IS DENTITION A CAUSE OF DISEASE? 
By George Wythe cook, M, D, 
Read before the Washington Obstetrical and Gynecological Society 
December 17, 1886. 
Reprinted from the American Journal of Obstetrics and Diseases of Women 
and Children. 
WASHINGTON, D. C. 
TAYLOR & BART, PRINTERS. 
1887. IS DEXTITIOA A CAUSE OF DISEASE? 
BY GEORGE WYTHE COOK, M. D., 
WASHINGTON, D. C. 
The process of dentition has inteiested me since I 
began the practice of medicine. It is perhaps the 
most striking phenomenon occurring in the develop- 
ment of the human organism, because we see the 
hard, bony teeth emerge in definite order from the 
softer tissues of the gums and range themselves uni- 
formly in the jaws. There is nothing comparable to 
it in the growth of the body. 
This eruption of the teeth is viewed with great 
solicitude by the anxious mother, and no little con- 
cern by the family physician, and many years ago this 
proverb was current, that “parents could not truly 
rejoice in their children before they had cut their 
eye teeth.” Having been one of a large family 
of children, I was no stranger to the notion that den- 
tition was a cause of disease, and sometimes of death, 
so that as a student of medicine my mind was well 
prepared to receive the teaching of the masters—that 
the eruption of the teeth is a fruitful cause of disease 
—and the doctrine was cherished as having been “ de- 
livered by the saints,” and was subject to “no varia- 
tion or shadow of turning.” 
And this doctrine seems still to be in full force, 
for, by reference to the text-books of to-day, I find 
that many of the diseases of infancy are attributed to 
the evolution of the teeth, and in scanning the mort- 
uary tables in the “Ileport of the Health Officer of 2 
the District of Columbia for 1885” I find as many 
as sixty-six deaths ascribed to dentition as the pri- 
mary cause. If it be true that dentition is the cause 
of so many deaths, then, indeed, has nature been la- 
mentably inadequate to the necessity of properly pro- 
viding for the growth and development of children, in 
making the evolution of the teeth, which is a necessary 
and inevitable process, a cause of death, and thereby 
defeating her own purpose. From observation and 
thought, however, I am persuaded that nature has 
not been at fault, but the error lies in assigning 
a cause for the disease, and dentition is a most con- 
venient scapegoat. I know that this opinon is at vari- 
ance with the popular idea, as well with the bulk of 
the practitioners of medicine as with the laity, and the 
purpose of this paper is to stimulate thought upon the 
Subject, that nature may be justified and the ailments 
of infancy assigned to their true causes. To this end, 
it will be of interest to consider the development and 
eruption of the teeth. 
According toGoodsir, the teeth are developed from 
the mucous membrane covering the edges of the max- 
lllary arches; beginning in the upper jaw, about the 
sixth week of fetal life, by the formation of a depres- 
sion, called the primitive dental groove, from the floor 
of which the germs of the milk teeth are developed. 
These germs, which are formed by a conical eleva- 
tion of mucous membrane, make their appearance in 
the following order: At the seventh week, that of the 
first deciduous molar of the upper jaw; at the eighth 
week, that of the canine tooth; the incisors about the 
ninth week; the second molar papilla at the tenth week. 
And the germs of the teeth of the lower jaw follow 
in the same order, being developed a little later. After 
the papillary stage of development, the dental groove 
contracts and is converted into follicles for the recep- 3 
tion uf the papillae, the follicles becoming the alveoli 
lined by periosteum. 
From the follicular to the saccular stage the devel- 
opment is rapid, the latter being completed at the end 
of the fifteenth week. The deeper portion of the prim- 
itive dental groove is now closed in, but that near the 
surface of the gum still remains open, and is called the 
secondary dental groove, from which are developed the 
ten anterior permanent teeth. About the fourteenth 
week, a depression is formed behind each of the sacs of 
the rudimentary milk teeth. They are formed from 
before backwards, and are the rudimentary follicles of 
the permanent teeth. The secondary dental groove 
closes in and the follicles become closed cavities, which 
elongate and recede from the surface into the gum be- 
hind the sacs of the deciduous teeth, a papilla pro- 
jects from the bottom of each, which is the germ of the 
permanent tooth. The permanent molar teeth are deve- 
loped from the primary dental groove. The rudiment 
of the first one is formed during the fourth month. The 
papilla of the second permanent molar appears at the 
seventh month after birth, and that of the wisdom tooth 
at the sixth year. It will not be necessary, for the pur- 
pose of this paper, to detail the manner of the growth 
of teeth; it will be sufficient to say that it is a contin- 
uous process from the seventh week of fetal life 
to the twenty first year after birth, when the wisdom 
teeth make their appearance through the gums. It 
will not be superfluous, however, to recount the order 
and time of the eruption of the milk teeth. This is 
set down as occurring as follows: The central incisors 
at the seventh month; the lateral incisors from the 
seventh to the tenth month; the anterior molars from 
the twelfth to the fourteenth month; the canines from 
the fourteenth to the twentieth month; and the post- 
erior molars from the eighteenth to the thirtieth 4 
month This is the order in which the teeth usually ap- 
pear but to this there are some exceptions, and it may 
be interesting to relate here a few striking examples of 
departure from the ordinary rule. 
“The younger Pliny states that the renowned Marcus 
Curius, Consul of the Pom an Republic two hundred 
and seventy years before our era, had a full set of teeth 
at birth. This was the reason of his being named 
Dentatus.” (A. Jacobi on “Dentition.”) 
Richard III, whom Shakespeare makes speak of 
himself as— 
Cheated of feature by dissembling nature, 
Deformed, unfinisli’d, sent before my time 
Into this breathing world, scarce half made up,” 
was born with teeth, and to this circumstance was 
attributed his cruelty, and is thus referred to by Queen 
Margaret when upbraiding the Duchess of York for 
having given birth to so,terrible a monster: 
“From forth the kennel of thy womb hath crept 
A hell-hound, that doth hunt us all to death, 
That dog, that had his teeth before his eyes.” 
But the most remarkable case on record is that of a 
Spanish dwarf, who had all his teeth when born, and 
never lost one of them, got a beard in his seventh, and 
was a father of a son in liis tenth year.” (A. J acobi on 
“Dentition.”) 
There are other cases of earily dentition reported, 
but these will suffice. I will mention here a few cases 
of third dentition. 
A patient of mine, an old colored woman, now about 
eighty years of age, at the age of seventy lost her last 
molar from the right lower-jaw; in a few months after- 
ward, a new tooth appeared and still remains. In the 
“Medical Commentaries of 1787,” this case is report- 
ed: Mary Mood, 98 years and 5 months old, suffered 
from asthma from early youth; she chewed tobacco 5 
at the age of fifteen years. Half a year ago she got 
twelve molar teeth, eight of which still remain,though 
they are all somewhat loose. “A country laborer in 
the south of Scotland lost all his teeth by the time that 
he was sixty years old; about half a year afterwards 
a new set appeared, all of them within the space of 
twelve days, and they continued fresh and firm for 
thirty four years. He is now ninety six years of age, 
and within the last two years has lost three teeth.” 
(From “Medical Commentaries, 1784.”) In this con- 
nection I am permitted to say that the wife of one of 
the fellows of this Society has never shed her first 
lateral incisors of the upper jaw. 
Of all the remarkable cases on record relating to 
the teeth, the following, which was reported a century 
and a half ago, is the most wonderful. “There lived at 
Leipsic a noble lady who had five children; with 
every confinement she cut a molar tooth. As soon as 
one of her new teeth got loose, the child who was born 
at the time when it was cut was affected with some 
severe disease. If such a tooth fell out, she was 
always certain that the corresponding child was surely 
going to die. And so it happened, adds our honest 
author, all the five children died before their mother.” 
And Jacobi, from whom this is quoted, adds that 
■“ thus you perceive that, as it is said to be custom- 
ary nowadays that children die from their own teeth- 
ing, it was customary for children in oiden times to 
perish from the dental troubles of their mothers.” 
I have mentioned these cases of irregular dentition 
•simply as curiosities. The important fact to keep in 
mind is, that normally the teeth are developing from 
the seventh week of fetal life up to about the twenty- 
first year of age. Tire term dentition, as ordinarily 
used, means the period of the eruption of the tempo- 
rary teeth. And those who believe that it is a factor 6 
in producing disease limit its causative influence to 
that period, that is to say, from the seventh month up 
to two and a half years, lint if the teeth have anything 
to do with producing disease, would it not he reason- 
able to say that they so operate during the entire time 
of their development as to confine their deleterious 
influence to the eruptive stage? What is the pecu- 
liarity of the teeth at this eruptive stage that would 
lead us to believe that they had an influence in pro- 
ducing disease ? Nothing, only we expect to see them 
emerge from the gums and present themselves to our 
anxious view, The growth of teeth is not different 
from the growth of bone elsewhere, and there is 
nothing in the fact that the teeth come through the 
gum, for this is a simple process, accomplished by 
the gradual growth of the teeth and no less certain 
absorption of the gum. 
•But there is no symptom, from the slightest rash 
upon the shin to the most profound nervous manifesta- 
tion, that has not been attributed to dentition as a cause. 
But how does this process cause disease? There is no 
uniformity of sentiment upon this subject. Some 
refer the difficulty to backward pressure upon the 
sensitive tooth pulp. Others, and perhaps the larger 
class, to t\\Q forward pressure upon the gums. And 
a FrenQh writer, whose name I do not now recall, 
promulgated the remarkable idea that the advancing 
tooth produced a pruritus or tickling of the gums, that 
was so persistent and harassing as to completely upset 
the nervous system and thus produce the “many dis- 
eases of dentition.” And again, Dr. Ilayden, of 
Baltimore, years ago wrote an elaborate thesis, in which 
he attemped to show that the teeth were enveloped in 
an acrid humor, which was the fons et origo of all the 
trouble. With these contrary views, no one of which 
is supported by positive evidence, it is not difficult to 7 
discredit all of them. The “humoral” and “titilla- 
tion” hypotheses may he dismissed without discussion, 
and there is not the slightest evidence of any inju- 
rious pressure either “forward” or “backward” in the 
growth of the teeth. Forward pressure upon the 
gums, if such there be, would be insignificant in pro- 
ducing disease, as this tissue is “remarkable for its 
limited sensibility.” There is no pressure backward 
upon the sensitive tooth pulp, for the tooth is pushed 
upward by the growth of the fang below, and there is 
no resistance, for the gum is as certainly absorbed in 
front of the advancing milk tooth as the roots of the 
temporary teeth disappear on the approach of the 
crowns of the permanent teeth. 
The facts are, we grow up with the notion in- 
stilled into our minds by our mothers and nurses, and 
by the doctor, too, for that matter, that dentition is 
necessarily a painful and dangerous process, and dur- 
ing the period of dentition so many diseases do oc- 
cur that it has become a habit to charge them to the 
teeth as the cause. But this is not reasonable, for 
nature would save the individual from harm in a pro- 
cess that was necessary and inevitable. 
There is as great diversity of opinion as to the treat- 
ment of dentition as there is as to how it produces 
disease. Soothing application to the gums, from the 
old-time remedies of “blood from the recently wounded 
cock’s comb”, and “fresh brains of hares” down to 
the most modern local anesthetic, hydrochlorate of 
cocaine. All sorts of lotion and unguents, frictions 
with hard soft substances. Free scarification of the 
gums was recommended by John Hunter and I)r. 
Churchill, and Marshall Hall repeated the operation 
as often as several times a day. The great Trousseau, 
however, said this practice was useless, and I believe 
the same may be said of all the other remedies pro- 
posed. 8 
A physician is called to see a child and gets this 
history from the mother: Some days ago it was taken 
with vomiting, and soon after diarrhea began, which 
has continued to this time. It has been very fretful 
and restless. Remembering what her mother had told 
her, she said she had not considered it necessary to do 
anything, as she thought the diarrhea was beneficial, 
and suggested that, as the child was teething, the 
trouble was to be expected. Rut she was now worn 
out with watching and waiting, the tooth did not come 
through and baby was getting worse all the time, so 
she had been compelled to send for the doctor with 
the hope that he could do something to speedily re- 
lieve the little sufferer. The doctor rinds, in addi- 
tion to the above symptoms, that there is fever, and, 
upon pressure, abdominal pain. He learns also that 
the child nurses with great avidity, and it has been 
allowed to do so without stint, notwithstanding it 
vomits the milk soon after it is taken. Upon ex- 
amining the gum he finds it swollen, lacerated, and 
contused over the advancing tooth. The mother ex- 
plains that the poor thing was suffering so that she 
thought that she could help the tooth through, so she 
had been rubbing the gum with her rough thimble or 
finger-nail. The doctor will at once reeognise that 
he has a case of entro-colitis with which to deal, but to 
what cause will he attribute the difficulty? Ten to 
one he will coincide with the suggestion of the mother, 
that dentition was the cause. That is the easiest 
thing to do, and it is entirely satisfactory to the 
mother. But putting aside all preconceived notions, 
is it reasonable? Consider the environment of the 
child, errors in diet, it is of an age when the mother or 
nurse thinks it may be taken to the table and given a 
“taste” of all that is before it, or it may itself pick 
up and swallow some offending substance. Failure to 9 
observe the laws of hygiene, want of cleanliness, and 
proper clothing, atmospheric conditions, how the 
mother dreads the “child’s second summer!” but no 
plaint has yet been heard against a second winter. 
Do the teeth hibernate? 
Taking into consideration these facts—that certain 
atmospheric conditions, bad hygiene, and errors in 
diet will produce the same kind of diseases in the adult 
as in the child, and that dentition is a necessary and 
inevitable physiological process, is it not more reason- 
able to attribute the diseases of infancy to other than 
a physiological cause? 
If I have succeeded in fixing your attention upon 
this subject, and you will consider it deliberately, help- 
less infants will be spared much suffering and many 
lives will be saved. But so long as the physician 
inculcates the doctrine that the evolution of the teeth 
is a cause of disease, the laity will accept that doctrine, 
and anxious mothers will stand idly by waiting for 
the coming of the teeth and hoping the trouble will 
soon be over. But, alas! precious time has been lost, 
and too often the penalty of such neglect is the death 
of the child.