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See also:DENTISTRY (from See also:Lat. See also:dens, a tooth) , a See also:special See also:department of medical See also:science, embracing the structure, See also:function and See also:Historical See also:therapeutics of the mouth and its contained See also:organs, See also:sketch. specifically the See also:teeth, together with their surgical and prosthetic treatment . (For the See also:anatomy of the teeth see TEETH.) As a distinct vocation it is first alluded to by See also:Herodotus (500 B.C.) . There are evidences that at an earlier date the Egyptians and See also:Hindus attempted to replace lost teeth by attaching See also:wood or See also:ivory substitutes to adjacent See also:sound teeth by means of threads or wires, but the See also:gold fillings reputed to have been found in the teeth of See also:Egyptian mummies have upon investigation been shown to be superficial applications of gold See also:leaf for ornamental purposes . The impetus given to medical study in the Grecian See also:schools by the followers of See also:Aesculapius and especially See also:Hippocrates (500 to 400 B.C.) See also:developed among the practitioners of See also:medicine and See also:surgery considerable knowledge of See also:dentistry . See also:Galen (A.D . 131) taught that the teeth were true bones existing before See also:birth, and to him is credited the belief that the upper canine teeth receive branches from the See also:nerve which supplies the See also:eye, and hence should be called " eye-teeth." Abulcasis (loth cent . A.D.) describes the operation by which artificial crowns are attached to adjacent sound teeth . Vesalius (1514), Ambroise See also:Pare, J . J . See also:Scaliger, T . Kerckring, M . See also:Malpighi, and lesser anatomists of the same See also:period contributed See also:dissertations which threw some small amount of See also:light upon the structure and functions of the teeth .
The operation of transplanting teeth is usually attributed to See also:
Later, Duchateau, an See also:apothecary of St Germain, made porcelain teeth, and communicated his See also:discovery to the See also:Academy of Surgery in 1776, but kept the See also:process See also:secret
.
Du Bois Chemant carried the art to See also:England, and the process was finally made public by M
.
Du Bois Foucou
.
M
.
Fonzi improved the art to such an extent that the See also:Athenaeum of Arts in Paris awarded him a See also:medal and See also:crown (See also:
G
.
Retzius, of See also:Sweden, and E
.
H
.
See also:Weber, J
.
C
.
Rosenmuller, Schreger, J
.
E. von Purkinje, B
.
Fraenkel and J
.
See also:
Thus there came to be two classes of practitioners, the first regarding dentistry as a specialty of medicine, the latter as a distinct and See also:separate calling
.
In See also:America representatives of both classes of dentists began to arrive from England and France about the time of the Revolution
.
Among these were John Wooffendale (1766), a student of See also:Robert Berdmore of See also:Liverpool, surgeon-dentist to See also:George III.; See also:
In England, and to some extent upon
the See also:continent, the old apprenticeship system is retained as an
See also:adjunct to the college course, but it is rapidly dying out, as it has
already done in America
.
Owing to the regulation by See also: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 See also:United States
.
Great Britain possesses upwards of
twelve institutions for dental instruction, France two, Germany
and See also: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
70o students; in 1907 there were fifty-seven schools, with 6919
students
.
Of these fifty-seven schools, See also:thirty-seven are depart-
ments of See also: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
.
See also:Recent studies have shown that besides being an important
part of the See also:digestive system, the mouth sustains intimate re-
lationship with the general nervous system, and is important as
the portal of entrance for the See also: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
.
Through the researches of See also:Sir J
.
Tomes, Mummery,
Research
.
Hopewell See also: Through their extensive nervous connexions with the largest of the See also: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 . See also:Gout, lithaemia, See also:scurvy, See also:rickets, See also:lead and See also: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 re-See also:search of modern times is that which was carried out by See also:Professor W . D . See also:Miller of See also:Berlin (1884) upon the cause of caries of the teeth, a disease said to affect the human See also:race more extensively than any other . Miller demonstrated that, as previous observers had suspected, caries is of bacterial origin, and that acids See also:play an important role in the process . The disease is brought about by a See also:group of bacteria which develop in the mouth, growing naturally upon the debris of starchy or See also:carbohydrate See also:food, producing See also:fermentation of the See also:mass, with lactic See also:acid as the end product . The lactic acid dissolves the See also:mineral constituent of the tooth structure, See also:calcium phosphate, leaving the organic See also:matrix of the tooth exposed . Another class of germs, the peptonising and putrefactive bacteria, then convert the organic See also:matter into liquid or gaseous end products . The accuracy of the conclusions obtained from his See also:analytic research was synthetically proved, after the manner of See also:Koch, by producing the disease artificially . Caries of the teeth has been shown to See also:bear highly important relation to more remote or systemic diseases . Exposure and See also:death of the dental pulp furnishes an See also:avenue of entrance for disease-producing bacteria, by which invasion of the deeper tissues may readily take See also:place, causing See also:necrosis, See also:tuberculosis, See also:actinomycosis, phlegmon and other destructive inflammations, certain of which, affecting the various sinuses of the See also:head, have been found to cause See also:meningitis, chronic See also:empyema, metastatic abscesses in remote parts of the body, See also:paralysis, See also:epilepsy and See also: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 See also:supply the loss of teeth by artificial substitutes . The filling of carious cavities was probably first performed with lead, sug- Fttltng or stopping . gested apparently by an operation recorded by See also:Celsus (100 B.C.), who recommended that frail or decayed teeth be stuffed with lead previous to extraction, in See also:order that they might not break under the forceps . The use of lead as a filling was sufficiently prevalent in France during the 17th 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.' 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 See also:form of rolls or tape it was forced into the previously cleaned and prepared cavity, condensed with See also:instruments under heavy See also:hand pressure, smoothed with files, and finally burnished . See also:Tin See also: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 See also:fair degree of purity, and, about 1855, led to the invention by Dr Robert See also: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 See also:alcohol See also:flame, which dispelled its See also:surface contaminations . The gold was then welded piece by piece into a homogeneous mass by plugging instruments with serrated points . In this process of See also:cold-See also:welding, the See also:mallet, hitherto in only limited use, was found more efficient than hand pressure, and was rapidly developed . The See also:primitive mallet of wood, ivory, lead or See also:steel, was supplanted by a mallet in which ' The filling of teeth with gold foil is recorded in the See also:oldest known See also:book on dentistry, Artzney Buchlein, published anonymously in 153o, in which the operation is quoted from Mesue (A.D .
857), physician to the See also:caliph Haroun al-Raschid
.
a See also:hammer was released automatically by a See also:spring condensed by pressure of the operator's hand
.
Then followed mallets operated by pneumatic pressure, by the dental See also: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 See also:simple See also: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 See also: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 See also:spiral osteotome of Cryer, by which, with a minimum See also:shock to the patient, fenestrae of any See also:size or shape in the See also:brain-See also:case may be made, from a simple trepanning operation to the more extensive openings required in See also:intra-cranial operations
.
The rotary See also:power may be supplied by the See also:foot of the operator, or by See also:hydraulic or electric See also:motors
.
The See also:rubber See also:dam invented by S
.
C
.
See also:Barnum of New York (1864) provided a means for protecting the See also: 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 See also:root-canals, it is the only efficient method of mechanically protecting the field of operation from invasion by disease-producing bacteria . The difficulty and annoyance attending the insertion of gold, its high thermal conductivity, and its objectionable See also:colour have led to an increasing use of See also:amalgam, guttapercha, and cements of See also:zinc See also:oxide mixed with zinc chloride or phosphoric acid . Recently much See also:attention has been devoted to restorations with porcelain . A piece of See also:platinum foil of •oo1 See also:inch thickness is burnished and pressed into the cavity, so that a matrix is produced exactly fitting the cavity . Into this matrix is placed a mixture of powdered porcelain and See also:water or alcohol, of the colour to match the tooth . The mass is carefully dried and then fused until homogeneous . Shrinkage is counteracted by additions of porcelain See also:powder, which are repeatedly fused until the whole exactly fills the matrix . After cooling, the matrix is stripped away and the porcelain is cemented into the cavity . When the See also:cement has hardened, the surface of the porcelain is ground and polished to proper See also:contour . If successfully made, porcelain fillings are scarcely noticeable . Their durability remains to be tested . Until recent times the exposure of the dental pulp inevitably led to its death and disintegration, and, by invasion of bacteria via the pulp See also:canal, set up an inflammatory process which eventually caused the loss of the entire tooth . A rational system of therapeutics, in See also:conjunction with proper antiseptic See also:measures, has made possible both the conservative treatment of the dental pulp when exposed, and the successful treatment of pulp-canals when the pulp has been devitalized either by See also:design or disease . The conservation of the exposed pulp is affected by the operation of capping . In capping a pulp, irritation is allayed by antiseptic and sedative treatment, and a metallic cap, lined with a non-irritant sedative See also:paste, is applied under aseptic conditions immediately over the point of pulp exposure . A filling of cement is superimposed, and this, after it has hardened, is covered with a metallic or other suitable filling . The utility of arsenious acid for devitalizing the dental pulp was discovered by J . R . Spooner of See also:Montreal, and first published in 1836 by his See also:brother Shearjashub in his See also:Guide to Sound Teeth . The painful See also:action of See also:arsenic upon the pulp was avoided by the addition of various sedative drugs,—morphia, atropia, See also:iodoform, &c.,—and its use soon became universal . Of See also:late years it is being gradually supplanted by immediate surgical extirpation under the benumbing effect of See also:cocaine salts . By the use of cocaine also the See also:pain incident to excavating and shaping of cavities in tooth structure may be controlled, especially when the cocaine is driven into the dentine by means of an electric current . To fill the pulp-chamber and canals of teeth after loss of the pulp, all organic remains of pulp See also:tissue should be removed by sterilization, and then, in order to prevent the entrance of bacteria, and consequent infection, the canals should be perfectly filled . Upon the exclusion of infection depends the- future integrity and comfort of the tooth . Numberless methods have been invented for the operation . Pulpless teeth are thus pre-served through See also:long periods of usefulness, and even those remains of teeth in which the crowns have been lost are rendered comfortable and useful as supports for artificial crowns, and as abutments for assemblages of crowns, known as See also:bridge-work . The discoloration of the pulpless tooth through putrefactive changes in its organic matter were first overcome by See also:bleaching it with See also:chlorine . Small quantities of calcium hypochlorite are packed into the pulp-chamber and moistened with dilute acetic acid; the decomposition of the calcium See also:salt liberates chlorine in situ, which restores the tooth to normal colour in a See also:short time . The cavity is afterwards washed out, carefully dried, lined with a light-coloured cement and filled . More efficient bleaching agents of recent introduction are See also:hydrogen dioxide in a 25% See also:solution or a saturated solution of See also:sodium peroxide; they are less irritating and much more convenient in application . Unlike chlorine, these do not form soluble metallic salts which may subsequently discolour the tooth . Hydrogen dioxide may be carried into the tooth structure by the electric current . In which case a current of not less than See also:forty volts controlled by a suitable graduated resistance is applied with the patient in See also:circuit, the anode being a platinum-pointed electrode in contact with the dioxide solution in the tooth cavity, and the See also:cathode a sponge or See also:plate electrode in contact with the hand or See also:arm of the patient . The current is gradually turned on until two or three milliamperes are indicated by a suitable ammeter . The operation requires usually twenty to thirty minutes . Mal.posed teeth are not only unsightly but prone to disease, and may be the cause of disease in other teeth, or of the associated tissues . The impairment of function which their abnormal position causes has been found to be the See also:primary cause of disturbances of the general bodily See also:health; for example, enlarged tonsils, chronic See also:pharyngitis and nasal See also:catarrh, indigestion and malnutrition . By the use of springs, screws, vulcanized caoutchouc bands, elastic ligatures, &c., as the case may require, practically all forms of dental irregularity maybe corrected, even such protrusions and retrusions of the front teeth as cause great disfigurement of the facial contour . The extraction of teeth, an operation which until quite recent times was one of the crudest procedures in minor surgery, has been reduced to exactitude by improved instruments, designed with reference to the anatomical relations of 6xtrac . See also:floe . the teeth and their alveoli, and therefore adapted to the several classes of teeth . The operation has been rendered painless by the use of anaesthetics . The anaesthetic generally employed is nitrous oxide, or laughing-See also:gas, the use of which was discovered in 1844 by See also:Horace See also:Wells, a dentist of See also:Hartford, See also:Conn., U.S.A . See also:Chloroform and See also:ether, as well as other general anaesthetics, have been employed in extensive operations because of their more See also:pro-longed effect; but chloroform, especially, is dangerous, owing to its effect upon the See also:heart, which in many instances has suddenly failed during the operation . Ether, while less manageable than nitrous oxide, has been found to be practically devoid of danger . The local injection of solutions of cocaine and allied anaesthetics into the See also:gum-tissue is extensively practised; but is attended with danger, from the toxic effects of an overdose upon the heart, and the local poisonous effect upon the tissues, which lead in numerous cases to necrosis and extensive sloughing . Dental Prosthesis.—The fastening of natural teeth or carved substitutes to adjoining sound teeth by means of See also:thread or See also:wire preceded their See also:attachment to See also:base-plates of carved Artinclal wood, bone or ivory, which latter method was practised teeth . until the introduction of swaged metallic plates . Where the crown only of a tooth or those of several teeth were lost, the Dental therapeutics . restoration was effected by engrafting upon the prepared root a suitable crown by means of a wooden or metallic See also:pivot . When possible, the new crown was that of a corresponding sound tooth taken from the mouth of another individual; otherwise an artificial crown carved from bone or ivory, or sometimes from the tooth of an ox, was used . To replace entire dentures a base-plate of carved See also:hippopotamus ivory was constructed, upon which were mounted the crowns of natural teeth, or later those of porcelain . The manufacture of a denture of this See also:character was tedious and uncertain, and required much skill . The denture. was kept in place by spiral springs attached to the buccal sides of the appliance above and below, which caused pressure upon both jaws, necessitating a See also:constant effort upon the part of the unfortunate wearer to keep it in place . Metallic swaged plates were introduced in the latter part of the 18th century . An impression of the gums was taken in See also:wax, from which a See also:cast was made in See also:plaster of Paris . With this as a See also:model, a metallic See also:die of See also:brass or zinc was prepared, upon which the plate of gold or See also:silver was formed, and then swaged into contact with the die by means of a See also:female die or See also:counter-die of lead . The process is essentially the same to-See also:day, with the addition of numerous improvements in detail, which have brought it to a high degree of perfection . The discovery, by Gardette of See also:Philadelphia in 1800, of the utility of atmospheric pressure in keeping artificial dentures in place led to the See also:abandonment of spiral springs . A later See also:device for enhancing the stability is the vacuum chamber, a central depression in the upper surface of the plate, which, when exhausted of See also:air by the wearer, materially increases the See also:adhesion . The metallic base-plate is used also for supporting one or more artificial teeth, being kept in place by metallic clasps fitting to, and` partially surrounding, adjacent sound natural teeth, the plate merely covering the edentulous portion of the alveolar See also:ridge . It may also be kept in place by atmospheric adhesion, in which case the palatal vault is included, and the vacuum chamber is utilized in the palatal portion to increase the adhesion . In the construction usually practised, porcelain teeth are attached to a gold base-elate by means of stay-pieces of gold, perforated to receive the platinum pins baked in the body of the tooth . The stay-pieces or backings are then soldered to the pins and to the plate by means of high-fusing gold See also:solder . The teeth used may be single or in sections, and may be with or without an See also:extension designed in form and colour to imitate the gum of the aveolar border . Even when skillfully executed, the process is imperfect in that the jointing of the teeth to each other, and their See also:adaptation to the base-plate, leaves crevices and recesses, in which food debris and oral secretions accumulate . To obviate these defects the enamelled platinum denture was devised . Porcelain teeth are first attached to a swaged base-plate of pure platinum by a stay-piece of the same See also:metal soldered with pure gold, after which the interstices between the teeth are filled, and the entire surface of the plate, excepting that in contact with the See also:palate and alveolar border, is covered with a porcelain paste called the body, which is modelled to the normal contour of the gums, and baked in a muffle See also:furnace until vitrified . It is then enamelled with a vitreous See also:enamel coloured in See also:imitation of the colour of the natural gum, which is applied and fired as before, the result being the most See also:artistic and hygienic denture known . This is commonly known as the continuous gum method . Originating in France in the early part of the 19th century, and variously improved by several experimenters, it was brought to its present perfection by .
Dr John See also:Allen of New York about 1846-1847
.
Dentures supported upon cast bases of metallic See also:alloys and of See also:aluminium have been employed as substitutes for the more expensive dentures of gold and platinum, but have had only a limited use, and are less satisfactory
.
Metallic bases were used exclusively as supports for artificial dentures until in 1855–1856 See also: The simplest crown is of porcelain, and is engrafted upon a sound natural tooth-root by means of a metallic See also:pin of gold or platinum, extending into the previously enlarged root-canal and cemented in place . In another type of crown the point between the root-end and the abutting crown-surface is encircled with a metallic See also:collar or See also:band, which gives additional See also:security to the attachment and protects the See also:joints from fluids or bacteria . Crowns of this character are constructed with a porcelain facing attached by a stay-piece or backing of gold to a plate and collar, which has been previously fitted to the root-end like a See also:ferrule, and soldered to a pin which projects through the ferrule into the root-canal . The contour of the lingual surface of the crown is made of gold, which is shaped to conform to the anatomical lines of the tooth . The See also:shell-crown consists of a See also:reproduction of the crown entirely of gold plate, filled with cement, and driven over the root-end, which it closely encircles . The two latter kinds of crowns may be used as abutments for the support of intervening crowns in constructing bridge-work . When artificial crowns are supported not by natural tooth-roots but by soldering them to abutments, they are termed dummies . The number of dummies which may be supported upon a given number of roots depends upon the position and character of the abutments, the character of the alveolar tissues, the See also:age, See also:sex and health of the patient, the character of the occlusion or bite, and the force exerted in mastication . In some cases a root will not properly support more than one additional crown; in others an entire bridge denture has been successfully supported upon four well-placed roots . Two general classes of bridge-work are recognized, namely, the fixed and the removable . Removable bridge-work, though more difficult to construct, is preferable, as it can be more thoroughly and easily cleansed . When properly made and applied to judiciously selected cases, the bridge denture is the most artistic and functionally perfect restoration of prosthetic dentistry . The entire development of modern dentistry See also:dates from the 19th century, and mainly from its latter See also:half . Beginning with a few practitioners and no organized professional basis, educational system or literature, its practitioners are to be found in all civilized communities, those in Great Britain numbering about 5000; in the United States, 27,000; France, 1600, of whom 376 are graduates; See also:German See also:Empire, qualified practitioners (Zahndrzie), 1400; practitioners without See also:official qualification, 4100 . Its educational institutions are numerous and well equipped . It possesses a large periodical and See also:standard literature in all See also:languages . Its practice is regulated by legislative enactment in all countries the same as is medical practice . The business of manufacturing and selling dentists' supplies represents an enormous See also:industry, in which millions of See also:capital are invested . |
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