It is to be observed, however, that the insects that are found generally in the ripe wild teasle—or more precisely their larvæ—had already been used for a long time as a remedy against toothache; indeed, we even find these means of cure recommended in the natural history of Pliny. In a book entitled Histoire d’un voyage aux îles Malouines fait en 1763 et 1764, by a certain Dom Pernetty, this author speaks of some remedies made known to him by the Superior of the Franciscan friars of Montevideo; and among others one finds the following: “One draws out the worm that is generally found in the head of the fuller’s teasle when this is ripe. One rolls this worm between the index finger and the thumb, lightly pressing it until it dies of languor. The one or the other of the two fingers applied on the aching tooth will have the virtue, for a year at least, of making the toothache cease.”[532]
Heinrich Callisen, in an excellent treatise on surgery[533] published at Copenhagen in 1788, writes at sufficient length and with great accuracy on dental and maxillary diseases. According to this writer, it rarely suffices to trepan one alveolus for the treatment of the morbid collections of Highmore’s antrum, as the maxillary sinus is very often divided by partitions into various cells, so that in order to give exit to the pus contained in each of them, it is necessary to extract several teeth and trepan their alveoli.[534] One ought not, therefore, to give the preference to this method, unless in the case of the teeth in question being decayed. But should they all be in a good state, or should a large opening be necessary because of the nature of the disease in the cavity, it will be better to follow Lamorier’s method, that is, to incise the gum crosswise under the malar process and then, after scraping away the periosteum, trepan the bone. Further, in the case of the disease in the maxillary sinus having given rise to tumefaction, softening of the bone, and fluctuation in the palatine region, it is precisely there that the perforation ought to be carried out. To prevent the reclosing of the opening before the cure is completed, the author advises the use of pledgets, small bougies, a piece of prepared sponge, or even a small tube. According to Callisen, the injections through the nasal orifice of the maxillary sinus are partly impracticable, and partly of no utility.
It always does more harm than good to file or to scrape the decayed part of a tooth, without stopping it afterward, as by thus doing, says the author, one only renders it still more liable to the access and the action of harmful external influences. In preparing the cavity for stopping, the bottom of it should be more ample than its external aperture, that the filling may remain firm.
For extracting molars, he makes use either of the pelican or of the key; for the incisors and the canines, of the forceps; and for roots, of the goat’s foot.
Callisen treats incipient idiopathic epulis by destroying it through cauterization, after having covered the teeth with wax; if the epulis be large and more or less hard, he removes it with the bistoury; as to symptomatic epulis, he holds the removal of the original cause to be the best mode of treatment.
This author declares himself decidedly in favor of replantation and transplantation, expressing the idea that these methods are always to be preferred to the application of artificial teeth. He maintains that after a tooth has been replanted, and its consolidation has taken place, there is no possibility of any further pain, the nerve being broken. The author relates a brilliant cure which he carried out upon a lieutenant, who, during the siege of Copenhagen, had received a blow that had sent all his front teeth into his mouth. Callisen immediately put them all back in their places with such ability that they became perfectly firm again. With reference to transplantation, he only believes in its being possible for teeth with a single root.
In works published toward 1790, Lentin and Conradi, devoted their particular attention to the morbid conditions that produce looseness and spontaneous falling of the teeth. For the treatment of these conditions Conradi recommended general and local remedies. The general remedies were directed to the suppressing of acridness in the blood, which he considered to be an etiological element of primary importance. As to the local remedies, they ought specially to consist in keeping the teeth clean by the use of a toothbrush, in painting the gums with tincture of catechu and myrrh, and in rinsing the mouth frequently with a decoction of cinchona or of willow bark. Against toothache caused by caries, he particularly advises essence of cloves, introduced into the carious cavity on a piece of cotton-wool.[535]
Friedrich Hirsch was much less disposed than were many of the preceding writers to incision of the gums in cases of difficult dentition. Against the accidents connected with this morbid condition, he prefers, in general, the use of gentle aperients or of emetics, and regards the scarification of the gums as opportune only in cases where symptoms indicating a high degree of nervous tension manifest themselves.
Against incipient caries, Hirsch used simple cauterization, which he held to be capable of arresting the morbid process, at least in many cases. He says, however, that when a real carious cavity exists, it is absolutely necessary to stop it; and for this purpose, rather than metallic or resinous fillings, he prefers a cement of turpentine and quicklime, made into a paste with varnish of oil of linseed. Nevertheless, when it is a case of the lower teeth, tin-foil is also, according to him, an excellent filling material.
Like some of the preceding authors, Hirsch admitted the existence of interior caries in apparently healthy teeth, and was the first to indicate a good mode of diagnosticating these occult dental affections. It consists in tapping the suspected teeth with a sound until one finds the one in which the percussion provokes pain, and this will be the diseased tooth. One detaches the gum from the neck of this tooth, and at the point, on the neck itself or on the beginning of the root, where a small protrusion is found, one perforates the tooth with a chisel, or some other fit instrument, so as to penetrate to the interior of it. Through this passage one introduces into the tooth a fine, curved, red-hot sound, repeating the operation several times. Lastly, one fills the cavity with lead; and in this manner the tooth will be cured and no longer painful.