Page 49 - An essay on the diseasesof the jaws, and their treatment

DISEASES OF THE JAWS. 27 efiects, although neither without pain, nor so instantaneously as is asserted, a destruction of the vitality of the remaining roots or stumps, which then become extraneous bodies; the permanent irritation of which, liowever, must tend to excite disease and in- duce mortification not only in the adjoining parts, but also in the remaining teeth and gums—not to mention the very great and dangerous irritation produced at the same time upon the whole nervous system.* ence of nature. Moreover, by the insertion of the pivot into the canal of the root, the natural curative process, in the decomposition and absorption of the fang, is either prevented or retarded ; while, on the other hand, the most convenient outlet for a constant and regular discharge of the matter, which is always pro- duced by the carious root in the surrounding soft parts, is obstructed, and ex- tensive and painful swellings of the face and jaws are the consequence, some- times accompanied by great disturbance of the constitution "It would, therefore, be best to abandon the operation entirely in dental surgery, if it were possible; but such are its mechanical advantages, and its immediate, appa- rently, good eflFects, that it would be most difficult in many instances to dissuade the profession or the public from the adoption of an operation which has been so long ^sanctioned by custom, and even lauded for its immediate success, while its ulti- mate dangerous and injurious effects have remained unobserved, and have been almost invariably ascribed to erroneous causes. I shall, therefore, content myself with attempting the amelioration of a treatment the total avoidance of which seems not to be obtainable." Some surgeons have taken the same view of this operation as that expressed in the above quotation, but the dentists almost universally regard the pivoting of the teeth as one of the most ingenious and successful efforts of their art. Mr. — Liston, m his lectures, observes, " Inflammation [of the jaws] also frequently follows the bad operations of the dentist, sucli as pivoting the incisor teeth. In this proceeding the crown of the tooth is removed, and a false crown is fixed into the remaining part by means of a pivot, which is pushed into the cavity formerly occupied by the pulp of the tooth. Now, this is sometimes followed by active in- flammation of the remaining portion of the pulp extending to the socket, which runs to such an extent as to terminate only in the exfoliation of the alveolar — process, and the loss perhaps of several other teeth in consequence." " Lancet," 1843—4, vol. i., p. 170. Dr. Smethurst, in the " Lancet" for 1844, vol. i., p. 412, has recorded a very instructive case, fully exemplifying the occasional effects of pivoting, in their acute form, to which I beg to refer the reader, only premising that the patient was hardly more fortunate in the choice of his second dentist ; for the artificial tooth, fastened with gold wires to the adjoining teeth, which he inserted in place of the pivoted one, was as objectionable an appliance as could have been contrived. * " The teeth having been deprived of their vitality, by the destruction of their pulp, are not only rendered useless, but are converted into lifeless encumbrances upon the system, which produce, by their mechanical and chemical irritation, an action similar to that caused by gangrene or mortification in other bones, by which nature attempts to throw off the dead parts. " The parts surrounding such dead teeth, namely, the gums, periosteum, sockets, and maxillary bones, are thus involved in serious disease j inflammation gradually