CHAPTER 3.

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.