Leuman M Waugh

Care of the deciduous teeth as the basis of occlusion of the permanent dentition

Abstract The most important preventive procedure in orthodontics is the maintenance of the full deciduous arch length from the distal surface of the second molar around to that of the opposite side until the teeth are replaced by their successors. The permanent first molar thus is guided in eruption to its normal position contacting the distal surface of the second deciduous molar and should be so retained until all the deciduous teeth are replaced at about the twelfth year. It is the most important of all teeth and must be kept in perpetual health and efficiency. This we recognize as the imperative factor in the development of normal occlusion of the permanent teeth. If the full length of the deciduous arch is not maintained, the permanent first molars almost invariably shift to the mesial, resulting in too little jaw area with crowding and malalignment of the premolars and cuspids as they erupt, and orthodontic treatment thus becomes a necessity. In normal cases the deciduous molars and cuspids provide sufficient anteroposterior jaw length to accommodate their permanent successors. Therefore, horizontal growth in this region is not necessary after the fourth year. In extreme cases of mesial shift of the permanent first molar, extraction of good teeth may become necessary for the attainment of a pleasing result. However, it must be regarded as a compromise. Early treatment is the best safeguard against the need for such a procedure. It should be synchronized with the normal growth of each individual child. In the buccal segments, for the correct alignment of premolars and cuspids, the jaw area should be large enough to receive these teeth in advance of their eruption, and the correct distal position of the permanent first molar assuredly provides for this. Mesial shift should be corrected as soon as detected by moving this molar to its normal distal position. Extra-oral pressure, with headcap or cervical anchorage, is often indicated. In the incisal segment, horizontal jaw growth continues after eruption. While the permanent incisors are considerably wider than their deciduous predecessors, there is some latitude in that growth of jaws forward and downward in this section continues during and after eruption. Should developmental spacing of deciduous incisors be insufficient to provide an adequate area for their eruption in alignment, the tongue and lips in function tend to guide them into alignment as growth of the jaw takes place during the two or three years following eruption, provided there is no mechanical interference, as when teeth are in-locked or in crossbite, or when supernumerary teeth are present. These conditions should be corrected without delay and should take only a short time. The appliances should then be removed and Nature given her opportunity. Quite frequently it will be necessary to align them finally during a secondary period of treatment. Protruding upper incisors should be corrected promptly to protect them against the danger of breakage. Deep overbite, when the lower incisors wound the mucous membrane of the palate, should be corrected promptly. Abnormal labial frenum should receive early treatment by appliance pressure from the distal surfaces of the upper central incisors, the frenum thus being compressed with resultant resorption due to diminished blood supply and impoverished nourishment. Open-bite, almost invariably, is due to harmful pressure habits of biting or sucking the tongue, lips, finger, or thumb. This should be corrected as early as is expedient. Relapse of well-aligned teeth will recur unless the causative habit is permanently broken. Certainly, the most harmful advice that can possibly be given the parent is that orthodontic care should be deferred until all the deciduous teeth have been replaced by their permanent successors at about the twelfth year.

The advisability of extraction as a therapeutic aid in orthodontics: Negative

Abstract 1. I. Growth of jaws and face should, as a principle, be thoroughly stimulated to the maximum of their inherited possibilities before interfering with the growth urge by the extraction of healthy teeth. 2. II. Since it is impossible to foretell at just what age unusual spurts of jaw and face growth will take place and to what extent, and since growth normally continues well beyond the eighteenth year, it is only in extreme cases that extraction of bicuspids should be resorted to much before this age. The crowns of teeth are full size when erupted while the jaws and face continue to grow beyond the twentieth year. 3. III. In a comparatively small percentage of cases, which may vary considerably in racial admixture and in different strata of society, mostly dependent on the quality of dentistry done for the child, the amount of tooth material and jaw size will make it impossible to produce a stable occlusion in harmony with facial balance without removal of some teeth. The number of teeth and the class of tooth should be decided for each case individually. The smallest number of the least important teeth should be condemned to extraction. 4. IV. The removal of teeth does not correct the malocclusion. Self-correction following extraction but very seldom takes place; therefore, appliance therapy must almost invariably follow. Orthodontic treatment after extraction is in many cases more exacting than before. 5. V. We believe that there is a middle course, somewhat as practiced by Calvin S. Case over fifty years ago, which has been quietly followed by studious and careful orthodontists, that will eventually prevail as the sound, guiding principle of practice in orthodontic treatment. 6. VI. It is our belief that inestimably greater harm is resulting from ill-advised extraction of healthy teeth for correction of malocclusion that has been done in the past fifty years by following the Angle dictum of non-extraction in orthodontic treatment.

Why do we have orthodontic failures

The foregoing surely offer a range so broad that one may choose to address you from a number of viewpoints, such as that of an art, a profession, or a business. Since our colleagues in general dentistry credit the orthodontist with being a good business man, I might have selected the third definition as my topic, because I believe that the misunderstanding by the general practitioner of the orthodontic problem is due in large part to the failure of the orthodontist really to acquaint him with the science underlying the specialty as a basis for the art of its practice. Were he fully informed, he would not think orthodontics simple, its practice easy, and its earnings large. We could soon point out to him that, unhappily, some orthodontists have failed to meet their obligations, have had to discontinue special practice, and seek employment in other fields. I might also have chosen the second application and elaborated on those temptat.ions that lure orthodontists so that they “fail by losing flesh and waste away.” I fear, however, that were I to attempt this I should, as a personal exhibit, be laughed from the platform. I shall, therefore, direct you to the first definition, “that which is deficient, inadequate, or anything done imperfectly or attempted unsuccessfully.” Orthodontics, like any division of the health services, cannot always be wholly successful. There are too many variables to permit this. But it can, with increased knowledge and its dissemination especially among its own practitioners, reduce the number and extent of its failures. This the specialty has always striven to do and, may I say, not without success. When one contemplates that it is only forty years since so-called modern orthodontics had its inception, and this in a most modest beginning, there is no just cause for selfcriticism. In fact, I know of no branch of dentistry in which so much collateral fundamental science has been garnered and assimila.ted. This has resulted largely from the interest of scientists outside the field of our practice while most valuable and practical contributions have also been, and are now being, made from within our own ranks. The foremost cause for failures in practice, I feel, comes as a result of the inadequate facilities for orthodontic education which have prevailed until quite recently.

Resolutions of the Northeastern Society of Orthodontists

J OHN VALENTINE MERSHON, one of the most beloved benefactors in the specialty of orthodontics, died at his home in Philadelphia, Pa., on Feb. 18, 1953. John Mershon, the youngest of nine children, was born on July 7, 1867 at Penn’s Manor, Pa. His parents were Onias C. and Amanda Valentine Mershon. He attended the local elementary school and the Model School at Trenton, N. J. His dental education was received at the Pennsylvania Dental College (later merged with the University of Pennsylvania), from which he was graduated in 1889 with the degree of Doctor of Dental Surgery. He served as Instructor in Dentistry at his alma mater for a number of years and engaged in the general practice of dentistry in Philadelphia for a period of nineteen years. In 1908 he completed a course of instruction in the Angle School of Orthodontia. Returning to Philadelphia, he limited his practice to orthodontics for the rest of his long professional career. In 1896, Miss Harriet Lane Worrall, member of an old colonial family of Pennsylvania, was married to Dr. Mershon. Mrs. Mershon continues to reside in Philadelphia. During his very active career, Dr. Mershon served as president of the American Association of Orthodontists, the Northeastern Society of Orthodontists, the Philadelphia Academy of Stomatology, and was the first president of the Philadelphia Orthodontic Society. His dental affiliations included the following: American Dental Association Pennsylvania State Dental Society First District Dental Society of Pennsylvania . Fellow of the Dental Society of the State of New York American Association of Orthodontists Northeastern Society of Orthodontists Diplomate of the American Board of Orthodontics Fellow of the American College of Dentists International Association for Denta, Research American Association for the Advancement of Science Southern Society of Orthodontists (Honorary) Southwestern Society of Orthodontists (Honorary) Pacific Coast Society of Orthodontists (Honorary) European Orthodontological Society (Honorary) Delta Sigma Delta Fraternity

Growing perfect teeth

Announcer, Dr. Harry E. Kelsey.-We take pleasure in presenting Dr. L. M. Waugh, Professor and Director of the Orthodontic Clinic, School of Dental and Oral Surgery, Columbia University, who will talk to you upon the subject: “Growing Perfect Teeth.” Dr. Waugh has made many adventurous voyages to visit the Eskimos in northern Labrador and Arctic Alaska. He has made these cruises in small boats and has brought back valuable information about the relation of food to the general health of the Eskimos and, particularly, to the health of their teeth. He could tell us, if time permitted, many interesting stories of his experiences among these far-away people. Dr. Waugh.-If you were to stand a primitive Eskimo boy 10 years old before a group of our boys of the same age, they would think he was nothing but a little savage, and he would be afraid of them, for he would have come from so far up in the frozen north that he had seldom, if ever, seen a white man. He would never have seen an automobile, or a football, or a baseball, or a moving picture, or have heard a radio. He would never have had a piece of candy, a nice thick slice of bread well covered with jam, or pancakes and syrup. And yet, that little Eskimo would have some things that our boys and girls wish they didn’t have. In the first place, he would have the most excellent teeth that you have ever seen, regular, strong, and without a single cavity. He would never have known about toothache, and though he came from a country where it is sometimes 70 degrees below zero, he would be self-reliant and laughingly happy back home. And when that boy grew to be a man, he wouldn’t have any decayed teeth or suffer toothache. He would never have heard of a dentist and would really not need one. Announcer.-Are you telling us, Dr. Waugh, that these people, who live lives of great hardship and are entirely without the things that make us comfortable and give us pleasure, have practically perfect teeth and no need for dentists? Dr. Wuugh.-I am telling you that and a great deal more. These people have practically none of the diseases from which we suffer. Physicians are unknown there, and I was the first dentist that the Eskimos of northern Labrador and Arctic Alaska had ever seen. Announoer.You began by saying that these people have perfect teeth, and, I suppose, healthy gums. You went on to say that they are free from the diseases that kill us before we grow old. Is there any relation between their excellent teeth and their excellent health? Dr. Waugh.-Yes, indeed, there is such an intimate and important relationship that if we all understood it fully, not one of us would allow our teeth to become unclean and decay. Decay of the teeth is a disease which may, eventudly, affect the whole body, but is seen and felt more plainly in the teeth than