Antonio Campani, of Florence, published in 1786 a treatise on dentistry,521 very elegantly printed, and illustrated with thirty-six plates very neatly carried out. This book, however, contains nothing of real importance for the development of dentistry.
Benjamin Bell, the English surgeon, a contemporary of Hunter, also devoted much attention to diseases of the teeth, and, if it may be argued from the clear and precise manner in which he expresses his opinions on various questions relating to dental pathology and therapy, it would seem that he had much greater experience in this field than the celebrated Hunter.
With regard to incision of the gums, in cases of difficult dentition, this author contradicts certain assertions of the German surgeon Isenflamm (1782), who argued that when the tooth is already to be perceived through the gum, the incisions are altogether useless, while if the tooth be still at some depth, the gingival incision will soon close again, so that the cicatrix will render the eruption of the tooth still more difficult. Bell admits, too, that lancing the gum is altogether superfluous when the tooth has pierced the tissue, all the more so that the accidents provoked by the eruption are then generally already passed and gone, but the operation ought, in his opinion, to take place much earlier; and should the wound close again before the tooth has erupted, the gum must be lanced a second time.
Bell contradicts the opinion of Jourdain and Hunter that the morbid gatherings of Highmore’s antrum are generally consequent upon the closing of the normal opening of the cavity in the middle meatus. In many cases of disease of the maxillary sinus this orifice remains open, the liquid therein collected discharging itself not unfrequently through it, in certain positions of the body. Instead of penetrating into the antrum through the nasal orifice, as Jourdain would have it, Bell advises opening the cavity by Lamorier’s, or, better still, by Drake’s method. Except in special cases, the first or second molar ought to be extracted, but preferably the second. After trepanning the alveolus and emptying the cavity, the opening should be closed with a conically shaped peg to prevent its slipping into the cavity. From time to time the liquid that tends to reaccumulate should be allowed exit, and detersive injections should be made, preferably of lime water.
Looseness of the teeth, which in old age may be considered a normal condition, is always a disease when it occurs in youth. In certain cases its cause is unknown, in others it depends on an affection of the gums, either of a scorbutic nature or consequent on an accumulation of tartar.
According to Bell, dental caries is generally owing to a bad condition of the humors of the entire body and to a peculiar morbid disposition, rather than to external causes acting locally, although these latter may contribute, together with the general causes, to the producing of the disease.
This author was decidedly averse to the use of the file. For stopping carious cavities he advises the use of mastic, gum lac, or wax, if the cavity is large and funnel-shaped; this stopping, however, requires to be renewed frequently. But when the cavity, wider at the bottom, narrows toward the surface, one ought to use gold or, still better, tin-foil. The pulp ought always to be destroyed previously by cauterization.
Bell advises great caution in carrying out transplantation, it having been proved by many examples that contagious maladies of a serious nature may easily be communicated in this way from one individual to another.522
In the case of a young woman who had an upper incisor transplanted, Watson observed undoubted symptoms of syphilitic infection with supervening accidents of exceptional gravity, which in spite of careful treatment ended in death.523
Hunter also relates having observed, in seven cases of transplantation, very serious accidents which, however, he did not believe to be owing to syphilis, although bearing a certain symptomatic resemblance to it. Contrariwise, the well-known German surgeon Richter not only admitted the possibility of transmitting syphilis through a transplanted tooth, but even that the transplantation of an altogether healthy tooth from the mouth of a person undoubtedly free from syphilis might be followed by serious accidents of a syphilitic nature, and this because the possible existence of a latent syphilis in the person to whose mouth the tooth was transplanted cannot be excluded; in which case the abnormal stimulus exercised by the transplanted tooth might very well give rise to syphilitic manifestations. Therefore, the fact that the person who furnished the tooth was and continued to be in a state of perfect health (as precisely in the case cited by Watson) would not be sufficient proof that the accidents ensuing on the transplantation might not be of a syphilitic nature.
Lettson also observed, in certain cases of transplantation, accidents of more or less gravity which he held to be due to syphilis, calling, however, to mind a case cited by Kuhn, of Philadelphia, where the possibility of syphilis was not to be thought of, as the morbid symptoms disappeared entirely, without any treatment, as soon as the transplanted tooth was removed.524
August G. Richter, the above-named German surgeon, in those portions of his work dedicated to dental affections and diseases of Highmore’s antrum, treated these subjects with admirable clearness and order, without contributing, however, anything original to the development of dental surgery.525
Nicholas Dubois de Chemant, in 1788, of whom we shall later have occasion to speak again, published in Paris his first pamphlet on mineral teeth, entitled Sur les avantages des nouvelles dents, et rateliers artificiels, incorruptibles, sans odeur.
Jean Jacques Joseph Serre (1759 to 1830). Among the dentists of the end of the eighteenth century and the beginning of the nineteenth, a special mention is due to Jean Jacques Joseph Serre. He was born at Mons, in Belgium, but his remarkable practical and scientific activity was chiefly called into exercise in Vienna and in Berlin. He published several works, the most important of which is a practical treatise on dental operations.526
Among his minor works, one edited in Vienna, in 1788, treats of toothache during pregnancy; another, printed in Leipsic in 1791, treats most extensively of diseases of the gums; a third speaks of the mode of maintaining the teeth and gums in good condition. This little book of dental hygiene, like the rest of Serre’s books, met with great favor, and went through two editions in a brief space of time (Berlin, 1809 to 1812).
The works of this author show great study, very wide practice, and an admirable spirit of observation and research. They had the merit of greatly contributing to raise the level of dental culture in Germany, and one finds in them a pretty nearly complete account of the dentistry of that period. Apart from this, they possess a special interest because of the vast number of dates and important historical facts therein contained.
As it would be useless here to enter into a minute analysis of the contents of these books, we will limit ourselves to mentioning a few ideas of which Serre was a strenuous supporter.
He combats an old prejudice that had recently been reinforced by the authority of Jourdain, that is, that it does harm to extract a tooth when the soft parts around it are inflamed and swollen. He likewise combats the prejudice, also of very ancient date, that teeth ought not to be extracted during pregnancy. Only, he considers it as well to avoid the cauterization of the dental pulp in cases of gestation. In extracting teeth, the forceps ought only to be used after the tooth has been luxated by means of the pelican. Serre highly approves of this instrument, although he recognizes it to be a dangerous one in the hands of those who do not know how to make a proper use of it. This author invented or perfected various extracting instruments, among which a conical screw for extraction of roots hollowed out by caries deserves particular mention, and which, under a somewhat modified form, is still in use.
One of the most interesting chapters of Serre’s great work is the one in which he treats of affections of Highmore’s cavity.527 He speaks at length of the anatomy of the maxillary sinus, of its relation to the teeth situated below it, of the various modes in which the diseases of the antrum are produced, of their symptoms and treatment. He passes in review the various operative methods, and finds that in general the Cowper-Drake is the one to be preferred to all the others. He says that to open the sinus the simple extraction of a molar suffices in the greater number of cases, the trepanning of the alveolus not being generally necessary.
J. Arneman, in 1766, published at Göttingen a synopsis of surgical instruments528 that deserves mention in so far that the dental instruments of that time as well as those of earlier periods are therein taken into account with sufficient exactness.
A. F. Hecker attributed the accidents of difficult dentition to a special alteration of the saliva caused by the irritation deriving from the erupting teeth. In these cases the saliva is supposed by him to acquire a high degree of acridness and to become almost similar to the poison of rabies. Departing from this theory, the author declares it to be necessary to mitigate the irritation produced on the gums and other parts of the mouth by the altered condition of the saliva, as well as to modify the quality of the saliva itself and to promote the elimination of the same from the body by emetics and aperients. According to him, liquid carbonate of potash administered in drops, together with syrup of poppy heads, manna, etc., is a most useful remedy, having specially for its effect to diminish the acridness of the saliva.
Besides this remedy, the author extols the use of blisters behind the ears, as also of tepid baths, which calm pain and spasms, favor the excretions, and procure repose and sleep. He rejects the incision of the gums as altogether useless, and is most opposed to the use of opium, which he states renders children liable to apoplexy.
And here we will mention, rather by way of curiosity than for any real historical interest which they possess, two pamphlets on odontitis, published respectively in 1791 and 1794 by Ploucquet and Kappis, who maintained that not only the dental pulp, but all the parts that form the tooth are susceptible of inflammation.529 In Kappis’ pamphlet we find the following ideas developed, upon which we do not think necessary to comment. The inflammatory process consists essentially in the increased flow of humors to a given part and in a more or less intense reaction of the vital force. Both of these things may take place in the teeth. These are liable to swell, that is, to undergo an increase of all their dimensions, in proof of which assertion the author relates the case of an individual, who when attacked by a violent toothache had found the spaces between his teeth so narrowed that it was no longer possible to make use of his usual toothpick, even if he had tried to do so regardless of pain. But when the toothache was over, the same toothpick again became serviceable as before. He says that there is no cause for wonder that in odontitis no redness of the teeth is to be perceived, for in other inflammations as well, redness is wanting, and, moreover, it exists in the interior membrane of the tooth. As in other inflammations, so also in odontitis, the usual issue is resolution. Dental fistulæ may derive from internal suppuration. The impurities deposited on the teeth are by him supposed to be owing to an increase of their secretion! According to the author, caries, the breaking down of teeth apparently healthy, as well as their falling out, is generally caused by an inflammation of these organs, that is, by odontitis, an affection that, he says, may be of very varied kind, the principal forms being the rheumatic, arthritic, sympathetic, and gastric.
Ranieri Gerbi.530 In a book by this author we find recommended a very singular cure for toothache, even of the most violent nature. It is in no way scientific, and is besides not particularly pleasant, notwithstanding that the author, professor at the University of Pisa, was a scientist of merit, enjoying special esteem as a mathematician and cultivator of natural sciences.
Under the name of curculio anti-odontalgicus he describes an insect living habitually inside the flowers of the carduus spinosissimus, that could be used with great advantage against toothache, in the following manner: One crushes fourteen or fifteen larvæ of the insect between the thumb and forefinger, and then rubs the two fingers together until the matter remaining upon them is entirely absorbed. Instead of the larvæ (which, as is known, represent the first stage of insect life) one may also use the fully developed insects. One then applies the two fingers that have crushed the insects or their larvæ upon the decayed and aching tooth. If the pain is of a nature to be cured by this means, it diminishes almost instantaneously, and ceases altogether in a few minutes. It is said that the fingers preserve their healing power for a great length of time, even a whole year, and in proof of these assertions Ranieri Gerbi speaks of no less than six hundred cures performed! Other insects besides the curculio anti-odontalgicus, used in the same manner, are said to possess the same curative properties, among them the curculio jaceæ, carabus chrysocephalus, and the curculio Bacchus, which last, says Gerbi, has long been used for this purpose by the peasants of Tuscany. The author also says that some German doctors and naturalists experimented with success with several insects indigenous to Germany as remedies against toothache. These insects, also mentioned in a work published in Bayreuth in 1796, author unknown, are:531 the coccinella septempunctata, the coccinella bipunctata, the carabus ferrugineus, the chrysomela sanguinolenta, the chrysomela populi, the cantharis or Spanish fly, and others. Later on, Hirsch also extolled the healing power of another insect, the cynips rosarum. With regard to the mode of application, Gerbi says that instead of crushing and rubbing these insects or their larvæ between the fingers, one can use a piece of wash leather in a similar manner.
It is to be observed, however, that the insects that are found generally in the ripe wild teasle—or more precisely their larvæ—had already been used for a long time as a remedy against toothache; indeed, we even find these means of cure recommended in the natural history of Pliny. In a book entitled Histoire d’un voyage aux îles Malouines fait en 1763 et 1764, by a certain Dom Pernetty, this author speaks of some remedies made known to him by the Superior of the Franciscan friars of Montevideo; and among others one finds the following: “One draws out the worm that is generally found in the head of the fuller’s teasle when this is ripe. One rolls this worm between the index finger and the thumb, lightly pressing it until it dies of languor. The one or the other of the two fingers applied on the aching tooth will have the virtue, for a year at least, of making the toothache cease.”532
Heinrich Callisen, in an excellent treatise on surgery533 published at Copenhagen in 1788, writes at sufficient length and with great accuracy on dental and maxillary diseases. According to this writer, it rarely suffices to trepan one alveolus for the treatment of the morbid collections of Highmore’s antrum, as the maxillary sinus is very often divided by partitions into various cells, so that in order to give exit to the pus contained in each of them, it is necessary to extract several teeth and trepan their alveoli.534 One ought not, therefore, to give the preference to this method, unless in the case of the teeth in question being decayed. But should they all be in a good state, or should a large opening be necessary because of the nature of the disease in the cavity, it will be better to follow Lamorier’s method, that is, to incise the gum crosswise under the malar process and then, after scraping away the periosteum, trepan the bone. Further, in the case of the disease in the maxillary sinus having given rise to tumefaction, softening of the bone, and fluctuation in the palatine region, it is precisely there that the perforation ought to be carried out. To prevent the reclosing of the opening before the cure is completed, the author advises the use of pledgets, small bougies, a piece of prepared sponge, or even a small tube. According to Callisen, the injections through the nasal orifice of the maxillary sinus are partly impracticable, and partly of no utility.
It always does more harm than good to file or to scrape the decayed part of a tooth, without stopping it afterward, as by thus doing, says the author, one only renders it still more liable to the access and the action of harmful external influences. In preparing the cavity for stopping, the bottom of it should be more ample than its external aperture, that the filling may remain firm.
For extracting molars, he makes use either of the pelican or of the key; for the incisors and the canines, of the forceps; and for roots, of the goat’s foot.
Callisen treats incipient idiopathic epulis by destroying it through cauterization, after having covered the teeth with wax; if the epulis be large and more or less hard, he removes it with the bistoury; as to symptomatic epulis, he holds the removal of the original cause to be the best mode of treatment.
This author declares himself decidedly in favor of replantation and transplantation, expressing the idea that these methods are always to be preferred to the application of artificial teeth. He maintains that after a tooth has been replanted, and its consolidation has taken place, there is no possibility of any further pain, the nerve being broken. The author relates a brilliant cure which he carried out upon a lieutenant, who, during the siege of Copenhagen, had received a blow that had sent all his front teeth into his mouth. Callisen immediately put them all back in their places with such ability that they became perfectly firm again. With reference to transplantation, he only believes in its being possible for teeth with a single root.
In works published toward 1790, Lentin and Conradi, devoted their particular attention to the morbid conditions that produce looseness and spontaneous falling of the teeth. For the treatment of these conditions Conradi recommended general and local remedies. The general remedies were directed to the suppressing of acridness in the blood, which he considered to be an etiological element of primary importance. As to the local remedies, they ought specially to consist in keeping the teeth clean by the use of a toothbrush, in painting the gums with tincture of catechu and myrrh, and in rinsing the mouth frequently with a decoction of cinchona or of willow bark. Against toothache caused by caries, he particularly advises essence of cloves, introduced into the carious cavity on a piece of cotton-wool.535
Friedrich Hirsch was much less disposed than were many of the preceding writers to incision of the gums in cases of difficult dentition. Against the accidents connected with this morbid condition, he prefers, in general, the use of gentle aperients or of emetics, and regards the scarification of the gums as opportune only in cases where symptoms indicating a high degree of nervous tension manifest themselves.
Against incipient caries, Hirsch used simple cauterization, which he held to be capable of arresting the morbid process, at least in many cases. He says, however, that when a real carious cavity exists, it is absolutely necessary to stop it; and for this purpose, rather than metallic or resinous fillings, he prefers a cement of turpentine and quicklime, made into a paste with varnish of oil of linseed. Nevertheless, when it is a case of the lower teeth, tin-foil is also, according to him, an excellent filling material.
Like some of the preceding authors, Hirsch admitted the existence of interior caries in apparently healthy teeth, and was the first to indicate a good mode of diagnosticating these occult dental affections. It consists in tapping the suspected teeth with a sound until one finds the one in which the percussion provokes pain, and this will be the diseased tooth. One detaches the gum from the neck of this tooth, and at the point, on the neck itself or on the beginning of the root, where a small protrusion is found, one perforates the tooth with a chisel, or some other fit instrument, so as to penetrate to the interior of it. Through this passage one introduces into the tooth a fine, curved, red-hot sound, repeating the operation several times. Lastly, one fills the cavity with lead; and in this manner the tooth will be cured and no longer painful.
In speaking of the correction of dental anomalies, Hirsch relates a case in which the deformity consisted in the union of two central incisors, which formed one single piece, resembling a paddle, and spoiled the appearance of the face. He divided them with a saw, cauterized the surfaces of the section, scarified the gum, and, to gain a little space, introduced a small wedge, until the gum had grown up within the new dental interstice, thus giving an altogether normal appearance to the part.
It is noteworthy that Hirsch made use almost exclusively of the goat’s foot for the extraction of teeth, of whatever kind they might be, the instrument being rather longer, however, than that ordinarily known by this name, and making his left hand serve as a lever rest.
To arrest strong hemorrhage ensuing from the extraction of teeth, Hirsch used scraped parchment, which he introduced into the alveolus and pressed with force into it by means of a sound; then he superposed compresses and kept the jaws tight together with a bandage passed around the head.
This author, too, was very favorable to replantation. As to transplantation, he says that even when the gum and the alveolus are quite healthy, the individual entirely free from scurvy and syphilis, and not above fifty years of age, the transplanted teeth do not take root perfectly except in an average of one case in three. For carrying out this operation he never made use of teeth extracted from the mouth of a living person, but, on the contrary, he used the teeth of young and healthy subjects who had died a violent death; these were, besides, carefully cleaned before transplanting them, and in this way the author believed the transmission of disease to be nearly impossible.536
J. E. Wichmann combated energetically the practice, then pretty general, of endeavoring to facilitate the eruption of the teeth by incision of the gums. He considered this practice as one to be absolutely rejected, supporting his opinion on the consideration that dentition, being an altogether physiological process, which, moreover, takes place in parts relatively of but little importance, never can give rise of itself alone to serious accidents. Besides this, he says, it is very difficult to say which tooth precisely is about to erupt and at what point. The incisions would, therefore, have to be made by chance, which would often render the morbid condition still more serious.
K. A. Blumenthal endeavored to confute Wichmann’s opinions, with but little success; for, indeed, the same opinions, expressed later by J. H. Sternberg in a more detailed manner and with ampler views of the subject, met with ever-increasing approval. Thenceforth, the practice of gingival incisions in cases of difficult dentition fell more and more into discredit.537
Robert Bunon,538 the French dentist, is one of the most illustrious personalities to be met with in the history of our profession. He was born at the beginning of the eighteenth century, and devoted himself betimes to the dental art, gathering instruction therein partly from different dentists and partly from the few odontological books he was able to find. In this manner he learned pretty much all that was known at that time by dentists in general. He then decided to travel, in order to acquire further knowledge and experience. He practised especially in the north of France and in what is now the state of Belgium; at Antwerp, Brussels, Givet, Maubeuge, Cambrai. In his ardent thirst for knowledge, when he happened to pass through a town where some dentist of note resided, he never neglected to call on him, thus acquiring fresh information and perfecting himself as well in the practical exercise of his profession. At the same time, his desire to learn all that was new concerning dental art and science was so intense that he had translations made of the medical and surgical works of Latin, Italian, German, and English authors. However, all this reading, although it enlarged his general knowledge, taught him nothing, or almost nothing, about those subjects that interested him above all the others. His practical experiences, meanwhile, brought a great number of patients to his notice, and, being by nature a very acute observer, he was able to establish the existence of many facts up to then unknown. At this time he commenced his studies on dental erosion, on the development of the teeth, and on the prophylaxis of dental maladies, his favorite subject. “I felt,” he writes, “that the necessity of having recourse day by day to the extraction of teeth resulted from deficient knowledge on our part, and I considered this extreme remedy as one of the greatest evils to humanity.”539 He therefore endeavored to extend his own knowledge in every possible way, and as one means of doing this he visited hospitals and schools; and, ardent champion as he was of conservative dentistry and of prophylaxis, he succeeded in interesting medical men and surgeons, midwives and schoolmasters, and parish priests as well, in the question of the preservation of the teeth. The teeth he extracted he kept for the purpose of studying the conformation, the lesions, the dental anomalies; sometimes he split them up to examine the dental pulp. And he never neglected an opportunity of procuring anatomical pieces that appeared interesting to him.
In 1728 Fauchard’s book, Le Chirurgien Dentiste, appeared. The fame of this work reached Belgium, where Bunon then was, and he immediately set about trying to get a copy of it. After searching in various towns, he finally found one in Givet. He read it with the greatest interest, and later, in one of his works, spoke of it in terms of highest praise. It would seem, however, that he did not learn much that was new to him by reading this book, which proves that he already possessed a vast odontological culture and was also profoundly versed in technical dentistry, which forms the most important part of Fauchard’s book. He was somewhat astonished at finding in this celebrated author’s work hardly anything on the subjects that principally interested him, that is, the erosion, the development of the teeth, and the prophylaxis of caries. This circumstance very clearly reveals the different mental tendencies in these two great men, the one, drawn toward the practical side of the profession which principally interests him and forms the basis of his work, the other, an impassioned searcher into causes, and student of prophylaxis.
After the perusal of Fauchard’s book, Bunon, who had already conceived the idea of publishing the results of his observations and of his own particular studies, felt more than ever the propriety and necessity of doing so; and to realize his idea, he established himself toward the year 1735 at Paris. Two years later, just when the manuscript of his work was almost finished, Gerauldy’s book appeared. Bunon relates that he opened this book in fear and trembling; its title, The art of preserving the teeth, gave him reason to fear that Gerauldy might have profited by some of the ideas and observations he had communicated to various persons, to write a book similar to the one that he himself had it in his mind to publish.540 He was able, fortunately, to convince himself immediately that his fears of being forestalled and plagiarized were unfounded.
Notwithstanding, Bunon was determined not to publish his book until the opportune moment and with all possible probability of success. With this object in view, he made up his mind first to obtain the diploma of surgeon-dentist. To reach this aim, he was obliged to conform to the regulations of the Edict of May, 1699, which then regulated the practising of dentistry, and this was as much as to say that he was obliged to enter the College of Surgery, to undertake two years’ practice with a regularly licensed surgeon, to undergo theoretical and practical examinations, and to take oath before the Chief Surgeon of the Realm. Once in possession of the diploma of surgeon-dentist, he was separated thenceforward from the vulgar crowd of charlatans and invested with all the prestige which a degree, so rarely acquired at that time, conferred upon its possessor; but before facing public opinion he desired to make himself known, and, so to say, first to try his ground, by making known some of his newer ideas, and see what reception they might meet with from his colleagues and the public in general. He, therefore, published, in January, 1741, in the newspaper Mercure de France, a letter on the so-called eye tooth,541 combating the then widely diffused prejudice that the extraction of an upper canine constituted a grave peril to the eye. He demonstrated the absurdity of this idea by putting in evidence the anatomical fact that the upper canines are innervated by the infra-orbital nerve, which has no relation whatever with the visual organ.
Still better to further his object of making himself a name, he published in the same year and in the aforementioned paper his dissertation on the teeth of pregnant women.542 There he demonstrated the falseness of the idea that one ought never to extract teeth during the state of gestation, and brought into relief the necessity of treating the dental diseases of pregnant women with still more accuracy than those of other persons.
These publications, bearing as they did the marks of good sense, favorably interested the public opinion. The way was therefore prepared, and Bunon judging the moment to have come for publishing his work, placed it in the hands of a literary man for the necessary corrections of style. He also showed his manuscript to several persons of consideration, but was grieved to perceive that the new ideas put forward in it were skeptically received. He now thought it might be as well to appeal to the judgment of a highly competent authority, and fixed on M. de la Peyronie, Head Surgeon of the Realm. This gentleman, after reading the work, highly praised the author, and Bunon gained permission to publish the book under his patronage, on consideration that he should give his word to furnish the proof of the many assertions made therein on all kinds of subjects.
The goal was now reached, and Bunon, on the strength of such illustrious patronage, published his book in March of 1743, under the title, Essay on the maladies of the teeth, wherein are suggested the means of obtaining their good conformation from the earliest age, and of assuring their preservation during the whole course of life.543
All the principal journals of the time (Journal des Savants, Journal de Trévoux, Journal de Verdun, Mercure de France, etc.) published extracts from the book and eulogized the author, who had even the high satisfaction of receiving an honorable mention from the Royal Academy of Surgery, in the public sitting held in 1743.
Bunon, therefore, was now famous, and had, besides, gained wealthy clients, as we see from the perusal of his observations, where the best names in France are to be met with, put in evidence by him without the least thought of professional secrecy. He could now enjoy his well-merited successes, in accordance with the thought expressed by him in one of his books: “All those who labor for the progress of an art have legitimate right to the honor and to all the recompenses to which success is entitled.”544
The study of Bunon’s work proves, in fact, that he had good right to be proud of having written it. The mere perusal of it, however, does not suffice to enable the reader to judge of its merits, for to do this properly, it is necessary to study at the same time his other book, published in 1746, entitled Experiences and demonstrations made at the Hospital of Salpêtrière and at St. Côme, before the Royal Academy of Surgery, serving as continuation and proof to the Essay on the maladies of the teeth.545 The essay is, in fact, a small 12mo book of 212 pages, written in a concise style, and, strange to say, most concise in the most important points.
Many facts of great moment are given under the form of rapid indications, or of assertions without proof; thus their importance is apt to pass completely unobserved by those who do not take the trouble of studying this work thoroughly and with the help of the explanations, illustrations, and comments contained in the second book we have referred to.
M. A. Barden, of the École Odontotechnique of Paris, was the first to undertake a serious and conscientious study of Bunon’s works. By so doing he has thrown full light on the author’s great merits, and brought forward the high scientific importance of his works.
One of the important questions studied by Bunon concerns the hygiene to be observed in order to obtain the development of a good dentition. On this question he rightly establishes the principle that hygiene and dental prophylaxis should begin from the period of the formation of the milk teeth. He works out this principle with rigorous logic, and finishes by tracing the hygiene of the mother during pregnancy, of the woman (be she mother or nurse) during the nursing period, and of the nursling as well.
As to the accidents of first dentition, Bunon sets forth a highly scientific opinion, fully coinciding with the ideas of modern writers, that is, that dentition is not the sole cause, nor even the principal cause, of such accidents, but simply a coöperating cause. He made the observation that in healthy infants, children of healthy parents and nursed by healthy women, the time of teething is gotten over without difficulty, while serious accidents occur frequently in weak and sickly children not brought up and nourished according to hygienic principles, or born, as not often happens, with special hereditary predispositions.
One of Bunon’s merits is that of having attributed to the first teeth all the importance they really have, and of having insisted on the necessity of attentively curing their maladies. He also drew attention to the dangers that may result from the eventual persistence of the first teeth at the epoch of the second dentition, or from the persistence of their roots after the destruction of the crown by caries. These roots, he says, by their contact with the neighboring permanent teeth may infect them, and cause them to decay.
Bunon’s researches into the development of the teeth enabled him to describe precisely the position that the various teeth of the second dentition occupy in the jaw with regard to the milk teeth, before these are shed.
Bunon was, besides, the first author who studied accurately dental hypoplasia, and it is greatly to his honor that his ideas and observations about this pathological condition have been accepted and confirmed in substance by the greater part of the authors who have come after him, having remarkable worth even at the present day. According to him, this congenital defect of the teeth is owing to infantile maladies, such as hereditary syphilis, infantile scurvy, malignant fevers, smallpox, or measles; the harmful effects of these maladies, however, are limited to the teeth in progress of development, and have no influence on those that have already come forth. Erosion, as this defect was termed by Bunon, sometimes affects the first teeth, but is to be found much more frequently in the second or permanent ones. Those most often affected are the first molars, and in frequency follow the incisors, the canines, the premolars; the second and third molars are the most rarely affected.
Bunon studied with great accuracy the means of preventing anomalous positions of the permanent teeth, owing, according to him, almost always to want of space. In certain cases he advises the extraction of the milk tooth in order to facilitate the eruption of the permanent one, and, necessity urging, he does not hesitate to sacrifice one of the permanent teeth to procure the advantage of a normal position of the others. With regard to this subject, the following passage is worthy of note, for in it we find sketched out the theory of preventive extraction as a means of facilitating the eruption of the wisdom tooth: “It is better to have the teeth incomplete as to number than to have the ordinary number badly arranged; for the mouth will appear none the less well furnished because of having one or two teeth the less; the other teeth will be commodiously distributed, and the last molars will find sufficient room when they come forth; thus, the disorders which these teeth often occasion will be avoided.”546
After caries, Bunon considers dental tartar as the most potent enemy to the vitality of the teeth. He distinguishes three principal species: the black, the lemon or light yellow, and the brownish yellow; however, he allows of two other varieties of less frequent occurrence, the red and the green tartar.
At a period when an extraordinary confusion obtained with regard to gingivitis, because of the great number of varieties allowed, Bunon strongly affirms the unity of this morbid process, and considers tartar as the constant cause of it, without denying, however, that other causes of various kinds may contribute at the same time to produce it.
In cases of scorbutic stomatitis, Bunon advises, and very rightly, the complete removal of tartar from the teeth before having recourse to any other local treatment. He also insists on the necessity of attending to the teeth and gums, and especially of freeing the former from tartar before undertaking the specific treatment of syphilis, considering the good state of the teeth and gums as one of the most important prophylactic measures against mercurial stomatitis.
Anyone who takes the trouble of reading Bunon’s works attentively
cannot help admiring his depth of insight, his spirit of observation, his
exquisite clinical sense, and his ingenuity. As illustrating this last quality
of his, we may cite two cases of fracture of the lower jaw that he succeeded
in curing in a short time by the method of binding the teeth, the preceding
attempts of experienced surgeons having entirely failed. One of these
cases is particularly interesting. The seat of the fracture corresponded
with the bicuspids, which, however, had fallen out from the effects of
trauma; the neighboring teeth were also loosened. Bunon filled the empty
space left by the bicuspids with a piece of ivory, provided with two holes;
then, by an ingenious crossing of threads passing from the second molar
on the one side to the second bicuspid on the other, very tightly tied, he
formed, so to speak, one single block, and succeeded in bringing about
the consolidation of the shaking teeth and the complete cure of the
fracture, which was effected in less than a month.