Chapter Xxix, Relating to Dental Anomalies, Is One of the Most

interesting. We here quote the greater part of it.

“Some historians relate that Pyrrhus, King of Epirus, Eurifeus, of Greece, and many others, had, instead of teeth, a continuous bone, furrowed by somewhat deep vertical lines, in no way different from what one sees in the multiple molars of the goat. It has never happened to me, says Eustachius, to witness a similar union of all the teeth; I have, however, sometimes observed continuity between three or four molars, precisely in the same manner as in sheep. It also once happened to me to observe in the case of an old man, a fellow citizen of mine, that the teeth were covered up on every side by a hard and almost stony substance, and no longer exhibited any trace of separation, offering instead the appearance of a single bone.”

“One reads that Timarchus, of Cyprus, had two rows or series of teeth and Hercules three.”

The author never had any opportunity of observing any such anomalies; notwithstanding, he refers to cases of the kind observed by other anatomists of his time, and, in a particular manner, to the case of a triple dental series in a youth who died at the age of eighteen. As the truth of the fact was testified to by highly respectable medical men, Eustachius lends faith thereto. “Neither can it be said”—he adds—“that in the case we are speaking of the new teeth erupted from other sockets before the temporary ones were shed, for there would then have been only a double and not a triple series; indeed, the series would not even have been double along all the line, but only along the line of the temporary teeth; and besides this, the double series would not have been maintained up to eighteen years of age—the time of the death of the subject—but only until the shedding of the deciduous teeth.”

“That teeth are sometimes cut in the palate is a fact attested to by Alessandro de Benedetti and others. It has also occurred, within my own experience, to observe this in the person of a Roman woman, who had a tooth in the roof of the mouth, near the opening which is in proximity to the incisors, and at Gubbio there is, in the monastery of the Trinità, a nephew of the distinguished jurisconsult Girolamo Gabrielli, who at the age of eighteen cut a tooth in the middle of the palate.”

“Pliny and Solinus tell of individuals born with all their teeth. Other authors, that Pheretes was without teeth all his life.”

“I hold it to be a fable that some women lose a tooth for each child they bear.”

“In some cases it has happened that the falling out and renewal of the teeth has not taken place before the age of thirteen or fourteen. In other cases, the same teeth were shed and renewed twice, that is, once after the seventh year, and again after the fourteenth year. It ought also to be mentioned that in some young persons of twenty, the last molar, or wisdom tooth, having been drawn, it was renewed during the same year. Lastly, it is also to be noted that in strong and healthy young persons, one of the other molars being extracted, it is sometimes renewed.”

In the last chapter the author alludes to some dental affections. In referring to the fluxions to which teeth are subject, he says he has observed more than one case in which such a quantity of matter resembling chalk was collected in the alveoli, that these gradually being filled thereby, all the teeth became loosened and dropped out little by little.

Speaking of dental diseases requiring surgical intervention, the author remarks that dental surgery was, in his days, a most abject calling, notwithstanding its having had, according to Cicero, a very high initiator—Æsculapius, the god of medicine.

AMBROISE PARÉ. Whilst the anatomy of the dental system was illustrated by the researches of Fallopius and Eustachius, the celebrated French surgeon Ambroise Paré was contributing in the highest degree to the progress of practical dentistry.

Ambroise Paré (Latinized Paræus) was born at Bourg-Hersent in the year 1517. His father and one of his brothers were box-makers; another brother was a barber. We have no very precise information about the early years of his life; so much is certain, however, that Ambroise Paré did not enjoy any of those advantages deriving from a good literary education, and after having received some instruction from a chaplain, whose disciple and servant he was at one and the same time, he was bound over as apprentice to a barber, who also taught him the art of bleeding. Toward the age of sixteen we find him in Paris in the employ of a chirurgien-barbier. After this he practised minor surgery for some years in the Hôtel-Dieu. But having undertaken the study of surgery without literary preparation and without any knowledge of Latin, he was obliged, especially for the latter reason, to contend with great difficulties, so that, although he had acquired in a few years sufficient practice in surgery to enable him to pass from the Hôtel-Dieu to the sanitary service of the French army, it was only in 1554, that is, at thirty-seven years of age, that he was permitted to take the examination required for becoming a member of the College of Surgeons of Paris. Within the short space of five months he was successively named Bachelor, Licentiate, and Doctor in Surgery. His reputation, which had already become extraordinary even before he had any academic degree, procured him introduction to the Court of France as surgeon in ordinary. In 1562 he became chief surgeon to the Court and occupied this post under the reigns of Charles IX and Henri III. Ambroise Paré was a Protestant, and it is said that in the massacre of St. Bartholomew’s night, he owed his escape to the king, Charles IX, who, to save his life, hid him in his wardrobe. He died full of honors, in the year 1592.

In his works this great surgeon treats the subject of dental maladies and their cure very thoroughly; this may be in part attributed to the circumstance of his having first been simply a barber (and, therefore, also a tooth-puller) and afterward a surgeon-barber, which placed him in very favorable conditions for acquiring vast experience in the practice of dentistry.

In Chapter II, Book IV, of his works, Ambroise Paré speaks of the anatomy and physiology of the teeth. It must, however, be confessed that Vesalius and, still more so, Eustachius treat of dental anatomy with much more exactness than he does.

After having spoken of the incisors and the canines, he says that the ten upper molars generally have three roots, and very often four, whilst the ten lower ones have only three; this is because the lower jaw is harder than the upper, and also because the lower molars, estant assises sur la racine, et non suspendues, comme celles de la mandibule d’en haut, n’avoient besoin de tant de racines pour leur stabilité asseurance.

Ambroise Paré, too, admits that the teeth grow throughout the whole lifetime, and that the wearing away consequent on reciprocal friction and mastication is compensated in this way.

Galen had already affirmed, and Ambroise Paré also held erroneously, that the exquisite sensibility of the teeth aids the sense of taste.

In speaking of the development of the teeth, Ambroise Paré says only that they are already solid and osseous before birth, he himself having observed this in dissecting the jaws of a child who had died immediately after birth.

In Chapter VII, Book XIII, Paré treats of fracture of the lower jaw. The method of cure he proposes is altogether identical with that of Celsus. With regard to the teeth, he says that “si elles sont divisées, ebranlées, ou separées hors de leurs alvéoles ou petites cavités, elles doivent estre reduites en leurs places et seront liées et attachées contre celles qui sont fermes, avecques un fil d’or ou d’argent, ou de lin. Et les y faut tenir jusques à ce qu’elles soient bien affermies, et le callus soient refait et rendu solide.”

Toothache, says Paré, is, of all others, the most atrocious pain that can torment a man without being followed by death. It depends, in many cases, on a humorous fluxion of a hot or cold nature which flows into the alveolus, forcing the tooth outward, loosening it, and causing the patient so much pain on the slightest pressure being exercised on it, that he cannot dare to bite with it in the least. If, however, the tooth is corroded, hollowed out, or pierced to the root, the pain is so strong, when the patient drinks—particularly if the liquid is cold—that he seems to have had a stab with a stiletto inside the tooth.

If the pain is acute and pungent, like that produced by needles being thrust into the diseased tooth; if the patient complains of a strong pulsation at the root of the tooth, and in the temples; if the application of cold remedies calms the pain, all these signs indicate that the cause of the evil is heat. Instead, the cause of the pain may be held to be cold when the patient complains of a great heaviness in the head, emits a quantity of saliva, and finds relief in the application of hot remedies. In the treatment of toothache one must fulfil the following three indications:

1. Regulate fittingly the mode of living.

2. Evacuate or dissipate the morbid humors; this may be effected by various means, namely, by purgatives, by bleeding, by gingival scarification, by the application of leeches on the site of the pain, by cupping on the back of the neck, or on the shoulders.

3. Applying in each single case the medicaments best adapted for calming the pain.

The author here goes through a long enumeration of anti-odontalgic remedies that offer no particular interest, as they are not at all new.

When a decayed tooth becomes the seat of excessive pain, and this does not yield to any remedy, one must either have recourse to extraction or cauterize it; this can be done either with potential caustics—such as oil of vitriol, aqua fortis—or with the actual cautery. By cauterizing, Paré adds, one burns the nerve, thus rendering it incapable of again feeling or causing pain.

Erosion or caries is the effect of an acute and acrid humor, that corrodes and perforates the teeth, often to their very roots. To combat this morbid condition, even when it is not accompanied by pain, one must also have recourse (besides general treatment) to cauterization either with oil of vitriol, with aqua fortis, or with a small actual cautery.

If, as often happens, that the seat of the erosion lies in such a manner between two teeth as to make it impossible to apply caustics or other medicaments, one must file just sufficiently between the healthy and the corroded tooth to render the part accessible, taking care, however, to file more on the side of the affected tooth than on that of the healthy one.

The file may be used, besides, to plane down a tooth that stands out above the level of the others, and for similar purposes.

If one or more teeth have been shaken by a blow or a fall, or have come out of their alveoli altogether, the surgeon should not remove them, but rather reduce them and bind to the neighboring teeth, that they may entirely reacquire their original firmness.

In allusion to this subject, Ambroise Paré refers to the case of a friend of his, who having sustained, through a blow from the hilt of a dagger, a fracture of the lower jaw with almost complete expulsion of three teeth from their alveoli, had the fracture reduced by him; after replacing the teeth and binding them to the neighboring ones, he prescribed astringent mouth washes and liquid or semiliquid nourishment, such as meat juice, panada, barley soup, jelly, and such like. The patient was completely cured and able to masticate with the three teeth as well as before.

Also in the case of extraction of a healthy instead of a diseased tooth, Paré recommends replacing it immediately and binding it to the neighboring ones, for, he says, by this means the tooth can take root again.

As we have seen, the first author who speaks of replantation is Abulcasis, but to Ambroise Paré belongs the merit of having treated the subject much more explicitly, and of having insisted on the utility of this operation, indeed, on the duty of carrying it out whenever it seems indicated.

Dental files (Ambroise Paré).]

Further, he is the first to mention another very important operation, namely, transplantation, albeit he himself had never performed it. The case he refers to has become a generally known anecdote. We give it in his own words: “Un homme digne d’estre creu m’a affirmé qu’une princesse ayant fait arracher une dent, s’en fit remettre subit une autre d’une sienne demoiselle, laquelle se reprint, et quelque temps après maschoit dessus comme sus celle qu’elle avoit fait arracher auparavant.”

One of the pelicans used by Ambroise Paré.]

Two other pelicans and a pair of curved pincers (Ambroise Paré).]

Ambroise Paré has recourse to extraction when a tooth is the cause of very violent pain, or when the existence of a carious cavity and concomitant putrefying processes render the breath fetid, and endanger the healthy teeth in its vicinity. If the persistence of a deciduous tooth should cause the cutting of the corresponding permanent tooth outside the line of the dental arch, thus giving rise to deformity, Paré advises laying bare and then extracting the deciduous tooth; for after this the new tooth may be pressed toward the point before occupied by the other, until it assumes its natural position.

Sometimes, when a tooth is too firmly planted, one prefers, says Paré, instead of extracting it, to break off the crown for the purpose of being able to act directly on the dental nerve with appropriate remedies, or to destroy the sensibility of the nerve entirely, by cauterization. This unreasonable and reprehensible method of cure is also quoted, under the denomination of deschapellement, by another French author, a contemporary of Paré—Urbain Hemard—who observes, however, that one rarely had recourse to it; for the pain and shock which are caused by this operation are not less than those caused by extraction.

It very often happens that the patient cannot indicate exactly which tooth it is that gives him pain, his sufferings being so acute as to appear spread over a great part of the jaw. One cannot, therefore, trust too much to the indications given by the patient as to the point of departure of the pain, and must take care not to extract a healthy instead of a diseased tooth.

The extraction of a tooth should not be carried out with too much violence, as one risks producing luxation of the jaw or concussion of the brain and the eyes, or even bringing away a portion of the jaw together with the tooth (the author himself has observed this in several cases), not to speak of other serious accidents which may supervene, as, for example, fever, apostema, abundant hemorrhage, and even death.

In extracting a tooth it is necessary to place the patient on a very low seat, or even on the ground, with his head between the legs of the operator. After having laid the tooth bare sufficiently, if one sees that it is very loose, one may push it out of its socket with a poussoir, that is, with a trifid lever. But if the tooth is too firmly rooted to be extracted with this instrument, one must make use of curved pincers, or else one may have recourse to a pelican. The author notes, however, that much skill is required in using this latter instrument, for otherwise it will almost certainly happen that several good teeth will be knocked out, instead of the one intended to be extracted. In proof of this, he relates the following anecdote, which we relate in the words of the author, that it may not lose anything of its quaint originality:

“Je veux icy reciter une histoire d’un maistre barbier, demeurant à Orleans, nommé maistre François Loüis, lequel avoit par dessus tous, l’honneur de bien arracher une dent, de façon que tous les samedis plusieurs paysans ayans mal aux dents venoient vers luy pour les faire arracher, ce qu’il faisait fort dextrement avec un polican, et lorsqu’il avoit fait, le jettoit sus un ais en sa boutique. Or avoit-il un serviteur nouveau, Picard, grand et fort, qui desiroit tirer les dents à la mode de son maistre. Arriva cependant que ledit François Louys disnoit, un villageois, requerant qu’on luy arrachait une dent, ce Picard print l’instrument de son maistre et s’essaya faire comme luy; mais en lieu d’oster la mauvaise dent au pauvre villageois, luy en poussa et arracha trois bonnes. Et sentant une douleur extrème, et voyont trois dents hors de sa bouche, commença à crier contre le Picard; lequel pour le faire taire luy dit qu’il ne dist mot, et qu’il ne criast si haut, attendu que si le maistre venoit il luy feroit payer les trois dent pour une. Donc le maistre oyant tel bruit, sortit hors de table pour sçavoir la cause et raison de leur noise et contestation; mais le pauvre paysan redoutant les menaces du Picard, et encore apres avoir enduré telle douleur qu’on ne luy fist payer triplement la peine dudit Picard, se tent, n’osant declarer audit maistre ce beau chef d’œuvre; et ainsi le pauvre badaud de village s’en alla quitte; et pour une dent qu’il pensoit faire arracher, en remporta trois en sa bourse, et celle qui luy causoit le mal en sa bouche.” Paré adds in conclusion: “Partant je conseille à ceux qui voudront faire arracher les dents, qu’ils aillent aux vieux dentateurs, et non aux jeunes qui n’auront encore reconneu leurs fautes.”

Two gum lancets and a trifid lever called “poussoir” (Ambroise Paré).]

But let us now return to our subject. After the extraction of a tooth, it is necessary—says Paré—to leave the wound to bleed freely, so that the part may get rid of the morbid humors; then the gums and the alveolus must be pressed, on both sides, with the fingers, to readjust the socket, which will have been widened and sometimes even broken in extracting the tooth. After this, the patient should rinse his mouth with oxycrate; and when the weather is cold and windy, the patient should take care to avoid fluxion in the other teeth.

The following chapter speaks, “de la limosité ou rouillure des dents, et de la manière de les conserver.”

After meals the mouth must be rinsed with water and wine, or with water with a little vinegar added to it, and the teeth cleaned from all residues of food, so that their putrefying may not spoil the teeth and make the breath fetid. An earthy yellowish substance, like rust, often forms on the teeth from want of cleanliness and also when they are not used to masticate; this substance corrodes the teeth, just as rust corrodes iron. It is necessary to remove this substance, by scraping the teeth with small instruments suitable for the purpose, and then the teeth themselves must be rubbed with a little aqua fortis and aqua vitæ mixed together, to take away what the instruments have not been able to remove. In order to preserve the teeth it is necessary, besides, to rub the teeth frequently with appropriate dentifrices. Among these the author mentions simple bread crust, burnt and reduced to powder.

In Chapter III of Book XVII he speaks of artificial teeth. Sometimes, says Paré, by the effect of a blow, the front teeth are lost; this not only constitutes a deformity, but is also the cause of defects of speech. Therefore, after the necessary treatment, when the gums are hardened, the lost teeth must be substituted with artificial ones made out of bone, ivory, or the teeth of the Rohart, which are excellent for this purpose; and the artificial teeth must be tied to the neighboring ones with gold or silver wire.

The palatine obturator with sponge of Ambroise Paré.]