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The Loss of Teeth
L in tz — Loss of Teeth patient is to be served w ith the highest type of service and the greatest possible efficiency. O n the other hand, there is the family dentist who is so much inter ested in his patients that he leaves his w ork and accompanies them to your of fice. Sometimes, he asks you to come to his office. W hen the patient is in the chair, he usually says, “W h a t do you think of this case,” or “W h a t would you do w ith this case?” Frequently, he has, before consulting you, told the patient w hat is the right thing to do. H e has probably worked for this patient quite a
909
number of years. H e not only knows the patient, but the parents and the family in general. H e also knows the particular type of occlusion of this individual fam ily, and, in a general way, he knows the family history. If you, as an orthodon tist, give this patient a hasty examina tion and then you tell the family dentist, in the presence of the patient, w hat you, in your great wisdom, would do that hap pens to be entirely different from w hat the family dentist told him, it seems to me that one of you, or both of you, are discredited in the eyes of the patient.
T H E LOSS OF TEETH By WILLIAM LINTZ, M.D., Brooklyn, N. Y. H IS study was undertaken w ith a view of ascertaining w hether the teeth are lost alike in both jaw s; which are the first and which the last to go, and w hat percentage of teeth are lost by the average patient by the time he presents himself at the physician’s office for examination. D uring the course of this investigation, other information was obtained which is of great interest not only to the physician but also to the dentist. T h e m aterial for this study comprises 301 consecutive office patients who pre sented themselves at my office w ith the usual complaints for which an internist is consulted. These were examined care fully regarding missing teeth and the condition of the remaining ones. As a rule, I found that if many teeth were missing, those remaining were liable to be in poor shape. T h e converse of this proposition was also true. I believe the
T
Jo u r. A . D . A ., M a y , ig f o
interpretation of this to be that patients do not like to part w ith teeth, even though badly diseased, but would like to retain the natural teeth, in preference to having artificial ones, as long as there is no pain. A ll these teeth were lost spontaneously or extracted, in both instances because of disease. Missing teeth can therefore be taken as evidence of dental disease. Rarely, healthy teeth were extracted on account of mistaken diagnosis or unsatis factory therapeutic results. W ith many physicians and dentists, the wholesale extraction of teeth is still a panacea for every ailment that the human being is heir to. T his attitude is, of course, w rong and is to be regretted. A sound principle to follow in this m atter is that a tooth must be proved to be infected or diseased as a prerequisite for extraction for any condition. W ith modern scien tific methods of investigation— the roent-
T otal
C a s e s ____
5-10 years.......................... 10-15 years.................... 15-20 years.......................... 20-25 years.............................. 25-30 years.............................. 30-35 years.............................. 35-40 years.................. ........... 40-45 years.............................. 45-50 years.............................. 50-55 years............................... 55H30 years..... ....................... 60-65 years.......................... 65-70 years...................... 70-75 years.................... . . 75-80 years...................... 80-85 years..............................
A ges
b O
6
i a U
ê £
1 1
o
1 »
•v O
5 1
4 12 23 2 9 20 2 4 7 2 5 15 6 12 17 2 4 6
2 7 2 4 6 1 4 1 11 2 12 33 1 9 18 139 77 34 65 93 32
19 33 9 26 98 69
S £
23
B oth
Molar................ Bicuspid............ Central Incisor. Lateral Incisor.. Cuspid..............
Jaw s
382 168 72 72 63
351
406
T o t a l s . ..,
Cuspid
15 12 17 21 31 32
1 8 1 2 7 6
<
1
Lower Jaw Molar.......... 189 Bicuspid__ 78 Central Incisor 32 Lateral Incisor 29
T o t a l N u m b e r o f M is s in g T e e t h in S e q u e n c e
5 4 2 5 6 2
1
‘S. '5. 2? 1 -1 O CB s
Upper Jaw 'M olar.............. 193 Bicuspid........... 90 Lateral Incisor. 43 Central Incisor. 40 Cuspid.............. 40
97
10 4 2 4 6 2
1
a
1 1 J3
a. o
3
■a 73 '5. 3 o ffl
S
£ a
-3
1
1 á
!
’a L>
L ow er
«
‘S. 3
s
M
Jaw
j í H
? 9
ft 9
o f
8 14 1« 19 17 28 28 80
1 0 1 2 2 7
<
0 1
9
11
349
20 32 31 51 42 34 32 30 22 21 8 4 1 1
1 -1
1
0
e
*0 «
s
'S.
-a
1,346 731 275 269 262
1,331
S3
js
Jaw
i
1
O Ji
Ia
1 J5 2
Jaw
s a •*& ? O eh
L ow er
ë H
-u
i
9
202
832 500 215 209
in
Molar................ Bicuspid.......... Central Incisor. Lateral Incisor. Cuspid..............
B oth
1,958
T eeth
o f
M is s in g
Jaw s
Lower Jaw M olar.... Bicuspid... Central Incisor Lateral Incisor Cuspid-
Seq u en ce
T otal N um ber
1,678 899 347 341 325
1,682
996 399 138 126 123
1 1 5 7 —1 ,1 1 9 9 10 3 2 2 13 31 1 4 7 6 7 4 18 20 2 2 2 16 35 112 3 3 2 11 29 2 1 3 23 80 2 11 16 17 41 91 2 2 5 36 11C 330 6 13 12 13 53 92 4 4 6 35 12C 352 8 27 27 26 87 98 7 8 9 35 97 401 11 ?5 VY *6 5« 96 16 16 15 48 10s 135 13 39 35 34 30 130 28 22 21 59 100 548 18 21 23 22 52 83 18 11 8 38 S i 360 16 38 38 35 72 109 34 32 34 75 I K - 580 27 J2 14 12 21 39 L3 15 11 25 45 207 25 8 8 7 15 22 a 8 * 16 2* 123 30 2 2 2 4 6 2 2 2 4 6 32 32 ? 2 ? 4 8 2 9 ? 4 6 3? 3? 9
a
1
« “ ® i *6 O Z
a
fc. O
C TOTAL NO OF CASES U pper
Lower Jaw Upper Jaw 707 Molar........ Molar.. .. 321 Bicuspid Bicuspid . Central Incisor 106 Lateral Incisor 100 Central Incisor Cuspid. .. Lateral Incisor 97 Cuspid-. .. Jaw s
Cuspid........................
6 3*?
M is s in g
? 4
Seq u en ce
9
Molar.................................... Bicuspid............................... Central Incisor.................... Lateral Incisor.....................
B oth
1,552
639 410 172 169 162
in
N um ber
4
T eeth
T otal
9
1 1 9 ? 1 9 6 12 3 1 2 12 29 79 4 5 2 14 13 3 1 10 27 2 1 2 25 71 11 15 17 40 78 2 2 5 35 99 304 13 11 11 40 61 2 2 4 23 87 254 24 23 22 58 77 7 8 8 26 79 332 ’ 3 59 74 f R 16 15 15 91 379 26 25 25 60 97 16 17 17 47 77 409 17 19 !7 43 67 14 7 6 29 64 283 36 36 33 68 102 32 30 32 71 106 546 8 S 8 16 24 9 10 9 20 30 142 2 2 1 3 6 2 2 2 4 6 30
Ü
is 2 S
•§ 1
Jaw
Upper Jaw Molar......... Bicuspid__ Lateral Incisor Central Incisor Cuspid - • • • •
252
1
21 16 19 5 1
10 28 25 42 29 23
P rl 25
EdH
U pper
FEMALES
L o w er Jaw
MALES
Jaw
5 1 10 2 2 2 4 4 2 2 2 4 7 6 1 1 2 9 1 13 13 1 2 13 31 11 3 4 4 9 21 9 1 4 fi 9 9 9 13 10 9 20 33 6 4 4 5 9 16 2 2 2 2 4 7 3 4 6 4 5 15 a 6 tí 6 12 16 i 2 2 2 4 6
z,
B j) go
U pper
B
A
MISSING TEETH
vO O
The Journal of the American Dental Association
911
L in tz — Loss of Teeth gen ray, bacteriology, electrical reactions, etc.— a definite diagnosis can be estab lished in practically every instance. W hen dealing w ith impacted teeth other re quirements must, of course, be met for extraction. Findings are summarized in the ac companying table. A. T here were ninety-seven males in this group. T h ere is a definite increase in the loss of teeth between the ages of 35 and 40 years and another marked in crease between 50 and 55 years. T h e apparent increase which occurs between 20 and 25 years is unreliable, since there are only four cases in this group. In the upper jaw, 15.67 per cent more teeth were lost than in the lower jaw . T h e teeth are not lost haphazardly, but in a definite order or sequence, which is prac tically the same in both jaw s: molars, bicuspids, central incisors, lateral incisors and cuspids. T h e molars are the most frequent teeth lost and the cuspids the least frequent and the last to go. B. T h ere were 252 females in this group. T here is a definite increase in the loss of teeth in the female between the ages of 30 and 35 years and 40 and 45 years. In the upper jaw, 16.60 per cent more teeth were lost than in the lower jaw. T h e sequence for the loss of teeth in both jaws was the same as in the m ales: molars, bicuspids, central incisors, lateral incisors and cuspids. Again we see the molar as the most fragile tooth and the cuspid, the most hardy one. C. Considering the 349 cases, com posed of males and females, we find that there is a definite increase in the loss of teeth at the ages of 30 to 35 years and 50 to 55 years. T h e teeth are lost in the following sequence: molars, bicus pids, central incisors, lateral incisors and cuspids. In the upper jaw, 16.40 per cent more teeth were lost than in the
lower jaw. A lthough in the mouth there are only three times as many molars as cuspids, there are five and one-half times as many lost as the cuspid teeth.
MISSING TEETH A. In sixty-nine nonpregnant women, 161 teeth (14 per cent) were missing from the upper and 152 (13 per cent) from the lower jaw, a total of 313 teeth ( 14 per c e n t). B. In 108 males, in the upper jaw, 385 teeth (22 per cent) were missing, and in the lower jaw, 309 ( 17 per cent) ; a total of 694 teeth (20 per cen t). C. In 184 women with a history of pregnancy, in the upper jaw, 1,394 teeth (47 per cent) w ere missing, and in the lower jaw, 1,224 (41 per cent) ; a total of 2,618 teeth (44 per cent). In a total of 253 females, in the upper jaw, 1,555 teeth (38 per cent) were miss ing, and in the lower jaw, 1,376 (33 per cent) ; a total of 2,931 teeth (36 per c e n t). In a total of 361 cases, in the upper jaw, 1,940 teeth (33 per cent) were missing, and in the lower jaw , 1,685 (29 per cent) ; a total of 3,625 teeth (32 per cent). From these data, we see that teeth of women who have never been pregnant are retained longest. O nly 14 per cent of these teeth were lost. M ales show a loss of 20 per cent of their teeth. W om en who have been pregnant show the great est ravages, w ith a dental loss of 44 per cent. In the entire group of 361 cases, composed of men ; pregnant and non pregnant women, and children, 32 per cent of the teeth were missing.
SUM M ARY 1. Needless extraction of teeth can be avoided if modern diagnostic methods are employed.
912
T he Journal of the American D ental Association
2. T h e female loses her teeth five years earlier than the male. 3. A bout 16 per cent more teeth are lost in the upper than in the lower jaw. T his is true in both male and female. 4. Both sexes lose the teeth in a defi
nite sequence: molars, bicuspids, central incisors, lateral incisors and cuspids. 5. T h e molar is the most fragile tooth and the cuspid the hardiest. 6. T hree hundred and sixty-one pa tients lost 32 per cent of the teeth. 144 Joralem on Street.
909
number of years. H e not only knows the patient, but the parents and the family in general. H e also knows the particular type of occlusion of this individual fam ily, and, in a general way, he knows the family history. If you, as an orthodon tist, give this patient a hasty examina tion and then you tell the family dentist, in the presence of the patient, w hat you, in your great wisdom, would do that hap pens to be entirely different from w hat the family dentist told him, it seems to me that one of you, or both of you, are discredited in the eyes of the patient.
T H E LOSS OF TEETH By WILLIAM LINTZ, M.D., Brooklyn, N. Y. H IS study was undertaken w ith a view of ascertaining w hether the teeth are lost alike in both jaw s; which are the first and which the last to go, and w hat percentage of teeth are lost by the average patient by the time he presents himself at the physician’s office for examination. D uring the course of this investigation, other information was obtained which is of great interest not only to the physician but also to the dentist. T h e m aterial for this study comprises 301 consecutive office patients who pre sented themselves at my office w ith the usual complaints for which an internist is consulted. These were examined care fully regarding missing teeth and the condition of the remaining ones. As a rule, I found that if many teeth were missing, those remaining were liable to be in poor shape. T h e converse of this proposition was also true. I believe the
T
Jo u r. A . D . A ., M a y , ig f o
interpretation of this to be that patients do not like to part w ith teeth, even though badly diseased, but would like to retain the natural teeth, in preference to having artificial ones, as long as there is no pain. A ll these teeth were lost spontaneously or extracted, in both instances because of disease. Missing teeth can therefore be taken as evidence of dental disease. Rarely, healthy teeth were extracted on account of mistaken diagnosis or unsatis factory therapeutic results. W ith many physicians and dentists, the wholesale extraction of teeth is still a panacea for every ailment that the human being is heir to. T his attitude is, of course, w rong and is to be regretted. A sound principle to follow in this m atter is that a tooth must be proved to be infected or diseased as a prerequisite for extraction for any condition. W ith modern scien tific methods of investigation— the roent-
T otal
C a s e s ____
5-10 years.......................... 10-15 years.................... 15-20 years.......................... 20-25 years.............................. 25-30 years.............................. 30-35 years.............................. 35-40 years.................. ........... 40-45 years.............................. 45-50 years.............................. 50-55 years............................... 55H30 years..... ....................... 60-65 years.......................... 65-70 years...................... 70-75 years.................... . . 75-80 years...................... 80-85 years..............................
A ges
b O
6
i a U
ê £
1 1
o
1 »
•v O
5 1
4 12 23 2 9 20 2 4 7 2 5 15 6 12 17 2 4 6
2 7 2 4 6 1 4 1 11 2 12 33 1 9 18 139 77 34 65 93 32
19 33 9 26 98 69
S £
23
B oth
Molar................ Bicuspid............ Central Incisor. Lateral Incisor.. Cuspid..............
Jaw s
382 168 72 72 63
351
406
T o t a l s . ..,
Cuspid
15 12 17 21 31 32
1 8 1 2 7 6
<
1
Lower Jaw Molar.......... 189 Bicuspid__ 78 Central Incisor 32 Lateral Incisor 29
T o t a l N u m b e r o f M is s in g T e e t h in S e q u e n c e
5 4 2 5 6 2
1
‘S. '5. 2? 1 -1 O CB s
Upper Jaw 'M olar.............. 193 Bicuspid........... 90 Lateral Incisor. 43 Central Incisor. 40 Cuspid.............. 40
97
10 4 2 4 6 2
1
a
1 1 J3
a. o
3
■a 73 '5. 3 o ffl
S
£ a
-3
1
1 á
!
’a L>
L ow er
«
‘S. 3
s
M
Jaw
j í H
? 9
ft 9
o f
8 14 1« 19 17 28 28 80
1 0 1 2 2 7
<
0 1
9
11
349
20 32 31 51 42 34 32 30 22 21 8 4 1 1
1 -1
1
0
e
*0 «
s
'S.
-a
1,346 731 275 269 262
1,331
S3
js
Jaw
i
1
O Ji
Ia
1 J5 2
Jaw
s a •*& ? O eh
L ow er
ë H
-u
i
9
202
832 500 215 209
in
Molar................ Bicuspid.......... Central Incisor. Lateral Incisor. Cuspid..............
B oth
1,958
T eeth
o f
M is s in g
Jaw s
Lower Jaw M olar.... Bicuspid... Central Incisor Lateral Incisor Cuspid-
Seq u en ce
T otal N um ber
1,678 899 347 341 325
1,682
996 399 138 126 123
1 1 5 7 —1 ,1 1 9 9 10 3 2 2 13 31 1 4 7 6 7 4 18 20 2 2 2 16 35 112 3 3 2 11 29 2 1 3 23 80 2 11 16 17 41 91 2 2 5 36 11C 330 6 13 12 13 53 92 4 4 6 35 12C 352 8 27 27 26 87 98 7 8 9 35 97 401 11 ?5 VY *6 5« 96 16 16 15 48 10s 135 13 39 35 34 30 130 28 22 21 59 100 548 18 21 23 22 52 83 18 11 8 38 S i 360 16 38 38 35 72 109 34 32 34 75 I K - 580 27 J2 14 12 21 39 L3 15 11 25 45 207 25 8 8 7 15 22 a 8 * 16 2* 123 30 2 2 2 4 6 2 2 2 4 6 32 32 ? 2 ? 4 8 2 9 ? 4 6 3? 3? 9
a
1
« “ ® i *6 O Z
a
fc. O
C TOTAL NO OF CASES U pper
Lower Jaw Upper Jaw 707 Molar........ Molar.. .. 321 Bicuspid Bicuspid . Central Incisor 106 Lateral Incisor 100 Central Incisor Cuspid. .. Lateral Incisor 97 Cuspid-. .. Jaw s
Cuspid........................
6 3*?
M is s in g
? 4
Seq u en ce
9
Molar.................................... Bicuspid............................... Central Incisor.................... Lateral Incisor.....................
B oth
1,552
639 410 172 169 162
in
N um ber
4
T eeth
T otal
9
1 1 9 ? 1 9 6 12 3 1 2 12 29 79 4 5 2 14 13 3 1 10 27 2 1 2 25 71 11 15 17 40 78 2 2 5 35 99 304 13 11 11 40 61 2 2 4 23 87 254 24 23 22 58 77 7 8 8 26 79 332 ’ 3 59 74 f R 16 15 15 91 379 26 25 25 60 97 16 17 17 47 77 409 17 19 !7 43 67 14 7 6 29 64 283 36 36 33 68 102 32 30 32 71 106 546 8 S 8 16 24 9 10 9 20 30 142 2 2 1 3 6 2 2 2 4 6 30
Ü
is 2 S
•§ 1
Jaw
Upper Jaw Molar......... Bicuspid__ Lateral Incisor Central Incisor Cuspid - • • • •
252
1
21 16 19 5 1
10 28 25 42 29 23
P rl 25
EdH
U pper
FEMALES
L o w er Jaw
MALES
Jaw
5 1 10 2 2 2 4 4 2 2 2 4 7 6 1 1 2 9 1 13 13 1 2 13 31 11 3 4 4 9 21 9 1 4 fi 9 9 9 13 10 9 20 33 6 4 4 5 9 16 2 2 2 2 4 7 3 4 6 4 5 15 a 6 tí 6 12 16 i 2 2 2 4 6
z,
B j) go
U pper
B
A
MISSING TEETH
vO O
The Journal of the American Dental Association
911
L in tz — Loss of Teeth gen ray, bacteriology, electrical reactions, etc.— a definite diagnosis can be estab lished in practically every instance. W hen dealing w ith impacted teeth other re quirements must, of course, be met for extraction. Findings are summarized in the ac companying table. A. T here were ninety-seven males in this group. T h ere is a definite increase in the loss of teeth between the ages of 35 and 40 years and another marked in crease between 50 and 55 years. T h e apparent increase which occurs between 20 and 25 years is unreliable, since there are only four cases in this group. In the upper jaw, 15.67 per cent more teeth were lost than in the lower jaw . T h e teeth are not lost haphazardly, but in a definite order or sequence, which is prac tically the same in both jaw s: molars, bicuspids, central incisors, lateral incisors and cuspids. T h e molars are the most frequent teeth lost and the cuspids the least frequent and the last to go. B. T h ere were 252 females in this group. T here is a definite increase in the loss of teeth in the female between the ages of 30 and 35 years and 40 and 45 years. In the upper jaw, 16.60 per cent more teeth were lost than in the lower jaw. T h e sequence for the loss of teeth in both jaws was the same as in the m ales: molars, bicuspids, central incisors, lateral incisors and cuspids. Again we see the molar as the most fragile tooth and the cuspid, the most hardy one. C. Considering the 349 cases, com posed of males and females, we find that there is a definite increase in the loss of teeth at the ages of 30 to 35 years and 50 to 55 years. T h e teeth are lost in the following sequence: molars, bicus pids, central incisors, lateral incisors and cuspids. In the upper jaw, 16.40 per cent more teeth were lost than in the
lower jaw. A lthough in the mouth there are only three times as many molars as cuspids, there are five and one-half times as many lost as the cuspid teeth.
MISSING TEETH A. In sixty-nine nonpregnant women, 161 teeth (14 per cent) were missing from the upper and 152 (13 per cent) from the lower jaw, a total of 313 teeth ( 14 per c e n t). B. In 108 males, in the upper jaw, 385 teeth (22 per cent) were missing, and in the lower jaw, 309 ( 17 per cent) ; a total of 694 teeth (20 per cen t). C. In 184 women with a history of pregnancy, in the upper jaw, 1,394 teeth (47 per cent) w ere missing, and in the lower jaw, 1,224 (41 per cent) ; a total of 2,618 teeth (44 per cent). In a total of 253 females, in the upper jaw, 1,555 teeth (38 per cent) were miss ing, and in the lower jaw, 1,376 (33 per cent) ; a total of 2,931 teeth (36 per c e n t). In a total of 361 cases, in the upper jaw, 1,940 teeth (33 per cent) were missing, and in the lower jaw , 1,685 (29 per cent) ; a total of 3,625 teeth (32 per cent). From these data, we see that teeth of women who have never been pregnant are retained longest. O nly 14 per cent of these teeth were lost. M ales show a loss of 20 per cent of their teeth. W om en who have been pregnant show the great est ravages, w ith a dental loss of 44 per cent. In the entire group of 361 cases, composed of men ; pregnant and non pregnant women, and children, 32 per cent of the teeth were missing.
SUM M ARY 1. Needless extraction of teeth can be avoided if modern diagnostic methods are employed.
912
T he Journal of the American D ental Association
2. T h e female loses her teeth five years earlier than the male. 3. A bout 16 per cent more teeth are lost in the upper than in the lower jaw. T his is true in both male and female. 4. Both sexes lose the teeth in a defi
nite sequence: molars, bicuspids, central incisors, lateral incisors and cuspids. 5. T h e molar is the most fragile tooth and the cuspid the hardiest. 6. T hree hundred and sixty-one pa tients lost 32 per cent of the teeth. 144 Joralem on Street.