“It happens in general that owing to vapors that rise from the stomach,
a certain deposit is formed on the teeth, which may be perceived by
rubbing them with a rough cloth on waking. One ought, therefore, to
rub and clean them every morning, for, if one is not aware of this, or
considers it of little account, the teeth become discolored and covered
with a thick tartar, which often causes them to decay and to fall out.
It is then necessary that the diligent barber should remove the said
tartar with the instruments destined for this purpose.”
We have seen that the practice of the dental art was for the most
part in other hands than in the barber’s. Nevertheless, the important
operation of the removal of tartar was also carried out by him. If,
therefore, even the barbers, who were not in the least the true
representatives of the dental art of that period, carried out such an
important operation, it may logically be argued from this, in support
of what we have said before, that the sphere of action of the true
dental specialists of those times (especially of the best among them)
was not at all so limited as imagined by those who affirm that in past
times dentists properly so called did not exist, but only tooth-pullers.
The barbers, however, having become, in a certain manner, members of
the medical class, sought to extend their sphere of action, and it is
probable that in a later period than that of Tiberio Malfi and Cintio
d’Amato they invaded the whole field of dental activity; for which
reason, when the barber’s art came down to a very low level, the dental
art must have degenerated, too, and have been represented for a certain
time only by ignorant barbers and tooth-pullers. Vicissitudes similar
to these have occurred in different epochs, not only in various parts
of Italy, but also in other countries of Europe.
FLEURIMOND. In 1682 a little book on dental hygiene was published
in Paris by a certain Fleurimond, the title of which was: _Moyens
de conserver les dents belles et bonnes_. Portal, in his history of
anatomy and surgery, makes mention of this pamphlet, and, briefly
alluding to certain parts of it, he says: “The author proves by
observation that acids act upon the enamel of the teeth. He makes some
very just reflections upon dentition. Fleurimond speaks of a tooth
powder invented by him, but does not say how compounded.”[381]
In fact, it seems that this pamphlet was compiled from a commercial
point of view, viz., that of making known the special tooth powder
invented by the author. The era of advertisement had already begun!
ANTON NUCK (1650 to 1692), a Dutch surgeon and anatomist, who taught
most ably in the University of Leyden, devoted great attention to
dental surgery and prosthesis. Relative to the extraction of teeth,
he says that, in order to be able to carry out this most important
operation, an exact anatomical knowledge of the alveoli and of the
teeth themselves is required. He insists on a principle of capital
importance that has only had its full application in the nineteenth
century, viz., that the instruments to be used for the extraction of
teeth ought to vary according to the tooth to be extracted. For the
removal of the incisors, he says, the “goat’s foot” should have the
preference; the canines ought to be extracted with the common dental
forceps, but sometimes, when they are decayed, they may be extracted
with greater security with the pelican; for the small molars the
straight-branched pelican is to be preferred, for the large molars the
curved pelican; as to the extraction of roots or of splinters of bone,
this ought to be carried out with the _rostrum corvinum_.
The author counsels never to extract teeth during pregnancy, except
under circumstances of the greatest urgency, and especially to avoid
the extracting of the upper canines (or eye teeth), this being capable
of producing pernicious effect on the visual organs of the fetus!
The best way of obtaining the cessation of a violent toothache
without having recourse to extraction is, according to the author,
cauterization of the antitragus, an operation which he carried out
with a special cauterizing instrument, made to pass through a small
tube, the better to localize and to limit the action of the red-hot
iron. With regard to this means of cure already recommended by other
authors, we may remark that, although it seems ridiculous at first
sight, and although no one could be so senseless as to make use of it
in our days, nevertheless, for the times of which we are writing, when
the curing of toothache was in a great measure effected by indirect
means, this remedy might well stand on a level with many others,
and was not perhaps altogether inefficacious. It is a sufficiently
well-known physiological fact that the application of a strong stimulus
in one part of the body may diminish or suppress a painful sensation in
another part of the organism. It is an equally well-known fact that it
is in no way a matter of indifference, in producing this phenomenon,
to what part the stimulus be applied, especially because of the great
difference existing in the relations of the several parts of the body
with the brain—the centre of sensation. It is, therefore, very possible
that the cauterization of the antitragus may really have the effect of
causing strong toothache to cease, at least temporarily.
Nuck used a variety of remedies to arrest dental hemorrhage, such as
tinder, burnt linen, vitriol, sulphuric acid and the cauterizing iron.
As to the use of the file, far from rejecting it entirely, as does
Martin, he holds it necessary in many cases for planing down points and
sharp edges of broken teeth, as well as for removing, at least in a
measure, the inconvenience and deformed appearance caused by irregular
teeth. He says the file may be used without causing the slightest
harm, if one takes care not to approach the inner cavity of the tooth
too nearly, and above all not to penetrate right to it, which would
give rise to intolerable pain. Such an accident, he adds, may happen
much more easily when, instead of using the file, whole pieces of teeth
are removed with the excising forceps.
This author acquaints us with a tooth powder, much used in his time,
especially by Parisian ladies. The ingredients were powdered cuttle
fish, coral powder, cream of tartar, Armenian bole, and powder of red
roses.
At that time artificial teeth were generally made of ivory; Nuck,
however, observes that it soon becomes yellow by the action of food
and drink, and of the saliva itself. He therefore recommends, instead,
the use of hippopotamus’ tusks, giving the preference to the whitest.
According to Nuck, artificial teeth made of hippopotamus’ tusks would
be capable of preserving their color even for seventy years. In the
case of all the teeth of the lower jaw being wanting, the entire dental
arch ought to be framed in with a single piece of ivory or tusk of
hippopotamus.[382]
CARLO MUSITANO, a celebrated Neapolitan doctor (1635 to 1714).
According to Carlo Musitano, the real cause of toothache consists in
the irritant action of saline or acid particles on the extremely thin
membrane that lines the alveoli or on the exquisitely sensitive nerves
of the teeth. As he believes, these particles have an angular form,
sometimes pointed or even hooked, and they reach the sensitive parts
either directly from the outside, through the air, the food or drink
(especially when the teeth are already decayed), or else through the
blood and other humors, which often, by reason of their deteriorated
quality, contain great quantities of such irritant particles.
Among the various influences which may be conducive to toothache,
atmospheric conditions ought also to be included; thus, says the
author, the inhabitants of the Baltic littorals, and other northern
peoples, are very subject to toothache, for the reason that in those
regions the air contains, in abundance, saline particles of various
kinds which penetrate into the organism by the act of respiration. It
is said, on the contrary, that in Egypt, where the air is remarkably
mild, the teeth are not subject either to pain or to decay.
Musitano, too, believes in worms in the teeth, but does not admit, as
preceding authors had done, that they generate spontaneously. He holds
instead that they result from the eggs of flies and other insects,
which, together with food, are introduced into the carious cavities and
there develop by the heat of the mouth.
The treatment of toothache ought to differ according to its causes. If
the pain be owing to acidity, one uses medicines adapted for tempering
the acids; if it be owing to the action of saline substances, one has
recourse to remedies which dissolve them; if to worms, to such remedies
as destroy them, and so on. Purgatives and bleeding ought, however,
never to be used as remedies against toothache; for, far from doing
good, they often do harm. As to the other torments usually inflicted on
poor sufferers, they are the punishment of their sins, for God often
gives the unrighteous into the hands of doctors! (This language will
perhaps appear less strange when the reader comes to know that Carlo
Musitano was at one and the same time priest and physician!)
After a lengthy enumeration of medicaments to be used against
toothache, which we pass over in silence because already known, the
author speaks of two remedies which carry us back absolutely to the
days of Pliny! He relates us a fact experienced by himself, that, by
touching an aching tooth with the leg of a frog completely cleaned of
the flesh, the pain ceases altogether. Also, if the aching tooth be
touched with the root of a tooth extracted from the jaw of a corpse,
the pain ceases, the tooth becomes as cold as ice, and often, after a
certain time, it falls to pieces.
As to worms, the best mode of destroying them is by using bitter
substances, such as myrrh, aloes, colocynth, _centaurea minor_, etc.,
but sometimes the use of sweet substances, such as honey, is a good
means of drawing them out of the carious cavities!
Musitano also cites a great number of remedies against the setting on
edge of the teeth. Among the best of these he mentions urine applied to
the teeth whilst still warm! Alkali in general, and particularly lye,
such as is used for washing purposes, are good remedies against the
setting on edge of the teeth.
The treatment of loose teeth ought to vary according to whether this
pathological condition depends on old age, or on scurvy, on syphilis,
on superabundance of humors, etc. Sometimes, especially in old persons,
it may be useful to bind the teeth with gold wire, in order to prevent
their falling out, but this operation must be very ably performed,
otherwise it may give rise to inflammation.
Relative to artificial teeth, Musitano says that they are made of ivory
or hippopotamus tusks; of these last he does not speak as of a novelty;
we may, therefore, deem it probable that hippopotamus tusks were used
in Naples for making artificial teeth even before the Dutchman Anton
Nuck (contemporary of Musitano) made mention of them in his writings.
In cases of difficult dentition, the best remedy, according to
Musitano, for facilitating the eruption of the teeth consists in
friction of the gums, once, or at most twice, with blood drawn fresh
from the comb of a cock! If, however, even this remedy fails to
produce the desired effect, it will then be necessary to lance the gum
at the point where the tooth is to erupt, or to press it hard with the
thumb, that the tooth may the easier come through.
The sole merit of this author (as to what concerns our specialty)
consists in his having declared bleeding useless, or even harmful in
the treatment of toothache, and, besides, in his having recommended,
with great warmth and in most impressive terms, cleanliness of the
teeth. What is more beautiful, says he, than a mouth furnished with
white teeth, similar to so many pearls? And what is more abominable
than black or livid teeth, covered with a fetid deposit or with tartar?
Unclean teeth spoil the appearance of the person, and nauseate those
who behold them.[383]
WILLIAM COWPER (1666 to 1709). Toward the end of the seventeenth
century the celebrated English doctor and anatomist, William Cowper,
opened up a new field of action to oral surgery by inaugurating the
rational treatment of the diseases of the maxillary sinus. In order to
empty Highmore’s antrum of deposits and to be able to carry out the
necessary irrigations, he extracted in most cases the first permanent
molar, and then penetrated through its alveolus into the sinus with a
pointed instrument.
JAMES DRAKE, also an Englishman and a contemporary of Cowper, operated
in the same manner; and it was this author who made known in a book
of his[384] the operative method of Cowper; for which reason the
above-mentioned proceeding is sometimes called “the Cowper-Drake
operation.” A certain time elapsed, however, before it became generally
known. Thus, in a book published by JOHANN HOFFMANN in 1713 there is no
mention made of this operation, albeit the author refers therein[385]
to the case of a young girl, one of whose canine teeth having been
extracted by him, there ensued a considerable flow of whitish pus from
the maxillary sinus. In speaking of this case, Hoffmann stigmatizes
many of the surgeons of his time who were not acquainted with the
existence of Highmore’s antrum, and therefore, in cases of patients
whose teeth had fallen out as an effect of syphilis, if they happened
to penetrate with the sound into the maxillary sinus, believed this to
be an accidental excavation of the bone, produced by caries.
However, the honor of having initiated the rational treatment of
diseases of the maxillary sinus is not exclusively due to William
Cowper and to James Drake; a large share is also due to the celebrated
German physician and anatomist, Heinrich Meibom. The mucous membrane
of the maxillary sinus was considered by him as the real point of
departure of the diseases which occur in this cavity, it being liable
to become inflamed and to suppurate, thus giving rise to much pain and
to various accidents. Meibom rejects the operation of Molinetti, that
is, the trepanning of the cavity from the front, the lesion produced
in the soft parts of the face being likely to give rise to unpleasant
consequences. “Some, he adds, try the introduction of medicated vapors
into the antrum,[386] but the best way is to _open the maxillary sinus
by extracting a tooth, as the pus generally makes its way as far as
the roots of the teeth_.”[387] The author says that his father, who
was also a physician, had already used the above method with success.
He does not speak at all of the artificial opening of the antrum by
perforation; but, as is well known, this is not necessary in many
cases, so that, even now, the operation is sometimes reduced to
procuring the opening of the sinus by the simple extraction of a tooth,
as was, in fact, practised by Heinrich Meibom and his father.
Seeing that Heinrich Meibom was born twenty-eight years before William
Cowper, and was already known to the scientific world when Cowper was
still a child, it is very probable that his operative method, having
come to the knowledge of the latter, was only followed up and perfected
by him.
CHARLES ST. YVES (1667 to 1733), oculist in Paris, records an
interesting case of a secondary affection of the maxillary sinus.
The point of departure of the evil was an abscess in the orbit.
The suppurative process, after having produced an erosion and the
perforation of the orbital plane, had reached by propagation the antrum
of Highmore, whence the pus took its way, issuing through the nose.
St. Yves had a molar tooth extracted on the affected side (we do not
know which side it was), after which, day by day, he made injections
of detersive liquids through the orbital fistula, which returned
constantly through the alveolus of the extracted tooth. By this means
the cure of the patient was obtained.[388]
CHRISTOPHER SCHELHAMMER (1649 to 1716), who was professor in various
German universities, and distinguished himself specially as an
anatomist and as an ear doctor, strongly recommends stopping decayed
teeth as the best means of causing pain to cease. If, however, the
stopping does not hold, by reason of the cavity being too extended,
it is then necessary, says Schelhammer, to extract the tooth; this,
however, may very well be stopped after extraction, and then
replanted, for it will take root again, but no longer be the cause of
any pain.[389]
PIERRE DIONIS, a celebrated surgeon and anatomist of Paris (died 1718),
in his _Anatomie de l’homme_,[390] admits the possibility of a double
dental series, holding the case, however, to be of very rare occurrence.
Another work of his, entitled _Cours d’operations de Chirurgie_,
wherein he treats very extensively of diseases of the teeth and mouth,
and their surgical cure, is of much more importance in relation
to dentistry. He recognizes the high importance of this part of
surgery, but expresses the opinion that one of the dental operations,
that is the extraction of teeth, ought to be left entirely to the
tooth-pullers, not only because they are, by reason of great practice,
better qualified to perform it than general surgeons, but also because
the output of force required for this tooth-pulling operation renders
the hand heavy and tremulous, and, lastly, because, according to him,
it always has something of charlatanism about it. (This is a luminous
example of how preconceived ideas can influence the minds even of men
of the greatest talent.)
Pierre Dionis, like many of the preceding authors, had frequently
occasion to observe cases of epulis. He speaks at great length of the
treatment of this affection, as well as of parulis, but says nothing on
the subject of sufficient importance to be worth recording.
Dental operations, according to Dionis, are of seven kinds:
1. _The opening of the dental arches in the case of spasmodic
constriction of the jaws._ This operation, of the greatest importance
for nourishing and keeping patients alive, is carried out by means of a
lever and of a screw dilator.
2. _The cleaning of the teeth._ For this, as for the other operations,
says Dionis, a certain amount of skill is required. The author advises
the use of gold instruments if one be called upon to clean the teeth of
persons of rank. This appears rather strange in the present levelling
times, but Pierre Dionis lived in the days of Louis XIV, whose doctor
he was, that is, in a period of unbridled luxury, when the nobles and
those in power would have nothing in common with the lower classes.
3. _Operations for the preservation of the teeth._ These, says Dionis,
are of the greatest importance, it being necessary to oppose a barrier
to the destructive processes of the teeth. Caries, when so situated
as to permit of it, ought to be scraped away; for approximal caries
one ought to have recourse to the file; in the case of caries of the
triturating surfaces, cauterization should be used, by applying a drop
of oil of vitriol with a miniature paint brush. Should the caries,
however, be in a very advanced stage, it is better to make use of the
cauterizing iron. But in cases of intense and persistent pain there is
no other remedy than extraction.
4. _Stopping of the carious cavity._ Dionis does not enumerate this
operation among those intended for the preservation of the teeth.
At that period, this operation was performed solely with a view to
preventing the penetration into and the retention within the carious
cavity of alimentary substances, and the disadvantages caused thereby.
The carious process, says the author, often ceases altogether, and
the pain then generally ceases also. However, as the residual cavity
often becomes troublesome in various ways, among others by making the
breath offensive, it is better to stop it. For this purpose, gold or
silver leaf is generally made use of; but this mode of stopping is not
durable, because gold or silver in leaf is apt to become loosened and
fall out. It is therefore preferable, says Dionis, to make a stopping
with a piece of gold or silver corresponding in size and shape to the
cavity.[391] Many, he adds, prefer lead as a stopping, on account of
its softness, whilst others simply use wax.
5. _The use of the file._ The indications given by Pierre Dionis for
using the file do not differ from those we find in other authors.
Dionis warns, however, against using the file to level down a tooth
which has become lengthened through the loss of its antagonist, for
after a certain time it would again project above the level of the
others.
6. _Extraction._ This operation, says Dionis, ought not to be performed
too lightly, but only in those cases in which it is really necessary;
that is, when a tooth is the cause of insupportable pain and its crown
is almost entirely worn away; when nothing remains of a tooth but its
root; when a tooth is so loosened in its socket as to leave no hope
of its again becoming firm; when supernumerary teeth or irregularly
planted teeth give rise to inconvenience or deformity; and lastly, to
remove deciduous teeth that have become loosened. The opinion that
if the loosened milk teeth be not promptly extracted they cause the
permanent teeth to grow irregularly, is, however, considered by Dionis
to be a prejudice.
Dionis strongly doubts whether a tooth that has been extracted
and replanted can really take root again, as had been affirmed by
Dupont, Pomaret, and other authors. This shows that Dionis had had no
experience on this point.
7. _The application of artificial teeth._ These teeth, says Dionis,
are generally made of ivory, but may also be made of ox bone, which
is less liable to turn yellow than ivory. He does not mention the
use of hippopotamus tusks, but we learn from him that one Guillemeau
made artificial teeth with a composition of his own invention, which
was obtained by fusing together white wax and a small quantity of
gum elemi, and then adding ground mastic, powder of white coral and
of pearls. This fact is, as everyone can see, most important, for it
constitutes the first step toward the manufacture and use of mineral
teeth. Dionis tells us that the teeth made of Guillemeau’s composition
never became yellow, and that it was also very good for stopping
decayed teeth.[392] It would seem, therefore, that it could be used as
cement is now used.
The Guillemeau of whom Dionis speaks is probably Jacques Guillemeau,
the author of a book now no longer to be found, which was translated
from the French, first into Dutch, and afterward into German. Crowley,
in his _Dental Bibliography_, only quotes the German edition, published
at Dresden in 1710, the title of which runs thus: _Der aufrichtige
Augen und Zahnarzt_.[393]
JEAN VERDUC, also a Frenchman, relates a case of the surgeon
Carmeline,[394] analogous to that of Denis Pomaret, in which a sound
tooth which had been extracted by mistake was immediately replanted and
took root again, becoming quite firm. However, Verduc does not speak
of replantation as a special method of cure, but merely refers to the
above case incidentally in speaking of the extraction of teeth. He
considers this operation a most dangerous one, and advises not having
recourse to it except in cases of utmost necessity. Notwithstanding
this, Verduc gives us to understand that teeth were drawn with
sufficient ability by most of the operators of the time, and precisely
because of this he omits describing the manner of performing the
operation. According to Verduc, the drawing of teeth is often of little
or no advantage against toothache.[395] In proof of this assertion he
relates the case of a hypochondriac, who little by little had as many
as eighteen teeth extracted, without, however, getting the better or
the wiser; but as this case does not prove anything at all, one is
disposed to think that Verduc, in relating it, had the intention of
being humorous.
MONSIEUR DE LAVAUGUYON. To another French surgeon, Monsieur de
Lavauguyon, also a contemporary of Dionis, belongs the merit of having
declared useless, in the greater number of cases, the practice, at that
time general, of separating the gums from the tooth before proceeding
to the extraction of the latter. He says that this is only necessary
when a tooth, either because broken or because its crown emerges too
little above the gum, offers an insufficient hold for the pelican.[396]
Our historical survey has now reached the end of the seventeenth
century. Embracing at a glance the whole of this last period of
time, we remark, among many facts of minor importance, some events
which, in the history of the development of dental art, stand out in
strong relief. Such are the replantation of teeth used as a special
curative method by Dupont and others; the method of plugging in cases
of alveolar hemorrhage, the credit of which is due to Rivière and to
Tulpius; the description of the maxillary sinus given by Highmore; the
rational treatment of affections of the antrum, inaugurated by Meibom,
Cowper, and Drake; the researches into the microscopic structure of
the teeth, brilliantly initiated by Leeuwenhoek, who discovered the
dentinal tubuli; the use of models introduced by Purmann into the
workmanship of prosthetic pieces; the employment of hippopotamus’
tusks in making artificial teeth, first recommended by Nuck; and the
invention of Guillemeau, which was the first step toward the use of
mineral teeth.
[Illustration: Lorenz Heister.]
CHAPTER XII.
THE EIGHTEENTH CENTURY.
Although there have been, even from the most remote times, individuals
who have dedicated themselves exclusively to the cure of dental
maladies, or to repairing the losses of the dental system by artificial
means, and notwithstanding the progress gradually accomplished in this
branch of the medical art, which progress was especially remarkable
during the sixteenth and seventeenth centuries, it is not to be denied
that, up to the beginning of the eighteenth century, dentistry was, in
great part, considered one with medicine and surgery in general. It is
but natural that dental art (and the same may be said of every special
branch of medicine) could not assume a real individuality until it had
attained to the higher grades of its development. As a matter of fact,
dentistry, toward the end of the seventeenth century, was already a
true specialty, although it counted but few worthy representatives
at that time. The definite separation between the science and art of
dentistry and general medicine and surgery, although it may have been
retarded, could not fail to take place; and this, as we shall presently
see, was effected by the celebrated French dentist Pierre Fauchard.
But, to remain faithful to chronological order, we will first speak
briefly of some other writers.
LUDWIG CRON, a barber of Leipsic, in a pamphlet published in 1717,
with the title _The barber’s apprentice versed in bleeding and tooth
pulling_,[397] declares, in a still more emphatic and general way than
De Lavauguyon, that it is useless to detach the gum before proceeding
to extract a tooth. This barber, strong in his own experience, dares
to assert absolutely useless this ancient practice, advised first by
Cornelius Celsus, and recommended after him, and in homage to his
authority, by many other writers. It is, therefore, possible that
even previous to Cron and De Lavauguyon many operators had dispensed
with the practice recommended by Celsus, although this had become an
accepted canon of the high medical profession.
LORENZ HEISTER (1683 to 1758), of Frankfort-am-Main, one of the most
celebrated surgeons of the eighteenth century, wrote a dissertation on
toothache,[398] treating besides very extensively of dental affections
and their cure in a masterly work on surgery, published for the first
time in 1718, and which went through numerous editions in various
languages.
When the caries of a tooth is superficial, Heister advises the removal
of the decayed part with the file; or, when the caries is deep down,
the cavity ought first to be well cleaned with a toothpick or other
like instrument, then filled with heated white wax, or mastic, the
stopping being renewed as often as may be necessary. When a molar tooth
is decayed, especially in the centre, the best way, says Heister, is to
fill it with gold or lead leaf, or with a piece of the latter fitting
into the cavity. If the carious cavity of a painful molar cannot be
cleaned as it ought to be, the dropping of a little oil of cloves or
of cinnamon or of guaiacum into it will be found useful, or even a
few drops of spirit of vitriol; for in this manner one obtains at the
same time the double advantage of destroying the impurities contained
in the carious cavity and of soothing the pain. But if by chance the
pain should persist, recourse must be had to the cauterizing iron, or
to extraction. Sometimes, however, even the most violent toothache
can be made to cease, either by scarifying the gums (a method already
recommended by Pliny), by cauterizing the antitragus, or by pressing
the aching tooth hard between the fingers, as Schelhammer[399] and some
other writers had advised.
Heister writes at length on the extraction of teeth, on the indications
and counterindications appertaining thereto, on the instruments with
which the operation should be carried out, and so on. Regarding the
position of the patients, he thinks it best to place them on a low
seat or on the ground, if the tooth to be extracted is situated in the
lower jaw, but if an upper tooth is to be extracted, patients should be
placed on a chair or on a bed.
Movable prosthetic pieces are mentioned for the first time by this
author. Although he is very concise in his manner of speaking of
artificial teeth (this indicating that dental prosthesis was considered
outside the sphere of action of the general surgeon), we nevertheless
learn from him that partial sets of teeth made of ivory or hippopotamus
tusks, and without special appliances for fixing them, were then in
use, which, when applied in the void between the neighboring teeth,
were maintained in position simply by their form. The author advises
keeping prosthetic pieces very clean, removing them every evening
before going to bed, and not putting them back in the mouth until they
have been well cleaned.
Heister also speaks of nasal prosthesis; this was then carried out by
applying noses made of wood or of silver, properly painted. In cases
of trismus, this author altogether rejects the forcible opening of
the jaws by means of screw dilators and such like instruments, as they
act too violently, and, according to him, only aggravate the morbid
condition. Even the extraction of a tooth is useless in such cases, as
the patient can always absorb a certain quantity of liquid food through
the closed teeth. On the other hand, the author expresses himself in
favor of the incision of the gums in cases of difficult dentition.
According to him, convulsions and the other nervous symptoms which
children are subject to during the period of dentition depend wholly
on the hardness and strained condition of the gum. It is, therefore,
natural that the symptoms should disappear when an incision of the
gums, reaching to the tooth that is coming through, has caused the
tension to cease.
The author speaks very particularly of the treatment of epulis and
parulis; but his views on this subject contain nothing of great
importance.
RENÉ JACQUES CROISSANT DE GARENGEOT (1688 to 1759), the celebrated
French surgeon, speaks very little of dental surgery in his works. He
declares himself averse to the carrying out of too many operations on
the teeth, and especially disapproves the use of the file, because,
according to him, it ruins the enamel.[400] For a long time, especially
in France, Garengeot was believed to have been the inventor of the
key known by his name; but he merely perfected this instrument. In
fact, through a later author, Lecluse, it clearly results that the
key existed before Garengeot. “For extracting,” writes Lecluse, “one
may make use of the pelican that Garengeot has constructed on the
English key.” In a note, he afterward adds, “that the English key is
an instrument used by dentists in England.” However, it is not in the
least certain that the key is really an instrument of English origin.
Loder, who wrote at the end of the eighteenth century, informs us that
the so-called English key was called the German key in England; it is,
therefore, not improbable, that this instrument, as some maintain, had
its origin in Germany.[401]
JOHANN JUNKER (1679 to 1759), professor of medicine at the University
of Halle, wrote on dental maladies, not only in a treatise on surgery,
published in 1721, but also in three dissertations which were published
some time later, and were entitled respectively: _De affectibus
dentium_ (1740), _De dentitione difficili_ (1745), _De odontalgia_
(1746). The author, however, for the most part, only repeats things
already known; his writings have, therefore, little or no importance
for us. He counsels the Cowper-Drake operation in treating the
affections of Highmore’s antrum; in carrying out the operation,
however, he thinks the extraction of the second molar to be preferable
to that of the first. To prevent the formation of tartar on the teeth,
he advises assiduous care in keeping the mouth clean, and recommends,
among other things, rubbing the teeth with sage. He disapproves having
recourse too readily to metal instruments to remove tartar from the
teeth, because, according to him, it favors the production of dental
caries. He holds it dangerous to extract the upper or lower canines
when they are not loose, as, by reason of the depth of their roots an
injury to the surrounding nerves may be the result, which not only
might cause great pain, but in the case of the upper canines might lead
to inflammation of the eye, and even of the dura mater!
When the caries is incipient, Junker advises rubbing the teeth several
times a day for some time with common salt, in order that this should
penetrate into their structure.[402]
GUILLAUME MAQUEST DE LA MOTTE (1655 to 1737), a distinguished French
surgeon and the writer of an excellent treatise (_Traité complet de
chirurgie_, Paris, 1722), repeats the advice already given by preceding
authors, to which he annexes the highest importance, that is, the
opening in time of abscesses of the gums and of the palate even before
they be completely matured, in order to prevent the suppurative process
from extending and damaging the bone below. This author relates having
several times arrested serious hemorrhage following on the extraction
of teeth, by applying a little vitriol inside the alveolus, and, on
this, graduated compresses, which the patient pressed on the part with
the teeth of the opposite jaw.[403]
JOHANN ADOLPH GÖRITZ, of Regensburg, in one of his writings published
in 1725, disapproves the too frequent recurrence to extraction of the
teeth, that is, carrying out the operation when it is not absolutely
necessary. He is also averse to the application of artificial teeth.
In support of his opinion he relates a case in which, a certain time
after the application of an artificial tooth, the natural ones to which
it had been fixed became loose, so that it was necessary to proceed
to the fixing of all three, that is, the artificial tooth and the two
neighboring ones, to the firm teeth beyond them; these, however, became
loosened in their turn, and it was at last necessary to extract six
teeth. The great space thus created was filled with a prosthetic piece
made of hippopotamus tusk; but the author did not believe much good
would come of this either. In fact, he is of opinion that the natural
teeth should be preserved by every possible means, and that, on the
other hand, even in the case of a few being lost, it is better not to
resort to substitutes. In the worst case, should the dental void cause
too great inconvenience by damaging the pronunciation, or for some
other reason, it may be filled by an “imitation” in soft wood.[404]
[Illustration: Pierre Fauchard.]
If one takes into consideration the by no means slight inconvenience
to which fixed artificial teeth gave rise, one cannot but admit
the aversion to them, expressed by Göritz and others, to have been
justified.
ERNST FERDINAND GEBAUER, in 1726, made known a case in which, a tooth
having been badly extracted by an incapable surgeon, the upper jaw was
so seriously injured that a diffusive carious process ensued, which
after many years’ suffering brought the patient to the grave.[405]
JOHANN BERNHARDT FISCHER (1685 to 1772), a very famous doctor, born
in Lübeck, who had the honor of becoming archiater of the Russian
Empire, related, in 1726, a case of replantation, similar to those by
Pomaret and Carmeline; but HEINRICH BASS (1690 to 1754), of Bremen,
professor of anatomy and surgery in Halle, endeavored to demonstrate
that in these cases the tooth did not really take root, but was rather
maintained in position by the contracting of the surrounding gum. One
perceives from this that there were still, at that time, discordant
opinions on the subject of replantation, and that this operation was
far from occupying, in dental surgery, the accredited position it has
acquired today.
Heinrich Bass also combats the abuse of extracting teeth
inconsiderately, without absolute necessity, and expresses the opinion
that this is especially blamable in the case of teeth of the upper
jaw, principally because the extraction of either the canine or of the
first or second large upper molars might easily produce the opening
of Highmore’s antrum, and thus give rise to regrettable accidents. He
is not, however, averse, like Göritz, to the use of artificial teeth;
indeed, he advises the application of whole dental sets, even in the
upper jaw, so long as there be two natural teeth existing to fix the
prosthetic piece to.[406]
PIERRE FAUCHARD, the founder of modern scientific dentistry, was born
in Brittany about the year 1690, and died at Paris in the year 1761.
His celebrated work, _Le Chirurgien Dentiste_, was already written in
the year 1723, but not published until 1728. It marks a new epoch in
the history of dental art. The most renowned physicians, surgeons, and
anatomists of the time testified their admiration for Fauchard’s work,
which was translated into German in 1733, and afterward went through
two French editions in the years 1746 and 1786.[407] We have been able
to obtain the second edition[408] of this most important treatise, and
of this we now intend making use for accurately analyzing the work, as
it is probably more complete than the first, whilst the third, having
been published after the author’s death, is probably merely a reprint.
The work consists of two volumes in duodecimo, in all 863 pages. In
the beginning there is the portrait of the author and a long and
interesting preface. The portrait, which we here reproduce, has also
its historical importance, and this for two reasons, the first of
which being that in it Fauchard is revealed to us as a person of very
distinguished appearance, and this gives us an idea of the social
condition of the surgeon-dentists of his time; the second, because
there are annexed to the portrait the following Latin verses, by a
certain Moraine, in which, whilst eulogizing the writings of the author
and his ability in the treatment of the teeth, and in restoring force
and beauty to them, he counsels him “to despise the tooth of envy,” as
it will certainly break against his merit.
Dum dextra et scriptis solamina dentibus affers
Illorum in tuto sunt decor atque salus.
Invidiæ spernas igitur, Faucharde, cruentos
Dentes; nam virtus frangere novit eos.
That Fauchard, in common with all men of rare merit, had to combat all
his life against envy, we are able to perceive from what we read at
the end of the second volume of his work. The author here says that
“the rumor having been falsely set about that he has abandoned the
profession; which rumor cannot have been invented otherwise than by
those individuals who, sacrificing honor to interest, would attract to
themselves the persons who honor the author with their confidence; he
therefore finds it necessary to give warning that he still continues
the practice of his art in Paris, in the _Rue de la Comédie Française_,
together with his brother-in-law and sole student, M. Duchemin.”
More than a century and a half has passed by since Fauchard was
obliged to defend himself against lies invented and set about to his
damage by envious colleagues, but even at the present day, when,
given the high grade that civilization has reached, and professional
competition ought not to make use of other weapons than intelligence,
study, and application, some do not hesitate to have recourse to means
equally disloyal, ignoble, and shameless as those practised by some
contemptible dentists of the middle of the eighteenth century.
[Illustration: A CHARLATAN ON HIS PUBLIC STAGE]
The preface of Fauchard’s book is especially important for the notices
therein contained regarding the author, as well as the conditions of
dental art at that period. And first of all, we find in it the proof of
what we have already said elsewhere, namely, that even before Fauchard,
there were not only tooth-pullers but also dentists properly so
called. Indeed, Fauchard makes mention also of the examination that
aspirant dentists had to undergo as far back as the year 1700. It may
interest our readers if we here give in detail some extracts in which
the author speaks on these subjects:
“Although surgery in general,” says Fauchard, “has been greatly
perfected in these latter times; although important discoveries have
been made in anatomy and in the modes of operating, and many learned
and interesting observations have been published, nevertheless,
dentists nowhere find in works on surgery sufficient aids to guide
them in all their operations.” These last words should be sufficient
alone to prove that the dentists spoken of by Fauchard were not mere
tooth-pullers.
“The authors who have written on anatomy, on surgical diseases and
operations, have only treated very superficially the part relating
to maladies of the mouth and teeth. If some writers have spoken in
particular about the teeth and their diseases, as, for instance, Urbain
Hemard and B. Martin, they have not done so in a sufficiently ample
manner.
“Besides, there does not exist any public or private course of surgery
in which the theory of dental maladies is amply taught and in which one
can receive fundamental instruction in this art, so necessary for the
healing of these maladies and of those of the neighboring parts.
“This branch of the art having been but little cultivated, if not
wholly abandoned by the most celebrated surgeons, their negligence has
caused it to fall into the hands of persons without theory and without
experience, who practise it in a haphazard fashion, guided neither by
principles nor method. In Paris, it is only since 1700 that people’s
eyes have become opened to this abuse.
“In this town, those who intend to become dentists are now obliged to
undergo an examination, but although the examiners be most learned
and well versed in all the other parts of surgery, I think, if I may
be allowed to express my opinion, that as they do not ordinarily
themselves practise dental surgery, it would not be amiss on these
occasions to admit an able and experienced dentist, who might sound
the aspirant as to the difficulties which have come before him in the
course of the long practice of his art, and who could communicate to
them the means of surmounting them. In this way one would not have
to acknowledge that the attainment of the greater part of dental
experts[409] is below mediocrity.
“To supply this want of instruction it would have been of great use
if some able dentist, for example the late _Monsieur Carmeline_, who,
in his day, practised with general applause, had made us acquainted
with his mode of operating and with the knowledge acquired through the
successful treatment of a great number of important cases.
“What this celebrated surgeon-dentist has not done, I today dare to
undertake. I shall at least afford an example of what he might have
done with greater erudition and better success.
“From my youth I was destined to the surgical profession; the other
arts I have practised[410] have never made me lose sight of it. I was
the disciple of Alexandre Poteleret, surgeon-in-chief to His Majesty’s
ships, who had great experience in diseases of the mouth. To him I owe
the first rudiments of the knowledge I have acquired in the surgical
speciality I practise, and the progress I made under this able man gave
me the emulation that has led me to further important discoveries. I
have collected among different writers what seemed to me most reliable.
I have frequently discussed these matters with the ablest surgeons and
doctors of my acquaintance, and have neglected nothing in order to
profit by their counsels and by their ideas.
“The experience which I have acquired during an uninterrupted practice
of more than forty years has led me insensibly to the acquirement
of further knowledge and to the modification of what seemed to me
defective in my earlier ideas. I offer to the public the results of my
labors and of my studies, hoping that they may be of some use to those
who wish to exercise the profession of surgeon-dentist.”
The reason why dentists before the time of Fauchard published hardly
anything concerning their art, was perhaps out of a sentiment of
jealousy, which rendered them (that is, the best of the profession and
therefore the ones most capable of writing) but little disposed to make
known to others the results of their studies and of their experience,
lest the fruits of their long labors should be utilized by others
and they themselves be materially damaged by competition. That this
sentiment of jealous egotism really existed in many dentists may be, in
a certain manner, deduced from a few words of Fauchard himself, who,
although he has the very great merit of breaking with mean, old-world
prejudices, nevertheless expresses the prevalent idea of the time,
consisting in the belief that every artificer, every inventor, had
not only the right, but also the duty of surrounding his discoveries
with secrecy and mystery. These are the words in which, making known
a certain improvement in dental prosthesis invented by him, he at
the same time expressed his conviction that by so doing he is acting
against his own interests:
“I have perfected and also invented several artificial pieces both for
substituting a part of the teeth and for remedying their entire loss,
and these pieces substitute them so well that they serve perfectly
for the same uses as the natural teeth. To the prejudice of my own
interests I now give the most exact description possible of them.”
Now, although a man of elevated mind, such as Fauchard, may have been
capable of sacrificing his material interests to higher aims, it
is not, however, to be wondered at, taking also into consideration
the lesser degree of culture and of professional ability of his
predecessors, that none among them should have been found sufficiently
disinterested to publish the results of their particular studies and
experience, besides all those technical details which according to the
ideas of that time constituted the secrets of the profession.
In the course of this history, we have seen that the dental art
was practised from the most remote times and in the most various
countries, remaining, notwithstanding, for centuries in an embryonal
condition. It was toward the end of the seventeenth and the beginning
of the eighteenth century that, in the midst of the highly advanced
civilization of the great French capital, it attained a high degree
of development, entitling it to be considered a special branch of the
medical art.
It would, therefore, be wrong to believe that the dental art was
created, for the most part, by Fauchard, and one clearly perceives,
from the perusal of his work, that although he made most important
contributions to this specialty, which he cultivated with passion,
nevertheless, the greater part of the things therein treated of were
already known before his time, although no reference to them is to
be found in previous works; and this for the reasons we have already
suggested. The highest merit of Fauchard consists, still more than in
his inventions and improvements, in his having most ably collected
and incorporated in a single work the whole doctrine of dental art,
theoretical as well as practical, thus setting in full light the
importance of the specialty, and giving it a solid scientific basis.
France is therefore the first country where modern dentistry reached a
high degree of development and also the first country where, earlier
than elsewhere, that is, about 1700, the dentists began to form a
well-defined class, to belong to which it was necessary to pass a
special examination. This examination, as we learn from Fauchard, was
held before a commission of which no dentist formed a part, and exactly
for this reason gave but negative results and responded but little
to its intended aim. The greater number of those who were authorized
to practise dentistry after undergoing this examination showed a
professional ability below mediocrity. Nevertheless, although few in
number, good and able dentists were in no way wanting, as clearly
appears from the preface to Fauchard’s work, and better still from
the following paragraph,[411] wherein the author speaks of the great
perfection reached by dental surgery in Paris:
“The teeth and the other parts of the mouth being subject, as we
have seen in the course of this work, to so many important diseases,
requiring the aid of the most able dentists, it is strange that the
sovereigns of foreign countries, the heads of republics, and also the
administrators of our own provinces do not provide for the expense of
sending young surgeons to Paris, to be instructed in a part of surgery
so essential, and, notwithstanding, so ignored and neglected everywhere
excepting in this great city, where it has reached its highest
perfection, both as regards the embellishment of the mouth and the cure
of diseases, often of a most serious nature. These scholars would,
thereafter, form others and would render great services to their nation
and to their fellow citizens.”
In the first chapter of his work, Fauchard speaks “of the structure,
position, and connection of the teeth; of their origin and of their
growth.” He distinguishes in each tooth a body, a root, and a neck,
making the remark, however, that this last is to be considered as
forming part of the body. According to the author, the name of “crown”
can only be applied suitably to the body of the molar teeth, but not
to that of the incisors or of the canines, which has no resemblance
with a crown. Although in the adult the number of the teeth is
normally thirty-two, it may be that some persons have, nevertheless,
thirty-one, thirty, twenty-nine, or even only twenty-eight teeth, and
this independently of any eventual loss, but for the simple reason that
the wisdom teeth are often cut very late in life (even after fifty
years of age), or do not all come forth, or sometimes are never cut at
all. The author refers to some cases of a supernumerary tooth situated
in general between the two superior central incisors and similar in
form to the lateral incisors. He also observed two individuals who
had each thirty-four teeth, sixteen in the lower and eighteen in the
upper jaw, and in these cases the two supernumeraries were situated
behind the incisors. Fauchard declares the popular opinion expressed
also by some ancient authors, of the milk teeth having no roots, to
be false. The roots of these teeth, he says, are gradually worn away
before the latter are shed, when the permanent teeth are just on the
point of coming through; however, if it so happens that one or more of
the milk teeth be extracted some time before the period in which they
are usually shed, their roots are found to be as long and as strong in
proportion to the body as those of the permanent teeth. In children one
finds, besides the twenty deciduous teeth, the germs of the thirty-two
permanent ones, for which reason it may be said that children have in
all thirty-two teeth without counting the germs that may sometimes be
found at the extremities of the roots of the large molars. As, however,
the existence of such germs is an exceptional fact, the twelve large
molars, if extracted, are not ordinarily regenerated. This may be
possible, however, if the germs in question exist, and, indeed, the
author observed two persons in both of whom a large molar had been
regenerated in the place of the one which had to be extracted.
Fauchard gives an excellent description of the alveoli and of the
roots of the teeth; he alludes to the varieties which these latter
may present, and to the importance of the same from the point of view
of extraction. Thus, speaking of the molars, he says: “Their roots
sometimes touch one another at the points, whilst at the base, close
to the body of the tooth, they are far apart. These are the so-called
_dents barrées_ (barred teeth), which it is so difficult to extract,
it being unavoidable to bring away together with the tooth the spongy
osseous part occupying the interval between the roots.”
In this same chapter the author calls our attention to some anomalies
worthy of note. He says that he has observed teeth that seemed to him
to be derived from the union of two or three germs. He also relates
that a colleague of his showed him a tooth that appeared to be formed
by the union of two, between the roots of which was a third tooth whose
crown was united to the vault formed by the roots of the first two.
Fauchard describes exactly the pulp cavity and the root canals, and
speaks of their gradual restriction, ending in an almost entire
disappearance in old age.[412] He treats of the nerves, of the
arteries, and of the veins of the teeth in a most detailed manner;
then, after alluding to their general structure, he goes on to speak
of the microscopic constitution of the enamel, following in this the
description given of it in 1699 by the academician La Hire.
In regard to the development of the teeth, Fauchard repeats what Urbain
Hémard had previously written. He apparently ignores the researches
of the Italian anatomists, from whom, and especially from Eustachius,
Urbain Hémard had literally reproduced all that concerns odontogeny.
In the second chapter Fauchard speaks “of the maladies of children at
the period of teething and of the remedies best adapted thereto.” Among
other means of treatment, he advises the incision of the gum when this
is red, swollen, and distended and the tooth below it can be felt. For
the incisors and canines a simple incision ought to be made in the same
curve as the dental arch; for the molars a crosswise incision should
be made directly down to the tooth below, taking care not to leave
any strips of uncut gingival tissue, lest these, being distended by
the emerging tooth, should continue to be the cause of pain and other
morbid phenomena.
Although Fauchard does not tell us anything substantially new about
teething maladies and their treatment, he nevertheless treats this
subject with much practical good sense, and does not merely make
servile repetition of what preceding authors have written about it.
In the three following chapters the author speaks of the utility of the
teeth, of the rules to be observed for their preservation, of the modes
of keeping them white, and of strengthening the gums.
From a passage in the fifth chapter we learn that tooth brushes were
then already in use. Fauchard, however, advises the use of small
sponges in their stead. He says: “Those who use brushes of horsehair,
or pieces of cloth or of linen for cleaning the teeth, do not reflect
that all these materials are too rough, and that the practice of using
them frequently and without discretion often exercises a destructive
action upon the teeth.[413] Not without good reason, I advise the
abandonment of this usage, it being preferable, after having had the
teeth cleaned by the dentist, to wash the mouth every morning with
tepid water, and to rub the teeth up and down, inside and outside, with
a small, very fine sponge wetted in water; and it is still better to
add to this water a fourth part of aqua vitæ the better to fortify the
gums and render the teeth firm.”
Instead of a small sponge, says Fauchard, the end of a root of
marshmallow or lucern, which has first been subjected to a special
preparation, may be used with benefit for rubbing the teeth. The author
gives a long and minute description of this preparation, which we,
however, omit, because devoid of historical interest.
As, however, the above means are not always sufficient for preserving
the teeth and gums in good condition, it is necessary in many cases,
says Fauchard, to make use of some paste, powder, or mouth wash. The
author mentions a great number of compositions of this kind, giving
the formula for each one—almost always most complicated—and indicating
the peculiar advantages of each of them. We will here quote one of the
formulæ as an example.
“_A spirituous water, desiccative, balsamic, antiscorbutic, efficacious
against many maladies of the mouth_:
“℞—good sarsaparilla, four ounces; aristolochia rotunda, dried rinds
of bitter organes, of lemons, and pomegranates, _ana_ three ounces;
pyrethrum, two ounces; cloves, one ounce; mustard seeds, one ounce;
wild rocket seeds, two ounces. Pound well in a mortar and put the whole
into a retort with a long neck. Add thereto half a pound of pulverized
candied sugar and the same quantity of clarified rose honey. Pour in
three pints of good spirit of wine. Cork the retort well and leave all
to digest in a cool place for five or six days. Then heat the retort
forty-eight hours in the water bath over a slow fire, without letting
the liquid come to the boil. Afterward, when cold, decant in a glass
bottle, to be kept well corked. Pour another three pints of spirit of
wine on the residue of the drugs; cork the retort again, replacing it
in the water bath for forty-eight hours, and regulating the fire as
above. Then, after letting it cool, pour off the liquid into the same
bottle. Next remove all the residue from the retort, place it in a
thick, white linen cloth, and force the remaining liquid through it,
and add to that in the bottle. Put back half of the entire quantity of
liquid in the same retort, and add thereto aloetic elixir and _baume du
commandeur_, _ana_ four ounces; pulverized dragon’s blood, three ounces
and a half; pulverized gum of guaiac and Peruvian balsam, _ana_ three
ounces; gum lac, two ounces. Cork the retort again and replace it in
the water bath for forty-eight hours, as above. Let cool, decant the
liquid in another glass bottle, and cork well. Pour the remaining half
of the first liquid upon the rest of the drugs, replace the retort in
the water bath for forty-eight hours, let cool, and pour the contents
in the last bottle. Filter the liquid well, and pour it into a bottle
of sufficient size to be able to add the following liquids: aqua
vulneraria and first cinnamon water, _ana_ three pints; second cinnamon
water, three half-pints; spirit of cochlearia, four pints. Shake the
bottle well, filter again, and store in well-corked bottles.”
The author adds that the doses of the different drugs may be reduced
in proportion to the quantity of liquor to be prepared; and that he
prepares so large a quantity at a time because of the great sale he has
for it among his clients.
The preparation in question is counselled by the author as a remedy
against pathological conditions, and of the gums especially. One makes
use of it in the following manner: Pour from seven to eight drops
into a wineglass of water; wet the tip of the finger and rub the gums
and the teeth well. Or mix seven or eight drops in a good spoonful of
water, using a fine sponge to rub the teeth and gums.
The example we have cited suffices to show how much care one took at
that time in the preparation of substances destined to be used in the
preservation of the teeth, and demonstrates at the same time that
Fauchard, inventor of that and many other preparations, besides being
an able surgeon-dentist, was also exceedingly well versed in dental
materia medica.
Chapter VII treats of the general causes of dental, alveolar, and
gingival diseases, and contains the complete enumeration of these
maladies. The causes of dental affections may be of two orders, viz.,
internal (general diseases, dyscrasic conditions) and external (the
action of heat and cold, mechanical causes, etc.).
After having spoken in particular of various causes, Fauchard adds:
“Little or no care as to the cleanliness of the teeth is ordinarily the
cause of all the maladies that destroy them.”
The author divides maladies of the dental apparatus into three classes,
that is:
1. Maladies deriving from external causes and acting, therefore,
especially on the crown or uncovered part of the tooth.
2. Maladies of the hidden parts of the tooth, that is, of the neck and
root.
3. Symptomatic maladies, deriving from the teeth.
In the first class the author includes 45 pathological states, 17
in the second and 41 in the third, making up a total of 103 morbid
conditions. This should be sufficient to give us an idea of the
accuracy with which Fauchard studied the maladies of the dental
apparatus, especially if one considers that preceding authors
had reduced these maladies to a very small number. Fauchard’s
classification is very complete, for notwithstanding the progress
made in succeeding years in this science, the pathological conditions
not to be found comprised in it are exceedingly few. Naturally,
the 103 diseases enumerated by Fauchard do not represent as many
distinct morbid entities. The author, in classifying dental maladies,
keeps especially in view the requirements of the practitioner, and
therefore makes numerous distinctions in each morbid process. Thus,
he distinguishes a great many varieties of caries, viz., the soft and
putrid caries, the dry caries, the caries in part dry and in part soft,
the caries complicated by fracture, the superficial caries, the deeper
and the deepest, the caries of the different surfaces of the crown, and
so on. Also in the classification of other morbid processes, Fauchard
makes multifarious distinctions.
The passage referring to worms in the teeth deserves to be here
reproduced:[414]
“Sometimes worms are to be found in the carious cavities of the teeth,
or in the deposit of tartar that covers them, and to these the name
of dental worms has been given. Observations recorded by illustrious
authors are extant which attest this. Not having ever seen these worms,
I neither admit nor deny their existence. Nevertheless, I conceive the
thing nor to be physically impossible, although at the same time I do
not believe at all that these worms destroy the teeth or cause them to
decay, but rather that the eggs of some insect having been introduced
into the carious cavity of the tooth, either through alimentary
substances or through the saliva, these eggs thus deposited have
developed and produced the worms alluded to. However this may be, as
they are not the real cause of the caries, their eventual presence does
not require any particular consideration.” Fauchard again recurs to the
subject of worms in Chapter VIII, in speaking of the particular causes
of caries.[415]
“It was, and is still, believed by the vulgar and also by some writers
that all toothache is caused by worms, which little by little destroy
the tissue of the osseous fibers and the nervous threads. If this were
so, the explanation of pains and of decay in the teeth would be very
simple. This opinion is founded on pretended experiences relating
to these insects, which may, it is said, be made to fall out of the
teeth by the smoke of henbane seeds; this, however, has been declared
fabulous by Andry, dean of the medical faculty of Paris, as well as
other similar facts which he exposes in his book on the generation of
worms.[416]
“Andry relates, however, that with the help of the microscope one may
succeed in seeing certain worms that form beneath the deposit collected
upon the teeth as the effect of want of cleanliness; these worms, he
says, are exceedingly small and characterized by a small round head
with a small black spot; the body is long and fine, pretty nearly like
the worms seen in vinegar through the microscope. He adds that these
worms destroy the teeth little by little, causing a bad odor, but
not much pain. He believes it an error of the imagination to ascribe
violent pains in the teeth to dental worms, and holds that these only
produce a very slight, dull pain accompanied by itching.
“I have done everything possible,” continues Fauchard, “to convince
myself with my own eyes of the existence of these worms. I have made
use of the excellent microscopes of Manteville, sworn surgeon of Paris,
and have made a great number of experiments with them both on caries
in teeth newly extracted as well as on tartar of different consistency
accumulated on the same, but have never succeeded in discovering any
worms. I am also still less disposed to believe in the existence of
these animals, because Hémard declares that he has never been able
to find any worms in carious cavities. I am thoroughly convinced
of Andry’s sincerity; neither do I doubt the truth of the facts he
relates; but it is easy to perceive from his own words how little the
pretended healers of teeth and their specifics for killing worms are to
be held in account; from the moment that, according to this writer, the
pains for which one is most obliged to have recourse to remedies are
almost always those not proceeding from the cause in question.”
In short, Fauchard does not believe at all that dental caries is
occasioned by worms; and only from respect for the authority of Andry
and other writers does he admit the accidental existence of these
little animals in the carious cavities or upon the teeth, refusing,
however, to attribute any importance to the same as regards the
etiology of caries.
This disease, says Fauchard,[417] is produced by a humor that
insinuates itself into the midst of the osseous fibers of the teeth,
and displacing the particles which compose these fibers, gives rise to
their destruction. The causes from which these disorders derive may be
external or internal. The external causes are blows, violent efforts
made by the teeth; the improper use of the file, the application of
acids or of other substances that injure the enamel, alteration of
the saliva, impressions of heat or cold, and also certain kinds of
nourishment. Blows or violent efforts may produce caries, according to
the writer, by occasioning the effusion of the liquid contained in the
vessels. The author gives analogous explanations for the other external
causes. As to the internal causes, they consist, he says, in alteration
of the blood and of the humors.
The teeth, says Fauchard, are more subject to caries than all the rest
of the bones in the human body, because, their tissues being denser,
the vessels are on this account closer together and more easily liable
to be obstructed, choked up, and broken. Besides, the position of the
teeth exposes them more than the other bones to the immediate action
of external causes capable of producing the disorders alluded to; and
finally, what demonstrates the dental caries to be produced, for the
most part, by external causes, is that false teeth, either human or
formed from those of animals, sometimes become carious just in the same
way as the natural ones; which evidently happens by the sole action of
external causes.
It is undeniable that the ideas expressed by Fauchard on the pathogeny
of caries, cannot hold good against criticism. Nevertheless, we owe a
great deal to this author for having once for all put an end to the
ridiculous theory of dental worms, and for having tried to find a
reasonable explanation of the manner in which caries is produced.
The teeth, says Fauchard, have not all the same disposition toward this
morbid process; indeed, notable differences are to be observed in this
respect. The molars are, in fact, more apt to become decayed than the
incisors or the canines; and the upper incisors and canines are more
subject to this disease than the inferior ones, because, by reason of
their position, they are more frequently uncovered and more exposed to
heat and cold, whether in eating and drinking or whether in the mere
aspiration or expiration of the air. It is to be observed, besides,
that when the eruption of the last molars is considerably delayed they
easily decay.[418]
Having very frequently observed the symmetrical decay of corresponding
teeth on both sides of the same jaw, Fauchard considers that these
cases are not simply accidental, but rather holds that the fact
depends on a special cause, which, however, is not easy to determine.
He offers, at any rate, a sufficiently good explanation when he says
that as certain morbid causes (bad humors, etc.) must affect both
sides of the mouth identically, it is but natural that the effects of
such causes should be altogether analogous on the right and on the
left, and manifest themselves symmetrically on teeth having the same
configuration, the same structure, and the same consistence.
Before speaking of the treatment of caries,[419] Fauchard alludes to
the fallaciousness of the many remedies against toothache which were
largely sold at his time by charlatans and impostors of every kind.
“Some pretend to cure toothache with an elixir or some special essence;
others with plasters; others by means of prayers and signing with the
cross; others with specifics for killing the worms that are supposed
to gnaw the tooth and so cause pain; others pretend to be so clever
that they can cure the most inveterate toothache by merely touching the
tooth with a finger dipped into or washed with some rare and mysterious
liquid; others finally promise to cure every kind of toothache by
scarifying the ears with the lancet or cauterizing them with a red-hot
iron.”
“I am well aware,” adds Fauchard, “that it can be alleged in favor
of this last prejudice that the celebrated Italian doctor Valsalva
indicates with great precision the point in which the actual cautery
is to be applied to the ear, in order to calm toothache. He also
determines the size of the iron and the manner of applying it. The
authority of so celebrated an author, whose opinion is certainly worthy
of respect, should induce me to believe that there may perhaps be
some cases in which it is possible to use this remedy with success;
nevertheless, I cannot persuade myself that such treatment can be
useful in common cases of toothache.
“At Nantes, a city of Brittany, I knew a Turk, a watchmaker by
profession, who was renowned for this mode of curing toothache. But I
also know that, in spite of the pretended cures, the greater number
of those who put themselves into his hands were obliged finally to
have recourse to me, in order to find relief for their sufferings. I
afterward saw several other persons use the same remedy with no better
success.
“There are, besides, an infinity of other remedies vaunted as
efficacious against toothache, but the greater number of them are so
ridiculous and extravagant that it would be both tiresome and useless
to speak of them. We will, nevertheless, give one more mentioned by M.
de Brantôme.”[420]
The author here quotes a passage of this writer, wherein he says that,
having been suffering from toothache for two days, the apothecary of
Elizabeth of France, wife of Philip II of Spain, brought him a most
singular herb, which when held in the hollow of the hand had the virtue
of making the pain cease immediately; and in this way he was, in fact,
effectually cured.
And here Fauchard expresses himself of the same opinion as Urbain
Hémard, who believes the cure of toothache by means of words, or by
the touch of paper on which certain signs are written, or remedies
held in the hand, etc., to be merely the effect of the force of the
imagination, and he opines that the patient, having a vivid belief in
the mysterious thing proposed to him remains under the impression of
an inward commotion, by the effect of which it may well be that the
morbid humor is deviated from the painful part to other parts of the
body. The effects of the various passions on the bodily functions are,
says Fauchard, very well known. Thus, when under the influence of anger
the wounded at times do not feel any pain, and those who suffering from
a tormenting toothache go to a dentist to have the tooth drawn are
sometimes seized by such great fear as not to feel the pain any longer,
and go away, only to return later on renewal of their sufferings;
although there have been cases where the pain ceased altogether.
In spite of this explanation, of which we will not here discuss the
value, allowing it, however, as satisfactory enough, Fauchard continues
by making a most curious consideration, which as it is of a somewhat
surprising effect in a scientific work, we will not deprive our readers
of it. He believes it to be his duty to give the following warning,
namely, that “the modes of cure, by means of certain words, of certain
signs, laying on of hands, written charms, etc., savoring much of
superstition and of diabolic artifice, are prohibited by the Church as
sinning against the first Commandment, as much in him who practises
them as him who consents thereto.”
After the above preliminaries, the author passes on to treat the
important subject of the mode of curing caries.[421] According to him,
when caries has not yet attacked the internal cavity of the tooth at
all, or only in a very slight degree, there are four modes of curing
it: the first consists in the use of files or scrapers, the second in
the application of lead, the third in the use of oil of cinnamon or
of cloves, and the fourth in the application of the actual cautery.
Fauchard expresses most energetically his disapproval of the means
of cure recommended by Dionis in cases of caries of the triturating
surfaces, which consisted in the cauterizing of the decayed spot
with a drop of oil of vitriol applied by means of a miniature paint
brush, declaring this to be both dangerous and hurtful because of the
destructive and corrosive action of the oil of vitriol and because of
the impossibility of limiting its action solely to the affected part of
the tooth.
The general method of cure followed by Fauchard is described by him in
these terms:
“When a tooth is but slightly decayed, it is sufficient to remove the
caries with the instruments of which I will speak hereafter, and to
fill the cavity with lead. If, however, the cavity be rather deeper
and occasions pain, one should, after having scraped it, put a small
ball of cotton-wool soaked in oil of cinnamon or of cloves into the
hollow of the caries every day. This medication must be continued for a
sufficient time, taking care to squeeze in the cotton-wool by degrees
to accustom the sensitive parts to the pressure. Four or five days
later one removes the material from the carious cavity. This treatment
sometimes prevents a return of the pain; it produces on the osseous
fibers of the tooth a slight but sufficient exfoliation and impedes
the progress of the caries. If the pain should not cease after having
continued this method for a sufficient length of time, one should then
have recourse to the actual cautery and stop the tooth after a certain
time, if the form and situation of the decayed cavity permit it; for
one sometimes meets with cavities that are not able to maintain the
stopping.
“If the caries penetrates as far as the cavity of the tooth, it may
give rise to an abscess; and this I have often observed in persons to
whom the caries of the incisors or of the canines occasioned great
pain. In such cases I introduce the extremity of the sound into the
cavity of the tooth in order to facilitate the evacuation of matter.
As soon as the pus is evacuated the pain ceases. I then leave these
patients in repose for two or three months; after this time, I stop the
decayed tooth or teeth to avoid their getting worse.”
As anyone may perceive, the methods used by Fauchard against caries
left much to be desired, when compared with those now in use. With such
imperfect methods it is but natural that one did not always succeed in
obtaining the immediate cessation of the pain resulting from caries.
The want of additional remedies was, therefore, felt; and, in fact,
Fauchard tells us[422] of two with which he had experimented and found
most efficacious against toothache. The first is a resinous plaster
to be applied to the temples; the other is a paste to be applied, in
quantity equal to the size of a small bean, between the gums and the
cheek, and which was composed of various ingredients, among others,
pyrethrum, black pepper, ginger, stavesacre, mace, cloves, cinnamon,
sea salt, and vinegar. After having given the mode of preparation and
application of the two above-mentioned remedies, Fauchard adds: “These
remedies prove especially efficacious if one takes care to introduce a
little cotton-wool or lint into the decayed cavity, soaked in oil of
cloves, or cinnamon, mixed with an equal quantity of extract of opium,
and if one resorts opportunely to bleeding and purging; which ought
never to be neglected in the case of plethoric persons.”
Finally, the author speaks of another remedy,[423] and one which we
never should have expected to find in his book; but he assures us that
by it many persons who had almost all the teeth decayed and suffered
very often from toothache found great relief.
“It consists in rinsing the mouth every morning and also in the evening
before going to bed with a few spoonfuls of one’s own urine immediately
after it has been emitted, always provided the individual be not ill.
One is to hold it in the mouth for some time, and the practice ought to
be continued. This remedy is good but undoubtedly not pleasant, except
in so far as that it procures great relief. Some of those to whom I
have recommended it, and who have used it, have assured me that in
this manner they were relieved of pain to which, up to then, they had
continually been subject. It is rather difficult in the beginning to
accustom one’s self to it; but what would one not do to secure one’s
self health and repose.”
In order to explain the virtue of the urine as a remedy, the author
pauses to speak of its chemical composition, and then adds:
“The rectified spirit of urine[424] could be substituted for the human
urine. One should then take two drams of this substance and mix it with
two or three ounces of aqua vitæ, or water of cresses or of cochlearia.
Sal volatile[425] has the same virtues. Those who wish to make use of
it should dissolve fifteen to thirty grains of it in the same quantity
of the above liquid.”
Fauchard then passes on to speak of trepanning of the teeth when they
are worn away or decayed and cause pain.[426] He begins by saying that
most varieties of pain caused by the canines and the incisors when
worn away or decayed cease after the use of the trepan. He, however,
understands the term trepanning in a very wide sense, comprehending
therein the use of any instrument whatever (even a needle or a pin)
with which one penetrates into the inner cavity of the teeth.
In interstitial caries of the canines and incisors one ought, says
Fauchard, first to enlarge the interstice with a small file of a
convenient shape, then to scrape the decayed cavity, and finally to
open up the canal or inner cavity of the tooth with a perforator or
with a small trepan.
“In this way the pus or other humors that may have collected in the
tooth can easily find their way out, and the pain will cease at once or
in a short time.”
The author describes with much minuteness the manner of trepanning, and
then adds:
“After this operation one should let a few weeks pass without doing
anything to the affected tooth, and afterward, in order to impede
further decay, one must put a little cotton-wool into it soaked in oil
of cinnamon or of cloves. The tooth must be left in this state for
some months, taking care to renew the cotton-wool. It is necessary to
observe that in beginning to put in the cotton-wool this should be done
with lightness and without pressing it down much, so that if pus should
gather again it may be able to make its way through the cotton-wool,
the principal object of this being to hinder the penetrating of
alimentary substances into the tooth, which would be the cause of
further decay. If the cotton were pressed into the tooth from the
beginning, the pus, not being able to find an exit, would accumulate,
and might cause much pain, if the nervous parts of the tooth were
not yet dried up or destroyed. The same thing might happen after the
application of a lead stopping, and one would be obliged to remove it
and let considerable time pass before putting it in again.”
Further on the author says that while the trepanning of incisors or
canines almost always causes the pain to cease, by opening up an exit
to the morbid matter retained within the cavity of such teeth, the
same is not the case with the molars, these having several roots and
several cavities, of great variety, which lend themselves but little to
accurate trepanning. “Hémard,” he adds, “judges it necessary to extract
these teeth, or at least to break off the crown (_les déchapeller_),
in order to give exit to the corrupt matter that is closed up in the
cavity; this sometimes causes the pain to cease. He (Hémard) says that
he has seen many abscesses in the interior of teeth, which were not
externally decayed, and that after having broken off the crown he found
within the cavity a corrupt matter of an insupportable smell.”
Relative to such cases, Fauchard says that, besides the teeth, also the
surrounding parts suffer and are imperilled by these conditions. “The
greater part of the violent fluxions deriving therefrom often terminate
in abscesses and fistulæ of the gums and of the surrounding parts, and
sometimes with considerable and dangerous decay of the bone, as I have
related in some of my observations.”
One sees that Fauchard was clinically very well acquainted with the
grave forms of pulpitis and their possible consequences, although
ignoring the true nature of this process, which has only been studied
and illustrated much more recently.
Chapter XL (page 177) treats of dental tartar, of its cause, of the
harmful effects it produces, and of the prophylaxis and therapy
relating thereto. Three illustrations which are added to this chapter
represent the different aspects of a mass of tartar of exceptional
size formed around the body of a lower molar. The surgeon Bassuel, a
friend of the author, had removed this mass of tartar, together with
the entire molar, from the jaw of an old woman. The mass itself was
almost the size of a hen’s egg, the superficies being very irregular;
it rendered mastication altogether impossible and caused the cheek to
stand out in such a way as to give the appearance of a tumor.[427]
In the following chapter[428] the author enumerates the various dental
operations: “Cleaning the teeth, separating them, shortening them,
removing the caries, cauterizing, stopping, straightening crooked
teeth, steadying loose teeth, trepanning, simple drawing of teeth,
replacing them in their own alveoli, or transplanting them to another
mouth, and finally substituting artificial teeth for those wanting.” He
then adds: “All these operations require in him who carries them out
a light, secure, and skilful hand and a perfect theoretic knowledge,
by which he may decide on the opportuneness of performing them, of
deferring them, or of abandoning them altogether. In fact, one may know
perfectly well how to carry out an operation and nevertheless undertake
it in a case in which it is not at all proper to operate. Into such
an error no one can fall save through sheer ignorance of the cause of
the disease or of the right means of curing it. From this it must be
concluded that the knowledge required in order to be a good dentist is
not so limited as some imagine, and that the imprudence and the danger
of placing one’s self in ignorant hands is as great as the temerity of
those who undertake to exercise so delicate a profession without the
knowledge of even its first elements.”
Before speaking in detail of all the above operations, the author
dedicates a lengthy chapter[429] to describing with the greatest
minuteness the position to be given in general, as well as in special
cases, to the head and body of the patient, and the manner in which
the dentist should place himself with regard to the former, so as to
be able to make a proper use of each of his hands. As a rule, Fauchard
made the patient seat himself in a convenient arm-chair; in exceptional
cases he placed him on a sofa, or on a bed. He draws this subject to a
close with the following words:
“It is, indeed, surprising that the greater part of those who practise
tooth drawing should ordinarily seat the patient on the ground, this
being both indecent and not very clean. This position is not only
uncomfortable, but causes sometimes a sense of fear, especially in
pregnant women, to whom it may, besides, prove very harmful. But it is
still more surprising that certain authors should even nowadays affirm
this to be the most convenient position, while it is instead one to be
entirely rejected.”
In speaking of extraction of the teeth,[430] Fauchard begins by saying
that the milk teeth, although destined to be shed, should never be
extracted, except in cases of absolute necessity, as, for instance,
when being decayed, they give rise to intolerable pain. The alveoli of
the infantile jaw are weak, whilst the roots of the deciduous teeth
are sometimes firmer and more solid than one would believe, and hence
it is that in extracting a milk tooth one runs the risk of injuring
the alveolus and even of carrying away a portion of it altogether with
the tooth, not to speak of the danger of damaging or even destroying
the germ of the permanent tooth lying below. Besides, Fauchard adds,
there are sometimes deciduous teeth that are never shed and never
renewed. One must, therefore, defer drawing children’s teeth as long as
possible unless they are loose. When, however, intolerance of pain or a
caries endangering the integrity of the neighboring teeth oblige one to
recur without delay to extraction, one should carry out the operation
with prudence and judgment, so as to avoid the dangers alluded to. It
sometimes happens, says Fauchard, that one finds in children a crooked
tooth by the side of a straight one; in these cases ignorant
tooth-drawers have often been known to remove the crooked (permanent)
tooth, and to leave the straight, viz., the deciduous one, which
afterward falls of itself, the individual thus remaining deprived of
one of his teeth for the rest of his life. The rule to be observed in
order to avoid a similar error is always to extract the older of the
two teeth and to leave the one that has been cut more recently, which
is easily recognized by its being ordinarily firmer in the socket and
of a better color than the first.
And here the author inveighs against all the charlatans of his day who
dared, without being dentists, to perform dental operations, and whose
number, it would seem, was ever increasing, so much so that he is led
to exclaim: “There will shortly be more dentists than persons affected
with dental diseases!” In proof of this he relates the case of a
cutler of Paris, who extracted the molar tooth of a young girl because
black spots having appeared on it, he believed it to be decayed; but
perceiving that he had only removed the crown (it was a deciduous
tooth about to fall out), and thinking that he had broken the tooth,
proceeded to extract the root, removing, in his gross ignorance, the
permanent tooth on the point of coming through.
Returning to the indications for the extraction of teeth, Fauchard
says that when a tooth planted irregularly in the mouth cannot be
straightened by any of those means to which he afterward alludes, and
occasions damage or inconvenience or constitutes a deformity, the sole
remedy is its removal. As to decayed teeth and the pain that they
produce, when the evil cannot be remedied with oil of cinnamon or oil
of cloves, with the actual cautery, or by stopping, one must have
recourse to extraction, and this to satisfy four different indications,
that is, before all, to procure the cessation of violent pain; in the
second place, to prevent the caries from being communicated to the
neighboring teeth; thirdly, to remove the fetid smell deriving from
the substances that are retained within the carious cavity, and to
impede the teeth on the same side from becoming covered with tartar,
as inevitably happens when by reason of painfulness in eating they are
forced to be inactive; fourth and lastly, because the dental caries,
not infrequently gives rise to other diseases, which ordinarily cannot
be cured unless the cause from which it arises be recognized and
suppressed.
“Sometimes,” continues Fauchard, “such violent and obstinate pain
arises in a tooth that we are obliged to extract it, although not
decayed nor presenting deformity.”
The author combats the old prejudice, that it is not right to draw
teeth in cases of pregnant women or of nursing mothers, lest the
operation should prove dangerous to the patient or to the fetus, or
produce alteration or arrest of the milk secretion. Only the fear
arising from this prejudice can, according to the author, cause any
of the dreaded contingencies. The dentist ought, therefore, to seek
to dissipate the fears of these patients, by persuading them of the
innocuous nature of the operation as well as of its short duration,
and should represent to them, on the other hand (if the operation
be really necessary), the advantages of promptly deciding on it, to
avoid the harm and the peril that prolonged suffering and the tortures
of sleeplessness might occasion to themselves as well as to the
unborn child or to the suckling infant, such as abortion, premature
confinement, alteration of the milk, etc.
According to Fauchard, “one should always take the precaution of hiding
the instruments from the patient’s sight, especially in the case of
extracting a tooth, so as not to terrify him.”
The author then speaks of cases where it is necessary to open the jaws
by force;[431] of the instruments to be used; of the mode of employing
them; of all the precautions to be observed under such circumstances;
of the necessity that may eventually arise of sacrificing some one
tooth when the enforced opening of the jaws has been impracticable; of
the advisability of sacrificing preferably in such cases one of the
premolars in order to damage as little as possible the masticatory
function and the appearance of the face; of the instruments best
adapted for carrying out this operation; of the danger it presents and
of the best mode of avoiding it; finally, of what it is necessary to do
in given cases to keep the mouth open, in order to not be obliged to
repeat the operation a second time.
The six following chapters of the first volume treat very extensively
of the anatomy and physiology of the gums,[432] of gingival diseases
and their treatment.[433] The subject is treated in a masterly manner,
although these chapters do not offer anything of original importance.
The same may be said of Chapter XXII, in which the author speaks of
scorbutic affections and of their treatment.
The chapters we have cited are accompanied by four plates, representing
thirteen instruments for use in the treatment of the above diseases.
[Illustration: FIG. 78
Instruments for opening the mouth in cases of lockjaw (Fauchard).]
The author then speaks[434] of the accidents which may arise from
caries and from other dental diseases, not only in the parts nearest
to the teeth, but also in localities more or less distant from them,
for example, fistulæ reaching as far as the cheek bone or the eye,
necrotic destruction of the maxillary bones, etc.
The first volume of Fauchard’s work finishes with a collection of
most interesting cases, which may be read even at the present day
with pleasure, and from which one may derive some useful information.
These cases are about eighty in number, spread over fifteen chapters,
according to the various nature of the cases themselves. This valuable
collection gives clear evidence of Fauchard’s eminence both as operator
and observer, and affords at the same time an idea of the extent of his
practice which enabled him to collect so considerable a number of cases
of more than common interest.
Chapter XXV contains some observations on “_well-authenticated cases_”
of regeneration of permanent teeth in individuals of ages varying from
fifteen to seventy-five years. We will here give two of them by way of
curiosities:
“In the year 1708 Mademoiselle Deshayes, now the wife of M. de Sève,
residing at Paris in rue de Baune, and who was then fourteen years of
age, had the first large molar on the right side of the inferior jaw
extracted by me, because decayed and causing pain. The following year
she returned to have her teeth cleaned by me, and whilst doing this I
observed that the tooth extracted had been wholly regenerated.”[435]
“In the year 1720 the eldest son of M. Duchemin, player in ordinary
to the King, who was then sixteen years old, came to me to have the
second large molar on the left side of the lower jaw extracted. It was
very much decayed. I drew it, and a year and a half after the tooth was
completely regenerated.”[436]
In Chapter XXVIII the author relates twelve cases of dental
irregularities corrected by him with satisfactory and at times even
surprising results. We here refer, in Fauchard’s own words, to the last
two of these cases, not because of their being the most important, but
because from them it is evident that Fauchard was not the only dentist
who undertook such corrections, although he was perhaps the only one
who, in certain cases, carried them out with a rapid method.
“In the year 1719 M. l’abbé Morin, about twenty-two years of age,
whose countenance was greatly deformed from the bad arrangement of the
incisors and canines, consulted various colleagues of mine as to the
possibility of correcting the irregularity of his teeth. Some found the
thing so difficult that they advised him to do nothing at all, that is,
not to risk any attempt. He came to me by chance one day whilst another
dentist was with me. We both examined his mouth with much attention.
Now, as this dentist was my elder, and I believed him to have more
experience than I had, I begged him to give me his opinion as to
the best method to follow in this case, in order to insure success.
Whether it be that he would not give me advice, or that he was not in
a position to be able to do so, the fact is, that his answer was not
such as I could have wished. I therefore felt myself obliged to tell
him that I hoped to put this gentleman’s teeth in order within three
or four days. My colleague was not aware that this could be done so
quickly; urged by curiosity, he returned when the time I had indicated
had elapsed, and found, not without surprise, M. Morin’s teeth reduced
to perfect order.”[437]
“Several years ago the wife of M. Gosset, Reviseur des Comptes, sent
for me to examine the teeth of her daughter, then twelve years of age.
I found the lateral incisor on the left side of the lower jaw strongly
inclined toward the palate in such a manner as to constitute a real
disfigurement. Interrogated by the mother as to the possibility of
remedying this, I replied that it could easily be done in eight or ten
days, with the method of threads, if the young girl were only sent
every day to my house. As, however, the young lady received instruction
from several masters who came to her house each day, my proposal was
not accepted, in order not to distract her from her studies. This
induced me to say to the mother that, if she were willing, I would put
the crooked tooth into its natural position in a few minutes. Surprised
at so short a time being demanded for the operation, she consented
to my performing it immediately. Making use of the file, I began by
separating the tooth from the neighboring ones which pressed upon it,
slightly diminishing the space it ought to have occupied. This done,
I straightened the tooth with the pelican, placing it in its natural
position, to the great astonishment of the young girl’s mother and of
other persons present, who told me they had many times seen similar
corrections that had been carried out by the late M. Carmeline and
others, never, however, with this method or in so short a time. As soon
as I had reduced the tooth to its normal position I fixed it to those
next to it by means of a piece of common thread, which I left there
eight days; and during that time I made the young girl rinse her mouth
four or five times a day with an astringent mouth wash. After the tooth
had become firm, it would not have been suspected that it had ever been
out of its normal position.”[438]
In Chapter XXX the author gives an account of five cases of dental
replantation and one of transplantation. This last operation was
carried out on a captain who had the upper canines on the left side
decayed and aching; he inquired of the author if it were possible to
draw it and replace it by another person’s tooth. Having received an
affirmative reply, the officer sent immediately for a soldier of his
company to whom he had already spoken on the subject. This man’s
canine was found by Fauchard to be too large; nevertheless, for want
of better he extracted and transplanted it, after having diminished it
in length and in thickness. This it was not possible to do without the
cavity of the tooth remaining open, and for this reason, when, after
about two weeks’ time it had become quite firm, he stopped it. But the
stopping immediately caused such insupportable pain (which circumstance
astonished the writer not a little) that he was obliged to take it out
again the following day, on which the pain ceased directly. Fauchard
saw this patient eight years afterward, and was assured by him that the
transplanted tooth had lasted him six years, but that its crown had
been gradually destroyed by caries. The root had been extracted by a
dentist, not without considerable pain.[439]
We now give one of his cases of replantation in the words of the author
himself:
“On April 10, 1725, the eldest daughter of M. Tribuot, organ builder
to His Majesty the King, called on me; she was tormented by violent
toothache caused by caries of the first small molar on the right side
of the upper jaw; but although she was desirous of having the tooth
removed, to be freed of the pain, she, on the other hand, could not,
without difficulty, make up her mind, thinking of the disfigurement
which its loss would occasion, and thus it was that she was induced to
ask me if it would not be possible to put it back again after having
extracted it, as I had already done in the case of her younger sister.
I replied that this might very well be done, provided the tooth came
out without being broken, without any splintering of the alveolus, or
great laceration of the gum. The patient, upon this, completely made up
her mind. I extracted the tooth very carefully so as not to break it,
neither were the gum nor the alveolus injured in any way. I therefore
was induced to put the decayed tooth back in its alveolus, and having
done this, I took care to tie it to the neighboring teeth with a
common thread, which I left in position for a few days. The tooth
became perfectly firm, and only caused pain for two days after being
replanted.... To better preserve it, I stopped the carious cavity.”[440]
Not without interest is a case of disease of Highmore’s antrum,
originating in the following way. A charlatan attempted to extract by
means of a common key a canine tooth which had erupted in an abnormal
position. He applied the hollow of the key to the tooth and beat upon
the handle with a stone. But the tooth, instead of penetrating into the
hollow of the key, was driven into the maxillary sinus.[441]
Two important cases of “stony excrescence” of the gums (probably
osteomas) are to be found in Chapter XXXII. One of these tumors was
removed by the dentist Carmeline after the patient had been tortured
with useless operations by surgeons, who, not recognizing the true seat
of the evil and mistaking it for a tumor in the cheek, had, over and
above all the rest, produced a permanent disfigurement of the patient’s
face and a perforation of the cheek that he was obliged to keep closed
for the remainder of his life with a wax plug, to prevent the exit of
the saliva and of liquid or masticated aliments.[442]
Several important observations on obstinate cases of cephalalgia,
prosopalgia, otalgia, and other varieties of pain arising from dental
caries are to be found in Chapter XXXIII. In all these cases the
removal of the decayed tooth or teeth procured the prompt cessation of
pain. Among others worthy of note is a case of violent otalgia caused
by the decay of a lower molar, which, however, was itself not painful.
This circumstance drew Fauchard himself into error, causing him to
believe that the otalgia was independent of the decayed tooth; he
therefore merely stopped the tooth to prevent the caries from extending
farther. The pain in the ear continued, however, and the patient
therefore consulted a doctor of the Faculty of Paris, Coutier, who told
her that the decayed tooth might be the cause of the earache, and that,
therefore, before undertaking any other cure, she ought to have it
extracted. This advice was followed and the earache ceased promptly and
completely.[443]
In another case a patient twenty-seven years of age was tormented by
violent pain in all her teeth on the left side, in the temple and the
ear, as well as in the chin, the palate, and the throat. The doctors
and surgeons consulted decided the cause to be rheumatism. The patient
was bled not less than four times and subjected to various other
methods of treatment (purgatives, clysters, poultices, etc.), but all
in vain. She, however, perceiving that one of her teeth was decayed,
had it taken out. It was believed that the cause of the malady had thus
been found and removed; but an hour later the pain began again with
the same violence as before, continuing for some months; after this
it ceased of itself. On the return of the pain, later on, in all its
former intensity, the patient consulted the very able surgeon Petit,
who advised her to see Fauchard, as possibly the malady might have its
cause and point of departure in some bad tooth. Fauchard found one of
the inferior molars decayed. This being extracted, the pain promptly
ceased, not to return any more.[444]
Chapter XXXV contains twelve cases of serious maladies arising from
dental diseases. One of these cases was observed in a patient aged
fifty-seven years, who in consequence of caries of the last inferior
molar on the right lost through necrosis a considerable portion of the
lower jaw, including the whole of the right condyle; he was affected,
besides, with caries of the temporal bone, in so advanced a degree
that the probe could reach the dura mater; he was, therefore, in
serious danger of his life, had to undergo several surgical operations
of exceptional gravity, and even after recovery remained permanently
subject to various disturbances, such as a salivary fistula, paralysis
of the lower eyelid, etc. And all this because the surgeons whom
the patient had called in had directed all their attention to the
secondary facts, instead of suppressing the primary cause of the evil,
represented by a dental affection.
A case observed by the surgeon Juton and communicated by him to the
author is also a very important one. The patient was suffering with a
large abscess on the right side of the lower jaw, accompanied by such
great swelling of the cheek that it was impossible to open the mouth
wide enough to examine the teeth. Juton proposed opening the abscess
immediately, but the patient would not consent. The following day
he was sent for in great haste. The gathering had changed its seat,
making its way between the skin and muscles of the neck, where it now
formed so huge a tumefaction that the patient was in danger of being
suffocated. The abscess was now immediately opened, but the swelling
of the face still persisted; it was therefore only after a month had
elapsed that it was possible to extract the root of the last molar,
which had been the original cause of the whole malady. The surgeon
observed that the liquid injected into the fistulous opening in the
neck issued from the alveolus of the last molar. After the extraction
of the root a prompt recovery was effected.[445]
The second volume of Fauchard’s work is entirely devoted to operative
dentistry and prosthesis.
Before speaking of the modes of cleaning, filing, and stopping the
teeth, the author combats the opinion maintained by some, that these
operations are in part useless, in part also dangerous, as having the
effect of loosening the teeth, of depriving them of their enamel, and
ruining them.
Fauchard then describes the instruments proper for detaching the
tartar;[446] he speaks of the method to be followed in cleaning the
teeth in order to not endanger the enamel;[447] he speaks of the
different kinds of dental files, of their different uses in relation to
the various cases and indications; of the precautions to be taken in
making use of them;[448] of the instruments to be used for scraping and
cleaning the carious cavities and of the mode of employing them.[449]
All of the above-named instruments are illustrated by figures, in
contemplating which one cannot but reflect on the inferiority of the
instruments then in use as compared with those of the present day.
The greater admiration is therefore due to Fauchard’s talent, which,
in spite of such imperfect and at times absolutely primitive means,
enabled him to obtain the brilliant results cited in his observations.
[Illustration: FIG. 79
Instruments for detaching dental tartar (Fauchard).]
Chapter VI is dedicated to the stopping of decayed teeth. The sole
materials used by the author for stopping were lead, tin, and gold.
“Fine tin,” he says, “is preferable to lead, for lead turns black much
more easily and is much less durable; both are preferable to gold,
because lighter and adapting themselves better to the unevenness of
the carious cavities. Besides, gold being dear, not everyone can or
will make the corresponding outlay.” The author here adds that those
who, from vanity or because possessed by the opinion that gold has
special virtues, will not have their tooth stopped except with it, not
unfrequently find dentists who, as the saying, goes, content them and
cozen them by using leaf tin or lead colored yellow, and making them
pay for it as gold stopping!
[Illustration: FIG. 80
Some of the dental files used by Fauchard. The little
square figure represents a small grooved wedge destined
to be inserted in large interdental spaces, in order to
give more firmness to the teeth to be filed.]
The leaf metals were introduced and compressed into the carious
cavities by means of three kinds of pluggers, which would nowadays be
considered altogether insufficient and unfit for the purpose, but which
then, nevertheless, served to produce excellent stoppings. The author
speaks[450] of a lead stopping which had lasted in perfect condition
for forty years.
Before stopping the tooth the cavity was scraped and its opening
widened, if necessary, but no special form was given to the cavity
itself, as is done at the present day.
[Illustration: FIG. 81
Instruments for scraping the carious cavities (Fauchard).]
As at that time the state of the dental pulp was not taken into
consideration before stopping a tooth, it often occurred that the
stopping caused violent pain, which rendered its removal necessary.[451]
Fauchard says that “if the sensibility of the carious cavity be too
great, the lead ought only to be pressed in very lightly at first,
then after one or two days a little more, continuing thus until it is
properly compressed and fitted in, always provided, of course, that the
pain does not increase. The sensitive parts of the tooth become thus
more easily used to the pressure of the lead, and the pain is in this
manner avoided or moderated.”[452]
[Illustration: FIG. 82
Three instruments for plugging teeth. The two small figures represent
silver plates for straightening teeth (Fauchard).]
The author also makes the remark[453] that sometimes, in scraping a
carious cavity, “it is not possible to avoid uncovering and touching
the nerve with the instruments; one becomes aware of this by the pain
caused, and better still by a little blood issuing from the dental
vessels.” In such cases, Fauchard advises stopping of the tooth
immediately, for if it be carried out with delay, it is sure to be
followed by inflammation and great pain, rendering necessary the
removal of the lead or even the extraction of the tooth.
[Illustration: FIG. 83
A gum lancet and two elevators, the second of which is destined to act
from inside outward (Fauchard).]
Cauterization of the teeth[454] continued to be much used in Fauchard’s
time, and this is very easily explainable when one considers that there
was not then any other means of destroying the dental pulp. In making
use of the actual cautery, the immediate end in view was to cause the
cessation of obstinate toothache. “When the teeth give great pain and
no relief is to be derived from the use of other remedies, one ought
to cauterize the caries after having removed the extraneous substances
that may eventually be found in the carious cavity. After the
cauterization one scrapes the cavity and fills it up with cotton-wool
soaked in oil of cinnamon. Later on one stops the tooth.”[455]
[Illustration: FIG. 84
An extracting instrument called by Fauchard lever or tirtoire, and the
handle of a pelican without the hooks.]
The chapter in which Fauchard treats of the correction of dental
irregularities is of particular interest. In speaking of his
observations, we have already seen that in this field also he knew
how to obtain splendid and admirable results. He, nevertheless, made
use of the most simple means—the file, pressure with the fingers,
common threads or silk ones, little plates of silver or gold. At
times, for straightening teeth, he made use of the pelican and the
straight pincers, afterward tying the teeth in their normal position.
He rarely had recourse to extraction as a means of carrying out dental
corrections.[456]
[Illustration: FIG. 85
Fauchard’s simple pelican (with one changeable hook).]
[Illustration: FIG. 86
Fauchard’s double pelican.]
To steady loose teeth,[457] Fauchard, as did the ancients, made use
of gold threads. When the spaces separating a loose tooth from
the neighboring ones were too large, he introduced small pieces of
hippopotamus ivory into them of about the height of a line, and not
exceeding the tooth itself in thickness; on each side of these was a
vertical groove destined to serve as a support to the next tooth. Each
of these pieces was furnished with two holes, through which were passed
the gold threads which served to bind together the teeth and the piece
of ivory itself. This latter was fixed close down to the gum.
[Illustration: FIG. 87
Dental forceps (Fauchard).]
Fauchard occupies himself in three different chapters (X, XI, XII) at
great length with the extraction of teeth. He describes a pelican of
his own invention, and speaks of the advantages it presents over other
pelicans previously in use. Notwithstanding this, it cannot be said
that the instruments used by Fauchard for extracting teeth and roots
show a sensible improvement on those in use before his time.
[Illustration: FIG. 88
Straight forceps and crane’s bill or crow’s bill forceps (Fauchard).]
Among the most usual operations, the author enumerates transplantation
and especially replantation of the teeth.[458] Whenever, says
Fauchard, a wrong tooth is extracted by accident, it ought to be
immediately replanted, and the same ought to be done when violent pain
renders it necessary to extract a tooth that is not much decayed, as
the patient is thus relieved without losing the tooth.[459] Fauchard
adds that this operation succeeds excellently in the case of incisors
and canines, and very often, too, with small molars.
[Illustration: FIG. 89
Cutting forceps (Fauchard).]
[Illustration: FIG. 90
Cutting forceps (Fauchard).]
After having spoken of transplantation, he says:[460] “There is another
mode of replacing human or natural teeth which I have never yet
seen used except by a provincial dentist whose name I ignore.” This
special method consists in the transplantation of a tooth—it matters
little whether recently extracted or not—after having made three or
four notches in its root of about a line in depth. The author goes
on to describe all the particularities of the operation, and then
adds: “After twenty-five or thirty days one removes the thread, and
the tooth is found to be firm in the alveolus, owing to the fact that
this latter, exercising a pressure on the root on every side, becomes
perfectly moulded upon it. In this manner, the tooth will remain
mortised, and may be preserved for a considerable time.”
[Illustration: FIG. 91
Pincers used by Fauchard in the operation of tying teeth
with gold wire. The three larger figures represent
natural or artificial teeth in which holes and horizontal
grooves have been made in order to fix them with gold
threads. The two smaller represent pieces of hippopotamus
ivory with a vertical groove on each side, destined to
fill large interdental spaces and to steady loose teeth
by means of gold ligatures.]
This method, invented by an unknown provincial dentist, has been
recently applied by Znamenski, of Moscow, for the implantation of
artificial teeth made of porcelain, of caoutchouc, or gutta-percha.
One of Fauchard’s greatest merits consists in the improvements
introduced by him in dental prosthesis and in his having, besides, been
the first to treat of this most important part of dental art in a clear
and particularized manner.
The materials then most used in dental prosthesis were human teeth,
hippopotamus tusks, ivory of the best quality, and ox bone.[461]
The author minutely describes the methods to be followed to repair
dental losses in every possible case and of whatever extent.
According to the circumstances, Fauchard used, for maintaining
artificial teeth in their place, linen, silk, or gold thread, passed
through holes made in them, and tied to the natural teeth.
When a set of two, three, four, or more teeth was to be applied,
Fauchard first prepared them separately and then united them together
by means of one or two threads of gold or silver in such a manner
that the set formed at last a single piece, which was then fixed to
the natural teeth. When the piece consisted of several teeth it was
reinforced with a small plate of gold or silver fixed to its inside
by means of small tacks of the same metal riveted on one side to the
plate, on the other to the front part of each tooth.
The author remarks that a similar prosthetic piece lasted longer than
those previously described, but required proportionately much more
work and much greater expense. He adds that, by employing this plate,
one can even dispense with threading and fixing the teeth together
with gold or silver wire; but that it was then necessary to make a
horizontal groove at the back of each tooth corresponding to the width
and thickness of the plate, which could be fitted into the serial
groove and fixed to each single tooth by means of two small rivets.[462]
At other times the prosthesis was carried out in a single piece of
material (ivory, hippopotamus tusk, etc.) that was carved in such a
manner as to substitute exactly the teeth wanting, it being fixed to
the natural teeth in the usual manner.
Fauchard sometimes left the dental roots in their place (if they were
in good condition), applying upon them artificial crowns, which he
either bound to the neighboring teeth or fixed with screws to the
respective roots.
“When one wishes to apply an artificial crown to the root of a natural
tooth, one files away the part of the root that emerges above the gum,
and even more if possible. One then removes, with proper instruments,
all that is decayed in the root itself; after which one stops the root
canal with lead and fits the base of the artificial tooth to the root
in such a manner that they correspond perfectly to each other. One
drills one or two holes in the tooth through which to pass the ends of
a thread, which serves to fasten it to the natural teeth on each side
of it, as described above.
“If the root canal has been very considerably enlarged by the carious
process, so as to have rendered it necessary to stop it, the root
being, nevertheless, still quite steady, one bores a small hole in the
lead as deep and as straight as possible, without, however, penetrating
farther down than the root canal. The artificial crown is then united
to the root by a pivot in the manner I shall now describe.”[463]
The method of applying pivot teeth is described with great accuracy.
In it the author considers all the different circumstances that may
present themselves, and says, among other things, that if the root is
still sensitive to pain, one should apply the actual cautery inside
the canal, before fitting the artificial crown to the root. For fixing
the pivot inside the artificial crown (which was generally the crown
of a human tooth), Fauchard used a special cement made with gum lac,
Venetian turpentine, and powdered white coral.[464]
In the case of there not being any whole teeth to which the prosthetic
piece would be fixed, but only roots, Fauchard made two holes in it
in perfect correspondence with the canals of two roots, and fixed the
prosthetic piece to these by means of two pyramidal screws.[465]
This method suggests in a certain way the idea of bridge work.
In Chapters XVII, XVIII, XXIV, and XXV, Fauchard describes various
methods for the application of entire sets of false teeth, both upper
and lower, as well as double.
The author says that if the lower jaw is entirely toothless, a set
of teeth can be adapted thereto without the need of any special
contrivance; however, it is necessary that the prosthetic piece
should fit perfectly, so that the configuration of the maxillary arch
and the irregularities of the gum, finding themselves in complete
correspondence with the piece itself, may keep it steady in its place.
The support offered by the tongue interiorly, by the cheeks and the
under lip exteriorly, contributes to keep the artificial set steady;
one can thus masticate as easily with it as with one’s own teeth,
especially if the teeth of the upper jaw be still existing and the
individual be already sufficiently used to the wearing of it.[466]
With regard to the application of an entire set of upper teeth, one
learns from Fauchard that although some attempt had been made in this
direction before this time, the results had been very unsatisfactory.
He relates that: “In 1737 a lady of high rank, of about the age of
sixty, who had not lost any of her lower teeth, but was deprived
entirely of the upper ones, applied to M. Caperon, dentist to the King,
who was most able in his profession, in the hope that he might be able
to furnish her mouth with an upper set. But he said that, no tooth
whatever being left in existence, every possible point of attachment
was wanting, and it would therefore be as difficult to do this as it
would be to build in the air.”[467] He, however, directed the lady
to Fauchard, who asked for a few days to think the matter over, and
succeeded in devising a means of applying an upper set of teeth, which,
in fact, entirely satisfied the wishes and wants of the client. “As
this lady,” says the author, “simply wished to have the front of her
mouth decorated, and to be able to pronounce more perfectly, I gave
less extension to the set. The lady eats easily with it and could not
now do without it. For greater convenience she has two similar sets,
which she uses alternately.”[468]
[Illustration: FIG. 92
Complete dentures (Fauchard). _f. 3_ represents an enamelled denture
with artificial gums; _f. 4_ and _f. 5_, steel springs.]
[Illustration: FIG. 93
An upper denture supported by springs fixed to a gold appliance which
embraces the natural teeth of the lower jaw (Fauchard).]
The author describes with great minuteness the manner in which the
prosthetic apparatus in question was constructed and supported, and
then speaks of the successive improvements introduced by him into this
most important part of prosthetic dentistry, particularly in what
regards the springs destined for the support of the upper set of teeth.
[Illustration: FIG. 94
A spring denture for a case in which the lower front teeth still exist.
Figs. 1 to 6, various parts of the apparatus (Fauchard).]
Fauchard also relates having made an attempt to apply an upper set of
teeth without the aid of springs, which proved successful in three
cases. “One can,” says he, “adopt an entire set of teeth to the upper
jaw, of much greater simplicity than those described, and which is
maintained in its place by the sole support of the cheeks and the lower
teeth. It must be very light indeed and serves almost solely to improve
the appearance and the pronunciation; but when the individual gets used
to it, he can also masticate with it. A set of teeth of this kind ought
to adhere well to the gums and to be constructed in such a manner that
the cheeks may afford it sufficient pressure and support together with
the aid of the lower teeth; these latter sometimes bring it back into
its place, without anyone perceiving the movement except the wearer
himself. Not long since I had to renovate a set of teeth of this kind
made by me more than twenty-four years ago, and worn by the owner to
the greatest advantage. I have since made two others which have proved
most useful to the persons wearing them. It is true that there are
few mouths adapted for wearing these sets, so much so that, excepting
the three referred to, I have never made any others. To be able to
construct similar sets successfully, the dentist must be possessed of
skill and ingenuity. Apart from this, they are the most suitable for
persons who cannot spend much, as they cost less to make.”[469]
Fauchard did not merely content himself with having perfected dental
prosthesis in the manner alluded to; he also succeeded in giving a
quite natural appearance to artificial teeth. To reach this end he
placed the art of the enameller under contribution to the dental art.
Thus he had artificial pieces covered over with enamel, imparting
to them the hue that seemed to him best adapted, and also imitating
admirably the natural color of the gums, so as to render the illusion
perfect. The pieces to be enamelled were worked by special rules, which
are minutely given in Chapter XIX of the second volume of his book.
Fauchard also brought the palatine prosthesis to a high degree of
perfection. He describes five different obturators of the palate,
which of themselves alone would be sufficient to testify to the highly
inventive genius of the author, although they are defective in being
somewhat too complicated. Some of these fixtures are a combination of a
dental set and palatine obturator.
We ought now to mention, in the order of chronology, some authors of
lesser importance.
VASSE and DE DIEST wrote about the danger of fatal hemorrhage following
on dental operations.[470] They report a few cases of this kind, giving
the blame of these accidents, however, to the carelessness of the
operator.
LAVINI published in Florence, in the year 1740, a very good treatise on
dentistry (_Trattato sopra la qualità de’ denti, col modo di cavarli,
mantenerli e fortificarli_), which, however, marks no advance on the
work of Fauchard.
M. BUNON (died 1749), a French dentist, wrote four admirable works on
dentistry, which were published from 1741 to 1744. We will here briefly
allude to the most salient ideas therein contained.
This author combated strenuously some prejudices then generally
diffused; such as that of its not being advisable to extract teeth
during pregnancy, and that of the extraction of an upper canine (eye
tooth) being attended with great danger. He demonstrated the absurdity
of the latter idea by putting in evidence the anatomical fact that the
upper canines are innervated by the infra-orbital nerve, which does not
stand in any relation whatever to the organ of sight.[471]
Among the other remedies recommended by him against the disorders
and perils of first dentition, there is one most curious, not to say
ridiculous: he advises rubbing the nape of the neck, the shoulders, the
back, and the lower limbs of the child, but in doing this the friction
should proceed from above downward, in order to offer resistance to
the flow of humors toward the upper parts of the body. The utility and
efficacy of this kind of massage in favoring the process of dentition
seems, of a truth, very open to question.
Bunon speaks at length of _erosion of the teeth_, and declares himself
to be the discoverer of this disease, which destroys the enamel of the
teeth already before their eruption. The first molars, the canines, and
the incisors are much more frequently damaged and affected by it than
the other teeth. According to Bunon, it is generally due to measles,
smallpox, malignant fevers, or scurvy, when children are subject to
these maladies during dentition, and more especially during the first.
He is of the opinion that erosion not only generates caries, but may be
considered as being the origin of the greater part of dental affections.
This author distinguishes three principal kinds of dental tartar, the
black, the pale yellow, and the brownish yellow; he admits, however,
two other kinds that are less frequent, that is, the red tartar and the
green.
He relates having observed in the jaw of a child, who died at the age
of three years and a half, a splintering of the alveolar parietes in
all directions, and attributes this phenomena to disproportion between
the size of the teeth and the alveoli. On the basis of his anatomical
observations, he says that caries only appears on teeth that have
already come out of the gums, whilst erosion is produced in teeth not
yet erupted, indeed, at times, several years previous to their eruption.
We will also mention, by way of a curiosity, Bunon’s proposal to
substitute the word legs for that of dental roots.[472]
FR. A. GERAULDY, a French dentist, wrote (1737) an excellent
treatise on dental maladies and on the mode of preserving the teeth.
His book, which was also translated into German,[473] contributed
to the diffusion of knowledge relative to dental prophylaxis and
therapeutics, but apart from this brought no increment to the progress
of practical dentistry. Some of the ideas of the author, however,
merit consideration. He clearly expresses the opinion that the shedding
of the milk teeth is brought about by the pressure exercised upon them
by the germs of the permanent teeth in course of development. The loss
of the teeth in young subjects, or in those who have not yet reached
forty years of age, is explained by the author in an altogether special
manner. He relates that Louis XIV, at the age of thirty-five, had lost
all his upper teeth, and the considerations he makes on the subject
bring him to the conclusion that the precocious loss of the upper teeth
depends in many cases on a paralysis of the nervous fibers that go to
them, which paralysis is probably caused by a dissolute and intemperate
life, having as its consequence the weakening of the organism and,
above all, of the nervous system. Without doubt there is some truth in
Gerauldy’s ideas, it being well known that the falling of the teeth (as
well as of the nails and the hair) often depends on nutritive disorders
deriving from nervous disturbances. We have the clear proof of this in
certain cases of tabes dorsalis accompanied by the spontaneous falling
of the teeth and nails.
JOSEPH HURLOCK, an Englishman, published a treatise in 1742,[474] in
which he warmly recommends lancing the gums in cases of difficult
dentition; he declares this to be entirely without danger, and affirms
that it constitutes the sole means of salvation for not a few infants
who without it would die of convulsions.
MOUTON, in 1746, that is, in the same year in which the second edition
of Fauchard’s work was issued, gave to the light a monograph, the first
extant, on mechanical dentistry.[475] The methods of this author for
the most part do not differ from those of Fauchard, nevertheless one
finds several important innovations in his work. To prevent the further
deterioration of teeth already much destroyed, and to preserve them
some time longer, Mouton had recourse to the application of “calottes
d’or,” that is, gold crowns. He used this for the front teeth as well
as for the molars, but in the former case he had them enamelled to give
them the same appearance as natural teeth.
Mouton also invented a new method of applying artificial teeth. Up to
then the ordinary method had been that of fixing them to the natural
teeth by means of threads passed through holes made in the artificial
teeth expressly for that purpose. Mouton is the first to speak of
artificial teeth fixed to the natural teeth adjoining them by means of
springs or clasps.
This author relates having carried out several transplantations with
perfect success, a thing that contributed greatly to his renown not
only in France, but also in England. He distinguished himself, besides,
by the correction of dental irregularities. Lastly, it is to be
noted that this author frequently had recourse, as a remedy against
toothache, to the stretching of the dental nerve by means of moving and
partially raising the tooth (subluxation).
A. WESTPHAL. In proof of the great utility of lancing the gums in
cases of difficult dentition, A. Westphal reports a case in which the
difficult eruption of an upper canine tooth provoked considerable
inflammation and protrusion of the eye on the same side as the tooth;
these symptoms promptly disappeared, however, as soon as the gum was
lanced down to the tooth itself.[476]
J. BERTIN also declares himself in favor of this operation; he
recommends never to neglect it in cases of difficult dentition, and to
make the said incisions deep and wide enough.[477]
L. H. RUNGE, a surgeon of Bremen, published, in 1750, a monograph on
the diseases of the frontal and maxillary sinuses. He says that in
cases of inflammation of Highmore’s antrum, the pus may make its way,
corroding the bone, as far as the alveoli, or, sometimes, as far as
the orbital cavity; and, _vice versa_, alveolar suppuration can give
rise, by diffusion, to abscess of the maxillary sinus. In this latter,
tumors of various kinds may form (polypi, cysts, sarcomas, cancers,
exostosis), the existence of which is ignored at first, and only
becomes manifest tardily. Runge’s father, who was also a surgeon, had
occasion to observe, and to treat an important case of disease of the
maxillary sinus, with considerable dilatation of the same, not only
on the side of the cheek, but also on the side of the palate and of
the nasal fossæ. With a strong scalpel he perforated the outer wall of
the antrum above the molars (keeping the cheek detached) and enlarged
the aperture by making the instrument turn around on its own axis,
thus giving exit to a considerable quantity of non-purulent liquid.
Detersive and aromatic injections were used for some time. The canine
tooth, situated obliquely, having been extracted, its alveolus was
found to communicate with the antrum. From this moment, the injections
being continued, a rapid improvement was obtained and the patient was
so completely cured that no deformity of the face remained.
Runge relates a case in which, having extracted a canine tooth, he
found a cyst adhering to its root. From this he is induced to believe
that in the case related above the disorder was also to be attributed
to a large cyst having its origin in the root of the canine.
According to him, the ozena always stands in relation to a suppurative
affection of the maxillary sinus, and for its treatment one must,
therefore, have recourse to Drake’s operations.[478]
GEORG HEURMANN, a surgeon in Copenhagen, recommends making use, after
the Cowper-Drake operation, of a small cannula in order to facilitate
the exit of the pathological material contained in the sinus, and
also to render it easier to introduce into it medicated or detersive
substances.[479]
LÉCLUSE. One of the most celebrated French dentists of the eighteenth
century is Lécluse. Dental literature was enriched by him with several
works, partly written in popular style, partly addressed to dental
specialists. In 1750 he published his _Traité utile au public, où
l’on enseigne la méthode de remédier aux douleurs et aux accidents
qui précèdent et qui accompagnent la sortie des premières dents, de
procurer un arrangement aux secondes, enfin de les entretenir et de
les conserver pendant le cours de la vie_. The work seems to have been
very favorably received, as its first edition, printed in Nancy, was
followed by a second, printed in Paris, only four years later. In 1755
he published another book: _Eclaircissements essentiels pour parvenir
à préserver les dents de la carie et le conserver jusqu’à l’extrème
vieillesse_. But the most important of his works is the _Nouveaux
éléments d’odontologie_,[480] the first edition of which was published
in 1754, and followed by a second in 1782.