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dental conditions actually existing. Out of 700 only 20 had no obvious decay, 205 had two, 152
from three to five, and the rest more, teeth in a carious condition. The following are individual
instances :—
Boy, aged 5 1/12, had not one tooth, merely offensive stumps.
,, ,, 3 7/12, had 7 teeth out and 5 stumps remaining.
,, ,, 4 9/12, had 11 stumps.
>, ,, 4 9/12, had 14 stumps.
„ „ 4 8/12, had 17 stumps.
Girl, aged 5 2/12, had only 2 teeth left
With such dreadful oral conditions and the constant absorption of septic material the chances of
healthy childhood are small for most of these infants, although the popular idea seems to be that milk
teeth do not matter.
During the year dental care has been instituted for children over 10 years of age in the schools
for the deaf. This is a matter of especial educational importance in connection with the teaching
of articulation. The teachers have to come into close contact with their pupils, and foul or septic
conditions of the mouth are often intolerable. The attention confined to children over ten should, however,
be extended to all ages. The observations made in the schools were carefully checked by
Mr. C. Edward Wallis, who voluntarily examined many children at the Michael Faraday School, and
who is able to compare them with the children of the Council's two industrial schools at Mayford and
Feltham. The boys are younger at Mayford and the importance of beginning young is emphasised
by the greater care these boys seem to take for their teeth. Surprise visits at both schools, however,
show the teeth to be usually in most excellent condition. From the work at Feltham, where there
are usually about 540 boys and about 125 annual admissions, some idea can be obtained of the amount
of treatment required to keep mouths in order.
The first step is the inspection of the mouths. A large number of necrosed teeth
were found in situ, and as a result alveolar abscesses, gingivitis, inflamed tonsils, and enlarged glands
were prevalent. Having selected those to be treated, from 15 to 20 were seen at each weekly visit,
and all teeth so diseased as to be incapable of being rendered healthy and efficient for the purposes of
mastication and maintaining the proper growth of the jaws were removed, to as speedily as possible
improve the condition of their mouths and consequently the general health. At first the time was almost
wholly given over to extractions. No anaesthetics were given or required. As far as possible all were
removed at one sitting, and the boy then told that so long as he kept his mouth clean he would have no
further teeth out. The removal of the septic teeth alone produced a great improvement in general
health, from diminution of the cases of sore mouths or throats, tonsilitis and enlarged glands. The
teeth requiring stopping were then taken in hand, and only 15 boyB, but often not more than 12, could
be managed at a visit. Assuming that 15 to 20 are seen every morning and afternoon, from 75 to 100
children will, as a rule, be dealt with weekly, or 6,000 to 8,000 yearly, by a dentist working all the time.
The secondary schools and training colleges show dental conditions among their pupils which,
considering their age and status, are no better than the conditions of neglect and offensiveness found in
the elementary schools. Of the 134 boys examined at Paddington Technical School and at Hackney
Downs 62 per cent. had two or more decaying teeth. In many cases there were spongy gums, and two
had suppurating conditions (pyorrhoea alveolaris). Among the men.students at Ofiord.road neglect
of the mouth was general, and several cases had suppurating conditions, the foulness in some being
almost as offensive as ozoena. Among the girls of the secondary schools, for aesthetic reasons, the
conditions are somewhat better, but one.third (37 per cent.) required improvement. Some never used
a tooth.brush, some once a month, or once a week, and so on, and few appeared to realise the importance
of the hygiene of the mouth. In the training colleges, although 43 per cent. are returned with dental
defects, the use of the tooth.brush and attention to oral hygiene is much better, although there is yet
great room for improvement. Hitherto the futility of mere examinations without treatment in dental
cases has made the employment of school dentists scarcely a matter of practical politics. The experience
of the last three or four years in Germany has, however, altered this. Professor Jessen, of Strassburg,
from his dental work in connection with the army, was led to turn his attention to preventative measures
among the school children. He has worked out a scheme for school dental care which was taken up by
the municipality, and is now being adopted as the pattern throughout central Europe. During a recent
visit to Strassburg this work was shown and demonstrated, and the work conducted on somewhat similar
lines in other towns was also seen and enquired into.
It is obvious that dental caries is the most widespread affection among the population, and as
a result the working capacity, and even earnings, of large numbers of the population is seriously affected.
Dental hygiene must be taught in school, but the continental experience shows that examinations and
teaching are useless, unless followed by the practical measures of inculcating and enforcing cleanliness
among the children, and providing remedial treatment. Most of these children will be neglected if
left to private enterprise. The affection is so insidious and so widespread that it should be met by
public provision. There is no way of dealing with money in the interests of public health which will
return so enormous a gain to the population for the small expense required as this matter of school
dentistry. Dentists never touch this class of child, and there is here no competition between the private
practitioner and the public servant. The children at Strassburg, as we saw when there, come gladly and
come voluntarily. They bring each other to be relieved.
At present there is not hospital accommodation in London for more than about 200 cases weekly,
say, 10,000 annually, but at least ten times this accommodation would be required to relieve even a
part of the children whom school dentists would select as requiring it. Probably dentistry would be
best practised as part of the work of the school clinics which are suggested. The operations would be
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