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and, in fact, eight of the eighteen unsaveable teeth in this group are present in the
mouth of one poor child, who is suffering from acute caries and general ill health.
In this particular case it is extremely difficult to keep pace with the various diseases,
although the boy is slowly improving. Again, in these schools, where continued
strenuous efforts have been made by care committee workers, organisers, teachers,
and by the doctors and dental surgeons, the numbers of treated children are very
high in group D. The general percentage of healthy children is 48. Lastly, where
cleanliness is high, dental health is high; a special examination of the individual
records showed that among 35 children with poor cleanliness, only three were healthy ;
among 82 children who were classified as having very good cleanliness, 61 were
healthy, a convincing argument (if it were needed) of the benefit of tooth brushing.
The number of teeth unerupted is almost uniform among these children, whose
average age is just under 14 years. At this period, according to the best authorities,
a normal child should have full 28 permanent teeth in place, and no temporary
teeth remaining. Actually, every other child shows failure to erupt one tooth,
frequently a premolar, owing to the retention of a temporary molar.
As would be expected, the extracted teeth are fewest in group D, where the
average loss is one tooth for each child. In these critical years, if treatment is missed
even for a year, caries spreads rapidly and necessitates extraction.
The fillings placed are numerous in children who come under treatment; the A
group shows nearly none at all, for the treatment if any is " extraction when the
tooth hurts "—an attitude towards the child's health that can almost be called
criminal.
In investigating caries, the following classification was adopted—cavities just
established, usually the size of a pinhead (the pinhole cavity, column 5) ; cavities
reasonably treatable by the school dental surgeon (larger cavities, column 6); and
finally those cavities where restoration is futile, or where the nerve of the tooth is
exposed. The figures speak almost for themselves. In groups A1 and A2, where the
teeth are neglected and where there is hygienic carelessness, the pinholes are many,
food lodges in every crevice, rapidly ferments, produces a larger cavity, and finally
destroys the crown. With even moderate attention to hygienic methods, caries is
checked, although one child in every two of group D needs a small filling ; this is
perhaps explainable by the fact that the school dental surgeon does not inspect
" leaver " children, and the very earliest decay is overlooked. It needs careful
search to find these tiny cavities, even on the part of a qualified dental surgeon.
The diminution in " unsaveable " teeth as care is given is obvious and striking,
and that any of these teeth should be found at all in group D is accounted for by the
inclusion of some children who, though receiving regular attention, are suffering from
general ill-health reflected in the mouth.
Slight gum disease is prevalent in the neglected children—almost every alternate
child shows it; whilst it is negligible in those cared for, it is found almost entirely
among boys who think it is effeminate to clean their teeth, although they may have
well-brushed hair and clean boots. Poor cleanliness (column 13) again, speaks for
itself ; although there was visual evidence that many children in groups A1 and A2
made some kind of attempt (on Sundays, perhaps) to clean their teeth. Deformity
was strikingly uniform among all groups ; highest in group A, but still high in group
D. These figures confirm those compiled by Mr. Ovey, published in last year's Annual
Report; deformity is due not only to hereditary factors, but to neglect of treatment
in the pre-school and earliest school years, and also to growth failure.
There was practically no healthy child except in groups C and D; even the omission
of a year's treatment may set a child back most woefully. Among the group D
children, healthiness was far higher (67.2 per cent.), almost exactly double the general
county percentage, and would have been higher still if the minute pinhole cavities
had been disregarded.