ZH^j THE ANATOMY AND PATHOLOGY OF THE TEETH. BY C. F. W, BODECKER, D.D.S., M.D.S. With Three Hundred and Twenty-five Illustrations. Adopted by the Natioxat, Association of Dental Faculties AS a Text-Book imjk Dental Students. PHILADELPHIA: THE S. S. WHITK DENTAJ. MANrFACTTKING CO. 1894. Copyright. 1894, by C. F. W. Bodecker. TO HIS HIGHLY ESTEEMED TEACHER AND FRIEND, Carl Heitzmann, M.D., THIS BOOK IS DEDICATED BY THE AUTHOR. PREFACE. WHEN, nearly eighteen years ago, I lirst entered the hibora- tory of Dr. Carl Heitzmann and listened to his lectures on general histology, I became so thoroughly imbued witli tlie conviction of the correctness of his views that I resolved to study the tissues building up the teeth in tlie light of the novel doc- trine. Ever since I have been a faithful attendant at his labora- ti^ry. Besides myself, hundreds of dentists have attended that institution, largely owing to the enthusiastic impulse of my much-lamented friend, the late Dr. William H. Atkinson. As a consequence, a number of these gentlemen, including Professor Frank Abbott, Dr. William H. Atkinson, Dr. John I. Hart, and Dr. F. A. Roy, have enriched dental literature with the results of original investigations, made in the same labora- tory, all of which wdl be found embodied in this book. So long as the cell-theory holds sway over the minds of the majority of microscopists, the views here laid down cannot meet with general acceptance. As early as 1859 no less a man than Thomas H. Huxley declared that the history of the develop- ment of the teeth was not intelligible upon tlie grounds of the cell-theory. We to-day can state that neither the normal nor the morbid anatomy of the tissues is explicable on the basis of that theory. How long it will be before the novel views advanced by l^r. Carl Heitzmann, and which are directly antag- onistic to the cell-theory, will gain a tinal victory it is impossible to foretell. In our time discoveries are made in rapid succession : some are at once accepted, to be discarded later upon more critical investigation ; others, which meet with incredulity or VUl PREFACE. open denial at first, prevail in the long run, as they must do if verified by honest observations and facts. It is gratifying to my highly-esteemed friend and teacher to know that already a number of independent observers have indorsed his views. It is true lie has not escaped the criticism, even enmity, which appear to be the lot of every daring original investigator; but while opposition may delay the acknowledgment of these newly- interpreted facts, it will not be able to prevent their ultimate acceptance. I cheerfully acknowledge the great assistance rendered me by Dr. Carl Heitzmann in the preparation of this book. To him I am indebted not only for the artistic illustrations, which were all made by him, but also for aid in the microscopical researches, both those previously published and those here set forth for the first time. While the minds of the majority of American dentists are largely directed toward so-called practical topics, I yet hope that no intelligent dental practitioner — and this work has been written only for such — will lay aside the book, after its con- scientious perusal, without feeling that he has gained some additional knowledge from it. I ask only unlnased, conscientious reading. I know that our profession is not lacking in students competent and willing to give this, and to them I trust the verdict as to the value of my labors. This book may help in demonstrating that scientific investi- gations are not neglected in our country. Its preparation has cost all my leisure time during almost a decade ; but if its publi- cation shall prove of service to my profession, I shall feel more than repaid. Carl F. W. Bodeckbr. New York, July, 1894 CONTENTS. PAGE CHAPTER 1. The Superior Maxillary Bones 1 CHAPTER II. The Inferior Maxillary Bone 9 CHAPTER III. The Teeth . . . ' 18 CHAPTER IV. Individual Characteristics of the Teeth 24 CHAPTER V. The Pulp-Chambers of the Teeth 28 CHAPTER VI. The Articulation of the Teeth 84 CHAPTER VII. General Anatomy of the Human Teeth 39 CHAPTER VIII. General Histology 46 CHAPTER IX. Development of Connective Tissue 68 CHAPTER X. The Minute Structure of Dentine 69 CHAPTER XI. The Minute Structure of Enamel 90 CHAPTER XII. The Minute Structure of Cementum 101 CHAPTER XIII. Synopsis of the Development of the Teeth 124 CHAPTER XIV. Development of Dentin k 120 X CONTENTS. * GHAPTEE XV. page Deyelopmext of the Enamel 148 C H A P T E R X V I. Faulty Development 194 CHAPTER XVII. Development of Cementum .227 CHAPTER XVIII. The Development of Teeth in Embkyos affected with Rhachitis 232 CHAPTER XIX. The Dental Pulp 244 CHAPTER XX. The Perice.mentum 256 CHAPTER XXI. Eruption of the Teeth 261 CHAPTER XXII. Absorption of Temporary Teeth 264 CHAPTER XXIII. Physiology' of the Hard Dental Tissues 270 CHAPTER XXIV. General Diagnosis of the Diseases of the Teeth .... 274 CHAPTER XXV. Irritation and Keav Formations of Dental Tissue .... 288 CHAPTER XXVI. Secondary Dentine 292 CHAPTER XXVII. Mechanical Abrasion 309 CHAPTER XXVIII. Erosion 316 CHAPTER XXIX. The Reaction of the Dentine upon Fillings 320 CHAPTER XXX. Hyperostosis of Roots of Teeth 329 CHAPTER XXXI. Inflammation 348 CHAPTER XXXII. Inflammation of the Gums, — Ulitls 363 CONTENTS. XI C H A P T E 11 A X X T 1 1. ,.^„^. Inflammation ok Dkntink, — Ehuknitis ....... 370 CHAPTER XXX IV. Pulpitis in its Clinical Aspects 380 CHAPTER XXXV. MoKBii) Anatomy ok Pulpitis 397 CHAPTER XXXVI. Dkcenekations and Atkophies of the Pulp ...... 412 CHAPTER XXXVII. Morbid Anatomy of Atrophies and Degenerations of the Pulp . 420 CHAPTER XXXVIII. Pericementitis in its Clinical Aspect 432 CHAPTER XXXIX. Morbid Anatomy of Pericementitis 462 CHAPTER XL. Caries of the Teeth 488 CHAPTER XL I. The Effects of Arsenic Dioxide and Metallic Arsenic upon the Pulps of the Teeth, — So-Called Coagulation-Necrosis . . 518 CHAPTER X L 1 1. Necrosis of the Jaw-Bones 584 CHAPTER XLIII. Empyema of the Antrum 642 CHAPTER XLIV. The Clinical and Anatomical Features of Tumors in General . 546 CHAPTER XLV. Tumors of the Teeth 553 CHAPTER XLVI. Cysts in the Oral Cavity 569 CHAPTER XLVI I. Tumors of the Jaws 673 CHAPTER XLVIII. Malformations and Malpositions of the Teeth 609 LITERATURE 614 INDEX 669 The Anatomy and Pathology of the Teeth. CHAPTER I. THE SUPERIOR MAXILLARY BONES. To the dental practitioner these bones, together with the lower jaw-hone, are the most important ones of the human bod}'. They occupy the central region of the face, on either side of tlie nasal cavities, and each of them, in a normal condition, is mounted with eight teeth. In connection with the other facial and cranial bones, they constitute the frame-work of the upper and greater part of the face. Each superior maxillary contributes to the formation of the roof of the mouth ; to the floor and outer walls of the nasal cavities, as well as to the floors of the orbits. Aside from the Ixxhi, which is somewliat cuboidal in shape, we distinguish four processes, — z.e., the inalar, the nasal, the palatine, and the alveolar ]>rocess. The body of this bone con- tains a large cavity, the anlnun of Wf/hmore, obviously for the purpose of minimizing the Aveight of the bone, and at the same time of increasing it^^ pro[)ortionate strength. The external or facial surface (Fig. 1) shows above the incisor teeth a slight depression, called the incisive fossa. Outward from this is another depression, the canine fossa, which is deeper than the incisive, and sejiarated from it by a vertical ridge, the canine eminence, corresponding to the socket of the canine or cuspid tooth. At the upper portion of the canine fossa we observe the infra-orhifal foramen, through which pass the infra-orbital nerve and artery. The posterior or zygomatic surface is pierced by several aper- tures, tlie orifices of the jxtsUrior (hnfal canals, for the transmis- sion of the posterior dental vessels and nerves. The lower part 2 1 2 THE ANATOMY AND PATHOLOGY OF THE TEETH. of the zygomatic surface gradually develops into the maxillary tuberosity, which is most conspicuous after the eruption of the wisdom or third molar tooth. The superior or orbital surface is made up of a thin triangular plate of bone. It is traversed by the ii'fra-orbital groore, carrying the infra-orbital nerve and artery. This groove terminates in a canal, dividing into two branches ; one of which, the infra-orbital, opens below the border of the orbit, while the other, which is smaller, pierces the anterior wall of the antrum, and bears the name of anterior dented ceuial, transmitting the anterior dental vessels and nerve to the front teeth. Fig. 1. External or Faciai, Surface of the Right Superior Maxillary Bosk. 7, Incisive fossa : C canine fossa : E, canine eminence ; F, infra-orbital foramen : P, posterior dental canals : G, infra-orbital groove ; .1/, malar process. The malar process is a prominent rough eminence serving for the articulation with the malar bone. The descending ridge constitutes the boundary between the facial and z^'gomatic sur- faces.' From this ridge a small portion of the masseter muscle takes its origin. The nasal process, directed upward, has a concave external sur- face. The anterior border of this process articulates with the nasal bones ; the posterior is hollowed out by a groove in which the lachrymal duct lodges. This groove is converted into a THE SUPEKIOR MAXILLARY BONES. 3 canal by the lachrymal and a part of the inferior turbinated bones. The palate process (see Fig. 2) is a strong piece of bone project- ing horizontally from the inner surface of the superior maxilla. It is especially thick anteriorly, the upper surface forming a large portion of the floor of the nasal cavity, while the lower surface makes up the greater portion of the roof of the oral cavity. The lower surface is slightly concave, and is channeled at the posterior part of its alveolar border for the passage of the pos- terior palatine vessels and the anterior and external palatine Fig. 2. Inferior Surface ok the RniHT Superior Maxillary Bonk. P. palate process; S, anterior nasal spino ; ^1, opening of antrum; .1/, lower meatus of nasal cavity ; L, lachrymal groove. nerves. The two palate processes assist in forming an orifice in the median line, the 'anterior i>cdatiiie cuital. This canal is divided into four compartments, two of which run laterally to the right and left nasal fosste, while the anterior and posterior compartments run along the median line. The anterior one serves for the transmission of the anterior branch of the descend- ing palatine arteries. The anterior and the posterior c^mjart- ments transmitthe naso-palatine nerves, the left running through the anterior, the right through the posterior canals. The roof of the mouth is pierced by a number of small cijnals which 4 THE ANATOMY AND PATHOLOGY OF THE TEETH. cany the vessels for the nutrition of the bone. The upper sur- face of the palate process is concave and smooth, exhibiting the openings of the canals above mentioned. The inner border of the palate process is raised into a central ridge which supplies a space of attachment to the vomer. Anteriorly, this process pro- duces a sharp prolongation, the aidcrior nasal spine. The pos- terior border serves for articulation with the palate l)one. The upper portion of this surface shows a large, irregular opening, that of the antrum. The upper border of the opening is par- tially closed by the cellular cavities of the ethmoid bone. Below this opening a smooth concave surface presents itself, the hirer meatus of the nasal cariti/. Behind the opening we notice a rough surface that articulates with the perpendicular Fig. 3. The Alveolar Pkocess of the Right Superior Maxillaky Bone. Xiew from Below IN Natural Size. plate of the palate bone, being traversed by a groove which, with a corresponding portion of the adjacent palate bone, forms the posterior palatine canal, directed obliquely downward and for- ward. In front of the opening of the antrum a groove is seen, which with the lachrymal and inferior turbinated bones consti- tutes the lachrymal or nasal duct. At the base of the nasal pro- cess is. the horizontal or inferior turbinated crest for the articulation of this process with the inferior turbinated bone. The wall of the inferior meatus of the nasal cavity is perforated by numer- ous small foramina, which serve as carriers of nutrient vessels. The alreola.r proc(:-- subdivided into three smaller cavities, corre- sponding in number with the roots of the teeth. The socket of the third molar is usually single, while that of the iirst bicuspid exhibits two cavities, and that of the second bicuspid usually but one. The sockets for the incisors are always single. They are of roundish form for the central, but for the lateral incisors the sides of the receptacles are somewhat compressed. The