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.306 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.”307 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.”308
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,309 which are excellent for this purpose; and the artificial teeth must be tied to the neighboring ones with gold or silver wire.
Chapter IV of the same book is most important, for palatal obturators are therein spoken of for the first time. “Sometimes a portion of the bone of the palate is destroyed by the shot of an arquebus, or by some other wound or by a syphilitic ulcer (par ulcère de verole), the patients being thereby disabled from properly pronouncing words and from making themselves understood. To repair this defect we have found an expedient through the help and ministry of our art. It consists in the application of an instrument somewhat larger than the palatal perforation; this is made of gold or silver, of about the thickness of a crown (coin), and has the form of a vaulted roof, to which a sponge is attached; when introduced into the aperture, the sponge, absorbing the humidity natural to such parts, will very soon swell up, and thus the instrument is held firm. In this way, words are better pronounced.”
Besides the above instrument, the author gives us the figure of another instrument, sans esponge (without sponge), which, taken altogether, is like a large cuff button. The small part, designed to be introduced into the aperture of the palate, can be made to turn round from below, by means of a small pair of pincers, so as to fix the obturator.
In the last chapter of Book XVIII, first dentition and the treatment required during this period are spoken of. The cutting of teeth, says Paré, is accompanied by pain, itching, and pricking of the gums; often, as well by diarrhea, fever, epileptic convulsions, which sometimes end fatally. The symptoms by which it may be known that teeth are about to come forth are as follows: The wet-nurse feels the mouth of the suckling infant to be hotter than usual; the gums are swollen; the child is restless, crying often and sleeping but little; it emits a quantity of saliva from the mouth, and frequently puts its fingers in its mouth, trying to rub its gums, and soothe, in this way, the pain and itching which it feels. It is then necessary to treat the nurse as if she had fever, and the infant should be suckled less than usual; some cooling and thirst quenching drinks should be given to it—for a child in such conditions suffers from intense thirst; the nurse should often rub the gums of the little patient with softening and soothing substances, as, for example, oil of sweet almonds, fresh butter, honey, or mucilage made from the seeds of the fleawort or of the quince; the brains of a hare (these may be roasted or boiled) have not only a very soothing action, but also, according to a very ancient belief shared by Paré, possess the occult property of aiding the cutting of the teeth. But oftentimes, neither these nor other remedies are of any use, because the gums are too hard and the teeth cannot cut their way through at all; the tension of the gums then produces very violent pain, fever, and other accidents, death even supervening in some cases. The author, therefore, advises lancing the gums deeply, just above the tooth which ought to appear, thus opening it a way, that it may more easily come out. He relates that he has performed this operation on his own children in the presence of many medical authorities.
Almost as if to show the high value of this operative procedure, Paré tells the case of a child, the son of the Duke of Nevers, who died at the age of about eight months without having cut any teeth. He, together with other doctors, was invited to carry out an autopsy. No lesion whatever was found sufficient to cause death, but the gums were very hard, thick, and swollen; an incision into them showed that the teeth were ready to come out, if only their eruption had been facilitated by lancing at the right time. Paré and the other doctors were of the unanimous opinion that death was caused solely by the impossibility of cutting the teeth on account of the hardness of the gums.
Among the many strange cases given in Book XIX (Des monstres et prodiges), Paré also speaks—trusting to the word of Alexander Benedetti—of the case of a woman, who, after the complete loss of her teeth caused by age, cut them all again at eighty years of age.
Although Paré treats so amply and with such competence all that concerns dental diseases and their cure, he does not make the least allusion to the stopping of teeth, beyond recommending, as had already been done by Celsus, that when a tooth that is to be extracted shows a large cavity, the latter should be well filled with linen or lead, so that the tooth be not fractured under the pressure of the instrument and so leave the root behind in the alveolus.
A century before Ambroise Paré, Giovanni d’Arcoli had already mentioned the filling of teeth with gold leaf, and, as we have seen already, there is very good reason to believe that the practice of this operation dated back to a still earlier period. How is it, then, that the illustrious French surgeon does not say a word about this? Very probably stoppings were not at all in use among French dentateurs and perhaps, even in Italy, this operation was only rarely carried out.
Jacques Houllier (1498 to 1562), a celebrated French physician and surgeon, also known under the Latinized name of Jacobus Hollerius, was the first to stand out, although timidly, against the theory of dental worms. He did not decidedly deny their existence, this having been affirmed by so many illustrious writers; he, however, speaks of them as if the point were a doubtful one: “It is said that worms are generated in the teeth, which corrode the teeth themselves, and produce a pain which is not very violent and causes itching with little or no salivation (vermes ajunt subnasci dentibus, et hos corrodere, à quibus dolor non ita fortis, pruriginosus, nulla aut pauca salivatio).”
But even while putting in doubt the existence of dental worms, he believes it his duty to enumerate the various remedies, recommended for their destruction. As to fumigations with the seeds of the hyoscyamus, Houllier, declares that what is believed by the common people, and what has been written by doctors of antiquity about worms being killed and seen to fall from the teeth by the effect of these fumigations, is all nonsense. In fact, he says, when the seeds of the hyoscyamus are burnt there fly away from them what appear to be little worms, even if the fumes do not reach the worm-eaten tooth. (Quod autem vulgus sibi persuadet, et ab antiquis medicis scriptum est de suffumigio è semine hyoscyami, videtur fabulosum. Nam inde ajunt manifeste vermes excidere. Re vera, incenso semine, evolant tanqua vermiculi, etiam si non attingit fumus vermiculosum dentem.)
Apart from this, in the works of Houllier, nothing is found that is of interest for the history of dentistry. He repeats several errors and prejudices of the ancients; he says, for example, that men have ordinarily thirty-two teeth, women, twenty-eight; and he, too, believes in the expulsive virtues of the fat of green frogs when applied to a tooth (adeps ranæ viridis dentem depellit).
Houllier does not contribute in any way to dental therapeutics, he only enumerates the methods of cure recommended by preceding authors.310
Volcherus Coiter (1534 to 1600), of Gröningen, an ardent student of anatomy, and a pupil of Fallopius, Eustachius, and Aranzio, studied with great attention the development of bones, dissecting many fetuses and children of various ages for that purpose. He clearly states his opinion that the teeth are not bones, since they do not pass, like the latter, through the cartilaginous stage, but are derived instead from a mucous substance.311
Johann Jacob Wecker, a doctor of Colmar, published in 1576 a valuable medical work composed of synoptical tables, in which is briefly summarized the best of what had been written by preceding Greek, Latin, and Arabic authors.
One gathers from this author that at the time in which he wrote it was considered an excellent preservative against the plague to rub the teeth with theriac, mithridate, angelica, and zedoary. From this it may be perceived that even in those days doctors had understood the importance of the cleanliness and disinfection of the mouth as a prophylactic against infective diseases.
In the above-mentioned book may be found a sufficiently complete exposition of dental therapeutics of that and of the preceding periods. There is nothing, however, which is not already known to us from our examination of the earlier writers. Worthy of notice is the information that, among other things, to facilitate the cutting of teeth rubbing the jaws with turpentine was recommended at that time.312
Donato Antonio of Altomare, a Neapolitan physician and philosopher, dedicated a long chapter of his Ars medica313 to the subject of dental pains and their treatment. He classifies these pains with great accuracy, taking into account their seat and causes, and pointing out in each single case the method of cure to be followed according to the warm, cold, dry, or humid nature of the pain. In what he says, however, we do not find anything new.
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.
In the case of parulides, to soothe the pain and to accelerate the suppurative process, emollient substances should be used; afterward it is necessary to open the abscess with a lancet, to wash the mouth with mulse, and to aid the process of cicatrization by using syrup of roses.
As to epulides, these must be made to disappear, by sprinkling the tumor with the powder of gall-nuts, or by moistening them frequently with a decoction of gall-nuts, or with sulphur water. But if they do not yield to these remedies, and are the cause of functional disturbances, the surest and most prudent method of cure would be the use of the red-hot iron.
Giovanni Andrea Della Croce, a celebrated Venetian physician and surgeon, was the author of a most valuable treatise on surgery, which was published first in Latin (Chirurgiæ universalis opus absolutum, Venetitiis, 1573), and then in Italian under the title of Chirurgia universale e perfetta, Venezia, 1583. According to this author, dental fistulæ are more common to the lower jaw than to the upper one. To cure these fistulæ, it is necessary to extract the diseased teeth from which they originate, even should they ache but little or not at all. To confirm this, he relates in full a very interesting case of a dental fistula, that he cured by the extraction of a tooth which hardly ached at all.
Flajani314 chose to see in this case a precocious example of the opening of Highmore’s antrum through the alveolus. But the description given by Andrea della Croce of his case does not at all warrant this supposition.
At the end of his book Andrea della Croce gives us the figures of many dental instruments, which have, however, nothing new about them.
Gerolamo Capivacci, of Padua, repeats the advice (already given by preceding authors) to avoid, in eating and drinking, the rapid changes from heat to cold, and vice versa, since, says he, nature does not tolerate these rough changes.315 In the mercurial treatment of syphilis,316 he recommends the patient, as soon as the action of the remedy manifests itself in the oral cavity, to keep a piece of gold in his mouth, that the mercury, on account of its particular affinity, may unite with the gold and the harmful effects of this strange remedy on the mouth may be thus avoided. A strange method of curing mercurial stomatitis!
Johann Schenck von Grafenberg (1530 to 1598), a celebrated doctor of Freyburg-in-Breisgau, has left us, in his Observationes medicæ, a very rich and interesting collection of clinical cases. In this work he refers to many observations upon dental diseases by earlier authors, which, however, have already been noted by us in their time and place. Among other things, Schenck von Grafenberg relates that Cardanus was able, more than twenty times, to calm a violent toothache which tormented him by lightly pressing the sick tooth between the thumb and index finger of his left hand.
Peter Foreest (1522 to 1597), a very famous Dutch doctor of Alkmaar, repeats the very old error—already in decisive terms denied by Andreas Vesalius—that women have only twenty-eight teeth, whilst men usually have thirty-two. To the two central incisors he gives the name of columellares. Sugar and all sweet things, says this author, are very harmful to the teeth, and he gives as a proof the fact that apothecaries have, in general, very bad teeth, on account of the frequency with which they taste syrups and the like. Perhaps things are now changed, since I am not aware that chemists in our days are to be distinguished by the bad state of their teeth!
In regard to toothache, Foreest records an important observation which he had made on himself; an aching tooth which a surgeon had not succeeded in extracting, but which was simply loosened, ceased, without anything else being done, from giving him pain, and in a short while became firm again, and he continued to use this tooth for about five years. However, on a renewal of the pain he was obliged at last to have it extracted. On the strength of this observation, the author believes that in certain appropriate cases, recourse may be had to the luxation of a tooth, rather than to its extraction to obtain a cessation of toothache.
This method of cure had already been advised by a still earlier writer, that is, by Avicenna. When a subluxation produces the rupture of the dental nerve, this, in its results is equivalent to a replantation.
Foreest is the first to speak of the violent inflammation of the gums and of the whole mouth, caused by the application of artificial teeth of ivory fixed in their place with gold wire. This cannot at all astonish us when we consider how imperfectly, in those days, dental prosthesis was carried out and how the immobility of the artificial pieces, caused them to be a source of permanent irritation to the neighboring parts, especially on account of the difficulty met with in giving proper care to cleanliness. He, therefore, entirely rejects the application of artificial teeth. He is likewise but little inclined to the use of the pelican, it being very easy to break the teeth with it, and, instead, he recommends the use, whenever it be possible, of another instrument which he calls pes bovinus.
Foreest relates several cases of dental fistulæ which he had cured by the extraction of the faulty teeth. In one of these cases, observed in a lady, the fistula had opened between the nose and the cheek, so that a malady of the upper jaw was feared (and, in fact, as William Sprengel observes, it is not improbable that this was a case of affection of Highmore’s antrum); he obtained a complete cure in a short time by the extraction of a diseased tooth.
According to Peter Foreest, the existence of dental worms is as certain as is that of intestinal, auricular, and other worms. Even on the pretended efficacy of remedies, capable of making the teeth fall out without pain, he does not throw the slightest doubt.
Foreest attributes to his master, Benedictus of Faenza, the merit of having introduced into therapeutics the trephining of teeth for the cure of certain violent pains not accompanied by any external lesion of the tooth. We know, however, that the invention of this operation dates back to Archigenes. Benedictus trephined the tooth with a very fine drill (stylo vel terebello subtilissimo) and then filled it with theriac, using, likewise, as occasion required, other remedies.
To demonstrate the propriety and the necessity of laying bare the neck of the tooth before extracting it, he relates a case in which fracture of the jaw was the result of having neglected this precaution.
Among the sundry causes of the looseness of teeth, he mentions the softening of the dental nerve (emollitio), but this erroneous opinion had already been expressed by Galen.
As a means of cleaning teeth and keeping them free from tartar, he advises, among other things, the use of pumice-stone powder. He disapproves, however, of the use of oil of vitriol—unless in very minute quantities of, at the very most, one or two drops.317
Urbain Hémard, a surgeon to the Cardinal d’Armagnac, published in 1582, at Lyons, a booklet entitled: Recherche de la vraye anathomie des dents, nature et proprietez d’icelles, où est amplement discouru de ce qu’elles ont plus que les autres os; avecque les maladies qui leur adviennent, et les remedies. This is the first dental monograph that appeared in France. The pamphlet is written with much erudition, but its contents are almost entirely taken from preceding authors. Hémard indicates by the term deschapellement (decrowning) the removal of the crown of a tooth for curative purposes. He speaks of this operation as of a method but recently introduced into therapeutics; but, and very reasonably, too, he shows himself somewhat hostile to such a method of cure.
As to what concerns the anatomy of the teeth, Hémard’s book does not contain anything original. The following passage, transcribed by Portal,318 shows luminously that Urbain Hémard, instead of making researches of his own, has simply copied the Italian Eustachius, translating the latter almost literally. The beauty of it is that Portal had not noticed the plagiarism in the least, since he says that if Urbain Hémard had taken into account the researches of Fallopius and Eustachius as well, his book would have acquired still greater value. But, in truth, he has taken into account, and has valued the researches of Eustachius so much as to palm them off as his own! We here quote, side by side, with a paragraph taken from Hémard’s book, the corresponding passage of Eustachius, that our readers may be convinced of the truth of what we have stated:
| EUSTACHIUS. | HÉMARD. |
... aperta utraque maxilla occurrunt
incisores, canini, ac tres molares, nimirum
secundus, tertius et quartus; partim mucosi,
partim ossei, non obscuræ magnitudinis,
suisque præsepiolis undique vallati: incisoribus autem et caninis docta manu
detractis, tenuissimum interstitium vix
osseum factum conspicitur; quo pari diligentia
amoto, obviam veniunt totidem
incisores et canini pene mucosi et longe
minores, qui post alios priores in propriis
caveis latentes, singuli singulis e regione
oppositi collocati essent, nisi utriusque
maxillæ caninus magna ex parte proximo
incisori incumberet, eumque propterea fere
occultaret.319 Primorum molarium et genuinorum qui
circa septennium ac longe etiam postea oriuntur,
fateor me nullum vestigium vidisse. Verisimile tamen est, rationique consentaneum, eos perinde ac secundos incisores et caninos rude quoddam, sed minus perspicuum initium ortus in utero sumere; sensimque postea similiter formari et absolvi |
... leur ayant ouverte l’une et l’autre
mâchoire, j’y ai trouvé seulement les dents
incisoyres, les canines, et les trois mâchelieres
de chaque cousté de mâchoire; à
sçavoir la seconde, la troysième et la quatrième,
lesquelles estoit partie osseuses
parti mucillagineuses, de médiocre grandeur,
garnies à l’entour de leurs petits estuis
ou alvéoles. Et depuis ayant tirees dehors
lesdictes dents incisives et canines, il se
trouve un entre-deux osseux; lequel ayant
pareillement osté, il se presente de dessoubs
autant de dents incisives et canines, toutes
presque mucillagineuses, représentant la
substance d’un blanc d’œuf à demy cuite
moindres pourtant que les précédentes
estant cachées dans les mesmes estuits
après les premières. Quant est des premieres mâchelieres et des gemeles qui à sept ans, ou longtemps après commencent à sortir, je confesse n’en avoir trouvé jamais aucune trace n’y commencement. Toutesfois, il est vraysemblable et raisonable aussi, qu’elles ayent pris dans la matrice, tout ainsi que les incisoyres et canines secondes, quelque petit commencement de naysance et forme, moins apparante toutefois, mais qui depuis se façonne et parfaict tout ainsi que des autres. |
At the time when Urbain Hémard was publishing his pamphlet in France, several other monographs were already appearing in various parts of Europe on teeth and their affections. A few years after Ryff had initiated dental literature in Germany, other odontological writings were published in Spain and in Italy.
Francisco Martinez,320 in 1557, gave to the press in Valladolid a Coloquio breve y compendioso sobre la materia de la dentadura y maravillosa obra de la boca, con muchos remedios y avisos necessarios, y la orden de curar y adreçar los dientes.
In the same year and city was printed a Latin pamphlet, De dentione, by Franciscus Martinus de Castrillo, probably the author of the preceding book. In 1563 was published in Venice the excellent treatise of Eustachius on the anatomy of the teeth (Libellus de dentibus). At Frankfort was published, in 1576, the second dental monograph in the German language, Zahnarzney, by Adam Bodenstein von Carlstad; and two years later Petrus Monavius published in Basle a Latin pamphlet on dental diseases (De dentium affectibus).
The above-mentioned works, apart from the book of Eustachius, which is, of its kind, a real masterpiece, have but little importance. We have cited them here solely to show in what years and in what countries the very first dental monographs appeared.
Girolamo Fabrizio, of Aquapendente (1537 to 1619), a celebrated anatomist and surgeon, wrote some very valuable works, among which a treatise on surgery, in which the part relative to the affections of the dental system is treated briefly but with great orderliness and clearness, thus giving a very precise idea of what dental surgery was at the end of the sixteenth century.
The principal operations which it is necessary to perform on teeth are, he says, seven in number,321 viz.:
1. Forced opening of the dental arches in cases of prolonged constriction of the same, so as to prevent the patient from dying of hunger.
2. Cleaning of the teeth.
3. Medication of carious cavities.
4. Filling with gold-leaf.
5. Removal or resection of teeth abnormally situated.
6. Removal of any unevenness or sharpness of the teeth.
7. Extraction.
In regard to the first operation, the author first of all examines the various causes of the constriction of the dental arches, and according to the various nature of this, he indicates in what cases it is fitting to have recourse to the forced opening of the jaws by means of appropriate dilators, and in what cases it is best to avoid it. In the latter case one must seek to feed the patient in other ways—that is, either by alimentary clysters, or by a little tube passed through a space already existing or purposely made by the extraction of one or two teeth; or else by letting a cannula reach down to the pharynx, through the nose, or, lastly, by introducing a cannula into the oral cavity through the free space existing behind the last molars. But in regard to this last method, Fabricius notes that if the constriction is of a spasmodic nature, the spasm may affect not only the elevator muscles of the jaws, but also those that govern deglutition, including sometimes even those of the tongue itself, and in this case, as the food introduced into the oral cavity could not be swallowed, it is preferable to convey it directly into the pharynx, by means of a cannula passed through the nostrils.
The second of the above-mentioned operations322 is designed, says Fabricius, to take away the dirtiness of the teeth and the bad odor of the mouth (dentium immunditiam et oris fœtorem tollit). The dental tartar (ostracoderma) must be removed by slender instruments of an appropriate shape, which, for people of high position (promagnatibus) shall be made of silver. This advice is sufficient to make us understand that Fabricius, although an excellent surgeon, had no practice in dental operations; otherwise he would have known that the hardness and adhesion of tartar is generally so great that its removal absolutely requires scrapers of tempered steel and not of a soft metal like silver.
To arrest caries, he first drops into the carious hollow, by means of a small silver funnel, some drops of oil of vitriol, or of some other caustic liquid; and then he performs actual cauterization with appropriate instruments; after which the cavity is filled with gold leaf (auro foliato).
When one or more teeth have appeared in an irregular position and offend the walls of the oral cavity or else the tongue, the excision (resection) of the tooth or teeth must be performed with a pair of strong pincers, whose shape must vary according to whether the teeth are situated externally or internally with regard to the dental arches. But as after the resection there will almost always remain some points or sharp irregularities, which by their presence would continue to irritate the soft parts, it will be necessary to remove these irritating prominences by means of the file.
As to extraction, Fabricius of Aquapendente counsels great prudence in performing the operation, and on this point he repeats all the warnings already given by Celsus, an author whom he greatly admires and the study of whose writings he warmly recommends.
It seems that in those times there was more than sufficient reason to inculcate extreme caution in regard to the extraction of teeth. This was not then performed by true dentists, but rather by barbers and by ignorant tooth-pullers, or else, in exceptional cases, by general surgeons, very skilful, perhaps, in everything else, but little practised in the operation we are speaking of; besides this, the instruments left much to be desired; and lastly there was not, nor could there be, any idea of asepsis. What wonder, therefore, if the extraction of teeth was frequently the cause of serious injuries! Fabricius relates that it often happened to him to have to extract, in little fragments, half or sometimes a whole jaw, which had been attacked by putrefaction, as the result of the extraction of one single tooth. This, adds the author, may easily happen, because, when the jaw is attacked by pus in one point, its very anatomical constitution favors the rapid spreading of the putrefying process to the other parts of the bone, as this latter, apart from its external lamina, is entirely composed of a sponge-like substance.
The instruments which are used for the extraction of teeth, are, says Fabricius, of nine kinds;323 and the most important among them—generically called forceps—are indicated by special names, taken from their resemblance to the mouth or beak of certain animals. Thus, the forceps with which it is usual to perform the extraction of molar teeth are called “pelicans,” and of these there are two kinds, according as they are used for the right or the left side, for the upper molars or the lower ones.
A third kind of instrument goes under the name of “beak” (rostrum), and serves for the extraction of the incisors.
A fourth kind is the “crow’s beak,” or “crow’s bill,” which is used for the extraction of roots.
Two other instruments are named in Italian “cagnoli,” for they imitate the strong bite of the dog (in Italian cane) and are used in cases where the pelican is not adapted.
A seventh instrument is called by the Latin term of terebra (drill or auger). It is used instead of a lever to separate the teeth from one another when they are too close to each other, and so render their extraction much easier.
The eighth instrument is a “trifid lever” (vectis trifidus), so called because it is furnished with three points.
The ninth and last kind of instruments are the dentiscalpia, slender, sharp, and oblong tools, with which the gums are separated from the teeth before extraction.
Fabricius also speaks of dental prosthesis, but very briefly. He says that artificial teeth are made of ivory or of bone (for example, from the tibia of the ox) and are fastened by gold wire. One has recourse to this means especially to correct the bad appearance and the defects in speech deriving from the loss of the front teeth.
This author also makes some allusion to palatal obturators,324 but in very general terms, limiting himself to saying that when a perforation exists in the hard palate, it may be corrected by a piece of sponge or cotton, or with a plate of silver fixed in the palate, so as to close up the aperture (corrigitur spongia, vel gossypio, vel lamina argentea, quæ palato appendatur, ut foramen obstruat).
For epulides and parulides Fabricius advises the same methods of cure that had been recommended by Paul of Ægina.
In the case of flaccidity of the gums accompanied by looseness of the teeth, the treatment must consist, first of all, in superficial cauterization with the red-hot iron, after which the gums must be smeared with honey, the mouth washed with mulse, and lastly astringent powders must be used.
If the gums are much swollen, in near relation to the molar teeth, the use of the red-hot iron, says Fabricius, becomes very difficult from the want of space, and from the close vicinity of the healthy parts, which must not be injured. In such a case, it is necessary to remove, with suitable cutting instruments, as much as is possible of the morbid tissue (caro crassa et putrida); then to cauterize the remaining part, making the cautery, if necessary, pass through a tube, so as not to injure the surrounding parts. When, however, the gingival swelling bleeds very easily, and its excision thus might give rise to a profuse hemorrhage, it will be best to perform the operation with cutting instruments heated red-hot.
Fabricius remarks that although other authors do not make any allusion to these large gingival excrescences, he had had occasion to observe several cases, and had also had various instruments especially constructed for their cure.325
Johann Heurn, or in Latin Heurnius (1543 to 1601), of Utrecht, in his book on the diseases of the eyes, ears, nose, teeth, and mouth, treats sufficiently at length of dental diseases and their cure, but without adding anything of importance to what had been written by preceding authors. His work is a mere compilation, which would be without any importance whatever if it did not serve to show what credit was still given at that period to all the errors and prejudices which are to be found in the writings of the ancients.
Heurnius, although he wrote a long time after Vesalius, still adheres, in regard to the number of teeth, to the already mentioned opinion of Aristotle; he says, in fact, that women rarely have thirty-two teeth like men.326
He warns those who suffer from odontalgia not to have recourse thoughtlessly to tooth-drawers, but to recur, instead, to the doctor, who will always treat the affection according to the cause on which it depends.
And here the author repeats the numerous distinctions found in many preceding writers, and especially in Arculanus. The pain may be located in the gums, in the dental nerve, or in the very substance of the tooth; and in each of these cases it may depend on warm or cold matter, on dryness, humidity, etc.