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734 DENTAL CARIES.
and the other beginning in the interior of tlie tooth-structure, internal
caries. This latter he seems to have regarded as analogous to abscess
occurring in the bone, and says
" As the disease is more actively resisted by the greater vascularity, and
consequent activity, of the internal structure than by the harder and less
vital external parts of the tooth, it never proceeds so far toward the cavity
containinji; the nerves as to render this membrane altogether unprotected
by the bony structure, before it has penetrated through the external osseous
parts, including the enamel, and has thus formed a natural outlet for the
bony abscess."
It is curious how long and how continuously this old error of regard-
ing caries as having its beginnings within the structure of the dentine
was maintained—an error that, seemingly, should have been corrected
by any reasonably close observer. Yet, with the then pre\-ailing sup-
position that caries was the result of inflammation, there seemed to be
no reason why it should not as readily have its beginning in the depths
of the dentine as on its surface. Koecker makes a sharp advance, how-
ever, ujion the observations of his predecessors, in that he affirms
decisively that caries never extends inwardly so far as the pulp of the
tooth without having first appeared on the surface of the organ.
It will be noticed that these views coincide with the theories of the
causes of diseases of the bones in general, but especially those resulting
in caries or necrosis. Decay of the teeth was regarded as a sim-
ilar affection, but it was assumed, that, on account of their inability to
repair the damages to their structure, the dead portion decomposed and
a cavity was formed. The causes which were then generally regarded
as leading to this inflammation were changes of temperature and other
injurious impressions upon the surface of the teeth. It was, however,
held l)v some that the causes might be wholly internal, and that decay
might l)egin in the internal parts of the tooth (Fox) and work its way
outward, not appearing on the surface until great damage had already
been sustained. This opinion followed naturally from the supposition
that decay resulted from inflammation beginning in the membrana
eboris. In the bones inflammation of the periosteum may deprive
the part beneath of nourishment and cause its necrosis ; after this
manner, inflammation of the membrana eboris was regarded as depriv-
ing the superimposed dentine of its nourishment, causing caries. But
the supposition most generally advocated was that the inflammation
began in the dentine, just beneath the enamel.
About 1830 the inflammatory theory was attacked by a very large
nundier of intelligent dentists, and it was shown that, without great
modification, it was untenable. Harris in America, Robertson in Eng-
land, Regnard in France, and very many others, presented arguments
against it. Among the most potent of these was that based on the fact
that human teeth that had been removed, and afterward prepared and
mounted as substitutes, artificial teeth made from ivory, etc., were as
liable to decay as the natural organs. As such materials were then
much used for these purposes, this fact was very generally noted. This
decay, which was in all respects like that in the natural organs and ran
734 DENTAL CARIES.
and the other beginning in the interior of tlie tooth-structure, internal
caries. This latter he seems to have regarded as analogous to abscess
occurring in the bone, and says
" As the disease is more actively resisted by the greater vascularity, and
consequent activity, of the internal structure than by the harder and less
vital external parts of the tooth, it never proceeds so far toward the cavity
containinji; the nerves as to render this membrane altogether unprotected
by the bony structure, before it has penetrated through the external osseous
parts, including the enamel, and has thus formed a natural outlet for the
bony abscess."
It is curious how long and how continuously this old error of regard-
ing caries as having its beginnings within the structure of the dentine
was maintained—an error that, seemingly, should have been corrected
by any reasonably close observer. Yet, with the then pre\-ailing sup-
position that caries was the result of inflammation, there seemed to be
no reason why it should not as readily have its beginning in the depths
of the dentine as on its surface. Koecker makes a sharp advance, how-
ever, ujion the observations of his predecessors, in that he affirms
decisively that caries never extends inwardly so far as the pulp of the
tooth without having first appeared on the surface of the organ.
It will be noticed that these views coincide with the theories of the
causes of diseases of the bones in general, but especially those resulting
in caries or necrosis. Decay of the teeth was regarded as a sim-
ilar affection, but it was assumed, that, on account of their inability to
repair the damages to their structure, the dead portion decomposed and
a cavity was formed. The causes which were then generally regarded
as leading to this inflammation were changes of temperature and other
injurious impressions upon the surface of the teeth. It was, however,
held l)v some that the causes might be wholly internal, and that decay
might l)egin in the internal parts of the tooth (Fox) and work its way
outward, not appearing on the surface until great damage had already
been sustained. This opinion followed naturally from the supposition
that decay resulted from inflammation beginning in the membrana
eboris. In the bones inflammation of the periosteum may deprive
the part beneath of nourishment and cause its necrosis ; after this
manner, inflammation of the membrana eboris was regarded as depriv-
ing the superimposed dentine of its nourishment, causing caries. But
the supposition most generally advocated was that the inflammation
began in the dentine, just beneath the enamel.
About 1830 the inflammatory theory was attacked by a very large
nundier of intelligent dentists, and it was shown that, without great
modification, it was untenable. Harris in America, Robertson in Eng-
land, Regnard in France, and very many others, presented arguments
against it. Among the most potent of these was that based on the fact
that human teeth that had been removed, and afterward prepared and
mounted as substitutes, artificial teeth made from ivory, etc., were as
liable to decay as the natural organs. As such materials were then
much used for these purposes, this fact was very generally noted. This
decay, which was in all respects like that in the natural organs and ran
