TEETH, DISEASES OF THE. 



TEETH, DISEASES OF THE. 



children, and which is called ancrum arts. It is in fact an ulceration 

 attended with a death of parts similar to what is called phagsedena in 

 other organs of the body. The ulceration commences in this case at 

 the free edge of the guma and extends to the alveoli and other parts of 

 the mouth. The surface of the cheek lying in contact with the 

 ulcerated gums becomes involved in the same disease, so that the 

 surfaces of the two ulcers are in contact. The teeth loosen and in 

 some cases become black from necrosis. The surface of the ulcer 

 is of a pale yellow or straw colour, with here and there a red point 

 raised above the surface, aucl which bleeds on being touched. This 

 disease spreads in some cases till the cheek is perforated, but it more 

 frequently happens before this takes place that the patient either 

 ginks from exhaustion or hcemorrhage from the ulceration of some 

 large vessel. 



The treatment in these cases must be both constitutional and local. 

 The bowels should be kept open, and tonic medicines (iron and quinine), 

 with a liberal diet, must be given. Locally, the nitrate of silver should 

 be applied, and the mouth should be washed out with a lotion con- 

 taining chlorate of potash. This latter salt has also been strongly 

 recommended as an internal remedy. 



The milk-teeth disappeiir as they came, at various ages. They are 

 succeeded by what are called the permanent teeth. The number of 

 these is thirty-two. Twelve of them, however, belong to the first 

 set, as they are never superseded. So that the true view of the case 

 appears to be, that the first set of teeth consists of thirty-two, of 

 which twenty disappear under the name of milk-teeth, and are 

 followed by tweuty others, which are called, with the other twelve, 

 permanent teeth. 



Dieuei of tlie Permanent Teeth. The diseases to which the per- 

 manent teeth are subject have been arranged as follows by Mr. 

 Tomes : 



Irregularity in the time of the eruption of 



the permanent teeth. 

 Irregularity in the poeition of the permanent 



teeth. 



Mechanical injuries of the teeth . 



Mechanical injuries of the alveoli . . . 



Diseases of the dental tissues 



DiMue* of the pulp 



Diseases of the alveolar periosteum . . 

 Diseases of the alveoli . . . . 



Disease* of the 



Tartar. 



Fracture. 



Dilaceration. 



Dislocation. 



Fracture. 



Caries. 



Necrosis. 



Exostosia. 



.Vi>-ci -~. 



Loss from the surface. 



Absorption. 



Pain. 



Irritation. 



Inflammation. 



Ulceration. 



Granulation. 



Inflammation. 



Hemorrhage. 



Inflammation. 



Necrosis. 



Exostotis. 



Absorption. 



Inflammation. 



Ulceration. 



Recedcncc. 



Tumours. 



Epulis. 



Polypus. 



Vascular tumours. 



Blue gum. 



It will be unnecessary here to refer in detail to these disorders of the 

 teeth and gums, as many of them are common to these tissues with 

 other parts of the body, and require the same general treatment. We 

 shall therefore refer more particularly to those disordered conditions 

 of the teeth and gums whkh produce the complaints known under 

 the name of toothache and faceache, and the other more frequent 

 disorders of these organs. 



Dtnlal Ca.riet. One of the most frequent causes of pain in the 

 teeth is that destructive process known by the name of caries Various 

 views have been taken of the nature of thia process ; but Mr. Tomes 

 defines it as " the death and subsequent progressive decomposition of a 

 part or the whole of a tooth." The changes which indicate the occur- 

 rence of this condition are, first, a discoloration of the dental tissue, 

 which is succeeded by softening and disintegration. The enamel first 

 Buffers, and then the dentine. The disease spreads in the direction of 

 the ilcntinal tubes down to the pulp, forming a conical cavity with ;m 

 oblique direction. It is not, however, infrequent to find the hole in 

 the enamel leas than that in the dentine, as the process of decay goes 

 on much more rapidly in the latter than in the former. 



This process of decay may or may not be attended with paiii from 

 the time of its first setting in. Eventually, however, the caries extends 

 to the pulp cavity where the nerves are situated, and pain is the result. 

 Even this is sometimes prevented by a kind of reparative process going 

 on in the dentine, which forms the walls of the cavity, and which 

 prevents the nerves from being affected. 



If the caries extends, the pulp may become inflamed, aud also the 

 dental periosteum, which may be followed by alveolar abscess. Before 

 inflammation of the pulp is established, the pain from the tooth 

 becomes intolerable by irritation in the pulp. This state comes on 

 gradually : first a little pain is felt when hot or cold or sweet or acid 

 things are put into the mouth. This goes on increasing till inflamma- 

 tion is established in the pulp of the diseased tooth. This frequently 

 leads to irritation in the pulp of the sound teeth, so that pain may be 

 felt in several teeth by the unsoundness of one. 



It is when the pulp becomes inflamed that the violent throbbing 

 pain known as toothache comes on. In this state a destruction of the 

 pulp may take place and the pain cease, and the tooth retaining its 

 vitality from its external periosteum alone may still be useful. This is, 

 however, a very rare occurrence. 



In the treatment of caries of the tooth, and its attendant irritation 

 and inflammation of the pulp, it should be recollected that all external 

 remedies are palliatives. A natural cure, which is very unlikely, may 

 go on whilst a little relief is obtained by such applications as opium, 

 ether, creasote, alum, chloroform, tannic acid, nitrate of silver. The 

 multitude of remedies for toothache show how utterly intractable a 

 disease it is, and how little amenable to anything like external treat- 

 ment. Nor will internal remedies affect the tooth, or in any manner 

 arrest the caries which produces the pain. 



If caries is observed in the early stages, before the pulp cavity is 

 affected, then the diseased part may be scooped out, and the cavity 

 plugged up in various ways. This, however, must be done early, in 

 order to ensure success. It not unfrequently happens that where 

 irritation of the pulp cavity has been set up plugging will relieve. 

 Where irritation is set up in neighbouring teeth from inflamed pulp, 

 then the removal of the offending tooth is immediately attended with 

 relief to the others. 



In the case of inflammation of the pulp, where the pain is severe, 

 the tooth should be removed. The hazard of ulterior consequences 

 to the alveolar process and the jaw should always prompt to the 

 removal of the inflamed tooth. 



The consequences of decay of the teeth are not at all confined to the 

 simple pain called toothache. The inflammation may extend from the 

 tooth to the gums, and from the gums to the surrounding structures, 

 so that inflammation of the submaxillary glands takes place, and a 

 swelling of the whole face occurs. Such inflammation may be acute 

 or chronic. When it is acute it may subside in a few days after the 

 application of the ordinary remedies for an acute inflammatory con- 

 dition of the soft tissues. It may, however, be chronic, and attended 

 with ulceration of the mucous membrane, which may extend to the 

 throat. In these cases local remedies may relieve. The application of 

 tannic acid, alum, or chlorate of potash will be of service, but the 

 great remedy of all is the removal of the cause the extraction of the 

 decayed tooth or teeth. 



Again, the nervous system may be the seat of the engendered 

 disease. The whole of the nerves of the face singly or together may 

 be the seat of reflected pain from the inflamed pulp of a single tooth. 

 These pains, often taken for idiopathic neuralgia, canuot be effectually 

 relieved till the cause of their excitement is removed. The reflected 

 irritation of the nerves may not only affect nerves, but even the brain 

 itself and the organs of the senses. All obscure pains of the head and 

 affections of the senses should be examined in relation to the condition 

 of the teeth, as a source of irritation not indicated necessarily by pain 

 in the tooth may be frequently found in its disorganised and decayed 

 condition. 



The other forms of disease of the teeth are less common aud special 

 than those we have spoken of above. Sometimes excessive pain its 

 suffered from injun-matton of the dental periosteum. When there is 

 no decay of the tooth, and the pain is clearly referable to this cause, 

 much good may be done by the application of one or two leeches to 

 the gum opposite the end of the root of the affected tooth. Antiphlo- 

 gistic remedies should also be generally applied. Where morbid 

 growths are the result of such inflammation, the extraction of the 

 tooth will be of service ; but even then the inflammation may continue 

 in the socket. Sometimes the inflammation is of a rheumatic charac- 

 ter, and demands a treatment adapted to this state of the system. 



Dieatei of the A Iveoli and (?<. From the periosteum we pass on 

 to the alveoli and gums. The diseases of the alveoli which are most 

 frequent are absorption and haemorrhage. 



Absorption of the alveoli frequently takes place as the result of con- 

 stitutional tendency, and * disposition to this malady is handed down 

 from father to son. Under these circumstances it is not an unusual 

 thing to observe a man under fifty with scarcely any teeth in his head. 

 This process takes place slowly, and almost imperceptibly, till the teeth 

 drop out one after another. Absorption of the alveoli may also be 

 induced by inflammation of the gumK, which may be kept up by 

 decayed teeth. The salivation attendant upon the administration of 

 mercury is also accompanied with an absorption of the alveolar pro- 

 cesses ;md a falling out of the teeth. 



In the treatment of these cases the great thing is to remove the 

 cause. Where decayed teeth, inflammation of the gums from tartar, 

 or irregular teeth, ore present, these must be removed. Nothing seems 

 to arrest the hereditary absorption of the alveoli. It ia^ike the loss of 

 hair, or other defect, an accompaniment of old age, and in certain casex 



