Chapter Vii Treats of the General Causes of Dental, Alveolar, and

gingival diseases, and contains the complete enumeration of these maladies. The causes of dental affections may be of two orders, viz., internal (general diseases, dyscrasic conditions) and external (the action of heat and cold, mechanical causes, etc.).

After having spoken in particular of various causes, Fauchard adds: “Little or no care as to the cleanliness of the teeth is ordinarily the cause of all the maladies that destroy them.”

The author divides maladies of the dental apparatus into three classes, that is:

1. Maladies deriving from external causes and acting, therefore, especially on the crown or uncovered part of the tooth.

2. Maladies of the hidden parts of the tooth, that is, of the neck and root.

3. Symptomatic maladies, deriving from the teeth.

In the first class the author includes 45 pathological states, 17 in the second and 41 in the third, making up a total of 103 morbid conditions. This should be sufficient to give us an idea of the accuracy with which Fauchard studied the maladies of the dental apparatus, especially if one considers that preceding authors had reduced these maladies to a very small number. Fauchard’s classification is very complete, for notwithstanding the progress made in succeeding years in this science, the pathological conditions not to be found comprised in it are exceedingly few. Naturally, the 103 diseases enumerated by Fauchard do not represent as many distinct morbid entities. The author, in classifying dental maladies, keeps especially in view the requirements of the practitioner, and therefore makes numerous distinctions in each morbid process. Thus, he distinguishes a great many varieties of caries, viz., the soft and putrid caries, the dry caries, the caries in part dry and in part soft, the caries complicated by fracture, the superficial caries, the deeper and the deepest, the caries of the different surfaces of the crown, and so on. Also in the classification of other morbid processes, Fauchard makes multifarious distinctions.

The passage referring to worms in the teeth deserves to be here reproduced:

“Sometimes worms are to be found in the carious cavities of the teeth, or in the deposit of tartar that covers them, and to these the name of dental worms has been given. Observations recorded by illustrious authors are extant which attest this. Not having ever seen these worms, I neither admit nor deny their existence. Nevertheless, I conceive the thing nor to be physically impossible, although at the same time I do not believe at all that these worms destroy the teeth or cause them to decay, but rather that the eggs of some insect having been introduced into the carious cavity of the tooth, either through alimentary substances or through the saliva, these eggs thus deposited have developed and produced the worms alluded to. However this may be, as they are not the real cause of the caries, their eventual presence does not require any particular consideration.” Fauchard again recurs to the subject of worms in Chapter VIII, in speaking of the particular causes of caries.

“It was, and is still, believed by the vulgar and also by some writers that all toothache is caused by worms, which little by little destroy the tissue of the osseous fibers and the nervous threads. If this were so, the explanation of pains and of decay in the teeth would be very simple. This opinion is founded on pretended experiences relating to these insects, which may, it is said, be made to fall out of the teeth by the smoke of henbane seeds; this, however, has been declared fabulous by Andry, dean of the medical faculty of Paris, as well as other similar facts which he exposes in his book on the generation of worms.

“Andry relates, however, that with the help of the microscope one may succeed in seeing certain worms that form beneath the deposit collected upon the teeth as the effect of want of cleanliness; these worms, he says, are exceedingly small and characterized by a small round head with a small black spot; the body is long and fine, pretty nearly like the worms seen in vinegar through the microscope. He adds that these worms destroy the teeth little by little, causing a bad odor, but not much pain. He believes it an error of the imagination to ascribe violent pains in the teeth to dental worms, and holds that these only produce a very slight, dull pain accompanied by itching.

“I have done everything possible,” continues Fauchard, “to convince myself with my own eyes of the existence of these worms. I have made use of the excellent microscopes of Manteville, sworn surgeon of Paris, and have made a great number of experiments with them both on caries in teeth newly extracted as well as on tartar of different consistency accumulated on the same, but have never succeeded in discovering any worms. I am also still less disposed to believe in the existence of these animals, because Hémard declares that he has never been able to find any worms in carious cavities. I am thoroughly convinced of Andry’s sincerity; neither do I doubt the truth of the facts he relates; but it is easy to perceive from his own words how little the pretended healers of teeth and their specifics for killing worms are to be held in account; from the moment that, according to this writer, the pains for which one is most obliged to have recourse to remedies are almost always those not proceeding from the cause in question.”

In short, Fauchard does not believe at all that dental caries is occasioned by worms; and only from respect for the authority of Andry and other writers does he admit the accidental existence of these little animals in the carious cavities or upon the teeth, refusing, however, to attribute any importance to the same as regards the etiology of caries.

This disease, says Fauchard, is produced by a humor that insinuates itself into the midst of the osseous fibers of the teeth, and displacing the particles which compose these fibers, gives rise to their destruction. The causes from which these disorders derive may be external or internal. The external causes are blows, violent efforts made by the teeth; the improper use of the file, the application of acids or of other substances that injure the enamel, alteration of the saliva, impressions of heat or cold, and also certain kinds of nourishment. Blows or violent efforts may produce caries, according to the writer, by occasioning the effusion of the liquid contained in the vessels. The author gives analogous explanations for the other external causes. As to the internal causes, they consist, he says, in alteration of the blood and of the humors.

The teeth, says Fauchard, are more subject to caries than all the rest of the bones in the human body, because, their tissues being denser, the vessels are on this account closer together and more easily liable to be obstructed, choked up, and broken. Besides, the position of the teeth exposes them more than the other bones to the immediate action of external causes capable of producing the disorders alluded to; and finally, what demonstrates the dental caries to be produced, for the most part, by external causes, is that false teeth, either human or formed from those of animals, sometimes become carious just in the same way as the natural ones; which evidently happens by the sole action of external causes.

It is undeniable that the ideas expressed by Fauchard on the pathogeny of caries, cannot hold good against criticism. Nevertheless, we owe a great deal to this author for having once for all put an end to the ridiculous theory of dental worms, and for having tried to find a reasonable explanation of the manner in which caries is produced.

The teeth, says Fauchard, have not all the same disposition toward this morbid process; indeed, notable differences are to be observed in this respect. The molars are, in fact, more apt to become decayed than the incisors or the canines; and the upper incisors and canines are more subject to this disease than the inferior ones, because, by reason of their position, they are more frequently uncovered and more exposed to heat and cold, whether in eating and drinking or whether in the mere aspiration or expiration of the air. It is to be observed, besides, that when the eruption of the last molars is considerably delayed they easily decay.

Having very frequently observed the symmetrical decay of corresponding teeth on both sides of the same jaw, Fauchard considers that these cases are not simply accidental, but rather holds that the fact depends on a special cause, which, however, is not easy to determine. He offers, at any rate, a sufficiently good explanation when he says that as certain morbid causes (bad humors, etc.) must affect both sides of the mouth identically, it is but natural that the effects of such causes should be altogether analogous on the right and on the left, and manifest themselves symmetrically on teeth having the same configuration, the same structure, and the same consistence.

Before speaking of the treatment of caries, Fauchard alludes to the fallaciousness of the many remedies against toothache which were largely sold at his time by charlatans and impostors of every kind.

“Some pretend to cure toothache with an elixir or some special essence; others with plasters; others by means of prayers and signing with the cross; others with specifics for killing the worms that are supposed to gnaw the tooth and so cause pain; others pretend to be so clever that they can cure the most inveterate toothache by merely touching the tooth with a finger dipped into or washed with some rare and mysterious liquid; others finally promise to cure every kind of toothache by scarifying the ears with the lancet or cauterizing them with a red-hot iron.”

“I am well aware,” adds Fauchard, “that it can be alleged in favor of this last prejudice that the celebrated Italian doctor Valsalva indicates with great precision the point in which the actual cautery is to be applied to the ear, in order to calm toothache. He also determines the size of the iron and the manner of applying it. The authority of so celebrated an author, whose opinion is certainly worthy of respect, should induce me to believe that there may perhaps be some cases in which it is possible to use this remedy with success; nevertheless, I cannot persuade myself that such treatment can be useful in common cases of toothache.

“At Nantes, a city of Brittany, I knew a Turk, a watchmaker by profession, who was renowned for this mode of curing toothache. But I also know that, in spite of the pretended cures, the greater number of those who put themselves into his hands were obliged finally to have recourse to me, in order to find relief for their sufferings. I afterward saw several other persons use the same remedy with no better success.

“There are, besides, an infinity of other remedies vaunted as efficacious against toothache, but the greater number of them are so ridiculous and extravagant that it would be both tiresome and useless to speak of them. We will, nevertheless, give one more mentioned by M. de Brantôme.”

The author here quotes a passage of this writer, wherein he says that, having been suffering from toothache for two days, the apothecary of Elizabeth of France, wife of Philip II of Spain, brought him a most singular herb, which when held in the hollow of the hand had the virtue of making the pain cease immediately; and in this way he was, in fact, effectually cured.

And here Fauchard expresses himself of the same opinion as Urbain Hémard, who believes the cure of toothache by means of words, or by the touch of paper on which certain signs are written, or remedies held in the hand, etc., to be merely the effect of the force of the imagination, and he opines that the patient, having a vivid belief in the mysterious thing proposed to him remains under the impression of an inward commotion, by the effect of which it may well be that the morbid humor is deviated from the painful part to other parts of the body. The effects of the various passions on the bodily functions are, says Fauchard, very well known. Thus, when under the influence of anger the wounded at times do not feel any pain, and those who suffering from a tormenting toothache go to a dentist to have the tooth drawn are sometimes seized by such great fear as not to feel the pain any longer, and go away, only to return later on renewal of their sufferings; although there have been cases where the pain ceased altogether.

In spite of this explanation, of which we will not here discuss the value, allowing it, however, as satisfactory enough, Fauchard continues by making a most curious consideration, which as it is of a somewhat surprising effect in a scientific work, we will not deprive our readers of it. He believes it to be his duty to give the following warning, namely, that “the modes of cure, by means of certain words, of certain signs, laying on of hands, written charms, etc., savoring much of superstition and of diabolic artifice, are prohibited by the Church as sinning against the first Commandment, as much in him who practises them as him who consents thereto.”

After the above preliminaries, the author passes on to treat the important subject of the mode of curing caries. According to him, when caries has not yet attacked the internal cavity of the tooth at all, or only in a very slight degree, there are four modes of curing it: the first consists in the use of files or scrapers, the second in the application of lead, the third in the use of oil of cinnamon or of cloves, and the fourth in the application of the actual cautery. Fauchard expresses most energetically his disapproval of the means of cure recommended by Dionis in cases of caries of the triturating surfaces, which consisted in the cauterizing of the decayed spot with a drop of oil of vitriol applied by means of a miniature paint brush, declaring this to be both dangerous and hurtful because of the destructive and corrosive action of the oil of vitriol and because of the impossibility of limiting its action solely to the affected part of the tooth.

The general method of cure followed by Fauchard is described by him in these terms:

“When a tooth is but slightly decayed, it is sufficient to remove the caries with the instruments of which I will speak hereafter, and to fill the cavity with lead. If, however, the cavity be rather deeper and occasions pain, one should, after having scraped it, put a small ball of cotton-wool soaked in oil of cinnamon or of cloves into the hollow of the caries every day. This medication must be continued for a sufficient time, taking care to squeeze in the cotton-wool by degrees to accustom the sensitive parts to the pressure. Four or five days later one removes the material from the carious cavity. This treatment sometimes prevents a return of the pain; it produces on the osseous fibers of the tooth a slight but sufficient exfoliation and impedes the progress of the caries. If the pain should not cease after having continued this method for a sufficient length of time, one should then have recourse to the actual cautery and stop the tooth after a certain time, if the form and situation of the decayed cavity permit it; for one sometimes meets with cavities that are not able to maintain the stopping.

“If the caries penetrates as far as the cavity of the tooth, it may give rise to an abscess; and this I have often observed in persons to whom the caries of the incisors or of the canines occasioned great pain. In such cases I introduce the extremity of the sound into the cavity of the tooth in order to facilitate the evacuation of matter. As soon as the pus is evacuated the pain ceases. I then leave these patients in repose for two or three months; after this time, I stop the decayed tooth or teeth to avoid their getting worse.”

As anyone may perceive, the methods used by Fauchard against caries left much to be desired, when compared with those now in use. With such imperfect methods it is but natural that one did not always succeed in obtaining the immediate cessation of the pain resulting from caries. The want of additional remedies was, therefore, felt; and, in fact, Fauchard tells us of two with which he had experimented and found most efficacious against toothache. The first is a resinous plaster to be applied to the temples; the other is a paste to be applied, in quantity equal to the size of a small bean, between the gums and the cheek, and which was composed of various ingredients, among others, pyrethrum, black pepper, ginger, stavesacre, mace, cloves, cinnamon, sea salt, and vinegar. After having given the mode of preparation and application of the two above-mentioned remedies, Fauchard adds: “These remedies prove especially efficacious if one takes care to introduce a little cotton-wool or lint into the decayed cavity, soaked in oil of cloves, or cinnamon, mixed with an equal quantity of extract of opium, and if one resorts opportunely to bleeding and purging; which ought never to be neglected in the case of plethoric persons.”

Finally, the author speaks of another remedy, and one which we never should have expected to find in his book; but he assures us that by it many persons who had almost all the teeth decayed and suffered very often from toothache found great relief.

“It consists in rinsing the mouth every morning and also in the evening before going to bed with a few spoonfuls of one’s own urine immediately after it has been emitted, always provided the individual be not ill. One is to hold it in the mouth for some time, and the practice ought to be continued. This remedy is good but undoubtedly not pleasant, except in so far as that it procures great relief. Some of those to whom I have recommended it, and who have used it, have assured me that in this manner they were relieved of pain to which, up to then, they had continually been subject. It is rather difficult in the beginning to accustom one’s self to it; but what would one not do to secure one’s self health and repose.”

In order to explain the virtue of the urine as a remedy, the author pauses to speak of its chemical composition, and then adds:

“The rectified spirit of urine could be substituted for the human urine. One should then take two drams of this substance and mix it with two or three ounces of aqua vitæ, or water of cresses or of cochlearia. Sal volatile has the same virtues. Those who wish to make use of it should dissolve fifteen to thirty grains of it in the same quantity of the above liquid.”

Fauchard then passes on to speak of trepanning of the teeth when they are worn away or decayed and cause pain. He begins by saying that most varieties of pain caused by the canines and the incisors when worn away or decayed cease after the use of the trepan. He, however, understands the term trepanning in a very wide sense, comprehending therein the use of any instrument whatever (even a needle or a pin) with which one penetrates into the inner cavity of the teeth.

In interstitial caries of the canines and incisors one ought, says Fauchard, first to enlarge the interstice with a small file of a convenient shape, then to scrape the decayed cavity, and finally to open up the canal or inner cavity of the tooth with a perforator or with a small trepan.

“In this way the pus or other humors that may have collected in the tooth can easily find their way out, and the pain will cease at once or in a short time.”

The author describes with much minuteness the manner of trepanning, and then adds:

“After this operation one should let a few weeks pass without doing anything to the affected tooth, and afterward, in order to impede further decay, one must put a little cotton-wool into it soaked in oil of cinnamon or of cloves. The tooth must be left in this state for some months, taking care to renew the cotton-wool. It is necessary to observe that in beginning to put in the cotton-wool this should be done with lightness and without pressing it down much, so that if pus should gather again it may be able to make its way through the cotton-wool, the principal object of this being to hinder the penetrating of alimentary substances into the tooth, which would be the cause of further decay. If the cotton were pressed into the tooth from the beginning, the pus, not being able to find an exit, would accumulate, and might cause much pain, if the nervous parts of the tooth were not yet dried up or destroyed. The same thing might happen after the application of a lead stopping, and one would be obliged to remove it and let considerable time pass before putting it in again.”

Further on the author says that while the trepanning of incisors or canines almost always causes the pain to cease, by opening up an exit to the morbid matter retained within the cavity of such teeth, the same is not the case with the molars, these having several roots and several cavities, of great variety, which lend themselves but little to accurate trepanning. “Hémard,” he adds, “judges it necessary to extract these teeth, or at least to break off the crown (les déchapeller), in order to give exit to the corrupt matter that is closed up in the cavity; this sometimes causes the pain to cease. He (Hémard) says that he has seen many abscesses in the interior of teeth, which were not externally decayed, and that after having broken off the crown he found within the cavity a corrupt matter of an insupportable smell.”

Relative to such cases, Fauchard says that, besides the teeth, also the surrounding parts suffer and are imperilled by these conditions. “The greater part of the violent fluxions deriving therefrom often terminate in abscesses and fistulæ of the gums and of the surrounding parts, and sometimes with considerable and dangerous decay of the bone, as I have related in some of my observations.”

One sees that Fauchard was clinically very well acquainted with the grave forms of pulpitis and their possible consequences, although ignoring the true nature of this process, which has only been studied and illustrated much more recently.