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Etiology in Orthodontic Cases*
ETIOLOGY IN ORTHODONTIC CASES* By HAROLD CHAPMAN, (Eng.) L.D.S., London, England
STU D Y of the textbooks will confirm the fact that not a single case is reported whose etiology is supported by a sufficient history of the case (local causes excepted). This led me to investigate about thirty cases1 from which certain conclusions might be drawn. The investigation included a detailed history of each case, some physical tests and some measurements. In one or the other of these cases, many, if not all, of the recognized causes of irregularities have been operative, and can be proved, directly or indirectly, to have had no effect. The cases were selected because they presented (1 ) normal occlusion exposed to reputed causes of malocclusion; (2) normal occlusion in a patient having brothers and (or) sisters with abnormal occlusions; (3) abnormal but dissim ilar occlusion in brothers and sisters; or (4) abnormal but similar occlusions in brothers and sisters. A consideration of no more than the first class of cases (those with normal ♦ R e a d b e fo re th e Section on O r th o d o n tia a t th e S ev en th In te rn a tio n a l D e n ta l C ongress, P h ila d e lp h ia , P a ., A u g . 2 4, 1926.
occlusion, but exposed tq reputed causes of malocclusion) makes it evident that the etiology of an orthodontic case re quires to be most carefully considered if it is to be of value. The conclusions drawn from this in vestigation were: 1. Antenatal causes, e. g., heredity and parental health, are major causes. 2. Postnatal causes are of secondary importance, except, per haps, mastication. In the normal occlusion cases, there is a better physique than in the others judged by the results of the physical tests. Malocclusion seems to be asso ciated with other physical defects; which Jansen regards as evidence of “feebleness of growth,”2 and probably a large percentage of cases of malocclu sion may be so regarded, though the other evidence of feebleness of growth may be difficult to trace without thor ough investigation, because the com paratively late age at our examination has given time for the body to mask or outgrow many of the more patent signs, especially if the child has been carefully tended. Artificial feeding, the use of paci fiers, the presence of tonsils and ade noids, and mouth breathing are found
1. C h a p m a n , H a r o l d : O rth o d o n tic s : I n v e stig a tio n s in E tio lo g y , D e n t. R ec., A u g u s t, 1925 ; T h e N ecessity o f C o m p lete H isto ries to E sta b lish E tio lo g y , etc., T r . E u ro p e a n O rth o d o n to l. Soc., 1925.
2. Ja n se n , M u r k : Feebleness o f G ro w th a n d C o n g e n ita l D w arfism , O x f o r d P re s s ; Som e o f the L if e P ro p e rtie s o f B one Sub stance, T r . E u ro p e a n O rth o d o n to l. Soc., 1 924 -5 D en t. R ec., Ju n e , 1925.
Jo u r . A . D . A ., N o v em b er, 1927
2046
Chafman— Etiology in Orthodontic Cases
2047
throughout the various types of occlu- ciety for the Study of Orthodontics has sion in the cases investigated which were drawn up two questionnaires, consisting normal, Class I and Class II, Division
I have said enough to convey the nec essity for full histories in orthodontic cases, if we are to arrive anywheie near
Fig-. 2.— M o d e ls f ro m first c h ild , f a m ily A .
F ig . 3.— M o d e ls f r o m second c h ild , f a m ily A .
of two sheets for each individual, one to be filled in by the dentist, and the
F ig 4. — M o d e ls f ro m second ch ild , f a m ily A .
the truth as regards etiology. To assist other by the parent, and each sheet so its members to this end, the British So- ruled that it may be used for three chil-
2048
The Journal of the American Dental Association
dren in one family. Copies of these as so few dentists possess the necessary questionnaires and the letter sent out instruments. There should be added to the questionnaires inquiries covering with them are appended.
F ig . 5.— M o d e ls f r o m th ird c h ild , f a m ily A .
F ig . 7.— M o d e ls f ro m f o u r th c h ild , f a m ily A.
It will be seen that these question naires are exhaustive, and, in drawing housing, environment and data regard them up, an endeavor was made to in ing other relatives with similar occlu clude all possible factors. There is sions.
F ig . 6.— M o d e ls f r o m th ird ch ild , f a m ily A.
F ig . 8.— M o d e ls f r o m f o u r th ch ild , fa m ily A .
one important omission: the physical I will refer to the question of mouth tests, including those of the muscles of breathing to show the detailed informathe jaws, lips and tongue, are omitted,
Chafman— Etiology in Orthodontic Cases
2049
tion these questionnaires call for. It is However, the method is not perfect; necessary to know whether the mouth e.g., in regard to a child of 6 years, it is breathing occurs by day or by night; also often very difficult for the parents to the cause, degree, age of onset, date
F ig . 9.— M o d e ls f ro m first c h ild , f a m ily B.
when nasal breathing was restored and, if several of the same family suffered, which child was most affected; etc. By this method, pursued by a large number of practitioners, a real advance in the knowledge of etiology could be made.
F ig . 11.— M o d e ls f r o m second ch ild , f a m ily B.
remember all the details asked for with any degree of accuracy; and, in a child of 12, the difficulties of obtaining an accurate history are considerably greater. The only certain way would be to write
F ig . 10.— M o d e ls f ro m first c h ild , f a m ily B.
2050
T he Journal o f the American Dental Association
up a history of the child’s health every Clinical Research, in the same city, but at less frequent intervals. Unfor two weeks or so, from birth. tunately, there is no provision for dental
F ig . 14.— M o d e ls f ro m th ird c h ild , f a m ily B. Fig'. 12.— M o d e ls f r o m second ch ild , fa m ily B.
care or treatment of any kind for these children until they are of school age, This is being done at the Child W el but the histories are available for any fare Centre, St. Andrews, Scotland, one who cares to consult them, and some during the first two years of life. day they should prove very valuable in any research work along these lines.
F ig . 15.— M o d e ls f ro m th ird ch ild , f a m ily B. F ig . 13.— M o d e ls f r o m th ird c h ild , f a m ily B.
In illustration of the method adopted After that, the child’s record is made at by the British Society for the Study ofthe Sir James Mackenzie Institute for Orthodontics, I present seven cases in
Chapman— Etiology in Orthodontic Cases
two families, four in family A (Table 1), and three in family B (Table 2). The complete charts of these are appended. Here, I shall refer only to the salient points. In these replies, there is not a factor disclosed to which a causative relation to the differences in the occlusion of the normal (or almost normal) ones and T
able
disclosed by the histories are negative in a similar way. In another family of children, I have models (not illustrated here) of six, every one of whom has normal occlu sion; or, in one instance, the occlusion might be described as Class I. I have never seen a family in which so many children had such good occlusion. Un-
1.— D a t a R e g a r d i n g F a m i l y A ; F o u r C h i l d r e n ( F ig s . 1 - 8 ) *
O cclusion.
1st C h ild
2n d C h ild
3 rd C h ild
N o . 539.
N o . 307.
N o . 540.
N o . 541.
F ig s. 1-2.
F ig s. 3-4.
F ig s. 5-6.
F ig s. 7-8.
N o rm a l
A g e difference. M a sticatio n .
F eeble
D ie t a f t e r 1st y ear.
In c lin e d to be “ s lo p p y ;” lack ed solids
M o u th b re a th in g N asal o b stru ctio n R ick ets D istu rb e d n u tritio n H a b its an d pacifiers E n v iro n m e n t:
2051
\ I > \ /
N one
4 th C h ild
C lass I
N o rm a l ( a lm o s t)
N o rm a l ( a lm o s t)
1 6 /1 2
1 8 /1 2
2 1 1 /1 2
M e d iu m
V ig o ro u s
M e d iu m
N one
N one
N one
T h e sam e f o r a ll.
* T h e rep lies to th e q uestions are f o r p ra c tic a l purp o ses id e n tic a l f o r a ll f o u r .
the bad Class I can be ascribed. The one factor that might be causative as regards the Class I case, and included by Jansen as a cause of “feebleness of growth,” is that the child was born only 16 months after his sister. The next child was born 18 months after this one, and has good occlusion; so this factor is not at all definite in this family, and it has to be remembered that there is no question of any form of deprivation. The effects of any remaining differences
fortunately, I have no history except that they are the progeny of nomads and were born on the Sussex Downs. From this, I deduce that the parents were very healthy and that the antenatal life of the children was unaffected by modern civilization. I have reported these cases not so much that conclusions may be drawn (except that etiology in the past has been thoroughly neglected), but to show that there is much scope for investigation in this field. Certainly, it appears to offer
The Journal o f the American D ental Association
2052
The letter sent out with the question the reward of success to those who un dertake it. It is to be hoped that writers naires follows: will adopt some plan, such as that out T H E B R IT I S H S O C IE T Y F O R T H E S T U D Y O F O R T H O D O N T IC S . lined, when reporting cases. 11 C h a n d o s S treet, L o n d o n , W .l . Hatfield3 says: “Advance in this field 2 5 th M a y , 1926. (etiology) is imperative if we are to T
a b l e 2.—
D ata R eg a rd in g F a m il y
B;
T
1124. F ig s.
9-10
C h i l d r e n ( F ig s .
9 - 1 5 )*
2 n d C h ild
3 rd C h ild
N o. 1125. F ig s. 11-12
N o. 1126. F ig s. 13-15
1st C h ild N o.
hree
Class I I , D iv . 1, id en C lass I I , D iv . 1, id e n Class I I , D iv . 1, u n i tical w ith th a t o f sec tical w ith th a t o f first la te r a l— n o t severe child ond c h ild
O cclusion
4 1 1 /1 2 years
A g e d ifference
1 9 /1 2 years
A n te n a ta l fa c to rs M o th e r ’s h e a lth ( a ) m e n ta l (b ) p h y sical
G ood G ood
D a n g e ro u s illness eld e r c h ild caused w o rry G ood
W e ig h t a t b irth
iV -i ib.
4- lb., 14 oz.
6%
D ie t, first y e a r
A rtificial
B reast f e d ( ? )
B reast fe d
H ab its
N one
Sucked fin g ers
N one
Nose a n d m o u th M o u th
N ose a n d m outh M o u th
Nose Nose
A d en o id s a n d tonsils
T o n s illitis a t 8 years
T o n s illitis
N o to n sillitis
G en eral h ealth
Good
G ood
G ood— gets cold easily
P h y siq u e
Good
G ood
S lig h t b u ild
B re a th in g :
j^
O th e r m em b ers o f f a m ily w ith sim ila r occlusion
at
of
7 years
Shock o f h u sb a n d ’s death six w eeks b e fo re c h ild ’s b irth G ood lb.
T w o fe m a le cousins a n d one a u n t T h e m o th e r believes th e c o n d itio n o f these tw o to be due to to n sillitis.
* In th e tw o e ld er c h ild re n , it is difficult even to su g g est a cause f o r the m alocclusion, unless i t be h ered ity .
differentiate between those cases which are susceptible of successful treatment and those which are not or, still more important, to distinguish those cases which require treatment from those which do not.”
IN V E S T IG A T I O N S C O M M I T T E E .
in v e st ig a t io n
o f o r t h o d o n t ic
e t io l o g y .
D e a r S ir ( o r M a d a m ) :
T h e In v e stig a tio n s C o m m ittee has h ad its a tte n tio n d ra w n to the p ro b a b ility th a t O rth o do n tic E tio lo g y has n o t received th e consid e ra tio n it m e rits an d th a t the causes assigned 3. H a tfie ld , H . K . : P ro g n o sis in D isto - are fre q u e n tly based on insufficient evidence a n d in q u iry . T h e C o m m ittee considers this clu sio n Cases, I n te rn a t. J . O rth o d o n t., J a n u su b ject o f g re a t im p o rta n c e a n d w e ll w o rth y a ry , 1922.
BRITISH SOCIETY FOR TH E STUDY OF ORTHODONTICS 11. Chandos Street, W.I. H is to r ie s
o f C h ild r e n
o f th e S a m e
F a m ily ,
for the purposes of investigating the etiology of malocdusion. To be filled in by the parents. Each sheet may be usedfor three children. Note.—In some cases the answers are anticipatedor suggested; delete the words which do not apply Relevant information, additional to that asked for, will be appreciated. Dental Surgeon's Name— Address—
I. Sign or number. To indicate family to whichchildbelongs. 2. Child's name or number and sex. 3. Race. 4. Date of birth (age) 5. Height.
6. Weight.
<
Early.
)
Late.
CHILD III.
M. F.
U. F.
Clothed. Unclothed. Age.
7. Walked at.
Take the children in the order of their ages. CHILD II.
CHILD I.
( Clothed. Unclothed. Age.
Early.
M. F.
;
Late.
( Clothed. Unclothed. Age.
Early.
i
Late.
8. Physical varia
tions ininfancy.
9. Knock-knees, flatfoot or other changes.
ro. Ante-natal factors (i) Father’shealth. (ii) Mother’s health. (a) Mental. (b) Physical. (iii) Otherfactors (iv) Normal birth or difficulties.
11. Weight at birth. 12. Length at birth and other mea surements.
1How long ? *3 list (Breastfed f Vigorous. Medium. (How long? ijJyear IArtificial (What foods? Q 1and to 6th years. 1After 6th year 14. Sweets. in H
1
16. Mastication.
Feeble.
Many
Few.
Daily.
Irregular
Medium. | Vigorous. Rapid. Slow.
Feeble.
/How long ? IVigorous. Medium. / How long? 1What foods?
jHow long? Feeble. (Vigorous. Medium i How long ? t What foods ?
Many
Few
Daily.
Irregular
Vigorous. Medium Rapid. Slow
Feeble
Additional Information to be written in the space above.
Feeble
Many
Few
Daily
Irregular
Vigorous Medium Rapid. Slow
Feeble
17- Habits, i.e. sucking thumb, fingers, tongue, lips, etc. Howlongeachday. Betweenwhat ages. 18. Comforter. Usedbetweenwhat ages. Howlongused at onetime. Ifusedduringsleep. 19. Breathing. Day. Night. If mouth breathing, state:— 1.Possiblecause. 2. Degree. 3. Ageof onset. 4.Date when nasal breathing restored. 5.Wed hich child suffer most, which least, andsoon. 20. Adenoids &Tonsils Age at which sus pected. Date of operation.
S o a t} iawmovement-
S L ? ) j awmoven,ent
X u ” ^ m o v e m e n t.
SftouT)iawmovement'
S o u ?H awmo™nent-
S o u T tiawmovement-
Nose. Nose.
21. Nasal obstruction. Present. Age of onset. Nature of obstruction 22. Rickets. 23. Disturbed nutri tion. Give ages. 24. Illnesses. Give ages of occur rence of each.
Mouth. Mouth.
Both. Both.
Nose. Nose.
Mouth. Mouth.
(Constant. \ Partial.
Yes.
No.
Both. Nose. Both. Nose. Constant. Partial.
Present.
Yes.
25. General Health and physique. Type of exercise taken at diffe rent ages
26. Inherited charac teristics.
27. Ages of children older.
28. Age of child. 29. Ages of children younger
30. Father’s date of birth. General health. Physique. Other details
31. Mother’s date of birth. General health. Physique. Other details.
Yjt»
Mouth. Mouth.
Additional Information to be written in the space above.
Both. Both. Constant. Partial.
Present.
Yes.
BRITISH SOCIETY FOR TH E STUDY OF ORTHODONTICS 11, Chandos Street, W.l. H is to r ie s o f C h ild r e n o f th e S a m e F a m ily ,
for the purposes of investigating the etiology of malocclusion. Tobe filled in by the Dental Surgeon. Each sheet may be usedfov three children. Relevant information, additional to that asked for, will be appreciated. Denial Surgeon’s Name— Address Takethechildrenii the order oftheir ages. 1. Sign or number. Toindicate family to whichchild belongs.
CHILD II.
CHILD III.
2. Child's name or
number and sex.
3. Occlusion. 4. Sitting height. 5. Nose and nostrils. Obstruction ^Left** Long, Medium. Short, Everted Long, Medium, Short. Everted Long, Medium, Short, Everted 6. Lips. Lengthofupperlip. Lipridge.* Upper lip. Firm. Lower lip. Firm. Pendulous
7. Tongue.
Habitual position. ILadfof contact Iwlth paIate Size. Shape. Strength.
contact }with
Contact , ,, Lack of contact f™* palate
8. General condition of mouth.
9. Condition of teeth Cleanliness. Caries. Hypoplasia.
10. Condition of gums. 11 Natural spacingof deciduous teeth.
1z. Age of commence
ment of spacing of deciduous teeth.
13. Attrition of de ciduous teeth Incisors. Canines Molars.
14. Premature or re
tarded eruption of deciduous and permanent teeth
15. Any other infor mation
16 Father’s occlusion 17 Mother socclusion.
Models and, when possible, photographs to be presented. (Also models and photographs of parents when possible.) Additional Information to be written in the space above or on the back. *Alip ridge isa ridge in mouth breathers uponthegumof the maxillaor mandible, usuallyboth, indicatingwheretheliprests, that portionnot com pressed beingswollen, either as a definitehypertrophy or aa cedemaof the soft tissues. Y»s»
2056
T h e Journal o f the Am erican D ental Association
of investigation which, to be o f value, must be considered by a large number o f persons who are specially interested in the work, such as Members o f the Society. The Committee suggests that suitable cases for investigation are those families in which there are at least three children, one o f whom has a normal occlusion ; or in which all three children have similar occlusions, but the Com mittee has no desire to limit the investigation to such cases only. Questionnaires (one to be filled in by the dentist and the other by the parent) have been drawn lip for this purpose. T w o blank questionnaires of each kind are enclosed. A separate chart is to be used for each fam ily. Where there are more than
three children in a fam ily extra charts should be used for that fam ily. Each child should be given a number, and in addition each fam ily a sign or number. The Committee requests that the Charts, completed with models, etc., may be returned not later than the 30th of November, 1925, addressed to me— 76 Grosvenor Street, Grosvenor Square, London, W. 1. Mr. A. L. Packham, The Hon. Secretary of the Society, w ill be pleased to furnish extra questionnaires on request being made to him at 79 Portland Place, London, W. 1 . Yours faithfully, B. M axwell Stephens , H o n . S ecretary In v e stig a tio n s C o m m ittee .
FACTORS IN THE CONTROL A N D CURE OF PYORRHEA*
By THOMAS BRADFORD HARTZELL, M.D., D.M.D., F.A.C.D. Minneapolis, Minnesota Y O R R H E A alveolaris, as w e all know , is characterized by a slow onset an d com plete lack o f all those sym ptom s th a t usually a ttra c t the atten tio n o f the victim s o f disease. T h e r e f o r e , the sufferer fro m periodon toclasia ra re ly appreciates th a t his tissues are n o t no rm al u n til the disease has de stroyed so m uch o f the tooth a ttac h m e n t th a t the tooth can n o t be preserved. T h is u n fo rtu n a te state o f affairs could be elim in ated i f every m em ber o f our profession w o u ld m ake it a rule to ob serve, as a m a tte r o f habit, and to dem onstrate to each p atien t w ith dis closing stain, the fa c t th a t a ll surfaces o f h u m a n teeth th a t are not im m ediately scoured by food in the n a tu ra l process
P
*Read before the American Academy of Periodontologv, Philadelphia, Pa., Aug. 20, 1926.
o f m astication are covered by bacteria, an d th a t these bacteria produce d estru c tive fe rm e n ts w hich, by th e ir toxin, dis solve the tissues and cause the break in g dow n o f tooth attach m en t. I f w ith this know ledge w e w ere to teach an effective m eans o f rem o v in g or com bating these organism s, n o t only periodontoclasia, but also tooth decay w o u ld alm ost cease to exist fo r a ll those ind iv id u als w ho grasped these facts an d effectively ap plied them . T h e co n tro l an d prevention o f a l m ost a ll the death d ealin g diseases has become easy ju st in proportion as we have learn ed th eir etiology an d applied preventive m easures to co n tro l the action o f th e ir etiologic facto rs. F ro m day to day an d w eek to w eek, w e see new victories in this field. T h e pathw ay o f m edicine is paved by these victories,
STU D Y of the textbooks will confirm the fact that not a single case is reported whose etiology is supported by a sufficient history of the case (local causes excepted). This led me to investigate about thirty cases1 from which certain conclusions might be drawn. The investigation included a detailed history of each case, some physical tests and some measurements. In one or the other of these cases, many, if not all, of the recognized causes of irregularities have been operative, and can be proved, directly or indirectly, to have had no effect. The cases were selected because they presented (1 ) normal occlusion exposed to reputed causes of malocclusion; (2) normal occlusion in a patient having brothers and (or) sisters with abnormal occlusions; (3) abnormal but dissim ilar occlusion in brothers and sisters; or (4) abnormal but similar occlusions in brothers and sisters. A consideration of no more than the first class of cases (those with normal ♦ R e a d b e fo re th e Section on O r th o d o n tia a t th e S ev en th In te rn a tio n a l D e n ta l C ongress, P h ila d e lp h ia , P a ., A u g . 2 4, 1926.
occlusion, but exposed tq reputed causes of malocclusion) makes it evident that the etiology of an orthodontic case re quires to be most carefully considered if it is to be of value. The conclusions drawn from this in vestigation were: 1. Antenatal causes, e. g., heredity and parental health, are major causes. 2. Postnatal causes are of secondary importance, except, per haps, mastication. In the normal occlusion cases, there is a better physique than in the others judged by the results of the physical tests. Malocclusion seems to be asso ciated with other physical defects; which Jansen regards as evidence of “feebleness of growth,”2 and probably a large percentage of cases of malocclu sion may be so regarded, though the other evidence of feebleness of growth may be difficult to trace without thor ough investigation, because the com paratively late age at our examination has given time for the body to mask or outgrow many of the more patent signs, especially if the child has been carefully tended. Artificial feeding, the use of paci fiers, the presence of tonsils and ade noids, and mouth breathing are found
1. C h a p m a n , H a r o l d : O rth o d o n tic s : I n v e stig a tio n s in E tio lo g y , D e n t. R ec., A u g u s t, 1925 ; T h e N ecessity o f C o m p lete H isto ries to E sta b lish E tio lo g y , etc., T r . E u ro p e a n O rth o d o n to l. Soc., 1925.
2. Ja n se n , M u r k : Feebleness o f G ro w th a n d C o n g e n ita l D w arfism , O x f o r d P re s s ; Som e o f the L if e P ro p e rtie s o f B one Sub stance, T r . E u ro p e a n O rth o d o n to l. Soc., 1 924 -5 D en t. R ec., Ju n e , 1925.
Jo u r . A . D . A ., N o v em b er, 1927
2046
Chafman— Etiology in Orthodontic Cases
2047
throughout the various types of occlu- ciety for the Study of Orthodontics has sion in the cases investigated which were drawn up two questionnaires, consisting normal, Class I and Class II, Division
I have said enough to convey the nec essity for full histories in orthodontic cases, if we are to arrive anywheie near
Fig-. 2.— M o d e ls f ro m first c h ild , f a m ily A .
F ig . 3.— M o d e ls f r o m second c h ild , f a m ily A .
of two sheets for each individual, one to be filled in by the dentist, and the
F ig 4. — M o d e ls f ro m second ch ild , f a m ily A .
the truth as regards etiology. To assist other by the parent, and each sheet so its members to this end, the British So- ruled that it may be used for three chil-
2048
The Journal of the American Dental Association
dren in one family. Copies of these as so few dentists possess the necessary questionnaires and the letter sent out instruments. There should be added to the questionnaires inquiries covering with them are appended.
F ig . 5.— M o d e ls f r o m th ird c h ild , f a m ily A .
F ig . 7.— M o d e ls f ro m f o u r th c h ild , f a m ily A.
It will be seen that these question naires are exhaustive, and, in drawing housing, environment and data regard them up, an endeavor was made to in ing other relatives with similar occlu clude all possible factors. There is sions.
F ig . 6.— M o d e ls f r o m th ird ch ild , f a m ily A.
F ig . 8.— M o d e ls f r o m f o u r th ch ild , fa m ily A .
one important omission: the physical I will refer to the question of mouth tests, including those of the muscles of breathing to show the detailed informathe jaws, lips and tongue, are omitted,
Chafman— Etiology in Orthodontic Cases
2049
tion these questionnaires call for. It is However, the method is not perfect; necessary to know whether the mouth e.g., in regard to a child of 6 years, it is breathing occurs by day or by night; also often very difficult for the parents to the cause, degree, age of onset, date
F ig . 9.— M o d e ls f ro m first c h ild , f a m ily B.
when nasal breathing was restored and, if several of the same family suffered, which child was most affected; etc. By this method, pursued by a large number of practitioners, a real advance in the knowledge of etiology could be made.
F ig . 11.— M o d e ls f r o m second ch ild , f a m ily B.
remember all the details asked for with any degree of accuracy; and, in a child of 12, the difficulties of obtaining an accurate history are considerably greater. The only certain way would be to write
F ig . 10.— M o d e ls f ro m first c h ild , f a m ily B.
2050
T he Journal o f the American Dental Association
up a history of the child’s health every Clinical Research, in the same city, but at less frequent intervals. Unfor two weeks or so, from birth. tunately, there is no provision for dental
F ig . 14.— M o d e ls f ro m th ird c h ild , f a m ily B. Fig'. 12.— M o d e ls f r o m second ch ild , fa m ily B.
care or treatment of any kind for these children until they are of school age, This is being done at the Child W el but the histories are available for any fare Centre, St. Andrews, Scotland, one who cares to consult them, and some during the first two years of life. day they should prove very valuable in any research work along these lines.
F ig . 15.— M o d e ls f ro m th ird ch ild , f a m ily B. F ig . 13.— M o d e ls f r o m th ird c h ild , f a m ily B.
In illustration of the method adopted After that, the child’s record is made at by the British Society for the Study ofthe Sir James Mackenzie Institute for Orthodontics, I present seven cases in
Chapman— Etiology in Orthodontic Cases
two families, four in family A (Table 1), and three in family B (Table 2). The complete charts of these are appended. Here, I shall refer only to the salient points. In these replies, there is not a factor disclosed to which a causative relation to the differences in the occlusion of the normal (or almost normal) ones and T
able
disclosed by the histories are negative in a similar way. In another family of children, I have models (not illustrated here) of six, every one of whom has normal occlu sion; or, in one instance, the occlusion might be described as Class I. I have never seen a family in which so many children had such good occlusion. Un-
1.— D a t a R e g a r d i n g F a m i l y A ; F o u r C h i l d r e n ( F ig s . 1 - 8 ) *
O cclusion.
1st C h ild
2n d C h ild
3 rd C h ild
N o . 539.
N o . 307.
N o . 540.
N o . 541.
F ig s. 1-2.
F ig s. 3-4.
F ig s. 5-6.
F ig s. 7-8.
N o rm a l
A g e difference. M a sticatio n .
F eeble
D ie t a f t e r 1st y ear.
In c lin e d to be “ s lo p p y ;” lack ed solids
M o u th b re a th in g N asal o b stru ctio n R ick ets D istu rb e d n u tritio n H a b its an d pacifiers E n v iro n m e n t:
2051
\ I > \ /
N one
4 th C h ild
C lass I
N o rm a l ( a lm o s t)
N o rm a l ( a lm o s t)
1 6 /1 2
1 8 /1 2
2 1 1 /1 2
M e d iu m
V ig o ro u s
M e d iu m
N one
N one
N one
T h e sam e f o r a ll.
* T h e rep lies to th e q uestions are f o r p ra c tic a l purp o ses id e n tic a l f o r a ll f o u r .
the bad Class I can be ascribed. The one factor that might be causative as regards the Class I case, and included by Jansen as a cause of “feebleness of growth,” is that the child was born only 16 months after his sister. The next child was born 18 months after this one, and has good occlusion; so this factor is not at all definite in this family, and it has to be remembered that there is no question of any form of deprivation. The effects of any remaining differences
fortunately, I have no history except that they are the progeny of nomads and were born on the Sussex Downs. From this, I deduce that the parents were very healthy and that the antenatal life of the children was unaffected by modern civilization. I have reported these cases not so much that conclusions may be drawn (except that etiology in the past has been thoroughly neglected), but to show that there is much scope for investigation in this field. Certainly, it appears to offer
The Journal o f the American D ental Association
2052
The letter sent out with the question the reward of success to those who un dertake it. It is to be hoped that writers naires follows: will adopt some plan, such as that out T H E B R IT I S H S O C IE T Y F O R T H E S T U D Y O F O R T H O D O N T IC S . lined, when reporting cases. 11 C h a n d o s S treet, L o n d o n , W .l . Hatfield3 says: “Advance in this field 2 5 th M a y , 1926. (etiology) is imperative if we are to T
a b l e 2.—
D ata R eg a rd in g F a m il y
B;
T
1124. F ig s.
9-10
C h i l d r e n ( F ig s .
9 - 1 5 )*
2 n d C h ild
3 rd C h ild
N o. 1125. F ig s. 11-12
N o. 1126. F ig s. 13-15
1st C h ild N o.
hree
Class I I , D iv . 1, id en C lass I I , D iv . 1, id e n Class I I , D iv . 1, u n i tical w ith th a t o f sec tical w ith th a t o f first la te r a l— n o t severe child ond c h ild
O cclusion
4 1 1 /1 2 years
A g e d ifference
1 9 /1 2 years
A n te n a ta l fa c to rs M o th e r ’s h e a lth ( a ) m e n ta l (b ) p h y sical
G ood G ood
D a n g e ro u s illness eld e r c h ild caused w o rry G ood
W e ig h t a t b irth
iV -i ib.
4- lb., 14 oz.
6%
D ie t, first y e a r
A rtificial
B reast f e d ( ? )
B reast fe d
H ab its
N one
Sucked fin g ers
N one
Nose a n d m o u th M o u th
N ose a n d m outh M o u th
Nose Nose
A d en o id s a n d tonsils
T o n s illitis a t 8 years
T o n s illitis
N o to n sillitis
G en eral h ealth
Good
G ood
G ood— gets cold easily
P h y siq u e
Good
G ood
S lig h t b u ild
B re a th in g :
j^
O th e r m em b ers o f f a m ily w ith sim ila r occlusion
at
of
7 years
Shock o f h u sb a n d ’s death six w eeks b e fo re c h ild ’s b irth G ood lb.
T w o fe m a le cousins a n d one a u n t T h e m o th e r believes th e c o n d itio n o f these tw o to be due to to n sillitis.
* In th e tw o e ld er c h ild re n , it is difficult even to su g g est a cause f o r the m alocclusion, unless i t be h ered ity .
differentiate between those cases which are susceptible of successful treatment and those which are not or, still more important, to distinguish those cases which require treatment from those which do not.”
IN V E S T IG A T I O N S C O M M I T T E E .
in v e st ig a t io n
o f o r t h o d o n t ic
e t io l o g y .
D e a r S ir ( o r M a d a m ) :
T h e In v e stig a tio n s C o m m ittee has h ad its a tte n tio n d ra w n to the p ro b a b ility th a t O rth o do n tic E tio lo g y has n o t received th e consid e ra tio n it m e rits an d th a t the causes assigned 3. H a tfie ld , H . K . : P ro g n o sis in D isto - are fre q u e n tly based on insufficient evidence a n d in q u iry . T h e C o m m ittee considers this clu sio n Cases, I n te rn a t. J . O rth o d o n t., J a n u su b ject o f g re a t im p o rta n c e a n d w e ll w o rth y a ry , 1922.
BRITISH SOCIETY FOR TH E STUDY OF ORTHODONTICS 11. Chandos Street, W.I. H is to r ie s
o f C h ild r e n
o f th e S a m e
F a m ily ,
for the purposes of investigating the etiology of malocdusion. To be filled in by the parents. Each sheet may be usedfor three children. Note.—In some cases the answers are anticipatedor suggested; delete the words which do not apply Relevant information, additional to that asked for, will be appreciated. Dental Surgeon's Name— Address—
I. Sign or number. To indicate family to whichchildbelongs. 2. Child's name or number and sex. 3. Race. 4. Date of birth (age) 5. Height.
6. Weight.
<
Early.
)
Late.
CHILD III.
M. F.
U. F.
Clothed. Unclothed. Age.
7. Walked at.
Take the children in the order of their ages. CHILD II.
CHILD I.
( Clothed. Unclothed. Age.
Early.
M. F.
;
Late.
( Clothed. Unclothed. Age.
Early.
i
Late.
8. Physical varia
tions ininfancy.
9. Knock-knees, flatfoot or other changes.
ro. Ante-natal factors (i) Father’shealth. (ii) Mother’s health. (a) Mental. (b) Physical. (iii) Otherfactors (iv) Normal birth or difficulties.
11. Weight at birth. 12. Length at birth and other mea surements.
1How long ? *3 list (Breastfed f Vigorous. Medium. (How long? ijJyear IArtificial (What foods? Q 1and to 6th years. 1After 6th year 14. Sweets. in H
1
16. Mastication.
Feeble.
Many
Few.
Daily.
Irregular
Medium. | Vigorous. Rapid. Slow.
Feeble.
/How long ? IVigorous. Medium. / How long? 1What foods?
jHow long? Feeble. (Vigorous. Medium i How long ? t What foods ?
Many
Few
Daily.
Irregular
Vigorous. Medium Rapid. Slow
Feeble
Additional Information to be written in the space above.
Feeble
Many
Few
Daily
Irregular
Vigorous Medium Rapid. Slow
Feeble
17- Habits, i.e. sucking thumb, fingers, tongue, lips, etc. Howlongeachday. Betweenwhat ages. 18. Comforter. Usedbetweenwhat ages. Howlongused at onetime. Ifusedduringsleep. 19. Breathing. Day. Night. If mouth breathing, state:— 1.Possiblecause. 2. Degree. 3. Ageof onset. 4.Date when nasal breathing restored. 5.Wed hich child suffer most, which least, andsoon. 20. Adenoids &Tonsils Age at which sus pected. Date of operation.
S o a t} iawmovement-
S L ? ) j awmoven,ent
X u ” ^ m o v e m e n t.
SftouT)iawmovement'
S o u ?H awmo™nent-
S o u T tiawmovement-
Nose. Nose.
21. Nasal obstruction. Present. Age of onset. Nature of obstruction 22. Rickets. 23. Disturbed nutri tion. Give ages. 24. Illnesses. Give ages of occur rence of each.
Mouth. Mouth.
Both. Both.
Nose. Nose.
Mouth. Mouth.
(Constant. \ Partial.
Yes.
No.
Both. Nose. Both. Nose. Constant. Partial.
Present.
Yes.
25. General Health and physique. Type of exercise taken at diffe rent ages
26. Inherited charac teristics.
27. Ages of children older.
28. Age of child. 29. Ages of children younger
30. Father’s date of birth. General health. Physique. Other details
31. Mother’s date of birth. General health. Physique. Other details.
Yjt»
Mouth. Mouth.
Additional Information to be written in the space above.
Both. Both. Constant. Partial.
Present.
Yes.
BRITISH SOCIETY FOR TH E STUDY OF ORTHODONTICS 11, Chandos Street, W.l. H is to r ie s o f C h ild r e n o f th e S a m e F a m ily ,
for the purposes of investigating the etiology of malocclusion. Tobe filled in by the Dental Surgeon. Each sheet may be usedfov three children. Relevant information, additional to that asked for, will be appreciated. Denial Surgeon’s Name— Address Takethechildrenii the order oftheir ages. 1. Sign or number. Toindicate family to whichchild belongs.
CHILD II.
CHILD III.
2. Child's name or
number and sex.
3. Occlusion. 4. Sitting height. 5. Nose and nostrils. Obstruction ^Left** Long, Medium. Short, Everted Long, Medium, Short. Everted Long, Medium, Short, Everted 6. Lips. Lengthofupperlip. Lipridge.* Upper lip. Firm. Lower lip. Firm. Pendulous
7. Tongue.
Habitual position. ILadfof contact Iwlth paIate Size. Shape. Strength.
contact }with
Contact , ,, Lack of contact f™* palate
8. General condition of mouth.
9. Condition of teeth Cleanliness. Caries. Hypoplasia.
10. Condition of gums. 11 Natural spacingof deciduous teeth.
1z. Age of commence
ment of spacing of deciduous teeth.
13. Attrition of de ciduous teeth Incisors. Canines Molars.
14. Premature or re
tarded eruption of deciduous and permanent teeth
15. Any other infor mation
16 Father’s occlusion 17 Mother socclusion.
Models and, when possible, photographs to be presented. (Also models and photographs of parents when possible.) Additional Information to be written in the space above or on the back. *Alip ridge isa ridge in mouth breathers uponthegumof the maxillaor mandible, usuallyboth, indicatingwheretheliprests, that portionnot com pressed beingswollen, either as a definitehypertrophy or aa cedemaof the soft tissues. Y»s»
2056
T h e Journal o f the Am erican D ental Association
of investigation which, to be o f value, must be considered by a large number o f persons who are specially interested in the work, such as Members o f the Society. The Committee suggests that suitable cases for investigation are those families in which there are at least three children, one o f whom has a normal occlusion ; or in which all three children have similar occlusions, but the Com mittee has no desire to limit the investigation to such cases only. Questionnaires (one to be filled in by the dentist and the other by the parent) have been drawn lip for this purpose. T w o blank questionnaires of each kind are enclosed. A separate chart is to be used for each fam ily. Where there are more than
three children in a fam ily extra charts should be used for that fam ily. Each child should be given a number, and in addition each fam ily a sign or number. The Committee requests that the Charts, completed with models, etc., may be returned not later than the 30th of November, 1925, addressed to me— 76 Grosvenor Street, Grosvenor Square, London, W. 1. Mr. A. L. Packham, The Hon. Secretary of the Society, w ill be pleased to furnish extra questionnaires on request being made to him at 79 Portland Place, London, W. 1 . Yours faithfully, B. M axwell Stephens , H o n . S ecretary In v e stig a tio n s C o m m ittee .
FACTORS IN THE CONTROL A N D CURE OF PYORRHEA*
By THOMAS BRADFORD HARTZELL, M.D., D.M.D., F.A.C.D. Minneapolis, Minnesota Y O R R H E A alveolaris, as w e all know , is characterized by a slow onset an d com plete lack o f all those sym ptom s th a t usually a ttra c t the atten tio n o f the victim s o f disease. T h e r e f o r e , the sufferer fro m periodon toclasia ra re ly appreciates th a t his tissues are n o t no rm al u n til the disease has de stroyed so m uch o f the tooth a ttac h m e n t th a t the tooth can n o t be preserved. T h is u n fo rtu n a te state o f affairs could be elim in ated i f every m em ber o f our profession w o u ld m ake it a rule to ob serve, as a m a tte r o f habit, and to dem onstrate to each p atien t w ith dis closing stain, the fa c t th a t a ll surfaces o f h u m a n teeth th a t are not im m ediately scoured by food in the n a tu ra l process
P
*Read before the American Academy of Periodontologv, Philadelphia, Pa., Aug. 20, 1926.
o f m astication are covered by bacteria, an d th a t these bacteria produce d estru c tive fe rm e n ts w hich, by th e ir toxin, dis solve the tissues and cause the break in g dow n o f tooth attach m en t. I f w ith this know ledge w e w ere to teach an effective m eans o f rem o v in g or com bating these organism s, n o t only periodontoclasia, but also tooth decay w o u ld alm ost cease to exist fo r a ll those ind iv id u als w ho grasped these facts an d effectively ap plied them . T h e co n tro l an d prevention o f a l m ost a ll the death d ealin g diseases has become easy ju st in proportion as we have learn ed th eir etiology an d applied preventive m easures to co n tro l the action o f th e ir etiologic facto rs. F ro m day to day an d w eek to w eek, w e see new victories in this field. T h e pathw ay o f m edicine is paved by these victories,