THE
AMERICAN JOURNAL
OF
DENTAL SCIENCE.
Vol. XVI. THIRD SERIES?JANUARY, 1883. No. 9.
ARTICLE I.
Drs. Watt and Taft on the First Permanent Molars.
(Proceedings of the Ohio State Dental Society.]
Dr. Watt; The question comes up with every young
mother, and I guess every old mother, what shall be done
with the baby ; and in general we just simply say, nurse it.
The baby ought to be taken care of, and I don't know that
we can say anything better in regard to the six year molars.
Just how the baby is to be nursed, whether to be fed on
goat's milk, or cow's milk, or tug at its mother and make
its honest natural living, depends on the circumstances,
whether the mother can support it that way or not?
whether her mammary glands secrete a health-giving fluid
?whether the state of her constitution will tolerate this.
Whatever, though, is to be best for the baby and all others
concerned, is to be done. So these six year molars ought
to be taken care ot. There is not much doubt that our
Heavenly Father intended that they should stay there until
the owner of them shall die of old age. I think you may
dissect the human body from end to end, you may make a
microscopic investigation, and you can't find any prepara-
tions for death. Everything in a healthy constitution?
every organ, if it is healthy?points to life, and not to death.
386 American Journal of Denial Science.
And the fir6t permanent molars?the six year molars, as
they are sometimes called?are no exception to the rule.
They are made to last until natural death ensues from sim-
ply the running down of the clock ; and, therefore, they
are to be treated accordingly,?that is, provided their con-
stitution is normal. Sometimes, however, in one sense
there is no physiology at all, but all is pathology, for man
is a fallen being ; therefore, the first permanent molars
often suffer. It is a great misfortune that the child is often
shut up in confined rooms, and an unhealthy atmosphere, at
the time these teeth are being developed, and they come
\v;th a feeble, defective structure, and hence Ihey decay
readily and easily. Another trouble, however, is that
about the time these teeth are tairly through the gum, and
before they have had time to consolidate, the child is sent
into school, and there is kept for about eight hours a day,
and must not move?it must be in dread ; and it is not one
time in ten that you can pass through a primary school and*
with the eyes of a physician, see one healthy child in the
school room of thirty to fifty children. It is just as much
as a bargain if the public schools, as now conducted, escape
being a nuisance. I am inclined rather to think that they
are a nuisance, with all the glory that we have attached to
them, and our talk about " free education." Children are
forced into unnatural conditions. Now, that is not a good
way to treat these first molars. When I get to be the
autocrat of all the Americas, a child that is under eight
years shall not be shut up in school at all, and it shall not
be shut up more than a half hour to an hour at a time,
varying with the constitution, if eight; and the teacher
that assigns lessons that have to be studied at home, and
then simply recited in the school room?to be studied at
home, when the child ought to feel as free as a colt turned
out on pasture, or as a lamb by the still waters?shall be
summarily dealt with. The child is in dread, is weighed
down with the consciousness that here is a series of long
lessons. The child of eight years old is usually taxed
Permanent Molars. 387
further, in regard to brain work, than the student of twen-
ty-five in the university. This is not 'doing the first molars
any good. The result is that the secretions become
depraved, even if the little child, with an ammoniacal
degeneration of tissue. If you desire a friendly kiss from
even a small child, you will find the breath loaded with
ammoniacal putrefaction. It does not smell much like
spirits of hartshorn ; hence, people don't think it is am-
monia. They forget that the ammonia is combined, under
such circumstances, with phosphuretted hydrogen. The
brain and nervous system of the child are actually burned
out. Hence, we find a far more offensive smell than
ammonia would itself give. And. we find that condition in
the child because it is deprived of fresh air; it is loaded
with anxious care ; it has no hours that it feels free from
the heavy responsibility, and ndtime at which it is allowed
to feel like a child. The consequence is we find all the
secretions depraved. When the mouth is in this condition^
these teeth, being soft, corrode. And parents, inasmuch as
these teeth have made their appearance before the incisors
are shed, think they are temporary teeth. And if there is
one thing that parents must be far more generally taught
than another, it is that these are permanent teeth, and
must be looked after. The secretions of the mouth must
be kept healthy. And, "in order to do this, the child must
be treated as a rational human being.
But there are exceptions to all of this. Sometimes, on
account of our race being wonderfully mixed, the child
may inherit its jaws from one race and its teeth from
another. The teeth are secretions. The secretory organs
are more likely to he inherited from the mother than the
father. The anatomical structure of the head and the spinal
cord are more liable to be inherited from the father. You
can always remember this if you look at the mule ; its head
and back are almost like its father's, while its size and the
secretorj- organs are like those of the mother. So the child,
which is more likely to have the head of the father, often
388 Ajnerican Journal of Dental Science.
takes the teeth from the mother. If the mother happens to
be of a race or nationality that usually has large teeth, and
the father happens to be one of the finer featured races, the
result will be greater disproportion. Wow, then, if these
teeth are found decayed, if there is not room for all the
teeth, and those teeth are so depraved that they can not be
retained permanently, then remove all four of them ; espec-
ially if the patient is a little girl, and yon don't want her
beanty marred, have them all taken out at one time-
Sometimes, by removing these, there is room for the teeth
to place themselves in their proper arch, and when they
have room thus to make their appearance, they are to be
preserved by appropriate filling in time and the proper pro-
tective treatment, which means the general health of the
child.
I am sorry to say that I think there fs far too ranch dis-
position in the profession to sacrifice these teeth recklessly.
If they are reasonably good and there is room for them,
they onght to be preserved, it is a great misfortune to
lose them. They have very much to do with the nutrition
of the child?more between six and nine years of age than
any other organs in the mouth. They are needed for pur-
poses of mastication. Then they have more to do in pre-
preserving the beauty of the features than any other teeth
in the mouth, unless it be the cuspids?I mean in preserving
the features, as they will show when the mouth is closed.
As a general rule, where one of them has to be sacrificed
for lack of room, it is better to remove all. If all four
have to be removed, it need not at all be done at one sit-
ting. I find it is usually too much of a shock for the child.
My usual practice is, if I have to begin the sacrifice, to
explain it to the parents and to the child too, and you will
generally find the child will consent as readily as the par-
ents will. Children at that age, little girls especially, seem
to instinctively understand that they are intended to be
good-looking, and that their features need to be preserved.
Now, these are very scattered remarks, and I know that
Permanent Molars. 389
mawy members of the Soeiety will say, u Pshaw! I can
make a better speech than that myself," and what I got up
for was to induce them to do it.
Dr. JT. Taft: Mr- President, Dr. Watt has made some
very good suggestions in regard to the care of the first per-
manent molars. Perhaps this question might have been
put in another form and be & little more appropriate, ass
u What shall be done for the First Permanent Molar
Teeth ?" However, that is not a special matter. The
remarks of Dr. Watt are mainly upon the question in
that form," What sliail be done in behalf of the First Per-
manent Molars?" And here, in reference to the nomen-
?1 atiire, " first permanent molar" is the better name to
apply to these teeth. The term " six year molars " is an
awkward expression, and one that should be discarded. It
is unfortunate to use a number of terms or words meaning
the same thing. Let us select the best term, and then use
it and discard those that are not so good.
Now, what shall be done for the welfare of the first per-
manent molars? We must begin where Dr. Watt began
his speech?at the early, or formation stage of the tooth, or
begin with the mother. Perhaps ihe treatment of the
mother should have reference to this, and to the welfare of
all the teeth, prior to the birth of the child. But, then, as
dentists ordinarily find thein in the mouth, they are all
erupted, and what shall he done with them then % Daring
the life of the child, before the appearance of these teeth,
reference can be had to the welfare of the teeth, these a?
well as the rest, in the treatment that shall be given to the
child, in its protection from disease-prod n g influences
that are so common, and to which all persons are more or
less subject. The hygienie regulations under which the
child should be brought, should be modified very muchj
indeed. In many respeets children are subject to disease-
producing influences in a very marked degree. This is
clearly shown by the large amount of infant mortality
Why is it that the young of other animals do not have this
390 American Journal of Dental Science.
proportion of death ? Why is it that the rule is, in the
great majority of cases, that the young of other animals,
which we would suppose are not cared for as those of the
human kind ought to be, exhibit so great a disparity in the
matter of mortality ? Forty per cent., perhaps, of the
human family die prior to the age of five years, showing
that there is something radically wrong in the eare, in the
exercises of hygienic rules and regulations for their welfare
?giving the best nutrition, giving them the best support,
surrounding them with the best circumstances, warding off
the influences that produce disease ; there is something rad-
ically wrong in all these particulars. During the formation
and development of the teeth children are subjected to dis-
eases of various kinds. Consequently the teeth will cer~
tainly undergo deterioration ; they will not be developed as
perfectly as they should be. Take, for example, the enamel.
The organ may be atrophied for want of proper nutrition,
and then it will be defective in one or more particulars, and
in some instances the organ will be starved, and contraction
will take place. Therefore, there is no union at the edges
of the enamel in the fissures, ar?d there will be those open
points or fissnres that we frequently find in the molar teeth.
This occurs more frequently on first molars; these fissures
are more marked ordinarily in the first molars and in the
bicuspids than in any other teeth in the mouth, showing
that there was interference at the time of formation of the
organs that did not afterward occur. There will be excep-
tions, of course.
Then, again, defects iu the enamel may be manifested in
another direction. By want of proper nutrition the enamel
may not receive its due amount of material for solidifying
or calcification, and that will manifest itself in various ways
?either in the pits and grooves, or the imperfeet territories
jn the enamel, which will be shown by the whitened condi-
tion, by the change in the appearance of the enamel,
defective spots.. Sometimes the enamel is defective through-
out. Now, the same thing may occur, without any appre-
Permanent Molars. 391
ciable reason, in the formation of the dentine. Reference
should be had to the perfection of the teeth in the nutrition
of the child during the time of the growth and develop-
ment. Though it may be good in all the respects to which
I have referred, subsequent privation of nutrition will pre.
vent the due solidification of the teeth. The tooth, at the
time of eruption, has nothing like as much calcareous
material in it, as it ultimately receives, or will receive under
proper nutrition. This, then, is a matter to which attention
should be given through the growing period of the child ,
not only while the tooth-germ is forming, but while the
tooth is being developed and growing, and afterward as
well.
The period at which these teeth coire is a very unfavora-
ble one for the best interests and the welfare of the teeth.
They come at a period when the child is susceptible to a
great many disturbances, and many perturbations of health
occur during this period. It is a time of life that is subject
to irritability, and special susceptibility to morbific influeu-
ences that surround and attach to it; and it is a vulnerable
time in which, at any time, disease is liable to fasten upon
this organ. Then, these teeth are erupted at a period when
the mouth is oftentimes in a state of marked irritation. It
is at the time of the throwing off of the temporary teeth,
and ordinarily under the best circumstances, there will be
somewhat of irritation in the mouth during this period;
and in so far as this condition exists are the permanent
molars likely to suffer for want of exercise?for want of
due use in mastication. The contiguous teeth are loosened,
and there is irritation of the gum, and a vigorous use of
them would occasion pain, and the inclination of the child,
at this time, is to protect the teeth from irritation, and to
avoid the use of them in mastication ; and the result is
that about these molars, accumulations are generally found,
and especially unless attention is given to the matter by the
parent, or by some one having the child in charge. There
will be more or less accumulations of vitiated matter about
392 American Journal of Dental Science.
the teeth. That will be the rnle with the first permanent
molars, for a year or two after their eruption, a circnmstance
that directly favors their decay. The child should be stim-
ulated or induced to nse these teeth in mastication, from
the time they make their appearance, sufficient to prevent
the accumulation of foreign substances npon them. When
we consider the amount of vitiated material and debris of
one kind and another?agglntined mneons, decomposing
material, and epithelial scales that cover them during the
year or two following their ernption, the only wonder is
that they escape as well as they do.
There is one fortunate circumstance in connection with
this condition in the mouth, that during the time of this
irritation there will be a large inflow of saliva, and a dilu~
tion of the deleterious agents. But this is not sufficient, in
most cases, to neutralize or overcome the vitiated product
and materials in the mouth that operate upon these teeth.
Then, again, the temporary molars are very frequently
decayed upon their posterior proximate surfaces, in contact
with the anterior proximate surfaces of the permanent mo-
lars, holding in contact with the latter, material undergoing
decomposition, out of which the materials that will produce
decay are formed. They operate, then, upon the anterior
surface of the permanent molars. This is a very common
point of decay. And in order to avoid or prevent that,
special attention should be given to the teeth in this respect.
And when there is decay upon the posterior surface of the
temporary molar, it should be cut away. The diamond disk
fe a very good instrument for this purpose, as, with it, the
separation can be very readily and easily made without
annoyance to the child ; whereas, the use of the tile would
be objectionable, and with many children it would be almost
impossible so make such separation with the tile. Yery
scrupulous search should almost be made for decay in the
anterior side of the permanent molar, and if there is incip
ient decay, let it be at once removed, and let the very best
be done in the eradication of decayed points, and a com
Permanent Molars. 393
plete, thorough polishing of the surface, and in the future
let them be kept as clean as possible. If there is a point
on the crown of these teeth where decay is beginning, that
should be ashley10@example.org. Taking any ordinary case, by such
care the first permanent molars may be, as it seems to me,
preserved. But, unfortunately, a large portion of these
teeth are allowed to be destroyed before particular attention
is given to them.
And, then, from the time of their eruption, they should
be well and thorough]}7 used, which will accomplish two or
three things : The friction keeps the teeth free from the
deposit to which I referred, and the pressure exercised upon
them gives strength to the periosteal attachment, and stim-
ulates the circulation about the roots and into the pulp, and,
of course, the bringing into the part an abundant supply of
the nutrient material which it demands. In this way the
tooth will be better conserved than if it was not properly
exercised. This exercise can be given to the teeth in the
use of such food as will require sufficient pressure upon
the teeth, and sufficient exercise.
{Sometimes, when one of these teeth is taken away, the
second and third molars will come in and fill up the space*
and there will be no loss; but in the gre^it majority of
cases this does not occur, to the complete filling up of the
space, that has been left by the removal of the first molar,
At the age of seventeen, I had two first molars removed,
and the spaces stand there to-day as large as when tnc teeth
were taken away; and the teeth did not move forward, or
the other teeth go backward to fill up the space, and it has
been a very great annoyance from that time to this. But
sometimes the-second molar will move forward, as a wThole,
and occupy the space of the first, to a considerable extent,
and occasionally almost entirely, but these are exceptional
cases. Often the second permanent molar will tip forward,
instead of moving forward in an upright position, and then
what is the result ? You have the posterior corner of the
tooth thrown up for occlusion with the opposing tooth
394 American Journal of Denial Science.
above, and a large portion of the surface of the tooth is not
used for breaking up the food, and there is imperfect mas-
tication and insalivation of the food. Sometimes the bicus-
pid tips backward a little, and the same disturbance arises
?the right occlusion for thorough mastication is destroyed.
In the proper arrangement of these teeth for mastication
they come together like the faces of millstones, and they
operate, face to face, one upon the other. They are not
thrown together, here a corner and there a corner, touching
only at a few points.
It is said that the other teeth are preserved by the early
removal of these teeth. Well, that depends very much
upon circumstances. If proper care is given to the mouth>
the other teeth will not suffer because these are retained.
It is not necessary for us to cut off one of our fingers in
order to save the ethers. No more is it necessary, recklesslyi
to take a\vajT one tooth for the welfare of the other. I
know that there may be cases of irregularity when ii is
necessary to do this. I am speaking now of those cases
where the development and arrangement of the teeth are
entirely normal. There is no occasion for the removal of
the first permanent molars to preserve the other teeth, if the
proper care is exercised on their behalf. I regard it as a
very great misfortune, indeed, to sacrifice first permanent
molars, and I think every effort should be made for tlieir
preservation and their retention in the month during life.
Dr. G. W. Keely : I would like to ask, if the patient
was eight or ten years old. and the four first molars were
badly decayed and the pulps exposed, what would you do
with them.
Dr. J. Taft. Well, I dunrt know what 1 would do ex-
actly ; yet I would treat them and endeavor to save them
just as earnestly as I would if the person were twenty-five
years old. If the person was well developed, and in good
condition otherwise, I should certainly endeavor to save the
teeth. If I inferred from the general make-up that there
would be a breach that would never be repaired in any way,
Caries and Necrosis of the Maxillai*y Bones. 395
1 should regard it as a very important matter to preserve
those teeth as long as possible. The observing dentist will
form an opinion when he sees the patient. If it is one of
tho3e strong, fixed, unyielding, firm organizations, you will
not expect the teeth to come in and fill up the space. In
a case of that character I should preserve the teeth as much
as I would at any other period of life, just as long as I
could keep them free from disease and discomfort to the
patient. By the way, I think the material with which
those teeth are filled should be carefully selected. 1 do not
think that in every case it is best to fill thoee teeth at once
with gold. Say, from six to seven or eight years of age I
should prefer tinfoil ; and perhaps, if the teeth were very
sensitive, I might use some more temporary material than
that. The teeth generally decay more readily at from seven
to eight years of age. I have many times filled teeth with
the expectation that the operation would only be temporary,
and have found, in many such instances, that the teeth so
filled have remained for years and years. There are teeth
in this room, now, that I filled twenty-five or twenty-eight
years ago, with tin-foil, thinking that they would not last
a great while ; and in years afterwards they were found to
be no further decayed, and the tin fillings were removed,
the teeth filled with gold and the teeth are to-day far better
than when they were filled with tin in the first place.


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