General Anatomy, Applied to Physiology and Medicine, Vol. 2 (of 3)

by Xavier Bichat

The following is the mechanism of this first dentition; the ossification extending constantly towards the root, the tooth can no longer be contained in the socket; it pierces the alveolar portion of the membrane and the mucous membrane of the mouth and an intermediate medullary texture that separates them, with much ease, as this triple layer gradually becomes thinner as the cutting approaches. Is this phenomenon owing only to the mechanical pressure of the tooth? I think that there is another cause; for observe that here the membranes are very little raised before rupturing; whilst that in polypi and other tumours that sometimes arise under the membrane of the gums, it is infinitely more stretched, still it does not break, but is only lifted up. The mechanism of the opening of the gums is not more known than the principle of the severe accidents which are sometimes connected with it. The sac which formed the original membrane of the follicle being thus open, its portion which lines the socket unites to the membrane of the mouth, becomes continuous with it and at the same time adheres intimately to the neck of the tooth; and as during the development of the root, the internal face of this membranous portion, at first loose as we have seen, has gradually contracted adhesions with it, it follows that this root is found fastened between the alveolar portion which lines its exterior, and the medullary portion which covers the interior; it is this which gives it solidity. As the adhesions of the membrane increase, we can less easily distinguish it. It is rare that in the first dentition the formation of the root is finished as completely as in the second; its internal cavity remains also very broad, and the marrow is more developed.

Second Dentition considered before Cutting.

It is necessary, as in the preceding case, to distinguish the nutritive phenomena into those which take place before, during and after the cutting. Before the cutting, we observe by opening the jaw, a row of dental follicles, corresponding to the row of teeth already formed, situated below or at the side, and separated from them by little partitions, the thickness of which is found greater in proportion as it is examined nearer infancy.

These follicles have precisely the same arrangement as those of the first dentition; like them they form sacs without an opening, the alveolar portion of which is attached, and the loose medullary portion is covered on its surface with the first osseous layers for the crown. The manner of growth is the same; that is to say, it takes place from the exterior to the interior, the reverse of the other bones; an arrangement, which gives the part of the tooth immediately in contact with foreign bodies, being the first formed, time to acquire the solidity necessary for its functions.

As the second teeth grow, their vascular system becomes greater, and that of the old ones diminishes; which arises from this, that the sensibility weakened in the last, draws to them no more blood, whilst being raised in the others, it attracts it powerfully. We observe also that the partition of the sockets diminishes in thickness, and that the root of the first is destroyed. This double phenomenon does not appear to be owing to the pressure exerted by the new tooth, as then the root would spread and become flat only; or if it experienced a real destruction, we should find the remains of it, which we never do. It is then probable that, it is by the absorption of the phosphate of lime, that the partition and root disappear, nearly as we have said the internal cavities of the cartilaginous bones are formed.

We see from this, that the ossification of the roots of the first teeth is of short duration; it begins the last and terminates the first. When it is of but little extent, the teeth become loose, from the want of insertion. The disappearance of the partitions increases it. It is at about the age of six or seven years that the shedding of them commences; this takes place in the order in which they were cut, that is to say, first the incisors, then the canine, and then the molars. Observe that the last, which appeared at four years of age, are not renewed.

Second Dentition considered at the period of Cutting.

During the cutting of the second teeth, we observe them come out in the same order as those with which they correspond are detached. 1st. The eight incisors. 2d. The four canine appear. 3d. In the place of the first molar, two new ones are cut; these afterwards have the name of small molars. 4th. The second molar remains, as we have just said; it is the first of the great ones. 5th. At eight or nine years of age, two other molars appear in each jaw. 6th. Finally, at eighteen, twenty, or thirty years, and sometimes later, a third molar is cut; this is called the dens sapientiæ.

There is then in each jaw sixteen teeth, of which four are incisors, two canine, two small molars, and three large ones.

Sometimes the second teeth while they are forming, instead of appropriating to themselves the nutritive substance of the roots of the first and their partition, leave them untouched; neither are destroyed; and the second teeth are cut at the side of the first which remain in their places. When this phenomenon happens, it is usually only to a single tooth; sometimes, however, it happens to many and even all, and then there is a double row. In general, the second teeth have a tendency to go out at the side of the gums. When very obliquely placed, by a defect of conformation, their crown leans forward or backward; instead of piercing the jaw, they remain always buried in the sockets.