TEETH IN INFANCY AND CHILDHOOD
While the baby comes into the world apparently toothless, the dental
situation of the newborn is not as free from complications as it seems.
At the time of birth the first teeth are _practically completely
formed_, lying beneath the gums. And under the first teeth, the
permanent teeth are already beginning the process of formation.
It should be evident, therefore, that the soundness and strength of the
baby’s teeth depend upon (1) the nutrition which the mother has taken
while carrying the child, and (2) the nutrition which the baby receives
from the time of birth until the teeth make their appearance.
And, of course, the continued health of the teeth after they have all
come through the gums, throughout childhood and later, depends upon the
individual receiving foods containing the proper nutritive and vital
elements in subsequent years as well.
This is in addition to the regimen of oral hygiene already outlined.
Cleanliness preserves the teeth against the attacks of foreign foes
(germs), and prevents their breeding; but a properly balanced diet,
according to the age of the individual, builds good, sound teeth in the
first place, and makes them more resistant to disease and infections.
So we see that by combining oral hygiene with the right diet, we are
taking advantage of every means to establish and maintain sound,
healthy teeth, and this goes a long way toward building up health and
strength in body and mind.
MOTHER BUILDS HER BABY’S TEETH
As we have intimated the quality of our teeth is determined largely
before we are born. This depends upon the process of calcification
which in the deciduous, or temporary, teeth, begins some nineteen weeks
before birth; and in the permanent teeth (the first permanent molar is
the first to calcify) ten weeks before birth.
The calcification of the crowns, which is the part of the tooth exposed
to decay, is complete in the first set six months after birth, and in
the permanent set between the first and ninth years, excepting the
third molars (“wisdom” teeth), the crowns of which are not finished
calcifying until about the 12th year.
From this it will be seen that the quality of the first set of teeth
is largely dependent upon the diet of the mother during pregnancy and
the nursing period, as the food that the mother eats supplies, through
her blood circulation, nutrition for the growth and development of the
child.
Even thirty weeks before it is born, the baby commences to develop its
teeth. At about the sixth week after conception, a tissue forms on what
afterwards develops into the jaws of the embryo. This is termed the
“dental band.”
From this _dental band_, are formed the cells and sacs and tissues
which in due time become bone and pulp and enamel, and all the other
elements of the tooth structure.
During the busy months of the inter-uterine period, as we have noted,
the teeth are being formed, and for several months after birth they
are further developing, preparatory to breaking through the gums. The
second teeth, in fact, continue developing within the jaws for several
years before they finally make their appearance.
Organic mineral salts and vitamines are of the utmost importance for
the development of bone and teeth, and these can only be supplied the
unborn child, and the nursing child, if the mother’s diet is abundantly
supplied with these elements.
Inasmuch as the calcification of the permanent teeth continues, as we
have mentioned for a number of years during the child’s early life, it
is therefore necessary that the young individual be supplied with a
well-balanced diet during all the growing and developing years.
Unfortunately, our modern prepared foods which are so generally used,
are extremely deficient in vitamines and mineral salts. Consequently,
not only are the teeth frequently poor in quality, so that they become
ready prey to dental _caries_, but the whole organism suffers from this
deprivation.
Nor do strong, hard teeth necessarily remain so. The lime salts
which are used in the formation of the teeth may become absorbed by
the system if there is a deficiency of lime salts in the body. This
absorption (robbing the teeth of a vital element) takes place when the
diet is lacking in lime salts.
It is worthy of notice that these mineral salts are contained in
abundance in those parts of our food which are usually thrown
away--such as fruit skins, the hulks of grains, potato peelings, etc.
In the endless assortment of prepared and denatured foods that are
bought so lavishly at the corner grocery, much or all of the mineral
salts have been removed in the process of refining and preserving.
Not only is the question of food important from the standpoint of the
child’s well-being, but it is also very important to the pregnant
woman. Decayed and acutely abscessed teeth are common occurrences
during pregnancy. This is due to the demands upon the woman’s body in
the development of the new being within her.
A complete, new organism is being formed, and the entire material
must be supplied from the mother’s bodily chemistry. If her diet does
not include sufficient mineral salts, then the needs of the evolving
baby are at least partly supplied by drawing upon the salts from the
mother’s bones and teeth, thus predisposing to dental _caries_. This
important question will be further discussed in a subsequent chapter.
TEETH IN INFANCY
As has been stated, the “teething” problem of infancy does not begin
during the middle of the first year, or later, when the teeth usually
begin to erupt. It really begins with the inception of pregnancy, and
when this is understood, the teething problems of infancy will be more
easily and satisfactorily dealt with.
About the end of the sixth month, in the usual course of events, the
first of the deciduous teeth, make their appearance, generally the
lower front ones.
These are followed at more or less regular intervals by the upper
“incisors,” then the “back teeth,” and finally the “cuspids,” popularly
called the “stomach” and “eye” teeth, when the complete first set of
twenty teeth have appeared.
The ages at which the first teeth usually erupt are as follows:
Two lower front teeth (central incisors)--5 to 7 months.
Two upper front teeth (central incisors)--6 to 8 months.
Two more lower front teeth (lateral incisors)--7 to 9 months.
Two more upper front teeth (lateral incisors)--8 to 10 months.
Four back (molar) teeth, one on each side of the jaw--10 to 14 months.
Four more molar teeth, back of the others,--about 2 years.
Four cuspids (“stomach” and “eye” teeth)--2 to 2-1/2 years.
The appearance of each tooth is an important step in the development of
the child. When all the first teeth have come through, coarser foods,
that require a great deal of chewing, should be given to the child, and
it should be taught to masticate the food thoroughly.
Thorough chewing serves a two-fold purpose; first it insures proper
preparation of the food for its entry into the stomach; secondly, it is
necessary in order to properly develop the bones and tissues of the jaw
and head, thereby contributing to the facial appearance.
Proper attention to chewing, together with consideration for a balanced
diet, insuring sufficient organic minerals and phosphorus to supply
the teeth and bones with the necessary elements of their construction,
and mouth cleanliness, are the basic necessities for healthy teeth, a
healthy body and abundant vitality.
This regimen will contribute materially to the upkeep of the first
teeth, until they have served their purpose, which is much more
important than is generally supposed.
The preservation of the first teeth until they have completed their
useful function is of very great importance.
The premature loss of the “temporary” teeth may be followed by a train
of evils--imperfect chewing, poor digestion, irregularities of the
permanent set of teeth, distorted features, and frequently severe
suffering from toothache, which, if long continued, may induce chronic
nervous affections. Children afflicted in this manner make up a great
majority of the “backward” pupils in the public and special schools.
Parents should make it a practice to take the young children to a
dentist at regular intervals--at least every six months, and even every
three or four months in early childhood would be better, because of the
desirability of catching any decaying spots at the very beginning.
This will go far toward preventing decay, and will lead to the
detection of decay before much harm has been done. And not of least
important, it will restrict the dentist’s treatments to easy and
painless operations, so that the child will grow up with no fear of
dentistry.
DIETARY HINTS FOR INFANCY
Whenever possible, the nursing infant should be breast-fed until the
ninth month. There is no substitute which equals the mother’s milk when
it is of good quality and sufficient quantity to feed the infant.
Furthermore, the development of the baby’s jaws, teeth and skull, and
the facial and throat muscles, are promoted by breast feeding. So that
not only is the natural food far more desirable, but the exercise
and stimulation to growth, which are involved with the taking of the
natural food, make a definite contribution to the infant’s welfare,
that is lacking in connection with artificial food and bottle nursing.
The nursing infant should have plenty of cool, boiled water between
feedings.
If artificial feeding is deemed necessary, it is always better to
consult a baby specialist. The advantages of this have been proven over
and over again. Many useful hints, however, will be found in Dr. L.
Emmett Holt’s admirable book, “_The Care and Feeding of Infants_.”
When the baby is three months old, it may be given once a day a
teaspoonful of orange juice, strained and diluted with the same amount
of cool, boiled water. This amount may be increased gradually until at
the age of one year, the child is taking the juice of one-half orange.
Orange juice is wonderfully rich in vitamines and mineral elements, and
there is probably no more valuable article of diet for persons of any
age. If oranges are unavailable, a little ripe tomato juice, strained
and diluted may be used. No sugar should be added.
Solid foods should be introduced very gradually, so as not to cause any
disturbance of the digestive system, or interfere with the development
and growth of the child.
At the sixth month, it is well to add to the diet a well cooked wheat
or oat cereal, preferably with the mid-morning breast feeding. Begin
with a very small amount--a teaspoonful at the start is enough--and
gradually increase the allowance.
At from eight to nine months, a vegetable and some cow’s milk may be
added to supplement the regular feeding. This is best given in the
early afternoon. The vegetables to be preferred are spinach, swiss
chard, asparagus, cauliflower, onions, green string beans, squash,
celery, carrots, peas, white turnips, or potatoes cooked in a little
water, and put through a sieve and served with a little butter or
cream. No sugar should be used. Very small amounts should be fed the
child at first.
At about the same period, stewed and strained fruits may form a part of
the diet. Raisins, apples, pears, prunes, dates, and figs are all good
and more or less obtainable at any time.
When the baby is about eleven or twelve months old, it may be given
zweibach or hard buttered toast with one meal a day. This encourages
mastication.
The thorough mastication of food is indeed of fundamental importance.
It is not only necessary as a preliminary to good digestion, but also
for the proper development of the teeth, gums and jaws, and the facial
muscles. The formation of this habit has a pronounced influence on
facial appearance and on health.
To encourage mastication, as soon as the child is old enough to eat
solids, some hard foods that have to be well chewed should become a
part of the regular diet, as well as the soft foods. Crusts or pieces
of dry bread, bread-sticks, zweibach, with butter, will serve this
purpose. Hard breakfast foods should gradually be introduced from the
time the child is two years old.
At all times encourage the child to eat slowly and chew its food
thoroughly. This is very important. It is a valuable habit that can be
cultivated, and once formed, it becomes “second nature.”
While on the subject of the infant’s diet, it will be well to emphasize
that choice and range of foods for the older, growing child should also
receive adequate attention. This applies to all the developing years
of childhood and adolescence.
There should always, if possible, be two or three vegetables in the
daily diet. They may be selected from any of the following: Spinach,
lettuce, celery, beet tops, or any other greens, tomatoes, carrots,
white turnips, dried beans, string beans, peas, cauliflower, asparagus,
green peas, squash.
Fresh fruits in season, and dried fruits at other times, should
be called upon--oranges, apples, pears, peaches, raisins, prunes,
apricots, dates, figs, cantaloupe, berries, etc.
Milk is a most desirable supplementary food for the growing child,
because it is rich in the mineral elements and the vitamines. The
presence in appreciable quantities of Vitamine C, however, depends upon
the cow receiving plenty of green food. Furthermore, in sterilized,
pasteurized, or cooked milk, the vitamines are to a large extent
destroyed. The liberal use of fresh vegetables, and orange juice, which
are rich in vitamines, is therefore advocated when the milk has been
heated.
There are certain harmful habits, quite common in the long run, which
mothers should guard against in the raising of children. Thumb or
finger sucking is a bad habit, because it produces disfigurement of the
jaws and face, and also causes tooth irregularity.
The use of a so-called pacifier is to be condemned, as it leads to
flattening of the mouth, tooth irregularity, and introduces air into
the baby’s stomach.
Mouth breathing, a sign of obstruction in the breathing passages--often
adenoids, is a distressing habit, and should receive special surgical
attention. Among the ill results of this unnatural method of breathing
are irregularity of the teeth; disfigurement of the face, air
starvation, and increased susceptibility to infectious diseases.
Everything should be done to enable the child to breathe through its
nose.
THE PERMANENT TEETH
The first of the permanent teeth to make their appearance are the “six
year” molars. Not only are these the first of the permanent teeth, but
the largest. They differ from the teeth that have thus far appeared in
that they are not replaced by others. As they have no predecessor, they
are often mistaken for deciduous (“milk”) teeth and are neglected by
those who consider the deciduous teeth of little importance.
These teeth play an extremely important part in the architecture of
the mouth. They sustain the stress of chewing during the period in
which the temporary teeth are being replaced by permanent teeth, and
they also largely determine the position of the permanent teeth which
follow. Consequently, the very shape of the jaw and the contour of the
face are in part dependent upon the proper development and preservation
of the “six year” molars. This name has been applied to them because
they usually make their appearance about the sixth year. There is one
in each side of both jaws. It is the sixth tooth back, from the front
center, and should receive scrupulous care.
There are thirty-two teeth in the complete permanent set; sixteen in
the lower and sixteen in the upper jaw.
They take their places in the dental arches, roughly speaking, between
the ages of 6 and 18 years. The last to appear are the third molars
(“wisdom teeth”), which may come considerably later than this limit.
For all practical purposes, however, the years during which the
temporary teeth are shed and the permanent teeth erupted, may be put
between the age of 6 and 18.
The teeth are the advance agents of the digestive system. They are the
grinding mills and through the process of chewing they help to reduce
the food (supplemented by the salivary fluids) to a form suitable for
the digestive action of the stomach. The principal divisions of the
functions of chewing are to cut the food into pieces and to grind and
mix it with the secretions of the mouth.
There are several distinct types of teeth, each class designed by
nature for a specific kind of service. In a full set there are twelve
chisel teeth, 8 sharp tools with two points each, and 12 solid molars
with large surfaces for grinding purposes.
The “chisels” are the _incisors_, and the _canine_ or _cuspid_ teeth.
The double pointed teeth are the _bicuspids_; and the grinders are the
molars in the back of the mouth. We cut our food with the _incisors_,
_canines_ and _bicuspids_. The tongue turns the food around in the
mouth, and as a part of the process the molars grind the food into fine
bits.
The following table gives an approximate idea of the time and the order
in which the permanent teeth erupt, the figures, of course, being
subject to slight variations in different individuals:
Four first molars, one on each side of each jaw--5 to 7 years.
Two lower front (central incisors)--5 to 7 years.
Two upper front teeth (central incisors)--6 to 8 years.
Two more upper front teeth and two more lower front teeth (lateral
incisors)--6 to 8 years.
Two “eye” and two “stomach” teeth (cuspids)--9 to 12 years.
Eight bicuspids, four upper and four lower--10 to 12 years.
Two upper and two lower second molars--12 to 14 years.
Two upper and two lower third molars--17 to 25 years.
It is not uncommon for the third molars (“wisdom teeth”) not to appear
at all, in which case they are usually more or less developed, but
remain in their crypts in the jaws for lack of space in the dental
arch to accommodate them, or are malposed (turned out of their normal
position), so their eruption is difficult or impossible.
About the time of this writing, Dr. Reiss had occasion to remove
two impacted, unerupted, incompletely developed third molars from a
man about sixty years of age. There was no clinical evidence of the
presence of these teeth in the jaws, and they were only revealed by
an X-ray picture. After their removal, the patient reported general
improvement in health, as well as the passing or local agitation in his
jaws which had hitherto greatly inconvenienced him.
INFANT MORTALITY FROM TOOTH TROUBLES
Dr. Harvey W. Wiley, the pure food expert, is responsible for the
following astounding statement, which should cause every parent to
pause and consider the dental question with respect to the child: “One
thousand children die daily in this country; their deaths due more to
defective teeth than to any other trouble.”
The high rate of mortality during the first year of life is too well
known to need emphasizing. However, the notable reduction in this
death rate in some of the more progressive communities, indicates that
very great strides can be made in saving the lives of infants during
the first year. And it is not unreasonable to suppose the increased
knowledge of mouth hygiene among educated people is an important factor
in bringing about this desirable result.
The influence of clean teeth and clean mouths on older children, in
preventing contagious diseases common to childhood, such as scarlet
fever, measles, and diphtheria, has already been noted.
John Sayre Marshall, M.D., a well known dental authority, in “_Mouth
Hygiene and Mouth Sepsis_,” states that nearly all forms of stomatitis
that affect infants and small children may be traced to an unclean
condition of the mouth.
NORMAL SIGNS OF TEETHING
The usual signs of teething in healthy children are an increased flow
of saliva; a tendency to put the fingers or some hard article in
the mouth and bite on; swollen and congested gums; fretfulness and
disturbed sleep; loss of usual appetite; sometimes slight diarrhea; and
often a slight fever.
These symptoms, however, usually last only three or four days, while
the teeth are coming through the gums.
Most of the digestive disturbances of babyhood, generally attributed to
teething, are due to improper feeding, and to chilling of the body.
The right kind of food and plenty of cool boiled water are the best
aids to teething. A hard dry crust of bread may be given, or a freshly
cooked chicken leg, without any meat on it, to bite on.
If it should be deemed necessary to have the gums lanced to relieve
difficult teething, extreme care should be taken to keep the wound
clean, so as to avoid infection. The lancing, of course, should be done
by a physician or dentist.
The first few teeth that have erupted may be kept clean by the use of a
piece of clean gauze, or cotton wrapped around the mother’s or nurse’s
finger and dipped in a normal salt solution (1/2 level teaspoonful of
salt to a glass of cool boiled water). The cleaning should include,
besides the teeth, the gums, roof of the mouth, tongue, and inside of
lips and cheek.
During the nursing period, the mother’s breast should be cleansed with
cool boiled water.