Page 48 - An essay on the diseasesof the jaws, and their treatment

26 AN ESSAY ON THE operation of cutting off the crown of a tooth ; a treatment which has lately been recommended for the tooth-ache. See " Principles of Dental Surgery," Cases 33, 4, 35, 42, and 27 [being Nos. 05, 60, 59, 66, and 64 of the Catalogue in the Appendix]. With the exception of this last operation, the various methods, which ^have been recommended by Hunter, Fox, and other den- tists, for the purpose of destroying the vitality of the nerves of the teeth, have been adopted to cure or preserve the teeth them- selves, more or less with a view to their subsequent utility, and although the good effects may be very doubtful, their authors are entitled to our consideration and gratitude for their humane in- tentions. But the operation of breaking or cutting off the crown of painful teeth, which the inventor calls excision, is nothing less than an amputation by violent means, and cannot be adopted from any other cause than a culpable timidity on the part of the patient or the dentist, who are thus led to substitute it for the necessary extraction of the teeth, without even preserving the only useful and essential part, viz., its crown.* It unquestionably filling of the cavity), being really an extirpation, and having for its great aim the perfect and total removal of every portion of dead or diseased tissue, it is obvious that the practice which prepares the tooth for the reception of the stopping, by producing either partial or complete destruction of any of the parts that are the subjects of the operation, must be based on a total misconception of the principles of the treatment. • This operation is now much less practised for the cure of tooth-ache than for- merly: yet I have known it performed quite recently by dentists who enjoy the confidence of the public. But as preparatory to the operation called " pivoting," which consists of engrafting a new crown upon the roots of decayed teeth, it is part of the every-day practice of all classes of dentists. Pivoting is a mode of fixing artificial teeth, which enjoys a high reputation both among professional men and the public ; it is, however, an operation involv- ing so much that is at variance with sound pathology, that I have no hesitation in saying it may with reason, as usually performed, be ranked among the occa- sional exciting causes of the very serious diseases which form the subject of this essay. This has long been the opinion entertained by the author, who, in his " Essay on Artificial Teeth," thus expresses himself: — " This method of insert- ing artificial teeth, is one which requires great caution, and is frequently highly objectionable, from its being always attended with more or less irritation, which is sometimes of a dangerous, and even fatal nature; I will not, however, deny that it has frequently met with considerable success, and has not been followed by much inconvenience, but that such artificial teeth have, as Fox states, been used for many years without requiring repair." .... "By the pre- paration of the fang, and by the attachment of the artificial tooth, every morbid irritation of the dead fang upon the living surrounding parts is ex- cited and rendered generally more permanent than when left alone to the influ-