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30
Gums and
general
condition.
Articulation.
Normal.
Treated and
sound.
it did not seem worth while to go to the labour of procuring the treatment cards from the centres
and identifying the control children inspected. A very careful charting of each child was made.
New sharp probes of various kinds were used so as to ensure as far as possible that no cavities
were overlooked. I purposely adopted a stringent test of each child both of the Wick clinic
children and the controls. Every crevice, however small, in which a probe would stick was regarded
as a cavity, in the same way one would adopt in charting up a private patient in one's own surgery.
In assessing carious teeth as slight, saveable or unsaveable, I used the following tests : A cavity
in which a probe would just stick or which went just below the enamel was regarded as slight.
I included in this group teeth which had not completed eruption if the occlusal crevice would
retain a sharp probe. Among them were many teeth in which the " cavities " represented developmental
defects and in which a filling was a prophylactic treatment rather than a remedial treatment
for caries. This is the standard which most dentists adopt in the treatment of children in
private, and, though it may not always be practised in school dentistry, yet it represents the ideal,
and for that reason I used this test in assessing whether a tooth should be regarded as carious or
not. Slight caries, therefore, means caries actually present, or potential caries which would
probably follow if the crevice were not obliterated by a filling. Proximal cavities unless very
obviously in the earliest stage, were regarded as saveable because the forecasting of the eventual
size of approximal cavities is much more difficult than in occlusal cavities ; as frequently they
turn out to be larger than one would think I thought it advisable to put the majority of such
cavities in the group of saveable. All teeth so extensively carious that the pulps were obviously
dead, or in which treatment would lead to an exposed pulp, were regarded as unsaveable. There
were a good many teeth in which the grading was difficult. Where there was any doubt, I placed
the tooth in question among the unsaveable teeth. I took as my criterion the fact that in school
dentistry the aim is to fill as permanently as possible as large a number of teeth as possible.
Hazardous restorations which may have a limited life and require frequent inspections are out of
place, and teeth which involve a prolonged treatment, except in special circumstances, are better
extracted. I therefore adopted a somewhat drastic attitude in assessing carious teeth as
unsaveable.
I grouped the general condition of the mouth under the headings of good, moderate and poor.
By "good" I mean that the general hygiene of the mouth was good : there was an absence of
tartar, there was no inflammation of the gums ; the teeth looked bright and the gums firm and
pink. The presence of a brown stain round the necks of the teeth was not regarded as a reason
for excluding a mouth from this category. Rather the contrary in fact, for I noted that in many
mouths which were conspicuously clean, a brown stain was often present. Pickerill has noted
this fact and has even termed the brown stain the " health line." He infers that this stain is due
to some factor which aids in the natural cleanliness of the mouth. It is not, however, an invariable
concomitant of oral cleanliness, though in general my observations confirm those of Pickerill.
The brown stain is a narrow zone of stippled pigment near to the gum margin but not impinging
on it, so that there is a narrow area of normal enamel between the stain and the gum. Quite
different from this is the green stain which adjoins the gums and instead of being sharply defined,
is diffused. Where this stain is present the teeth look dull instead of bright, and the mouth is
often dirty. The actual presence of caries might co-exist with a clean mouth, and similarly a mouth
free from caries might, though not often, be classed as "poor" so far as the cleanliness of the
gums was concerned. A purely localised inflammation due to a septic tooth did not necessarily
prevent me from classing the gums as good if the general condition of the rest of the mouth was
good. By "moderate" I meant that there was slight gingivitis, or the teeth looked dull though
food debris might be absent. The main factor was the presence of gingivitis. By "poor" I
mean those mouths which had marked gingivitis or looked uncared for. Tartar might be present
and it was obvious that the mouth received no attention, though I did not take as my standard
any conscious efforts at oral hygiene, for by this test few children could have been placed in the
category of "good." Many of these children suffered from irregularities which were really the
cause of the poor oral condition. Though the cause was beyond any efforts of the child to remedy,
I still placed such children in the third category, just as I placed in the first category those children
with clean mouths whether they used a tooth-brush or whether it was due to a natural immunity
and any personal hygiene was quite absent.
As already stated, the form I used was one in use in the Council's dental service, but as it did
not seem to have any bearing on this inspection, I did not note in detail the state of the articulation,
though in the column of " notes " some brief note of irregularities present was made.
In this category were placed those children with a sound dentition in which no fillings had
been done. Where temporary teeth were absent I made enquiries. If it seemed that they had
been lost naturally, they were regarded as normal. If there was any evidence to suggest that they
had been extracted because of caries, then the child was not classed as normal, but as "treated
and sound." The number of normal children was very low, four in the children attending the
Wick centre and 13 in the control group.
In this category were placed all children whose mouths had been rendered sound by fillings
or extractions. Even if a child had only one slight cavity, and, although this might have developed
in a tooth which had erupted since the last treatment, the child was still excluded from this
category. The only exception to this was in children of 12 and over. In these children a loose
temporary tooth, even though carious, was not taken into account. Such a tooth had practically
outlived its functional activity, and its natural loss was close at hand. It seemed reasonable,