Pa e v e n t l o n of M a l o c c l u s i o n . (B.
finite knowledge as to t h e a v e r a g e normal
F r a n k G r a y , D.D.S., Colorado Springs,
Colo. (Dental Summary).--It is quite
c o m m o n l y s t a t e d a m o n g t h e best practi-
tioners of d e n t i s t r y t o d a y t h a t the public
is d e m a n d i n g t h e services of our profes-
sion to a far greater e x t e n t t h a n was true
ten years ago. It is m y belief t h a t t h e
activities of individual d e n t i s t s and of
d e n t a l orga~aizations which seek to e d u c a t e
the public in oral hygiene is the chief cause
for the i m p e t u s which has been given our
work.
T r u e enough, t h e efforts of the con-
scientious d e n t i s t for m a n y years have
been a i m e d a t p r e v e n t i o n ~ i n a sense:
p r e v e n t i o n of pain, a n d t h e p r e v e n t i o n of
the f u r t h e r d e p r e d a t i o n s of dental caries.
B u t is is t h a t conception of p r e v e n t i o n
which looks to the protection of t h e dental
s t r u c t u r e s from a n environment which
invites disease, t h a t h a s claimed the t h o u g h t
of so m a n y of our best men in recent years.
Malocclusion of t h e t e e t h ought to be
prevented. I t is as far-reaching in it,~
pernicious influences as a n y of t h e condi-
tions which confront t h e profession. De-
formed d e n t a l arches; unhygienic m o u t h ;
carious t e e t h ; m o u t h - b r e a t h i n g ; distorted
and i n h a r m o n i o u s faces these are the
results of malocclusion.
T h e p r e v e n t i o n of malocclusion is so
perfectly possible t h a t every p r a c t i t i o n e r of
d e n t i s t r y surely should be keenly alive to
the situation.
T h e t e e t h of t h e decidious d e n t u r e must
be kept h e a l t h y a n d i n t a c t for t h e i r normal
period of usefulness U n d e r no circum-
stances m a y a first or second decidious
molar be allowed to decay or be lost prema-
turely. If, u n f o r t u n a t e l y , such a t o o t h is
lost, its space m u s t be r e t a i n e d mechani-
cally until t h e succeeding t o o t h erupts.
Once the p e r m a n e n t molar drifts forward
into t h e space of t h e second deciduous
molar, a basis of serious malocclusion is
established.
W h a t I h a v e said a b o u t t h e deciduous
molars is quite as true of the deciduou's
incisors a n d canine teeth.
O r t h o d o n t i s t s are c o n t i n u a l l y expending
their efforts to o v e r c o m e t h e influences of
neglect. E v e r y dentist should have de-
period of life of t h e deciduous teeth, a n d
see t h e y are r e t a i n e d a p p r o x i m a t e l y t h a t
t i m e - - o r i n d e e d u n t i l t h e succeedin~ t o o t h
is clamoring for eruption.
Again, i n a few cases, t h e deciduous t o o t h ,
for some reason, is prone t o r e m a i n t o o
long in its position. T h e reasonable
procedure in such a case is to determine,
by m e a n s of skiagraphs, t h e progress to-
ward e r u p t i o n being m a d e b y t h e perma-
nent teeth. If well alortg t o w a r d e r u p t i o n ,
a n d t h e age of t h e p a t i e n t indicates its
wisdom, let t h e deciduous t o o t h b e re-
moved.
Strangely enough, t h e deciduous d e n t u r e
of some children (say a t t h e age of four
to seven years) is m u c h underdeveloped~
As t h e child a p p r o a c h e s t h e period a t
which t h e p e r m a n e n t incisors should e r u p t ,
there should be in evidence a c o n s t a n t
widening of t h e d e n t a l arch, a n d the so-
called n o r m a l "gro~vth spaces" s h o u l d be
appearing b e t w e e n the deciduous incisors
a n d cuspids. In m a n y c a r s t h e "growth
spaces" are wholly lacking. This, of
course, m e a n s t h a t t h e p e r m a n e n t incisors,
with t h e i r greater width, c a n n o t possibly
find a c c o m m o d a t i o n in t h e space occupied
by t h e small deciduous incisors. So here
is an o p p o r t u n i t y for p r e v e n t i o n t h a t
should not be overlooked. G e n t l e me-
chanical s t i m u l a t i o n of t h e d e v e l o p m e n t ,
laterally, of these arches, should b e re:-
sorted to, even a t a period of two or t h r e e
years p r e v i o u s to t h e a p p e a r a n c e of the
p e r m a n e n t incisors. Dr. Barnes, of Cleve-
land, h a s called such p a r t i c u l a r a t t e n t i o n
to t h i s t h a t I t h i n k his n a m e should be
m e n t i o n e d in this connection.
I n dealing with malocclusion, t h e a d v i c e
to wait u n t i l all t h e p e r m a n e n t t e e t h h a v e
t a k e n t h e i r positions, Dr. B r a d y once said.
is e q u i v a l e n t to telling t h e p a r e n t to allow
the case to get as b a d as possibly can gec,
before m a k i n g a n y effort to correct it.
T h e successful t r e a t m e n t of malocclusion,
which is a t all complicated, is tedious a n d
exacting, a n d requires a q u a l i t y o f presist-
ence a n d fitness o n t h e part of t h e oper-
a t o r t h a t is only fully realized b y tho.,~e
who h a v e a c t u a l l y e n g a g e d i n t h e work:
Any fee t h a t will c o m p e n s a t e t h e operator.
536 The International Journal of Orthodontia.
even in a modest degree, for his services,
may prove a bur'den to the parent, if,
indeed, the orthodontist is not accused of
" h i g h w a y robbery." A child of twelve
or fifteen years of age, with much ir:~gu-
larity, requires a t r e a t m e n t period of the
greater part of one year, with a succeeding
retention period of two years' time.
Because of the reqt, irement as to time,
and the consequent fee demanded in these
established or somewhat " m a t u r e cases,"
only one out of the many can ever be
treated. Possibly one out of seventy-five
or a hundred cases only, will have the
services of the o r t h o d o n t i s t - - a n d in com-
munities where there is no specialist the
proportion of treated cases is practically
nil. The result is t h a t hundreds of thou-
sands of children all over the land must go
on through life with varying degrees of
dental and facial deformity, much of which
could have been prevented by the intelli-
gent co-operation of the family dentist.
In filling teeth with gold, certain well-
defined principles are adhei'ed to in order
to arrive at a certain degree of success.
So, out of all the chaotic beliefs with
reference to t r e a t m e n t of malocclusion of
teeth, certain well-defined basic principles
have finally been accepted by those who
have t h o u g h t most upon the subject.
The great fundamental in orthodontia is
normal ocdusionl TO work to any other
principle is to acknowledge a degree of
defeat at the outset.
A brief resume of the avenues of pre-
vention of malocclusion might, therefore,
be as follows:
(a) The preservation of the deciduous
teeth for their normal life period.
(b) The mechanical retention of the
space i f the deciduous tooth be perma-
nently lost.
(c) By nothing to decidious teeth are
not retained tot a considerable longer
time than is normal.
(d) By stimulating the lateral growth of
the decidious dental arches when the nor-
mal "growth spaces" are not in evidence
say, at six years of age.
(e) By paying some attention to the
naso-pharynx and nose to see t h a t the
child has no occlusion oi the air passages.
(f) By bearing in mind t h a t prevention
is better than cure.
(g) By remembering the best time to
correct existing malocclusion is now.
If the question be asked: W h a t mechan-
ical procedures may the general practi-
tioner follow in dealing with incipient
malocclusion ? I may reply:
1. Where the second deciduous molar,
for instance, is lost, he may fit and solder
a band to the first permanent molar; an-
other to the first deciduous molar; connect
the two bands by means of soldering a
strong wire betwee,a them, and cement the
little appliance thoroughly to place. In-
spect it at intervals of three months until
the second bicuspid makes it appearance.
2. The dentist may stimulate the lateral
development of crowded deciduous arches
by means of bands fitted to the cuspid
teeth on either side to which a soft lingual
wire is soldered, the ends pa~sing a bit
distal to the cuspids, to engage the lingual
aspect of the first deciduous molar. With
a suitable wire-stretching device the wire
may be gradually lengthened, thus secur-
ing a considerable degree of expansion of
the anterior part of the arch. This
method will not successfully move both
crown and root of the cuspid, as may be
done by some of the newer methods.
3. The dentist may note the influence of
an abnormally attached frenum-labium in
causing serious separation of the perma-
nent central incisors, and may, by follow-
ing a fairly simple technic, put an end to
the abnormal muscular attachment, with
the electro-cautery drawing the teeth
together and retaining t h e m pending the
eruption of the lateral incisors.
4. If the dentist considers this work,
even in its simpler phases, undesirable or
burdensome, in most communities of con-
siderable size he may co-operate with a
specialist. In any event, let us not un-
thinkingly pass by conditions, which in
their incipiency w o r k n o great ill, but the
neglect of which is fraught with conse-
quence which scarcely the full purse of t h e
patient and the skilled hand of the operator
may fully correct.
Mastication and Food Utilization.--
Again and again in e v e r y d a y life we find
that some dictum which either c o m m e n d s
itself to common sense or lends itself
freely to a r g u m e n t a t i v e proof is being
made the basis of a widespread propaganda.
W h a t was more reasonable t h ~ t o a~sume
that water ingested with meals would
dilute the gastric juice and thus diminish
its proteolytic efficiency? A n d w h a t was
more logical t h a n to urge the abolition of
such an assumedly harmful custom of