In certain exceptional cases the milk teeth have been known to be re tained into adult life. Some years ago Mr. Napier showed at a meeting of the Royal Medical and Chirurgical Society the cast of the mouth of a young lady of twenty-five in whom the milk teeth were still retained, with the ex ception of the upper central incisors. The same abnormality had occurred in the case of the lady's sister, and it had been also noticed in one of the mother's relatives.
The beginning of the second dentition in delicate children is often accompanied by signs of gastric or intestinal irritation. The child seems very sensitive to changes of temperature, and is subject to attacks of loose ness of the bowels. He is often irritable and restless ; looks pale, with dark circles round his eyes, and sleeps badly at night. His stools often contain mucus in large quantities. Such children are very liable to the so-called "night terrors," which in all cases, so far as my experience has extended, are merely attacks of nightmare, the consequence of indigestion and acidity, and can be at once arrested by diet and suitable treatment. If, however, care be not taken to modify the child's diet to suit the degree of digestive weakness, the derangement continues and the patient begins to lose flesh ; indeed, in some cases a great degree of emaciation is reached.
Diagnosis.—The clinical importance of the first dentition consists in the frequency with which the process is found to complicate all the various. derangements and diseases to which infancy is liable. The pyrexia in duced by teething often infuses an element of obscurity into a case which would otherwise present little difficulty. In infants we must be always prepared for this source of confusion, and should never forget to ascertain the state of the gums before bringing our examination to a close.
In the case of pulmonary catarrh attacking a teething child, the com bination of fever with cough, rapid breathing and active nares, suggests the presence of pneumonia. It will, however, be noticed that the child does not look ill ; his cough is looser and less hacking than the cough of pneumonia ; his pulse-respiration ratio is not perverted, and the history is not that of inflammation of the lung. In searching further for a cause for the pyrexia, the gums will be noticed to be tense and swollen, and the source of the fever is immediately explained. We must not, however, in all cases where the gums are hot and uneasy, at once conclude that they are the sole cause of the symptoms noticed. It sometimes happens that serious cerebral disease occurs in a teethino. child ; and if, mistaking their nature, we attribute the nervous symptoms to dental irritation, we make a mistake which the friends of the patient are not likely readily to forget. Therefore, nervous symptoms occurring in the course of teething must in every case receive careful attention. Headache, mild delirium, vertigo, startings, twitches, and convulsive attacks are so commonly the conse quence of general nervous disturbance from any cause, that they have lost all claim to be considered special manifestations of cerebral disease. If, however, the bowels become obstinately confined, the pulse slow and irregular, the breathing unequal and sighing ; and if, in addition to these suspicious symptoms, we notice that the child frequently frowns and avoids the light ; that he is sullen and drowsy, lies with his eyes half closed, and screams out suddenly as if in pain, we have every reason to fear the occur rence of tubercular meningitis. In all doubtful cases the effect of a mild.
aperient should be tried. Castor oil brings rapid relief in most of the cis-. turbances of a teething child. Therefore, if the nervous symptoms disappear after the operation of this simple remedy, their purely functional origin is at once apparent.
In the case of diarrhcea from intestinal catarrh occurring in a teething child, there is not the same source of fallacy as in the other complications, for in ordinary cases looseness of the bowels at once causes pyrexia to subside.
derangements which occur during dentition must be treated upon ordinary princijules, and the reader is referred to the various; chapters devoted to these derangements for information upon this subject It may, however, be remarked that it is especially important in a teething child to keep the belly warm, and to avoid all sources of chill. Also, that it is essential, in all cases where signs of gastric or intestinal disturbance are noticed, to reduce at once the quantity of fermentable food which is being taken, as fermentation and acidity are the earliest consequences of the catarrhal derangement. In cases of diaialcea there should be no hesi tation about arresting the looseness as quickly as possible. A dose of castor oil should be given ; and if the purging do not cease after the action of the aperient, it will yield readily to bismuth (gr. v.—x.) with aromatic chalk powder (gr. v.), or to one-grain doses of oxide of zinc. If fever is high, or the gum seems to be especially painful, great relief will follow an aperient dose of castor oil. This at once reduces the pyrexia and calms the tension and uneasiness of the &um. The irritation of the swollen and in flamed gum may be reduced almost immediately by rubbing the afflicted part with the finger, moistened with fresh lemon-juice. Some smarting is at first excited by the application, and the child's wailings are increased ; but after a few minutes the smarting subsides, and with it disappears much of the discomfort previously experienced. This practice is common, I am told, amongst the native nurses in the Cape Colony.
The practice of lancing the gum, which at one time was looked upon as a sovereign remedy for all the disorders incident to the period of teething, has now but few supporters. The only condition for which I should feel inclined to have recourse to it is that in which convulsive attacks occur in a child whose gums are very tense, swollen, and tender. In such a case, where it is our object to remove all sources of irritation, the gums may be lanced freely with advantage. Lancing the gums with any view of there by hastening the evolution of the tooth below, is, of course, putting the child to very unnecessary pain.
If, during the second dentition, signs of digestive disturbance are noticed, and the child looks pale and begins to waste, and especially if the symptoms called "night terrors " are noticed, the bowels should be acted upon by a mild aperient every three or four days ; the diet should be regulated, re stricting the quantity of farinaceous food and sweets (especially forbidding potatoes, puddings, cakes, and fruit), and the child may take six or eight grains of bicarbonate of soda two hours after each meal. I have never seen a case of "night terrors " which has resisted this treatment.