooronoid tbnn with the condyloid process, aod 
pnaents un iU inner surface a proniincnoi} ap[Hirrnt!y giTing 
aUachtuent to ligaincnts or mitsoloa. '["ht^rc is not a tract? uf 
an iofenor dcntAl cansi, and conseqoenlly no mental foramen; 
but whether this abscuce of its proper vascular supply is to 
be regarded, as a cause or au viTect of tbe atuuted growth is 
auatiiio^t insoluble problem. 1'bo tnlKTcU-s for tbi; attach- 
ment of tlte gcmo-byoid and genio-hyo-gloMtta, wbtch probably 
marked the luudiau line of tbe body, do ant cnmspond with 
{>) TnDncUaaM,OdraUdi)«fc*l tkxirij. MAreli. isix 




STAT KM OF DKNTAL STBOEBT. 



the poaitioo of the idcduiI iirominoiiM on the outside of the 
jair, which l&tt«r has ]ttruken id tho axTmmetrical dcretop- 
moiit u{ lace which mtut h&vc cxiH4ed, iu>d is cuositlenbly 
dioplaood townrd^ the right side. 

In exBUiiuicK a scnis cf mutaMe preparBtkios, it nwy be 
aeeu ihat the crypta for tlii! jiermaDi^nt molar twth are tB 
the Brat iniitAncr fiinnnl intemiil U) tJit' riilgo of bone which 
fanai ext«'niiitly the l««c uf Hiv coronuitl procem, and that tlili 
riilgc IB ooiitinuoits with the external obliqne line i>r (he jaw. 
Alwi)r{>(ion ill Lhtsm-i^tblKnirbooi) apiKars to slop short Itefiire 
reaching the sbBolnte Ixue, find 1«aves a tmco of tho ridge 
alluded Iq: tho trace contititutinii tlin obliqiM line within 
which the alveoli of the motar tvuth zioyr up. 

The devolo|inuiiit iif thct jnw nmy, in winw rc«[KCts, be 
compared to moiielling. t'ortioTis of new tiwiie are laid 
upon that alrenily rurim^l, ami rnluoid to thv fiU.ui^ fflso and 
b)ia{ki, and i^ain renewed at tmoh poiiilH a« the attainment 
oC the uUimntfl fonu of the part may require. 

BtlU, erea during manhnotl, tlie maintenance of the romi 
of the jaw is dependent to a great exti^nt ii(>nn the tt^th. 
Wtien the organs of uiaatication are loat, the whole of the 
alvoclar {mxxases are hy dcf^rccn remoTod, tlie iworns of ab- 
Mir|itiuQ being arrested only nt tboea pMuts n*hore muec-les are 
iiuert4>d (see Fig. 4^>); neither is the waste limited to the 
alveolar margin. !t>itb the outer and inner surfaces of tho 
bone are reduced, and even the interirtr becomes more pr>ruiis 
than during ihf! )>eri(yL when ttie teeth were present. Tho 
apllUB taeolalM, however, r«taia nearly tbeir full (ize, allhbugh 
tbo angle of the jaw about which the Ruiweter itnucle ig in- 
■erted, siiffom consitlpmbla lom — not however nntil that mosda 
is thrown partly out of use by the loas of tbe teeth, niul coa- 
Mei|iiently of the capability of niiutication. If two jaws be 
taken, the one full <:<i t«eth, the other from au old edeotuloiia 
eubjtvt, mid iu each tbi- dt-ittal cnujil Imj exjiosod tKmnghoiit 
iU length, we may then, by the U5e of a file, taking the caiiai 
OS our guide in renio%'ing the bone, reduce the younger to 



TBaTBDiO. 



Ill 



^P the form o( the oMvr jnw. In tlie one case wc have ■ jaw 

" for the iiapUintalioii of WMh, ud for the iusortion of powoiw 

ful iiiiiak'S for liriuKuig tlio toelli inlu vfTvc'tire use, in 

addition to afforJiag nttacbinent for muiicl(ui oimncctixl with 

{ the OT^M or BfKvch and deglutition ; anti in tliu other, the 

jaw Is aulMerrieDt only to the latter jmrjioseB. 

kWe have hitherto spoken of the lowor juw, which, from 
t8 alight ooDDection with the other bones of the face, cau be 
ttadied in its progrcMivc cbaopK* of fnrm and size more 
readily thiin thi' KUjiierior rnaxilla. Mr. niltun, in his mooo- 
gnph oQ the derelc^Raent of certain [>ortioQS of tLo crauium, 
I makes the foDowiog Btatement : 

^K ** The sphenoid bone forms the centre around which all 
^F the oUier iMneai, botli of the cmiiiniii and face, are doreloped. 
It is truly and literally indenl a wed^>, as lU luunG imp[k« ; 
and thos impactixl ur wedgixl iu amongst all the other cranial 
and facial hniceL, it« prdgressivi? darelnpment spreading iIa dif- 
ferent processes out in all directions, plays a mo«t ImportAiit 
part; nut only in determining tlie adult ntnBgiirutinii of the 
skull, but TQ adopting the Giuil coururmalioii of tUe orgaos 
of tlie face to the fDCtctuiiii;; pLTfuctiuu oi cbeir associated 
functions. The mouth, nose, orbitJi, and pbar>'[tx, are all 
t awrc or less directly influenced, and contempomuwiusly ron- 
j dered more perfect in fonn hy tlie complete development of 
I thia bone. 

I "The primnry idea, or iiriinnry intentiun of the devHup- 

L^ meat of the sphenoid, seems diieRy with reference to the 
^P masticaUiry fnnrtion ; but in the dmugcH lliat it pnxlnces In 
^^ the direction of the cranial and facial bones, it may nut 
[ inaptly be compared to the scaplioid Imnpa of the carpus ami 
tarsus; for in itn ^uwtb and fiiifll dcvulupineut it ofTi-cts 
for the cranium and face precisely the same object that these 
banes elfect ff^ Uip iiiutd and fiioL 

" Like tbcM bunca, then, the jirowtb and completion of the 

spheDni<l, in ftpromiiiig out the cmniuin, and in cnUrgiug the 

rities of the orians belonging to the Incv, supplies the defi- 



ua 



A STBTEH or DKNTAL StTBOntT. 



cienoy of the tnoticalar tctuion which in other [«rU of th« 
butly }in« so large a aimm io dotcnnimiii!; Ihu finiil or pcrfo-'t 
fonn* of the booe«."C) 

Of the di^Teivnt {larts uf lliu 8{»hviiuitl Uim; thuvi wliich 
ucui^rgo tbo greatest chnnge during the ixtriod under coa- 
U(leratioii,a8n))^nlsHiz«, aod wbich oniolsu tUuuiuBtdia-cLly 
caimectc<l with the ])rcsciit inquinr, arc the ptcry^iJ filate*. 
How pnrlA incnsaKo to the extent of on(^-tili^() of their uLti- 
mato leugth between tlie age of servu aud iweuly-ouu jean. 
In & c|)ccimcn of ■otto yfiiirs, the anterior «urfBoo of th« 
ptflfjgoid fovccn is •o[)arfttwl from tli« Qni jivnuanuut molar 
by a ditrtaucu Kcarovly excovdiu^ « quurtcr of au inch, sod 
the juwceat socond nioliir livs in the tu'bt'nMity, in gruBt v«rt 
extcranl to tbt- Bphcnoi^lul prowssts. Tb« ejincc, at inx-stiit 
•0 incoi»«i<i«r.il>le, h&a, before tli^ adult form ia acq^uircil, Ui 
be iucrva«t:-d fully two-thirdx, accompAoied by an incroaaed 
length uf the pterygoid plahw, the general direction of which 
rcutaiua uuchau^ed. The gfiocral principles which have been 
pointod out as ]icrtainiiig to tlio develoi>tH«Tit of iixe lower 
jaw, may he appliud to those facial bouoe which arc uoonwlud 
with the tnasticatory apparatus. The tuberosity la to the 
upper what the baae of the cnrtinoid pmcees is to the lower 
jaw. From this point the alveolar line is lengthcnod. Ic 
the Bpccitiu'ii la-st iiienlioned, this neooiiil mnlar is buried high 
up in the lulwru»t}'. Souti after the expiration of the twelfth 
year, ihv distaiicu between tbe pterygoid iiriniesa and the 
QrHt molar will have iuciewed sufficieutly to allow the second 
tnolar to lake Ua phiCf in the dfUtal line, and by the espim- 
tiun of ihe twentieth year tho third molar i» luinally found 
in itH nortual ixjuitiuu. Up to thia period, the facial bonea 
are ooniiecte«l to each other and to the liones of the crnaium 
by Biittir«» only; and in the aolt tissue within thcw, develop- 
ment of bone takes place. 

(I) Xdln on moB af <li« Dsn-liiinMiilal »n4 FnncUcmd Relation* of tvrWn 
Hjnin cif 111' Cnuiliim. Si^lnrtnl l:^ V. VT. yayj, HJ)^ from Leaniai mi 
Aattomjr b> Jotui llUtoo, F.O. mu. 



TBKTHinO. 



as 



^K Tlio lauLillnrT tmui, wliJle tjiolr ])roc«f«H nre incnwiRl in 

^v.langUi, are moved bodily forwanl, the nte of frrowth ke«piDg 

^T puie with the Jncrnuo it the luboronity. CutncUloiit with 

<lev«lopinfitit, the motlMliDg of ourtAin jiarta by superficial 

ahaorinion ix cftirted nn. By this ptt)oeaa, the aotcxior aoiw 

fttor or the kiwer bunbr uf the malar jtniceu is rsmoret), and 

■ thiw thrown backward. In the v^vm-yt^n' specimen, it Ilea 
itDmu(tial«); bIkjvh the autofiur lliird or the Gret molar; at 
twenty-one it liolds a similar [xxitioii witli respect to th« 
•Pctmil molar, Uitifi showing a nifwiciico Li|iia! to tho millh 
of one tooth. 

Aa roipecte thu ohauKt^ of furiD aud puffitiuo wbicli the 
glenoid cavity nnHergoci! during growth, but little noed be 
aai'l. Hero wc have articular imrtila'^i-, Iwneaih which the 
retiuircd amount of bone ia slowly dureloped in the lame 

■ manner as in thu mib-irticutar ranilagc of the lower jaw. 
llu growth of the alveoUt pFuoi!» need nut bo again 
referred to. 

Allor Ihe tiMtJi are lost, the upper jaw undergix's great 
change both in size aud in (una, not, how«v«r. from what in 
called inttTntiltal absorption, Imt simply frum {irognsiitvc 
auperflcial ab«or);tioiL The alveolar piocesaea ar« gradnally 
lOHt^ and the whole Ixme is rMluoed iu thickriesx, T\w. ptery- 
goid plates of the fiphenoid bone become grcMly dimiDUfaed 
in nseaod strength, wbtlu iliu ^Icuuid cavity lo«c8 its strongly- 
pronounced margin, aud henrfi iK^comiiH flattened. 

Certain tbrms of irregularity in tho conformacioa of tho 
jaws being clo«e)y ooonecled with deviation fnmi tho uortonl 
arnuigcm'>ut of the teeth, will be coniidered in ooDtKCtiOQ 
with the lalt«r eubjoct. 

Irrfifijtirity t^ the P*rmanfnt Toeth. — Ilitherto the de- 

Bcriptiim uf the {KTmauent teeth Iloi^ I>cou coufiiiml tu their 

evolutioD when those general laws which reflate th« tim? 

of appearauuv. the position, the fnrm of the individual mem- 

ihers, ODd the implantation of the whole Mt, havo operated 

f withoDt intorruptioD. 



114 




A BTSTBM OF DBIfTAL SCBtlEnT. 



The derifttlens from the normal coiHlitionK m rapects 
■rruigfiment, nunibor, furoi, and the periurl uf tfni|itiun, have 
y«t to be considered before wo come to the ooccltisioo of that 
division of the subjuct whicli haa bran pLacud under the 
general liwwl of lectliinK. The diviricnu of this sobjoct will 
be treated in the onler in which thaf have been eoum(f 
rated. 

But before pnwiing; to the oonaidemtton in detail of ibem 
HTeml irreguhrilies, it will be Intercstiog to inquire into 
tbo oondittoiiM iimler which t1o\iaLioiut from a Domial type 
occur. Id a vpry oonsidcml'dn niiml>f>r nf canes the whole 
abounnality in wuseil 1)y purely niecLaulcal «gencte«, such 
as tl)0 nuddc n't«nlion of temiKnury tMlb, and may he 
almuet rc^aniul ma iiecidvnUil in tbuir orii^ia. Tliu eruwos 
of the teeth in such cases lieviate Trom their Dortnal pon- 
tioii far niore oon^idembly than tbeir roiits, tho ajiioes of 
which will vary geocrally be found to occtipy their proper 
plnt'es. 

But it it far from miconunou for the aU-eoIar lArder, or 
flren the whole jaw, to be iiiiiIfonnM, *.i thut the whoU 
length of the implatiteil portiuus of Itio teeth will {wrtici[At« 
ia the ine)!;ul.arity. 

The origin of such malfonnationa must be aunght at a 
period loQg antecedent to the eruption of the pcnuauimt 
t«eth; they are, lu fact^ often congenJtiil, and tnu;eeble tn 
hereditary tendoncics. 

It muab not bowe\-cr he mippOBed tlmt becauiic an abnor- 
nality la alight, and Ih apparently duo to auino meohauical 
cuuw, it may uut have iM-eii inherited. 

There ii no lacJc of ■evidence to prore that rariationa in the 
poBitiop or miiiilwrof teeth wliich uiij^iit at fir^t tti^^ht sectii 
occidental are trnovmittod from parents lochildreu; of thin 
Dr. U'Qiiilien ;'ivi's mnva HtrikLug exampU'i;.(') Thu*, bts 
found the upper lateral inciBom biting inside tbo corr»* 
spooding lower teeth in a geiitleniau, and in three out of 
(■} Pcaul CbnniM tuL iiL. p. II, oi oeq. 




TBrrDiNO. 



lU 



four of hU cliUilrea; tbo fouTtb child k&d not cut Umm 
teeth Bi the time whiin thu ohsoirution wan uiwlc. In 
anotlicr family a gcntJen^aci, his son, and liis gnuulsuo &liks 
never Iwd any lateral inciwn id the upper jtiw ; o iccond 
son uf till) miab t;eDt)enian hul tliutn Bxnwduigly dwarfed, 
•nd in aocue of his children tbcec dwurCKl lAt«ral incisort 
bud bten so uiiBi(:htly u to kad tn tlm teuth bt-ing cxUnoted 
kiu) ftrtificUl mb«titat4« put in lh«tr pUc«. Id a later diuu- 
ber(') uf the saniD juunial a lainily is meattaood a« iraU 
knowti to Atnerion deatiuta, in whom do ixvnuunt teetli 
at all are fouud. 

An mstuce of th« congenital abtence of btoiqild tftttb Is 
^veo by Ur. Heath ('), and in my uwu imclice I bare lately 
met vitb an example of the alMcoce of tba left upper laieral 
inciaar iu tbruu Hiftton; on thii right sido thcw t«cth ore 
preaeot. 

IrregDliuitiea apparctitly uKMt trinal may be, in foct, oon- 
IjsniUl: thus I hare lately aeen an iuatauce iu which, 
•Itbough lh«re is tu> crowding in the Jaw sufficient to 
•eoouul for it, the r'n(lit up[ier <»;iitrui iuc-i&ur is tu li i^li)^t 
extant twiated on ita axis, and lies a little behind ibt hWov 
tooth: jirwiMHly Uif taxuv irrw^ularity L-xist6 in lb« father 
of the child, aad will appareutly be repeated in another 
child, in wlwin tlie tooth ia as yot unly inrttally cruptod. 
A CAM b quoted by Ur. SedgH'ick in which, during bUh 
dtfitilion^ a douhle looth took the place of the Icfl lateral 
iocitor, this pecutiaiity being iuhorilvd from a paternal 
grandfather. (^) 

KiuuorouR otbvr vxajnplvii mi);ht bo collvctod, hut the 
fyregain^ will autHcicDtly ncnri? to illiutr&tc that strong 
tendenoy trj htrolitary traustoi^tuou of peculiarities wliich ift 
found to exist, and to suffice to cauac d«ntal irregularities. 

Oorrelalions of grovtb an found to exist between ]«rl« 

CI) IWoul OmmuM. roL xlll., p IIS, 

(*) InJurlMud niMSMe* ef Uw J^a & p. iHl. 

(ij Brtlbh not Vum^n MnUra-auniTg. Kvvlcw, Apttl. ua. 



116 




A STBT£11 OP DEXTAL SLmaiCKT. 



of the OT^tLaimi, vhieh, eo fnr ae wv know jit pn»eai, have 
1Ut!c or DOtbing to do Trith odo anniher; but in other 
intampleK of tbis coacomitact vuna.lioii muic homDlogiCAl 
njfttioD can be tnced betvrwD the vturing orguia, Sach 
is the case <nit1i hair And teoth, which in their oriKin are 
clotely aimilar, ami wliich only becoiuo strongly diffcwnli- 
atcd in their after dfvolopKjsnt. 

For examfjlc, the hwrlcas, nak«<l T\ir)ciah dog i» tixtnaadf 
dofioieiit ill its t<H?ili, often liavin); twaa except noe molar 
on each sidr, nnd perhaps one or two iRi]>erfect UKiaoreO); 
iinij tliu Hninc fart hiut ))ccn nbwr\'oii in a hsdrleas terrier. 
Inlifiritod baldness hu boon foimd associated vith inhmted 
deSeieocy of the teeth, atul it is fitat«d by Mr. 8eii^ick(*) 
tbit In raro ca«eii wbrre the hair ha» boon ron«wed ia old 
af^ this ban usnully been accom^tiiud by a rvuovral of the 
teeth. 

Mr. Crauford, as ({iifiteH by Mr. Danrin, statcw tbat at 
the DiiiTiitse Court there was a man covered with attaighl 
itilky hair, which tm the spine and shoulders was as muoh 
as fire inclies iii len(!;th. Ho had DO molar teolb, and Iho 
iticiiiors wire ver}' small ; his daughter inherited the pccu- 
hiuity of a hairy nkici, hor incf, even iudtiding the noaa, 
being covered with silky tiiLir, and, like lior Esther, abo bad 
DeiChor molar nor bicii&pid teeth. 

TUea© hairy person* did not present any marked pecu- 
liarity at birth, lave tluit thcrs wan a little hnir about the 
ears, whence it nprcad aU aver the body ; and it is a signifi* 
cant bet that thoro wa^ nothiu^ nbcumiial En thctr milk 
dentition. In the c&ac of Julia Pa^truia. rendered ramout 
by the eshibiCirio uf h«r stiifTui iskin aftfr Itur death, tbo 
forehead and the chin were densely cotered with hair, and 
there wurc wi uiaiiy supcrnnmi-^rBry teeth in the mmith tbat 
the appearance of a doable row of teeth in each jaw was 
presented. 



0) Carwla, AaUnili uA PUuu mukr ItamMtkuhn. vol. I., p. 31. 
i*i Brltldi sad ForvlfR Ui^Xo-Oilnifc. Itevtow, AprU. 1SG3. 



TKKrUtNO. 



117 



It is rctiurked by Hr D&nnn(^) that thoMorden of the 
Hoimualia nrliich are ruont aberranl in their dwmal cutis'- 
inga, namely, the Cctooca and lUieatatA, are aim remark- 
able fur cleficieoRy or redundancy in th« Dumber of their 
l«eth. 

The aHociaUao oT certain forma of maxillary d44bnnily 
«ith other d«f«cla, inch at coag«uital idiocy, majr jwrhaps 
be explained on iht' priwnple of corrclatiuu uf t^ruwth, btU it 
will be Riure conTenir>nt to defer tba diaciuuuou of thia 
branch of the inibject until the npecial irre^laritic* alluded 
to are denoribed. 

Dental irre^taritieA in Mine few instances only an* refer- 
able to the action of tba law of *' correlatioa of growth ;" in 
all the instances with which I am acqiuiinted thia law haa 
operated tti )iroduci»g eillier deliciuiicy or rwiiitulancy in thu 
nomber of the teeth, rather than in oautiiig the assumption 
of abiuinnnl fonrui or positint). 

Irrf!ffuiarilii in the pmition ff the permaient tteth, Utv 
ipeotivc of tho numbrr involved, admiu of divlKlon into two 
diltiucC gniupH. ItU lrrp<;iilarity in the pusition of th« 
CTDWDf, while the roota at thoir temnual points hold the 
usual place. ^Dd. Irregularity both in the position of the 
erowna and roota. The fonoer tisu&Uy admit of treatment 
which doc« not nececuarily involve the toaa of either the 
miiptaeed or a neighbcniring tooth ; white the latter ci^es do 
not admit reniedy, excepting by removal of tliH luaiplaciAl 
organs. 

Tbaae exnmptca which fall within the Gm division will be 
first cotisidered. 

Thu bout teeth of the npper jaw, inolnding the conineH, 
may deviate from the uanal position uithor by {•"■j^tin;: 
forwaid or retreating hockwanl. In the former def»rmiTy, 
the (jrominenoe is tomotiine* luffioieDt to prevtiiit the li(H 
^ni cloaing ; hence the t«eth are coiutuitly expo«t.vI, cveu 



(>) i ittBuli tni PlttiM VBHhT DoanUeUluci, y. >V- 



118 




■TCTm or DRSTAL flUIlOBRT. 



whoD the mouth ie shut. Tbe low«r li|i, iusuotl of I;; 
over tJi8 wlgM of the Wvth, pi«sit« bchiml tlicin, while 
lowvr tijelh meet Tbi> t^im |MwlRriur to tho ni'okii of the tip[er 
tocth. In searching f'>r the canio of this iinsiphlly form of 
iiregularity, wo raust cxaniiuo thi; ctinditinn cl' both tbe 
Upper anA lower jnwe, tnd aUo tlio (ftntc of uitagoniiiiD of tlie 
upper and lower teeth. 

The defiirmity may rwutt IVom cxcewbc dovelojwnent of 
tht> alroular ptuoewM of ihp anterior port of the upjier jaw, 
bitt more commonly we dall firul that thi> nuilnr t«elJi are 
nDoanaUy short, thereby allowniig the inciiwr twth of the 
lowor to pKbS unduly upon tlie incliiml lingual tiirCaccM 
of the teolh of the upper jikw. The upixr tftth, yielding to 
the presmre, are forced outward, mid ure rolaiiiwl iu the 
malposition by the twtti which have l<?il t*j iIib di.tplaccmcnt. 
I^ In cases rosuttinf; fr^m llio lattvr cuusc, thi; imiuiry be 
oxtcndwl to ibc cimdition of the lower jaw, it will bo found 
that with the eliurt molar kt^th vra have a nhort alveolar 
rang« and short rectangular ramus. This conformation li 
prohahljr the primary cause itf tho niinchicf. i:^u[tpnniii}; the 
line of growth in the mm(ij> to hare becotne nearly rectan* 
gnliir, as roganls tho ImxIv of tbp jaw, prior to the devclnp- 
nflat of the wisdom t«et)], aod tbe amount of growth in tho 
Tertioal dinvtion to liavo been tlefidcnt, the m*>lar teeth 
would \v limited in hei|;ht by the antagonism of the oorre» 
apondiiit; teeth of tlie uppor jaw. That the length of the 
taoiar teeth is inlliienr«d l>y t1i(« groM-th and pi^iiiiou of tlie 
ramnA, a caito at present imdpr my treatment Kitisfactorily 
demoDotratea. In this in)itaiic« the ramus has prvacrvod the 
obliquity RhAraoteriiitir of childhood, and occasion* lh» per- 
maneut •epamlion of the tip|>LT and luwcr front twth when 
tho mouth is closod. Tlio pnticnt Is upwards of fifteen, and 
the usual numbia- of t«L>t!i arc prsReitt, but tha necoiid per- 
manoDt molars arc tho only t«oth that come in contact, nud 
thcsu Hcarotdy project aUive tlie tp\'cl of tho giimn. Hero 
tbe ruuuH is sufficient lii actual lui};tb, but the obliquity 




TlBT'BIXfl. 



119 



renders its lenjEth nunvnilAtito for the Tcrtknl dantopmant 
of th« TOobr teeth. IC then, mt have a rcclAognUr runus 
of diminished lengtli, with Ehort gritKliai; t«eth Daiocidmt 
witb welMevelnped iDcison, it iH not diflicTilttci see that the 
opper Drill lie driren natmnds by the lower frant toeth. 

The c^mditfoii under connderatioa may aUo ariM from the 
tArdy cni[ition of the molar Locth teavini; the inciMir-i Ut act 
tvr a time upOD aach other, as they do when from any antto 
tha hack teeth are lost, Theo, again, the inciHore of tho 
lover jm ouy attais an tmuiual height, or thoy may projeot 
10 an UQiiBual dogrm, and produce tho uitachlef. Or the 
raralt nuiy be cooaequent upon a ro^lar linear armngMneiit 
of Urge tenth in a Jnvr having a small nlrcular hone, in which 
oaae the teeth ^or ta their croptioc will aMume an unuaaal 
ant«rio^ obliquity. In aome uwtancoa the teeth have btwii 
slowly forced outwards by mechKDical preiwiire oouse(|Uent 
on a child jimctiring tho habit of snckin;; its thumb. 

But whatever tJis cauKO, tho t^uutinent uf this fomi of Irm- 
gol&fity is apt to be veiy troubl««onie. It i» riot diSlcuU to 
redncB the teeth to a ]voper poedtictn, but it ih very diBicult 
to keep them thera. Id a case which came under my troat- ■ 
nMOt four yean ainoe. tlio oppor tveth prt^jected ontwardH, bo 
thai it required a great efibrt to get tho upper Up over them, 
and whc« the month was closed the flngcr could he laid 
between the lingnal anrhctt of the upjior and labial nnrfnoB 
of the lower teeth. Tho habitual position of the under lip 
ma behind the upper front teeth— a habit whicli in itwlf 
no doaht tended to incraase the amount of deformity. The 
arrmngement of the teeth, as rwpects each other, was per- 
fectly uiufurm nod withuut inter^'euiog spaces, while this base 
of the jaw wns normal in size. It was therorore quite obvions 
that before tha teeth could be pressed backward, spoce mnst 
be provifled to allow of their movement in that direction. 
In order in effect this, the two posterior bicuftikida were re- 
moved ; a meul pUte wns then fitted to the labial snrfaoe 
of the projecting tooth as far on either sidi; as the oanine, 



190 




A STflTEU OF DBKTAL SCRfiKKV. 



md was extnndcd inwnnlB liolow tli« edges uf tbe tootli in socb 
a maaoer a» to pre\-CDt th« under lip frotn puudng behind 
Iho nppPT trcth. A Btron^ boml or Tulc&iiizcd cnuutchouc 
vaa Connected with the plate, and paased roUDd th« bnrk of 
ihe head, hy means dT this apfaratos the teeth were in the 
oonrae of six weeks presaed into a very good }>>siliuu. The 
lipa could l« cl<i4«ci in tlie UHual manner, aiul the mouth 
when Boeu in (irufiie had \mt ita ubjoclicNiahle (jromtuenoe. 
The pnlient on leaviug fi»r iho coiuHry wn« ilirecwJ to wear 
the apinratiis during the iiiglit fur cU muutlix. After tire 
lapse of ci^htticQ mouthi) Khc rotunicd to town with the 
mnuth jufit aa (imiiiiDuut as it hoA been Iwfure IreatnieaL 
On inquiry [ found that she wore the plate for otic month 
only, the i'laalic: bnuda ha<i then ^ven way, and the piwran- 
tiotury meaaurcs hail frftm that time lieen negiecl«l. In the 
inlcr^-ai the wisdoDi tc*etli of tin' tipjier jntv had hn-n cnt, 
and tliey B«eined to have exercised aouiu iiifluuncu in forcinf; 
the lectli Into th«i fjrwanl [msitioa. Bnt Bonie other canse 
than this was also in operation, aa the leetii, although pro- 
tnincnt^ were not now, as fomnorly, in cLobo lateral contact. 
•The wisdom tn^tb, from their |)o«itian, lieiug iierfoi'Lly use* 
loH, were remoToii, and the treatment aSroady described was 
TVDowed, and with thv foruier siicoesA. Thci teeth have now 
aettloddown into n poKition intentu^liato between thiit which 
they held Iwfure ihcy v.vtv niilijoctotl t«) truttniutit, and Uiat 
to which thi;y were rediicwl hy the u*e of the \Ante. 

The foro^t.'iiig «iso tiiay, I think, be rcf^unled iih pre- 
sctiling typical characters, and may therefore be dwelt upon 
for tlio piirpuse of uiuciJatiiip some of the jit'iiural fealorca 
oanni.4cti.id iTith irrcgiilarities bcforo we nd^'anco further. 
Potteibly the front ttwth, while within the nlvrolar cry|iit«, 
assomed an nnusnal obliquity of position, and thus grew 
outwarde independently of any inlliience exerted hy the 
antagonistic teeth. But whatever may have boeu the cauw 
of malpofiidri]), the growth of the teeth wan uucompaiiied by 
the derelopment of stroDjjIy-pronouiioed dreoli, oorrc«pond- 




ntKTimvo. 



ni 



* 



'bi|; in dinctian witb that of the lecth. In cues eucb u that 
.docribed. it ic sofficicatly obvioua that before tlw dircctioo 
of the toeth can lie itmujuienltjr chao^d, tbo <lim:tton of 
the weketB must aUo be Albgrad ; • couuderebit! portirm of 
tbe exuting atreaUr (iroccKses miut he. removed, and new 
booe for tbe rppcur or rvbuildiag of tbe tockcts Ife imduoetL 
]t may not, however, be uvcfuaary tltuT tin; pcwJtiun of tlie 
buttuui of tbe Bockete ubuuM ]»: cbun^iHl, nltltuugh tbe inAf- 
put fvquir« to be ruiuced u> a semicircle of tiiucb sni^illcr 
f*'*i'™i iivw we kiiuw thut niMlemte [iretnnirv, vuiiHluiitly 
raaiotaiDcd afnti bone, will lead to its absorption ; if thtrvfore 
the cruwns i>f the tutUi be atcadily and constantly prcHSud 
vpoit, thai portion of iho socket which rccch*** the jircsfflre 
will gradiuUly diNapjKiu-. 'Hxe imniniiRte reRiiIt wjU he aa 
MlI*rg(in*Dt of tbe iHwket in which tbe tooth will foi llie 
ttne iMivc imAy ; in i>tiicr words, it will bwuinc loo«r. 'i'liie 
ModHiou, if luDi; Doutinued, wonld lead to the rarly loss of 
tlw Kmtb; bencv, to eusure suucen in our o[)c'mtii)iis lor 
nadjiutiiienl, new bone muiit bo produced in those {nrU 
vt the iocltt^ from which and towardii which the root of the 
lootli haa tiwved. The fact of a tooth becomiog loose Under 
■DdoD prewore, iihows that the abaorption may ]invecd 
man rapidlj than developateut of bone. 

Tbe reeognitioti of thi« faet, which may be aMiimcd as a 
ojBstant eundition, luggcftta a wry important queatJon — \'uL^ 
at what rate in Twpect to lime can new alvootar bone be 
Anvlofiod, whi'n iho nituoval of Ibu pnM.-xbilini; tiBstic has 
ban Ind'Kcd by preMure? The dctermiiuttioD of thiH point 
viU alao aasiBt tn determining tht< degree of prensitru which 
he oaed tnoal advanlafteotutly, aod the letigtfa of time it 
rill br nncMsary Ut (tmploy merhanicnl mmns for retaining 
tvolb io tbe poaitioa iiiti> which it has bwn furcvd. If 
rttmiw cnse be taken for ireatmenl, the oitiiit of cluuge 
Itwed, «up|tAi<inir Ihv tnmtmetit to bo jicrmauvntly tuc 
will ammnit to lb« deetmctloo of a roiP'tdcrablw 
of the esiatiog, aod the production of new ulveuli. 



133 




eriTBic or dbntal bvbobht. 



In tho ab§ence oT ve]I>«st«bliiibm! &cu gatn«d fhna dl^ 
Mctions, io TMpect to tho period requirvl either for tho ro- 
dpTeloptnent of alvpoli, or the dogn» to which restomtion is 
cftrried, we (ire tliruwn \i\«m tba general rcaultfi obtainn} in 
Uifl treaUncnt of cases, and upon the conditiona which are 
fouDd to obtain in tho dcTHlopnirait nf alveiili itiiriii]; the em\>- 
tiro period of dentition. It hn* bevn shown tliat the H>ck«t 
j^TOWA up ootconporaneoiuly with the gnuliift) dBTeln^Hnrnt of 
the toofh, btit in this cm« the prootw of growth is extended 
over mBQy month*, and tho reiinlt« oht«iiiwl in the rediic- 
lion of imgularitics do not t«itd to show tbnt tha alTeoUr 
reparation is moro rapid thuu tUo urigina) alvwlar dsvclo)!- 
mect. 

If, for fTampI*-, slightly ]»rot**''"R t<**h arc by tamat of 
pMssuro bnmnlil ropiJIy into the proper liuo, and are th«n 
Icfl without mechanical Twtraint, they will spnodily return to 
their former ploLV, ami tn.'ouluc firiiiLy fiivd lu llivir suckot« iu 
a much shorter timo than they would have tioae If rcuint^ 
ill tb« newly-aoqnirwl pttsitiun. Thia circuiiiKtanoii would 
Hem to indicate that in moring tho tocth tho sockets had 
boon atrctched or bent rather than ahHorhcd; but thcTB are 
many caatw in which lh« aAHumption that the bone yields by 
itaelBBticity in tlit>dir«ition of the preaanre appliwi to the 
t««th, does not ufTor a ntii&cbory explaaatioii ; and I am 
dieiMisetl X(i think that oven iu tho cases wht<ro thi» exi>la- 
nation wutiLd at tint sight appear tenable, thu pheovuicua 
may Iw attributed to oiher catuos. 

The immediate conMqncniee of <»ntlniied prfwmre open 
the crott-n of a t^toth, is irritation and thickening of th« jieri- 
detital membrane ; and this resnlts in the tooth being raiited 
in ita ftocket to an amount ec^nal to the increased thirkneiw 
uftho uii^nibrauc 

The root of the tooth, from its more or I*« conical form, 
aoqoirm, wliL-ii raised in tlie Kwki-t, an inon-Biwd ca|«bi]ity of 
motion, without tho bItcoIus itaelf becoming enlargwi. In- 
stancM in which tlioae conditions ar<j pnidueed hy dlc^ase ore 




TKRTHINn. 



133 



I 



mrv. A loath is attacked vith pain, and in a 
jdlieut iltKovertt tliat lb« tooth hut bL<cumv too 
And frcb "lifihtly loos*. The inc«*»ed c*iAbility of 
uutiua in racuRiiisud if Ihv Looth bo |;nu[)«il botwvca the 
thumb and fingers; but It irill at the same tJme be found, 
thM altbouKh it n»dily yields within cert&ia limits to jires- 
nn, jM chat llie momn«nt is abruptly stopped when tb« 
Mm of the root eomeB id contact with elthar wnll r>r tho 
■odtet. A picoeof india-nibbercompcMMd betVMn two twth 
will, in the coutm of a leu* hours, forcv thnn ajiart, each 
tooth hecomioji trader to the touch and alifchtly loose; but 
altbtiugh tlit> tn-th, on the rcmovsl of tbo awutchoui', for a 
UnM etaitd upwi, they will spcmiily raeumo their fgmtcr 
poaitimia, bccoaw 6rm, anil freti from tCDdernew. In this 
<ue, it fan aearoety be amiuwiI that th« socket became en- 
larpd by abMrption, ud again contracted by depoeitioa, 
ilthoogh the MparatkNi wsa |;rentcr in amonnL than could ho 
amMtntad for on At njipoiition that th« pnideDUl mem* 
Imne ooly yielded to the prc«min< ; but tlui diflloulty of 
CIpltMtioik dinappears on findin^t tb&t the le«lb ar« dightly 
nbad in th? socketa. In tba« inaliiucce we have pxaaijilcfl 
of the nuinner in which the pocitioD of a tooth niny, under 
iwwaiira^ Iwcump rbanpcd, wilhnut the auckel uudt-i^uitig any 
wknmnent. In the trvatment of oaaec, we find that within 
the iirst twn days the out>»ian'ling teeth show most iMtla- 
lactQr>' remlu, and wb are a|A to oooclude that the difficulty 
win be rmdily nvirrcoine ; but in aubeequeoit examinations 
we fail to rvoogniM a oorTe«|KBidiiig amount uf jirogireaa. The 
1n*olv«l soft tJaaw readily fteld, but until remored or 
Weakenni b^- abaorpLi^iQ. the bone nf tho nookotA resitta tb« 
ftirtbor tnotpoicnt of ibc toelh. The rate at which it« 
Nmoval wo bv aaft-ly mdnnsd is not, I think, utinboturily 
WDertahied. That we ciin induce its sbiorptlon. natn«rais 
WfamtAei fitfre : bnt lu cmler lo briti*: ulout tho re«iili, it is 
aw Mw ry that the imMinin should W umroRD in Avfxvci, and 
b&ioterruptird. Dalructin taflanituatiuu will iw t«t uf if llio 



134 



A RYSTKU or DSNTAk SDRflBaT. 



pressure be loo k^'kIi mui iT il Iw t«u tlt^ht th? twtb will niA 
move, or Iho mowmciil 1:4s m slon- th&t bntti ihe |«ticnt lutdj 
pnctitioaur will booutiiL- wrarittl bcTorc a succcMful result 1 
been gatnei^. A certain amount or initation in the nocket i 
& neoesHiTy att<!ndant upon the trfjiiiiiptit^ niherwiac nhsorj^- 
tioo of tilt) Mjckct would ni^t l<e il:l■luct^L Other coiKlitiona 
being the same, the age or th4> i<alient will inf!tieno« tb« 
resulte. Tb« younger tlte patiunt, tlic uiuro muitly cnn tbo 
teetJi be moviKl ; th« old«r, the more difficult will tbeopvratioB 
Iwoonie. 

Sui>posiag the irrepiUr tMtli to have been reduced to a 
pivtper jxiHition, mid tliAt the niarcnieat of thion has been 
attimded with a ccrtaiu [iiiii»iiitofdo!«truction of tlic exii>tiii|M 
•ocket, we havti thtju tu inquin? whothrr the lout [n,rtH will bo^ 
iilUy rephioed, aud x{eo, ihu Ivu^th of time rts^niTud fur 
formation of ttn? new bone. It is not prolmblv that a Bene 
uf [ireEioratiuiis, iUiiNtmliiig the coiidititm of the parts at' 
tlifl^reiiC stages of treatment, will l»' ohlainvd; wc totut 
tharofure beoont«iit with Ittw [nixitive infiirniAtiiin than Htich 
a MriM would fiiruitih, nml araiV onri>elv4<iH of such facts ul 
can be gatbcrod fruiii thosv ausen ia wljiuh t^wlli have been 
foroed from tUeir former positioQ by a loss of proper antago- 
nism. "Che diBOcrling-room will fartiish I'xampluii of thisi 
cbaraotvr, and in them w« shall find that the shifted teetk] 
havo a le)» pcrfivt iniplitntAtinn Ihun those which have 
nndisturlxMl. The Bt)ekt;t» will not riKo to the level of 
of thd other twth.: from which it may lie inferreil tbnt the 
luKH uf the ditipIaccU tuL-th will \ms luutteiit-ii. Whether the 
flame conditloTut obuin in teeth which hnve in early life 
intontionaUy uuvod, ubtiervatiuuii directed to iDdi\-iduail i 
over very many yc:ir« rjia alone dvtentiinv. But suppodngj 
thay dn, we must piit o^iost the diflndranta^^e the fact that 
the labial wall! of the K-xk^ts of outstanding teeth are very 
oommonly di'Beient in etn*nirt)i, or ini[)erfect, and that teeth 
■D placed are liable to become ioojic prematuroly. 

Admitting, then, that Bockctj partly removed under treat- 



TKBYUINQ. 



125 






ment will b* rector«<l. the qtiMttion iiriii«t us to th« time which 

will Imi uvcupied in thu n'stvratioii, — in othor wunlii, how 
loug it will be DOcoMBfy to liold the t<«lh in th« u«w1t- 
tpqtiired HitualJon. If unrcstruinx^d by niix-hauicul iiieatK^, 
'iuA aDlnfliUDced bj* antsgomstic t««tli, the old poATtiuQ will 
anoD be r^ainecl, and the teuth will lieoutDv firmly dxetl in a 
much Bhorter time than they would do in th« acquired post- 
ti<yn. It would appear aa if tbere were a natural law tending 
towonli the niaint«iiaiic« of a coDforniation when once &&■ 
sulDOd, allhough nn invgiilar nni%Hnd whirh cbIIs tntniirtiaTi 
the repruductioQ of a loftt jxirt more mtiidly in the place in 
which B tooth hu been moved from, than in that into which 
H liM been morcd. 

W« constantly Lear of and sec cuies ia which outstanding 
front Uelb hare lioen roduccil to regularity, and have buIiw- 
queutly reined the objectionable poeition, Dotwithstacding 
the aaaunnoe* which hare barn held out tluit anch untoward 
rmultaareconBeqiuuit upon want of proper mauagenient on 
the part of the practitioner. Thirc in, [«rhapK, no point in 
the wlioln field of dental surgery thai yioliia a finer harvekt to 
tb» charlatan than that n8<irdcd hy the titfatriCTit of irrognlftr 
todh. Tlic pulicuts are ueuvwerily yotiug ptople who have 
not i«s»ed from the core of lb«ir parentH. Thero ta a ^^reitt 
dcBtni oil the part of thu lalkT that the tc«tJi shuitid hv good- 
looking, or at [cut not ill-looking ; at the same lime, thi-'rc is 
great unwillinjzne.'ui, Ixith with tlie patitat and the parent, 
that the trtauncut thould bo exlvndcd ovur a long piriod of 
time. Tht' prt'«-n«.* in the mnnth of a mechanical apparatut 
preMint; upon th« teetJi intL-rrorm with the comfi>rt of the 
jouDg jmtieiit, ami th« fnxiiit^ut altcndanci) at the house of 
the dentist encroachwi iii«n the hours nllotied for rttidj". 
Both circunistaocM reuder prolonged treatment liksoiiie, 
intpelieooe ia aliowu, the inctmcttoas are nogltfctcd, and, aa 
a natiintl confietjuence, the reaulta fall slwirt of those which 
might have been obtained had the treatment btxm consistent. 
1 believe it is iu accordance with the oxix;ricucc! of thoae 



BY8TEH or DBNTAL SrOOKItT. 



wbo htvc deroloil thoir attentino to Uio treatmeDt of irrago* 
l&riti«^ that where the trout t«f>lh have heea )ifx>uj;ht id 
by mechanioU moauis sad where mechniticnl mmtis are 
required to bold them in place until th^ become pertnik- 
oPDtly 6x«d, the troatrnvnt muat be C0DUutH.-<l for twelve 
mouths. It may nut be uecc»8ari|' thai the appunitus tJiould 
be coDaiAntly worn linr the wbnle (wriod, but it vaiiuut be 
wholly thrvwii a»\de. 1'uwanla the Utter yatt of the time, 
it mAy he wi^ni occiuionally only ; but even after the lapse 
of twclvv nioiithis Kbimlil tliv tv«tJi vhuw any iudicatiMO of 
mox-ciD'CQt from the desired position. luecbiuiical restmint 
muKt Iw Toaiimi'J. 

The foregoing remarks apply ^eticrally, but each case will 
prvsutit itK Dwn peculiar chuncturistics, unit Lbtt truotineut 
irniat 1m> varied to iu««t th<m. The age of the jiatieiit, tbe 
state of health, the degree of aiwceptilnlity Ui irritaiinn and 
pain, the uumber and oonditkui of t««tb pn;iM:»t, tbo tita 
of the teeth theirticlwR, the sixe luul funu of tbu L>a»L- of the 
alreolar portion of iho jaw, and the conAgiinition of the 
nine port In tbe porcntu — all these puiuu niiiat be taken 
into conaidflratJoQ bcfure a course of trentmeut is dvter- 
tnioMl on. 

Bi'vcrtiu)! to the com related (m the pur]>060 of introducinK 
a statement of those cooditions which prvvnil more or losn 
in nil tauwH v( iimlpuMitiuti uf Lbi; locith, it may Im ulucrvvd 
tlmt other methods than th^t adopted might bare been pur- 
anod for brinfpng inwarda tlio pmjccting teeth. Thus, » 
plate eitlier of vulcanite or of mul&l might have been fitted 
to the hard palate and U-\ the neoka of tho molar teeth, and 
to Ibis the front toetb miKbt have been tied, either with silk 
or caoutchouc Ugaturee ; or a metal plat« luiglLl bave been 
fitted to the palate, and extended to the labial surfaces of 
tlie loolar teeth, and on eitbvr side attochnient'i for a band of 
india-rubber stretched over the labial Burfaces of the frrnt 
teeth might hare been ntaic The appamt\is adopted, bow- 
ever, posMssed an advantage over tJibee ; it pruvcutud the 




TEETursa. 



127 



ttoddr Up frtm exanusint; lui antaganuitio iufluence, wbile U 
WM Biinpt« ia cooBtrocti^ti, aad readily applied. 

An oppatile form tff duplaticment to titat which kat bttn 
dtrnxibed U/arfnm uneomtntm. — Theautarior t«otlit iiutUad 
uf Btaodiog Dut Ear in I'miit of tlioac tif l-he lowrr Jaw whca 
the month U cloaed. &re dir«ct«d mwiiniB, mqcI pius bebinil 
thetn. Tho patient is anid to bo trader-hunjj. The upper lip 
ii gencnliv »l)ort aud retnatui)^ wLil« the lovr«t lip and 
chin hold ho unusually forward ptwttluo. 

If tlio cuinoidcat coudttiutus uf thu Jak-s be examined, it 
will be fcrund vitbiT Lhut tbu nlvwlar rid):e of tlko upper 

1^.11.(1) 




DUVxiUa is tiQUioally small, as Khowu in tbe iicxx>ui [Maying 
t^oxv-, or ibHt Ibe lower jaw baa departed from tbe tmrmEd 
larm. Id tb« spfcitttea from which the illuetratvon is token, 
the infmor maxiUa docs nut differ, eitbvr in ^'Dcral dimen- 
BKHu or ia oouGguratiuu, from tbe uoniial xpcciawns ; bst 
the U]>per jn.w id itit nlveotar portion ib beluw tlio usaal di- 

' (1) Showing Uin <«Di]it|nn «f iW u*ih Mill J»wi III • ■p«(Un«B In whldi ibn 
•ntoriiT (■[•pvr IMli were taTMUd MlMidtMly wub MMJm uat in ibn 
inprrlur mMHlL 



A BTSTRM or DBHTAL SUBOeBT. 

meoainns. Th« tmtJi nrc i>IjKcd regul&rly, btit ttie ilTcoliir 
lino in fully octupiwl, to ihi.' rxcliuiuii of the wisilcHii teeth ; 
and the hcod<1 looliu do«o» upoD. the Uiird moUr of the 
lower Jaw in tlto {junitiuu iiMunlly awngaod to the wiiulotii 
tootlt. wUicli. fruoi itA backward direction, \m thrown alto- 
gDthrr (lilt of tifie. 

The ti^iir« which illuatrates the inventon of tbo appor 
teeUi o^notiloiil with a woll-gmwn apper jaw, is takeo from 



«r.M.{i) 




t ipeciiaen in which the temporary t«etb &re prount. la 
this due wo have an excess of growth in the lower jaw, th« 
hody or which is tUKUoally Idoj;, and iB associated with a 
ntmuji which hus prewrreii the obliquity vhara<.'t«ri8tio of is 
mttior ag«. The line of growth, en indicated hy the poHition 
of (he artiaibtr process, i> calciiUted to giivc great length of 

()) Stev* iBTFralim of tfar ui>p«r frmi UHti oa(Ddd>nt wlUi uiintuol 
i|t¥e)o|Mnim of ihe ktwtr )*w, tbe njiper tuUlU b«*kiK aUalixil itur ovraui 1 



TEBTniKO. 



129 



jatr at tW oxpeiuo of depth ia tho ixxterior portions o£ tlu: 
olveoW line. 

Tbe CAUH Oif Uui mnl of proper relationship between tbe 
upper luid lower jiiwsaiid tbi'ir n.-s]iiH;tive twth, is in nuiny 
caoos vory obacuie. lu ccrUtu fauiiliM it ucvura s» au 
lii-FodiUry cttaravttT. In other caws, the ik-furriiily may 
bare boen coarnqneiic upon tbe relatively tardy sniptioa ur 
the iDvenc<d poaitioD of the upper toi-th in infancy. 

Bnt wlintever mny hare been tho cauee, tiie malpofitiou 
wilt l)c [MfBincnt, unless remedied hy mochanicsl interfe- 
rence. The under teeth will present a l)arrii*r lu the out- 
«rard tnovement of the inturned teeth. 

If suhjci-ted to treallDUQt at a sullieieiilly vaily fioriod, 
thesa cases may te )»x>ught to a iuocc«»faL isAiie with macJi 
leas diAiaiUy than iboBe in wljieh the teeth arc everted. The 
difficulty of keeping tlie teeth in tbe [usitiou into which they 
have been Ditrvai ia remedied by the antagonistic to'th of the 
kwar jav. Wheu, therefore, thu upimr aiu liix)ii<;hl sulTi- 
dently fonA-ard to close in tronl of the lon-or teeth, onr treat- 
menit may be diEeontiDoeil. 

NoTT tlicre can be no dilTcreiioo of opinion an to tlie 
pTX)[irieiy uf adopting measurea for reducing: to a ndrnul 
|jo«iliou l«-eth whidi are |>erQiiineutly turutid'inwardii. Wu 
hnve thercforv Ut conaider tho age ,ti which the oi«Tntion 
coo Iw most ailvauti^euiisly uudertAkvu, oud tho matuier of 
Iierf'^rmin;: it. 

Tho anatomical conditions of the u<eth,nnd the parunlwul 
thciD, At the pcriwl of vruption, hav? K-en already deiirribod. 
If these conilitions are understood, Imt litlle doubt will Iw 
eDturlaiacd upon the propriety of adopting mechanicat trenl- 
ment at a oowparulively early [icriotl. Thoro would be mi 
wlviuita^ gained by waiting; tUl the vockots are fully formed, 
aa tho treatment luiul tht^a inruh*e their ]xu-tinldt;ainiciioa, 
and tbe reproduction of nen on«ii. fu the ot her liiuid, if the 
treatment Iw cumincm'^il jiHflicienlly early, tho liir^o ojwa 
SPpkctB will allow the growii^ tcetU to be tuuTcd furwanl, 



L80 




A BTSmr 09 DKMTAL fUBORBT. 



■tnd ihoso parta of tfaa sockuts an yat naformol will bo deve- 
loped ia acoordiuice with the directiun given to the teeth. 
So Buon, thi-rt-fure, as U i» dia<x>vercd thiU the iijiiwr full 
wiUiiu tho lowvr front iccth, the treatiueat may be com- 
mBiicfd. If meaaureu wbto aduplM prior to tho oHiabliBh' 
merit <.>( intti^ilar antagouuun, n'u sbuuld |wrba]ffi be cfiectjog 
by piiK'liaiiical interference thst which oatnrp wmilil bnve 
nccumpliGbod with much lens iiicouvumeitce to tlie jiaticnt. 
¥tvr can liave EUlcd to remnrk tbo rancli greater piemlcnce 
uf irregittartty in tbv pormaueLt tucth ubuut tUe tiuL< of tbrir 
eruption^ thau at a Inter [x-riod, in that cl&u of society the 
memN'ra of which do uot avail thonutolvBit of the SBrvibee of 
tl»e dcDtiat, exceptmg when the proHcnco of nn achiag tooth 
v*n no loni^ l>e Imrnc That in many iitBtanoea teeth whicb 
oa their first Ap{>earanc« tliroiigh the gimit hold aa objvo 
tioDsble position, will, if left tu thom«lvf'«, uLtinintoly fall 
into tile iirn)icr Unv, is a fact suflicieotly well elltabli^be<.l la 
wiun US ft^'siniit ititcncroace until it iit olearly Bbown that 
our oaBistancn in repaired. 

From tho frequency with which irregtilaritiea aiv remedied 
by uaturt), it has bucti 8ii|«|>owd tiiat there is a Ktruii^; io- 
berent teadeucy towardfi the awiiimp'tion of a. normal poatioo, 
iiiid that tcuth will iti couHuqiieiicu uf thus teuduiicy, aU 
mecliAUical obstacles bciug temovcd, uke up a regular 
armni^etuiTit. 

This exi>lauftlion is not, however, wholly Batisfocloiy, in- 
nsaiuoh na it ignnn» the Existence of eertain mochnnical 
agencies which are in constant operation, aanaely the 
prcsanrc exerted by the tongue and by the iiji*. If any 
tooth |iroject outwanbi or inwards beyand tbn line of Ibe 
surrounding teeth, it will obviou&ty auitain more than its 
nhare of the i»roefiiiro exerteil by ilio niiiscleii of tho lipa or of 
the tongae. Aud as the lifts and tongrie act eveiUy aod 
itynimelrically on every part uf ihv alvcoUr arch, their aoliun 
will ubvioii>ily tend to the correction of aity irregularity 
tliat may have occurred, if a regular diiiiM»itioa of the tcetli 



TEKTBCtQ. 



131 



not rcuilered imiKKiBibte by want of space, or othor mo- 

luival otstacie. 

Tbe moacles of the toDgue Id iU vtiicd xaovemaiu exert n 
man puworfal ittilacnce tiuui tbuee of the lips ; aud tboa it 
hi p p en i that a ux^tli {tlaced tiuide the arch la for more 
quickly pualt&d into itx nunual |KjHitiun by tht> uperatiofl or 
ounnU forca thnn one vbiob lies oniside the liiie. A very 
alt^t auioant of tone, if only it he cmslauliy ai^ittieil, is 
fldHdcnt ti) alter the{]u»itiuii of a ticwiyvruptcd tu>tli ; and 
Ihia tvea protjim- I'f ihv lip*; niiri ii>ii|^iv i.t jirulmlily the chivt 
«g«ocy. not only in corroclia^ aiiv im-j|;utarity tiiat may li&r« 
■hsGD, but also iu i]pl4.-mrniiiif; tbe regular arrao^ciucDt of 
tbtt teeth duns* their eraptiun where no mecliauical obstAole 
nutfferoi irith tiK'ir orra dUpuKiliun. 

Some dilTenaK-e of o)Hiitou exuts na to tho beat mode of 
pRMiQx ibe t«ih uutwMds. Tlie oWw method of procedure 
Mauaalnl in licthi^ a inotal plate tu thv luwcr t^i-tb, from iHe 

Kirface of which a plate of metal i>toj«:lvd, which, •oi 
the iDuulb, {asBcd twhind tbt; iiviii wlioae posiiiiio 
change^ Id tact, tlte lower tuetb were by this pnn 
firially lengthened aad tumo] inwordii, ukI oonn^ 
the amoBDt of force cxert«d upon tW Diitplacod 
neta aepeaikd entiiely upoo the vohiutary notion o{ the 
jaw in doeing the uiouth. la moiiy cMe« Lhla mvthud 
trenitncut will be raccewful, hut it is slow, nnd ooneo- 
tly jirodacea a proluaged impeduucat to urliciilatiim aiul 
and it U u\Ka to a furthvr ohjcctitjii. It ia not 
ly CQCcesaral, and at 1teet ilejwndji to great, pari u|oa 
tha "Vuluntary cflbrts of the* jnlioot. 

lien reouijUy, Tul<wiilf ['latea fitlnl tu the jjulnte, imd 
vtanded over the mular t<'«t!i, bare been ad»[tte'^. Thi- vtiU 
caliile over the umslimling surfiMca of the iikoliir twlli i 
auffidoDtly thick Ut prvTvnt the uJiMr uihI lower front > 
ftuoi uillumtciuij mcli ^>thcr whtii ilie moutli ia clwn). Th<i 
(late Li dtiod lo iho necks of the t^-otb tu be opuniit«i a[ion, 
bttwecn whirlt and the pinte portloDB at Ury ctnii|ireued 




183 




STBTXK 01 DENTAL SUKGEBT. 



wood ara plAoixl, in cikviti{>B cnL in tlte vulcaniU' for thear re- 
cepHoti. Each inHtiiivUDg tooth will hare its correspoadicg 
cavity iu the plate, tht fnnnation of which requiren some 
little attention. The fonn should bo similar to tliat of a 
shallow dran-LT, thu front of which has. ItooTi remared, and ao 
proportiQn«d as n^rda the upper and lower gtirfacM of the 
ptato in wbirh it is cut, that the section of wood will nut 
fall oat into th« mouth. Tbo wood should be fitted to the 
cavity, Aiid left & little ihickeir at that end which U(« tovranlii 
the gum. The plate haviDf; boon adjostad to tbo month, 
boles must bo drilk'il t)iruuf;h it for the adminlon of liga- 
tures, which may be [nxnteA round aud 1i«d to c«i« or other of 
Ihc molar twth on each iiido nf the month. 

1q arranging tho ]i^ntiLrc«,care niuet betaken that they do 
not preea upon aud irritate thcguins. It will be remembered 
that the ^nI■l8 approach uearur to tim nias(icatiii(; KUrfaoint of 
the teeth 00 tho Un^al than on the labial side. Hcnoc, tho 
holes in the plat« should bo mntio at the point oormponding 
to the free «!(?« of the gum aKaiiurt whicli it ruste, and coa- 
tinuril obliquely in adirt>ctioa cuntinuaiis nitli ihe line fol- 
loirad by tlte gum in its passage between the teeth. If this 
precautioa be obtKrvixl, the ligature when tied will pi\si in & 
straight line from ttio Inliial tturriu>eof the toothtotlwlijigiuil 
Burfitco of the plutu, williout interfering with the gums. In 
flflleoting the teeth around which thu ligatures are to be 
pawed, wo must be Kuided by the forms and tho pt-silion of 
the teeth available for the pnrpo^ ; but ohould the tompuiary 
molars l>c prcKUut it will bo Wi'll to make use of tlietn in 
preforcuco to the permanent tecih. The abrupt t«niiination 
of tJio caainol renders Ihera jMu-ticularly suitaMo for the 
purpose, and the short period dnrieg which they will be 
retained renders their injury a toattcr of little runsuqui'Dcr. 

By the foregoing means the plate may be firmly fixed in 
nnler to afford a point tTappui for the action nf the rnm- 
]ire«sed wood, the cells for the reception of which will be 
formed oo tbe one side by the leetb to be moved, and on 



TEBTSDfO. 



133 



tbe other three sides by the pUte. Atter compmBbg for 
aome houn a jpieM of liry willuw, iilano, or tutu* other Kift 
woud, naall scripB may be cut uff, uul fruiu tbesd fngmeot* 
utut bo ]ir«inred vhidi wU] fit with moderate iu»:ui»cy to 

/*« ss-C) 




tbe BpoocN formed by the plate and teeth, taking can tbaC 
the gniin nf Uie wood ninB parallel with Uia long axes of the 
teeth. 80 BOOQ u the wood commencea to absorb moistnrc 
it will exfand, and in a direction transverse to thnt o( itx 
grain. In exfandinf;, either the tooth in front of it must luuve 
oatwaria, or the platt' murt be driven haokwands, and ^th 
It the oiolur teeth to which it is fitted. But U tbu front teeth 

(1) SUr»bm ■ vnlwiiH* pUte flttod to the sppcr Jmw, fcr tfca purpOMi tS 
fcntag ant wib tbo entnl laolmjk Tlw nlmiiu U Ml aaflkteatly thick 
artf Uw iwf kit1n> mlMi of Um teck leetb to pnv«at the lower IwUi Imoi 
bill— dt U(UM Id tn npenivd ajmi. Tbo »Ut» U reUhxil by UvUoim 
ImmI Ui/Mie]:! Ibo Tutauiltc uid muDd tlw Muponry oabn ; pancrtor to 
Uw oraltal tadan^ Dm ■{mUum tf tin «alla br ibe leorptloo uT tbn cdiD' 
fvnnd wood «« AowB. 

Below lb« flRoni, m iMUm 1^ ibt |Wla in (Ov b glvim. Hbuwinf thii nD In 
Im iMWh. villi itia flM* oT wvod nsiavtd Md pluad andtniMtli. I am la- 
4(bMd to mj bloMl, Ur. HwilMia. tor ifan apedoicn (tom wbicfa tfata Optra lua 



184 




STSTXK or DKXTAt BTTBOSBT. 



are ctpablQ of the U'nst resigtauoc, tlicy arc the first to tkM', 
and titaruroro gradually advanua Itcfun) tliu trxjandiug wood. 
From timij to tim<; the wedge* must be renewed, each new 
picDo boiug filiglilly larger tlian iU in-MlccL«Kor ; ilhiI as the 
teeth move upon an axia situated near tlit- Hpicctt of their w 
sjtectivB roots, the receptacles boctmie chaogol iti furm,an>(l it 
will bo nccusuy to modify the form of tho ^tootm in tho 
mlcanile plate. If this |irflcauti»n be iw^lectod, lltsre will 
be a diflicalty id retaining the wood after the teeth have beea 
nuired from their original position. Thu r»u3[ilacle will have 
ebaoged in form as rMpecte the reUtira ^»>of tho up^tcr tuxl 
l^wcr portions. Houce it bocotnM ooctiasaTy to dovpoa that 
liiiil of tlie groove which lies near the gum, and the exoa- 
ratioQ must be mado snffidcntlf deep to restore tbe panil- 
Itdiatu which baa bccu luttt by the outn-ard m'Ovemeiit of tlio 
tootb. When tbe re4uin.<d aiuount of change in pooitioo is 
ooosidembte, luid the hoJf of this baa been ^ainixl, it may be 
Deccuary to diitcnrd tbe original plate, and substitute a netr 
one JIttcd cloae to tlic teeth opemteil upon, ho aa to admit a 
tbinnef and more n.i(uiai:;eablc wed;;n tliau that whirb wuuM 
have been rcquinxl bad tho treatment been ooDtinuod with 
the firat-mndc a|ijxiratuB. 

Il U doubtful whutbcr, as a general rule, more than two 
teeth can ba advanta«eouBty operated u[xiu at the umu time. 
If, for instnnce, the four itici«irs are itivuUi-d iu llio irregu- 
fatrtty, it may bo desirable to ijusli furward the control teeth 
flntf and then ntovo the laicral teeth, or vice m^nit. But in 
adopting tbia plan wa muist not neglect to tako means to 
prevent tbe teeth firvt opt-mted npon from retreating to their 
old place while the otJicm are Iieing forced forwaiJ. 'ITiU 
may be acoompltithod by inserting into tbe vulcanite frame 
pegs of wood, tbe free enda of wfaicb rvst u|x>a tbe bucks of 
the moved teeth. In this application of tbe wood the end of 
tbe grain will rest njion tbe luuth, and ns there is but very 
slight expansion Lengthwuc of the grain, tbe teeth will be 
aim|)ly held in poaitiou. 




TBITHIlfO. 



185 



Wbea tb« wlutle of the itistiuidJnt; tcoth liavc Iwcu movcil 
ontwuxlR to ftD exieut sufficient to vnsuro lli«ir pAAsini: in 
fniut i)( lb« luwur t«clh ou tlit; luuUlli. Imngclusud, Uie nn: 
or the ap]tanituH nwy bo tiittonntinunl. Soin«tJm«6, however, 
it will bft runiK) tliat tbu bock tcitth of tho uiipcr ni^l lower 
j»wi, from baring been kt'jit apart durin-; tliv tri-.»tm*iil . 
loM tbdr imiper onta.^oaism. Ttii^' bcoonne raised in their 
•ock«t», luid [iravvat tlw fcoat t«ctb from mwtiug nch otb«r ; 
under thwc circmruUDOOt, tbow poTtloDH or ihv vulcoDitei 
pl«M vrldidi extended over the muti»tiivg siirfacM rf tbc 
Iwok teeth mint be removed ao w to allow the U'ctli U> c>*mt 
in coQtact, vhile the plate pmvcnlA tlic front teet,h from 
blling back into ihe fonncT pouition. In a few Aayn liii- 
[voper aoUgooisia will be restored, aad tliv [ilnto umy be- 
diacBidfid. 

Instead of osin^ Tulcani(«, uetal may be used (ui the plate. 
The molar (celliuu eillivr viJe niu <:u|ip(.-d with ^M, the cap** 




beblj; nuKle HO that they fit tigluiy npcm tlm tet>lh. rruin 
tbeae a band of mntal ia cxtcndod in front of the twtlt. 

(•} Sbcnn nwul capa HIM lo ilit nokr ImUi. with a bMiil txiMKlUiK fruin 
IhNn In tnaH of tlu Indwr*. To lUe tnsta] tunl •> 9x<4, tiKitiitnv incr 
brbig poiMJ niuud Uk nvnt t««Uu wcn- ifUdKil. and iln* Urn tuvrntd lirtb 
Itrmnl imUl ilmj cum Ui rvotect oiUi Ibo iMod. Tlw cmp »w tnalH t? 
Sir. UuitKOi, to vbom 1 am Inlclilfil lor iLr (prdmra sivtu In lli» Okuiv. 



IM 




8T8TEM DP HBHTAL BUBOIBT. 



IloI«a Arc drilled in tbo band op^Kirite to the twUi. and 
blruui; nilk Uiitnil in [niaenl ixfand tha nockormcfa tnotb uul 
Uiroo^ the c'jrro^pondiug bolc«,uidtied tightly oa thcoai^O' 
■urrMoe of the luuul. Tb« teeth will hy def^ren be dnwn 
towardu lh« liard, lint the |>rocess is a alow on«, ftnd requires 
^viiaent renewal of the lignttiniit. 

1 have oommonly used vulcnnizeJ caoutchouc iu the place 
of silk ; with this in»it<?rta1, tho tsniiion i.4 more imifonn, and 
tho reiitiwuls Deod iiul be made m fre^aeoUy. lite fixing of 
the indin-rubbi^r to Uie bond waa at firat a diffioalty ; tying 
was inipnu^ticAbliJ, and books ccmld not well be used. 1 
found, howf!rcr, thai by cuttinK fine sliu with a hair am 
oUiqufly through ttie metal btuid, and thp.n [inMing the two 
ends of ihf> caout^hoiic in a state of tensnon intA theni, ihi 
li|j;aturea wvre timily retained, &ilk ligatures retitiirerebevd 
orery second day, but th« caoutchouc will Imi double the 
linuH and will pruduoo a much luure ni|)id cQocl. I have in 
£k.Toumble c^afies siuoeed^ in bringing t^eth out in theooone 
i»r a fortnight, and Hm case hiCS been diamisBGd. 

Id tlie ]iliico of using metal in tlio foregoing manner, a pUl« 
may be tiit^ to the i«)atc, and retainnl by handa passioft 
ruoud tlitf bock teelli, or by portions of wire extended o¥w 
tha crowua aiid bent down so as to o\asyi the necks uf the 
teeth. To ths palatjil iwrtioa of the idate, bandit of toetal 
rtnidcrt<d vhi^iic by hammering, may be attached, adjiuting 
the free ends ko that they HhuU ynat upon the backs of tJie 
uial|i))icod twih, This m»iini.<r of fruceeding is inferior to 
the two preceding methods where a muiiber of teeth are in> 
volved, altliougb in caaa where two or three teeth only are 
riM)uiml to be tihifted, not only dutwanb oi^inwards, but ahu 
upon their nxea, it ofleri »mnc advantagofl. 

The treatment upon the principle of elongating the lower 
teeth ne«J not be recuTrol to, as it ba« nothing whatever to 
reounimL'ud it. The jtlAtvs luixl iimy Ins made uf vnlouiite 
or of foM, each having iu special advantages. Kxoeptini; in 
thoeo cOBBb where the antaguniatic teeth aerre farmaintaining 



I'liKTUUra. 



137 



f 

^ft tlw pndUtnn acquiretl hy mechanical ioterferunce, regulation 
^H pUUs miu( bo worn for many months, tnd wluiterer taay be 
^^ tbfl outurfaU QMd in UipEt con<tnictioo, the teeth to vhich 
Omy m Blliichad ^am nothing by boiiig m> umkL Metallic 
bandi pndrcb'iiK natural for the HUpporl of artlBcial teeth. 
Dot nt>roiiimoiily ffudnce injury to the fomter; au<l it is fair 
to inf^r tbnt when, in pntfaclod caam, r^ulntion plnlcs ore 
nnoinad by similiu- ineao«f boido amotiDt of minchief may 
remit. Ueoce tb«nanthoMwhooondeiniitheiueormotaL 
Tlu' qticfftion ariscB as to vbotbar vnlcaiiita in really leas 
injnriuna to the invested tawlh than gold j arnl, judging from 
tba ex|itiriKUue puui-d by n-atcliinj; tho vflit'ta of artificial 
taoih cotistroct^Kl witb each, I think wo «biill b« auwtrajned 
loEMtm in bruur nf thu fumrer. Still, b«foro vay »^m- 
efaihle hurt can bo |*T>dticw], the metallic fratiM must be 
won fbr a long lime, and smpptwlnf; it ran Im attached tu 
bomporaT^ t«oth, thia conaideration neud not iuilueooe our 
aekfTtJm. 

Tlia adraDl«e« in raapoct tu time and tho relatire amount 

oT iaooDTenimoo entailed upon thf patient by tho one or other 

method of iirOcoduro muxt not bo diur^jardud. The erer- 

varyins cbomct^r of the cmci r«ndera it diffiettll lo lay down 

any ^uunml ruU as to the advaiitagnt of tho one method oirvr 

tbe other, ai reganU tbo time tequirod to produce the di«ircd 

dEeek On Lhe whole, perhaps, although canoBtnntod by the 

010 of ouIaI pbilea are more speedily ooinploted, DCTcrtLelen 

^ mkatitte b more ct-'iiorally to be- pn-furrcd as mora ooni- 

^L^lDTtaHoT aikd less iajurii>u8 to tho teeth. 

^^^K Alihoofth iu ihe majnrity a( cams it will be neoueary to 

^^^Bctify nth utaljuditjun of the teeth as nature alono will not 

Rinedy, by the qbu of plates, there arc othis' lueUioils by 

wliich tbeir poaitjoa may be ohaogod. A patient ptMseaaed 

of anfflcient determination may often suoceed in bringing 

Conrard n mui]>laf«(l itpiwr iuoiwir by the nae of a jijeoe of 

wia.id, rmployn] like a levtr u> forcr it birward, the lower 

iMtb being takua IB a futenim. 



iS8 



A BTSTBIt or DIMTAL fitntOBST. 



Lif^turm or clastic hnnds amy }se lulapted to the toot 
which it IH rK|uiro(l t« move in mich wnya an Ihp ingenuity'' 
of tbe opentor may dt^vie^. alvmyg bcariag in mind, how«ver, 
that Bnleas i coniiderolilc number 4if ivtXh »re eoibr&ca] by 
it, those token aa the supportfi will probably be as toxich acted 
oil 08 the tooth which is to Iw muvMl. 

Bet whatever cohtm of procedure is dixidi'd Dpon, there is 
one poiiit which must carofoUy be kept in mind : the diroc- 
tioa of the long axis of the tcolh maj he cbao&ed, but that 
is all. Th<? nprx of tltn f»ntt will nniuiin fixnd, or nairly »;, 
whik tliu crunii of tliu tuulh will iiiuvl- iii aa arc of a 
the centre of which li«s at or very near to the apei of th«| 
fdug. It ia thereroreof tho nUnust imisortance in eBtinmtinjJ 
the probability of suooess to ascertain aa lar as posiible tl 



iriifitt^;i<if 




l1»ataon of the apex of the lang ; and it U obTJous that those 
CUM in which lUe irregularity is due to (wmc ancli iiiechar 
nicnl cftUBc as the retentiou of temporary tooth will yield to 

0) SJxnrlng ttw ^uil tevtb nmtlDi fdgi w td^e. 



^ Ml 


h 


^^.JMWHHMHI ^^ 


1 

^ TaBTBlNC. 139 

^rtnvtnmil fiir mom nnrtilf thnn tboK in which tho whole 
klrnilAT juition of llie jaw b mrolved, awl which ore oft«a 
^^oToaiiKvnttal urigin (Ct. p. 114). 

^^fe iKUrmediatc htlui«en tht Iwo/orm* cf irreffularitj/ ulrtadt/ 
^M}4iterH!>tdt is itiat in which tlio frout teeth lucct ofgt to edtft, 
H m Ainm in tiu) prccoding figun (Pig. oA). U may ho ra- 
^Lgvdod u diffmti^ vniy in degreo from thow cwws in which 
^I'tlM apprr fniaL U>cth w invcrt«l, and u dependeul npMn 
^■liuiiUr caoses which luve »iieT»t«i1 with lew Xond. 
^^LA/orm t^ imj/iUarity m\iAv\n^ more or lus tJie whole nf 


l'^ 


1 ^- .'l,\ #-^ ' 


i 1 


Bof Uw maxillae 

^^ m-ilar teeth, on 

while iho lifrpc 

cndoly turned r 

In tlio Hfwt 

(OaMriuidMia 

«mn>*lH»irftM<i 


ud H»oci*ted with nti slnonnii 

hi tho dcscri|'U()u of oue n 

vloriag tJw EDOUtht nlnnc rem 

T uid kiwrr ineisura, wilhou 

mtwMd»or inwarda, 4iaml n{xu 

ttira fmm which tbu illiiEtni 

KAnMihm In *likk (1m mlaf MMb on 
OMMkwWUM iwaeXUi*trm i< tl« M 


i 1 

1 ilifvelopniont 

Uuded to, the 

le in Doatoct; 

t Iwing eiUier 

■t, 

liiiu U taken 



A BTSTKM or DRNTAt. BITROEHr. 



(Fig. 66), tlic dpwTw of !u?|Ku»t)'in is moi)«rnu> in atnoatit, u 
compared wiih nuiiiyaiscK [■rf.seuU'O U> the [>rActititn)«r; hal 
it affonls Au <3p[K>rcui]ity of sliowini; a [xculiority t& tlie cod- 
/oniULliou iif Lbc luwer jaw UHuully tHiiticuli-ul wilii liiie form 
of irregularity. Tt coiuiKts in a great development of the 
anterinr {nrt nf thH jaw in tliu vertiuil diiFctinn, wiUi a dimi- , 
aiilwd deplli lu Lh« piarU which muUiu the luolar teutb, 
elated with ou unusual obliquity of t)io ascending ramua. 
Tliu line fj( gr»vfth iu tliB IsttiT port has not takvu tliv r«ct- 
ooKoliu dintction wliich cbanctorisw tho wBll-furmed adult 
Jaw. Tlut aulcrior {lart of the olrookr ridga of tho uppar 
miucilk hiis noi iittuiuLy} tlio nommt depth — a peculiarity 
which the aceonijanying ilUistratioii does not exhibit in tho 
ilegree commonly seen in cases of this nalnrc. I have seen 
nrenil itinliiticcs in >vhich in thv clusud uiuulh the tin^-r 
could be jiajuwd Wtv>-L<eu the front teeth. 

Tlic twth themsL'lves, and especially the 6rBt jiennanent 
molars, usually present indications of imperfect deveiopment 
of their tiKKiien. The »iirfacc of ths cnamol is irregular, and 
marked with jtits and traiutvcne grooves, is yellow in colour, 
and readily brv>koii ditn'n. 

The nniilonuca) ojudiliuua wbicli are ooinoident witb this 
{nna of irrcfjularity are rMilily diMtinKuitihed, hut the cauaw 
nhich have doetruyud the VvUitiona of the wvural parts of 
the jaws during devek>i<tncnt arc very obticurc. In miwt 
iuHtances tlie pacienU have Iwen iiHAhle witiioiit effort t» 
breathe through the nosu, and tho mouth has conKqucntly 
Iweji hiibitunily kejtt ojieii, even during Hlt!ex>. PoKsibly the 
constant traction exercised tipon ihe anterior pnrt of the jaw 
iu keepiu<; the mouth ojfcn may have hiwl some intliieuce in 
dfitcnnining the peculiarity of form, and tlie froodom frwn 
the prtissurc uxercifioi uiuUiiLlly by tbu antHguaisUc moliir 
teetli upon each other, may have led to theii rising higher 
with thHr sockets thui they do when their oonformation i» 
normal. 

1 hAVO atteniptod to diminish the amount of deformity 




TEETfflNO. 



141 



Rl.dN«e only. Tb« fAtitut ww a ft'inftlc, iwolre ycAis old. 
AoBt trctli vere ii^iurutc<l )iy a vnAc iiit<mtl wben 
uir ilmt iDolAra wnv in cnotnci, fttul thi; lijiK clnsnl with 
diflicully. ItK chiii, althouf;b rotrcntinj^ vna of utiiisual 
(W[rt}i, nnii, anocinlod with the oudt-Hvd Upe, gnvD a vamnt 
«X|)ranioa to liw face. Tbe luvtliod o( trcitmeDt which 
vgnnA tits tcreatoet prtMptct of nicceoa consu^vd in niAJn- 
tHhuttg B atmiy upininl preiwurc upon the utorior part of 
eW lower jaw, Itnving the antaifptninng tnohr Uxth tu net 
« ■ ftikTttm. A sheet of (mttA-percha wu moulded tn l^t 
til* |«nnt of tbc chin, ami a cAp titt*-d t« the head, and the. 
tvo mn coDn«ei«ci 1'>t strong bsnda of caoutchouc — oue un 
I mch tide. Thr aniuuul of promure t'xertcd \ry this con- 
K triv)itic« was foifEtcicnt to j^rodiicc t«nd«nieu in tbt«e tw-th 
^l which doKil ufNiu each other. This source of diecotnrort 
^B pywid away <if it«elf iii tlie couoh! of a lortuiglit> without 
^" any modifh^tion of the fJan of tmuinrni. 

Al th« tiikd of three month* the front t«eth, which at the 

lime tbe tFcattncnt was achtjiu^l wrre Mfmnuod by Ihree- 

vifththa of an incti, itow caiiie iu contact, nud the geiter^l 

ft[i|)eumiK« of thp fa» wan ^t-Atiy imptored. Tbe patient 

na diraotcd tn oec the appnnituft duriuK the night-time for 

II Imm fix loontfaii, anil to nhow tienelf at tlie ezpintioD 

of that period. Tbeae iwilructioiu wvre dungardcd, and it 

WM only afirr a bpw or two years thai she una agun brouglit 

Iu toe. The deformity tiad retiimnl with the eruption of the 

■ocnod permUKnt molan, tho nmticAling mrfiure* of which 

^^ iMth oloDii came in oontari wbm tho month wu cli«ed. I'hi* 

^H irtottiMnt wliich two y«*n More ha<l hoeu Attended with 

^^ a Cur atnoout of socvcss was again iidopti.<d, bat cither frnni 

witat of ixTtevwrance or ttioti the increased ago of the |ati«ul, 

J^m a ■li;;ht adruiUii.'K only was paiiuid. Had tlw paticjit pent- 

^B XKn*i fmtii the fii»t id thi* oHirvn iho wna directed tu RiUow, 

II' the would til .1 gT- ■ iiave bwrn uvcrc(*nc. 

In • 1 the form ol ■ . uudtsr considBralioa, 

th> tit'tt fltriking and the tnunt itDjnrtant fcalure \a the ulA\* 



us 




BTSTXM OP DENTAL StTBGEST. 



qoity at which the ramus la pUced with rvapcct to the bodj 
of tJu! lower jaw. The Uiii! of grovrtli lia» Ixt-n almost directly 
Ittckwardft, au<l lht> itif<;rior d«DUl caiul, inHtea>l of being 
ourict] apw-anh) in iU |ML>itiTicir tliinl, ia almost stmigtit frotn 
CDcl to muh That tona iu which lite rvctaugular jHwitiuD bafi 
hccn pnMuaturcly nst^tuned, ami rho naconding nuuus Ix-luw 
the OBiial beigbt, ha* •Lraul>- Ixt'ii iidviirtud to. Hcru we 
haTeaolaasofcasiu iu which ihvobltfinitr (x-culinr toinfaitcy 
hiM tx.'en Qwiutained thnntgtiihiit tliv whulu [luriwl af gruwth, 
and, Afl a oooseqitencc, ad alveolar lino of uuusual length Is 
, pruduced. Iu tlip prematurely rectangaLir jiiw we aeMom 
&ai sufiioiuut hjucv fur the liiOnii«l iiui'taiitaUuii uf the win* 
dom looUi; in Itw uhiiqtic nuudlhi, un thv cuutmry, there 'a 
room evea for a fourth iriolar. 

The spectmcD frutii which the prccoding figure (Fig. 56) 
hu been takon, affurdK n hetler opportiiuity of vxaiiiiiiiD^ the 
•afttomicftl n-lhtioiu of the several foru of the Jftw thnn i» 
affurdud in the living subject. In this wo iihall see that, had 
the aLveuUr portion been derolopcd in aocordauee with the 
tuRuiI {arm, whilo the uhliciuity uf the Unit uf devetupmeut 
was preserved, the Boporntion of the front teeth would have 
hosD fu greater ibaii it ia; but oature, luiving departed from 
the Doniml funn in liir* joirticuW, to a certain extent couuM^ 
balances thx; di^funnity by n. deviation in another direction. 
Here, tbu alveolar proouiwcH at the back \yait are uniiHimlly 
flhallow, and in the front part uf the jaw are unusitally deep; 
thu hack, teeth arc ke|)t down to a low, and tbo frQDt teeth 
are rutKnl to a high, level. Tlie treaCmeot adopted in the case 
already oit«(l wati in nccurdance with thi? indications afforfled 
hy the s^iechuen ; the back formed the fulcrain by the aid 
of which the ulai>iic bands pressed Iho front ]iart of tbo jaw 
□pwards, and drew the rnmua downwards. 

lliv following iDt«-rtvitin;{ efl»o kIiuwx Lu what extent tbo 
form of the jaw may ho inodiOed by the tnaintenatice of cott- 
sUnt ptvssurc during early life. The [ntient was a Btning 
healthy yoimu ivoiuan, iweuty-lwo yeara of a^e. Hur chin 




TIBTHINO. 



U3 



dmwn down towml (lie steniiitn by n brn«<) cicatrix, con- 
■p<]U4<jjt iip:)ti ft btini nMneivwl wltcn fira ftmni old. Ilie te«tb 
of lliv lower JKW »tix)il out uliniHt at right aagleft, and were 
Etf in frant of choM of the upper jaw. 1*h<( accompanjlDg 
Uliuttutiuu is takvii lirom a cut inai\« wheu ttio )ntieiit wu 
in the MiiMltwx llMpitAl, ind ihowB occuratoly tho position 
t4 tile teeth sud the lorin of Uic alvcuUr ridge, llie jioeitlon 




the ]iro[irtrtiini.i nf ihe lower border nf llie jaw and the 
rail being ouciuctud by a ioDPa burl cicatrix, cuuld otily 
The tuxwncf, ibrrvruir, of the llliwlration u 
the bidden |mrts canont bo depended od. The injury 
occttTTod tJler the tonpi'mry tticth were matured, but prior 
tu Uia oniptiuu or thi; ptfiiuuwnt organs. IK-iu'e Iho troctiuD 
Bxertod hy ihe cicatrix in oppotition to the TiAtoral action of 
lh<* jaw, and of tbu eadt<avour tu kw!]i the boo in the natural 

')) lff»w(n« bkra th«i • oml <£ Iba nppar lad bwr Inrih tmS gmM at a 
fMlrM. ipd t«iiit]r-i««. who rt dw afv of Sm youi km hMlly iNiml nbau 
(fea iHck an) dim. TbtiUn wwctr ili»eawnttlBaertte<tatM]t,ffra'l<Mlly 
•■»« 4wn lovtrdi lb* (Iki(, ud Uw •JvAotot punkw of iIh- lomr >• Uoaw 
■ wi l M l b llM mar i BW UiDWii is tlv ftpif*- Tht Urtb an ivrTrfi ■« rrc«d* 
nifcff. n4 an UtCnMj «iU luniiML Tlia miUIm i>I I(.i> ho»a ha* Urn 
•MM ky Cm "nH. Mid bnra naM nut to dcprndnl on *« a lalthmi r<iiK- 
I ^ Ibt oMrilUM or Umm fNTU. 



U4 



A 6TBTE» OF DiLSTkU 6DRGEET. 



pueitioii, cBiue iDto qwratkm when tlio [wnoaucat tooth w«re 
peasing through the gume, aud when thoir alvccbr pioocuea 
were gnmiDg up with thom. Ah tlie pemument alveoli vera 
for the moit part developed tinder the iufiuence of the ever* 
ointmctiiig cicatrix, wb shxll lie jtistitied in n.ssiiiiiin>; that 
they were urijfirnUy fi>niic<l tu the ev«rt«<I {>o«itiou vhonn 
ill the Gi^nrc, rather than that they were dcve)o|)cd iu 
thu mirmal pusitiuu, uu<l hcut uutwiiTdn and do\i*n\^*ardi! 
sabseiiucutly. Btit whfttevcr cxpUiiatioii inay \k adopuyl 
u regards iho ]iroceis hy which tiiv defonuity has Ikwd pT\>- 
dnccd, tlte case oBlts a vcrj- inirtructivc illtiHtrattriti of the 
amount of change in fnrm that a fcjfcc iocessant in it« 
openttloQ may T>nDg about in the jaw duriog the period of 
groirtb. 

Thtre i» yet anothtr farm ^ irrrgvlarity la which tb» 
whole of thv tu-th of uuD or of both Jaws an more or \ef» in- 
volved. It is that which is conuuoaly called the V or uWje- 
tAapfd mouih; tho tcetJi, in plaoc of holding; Uio rlUptical 
arratigcmeDl, occupy Ivru converging line* w-liich luijct at 
an aogle in the anivrior pnrt of the jaw, prodwittg, an an 
atuKMt iDVnriable result, an extremely hi^h and viiult«d 
l»Ut£. Tbo position of the Icmh on the twu etdt-s of the 
jaws may be |wrfcctLy tiyiumetrical, and tbo conformatioQ 
ni&y, in rare instances, cwTTes|)oad in the tipper and lomax 
roaxilla'. More commonly, however, the deformity i» pod- 
fmetl to, or exists in a much ^eater degree in, the appu- 
jnw, the central indsors of irhich frtqiicntly shint J'orward 
iind stand iu advance of those of the lowi-r maxilU. Tbfre 
ia an appcaruocv of cuutmctiuu acrutui thu liiiu of the bicusjiid 
tc«tli, looldng a» if the jaw had been pinched inwards at thia 
point ("Pe Fiy. 57); K^hind this the tiWar lec-lli rajiully 
di^tir^c. Each cose will preaeiit itssjiecijil ;)»:ulinritie^ Iu 
ODC, the tncdinn sides nf ttio n-ntnd liicinors will project 
forwards and tueet at angle; in auulhcr, angles will liefunurd 
at the Junction of the lateral and ccntial incisors ; in a ihini, 
the cential incieote will form at the janotioti of their mediae 





TESTUIXO. 

srdw nn angle dircctrtl tnwanlK, hulI u-il]i tttt-ir didtAl Rkte^ 
Vkd iKe ii»tiii«i «dM vf lliL' hit-:™! iiicisors, two ttn^leh 
dtTVCtnl uutwunls tii>t unliku un iuTiTtMl W. Iliu docii 
raalt«<i form of the hard palate U aometimci came<l to Ktich 
an dxtciit &a Co suggait the Hloa of the two skIbs of tbc jaw 
baviug Uon fovced towards each other, and th« roof of the 
ni»atl) drivm n(>wir<l.i. In other caach the lioih;ht ui nut 
granlur Uiao would iMcnuarily mull (mcQ the fKlli«C)tQlioQ 
of the vertHial (or thcobliriue ptMitlons nf thi; alrtnilar por* 
lidDa vt tlie jaw, nud it it uot uocomiDOQ to fiud that the 
height, alihoujjli ap]iireully in cxocvs of Ok i»>riiul «kvu> 
tioBr doei not tu muanuement exceed that of a tineLy 
dflvvlopod mauILa. 

It will not, liowerer, Ijh neoeuary lu ent«« ioto all the 
niDOr iDodiAcationa of form |n«wnt«d in cases where this 
diameter of deformity prevails. Althouj^b numerotu cx- 
•tn|JM praeul lb«in>elve« io wltich i«rcut»gc i-anoot lo 
addncM aa a cause ibr V-«hapeJ dcnUil arrhes, yet in many 
UmQiea this pot^uliar conformatiua of the luoath will he fuuiul 
H ao btfvditanrcharactcmdc. But thruugh whaterer infio- 
■nre thu delect way havu primarily ahMD, lh« reiult i« a 
d»|»rturo froat the norma] anatomical retottoaa betweoi the 
teeth atui the jawa, and aa the hw of the Ibrtnvr is deter* 
aincd wdne yean bcl<.<re the latter have arrived at their nlti- 
Diat4> liimewloDa, to can biit regani the liuilt as originating 
in thv jawa. 

Tit. ColsmauO ha* esAminod n hrpf oiiinbi^r nf children 
witlt a view to tnuring tite ooniMWtkpn hetween the gecteral 
drrdciptn^nt and that of the jaws, nod the mnclumuns at 
which ttd haa arrived are m> Inntnictivc ah to call fcir mention 
In tlib place. The anl«r'^le»ui and par^ntA|:e of the children 
bmuglit to a hoapiul muat always he a diOiiult if nut an 
faopoaalble Ruliject of inquiry ; hut doI m> their ftp]<carance, 
vfaich will affiifii a btr jtuide in UeliTtuitUD;; whi'thcr lliDV 
M* ooarve, hnilal and low hred, or whether thoy lieor tb« 
(t) TnaMrtlMuafiha(M0Mafa«lnlflMtaif, iufi, r.ss*. 

L 



U6 




KTHTKM OP DEHTAL KltBllSKT. 



Stamp of a higher clvjltsatifiii — in iitber vrurds, may 
spwkoii of iu " well ht&V 

Taking diiUlrcn of " wfiU-brcd aajiect," nn leatt tbtui rixty- 
iiiae iMir l-viiL wt;rn H>uii<l Id ban; inure or lea* eo[Ltntct«d, 
Iwily (ii'v<tl(iiic-(i jau-H ; whrri'aii cnking cliiUron of dooidedly 
luw iU))M:t,<ialy fri)ru aeVfji to vi]dd |)cr cunLmanircsted t3)U 
modition of tU» jaws. Amongrt. cliil<lrPD of doubtful aspect, 
wliu could not cerUuiily Im! rcfismxl tu uiUiar of Uka abcn'e 
oUsflM, (wculy-four p«r c«nt. had coRtnu;t«(l jnwv, thus 
rumiiig ill an in tor mediate ixwitiwi betwixt Uiu Gntl two 
cl«ii»es. 

It n-as remarked by Mr. MutntncryC), in tlie cuurao of a 
vi-ry extcDdcrtl Kcricn uf ubaurvutioDs on the Uwlli ut' aaTag(« 
races, that irrogtilarilios of the t«L-th and contracted jaws 
were as rare as doslractive attritiou was conuiion amoofprt 
ihuiu, ubiUt {)n}cW)r the contrary U trne of civiliJM<d races. 

Aud Mi-JufTs. Cartwngbt and C^jlcman re]inrt tbnt thiiy did 
not find any example of oontraclM jaws in the Urge collec- 
tion of HkuIKi conuinrnt in tbe cr^itl of Hyttio Chiiroh; 
ukulls wbicb are c«rtAJuly of very |;rt»I atitiquity, tbmi|^ 
tbtnr precise biAlory lit, 1 believe, a matter of dls|)ut«. 

'Jlut tbc eotDpantivc disuMt of tbu organs of manticatiuR 
among civilisi-d races, who cook nm) ilioroutibly luften their 
fomi Ijofore masticaUiig it, should Itavc lod to a Ipsa powerful 
devoloimwnt of the jiiws, Ih a tbinj that might fairly bo 
I'SIwcicil, and were Uie imnirrfincB vf eontracujij jaws a thing 
;»cr se, it would have compai-atively little idgnificanoo. But 
it ha|»|K9i8 lliat I ho Vvsliajivd uuuftNiQUtiou of tlw jaws is 
v«Ty ol^<>n a^^ociauol with other deviations from the standard 
iif liwllhy orpantsation ; thus it Ls cxtremi'Iy onmtnoD fwf 
Lh« suhjectM of thin malforniatioii to aulTer froiii eularged 
tonsils, nn>1 U* pruaeot cnany jnilication* of weak health, 
whiUt it in ram to nioct with it iu strong n'lnist jkereono. 

And Dr. [jantvion Down C), after ttuking ohsorrationa on 

(>) TTuniakia«orUie<Mairtolii)ctttl6oahiljr.arwirFM.T«).H.,i«sr 
n IHlL, vol. nr., p. lS.lall. 'v 



TKRTHINd. 



U7 



limber of coniieniu) MioW, iuts ritutiii, with 
ipttoOt tJut iheni uru slwayM A ilinitnutirin of 
littwwo tbe posWrior I>iciu[ii<U, and *n innmltnate 
itUitie of Uir jalalci tii bet m l)-)iical V-)(li«)in) maxilla. 
tboagh the typicnl cbkntcten of tJi« V-slmpty) maxillir 
(lepeaileni iii huum degnw on tli« {traaonoc of the ]KTUin- 
il iMtli, Dr. Lauj^d Dowu U of upiniou tbat Uuk ti\sH- 
ioD rnay be delerted At a niucb (ttrlter poriml, u»l he 
cuariBoed of iu catistaiicy that bo relies ufioQ itx 
fcriM-ncr as a diagtuntic lest wlivtbcr the i<lU)cy of IhM 
iiidnitiiutJ be tnilf o(n)|rflt)ital,or buthe niiiult of |ntbulo(Eii-al 

^r The fact that tbts JufiirtaUy of the pwiiiaafint dentittKO 
If bfU to be ih* mark of cougeiiitAl dcfivtA »f orKauiMtion 
UaiU a Mpeci^ inbejeM ta the cbquiry, at wImE \»tUA tlot-s 
it tcallj ori^'natc? It hu beeo luuaUy cxiilaini^l as in Kri;jir 
1 a 4.iidmi}U«)oc (if a iliaptopurtitto btftwit'O tbv nir-f of 
I' ti^th ami tKo lauc of tbe jaw, but this cxpUnattita 
(fUrioimlf uill mil Aivinmt fur all Uiealiserrod bicta. 
It rcfci'ui<.'« be matli- iti that (-jftioii of tlitf work In which 
IP ^nivih u( the jnw is dcMnlwHi (]n'iv 1(W), it will Imj writi 
tlw from |>^rttiiri nf iliv jaw, lliat Mhich conuio'v) tlx- 
i|iocary t«rth atid urtt-nmnlK the [wmtaniPDt incisoni, 
iiua ami lncuK))iili>, iin<!uf>;tM»i do Diali.TiaJ alt«ntiuu iu 
afkr binh. Imt the gBln in du> i» i*t(rcttd by athliiiiiu 
Hm 'Utter anriacn xaA tu it^ |niitcrior cxwduiu 
But an iDcrvafki iu width i* a neceaaity, in f>r<]«r that thr 
may maintaiti itx r«Ialii<iiii with tb<! iiicrtvMiiiii cratiiu) 
; irkil if tb« nimita of the final jaw are not in t'ltf fir->t 
LV tlivf^r.-rnt, ihr npwly ad'Uti jDrtiuu at ibe bark 'if 
bu altci»la/ l»nli>r will inna mi iuii;k- with that |ircvitiii»ly 

Hmrf, if the Cirial jaw faavc not att&iiind Ui l)»e form 
«fi|m<jiriAl« Ui itt fiuilM'T jETOirth at *a <«rly figTiol, tlti! fitnii 
1* aoi oMiimtHl bj' tbv furthrr fmiciiM of ilevclopneiil, Iml 
♦b* iwwlf wWwl portlini I.^rtn to augle Iu l>»u \;vcui\i!A 



14» 



A STHTEU or DKin'AL SURaBBT. 



rc^on, which remains through life u a mark of Dulfbrmn- 
tion, scarcGly nnliceahtu lit the time, which occitrm) duriuj^ 
intra-iitcrtDe life. This serve* to explain litw it h that a 
cliamcbT nf permanent ilentilinn nwy come to Iw dijLgnfwtic 
'4 coui^eriitul disiiose, and also huw it is that the lower JAW 
iH w) Belilutii ulTertod by iIiId iiiairi<niiatiuii. Fnr, u hiw 
Iwcti mure fully dcscrilx-d elEeu-bcro ('), the curuiui uf thv 
nIvDolar bcrder of the lower jaw bava attained to thvir poste- 
rior divergence at a {leriod whvn tlie correepondit^ parU iu 
the up[x<r jaw Are tis j'ct parallel. 




Ill Home instanwB the deformity is conftnod to tlic al- 
VLi4iir ridgl-K, whilst in utlivrs thr whoti; Ikimi uf the jaw it 
involved. 



(■) OurlM S. ToniM. •' On ttt DereloiiunUI Ortciii of ibe T<«liaped 
MuUU." MiKitklr EtM-lnr of IkaUl 8rl«wi', iunr, leir 

lUiBBial MHrtnctlco In the DrlBfabourliMid of Uif Mnuiphl and Onl pcnouimt 
mclv ImUi. On ih^ Irft "Mr iNilh or lh(i th"ni]v'ili wcrr TCiDOWd. ind In the 
nsbt Uir ■rrend lilfiisplil wiu vxtrarctnl wtltiuat aay arivanti^ brinit ptii«4 m 
ffanii the ootrtrvtrrl cnivfiiiinii rr ihf jiaUtc 1 *iq liiMiled to Mr. lUrrlwn 
s>r the Off »r aua fni«fT«iii( ■poclmeti. 




TBBTHDra, 



149 



the ptnooM of ontwd growth during Uio prcwoce of 

the loaipotvry tnitli luui Ixwa d»f(M:tivo,att<l tbo purmanent 

t«*th wbil« withia tho ■UtcoIat crypt* tiAvo \xea forced Ui 

Uke Hooli A poeitian u tbc! sfMCo allotti:^. to tliem woiih) 

allmr, oo siiccesuvely appearing tlirongh the gums they wiU 

Mcosnrily prasent ths irra;^«rity of amuigeinent iiit" 

which they had fiUlcn daring dorclopmeiit. But if tfa« liaae 

of the m-WwAmt (wrtion of tii« j&ws hut reacbml tlie norninl 

dimoMoDB, the tmtii, ftlt^ogll liul-pUc«d. it I ho timo ol 

1^^ eruption, may ultun»tflly bcoanw regular, an at Ihu |«ri(>il 

^■t]i« atrcoU han ye( to luidergo modificatioa lod further 

^Kdcrelopmeut. 

^H If toaw of tb« prucwUog figttrai be oxaimncd uid com- 
^"^ pared with Ihuso in wUith tiio arraDgituwot of thu two scIb 
la oortual. ih« mnaaer in which irrvgakuities ariM may \v 
■KQ. In studying the cniuea which jirxhtcn th« riuil- 
... piMttiinu in uhich the whole of the atitmur teeth atu 
^K itiviiirrd, the isvcMJ^ion mtut bo commcucod priur to ih<> 
J^g crujilinu of the pennaoeiit twth. 

It hat bcoQ Tuoal to awumo that thv priTnatnre cxtrnctiun 

of the tunpoiaiy teeth oocanocu oontracttoa of tbo jaw, but 

I do Dot think that auy anAb>mical facts can be hruught f'lr- 

■aid in support of Iho sujijWuiilioD. If a temiwrary tuuth lie 

ranoTod, the crowns of the contiguous teeth may lutri 

lowanls each other, and give ao ^»pe*ratuM of onntraciioR, 

tnt it does aot rooUy inrolrs * dimhiiilMd mw of thut port 

^■«f the jaw fmin which the tooth hii» bwn lost, lu tlio (.-&«• 

^Birviu winch the accotn (Allying illaHti^tton i» tak«fi, tho two 

^■ceotral inctaon were lout loug before thtrir auocoiaani weru 

^T IM^ for enpiion ; hence the oodteli became obliteruted, 

and the alveolar ridgo nuido good ( but wa do twt soe tlie 

,aliglU43it trace of cunirautiru) iu the jaw. It ha* Iwcu stateil 

by Mr.C«nwTight(*),that if tbe central tociaon happen to In 

. at birth, and at ooce RtuuTod* on account of Uiu ixijury 



(') 



<f Um (MoMUlntfua ftHMy, IIM. p. Ul. 




Thim Bgnin, if Bpecimens be eximined in wbich tiio twn 
BfrU of tooth are prwwnt, i: will ho seen that ihe implmntation 
nf till- TfrniHvrary t«el)i orctipMW biiC-a verv sam\l s\vicv io 
tb« nivvolar I'lAse, u contprtri-fi wilh thut occupif^ by tho 
cri.iwn» of tht |)emun«nt tectii.- Now, it is extn^iiu'ly diffi- 
cult tfl ciDircvivc bow tbi' nnnwral of the Leia|.ionry teeth can 
indnco the jar tc contract upon the crowned nttA growing 
fiernument teeth. Or^tiK in an active statQ of iIaTvhi]naent 
iiulncn the cxpaasioD of jturts nb*jat them, and tfacrv is do 
^■lod rcHfion fnr finp]>ofiing that the janr fomis aa exception 
to this rule. The perautcsoc of the fint, which ore placed 
inuiirdiuti'Jy tii ffoiit of the MCODd act, may, atid bwittently 
dw», )Dt«rfer« with the outward progress «f the htitor; bat 
I caniiut MM how titu nnnuval of thv lem[xirary can prudnce 

(■) Thr iippn-rjiiw nf ■ iail|}nelb«tifwn sIXBod WTMij'eAnaM. TVoAtml 
(lafeNT* had boeo Ion, and Itw *l*p(ilar rli%e had bMMie roimdtd b/ iho 
oUUeratloQ el Ih* McIkM et iIm l«mporaiy tMth ud Hut drtelopMnit of nnr 
faiM. I( dw pmoalspr Iom ot ihe irnpbraiT In-Ui war* ri>U»B«il I7 «nln^ 
Um at tiw Jk«, (hi eoDiUUaii abould to thowo la Ibte <ud. 



TKKTUIXO. 



151 



lictAl iiifluriicu iifMia tlii.* orrnu^-iuput of tho per* 
naiwtit wih. lu Or- c»m hIk'mu id Via. 51t, ihv tvmponry 
iBoaaiB bava btao ahcd stnuc tinii> fritjr to thi* f-niptinti of 
tbdr MOceMoti; yoC there is do Ln<1ic»ivon of contractioB of 
jnr. A au« emue xmAn uiy mitioo rwently, in whk'h the 
diiU luul bocn de«tiuito of tcmpontrj ttrtli, vxci-i>tinj; 
im\y thu Mx-oud i«in|>iinrv molm* on tliti ri^ttt sklc of the 
kransr Jaw ; tho nuuulta were, notwitLstiindiDg. n-vll fornual, 
lad tho permancDt uwlli ap)<care^l willk an nnnraal re^i- 
brlly it( uTangeiucbU Hftd tin* devokipait'nt of Ab jaw» 
Jfffwided Dpon the piennce of ten)pontr>- te«tb, n-o sbtnihl 
mrvly havu euui iii tliJM oaee Muie ooKraut uf rontracuoiu 

SahMqurotly, huttvrcr, thore may be wkoo tmount of 
imotioU ioo'iiYenwuoe rcsaltiu^ froni tltn prematdni rc- 
UKival v( Ihe t«ii)[X>rary tvcUif but it ts ul(o|retber iiiiivpeti- 
daot of ooDtraccfljii of th^ ]aw. TIio iivwiy-ciit Incm^rA. in 
thu abeuca of adjoiuiu;; Kfilh, will KuuvtimuB I»ui ix^'fty 
fmu the iD«dlAu line, kavtris a ccQiral opeaittg bctw-ecn 
Ihna. Ttib in, hnwevn-, an ux-il lint genrmlly ctms ittelf. 
Thu catiines and tncuapitU, wb«a tlivy ii|i]M!«r, force tbo 
U<elh into (he vur^cal [rndtion, nnd the space be- 
iUt«rat«d. 

nay in wmw nuttuctA In.> <lii«<lvnntAgooui to remove the 
imufotmry Icvtb prcumtun-ly, liul the tlindviuita-^««t will not 
ha ibuipn in the nittl-|<j«itiuii of thu nicc<.vdtnK iwth »t Ihr 
pviod uf tiieir cni|iti(m. Bat shoald the tirst tc«th bo n- 
taliiM) Ivyoitd the n-^nual licriod, the miKhiof rvanlting frinu 
Ibrir iirrMQcti will be MtOwk'ntly obviniitk Wb«qi thv mib- 

nf [nrtial IrrpgulvHty w enniriden>d, this point will bn 
iiavd nvidntil by llif lUt-iiaipHnyin}! illiwtnUiuni. 
.<n> thir ctitirw I'f trralnivnt b decided it{)i>D, the coo- 
|fiwut«id by tlw jaws aiiwt bo actnimU-ly ibtrrrlaiiied, 
4Ud it alu'uld t^ kii'twii wlivtbcr tlie iloliiniiily if htiKtVitnty 
or arciii ■ J»»i \^ iLscoftAin^l wlietlnfr the 

)a«» *!' I (mmc — ut tluiL |xiiDt M'lR-rv the 

alveolar pxtMHi nergn to the body of the bono*. And it is 



fmu the 

^ them. 1 

^M^ Thu catii 
^^^^.^ 

^^^^«a? 




$9 



A ST8TKN or PINTAL SFBORRV. 



eqoaUjr important that w-e Hhnuld U^m whether the mal- 
pontioD of the wooikI, Uaic nntujti froui the Uit\\y sliwldiug of 
tlie t«inix>raTy, eiet.. If tlie cane pre»>iito<l for tn>iu.inent 
exliibiu ft fufui coimii'bti to the kmity uf which th« child is 
A member, vr shalt pmbahly bars to onoonnter greater (Uf!i- 
culty thnn if it he a Military example. After tins tootii Lave 
been rwiioTwl, there will \ie a greater tendency in the one 
caw ihau In iJic otlirr ti> retiini to iIib original positmn. 
Sujipc»iug tho V-«Lapvd arch Iw furcod iiitu the dliplic furu 
In a COM) whore tho hum of tb« jan-8 U Ir-Iow tho noruuil 
aize, tho positJoD of the tooth individually will l>o m obUfiue, 
ma TeapectA the Jaw, that thoy will buooino unsightly ; and 
mnrefiTer, it. is qneAtionable whether tho subtuqueoit alreolar 
dcvolopment will be suflici'ent lo tecuro a 6nn impiantttinn, 
llenc«, in cases wliich pretteat this character, it luay be 
darirablo to remor« pefotAuent toctJi, one bn cither mdf- of 
tho jaw, iimru wpeuially whuti tliu (runt U.'C-Lh are unduly 
]>rominent, and consoqueutly raqutro to be 1>roiight inwards. 
If the nisl-poaitioii has reeultiil froia ibfl pDrsurteuua uf 
temporary teeth, tb« permanent teeth will lend to fall into 
tbci elliptical arraiigeiaent no aoon aa the obstrnction is 
n!iiu}%*vd, from mum* which have beau explained on a 
jireotdiiiK iM-xv (p. ISO). 

Wlieu thvrxi i^ vvory ruoaoa to suppose that the Inse of 
the jaw in free fnim contnktion, Ihu teeth iiiay then lie 
forced nulwanlR till the dcitiri^ confomiAtion is attnined j 
and in cases where the deformity hjw been equal both in the 
iipjier and lower jawo, and tli« antagiwiiun jterl'ect, it will be 
necewury, after ilie iipper tooth have been nvarrftngod, to 
repeat the oiteration in the lower terth, and thereby rtwloro 
iJto antagoniniT) which would otherwiM be diMurbod. antl in 
ihu effurta of re-ad justuiuQlp iailueneu unfavuurably ihu 
resulta of the operation. 

The fomi uf a|>paratus soitablE.- for expuiidin'^ ihc V-sIiaiied 
deaial arch need not be minutely deocnlwd, as either the 
irorjr or the metal plate — a descri|itioa of each of which 



TEITBIHO. 



153 



I 



is girot ID ooRuection with the umtroeiit of inTorted t«eUi — 
vUl be fooQi) fActm. 

Id tbo iticcMmlii]^; iiK^Ln.-, fumisbrd luo by Ur, Uiirri^uu, 
tba debnoity is so great, and the base so contrnctcd, thiit 
tmxttatvi ln!KtTii<iit wnuld bu attended witli gnat diflirulty. 
The bicu«pjd3 vtcro ruuoved with the hri\« t)uit tlie Iruut 
Icatb wnuld fall hark ; l>iit, vrillk tjie cniiition of the wi«dom 
UMb, tb« fint pcmiaoi'Qt molAnt idothI furnanls iutu ilia 
rarant ipaoaa, and the more anterior toctii jimK-rrcd thtir 
(irigiual intdtiuD. It wuuld appear in thia, as in luauy other 
CMe», that uMiire, having ncogaiitod a special, thonifh au 
imgular form, oAerod nsiiiliuioe to any mbscquent change 

nithortij otUsituiB boa been direuted to Iboee coaGs only 
in which the front tMUi> thoogb unUbnn a« regards their 
iailividual armngenMnt, hare been aa a whole out of tbe 
oataraJ position. Instaoce* in which aam« of th« teeth aie 
ttnl-placed as roapects Uw orownii, while the retnaiudcr hold 
th» nonoal tiMiUaa, bare now to bu ooustdured. 

Stporaiion ^ tkt ttmtral tnmont, learlmg an imocon[nfld 
apace in tbfl nmaan line, ia [wrhapa the moat siropUs ami at 
tba ttiav time tbo moat tuauogvable, form of im^Unty 
whirh rmnn undor our notice. If the tei-th are olJiitrwiMt 
comwtly iiboml, a ring of iudia-mbber rtrrtched over tbo 
two t«rUi will ill the ooarae of a few daya bring them to* 
gntbor, afUiT which tba oocwMonal nwi of tb« ring or of a silk 
llgaturv will be nifBdent lo tcUud Uio teeth uulil they 
baoomt ftxMl iu tba new {msitloiL. 

Altboo;^ the tmc T-ahapvd jaw is a ooo^'nital mal- 
fbnnatkni, yet Ute d^fiirmity m prmluced may he in aome 
eaata iMTtUlly reaudiMJ, nr at liaist itu[<rovwl by trctatmcnt ; 
aiMl tbla uppjitunity may be taken of dJaciuaine miom ixjiiiUi 
which bear on tba wboI« qogithia of deoUl Irregalaritt<^ 
It mnct first be diitcnniii(<d bow fitr thn wholn jaw is mat* 
finrmad, (n H aotncUmM bafpens that while the V-«ba[)od 
CoofonnalluB la |««aent«d by the ujipcr jaw, the heck tuvtU 



154 



4 STflTSH or DKHTAI. DtnonT. 



ti( UiB lower bite outftkle Lhow of tbe tipjuT jaw. But little 
can be done to remedy such citcodc^ malfonmitioii hy 
Lreatmeut; it is buui-vtrr^ iutcrnitiii)!; to uote tliat ihits lt^<-' 
the oconnetuw of the V-siiniH-d ujiptr nAxilld, ia in ■ uiiiosun; 
lilt! retention in tlie aOnlt of a ouoditiun vf Lbiop wbicli iu 
the foeiiu is nutcual. F<k at the perioil of developiueDt 
aln«dy allitilnl to (p. 146), (lie ixwurior divcifpnce of tbo 
lower jaw wutiM, if Lbcre were twth In it, lead to their 
biting tiiitside thi>M of ihi- upper maxilla iit the \yaick part 
at th» mouth. 

/fltwrtton fir evtrtion <^th« tetttrai ineinort Is not anci>nt- 
mtinly necn in atsea whorn the ejection of the toiu[x>rary 
t<«th has be«D delayed, and tli« Bucccasora have come down 
«itber behind or io frotil of tliein, oi when tbe orupiioii has 
been poetpoaed until the lovnn teeth have attnined th[>ir full 
htfiKht, Hud iu the ab«(!nce of any counlcrHctiu;; ii)flu(<nc« 
from antiigoniHtto tenth, hnve oilher taken a hi|(bor of ft 
muK fam-ard pontion tban they nhoiUd bare littne; COOM- 
quently tlit^ up|WT teotli have Ix-cu tlrivcu, wboit in a xtate of 
activ* growtl), either outwards ot backwanlo, just as th<>y 
nuiy Ktriko on the labial or Ungual xurraciM Liiiiiii.-<diately 
after emergence. 

On tlie nther band, the lateral incisors may, as iu tbo case 
figured at i«f,'o CA, lie iu front of tbe central teeth durin; 
development, and the four tL>«th, advancing in growth with 
equal rajnditj, oblige tbe latter, at the time of emptioD, to 
tske n Inrkward place. 

Bui by lar thu iiio»t common cau»e of diBplaoemeot ta the 
peisistcoice of tlie teniiKrary teeth. The following figure 
may l« taken aji a fair muunpk of irrvf^uliuity ariaing &om 
thb auiM--. The temporary Iwlb being retained, their 
mcoetaora have ootiMquently tJtkea a posterior position, 
which atlowD the lower teeth, when the month i» ckwtii, to 
[MSii iu front tif tbent ; and thuh, in tlie absence of mccluuii- 
cal iaterference, render permanent tbe mal-poBitiun. 

Whatever may be the cause of tbe irrcipilarity, the ' 



f- 



TKBTUIXa. 



15o 



inTolTvd io ile reduction will not be gnjac In case 
tbvT an ilirccl4>d inwarils the aw vf aihat k metal or a 
vulcaoile liUte, proTidHl with diMubvrs (or cuui|)rfMicti 
wwd, wili speedily force ibcm iutu a mffieiuuly furw&ni 
(i«i6ith4i. (^r llity iikay U- dn^QiniU uulwanlH by duKitcKout; 
Utndu i>aHH.ti ilifoiigli a »lit titir of metal. jA^bUi^ iu front iu 
ttiv luaiUHt vLri'aiiy iIcntiIjmL If thi- Tnull Ik nntiue ^o- 
luioeTKr, t)iu) tu»y be uvertuote eitliei by iui«laauc Uwdof 




I 



to ilw labial snrfHce of caps lilted to the 
fixctl tu uiirtal Htudu [Jftced imniediHtcly 
iBittTt ti< be artvd on; &r by titk Ugaturra 
throng a pUti* ailnpted to tfac bard (mlate, luid yrer 
poftioofl of caro|iruxcJ wood, which liavu been fitted ui 
iquan duunbon (mdiiord on ihc linfrnal >iirbre dir their 
RNptiun. Wbca njiplM tu ibis mauDO', Lhi? wood wilt 
ni«lid bt ibe inwud tUnutinn, and ooDan|ii»iit)y cAiry tbo 
Kl^ntM tackward, aitd witJi them Uw cuLntAuihnjt tcvUi. 
8hanU the nwrnai I'dsn of thn Ltlvral tiwlb be mi pUccd that 
lb* inward ibovcniout uf tbn oentral incifioni in ulniitntctni, 

(•) &*•>* tb* pHSunail (vntm) InalMo tvUNf ilirw^ lb noi paM»- 
flMir ■» Om |»«*MIh tMBpunry b*tb, tanig m taMwal Mn wlUck Uw 
tow iKtoM fiM «t«» UW BPMfe todosi. 




STSTEM or DBITTAL SOBOKBY. 



cm treatiaent muat commence by forcir^ the former oat-" 
wanla from tho median line, until Utcy erase to cinbnma8 
the opiiatiou. This iiiay iii mosl casoi he dunu liy pUcing 
pieces of india-rnbbor UctwM'D the IntiTsl and ccDtrnl t«ctti. 
It 18 Scarcely nofiessary lu tviK-ut, ihiit when thu lower Ifttli 
clijiw in Trimt or upm tlii' odgm of tlie Mpjter, the plate mcbt 
be mailo suHiciuntlr thick ul thtwu jails whicli laan aver tbu 
btti^k tceUi to prevtmt tlu< nntu^nisttc itiflneoce. 

Tonion, or tuntting </ Ms ceHtral iaeisora ii|k)Q Uieir axis, 
is far from nuc. The defect in i>o8ition may bo oommoD to, 
WdA equal in iitch tootb, ur it iruiy lie ^rcivlt-r in Ibi' one ihiiii 
in the otbor, or it iiiny hn confineii to one tootb only. Either 
(be mesial sides niiiy be dirwlwi tuwHrds Lb« pelate, or tliey 
may 1w turned towards tbt; Iiim ; or the one tootL may be 
tuvieted in tlte om, and tliu fi-lluw tooth in the other direc- 
tion (Fig. 29). 

Id n case recently under treatincot, the right incisor madu 
ito s|>)M.mrntii!e ai the. fige nf thirteen, with the lingual sur- 
faoD punUk't witli tbe median line of the month. lu this cam 
the tootli 18 n qtmrter of a turn out nf jhlnoe, bnt iiiRtances 
«n reoorded in which the tn-ieiiug has extended to m 
nnich ta half a turn, ho that tlm Uii^uilI siirface preaentfl (o 
U]». 1 bare one exampk shoviag this itinuunt of torftion 
in a bicufipid tooth. Id many cases of Ihia kiud the mni-f 
poEitiun iuut been awmiied during the peritKl uf dovolo]>ment, 
and.ii then ooawcjnent upon nrrcB-ted devclopnient of the 
anterior pari of tbu jhw. Buiiietiiiie^, however, it results 
from the retention of tlte temporary inci»or». And it in not 
imjOYibalile that the ruut uf a l.i7ii]M>rary tooth, if displaced 
by a blow or by a ntdc o]jenition, may dirturb and tnni the 
■ociceBiuir n)Hni its axis wbilo witJiin itA crypt. Thi! mtarded 
derdopOQeat or eruption of a tixith may also be cited as a 
cauM of ita torsion; anil it if. not difliicitlc to see bow the 
nial-poBitiuti is ^eii |ifoduced. ITio luljoining teeth being 
already through the piiu^Jcan toward the un(>cpax>ied Hpat», 
Mod oSei an imjiediment to the pro|;n)*sii)g tooth, 'nhicb, 




Tsjn-umo. 



167 



cvmjArftltTcly Inise implanlHtit^D &t the prnptive 
epoch, ttimi rut tW oxu, ami dcsetMiils or asctrDds. as tlie com 
lUAj Iw, iu tbst pontiun iu wtiioh tbe leoat resisUncc to its 
[iropiiM i* oGbred. 

In on case » it ilsalmble tn low a nentnil incinrT; honce, 
If w« havB nuoo to suppoM that the twist«d tooth is io 
ita^ ix'rfect. It must be bnniKht to ttie proper pcMition ; and 
ibouM tt Ap7«ar impoMib1« to obtam gofflciont b|)Aoo with- 
tml MmficinK a toutb, wt- miutt n:iuuvo one or otbiT of the 
iiHtfe ptMt«nor tMth. 

It i» qtiiU' possiblo cssct may occur in which stich a pro- 
ODsdujf bvooiDBS Doooaaary, altbuu)^ I have ranily mut with 
llwn in my own pnelioe. Bot befcre deciding upon sacri- 
baaz > •onod tooth, we must be well assured that tha 
Iitdaor b Dot subject to defonnlty, liko that tihowQ id 
Fig. 4^ whtrrc the deaccnt being arrcstKl by the pnwcncA of 
K BUprrnuitiDmrT Looth, th« fan^ haa Iiumi durvltipoit in an 
trMKoIarly cnrred form. Instnnovs will SbiD«tin)ca prcaeat 
thoDwIvai in which the ezpomd partion of the crovni ia 
rwttted and dinx;ti>d timrRrda the palaU, while the root of 
ill* tootli ill in tbtt amal position, the t-rowa and the &ing 
bring Jojned at an ugle, pramitin^ that pwiiliarity of coo- 
fcmati'iii ubtch haa been denominated ditaoer&ttmi.C) If 
in fucb u catc a bcttlthy tooth were renurred, we should be 
ootniniitins a »<-'nauii iirnj>r. It Ihtrelcire becomea ouocBaary 
that a vuiy careful (-xajniaatton uf th« mouth should be 
roadd lirihn! thi; trenUncot ia dt-tormined on. The poaition 
(if the ruul (if Ihu erring t<K>th abonld he ascertaiuvd. and 
thla may ^nmilly be done by a rnreful examiDstton of the 
i^m, ttt-tMOtli whicli the outline of the root, if io thi) tuiuil 
(XMitioii. iiiity \io fvll. 

It i» i-ATVfXy invcBsary ia rcrnark, that wbpn the nccanity 
Tar the niiK-vai of a tooth ftriws, our rhofce will lall npOD an 
nnvnind tmi*, nIihiiUI onch hi* prrsmt, oreii limiigh it he at 
amw; iU*laiKxi frtiin the |uiiit whtn^ the ufacc ia re<imred. 
<i) iMiaTBMi Omul nfMakij aaASofi^. 




EnrsTSM or nnrtu. rdbobbt. 

As TBBpecU the trcfttmeol tn bo u^optoil, I nuinnt do 
bett«c than dcacribe ihe ooune pamwd in the rollowin^ assr. 
ittfuiiuueh aa the illiiKtratioTis nao O MMy for the duciiUtum of 
ilttails will sofTc the ftirtlwr pnrpoM of lihomng ihe tnothod 
AjiplinHe to caan of irrogulnritiM nffeotiug other teeth. The 
pAtimt wu a f«m&l«, aged fouru^n years. The Irft. 0(>ntral 
incisir up to the n^ of thirtom did not make itH aitptaratiou, 
conaeqiMBtly the cmwn 4^ the right lAt<>ral nnd (eft central 
toetlllcftned towards awh mhcr, W^-ing an int/<n*n1 insuffi- 
ciant lor the tiiiseing tuotli tu take its iialnral |«iKitii)». At 
lUrtsea, hoveviM', the tooth apix-arM, with its nicdiAn Hide 
dirertnl tmninlH Ihi' lip, hnt it was not till a year bad 
«lapAcd that rhc cam came under treatntent. The ffucoeeil- 
itig figure will aliaw Ihe ^encnil poeilinn of [h«> teeth, mid it 
may be remarkod that th« caninoB wcro «li?htiy more pro- 
niiiMiit than the anlitriitr teeth. A careful exaiiii Ration led 
to the (ymcluBion that, eujiiioKinj! thi> laU!nU» and tbt> left 
central iiicinor were jirvsMil ont, so as tn range fvculy with 
thir (aiiinps anfficienl h[«u:« would thereby tte gained to 
allow the twistol tooth tn hold th<> nnrmnl position. Aoting 
oudtT this impreMion, a plate was made to fit the ]ridattt, 
and attachod t*i tho bicnsprdx Yty wiw continuM xwcr the 
uniwtu) of lIkml- tuvtli on intbcr «idi] <if thr tiKioth, and 
t*rrainatflJ by a smalt T-lik« exTwniity, wliich. l)y way i>f 
pmtectitiK tho it-cth. «-as cavcntl with a thin inveMmflnt nt 
fl<M3 silk. la thi« manner the plate wa.1 firnaly retained in 
its place 

Tho next ptDCOcdiDg amsiMod ia Mildcriiif; tn thi< liack 
jmrt of the plate iwti tundt^. oomposnl of p)ld, renderwl 
elastic by the additiou uf threa grains of ]}|atiini7ii to one 
penny wi.i gilt of tho oniiunry wighteeo-carat cold. Tho fr»c 
tmda of the lands won! &djust«d to preKn mitwanlK and from 
the im-milar tf^tlh, the two oontigtioa» teeth, iu the mantier 
ahown in the aLv^miinnyinc fi^iirn. 

tn the cofirne of nine days, mfficiont effect had Iteun yurt- 
daemii to rentier it ikuantbic tlml ila* inciwir itacif should i>e 



TCffi'liinn. 



169 



•ete4 QpoQ in order thnt thir iiii:T'.-a.«e(l inivrml sliould be 
onntr**^) l<y llw uaitb for wliiclt it limi \kcu obtained. A 
»- " «w couktntcf>l. Ill thw It i*t oi ^U\ wm 

rir III fmat of Uie u.i>tli, ami allacbcil 1» llio aiiU-riiM' 

T-{aaea on riUi*r ^e. lleUl »11.<i fi^r tiie rcccpcirm of cnni- 
pnne4 wand wa« tluui onldnml tu tliR |)Uit> and Ut tJic> 
hand. Ona wu |4acuI io tlut the wood wouJd |in)M npon 

J«ff.Bl.(IJ 




dUUl M^y uf Uir tooib, the oth«r u\vtk lim UliUI 
Wirfaec amr tlii' mtulHiii ftoglc. Itic fonvti tbiio broitght 
isto pUr liciii)); in o[i|*)«il« ilirmioDH, tnrriAl thu tooLb 
oiflMi lUsxis, and n-m Biifhrirnl U^ inlliifnoo Uip iiiijitnKinR 
tewiml Mfl (X^utral tMlb, HD'l f»rr« llirni (rnt of ihe *v«y of 

(1)awm«irtlBltl oartnl Inttai IbMmI ■« I» «MJi >■ Um Ml abtM •« 
• ^p«Ur uf • wvoluUv. viUi 111* B^jiaDlB* liuftiun In di^ (tniucl wlili 
■■MMMluiitHlnriMM. tfa* wW rWt ««9d la fta Mm •!«»<« Ita 

•iwattai to BlHwn <• «<U. wWi lk( tini riMHe hu* «t »d-l --l-i-l toUm 
Wdi|MM4f llM|4ak.M»4llirb««fafc ba pMH'unfOr Ml' ' 'iglH 

liimJintMl <Milnl ItMteiT In onlirtofl^ •!«(« Inr twi , <n< 

•mUl l«ft> ihrtdi biln«.iUtMin« <«a4l««Uf«a**t"' '-'»•<•■' tlw 
MMiUw ur Ife* plito li dMwm. 



160 



A BT8TSM OP DENTAL STTSOBBr. 



tho olowly tanimg t4X>tli. la & few dajrv it IwoAino dcom-- 
■ary to Alter tbe pu«itiOD of the ruMptAcles for the wtxiA, and 
robwqnenlly to more tbem from tizao to time towards the 
relreBtiug angles of the Uwtli. 

Attvr the second pl«U< huX been lu ii«« tbro« w»c4c8, th« 
luotb hod Ro far cbaugcd it^ poetlinn tluit tbi< iiip^ial Bide 
stood slighlly iu frunt of tbu left iQCieor, and the distal side 




a littU poRterior to tin lateral indaor, prcwnting K dognv cf 
irn»suUirity wlikli would attract but litlli' iiutit:(\ 

As the loft inciiw wns still n Utile internal to the arch 
which WDtiM be desi'ribed if the rjiiiincs were taken as tha 
guide for itD forniatJoB, a ceil was adjusted upon the plat« 
Itehind that tooth, and tbe wikkI brought iota opemtian. 
At the seme tiino, the operation upon the lingual Aur&c« 
ncnr tlifi diHtal auRle vtoh contiaa<!cl, and tbe degree of 
preesuru upon thi^ Uhinl surface wah couiiderably reduced. 

(I) SLotn Ui« oundltlon of Ibe cm* iltuafralol In tbe pTBcvdIng Bgair aPm 
the a^lttaloK (««>><> >»*• ben (gMwabd bj lh« vUtlk Uuid*, util tha dJapUtvI 
tooUi (onvnl *ll|^il7 tfrm IU ortnlEul jntAUva. Th* platt imi to UiU. tbe 
•MM>1<*aaiof U«o|itnUmi. Uit.oMn tt Mu. wlUi Ihv nwtelllc bwu« for Uw 
rto-pllan til llie canpirwil KihiI !it ihn po^loiu Milub^ for rtllcUDK tlw 
taVtm fKffm of Uw UsIukol U olU b* appM-Hit Uiat Oie boxn wCll 
nqfdi* ■ <twnBi) uf puatUan «bra Uie lunUi hin nravtd awRj- fhnn dMm. 



TCETUI5a. 



161 



I 



In tbo fcnirw! ot a >*con'l term yf thrwJ wwk«, tie tooth wjw 
Immglit iato jiwiUou, niii^o;; urcaly willi Uio cMjiilignutw 
teetb. 

Tlwr foTf^gotDf iilastntion will show tbe principles np<.n 
vluuh tiiu ojientiou wiui coaducUKi, alttwiugli the wcmI- 
nuiniag cclta are gimoi in anc poutJon only. Ittniut be 
lUularBtuwl that ihey vrtae moved froiu time to time, so as 
to (oUow up the moving tooth, ant) so adjiuted u to bring 
tha (jrawini l^ Iwur iu suvli Jirectioiu u at the tium np- 

'I'hiB case will be n^Bnled as one pnwutitin^ a oouBiderabk 
aiuouut iif difficulty. A. aucecssfol opcrntioa involved noi 
only twiBtiDi; a tooth nptm iLH asJB to tlw tiatt-iit. or u 
4Iiart«r uf a revaltition, hat abo the aliiftiag outwanU of (he 
kft oeutral and bmh of the latpnil incisors, io oniej lo make 
lUMii fcq- the ctnHtiiig tuuth to tarn. Thv bfiw of the 
alvaular arrb waa, iiowevcr, Miflicicntly derekpnl U> render 
thv rmi)juatBit«nt uf the Ivdh practicable viilhotit bavinK 
nooorw vn csinction. 

Tbe fnnit t«i~-th having been cnrriod into th« AcnrtA poai- 
tioit. it 1mi-.iiu« OKcasary lo takti jataumtei to k<-pp them 
Uwr» until they became finnly fixed in their iu«kftl«. T<i 
•KkI tlu« i«t«ntioa. an ivory ptat« ivm 6tto>l to tb« jxUate 
and Ui the liu4{ual Ku&cve uf Uio teeth, estemiio;; as htr 
lact M thv first pennooent inolara. The bicuHfiids being h 
httJv InteniiU to the prupcr oatline of the arcli, \iegi9 t^wofxl 
«n«o inwrtml into the ivory at iJie points currcspDndiDg lo 
ihi* n«cita of tlieae IwtU. Afk«r niljustmont, iho peg» pnv 
jnncii [ran the |»bt« iluffii:ivully Iu inaut iinitly U|Kin tin* 
if:' iht and thiut {irrfunn the (k>\ihU> pur|>OM> 

u[ r ' t'o in itx place, and i>f fiiicing the ti;<-lb, 

up Ml ri dei>etiilc<l, »ii[;hlly vulwardK. Thin, 

th<^i. I .1 tha i-oMf At tlio umv I A]n wnliOK 

(Il!>.'tU), aut 1 l->ul Du d-jijbt tlut l>tir<iri.> the expiration oC 

I Iwalvi' [itontha tho l<^th uili luivc .frlilul down in their 

. praaeiil {uailiou. 



163 



A ITSTSM or DEKTAL eTJEOBBT. 



But thff process of twisting a tooth on it« own txu Isj 
inoniiK or graiituil pnuwira U one thftt nGcfiadtatet ihnrsMof 
a plate for « v«ry cuiiEitlvrabb length of time, and iuflicto do 
siTi&ll diiwonifort on ttm {^ntienl; nod it bu becu fuuiKl thai 
the Hame «iid may he attainul by seixing the tooth in » [air 
of foroapa ojui fortihty twisting it muml. 

It tut<:bt have been antici jifttnr) that Riicb n prooedore 
M'oiilil he fnUowod by the flenth of the pulp and comeqiwilt 
aIvooI&t abRTpsK, Iiut this unt'iwnnl n-sult hftppeos v«iy 
mrt'ly, and niay /ilmnst always \m avoided by performing 
the operation only on fnvuuiahle caseit. 

Before decidiuf; on forcibly twUting the tooth, the operator 
should wtliRfy hinisolf tliut there Ik Bufficiunt spACv fur the 
cniwn in it» upw poBition, and alto that the direction of the 
Tixt is siirh that it will allow uf the crown rangiiig regularly 
with the £iimiuiidiii<; tccLli. 

The most favoiirabk period for its performance appears to 
he tbo fl^o of night or ninti y^ars, when lb« teeth are fully 
eraptod, but th«ir sockets have not yet attAincd thoir fiill 
wtrength. I hare however inicneiwfnlly twisted the oeotml 
incjsoirs in a patient t^fii fifteen, aod id aevenl iDstencw in 
itiontK Mffni thirteen ; bnt, or a rule, It nhould be done at a 

ach carli«r o^, for the aockets bccoine Tery denve and tu- 

leldiu);, »u tnucb w that in Bcveml csaes I have failed lo 

move the toeth n*ith any ilt^L-e of force which it has iwemed 

aafe tn apply, and have been therefore compelled to abandon 

the attvinpt. 

Tho toot!) may 1x3 Mitcd hy ita labial and Ungual, or by 
ita mesial and dintal irurfacuB; and it will oElen be con- 
rcnicnt to cliangc the hold of the foroeps after the tooth ia 
partially twUtod. Thu», if the tooth stands nearly at 
angles to its proper positioa (at:, for citamplc, the 
€i!ntral ineisor in Fig. 61), it would he Qafiit<fit to apply 
blade of the foroepa to the mesial and the other to the distal 
nirftoo> but it would not be pomble to coitiplnte tJie torsion 
with the blades in this poeitiou, as they MouLd couie iu 




TOTHIXC 



N 
* 



» 
* 



oioUct with the biUral Ant) the otli«T central incuor. 
wtwra tlip looth io porlklty turned, tlie forceps miut 
»{i|illnl lu tlic Imgnal »nil labial sur&rts, liy wbinb 
the Dfienliou ni*y be c<>tni)let«d, and the tottli left iu u 
perfectly normal iMudtion. 

The lostnuMDC used tboold be a jxiir of Rtraigkt inciaor 
toerf«, the bhides of which alKnili) be prcvcoU'd from chip- 
t^OfjE tW Motnel, by the iiilcrpusition of aumu soft sulietjuici'. 
BotOtf -i^ratur* uw a slip of mnd-papcr for the piirpiwp ; 
oUtera OM* papnTt tmL this is aiit lo slip. A piure of Ind- 
foil answer* tlio purpose v«fy well, and i« fr*e from th* 
olijnctjnns u-hich <ip[<)y U> tbp other two. The tocitli tdiiiolil 
be firmly piupcd nt the vdgo of the ^m. and ft«8idUy 
twu4al iu tin dutinid direction until it in fell U> yinld ; no 
attccnpt abauU be mada Ut looseu it by twisting it alter- 
omuAj in oppoiit« diroctloos, as has bocn doac by some 
opanlon, as this loo«>!nin^ ia jircciM^ljr nliat it in dMiroble 
to avoid as far as ii pnosiblp. As the tooth on betni; rdcawd 
■pringa bs4:k toui«w)iat, it is (fCoenUly Deccasary to twist it 
amirwhat Earthvr than inlo iu normal position. Where thn 
tfnih baa to bo twbt«<l tluot^h n iittarler of a circle in a 
that old sul>)orl, ih« rosistancc will someliniMi be very 
ible, and I have In wveml iiudautva obtaiURl ii 
i|[l,Iy • . . V miilt by turning it through only 

balf th<! mill t-'r, niid allowing it to f^t finn a;nin ; 

theti, iffrr Uk' Up**' of a fi>rtnlgbt or thnw weeks, oom- 
plrtinf* the Dpmtion hv twibtin); it tbrongh the remaining 
dbtenoc. AUhongh on ihc firat ucau^ion the resistance may 
tuna been rrry Kn>ntt the tj<oth Keucrally yields very readily 
loUw aecond alteinpt. and I think sach a couiw prefenibie 
bo tiic a» of Tvry great f6n:« in nrder to oompteto the 
ofaTUkm at tha firnt aiu^inpt. 

TlMVa la gnurally vury little bloeding, and not mnch )«in 
ravblnc tmm the operariun, thon^ of ootme, the tooth 1« 
aoOMnrhat bnao and UiuAe^ at tirst. In ontor ti:> iiisuru it 
telag laft at paricct rest, and nrtiunod to il« new position. 



163 I 

Ucuoe, I 

itut N' ^H 




lU 



A. BTSTBM OF UEin'AL SITKOBKT. 



it is Ndruable to floft«n 8 pieco of gntta-perclia nod press it 
ovi>r ths iiwisore and catimus of tbe upper j«w immedtstdjr 
after the operation, directing tiit patient to bite the lower 
t«vt]i inUi it#'iiile it is etill eufU 

Till* Hillkeup in it« place, and diould be worn tortwcnly- 
four buurs at \easn, or ioiiKer if tbo twolb rtmiiiiDH very loose ; 
of cxmnfc it luusl lie reinuVGd during meals, but it it safer to 
Donfitic the [mtteni's di<!t to soft thidgs for a duy. T)]c- 
extrouie letidL'ruu«s &u<\ 1uo»&l«m will jmas oGT in a day or 
two, whm tbo uiw of tbc pitto-percba splint may bo disoiin- 
tinttcd. If ihfTB is awvtlin;; and tcndoniout over iLe Kucket, 
this may Iti' ]iaint4^d strongly witb tincture of indino, or a 
bccb apiiUcd i but the lutcwHilj- for aoy aucb treatment 
wldom Arises. 

I am anpiflinted witb one ruse otdy in wliicli nenrxnis 
of the tooth viinuvd ; the i»tjeQt ws« a child of suitable age. 
but was a tiii.s|iitu) )mtiotit, apporcDtly mil much t<>nd«4i by 
its partntti. and j^robubly do care was lakeu after tbe 
operatiuu to piciierve thf luutli fruni iiuivemeut. In IbiM enoc, 
1 beliere, tbe pul[i cavity wan drilled inlo, through tlie 
lingual surface of tiia crown, and tlio fuii^ &llt>d witb cutlou 
wool steeped io c&rbobc acid. Tbin treatment wu pi>r- 
fecily i)uccc««fut, niid the tootli afler a sliurt ttino became 
driuly fixed in its )H>ckeL 1 do nut know tbrougb what 
distance tbe tootb w&s curucd, nor wttRlln^ It nflcred mnrr 
thaa usual Tosiatauce, but tlii> iLututvurd rusult wajt attri- 
tiit<>d to the want of laoper care exercised after the oj-e™- 
tion, 

IrregtilarUy in the poiition <tf th« laUral tncuors. — In tb«^ 
opper jaw these T«!ih may lie miBpl»r«l iti any of tbu 
directions numerated and described in the proccdinc paeea 
io connection with malpositiunsof tlic central indson, hmice 
the description which ba^ served for the one may bo applie<t 
Io the other series ai dnrnnnilicfl. I'erhnf« the nint>t common 
form of irregularity of tbe lateral inciitors in that in which 
they take a pusttriui prviitiuti, tlie mcdiao edge uf each lyinf^ 



TXinilKO. 



1C5 



licUod the nmtijptnttH »<lc> of ihe cenini) incisor, and th« 
diiUil ndge beluitd th« luodian lido of the caaiiie. 



ftf. «L{') 




Iq llie pXAinpId fl^r«d the tcotb hare retained the jwnitioa 
MBuawd daring their dcreloptuvnt, when, fn>tQ the iiunif- 
Itcient tizv uf thn Anterior |Kirt uf (lie tuclit thui ur aome 
tfthtr form of dUf-liuM^ent mui » xuxesslty. 'Vhe cnninfls 
htrv boUl lh« plocv which kIhiuIiI hav« been ocaiipi«<l by the 
Ulerml t«>th, Iml hati the Inttcr taken LhHr numiKl IN-Milioii. 
the f'Ttiwr wDiiM haru Ihvh Uirown out uf the Ovatoi linv. 

Wu uusL Dul, huuevcr. iii endeavouring tu tnhje the cause 
of mere muqiUu-inent in cju^es like the uno figured, for(;ot 
tJut hid a tir«i«rr •linn.iioD Wn giTCD to the twth as tlicy 
RusoefldTrly ttpfVAred through the garm, lh« alveoli wonld 
lM*e fjffwrt up with thciii, nnil if ttio h«M of tlie Jaw tiad 
«tialitc<l ft #n(rif inil tii«r, oi> lne(riil«rliy wouW Itftve iKx-iirrwl. 
mrm bod the teeth, wh«tk within the jaw, faaen MomewhiU 
imgolarly di«iuwi|. 

[ti the nUM tram which the mieoMditig illiutmUoit u 

(I) «hM«l« llo lalMal Indkin rbtvd iKlHHl l« Ikr iknul Ml4^ Uif 
Aiww^ »nk Mn« ooatncvp). Thta UlvdnUgn !# Ufcon (mn a sm* vt tU 




A 8TSTE1I or SBirrAL gCBOCRT. 

laken, thow ib no indicntion of costractioii of (lie jaw. 
Uiv ouv fijiU' of tlio nimitb, tbi3 t«ol-h are pcrfi'dly r^ilnr; 
on the other, lb« lateral iactsor aoii the ciuiiue are directed 
iDwaids, anil paits, wlicu Ihv niouth U shut, bchiud the 
omTMponiiiDg teeth of the lower jaw. The arch being at 
this point Ik^iiI tuvrunls, aud thu alreoUr s[»co thereby 
ooDtracted, th« teeth, in ortlor to find a |iliu» fur tbcinaclTes, 
have forced the cj?ntral inciaor forward, and driven ito itiddiaD 
edge over the labial aurface uf the adjuiuiug tiMth. In this 



«(.«.(■) 




upccimen we havo an vxaniiilti of inregul&rily conaequent on 
the teeth, frimi wrnie caiisu (jirdiitvlily the n^tarded ejection of 
the teiiifN^niry teeth), takiiii^ aii itiii>ro[)(ir clin*ctkiQ at the 
timp of vruptiott, thu jaiv hning iiomiol in eizc ; in tho {nhv 
oediu^ coKt}, aii illtiitlmtJini of irregnhirity conH0(]u«iit iiiMit 
a contriict<^^>i maxilla. 

A *\\^hi <)pgree of vvcrsiuu and BC|ioratiuii of the lateral 

(I) lUioirliif tlir Utml Isdaoi and nninc iartrM. Mil cbf cnitnl tndMr 
tldivnoanmrdiMHiMraMUieklluwliMUi.tbnalTcoIar arch Mtubuc tKl^ 
flwn'ain uanCn«ClQD. 



TEBTHWO. 



167 



tluioaDUaJ tootb it thv tlmo wbea ttw canine ii «!• 
vmnciiig towuil* tlw tturtact: uf tiio gum, b Ar from nn- 
comnKn, And wbt-n the Utter tooth is Impeded in ilsprognws 
tgr Uw ftmBoca of ltd tcmponry preik<oeaaor, the distorbance 
<i tbc blen] incisor beoomos still more uiarkod. Tbo 
bUowiog GguFC sbowii lbs affect protlucctl by tiie ftfrcgoiLg 
oombinstiop of drcanutanou. 




Wbpu the couicsl form of the cautne, it« crown boiag so 
ly wilier thau it« aomuwhol flttUmod faug, and the 
;lj protninBat coiiwiity ol' it« ni(xliuii kiUu tra taken 
' KDOUDt, wv aliftU not be at a loss (o see how daricg iu 
' doeeot the toot t)f Lbe lateral inciwr U presficvl u[inn, sud the 
aowa ooDsoqueally f<jrc«d uut of position. Instances are 
not Vttatiof; iu which iho root oT this tooth baa boen moiv 
cr laas ahcorlmd, to maks way for tbc canino ; and I haw an 
csainple in which the faog has beou bent during; ita dc%-t4i>p- 
nxnt, BO as to fiirm a bollow, within which the oonvoxity of 
tbo canino lAy. 

Id CTUinn-tioQ with malpo^itioa of tba canJaS) a figure will 

<■) lltovl^ Uk Uurrti \nrUot pt^md ml irf ito vtniti paMto If Ito 
^Ud> Is tM ilavnt w iw. rart^ ttl lh« (lan. Th« iiiiwu cw uT tlw Wp atwy 
— laafcMlBltMifrtwwpoatfcwrJllunOTianwHtocUi ttUof lh> oHWm 




BJSTEM or DBKTAL eUROEIlV. 

bo ^TCD) tfthoT) from a case in wbjcb llic Utrnil iiicittor hu 
biMD tiriveu outwnnla towards tlio Up, hy llie caiiiufl coming 
Ifarangb the gum lmmedi*tcly bejiind the furmcr tocrtb 
(Fig. 67). 

The principles wliicli have been laid down for the trwti- 
uiont of tlic variouH forniiiof irr^^likricy iu tlM> ceutml, ojjply 
vcjuilly to the lateral toolL, when similarly situated, oxoq*^ 
iog that Ibc onp ik, aa reBpeds nppfamnce, a Ivas vnluablo 
tooth than tlie oUier, aiwi may therefore, ondtir c«rtAin 
ciroiitnKtanceii, he. mcrilicixl with \essi hesitaticio. Wlieu. 
for ioiitance, the lateral teeth are oitiuled as in Fig. 03. we 
ueeil not ho&itatv tu nniuit-e thLiii, flii|i];ii.ibin;i; the antA^iiisiu 
ii uonnil, and a more fLinvnrd |it<«itiou of the central teeth 
wovM leave a wiiln inl/n'<ral hetwi-cn tlie linf^iial siirlaro nf 
the ii]){Mr and labial HurfACB uf Lite litwur teeth on tlie iiioatli 
being clo«ed. But if the central incisors in soch a case 
IWitsod behiniL the cnrresiwmlinji; t«?Ui of the lower jaw, it 
would Lheik be our duty to brlug them forward, and after- 
wartiit fuToe Ibv laterals into the epaou which the iirevkiusi 
i>)«nitltia had gained. In cases pnsscnting the itoctiliaritics 
Rbotm in the Fig. (H, tlie o|jtTatiuD is very simple. Wo 
bare only to briDg the iurert^l tooth, or teeth, outwards, 
and Die antagonisin}; Uivlh will keep them thpn-. 

Sup|M)i<ing the diaplacement to l« ca»i>ed by the canine 
wheii about to tatce itB place in the iwrie?, we most wut 
until the evolution is completed, removing, of course, any 
temporary tooth which uiav operate in disturbing it« coarse. 
If after the cni|>liou of the eauiue the lateral cki» not regain 
the i)ro[>er position, the nsunl means must tben ho adopted 
for it4 nwtoration. But it may happen that the teetii are 
driTcn inwnni* or omwards, or are iwisled by the canine*, 
whiah, in the absence of snfHeient npace for their [iroi<fr 
evolution, take a position either external or internal to the 
dental hue. 

Jmsfil^rU^ in M< pofitioa i^ th< oantne imih. — Of all the 
none are » frequently oat of the nomuil poeition at 



TBETHlKa. 



169 






lip (itne of tru\tlk'tx a* tlie lauiuec, aiul il may be kUiUiJ, 
^vithvut fiar uf mntnuliclton, Lbat no othor incmltcn of tho 
Htm fivt]uciitly IaU fsvm ait ulijwtiunablu into Iht |inj|)pr 
^uctltiiQ wiilinul nterhnnicnl ASiistatiot!. Wu odnntanily etv 
maa in wbirh, nl the u-ic of leu or Iwelre yvore, Uio»c Uxth 
bolr) a fiiliixtkin itniticwlutl external to the arch foniierl hy 
[titt iutiHors; Imt i( thry aru wiitcliei) it will lie found that 
Uia i^fatccuth ye«r Iwa been allaitied nil irrogularity 
rdimpixsral. It iKConiGK ft tnatttr ot muna nkotncDt tn 
MCwtaiu by wbal prooew* iht uuilonuity of arraugemeot i^ 
■llatDnJ. 'I'lt'' n>;f^u:icA whurli lemi In hrlng about a nonnal 
■rnu)0nQ<iir of the tc«tii bnve olnftdy b«sa mentioaad 
(|ap- 130), iui<l iJit-nc niU u[icnittt not uoly by bringing in 
tiw initauudiii]^ caoiue, but kIm, proltubly, by iu MtnadognQ 
pn«MD)c "utwanlii Iho incuMin. TberB arc, btiweTer, many 
mm iu which the; iniMral between tb« taterul iociaora and 
Dlerinr liiintfipiilii is ao stoall that Uie canincaneceHurily 
AXU'ftial to the lUutal arch, aud stautl «u much iii 
il of tht« lAli.'nil t*'*<lfi tlinl the outwnrtl tnorvmuDt of thv 
ttcr ur liiu iun^ itfugreu of thv funiicr hy ii iiatttral 
ftiruMw* ia rtmicml imi-TSHilik. On rcfcrriu^; to lh« pn'roil- 
l&f;urT<r, it will tw btva that if the uutwanl dcvuluiiuii'iit 
jofthe alrcrtlar riil)>o it iux]x-n>io<}, this poaitiou of the canine 
fuJliivra OH » Dncvi&sary n»utL, the dv^me nf diNjilart-'iiient 
ling Willi tlii; auouul of a«it|>vni*iou. llicu, agaiti, if tho 
tmnnal nliiii|iuty in nut aHtiimed by the froot tcetli, a Rimilar 
oudilkiu M ni«)i«cta thu cauiiim roanltA. Tbu prutoogwl 
nrtimilna of the tmi|»rary ]>redvcoarar may also be cited a» 

ItHulinie in a lik^ oflTi-ct. 
.'\ltlioiicb Itieaiitorior is by far the mow omiinon frtrra nf 
dU)'I:u-fiu"ril. no out anliK<|iH>i]tly tea the ratiiuti jiieniitj: 
thi rJor to Lho donlal liiie, the tvrniinal [-irtion of 
thr I' ' 'ti lliis, ao ill all lbs funiu of irrrgularily 
Mihfrio , In titc wmaal pMicion ag r«9p«cU the 

faav of (!.• .^( Hdev. 

In tktvnniiiiag it|>oD ihc tocUiod of trmtiDcDt, m must b« 



• 




BTBTEU or DEXTAL SUBaXKT. 

guided by tbe priiici)>l«* ]uA down in mpect to the treat- 
moot DrMuiilar fiirtu^ of irrcf^lfirity nccnrriug in rithnr teeth. 
Whetliur tlM involvod tootli U extorml or tntomal to the 
dental line, t'ithor the arch mu»t bti ciijuudwi or a toolli 
must bn removed, before suffident space can 'tie gained for ic« 
luliniamon to uniformity. Wb have the altcrimtivu of prwB- 
ing outmintfl the neigh honrinft ttseth or iiacnficiiii; n tootlL 

Thp cAnine iii the most dnrnhle mnmlx-T of ihc whole scries, 
beuce it nitiHt, if jKusible, be brought iutu place ; moreover, 
tlu pointed fonn of the cnnino ^vcs it n cluimcter not 
atmred by tiiu othvr t«etli. bo that its abiwucu ix iiuticcft'bt& 
But circmnstADCM arbc under which iu extraction become* 
expotliont. U, fur instanco, tite tooth inercos tho fpun con- 
sidorably above tho alvoolar nmrgiu, anri ia directed outwardaf 
tmd the iDt«rval between tliu latt-rftl and finit hicuKpid but 
sliffht, wv i>liiill then do well to remove it. Tocth im nituatcd, 
being very frt'quenliy Hhort, iind having Imiwrfwily-foniiwI 
curved routs, are oftoD incujublu uf lulling thinr prujuir place 
in the »orii'«. A I'Jiw prcaeotod Itself, only a few ilnvd »iace, 
in which the right canine wa« to placed. On tcmoval, the 
root waa fonod to be short and curved. Bod an attempt 
been made to bring it into line, the a|)e\ of the mot wonld 
hare been forc<>d through the UhinI surface of thc^ gUm, and 
the cruwti wuulil liave stood at n lit^lier h'vel tliau the 
oorrosponding part« of the neiglibourinp t«oth. To have 
McriGoed the latent! orbicu«iiid for lhiflil«foclivoly.4lGveloiwi 
tooth, would have been an obi-ionit cm.<r ; and to have forced 
the antemr t«'th outwards would have beeu equivnlutit to 
producing a deformity in the whole in order to meet tJial 
which had arisen in one of ihf front teeth. Ui^nce, although 
tlw rule that the caniua iiliould lie jiivwrved is a «ound one, 
it miiHt n<^jl 1«fl blimily follitwi'd in every case, but the ul- 
timate prusiwct of K^ttui); it into pliu.-e must he carefuLly 
oonsiderod. 

When we have reason to eujiposc that au out or instanuin^; 
ckoloo is not in any way defoctive, yut tho space accorded to 



TRKTHtNU, 



171 




^ 



f* hMmffidcnC, iwl the antcri^ir teeth, u nspccU the t«€t]) 
of tliB oppcwite Jaw, are w<>ll plaoci), it becnmcs a qimtivn 
vbicb of the DCighbouriog teeth should be romnvcil. Tho 
Hlectiioi iiiiiKt Ik iiiiu1« i» rcfcri-nw to the condiLiorL of tlio 
fcljoiiiing Uvth. 8)irtii|.l cUhor the firat ppmwfieiit molar, 

nthcr cif Ui« liioiisiQilK, vt cvmi the lateral incisior, be 
8, we nhftll have no diflicully ia makirg our ehoi«; 
ttdkbcnild miire tfaau ttne of tbeeo taoth l<e diMiLseil, we 
ilbo4iU thoD wiect for rauofsl thtit one which is noareitt to 
IW GWiiDa. But if all the teeth ant M>un<l, we tuny tlieii 
ncrifioe that which is the most liable to become tiigeui^. U 
hw Ivru abuwn llut the lir^t pennaiieitt molur cxhibita the 
f7«atc«t tendcDcy to diMue ; thiM, iioiler the age of liftees, 
the rwrrrtire liuhility to \tm frtrni caries nmit in the fol- 
towiiig imli-r: — Lnti-ntI iarisi'm, 3| per cent. ; finit liicnKjiiils, 
7 per ocnL ; iecoflil bitii*]>idit, 8j p«t cent. ; fimt ivnuanenl 
taUarsGB^ |wr e«nt.('> 'I'ho vtatiiittcul factK ndvtiucDii in 
tlw lectnrai bom which the forctfoinjc details have been 
cxtiBvled have metwiib niiifinontkw at the hniuls of Ur. 
Ulderwnol, id a paper lYiiitaitiiiif^ niniliir statistical remilta 
pnUiiluxl ill tlie " Animean Joamnl nf IVtital Science." 

SoppodOf;, then, a nouinl tuotb EUiuit be Bacrificed, there 
oan lie Init liltln iluuht that ws shall <1» wisely in Betccting 
the firvt pvrniaueut inolor. 

Aft'T ihr> condemnnl t«oth hu been remnreH, the neic 
■(• ' •niit^liiy; uiiiy It toiijinivrwl. We tiituil deter- 

mi ■■ >T ttw* bicufij'UU will foil back nuil allow the 

caaiDA ki ukr a projiur (HiHitioii wilUuiil loechonical aseisl- 
uuo\ or whether our aAcinunce will )« rorjuireth In detor- 
miaing thi» i«iut^ the npc of thi> pntient and the degrm of 
irrwiUrily u re^rtln the canliM-, will form our principal 
fplidcM. It ift aUii necnanary tit notioe how Ear ttie arUciilatiilD 
of Uif uncr and lower teeth nmy jwreut the bicuspids 
fttlliti); iatrk ; IVir iuvunc^ when th«> ii|i[>er jaw ia oholl the 
luwpi blaui|ud inay bite behind ihe upfur. in whkb caw it 
('} LaooiT* na iJMt*! Ittj^t-Ai^f urt Swanj. 




A aVBTEU OP DENTAL SUROKBT. 

would [ireeeut b KtriaitH obBtacle to tta mcnremcnt bnch- 
wnrds. 

SLuuM it be determined to bring nn mitftanding ranino 
{Q(o the (k'Qtnl liD«, eithirr \>y actin;; on the tooth itfldf, or 
hy operating on tho iieigbbourinf; t«eth, nn well lu iiim^h ibo 
canine, Ihv method devcnbwl a» linviuK hwii succt«sful in 
liirtiing into piaec a iwietcd central iiiciiktr will 1* fotind 
effective; or a vulcanite jiloitu may \>o UMtl, if tbtf ufwralor 
rc^rdg mi.it«iUc n-^tilaliuu plattw with diitiruKt. 

Jrrtguhrit}/ in tin position (j^ tie bietupids. — It rarely 
Imppcu that tbv fr>>Dt l««tb are crowded, without the 
Ucuspids to KOme extont ]»rtioi|iali[i^ in Uto gviii-ral irrcgu- 
Imrity. They are iixudUy Hitnatnl inurnftlly to ttie normal 
pusiliou, and are iiistriuuenlal in tliruwing the cauincft 
out of tt)« jiro]>er liiie, or in giriu^ the a|)pearauc6 of 
andue [)n>min(?nce t" those toL'th. The liiciiajtidii may be 
regarded as forming ttie bane of the ti.i-unc'ircular dontnl 
ouive, ■which, if con! meted, nnceiuiarily involves «ther » 
d«n-iuttui] from the uoniial figure, Hfi Ki-en in the V<hh&]wtl 
mouth, or it obliges Komio of the teeth to take either an 
oxterrad or an internal ptmiUou. 

If lh« curve described by a perfectly irell-arrangod set of 
toeih tie examined, it vrill bo found that it appmachoi a 
wmiciroie an far as the bicuspids, and that the molars occupy 
curviliDcar linen, di%'er(or>g alighcly on they ]>roce<^ back- 
wmrda. The arch adinlu of dinsion into tiro part«; tbe 
anterior Meiuiuircuiiir portion being occupied by tho succostKini 
of tbe deciduous t«eth, tha posterior division by tbe tnie 
tnolan — tteth which liavo no predeocsaon. Should, there- 
foK, the breadth of the jaw at the junction of the two 
diviHionji fall below ihn im>[)er extent, and the bieiupids of 
either fii]i> cuuMMj^uontly u|>[irum-h loo Dear the median hue, 
not only will the front teeth b« t>in>wii out of the seini- 
drcular curve, biit the molar teeth will occupy lines whicb, 
•Ithough diverging from the starting-pciats, will nevenhclcM 
• fail to attain an amount of M^iMiratiou as rci>]KX'tK Lhu two 




^ 






fitlm of the motitK, conbijit<^t inth a wdl-devcloped donlnre. 
The csM figuPKl «t p«ga HH illimtraU'ii tite coiitlttioii, and 
indeed ofaows an indentation in the arch at the poinu of 
JoDCtiofi of Uic nK>Ur aud bicuspid tectli, Uui origiu of 
whkb baji bwn already »)iUincd (page 148). 

AlthcH^^i uot a cotuniuu cauu, vauva may bu funnd in 
wtt«^ dineue in Uie hiinporary molarti, luid Bubs«<iiieDt 
alTRilar absceai, havo occaaioned thu dis|>ln(-oiumt of the 
bieuapida. In tbo caac figored at page 69, the drst Mcuspida 
haw hertt driTen outwanU by d)S4.>ase about the tirat lorn- 
porary ui'jlan. Likv tlie t«eth in the fn^nt of ibe inuutb, the 
hicnspdU may be divrrtcd froui their pro|ier posltiuii by the 
tMtmntflDce of temponuy teeth. 

When one only nf iIk two bicaapidB in involved, wi> shall 

IRtfnUly find the Kcond bicuRpid to }» the mUplnct^l tooth. 

la (bal eaan, the miscbief luay have been produced c-itltor by 

r "'rk-ul Kfocv for a rr«;iilar orranKCDiL-nt, or from 

■ ■f tl»i wiioln nr a part -rf il« prcdn^ewor. 

Wbcu tbt' Ciinuor causo has li'd lo the di-furiDily, the 
dfKrM Oif displacement will vary in acccrdano* with the 
amount of rontrw-tifm of the sUotIn) apiire. Thitn, when 
the flnt biciiffpid and first molar oro cloM'ly approximated, 
ilw Mnaid 1iiirtiif|iid or iirauiolar corouioiily eomca through 
the fcuin i&terually to tU« arch. 

Il in far from nncommon la find the tattvr tixith, twisted 
ttpoa llfl am by lh« prMenc« of the Ibgual iv>ot of the 
•ecMod unnptirani' molar, w««l^l bL'twe^-u tho liret jwrma* 
l»cnl ntolar liiid tlw fimuer liutb. Iti a HUccfi^liu;; figure 
(Ftj^ *W>. ihu M^-ond litciuipid is oomjiltMjJy niniM round, 
M that tbo lininial baa Imkoumj ttie labia) ourfacc, and in 
thU (■««« tbr Ubial r\wl of tho icnipiirary tooth baa been 
nUtnnL 

la drtcnnimni; apoo Ibc oourac nf trcaimcnl, wo muet be 
gttUwl, III Ibn fint plaui. by tbo condition of l)ii> Jaw. If 
th« laa« U <utiUat:lcd, it will \» iMcopary to rmiovc a loolli; 
btti Bbould tlie tnatb bo tunwd inwatd«, and tbcit outward 




8TBTEU OF DBNTAL SrBOKBT. 

tnuvoRieut poMible witli»ut deraii£;niui-nt of t1ie aatcrior put 
of Uie deatal arch, we must then *dopt & plAt«, &ad have 
recuuniu to ihti cuuiprtuuted-wmiil vrc(lgt<8. Kitbur mrtal or 
TuIcAOite may be uMd in constructing tlic apparatiu, uid 
tlio we<l^t», if jtnipurly propdrliuiicd, will Bcrvn for iUs 
rnleuUoa without Uiu aid of li^atureii or rloitjis. Tli« move- 
ment i» vrry rouiily efTectol, being sioinQiimGii iimiit«n- 
ti6lia]ly bruuKbt nboul by the vury iiji."Jvnilu ]>n»»ure of 
utifioial t«cth, but wo iinisc not n^clcot to lalte into iuxotint 
Ulfi antAK^nistii of the ojipuHiti); t««tb ; iieitaJly tb« lLn;;uftl 
CUffps of the iipi<cr close lictwwn tlic out*r and inner cusps 
of the lower t^pth, and iinkas tbo Inwer biciiH|>idH arn inovwl 
outwards corilempryraiicttnuly with the iipi-er twrtli, the 
norauii antagoniflin will tw destroy»d. Morcovpr, th«ro will 
Im a fltroQg oouDbonctiDg force excrcisfld by the tutioiury 
teetli upon tlioso under ugxTuliuu. If thu nppiT tei>th, for 
cxBioplo, are mo\i>d outurardu m that tho lin^iml c\isj» clnae 
on tho apioea trftlic lahinl tiibercW of tho lower toetli, the 
(AbuT Icuth will be kept a}iu.rt tinlil the liii;;iial ciifiHi yf Ihe 
muved twth alidi; down either ujion the inner or outer mr- 
faoe of thi; Labial cu»)ia of the loW«r t«cLh. In thoou csmw Iq 
which w« fiud a faulty antitgoniNit, our trcntiitimt kvcomes 
tm>re Aitiipli'. If, fur (ucajiiple, an upiwr touth closes exlor- 
nally or iutt-mally to its antagonist, our operation will be 
coQ^Dcd to tho nial])laocd tooth, which, 9u flooa ns it Rp- 
proouhtis il« proper poeitioo, will be carried onwanhi in the 
proper direction by the infliiimceexerted by the aiitngnTiiNitig 
tooth of tbv low«i jaw, in the loanQer doKribod la ooonootioo 
with luiMplaved central and latoral iocisoni, 

Jrr^ularitjf in tht potiliim vf tht crowns v/ Iht jitnnanent 
tnoluri, without the rooiA purtk'i|>ati[i{; in the iliNjilacemeot, 
is of l<>iiHfr<xiu«iDt occurenoti than dorangeiuBot ofthti more 
antorior teeth ; Btill, cases sometimes proaeDt themselves in 
which the normal positions are not maintained. IVrliapA 
tlie most common form of deriation is that in which tho 
BBooud ]wniiaii(!ut molar on either aide is turned iuwanis 



jMwtmaa. 



175 



» 



tmnplii Ok iDcdiAD lino of \bt> iitoiuh. In n c&st given to 
n» hr niy frieuJ Ktr. Alfrwl Cuntoa, tbo Uirvu moliim an 
tntofvi io ft triangle, t,lio socond being plw4?tl int«mally to 
Xkr otbct twi) tttotftre. lu Uiis caw, llm ob\-iDUH tviiietly 
wmM be tbe mnoTal of the tnalplantl tootb. In cams 
vimtv t1i« fint molar lams in towards tbe palata, tlic poel* 
tfcoo mi^t, I )jrt»uiuCi be cbftiiged t>y lb« |wrsi«t«ut use of 
ecmpnmai wnul ii(iiilinl In the maoner blreadj' Jeiirribiti ; 
^t m nnlf find tbue teeth out of place vritbout tbe 
anterior Ufelb ]mrtici{«tiu); in tbe ili>tan^tftiitiu)^ in which 
cue the tmtmcut would become r«ry kdtous. wttro wi> to 
att«io{it U) rulnoe to onlor tbo wliutu of the t«cith 
4uat«d ant«rior to tlie M«oiid [wnnanent molar. In au 
laAy Biuuber of the " American Joiimal of DenUl Science," 
an apinratiu for cx|AU<Iin^ tliv tvlmtt! nruh is dcccrilwil and 
Sgitnd. It conxiiitni of a citrlnl ))UU> fittoii to Uio |alate, 
an) i'linlmi in tb« tnrdijin line. Thu jilato wbm hitcd Ut tho 
neclu oif ibo tccih, against which, it was mnde to prcM by u 
•pml spring, tbe extremities uf whicli ware eonnoRlnl tc* 
M.thtt dd«> of th« ]>late. I have no exporieuce of the raliw 
«f tJits metlMMl of itruceetUuij;, iK^ilhvr Imvo I attempted to 
chaa^ the imkition of mutar toeth by meclianioil meana. 
Id the vwt uuijurity uf thit i-ai^ea wbiub have oomc nndrr uiy 
BOtioa, this trcatiucnt hoK bann nnubred ioadioiiwiblv by the 
ootaeldaDt oontraction of the bMte of the Jaw ; and in thoae 
to which praHDre might bavi haen mod, tu>t cmly must tho 
vfptT teeth have been opiTated Bpoo, hut (he oorruaponding 
twtb (if thu lifwer Jaw aiaa, in order to oiaintain tlic {irofwr 
antftgunlniL 

As malt •wliPi) "I^ ^be wisdom leutb aliutet iuvariiibly in- 
Tolvta their mnnrsl, whutcrrr may l« iho |ir«itt(>n i^t the 
rocAi^ thr tutiftidontioa of the wbulv Bubjcvt io n»[>cct to 
tbne tactb wlU be gWen in tmnnoction with complete irregt^ 
larity. 

In trmtiii; of thow auw u( trregxiUrity «b<ch admit of 
mMrhanlral oonvcttoii, 1 Iwve confined the dcsoriptiao for tho 



176 



A 8TBTE3I OF DSiTTAL StTBOKRT. 



iDxwi part to tlie Uvth of th? iipiwr jaw, under the imprm* 
siOD that it witnld be iinnccessarjr to gire n detailed acccnint 
of iho defects ijf nmui^cineiit iu tliu eom>«[iou(iin^ orguu 
in th« tower m&xllU. It oiAy, however, he Htat«d generally, 
tliat the fonna of irrtrgularily which occur iu tlio upiwr may 
also arise iu the lower teeth, aud th&t ihe tieatiiient suiuhlo 
for thfl one will he equally fittnl for the other. Thv con- 
sLrui.'Liuu<.irtlit9]>IjLlu, wliL'tbcr iiicUl ur rulcuiiitabo oewI, will 
of coursd Iw tnodifit'd. We hiive here to adapt the apparalo* 
lo thn teeth and tho liii^tml Hiirfacc «jf thi' ruihh only; fs- 
copting in thi^ fcwcgoing porticulaj*, tho inothoda of ojwrfttion 
will Ite precisely simitar to those alrciily desi,'rih(?<i. Tlie 
verlical [Kisitioii of the lower teefh read-'r* th* rvlenlion of 
the coinprei9L>d wedgeii of wood pftrttriilarly eauy, and thia 
AdvantA^ is still farther incroawd when tho te«th m operated 
upon are inclined cithor Dntwiinds or iiiwaida. The opet»- 
tionn for tho adjnstmcut of irregijlnritioii of jxHtlion am, 
howt'Ter, lews frequently attemptcil on the lower than the 
upper jiiw, owing Ui the funiicr bt-iuj^ hiddon lo m great 
extent by tb« lip, *o that they fail to attract that amount of 
Ari^ntirm which is piveii to iipiwr tcptli. 

hrtgxdarities of the })eTmitnent teeth in wliieh MA the trowu 
and thf- nW< are nut of tka normal position — latui cr fonv 
jittt* diiplaefntent of the patnantnt teeth.— TruDSi^mcA tcvth 
C<nii« nnder tliiit head, bnC aa they do not adroit of restorative 
tr«atcDcnl, cKajii^Jtw iltustratiro of thin fonii of di?tKirtunj 
from the normal arrangeracnt may Vjc pr«n at the conclusion 
of the pmscmt dirision of the !>ubji>ct. 

Thfl follfwina illustration (Kig. Cft) shows the amount ta 
which a cwutnil inciaor nifty Ijo tlimwn out of tho proper 
iwsiitioii, Hi-ro tht cause is sufficiently obvioua in the 
pcoaeuio of ft (nijwrmiinoniry tooth. Oawa in which the 
centmls arc completely di.-'placod arc, however, comiianitiTely 
rare. All att^-niiits. at treatment would in any wich case ns 
that which in tigiirwl nocewarily be uselefis, suppociiiu^ thu 
dDVclopuiont of tliv root lo have been advaoced. U«d the 



TEETttlKO. 



177 



lomcrvy tooth 1«An rcmuvo^ &■ goon u it appeared, 
Kuur wuuld jJfOlnlity luivo taken iU nnmuU iKwitioii, 
eren thm thi> liUpliiccmi^at inuring tleveto|<iQ«til 
. Inve bera tuo gre»t Cor Ihe u])vntiori to have retutlted 



tfl^^^ 



■■^ 




'lik ' -^ 



(J((frfHppf 



r'4b mt rtmenihof to hAve eeoo luijr cows iii which « 
itnm] inrtwj'r hibl been totally tlisplamd, Dxcx-ptiu;* vrhcn 
ih have l«*n iranspoMd; there is, however, tin rcftwrn to 
ajijaMv tliAt. they are mrife tnceinpl thait the coDttiil teeth 

tbia form of irr«Kiilari(y. 

Tho fomgobi]; oliiwrvaiinn rannot he njiplicd to tfac cuiinu 

th. Tlivy arc iuuk fivqujeutly IhiUi any other <1«»cri]>tion 

' teeth the tubjects of Inial 'lUiilnctmeDt. Evun in my onu 

tioo thcra are many examplM illtiitnitivc of the «!>• 

f>c»it)i)nj) into which Uina t^th mny Vw throwa, 

•r( iLv iot>»l coium'jii forma of tli^platxiDent is 
Ihfti t)it' nuiinv iit ^iltuit'sl |io»t«nor tu the ilentAl 

'I I.' , >.i < ;■ r -i-iMlibH lolhi- BpK* wlilcli .iivulra tho 

iciitrtl ji]-i iifMii II < :s<>nt. It iiut> hapjMU that tlm iTuwu 
jly iiri;i)pii» tlus jxwilion, in wlii*:h cjiw th* •U-f-wiiilty 
silinii uf rvinnly ; Ixit whcro the nwl iiariici|at4» 
IVMJXy wil4i (he vtown, u iu tlw exoiuiile which furms ih* 

(I) Ifcapi t1»> r%M tMitnl inrlHir alUi bilh Iti* <tv*it «il root Jl#4*<^r4 




STITTKM or DRKTAt. BL^OliRT. 

sulijccl of Fii{. 07, rcatOTBlion to the nnrmal ■iTBiigetnenl. 
Uttjugh iwrhapa nol impoasiWe, would bo aMetiiied wiili 
difRcuUy. Hie qacstion then arises m ta wliich of thu teetb 
«houW bo rpnioTcil. The t<^!H|iorary cauiiw, if left, may 
fndnrc fi>r wtuv yeu*, but if it liC extracted we iiiny \k 
uoaltlc t<i I'linv the ]ieriiiiiiic-ut tnt^tli into its (ilu-'ti, ui<l fhotitcl 
wc raccwi. the cniwii ouly would be moved, licnw> ihctoolh 
wmilil iMiltl a elontini; atiil ]>rubably unsightly putitiou. Vy 




/'-r 



sr-n 



r 



owa choiuc would fall iipon the ciuiine. It wotild, I think, 
be more easy to jireiw thv latcml lootli inwantH, the terminal 
iwrtiou of ibtt rixil -^f whii:h is nvt diBplac«d, thnu lu draw 
outworiit into [itie tlio CAnine. In (lcciiHiii;o» onr tri«iiiKiil, 
w« mtut in do com 1o«o hiyhi of the foci, tbnt altbda^h ii 
may be quit* pcnible to force a tooih from mi irregular iuto 
a ngnlar poeitton, jnl that the ui^ratinn may, under Home 

(1) SIio«i tbt Idl vuliw fl»n>l bublBd ibe dmuil Une, Ha cnnni Iwtdlng a 
v»nk»l fnnlllofi. *»1 til* root, aukw KT<^tUr corvMl. cqutUy whli Ui» ' 
dlvUnd. llw UMml IndMr hu tin a vnrtri t^j Uk aidix; wUto ' 
inn^nuT unlnr Ii-jIOm tbi [oiliiuv wbtdialMtUil hare beta ncupMbrl 
dUi'lKvd luuUi. Tile itebt ioBi]i»nu:j> miUih to rrUliw4, and tlu ppreiaiml 
woUi pUnd ht/iKunUllj. • portUs uf Um otwb eoljr bdtv iwu. 



TEETH tNO. 



jircumittaitoea, be bo prolongetl aa<] painfnl, that the prapoMd 
ivlvBDUs^ will not cnin]wni4te for the KulTcriug which its 
utiiplialinM.*ul vKmli cnt&il. 




179 



In the preceding lijun mi . xlionu in whic)i the ri^ht 
canitu) is pliccd actu^^ lIil Jmuil arch, the root \fciii\i 
ilir«ct4xi l4itrBitU thv tn^xjiiin lino of the fA)flU.% ant) the 
crowii towards the cheek. The pttiut of tho crown vr*» the 
only port wliich was tutt tonijilpufly hiiried in bciuc. Tho 
latter tU«ae hu be«a cut away for tb« purpoBe of ahowiiig 
tfae conrae takfin hy 1Ih> tootti. 

A hortzoHt;il pc#itiiiu iu th« buw uf the nlvcoliir riilga is 
aocneluiieit takeu by the canine, the apex i<f the crown being 
expOMxl to viaw, or cortired only hy gnm or iuilwddnl iu 

Teoth BO ptaood nuy remain without prnduf^ing incon- 
venience throuKii ft toog Ilia, and be ducorered only towanU 

(!) Sbe«« Uu) HbUi aMiliu pbutf traaratMtr hi tb* (m* of Um klmlv 
tBM, Ik* OOWB bttliK illrrdMl tavnnln Uu> ciiivk, kiul Ihv r»( toward* Um 
MBllM IHm of tlw moatti. TW tmw liu bMu mat-rtd w ihcxi Uw eovrM 
I tir UN rM< or lt« iU«plK«) logib. 




OTBTBM or DUTTAL SCBOERT. 



Ita clott. When -with adTUcing age tbo teeth Tall oat, ami 
the &lvoolar \ynxemw disappear, tho loiig-hiddvn tei-th luv 
l>roaght to light, and tbo paiieot bncW he is cutting a third 

fig. w. (I) 




wt of (eviU. Tb« two foIluwLiig illustrations are uHtva from 
« rcmnrhahlp «peciinen pvea to me by ]>r. Urinmn, in which 
the caninw wore eyuimtftricDlly amnged in tlie horixualsl 
{Kwitkni doioriboi In a [trK4^iTii; com. 

A )»ticnt adtnittctl tilli> tho MtddLewx Hi)a)HtAl iittder the 
f«ro oJ'Mr. De Morgan, lost n portion of tli* upjicr masUU 
irom KyjiliiliH, 'VUp ApoA \mtw (m its ncmiing nwny was fitund 
to CDutuin n caninu tooth, nliitli rsn umJw the Boor of the 
now ill a dinvtion pnrallH with tho mnlinn IiiH< of the pahlle 
(Fig. 72). Exccptiug the abtienct! of the canine, the ilpntal 

(t) Shows Um rluht tanltw or the upper J>w burlpd In (h* bM> of Ibp 
atmlM pmulDmM, iu tuMttt o«rTM|ioij-ll'>ii with tlMl uT tb* kttrr put. 
Tit* bone tiM tan ««l •v«j to dww Dk dltccUun Mkru bj tbo Lwib. Tlw 
SmL i^evfU im brcooM rilcbttjr iirbud vo Iu axis by ihu nulplawl awta*. 
(ki UlalfAdiluurUieKiuIlUibcMwiKlUawpMhBbpni twiiwd numdwKll 
H* ibigoal auiiko* It dlrcMtd lowirdi the clweb. Tbe iirawiice oT tbi «M_ 
of Uh Mraul ttnpocaTjr ovibr hai prvtobly bf en InMnunmiUl In pTVdO 
ihli ehuict (Ton lbi;iii>nuL piiiU''^. 7^l■ caM U n(t-rR4 W Ui a ^r 
paWL 




TKCTIUSG. 



181 



WW ■otmaL 8ovi!»l vxamptn of tho MQine lieiog 
trnd it) the AQtrntD h*ve bo«n recordetl. in cne instnnce its 
«laclim«4it »{ipt»nng tn be to Uiu Hiwr vt tlw urUU 




t olUi lilt UiM etf Ibn iltfuUr tiiniimail, 'nvjr tavr 
Id ■)>« by Um hm of Um l^lt) *iid *uUh<|im>iiI alvwyUon «■ 




1S2 



A SltBTKM OF DBST4L SmiQEBT. 



Although U)t«l disp[»c«racDt of the cn&inB tooth !b leas 
oommoa iu th« luwer than in the uppur ncriiM, examples of 
this fonii of irregulftiity in the lower jaw arti jwmetimea met 

JV-"-t') 




iV.ts.TO 




(!) Show* ■ anqqMran b«iB Um uppirJiwwUch tocasM itoiMbKl 4anas 
ut aUftck of trpliUli. h nouicu a iBalnc iMth rtliuttd bortiouialljr In ih« 
learafllMtKvc. ludlrwtiMi MntpuilUlwUblbi natdtui Uik ol ibp ^UU. 

(*) Ftin a •pKlmcB lu wkicb Ibe lempom; oulaci wtn pcniiuni, aaO 
Uw pcnuaoeac mdiMt pUocd haHioDial^. On Ihi Ifft ildf^ ■ mUBcMui 
•iDouui of intie hw bfcn nmomi U dww llie imrftlwi or Uu barkd tooU). 
Un il)« mbt fid" dw polni of ibe auiln» bmj be K«n tetwcCD (be Mtml aod 
tba ocotriil IndKir. Tbe riglil icinpumrf UirnU locttor hu b!<B rdalMO. 
wtdcDd beiw««i the pcnoaapnt cenmi lul klecat Iceili. 



TESTHIXO. 



188 



Hh. Of (be two siiet-itiiftiK si*I*H:U>i fur illiifttniUon, the otia 
which the unth U [lUc^^l horii/ibta))}' U the luim [jcciiiiar. 




the Mooml, tlw tMiip)niry canitioa wn irtoinoil, ukI the 
imiil (xj^intw Ixrcuuiw miiturod within tho sub«tftuc« of 

0) 9lww> an bif-tior «miIR« \m which Um ti«l cMiln« la ttlarMl karUDouiir 
I ife> tlTHiUr UTjer Utbuto to Um dMt«l mIi*. Tb« UMb wm upuaM 

iOm- riual abuau lu lii* tigurr. 

(i]i ttwnn * lonrr euiiiu In «hlii> die UnpHuj <tkr (■cImu of *hlcb 
Urn abuwn Itj II," AiUM IHiw) *vra retal«i4, lurf il» ^luMmt owInm 
HfW>»<»^ viUiln Um mImhim* «r Uw >tv. llM iMAo hu tnn ■•»•«•« m 
ita an* •Ub ib ■ino Um rilndbm ukm Igr Um wwlb, wUdi bw iNMt iwlnal 
« IM ATI* w I b* tUcH of • ^MiVr (f « ura. 





184 




STBTEK or DBSTAL SUBOSBY. 



tltejnw. llic ivtvtilitiii iif tlic tem!".irAry may bo ftddUMd 
M tbo preruUiig caiwe of tdCiil dUplarcnient of the punnuipni 
cuune. Ill Mfwiul ui \ha i>ret<i'diug illuHlraiJuaa, tliese 
nicmber»of the temporary net art: prox^nt. In dllitT casrai, 
huwfvcr, tliu sTcb U fully occiipiwl by tin; {wiiiiiiiieiit Wrtb, 
t*} tliv cxcluAton of tUc caniDcs, and as tbctc arc commonly 
t}iH liii^ to take tb(>ir raR]M%tirB fiaces in the Hcrive, they nns 
xrhcn »>< cxcludvil, liablt! lo be turned compleuly out of lb«ir 
tutnnal [MtAiitoti. 

Tiie i)ivsctic« oS tliacaise, or tlie occurrence of mccluuiical 
inj\iry ui tliat [nrt of tho Jh-a* In which the cnnines are sitii- 
alwl w']iL-u iLiitluigoiog dcvi-li'iiiuvut, mtiy drivtf tiivni fn>tu 
llit'ir |ir(ij>LT jxMitiuii. I cAiini>t, liuwcviT, rail lo uiJnc) a 
cow which wonld mtvo for illusiratian ou this poinl. 

The rwmlta entailed by total [uiil[)ositiuti of th« caDitit>8 
•re iifliLally nniniporUnt. Tumouni ariniiig in the ueseout 
structure of the jaw have Imwcvffr, in a few oum, beon 
fuuiid tu eunbiia e. hiildi:ii t^oth in thi-ir centnsnDil tiiu [wlh 
»o placed h»VK hvva rc^'arded as the causo of the di««3«e; 
and in more than ntie instJince, a niisdiiig tooth lias Ix^ni 
rvmovod fn^m tlio interinr of a tuiiiour, and th« operation 
l«*ii follitwr*! liy ttiihsidoncc «f the disciuo. That t«tli 
eiiiljtxldeil iu tho aithstauvu of Lbd jaw umy l>uciii:io a Mnirca 
it( Irritalion, and [ircilisposc todiseasfl in llio |»art in which 
Ihny arc sitnatal, ran acan^ely br dotihted. In th« case shnmi 
in Fig. 72, it ia probable Uiat the [u-uMnco of thu caniDe not 
only dt'tenniutil ihc aitc of tho ntvrcmis, lint bIsd llie ocoor* 
rencc of the diun«v, SMing tIiac the loH of thi? booe was, as 
re^nts the alrontnr [lortuiii of the jaw, liuirtt-d to the parts 
immediately nroimd the tooth. In the year 185Q a spoci* 
mon wsa exhibitnl Ut Ibu niL-nilunt of tlit' Oduutoloi^cai 
Bocieir, in which a canim? tuvitli Uy liorizoutally on tho 
floor of a largu cavity fortnt'd in tli(< RuWtsncu uf the lower 
Jav DMir it« lower Wirdvr. The histury of the case, with the 
chanwtcrs prcaMitol by ih<i enlarymient of th« bono, induced 
the aurigeoQ to exctao thai portion uf tho maxilla iu which 



TEBTai.VC. 



!8d 



Fthc dueoie vna sititntcK), imd it vma the exciiicd portiim 
Lwhich WM »liowQ at the Society. 'I'liiH ouv will be found 
rally deRCribwl in the ch>pt«r tit-atin^ on disaues of 
f-thoJawH Imlucal by minplncnl UiPth. 

Cotiiplete iiTegulariiy in Ihv (xwiiioD of tlie lRciut|iiris to 

extent itlion-n in si^tno of Ihv proccflniiE S^rm of tni»- 

Jao«d teeth, in of very rare occiirrvnce. In the nuat »lrofi5;ly 

aouncMl awe which hnn cotn« unikr my own oWrvAtion, 

lui root of the twcuiwl ticua|)itl of th'O u|t|n.T jfiw jasGiil 

iMcknanU )K-tw«ni th« Uji^rual and Inbiiil rooCa of th« first 

,iDolar. lu tko cn«o UluMrntiHl, tJie din.'ctioii of the tootli 

/Vff H-O) 




y j« macb the nmv as jn lliv rnrt-gnin}: [^aae, Rltbmigli ftiMintud 
j^Bn tilt? trm'ftr JAW. Tltc lint molar \mi licvii I'wt. heDc« ths 
^KvliitU'tid U'lworti tkli r(Ot4 cf th&t am^ th^ diaplncMl bicuspid 
^^nn Duly 'n' stiriDiM-il. 

W^ Exatu|>lcs in which a bictutpid iitaiiils otiliqiujy tcroBa the 
iU'RIaI lioL- Are niA unniniiiimi, hut in thcMt the tlisplweiuvnt 
t« nrdy otmiiloto; the cstrvniityof thv root i»ngunlly in tim 

(I) Amt* • iawtr RMuItU (n which Iho right tn^ma bkratiild k pUcNl 
oUt^wll-, tbr root bflni dlrvcUd Wk««rdii. Tli« avm, Urtiogh «p«iM4, 
data D«t flM 4lw<n the lev*! vl Uu> ftlvctiUr Bittcla. 



186 



A BTITBH or XtMSTAL BITBOIBY. 



nonnttl poailjon, and tlie cmwn, ir tliere vnre saflicient syAce 
in tlic rlenUl litii;, cuulil be brought into tli« noruuil porition. 
Now add tkeo, liowover, a biooepitl lunj* l>e foiinil with tlie 
crowa direcwui lowarJs the totigue, and aitualed Mow the 
ftlvucilmr luurf^in. Siicb a easo ie figured by Goddonl. (') 

Tlie Qnt ]x>rn)an«iit molar app«uio^,M it doM« posterioriv 
to tlic tt'nipumry Uwth. »t a tiino when the jaw is in a state 
uf aclive growth, ncldciin, if ever, becomes the Bubjoct of com- 
plete iliBplaccnifnt ; ami I know only of one case in whiclj a 
fully-(l«vel(.ij>ed secuiid p?rniaueiit uii>Ur has bttii fuuDd Vdow 
the alvTOlar margin. It in fit:un>i! by (iodilanl fruiu u pn- 
laratiou iu the cabinet i>f tlie Univi-r^ity of TeniuiylTania. 

The third niolant, or wisclom tecrlh, Wiw^ thti last to take 
their place in tho tchutt, are, from the uhi>l.'V'l«H up[>0Bcd to 
their eriiptinn, a frei^nmt cause of (infft-riiig, iiinre eepedally 
ihoK of the lower jaw. The fteouml molar immttUatcly la 
fn)rt., an<i the terminal p^int of the alveolar line behind, 
bound tha 8})ace nootrded to tli« windoin tootti ; each tootli 
whii-b hat no de^uotu ptedocwsur is develo^>ed beneath the 
hose of till* coruiioid pnxx'Da in the lirvt iuaiance, and an the 
corouoid process noLideit by nhsurptiuu on its dUterior and 
•lepotiiion on iu i>u«terior surrnceK, llio touth is enabled to 
dtaia iiilu itti projxT jusition; but if the luujkwftnl dvvelo])- 
meut of Ui(.> maxilla.' baa been amcitcd, (he iDterval will he 
iuBulficii'iit fcr the uonnal amin^enR'nt of the pn-R'nluiK 
tooth. It would apficar to he the exception rather than the 
mlfl for the wisdom iM'tb, vspccially of the lower jaw, to lak« 
their place among the organs of niHi^ticaiion, witlioitt pro* 
dtirint; imnio amoimt of BnfffriDg at tin* time of their ernplinn, 
and the degree of iti(x>uvvtiicticii exii(.'nenc«d is often «u()i- 
uitmtly gmat to indnre the sufferor to ap))ly for profcsxional 
aasistaiice. In many i>f thu cases which iirifo iu Ibt lower 
inaxillft tb<i loeth can acarci-ly Iw flaid to be diBplflced. Tlu' 
devialtuii fcuni the oornml cunditimis i;; conJinfld to the jaw 

(>] TiM AMtamr and HiTtloloQr of tUc tluman T«tb. Vj Dial B. Uuddvd. 
Itilladrljaak Itiu. 




TESTinHO, 



187 



I 

I 



itwlf. Tbo iooih takm il« natuml direction, but tba flpwx) 
into which it hu to (broc ilMlf is ineufficient, coust^uently 
the «JifltHl shIu livs cIonu af;»inst the antrrior RUrface of th« 
curouoid procoas, loflTing no room Tor tiie j;\iia. The Utter 
lurt, under tbeoe oiiCDnutannM, is ^ireHaed hjiwatcIb, ntul li«6 
more or leas over the muticatin^ surface of tlie tuuth, ami 
M oonaequently Bubjoct to !»■ l>niisod fmtti tirar in tinio by 
Uie toolh or t«etli vf the iqiiwr juw. In tlii» nuiaui-r miliuii- 
malioa id die gitm ih net up aiid luniutaiiutl. The diM-aK 
toUlotu liu)it« it«eir to the jnrt iojua-d. It tnore cominonly 
extends to tho odjogiiiiii; j^urts, iuvulTiug the aoft textores 
about the ucendin^ ramus, and rxt«ndtag ftom llicnce t« 
the fawm. The act of dojilutitioti becomes paiuful, and the 
moCioDS of th« jaw are Kstrietcd. 'lliv luititrul u-)[» yuii 
that it U quit« Impoasible for hiiu to 0]>en thu tnoiuh stifii- 
cti-Dtly widf fur you to make an oxamiaation of the tmth 
whk-h Uka otxastooed hU iiiiwry. Aflvr it ttiiir, Ihv uviT- 
tyingstim mippurata*, aiid tl«j moremeat of the jnw Uiouim 
l«Mi c«i)»trai(K<d. 

'ITio jiatient, however, U extremeljr cautioiu in oeing the 
toeth, utitii tbu Luilammalnry action has Bubsiilud, leaving 
in aoinfl cam* tho gum in a imaition to be acAin woonded 
by the Qpper tM>tti ; in other aiaea leaving the whtile of thi^ 
nuuticatiog surfate of the tooth perf^tly iiiic«*Terod. If the 
pntteat lie aam licfore any gmt liiftindty in itjjiiiins: the 
mouth liiM urisen, the tmlli itiny ha Cf^uiurnd ; iudwd, iu oil 
oaaca wbtTi' the tooth is wpdgwl iij;ht!y belwceii the [larts 
already described, this tnuitniont will Iw the mast jiidiciotis 
we can adopt ; for should ihe gum. after the iuflammatory 
symptoms subside, retreat behind tho looth, aiiU the lack- 
wanl positiou renders Llm liittn- useli'isx as im iiri*Aii of tiias- 
lication. And should th« fum retain its uuit&tuiul ].>'j«iliOD, 
iJie patieuL vfiU bi- liaUv t*i rvjieated iittackH v{ inflnnimatioii 
UDtil either the guiu-coveri:d tooth or it« antagouiflt has been 
reiiiovetL 

I'ikere Qtay not, hovruver, be suffiuieut sjwco Wtween th« 




18fl 

tncuiiJ molar noil tlte ramuR tw tlte wlsdaiu tooth to rrolnide 
ititolf; it limn either becomes (k-veloped bdow lli« ■IvcoIm 
nmif^ii, <»r H oOrne* up pvtly within the base of th« ramus — 
(•ne half of tiio cn^wn of the tooth licin^; covcixti by boiK-, the 
oUior by Riun. hi wlhcrof thtwetaaeslLo pativnt mi» y or may 
oM be »ubjcct«d to snfft-rinp, cotmcqiifut iiixm tlui nhnoniinl 
|ii»iitl<tn nf tlie toitth ; luid tho abuciioe or prweiice of mi»- 




chii^ will bi> tl^'r4^Titiiiivil ^RuLly hy the hLn<;)il to which tin 
tooth rise* lu ihe )aw, as rcsi>ect(i the autagouislic tooth, 
aiid ]«rtly hy llic ciinBtitiitimial aUte of the pHticnt. The 
Biinit condition of jmrts which in one ptraon would Icaii to 
liCllv or iiu inri>nr«nieii(-D, wonid in n Imn tieallhy subject 
produce great irritatioi), A]id L-vec iiecroi*i»i; the cxtcut of the 
diwsifie rarj'ing, again, with the suswiiviliility of the indi- 
vidual. Id aoy CMe tk<> iuvolri'd tootli ohould W extracted 
BO soon AA it is found to In* a KOiircv of irrilation. 

(>) FnoB ft i ^m l uM ii tn «U[di Hut Uiim moUr hu brtn d«vrlap(d below 
ifev alVNliir OMrBM, wlUi Uw iUsiaI iiilc under Uu hut cf ibe uMjIag 
nrnmaftht Umtjav. 




TBBTEIKO. 



180 



tftnjptMVtliUK (omuint ilevialifin (rata Uie nnruial 

rfb^lnlh prenmted Uinnvelvm in the alveoUr Uds. 

now kod Hum ocour in wtiicii, while tli« vertical 

jnution U niAJnUinoA. the toolh la rrnioT«<l fmni the alveolar 

I'pnrtinn nf lii» j«w. In tin* upiwr iiiaxiiln, it u\af he nlliiale>l 

tbc jutu-ntir partlcit) *>{ tlw tubcrocity. •bui'A clic k-vfl of 

■Jmuli, ami io the luwor jnw within tlic mniiu. I am 

|D^«t<tr»J to Mr. iJAUDilcrs fiir tb« nw uC tb« Kpecimen which 

tltti Ktibjoct ot tiiK fullowinx illustnitioD. In thbi eX' 

\mmiiim the wunlom toulh oji eithar sHe a Hittuted high op iu 




the nunoB, the crowa reoofaing noiri; to tlin Irrsl nf ibc »ig- 
|l»^i3 ui^tcli. AUiioti^ ailuaivd In sach au iiuusuftl iKxtitiuii. 
Jeing Trum llu! state t^r the hnnr, it Aoe* not ft|([MNtr that 
HOT were a aoarce of irritAtiuo. There in a total alMoaco 
ilist iMirciiiii cctuiHtian imlk-stivo of incrcwtMl vasnihiriiT in 
\miiA iitiuiwliatclf ■tirronmliiig tUs tuutk. Il is pniliaMe 
ii;' lifa the pnwtice nf tlio thiM iitnlar c>iu)<i rii't have 
I titl, aihl in the alMenoe of iIuusim nhunt tliu jaw 
UetocUoa woa a matter of no |i;rcat imporunw. Still, 



<!} ^'^nc thm wMoB tartfi loAMhlnl In 11m mibI at Ui» bim Jaw 
■l ty Mr. SktiMlMB IB lit nawum of ilic (Mon«<4mtBU6odNr. 



Pm> 



it is deeiralilc that it shitiild be borae in mind, wlien diteiM 
abont the poateriar jNirt of tlic jftWH \i coinckl<>Dt with the 
abwuo! of Uic wttidoiu tei-th froui the usual siluatiou, Ihitt 
the \mt l«cth may lici biiriix) iu the m]b»t*nca of tbe bone, 
and bv the I'sciliug iraui»u of iikiM.-hit;ll 

lo the mnjoritr or caves, however, the third moUra, wben 
misplaced, Icwc Ihu vcrlkiil position, They commonly take 
3a oblique ditvctiou, cither forworiU, outwards, inwnnU, or 
liftokwanis. In the lnwer jnw, tho forward dirrclion \» by 
tu the mu8t coiiiiu<.id furm of irre^Urity, tbv dr<!rc« varyiog 
from a alightly obliqut to a fwriwily horitontai directton. 
Tba auooMdiof; series of %ucn) sliovr various dcgram of tiiii 
fonu of iniiqjlaannenL. 




lo eadiMtTDuriQg to trace tb« cauaM which have prodoc 
thi8 cUisB of im^ularititut, wc mast tcoogniM two dutinet 
oouditioos. Ill tbt! oac, the tootli, in {Hvauog furwanls, has 
Ukuii tho direction in wluch the least rceistanoe mg offered 
to iu prngrcw; io the other tbo inal}iO(iition haa buen 
assumed at a comparatiTcly early period of dcTclopmcat, 

(Ij riMT of iM Iraur mrfic* dt \etx tMft o( rbn low** >w, Uw b«M bdoc 
nnwTvd (u ihoir the obUqw dm<:tlaa of ili« thM Dular. 



TXBTBUKK 



191 



blMpacUrii of rciwtaiioe ftt the lione of ernptUm. In 
Fij^iL 79 Mud 80, the t««th sppeir to bftre adrancMl until 




I {BrtUDf mM'r4 U iluw ifc* aUli|«t tttrrvlXm of *br Uitnl t»nlar. 
(Ti •laFvinrtbv Mirt «urfeMot tba lowetjaw, *IUi llir llil»l nnUr pUcnl 



192 



A SYfrrEJi or dkxtal HcncBRr. 



Ui« mcdiau wlgfl or angle of the crcwns impii»g(yl upon llio 
n«ck*t (if tlio »ni«rior molars. 'Hid Tons-unl niuTuuictiU of tlis 
UicUi tiieii td-vaine coHij^PH^Iy nrrestcd. In Kiga. 81 and 
82, ch« toetl) must linvc bi»n fruiti ihi? first rontin) prvtiy 
much in the paiilion wblcb tUcy nrc sliowi to occupy. 

Fit. M.-tl) 




In the upper wiadom teeth the oblique direction furwanls i» 
leia frequently nasuniei). TIio followins fisuru will, l«m-t'viT, 
illiutrate the iona of irregularity in iliu upper mnxilla 
(Fig. 83). 

In the lower jaw it is not commoD to find Uie third molar 
directed oHiqooly oulw:irii, aitliimgh eaaes hAve occurred in 
which it htw MTOuictJ that position. In on« or two inrtanwM 
I Imvc scL-n ihc crciivn of tho tuntli btirinl in tliu Hubtttancv 
or tho chuoh, ami ho much obncurixl l\v tlic 6w<>lUn^ and 
iiifiauiiiifttion of the auii piartfl oruiiud, lluit itii prvMnci! vnaa 
det«ct«d with »om(j difficulty. 

In Ihc! u\>\i-T jiiw, liuuuTcr, tho outward direction in more 
frvqucntiy ttikcu. In tlio accompanying figure (Fiif. Si), 
takiti fnnn a HiweiUKiii in my own ct^lection, thit^ fir>nn i>f 



C) aiiHn « loirer >*' In «hldi Ui« ilalaai hxrlli liu Ukxa a bDtl»>i>i«I 
pnltMii Mow U» ltv«l vtOtf kItwUt mariln. 




■men or osn-iU. scKGEar. 



piervnl the cheek. The crown of the tootli wu, liowever. 
hitiden by the whuken, and Bfipaufwi to proJimv rio iuom- 
veiiieticB. CfeU of the choek, with the prtijecliug tijoth, were 
lAkcn, nod E hetiove one of them may be una in ibe musL-uni 
vi tliv Ci>lleKL' of Surf^uuuA, 

A ca*t occurwd in tbe pracUcc of Iho Into Mr. CmicJc, in 
whicli iL lovniT wiwluui tuuth had nukiia it« way to ttie sur- 
f&co Had pierced the skin clow to the angle oT tho lower jnw. 
TliB crown of the lucth, oa is sreu in. tho Hcriniifwttj'uij; 
figure, ivas firmly eniliraoed by tbe puckered «kin, which 
preacTiUKl the nppeantit-^ of dcatricutl Us&uo. 



fV.w.(i) 




III this CMC the tooth w*n romnred, and tJie openiDg iii 
tbe skin clu«tod uponUitiooiuly, without oaceBsilating oay 
forthw sargical interference. 

QuvM iti which the third mohr in diroctnl with ■mim trr 
lew obliquity inwardfl are met with in the lower jaw, but 
in ihti iipiHT ninsilla tli«y nre very uncommon. KxampleB 
of iccth which [caji iitwanls in a slight dogree may bo smo 
fruni timo to timo, bnt such hardly call tor descripUua in 
thiA place. 

1 do not remember to have «eeD a cAse in which a kiwer 

^t^ Tliif HtCUv la UkFD fnitn k nx mnlrl hplanflnf to Ut. Oul«rl|hl 
wbicti to depuaiinl In titt maKum v1 the Obmlolaglfxl tiuctH/. 




TBETHIlftt. 



inad«ii luoth amuned the luirimntAl ])OHitinn, with Uie 
««' iM» low&hU tbepMtcrior Uirticrof ihi) 

a*. .1'- iiifLTinr maxilla; hiit (if thin furm 

nf : > til tLv u|>]«r JAn- 1 liave several Axatiiples. Itx 

Ob' ilw rniftii of ihc i.«>lh nwt« sgainttt th« ptcnr-- 

toid jimtB of the i^ihcDtjid Imuu; iii auuthc-r, it takes the 




Mnacout (Mitioo, with the orown <liroct«<l backwnrdi uid 
« B|tle mlwatih, ani) m Lbv muwum ur tlin (Montulogical 
Bncirl5' i* a luodrl tiidViiuft a wtedoui tooth erupted Id the 
miildU' Ihw fl' the jmlata 

Then u uo reaiKin for ftupfKusing that the imgolar toutli 
O tbMS liiilancn« jimliu'ed any incoiireDieoce. 

Two cAtve bavB come utkd«r my uolkc, iu which thv dint." 
tim 'if tlie third RwUrs has been complet4>ly revAraod. The 
teeth Itavu Inen upside dovra. The Grvt eiain|)lfl of tliti- 

<r) Hwrnlm iW >i>>l»ni luuUi of iIm kfl tM* of Um a|ip*r >Mr, «tUi Um 
n>«a IjrlHK M*lart U« i'4»T|!ulil|>>>l«ortb**iib(fMUkan* 



196 



A BT8TEM 07 DENTAL BtTBGEBY. 



rkre torm of diEplacement came into my possessicHi with the 
foHowiug history. The patient Buffered pain from a carious 




msobA 



le upper Jaw. Tbo ncliing tootb was rc- 
catiiB the Uiird tnuliu', the Dugs ot wbicli 




(!) Shawl Uif irlBlinn lo^ of Uit rtght aUt tt tiw upper Jut pUnd iMri- 
idMaIIt. and Uu> cnnm dtmtnl tw;k«uil« ind ft UUI» OvmrtL Tte feSM 
hu bdt rrnwnrtil In ibaw ebt poalLlon nf tlw tooUi, 

(T) A «ea)ad noJw ot the v^yw >w. witli tfao wlHlotB toolb Inretttd and 
cabraw* wNfalfi llu nutt. 




TXtTHUfO. 



197 



^^«ne iatetlaeked with those of the disnuett tooth. The 
^KrowD Hitl niuU of tlid wcjiul held the ueual (iLwition, Intt 
^Wm DonoipoDdlatc pATtH nf the third mokr M^cra completely 
Binnftod, tb« wb11h1(.>vi;1o|]c(1 roots of the one embncJog thoae 
Bvfibe olber tooth (Fig. Bd). 

^P Irrtfulanty/rom tmujuMilion qf permnuent (edA. — Id * 

^■fncticttl point of view, no great int«rcst Is utached to this 

Bira <if im^birity, an it duee tiat admit of remedy. The 

■ooMcdiDf illiiM,niti<.ai is taken from a case in which the 

4»ota «iapUced belffwia the central and laternl incUor. Somi^ 




the cmnini! will be found bolvriwu the bicuspid t«etl|. 
,Tlw maxuwr in which tmu8i>0Biti(iii may arise will be Btt'u 
•ame oT the carliur liguros are examined. The [Ktsilinn 
ctaine uf the u^per jaw is, doriog tbc yxrUrd of 
iCTjt, w mneh abore the adjoining* teeth, IhnI any 
bngnlority in the growth of the Dei}cbbouring iaHb of the 
alfvoUr ridge, or of lis onbnits, may throw it Hthcr in 
I of the lateral or behind the fint biciupid tooth. Even 
[Mwitkia of the dcvclujnng onsp of the canine itwLf nuiy 
to a similar resnU. If, fur iuatance, the point l>c 






ptMiil tattt—B thr Utor«) ladioc AMI AM bWwrliL U an oikar n^xu 



i 



198 



1 HTBTKH or »EST4t gCRQWlT. 



4ireote>d either forvranis ur IjAckwanli, the tootli in itn 
dfiAcent may 1i>rc tlu- prcpcr porition, aod cmne either bu(i 
the iucuont or Ibe Fimt iin<l wcond hicaspiila. 

trreifufavity in thu number vf the f^rvitinenl ttih prfswnts 
iUsdr ax lliu iiuxt sut>j«i-l fcr ii>ii»ideratioiu TLirly-lwo 
iH^g the tiumltor in a normal iofwn of |M>nnKn<'Ttt t«eth, «ay 
dervitioD, wliuther il Ito ju an €Xco8» ur in a Oiiiiiiiiitiuu uf 
tbftt number, nnll consHlut*! an irre^ilarity. In other words. 
tliene may he iiTfipiiliirity from toi) many iir t<i"> few teeth. 
EacIi of tlieM; foriuB of dejiarttirt' from tUe noniiKl scries it 
fftr fnmt nrv; but of the two ffirrnr* it i» perhajiK more 
omimun tft fiiiJ that in whioh tbo tct-lb aro in nscMS, one or 
two mipcnnimcniry tpcth, as thoy nro tcnucil, Wine 'prcwiit 
The rniinwtion which seeain to pxixt U'tiveen tlic hair anil 
teeth in respect of abnormal devt^li'imient lias ala-a-ly b«a 
notiasd (page lUi). aa wa ajso tho fact that sucli abnor- 
malitiea are often inhcritM. At all «v-Eintd wd will first 
coimider that tondition in which tbo teeth exceed the pro|KT 
numlier. 

SuiXTininierary toeth ihmv sprina «p during the spcnntl 
dcutitiuii ill any jNut c( tiic alve*:>liiT iiri'h, ami the foruu« 
of such te<rth nmy either r*s*pmble ihoiie cf 8|)ccial uieiubera 
of the noniial neriea, or tbcy may deviate from tach of the 
rocuguiood furuui, aud iumuiho a wniii^wluit irrt^itlar coniml 
ah^w, MiflScicntly characlcriittic ia itHclf to be at once lecu^ 
niud aa tliat uf b aupormimcrary loMlh. (') 

SeTernJ coses, occurring either in the Arfit or tlie Mcond 
dentitt<>n, have Cfinie ntuler my onii nksorvnliou in wbicb 
five equally wvll-foruied iucisura occupied the lower jaw. 
In naltber taae a'ait it pontiihlc to lieterminn from an examina- 
tion of tbu crowna of the teeth wliicli was tlie supjilo* 
mental Umth. A iblrd lalvrul iiiciMir iu tbo upper jaw, 

(!) Hntnn llul BujirfDUiuvrv? iectli unune Imi dlUtnct fbtn^ tlv MM 
tatkig ncuUr, Uia oibcr Invaalv, h lolitlil. pntwi*. to ulranugMM* 
«lm aptaUnii or UxMi nlilcli In m rraprct dlQbr from mrmhan et Km 
aonaal tslib lo bm itw larai anpjilrauiul, itmniat npamaatmj fbr 
ttin lnTgular-«li«pii] tatlli. 



I 



I IMM fa. 



jvmnxG. 



189 



r 



ucouitmhlo fnitn l.li« Domiiil lonili, I have seeu iu 
caM only, liwtancos of « third caniiM) ur uf a Sl'tb 
kstwpid, kiul alia qI Auppleiueolol luiitnr i«etb (llio (unu 
tf ibi iddiUoDftl tooth Iwi&g perfectly norauil), Uavu U-vti 
HtB, UuiBgh 1 bi»lieT« Uiey are fxlrviucly nuv. But 
nanfika m which an iU-4h&pod t<»th withoiti dvbrmiiu'd 
farm i» luuiui placed Iwtwouii the fruut twth, or behind 
than, at even boUing the place to the Exclufian of tb« 
aoRDa) iDember of thi? nut, luv iia't with by all who are 
tay^ed ia pnctictf. Tbe uuuibor u outuuioaly liiuiwil to 
one, or at nwBt two, aap?niuiuorar>' teeth ^ynimetricAlly 
wmmed; buc I h»T<i aeeu a caae ia wliieh there ucie four 
m|iBniiinienuT (wlh, forraing a ^Tuufi witli the ii]ii^r itt- 
daon aad uatuuea. The trout part of the uioutli looked to 
he ttiiililoi ncer Triih iwih, withont any attempit ai a <)eHtiit« 
anrnn^iucjit. Itulenl, Iheit was mme little difllculty in 
RcogniKUtg tb« nnnnal momben of dw Mrin : for while the 
wipvniutnpmry t«eth lo mime extent reonnhled normal front 
tarih. the latter were ill-formed, and apjVMched the fornu-r 
in cfaamctn'. Aft caww like the foregoing occur from tmn: to 
timr, iu which the reoognilion of the sajwmuuivriLry tjoib 
ur iMTlh ia nttfiidiil with dilliL-ulty, tt bucuoua oeocMory that 
w* »!itrf<t<l. if [fOatoible, MUbtiab tliA fl{ioc(al cbaract«n vhich 
*r' lo fiu|!tTmuu<!Tmry tcvth, fu diHtii)|;iiiidied from 

laM. 1 normal mcsutieni of ttio aeriee. In the abunoe 

uf r ' I. •^ I mluigt:, we tnay allow a au^icruniucnu; looih to 
ttiujm urn; uxcludv the normal tooth from ibf place, aa 
tbown io Fig. 4& ; or we may he tndocod to remove a hndly- 
■bajaal luuth ander the iinpreMkm that it ia QOt a UMubvi; 
ortiwtcric*. 

V : ' n? tfaa diacrimitiattiin dciA&dB upuii very uioe 
di.1 '^i«nc«, th« DociMeary kn(>wi«>]g<*, rviui if it U |>o»* 

■■mU by tiic aiilhur, can narouly bo convi-ywl iu a writren 
dwcrii'ti-'i. Mr, J. Parkitteon has placed hii collwtion of 
n,; .ry twth nt mr dispufiat. Theso, with a rajonil^r- 

xU' r coUeviol by myjwif, fomi a wrios mfficientlj 




uiit rniiowtag Mkuuuits— The lisp 

arv not dinUngaished bjr my ilifTerenoc 
iwminatw on tbeneck of Ibt- loutb iq 
Id tliis n»peot from the teniiiual liou i 
crowii of the tootli will, in the nifcjar 
aimplc ix>n« with a 8hur|) h^cx ; id otii 
iriU be replMod by aa irregulATty d 





resjwpding in char»cl<T to the niastja 
ou»pi>] or mular. Mon- ntrvly tb« conic 
ii loet, [ind in itu plHvv wo haw a n 
opowTi, th(! giiDding Rurface bein^ marks 
a deep fiHure. Svvcrul exainplcs ha 
ubwrraUou, iu which the crown bos bi 
or four platen, meeting «t a pfiinmon cw! 
u to prodnoc a oven. It would, how 
attempt to >deitcri1)o more than tlio gcnen 




nrrscfo. 



201 



iitfwiibljr iinftl^ 1t>e cruwn not uDOomnwnly |>re«ct)tA a 
nraun uucmnt orcotniil^xity, aod Jipproachctt to tlu) form of 
• molar lootli, Lm I Ho nut ivmember U> hare aeeo a eioglo 
aptciium of B aUwtly •o-oUled itupeTniimenuy luoth, in 
wliieh tbe root wm liimlcL. 

Tba htau<ry uf sii|vrtiaiiHTrary toatb hu not attrftct«d ttwt 
dggrtw uf fttt«atioD Kt U10 tuuuls of pntctHionvn which the 
nbjret drntnat. than am aorcnl puinU Uiq iureiitigatioa 
of which would b« itttvDded wilh adranuge. Tbux vre find 
that aapvmamernry tcctli, fur ibe tnuot jnrt, on- iimtured nud 
inakfl th«ir appeanUKe licfore the pennancct t^t-tJi sltuatvd 
t& tiia Mme part of tbo tnoutb. 

/*••>. CO 




to iha caao fi^^oral at i*^ 1T7, the |)C«itiua of tbe central 
incinr U prcuccapUid. In the succMding iUustration, a 
njamiitoicrar; tonlh bolda the plAcn "f Uil- lateral iociiufr, 
wbkti, with lh« couf ntl, U btld lack, fioiu lakuig tbe tionusl 
(•Nitlon. In tbe vpccitrica frcm Mr. fjaou^lor*' collection, 

II) a|«bUlrlnraf U# ifBdnMM AMna hinp-MutdM. 7W Mrv 
mmmt^ *KiM u ilmau^Uvmm tbm omIm aoA iha cmatl hwlMr oCilw 



300 



A. STSrm OP DEMTAL BDSOEBT. 



lar^u to jostiry the olnerver in reganUng any |)ectitkftrity or 
(una which provuU Ibrougbout the coilectkn H a special 
cbanctarutio of eaperoumenry teeth. After rentovitig from 
th« MriM Iboio which ara aut 4istiiigmBha1>ltt from normal 
fi>niiB, we hare Temaiuing, t«cth tlie crawos of which exhibit 
the following characters; — The liii^^ and khial anrface* 
are not distingolshed by any liiflvn-ocv of ftirm. Tht! enamel 
IcrituuabcB oo the neck of the tooth in an erua lioe. differiD^ 
in this rcepcL't from the temiijial line In ordinary tooth, llic 
crown of the tooth will, in Ibe majority of casoa, preaent a 
nniple cone with a sharp apex ; in other inmlanccs the point 
will be rvplaoed by an irrogularly depresotd surface, oor- 




rcAponding in i:;haract(<r to the roasticating flurface of m 

ciu[)iil or molar. More rarely the conical or cylimiriial fomT 

' fa lost, and in its place we have a mane or k-^ flatlcDed 

' crown, the grinding Eurfaoe being marked tongitudiiially with 

' ft deep fianire. Several oxampleH have come ulkIct my 

obaerrution, in which the irown has been divided into U 

ur fuur vlatei, moeling at a coniinoti centro in such a 

H to jmdiitie a cross. It would, however, be hopeless to 

attempt to deocribo mure tliaii ttiu ^i-n«.'ral chamctera of sut-oi- 

ntunenry teeth, itiaamuch as the minor diflcn-ucos of form 

arc infinitely Taried; no two are iinedsely Bimilar. 

The roola of snponiutnerary teeth arc, I think, alt 

(I) Sliinr, tbp rnnt *t«w sf a iptctiBn to wtlch « ^■[ltmI■Ill^^KrJ icuUi 
■aioukl lu Uic buiU teeth wcii|ilEa llu apan tetwocn lb* Uurtl UiciMf 4aa 
anlMtMtta. 



TKBTniNO. 



imtuQt ol mv own. n dimiiioiivc toalh. rowmbliug a tiDftll 
uul ladly-fonuei] vrutlnin t<.i>t)i. ni>))atriicl <>n t-ucli m>Iv u( 
th« mnutb external uuhr I1r>itiiii<) tuxittui pnimiioiit tnohin 
of Uk opfier j»w (fi;;. 04). Tito age of tfiu imiuiiL ami tlii> 
tpfttTando ur t^u ttwfli ihcniselvM lei] u> tbe mipiioeitioa 





thoT wm thf rrpmenbitirca of iho wisdom tv«tb. 

^Vilhiu two or three ymni ttio tTrujiiini) of itie trnn windom 
totth Ln tbc unual [io«itluu KhuwM thM lli« tiuppoeitioil was 
t&sorract. 
buunoni liJiro, however, occnrred In wbkb an ftdditloruil 




i a uonual uieuifccr uf tilt aeries, luiU ■ mtutliu occtirreULv 
. hKu nmwrkixl in mspcct to the bicufjtidi. 

• Ill* fin«ii *i>«o(a«pMiaMk Ik wMdi no •«pttiiMM>nur b*lb 

' %AMr I'F thf <i>nu*I tndBd*, oltlldliB l>(t(mtiiaMft>lM»«rv*MtO 

m» Mloiotw ib>«. 1 Ml lHdM«4 h) Mr. litmwtKn tut ib« «m vt ihl* 



! no<«« •^ 111* «1T<' )•" 



308 



A BTBTBH OF DBVTAL SCKQKniT. 



two MUpMHunicrHrii' tetMb (Fig. 03) occupy the place of the 
i-vntro] incisore. One of tho excluded teeth lias come tbraoi 
alwvG the alveolar line. 

Again, in Fig. !l'i tfatirc are two mi]ierniiTnorary t«ett),lLad 
Utw of Uicao liae to n certain eittvrit iiiUirfurvd wiUi tho piwt- 




tioa of the central iodwr. Now, Id eacli of lhe« iiistancee 
eh« almomiBl have precedBil the oonnal k-^th, itmi oC'CAsloocd 
the malpuaitinn of llie latter. But it umy liu[i|rcti lliat &« 
MaperaomcraTy tooth apiimrs in tlip plnw anj .il the lime i 
a mirnial tenth, tJie latter liavin;; l-oeii rutanled m its 
development by the preaencc of tht; former, !ii one cft« a 
central incidor of tho upi^r jaw- waib cut at tlie tisiml time^ 
ind by th« side of it a ^uptTDumerary. Th^ lnrt«r wsu at 
once rwiiirtvptl, umliT tlif strong belief that the ulw-orit ceutral I 
tooth would after a tiuitf make iu appearance. The uxixx'Ui- 
tiijn wuH n-iiliHeil, but tUn't yv&rs clajiNed firtit. 11ic ceigh- 
bourhood of the incifors must be reputletl an the mosrt 
cummon ptMitiun for stiprmiiTiiemry toeth to take, and the 
upper is moro ^qaently fsvourvtl Llinu 1Iil> lon-er jaw. 
Initanccs, liowever, are not wanlii\g in witich the additional 
iJM^tb appear ainong thi; umlar diviaiua of the serie& In a 

(I] 5te«« lk« VpMlMOW piMKUrd bj a tjM uhm IK<ni ■ motitb tn 
vbtcb two tHirtniiiWiiiWIJ t*»tb appMnd Milii-I ii>« inriikr*, unt r-wautklliif 
to tutat txtm% ut IndMT, the lAhcr kltoflcthtr imKUlbr m thapc 



TUTUIXO. 



90S 



nmuBtwy tmtii, on be tincal. Still, my own penon^ 
obaorrMknu wonM, prrtups jiiHify me in otAtiog tb«t tapor- 
nomnvT to«Ui ore nwre fmiueatly fuurni iii perfoct tiiui in 
!ui[icrfiKtIy-Jardoiped jawi. 

TIm relfttwnii of sniKmumerary to the temporary teeth 
dohns the •li.'velopiDeiit of the former are not, in the abssnce 
nf ftetoal obaarsUons, miUly mdcrstDUiL Tho growth of 
the fanoatiTa puliM of the pcm»iiont witbiu the sockeu of 
lh« Mnporary teeth has been demnbnt, together with thi- 
yragr — i ve rannatiuii of uryptu iu the inner walls of Llie 
WcfceU ff* the reception of tJie pulfs. Now, vrhore w« have 
npanuUDOimry tueth iu the front part or tbo niouth taking 
innedflaoB lU^tly. io mpect lo time, of the permanent 
lesth, a questjon la saggented a« to the relatinnB at an early 
petiod «f the fonnatkin of the latlrr tu the ivm|Kirary teeth, 
and lo the anpemumerary. It rvinains lor future lUiatomiatA 
to detarmine whether aupemumortry Uwth arise Id coim«ctlon 
«tlh the tempumry or with the [wniiaiiL-Dt teeth, or whether 
a Domal pernuuieitt tuutb may nriHo in oonncciion with a 
egjwm ai iMrafy, the one holding the same relatiuaa to the 
other as tukder onltuary ciicaiUBtaacee, the fiiiet and eecood 
uetfa do to each other. 

A lingle phnue wiil Buffic« to deicribe the treatmeat of 
eaeee in which Hapemnmeniry tcetli make their a{^ataDCe. 
Th«7 shnutd l» cxinutMl so aoon as theii chazactor is clearly 
Mttbltafaed. 

lostanoaa may, howurer, ocrasionally present theraaelres 
k> ths practitioner, in which a mipemnmerary tooth may be 
retainad wiUi advantage; but tbcwj will, for tbv mnet part, be 
**"'>*Hi-* to Ihoae oaaca iu which, froDi ueKlvct, the whole of 
the laatb have bwn sIIowmI to nunain until all chaaoe of the 
OMnal looth entniof; into it« proper poaitioi) oo the leraoval 

the inlriklM- IS Icml 

Tn the OMe shown in Pig. 66, the central incisor woold 
have ^La)'l> ■■ri.-uiiitiil Uie uhiihI jilacc, luid tlie mijicnimiie- 
^^faty tooth bveu rernovcd on iu first ap]>oarattce through the 






ao6 




IITeTSM or KCSTAL Sl'llUBBV. 



gvni. but bad ita eitraction btwu [lerfonuni after the cvui- 
plftiuii both of itflclf ami nf the ()it^|i)iirHl rentnl tooth, no 
tdvontage would have been gained by tbo operatKiD. The 
positifin nf the centnvl incisor liavingi; Ix-en una]lemhly 
detonniued, the «paco left by tbc sxtriLction df tliv intruder 
irould li«Te rcmatiieii unorcupiM. 

I-'uder Lhu beud of itroffitlarity in the uuinber uf tbo jwr- 
nianont teeth, tho»c cases in which tbe dental urit* it morr 
or laa rie/rrUve, yfX renuiiu to l«e roiisidered. 

IiiRtances hare been citeA of ■ total kbwDM of ths jvrma- 
nent t^vtlj. (M Oiic ut two aticli amw hMve been deurifaed 
to tiie by gentlemca who hare eiomioed the nhjeoU for 
thciiisvlven. In tiiy own practice, huncver, I have ^«d to 
meet with sn individuaJ who from the firrt ww pei^Ktljr 
deslitutu uf pemiuiii'ut leetli. The utniresl ajipruaoli to the 
ed«i)t»te coaditiou nbicit haa id any way oonie under my 
own objierratioo, i» ezliibilfxl in two easts taken by Mr. 
narriaon fruiii a pntieut uudcr bis truilntcnU One molar 
occupied each side of tbo up|»er and lower jaws. These four 
molar tL-alh, willi fuur tuciauTV (two in each jaw), v/ae all 
the permanent teeth. 

Acoonimg tn tlic RUiti-iuPuU «{ the |iatient and of ber 
frituds, tlie teiii{H»ury teeth presented no peculiariticfl either 
an regfwla theit nnniber or the manuer or the timt^ of their 
abadding. A tenipurary caoiue tuuth vtm» letttiued in the 
upper and luwer jiiw ; tht- other meuibers of the dedduoM 
Mt droppeKl out at tlte usual time, but, with the exoeption of 
thu four cuutral iuciHorH, tiicir aiioceeaors were wanting- A 
ouo ban Lcfi) alrnvly design bed, in wbi<;h there waa an 
almoul tuliil abtH*i](.'<! of the tomj^'niry aeries, ytt ftemtane&t 
teeth ii(^ only made tbetr appcnranoa at the usual tiina, but 
took their itlnce with grcai regnlsflty as respects amnge- 



(1) In Ui« mowiiDi t4 ibr CMentobiteil ^MMy ut tt^mi noiMi el cu« 
In irhbb Uie Inili wtn drlklrni (im QiuIoki». faf 21;, uul alluilna bas 
■Inwtjr ben ntdt* lo Uie salijKi In dlHnufJiiK tbe origfti «{ TUVod* ibota- 
iiuUUM(]W|cr lt»>. 




nurraiva. 



207 



Eqvt, ftlihonftb Ui«M two hiDUbcM uuiy be looke<l 
npoti u rny ran ami nct'{Aiatuil oaat, yet tboy prove that 
ttftni'imrr iln not necc«snniy precwle pennanettt t«6th, and 
ttmt t«ni|>>wmry are not iwcesaarily followed by poniiuietit 
tectlt. With tbcM im:l» before us, w« are aol able to turn 
lo iIm> ciiiMiitinn <if tlif! u-mfH'Tiiry t^vth lor ex])lnitatinii of 
■ny lUminutHm )u tli« jKirmauent wriM, vrilb much bope of 

^ iiiiy >!;rbat diuiiuutiou in iLu nutaber of tfae 

pel' -*m'« U nirvly uvru ilic •I^hwdcv uf otie or two 




I 



nwrubvTi of the wt i» fAT.^ii) uocomutMi. 1 know sevcrel 
fK.-: iu«mb«ni iu cw.-h uf wtiicli are dnitJtuUr of 

U^ - TR in the iipjii-r jnw. Althnugh it ja n«Dal for 

•tnoi&utittu'a, wliHtiLT CijiwiBtiiif; in ha ttxotwt of n di)6ciuacy 
ai minihor. Ui affvcl Iwth tUlt* of the tnoutb, yet this 
ajvum-iry ia itut, »lwHy8 iiKtst with. I bar* two paliflita 
(aa«n) ill wliuiu tlj» ri|^t u|i[«t bUiral Ukciaore are aboent 
iW UA Ut<n)ii am amall, but otherwise well fonnn). 

0) Tnmt *ln« t4 an tncr >i« pt a foaiii tablKL TIa Woipiinrr Uvnll 
Mw lk«l il« imp>:»W7 Utml loriMn were ouitUii, mol ib* »bwiM» «f 
VHHHMit MMnl Mrtb ti ahu (kmn. 



208 



STBTSV or DBNTAL BOBOdlT. 



I Bin iDflehtei) to Mr. JamcB ParkioMD for a spooimeD of k 
TOimg jeiw in which both the temporary and pcmuncnt 
Ifltenil iiioiiKirs are witiiting. 

The Mn xnA Anv^hifj of a gentlrman who hjui do laloral 
inoison in the u|i}H.-r jaw, each bote Lh« miuka uf t)ie>ir 
imrent^e in retpect to the t«eth. Tho ton hml but ont 
Uteml iacistir, ami that was a Tory small ami iuipcHi.'clly- 
developed tooth. Tht> (U(iglit«r had. however, two lateral 
incinnrti. Tbey made thoir appeoranoe at n vrry late period, 
and preaented the characters oaumoii to supemumeTar; 
t«eth, each tooth Ix'ing nothing mora than a tmiall flharp- 
pitUitml ooiiD ; and otfaor iiurtaooea of inhcritwl pvculiaritiM_ 
Iiaw already bwa giron at ptge 114. 




I bdlen whan ono dntcription of tooth only is watititu;, 
wUl generally ba fouud that the latenl incisor is the misoiof; 
member. Perhaps we should *iccpt fpom thin rule the 
wifldom tooth, Thry, Iiuwovlt, arc «o extroiiu-ly irregular in 
all respects, aa compared with the oUmr teeth, that we are 
seldom in a poaitian to declare tht>m alwcut, alllioiigh they 
may not have afrpeared above the surface of the ^ums. Hni 
if tho third molars are less frequently ahecnt than the laloral 



(I) amt • wnn.do»«lopBl •dnW J»w, la whidi Uw «K«id tanjOtafT 
bhiIm to penMcnl, ciu wcni>d blawjiU h&vlng b««li d«v«U>pflL 




TnTHtNO. 



209 



next in tbe order of aWotees. The 
waooai IricoBpiil u sooustimes ubaent, nnd iU pUoo Hupplied, 
n in tlie preceding UhutraUoD, "by the seoood temporary 
motir. 

Fhim B stnctly prtcUcsl point of view, theae cases of 
itSdtoey In tbo number of the second set of teeth hare 
but littlfl intcrcrt. By those, however, vrha punne riental 
•orgerr u a liberal profesaoo, they v>-ill not be paatxnl over 
■itb iiidi0Gi«iic«, altlumgh onr prssent knowledge uf the 
•abject will Dot enaUe tu to ncognito tbe cause which hae 
prodnoed the defect. 

It is, howcTBT, of great practical importance that we 
■hoBid be folly awsre ttiat Natoro aoroetimea (ails to prodnco 
iboH permanent teeth which are preceded by temporary 
laeth, aod that in such cases the latter will, if nllowed to 
rauain, aerre the porposes of maiticuliun antl arUcuUtion 
Dp to tbe middlo period of life, and ia some iastances erco 
bur. 

ImgtilaHtj/ in Ht /ortnt of the permanent teeth — It h 

not ptop we d at this phtoe to eater into a mimitc description 

^of choa* ^ght deriatioaa from what may be regarded ax the 

[Ileal form of any member nf the dental series, but tho 

spaoe will b« occupied in oonaidering tbe more 

If-onarked cn«es of deinrtare from the usual cho- 

^nctcn;. 

Teeth, Uioo^ individnally well uliapod, may be so much 
ahore or below the ordinary sixoi that th«y become dis- 
figuring lo the poRwnor, The two aoounpanying illusitra- 
liMiB (Tigs. 90 and l60) are Ukea life-sixe from two sets of 
II U etht the one compoaed of teeth individunlly the largest, 
I^Hlui oUier of tlia Bmallest> I hAva over snit. 
^H In tbcsa examples, tho peculiarity bos been common to ill 
^■dw members of the rapectiTo lets of teeth ; but we ahall 
^'■oaMtimec find in tbe same mouth tcotb exccnivoly large 
UBoetatod with teeth exccsiiirely sniiUL Fur example, the 
ecotzal incisors may greatly i-xoued the averago sixc, wbtle 
• f 




mo A BTSTEX OP DRKTAL SDnOBBT. 




Pig. 100.O) 




(I) A rraiit vl^w, UftKlar, oT w unnnnlljr Imrb im of (rant Irclh. (f Ola 
tmparintloucrjawi. 
(I) A (wot vtow. Ull(-«bib of an «*l«inelj- •mall M rf pemMieai ftwil 



TKKTIltlfn, 



Qll 



itiml tM^h ATT represented Iij anu]! oonM onlf. Tlicii, 
T.lie uorrM|k>i)iUiig Ustli of ths ttrn« JRW iiiny tiilTer in 
nu AD(1 form. The one nmjr he Urge *d<1 wtll formed, tbr 
gUier bidkI] uid iiii|ierrtx:Uy dcvrlopod. 

I U11 indebtwd h> Mr Alfred C'&ntoa for th« rery l&rge 
wtiilulu tiaitli wbidi funns the Hobjeci of the next Bgtirei 
meI iU)uirBt«s *th« point jiut nMnlioned. The tooUi u 
donhla the vuiial mz«, and is tb« only nwrolKr of the >*pt 
which cxhibiU tkuy {wculiarily cither u to dinieiuuotui >« 
Ifarm. 




IrrpfcnUriiy of frmn is, bowever, MKwtimM eonneeted 
with liiitiiiiiittiiu of fite; one tooth may bu nnafiually mull 
uui ill abti^d, vrbUa Ibe crthcr member* of the set art) vvtt 
devvlofml. A nuo cutic uiidvir my treatnient about fmu 
roan nnoa, in which one of the upper central toeth war 
irreipilar la timjitt umI alMOt one-fonrtii ihe mte of the 



rt0.iu.iti 



i 



n0.ui(*} 




rWTra[«ndinf; tootli (Vig. 102). From unroo panse, tlic 
I (Usuautive iiiciaur oocuiouod a gooil dml of irritation in lh« 

[t) Amt^ llH<<i^ aa n«Kii*1l7 Ut^ «M>«n IdoUi fnm tlir tMtM >i«. 

(*) IWMItori Ui tUBlRl oMfkl IIKlaW itf Ibc U|>^ir ll*> 

p) lfcit*i «f th* Kppw J«w. Willi Uw ftan liwftMir a*v«hifd. 



212 




A iVSTBX or DSSTAL fll^BQEBT. 



sum ; tliis wifji the unsiglilly chftmcli^r of llir tooth itwif, 
iod to its being extracted. Thu teeth a4joming the vacated 
HpacB vcro, i>7 meaiu of li^tuMw, gnuitinlly lirongbt ton-anLs 
«acU other, and ev«Dlua]l>- ici far reduced the iaterral, th&t 
the ahcumce of the foulty ocntnil wiu not nitBeed. 

The in'cgulurity u regudB axe will sometimes be limited 
t(i tlio riMjt of a t(k)tli. In the example* fmm which the 
[ift-cviliiiK iUiiRtrntiuii wax taken, tlie crown b&s allaiited the 
ii*u«l mm; the ouaincl, however, exhibits indimlions «f 
di]fi.-cLJvu urgaui^itiuii, and the rout U iiifwt imfxirfvctly 
developed. The tooth was rcMUoved within two yvan of It* 
ii]);>('ArAticc, in consMiuiMicp nftlio irrilAtinn it citdtcd in the 
siirrouiidiiig Ktiiu (Fig. 103). U cou Bcarcely bo (tuppoaad 
that any contititutioDai condition would ca\\»v the pnxluctiou 
of one defective tooth, and leave iuiinduencL>d oilier teeth 
(ip\-eIopiDg at the aaine tiiii& A strictly local cause may be 
looked fur with much greater chaiirc of l^ucc4.■»a. The 
l>ral<>nged existence of gam-boll in coDnection with a ttiu- 
[lOTmry tooth may produce the rwiiilt, or the ciicrwudiineiit of 
H neighbouring tooth ti]x>n the fomtative piilp may Irad to 
the Ibrmatiuii of a dwarfuti and misHliapen tooth (P'tg. 27). 

Perhapa we kIioU not find n more fittini' plaev for con- 
ftidering tboM dcriAtioni^ from the normal fonns of the teeth 
which are oonaeqnwit u|xiu iuturruptcd dcvelopnienl of the 
dcittal tissues. 'I'hc crown« ijf tlic affected teeth, instead of 
pn-Hcnilinf! tho Iieantifitt amfioth and ^loHsy stirfaee charac- 
teristic of fincly-«lpvelo]>ed eimmel, are diafignred by the pre- 
wnce of an irrpgularly grooved or pitted gnrlace, ncctimpunied 
1>y a considerable diwiuuttoa iu aic. llie lucisuns tsv 
commonly very thin and compreiHed, while the caoiaes ood 
the ounpe of the niolan are terminatcrd by sharp itointe. By 
the aid of the inicwecope we may learn that the tiwiiea aw 
unl only deficient iu qtinntity, bnt that they are defective 
also in quality. Keilhor the eiixiiiel nor dentine is jterfLftly 
deTe)ii]iud; the cli:uieiita of tlm former are imfierfectly cuw* 
Uiiud, bence the tissue u punnu, yellow, D)>aqtic, ami very 




918 

fragile, and to (he latter, the dentinal tubes are wnnling in 
tiuki uniformity of rise uhI kmngmoent idiich they exhibit 
rolojx!*! cccUi. 




Thv cc4MliUoB of BVfitnn which operates ao tmfavMiniUy 
ifvtilopini: tiwth fntjuflaUy pimen off bcfora they 
:M ; consequently theme parto of the twth whicli 
■fUr the limith has JrapruviHl aGHome the normal 
inrr«. It U very coiniDOn to find t«eth which nhuw 
Uuit ihuy have been prodaced nodertvo txm- 
' m : Ui« oM half of a tooth vill be iuiiwrfeclly, 
th» olhrr perfectly dcvclojiwl. The otnermtloii may with 
iqiial Jufttice 1« applied to whole Mt« uf Iveth. 1'lic whole 




I. 



eVSTEH or DBITTAL eOBQUtT. 

tirtlio crowDi of tl]« ceutral iiictaon mny be alto^hcr im- 
iwrfwt, while « small portion of the latent! lectli will br well 
fMrmixl, In t)io (mninp, th« good poTtkm of tbe crown will 
Iw larger than iiui hail, rikI the seoood TnoJAT will he 
Altogether withnnt any risiWe ilfffrvt. Ti»cmg tho tcotli 
[rom front to Imi'k, we may i^er- ttiHl tlic ilefecl crofio ont 
at n fiplinite point, oail that Ihcrv will hv in tbts respect a 
slrit't currcspandauco in thu iwo wdcs of tho mtnitli. 

Tliu <l«lbct of structure will l« limited to such jwrtioiw of 
the several leetli its were TiiHler^niitg dcvelopniFnt at thr 
oame time, and cotueqiuoitly luuler tjie same tviixtitutioaal 
mate. If, for infitanoe, we find the one-hnlf of the rrowns 
v( till* cviitrul incisors and finsl jjcrnisHcnt molars iiupfrfect, 
ono-thinl of the Uleni] tocth will he in a corrcwpoTwlint; con- 
<Uti«ui, white the defect will nut extt^nd ovvr more tbau & 
iDunh of the cromis of thfl caninw. Agnin, if the extent 
of the dpfoi't bo lixultM to the cutting wlgf.-* of the central 
iociaons, the ktotal inciaon may he free from imperfeitiouK. 

Ah yet, those caacs only have been describMl in which the 
dental tiiutiie exhiliilfi over a certitin jiortioit of a toiUh olv 
vioiM uga» of ft d«fecliv« organisation. But we M>mi>times 
find teeth which are riuirkod hy ktooy)* aud ridg«*, very 
repUarly diipceed. The erooveB are the rwidt of impcrrect, 
and Iho ridgeii uf perfect devtilopmcnl uf the iiiamol ajid 
Htibjaocnt dentine. The«e transrerKe marking resulting 
lh>m alternation* in the lle^'clr>pmenta1 ])rocoe«, find an etact 
innllel ill tlio Ktrtm produced by Bimilor caiuea en the uailft. 
ttwihi; to the more ropid and pcmii^t^nt growth of the latter. 
it is oft«u pouihle bu aee the mark kift by a severo illoeas to 
thv form uf u traDxvL'nicicrooTVMnws tlie mil, thia bviiiu the 
rwult of a temporary oeBsatioo of itaderetopment. Although 
ill many, it i» not io all oawa easy to trace Ihifl ridgwl, or 
pitU"!, <ir hoitevcomhed conditioiL of the teeth to the prxaacc 
of Kf loos indjapositioD of the patient during tbe period vhsa 
the dcfeotire portions of the loeUi were being developed ; it 
mo, however, be «carc«]y doubted that an iinpcrfNt organise- 



Tutraixa. 



316 



. of iLv IMth, If ut)4 the reaiilt oT some special diacwc, 

B atmaltM, influencing the ^rstam generatty, is yet 

cnaMqaeat apoii » comititiUicoAl cooditioD. lite bxt tlial 

If doe UnAii ifl &irec(«ij, lIhiw; (ArU of olli«r leuth whicji 

iMne>|ua(l in re^iivrt U> the [teruxl of fomnalion will prcNtit 

ft siiiuUr cuuilitiuii, prwrliidva the atiiiixMitioD tbai tltv effect 

hn been jiftxluctyi by & tnuroly loc*i cause. The evidBOM 

pmsU to a };biu:iii1 l-sobc, biiL iL will out. uniwmmunly Im very 

difficult (o diacover the pr«ci»t) tuttiire of that cAuae. llic 

^^janmtc may tt-U yuu that yuur yuuu^ jialicnt iuia biwn pur- 

^^pcuJariy healthy from the time of birth, having at do time 

^^^aff«rai from iiiuro Uuui a voiy Iritliiig an<l short-lived tii- 

^m di*|>Miti<>D. On intiuirT, ymi find that the temporary teotb 

\ mmn wvH dmt'iojicyl, LutctI ilivir liiiit-, and th«o droj)[)nl mil. 

I haw a }irc)A;attun iu wbii-ii tbc jaws are jarLicuUrly wall 

(towtif udtb* t«mp(>rary teeth unasiiftlly tinv; yet, on rv 

uoviBf! the bune to show ttie i)urtnau4.>uL t«>th, it vruti fuiinil 

i1m( th« Uttor irere honoycoabcd to • great extent. Ilx.- 

oonTcrvc of thU is often Ktmi. The tetnparary teutb may Iw 

hwt (rum caries at an early |«nod, and the maxilliQ be con- 

^^ traded, and still the jiermancnt teeth may to all apiwarauce 

^M k wdl ehapcd and fnw from structarat defeet^ There in 

\ saiple eridence to show that the ooiiditinn of the teinpumry 

■fc auiaai be taken as a jwhiUvc indication of the nature of 

Ibe laoceoding p^nn&nont teeth ; neither will the eridBDCe 

fofsiahffl hy the parent in all cases enable lu tu acooant for 

the pTBKiin! of tbn pocnliar form of defect Id the teeth to 

vbi^ aT-TAntiiin bu lw«ii ilirected. 

U is belicvfld that Ibe effecU of beredlUry sypbilia may 
|^_ often he XncM as the canee of a peculiar dwarfed condition 
^■flf eertaia teeth. Attention bu been drawn to (his jMiinl by 
^^ Mr. Jcinathou HntchinMn (>), who ha<> {minted oiit that. tna»- 
miich an npiKifi^- iuDanimatiotu do not occur daring the period 
Lof inlra-aUnine life, the teeth belonf^ng tu the daciduoui- 

I (t) THMMrtio** <■( Um Putobfln) hdrtf. *bI. U., r- ***• '^ ''•^- *■■ 
l^aiT.end rraMMU>dM•fUMOd«nW)l«lul^«lMr,«llLII..^M.I«»^ 



216 A STBTBM at DZHTAL eCBOKBT. 

sorim arc nut Uablu lo bo allfwtM, tbough tliey luay bo lo»t 
Ity L'xfuliation roDMi^uciit on BloiuftlitU nod poriMitiUs. Ou 
ilw othwr hand, iHq occurntuc* of Hi«i-ilia nffectionfl of the 
ntoutli toon Alter birth may be rcxUIr eiippocted lu alTect 
ihc ]M.Tijtau<!ut U»th wliicli are Ht tbin liiui; ilcvdujMUg, and 
certain rliitracters are «»uin«rat(<d aa imUcatiTC of SQch in- 
lericrenra wkli the growiag t£eth. 

The inciaon and CADloes an of nnaU aiee, and peg-abaped ; 
the cromi \» notchod, llie ootch beiDginthematnaounaiTity 
firooi iho oQti comer to tbe (rtbvr, thouj^b tbtwo may be 
ROCondAry notche* in this general concavity. 




<UM^ 



TliB cxbitence of a " circumrereQtial notch " encircling 
the cauinett ti&ir their {Minis, is also tiot«d by Mr. 
nutchiniion, but is Ity him nttiibutod to a " ciri-^iimfcr^utial 
wuariiiK " of the one tooth on it^ opponent. This oxjilanntion 
is iondmissible ; tliu ^roovu rttuuiug round thecruwiiuf tbn 
uanine near itii a[to)t in himpJy Uw. mark of a tetn[H>rary arrat 
of d«telopinent (toe page 214% and h precisely analotjcus to 
the (limilar gmnvi; across a nail which wnictinies U M«n 
after a scrinua illnos. It is very pixwible that tha aTTt!fit of 
dflrelopineiit may have >)ocn brought about by an attack of 
stoniatitia, and a itimilar circumfsrenlial groore would 
probably W found oncircling tUo incbtors at a point lower 

{)] '•Sn^ttk- litcUunt copW tnm Mr. Uutdiiafwi^ f^po <l»e. cil.}. 



f 



TSBTBUO. 



317 




4avit OD Xhds crowns, Meing ttmt calciScoliou of them tcf^h 
ti bi kdranfw of tbat of the caiiinM. As bow«v«r the trov 
origio of the groove on ttio coniue wh not rnoagnisitl, thr 
p wa o or tlMnoe of niuikc marks oo tbo iDcisors U Dot 
lOMSttiooeiL 

TMCh dflkoribed u "sji^litic" bare a doslcT, opK{'aa 
loe, &uil Arc small rcbLtivelv to the sizb of tbo jaws, 
fllatiuct iuu-mtU are left between them; moreover, 
"Ukuj ore of a vrrv soft charactor, so that they speedily be- 
eone wora dovo, aoid the characteriitic trausrerse Dot<di 

Olilitfntnl. 

Jt mtitt, hoverer, b« bortw id mmd that «veD Ihciugb th« 
— nciation of teeth of this form with uiliehlcii .iy|Jiiliii were 
ottahUitfaed, it hy- du tumas DecceaarilT foll'jws that 
arc the dinrt result of altavks of stouialitiit. The 
U inhehte*) syiibiiis is capable of iirufoundly 
tb« nutrittoD of many [larts of the bo«1y, and it is 
■ likely that ib( pffwta wduM be bnnif;ht about directly 
they should be maaiCeeled seooDdarily throng i1m 
rcniiiin uf ao nitArk nf slimiatilis. 
MunwFvr, coustitulHJiial pypbilbt attacks the hair, the 
iMQs.aDil the ^u ceiwrolly with gn'ot fny|<)pnry, and the 
bomological relatioo vhtch exifitjt ImtIWitii the t^lh and 
varioUB dwinal appendages may serve, if Dot to explain, at 
Isast 1» rvniler Iraa mt\vitan%, the fact that the ilDrcIuinug 
(well should be a oltoMii Kite (or ita Diani(Mt«tk<n. 

It has been pninied nut by TrouHieati (') tliat the Tariutia 
sy^ihtlitk affivtioiis of the ni<.>uth in a chiU are rarely sceo 
tiefiqv th49 secoud week, aiid seldom nuuiifeatcd after the 
tigbtb month (uoloss they bave prarioasly made their 
Hyar B ooe). 

Ic iMoomea, ihoo. a Diatter of inijiortaiMW, in deciding upon 
lbs eatTsdiMtst uf Mr, llutchitiwurti view*, whic U hsve been 
nUMtffedly accvfiiftl in a rweot pa[ii;r by Vh. itcrkclcy 

(0 iKmmrtn. OMmi UcUins (Xfw SjionJum SkMjt^ tniabUo(>> 

.•OalafeniU-nrpanift.'- 





218 



A BmTBlt or DKNTAL SCSOB&T. 



Hill 0), to Mcttrtsin with practsion the ezbeot to which o&l- 
ctficnlioii ius proceeded i» the Afrt<ct«d tc«th at tl)i> period of 
the uhtld'a deTeloptnent. Unfnrtiiniilely, the jaws to be 
fiHiJiJ ill iinisetuiia liare almost iaTuiably bveo maceraMd, 
ui() (he niiniito cuHfying ti{» af tbfi iiennnaent teeth loM, 
iuj that It is not euy lo icquiro definite knowledge on the 
Mibjcct; murLvjvcr, the stAtvuteots of v'ariou)* authors differ 
in the. timea asai^ed to tlifl ooinmADcainuit of calcificatkui 
iu the ftrrtiiamtiit teeth. 

In G ray's Auttomy (thv authority for the pt'riods not heing 
givfu) it i» Htut<Nj that falciflfatioii tii thi< UL-utial idcukics 
take« pUcv about the sixth oracYenth itioulh ; ia the talenila 
and tho cmiines about the eighth or ninth month of fatal 
life. Should thcM dates bu correct, the theory that th« 
deformity is producwl hy Kf>nuttitii« i* placenl in jeopardy, 
aetiog that the port innnt pn)ri)unilly malfunned ia the tX' 
trerue tip of the iuciHor — that is, the part firft formed — the 
calcilientinn of wliicli in said to begin at the seventh month ; 
ID other words, at leaet two luotitbs hefore the i>robabl« 
occumnce of a sjx-cifii; st^jiiiatilis. 

On the oth<>r hntul, Ktillikor^'), witbont girinfl deflnite 
(lalsH fur the coramocceiuDnt of ralcificatiun, iinplioH that it 
is tMimenhnt lat^'r: aiui Itrthinami Maptot(*) dtate that the 
follicles of the pemmnent ind.'tors and caninea first apfKar 
nrithiu a rau^e of alxml fifteen days before ur after birth, but 
they do not «ay at what time cal ci fication first coromeooes 
on the pupil In, 

1>D« poiut, however, appears to have been overlooked by 
Mr. HntohiuBoD, namely that the cakilicatian of the Icuipo* 
rexy tocth is not so lai advanced at the time of birth bat 
that wo may oxi>f*(rt them to bo infliienred by the iiceuiTODOC 
of difiturbinfi; causes during the first month or two after birth. 
(.In ri^fereaxre to Fig. 1 (page 6), it will be seen that only tbe 

(>) HuQtlilrBavlffotifDRitalBdtBai. JosMfTI. 
(>) K^UIur. Hutul or ilniuo MlcroKopto AoatoBir. l«sa 
O BvUa (t Ib^tot. Mtnwtnni levmteattkTvloKMinmtilMFUIUmlB 
DvMalm. isno. 



TiSTnixa. 



919 



tip rtt Ihn tmiponri' cAniT)<^ i» tm y«t nlcifiod, nt thnt nny 
clwxk Dortimh); in it" 'ii'v^-iupnifiut will Iw iiiM-ltfl \ty a 
irlrcanifcTeulul giooT« not iiuitc ftl Ito tip, boc « littlo way 
*lawn th» crnwn. 

But liUl« caui tie doua U> im[avTe te«tb nilb realty uTg>ui- 
MtioQ. Wc luay direct the puticnt to keep the tooth ncrnpa- 
ktOMly ciroji, aiul u*c tnny Cmm time to time iaruinv« ar 
mimx wttti • Htte file the irreguUritteo ot anrfacc. Whcm 
tlut drroctivu pott w dutifiiiixl tu tbv iiiiinedinte vicinity ol 
Uw cuubvg edgt o< a tooth, it may in many aua tw wMlv 
r«no*r>l. The tMlli will Iwk i-imrt, |<«;r)ui]M, aflor the 

■ ■, which fthotild, however, be tlelaywl iiniil tlic- 

'. i-tit I'l ll>« t<x>tli 18 oHiiiilptnl, In many itiiitannvi 

I iukiv twtiti able tu HIi.' vflT nil the faulty tiMae Trom thi* 

cuiim- tfPth, a conaiikTiiblc pnrtwtii iif it fnim the Ivteral 

tnciaun, aotl • little ttvtn the onitral IwlL 

KotM! ilrKnto nf raatlim will be oenled in uiung the flic. 

If tuo much at • lioic be retu»vetU vt if th« o|]Otattoo l» p«r- 

■t too ixriy a p<Ti<Ml, Itio tn-th i.>pMiil«!d ti|iuii will \¥^ 

Wlmtirly tvibler. Aa a i^cuvral rule, it i» well to delay 
uiy attTTijit bj irii[in>ve thu ii{ipiianukOc of the doIactiTu tceih 
by 6ltii^ iiuLtl tlit> [tttieiit is from twelw to ei^lMD yoan of 

The deprawuiut or biulta in the tniHoiel intist, howcrrvr. 
Grow time to time bo carefully examined, ntul <i1k>uI«1 nity 
tediotiva of minis bu disuiiVLTuil, thu cavity in trbidi the 
dbaM i» aituatol must be lil)«d without delay. 

81^1 (Uviiitiiina from tlie usiul litnos at tiio CTDWtis of the 

t tn>tti ti««<l not b# d«sicribr>i|, biit it in uec^eMTf 

attention oinmM )m- ilruwu lo U»« Eucl tiukt —tppintKniiil 

ttiv mm^L'tiiiK-H fuiiini ariijng (noa the iioiika <•( Iturtb, 

j)«*«;iitiiii; ull tin- ii; ' ■iI'diMiiiol •uiwrnniDrmry 

1 iiave known n . r fv.xp upcn kuch a cuafi, 

tihtviDg It. 1 pT'^iinif. t ■ I >■( u iHtnry toith, nml 

ibafjaiit, nut unly the I'l.-; , ' ni Mi- i < [ ir from which ic 





I 



syeTBii or dbxtal HusanT. 

'rile cue from whicli tb9 following UliutratioD (Fig. 106) 
is taken occnrrnl in my owii pracUcs. A Urgt- uodiile cn- 
ousp projccled from the neck of tlie tooth. It was iwrfoclly 
ouvenxl by the (;itm, no IJial its preaenco could not be sus- 
juKU-d, UQti!, in passing the forcop* up townrds tlie nock of 
tbc loulli, tuime unustULl olwtruetiun was felt 



A?' ">». (!> 



ng. m. (•> 





Su|iploin<mtal cusps otily hare been Kpoken of, btit wo 
■omctiiues see a tolenbly perfrot little loi^th growing uut, as 
it w^ret frnm th^j mia of anntlun* tooth- In Vig- 107 a funnlL 
tuotti is shown co«iit!ict<-(l with ihi.' distal sidi' of tliu Ec-cotid 
or third lower niolar l-i'lrvw tlw tcrminAtifMi of the rnamcl. 

Mr. IlBrnHin ]ilacnd at my iliHtxuuil a nmlar, from Ihe 
lateral surface of tho cromi of wIiicK a miuut* but wcU- 
formnt NUpiilejncDtal tooth projrM'ti) at n right angle. 

Under Oie head of irr«gulAritlc« in the furou of teeth, 
flercfal pbynJca] p»cultnritii»< have yet to t<e ooiwiderei], for 
dMOiibing wbich it is difficult to gD<l a more fitting place. 

Thoeo deviations from the normal numlwr and arrange- 
ment of the rootA of teeth wbirli influence dentAl npemtioriR, 
will be treated of in contiwtion with thi- opi-mii^-ns thcm- 
selfW. But as the diivuiwiun of tho subjwt »f irriL'^iikriliai 
of form generally wmild iuclude luch as are manifested in 
the roots, an well as Uiosu wbicb occur In the orowns of ths 

(1 ) A ptmuMijt toolb. Kidi ■ Imntr nndulc of ciunel kCUdied to U» De^ 
bdoti the point cuTcrd In; Ihs nice it ilir nam. 
O X Umvi mobr, -wlc}) 4 *iuaLl tooib |itv|nilii| fnnn LI0 tide. 



TSKTIIlNa. 



221 



^r teothf the maUer cannot l« altogether pused orcr at Uiis 

Hie iueiwn rait; have th«ir icoU crookod or bmt, of cren 
tvcsud In a cpinil romi. b<it I have itocn only one exAinfile 

tin which tliey ynn bifid. I& Uut cue, n UiobI itici».>r of 
Uit-ujipurjaw Imd A cusp risiingup fivim ttichaM4>of tlipcruwu 
%m it* Unfcuot nir&ioe, and n Biuatl BUpplviaontal root liHil n 
coirefpOQiliDg fotitioo u respects the root of tlie tuuth. 
In the iii'fer caoiuo teeth, two or tbroo KpeDiineiu noly 
have Cnllctt uodn* ray Diiticc wbii-h hitv« exhibited a teodency 
to a dtTJnon of the one large and atraug mit Into two, an 
■cCimI divUioo being confined to the immediate ricinity of 
the Hfmx. lo the lower tcoth bi5d roots are more common. 
The btciupid t«eth, unlike the front toeth, ore rery linbls 
I loilTr^liuily in the armnjteravQt of tbv roots. Nortnally 
tWy bavo but uiio root, whicb it lulvnUIy caiupressed tb 
I npp" l«eth. And to the lower teeth h)m> Jt la to BMoe extent 
aaai{ir«a«d laterally, yvt iu a much Icaa dcgrcv than in the 
IB cofTeipo n diog toeth of the nppcr jaw. Very comnmuly, 
^B h<jW(i%-i>i-, we ^tuill find that the flatl^tuxl eiii^l'' rix't of ih<i 
^V ftnt biL-u^pId vi the Upper v replaced by two, aikI »>;uietiiue8 
even by three, well-funned TftngH, holding ttiu saute relaiiVK 
poaitkin II* the nx>t« uf the upi>er muliir tevth. 

Indkntioos oT a divlsiun Inbu three fan^ in the upper, aud 
taCo iwu in the lower bknupidH, may ofUn be seen, eren 
where tbey arr not actually Kpnrated ; awl the toeth on the 
.•|>l- I i - of the moutii Qsually preflerre on exact ayni* 

■ ..I Mil between molar and jircfuular (btettsptd) 

ti< niu aaimaU, M, for iniitancc, in tlie borju-. 

rtu\ barilly lie said Lo vx'wl, is not corrird Ui any v^ry arv&x 
extent iti tnaii; and it )» inter«aliag to note tbuL iu the ati- 
thloi>oiwirphni]9 apM the bicuBjads hare throe fkugs In tbn 
opfwr, aud two iu tlie lower jaw aa a norraal cooditioti. 

Whflh<^ M not we arc diB)K)aed to a^rrpt RUich fiictAat the 
uccnmnce o( tbrwHJatigiid bkufptdfiaa ipdiiaHoni oC fcreniioo 




to an ancMtnl typo, there can be no Aaaht that the expUna- 
Uon v( Lhc occurrence of Uiis nbnonanlity m the fangs of the 
biciiKpidii ii to Im) found by a rererenco to tiie teaching* of 
oum|«rative BiuUuuiy. 

Tli« tiiciupi'ds uf ih(! lower jaw, ftltlinntcb Uieir fiiags may 
be boot, but boUIoiu lermjiiatt' Uy two roots. 

Aiaoiig the molar t«ictb, tbi^ first pcrmaiirmt roolara will be 
roiitii] to be tlie moHt ennBlatit, and tbv tbird tbe least cati- 
»UiDt.iD tbu nuuibar,Hlia[m,anil [Kwiticm uf thcirrwita. Three 
may l)e regnninJ as tbe ty|iical nuinlter uf the mota of tlie 
upper riiMlar, and Ino an tliat uf tlie luwer uiolar teeth. 
Now, sUbough we lind ocTuaioiiai exc^ptiniu to ihnte riilea ia 
the fint {wrmaneDt molars, thej aro rer; unvuual. in the 

Fiff. IM. (<) 





two leoth fnmi the tipper jaw which are figured, tlic three 
roQtd wo, by the canfluence of two, reduce-i to two Id num- 
ber; and I have suuii lhiv or two vxuusa iu ^vliieh ihv two roubi 
<jf a tlrst pL-nnanetil lowfir tnolar vrere united ao is to furro 
ime euniral iiiaas. 

On tbe other ban<i, iu the place of a dimuiiahed, we may 
hare irn-gubirity fnim an incnuunl minibiT «f rcMna. The 
lower molar may have thioe, or even fuur, rmilf*, and the cor- 
reH)x>D<tin;j iiplNT ttotlj fum- in the plac; uf three root^, Bill, 

(1^ Sliom tirn fin) pmcuu-nt tnoUn af th* ttjrpBi Jiiw. In ttir (calk to 
Um ri/ht itui ivo UliUI rvoM am udILmI and itdnoMt to mm, ■nil In tlw WU 
Ii<iii4 tlgnra ih» pmmUir UbM aim ili« jmUUI ruuta an wlwd m ■» to Ibnn 
<mt bntd Mkl IUiuomI rwH. 



r 



TBRTIIIN'O. 



223 



» 



u WW twrora stated, tfaoK deiurtaret from the Dormal number 
■lul MTangameDt of tlio roota are very uncomtoon in the first 
pcnnatunt idoImtv. 

In the seouwl ponnanent molar, however, they arc by uo 
nwans rare, and in the wisdom t«6th the t/pcol form is very 
•ddom prodocad. 

Ko nijfl cu be laid dowa for the Ibrm and Dam'bor of the 
iDoc* of the deotoi sapirati»% so Toriabtu oad inooastaot arc 
tb* fonni awaned by tbeso t«oth. lu one cau tho tooth U 
tomtnated by a single conloal ruut ; in uuother, tbo one ig 
nplac«(l by Are, or ereo kIi, ^mall rootn. The nocoiopaDy- 
ing figttn is taken from a wiadcmi tooth of the upjwr jaw, tho 
ttfkgle sharply-poijitcd &iig of which occaaioucd (nin whon> 

Kg. l».(i> 




4 



iva the ciown wis pressed upon. This, whloh in life-sixe, 
inay be compared with the fignra of a wisduui tuotb pven in 
a pmrvioui page (211), In illustration of the sizes between 
which the third molar mny ranges 

The acouiupoayiug figure (Fig. 110), which u borrowed by 
the pcrtniMdon of tbc Coxmcil of the Odmitological Society* 
rtpTMcnU 8 tooth iha fax^ of which is cx]iandod out at its 
apex into a onp-diaped djslc, on the tnargins of which 
are wTerul fanuuioa by which thu ocrvM and Tessela gained 
acoHS to the pulp. The tooth U more fiiUy described in 
the TransaetioDS of the Sodi'ly. (^ 

TbsTS appetn to be good foaodstioQ for the itatemont 
tint the upper wisdom loeth in the lowest asvage races havo 

an IbowK, Hfc- ^w. ■ vIMam tooUi ma (tw apprr )»«■. 

n Tiuswlloca of ilM (HoiiMaUad Sccbrtj-, imi> mHo^ toLUL, p. WO, IfTl. 



224 




SVSTIIU UP DBNTAL fiUBQCBT. 



thoir three f&n^ diBtinctC), although, ou looking oret ft Urg« 
number of Hknlla in viu-imiB moseuins, I Itavo funud esoap- 
tions to this mlc- 

llit! great variability in Uie mto mni shape of the wiadora 
tooth, in civilized nee*, iu occaiioD&l ftli80QC«) and the iiT»- 
guloiity uf tha period at wbicli it is cnipled, may, wlien 
coutiaiit«il with it« large eizo oivl regular form Id tbo lot 
Sftvn^c races, bo ukun as an indi'i^Atiuti that the 
toolli is filowly disappearing, and that tlit^ro is a 
pntbahility that in future gcnerntiom it vrill be normally 
nhaent. Moreover, oompAralive anfttotny lends a certain sup^ 

rtg.no. 




port to thie ooQJdcture, inasmuclt as id the aotbropomorphotu 
opea, irhwe it is a proportioimti^Iy larger bjoth, it is erupted 
At an Gftrlior period, coming into plaoe before the canine 
tooth. 0n this matter Pmfejwor Huxlpy{*) aajra: "In the 
Gibbons, tlie iwrnimiR'nt curiino uniBr^e* oontemporaneoualy 
with, or before, the Iciat molar ; but in tho other aathropo- 
mor^>ha the last permanent <;suiue is cut, urdinarily, ouiy 
af^cr the apiwaranra of the lost mDlar." 

in connection with irregiilAritios in the nitmbt7 aod form 
of the roots uf the teettk, tlie iinusaal deriatioaa in the 
site may bo mentioned, The corpcspotiding leeth will vary 
stt|;htly iu ulntoat uvery iiiMtance where n comparisoD can be 
made; but in a few cnscs lh» dopnrture from the nonnal 
length will be gnmtly iu eicom of -what may be ro^rded as 

n) 0<r«>. AittUmj of Vanebnte. <rvl. IIL p. 3» 
^ Uiahj. Autumr vT Vcrtrfmcta Animal*, p. Uf. 



k 



TVBTHlXa. 



225 



Lhv BVemfE* Btandtid. Mr. J. Parkioson gara me a pair of 
GiiiiDc t<wtli wbicb bad atiAined (he Icngtli of one incli aad 
lJiRK>«}c)ithA, Llitt rouUi aUiQc DUsuithuK oav loeb. Kxc«M(ivo 
kOilCh iu tli0 nx)t '^f a ti>otli ctmiot be proilticLive of tQJliry. 
to the tuolU ilM-lfi but the opponte cnnilitioa, cxcoiMive 
■barUoH in tbc root, is often ootiDectod with the early Ioh 
uT the injlh. Infttancea are sometimes found iii which, 
■)tboiij;Utbt)Crowiio(a toutb luu acquired UiL-\uuil^ze. the 
root u KXUvttmly short and orcAk; ooiUK)qiu)otl>- thi- ini- 
{■Untatioo is deficiont in that stnogth and even firuuu-w 
whioli la necasBar; to insure the durability of ibi- organ. 




h 



I 



ft 



In another pUoe, under the head of Ditaeeratum (^), I have 
tlHvribed a oanditiim nt tnotb rcsiilting from disiilaciuiioiit nf 
thvcalcJAed pt/rtiuo of a tooth from the lissuea which verv 
tiwlnuuciilal In ita prudncliuu, the dcvelnpniont being oon- 
tioned alW tlio normal pcnition of thv caUifiud ]MXi Lad been 
loat. Buppoving, lor example, tlic crowa of an inciisor when 
|«rtl>' f^inuiti be moved from ita posttiou upon the pulp, and 
turned oiiiwardu or inwards, or to either aide, and there to 
remaiii in a Ktate of reat^ the developmeot of the tixiLti may 
tbet) be cuntiniMd vith the displacement of one-half of thv 
emwn pennaooatly pnxerred. 

ta •ona eaaea tba amount v( dUtortion will be alight, in 
nUkera so great and ao disfiguring that the tooth is ueces- 

Ot !lwwt«a 4 amtnX Indwr «( tk* n|ip(r>>.iatnw*ur itbkli UiMcltU 



33G 



A SYSTEU OF DENTAL StntGKBT. 



Bariljr aacrificed. T hare neen epecimons in vhicb the crown 
of ao iDcisor hiu h&in placed at a right angle vritb the toot, 

The ijMlincc* of dil»c«niti(m which have fnilcTi within my 
,own QOlicw bava iwtTu Umilud lo iiiciujn auiL bicuitpid te«th. 
Tbere ii no reason wliy the muUr teeth should not be siibjoct 
to tliBtlofomit-y eqiialiT witli Iho fruut teeth, BxtXiptii^f that 
the situaliuu in the mwuth of the Ibrmer rendwB them 1«m 
liuMe ta nccuhntaX disturlmnce thnn the front tueCh. 

To the naked oyu the diHplacnuout of tho crown is suffi- 
cicnttj' apparent^ hut tiic c-oincidcat demnf^ment o( the tiasues 
can be aeeu only by the aiil uf the uiicruscope. If, hoverer. 





wc tako a thin section from a tooth tha crown of which has 
been moTed on its pulp durioj; thu jMsriod of calcificniinn, tra 
■hall find the deutiDal tul>c« greatly bent or disturbed itt 
their {"oiirtie at the jiuint of injury. The relations uf the 
enamel, the dmtine, arid of th« cementum, are also inlerf*r<4 
wttb at a corrwponding poUit. 

There is one other deviation irom the Dortual couditios 
which, BS it aSecIs the funtis of individual t4x:tb, mn»t be 
included under the present beading — viz., tfit union or gemi- 
nation of omtigutmt ttctk. This Bubjcct was entered upon 

(I) fSMim Vktr^ in*Un«« at diUerraUan. Tht flnre tn Uif Idt li Ufccn 
tmao Ml apiwr btnujiUI, the m<wii of irhlcL liid tw«n iuovmI on lli« pu'tf. 
TWr teMtt- figure li Uiat of ft rrnintl indJur miMTnl itMnabny In Cdn^ 
iiaener nf Ibe mtttef rAgf; oF the \oalh lidug illtMlMt l»watda tbr IMifM. 
Tha tMjr tud tnrt*o] • blow nr-oa Um onnUi. TIm rlKht-hamO OfUM atxim 
Um k|ipMrMiee ptMroled bj a seciiaB st «■ Incjivr ftUniitftT (MnriBMl fe 
tbe pKCBll&g ounplei altlwinh the ttnUtmcot hs> JM to Imj nwiftf im 



t 



TKrracro. 



227 



^KtMDJiectkin with tbo Usiapor&rj leetb (jnge 157\ Inn in 
^^^^■et to lite pernmnmt teeth it bos yet tn be coDsidcireiU 
^^^wli*n two teeth ai6 i«nnaneQtly united, tliv uniL-ii iimrt 
bwo Iwen ifffcctcd thmn^h the inwljmu of Ihtir recpwtive 
palps [vior to the ilvveUriineut oC thv t«elh UiL-miwlrDS ; to- 
tbe otmnertioa mnift linve resulto) from dtf«(isotl uctioQ in- 
Tolviog tc«th pUvcd ia elotfi appMiUoo. Cases uf this latter 
diMi, bdo^ the nrsotl of cxovtOBis, will bo cotuidored in coQ* 
Mctiau with that dJAiue. lu th« xpLxiiiuen wltich forms lJi» 
of tbo rotlowtng Bgnru, tb« pulin of lh« contra) 
mmit Dut only hava oatnc in coalnct, but have Iiccto 



*V-i".t') 





upun ewh other with sufficient force to caom tli« 
'io kavo bei-omu to a sh^ht eitciit imittliied in thu right 
tootti-ptilii. The dcvrkfnicnt of thi' united croum tuinitg 
bora (jLtffHTtvtt, each toiith lind its mot scpAratvly [irmluaML 
lu u TL-r>' iDtemcing apecimco, for the tuc of which I uu 
ichtrd to Mr. Styem, of Nutlin};)iaii), thu tvntnl and 
lenl Uicisors w«n iuut«<i througU-ut thoir whole length, 
line of cunfluDicu, thottgh siiflimcrilly marked for ffco):- 
tloD, wu tiot deeply cat, connequently Uiv four t««th at 
r ibort distance lotted like two estreuiely Uigo hul sym- 
tueirical ocutnU Iiicisors. 

Uolon of tho lateral iociaor and canUic is nuw awl thro 




{() fWil I vl«« ol tb« lingtal Mrf or tiM ktrtal ■nftoH « ivv praMMvi 
IKfeon of Uit Qifvr J*«, UwovBBt aTvtka an nacd. 



r 






division liy moniB of a file. The 
ing the pnlp-cavity, and coiiite()ueiit 
nnitnl teeth. Ksiensiva alvi<i<lar aW'. 
relief uf which I removed the teeth mnc 
lion of filing. In this ex»niiile, allhi 
perr«rt,aud effeiotoil bjrtho dmlincof eu 
point of juocticm, common to llic two, 

Fif.lll.(t) 




I 



iiz» of eacli tooth ven defined hy a dep 
whole Icogth of tho Uwtb, aad oomwpund 
Um on iLe surfaco i« a contraction in th' 
U common to tlic two tocth. In examj 
it will Bomclim«a ht found tbAt i supemi 
imilod to a normal mmilicr of tlie dcnta 



TEBTBISO. 



229 



bit«ml. In ooe exaiii|ile, the Iccth bad boen 

tnim Uie upper, in the other the teeth Femait>al in 

Icwo' jaw of ft patioiit. In ■ third oiw, each central 

r o[ the upper jaw hail )uined to its modiaa Kido a BH}wr- 

tixith. cqtul to nboat one-htlf of iu own breadtb, 

'\--^ by tlie uiiiou iwu front te«th individually 

■'T than the uormal «iiw. 

■■■•■vn a caoJuL' aud a bicuspid, ur between tbo 
itwu ' -.or bettreen a bicuspid and first molar, cxcof>t- 

the TvsaU of diaeawd action w-'t up long ufU-r the 
fiinmt uf thi) teeth lifts been cumpleted, is of very rare 
oocarrenoiu 







Tlic molar teeth are nut, however, oqnally exempt tron 
gBmioatiDii. Many speoiiueni hare beru [ittucrvvd flhuwti^ 
It aniou between the second and third luulara. [a 
• txampie figured, the Ihinl uurfar paiucs obltqoely brtwe«a 
tiw laUtiue and p«iiatei-i«r labial roots of the aeooud luular, 
sod U united to nivh or Lbcm. 

In anuther S|«cimen, plauod at ray dispoul by Mr. Bar- 
riautu lh4? Micond and thinl upprr raulnn) are united at K-rcral 
I IKHiita, without tliD urdinnry [lOAition tu tiiL' jaw ol' t>iihcr 
[lovtlt being matcrinlly alti'rM. 'I'bc masticating aurCaoe 

I BMn tt« «nul and thM omIm* mriud. Th» Ttiil lean Wt w i— 
t«« laiitb tnm Uw UUU mfim i ika Wl, fnai Uh n^Ml or [mMaI 




S30 



A BTBTEX OP X>BNTAL BlHUlEBy. 



of the wisilbm tooth \b apoa a lumber level tbaa that of the 
MDOnd molu- ; but tho diGTerence is nut grcmter than is often 
nen to exist Iwlwecu the carra3{Kindiug teeth in the tuuuths 
ofpntioDtft. 

la examining a sorios of coiui4lc pemiaDcut twtb, it vrill 
be foond that where the crnw-as arc tnrolrcd, the nnioo is 
effected by a contimiity both of the dentine and of the 
eiuuuel, the coun«ctiug portioDS of Iho tiHsud beiug common 
to the two teeth, and by dcittino anrl ccineaiiun, or by 
ooAientum only, where the union in liiuitcd to the roots. 

In the one ca»e, lK)th tbe ilcntiiwl and enamel ])ulp« vrero 
united, and tlius [ircxliicGd a geminated tooth ; hi the other 
CMC, the union must have been effected long after the crowos 
of tbe toeth were develnpied, and at tlio timu tlie Tuots 
vote forming. In oasos of union occurrins under tho latter 
circunutanciB, the medium of coniioc^tion tnny l>e limited to 
the cementuiu, much in tbe same mnnaer as we see the uon- 
tlguoua roots of a tooth bonnd together by thfi interposition 
of ccinuntuiu. Those examples iu which, by Ihu iar^jp Acve- 
lopment of ccioontum con»c<iuent Tk[xin diBoaM, two cod- 
tigiioua tootli Iwconu! uiutiid, u;tut nut im uUsscd with snch 
as may be Ngarded as cas«8 of congenital union. The 
CenwDttLm ta»y he tho uniting modimit in either cam ; but 
in the one the cemeutum 'nill not oxcoed the normal amount, 
in the other it will exist in exceRs, and constitute n di«oase. 

Under the bead of irrej^uliirity of the peniiaueul toeth, nn^ 
subject only romains for consideration — namely, JrrtgNiarHy 
W iita period tif tkeir eruption; thitfirvoiatunut the retardi^l 
appearauoo of mombur» of tho penuaneot set of teeth, and tho 
deviations from the mtturul order of eniption. 

TliQ molar teeth wilt vary in different incUTidunls as to the 
time of their eruption, but tho nmnunt of Tnriaiton is seldom 
sufficient in extent fairly to come uader the head of pre- 
mature eruption. Bat in tlvose tecih which onccced to meio- 
bers of the dccidooua set, a cootidcrable amount c^ deviA- 
tion iu antcoodooce of Cho oonn&l period may aometiuies 




TUTBIXO. 



331 



P 



» 



he obaerrod. Before this, however, can ocoor, the pr»- 

oedinj: ooctipatti of tho ■]kk« moat bftvo l>c«rt prcnifttnrply 
Joel, llot in Uie tJitnl'iiu^ of the toiipomry u»ili there will 
b« a certain niig« of wutioo in rMpect i^f time wiihiD 
wlticli tlui loat of (e«th ouinut be rc^vdeil n» jircmuture. 
Tbfl coodiUoa of health may hasten or retard the ptroccM, 
■till it Id prohablfl that hcrcviitary |)mti«po»itian runy olao 
curt an iofltKDce in determlainiK chu Time at vhich the 
doddumw teeth fall nut, nod malca tuom Tor their imcoctMors. 
to tho vast majority of cadea, hoveror, th« pr«iiiature loss 
of tcmpomrr teeth depends upon tho a(!currcne<! at caries, 
Aod the couiie«iueat exlractioo of th« dlffsased ar(;aiu. Many 
chililna niQer ao much ]«in from tlecayed tem]x>rary motars, 
that the geturnl healUi hecnmee disttirbad,and their removal 
U Gooaaqncaitly aeoeHitated. Now, it ii in theso cases that 
th« soooeeding hwth somotliDes appeur prematurely, imd 
oonseqiienUy ant of the usual onlvr. A certain Dumlwr of 
exaiupliM have fallim under my notko, in which ono or more 
of lb" |iiciu|iiJ loeih have npjvarod m tarly as liio latwral 
inciaont ; and althongh in ane or two ioatancee (he teeth havo 
bflcn imperfectly developed, m ether caaca all iadicatioQa 
of faulty organisation have been absent, in a little patient 
of my own, the whola nf tho decidnnua I«cUi divayul uearly 
down to the lurel of the gnm, and produoed soch sertooi 
nfhrinit that lh« child fell into bail health. At the age of 
tfaraa yuarB atxl a half tho ducayi'^l teetlt were all removed 
(•xoepting the accond temporary molan), tioder t4ie itiflqeoce 
otf cUliiniffirm. The oinration was mooeeded by a restoralloa 
of bmlth, and the pemuoant toech are now appearing in the 
Uiual orilpr, both as reapecta the time and the place nf their 
nnipttoo. Now, in this caae the (iremature lotis of the first 
ha* Dot l-n-cn fullowud by th« ]«enuture eruption nf the 
iccoiul wt of teeth. In a less booltliy labjocl the result 
mij^t have been diflervni ; or hod the teeth boeo ollowni to 
reumlti in Uiifi cose, ainl. Si itampa, had kqit up irritation 
ia thu tStunS) it ii more limn pasllila that aome of the per- 



A STflTRM or DSNTAL vmOKBT. 

irat tcoth moiiM liaru been injured, ajul lutvo sppeandl 

Itrcmntiircl ^ thmit^h im inf]aiucd gnm. 

In a ijrdclical point of rievr, xhe accelenUod is lew Jote- 
reotiii}! than the retartiod umplio!! of icerti. T]io prumature 
npjjoanuice of a tooth caimut bo [jruvi-ntpd, and wiion in 
righ^ the inigchicf it luny uccomluii cAn Iw aacertaincil ; but 
when tho omptioa uf u tootli is ilcluyed, tliere in grnit diffi* 
culty in leiuTUQ]; ila relmtiona in reitpcct to tbe otUer tootli, 
its own conilitlons u reganls size, lihape, auii 8iag« of 
dordoj>mrnt, and the nmonnt of inftuencA it may oxcrt 
either in thu production or in tliQ Duiiitoaaui»i ui neuralgic 
paioji. 

The irregularitiea of position, and tie results to wUich' 
they lead, have beea already descnltod ; liciicu, in the preecnt 
Bpctiiin the inquiry nuiy be Iiniii4>ii to tlie qu«*iion of retanlmt 
eruptjoQ of t«ath wbiub aru niit irrc;;ularly placM dcriug 
tbfi iwriud of growth ; in other words, to tectb irregular only 
in nspect to tho priod of their eruption. It \« by no moans 
UDC'unitaon to find that certAia tueruWa of tlie pennant'iit do 
not nppuar At tbe tuual time, and even after the hijiKo of 
acme few y\:nn are still absent from the n^^nal position ; and 
it ia not, perliaps, until long After lb«r prwcnco ha.s been 
called in question that they jienctrate tho fEitm. Id a cu« 
wbicli has l»Lvu deserilxil at page 158, the right central 
iiiciajr of the upper jaw apjipared at the Age of thirloen, Ibat 
it, aix years ivfter the fellow t»:>olti. In & eciMiid caae, an 
upper canine pierced the grim at the jige of two-ftnd-thirly j 
and in a third, a Hiiuilar tuoUi cut tltu f^om after tbe pntlenl 
had pfiued the age of forty, Agatii, many caaea have oocur> 
red in which teeth bAve been cat at a very Advanced ago. 
Tbe recognition of this wide mii^o in r(«|ioct to the time 
of the occurrence of a procvta which is coincident with a 
known epocli of general growtli of tiie body, auggeita an 
inquiry into the condition of the teeth thcmMlTCs at the 
poriud of eruption, ftnd nlm into the nature of tbe proceaa of 
eruption in thuse oxceptioual onaoi. Id rofenmce to the fint 




TEBTIUHfl. 



988 



tBt, W6 hiive to Ictni wltcUier, viUva tht eirplioii of a 
k^h u rvUnl«d, tlio ttcTelopniimt i« oqiiaLly tU'tnyol, oaA 
iltetita the fiHioec ia oaoMqiieut npou tbc Uitor condi- 
Uon, or whftbtv the one process Toay bo quite iniiv|K.-ii<le[it 
of tbo oUiDT, To meet the aecood quoitiuu, two procmse* 
by whieb ft tootl) may )w cot ;niist 1« recoKuised. In une, 
the idjotii iuetr pnMCM lorwanl, and makee its way to the 
«arikce : to the otfaer, the guni« recede and expoiic the tooth. 



K^. 111.0} 




vhidi, liarinf; Wn siatiunarj-, vrould have renuiiuid in 
<oace«linrot Imt fur tlie rmcdeuee of the ffimuL 

^10 the caK« of retarded eniptiuD of special teeth iu which 
have hAil na ofpnrtaDitf nf i>snnitmDg the letith thcm- 
M», tlierv liB» 1<t<eu Uu eviiluui-v to oLuw that the deve- 
HBtii of the dviital tintnies luhl becu interni|ite(l. The 
fa may he shorter than uKtial, aud thfl ennrii faulty in 
fwpnct of form aitil of^n)Mti<:i[i, hut lUo prewtux of tbeso 

<■) !%»«« iImi |*rtil<-nc« uf III* tKtina imilfunrf iw-Ur nlaiJIhC Un 

■( ll» mmeti IMcMfibl. vblcb t* (lunnt, l>jr t>w mall ibn u( titr 

\m aliKli II ■■■ pin«Ati»<]. I" )■■»• bmi ■MIHnl ami AitUntfnL TW 

•rj tm'b l> iIMik^ tif ttv wtarM. TIm aiilbiir I* la 

HtMufcro fta iba hm dt IbM afiRUacH. 



234 




SnTBH or DOTAL 8UBCEBT. 



defectt doM not {vots that tha prodaction of the tooth WM 
ddAffld. IndMd, there is r wuit of decigire ertdaoc* in 
support oT th« opitiiun tbat the Hctu«l ilcveKipnuail of tlio 
teeth {« dalajrod much beyond the Qeiml jwriotl, although the 
nninennui cues of Ute eniijtioti wouU at Brat sight &voQr 
the aujijJOBition. The pcrio«l of oniptiuu does oot, liowever, 
in th«iio «xccptioi»l cajma, hear nny Dccessary rclatioa vith tho 
timo at which Lhu devcloiiuK'Dt uf the teeth wa* oompletod. 
In dome examples, tlio oKstructJog cause u safiiclentlj ob- 



iVf. n*. (>) 




vioUr but iu uthurs, wc full to sot wh^ the tooth did oot 
lake It* place in tbs ueries at the usual time. In the case of 
a fciualn, tlio npper canine was absent, a space being left 
between tbo fint bicuspid and lateral incijuir. At the age of 
forty-five, the mifwing tooth slowly protruded itaelf. ' Now, 
in this instance the way was not prepared by the loss of a 
tooth, neither wrre the gums receding ; beace we ore at a 
loM to see why tho eniplion (if the tooth was delayt-d, or 
why it appeared at thai age rather than at any other!, 1'he 

(1) Sbovlnc Uio flrai btaewpld ntarM In tU vrapUmi t? Uio pnwoM of 
B ttnpanuT looUi. Tb« Ucmpid Is • pttlnMr wU-daTthtjiPfl luuUi. tret 
dwcniwrwidlflllbVBlmdw b atMttiL Tlw laiuiKnnr louUi tt muknl b* 





TKBTHING. 



235 



hoverer, Invtroctive. aa mpect« the process of 
eraptioa in retanipd tooth. Thprr in no reawin for n-tiiuniing 
Ut«t the dcrvolopiuent i>f the tooth was Ut«r tbiui of the 
oonespiadiD); tooth wbirli kpiteared nt tho onioI time; 
n|>pQsing, thuo, it u> be admitted that the tooth wu com- 
[iteielf dcvc!o[K«i U-foro tb« p(wc» of cuttiup ctnumoueol, 
the frocew itci-lf tawst be in maie rc»spoc;t« diffvmat from 
Um( irhkh oDCun wboD teeth are cut under ordinary cir- 

n^L 111.(1} 




» 



mutancQ*. When tJis proOMW ifi Donrnil, sa mipects tlio 
tlnw and Uw itagc of dcTolu[nueot or tbo toolli, Uiecron-D 
■{ijwan thiDngl) ttm gam long Iwfore the root h$a attained 
hi foil Ituigtli. l^u uruwD is in f^raat fmrt linmght towards 
thi! Mriiwe or tho gum hy the progroaiive lengthening of th« 
rooi, and is anerwards Ktill further raiwd h; tlie taiDe 
procoM. Kow, vhcu th« eruptioti is accomidiRlied nibMqooQt 
to the devdlogmi'-nt nf tho rowt, lIjc nioTcminit of thu twrth 
Bnut bv nffeotod lijr ftgrne ulhot tiieana thaa by thn program 

(I) An tldlt lomr par. urtUi iha nnhw KUtrd'4 ta Ik crapttao. Uw 

W»flrilw>M* liMbmaUAitajrtiikfaowUietMiUaaaftlwtMUi. 



236 



A STBTfiU or DBMTAL BDBOERT. 



nve bugtheniiig of root. The completed tooth has to change 
it! place without itself undergQiog any ch&nge. The hone 
which 8Uu<l8 ill 1w wiiy rnuflt Itc niimrbeil, and the lower 
portion of the >iockct from which the root of the tooth moveo, 
must \k coQtrftoUil liy tiio de|ioHition of hone, litilood, in 
the abMiice of a better hypothesis it may he BMuntenl that 
the gntdttal contrattiun or tho sookt-t is tho nusns used hy 
nature far bringing; toeth to the nirface when tlie proc«m of 
oraption has hceti dcla]rc<i bL-yund the normal jimod. In 
the oiie ia»fte, the movement ia effected by the d'CvelopiU'enl 
of liou* wilhiii ihc nlvoolns; in th« other, l)y tho progrc-ssire 
dttvL-lugitnL'ut uml cuiiNt-iiut^ut k'ngllieuiu;; of tliv tuotb. 

In many cast*, howi^vtr, \he rctardod touth become ei- 
[»«<d to view by thu abH>r|itiuii uf tliB suporjauvuC gum, the 
twth tbemselvfls being perfectly staHonary. The prtissuro 
uii the giira (3inw!tl by artiRciai teeth will not nnC'DnLmoQly 
caDM its ab«or|ilioii and ihu ex|N»ure of a bidden Uioih, 
aiid (hi.-) tooth, otioo having b»n harrd, will often descend 
to a Kiwer level than that which it bad preTwiiisIy nocii|i)Fd[. 
The tnatuicr in which this takes place, and the cflbct pruducud, 
may be soon on n-fRrriiig to the It^pires illiiRtraliiig irre- 
gularities Id the positioo of the permaneat t«eth. 

Tlic cause wliiuh iiioRt odtninotiLy rclsnls the cutting; of a 
pennflDfiit t-xiib La strictly n mechanical one. Tho space 
which Bliould iifTord s pWu for the iiiissiu^ twjth is already 
oecDpied either by a pentistent dvcidiioius tooth, or by Ibe 
crowding togctbt-r of tho conUj^ous fiermanent t«clh. Umler 
these circiuiuitAncea, the normal occupant of the )t;>ot i« 
cither held buck, as in Fig. 117, Sec., or takes mme ex* 
tremcly irregular po«ition. In the acoHiipanying lignre, the 
BecMid biciis|iid» of the tipper jaw were retarded by the 
pn»e»oe of tho temporary moUmL The deciduoiu tooth on 
the one side of the mouth bod lost all its root9, and there 
BpjieurH iiu reason why tho Liuiupid did nut taku its pkce at 
the usual tituo ; but on ihc othc>r ade tb« temporary molar 
ha« retained the greater portion of ita palatal root, and 



I 



I 



TErraivG. 



287 



mueqnenllj hnld finnly in pliiix) to lh« cxriiwion of the 
MeiifjHil. Altbongh in th'u example cLo usual poriod Tor 
tlio tv|ilamuciit u|' Ihr teoiporory rnoliirs hu not lieeo 
lul \>y uton tban two yean, it u not ou that accooot 
t ftUitructirB. 
im a t«iD|iorarx tooth'does tKit foil out at the uh-u&l 
tifiui, it beonmos a M»ioaa qu(!«tion wlu'iher we slioalii allow 
I h lo KnuuD ; wtHtlu-r vre Ahotik) Mrait uuUL it bvcoiiiai luwc 
I tttfurv its nnnoval u att<.'inpt«<l, ur rftmoro it irresiwctJTc of 

Kg. IM. (0 




llbil c(ilU)il<!nUian. It i* oiM di'siniblo that tb« qoiwtiun 

'abould in «*cli com Lu ■ettlcl Wtore the [wtinl of replace 

nunt 1m» been long pannl liy. New, in tbi' exampio which 

toana llts flubj«ct u( tlw la»l iiiiiuis th« biciutfid on tfa« right 

riik ha* been riightly, pcrtmiM ti»t injuriooaly, retarded by 

lUie UiiD{Hinirj molar, but tbi) Inttvr tooth would liav« 

[ttirmlily givwn place to.il» nucocsaor. Not so, howcrer, on 

[Ui* right siile (if UiG uioatli. The retontion of tlia palatal 

(1) awf«)ii< Ik* •xnnd Mm^Un, u tU or* o( ATimh ytu*, rrtanM tf 




k ITSTXH or UtnAL SCBCEBT. 



root on the part of the dcd^noiis tooth, would have en&bled 
it to hold pcMOSdou of the pogitioo, to the «xcluEion of lb« 
WCond bicuspkl, prij<iu(.'iu>;, [wrbAjis a ejuijlur rmult to that 
fihifmn in Fi),'. IIT. But if we n8olT« apoo nmoving doct- 
duoTLi teeth in all cftau when the nonoBl period arrives for 
tjieir reptoci'mimt, the practice will rov and then lead to 
dlmppointmcDl ; we may remove a twnfrfirary tooth which 
ts dwtltiito uf u Bucd'Bsur, 08 shown io Fi[^ 98, or we may 
m&kfl way for uii imperfect tooth, larwior in every respwt to 
it£ predocGBSor. Thew exceptional usmh are, huwevi^r, of such 
mre occorreuce, that althougii they ehould cot be entirely 
diBTCgarded, their inQiivnce upon our practice Hhotild be but 
comparatively slight. Then, again, the temporary tooth may 
not oaly retard the jiunuaiu^nt tooth, l>nt it may also lie at a 
lower level thoo the adjoining tooth, and cooMqnoDtly if 
Allowed to reDiab, render little or no aerrico in niMttcation, 
85 in Fig. 117. 

Hoarding, tlien, tha ytmMietux of temporary teeth as a 
cauae which oommonly operates luifavonrahly, nut only by 
rotardiug the eruption of pemmtiont tcutb, bat aliio b}' pro- 
dutiug irreguInriticB in tht' dcnUil ktics, their rwnovil must, 
as a genfml rnle, be attended with advantAgc. 

1'he wisdom tooth a sometimes prc%\'nted firom assuming 
its pro|)cr giosltlon by b«ng sitaated ininiediately benatb 
the second molar. Teiy leoently a second upper molat was 
extmtU-d at the Dental Huttpita), betweou the flings of which 
was a beniispberical cup of bone with a perfectly smooth 
BurfiMse, wtiicli was at first night imagined to be a portion of 
the floor of the antrum. On exajuiaing the montli, however, 
the crown of t!ie wiialnin tooth was found to occupy the 
space whence the toolL hml Ik<l<o extracted, so that the cup 
of bone proved to be a portion of the bony cell in which it 
It&d lain buried. 

Whclhcr the wiadom tooth wiE now descend into the 
alveolar line (the patient being over thirty years of age) 
remains to be H«n. 



I 



i 



I 

i 



mraciG. 



2S9 



Hve ohangos in thn teeUt u\A jaws, which in 
fubject keep pece wiUi the general growtli ol 
the body, hare to Bome exU-iil been trocetl ; oiul the result* 
which are ealailad whca the develu^uat uf tboiw port* 'a 
iaUj(erf*\ wit li have be«n j<iiuutl out; uud this briii^ im 
to the eod of dim diri«ii>a of our subjocU The iiecttoii niiiy 

rig, 131. 



ihe ooiKltu3fi(I by the introdartitm nf tbo pn.'ceiliDg fignre 
|(Pi|f. 121). The (?peciniea delineated U, I think, nui<iu«; a 
hippopotamtis'ti iu»k, the ciitUtig cilge of which, from n-nnt 
of antAgDulMR, ami t^e cuiue^ac-nt abaeoce of wearing away, 
graiiually &drniinc<) iiiili] it eotcrcd the [mlp cavity, ood thw 
put an ciid to tb« further ^Tdopment of the tooth. 



[ 240 ] 



THE DENTAL TISSUEa 



Lbt of wiwltii roftrrcd to in the Bectiou wUtiHg to llij,- 
Dcnul TiMuw :— (') 

1. K»LLiSRK. — " Uaodbuch (Ilt Gcwcbulehio." 5to Auflage. 

2. Waij)Ictcr. — "BtriGkor'fi Ilandbaok of ITiimiuiftiidCom- 

pAriitirc Hiatology." SydcDhom Sodctjr IVnsslation. 
)870. 

3. Boll, P.—" Dnt«reaclinngon iibor die Zabapalpa." 

Arehiv fUr Mikrus, Anal. VoL iv. 1888. 

4. IIebte. — "Uiitersacbimgea ubcr dea fcUi«ren B*u der 

TAhac" Vtrcliow Arciiiv. 1866. 

5. Bbalk, Dji. L. S. — ^"Od the Scra«Car« of the Simple 

TisaiieB," IHftl ; and, " Lectures on Uie Stniotiire and 
Fonoatiou uf tbe TecUi.*' (Rfi[>riDt io "Archives of 
J>cntistry," vol. i.) 
noppB-SBtLKtt.— " Viroliow's ArohiY.*' Bd. v. and bd. 



». 



XXiT. 



7. I'OKBA, J.—" TmnawtioDii of the Royal Society.'* ISfiO. 

8. Saltkb, S. J.—" ArchiTM of Dentintry." 1865. 

9. Neomaxn'. — " BotUil|^ sur KentniBS des normalen Zfditi* 

and EoocheDgewebu." I8Ci?. 
10. BoBts et Maottdt. — " Hur la i;m^sc ot dfiri-lopponient dw 
FoUicules dentairoi." "Jounutl de k PLysiologiv." 
1860 and 1861. 

(1) At iTpMtn] r*rrrftiiia irlll hare Io be mirle B th* (Irnrii brbl hj raiiniu 
MdMflUM. It hMii^Iti^ (ilrUahlr. In i^fdln b> avnlil nwdlMw rrfvll t Inn uf ti>" 
UUm at hooka, to (I** n 11.1 of warki refcrrrd to In ■ odIIkmI f'Tm. 



r 



TBB DBST.^L TIKSUKS. &41 



11. Hphxt.— "On tlic Derdopment of tbe Toethr &c 

"Qtiu-terijr JounwlorMicfoecopkalScIcacc.*' October, 
lH5d. 

12. Habtiso. — "QuafteriyJournal of MicroBcopic*! Science," 

April, 1872. 
13- Baibib.— " nhtuh and PcmiBn Medio^Chinirgkal Re> 
Ti«w.' No. xl. October, 1857. 

14. CzxiLMAs.— " Boitrage tar Mikr. AiiAt. d. Meoschl. 

Zaime." ZcitwlinfL. t. Wiss. ZooL ifiSO. 

15. AVsyEeL, Bkuck, SA»ri Siaii-tA, u quoted in UsXLK't 

"Iteriefatilberdie Portacliritlcrler ADutomic im Jahre. 

1871." 
IS. &. Lbvt. — "Ueber die Enl wick lung des ^mbeiii ond 

dc« SchmtilZM." ZeitMrift. f. WUii. Zool. 1854. vi. 
17. Toms. J.— "On the Slnicttiro of the Dental' Ttestiw to 

the onlcr llodcntia." ** PLiloa. Tranaact." 1850. 
ia TollK^ J.— " On th<^ Strvcturo of the DeoUl Tiuoes of 

Mii»iii<ial AiiimaK" " f'hiloe, Tmoeact."' IK-19. 
IS. ToHis, C. t>.— " Ou tlieNAtiireof^uiaytJi'iiMvuibraiM." 

** Qnul. Jouruat of Hicroso. f^ieooe,* 1872. 

Tnobb itboonnBl eoDdittonii of tbo teeth and of tbo dental 
■lefa which are the direct coonequtinoe of intHTuptioo, either 
tu the progTvssire deve]o{nncnt of the uIteoIot portions of the 
inaxilU>, ur ia the wuptiou of the teetli, baire beeo deacribed 
onder tlw general hefid of 'i'ecthing. We have now to am- 
Met tlio <lj-Jilal Llnues iu rvlHtiuu to tUe litwaBea to wbioh 
lltajr are Bubject, bolbro pas«lDg to iha study of the diwawe 

Imiwloot stmctural developmcot, although a fircdiaposiug, 
bo regarded aa tbo exciting cause of diseased action, 
jokritj, either to tlia form or the position of toeth, is 
kltogutber attribiilnUe to ■ diHturboncG in the lairs presiding 
the deTelopmeol of the dental orgADs ; but th« deitruo- 
of a Toolh by caria oonitneoMs aller the tootb takes jt« 
in Uw alv«obr Uue, naA becocnes exposed to iniliKOoM 

It 




SYSrKM or DEXTAL BTRaiST. 

from vbtcK it was altogether protected prior to lU eruptioiL 
The tw-th may, and very commonly do, present nil the ^certtl 
ch&nw(«r« of weUiiltivcloiwd on;aii«, oihI yet wLeo exuutnod 
hy the nld of tJio microscope, exhibit unniiataknbte ngna of 
defective or>;nuiztttii>n, nindcring tlieni liighly eu»c«ptible to 
when pitcoi witbiQ the influence or the neocBsary 
idiLitnis. 

On the othtT hand, thooe defects of Btmctiirc which rcnd<T 
the tooth liithio la early and rapid deetraction, may Ik »])[«- 
rent to the naked eye so soon at the crown of the tooth 
hecomee visible. 

Before, bowerer, the characteristics of the dinwes, and of 
thvir prodispoeiog and exciting otiucs, nra ent«rod npon, it 
will he denrablo to give a short sketch of the histological 
charactos of tho tissues iu which they art* situnted. It will 
not be neoeaury to enter at any great length, either into the 
devalopmf!nt or the structure of the t\taMta of the tooth, in a 
work on di'Utal siu^'ry, thuu^li, iuiunitiuh us ao under- 
standing of pathological conditions requires an accurate 
knowledge of tiii.' chamcteni which apiwrtaiD to the normal 
strncture, LI is deairahle to give a brief account of the Toriou* 
ficnutl tiuiuei) iu tliJH place. 

A tuuth is compoHod of enamel, cementuin, detiline, and 
dental pnlpi. 

The rcUitive pusilion of tUu wveral fitniclurrs which coi- 
loctiv^ly form a tooth may he Twst seen hy dividinf; one of 
the frunt teeth longitndinsJly. Oimmencing the oxiiminatJOa 
fnHn the lUTface, we shall find the crown is encrusted hy a 
layer of onanto), which is cum panili rely thick over the pro- 
minent parts of the masticating .surfAri^ hut becomes thinner 
on the sides, and is ovcnttinlly lost on the ncclt of the tooth. 
At its (*jnuinsl cd^e, the enamel isslightly overlnpjied by the 
ccmentum, which holdx to ths fang and neck of the tooth 
moiilar relati^jiis, iu rwpoot of position, to Uiat which the 
onomol does to the crowit. 
Tbe cemontum attains itii maximum amount of thlckuoss 



.THE DKMTAL TIRSRIR. 



243 



I 
I 



•bont the lerminal partioa o{ the root, nnd suffers a graduiU 
41iaiontiOQ until it ia k«t on tlie neck of the tooth, lii a fsw 
iliilwiii I it ma; be tmoGd, Dot otiljr orer the t(>nninftl cdg* 
of the eiinmel, but Tor tODie littl« distaucu ujuu thu turouAl 
(KVtitin of thi- Kioih, iumI Bpecimca-s nri; now and thcii found 
ia which it appoan tu putially &U up ilmp fiioiurus situ- 
auri bMw«ea tbt! tulxrclus of the molar tcoih. Such, at 
liiaal, aeema iha moat [)n>halih9 vxpliuiatioa of the occuncncyi 
of bodies occnpyiag deep fissures iu tho enamel, vluch pr«- 
•sot aU the chanctWB »f so-callod lamituil eel bi. 

Tintj are, ualesa di*tort«d by mutual prewiure, roattded 
lisdiea in tho centre of which arc hollow a)nici» of vatTing 
■iae t in aoou instaoocs Iho central ipMD is aoiall, in vthcrt 
largB and (avdueed out iticu numberieei caaaliculi. Th« re- 
HmbUoMi uf th»e bodies to thoaa Iacwub oootained in cap- 
mhsl iV r i n vrstntcnta, which ore to bo seen wbenvcr (.-eiii cut tun 
ii ' . are oommonly abim^Unl in csoiiloHa.1 oemfntuni, 

or 1 •; cemeDtnm which fills ap the iatentiocq of ibe 

crown in {■clij-dLTiUA), is luost uompleta, buth iu si/^ and 
a|ifw*ruK«: and it is difiicult to miffpoee that thoir origin ia 
dlflorrnL It would, however, bo out of jilim: tu tfater iaUt 
aay luog discnasioo whether coronal oeoMOt axista in man, in 
lbs praaiml work ; tlie more so no the beta bearing on tlia 
iltmtioa are la bo fooud in a collected form elsewborc (19). 
It mar, howenr, be mentioned hero that tho dork niBNsw 
bond in the fimuraa of enamel may, by uaus; acid until tho 
cuind ia dmtroyMl, bo easily shown to bo nothing otxc than 
purtiooa of Niurraylh's membrane^ whkh haa iu these [>1acfK 
•tuinai a gmtly increased thidtneia. 

Hi* enamel and the cemenlum enctoae the <lcntia«, tho 
DQUr cnrfnoe of wliicb. If the jnre»lliig tbrats were rvmiivnl, 
WOtttd Mill prcwDt the cliaractemtic form of the looth wilh 
bat littla nll«niiioQ, cxceifliiig a »liglit dujiii>uti<'>n of sixc, 
wbile llie i'M^\m wntild ho Bomcwluit shitrt>er than U'fure Uic 
m&v%-al of tliv mianicl. 

Tbc gnn< imlk of llw l»oUi ia cnido op of deuline, in ihu 




at. 



i 




ffVBTEM OF DBin-AL SCnORBT. 



centre of wJiich ifi found a cavity, bcnxing ■ general rcswn- 
hiance \a Torm to Ibat presentod by Ihe toolh itself. In Lk« 
central rarity tlie pwlp nf the Uxith is oontainwl. In th* 
roots of the ttreth tliu caviry \a sui&ll, aud LKp pulp is at this 
point iiriiicipAlIy compottc-d of nprvco and blood vemeU ; but 
iu( the iifck vf tliu tootb in approached, thi- cavity attains ita 
Tiiaxitiiiim *\t^, nnd afterwards dimiciiihes as it asraiiM* the 
ftirm prrapnted by the oilt^fr mirfaoe of the tooth. The pulp 
cn%ity comiBunicates with tlie surface of tlie tooth by a tnuU 
oiMniin); situftUid at the end of thf riMrt, and through Ihiv 
opening the nt^n'ett and veK^ds enter. In a few cases, cAuls 
for the paaHa;;c ot vrufltlH uiay be found entering the pulp 
cavity through tlie side of the tooth, midway between the 
nevk and the apex of the nwit, n-hile in a fov othiTS tliey 
eatM by aereral minutv c&nab ; hut them intut bti legnnled 
as exoeplion&l cosaa. 

T/ir Kfiamtl. — In a fully fttrnit-d tooth the enamel contains 
only from one to three per cent, of organic matter, though in 
the oinqiie chalk y^lcxiking enamel of a looth not yet onm- 
ptcted the or^rauLc comtituentx amoant to as much as ^flem 
]ier cert. This (iri^nnic matter, said not tol]rlong to the claat 
vf gvlatiiious tissUCK, but to be cto«cly simUar to ciMtheliuiu 
in lla cbinuical rchiiiuiui, is 8UtM Dot to exist bvlweuu, but 
in the ntbstaDCO of the pristus (Iloppe-Scylcr). Tbs nuunel 
is made op of parnllcl fil>rcs which lie in close contact with 
one another, no interruitng »ubet«noe being detDOtisti 
From their close mutual appoatioo tbey asBume Ibniui 
or Imm nearly appronchiug that of hexagonftl prisma; no that 
on transrente section a mosaic^Uke pnttem of hex&^nal areas 
is seen ; but some fibres will bo fuuud to be ucarly square, 
other* nearly circular. 

The iniuT ends uf the fihrcs rest u|)Oa atul are united tu 
the Furface of the dentine, while the out«r extremities form 
the Borface of tJie crown of tlie tooth. 

Tn tmcin;* the courw of the lihrex, it will be fotiiid tliat 
those aitttatodoQ the prominent jiart4 of the cro«'u lake a 



THK DCXTAL TIB8TTB8. 



245 



^^^^niral cmtrse, while on Uio fiidtn of Uie tooth they pursue i^ 
horixoDtal dirvclioc Erery intermnltate ponitino betwe<«u 
tbo nrtiml aiut tba bnriMntal will be kbo on examining the 
enuulu it pMmfromtliociittingBdseof an inciaor.or ibc 
MHfi of a iiMihtr, down tlio sitle of the tooth. The eurfooe of 
the deotlm pKwnting a iiior« nr lem ooaicitl figure, tho 
ptunnrl Atim in Uit-ir jniwAfTo nntwAnbi vrotild Iwoome k|»- 
r»t«<l from each otbvr, unless th« fibres grulimlly enlirged, OT 
BnlaB snpplmmjtal tlbrpK tillod up th« inbrralii, Mont fibres 
^ipeftr to exteod from Uio Kurloce of the dentine to llie «tir- 
tm t)( the euHiwl ; and a* there is do reosoa to think that 
i^lhe fibrea are sabjwt to graclua] coIugFir^Dt, the prc«rac« of 
aeiilal fibrvB domI not he duuLtvd, though their ex- 
EblMioe ifl Hot easy lo dctnomtrate. 

The fibiTs. ill tlieir jioABaga fniin the dentine to the free 

mtrfacv, piii-Hiio a waTod, or, ncrontlng lo ElauDOW, a spiral 

11 ooune ; in inon tho vanrin^; direction of contiguons fcatuU of 

^Bfibtm in not niifticltnitly rn;iiliir to bv nriidily tr.tce<l out ; bat 

^Vbl ocrttia of the rodcQtia (7) altemnlc layers of Ktraight 

fibcoB pan in dirpctiona at ni:ht un^lm to on« anotlier, i« m 

to prodace a rory rcgolar pattern, l^y tracing the gradatiou 

pre tu ted in Uw enaoiel of such rodenU Uiroiigh thoae in 

oUwir membon of the order in whom tho [Attem becomes tew 

ngnUr, nwtng to the smuinptiuu of a waved cuum by the 

film, many of the peculiar appcanuceti peacnud by human 

ouunet may be more rcndily understood. 

Tkeae appearanoea, kuou-n as the "deciusation of tho 
Sbm.' aredue to the fact that in the tbicknesa of the wotioo 
anveral laycm of enamel fibre* an included, and the fibrcH of 
the teveral layeti paaajng in more or leea different dfrecUona 
^Tc rue to rartoua j^ttitunii. 

If a thin section, in which the fibres are expoan] in their 

Inigtli, be examiufd, it will bo found that ihvy ara indi- 

[TiiliuUy marked by Imn^irerw 1i»t<a, or slrije, uluated at 

ibly regular interTala. 'Iliece striAt do not noceasarily 

[cotaddo in tbo (»nti^ui>uB libRs throu^^hunt the >ii«einKn, 



346 



A irgTBar of DKXI^ BaftQKBT, 



although tlioy may be continiioiiB over n confiiderablo DUmWr 
of fibres in certain |Aart« uf tbe prapMntlioii. 

If sectiona Uken fmm a niiDiW of teeth be examined, it 
will be ibimd that the strin arc much more strcm^ iuiirk«(! 
ia some thno in otbera, and that thtT' aru nwwt strongly 
|)n)niiiince<l in thtnu* ]»tU attho nfKataem whtcK when seen 
by transmilW'il liaht, bave a 'bmwTi colour. Tins, which is an 
exoe[itinnat cdmiiLinii, and liaiit«<l xa cxt«ul \a wiiU-formed 
teeth, will be fonnd to pervade the whok* of tin> ciuuik-I Id 
the t«tith of certain iinlieiUthy Hiihjecttt. Tlie teeth, ia plnce 
of the hrilliioit white and almost traniiluccnt nppcaraucf , have 
a dull u]«i[ii« yellow eolour. Eoamd havtag this defect 
presenbi stnictiiral character which are much more atransly 
marked thau obtuiu in that which is inuro ]>effwtly deve- 
loped. The cauK of this apposkTaDCc of slrUtion ta still u 
doubtful question, none of the vcr>' va-riuus ox pl&natioiu 
which ha*"© ho«n offerod iiroTing wholly satisfactory. 

It is explained by Wnldeycr by a reference to the decussa- 
tion of tlio priims i seeiup that the prisuie uru uoitwl without 
iDterm«diato substance, and that coutiKuoii:* layers do not 
pan always in parallel directions, it fdbwK ax a necessary 
ODDseqaenoc that the outlines of ca<^h cuniuel priatu cannot 
be perfectly straight and regiilar, and it ia to thiii caniie that 
he ascribes the varicoeitiea ; while Hertz (4) accx>tinta for 
their presencQ by the assumption of intennitleut cabiGi»tton 
of the prism. 

The distiuctnew of the tmniivonH- alriatiuu can be |i;rc&tly 
increased by the use of dilute hydrochloric acid. The manner 
of procedurv is ae fuLlun-a : after roduciii}; a st'ction of enamel 
sufficiently thin, pUco il for two or three seconds in the acid 
(one |xirt of hyilrnchUiric acid to twelve parts of water). 
Wash the sectiou and examine it in water under a 1 objec- 
tivt'. It will now hf. Kocn that the acid ka« acted upon the 
different ])ortiona of the enamel fibres with rarying effect, 
attacking the oentml portions of tbe fibres with tbe greatest 
rigour. 




•not DKKTAL TISSUBft. 



247 



I 
» 



The ftpiie&maces jott dcBCribed arc aonievhat difficult of 
•xpiuwUiMi ; but exceedingly ntnilar itwtioos uiajr be ob- 
toined from developing enamel withnnt the na« of an ftcid. 
Tlie dcponUou of the Iiofxtviiiug alls takes [ilaco in Uiv first 
|ttMX' at ibe [teriphi-rj of th« oiuUDd rells, aod goes od to- 
wanl* its oeutreuutil it i» flllud upuutiroty. Uence enamel 
•• St first formed is fcDCstiutM, sod the older tho rorming 
♦ttamt! ihm Smaller uru Ibc (Krlurations; this condition has 
been wdl figured by Uoitz (4). 

It nwms, ibereGont. tbat the action of dilute acid is to 
nrefM the course of calcification, remoriug fint tbat which 
was IsAt deposit«], and the varying appearsDce of the djf- 
fcnat sections is, in oU ixvbsbilitf, referable mvcvlr to tbeir 
obliquity. 

\y\ti:u euoiDel is firactured, the line of (Vsctnrc appears to 
Tim throngb the ooutra uf the fibres, sod not, an might hare 
beed expectcil, throngh Uieir inlerfipace. 

]p the part* of tb« aoction wbcro the fibreii bare been 
divided transTcrsely tticappaarsnceof aperforatednM.-mbraufl 
irill be left, tbe opening! coireepooding to the ceotie of the 
flfarw. 

«0 111.(1) 




If the Miotion chance to divide tbe fibres obliqTiely, the 
opoaintts leA aft«r tbe action of add will opptraadi an oral or 
even a sqosrisb form, aocording to tbe forms asmmed by tbe 
liriiRDB tbomaelTss as a rcmUt of mutual preaiare. Kow and 



«a«r tfe* nmwval <M Iha aaitnl pofUrfH «f ik* Ulna bj Mad. 



248 A BTiTEM or DBKTAL SUROEKT. 

iben, however, AQ nppennuioels seen wbioti is depictol id tbc 
ucompanyiBg iUuslration (Fi^. 12'!). In thia case tbe icid 
baa 8U)p[)«l Bhurt of wLully remuviiit^ tbe ftxisl portion of the 
flhrw, vbich remaia ia a gnuQlar oiuiquc mass. Fran the 
genenl ftppcaranc« of tbe nctiaa frum which this drawing 

Fif. lU. (1] 





; taken, it would bo ta]:mi for b longitudinal sectioD of 
eiUMiiel; it it, Uoworer, exceedingly diflicuU Co get a truly 
loDgitudiiuI Bcction, &n the rcry vam^d oourae of the libres 
prficludofl the pouibiUty of getting n Bociion. in which tbcdr 
directioD rcmiUm the nuue for any diBtauoc ; and tt b mon 




A MClbi) riiulhrir iraM, In wUcli ibf |>lnnr cf Um hcUu eroHa (be 
4IKIVC1I of Um llbR* oblhtnrly. 

(■> t*Ktlon In mbUA ihe add liu (to|i^ ■bort of rttudnc itrtiul pertontioM 
iHTing kiMew] lb* «nitm ut lb" Bhm (<tit «ndi of?) looking ikrfc and 
i:niMil«r. Tl'e Bfw la In one naftci hm\ty : It I* nrrir p«M(bl« l» am tbe 
wiIUms «r lb* lUil: KiaMM -nry tfaMp<7 Arfln^ kod tbty iMoanr >••«« • 
I miun or <iv*) hna UiM ii toe 4cpkM. 






rax nxxTAL nsmm. 



249 




[<rul»ble that the «i>paumiu» hen depicted u due to the 
obliquity uf tli« Mctioo. 

But Uic citn(iitioiiii which are maoifeeted in perfoctly mv- 
tared QonnaL enamel do not obtMm until the d«T«lupni«nt of 
the ii«8ut) t» fully accumpliBhod; aod it will be recollected 
CbAt young onamel cootnins u much as fiAeon per eent. of 
Qipmic niullur, wliilut Ibis \» ditutnislicd in adtilt ciuuuel to 
thrw ficr ccqU During the proceaa of fornutioD, the fibrou 
arraoganpnt is exceedingly dUtinct, aiid may n»di]y be 
denivaiitjut«d by the aid of hydrochloric acid. If, for 
example, a thin Bertion he made fmm a tooth the crowii only 
flf which is uadergoing deTelopiuttol, and submitted to the 
aetiOQ of acid, it will be found that tlio eantiy in);re<li(!nt dia* 
•ppeara, leaTiog a leiiea of di<calci&c<l lilirL-» nttjichui like a 
fring* to the aurface of the dcutine. Tho cionDt^r m which 
theae diHenmceii uriso nny, Itowcvt-r, lie neen if the enamel 
be carefolly examined during the prof^etaire stages of it« 
dereloiani'Dt. It is desirable to enter to some exieut into 
the fubject of enamel davelopmeut in ordvr that atructund 
defect* may be the more readily lUKlerstoud ; Mie more so as 
the itifaromtioD on this matter contained in the text hookl 
oniinarily accouuhla to tlie deotal HliulnDt is bnt acanty. 

Tlie investigation may Iw imrsuni with advantage in the 
tooth of a sercn or nine months* fa>tus. If an inciior ho re- 
moved frvMii its crypt in the jaw, encloticil uith'm ita iO' 
TMting s»c, vra should, wert it peasihle to make a stctlon 
throuf;h it witht^ut di»turbitij; ita Mvural [nrta from thdr 
nonnal relations, find the following succession of istructuree 
over the crown of thi! tooth. On the immediate inner Buriace 
of the M£ would lie the roaoded epitbelium-like layer of cells 
»htrh cunBtitute the external qtithelium of the enamel 
in contact with this, sul'M'^ueulty to the diaappear- 
am;*' of the MHinlc reticular tiuiui', would lie theoclU con- 
•lituiioK tUv Elmtuiu iuU-nuediimi, and nvit to tb«t« the 
bnaQoiml, prismatic, ci-lU wbirh are called tlie internal 

llwHuju lA the enamel organ or vnaiod oatls. Those laat 




A SXg-nill or DKKTAL SCBOEItY, 



ut conuocted by one «xtrvuiily with the oolU uf the stratum 
iatcniwdiuin, by iho uthur with th« HurriKw of the dwe- 
lopiug eoamel. 

Such A section caiinat well be nuulc, on mccuunt or tbe 
gre&t hardnew of tlie eoamet ; but lliue reUtiuDii may be 
well Mwn iin Bcetians at the tooth wicji of young Atiimftla, 
wbich have boon banleued in cliromic acid, and Biibse<iueatly, 
d«c«)ciltti<l and cut. Hut most infilTiictirp preparations' may 
bo iiiadi), by which th« {inuVMi uf cuiuiicl (ii;vi'lu))iut:iit nuiy be 
tiaccd, iu fretth tooth itac«. 

If, fur Dxaui[>ki, u dcoUl mc which has bopo nmovnd from 
the foetal jaw he carefully opened, it will be found thiit a 
gdatiooUB acDiifiuid sulwtanoe is interpuaed between the tiuier 
wbIU of the mc and tho coronal Bnrface of the young tooth. 
Cyliiiilhcal culuiiina, having iimr the extremity which lies 
fiirtheet from the furiii<.<d cuatuvl a krgv oval uuclccu, togt'ther 
with a large number or spherical or ovoid nucleated cells, will 
be seen to make uji thia geUtiiwuR matter. 

The long oellt are the formatiTe cells or internal epithelium 
of the euamcl orgnu ; and if the ouaiuvl it«rirhe examined, 
slmiUr columns will be found adherent to its surface. Their 
imacQcc may aim be deinouHtraled in tlio foUonring manner. 
After diWdiag the dental sac, and lumiag it back so u to 
expoBG the forming tooth, place the i^rrparation in a watch* 
gloAS ooDtainingditute hydrochloric acid. In a short time we 
iball see a niembrano>like ntilMtanoe detach itwlf from the 
mtfiusa of the cnAmel, which, with a tittle careful manlpu- 
Utlon, may be removw] to the microwopo for cxaminatiDa, 
and it will then be mwei thtit odo side of the membrane ia 
compoi>»l of columnx of the enamel pulp, and the other of 
decalcifitxl enaniel fibres, and that the ctrfunina and fibres aro 
joined end to end. 

Thi! colutonH are, however, very readily detached from the 
perii^eial ends of the enamel flbree, which are at tbU point 
Ifiterslly united, preneatjng the appcaranoe of a membrane 
which not uDooinmoil^ onumei ■ dAp brown colour, oontnut- 




TH> DBKTAL TIBBUBB. 



251 



injcwith Ihe mine internal anil ooloiirlnt) )K>rUon of the Glircs, 
which. like tti« colnmiu c<r t-h« |>ul[i, may becoTiw dfiUctied. 
When the coluDins are dcUchetl rmra the one Biirface, a«0 the 
(Ao^MRiit purtioiui of llic LMiaiiicI fibre* are ri-'iiiuveJ from tlie 
ntber, ve hare rcituiiniD^ thnt which Mr. Hiixlejr has rc^ftrdecl 
M the mnnbnina prefoniialivu sittiated l>etwe<cn the enamel 
{itilp and the ettamel. Mr. Uiixtry was th^^ firnt to diKorer 




» 



thai tliis mKoiliraiiv couUl ho rabod fruio the enkruel at any 
pofiod of its growth. Up to the time of this discovery it was 
gettenlly bdieved that tlie enamel woe formed by the calcifi' 
Mtioo of the columtK of the enamel pnlp ; but if (be m«mbmw 
nised by the acid ahoald prove to lie, in the strict aenae of 
the trrm, a well-dvfliMd menibtmue, Kparable both from tbt 
cnunet pnlp anil thii enamel, and not to be a traantinnal 
oooditiun uf tbc one Id iIji gradual progma towards bevumiuji 
tbe otbtT, thim the cdUvemiiMi l)y{<utbeHi8 mtutt l<e reliii- 
qnilhed, and we shall fiill back upon the opinions held by 
tbe older nutburs; uul we uiusi, with Mr. Huxley, regard 
ihs enamel urgan an exerting uu direct tnduetice in the dev** 
kfoumt of the enamcL 

(1) ahBWInf tiki aaliMMM flf Ub rnuul pnlp h, «MiMrbd at « *1lfe Um 
ii— iaiy< Mumri Stan m «, TIm nmtut af Out rimM cvUi km Mfn oained 
Item Mm tlftn. 



252 



A STBtBM OV DKNT&l. BUROSHY. 



Rot io a sorloa of iiivoatigfttiotu made in refeTCDce to tlie 
eluctdittiuu of this |MiUit, the remilU did not coiucidi! with 
those rooorddd by Mr, l]uxl«y(ll), and sulHtet^ueutlj'' liyM. 
Lent (I C). The niuiDfir of proc<!e(]ing was rimilnr to tliat 
pursned l>y the authors cit«d, vhicb u de«<rib«d in the pre- 
oeding page. No difficulty attended Ibe productioii nf tlje 
numbtvie, but the oolumDi of Hit tntmel pulp ven fuiind 
•t tniLDV jwiDta ntihercnt, and their conltnuity with tho filnvs 
could ia eumo casix bo dialiactly liucud, u Hliovm in th« pro- 
oeding figoro (Fig. 125), Agtin, th« detached columiui id- 
fawvd in bundles to oacb othec by the ends which approochud 
tho onamol, aad many of the calumiif mn tcnQiiiHt(»l by 

Mf. in. 




driicate ivoceacet, which mutt at the time of Mparation baro 
beoD wiihdniwti rrom the itiU-riftr irf iho p&rt[B.lly calciG«d 
fibres, and caiisequuully muHtbaru piuatxl through themeiu- 
bnne which ia soppcned to sepsinit« the Iwu tixHuea. 

Immediately above the point fmin which the process starte, 
each oolnmn haa, when sep&rnted ^m its fellows, a slight 
ciicumtBreiilial dilatatioo, lu though tlie cylinder hod beuu 
evoited at the edge when the separation was effected. On 
oloaer examination, the culumus apjtear tu he made up of 
tubular tnetnbrnnous fthcatlia, within which, at tJie end most 
diHtauL from the enamel, an? lai^u oval ouck-i, the remainder 
o( the cell being filled with contents mun or lew granular. 
At lbi< end directed towards ttie enamel the invctiliiig taem- 
braoe apj)«ars to be abieut, and it ia often pouibio to see with 



niB DKNTii. TUKTU. 



35a 



the ttlmost di«ttnctTi«ni tint tlie rntuncl ntll tonnlnAtnt by » 
tabular »[wiiUig. Tbs procesaM sliown id the Urt 6gar« ore 
am hy uiv means coiuitaatljr preaent; thw cHIb often termi- 
nate br a iotnewiwt everted, trutnpet-sbaped month, tliia 
a|ipmniooe of evenion bnog probably dnm to the tJu-t that 
t^e reel of the cell lias nbrunk in oonwatnencfl of iniiurmon 
in alooliol or glycerine, wbilat the end lying in contnct with 
Um calci6ed enamel has beeo ao Ear altered that it is rigid 
and incapable or nhrinking nnder the action of reagenta. It 
ia oftvu poMible tu see the oritioe of tbis everted moaUi ia 

aame cell* whkh iffownt the pfocewefl above fignrnl; 

eruiiif; which il ui»y be added that Herts (4), and 
WiUdcycr (2). confiroi the fact of their oMurrenw. and accept 
the cxplanalidii here offcnil of ihcir natiiTB, 

Kuw, xupponng: the dccal<-i6od enamel flbrra are detached 
' Cimm the (x>tiimn» nml are Ttcweil Aingl)-, it will be lieen that 
tlie ends which «p]'nMchcd the duntioe are dmr aod ttaoa- 




pw«nt, while thoee which QK«t the colamoa are coarae and 
granular, appearing by tnuisinittod light of a deep brown 
eoloor; indrad* but for the colour, it woalil be iliSiunIt to 
dbtingtuah the diatal exlTciuiti«9 of the dccnictficd eiuunel 
fibne from the pmxinial ends of the oolamna of the ODamel , 
wgana. (Fig. 127.) 

The ooncloatona roi|)eciiii|; the developaunt of llie eiunwl 
which are Btut in accordance with the appoamncoa obaerved 

tf) gtwwip* d» dwddM nunul nbm maimtnl wlik ikr 




8TBTBK or DKNTAL SUBOKKT. 



tn tliMe. the colaituu of the enamel organ (eiuanel e^h, 
Mfarnal epUhetiiaa of the ctmrnU oryan) are «iihiervi«nt la 
tha development <A t^c. ennmnl prisiniA, into which they by 
OtldfiDatioD become actiinlly cuiivcrtod. TUim conTcraion 
goea on In tbv following method : ihc proximal imJ of the 
cell iimiergrtps aouio cbeniica.1 change pruparatory t« calcifi- 
cation, and is »ubHequeRlly calcified; l>ut thU calcificatioD 
doei twC go on unifnrmly Uiroiighniit it^ whnlf; thicknttis, but 
prooeedi from its pchpbL-ry low&rdti its biLerior, the centra] 
portjon of the oeil thus bcinf; calciiinl lat«r than the external 
portion whicli lice at tke mbiub lerel. At the sunc time that 
calcification i«;>nic(;udiiig inwardaioeacb itiilivitlunl cell it has 
muted bb« CDolignoan cellx to each otbor. At this poiu(, 
uniely, at the extreme margin of caU-incatioii, the colutiins 
(mS*) vuty rtadily tH'pnml^ from tlin cnlci&cd fibres, leaving 
the sucliioc of the tatter having thr> nppArancn of a perforated 
membraQp; thu |wrforations bcint; dtic tu the wilhiimwul uf 
the central iincalcified portioim of tbec«lLB, which coDstitute 
the pruufixKCH of thi; ctiatiiiil cells itgiirnd on a precedin;* ja^. 

I'be calcification of the Miiilral porliuna of the enauiel 
tibrm dnoa not, aa haa been already etat«d, keep pace with 
tltat of their oxtiTidrs ; nor eron in fully couivlelod vtiainol 
doea it attain to precisely the same chiLractcrs. For, as niis 
mentioned ou jinge 'J4li, the octinn of acids is uiure ra[>id ou 
the axial portion of the adult (ibrea than on their cxtmow, 
BO tJiat by iis uar that njipearnnce of ti-neat ration which ia 
seen to nornully exi»( in young developing enamel inay he 
RtUired. In the progrew of calcification the aticlui of the 
enamel odhi diiappear, and it ia probable, u is belit9<red by 
Waldeyer (2^ that thcj internal opitlielium of the enaniei U 
rscrdted by the cclU of the atratam intormedinm as it 
becomea itaeirtued up by advancing calciiicatiun converting; 
it into enamel fibres. 

But, althuu^h the balance of eridenoe aeenu to be in 
favour of this view, it is not atuiciited to by aU tibaorven, 
Tiitia Ki'Iiilsvr (I) itiiiigiucs l-bat the enatuol cells du aol 



■ 



THK DBHTAL TU8DES. 



ass 



Qodergo direct popTeraion into cnamd fibres, bnt that the 
enitnw>< it, as it were, fthed <nit from their «ii<ls ; that tt i« 
a McmtHin from them, not a depositioD ia tlioir own Hcb- 
■tance. The prooc8«ee which nro no often to bo Men OD tlie 
ends of ODOtncI c«lU he rvgartU as artificial products, rihI 
explains lu beiug fragineats of partial ly-derelojied tiDA.mel 
•ocJdentall.r torn inray with the oclU. 

Uorv roo'DLi;, Wenzvl has written (15) in nippcrt of this 
axcnUun theory of eiutmol developmfnt, bat the grounds 
advaocetl by him du not Ap}x-ar ftt nil cuiiclosivo. 

Jkgaiu, IVofewor Huxley (11), whoM opiniou oq hi«tolo* 
gioal mattOTs Tnnst always carry great treight, ox[ir«Msud the 
opinion that, "Neither the capsule nor the 'ecaiDel orsan,* 
which eoitBi«t« of the epithelium of both the papilla and the 
captiulc, roiitribule directly m any way to the development 
uf the dontul tiMfuea, though they may indirectly." 

This opinion is liascd upon the fiiot thnt, by menns of ad 
Kid ca[«ble of dissolTiDg calciom carbonate and pboephate, 
a membnue can be raiaod from the surbee of dendoplng 
enamel at uiv sta^e in \\* i;TOWtb, the membtane so obtAioed 
bein'r identical with the mrtiibnuia prefonnativa of liaschkow. 
Ulifl structuml cbaracteta of this membrane have been 
Bktreody in same mmimn] described ([xm^ -^tOt ^.nd it now 
nSHins to inquire somewhat more closely iuto it« true 
bUDr. Whatever be th<> explanation, it mntit not he for* 
gotten thai Ihe premakce of this so-called ineuilirauc qui bo 
denioDxtrated only after the nte of reagcotx, and rhnt a lis«ae 
the exutoQce of Mluch cnn only Iw diacuvered after the 
njiplication of potent ohcmical reagents, is ofvn to the sns* 
fiicion uf being merely no utiticial pmdnct. 

It will be rt?member«d that this meaibranc, which ta found 
to tw fiiramiiinled, iswhat remains after the eiiamel cells have 
Utn torn awny from one of its Hurfaces, and tho cali-ifiMl 
•-liiini*!! fihm from the other. Bnt it may bo 8«hed, Why is 
it that n-o hitve oobeeion at this p«rt, white the oilU abovr. 
and lliu fibna hekiw, ao readily at-paiute from each other and 




A SYSTICM OF DENT^I. SUROEIIT. 



rrom Uie colierent jmrt ? The (olutioD of Oiia question is 
probably to be round in ib« diemical naLun> uf the |art« odd- 
oemed. It » prohnMo (hnt thin, whicb intcrreCM bttwecn 
tli« fully oulcifii-(l ami tLu uucniDiliiAl [lurts, liu uudvrKuiu 
Bome ohCTntcnl ciian;i« prejinnnory lo, or coincident witb, the 
finl dtfpositiuu uf litQD Halls, by which it is reatlered mora 
resbtoni to tbc actioa of rc&gcnts thaa that whicli liet oa 
eitber uida nf it What the nature of tbi;) cl^angs nuiy \>e, \b 
to »ome ext«'ial conjectural, tboiigh ibe tvsearcbei of Professor 
Htrtin^, to be mo&tioneil on n nucciwling j»ge (fugp StfS), 
tlirow mudi li;:bt on tb« quvKtiDii. 

In fine*, ibt^n, this ntcuibratio it to be K^rded as the 
yoim^cHt layer of eitatui-l, as yet bnc Blightly iiii{)r(.'gaatcd 
with Diinerftl coustittieiits ; and tbis view bos laivly received 
full oonfinniitioD at tbo banda of Wnldcyer (2). 

Altbough th« fibres of the «nainel h»ve aiioined their full 
lengtb Hume time before tbe tootb is cut, tbo deTclopTtiL-nt uf 
the tiuue can Bcoroely be regarded na matared until aftvr that 
pcritxl ; far at the time a tooth pas»es tbrooxh the sum, the 
ciuuueL is (»ui[«ntively 8vfi and fragttti, and it is only afl«r 
tbc Japsc of some montlis, or even years, that it attains its 
fall di»;ree of banliiosft. 

l*rior to the atirfaoc suflering any wear, a tncmbrane can be 
separated from the mrface of tlie unnmcl l)y Iho employment 
of au acid. Mr. Nasmylh waa th^- firiit to dmw attention to 
tbix fact, ami he dB»oril)od tbc Tnenibraoe aa separated ae tlie 
jHiniBti^at dtoital capsule, 

Mr. Huxley rottaidi-rs It to he identical with tbi> luctnl'raua 
yrefonofttha, that is to say, the membrane iriNrvcuing lie- 
twran the euaiiiel cells and the innmcl fibres; wbidi Ti)U»t bai 
rv^iled as a men arciAcial product, and as having no real 
' axistetic«. 

Waldeyei (2), wbo recognises tbe ariificial nature of the 
polled " tnembr»TiB prcformativa," regards thin Xosniytli's 
m'.-in]>miiii, or cuticiilit df.-utiE, as furnioil from tbe external 
epilbeliumof tlia enamel organ, which, afWr tbedisajipcanuiue 




I 



ur the Bl«llala ttnuc, comes into oootut with tlw inUnval 
Ft»tthclinni, or enanutl cells. Amronltut; to tbta ul»crver, the 
colU 111 thi' eslcmal G)jitliuliuiii uf tliv eiiam*;! or-jau tiave 
uulerig'OiM ft moumorphMU mt'> s cuaiiAM tiHfiuo, and bi: 
ftUtcB tuftl tbo oiitliue of tbe cuUa uui be ajii{)[<ed out by 
stainiiifi with nitrftU otnUet. 

Kulllker (I), buwcrer, ntrongly duaenU from Uiu view oT 
Hs Dri|0Q, aoc], wbilst ftdautliug thai KOCiinit« reiH«rvUt'R dti 
llu mntwr ud wouMug, lliinks it mttte bkcty that it iit a 
cuiiQcctH] biyer funiisbed by tlia ciuuucl cults a« ft coviiiug 
to lii« wbc^o cDainol, ft maunvr nf finiuli for which, ha saya, 
Blftoy aiMto^QS may be fouiiil. But noDe of these vivvra are 
capftbltf of iiixouuUug for ull the a|>i>unraLcee ob»ervetl in il. 

Thn cuiicuU deiiiifl (ciiAiuel cuticle, Na^ntyih's membrane) 
\» ft uiriiihrftne which nay be raised on a continuous layer 
frviu the iiirface of au uuworL twtb by the acttoc of ftCid«. 
It U uiLcbftaged by luaccratioo in water, by boiling in strong 
aoDtic, hydruchlunc, Euliiburic, or uitrio acidft, by thv last of 
which it ia statoed y«lkrw. Boiled in c&mUc [wiajh it iwells 
alight ly. Wiieu bonit it give^ off an ammoniacal odour, and 
iMvat n ipoi^ aab. 

In thn flra cditioD of this hook it was sutcd that lu 
MVcTftl aproituiinB which hftd been drcalciBed after bring 
rednoA] sufficienily thin for micruticopic csammAtion, Ihlv 
meoibrane wa« obviously contmuotu with the oeiuenlum of 
tbe fnog: and in other ijin-iriivuH which bad not been treated 
witli acid, tbe tuuiiiimne ww thickened in the deep de- 
inmaiuus of tbe crowoi of moUr teeth, and there t«iiU)ted by 
dtattnct biciuu^i. Tbe occnirenoo of thcac two ctrcunistaneea 
would iiMlicftto that Niismyib's membrane ie ceioentxtm, 
nihiu- than niciiibtHna prefurmativo. The gccvial abaonee 
«r lavuDii? in Ifaia lucmbntnc i* due to it« want uf mflSciaat 
thlchmw to i-ontain theiti, jiwt as we fitid these bodies want- 
ing in the crtaBnttiin of the Uaji when lhf> layer of that tissue 
li nry ihio. 

BbI iuaamuch as ikssu faett ap|«ar lu have baoD omUnlced 






•258 



A fiTSTUI or DEKTAI. 8UBOBBT. 



bjoKKt recent writerB.RrulthitTicn' as to itit nntvre ienored, 
ft MriM of ubwrnatiuitH ou a large auuibut ol spccuuMU bftve 
receotly beon nmdc, which arc iu the fullost dcgrae ood- 
liniiatory of thfi ooDcUisimts stated in tlie first oditioD of thi* 
lK>ok. It wotiM bcru be out of place to rntvr at uuy Itrnglb 
into tliR fmrtfi mi wliicli thiit .ilat^inpnt is based) the ntoreaAi 
M they ar« to be found Htiwwhere(') ; bntJt may be tncQtionel 
tlial it ufUai fleemo tu lie cuEitimiouB, not wiUi llie hilly 
formed oomentQiu wUicb iunni a thiu 8tnictur«leM l«y<T rotmd 
Uio oei.-k of UiG ttiotb, but with Romathtng exteruiil tu this. 
And it i^ A rery siguificaut bet, Uiat this mcmbraae prxreents 
all the cbaracten of tissue prepared for cmlcificatiun, which 
we already know undergoes somo cbeiutcal change preparatory 
to tJie actual deixMition of nits, conferring upon it a remark- 
j^tjbie jiower of roiiHtiti^ rcagi>Dtii (sou pa^es 256 and 2lrii). 
Atscnrditift to tbcsc rescarcbea, then, Naaroyth'it mrmbrane 
to be reg&nled as ooiDciitiun either imperfectly latlcifiod. or 
Dt yot calcified at all. 

Apart, howerer, from this apparently nmototelosa layer 

described by Mr. Xattmyth, we may sonutlmM obserri) a 

diniinutioii iu the libvoua eharactn- of tliu eiuimirl at thu tur- 

miaatious of tJie fibrm on the Buriace of the tuoth, aiid abto 

fat the t«rmitial odfce of the ennniel on the oeelt of the tooth. 

In each of these siluatlons appearaooee niay be foand which 

Ritg;;c«fthe i^ea that a Quid blasLetna beouno ctilcitiM, nnd 

that tbu fibrni lind in tho proona Lcoume fused ami nioru or 

I lew lost in the ma«8 »> formed. Iiideed,io the situation last 

niDUtiuned, Imiiiiintiuii nf nn imiiatinct chanuiter may takSi 

tlic |iUc« of fibres ; or l>otIi the lamiiiated and fibroiii!i ar-^ 

k.nti0Bment may Iw r<!|iWf^l by a Rcntctare exhibiting littJc 

urangetnout of pnrta. Iu wuU-developed teeth, liuwever, thia 

deviation from the usiinl cliaiacter of enamel ic Hniited to tlie 

terminal edjce of tba Usmic 

The preceding observation)! frir the rocwt pnrt relate to the 

<•> C. S. Tim«. ("In ih- Niiuirt oT NamyUi'k Xnntcjnc. Uwrtctr Joonwl 
«( )Ilc«i«ii.pt»l Selrw*. mil. 



TBS DEXTAL TUSUBfl. 



Huinel wfaro perfDctly funnel. Wo iiare now to direct 
ittentkm to«)^«cU in ttio «lractural ehanctor of tbo Umi 
Faall; OTjipuizatkiii vi-ry frMiiiciitljr IouIk ioilirecUy tu I 
dovelojnDrat of diHOM: it is thcrefuM dMinblc tbat tl 
oawUtioos whirh cliaraclfriaa tbo inipetfecliDiis bIhhiIiI 
neogaisfd. Wc nuj* divide them into defects ia the quonli 
Mtwi iu the qiulity of tbc tlarac 

The Dentine,-^( » median Inngitndiaal sectiflo of a 
be mide. U will be leeQ th«( tb« surTiKC of Ibe central cavi 
ii frv«ywb«re pinrceil by wi infinite nombw of extreutri; 
minulo upeain^ They lire tbe orilicca of tb« dentinal to 
the parieten of wbicrb, tif^i'tticr witb t)ie iiiairix in wbi 
11«, make Dp tbc walla of tbo fulp-cavity. llio tube* 
radiiUe conrw from tlia ocntinl axix formed by tbo 
earitr tmranls the suifao* of tbe tooth. Iti tim cro 
kIm) to iDtne extent, tboQ([h in a lev dcgrep, in the root, h 
■ddition to namorotu aeouudary oiiuuts undulatioofl, 
taboa d«acriha aercral bold curws, which are oMiinionly d 
■aibed aa rncvmblin^ tbe italic letter/. Thma aitualc iu 
amni differ ht aoine reapecta from thoac which occupy 
itpot of thu loath. In ench ntUAtion tbe farmnckea wbi 
f$rra off are very namerDua, but iu tba crowD there a; 
|Biralivily fi>w, until iJie tiibca a{^roflch the surface 
by ttic ('iuin»>I ; wbila In tb« root braaches are given off fi 
the tube* throughout tbc whole of thoir connie, inore abui 
daatly, howv^-er, as they near the aurlaoe of th« dontini 
Tbe dentiiml iubn, by the anastomoato of their brniH-lict^ 
baoAD* coaiMOteil vrilh each oilier, uul alao establish rd«> 
tknu witli the cxtemnl dental tiwtuns ; in the crown of tbi 
tooth tlirjT trrmtiiato liy ruriniuf! loopa, or l«coti>c too miautfl 
lo be Imotl, or {om into ttia enuniM ami buooiuc lo«t. In 
(■etb tbe dentfnu of which is iui[«r(ectly dcvvlopcHl. tlM 
nrniiuil Itrmchea are U>sl attiuuz. or end in, tl>e minnU 
omtin which abtmnd in the Uycra at or tiemt the pmpbvrml 
4nrfM« or tha deDtiiif. In Lbv neclc and root of th« t«<oth, 
the branvbtsa of tbe tubca auaetuuiuae Trcvly, mod an li«| 




flTBTCM or DtHTJtL BUKOBBY. 

nmi th« aurfitcv of ihe tisMie ; nt*r the nrck tliey stup ebort 
of tlic opmi-rittiin, but tcmanls the eml of llie root ibey Dct- 
ancfliuuionly ]>m» iuro the (xroentuin, ami connect thom- 
Bolvtw Willi tlie laciin»>. Hy Uir extension nf tUu (lentioal 
tuUn into tbe fuomvl (*) and ioto the cernvntum, a conoectloii 
U fonned iuor« iiiiimok' Uioti mere 8uijer|<u«itH>a auA a<3- 
boKHNi ur lite one to tJio other would baT« ciUblislird, sud 
the tnoTO BO M the thrc45 tiaiMK* on: developed irom dutiDCt 
formacivu clemi-ul*. 

Ill a HKtton wblcH has been drtol tbe tubes beouiue vrry 
distinrJi And it is oft«u poeiublc, by luldiug a coloured fluid 
to thf |)rvr4>atJoQ whilst it Is nndiT tbe tntcn»co|ie, loub* 
wrvu lis (gradual pasaoge iiito tl]« tubes. 

With tv.-tfwct to the ccDicnbt of ihc tubes in the trrsh elale, 
it WAS foniicrly sufiposed that ibpy ctiiilaiued a c\eiiiflutd,and 
Kcrt* l»ciic« not caxy to obMn'o in a (nth woi. jireixinition. 

But the view that the canal)) arc hollow tuWs ouuvcyiDf; A 
DUUieut fluid hoc, for uumy ycara, bcvu alinofl uuivcrsally 
^AbanddEiKl ; M. K(illikur(l) nndiiltH>r8, wbo were atfinitdis- 
to CftU in <{Uir»tiou the csistDDM uf in>lid colitetitf 
lu tbe tubw, Iwviu^ fur somo time past ^Ten ex[ire68KiD 
to their conviiittiiii tliaC they do exUt, and may readily he 
dcraonstratcd. (*) 

If a i»rtiu(i of enamel be Bccid€>uta]ly brolcei) from the 
crown of a tooth, to that the donUii« becomes exposed, the 

[>) III Uie iH'tniui'UI unliiiAl* Ui*uiiir»n[i nlrnatin ot l&« OFntinal tulxo, 
nM onl^ bita liul llinjiiili tilt grrntrT |hrit'on nf Uit wIhiIi' liilRkwa* iif tlul 
Uuor, &ttni> ■ dianclcr taQli-lriill]' iiMllutl lu dinlliiKuMi Uw Uvlb U tlial 
ftnni M>y "tk^f vrj.r uf iiiuniutU.— Oo Ibt SlnxUir* of ibr Uiiuil TiMur* «f 
Uit MinnplAtii. Ililtiwiiililiui 'IVMinttluqiK. Itoi II,. IKIS. U nuj be \ttti- 
OtMtUf nu-uiiijiira IkcTv \lni rliit pttutratlao af U>« UMBtri Iif |Im> ibiiliiiRl 
(iiIkii Iw* hrni iloiililol by Wil.ivriT awl Hvtl', mAU^ aU> ihhbII)!} br inor* 

dnw tiian ibdr |i<>Mi4tr mth* tbt bowo-kry to toy wnll^iy rrt ttti ion, mi.1 
^K''>ll»(«r tncaika (1) iLollie aaABM«BaOdvclM>w WilibTir wMI Hnti omi di-i^ 
I ralMf DO . 

(*j llr- lulbr ('■J MMiib 4>m(K «r quiu atune In ib-nrlnc the rsliltDet' df 
IVodt Obrlli ill 1b« ilciiUakl ifetK*. but lb* imnMKta Ob «lik)l 1>« dw«s (o twlnx 
lull; taH by Ito MkiMMMi ut Tarlon* wrlten. BDialilr <ir M. K5llllcer, du nui| 
r>ai ftir Bon Uian inMrtug tKiU«» btrr. 




TITB nitNTAl. TISSUES. 



varfiiw or l)u! Ifltter will Ik highly wnBitive to any rorialiuti 
«f tent!>cmture, or to ths ooDtiict of fbreigQ budlos; even 
rIii^ prmstirc from Uie langn' iHII givo p«iin. It ib, howorcr, 
nuWwortliy that ibo dagrw of paiu in not increawd hy Id- 
RrouinK thv pniwirc. Thm >ka>», it >* n Tncit of every riny 
ofastTVitticia llial the dentine tuiincdtntcly below (lie cnnniel 
is iDMcb ninre smsilivc thftu that which Hw liceper in the 
nibiiaiicc of a loolh. 

If (hi.- pnlitofa twtli lie(Wtro(«l,'-illwrbya«ln»ilniinmlj 
or by thv uacf of an tiuihtiruiic, Uic scnsitivcmeM of tbo wfaolft* 
r-of tlw (lentm4> U immHiiately tust, no pnin being expvrlvnood 
vboo it IK Biib8n)U(ntly cut, either aita to Uie cnainv) or to 
Uhi pui|>«aviiy. 

If the I'ulp b» dwtroyed the dentiiM loMS for over its 
pown tkf fc4>lini: |Min, thongh it msy in favourmblo Bitiialiuiu 
ivtuin lianl uiil frcv frum JisoolonitiuOi even if uxi^mc^i to 
*the flqi4« of the tuootb; itji Hntitireneui is tlira wholly 
doytniili'Dt on iu r«>i)i>ei-Lioa with the pulp a( the liKith, aitU 
It bus no inherent fcniiiliility in its own subataucc. 

N<'vi>rtlicl<ui«, the Mmntivitne-w nf ileutine may be )E)o1 ovt 
wilbinil iho lieAth of the pulp lakioii pl.ce u a neceanry' 
eonditiiin. Tlie UTth »f ymini: )tubi<<cUi arv mtitii nuirv m>ii- 
■itlvL' UiHii tbiHM) of oltluc people, ami this is luorv ssjx'ciully 
the ouc nbfn lbi>y srv uiM-kwl by (iuio!i. 

Tbo iknliiieof tirth whtcb arv rapidly decaying ta niacli 
nan muiliTv than tLnt of te«th in which Iho dostntrtion 
pr u gfM W M i nwrr Nkmly. Tbefonner oondiUttu ih iiHlii'ittM1>y 
tbi light onlcHir at the dMomposlof ynrt, i^i^thi^r with ihi? 
l<xtcnt of tiftano ioTo|v<<d,; thri lAttn- by tlio divp bmwu 
'culour. nii'1 tbi> iy)mpnnttivv hnrdncw of the alTvctoil dcntiiti.-. 
]li oertAJn cam» nf mrics, the soflvnot tisicit nppou* t*i h- 
«stmnrly nnnHilivp, m> lh»t the (Mliunt nin ecarcply \km Jta 
nmoval; liutwhnn tbt; instmuMnit niK'ttMlhe coni[Amlifcly 
lualUiy datititw, the pain, alLbougU ptVMOt, ia much \tm 
Mranu 

After a portion of deotlnu baa bdim for aactw time •xpoMx), 



362 



A VSntM or DKXTAJt eD&QIBir. 



<ir if till: cX|>osuro be brcnintht nbonl gradually I>y the tlow 
wcwriiig Rway of the enamel, tlmt acute wn.'titi^'nnna wbich 
liBS been d^ascribwl is uot fuuiMl to nxuL lu jMrU wliicb 
have be«n tnbJMt to the fon-p^ing t>-in<littuaH. it will, 
on eXAminat inn, \w tnnmi ;biit thn ilutilituU tiilui, tbt) |iMi- 
I'lieml exin-iiiitivii ol" wUirh have been esi<o«ed, atw more or 
le«R oMit«mt«<l in ouine i«rt cif their courBo between the 
sortoce aud the pulincavity. 

Aiii\ it is ]>ostribl? to destroy the wnititivcneM of ilentim- 
liy local appliratinnii, evch u citrato of ulvor, cblori<le of 
itinc, or nroenion!) acid, any oiie of which will have tht i'ITl-cI 
of n'Uil^-rin;^ perfectly inReiiftihle thu mirface to wliieh it may 
be Jiprilieil, though, unle** it* action bercry protonKMl,itwill 
itut iiem-trnti- to luiy great doptli. Ou ruiuoviof; tliu ituiue- 
diflu> surface whtcb has been acted on hy ihew eKchamuc? 
the (Irntine Innralh will hi- fuuud to Ix: as sciisilive lU) erer; 
ihu4 unnjuivixally showing that their acdoD has not broti 
upon ibe pidp, biit upon tha apot to which they hare been 
applied. 

On reriewing the varioiu circnmatancc* under which den- 
tine evincen Mtoaibility, and thorn under which that MeiuiUlity 
it lost, it is difficult tv avoid the coucluittutt that the deiuiiial 
tubes are in Dome way the medium through which eenaatioa 
19 distributed through the snbetAttccof the tissue. Bitt if the 
fiolo office of the tiilxw wero cnnTeyancf; of nutrient fluid 
derived from the pulp, the diQiculty of accountiog for the 
nenjiitiveupsii of tiie dentine rGiiiaiDa,uiaaDanch as we hare uo 
innance of sen»ition being inAnif««ted in a fluid. We Tnight 
endeavour to gutont trf* tbu difGcully by asKumiu^ Ihal the 
dentinal tubes are cciiistantly flUud by fluid, and that preo- 
mitv made upun the fluid at the exposed ends of the tubef is 
fell by tbo pulp at their inner cxtremilies. This assumption 
dotnt not, however, arniimt Uv ncArly all the circiimRtanees 
of the caae, fiiliog altogether lu explain the f;reater aeiui- 
bitity of the deiiiine tit njv [nirt of the touth than ataooUier, 
or tbfi local eQ'ect uf escharoliea. 



tn MUITiLL TtSMTW. 



363 



I 




The vaat of iiuocdjinco betwrcn tbc viuws formerly cDler- 
Uiuitl u)<uu Itip •truct^iru of ileutine tunl the phyuolugicsl 
cooJitioiu manifesloii liy that tiaane when io oo&neclioD with 
the Ixiily, bu wbully sriMnt fn>ta liic anmaptiou thut Uiu 
■^^"l'tVl^] tabes ore ulcly for ibc conreyaooo of Buld. nod that 
thflj* woe dosthate of soiid or Mmi-Bolid cooU'uU. With the 
hoi<t of icaiaiikg tome fiinlior knowlctlgK- npon this iMint, 1 
oominrapKl a aerieB of obaerTatitms, faario);, Kowcvpf, bnt 
iiUlc ex jicctjitiou uf (uiding that one of tfa« moct imjwrtAnt 
part« ib dontal strucluro bnd been overlooked, nuiwly, that 
ourlt tlvutmil tubs in pemuuiuutly t«uautorl t^ ft sort fibril. 
vblch, after pusing fnim the pulp iiit^i the tubes, MIowh 
their mtniflcttUoos. (^) 

If a tooth or » Kwliun be sDbject«d to thv autioo of dilutf 
Kid ( hydrorhliirtc Mcld uuworing the purjoie well), a flrtu 
dulio maaa U obtained which prewrvea tbo ettemaJ fonn' of 
the Unth, and, uu micruAuopic eKamiiuitioii, is fiMud also lu 
|iraserve its elntctore. Jt la iti fact tbt* oiputic bun* of 
dentine, the fnuiu<wiirk in which the calninwui; salLE wvtv 
ilapoaited, wbich is left bebittd After their remova] by tbe 
■obL 

But if ID tlie plM« of dilute a>.-id, coiiceiiinitutl bydrochlo- 
tic a>;i<i lud been oiuploy«l, alter a Litni! Doihin;; Imt a 
•ticky, alioiy man would have rctnaincd. irt no way rrtaining 
ibc fnrmof tlic tmth. And. on niicruaiwpicexaiuinatioti, tlii« 
would Iw futiud to oooaiat wholly of long labea tangled tog«- 
tber. and obrioualy ^-vry flexible and <rpry um^h. 

Tiiiwi tllbca, which cnastttuto the spnrial n-alb-of the 
deBtlDkl caiula, aT« tiM tnost indcstmctiblo f«rt of tbe whol4- 
tooth ; pruloti^ boUittg iti Btnio; hyilnKlihiric acid vr tu 
u4iMtic alkaliM has no ctfr«t iifon them ; and they may bo 
obtAined i>vt'u fmui Euasil tM-tb (Hoiipe-Seylor)^ 'I'liey cuitatl- 
tnlc tl)« " dentinal abnulta " of Sietuuuiti, aud tffwioualy t'l 

0) On IM l*n«ni» or ra>rtl* ii( Hull nvar la ilw l»iiUukl Tabm, hj 
Vul, ll«. IkH. 




964 



A 8TSTEM or DKKTAL SUnORBT. 



tlic decalcification wore inliuuttely connoctcd vriOi thenuUrix 
which thvy trnvonsc. 

'i*hey may be obtained afU-r the tooth hiw; been long maoe- 
nt«(l BO sa lo putrefy, or has been bag boilod in cAoHic 
alkalies m that nny soft timiic woitl^l have hwii d<>str«yed 
(KolUkcT, 1). Their precise chemical nature reinAins ftomi^^ 
wluiL doubtful. Waldeyer (2) cousiili^ra Ihf-m ullieii tu irlastlo 

!uc ; bnt NouinaDD (i)]) holiU tbvin to be calcijlcd ; whilst 
Kifllikcr (1) cuDipanxi tliL-tn lo tlic iatornnl aliralhs liuiititii; 
rtlA Havoraian cAn&U, au<l to th« capsiiloe around ostcoblatta 
which may somc'timcs bt- inolaled in ci mptitum. 

Uel«rriiig for the present Clie fui'tber cooiiidL'nition of the 
(Iciitiiial slientbn, wc (ass to tlioir contcnu. In the iotviior 
of auih (in the fre!>l) toolJi) lic« a suit ltoiuti)!<:iit!uiiH tl1»ril ('), 
by u(j m«aim gn indent rnclibl« a* tlw sheath. Thus, If th« 
Unith be allowL'd to putriiTy, ur be boitnd, or even trcatvd in 
the cold with caustic alkalies, it absolutely disappears; and 
il in by no m^ns ilifTicutt tn destroy it by tho use of acids. 

If a, section bo mado of a recently extracted tootb in a 
direction i^Mrallcl with the tubes, plarcd in illliite hydrochlo- 
ric acid till il i» decnlcifinl, and Iht^u torn iu a direction 
IraosTcrH! to thftt of the tohctt, the* Uirn edges will be ueen to 
be fringed vritli tranajiarvnt proceH«es of varying; length. 

In repealing tlio exjieninvnC, it is dcsimbto to placv the 
dccaleifieil woiion upon the iitide bi'iorc tearing it, ns if it be 
Ulkd from the surface on whicli it has been torn, some of cba 
longer fibriU niity girt folded lack u^ion tlie body of the 
section, and tiina become hidden from view. 

Whoru till* itc[jttmtJon between the lum surfaces lias boeii 
but aligbt, we may oft«n hoc nn unbroken cord BtrutchiDg 
icroAtt the intwval bolwwn the two halves of the dentine. 

If a e«ctiou be taken ia ivhicli the tuliesnre ext«iidwi into 
the LMianiel, and Buhniitte<t to itic action of acid, it will be 
found that after the UtUv liume hm bwu diiwulvvd, lihriU 

(!) KotllhM', VUSerrt. MwK Kcmnuao, Ltnt. tWiU, !vnll Sltma (abn hM 
<lniiaaMlrMtdlbetr«Al>UaraliiiHD|>bibla«ii<ll(iltMnI*}L W*bmI, uul ottM*. 



TOE PKMTAI. TIBSCBS. 



MS 



wlU TcnuUD coDDccU(3 wiih the dcDtm« at those points where 
Uie tubm iwnptnili.<<l thn raiwrjacent Hruclure. 

Kow, it in jwrreotly iiOMiblf tu gtil boib the shnitbB and 
their oonutined tiMli tUiwlinfE out from the «lgi> uf ihe Jen- 
tine ID <KJ<> ami thn utuo speciuien. NeutuAQU (0) hiw 8UC- 
c«pded iu dtftooniiinUDg both thn »li4«ths and the filiril» in ihe 
eauic specimen by tho use of acidx ; and BvU 0) hlit <l«flcribed 
and figiimd ibe eh«atlu projectins from the edge uf Ihc dcu- 




, and the fibrila from ilio vai of the ihratlis, usintt for 
I ptirptfw twill wlik-Ii had Uwn plawrl In Himmic acid io 

ut hnnUti lilt; fiil (lorta, and MibM->)iieLtly dcoilciliod. 
It is qiiito pwH)>le that in »onie of lh<< dfi-alcificd spuci- 
tncOH ori^ciiially figuml ah tibowing the fibrils, wluii were 
niallj t«n weru ttia dt'otinal BLeallia, the Mpnnte exiatence 
of which wii» nut at that litni; fully rrmH^iacd ; btil Ihhi doM 
not hinAy to MCtioiu which have uot bcftt dMalclficd ; in 
th«Mi the 6)>r)U, ami thi!]rakine,arv found u> project from the 
citt vdfiv*. 

Bat if tlie mil f«rt« have Icvn dcsl/ored by caiutic 






■a It Uip loMb nr an *On't. m*H III ft filiuv «llb 
'il<n,«>il anaraknl* d<«akllbrf aul (bra iiir* In 
-ftofUMMtoft. TIh StoUi an ttewn ufMiing 



S66 



A BVSTEai OP DltNTAL «L'IiaKBy. 



ftlknlivs, or by pntrefartion, the sort dbril can no lon^r be 
brought iuto view, altbuii;*ti lh(-n> ix iia fliflicull; w]iat4ifW 
in deuiDiirtjatiaic tL* w«lU of the trbe« (Koillker, 1). 

It in Qot ucwsMury, buwuft-r, U> iliwaldfy di.'iitin« in order 
to •how the Sbvls. If a similnr section to ihax already d«- 
«aribodbe diridDd wiih the udgo of n knirc, innny oCtheee 

Ftf. 113. (1) 




dcHcato nrgarw will be wm-u, but they arn usiully broken off 
much sliorttT, umny of thorn scarcely pwjocting beyond tlir 
wlfif'-a of tho iiitus. A^is, if a miniile portioa of deniiTie 
be cut witli a nbarp kuifu frum tho surfave [)nHluaHl by (rac- 
taring a perfectly frcth tooth, the same apjivarAiivva will lie 
KL-ca, but iinl with Ibv same ucrtuinty and disLioutiim, u in 
thf provioiM examples. 

In unliT to dsmotuitnitc tho oonnuction of tho 6l)rite with 
the pul[>, fini' iH<ccions should be tniuio with » Kharfi kuift- from 
the edge of the. pulp-cnvity. In ibis nuiTiDcr 1 obtained the 
specimea from wbicli Mr. Dt- Morgan has becQ kiod caoogh 

0) Afkc Dull. Id Ibi* MVtIuii Ihr -Irnttaial (tuuihi project fur * kbuit 
dktuoi bcrouil ihr inrirailiis uufait, wlilbt Uat Obril* vt) mm l»«illi( rrwii 
the »niiluth»i of lLc •hrAtli. 



TBS 08STAL TIMCEB. 



267 



^H tc dnw the iuxon)|nnyitis iltostriUiua, showing the fAihh 

^P streichine from the jmlp to the diapliuroil dentine, mid wme 

t^g of tb^m pHMiog nut on tho otht-r eido nf tha ingmeat 

(Fif!. I.IO). Ttint iti« librilD pr<}c«ed from the pulp mny be 

MM-u by i-mn>fiilly fracturing; a Trash tooth wUh as little dis- 

ptaoenwnt of the fmctnrei p«rtii u poesible; aod then, I7 




^ 



ly renioTing Ui« j/Glp froin il« |iUc« in the louth, wc 
■hftll In ctiftbied to examine the BhriU which haT« bocn 
druwn i«\it from the tube*. Uy thi« procedure B<.'n>e of th« 
filffiln vriU l«o wiilidrmwn bmn their immuil pnntkin tn the 
dcniiLo in tho fn'cater jmrt of tbdr length, ■ few of ihtm iv- 
laiTiiiit* dhort It'U^s uf tbm imrR-luw, but sufficfpot to vhow 
that Llicy have CORH frofn thii hnincbeaof thi* ilfnUiial tub(«; 



0) A m o ka wtJa wllh* tolfn tw Ito «4f» of ihe |nil|>4anij uT lui aduli 
■eaUi. budMdtv • forUoa ctf tb# iralv ; («> tb» •KMiiu- ; (^} tttt (aitp^ kUIi tte 
frinifctnil Brtli •raf^nt l« llnr«; {i) Urn deMliul RInU iltsan unl ■( ik* 

a|P«r oa il» flvto flUTtMi nmovol tr«a Uw pM^t. 



■ IIIIU ^.k^iuvidet wiih Uw obMrrOuMu ot l)r. 

munU 8n- Isrgral ix-ftr to tlie |HiIp, ami txHxii 
aiiuillcr towanls tlii' pL-ripbrry ; and with the 
And M«;;it<it (10), wliu {mint out Ibnl the i:n 
found in tliv results of annlvGes of liunian t« 
the fact that the teeth become more rich ia 
u mfi a^ToDoos; to that, unlera twth from in 
nnic'ftge, or rothrr t«fth which H^e jnst in tb 
tbait »Jow calnGaiLion, are eclnitcd, tlie restu 
jtecenixy rcry various. 

This, profagibly, also aoonnnts fnr the statiin 
who bdiuve* that tb« ewft nhril exists only 
near to Uie pulp, hut that at a rfiRlanrpttUaln 
bility ie that liiu tc«th suhinituni lu exaiiiina 
iDi)jvj[)u.ita of odvancc'l ngp. 

In ]irc;)efations in which we an> fortnii»l« «i 
a jFirtion of the piitp with tho (!(mriui% it. may 
that the xoTt fihrile aro proctuwtia of tin ci 
" odontobUst^" which coimtitutv thu pccalii 
tlte " tuuinbnuui eborii.'' If a tooth be taliei 
fonnntioD of ilentiui> is ao long:Pr actirc, tha 
1^Uf\ am) oviil iu fomt. tapering ilnwn towai 
till thfiv attain the siso of the fibril ; but if ih 
exaniiiKHi iuayuuiig aii'il nipi(lly-7:rowing IddI)- 
to be much wider ard to he mmcatg^oa^j 




THK DKKTAL TIMCBS. 



Ilu) proorM which snlere the canola in the 3cnLiu« it oot 
the only 0D« i>roc«<yiin(; fmm the cell; thnv is always » 
procaw At iu oppoeite pole, prix)oetliiig:iloirn into Iho palp 
and (rouQicUD;: it with oclU o( a deeper Uynr. and there u« 
aIao latcnil |«oct»»(M wiitcb ctNiOMt H with tho mtoutobiwit 
which he aruuod it. 

I'he fibrils ftrc aolid and bomo;*coe(ni8. uid may Iw Btaiccd 
with CAimiiii', though they iki not Mke th« ]ngnieu.t witli thv 
auae n-vUneea na thu Diu-'loi of the cells <Ui. 

Ou uxoiiiiniu^ a ptilp with u low mugu'rying power u Imrgo 
tiuuihc>r of fattficuli of nerve fibres are eeea {^avstng npwanlu, 
pnmllel with the long asia of the piilp; thcsi* arc mainly 
■teriviil fri'in a single kncibh Derv« trunk w)>ich jiasks into 
tho faiiR, often aecompanit^d by fcreml smaller br«Dch«L In 
Lh« t'ipHUiled purlioD of the pulp in the c-mwn of the tootb 
tltew Qorro librci form a rich pleiux with elongnted meflbea, 
ftiHl, Hccunlin}; to rmfcuior KUIIikir, hrcak. tip inlu primilivo 
^ibna which form evldniit locpii. Dy tnatitig perfoctJy Ireeh 

iiipe will* a vKij dilule aolutitm of chrmnio acid (J^ per- 

It.) Boll (3) wu ahlo to ilKortt an em^ntiutui nniubrr of 
minuti! filrila, which h« traced into contiimity with the 

irk-h«n)ered oerve fibre*. 

Wlint become* of iheRO fine fihrea,* whirh are cHpecialljr 
aimndonl itiinH»lui(c-ly lioiieatb thu oieuibraRa I'tMiria, il 
UM cvttAinly IcDowo; but frotn thu plexus Doll obeerwd 
Duiueruue fibrils pusning up botwci-n the; odontobhuts, 
iVid projeciing out beyond them atnongit the dentinal 
IhriU. 

Fro4n Ihe iliivclioii m frM|uently iiswamed by tiicw very 
&DP fibrils, Itoll suppjsrs ttut they tnu.st, liko the d4.'titiaal 
Ibiila, have bo^n dr.<wn out tr<jiu the Culxw, but liu has not 
sturrasfnl in actuully w^ni; otie jouumdi; Into a dcDtitw) 



lliv nntan and functions n( Uie dvntiml Bbrihtdtill ranaiu 

fur cittipiilLTatiuii : hut, rn Q-Al ulso found, the Biudy uf thit 
Oiattcf if m iuexiricnbly niiJird up with tliit of the dm'i'U>)F< 



970 




A BTBTIH OF OBSTAL BtntOERT. 



meet or [le&tiite, that the one carniot he duall with vitbout 
onteiioi; M sume Icngtli into flip, other. 

Various and imi'oiicilakl'C upiuiuwi are hsld on this liiMtar 
of devolopment, hut on tlie ono point, mtincly, (hat the 
odontublnsts play Bome vary ini)x)rtaiit part in the jirocen, 
mokt autboritiea are agre«d ; though l'ruft;s«<.>r Huxley maiii* 
taixlvd thar tJie dentinal pnlp Imd do very direct ioHuenou in 
tb« fonuatioo of the dentine. 

The tooth genn, or jjopitls dentia, corresiwnils in form lo 
the future tooth, or at least to tb&t part of it which ia at tlic 
initjcvlar timi- about Vj he culi^iBitl. la its cvntral purtiun 
h ia very rich in n(>rve8 and alM in vflaaoli, the latter forming 
■ doaae |dexus imrnediately bcnoatb the outer layer of ape- 
cialwed cells. Thin layer, the niembraDa ehoria, is iii>c {«ne- 
tnted by vesseU, Imt ronsist^ of a iiumWr (i>f cellii (odomto- 
bluta) arraiii^ periwudicularly on the iurfiace, liki' au 
' et^tiieliuni.andpittts(^ closely bc^cttiLT 90 as tobeiiiititituAtc 
amtact with one another. 

Tie ioterual portioDS of tlic ptil[> conaiat of a fine CbrDua 
coaoectire tissue oontatntng ^reat niiinlicni of cell", at tirrt 
round but Utcr bocouiii^; B[nxidle-Kha[Mi) (KulUkor). With 
renixicl to the outer layi-rs of tin- ^vipilLa, aiime Httle difTiTunce 
orn]iinioiicKiatA; tliUB'Ktillikor hulda thut it ia bounded exter- 
nally hy a stmctureleiw nn;mbrane(Mii;inbnina pn'rormatniX 
wliicb, however, plays no part i[» the dovpluiiinetit nf the (1 
tine, while like cxistcnoo of any membrane in this cituatioQ 
daaied by many other obwrvcra. Thr taptanalioo ■;ivuD 
IlobiQ and Hagitot (lO) of this appearance oC a ni«iubraiie in>' 
a jilacc whi-rc oono exists aesms rrasonablu : tliey point out 
that the gelatinoua-Ioolcing intercellular eubstatice wliich 
■ItoumU ill an early euibrynnic pul]) pro}wt» ontnu^s l>e>'()nd 
the odunioblaat Uyer, ao that it a[>iM«ni to fortnaaort of film 
iorvamiitli over thane ccllii. Xlonniver it u xlated liy thiMn 
that tliia intercellular nature is more dense at the periphery 
of the pulp than in ita interior, so that the ntaeinblanoe to a 
delinitfl limiting membrane ia yut farther increuiet). Tliia 



'1 



THS DCfTAL TI8BVKB. 



37 1 



H Tiev, uunely, that thi; tnciulirana preTcinnatiTa of Riuchkow 

^ is th» tnom cxtenul layer or matrix, ))n>j«vliiig bcyund tba 
gdontoblaiitA, is aim ailrocatn) hy Hitix un>l \Vcnzrl(I5). It 
tiuM ituC, luiwtivvr, a|i)«ar ibat tliisiitnKitiin'lms iiiouix pl&ja 
U/ [Hit in dentine fomuition ; in lACt, Iloll sintcs tlinl it diii- 

With rvgnrd to the aharo uken by th« odontoblast cells, 

tbe previili-nt opiniotui admit of dirinioo into two cUshco; 

I ucordtng to the one, tbe whole of tbe dentine structures, 

namely the fiiiriLii, tho sheaths of Neumann, and the matrix, 

are vtiolly and directly derived from the odontobiiubi, whilst 

aoeording to the other, tli4> matrix i« a •ctwratu Mxnutiim, 

ao '* intCTwIUilai " subalanoe, and the caiuiU aitdfibriU alone 

are dmred dirwtly from a convcreion of thu odnn to blast*. 

To take thelutter view fint* it is lUppokcd by KOlliker and 

1^^ Bern that ttic odoatoblaat layer of coUa furtiidb a ttcyn^tiou 

^B wliich 18 of a gulatiuoDs uaturu, and is iJimI out frDiii tlie layer 

^H of oelU in ootunnon, but docs not stand in any di'Soito »iruc- 

^H iural relation lo the inrlividual cclU; by the ralrificatinn of 

^^ this •ecreli'^u the intertubular matrix i« foruod, whilst tlw 

ooUfl aiul tbnir proooRMR go lo f^inn the tu1%s and their nui- 

tent*. (See also Wenxel. 15.) 

M. Lent ti};uri.il and do^rilwd long fllnmonltnts |iroeew q B 
of the dc-iitine colU which be reg&rded as fortulug the caoala, 
the cii:4l4^tice of ilio wifl filiHli not harin^; lan-n n-cd^niaod at 
tli&t time. Pruftiwor Kulhker a>ubidiin« thAt a bingle cvU may 
gfaierat« the wholo lungih of a tube ami its contenL-*, but 
iiualitlu) the Malcment hy itfiying that, though coiifttricted 
eetU occar, it ia foasible that the connection with the inotlier 
•sell may uerer be IokIt <*o that it may or imiy not In trui- 
that one coll fonua the whole leiii;th of the fibril. 

fn u|>[wwitiuu to Ibo views above brii-lly indicatol, w ihn 
opinion held hy Waldoycr, Doll, Dr. nt>alo,a»d niany iichern, 
that every |art uf thudeutine i^i a dir«et {>riidtiirt of the ron- 
ireraiuti of the ixtuutuhluifa. Thia intti:r ricw is |)n>)MLl>ly tlie 
tnw one; but, aa will [ire-wntly be sct-o, It dow not, allKr 



272 



all. dilTrr isu vny wiilely from that held by KSlUker nnd 
HcrUL 

On refuFEmoe tu the aocoai] Anyitig figure, or to the excellent 
fll^iivK given by Bull (3), it will lip wH?n itiAt Uie n(tonbnh]iuit« 
doiwup to tl)Q dentine mv iu actual c<<tiUct withoapaacthLT, 
and that tfaere is no ruuiu fm an tnterceUiilar substance. 




Tho (irt'i^ralioii was made by Lreakiuf^ the tooth through 
tbo wntre imruof'ifttcly niter its ivniovnl from the month, ami 
ciittiDg nnth a sharp wulpcl a very ttiiii rra^ent f'mni the 
eHge of thfl palp-cavity, the pulp itsc-lf Iwiiii; present at the 
tinio. Wo have iu this f^xuilple t\K d«ntmaL ci'Us nilhi-reut 
to the duvplopuig dca'ine, and the continnity of th« cnl- 
cificd ood tinoahnficd tis^iic^ clearly i>hi>wn ; and fnrtlivr, 
that it is only necessary for tlir cells lo bt-ooinc hA^lenwl, 
and, as it were, fiisod together, by the rweption of tljc salts 

(•) AnwtiiR ttw tpivinuicr. prtsn.iMl b^ t MctUtn tvt whfa a aharp fei>Ifr 
man ihu nlKt' i>C ili« ^ulp tmvliy u( » tootb mmUjr oUMted. Tttr pm- 
pkml 4cnt]Ml ceUa on rrtalnvd In ibeir ntnntl pwttltn m n«|cn» ilw 
drMlorlDg dcntlM. 



TUB DENTAL TIWICTS. 



373 



Hoip, hi unlcr to ran vert them iato a mun aimiUr to tlw 

nine III urbiL-h ibey are atUtlitHl. 

The nu]«t extpriul iMtrUnru of tlio odiinti>}iIiuiu Qnt1«rgio a 

HMtamorphoHis iiit<i a ^(^Uu^PItlJni« mMrix, wlik-h ifl tlio smt 

uf i-slciUcation. wbilfl their uioal cx-utiui [wrtious re^&tii suU. 

annlufni &.i the Ghrilfl. (ntrrmtHliatc Itetwcrn the cfn- 

il prniiuientlir soft libril ftn-l tLu ^-ucr&l oilcilinl tnalrix, 

El* Uiat {Mtrdfiii vrbich inimc'liftlcly sarmuudii the fihril. 



/)>. jai. ii) 




-siic:, 




^ 



I 



lumely, tlie tlcatiual Blimth. Acconliun to this view thv 
fibril, ihtt Hhffttb, and thB niitrlx 4r« Imt thrvo HtagrJi in ihti 
dcTclojuamt uf the sarou tissue; m it is fsiirutM^ by l>r. 
Boalv, tliey uq liUipUani, or ^ermiDal matter, formed tnotcrinl, 
mnd caUn6nl fumiuil matcnnl. 'ilirrc is much to he said in 
ftiVniir of tLi» tiicory of dentin* foruHition ; tJirrc ts th« tvl, 
itMitiMl on by Dr. IIouIp, tlint tho ImllouR of the rniiuin xnt 
IsrjMt nciinwt to the iH|[|t, and smnlleit al tlic {it-riiibrry of 
Uirtiaith, in ulbur wink, at the nldvM ]nn; aiid Tlint nl- 
ciliL-Aiiija is bUU btuwly guins un, even m adrauctd liff, 
li-julin;: ui (bo [pcriphtTai (ililiii-mtiim of tlio tubn, A further 
catrulMrstma of Lliiii may 1)0 found in a pHp^r jHiliti^Lnl 



(1) liilMil riaiUnal odln, which bam trcmnM iWadit^. and *(*• bnml 
•hUh* MbMi 111 Uk Dabl U whfgu lb* aw f ftUwa fcraifeiii tlM nl^M irf ik» 
iMi UlMiraikin »m |itM<ad. !■ thiH Um) pqlf p w c to i tad U<* luml vnoni'* 
a* *nt *-■, MM ■¥« (0 bt lfe« M» mUm i|M(U pnonUoM arc lakm in 
pnpirl«g tw iprOiBM. 



X7i 



A eTBTEH or DKNTAL nnieERT. 



Mime years igo^ on th« Dental Tiiwiin of tho onlcr Hodcntfn 
(Toiin-jt, 17). 

Hiraathcra iCatts], Bpcakicpof tie incisor leoch of rodents, 
lliBt *' tJiL' tniiefl wliccli jinwwil frum lb*! [mlfM:aTjty n«ir tbe 
IwiN of (lie tooth, are, in most cnnm, jtciveptiijly \av^vr thmi 
\h\>f*i thnt ^tv flitnftlEst high<>r up; biocc tt Mlontt timt, u 
thf latter <EVOr« odcv iiuir ihv InM.' of tho twth, thv lUiitiDst 
liilies nndr-rgo li (iimitnuinn of calibre after their fiMTnation. 
Ill tlio Itcth iif tlif SciuridiD 1 have fuutti) a dillfreucL' of sjae 
nutciuntnig to a third or half between the tubca nwir the hew 
Mill Lho8i' OLar th« Kurlaco iii wear." 

Then, again, th^re is the 8lnuii;'ly-ex|>reawd opinion of TV<11, 
whoHtaicK thnt thn odontnMastN havu o'naiiily nn liniiiing 
mcmbrani", Init «ha"!e i>ft itiseusiMy frxiim t'li^ir iiinerriKutt to 
liieir out«riUiAt iwirtion, niid it i» noiirwi liy Wciizcl (15) 
lliat intix otloDtohlosls have du iiicmbmuutu iuvestiiieuU, 
niiarply-dcfiiMKi contours being seen only after the use uf 
re-ageiit'*. Tin- luceiit valiiaMc rtwean-hpR of Professor Hart» 
ing(12) ser^-c w throw c*>nHi<lcrablo Itght un the qiiwiioti, 
lie apiit-an* to bnvu follnweii itt ihfi line of inqniry first 

, parstic-d by Mr. Rainiv (iiigo^Sl), and was snccrtisi'ul in 
nakitig a variety of stnu'tiiral fnniis by iiuliiciiifj tliu voiy 
(■mdiml ]>rccipiU(tiuii •jf liiiiv mUs iit solutions containitig 
albniuoii,or other organic coustituenl'* ; and not only did the 
lime salts AAHume a dcfinitti BtructunJ armugtiLoont, l>iil iha 
albumcu iloelf became profoundly modified. 

It was fonnd th»t on treating one of thu "eaI;;oii|dicTiteti,** 
or oUicr foniis ihint artificially produced, with ad acid, tboagh 
the hme was r-ntirely r^ntov^d, the niai^A retaint'd itti fomi and 
•trQCtnre; it had, in fficU au urgautc matrix. 

Thitt iiuitrix wim composed, Tiot of ordinary albumen, but 
of a subslnuce doecLy reHemblinji: chitinu in its cheniical 

"rvlailonti; that is to my, a Iwdy cxceedinjjly insoluble and 
eiccediusly resiHtAnt to the action of re-agents. 

Now, it IB a Teiy remarkable fact, tlmt ports which are just 
on tlio borderii of calcification do present thi« v«ry cbaracte 



I 





TBI OBVTAL TIBSUn. 



375 



m 



* 



a renmrlable power of reaivdng r»*giODtt ; thus it 

wfn be rt-mruitwrrd that the hkmi indoatructibl? [wl o( the 
«h<)le uwtJi (ub«taDC« i» tint deniiiuU ibMtli of NcuiuAiiu, or 
Out [art whit-ii inu»Yi*nwi Iwiweca the aoft fibril aad th« 
ipletol nutiix of (lie doDCiDB. 

Similftflr, it is (uund lliut tlic Uuinga of Hnvcnian caiubi, 
ttin iuiiiiiMliat« imruuuiliugs of a bone lacauti, toty be 
iaoUtod hy tlie use of acids; that is to any, they have A 
gnato' (mwor uf resutance tliau etUier tin* fully ealctfied 
tUHie or the *uft lituoe which Dr. Bealc terms hiopUiinL 
If a tooth which hiu bcvii affeulvd hy i-wk'S be taken, 
uctis may be w«u whicU arc wholly coo^tnatory of 
rieira ju^t expuuitdui, Wluu tlie progrcas of the diaeaas 
bno raiiid, the «ffro( io prccinly that of an acid > that is 
to aayi iho very resistant dental aheaths nf Neumann may be 
iioUtod iu short kngUis, asd appear as distinct tubes. 

Bat if WD take a oarious tooth in which the progrvM of th« 
duoue has htea &low, and tb« diseased part coiuoqaeatty 
firtttt and of a deep browu colour, aud mske ihin Kcttona 
with a ku\(e tnniiverHi to the dirccUrtn of the dentinal tobea, 
it will be Tuand, by the om of the micnwcope, that the pre- 
paration ts made up of cominnitively litrge diocs, nich lianog 
a centnl apfrturc cc tnarlc ; and thnt the discs are niiiied to 
each othnr by an iuIequKcd ti&suo, small In aiiiuUiiL, but 
lie of dittiiict rccognitioQ. Hov, these discs hare a 
i;rcal4>r diaiuBt^r than tlie dcnlituU tubes, as seen in a 
rse swtiou of healthy dentiae, and they have, more- 
i Trry vsryiog diameter. If the caries is in an cnrly 
the diacs are not very large, aud tlie iulerveninjr snb* 
is ptcsenl {d coosldemble amount, but as the ducssc 
the dJKs cnlArf;e litl tboy tuc«t one another, 
it be grnutod that thu soft libri!. the sheath, and the 
uv but three itagos of thu wno fumiatiw e(ement», 
laaomfloa observed are readily explicable. The fibro or 
nal aiatter disa|<peura, und leaves tlw central apertara i 
linirtu (?) iDiertDcdiate layer which fonns (ho ihaath 




276 



A STBTKll or DIXTAL BUBT.EBr. 



reFistH the diRintegmtrn'^ actimi, while tlif [imjii-eBS of the 
•Useitse urailoaliy undoes Uio wurk uf fi^ltifimii-m. 

Id a certain stage of the diiieaae the tubcti appcnr to have 
DXtmtni!!; lliiok wutis, ^ llial but UttLu siuicc i» k'fi for uti 
mbcTtubular connecting t^Miiis whtTi-fls in healthy dcntino 
till) dUtneter at' the tulwui is relativi'ty small, unil the aiiiouul 
of iutertubuUr liwxMj is comp«r«tiv«ly Urge, llje different 
clinrac'tei-s seen in tlin iwo CR.vs niny ]ierho|is mlmit t)r 
cxpUitutiou on tLti fullowiitg liy[K)tli<.-si9, uamrly, that tho 
iipHcal rliflvrejtcf. bt'twecm tlie 8liL-aih» aii<.) the oilcified 
mntrix JB removed by the disease ba it cfTocts tbc work of 
decttlcifyiiiK lU« li«8u«; but in, the later utiiKt-s ihc Krtntw 
pfiwiiT o( re«iBiaiico dim to the ])ccul!ar phemicii! characters 
of the sheaths lead ta their rviaainiiig bthind, iwUtud by the 
total dibiQttigmtion uf the iiitetrening tisHUD. U is ijuite 
poMtihlc to onnocive that at\ equal degree of calcification wnuld 
4)flace tbi) dilTt^rviiL-cH wbicli were Bji|wrmit iu lliu Mifk tiwitie 
prioi- to its imlnralioii, and that a higher or lower degree of 
onlcilicalii>Q in the part iu ittituLilintv (.'uulacl with di'ntlniil 
lihriU, wiiiild jirudu™ mmh a distinctiun of jiarts ua that 
which characterises tho dcutinal tubes ; and ihai dccalcifi- 
catlou mii(ht, under favoiirabic circtiDiHtniirefi, reatore on 
appmraiici! wbich had been loet, and obliterate cin« which 
bnd been produced by calcificfttion. 

It hiui already bum pointed out that ov-ory odmiloblaat 
oommuQicates by means of its pulp procciui with the cells 
which lie ileeper in thu pulp. Hcqcr tvhcQ one odontoblaiit 
is Tully nBodup in the process of calcificatiou. aQothor is ready 
to take ila plooo without nay breach of cnntiimity, wnd orery 
ilentiil fibril mny be regaided m the remnaQt of several oos- 
lintions odomohlnsts. 

In respect to the pArvochyma of the dentinjl pulp, M. 
Kolliker Bpoakti of it« relation Co coimoctivo tissue. Now, I 
have ecea insl&uccd, aiid uot unconiniuuly, in which comiec- 
tive tiaMic very ainiilnr to the Btellaia arenliir tisatie, could 
be traced in the sub>»tauDe of the pulp of a fonning tooUi. 




TUB VBHTAL TlSeVSS. 



977 



* 



tbe relfttioitfl or tli« pori|>benil dcnliual cells to ench 
uiid tu tbci ocllfi placed inlemaU3r in the nuicr layer, 
fiillv TM^e oQt by the aullwra cilod. If ouo cell, or 
•voa twu or Uireu onl)*, is conarued iti tli«i formMhinn nf k 
dfitttinnl tube tlirougliout iu Vfliole li>uf{lb, it wuiiM Iw 
dtfflenlt t<) Acmant for tlie preftcnce or (iltliUiniUd tracts of 
twmI* fuan'l iu the l«etb of muty taumaiti, lud occusiooailr 
la the teetli even of the bumaa subject. I bflT« NTiral 
antiona of molar tcotb, iu which lar^e looped tubes, cor- 
nq<oailiug in Miw to Utn c-apilluries of the dentinal |>ul]i, are 
fnaeut in the dentiac. Tlioir position and f.iix! will jimtify 
tbe ooDclvwMjOB that (hey were oiic« occnptdl hy vetistls — 
tbAt tbey siv tbe remnants of tliti vcwirlK of tli« fomiAlive 
dxntinal piit|>, Xow, Mupi'ositig the pAronchyma uf iha pulp 
liatl bwii Imdily rcuiuvvd Ut niuko way fur tho ccutrLiH.'tal or 
iowmnl irmtrtb of tho dentinal colls, it i» not eAuy to soe bow 
Umw vainala outild have boon left. But if the ciilla uv pro- 
daeed ia liour Mcieo, the niore internMl ones U.-ciit[iint! 
gmduilly iKivvtoped w the cxtorniU iindtr^ calcificattoii. tbe 
(■rdstcui-r III ublitcntod vascitlar nuuls mu Iw rca<iily undi-r- 
MOud. it i» Utlo the csi<rtCTi«^ of llicac cftnftM in the ticntine 
U quite eiceptiiioal in hnman l«vtlt, luit iti tlit> locih irf many 
tnuaniitlK thvy form a constant charvlcr. Thi> •Icnliiio of 
mstnnuilian teeth, bowuvcr, in otbtT rcsj«ct« currui|x>a(Li too 
cUnMly to adnkit "f tlie siiititwition tJiat llic process of «)«volo]>- 
IMbt varies in any i>iuietitial poiticiilar. )f, far esaniplo, we 
'ttke lite dcrtloping iDcimr of a ulf, aud esntninc the pulp 

tor wtthdnwiiig i| fn>u) the iuviwliiig rap oi' dcniiiie, we 
lloil here and llicrc lonj; tuholac procciBeK prujcciing 

m the Htr&ce, the cuntiiitialioiui of Vibich niay he- traced 

to thv rabatanoa of the pulp, Th^r nlzo, t>o«ttion, and 

lUDCtion with Ibe pulp k'uvn no doubt that they ore obli- 

capilbirira, tbv conLs of which have bvcn retaininl 

bltr tlte peWo arouii'l Ibi-m liavv iindi'r;*otte valcilimliun. 
ttir |<ureiM:byiua of tlie pulp ^radnally mode way for lb« 

wan] growth of Che external cella— tbe jntmhnuia tiariB ol 



278 




BXnXH OF OEXTAl lUIOKBT. 



Kiillikcr— lIicsG oinaU wmiW anroly have gone with \t. 1 
btxt DUidc prt-paraiioDi in which scTcral cells, more or leM 
doi^ted in fnrrn, hnvc Iwen TiniCcd <^nd to end, nnt iritb 
tluit uniformity, as regards uz« and poaition, whicli chano- 
tenscc tlic mmibcrs or « Itoeor Acriei of cells in oHilfjriiiS 
teiuptHuy cartilage, but utill their pn^itioo and conneotioD 
wHb each other has been stiflicicntly distinct for positiTe 
lecognition, Agnin, if we (txaminrt thA ]>cri[ihcrftl m\i» in a 
pulp in which calcification i» aVint to Cf>nintftnre, and nom- 
pare them with fiiiiiilar cvllft in a pulp liikvii from a tooth tliu 
derelopment of which i» a])proAcbiug coniplolion, H will he. 
BCfii lliat in tho fonnirr tbvy iiro much sniallcr iu site and 
tuore nuiueroua than in the lattt;r example. 

It may hpdsked.whethoroneeloniwitof the pulp mon* than 
another tnfCer* absorption, in order to give ii]Wos for the 
denlinnl cpIIr to grow, swing that after th« cap of dfntinit 
haa b«an formifii, it limits, by rnclo«itij; within itit unyielding; 
CHW, tbp jtcaerftl htilk of tho pulp. Swch a qucsrioo can be 
answered only hypothttically. TJip pulp wmlAins as infinite 
number of niiciei, any or a cenain inimbcr of which are pro- 
bably cyii«lilo (if hpcf^minj; (ii-vrlojind inlq rells. I believu it 
will ultimately be found that a growing cell, when placed in 
organiKwl matttrr which is not it«elf in a rtate of dt-vwlop- 
nioiit, ut capable of growth at the expense of Buch lu&tti-r, 
whateT«r nay he the degree of its orgAnixfilinn. It is quite 
clear that many of the nuclei, the vonvls. and coiiui'ctire 
iiHOerittl, whicli coQitituto the dentinnl pnlp, disappear in 
iavoiir uf thu dcnliiuil cells prinr to the talcification of the 
latter, thoagh the manner of their diiwppeRninco is not fully 
miule nut. 

We haro now reached a. point when the fnuctious of the 
dentinal flhrila mny he more profitably difcuiwcd. The coo- 
ditions untier which sonaation a laauifrati'd in the dentine 
lave already been stated. It^lher with th-wte under wliich 
it ii lost, mid the difficulty felt in aocountin;; for ttiese 
phciiomona bos been poiated out. The recosoitioD of the 




run DBXTAI. TIKKCtlS. 



279 



dnthtal fibrils may, fanvercr, I think, help to TcnwTe that 

^fficulty. and enable thu }i]iyaii>to^uiL tu«x;'laiu why, under 

OETtain cimiiDatiuims, ilfiitiiio is siDuvjitiUle of pain* wliilo 

.^■luler tillier o>u<lttioQS ttio »«niutiveiiDai is lost* 

'^H Thnt the lif^ntittK on-es its senutioti to the pivMncc of 

H^nft tuuue in tbn lulfftii cAnnul, I tyiiiik, le nublily JiruUcil, 

^hMniu; that if tl>i.iir wnnectum with Ihc pilp he cut off by 

I^Vlbo deslmctioa oi the latttir. all sL-oatiua is at oocc lust. 

^B At has ftln-aiiy been Ntnlnl ({»ife 201^), tio one tiM ever 

•>« ft wave Glirv entwra duutinal tclw, lhnuK;h Doll eoasidiiv 

H probable that th«y do so. 'iho present kaovledge of th« 

piri|dipral dietribulioQ of the nervous system U by uo tucnns 

iD cxnnpt«l« that gunenltAlioaB may be safely drawn from 

Hi Md u the u-w of thu higher puwcni of the microscopv 

b*0OIDH mors uudccAtixid. D^rriK v{ vslneme niiaiiteneos ant 

htaof- alioovt daily tru-od iiit^i tt£»ueH whi-occ they had pr«> 

¥wsaly beeo supposed U> bo absent ; at least, in so far (u they 

faaH orvpr been dnnoiutlrau-d. 

It ia auL absolutely oertain that no structures other tliaii 
tmrm hftvo the i>OM'er of ooiuluctiDg scotieat iin[>c«tsloiM, 
and benon it is not quitn neoiMsary to assuim tliat the den- 
tinal fihril* are actnal nerves before allowing them the povrr 
at cniiiinuiiii'atiiig seDsatkiii. Many nniuisis are endowod 
witfa ocusation, which yoc poasesa do dcmiinstrahle ditvous 
tytOam \ ami n-e may tind many points in tho liutuan Iwdy 
lUghly wiiMtive, without our being able to demonstrate the 
fiCMsnci of nerval in snch niiatbers as would acoonnt for the 
pain uiiifornily eiperic-nced from the puncture of a oeedle, 
npuo tbe soiJiKMitinu ihut the iu.-«dle liad in each case wuuihImI 
K aenrc. Addittonid ovideucv iu favour of the Tiew that the 
filrils, or olhttf suft uantouts of tlio tabos, poanas secuntioa 
may be obtained by examining their coodition in dttcawd 
leeth, in onnQuction with the pheoomena tnanifeaoil by ilie 
dbAstt. In tiioM msm in uhirh the fibrils are obtiU-ratnl 
id the manner wbit-h will tw hereafter dfarrihcy], there U 
: abwnce oi jaiii n jieii ths «Axtal |iirt ih cut iutu, but 



S8D 




SYBTEK OP DBffTAL StrRQBBT. 



Kt lOOD fts the insUtunent reaches tlic healthy ilcnlinp, mora 
«r Ims Inomvvnicncc ix fi'lt. If, on the other hflTiil, there Is 
iiti consolifUtiim i»f iUb fiUriU, biit tlm pilp is yet liviii;-, tho 
■ ■perntion of removing t}ie canons pcirt ia pniductivf of pain, 
vtW fVoTii tde commetiremeiit ; in<i['e(1, preiisiirp ti|»q tiio 
korboo of the softetit^i tr«qi« civen rise to discoinf >rt. If in 
sneb casn* the «>rti'm:ii ^icntiiMf Ixf t-xiininitxl, tiljHIs nmy Iwn) 
And liicre be fcuml but little altered froin their natiinl 
Kppi-nmnL'v. 

Th't> gTMtcr dogTM of scasitircocas olnioTvnblQ in the tisD- 
tifMJ imniiNliBlely bdow the vnaimO — thut is, at the ptmt (rf 
iilliHinle iltHtrit^ution of tho tlentinal tub«s, ami coii»e«]ueiitty 
of tlxiir contents — may be fiillv ooofHUitoi fi>r oii the KUp- 
poettiou tbat tbe latter are organs of K«ni>ati<iii, *w] sabjcot 
tflthowTne laws as n^rreH of fFiiiintion, tbe highest sensl* 
biltty of whidi i* confiiieil to llioir t4MTninal bmnrlius. 

Ilio roco^ittoo of the licntinal fibrils roost lead to a 
taoUlicatioii of thv upiiiiuDE oncu cDtertainfld •« rcgu^lo the 
offitx of the tobMi, nnnioly, that ibey ar« for tb« circolatioii 
of fluids only. Tho prBsemMi of ntfl tisKtin wnitM not, how- 
ever, biuder the slow pnuage of fluids; tbero are ubuml&nt 
in8laiu'C« of niitritimuii chiui^H taking places at a ilititsuoe 
fmm vuhIb, and tbe fact that calciflcatioD of the tihrils fCOM 
on in old d^ sbuvrs dourly that iUinh ofin aiu) do pass aloDg 
Ibrai. For when tho fibrils b«oonif calcifleit nenr the Hiirrhoe 
nf tba dentine, the honicnttig nialerial mnut hnre been 
dcriverl from tho pulp; at leafit, when tbe coiuw^i^lation hat 
taken ]45C0 in the crown nf the tooth. 

From uliat has bwti »aii), it will be obvious that M>ine 
wuoertaiuty must ni [Wf^cnt teat on the funclioi» of the 
dcutiiial fibrilK. That t)iKy, or mniu othi'r Koft uoutvnts i>f 
the mbcs, arc tho agent* by which seaMtion Is carried to the 
jinlp may bo n^imlfd a» pcrft-ctly ostsblishoil ; ttri<l. tiia.<iiniich 
AS uo other soft Btnieturw* have been trocot into the ti!bc«, 
the infttreiiee IB tluit tho fibriU thotusolvos jiork'ss this 
faaclioa. M the srime time, in other parts of the body ther« 




TRB DKKTAL TIBHTES. 



281 



esifft nrrvm nf snrh miniilf ni/^ tluit thrir i^niimncc, thoiifih 
it DWy b« iufcrrwl elwubi^rt;, Latt Otilv U'eu ok ji-t dciuou* 
crnttnl ill lii«siii-.4 tvliich nammlly prt-Ht^'iii ^T(.■»t Ucilitiea (or 
cxsiuiuatioa, itucli m liiu bal's witig slniipol oi its (Ait«r 
taycn; %Di\ were »iicli filires |o txiiit in th« teeth, which 
ivntont kimh ^'cnt uImIucIm Ui the use of liigh powere, lltcy 
WtrnJd sliooet aundy ewsaiM! otir nutice. 

With ri-rcreiu.-L> tu this matter, I'tvfcMwur KSIIikcr mtiarks, 
that, inasuiucli »*«lliil.'»r clcniMit* have brt-n, accordiag lo 
moilfrm obwrvHtiuaB, oflcn luuiul in coutuxtiuii with nnrvo 
tiK^iu^s, it is not at all impotwibU tbst tU« otlontolrUats may 
kUiii>l tu iwiiie rcUtion to llio ctiilini^e of uitvl-s in tliu pulp. 

In lite [>rt*s«Qt tttate o( our kaowledge, tht> qacsttoo ouuiot 
hm refjuticd ns cnpnhlD nf being deliniutty hgIIIpiI ; this 
much duly la certAid, that HDsaiioii it conrcyed by 8om« 
Wt contents of tlw ttibe«, vhethcr hv the fibrik or by some- 
thitis phit- caunut Im pottitivoly Blntei]. 

Aoconling to ih« retenivhcs of Mr. tlainie, already ftUudnl 
U(IS), if CHrlMiuala of lioM is formed in » thidt nolatioa 
of mucilngo or albiiniL'u by tb« deoonipoaitloo of (»rlx>tut« 
nf mmIo. ur ul polRsli, Ihc oowly^formiil suU takes a globuUr 
tasl<4d of a cryfcU)hn0 fonn. The glohulca produced ue 
roiu posed, howcvtsr, nut only of carlK>tititu uf limv, but also of 
a tn-rlAiti [MirlioD of the nmcilagn or nH>uni«ii iti which the 
cuntbinatioa hu tAken place. In proof of thii aitscriion, be 
stAtci tliat the liiiic! may be ruuHivu) by au acid, without 
ncHioniiii; th« dntriwriion of tlie Ions of the globule from 
which it lias htxu so ab«lxiict«d ; JiiEt as the form of a hoce 
ts maiatnioed after the earthy matter Itaa been retooved. It 
ta fiirtJicr stated, ihut |ihii«[iliatv of lime, if pradnced noder 
•indliu ciroiunRtaiices. vtipposing a minute qitanlity of car- 
{••rtnipof hnu; be prnKnl, will, tike tlie rarhnnate, aiuiime 
th'.- ^1'>btilarf<:'rin. I'hrsvfiloljulcKarv lamiuntt*! in vtniclure, 
I'l ij.jv;,! ii. I I .Muihlc lit itirrraflo by the mhlitiuii of new 
yxn u|><ii tin- -ii! HOT- If two i>r mure Up in oititact, they 
t)erotD« perfiTUy nnitcd into one lAtntnalcd maaa, \rj ^!i» 



983 




BTSTKM or DKNTAl. SmOEKT. 



blending or ftutJun of tlio lamiiia* wlilcb conifl in routact 
live globules them»oLvM aro »Ut«d tu be produced by the 
rAateficenra of fitnallnr raaHsea, wliich AgBin are rootlu np uf 
ftill smaller B[>lieniles of similu' inaUrial ; the individuality 
of tbe oonstituent bi>diB8 being nkimatel^ lix^tin tbeuDiform 
fuMOD of the whole into oTie comfnct iuhm. 01i>butar manes 
wliio)i lit one time hnvoa rongh and mulberry-liko npijomuice, 
gndually, by lb« cualmcuiica bdH, tut it vrcrCf fiwiug down of 
tbo cooKtitucDt sphcroloi, become perfectly iimooth. Tbe 
lat&iiiatioD i» suppuaed tu result froni tbo amva^ciii«ut oftlie 
tiias!)i>4 in ooncvnlric layom. and thrir miWeqiieut (.'OAleaoenoe. 
Id the discoTory of the subntitutinn of the glubular fur tbe 
crysulline form of these two mIis of lime, Mr. Ilaiiito oun- 
mdcrs be biui found an oxplnnntioD of the ])r<H'«iHi uf calcific&- 
tion, not only of bnnc and teeth, but al-m of the foncntion ot 
shctU, and liis n'sultti liave been confirmoil and uxteuded by 
the more recent re^tcarcbes of ProfetiAor Tlarting (12), who 
baa added to what was nlroady kuowii tbe impurtant and 
sigotficftDt fact tliat Ui« albuiueu itwolf beconiM cbangcd ioto 
a reinarknbly towilublc and rwiatant stibfitanoe, reaemUing 
ubitine ia ita behaviour witli ro-AjjcuU, to vbiob iMgtvea tbe 
name of calcoglobiOin. 

ir thL> thin eti'^e of the forming c»p of dentine be examined, 
it will be foiind to bavo the appMrancc of beiof; mode up of 
globtilai of varying sirs, thia appearance being in great pert 
destroyed by tn«tiiicut with a dilute add. 

Tliitu Donditiuii luix been well fi^jtired byMeaRm, KobEn uid 
U&dtot, and ia familiar to all who Itave watched tbe develop- 
ment of dentine. The calouvous matt«r is in tbe first 
inatance depnsitetl in the matrix iu tbe form of isolated 
globniee, thes« increase in size and altimxtely ooaleacr. their 
oatUoes becoming obliterated by tbe deposition of calcanmiu 
salta in their interstioes. 

Dentine in the globular funn may \m> found in unni- 
detached mwaes a<lheront ttt the Hurface of the pulp-cJivity, 
bdJ ia /nrfcctl/ dctiiabtid cphvrulcs in tbo eubstancti of the 




Tm DKSTAU TIBflVBB. 



283 



fc«lf. in the tocth of nilulu. In the lattrr aitiiatictu 
3iUi» am vurj abiUMlant iu toelh vrbtcti Imvu been 
«»».-l b}- a cmrks ; and Ur. 8»lt«r apt>»nt to consider tho 
jffcsciwe of tliB deUchcd tiiuweA of dnitint! in thp pulp as the 
ooosr>pi(mcc of dnoiutc. I do not think thia view U qmto 
Ccirrert, lur in three uut i>r five iqiecimeDB of pvrfi-L-lljr sound 
moEiir t«ctb rcmorod from Bubje<-ta in the j>ott-)norttm room 
of ibe buopitol, I found globulnr ni«ssofl of dentine within tbe 
flnbetaiioe of lh« ptilp^ Again, in tLo developing te«th of 
taiuuuuita. tbcae ^tubular nuwHC« aro HUliterod freoly thnngh 
Ibt dentinal palp, and u ouificaiioo advoncw, becoDM sot- 
rounded by, uud luet in, tli» i;ouerul uinjM uf tliu dentine, tf 
Uu Boriace of tho pulp^cavity of a partly-fonnod tooth of a 
ruminant he exanilncil, ibo ^lubulos will \x found embedded 
ki vortouB depths iu (h« subsuuco uf the dfutlne. ICeura. 
Uobia ami M)i)^u>t call attvntion to the tx^islcuce of small 
iauktod atlcon'ouH i^nulca of sphoroldai rorai, which iire t» 
b« found In oonaiderable Diimben icattered through ibe 
^^ snhRtanre of the iMtI{i at an eariy period of dentine dovelop- 
^1 nietil ; Lhi-y Itare alio been daicrilied by Henle and otben in 
^H thetMthof man, aswellas inthow of nimiuanlAaiul rodcnta, 
^B and they taay b« found at all poriodit of dvvelupujvut, aa w«U 
~ aa in ftiinli lot-th. 

SuuieUineB, liuwercr, tbecMlBsocnceofthaglolnilea fonned 

in derolofiing dentine only taliei place imperfn-tly ; thai la 

lo ••}'. contigooua globutw rnity oalewe in mch a way aa to 

out otf and iaoUto a portion of Ute formed ouitrix vrhicb baa 

|^_ not as yet been imimfrnnled with wtlta. When the tooth is 

^B dried the soft matrix which had occupie'l this aituatloD dries 

^H op and afarinkfi so that a nunv ur less im^^alar cavity, hxdc- 

^H fl^ black, from iu containing air, ia left. 

^H Tbeae esTiUiii are known as "inter^Iobntar" Kpooca. and 

^H mra ao dcMribvd by Cxeruiak (14) ; they may Im excellently 

^H fren in iwtb which bavo brea reudcrtd tranfilncpnt by hoil- 

^H_m in wa^. In tho specimen borv fignrwl (which lias been 

^^^^jirvpared) it may be ««cd that the wallc of (he csTit; ate 



234 



A 8TOTUI or DEVTAL SVHGEBT. 



mndo up of ^ubultm, «ud that i(» im^Uu- form with pn>- 
OHMS running ont Trotn it U rvfenble merely to the fitct that 
intenajacos am hd 1>etweoii a uutnber nf unyieldiug spUorical 
nuusM. 

As han ntrrady bnen menttnned, in the fresh slAtu these 
eaviticH are not emptr, Ixit &re occupied l>y formed structnntl 
matrix wlii<-li has not. btfin as ynt cnldtied. As niiglit be 
oxpecteil, thvrefvre, the tulx-8 and their contents paM across 
the sfwiM witlioiit any interruptkia in tlioir continuity. 
Tlia Eofl iitattix which iitU the interglobular space may he 

tig. IN. 




"lightly stained by prolongwl sonking of a fresh tooth in I>t 
BcaLc*B cnrtninD fluid, and it diflfors (timi (Iii; stirrouDdiui: 
QUtriic which has been impre-gnntcd uilh lime in salt«, in 
Uint it is more nuiHtjkni to the action of lu^iils. Like tlie 
denllual oheatlia, i\w lininj^ of Mavcniau canuls, or th« 
eDcsfiHult-d lat'tinfp of conieuluni, the soft contents of the 
l^pncc may ho ieulatcd by nmn-nitiuo of tho tooth ia ai:id» ; 
id thrry present na n-iili nnotbiT example of thai rcranrkahle 
kBuinil tratibfiirmatiou which tissue undvr^uos imuiodiatt'ty 
hum tho d<.'poi)itioaof Utuc salts, coDfcrriug on tl<o ifiriictun-s 




m BKHTAL ravuM. 



lifttcily (m t)ie verge iif mlnifioiition siicli ft rera&rknblc 
powtr oC re>>ieiiTig re-ageuU. 

OonskinuDy, l)»vevi.T. tlir contenut or tbc 8]«ce appear to 
tindcieo calcificalion at a jjcHmI HulnmiiiKiit to itx ronuatjou, 
■nii thiH il'x-s nut liare (liu dTocc or «atin-ly oblitcnitiiig kU 
tnoos (if iu origitka) coatour. 

In thre vny an sppt.'aranoc may be prodncod exceedingly 
fOggeativii Qf portkiits uf areolar tipsae liavin;; beooiuo in- 
TtdvHl in tbo calcifyitiff prcictiiw; hut the more probobla 
explAnmtion of tbo Api>CAni)iPe is tiiat ait kiti'i^lobuUr space 
Idm hMO (isnned, and juibso^nently obliterated by th« further 
pmgniss of calfificBiiuu. 

Ju tl)« neighbtrarhooil of w-i<U-inBrk«d iiit«TgIohular spaoee, 
mora or lem diBtinctly du&ucxl, globular forms may almnst 
timyt be traced. 

TecUi in which globtilw and interglobular ii|<acics abound 
atiSer very rapid dmtructiou when attackod by caries — & 
raault which ia oonw<)uent upoo thd porons etata of the 
'(i«Q«; bat they prasont cotuidcrablo rariatjoiis in thia 
ntpoet, thoM t«eth which presctit the appearance which 
Ini baen dmcribud as areolar dentinu, onen poitseeaJng great 
panrcn of resutance, so that the ])rogrus of cariM in audi 
toeth is sluw, ratlior llinu ulbi^rnnEc 

AUlioiijch tJio preacDce of dufecla ia the structure of tlwi 
dotitiiM no doubt oantriluiteit to hasten the dcstnictiun of 
teeth when attacked by caries yet, as a predis{>o»inx cauae, 
thrj are wcondnry in ini[)ortnnc<! to nimilnr fiuiltt in the 
ocpuuzati^u of the onnmuL Sufficient imivriutcv, however, 
•tUcbcs to the dcpartiim from the nonnol condition of tho 
(lantinr. to rnnder it di-airablo lliat Mtao account should be 
giY«n of the characters by which soeb dcparturea are dit- 
tinguiflheil. 

Whrn the orgauization ia fXTfect, the tubdi^udooa of the 

;4laDtlaal tubes pnu np to Uto liutxirjiinctiun fanui^d Iwtwecn 

llw (nnar anrraoe of the eiianigl and tbo onti-r surface o( thv 

lientine, the inttrtubulor tissue being at this punt okar and 



286 



A BT8TKII or DKSTAL BCBOBRT. 



tiaiia|)QRiit la loa petf«ct toetb the clii&raofti aiHl trnDS- 
pftrciM7 nrc roplACl^4l bv a ^onlar conditkin of tbc tiuue ; 
gnaules, or spberulev, or miaute globulw, alchougti unite<i, 
jret nUin aoiue TracM or tbeir indivHiDalily. and among tht«« 
ttie coroiiiU driilinnl tubes uie \v«U TLis ouiiditioti, in a 
ffwticT or teas degree, U almost uoiforiuly present in ilie 
peritiheral portwn of tlwtiL-utiucof tlioitxjt ; butits.fxisU-ncc 
in the orowo o( the tooth muat be ragankd u an indicattua 
of fimlty dovclD|imcot. In Mx-kiuf; to cxplaio the canw o( 
lliU gnmular coDditiun, Mr. Itaiuio (if I liave re*d liis pa|i.T 
CtKTvotly) wuutil ri^gnrd Uiu [4icuomi-u(iu im nimUiug fnmi an 
amat in the coalescence of tbedentinal globulca ; attd tliis U 
pTobably the true iTS|»latuitioti or the r«-t, Iho so-callMl 
jnHoaW kjrer, which underhe* the cem«iitum in tlie &n^», 
being made ap of a grckt number of minute interglobular 

An; change id tbe direction of greater porfiMty of tlie 
dental tiiutieH, may be rcoarded ar favourable to tbe de- 
atruction uf teeth, 8Qp[w«ug them to bv attached by caries ; 
and it in only ui such forma of dcjjarturo from the Dorroal 
atate of tlio tiaiue that atleiitron DC«d be directed. Under 
ordinary circum&tanciM, thu di-tital lubea dimiuisb filightly 
in diaiiiVftiT a» they approocb tbe iwijiheRil t>urtion ol' like 
crown of the tooth, bat it will iu (tome specimras be seen 
that to (laninK au iDterglnbidajr apace they ore coruridenbly 
<iilat«d. Aisnin, the tenoinal coronal brancbea, iostfad of 
tcrtiiiimtiiig by auaatomoaia, or by U-coiuinjt imverceE-tibly 
minute. luay paat into small iireguUr cavities situated near 
tlie flurfat-'e of tlic donttiic. 

In a wiH-devclo^«d tooth a certain number uf tbe dentiiuil 
tubea will be accn to paan across the line which marks the 
junction of the enamel and the dentine, without siiffeiiii); 
any incrcAW! in size, and after procvnliug a short diclance in 
tbe furuivi li&true, become extxvucly minute and are liwt. 
Dnt in leeth of lau perfect o^aoizatkn th« dentinal tubes, 
after laanog into the enamel, beoonw auddenljr dilated into 



TaC OKXTAJ. TIfiSCBS. 



287 



lively liic;:u eluttpited cariitra, miicwlint irregular in 

.buiUiltmhlyuuiforiu ia tiitirdirwliwu^'). Wiliioul 

'fuUowiag dowlr tbe oaane of the enaiu«-L Bbrcs, Ibcv bnre 

A gif)«nkl tlireclioa luwuUs the mriiuw of lht< tuutb, moA 

termtiiatc »hni{4)y «fu-r a<]Tnncing hilt nbhurt dUtAiice into 

the tuhnuutw ai titar tiMiir. 

Many xtliur lU'riniions frora that which mtut be regarded 
U lliv uiiniiul iurm of the dcatioul tuber, have }>een already 
el«cril«l(*X *i"l Ta\tl\i\ now be eaumemted, but tliat tbey 
for tlm liiottl port arv ntriclly local, lieiitg often con&nvd (o a 
tubes, and nre coD»e(| neatly inca{iftbl« of exertiiu; any 
icftce npm ilio Iwtb in whirb itiey ocoir, henuo Ibe 
iiivQ dues uot £iU M-ithtn the soupe of Uie Tireaont 

l*ha Mruciitro or (be cemeotuui wIU be dvacribed bcfur* 
tfcatin;; up<in its discmu^s. 

Tlio Mriiutur* of the ennmcl and the dtsiiliuti has bfcn 
enterrd into at wnie length, prior to trtatiiig upua th« 
iliacMi4 to wiiich Utvy am Mibjit:i,ou iLo eii|)[MiBitKiii tliitt 
tfio UTi^uiiuttiun of a lort ;di»uld b« kept ckurly in riew 
whu an attrmpt ia tondfi to appntoiate the nature at its 
IdiauMa. 

The most appan-nt defwt in the onatnel ia tliat iu which 
I tbt surfaoo ia irrvguloi. eitlitr from tlie preseucc of nuiuerutu 
I piu, or iiiiieut«tliiiiti,or of deep itmnsvorae grooves, Uiu InUjr- 
'ratiicg parta beiDg nonno] ia nppuamaoe. In cither case tba 
[(lotrci may he mth«r in qunnlity tliun in iJio quality of the 
tuauc. allhwub in thv UUIcr nviwct the or;^anizatiuii may 
alsD be imprrlivt. Te^tli preaentinz tiiich cbnracu^ra are 
|0[itninoiily •|iul>i>ii uf as hurivycunilmL Tbey frequently 
tlteuhtar cnloiir anrl the wini-transparency of healthy 
(Wbkh is eul)Ktitui«l a diUl yellow appeumnw, 
idee of colour Ui'ia^ cunfiiuil la the d^meaafrd 
(•1 Vnhmm KHIIbT t'vnk m rMtlknt Ofon of nA (vrWw Ui hU work 
'li liMnni an tliaui nj^Uoff and Satt^j. 





28B 




HtKTKlf or DKXT&L SCBOEmT. 



portions of the enamel. If ■ n-etiun he made rnrni a looth 
whtcli jireMUlB lliese vKU-rtml characters, it will he »eea ih&t 
th« AurfACC of tho drattne doos not nccPiUArily devjau from 
tiiv UHHul form, but tl;at irrt-gulHrily in tbiukDeM is ojnliaed 
tu tlia onutncl whfcti IW upou ii; »t omt |v>irti tho dentine 
will 8(]]i|}i>rl uLily a tliiii uiul [)tTbiL))s iuijwrfuctly dowlupud 
kyvr; at aootbor, a couittdcrablc depth of wcll-funnM 
eniunel. 

Ill teeth wbich are (trooveil nnly while th« natural ciilour 
is maintainM, it may be foiind that the duviatiiu) finra the 
uprmat CH>ii<!itioa ia cou5ufd to alceroatiooit iu tb<- qitnutliy 
of the tit^iie, the iwiural oliancU-rs, u res]wcLi the sinicuire 
of tbo oiiatnol, being prevervod throtit^liout. But it i« 
frcijuontly sci-n, that ia ibo dwficr ]ioni<jii« of ib« gpwvtw 
tho I'oloiir Oilfurs froiu tliat wiiicU obtaius in tht coutiguoiis 
healthy Blnicturo. In tbia, as in the case of iJip hotii'y* 
oomhed te«tb, tbt- abnotmal colour indicates &deltH:t ia the 
Strocture. 

U has bvea stated, that irregularity in Ihn snrface of Uie 
eiuiin«l dooa not imply a corrvs{)OQdiDg invuularity in the 
surface of tho dcutiiiu ; under unliniiry oiri-unutniivcs, tlic 
eUvfttioiiB aod the depreatioux on the surface of the crown, 
have counteqtarta on tJie aurfacD of iho aubjaceut deDline, 
differing only ia tlii- extent of Cbo elevation. The eoanuil 
attaining its maximum thickness aver thoSH farta of the 
tooth wLicb arc luost prumiiieut, cousequeutly breaks lli« 
parallelism of the lines formed by thi^ ttiirCnoes of the two 
tissui's. AUbuu^ib this is the geuerftl rule, mauy cases will 
\x seen in which the surfaoc of the dentiut' pn-wiits the 
usual form, whjlu the enamel, from diik-ct uf qiianlity, fnils 
to coulribiitc its sliaru In buildiii;; ii[> thu cronn of ibe loc^tb; 
tnA tht; CUS)« of tho oioUirs aru omseci'iently ^tuuLed. 

On tlio uthiT band, the Biirface of the dentine nwy deviate 
from the natural c<»ifurmatiuQ; tlie mrislicaiiuj^ sorfnoes uf 
tliii molar toeth may be flattimcd, or dm ciups may be thin 
•od speai^eJuipei], as though ^iuchcd dat, aud thi; incisors 




DBKTAL TISBCE8. :£ev 

m&y bav« the wamc outnpraMed fona. In alt such cases the 
enamul will be defective in amnnnt and irregiilnr in iu 
dictributioD. The cuoe nose which influeDced tb« devflof^ 
rooat of the dentiofl on tho surfaca of the tooth, will have 
equally inSoeDccd that portJoD of the enunol which lies in 
ctmtael vilh the dentitie. Uiul the furmftftkn of thu Kupcr- 
fioial ]iortioa of tli« deotino hcea ocmutl, tb« eoamol, which 
is devebped npon its snrfsce so sood sa that surface is kmaal 
to nodve it,waold have been free from defect, although moK' 
ext^mnl jiortJona, formed at a later perioO, mt^ht have been 
tldcctiTC. 

There Is another form of defect in quantity. A molar 
tooth may prcwut to the naked eye all the appearances of a 
well-dcretopcd org&n, anJ yot the eoamel may be Imperfect, 
and the imperfection may bu in such a funo ns tu iiiHuru the 
early loasof the tooth. From the naturftl cirprvssions wliich 
se|nntcd ths ooeps of molar tpeth, minute Imt deep KRXDres 
may ba extended through the enamel to wUbiu a short dia- 
taooo of tho dentine, and Ibey may bwome larger sk Diey 
needs from the anrf^ of tho tooth. In most cases which L 
Imvo examiDed, they have been filled with ocmmtiim, or 
nther with that modification of cementom which oonstitutta 
Nasmyth's mfonhnne, and very communly they become the 
*eaturcarMi(l-'ig.l3i). 

Tbew minute crevicei*, the, existence of which in many 
tetth an ordinary examioation woold not lead one to anspect, 
n» constantly met with in connectioo with thoae fomiB of 
(lefK-iivD ciiaiiHil which liavc been already described. 

Itkdcpendont of the <(uaatJty, the ({naUty of ttio tivne may 
be defective, and eomtequtuilly niiablo to ro«i8t tho influence 
ofageuta calculated to injnre the tonih. Tlie account wlti^-h 
has been pxen of the Ktmcturo and deTelopmeut i>f (he 
idiainel will, though in a histological point of view vrry 
imperfect, be «uliioieot to reoder intelliphle that ^hich bas 
lo be laid on the iml^ect of imtierlwtioit in the organizatiou 
kteuei 



■J 



290 



A STBm OP DEHTAL SmJBBY. 



The Bliroua clmrnctor of the enamel, which in the perftot 
lissue is lost bv tbe blending or fnnon of the sheaths uf the 
oolumiu of the «iiiunel-[>tilp ■□ Uib |mioe« of calciticiitiont 
may bo pemumvatl}- mauitaiiwd. Each fibre may to a 
eonuclen'blo extect pmHsrre its ittdiTiiJiiality, n condjtioti 
irhich givGA an o^nqoe appcarawc U> th« tiBKiie, and at the 

*tB.l>4.(l) 




sxnie time greatly iiniiairs iti< strength. The fikuuH cbu- 
racler rony prevnjl in ccrtnin pftriK of a tonth, or it tnay 
extend through Uib whol« of tLi* etminol. More commonly, 
howeiw, it will bo etcn in lints putrnllir), not with the 
aurfiwK of the wuiucol or of the deoUoe, hnt with thv liov of 

RTOWth. 

The fusiuu of Ihu ulieallw wf the orfKinftl fihiw may, 
however, be perfect, whil* the central imrtiuDH or contents, 

0) Sbon'a Oetp tmvn la Urn Munii Invbl^l* to ih* ubIwI tyr. T\» 
Mctlon wu uKrti from ■ fli*! prnnanmt molar <ir(I>a IowvtJkw, mum-iil raoa 
iifttf lu craptkn. 



A 



H^ tat 



TOB DEHTAi. TlSanS. 



231 



I 
I 



may bare fiiUaa ■bort of perfiect devdopmetit la the i>Uci! 
of bimlr-inari»d striation, we maj lii>d i'ith«r jicmlU'l naiea 
of woll-ilefined Totuided tuassee, as abowo iii ¥i^ 11^4, <a a 
Uae of fiae ^nuleau Again, mioate cafitic* anan^ in 
singiv linra may occapj the oontrea of tlic fibrcR, aiul in soiuu 
(vw CMw I havi> won by tLe coi)J]u«d» of ■ Hriea, a tube 
pnxltumL 

llie foregoing coadJUona loay tw puuietitucs fmind in 
patcliw aiuuuj^A tba uonnal tuaiw of (M-tb wbich have iba 
ganaral appoorutce of being pcrfvctly <lovclupe(] ; but when 
tbe Mianwl is oliviotiHly imperfect, ami ptvacnia ttie buney- 
oombed obaractu, tbe stnictunl delettts will be muob more 
generally difTiiBeid. 

Not uuly may tbe furiou of the stiealhs be iinperliDCt, and 
Um cvDUal portions of the fibre fall abort of tbe noruul 
oooditiona, but ori-n th« arrangenuDt of tbe elements of tbe 
liuue be lout. Both tbe longitudinal and trouxvcrM) marking 
may be replaced by a general gmnnlnr condition, as though 
tba tiasue bad been foruuxl by tbv calcification ofunarranged 
spherical nuuaea, abmil the siie of bluod-globntes, with 
iwrhaps bare and there a cavity of irregular form inter- 
poaod. 

Id tbe moat perfectly derelnped enamel, tbe longitudinal 
and the tnuuverM nuvkingi an oomparativriy bini. and 
tinder a high magnifying power witb a good light, thpy 
■ppaar, not as dark, but as tijcht lines, corlosing spaces which 
an ooonpied by a inAt^rrial which is s little moro dense or 
opaque than that which fi-rma the lines. Any departure 
from this ounditiun may be justly reRanled as a predisposing 
cause of caries, tbe dsigrM of predisposition bt'lni; propt^ivned 
to tbe relativD umuuni of iNinisity in thu tissue. In the 
foreuioeL nuk, as a iiredis]»sing cause, must l» placed the 
dnep but miunie finuras fuand un tbe niasticatiog surface <if 
uiuUr tcetli ; and next iu order, tbe imperfiwt fuaton of tfao 
abeatha, and the roiuu^oent rot^ntinn of ibt fitinms stale of 
the atuutivl v.< fniiiiautly awn on Lh« sides uf lei-tb. 



292 



A 9T8TBH OF DHNTAL BmcGGRY. 



t 



Many oiIkt htructoral lioPecta in tbc tiiamel Blight b* 
noticed here, but, inasmuch aa they have no very practical 
bearing, want 'jf s{4ce fotbida their introduction. 

The ciifcio relation which cxiatfi between conBtitutional 
conditions aiil iniperfecL deveJopment of the teeth ia ofteta 
exceedingly Li>'nrly indicated by the four first penoanont 
molars, which, Ix^ing iimultnneously developed, all present in 
an extreniii di^rea tb« character of hoDoycombetl reeth, 
whilst the other teeth in the same mouth arc well fnrmed. 




b 



CARIES. 



Tne coain&l And the (tcntino are the liuaoa which arv 
moro eupGoinJIy liiihle to be affected by conoa. In tbem tbv 
prooeM of <l«8l3iictioD commenoM. Th« ducaw may oxlcod 
t(v or TMf vetm ixnamsiuM In, the oemeDtnin ia Isetli from thv 
neokf of which th« [irolecting gum tuu bwa rcmored. But 
iheae are ez<x.'|itiutuil cium.«; wv muy tlierL-fura, for the (ire- 
BDM, tnat of Ute diasMc as »d aflinotion of the enamel and 
deatiDG only, Icaviog (or fatxue coDxidonttoa the nmiit« 
wliicb folluw whuii the ilinwim bacomet complicated by ex- 
tetkdiog w (ar into lh« tooth as to lay op«n th« {Nilp-oiTity, 
aad iurulvv the pulp itaolf in rapid cktitriicLiuu ur in chronic 
disease. 

Although dental cahtt has bceu investigated anddeacribed 
hf all vbo havv written apon tho sabject of dental surgery, 
(mm Iha cailieat pufiod when disoiders of th« teeth fim 
attracted sttcntton down to the prcacnt time, yet it can 
Bcaioely be eaid that the nature of the disease is perfectly 
understood ; for eren now two hypotheses preraiL In one, 
the disMae is afaiinied tn lie no disease whaterer, but merely 
tiu teault of chemical soltUioo of the dental disiMs, and tfaete< 
for* dependent, both in its origin and its progreaa, on cite 
tUMwntroUfld action of phydcal and chemical laws. 

Aeeordlug to tho other bypothe«i8,che fact that leoth ore 
put of a living organism, if not eueuttot to the o«^d of the- 
mischief, at all events profcnndly modiEoa ttt pni|pwi. 
Unfih hat betti writteA la broiir of ricfa of thm rltwi^ and 



294 



A SYBTKH or DBXTAI. flrHQKBr. 



jret the subject canQol by miy mcana bo held Ui lie Bettled. 
A* it would bo inipoBaiblo to aimiiiMU'ue uid criticiM the 
views odvAnced by (be numeroufi HnglUli nod foreign atttho- 
ritie« who hiive contributed to the literature of the subject, 
witbciitl iiiululy encumbering the t«xt.ftriil m, at ilic •aioej 
time, the present volume would be incomplete without sue 
• eh&pter, U w thought desirable to niibutly iIkiw thmriM] 
tloal cooRJdontions in the Torni of mn Ap[)e[i<i)x, moreljl 
giving hcrfl iu thu t«xt ■ brief nccoout of Ihu ■(■puaxmneca 
ftctually observed. 

I'be {ihvHioal fit)^is which niHrk tlio pn.'suDCv uf caries ac*.l 
first vi»ible iu or through thfl onameL But ihey will vary 
autuflwiiat iti wcxirdaiiCL' with thu chamutvr of tlfu Hurfaco 
affected. If the diaease arises In a Gssare on the muticatlng 
!inrrari>, or in a ilo[M-cKsion on the crown of a tooih, a dark*) 
coloured spot will be the first indication of ila preaeuoe ; bat 
if the diceiue hsu* attacked a atirfaco free fnmi any indflnlatioo 
or fianuv, tli« atToctcd jiart will lost- its tnLnsluiiency, and 
btoonia ojNiqao andwhito: Rtibaeqacnlly tho white will be 
'jooceaded by an aflh nr !t|iit<^, ami tinallr by a hmwn rxtlaor, 
[nun or less deep. If the enutnel be examined when in tho 
LrliiT stages of diaeaae, it wilJ be faiiud tlmi the prcMocc oEj 
'opftcitj' is accompaalcd^ and no doubt occasioned, by an in- 
' oroawd ponMnty of tliv tiaaue, a uunditiuii wbitib hu» auccuede 
to one of tlio forma of imperfect development already do* 
scriheil. Rithcr the union Ijetwecu tba sheatlis of tlie forma- 
Ut« Gbnn haa Uku imperfuct, aud the atrictly fibrous^ 
< ooodiuon liBK iwcm mnintajiuyl until, nndcr the iotiucnce 
diieoee, liie unwn, at beat but iiiiperficl, becotnes HUlliL-iuiitt^l 
iutemiptod to give 0{>actty to tho pnrtd ; or thi' panuli 
eonditiou previoosly alluded to hits Uxu continu<xl,aitd thus 
rendered the llsano aiiaocprihl>a to infliicncea wliich would 
bave failed to produce any iujurioux effects had tho ur,9uii- i 
cation been mom porfoct. 'I'hoprodiapoaiutc cAUBeAtodiseam] 
haTO, however, been described in ooniiociion with the Htnio- f 
tore and the develt^mant of the eoameU nud the deacripUoa 



OA&IKS. 



Dfladnotbo rcpMtod. After iwt^aiBingadUtiaotiiMibclwmi 
the c«Dtrat and the ext«nul portion* of the so-called fibm, 
and the toon rapid notioD of » nioenl add apon the 
aoataiiwd than optm ttiu ooulAiniiii; part, it may reuMuUy 
be expeotod that wme nich itiHrri'inM would Iw ohsrmd 
in iiiauitl wLtm Uud«;gaiiig ohaui^ (rum tbu actjoii of 
tliwMse. It would be moirt difficult to ubtaja u trAtutvcrwt 
notion of Muuniil wliich has buea Babfoot to t^u diaoitH 
prudnced by cariea, bat wc may, by bnaking down npoa a 
gbaa idide ftagtiuffita of iho brittle and chalk-like enamel 
tAkon froDi a cahoiu totrih, {soduoe a lafBcientJT ntiefaciury 
preparatixti f«r demonfltnting tbe fact that the oentral 
portion of tlic tibre U tbe Ant to mffer decompooition, mncli 
in Lhv HBiur moaner aa when thu dntrurtive ajtenl m iaU-n- 
tJonally appliwl to a section prepared for experimeotJil 
treatment. 

Hm fimgoang dneriptioa a|iplie« tu tiuiaa cam whare tjie 
ii U m— a "bam oDmiaeDoed ti}ioa a a nf&cc free from dqnwMotiB, 
and extended throu^ the porotu enamd into the doatinc. 
Not that tlio procvaB of decay matcrinlly drfleni in cou- 
foniiity with the character of tbe furlaoe nttAcked. bat the 
progren ia aomewhat variod, both in rMpect to the dirertinu 
io wludi the disesae extends, and lu the rale of destmctiou. 
When tbe dJaoaao la calabliabei] in a fisHurc, thi« indinitioiix 
of its praenoe are not strcmgly pnmuuncod, until a rery am- 
odenblo amount of deiitriction luu )ioen pnjdeced. A ccn- 
saqacnoe which rDsnll« fr^m the di«a»e baTJog extended into 
tbe dentini', peoelT&tiiig to a oonsidcnible depth in the direc- 
tion »r Lhf tnliM, and spreading bitemlly nnder the enamel, 
without affecting lu outer nir&oe : with the softening of the 
dentiDP. the Inner stiHace of the enamel becomes aoftenetl 
from witbln, until the tooth at that point is so much redoced 
lo ftnvgth that the enamel breaka in, aud suddenly reveals a 
LarK*> ^nd aeaniely suspected cavity. 

Kiir the rotivemeDoo of deacriptlon, tbe diieiuo, when it 
otHnuuvB this furm, may be termed pnwtraling earie^ n- 



b& 




W7^- 



396 



A 8T8TEM OF DENTAL KtmOBBV. 



serving the term*, iprradlng caries, for the form prorlously 
described. 

As rospocu the deotiae, the ppogre« gf decay does not 
foUour the same oonnie ns thnt which haa be<>n described iu 
rvferoQoe to tho enftmel It will be r»meraberod tliAt tb« 
dentine is formed fmm rytindncJil celLm, or rods, of the 
donlinal pulp, the individuality of which i« lost in the 
liracass of caldBcntion, ]f tre take n thin section finni n 
vaiiaiu tooth, it may be seen, in thom i«rU of the pniNmtioci 
w])«r6 the tubes ato divided tranaverRely, that each tube t5 
muTOundvd by a t'ory thick r^eath — the diseoHed condilioa 




has in a measure undone the wotIl of developmaot and 
thrown light on the queiitiun how this waa cfTectctl ; it may 
ftlinoxt bo said to have rsMorctl the outline nf the fomiative- 
uelU — the tiMUo la to a certain i^xteni hmkcn up into it« 
histological elomonta. Uudur tlio miuru)«cu|>o tlio sucliim 
lookA as thongh it might have 'bwa bailt up of multitndes of 
tobacoo-pi)>e Htenis, unittHl by uii iiiturvcnia|> Eiibfltanoe. 
Hncb lit the condition when disorganization baa advanced up 
to a certain point ; at a later period Rhort Ifitigthn of the vails 
of tlie tubes (lientiHal iheaih, tahatc&cidat qf Neumann) are 

(I) A KCllHl frOM iSMIUII* MdAMd bf OUte |bOWtll« UlO C<niMUl4l«ll 

dtnUul uki tad ltafl» Ml tnmvtntlr. 



OAUIB, 



997 



'fcood iioliit«d; and fltuUjr Uia whole time braaks down 
Into minute gmnalar pwiiclee, which ure hy degren 
may in the aaliTa. 

The fimt chemical change foiuuBte in Iho removal of the 
limifr-aalu from the gelatinb, leavb^ th« doatiud of a con- 
instance opAble of being nwlily cut with a sharp knife, when 
It will bo found to exhibit tine structural charsvters Jiut de- 
leribed. It might be sappoeed thnt siinilar rvsulta would be 
prodtKed from dMalcilyi&g a touth by the aid of a dilut«^ 
ndnenl acid ; mob, bowerer, has not been the csae iu ez} 
rimenta iiiBtitiitcd with tbo view of d«t«rmimng the 
Indeed, I know of no artificial tncwia whereby tbe vf 
aiiccs whiirh have been described cmn be aa fully brought out 
, M by the progreM of diaeaae. Tbe qnuitioa Datnrallj 
I waggeata itulf, may not tha «i^)cubuc« of dcatioal rods bttJ 
BoUiing more than a oertaio ata(i;u in [irogrowivo ducompovj 
ntion, duo to a wilvent Htiid obtaining aooeSA to the 
Uuoogh the tubas, and tbe outline of «ach rod be indicstiTtf 
only of tbe doptb to which the fluid bos pcnueated ? 

As a nutter of bet tb<^< ouuDMLiug material is tbe first, i 

t-the valU of tha tubea the tut, tobeoomsdiiintegnted; 

'Ihia, prerioHs to the diacovcry by Neumann of the rery in- 

' doatructible nature of the daotinal abnthaf aeemed to anawor 

the qumtion -q the negative. Knowing, howfnr«r, aa w« ; 

do, what great (mwcis of ruaistanoe tbe wnlla of Ibe canaltf'' 

\ poaMN, this expLanatton of the tobacix>-pipe appearaoca ta 

^nnderod tu won probabla Oocasinnal exceptiiins to this 

■eqoeuce ofdiaor^niaation, will, howercr, be found in 

which are deatroycd with i^At rapidity. In them thu tul 

wiD appear to have become «ular|^ in the mnnutr figured ii 

my jtreviiMu work; and the distinction of the tubuUr sod 

iolertubular parts u( the tiwuee will be but faintly pnr- 

. Doaiwed, and indeed may l<c altop.-) her wanting. But iuppo*-j 

f{qg a aedian &vm a oanoui toatb iu which the deatructic 

jbaa been gmdnsl, be taken, the (ullowiu^ oooditions may 

L'tifaaarral : oommeocing at the part where the denthia 



398 



A ST8TEU OF DEHTAL BrilGEItT. 



kdU pcvtty iioarly lut aataml appvarancu, we them yarn to a 
point wltere tii« sppeuuDow depicuxl on tliti preceding {lage 
are iteen; still furChur (m, thui coudiiiuu Iwcuhiuh ycL ukiic 
Mrongly mfirkal ; and at (be extreme edge, supposiog the 
Mctiuu U) have astomloii to thv stirface uf Ihu cavity, the 
jcocew of (lidintc-KTiitJoti may be «ca. 

If the <leiital Ui\)ea bo isolfttiMi by the ajti^licaLinn of aritla, 
tbcy will often be found to prcftent vuricwitica and globular 
BwellingH. C) 

If a t<x4.h Id which the di*ea»e is Unill«<l in extent he 
divided, the relatinnitofthf dtses-swl to the lim1t.!iy)iitrt»iniiy 
1» axamioed. l'h« alTected duolixie will bu citbur <.>jia<iu« in 
appeanuioe, or it wilt have awuuud a browu culuui; and 
th«o ohangBB from the oondition of health will be taan 
oxtacd tmderneeth theenainel beynnd th« lituiui wliich liound 
the ixunal indicatJoas of diaeaw io that tituind. Dot it will 
be in the ilirrction of the dentinal tubes thnt tb« {li»CA»e will 
be fonnd to Iiavr maile tlio ^rutit«at pruKn'ss. Suppueiu;; Uii; 
diiMue to have coniin6mN>d njxiu tbo niiuticatiug eurlace ot 
A molar tootli, it will cuiiiiuualy bu fuund that thii nuua of 
diseased tissue, whea limited in anioimt, premoUi the shape 
of* oone, tbi! apes of which in directed townrdj the pal|> 
carity, aiid the Ittse towarda the ouamel. 

'Vhc Boctioo will ehcrn that the de«tnictivc agent, having 

gained aocoaa to tfafl dentitw through an opuning in the 

I CDBiiwU haa epnad, to a eertain extent^ upon the peripheral 

I nir&oe of the tisBUS, tbrauffh the tonninal bmnchea nf tba 

' tubes, and thus formctl the Laao of the cone ; but that it haa 

■provl 14 iL ^eater Icji^h in the oourw of the trunks of tba 

involved tubes following their ooDrerf;ent ooune towards tb«j 

(■) bdUmit tgw» tn ^vm of time Imdol, doagtud bodlH In Be 

aad WM\ Ada* utr I^thotaglt tkt Zatme. pan Ui. pp<. isa. sa s ud iW ' 

taCn 4(Kribe4 la WfdT* PsUwloilc dcr Zalino. la both pbumt. Iwirtinr, 

Uht aN dvNribid m " IX'utluHlbn'undlUr.*' ■ ir*Na Ik* nan mraalag 

, aUatWI to wbldi I do not know, tettaf thai Itt tliBtteae* p«ailr dttModa 

^an Dm tUw lield If Uw wHur of th« ilwr ukeii if Iha aanWblatU la tbt 

Jteauiknictifcailaa, uili4tlwn)tlnurtmictu:T-«f dsnllu. TbwU nl^ 

I Um dHiilaal Urtl, ^ht dcnitDal •tmih. ut both. 



0ABLU8. 



299 



pitlp-otrity, and thus produced the a^x of the cooe. But if 
ftQ example be talceD in which the Msenae hug AHumd Gf 
aprnailiiiu character, tbo cwutcal (onn of iliu tlisorgaoiSCd part 
will Im leu BtruDgty, if at all, prooounoed. Id oertain cuat, 
iudoofl, tile whole of tbc niuticating aarfiioe of a inular tooth 
bi Wl before the dlaeaM \i&i ailrauced to a siiQicit-nt depth 
in thu directioa of the pulp-cuTity to i:x]>o«l> its vasculnr 
c>ant«i)ts. Id the defectiT<> t«eth deecrihed im " boneyinuibed 
tcrth," Ihe diwiuie, after the Enamel haa beeo deetroyed and 
iho ilt>tituie rvtluued in tiiickncas, become* in oertain ctHs 
arre«t«d. 1*hc cxfiowrl tUxne Assumes a polisliod surface, deep 
browD culjjur, aud iicquirvs a d«UBit7 which l-ujUI«( Lh« crown, 
tilongb rJoprifw] uf 9naawl» to ktvc the purpose or niiuti- 
•eation with scarcely Ion effitijoccy thou aa uaiujurEHl 
touch. 

Coiucident with structnral chaniii^s in the dentine a certain 
aoMnuit of UDcauMiiBHS vxiste aud luarki^ lUtj pnatence of Uia 
fUnntun ; and of tbis we bare yet to speak. 

I beliovH it rarely liappMis that tbu |)reeonoe of caries In 
it* earlier stagos ia aito^her un9tt«nd*.-d by some uncaHinca 
in tbo affected toolh. Tbu amount is oi'ti^n wry slight, so 
alight^ lliat the attention will be directed to the part in thooo 
only who are in the habit of devoting considerable care to 
tht! prawrration of the teeth : on the other haiid, liiere are 
many who immediately rrcitgnixe the presence of divaso by 
tho diAonmfort it ocrawouK; and in except iuanl cbm-h the 
potienn deacribe the affected teeth as giving then) a coo- 
nderablu amuimt of pain lotig befuru tbc diseaw) has pro- 
freaaed to ao oxtent capable of dircclly iuTolving the pulp. 
Tootboclie of this duiscription must Ite distinguished from 
thaf which is conaequeiit iijun iu&amnmtioD of the pulp, 
whether resulting from e\)to«ure prndnced by caria^s, or 
aridtng from any other cause ; and. tho diatiactioiw may be 
made by observing the charactera of the pain. There is an 
abeeuee uf ibrohbiug, and a leu degroo of intcniiity as com- 
pared with that occasiaoed by Itiflammatioa <j( t^« \Ri*f^. 



A BTBTBM Or DKXTAt. SUItOEHT. 



' Bcntfl pretty narly it» luittini) afipeu&noe, we then paas to fti 
point wh9r« the A{>{>i-araDc«« <l«plct«ii on the proctding |wg« 
in BMa; Btill fnrtlii^r oa, UiU L-utitii(iu)i Iwoomee yet loora 
■tronf^j marked; and at the extreme edge, snppoting tho 
BMilion to have estendod tu the surface of tho cavity, tli^ 
process of difiiat^atioD may "be kod. 

It' tbfi iliintnl tnhts \k inolatcd by tho appliaition of acidS) 
tbey irill ofteo be Iband to pr«MQt rariooeitiet and globoUc 
■wellings. (') 

1/ a tooth In which tJio lUwase is litiut«i] io vxt«ut be 
divided, the nlat Jod« of the dismod tu the healthy i^rlii may 

tb» •xamioed. Th*.* alTti.-tcd JcatiDe will b» eithw u[iw|ua in 

[ ftf tpeanuico, or it will Iiavu afisumixl a browo colour; and 
th«M cliaiiges Etom the couditinti c>r health will he t!een ta^ 
<xt«nd undt^menth the enamel beyond tlic UmiU which lound 

[tbs axtentAl indicatiorm of diiiEgute in th&t tiaant^ But it will 
"be ID th« dirtv;tion of the HoiitiQal tubeH that Ih* disMW will 
bo fouixl to have iiiaili- tho greatest proKreBa^ Suppudog tho 
dlMMe to bar« couimcnced upon the ntasticatiof; iturface of 

hAtnalar lootJi, it will commonly bo found that the nusa of 

^dbtased tissue, whon liiuitt^d \a atnount, pretients the shape 
ofa ooa^ the ajiM!X ol' wliirh in directed towuda tho 2iu]l>- 
cavity, and the boas toward!* the eoamel. 

The BoctioD will abow tbfil the deslnictivp ageut, having 

. gained acceaa to th« dooliDe through an opening in the 
eiuaael, ha« Kprcad, tn a certain extent, upon the peripheral 
■ar&OR of the tiaau«, througli the terminal branches of the 
tube*, and thtu r^.iniifd tho batw of the oooe ; but that it baa 
Ipread to a greater luugth in the oonrae of the truiike of the 
involved txi\xs following that convergent ooono towudfl Ui« 

0) Exnlleat ripim art gtvn «f Hum bMdad. elongittd iMdiM tn ElaMv ' 
haad W«(II'* Allu tur IVbolosli- iltr TMuv^ pirt III.. p|k T>3, 01 ; and Ibqr jlt* 
ffnribar dncrlbnl In W«dl'» rilljulo«l« i\fr Zaliut. In both placw. liM*e*vr, 
Mbcy U* dncrtUid w " bmUii*illHil'«rUlt>«," a wont (b« Mtact nxuilFig 
tadwd Id wbtefa I <lo not knew, tidof OM \tt ^g-i*— — maUr iliiMaidB 
I tte vum IwU by Uw wrllv ef the Auv taken by Uie •daMilMU Id Un 
tlm of diMittiie. RQil vi Uir uitlttuto ttmciart o[ ieUiaw^ 'Hiut It migfal 
. lfaBdu]lJiudDt)dl.UicUtiitlu4l*lKaiti.vrlK){li. 



CAUIKlt. 



391 



pulp-cavitf , ftutl thus {>roduic«<l tht «pex of Ui« 



coae. Dut if 
disease haa asMtmed tbe 
RpnaiUiM cbftmct«T,Ute conical form of the diwNrgnnilted )i«rt 
will lap Itea ■troDsly, if at aII, prniK^tniMd. In cetlAhi cmsea, 
iUiWil, the whole vt tlie masticating atirfaoc uf a mutar louth 
ill tnst hcUin tlie disease haa adTaoced (o a BufGcii'Ot depth 
ID lilt) ilirpcliuu of ttw pulp-vavity lu vxpme ita vascular 
ooatontK. In tlw ilof«ctivi' twih dNcribvd as " boneycouilicd 
tocLh." Ihr dJMiue, aftur tbc mainel has lisen dKtniyn] and 
th« doutine pK)uc«d in tblckDMB, becomes in certaiQ CMH 
amntol. The expnsnl tissue annmea a puliiiliDd mtrfani, deep 
hrowo oc^oar,iuulaoqaircsad«tutitT which enablca the crowot 
though deprivnl cif enamel, to arrve the parpotw or masti- 
■mtlon with tcarceljr lew tfRavaay than an uuinjuied 
tooth. 

Coincident with utractnnU chaogea in tlie dcntinu a certain 
unoant of unnuinem exiiU and marki the pnMuoa of Uh 
diaeaae ; and of (liis wv have yet to Bpeuk. 

1 beliere it nrelj happens that tbe ))r«cuw of cariM tn 
iU earlier nlogee is altogether unallcndt^l by «ou>c unsouneaa 
in the afTccled looih. Tho nmount ia often tct7 tlight, w> 
■light, lh»t the alteuticm will be dinwted to the part in thusQ 
only who are iu the habit of davoting ounaidcrible caro to 
iha prtDCTvaiion of the t««lh t oD th« other hand, then are 
niAoy who inmiedtaUily rcongobe tha pneence of discaae by 
the iliKtimfurt it occMioos; and in excepiiooal caeca the 
paLiruta doBcrilw the offneted teetlt as giviuK thorn a con- 
(idenhle amount uf i«iD lon^; before ihv dlteafiu )ihs pro- 
pvaaed to au extunt capable of directly involving tho )iiil)). 
Tooihaob« of this d&M;n|<tion mu«t be di»UDguii)i](>d from 
ihaC which ia cu)>ei)uvnl nyua iuAnmnialJMii uf thf pulji, 
wfafltber nwultiog bvm exposure produced by carits, or 
arUinji; from any other caiwo ; and thu diittinvtioni may be 
nade by ubHTVitijj the chantotora of the [laiii. There iaan 
ahHMV i>f ihniUiing, and a h>a d^ircu i>f inl«iuity a» com- 
[ami with that oooaikiDod by indUumiattun uf tUe jmlp. 



IliflT^ 



-wTp-- .■ lanp m . 



^I^H^B 



A sirnm or nsMTAL svboxiiy. 



Contact urith hot or colJ Buids does not usually prodaoe 
any unpluuiaul eOect. 

I believe tito scat of pain to he mainly in the jwriiiheral 
portiuu of tbo doDtine, and that after tbe destruction of 
Titnlitj in tliU part of the tooUi liaa l«»n cnnipletcrf, the 
BenMtiuQ of dixcomfott iu i^reat jmrt paaws away. 

No doubt thiTc Arc caxeK in which the jweseiioc of carieg U ' 
UQBttBoded witli Hoy fccliuj; l-vcu of dignutnrurt, for vio find 
tboee in wbom the pulp Ix^comc^ exixMcd and dieappeare 
without a moment's toothache. If a jart endowed with 
vessels and nerves, and a very high degree of senidhility, 
can he dcutmyed without jain, as it were unconsciuuiiiy, it 
would ^x uorcMonablc to suppose that the dentine cannot 
nod'ei^ disiotcflTatiou witlioiit nianifesliii^ seiisntion. Why^ 
in oue person the destruction of a tooth should be attended 
with HO macii, and in aiiolh«T witli so little sun'rrin^, is a 
quvHtiuii wliicli we are aa Uttia able to answer, aa we are to 
Bccount for the great difference in susceptibility to thoxction , 
of rsmedioH, so fmiuently mauifwted in paUcuts in wbc 
iQch coQstitatiotutl pecuHaritieB can be discovered by ciport-] 
tneat only. 

Tbe dentinal fibrils are subject to a chan^ more or 1en-| 
c!otnpU-l«, the exiHlenco of whioh may be recognised even "by ' 
the naked eye. If we divide a sound tooth through its long ' 
axis, the deutiiio exposed by the scntinn will present ft tole*^ 
rably uniform dvgree of opacity ; but if tiie tooth has boon 
•ttockeil bycariod, in addilion to tbe diiKoluration ofthe|»rl; 
which has undergone chemical chan^ we liball find a com-, 
{larativcly tninB(iareat nuue ntmovwi a ah«rt distance from,' 
and suiTOunding the disorganiKing mass. If a tliiu Mvtinn 
be taken from the tooth, it may then bo seen that the trans- 
|)areuc;y is |irodticiil hy the air K-iiig lliuruu^^hly excluded 
horn the dentinal tubes in this part of the section. This 
seems to be due to the cunsulidation of tho dontiual filmli 
within the tubes, thereby obliterating the latter, and ren* 
dering their outline ob;»eure. The oonsolidated condition of 



OABIBS. 



801 



the fibrilB nwy, however, l>e shown in n moro ntis&etory 
ojanoer hy taking a tooth in which tiie iirogross or decay hu ' 
bc«n iikiw, Imviog tb« dlMrg&nijnng d«Dtiii« «f a doep brown 
^A>tour, iintl coniiArntivflly finii iii U-xltuv. If wo cut with a 
knifa a tbSn section in the direction tokca by tbo den* 
tubes biNU the diHColuurwl ixirtioii (ii the tooth be well 
i% the ooDsolidated fibrils will Iw Men within the 
tqfaeB broken abnijiUy iiitj) «hort lengtbs. Sometimoi tht.>y 
ftn preaent iu great oumben. Mattered orer tbe specimeni, 
aimy lying within the tubes, othi-rs upon tbe ftur&oe, and 

Kg. IM. (I) 




Jy they may bv m«q with one «nd pnijocting from' 
isdge of tha Bvvtioit. aud the othor within tbe tuLw. 
Ulds earaolidatjfpti of tbe BbriU neoeasarily exeroises a oon- 
abla influoocc b armtinft the prognaa of diBoan, by 

(>> A •NUan Id • pUnx wtth Ui* Mhm, ttam (wiow 4niUK ibMrln( 
iWiwUteUn or Om tbrlU, auM <d wbMi m aon snlMdaa fMa Uw Ma* 
: Ite lyitflami. wliUi otbm twn Imb brokw mxtku tkt tuim nd tn 



803 



A gTSTXU OP DEKTAL 8UB0BKT. 



reoderio]:; the d«ntiiM much more A&aao awl impervious thia 
wh<-*n iu tbe oonnal rMc Tbu eone of conschliilation onte ofT 
vid ivolstM ibe disease fixiiu the befthhy pottioD ol' tbe 
fontli, and iU pmductiou iiiiiHt ha re^ranled w an attempt oa 
the |)art of iiiitare to cipuauiMTibo and limit clio nujuhiof. 
That Uiia tnler[Tetation of the phenomenon is oarrcct, will 
Im torn on i-kftiiiiiiiu;! Icclli in which tho rato of prognwciva 
dwtruetiom haa %-aried, and »\m hy Cfinsidering the oondittooa 
praaenbed ia other tintiou v/hvax thoy an attickod Iry liica) 
disNMe. 

In reopect to tcuth, it will bo ^od tliat when the dentiiu 
fau been nk[)i4U7 dratroytNi — when, in Euct, the amount of 
vofteaiiig ie great, and tho tsxtcniu] iiiditiaUun but cuiiii«ra- 
tiT{>l>- alight — whi-n tlut which at fint sight would appear to 
an uiiacciistonied eyoa small cavity, is, on the removal of tbe 
disorganized ti^ue fotmd to be a very large cue; that the 
coniwIidfitiuD of the librilii hu ixeii iinj-orrcci, or ]>orli&]ii 
altugetlier waiitin;^ and that there is coJncideutly a hi^h 
degree of BCnutivoiicss under aperatiou. Again, ctimpare tlie 
furcf^uiu^ case with une in wliich tlie destmctioa lias beea 
ootnp&rnttvely nlow, and the cxtt!nt a( the diM>«ite more 
lirnititl, aud it will Uicii Im mxu that tlic ev)deiiix^i> of conto- 
lidalion are in Hk r-itiicr »-cry slijibt, in ilic Inttcr very 
ahumlant. It will, in fact, he fuDnd that tlM^ rate at wUich 
the diseafte advances will accord with the amount of omitoH- 
datioD. It must he banw in mind that tliD diniaae ia, for the 
present, regarded as Btrictly limited to thedenttue and eu&Licl, 
and t1iat the leeth arii! a&Hiimed to Ixe in an nlliemiHO limlthy 
coiidiLiou. WLifii tlie pulp becoineit exjioffd. or when the 
giiinti hare ri'ceilod luid espuHcd the neckx of the ti^elh, othur 
conditions ome into oporatioo, and modify the «yin])totH«. 

J'u what estcDt thin uhUt«rBliuu ul tlm tubes is tti be t«> 
garded ua & \ital action i.i a iiiieHtiun Uic^ diticiiiuiun oT which 
mnnt be deferred to the Appendix on the nature and cacws 
or dcutal caries. » 

Utmtu paper applied within th« cavity of t c&rious tooth 



CARtSS. 



808 



iDTariably Ktvet stionely-iiiarkcd id<l raaction, and 
ma ramiHhes eTidnnce of the existoace of an «^^t capable, 
if unrausUd by the rilality of the denlino, of dqiriviDf; tJiat 
tianie of ita oortfay gooatitoeDta, leaTW}; the gelatine to 
nodflfgo gradual deoomposition, bvoured by the boc and 
Dmirtiirt^ v>f tlie numtb. 

In examining the oremnstaMBt under wlitch Uw dMom- 
poaitioD uf tbi) dsntino tak«a pluoe, and uuder which iL is 
reaiit«d. apvt from the influenai of Titality, any one mnaC 
he struck with the iiower that is fxiT*ij>d by the more Cunn 
of the aur(ac« involved. Supposine the disease to be sitaat«d 
in » Atep fissure, or afnai the Bida at a Uwth, against which 
another iwtth Lt plaonl, the deoompoaiUou will go on wiUi 
more ur lou mpidity, ihe rate being Tarind in occorduico 
with tba Cunditifpn <if the onkl fluids. But if thb cavity be 
auperficial, and *o )ilai-<-<l that it in subject to friction during 
Olasticstkni, Ihe [vngroK i^ naually relalJTely slow; and if 
the low wall) of »ueh a cavity be removed, the port will 
boDome poliaherl by the act of niiwticatian and by iha 
notiOM of the toofcne, and deoompo^itiua will U ooo^ 
idetdy airvsUMl qniie indopeodenlly of any |x)w«r of f«eia^ - 
soce ezcrciMd by vital action. Again, let a tooth bo ptoMd 
undo* drcnmstances tbo opposite uf thv prcoedin;:. For 
example : take a bicuspid of the upper jaw, tbe diital nirfaoe 
nf which is di'caypd, and remove the wofUmeA dBDtine; theu 
let ^ry cottoa wuul be forced between the defcotive tooth 
and iu npi;:hhoMr, and rnnewed only oudg it; three or (aat 
kyit; aL Lliu end nt a torUiiiiht ur three weeks it will \m 

lod that the Kurface of the cavity which wa« left bard and 
after the fint operation, haa beoouui soft, and that tJie 
tBing extends to a coosid«rah)e depth. Hod the cotton, 
prior to itn intrnduction bctH-ecn the teeth, been dipped into 
a foliition of any resinoiia gum, vuch ax nia*tlc, the auiface 
o( Ihe rarity wonld have renmined unallerrd, owing to tbe 
■iKcltuioo of uoiatiiro. But where wout only in iiwd, the 

Bretkm of Uk niuiilh arr out only not excliidoi, but are 



sol 




STBTEll 07 VKmJOi STTItOSItY. 



tield in oonMaiil K])f)CttiLlou with ih« exposed dDntino tir 
ntumtcd wood. 

Kx[>criinenl« of this cIiAiacter lead to the eonclnsioQ that 
within the mouth ag«nt» at« preseot wliit-li, undrr f»Toi)ring 
cireutnirtancce, aro capable of decomposing tl\c dental liimies, 
aod the aourc« of tlwsc agfiits beauucs tb« oexl questioo 
which nntumllj suggcsta itwlf. 

TLo fl«m.-lio» frDin titc muL-oiu memVraDO Ih ordinnnly 
slightly acid, while the salivary fluid, when nonnal, I« allcalioe. 
The nssiilt nf Iho admixture of thcsi-, if LV]tiully prupurtbuHl, 
would Iw a neutral Iluid. In ccrlaiti conditions of hcfllth ercn 
the nnlirnC) in»y 1>e nrid, ivnd the mucua woukl llii;ii riitaJD 
it« urigiual ctiaracter al^r ibe mtxturo of (he two Suida. 
Ajtain, the iicgr«e of acidity of the niiicns may he iDoreased 
beyond tho uurtu&l aiuouut, aud lU U-uacity way enable it to 
RtnaiQ in ccrlnin eitiuitions untnixod, and conscquonily im« 
influenced hy the alkaline character of the sflUvary fluid. 
The quantity of the macns may be exdeesive dcher from a 
local or a gencrHl muse. We mrt nnwrnimonly iind in moiithe 
tenanted by rmmeroTis carious tccih, tho gntnH thickmed aod 
vascular, niid cu\Trcd with a coating of thick adiiesire mucna 
capable of being dtawn from Ui«? gnnia in long atHngs. A 
case Ih freah in my nicmury In which ih^.* tt'Cth wvnj niptdly 
deotroyed hy caries, ajid coincident with the di?etrucii7fl 
|in>oe8B the Ntlirary fluid was scanLy in auiuuut. Tbn mniith 
owed it« moisture to the secretion of the mucous membrnno. 
The patient complainetl of great diHcontfort from the dry 
aod clammy condition of the mouth and throat. The ti-etb 
iKal were firnt loet decayed in those Ritxtationn in which wo 
iiBnally cx[wct caries to show itaelf ; but at a later fieriod the 
whole of the remaining teeth were alniust sitiiultaDcouidy 
attacked near tha edge of the gum. producing round each 
tooth an annular Iwlt of soHencd liuuc. The ]«lii-nt suffered 
from long-standing dy»peptio eyuiptoniii; and among tbew 
a TitUt«d condition of iddcus secreted from ilie suriiMeof 

I StctlM4hl9M-M ttwMlvk. 



CAUC8. 



3U0 



^M the Tnomh, ntMl * dhninishfui ttaount of wUva formed foo- 

^M miDCdt fiNitorcft. 

^B In th« foregoiog cose then* coald be do donbt thai the slkte 
of tb« Qial flaids waa drpendFDt upon the gcn«ml ootulilirai 
of the body ; but in nm; ones it u hy no mttna Miy to 
dBtflrarine faow fnr tbo diMrder of the leelli wdepondeoiapon 
a fnml dsna^eDinDt of lbs «ytt«m ba?iog a coincident «x- 
illoiD^ or bow far tho general diatarianoe of bfialth may be 

^K ^ciwiiJi-nt upon the diaratcd cottditiou rf t1i« teeth. Young 

^P pa;])le ore ofteu broro^t lo lu in whom, coincideni with the 
tzteiurive dswlopouot of carioH, we dud au abunJaul 6ow of 
salin, and a btamentiaa of mucus; bot 1 think ibc latter 
ii usually la ezoust, and is found cUajtiog to the teetli, 
instead of bcoontinK diawilTed in Um saUva. In casea like 
tboM jnnt citod, I believe we m»»t regard tbe maciis aa fur- 

tnteliiog theigcQt by which the dental tianiee are decompoecd ; 
and this opioiou baa been Mnngthaned hy tbe Tesalla which 
followed uix^D Inntin^ wrv eial i«eth in a annm-r odculat«d 
t<] test the capability of tbe inocouB niem)knini< Vt fnroiiilt an 
agent dMtmclJve to tho t«elh, llie »ofl«ued tiMUA waa n- 
tDond firom n cavity (tn ilie dislul aiile of a tlrst bicu^id of 
tlu nil vir jaw, and aame dry cotton was furced bctwmn thu 
1^ biouapi'ls in such a manner aa to presa strongly upon tht- 
^H gum. The cotton was tcnewnl once in three days. After 
^M the flr§t ai^kation the gam liecame sli^tly hiSaaked, and 
^P bkxt OD the runnval of tlie ooUon, and tn th« Doona of a 
^^ fonniabE tho softening of the dentine voa foond to hnvo 
extended lu a oonaidermble depUi, sbowinj; forcibly that the 
niti> rif decay lutd been iocrcaaod by the treatment. Ilaring 
frM|UfiUtly oliavrred with more or Icaa distinoUiom similar 
a aiuular modu of IreatDienl, lutd tbe aixmncn^ 
ilia wh«r« th» gum baa not Iwen irritated by tbv 
p wwn ce of the wtton. the cuiiclustou, that the lUUraUa 
^_ nmobmnc when irriutcd throws out a Mcretion capable of 
^B injuring Mihceii(il)l(; ti'etb, followH aa a nrcmHary dorluclioii. 
^^ This concliuitoD will aUo bo JoBtlfied by Ibo resnlt^ which 




306 




arsTEU OF DKNTAL SUHOBBT. 



oftcQ follow Trhon tlie fliling introduced iiilo • cavity is 
alluwtxl to pmjtx?! su OS tu kc«.')j up u statu of irritatiuu iu the 
^Di. The patient after a tiini> rctiiniR with toothache, and 
OD examinatioii wd find that the tootli has decayed ahuveUie 
Dtopping in the immodiotc Ticintty of tho irritntod gum. 
Tho irritntinn, if contintied, may load to the necmtinti of pa«. 
Byt pus. when oecreted hy the mucowa menihrane, prewnt* 
tliL' ontiimry alkaline clinmcter of that fluid, and do«a cot 
appear to exercise on influence upon the dentine , 

The cora aa impccte the liiiiD); moinhrane uf the month is, 
however, not without a parallel. Tim mucotu tneinhrone of 
the hUdd<>r, when tii a sLnti; uf irritntion, pouiB ont a KtroD)dy 
acid !i«<:retion. 

A disordered state, local or geniinl, of the mvcouu metD- 
brane, muj!t not, hntroror, ho re);arded as tlie only tviurce from 
whence may bo produced a°;cnts capahic of dcoompoaing 
faulty enamel or dentine. For instance, esampica presont 
tbetnaclTOs iu which the teeth rapidly decay iu moutha 
fteo from any increased Toscularily, local or general — Tiw 
fmni adlierent mucus aUiut the teeth, oud also froai any 
sign of that fluid being cither exccesive in qiintitity or 
vitititM ill quality. If in Ruch rases the oral fluid be coie- 
fnlty examined, I helicve it will ho found that the salivA 
it*^ ha« at intomils loeit ita alkaline character and become 
aetd. Sovenl patienta (feDialen) returning after a prolonged 
reaidencc in India, havp presentnl the foregoing conditiona of 
this mniitli. Ilioy have been pale, bluodleaa, and i^reatly do- 
'i>ililalcd, though not neoemarily greatly attenuated, sobjccta. 

In Rpeokin;; of the oral fluids ax liiLviug oanatllueute poa- 
seuing lofBcient activity to rob dentine of ft* phosphate of 
lime, we must not lose sight at the &ct, that where teeth 
decay Ter>' sbwly, and the diaeaiie arisca in aitoaticna io 
which defective orKHnizatinn in very often fonnd,analnindnnt 
supply of acid may be produced by fenucutaliun of tho food, 
or may find ita way from the ttomacb. 

Without going into the oonscquencos prodnoed by caricH, 



CJLBOEft. 



807 



k 



when the imtp-cavity ia laid open, the inflaence exerted opoa 
the ptilp when the disease ii edTuicing towards it, may 
he aotiood beCora the qoection of tnntuient U vulered apoa. 
With tbeadrance of ageitheatesof the pul|>-cftvity bn-omes 
gradaally dirainiAbed by the slow additioo uf duatitie to chut 
which wu formed when the tootb ww in a state of acUve 
growthf end thi« oooditiou is still Dwre strongly nuuked 
in thoM teeth which hare been worn by niastkiition ; iodeud, 
in MtDo caws the cavity is almoet, in others perfectly, oUiiP- 
mtod. In vilhercssethe Affect is, m respects the coatrseticm 
of ihe carity, getursl, but the local develupniuol uf dcaline 
oontiuuous witli the pre-existing tfssae, is lery often cgiDci' 
deot with caries. When the crown of the tooth is attarknl, 
the palp very coniinouly r«SQtnGS itsformfttire fiuictioDs at 
a plaint corresponding to that towards whirh the diseaae is 
adnuiicing, and adds as it were a jiatch, or plate, of new den> 
tine (or secondary dentine, as it in commonly called), the 
tabiUnr ami interttihular eubtttance of which is oontinnons 
with that of the older tiitnie. si>d Ihns tl)e tsbes of the two 
parts are ooulinuous, although at the point of junction they 
an afUn marked by a slight dilatation. When the tooth is 
strengt1ien«d by adilitiuos made upon the walls of the pnlp- 
oaviiy, in coi»equenc« of the iooth becoming weakened by . 
diHoas operating upon the outer surfaoe, we haves reniarkahlt< 
ontnple of the manner in whicli Nature atternpta to remedy 
ft deAict. Itnt the repamtJTe eforts are iKit always |«o- 
daottre of favuurablo results. Id the pUcc of additions being 
mad« to tbo pre-existini: di*DtlDC by the calciQcation of thv 
■opcrSeial port of the palp, seTi-nil, iir oven many, indepen- 
dent centres of oalcificatloa may be establisbcd within its 
sahstaaEQ. In anme casM, wv find Duniemus irregnUrlr 
giobalor tnassM of dentine: in othcra, one or two nodnles 
safficiently lar^c to ocoipy orarly the whnle of the cavity. 
It setdotu happens that the larjter inawes ore Jet-elopiid from 
a single centre. They appear tit hare beun prodoood by ifav 
m1 coalMOeooo of a numbar of leaer globoUfw 




Tbiv aecoailAr; nudulftr dantiiio inay or ntay Dot be adiicrent 
to Lbo wallii iii the pulp-cariiT ; it is, bovtrtr, mora fre- 
qaetitly free tlmu attacht-il, awl iu ihat cam failA to answer 
tbc tueful piu'fioiie of protoctiag tbu pulp from expoMtro. 

Hr. 8«]l«r sp^-akv of the caldfiinliua vf ihe piilp whea it 
ocnun upuD tliu sarDice, pfuduciu^ new doDtine cvutinuoui 
with tbv older cmuc, m extrioftic calciticmion, and like aew 
tissue u! dontiuo of repnir. (') 

Carie*. — Tr*atmtrtt, — Tbd disease tt pniKnt hns been it> 
gudct] aa confiunl to thn iWalliifl aod enamtl only, sod in 
eatcriug upou Ulc ircalnieiit, die twrno limitalion will bo o^ 
wrviHl. 'J'k« ezpi^siiru of the piitp and oth«r complicationa 
n-iil lit KubseijaoQtly cou.sidvred. 

Id iha tntotiueut of niiiiple cAries two metliodB sra om- 
jtloyed. Tlis nmovol of the diaetfled, togethtf vlih tha 
somiundiDg hoalthy tiNHuv, to suoh an extent as to leave 
Ik |ffirf«otlf sntooth RUrfAce, ooDittitutM one mctliod ; tfau 
muoral of Uie diaeaitt^d tiAOur, and tbe rabstitutioQ of aouto 
inclcstructibLe luatertnl Uk tlie lost part, couBlitute tbo 
second ni«Chod of treatDient. In citlicT cMe th* disOAsed 
port inui^t be rvtuovod, ur, al all vvuDtH, iiucli purtiuuB uf it as 
luve beeu tofteni'd by the ab^tmclioD of the Itme snlta. 

Iti askirtiii^ liL-tuouu these two uperaliunB, wti mttfet be 
guidod in llic finl ptouo by tbo dt'pih to wbidi the disease 
haA penetrated, aud by the eitiinlion in which it is eeta- 
blisbed. If the dlscffg&nlxstioi) has doi extended iDto the 
•lentiDB to a diiplh which grually exceeds the tlutikncss (>f tlie 
enamel, ADd cither the median or diiital ■urface ot' a tootli (es> 
])ocisUy (if a front tooth) tw the port attncked. tlic o[MtratioD 
of tfxcisiou Diay be performed with udviuitage. But if the 
tix'ih are irregularly |iliux'd, the advautages of this nic4J)od 
of trcAHacnt nuiy be eiiher increasod or dltalaiahi-d by the 
IJoCidiiirity i»f Ihe case. Teeth, when crowded together, will 
bv iQiptuvttd by the operation if they have tieea attackod 

(I) Pwr tnrttitT Jor«mMii«a nbilvt lo Uk «c«umiM nt OhiUim audala*. 
MtHlMMwafUwPuIlk 




ntunncirr or cdm. 



809 



* 



^ 



witli dtteue on llir lateral inirnkM*, bnt vim ft lepantioh 
eiixU ftlKAdy, the widcnmg of the np^nnre \tf tb* Sl« will 
produm an tmeijthlly Appcintu.-e, wiLhuut offtniafi any lul- 
v&ntiiffl over filling the cavity. 

Tbo operBlion uf lilins in out eonfinDil tu the simple re- 
moval of the iiffcct«<j portion of a tooth by the 6lo. Kol 
aaiy mnst thv flisrasod [nrt Iw cut awny, but it tmiBt he n* 
moved with tnioh other portions of the sorrouuding part4 of 
Um tooth as will enable the operator to loavB a perfectly 
«»ooth surface, and one which can readily bo reocbed wbeti 
the tcpth an clenmil. Fllai nf oeveral degrees nf conrwDCss, 
•■r cut, M it is callW, are required, and of rariotu ihspes. 
BotJi these condiUorut have beui oarefally oowklerod.and we 
cm DOW find at tbe denial inttrrunpnt mnkers almost an 
■kdl«B rariely of tha required foriiut. But xhuuld wc (ail in 
fiDding tiiich a file aa would beet anawer our purport-, a \«t- 
Urra may bo made in any «oft metal, and forwanlrd to th» 
Bli^makcr. It would be an eiidlen Umk to doacrifae every 
(bim of file which haa b««n uaed in operating on the teeth, 
mora aapBcialljr as each operator will eedt for himiwlf stinh 
ihapee as luit his own viewi, and are adapted to bia own 
nsllwid of ojiL-niLiD);. The use of the fde having been carrie*) 
10 ft voflicieat oslcQt, tlie roogh mrtvx )vA by that JDstru- 
ment has next to be ranoved, and a smootH and pnlnihed 
uM, frM from angles or depreMioos, aubatituteil. In the 
pmiurtirm of this siirfaoe tmmioe powder i* UMyl after the 
Ale is abaodoDed, and mbBequcDlIy chalk, applied by meana 
nf A strip of tiaen or a piem of wood out into a miJtaUo 
■dupe. 

The mMtan or distal aido of a IWtnt looib is the ntoalioD 
itt which til* file ia nuMt oommnnly api>lt«l, mkI the opamtion 
will leaTe the denttne exposed to a pv«t«r or lew Rtflot. 
Now, if the rouffh ur Kntined surlJaoa left by the file be 
allowed lo remain, and be to situated that tlio food ia 
nuuticAlioii. or the uiii^c in its canntant nuptinD over the 
putt CtiLa to remedy by friction the defective vpetetion, wi> 



A BrerSk or dkktal BCftoxsr. 




810 



Kb*U soon find Uio oxpoMxl (ientiae extremely sensitive, dia- 
colourDfl, uid softenrd. Kxnmplpj nrc sviflicietitly Dumcroui 
iii vliiuh a dividing file hms 1n.tii piiK»L-<l botwuca two sound 
front te«t& for tho porpose of r«U«virig ht4:rm1 prwora. 
'Dit' iliviinon su pnxlncMt haa oloaed up, ami tb« {nrt pUooi 
beyuiid thfi influence of friclinn. lu the coarse of a com- 
panUvoly short time, «wh tooth tlin enamel of w)ii«;h has 
Xtcim cut throuKh is attockwl by decay ; a cavity molt*, lem 
fiivourablo for pluj^ing than would h&ve uiAen bad the 
uperatian of GUng been omittud. 

Nature sometimeii perfomiH for herself an opcratioD wb!oh 
ta analogona to filing wb^n properly perform^, both a» re- 
gards its phyincal pociitiaiity sud its results. I'he vails 
of a broad hut shnlbiw cavity produced by caries break 
lioum, the aofwnpd (issiiM arc oxpo««d to friction and 
rubbed away, till at la&t thv bard dttntioe is reached; this 
beoomes brightly polished, and euduTM for an indefiiiita 
timo uiialtorod. 

The ficK^uuut occurreucG of unfavourable resuUs haa led 
maiiy to ragnrd with ronxidernhlfl rliHlniHt the oporauon of 
filiag, and the dixlrust ii justified when tbat inKtnime&t i» 
used iipnii sound teeth for the purpose of relieving 
lateral [ircMurc of ono twrih upon another. But w« may 
case* in which great advantagen have reunited from t 
operation, and it will not he difhcxdt to discover tbe coi 
ditiona ihv ob«ervaDc« of which lias led to those advan 
In the majority of cases it will he found that, wiili tbp whol 
of tbe disorgaaized, a oonridsrablo portion of soimd tissua 
baa been out or filed away, and tbe Kurt'ucu resulting from 
the operation placed within the influence of iha food in 
mastication, ajid of tho tongue. In order to secnre thcae 
two conditionji, it may be necessary to remove so much of a 
tooth as will iiiterfLTe with its appcamnce. It is better, 
however, that the form should sufler slightly than that the 
whole tooth xhnuld be lost. 
The filo only has been opolcen of^ hat imtrumeata 




TREATMENT OP CAUBI. 



311 



^ 



uetian)el-cntt«n,or chiiicU,are A^cdiI; used in coojuDClion 
witli tht> flic; With tltew inunimenU the diaeued part 
may, !□ miay caws, be removed moch loore raptdly, awl 
<rith Icsa incoDTenlenoe fa> tba patient, than with the &U, 
and tb« rarftoe will bo qait« eqoal to that prodaced by the 
LaUirr uuLramMit. 

And iliv comfort of the patient is not tbe only advanta^v 
pOMeaKd by the Poamel-cnttGr ovct the fite, foe with the 
lattvr tt ia oft«a difGcult or itnjioMible to avoid ramoring 
moch of the labial niriace of tbo bntb, wbicli, so br us lbs 
itltisQat« KSultA of the operatkiQ go, might hare been allowod 
to romaJn, and tho abwuDa of which tnust jiruTe very dis- 
figuring. Thua, it need bardly be nid that, in openttios 
npon an iipjvr incisor, tlie anterior Kurfa<v of the tooth 
■hould be aa little owroacbad upoo aa poaaible, the removal 
of ibe cDamsl «nd dmiioe betog cooflned to the median and 
lingual snrbcat. Sufiposing the ocmligaoua surhiccs of two 
l««th to btf aff«cl«d, the in(«rval between them i^roducod by 
the (>[icratirin should he wedge-shaped, tho edge of the wed^ 
being directed towaida the Up, and the base towards the tongue. 

ir the hicaa|)tdi! or molar teeth were inliyeotad lo a similar 
operntioo, the edge of the wodge^bapod interral would be 
dirvetetl towards the gums, and tb<* hue on a line with the 
maaticAttog surface of the teeth ; the wpftration would also 
be wider towards the tongue than towards the li]w. 

A very uwful funn of eiuuui}l*cutt«r boa been recom- 
mended by l»r. Arthur for the CHtting down of teeth with 
the ubjevt of lnvLn<i n ituuuth and wDll-«hs;icd surface; It 
conslsta of a thin fiat bUde, of hardened tAccl, tho edge of 
wliich baa been ground off aquare. Tfaua tho cutting edge 
ia a right angle, and tt will be found rery efficient in re- 
moring denaa enamel; it may be made of very varkma 
ahapM, It* pecuUaHty bmng that as the edge i« a right angle, 
it can only be conwnieatly abarpcard when thu htadc ia 
thb i it may he led almost or quite lurd withont danger vf 
ehiiqiin;:, if the quaUly ut steel be good. 



u 



SIS 




BTarxH or obntal ArnoBitT. 



The resiilu of cutting awxy sufwrfictnl decay in sorh 
miiiuvr ati \u leave a polisVied and tliorai^lily exposed surfRoe 
an often eXModiligly wtiafectoT)- ; ihc ilifficulty, however, 
tin ID the sotedioo of cum, for it U nt tiut«B atu-iul«l wttli 
Uw most dixastrcnu resnltt. It is often possible to recognise 
conps or carieH in wliu-li, although the diseased ftil mi^lit be 
removed ly the file, itfl mc would W itijiidiclon*. At all 
tjmes the BRnaation prtxiucvd by filiu^ tht teeth, to My the 
lettnt, U vef7 disagneable ; but in cortain etatc« of the t«etb 
Xh» pnxxAiite is altauled with great paio, «u much m t^t 
the upviation CAunot be properly performod. Agnin, wb»n 
vre find nssooiated with caries a Ihickcnud aud vaocuhir 
oonlitioQ of the gums geDeraUy, &cd more especialiy of tb«w 
par1« vrhiuh )ieu« betwoeu the teeth, together with an 
extidatibu of the thick rot>y muciu to which I hare already 
referred, the oponUioD uf filini^ will be attended with very 
doubtful Aucceoi. LTwe filed uut a small cavity, it is pro* 
bablo that in a short time ftTir>ihor, oqiial to the oitout of 
denUnff espoted, wuuld taku its phici'. 

On the other hand, cases apparently moat Cironrable (m 
thirt mode of treatment will tii>w and ilien show result* 
equally utuattHfactorj-. It has recently beon itrujioiied by 
Dr. Arthur (') to very greatly extend the applirahility of thb 
operation, and to use it nut merely a^ a rvuii>dy, but aa a 
preventive aKniiiKl the attarl(» uf caries. .Suirtiug with the 
assumption tlint iu certain iiidividnaUdbcay of the teeth is 
perfectly certain to occur, aud ttiat the»(' ludii-idualii may be, 
with but little chance of error, recognised by the dontint, ]u> 
proposes to cut away wund teeth soon afUir tlii>ir eruption, 
in auoh a manner that they may 1>e iaoUted Inmi onu auuther. 
Wh<i% doubt exists aa to the necessity uf nich a procedure^ 
advocates separating the incisors from one auoLhur as sooo 
they take their places, and carefuily exaniiBing their 
proshnal stirbces ; he Rtalee his convictioo that if the 

O TcMtnmt uul PnTfnUon of Ixoqr of tbc Tvrtli. R. Artbor. H.D. 



TUtATVrKT OF CABISS. 



S18 



r 



i<m vl cohes is dutccUid on their prtaitokl 
the tweirU) yeu, the ntolnr and biciupid 
Cortb m perfectly n-rtain to he attacked. Ti>(|iiola bt» own 
vnrdi, " What I propow ii tlio aeparftlioii of t«etli clotty in 
t<oiiiwl, which are of such bi^l character, and ar« exposed to 
fluch dviitnicttvc tnfiuenccs, that thsir decay U iutriuible, nr 
haa already occurrod.*' 

Atthiiugh it ifl pFobaU; true ihftt the tTMtmcnt of cariea 
by itxciKton and imhMquent potiafaini; oftbi! Eurfnce might he 
|«lCtiMd witJi advantage tnor* fnquenUy than it in, yl^t it 
<1liay he donhted whether there u much oridvncc in favour of 
m Ik>I<) h plan of tr»tDii-iil a> this. ]u tb« first |ilacu, it is 
ttieilly tnip thftt there arc «ome montha of which lb« 
:t mnr ennfidcntly prvdiet thnt alnuKt all the Uttli will 
.iv«ly decay ; but are not theso aacUy the cum iu 
evfry point of expomiro of the dentine mule by the 
file, m eiiiunul-cuttoT, bKamea a xlartingixiiut &r cariuB V 
And. on tlio other hand, ora not those fiiTourabto instances 
In which cariee hn« never re cur re d ofiec its first excbioiia 
abuoct always to be fnond in months where ihwn is nn 
isnii^ tiPbdency to caries? 

Agfttn. ft is ailmitted by IV. Anhor that the opontloa 
may haw tu tw rrpestnl uwr and over Hj^n, and that 
oonstant earn and attention is rwiuired on the fnrt uf 
patifnU Bnt, as has Trry tnily Iwco remarked fay a critio, 
bad all thta polishing with ta|>c, &c, lincn carrwd ont by the 
puii'nt withont any oj>mU4(ai havini; Twen {<erformed, intet- 
itial caries wuuld pruliably have never nrAnrml. 
Moreover, teeth IhaH artificially separated are very prone 
U) tililfl their ponillun and i^liwe np a^n, nec««itating 
repoiitiiius cf the opera) ion. and invi>l*ing pval loss iif tooth 
»iilMUni-c; cvm if llwy d^ itnt, the incTilable eitporar* of 
le eum At the bottom ul' tbe wHtKe-Blui|icd )tjnc«8 will lt<ad 
its being kept is a state uf irritation by food forued down 
pno it. 
The file and the enamcl-cntter have been spokoo of in oon* 




BTBTXH or DINTAL aUEOIBT. 



nectton witli tboae camn which maj- he trcaled by opentiofl 
in the I'lt'rfornuUKO of which ihoHc instrnnieiitf) only are uwd. 
Dm we shall kava a^^iu tu rvcur to thuni in oooDOCtioD with 
tlic opcrncioQ of tllUng, nad a* the mauoitr of luing siich 
imLrnmeiits will Ihen be dmcribed, it will bti imnaeBaenry to 
eaUir upon th« considcmtion here. 

In the treniraeot of onriiw, filling miittt orer be ngsnlcd u 
the great remedy by which the diMwe may be aTmted, and 
the dcfciclivo tooth n»torcd to a state of efliciency. The 
oper&tioD cfiiutstA in the remoTal of the disorguiucO tismei. 
Slid rt'plucini; thrai by a inalvriKl Bttiog perfiDetly the cavity 
jirodiineil by their removal, and capable of rttistlog the 
chemical intiuenca of the oral fitiids, and (be mochanical 
«SccIa uf ihfi fixxl duritig iiia»(i(uitiou. 

'fhe di»iirBani7.ed i>ortion of the tooth is cut out, and thci 
htst |)art IK mado good by au inorf^uic material. 

Thotc \a, perhaps, do other opcrntion perfunnod upon tbc 
hutnan body which ia attended vith the same luiiqimlilied 
luccesa an that of filling t«eth, for wre not ouly 8ucc«od, In 
the great majority of cases, in arresting the further prograu 
of dinaro, but we abo ropJacc ttw part which has been lost 
bf as imperialuiblQ material, and render tbo organ as tisefol 
as it was prior to its becoming the aubjoat uf cariew. It is, 
however, a great error to suppose that tilling will, under all 
circumstaucM, jfcrmanently save the tooth, even in caaue 
which at tbo time the operation is performed promise 
favoural)ly. 

There nro tho»e who arc diiipoKd trt ref^rd the decay of 
a toolb which baa beerj liU>exl as tbc nvult uf waut of skill 
or of care in the operator; sucli an opinion i» perfectly 
untcnftbie, when the chamctor of tho o|)emltuii ie cunMidenid 
in connection with the tissncs which ar« involved, and the 
Turiotu cciiiditiouH uudiT which diaorganiiatian iiiav be 
affeoted. Tbc very fact tbnt carica has appeared in a tooth 
demonstrates its predisixji^iliun to diaeaae. We can, for the 
time being, arrest ibe diaonler, but it may reappMr in some 



TBXATMRNT Or CASIXB, 



815 



r other part of the tooth, ood nifty in fact oomiaence a Moond 
titni> in the enamel ami tlpntine in the imiriMiiate ricinity of 
the plug, which will then fonii jmri tif ihv circuiiileri'U<:« uf a 
new cavity. Such results will ovcasiotuUly arise in the prao 
tice uf thoM who UM the atjucnt shill in their operotiuoa, 
anil they will bo awa elill taint fiv()u«utly hiood|! the patieots 
of tliOM whoM cry U infalllbtlUy. The ultimate euoccsa of 
■n openttion will in (i^rcat part depend upon thu skill with 
which it iit performed, hot it will not dcfwod wholly upon 
the operator. There are other sourcoa of failure than thv 
anQi[i«d want of tikili in operating, and »ach m are nut ander 
ths «ontio| of ihe dental nirgcoB or of th« patient. 

In aome moutha the majority of the twth will oontwu 
plugi of nrioiu n^ea, ru^g perhaps orer a [>eriod of twenty 
or area foriy years, all of tbooi looktr^E bright, and the 
oootlgoDOB dcotal tintu fre« from discoloratioQ, tbo mticous 
membrane of the gum healthy in i^jiearance, and free from 
adhceire mucua. In another mouth, a^oin, in which there 
are many plugged teeth, trvatod hy the mdic operator, we 
may find each pluf; sunxmudcd by diKolourwl deotiiie, 
araociatol with a thickened and vnscolar stato of the maooni 
nenahfmaa. With the UpM- of time the decay io*iicat«l by 
the diacoloration uxtends, and the plug fall* oaU Again, 
jnJttanoee will be seen in which a number of plugged t«eth, 
after standing without approciable change for yean, show 
ligos of giving way— not, however, in oonaequeiwe of tha 
defective character of the operation, but in ennieqacnoe of 
fidlure Id Lhc geDoral health, and a coocotuitanC viliatiuD of 
^ the oral duida. 

^M Attentiun baa bora called to the fact, that instanoes will 
^m ooenr la which iba operation of filling fatU to aecure a 
^m pennaaent advantage, not for Uie jmrpow of do|3reriatton, 
^1 bat in order that it* value ai a mode of treatment may be 
^H fully racogniwd and rendered indejnmdent of the Injoriont 
^V tffecta which the exaggerated eipectalion i>nrtmraged by 
^^■HMi and the want of proper oonSdaiMX eutcrtaiued by othM% 



S16 




k StSTIM or DRXTAL mUBKY. 



hurts « tendency to produce in lli« mind* cf tluKse wliuw 
i>r observiilio& luu b«ea but limited. 

Tbe opeimtion ot fAritg^B^ is divided iiiUi two diMJoct' 
lIlgM^-Uie 6nrt- of wlitcb is ooofiaed to iht removal of the 
diBorf^ninwl tiHRurt) nnd the produrfion urn cavity of stiit- 
ftble ftUiije ; the Bccund oonsl«tiaf; in lliv InlnxbictiiHi of lh» 
lufttcrial uited for makinf; the ptag. For Itw pnMent ihi* 
pR|«ra.tiua of thei cavity (or Ihv rM^tt^ttion o( tbe pliu lutist 
wccive attention, upon the proper pBrfomiRnw of which 
the tUttmnta sucooas nf the oporatiun will iu great pMrt 
■ie]Mnd. 

Ill llic^ Ireatmeut of a caee, tbe Bret point for decinioD will 
be th« extent to which the dinoied dentine can be mniored. 
'Ilie gBoetml rula ta to ouk ont tiie disorpiaixcd thmie, until 
tbe mlla of. tha ctvit; p-esmt tht colour of hc&lthy deaiine : 
but ibere are exceptions to this ndf. Iu the finrt plac*, the 
deutiue maf Law bewnu to a certain «xl«ut diKolotired, and 
yd tiiiv« retained it« normal hardnosa. Again, the di»> 
vulurmtiuri, and uvea Huf^vntu^, inay have adranced m liar 
Enio th« tooth that tbe removal of thp whole would mdanR«>r 
the exputiurD of th« pitlp. If tbe pnlp be axpOBcd duriui; tba 
upcnttionr ^'^ ^oa of the tooth is to ADmi> exnmt (.>ndiin|tcrcd ; 
ixnuKciiiently it ia better that a layer of dtMoloiired dcutiuv 
ifaouM be allowo':! to remain for fhe pn>t«ction of the pulp, 
rathrr llian run the rink of sooritioin}; the tooth, f^uppn^ntt 
tliat tljo waJU Dvar the oriSce are strons &ad wuikI, it ducii 
not apiH«r that lliu ri'Motii^n uf a little slight! y-snfu'ni'd 
dL'utini! at tbo buttoni uf thu cavity int43rt<}re« nerioiMly with 
tiie duribiliiy of tbv plug. Tliw prrscnLv of any acrftonad 
tlaatu! at or m-ar the orifice cf the cavity muat, howa*er, Im 
carefully (•luiniKl against, for thu ne^Kit of this procanticm 
would be follcrnvd by the exlensinn ol the diiwAAe^ 

An exposed ed^ of diaorgianiEBil dentinu will allow solvent 
fiuida to pass througli it to the Kound tissue, rapidly or oth«r- 
wi«!, asi thu snrfAco «xpoMd is raUtirely fcrvat or mnall, and 
spreadiu); from a iiingle poiut at the cirvumfareuoe of a plug, 



TkHATHKNT OK CAKIS8. 



SIT 



* 



dKiir wUI by degrees encircle it iritli a scflcned aoH 
IKUfixui layer. Thta, ihoii^h a nullicieiit, 'm nol the vn]y 
iCMoa iit attcudini; conrulljr U> *1m kidot&I of all the dis- 
oqj^ized Umugq near tho ori5w of the cavity. U ia next to 
hQpuMibl«> to [«oduc« a scund and adid pltttt the circuof 
feientlal boutulary of wlikrh is auft and yivldtng, and the 
difficulty would U; Btill farthor increased if the aobctaaoa 
aKainst wliii:h ilw ^^old i« prvnctl be nturoml with moititarr. 
Tlu) ri'tuutiou of M>flcnod dantina, eren in the lintton) of a 
cavity, t.li<iiil>), tC pnaaihla, bt> avoidud; but if it bvaUowed 
u> tciiutiu IxiUi in the l>ottoia aud ou the Bide of a CAvity, 
till- KpLfutioa uf plug)jmK ^11 be attended with but h'm jioruy 
>idTiiutitf[& The gold la suoli CUM cannut Iw fully cotrnkiuei 
villicr l»y dtrwt ]trvwan) ap^ost the bottom or ogaiant the 
aiflea of th« cavity by the iiroc«H uf wnlgin^c- 

'ITw Ural sif I* of the of«f»tk>n ia not, howf^w, ODinplet«d 
the softened tisstie, for thon^snlting cavity 
iJMKnt a hrm farouiabte for the nivutinu of 
'ill* pln^ '\^nwn tlw diMsae haa penctr&lM] l<t a ohort ilia- 
lomo oaly, the ivtuw^'aL of tha decayed jiart wimld Ivave a 
nwnooCKa^ity, ihi.* ^ping atdtM of vhich would farour the 
«acap* of tiw |riug whvn j>rvw&d u|wq ono aide only. It 
oan«ec]u«iitly becomw nccrsaaj^.aAvr the dtsorganittd matter 
haa bunn tAknn away, to [vnot-od with the excwion vt mora ur 
Usa of the hcnlthy tinaue. until a canity of anitable tana. 
haa been [«oduced. A cylindrical bole nuy be ragnrded as 
prtfMQtiui: thv> most advajkUtgnous form for the ncvptioa of a 
plug, i'lit it is in a cnniiHumtivoIy ttniited number of caaaa 
lUly thai tltU rcguUr ti^i^ire can he obtained. A c*rtaiD 
uf ajiifrviiuiatutu aui, Itont-vcr, begotuvnlly ratobed, 
tlin oenrvr tin- a[i|nxiiiiAtioo tlie grmXM will be the 
bcility with which the operatioa of plofSiDg ia parlbmwd, 
and the grvftt«r abo will be liw chaooe of ptXKlncin); a datable 
plug. 

When the diaoaM haa adviuuiad to a gream extent than 
tt U auiuiuHl to bavr dune in Ibe pnceding oxaiuplp, the 




k. 



S18 




A nrnvK or dkvtal flirunDy. 



KRioTal of the !>oft«n«l timtic will often leave « Urge ctvity, 
Uw orifice of wlicb in considerably contrachsl, owing lo 
cuanicl, atid pcrfaaps « chin Uy er of the lubjaccct doatine, 
having nstetod the inflaeuco of tbv dctitnictiTe agents more 
aoccesafully than Urn more deeply-seated tUsuc. It might 
thanght that the overhanging nf the ddpH nf the c)riitcf> 
favour the retention of a plug, and the aaaumplk-n would 
jKrhapK i>o jiisiiticil if it were pmrtii-ablfl to tnirndiice a 
perfectly wild plii|i in a carity w eha)>ed. U&fbrtuuatoly it 
U extremeLy difiioult'. to forc^. a filling under a |irojecliii(( 
' Mg* so as to product' tvta a. modi-ruto doKPCu of solidity in 
tbo port which occnpicd the anglu ; and the coni»n|ucnt iin- 
perfecttuH in utill further increiised when, in condensing the 
Kurface, coiinidenihle prtwBure la directed in a line from tbe 
top to the bottom of lLu plug, the ofiect of which is |p 
depress iht! {lold and cairy it away from tfac iimler niiHaoe 
the projectiut* tiiar^in of the carity. Th« plu;: cmy have 
Tery gatiafActftry appearanc* when finwhed, hnt in a ooiQ- 
parativuly i^i^rt tiiuv evidence of failure will bu dtsLvrurod. 
That portion of the tooth which 0T'«rhangs the plug bcii^ 
but iraporfcetly Bupportwi from within, will brEak down, 
moisture will find it« way around the plug, decay nill bo 
re-flstahlished, and if the ujMinitibu is cot rupcntod, the tooth 
will be lost. 

In onler lo avoid unfavourable resultfl ariRing from the 
foregoing cause, the overhanging edgee must be cut away, if 
not Bufllcieiitly to produce rectilinear wnlls, yet lo ri-duoe 
tbe angles to mtKluralely cufvikI surfacn. Thi.* walls of a 
CBTity may biilp.' utitwnrds or inwanl'S h\it nnythiitt; ap- 
proaching to ren-ding angles or sharp coracm must 
svotdeiL It may he nocMMiry to repent, that the presau 
applia) by the filling instruments oondeTiiie« tbe gold only in 
the line in which tlie force is direct^. The metal is con- 
densed beiitutli the instrument, Init it docs not spread to aiiy 
appreciable extent in the lateral direction, unlew a perforation 
bo toiide by thu iustrunacnt, and tho dirooliuu of the forca 



TBKATIIEKT OF CAUU. 



819 



t 



I 



elianged; toA in no case will the contleusaUon extend to 
icay connderable distance. For ii)Btauci>, if gold be pretMd 
into an uut« Angle, it will become tuird upon tbo Burboe 
preased upon by the iostnuueDt, and also npon tbe nir&oe* 
which have rested npon the Bides nf the carity whirh at their 
pMDt of junction furm (he angle, but the gold which lies in 
the an^e will remain poitins. If the instminent u»cd wcro ia 
Mob caw KuCTiciently ehsrp or pointed to lit into tbc terminal 
point of the carilT, of course the jtold caolA be fiirced into 
it, but in pnu-tice it would be extrcmoty iooDiivcDicnt to 
employ mch an instrumoot, and under tliv circuniitboces 
sf an angalar depramoo extending around the cavity, 
impoaaiblo. 

When the cavity in very Hhaliow, the general rale with 
mpcet to the sides being parallel may be deviated from with 
advantage. Il will bo well to make Uie buttum compam- 
llvely flat and the aides rectilinear, or divergent fi»m without 
faiwanla. It may happen, however, that this fonu cannot, 
oi^ng to the cooiBitioD of the tooth, be produced ; that the 
ooovergeuM will be from without inwards, gi^ng the outline 
of an inverted cone. To render a cavity so shaped capable 
iif rutatntng a plti^, ouc or two Rhallow i;rixivra afaoutd be rut 
aroand the circumference of aufScieut ilepth to bold the gold 
firmly in its place when forced into tliem in the operatioo 
of filling. 

It will be iinnccewary to ent«- farther into the form of 
cKVitiea until wo oonaider the'apc<roti<iu of filling in special 
cans; but there are other points in rtspecl to the pro- 
osdare which may he consadered in connection with cavilirH 
genmlly. 

The BtrengUi of the walls of & cavity is a very im]iortAui 
nbject. Il'u useless to letivc a portion of a tooth suodini: 
which a trifling dcfCroe of force will at any Unte brmk down, 
and thitff expoae (hti plug; and it is wocm than uselcu to 
leave tliat wbtcb will uive way during the operattuu of filling, 
and thua perhajni tindftoger the whole tooih. An unwilling- 




»30 



A BYarnUt OP DKITTAL eVMWMV. 



DCM Id interfere vtth the nppeftmnoe of ft tooth out UQ* 
eiiacmoDl:r iotiuces the operator to nttempt the pro«rvatjoa 
ofa |iwt wliicli ercntttiUly givos wny, auii ncoeBMtatflB the 
pvrfbnnaoee of ft Mcond opontion under dreamvtaaoM !«■■ 
fkvDumblB tliBii obtained ou the first oocasion, ftnil the tooth 
is left in & more luuightly condition tbftn it vroalii hfive beeo 
hftd the rragilc [»rtkiii beuQ freely cat awity in thv fim 
ininancR. Hicukwotnto 'strength required will rnr>- witli the 
pooiti'm whicli iho tooth ocecpks in th« niooth. In & nkolar 
touih, H-bich bihf to sustaia tbc full force of niMticfttion, the 
ur&Lls of tti« cAvity miut be vompoocd of eosmel and deutinet 
witli a conatilcralde tliicknewH a{ tha lattvr ; wberras, in [root 
t^etli & much thinner layer will be found nifticienU Ituleed, 
iit incisor t«eth Uie eiiainel ainnp, if the eitent \ie limited, is 
■metimeH sufBei«iitly ttrong, when Bii|i)xirccd by > |)ltif:, to 
eadura for hiadj y>*n. The colour of the ^Id nuy ^ow 
tfamngh at the point where tlto dentino ia entirely absent, 
ftn<l yet th«re may be (inflici«nt stxeiigth \n the enam«l for 
the inaintcn&nc« of the pltu; and of it» own atniccure. 

There m yet anoth'cr poiut ia tlie fomiatioc of a cavity to 
whk'li altcution may )>e advarCapcoii^iy directed. 

The cbancter of thv m&i^pn of the oriScu ia scarcely Um 
important than tb^ slia]M> of the cavity itwlf. Aa a gennml 
rulo, tiie pluiiA which ftre Burrunndcil by eiutmol arp more 
durable Than llinse innertixi in CRriIi:^« the margins of whici 
■re |»rtly Airmeil by tivntine or cem«ntimL. It in coiums 
(juontly desirable to preserve,' if poaniblc, the I'onncr tisuna, 
and to reiuiive the dcutine at the margin of the oriSun in 
riocb a mantier na to allow th« gold to conae in ooDtact 
with tho pnaiiKl, au that thi' tli-iitiiui luay \w wholly cureml 
over and protected. Where the circumference of a pUig in 
baaoded by Htnm^ Fnatnel, as on the mnf:l icalin^ .miriaoc of 
a tnolar tooth, the undulating cliAntcl«r of what wo may call 
the top nf the wall, is nnimportant; but ahoold dvnliite 
tomi a (mrt of (bu whulc of thv boundary, aa it will do when 
the ditwoHp is situated on ihe neeial or distal side of a tooth. 



TBUnOST OP C&BUS. 



831 



riboQ it will be mcMMry to rnlac« the margin of tbe ori6ce 
to A fUt RDll SmOoUl RIllfACC. 
Serisnd forms of inBtnuuoota are ased in prD[iariiig cnritieiii 
for tho mcsptioD of [xlogs, btit they come under one or other 
of two hoadit, TIL, cutt«n and drtUa. The coo cUati will 
iocluile wbat arc Dommonty railed " excavators " s&il ewunel 
cotters, wtiil« ia tb« otU«r will 1m> mngcd drills of varioas 
fonii^t >u>d burr-beads, aa they ant isllod. 



«#. 13T. (I) 



i 



m 



It will not bo neceanry to do idotq than uiako a few 
gODoral obt«rvatioiu upon ihe taaatinr uf uaiiig tbe inctru- 
nsnU Dmi^oycd in rt-nirmjig the dlsoafed time*. T}ie 
fonna which haro l^cn figured may be uken as iliuee nwat 
oomtDonly iiai>i, bm il>e mianta rariiUiua in axe and shape 

(1) n|k.l$T,1M.itM*MntufU>CIDMDKAUlDnuO<«a(«Tim(m. 



ST8TKM or I)I»TJU< SrfiOKRT. 



roquiml from time bo Lime generally leaiU tu a !;rMt ncca- 
muUiion of tlm deKripUon of iivitrumeDt^. The operator 
■bould be ahle to make Tor himaelf lixcaratan to etiit itnj 
pecuUar caM which, tuay ahso. Th«ra w, howerer, oaa 
praperty wliiofa ifaould be poiMend by aJl, whatever tb« 
ahapa or size of the LostmnMat. It ahould be mode of good 
at4!el, and kept perfectly sharp. A blunt uistnuuviit tt-nda 
to prolong *a operatioa wtiioh is sdvutyt dUagreeabld aud 

rig.iaB. 




I 




sometiniBK very paiiiful. With a piTfectly etiarp escavalar 
tho diseased tissue in quickly removed, and with a odoi- 
poratiwly idif^t arocmnt gf discomfort. A few rapid and 
wel|-direcl«d strokes of tlie blade, and the aoftened irnne is 
cnt aivay, and althongh n. proper fonii hae yet to be giveo to 
the cavity, the subsc^ueiil stepa of the operalioo are seldoto 



TILBATIIKXT or CABtXS. 



^m prodoctivo or aa nneh discom* 

^M Toft OH attei)^ thit removal at 

^M tho M>ftmc<() tiiune. In tJic rv- 

i^ iMivnl \>f luiflcDwl (teutiDii from 

a ietiitr tooth, the oxokvutor 

iliOfUd be naod iu encli n laatiiier 

IL» Klwaya to mt, and DOl tentpt ; 

this ui a {nint which can hanlly 

bo too strongly ineisttxl on. 

thungli it is vay nftcn ne^lwted. 

^_ Under the hmd of drilbi an 

^B indnded thcM! instruniRnta Rsed 

" in the pr«(AnCk)Q of c»Titi« 

fur tho raeeption of pliigx, whidi 

^L cut hy a rotatory motion. 

^P The rusc-hiwi ia very Ksrrioe* 

' ablii in reducing to a cylindrical 

form the ragged opening of a 

siiiuU cftvitj. The lile-like chsr- 

^_ after of ttt« nirfac* enablea tbe 

^M oytnlur to cut away with rcadi- 

^^ oaM tlie eoanwl which baa ho- 

ccnao woaluiuxl by the aoAcnit^ 

of the vabjaooDt dvntiae. Six or 

eight Uf«s of hcada should )v iii 

band, and mch niay form a 

ieparatc instmmont made ia 

piiuuti wire, or Erotn a seven-inch 

len];tj| uf aquare or round iteel. 

But it ifl perhaps better to have 

ft Kl uf blades fitt«<l to a com> 

nioa holder, and tho crutch* 

bandied roM^lieod aod dnll- 



328 



rig, i3s. (!) 



ri0.Ht.p) 



\ 




ImlMtiHlwbobttr, 



I of pm b f il'. tbc ccntn one plunl In ikt cnmli- 



|l VJMimt 



(>) Hc-IUM Ua «[ Mc-bi*L 



V^mam^' 




\] 



A 8T8TK1I or DSMTAL fliniQBBT. 

tiultlcr will bo found to present many advaotagM. 
rnitch rests botvoeii the thumb and foreeoger, or brtwwn 
the luttur and the SGoond fin^r, loariDg the tips of tha 
>>.Hi.(i) thumb and finger free to roUlo the shftft of tha iit- 
i>Lrumf>nt, while |irefi8ure ia tnado upna the cmtob. 
(Kig. 139.) 

For aomo ymrs I have used this inetniment with 
th« form of tbo cnttor modified. Instead of pro- 
ducing a siiherical head, Uio st«td liM been allnwrnl 
to Folain an imjfbnn cylindrical flgurt?, and teeth 
hnvo ItcDD nut, not uuly at the exttvmity, but for 
»oiac distancfl tip the sban. (Fij^. HO.) 

With (his (xinHtructicm of colter wo socotQ all 
th« advuitag«8 or the roee-hoad, accomptuiefl nith 
nn additional amonnt of strength in (lie part mr- 
rexpoiidiag to the neck of the 1att«r ; also the ca- 
)«l>ilit}- of enlareiog mi ariflce thmii^i which tho 
|xjint has outerod by tbo cutting miriSuM (^ the 
shaft. 

The rotating file cir n)6o-hi>ad ia rcry at'rviasililp 
when the enamel requiree removal, Init for cutting 
the (Ifntiiio ui ordinary drill preaenU many points 
t^( «;up6riority. It cuU more raptdiy, can be more 
cAstly niiwifi Rluirp, and its coiir«e can be more 
rui'.iily directed than the roso-hoad. owing to the 
I^tl-aUt ninouiil of prtwsun.' required to liriiig the 
liitler into effective operation. DrilU of varioua 
Hiw Riul 8hni>e» nmy \n; monutM in tlic crutcb- 
Iwudled stock shown in a preceding flgurt^ or the 
ilrill and Hhuft may constitnte one oonti&uoua 
length of 4lo«l (P)^ I'd). The latt«T arrang«- 
tucut poeacsaca some advantages. Tlio kIioII is htld, when 
rotated, between the thumb and finger ; and as but little 
prisitLre Is niquirecl to make the blade out, the direction and 

(I) IMU ntf* tnai « cTUndrictl pi«ce of sIhI, wUh Uk ]>alal cfaapMfeS 
tnm «Kfc fMr. 



TB8ATHE!(T OF 0AUB8. 



325 



the rat« oj* progrcM which the instrameut makes can hn ^tr)* 
tvoilily felL The ojwrator will tind aili'anbiga in having 
variitoB ukm of this instrunipnt, the form of Iho |wiuta being 

Sevsral romii of metallic nockets which reccire Uie lieail 
of the drill, or rosfr-hcarfc*! iiwlnimrnr, nre iwld for th*' 
paqww of imiU'uliu); thi- hnml, nhich u uthvrwiae a|)t to )>c 
cluOWl by tb« pressuK atcmatf to raaka th9 Jiulniii>ent-< 
cnt ; utta which nuBwers the purpose oxocodingly wtll, 
consitti of a metallic cup, in which th« tijiper end -of thp 
iOBtcumeat rcetii, uid a ring which rptains it in IIh place hy 
passing oTer oae of the finjfers. Bat,4s<lrilli[ift is at all 
UmeH tadioua ikoA fatigiiiiig, mniiy nlti>mptJi liave been uuule 
to derise drills driven by mechanical inrtkiig. S*ich an io- 
stmroetit is Harrington 'x i^ni<)u, in utiich the motive pow«r 
ii a strong sjiriug. The drill U tlrivcn at a great spvcd by 
an armnj;fltni'nt of cog-wheels contained id the box. but, u> a 
matter of coarse, with a corroBpoodiiig Iosr qT (uwer. Thi)> 
ia tbD objcotkm thnt hiui prored fatal to each of the numer^n." 
piece* of meohaniam dovisod ; there is a lack of [lOwcr, m> 
that the drill stops so soon as it is prvMod hard Against it« 
WDiit. But for fiiiinhiui; the BurCnoc of a plu];, ur any simiUr 
pTiriwBe, wfacr« much pow«r is not required, both IlArriQ{>^ 
ton's crado, and tho American pnoiunatic drill, which ie 
driven \-y a pair of bellows, tan useful instruments. 

Lately, however, an arrau^ment in which th« motive 
power is derived from a trvadU has \xca introduced under 
llie muue of Morrison K dental engine, and this apiiotni to 
posans that power the lock of which is no bial lo the ub*-- 
ftlllteas of the other fonns of mechaoiiim contrived for thi« 
porpose. To tiiiuulvly describe the apparalas would take 
np too much i)|«c<i, but hy an int;tuiutit* a<;luptAttun of spiral 
i|filifl;i as a meaua of couve^'ing the rotatory motion, very 
groat flexibility is given to that end of iho long ana on 
which the drill <ir rvMu*-head ia carried. In this Instramcnt, 
ihe diflioulty of K<cuiing adeqiute power appean to bftTi> 




336 



A BTtTBlt OF DKMTAL BUBQBBT. 



bceu surmouQtod, lint it Iiom uut bcou suflk-milly long 
io Uiis oomitr; to sfpcnk verjr jiosiliTely »« to ita value. 

KoJiovai of Seruitive Dtatine. — Vaaea nrc not infrequently 
met with in u-liioli the c&rious dealino (MMaoMcs ffuch &n 
(ixalted degree of M.-nmbj]ity xhnt Its reraovRlcmnnot ba borne, 
aud tbo iiBticut tlincbus frum the «light«8t touch of uij 
iiwtniTnent. A minuto qtiantity of UMnic plncwi iu the 
cavity, and rvtaiuod for a fow buuts, will rt-udi-r tli« part 
fthwt"t«)y insonsible to pain. The objection, howcvw, to 
Bnch a caursi! U tbe ^(liculty of liuiitiuj; tliB actiuii of the 
(irveuic to tliv curfaco uii wbicli it is n[)plii.-il. Et may find 
its way to tb« imlp. and ucca&ion tbo deatb of that orgaa— • 
coudilioii H[i«tHli1y fuUowcii l>y dincoloraiion of ibo wUbla 
cronm of the tooth, and very jvohably by the RtipprvcDticm 
of alveolar abscfsa. Thus Dr. KingElrary, in a recent nnmbcr 
of th« " Dental CoHmoa," relntes an innaoce in which arseoio 
hiii Itceu iu«4l for the purpo«c of oUimding the wmitibility of 
d(^nUllt■, and hiul uauxnl tbo iiUimato ilvaih uf thu piil|i iu do 
leu than seven tevth ia the niuutb of one iudivlduat. 

Honi^e the iiflo of' arsenic is ix-rfisctly inadniisiblo when 
the CATity ia deep, and can only be used with any degree of 
•Mfifty for alliiyiiig teiKlorneaa nf thf tayfir of drutinu im- 
mediately bcncaib Ibc ctuuncl. If it i> to be used at all, it 
(thould iw ajiplifd dry, or rery nrarly no, Ui avoid the ri-slc of 
its reaching the d«;i>er ivrlitms of the cavity, and the cavity 
carefully scaled, piyfrrahly by n tempomry filling of ^itta 
|wrcha. Dut as theru aru ulht-r agentii which aio capable of 
reducing lh« xoasilivc-uvNt of dentitii;, itit uw is lo bu de- 
precated; though it must be admitted that it is tho luwt 
efllcient and inuttt curtain in ita action of all the rtmiedtes 
propoted for the pur|io«). 

Next to arsenic, in jnitit of cfficary, cotnea nine chloride ; a 
«n^l fragment ol thu ptirliitlly ileliiiuescod salt, or a piece of 
wool dipped in the iioliition produced by ailowinj; the haU to 
dcliquescu, will, if held iu tho cavity for a few uiinult-ii, 
greattj reduce tha aeusitiveoess of the dentine. The appli- 



TBIATMIHT Or OABIIS. 



337 



cation of llio zioc chloride oilea e*u«M severe borning or 
aching [nin fm- a bw miouu-s, IniL after Ihia bu [mhkxI 
ftway, tiltlo teudenwas nniaiiu. Although the applkatkn 
is petnfnt and Icsn dficaciims than that uf nnwntoUK sod, 
it ij to be preferred, inojimach aa there is littlo danger 
of ceoBJng the death of tbo jialp. 1 have laluly adopted 
a manner of iwiiig the xinc cbkrida which is convcDient, 
and yirliift Hatisfaftniy nsaulta. A small fra^^ent of 
oottoD woiA u taaaud i>ut till it \» rmy thin, ud mixed 
np in aome very fluid littc dxychloride ; then ptit into 
the tooth and left lo hardou there, juxt a» thoagb a dre«Hing 
of gum eandarac were boinn; a|iptied. Zinc uzychloride, oveii 
iriion mixod up thick, contain* tome little Itm zinc chkridCt 
and when used very flnid (which wo are enabled to do by 
inoorpamtini; a little n-ool with it), there ia an ample amnnnt 
of the free aalt to allay the RenaitivcQeaa of dentine (^ 
After the lapse of a f«w dayx, thiit dreMii»>^ which doea not 
eaUBo to much pain at the lime of iu application aa that of 
the [Aim salt, ie reuiovnl, and tlie touUi is than unially 
abeolntely iownaitiTe to the toocb of an inetrumeot. 

A Taricty uf sulistaiicos >uch aa chromic acid, cauatio 
potaah, anil other eschnrotJcs, have been naod for lhi» purpoae, 
but the rcMilta aro by no means such aa to recomuwiid thrir 
employmenu Camphorated apirita of wine, tunln, cnrboUc 
■Old, or thymol, repeatedly applied on cotton wool, will 
generally rt<>ltu-<> the sensibility FufTiciently to allow the 
t^matloD tn he |Krf<jnnetl ; atid, in Ucl, any form of tem- 
porary iilliug introduood, with mflSctent etre Co exclude the 
Mlira, will jtoon bo foUowfd by a aofaeidaiioe of tb« extreme 
■ibility uf the tiaauoi 



(•) Ob OsytUurMi nl Zlw. C. S. Toinia In RntM JMnml of IhnUl 

TCLxill..|LU2. 



( 328 ) 



MATERIALS USED IN FILLINQ TEETH. 



Temporartf ftUingg. — There is k Tsriety of cooditions, such 
lui ft doubtful exposure of the ncrvo, cxtn>n)e seuRitivi!- 
Don of tJiv d«iLtii)«, or tho pouring oat of a certain amount 
of dlncharge through or from the pulj) cnvity, whioh rcnJisni 
it iu)dealra1}le to ioaert a |ierm&Deiit titling. We may have 
naort to some of thu 'varioun temporary filling, cither for 
the apecific object of cnriog one of the nonditiorui which 
preclade the iuime<U«t« use of a ponnaneat filliuf;, as, for 
exaiupiv, t)iB nsa ufj^m mastit; and tTPosoto whun the aen^ 
b nearly expoMd, or the insertion of a gatta percha lilliDg in 
a tooth very isenaitirc to diangsi of lftD[)f.>mlun: ; nr we may 
employ them simply th«D as experimental filling to he 
rt'plncnl by permnnciit plitgt so noon aa we are ntinfiMl that 
no miflchief is i^oin^; to bu Hit \ip by tlie tooth Ixiiag filled. 

When from any cftUB« it i* innjviaabla to place a [<cnna- 
nent filling in a tooth, wc hav« rwourM tu ruriuiiK subataiicea 
fuittlilo for temiiorary parpoeos. Solutioni of Tariona gum 
nsins in ether or alcohol are exceedingly useful ; gum 
mndarac, autmi, maetic, oopot, or dammar, reduced by the 
solrent to the flul<iity of thin trcacln, may bo introduced 
into the cavity on a snitaUo piece of cotton-wool. By erapc^ 
ration of the mlvcnt, nod partly by its dilution by tbe ealira, 
tliB gam is pn:4Ci|iitated, and forms with the wool a tolerably 
hard moat, ca[«bl(< of lasting tor some days, or even a 
few weeks, though, as a general rule, it should be renfwed 
erery two or three ilayi*. Tlie cavity should be dri«<l iMit 
with cottoa-woi>l, or what is better, ainadoa, liofure the iiw 
iroductioQ 0/ tlie luace. 



^ 



^ 



XATKBULB OSSD Ot TtLLXSa TEBTB. 329 

"niera ui but littlu clioice betwoM tlie gum roiiii eoiw 
iDcnted I either of tlicin, in % ttAte of solutiuti, will answer 
gnfficLcntly well. I give Um prafonUKU to gum andiumc 
u being iDoro free trom Mate Ibaa Ibe otbon, if oo{ttl b« 
excepted. Bnt ether, Mug tb« Bolvent of coptl, nndeti 
the MilutioD nktiur Iom manopsablo than tliose tuado with 
aloahol. 'Vhc mpidit; with which the ether eacapes. how- 
ever wdII the bfvtttn in which it is kppt may be corlLed, very 
aoou rcducju the itoluliontoacouilitiou uniivailaUe Cor deotAl 
purpoMS. 

QuUa purcha, with which rail* mioenil BuLefaiuci% such as 
pimdend tilcx or glaai, hiu been incorpont^^ makes a r<^ 
markahly ^twd temporary fiUing, capablo of la«tinf; far eoine 
mt/ulhs. In using this oom|)oand, a piece of mitablv siu 
miut bo taken, and warmed oror a spirit lamp until tiie 
whole maa* ia »oft«Ded. The cavity banng been dried, the 
heated gQtiA (ivrclui ia ininylucul, and lliu BuperHuoua ptn^ 
tkm remoTed with a warm instnunvot. Caro must, of coame, 
be taken that the filUtig ia not too hot, otherwise its intro- 
duction will be attended with pain. But, on the otber Iiand, 
it most be snflicicntly warm fur the anriaee to bo a little 
sticky, or it will not adhere to Uie surfaee Oif the cavity. 
Care miut also be taken that the gutta percha la not hnmt 
when it lh heated over the flame. Aq excellent method of 
feooring its adhesion to the walls of the cavity is, after 
tharoU);bly dr>'iii|^ the cavity, to mop it out wilb a plixlf^ct 
of wool dipped in chloroform ; tbi«, being a ready solvent for 
gnttB prrcba, aocurEs ita pfrlbct aditeaion to the walls, A 
liltio cliiotolomi appUcd in thin wAy U also often very usefnl 
for smoothing tb« edges of giilta |K-rrhii tiltings. 

Of all the temporary lilliiigh in use, the ])rv{iaraltoDS of 
fulta [leTrba are far the muet reliable; and, where it is 
protected Cram the wou uf maflication, it ia exceedingly 
daralila. This fonu uf filling ht pnniualarly iiteful in tbow 
in which the teeth, nltbongli t:eiipr4lly froc from pain, 
will Ml bear the iiecsanro n^uirod for the inlrudut.'tiea of • 




880 



A STSTXU OF DEVTAX RUniKRT. 



utal BUinL 
readily liSaH 



mvtaltic jiliig — a conditkm whicli will coiutm mly pniu an-ay 
in tho wuriw of ilirw; or foiir months, if ttw? cftvity be s«alcd 
tip wilb th« guttA i^rcha. loalaaoel am not uucomniaa 
vhero, afWr the introduction of a gold filling, tbe tooth ie m> 
jmnfolly HoDiiure to chansca of tempcratiire, that the patinut 
is ia dread of either hot or cold beverages, or even of drawing 
cold air throngh the mnnth. IT the ^tta jiereha be nibsti- 
tuted, tba incoQvciiuaiM paMes off, and the tooth -inll, tt tba 
end of B few moulhs, bear the re-intrwiuutioD of tfao gold 
withoat auy of the preceding disoomrort. 

Outla fwrc-ha is aira Yvry UMful ae an exporimental BUina 
where there la Moie douht wh«thar the nerro am he i 
•live, aa in the com of the touth aching, it can 
rctsoved, e*«n by the palienta tbemaelni, ilionM the nccos- 
aity for their bo doinj; arise. 

For temporary filings, tlie varions preparations of zinc 0x7* 
chloride are exceedingly nsofai. Zinc oxide ik mixed with » 
Arooi; aotution of sine chloride inlu a thkk piutv, which, after 
the lapse of a short time, hecomoB petfiwtly hard. Differeat 
makers introduoe difTorent siibaianccH wbidi in soma dogrea 
modify the rapidity with which it scte, and possibly alter 
the reaultant compound tn some slight oxteiiL 'I'hnu borax 
is often intrudacpd into thit floid ; atui powdered i;laiw, or 
actual flilicA, into the powder, for the pnrpoto of mechanically 
oonffimng greater hardness va the mass wb«a it has set. 
But the varioaa oateoplnsiic fillings which 1 have i-xomined 
difl'er ooly in 8li<4lit and Iminaterial points, and thn nbjec- 
tioDs wfaiob can bo urg«d ogaiust ooe, &pply. 1 beliflre, 
almoKt equally to alt 

The einc oxychtoridiMi are a cLua of bodies for the moat 
pan mulily dwotnpuscd by the action of acids and alkalies ; 
moreoTer, the ninnnef in which the raixttirc i* made pre- 
cludes the j)o«sibility of a definite cheaiical compouod, with- 
out exDesH of either oooalituont, being fuimuNl. As a uiatter 
of lact, there i» always free zinc aUloride to be found in tbe 
finished filling, and the filling is conaeqiiently hygn»copic 



3 




MATimUtS trSBD IN ttLUSG TEETQ. 



831 



I 



I 



Tb« objectiotu to iU use, which emliody iho nAiilU of many 
»pcrlni4mlH,have bw-n vl^cwhuv (t(9t<.Tibe(l('),&nd it tsouly 
Decnuary hero to eay, tlmt oxy>r-Tieiic« of flft iie<! in t,ho mouth 
gon tu coufirm tbc ooacluflioQs which bail been nrriTed at on 
dwttucal groundti, luuDdy, Uut it in imMialik 

I have uevor soen nn inKtAncn in which n Kinc oxychloride 
ctopfiing, nhiuh wua at auy (loiiit in omUct nilh the gulOf 
TcmaiBn] iauct for any ooa«idiT8blo Ivntcth of time. No 
tuatter lt»w auvfuUy it hiu K-cu niiplied, if it rcaclten down 
to lh« gi)m, toooer or Uicr it will ansure^ily fail ; and this 
[inoticol rvsuU in iioUiin;; mun: thaii what might bare beeo 
DXpoctod from purely chemical oonsideratioiUL 

Wlwre, hawBTer, it is away from thn oA-^ of tlie pim — 
a», for insuooe, on a {!rindin;< aur&ice— it lasu much luoizor, 
though it wtnrB down with the friction of mastication. But 
where it h wU'Uy prbt«cteil by Unimi covered ia under a gold 
BUing, it laatA an iiuleGnitcly lung tinic. 

Aa a temporary Glling, tbm, it is very valuablo; but it 
baa DO claim lo the name of a pennaiiont filling. In n];i>ly-, 
iaf. it, the paste aboold be oMd very dry. and tb« filling 
mrtpfully protecled from mointuTf till it ha* fully net ; this 
may bu dona cither by keefHu;; the rubber dam apjJicd to 
the tooth, or hjr vamiahin^ iin auriace with a soluliun of 
gutta percha iu chloroform. Out all our precantioita ar« to 
•omo »t*7kt fitttlo. for the pajpte has hyjm)«co|)ic pr<Jpvrti«a 
which cautL' it tu iiiihibo water, evcu from the atmoii{4ieTe, 
aflcT it has hardened ; oerf nht^<lc«it it is vory esaeiitinl to 
prevent H Ruod of mlivA from vrnahio^' away 1L0 zioo diloride 
before it hu hod lime to cotnbiao with the zinc oxide. 

Ptrtnnumt fiUin^t, — Piuulu;* to thp da&i of mototlio rab> 
itWMMi^ which do Dot niulcr^o very malfrial ohan^ge io 
the tnmtth, wo hiivc tliree diflereot kinds : fusible metmis, 
■maleAOLt, and pur« metals. 

It is a carious propdrty of eerlalu alloys to have a nirltlng 

(I) (!■& Tvai^lB BnUih Jvttruai uf UbHaI ActoM, MLidLtiLiai. f)a 
IIM Okrililsrwr. 





point below thkt of the coutimcnt rwIaIs; lhn&, thf> aAd\- 
tJoo of cadinium lo cvrtoiu 0tliL>r alloys txmfen this pruj^rty 
iD A marked de^w. 

Sovcnil furniiiliL' have l)eeti propcwed (of vrhich tho best 
knowD is Dr. WoudV) for fonuin^ alloys wbicb m«U at « 
sufficiently Inw tfimpcmture tn be applied to a tooth by the 
aid of hot LttBtmiiieutt; but such prci<aratioa8 have fount! 
little larcMir in thij country, and I \\nvf titit little experience 
tu tb^ir use. 

It mty, I think, bo ascnmccl a« a sottted point, tbnt for 
dimtal puqxwra a pure mi-'Ul, such as gold, or even tin, is ia 
alt respects prcfL'mbl* to any mixtures of iii«tila at preaeai 
knuwn. Out there are cisos in wliicii tho one oan bo naed 
while the other cannot. The American wrilen on dvotal 
Burgery bavs urged every possible argumtigit against the use 
of amalgams, and have gone » far 00 to pan ralet for the 
cxpalaioa frixm dental societies of membcre who would not 
pladge tbciuselves tocliflcoiitiniiethe use of mercurial filliings. 
.Yet there are teeth the condition of whicli is Buch that gold 
tilliu^s cotiiLUt lu iufwuted with Any chance of aucoesa, hut 
which, if plugigod n-ich a good amalgam, mil la«t for yean, 
and be pcrfixsLly i-fTuulLvo for a long '(nriod. 

Common Bcnsc vrill, I think, decide the qitcstfoD wlietlier 
it is bolter to have a tooth filled with ato&lgatn, or to lose 
il at once. It haa been \irged that the mercury xiscd tn 
making the iJky will mlivate the patient. I have n*Ter 
Mf n a case in which tbin result wai> produced, nor do I know 
of a well autbeuticaleil instance, and I think we may fairly 
conclude that the iustauctts are to vzlrvmely rate that lliey 
need not influence our jintctice. 

It muflt, however, be bonie in mind that I un not 
advocating the uw of uiual^uuu where pure uiotaU can bo 
used, but I do contend tliut tho former are extremely nrnfat 
whore the employment uf tho latter is prohibited. Takn, as 
an example, a tooth Ui« crewn ur which has been hollowed 
onfc to 9uch an extent that the introduction of a foil filling 



A 




MATRKIAU USED » rOUKO TKKTII. 

would break dowu nil iliut rvmauiB b1»v« tbo nidian! uf Uiu 
fTUiu. yet ia wbicb tli« pulp li» Im^a cdclfied &od llie toolli 
U five from tcadarnera. Such u tooth if left to iteelf wiU 
HOOD criiaUo away, but ir carefully filled with amalgam tt 
iiiAy last for yrarn. 

Uatjy eiamplcH may bo founil ia wbicfa Uino kindi of 
filliag havo prcMrroil the tMtb in a state of naaAiloeM for 
long fwnods, tbo tuw of p}M at the tim4 Cie opvratioa was 
perfomud, from sorao caiuc harini; been intordictcd. It ia 
true flu toetb may be stained by tbo Glliug, but tbe prtaeooe 
ofaatained tooth U prefurablo tu vacaul kutiui, uiuru espi>- 
oially when nituntnd at the bock part of tbo moutb, and sub* 
■arrlont only to the purpow of mastication. I*hi9 objection, 
bo««T«r, can at the preaent time be wauoely nid to hold 
good. The amalgama now in u«e do not itain Ute Rnbfltaoce 
of the lAoth Oft tbe utder preparattons dul — a proiwrly diut, I 
think, to thfi imaence of more or less oopper in the com* 
pounda fonueriy emplayvd. 

It ia not uncomtDou to meet witb caao which niipport 
those Tiewa in respect to tbe occasional usg of amolgomi. 
Ffttianta sometimeH roiinwt that such fillinga may be r*> 
moved and ^Id subatitntod, but more (Ve<]u«nUy on cffidoaa 
operacor ni^ei the neceuity of ndlUn^ teeth which lutve 
been jndiotoiuly and effectively tr«at«d. One of two roaolta 
follows; cither the teeth remiita oa useful us they were 
httcm the sabatitiitkiD of gokl for amalflom, or, what u very 
oommon, the teeth are rendered tender by the operutioo. and 
the patient, after mora or leu mffering from infliuntoatioQ 
about tbe roota of tlm rofillod teeth. \» obtigai to submit u> 
tbo extinction of organs whi^lk. bad they been allonrad to 
raniain uttdiatttrbed, wotild iii all probability have oontinned 
Hrvicvable f^r years, 

I hare in Juy own moulb two wiadom teeth which, tbrea 
years ^ncc, wen so much tiecnyoil that it seemed hopelev 
to altetupt tiieir pnservatioii. They were extnrmety tender 
when brought iu contact with banl food, eucb as biwtut ur 




S8i A flTflTXU or DKMTAT. flrniOERT. 

crust of bread, and (o\l as tiiuagh Uicy would ocbe 
aaor veekB haA ■putted. I removed tut well as 1 ooulil 
carioiw portiotw, of course very Impcrftctly. and filled tbem 
wilh anuitguo. Tbuso twUi have since that time j^iveo me 
no (lucomfort : beuce 1 have a ri^ht U> cousid«r that Iha um 
of 8ni3l;;;sm ban eoaUed me to retain two teeth which 
would otlierwiM liavo been remoT«d ur have falleu into 
dititiso three yeartt ago. 

Till williiu a coiu^fara lively receot fieriod Jt wiu custuEoaiy 
to rvdtuM into fiiingu tbo ordinary silver coin, mercury wu 
•ddad, ftnd tho compound vrorkti up in a mortar or in the 
jnlm of the Imnd iiutil tho whole Iwcnjoc n-dDui'tl to a stiff 
pute. The saEierfiiiouA mercury' wa« then eqiiMzed nuti 
either byprcesinj; tho maas between the thumb and finger or 
in a fold of. obanioi:* lenthnr. Alter thin manipulatioD tbo 
Oomixtund is placed in the tooth, and in the roMrw of a fcT 
houn liecomeH quite hard. Allhatigl] this fnnn of i 
is bright wlien intrijduced, yet in a abort time tbe 
becxKnoB black und tlie whole body of the tooth by degree*' 
usumes a dark grey colour. 

A, series of azoalgams have been long buown as Sa1livui*l 
cements, which are in tho main uomposetl of copper, but the 
ootDpuHitioii of the several (laalitica oQercd for sale bas not 
been. dc«ribod. They nra sold in Uirge pill-tihapcd moBiict^ 
and the operator i« directi.-d to cmidi iu a mortar a Kufficient 
quantity for the cai>c under tK-atmeut; imrl to place tbe 
mass in an iron apoon, which in to be held orer the Hamij of 
a Bpittt-Iimp until globule* of mercury appear upon tbe 
iurlttoo of the frogmenla. In tho heated condition the 
compound is returned to tho mortar, and rubbed imtQ 
redooed to a pute. It is alterward» squeozed in cbamoiB 
leitlier, to separate the excess of mercury, and is theu : 
br use. Thoeo amalgains poesow the Bame objectionahle'l 
qualities as the one alreatly noticed, bat in a lees degree, and 
are therefore ppefemble. 

Precipitated palladiuu!, when rubbed up with meronry, 




MATKIUAU tmO at riLUXO TECTB. 



835 



N 

* 



^ 



tonm au anuilgani whkh doee nol Htsin thu tooth iilUiough 
it becooKf Id Uio moatli of a dark grvy oolour. Tbe pnx;eaa 
of tutilitig tbe two metiUs it a little lireBotni>, The mercury 
rolls about Id a fioely-diTJdnl pcUladiam, and at first shows 
DO dtspoHttJoD tu unite ; 1)ut wlivu llin cxinibiiiatiDD ooid- 
nwncea it proceods npidly, and is accotupauied by tht 
eTointioD or coDsidenhlB boat, ATter tlie metals are inoor- 
pont«d, DO time moit 1« lost before tbe otaai ia iutrodooed 
into the buliy tooth, as the proocw of Itardeniog pnxweda 
Tery raj^dly. This alloy in thu soft «lAt« ia rery pU^tlc, 
and will iiiko an cxtrvmHy delicate oonntorpart of any 
nirfaica apon which it ii pre«Ked, much more to, indeed, than 
any other form of lunalKam with which I am acquainted, 
llu) iTeoeding oompounds when pruwd io the soft state 
between the thumb and finger, impart a very peculiar grating 
sensatioa, a pn^icity which thtt jiollsdium amalgam does Dot 
poaaeaaL 

Dr. Eii-ana introdiuwd, aorenil yean siDoo, a oumpouod of 
cadmium, Tin, and mercury, wUch at fi»t appcartd topoaoM 
many ■dvuutopea over all other Mmilurly-iMQutitnted aUoy& 
When perfwtiy Mt, the colour r«ae«nhl«d that of tin, and tba 
dogm! of lutfdneaa was sImjuI t-qual to that niptal. TIiom 
conditiooa prewnted grwat adrauugea over tbe bard, brittle, 
and dork atoalgama fonoeriy uec-.l, and the new compound 
wu C0DK()ueDUy very fjeiierally adopted. It was, bowerer, 
aooB found that the caulmimn, when iibed aa a filling for 
teeth, bucauie subjecl to r]i|>id oxidization. The mass loat 
its tin-like MflnrsM, and beramo friable, while those portioot 
ia contact with the tooth vn-tv n>iivertrd into the yellow 
oxide, givicif; to the ntrface agntnNt wlilob it nated a brilliant 
yellow vt ufMigv mlour. livaw it happened tb&l the nee of 
catlmium aa a l«ua uf deutal amaljEams was no aoooer 
adopted than abaudoocd. Attention bad, however, been 
dnwn Io tlw> subject, and atlcinpta were made to And a 
cumpuuitd whioU would neither oudiae not aanuno an ob- 
jwtionnbk colour. 




i 



836 



A BTSTim or DKKTAL glHlORBr. 



Mr. Arnold Rogers pnblUbed, ia 1650, no accooot of an 
amal^m wbicH he liul ilsmI fur acvi'ral yonrs with snooeaa C). 
It WW oompoBed of o&fi part of cold, one part of ailver, tioA 
■even parts of meri-ury, atid rpr]uirMl hnting before use, 
mttcb in Llie samo manner as Snllivan'H cements. Tliis pre* 
paralioD wtu nut subject to diitcolo ration, but 1 am tohl by 
Mr. Itogera there wiu same ilifli'i.-iilty in obtaining nniform 
resalts as regafda tbu ■Ict'rt^e uf biirdDcss of Iha plugs, and 
the Ham rcquirod for thv bAnlcniit^ n-bi-u iMcd iu the montlii. 
Tbeaa difficulties led bim to duiiiiiDtiaui! itd use in &voor of 
other foriDuLas wbii^b bavo slacv l^'on iiitrtxliic'd. 

MeuiB. Asb. of Qroad-Btrcet, vcnc) an alloy, niippooed to 
be eampasod of silver, and tin, and a small {lernenta^ of goU,, 
lo which mercury is added when r«qnin»l for use. And 
Mr. Bobnrtiian, of Birmingbnm, at about tlie atmti datOi 
imbliabod a furmula, cotitaiuiug stmilar iufrr(idiBat& It ig 
CCNDpOHod of "t;old, oite yosl; silver, three part« ; and tbi, 
two iiartA** The myrais, wbii'h must lie iierfoctly free from 
inipurititiR, are uicltod tosetbvr, and riiu into as iLgot, atul 
oftarwurdB leducnj into filing ('). To these mercury is 
iddod at the time of using, aud tho quantity retjuirul is 
equal ID weight lo ttie iiUngs. 

But, altbougb tbc tiisues uf t^e teeth are not diwoloiired, 
yet evfin these prepuationa become a little dark in hue after 
tbcy have been t-omo weeks in the month. Moreorer, they 
are bard aud brittle ; hence & preparation capAble of relaiajng 
Uh.- pbysiL'nl pri>|MTtii'3 wbicb l>r. Kraiis's ama^am poagmed 
at iho DDsot. would bv nu iiuprovemeat upon tiiow told by 
UcMfra. Ash and utbunt. 

When required for imniodintti u«o, the requisite amouDt of 
filiDfcs ia plaowl in a mortar, or in the |»lin of the band ; 
mercury is added, and the two are ruhNHl together until a 
ttiOr paato is furmcd. This BbouM be wadbRd, either with 
akohol, or (according to Mr. Rogen;) with coinjHiiind ginrha 

()) PhtrBMcuUGBlJoamftl, ral.ls., p. loz. isso. 
(*) IbU., vol. tt.. So. IL 1133. 



I 



k 



XAmtUU CSED tS nLLDtO TIBTH. 



3S7 



I 



I 



of unmoDit. TIid fint partiao of flnid will be ilrwply 
eoloiirt-d, but nfler one or two rcpclitiotia ttip ftmal;;ani will 
oeave to import anyeUia to tb« liquid. The tdjus mar then 
bo dried io a napkia, and after »que«Eiiig «ut all t)i« m|«i^ 
flnoDft mercury, id ready fur innirtiua inUi tUo Canity tootb. 

la coodnctjtia: the operntioD, the cavity should Iw freed 
Itwn moiatiiro, aud Uie anial^Am nmy then be {iruiwed Qnnly 
iti« care lieiog takea tbat the carily U thoroughly filled, 
wfaile none is allowed to [irujeet— « i>recRntioo that mutt 
be eii>4idftlly obwrvad wbera ihe giun lie« over the margiu, 
and thereby concaiLi the edge of the uri6cc. The plug will 
become perfectly hard in the coune of a dity, and should, if 
opjwrtiinity is offerwJ. lie filed sniooth apd )>oIi8!ie«l, together 
with the mai^tu of dcnttuc or vuiunul by which it is nut- 
ronndftl. 

The kind of Mirface aasumed hy atnalganw ia Ihe proceea 
of hflnlening will be considered iti connectioD with the 
Bttrroa-.^ Iirrwnted lt>- llmm {arts of i^old hlUnga which lio in 
Doiiloct with the ^vall]| i>f cavities. 

effect upoa the dentine, ppxluced Diore ftilly by 
amalgamii than by those at praecot in use. nuy 

Dntlntd. The blockcaed tisinie a^nlust which ihc amaU 
gam hu rottnl for a lu[i^thvne<l iK'riod, is commonly foaod 
to be t'xJremrly hard, much more »o than healthy dentine, 
ontl much more «o than tbat which ix diibjucent. h ie often 
difBciilt to cut away Iho discolourid and indurated tiiwua, 
bot wlxm this is cSected the iiislniiiieat readily o}>enileB 
QpOQ that which Is next prtwoiKiL 

It wontd be out nt pUco tu viitvT at any ^rrat tenf^h intii 
the chemical aod phyaiotl properties of ftmalgams iu ih\* 
trnrk ; tliey bnvu l>eeD ni<K« ftdly iliaoumed olaewbeniC); 
bat there urc fonii; few obarat-ters sltared by all of theni 
which rtHiiiirc uieutiou herr. UidNntisfinl with the amalfim 

fnsBiQi in oar, t undortook an extended seriaa of cxpcri- 

(<> C. *. tooiiv. Ml -nriinX mat Orolcd l>n>p*nir» of Al—lptiw' 





iokttiU with tb«< TJL'w nf dt-termining the ml aotirrmi 
lUlare, aad waa Im] to the cuiH-ltisiuti ibkt clicmical actku 
oa the ulloj liad litlle it uothiti;; to 4lu with it, bat tb*t 
uroal^^amit aL ao tinie I'orm |»rli:ct [Jugn. Every oob of tiuMv_ 
whicb Wore milunittvU lo eipcritneal ooutracted u it 
hard ; wmia vpry greatly, otlu-n t«ea, but alill all oont 
lo ao extent tbat miut imperil the piwcrvulion of contact lU 
round the circutaroreooe uf llie [ilu^ IVil t)ii» cootnu-tiun 
takca pltoo with tht greatest Tsptdlty in the first few boim 
after tiic ama1<;iuii box been mixoii up, and KulMeitta-nlly 
is alight in amount, lltougli it is oft«D not coinplvn-J fur 
twidve liouni. Uciicc we may jnirtly UBtover the tlifticalty 
by amidoyiti]; an amalgam which oeta with great rain'dity, 
auch as palhulinni. In iL-ting thia metal as an nnial)(iim 
th« greater parL of the tthnnkiige is over befora the plug 
is complsced. 

Gecenl experieticv hmX already sliown that of all aiualgama 
io use^ paltadium was dediledly the beat, and thai next to 
tliiacamc copper; and it was exceedingly rattfifai;U>ry to find, 
in toy experimeiitfl on this matter, thai these two displayed 
leaB flhrinkagn thaTi tuiy of the othcrK Ikit of the nunu^nios 
amalgamc «ubmitt«d to experimeDt there waa not one which 
did Dot contract markedly oa it hardenul ; en that they rottrt, 
otH and ill, h priori he pronotioccd unreliable. 1 1 vai (band 
Lhal the addition of pinlinum tu silver and tin aiuatj^ama 
greatly ha«leneil iheir wtting, whiUl the addition of gold 
teasoned their contraction; there ia, however, a limit to ibo 
i)Qantity of gold which can be advantAiteouitJy added, iaa»> 
much as it eventually iitt^rferes with the complete setting 
of Uie ccni|X(aiiiL 

So far as 1 am aware, no scrviccahlo amalgam which doea 
not cuntniL't as it liaideus has as yet bran pnMluood; 
Mr. Fliotchcr has, howovcr, by the addition of bolh gi>ld and 
platinum to a siK-t^r and tin alloy, diicceaic^ in pnidncni^ n» 
amalgam in which the total shnitkage ti nut |irt«t, whilst the 
mpidity with which it seta aliowv aonic part of the c>:'utnic- 




MAZHBUU vno nt rn.uNG Txoir. 339 

tkni to tiiko plaw IxiRirc ihe opcnaion is coiiti>lt>ti<. T)irae 
ftiiutlpuus li&vc Dvl brvii ill lue for a lenglli uf tiiiw sulEcivol 
to tMt tbcir nctMiil viUiiv in the moulh. 

There h, however, aoother bull puKBraenl tij> ninui^nia, 
wliJcb faM be«D Ifttely pointed out by Mr. Kirhjr : not only do 
Utey otinlntct, Imt they iin»a uudrr^o onuaitlimblH chAn^eii 
m form u thvy Itanlcn. Thus, he f^iind that on nioiiMin]; 
f|wciriH>n8 of •nuilgnin» into the form of Ions hoTB, with a 
view of nnsuntriiu tbvlr U>u;JluJiuiU conlnkctkia by a micro- 
neter aoniw, that in mmta iiuutwci it wm impnnible to 
npboe tbtt t«riii)le in tins IliUe trough tued far ibe ]nirpoite. 

Pnim vuiooa gnmndii, it wanld ar«m adviaftblu tii tuu.- i* 
little meveuiy aa poMible in mixing up an amalgam, and it 
ia probable tb>i( thu tooat dnrable pings wonid be nmds in 
tbtn way ; but it Diwiilil Iw ntcutioncd ibat in Mr. Kirby's 
lutidi^ tbtf ban which Rhowi.>d thu i^reatciu altonttk'U in form 
wpro tliutw which hud hpen iiiiKed very dry. 

Iniuiniicb oa the ni'lvont powers of mercury are greatly 
iocresaed by wsmitb, it It Itc dndrwl to iotmluce the 
oiuolgam in a wry dry mid atmont friable condition, wnrm 
irulrtirDenlg should Itn Mtiplnvnl. 

Aa boa beau IaL«ly puiulvd out by Mr. Makius, in the 
Mnptoyiiicnt uf a •ciui-iiiiid niiinl^iim vk gvt an tffTect 
auAki};uQs to that [imducod by Miuuutiug a h|>oii}^>; lliaL a 
to aay, tbo llntd, in this cose mvrcury, geto fom-d to the 
wmtteot » that the onmiMXiition of the maw in diSBnait porta 
vadoL It ii Msy to mm that this may teMl to a vacmcy 
nmotl the nlges in twu ways: hy the ali(wr|>tiou uf tlie free 
mennry hack into the cofiti;fQoui jioniuns of the ping, or by 
ilM j;Tiiiliial i>va|i'jmiirifi. 

OolJ. — Thiit ira'tnl is |ire*<imitimtly miitahio for the jmr- 
poM* mC tilling i<vtb oil tu.Tiiiiiit vf it!) wftniisa, wiii<-h n'lulfK 
it juneiMc Ui get vory at'iitmtt! ailaptatton lo tht* whIU ufthe 
tiiTity,and also ua iiccwiiit vi its power of ren^iniioaitbiiion. 
It has aUo another TOluablo pro|M>rty, vLuwIy do]>eiidL'[it un 
(u wiflnoia, namely, the nadlnew with wliich tt may be 




my, difsnlvhiit it In tqiia ' 
>ibttin]; it; the fonn iuhi 
voryiiit; greatly with the 
and with luany other ootiditid 

Whvu ibo aqtu regia Mhitil 
oxalic or htiliitioroua uciAs, the 
«pf»n)zy uuuw ofuryttallinoslxd 

Mr. Hakiii* wwi, I thi' 
Of crystal pfili, u it is i < 
used for dontnl purpo^o^. i1 
niimiti! tKtalinlrvl cty&UiU, coiJ 
librra, vltich at part* pxhibil«d1 
wbtAe forming a sfiongy maaa 
gyoDge QDdur pmsore bwamo 
it could Dot bo dfaitingul^fld fr 
pieces of th« sponge, if a^>)ed to 
(H>nd«nwd, on tlio cuitiluymeat ( 
adhorotii. Thii) ulbwivc or w< 
KrOrdiial fomiKtion of a plug, solii 
but little diflicitity ; aud in ll>e 
nitiotiof tliRftHhcsive pntpcrties' 
new gold appeared to offer great b 
10 Bniwrsede (he use of foil in n 
hare Men, from time to ti^ 
Sfr. Klal 



rP VAxniAU VBXD or nnaa tutu. 341 

'finb vera M nnbrounblo, that for a time tb« u»e of tb« 
sponge giild wms nlMmlounL 
SulMoqueiilljr Mr. Qarliuu, of MaidHtuae, |!a%'« lib atUQtioo 
to the snbJMt, and intiixliicM a sponge gold not albO!;i!ther 
diuUuUar to tJiat wbicb Mr. Mnkios prpdiicvd. It u formed 
nudnlf ^jToclnliedtal cryxuU and indtxtiiK:! 61am. 
Soon after tlie ijrwliu.'tioa of t-imago ^M in ihU conntry, 
the al.(*nuoQ of iratwatlantlc practiliutMsw became dliwtwl 
to the subj«:l. Mauy eiiionnidiU than, as here, wcra inadtf, 
with TCTr«jHi»iii>nftli)c muxes*. Ultiruatcljr.Lowevor, a very 
beaatiful prejariitiim watt ituulc Uy Mr. Watto, and thitt is, I 
betteire. it ravouriui funn of Hjioti^if kuIiI in Amcriot. Wt* 
know it as WatLi's Ameriran cryMal giM. tlie vulimMo \m>- 
pertim of which havo b«)u very Btrougly pat forward hy 
Uwitulle and utlicni in ib« American dratal )ounuil& llii* 
gold cooies to the hand of thtt ojimUir tu tlie tViriii of light 
•pongy cakei, readily coinpnr»sib1c bctwecu iho ibuinb Aod 
finger. Beretal dQ;mM a( dutuily are produi-wl, bat th« 
obaroct^n- of the gold is othMwlae the aanic. Br the aid r>f 
the uiti:ft«ci»[Ht, wl' are vualiled 1j> nw thai thv Atiwri'tin 
diffon ill iu itructure frvui lUe English spoDgv t;oU1. Each 
IB crybtalltne, bnt while the bitlcr conmatA of cryiilala of 
the fonn iionnal to llie nieUl, tli« funncr in iiiftilr up nt 
bcBtitJrtil folinrdous crj-staU clowHy rewmWing in urncml 
Appearaace tlio leaf ur frond of a c«>niu)ou ft.-ra. 1'hcy havo 
ooniMfh'rablit sui^rticial extmt witli vory slight thickne**. 
and Ii« tu-Mht-T ^Tciatty DaUni;lpd and iiitrrioclcnl. 

In tli« earl'K-r i«m|>tti9 % conxi-Uirablu aiuouut of amoqthoua 
]ld waa cuiangtud aiuougflt the crvKlnld, und In aoitw cuts - 
lo of ikM wm precrat in a imall lunouQt. ThcM tanpcf^J 
ioiM hare ItMii it'Uiviiiixl, atMl lhi> ro);iilin« ixindilion it 
by ail the ntonufactunira. Uui» rncnntly ii:tin|i|(« 
oftpoDpr pild prpjiarpit in I'lmansubed thi* ivuntry. 

In onlcr <it oiiiumaiid Uih heitt rsatilla iu the uw uf Ihn 
cryKtnl {[•>ld, four pointi nxiuirc attnniion. 

Xba guld uiiut hare beou ivceutly mantihctunMl, ut rv- 



343 




STBTXX or DISTAL BDROKBT. 



cenily ftrincftlwl, in onipr that the «Uw*iw pmpMtv sIiaII ho 
l'ull)')>rx>ui>uncctl. lliv {^Iokb mufit bu built njiof unuU fra({- 
niDiiU, uifti ntte bvJDK iMrAfUy coDiuli<laU.il li>fon> naotlirr 
U addod. The nivtal uaist Iw iiminrctl (roii) the coDtnoC 
of moiUurc nutil the |<hu is rortuei). Ami H|i|ir(i|)ri)U0 
iiifltnimeiitfi mtuil be nsod in porfomuogthe D|teniLli>n. The 
u^lL>ct iif Hllier of tli<»e ctinilitinas will Iw blluweil by an 
tmEavunmlilv result. 

Spong4> g'lttl nil exixmrr In the atmosphere aooo Ukks its 
imniliar lulhr^ivt.■ ijualiiy, fttnl iNMruruiw i|nil« iinmaiM;;;e*bte i 
iii»I<^ of woWiiig 1n;:etli«r uiiiU«r tht' Jittipiflnp inRtnuncot, 
it full)) tu iHCCCx, nml nil BLtumptii tu aiakv tultlitiviis tti tb«t 
wbicta i« alrcwiy a>tutolidat«il are iui«ucc4>s«ful ; ou this 
accuuiit it in dvbimblc lu aiiuiiil thu mvtnl whi:n' uiiy duiibt 
cxiau as to it« conditioa. By the i>roccsa uf hvHtiug. tlie 
adhesive |iroiwrty is rf«u>red, btch though llie U<ni|wratare 
to whicli till) pild in vxiNMed IiiUm t>hort i^f a rud hc4kt. Bat 
to whttlovCT extent tin' Wf^Uiing jini|n'ny ia [imiiited, the 
prL>M!iico of muitttunt will nt oiico niiilvr it iinavitiUhle. The 
nivu], from Hn pomuM wnditiun, u1iK>rli)t Ukc a »|)uriic«, aiitl 
iiiKbiul of cvtiiBulidatini^ uiidLT tW (inuuturv vi [he iuntmiuvtit, 
wwks up iulo powdiT. Wo iiiUBi tilpniore i^anl avairiHt 
th« admiwnon oT the Ea]ivn, aud nUa pmtcct the toolb under 
o|»ratioii from the uxpired hrvHth, whicU being chaT:gcd with 
DKttftliiru will, if th(f metal be of a lower t«iu|K.>nitiir« than 
itSL'ir, <)i*po»it upoD it A HiifKcicnC jtmnunt of fluid to intorfer* 
with till' sdliwivu in^ijicity ol iLi- "luld. 

Th« iii»tnmK-ijt« fitrctl for ojicratini; with cryHt«l gM 
HiSvr irom iUcU lut aru rctiiiiri-d for tlm iQirMluctiuu of iion- 
adhesire foil, but ia most nnpetw resemblu tbosa beat 
adapted fur udhostvo foil. 

The working end, iiwtead of terminating like a ite<d^ is 
more m* less tintt^^tie^lf and cut ii|i into a scries o( sitiall 
point* or ridoi's, in the ranimtiou of which it is iieocHsary to 
oxt<rct»e some littlo cflre. The more pi-rft-clly formwl are 
tbo ridges or qiuulritatuml cuum, lhi3 moru coey will be the 




MATBBIAM tTSBll tS PtLI.ISO rSETn. 



MS 



TMUlffTPfn! of the gold. Afier « Little use the edges or 
poinb btffiooie bluDlod, and m|nire rcRtorntioD. 

An inntnitiM'tit wlikb iircsonU s workin<; surfaw of umu 
little fiise, will Iw fimnd amrvDiont for introiliiciii;! the ffAi 
ito tiie cavity ; bat w eouD &» w« bg.rv coui|irww«>l tbo ^uk) 
Innly sgutut the wall of tbe caviljr, ur upon tlMt tvhicli has 



nt.it*. 




I MtuoUilated, a Na&Unr iuUnmunt laut b« worked over 
iB>irfitoH.luidultiiiuu«iy a )«lillsn)a[l0rooe; iodeod, a pniiit 
may ha wuhaiigDd for tbe diHitiered wurking sorfaoe. iiy 
Ibo nfiMttd QM of a poiDtud inslrumrot, aftar a new piece 
jB of guU luu beea wblod lo thai which bad bMO ffwviouifly 

(■) Clfli utanliu duw tMn* of tonatMk fcr tmndwUit wdnw 




344 



A snnx or pkktai. Btrsontr. 



introdncctl, ttie solitlilj' of the jilug i« onmrad, uxl a ifurfaM 
favoiirablo for the addition of ttill more gold in pnylncfd. 

'Hie clianu:t«.T uf tbc HuirAL'B lu wUicli fiirthrr ail>littuu« of 
gold &re rec]uire<l is of DODsiiUr&Uc inipurlAucv. In t}i6 flrst 
|>laci^ it must 1« ifcrfpctlj" cXean, otid Trwi frmn ini>i!<turo of 
AD,v kind ; and ia tLe secoud, it miMt bo rough, either 
from the imjireauoos of the one or the tii&ny-poioled iofitru- 
ntent. 

IaA the RUr&HV Ite mnrle wet by tlie InnjEiiOt or Rtnnnth hy 
the bumi^hM*, and uo inure ^uld >vili adliera until it in afiain 
rendered perret^t.ly elesn and rnluccd to the rough eooditjon 
jnvviuiuly mentioDcd. 

Mucli bu been uid in praiiiv of cryitAl c^old, owing to the 
mdinuflB with which the lust half, ur cvim two-thinU of a 
tooth cut bo restored by building up in metal a copy of the 
absent ]iart. Whun out of tlte ni^titSi the half or the wfaolA 
of the crown of a tooth may \x rcproijiicod in Kpougo gold; 
bnt in the mouth thi' ti|i(!niliuii of nwlomtioiD i*i by bo roeaiui 
■ui eitny : itittiot iRi|N»iftilil«, but it i« pcnoraUy iini)nicticiLbl& 
There are few ]iaticnis who cituld 'kev\) the mouth ojien for a 
lufficieut length of time, and wh«u thoy can, the tooth 
gradunlly cwIh down to a lower temporature than the expirod 
hceatli, ami prodinUtlion of moiKtarc u|xn the metal is the 
remit. Ttic o|iemtlon may he HiiAjtRndml for a flhort time, 
if on rDcommciicin" it tlie gold \m rriimX dry, aod the 
surface acraiicd or filol, no M to i^niturr n clcnn surAice. It 
ii wldotn, howeTCT, that the rt-milt is [xirftctly is(iti»fact<;r>' 
when the procedTirc i» interrupted; indeed, tbe reatomtioD 
of any ooondenhle umnimt of the crown uf a tooth is rarely 
attended with lasting nicoeu. A few Bhow-casos may be 
prodncod, hut the operation is too tedious, and the ultimate 
result i» too unc^rtaiit, to admit of general application. 

In iiixtilntin^ a ooinpnriittm between gold finl and crystal 
jjTold, the microKopc may bo called into r?[|nimtiou with 
advanTAf^tj. If [ilii^s be mailo in porforatol piwwi of ivory 
(in the manner already alluded to) with the various forms of 



KATKRIAXa FHEll IK Flt.I.IXO TSKTH. 



345 



^B erjrstal gold, wo sluUl find Uuit the saHiuti which hut bocu 

^P prsMNxl ujiori. mill hait rebted Against the tvory, U made tip 

^P of cryxTotA, the r<inTi> of which have been nnalUTul \>y the 

prvHurv. Tlivir i>n»oii«i ui ihm Kitualinu indicatt* a oertaln 

wnoDnt of |«rotuty, and it is due to the dvutinv twl uffering 

mfficioDl iwistaDia) tu intivfurc wilh Uio crystAUiuu cliariKter 

of tb« [uctaL Ilnd the hole been in metal, instcud of ivory, 

the iasrrtMi [>1iig vrmild bare [ireocDlcd a tuach gntolur 

^— density Ti|«n the lower toriaoc: or hod tbo CAvity beoD Utied 

^m with ftuiniel, a sioiiUir adnuitJigF wiwld bavit been gained. 

^^ In iimctioo tl ti wry frtiijueuUy iwcD8»aiy to plug a tooth 

frotu which thu whulu ol* thu diiwaafil tissue auinot be 

nmiOTcd; hence a RubKtance Boftcr than hmllhy d«nliiMi 

Ibmis the vttrface, the mrislADce ofTcml by which n-ili bo 

quite iiiea)Hblv uf (irodiiciDg; cinideiixatiou cf the gold to the 

extent obtuinpd where the dtanrganixed part ia wholly re- 

uuiiMvpiL-ritly, if cryiitAl }>uld bo ummI. th« vuolowd 

of tile J'bi^ will bo iiiqiorfcct, Uicy will Im capable 

of abeorlnug inoistuie, ouil may afl«r n tltiw Ui lirokcn down 

with Tury aliglit fotcv. Ou thu other liand, wbm th« canty 

ia diaUuv, wiih the bottom hard, and tbo orilJce Bunmmdcd 

by etuunel, perfectly RatistActory n>8ults may bo obuined. 

Id iboiie cMsra where decay haa cnmnu<nc«d ii{iaD tlie htbial 

aariikoe of tht from leelh, the cryktal L'old mity be uaed with 

.. gml wlrnutA^e. Tlw plti^ aboulii bo made to project, and 

^H then he filed ftuwn to tine level of tlio surrounding aurfaca 

H uf th« looth. 

Tbv alCainmeut of alMolutH nolitlity in a gold plag made 
In the mouth. U not poauMo. If crystal gold ^» oMd, the 
microKCupt! will ahuw a certain omuunt of pt>roaily ; if foil be 
employed, it will show tlie prenenoe of Biaurea in the peri* 
plienil surfaoii of tlic |ilng. Now, if Dtcualon? finds its way 
U> the vurbce uf the furvtoT, it will a)jre»d uver the whvle 
circiuiihnince •'>{ the jiliig ; hot in th(> Utter it will be con- 
fined to the minute fi»ure« Mliiated ul duitant Uilert-alii over 
Iti ntrfiwc. A(t«r nring cryual gold for aome ycar«, and 




346 




STBTKX OP DKKTAL nrnaKitT. 



foamining very rltwoly itilo tlir fwhIu, I have cnme t<t 
ooticliuiion that it ie itilcrtor tu foil for t)io cuu^imcTJoD of 
tliat |k)rLi(jn uf tlip jvlu^ wliieli rr-su ii}>nitii>t tlif ilpntitiit. 
But if the oporalioQ h*i cr>nimtnc«l by lining the cavitT vriUi 
foil, Uie oentrnl jwrtion of thi- T»luft mny h« ■dvaulajn^uiily 
ma^ wltlt crystal gold. Dy thus combining llic two Tonus 
of gold, pluRK may be pnxliiced, the density and iiDjienue- 
ability of wbicli conuot Iw siiri«Ksed. 

Bpunge ifold wtinn Iotij^ krpt, appMrsi to nndsr^ mroo 
moltKuliLT change, gmtly iatmfcrin^ with itit wcrlding pio> 
pprtios, which are only in a meMara nstonNl hy Aiinmtini^ 

OM/vil is prepared by Ixntinf!, or t^uinv limes in the cam 
of v<'ry hoary foila, rolling, into thin clicet* a jwrfectly pare 
tnctal. Thr< eliout when |ircj«retl fur deutal pur}>>M]e is 
nsuiiUy fotir inches «]«»», and is Dunilicrc<l in luvorilnnoc 
wilh its wciglil. Thii« the Kos. 4, 5, fl, 7, 8 iiiiliaitti tho 
tiUDLber of gruiaa cnntAincil in mch fotir-iiich s)>wl, and 
recently T«ry nxich heavier fulls havo liwn employed^ 
reachittg as higli aa two liiindrod iind forty giuitiB per 
shMt. 

The gold Icnf of oomnterce Manalt(%<>th(>rditT<MX-nt Article, 
In nnlcr tn |)Tnduce a lAf mfKcinntly thin for ^Miiik pur- 
ponwt, it in necessary to intnMbiciJ ft wriain auionnt of copjxw, 
■a otlicrwiw tho tnetal whon i;re!nily rediired in thicknpw 
will out leave tlio relluni, b<>twocn nhcvU of vliioh it is 
bottec. 

Cuuadembtu care is nwcBsary in iho prL-i«iratit>n i>f tha 
gold leaf, as it is aK^lutoly csBontial thjt it shall pomcss 
certain physical rtiarnrU^ml icR as viiU as chemical piuity. 
Thus it inuit be tough and soft, and niuit possess either a 
high degree of adheslTeoflSB, or else tititxt In ocimpletttly aoa- 
wdhenvv. In tho one oasu, if m-vvrsl strips bo placed in ft 
piil-liox and vttll shakea, they should litxntne IntPjArably 
unitod, whilst tu the (»thcr they should not adhere when 
firmly pressed together. 

Much light has beon ihrou-n on this matter of adbarirft- 




I 

I 



VATKtUALI CaED OX RLXJKO TUCTB. 



347 



ncm in n vnlimlilu |iu]M.>r f¥uil by Mr. Mukiiut(')t iu whJcli it 
MHO LiiJ -luwu lluit lliv rwiuuito condltioiu fur compUto 
WRkliug wete a porfevt aImucc of ioijiuritivs friKM Ltio surrao.-, 
iklhfmit Air evDQ operating iliuulvuat4;i!uiuly ; fnitKltmi 
from moictarc ; uid a mft, yieklini; condition of the nwt«llic 
)«rt{ele*, which iuu»t iiut have lUiftiiod greut prcviuus coin- 
pnaHiun. Thiix.altbou^ rilv«r, C4;|)per, or plutimim, whoa 
to Um |iiUveriiU'iit cuoditicm, laay be wvlilctl by preBKuro, 
csroltwt UMoipuUtioa v( tbc p</«*(ler by wblcb tli« porticlca 
iuvo bMiuoie io a meofinru bunttiibHl pllectually pruveata 
tbeir imkm. Mr. Uakio*, id speAkiug of adhetive fuil, vtyt, 
**Tlio »ur&Kw ohtoined i» not ■ Mnuothed one, muA is br 
froiii jwUsljod : whcu examined by Um micrxACoptf it will !« 
WHi Io bo covvrod «vith c-umt^tiuus with corrMjxitidiDg 
dvpnnriotui. Thv uffitr edges of those ap):«ir btinii«ba), 
bat the dapPMkioQS with which the gronter part of tbo 
surfiiea is covcroU arc [wrfottly liurth<d ; atul this is par- 
ticularly the c&w in what is aold a» adhvMve, full, which is 
&r mom iniitlcd, und of that brown colour which, in pro- 
dpitMed gold, ileuotui h<il slight cvul«iualiuii of the uvlaL" 
Again) li« Myii. ** lu ailhiwiri! Ibil vk luTp n rotiKh surfaoa. 
Bud aUu ituuiy of thv rouditiuiw prcacut in spMigo Eold." 
Tbn>, in adh«ri>« gold it Mtoms that the laoial U ouly {«r> 
linUjr wHdMl. wa that ii is in a very bvotinilile condition for 
forthrf uidtYan ltuttruia«Qt; whilninuon-adhaitT* 

(uil tLi .' olwaily liumiBbwl, mi that it hiw tto gmt 

teadebcy i^ cwlKra. A very elighl amooat o[ mohioain 
chaage, sneh aa oiay ho bimighl aUrat by annaaliDg. HiOIctt 
hi ixiav«rt tliv uuu-adliasv* into tbo adhntvo form; this 
proooH of atuivalltig la, howwor, adrantagmni* (ruiu oUuir 
cwucn, iMaldcN that of itltcrLu^ uiuluular cuiidition, aa it 
wEorcs the ohBcnee of moitturc, and also §ct* r^d t>t adherent 
air. 

Liki< crynta] ^uh\, gnld loaf appcMn to undergo aouie 

0-) a. a. HmUm, "On Ib* VatMVt IMata Iv WmMI^" 




8I8TSM OF OEVTAL SUKCtBT. 

molecular change wbi'ti kt!|it furs length of time, lewling to 
tu oseuuiin); a bard, b«nh texture. 

BeTore iliwcnbiiifc tJie iniuincr of intrwtuoing the Koldt H 
will bo well to devote a litttc epace to the consi'lfratiuD of 
tbe inKtratuenta utujibj.vcd, ouil the luctiioilfl uf k(.i>[iUig the 
cavity free from moisture. 

M'thtjd* iif Actfinif Ifif atviiff Jnf. — ^The most naiTeraally 
applicable appliance fur this purpose is a small oaplcili 
lwist«l iDt<) lb<! form of k rn]wi; tbe rull Heiu^ pasaod 
over the crowns of the t<«th Wbiad the totrth (o be opcmted 
DO, aiid held dnnni on either side of it by tJie opcralor'a 
ftttgent. Though it is easy lo dnuunrtrato the varioas 
Vsyt) in which the napkin may bo applior), it would be on 
wdlcsA task III attempt t« dcsorilic them. In cniployiDg; the 
napkin tu the lower jaw it is generHlIy jwssible to omke 
pruBaiirc ornr tho mouth of the salivury dnct, no aa to 
prevent or retard tho exit of »liva; when opctaliu)? on 
the ivft xidc mf llm jaw, tile first and second r)n);iirs uf the 
openMr'i left laml may Iw mncA ronvenicntlj atM tu bald 
Iho DHpkin down, whilst in operating on tho ri:'ht side of 
the lower jaw, it will geui^rally be more ccnveiiient to staiid 
Iwhtnd thv patient, and pin)i]oy thv tbnmb of the left hand 
on the iusidv and thu firr^t fin^ur un tho (>iit«idL> uf the toeth. 
It i« oft«n, bowcvL-r.tXL-i-isivcly fntiguing to hold the oaidda 
io its placo, and this may bu litme by a Hawcs's tongut* cora- 
prcMcd* applied over the inner portion of napkin, whilst ft 
aingla finEur of the <i]>«mlitr'a hand h'^lila <!own thn outpr 
fold. Dr. r. Smith has modified iiml i^n^atly itnproved 
IJsneit'a dnct ooinpreHwir, and ibe In^tninient »o allere«I is 
extrcTnely useful. The Gauro which la hero given will 
explain itaelf; in applying it the napkin ia first adjiuttodt 
(tod then held down by the intrtMluction of tlio horizontal 
arm with il« horoe-Bhoe end, which hiui been ureviously 
dotatihod fmm tho rent of fha iiiKtramcnt. Wliitiit this is 
held in its place, it« free pnd is i»lip[t«d tbrongh the holti nt 
the tup uf the U))right (which haa been prciiuusly nused to 



w 



lUTKBUU rSKD tH TtLUXO TUTB. 



949 



its full extent), u^d the i«i)itc>d plate ncUipU^ beluw tba 
pttiani'ft chin. The uprigbl, wbicfa U rurauhcd with n 
nbchirtal iu luck so Lbat tt. will Hlipilu\tii, but u»t upwitnlt', 
is tlien f>rc«Hvil donu until the nApkin is K'cimljr fix>:<l. As 
a niW, [uktiL-DtA miicli prefer Lbe ase u( llit» in&lnimcut tu Uia 
iiitrodiu:tiij>o of U» ojieniUjT'iL fiajjers. 



Ftff. Ul. 




in pruluugMt ojierotjoiis tlie napkins on apt to bMwmo 
Mtui»t«il, mmI the (lidioulty of kfcpintc a lower tooth rlr,T 
is oftcQ vi-ry great. Tu inwl tliie diQiculty variuus fomw of 
nlir* [Hluijis liAVti been dvvbed. 

Dot the npplinnce which gives the greatesi twru^ty ti^iott 
tlia jurt\iiit uf mlWa i« tbe rohUr dam. This canRsIa of ■ 
«tK«t of rhiii indi«-ni>>her, which nmst l>e mOkrieDtly tooith 
to ntnttch rvndily witliout tiAting. A «hr«t i-r snrh »ita is 
Uk«n ihnl «ll fuur cwftivn may he hrouiilit vulddr the 
numth whrn it is npplini ; bntcs nr« th«n idimIo in it in » 
tniitallc |x<Hiti<.in, tbrc'iigh which lite cruwne of the tenth nrt> 
pauHl. Tliuac hulM majr he n\ndo with n )iatji'h. or by 
vaddml.r forcing tlio handle aid vt on excavAtor thmii^ Ihv 
dghlly-fttn-tcheil iihMri- 

It U wlduiu inillicicQt to lass tlt*^ ntbbtr orer imc looth 
oaly; nnhwi thp tooth U* lie i)}>«>ral«il on ataiitiii iilinic, lho 
rubber nuuld rise to high itruuud it tluit Ihir h^hl uid the 



i 



S50 A mTBM or dkmtal wottanx. 

view of th« cavity would be obKured. Il^nce it in anuUf 
jwimmI over tlic tuoth in rranl axti tbat Iwiiiriil the one Ia Iw 
(^[wnlBil uti ; liui, uf oourvD, lio t;(!iii.Tal rule can he laui iluwu 
oa tliLi loiiit. If the Uvtii Aaml cKmo ut ano atwUter, ^«lf 
klioal tW dglill) uf ftu iiich «liuuM ititcireae botWfon th* 
botcM in the rubber, but if tJien ia mn Iniervol W-twevn tbe 
tooth 4 lu)psr space mtut be IcA, lu tliat Uic iiittin'«iiitiK 
gam nuiT be oovoMd. 

In applying thv nibl»r the itbeut ui ]iut nn tin stretch 
betwv«n tbo forefingers of th« rislit nn*! tcA hands, ptaced on 
cjllicr Ndc of the fir^ liolc: it u thus fgrceil iivur thf rroot 
tootti, then over the next, and so on fram before bacicwarda, 
tUl nil the teeth which are int«Dd«d 1o. bo iiiclude<i aro 
Ihnmgh tbdr rnpectlvo openings in the sheet. 

Tlie riiijlier is tiieo Hligbtly inillvd awny rmiii i-ach tooth, 
•ad Ihu (r«v edge lying against Ihc neck v( thv t'X>(h, wbtch, 
from thn iimnni^r itt which the rubber liaa been applied, will 
look ii|iw'i(rilii, is luckeil iu by the aide of the ae^k nf the 
tooth m thiit it is diructoti dnwnwanJti ; this may easily be 
afftKtutl liy Uie tiw uf a bumiaher, or utlier lilunt inatrutiieuL 
Wbeu tlio ahape of the uxth is farourable lo in retention, 
no further ineamiras aro ruijnircd to keep it in ttjt jiIum ; bat 
ahmilil it tend to slip ajiwarda, picccii of w*xe<l ailk loity be 
paoKaldown Iwlwei'Q each tKolh.and their eiiihi tied togeUier. 
1)1 Other ewe* wivUn wod]if8 iiixy W eiupluyod to retain it 
lu it« platw, or li;;alim« of wasLil tijlk lieil arouuil ihe iieck 
iA tbo twith prc^-tmuly tu the appltcatioa <if the nibbcr, so 
08 tti form artificial ledges. 

It i& setdom necesMry to apt>ly the mbber dam tu order to 
Gil cavities in Lht> ^ndioj^ Kurfnccs a( upper taelh; a fold of 
QApkia (dacod between the cheek and the alveolar ridge will 
^rnvrally auswer the purpose in mch casei. 

There are, bowuver, niauy oomm iu which the af^lication 
ia exccedinitly ditlicuir, and in which the labour and j,)08sible 
lailun>, alter vvi-r)- privimtiua has been taken, render ila nae 
hardly north the trouble of itc adjiuooeiit. Uinor difll- 



I 



I 



HATHBIAia VSBJ> Ut TtUASG TSETIL 351 

ttios may, tuiwevvr, be t;ut over: iu ihv fint plaoe, it uiAy 
Iw BtAtud u gctuinlly tniL* Uikt, whercv«r tlu> 9om silk will 
pasA duwn bvlvrL-vD tcvtb, it wilt carry down tlic rulibtT witii 
jL When, uwiiji; to Uu; ooqicaI sha\ie uf the UMtU, tliQ 
robber, after heio;; diirly applied, slip* off, ttnd cannot bo 
r«taine«l by tt ligature oX wiucei] silk, it uwy bn held di»wu by 
a piece of uift iron wire, bent w u lo roughly lit U)t> ta>tti, 
M)d bttviuK it« ine ends curied out oq tbe buccal side, 
when ibey *k b«l<l down by » ainslv floKvr. (') 

In ccctJUu pusitiuUB tbo rubbnr may Iw li«M mituf the wny 
by an iutnimeot gnupcd in tfa« left band ; tbttA. in lut inter- 
stitial cMvity, ibe corvlcal ty\fie of which i« bolcrw the gum, a 
view of tli« u]>f«r ]<art uf the cavity may he obtaitHKl liy ttio 
iwe of a btunl^nded in^itrumcnt bont at a right an;>lo, which 
taemployvd tv furtv iht: e>lgcof the rubber abore the margin 
of the cavity i wiiuu tbc: upi«r |iArC of ths cavity ih tilivd, 
tlw uocoMity lor h<j)dio^ baclt the nbbor ia ovlt, and iho 
loatmiMU may be inid asi'lc. 

Far caa«a in which the alwTe-nientioncd measnr» prove 
tnaufficicot to rotaln the rublxsr, it bmt beco prupoaed (lac 
rii.) bo iiMt* iDPinlliu ciiui|» fittod to the teeth, but 1 bara no 
txperivuce in tlieir tUM. 

StpoTuiing TiofA. — Ag tlii> tralh, and luurv ]«rticularly the 
lodsun, itn* in closo a|>t¥)sitiou, it oft«ii l)t<como" nixvasary 
to cfKxt Knne MJiianition in order to allow of tho iiitriHluctiun 
of instrumonia. Iu soiua jn^un**** wc do not li»il.it« to cut 
away touud portiuoit of the tooth to effect this [mrpnse, but 
sodi a cxiuriie U nut always idvisablfl. In the €a*c of front 
teotb, if the decay has a considerable roporticinl extent, it 
will l« well III cut away tlio liitgual surUue of tlie lo«>lh with 
aa Muunel-cuttor, in nich a maniuiras to leare a V-Hlkapi<d 
dlvifiiuu. which dooH tint I'ncrMich <:>n (he bucont stufsoe. If 
be Dot dune, a curity with brittle, ragtnxl vnU* will 
It ; but when tba suiwrficial rxl<.-iit of the (Uaoaas ia 
it wdl be beltM la avuid i:utling inb) the Uwtll. 
<t) ta. Ilodjaik U tWRUl Oamvm, y<A. *tl, f. ttU 





VTBTBM or VKtVAh SFBnnT. 



Tbo roqiiuwl RjAce may be jcntood h; tlie intrixinirtiun of 
strijH of wnnd, o( indm-rubber, or oT ootu>n-w«x}l IwiwoeD Uit 
teetli. 

'i'hc lepamUon nujr be efTertod at once, or the force nu^ 
bo moTu t^nadiully oxortwl, wlik-h Littsr U tb« aafest conns 
if nny considenble tmount of space has to b« gained. 

TliB methoil of " <]utck wedging," na it is tarniiti, has, how- 
vra, a good many advocates, and may be flm deicrihed. 
For this [iiiriiiafi two wwigps of oninjtR wood are required ; 
one i« I6rc«d b<.'Cve«n tliD necka of rhe twtb, and tlio scxxiiid, 
whicli ia more tajierins;, is forecd between the points of tbe 
iMtli. Ge»t1o tajw of a mallet are giren to the Utter, and 
the spnca tliim gniued is aeotiri'd by a tap «ju the Gr«i wed^ 
ThoD, by allLTiiali.- tajw cm tliQ wcdi^-s, tira tntli arc forced 
apart, atiil wheu an adoqnatc tntcrval has been i^^iui'd tbe 
aecoDd wcd;:c iit witlidrawu. llm force whicli niay be 
CEXerlwl in this way is very greut, and many uiiiowmd 
nocidcDti liKvu bwa reporttxl from an iocautiotu uw of tha 
niatlet. 

TbtB TUfithod can only be recoTtimetuto<.l in the caso of 
iDciHir twLli, wliicli roqiiiro to bo moved ilirou>ih a very 
aliort distance ; And tt must not be roeorlcd to where tliere 
is any imhnaltby conditinn of ihe gutnB or alvculi. On the 
wbol«, the method of slow wed.:ing ia «afer, and is the oaa 
gpnerally a-Wlilrtl in thra coiiiitry. If wntMibeemplnyed, only 
a modoratv dtt^rco of force should b« ased In iaserttug tint 
wed^tf, wliicli may rcqulru to l>e Tcplaceil by a Isrgur one 
after thv Inpeo of n few dayst. But clio muKt coorouieot 
material is india-rubbop; this sliowld I'e cmpIoyM tmly in 
very thin pieotift, whicii nmy ha cut from the mIuI himp. It 
should not be loft many days without renewal, and in no caae 
ahoiild n thidt piuce be introduced at once, as t^ia wonld 
exert a decrt* of force which might prove injiirions. 

In tniiny ciuws tliu au[jiualioD mny be very coniituiently 
eff«ct«l by the use of cotton-wowl, firmly prewcd between the 
taetli : Uus abouid bo froquenlly nmc-wvd. 'J'he time rcquirol 



3f£TH0De OF IXTflODrCINO TOX GOLD. 



353 



^ 






for Kpnmting l«etli will vtn rrom two to Bcreti Any*, mncb 
disprudiii); uu the a^> of llii.' pativut. 

When tccih hare been mor^d by Uie prootwor we'lgiD^, 
it will geoerally ccHuIiice to llttt cuiururt of tlia pntietit lu 
pIftOB a wcdsEO moderately tightly between tlio t--oth while 
they arc beinu fiWuA, aa this will keep tbcm finaly fixfd, 
■od to a cotuiderable «zteat obviate the teodenioss which 
alway* exiMU in lAclh fonxd trom t)i«ir {iroper pooiticia. 

Mttkods ./ ihtrvlttcing Ote Ooid.^Cryttal GQld,—1\M 
%^\ux uiuMt Iwi turii up iutu satali fnginentit, the axia of 
whkh will \x in wait dt^n^ nguUtod by ibat of the carity. 
Kacb fi*;nn«nt, ku ito introdnetioM, inuM be thoroughly cuo- 
d(!Uwd iicrure uc jifoOecd to add another ; and thia cond«o- 
anlion mnat be d>ine gradually, and at Bnt ^otly, ki as to 
ATflid |iulv«riuag ttie gold. Any altempt to introdiioe a 
large ftnumnt of Rpo^V^ ■^°'l ^^^^ coDsolidiitc it as a wlwlti, 
will eventual^ in the pndnction of a {ting ban) on its surfai-ii 
«h1 very aofl io its interior. Such r»ulu were coaunou 
betoTR the tiae of Rpon^e zold wast |x>o|WTly nn^prfttooi). Ilir 
littiga looked very bright aikd aolid oa ih« aurlace ; but their 
dUntogratioii ftpeedlly oonUDOMed, and tbo cavity operated 
uiion, itutvad of cuntainiDic * plug of aolid nivtal, wai* IbaDiI 
(u li« occapfvd by a nHirv ur U-m co)i<Trnt imwe, »o Buft that 
tt could be htolten up by tlw finger-utiL. 

Tho fm.nuvQt« of i-ryslal cold nii»y be very conreniCTitly 
]iickn] up atid carricHl to the carity with plti^LH for»(«, 
Aod thp condctiMtion tnoy he, to a ronsideralile extent, 
effesled witii lh» umi? itntnimeat. On ]tt:;e 34<1, flijunsi 
of instramcnbi which may lie uwn] for the Introduction of 
^NjiiKv iculd arv p^L•ll, but the tiitnt •'cnrrally suitable funua 
ut tl)« (oot-itha|«i1 plti^ers. As it \a abaoluuly necessary tv 
flevolop this aiihesve pmiwrties nf the ^Id la the qIuhmI 
aitcnt, 11 ih g«i«rally adfiublv U' annral the gold imme- 
ly before mw, Tlie (Vtigtncn:* (■wj«irwl fur nie may lit- 
Jti) )>y bluittn': UHim mh a nlinil cf mica over a *pirit- 
bv I'Awinj: (4ch \\Mce» tltTi>uzb iIm: ilatuH a* it ia 



: 



^ or tiy n 



2 A 



8G4 



A STSTEV OV DtXTAL BOBOIBT. 



hIioiK to be omA. Sometinutt tbe oat pUn, and noiMtuDM 
the other will be TouemI tu siiccood besL 

(ioltl Joil, nm-iidiufivt. — 'Ihe methods iii which tli« 
pAA may 1m iut*d *w Y»riou». The leaf lOBy be fuldcA into 
ribnods oT snitablfl length luid lircadth, and (liem.* iimy be 
cut u|i into more ot leu x^uue \Atca ; or the wbulti msy b» 
loosely twisted into rojcs (Fig. 146). ~ 



n^. lu. 



I 



Or, nsaio, the leaf may be cut into four or moni picoo* 
aich »t wlaicli is cnieh«d up iuto the form of tfao rope Vy 
means of the instrunicttt mM for tho |>iir]iuiw, which cotuiits 
(if two iilicetH nf irotiil, one oA'^o ur each of which ia turned 
up W u to forni a leil^^e abmit one-fDurth of an inch tlf*^ 
'1 he rilHuid ur mpv iis cut iuto lengths ttumewhat uidra thmn 
twice the depth of the cavity, aad the {rferas iutrxx^iiced hy 
mt-atia of au inNtniu)i-ut with a tolerably largv extremity ; 
tho midtUv uf «&L-)i is carried dowa to tho hottooi of the 
cavity, w that tli*! two cads project from ita oriGoo. Wliea 
Ibo cavity ik nearly full, ad iutrumcnt with k noaller point 
ia uAcd, and oo^cnd of each ecrip carrioii down to the liottom. 
When we am uiiakle to i)itruJuc« aiiy uioro fuil, a tdiarp 
wpd^c-^bnpcd or trocar joint ia forcwi into the centre of the 
plii^, ¥o that in ttw act uf pcrfuratiuu thu gold is vvr>' farcibty 
pr«fcH-d from the centre towards the circumference of the 
tMvity. Ihe hole IhiiK nindo is Giled hy folding ia Btripa 
uutil DO moK c3ii be tDtroduoed. The operation of |>erfoTatiag, 
ftud fiUiDg iho perforaLiouR, is repeated until it in no longer 
lioswlile to tuake the iiutnimoat cntor. The aticcosa of tba 
limocedinR will dcjieud u|>i>ii tho character of tho foil em- 
|>lo}'ed, that whiuL is dr»tituto of adh««ire properties being 
atone auitablo when the foregjoing inaiitner of opcntting is 
adopted. Had Uic u|%ratiua beeu conducted with adheaiTa 



HETaOOB OP IKTltODUOINQ TUG OOLD. 



855 



^ 



foil, gtfAi diQiciilty would liave been o»count«r«l in carrying 
the iiMt to the bottom of the cavity when the opentioa 
■pprasched Duriiplnliou. Bncb fold voulil twihuru when it 
cauw in cont«ct with the gold a.lrcitdy impsctod, and if force 
wurc ucuployed the iostrtunent would CMt thront;b the rilmad. 
Wring the orilic« ninTOwtKi, while the lower portioa of the 
carlty remunol aifliniiaUtial ; sncl unlewi ^•at care w«re 
taken thu uimatlon would tcnninAtv in ihu iiroducliun of u 
plag Terjr h«id on the surfocc, and soft or porous in the 
iolninr — a diaracter o( 6\haf!, preesnting s K<x>d apiiounace, 
bat (.-Ainble of Baviag the tooth hut for a >hort time. The 
hardeourl surface will B:iTe way, and the phig either become 
dap w i O tl. or it will fall out. It luight be lappotied that In 
fiUlog a lainll cavity, wbicli iu the gunenil wnite of tlic term, 
tboagh it equals the «ize of the whole tooth, cannot b« very 
la^;e, the ffAii foil would bo rDiuiiremed throughout the whole 
nun of the plug by jircMuro made upon the external aiuitoe. 
Experience, however, idiowR that this cffisct cannot be pn>- 
dooed. The foil, whatever its chanct«r, beoomw condennd 
iimnediati-ty nmier the JmilmRient into n thin, hard Kftle, 
vhicb arcIiDft ovvr and |)rol«-t» fniui iireNHin that which is 
betow. IliU condition obtaini in all the foniiH of gold arall- 
able (nr d^-ntal parpoees. In no rasa caii a modeialw eiaed 
plug be iotrodnced and coinprecscd aa a maa»— to*be effectiTe. 
tlie |vaeare ninst t^w applied oonaeeutiTely to each of the 
many portioui (and Iheee most be small portions) of which 
the ping )• KTiwIitally bnilt np. But i^tboa^ wo cannot ile< 
pend npon producing a aound plug, unfcn it is formed by the 
gradual addition and cotniveesioo of email pieces of gold, yet 
there in a fnat difforence in the quoUlioe of fw\ in rwpiwt to 
the manner tu which they are ionneuoed by prwsnre. Thus 
ftdkeet of the non-adheaire, when made into a Wl by rolling 
between the fingpm, may he oompreaeerl and adapted to the 
aideaof the cavity with aotne degree of iinifnmiity throagbuat 
the mau; but if adbeelve fotle be rimilarly treated, we shall 
Ind that the surface agunBl which the plugging tnstmmant 




3Sfi 



A HTSTEM or DEKTAI, KUnaSlV. 



hM hem pramod is ouoiinnMyl into a b&rd laror, whilo thai 
which liL>« next (o tho cavitv hu been relfttif-ely buL stiRhtljr 
tctod upoa, anil iintbabty, uuit««d of adapting itaolf, bu 
toroed atmy froui Hw t^mtb kt leveiul jwiuU tuwanls Hue 
iiMlnioient, ftn<l bocome loose in the cnviiy. 

With th« uuii-Ai)h<.-xivi> fuil, a tniu>H oftur iolnxlQetioo is 
resilily a[^li«l to tliA wuUm of the cavity, vhicli 
ooQlnctAil U) lui atiiount com-spntuling tu tlut or ths 
«ddo(i| until at last tbo whotu space is occupied by go] 
Bui each miuw no a-Ueii, althoiigji cliMoly adnpted to tlut 
alraady iiHroduoxl. will preMrve its owu itlenlity. aud oa 
the tooth Ix-iii^ i>n>ki)ii ti|s inay be Mparatecl tr<Mn ibotn with 
which it has lain in coatact. Un brcakiog up the pltig, It 
will bocomH ap)nrcul that the oonijxiiic<nt nianas have been 
held tt^ther by a Hystotn^of packlug vichin a circumiKribod 
HpACe, Dot by tli'< n^hesion to e&ch ntber of the aev«ral poi>- 
tioaa of wbioh tlw jilug lias been built. It ii very Tutnwry 
that thin point »hmilfl he fiilly underet^MxL 

If thu operator pn>[)u««(i imiug tlje noD-adhesiva foil, he, 
must pTDOoed upon thu princijile oi {wetting, B4id the layers 
irf ibil must paaa ill a diriwliua Trum thu bottom to Lho oriBM 
of the carity. 1'hc foil may, bowuver. be iatrodac«il iu oti 
furtna than that nf a lonscly-twiited rope: it may he ru)' 
into a ball ^f vnfhcieat size to looM-ly fill the cavity before it 
ia oomptcMoil, asd whon Id position [-erforateJ with a sharp- 
pointed conical instrument, of suilicieiit &ixe to turou tlte foil 
■{{aiiut the circiimfeTvuci! of tbe cavity. Ui Ulliu:; up the 
oentre) aperture chtut producnl, the siden o{ the lilling fJiovld 
bo toKoA down, Ac this etoce of the ojwration we slutll have 
a deoM plug intmovably fixed upon the Door of the cavity, 
and riiiiDg iip the sides to within a limjtt^d diAtAnceof iu 
orifice. To cuuiplote tho filling, tie careful 8U)iPr[Mwttion of 
layeni of adh«(ire foil in alone itcceuary. ^i thi« manner a 
plug may be built ii[> in a i»vity, two sidus of which have 
been lost, supposiog the two r«niaimiig walls are tLmug. 
For cxami'Ie, a hirge fimnro running across tho mostJcatin? 



METHODS or nmiDttrcTxa the oolp. 



357 



Hirraco of « bicuspid, snd crofiplDi; oiit npon the mesial aiul 
(lutai Bid«a of Lbfl crowa of Uie tootb,iiuj lie thus efleetivcty 

filled. 

Another method of m&nipnlitttoit, by which n t>«rfcctl7 
SBUtbcUvy plug may oflea Iw mai\e with oua-iulhcii) ve foil, 
cciuistH in foldiu;! the sheet into a long, flat ribaiid of sniUUe 
width, and cuttiDs it into narrow strips. Tbi»c Btrii«, wliicli 
Bbould he TBthor more titao tirice ta long sa the cav-jty fat 
deep, arc suecosriToly plckwl «p by a hhint-iwinltd plugger, 
HO that tboy an aniin»«i im its point Uki; a star; oc the 
^_ Htript may be eo amnged on a thick piece of Tolcanlsni 

^r caontchoi 



fig. i*$. 



^ 

w 



caontchouc, and picked up by prcoiDg tti« poutt of thtt in- 
strument tm the CQDire of the star, 

Jo this form ibtt atripsarc i-arrii-d to tliecarityaod jmsBed 
in. IckTiDg the radii of the star projvcttni; ; a srcuod and tt 
thbd star aro taken op in a similar maimer, and fofoed iota 
tbs cavity. Wb«n the centre has beooms fall, the projcciing 
mdn or radii may be focwd in amr, but not at, tho ciroam- 
f«reoa% ly the ou of a fiDe*point«d InstnuncnU [f the 

, mstromcnt has b«vii well chosrn with r«s]M!ct tu a jinulusl 
dimlnutiuo of size, an extremely dense {4ag will be tbe 
Ksnlt. 

Tlie Aineriuins were the fint lo propose tUe formation of 
ibe foil into cyllnden; thcso cylinders may be tnndc io two 
WBt B, the one by loosely (oldUq; the nhMt lime or fuur times 

[ and then twisting it into a rope, from which short lengths 



J 



3S8 



A STBTBH or DKNTAL iCIGBBT. 






Are cnt off; the other, by clonly folding it into a flat rifcwid, 
and ruUing tbc riband round a fin« brusch, or, wbat is bett«r, 
an biHtnunent made for the purjxwe. The cylinder* pn>- 
nf.ui. fit 14*4}) dnoed hj the flrat method are soft and veiy 
oompraesible; thoee by Un Lut much teat 
Ko, the respeetiTe ndviuitagec of the two 
fbrau bai^ dependent od the nalura o( tho 
oavitf. 

The cylinden are made a iittio loiter 
tluio t)ie depth ofthi^ cavity wliicU they ate 
iutcutLed to fill, and nrn introduced by (dug- 
gint* foroepa. (Sec Fig. J»i.) 

Every cylinder ia placed in mich a po> 
Kition tbat niio end rest* on the hDtt«nt 
whilst the other projects from tlie urifios 
Uia cavity; thtia, if tlm cavity he on 
finding Burface, each cylinder will «i 
vertically, but if it be intantitial, ervj 
cylinder «ill Itc horisontally. As it hiu 
beea happily expressed, the cyliulvra are 
placed in the <avity Uke cigan in » 
tumbler. 
Two methods may he punsued in their 
introdaction into tho cavity : a anmber of the tigbtly-rolted 
cylinders may be set npright in the cavity till it is luoedy 
filled by tbem; a wedge or tn>car-Bhaped instnimcnt i» then 
forced Id between them at any [«inl where it fan bu uiiid« 
to enter, and the bolaa thus [>rodnced iillod by frMh cylin- 
dera. At the last, wbeoi only mraall porfuinUona can he 
made, it will be found easier to fill theao up by the uao of 

(>] tTu<iuri.»al far roUIng Uw fMI Into cittindrn. "nn (tmH Lt cat Inlo t*^ 
M*d toMmi on lliflf tl[l llir irtatUnK rilurHt l> uMncwhAl wlilnr ilwn Ibf cavli^ 
t»4f»|i; It Umltxl c:luitr lauM ind brlni-m tlic tli^n poinuof (hr liwtiuiQFUi, 
«Udbar«claw<lb]rpu*itlnKUP tlii;*l«llD« ^f■■f^ WbetiAMUDclnit IiukUi hu 
hem rritol ap, Uin rtbaud It cut oil, and (li« cjlindot rclMMd ty vtry ■IIkLiIj' 
Afaoloff l<«(k tbc Mltat tifS- It *» onunricnt tu atkt ■ iiock of cjlttxkn 
uTtMraiteiil »Kt. toiplni Uxm In • buiiU until nqnind for on, 




I 
I 



I 



u 



METBODS or ISTRODCCntO TBB GOLD. 



Rtars of gold foil, or of adbesire ^Id, tba huTf nttmben 
uf full atuworitig this purpose odininMy. 

Or, tv Iwgio with, a cjUodccof auch o size tliat it will only 
jiut enter the orifice of the cavity is pUcei) iu it, mre being 
Uk*m tu aroid preaBio]; it, teit it become coD<!«nAO<l before ft 
bM readied ita place: lliif cylimler in Ihon forool n^inst 
oM mUl of Uie caritjr by the uim! uf a fooMhapwl i>lagger, 
•nd idsII^KkI, if the mallei bu used ; othvr cylinders nre then 
placed in the spuM k> nude, aod Muiiluly coudtnued a^iwl 
iha walU itf Uie cavity and tbt- Ki'Id alrcwiy iniroducod. (hv 
£Ilio|i Iwio^, t* iu tbft &Kl method, tmisluil by inakiui! 
perforations in the centre and dUinK tJi(»c op. 

As the foil, rolled up into cyliDd6r^ in alrcRdy (;|o«(>ly 
prened loKutber. great caro mnst be taken not to nixtrr thv 
eyliadem hard, unnmnn^eablB lumps, by couiprcMing tltetii 
agBtiiJt th« edgf* ^f tha curity durtag tliftr intrMluction. or 
by incaiitioiu toiiohca of an instmmenL The cylinder ahoulil 
be carried to it* place perfectly soft, and there oiDdciised by 
prwwire applied In \t» shlea, and out to iti enda. 

lbs great point Lo attend to ui to apply all the form to 
tbo sidtH of thi; cyiiDilorM ; vcf. aiv ihi>D r>>m)in^D^ tugrtber 
parallid Uyureuf foiUiuidnta succml iu laakiii^anextcciualy 
aolid phi^ whereas if we att«.>ntpt lo roiulenM them by oiin>* 
pCQttiDj; their eud^, tbey at once bec^m* knotty and lunl. 
Of oooTKS when tbo utmost solidity attainable has been pru- 
duoed by force applied to the ndn of the cyltndam, whether 
fagr wedging or by tbo uw of foot-ihiped ptuggera, then the 
aorfac« of th«< iiliig mimt lie condenaed : but if the precediwf 
dinKtWna hare bwu followed, ?cry little imprefl-ion cait 1w 
made opoo it. 

Wbirn, froui the abaiw of the carily, it i* likely thai the 
firrt portion of gold tntnKlnn^l would rull alwiit, t1i« Miflt.-r 
i^lloders luMtly rolled are the mo>t cunvemcut to cutumencv 
Willi, choiiglof; to tbe finuer OQca wbim ih« ftnit plecm ant 
well fixed. Ity introdocinK the foil rolled up into eylitider% 
ibo laycn all niu (tom the orifice to the bottom of the cartty, 



ma 




A nsTBM or DRSTAL stmocar. 



iiwtmd rif lyiiL}( in imy cbuice diioctioi), m that U 1* quit* 
imjiiwiilrle fur fmipiiPiila Vt peel off Uio suHkc dC the plogr 
iiwirviivtir tlii* fuil, Iwjn;; amtu^Ml in imiidlcl Uyera, is lobdiljr 
eoTulnnMHl bj » force ii[>|i1uh1 in the ytojtcr dtrectioii, w> cliH 
Ut Iu^df quautiliiM uf U»\ tiuj bu Mtfelj iutrodiaccil in a 
Ninglo |>icco ibatt by any other tu«tbod. Henco (or lar;g« 
i-nvitli<« u-itli Gtniuf; walU Uio tuftlMtd of cyUDtkr- filling i» 
llio inoitt cxpcdilioiu. und, 1 think, also th« most ccrtaiQ io 
ilM n-ftulU. Uf coitnse, Lbc Boiler tho qtiiUity of tbti ftnl, tiio 
Msicr the operation ; with ft hanl, banh foil, vtry Qnaati^ 
fhi-titry rosuIt« woiilti bo got by uniiiKcyliiulfra. 

llillicrto tbg iiiel)M>d» of filliug ducribcd bare depetxltd 
UD " [lacliilig," or tlii> piocvR beiug wetted iu so tluU th«ry 
(.-HiuiuL oacaiw, thuui^b tboy reiuaiii tudividuatly vopatBtc. 
and oil bnaUcint; tho tuuth niiijht bo p«rted fhiDi oni- another. 
UiU ibers la a property of ({old, in lb« tirvt iiwtuDOii, I 
bellevi', omidcntaUy discovered, vrbich cnublod us to fit! 
ruvilJM wlwrc mjinc of tbi' n-alLn art) dvfi^tivi- ; Ibis la the 
vapaliiliiy uf pun.' guld of welding into a solid maM niul«t 
|>reiiauiv. In fiUiu^ n cavity uilb full in wlticbtbiKadhenre 
lirujierty has been dweloj^wl to iiit fuUcet extent, a rery 
ditfemnt niaanor of procedmro its a neceaaity. Perforating 
witb ii tArga wedgo^abftpcd inntruiDetit is inadmisBiUe : was 
It att^iiiptml ih<! rwiilt u-»uld Ihi tbnt the gold would bceoine 
liiinl jnst utoiiimI tbu iuiUruntent, aiu) nowbvre elae. Houoe 
■■nr^i tiinall friLgnient liax to bo tlioroughly cocuolidated a> it 
Ih iiitividnoc«i. Tbi^ first step Li to ihiimughly fix a mais of 
Ibil at some [titrt uf tb« cavity ; this may b« done by drillitig 
a AMiall hole at Konie iwini, and wtilging ft sinall portion of 
foil into it, but more oi'^uimoQly it is jioMiblo to securely fix 
a ball of non-adbtiHivv foil n^iiut mjiuv (larL of the cavity ; 
or, by tiaiog a second initrument in the left hand, the first 
(nccoof gold niny, iu diilicult cobc-s, be rct&iti»l in positioD 
uutil it ia rixed by b«ing thorougbly cunUcinHMl. 

Bnme openitora, hoirevcr, genftmlly drill retaining points, 
n»t with any view t» the r«t«Qtiou of tbe fiuiabcd plug in 



I 



UBTBOM or IXTBODUCIxa THE OOLD. 361 

iootl), kit «{mply in ordrr to aecarely ancltor tbo fint 
few pifcw ol" gol.i. 

WIjfii ouce tlitr Gntt (mii uf th« plag is fixed anil tlioron^fhly 
consDlidfttal, the KubMxiueDt «to{» of the operotioD arv com- 
pBttttivcly esuy : stuall [turtions of roil, wbicb iiuiy tie Uxnely 
toU«<l. or i>uu[>ly toni, are linnly prosaed witb tbo poiat of 
tiie iiMUnnicnt njum the gotil alrBudy in the nvity, carv 
Wng lAlieD UiAt Uif iuKtrumaDt is applied to erwf pan of 
tbu surbw, and Uiat tho gold odAci is dtetiibuted pretty 
ewily over that U|4iii whicb it Lit placod. Piece after piece 
ia hiMmI, «acb ono being thoroiiglily consoUdaU-d on the gold 
alrrody in the cavity befoni nay more is added, until tlie 
l4ag proiecta altxbtly from tbo orifice of the cavity. In 
ap|(l>'iitg tbe gutA, it sfaould be pnmed against the walls of 
the cavity as well as on to tbe Tv9i o( the ping, elae tninate 
GaaurGa am apt to he left. Now, if the foil iuu been good, 
and tbe opentkin carefully peiioruiud, wc aliall not bare • 
plug made up of a aeriea of smnU maww, and retained 
lOgBCliU' by tbe wallx uf tbe cavily. but we bIuiII have a aolid 
maaa of gDld, which, if tlie tooth be broken, will form a caat 
i>f the cavity froia which it baa liecn liberated. 

The ate of lite term solid u np|>Ued to gold plii^ reqnirea 
qMlUioatioo. 1 buUtn'o it is quite impomiUo to prwluoe 
with foil, or, iniLeed, with any ronn of gold, u plug having a 
degree of solidity equal to that of an ingot of puru niuLaL 
Ttks resist&ncfl to preuure of which the tooth is ca[*ble 
WDiilil prove inaaflkienl for the produotioa of abeoluto 
■oUdity. Again, the dentine, a^iinst wbtch the metal b 
praaod, is not siifficientty hard to ifiord tbe renilancc which 
would bo reqtiirod. For the sake of testing tho working 
quoUUes of npecitnena of gold, I faove betn In the babit of 
damping a sUp of ivory, having cyliodrkal perfoniiioDSi, 
upon a hluck of tbe game toAt«rial. After fitUu^ one of tbe 
faolea tho lip is removed, and the lower anr&ce of tbe plug is 
pTMented l«r «kaiiiiiiatioo. In no case have I mwu a foil 
flUlof In which iDiiiute fissiirN could nut bo discovered by 





the aid of thB miouecope. IIoweTcr, sufficient dctuitjr etn 
be produced to giw tbe plug the BppGaratic< and tho focting 
of ptrfeot solidity, ajid to on&uro diirfttiilitT. More is not 
ruqiiired. 

Whatever Tncthod of ituertiaf; the gold bo adopted, 
the c>>nnpr4>»aion should 1>o ex(irt«d nuuoly Iq a lAtenl 
direcLiuu, lowurdti ihu nalU uf tho cavity^ and it is oo 
ibix ftccouDt thitt the foot-shaped ptuggen an so voliutbl*. 
whvtiicr aa toalkt or hand instniiuents. Nothing should 
be left for a compreuor «p|>lied to tho surface to do: 
an a {iroperljr inaerted piiig, it will hare hiit litila or oo 
effect. 

Difiiciiltint in thi^ u»c of lulhesivf fml may arise fmm ibc 
g<^ already ia the cavity liaviti|{ buen imuSicieully oon- 
aolidaUid, and no yii-ldiii;,' txifure the instrument aiid thp 
aupcraddwi luycr, instetul of affording aa unyii^Ldiug tfui&ne 
agaiiut which the latter may be welded ; or the failure may 
arlifl fmtu ilia surfiice of tlie gold licing wHlod, »r wetted hy 
saliva, the condensation, of the breath, or condenaatioa bom. 
till,- atiuospbcru. If Lliu ):old dous not adlieni rtttdily it 
should be annealed, eith«r in thu «h»#t, or by passiag mck 
fragment thruu^b the Qhido of & Kpirit-lainp ; with tho boavy 
foilit the lattot ccnuse is preferable. These heavy foils, whiok 
may be rolled in the place of lietn^ heaten out, arc reinarkal)ly 
adbeaivu ; thu uiaDQer of using tliem does not differ 'm any 
materia! partlctilar from thiit juiit descri1>M, nave that tbcy 
abould be cut into piccus ucarly the sixu of tlie eavity, a^ it 
la difficult to fold thorn : by having pieces of a Rnitabit^ aizc, 
each piece is laid ou flat, aud funna a complete liiyer in iixtlL 
Tho very heavy numbers, such as 140. arc mrt easily 
coiulonsed without Uie M»e of some form of mullet ; stUl 
with cans arid in a suitable poaitioii, very densa plugs may 
be inode by hand pressure alont^ 

Although the very heavy foiU will probably nerer have 
more than a Irniiuxl api^licablHty, such iiumbeni oa SO on 
exceedingly useful^and Id large cavities, when It la aeeenur 







MBTnODS or DTTbODUCCta THB OOLD. 863 



k 



* 



or dcHtraUe to oommenoe the use of an adhesive gold eorij 
ID tho prooeduro, they an Tery valunUe. 

Wherever adhesiw ^uld to emplijyi:^!, mcli mooesaiTO ^c*» 
ibotild ht laid oQ aa fiat a« pouiblt, and do attempt mide to 
cnuDple it np ioto deep holes, as though it were uon-odfatislve ; 
•ml the belt adfaesioD will l>e ^ineil by usiiu; a mod«ntft- 
need point at fint, afterwards exchanging it for one some- 
what tsuiHlliT ; aud thiit apiilice with double fcHve to the use 
of beavy foiU. 

It muet Dot be soppuiRxl tiiat ia the fonuatioo uf a plug 
any one of the ro«tLoda wliich have Jiut l>eea describeid In 
gvnenti terms U nect'fotarily adhereil to from boginniog to 
vnd. Thus, fur example, it is very often exoeediii};ly iucoif 
rtnicnt to comracDco n filling with adherive foil: on the 
other hnni), il ts often a great oonvcuicuce to fioixh the 
gariajM of a plug oonstnwtod of non-adbeeivs gold with 
addilionii of gold DKd adbeaively. 

In luiug adlieiiro gold tb«re Is ptthapa rutber more riflk 
of the pxiA rolling away fn>m tho edges of tho cavity, ftnd 
ito tearing minute fissum), than when tUHi*adbeaiTe ^old 
ia employed ; hence we sometimes see boantifttl hard, solid 
fit>iuKs fniling, aod oontpotatively soft Gllings sncceeding, 
simply bocatiiH the gold ia in the kttvr caw better applied 
U> lhi< wl^GB. On a[i adhc«ive filliitg, proporly cotwoltdnted, 
the bumlaher can do comparatively little in wcuriag good 
fDDtact round the etigm, but in a soft-foil plug, however firmly 
it may have been coDdcnsed, the edge may bo efficiently 
bumtBlml down, 

A failure will, howover, fometlmM depend tipon the 
character of the foil, which, although pcrfL^ctly good, may be 
uniuited lo (he method of manipulatioD «inp)<>yed. Tftke, 
for cxun[4f, tttif rrmlts oT the fullowing exi«Tiiitc4its, with 
loBTM of fittl Vikfu fmm ihc nuna book. The foil em^Joyed 
bad bevn pn.iwv<t fnvm cr>'»tiil gold, reduced lo fonr-gntin 
ahoeU by beating io llie luual nuumiT. AUhough annealed 
me to tlini during tbo ptoocn of raductloii, tt had tuit 



864 



A BT8TBH OV DKn-&L SimGKBT. 



boco Kulimittcd to heat after the final beatlitg. The coodition 
was th«ivfor« that of tuumncaled foiL 

ftcrernl shectx were (bldod aud cut up into short stripn for 
Lbi! parpmo of using In the st«lhite nianner. lit working it 
V!\3 found to he (ulhestw, hut at the wun« thlMi very britlie. 
Auil ooriwniiienlly re(|niml nnLLRiial cjuk m ititntducing it 
botwwn thv ivdth, othvrwise portions broke off and fell into 
the mtiiith. Another iihoot was torn in six or eight pieces^ 
luid rullvd up botnoen the fingers into as m^ay small Inllik 
These wvrc intrmluceil, one after tli* otlior, inw a Inirml 
cavitjr, with a small iuHttuuu'nt having ■ Blight spxiai curve 
Dear llic pwint. The cmitrfl of the t>flU wax first {tressed 
lightly into th« ca\'ity, atul the edgES subomiuently turned 
in, and then the whole wns thoroughly compreaaed. Duriog 
the operation the }[old went down hofore the iustmraent into 
> T«ry solid condition, hut there was not the slightsst 
ivndpncy tu turn up on one side when thu other was preawd 
|4oini, or to mil In (be carity. Th<> gold filed freely, and 
[%llBn coniiik'ifil the ylug, imfscntod a most nttsfactory 

Prom the same book a leaf vos taken and rolled int 
rather firm balla,whi(!h n'ereanlwequeutlyaimoolnl. Un^ 
Ihia trMtmcnt, although the ftdh«fiiT« quality wui brouf 
out moro strongly, each l«ll, instead uf ^iu;; down 
bofure thu instrutuent, hnd a tcndvDcy to tarn, up and olo 
the orilit* of the carily, Auothur loaf was aQDinlL-d fir 

I and then n>lled into bulU, vrhiuh on trial proved superior to 
the umenle*), hut infnruir to the unannenlpd lialla. 

Trum tlui NiKR- book two leaves were loki'u; one 
AQQealed. and af^cr division Into thirda, twiHted into thro*^ 

. looae roiwe ; tho othur li^af was dividnl, and rolled witbrint 
anuealil^. The IntCvr showed a t«ndcncy to break to pioooi , 
and waatfl, white tho formi^r parkeil and aillicred, the on 
fold to the other, with great nadiaeas, luid produced an 

'Bxtrornely good plug. 

The furegoing roenlla have beea brought forward to abcrw 



^ 



XETBUDS OP UnTHOOCOlHO TBB OOLD. 365 

tlmt (tifTordDt B&mplw of gold, tboxtgb cocb porlcctly good of 
ito kind, may rcqiiini difTercDt tueUiuds of iiia4)i|mlfttiou 
in order to (vixlaco the best ronilte. Aad they have b«ca 
DOtired before dfiiKribiog the rarioun ntet4i<xls of operating 
upuu the iiiciMnr booiiise tLe froiit t«ctli require delicate 
trvaLni<.-nl, and becaiiRe thtre ia good rokoon for su^nnnf; 
tlutt i)ii< dcfecta ftiv often oooMqucml upou th« niaaner of hm 
beioK ill tait«(l to tbu |<articuiar sample of foi) employed. 
llad tlio OH of tbn HtetUtc futm of the unmoooaled leaf Iweo 
pernat«d in, tlie plugs wuuld have crumblotl ; and had tb« 
urn of Uie ADDcaled balla Iwen continiiiatl, the plug would 
baTebwDwithdiaicnltyrertrained from rolling in the cavity; 
morvuvcr, ibo fijna; ruiutrcd for i(a voiuoluUtiun vfuuld iii 
many caaes hare bocn grMUrtliao the inciaot t«cth are ablu 
to bear without ctidan};nriti^ Uiu burstiof; outwardii of Lhu 
labiil wall of the Gavity. There are few who hare not Men 
a crack nui acrow the enamel, iwrbajis in more directions 
thna one, jiut as the operation was nbuut to be i.'<implL<ted. 

I&iCancea will occar in which the sur&oe of the plu^ ts 
good, and the circumforence solid, exceptioK al thu upiwir 
part n«ur the labial tDrriice of the tooth, a situation reached 
wlUi eome diffienlty by tho plugging iostriimeat; nod even 
then the tmj-errectioo ia not ducoTpred nntil the file wountli 
llie gnm, and a little bloud ateab in, and readi'ra ajijiareiit a 
Uuo, tu the roiine of which the gold baa not beon forced into 
contart u-ilh the nirfacfr of the oarity. 

Thwo reniArka have liecn innilc not irith tbfl viaw of dc* 
{■recatins the uiie of annralod adhesive full, but in order to 
dmw att«utioii to the ttcoeMity of observing great care in the 
oODstntctUin of fdugs whtrn that form of gold m empli^cd, 
and alav fur ibtr imrpoH of sbuwin); Uiat altbougli ■ sampb 
'if (nil may not auivcr the t-xpccutlon of tbt* oiwnitor when 
ilsnl in nne mannizr, yet that it may be jwrfetrtly Batisbictory 
whea a difTereDt method of introductioo to ouiploywL Even 
^_ thn degree of banlnns to whieb the bails are mllol or the 
^B n)|Nia twiawd, wUl u(tusnc« the bciliiy »iiJi vrbicb tbey are 



8SB 




STVmi or DBKTAI. eVROKBT. 



nqwctiTcly nwd. Tb« clc)e:reo of b«at to which the metal fci 
•Dbiiitlteil iu aitiiealincc will also exert tk ixiRAidentble id- 
finance in determining the mnnnc-r is whicli it e*a b« most 
cflbctinsly nmuipulnttiL It would, however, be very diUBcult 
to enum«r&t« every clrcumsuuce that miiy Bri«e iu con- 
ncotton with the use uf thu difTerent forms of gold omplovBd 
Id pluming teeth, ood to gire a det&ilbd deaoriptioa of Ui« 
meiliodB of oTercomiag every difHciilty thiit may prevent 
itirif to the operator. The task would be alnioxt eudlcM, 
Nid if nocomplished, would not even then rnliero the dentist 
from tlie necMsity of mailing himMlf practically oa^uatnted 
with iho mbjeot by meatu of carofully-oonduol«d experi- 
meatB, both ixt ncpHict to tha materials uaod in the furmatigD 
of plagK, ttud the itutrumimlti employed iu conducting iho 
operations. 

The cavity by one method or another having bera 6Ued. 
and the guld allowtKl Iu project elightly froiu the orifice, the 
next ftlep towardfl the cnuipletlcHi of the operatiiiQ will 'be to 
redoes the surfhce of the plug and th:.- marKitui of th« cavity 
to tho aamu gL-neral Ic-vel, alluwing a slight degree of fulocM 
to the central portion of (he plii^- 

This part ol tho ugiuratiuii will readily hu cQi'Cted by a 
suitable file.aflf'r which the plui: tuny be cartfully examined 
with a sliarp-poinU.'d iiifitrutiit'Ul, nod Khonid any part he 
found suSdciitly 8i»ft to allaw of penetration, the aperture 
muKt 1x1 enlar^nl ami additional foil jiitrodiired, afUT which 
the hlo uiUBt bo a^iin used k> reducu aay tUtitiuahtieo, and to 
remove the iin|u-e»!iinnf« left hy rhe inAtnimeiit. We have 
now to reiaovt. by tuctinH of puuiice powder or fine silica, 
airplied upon a strip of soft wood, or by a corundum lape^, 
the raarkti left by the file, and subsequently the surface ma] 
be bumlshAi:! with a little Honp. It will be found that th« 
burninher will facilitate thu etej* uf the ojwmlion, if it be 
used after the file liua been abandoned, and a^ain after the 
application of the pumice powder. Indeed, in many caaea 
the firm application of a bumisfaer will aasiiit io the ooo* 



UTTSOM or ncmoDCOina tbk goi-d. 



867 




^ 



» 

n 



toiidiition of the plag, ftnil in the prodiiotion of an even 
Kurfavc, Ufoie w« luv« r«cou»« lo th« file, uul i>riQr to tbe 
taltvs fining icoeas to tbe surface of the GHini;, 

I'erliape tio timre xuiublo place will bo fonDcl for alliidiiig to 
tb« BulijiTi vt " Contour Glltiipt ;" tlutt tit to say, vben a part of 
tbo urown of the tootli has been lo»t, the rcHtomrioD in gold 
o( ita oripual fcinn. There are few English [»ti<-iit8 who 
,ld suhiuit tu llie iiuwrtioti of a contour filliiii; near ttte 
of axe month, on occonnt of Jta very conspicnoue 
ttpftmrsace: Iho question heuce rvisolvts itei-lf into oo« of 
Utility for purpOAM of itia«ticatioD. The advocates of coa- 
bottr filliug claim for it that it rcstar«a tbe natural form of 
tbe tooUj, which ia preaumably the beat possible form, ajid 
that by Kj (loing it [irutocta the gitni betwem the teeth. 
Neverthelcsa, althongb it is often AdTinablo to leave thu gold 
rouvexnad|in)jt'ctiag to some (■xtent from tbe cavity, the caaca 
ill whtuh a real "conlour" filling prorta tuefnl aro few; and 
tbe niBttvr is well Biimnted op by frofcasfir Aiititen, in the Uut 
ith) edition of Ilairis's Dktianary of Dental Siii^m', in 
following leans : "The majority of them are a useless 
waste of liic ftkiU of the deutjat, the luuuey of Ihe (mtient, 
ind tfac-tiioe of bothrand i& another place, "Only let the 
oivntlijr awurv hinuself thut he in Ubouring Uv the real 
benefit of hit [latieat, ami not di-gnuling liia art, on the one 
hant), by biuuourinft an idle wltim of hia latient ; or, on the 
other, l>y luakiu^ btin tlw relucloat sdvurttsiug niediutu of 
dental inpenuity." 

PlvX/iit^ JntirumvHU. — Tlie form of Lhose, and more 
especially that of the handles, baa been nliuoat infinitely 
rariod. Eucb o{)rr»t<ir baa his own favourite {ntteni, and it 
woold l« r|itit« in)]ios»iblc, wtUiin any mcderale limits, to 
give a Complete aoniant of all tbe varieties nuinufarlnred ; su 
that. t)if description in this pUce must be couluied to a £bw 
of tbe more genermlly useful GonDS. 

To cotninence witii the b«ndl«s, ootiililanblo dirnrity of 
(^oion viialaasto tbomoaiaiUtsbla fom. Uany operators 






A srtms Of DEMTAJ. fcCBaUT. 



un tho ineUumt-utii coDKlmctcrl fi:>r uiw with tlie nullet as 
hutd-pluggon (sec Vig. 151); BnUcrV itet of piDggers beiog 
especial bvouritcs in tliis country. ^ 

For \aLTgfi condensing instruments, or for bnrnishcrc, tho 
oval wtxxien tuimite rapreaente^ in Fig. lOH is, to my think- 
log, tlie preTfinble form ; it ii Urge enuu^^i to 1<c very Bniily 
gms]w(i io the palm of tlie hand, while Uic ]>oint af Ute iu- 
Btmment is not far £roin the thumh and fingers, « matter of 
mum; iiupuriuuce wlteru ooii«idenihle force must )ie used. M U 
en^blw tlie opcntor to guard ■guiisx the point clipping and 
injurin;; tiio eott parts nmuid. Iliu^ in umii^ ii hurajdher 
the thumb may gcnurally he nsteA on th« tooth oper»t«<l on, 
or on one tvf jm nei);hbnuni, and force exerted in a direction 
tow&rdft the lliunib ; in this way there Li no risk of slipfHiig, 
and tiie forrti applied is Imli at<wiier ami sCronger than when 
tho puiot uf the iuKLrutiiviit n^ulies t&r Iwyoiid the fingers. 

In the more simple fonna of plnggcr the shaft is pcrf*X!tly 
«tmghl, but tlwre aro some cavities which can otily br 
reached by i:urv«l iiu((ruiiient». A very nieful form ia that 
ill which thi' Mhutt is lw:rit in n s]iiral liin^ion lo lite extent 
of an eighth or a quarter uf a lurit, tho cuii iHiiug iiiurv or Icsi 
open or irregular to suit ihii ri'quirr'rucnlA of jiarticuW case*. 

For filliug the lower tooth, and in»r« e«pacially for reach- 
ing distal cavities in the lower jaw, the ahaft of the ttuclm- 
inent may advaiitagixni»ly be bent at a right angle. Fur 
reaching ca^ntioti lar buck in the motith, the double bend 
repr<!«eiiti?d iu Fig- 149 is MjrvifcahlB. 

There are aome few o]«;r«Uirfi wbo work with perfectly 
tnnoolb-TK>iutctl ituitruuit-nu, but tho groat majority ihvIkx to 
use [xiiiiia moni or lens deeply scmiicd. Tbmo aorratioiia, 
which ithotiid consiiit of 8har[i-jxiinlcd jtyniinids, may b» 
out nilb a «b&rp dividing file, and lini&hed with & sinaH 
ihreo-stded file ; but it can be more rcoilily acoompliidied 
bj a Kpocial tool. Such a tool Ls readily c«nstniot«d by 
t*ktQg IU) ordinary recdod scalper, softening it, and convert- 
log ilo longi;niliii»l ridges into tcvtli by making transverse 




VETHODS OF INTItODCCISO TDK OOtD. 



3G9 



N 



f^. 110. <<) 



I 



cat« with a 61p; when rfbHrxlottril to ■ file temper, it will 
cut oa tlio Bofleued Ete«l pc^iiits a seriea of groovw and 
edges, whiob, by nn apjJicAtion of 
tbfi tool ai riglil aogles to ita 
fornier diroction, ara mnrerled 
into pointa. For the inacrtioD of 
sponge gold these Mrratioiu sbouM 
be Trry shAllnw, hat fnr ordinary 
•dbduTv gold thvy laay with 
•dramage be nHDCwbat draper. 
Much of the ease with which the 
operatinn v, peribrmeil dcpcnda on 
the accnrmcj with which thete 
points arc fittiahcd ; thejr ahould 
be sharp, aLd yvt luivo tho girld 
without clioginit, and should not 
get rlogged with the fpXA. Tbeno 
oooditioDs can only be attained 
by n bi^ degree of finUh, whirh 
ia, howerer, naobed by seT«nI of 
ow infllniiDoot makers, as w«!l as 
Iry ionM of the AjooricaD work- 
man, wboHe iiuttnmwtlts are all that can 1m; desired. 

An regards tho tvrm of llie working ends, they may bfi 
either flat or wedge-shaped; pcrhitps the moat gcounUly 
oasful of all the farms is tlial known as the " footrtihaped 
plogger.'* Tbe foUowing figure (Fig. ISl^ tukeo from one of 
Butlcr'K iilusgers, does not exactly rvpicacnt • chanutrrislic 
(oot-^liBj-Hi ptuggOT, which boats a close resemblaucu to the 
form of a Tout, thi* shaft repruacotiDg the leg, and the work- 
ing surface ihc sole of the foot. 

For porlnrating a plug of non-odheeivc foil, oruf i-ylinden, 

CM AplueitiiMt iBtinusMt Iki Utda K wtikfabM * trlnl tmvt,ait^td 
to intraUio «iii3 'umImw iuU MI iMw M*1(ka MttMnl oa tbi bmIiI or 
nuanrtMsorilNlraNHMtL A(irif.*ngbiaMlBltftltMinniMM.«mto 
ri^aofC 

2 S 






8TD 



A flTSTEX OP DrarTAL SOIGEItT. 



tm instrament with a sk&rp point, chanuered like a 
J^n^. 111.(1) will bv fountl nKHt un-lal ; the oral wq 

liiruUes are eicellent for sticb a form of iiutnt* 
tovnt. 

Tho Araeriaiiit weri: Uie fint to briug into 
tvcry-daj practice, though iwt to origioate, tbs 
tiBP uf th<* mallet C), not only for ooosalidatiQg 
tha plofE wh«n finished, bat for conde 
each |t)cn' as it in introdnoed. It is a 
ofScicut iti[cnni> uf thoroughly ooDdetuini; the 
sn\A, nod irt Hdoptnl by a frreat iituulw-T of op^ 
rutcTB : and it its jirodudivo of len disoom&Mi 
tfl tlio pfLiicnt than would have been expaotad 
a firiori. 

The mnllot flhonld he catatracu^ of soom 
heavy iDAt«nftl, a. very gcioil form oi'mttstitig of 
a h«ftd of kthd inc]o»od in a cylinder of Ucrrnan 
Htlvcr, tij which m ailm^hol a handle about eiftht 
incbea long. Hut the use of the actual mallet 
is, to gay tho leai>l, very iaconvmicnC in tho 
abnence of an asAistant; and a variety of anto- 
iraiic inalletfi have been divined. th« majority 
uf wliteli niitiply repeat, in the fumi uf a blow, 
tbnt. nanie nmoiint of fnrce nhich has )ie«n 
nlruidy Dxp«udvd oii the Glliu^ in the form of 
&teady |>rewure. liiA.imi)ch lu the same fon» 
ia more efToctivo in thu fonn of a tap than In 
the fonu of aleady iimuuru, these autoniAtii: 
n:iall<'tt< are adTanlageoui ; but the fon» is gene- 
rally uunfficient, and tboee which giw a Mow 
that is independent of [ireviqua prMnnnt are to 
bo preferred. 

To luifl this diflicuUy, the furiu of automatic 

(1) M»ll« pl;ii)xrr iTi»rt«-«nri' Butlrt'» iMIicrn. 

(*) It. Uuitu"'!. v1 Margalc. •<■> 01*07 ?*>'* 'V> <» Ui* luMC flf coh* 
MlliUiEnR 111* c(il<> <T nwiMlDii ; In Ui» flM tnaUaM «llh Itw IwBdle o( la 
insttnm-.nt. ■»] •(>' t'* ^t'I* wllb a mellct. 




MBTHODfl or VtTBiODVCUtO TJIZ GOLD. 



371 



I 
I 



^ 



Fiiring DUillH reprwentod io Ihe fipiro wns devifled; the 
one brre ligDrod i« not tbe 
OM moM genemUjr uaefiil. 
bnt frtitn Uiis drawing tbe 
Bkora simple torm cftn b* 
readily nndento»(l by a do- 
acrijition only. The irurtru- 
mcDt is held woovHitt lilcu 
ft pen, the furafiDger lying 
extended at fall leokith upon 
it, and directin;; iu muvt!- 
neott. Id the ioternr of 
the shaft is n fcfinU Hiviiiii:, 
in the iiiaida of which 
pUya a Biacl rwl funiishwi 
ou the ontudu with tv-v 
trory balLi. The blow is 
atruck by pulling op one of 
the irory balls by mcuu of 
the hat joint of the secxmd 
fin^, a« seen In the Ugaro. 
When tt haa been imiwd t4> 
B suG5cieut diirtance, it is 
suddenly released, by allow- 
ing it to slip Irom Iho 6Dsar, 
and a blow is g^ren on the filling by the cliuticity of the 
itpiral luffing. In tho laatrutneat urtliuirily t.>ni]>l(iyed, Uw 
Mfratod points fit into o socket at the lover end, thii socket 
btvtoK a piny of about a quarter n( an inrh upwards and 
downwanU: th« blow of the ccntnl rod which cairtes the 
iroty balls (which lisofouorsc, perfectly He[«nite and dtetinot 
from ih« Botdcet-piece) boing received on its upper end. 

niie instmnicnt here figutvd differs by the Docket which 
carnui th« serrated pln^jging-pAints being made in the same 
flMO of metal as the rud rnrnrnng the balls and coroiveving 
(1) Hi. Tmm*** iprint natkL 






r<9- >»• C) 



k inrai or dental sfboot. 

Uie Bpnne, no that tbe ptagging point is uttkaUy nlaed ftwqr 
from \ht gol^ ftod is driven down i]|wa it apun by ibe Uow 
oT Uie flpriog when the rod is r«lwsed. Id addition to thia 
tboTXi \» a fixed leg, tlic point of vhich also U serrated, and 
H'bicl) is euflictcutly king and thin to ouAbU lUe o]>eralur to 
spring it amy from the itriking point. In natng this fnrtn 
of niallct the ^U is held duwu l>y Gnidy iiriscint; the fixed 
leg npon it, n-hll« blows tan ^ven \pf 
the second nr BUiking )e^ At a dis- 
tance froin the first varying at the 
will of the opf-mtor. It is exceedingly 
UMful in CAvities ia wtiiuh the gold 
Is disposed ti) rull, na tiir nide can be 
sc'Ciirely hold down while the other ta 
haniiuuiul. 

Tku {x>inte art changeable, but it 
adds gioatly to the oonvenience of the 
i>[icmti'r to have inoro timn one viiring 
mallet, ^ a« to obviate the oecc^ity 
fur chat^iia^ thu point during (ho 
prop>»s of au o]wr3tioQ. 

Aftci a very little firactice no diffi- 
culty will \k fiiiiml in varying at will 
tho force of the Uuw: the lightest 
possible tap may bo (civen, or, by 
•Irawing up tie bpring to tho utoKMt 
insftible extent, a blow itii{;lit be givoa 
which would bo perfectly unbearable. 
The gold having been iutrodacod, the surface ia next con- 
donMiil by the nse uf inatxumeuUi of grndalet) siaeaj in 
interstitial cavitinii, out very acci-saible, this ia sonietiinoa 
ratlicT dil^ctilt. A mu«t useful iuBtroiaent, M'hiuli is fitr too 
little nppn^cintctl, is the condeniun^ plugging forcepe; it Is 
used by };nutpinglL« tootlirniid si^uecsing ihu pUi;; by closing 
the handles : cstution iit, of courw, requlced in its use, but in 

(I) Mr. Tudm'* mwOautlon «f «oii4«DSllif ^Vag^nt ftimps. 




ICETBDM OP I5TB0DUCU10 TUB GOLD. 



373 



I 



carofnl hands it U most valtiablc. A modlflcation n-liich 
randen luara i»sy thvir udupution to Uio loutb cousiaU la 
nidaclag om bUde b^ a rotating cratch ; tliU adsfiu iiMlf 
to tbe UrcgnlaritiGa in tho romi of the tooth ^ ^^^ .,. 
wliiln th« other jaw aots oo the acrfiiHW of 
tJie [di^. 

An jDetramoDt whicfa is {xirfGctly li»- 
valualile tar thu mlruductlon v( tliu gitld is 
tbe ordinuy plugj^ing force].<s, thu [viou 
of which arc Berrated, Bud vhen doted rc- 
aemhU ux ordinary plugger. The gold may 
not aaly be carried to itK place by this io- 
■tramcatt but, bv cloeiug the javn, it oui bo 
caaAeaeaif the fiirocjiB ncting as an onli- 
Miy plng([er. For Uie introdoctioa of 
c^linden they are iadispenaahk' ; nod they 
an of great advaDtagis in tuing eitbar s|Kjngo 
gold or the bcary foila. 

Wben all the gold has beira iiilr»iuooil, 
tlu) ucwu hu to be romored by suiiablo 
fllat. The abapoa of tUcfto are inQumcrelilu, 
and each on« miut tchei for binuKiU that 
which he prcrcni; but attmtioa nbould he 
cailod to a moiit uaefal fonu of file for Sutsh- 
tDg filUnga oa griiultiig surfnces : it Is like 
a bux« row-haul, and is ucod by ruvolvii^ 
it while ivwsed on the snrfuc of thi- gold. 

The ineiiiulitMN left by the lile may be 
retitoTod 1^ the tue of oonuidum poitita 
held in u suitable pair of forcopa. (See 
Fi|i^ lUO.) 

l'h« applicatioQ of immioe or fine biIpx oo a piece of wood 
will tunvv a rery fitus Bariiici^ or a piece of ArkaDfias or of 
\Vai4T uf Ayr Moae may b« asod for the aame pur|ion. 

The fiitiahttig juUnb in giren by tneans of honishon, 
■ (0 ri"««nf tofopa 






* 



iKKmimenta of rannl {arm matU of hutlcDod brif^htly- 
poUahod iiUsL A f«vr fcrrms are her« ^vea for tllnstntiuD, 
IiHt n etml variety of diflfereiit shapes (irw in um?. (Fi™. 156.) 

Tbc fi>n;ci» fl|i[Urod OD page 381, which cony a hiu&U fras- 
uieiit of itividinv Ale, are often excevdiujjly iiBcful in lilling 
Aod filing, whilst A aimilar pair of Itftliter make, ilcftgnml to 
oury smsU points tnulo of coniuduiu, will bo found verb- 
valtuble in finishing the sorlAce. 

TrMtmeni tf Oivitiea in tAt fhmt Teefh.—The tacility 
with which operations en any of the teelh can be i^rforiued, 
u gKAtly dependent on the tneona of plnctng tlio patient in 
a initAblc piisition ; aiwl greot dirnnttty uf upiuino aa to the 
most oDQveni«ut form of cludr prevAils, lo that it would 
perhape be invidious lu name any uni; tualier'B [ottern as 
preferable to all others. Ilicre are one or two requtreoients 
which altould, liowever, Ikj kept in mind in the selection of a 
oholr, and which may lie iutruduci-d Iwru fur the want tif a 
IDon 8iiitahl« pUocc In the lirat plac«, the range of vertical 
nwtioQ should be considerable : fur D]ii>rAtin^ ujion the upper 
incisors, it is often oonrenient to bnve the patient's CQonth at 
or Dear the lerel of the operator's eye; and whilot in this 
positum, the bead should be able to rat backwards, so that 
ih* alveolar lin« may be nearly vortical. Fur u[)emtiuns on 
the lower teeth, nioro capecially extractions, tho |«tiont 
aliould Ik placud low, so that tliu o[»rator'8 nnu is not uiiich 
laieed ; fsw of the chairs in use allow of the i>atl«al beinf; 
placed sofficieotly low, Morrisun's pattern being, in Itm 
reepioi, the twat. 

It is dddrablc that the back of the chair shc«nld have a 
reclining moveinenb itido]M?adcnUy of the scat, nml the hend- 
raat sbouM he so ooDUivMl as lo allow tho [nUcnt's bead to 
Ue Eiir bock, or to rest with tho chin upon the chest. Uy 
bkcliaint; the head lo the one nde or the other, or by the 
opentor sitting oa a stool by the side of Ihe chair, aoceM 
may W ^uiil to mo«t cavities without the asHumption of a 
▼cry constrained powtivn. 





376 



A srsTm or dental subgest. 




As tho Uxih are iwn»lljr in clow appowitioii, it 
tuKeunry to rceort to Dicons capiblo uf pnxluciii^ a sufflcta 
amootit of sepKration to kIIow of the introduction of it 
roenlA. Tlie tittd may Iw gained either bj the int 
of strips of caoutchouc or of onmprrased woocl >>Hwem ' 
fig. tn. m teoth, or we may cnt away tho feulty 

tootJi. Tliu selection of means mutt 
m (Icpood upon tli9 lUta of the toath 

\m opomt«d upon. If the decay bai 
consfderablo superficial extent, it wiU b« 
well to cnt away the lin;ruBl Hiirroce of 
the tooth with the cIumiI (Fig. 157), 
in Huch n manner as shall Icare a V- 
abaiwd dirisioQ bvtwDcn thu tvcth, witb- 
imt iiilorfonD;; with their oxtoraal ap* 
peamncMj. If th(> superficial extent of 

ith« disease be liniitod, it will be well to 
arotd cutting into the tuuth, as wo 
should bd aaoiiicing MUDd Xiasao, Tba 
reqnlBito aopamtioQ may be ubtaioed by 
the initcrtion of india-rubber betweea 
the affected and the contigunuA tooth. 
In sonie cases a suSdcat interval will 
be produced in twenty-fnur hours, whiUs 
in others a much longer time may be 
rcqnired. 
Th« next step 18 the removal of the 
distirgnnijwil dentine ; but Iiefore proce«d- 
iu;^ to n-itiuvu the d«i'ayed tiwue, thu 
condition of thff |^m with respect to the 
diseased tuoth elwuUl be considtjred. In many coeet) we 
fblll flod the free odge vascular, and desn-uding below the 
upper margin of the cavity, and perhajis rnrled into it. When 
in thi« ittiile it will be next to impossible to operate wiiboiit 
wounding Ihe gnm ; UiyoA will then tiow for eome time, and 
(■] Siraltlil tiiMutl-culUr. 





1RTB0IM OP DTTKODVcmO TB8 GOLD. 



377 



^. 
mil 

HP 

■oocq; 



{wrfccUy olMcura the cavity. Formerly the jAtJont vonld 
hare booD sodi RW&y, with dircctioiu to (bcoe cottOD-wool 
Mturntcd vrilli u MiUitiuii of dibmUc between the teeth, rcaici^ 
Ing it from tiinfl to tita* until tlie gum becania forced u]) out 
thv way. I believe we owe the following ready bwI elfiictual 
thod of at OQC« grttiog over the iliSiciilty to uur Anivricao 
Ihrm. If a jaw from which the soft parts bavo been 
nOkOTad be axaniiDod, it will be seen thftt a iriau^uliu uptce 
wapmttBMm nwha of tEte tcftb, the base bdn^ fonnodby 
tiie alvmlar proocasi and the &pox of the tnangle by the 
otmvergetUM of tho mesial and diBlal aur&cea of the con- 
iguouA teeth. The interval m produced (Kigura ^>) is 
iped by (he gum, and oar object U to prevent ite 
Idaeding, and at the samo liiue to move it fh>m the margiu 
of Iht cavity. To accomplish both purpoew it is cecosMiy 
to take a strip of ioft wwdt raeh as willow ch- plane, and 
mil or file it into a trianinilar rod. When reduced to a 
Mitable riu, introdnce it by a steady [veMitre between the 

» teeth, iahiug carR tlutC. Lho bjutiH of ihu triiinglo currcBpoode 
to the edge uf the alveolar proce»»; by this means the gum 
wUl be prnwd up against the Utter part, the hletHliiit; will 
be stopped, and the cavity in the tooth fuUy exposed to 
view. The intnxlaetion of the wood will oocasioD a little 
pain at the cnoutcnt, hut it aoun givea way to men aneaainMa. 
When teeth have been giwiiuitly eepatated by caoateboae, 
the |jireeonoe of the wo1r« l«'tida to keep them steadily fixed, 
and thereby rendrni the nfieratlon of plng^n^ lea« painful 
then it would have been had the tooth lemaiuetl tuumjipurtecL 
The ends of the wood will, of cuurae, be cut olT cloM to the 
lingnal ood Ubinl surfavoa of tho teeth, and the retoovol 
J at thi! enriuns dtmUnfl may then be aeoompliiihed without 
itcrruiniou. 
If wl' are opcntinf; upno the meiial mrfaoe of tbc left 
inci»or, the t^aith may be hekl by the index fiu^r 
thmnh uf thv left liAti<), the arm barlm^ hwm poeecd 
uuod tlio lieail tu the left >)dc. In QatiLg the excavator, it 



lAMfi^i 





A 6irHTR1l OF UEXT;^L SUBGERY. 



miut erer be borne in mincl llut tUe i»ul|i^ tbuugh leM m 
nze, oom»pond« Tery clawly in »hH\ic t<j lUi' toutb itscir,iiiul 
ktUioiigh it niAjr be, and often i«, slterol in sbspe by Ibe 
oaldfictttioii ur tbv |«rt tuwarOii wlikh cbs diaesM> bu pm- 
oseded, yet tho cutting itntrumiiit must be luod with caiiUoD 
after we bsve atlvaiicwi tu a cwrUiiu clpptli into ibt- dcndoe ; 
for Rhould tbo pulp bo vroimdcd, tbc deBtracltoo of tbe tootb 
may bo «idun!;eri?<i< lUitltcr tluta run an ubviaos risk, il 
will be bett«c to IcAVc a litttc <I)»i:oloiired tbano at Uu 
huttom of tbo cavily. Frnin tlio wulla and from tbe Hoor of 
tbu cavity, on it4 labial ami liogual sides, il iiuiy be cat 
Bwny, M in the latWr Ntuatiun we fibali escape tho palp by 
proooodin^ behtn<l or in front of il. 

lUriug ebapod tbu cuWty in accurdaoce witb tbo ditectiotia 
j^vvn vrlion tmting Tipon the siibjii't generally, tho part 
sboiild be clcnriHl of all extmnixtua mnttcr by direicting u{niu 
it a itream of warm wator, by means of a syringe. 'Die 
cavity ibould now Im wiped Ary with cottoo-wool or tiasne 
paper, and ila iibape Tei7 carefully examined. Should any 
doubt exist as to a proper form having been produced, * 
ItttiL' warm wax ur gutta-)Krcba may be prened iutu it, and 
a cftfft obtained. By this fiimple procwlnre wo Rhall often 
diecovi'r that had a pluK butn iiittvilucud, tho cbaiirw of ita 
pn»erving the tootb for any Icns^th of time would have beea 
bi;c sHghL Supposiog it im found that the walla of tbo 
cavity arc gettnraLly direritMit from witliiu outwarda, the 
defect must be retnctdietl. Small boe-shaped tDatnuiients 
will t>B found Btutji,blt) (or n-duciug to paiaUelisu the lubiul 
and lin^^ual wnllH ; and a drill, c-arefully directed so tbnt it 
abaJi not approiun:b too cloAPly n|»n tbo pulp in the neck of 
the tootb. will reduce to a proper figure tbe upper wall of tbA 
oavity. Tbe excavator, Jtgurcd on jvign 'iSS, will be fuund 
Vflcy wrviceable in preparing tbo cervical portion of the 
oavily. AfU<r feeling anBurt^l that ihe cavity has atxiuired 
a form favourable for the retention of a plug, it must be 
thorouglijy wa8h«l out, and subauiuenlly made perfectly dry. 




MXTBOM OF UnnODVCaiO THE GOLD. 



379 



I 



Steps miul Dovr \jO lAkvu fur (ite^'entitif; tbe aoceai of 
molstare : a rotl of eottoo-wool, or a mtall na|>kia folded into 
A rifaand, sticnild tw [dsced betw^vu thv gitms and lifia, and 
brought round npoo tho palate behind tlie front t«etJi. It» 
pomtinii may lie loajuuviTunl li^- iiii> mil«x am) Mcund dDgt-rM, 
or th« rubber dam may 'be apijtied. Ilie chancter of gold 
suilal'lc for the «w bavioft Itcen do- 
temtiotd n\va, and n Bufitcnnt qnaa- '*' '*"■ *** 

lity unajjgvd iiyoa Uie operating ^ 
taUe within rrach of tbe right band, I 

its introductiot) may be commenced, A 
tbo patieDt bavuif; been prrriotusly II 

reqoeated to breathe th^ogb the il 
new. M 

If the csrily be not very large, full f I 
uiuiicd Id the stellate form will be /I 
Cnurid to vork adTatttagcouBly. Two f 1 
or three stars may be taken op on / I 
tbe point of the inotniment and / \ 
IceBead towards the upper wall of the / I 

ctrlty; ooe after and within tbe / I 

other. The anns of the storv ahould I I 

then be folded itiwmrdit, and tbe whole | jJ 
oomprcMnl thornn^hly against tlw / '^ 
iq^Mir port of the cavity. Sume little 
oare is retiuired at this Mage of th<> procoedlnf^ otberwise 
the fold on Iwroming coodaaaed will bi^in to rolL The dt^ 
pMitiuo Ui niovo fruui una )«rt when it ia prestad opdnst 
uoihur part of tbe cariiy b tM>tuirAlly prodoccd by n^leet- 
log to ciMnprcsB the wbolD gradually and with umfinn fiiroe. 
H tbe centre of the plag be coiuolidated while the drciun- 
(sreoce remains pnroiu, tlie latter |Hrt will turn away from 
Ifas Icxith towardii tbo instniDieuI, and oa pretenre 



SppUad to any point of thn circntiiffraice, the inasa of gold 

(1) A fmh if bMCrawMal*, rUM «>l Uh. Ibc hteOM tattan a itUM iptrBl 
mrtK mOuU* ftr latraladoc Ibfl uuo ttHtM la tbe Inbi iwili. 



^«r?^ 




A sisTsa or dihtal wonoMMT, 

vrtll lam or roll up from the c»vity at. the opposite poiot. 
llaving recnfptisod tho mumsr in which n difficulty ma; 
ariM, we have to consider how iu oocummce inay be sToided, 
ar. If pnHoU huw it ttuty bo oraroonie. Tho objflatioaable 
eoadttiaa nuy be avoided by posBing: tho iturtrament orer 
(he whole laHkoo of the gold nitb a light ttiuiii, repeating 
the operattoD with gradanUjr increawd force until the whcAo 
is oqnally oooaolidatcil. ttnt afaould tbv fi>il show a diaper 
aittoD to roll, we shall do well to remore it aod recommaoae 
the operation, or to take an iattrnment in the left hand and 
hold duwn one part of the oircumference while tho other it 
Dumprcvod. 'Vht tuo of two inrtm- 
nienta in the mannur already alluded tn 
ia tiot unusual where adherire foil ta 
employed. 

Afiiit thoroughly coudemiog the (bU 
in the upper part of the cavity, ibe 
complption of thd plti}! is comparatively 
rasy. If the adhesive foil be used, the 
0[)Bnition may bo pretcy nt|udly per- 
fected by aiiding short etripe one after 
the other, oompreaaiiig; each consecutive 
piece u]«u Uio gold already inlroducedt 
taking cote that in makinj; the folda 
the dtiplicaturue du not GtU ihort of the 
walls of the cavity, othorwiac the plag 
will ))e han^ in thu! centre and soft in 
the ctruuuifrrence. 

Shonld iion-coheirivc foil bo preferrod, 

the mme method with respect to filling 

the upper yaet of the cavity fiiA, may be adapted ; but in the 

mbftcquont prooc^ding it is necessary that the folds of tha 

rope or riband should prus fimm thn hr^tiam to tho ohQco 

(t) A pair of InttntmnnU, rigbt and UO, tOjpUd fur eonqmulnf ]ihip Di 
Ik* Bs^al gir dUUL nrbo* of Awit Mill, or ft>r 4ildiai <dlN*lv* Ml or ip«g» 
pM io iIm nrEwe «(mi mllniihwl ptoc 




BUTHODfl or IXTKODITTIXO TRC OOLn. 



381 



I 



of the cnvit^. To effect tlii«,'u) instmnicnt 
^tli tbe wnrkii^ extremity terminating like a 
Wfidg«, will be loimd the most arrvifoiblc fun: . 
The cavitj> baviug Ixwii fillip, a thu\> udlji' 
or point, or, wbat I iliiiik is bIjII lx-tt4T, -i". 
isstruiitemt bn}ii[;hl to ft iioint by four cli-uu- 
Cert, tbua producing a iKjim ftod four ilivt-rp nt 
edges like a tmcar, ahuald be forced intu tlw 
ooatni of Ibe plug. Tbe gold, by tbis treat- 
moot, U foroed from the cetitru towards tbe 
dreumfi-nocc-of the cavity, and without any 
t«[Kl4mry tu displace the plug. The liole niado 
by tbe porfgrator niUKt Iw GlK-d by llw furtliar 
Addition of gold, which iimy bv iutiDduoed 
witb iiuuuiueiit ill baud. Wbea perforatJODs 
can no looger be made, nnlesB by nung an 
nmouut of furcv tbat would vwlaoip'r the watht 
of tbo cavity, an iDairumt.-ut with a Bat bkcv 
■buuld tw carefully worked over tbe whole 
Kurfuca of the plu^. Ilocoarao must now be had 
to tbo file. All gold whicb projrcu beyond tbo 
mar^ilu of ibe cavity— more especially tbni 
which ii directed towanU tbe gnm — fihnnid Iw 
cot away, tJie iadentatioua jiroductd by tbe 
tilling; inscroiuont fiteri oiit, leaving the mirfiiM 
of the (Jug purfixily free Itom lrrai;ubuities, 
and o<i ibc aame U-vcl a>i the atuToandiDg tooth. 
Tbft file may bo [oUuwvd by a. atrip of narrow 
tape wlticb, o/ter wetting, hoa b«ea loaded with 
painic(<-|iowdcr or finely- powdered ulex ; an 
end being held in eaub hand, it aboutd be drawn 
wama the siirlaco of tlus plug with a neadj 
■ud iDoder&t«ly iiiick motion, ao<1 th« (Hction 
conlinnMl uulil Uie file umrka are lemovcd 



.IM.C') 



Lip«o th* mnlian <x Aidal malta <> 
v»t ia*rtoM«atonn7acofW«iaM{<oiiit 




389 



A BTSTBH OP DBNTAb aiTBOIBT. 



from ih« imrfiKM o{ th« plu^, when chalk nuij: take tli« plaoo 
uf Uio (luniice. This amotuit of VBte in finiahing a plus 
may perhaps bo thought uuDccoasary, uid tbs ofiiuioo may 
appear to receirn rapport rrara the fnct rhat flome roiigblj- 
finiAhAl plugs Last for m&uy years trithout undei^Dg defaH 
rioration. Rnt on a cIosi- uxamiuation into the cbaraclvroT 
the cases it will Iw fuund that tlio uiBjittaition to decay wai 
not actiruly pnjiicinnc«d, and that the walls of the carif 
were strong in ev«ry port. Hinl chene ehnraclenj been 
Toaed, it is probable thnt, in plscc of tindiag the ploga. ' 
should have h'fird that front t{.-i>tli had bu-n'plug^ed 
yoara a'^:), but thut the Qllinga fell i>ut iu a sli^irt time, and 
that t}taK\ with other t«eth which were theo diseased. 
(;ru(luaUy docayod away duwu (B the ttrvel of tiro gum. 

The initncdiati; object in filling a tooth is to perfttUy ex- 
clude from the cavity all extraoeotis matter, fluid or ntherwiae, 
and at the saim time ta leave a itirlace upou which mucus 
or [iiinute particles of food cannot readily adberu. If the 
nnrftoe of the gold he left mu^h^ thci^e iodioatjons are not 
fulfilled; food and other matter will collect, and DMMsitatA 
the &oqiienl lute of the ti:>oth]iick, which lallin:; rnim time to 
timo into the ioeqaalitics of tho gold, evimtually disturbs the 
(lUins. Tlicru is aiiothur adrantace resnlting from tininhing 
with care tbu sardux of a plog, and it is this : after the outer 
and lianlcr |»rt bcut bc-eu fik<d away, and ihe surface of thi> 
]ilug and the contiguous dttrfnoc uf the tuoth ivduced to tlin 
Mmc level, we not nncomnionly find that the ping is soft at 
some poiut, and admits of Wiug iwrfurnlrd. The diBcovery 
ofadefvct having \kcm miult.*, a remedy must bo fotrnd^eren 
though itd application may necessitate thv removal of the 
goW and the n-oomraeuoement of the operation. For to leave 
the plug; pnrrions to mnistiire will be to endntn^er, If not to 
CDsare. tUo further iojury of the tooth. Unfortuoately, the 
foolt isTcryoommonly iu the wor»t puiaihle poaitiou, both as 
regards its effect in exposint; thu tooth to further discaw, 
and Its cainbititii-s uf niiiundincia. That part of the cavity 



MBTBOOe or INTBODUOINO TKB OOLD. 



888 



nmrcft tbe gum ti nccMsarily Ibo fint to roccirc tho gold, 
vhich, onlisM it be nomprened before the introdnctton of tho 
f(Hl in tbo lower portion of tho CAvjtjr, will, Trom tLe difiicolty 
with which tJio diiitaiit part ii) saboeqaenlly rooobed, nnnain 
in K poroiu condition. But oving to tho farm of caritj 
usnally pnMtuci<d liy caiiui upciii th« distal niiil mcaitU ludes 
of tbe twtb, th«re in sooio Iilt1» tact required to perfectly 
cunaoKilttlo tliv upper, |irior t» th« iiilr<Kl(K-liiiu of tbo lower 
lortioD of tlM pluft And we consv^ucatly find, that tbu 
defects an tnoxt commonly 8iluiit«<l nt tho iip}>cr margin of 
tbo mvity. If tbore be snfficiual. sixxv betvrcvo ibu tcoth 
to admit an inBtrumcnt> perforations cuiy be made tod ad- 
ditiunAl f^Aii introdnoad, but if t)i« epacc bo too oontruted 
to oUftw of the Mtiafaclofy cotnplclion of tlio i»lug, it will bo 
tu botbor to cnrnmcnne anew. 

A failure will, however, eometiine» d^wod upon the cha- 
meter c( ihe foil, which, althonub iKTfwtly good, may be 
aaanlltfd to the methiid of ntMupiilatiou empluyod. 

A emuidenble a|iMe has beeo grrcn to the masner of 
plug^ng cavitiw tm Ibe mesial aurfacee of the left c««tral 

tlnciaora. The deacriptlon will, howovir, apply e<|tiAlly to 
opcratioua pcrforoieii upon tho distal Hurfnco of the ri»bt 
hiCiMn, aiKl to Iboae aituatod on tbe distal mirface of tbe 

joarreapoDditis l«>(b of tbo lelt side of tbo moutb, oxcoplini; 

innl7 that the head sbonld be torncd towarls tho 0[<crator, 
Inalead of fn)ni him. 1'b« left hanil, t<M>, will be aoiuuwhat 

IdilbieDtly placed. When it becomea Decenary for tlie 
jwtitmt't Ace to be directed lownrda the operator, the fold 

I of tiapkiu plactsd under tbn Up aud beliiud Ihe teeth may 

I he retained by the tbnmb in tho latter, and tho index finger 

1 in th» funiivr diltmtiuu. 

It haa boen awntmrtl tint the loctfa have been aepanted by 
iitcons of indb-rubber, nr out away on the Itnfcnal aorftoa, 
w tb«)iit uialerially iiit4>rri-nng with the part of the tooth «x> 
powd to view. llDt it may hap^wn that iba Uhial haa been 
ttcnicbcd DpOQ by diacjuc, whUo the Uogtul surfiuw la com- 




384 




BTBTBM or PB.XTAI. BCBOUT. 



IMintirelT' oninjured. In thit nuwi the jiiold may be tDtr»>' 
duood fmm the rroot, leaviuif tbo whole of tlie back jiort vS 
tbo tooth standing. R}* tbe adoption of this plao, more ern 
of the ftoot of tlie tooth inay be retaioed liian though the 
firm, atixmg Ungual wall of the cavity had Uxa reduced. For 
witli the ttiroe sides of th« cavity strong, tlic foarth niay be 
prawtTDd, although too weak to stand onsapporUd hy lb» 
plo2, the GraineM and the retention of which will be mffi- 
oifintlyMCUr«d hy the uppn-, the lower, and the lingual wallf 
of the cavity. Id conducting the operation, howi-vnr, Ricat 
caro innst be taken w avoid injitrins tho neak part; and it 
will be found expedient to iotroiluce the foil in small poctloiat 
making Mich ]ni<co firm Iwfore the Biiooeediog one is added) 
for should an Attempt be made to cooiMlidate thft wboI« ptug 
by perfoniUti;^; thw ccutnil part of the buub, the wivUicr wall 
of tho cavity will ^ive way, and thus frustrate the objuctoT 
the operation. 

Oaaee not )nfivf|Ttpntly arise in whkfa the walls are all 
mtioh weakened, exccptins only at the upper part of the 
carity. K thiit ;arl run \wi no shaped as to very firmly 
retain the i^'ld i«ck«d into it, the rest of the <:arity may be 
fillod by gold ]»oked adhesively on to that first inlToduoed, 
very titile praseTire being made upon ibe weak walU. Thus 
it ifl oOen possible eo to form the upixir half »f the cavity, 
that it will firmly retain a ball of con-ndhcsivB gold presaod 
into it and mallct«d till it is ixTfLTtly bard; sponge ftnld 
may then bo buiJt tax to this till the cavity is full, and 
a ntisbctory filling introduced whore the walla, towards 
lower and, are littl« ebc than enamd. 

A nsefnl contrivanoe for making up }>eUcts of non-adheriv* 
gold, caiun«ting of two sheets of xiuc, has iilre»dy Lieeu da- 
ficribnl. By means of thin h1I liandlingof the gold is avoldwl, 
aud the edheaivo gold will more readily stick to Ihu pellet 
first introduced. 

Osses will arise iu which the diBeasc has ho far injurod the 
tooth, that instead of finding one, all the walls excepting the 




MBTHOM OF IKTBODrOIKO THS OOLD. 



S8& 



W^ 






Upper are rendared too weak to admit of tlie application of 
•uffict«Dt foioe for tbe introductioD of (oil, aod lh«r« a no 
pTMinot of iotroducing a RBtisraetorj mold |4ug by the 
method aboTD m«ntioti(yl. Either the tooth laait ht sacH- 
fioad, or name soft 8top[>iu|C material must )n3 used. Amnl- 
gliiu will woAn the tooth dark in cotoor, and cumot, there- 
ftm, bfl employed. The ioHTtiou of gutta peroba and ailex, 
knom as Hill's or Jao^ib's Atoj^og, in not open to this ob- 
jecUod ; and I do not know that in nttintions whore th« 
ntattfUl is exempt from any great amooot of friolioD it is 
lea* durable than the atnalgatn. Uany oaaai have occurrvd 

which ft ^Ita-percita plug has boec {wrfectly *Miud at ibe 
end of two years, asd prcscat«d all th« indicatioiw of lastiog 
for a imicfa longer period. Aftor all, tho prvKurTatiuo of a 
looth iDJurcd by dUeaae to the extent under considvnition is 
at best bat vory uncertuQ. A hard cnist, a fragment of 
bone, or a jiuticlc of grit in the food, oq striking the tooth 
daring mastication, may break down the walU of ilie i-anty 
and liberate the plug. 

Such catitie* may be SUrd with the zioo oxychloride, and 
lor & time, at least, will 'be pmerved, although the otopping 
will, Kxmer or (ater, fail at the cerric^ eilge. As the [ailnre 
of the sine salt almost invariably take* [Jaceatthis spot, the 
difBcully might be in aome memsnre obfinted, if this pert of 
ibe flliinK wora ma<ic of guli). It is poiiBihle to imjm't gold 
to tb« cerrical portion of such cavities, ereo, where it is im- 
pooaihle to f^t mfflcient anchorage tn ecffim the reteutiOD of 
A gotd &1Iln'^ ; and by GlUng the remainder of tlie cavity with 
nac oxyc^loride it Is aectired in ito place In scTcral i»- 
stattcea I hare known racb filliiig» to last much heyoikd the 
average duration of osteoiiUstic Hltbiga, thongh, of coarse, 
hey are at best hut a " dc ruior reaart." To fiaieh such a 
Qg effoctn^ty thf> tine salt miut be allowed to set, and the 

pf'iog filed and bnraiafaed on oaotbcr day. 

Carte* may attack either the lingnal or the lalnal enrfaa* 
of tbe incisors, and neoessitatc the adoption of remixlial treat- 



Ifa 



m 





886 A STHTBH or DK^TAL erEaBBV. 

menl, Nntunl flopressioDs oro not aooominoolT fuund ui 
thm enamol on the lingual mrfooe of the incm>r teeUi, awl 
rliiCMt is apt to establish itself in nicb sitoations. The 
oaritiaB wbioh rasolt nn generally of a ximple ktndf aadj 
Dot i«quin BAjr ipcotAl dcKriptkn. 

Wlien liM (UviJopinBiit of the enamel b&s been (it<ocitrtL 
pavltiM may b« produced by diasuse in thoM part« when; 
the nAtuml licfL-ct is uhmI strongly prDDOODoeil, whether H 
be sitoatwl on tite liagual or labial Butlsces of the t««tb. If 
submitted to treatment at a tolnaUy eiirly pniod, the fade 
is Dsually cbaravteriaed.by graoter breadtii than d«pth, «id 
its shallo'n' walls slope outwards. 

Tlie oarity, after the mi-re remonl of the dimaee, inay be 
ODOijiared to a utioer — a form incapablu of retaining a {ilog 
vilb auy dej^rw of oertaiuty. The fint step iu tba procead- 
ing mast be tljc rMuctton of tbo walls to a T«rtkat posatkm 
by the lumnf a small, sharp eicavator, anal it will be wtAl, 
when the ca\Sty is vory shallow, to produce a slight de^nM 
of nrulerciLt. In selocting the iaat«riaif> fi-tr forming a plug; 
foil BDit cryatal gold may bo taken with adrantage. Three 
or four thicknoases of foil, safficiciit to line iu an erea Uy«r 
the sorbce of the carity, slionld be firat inlrodncad; souUl 
fragments ofspcnije gold may then Iw added, and dioronghly 
MimpnKsed, oueafler Ihu other, uiitil the rcaultii^ plutc xtaulx 
hi^er than Che geoeial leTcl of the tooth. Or if a groore 
\m ciil at tbo nppar and lower imrtioiis, or at tU two stdoe, as 
may happen to bo most convenient, foil insy Im packed t»- 
carely into each of those plaoes, and tin* plug oumpU-tul by 
filling op the oential space between the portions hrst intro- 
dtKcd by some form of ndhesive gold, tlui latter acting like 
tiM keyatoue of an arch. 

Aftur romovinf; the 8ui<erduou8 gold Kith a ble, Ui« nurfsct' 
4^ the plug should be vxaraioed with a eliarypututed iostm- 
nic^Di, and any dofiBct made good. Iliis having htsm done, 
and the instrument marks filed out. tlie surface may bo 
f'lrtiier improved by rubbing it with Water of Ayr or a slip 




WCTHOM or DtimOSUCDfC THX oou>. 



3b7 



I 



or ArkAiuae utoae, togotLer with the Burrounding roanwl, 
•hoald that be rov^ uid broken ia character. The open- 
Lion will be cMnptfitfld wlien the Kurfac« of Ihe gM ho^ 
been fiolikbvti etUier by tbe ane of chalk or the buruisher. 
(jKTitira of this c)iaract«r itttty uftvn be ra|iidly ftnd eiTec- 
tirely filled bjr the tue of uiiall lueces of hiMvy ^old Toil. 

AtiDthor deecriptino of caviif in the froat teitth rctnaiu5 
ifi be DOCiced. A narrow iraaiirernf ntit pnHliiccil, 1 bolicve, 
IB tlie fim instance, by the tootb-bmsh, is Honivtimc^ fuurut 
imiDL'disteijp above the Lcnninal edge of the eDftmci, tleep 
rn the cenlrc^ but cropping nut on either side, with tbv 
mtik diverging otilwanla. Tu reduce such b gruove into 
a form for reccirlu^ a pilo^, the apper and lower wnlU 
tnu»t be eliglitly uoUer-cut, and &t the iwn cxtrtnoitiM the 
gnwve i«Jt<>ald ,bc deepened by the um of a drill k> ah tf) 
foriu a raiity. If the opumtinn be proprrly ouiuliu^tiHl, tint 
groore or alii will bts caurertefl into a trough, Uip udia and 
ends of which will, if nut under-cut, at least be perfectly 
TarticaL 1'be o[i^miir>n of flllini: may be oondncted in the 
«DM maimer and with the mna materials aa in the preceding 
oxaniple. 

In the treatiDcnl of cavlliei in the eaatne teeth, the direo* 
tloiw which liavc been >fiveii iu reepecl tu the iucUor teeth are 
equally applicable, both as reganU the matintf of bperaliog 
and tlic uiatvriala used. 

TVtatmmt of Simpti Cavitit* in tht BicHMpid TerfA.— 
Any iiort of tbu orowna of the bicnxpid teeth lusy be at- 
tacki'<I by decay, but the meaial and the distal rarfncea nro 
the utuHU<iii« iu which it is moat freqnently dercloped. 
Sapposiiif; the miacbief to have oconrred on ihe mesial 
nr&oa oi thn ncood bicuapid on ihe ri;;lit iiido of the 
month, the operatioa will be coiuiutnoed by cnuiog away 
tb* enamd from the laeaian cdi:« mf&ciently to oximw the 
cavity, and to admit of tlie iainxlaotion o[ ia«tniiaenl» 
omployed in the nil«C(iauut etagva of tltc opermtidu. llie 
rwliBt« ilirertkm fullowtil by the enamel fibres muKt be 



b 



388 




k BTBTKM or DSMTAL BimOEBT. 



borne in utind, uttitirwi!<i' the n.'^moral of that ti»a« 
iticntied wirh jrrMit«r difficalty and gre«t«r Uicoiirenti 
to tlie palii-ul than ntemsKey, Thrt mant suitable instra- 
rig. Ml. meDt is the flat cbiael-^liAped cniiine1-c\itt«r, the 
edge of whinh, on oiTiimp.n^'ing the n|>eratioa, sboald 
t)e ap[)]j«l in a direction jarallel Ut the coDrac of 
thf alveokr line, and gnwlaaJly changed to a rect- 
augular potutir<n i^ith tha diitappearatiM of tbp part 
oodFTKoioft Kmoral. Tbo «xci»on of the ouioiu 
tiHuo will DOW be oficcted witliotit difficulty; and 
haritiK Jidviinoed tb«8 fir, it nill bo tdvtMble to 
introduce tho wooden wedge between the teeth in 
tlie tnaoner desctlbed tt |»ge 377. The gam 
lisring been prested up against tho alreolos. the 
cavity may be redoced into tlie roqqiiwd fooij 
without £oar of ctnbiLrrajismflnt frotn a wotinded 
veaaeL Care must l>e token to remove all the aT- 
fected tissue fmin the upi»r part of the cavity. 
Tbi* may be accioiui>lisliod wilb a drill, but tlie 
position of the palp roust be borne in mind, for in- 
Htnuu(!Ut« of thiB chamctcr, wliou io "MmI order, 
cut rapidly, and if a proper direction be not ob- 
aervol, the pulp-cavity will be ojiooed. In pm- 
ducing parallelism of tlie sides of tbo cavity, the 
hoo-ohaped excavator will be found very uaefu), a« 
will, also, tbo ruuud-«nded axcaralor bore figured ; 
and JKvcml alzes and forms of thorn should be at 
liand, Bome of wlticli are oonstrucled to cat by a 
drawing, otbom by a pushing raotton. If this port 
of the ojioration has lieen condncted with Rocceea, 
an oval cavity will have been produced, the walls 
of whii'h converge »ligbtly from witLia outvmnla, 
more especially tbe npper wall, the margin of which will 
be ODvorad by tho vi*t<d»i:^ thiis producinf; a nhiLlluw L'Avity, 
a temporary side being formed by tbe wood, llie buad 
of (he patient should be thrown back into the jiositiim 




p 



mrnoM op ixtboduoino tub oolp. 



389 



» 



(dmilar to lliat d«aciibfd u ihe most oDaveaicDt 6x operat- 
ing on the front tooth. Instnutiotis baring been giren in 
nfenmou to kn'piiig tho mouth open, to breathing through 
tlu iKiRO only, the teeth niid gimia ahoiild be wi})od dry. 
After pbtcing a fold of Itneo betwoen the lipt and gum, 
•ml atiuther on tho lingual sidci of the tooth, the cavity 
should he tboroQghly dri^d irith tUsue jvper or cotton wool, 
or any other oonveoiciit luatcriaL 11ie thumb and fore* 
linger will be employed to keep the fold« of linen iu pliKv, 
and lo raiM- the lip out of Uie way. If the Aow of ntiva 
19 very aburidiuit, a slip of Adhesive plasterC) ntaembling 
oonrt-plasior, may be placed upon thi^ Ungual and labial 
lurfacee of th« gams, and allowed to extctiJ a aliort diittance 
OTCT- thr tooth. After being held in position by the linen, 
it adlterra firmly tu the guma, and perfectly eKcludes the 
alivv from ficwing it« way between the teeth or the nibb«r 
d«n a|ipH«d. A sufficient quaolity of gold bsviug boon 
pnpand, iu introduction may now be oommeooed. It 
will be dcsinble to have a Itrge piece of non^dheirire 
fon, looMly folded or crinkled up betwoen the foil-fold* 
ing iaitnim«nt described at page 384, to lie against the 
margin of the upjicr cavity. This mn«t be oaiefully in- 
trodoood, and thoroughly condensed by the plugging iostro- 
meat against tlie upper wall ; for this purpose ttxit-ahaped 
pldgBen (fig. 151) arc very nsefitl. The forms shown in the 
aoeompaiiying lignree wilt be found aoitable for the purpuse. 
U tilts, the lir«t imrl of the operation, hu been sttcceas- 
(itlly prrfonnnl. tJte gtild will be flnnly 6xed in the upper 
put of the cavity, and the mudt difGcult part of tho opem- 
tioQ accompliHlKtfl. Wo have now to fill what may im 
ragnnled as Ibv secoadary cavity. This may be done by 
wUing snccttsAivv piceca of sdherire gold, taking care that 

(1) TiMt ftt^^. ami Ut* Hu^lnl tt imI« II, ««ra doKvAvd brfbra Om 
fUoeUilagfttl BKtoir, »aS M>t acenvM mm ptiUlatod III Uh Ant mOwM of Itw 
"TiaHMthauL.' |i|>naiS«il7<«atiuKstitu-p'naa HantnuM wllbfrfaUlnA 
Cbw r>tkif«iiiK ^ *">■ *«rtM« alhtain, tc^iig lb* otiM li <tna» Infarrhw* i<> 



•ss^^r- 



890 



A flVBTBll or DMKTAt. iFWlMT. 



mcli U tboraughly adberent to. and oondciued tipon, it* 
|)f«cl«oeuor, Rod tJiat oiicli ia Uul im with sane depv* of 
evoniusaR. If tii« latter caution is nrglectcKl, on coniptetli]^ 
tb« openitiDD it will be tbuiMl that the plug is perfectljr 
Ktlid ID the centre and porou* at the tide*— • £utlt7' 



ng. lat (>) 



rtft. i«j 01x1 IK. 




ditiuD which it is difficult to nniedy withoDt oommeiicinf: 
tb« operation imew. 1» order in guard AKBinfti the occur- 
rence of this error, it vill he well tu Kv»K Can plug from time 
lotimowith a Btiuftre-ixiiHted or » irodgo-sha|X)d pcrfonit- 
iag inBlfuiiiciiL ]l innj be DecesMry, whi^n llie lnwrr wnil 
is appmiiclicd, to change the itrntrumeiit iti fsrour of one 
the Uade uf whic-b is more bent upun the Rlinfl (I^ig. 1(14), 
in order to emnue the gold hiding curried to th« bottom of the 

I'} n«*. 1S3-S-I •bow (MlnuaenU bnvloii ifa* mjm ■hmmI cbmUr. ih«- 
im Mnc ^aptod for Introduclog tiu goU, vbcUwr fcll m apeafi ; tiu •c«sii>i 
MHl ihlnl fbr Uw cvKdenMlleo of Un plvs. 




t 



* 



(or nrTRODDciMO thb oold. 



391 



Fifi IB. {») 



jr. It has been assumed that tbe first porlioa of tbe plug 
formed or foil oKylcnt^lv adhetiive only, and that in tlte 
Bab«equfiot ■(«[» of ihe opet&lina gold poflmuing lite highest 
ilegree of ibdhesirencM wu used. As good, and perhaps s 
lietur mult would hare bean obtained had the crystal gold 
been uacd, providing the cavity bad been fim lioed with » 
thiu Uj'vr of tvil 'Yhao luv Lfaose who in all 
CIM> niipioy thft DoD-adhesive foil used npOD 
tlia wed»iii» systtin, and I bare seeu pittxa so 
made that caoaot be objected to; but 1 much 
prefvr the usa of a material whifJi, when con- 
aoUdal«U, (orms ooe solid tarn. 

Whan no furthiT luldititiu of foil nr cryslal 
gold CAD be added, an in^trtimeDt having a broad 
cooTex »iiriace cut up into couii'sl points 
(Fig. 166) will \x found UKofuL It should bv 
iveaaed finnly oo the surCftoe of the plug with a 
ratliag motiou. The gold will thus bu roducvd 
to a corapantirely level turfaco. The preaeoce 
uf Ibu wed^ will )irot«cl the truni froan injury 
during the prooeM of Aling to a lev«l aurtux* 
the pluf; and the snrrmindiDjt tooth suhHtaitce; 
the wedge should thereforv be retained ia its 
pMitiw until that port of (be operation is com- 
pleted. It is necessary that a free utervol 
ihoold be left between the teeth, iu order that food and other 
matter shoald be readily removed. If an error is conunitted, 
it will be in the too *i>ann^ rather tliau in the too free \\» 
of the file. It only remains to complete the plug by 
pulishing in the uruaI maniior. 

If the cavity be situated oo the distal, instead of the 
meuol surface of the tooth* or upon eitlitr of tlKiae snrfaMi 
io th4> hirDspida of the left side of the mouth, the steps of the 
opernLioti will be the aarae on in the caae already desoribed, 
flxoeptinf; aa ntgards the pcaition of the potitnt's haad. Tbf 
(>; Shmt aa taAnnrat «Ub sa upasM rjuiaJtr nl Me Blnals cwwa. 




393 



A anrrtx or dkxtaj. btboxbt. 



b« must be toraexl a little towards or from the operuor, i* 
may suit hiii oonrvnieuw. 

1q forming Ui« npp«r edge of the cavity, when tha dectjr 
hu rc&ch«<d the level of the p\m, it in often very difficult ta 
got a smooth, satUractory tiuurgiu; tod «v«a when it lot 
sppcired (o be all that could be desired, it oot infrtq^uentlj 
Ittppviu that the enamd iplita oB* during the iutroduetioa of 
ibe gold. I'he eimmel at (his jwc of the tiwtb is natnrallf 
vary thiu, uid nMulily parUs Trum the deotiue ; bcDce it u 
periiapa desirable, when the cavity ezloods v«ry twariy id 
the point whei« the eaamel t«miiiuit«B, to can^ it a litde 
bnyond it, eo as to got rid of this fra^e pfooe of onamd, and 
oldain a cavity tlie oervicaJ wall of- which is hordervd. by 
cctnontum. Jt is rare for cari«s to oripiut« io the cemeotius ; 
and it is the opinion of mauy American operaton of r«pate, 
that the cervical wall had. better be DompoMd of c«aieiitam 
thaa of eti&mel. 

It is often a matter of difficulty to introduce the gold 
beaeath the enamel and i1>*nttne which bound the c«vi^ 
tovntrdt iiiE moatLcatiug Hurlace of the tooth ; if the plug is 
not perfectly solid at this part, the tooth will give way over 
it daring masticalioa. A method which is oitca very mt- 
vioeable, cMmxists in altogetlier cutting away this wall of the 
cavity with ao enamel-ontter. to this way a cavity is formed 
hariog only three walls ; in order to securely retain tlieplug, 
which forms n part nf tho niAsticAting anrfnoe of the tooth* 
the cavity most be made somewhat wedge-ahaped, both front 
above downwards and from without inwards, the largeat 
portjon bolng, of oouiw, at the cervical'wall and at the Soor 
uf the cavity — or, at least, what uuuld have been the floor, 
had not the masticatiDg wall of the cavity been tenioved. 
Tho whole cavity is tbos easily acntBsible to straight in&lm- 
ments; and by conunencing with a piece of nooHidheitiTe, 
and completing the fillit>g by pieces of adheajre foil, moat 
satisCikctory rerdts may be obtained. 

American dentists have lately introduced a plan of filling 



I 



MKTtlODS or IMTBODL'CUtO THX OOLD. 



393 



/I^.1M.(>) 



^ 



ihoM iotBrstittal ca<rttii» hy the tid of " matrioGfl ;' thwe 
coiwiMt of poUsbed plates of metal introduced Iwtweeo the 
t(eth,>oftsto«rve ui » temporary fourth wall to the ccrriual 
partioti o( the cavily; they ve removed either when this 
part of the carit}- u fillod, or are allowed to reni&in until 
the whole ])lug in completed. 

Trvamefit ifHimpU VaoHu* ia (A< Upper Molar T^th, — It 
will tu.it. bo noousaary tu cuter mimitnly iuto uU the del&Ua 
connected with plugging the tnolar toctb, as the oocoODt 
would be bat a rcjMilition of that which has already been 
described in conaeciion with the operations upon the mcwv 
■oterior t«eth. The difTerenoca only need be {ninted ooL 

The head vf the patient should be well 
thrown back, and placed at a height lo 
nit the ca&veiueoM of the operator. 

If the iHawBe be situated upou the 
OMaial Aurrnop, the tooth aboold be freely 
eat away, in the manner recommeaded in 
the treatment of btctui|jids when decayed 
inthocorrcspondinnsituiiition. Tlio rubber. 
dam will render great asaistAnoe in pro- 
Tcotiag the tongue from brii^ing moisture 
to the tooth, and alsu tn rendering It nn- 
fMeenury to change the (bids of a napkin, 
wUdi aotnctimes bocomeaatmated during 
the operatit^ii. 

In coodennog a plni; upon tho maa- 
ticating surfaoe, the acouniixmying Ibnn 
of instnmicnt will be found serviceable 
(Fig. 16tl), more e8|«ciAlly if the cavity 
be situated in the uouod or third molar. 

When the <UatAl turfiMe is attacked by decay, the enamel- 
cutter must bo freely used, and the tooth cut away until, on 
the coiunii>t)Ure u( tliv lips beiog drawn laick l^ the first 

()) SkBaiM sa tasirmaii Iw taunliufaii wUmIvii Ml or >paa^ ■old utn 
*Mh li Ihi ianitniilr< •uriMa of ibt yffsr wtlara. 





394 




STSTBH OF DBKTAL BtmaBRT. 



«#.1II.(') 



and wcood linger of Uie leTt lituni. tha cavity can be 
llus ofieratioiL of plugfting ia br tou tlilGoili to admii of i 
moccwfiiUy pcrformod in a oavity whicb b oul of aigbu It 
will ooBBei|uc»tly be soiiivtimes fouud neoesearjr to reiion 
the tooth to a greater extent than vroM have been needed, 
had the distuiM> be^n vitnaled «i ths maoial fnirfitee of 
the tooth, in tHci introdaotioD of tho gold the Uiatnuaent 
will mter the mviiy at. tbe angle formed by lh« diual aad 
labial auihoo of lUu tuutli, when 8itu«t«d on tho right 
fida of the toontlt ; and in order to afftml tlie raqDlaita 
apAoo^ this angle of the tooth moat be ndmed 
to a greater cxtimt than that sitiial«d near the 
litigiial surface. But if the operation ha on 
Uie Icll miliar, it will bo foimd advaotJiKvniu 
to subuiit the latter angle to a oonuderaUe 
amount of rcdnction. In citbcr case, bowavcr, 
wo Diiut to a DODiiderable extent be goTcnied 
by tb« coane taken by the diwaae, mud the 
i-xLvQt of Uijur>' it has producod. 

The [ircparatioa of the carity most be pio- 
ceudod with upon Die aaioe genont) jilau as that 
already described, and tbe instruDicnla UMd in 
plugginx the biciupid will be equally suitable 
for tbe molar leotb. In oonaulidating the 
Borfuco of tho plug, the aoconipauying fona 
will be found suitable. 

For canties situated on the labial mtrboe 
uf the u|)pet molars, a [sur of in 
right and left, somewhat of the forms given in the fi| 
(Kt^. 1'^), will be found serricvablp. With the livad thrown 
ImcIc, and tbe face tuniod to the ri^ht or left to suit tbe 
eaac, and tb« cumiuiseure of the li|i& dniwn bnek, ibe ravity 
cut be mtdily reached with the iustrummit. aud a turtat 

(') Sba*ln( M iMCnmwDl MlhMi furUw IniroducUon of crTiAal RoU,«r 
(or fiiulljr madoudBi tbe niibtt of a tUMUllng Blu&lnt I* the aval mAw 
111 wt i>|rprr moUr or UcwfiM toutlL 




xcraoM or nrrftomjoiRo thb qolp, 395 

glreo lo the l)Ude will enable th« operator to force tho foil 
Bpffsnli and bwkward*, witliout allnwing the shafl of the 
inxtratDeDt to interfere with tba leelh and lip* of cUbor jaw. 

fit- IM. (M 





A BTSTBH or DKNTAL STBOEBT. 

pluyixl in UiD iiunxluclbu of {uil or tfoagb gold. lu thv 
trcauncDt of a case or tliis kind, wo uluUl do iir«'Il to qm 
aTn&lgain. Tlio tooth nwy not k«t for auy great leof^th of 
lime, Imt tihoulJ it be rendered KTvicc«bl« bat for a twelre- 



Kf. 1C». (1) 



•■& 



moalh, the totereet a{ tbe pnticni 
will be better aecrcd Uwn it lite 
tooth had Iwen broktm down in an 
Abortive attempt to make a guld 
plug. 

Again, tliere are those wbo will 
■lint Hubmit to the prolonged ope- 
ration entailed bf using ffAd. Tbcy 
become so r«8tt«« that tbo ibmia- 
tioQ uf a sound plug U rendered 
almost impoisiblc ; at»l Bcciog that 
a ;;ood amat^iti in iwm lik«ly ti.i 
srivv tbe ttuth than a ik-fective gold 
plug, it will be vi-iscr to tiac the 
fnrnier matnrial. Tho slight di«- 
colontioQ which may etisue is in 
tlic molar tiwtb of minor import' 
ance. Gutta pcrcba might be ased, 
but it lioea not roodw the sujipi-rt 
to tbe /ragUe tooth that is afliordod 
by tbr> barOcued amnlgam, tlw sar- 
Otce of which will endure for years uomjored by mu- 
ci cation. 

Treatmrntti^ Bimpit Caviliat in the Tmth tf IA« Lower Jaw. 
— In operating npon the lower teeth the proo«xliDg will be 
varied as respecta the pcii^itian of the ]«tiont, the form of the 
instmmento lued, mid th« precautions ooccssary lo excliidc 
tbc intruKiim nf ihp MJira fmm thts part imder treatment. 

The eijuaiel -cutter wiU be called into requisition, but the 
titrmightoliiael>Bha]:ed iiuttmnieiit w naeful in the npper,&tl9 

(>) RMlit uMI Iffi MbTf-bicdrri enuiwl-<iiU:rn, mltftblc far -ifimtliii upon 
tiK nMiltl «r diaUI nrfuxuf ibe iAcfUfiit qs ttni uutitn <4titt \o<ira i*^- 



nraoDs of istboducixo tbc gold. 






b-i TTKrl ibp r«qinrempnta of the opcnLion in the UvAlmoit of 
tmtb ift tlie tower j2w. Tke aabjoiae*! forms will Vo fouul 
Ivttcr Buital for the jiarpocc. For reroaTing the nusiai or 
•iiaul wir&ce of ths caniD«8, biciuptda, or finit tnolan, in- 
fumncDM t\ys blailes or which an sabre- #>^. ito. (t) 
thftped, and id & ttraigbt lice witb the 
•haft, will bo snfliciciitly snitablc, but the 
cum^jooding mrfiuxa of the Mcoiid aod 
tfafiy] molar teeth csimat be ooDvcnit'nily 
rMcbed by ttraigbt instnimentiu For the 
UlUr t«cth the bbde aboold he [ilacetl at 
An anfi;U of forty-five degreea wilL. tlio 
fh»tU, *im1 the cutting edge fonnod by a 
mfcr (rum tbu uDdn in odb, aud from 
Ibe upper sorfaco of the bUdo in n Kcood 
tDBtrtuncot ; ami pnamcl • cotters, tho 
Uiwfa* of which ar« bent at right Angles, 
wiU proT« Very luefuL 

la the ivepamtioD of cavittea in the 
lower teeth, the Hone geoenl mine gt*en 
in refpecl to the subject generally Dinii 

Ibe olmred. It mttters not where the 
ivity is rittuwd, the plug wilt soon fall 
t, unUn the runu Is HuitaUe. 

Trior to the introdiK-tion of the pM \a canities tltnated in 

>■ mesUa ur distal sorbce of the luwer incieor or canine 

ih, tlie wedge should be inaerted. aud ample |)r«otntiom 

ihniiiti \>c iflticii fur the exoliisioD of the nliva. If the robber 

^ilani be out eiiijiloyed, after placing tlia hcnd so that the Gum 

turned mfficifntly tipwards to allow the aaliva to flow 

iwivde tho tfaixiat, a etrip of the impervious plaster may be 

ilnced upuo ttir lingual surface of lb« giutuii and teeth, and 

ween it uhI the tongue a tolerably thick fold or rope of 



(<^ tmttm\-mtm. irldi Uw bl«l>- plMvd U in m^a milk (bt ihA : th» 
' IrUHf fanmdii i« wi tdp I7 • tfaantor fnn ili* iqifvr, iIm Mat tnm tW 





■i& 




808 




KTiTBH or DKJfTAL ftCBQBBT. 



UseD. A comspODding fuld may tb«u Im placed Iwti 

tlii: It)) Mid giuus> the two bcin^ nUiued in pwitian bv til 

tliuiiib and fonfioger of the l«ft hand bnmght roaud tbe 

bMd uf tbi- fMtieut, Lliew Ivo Mds being oa>n|H)sed oratin^f! 

napkin, tnUtt^ into a rope-like lonu, and carried uvcr tbe 

rrown nf tlie Uvtli. 

The cavity Iiaviue hoM nmdflnd (icriectly di7, tbp guU 

may ho tntrtxiiicoii with iIutru^ll^Dt« similar to ihom: used in 

ftf.iti.Q) coudtwting tba like operatiaDK oa the oom- 

spoDdiojc opper teeth. Cavities id the cantoc 

luftjr perhaps in mjuib caaee pmro cxceptiooal, 

and rniuirc liiniilar manapcment to that 

which will be EubsiiquotiLly dBsoribed na ap- 

l>licable to tbe trcatmcat uf the oontiguoiu 

bictiBpids. * 

In tilling cavities situatnl oq the mesian or 

distal tforlitce uf tho labt-naued teeth, the 

Bpiral-bUded instnimcnt may be cmployeil 

u-ilb udvautugo, tho ^td bcins iutJt)duce<l frum 

tli(! Ubial side uf tbe tooth. Whea the dUtal 

mirfovv of tbv ri{;lit terth is iwder tmtnif^nt, 

the operator should staoi] to the ri^bt, aud a 

littla huhinfl bis patient ; and on tbe tdde, bnt 

ii)i(;htly til front, wbeii tbv oorrespooding \»r% 

of the left Iticiispids in opcntcd upon->the 

jtttieat in the furmer caire leaniug bis fiioe to 

tbe Icftt in the lattvr to;rarJa tlie right side, lliow in- 

fetaocus in which the orowu of th« t«etb ore rednoed to a 

vonniderablc vxteut oo tb« IIiijj;uaI side. In cuQieqneDCf of 

thv difleano having cDcruiiched upoii the nnisticating «ur£Bi:t<, 

aa woU as upon the Deck, will allow thu foil or ip«nge to bu 

introduced from above nave ndrnntajicoujtly tliau frum the 

tuk. Tbe plugging inatrument should havf « short blade, 

i}) An (Miranrni n«4 tor c«m4m>Jii8 Cb« turbn uf Uic suU ItiKruil «Um^ 
on Dm OUUI rid* uf Um rig))!, ur ibt CDMkl Me of tbe left Uou*pkL An 
mtnuMot rratmbllnii ihr «m •!»«» la iIm Rciirv U wtll adspwd Im- ua- 
ilHMtMiaefiirfMcof ilw fold. 




'tOfBtotm or tNTaoDociKo tbk qold. 



390 









lient naur]^ at a right angle, and the shaft luelf thouU bIm 

^be nlightly bent iu the snnie dirvctioii, at a dUtauce of atwnt 

irM^Tuhthi ofaa iocb from tlie bUd«. The two curves will 

iiifale tho blade to book over tlic <;it>wii ol* the tooth niMi 

e&l«r tbe cavit^r, Tbei^Id havmg been ialroduc«d, die sub- 

Mt|UDQ( •lagM of the oporatioD iutoIto only the ptoooedingi 

uiiMlly afkipt«d in oomptetUig a plug. 

it U in uiwrulin^ upon th« mular %mih that wc vnoouotcr 
tha groatest Biiioiintof diflimiltj', ovriiig to thn lar^ ijiiantity 
of atUvs which ci^lects and ov«-Ho'W» the teeth. Som« 
patianta can swallow while tho mouth i« open, and tliuK 
from time to timo get rid of tht! ncciitnuUted fluid, but 
then caniiut ; aud if ueaua for its removal aru noL luluplcil, 
erowiu of tho t«eth bwoni« entirely mibtnorged. To 
eroome tltis difOoulty, foldx of limio may be placed in tliR 
owatfa. and renewed to soon as they become wtnrated, but 
whcrrrer it otn be conveniently applied, Clie robber dam is 
the maHi eftscttial mcatis of iirutcDtiog tbc cavity. The 
patient'* h«ad shonld he thrown sli^tly back, and tiirnad a 
little towardit the side fip]»site Ut that on which tho fanlty 
Etii are situated, iu ord<:r that the raliva, wbeo the amount 
not cxoesMive, mny How fiom tiie leeth onder ojwnilion. 
\A tmall ptteti of adbesiTfl pLuter may alao be placed apon 
Iteno's duct, which opnu upon tbc eurfan of the cheek ixmr 
he Ant nKilar of tho upper jaw. Or aftei rolling a napkin 
* into a rope, bend it in tbc form of a loop, and lay tbe cnrv«t] 
purtiim over the maatlcating nirface of tbc molar poaierioi lo 
tbe cavity about to be fillol ; thru liring tbe two ondi oiit- 

I wopdA, allowing the totonnediate p^irtioiu bo lie by the sidoH 

^Bof tbe tacth, one on ibc lingiuil side, tbe other on the labial 
^Hpide of cUe teeth. If tlie opuration ie ou the right lide uf the 
^Kiioulb. the twisted tiapl^iD can \k rcUkinol in fmsitioa by the 
^Bthntnb and Hoood linger of tlic left luiud liran«ht rotmij 
from tbe barb of tbc head. If a fold of IIiiod U> pki':-! 
between tho cheek and tbe Upper tOFth, Miiiie prauure nuy 
ho mode agalnat ibe onfice of the parotid dtict-, and will tern- 




400 



A BYSTSX OP DHRTAL SDBOBRT. 



punrilf close it With a little louiAgenwDt, wq shall soc- 
<.iM.>l ID kecpiDS t^ tooth uader operatiug dry for a aufDcient 
tragth of time to enable the gold lo be mtroduced. When 

«^. n> a»d ITS p) ,t'f °If""<^ *» -^ *»«' 

left Btoe of toe polMnta 
moutb.thc smngeinent 
will difTrr unly in tlie 
position of the left 
hand, which will theq 
bo ici front ; the thtimb 
tvill rest on the latnal^l 
and the wcond finffcr 
on thv lingual vide of 
the t«eth. By using tbe 
Reeond Sngcr ibr tbe 
retention of tbe nftpkin, 
the first is loTt free fiw 
utHiflting iu tlic gai dance 
of the instrument, or tbe | 
adjuiitincnt of tlte nap- 
kin, should it become 
diiplaocd: and the uae 
ofsocban iiistramcntaa 
EawM's durtand toi^e 
cani]ires8orwill sav« tbe 
operator's 6D|:en much 
fatigue. If the flow oT 
saliva be exoeasirc, a 
Binall fold of hnen may 
\te placed tivhind the lu- 
daor leetb, and when 
sataratvd, renewed with the right hand, while the left k6e|« ' 
the na)>kiD which surrouwU the faulty tooth nndistorbed. 

(>t iMmnwaH conMnoud vtiii • dunble nrr»f«r tlllinc otrlUt^ hi ihe 
nutUuHnf nrfkn nf lli« lower nwlir tMb; Un Umarr being ivlled br| 
ctSUury tax. tbe WUr fcr •dtirslv* fell or ffvaft nU. 




KETnODB or INTRODUCDIO THB GOLD. 



101 



nt.tu.in 



If the ca\'ity uuikr trcaliuout Iw aituAt«d ujmo th« niuiti- 
cftttng surlace, an instnimVDt iirvwDliDj; a double curve will 
be found to meet the rcqiiirGOienu of the coae {Fig. 172). 
The eoTTd of th« nhaft canisa the iiutrunKmt <tv«r tbn t-ooLi* 
goova taeU) witjiixit the haiullv beini: inounvenU'Utty niiti. 
After the p>ld i* introdnred, anuther rnrm of instnimcDt will 
bo fuund useful foe oODileiuiii^ the plug 
(Fi^ I74),wbtcb, being tjipoacd u> w«ar, 
caoDOC bo loo bard. 

The ihoft is beot stmost in the shape 
of the letter S, and when uaod dosoendB 
from th< Lower Inrder of the clewed hand, 
the blade tomiinatin;; in th« wurking 
•urfiue betas tn a vortical position. It 
ia necoonry to mppcirt the jaw of tixt 
pstinU with the left hand. 

For oponUing oa csvitit» iu Uii* Ulfial 
•orfikcv, a doable -carvel iTiKtmment, 
airnilnr aa respocta the Uade, Init with 
the curT« in the ttbaft in n difTvrimt 
dirastioD tu those laat deacrib(»l, mil be 
found very senriocahle. When in use, 
the abaft, will bo uoArly parallel t^i and a 
little alwvo the crowns of the lower 
tMlb, Ibe blade doaDendiii;;, ami lliu 
worlciog extremity dJr«cU.>d obUi]Ti«ly 
downwards and backwards (Fi;^. I7i>, 
176). By ail(f|>tjui; tliia form. th« opcmloc U enabled to 
keep in view thi; Uiwi:r ntar^n of the cavity during the 
[•cklnR lit the full— llw part in wlitcb iJic plug ia moat 
frwttteotly defective, and oooiequontly r-(i<iinDg the grealeit 
care in ita constnictton. 

Tba moat tnuUnoue caaM to treat with fficcMa are tfa>»P 

i'} *i. iMtmBMH far emmfnmtmt plufi tiMradane \» ihe irttrwlm 
aurf ■ rtuT iiBiUn Tbs *MAi6 u ETM(al Mia tim Uwl* IHM^ni 

du>i - ii« towor Innlcr ol tb» (Kim<I twmL 

2 D 







p 






ftSTHOM or UITRODVCUiO THB OOLO. 40S 

V c«vit,v to W rnwlinl. A gooil quality of «U«l well Um- 
X«t*iU is required to «uub)p thv oiktsum- to out Ibruugh Ibe 
aooDd nnunel of moUr u<cth, luoro ospemlly when, as in 
limer n]ollln^ the position U anfavonrable ; for filling fach 
CAvitiea cjiiwiiTS will very gciterully jirovc tbe nuxit ao«<- 
renient form of f/AA. 

In ilflBcnbtog tha truatment of caries, Ihs obaerrstioDS have 
bMD coofiaed to those comb in wUch th« pulp of the tooth . 
h*s not been iQvglvi<d in the diaeaae — caaea in which the 
carit]* to be treated hat be«ii simple. Tbe more complicated 
liinua of the dianse remiilii for conrideration. They will 
cvme tinder two divitfiuDu; lintt, thoM ctm» ia which the 
pulp IB CTpcKted, hot not obviotmlj- dlncfiaed ; wwondly, thoe* 
iu which the puli>>cavily in laid upon, and tbe palp diseased 
ard«ad. 

OaHu with jtetfoTXttion of the pvlp-cavitj/, the pulp btittg 
fteoIlAy, U a ooodiliou that is but seldom m«d, uo^ng w 
the result of on operation. Tho dentine in contact with tho 
pulp liaving been aofteiKd by diBeaae, is rwi'.oT«d when the 
caTity is prepared for filling, and the pulp thereby cxpowd. 
I'erhapa it would Iw wrong to ouunie that in (Ucb a case 
tbe pulp is abeototely sound, but there may t>e Dotbing to 
ahow that it '» discu(!d,and nothing to wnrmtit the adoptiou 
of any other tmtmcnt than that which would be pursued if 
ita boUthinoes were nnqucetioned. 

I Atn not prejAred to aay that we oeTer fiitd tbe palp of 
a caruiiiH tootb Uia cavity of whkh hae been laid open by the 
dhdntegration of its waUs, free from diseaee ; but caaea ex- 
lUtliig fDcli ooDditions are very tare : whneaa the expooore 
contoquent nixm the rotnova) of ouious dentine is not very 
nneommot). It is en unfurtunntc accident which cnnnol 
alwayv be avoided — uuCorlunata, bemuse it wonid hare heeo 
faeCtrr to hare retained the ioftcnod tiaflnc, tbe remoral of 
«bi«h rx-oMiunHl the t.'xposiiri'' of the jmlii, and to have pro- 
tectvd it from furttur •liv<>iii[io«itinn by [''u^Dg the cavity. 
Bail this trratuieni bvcn adoiitoi, wc ibould, on otamiluitioD, 




i 




■104 



A BTRTEM OF DKHTAL STTBGRRT. 



after the Upae of it few tnonibs, hive fouDd thnt the 
itaeir bad become cnldfied as. the point oorrespondiuK to < 
diaurg«ii»ed deotinc. The prcMoM of a plufi su.n tlic 
fttrther profljen oT tbo diMaso, and prevoita the fluid «f 
th« mouth from pt-notrnUtig throu^'h tbc defective wait of 
tho pulp-cavily, while the (ujfU'Ded (issue retstned *■ a 
ooTering to tlie jiul]) saves tbc latter from the Qfiieett d 
Buddua cbangeH of temperature, which vroutd have heeo 
directly oonvcyed throDg^ a metal jilug hut for the JnW 
veoiion of the dentine. When. ho««Tor, the 
[iroduced diinii^ an ci|wmtion the {xilp in nauoUy 
And hleoda freoly. The paio Is c'>inmon)y iLcat«, hut sooa 
NtibudcH ; but KcmicLimcfi no pain is fxjiorivDced. After thn 
bleeding baa ceased the cavity should be eyringed out vith 
tepid wnUir, mul carefnlly dried with Dottcru-n-ool. The 
icttisl state of the vralla of tlie carity, the aiza of the fa- 
/oration iato the puLp-cavity, and the condition of the dentine 
imuiodiately around tlie huks can tbco ho examined. If it 
bo found that the whole of the BofleQcd dentine bad heen 
removrd, that Uiv ap<:<rture into the pi]li>-cavity is verr 
minute and ^uirviinded by aound tiaiue, we may pcooead lo 
plug the tix)tli in tbe usual mauner, adopting the preeautioo 
of l&yiQ!i a smatl piece of foil, folded six or dgbl times opoa 
itwU; over the apertura But should It appear that the 
opening into the carify ia of oontiderable sizfl, or that, 
tliough !imnU,it in Burmunded byauflencil tienje, the removal 
■if which would increaae its size, a different moitc of piuceod- 
ing muet be adopted. 

An miicli aa powihle of the di'vrganiccd tiwue^ short of 
enliwBinf; the aperiurw, sLrmld bo carefully cut away, taking 
care (tjut tho walls uf the cavity arc n.-ducod to a suitable 
form ; an nnitldal suhNtitulc for the miarinc ponton of the 
wall muet be prnridivl, in tbo projiamtiou iif which two 
oonditions ahould be ohaerveil. Like the dentine, it ahoold 
ho a nnn-enndiictor, and olao, like it, be capnble of innUxting 
tho pulp from pTeuurv. To posaeaa thu latt«t quality tha 



UKIBOtfi or UTTBODCCntO TBI OOLO. 



105 




ft. 



mutt bave a certmia de^a vS stiBngth, and b» 
•lightly ctocATc ou ibat surface which is pf«Mtited towacds 
tbe pulp. 

It is u»ua] to epeok of tlia opcnuion under tlio title of 
"cBpping*' the nerve or pulp, ikiiit the ^iiilwtnncxi stiaped u> 
cuTiT tba pulp u th« " cap." Gold, irof^', Iha quill-boru, sad 
man)- otbor subtitancctt have been used. 

A |ti«cft of Boi table site cat from the bftirel of* stent quill, 
faoilig rmdiljr pnxiuced, vm formcrlr oft^ti tued. In deter- 
mining the afaspe and mxe of the c«|), it cniut be remnnbered 
Uut tb«rB ii no objection to the whole of tlie floor of the 
oaviiy bdag oorvnid ; ac all event*, tlto cap should bo mlB- 
ly larp toetunre ilf«d^fs resting at kpdw little distance 

im tbe nurgiD of tlio npcrttira by which tha palp is es- 

otbenrijM) it will fail to protect the latter part from 

lara dtrnn^ the opontion of plugging) and Bnlnequenlty 

fram that ooosaqiWDt upon the tooth being used in taasti> 

cmtifin. 

NVbile it is at<ceeearj' that the expoeod portion of the palp 

odld be perfectly protected from premtra, it it perhapi 
equally dtwimble tliat a Hpaoe Bhould not be led in the 
concavity of the cap into which the giilp eontd be reociTcd, 
wtTB it from any cause lo [itoLnide through the a|«Tturv in 
Its fni-vi ca*ity. Tbe natural conditions of ibe |«rt to- 
TolTed sbtmld be obaerred, and as far as iwHwhlc mtoruL 
To follow uut ibeve indicatioua, the expoeuil pulp should be 
protected by an artificial covering, which, while it prulecta« 
will At the saaie time keep the pulp within its natural llmita, 
and defend tt from ntdden ohangea of trmpernttire. 

In wtJuflting tbe cap, »mo little time and altentitm ntn«t 
be given in order to secnre iu taking a level bearing upon a 
■urloofl which may be, and frequently ia, nnereo; and it 
ehonld al»r), if practicable, Gt to the walls of Ibo cavity with 
sufficient tightnna to locun) the retention of lu fwaitltm 
during the tutrodnctton of th« gold or other materiaL 

itflfons bowrrwi we proorcd to 511 the cavity, Ii mat b* 



riH 



406 



A BTBTEX or DKXTAL RCmOBBT. 



ilotn-miaod vhetber ibe |)lug u to W rogkniiil us « t«n- 
pnnuy fir a portnanent one. Sboitld llio tmintcnt jsovv 
succeaiful, the exposed portion of ibe ptilp will, in the ooun* 
of ft Tew months, become calciftcd, nnd the apvrtnre in the 
cavity stopped from within hy n layer of Moondary drutlne. 
Auuming thia procow to have tiocn ffTectcd hy luuiiiv in a 
tooth that bat been pemianuntly plu);(rod ovw a cap, it b 
qoite poaaibte that the tiUint; will prcaorre the tooth for fto 
uulimited period, bat it i» fur more )>rolable tliat a )>liig 
iatrodooed under Kuch circumstances will, afler a time, fail, 
aud the failure perhapx may out bo diKovi-nMi until the 
crown of tho tooth i» all hat lost. Had the filUnf Immh 
regarded u temporary, the tooth would have Itet-n examiotd 
aFlvr tho lapse of «ix or eight months, the temporary plu^ 
romoTed, aiid a gold filling introduced undctr cttxnimxtanoeA 
far mora favoarahle than ohtaioed when the o|MraUoD was 
complicated hy the prt>M.-iiou of a cap and gBDCTBl toodenuw 
in the tooth. 

So much ULcurtuioty, huwover, was found to (allow on tho 
Mppiog of expoaed Detrea, that tho practice fell into aoine 
disfavour, hut it has again Itceu roviveil in a aoinewhal 
modified form, and laecu with birly taoceaafal resaUa, In 
the [AiKe of uaing a pmteotive cap of quill, or other hard, 
unyielding substauce, it i» now uhuuI to lay oTet the point of 

vMpomro a rcry iimall piece of ootton-wooL soaked in thymol 
carbolic acdd, or a drop uf collodion containing carixdic 

'acid, Ch-er this a filLiiiz of gutta-pucba, or, 1 think, 
prcfi?rably, zitie oxycliloride-, is ineerted and olloncd to 
feiiiniii for Boino moiilhs. Some writeni advocate tbe (Unct 
npjiliuitiuii uf thi' aiiic uxvLhlbriJe tu the exposod surfiue of 
the pulp; but I pwf^t to protect the point of exposore hf 

jtmo or other of the Bubetauces mentloQed. In many tnstancw 

Vhero the exposure of tho pulp is very small, ur when some 

[iftenod dcntiuio remains, forming an in<mflicicnt pTy>teclion 

to it, a layer of zinc oiychloride may ho pat over it and 

allowed bo harden ; l\m is cut away on tlio next day, 



XBTaODS or CrTBODfCIKO THB OOLD. 



407 



I 



» 



eotcepUitg or«r that. Hpot when its prcMooe !a desiniblo, aiii] 
Ibe rast of the oavity ailod wiLh vM. 

AlUiuugU ite preceding {ilan olt«a meets with aacceaa, an 
a gfooml rul<^ I Ijeliwe it is wiser to eai|iloy a tompcvaiy 
fiUiDg, which uuty be odTuttagvousty coniporcd of siilc ox.y 
chloride. Mr. Thnnisa Rogers, in bo elabomte paper (') (to 
which I mtut raia Uiu reader Tor a fullur aowuiit uT all that 
rvbtes to th]« lahjcct), makw the following RtAt«mcQt : — 
**Ai t ooosider it to he a matter of great inipurtAttce la 
•Toid u mach t« pombUi all irritatioa to the tooth ia thU 
deliaitii coadition, I fill over the cap with amalganw" 

Whether amalgam (in which caae it would be well to VM 
an amalgam that hardens imperfectly} (^), gutta-pBruba, or 
siao oxychloride be Mlooted, ite ninoval, and the BubstitotioD 
of a gold plug, shooM be iiH[M«d oo bo aoon as tlie tooth Lb 
in a proper conditloo to warrant the pennaiMnt operathnu 

It baa been aanuned that tn all caaei of ezposnre of the 
palp daring an ojwntHHi, or under circumitanoee that justify 
tiio opinion that it is free from diaeaao, oar treatment shonld 
be addmued to it« ]>rosurraLiun. 

Such is the gonenl nlu. But tbore are caaos io which 
ikis rate caimot be noted upoii, ou uoouul of the imfxs- 
•ilnlity of following oat the tivetnicot roqaired for ile 
obeerranou. 

From prolonged irritation the pulp may have passed into 
such a condition that it will continnci to ache desjiite the 
application of sodativcs ; it may be the Kat of irrvf^lar 
nodulea of ooloifiaUinn, or it may have bst so mncb of its 
mbfltancM by soppuration that it no longer fills up the 
polp-cavity. Again, the walls of the cavity may be ao 
•hallow that the reloDtion of a cap wiUi a plug extomal to H 
beoomes » mntter, not only uf dtlliculty, but o( impossibility. 
Or tbi! crovu of the tooth may be aa much injured that, even 



I 



<0 Tr wi w rt to B xiDbtq^B n tok^toiaadiiy.votL 
Qvrtas Ito XKpcaH Palp.' 
l>j 1U&, ni. Iv. nrN HriH. Mr. C S. Tonv •• Oe 



ar.T.JLIhvn-Dn 




J 




STBTEM OP DXHTAL StmOBET. 

if tbe pulp ir«re mpped, the Introduction of s jilus vronld be 
aUorulod viU) Tuk of breaking down tho bbell. The |nliait 
nuy b0 luiAble lo return to yoa, or to obtain tbe auiBtaaoe 
ot ■ denttxt for Mtnc ymn to conie. (>n the occnrrenrc of 
uircuuutiiuccs tucb is thote enum<>ratod, the prvMciiT* 
ttyatem of irefttniont miiBt he abiuidoiiMl. tRstewl of Ktriring 
to Bare the [mlii, meatin luiLtt bo odoptfid to bring abuat iu 
(Imuuctioo. The most cfl'ectunl, nad at the nmc time 
nibst, nuuinw uf kccompluhing tliic end, coinrists in laeiiiiig 
a very fine nnd flexible broach tbrongfa tbe openio^ in IIm 
polp-carity np Uie &ng ut Uifl tooth. Wben the furlber 
progrou of the instnuneot ts jurcsted by the diminiithcd nt» 
of Ui« cavity, a rotatory motion should be given to Ihn 
broBolL Th« eRect will !« to cut off the pnip In the root of 
the tciotb at tlic- luost oiuatricted part of the canal, ami, cod- 
seqaently, of tlio pnlp iiBolt This treatment is 8|<plicaUe 
to Binglo-routed teeth only, and even in iheBe the opcntioii 
is scnnetinies attended with great pain, owing to the difficulty 
of pMsing the broach to its proper d<>»tinfttion. Whatever 
instnuoeot ba used, it ii?iould be nt once boldly thrust Iiume: 
littio or no niiwio pain is pTcn by such a proceduro than by 
a mere touch, uud iodcvixiuu ou tfao part of tbe operator 
involves prulpn^ed suffering to the jmttcnt. 

By destroying the pulp, we concert the uaca simple into a 
oomponnd cavity, tbe one pert being formed by the pnl|>- 
cavity, the other by tbe cavity produced by the pciuwry 
disease. 

TliB two cavilice bavo uow to be regarded aa one, and 
ete|« must be taken to reduce it to a suitable form for tho 
reocptioti of u plug. Tho canal in the root, alter thn with- 
drawal of the pulp by a spi rally-twisted broach, or preferably 
by one of tbe knrbed Instnimunts cunbtnictcd for the pur- 
pose C), sbooU be enlarged with a drill, and tbe distinction 

(<) DrotdM for dMtroTlai mkI tniMraiHns ibc pulp (boiiU bt r«7 Oob,. 
eUuUc Hill Itmlbtr, gttwr«r|M lh> ctptbailj oT fulluntui tbe curr^d coont 
II— tT lot Itia tAcllTT p«TfurnMix« vT 11m ofwHtlva « UI not bt fttittlanL 




HXTnoDfl or iKTBODTTcata THB aow. 



409 



iweeti llif two cavitiM dwlntytid by gradimUng tlie walll 
oat«r into those of tko inucr cavity. 

There sp|«ant to he swm« diffrrDuce <if opiiiicMi as to iht 
tinw «t which a tooth can bo most ufcly plugged art«r the 
palp bu be«n removed. There are thoec who consider that 
lb« cavity tbould be filled with eotloo-wool and mantic, and 
tha tooth allowed to reniAiii uitmoleated until any irriuition 
tluu may 5U|KTTen« upon the destraction of the palp haa 
0(unp46U:ly Biib«id«d. 

Tho oxperuince doriTctl from tny own practice has led ma 
Jo arrive at a difTertmt conclnsiun. In tho cssnt which have 

>ir«d modt succeasful, the canal in theiroot has Iwen filled 
jtately on the ceasstion nf tho hieiitorrhige, and the 

intioa compltited on the same or a Tollowing day. When 
^thia ouatBG liaa hoen followed, irrttatioo of the alveolar iuem< 
brioe of the socket haji Kldoui luisen ; bat when from any 
oaoae tbe pormoncot filling of the root hu been pcatpotwd 
fiv aotno daya, a oertain amount <ir irritation hoa come on, 
the icwtli Ixootoing alightly raivcd in the socket, and pninfal 
wbeti pnmed upon. In same instances, the uuittvuurable 
•S^ptoou bftTe gradually pasaed away ; in others, the tooth 
liaaheao loat. 

Tbe diflereot fesnlte come^oeat apoa the tvo modea of 
tfwauitenfc may be explnmed apoa the lUHiunptiao that wbeo 
tbe panaa&eDt filling is uaed, the ingrcaa of oral fiuids is 
pertiecily ])revDutwl, and the accumnlation of anjtbing more 
tbaoaTory minute amountofoo^ulatn impoasiblo; whanu, 
when cottoo-wool ooty is employed, the permeation of aaliva 
ia not Ktidend im[<ouible, neither U Uio ooUcctiuu of a 
relatively larger amoant of cooguliun gtiarded SQaluat. 

TLb oonaequoucea which follow tbe laoerotion of a aofl 



Ptai wtumutm** Imacfei 



wd to B nft i^rlar tonpfr, in ommbmIx 
■MAI In a nun rtkta-f loMnaoM OMf b« bmm Of taktof ■ Km uMA* 
q^rtOK, •»< pxnoiag H Oawu wtW a iiww «<4wl Imdl M pntMM. If la « 
■nad Ik ktnprt t* illgbuj MwcM, Um pdM amf be »lNad to Oh mum U 
ttm or iMf uin» 




i^ 



^^ 




410 




mm OF DKMTAI nrBODT. 



tiMiie vill, OBtem parihua, g«narally be ivoportioned to I 
ftoinunt of sur&ce injured. In the cmw of & lootb, 
Mctiuiml aro& or tbe pulp qmt tUe «iid uf tbo nni li » 
mall, thai tU dIvUoa in a hialthy !)ul>J«etwiU not be (ii)* 
lowol hy iaQainiDAtioii, ODlues Ibn injureJ put is sulise- 
qaenily expo«od to irritattoo. But »bouId tbe nilira fiud 
AcceSH, ors large caaculum culleci in tbe racant caTiCjoT 
in tlw icMratioei of tbe woo), and d«compo»e, tbe bMontad 
■ariace will beoome inflamed, and the diaesae will exund 
Ijorn tb« renuuuit of pulp to tb« perioetoum of tbe root and 
Hick e I. 

TliL'rv nia otbor inatbods tbui that jnaC dewribed of de- 
atT<)yiii||! ihv piil]i ; and tn canes wLcr« tbe u-tc of tbe broach 
i> atu>n4«d with dilTicully, owing to tbe poaition of tlio 
opL'ntng in the |mli>-aivity, or to the tooth haTing more 
than one root, they are to ba iireferrod. The am of CKharo- 
Uofl for diMtfoyit^ tbo pulp can no locgei be looked upon as 
a noval mode uf treatment. The praclint baa stood the lest 
of time, and may be regarded as one of many great ifflprave* 
mente in dental surjtery matured during the pnsBent geoera- 
Uoo, Kuspiui, in a pampblet publiabod in 1797 (*), mentionc 
destroying Ibe pulp, and HU)iaG<|»eDtly tililing tbe cavity, but 
tbe updratioQ was not gunorally aiiuptod, and its dotails anii 
results wcrk«d out, until n-itbiu the last twenty years. It 

(>) Rmpliil.ln bU "TmUM on tb* Ti«lh,'lha «i|[li<l> nliUoa, p U WMwl 
ItK.iiukMltiv folii>*lD)t luuatwiit: "IVbHw^T oulw appwn H maM tK 
ojMnri iiltli a ■ujHrt'Tly liniiii III iliv v<*ry botum. If In doloa <o Um chord nt 
t]MUioibI«dlsmTnni, ilu> opcntlim «llt pnmr polnful ; ti» ttriL II mux te 
lUatfny*^ rIttai-T Willi au Initrvnimi, m wtlti tW adiM] «HibT7. ur mn» 
auttc iMpUH. 

•• We niiHiii to tw TprT BtlmU** In Uir upmlhin ; fur \t wt> <!i> w< utlrrlf 
Arttny riv tald chanl,lKit only prlelt It, t tie tnnat limine jhiId* vUl vunwul. 
Uif iihrr will) ui biaaiiiniBUut^ und ll)f InetJUbt* iimMilj of ilnminc Uw 
iootb. 

~ \Vli<^ atuulli hjr tlll■lo•■•Jrlu<tlnr■11•llvuIIl«I^W!mtM^h ii]Ui4W |I|h| 
artUi bad or giM, In onlcr to piv<r«it any add or mIIdv pcttlcU* ttam fmiay 
thranBli Uir hiilc wt>T« Uw dmnl WMit lni« khe audtet tu bun It* dolhUD 
nMonbniRt: lor ilva tbtnauuld b« no ncaca af rvlma buthj drantliif (IN 
hwUi ; hvKB all Um tmn iLat had botti uktn, wd all ilw |i4tn Umi liftd ham 
Midimd lu ivniKV Uk UMli Lowntfble, wusld itacn b ■ of no arall." 



J 



mcTSOM or raTBODCcnfo tub gold. 411 

iaifngular that h priucipU llio soundutMs of which had boeo 
fttlly MUbltshwl fur the beet part of u MDtnry in tU<; openi- 
tion uf {uvotin^ should not have beeo applied to the |ir&- 
•ervstioQ of ttwth the crowns of wliich wera but jiartiftlly 
decayed. Every one knew that after the reniova! of the 
pulp^ a piece uf pAA wire lai^ht be ^aued uji the br&lthy 
Tool of a rraot tootl), for the pun^^w of anpporting a new 
cniwu, hut it ilid ui>t uccur to thoM who |}rai:tiflnl pivoting 
that thv cnjWD of a tooth could b« preserved by an opcntloa 
Qonductml upon the same pritioiple. It ia not, howorcr, very 
difficult to MM how the fact waa OTerlooked. llto gold pio 
wsa luit introdncetl f'lr the pur|X)e« of prcaerving any portioa 
oftlia faalty tooth, but van rv^nrd«d a« purely 6ub«ervieDt 
to the aopportof a nvw rrown, in liif plaov of that which 
liwl bMD too Ear injumd to render its rctentioD dusinbto. 
I Tbera are se-veral Koueral rtilcH which may be laid dowD 
iB nspMt tA thd scieetioQ and tlie applicaiica of eMtutroticfi. 
The £jsi in point of Importanco is, that ibey ahoald not be 
employed when there in rcaaou to su[i[)<Me tliat the p(>ridciital 
■MmbnuwiadUeaied, and for the following reason. It«eIdom 
hap|tena that inflammation extenuU to the nxit ariaca, ex- 
cepting as an exteuaioti of diseaw>e ori^atiog in th(; (ulp, 
during the pro$ren of which both the pulp iu^^If ami the 
canal ui the fkog bocoine cutiHiUorably enlarged. Coom- 
quently the action of the canstic may cot be limited to the 
palp, or if it be, that portion wliioh ia allowed to remain will 
be ill a diieaaed condition, and cs|)able of Icecpiog up the 
morbid action in the alTnotas- 

Tbe aecood rule to be obaenred ia, that do more of the 

escharotie ahoald boappliurl tbui will be soffldcut to prodnoe 

iIm reqatMd tStaL For if An exoeei be aied, it ii more tbaa 

^protMble that the action will extend beyond the re(|uirod 

LlinUta, and (irodnoc laJhuninathin of the peridental tnsmbraoe. 

third rule ia, tliat tbe applicstioa abould not be con- 

BOed over a luager [wriod than ia aweaaary to eoMirs the 

icticD of tbo body of the palp. If allowed to Tcmain 



413 



A ST8TBH OF DBhT&L enRGEET. 



for a long time to tb« tooth, it may permi»l« the daitiM 
ftod nlTect the perideaLal tnembrana ; whereais if tlie buly of 
tiu ptilp be dead, the degree of Knaibiiity t>t tlmt whicb 
reniRiaa in tbe roots \a m mucb lowered Ibst it niny bo with- 
drawn without tMxasioning any cotuid^rehk amouot of pain. 
By obflcrviiig thin precautjou we enHure the rcioovsl tif the 
ctnstic, anil Imve the pnlp at the point of niptara in. a moch 
ntiKo faviMiniUe oouditivo for buling than if it bad been 
Mtaratod by tJj*' (Hcharotic 

llicr fourth rule is, that oHcharotin iiboii]*! not be npplia! 
to a tootb, with the riew of destroying tbo pulp, tiiiIcm Um 
fang i* fully d«rekiped, and tbs aperture through tbe ex- 
tremity of the root reduced to ita uUimato Bze. In joaag 
aabjectA the caoAl in thu root of a tooth 1b very large gano^ 
rally, but iiior« eapecially ac the terminal portion, and Iha 
pulp maintains a corresponding *ita. 

Tiic cxpedicnoy of destroying tho i)u1i> by means oS an 
Mcliarotic haring h&m dctcnuinud on, the sabetADoe beat 
fitted to produce the effect miiKt Iw Milpctcd. Thu miiMnl 
•cidi, nitrate of silver, chlorido of rinc, and many other mb* 
atanoea poesusBio;; cansLic propertJM, have muh in turn bcvo 
oMd. ArBeoious acid has, without giving riH to a greater 
UDoutit of pain, Ik«u found to act with more certainty, and 
in leas time, than any other agent. Tho certainty of its 
uperalion U so greet a raoammuMlation that arsenic is alincwt 
invariably prnployod in prcfcrciico to any other doscriplioa of 
caustic. The extremely active chancier of this sabataDCd 
U a poison led utt tomo years since to prvfrr ohioridsof It», 
which, although Icsa certain, is a i^f^ i!muptou» a^^^t k> 
employ in tli« mouth. At lli^l ' .1 

of arsDnic capable of pn)daoliig 
been delermmod, and 
in which k]^>ii 
followed iu VI 
the gum wa^ 
More extrnded . 



.1 ■- .. _* ii 



mTBons or crnuNVCcnB 



413 



, the idfaatagea offored \^ Uiu wimtr^ 
__keQ iu place among the nod Birfal«f tWi 
dLipoeal of the \yraci\t\onn. 

Tli« twenty-fifth of a gniB of meuoaa ac>_ 

s fin« BtaU: uf dmtriun (ft dnM wllul^ if mSo**4, imbU ftg 
productire of m injury), is ntfficUoi, wIm [ wi iylj flffftia^ 
to dntror the ritality oT Uw pulp of a hiip m^ tatk. 
Somo pnc^tioniTs prepare & coapavud, «a^ Vf pU^ 
together equal pnrt^ of ftraeruc BJid laij^tij, |^ ^paMfe 
being ailded for ttie porpOM of imij«pitiii; i^ p,^ |i i IhbJ 
by tbc corriMivu action of Ute mineral Mlrt^aL b ay «m 
pfSolic«,l prcf(TtoaMthotreauci]oiM»Mdi||M«tb 
fcllowiog mannvr : s amall Wll of aMOf'mvi.^a^j hrpr 
tbau a pin'a hvaA, w formed on the end cf t fi« ^mk^ uti 
dipped into cr«o«)lo. Tlw arsrtik: U Uiea tdi«»j^Q^ 
»liiratc»l w'»l. wfl'ich, thuii Uutinl. U w^f^j jj^^ ^ 
oontwiwith th« eipoBeil portiou of iha — w -j „^ ^ 
in position by iho intftxiiiction of a g«cnftl |i» ^ ,^ 
utiirated witb a soluiHin of toaAic. Ttw af|l^^ U^ 
derrd yet Tonre cvtiaio by ukinc up t ^>i^^M«i^3^ 
~ K biiint iKiiut of an inatnuuwit wUcH ^^^^*T 

lib ciirMi'- iwi'l or glyc«rina. and qfl^ Afc » ^ ^|_ 

Wiipu ll 
t*joUi, th*" ' 






414 



A SrSTBX OF DWTTAL ICMRBY. 



mutt bt Riveted to avoid mwtioting apoo lite tootb, or 
dntnrbing ihe n|>))liciition by any other tneans, even tl>oiu;h 
tha poiD it uGcaeiuus thuulil bo sewn. Both tlie uittoudty 
Ukd the duntion ot tlie \mn pnxliioctl by ibe deatmetti 
■etiOD or aneaio upcu tba dvnta) pulp an iocoiuUiit toi 
deiElM for which tbc n-co^isable dilTeraiccH id the cases fiUk 
to aooouot. One [tttiRntwill tell yoii ttiat tbeapptioatioa, 
pluduc«d no paio, another that the toothache was 
Mverv, and lasted fur ton or twelve hours, while a third wiU 
dvscrilw the pidti m moderate ia d^ee^ and of a very 
beartible kind. 

It ia reioArkable that the applicotioa of aneoioos aicid to ft 
tootb which haa previously been Siching severot^^ 
/v. itT. ( J j^ Hkl»iu followed by much pain; perbapa tlkkl 
may be due to a pulp Ui a stfit^ of infUmmatiMi 
be[a^ nuiro rtuulily deolruynl tlmti utK* in a aim- 
parativcly healthy coniUtton. The more free the 
ust)o«iire nS tlio piiljs the less pain will, oa a mic, 
ho experienced : there is no condition prodtiotive 
of such aovere sMflroring m a mere pin-bolo ox- 
pcwiuv of the [nilp Ibtuagh which the arsenio 
pauuH;« only m »iilHoicDt quantity to set as aa , 
iirilaDl ; Uiu reauU in that the pulp swclb, 
hrniiftl ppotruskm i» furct'd tlirough the courtric 
orif)€0, and the aching and throbliing nro almost^ 
unbRirablo. It u in a complete expogore of the 
pulp, and an effectual application of the oacliorotic. 
And bot in the admixture of drugs Mich as nKprphifel 
with the uruenio, i.lint wu muKt neck to obviate' 
Kuffering diiriit:^ the destruction of the pulp. 

A small o|ieuing into the pulp-cavity may ba i 
advauta|{«ously ealargt'd by the um i^f the ii 
OWDt here figured : from itn aliape it baa the adii 
of nol alipping abruptly into the pulp, aa would bo the 
were a roee-headod drill or a broach otnployeil to eoUrge the 
<■) Drill lot uptniat Ui« |«li»<ivH;. 






lorrsoM or intboducdtg tbk gold. 



415 



riff, na p) 



rifice; moroover, tho in»inimcnt in queetion outs with a 
siuiUl vouuiit of iTcuure. 
After thv Inpm of frum twelve to thirl jr-six houra — dq)CD()< 
' lilt; uii the sixo of tbo touth and tbe «xt«Dt of surf&cc uxjkpsikI 
U> ihe action of the Mcharulic — the wholu nf tlje cutlon-wool 
niay be rcmovMl, and thocBiocbtof th« apiilicatfcnuccrtiuned. 
If ttu! lesiill haa liMn (arourabk, ihv scDsitiveoosft, hetons m 
great, will hnv9 cnlirelj' pciOMtl awa jr, Oopacft- 
ing an iiuitnimcnt into the pulp-cavitjr, fligbt 
Llevdin;: may lulluw, imt tUv jnlient will not 
fxHnplain of ])ain, Qnlexa the elTvrl of tho io- 
Btnuueiit liaa b«eo to i'oini>reM tlie whole 

■ contcats of the jiulp-cnvity. SLuuM the |mlpv 
bowefer, on exauiuatioo, he found m an 
acutely aensJtivi- coiMlition, it nuiy he concludird 
that the ia^NM t4 iha VM-nic has been fire- 

ItmiUkI. either by the Bj<crtiirc into the pulp* 
cavity being estn-tiicily njiuiII, nr by a mam of 
Btcc^ivdary tkmiLe lyia^ uganigt the opening. 
Hut whjitcviT raiiHo may bavo rfUu-dcd tlie 
ofwrotkpii of the etM:harulic, the B]i|>liaUiou 
mnst ho rrcH'WO*!, and « furtlier time (tiveii. 
Ilie required effi-ct liavluj! bom produced, the 
-whole of tb« decayed ilciitinfi flhuuld now ho 
Kiiiovnl. aiid the opetiintf intu tlui pul)f-cavlty 
aiifiicicntly enlarged to allow the [lulp to K' 
wiLhitniwD entire. 'I'iiis |jart of tlie o|wriittii^ 
.luay ijient-niUy 1« effwtiil by a fine broach, 
[boaltod at the cJid, or by ti tMistud flat hroMch 
[of ibe Itind already de4cnl>ed, or by tho Iwrbed 
ntrre extractor here fibred. Tim operator 
linvft be |>rei4rfr<l to tncet with occaaional diffi- 
[ oultiea, owing la thi> prt'^'nro of masBw of nooondary dcDtiii4< 
within llifl aubfttaiioe of the pulpw Thry ar« KHuetiuiee w 
trrtfiilar in »ba|>e, perliaja dipping down into tlie 
(>) laatrtiBwnt tit [*&iuTta( Um Oima 




A NTSTEU or DEKTAL BUROKKT. 

fanita, tlutt their wtthilravral oocttpim ajtne liUls timo, tli* 
pulp beoomin^ liroken down by tii« o]eratioii. Id such 
cue* the contents nf each fanp munt be (irawn out scpartMy. 
Altliou^h the b(.<dj of tho pulp 1iil'« boconto inwnitiblB, taare 
or low paiu tv-iU Ix> f«lt whuu the pulp sitnat«tl !a ibe roots 
of lbs tooth is bnikpn iickeh at nr near the orifav by which 
it puMMiDto the alvcoluA ; but the pcun sotMidoa imraiviiiatdy. 
Shonld Blight htEmnrrhnefl fullnn-, the operalinn may bo nw 
pcodod for a few miuutus, hy which timo the blooding will 
have ceaMd. 

If the treatment haa bneu fluroeasful, thn pulp-ravity of tba 
body and of ih« roots t>f th« tooth will hav« been cleared of 
their Dntiirol contenbi. Th« fiulJier tnwtmoit will conaixtin 
fiUin;: Srst tb« rootii (wbeti practica'ble) with gold, then the 
pulp-cavity, anil lastly th« oxt«riul cavity. The noce«ty 
of flltini; tlit; root4 h&» be«a BtroD^y luiatod od by t]u» 
Amoririin writer!), nnd thi-n* cati be no donbt of tho advan* 
tage whicii rvsitttK, Fup[)OHiQg tho canali to ha.vo attained a 
oertain oingDiludc Hut when tho root is snuill and it« cnvity 
too minute to admit o &uo brueob, it ttiay 1w loft without 
tho fcflr that auy cril oonscqucDC« mhII oiuu&. Id a ftrst 
raolor of the upjxT jaw, fur GXOinpIo, Iha aotorior oarl palatal 
root* should ba filk-d, but the posterior root is commooly 
tiarerspd by a canal Unt auiall to rendor Riling necesBary. 

Som« doubt has l>een exprcMed u to tbo practicability of 
lulling Uie root* of li>eth. nnd no dniibt tbn operatioo it 
tedioaa; but wlieu sufficrvnl l)m« is givuu very litth) diSl- 
culty isexporieDcod. lu front tn-lli it is simple enough, and 
in the bnck t««th it must be reQd«red Bimple, oth«nvi«c lliu 
rwult will be imperfert. Thu crowu of thu toutb must, in 
fact, be cut away until tho pnlp-carity ia fully eiponeii aiul 
ita continuation in the root* bmiight within the r«ich of an 
iu&trumont. It will in moHt caaes bo found desirable to 
vntar|;e tho canal with a Itroach. 'Ili« quMtlon coostaotly 
sagQMU itaelf aA to what oxtcnt tho ctilnr^mrat shall bs 
Banifidf Mid to whAt depth. The dflierminAtit>u of tbcM 



XRTBODi OF ntTODDDOIXG TTTS GOLD. 



117 



^ 



I (ieiwwi U|»i>u the [n-culiariiirti of the casn undu' 
Tiid olijtiL't of tLe cakr^cment is tu racUiUto 
tlu operatlou of plugging. lo aonw laituicu it nwy ba di»- 
peOMi with, iu othefs it tuiut be ctnied to « coDsidcnblfi 
extunt. Thus, when the cans) is lurg(> at uiie i«rt of its 
vuouiafi*rouc«, and reduced to a mere alit at unntlior, it mil 
be sdriRiiUt; Iu reduce it to suiiiPtliiDg Approachiiiji; a regular 
vUtluKi. Iu rwa()ecl tg (l«]ith, the cuUir^eiQeut uoay bo carried 
«ritb ulvuiiage i4) tli<> point lioyoiiti which a fin« Ijroach will 
Uut T«M in the tuitunil staLo o( the ruut. 

Uaving fully prr|)arcd ibo cavit/, both is respect to ita 
funu and rouiuvol of extranootu uiAtlir, and |>rotvcted tliii 
touLli from tlio inRux of saliva, the cavity niu«c be made 
pnfootljr dry by losstng into tbe roota cotton-wobi rollixl 
flI»D a broocb. 

We uiay now proceed to pack in the gold by tme ur ulbcr 
of Ui« f£>Uovrii]g tnvtbodB. 

Boll ruiuid a hpMcU which «r(ll rcAdily pu»s to tlio bottom 
of thi) auml a smiJI amount of foil, tirmly, but oot ao tight 
but that ibo bniach can ruadily be withdrawn. The gc^d 
niMjr tlien, while iiintti the liruach, be prtntwd to tlie bottom 
of the cavity; withdraw tfa« broach a short distanoe, and 
ag&iii rvltini it, uhidr Hunicivul prassiiro to oooxulidaie tbe 
gold, whith will be cariied down before tiie iuHtnunBRt. 
KiU'r thoA fiirciag iii tlie llrat tube of foil, the ;huc&i« tuust 
be repeAt«d again aud again until the root is fiU«d. 

In the place of ii\e vaUi of toil, very narrow ribnods may 
bo uied, but the opinatiudi is more tedioua, and docs not 
pOMca* any nd^-aDtage ov«r the method airady described ; 
if rilnuda be vtayloyeil, they may be advaotagtt^sly cut 
from No. 00 ioil. Invibg them but little wider tbau tbo 
Jnatninuint which u. to introdoca them. 

A ibin) nitiibod conaiats in taking tlires or four thick- 
BMHt of foil, and cutUop therpfrani very small acjuarv pieoec, 
which an oue by one introduced upun the p>>iat of the 

2 K 



4 Id 



A HTBTEU UP UEKTAL nmOKItT. 



faniach, ftnd coiiBolklatod. Or a piece of uuft uineatei) gold 

wire mfty be iiuerlcd iiito Ht« fantj. 

Sonic little att«nttuii miii-t be givon to the itiBtniDientii 
untployed for this delicate oprrutioii. If an onlinsry l4wr> 
Hided broach is u»ed, tlic t<nii|«r uiuat ba n>dHc«tl to that of 
\ Rpring, otbcnriw it will snap off during the openluin, n 
portion prob&bl,r rviuaiuiaf; in th« cavity. 1 have kauwn this 
nccidpnt hapjwn in «evonil cams, and a pnTtkii of stwl ha* 
unavoidably b«i'n allowed to rpinmii in Ibo toolb, without 
any evil coTiMqncucc Iwcoining immixliAl^ly dereloperl. 

A preferahle intitnimcat may \ie made nil lier frnm a |unco 
uf steel wire, or by (gliding into a cylindrical ^bflpe a ttn\> 
taken fmtn a clock xpring. The ttXtTemity, if left Rut, will 
cwry lh« gold to th* Ijottom of the cavity more rwuiily than 
it would du wvnj au ed^ie ur (wlut [mMlucoi. llii! viirved 
»wLich the brooch is nquired to talto reudcn elasticity 
lely DS9iiiiLi.-il, nnd in no way can this be nbtaion] more 
nnd [uoro certainly than by ada|>tiDg to our purpcM a 
[Hvcv of watch or clnck spring. 

•J'iio mot or rootii boinj; plnpjptl, the sulwi-qiu-ot port nf 
the operation does not vary iVom that of makirg an ordiBary 
[Jug, escepnii^ that the cavity in the tooth in oniuinally 
lar^c. and will thtrefore occupy a greater length of tine 
than wunlii Iw consnnird in filling a Mtnple cavity. If m 
large tookr, eithur of the npper or lower jaw, be the luhject 
of treatmeDt, the coiuponnd cavity, even afk'r the roots of 
the touth are filk-d, may b« to deep that dif&ciiliy nil) bt> 
encountered in packinj; noii-adlicsive roM so aa lo fonn a 
iiiii;:k» pUig. In fliich caaus it ia woU to first fill ix-rfittly the 
|Kilp-cJiTity, and tlion t*> proceed to mnkc lh(.' iiniru cxt^mM 
|»rt uf the plug. It ix a ooDveuient practice to fill th« tvot;! 
tritb ^Id, And tlic crown of the tnoth with snme temporary 
litlinK. puKtpoiiin); the com]>Letiou of the o[«r;ition for a 
fortnight or more, m that should any alfeolitr irritation 
ari^, ttiA removal of the plug may be readily effoirted. 



VKTIIom OF lltTBiODDtiina THH GOLD. 



410 



W 



mi the fuTLyuirig n|N?r.ir.lnD b careltiHy |)orruriiie«l, the 
. is ^titvnUly vi'cj MiiflfAutory, ilie t4X)t}i Wtuj; reduced 
fiL' nmili(ion of one upon ihe root «f wUtoh n new crown 
be«Q fisoJ l)y a (qroc In rauli tiio cuuuectiun wilb tbv 
lltHng tuwMu ift limitM Mi the estenuil siir&cc of the root; 
Hlkil in iJiM'. aa in Die ultier, iiiHanimntinn of tlic itenlal 
.(«riuttt*iim tiiny eusiw aooii iilWr Lhu <)i>tira(iufi. dther if ain^ 
lot fiW-rveil in ila |M>rrontmrR'<>, if ihv |M.-riiKU-iim be f\i»- 
ur if tbo {(lUcnt Iw in » ba«l Ktatv of bealUi vrhtu the? 
nporattuQ i» iwrfurmoL 

It mtMl. liuwover. In borne in mind, thai we hftre bern 
Uietlin|i «if tbu«<< oues only where the pulp hbt been cxpostHl 
ilnrioi; an ii|«nUiuti. Thv jvCAPUtiO of diftraM in tite <lent*l 
prrio«t«uui will th«r«fore Ut rare, AQd the sonrcc of fnilun^ 
may c»ii8C()iicntiy bu luofcnl fur in the grnnul fiaie of 
beiUtb i>f thi^ iiKUent, or in thv iu»nDrr in whiL'h the o|wtr- 
li»n has Ijom prrformiiil. I can call tu mind ttcveml lo- 
sUboM of lail»» iu my own pnurtice which weK constxjnent 
upon a ntrtaia portiun of Um pulp hsvui}' retaiiu.-d lU vilnlity 
and held it« place uooli^crvod iu the tooth. In ouv caac ni; 
apt* r miliar iM'onmi' vwry iwiisitivc tfi ehiingt'S nf U-'tniicniliin', 
wiDstitrtt whvti pfuMtfil ti[>OD, ai>d ^li^hily Vvn^. h wm 
nUDOvod, uimI, on fxiimitkntioa, tha pulp in tiie pnslprior 
d'fiUl rocit wiu fonad to have rouiocd iU vitality and to 
bin! bnwme Inllnuicd. Iu vne inKlnooe an upper bionnind 
B vay laitifuL AftT rc-moval ib« pulp ou th« o&e 
tt Uic oampressrd cavity vnu fouod tn luivo cMsjied the 
tiroaoh oud relaiuwl it« vitaliiy. In each com tbo »oun» 
of teiliirc Uy in the incompktt! dcntniction nnd rvrnora) 
of the pul[i. 

Td t(«pr«t to the general hralth. Mmo little caution ahonUI 
\k ol-jt'rv<?d in Ihc twirgtinn of Uic riwc* fur lilliiiK lite umU 
and tilt- pulif-cjivity. It will he wine tv aToid tbo operation 
ia tbiHe mIio piitwnt the strnnunis diaihcEt!i, niuru Dfjxxiiilly 
-when it i« cutiplcd with pryttl ftonnhilUy of the f^>th p^nt- 
tattj. TcrMin* who are liable to nenmtttic paiDfl in llii! brad 





msni or okxtal iumbbt. 



and (ace aro iinproniising subjecU, and we cftti xnnnljr 
espect li vury laroun^ile reauit vhnK the ^ains ore in mi 
Qnhe&ltLy cundilioii. 

The tMXurreuw of * small itD<l uiilmportauc clinjiiic gum- 
Imil, couiiu^ aod gutog wtUi btLlc tir tw iti<.t>aTeaiiiuce. muA 
hu pl&ced amoDgst the rosulu which tn;iy Mlow the tUntrne- 
tion of tl.Q pulp atul the suhM-qnenL ftlliog of the potp- 
carity. lu teapect to the root itwlf, c^toogeA, I belieris 
oonnneooe from the time of the opierotiou, and procvd, 
niorv Of 1(«8 slowly, uufil the tuoth is losL Id pi?ote<l teeth 
the rout Hniivtiirwii becoiiioA enlarged, but niuro conunuolf 
suffers a dimioutlon of bullc. In a cora which cune onder 
my notice, lliv jiit-nt liad hi-eii vx^msoJ hy alworptnii od oae 
flidc of tha root ; in ftoothor a sufficient lunotuit to enahnth 
thn polii pin only rciuAined. Apain, if w« taka IIhj roots of 
te«tli nhi^li, nftvr tUv Iws vf the vrvwn, have ha<i Uie pulp> 
rarity scnUtl up hy KcanAvy domine, wo shall fifiJ that 
i^iUht addiliuus ut I'viiLutituin hnvt hvrii iiiaiii* to thii (suriact, 
or that the ovrrAce hrui bc^o gnidoally wastod by absorptioo. 
In uiany casat Lhurc will bu luiiplt) oviduiice to show tlint thii 
two actions have alternated. Ultimately the wiutc vxccoi* 
the repair, the rout ib sliartcned, lonea itfl implnniatJon, the 
MKket diaappcare, aod the tooth, aA«r the lajjee perhaps of 
sf'inc yearn, falUont. 

Ju tho pbce of filUoR the fangs «4th gold, cott'>u-wuol 
Kiturnlitl with carbolic oeiii iiiHyt<(.' Dwd ; the rvsulla are, for 
IV time, at all eventa, very Batiffaotorr, tnoiigh eventually 
tlio carbolic acid seems to disappear, and in some cases tha 
wool become!) &alumled with ilischArge, and then a gumboil 
IK the inevitable rciult. 

Other metliotls of traatiog an axpoecd polp than Ihuar 
already de«criU.>d liare beeo proposed, aud fur a time foimJ 
favour. Mr. HuUihco described au operation wliteb baa 
aioce TOCcivod his name. It cvnHiiiti iu drilling a nuiait bole 
tlmnigh thu neck of Ihe looib iuUi the pntp-cavity. Iliv 
lp«rforatioQ is aado eithef oiuler tho t'tw) adgv ur tbroufEh 



MBTRODB or nTTBODVOma THB CWLD. 421 

tlie gam, a short distance above its terminal inar;;in. Tlie 
cavity produced by caries is then filled permanently, leavinj; 
the artiGcial perforation open. But as this oijcration relates 
to the treatment of diseased pulp, its furtlicr consideratioa 
may be postponed. 

Some few years since it vas proposed to char the expoRcd 
surface of the pulp by electric cautery, with a view of 
destroying the exposed portioa preparatory to the introduc- 
tion of a plug. In my own practice the advantages derived 
from this mode of treatment were* very questionable, and 
the operation vraa therefore abandoned. 



( 422 ) 



DENTAL EXOSTOSIS. 



Pig. m. <!} 



Tne implanted ix>rttotu o\ tlic tccUi. likE> other pnrfs of the 
skeleton, arc liable tn liical hyppritwphy. In the liunps tlii* 
HtruL-tnre ta uuifonu liiruu<;Ut>ut tlii-ir euWtauce, aad the new 
llssiw (loos not niat«riaUf differ froni ili&t to whicli it Is 
ultied. llje ruuU of tim toctli prvM-'jiL tliix puiut of liiflTtrr- 
encr: they are composocl of duntiDC clotbol with an external 
Uyvr of veuicntiim, a tiBsitv which oSen iit> Mriktng cha- 
raciiT hy which il caii be distiugliielieil from ordiiiflry Ixvnti. 
In exostoBis this layer twcotnes thickened citht-r loctilly or 
geoentUy, tbv deullav tu no cft«c y<&rtici]ntiii^ 
b the BDkrgcmcat. Tht diiMUO may bo d#Rttod 
ns nn addition of tissue, morn or Ivsi uonukl 
in character, hut nhiiorrnal In amount, to a pre- 
exlHting tiseuu or the mme structural character. 
If, fur example, we make a section from a tooth 
tliv mot of wliieh lias been incmwed in Biz« 
beyond the c&tnral dimeosicns, an nnniturftlly 
Ihiok LayiT ai cvinvntuiu will be fuutid, hut it nill in laaoy 
instaDoeit be difficult tv {>oiDt out a sharp line or demarcft- 
tion diTidinK the ^-cxiulin^ from the rcceiitly-addod tistrasL 
In respect to the structuro of cciuontuin, it uarcely falU 
wiUiin the aoope of thu pn-aL-tit u-urk to vutor minutely into 
its histological obaraciers. For a (ull di3tcri{>U<^>ii of these 
t\w. student ia referred to Mr. Shfllcy'fl paper in the "Tniiu*- 
iLctioDeof the Odontological i>tK-i<:ly.''(') tu works on Uih- 
tology, and to the previous pubUcatioa of the anthor. Bat 

{!) Aitiipp<>rblcaM|ildioot)i,«iihMo*t<»l<iorilion«Mti(iiniotllianint 
(>> -OnDfnuiKxoaiMU." Hr H«rt«n Sb<^ltfy. Eh|..1I.& LMil.llJu:jt. 
" TnoMCtlain if Um OdocMoftnl twdcty of iMiatu- l»H-St. 



dkkta;. KxaeTOffiB. 



423 



tie fijace may be given tii tliL> cunsidomUou of tbe mom 

iiUtfuL feattires vi the liuuv. 

Tbe Ktructutal c^liuniclcni dt[)*:uJ iu a gn-iit degnw upou 

tbe uuotmt of tissue prettot. Whvo it » limited to a thin 

layer, the laciuuearc lUtogetbor aliBettt, and ovou caualivuli 

dv uut Ajipear imiil a certain Ibickncsa iB attained. If a 

longitudituil berlion of n front loutli be taki>Q lur cxaniiiui- 

tiiu i'«ni«ulum near the ueck will ])r«Mutit a tiuQ layer of 

IS|ArcM tmiu), niarket] vitti liitiil indioiitiuns of gnuiii- 

h'ty, ucwm^oiod tn auuio caec« witU uu oUcure lint^r 

: appMniiiiy.-, Mi^tstivo of the idivu that die otlcitlci\n»ii of 

jpuallel £brci bad contrilnitvd to its pru-)uctiuu. Prucvtii- 

. ittg tit tbfi directloQ of ibo rout, iliu ixuioutuiii thiok«iii>, nnil 

is uarenod here ami llicre hy caaaliculi, aud sliU furtbtr 

dovm lacanir mako th^ir njipearancc, firvt as a aiu^h eenvb, 

then, vitb an incrtra^ ihtukoeM of ttie cementum, in num- 

ibom; tti« uQUiber ^«n<.imlly dvpcrtdinf; upon tho thiclEoesii ot 

ftlw Umuc Till! cutialunili of ncipblKiuriug lacntuu anas- 

lotuiBc fnvly nilL edvh utbtr, and otitaLiisb a network of 

conuiiaiiim-iort tlirmigliout tbi! wh»1(^ ludvfif tli<!cviiieiiMtiii, 

and uojA^ionally bt-ooiue counvctcd vitb the icritiiuai braiiciiUH 

of tlif (ictitiuAl tnhuli. The rAmtnuiiiL.'anaD thiw i^iahliKlicti 

liOtMeva tlu! tw« ii.viiit-s ba:^ been t)ui]l)U-<l. tiovcial jiruinrif 

tiou», bowwiir, m iny omk jwitiwaaiou dciuoiutriitc tlut lact 

bvyaiid utviL 

The oMiirreooe of naciUar canals (Uavcrsian caQal*) u to 

■ cortain extiutl exce[itioaal, buioj; du|«niiiiijt u|nju the pro- 

I ttfuw of a birgvr amouat of ocmentum than iir usiuilly found 

[to pRffvotly UcaltJ>y teotb. Tbcir ^inwcncc- in not, liowerur, 

nacweaarily an iitdicalioo of diocOM ; fut vrhm two contitiuoun 

roou aiv Niiik'd by llio intcrrvnliua of coincotom, a %-Abcular 

caiial will not uui-umuiouly b« fouud to traverw Uk luudiuui 

' af anion. In bone, ttio Ta-icular irnnabi are diatingnisbed by 

>ciiM iir otbor iif tbu f•flbl^viug cbaract«n. They art; uitlivr 

itnrrunndixl hy ooitonitric t.imituu of uwtHiuii tivauo, or thvy 

, mm ebcliwed lu tiMUe which has not A ivcU-proaouuoud cou- 




BTBTBU or OEXTAL »0BOBRT. 



centric ArrangeitieDt or t)ie ktninm. In th« fnrmcr case tbc 
IncnruH pnrlKko in tho coneetitric di»pi>siti<ir. nnd direct ii 
latpo ])Ott}oa of th«ir canaliculi towBnle thf Unvcraiun c«li1 : 
in ibe lalt«r their aiTatigemcnl is \w» dctiuiiv, kiuI the mii- 
liculi aru directed witb Ivss regard to t)ie ]<n!iitioD of the OOD* 
ti::tio\t9 \iMCuliir cvnnl, la tho onu instance tbc charactiun 
indicaln the prooencn of Aeccindnry Ixme, or bone which hu 
becD dG\*eloped lo mpply the place of preexisting hocfl 
removed hy aheorption ; in the other, the presence of primary 
bODe, or that vvhich tiaM bevn fIi>T«loped in temporar; cxe- 
Ulagti, or u|)un llic sur&tce of au existing bone. It beiug to 
bone dftTeloped under tho latter circmn»tauce» thfil cemca- 
tntn is most rlr^t'ly nllitit. tho process uf its formatkia may 
Ito considered ivUIi advnntogu. In young suhjccts the shafta 
of long biiTirii nre gnulodlly fncreaseil in diameter by ad- 
ditioiM til tiiv Kurfucc. Ttie flat and othrr tones oreiucresMd 
in thickncsH by a simihir process, and wirh the femur or 
humcniK, will be found ojunlly conrenicnt for tsaminalioD 
and clo»cri[)tion. If we take eitlier of the latter in a per- 
focily frcaL Mate, arnl mnko. imnsvcrM sections, either by 
eiitting hhuII fVa'^euls with a »harp knife, or even hy 
grinding, taking CAre. ur i>rcftfrvc »n tuuch of Ibo periotiteuai 
as ]M»siblc, the tolluwinf; appeamnce will, by uieana of the 
ndcrotcope, \w n-oi^niscd. Huirting up from thf> xmetml 
Hurfaeo of the Iwue will he 6eeii n )«rii-« of proce^KA, di5{X«ed 
at more or leas regular inlcrTalii. prt»dncing ri^ijcej* awl 
fnrruws, which, for tho muHt part, follow iu the length of 
the bone. Each process u temiiualed either by a rounded 
or a dihtted extremity, lly the incrrituio of the dilatattona 
of coDtigDouB procemoa, and their ultimate contact and 
union, the g^X)VBS are rnnverttil tntn raiinis, which are 
occupietl l>y portions of the celtuliur layer of the {HrriuricMiUf 
which arc llnd«^^Cli(l)l! couvernion into " medutln," and am 
alliiuattily ptiTuica'ed by blui»l-Tee«els. 'i'iic new bono has, 
hi fact, been moulded around the portions of the perioslemn 
— a prooew by the repetition of which the shn/t of the bone 



PrNTAL EXOSTOAIB. 



4!25 



I 
I 



I 



auy be Uiickeoed to on indfiinite exunt. hi Ixine jvoduced 
UDilcr tLo fcin^oiog ciKiimiitances, llie iiidicatiotitt of UmiiM- 
tkia are gcnenUlf indUlJnct, and wh<-ii pmsent, follow the 
geoenl anrfiwe vt the bono. Tliu ftrmDg(>mi>Dt qI tb« lacutiw 
is ralMerrimt u> tbic of tlw loniinie, conReciiiautly in the 
primary txftio tlw absence of the oonceutno onler in the 
Jwtvr i* nrconipanied by a similar dcviaiioD od tbe jart of 
UnuuB and cannlicnli. 

It is UitbtsdescriptioQof prlmai7l>on«tluit t>iccetDtM]tunt 
of tbe teeth is mo«t cltj««ly alliul, and fiotn thnt it la diHi- 
cult to point oat auy distJDjjuisliiug etnictaral chAnictt-r- 
TfaM clow respniblance id the two tiitHUcs, when iluvtlojwd, 
Kflden it desirable tltat (unue account should be glvcu of the 
maniurr in whicli the fonrer is dercUipwl. 

Cloee (o the rarfuce of Lhc bono tic iieciiliar granular cells, 
tiioch larger [bun those outride tbcm, to which the nnmn nf 
** oet«.«l coUs" waa fnrmerlr gireu, vrhilst Gunuau wtiUT« 
speak of tbein aa " o«t«oV>laKt»." 

Tkasp "oBteoblastB" timko their appearance whwcvi-r 
bone is being developed, whether in cArtihige, in tnemHmnv, 
or iu pertDfrteum ; in point of foct, it is held by llollei(') 
that the developmrat of booodiflvn in no respect in thew 
diaumilar iiit»iu ionii, so tbftt the cartilage may bo rcgftrdwi 
u llttlft dee than a GOnreuent support to the deriloptng 
bone. 

No boiw j» in any. cam forued (ill aAcr the appearance of 
thU " <Mi«oMakt " tiMnu> ; and Itullet believes that the orIco- 
bUat cvlUarv uut itiwliljtHl carliiage ccUa, nor c«Ua derived 
froin tlteM Utter by a procvBs ol iir<.>tlf' [aiic>n, hut that they 
un MMmlially a now p\>wth. At ull cvduU, ihti Uyer uf 
oalcoblajil ccUa d<Hes not gradate into the stmirturcs otiuido 
It, Inil is Ml diHlmctly markeii off that it alnioat absunies Uiv 
character of on epitbeliuin. 

ir we harden a tixith in chromic add, and enbewincnlly 

;■] A. KutM. Art. "Oa iba CMiniMtl** TIhom.* 6tit(«M't " ILuidbi«li 
«i4 Uaifuuln lllsMlqQr.*' 




426 




8T8THM or DCNTAL fltTKQBBT. 



decalcify and cue it transrenwlr ibrnngh the hng. ws 
nrilh tlid fullijwiiig Btructurett from witlioiit inwards. Ob 
tliu uutaide ia thu utiter port of Uie periKsicum, cuiwitituii; cA 
(i«cU8iiating Eawiculi of coonective tisaue; luturial to ibb U 
a layu Ui wliicli the iiaioe of "cambium " li»» Im.cu smuv- 
timett given, c^riuiiHliri^ of rouiiditili c«llii with prixeatis, 
fheae tio in a rcticultun made vip of celU wbioh i^tve out 
A tQi&ll iiutiiW vi liMniogeneoiiB tnmspwuL pniruMis; bjr 
the iooacuintioD of tbeae pcooMKs & Dctwork U formed, 
whjvli liae lieoQ well lignrcd by Dr. Linne) BoaJe. (*) 

Between tlto reticulum and the fuUy-fonned cctacntuni 
Urn ttie (KitooblBSt layer, cousiiiling nf niiicb liirgpr ccIIb, 
wlucl) are wfleu pruriUiid with fiue procc«st«. Tlie traD»> 
{loreiit huriiDKeiiMHis procriwes alrmdr 8[Mikoii of an forming 
tbfl reticuiuni may be mad in many plaint pAt«ing in throngb 
the UHtwiblast layur, and niay be trwtii [Hu«iug wiliiuiil 
tntemiplioii into the matrix of tin.* cfmcnttim. Aa Um 
o9t«ol)l(L')t!) iVirni ft continiionH layer, and are very numefooi, 
it ia ubvioujt tiiat only a small |wrcetitagH of them ever 
form UcuDJD, ur othcnrise retain tb«ir indlTiduality. Aa tbe 
praeoes of caloificatioit goefl do tho outlimw of iudirlduol 
oaUs Aod of tbo trabeculje of ibo reticulum become lost in 
th« gL'iieral tranxtnreucy of Lbo matrix, ouly u cell biiraaod 
there roiniuning as a lacuna. 

The cspiftlianoo of Ibe foniiation iif banc lacmin from the 
osteobbsta gireu by nrulo and X*r. Ltoael DcaIc, v^bicb has 
been aubstanttnlly ft(.T«pti») by Waldoycr and liollot, mwub 
to aword bwt with tb« appearances obrerred. 

The di-]xi8itiiju uf i-alcarcous matter, and that change 
which immt-dialvly privcdus it (so as to produce tbo " funned 
mBb^riAl" of BiiuIg), takvH place from withntu inwnrdtf. 
Thiu we might picture to ouriH>lveA oacti calcifying i«leo- 
blaal tLs enclosed by bnrd structure, like an Fp;-KbcU, con- 
tinuovm depofition taking place on tho inside till tbe ct-utral 
cavity w&a olilitcratod. At tbe Mime time, tlm contiguous 
(I) "UmiwIiUiKtttreoritoatnvt'TkMia.'' 




^QITAl BXOStOaiS. 



427 




iXiuts hectime iuw<\ tugethcr by itivir cJttmrirs, fui ituit 

iliviiiitftlity U aUskIuU'I^- Ik-^t. lit & c«rlaiu numN^, 

BowDTer, tUJK eatiro obtiterttltm of thv tx-utml cavity due* 

lU't uke {Jitce; bm the CAlciHcation adntaciug with somv 

of irregularity townnls the centra, lenvett tntckd o( 

UtM«lritic«l umtrix, iid<1, QuAlly, slope short or oMitorktio;; 

(hf Central caWij. TLiis tho centre of the oKtoobhut nunc* 

to be ooonpiod by a epaoe from which ttHSiires lacliato ; iu (act, 

a ** fcwuiift." AltlioTigb for ibe parpo*e of lieacription thin 

trul portion iias Inxn iIi-mtiIkiI a* a "spm.i;,'' it niuat ooL 

forgotten, tbnt iu the fint iiutflDco it is not bellow, but 

in perfectly fillnl by Uiu uuculi-iliLMl matrix, uud thut in il 

igintUy Ity lb« iiucl«uii of the uftteoblafit (gccmiitiU luattvr 

lt( Bcnlr). Tbu», l>y stainio)!; with ciiniunc tho Qtieleiu may 

ofttn b« defined ia a clei'etopio^ t^«th of ft call, lying iu the 

'Lellale "laouoB," liut lh» nucleus anon disoiipeurs ; onO iu 

iW dry Moks the lIujiUM ia rwUy ■ *V*^v, as its ooDtouts dry 

ukI ttbrivel ut*. 

Aiiii just as ctili:if[cAtioo amy fail to ublilurstc ibu oi-uli-c^s 
of nil th« 09tcobUst«. »o il may fail to oblitcmtc tlicir cx- 

ttonuU contoiirH; wliL-n these aro vihiliJc annind LtMrunc, we 
Lave the »«<^-alleil " <.-iicap6uled lacuu <-," or ueslA of Mt«o- 
blaau. 

na vanuQB vkin vhtch haTf bpPn pMrrtBliy^l niprdlng thr Funuilli.ti cf 
OWtaaHB ami «»kUn]ll haiv tw<ii mrLCis-lj W-iI-hI h>' (>- Ml,,'). ,, .„.. < .;., 
f. IU. Ha DfaanvM, thai *■ dii^ nic K<^tiua.ilj inppnni ta Ih fii'ilvrd Irun* 
Vm ikrlli if Itir H>a UMiw tuTulTad IB Uw mMuIIiw by mcm lort u( Uf1*> 
nurybatb wblcL Ium bM« nrtnuilj oMBodmL Sun* wppCM Ihit 11|« edb 
bMMH Uh larau. aM ffahl o«i lirM«b«*(UlMUM ptgnaal <wlli) lufonullH 
'-f»"'-f iTltinmii I), tiuwti itainc Uui il to not U* enU tut it« inuHof 
■ llito ifciwn irat Um lb* miIhUiim «lllw iiKlMM b> aflcrwuri* 
ttKiftad. ta^lBs U« luiuu (I'odd uul K>wnwu>}." Til* nudMia 4i*cilt*4 
I^T«<UM)d kwauti la^t«Mli«l a«li llwl MhlJl hMb««l UlM UirETiuuUl 

'«a. Mrf thro Mhioh Ui* uii!-t. i-u lb* taniw to h> fl)niw<L "tfcnbc*) 

ttnika UMUi* iKDiM I* i ftv.iy irninib* wiiMtrf* otUoblA bu bora 

fMtkUjr OIM D]! (it t»]t:irh=>u.rii, Md llMt Ito MMlkaB an hniuftod 

■ljt> t«rt tn tuMHiOaiK* «l tb«Miiai|iial4>v*IUuuo'Uwb>nl tnalwr. 



I 



Q) - MifenatoplKko Vimmmlhmmgmr (*f - PhyalatDiM Aiuluvj'-' 

(■J 'JUNUonlii Gfa»fnlr.~ 




^ 



i^h^^ 




•128 




STBTKH or DCXTAL BUBQBir. 



Uin tb* luNancPof Uw ivrrwUki^f pluita." " ll tallvr ajiiwUBlVMal 
thr hctian- ami iiuullculJ nm lluli! Tail><tl«« IrTl in ittr I^Mtw itin^ ' 
■>pO<tO<m cf UwrFikiiUr flbrm. •« vp>-a Dgiim trv Itll oal In Um wvarlBg*' 
WNM wtlOdU CaVWi (bill not ■ lUtln • nrll, n* Urol* buKtiird), and tlial Uhh 
tte aihpMlUuQ of Uw iiilnittc aprnurr* rxtatliiK I'lwn-n ihe tt«ioaUUii«M «[ 
iba laucl-l* s['--r% rlae lu >1m- iviiwll<-uii " ■■ \t Uii- t^iuf tiin* It amn* nol 
iioUkrljr llMt • o-11 ur • cell budrua may ortitmlly lir In ilw Umu vr cmttal 
witr, BiHl tuar v"')"!" d-tritiiliir tLe {itKa uT It« fuiniatlun." IJa«a)Jt(lJ 
MKIVM %illl Schwann, mhllr Gitt*r<>J anJ ltruii>(r] annK to bold Ibe vliat 
gt TwU aiiil llmiiuaii. With Ihv rxcrfitluii u: |lr. ?ilui|>r]r. ih" sbo*»4Uind 
Hlfaorttln CIMJ prrliap* iJlffFt tnoi* in the uir uf ti-iwa tlind lA trailer of bK. 
TlitappMniiiow HouM al fliirt vI-vk ivmi tu jtiMiry tlic if>iiikni PipRVW^ tv 
Ur. Sluriwr; tmlnaupriil rxamlaatlon ol tbr U*aui<tuili>| i'*<lcrtla|iB)nl, 
tbe uirqBcatwnalit* l«t tlMt In llw ili^lupiiwiil trvm wrUbff: itw BnlMJUr 
eflt btcamn cuniprts^ Into a lacuna. lae-l!i»r olth llir cirttiDi«I«Hi<f tlMI 
lacwul cell* ai* rn^iumlljr Iininil in Uv llai'mUii rouak <nd <iu>i«(b>t«J 
•tratlDT*, mpninllr In tbr loui of o'A aut)Ji-.ta, ■it'll at llwc* tnli^lnl in tbt 
•nuct'irc rd tliT Umi: tiar* Ivfl im rrmu (lu ilvutil In ilie nntlmn* ailiola ibal 
Uui taiuiUPMn tonn«4(K>n) »pt«UL nuciMUil ctU*. Iw tW iiuuuht ttMcriM In 

tlMlrJlt. 

t'tirber deiailn of Ibe appBoninoes obserred in oesifiaitton 
may im found in LIk.* fulluwing oMnct ftvin a. t>a{>cr in the 
Royal Society's 'I'mnuactionB (') ; the osteal cells there i^^km 
of nre cquivnletit to the osteoblaata nf intrr wrttcTS, while 
the difTvniuliatkiQ U-ttrMU oat«ftl ftml ** lactinal " cella exiaU 
only in so rnras tbey are the mnw clcmenUi iit a diffennl 
BtagH v( Galcific«itoii(i«e pace 42T). 



"UUm advudng Mtft «f * purivial boti* Im< Uktn rUh«r fhiai a hi 
taiH M- • brul IuuIk atiil lb« pnfcnnltiBi and don maltr far canMlj 
n-nuv«4 Ifui* tln^li rv«]ic(ll<r« Biir&eMi «» aball Gcid Uk frowInK boot MUl 
famMsJ wnli *vfl (taaan bvlb «M Uw ooltf anl Intio •uriara, which ll |in^ 
laiifNl fMn tbe Im olfn, WImm »uinlii«il uid«r ■ tivuunUD llglii itita 
tbma wW tbow dlCTemirM uf ohMMUr In 4lfl«rtni putt>, va/jlny wUh ibv 
dlMMna frcFiu lb« bene at wfaddi Ibe ob««TvaUiiB» arv iiuile. Tlina, If MKMMa 
liediwetMl to UiP pan rartlMt nmvndbva Uu bvne, it «lUba Mnmhuibo 
nwihiaae Uk« maa* la oanpoaed trf wal ccU* «Ufa altgM ffulaafMlaaa ftm 
iha utnmiika. wUeb an rrMinnnif arnupd tn di* IWn of tiaiiJi <f ibnraa 
***■— IV. SUttprj baa abMcrcd Uiat Uie utmtKWM km wlitdi ibn Uat 
•nMdiMllki Abnna UHoa In an aar|]rnaca«t iHiiliniiniiil. ami liiM otaHt- 



(>) "SlkTCMBpie Analomjr nflbe llninaii Bodr," p. 3ts, 

(■) "Allpflwloa Anatimili.'* 

t») "OUwtvaltana no llic ^nclurr anil IVwlopinTOI a* Koaf." Bjr Jobti 
Tumrt. I.K-S, buifitvavlMQiUi tu Ifar HliMlmrji Hixjittal: oad Ikmibll 
m Huifan, Muic<in h> Ibe MI4dlMM tlvapUL 



DENTAL XX0ffT0flI8. 



429 



H cc*w« M »n (M^'xl MH OMallMlhw toWanl* ll»* tvli". llrri' In Iha {imn vt 
^V cell* Willi rioDtc*)"! [iro CTw , or c-IU amuiHiwI In bbm-Ukv llrnv, wn Bnil 
■Bill apinifab^ ■»(<■ « uum. anil •■• i-I'Mrlr (i»<fcnl ■■ tu Iravr llillr irwiii for 
IfttrinTTiRciF li—f- Thr oj'i it|ip •( to Imtp incnMnl In •l»p at Uio cran of 
tb- I M>Ui) at an <«Tti>rr «Las> uf iti-mlniniKiil. ami lomrO • 

h-: I ibmi. Krt ryw ()"f <! ■tunt Gn"lii|i two* • ranftil 

^_ ax J.-. . .'-il nil* aUai'liol u> III (utbtv. •tkllr tlj* tiirfw of tla 

^H buB iiarlj will |Hn-T.t n vrtr* of >iinl'iir bmllp* ««iltol. T« llitw of l<ro|nw 

^H la Mtva lb* nma -.iT •^Uail nlU, u dlnliiKubkcd Ihn laniaal and utbcr orlla. 

^V " In gile t wcoi-te diameter* ihc a«W) oriU O^axclr mrtubl* th* (tmiqIu 

^P crlhuf tnupunfy QtftUMri •□ eIuvIj, Indtvit, ttiAl tb* Ullfr. whno drtidHd 

^r (nns tlut <wtih«F, cobM i»l4 ■reil be «U«:nf uUimI mm tbnii. Thtjr u* for 

Hi* IMM part ti^erinl at aval in foim, ami Up aa Uw aurlaDe of th<' fTflwiiuc 

haoe Id ■ or<wili-<l nu-, bcld lovniiFr bj- an IMtrtsBiiHt ainl ajiptnoity 

Mr«rbiKln»m>tiU. Hen and tacrr »«> flnd a orll wbldi bu «rniBiaUiitd 

atnn HmM an uuirr iMnaunroi of iramparrM t laap, and baa. In bet, hteaiMt 

dlMlafitd tMo a laruul crll il*«t1nil lo (Mnin* • laraxa. 

'*Tl>M|wwrafa(pii«ibiiug' In tbiaiil>wnbad. tatboinnbaarUwUinaf 
■feMMuDlbaanrfiaiiif tiMbaiMMBttnl oJb an deTelvprd mmI Rr.idutUr kkt 
Harbm; •fewatlUlMaai»devBlDpi<dlMiu laL-unalMlU: tti<^ Mrtby ulu an 
addid, and omnamiQj bean* ind e«n>1tmll an? furmnl : irr trm ban boar 

I|«MnuiM|t Ow iiMal rbWHim tt thai Umud-. la bone devfkfinl In ibt fonv 
ftag DMuDar. vt Hod lb* ocubcalt not meivlj txt/cttaian to Mk mrltc* ac tb« 
dt-van. nr KniMomMlag wMb liio caoullcuU <A lacuiial (*1|> lylna tB (ooUcl 
•rii.', Uliii tr«ri7iuaIldlrwUun«, and paaiUii Uirwugh a* anaoaK*! 

lb' jtadwUUI>b<iit'kb|iUxiiapaafanHlofD«*S(^ lDdoHl,m>f<( 

Uii. I-- 1 ihvorlKlnal UcUlwl nlU tnily In llionvtaaM «Iwn lb* laiviM* 

ban Iwt r**, vr arr tntlTvlir ilnoH uf aonKmli. ll Koold a[ipnr luhr ■ Uw, 
la Wltlcb ihcf* ati' (vw. Iluir.'>n|'ll>">*> '^■i ■''t"Q aiiaatouiBla tai mlabiliibMl 
brtWKii Bdh<Uilci« WniUK Iba ImomI toXlM U'nd «lib lb* «Dntl([i*caw part*, 
and ant na Ikui^t >v«i(nbKU* •• dhtlniC buil>«; Tbv pco ci aa I^ wliloh tbo 

■ vUBtrical bvni« an IncrMtcd In iUaHif44« U In all •«»:ti(ln1 ^nta ibulU* (o 
Ibal itfKrtbnd m {MUlnlns to Ibe fiv*tb Of Hal Iwm. ^jtiulUr oitfal nad 
homal olla on furwutl, bol Ibt nlaUvi aisuiuil of Ht* oialrtit It gnatrri 
■ o tTO'W. tbt wUal cdk ba«C « ibtwdtkNi id itaaniOF n lla>«r «rr*i>)CfiuMl 
tianwpondlnf •• lh« dtavettmi nf tbr Uinln(> «f thu ountl^rwiia tm-H'. In lb** 
tarn Ifaa nOa mn pbcc4 to dooi t» neb lAka aa tu |r»«c bnl liUH Mm l«v 
InUmntaB Uwn*, but ki«*on tb« Uiim an acpnciabM amoant maj bn 
rimiiilwl TUa woiraticc, bovcm, rarta in ASrriart hh cI bi ww. In one 
itm laAb fnttmbmu, in aKrttaw ibt tnoapanM ilmn b tb> nivn- »tHin>Utii. 
OwMUallr ibr rt>wi«CT U«««ikanllbvinntar*IUb«Ui->uni>u..i^ tba iBiar> 

Imiaf uwqantit Utou. anl Ibt aBaUnr Ua BBMbtt of lb- mI-aI ocIIil Bai 
U all ow. wbalccct llu as« of Uh tu1{|«cl, ut ftvtii whalrTM part of lb* 
aUbm ibr ipfclBini t» tekni. tlw txUa and Uw iDtvraiallatu tl*>u« liwviDe 
btaadid in ibt imom* of wirmbQ. ami ib« wbuJa |pn*4it> a marDrm 
gKDBlaTappMrwKr, Gia:|iUattBUi*ldalaiMsbi«htdibmibuiMa biidvi'dr 
dawalcffd. or bi Umm wlildk ban tnn DaUacd bi Ou pnTkiut pan uf Ibo 
Wa (MiwMljr aad ponioHa af booi wtm itat dMobI erib, bcuaa) 



: 




till-* onl.v Olio uitii which I am i 
mic-roecopic appeanocefl osmciaUt 
lii-rc ']iimo«l. 

" r])oti osiiuinlng tlift |)erio6to 
rocentlj* drawn, which ban been the 
irrltHTuin, we iinil it much more 
«nnK' plat-PS it iti very mmh thirkri 
(rcqiii'ntly adhering to it are [«diii»^ 
which have hwa called coftgulatod 
titncia «r comfntutivcly large Lulk, 
been the mibjecl of recent inflain 
follitwi tliat thf trtoth muni he ei 
tiiAl vvtin tlio latt«r mutvt be UmIT, 
dato tlic DUirhM gTO»-th. Ami iu I 
cvpliou of lliitt iitc\, I iiiny hcrv r4l 
(Unary facility with wiiich the jaw-f 
An alvenlu- aW:e»t hollows tbcnij 
llirougb them in a few daj'» : or M 
luro extracted, and in a few montj 
fonnw implantation in visfblc, and j 
'hctore a titmour. ciiT«rtng it U'ilh|| 
ra^iidiy to coUafeiti again aft«r its W 
ridp-. i 



DBXTAL Exoaioan. 



431 



on lKa periosteum also jArutke of tiis latter chamcUr, being 
lungh and lemi vu«ciilar. 

" Esoiuinol Iiy tlic microHcopo, tlic vxtnmal soft sarfiiL-i^ is 
Men to l>« piincipally composed of large oorpuEclvK, (;ntuut&r 
ud nacjeaied, and which in water swell ap and Ijursi af)er 
« lime, 'lie iTiore diffluent poru aro «iitircly corapoeed of 
ibeae sjilierioil Ualif'B, which a^^ne m obaracut' witb those 

teorpoidn uniuilly met with in ]>iurl8 recADtly inflamed, and 
ifrninl hv itoiiio rxvirjaticni oirpiisclcs. In luliiitkin to these. 
uniill masaa of ^oduIat blaotutna are uleu visiblv. 
" Tlwt principal constituent of the next undermost fortion 
ifl aMD lu bu fibruus tiiuua in a stnto of furtoation. For 
turn may b» M«a (and to «oioe ini»tancc< ii is most admirahly 
sliowii) uvnl eorpUHC'K-s with lihroun proloupitioiiK, autno 
vrilh a cliurt fibre at one eud, riLhem leni^thfned ont at bcith 
enda, and putting on the characteristic nndiilation. the 
I cwpoaeles ate IikIiI, and Knwnlly bi-uucltat«d, whilat the 
B fihroas ext«oaion» arc i-ligbtiy mon ojnqa«. 
H ** Still DBar«r ilw bingi we Snd ths mass tougher, aud cum- 
|>owd of fibroti» tissae, but niiogled with it atnorpbods 
H^nulet of a gelntioDUB appearanoe, and in tho in(«liex, ami 
Boating about the margins of the masa, are a ntunber of 
otaI crlU. 

"At iu Juoctiou wiUi the fang iLe tubttatioe becontss 

denso; it ii tnni wiUi difficulty, and under prrs8ur« slips 

h abuvtt liHweoD ibv two f^hiMBK, aud refuses to bn llatUuiMl 

K not. t'i>deTthe microsc^po il ap]icar» lUi a iiolid.ainorphouii, 

V ycUnwlsli mat(H, In which, however, niay be nlill dtHtingnished 

tbe wary D;i|«anutCQ ol the &hroiu tissa«. 

' ** In this deniie gclatinutu salwtanoe, oaiteona matter, which 

lias been detached Irvai tho fang along with it, may Ns men ; 

not, liowever, Hboating uat into It in tbo form of 8picHl«>like 

iwnficatiuu in the fibroiid matrix of tb« boDSS of the skull, 

^fthut sa raundtKl oniorphonii moleculufi. 

B " A munr caRfal cuuniimtiou of th« c«lU (oimd floating 
' freoljr in tho field of the rulcrtMCope arontid the margins of 



•V ■^■■~ 



KTilMd, for in«Unce, calU may be ftoii 
daat in the Ditddle of tbc * coa:;uUblc 1] 
clliptiaU fl1iii]>c, tmnspunTit, honioffsn« 
ustuUf wich two Qoclei. Tlico they xany 
gnuiuUr caat«nt« nnd larger iiticlvi ; atid 
eMmit fltuffeJ wltli & otore opaque and df 
IMsed in lar^e grttnitlMi, among wliicli 
p(Mtivoly be i)oiiited oitL | 

" Whan ft fftug ta whicli thc«e idmm 
lated lyitipli hait bei-ti allowcsl to dry, 
wctioQ bo niA^le, it in at omc evidebt tb| 
they were attaclieil &ni tlie seat of a pr^ 
voia^ntuin ; nitd a lliiu tmi^inreDt alios 
r«i)pic exnmiiiiilinii siioiva tiie extn^eo 
luLVu ii1x>ve descrilied it, aod also tlw 
ar|1mt(.'Ut to it« mar^D, Iti i!jiit« of Ilia I 
it liAH l>eeii Giilfjcctcd iB iTtrjiariiig iJie M 

Od coinpariug llie itiau-inc>iita mode 
Uiosa oooUined id the previous extract 
tbvn ar« do MMotia] pointa of difl«ra 
muda of fonualiuD of Ikuu atkd ceiuealiul 
are i>ryd«ccJ, tlic iniiii-idnality of which 
procGSfi of calcidcattuii, tngcllifir with tb 

In tbft soft tiMoe which oonnectB the 

11 11 At I . \l. U ll_ 



hkktju. exostosis. 



433 



» 



TdMtT« ooiuiKtioD wi<Jely iipftri.''C) The ctmcctum be 
_ lb Oft • productii>n of tlio turit.T iinrfucL^ uf ttii> |<LTi- 
ieaumax, aad as in do iray connected with or ilepeQiiciit 
upun tlie pcfivsleum uf Lhu Docket, tbe two niernbranes lx:ilig 
iiica|iabl« of offiific unioD ; k Blat«iuetit wbicli he cotiiiiden is 
jiutif)«l by the fact tJint the root of n tooth, although tho 
Hjbjvct uf txoetosis, nerer bcoomo* ancbyloMiI to the jaw. 
Had periosteum ftionc interrcncil lictween the tootb an^ the 
•uckttt, an osswnu unioo would, it is oaamod,' havo oocn- 
•iooally taken place. 

By the " poridcntonm,*' Mr. Spcnco Bate appears to maui 
Ktamytb's DMCobraDe (coticula dentis) od tite crowa, and 
Um external tayrr of cemeat oo the rootfi, which, as I have 
cterwben ifaown (*), aro cootiQUOUf with one aDOthi-r, nit4 
an io bo re^^ardcd as inooiuptete onmcDtniu. tt is perfectly 
impuaiUe that the " peridetiUium " can build op fneh 
oeoiflntniii, as it haa it^lf uodergoDo tLat nietamurphosis 
which Or. Liood Beoltj deacribea aa change into " formed 
materiiil,'' and the ^icriod of tta actirity is juax^ ; it ia only, 
ao to i]«ak, waiting for the fuller depositioa of calcarcoiui 
aalta to Jtwlf bocomv perfected oemcQtuni. 

If wc except ttua youngest layer of cementum, which i» 
oeitLer vascular nor aoft, tiiere iii ootliiug like a differeo- 
ti&tian into fiul'l tissuut beloQ^ug to the tooth &bd olhiTs 
belon^ng to tho socket. Umce tome other explanaUoQ 
Diuat ho HiDght fur tho fact that anchylosis, which is the 
iMnaal outulition in moat reptiloj, does not take place id the 
famnan Hiihjert ; indeed, the mnro Enct that it LakoR place in 
mplilm vihv do posMH wltst Mr. S|«DCe Bate calls a " peri- 
di'Dleatn," in a Hutlialant answer to this bj-pcrtJieeis. 
It may he rvmembanid tlitt bone or oenumtiim is not 
vabkpfd by n direct metamorphoBia of the periunlcuiu, but 
lytkucaJcifiuiljonuf anairgrovtb. Kuw, the Tariotu stagM 

CO "^M Dm rrrUniUI Hranlirai^ In tU rOiUlaii to Ow SmiU] IWdw." 
C lyiM* Oita. bq>-~ UrlUrii J«B»il «f D«pfal ScMm-." n>L L 

2 r 



4S-1 



A 8T8T1UI or bKXr&L BUKOEItT. 



i 



i 



of this new «JovoIopment •» to bo seen on the lDD«r, or tootb- 
Bur&wM of th« pcTit"t«um cf th« BOck«t, ami ooi un in outer 
or bot>« «arruc ; uid this may in n mcunrc »ervi> to oxplua 
why bony union dowiwt Uke jJace. 

\9hm ft diMMM consisti iu the mere Lccreaae of a tbau*. 
the jirwtaoe and poaiUon or which an nurmal, the tnuuiUon 
ftom health to dlMoae ii Imporeqitihto. and is agiially desti- 
tute of rfTDptoouL It i« ooIt when the Nnoont of new tbame 
hna nttainml a ooniidcmTile tliiekncflK, Hat distinct flym{)toiD« 
are developed, and even tht'ii they are in nmny cmnv* abeent. 
In dental esostosis, a distinction ranrt be drawn betweeo 
tboM canea id which tbe diecow is ecnteqUHut upon fg^ 
existing dincnse in the tooth, followed by nurk«d irritation 
of the alveolar mrmbrano, and tiwuo \a which it ia develcfied 
iDdepaBileuTly of nny other diMenie. 

/to; i»o. ('} ^'*'-'" *''* ^'**'* •'■'*^ '" oonnectloo with 

cruries, it is stteodBd by a Itiickvuing of the 

«!>. gnini, which lussume a drafv dtiU c<>1uur, and a 
J diflpOiiiUon to liin.il ivhen subject to frictioii 
r either fmm th« toolh-brtwh or food. Bat 
vrbt'ii the cTvwn of a twnh 'u frw frum diseuo, 
axoHtoaia of thi! root may be noatteoded vith 
nny rocognimble chon]>i> in the ouudltioD of 
the coDtifrnoDB gum. The occnrrence of ■yni- 
imthotio pnJns in tlio Liatd, face, or neck, may be, aud often 
H, the only indicatioa of dbeass. In the prcfcitco of «uch 
]mia8 it is often cxtrmnely difHcult to detcrmino whothar 
Uic teeth are in fanlt, and if so, which tooth ot teeth have 
occaidoncd the infTcnnii. Sooner or later local tymptcaaa 
may arise by which tlie ofieDder can be reoogniied. Tho 
tootti will hccomi! tender on proamir*, or wn»itive to tho 
effect of hot ur ooUl Hitids, or tbe gam may bec^xue a})6orbed, 
and leave viposed the neck of the tooth, which cvvnlually 
booonica IwEG. Such obvimiB Hyniptoma, however, commonly 

(I) A«MkrMelh«rttaapp«>w. tbin-otisf wikbantWctanalbfite 
ad<lillOBoIeHiuittutk,ilM ttawit bdnf fm* fnn i 



VWKTU. BxoerosiB. 



435 




Appear only after th« pitieat hn uudorgooe great saffering 
froni aiiii(>iM)i) iiitujniliic lie duuliiurmix, a v(mi]>lttmt for 
tiie reliel of uriiich )>atieiiU hnve aul>iiiilt«U to liave tooth 
cxtrutnl, nlthough the reliff BJTordfM] after each 
*!ȣ Iml i|itcf!tiuiialitc. 
Tliwc arp c-»«^ liowc\Tr, in which the presence of uxos- 
Uhia, Kvai iif (tli^lit amount, pr><lui-«s great niiwry : a c«rtaia 
tootli i» }>oiiit«<l to \*y th^ ]>alIeDt aa the caiite. It5 removal 
faring ri'lief. Tho rornplAint rctiima, another tootli is TixeJ 
npuD. aiui removed with a «itntl«r rwall. Auolher uid 
,f r follow ; and it 1^ only >fl^r all the u-eth in the np|er 
'er jaw bare Ijot'n reinovwi LliAl the patitiit gain* ]>or^ 
numit immnnity from pain. A caM which rolUiw(.nl tJiis 
ooorw-- aaaK uniler my treatment six yetu-H aco, and it is 
•mtoely eishlecn irK>ntl»» aince the Uwt iw-th was remotod. 
The crowtut of tht utjth were suiuiii, hut lh« rwota had be- 
O0CD4 elijzhtly eulaiged by oxostosts. The patient, when she 
finit oonetiltcd me, stated that she hud fiuffered (ram tio- 
doulourcox for sereral years, and had submitted to (he tuoal 
treatntMil without admntag^ Two teeth bad hccti (.-xtrncted* 
■nd the operation was fullovrcd by a remiiutitrn of the synip- 
loma. The jiain, however, »ood relumvd witli full severity, 
■od at the time abe eam* ander my charge two nppLT biciui* 
pkl t«eib wen- rof^rded an being coaD«ete<) with the pro- 
daotiun Iff the dtscano. She Btatetl that the pain came on 
gradaally at irregular interrala, lasting sometiine^ for twclre 
or foarleeD honrB, or until, exliaimtMi by milferin^ or rntr- 
ootiBfd by opium, she fell asleei*. llie iuspected teeth 
BfipMred <)uite healthy, but the pntient stated, that though 
liiey did n(« ache, yet that they were «ldom free frcsn ao 
imtaay iwtuotion. i^hu alunjra felt llial ihey were then), a'd 
prior to an attack of facial )<ain they became hot aud f«lt 
folh Lft-ohEs were appliwl to the giuna, and internal 
romMlk« ailmitiifltt^red. but witliunt producing any niili<^t)ou 
ttf '• Aft«ra ttiie ihv l^-olh became wiuilivc 

tn 1 1 I tu^ uf leiDivrutuie, uid a ourrvul of oold 




i 



4S6 



A STSTIU OP DKKTJU, mTBGIRT. 



water or air not only prodnccJ pain in th« two t«eth, bail 
Itrought on an attack ai pain ■» tbc bioe. The tarth 
extrac»d, and for seveni aioaU» the patient wu oom* 
jnnitively fn'o from \taii. Other teetb became siuilarljr 
affected, fiod were removed with similar results; but it wu 
ouly after tlic whole of the tecih of tli« upper jaw had 
extracted that tbo patient became perfectly fice from 
rcoitnrrncn of Iho diwoiie. In another case the patient 
mfftnd for aevtral jrears ftx>m intennittent pain in the 
and laev. For a luug iiuic Ihv catisc i>f the dinease ap^ 
to Lrtvc a conotitutiuiuil rnlbei than a local caoM. but tho 
usual ri'iiie<lios tailed to afford relii-f. Aflvr a time a feelin); 
of aneaKiuesa attracted attention to the oQly reroiiining molar 
tuotti, the Hoi-.nnd moliir uf tho upper jaw, situated on the 
side in which the pain wag felt. Ou remoTal tho crown wm 
found to be sound, but the roots of the tooth ware enlarged. 
In this, ax iu the preceding caae, the liability to pun in the 
faoo cenaod after tho operation. 

In the two caaea cited the relief wah nomplote, atlhough t^ 
no means insiaDt&oeous. The foin became graflunlly leu 
serere^ and the altocka leaa frequeut> and ahortly ecsMd to 
recor. 

It umy he sta(e«] generally, that the mnovnl of a loath 
which has been the cause of aytnpatbetic pain, n^naUy 
producfs a sevtrc attack, the poroxyMn Iwaring aome lela- 
liou in it4 •.luratiun and in int«aBity to the pcevious attodu, 
antl til the length of tinie during which the disease baa 
existed. 

The iiynipnthetic affeoUon may, however, ia a few ran 
examples, extenit to a derangement uf the whole nc 
syat«tn. Two casev bare uccuired aiider my own ol 
lion, in which epilnji^y was coo!tei|u«ul upon dtseaaet) teiet^ 
thv mo«l prouiiucut feuturo being vxoAtosis uf tbo roots, 
whicii will lie iltwcribL*)! at n future page. 

Tho al)Loriiial gMwih of llip iximentum is, as cvDi|«n)d to 
exostosis of huncs, confined within rery namnr limit*. Th,* 



TXSTXh EXOSTOSIS. 



487 



riff. im. (I) 




I 



size of the root of » tooth Jnny be douUol, aD<1 two oon- 
tigooos t«etb may become nnitod by tLe deTclojiiuRnl of 
cetneatam about tbeir tvuts, but w« never Me a grait ntau 
at new Homo prtxhiv).-!!. 

I am iiiiicbtctl U> my friuail Mr. Speow Date for the fol- 
InwTDg illastrAlioi). and for the 
ItMUt of the Hpfx-smcQ from which 
it vms taken. 'I'lir amntint of 
hypertroijliy is hcru vary otni- 
«t(ternhlo, Aod has Dot only oun- 
Docted the two nnta of the tooth, 
hot alao the reniauiing Bramp of 
a oootiguotts tootbt tba crown of 
which had bocu previously loHt. 

llmmgh the kiadnaB of Mr. 
VoniD, of Ponmnuutli. I am 
enabled to »AA on exaniple iu wliiclk tlm sMond and third 
nppsr molan arc united by the abnurmal lieTcIopmcni of 

OODfnitUlD. 

. Althotigh nniaerout instances may be found where two 

tooth han* bectonc iinilud by ccmcntum 

dev^ped ooder circumBtances which 

oonstitat/! its fttmuition a disease, yet 

in ao well-aathenticated instance hju 

the cementum beontne ooaiiimooa with 

the bono of the flockeU In reptitea the 

anchylans of the teeth to Ihe jaw {a a 

nonoal «ha»ctort but in the fatuuaa 

Mibjeot a eaao it yet wanting to Rhow 

that ,ancfayliwis betwei-n the tralh and 

tbe Jaw is under any cirenuutances poaible. In two Uwuei 

■o aimihu' to oaob other iu Btniotnre that their diBtiuation ia 



pit.m.m 




(I) 8bv«luf «Ma(Mb la ■ towr iwdu tootti, iiaklB< tbo iw rwl* ml tba 
MHiBpe<« ovUpuw hwilL frwn ■ tpcai— In ibm arthwiHw <f Mr. B|wna 
Bit*. 

(*) Siimlnc (W xMd ud Uiinl noUr Uvlh uT ibt apper Ja» unlM Vf Hut 
•taoniMi ilrvriu|iHnit of «niM»ua. 1 un ImfeMad tu Hf. UuUu Ibr Uw u* 
oTIUli 





STSTCH OP DEXTja SCBaERY. 



c [vuuu 



often attendnd with diflivutty, yn iliould be Mo to point uul 
vby tbdr MrT«ration in Cha pruwneo of diHsse it klwsji 
preKTved when ccntiguotus bones placed undor aimilkr cti^ 
comittnoea become so rea'tily united. 

Ifm exKiniiio A cisa of locnl iltHeiL»e in a bone — a phftUnx, 
for ezainj)U>, m whirU the Tiuility is «t one point lost— m 
■hall Bud lui ri[)i;uiiig through the \n\cgutaea%6 fn.iDi which 
pus is di»c1»rgod ; cxtQDding ftvm this point, tb« akia »nd 
poriuetmuii will bo iaQumialtu & L-«rtaiu distance, tfaediscand 
gradually laer^g into the healthy tissues. If na opfwr* 
tuuity u{ a lareful cxamiiutioD Iw aflDrded, it nill be foand 
that where the deadjoiui! the Uvia^ bone, the latter is 
going aUsLirptioti, and that lieynml this point nvw 
tissue is liecoiULDg deTt;U)].>ed u)Kin tb« nurEaoe of the 
cxtRlin^ iKiiir, the latter part cnrtcspondini; tn the jnoctioD 
of tha hinilthy ami the di!iL>as(;d hoII tiiwiics, and the tanoei 
to tjie part where the skin exliibit«d all the imlicaliuu uf 
chronic infUntmatinn. In a. tooth the periostenl investmeok 
of which has become iaflam&d, coaditiom in mauy rcspMls 
sinutar to those which take pUco in bone may bo observed. 
Thus the end of the tooth vill be deDSded of periosteum, and 
In some cases diminished in bulk by aboarptiou. Higher up 
the membraoe will be adherent and thickened, and beoeath 
this the cemi>ntnm abu will bo incrBOJied by rocent additions 
of new tiasua lu order to allow cf Um increased bulk, the 
alreolns is necessarily enUrgod, Still, the inlcrral which 
BepnmtiTH thv wuU of the eocliut fruiii tliu contaiuod root is 
soull, and might readily become the scat of bone uniting the 
tooth to tite jaw, hnt fur the existence of aome cause which 
preTctits the union of the tooth to the Jaw while il aUowf 
mm hnnea, whm similarly placed, to heiwnie ooiuiect«d by 
oesificstiou, 

U is not uniistuil to see luicrosct^rio evidonco of an alter- 
oatioQ of ubsorptinn nod dopositioD of ceuicntnm, and this ia 
wpcclnlty apt U> Ix' I'ouiid where a t>tump has for a long ume 
hen a source of tilight irritation. 

The ah»rptioQ which takes place later may go so £ir a* to 



DBNTAI. EXOSTOSIS. 



439 






Mg.\a.(}-j 



into the dontine, after remOTii^ the whole thickness of 
ctsmpDt; fninplw at ahsortion and eabeequcuL tlepo- 
ritiou uT OHsetnut iiiul<!niU in Mil- (-iLVitJcs so 
fortDfid bare Utcly been dej£riV>c-<l hy Mr. 
H«iiy('J uudrr tbu aani« of InoBUwia. 'IV- 
•bwqniwD b effected by the ai^ency of pulv- 
aoclislDd celbi, wbicli an derivtil from tliu 
oBteolibsts Of funoative bon« cells. Whether 
tbcy iliemmlves bocome iakififxi,orm turn givo 
jdacu to) fnd) ottooUAats, bu not, » Ikr ns 1 
know, been determined l>7 octoitl obwrmtion ; 
Init, toeiaz tluit calcjfitid cutilago matrix is drilled with the 
utmost npidity by die adTuice through it of the OKt«o- 
gonoiu Icauei, il aeanti looet {iruLiMo that the isaina oeteu- 
bUtt nils are CApaUa of effectiii;: the absorption atxl nil»e* 
qtuxntJy btoomiii;!; oolcilied. 

(T) •> r iiiiiitiiii of iiM oaonMoiica smmt.* itamiict, lan. tea Apni. 
i*n. 





NECROSIS OF THE TEETH. 



WaKV a i^rt or the whole of « tooth hu lott iu vitality, 
Uie ooudttiuu is exitresned hy the term aeorosta. The dimuB 
iimlTn the death, but not uecemrily tbe deeompMition, of 
the dead pRrt, Lh« tiwnes of which beoome diaootuured* bnS 
arc seldom toftcnod. 

I'bo tL<rra is no doubt lutsociated ia the ioin<i8 of many 
pracUlic'aen with thai staU whjuh is attended with dia- 
ooli>rtition of the whole of the crown of the affocted tooth. 
Bui the di»coloralioij of a tii«d toutb is, tu-ictly )t|i«akifle, 
au occidental and by no mesiu necvwory coincidoace. It 
do|>vudx, iu thv lirat pUix:, upon the pul|) luring ito viIaUi; 
when its vcMcls are filled with blood, and Dpoa ch« altimatc 
deoutn[)UHitioD of the blood-|;lubul&i, and tbo aolutioQ of Uie 
oolouriog matter iu tho fluidn present. These permeate the 
doHtincs and ii)i|)art to it a j»nnaaaQt Ktaiii, tho discovery of 
wUi<:h is iuoked upon as &q iafalltble iudicultoa that thi* 
tooth is dead, 'i'bo toss of the nnrmal colour is nbrionsly a 
losn) caiUK<j.uvLc« of the death of the pulp under cvrtain cir- 
onmituceB, and ■ oonaeqtiDOoe which takes Home time to 
dftTSlOp. 

The depth of the Htaia will also be TitriL>il, Lli« variation 
dcpenduig u[x}U tho age of Lhfi ]]AtloiiL The younger the 
subject, the larger aud mure vascular will be the palp, and 
the deeper tlie staiii produced by its decomi)otiitioti. la old 
people, on the contnury, the piitp iw rclnlivel^ small, no<i lfii> 
di»iColi>ratign of the luuth couacqiieut upou ita dnth i« but 
slight, aud may, iu fact, bo altogether wantjiig. The dia- 




^ 



ooIomtioQ may in »)cne cmc< be removed hy treatment witb 
bleaching; tucpnbi, afua the pulp-cnvity oiid oooal bmva t>ecn 
thoroughly washni out. 

Uhloriile of Hmc, chloride cit sodm, chlorinated soda 
(Labanaqav's doid), aad ouUic odd, liaw all beeo recom- 
BMndod for this pttrpoM. Wliat4;(rer a^nt U tuod, the canal 
aboold hs clwNid at thu apex by a pled^t of cotton, the 
Unofain^ nuitt>riiil Inlnxlncvd on wi>ol, and lenled np in 
the cavity for thirty miDuteB or an hour, and after a silf- 
&cieot etTcct has been proditoed, thoroughly washed out 
^aia. 

A perfectly d«sd tooth ts sdmi thrown off hy nature on lui 
extraiieoiu body, ito expulsion being attended with more 
vr letis locul tnBammation of the surrounding aofl parts. 
The amount will to a couiidenible ext«nt de])end U[K>n 
tho relations of tho Reveml parts involved at the time tlt« 
diBtli ut thv tooth taken ptacv, and upon the caaBU which 
prodttMdit. 

If^ tor instantK, th« alvvuluft and the ^itia have recoiled, 
the inflounutioa excitod by the dead tooth will not be great* 
unkas the death of the tuutJi ban been oDnxcciuent upon in- 
tlammatian of the pulp aod of the dental periosteum. Even 
then the aymptotoB will be leea severe thau tJiey woulil have 
baoD had U» alveolus and gum riwu to thu usual Ivvcl. But 
we aee many disculomiid ttwth which have remained for yours 
flrtnly implanted iu the jaw, and their preaeaoo haa been 
onattendM with »crioaa incoovcaiooce, yet they may be 
deacribod correctly as neoroiKMl teeth. In such cases the 
diww ha« not, however, inToWed the whole of the tooth ; 
■otiu fort has ratuiuvd its vitality, thmu^h which the con> 
EteotioD with i)i« solt tissue \uut Ixx'U inaiuinincd, and consfr* 
qtumtly Itip UMh ttaa been euabioi] tu hold itit piace. The 
eireauulaucc that a tooth, the crown of which piestxta all 
the oxtPTDal rlumctent pctmlinr In a dead tooth, retains ita 
[MMitiuu. Olid iti certain caws fails to pruluce cooidderable 
local disturbance in the jaw, widle in other instance* jreat 



W 




rolvpd. ratbrr thuii to any sjiwniintln 
TliUB the Jeatini' ina.y loM its ritaUcy 
(itilji bai-ini* bean deeiruytil, atiil tt 
peciilur browoifih nd ooluur wliicli at 
positiuD an«1 dtlTuiiioTi of Ihe blond 
througli tiiP ilmitiae, mid yet t)]« cunt 
oonnoction with the f-eri'wttfuni. Thiai 
mMos by wlik'h tlio tontli may njUuil 
de6tut« x^riod. GxntnpU* are o(U 
pulp liu >«9D mddenly ilMttnyod by 
jtsut pwvioiwly, and the lojary bu 
lyilumtion c( the crown of the tootb. 
chut the tooth u dead, tint thia la ool 
■leath has been limited to the dentin 
rvtaiucd ita riulily, although ita noi 
perfectly preMrred. 

Again, in invuttu^^ n tooth vcb redn< 
condition. The vitality of tlie dcat 
tlie pnlp U destruynl, hut if Lhu u[jei 
•occeaa, the life of tho cotncntum m\\ 

The time during which a tooth 
rouiu ita ]>o«itioD without undergoin) 
tmliiuit«d. 1 believe that I he cenmi 
of an incteoaed, If not ft morbid actioo 

-flf dm liantinn in loRt. In nnOM RAi 



nuiBoeas or thm thtil 



4-13 



» 



* 



\wi to the ncwiyHuMctl tUsiic ; for tb« apjioAniucfl }q^ 
\>y some Bjicciiiiena wcmiil justify tliu concUitUou that 
the cdueuiimi which cxisti'd &t th« lime tbu dnQtiue lost its 
amnoettoD with the sotl |mrts, though twt defirived of life 
CODcurnDily with tho dentine, yet ^nbaequeotly lont its 
vitality: lint oct, howprer, heiute new cemenmoi had been 
•iklnl upon the tuiDicv uf the older Iimub in [Mirts. 

If we letnove a tooth wljich lias bet-n tlw subject vi the 
Ctve^og changa, nnd allow it to tieconie dry, thow portiona 
of ccmuutuiit n hich are of ootntiamtivcly rix'ent fortiuitioii, 
will jircbfiit th« opaquo irkit« upoct of hailthy Iwdo; wblls 
the other purt« uf Lbv tiioth, incUiiliug thd oMur oomuntum, 
ezUiliit monr or lesa discolorattoo. .Now, it \» pouible that 
the whole of tho tooth hecanic uecroscd at the samv linu!, but 
it i» anon probable that the death of the Muentum was 
rabwfliwot to the d«n(h of the liontim*, and also to the 
dendapaient of a new layer of oemimtum. OtberwiM Jt 
must be admitted that Uie living tisrae was developed 
oino, and tuiitad to« and uuntinnouB with, the dead 
stnictUTo. 

NccrwUs may, however, bo confinod in the tlrnt inatanc^e to 
tilt ovui^ituiii, the denlioe sttd deutimil pulp retaiaiiig their 
Donital rrlalions. lu rasu» which prewut this cbaraoter tho 
tooth lioctiDiue loose, aud the gum usually, although not 
acotsMsarily, rvoednk The surface of the oemcDtum i» diy 
tachol from the puricetoum, esceptiug perhaps at and about 
th> extremity of the root where the uervosaud blood-vctsels 
pua iulu tlw: puI|>-caTtty. 

The ]at>PQC <?oinplai[u of intcnnitKwt pain in the tooth, 
QXoibablc at any liuiu by Ibo Hjijilication of hot or cwlil 
water; very couuiunly pu^ will cacapo frotn between the 
CooUt and the i;iim ^htsu ibc Uttor is prrased. Tho crown 
of the uxttli di«« not owiuue tUu dark slate colour which 
follows afli-r the tioath of tlie pulp. Id this form of the 
dlsnw additiuns aio not made to the ccm^utam, uokas in 
small and taulaied ^ts. Generally the ceuientum is graotlj 



i£Gh 





eyBTEH OF DBXTAL aUBOElT. 

redocod hy alwwptioD, uid eren the denUoe in many i 
taffura also. 

I nmienber s caw in which seven fmnt teeth tc«t Ihetr 
Attac^imODl to t)i(i Kxkvt, excepting where Lho Dervm aad 
blooH-resKU cntprpd the root> wjihout the vitatilj of llw 
pulp baviug bct.li fiHcriSccd ur the f^aioB tbcorbad. 

I'hvre is yet aQoth<.'r Ivtm of jiutliiU Decmis. One root of 
the tlouble-rooted teeth, or one or two of the trchle-moted 
teeth, may become dead and pcrfi.v:tly deuichod from the 
lining membrane of the alrcoliw, while ttie remaining root 
cr root« jiTcacrre their ritality. Teeth wh«n ia this ooo- 
ditiou are aj)! to be at time* vi-ry troubUsoome. When they 
ue used in ma«ticatioii p»iQ id ■.-xperienced from the devi 
root being pressed into the socket, the Hnini; mombrane of 
whioh it iujared by the rou^di surface usually prewotcd by 
the dead root. 1'he contiinicd irritation arisiog fhmi this 
cause is pnadiiclive of tlackecing of the alveolar covering 
Kcompaoicd by the development of a high degree of aen- 
sitiveneBS in the hyiwrUviphiei) parts, the suaoeptibility to 
pain iu which is coDi»o(iu«iitly iQcreiued, Hot or cold Qaids 
taken into the Ttuiulh nlso L'xciU^ (iain in the tooth itai-lf, or 
la thu irritated alveoliu (it iii very difficult to say in vhifh). 
The alveolus and |;um of thu dead root may or may not 
boQOmfl abMrbod. 

In one caae we may see the whole of the root, eren to iti 
eKtnme poiot, hud bare by the renurral of the ioveKtiug y^rxs, 
and in another ease the gnm will maintain ito nomul height. 
Of the twu, tlic former cuiidilJon is preferablSi on acnmnl of 
the greater degree of irritation aad pain which usually attend 
the latter. 

Ilic thickened |M-Tlost«uin, if adbnvut at any pmnt to tbn 
eBRHmtuii], may bv, and sutuuLimes is, withdrawn from tite 
socket on tbv tooth bein^ extracted. It is osufllly lij^ht in 
oulour, of cousidt'rable thickness, and almiist as dense as 
fibrD-cartilage. 

lu n»[Kwt to thtt treatment of either partial or oomplcte 



raOBOBIS OF THE TBETH. 



445 



necroeiB of a tooth but little can be said, further than that 
so Boon as the diseaaed oi^n becomes a source of serious 
annoyance, it should be remored. 

Any attempt to restore the vitality of the part would be 
uaelesfl. The gum and periosteal covering of the neck and 
roots of a tooth having lost their attachment, never become 
reunited. 



( "« ) 



ABSOni'TlON OF THK IIOOJ-S OF PKUMANEKT 
TEETU. 



Tut romovsl by abmqitiun uf uiui-t; or lets o( tbe coot in 
teeth the cpowiib «if wliich Iiaie Iwn iiijuml by disease, has_ 
beea slrcaJy iiti'utioDixl ; l>ut ca«L-e from time lo timv 
la vhicb, whik- tht- cruMtii uf a t<Mitli is jierf^ctlj' muml, 
root te attaclitid hj nbsori'tiun. It U to ahnurptiuu, wlivn it 
oceura TUidur the latter circuisfttAncca, tbat ateeotioD wiU Ik 
dinctod. 

Altliough the processes of abeorptioa will tie the 
nndcr wlintcvur rirciiuialaiia's Ihvy iu«y be hbI iu uctloii, 
we iu»y anao^ th« caux uuder two diviaioos, iu Accordsnc 
with the clmracttT of tht* L-xt-'itiuR niuse. In ihc first nuqrj 
bu (ilnci-d tbtiae examples iu whicli the whole or [«rt of 
root uf a ROiiiid ppnnanent HmjIH is nl*nrt'jeil trithntil rrfenmc 
to tlM> <^R)wtlLcif nil a<1j«.-(iiiii^ t^xjth ; and in the oecoud, thu«c 
ca&cs whcr« a p^rcion of ii iwntmnciit Uoth Is iibsorbed to 
make way fur the erudition uf a iici^hlNjuriui; tootli. 

I have sNTn inany ca-scji of aheorprimi in pfr- 
nianent teeth. whiTt' tlic wa«Le lias so fitr re- 
diicci the root that tht-y bccxme Icow 
IMiiifui : b)tt I nm iiKk'bt<.Hl to Mr. Cant 
find to Mr. Croottu'iiw ftv npocimcns nbonir 
comjilctu nliborpticiti of the rcxn. In the 
oaso the central inc)»ors, ona aft«r aootbcr, 
bMUaw loftee, and fell mit, on the younger side of fijrty,,, 

^} PcfBanrnt crnlnl tTirl>i>r, iIif rmt. of whldi but bwn at«prtM4 : 



Uf. Hi. (') 




ABeOBPnOX OF THK ttOOTS OP PKKHAXEXT TEETH. 447 

JUK K tboiigh they were cemponu7 teeth maktiu way for 
HKoeaon. Id the otbui, a permaaent bicnil inciaor 
|twl under Mmilu ciictinistancea. In neitln-r lAtifinC 
Uinre any imiication of the preaeoce of iltsnise, latthn- in 
tbe gum or in the nlvvular {'TooeflB. The aiteiittoo was 
MtrMtrd bj no othor ttrmptoiu than the fcradnally incnmiiig 
tc^iM^K"^ i>f ibc touth. lu H {uLicnl of m.v own, aa npper 
oemtrnl, at th« »?« of fifty, bvcanw rather HtKMeuly loose atwl 
puofaL It was sabsBinently rcfuud Itiat Lbv ouii/^^, igs,(i] 
nde or tfae root bad beeD reiDored by alwor|<tioi), 
the imicni) haring hten nrrcsicd when the walls 
of tbc |)olp-caTity were reacbnl, Icaring th« jAilp 
[HTfcctljr eocaard in a tliin Mv of clrDtitic. But 
lor the auperrtntion of intlaiamatioti, foUowml 
by tK« necretkiu of poa, it is pruhnlilc ttiftt in thiit, 
as ID the preceding caaoa, the wholtt of the root 
wtmld have been remoTcd. 

Tbe fart tlrnt the walla of the palp-c«\-iiy fcfiiiited tb« ab- 
torbmt acltcn with ^otcr force than any other pnrt'of the 
dcnliiKt, accjnls with what we may observe takes 
|ilac« IB a lim>t«I dcgrcu io t«mponu7 teeth. Ii 
ta protiable that the preeeuco of tbv pulp ipvo) 
tJua puw«r of reristancfl ; fot in pivi>l«d t«utb. th« 
root in comtninily reduced by absorption, and por- 
I'lunilioiM are aora«titnc8 made, by which the 
pto Is oxpcMHl. lu a BitecimeD io the mu* 
u of tilt OdoDtolo^cal Society, the root of a 
toiilh haa been in great part abiturbnl io con»e- 
qomco of the irritation prudocvd in ita aocket 
by a bri'ile which had made its way up tl»e empty polp- 
waaL The pm«eHa of abaorptioo having lieen diyeuwwH ni 
eoonection with the sbHlding of tlM temporary toeth, it need 
Boi be a{giun enteml upon. 
p\ A pKButMi tortMr, on* aU* v( ito root belna nmv'nl tf abmxf^M. 

A)'' 'lNllM|>U[|t1lMl«*1lplOTr««d. 

r .. K*4 reiluntd In liat hf ilkufrplUm, ud loU pin 

M)- f-jtatlwi, Um pni4«ctd by abMntMl- 



Mtmm 



448 



& 8TSTE1I or DBHTAL enawKT, 



Tbo casea which fkll uDiler the aoDOod beading nn ntaillj' 
depondeat upon Uie malposition, aod ooosequent relarded 
eniplion. of a pcnnsDCnl tooth. 1'be extent to wbich tlie 
absorption of tiwiiie ia carried in iiKnally limited lo the pio- 
daction of a slight d^prosaion in the n«dc or root of tbe 
tooth, hut bi B kvr caaes the procuRS is oonliiioci) until Ibe 
pulp-cavity is laid open and tho pulp erpowd. 

The cuninea of the up(>er jaw luring more fruqucntly mal- 
plaoed abd retarded in their crui)tioa tlian any other teeth, 
we abould expect in find infilancuH uf alMiirptton iu the Istrml 
iDciBorB and CirHt bicuspid teeth. But in these we aeltlotn 
ano niorft thn4t n siniple dGpresainn, towards which tbo ad- 
vancing crown of the coming tooth hua been directed. It ia 
cpoii the second molars that t)ie greatest extent of fnjurr b 
inflictt-rl. When the ltowu of a vitdom tooth is directed 
rorwardn. it teada to absorption in tbe neoi: of the ohstnicting 
tooth ; HTud the process, though gencn^ly arrested before Uw 
Mcond molar id permanently injured, will, in aocue caaea, lay 
open ilM piiliM»rity. I have seen aereral cnaet in wbicb tb« 
injury has been followed b^ tnflaiuniatiou of tbe palp* Decav 
ritaling tbe ItnmocUate removal of the tuotb. In a cM« 
whiob oc€\irr«d recently, the patient coniplaiovd uf seren 
pain In a second molar of the upper jaw. The tooth appeared 
in every respect sound ; direcUons Wfre Diercforo given Ihat 
n leech should be applied w the giim. On the following day 
th6 patient rcturaed, ctiuiiilaiuing (hat the abetmctiou of 
blood had fail'dd to produce reliiif, and strongly urged that 
eho tooth rIiouIi^ be n.-m»red. Tbe tooth had booomealighll; 
movable, aiid tbe crown bad lust a little of the oatniHl 
brilliancy of colour. AfU'T reniuvat, tbe rauw of the aufTer- 
iuj; waa loaiiifest. The |rul[>-cavity had been laid open, lite 
pulp became infianie'l, lost \U vitality, and at the lime of 
tliu upcnition wii? in a stAtA of docompocition. In this 
instance there was not tbo slighu«t eridcnce of caiiea ; but 
in others wbich have come under my nuticw, the cavity pn>- 
dooei hj abaorptioo nbeeiiaentlf became the » at v( coritia. 



I 




F - 



ABSOBPnOH or THX BOOTS OT TJSBMASVST TBBTH. 449 

The maimer in which the latter result is broaght about 
Teqaires some explanatioo. 

It has already beeo stated that absorption is effected by n 
vascular papilla, which advances in front of the moviog tooth. 
In those cases in which decay arises in a cavity so produced, 
the papilla has been situated but a shoit distance within the 
margin of the gum, and the cavity consequently becomes ex- 
posed to the flaids of the mouth when the latter parts shrink 
down to a lower level. 



2 o 



( «o ) 



EROSION OP THE TEETE. 



It oocMiO[uilty liAppcDJ tbal t])« cnamvl and the Eti1:>jttccDt 
dentioo bect'imi t-nlvii nw'ny. witlniut any uf llic inxliiiary 
aiijio&nincM of donul caries bc-iug nuuiifcst. Tbc favitita, if 
such th«)' jxtay bo called, Arc m gtiucml n^tilar ixi form, and 
i«uoer-slin|>«(), tlic reuutval of the enamel liavitig taken ]Atu» 
ninre widely ifaan that of the dentine. Tlie suHjkc i» per- 
fectly hard and jjolubcd, aud oftfii abboluUly free frum 
iU«co1or«tion. 

IliU offcotioD, which was doHcribcd ty Huiiter undv tlie 
nnnte of"dK»y l>y di'mnktioti," mo«t comiDonly ftttacke the 
utH-ks (if tho Iwth, funaiiig a siiiuolii iHirizontal gruuVf clt»c 
to the ctjgc of tho gum : it is more frequently met wilb in 
the iij^pcr tliiu) iu tlit^' lowvr jfiw, nnd cloaely iutDubit«s the 
tipiwumiicv prui3iiccd by mecltantcjd abrasioi) cau^etl by tlw 
frktioo of a t«itli-bni8h. 

Now and llicn, hovrcvtr, t««tU an* attacked in |>c»itiotui 
inaa:cssililc l« tlie tootb-bruttli ; thns, in ibc 
coumv touth b«-rt; li;;un3d, tho grooro wa^ not only 
upon the Bntcrior surfaco, hut exteudwd hack oo 
Ixjlh Ki<leii of the n«ck of the touth; iitoivoTer, 
it WBS distini'tiy undercut. 

'V\m enision may »ii on till ihu ])ul]>-cavity is 
oj*ijed, and cvim ixiKtd, to thv tooth i* fairly 
cut thninnh hy it. An iinfUnce of a lowtr bicn»- 
[liJ, nith iu rrnim thnii undpniiiiicd, hu recently 
presciiteil itself, which, from il« position, WM 

C>} Oular. o( wUdi Um tnoX nail tiirt <d Ui* neck uv dnptr gfwvi^ 



ne. wT. (') 




BROStOn or THB TKETH. 



451 




r(f. Ita. 





* 

I 

I 





thoroochlT pn>lecte<i from firiction. Altlicmgh the lahinl 
snrf»cest>rttw teetli are usually Atlacknl, Uieli&ipiftl mirracm 
may tu some (ew iustaacot Im t»\xti ft>\ny; iu the two iii- 
ni«ucs hrro !!{;'>''<!■' '''i*^ baa tAkeii |<lftr«, l}ii><{iini hftiin^ nt 
the Muue tiiQfl n<c4<<le(L In tbf> right'luud Iit:iiie an isUud of 
eoUDel luu heeo Lhtu rataond fttnn thu liiiguitl durracr nf 

tjotnetimes the etaaattl b nttAcked nt flvrnst painU on th« 
•urfiacai «f the cnwn fif tbe front 
; tbiK ciiD'litioii hivt dfily hwn, ho Tor 
M I kaunr, lacl nitli iu lite up[n.T jaw, uiU 
in th« mviiUis of thoM nbu bavu siitU'wi 
{rbu pruluu'jvd iU-lM'-altlb In a |aitiant 
uuHcf my care, the enamel hint Ijccd 
iu irre«nUif-fcliapL!ii [latiihrs frani 
n[>[>(7' itiL-Mon Aii'l ciLtiiiiM, And 1<> a leas 
put from the Wictiiiiiiiis. 'I'hu milijacmt 
ilmtmi!, wUicii had bwu I'lit lit'lu itrodcil, 
wait[)orf«lly hard au<i ptilinhe<l, but the (dgos of Ow eimnwl, 
wldrli wflfu (dtaTTi aud au-inW, wcrv |-iarti»lly diuiuU'grated, 
i^halky-lmkiat^ nod cniiubly. Tliv pviknt had boeii crm* 
fined Vo ba luum, and fur Ilia irrvuior pArl of the timu, Ui tivr 
bud, by A iu>vi'rf attack of rlu'Uinaiic fever Aivd itj »BqTie]», 
fur u|>«anla uf uiue muutlit: atid diirin;; tbtt» tune slio had 
tak«u much iiwdicinn, and bad been IncapAble of giving; any 
atlciitiun tu her UvtL. 

A i(nn)CM'liAt dmitftr cow ia figured in HiUTiK'fl " IVDrtil 
ffnrfCLTV '' (Icnlh (^iitiun,|i. ^£81); atulDr. Pannly iiienliKiin » 
eaae tu which a oataral toutb, aet upoti au arlificiAl {>i«ce, 
wa« Muiilarly gmoTed; thU lant iihaerTatinn I can conlinii, 
and may add tbut I uUervod it in a caw wLri« the I'Uiicoi: 
rnf«ly or oev-er reaorled to tha imo of a tooth-hmsh ; a 
«iuiUr ubamralioo waa rccotdad by Mr. tlaniauii id ih« 
** TtmnaiKlionii of Uir (AlonlDlotpeol Society" May. 1H70. 

Etub A yfit mora ooucluairo argument for the Kxi»t«ncv of 
tbia " dTOhiuo " of iba tevtb, u dbUoct Ihwi nuin nwcbunJcal 



45S 




A fiiaTui or DSSTJU, BintaiBT. 



is furnished by nn i>b«erv«tioti of Dr. Mario ('), 
-n-lio foiiad tliul the tcctli o( a m« lion (Otoria }«hata) bail 
been thua wasted. The excellent figure frivcu (/oc. erf.) i» 
ton lai-go for r*f[>rii(luclii>n in tbi>M p^cs, but it u at dom 
urideot. Ml iUBpccttoii of tlie drawing, tbflt tbe circum- 
ferential gruovin^ of thuM} t«eth nauiioL W ai-'cottuteJ fur by 
friction, (u id mo«t lostanco*, and notAbly in the (cnot 
uaaiuas, tlio plmx's mmt affected tuv ntuati-d ou thv eidea at 
tbe tMth most protected from wear, and tbo crowns are 
inarcly nmm down in tho oniiiiary way. 

lliiii coiiditii>Q, at leaiit iu this extremB dpgceo. Is D<n 
common aniDiig tlm nealA, biit [ hava seen an approach to it 
iQ tlie teeth of ullter Biwcimeos of otaria, and in tbe pv- 
bow'iH sral, 

lu the inueeum of tliu Itoyal ColliJgo of Snn;«>ti» there 
is ft stculvtou of ularia utulleri, in which thij form of woHJu^ 
of the teeth in well «xf-inpliScii. In it the tooth nro much 
woru down l<y ma^tticauoo, but in addtiioo to tbi«, tonw vf 
them are (W«iily ^opvcfi in [Mwitionti not at all uxpaecd to 
wear. The ihiid left uj.[)cr incisor is thus necpJy notched 
on it« DUtoraud auturiur iLspecl, closo to the odgo of the gnm, 
whilst other teeth present a sluiijAc condition, tbongh \cm 
nmr'kedly. 

'i'hiMX' i» yet anutW form of wacttng of the t<-cth. which 
ii VMiva r»re than those already d««crib«d, Iti it. nnt 
iflolatud e[fUlfc, but thu whulu ux|H>scd pnrlioa of the toolh ia 
Bttaclicd ; as the tnorbid nctioti goes on the enamel i* slowly 
renitivHi) frulu tbo cmwu, »> tliat tbe teeth IxHMinc tdmrln' 
and Ibinncr, and aasuiuo a {•cciiliar yellowiah, tmnslucMit 
appearance, the poNitton nf the pulp-cavity being Btmngly 
marked by a ilifTereDce of coluur. lu the vuly caw which hu 
come uniinr my own oViMji^alion, tbt- wusuiig of the tt-eib Wiw 
eiitabli.thLv] l)ey(ju<l all doubt by taking modfiU fnmi time tc 
time. The jntiuut, an uua-mir gjri, was reduced to a Mate of 
groat pnwtratioD by acute clyK[<f{«ia, and was lor a coit- 
(<) 'rnnMcUuitt iif ili< rMc«tvlo«lM] Sodrty, 3m», laTf. 




KBOaON OF TIIB TS8T& 

time ormflncd to lirr l>oii; she was, however, ao 
tlmt it iriut I'xccvdiiigly (Ufllcult to ri);1ttlv' estimate 
Tier ooiKlitioo. At one timo tiicro viaa j^ioat lontlcrncas of 
tb« tnsth, and general pfrriLiKtiliK in tlie front of thi; mcnitb, 
wbioh, junging hy colour alono, appears to have ivsulted iu 
Uie <l««Ui uf one of Uie upper central moUors. The U9i* of 
alkalitte aiipticatioot M«roed to hav<> no «lTeot ivhatfirer ; but 
the paUoit'a condition has now K"x>t'lj itufinivc<l, uud tho 
diMue a|);>earfl to be no tougor profEnssiDf. It i^ n'tn-irkabln 
that {hiring bur [jrotun^eil illiiras, whilo tlio U-vlIi weni being 
t^ifdly (rntilo^, Qo cariei occurred in the mouth. 

A case ol wiutiug of tlu^ front toetb, by whicli a wjaration 
of threo-ci^htlis of an inch vas brought altont between the 
inRiHtm in Uie coureo nf two ycira, in rolatci in lliuris'a 
**DnitalSiir|$»ry'' (]i.2&l); and Mr. Belt bi^ given 6gure9 of 
a auK) in whicli thiii waetiu^ ulToctin^ mainly tlie edges of 
the tMth, fiffectod a wido Mpantion b«tn«oii the a[>pcr and 
lower cvolrul inciaon, and attocltod alN), UiuuKh in a leM 
d<grw, Iho lataraU and canines, M-liich oould not Iw brongbc 
Into OOQtnct with one annthor. 

Tbtt muse uf thbuv vartoim furintt of (rrosicu baa been, 
fyxaa time to tim«, tb« «iibj«ct •>( great (li«ciu^OD ; thou^ 
bjrfiuttiefies, such fur iuittaiii»i oa that whiih attri- 

ilH it to di&eawi inherent in- tbe dentine, may be at once 
dlamtaMM). 

It boa already boi>n abowa that mecluuiico] abrasioo %rtU 
not icrvo to account for all the caxTR. 

AbturptiuU cannot Iw called in to ai-counL for Ibe remoral 
of the tooth fubtftanoe, for it often takn place at ipotA remote 
ffuui any utructuro capabk) of dovdoptng an iibwrK-nt organ, 
and it apttms that we miut fall back upon the idra that it is 
au esami'U) nf chemical anlutinn. But wbenco tbo nnlvenl 
oomca, ami why tbe afrcct«d Borfiicra an oot tbe site of 
ordinary caries, are qucAtionit vrhtcli nunatn unaolved, thoui;h 
it aeenui probable tbal mucna, by femuDtini; or affording a 
nidus Cor funauntatiuu, may iirovidc an acid solveiiU 



4 




454 



A SV6TBM OP DBNTAL SUBGEBT. 



Dr. Magitot (') regnnU tho grooring oS Uie necks of Um 

tcpili as tb« result ot' caries, which has tcndvl to kixiq- 
Uiiei>u8 cjrp "by tbv obltt^nitioii uf thu lirMttnnl iiiIipa; but 
this riew doei; not differ from that which iiKnl>«« it lu 
cbomical sdluriun, an I>r. Mngitot Imlds thai cariet, JtMlf ia 
tliv ruatilt o(r Hittmical BoWeoL 

Wiien the carities in-ottnoed nre of niitalile funn, the 
t'lirther itrogrtia of tlie m»la<l>- umy be ftrrcoted hy filling 
tWm ; aod f&r tliia purpose giitL**i>orchn is oOen found ei- 
vTCiliiiiily cflicivnl. But wlitfro tlic eurliu.iw HtUtckud do not 
admit of iiri>t«c(ioii by a filling, treatment dod* not yield 
imtbitiu.'U>ry n%ult¥. The iisi^ uf »oft t(Kitb'bru»liut ehuuld Ix 
i'njuinod.snd alkaline dGntifricc^prcscribed.as being th« most 
liki-ly tti prevent wilTciit iKtion on thft Uvtii. 

Tha cavitiiA produced by otottion of ihe (vctli are often vx* 
cfssiveiy sensitive to the t«nioh of an iiwtnirm'nt, or to alitT- 
nntioDs of lom]*TBtnrp. This senditivcncss may be nireil by 
appliviitioiu of Ditrate of Kilror, ur, wUarv a block statu would 
be objixtionaVile, by chluridu of zinc. 



<■) llvtkcrclwinirUOulvdnDRiU. lVb,]m.p.8ia:--LaavMaaW 
aln« l^HpgM itmaltor qui !• bll noatpam k m init dt Ida ttuwrvnMl 4 
ptrolB Unea, pollM. JitfV «t riatttanlM. OmmiI cnotTtMifiu UuvnlcitllTpn 
attUm MMann dMjmlmt MDi 1* iKmM 'cartn •iBMltat ]*■•«(«,' n iV^itk 
modi d* (mdnrtlon n'Aftlt jm WfHifai. EUt* ont, m fffM, hnrts lu 
•ppaiHUM dn ruMun viriubtr. raola dm otvu-vatloDo tor U nutamUm im 
dtwiMB pMmIm 4* U aulctlto BOM Mrt djnaD'rf uoe n> •tllottt net* atpalla' 
N( MM antra duw qm dn cwM da celWi pMitfs k I'MU d* |a#r 
ifMiuale on buVm Mm*." 




DISEASES OP THE PULr. 



{vnion or orgiui or tlio bnly, eJthw in Itmlth or diwaw. 

[pan bo inori>oiirleniiy coriAHlcreJ. Wlietlwr »n inflarao'I oye 

JDr » ilianacd tuoth rnriu tbv stibjocL oi iuquir}*, K mtist bt> 

iKime in mitA >bAt neithor am oxitt but m ooe of many 

'faru wi.icli c«IlnriWely fumi the boiljr; th«t the liwiktiy 

Ofoifitioa of an ot^:i U tluo to ft von«s|)oiuUn^ tXAUs of tb« 

wbolc orgnii'tiin. uul tdotv vapvciMly to ft «uun<l txintlitW-n of 

the or^ns in JIa tnimealiata virinity, nr with whiirh it ii> 

elosdy assncinted ; «nd thnt A «tAt« ot" dis'-aw may \<^ o«i- 

anjuntit ii|a:ii), L>r «v{!ii » syniiiliim «!', A (lisoritunit HiAtu itl n 

DBbEhboorina jwrt vf llw bwly. On Ibo oih«r hand. » ilioedswi 

oondilton nrigiiiAtin^ m no oj(> or n. lootti, in«y in<1uc« Mm- 

|«lbetiu AfltrrtiufM hvou in remote orpianii, and in dniiig eo ii)ay 

ily dUtnrh the gciural health. It U nocivmry ttiiit 

muttuU ■)p)wii'lriiL'Q of the vohmu orgatw iipou ewli 

!ier ii}io*il(l be fu'ly »ckni>«ledg«d by tho«D who restrict 

.tbomuilvai to spedal hrancbes of practice, and who natiirjlly 

n MP^nit IvU'toiicy tn boUtv and ;>litc« in an inda|ivndpQl 

ion, iiml to give an ox.ifE'ienitcd importance l». ilir 

dlMOsua of Ui(.> onu uf?;vi or «et of ori:ana to which ihi-ir 

IUtcntiou iA nu'to mpodAlly dirMtvd. 
'J'br» olNKTrriUiuns aitmit of npjilication to prnctilionorH 
nf dvntA) wirgery, wbo are "iroogly teniptod to regard local 
Doodltttum w'tlwrnL ri'fervnce to tho ((enpral mnalitutionail 
atato, of which thoy may l>c Wiit nn indicntiua. 'Hio reiufdiwi 
whicti ho nndit man atbxtiw arc local In their Bpfilicntion 
ukd tBfcu It ifl oqIj wbna tlta cbatacttr of tbo iltHiaHi ix 



456 



A STBTBK OF DBIITAL BCBOEBT, 



somewhat ra^e, as iu the groap which to abont to be nm- 
Bid«red, that the attention b called to the geDoral oooditum 
of the body. 

Im'tatiim of the Deniinnl Puip.—A difleasfd condilion »!' 
the |>nlj>, whatever ninj I«e the nature of the diisiaiBe, is, in 
the majority of instance*, OTiw'<nieol U|)uu the pulp-c«vjty 
Iteing laid open, tfiUicr by the dculructioa of ite walls by 
carioB, or by iiijur>' of the crown of the tooth from mochanial 
vii^cDCv. But a few ciwcs will be met with in which thf 
tooth becnnwji pninfiil, and highly MDmtive to the efferln of 
«iKldeti change* of tempcrktun,' induced by the contact of 
hut or cold fluids, and even tu slight prcamre u^jon thv crown 
or nixnx the nodi of the tooth, whilo the walla of the palj)- 
cavity are free ttom injury. In such cnsos the i«tii.'nt« will 
coanplain that tlio tooth in iucnpablc of bearing with cmnfon 
the pressure exercised in tnaHtication. C-arcful examinatioTi 
itsitally leadn to tlic iletectioQ of caries, or to loss of a portiou 
of the crown of the tooth, cither from wear or fracture A 
wrtiun desrree of |iain is prodiicwd by prwsing a Bti'el itistm- 
inent U[X)n the injure! spoU, hnt tho df^^roo of pBin will imt 
oorrvsjioud tu the uuoiiitl of fiirce cuerciited ; inditxl, slight 
ootitacl seems to pvo qmii^ as much fmin as firm pMssure. 

lint we may fail in dLit«:tiiig any uiiijuariuu of BtnictunU 
cluui<*i; iu tlte tmsitiTe teeth. Thu disordered fLnte tuaj' 
«lepcnd upon unrne otber tofith, which, altiKingh itaclf frw 
from («in, may prwduce sym|)Bt.hetic irriubiiity in other 
teeth; thus pain really due to the nisdom tei-th is often 
referred to tha bicusEtids ; or it loay depend u|x)n a cauw 
whicb has a constittttionnl or general ori^n. The earlier 
slaRen (>r cold, rhcuuialisui of the jaw, or the praaence of 
mercury in the system, ai-e frequently aocoiupooied by an 
irritable state of the teeth. 

'SVhen the forc^^uiug local symptoms are [ire^vnt, it is viTy 
diOicult in detenninu whether the Kcnsc of juiin iii the tooth 
is cuqUuuI lo the dentiusl fibrilB, or whctlier it is Hitiiated JQ 
tJif puip, the su8Ct>]'lihility of which has become ahDomtai); 



I 



UtBITATION Og TBK PVU. 



457 



buigliUEteil. Tbere ts au reuon for suppotting that tlie ibrik 
are lucafsilile of assiiTnin^ ft ooodttinn of excessive Moelbility, 
■nd ll»t tliu ttiorbiil state may tint for a timB be onnfinal to 
Uiom. But it ii quite |)o«i>ibl<i tlut the mcrcASi-d siiscepti- 
bility niftv ori^iiiatu in aod be liinitMl lo the jnjlp iiwlf, wliii:li 
IJiUafliUjr affocted by causos wbidi otberwinc M'ould 
ftmmy s&Dmtiuiiit. 
TliAt 1 Htate of irritulioD may be auniiicd by the pDlp, is 
■illBcientJy prorcd by tha bet that tb« imtable coinlition of 
the tOuth iriay he Kiiccwdnl by iiiiaiiiiiiHlioii of thai un:au. 
"Exaroplas of tbt sequwico of tlio on* to Ute othw conJition 
ImtJ be Bcea in teutli, small purttdiifi of which hsva been 
I bwkca off without injury to tbe pulp-cavity. When to in- 
f Jnred they bcuome gradually aeitsitive to olianges of Uin> 
l|iarature, and tb« fiaiti, which &t first was trauMieutr at laxt 
rntdorei after the exciting caiiic has bi'cn rviitoved. Ths 
Btnuuot of join is gnuliully incraud, and evduLiially t«r- 
I mJnatca in u ecver^ attack of toothache, occasioned by acttte 
Inllfuiimatioii of the pulp. On the aching ttmth lieini: n:- 
' moved, it will bo found that although the palp-cavity is 
etititv, tlw: pulji is pawiog into a elals nf disurgaiiixatiou. 
A kintil&T course (^ symptoms will som«tim«^ follow tbo 
opentiuu of plti;;giug a simplo cavity iu ttM-tli which have 
boou in an imtflblB condition pricir to the opemtioa. For 
namph', in a )Htipiil l&lcly under my care, kuIiI lillinga wero 

Iploffd iu twu lueHJal cavitivs iu lbs right aud loft lower 
molara; tli« caviiios were fully cxpoRed u>Tieiv,And do iadi- 
pition of otixfitiin-* of the pulp wa» to Iv swu ; iii fact, the 
airiljes were so shallow that tl>c introluctioti o(a blling was 
iliflflrult. In tiift course uf ft wiyk llie gold bad to he re- 
mcwoii ; too late, however, Iu prev out tlie s[xiDtanoous d«alh 
of llie'pnip. In this mine jntii^nt 1 hiu) txvi) aliortly before 
that time compfllod tu rvniuvH a Cfuwn filling, wb<ini the 
cavity vu lulh MTuall and itballuw, on accunnt of the irri- 
(ahility of the pul|^ Thu auscojittbility of Ibc |>ulp to irrita- 
tlon varii'f greatly id diffenmt jwnons; tbcrv oic ftjmo icir 



iE 




SrBTCM OP IlEKTAt. SITBSBnT. 



for whimi it in next to imposciUc to ancceiafully perform the 
oporatiuit oftillitiij;. 

No (lonbt thu pnl]) of a tooth may pnu Into li «tJit« of 
irntatioQ, >i)ilo|Kindout of injury sukUuiiuiI lt>* tliu bnnj aoil 
protoctiQK tissum, just a* in ccrtAin stalirs of tito iiystviii tlw 
susoeptihility t» discsM) of any olbpr arpui of Ibv body may 
be iBcreAMed. Iltil in tli<.<«« caaea lu wUicfc Cbe crtWQ o( dn^ 
tootJi hns stiff4'r(!<l, them appmrt good rcaKin for mpfxiri^^l 
that tb(- almormaJ slata bogiua iii tbo dmitiiial tibnU,«aa 
43Xtvn(lH ihtvrtijih tbcot to ths pulp. Tliii view tit, 1 think, 
stipjidd^ by tho reanlta whit^h fuUow careful treatment. l( 
in a tooth the crown of which has l>ceu iujurwl by caries t« • 
alight duiith only, but in whiirii the tloiitine is highly ieuii* 
tive, nitrate of allTtr be appUod to the affecKd pait, tlw 
auscvplibility to [fiin will in a few miniite!i be ^nuitly n- 
duoed. A urailar result will ft^llow the ap{tli<»tioD of other 
forau of ewbuotica, unltni tha walls of tlw piil|>-cavlty arv 
anflicicntly reduced in thickitc<s» loalluw thu apfitivatiuu to 
pus through to the pulp. Tha effoi-ti* with tbvM octlve 
Bgcuts are rapid, bitt their ii-w is not free (rnrii dimmer ; for it 
is not alwaya eaty to «U»covcr how moch or how Utile Mwod 
tiauie may intervene betwraii th« pulp and tlw venntira 
larface. Dxcuj^Liag a» a niatLer of expcritiicnl, or when a 
saQIciont length of tiiuv cnuriut banllnwod for th» applica* 
tioQ of loBs active reniodictt^it will bc> well lovoiptuy regotaUo 
astringents, «uch as tannin, or soliitionti of gum-tesitis in nl- 
Ciilinl, and to oonlinue tlie treatment till tha tooth regains ila 
nonnnl Ktate. 

Id a pnivioiiM (n^e it was stated that the dentine Ions 
aeoaatiott on the ptilp beini; destroyed, an<I it is now s)mwd 
that a ■cositive surface of dcutino loses its iwwer of fwltDg 
or transmitting pain aOter treatment with nltr&to of tilvet. 
The roenXis thus obtAioed indicate pn-tty dourly that w* 
shall not be wron^ in attributing a coQ»i<)erable share of the 
hyperwi!sthes]a to the dentinal Altrils, and the conclusion (a 
atill further jiistibwl by the fact that if we cxciw the mirfaoo 



nuiTATiov or thx vcu: 



469 



_which bu been octM upon by the nitrate of mlvcr, tho newtV' 

I ntrlBce will exhibit tli« condition tif ecnuilMlity, wliich 

le apfiiicmtluD of Lb« Ktctutrotk removed Irum ttiat nbtcb 

liu cut away. If tiie attcuiiit lu show tliat Au irrilAble elate 

ilio (lalp when umiwclul with n danuigpH !iliit« al ihtt 

CJomi of tbe looiL U jirecetled by, and conscqueot OQ a 

Mmlbu' euU' of llm dmtinal llliriln, ha>i been siicc««iful, tliere 

aritl \m Qu ^T«At dttlicuUy in vAtaliliMhiDi( & itioti^ grunod foi 

uiniiimK, thnt wUen the leciii lj«coini> inirAM«> in oonse- 

qoenm <>( tauiwii b^Uh^ tbruogb the M}-at4Tm, that, to feras 

atr tcrtb uru ooooeoned, tbo Kste of irritability la aituted 

the |>til|> it«^ 

Tjib supervention of inflnmnution of tlic pulp, independent 
eifosiiro, Usa been allmiud to oa an occa.'^innal nuiiU of 
ritatluD. Bat it mora cLiouuoaly bappetu that ilio diiiraiftcd 
tdition of tbo dental liwuca 'u aUowed lo prof^-HB, Ihti 
illHCMvity ia bud o^xm, tuvi the exposed palp then jiiLues 
itu a statu of diseuac, acate or obronio. aa circuuuilaticm 
ay detdnitmo. 11, liowfviT, tbe disMw in the c.-owu of 
tbe tuulli be auTOCHKruUy tn-atvd, th« etals of irritAbility will 
by dvgrtwi pan away, aiul tlui toolb will bu rcstorad to a 
in> •>! isiiuWt and aufuluoos. 

Jmtfttiiiu, Ll' luD>; cuDtinucd, is uaually, bnt not oonataAtly, 
Ivtt of oortotn cbaogM in tbe pulp 
wuuuplcs uf wbtclt may \w sven if 
III rnniovcd aftur a loog-coolinued «t»t« 
rtnaanin'— ^ iuw hoen snctremlixl by active 
i» (xaniiniil. Iti Homc llie pulp 
'will he {tiuiid tu contain nutueroiia iiuduleii 
of doDtlii* ; in othbn, Uic i^raater pait of 
the pulp wilt bt' found ocmvi'rt4.-d iDt<^> m.-- 
ooodory d«atiau (Fig. IHD). Or tlte oUcifi- 
cadon uf tiw pulp ntay b« limited to tbe production of m 

{1) Bkawtm Uxt |m1|>«»(I7 t^ * Una ]w>niunnu nwlar of lim anirr Jaw 
fviMitr I'M muti A iB>M (d tmotay drtiuiw, pndiwd I7 <alclDcitUjn of 
th* jnil|t iM^Moa it) tarba U Um ouwa «1 Uat auia. 




Wii.ta».<i) 




460 



A 8TVTEH or DCTTAL nmoKRT. 



i^>. iKi,ti) ng. in (») 




patch of dontin« aililcd t«> tlio w&ll of the iialp-carity 
(KiS. 190, and Fig. lUI). 

lo neither of the |ireceiliiig catfes can the calcification havo 
lMJ«n fflectod iluring th4> day or twu 
of aotitfi (tuSeriag iu tht- t>Xflh, cud- 
iicqiieiitly it Toay bc iiLfcrFC*! tliat 
lite ]irodUL-tiou of SL-couaiiry tlvutinfi 
look pUoo when the irriublc con- 
dition prorailEc). It aiust not cm 
tltia account he assumed that cal* 
oiRcation of th« pulp invariahly 
follows upon irritaMe coadittoni of 
tlie tooth, lor uia«s will b« found in 
vhich the prneDce of secoudary dentine cannot be raooglUKd, 
and uthent in which n Inrgu poriiun uf the pulplios undergoos 
calcitirjilicn withniit the prec-x-kli-nce of iirilalnlity in tba 
touth. Iforeovcr, it soema prolmhle that the mere preMOco of 
tlie«c isolated nodulea in the [mlp in capable of exiitin^ great 
irritatioD, inxtead of bein]* n tcriiU of previous excitation of 
the jiulji. It luust ahtu bv remembered that small isolated 
calcareous glohulcji are to Iw Ibnnd in |ierf«ctly hcftlthy 
d£>velij|iin^ touth (sue ixkgr 2S3), 

Tnatmtnt. — When the irritability of the tooth is oon*©- 
qnent ii)m]Il tlie pteoenoo of aimple caries, our aim tnutit bo to 
introduce a pcntiancnt ping ; aoiue tittle c&DCioa miut, bovr- 
ever, be «»ed, other\vise tht remedy v\\\ Irat wrre to increaaa 
the diMaw. The pali«iit luity hnve sufficient enduntuce tii 
atlow thu vxct&ioii uf thr wliule of llie afrcic-1ed*dt.-iittuci, and 
ttie t^uhoeqiiont intrcdurtiou uf a gold or other nietallio fillitig, 
hut the prcaoncc uf itji'tal, from the rapidity with which it 
tmntiTiiits ctiungcs of tem[ieniturc, served, when ttio tooth ii 
highly sensitive, lo inctuiw rather thau mitigat« the eril, 

(1) SKti^m pf a IwiUi, ■hnwltut tfa'- ItKii Uilck-nluK ut lb* wttt of Uh> pBlp- 
mvlly. ■x>it>'-|>i<'til ii|>irii lirltalloa fniiluiMl by u>tviiii-irii; nulCM. 

(>) II ctopiil III Khii'b » fi>mulii:rii uf x-cniiilir; tlmliiir Im bll«l tnnlnUla 

terruntUHi "i Uie pul^«>vHy.-~F^n}tt lomo'i " Luciwrt on UtnU I1trii«|gcr 
and SaisoT'-" * 



tUtlTATlOK or TBI PULP. 



461 



P 



The wnsttircncss will, honvrer, in the majority of casei, 
^ncltuilly stiticride ; in olli«n>, we itwll be re>4utr«l to rcunore 
tbo iiirtallio pItt?, sntl i«ub«tilnt« a non-ronductiiig matoriil, 
Tlic [irciaml liuila-jwrclwi will Itc round cxin-uwly useful in 
tlic LrcttLm<.-iit ul'buch cMM. loilocil, tvlicnvvor we finil tbat 
pvatij: iucrKuni E«n^biUly U mtabliHlini, wo shall da <rrc\l 
U> iiitti"l»ce a tcmpowiy |iliig o( tlii» roaiorial, takio;; Ciire io 
mhittitnte goW when the tixith han m-nvcpcii its nntmal con- 
dlion. Ill triAuy (.■«*», howcvur. llif |«iiu occasioned by the 
excink-n of Ihc ilw-ayed lU'iiIiiiP is ii-rfwlly iutolt-niblp. The 
applioition of cblirMlonii, trisMittj, or camphorated HpiritB of 
wioc will luwcr (litf siitMl-iliiy hlijjItiLy, but DO otbcr ngeut 
hiR ill my IiiukU been h> imninltate and comjilote ia jla 
actioa w a Irngrornt of nilrntA of nlvcr introduced into tbe 
cavity, aivI ntUiwvil to reniain fur five or six iiiiiiutva. Of 
ooiir«e, ID liie front t<-«tb iunai caiiatic cannot be uwd, ovinj; 
tu thv diac<>li>nititin u-hicb it occaminin ; buL in tbe linck twiii 
UiD dark ataiu is of lew coimcqiietitfc. Tbu nnliiral cvilonr of 
tbe tissues ffveu in thv inoliir K'cth, should, if possiWo, bo 
prmrvn), but oot ul Iho ritik uf luein^ tlii-m :iltj^i'tbin'. 
Then l* another iiHvanlA;i;r which attends the tisr of nitraK:- 
tiTulvvr; il lias a iHiM-prufarrcstiti-' lh<< [im^n'wi nf itivay. 

Id cmneotiirti with n ^(m«nilly hciixhtfnwl wMi»ibilily, w 
wmtitlnuM liiid a ring nf docninpntflng and extremely wuiti' 
tire libtue vuciroling thu nvckit of ntvcml, ur pcthaptt all, uf 
tbe frunt loetb. Tim nitration of piut^^tn^ is ipiite out of 
Ibu quvrtioii, and the coni]ilt'tu dcfitructiou of the (peUi ia 
thwtiBnre rcdtwwd to ii men matter of time. Owing to 
\iff\zi\MKy ut M-mo other rniiw, it tuay he dfnira))l« lu adopt. 
uhhih lor alliijiii;! tbtf 4iis(;i>|itibility of (be tcrtb, niid nt the 
MUw! ttiiMJ tu |ire*erve tbetu. If |t>»ailili?, fur u frw ini.mtii8- In 
thi ircatment of ciuosof tbi» di<«cript.i>in, nJuatc of Oliver bua 
}auv(nl vvry voluablu, Tbo uulbur can call lu mind many 
caawt In which, by- the apjiliinttlnii of Itmot caiutic, )iKat 
ilisiY>nifurt wsa rutuovn], tlw |Ki»rnce of liot tir cold HutdH 
rotnliuvO loktible, and the UMllti allbougb bbcketwd at tlie 



SrSTBM OP DBXTAL StmOHBT. 



Decks, wera kept Crom farther (lcl«rioi«tioD Tot Bvo ut *ix 
jten. 

[t n»x 1>* "ti*^ <^h^t (^ Tor^oing tn»tmoDt bean rather 
npcm an almnnnHl uciiulitioii ut' the linuttno thu) npnc on 
inriUblo ODQ'litioti of the ptilp; utd tho uhjcctioii imy, in 
soma 0U8B, he valid, hut il will lie alinmt inipofwibk to 
(lis^gmah between {«m felt in the deutinal fibriU and in 
the pulp, uni] the diftiiietinn in mpi>ct bu Uie tn-atuu^l i* 
uiiiDporUDt, unlcafl the ailmont biw & coturtUationat origin, 
wticu il Uliutt ol' vuunsu be Iruilutl by reiuixlius whicb ojiHSie 
Uiruogh the ^neral iiyKt«iii. 

Atmi* jHJinmtnaiion f'f the Dentioai Pulp. — Tbe oeonrroDOB 
iir iuQaiuiiiutiiiii <^f tLu |)iil[> a luuitlly cuii]<eiiucut u{K)Ii it» 
expo«aro, broutjlii aWul ahhei by cajic* or llie accideoul 
fnulura uf thu tuotb. Nut th&t tliu pulp ia niura i-xeni]rti 
(Vom tlio occurrence of i&HammatioQ thna sotac other n>ft 
tiatiuw, bat atill Ute chhoh nf iili(i(«thic iltsraisc are not very 
frequent. Jti niiitrty-niiie coaw out of a buudrcil thu dia- 
oosi'ii action 18 omtiicqiient -oftm the iK-rforntikm nf the piilp- 
cavity. 'Ihe followia^j a the u«ual cour«; of tvtubc— A 
licrle itdiKuvmii iti a ttntth. I'uorl and other matM^ii collect 
ii) it, and ntti trout timv lo lixue ixiuovml. Tb« ivMCCtca o/ 
foreign bttlicft ut iin\ prxduow no iTtc«invcni«nco, but aflor 
awhilo CDTUun fiiib>taDCi>s, such as liiigitr, or silt, or ad^i 
matters, wbtn \iMi^tnl m (he tooth, rocnsion coosdonhle 
nuMduoM, wliicli ia, aftvr iiwliilc, exchnugttl for )MKitive 
pain. ^1)0 nsnoval of tha irritating matter in soon foUoircd 
by t])0 rcsi'Tation nf ooraforL Tbix &tate of things may go 
uu lur aume tiiuc, but, sooner or latur. tim |«iii, iiulMul ot 
paadng off, itt<.-ail)ly incrauKS, astuuu.'s a ttirobbittK chunctvr. 
bocomua fltill luuro acute, extcnda fTOiu the faulty tuith to 
kite iwi-xli)N>urini; tMth, and to Iho aide of the faev, Ilt4i luoth 
iumitiig the cuutrs of itfi intcnuity. After the ]n|»n of tume 
hours lh« fAin luiially «nl)si<]««. To rvtum agitiii va tb» 
aligbtaat |tniV(N:atioD, urou the |iatje»t luauiaiii!; the tuiri- 
zoDtal pwttiuu. If a tooth b« Mamiimd subttaquvut to two 



ACQTX uttlamiutiox of tbb tvtp. 



468 



I three, or perhap« cvim after oiio scverv aiuu'lc of tlirabbiog 
in, ibft |mi[) will U found to haw Wt ita riulity, aotl to 
liaVtf lasBixl, or to bo in the prnoesH of insEing. inlo ■ Btatc 
of deoomjositkuL WitL the deatli of tUo pul|i tbe infferiog 
ilurs niH neccsaarily sitl^itli'-, bnt th« character nf ihA pain 
Lvjrill Iw cliaii)^ Tho tbrohbiug ccsuca. and in iu place 4 
^Blnll. heavy pain, with a Wlin^ of tPiit«ioii, is IcR. The 
^■ooUt fwla too I0U41. utid JM, in fact, »lm^ iu tli« socket froia 
^Hbiokitntng of the ilcntni {cntMbctim, conRtiiH-iil upon to- 
natliriiatorr actiun cxtuadin^ from the pul() tu lliu suU ttsvufl 
kbicti cuuDoctB the root of tlis tooth to tho sut^kct, indi- 
MtiDg the oHnmenoeineDt of an alveolar aluKxcuL If Ihe 
,looih bo allowed to kiuud in the month without aduptiaj; 
i4.<«iial trcttlDiciit, ttie pain after awhilo usually KalMidea^ 
ud Uw elongation and t«ndemc8» of thn Uioih (cmdoally 
off. 'lite pulp-tsTity, uu cxaiuhialiun, will hi* fouiid 
Mtilatn decooipuAtng t'm^ieats of the d^ad j)ttlp, or 
irtidea of food, from which will he ciuittfil » pei:uliar 
lioaphnlio uiour, an iiidicHii'Mi lliat the pul|>-carity of the 
th boe been opcwd, and hoconiv the niccpUole of a secro- 
. dinliari^al, either frum a i<urtioti uf Itring jmlp^ ur fhnn 
! tunbce of an alveolar ahswsa. 

Sucli, liivu, is thi^ nsiiol cciurai! of eveota, when thp pitlp of 

tooth bevumo iuflanie<l. The naulta of iiitlatutuation 

Vf, bowevt'f, be modified by tho ooastjttitiotuil coudition 

Itf the puUnnt ; the sjiiupluinB may bo Ivst aovcre, or thc^ 

may bn firoatly u^^mvulcd. Id ainw cases the pain latti* 

but for a tibort Umr, and u eotttjArftiively mofterato in 

dcjgrcc, while in othcTs it in i-untiuuwl fur days with ^mt 

iuMusity. AuiaiDt iii nne com the alvuriar tutkuinialioii le 

«imUA, and in aiioihrr ilie whole moulh ImMnx':* allected. 

jdeut vf till! ojmtKuUonoI itatc, tiiesu diirvreueua in 

M'tll no doubt tUi«iid njwa tbt conditi<>n of Oio palp 

to tho adrnit u( actiru diawasu. Thu sizu of the palp 

ill exrrviie a vnry miuenol iniluonre; niKi thu ounilwr and 

iu of the ^lolitilos uf secondary dL-ntine witiiin iu Biifaetaitoe 



4&4 




snmc or sbttjll sunaaBT. 



will atw tend to modify- tbo soreritj of the STrnptotoa. Geac- 
nlty, tbo Hmalier Llie nTiintmt nf vasculnr tisBUe involretl in 
th« duteiiae, Clio niildvr will bo the kriiiptora*; it ii^ cou»e- 
(|iionily, Hi'trii liiat in 3>oiitig [lektiiltf in wboui Hit; pulp i» 
n:1&tiT«Ij- laiKC luid tlui amvuut ur sctxiaiUry deatiuo witLin 
its Hubtitaucv coiii|MU«tivi'l; siiiall, (bv nufletinf; to j^mt^r, 
and tlie iiilliunniation iiioK extended tium in oLder sut>JBCtK. 
The sitw of iiie npenuro by whkli tie pulp ia exposed, will 
•Iflo iudueucB iiie amount of sutfcrtQ^ which attaods inflam- 
mation of tlmt urgu). Luf.'ol ooiuitrictioii or an inflamed 
part, under all circutntttanoes, greatly aggraratea tbo faia. 
In a tciilli llie pulp ia uctformly oonflned, oxoeptiug at the 
{wiat wlicre tW wall ot tlie cavity baa be«a perforated; 
whon llic rpj»e'.» become diiileruled, and the more ftnld 
porliuii8 of tlw liluod are tQused, the pulp will eolofge at 
any point where cDlarpsnoct is poasible, nod It U oooat- 
qutrntJv pmtrudwl tJinm;^h the apertnre in the walU of llie 
pulp-car ity. The hulo iu tJie suhstauoe of the tooth ia 
always much Urger tbAo th« opening into thi* pulp-cavity, 
consuquuiitly that part of iho palp which has been pK»- 
truded throii}:Ii tho uurrow o|M>aing into the larger ipaoa 
may tbcrc Utt'iiic enlar^'ot). while the i«rt which oonneeta 
it with the pulp 19 coo^trirtwi. 
^!l'huru an; but ft- w of us who do not know mturihiii" of tbr 
which rc^ulM from dnwiii;* thd air from a corioitn and 
iiuhiii;^ tooth^Mf, in other Munli^ suckiiift it — wkrreby tbr 
atmoHpheric prod»uiv ia taken oft the expowd [wrliou of thv 
pulp, luAving the vessels unsnpfJorUxl to witbstaiMl the finx 
of the circiiUtion. The immediate rcsiiU ia, tliat the palp 
is foruod a^inflt or through thf o|icaiiig. and tn some mtn 
its Teuelii nre nipturnl. Tlie blvcJing m proilucud uot uo- 
tnmmoaly rclii-vut the distcudcd vcs^uls, and tlw inllnnt- 
niftli<>li in for tlie lime cbccknl. That which wc can 
|injdiu-e Qt will occurs, la a greater or lew degree, without 
our iiil^runtioci: aud the ainiHiiit tn wliicli the pulp is 
liTotnidod, aud the degree of strangulation which is itulticvd 



L 



Acun iim.ijaiATiox or the ruLP. 



465 



* 



hy iiie farm sod size of the aperture in tbe imlp-cavit)*, 
will, to iwime extent, gorem tha intensity of tbo psio cod> 
wxiueul upOD iaflunmatiou. 

Tbs trratmtnl of icute inflintmition of the ilentAl pnlp 
muBt )» regulAteil liy tlw slagu at which tho discasn ban 
Arrived when relief is eoagbtt aod ibo general ooaditiou of 
Um crown of the tooth uiil of the suiroundiDg part*. If 
than is rewoQ to belieire that the iafiuumatioo hiu uot 
catended to the alveolar pcriosteam, remedial trofttmcnt 
may be adopted witli a fair chance of succosa ; but slionlil 
it be found that the pulp of tbe tooth is paamng into a staio 
of daarguiix^tioa, and that suppuration in the socket ben 
commoiioed, tbe temcrai of the tooth ofera ibc onljr ccrt&in 
■ad speedy nu«UB of tenoioatinj; tbe diwiue. If tram any 
ORtse that operation is rendered ohjecttooable, the pain 
wbirb attends tbe prooesH of enpptimtian may be mitipiti!d 
by the uw of dflooetiou of poppv-hnids hnld iii the moutli, 
and by making a frei opening over tbe root of the tooth, «> 
«Mu m» jnu M fonned. Ouo or twu loeuhcs api-livi to thu 
gum yviii oftentimes be aUended with odvaalagc, Init I hare 
ooi DDeaainionly been diiappointcd in the resuIU Tbe 
rwaedy has aggravated, rather than alleTiated tbe "uflering, 
aad tht? rnnnation of puH anil ite BuiK^t'^tm'nt eera|ie bare nnt 
been uAterialty battened. 1'lic trcatucut uf alveolar abeciM 
will, iMiwevor, form thosubjwt of a ftituro Bccli-n, and ihe 
vlnatnunit (ui the pr«>«rvaliDn of a tooth so affected will be 
diacQKaed. 

it, however, the diieaee be limited to tlie pul{», wo ha.vv 
ret to ctnuider whtrtbir tbe t-rotrn of the tooth is in a snfti- 
cicnlly fpoA elate to tvuder its prrxiTVitliou dt.-!<irHljle, or 
wbetJier, ID the case of a front toolh. the root should be 
i jB T Od tu st)i>]«>rt nn artilieial crown, secnred by meann of a 
'^hvL ia dtcidinit thew questioba, the geoend state of tbo 
gUTiMi, tbe idlneyni^rotiy of tlie patient, nnd tbe c(rnditina of 
the tooth in rcHti"^ lo the state of dovtilupuiGtit of its rugtsi 
'tnuat be taken into necount. 

2 u 



aitdt 
i» Wn 
■ will. 

1= 





BTSTSM OP DR5TAL BURGBRT. 

If the !i:utng aro in a thickened and nohcolthy stub), or if 
the jnUeut be liublr to ncurnl»ic |«iu ubuut thf face linil 
i»w». «>r (thouW there be reawm to nuppfwo ihul the raot* KW 
not fully (iDVcIoped.antl the apprture at tlioestrfmitT of oadi 
root coutnutetl lo its ullimiUe atzc, it will be well tu removo 
the tnoth. lu t4)fi nhsMticc of any disqualifying cniuiitiDii, 
wc uin; s'lopt ft |)la.ii uf tr«ntmonl for the prwerratioD of the 
UMth. That |<lim will oonaist in tlie application of an w 
charalic fur the mpiil datlnwtioQ of the imlp, with the 
view of filling the pulp-cavH;, and making jtood the tnjnivd 
jiortioa uf Ihr (uuth by oieiLtui of gold, w mme other ma- 
t«riji1. ArMMiic, when nppliorl in the num&pr alrrjtdy iv 
acnW'i. will bo fouud to be tb<? b(.'»t a^ut for bnn]|;iu;! 
«h>ut the result. Thu fain pr>xliiccd by tbo diacuo is 
caldoDi iocrBanod by the areenic; iudeudt it is not uouni^ 
for the violent tlirobbing to bo almost immediately ex* 
chau{^d lor B dall aching senaiUuD, which paMMBway lo 
the counM of four or firo hoiirs. 

Chranie InJtammaUon of the Dental PvJp may arise indo- 
pendotitly of c&ries, or of the mechanical injury of a tooth, 
bnt pmcticftlly its occurrence may be ass«n>c<\ to be coaie- 
^uctil upoti, atid a3tiiu8t invariably ooiucidenl with, lbs 
proAoaoe of ui opening iato the pulp-cavity. It differs from 
tbo aoutB form of the disease in the l««t active chftrai^ter of 
the nymptonu, and also in tho rwuUii tn irhich it IcwU. 
llie jiain ia seldom long continued, or very iutonse wbca 
pTMCDt. Il gctieraliy comes on at irregnlar iDtervalat ft 
l)erindica1 character being observed iu exceptional cases only, 
althoiuzh Ihow partial inflamiuatioos of th« dental pulp am 
aprciiilly pn>n« to aet up wanderinj; neuralgic puina, the tnie 
oirigin of whidi may be obaoured 1^ tJi« complete ab»ence of 
local loothncho. A euddeo change of tempemtore, the A)ipU- 
caLion of an irritating sukottaDDo, aach aamlt or 8U;;ivr, nill 
generally bring on a paroxysm of |nin. 'which may oudure 
but for a few niinutea, or may last for SL-veral hours. 

On csrefully exaininiug a looth which give* lioe to the 



OHSOHIO mrLAXHATION OF THE PL'LP. 



467 



Ig •>i»ptoms, it will be rouod tbat the pulp ftt the 
pnint hM aMtimcd ■ deep rod colour, is oxtronii-lT 
■ansitivfl when touched with kd iostrumcnt, and btfdle very 
nadily. If the tooth be remoTed, aod the crown brokeo 
throu(*h so as to expom tbe pnli^ it will tben be (tM>n ttiat 
the iiijlanuiiatton has been ltmit«d to that part which woii 
expoied, th» remaininf; i>ortiun of th« argau biiviu^ rttlained 
tbe uormal pal« colour. Bad the dlseiM assumed the acut» 
farm, the whole sulH^taDcn of tho putp would have Iwcn 
injected with blood, the exposed port beiag dUtiogaUhed by 
tbo groBler intcDsity uf its ooloor. 
In tracin); the aereml ooaseque&ces of chronic inSatumft- 

Ition, the first which ahould attncl Attentioii i» the change 
in the character of the expoMd portion of ptilp. It becomes 
for tJio time being an orgnu of secretiun ; purulent or Rcrous 
flaiil in poured out from it» surfiuw, tbv amount sud characUu' 
of lh« ditchnrge vaning with the general health of tho 
patlmt, and Uiodc^rix' or irritation to which the diteased 
put b&s from time to time boen 3ubject«d. 

Sajifiosiii;! this nbuoruinl ooutiiliuu lo he established, the 
proecDce of pnin i« not n n«oe««ary con«v^u.enc« -, and it ia 
{inimrtant tlial the fact tibuuld bo ko[)t iu view, fur nhotild it 
be aMumcd thai the pulp ia not expo«ed because th» patient 
baa ii(>t BufTcnd froni toothache, aud a plug be tiitroducnl, 
it i« highly probable that tbe tooth will be lost. The dii- 
ehirge will h>^ Mncfcad in by the plug, aud its accumulation 
will, in tho ninrse of a shtirt tiniL-, bring on an attack of 
acute iuflamnuition of the whole pulp. It is ttieo?ftire of 
grmt oouseqiience, before prDceodiog tu trml a carious tuotb, 
10 aacerfaio whether the pulp bo exposed or not. Tlko 
^_ history of the caag will not always determine the queetioQ, 
l^nod the poaition of the tooth, or of the caTtty in il^ may 
^'^V: such an to rciidor a ntjnfactoty inapection difficult. 
The proseooff, bowaver, of that peculiar pbotphaiio odour. 
to which allitmun baa been alrmdy made, ia a tolerably 
on iDdicati<ja that tlte pulp ia fixpond, Ukd th«t a aacntioa 



468 




STBTKSl or DBSTAb SVBOVaT. 



NcapcB IVom its snrfacft; ind it it, moreorer, a sufficknt 
wiLmiii;; to abetain from the immediate introduotiim of a 
penuancQt |)lug. 

A »«contl ri'Kiilt of clironic iiitlnninuilion is llie rormatico 
of ao ulc^r, of a v«r>' poiofal auJ irntaUe kiDd, upOD tbs 
QXposed surraev ; ami a thinl coii««qncnco ie iho dcrelopmeot 
of grmnuUtloas, whioli ma.y erow until a mau U fonued ex- 
cimling the aix0 of the pulp itaelf, aiid. In some caacs, com- 
ploU>ly filling op tLa cnvily produced by tb« dMtnicUoo of 
the cnam«l and dcntino. Tbia cuuditiou ie usually do- 
scribt-d aa polyiniH of the dental putp. I1ie morbid growth 
IB uot neceatuinly very scn-iitiTc. It bleeda nadily, aad 
ODita a very utTetiaivu aecrctiuti. 

There are other t«svi\u whicH at:rad chronic inflaininaiion 
of the pulf.^ Uqu ouafii»ts in ih.'ti gradual iliKappcaianoe •>( tbcp 
piitp witliont ptin, and conseqacntly withoiil any Byinptoiu 
whii:h attracts the attcjititka of the [aticut. The practittuucT 
liEida the pulp-cavity empty. 

The TGHtills of iiifiiuiimntion hitliorto mcntioited are de- 
structira in tlwii Inulaticiea, but tbo preaunce of diaeaae is 
usually attended by raparative eObrts. The development of 
iioduivs (jf dontino in thv putp in almost invariably coitt- 
cideut with the wrctirmtco of carina; and tberu ia no reaaoD 
for aaaumini: that the prooeu of formation ia arrested in the 
comparatively healthy portjoa, although the L>x|K«ed mirfiice 
of th« pulp iic inBaiiied. But there seamed aome rsoMQ lo 
doubt wheihrr the ciiosed siirruco vould nndi-i}^ (»lti6ca- 
tioii. Hr. Amuld IW^eni han rrcviitly placed at my dia- 
pOMtl a pr«pflTatiun uhich, 1 thii>k, seto the question at rest. 
A imtifut iip|ili«il tu bavu the roulit of a fint moiar niiuoved, 
the cri.iwn baring been brokun oK nmiiy iiMinthA previously, 
whei), fur the rclif^f of pain ooniu^quvul U|x>fi ciuiua, thuAX* 
traction of the tooth waa attcmptci. The pain ceased after 
iho ftncturu, and the ruulti irl tbo tiiulh wtro sllowod to 
rcniaiti. After the la^Kc of aomv uontha, the rotnAina vt 
tbo L(uken toolb cftMati axk\w'ja»w»t«tt'i.vW^ nk*™ removcvL 



■ 



» 



obhonio cmjuuuTiDH or tux pdlp. 



469 



n§. in, (I) 




llie Bfieciinea (l^ig. 1!>2) sIiowk that the tootb iru broken 

thfough About thtt mi(l(ll« of tlte putp-carity, projecting 

from which we nuw Qnd a mam of ae- 

0Qii[d4r]r dentine. It Dot ouly projcctc 

(rotn the cnvity, but lian^ over and cun- 

ceala the itharp edges producal by the 

fracture. It ta obvioua that in this cjuc 

the vitality of tlie jiulji was mniDtained, 

that it beciune «olarg«] aulMef^uonl to 

tlw unmcceasrui o^ieralioii, uhI afl«r- 

mnb calcifleii. 

There u no PTtdefrco to show that sucoudary divtitine can 
be fam]4<<l in any other tissue t-hno drnlinal pu1j>. In the 
cue under contidcrftlinn, tlio Kwundary dcntiae paaaos over 
tlie normal boun<iary of tlie palp-cavity; wc t«re th^-re^orc 
jastified in aMoming that the pnlp itw-lf becAme enlnrgnl. 
Kow, the tuotli bad aclied before ttie |>riinary operatiua wiu 
nl, and it may tbfrtfore bo taken (or gratil«il Lliat 
pulp was at tliat time more or k-M inBaiucd. 'i'liews 
Buria, althdn^h taken from a aingle coso, wamint the con- 
cluaion Ltiat thcr<> am circiinutanon nnder wliitih the dci>- 
tin&l pn>p, although it baa been diseased and ezpoaod, tnaj 
be ooDTftrled inti.) Mcoadary dentine. I laving oalablished the 
fari, the preoite nAlorc of the circunutaoces which favour 
this re[«nuve actioii aliunld bu detcnuiaed. 

lu the case cit«d the Hootwlary deat'inc was exposed to 
view whvu the polioot appliud lu Mr. Ro^eni, but the 
pulp, during the proceas of calcification, muit, I think, 
have bcui| pnitccLcd in tlio first instance by a ooagnlum 
of Mood, and nibMqueatly by a perfect covering of or- 

(1) SbMM tb« tooM aad awk nr an upfrr moUr uwa. tb» avwn oC whkA 
imI Inca iMkra uff In imaiftlm lu KSiTMikn. iDaa ika* alterwMd* 
Uh mou wtK miwvfiU mnt It wm Umi iammt thn a hmm «t mttmi^rj 
tertiM jir^iclil iTun »ul utvTtiaaB Um (ur(i<i* of the w Mtelng rcftiM or 
Ikt iMl^ntr- A ■inilv vpedtMA l» ptaMt kr Um 4M« of Utk la On 
04dttial«t(m(6wl«iy'iiiiUH-uai, UMhUturrur wlilrfaH prntelf ibnllu. tW 
!■■ laiMilAturtiiwiiM MkvwIldlMvc Vftlf4«MtTt\j.«ttJyBttA«rKhM>vi, 
Mr ito Aflfi aM UH> ftjuaMl |Ki J|i. ihM tlECK4kiK 11 vntaOtaft. 




h 



470 




8TBTCH OV DKHTAL SCUOtAX. 



rtf. IM- 0) 




f^nitiiA tiEBiie. Hud it bcmii otliorvrtet!, tlie jHiIp would 
jirubably hare be«a iQJuied and ultimately destroyed by 
magiiokcioQ. 
1 ua nut acquniulcd vnih any caw wliicti old be Kgardad 
a» Btrictly ]virallcl ti> the foregMng;, but W9 
nijiy fiud iuBtftnoM— if a number of tectb mn 
dii-lfinl — Hhawiug that the hulk nf the soft 
tititiiiD had bc«a calcilied, althi>a^b at the 
Itoint of vxpostirp the ivurtTKion remained 
inoompleto. I bclicrc it ont iinonminanly 
bappetw, that ihu cALcifioatiun kc«|« id ad* 
vAuco of the iirogreu of carivs, and thus |jn>- 
tJ^'its Ilic jiwlp from Bxposure. But such teeth 
an not rcmuv<>d. imd thercforo do not ootna into oitr handl 
for examination. 

AllimiuD lias already been mode to the &ct thai cbruolc 
jo6amiualioD of the (>ulp may not be accottipaDte<d by [wn 
in tlie booth itself, yet that it may cause »evcr« eyin[iotb()tio 
puns ill the head and face, and that tha pain noay ettaoii 
down thc^ nock ii« fnr asi thi> shoulder. I lymeniber a n» 
ID wbbh tbo patient aufFcnsd aerere jiain ua one side of the 
head and face at tolerably I'cgiilar iniervala. The pain i.»iu# 
QQ in the GToning, and lBst<Nl for six or eight hours. It was 
for aum« weelta regard^ aa a caae of tic, or betnicrania. 
After iut«rnal reraeiUea bad failed, a decayed but painless 
wisilom looth 'if the njyper jaw was romoTed, and from that 
timu thu Ijidal pain dimppearo'l. Tito pulp of tliL* l<xA\i 
was ex]M»cd and infJAined at a point oonvspooding to an 
aprrtun.* in llio pulp-cnvity. ■ 

Treotmtnl. — The same geiien) principlM thnt were staled 
in respect to tlie tirntineiit of acnte iiiust be aclrd upon in 
the Dianagement of chitjuic inflatmnfttiiX) of lb« pu]|h Be- 
mcdial meusures oRtr but a very small chance of success if 
the dtwase baa uxleudod beyond the liuit« of the putp^ and 



^ 



» 



CHBONIO IKFLAIOlAnDN OV TBI PULP. 171 

it wnnlfl be tUelcsa to atli^mpt the pretervalion nf a tooth, 
tbvcroirii vf which couU cot lj« reiMlored uffcctivo, by fittiag, 
aoless, perliKfK, in tbe emte ofii rmiit tix^tli, tbcr root of which 
it may be desirable to proBerv& la polyjiiis of tlio pali\ 
prrterraitirv ircatmeQt trill inninlly bil, owin; to n cninoi- 
dent Bitlitrgcinent of the ai«rltire at the extremity nf tho 
root, ami to & morbid condition of the veowU nnd otbpr 
UflMM li> which tluit aiwriure •;ivei [mnnge. 

K, however, the diwaMC is strictly limitH lo th« ptJjN 
and the symptoms also sra strictly tocal, tht- chaDC» aru 
La fiivour of aucccas, if the |«tieDt wiU oubuit to the 
DecoSMfy trBiitnient. The pulp may be df^strnyod by ar- 
aenie or othei lutioiii, nnd the cavity filled ; but the atroog 
(ondBooy showd by tho {nilp In fonn accondary dentine, 
ami thus flhidd itsiilf iivm further ii^jaryT dhould, if pot* 
siUe, be taken ndvantaKr of, i^oa though Ute pnK«fdtng 
aiay inrolre a iiiiirh longer nnd more trtri hlesninc iMmnteof 
tnaliiieiit than would be required if tlic pulp were at onc« 
deatioyed. The prcM?rviiiion of a |>ortiou uf the piilpi and 
ooQseqticnily of iho vitality of tlo dcDtioe, renders tbe 
tooth tniich U-» liablu to attacks of alveolar abaceaa thau 
ft woald hare beeu had the fi>nuer part been lost In adopt- 
inj; this counc of tr«.-atnu>nt, we muat address our remedies 
to the exjKMcd Biirrace of the pulp with the view of atreat- 
ing the lUitcharge to which, whm in a iitntc of chruiiio 
taflouiiuttlion, it ^ixix urj^iii. The daily ap]>lii:attuii uf caai- 
pbont«(l ^irils of wice. or of a eolutiua of tnaatic ia sfoiil 
Dpoo ootton-wool, will, if pfTscTcTcil in, produce the desired 
ifl'ect in the majority of cases. At &nt the cotton, when 
ran)o\t4 fri>Tn the tj>oUt, will be strongly taiotnl with the 
t«culiar phoHiihatic humII, but the inteatdty of the odour 
wUl K'luliially dinuniKb, and after a time altogether dis- 
appear. The part uf iha cotton which has hoea in oon- 
taot with thu pulp, at first «tainvd by tbo loorUd secretion, 
will, when the discbarge ommo, no longer abow any mark 
lit dtMulnranW Auotbfer method o( txca)CDM&x, v^oK^t 





472 A BTSTSai OP dkxtal sckokbt. 

•ffeotive, ATid in my hands man mticfftetory, u it raqniret 
» tw» oxpenditure of time ax\d le« froquont reiMVidii of 
Um T«nnliul ii$;ent, conirixU io the nppliotiioo or ft ioft 
inftM, ooin|>08&d of Unnlo, mixed witb gutta-perclta in- 
duced to a KoUtiiioiLS cxinsietvuco, with clilorofonn. Tlw 
astringent properties of th« tanoin act in arreetiQg tlw dis- 
charge, while the gntla-percha twlds it together, aiid eo- 
ftures its contact with tho pulp. Although the soft plug 
will last Tor some days, it by dcgiv«s vtate* away; *till 
th« renewals are required Lew^ fmxueDtlj tliau when the 
rottOD and epirit an uMd. 

Hut the ftgenU of tnoiit raluu ara pure cnrboUo add and 
thymol ; they sbould "bo applied on a small pU-d!;ft of 
wool, and Bcaiod up in the tooth by a larger plodgvt dipped 
hi a BolutioD of nome one of the resins ttsed for the par- 
poie. 

Tbo tontment having been eommeotxd, the remodtal 
ai;out«, whatvver they may be, must be appli«d unintor* 
mptedly, olherwjae tho chances of a Buoccsshd result will 
lie but poor. It is use1i!«s to apply an aetrin^nt oao 
day, and on tbo next Icare the carity open and tlw pulp 
miprnteeted. 

It will l>e apparent that where the aperture in the pnlp- 
cavity is large, any kind of soft plug wonW, imder very 
modente compremioo, adapt itself to aud bear painfidly 
upon tbo expoiwd surfAce of the pulp. To this circiimsuntv, 
and to the want of perHereiaaofl on the jsu-t of the pntii'iits 
when th4> tiy>th admit of prooervation, may bo atlril>iit<d 
iiiauy of our Gnilui-eA in the tr«atni<:'ul <if cases which it 
the onset promised fnTouraMy. Assuming that a suoci!s>> 
fill iaiiw may bo ubtjiiiimi, wo shall hnvo f^nst diOiculty 
in foretellinc the time that the case will be antler trcM- 
mcnt. I havD known iniftanceH in which all Kigtis of 
tlischarge from the pulp oeasod within a (ortnight ; bnt 
i iuive also met w\th Tnan^ ftnom^les which were t^uilc 
lUWODtrolIabla either \jy rilodtuASs wi^'a.VVia ^A. vanaa at ^ 



CHBOXIO IXVLAHBUnoK OF TBB TVhV. 



473 



I 



I 



utringeoti. oi Ul<l^e0 hy aq; kiod of trcatinvut sliort of 
ttic actual (leRlniction of the jiiilp iMolf, No doubt Lbis 
onMrtuntjT u to the n»ult is la part du« to the difficulty 
witb which the diaoMed stxnctiue is aeen, and the state of 
diMAM ftpprecigted. 

Tbff BL-Lual cautery, afi^Iied bj meaiu of the batterr, at 
one time obuined a certain amount of GiTour. Some 
d^toen years Hiore I tm-d the w)iite-hot wire In the treat- 
ment of a coiwjdrmhlo iiiiiiibi;r of caaea, but fiulioff to 
prodnce any permuMmt advauta;;?, the u» of the b«tt«ry 
hUr up tu the pcTKCDt time, bveti alNUidaoed. Ae a imwis 
of deatroying the whole body of the putpt it is mora 
pain-producing than nrsemc, and luos coDi|deta in ita 
action, owing to the diflictJty which atteiidii the intro- 
doction of the wire into the pulp-cavilj of the body and 
nwla of the tcwth. 

Thow who advocate the u«e of the heated wir« direct 
Uiat the ezpond surface of the pnip shall be charred, an 
operation by which n Bccretinj surfftce is rcdooe* to a dry, 
hard scale, and thervCorc fur thi- liiue dei)rived of it« tuy 
oretiag power. The tooth ia now to be plujrgcd, incloaing 
the btirut tisBue ; fur if we do not prucrad to plu|; the tuoth, 
tbe eacbar will be tlirown off, and will leara behind a »e- 
ereting anr&re. Thttre will, in fact, Im a n'cnrrence to the 
Mtot tiate of thiuK* that obtained prior to the application 
of the cautery. But if the tooth bo at once plagued, will 
tha eschar separato in the manner which cschan umally 
•^rat«, that ia, by inppuration ; or will it dct«<'h iuclf by 
daaquunfttiim V If the treatment be «icc<K.<ifiil, tho dctUL-b- 
EBont of the burnt tiwue mual bo effected by the 1att«r 
|VOoeM, or it must remain in connection with tho living 
UatiW. Id tj»e oasea treated by myself, the BUppurativ« 
|voooss was Mt np, the attendant iatlaniiualory action ex- 
iMlded to tho periMteiini, and tho teeth were coDsaqucntly 
losL It (h i^Mibtv that there nr« otfiditious under which 
tho trratjueul Ijr eJcctnc caulcr^r w\\\ Vk aUei^A&i -^"^ 



■^ -'- *■ 




474 




A BYBTSM or DIHTAL BIHtaCBT. 



kdvknUga; bat it ia dUUoult to leoogBiM them, uul iu 
the abMDoe of praclM kauuinlge, tlie operator is forced ta 
ttlmndou the use of an ft^eiiL tin? iadlrLV^t result uf whioli tie 
is un&ble to predict, auJ tlus pr^tice baa f^ndually fallcD 
into oomitlcle disuse. 

VfhvD tb« rxixnud pulp h»a ceased to discharge^ tha 
sooner the cavity in tht^ tooth fs waled up thu WitfT. In 
oooductiii^ tlus ufivratiuD, can niuet be taken both tu nvoitl 
oomjpraaaing the pulp Aod mibjocting tht tooth t» an on* 
BBCWiWry atnuuDt of tnaoipuiatian. The forco twcauahly 
employed in prodncing a i;otJ plug, and tbe rapid ooDtductr 
iuig power of ao auialgaiti plug, render each ol>Jecliftnable. 
Tbe dindvaQtngfl vLich attcodi the \ao of the latter may 
be OTenomc by capping the pulp with a Don-condut-tiQ); 
flabauuce. A better ruult will, bowcvet, follow th« ioUv* 
ductiun of a gutta-percha plug. In tim materia), aa jm- 
pared for dental purimses, we liave a [lerfect noa-coiiilucUir 
of chnnjeii of t«.>mporaturo ; it ia re*dily applied, perfectly 
exuliules ftXxl ami Kaliva, uud is cAtily rauiovvd HhutUd Kymp- 
toms of intlamnmtiou of th« pulp come on. A plug ao 
formed tniuit Iw tbgarded aa t(?U))NH^ry in ite uffecl. it 
will iMt for many months, or bvch one or two years; but 
K> aetrtn a test of ita durability should not he tried. It ia 
in aomo c«m» vn*ier, and indeed better, to oae liuc oxy- 
ohloridc as a tctnjiunLry tiiling; it in lun dunble, but that 
ia Qo objootioD, aad it cau bo iuaerted with 1d«s disturbaooo 
of the covering uf tUu pulp; hut ihia latter mu»t \)C carefully 
guarded againet contact with the xino »lt. If, after the inpae 
of ihroe or four mouths, the tooth is free from all agna of 
abnormal suaoeptibilily, the gutta-peroba aliould be removed 
for thi> purpose of suhstituting a permanent pltig. It ia 
Well not to hurry the final oiwtation, hut rather to re-iutru- 
duco gutta-pereha when there is trndoraeM or any other 
iodicatiun which would throw a doubt upon tbe capability 
of the tootb to bear tb« iosortjon oc the pieaaaoe of a mel^ 
plug. 




* 



OHBOMIO DfTLAniATIOK OT THX FtTLP. 



475 



Although every reaaonahlfi prccAutioa bo ndoptvd, a 
eerlaiD Dumber of cftsee, which at ibe tjnu ap[tearal per- 
fectly »uon?Bsful, will, aft«r the lapae of throe ur four 
numtb*, ^11. Ilie tootb uiwx|ieGt«<lly becomes teDd«r, ft 
ferUng of tension comes on, toon to he siwcwyied by ilirob- 
bing pain, the uhuh) iodicatioiui of acute intlauiuiatkiu of 
the paJp, Either the plug or the tooth must bu r<-ni»ve<l. 
If the Conner course be taken, the pulp may Iw destroyed 
with arwnic, Btippotnog the disGSM to be altogether within 
tliB aobHtanoe of ihf. tooth, proceeding ia the aaine manner 
u in the tre&tnumt of acute inflammatioit of the pulp. 

In old aga tbe pulp, Co aotoe «xt«nt, ahrlvcia, aud be- 
couaa the s«t of varioua i]eg«ii«ralire procc««e«. Thus tbe 
arterius and vpins bircumo tudiBtinitiiitihahlf^ und their <xMts 
are kopt rigid imd diatcuded by irregular catcarcoux ilepo- 
sitlons upon them. TliromboKiH of the veasels occurs, and 
the olut« ofU:u di«urt;uniiw, «> that cryttals of cliuleitturiuc are 
koiOfi la thetn. The aumo trunks at the some time undergo 
(atly disgCDxintton, aitd tbo udontoblaat layer Iomu its dis- 
tinctive characti-rs. 

Tkoaa itanie rosulta may follow upon irriUtion of the palp, 
even fa young people ; indeed, whoa a portion of the pulp 
has been lost by Hupptiration, it is utiiuil lo tinii ilint th« 
remainder bas toidergoae di^oeratioa to ■ greater or iesa 
extenl, a bicl whitdi lerrea to explain the p^nleaa disai^iaar- 
uccofiDcb pulps. 




( 476 ) 



INFLAMMATION OF THE ALVEOLAn 
I'ERIOSTEUM. 



I'he iaflammiitory affectiotu to vhicb the Uaing mi 
brane of the BorkcU, or the intra-AlvcolAr itcriosMum O, 
of the teeth is liable, at^mit of diviaiou iuto the fullowiog 
grcMip* : — 

The first will include gsnvnil iaflamniation of the alve- 
olar tnembratw Affecting the Kcltet of ewh tooth, or, 
all events, the mftjoriiy of tlie teeth equallf, find dependet 
for it« origiu iip(^>u a (.-i>D»titutionAl couditioD, such as rheo' 
matiani, tht- i]r«i«!»ci' of luercurj' or some other agent in the 
Jijttdm, Arc. ^0. 

Local infiamniation inTolving the sockvt* of oDe or tvoi 
leetli, and dependent upon & local oaus«^ will come -unc 
iJie MKond division. 

11i« cawtes of porio8tilis Alx>iit the jaw are varkous; thus 
it may be ict up by the inhnUtion of pko»|)lionis fiunc 
aud uUiiimtely f^ve rise Ui phuspUuruH uocrofiis. Or it 
arise in a acrofuloiis person ; or, again, as a result of syplul 
or rlieamatiiim. In any case cffiuiioii of serum lakes pL 
between the lx>ne and the periosteom ; thi« may be abaorlied, 
ur fu>ft>-n doivii into pus, or beoome orgaDisod into fibrin, 
and thin fihriu a^^aiu inLu true boDO. It is pointed out by 
Mr. Wood that the hnrdeniog )• more common in a rbeu^ 
tnatio than in a iitnimous or syphilitic node, on aoooiiat 
th« greater readiuewi of tUu fibrin to or^^anlse in the for 

(■] This tinn I* ui(4 ta (llinlnKul*h tbc p<t1i*tcvm vUcti Un« ifao I 
«r tbe lertk Ihn that itfakb eurcn Uie cola vftlU ot Uic tlvniU. 



r 




I 



t»ri.AHiiATiov or TBB ALTKOLAB nuoiTsmc. 477 



diaeaM, ftud aa a ooDaequcon of tliis neoraia is much tesa 
tikdy to entnie. 

iDtense toothache U an eatiy Ryniptom of rtwiimntic pe- 
HostiCiM, wliicb In, like olbtr rheamatio ailmctita, tnvatly 
»ffect«d hj tb« VMlber; tbcre is not much u-ndcncjr to 
Uiog ur lu xuppuraltou, wliereM in Hcrofiilar )«niwtitiB 
i« pftiu U often sliglit, and the swelling U usually COD- 

ble. 
At the outMt of geneml InfifttumAtlon of th« inlra-alT»- 
olAr pcnoatfiun, tlic Srst indimtion of thu fm«ciioe nf dineaae 
fuuud in Uie K^uU. the imcaainess in the first instance it 
if thai kiQtl wliivli provokes a dispueitioa to griod them for- 
cibly logvtber. Fur tie moment, the pressuro of the t«et}i 
Into th«ir aoclcct* give* relief, hnt iho fcolings of djioomfort 
sfieedily return, suvl io lb« oount) of time they bcconu! iin- 
piMaantly acnsitivc- to preacara^ Tbia ii saccoeded by ii tvii- 
d«ru.-y to ache ulighUy oo tJieir tetnpenttire bring diftnrbod 
by a current of cold air paiatog over Ibeoi, or by (ho jin]- 
wnoc of liot or cold fitiii^s. A» tfae diseaw prograaoi, each 
looth fccU Ivuglhened nnd looaaDcd, and c&Q no longer bu 
tiaed ill rawtticalion without iirodudni; a cunsidorahle amount 
of )>aui. The patient restricts biniiwlf to sofl food, and takes 
even that with aotno diTgnH< uf cautJon. If th« ttate of the 
moulb bu viiaiiiined, we aball Imd that the diaeow haa cx- 
tendeil from thi> inni?r to the onter covering of tbe socknu 
and to ibo Kums; Uuil tbu lottvr are nf a dark colour, 
tliiokened and vaKuIar, with ttio free ctl(:o imire dwply 
coloured tluiii the surroatulio;; ]arts. fjicli toorh may be 
morad altKhUy from riAe to side with the thumb and finder, 
a omiditiim due to thn thicheuM nratn of tho lining mem- 
brane of the socket, and tin conMn|uent cleratlon of )be 
toolli from ita |««|wr level, 'the severity uf the HymptomM 
wiU vary from day to day, u tbe genciral flonditftm of health 
La bettor or vone. When th« diaeaso is BBieolially rbmi- 
ia character (and it is to the dlaeaao when ao tnodifl«d 
tbe Kirogping deaeripUiMi u more capedally ap]4iciiblc). 



478 



X nSTIH or DEKYAt BURQEltT. 



the inllamtuation soldotn adt-niwes heyoEul a oongestoil state 
of th« reoHeU, with clTiuioa into tbe mnouDding tisaties. It 
ii only in exUHjtnoIy aerere oww that mppiualive action is 
wta1}tish«d, to/i In than tho atcrotion uf pm u limiud to 
tbat portion of the alTcohr msmbrAac which merfxa into tlio 
mucous luembraDe at the nwks of ths teeth. The piiratent 
discharge oozen \ip hctwDon the gums and jthe tMth, awl 
may gcncmlly Iw lendernd visible by milking preMium npoo 
the former. The state ie altoseihcr diflerent from that of 
alreohu alMceas or guui-boil. In the fnrnriur the [nv it ftf 
diiood at tho necV of the tooth, ami findii a ready ooape ; in 
the latter, it \» furtuvd alxjut Uic ruot of the tooth, la unetoBMl 
within the »tcki*t, ivml bas to find its vay cithiT by thr side 
of the tooth or tliit»u;;l tliu Ah't'iilar w-al! to tbusHrfaceof the 
gum. 

Pmlongcil inflammation of the nlTpolar Tncmbnine may 
leiid only to the ah«orptioa of the alwuli, and. this, vrith tlie 
couKcqiieut loosening aorl loas of the leRth, is the more onm- 
nion result ; but oxamplcs are not wanting to show that the 
vippurativc eUite mnj', in enfeebled and nnimou) mhjccU, 
bo fiiicceixlod by ulceration of the fwfl part«, and necrocii 
of the alveolar margin, inrolrinz, pcrhapa, tbe loss of a oon- 
xideraUe portion of the jaw. 

I hnve seen a few c»i»s in ivhich the inflammatory actioD 
bas ulliiDat«Iy led to tin' production of inrfie florid Kranola- 
ttODS. They hAvo siwuo^ op close to (be teeth, the crowns 
uf which have bnen, in great [Ait, ovomtn nod rbacurvd by 
tho morbid growth. Ibc patients cotopUiaed of i«tu and 
tendomeBS in tbe lei-th, nml pcrfprt inahility to use th^-m in 
the mastication of food. 

WliHo intiamniation of the alveolar periosteum is con- 
neclM with a rbcum&tic state of the oystum, tbv prind|<al 
iuilicatiou of tbe prewincc of that disctwo may at tim^'* he 
coufiii«d lu tbe stale of the tcc-th and gums, but tbe nhnor- 
mftl coDdition of thmo parts, when bo afi'ected, am icarottly 
bo a&id to imeent a specific ehanicter. The paliont wtU 




I 



txTLAMXxrms or nu alvkolab pkbioctvcii. 479 




kttritmla Ui» visiUlioo i>f digeow to uxpoenrc, to a drau-ibt, 
to bavmg UkpQ colJ, and will t«Il fuu that tjie feeling of 
comfiirt will Qow, as bcretufore, bo rcsturul in the c*.>ane of 
fcwdnys. 

'Iliera are, however, cbsdb of inflnminatiaii of tho alrmlar 

Eperiosteum wliich prcMOl « specific chaiactor, liavu • KptKiGc 

ouiin, ami ftillow n K]«y;ifio Ltmnw. Onv of tliu cfTucts 

prodiicod wWa ths syKtem ia bllia}{ oodur tbo inQuence 

of tnvrcury, i» s coaKt-stod sutte of tho tchwIi of the 

alreolar periostcfim. Tho tccil) hnoomD tender, ctoiigiitcd, 

ad looav,. and the breath tAtDt«d with ib« mercurial 

Btar. I4!i ihc eihibition of the uiincrHl \te cuiitiiiunl, and 

;f> sloughs will Ito tormtd npon the iuSamed [«rts, sad 

jrtiuns of ihv alvuoll, with tho ooatuianl t(.<oLh, n't!! be 

||o«t. If, oil the contrary, the toercury bv discootiuntd 

rbeit till: inflammator]' outioa ia, aithuugli woU marked, 

lie ia amount, tbe itiduc«d disease will gradually 

ide. 

Tbe following fiulwluQcaa are tneationed by Dr. Watam as 
occasionally producing ptynHmn. rrrpamtioiui nf gold, of 
co(>per, of a»Umutiy, awl am-'iiic; alnu cMtur-oil, (tigitalia, 
Iodide of fiotiiasiimi. oj>itini, croton-oil given intcmaUy, 
and mtm-mumtic nrid ajtpliid to thv surfiuo of tlie body, 
^UuLTo alHi t-een mcntioaed u occatiunally prodoctire of 
^Bkiaiilar resulta. 

^M ICodereto lOliraUou, induc«d once or tn-ic« only, ntAy 

^rimnso but littln mlsohtcf, but if the ptyatiam br kept up for 

a Uitig time, ur if it be frequently indnced, a permoneul 

iojiiry «-ill be inflictci) npon tbfi organs of tna^ticAtion. 

Tlio production of frequent or |irulotiK«l iuflAiutuatinn of 

Uu! nlTrabr pcri(M<tciiin will be fMllowcd by the &b«orptfoii 

of tbv nlvtvlt, till] >;uiiu will rvculo, niid the tw^th, tiaving 

n tlicir implantation, M ottC long before their destined 

tna 

The dt-prce of miiwhief will depend nf>on thi' l<;iiRtli of 
ae the ej-stem lias been k4?[>l under liie actii>D of mercar}', 



480 




BTBTIM OF DRSTAL BCBOCKT. 



bnt the idioeyacnujr of the patient will «i«rcu0 a lUU 
fp-eatiT inflnence. There are tlioae in whom a Hingle don 
of calom«l, or even of blue ]>ill, «nU prodoco Mliratioo, and 
the aocoiid or tbinl induce the fonnatioo of large ■>""g*"^ 
with Qecroais uf mtm or l«u of tlie alvoolar t it w oeWBi. 
Therv arc otban, Bsaiiit Id whom it is extt&caely difficult 
U> produce ptyalisni. 

The deetnictioa from sbngbiogof the aoll parta in the 
alvoolar rofjioii nf tlie montli, coDsc(|uent iipoD iitflainmatton 
OomSMDCiiig io the gntnK uid intn-nlvcolikr pcrioateam, is 
BoniBtiiiiL'K BO cxCciwlvo (liut t)m cicatrioes whicL follow drag 
down and tix tho chevlu firmly Uj Uie m&xiUA.-, aud limit 
the inoliuu of tlie jaw, ileiirivini; tlio patieut of the ability 
toopeD the mouth suRlcieutly for tha ready tDtroduction of 
aolid foud. 

The treatment in geiwral ioflanuDatioa of th« alveolar 
perioatenni rmiRt, io oasea dependttnt upon a bud fttote at the 
ayitena, be adJraased to the imprnvi^ineiit of the general 
health. If the local dtmrdcr depends Ufon rhunmatiam, the 
usual ronwdies for the relisf of that disease slunild be ad- 
ministered, sudi as alluliea, absUoeace fivm malt liquoca* 
and fonieiitations or Bteamiiig of the iDoutb ; itt soae caau 
iodidt! of potAiH»iam in largo doaes will hare a most mirfced 
eflft'Ct in cutting tlie disease abort ; if the maUdy as»uiuet a 
strumous type, Uie remediM best suited for the treatment 
of fltniniA hIiouU be pnutcribcd. If llic ditease be dopm- 
d«nt on na eufvebled state of the body, a genetoos diet, 
with quinine, or aoinc other equally active tonic, will prove 
advaalAgeoiis. 

Oaaca which partake of the latter character and yield 
npidly to gaioroits traatmont, prsfail towards the sod of 
the Londun seasim among those who have applied theoi- 
•elves Ux> cicncly to busimwi. 

Iti Hiding the general trvatmcDt, local remedies will be 
found uiii'lul. Th\hii<^ Ihe stigo of cnogestioti, fiiiely- 
juwdered tautuuiuaiS \a ia\k\M& «&vni^^ v^xm lu^tand 




mnxmunon or Tim alvboub PKuoflTimi. 481 

moriiiiig, or btcu more frer|ni.>ntly ; or Uie gtuns inny be 
poUitM iriLh lincturt of imJiuo (doublo atren^tb). If the 
h-crviicns :•( tht> muotli an ofTcrsivc, or if piis be fornied 
iMlwecQ the teeth tuid giimii, a woaIi oomixwed of eight or 
ten tt^tio^ of ctiloriile of eitic to aa ouncv of wat«r, will 
affurti relict, if heiil in the mooiUi for twu ui three niiDiit^v, 
at internals of foar or >ix hmin. Wheo the Inflnmmstioti 
U tljght, a M>lulioii of Uimx iii tuu-dv-culo^v funuB aii a^tvK- 
•ble and efficirat Application; but wh«ii suppuratioD bait 
beeu mlablished, or when sluui^hs hnve furmed, the Euliitiun 
of chloride of zinc (the strength of which should be varied 
to Hiiit the raw) riU he found to prodncc a much more 
rapid and bcnefiditl elTwt. The fcetor which attends suoh 
caaf« i* at once remov<^ by the zinc, and tho parta tinder- 
)^Ui!{ iiii]ipiiiatioR, if the ^oncrnil health be improved, are 
broiijjhi into a luuro healthy Htate. A HUto of inflammiitioii 
having been eKtnbltshod fh>ro a gea«n1 cause, iit HOinuliuies 
kepi up by two or three defective te«th. Now, whattnrer 
may bo the nstiiri* cif the defect, in iho ah<M>Dce of a speedy 
and complete reooedy, the leetli oliould iw removed. 

Local Injiammntion involving the perioatt^tal ioveatment of 
tbc iwita of one or two teotb. — It will l« convenieul lo oou- 
■kler thiD 8t)>i>(vl Dn<ler the two Iwida of active, or anitc, 
and chrvnic iiillnminntiou. 

CiiiJer the foraior will b« placed as«e which terminate in 
alveolar nW-vas, as dblinRtti&iu'd from those casca of chronic 
diuoac in which the {icriosteom rcmaios in a sute of inftam- 
oiatlon wilhntit |ira(.-»erling to snppumtioD, exc«(<ting; at tbi* 
pohit where the j^um aud tlw poioatcom oiect. Such rain 
will (all Qndi'f iliv IntiiT liivti^iuu. 

Acutu iDfiiimautioii of the dental pgriotteam, when coo- 
ftned to thi- itlv<x)li of oiw> or two teeth, usaally arises in 
nmiieclion with, and aa a dintitict foiiueace of, i>re.-rxtii.liu|i; 
diMuc in tbc involved tooth or tocth. Kxamplcs nre, how- 
ever, Dol wniitiiii; to »how tliiit tlii^difiease may Vib i%UOD\!ki^vi\ 
In the Kicketd of t«eth perfectly free hma can««, «>vi& it.\f^- 

1 \ 



482 



A STSTEM or DBSTAL BOBOEBT. 



rentjy from any other morbid ronditinn ; these cam an 
pn'bal'ly rcfi^rablc to ooe or other of the cawfoi) of p^nenil 
pcriwlitui which have jtml Immi «mimwBt«i. WhaMrer iii»y 
lie the cKf^itin^ cikiii^, the fiyniptOQUi of the discaw pMNDt 
buc litllc rnh'^ly, excepting; as rcspccta thi-ir intcority, the 
npiiltty with whk-ii tlie diffcrviit iituutnt of iuflntniiiation 
*UOC«od each otbcr,*Dd tlM«xt«Qtto which the neighboarinft 
(Kris become iurolTwL 

Tb« inflammatory actioD usually Bcbi in vrHh fediogB of 
(dij^ht iiEieasineas Hmt t(Hision,wiuuttitiDf.«rliii!hc]Lcito a strong 
deaire to prem by the opposing t«etb, or to Bbak« with tlie 
tingcn, tbeaSlceted tooth initHsorkei. Slight, st«ailypreKttre 
of the foil); iuto the jaw airtu nrlicf, hut tfad uiKAsincM 
rcturad on the pri'ssurc being with<)niwii. The wow of 
imeiuuncHS in boon foUuwcd by a ilull, heavy [ttui, and the 
tooth (eels to be longer than it« fellonrs. The duKire lo more 
the tooth in its ttoclcet riintinueii, till di-w-iKO htui icixlrral th(i 
part* to leridvr that prv^ure cau no longer Iw bomu, aud evati 
the muuth rutuiot be tinitly closni withont pain. 

Tlie oxut«noo of diseaM witliiii thu Hinkct is snnii nhonni 
in tbtt gum, which beoomw swollen nud tender opiKvuite the 
.fangi of tlio Lonth whose periociteiim ix affenled. Id adtUCtOB 
to this latter ^jiuptoin, and often prior to its appcaruioe, 
tlie irc« edge i>f the giun araumes a deep red oolnur, utuus 
mr/ipantcd by pain, ttmitmem, or ikotioeahle nwrlling, 
Thi! utxk of llio lootb appear* BiicircU"d with n welt-dogned 
red liag. This symptom is usually preaetit in the earlier 
Htagc ; but as tliH disease advani-'L-s tlio distinctiua is lost to 
the jieueral indamniatiou uf the gum. The pain becomes 
more setvn), but still prcsorves its bcary, wearing charaotcr, 
and though uot always coostant, U seldom alweat for many 
sDcoessive liouri. 

If the {vogrcas of tho disease be uiumc&ted, tbo perioAtoiim 
becomes detached l^m the ccmcntum, and the poiut of sofo- 
ratioD tuunlly cuitmiciiL'iui at, aiid trxtciidii frutii, tbv fonuneu 
in the root of the tooth. Into the interval thiu formed ptis 



IimjUIMAnOM or tub ALVKOLAU fSBIOSTBDV. 183 



< pourvd from Lhe Mparated snrfaco of tfae perioatcum. Tl» 
in^ BC thu put loMs iu rit&lit^, itad » bucbad in pvui. tbo 
^aaulitr of wtiidi L^gnuluajly iDCKosed, fjaca being gained 
tB the ilveolas for tlie diUution 'A the abflcesi al the i*x|i«dm 
of Uiu bono. The vxt(.-ut tu wliicli tb« rIvciliIiu i>Monia 
cxcsviaed iHli vary with uch cane. It maj be boUoired oat 
lo a very limited, ^xtttit arotUKl the apex of the root, or a 
larga caTicy roay be Turmeil, <>j[ractling in ilimeiLHsans that 
whieb haa been m»Aa the nibjwt of tho lu-cotiipanyiDg tiicorv. 
llie size of the abiioeM will dcpcuil a{*.>ii Uiv activity <ji tbo 
symptom*, tbo time the pus ,ia peui up^ and tbe acate of 
iaaU L of tka patioui. 




lb 



riooa a* »nppur4ti<iu i» c^lnliliabMl a praom ta MM ti]i 
for Ulxfuliag Uie Recri'-Lii>n. I^itber ttic perimitoinn beoornai 
dtftaeboil Iron) the ncok of the ttxjth, aiid tlie puii lind« it« 
my by Uui ndo of the nncket aud pasw out a( tb*! e(lg« or 
tJM! K^ini, or a |icrfc>r)itjiiii ia nuuio in Uu wall of Uw alvoolua. 
rougti u bich ihr cunU'uU i.(f the ahtcMa pa« into tba mb- 

(t) an Mivrr >» Ik wtitck tte rSM ol nWtolM iVmmi \a «snc««M.i>% ^^» 
tfbomn. 




4S4 



A nam or drktal nmoxsT. 



stance of Ui« gum. At this stage f>r tht dneMs we hsvp a 
kind of double absocM — aa abweM wil^ ■ con«tri«,-tion, i>n<* 
diTiflioti of which m aittuttcd in thegutnliuid tUeolber withiii 
Hdb alveolue, tb« two b4>ing coDiiect«d bir a amall o)«aiiig 
thnm^ tbv alvcular platv. If tbo discsse ha lefl tu nm it* 
owQ coone, ibe ooatentt of the absuM will acxmer or Uit«r 
find th«1r way to tbc suHace nnd BBra|)L>. But Ibe lime 
QDcupicd in tbe procc&B nitl depend upon the aituattoo of the 
dUeace, upon the condition at tlie parts prior to ttie ndn^nt 
of disease, and upoa the geueral condition of tbe fatieiii. In 
thosB who are In strong hnilili, the ff^rmatitin of lui alveolar 
aheObs is soon nicciiedeil \fy awvlliu;: uf thu •;u)ii nod tbo 
escape of the piis. IM in |iatirnt.t who nrc in a dfhilitnlctl 
cooditiuu thudistuue ndvancvs murr tiluwly; tlic pnidiicU of 
suppuration accumulate, and a Urge abscesi is formed, at the 
cipcuse, pcrbapR, of Ibe Dockets of apveral ndjoiuin;; t«cth. 
ConRidcmblo miMbief may bave bden froduced bofotv tbe 
natural relief by tbo Kpontancoiis bursting of the abscess !!• 
ubtmned. The piu, instead of escnping into the mouth, may 
find its way to thi? finrfAco i>f tho face, or into the antnmi. 
TliL' lattor itwult is, ol" course, only likely to occur wlifii the 
(liwasc ha« originntcd in tTie bicnspifl or niolftr teeth of tbv 
upppr jaw ; a im«c, liimevcr, came luukT uiy uotite in whit-h, 
L)U the extraction of a central inciiKir in conBc<]ucuce of 
ulvGolar nl»ci>Mi, n pcrfumtiou iutu the antnini vna found (o 
exitt. The pioiiuus symptom:) nf abscew oC the antrum lutd 
b««n but litile marked. 'ITieiB jn no tootb from the 9iH;ket 
uf which an aUooss may not extend to tJie Burfnce of the face. 
InsMnoos are sometimes met with of sn abscess connected 
witii tbe riHit of a Icwur iDCtxur tooth ujionin); under the chin, 
and tnoro rarely, opoDing in Tront of the chin, 

AbacewKM resulting from difHmll eruption, or carieM oflho 

wisdom t«eth. occasioually };e«» forwards iusidv the moutb. 

iuhI njioii near (lie canines or hiciispiiht; or they may jiasM 

bacltwardt and bunt into tbe &noos(*); tbey an not 

(1} TnMoaiMM tit III* OiioKtotogiril StvlHy, 1M», p. n. 



^ 



DiPLiitxATioM or rax altbolab rx;fti08Tittni. 486 

unconuaoQly itrodocLive of v«ry ooniiJerabU ooiutilutiooal 
ilUlttrhuice, sn<l ara pr<M\e to rsuae (rim)tis, of M'hkb one 
case u rooonloil as having taftlud aa lua;^ m ainv uiuiilbfi, nud 
Kt tlie «od vf that time liaviag been cured by Uie remoTal of 
the UmiK 

A ciue of abscess resulting front « first moUr ii tiKrutionod 
u having in the fint inEtaiux; burst betow t)u jaw ; tbu 
fomied ]>itf gravilatiDg <krwn l]i« Deck, a Hoood opening 
lowciT duwn nsiiltod. anri Hnally turo aiouaea opening below 
tbc clavicle wcr« eatalilUlied. 

Aim! even Ueatb may eume (mm these abeoesMa; tbiu 
U. Robert (■) records a case in whicli abaiMai around a lowei 
wiiwidiii tooth was frJlowud by uccrusiK, aud punik-iil iiiQI- 
tratiiw (if the aide of thu neck, from which tfau intictit'a dealli 
n»nlt««l. 

E&tvuaive alv«oUr abecosa not uucoouDoaly resolts iii 
partial oecrotia of the bone, and as a conaoquence dMtli ba» 
bnru known to uusud in aevunil iUEtoncea, but ihoae cwi bt- 
nior£ appropriately treated of nndnr the bead of Xeciosis. 

Whi-n llio lower mular ih- bicnsiid twth cause an absocst 
which riiulit exit on the intx, thvoiicuiu;; is itsiiatly beluw th>- 
atlachmsDtnf the hiiocinnt/ir mnscic, and noUecttufia of matter 
Ibnned about the tvivlum tevlh ofleu pans belneen thv 
niiMck* and botkc, oimI eM:a|>e at the atii>le of the jaw. It 
Mill i^Darally bo found that, in casi-s wheiv the alweas 
buFBta exlenmlly, tin- eud« of l)te nxits of tln« iwlh jnas 
beyond the lorel at which the inucoua iDOtnbrone is reflected 
froia iha ebe^ to llie Kxtau (Salu-r). t'nlcr certain cir* 
Riioi9.tauoeH tbo absoccs sac may become a fiemiui cyst, ns iit 
moitinned liy Mr. Kalter ; this, which tuay nccor in all parts 
of the Indy, is so(r>etiiike« attf-ndrd with |wculiar oonsiiquunrBi 
hi tlii' jaw, for th* cyot may enlarge between the phites of 
i1h> alveolus, and thus give origin to Luetic disease at the 
iaw. 

l^njipnr tint in the lymphalia glands ia a(rM\u(mt. wc^irnd 



^ 




^48« 



A ^STEH OF DBXTJU. flOUOnT. 



of alTeoIar absocfls, and is eipociaUy prtmc to In^ipcn ta 
»triiDaoiu aubJKta. 

A cirllectioa uf pus fnmieii in I he w>clc«l of an cjipo* in- 
eiaor. wilt s«netiiii«i burrow alimg between tbp booe and 
periostfiini of tlip liard |ialnte, awl «ipen iiimn tbc prtrfiice of 
the iwft pnlute: in othiT cusn, Ihi' |wrio<<t(niin i* n-pAnilcid 
from the ono side of the hard palate. nnA fonrvd downn-irdit 
t<) a lovel with the cmwna iil' the teetli by the aceDmubten] 
|mB. The fTSMure canned by the abicew, which often be- 
ponipa rhmnic, may cnnne ahsor|itinii of a pnrtion of thu 
|nUtin« proceM of tbc suptrior maxilla, as occurr^ in a 
rwrnfly niirter observaliou. For soinv reason not very a| 
imn-nt, abKCQta OD th« peUt« ahncst iDrariabty procMda tr-mi 
a lateral incisor. A caae haa lately been rocofded In which 
puB dripped dawn })ehiii(l tVie Tnlnni ; it waa found to 
procoed firoin an alveolar ibeoess nboQt the lai^ of a latonl 
iDciftor. 

The openiiis; of the abBcem, whi^ther cflected by nature or 
by the band of the siirgccn, rnrrns an pporh in the oomplafaiii 
Tbo aymptoDi* front that time ^rarlnnlly flubside, tbe pain dies 
awsj, and the smelling rapidly diminishos, leaving a nnnU 
opening throii|;h which [lus will cuntiiitio to tw diacbsrged. 
The coate of tbo absctwt grs'lnatly cnntract,and elotie ttpoo 
the tix)t frotii n'liicli thvy had hcKuuit.- i«(i{iamt«'<il. The te[ 
tion of the two parta ia, however, pcnuancnily msinljiined;' 
Whtla the inner mirfooe npfiroachea the rrut of ihc t^tuib, the 
out<T Burrace of the coala of the abscess become* thickened, 
andoccnpies the ii]wcc whiHt wniiUl othprwiae be Ipft t^iween 
the expaudwl alvi'oliu and Che colta;ieeil kI«c«ss. In exiraei<*] 
ins t«^th which bavc heec the raiiso of aWeohir abeceBS* tl 
coaia uf tbr; ftbaoBsi are somotitQei' withdrawn entire, ttt 
an op|)ortunity of otnerring the pniiedtiig ooiiditiona 
all'onled. 

Such, them, are the orenla which, in tbe ordinary counw of 
the diaoaao, mark th« prwrcm of alveolar ahnceffs. Excep- 
tional casea nowaad then occur. Id which the local are acoom- 




I 

■£ 



DrrtAJOUTioN or thk altbolab rKBioerBUH. 487 



|MiD|pd by icvere cCHuLitutioua] Hymptoiiis,Anii>miliuKp(TliH|» 
U) foror atu) lidinunt. Such in^toiKca srv, howeror, of com- 
|jimlivcl}' rare uccuncutio; imlenl, iL in vrtHNlfFful how iiim'ii 
btef toay bo done to the ftlvcolu |jroc<<«9i-9 without 
ting nny great unuunt of ettbivr local or ccHistiliitioiial 
dl«t(irba»c«. Aq cbaceu «nclo««d in the sul«tAi>c« of »ay 
other htitwt iti the muiner nti alvenlmr ahccees i* M its coni' 
roonomiL-iit *hut up in lh» j*w, wuuld, ioatcad uf (Koducinp 
twu or (Jiive ilitys of bMlhachu ami a surollen fiuj^ ooufini! 
the pativut tu hu ruum fur weeks. 

It i» not ancommon for an abaons aa ibe hard |»lAte to 
|U> into 4 cbrooie oondiUon, and muain ahnost Qonoticed 
by the [MLtiffut for looutha, or oren years. 

Alvoular perioMtltiB may, however, move ntore tlovtly 
through ilB varions itagea. A connd«rat<le Ivnjith c^ timv 
may iiiturvcne Mwro tbe cotninenDeintut of inthuiuiiatury 
HCtioQ Hnd iho fonnatjon of pu9, aD'l in th« meanwhile th« 
l^vttuiil uiuy Im thv Buhjwt uf viulcol inteniiit Umt altjicks of 
pain, tMt, iwrhAtw, conli&rd to the tooth alo&o, but otlea 
BXtendiiiR O) tht- fa<»i and hvad, in which aitnatiima the |wn 
may bv Cu* more iutok'rabtc than in the tooth itself. 

In caBna anBwerin>; to the fon^iog defloripttan, tl witl fiv- 
cjnently be fotind that dcntAl exoctoaia, alighc in hmoant, 
[NsrbaiA, yot distinguisliabU*, has oonitutmcfid mi the surDiCtt 
ooViTud by. or in cbwe proximity !•>, tbe inllamed tiasueu 

In nthor cases, again, the aeparntion nf the inflatnod tiiwiie 
Is limited Ui lh« a|>cx of tbe &ii]i, through (h« canal of which 
Uia pua ooxcA ; but tli» rolluf iji then only |mrtinl, and the 
|)anoiit«um continoes to thickeo, and tbo alvoolus to ootergv, 
io iiiako way fcir tlif incraaMiinftiwuf the diauased inumbnoti. 
Tbfl paio is Intunoittcat. aod often simaUtCiH Iti it4 characbor 
tii>dou)oarciix. The cundilion I hare described is nMrv fr«- 
qaenily foutkd a«a>jci*((:?d with otoatpa than with tcvih tlw 
enwDK of which are but [witinlly decayed ; and it is cammon 
t« find ilwoictrouiiLiaiaraoTeralcoQtiguotti itumv* svb&WVs 
iDToived. 



I 




anlil, rmm some <:ai]ao or ot3 
ftlveulun cduuiniag Iho man 
cIomn), and jius re-ooUocU. ' 
again GdiI tbvir wajr to the n 
paiioul IK restored. Sooiut o 
more 4ciiT0 fortn, aad oeeec 
tooth. 

Cun uf tliU purive ohancU 
sympatlietic pain, luid ^ald t 
lite gntn, too, over liie aJTcctol 
thickeDod, miaut«ty iiodulA(«d 
motlkxl liuu. 

'Die Sstutotuoi>etuiigor a dM 
timiM ftituaictl on a loag pa 
froui the {Tuin to the extent uf 
It nmy be flv^iMo, and lie 
gnin, or tho cbAiactcr of a di 
aMUincd. 

In any deH-riptjott of caWf 
iicut« in the first instance or 
in nn iinfavoumble mate, th& 
don, ext«ad to the pcriwti 



DtFLAWUTIQll'or TBX AlVIOUB YSmOSTBUV. 489 



itiun 



Irv(|in 



A G«tutou« opooUif; ID Lbo ^tn, with slight Ihickening 

>r tb« iiirn>ua<ltn{( parta, KinslDii lo mark the Hpot. 

Scwrol spwdmoiM in uiy <iwn oollvcttim ii)i<in- that active 

iriiiiitntatioD of the dental jtcnostcuRi may aHh in coimcc- 

with a Utoth witliiiiit our beiiiE nlilo to tnici^ tlin oiww 

ut ft large alveolar cavity may be formed, tbe iuvolv*d 

ami tti4< neigh Inuring [larU Lviiig. ko far a» we can ai^ 

\>y. hx Jiinvteea cases out of twcnt}-, Uowever, Llii> 

fullowrs or rvvulta from, or is ui extensioD of, iaflam- 

of thn iIsdiaI pu)i>, or in coo^ueut uu rcvroda of 

i|b« wbolo or a part of tht fang of a defective tcotb. 

Trtatment. — Tiiti piilp-cAvity and {attga abotlld be 

klioroQghly cleared out, and a dr^uiu]; of carbolic acid or 

ihyitti'l iiitfuduoud, aiid rrLuwed i-v«ry day, Ivocal bicfdiiig 

ii'iitly fuiU to afford rtdivf in tnflammutian of tlie pulp; 

vrlR-ti tlio dctital perionteiuu becunioa tlic neat of diwow, 

^ftbHtraviiuu uf Lluud U uur Wst rciu«iljr. If ndoptul at a 

4encly early atago, it seldom foils to produce rcHvC and 

frequtnilly cuU sliort the disauio. One or two lewhca sliimld 

l^bp apfdii-d, by tlM help of a lecdi-tiiht!, to tlio giiui, op|i«Mitte 

MS ewl of the FOut of the affected tooth, and in ouum-ctiott 

' nith ibi.1 lo':al blcv<liiiR an aperient roay be ^voi. 

'J'bc gnu over the afl'ect<!d tnoth should be Etrorraty and 

(rpcatMiiy ptuntvd villi tiDCtorc of iodjnr, and I'leuiiog'a 
im'ture uf iic)>i]it« may bo advaDtagooBsty apptinl, ihou^ih 
■atiori ig rnpiirod in iiaing so pot«Dt adnig in the mouth. 
f th« inllaDinisiury nctiou lua guiio ou uir a day or Ivra, it 
I prubtibto t'mt suppuratiua oaiuiot bv avoided, specially if 
Ha affection iiaii apread lu the giim. In that casp, tk> loolb 
skould be rt>movvd, and if lbor« is reason to suspect thai pua 
in ltMtgi.<d in the aabetaiKze of Uie gnm, the part ahoold be 
frooly iociacd. 

A lU'ubt may aometimca arise in the dentist's mind 
«rh«lb«r. tinder certain dnnimaUDCCfl, tltp miioval uf a tiiulh 
' lo, TIjus*. it way not be cU-ar that tlw (ik»tli w?* 
MMinw of the diseafie, wbiub nukj W\u\»:«tk ^v<» 



fibc 



480 



A SYSTEH or DEKTAL SCBOSBT. 



U> rtu^iimatisni, to struma, or to ayt>hitta; iir Bgaui, the 
jntient toajr liare slraadjr mOtfcd iiroai »Tphilitic necroMt 
elsewhere, and alight wonnds b(> prone ui tsko do alcerative 
aethu. it tliL- flisi»w can be traced to rbmuoatiani, th« tgctb 
aIiuuM iioi )« extracted, even tliutt^h ihcy are *-wy loceci as 
tlif pru)»)uUiy or a fAVonrable icrmiiiation is ^«aU But if 
the diiteaw appears to be connected with Binims or sypbiUi^ 
nn he»itation dolhI be teii m reiuovii];^ any carious teeth, M_ 
they are ftr more likoly to c&usa cxtunsioa of th« 
by r<»iiaii]iaj! oa sonrotw of imtaLion, than the opeimticflt^ 
likely to do mischief. And ctuii thimgh tliv inrulred teeth 
bo H>uad,wh9n oD'CO ayitliilitic or strumous )i4Tia«titis hu rao 
on to a uotisiderablo Icasth, thv dostntclioii of Lhu iaTolTnl 
teeth by the dcAth of their nocket is probable, and the ex- 
traction of greatly loosened teeth niay Iteouuu-' the beat 
ooorse. 

The reicoTal of the hivolvod tooth, howavcrakiirully |Dfr- 
fortnod, in not always luUcwMt by a wmsttivu of (nia i oa tha 
oonlrary, the degrve of siifTcrinK is Botuetinira for awbile itt- 
croaseil, ariaing, no doubt, from iho lacvratiuD of the iQilamed 
tiasttes. I'be dtiratioti of the afior pain will geacrally be 
propartiooed to the «xl«iit of tiie itifiamtnatioii, and lo the 
nmoitnt of sympathetic ji&in previoii4y excited, 

111 all cases or )JBin afu-r l.bL> oporetioit of extraciian, the 
vacADt Kicket i»bould ba sponged out with a lDc«ely-roll«d 
pixlpiet of cotton steeped in phenol MHltque, or in the toU 

ritiR Kubstitiitti f>.ir that prcpaimtiui — 

R. Acidi carbolic! glftcialis,ij. 
hiriunriR imtoKsft^ J^. 
AtiUi', ad. 5viij. 

lliifi will UHunlly ^ive very ^n«t reUef, and tlie wool may 
be rDfrerml tu remaio for a day or two, if tha ixdn tondit to 
return on iu removal. Hiii il will itnen b« found that ow 
or two npplicatiotu of the fluid will diipel the serere pain, 
and that the wool need not bu luit in the socket. Should 



r. 




ISFLAXVATIOH OF im ALTMUS miMTirH. 491 

Uds bil, Uie sufferer bIichiU bo directed to hold a strong 

nod bu[ deojrtion of pop^jr-htmls in tlie wouth, atu) to 

_fQlton Uie luiiuUiful wIilii it cmwa to feci Itot. Tltiit npiilica- 

sliould be coQiiuued till the jkiin abaicH, »& ov«at wbich, 

Van in ibo wurst oum, uiay l>a liwk4xl Igr witiim «u lioar 

'two. 

ir biim any caitse the removal of the tooth be iiwx[«di«iil, 
niiist LhvD do what wo cbd to raliere the pun inJ lo 
Jnoo lh« dneMo to a *tat« of [wwiv« ^inUtlL When 
» reason to belunre thnt poa liiu not boeu roriu«d, k 
leech maj tw sppited to the foni, aoA sperieDtt f^iren ; bat 
jiboald you lind a circtnaKrihed swelling over the Conth, it ii 
tly cenAin tliU pus U nink'n^ its way oitiwards, nnd it« 
will bo hastL-uud by ihu OBh of the gum Iadml The 
ioitnundat for tl)iJipBr]>o«clB a short Mid strong donbb- 
)gsd acalprl, which shoald he thrust forcibly down lo, and, 
poesibln. through, the sponey IwHi orerlytiig the abboeu 
By tliiui anticipating tbo dnlliufc through of the alvcolox 
tlu>abwM!n, lliB [Hlient ta mvod much suffvnii^, ivhteh iu 
the iDAJority of cam <xa»e» Kith tbe perroration of bone, 
whntbeT tlii« be rffeotLil by n.itiire or by arL WbiTt'ver than' 
fa KTcat geoeral swcUing aiid tvodcmoss. gjcat relief may be 
^^BivwB by a frw incitiion, uin\ by drilliu'^ riimuj-h thu bone 
^Eritb ft [ars« and sharp hnnu-b over tbe apex of the fang. It 
^Bb ea^y to (li^tingitiiih by touch when th« instrument rvacthes 
^Kke laag, and tho o|ioratiou givos far lu«s pain thao mii^t 
^^lave bveu autici{«t«d. 

PrvviouK ui omting tlie inciBion, the gam may be paiuted 
OT«r will* the following solution — 

&. Iliict. todin. (ikiabk- stren^h), 
riemLi^V linct. aconil. U, 

tndxtui oflcrwardi apoaged oat with 

t; it iiead hardly b« added that th« 

torn of aconite must not be applied near a mw^nrfow, 

llw |<olwuuiu> offiKU u( lliia very potent drug might Ik 




m 




BTSTBH OP USKTAli 8IIBI1BKT. 



uiBnifcsUti ; t)ie mont au ns Uie snsaiiubUity of diflureDt 
jwisotu u> tu actiiiii U very various. 

Wlieii tht* more active sj-iiii»t«tn» havff Riii»id<>(l, a jiuaU 
lifctiUuuH ojn'umg will rviuain [<jt Uifi exit ul lliu )>u£, ittileoB 
the fluid finds iu war tu the sui-lJice thrxiish the tang. It 
IB quite pMsiliiii limt ttin nutto of an abHCuas nitiutal in iba 
(lilAtvd alvtiutua niay ctnt^niCL' Uie necroMd extremity of th» 
Cmu;, «nd cMuw U> secrpte; in wliich ohae the guio wodd 
Ileal iwrfvctly, Invio^ the cud uf tbe tootli ia a Biuiikr piwi- 
tiun tu that of ftu MicyMed fumij*ii body. But I do not Ihiak 
this vreot is ocuniiiuu, DoithiT would its occarieiuw l<e cx- 
p(M;t«d, vrbcD it in conaidcrcd that the fanga of teeth admit, 
under presture, of a slight do;'reu ur muliuu. 

Chronic Injiammatton qf' Mr Htnlnl ftriMUnm, ltniit««l Ui 
the alrntlar tnciDbnuiu of uuo ur twu tcelh, uix-j^tiu^c in ilt 
extent, aud dei>endeuot! upon a local cause, r«s*'niblui tu 
chanLcliT liiat furta ofdificnse which haa been deiicribed imder 
ihc head of tiL-nenil inllHuiiuaiiuii of thu alvi^Lar pi-riOKteum. 

After A COM ha» |iassevl through its earlier •tai:<ui, there t» 
oome difficulty iii deteniiinijig whether the tnahuly urijiiiiated 
in the giitn or iii th? [icriovleiiui. At the ouiwt tlie oiargui 
of Uie gum exhibits incroa&cd vaitculnrity, liccoaieH aligbity 
thickenod. iLi)d blwxU rondily. If allowed to ruu il« cour» 
utiinUTni|>(cdly, r.)ii< itiflaimtuiiiuu jnaAM from thciii»iic»nhuul 
the ueek of the tuiLii towanU thuae which Rumtutid the root. 
The t>Mth becoimH Ioimc, the cd;;c of the aWeotus diaa)>pe«n, 
aikI the guu) i^iuks d<>mi. liy slow di^eea thtt tooth lowt 
it« implantation and Mh out. G«o«rally thv dtscue » 
attcudud with htil little \Mim, exix*p(iiii; Kudi ai it prodtiOBd 
by force njiplied to tlio loOMiied t'-xjih. 

Tcxith afuT ttxith luay be, and iu old (wuplu fmiueully if, 
loBt, till thf im^th becomes cdentuloiUk 

Tl)« intlinimRtton may, Imfviiver, take a more ortiTfl fono. 
We niiall thcb have ptis M-crot^d fi-ooi the eurfaoe of the 
dttdUed tiHNiie, and granxttAiiorkii may Rfiring up bum tha 
margin or I'ruiu withiu the stwket. 



Um-AXMATIOH or THB DSNTaL rEBlOSTeuM. 493 



Tbtu aappiimtion ittny occur nmitml the roots of Kvnfnl 
li«iUby twill ill HnuiKiUiiur xyi'liUitk pFrBons,a8 Ijiis nlready 
be«u ruc'titiunoil, hihI tliis is <>iiiiociiillyB[)t to ocnir atxmt tht- 
iuoiBurv. 

Among th« eau«e« which excite chronic inflammAlioii of 
the deutal imrioKteuTn imjr 1u eDuinerfttrd, the culivctiun tA 
lartor, a ligftturc nhont tha neck or t t«otb, or jirewure 
Hpjilicd in tui t>l)U(]Uv 4)ir«ctki» by mi iitita;niiiislic looth. 

7%« trmlment will J^jieDd npoD ll>e naitire of tlie exciting 
cause. II' H ltH»l cuuEM he <!L'tecti^, iu reniovsl must br ilic 
fint BUp ill lh« treatraoQt; nJ^wanls ascriogcnts, micli u 
tannin Applied to ihc giimi), will aiutist. in rvRtoring the pKrt 
to ■ uiurc healthy oonditioti. In [Kilieots of advanced a^< 
treatment prcKlu«« but temporary rrlicf, more rapcrinlly it 
the nnta^uism ot thu apper xihI \vvm tcctb U dlxturbod by 
the lonoran tmporiant mi'tnlM-roiVitli^r serin*. But should 
it bo fbaud IhnI an ctoDgnml or di8[>laoeil tooth in unfairly 
forced npoD it< nutagooiftt, or upon na adjoiDJO'^ tooth, uid 
is ibuB lodacinji; dtac-mw in tbo Mnc-kvi u( ibu bitlcr, the 
offender niuat be tdiortenod by tbo iUe or rcmorcd. 

In the* r«rpg;otn!! flurtion it hfla hL«a arauinnl that the in- 
fl-immfltor^ Action has exiemled over the whole circumfprence 
and lU'i'Di of tbe WM;kt.<(, and it is not nKiial luriml Lbvdisaise 
ed to v: mora highly dewlojwd on n fortiou oidy of tlie 
uf a Kiund tooth. But ihmv are niany cases tu whii:b 
thia rulo uill not Apply. 

When a pnrt only of t}>c perioAtctttn is aETccted, the dlBcaae 
prawQlii a MniicwbAt dltfcmut aijicct; it unuoUy oociin in 
;ion with a ftmii|>. tlie cn>wn of iho tooth having 
dcstrnyod by ciuic*. 'i'hc ]ipritmtt!tim nbuut the ex* 
Enmity of the tootli beconica tbidcened and uodnlatcd ; the 
ftickvl widifna aa the dbeuae advauci-B, luitil tlie nri^bluurini; 
alroolna if Inid open. With ibiir cute ihcm is occasional 
and aunii'tiinw Kvm.' |nin. iii>t nvcowarily odnritiMl to ibv 
wut of thff diHUM, ufttui nut in itic afTvctod alvvuliiis nt all ; 
Utt li \a (At iti t1>' iiiw, tir in the clicrk-lx^ttu, ur iu ibe rar. 





BT»TBH or CBKTAL SUBOKBT. 

Tbo edgfi iif tbc nlvculiu sFlduDi bwomi-s ibeurbed, m> 
th* fang is held fimily ia its jtljtctt. 

When tliere iiro tUm: crownleae bogs in a rovr, ami the 
periatt«uin of (ino only tli« «iil>jc«t of cbrouic iuilaiimintioD 
I aboot tba end. it is rxtn-mfly riilHcnIt, if not JtDfKMuble, to 
dttect tho ofl«ii(U-r, tuile»« n-vmlnl b; Uikilcmesfi on praiiure ; 
gf Ibe Dinr^Q of the gum teing ciicircl«d with t red Utw^ 
neither or which ftymploinii iit cotistutiC. 

This bulbous «Ute of lli« dental cnembraoe (often termed 
fiuigoas) i« ooMMODally found in ootinvction wiih <I(U)tal 
oxoitMiB, k&d foiDDtimK with oocrona, but in th« Litter 
caw tite (liimkM ix db(]>0Med to beoume active, aud to end hi 
iilrcolar abKcss. 

Tliura is but one method of troittnont — tho ofifcctsd loath 
sIioqU bd reuivved. 

Whrn A ji!itic!iit oiill'mng imin in the jnir, or &icc, or Mr, 
ie uoabli' tu Glulf lie exact mvI uf inin, but ia dispocad to 
Mcrtlw It to tlie toctli, it viil Iw woll to Ktnovc any stumps 
that arc fouud iu the mouth; fur tbc }K'rii>fit«um of ono m 
of all of litem may be ibickeucd and diseased, and tbia 
will nnt lie bnuwn wiih certainty till tbciy arc rtmored. Very 
iKniTaHy tli0 (lineaMd tiuiic in mor« linnly coQDecled to th« 
tooth thno to the alveohis, aud is tbereforv drawn out with 
Oic tooth. 

A disoKM* hnving estabtishod itaplf in tbe soft tLwom sub- 
mricnt to thu luututuuuacB oi tbu t«cth, tliu ncoguitiMi of 
ilB Qtigin id at »U times Bltcuilwl with diffiimlty, for on 
Mooer i» tbo pcrio&tctmi attAckixl tbnn the contiguous gam 
facoonice aflccted, and inlce iktmL This remark Ap|Jin erim 
to tunxiiirii arising in this port uf the l)ody. A. tuniMUr may 
urigiuatc in the gum, or sprin;; fTom nithin tbo socket of a 
toolh, ur it may cooimcnco iu tliu pcrio«lcuiu Juvcgtins tbti 
outer «iirriic« of the alveoli ; but iu oilh«r case th<* );;ruwtlt a 
usually duecrilwl nndcr Uiu hiMd of tumours of the giiios, an 
anan^iit-Dt Tnhicli, f«it ihA take of cmwenitiuce, will bs 
«dliei«d to in the pitaeat \tuUitcc. 



( 495 ) 



NECROSIS OF THE JAWS. 



IV- tu. I') 



Tmc defttb nnd ultimate sopaniticn of portkiiM of the akeolu 

aarf^nx are, in a Hli;zhl di-gree, of vtay cmntjynn mciirrCTU'c ; 

pM thill Ktifi*: of th« nUeoli mav exfcflinte after au extroctiuu, 

aw«rer skilfully ^^^ormixl, luiil nu ill results att«ml its 

MUg Ki, save u pFuluof^liLHi of lliu braltug jirocusi. But tn 

FliLwc of tliia very limite<l dt.'ntli of tb« Iionv, tlie n«cn>siH may 

'.Ik tu iiMire cxleiLsive, inrolving tlio cniii|>lt^le dratructioii of 

ttie jilv«oIar portioo, and erea of the whole depth 

of tho Jaw. The lauiMS wliicb Iwio-j about uc- 

crosift of ih4< jaw ait) various, and cannot, in erery 

iustAuco, ha traced. 

Tbost ill a caw receoliy uad«r olMflmaiuo. the 
u]i]wr ouiiou of the loft Bide mm found to be 
jAiiifiU nod siigtilly loom; the pain inorcaaed, 
lunie littlu.KWtillitig: itp]K.Mrt'(l, and pus wiis fwind 
('> vxndt' anmmt the lix>t.h. Aa Ihvrc sd-nml to 
li« uu hiijH; of Mtrmij liic toot)), it vraa cxtraclnl ; 
wbeii, Bitm'hfil tii the apps of tKo ri>ot, was liumd 
A ftngmeiit of in\-n.t«!*.\ boui-. on iLe uiJjwr part 
,ut vhipb, tu> 18 ttliown in iliv ligiiro, not a hiillaw, miKiotb 

^ {tj Ltd nppM Ufltni^ lo Iks apra of Um £nif of wblcfe to BlUdtod ' frtc- 

k«r MomM bmtr. Till- ImUowot iiirkM tm Umi appet Mkl r1ght>bMiil 

< arUw bow riiniini * p^ib.n nf Ub- Owr of Ottmim. On lb* Alt «r 

e la « nMoUk (llgMlf dojinvk-J Mtrfao; (nut* CMkiplaUIKU IH Ulr llRlira 

Is Uic- «pr<tin'»), vhklJ ims fwiuiii Uatv Inrn itiw lu a^lvjipiiiia eoo> 
ueut Ml Uw [irrMnr* ut ■ udirtibuuttna l»^b ; aul iMn )* « ilMt^ uiiwa 




496 




■TSmf OF DEXTAL BttUlEllT. 



sjulwoe. lliis vtas foHtxl lo Iw a pnrt of the ilrar uf tbo 
into wliich air paxs^-d fi'ccljr; «nd Hiiid» poured tbrongh tb* 
nora in drink icg. 

Since tbc removal oT the tooth itome yesn fanTe cUpaed. 
the spertim Iraing corercicl by & prnceni rrom the artiliciol 
teeth which are worn by the paiient. Thw reniediM the 
tncoDveiiicnceK of a conimuuicatlun ciiiiitiiig botwwn tho 
DOW and tho mouth ; but, sitboush tli« aperture has gmtlj 
voutrautLfl, ii shows no dUpoiiition to vntirt.-ly cloeo up. 

Tbc moat reiitarkablo feature of tbi^ auv ii the cnliro 
abscucc of any laslgtiable caoM for the mischief; thi* patient 
wss i hoftlthy man of middle age, with aL> history- of syphilis ; 
the tootli had bcun only in a very flight degrve dvcnynl, and 
hod been cucoeMfuUy 611ed with gold years ]<rvviauBly. No 
blow bad l>Beii roceivtiil ; in sliurl, nothing wliatevirr could be 
discovsred to account fur the li'«ioii. 

Another cmc lately ntnic andvr my care, at the Dciit«I 
HoHpital, of t)«;roais oconrrin;; without any aBEi;*nabte cauait. 
In tiiu cane the scqoeatniin *« much larger, extrtidini; ftwri 
ihfl second lower nnjlar of the right stdi* lo liie Uteml incimr 
of tlio same tide, and included liio mental foiauii'U and a 
portion of the inforior dentAl caunl. Tlio tecib iurolv^l In 
the duad boiic w?re all souitd, and the patient, whose stittr- 
racnts np]>wiri''(l iK-rfet'lly reliablo, could not throw any light 
an the orLgiii of ilie dittCAM. Xo history of syiJiilia could \» 
cliciloil. 

'i'hv iininedinte canM of necrosis ui ji^hrmlitis reanlting in 
imrultmt effun(>n betwwn the bone and iJio pt!ri>o«t«um. ami 
in a largo majurity of vases the more remota causa of Uw 
dis^OH can be traced out. 

Thuii, in chililren of stnimuua diothnts, larjtii pnrtinoa 
often necrose, and the difie<a«o mi*y be, and. 1 think, rery 
uomnionly is, aot ap by n dccayol (ootli. Ilie lJH>th-pitlp 
inOatuof, the Luflaniuiation extendi! to tha pcriusleal lining 
of the socltet, kA Ctom th«iHM spnwls to the Uxiy nf 




^ 



KECUnSIS OF TQB JAWB. 

Avery frt-qucnt I'auM of qccixmIs ib coiutttiiliiituil ijphllu, 
which may lend to the (kBtruotioo of any part of the )4W 
(wee page 182), ibongh tin cbosea <ite Moms to be the [wUtinv 
\U> uf t}i(> upper oiuilla. A ocnle forms od tho luknl palate, 
y tlegcnerates and liqucGe*, mid by aepuating th« 
'pCDOAbrUlii from the boue, lead8 to Qi-oruais, nad con<»equ«nt 
porftntiou into tlic nnrex; not uticommonly the uorhid 
action ouniinetiuea oo Uie tloor of th« itaris, and tbi-noe 
peovtnitM tbo Itord p«Ut«. 

Ab hfts already beua staled, aecnwis of the alveohir iK'rtioD, 
»QMtijQM exleoding further into tlie body of thv U'ua, may 
bo dot up by a diiit-ased looCb, though thU will happen 
but mrely in a heiUthy inilividiULl. UlDor&tiTu slamalitia not 
rory rw'ly IcmLi u> ibe eicfolUcioQ of mull scaIm of bone ; 
and, in fnrt, any fonti uf ulccmtion of thu pims nuy caiut! 
thi^ oivn aeriotu ratftchief ; the ulceralioDs due lo satiratiou, 
to vcorvy, or raiicrurn iiris ifv\ufi I'^jincliUiy plXHiL- Ui IumI to 
neoroeu. Very ffxtoiuiiva dvHtrucliuu of llie luue (ifl«n 
IbUowi esantbcnuitous fovGrw, And exjUQuru to ihe rnpoun 
of plKMfAonui Aettf up a Mvero Ibnn of the diMsuo which 
premnl;! iM<rernl special cbanu.'ieri»tioi. 
MediMiicitl vJolcQcu will often cause the deAtb ot portions 
the ci&iillie ; thai., {urge seqnciitnt often come awmy aft4T 
t wDuutls, or tdvr fruutures; uid the unskilful ex- 
ion of tvclh U nfialilo of causing esten^iva mi«cbict 
lie, a |)Rlicnt lately jifurvutetl himiwlf at the Deutul Hos- 
pital in wboEii the alveolsr portion of the lon-er jaw n'as 
frtvtnml from tho poailioa of the fint raoW to that of the 
latoriU iriciiM' of the oppo«ite lide. The firMttire, vhich vm 
CADSoi by BTi inetTectiifl! attempt to extract the first molar, 
bad nu) horiEoubdly round the }»vt, completely separating 
tbo iti-fulsr ]XittioQ from tii« ln»e of tiie jilw. I van iinnblp 
to k«un wholIioT tlie forccpis ur a key iu»Lmmeal li&d been 
osed; the troattuent adoptAl «raa fixaUuti of tha frngtncnt by 
A gnttA-perebft cop adapted ava the crowns of the teeth. 




498 




RVHTRM OV IIRNTAl. HOMIBHY. 



Tbe delached piece, bowevtr, did not reunite ; a 
fonned under the chin, and finally it wu remoTed, in ooo* 
««()uenco uf iu bccumiog oecrusnl. 

Nocronis of n porti'-ni of tliM liooc may follow upon tba 
extnclioQ a{ a tooth, however Bkiirulljr tliii hu buun por- 
Comnid ; nnd It must not he 8up|»i!«i.Hl th«t tbe opemtioa in 
always, or even commonly, to blame for thf sdvent <jf 
neorceu after the extraction uf a tooili. TJio comJUious Imd- 
ing to uerriMiH are, in the grt-at majority of cakm, develnped 
pravioosly t» thi? rcm^ivxl nf Iht? tuoUi, and nre quite indo- 
pendeitt of it« roiooval; llie jiecmtiiB would generally ha*« 
been quite as Rnre, and ]>crli«|ift even more extensive, had 
the toolli bwii lul't in. Tltcrc i» nut tlie Miiatltist rvason for 
believing that the removal of a tooth should be deferred 
because llie (ismies around it arv in a state of acute inlkm- 
mation or 8n|i]>uratiou : if the tooth be the exciting catue of 
the niiHchicf, there is no encuae for delflvinjf it« ^xtTSOtjoa 
for a Hin^tc ntomtrut ; und the upiuiuu to the ctnitnuy, hrid 
thuu[;h it Ix? by a numlx^r of mcdit^l men, is in no degnss 
allured by dooti»ts, and l>e>ing hosed on u<> cvidenoo whateTBTt 
miiat take rank in tho cat4:goTy of popiilar errora. 

Fatal coiiBOfiuuDfeB have, in BovenI iuBtanoea, been known 
to follow ujioii n«:ro»ia aftor tooth extraction. Thut, in 
WtMll's " rsthologic de Ziilme " (|a^ 173), a case is quoted 
from M, Leyniteele, in which a portion of tlu> lower jav n-aa 
:«pIinterod in thn rflitiovjil of a tnoth ; pua burrowed along 
tho side of the jaw, ascending by tlio ramiia to the hase of th* 
kkul! ; and gaining access to the cranial cavity by the fiiramea 
ovalis ruliiiidiirii, aud ipiDosum, eauwd the patient's death 
froiu mcniTigitis. 

Another cam rcmilted from an unsuuoostful attempt to 
extract an tipper molar toolh; supprimiire perio«litit around 
Ihc tuoUt i>i)Hui<d, and rapidly B|ife»d to the body o( the Jaw i 
after a fortni^lit the necrosed bone was readily removed, hut 
aevere rigont ensuedi and the intient dicdi at the cud o( % 



HBOMUB OP TUR JAWS. 



499 



lonth. of pycmna, the immadiate cauM of datli twiiif; 
"pleoro-pneunninia ('). 

U. Bobeit (') alM nUtes a mm in which necroHiN fin{»r- 
venod oa ui nbecesa connected with a tuwcr »-uiliiin toolh; 
what lidcAcnbod u "paralent iufiltnttinn " of ihe side of 
Uio nt-'clc (ollowvd, ao<l thv putient mpidlf unk. 

The diseattt* uay aline at luiy iinriixl v( life, but it uocum 
uwrc fn<qiienl1y in <rbiltir«n than in iulalt8;ao4) tri tli« 
fijtiupr it iH, I tliiuk, more rauuuonlj' fcvu ia tliv luwc-r lliaii 
in tha upper jaw. 

Is chilJniti the scq^iMMtnmi ia g«Qiirall>- Umitod to tba 

,eta of one or two tcmponirj, and the crypt« containing 

« fluoceediiig puriiiaui^iiU u-oth ; and lb« situation in wliicli 

the lUscaisc ra<<*t fn^uontly miabliRb«» itself is tliat occtipiwl 

by tbf t^'niponiry mnlnni. To tliiis niie many exceptiona will 

found. The deaO hoot may \m cant off, and loavc thn 

ftinniog purnmnent loutli or t«iri.h behind, injnred, perUapa, 

Imt not destroyvd. 

XecrcKQs, wlwD it ocotirs id adults, may &1I upon any i«rt 
of tbe alveoLir areb, and may arise at any period of lifi*. I 
ire Mwn caaea in young, middl«4ged, and in quit« old 
pie. 

Tbe indications which attend necrosis ar« at the outott 
ULiajptistinlilu front icflammalioo of tlii- alveolar |Krti3»< 
,n), but tbey diflfvr as the diseon advuuw>. [iijitwd uf 
formation of a local and circtunitcribcil swelling, ibc zuni 
over the diccaccd bono becomes ^iiai-rally ttiiikt^nod, MimKl, 
and of a doep red colour ; pns oozes up fWm tito edge of lh« 
saxix. AfLiT a Limn thegnm teparatos tram the alTcolaB,tlM] 
margin of which becomes exposed. lUe involved toolh or 
tecih louaen and fall out. in the course of a few W4!t)kH tlui 
d«»d alveoli are dotache>l from the luhjaccot living botw. 



^»»)t 

nhe« 

' thr 

'by 
ha 



soo 



A ttwnn or DEVTAL srxoEnT. 



Ritd lie looM ia the substance of the thickened gum, lutbed 
in jius. 

Pkin ia cotoplained of earl; Id Uie dUeaM, Biid is tarn 
monly supposed to lie ttiothaclie; later in tbe course of tha 
Decro&iR tliv face beotitncit twullou, «i|ic<ciA]ly 1q cmes gf 
Phi)t)]>tii)niH Necjosi.s which disciiAe, being ia some respect! 
))OOQLiar, re^iniri^ a tihort special d4)«cri(jttuu. 

ir tbi' pu», which i* very profoitclj pourt-d ouc nromid tho 
»cquceiruiii,di)C£ not ffud a roady uxit into the mouth, it will 
ofutn point brluw th« chin, or eT■^^n pa»8 down the n«b 1»- 
naalh tbv Isocin, thus Eomctitoni reaching tut luvr na tiu> 
clavicle. In the caM of lti« upper jaw Uie pus usually niAk«> 
itti way intu tli« nicutli. 

PhogfJtona .Vccrom. — A pt-culiar fonu of nrcnats aflecting 
the jaws bu been repeatedly ohHerred in persons wbose 
duties expo«» them to the vapoan of pho«phortu. 80 
numenms arc the cases, and so clearly Ik thvir history 
tran-able, Uiat uo dmitit can be entertained that tbe pbos- 
phomH in the actual cause of the disease. Ilicre ia s 
pr«vule»l idts Lbat tbe lower more frequently ni0Brs 
fh>n) the disease than the upper jaw, but this is not 
Wrne out by Htntistica, as nnt (if flfly-nno cases coUeoted 
by Von Bibra, bolb javr« wero aifecled iu five ioataocm, 
the upper alone in tu-onty-one, and the lower iUom in 
twenty- five. 

One fact connected vritb the origin of this diseue gires it 
a special intorest in the eyes of thi> denial siirj;ct>n ; tborc ia 
n cotuideralile amuant of evidence in farcnir of the view that 
the poison acts li)cnlly,bnt that in tbefinit innlance it cannot 
attack an anbrukcu^arfBCc. Hence, it ttsuaUy gates acoen 
10 the bone tbruiigh tliD socket of no exlmct»l Uwtfa, or 
ibmugb ill** cafity of a carious tofiib. enp08Ur« of the pnlp 
bciiiii, rti^conliiig lu Mr. Salter ('), lliu ualy nuiunor iu which 
(t gains accv». 

(I] Udamrs-DVataBaryof flanHT,"*eLlr,paiL 



pRuarBORUS kicrosis. 



601 



^M It ia stfttnl tliftt Uie dtwoM hu Dorn' been koown to oocor 

^B it) II p(TK>n whose toeth wcro ouund; irliilst nutny M-ho have 

I^P worked (or yairs with impunity, have only b«?«o attacked 

^a After teeth hjui hecntno cariotis. The vxprrimmt of Von 

" Bibrt fully wofirmed thi« opinion ; he expiji«ed rabWt* to 

jAwphoruR rnmex, and found that they cxperient-od no 

injury to lung lu tbu tcctb aiid jaws weru intact, but that if 

teeth were extracted, or iho jaw oth<iruige exposed, nwroaie 

spomlily r(.>lluwi<d. 

, llic dt-icaK rcry rarely occurs, except in the persoDt ot 

^■iucifor-molcli makcn, but Mr. Fa»vt quotoa aa instanop 

^^wbero it was indnc«d by tb« inbaliuion of phoBphoros fumus 

as II quack roninly fuc nnrvoiM do^irBBKia]] ; and Mr. Heath 

(op. eii., p. 11.^) quota Qtaodidior to tho effect that a case 

had been met with in a child but six weeks old. lliis cobb 

is ramirkablti iaumnch as tho t«6th vwn not yet ernptod, 

ao that thi' poiauD seems to bare obtained access tbroof^ an 

uuhru)E«n surlbDe. 

I'hiH form of oecTDsts is, p«rbaps, the moat Mrere of any 

rhidi in root with; lu ayiuptotna do Dot marknlly dffTer 

tl^ow of necrosis induced by otlwr causes, save in their 

ity. 

swelling of tbu soft part is rery great, and the in* 

logUQiDDt hocuDun nry nil luid BUtnin;;; tho sup|inraUoD, 

^vbicb iiiay ^ve rise to external fistulona opcninfp, though 

hulk of ibe pns \b graenlly dLtcharged into the moulh, 

very profujte. The advene of stippuratiou is luarkod by 

Igorn and pyrexia, and in aev<>ro cjiwvt by delirium ; after it 

fully eotabUsbed the Mverity of the oonstliutiuoa] symp- 

> abates, thou^i tht> pnTteut's health suffeni rory greniiy 

inabiliiy tu takv B^lid fiiod. froio swallowing deoom- 

' tma, and from eshiiiiiition. Gangnincof tho toft ptrta 

'MyaipcltLfi may au]i>}rvcue at ci^nii'tirarions, and terminate 

pitiGUl'tt sufTcringa. Still, ihe majority of cues recover 

with cunaiElcriiblij Iom of bono, lu the caw cA vVu Vit-^wx 

J»w u rvr_y lur^e aiaouot of callus ih thto^m tAV ixowuV 'Oi\'6 



nil" 
KJWliidi 

■ftplDt) 

^■■Kit: 



i 



SOS 



A eTBTKH OF DCKTU. BimOKBT. 



hMlucsinim; wb'ile \a Lite ca»e of tLe upper jkvr Uttlo or 
notio ii fuund. 

Thv btiity cl«[M>!iLl wiiiuh U ttirown out in plKttphonu 
necrosis Ib peculiar in api^ftnocc, ami has liecn compaml to 
pumiuo-Ktutiu ; lUthuugli usuAlly present in great quantity. 
it JA Dot iDTariably to be fouud, and in the esamjtlo bcrr 

PI9. IH. 01 




figtiTod it was apparcnlly absent. It is abo esoepttOBitl 
a [Mirtiou of the jaw to lie nfTcctcd in pboBphonu lucroifflij^ 
the dcstnioiion tnori! Dommonly ioTotring tb« whole body of 
the Jaw, 0ms aacedding nini atone romaininj; intacL It is, 
of course, itnpoJtsUilB to say liow far the diwaac might hava 
PxU?ndeil luul the pnttent lived ; but the nccroais in tira 
tipMiim«a Aom not reach lar beyond the middle Ua^ thoof^ . 
no atlempC nt se[aiBtion baa aa yet m«n made. 

The uc-w boue tbro-niL (mi aoldom surroundit the >fqueetrnin, 
but ^ueralty forms a trough in whiub (he drad booe lies. 

The E;D)iitration of the !M>qnc«tnuu umully tftkea a Teiyi 
, long timr>, often a year or more ; but (be surgaoD must «Q>j 
so account be t«nipted to roniovo it before it ia detaulii 
All that can Iw done U to support the pinicnl's strcnjjth hfi 
igenerouA diot, nod by ttmics; ihougli Ihv duratiun of tbo 
nodots tbo avoidance of dn^ aa Ikr u povible, 

(I) J*m iteta ■ hadftr-tiHtdi nuferr. a^ SS, «rho <llcl wliIM vntrrhn I , 

liMpbonii tiverab. Th« biw iKiHMiued fton tbc tucc ol the left noma m i 




UXAVTBUMkroXJS :)EOR06I8. 



503 



I 



The TDOuth Hhaiitd br frci^iicntljr iiyriiigt>d oat 
is oT Coodj'n huiJ, ur I'U^nul itoduiu«. 

Dr. GBnwtaon wln»c» ihe iiwortion nf pledget* of cotwn- 
wc-A luLu Uj« giniuwai, wilh a vicnr or hnalvulng the sotnnitiuu 
ot the porioKt«uni, whicli ii alruwly in<>vtlubt«. 

Lai^c quiLUliUus of jnis will Iw sw-all(iw<Hl, but it U de- 
firablv tu iivoid the fonuatioD of any oxtemal siDusefl, tad it 
iuducs the discbarge af pas iuto the tncuth, as the stuuBW 
woulil afwrwarda prove rtrj tioubleaome. 

lu the njiper jaw ihere u a greater tentleDc; to rpcnrrence, 
but thff cuiirM of the disease is not ho viuloul, and the 
Docroeed ptwtions may he removod much sooner. 

U it Biftted tiy Mr. Salter IhAt in lliis foriu of iiecrosis 
lliere is do great t«ndeDoy to extension of iJie duwose; th« 
vbole r^ion offocted is attacked &t once, from, tho very first, 

lat is to 8ay, at tho petiod of the fiivt attack of aoatc 
'indannnation. 

JCxanihematoue SecnmiM. — ^During conTaleBeefMOofdiUdrea 

frotD ibe criiptivv feTtnt, and particularly after scarUtiu, 

portioufl of lliu alvculiir border uf the jiiw, very oonunouly 

Deluding tho daveloping permaneoc t«Mb, ore fouii4 to 

exfoliate. 

Tliu course of tha dtssaMi is not oatiaUy riolvut, and aH 
that will b« required i« to niiiove the fragraents a» they 
tioDoau) luane. Otlo WeborCX bowovcr, cucaiitiuH tlio occtir- 
letiM of far m(H« serere cases, which threatened gangrene 

im Lhi! uKcoHsive inbltrattun of the salt fiarts! in nuoh 
cases free ami deei> tnciaions would 1>e retjuired. The difease 
Ss remarkably Hymniolrical, aJfecliog the two Kidea of the 
itli alike; it 'n uiont frequent about the ^e of firs or 
years, thiiugh it hait bevu met with at a hUer t^ 
Benral oxample« of jaw DecroflU occurring aftar uonUnued 
fever are to be fonod in the difTerent hospital museums. 

TraitmrM if; much tJie siUiig for every fi^rm or necrosis. 
WlUlst the dwcanfl w ID ttu) Htage of ^wnrntAXlx^, i}bTv&'uGuv&<{» 



501 



A ST8T8M or DEXTAL BCBOKKT. 



I 50 

^1 to run cm to necrosis, free incisioDs &)i4iihi be mtul« throngb 
^M the infljuuod piimtt, nml ])opi>y fotn(.>nt«ti4)tL8 iiMJduouily 
^M UMd. Any lecib or «Euiiips which may bu cftiuioK trrit** 
^M tioa should be ct onf« remored, no matter how vjvlmt the 
^M iQflmutiuitiuu aTDDm) thmn may bo; aotl tho |inu:titiani)r 
^M who Is deterred from «» doing by the popular idea that toMfa 
^^^nboulc] n^it bo rcmoTeil until tbo iiiHammatiiiD boa snlwided, 
^^^Pk likely (Miougli to be wAilin^ for a Lita<! that will no<rcr 
ooBir, nuii ifl iu»uredly gricvctutly ;>rfjn<lk-iit2 bis pnlient^i 
cbftDc^e o( escape from tlie munj Hrrkius ulmcDt. 

When tho diKeKM hoa actiutlly Kacbed the Mn^ of necroift 
there uwd W no heutatioa in remoriag a tootb wblcli bM 
cniisci tlio disease, hot tho propriety of at once (fxtmcting 
Kmud teeth which hivvii V>eciiiiie im|ilJMt«d by the extetuioo 
of llic ilJMase may bo q^ut«lioncd. 

Itiitlaticcx hiiri' boon recorded of t^wtJt, looeimod ud KpiM- 
rontly ID a bujiolciis coaditii>a, bttvtny:, &ft«r tbe i«mov«t oC 
Ihi' BL-quortnini, bccnmr firmly filed, pither in the mtudning 
[Njrtion of the K>di- or in alvcoti yuboequetitly developed. 

ng. IDT. <o 




Tbo B«iiiCBtnim here figiinxl contaitiR (a) tUfl sockets of Ibe 
canines and biciisjnds, luid the hiittory of llie casr, n-UlBc) 

1 1 luioHiUlnlnc tha vriDphTi** (b1 *nd (to nfata of tlir bteMfU 

^n < Wnu & AM^rtivs lb) Ml . 4e- WMvn. - Leuare* tm Otl^ 




EXAXTBBMATOUS NKCItOBUI. 



605 



by Mr. Bhaip »t the Medico-CUrurgltml Socifty ('). «» 

I briefly iw fulluws : — 
The disease bad comtccaccd wilh toothache, aix nioiith* 
prvvtotuily.fuDowuil by&h-mlor alnoeBS, uid a Bstolor opening 
uudtT tbo chin. Exlcnslve gloention of the iotegumcats 
uiulvrlbe vbiu haA enHiiccl, and after ibo l»|«o or two iitontlift 
it wiis Ibougbl that tiie i«que8Lnim wu <i«iAchcd. Th« 
cxiHing sinuus under the chin vmrv throwu mlu ouc, Aad 
the dead booe, amoiuttiug to about two^hirds of the lownr 
[}nw, cuily rvmovod with ri}rcB|». Ilie tfieth, with tbo 
.exoL'pliou of ft Ucu»i*id which bad been eztnicted, nanaioed 
jin their pUoes nnd hccnme uilRrobly firm, notirithHtatidiag 
jthe entire deHlructiuuuf their ori^pual atreuli. 

Mr. Heath (np. eit., \\ V'i^A) hiu (v.II«!ted aareml other 
i io which iho iwtb romained firm after llio removal of 
^Mqtuatra which amtJiiced their ftocketii, nod were io • 
nuasoro iianful to the |«ticot ; though in other raaea they 
wen iDDoavvnieDtly looae, and were Buhsniiienily ivmoved. 
Mr. Heath altuj rclatM a eoac in wtiicb the tt'frth reniainod 
finu after very oxteoMfc necrosis of the outer plate of the 
alvoutuK, tht- inner liuviii^ romaincil to serve as & supjiurL 
It has (mod usually supinwd tliat rcntorstion of bone after 
bU waa diectfd by the |MruwU-uiu, and in muHt in- 
ibia U certainly the case; Mr. Tb^iiias Smith (*} 
however, mift witli ao example of now formatiim of 
boD*i which be oonsiders coubl not have bwu derived from 

Kperioatenm. 
Mr. Sftltcr C) points out that the newly-funiiMl tower jaw 
h apt t-j be Blworbtd, and to dwindle down to a meiv )nr; 
^ and DiJda, " How (or tliis losa by absDTption of inippli-muntal 
jDe ntay l»e prcvenre-i by nipplying it wilb a function 
trough the mmiiA uf arLibi;iiU tmib, ut a quiuttum of theo* 
Dtiool iuterest and of ptactical impurtatice.'' 







"MxiaA, f*L xvia., pi.4ia. 
■J 'A liunsery." wt- w- 



506 



A STSTUt or DBKTAL BCIOSBT. 



It IK n curioiut fnct ttmt th«ru is rarely or ovver ftojr njmr 
by >>on« alW nocrosiii nf lliA iipppr jaw, though in chjldran. 
and moru (iiuiiculiLrly aft^r exaatbeiuatoiu Dccroeui, the ptp 
is ortea fiUod up by fibroux ti»«iH'. 

Diaeasu in n iciupomry toutii will Kiiuctima tmi ap in- 
fbmmatioti, whicb id t scmraous or cnfceblod subject cuf 
B])reui, HJid nltinmtely involve a Inrge pnrticoi of tbo jaw, 
and rcnuU in necro«is. Tbc Weth, whetlier penuanenl oc 
temporary, implanted la the eoqut-iitnim, are nsoally locL 
Mr. Oliver Clialk relate* several ciues i» wbicb portioiu of 
ibe jaw, inrliuling the temporary and the crypU of the pcr<- 
uaoent t«etli, u-ero lo»t. New bone vvuutually took. tJir 
pbu» of tbnt which bad bocD mnovud, and l]io jaw as^u 
bocune pcrfoct. In Bevor&l of tlieM cues, pormaiteut te^b 
moBt nncxfioctedly madu their appearanm, siiggoBtini; tho 
idea that tbe teeth, as well la the b<ine, had been repnidnctid. 
la each instance in which tKifi'iinumal result oocurrod, Um> 
BOquestrum wns allowed to beooiiiu pccfi-ctly xepnralAd and 
quitd looM, before its withdrawal through th« opeEuag whivb 
olirady oxistod woh attvuipled. The pbooomvita, on ruspeota 
the teeth, admit of explacaiiou on other grotindii than thJkt of 
suppusirig a aaound oerieK uf jicnuaneDt teeth to have been 
developed. 

Dead is in all oaees (ietaoheil from living bone, h? abior|^ 
tioa of the Uyer of the living tinne which counect* the two; 
m addition to which, we commiiuly find markit of nhttorptioD 
acattund over tb« whole of that aurlac« of the aequeatnim 
which has becu connected with the soft |»ris. Again, the 
apertures of the ciypts are by the saom pmcesa graally 
enlaced. The connection Wtwocn the walls of the crypt 
and the sac of the dovelnping tooth-pulp is in tlie nonnal 
state but a itligbt one ; and ihin, in the charact/'r of caMS 
referred lo, may be rendenxl still more sitghi by the praacnoe 
of disease. Now, in tbi) ]tresi?n«« of the foregojog oonditJoos, 
it la uul iiupr<jliablu that the (nilpH of the penuaneul levtb 
remained attached to the softpart^, while tbecrypta iticloded 




SXANTBEUATOCft KEOBOSIS. 



607 



^ 



in tbo HequDstram vrvre riiRKiT«J ; nod if such were the case, 
the dvveUiptng teeth might ft^iu be niiTOundcd by newly- 
formed boDG. Tbfl trath of this explaoattun of the tiiftrtner 
in which the peculiar re»ult« were brought about. Is rviiilcrc<i 
tiKibiibU< by the iilneoiie of atiy woll-authenticatnl caws of 
the uccurrciice of » second nut of ]x:niiautiiil teeth. 

Bnl whatcrer exptfuutina l>e udopto), I think oil will 
A^TM that it is ilcAtiable iu tbo«« ciuvs wtiere uecTona of the 
Jaw oecnni during th« pmscacc of the tctupanry tct'ih, tluU 
the stiquntniiD should bo allD^vcd In nsmaio until it is 
pcrrectly detached both from the contignous bone and soft 
porta, befure its wttbdrawal is attempted ; uid that its 
rentom] should b« effected with the least possible injury to 
the latt«r, so that titc permaaeot ti>eth, if not dflittiD>ed by 
tb« diacwe, may tw pinocd and«r Iho most favooiablo cir- 
coinatanoea for their future |m>wth and evolution. 

Beforo tho dead is separated (W>m the Urinf; bouo a layer 
of the latter mtut be abaorbod, a prxieas wliicb has already 
bMU described in ixnitiection with the shedding nf the tem- 
porary toeth. The soparation of the scqcestrnm muKt be lefl 
to nature. Wo c«n niudiT no din.-ct ussistmux ; but it must 
be the bnrinees of the practitioner to see that nature has a 
(kir chance, by atloudin" to the [general health of Ihe patient, 
nmotliig any obrioos sottrcc of local irritation, and kwpfog 
Uie diseased part in a cleanly state. In affecting the hitter 
ptupow, A wash composed of five grains ot chloride of zinc 
to an aiinoe of distilled waler mny tie iuhxI. It will excite 
bwltby action, and grL-atly diiuiaisb, if not outireiy ore*^ 
cooiv, lh(^ fiptlil anieli which attends suppnruticu associated 
with dmd bone; or dilute solutions of pcrmnnganate of 
potash nifty be used for the same purpose : the point of a 
Bjringe may be inserted into the Binuaee^ so as to effoctnally 
Wash them ant^ 

If, after the soqiiesl-mtn has been sepanted bvm the body 
of tho jaw, it IB (<riUni;led in the utft parts, the scalpel miut 
be used tu elTfci its liborativn. With ilu: remoral uf the 



SOB 



4 STSTtU or DINTU. STBaKftT. 



dtAd bone the treatment of tlie caM may be aaid to tflnniiml 
I'bc mHATnmKtory w.'tion in the ganin one] conti^unna 
txiice, iu the abieiicv of a source of UTiUtton, nf 
giibiiid«4, and the tnoutb u speoiQy restored to ■ luto 
hmltb. 

His impotlant, however, that tho wquestruni vhoalil 
pleked out sa tooa as tt bos become \ootc : if thu 
nogloctcd, burrowiog abeooMM ns; be formed. Thai 
CalUio rvlaim a euc in which a ]iinw of dead Nmo finni tl 
jaw pawed dova In al)Ke«8 carltlea, and was Rnallr reiuot 
beluw the clavidu; anil Mr. \7uud has furciblv ]n3iati<d o% 
that it i* quit« ponible to wait too long Morv rvmorio^ : 
dead hone. It has alreadjr been mentiaDCHl that den 
penuaaont tooth are oftoa lost in the aequestTuni thi 
in the M-cnllcd " c-xantbcmatrnt* necrosis." 

Not otil)\ h<iwi>ver, may the pennunent teeth be exfblii 
but tho whole Iow«r jaw haa been known to be cast 
Mr. Pollock figured nnd tivM-rihrd sudi a cA^eC); thero' 
not a vcstigv ofa lower jaw, which, acourding to the 
nicnt of Uio patient's friends, had bem thrown off when 
was two years of age. The defermity was le« than woiil 
havD been ex|«c|ul. 

CO Atl. - UUmkb <if Um HouUi." llulsiM'* 'UkeOnur ol. (nit^ari^ 

■BdMnuoc. 



( 509 ) 



I 



I 
I 



ABfiOBmON OF THE ALVEOU. 

Tbb graduft] wasting of tbcalTcolw proMsses, accompanied 

hy A corrM[ioniliug reoedooce nf the ^ms, keepa paj:« with 
tlKwo general chuigcs wbtcli AtteDil tlio ailraucc tuwanla old 
tga. Tho neckti nt teeth becnrao cxpased, the gimi oon- 
tinoM to fiiok lower uid lower till th« wholv of tlie routs uv 
uocoreredfWidUiDtwtJiiitlulliUluut. The loss nf tinpliuita- 
tioa is Dcpt imaccomfuikd witb change* in tha toctb thom- 
idves. Tliv nx>t^ are deHtttul« of cetucntum, aud U-como 
trausluwnt, liki.1 wliilc horn, ami retiiiii that clioracter wbt-u 
iwrfartly dried, diii«riDg id thia riw|wct from locth In a 
Bonnal itato, the ruota vt which, wbvn ilcprivixl of tauiftture, 
an pcirl«cLl,v o|)aque. In the ouo lh« opacity la doo to the 
■IryiiiK'U]' of the dcDtinal fihrilH, aiid th(3 eonMt(|tient empty 
«ut6 of the deatioal tabes ; in the other the fibrils are iu a 
pUffo or tees perfectly cah^ifiMl coodition, and ore incapable of 
ihrinkiuij up nhcii the mointuro is withdrawn from the 
tooth ; lienre, in the aUteikre of Mihuinr iiitjmipaccs in the 
subctauce of the duniine, il8 traiixiiarcDcy ta necnaarily 
prewTTnl. With thrwc concurrent cluingca, it la diilicult to 
duu^rmiuu which tokos procedenoe, and whether (hey hold 
the n-lutiun to each othvr of cnniH! and cflect. The evidence 
ii greatly in Eavoor of the asHumpiioD that the oonaalidatinn 
of tlic dcQiino in the root of the tooth m an agvd subject, k 
th« pmirdcnt oinulition lowerinf; the vitality of tlie tooth, 
and r/t n certain cxumt minctng it to the state of a foreign 
bixly. aiid thai the sockiit and ftiini are gmdually alwurlwd 
Ha a conmxiueucc of the ebbing vitAlity of tlw part to wlilch 
jLey aro bubacrvienU This view, I think, hi^da good whuu 



510 




A ST8TK1I or DBKTAL fUWIRKT. 



the [JienAmena are sMn in ihoae vbo hxve pused tho mUdlft 
pcriud of lift-, nnd also in certain olbcr cases ; bat a qneation 
amy be raised as to it« validity on the ground of wont of 
omfonnily w thnse fiwps in which the ituwiir of thu tevtb 
ore Wt, aiid the rootH thi-rvliy li^jirivol to a great extent of 
their life, and yet Iho alworption "f sockclfl and gumti doe* 
Dut follow. I IjiOii-ve, liowvvtT, lli« diOWunco of rvsull is due 
to a lariatton of the conditionit. In cases of aT«orption ot 
ihe alVGoti, the nxila of the leetli aa< almafat c)c»lttal« of 
cetncutum, wh«reMi Id tho roou of teeth around which th« 
80cket« and gnm!) niv pi'sservod, the rcmenciim \a also re- 
taiued. Exaiuplm illustrftliiuc this condition will hcfouud in 
yuuQg or iuiiii)k'-ii<:t.-d |mtEont» nhiwe ti-uth have ilix»ytxL iiud 
brokon off close tu the 6ijgo of tho gum, the Itral of which 
ii for a certain time pnwemxl. Sooner or later, howpver, 
iht' «l{:u of the hIvcoIub rccr-dw*, and is followol hy Llie sfU- 

Th«re arc othoT cotidilt'inx t)ian thniic alivady onniiicnitM) 
under which the twth may lose their eockc^ls. A case n:> 
oectly came to my notice Ln which, without any appreciate 
vaatlng of the guniR, the whole of tho upper front teeth 
bccaiDA vzce»ively Ioom and fell out. The alveoli w«n> 
altogether abnnrbed, or vrere )^n<at)y enlargral, hut the ]ir&- 
Mtice of ftny maaifest di«atte, oither in tlie teeth themselvea 
or in the surrounding parta, could not he d(«t«cted. The 
guius were not itiorr ro-sculir than wniild be omnidiTod 
oousititfint Mitb hmltb. lUid iu the teeth tlivtv was a total 
abaenoe of tint hom-liko aii^icAnincc previootly discribn! ; 
iodeod, the cauno of the rnalady wu too obacort to kdmil of 
recognition. 

Ab»or[>tioo of the alreolor procemea may be mora partial 
Uui) in the cases previonaly coniddenxi. The out^r ur the 
lau-it plate only may dinappear. The nccominnyintt illus- 
tration u taken from a preparatiiin in which tho Ulna) pUte 
fiorrcspondiTu; to tbi- upper front ttcth hue Ixx-n M^uiorvd. 

Indications of a similar chan^ in other [nru of (be jamt 
ihown, but the amount of toes is compualirrly triAio^. 




ABSOOFTIOS or THB ALVBOLl. 



&n 



The toara prominent or oat^BUuding teeth an tboM tba 
lockflU of which sro m«l Huble to hocoiue abeorbed ; toeth, 
ttheronta of which wo but thiuly covered by bone and ioft 




thn mMlto or tlMinilh* of U>* *I*mU of (te HfOpnraTy taMD (Tl.U D^wm 




syareM or dkktai. enraEBT. 

[larta. This fnct U shovrn in tbe cam figured. The right 
appcr caoinc hm lost tlie whole of the anterior wall of ito 
aocki-t, MthiW- Mm cuiiti|;aoiis Utoml iuotBur, which lien back, 
bu reUUicd tbo comspoDding piut of tho alveolar iavest- 
meal. Tho canine teolb being tho laat of the fn>nt teeth to 
take their position, are subject in a oooliacted ynw to atand 
in lulvnncc uf the dental arcb. Thu canrm tttkea hy the root 
can be readily traced, and the email amount of bono aul 
giini by which iu antarior siirrnce in c1<>tliril U recogniaoL 
U IB from the roota cf a tooth so [^aocd that the autc'rior ami 
projecting wall of the socket mcwC ft^uontly disappcara. 
The labiHl Kurfacc of the nxil hvcouiea exjiuHxl thmughnut 
the greater part of its leafflh, leaving thr tooth dopondent 
ttpon the [Hiiitvridr or lingual wall of tlm socket fur it« 
retention in th<! jaw. A prominent and compuatireir 
tmeupportcd pneitinn would seem to ofTor an explanatioit of 
the early diaappearaiice of tho outer plate of the alvoolua, 
but auea are now and thon scon to which tliia vxplaaalioa 
could not lie eatiafactorily applied. A specimen in my otm 
collection exhibits thi> full compltrmeut of twib in the upper 
jaw, Kuuiid auJ well arranged, but from a bicuspid tooth the 
whole of tlie labiitl plate uf the alveolus has been abeorbed. 

It ia in uiniiy uoiccs very difiacuU to diKover a aatiah c tory 
cauM for the premature difuipptamnre of the alveolar pro- 
oeas««. The prnsvuee of iuflaruntatitn <if the guuu, or of the 
alvsi^at periosteum, or of oolleclioiiR of tartar nliout the 
DCcka of the tcctb, and tho oon«e(|ueiit initatiou of Ihu c«lj^ 
of the guma, arc followed as n aocoodary conacqucDw by 
abiorptiou ; but it is to the- oociureoca of olTcolar absorptioii, 
without tJi« precedence or accompaniment of obvious diseaae 
in the aofl tiisnca which clothe the »>cket, that ftttention luu 
beca directed. Tho fre(|U«iit use of a hard tooth-brush will 
liasten the wanting of na out-standing socket, (be oorrr- 
spundiug gum of which haa the appeanoce of boagstntchcd 
Itt A tljiii layer ovur the neck of Uie tooth. 
When tiic alvcular \ou\ft eai«nX\\at»t^KA.i.t.bi mouth. 



J 



ABSoarnoH or thb alvbchj. 



CIS 



^Bt vill, oa inqniiy, rery onmmonly he fonnd that fl Bitmlar 

^B misfomitM! hoii V>elalten other AtiA antecedent mombcni of tlie 

V Eunily, — tbat lh«< [Mr«di«]>0!<iti<>n to ou early fiiilare of th« 

tMth, from the roc«<l«i»:« of their »cketj, i* hereditary. 

Tettli wliicb linvo 00 uita(;oiUBtff iii tbc mouth are pei- 

tupi more liable to b« lost in this way tfaiin thoM which 

an in full nee ; am) it is not unusual for tho ticusptdx aitd 

molarB to be thiu ih«d, whiUt the teeth in tb« front of the 

mouth reinnin flrtn. 

J Ot» of tJie eftrliest indications of the advent of this Mat« of 

^K thintrii, \» n thiolceiitiii; nnd mTiniiin^ of the edge of Iho gum, 

^V which ciiMcs to U* cluM-ly ailLcrvitt lo tlie neck of the tootiL 

Id Uii^ sulcus betwvrn the iif^^k of the tooth and ihn free 

«]gDof tbc n^ita tlivn is gcuemlly a little pus, aud alraoet 

always a thin rinj; of bard, dark urlnr, invitiiblc tmlL<t« the 

gum ia foK«d Airay fniiu the tooth. Ae the diMise firo- 

gKnM, the tcotb bocomea dctooLcd (Tt>m tbc tott pirttf to a 

cODwieroMe depth, so that a jiiiHX r>f Ho-calted " dcrtiflt'ii 

twtat " may bo [»e)«d up betwwn the fang of tb*; twith and 

tluialnxttus. At this stagv Ihrre is usually a ixr[uiiil«raUe 

amount of di»charge, which in peculiarly offciuivc, and tlie 

breath of the imtient has a nanseating uduur, by which it is 

oftea poaiiible to tell what is tlie inattci before iii»pcciuig 

the month ai nil. 

Tbcro ift oft«n a coondetaUo anionnC of nciiral{;ic paiii 

attendant opun this rcudition, which is very iutimately 

coonfictMl with chronic tuflaaunatioD uf the gums, ami may 

arise as a conwquencc of aoury or of tnorcurial salivation. 

^H The causes and patiioluKT of the diseaau are rury obscure; 

^M It olteu arises iu thoruuj^hly healthy iwrsons who havo haidiy 

^m yaMinl tba perioil of middle Uib, and whose teeth havo becu 

^P esooptiooally &oc frxnn caries. 

~ All thoM* (p<clh which bare become kopeleaiy detached 
from the pcri<'<st<-uin should bo reaMTed,aa tb«r» appears to be 
kfome l4-u>U;rtcy In Ibdi^xtcoaioDof tbotUaouftfitnuau'aSluAu^. 
^Icolb to ilji niHghbvan. 

1 u 




8T8TTO OF DENTAL SttBOERT. 



llio [tnnl, donae tftrtar wliich eocircln the neok of the 
tooth beneath or &t the level of the edge of the pim shmtd 
bo carerully removwl ; not booaoec ib i8,M haa^beeo ntppoaed 
by some, a caOM of the dl fl w w — it is a BeooiuUry d«poeit, 
aod could tuiver hsTS got then without ])ro-«xikt«»it diac—p 
— but because it is a aouixe of irrit&tion. 

If there is much diacbarge, thu buIciih botween the tooth 
ft&d the gam should be touched with a fragnieot of «alU 
ai»c ohkiridfl, aad the patJBnt direct«<l to wipe it oni wtth a 
caintl-bair lirufih at laaxt uucu a ilay, Ihubriuh biniig cliarged 
with a flolatioii of ziao chtorido gr. t. ad {j., or witli ph&iol 
Kodique, n cMjnrenient Huhittiiiitc for whieb id sobjoiDod — 

R. Acidi oarlwlici, 3j. 
Lii). poivaaii, 3j. 
AqiUD nd ij. 

Or, if an astringent aoeiD dosinbte, the ft^lowiog wQ] bo 
found very efficient — 

R. Glycerini acidi corbolioi. 
Ulyccriui acidi tAnnici, ili i,»». 

If tbers he ranch cooftestton of thu gums, they may he 
freely lanced, and freqnsntly punted with tinctare of ibdfais 
(double atrcngth). 

In Bome fi3w ca»M much good may bo dom-, but as a mie 
the ruulta of treatcioat are very aantis&ctory. 

In th« absence of an oliviourt cause of mi9cb{i>f, we can 
but dtruct that the patient should um a aofi toutb-braah, 
emjiloy a mudcrately astriu^Mit diqitifrioe, lake care thit 
the teoth are well cleaned, and, at the same lime, arotd iiri- 
toting the edges of the gum» by rninecoiaary friction. 

The use of a {decc of stiff twine will be fonnd voty Burnet- 
nblfl in deciding wbctber or not a IwMcoed tooth riionld be 
extracted ; if it can be pamnl up nearly tu the npcnc of the 
fkng:, on half or more than half the circurofemicc of the 
tooth, Uie chance uf its again beooming fino is very nnall. 



J 



C 615 ) 



HYPERTROPHIES OF TRR Af.VKOLAR POKTH)N 
OP THE JAW. 






A fOBH or abnonaal dcTeiopmimt of bone in the nlveuUr 
i«|pon, which is pr^uclive of great iacoareDieoco to Ibe 
patient, onnniEU in n gnultuil ti[Iirig-np of the sockets of the 
teeth by boat'. 
After the luxfttioD of a tooth, th« socket in young sod 
idill^aged Bulijticta l> to a certain extent fillod up itom tht 
InUom by tlie derelopment of lkon«. This ptoceas, irhicli, 
aft«r the lo» nf n tootU, is reperatiris beoomn ilntniotive 
when the action in net up in the noolcet of a sound tooth. 
Tbe tooth \iy slow degrees becomes loa^ei than its tit:i^hlx>urs, 
and after the lapK of a considerable loogth of limo, t<K>#ens 
anii UllsoiitiOr is reniuved id coDsoqainiccnr itx iocuuvutiivnt 



■ In ( 



In ottier caaea, a^gain, tlu! teeth, without being estnidnl 
by thv d«veloptD«iit of boue within their Bockots, ar« A«pA- 
nted frtnn caeh other by the tliicknning of the intcrrvniog 
bouft. Id aom« cmsM th« shirting of position may he dtiv to 
dmut;^(a«nt of the nonual tuitagonism of the u|>|ier uml 
lower tooth ; but there arc rthen in which this cause will 
fail to oxplain the gradual separation of teeth which «re 
apinrculJy sound and healthy. This deposition of biJiic 
may also harv th« effect of ili»pLuing tbe tcetii forn-anl, thii-s 
in the cnao of the upivr luuimirs, producing a very uusi^hUy 
apponrancc. 'Ilie gum is usually palo, hard, and duaely nd- 
liereot to the ncck« of the (cvtU. 

U>-pertropliy of th* alvoolar pnrtion of the law, wbifu 
limited in ext«nt, ts far from nncuoimoo. A uulule uf botn* 



516 



A SVeTEU or DEVTAI. SUROBRT. 



118 lar{;e u n pta is often seen frojectiDg from tlie Uc^tul 
eiirfacij of Xho Kiwer jaw, (tnd lillle (^ no incDDTeiiienee n'j 
felt from huc}i growths, even whrn an Urge M the h&Lf of M-- 
nut ; and many inttancefl have como undo- my uolioe ia. which 

^. SML (t) 




corrMpondiDg growthB hiivr tipnin); fmni tlie lahial siiriace of 
tbe sockets or the molar U-ctli of the. up[ior maxilla. I re- 
member one ciue in which a tdout Vtony ricige ma out to the 
extent of mnre than half an ioL-h, and iiivn tuTDcd ajiwvdar 
Tliv jtttitfut Btaurd tbat the MKincnt or food on thv abgit, tMA 
lie U)ni».i] it, WAS the oul; aDuuyance to which tlie exoatoaiff-j 
mbjcctcd him (*). 

Olto WL'bor (*) mcniiou* tUe occurrence of limited exoa^ 
tD6M and thickening of ibf bone ocftr the olreolar bvrdur, 
and rufen Uiem to the irritatiou cniiMxi by ditwuM^d tevih : 
be observes tltnt over eiich exostoses Lh«re ui marked tciulor- 
ness on linn prcAaure. 

Small oxukIomjb, which seemed to b« due to the irritatim 
i-aiii^'d by carious teeth, have io samo few caaeti bcetx known 

(■) fB>a«ith» Ikimtrttbtn Uw iDwirJftw KpualcdtnmaMk ottm-tatt* 
niMllan Itaw by tb« Ibklcetilos of tit lirttTVfiiinf bem, Indcpraaeai «r ibe 
prnH«(v ot dl<rJM. (Frum Mr. SutDilm'* oJkctM.) 

(') Ad excvllrnl rxatnpir dT ;iiiineiuu» aosicM*, rtwUcil om llx alfnlar 
bonlrr of tli«J»w, i« elrra tn " Atlat tor P*il>okctF der 2iba« " tmi UtMM 
and Wrtl. Plait «».. Wn. ■LS'. 




nnKBTaopTiT or thb ovut. 



B17 



to diiap]war &fter the ex inclion of ihe t«eth ; a caur»e whicli 
sbmild, therefore, a)w»}-ti be trietl. lint, u a gPHf-ral rule, tiu 
tre«tm«Dt Imt excision of the toorbiii growth vill bo of any 
BBrrioe; anil this becoam neceeaaij vhcn the maas, from ita 
iuSB or |x>riCioi). eatuM mocb iacoorenieDce. Owing to tbe 
eioeasire hardness n{ tuijne of these exoetoMB, their removal 
ii often attoaded with iaor« difflcolty than waa at all antici- 
pated. A Hey'* nw will geatnilly be found the nwwt niit- 
■Us innromait for lu removal ; it U oitea too hard for a 
gouge or bone-ruroGpfi to bo of mnch acrvtce. 

Id other ioatancca Die enlat^oment of the Ixnie ia of a soft, 
Bpmfy character : teeth rcmoTed in soch caaca come away 
^KTvry readily, the boiio ounveyiog a peculiar yielding teuta* 
^nion to the oiwrator, M though it crushed undor the applica- 
^■tioD of modi'ratu force. The ealargetnent slowly diaapipvom 
H kftcr ibc removal of the source of irritatioiL 

JIgpirtrophjf t/ Me 0am* and Alvcoiar Proeees-.-a. — In 
itonie few cases a general hyiwrtivphy, involving tlu; whole 
Dr the greater jiart of the gnmx and aJvoolar prooeaaes, haa 
eu obwrved : for the opportuuity of examining one of thena 
1 am iodebtad to Mr. .'Vlfrcd Canton. The whole of 
' tlie alveolar hone waa greatly enlarged; it projected upwards 
to the lower, and downwards in the upper jaw, oarryiug 
bafore it a red and thickened gam, and coDceallu;^ nithin 
(bp groove fonucd by it« linpial and bbial (lortiona the^xir- 
respoading nirfaceb of the teeth. The thickening tn the 
front part of the mouth was so great that the lipa coald 
itot be cto«ed. At the hock j^Art of the alreolar arch the 
plbickeai>d and elevated gnms of the resi^ctivo jaws, thmigb 
itteoed by mutual pnaanre, did not allow the molar teeth 
in oopMct. 
patirait was a half-witted, atrnnHraa child, S];cd about 
yearw, wboae appearance led to the preeoroptiOQ tbat 
III t he diaeaae was a maaifestatioo of the etnimoua diatbesia. 
^Blo tieatramt was attrmpta) in this com, the \iaV\euV xtA-^ix^- 
^Hng toherjutjVe nllage. 





&18 



A BTSm Oy DKHTAL fiOBASBT. 



Seven) csccb of the aficction faavo hoen puC on rrtviHCTL 
A fairly rb&ract«riBtic can wliich occurred io tli« [)r»ctic« of 
Utr. Symc, ami wis awn more thAD onro by my fatheir, wu 
met wiU) in ao adalt,«id alTeclod both jftm alike. Tha 
tncraaK tnu slow, and no opcratira waa rcwtrt^d to ; As 
•ccomimayiBg fif^ura » taken froDi a model now jn tlii 
moaoum of the Odontoto);iciil Society. 

/1».M1.(>) 




Another case, In vhtch the growLh was mac^ lorgar, 
eaiuod mom dlstonloQ of the featurea, was 
oporatnl upon by Ur. Pollock. 

The following notes of Mr. Pnnock^ ca»o are abridged 
fWnn Hr. Salter's C) article. At the fmii week after birth, 
^ t««lh had ai){.>eared, and St v&» noticed thftt the gmu 
were thick and puffy. At tho a);e of twu yean, all the tem- 
porary taelb were extracted, and the gtima caatcriaed. 

At the How of odmiasioa into St. Q«nrgv^ Hoairilal ths 
child was eight yoara old ; it waa rwnarkable for an abtiormal 

O OtbfT CHT* mar !» AmuI tn-^ Sn*m atemvitr," t>r S. D. OroM, II .O, 
PMIwhlpbla. ia4 c4Uka. T«i U.. ji. AU; -- Boaua MMMU uiA Garglml 
jMrntl.'' Apfil. i»t». iw* OMW t " Iigortf* mmI V k t u u af ibe J««ik* tg- 
C li>Kik ttid fdHMi. ini. p. lit. 

{•> PromtiDMWotUivitpfvrJaw of Mr. Symf'^M*". 

(t) - A Sjrim «r SwgeiT.' 1<y Tlnrntliy Holm*. M.A., 3trf •ailMi. IRO. 
Art. - MtMMa of Um THa." n>L iv.. p. SU. 




BTPSBTnOPffY or TBI 0C1I8. 



619 



daTi>lopnMint of bair, which grew low o& the forcboad, ami 
nachod in froDi of the can od to the (.hecks. A large jnnk 
nuUB, which nmid not be oovenvl by the lips, prntrodnl 
from tbe mouth; it wu iodistiDctly lobed, with a dense, 
uuenatjve, skis-liko lurbce. The greater bulk [icooeodud 
from the upper Jaw, which orerlapped the lower, tbe Utter 




being, as It were, imbedded in iL The maas via rvthoved 
by u|ienitioii. portiutia cf it being cut away with scalpeli 
and bune-nippens and lli« reaioval oompleUK) at succenimc 
opentiooa. 

There was a «]iRht tendcney to mntm-Doc of the growth, 
to Btructun- it was fmuid to oooaist of hyiwrtropliy of the 
fllreolAT border, together with immenM thickening of the 
fihroux portion of Uie gutn, And au vxul^eraiit growth of 
p•[HIUl^ lu tbe upper 3** it extended Uiree-quaiterB of an 
indl furwiuds boyoud iJic alveolar Innlor. 

TboM of the temporary teeth whioh had Dot been ex- 
tncted were dei>{>ly iiubt-dded in the mass, though the Bnt 
penaueut tnoUn bad aitpcared. an*! the seoood lower tern- 
ponuy Riolan were visible, as llif hy]ii>rtroph]r wae not ao 
greaL at ibu back of the mouth. 

(') Praiua|>hatarnu>dtloftlwU]>|iTtJ«« taiU.PuBadftam. 



520 



A BTBTEU of DKNTAI. 81 



Tbo foogfi were found to be irabeddei in aoekets, fant ifae 
ciinw-n« were «nclo«od in serous-like ebtmbers in tha denM 
tibrouM tjiwu4!, aud nt-re five from bony aurroCDdiuga. One 
of tba HUjieriflr centxAl incioOTB wu iwuiy an irtch from 
tlw Rurfoce. The permanent t«etb were exoesnvct^ i»rge — 
the tnoimn larger tlmti any wbicb Mr. SaU«r bad ever httan 
Mxn in R fcinal«'s mouth— and thoir bftny loculi had not 
Ixwii al)i<orU.xl tu iho extent usual at Ibo (mlivot's i^e. The 
flpltht'limn had bocome converted into a hard and thiclt <pi- 
dormis, IwnmUi whk'h werp enorniously long fia[>illic, atuia- 
ing to onc-Hixth or ouD-roiiFth uf an ioch in length; this 
papillary gmnih bdO)! in unity with the great teeth, cxoen 
of coarse hair, thick cikin, and other indiisktions of a t«a(l«acy 
to legumontary hypertrophy. 



F^-aos-Cn 




But by far tbo most remarkable example of tkii hyper- 
trojihy i> related by Mr. MacGillivmy (*), fnim whww iiai>or 
(fur the UM of which I am intlcblcd to Mr. Ucatb) this 

(<) Ftom B pbewgnpli «r Mi. UM<iiUlrr»j''> ■■•e. 
C) - AiutndiMi Mrttial JuuhmI." JLMgam. mi. 




I 



N 
» 



rrpKiiTBOPHT OP TBS ovm. 521 

aecounl and fignre are taken. It U noted thnt the guina 
w-ra uDusoftlly large at Inrtb; of the deciduous t«tli tiro 
ooly mailc tlieir a{>|)eamiicr, aiiil by thv time that the girl 
h«d RAched the ag« of four, the growth had atuined to «uch 
K usm that her medical inan attempted iu rojircHsiuu by 
CACttic* with little or no success. At the age of ten, an 
opetBliuu vroB pcrTunnnl in whinh nine, completely hiddirn 
iMlh ware «xtnct«d, vtd the rMlundiiDt khius [miviI duno. 

When first seen by Mr. MocUinivray, the imlijcqi was 
twtiity-niu« years of agu ; the uiwith was kt-iit widoly open 
by great lobulatcd m&Mcs sprioging from both upper and 
lowor Jam. These huge InbuLtr nxcresoances were found to 
Kpring mainly from the palatal aurbce of the alvoobr portion 
dT the jaws, the labial mirfacM being oomijaiatlvdy healthy. 
Imidd the mouth they nodi backwards along the hard palate, 
and projoL-t Wtuw the soft palate. Tlio Hurfauu of the growth 
wu everywhere lobatated ; iu some parts smooth, in others 
roo^ from the preaooco of enormou« pai'illiu ; it was no- 
where ulcemted, aiid no pain vraa fell in the massea. 

It» removal v.-w effected iu three eeparate operatiooa, por- 
faminl at lutervala ; the lobular maaiea of gum being pond 
off wiih a ecatpel, and tlie bypcrUophied alveolas exoiaed 
with lxHie-fon»[n ; prnTtisc hn'morrho^ oocarred, but was 
anwted by the uae of the actual cautery. 

The patirtnt uuuio a good recover^*, nnd the operation aeemi 
to bare hc«u perfectly miooowful, both ajtrcganla the patieut's 
«p|)earaoce~ahB now being able to cloae the month — and as 
n^iCaRL) the recurrence of the diBeaae. 

In this cane, ae iu Kr. Erichaeo'a, which was examined 
by Mr. Itnice, no abuomml struolures wtre found: It was 
a case of trw: bypcnropliy, in which ecmte of the papilla 
attained the pourmuus lenf^h of half an inch. 

tn moet, though uol all of the casee, the disease appean 
to have been Btst noticed at a very early period — ia fi^t, U 
probably ooogenital. It doea not vi iico»«ity interfere with 
the develofODent of the tocth, although they an oonoMlod 



622 



A BTSTXM OF DDTTAL BOaOMKX. 



hy its rising up roimd them : ia Hr. Fcdlock's imaB, iwbM 
by Hr. Salter, it is noticed thftt the teeth wem of nniimllj 
largo size, and were developed Bomewhat befcwe their nonml 
time. 

It does not appear possible to certainly oonneot tiiit iliwini 
with any conBtitution&l taint ; for thongh in Mr. OuUimX 
Dr. Grose's, and Mr. Pollock's cases the ohildren -wen Ktnt- 
mous and of defective intellect, in Ur. MaoQillivr&j'a cmb 
the patient was otherwise perfectly healthy. 



( fi33 ) 



HYPEROSTOSia 



I 



Thc maxillary booei appoir to be the usual Ktarting-poiot 
of a reaiarluibU) form of general hypertropliy ot llu* Ixiue, 
wbicb ID KTwc CUM flfTecu) tho i^'thtr tent* of tb« fiico 
and craiiitiiu, aJid* more rarely, bouta t.-lii(!wlicr« iu the Ixxly. 

Altbaugh it U a rare disease, aod on« which falb into thc 
bands of the tnirgeuu fur treatmeoL, it i» wry uoceesary for 
the dental Bnrgeoo to be acquainted H-ilb \U oattire and 
cbaTaftrni, as it is liMy ta ha brought before him in ita early 
stamen tvt hh ojiiniun. 

Tbe disease consUta In an Interstitial growth and alteration 
aflecting llie whole mbstanc« of thu buoe, and nut merely its 
tnr&ce : in its profpvss the whole bone becouMs enlarged ; 
Ibe aiitrum, and eFentiially nbm the nasal cavities, ob- 
Utemted : It goes on to encroacb on tbe orbit till the «ye b 
destroyed by its pR>Mure, and thi^ moot htdoous deformity 
prtxlooed. In Mr. Heath's work(') torcral flgOKf an gireii 
showing thc extreme dvformily which ia caused by the 
disesM. 

Tbe coarw, muf;h, jmroos appearaooe of the snrface of tbe 

bone is well showii in the plate of Hr, Bickerateth's cose {% 

and this mmo [mrotij caticellat«d strurturG. extending thmugb 

the whule i>uUilauce of the l<oiie, is seen iu ibe afp)«]ided 

figure, from a specimen fur the use of which I am indebt«d to 

thu kindiiiss of Mr. Cbrixluphcr Ueatb. In tills Cftso tbo 

diseaso was Bret notiMd nt the ag(< vt thrve months, when the 

left side of the tatx watt found tu be tmlnrgiiig. The left b\b 

became cloa^ at the ageof »ix,ani] tbe enlargtfRiCDt steadily 

(Ij -TH—MiMrt Irjnrliinfltir ri-r"1tiil1 rltllin. 1ST% p. UL 
(T) TnaMnliiiM aftfes Putebfiiml HocMj. iiss, p. Ut. 




CSi A STBTEH OF dextjll etmorat. 

iiicfeawd till tbo boy ivoohiKl tha nge of twvlvo, wfaeo 
Ivft upper maxitU wu removed by Mr, H«BLh ; ihe iatcga- 




ment having, bowi'rer, lOinrcd in the hypcrtropliy, 
deformity still rfniAJns. 

A model of tlifi mouth (Pig. 205), token bofiin the opetiT 

Fig. MtV. 




tioQ, shows that on the right or healthy side the pertnui«nt 
iociHors, caiiino outl bicuspiijs, ftre io place; wliile oa the 

0) Hitf of Ihc Icll upfier mullls CUr. Hiath'* cur] ; tbo McUm lui Imm 
ttnieA ihRHifb ih« pMintnail leeili, wlikl'i bMt nric m jtt bMo *ruf4«d ; ■<■>• 
oT UieMth u«la IbeMbnr hAtf ot llie bone, mi^i tbrj tn nol *bai>n In 
tUiOgUK. 




ByrBBovroiu. 



635 



^ ofth 

I 



\t(t ado iW tamponiry iucison aud caniuv (?) are rcUiiied, 
uid llic bicuspids t>ot fully eraptoi 

An seou iu tilt! iHvtioris luadu Oiruugli tbo Ixnie after its 
remoTBl, the iadwrs, caniDo. bicuspids, and Srst pcniumenc 
inokr(rarioDs) are ri)iiii<i to be welUlevolupod, fuU-aized t«cth. 

Behind tha Gnt penuaoeut uiolar tbe antero-paeterior de- 
Trloptnent oT the jaw lias Itcen chvcbnl, and the second i)er> 
iQADmt molar is a Boiuowhat sLuotMl Uxtlh, wLiUt the cruwn 
of the wisdoiu tuolb U vxiRiuvly strwlt. 

In this oBo, then, ths development of thucu members of 
portnancnt set which %k tbe Iwt to take their place wu 
Uil. auil ihi> whole procrMs of deutition retarded, eo that 
th« tcmpoTftry iiicis<»s and cAoines -wt^re rrtatnod for Mrenl 
years beyond the ponod nt which llicy eliuulil Imvu b«.-a 
shed. It is staled that the temporary t«otli were erupted at 
their oortnal pt^ods. 

In all ibc CAMS the enlargement of the bone is ilow, and 
at fint jwDlees, so chat commonly many vmn elapse before 
the patient suirvrB the removal uf thu max.illa, which is tbe 
only availabk trMtmrnt ; it twN^nis nninlly to coaunence 
before tbo »ffi of piiljeiiy, though this is nut a iiuirecBal rule. 

Little ornothiot; is known a« to lt« dri^n : it is apparently 
in no way connected n-ith either syphilis ur struma, and has 
been nippoied to consiKt primariiy of an iuf1aniiiiiil4>ry affec- 
tioQ of tlie periostciini — tv which view, however, there on 
miia objectioofl ; while by Otto Weber it is aopposed to bs a 
ranlt uf Li7si[K-la8. 

in Mr. Biokentetbt) cue Ibo diseued bono presented a 
carious nucroMcopival structure, having large bmoching raa- 
caUt canals iu iu eabctaoce, totally onlikv the ordinary 
Harcrnan canals : these were dncrihed and B)^red by Mr. Ue 
Mur^pto in the Transactions of tbv I*atbolD!ncaI SodvlyC); 
but III Mr. Heath's case, which wajriexiimincd by myself, these 
canaU did u«tt rxiHt, the utily iu>tvwuithy |H.-culiarity lieing 
the abttencv of wvU-dcvdopcd Haversian Kystems. 

f >> TraaMOlwM nTUM AtbaloKtMl SgEkty, ISM, f'A. itU.. ^f^ -»S>~ 



1^^ (>> TfM 



( ft36 ^ 



DISEASES OF TnE GCMS, Etc 



Stouatitib. — Inflmmmfttkm aflectiiig Lhu loitoaas numt 
L of llie tnootli is fiu more oonmun during cttrlj chil 
ftban at any Inter (wriod. 

Dr. Woet, in tnaliag apou influomatioii of the 
(stomftUtis), Hty> : '* InflanuiiatMa oT Uie nuratli is kd < 

by DO raeau oonfliud to Um ptriod at teething hut It 
. OD in childrea ur ■)] agoB, aavunufl very differast Ibniu^ 
leodB to TeiydifTenmt rmalto in odo mm: (rom 
[vUokclianeteriM Jtinioo(li«r. Th« mocotu foUiolw of I 
[nioDtb arc tbo chief mai uf tin; diitouo in oue oaac ; Uw niV 
ataooe of the gum in u>otb«r, stxi that of the eh««>k in « 
tlitrd. In the firnt (folliatlu* ur a)>htbous stumaUtis), the 
aflectioQ iisaes in the forroAtioaof acveral noaUnloHs, which 
henl crentonlly nf thdr own accord ; io tbo aeooii(i (nlum- 
tire KtoniatJUs), an unbaaltby prooMS of uloerftUon destroy*' 
th« guma And denndoi th« toetk, bnt it i» tudy in iu •«]-] 
vuwe, uid tends to a spuntuuKMts cure ; while* in the 
(^:«nf;T«OMu stomatitis), roortificatioo involTMell the tJi 
of the cheek, aod epreada with a rapidity which remodiea 
to check, mid which i< ajrested at last cnly by tbo patient 
death/' {*) Although cnch of the fongotng fornwof die 
haf a constitutlonAl origin, and for cbo mott put bll undi 
the tnatmeoi of the gor^coo, yet they aonietimea oome undf 
the botioe of the d«uti<t. 

Simple Stomaiitis (Erythmatui fitamalitiM) vt cittnuh 

(■l-LccUrMcmUMDbMMMuriiilUijHadClitUkMd- BfCterfn' 

ILO. TUMIttbllMt. 



i 



APBTHOra (FOLUCUljlR) BTOMATlTia. 



627 



tcriwd b; aligbtly dovated. mldi^li, glietening patches, which 
l^inaycoAlMMM thnt the whole «uTfac« prraeoUthcchAtacten 
^nf iDflmunatiaii. Omsiuoully wbitieh pttchcsuccurua tbraa 
^■nurbow, di)« t<> d«>squ&m*UoQ of the «[>itheUuu, or, in Mava 
^finMlutOOS, IdcxuOiitiun. 

" It M rery coinuiou <3ariug lh« period of fint deotittoD, and 

b tbcn aoooRi|i«iicd by febrilfl eyniiitoma, but il is prc^ble 
Ibftt Ifao uoimtilutioiiAl disturlviace i« iodofj^DiU-ut of the 
|| ftoniRtJtis. It tnay uiao b» pn)dtt(:cd by inriuuts, such u 
^^^imukLiug fcod, ami is doL uufnK|ucnUy cnusod by gastric 
^'initatioo, drunkard* being t<articulArly liable to thio and 

more CRvero formii of otomalitifi. 
I^H It* treatment U aimpLe; a dote of aperi^ul tncdicina, 
^Hnd enioLliuiit mouth-w-aiihcB, being generally ufficteot id 
^Tniring it: if th« patioit be an iufiutt who u bong brought 
up by haudt a litllo limo-watet ahuuld bo added to (ha 
milk. 

Thruth, — In its early stage thin is qnite indtsUngaislMblt 
Gram simple stomatiUn; Init (be jntotivs very itp<^hly become 
coated with a very cbanu-U'ristic exodiition, which is at first 
oloeely adherent j bat after tbe UpM of a Tow diyv il peela 
fpti, only to be repliured by a frmh inembnuia 

It is A rare diwoM! in adults, but in cuiunion in children. 

It U Cwiitagious; but in a healthy child, or in a child snfier- 

froinaculudifcasu, it iaof litlJenHmictit ; whim, however, 

if suf<crveDr« io ■ child cxhautted by chruoic disease, it 

^farutrllB a l«lal tonnination at no vury distant date. 

Tiin membmno whi^b givm to it ita cbaiacteriHttc apptar- 
ance ia in great part tnailo up of the uiyccliDm of a ftmgoi 
— the OvJiuttt Alhiftmt. M might U? expected, it is Tery 
amoukbli' to Uical Lrintnieob ; such applicativDB m lorax, 
aloia, or iulrol« of itlrcr vpoedily curing it; biit iierbaps tho 
b(«t appUtatiuiu ar» tlio ollcaUiw solphites, or ecoa aul- 
pburoHi auid itself. 

JjAliiou* (FiJIicuJiir) ShMMtitii.-'ln tho firat instance, 
UiB individual uillaiucd fullidcs may be seen ar isclat«d red 




62S 




smw or DSNTiJ. BtmosBr. 



ipeckfl ; but tliey very spcediljr Bofleo down, and pass 
omII, round, 8hArpH>dg«l ulrera. Or tb« flnt thing notiofr- 
*Ug may ho a Twicular, licr[)rtic Gru(>liuQ, tbe bunting of 
tho veaiclce leading to the forniation of small ulc«ra, «xONd> 
itij^ly pAinfiil, ant] gvnemlly eunuuuded with a narrow bri^ 
rod zon« of inlliimmation. 

The iilcr.ra sre selficim or never sin^lr, nnd nr« oflconA 
foand abont the frnnum, in the sulcus botween the Upa and 
gums, or 00 tho lower Huriace or tho toDgne. 

It ia A trivial disorder, accunipauied nsually by do cotuit- 
tntiooal diaturbanre; hut it is prodactire of great dia> 
comfort to the intient, ou accuunt of the excoeure tendcmas 
of the ulcers. 

Ai) occneional touch with nitTate of ril7cr will relieve the 
tendemess of the raw onrfaceB, and thts um of astringeal 
washes will H^rre to Bccctcratc tlunr liwIiuK. WHira it 
occurs in the snicus between lhe]ip« and g\uiu>, tbe hwtii 
miDit he kept Knipulously clenit, and it will nfteti prorv 
adT-aiiiaf;eouB to paint aniund iheir necks the glycarinuin 
acidi carbotici ; as an application to the surfiiop, tho followbg 
may be oaed, applying it on a Klip of lint, which is allowtd 
to lie ID tbe sulcus — 



R. AcitU carbolic! glacialis, 
Lt>4. potastifl*, ail 3j. 
AquB ad 5iij. 

llioular stomatilts Is most frequently tuet with 
tl is uot p(<uuliar to early life, hut is nMt with 



I 



in 

at all ages. 

Ituitcftd of meeting with a c1ust4!r of ulcers, we not oncom- 
mooty find a single dcefdy-excaviUnl, small, round ulcer is 
the sulcus, at the junction of Ibo gnnu with the mocons 
metnbmuu of iht.- li|Hi. or un the free mucxiiiii mmnhranc But 
that the ulcer ia single, it might be deaoribed a:* follicular 
Bt')mutttiB ; sad though it is iiuii^uiiirant Utth in extent and 
duration, it is extremely sensitive and trouhiesoine^ rendering 



in.a»UT[TB troHATITIB. 



52*^ 




fenM^t of Hut bmgue, ind tbo act of piiutjcatkin 

jj K the mriaco be touched wiUi uitric Mm), an aliDOst in- 

^K^lantoaeims cnn u cfTowtcd ; th« tJ^iitlcnictis ii mtimly re- 
^PtnoTt^ Ksd the patk-nt will tw\ mi fuitbvr iiiouwuivnoa. 

I'lrmtiee .SttmuUHi*. — This ftjrin of utotnfttttU i* on*' 

which rf(ii|iifiitly conies nnder die ntitioe of the drnuit 

Mirgwi). 

Cramiiencing at r<r near the vAg^tt ot tb« cunw, moro fro- 

nmtly in thfl luwvr than in tho upper jaw, uid usually tm 

aide only, it may sprmd till the wtaote iDl«rior of the 

in u luBM i>f ulcers. Tb« eil;^ of the gam becomai 

;cned and congaled, sad hiut oAen a pimply apf«anuioe : 

J it AMiuoF-s a deep purjila colour, and bleed« m tha slightest 

^B.tonch. L'lcyration^iMdily succeeds to this oondltiou ; com- 

^BuwiiciHii on Uio edges of the gum, it exteoda A<x\Hy inUi liiv 

^m lubeUDce, ia aevcra ombb laying ban the iKcks of the tci>t)i 

H and the olvoolar prooMMa, 'I*h« mucmis membrane of tlio 

ohteik, wherv it cctium iulo contact with Uie nlrarnlod mr- 

bces, oRen becomes the seat of similar lesions, so that n 

Uiie of nlomtiuu cumtspoudin^ to the [xtsition nf ibu tcctli 

nins nlnivu the itisidc of the check. 

The malady oritonatea in the front port of the month. And 
it is only in severe casea tbat it exieods back to Ibe tDolar 
rciflon. 

It is said that exndatioa precc-dw Ui« occorrciiM of uk«ri- 
tion. In its fully-derelopod f»rrn, tlie ukvr is uiurkod by tho 
rollowin;; chanoton: the surface is 00T«red orer by a dirty 
wiiilc or yellow matehni, which on rMnorri by a ciirreiit of 
tifpid wAUir, leav<4 exposed nuntcroui scarli't points ou a 
yHluwtBh K"mud, which Is made of dl^bris of Tsrioaa aortft. 
Th« edjiex of the ulcer are sL&rp and ra^ol, uf a colour 
ntiiiniit; fn^in viuk't to a hhlliant venniUon, and are at first 
supefficiitl ; but us ibe discaM progresMx they hetuinM derpT. 
lu cas<!S of any .sererity, ilui sMo of Ihe £toc is apt to l>o 
«ivi>lteu, ami the lytujihalic glaada ■nhir]ged and tender; 

2 K 




530 




STtTnt OF DSTTAL HmtOltBT. 



there ]«, however, nothing like Uie extreme iodamtli 
ibu CL-Uular tisMtio lutil will) in cancnun oiiii. 

Tbo diaoAM mny niii on for some inotitli8, in which cuf 
iU cuT« becuuiuB truiihltBume, aiui« ou<.-« well ustablisbed, it 
i» very prone to recur. 

Ill a sitbJ4>ct pruditifUBtiJ to tlie disMM, trivUl source* of 
irritiitioii will scrvp hh im f-turting-poiut, such bb lui mbnuioo, 
or • aiJ'iuiLs tuotlt} I'mcturc luid neofoeis uf t]iti Jaw have Ukfi- 
wite 'been known to wt it u|>. 

, Althuui;h adults ore uut wholly exeitijit frotu attacks of 
ulowativ* stftiiifttiti*, tie di««*»e occtirs T4;ry much loora Dre- 
qiUTUtly in ubildron, e8|iouially betwoeu Uio ageis uf fivti aad 
it>Q years. The cases which have come under my own untiuf 
Imvo uocurred in youu^ |h.'u|)1o liriu;; in cniwdvd localiUei, 
anil who httTv beeu imperfwlly clothed and fed. According 
W IV. Wefit^ however, " it is by iu> nieAiia n mniitAnt ikxut- 
rcnoe lor auy B^tecial deraD<:;e)ueat of (he •general ltt«ltb to 
precede an attack of ulcerative sti:>Tnatitis, thotigh the chiLdroo 
who ore affeu^twl by it are seldoni mbuat, ami in many in- 
hUivsos aro such m have t>utlered from deficient food, ur a 
i]atD|) aiiil iiriheaiihy Mging, or both." In yonnx childreo 
who are but iiidifi'«r«ntly cared for. ihe di»««8« in its earlier 
sta^ei ix ovtTlui'kod, until thu sukpicion of thv aiu>nilaiit is 
aroutcd by tho f(ttid t!lal« of tlv breath, the dribUiiii; of 
Ibc saliva, am) the uiiwilliD>niraso{thprhil<l to take into the 
mouth food or anything that in caloulaiul to produce |aiu in 
the ulccmtcd stirfnce. When tho diwiMu ia uochcekt^ by 
trcatmiiit, it nuiy lay bare a largo |>ortiou of the alvvitli of 
WTontl t«^'ih, which, with their sockets, becoae <lcAd aiul 
blackened, and thc«o aenru to keep up the niaJady. 

3'Ae Trtxttmint of Qlccrative stumalitijt i& usoAlly atttmikd 
with weli-itiarkt'd siicchm. I.i(X'al trmtincnt is by I>r. Wcwt 
reganled an of aecoatlAry itiijvrtAiice, mid utii^bt, bo saya, in 
many riuu?M tie omittt;;*! witl>oui pn'jiniice lo ihw [inlicut. Ho 
nyH, "iMliotiD of aluiu, or the burut oluni applied id aub- 
stancv, or ibc cblurtde of lime in yovntr, have all b«ea llMd 




I 

■ 



mciUTnni stokatitis. 



lac«Uy, with mote or lens beneflt. , It wu my cuslom alan b> 
prvwribe tl>L>»« reaiMies id ulci^nitivu KUmiatitu ; l>ut sioco I 
bocAiiK' HO|tuinh3ii wiili Ltiv virtue* of chlomtu of |w(aisli, 1 
liHvu U-arned to rely u)iua it almoet DXciusiroly. It ftiijwors, 
indi^l, almost tn dciierv« the name of a speciSc in thiA nfToc- 
tloQ, fur « Diiukctl tmpruvemctit aeliluni bils to be utiMrved 
Id the jnticut's condition alter tt has been sdminiAtcred for 
two or Uiree davM ; aod in a week or leu dnvo Hiv cure in 
i^noralljr omnplctM. Tbriw grain* every foar hvKn, liisaolvcd 
iu water, <u»l ttwcvtciiwl, ia a aufficifiot doM for a child tlirve 
years old ; and five gmins is tb« largwc (jtuuitlty tliat I have 
adiuinn^Lonxl ta a ohiM uight or nine ycam old." The '^Docntl 
bcalih of the patiout niu»t at the name time be wawhed, and 
a {Nirgativi* iidiiiiriihten.>(l if lli» littw<<L4 niguire relief. Nn- 
UiLioaa food nhonld be given, nud in tlic feeble flubjix-U 
quinine or other tunics xv^Hcribal. In the cases which have 
C(UU« tmdar my own treatment, tL« adiuiuislratiou of tbwe 
tmneilics has liocn fblluwnl by the ra[4<l rcoovcry of th« 
[Kitii'nL 

This ajiplicatiou uf uitrntv v( silver to thu anrlace of thi' 
ulcvr nt <jiice changes itn rhaiact^r, liy forming amijierficial 
alough, afUir tlic «e{«rativiit of whkh a healthy gmnulatin); 
Mulaci' in left. 11i<- oK^^eiuivu tettdemesa, too, is aliuOBt 
ihtdncuaBly rcliwvo'l. 'Ilie use of a wash <xinii<osed of five 
KraiiiH nf Fhtomto of luda to one ouso! uf water, will 
cu)i|n-vM lln.< (.ttffiiMVv v^difur. Teeth which are bopeleialy 
looM, and productive n{ irriutioii, »bDiiId Iw removed. 

PtUienia sutTerio"; fruni ciinstitatiuual syjihiUfi ara ooca> 
tionally nibJMt to ulceration in the ntoutb, in<liBtingtiiababla 
from nlciiralivB atomalitix. Tbe tiuicr imrfnca of tho apper 
lip may 1>e affected, atkd an ii1c<rniiion oorresposdiitg lo each 
UxAii fiirm, and s]in9ad on to the gum&, 'llicrv is Rome risk 
of iidhc«>ion« forming between thcw contiguom tur£u>i!» 
dutinic rinviri nation, m tbnt the |wtl«it should be dirootcd 
to cnutinualty kcup u tfli{)<tf Uni.BEocjiud in suiuadiianCectaDt 

Ution, bfltvccn the alliKtod (iii-ta. 





BTSTEM or DEXTJLL StntOST. 



S32 



Tlitwe <»» which I iuiTo tao have all jMdmi to 
admiitiKtrttk'D of iodide lA poUttium. 

Thaw aypbilitic uloontions ant not chamctartand by tli* 
exlmne teademeu met vrith in ib« ortUiuu; fima v( lb* 
(liseue. 

Owt0renoH» Stim^UUfB. (Komo, Cftocnuo oiu, 
aria. Ad.) 

Althougl) this ii s difeaw wUch wouM not fall within 
(iTDviniT or the duntal surgeon, DevvrtheleM ho shr>aM tr 
ablo to ra(x.<Kiiiz« it, m th« only cbaaoo tor the ptUienI bn in 
the iuiuiixiinu- KU'l dcciKira ttvatmeDt of Ibc* nore. The 
oonim of the liavofv U frtgfat/uUy rapid, uid the tcnainatum 
aimost always foul, though it is, happily, far from a oqiuiood 
difinaao. 

The finrt thing generally noticed is Kwelling of the 6tm • 
this swelling w pecniiar in its chancier, the »kin being very 
leiue and ubioioi! ; tb« awelling is rery hard, deiuw, aud 
circumscrilwd, Init remarkably free fmm teodomesB; in ita 
centre is a blotcby-lookiDS red spot. 

If tfa<> nuiQtb be examinod, there is seen to be an iir^nlar 
aleor, with livid red edges, sometimea in the solftii, Hom*- 
timea on the cbeek. It in not rery aenflitivv, but pmdaecB 
profun aaliTAtino, and gives forth a gangrtooiu u^hitir fnim 
the Ttiy fint. It spread* with extiaordirkary rapidity, the 
red Hpot nil tfac cheek ninultaneoualy boroioiiig black and 
■lonsbintt, ao aa to open the oral cavity. The deetractioQ of 
the tismiM of the obsek takea place with extraordinary rai^- 
dity, and the death of (be patient generally enniM in th<> 
coune of a week. One of thv «tmu^st foatures of IhU 
rrightfidlf defllructivedi«eaM ia tboabsoncfl of pain, and oren 
of great oonnlilntionAl dteturhance i food i» nstially taken 
well, even to the very last. The disease ooctm lu chUilfvo 
of debilitated coQstltutionit, and aoinvtiuies presents itaelf a» 
a wqttela to ncate dixeasee, lie subject* generally being fnnn 
two to five years of O]^ 

Conattliitiotinl tmliaoot can do Imt little : ao soon aa tli" 



O&lTOBSirOUB SrOHATtTTS. 



fiSS 



discMC w reoo^wed, tbe nicer obould be utterly dotroyed 
widi filming Dttric sctd ; nol » ninment RlimiUt h*> ]<Mt, as, if 
IINignm« bM oQce Jitirly Kt in, th« aum is dnuit bopelcM. 
Bnt, uoibftoDftttly, tliQ aoccM of t]io iliseaas boiog unao 
compuied by safleriog, it is Ml<lom obeervod until it ii tcu 
Ut& llio fiee spplieation »( nitric add Kbookt nevvr Iw 
ne^wlnl ; recollecting the npidity and ths Klmost oerttin 
faUl nsnlt of tho malady, Lhe kht^coq must not bositate ta 
destroy tlui affected tiuues vid«)y. Diaiufeclaot wubiea 
aiioold be dilignntly lued, and the child's strength kept np 
by iIm free adtuiuiBtratioD of HtimtiUuta. 

Some practit)))ti«ra nse coneentratod hydrochloric acid. In 
the pl&cu of nitric acid, fbr deatroyiug ttiti auro, and ouusidur 
that it glvw moro vaUufuctury n-snlts. 

Aetiim iiifiammationf when situated in tbe gnnu, rafniUy 
iDTolvM the adjoonut poriutttcum both of the «xtenul aad 
ioteroal stirlimuf of the nlvi^xili, and by thia extCTniios, tends 
to tnuk the grigioal character of the disease, iho nature u( 
wbieb* if the csao be not awn in an early Biat!v, itiay \k in- 
vulred in couBiderable ob«curiiy. TIm malady, howirvcr, 
■xtands in another direction, and by so cxtondinf; its uatnn.- 
becomoa declared. Th« iuflaounation, at firrt limited to th« 
moeous memhrano (kf tba|{amsBpn>ds toDiaiof the mouth. 
Tlui aalinry glanda become affected, and pour out an ex- 
ocirire amouoi of »rcreticio, tlio tbw of which booomes a 
cnoapiciiDus feature in tbe diaoitler. Whin this takes place, 
the fAticnt ix said to he mlivntod. Although cosoa of i^n* 
taiieous £aiivBtiun on- ntcnlcd, vrL'tl-nuuked examplee arc 
rarvly met with. As th« result of rviOMUet adtmoiMered for 
the cure of disnue ita uocurrence is coqimon, bat not eu 
oomnion u in focmor ynars, wliea nefDary was more fi^ 
qucntly Uiwd, and ita uffects w«ro farther prv^od. In rnsM 
of ibflaDUUAtloQ of Uio gums u> induocd, an opportunity of 
aratdiiog tbe dlscaffi fn>m Ita commeuccmunt in afTtH^lal. 

In «alivat4oii produced by mnnmry, tbe eilcct is lirHt dis- 
cemihla upon the gums. Some boun prcrioua to tbe orrur- 




A STBTKM or DEDTTAl. StmOBBr. 

tVDOe of the nietallio tuto, xnd to tins tmcr of the hrmtli, 
luul also tu the MrcneMaod (iiscoiufurt of tbc mouth which 
□lark tbc inBucDcc of icercory od th« ty*tem, tlie puna sltow 
indiealioiiK that litem romlitions arc about to appear — UiM 
tli« patwtit will iu a fcvr Loan be s»li7at«d. The staU of 
Siaia I uni alioiit lo ilatcrilie \s, in fui;t, a preRimittury tiga 
t}{ ptjaliHiu, fur idiDuld it B}>|*car, ftotl the mercury bo inuo*- 
diately dixcuiitiiiuod, yet sulivaiioa will come oo. The oipi 
is ihut: — tlic adhi-rcnt portion of tlic muaonB racuibnuit> of 
tlio gums assumett an f>[iM]uc wfailo o(4<Mir, contxasling 
strongly with the nnu-odherent {nirtiun, which prnscrvet ila 
nnt-uml hue or becomes more red. 'I'be free ed^ of the fuma 
i» iDttvrabte, but that part which lien over the edge ot the 
alreoli is firmly tied down to th« perioiteam; and as the 
cd«Ofl v{ tlic aU'eoli present a festooned line, so the whitened 
mucous membrane presents corTespottdinguDdnlatiotiB. Again, 
whcro thp nuiooiiN membmne is li.ix'fly ri;l1«cted from the 
gum to the chwk, Ihv uiLtuniJ oi^iUhii is prceurviul. ThB 
whiccncM of gum is prodtictxl bv an increased sccrrtion of 
^pilbvliuni, wliich, ft\>m Iwiu); tliictcvr and mon opaque than 
in tho lienllby itlat«, rendcnt the colour fpven by tb« TMiria 
to tho MihJAcent tiwnie Icuw np]ian>iil. 

Tb« sorfoce of the mucous mcmbntoe, when deprived of 
qiitbolium, in etudili'd over with tnuuutornble smalt conical 
elerations or pa^MUic. 'lie thickened DpithcUum ta reaililjr 
nibbed off the toife of thu papilLie, wbiW it retains iU fiilt 
tbickuflss in the inlerrening deprewiiona; hence, if clumlir 
iUKpoclcd, the ;^umH %vill not bo seen to present a uniform 
wliit« hoe. but a mottk>d a»pei:U 

With the tncreaflcd thickness there is a doereasaor leoactty 
betwcvn the scalcti lUal lorin l)ie v|iithelium, for the nirlaoe 
nniiy tte much more reodily nibbed ofl' than when in it* 
uatutal - talQ. 

This curious uid aseful premonitory aign of coming 
ptyatiiim was, I bi'lievo, first noticed, and its value pointed 
fiut, by Mr. Cork; at all events, bo wmu the first to draw 



CHRDSIO tVrLAllMATIOS OF TBS OVUS. 



58B 



tay attonUoa to thu bvl, ftml I aio mit awsro that ii hail 
\men firevioiul^ described. Siiicp, howwer, Mr. Corfo men- 
tiuned tbo renult nf Itia tibwnntiims as to tlie mnstancy of 
tlie ri^ni, J bavo vpnfied Tor myself itN praM>nc« in all «um 
of salivali)]!) Mint liaVL' cnnio under my nntiw; and fraai 
th«» th« fore^uiujt ao-oiiiit has been given. 

Wlira tlic! cnudilion rif merourial aalivation is birly ecta- 
l)1uh«d, the (Tuu and palat« tiecotne markcUy cwotI«at a* 
does «]»« tlw tooipia, eo lliat it is d«i>ply iiidcutvU hj th« 
tcotiu The breath iMconiui iDtulcrably uffandTe, sod the 
moiitli ran only be opcoM iritb difficulty. 

In had oaaea uloctslion and conscqueni hvmorrii&fc* wear ; 
sloughing and necrosis of tiw* bone nuy siipcrrcn& It is not 
imnDtimuiii for llio miirtith to Iw permaneutly closed by cica- 
tricM c*it(tM|upcit on th« >(li>ughine prooeas. 

Ajivrii'ntjt shouUl \k ^ivcu, and cblvrat« of potash, both 
tntecwdly and m a wiuh for tb« mouth. 

Ciinily'i! fluM fonna an excellmt wash for oksosiDg thu 
tDoulb aiid doodcriMng the br«ath. 

OD^tunonal •cariticatidTi of the ^nis,and the (npical applt- 
caljiin <>f ioilitio, will asdist in restoring tluan to thoir normal 
ooivliltun. 

Iq syphititio ftomatitta th«re U DO itnally-iiicreaaed floir 
of taiivi ; th« dLsMae tends W d««inKtive nleersMon of the 
puna and snpiirBclal iwrroms o( tbo javr. 

Shallow nlcers form benwilh tbo tongiic, and mnoous 
^pilrhm ap[i(iar on tbo checks. Although utbcr evidvDCM 
generatly prwent lo aid tJie (liaKDnais, Ux^ are ml, 
aTariftMy prewnt. The disease loadily fielda to iodid« of ' 

taMiimi. 

Chranie la/hmmation qf tkf- Oum*. — Tbtfl form of difleaiw 
I