Dental caries

“ Wild animals are not subject to caries or dental decay, as are man and domesticated animals.
Mouth-dangers
There are two forms of mouth-danger that should be clearly differentiated. Dental caries, or decay, is at first largely a chemical process and affects the tooth proper. Pyorrhea, or Riggs’s disease, affects the tissues surrounding the root of the tooth, and is accompanied with infection by pus bacteria, and possibly also by animal parasites, termed endameba. Scrupulous cleanliness of the mouth largely prevents both of these maladies. ”

“ In the normal mouth from eight to twenty years of age the teeth present from twenty to thirty square inches of dentate surface, constantly exposed to ever-changing, often inimical, conditions. This bacterially infected surface makes a fairly large garden plot. Every cavity adds to the germ-nourishing soil. Dental caries—tooth decay—is a disease hitherto almost universal from birth to death. Thus the air taken in through the mouth becomes a purveyor of its poisonous emanations and affects the lung tissues and the blood. Food and water carry hostile germs down into the stomach. ”

“ If there is any reason to suspect adenoids, parents should take their children to a competent physician without delay.
Further, and on general principles, they should have their children's teeth thoroughly examined by a good dentist. A child whose teeth are decayed is a [72] child suffering both from nerve irritation and from some degree of poisoning, due to his swallowing food that has become infected by its contact with the germs of dental caries. Such a child has abundant reason to feel uncomfortable, pessimistic, and sullen. So has a child whose teeth, if not decayed, are crowded together. ”

“ 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. ”

“ Caries of the teeth has been shown to bear highly important relation to more remote or systemic diseases. Exposure and death of the dental pulp furnishes an avenue of entrance for disease-producing bacteria, by which invasion of the deeper tissues may readily take place, causing necrosis, tuberculosis, actinomycosis, phlegmon and other destructive inflammations, certain of which, affecting the various sinuses of the head, have been found to cause meningitis, chronic empyema, metastatic abscesses in remote parts of the body, paralysis, epilepsy and insanity. ”

“ Gout, lithaemia, scurvy, rickets, lead and mercurial poisoning, and certain forms of chronic nephritis, produce dental and oral lesions which are either pathognomonic or strongly indicative of their several constitutional causes, and are thus of great importance in diagnosis. The most important dental research of modern times is that which was carried out by Professor W. D. Miller of Berlin (1884) upon the cause of caries of the teeth, a disease said to affect the human race more extensively than any other. ”

“ The skulls in every case, when sufficiently perfect for their form to be made out, have been of the long or dolichocephalic shape; and all the shin bones that have come under the writer’s notice have exhibited the peculiar flattening known as platycnemism. These Neolithic people had a remarkable immunity from dental caries, although the teeth are frequently so worn down by mastication that they must have been almost level with the gums in life. ”

“ Put a mat of tin at the cervical wall of proximate cavities in molars and bicuspids, and it makes a good filling which has a therapeutic effect on tooth-structure that prevents the recurrence of caries, probably because the infiltration of tin oxid into the tubuli is destructive to animal life. Where the filling is not exposed to mechanical force, there is no material under heavens which will preserve the teeth better." (Dr. Beach, Dental Cosmos, 1889.)
"I extracted a tooth in which I found a cavity of decay which had extended toward a tin filling, but stopped before reaching it ”

“ Cauterization of the teeth454 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 that290 may eventually be found in the carious cavity. ”

“ Although the dentine is not as unchangeable as enamel, but manifests, by becoming firmer or softer, that it is not quite uninfluenced by tissue-changes, yet its caries is not an irritative process that the dentine takes an active part in, but a passive process, and consequently the removal of all diseased portions and the protection of the non-carious part of the tooth suffices to stay the morbid process completely. ”

“ As the products of inflammation can not escape, they collect and work their way downward, where they produce the most painful inflammation of the roots and the periosteum. The chief object of the rational treatment of caries of the teeth consists in the removal of every particle of carious substance out of the diseased tooth and the protection of the sound dentine that has been exposed against external injurious influences by covering it with a fine substance which is not attacked by acids—gutta-percha, cement, or gold. ”

“ Although the teeth of some individuals possess but little durability, and, when caries attacks them, go on rapidly to decay, in spite of all the aid which science and skill can afford, yet, there are comparatively but few instances in which seasonable and judicious treatment will not arrest the progress of the disease. ”

“ Only in very rare cases does it attack the roots of the teeth. It rarely appears after fifty years of age. Hunter does not admit that this disease may be communicated by one tooth to another. As to its treatment, the caries, if superficial, may be completely removed by filing the decayed part of the tooth before the disease penetrates to the cavity, and its spreading will thus be arrested for a time at least. ”

“ Disposition to caries shows itself even in the developing tooth in the composition of its enamel, which is undulating, whereas teeth with quite smooth enamel have much greater power of resistance. The enamel appears to be the only tissue in the body which is subject to no metabolism, and which remains quite unchanged. Every alteration in it which is caused by external influences, and every defect of the enamel, remains during the whole of life, and can never be repaired. Dentine also shows differences in structure as regards its disposition to caries. ”

“ So able a writer as Wm. Henry Potter (of Harvard) says: “In the first place, it may be said that caries of the teeth does not resemble caries of the bone. The term caries, as applied to the teeth, is a misnomer, given at a time when the true nature of the process was not understood.... The pathological change which occurs in caries is a decalcification and disintegration of the several tissues of the teeth.”
I confess that strikes me as a very excellent description of what surgeons usually term caries, namely, a molecular death of bone tissue. ”

“ Giulio Cesare Aranzio (1530 to 1589) , a celebrated surgeon and anatomist of Bologna, in which city he taught from the age of twenty-six years until his death, is of the opinion that parulides—that is to say, inflammations or abscesses of the gums—and epulides—that is fleshy excrescences of the same—are usually caused by caries or putrescence of the teeth; but that in certain individuals, from a peculiar weakness of the gums, these are easily attacked by inflammation when the wind is in the south. ”

“ A caries36 of the bone is at all times a disease which is difficult to manage, both on account of the mechanical obstacles which we have to overcome, and the slowness with which the affected parts perform their actions either of disease or recovery. The divisions of this disease have generally been taken from the appearance of the caries, and its extent. We have the dry caries, the worm-eaten caries, the spongy, or carnous caries, &c. and we have the deep and superficial. ”

“ When we reflect on the mode of nutrition of the tooth, it seems almost self-evident that any depressing agency which could lead to disease of the pulp must, by an augmented action, cause greater disease in the structures which depend on the pulp for their nutrition to start with. At most, disease and pain in the pulp alone must be nothing less than a pathological curiosity. Such, however, is not the case in the vast multitude of cases dependent on caries, in which the pulp has lost in part or in whole its protection from external morbid influences. ”

“ If a child be brought up on the lines indicated and under healthy conditions generally, it is tolerably certain that the maxillary apparatus will develop normally, that the teeth will be strong and well opposed, and show little tendency to disease; but, inasmuch as the methods advocated are but seldom put into practice, disorders of the teeth, more especially caries and irregularities, are common, and hence with a [Pg 175] view to promote more efficient mastication it is always advisable to examine our patient’s teeth. ”

“ Decayed teeth may be filled, according to Valescus, to satisfy four different indications: To calm or prevent pain, to prevent any further spreading of the caries, to kill the worms, and to sweeten the breath. He advises that the carious cavities should be filled up with powdered nigella, pepper, myrrh, salt, and theriac; or else with pyrethrum, gum ammoniac, and opium; or else with celery seeds pulverized, opium, and hyoscyamus; or with the cast-off skin of serpents boiled in vinegar; or with gallia and cyperus. ”

“ This was so much of a success that I threw aside chloroform and ether in removing the living nerve of a tooth with instruments instead of using arsenic; and for excavating sensitive caries in teeth, preparatory to filling, as well as many teeth extracted by it. But this was short-lived, for it led to another step. Sometimes I would inflict severe pain in cases of congested pulps or from its hasty application, or pushing it to do too much, when my patient invariably would draw or inhale the breath very forcibly and rapidly. ”

“ The teeth are composed of very hard bone and enamel. The latter is a substance exceeding in density any other in the body. It covers the crown of the teeth, and is thickest in those parts which are most exposed to forcible contact in mastication; but, in no place, is it more than the twelfth of an inch in thickness.
10. The most common disease of the teeth is caries, or decay, and almost every part of them is liable to be affected by it, but especially the sides of those in front, and the crowns of those on other parts of the jaws. ”

“ If dentine has been decalcified at any place by the action of acids, it undergoes putrefaction under the influence of bacteria which do not seem to belong to any particular species. Dentine is sensitive, though nerve-filaments have not as yet been traced into it. Actual toothache does not occur in the course of caries until it has reached the pulp. The inflammation of the pulp is particularly violent and painful, because the tissue is so richly provided with blood-vessels and nerve-filaments. ”

“ I. All men's teeth are naturally in a state of total decay or caries, and, therefore, no man can bite until every one of them is extracted and a new set is inserted according to the principles of dentistry adopted by this Society.
I, for one, should want to discuss that before signing my name to it, and I should say this:—Why, no, that isn't true. There are a good many bad teeth, we all know, but a great many more good ones. You mustn't trust the dentists; they are all the time looking at the people who have bad teeth, and such as are suffering from toothache. ”

“ 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. ”

“ Feels himself gaining strength daily; can walk without pain; wound is contracting and hard; granulations seem to lessen the depth of the opening in the bone; there appears to be no sequestrum.”
When caries is fairly established, and the integuments have given way, the best and most successful proceeding is that pointed out by nature—destruction of the diseased portion; and the means must vary according to the particular circumstances. In many cases, nature seems to wait but for the separation of the sickly parts, either by accident, or by the interference of art. ”

“ The close packing of the lower incisors may assist by preventing the retention of decaying fragments of food. Sexual selection may promote caries by favouring white teeth, which are more prone to decay than yellow ones. ”

“ Numerous remedies exist for cleaning the teeth, but according to Rivière the best way of cleaning them consists in rubbing them with a small stick immersed in sulphuric acid (spiritus sulphuris aut vitrioli) and afterward drying them with a piece of linen. This remedy not only cleans and renders the teeth white, but it preserves them also from caries! If the teeth are very dirty, the spirit of vitriol may be used pure ”