Page 36 - My FlipBook

10 PATHOLOGY OF THE HARD TISSUES OF THE TEETH.
starting in pits in the abrupt portion of the groove nearest the
incisal. The sharp, deep pits shown along the line of the second
groove have not been caused by decay, but were there when the
tooth came through the gums. These teeth are from different
persons, and in both cases were extracted in order to remedy
the defect with artificial teeth. This seems to have been done
under the mistaken notion that the roots of the teeth would not
be good for artificial crowns. Extended observation shows that
the roots of such teeth are as apt to be well developed and as
good for crowning as those of any other teeth. When the crowns
are so badly deformed that it is out of the question to employ
filling operations and preserve the pulps, artificial crowns
should be resorted to, rather than to remove the teeth. In case
the crowning involves the removal of the pulp, this should be
delayed as long as possible in order that the roots may be fully
formed and the apical foramen reduced to a small size. One
should wait until the patient is sixteen to eighteen years old, and
twenty would be still better. In many cases of considerable actual
deformity of the teeth the color remains very perfect, and in
this case, if the incisal edges of the incisors are fairly complete,
the deformity is not prominently noticeable, as is shown in Fig-
ure 8, from a photograph taken directly from the mouth.
Etiology.
This deformity of the teeth is always caused by illness that
has interfered with nutrition at the time the particular parts of
the teeth affected were in process of calcification. My attention
was strongly called to this through a controversy between Mr.
Hutchinson of London, and Dr. Magitot, of Paris, who took
opposite views some thirty or forty years ago. From Mr. Hutch-
inson 's observations he was led to believe at first that all
of these cases were caused by inherited syphilis, while Dr.
Magitot had come to the conclusion that they were due to
eclampsia. This controversy led to a closer study of this whole
subject, and finally Mr. Hutchinson yielded the point so far as
to say that inherited syphilis was a frequent cause, and for many
years beld that the type shown in Figure 1 was always caused
by inherited syphilis. That form, therefore, has been called the
Hutchinson tooth. As showing how errors are liable to be per-
petuated, most of the books on general medicine, surgery and
venereal diseases, which mention these deformities at all, ascribe
them to inherited syphilis, following the first writings of Mr.
Hutchinson without further investigation. They are continually
accusing innocent persons of crime.
The author has followed this subject pretty carefully ever