Chapter VI: is dedicated to the stopping of decayed teeth. The sole (1)

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!

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.

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]

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.

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]

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]

Fauchard’s simple pelican (with one changeable hook).]

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.

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.

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.

Cutting forceps (Fauchard).]

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.”

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]

Complete dentures (Fauchard). _f. 3_ represents an enamelled denture with artificial gums; _f. 4_ and _f. 5_, steel springs.]

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.

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.

We do not enter into a minute examination of these works, which, taken altogether, do not contain anything very new. We will only remark that Lécluse treated in a succinct but correct manner the anatomy of the mouth; invented some and perfected other instruments, the most important of which is the elevator that still bears his name, and finally, that he frequently performed the operation of replantation, warmly recommended by him as an excellent means of cure in certain cases of caries. The extracted tooth was stopped and afterward replanted, and, says Lécluse, became fast within eight days, proving as serviceable as a perfectly healthy tooth, and never again causing any pain.

PHILIP PFAFF, dentist to Frederick the Great, King of Prussia, was the first among the Germans who wrote a real treatise on dentistry. His book[481] contains, in 184 succinctly but well-written pages, the anatomical and physiological notions relative to the teeth, as well as all that belongs to dental pathology, therapy, and prosthesis.

Besides a few observations about supernumerary teeth, Pfaff relates several cases in which the incisors, inferior as well as superior, were renewed (twice consecutively), that is, once at the usual epoch, and the second time between the seventh and thirteenth years. He also cites from the anatomical tables of Kulmus the following epitaph in low Latin, that seems to allude to a case of third dentition:

“Decanus in Kirchberg, sine dente canus, ut anus
Interum dentescit, ter juvenescit, his requiescit.”

In cases of hemorrhage ensuing on the extraction of teeth, the best hemostatic, according to Pfaff, is essence of turpentine, a remedy which in these cases he had always found efficient. He introduced a little ball of lint bathed in this essence as deeply as possible into the alveolus, applying upon it some blotting paper reduced to pulp or some dry lint that the patient compressed tightly by closing his teeth.

Gingival abscesses as well as fistulæ of the maxillary region almost always owe their origin, says Pfaff, to decayed teeth, and can, therefore, in general, not be cured except by the extraction of these teeth.

The prosthetic methods described by this author are, for the most part, identical with those of Fauchard and the other French dentists already mentioned. As to the materials used for prosthesis at different periods, Pfaff mentions, besides ivory, bone, hippopotamus tusk, teeth of sea cow, and human teeth, also teeth made of silver, of mother of pearl, and even of copper enamelled.

The chief merit one must concede to Philip Pfaff is that of having been the first to make use of plaster models. It is, therefore, to two Germans—Pfaff and Purmann, the latter who, as we have already seen, used wax models—that one of the greatest progressive movements in dental prosthesis is indebted, that is, the method of taking casts and making models, of which method one finds no trace whatever in the authors of antiquity, and which, it would appear, was not known even to Fauchard himself. The wax casts of an entire jaw were taken by Pfaff in two pieces, one of the right half of the jaw, and the other of the left; which were then reunited, and one thus avoided spoiling the cast in removing it from the mouth.

Another great merit of Philip Pfaff is that of having first carried out the capping of an exposed dental pulp, previous to stopping a tooth.

Notwithstanding this, Pfaff is not the first who, as Geist-Jacobi is inclined to believe,[482] _had dared to apply a filling over an exposed dental pulp without first cauterizing it_. As we have already seen, Fauchard did not hesitate in the least to fill a tooth when the dental pulp had become exposed in scraping the carious cavity. But the French dentist carried out, with much delicacy, a simple filling, whilst Pfaff first capped the dental nerve.

JACOB CHRISTIAN SCHAFFER. In 1757 the evangelical pastor, J. Ch. Schaffer (we do not know if he was at the same time a dentist, or merely an amateur in odontology), wrote a little book[483] to disprove the existence of worms in decayed teeth, and to show the fallacy of believing that the supposed worms may be made to drop out by means of fumigations of henbane seeds. His book appeared, as a matter of fact, rather behind-hand, for in it Schaffer repeats in substance what Houllier had already said two centuries earlier, and after him various other authors, including Fauchard. At any rate, to coöperate in the complete destruction of error and in the diffusion of truth is always laudable. We feel, however, bound to add that in the very same year in which Schaffer’s pamphlet was published, DUFOUR, a Frenchman, described a worm that had been taken out of a decayed tooth, and called attention to the fact that it was altogether different from the “dental worms” described by Andry.[484]

BOURDET. An excellent book on dentistry[485] appeared in France in the year 1757, the work of Bourdet, a celebrated dentist and elegant writer, in whom the gifts of literary and scientific culture were coupled with a vast experience and a profound spirit of observation. His merits procured him the honor of being appointed dentist to the King.

This author condemns as harmful the use of hard substances (such as bone rings, etc.) that people are in the habit of putting into children’s hands during the period of the first dentition, in the idea that by pressing these objects between the gums, as children instinctively do, they cut their teeth more easily. As to emollients, he holds them to be completely useless, and prefers to all these remedies the use of lemon juice.

According to Bourdet, the teeth are so apt to decay, partly because of the frequent changes of temperature to which they are exposed, and partly because, differently from the bones, they are not provided with any protective organic covering.

In many cases of caries, Bourdet extracted the tooth, filled it with lead or gold leaf, and replanted it; but if, in extracting, the alveolus had been somewhat injured (a thing very likely to happen with the instruments of the period), he replanted the tooth immediately, to preserve the alveolus from the damaging action of the air, and carried out the stopping at a later time.

Even in certain cases of violent toothache not depending on caries, Bourdet luxated the tooth and replaced it in position directly. But as some dentists had accused him of having passed off as new an operation already made known by Mouton since the year 1746, Bourdet defended himself by saying that whilst Mouton only shook the tooth, raising it a little, simply to distend the nerve, he, instead, effected a complete luxation, in order altogether to interrupt the continuity of the nerve. Anyhow, this operation was not new, as it had already been recommended and practised by Peter Foreest, in the sixteenth century, and in an even more remote epoch by the Arabian surgeon Abulcasis.

Sometimes, when the permanent canine comes forth, it has not room enough, and therefore grows outward. In this case Bourdet extracts the first premolar; the canine then advances gradually of itself toward the space left by the extracted tooth, until it occupies its place exactly. He also counsels the extraction of the first premolar on the opposite side of the jaw, in order to preserve the perfect symmetry of the dental arch on both sides. When the arch formed by the jaws is too large and of an ugly appearance, Bourdet advises extracting the first upper and lower premolars, so that the maxillary arches may acquire a more regular form. In cases in which the defect of form exists only in the lower jaw, that is, in children who have protruding chins, Bourdet corrects this deformity by extracting the first lower molars shortly after their eruption, that is, toward seven years of age. In this manner, says the author, the lower jaw grows smaller and the deformity disappears. The inventor of this method, as Bourdet himself tells us, was the dentist Capuron.

Bourdet made prosthetic pieces, whose base, representing the gums and the alveoli, was made entirely of gold and covered over with flesh-colored enamel on the outside, so as to simulate the natural appearance of the gums; the teeth were adjusted into the artificial alveoli and fixed with small pins. At other times he made use of a single piece of hippopotamus tusk, in which he carved not only the base, but also the three back teeth on each side, whilst the ten front teeth were human teeth fixed to the base with rivets.

One of Bourdet’s principal merits is that of having brought artificial plates to perfection by fixing them not, as heretofore, to the opening of the palate or inside the nose, but by means of lateral clasps fitted to the teeth.

In a special pamphlet, published in 1764,[486] Bourdet treats of the diseases of Highmore’s antrum. To facilitate the exit of pathological humors from the sinus, after the Cowper operation, he introduced a small cannula, forked at one end, into the antrum and fixed the two branches of the fork to the neighboring teeth by tying.

In some diseases of the maxillary sinus (polypus, sarcoma, etc.) Bourdet recommends cauterizing.

Besides his principal work, the pamphlet on the diseases of Highmore’s antrum, and some others of less importance, Bourdet wrote an excellent book on dental hygiene,[487] which had the honor of two translations, one German, the other Italian; the latter published in Venice in 1773.

This celebrated author inveighs bitterly against charlatans and quack dentists, and throws light on all their impostures. It appears, however, that in the midst of this despicable class, so justly condemned by him, there existed a courageous though unscientific operator, to whom posterity would have attributed due honor had his name been handed down, for he was the first, in all probability, to try the implanting of teeth in artificial alveoli. This is, at least, what we deduce from a passage in one of Bourdet’s works, in which we read that a charlatan sought to impose on the public the belief that he could make a hole in the jawbone and plant therein an expressly prepared artificial tooth, which in a brief space of time would become perfectly firm and as useful as a natural one. Bourdet adds that an attentive investigation led to the recognition of the said tooth being simply that of a sheep. It would appear, therefore, that the operation had been in reality performed, it matters but little whether with the tooth of a sheep or with one of another kind.

JOURDAIN was another eminent writer on dental matters, at this period. Rather than a true surgeon-dentist like Fauchard and Bourdet, Jourdain was a general surgeon who had dedicated himself with particular predilection to the study and treatment of oral and maxillary diseases. And precisely for this reason his writings, although of great scientific importance, are far from possessing for dental art, properly so-called, the same value as the works of Fauchard, Bourdet, and other great dentists of the eighteenth century. His works, as Geist-Jacobi justly observes, give us the impression of his having been a theorist rather than a practical dentist.

In 1759 Jourdain described in the _Journal de Médecine_[488] an improved pelican and another instrument to be used for straightening teeth inclined inward. Two years later he published his treatise on the diseases of Highmore’s antrum and on fractures and caries of the maxillary bone.[489] After this, appeared his book on the formation of the teeth.[490] He therein describes with great accuracy the dental follicle from its first appearing to the moment of birth, following it throughout its evolution. This lengthy book is most interesting, for it is not a mere compilation, but gives the results of personal research and experience. But by far the most important of all the works of this author is his treatise on the diseases and surgical operations of the mouth.[491] This book went through several French editions, was translated into German in 1784, and has had, besides, two English editions in America of comparatively recent date, that is, at Baltimore in 1849, and at Philadelphia in 1851; all of which proves the great value of the work; it treats, however, much more of general surgery of the mouth and neighboring regions than of dental art properly so called. The first volume of 626 pages is almost entirely dedicated to the diseases of the maxillary sinus, which, for this author, were ever the object of favorite and particular study. He is not in favor of carrying out irrigation of the antrum through the mouth, even when an alveolar opening has resulted spontaneously through the extraction of a decayed tooth; he prefers instead, whenever this is possible, the reopening of the nasal orifice, by means of sounds and cannulæ adapted for the purpose, that is, varying in thickness and in length, and curved according to the necessities of the case. The natural opening of the antrum being reëstablished, one irrigates the cavity through it by means of a cannula to which a small syringe has been screwed. When the teeth are sound, notwithstanding the diseased condition of the antrum, Jourdain is absolutely contrary to the performing of the Cowper-Drake operation. When, on the contrary, the malady owes its origin to decayed teeth, Jourdain extracts them, but, as already said, carries out the detersive and medicated injections through the natural opening.

The author divides the collections of the maxillary sinus into purulent and lymphatic. The purulent are painful and corrode the bone, the lymphatic are not painful and do not corrode the bone, but distend and soften it, producing external tumefaction which yields to pressure, and, on this being diminished, gave out a characteristic sound. These so-called lymphatic gatherings referred to by Jourdain are none other than mucous cysts of the maxillary sinus. Also the other diseases of Highmore’s antrum (polypi, etc.) are taken by this author into attentive and minute consideration.

The second part of the work is dedicated to the other diseases of the maxillary bones (especially of the inferior one), as well as to those of the lips, cheeks, salivary ducts, gums, frenum linguæ, etc. Dental hemorrhage and difficult dentition are also spoken of in this volume.

The author relates, with regard to the latter subject, that he had observed, in corpses of infants who had succumbed to a difficult dentition, that the crowns of the erupting teeth were covered by the alveolar margins folded upon them. This, according to him, must be the reason why even lancing of the gums proves useless in some cases of difficult dentition; it is therefore necessary, whenever it is possible to recognize the existence of this state of things, to destroy the bony margins that oppose the erupting of the teeth; the author declares that he has frequently done this, with fortunate results.

In 1784 Jourdain published a treatise on artificial dentures.[492] He therein specially speaks of a complete denture with four springs, perfectly adapted to the purpose of mastication. The author attributes the merit of its invention to MASSEZ, who had imagined it toward 1772. If we may judge, however, by what Joseph Linderer says,[493] this denture appears to have been too complicated, even when compared with those described by Fauchard.

LAMORIER and RUSSEL, contemporaries of Jourdain, also studied the diseases of the maxillary sinus, and published in the _Mémoires de l’Académie de Chirurgie_, vol. iv, several important cases of polypi and other diseases of the antrum. Lamorier is not in favor of the Cowper-Drake operation. He recommends perforating the antrum immediately above the first molars, or rather between it and the malar bone. In this he seems to have been influenced by the considerations that the wall of the cavity here presents the least thickness, and that this is the most dependent part of the sinus. But he did not always deem it necessary to make a perforation here, when a fistulous opening had previously formed in some other place. His method of operating is as follows: The jaws being closed, the angle of the mouth is drawn outward and slightly upward with a curved instrument called by the author a speculum; this done, the gum is incised below the molar apophysis and the bone laid bare, and then pierced with a spear-pointed punch. The opening is afterward enlarged if found necessary.

Several contributions to the knowledge of the diseases of the maxillary sinus and their treatment were made about this time by Beaupréau, Dubertrand, Caumont, Dupont, Chastanet, Doublet, David, and especially by Thomas Bordenave, who published an important work on this subject, collecting a great number of clinical cases of great interest. Speaking of the Cowper-Drake operation, he expresses the opinion that the tooth to be extracted is not the same in all cases, for if some one of the teeth situated below the maxillary sinus should either show signs of decay or be the seat of persistent pain, the choice should fall upon that one. If, however, these teeth are all apparently sound, the one should be chosen that, under percussion, is most sensible to pain. In those cases in which the choice is altogether free, Bordenave prefers the extraction of the first large molar, for the double reason that it is generally situated in correspondence to the central part of the cavity, and that it is separated from the antrum by a very thin osseous lamina. In certain cases, the maxillary sinus is divided, by body lamellæ, into various cavities, and then, as one easily understands, it may be necessary to extract more than one tooth for the evacuation of the pathological contents. When the teeth situated below the antrum have fallen out, or have been extracted some time, and their alveoli are in consequence obliterated, it will be better to have recourse to Lamorier’s method. This method may besides be useful, according to Bordenave, either when all the teeth are sound and it would consequently be a pity to sacrifice any of them, or in special cases (such as large polypi of Highmore’s antrum, extraneous bodies, etc.) in which the Cowper-Drake operation would not afford sufficient space.

L. B. LENTIN, a German, in 1756, published a pamphlet[494] in which he recommended electricity as a means of cure for toothache. Other writers recommended the use of the magnet, which means of cure had already been advised for various affections by Patacelus. During the latter half of the seventeenth century, Talbot, J. J. Weckes, and P. Borelli related several cures of headache and toothache by the use of the magnet. In the eighteenth century F. W. Klaerich, a medical man in Göttingen, wrote that he had used the magnet advantageously in not less than 130 cases of toothache.[495] We find it recommended later by others, Brunner, and particularly J. G. Teske, who, in 1765, wrote a pamphlet entitled _New experiments for the curing of toothache by means of magnetic steel_.[496]

He considers the use of the magnet as the most efficacious of all remedies against toothache, and believes its action to be similar to that of electricity.

In the following year, however, the belief in the new means of cure was sensibly shaken by F. E. Glaubrecht, who declared that although the magnet calms or causes the cessation of the pain at first, it returns constantly and with much greater violence.[497] The curing efficacy of the magnet in cases of toothache was highly vaunted in France by Condamine.[498]

PASCH attributes the effects of the magnet to the chill produced in the parts to which it is applied; in proof of this he adduces the fact that if the magnet becomes heated by being kept some time in the hand, it loses its efficacy altogether, whilst on the other side one may obtain the very same beneficial results with a simple steel spatula, just on account of the action of the cold; finally, he adds that the chill produced by the magnet on the affected part explains very well not only the good, but also the bad effects which it produces in many cases, such as increase of the pain, inflammation, tumefaction, and even at times spasmodic contractions.[499] Thenceforth the enthusiasm for the magnetic cure diminished gradually, all the more so inasmuch as that shortly after the celebrated English dentist Thomas Berdmore ridiculed it by placing it in the same class as charms, exorcisms, and other foolish and superstitious means of cure.[500]

ADAM ANTON BRUNNER. One of the most distinguished German dentists in the second half of the eighteenth century was Adam Anton Brunner. His two principal works are the _Introduction to the science necessary for a dentist_,[501] and the _Treatise on the eruption of the milk teeth_.[502]

This author falls into various errors with regard to deciduous teeth. According to him they are twenty-four in number, and without roots; but these may develop in those milk teeth which in exceptional cases remain in their places after the period in which they generally are shed.

A milk tooth, says Brunner, ought never to be extracted unless there be manifest signs of the presence of the corresponding permanent tooth, or when it is painful and decayed. Badly grown teeth can often be put in order solely by the pressure of the fingers frequently repeated, but when this is not sufficient, one must have recourse to waxed threads or to special contrivances.

In applying a pivot tooth, he screws the pivot to the artificial crown and perforates the root canal only just sufficiently to admit the other extremity, which he drives in by little strokes of a hammer upon the crown, without its being necessary to use cement. We learn from this author that in his time there were turners and other craftsmen who occupied themselves with dental prosthesis.[503]

Brunner prefers gold for fillings to any other substance whatever.

J. G. PASCH, whose name we have already mentioned, relates the case of a young maidservant becoming suddenly affected with deafness, and who recovered her hearing completely on the eruption of one of her wisdom teeth. From a passage of this author’s we learn that at that time many had recourse to the crushing of the infra-orbital nerve as a cure for certain cases of toothache. He, however, decidedly rejects such a remedy, as it proves for the most part ineffectual and may, besides, produce very serious consequences. This author carried out many experiments as to the effects of acids on the teeth.[504]

C. A. GRÄBNER[505] recommends not deceiving children by extracting their teeth unexpectedly, but rather to persuade them of the necessity of the operation; for by deceiving them one loses their confidence, and in many cases inspires them with an invincible aversion to the dentist.

This author invented a so-called “calendar of dentition,” for the purpose of showing at a glance the period of eruption of each of the deciduous and permanent teeth, and as well for noting down the time at which the various teeth are changed, so as to avoid every possible error in this respect. This calendar consists of a figure or diagram representing the two dental arches, with transversal lines that separate the different teeth one from the other, the relative indications being also given.

The observations of this most sensible and conscientious dentist with regard to the extraction of teeth are worthy of note: “The haphazard pulling out of a tooth is an easy enough thing; the only requisites for doing this are impudence and the audacity natural to the half-starved charlatan. But to carry out the extraction of a tooth in such a manner that, whatever be the circumstances of the case, no disgrace may accrue to the operator or damage to the patient, requires serious knowledge, ability, and prudence.”

RUEFF relates the case of a man, aged forty years, who, having made use of fumigations of henbane seeds to relieve himself of violent toothache, obtained the desired end, but at the same time lost his virile power. He, however, reacquired his force by the care of the author.[506]

THOMAS BERDMORE was the dentist of George III of England, and one of the first and most eminent representatives of the dental art in that country. Before him, no one had had the appointment of dentist to the royal family. In the year 1768 he published an excellent work on dentistry,[507] that was translated into various languages and went through many editions; the last of these appeared in Baltimore in the year 1844, that is, seventy-six years after the first English edition—a splendid proof of the worth and fame of this work.

Berdmore contributed to the progress of dentistry in England not only by his writings, but also by imparting theoretical and practical instruction to many medical students desirous of practising dental art as a specialty.[508] One of these was ROBERT WOOFFENDALE, who went to America in the year 1766, and was the first dentist whose name is there recorded.