A History of Dentistry from the most Ancient Times until the end of the Eighteenth Century

by Vincenzo Guerini

Caries, says Hunter, is a disease of altogether obscure origin; it is not owing to external irritation or to chemical processes, and seems to be a morbid form altogether peculiar to the teeth. Only in very rare cases does it attack the roots of the teeth. It rarely appears after fifty years of age. Hunter does not admit that this disease may be communicated by one tooth to another. As to its treatment, the caries, if superficial, may be completely removed by filing the decayed part of the tooth before the disease penetrates to the cavity, and its spreading will thus be arrested for a time at least. In cases where the caries penetrates to some depth, without, however, the destruction of the crown of the tooth being so extensive as to render it useless, Hunter believed the best mode of treatment to be extraction and replanting of the tooth after having subjected it to boiling in order to cleanse it perfectly and to destroy its vitality entirely, this being, according to him, the mode of preventing the further destruction of the tooth, which once dead can no longer be the seat of any disease. If, instead, one wishes to have recourse to cauterization of the nerve, it is necessary to reach as far as the apex of the root; which, however, is not always possible. This is a very important point, for no one before Hunter had yet affirmed the necessity of entirely destroying the diseased pulp as an indispensable condition of the success of the filling to be later carried out in order to conserve the tooth.

Hunter is extremely concise when speaking of the filling of teeth; considering the great importance of this argument, his conciseness can only depend on his having had no personal experience in the matter. He considers lead preferable for fillings.

The frequent occurrence of erosion of the teeth, whether of the cuneiform variety or of other kinds, did not escape the attention of this acute observer, but he was not able to give any explanation of it.

In cases of empyema of Highmore’s antrum, Hunter advises the opening of the cavity through the alveolus of the first or second large molar.

Periodontitis is classified by the author among the diseases of the alveolar process. He occupies himself with this affection at great length, seeking to explain the mode in which it is produced. He distinguishes two forms of the disease, according to whether or not there be exit of pus from the alveolus. The alveolar process is, in his opinion, the principal seat of the disease, to which, as a complication, is added the retraction of the gums. For the diseased alveolus the tooth becomes, in a certain manner, an extraneous body, of which it tends to rid itself. The alveolar margins undergo absorption; the bottom of the alveolus tends to fill up, analogously to what occurs after extraction, and the falling out of the tooth ensues as a natural consequence of this process. An altogether similar process, producing the falling out of the teeth, is the normal consequence of senility.

The author considers that the malady in question has as its point of departure an irritation caused by a tooth; and as almost a proof of this he relates a case in which the extraction of the affected tooth, an upper incisor which became too long, and the transplantation of another tooth caused the cessation of the morbid process and the perfect consolidation of the transplanted tooth. However, Hunter does not draw from this isolated case the conclusion that transplantation may be elevated to a method of cure for this malady. Indeed, he says that, so far as is known to him, there is no means of prevention or of cure for it. His treatment, therefore, is merely directed to the curing, in so far as is possible, the phlogistic symptoms, by scarifications of the gum and by the use of astringent remedies. He does not exclude the possibility of a complete recovery, but the mode in which this obtains seems to him as obscure as is the nature of the disease itself.

In speaking of the correction of dental irregularities, Hunter advises not to extract the milk teeth unless this be an absolute necessity. He says, besides, that it is useless to extract any tooth whatever, unless one endeavors at the same time to force the irregular tooth or teeth into their normal position by exercising the requisite pressure upon them. In young subjects the regulating of crooked teeth is an easy matter, because of the softness of the maxillary bone. However, it should not be undertaken before all the bicuspids have come through. To correct protrusion of the upper jaw, the author recommends the extraction of a bicuspid on each side. To regulate the incisors it is sometimes necessary to make them rotate on their axis with the forceps. In certain cases of protrusion of the lower jaw one may have recourse with advantage to the inclined plane.

As a general rule, it is useless to lay bare a tooth with the lancet before extracting it, although in certain cases this may be advantageous in order to render its extraction easier and less painful.

Hunter was a strenuous partisan of replantation and transplantation of the teeth; he made various experiments on animals, and treated this important argument with particular fulness and much better than had been done up to then by others.

In cases of difficult dentition he considered incision of the gums most useful and, if necessary, to be had recourse to several times.