416
DENTISTRY
tion by law of the educational requirements, the increase of institutions devoted to the professional training of dentists has been rapid in all civilized countries, and during the past twenty years especially so in the United States. Great Britain possesses upwards of twelve institutions for dental instruction, France two, Germany and Switzerland six, all being based upon the conception that dentistry is a department of general medicine. In the United States there were in 1878 twelve dental schools, with about 700 students; in 1899 there were fifty-six schools, with 7633 students. Of these fifty-six schools, thirty-six are departments of universities or of medical institutions, and there is a growing tendency to regard dentistry from its educational aspect as a special department of the general medical and surgical practice. Recent studies have shown that besides being an important part of the digestive system, the mouth sustains intimate relationship with the general nervous system, and is important as the portal of entrance for the majority of the bacteria that cause specific diseases. This fact has rendered more intimate the relations between dentistry and the general practice of medicine, and has given a powerful impetus to scientific studies in dentistry. researches of Tomes, esearc . Through jj0peweq theSmith, Williams, and Mummery, others in England, Hertwig, Weil, and Rose in Germany, Andrews, Sudduth, and. Black in America, the minute anatomy and embryology of the dental tissues have been worked out with great fulness and precision. In particular, it has been demonstrated that certain general systemic diseases have a distinct oral expression. Through their extensive nervous connexions with the largest of the cranial nerves and with the sympathetic nervous system, the teeth frequently cause irritation resulting in profound reflex nervous phenomena, which are curable only by removal of the local tooth disorder. Gout, lithsemia, scurvy, rickets, lead and mercurial poisoning, and certain forms of chronic nephritis, produce dental and oral lesions which are either pathognomonic or strongly indicative of their several constitutional causes, and are thus of great importance in diagnosis. The most important dental research of modern times is that which was carried out by Professor W. D. Miller of Berlin (1884) upon the cause of caries of the teeth, a disease said to affect the human race more extensively than any other. Miller demonstrated that, as previous 'observers had suspected, caries is of bacterial origin, and that acids play an important role in the process. The disease is brought about by a group of bacteria which develop in the mouth, growing naturally upon the debris of starchy or carbohydrate food, producing fermentation of the mass, with lactic acid as the end product. The lactic acid dissolves the mineral constituent of the tooth structure, calcium phosphate, leaving the organic matrix of the tooth exposed. Another class of germs, the peptonising and putrefactive bacteria, then convert the organic matter into liquid or gaseous end products. The accuracy of the conclusions obtained from his analytic research was synthetically proved, after the manner of Koch, by producing the disease artificially. Caries of the teeth has been shown to bear highly important relation to more remote or systemic diseases. Exposure and death of the dental pulp furnishes an avenue of entrance for diseaseproducing bacteria, by which invasion of the deeper tissues may readily take place, causing necrosis, tuberculosis, actinomycosis, phlegmon, and other destructive inflammations, certain of which, affecting the various sinuses of the head, have been found to cause meningitis, chronic empyema, metastatic abscesses in remote parts of the body, paralysis, epilepsy, and insanity. Operative Dentistry.—The art of dentistry is usually
divided arbitrarily into operative dentistry, the purpose of which is to preserve as far as possible the teeth and associated tissues, and prosthetic dentistry, the ' purpose of which is to supply the loss of teeth by artifical substitutes. The filling of carious cavities was probably first performed with lead, suggested ap- F,llinsor parently by an operation recorded by Celsus (100 B.C.), who recommended that frail or decayed teeth be stuffed with lead previous to extraction, in order that they might not break under the forceps. The use of lead as a filling was sufficiently prevalent in France during the 17 th century to bring into use the word plombage, which is still occasionally applied in that country to the operation of filling. Gold as a filling material came into general use about the beginning of the 19th century.1 The earlier preparations of gold were so impure as to be virtually without cohesion, so that they were of use only in cavities which had sound walls for its retention. In the form of rolls or tape it was forced into the previously cleaned and prepared cavity, condensed with instruments under heavy hand pressure, smoothed with files, and finally burnished. Tin foil was also used to a limited extent and by the same method. Improvements in the refining of gold for dental use brought the product to a fair degree of purity, and, about 1855, led to the invention by Dr Robert Arthur of Baltimore of a method by which it could be welded firmly within the cavity. The cohesive properties of the foil were developed by passing it through an alcohol flame, which dispelled its surface contaminations. The gold was then welded piece by piece into a homogeneous mass by plugging instruments with serrated points. In this process of cold-welding, the mallet, hitherto in only limited use, was found more efficient than hand pressure, and was rapidly developed. The primitive mallet of wood, ivory, lead or steel, was supplanted by a mallet in which a hammer was released automatically by a spring condensed by pressure of the operator’s hand. Then followed mallets operated by pneumatic pressure, by the dental engine, and finally by the electro-magnet, as utilized in 1867 by Bonwill. These devices greatly facilitated the operation, and made possible a partial or entire restoration of the tooth-crown in conformity with anatomical lines. The dental engine in its several forms is the outgrowth of the simple drill worked by the hand of the operator. It is used in removing decayed structure and for shaping the cavity for inserting the filling. From time to time its usefulness has been extended, so that it is now used for finishing fillings and polishing them, for polishing the teeth, removing deposits from them and changing their shapes. Its latest development, the dento-surgical engine, is of heavier construction and is adapted to operations upon all of the bones, a recent addition to its equipment being the spiral osteotome of Cryer, by which, with a minimum shock to the patient, fenestra of any size or shape in the brain-case may be made, from a simple trepanning operation to the more extensive openings required in intra-cranial operations. The rotary power may be supplied by the foot of the operator, or by hydraulic or electric motors. The rubber dam invented by S. C. Barnum of New York (1864) provided a means for protecting the field of operations from the oral fluids, and extended the scope of operations even to the entire restoration of tooth-crowns with cohesive gold foil. Its value has been found to be even greater than was at first anticipated. In all operations involving the exposed dental pulp or the pulp-chamber and root-canals, it is the 1 The filling of teeth with gold foil is recorded in the oldest known book on dentistry, Artzney Buchlein, published anonymously in 1530, in which the operation is quoted from Mesne (a.d. 857), physician to the Caliph Haroun al-Raschid.
