The period of the first dentition is subject to many variations, but as a general thing it occurs between the seventh and the twentieth or the thirtieth month, although sometimes it is delayed much longer. The teeth* usually appear in each jaw in couples; thus, about the seventh month the two central incisors of the lower jaw appear; then in a short time those of the upper jaw, followed after a short interval by the lower lateral incisors, and then by the upper lateral incisors. From the twelfth to the fourteenth month the first four molar teeth appear, and from the sixteenth to the twentieth, the lower and upper canine teeth; last of all the last four molars.
* See plate 5.
Notwithstanding the above sketch describes the usual process of teething, yet in very many cases there are deviations. Sometimes children are born with teeth, or they make their appearance shortly after birth. Thus Louis XIV. of France, Mirabeau, and Richard III. were born with teeth. Often the order of succession mentioned above is violated, the upper incisors making their appearance before the lower, the molars before the canine teeth, and so on; frequently also they do not appear in pairs, there being a difference of some months between the appearance of the first teeth.
But the first set of teeth are only temporary, being supplanted after a certain length of time by a permanent set. Up to the age of five, six, or seven years, the jaws of a child may be said to contain two sets of sockets, which are kept distinct by a bony lamina. But at length, while the process of growth and development of the jaw and the second set of teeth are going on, another commences, having reference to the first set. The root is gradually absorbed, so that after a time the tooth itself may easily be removed with the fingers. In its place the second or permanent tooth shortly makes its appearance.
The first two central incisors of the lower jaw usually fall away about the age of seven years, and are speedily followed by the permanent teeth. About a year is occupied in shedding the four central incisors, and another year in that of the four lateral incisors. The anterior bicuspid teeth of the lower, then those of the upper jaw are next shed, usually occupying about a year. The posterior bicuspids go next, then the canine teeth. At length, usually before the age of twelve or thirteen, the second set of twenty-eight teeth is completed. A few years now elapse, when, usually between the age of seventeen and twenty-one, four new molar teeth are put forth, called the wisdom teeth, completing the full number of thirty-two teeth in the mouth. Deviations from the ordinary rule, are as common with the second dentition as with the first.
If the child is healthy, and the process of dentition favorable, the suffering is slight. For some time the gums are swollen; the child dribbles incessantly and thrusts its finger or any thing it can seize into its mouth. As the teeth advance, the gums swell, and become tender, but with a feeling of tension and itching, which causes the child to wish to bite some hard substance. The gums are inflamed, and are hot to the finger; the child is fretful and uneasy. Dentition is usually more severe in winter than in summer.
In severe cases of dentition, the symptoms are much more violent; the mouth is hot, the gums swollen and so exceedingly sensitive, that the child does not wish them touched. There is fever, thirst, and sometimes convulsions.
Connected with teething there are many sympathetic affections. There may be either constipation, or diarrhoea, swelling and suppuration of the glands, eruptions on the head and other parts of the body, cough, and great irritability of the nervous system.
It is important that the bowels should be kept open and the head cool, as there is more or less determination of blood to the head. The child should be permitted to bite on some hard or elastic substance, such as a crust of bread, a piece of silver, ivory, or india-rubber. If the gums are hot, swollen, and painful, they may be bathed with cold water, and if they are evidently near the surface, and there is danger of convulsions, they may be cut with a knife, being careful to cut through the gums until the teeth are reached. This operation however is very seldom necessary.
Aconite.* - Should there much fever and restlessness. Aconite may be given once in three or four hours.
Belladonna will be indicated, if there is derangement of the nervous system, swollen and inflamed gums, flushed face, and indications that the brain is becoming involved. Also where there are convulsions generally followed by sleep: the child starts from sleep as if frightened ; the pupils of the eyes are dilated; the body becomes stiff, and there is burning heat in the temples and hands.
The remedy is often required in alternation with Aconite. Twelve globules, or two drops, may be mixed with a glass half-full of water, and a teaspoonful given one, two, or three hours apart, according to the symptoms. When given alone, it may be taken once in three or four hours, except in cases of convulsions, when it should be given once in ten or fifteen minutes. See Convulsions.
Chamomilla is a prominent remedy in many of the difficulties connected with teething. It is particularly useful where the child is restless and uneasy at night, has spasmodic jerking and twitching of the limbs during sleep, starts from the slightest noise; hacking cough and oppression of the chest; also where there is diarrhoea with watery, slimy and greenish evacuations, worse at night. See also Diarrhoea.
Same as Belladonna.
Dry cough, and disposition to rub the nose, and also to grate the teeth during sleep, together with other symptoms of worms.
Prepare same as Belladonna, and give morning and night.
* For further directions as to the administration of remedies, see page 12.
Convulsive jerkings of single limbs; heat followed by perspiration. Starting from sleep, with piercing cries. Give same as Ipecac. Consult Convulsions.
Calcarea should be given where the teeth are slow in making their appearance. Two globules or a powder may be taken every night.
Diarrhoea with straining; profuse salivation and redness and soreness of the gums. Give two globules or a powder three times a day.
Nux-v. and Bryonia should be given, where there is obstinate constipation; three globules or a powder of one, one night, and the same quantity of the other the next. Follow in a week's time if necessary, by Sulphur in alternation with Nux-r, in the same manner.
If the child is nursing, the mother or nurse should pay particular attention to her own diet; if it has already been weaned, its diet should be simple, and unstimulating, avoiding those articles which have a tendency to derange the system. Cleanliness is of course essential as well as pure air. Daily bathing should be practiced, and the rooms kept thoroughly ventilated.