The process of dentition is much easier in some children than it is in others ; but it is difficult to assign a reason for these differences. The fa cility with which the teeth appear seems to be dependent more upon indi vidual peculiarity than upon actual bodily health. Teeth cut early are not always cut easily ; and delayed dentition is not always, nor even usually, troublesome. A perfectly healthy child may cut his teeth with much suf fering, although fully up to time ; while a rickety child, although very late in teething, may suffer no inconvenience at all in the process.
Symptoms.—The symptoms which accompany the eruption of the milk teeth are very variable. Sometimes no signs at. all are noticed, and noth ing is known of the matter until accident discovers the presence of a tooth through the gum. Usually, however, the infant is restless and irritable ; he flushes and is feverish. A copious secretion of saliva occurs, and the child " dribbles," the fluid flowing from his lips over his chin. At night he is disturbed in his sleep, and in the daytime may be noticed suddenly to give a little cry, or contract his features as if in pain. He also makes • " munching " movements with his jaws, sucks his lips, and gives every indi cation of uneasiness in his gums. Most writers on this subject, following Hippocrates, describe a painful itching sensation of the gum, which is said to be present in these cases, and whether or not the sensation is correctly described as an itching, there is no doubt that it causes distress, and ap pears to be relieved by gentle frictions with the finger or any other smooth object. On examining the mouth, the gum is found to be swollen and cushiony, and sometimes, shortly before the tooth appears, is very tense and hot. At this time, friction, which before was pleasant, becomes very painful. The gum is evidently tender, and the child may be sometimes seen to hold his mouth half open, as if he feared to close his jaws. All the symptoms subside when the tooth pierces the gum.
The pyrexia of teething is very irregular. It is often higher in the morning than at night, and is liable to rapid variations. Thus, a little boy, aged fifteen months, had eight teeth, and was cutting his left lower molar. At 6 A.M. his temperature (in the rectum) was 99°. At 10 A.M. it had risen to 103.8° • and at 10 P.M. was 102.2°. It gradually fell during
the night (being taken every four hours), and at.10 A.M. on the following morning was 100°. It then rose again to 102° at 6 P.M. ; fell to 98° at 2 A.M. (third day), and at 10 A.M. stood once more at 103.8°. A good dose of castor oil was then given, and the temperature at once became normal.
In a teething infant the mercury often registers 104° at 8 or 9 A.M. ; indeed, in a young patient such an amount of fever in the morning is alone a circumstance of great suspicion, and should at once lead us to examine the state of the gums. Few diseases, at this early age, cause so much pyrexia at this period of the day.
The symptoms which have been enumerated do not necessarily herald the immediate appearance of the tooth, but will be often found to come and go—waxing and waning in severity, and sometimes subsiding alto gether, so that the infant passes through alternate periods of suffering and ease for some days, or even weeks, before the tooth comes through the gum. Usually, more distress is experienced during the eruption of the canine teeth than at any other period of dentition.
Complications. —The symptoms just described may be looked upon as natural to the process of teething. In many cases, other symptoms are noticed, expressive of derangements which do not follow naturally from the evolution of the teeth. They arise as accidental troubles, and must be attributed to the ordinary causes of ill health acting upon a body in a state of irritation and fever, and therefore peculiarly susceptible to their influ ence. These are stomatitis and aphtlue ; repeated vomiting or diarrhoea, more or less prolonged, from catarrh of the stomach or bowels ; cough from pulmonary catarrh ; otitis ; various forms of skin disease, and cer tain troubles of the nervous system, such as squinting, convulsions, etc.
The stomatitis is of the simple form, as a rule, and consists of an erythe matous redness of the mucous membrane of the gums over a considerable area. The affected gums are somewhat swollen, and are hot and tender to the touch. If the tenderness is great, the child may refuse to suck the bottle or its mother's breast. High fever always accompanies this compli cation. The ulcerative form of stomatitis is also sometimes present, and has the characters described in the following chapter.