Page 53 - An essay on the diseasesof the jaws, and their treatment

DISEASES OF THE JAWS. 31 no account of the state of the mouth, but affords indications of their origin being connected with the alveoli and teeth—in seventeen of these cases the indica- tions to that effect being quite conclusive; and twelve cases in wliich the teeth themselves are reporte d sound, but no proper account given of the condition of the whole mouth, seven of them, moreover, showing evidence of the gums and alveolar processes being particularly implicated. It is a remark made by Sir Charles Bell, (" Cases of Surgery," vol. i., p. 4, and "Lancet," 1833-4, vol. ii., p. 216) that "the teeth, gums and alveolar processes have something in common ;" that " they are one in constitution, and consequently I one in disease ;" and that " there thus exists a part of the jaw-bone intimately con- i — nected with the constitution of the teeth." Mr. Fox, to the same purpose, re- marks, " The alveolar processes are to be considered as necessarily belonging to the teeth, and not essential to the formation of the jaw-bones." (" Natural History and Diseases of the Human Teeth," part ii., p. 93.) Considering, then, this intimate connexion of the alveolar processes with the teeth, and comparative disconnexion with the body of the maxilla, the many evidences that have been adduced of the alveolar portion of the bone being the usual seat of the diseases of the jaws in their early stages, the notorious liability of the teeth—so continually exposed to a variety of vital, chemical, and mechanical influences—to the ra- vages of several painful and tedious diseases, and the very frequent occurrence of dental caries and other affections cf the teeth, as forerunners to the diseases in question, we may regard it as demonstrated, that the disorders of the teeth are, j almost without exception, the original sources of the affections of the maxillae. | ^This is rendered, if possible, still more certain, by the circumstance that those cases which at first sight seem to be exceptions, probably appear such, on accoimt of the want of attention generally displayed by medical men to the exciting and other causes of these diseases. In relating cases which have been the subjects of operation, they are too ready j to leave the liistory and early symptoms of the disease to give a detailed account of the steps of the operation. Many, even wiiile mentioning the presence of carious teeth, swollen gums, &c., seem quite unconscious that such affections of the mouth are capable of giving rise to more serious diseases of the neighbouring parts. A most extraordinary example of this blindness to tiie agency of morbid conditions of the teeth in the produc- tion of the diseases of the maxillaB is to be found in Dupuytren's remarks on one of the cases of osteo-sarcoma given in his " Legons Orales." After tracing, in his relation of the case, decayed teeth to be the original symptom, and the alveolar ridge the earliest seat of the disease, and finding in the timiour, after its removal, several carious teeth pushed out of their sockets and embedded in the — tumour, he proceeds. " In the above case this malignant disease developed itself without apparent cause, in a healthy person in the full vigour of life." ("Injuries and Diseases of the Bones, translated by Le Gros Clark," page 422.) Thus also, we frequently find the teeth reported quite sound, for the purpose of showing that there existed no dental irritation, at the very time that all the symptoms of alveolar absorption are enumerated. This is very obviously so in Mr. Hethng's case,—no. 310 of the Catalogue. When we reflect that in the adult jaw-bones there are no fewer than thirty- j two distinct articulations, which, on account of the firmness of their connexion, f the unyielding character of the teeth on the one hand and spongy concel- lated nature of the alveoli on the other, as well as the presence in each of dis- tinct vessels and nerves—terminating in the delicate pulp, which in structure and sensibility has been compared to the ganglia of the nerves—are the most pecu- liar of the whole body, we shall be able to perceive the reason that the maxilla; are so liable to be seriously deranged by direct violence. Blows on these bones