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DESIGN FOR TEACHING
IN FLORIDA SCHOOLS
STATE DEPARTMENT OF EDUCATION
THOMAS D. BAILEY, Superintendent
,y-p. I IP L1_
Physical Education and Health
DESIGN FOR TEACHING
IN FLORIDA SCHOOLS
Sponsored jointly by
STATE DEPARTMENT OF EDUCATION
THOMAS D. BAILEY, Superintendent
FLORIDA STATE DENTAL SOCIETY
REUBEN P. GROOM, D.D.S., President
FLORIDA STATE BOARD OF HEALTH
WILSON T. SowDER, State Health Officer
STATE DEPARTMENT OF EDUCATION
THOMAS D. BAILEY, Superintendent
Kittie Mae Taylor
Supervisor of Elementary Education
Lake County, Florida
ONE OF THE PRIMARY PURPOSES of education is to help
children develop physically, mentally, emotionally, and so-
cially. Dental health education is recognized as an integral part
of the over-all health education program which will aid children
and youth in this development.
Properly conceived and intelligently implemented, the dental
health education program may do much to assure good oral
health and the prevention of a large percentage of dental diseases.
This program is a joint responsibility of state and county health
departments and the professions of education, dentistry, and
For this reason the Florida State Department of Education, in
cooperation with the Florida State Dental Society and the Florida
State Board of Health, has published this bulletin for the infor-
mation and guidance of all who have responsibilities for the
health of children and youth. The interests of these three agen-
cies merge because of their common concern with the effect
of dental health upon the general health of children of school age.
Design for Teaching Dental Health is a guide offered to the
schools of Florida, kindergarten through grade 12, as an instru-
ment for helping school faculties develop and improve their
health education programs. An attempt has been made to present
factual dental information with correlated and articulated edu-
cational experiences which are desirable in influencing the atti-
tudes, practices, and habits of children and youth. Such programs
should result in improved dental health for both the individual
and his community.
There must be a real concern and positive action by educators
and dentists if the youth of our state are to be informed regarding
the importance of attaining and preserving their oral health.
Therefore, school administrators and teachers are urged to ac-
quaint themselves with the objectives of dental health education
and give serious consideration to implementing the program as
outlined in Design for Teaching Dental Health.
THOMAS D. BAILEY
State Superintendent of Public Instruction
RECOGNIZING THE NEED for a guide for Florida teachers
in the area of dental health education, the Florida State
Dental Society, under the leadership of Dr. Robert F. Vason,
Chairman of the Council of Dental Health Education, sought
approval and cooperation of the State Department of Education
and the State Board of Health with initiating procedures to
develop such a guide.
The Florida State Dental Society asked Mrs. Kittie Mae Taylor,
Supervisor of Elementary Education in Lake County, to prepare
the guide. Mrs. Taylor had previously written "Truth About
Teeth," a guide on dental health education which had been used
effectively in the classrooms of Lake County and other counties.
Through her dedication and untiring efforts Design for Teaching
Dental Health has come into fruition.
Acknowledgment is due the Board of Public Instruction and
Superintendent L. J. Jenkins of Lake County who made it
possible for Mrs. Taylor to accomplish this task.
The officers and members of the Florida State Dental Society
who gave their time and professional experience as consultants
deserve the highest praise. Special recognition is given to Doctor
Robert F. Vason, Mount Dora; Doctor Leon Schwartz, Tampa;
Doctor Wallace Mayo, Pensacola; Doctor Reuben Groom, Jack-
sonville; Doctor Richard Chace, Doctor Robert L. Edgerton, and
Doctor M. Ervin Wahnish, Orlando; Doctor L. E. Pankey, Coral
Gables; and Dr. William O. Shumpert, Fort Lauderdale.
Grateful acknowledgment must also be extended to Doctor
Floyd De Camp, Director of Bureau of Dental Health, and
Mr. Vincent Granell, School Health Consultant, State Board
of Health; to Mr. Perry Sandell, Director of Dental Health Edu-
cation Bureau of the American Dental Association; to Doctor
Philip E. Blackerby, Jr., Director, Division of Dentistry, W. K.
Kellogg Foundation; Doctor John Brauer, Dean of Dental School,
University of North Carolina; and to Mr. Arnold P. Austin, Pro-
fessional Services Division, Proctor and Gamble Company.
Appreciation is also due the members of the Health Education
Departments of Florida State University, University of Florida,
University of South Florida, and Bethune-Cookman College,
who read the manuscript.
Special recognition is given to members of the State Depart-
ment of Education who assisted in the development and publi-
cation of this guide. Dr. Joseph W. Crenshaw, Curriculum Spe-
cialist, reviewed the material, made many helpful editorial
contributions, and assumed a major responsibility in its publica-
tion. Others who assisted and gave strong professional support
were Dr. Sam H. Moorer, Director, Division of Instructional
Services; Dr. Fred W. Turner, Acting Director of the Division of
Instructional Services; Mr. Zollie Maynard, Assistant Division
Director, Physical Education, Health and Recreation; Mr. H. E.
Williamson, Acting Assistant Division Director for Health, Physi-
cal Education, and Driver Education; and Mrs. Thelma Flanagan,
Supervisor of School Lunch Program.
We are further indebted to Mr. J. K. Chapman, Mr. Howard
Jay Friedman, Mr. W. H. Pierce, and Mr. R. W. Sinclair for
suggestions and assistance with layout, illustration, and prepara-
tion of the guide for publication and distribution.
Acknowledgment for illustrations and special items is also
gratefully made to:
American Dental Association, Chicago, Illinois
Proctor and Gamble Company, Cincinnati, Ohio
National Dairy Council, Chicago, Illinois
Lactona Products Division, St. Paul Minnesota
Oral B Company, San Jose, California
J. M. Ney Company, Hartford, Connecticut
L. D. Caulk Company, Milford, Delaware
Levering-Riebel Company, Camden, New Jersey
Lee Ramsdell Company, Philadelphia, Pennsylvania
Robert Wood Company, New Brunswick, New Jersey
General Electric Company, Ashland, Massachusetts
Ritter Company, Inc., Rochester, New York
Table of Contents
FOREW ORD ............................. ....... i
ACKNOWLEDGMENTS .......................... ii
I. KEYS TO DENTAL HEALTH ..................... 5
Keys to Dental Health .......................... 5
M message to the Teacher .......................... 5
Purpose of the Guide ........................... 5
How to Use the Guide .......................... 6
II. THE BASIC TASK ............................... 8
The Task of the Parent ......................... 8
The Task of the School ......................... 9
The Task of the Teacher ........................ 10
The Task of the Dental Profession .............. 11
The Task of the Community .................... 14
III. AIMS AND OBJECTIVES OF DENTAL HEALTH
ED U CA TIO N ............................ ....... 18
What Is Dental Health Education? ............... 18
General Objectives ...... ...................... 18
Specific Objectives ........................ 19
Three Phases of a Dental Health Program ........ 20
IV. DENTAL HEALTH INFORMATION FOR THE
TEACHER ....... ......................... 22
Child Growth and Development ................. 22
The Mouth-The Gateway to the Body ............ 22
Structure and Function of Teeth ................ 23
Dental Diseases and Abnormalities ............ ... 37
Prevention and Control of Dental Disease ........ 59
Nutrition ................... ............... 82
V. INSTRUCTIONAL PROGRAM FOR THE ELEMEN-
TARY SCHOOL .................... ...... 94
Kindergarten and Early Primary Grades
Taking Care of Our Teeth ..................... 94
Early Elementary Grades
Tooth M maintenance .......................... 101
Keeping Our Teeth Healthy .................... 109
Upper Elementary Grades
Prevention of Dental Diseases .................. 121
VI. INSTRUCTIONAL PROGRAM FOR THE JUNIOR
HIGH SCHOOL .................
Dental Health for Teen-agers ............ .... 136
Dental Health Education and the Science Fair 157
VII. INSTRUCTIONAL PROGRAM FOR THE SENIOR
HIGH SCHOOL ..................
Fluoridation-Total Water Adjustment .......... 166
Careers in Dentistry .......................... 176
APPENDIX 1: Glossary of Terms ................ 192
APPENDIX 2: Bibliography ..................... 196
APPENDIX 3: Dental Health Education Materials 200
APPENDIX 4: Other Teaching Aids .............. 221
APPENDIX 5: Sources of Dental Health Education
M material ......................... 224
DESIGN FOR TEACHING
There is not one single thing in preventive medicine that equals
mouth hygiene and the preservation of the teeth.
-Sir William Osler
CHANNELS OF COMMUNICATION
S I Home
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KEYS TO DENTAL HEALTH
Keys to Dental Health
Message to the Teacher
Purpose of the Guide
How to Use the Guide
Keys to Dental Health
THE PROMOTION of dental health is a very important phase
of an effective health education program. To become com-
pletely functional, it should be embodied in the curriculum as
an integral part of the entire educational plan. The development
of such a program is the joint responsibility of state and county
health departments and the professions of education, dentistry,
and medicine. The child, the teacher, and the parent must each
understand and appreciate why good dental health habits and
preventive measures must be employed if the child is to enjoy
good dental health, decrease dental disease, and make it possible
for his teeth to last a lifetime. Each child should understand
why he should brush his teeth, why he should restrict sweets,
and why he should visit his dentist regularly.
If Florida's children and youth are to become informed regard-
ing the preservation of good oral health, there must be real
concern and positive action by educators, dentists, and public
health departments. The members of each profession must ac-
quaint themselves with the objectives of such a program and
participate in its implementation by giving it a place of impor-
tance in the curriculum of the schools from grade one through
Message to the Teacher
A man saw three laborers at work constructing a new building.
"What are you doing?" he asked. The first man replied, "Cuttin'
stone." "Putting in time till a better job comes along," answered
the second. The third man hesitated a moment, then said simply,
"I am building a cathedral!" This last reply suggested a key to
the man's success in his life's endeavor and to the vision that
was his in seeing great things to be accomplished. He was the
Keys play an important part in our lives today; we all seem
to be searching for them. Our key ring is already loaded with
keys to prosperity, to health, to popularity, to peace of mind,
and to many other things. But this man possessed that key called
"enthusiasm," a key that is available to everyone who will lift
his sights to see the possibilities that lie ahead. Can you imagine
this man remaining a common laborer all of his life? He was
caught up with that quality of enthusiasm which enabled him
to have a vision and to permit ideas to take physical shape and
A TEACHER should possess this key of enthusiasm, for not
many things are more inspiring than to witness the unfolding
of young minds. As he helps children grow mentally, physically,
and spiritually, the teacher has the privilege of building and
shaping living cathedrals. With the key of enthusiasm the teacher
can unlock all portals to the creation of beauty of character,
righteousness of heart, and a sense of living values within those
who are America's tomorrow.
To help children build these values the teacher should be ever
mindful of his responsibility for guiding them in the development
of keen alert minds and for building strong healthy bodies.
Those dedicated to the teaching of children are in a strategic
position to promote good health so necessary to the prevention
and control of disease.
The man building the cathedral was following a plan of archi-
tecture. The responsibility of a teacher in an effective dental
health program is of a like nature. First, there must be the idea-
the dream. The structure to be designed must epitomize the ful-
fillment of that dream. In this instance the dream is a goal in
which some of the objectives have been already established; but
its ultimate achievement is hampered by fears, doubts, illiteracy,
indifference, and a host of other entanglements. Here a teacher
can utilize his key of enthusiasm to help dispel the impediments
which seemingly obscure the paths leading to the realization of
that dream. He has the potential to change the tide of destiny,
to remove the enshrouding entanglements, and to direct children
into the path of healthful living.
Purpose of the Guide
Teachers possess the power to develop attitudes for desirable
habits in children that may enable them to go through life with
very little difficulty from dental diseases. For this purpose-to
aid in the teaching of good dental health habits-this guide has
been designed. The opportunity to direct and lead children down
paths of excellent dental health presents a challenge no teacher
can ignore; the very drama involved strikes the note of response
and determination to fulfill this goal in those who are dedicated
to the forming of healthy, happy, and intelligent individuals.
Teachers are asked to think of this guide as a gateway, leading
to a heightened vision of the teaching of dental health, rather
than as a prescribed method. In the past many vague generalities
have been made describing procedures for attaining these goals.
This guide is designed to enable teachers to understand what
they are to accomplish through the directed activities of pupils
in the field of dental health, and to formulate effectively a vital,
worthwhile program of dental health for the children of Florida.
How to Use the Guide
It is suggested that a teacher read this guide carefully in its
entirety before adapting it directly to organization of dental
health activities for his particular age group. Close articulation
of the program in all elementary and secondary grades is neces-
sary for continuous growth of the child. The child's present
needs and abilities are determined by past experiences. Consid-
eration of that which has been learned in previous school experi-
ence is necessary.
As the teacher organizes the instructional phase, he should
give careful consideration to the objectives he proposes to accom-
plish. After the problems, content, and general outcomes for his
grade or age level are identified and the resource information is
secured, he is ready to plan ways of weaving dental health teach-
ing into the total curriculum.
Each teacher is encouraged to use initiative and creativity in
directing the instruction so that the total program will be of a
wholesome, stimulating nature, prompting real learning experi-
ences to take place. Rather than feeling that he has fulfilled his
responsibilities by teaching the unit suggested for his age level,
the teacher is urged to take advantage of the many "teachable
moments" wherein dental health instruction may be correlated
at any time during the school day.
THE BASIC TASK
The Task of the Parent
The Task of the School
The Task of the Teacher
The Task of the Dental Profession
The Task of the Community
The Basic Task
The Task of the Parent
T HE PARENT stands as the first key person in the basic task
of health education which is initiated with the beginning of
life and should extend through its entirety. The prevention and
control of dental disease are most effective when the parent will
intelligently carry out his responsibility in the application of
dental health knowledge to help his child attain a sound set of
teeth in a healthy mouth for life.
A child needs to learn, long before he enters school, the
importance of mouth cleanliness. Through proper guidance by
the parent he will have made dental health habits and practices
a part of his daily routine.
The parent assumes a challenging task in preventive hygiene
and promotion of dental health for each child under his care.
With him rests the responsibility of being informed of the facets
of preventive dentistry:
(1) Proper brushing of teeth after eating.
(2) The filling of small cavities and the preservation of
healthy primary teeth until they are shed normally.
(3) Early detection and correction of defects in permanent
(4) Prevention and correction of malocclusion in children.
(5) Early recognition and treatment of infection of gums.
The parent well informed in dental health facts realizes that
teeth are not only a good health asset but also a personality and
beauty asset. Their care requires some effort, but the results are
The parent is in the place of responsibility to:
(1) Give guidance in the development of dental health
attitudes, habits, and practices in the home.
(2) Provide a diet adequate for building and maintaining
the health of teeth and their supporting structures from
the fetal stage through early formative years.
(3) Plan for regular and periodical dental treatment be-
ginning when the child is 212 to 3 years of age and for
the correction of dental defects.
The task of the parent includes being a part of the school team
and participating in school and community programs to improve
dental health. It is then that a common purpose will evolve and
give unity and direction to the many efforts toward prevention
and control of dental disease.
The Task of the School
An individual may achieve a healthy mouth if he carefully
practices protective health habits from childhood and is given
the opportunity to benefit from the current knowledge of pre-
vention and control of dental disease and caries. For many years
indoctrination in these practices has been accepted as the respon-
sibility of the dental profession. This has not been fulfilled effec-
tively enough to prevent and eradicate dental abnormalities. Help
from the teaching profession has been enlisted in this monumen-
tal task since no other single group works with children so closely
during their formative years.
The responsibility of assisting children in the development of
proper habits, practices, and attitudes and of providing knowl-
edge and understanding upon which desirable dental health pro-
cedures are founded has fallen largely to the schools. All evidence
points to the fact that conditions contributing to dental caries
are gaining in prevalence. Schools must provide every opportu-
nity for the development of good health practices, as well as
instruction in dental health education.
The education of the whole child has been set as the ultimate
goal of the school. One of the most important factors influencing
the attainment of that objective is the mental, physical, social,
and emotional health of the child. Dental, as well as general
health instruction must, therefore, become an integral part of
the total school curriculum.
Figure 2: The parent plays a key role Figure 3: Teachers and principals attend
in dental health education. in-service training conferences planned to
improve dental health education.
The Task of the Teacher
The teacher is in a position of influence in the realm of educa-
tion. But with this position comes a great responsibility. Since
the teacher is in day-by-day association with the child, he is a
key person in the dental health program. An alert teacher can
find, almost every day of the school year, an opportunity to instill
in children an idea or two about dental health. The watchful
classroom teacher is aware not only of the necessity of frequent
visits to the dentist for needed dental treatment but also of the
importance of good mouth hygiene and the use of proved meth-
ods of control of dental disease and decay.
The teacher's position is a strategic one. The health and happi-
ness of the children of Florida can be immeasurably improved
by cognizance of the essential facts of the care of the teeth. By
encouraging these children in the observance of correct daily
habits he will help them to have better teeth that should last a
lifetime. The effective teacher is one who knows and is practic-
ing the fundamentals of dental health. He will find little difficulty
in imparting this information to his pupils, and by exemplifica-
tion will stimulate in them the desire to do as he has done.
Dental disease and dental caries are caused; they do not just
happen. This means that someone must be responsible for their
prevention or control. The dental profession looks to the teacher
for assistance in awakening pupils to the urgency of avoiding
dental pitfalls. In this day of ever-increasing dependency on the
teacher, the major portion of this endeavor falls to him. It is his
task to imbue children with the knowledge that teeth can last
throughout the lifetime of an individual. The teacher can be as
great an influence as the dentist if he takes advantage of every
opportunity to impart more knowledge to the students about
The teacher's task goes beyond the functional areas of a dental
health program, since he may play a vital part in the area of
research. Few people have a richer opportunity to study the ef-
fects of health education. Evaluation of teaching techniques and
teaching units is an area of dental health research within reach.
The question must be constantly before him: "How can I make
classroom dental health education more effective?" He is in the
position to evaluate the resultant behavior-to determine if
"knowing is followed by doing."
The task of the teacher is indeed a challenging one, for he is
one of the key persons in this great undertaking. The teacher
does have it within his realm to help pave the way for preven-
tion of dental diseases.
The Task of the Dental Profession
An important function of the dental profession is to promote
the education of the public regarding oral health and preventive
dentistry. An effective approach to the promulgation of dental
health education is through the elementary and secondary
schools. It is the task of the individual dentists, dental societies,
and public health departments to exercise leadership and provide
consultation in helping to develop material and conducting pro-
grams to share with school administrators and teachers.
Elementary and secondary teachers may look to the local den-
tists, dental societies, and public health departments for the fol-
lowing kinds of assistance:
(1) to serve as resource persons to educational groups
(2) to aid in planning in-service training for teachers to
build a better understanding of the basic facts of dental
health and prevention of disease
(3) to make effective instructional material available
"I, I _I- n Y V *' V
Figure 4: The teacher is a key person in the dental health program.
(4) to plan dental examination programs
(5) to review for scientific accuracy dental health teaching
materials which are obtained free from commercial and
(6) to make dental offices or clinics available for educational
field trips where the dentist or dental hygienist may
give purposeful information
(7) to devise cooperatively an acceptable plan of school per-
mission for dental appointments to facilitate the neces-
sary care which after-school hours will not fully accom-
(8) to foster the development of local community interest
to promote school dental health education through such
other agencies as civic clubs, PTA groups, educational
television, radio, newspapers, et cetera
Figure 5: The dentist renders needed dental care to the underprivileged child.
(9) to organize and support, with the aid of school and pub-
lic health departments and other agencies, necessary
dental clinics to render needed dental care to the under-
A dental health education program aimed at the prevention
and control of dental diseases is not only the task of the dental
profession but also may well be one of its most rewarding
figure 6: Modern dentistry is an almost painless experience for children
Figure 6: Modern dentistry is an almost painless experience for children.
The Task of the Community
The dental health protection of children has become a para-
mount concern since dental caries is almost universal and no
infallible means of preventing it has been found. Coordination of
effort and cooperation of many groups must be utilized in the
promotion of a dental health education program if it is to be effec-
tive in the three basic areas:
No dental health program may be considered complete unless it
gives balanced consideration to each phase. The community, with
the school as one facet, must share in the responsibility of this
Ways in which the community may serve are numerous. Some
communities will doubtlessly be able to afford more services and
be more creative in their approach to the problem than others.
If it is to do its part, each community should, however, assume at
least six responsibilities:
Figure 7: The local dental society, Kiwanis Club, and schools cooperate as the city
mayor reads the proclamation declaring National Children's Dental Health Week as a
community project in Mount Dora.
(1) To set up surveys to determine the dental health status
and the needs of the community
(2) To help establish clinical services to augment the pres-
ent services rendered by local dentists
(3) To provide authentic and current information for par-
ents concerning the accepted standards for dental health
(4) To organize community efforts for providing funds for
(5) To maintain dental treatment services for indigents
(6) To support such legislation for better dental health as
fluoridation of community water supplies.
AIMS and OBJECTIVES
DENTAL HEALTH EDUCATION
What Is Dental Health Education?
Three Phases of a Dental Health
Aims and Objectives
of Dental Health Education
DENTAL HEALTH education is the sum total of all experi-
ences to which a child may be exposed in the school, in the
home, and in the community which favorably influence practices,
attitudes, and knowledge relating to dental health.
School health has become a vital part of the school curriculum.
It has become functional, based on the needs and interests of
children, with factual information used to bring about under-
Dental health has been recognized as one of the vital needs of
children, since dental diseases are almost universal and no means
of completely preventing them have been found. Thus, efforts to
bring understanding concerning prevention of dental diseases
should constitute a major objective of dental health education.
Planning a dental health program requires a statement of ob-
jectives. These are related to the broad objectives of the school.
As a guide to those who plan dental health programs the
American Dental Association has stated the following objectives:
(1) Help every American appreciate the importance of a
(2) Help every American appreciate the relationship of
dental health and appearance
(3) Encourage the observance of dental health practices in-
cluding personal care, proper diet, and oral habits
(4) Enlist the aid of all groups and agencies interested in the
promotion of health
(5) Correlate dental health activities with all generalized
(6) Stimulate the development of resources for making den-
tal care available to all children and youth
(7) Stimulate all dentists to perform adequate dental health
services for children.'
The following specific objectives are adapted from Frances A.
Stoll's Dental Health Education, a recent and authoritative treat-
ment of education for dental health:
(1) To help every child appreciate the importance of a com-
plete set of teeth in a healthy mouth
(2) To show the relationship of dental health to general
health and appearance
(3) To encourage good dental practices, including personal
(4) To avoid accidents to teeth and habits harmful to the
growth and development of teeth and jaws
(5) To encourage children to seek and accept periodic dental
treatment, including correction of remediable defects
and preventive and protective measures
(6) To enlist the cooperation of parents in the efforts to ob-
tain adequate dental care
-(7) To'provide authentic and current information concern-
ing a nutritional diet for optimal general health, with
specific references to dental health
8) To provide learning experiences for the purpose of in-
fluencing knowledge, attitudes, and desirable practices
related to dental health
(9) To instruct children so that they may conserve and im-
prove dental health through well-founded motivation
based on facts
(10) To improve the individual's dental health status and
thus provide better dental health for this generation
and future generations.
Official Policies of the American Dental Association on Dental Health Programs,
Council of Dental Health, American Dental Association, Chicago, p. 12, 1954.
Three Phases of a Dental Health Program
Dental health instruction may be included in all aspects of
the health program. It will:
A. Be integrated with the total interests of the pupil
B. Be correlated with the subject-matter areas
C. Provide accurate factual information suitable to the intel-
lectual and physical maturation of the group
D. Be arranged in units so there will be a successive
advancement in information and learning experiences
from kindergarten through grade 12.
There shall be provision for:
A. Periodical dental surveys which include diagnosing needs,
recording dental health status, informing parents of den-
tal deficiencies, and correcting dental defects
B. Thorough examinations by the family dentist including
x-ray and laboratory testing
C. Regular cleansing, topical fluoride treatments, restricted
carbohydrate diets, and early remedial care
D. Fluoridation of communal water supplies.
Early attention should be given to:
A. Encouragement of children to seek dental care from their
family dentist (If this is financially impossible, they may
seek aid from cooperative agencies.)
B. Emergency treatment of pain caused by injury or
C. Filling of cavities of deciduous and permanent teeth
D. The proper correction and control of diseases and condi-
tions of hard and soft tissues.
DENTAL HEALTH INFORMATION
Child Growth and Development
The Mouth-the Gateway to the Body
Structure and Function of Teeth
Dental Diseases and Abnormalities
Prevention and Control of Dental
Dental Health Information for the Teacher
Child Growth and Development
THE GROWTH and development patterns of children have a
direct relationship to their learning activities. Since such
patterns have great significance for health education, it is impera-
tive that a teacher know the characteristics and needs of the
children. Learning patterns and the achievement of specific
knowledge are, in themselves, aspects of growth and develop-
Significant advances will be made in the teaching of dental
health when there is understanding and awareness of the growth
and development patterns of the child. This process is gradual and
varying in each individual child, yet certain characteristic pat-
terns are followed that reveal basic, intrinsic needs. Each child's
dental needs should be treated as individual requirements, for
there are varying levels of maturity in any one age group.
The development of the child does not vary sharply from one
age to another but, rather, gradually emerges as an over-all proc-
ess of growth. Therefore, the current development should be
considered in proper relationship to the past and future stages of
growth. Formal dental health education of the child may begin
in the primary years of school, but the characteristic dentition of
that age must be understood in order that effective dental health
education may take place. Dental development is an important
determinant of personality, greatly influencing the emotional
make-up and social behavior, as well as personality, in later life.
The Mouth-the Gateway to the Body
General health and oral hygiene go hand-in-hand, for complete
physical and social well-being does not exist when carious teeth
or diseased gingival tissues are present. The mouth is the main
portal of entry for food and water. It is the organ in which the
mastication of food is accomplished on its way to being digested.
Similarly, it may be the doorway through which certain dis-
eases may be introduced. Disease or infection of various kinds are
commonly found in the mouth or about the teeth. Cleanliness is
an important factor, if the mouth is to be maintained in an effi-
cient working condition. Almost every person can achieve a
healthy mouth, provided he practices protective health habits
from childhood and has the opportunity to benefit from present-
day knowledge of prevention and control of dental diseases.
The mouth is made up of many parts. Its sides are called lips
and cheeks. The lips serve as the doorway to the mouth and the
cheeks hold food and water within until they can be prepared for
swallowing. The muscles of the lips and cheeks produce the
varied facial expressions. The inside of the mouth is covered with
mucous membrane containing mucous glands.
Within the mouth is the tongue which is necessary in speaking
and in preparing the food for swallowing. It is a muscular organ
composed of three main parts: (1) a root, (2) a body, and (3) a
tip. It has five muscles and is covered with a mucous membrane.
Taste buds are located at the back, on each side, and at the tip,
which make it possible to taste sweet and sour, salt and bitter.
The mouth has many cells and glands, the most important of
which are the salivary glands. They produce a saliva which
mixes with the food and helps to prepare it for swallowing and
Each tooth has a special place in the mouth. The teeth in the
upper jaw, which is called the maxilla, and the teeth in the lower
jaw, the mandible, are placed in socketlike compartments along
the gum line. All of these parts of the mouth are important in
keeping teeth healthy.
The Structure and Functions of Teeth
The Kinds of Teeth
The central incisors, located in front of the mouth are used to
cut, or incise, the food. There are four central incisors, two in the
upper jaw and two in the lower jaw. Each has one root.
The lateral incisors, located on either side of the central in-
cisors, aid in cutting the food. There are four lateral incisors, two
in the upper jaw and two in the lower jaw. Each has one root.
Labial trenum (upper)
,/ ,l .\ ..
Bulge caused by
fhmulus of pterygd
(glo sopalatine I
Gineiva ---- ,..-----' i --- r tb l
Lab al frenum (lower)
Figure 8: The many parts of the mouth are important in keeping teeth healthy.
The bicuspids, just back of the cuspids, have two cusps and one
or two roots. They are used to tear or crush the food. There are
eight biscuspids, four in the upper jaw and four in the lower jaw.
These teeth have one or two roots and are sometimes called pre-
molars. This particular type of tooth is found only in permanent
The molars, in the back of the mouth, have uneven surfaces and
two or three roots. They are used to grind food. There are twelve
permanent molars, six in the upper jaw and six in the lower jaw.
In the upper jaw they usually have three roots; in the lower, two
roots. There are eight molar teeth in the primary set, four in the
upper jaw and four in the lower jaw.
The Functions of the Teeth
Why We Have Teeth-
1. -to chew our food
The primary function of teeth is to chew thoroughly so that
proper digestion can take place. Children should be encour-
aged to eat slowly and chew thoroughly.
2. -to help us speak
Proper position of the teeth and formation of the dental
4 mos. in utero
4 mos.in utero Cetincior
6 months t --
14 yrs ,
6 a tyrs \, / \
Cuspid 1st molar 2nd molr
', ; i
--* Ir ,r.:, r,ng (0 I r..n )
* t he'.-jl -iqi kr,-orn)
1- Prenatal period
(birth to 10 months)
i- Childhood period
Figure 9a: Deciduous teeth.
; '0 /-
/. / 12 W i r-h d!a
f I ; \ \ I i*; / \ d.
-j I \ \I ildhfl> rinp
. I ...,...t, ... )
-- ...-.. ,. <, ,-,- n.. ,cildhdrin
tjbnl0e r II OdUa Id bcuip ne d Oat 2fl1td peneanaet loter
1.:.-- '. Inannc period
2yrI Early childhood pe
S ter childhood period
SI i .
arches are essential to clear speech and effective enunciation.
Missing teeth, or widely separated front teeth, and protrud-
ing teeth cause irregularities in speaking.
3. -to improve our appearance
Irregular teeth may affect the appearance if they are in a
protruding or receding position. Pleasing form of a face with
balanced harmony depends on well-developed jaws and teeth
in their proper positions.
-7i -j r ,.' ,.
Figure 10: One function of good teeth is Figure 11: Another function of good
to chew our food. teeth is to help us speak.
Figure 12: A third function of good teeth is to improve our appearance.
The Structure of a Tooth
A tooth is a hard, calcified structure firmly fixed in a bony
socket, composed of the crown, which is the part visible in the
mouth, and the root or roots which are anchored in the jaw.
A tooth is composed of four different types of tissue:
(1) The enamel, a substance composed chiefly of calcium and
phosphate forming the hard glossy covering of the
(2) The cementum, a bone-like substance covering the root
(3) The dentin, an ivory-like material that forms the body
of the tooth
t*, -; ^
'- ',' / '",,
Figure 13: The tissues of a tooth: enamel,
cementum, dentin, and dental pulp.
Figure 14: The
major parts of a tooth.
(4) The dental pulp (sometimes called the nerve), which
forms the center of the tooth and is made up of nerves,
blood vessels, and connective tissue.
The parts of a tooth are the roots, neck, and crown.
The Supporting Structures of a Tooth
The supporting structures of the tooth are:
(1) The gingiva, which is the soft tissue covering the alveolar
bone and surrounding the tooth
(2) The periodontal membrane, a hammock-like fibrous
membrane by which the roots of the teeth are firmly
attached to the alveolar bone (This makes it possible for
the teeth to bite and chew effectively and withstand the
impact of the closing of the jaws.)
(3) The alveolar bone, which supports and surrounds the
roots of the tooth. It contains the sockets in which the
teeth are seated.
The Primary Teeth
The child's first teeth are called the primary or deciduous teeth;
there are twenty teeth in this set, ten in each jaw. The tooth buds
PULP (INCLUDES THE
,, o J
Figure 15: The healthy tooth and its supporting structures: gingiva, periodontal mem-
brane, and aveolar bone.
begin to form approximately the sixth week of prenatal life and
the calcification tie sixteenth week. This calcification process ad-
vances rapidly and by the time of birth a considerable part of the
crowns are already formed. These "teeth erupt and are shed
through normal processes at varying times. Neglect of the pri-
mary teeth may result in their being lost too early. This may lead
to irregularities in position as the permanent teeth emerge. Decay
and infection of primary teeth are equally as detrimental to
health as decay and infection of permanent teeth. Since these
primary teeth have definite functions to perform, they should be
retained for the full length of time necessary for this function.
Functions of Primary Teeth
(1) To masticate food
(2) To afford clear speech
INFANCY AND PRENATAL
S 5 months
_' 7 months
(+ 2 mos.)
(+ 2 mos.)
- -' (_+ 3 mos.)
( 3 mos.)
r- "*( ->
',' .-' (+ 6mos.)
(+ 6 mos.)
S-- ~~. 6 years
9 mo-' 5 years
i-,,= .- -. T,- ( 9 mos.)
Figure 16: Deciduous dentition.
(3) To give form and symmetry to the face
(4) To act as guides for the eruption of the permanent teeth
forming beneath them
(5) To aid in the development of the jaws
Eruption and Shedding of Primary Teeth
Time of Time of
Upper Eruption Shedding
Central incisor ............... 7/2 mo. 7 yr.
Lateral incisor ............... 9 mo. 8 yr.
Cuspid ...................... 18 mo. 11/2 yr.
First molar .................. 14 mo. 10/2 yr.
Second molar ................ 24 mo. 101/2 yr.
Second molar ................ 20 mo. 11 yr.
First molar .................. 12 mo. 10 yr.
Cuspid ...................... 16 mo. 91/2 yr.
Lateral incisor ............... 7 mo. 7 yr.
Central incisor ............... 6 mo. 6 yr.
NOTE: Primary molars are not shed until the child is
10 to 11 years of age. If a primary molar is extracted
prematurely, a dentist should determine the necessity of
maintaining the space for the oncoming permanent
Lower Upper Lower Upper
Age (months) Age (years)
Central Incisor .................................. 6 71/2 6 71/2
Lateral Incisor ................................... 7 9 7 8
Cuspid ........................................... 16 18 9/2 111/2
First M olar ...................................... 12 14 10 101/2
Second M olar .................................... 20 24 11 10/2
Incisors Range + 2 mos.
Range 6 mos.
Molars Range 4 mos.
Usually the teeth erupt and are shed earlier in slender children than
in children of the stocky type.
Primary, or deciduous, teeth require the same regular care as
the permanent teeth. Beginning at the age of two-and-one-half
to three years of age, a child should be taken to the family dentist
regularly for examination. Often x-rays are needed to do a
thorough examination. If needed, treatment should be given im-
mediately. This, too, is the proper age at which to start stannous
\ .[ INCISOR
Sf \'\ IMOLAR
Figure 17: There are twenty teeth in the first or deciduous set, ten in the upper jaw
and ten in the lower jaw. Their names, locations, and dates of eruption are shown in
the photograph and chart.
fluoride treatments. Decayed primary teeth should be filled. In-
fected teeth should be cleared of the infection before it harms the
permanent teeth which are to follow or is detrimental to the
health of the child.
By the time a child starts to school, he should have had a full-
mouth x-ray examination.
Results of Neglect of Primary Teeth
2. Primary molar dropped out of line
Figure 18: Results of neglect of primary teeth.
4. Space left by first primary molar
5. Teeth forced out of proper positions
6. Bicuspid prevented from erupting properly because of
7. First permanent molar tipped forward into space left by
lost primary molar
The Ugly Duckling Stage or Period of Mixed Dentition
Between the ages of six and twelve years, the child experiences
what is called a "mixed dentition" period, which means that there
are some primary teeth and also some permanent teeth in the
While the permanent teeth are slowly developing in the jaws,
the roots of the primary teeth are gradually disappearing by the
process known as resorption. When the permanent teeth are
ready to erupt, only the crowns of the primary teeth are left and
Figure 19: Dentition of a six-year-old child.
these are usually lost at this time. The first permanent teeth to
erupt are the lower central incisors. Following these the first
permanent molars will appear behind the last primary molars.
The Permanent Teeth
When a child enters school his jaws are veritable tooth-building
machines. Not only do they contain the twenty primary teeth, but
also they are manufacturing the thirty-two permanent teeth,
some of which began to calcify at birth or shortly thereafter.
During the process of calcification, the enamel may be affected
by any interference with normal development, such as poor nu-
trition and childhood diseases accompanied by high fever. These
disturbances may result in defective or incomplete formation of
When the permanent teeth first erupt into the mouth, they may
appear abnormally large in relation to the size of the child's face.
They also may seem to be so widely spaced that there does not
appear to be sufficient room in the mouth for the rest of the teeth
L A IERAL
'I MOL AR
S. J 'DOM TOOTH)
SI / IMOLAR
... I INCISOR
Figure 20: There are thirty-two teeth in the permanent set, sixteen in the
upper jaw, and sixteen in the lower jaw. Names, locations, and dates of eruption are
shown in the photograph and chart.
Age (years) Age (years)
Central Incisors ............................. ................ 6- 7 7- 8
Lateral Incisors .................................... ............. 7- 8 8- 9
Cuspids ................................................. 9-10 11-12
First Bicuspids ...-..............-....... ....... ....... 10-12 10-11
Second Bicuspids .......... ........... ......... 11-12 10-12
First Molars .................................. ...... 6- 7 6- 7
Second Molars .................. ............. .. ..... ...... 11-13 12-13
Third M olars ................................................. 17-21 17-21
The lower teeth erupt before the corresponding upper teeth.
The teeth usually erupt earlier in girls than in boys.
to erupt. But normal jaw growth will usually take care of this
need. Both primary and permanent teeth complete their root for-
mation and calcification after they have fully erupted into the
The First Permanent Molars
The first permanent molars are considered to be the most im-
portant teeth in the mouth and are sometimes referred to as "the
keystone of the dental arch." These are called the "six-year
molars," of which there are four, one on each side in both the
lower and upper jaws. The pits and grooves in these teeth are
deep and inclined to retain food particles, making them suscepti-
ble to decay.
The loss of even one molar may cause the other permanent
teeth to shift position and to interfere with chewing, as well as to
destroy the normal appearance and symmetry of the face and
jaws. The first permanent molars generally hold the upper and
lower jaws the right distance apart and should be kept in a
healthy condition throughout life.
Approximate Time of Eruption of Permanent Teeth
Central incisor .........................
Lateral incisor ..........................
C uspid .................................
First bicuspid .........................
Second bicuspid ............... ..........
First m olar ............................
Second m olar ...........................
Third m olar ......................... .
Central incisor ......................
Lateral incisor ....................... .
C uspid ................. ..............
First bicuspid ..........................
Second bicuspid .........................
First m olar ............... .............
Second m olar ...........................
Third molar ........................
(+ 9 mos.)
-. 8 years
S (I 9 mos.)
(+ 9 mos.)
', 10 years
fi". ". -"i, (i 9 mos.)
Figure 21: Mixed Dentition (left)
ADOLESCENCE AND ADULTHOOD
: V -.. :,
: (+ 9 mos.)
K -' A ,
S, 12 years
+- ( (6 mos.)
S :21 years
x _t 35 years
and Permanent Dentition (right)+6mos.)
tL, ... .21 years
an \- Pe r etiti.ion.& 35 years
and Permanent Dentition (right).
The permanent central incisors usually erupt between the
sixth and eighth year. The first permanent ("six-year") molars
usually erupt between the sixth and seventh year.
The permanent lateral incisors usually erupt between the
seventh and ninth year, replacing the primary lateral incisors
They erupt next to the permanent central incisors.
Figure 22a: Clean, sound teeth are a
health asset and add much to the child's
appearance. They usually indicate that the
child is receiving good dental care and
Figure 22b: Unclean and decayed teeth
create a most unfavorable impression.
The permanent cuspids and the second permanent molars
erupt between the tenth and thirteenth year. The second per-
manent molars do not replace any primary teeth.
The bicuspids, usually erupt between the tenth and twelfth
year. They replace the primary molars, and are the fourth and
fifth teeth from the center front of the mouth.
The third permanent molars (wisdom teeth) usually erupt
between the seventeenth and twenty-first year. Often they do
not erupt properly and must be removed by a dentist.
Dental Diseases and Abnormalities
Dental caries is a localized disease process that destroys tooth
structure and produces cavities in the teeth. Dental caries is com-
monly called "tooth decay."
What Causes Dental Caries?
One of the most generally accepted theories of the cause of den-
tal caries is the action of bacteria on fermentable carbohydrates,
principally sugar, in the mouth. When carbohydrates are placed
in the mouth, the bacteria use some of the sugar as food. An acid
Figure 23: The Chain-of-Decay.
is produced as the bacteria's waste product. This acid is capable of
dissolving tooth enamel and leading to decay (dental caries). This
may be called the "Chain-of-Decay."
1. BACTERIA, the first link of the chain, live and grow on
the surfaces of the teeth and soft tissues of the mouth,
waiting to be fed by the ...
2. FOOD, which forms the second link of the chain. When
the carbohydrates are placed in the mouth the bacteria
use some of them for food.
3. ENZYMES, the third link of the chain, are given off
through the normal process of bacteria production and
convert the sugars to ...
4. ACID, the fourth link of the chain, which is formed
in the dental plaque and held on the tooth surfaces, dis-
solving the enamel and thus beginning ..
5. DECAY, the fifth link of the chain, by the gradual de-
struction of the enamel.
Thus, the Chain-of-Decay is formed. If any one of the first four
links can be broken, dental caries can be prevented.
Progression of Dental Caries
Dental caries begins with decalcification of enamel usually in a
small hole, in a fissure or a flaw of the enamel, or in any area
that is hard to clean. If it is left unchecked it will penetrate
through the enamel into the dentin where decay starts. The den-
tin is softer than the enamel, making it possible for the decay to
progress rapidly, soon reaching the pulp.
As the tooth decay progresses, the blood, lymph vessels, and
nerves are exposed and become infected. An abscess may form
either within the tooth or at the tip of the root, usually with ac-
companying pain and swelling.
Kinds of Dental Cavities
There are three main kinds of dental cavities:
(1) The pit or fissure cavity forms in the small grooves on
the chewing surfaces of the teeth. When the cavity first
starts it may be restored before causing pain or trouble.
If left without attention, dental caries will progress.
(2) The contact cavity takes place in the area where the ad-
journing teeth meet. If one tooth begins to decay at the
contact area, the tooth next to it usually decays.
(3) The gum-line cavity appears around the neck of the
tooth at the edge of the gingival tissues. The causes are
sometimes improper brushing and failure to massage the
When the Dentist Fills the Tooth
After caries has progressed enough to invade the dentin and
form a. cavity, the tooth can be restored only by removing the
decayed part and replacing it with a filling. The filling of small
cavities may be classed as part of preventive dentistry since it
helps prevent the formation of larger cavities and subsequent in-
fection and loss of teeth.
A cavity in a tooth is first "prepared" and then filled. Preparing
a tooth means cutting away all of the decay structure and prop-
erly shaping the resulting cavity for the insertion and retention
of a filling. The cavity is sealed by the filling, which also gives
necessary strength to the structure. The materials used in fillings
are usually silver amalgam or gold.
The procedure in filling a child's tooth is essentially the same as
filling an adult's, except that the procedure must be varied ac-
cording to the size and shape of the dental structure. By filling
the cavities, the dentist restores teeth to their proper form, func-
tion, and appearance.
A film of bacteria clings to teeth
and acts on certain foods to form an
The acid gradually dissolves enamel
until the dentin is exposed.
Dentin decays rapidly.
Decay reaches pulp,
as enamel is undermined.
Enamel collapses, infection spreads.
Figure 24: Progression of dental caries.
Figure 25: Types of dental cavities and their progression: pit or fissure cavity (top
line), contact cavity (middle line), gum line cavity (bottom line).
,A r A r- '., A "' "
rr r If n te c g l
indicated in C, and require more expensive fillings, as illustrated in D.
Figure 26: When the dentist fills a tooth, small cavities, as indicated in A, can be
corrected by inserting small fillings, as in B. If neglected, the cavities grow larger, as
indicated in C, and require more expensive fillings, as illustrated in D.
Figure 27: Amalgam filling in a molar.
Diseases of the gingival tissues and other supporting structures
of the teeth are called periodontal diseases. The word "periodon-
tal" comes from the two Greek words, "peri" meaning "around,"
and "odontis" meaning "tooth."
Periodontal diseases appear to be one of the greatest causes of
the loss of teeth after age thirty-five. Contrary to popular belief,
these diseases do affect children.
Kinds of Periodontal Diseases
Gingivitis is an inflammation of the gingival tissues,
causing them to become red and swollen, and to separate
from the teeth when touched. Sometimes even the chew-
ing of food may cause the gums to bleed. In the early
stages it causes so little discomfort that it is often neg-
Figure 28: Gingivitis.
elected until it has become progressive, making treatment
much more difficult.
2. VINCENT'S INFECTION
This disease is commonly called "trench mouth." It may
attack the gums and tissues of the mouth and throat.
Symptoms are swelling and excessive bleeding of the
gums, pain, and a fetid odor.
If gingivitis is not treated and controlled the condition
develops into periodontitis. The inflammation spreads
along the roots of the teeth with gingival tissues detaching
from the roots, forming a pocket which becomes filled with
food debris, bacteria, and pus. As the disease progresses,
the bone supporting the teeth is lost, and affected teeth
eventually become loose, necessitating extraction.
Causes of Periodontal Diseases
Irritants within the mouth are the most common cause of peri-
odontal diseases. One local cause is calculus, or tartar, which is a
Figure 29: Vincent's infection.
Figure 30a: Normal Gums.
hard crust-like material that is deposited on the surface of the
teeth where the gingival tissues and crowns meet. The calculus is
composed chiefly of minerals from the saliva and of bacteria and
other substances normally found in the mouth. If not removed it
irritates the gingival tissues and sets the stage for gingivitis. Cal-
Figure 30b: Advanced periodontitis (before treatment).
Figure 30c: Advanced periodontitis (after treatment).
culus cannot be removed by brushing, but only by the dentist or
dental hygienist. Masses of bacteria accumulated under the edge
of the gingival tissues are also causes of periodontal disease. These
should be removed at regular intervals (3-6 months).
Other irritants might be:
(1) Food wedged between teeth and against gingival tissues
(2) Sharp edges of badly decayed teeth
(3) Improper meshing of teeth upon chewing or closing the
Some of the aspects of nutrition that may contribute to peri-
odontal diseases are:
(1) Inadequate or unbalanced diet
on teeth at gum-line
of gums (Gingivitis).
SIf not treated, the
S inflammation spreads,
and pockets develop
between the teeth
and gums. These
bacteria and pus
swollen and tende
Gradually, the bon
supporting the tee
is destroyed, and
the teeth become
Figure 31: Periodontal Disease. How the supporting tissues of teeth are affected.
(2) Inability of body to make use of food properly
(3) Texture of food eaten.
Prevention of Periodontal Diseases
Severe periodontal diseases are more common in adults than in
children. Such diseases are often due to dental neglect and poor
oral hygiene during childhood and youth.
Essential preventive care consists of:
(1) Brushing immediately after eating to slow down accumu-
lation of calculus and to remove masses of food, laden
with disease-causing bacteria
(2) Nutritional diet and maintenance of good health
(3) Regular visits to the dentist for removal of calculus de-
deposits and the polishing of the enamel (prophylaxis)
(4) Periodic x-rays of teeth and supporting bone
(5) Correction of malocclusion.
Irregularities in the alignment or position of the teeth within
the jaws, or abnormalities in jaw position resulting in the im-
proper relation between upper and lower teeth, is called maloc-
clusion. Whereas "occlusion" implies the manner in which the
teeth and jaws come together, "malocclusion" means, literally,
Many cases of malocclusion are the result of hereditary influ-
ences, wherin the primary cause can be directly related to in-
herited characteristics. This would include such factors as a dis-
crepancy between tooth size and jaw size, abnormal growth of
basic jaw structures, and congenitally missing teeth or extra
However, many other factors of a more local and environmen-
tal nature are extremely important in causing or contributing to
malocclusion, such as:
(1) Premature loss of primary teeth-the most frequent
(2) Prolonged thumbsucking or fingersucking, creating
abnormal pressures on the developing jaw structures,
which are easily molded
(3) Primary teeth not being shed normally
(4) Lip and cheek biting or sucking habits
(5) Abnormal swallowing habits-due to a large tongue,
poor tongue posture, or a tongue-thrust habit
(6) Faulty timing or improper sequence of eruption of the
(7) Mouth breathing.
Whatever the cause, the presence of malocclusion is not simply
a matter of crooked teeth alone, but may result in serious emo-
tional disturbances founded as a direct result of the irregular
teeth, and, as well, may significantly impair the physical health of
the child. Facial deformities are commonly associated with mal-
"Occlusion" refers to the position of the teeth
.in the jaws, and the way the upper
_, ., and lower teeth meet.
"Malocclusion" means that the teeth do not
-. f meet properly, or are in abnormal positions
In the jaw.
'. One example of malocclusion is the protrusion
of upper teeth, sometimes caused by
." thumbsucking or hereditary factors.
Another common problem is known as
an "open bite," which occurs when the back
"~ -. '.. teeth prevent the front teeth from meeting
properly. This can create difficulties in
S chewing certain foods, and can place
excessive strain on some of the teeth.
Malocclusion can bring on decay and gum diseases, besides causing facial deformities
in some cases, and emotional problems.
Figure 32a: Malocclusion.
occlusion, and such deformities, especially in combination with
unsightly, irregular teeth, can not only destroy a smile but may
also inflict indelible psychological problems on a youngster who,
at this stage, desires so strongly to conform and to be normal in
appearance. In addition, malocclusion is frequently accompanied
by speech defect, diseases of the gums and supporting bone, poor
oral hygiene and bad breath, increased caries susceptibility, and
inefficient-occasionally almost impossible-mastication of foods.
The best preventive measure is regular dental care, started at
an early age. The dentist can observe the developing occlusion,
and in many instances he can institute correction procedures
early and at the optimum time, thus lessening or even preventing
more complicated treatment later. Space maintainers can be
placed when primary teeth are lost early, thereby reducing the
undesirable movement of adjacent teeth into positions of maloc-
clusion. Habit restraining appliances to curb the damaging effects
of prolonged thumbsucking or to improve the posture and usage
of the tongue during speech and swallowing are frequently in-
dicated at an early age. Speech therapy may be prescribed.
Thumbsucking beyond the age of four or five years is frequently
considered to be detrimental to the developing occlusion, and the
longer it persists, generally, the more serious the damage. The
amount of deformity that results depends upon the frequency
and intensity of the thumb pressure as well as the duration of the
Malocclusion develops most frequently, or at least is most
readily observed, during the mixed dentition period, when the
child is losing the primary teeth and the permanent teeth are
If major corrective treatment becomes necessary, the dentist
will, at the proper time, refer the youngster to an orthodontist,
who is specially educated and trained in the diagnosis and treat-
ment of malocclusion. Such treatment with orthodontic appli-
ances ("braces") may require only a few months, or it may be
necessary to maintain therapy for two years or more. The patient
wears a "retainer" to assist in the .stabilization of the teeth when
all tooth movement has been completed and jaw position adjusted.
Oral rehabilitation is a process which may be employed when
the teeth are badly damaged by decay. This process restores the
chewing mechanism to as near normal function as possible.
The need for rehabilitation is indicated when:
1. The teeth have been filled, refilled and patched so many
times that they are practically all fillings
Figure 32b: Effects of Malocclusion.
2. The upper and lower teeth do not meet properly because
of missing teeth and faulty restorations.
Unnatural forces are exerted when the latter condition occurs.
These effects, called trauma, cause the joint of the lower jaw lo-
cated just in front of the ear to function improperly. The muscles
and nerves are also affected, resulting in varying degrees of dis-
comfort. Oral rehabilitation is necessary to bring about a harmoni-
ous mouth relationship to correct these malfunctions.
In the rehabilitation of a sick mouth, diseased teeth that are
beyond repair are extracted. The remaining teeth must be re-
stored by whatever treatment is necessary. Crooked teeth that
may be used in the rehabilitation must be straightened. All decay
is carefully removed from the remaining teeth so that they are
sound enough to be used as a foundation for rebuilding. Every
precaution is taken that the remaining teeth are in a good condi-
tion and the supporting tissues are healthy.
Teeth that are badly damaged by decay may be restored to their
original form and function by individual restorations called
crowns and inlays. These restorations are also used to support
replacements for missing teeth. The gold crown is a cap made to
cover that portion of the tooth which projects above the gum line.
It is placed over the tooth after the decay has been thoroughly
If the tooth is not damaged too much by decay, a gold inlay,
shaped to the form of the cavity, may be made to fit into the
tooth to replace the portion that has been decayed. When the
damaged tooth is near the front of the mouth in a visible area,
tooth-colored porcelain or plastic is used on the front of the
crown to cover the gold for cosmetic purposes. Porcelain crowns
are difficult to be distinguished from the natural teeth.
Missing teeth are replaced with appliances known as partial
dentures. A fixed partial denture is used when the space made by
missing teeth is between two teeth. It is supported by crowns and
inlays on the abutment teeth and stabilizes these teeth prevent-
ing drifting or movement which may lead to serious malposition.
A removable partial denture must be used when there is no tooth
behind the space. In either case the space may be the result of the
extraction of one or several teeth.
dividual. This condition must be carefully considered before re-
habilitation may be initiated. A healthy person responds better to
the treatment than one who is in poor health. Younger people
generally respond better than older people.
Another important value of oral rehabilitation is the appear-
"* ..is ^ -
Figure 33: A Gold Inlay.
dance success of the individual. The social impact with the emotional overin-
dividual.tones of the effects of this process must be carefully considered before re-
habilitation may be initiated. A healthy person responds better to
the treatment than one who is in poor health. Younger people
generally respond better than older people.
Another important value of oral rehabilitation is the appear-
ance of the individual. The social impact with the emotional over-
tones of the effects of this process must be considered. Modern
Figure 34: Typical restorations of tooth surfaces. (See additional illustration, page 54)
C g.-"' "'-"**"-'-'7--- .-. ----<"
0 4 *,
E-- j ^
1' r 11 ) ,
E IS A F I 4
I I I I l
PRECISION ATTACHMENT FOR PARTIAL DENTURE
(' f ''I .
dentistry can successfully change the mouth from a liability to a
physical, mental, social, and emotional asset.
Figure 36: How oral rehabilitation may affect appearance.
Accidents to Teeth
Accidents to teeth are serious occurrences. A large percentage
of fractured teeth occur in children. During the ages of twelve to
fourteen years, the junior-high school period, the incidence is
greater. The maxillary or upper front teeth are the most fre-
quently injured. Unsafe actions by children engaged in activities
often contribute to cases of fractured teeth. Parents and teachers
must constantly impress upon children the danger of unsafe ac-
tions and insist on adherence to safety procedures.
Kindergarten children and those in the primary grades need to
(1) The proper use and handling of playground equipment
(2) The proper method of walking up and down stairs
(3) The danger of putting foreign objects in the mouth
(4) The damage that can occur from biting on pencils.
A child may have several teeth knocked out by a moving swing.
Head-on collisions may result in injury to the lips and possible
chipping of the upper anterior teeth. Any such injury should be
reported immediately to the proper person: teacher, principal, or
public health nurse, who will notify the parents. Teeth may be
saved by immediate action and treatment.
Children in the eight to twelve year age group need to be re-
minded frequently of safety hazards in the school and the home.
Pushing and shoving at drinking fountains are especially hazard-
ous to teeth. Children should be taught the dangers of such
unsafe actions as:
(1) Running with sharp or pointed objects in the mouth
(2) Biting on hard objects
(3) Cracking nuts with their teeth
(4) Pushing, shoving, tripping
(5) Careless riding of bicycles
(6) Carelessly throwing objects.
There is a marked increase in school accidents during high
school years in shops, gymnasiums, and on stairways. It is impor-
tant for instructors to emphasize the need to use tools with skill
and care so that the child and his neighbor may not be injured.
The main hazard for this age group is found in competitive sports.
School authorities require mouth and face protectors and make
certain that the rules are enforced. Mouth protectors made of
soft rubber or plastic help to reduce sudden shock to the teeth.
If an accident does occur, the teacher or other adult in charge
should be able to do quickly what is best for the child's welfare.
Delay can be very dangerous in the case of a traumatized tooth.
Figure 37a: This athlete suffered the loss Figure 37b: Tooth restored with bridge.
of a tooth as a result of an accident.
If a tooth is cracked, loosened, or knocked out, the child should
see a dentist immediately for proper care. It is possible for the
dentist to cap temporarily or protect the fractured tooth until
permanent repair can be made. In the case of a tooth being com-
pletely knocked out, immediate reimplantation may be possible
if the tooth is dropped at once into a glass of water and the child
and the tooth hastened to the dentist.
Mouth Protectors for Athletes
Much progress has been made over the years in providing pro-
tective equipment for participants in contact sports. The use of
face guards is common practice in football, but the incidence of in-
juries to the teeth and mouth have continued. Fifty per cent of all
football injuries occur in and around the oral cavity. The use of
carefully made and properly fitted mouth protectors may protect
most of these injuries.
The National Alliance Football Rules Committee, in January,
1961, adopted a rule making mandatory the wearing of fitted,
flexible mouth and tooth protectors by all boys participating in
football. The rule became effective for the 1962 season and ap-
plies to all member high schools and colleges of the National Fed-
eration of State High School Athletic Associations, National As-
sociation of Intercollegiate Athletics, and the Junior College
Athletic Association.1 All Florida schools are members of the
1American Association for Health, Physical Education and Recreation; and American
Dental Association. Report on Joint Committee on Mouth Protectors, p. 20, 1960.
Figure 38: Football players protected with properly-fitted mouth protectors.
It is important that school authorities work with local dentists
in designing the mouth protectors to satisfy this long needed
Player acceptance of mouth protectors depends on several fac-
tors: fit, personal comfort, retention, effect on speech, and breath-
ing. Custom-made, individually fabricated mouth guards have
been found to be most effective and to have greater acceptance
because use does not impede speech. The cosmetic value suggests
the use of custom-made mouth protectors for least distortion of
It is now possible to fabricate these mouth protectors inexpen-
sively, quickly, and easily and still retain the desirable character-
istics by using self-curing latex with rayon flock.
Prevention and Control of Dental Disease
Proper Home Care
Why We Brush Our Teeth
A clean mouth is the gateway to better health. Home care,
faithfully practiced, is the most important single contribution
that the child can make to the maintenance of mouth health.
Diligent regularity in toothbrushing is the basis for home care of
Figure 39: Proper home care is important.
We brush our teeth because it helps:
(1) To clean the teeth
(2) To keep the gingival tissues healthy
(3) To improve personal appearance.
When We Brush Our Teeth
For toothbrushing to be effective in reducing caries, it must be
performed thoroughly and immediately after eating. "Acid pro-
duction occurs almost immediately after food has reached the
bacterial plaque."2 Toothbrushing can reduce the number of bac-
teria in the mouth. When brushing is not possible after eating,
the mouth should be rinsed vigorously with water.
How We Brush Our Teeth
The dentist is the person who should determine the best
method of brushing for each individual. The following method is
one that is recommended by the American Dental Association: "
Place the bristles of the brush pointing towards the roots of
the teeth. Rotate the brush so that the bristles sweep down
'Starkey, Paul, D.D.S. "Instructions to Parents for Brushipg the Child's Teeth,"
Journal of Dentistry for Children, Vol. 28, No. 1, First Quarter, 1961.
:American Dental Association. Teeth, Health and Appearance, Fifth Edition, 1961,
1 Clan the outdre u'race
o/f the upper back teeth.
2 Clean the iide surles of the
upper (and Iow)er) back teeth.
3 Cl the iaulde surofe Clean o ide
ol the upper front teeth. ol the lower back teeth.
Figure 40: (1-8) Approved method of brushing the teeth. (See additional illustrations,
page 62) '
over the gums and teeth in the direction of the biting or
1. Clean outside surfaces of upper back teeth.
2. Clean inside surfaces of upper (and lower) back teeth.
3. Clean inside surfaces of upper front teeth.
4. Clean the outside surfaces of lower back teeth.
S5. Clean the outside surfaces of the upper (and lower) front
6. Clean the inside surfaces of the lower front teeth.
7. Clean the grinding surfaces of the upper and lower teeth.
5 'lean te Clean the h sde sur aces
nu pper (aind lower) Iron teeth 0 of "thr loiwrer IronI r-elh.
Clean the gritdtog s-too8 Cloat. eared-f1or th
7 f the tppar and lowe teeth. 8 aClen, Uhealth and aptth e
Three general rules for brushing are:
1. Brush immediately after eating
2. Brush each area at least ten times-the surfaces next to
the cheeks and next to the tongue, the upper and lower
3. Brush the upper teeth down toward the biting edge, the
lower teeth up toward the biting edge.
The appropriate toothbrush for a child is one with:
1. A straight handle
AL-- .--- -----.. .. --....
Figure 41a: Popular types of toothbrushes.
2. A small working head
3. Two rows of bristles, cut straight across, with five or six
tufts in each row.
The toothbrush should be cleaned after each use by rinsing it
under cold water and then hanging it to dry in an airy place. It
is a good plan to have two toothbrushes to be used alternately.
The dentist can help to select the best toothbrush of proper
design for individual need. The style, design, and manner in
which the bristle or nylon filaments are stapled to the brush must
be correct for the way in which the brush is used to clean the
teeth and stimulate the soft tissues of the mouth.
Figure 41b: Electric tooth brush.
Figure 41c: Rubber-tipped brush for gum massage.
The dentifrice serves two purposes:
1. To assist the toothbrush in freeing debris and stain from
the accessible surfaces of the teeth
2. To aid as a caries preventive agent.
A dentifrice, in itself, will not prevent dental caries, but it will
enhance the cleansing effect of the brushing. However, the use-
fulness of a stannous fluoride dentifrice as a caries preventive
agent is recognized by the Council on Dental Therapeutics of the
American Dental Association.4
4Reports of Councils and Bureaus. "Evaluation of Crest Toothpaste," Journal of
American Dental Association, 61:272, August, 1960.
Other Steps in Oral Hygiene
It is important to massage the gums since it promotes a
better distribution of blood to all parts of the tissues next
to the teeth. It serves as a stimulant to the blood stream
and brings about relaxation of the nerves by relieving con-
gestion. Regular massaging will make the mouth feel bet-
ter and cause the gums to become firmer and healthier.
The best way to massage the gums is to place a small
amount of dentifrice on the thumb and forefinger and rub
the gums with a rotary or circular motion.
Some toothbrushes have a rubber tip at the end for use
in stimulating the gums. This device should be used only
on the recommendation of the dentist and with his
The purpose of a mouthwash is to help remove loose par-
ticles of food from the teeth and mouth. Pure water is
satisfactory for this purpose. The usual commercial
mouthwash has no medicinal value. A medicated mouth-
wash should not be used unless prescribed by the dentist
for certain conditions of the gums and other tissues of the
3. Dental tape
It is almost impossible to remove all of the particles of
food from between the teeth, no matter how thoroughly
one brushes. For this reason, it is often advisable to use
dental tape, or dental floss. It is not a substitute for the
toothbrush, but rather a supplement, for its purpose is to
remove food particles wedged between the teeth beyond
the reach of the toothbrush.
Dental tape may be obtained in several thicknesses; the
need depending on the space between the teeth. Persons
with teeth particular close together often find a very
thin tape is easier to work into tight areas. The regular,
threadlike form is often preferred. The personal dentist
can advise which is better for an individual.
Figure 42a: Proper use of dental tape in the mouth between teeth.
Directions for use:
1. Draw about an 18-inch length of tape from the container.
2. Twist the tape two or three times around the forefinger
and middle finger of each hand, leaving the thumbs free.
3. For upper teeth use the thumbs as guides, holding them
about one inch apart, with the tape taut.
4. For lower teeth, use the forefingers, no more than one
inch apart, to guide the tape.
5. Work the tape through the tight areas to the base of the
teeth by moving it gently back and forth. Once at the base
of the teeth, continue this action for a moment to dislodge
food matter wedged there. Remove tape the same way.
Care by the Dentist
The dentist is a doctor who has been scientifically educated to
diagnose and treat diseases of the teeth and mouth.
Figure 42b: How to hold the tape properly.
He can help the child toward lifelong dental health by:
1. Counseling the parent on the child's dental needs
2. Examining the teeth at regular and frequent intervals
3. Discovering and correcting small defects that may be
4. Removing stains and other blemishes
5. Teaching the child how to brush his teeth
6. Teaching the child and parent how diet is related to den-
Regular visits to the dentist should begin when the child is
between two-and-one-half to three years of age, shortly after all
the primary teeth have erupted. These visits and check-ups
"American Dental Association. Teeth, Health, and Appearance, Fifth Edition, 1961,
Figure 43: Periodic care by the dentist will help the child toward lifelong dental health.
should be repeated at regular frequent intervals for the following
1. Thorough cleansing
2. Dentist observation of growth of teeth and to make cor-
rection of irregularities if indicated
3. Discovery of early symptoms of dental disease
4. Rampant caries may be controlled if cavities are dis-
covered early and filled while small.
It is recommended that a child have a regular dental check-up
at least two times per year. This may vary according to the con-
ditions of his mouth. The dentist can advise on the frequency of
Thorough prophylaxis is the careful cleaning of the teeth by a
dentist or a dental hygienist. It consists of the removal of all
foreign material from the crowns of the teeth and the smoothing
and polishing of tooth surfaces. It helps to prevent damage to the
gums which may result in inflammation as a result of irritation
from accumulated deposits.
Figure 44: X-Ray examinations are important at an early age.
Dental X-Ray Examinations
Many defects of the teeth and surrounding tissues cannot be
seen by a dentist making a visual inspection. Only x-rays can
help reveal the condition of the hidden parts of the teeth and
soft tissues and bones of the mouth. These examinations at
regular intervals provide a history of a person's teeth and help
the dentist see changes in the teeth, bones or soft tissues that may
be indications of disease or other difficulty.
X-ray examination is particularly valuable in preventive den-
tistry. Pictures of the teeth will reveal the beginning of decay
and enable the dentist to correct the condition before the teeth
are seriously damaged. In young children they are also used to
determine whether the permanent teeth are in normal position
beneath the primary teeth.
X-ray examinations are essential to the most effective diagnosis
Dental x-rays are necessary because they reveal such condi-
tions as pictured below:
1. Early stages of decay between the teeth
On the surface,teeth and gums may appear
Free from disease.
But with the aid of
X-ray pictures, it is
possible to detect
early stages of decay
X-ray pictures also
help to detect.. .
X-ray examinations are essential to the most effective diagnosis and treatment.
Figure 45: Why X-Ray examinations are necessary.
2. Recurrent decay
3. Impacted teeth
4. Periodontal pockets
7. Curved roots
Figure 46: X-Rays are important for this teen-ager if she is to be assured her teeth
will last a lifetime.
Topical Application of Stannous Fluoride
Stannous fluoride is a chemical compound which is effective in
reducing enamel solubility and giving a high degree of tooth
The single topical application of stannous fluoride solution
offers an effective anti-caries treatment which may be adminis-
tered in the dentist's office.
In recent clinical studies at the Indiana State Board of Health,
Indiana University, the University of Toronto, and the Minnesota
State Department of Health, this method has been shown to re-
duce the incidence of dental caries in non-fluoridated areas and
fluoridated areas in preschool children, in children of school age,
and in adults. In these studies the following results were
Thirty to fifty per cent decay reduction in children
Thirty-five per cent additional reduction for children reared
in fluoridated areas
Twenty to fifty per cent more effective than four applications
of sodium fluoride
Twenty per cent decay reduction in adults.
Impacted third molars
Abnormal root tips
Cysts Impacted cuspids
Congenitally massing teeth
Figure 47: Dental conditions revealed by X-ray.
Stannous fluoride applications consist of the following steps:
1. The teeth are given a thorough prophylaxis, or cleansing.
2. The teeth are thoroughly dried.
3. The stannous fluoride solution is applied with a cotton
applicator and left on the teeth four minutes. Care is
taken to keep the teeth free from saliva.
4. Usually only one quadrant, or one fourth, of the teeth are
done at one time. After this area has dried the next quad-
rant is done.
Figure 48: Applying stannous fluoride.
The prophylaxis and topical application should be repeated as
often as necessary to keep the disease under control. A highly
susceptible person may require a re-application every four or six
months. For a patient with a low susceptibility yearly application
A daily use of stannous fluoride dentifrice will give added pro-
tection against caries as well as increase the effectiveness of the
topical stannous fluoride treatment.
Other Means of Using Fluorides in Preventive Dentistry
Because no single method of fluoride therapy is completely ef-
fective, Indiana University is now recommending the combined
use of fluorides. These are, in order of decreasing effectiveness:
1. Communal Fluoridation
2. Topical Fluoridation
3. Compatible stannous fluoride prophylaxis paste; and,
4. Stannous fluoride-calcium pyrophosphate dentifrice.6
OHennon, David K., D.D.S., and Muhler, Joseph C., D.D.S. Clinical Use of Fluorides,
Reprint from The Journal of the Indiana State Dental Association, Vol. 41:88-95,
The idea of incorporating fluorides into prophylaxis paste is
not new in preventive dentistry. If it were effective it could pro-
vide the effects of a topical treatment at the same time a patient
is receiving his dental prophylaxis. .
A small quantity of stannous fluoride incorporated into a
mouthwash may be effective in reducing enamel solubility but
the presence of saliva greatly reduces its effectiveness.
An interest in fluoride tablets has greatly increased during the
past two years. This method was designed primarily for those
people who could not receive the established benefits of commu-
nal fluoridation. No clinical studies are available in the United
States regarding its effectiveness in children ingesting fluoride
tablets during the period of tooth calcification and for which ap-
propriate controls are available. If a child consumed one quart
of drinking water fluoridated to a level of 1 ppm, he would re-
ceive approximately 1.0 mg. of fluoride. Most fluoride tablets
which are available over three years of age are designed to pro-
vide 1.0 mg. of fluoride per day. However, the fluoride tablet is
usually ingested at one time, and as a result is rapidly eliminated
from the blood, thus providing only minimal protection to the
In order to further increase the benefits induced by communal
fluoridation, the use of a compatible stannous fluoride prophy-
laxis paste followed by the use of a topical stannous fluoride treat-
ment is suggested. To help maintain the anti-cariogenic effect in-
duced by these three methods, the daily use of a stannous
fluoride-calcium pyrophosphate dentifrice may be used. Clinical
evidence using these four preventive dentistry techniques have
shown caries reduction in the order of ninety per cent with no
cumulative fluoride toxicity.8
A new and simple method of applying the caries-inhibiting proper-
ties of fluoride to tooth enamel has been introduced lately. Taking
advantage of the very high negative charge of the fluorida ion and
its consequent attraction for positively charged tooth enamel, the
method employs a specially designed toothbrush containing a tiny
source of electricity to impart a positive charge to the teeth, thereby
attracting the negative fluoride ions found in a standard fluoride
dentifirice. The method is also said to be effective in the control of
hypersensitivity to the teeth. Further research may prove this idea
to be a useful adjunct to regular dental treatment and home care.'
OThe American Annual, An Encyclopedia of the Events of 1961, Dudley and Smith,
editors, p. 218. American Corporation, Washington, D.C., 1961.
This method of application is still in the development stage.
Care by the Dental Hygienist
The dental hygienist is a professionally educated person who
works under the supervision of a dentist. She has learned dental
science and understands the dental problems of adults and
Working with the dentist, the dental hygientist-
1. Gives a complete dental prophylaxis which includes clean-
ing and polishing the teeth
2. Instructs the child in care of his mouth
3. Takes x-rays of teeth to assist the dentist in his diagnosis
4. Renders fluoride treatment to the teeth.
The public health dental hygienist serves as a resource person
in school dental health programs.
Control of Dental Disease by Community Programs
Fluoridation of Communal Water Supplies
1. What is fluoridation?
Fluoridation simply means adjusting the community water
supply so that it contains the optimum level of fluoride neces-
sary for the reduction of dental decay. This fluoride level is
about one part fluoride per million parts water.
2. How does fluoridation help children?
The consumption of fluoridated water during the time teeth
are forming produces a tooth structure that is more resistant
to decay. The addition of one part fluoride per million parts of
water to communal water supplies reduces the number of
teeth with caries experience by about sixty per cent, and de-
creases the number of missing first molars by seventy-five per
3. What does it cost?
Costs vary from community to community but the average
expense is approximately ten cents per year per person. This
loStoll, Frances A. Dental Health Education. Philadelphia: Lea and Febiger, 1960,
Figure 49: The dental hygienist gives a complete dental prophylaxis and instructs the
patient in the care of the teeth.
nominal cost cannot be compared to the benefits a child re-
ceives which continue throughout life and which will reduce
future dental expenses.
4. Is it safe?
The House of Delegates of the American Medical Association
voted on December 5, 1957, that
Fluoridation of public water supplies is a safe and practical method
of reducing the incidence of dental caries during childhood. No
evidence has been found to prove that continuous ingestion of
water containing the equivalent of approximately one part fluoride
per million parts of water for long periods of large segments of
the population is harmful to the general health."
The Dental Preceptorship Program
The Governor's Citizens' Committee on Public Health, ap-
pointed in 1955, felt that some provision should be made to pro-
vide adequately trained personnel in dental public health work.
As a result, through the combined efforts of the State Board of
Health, State Dental Society, and the State Board of Dental Ex-
aminers, the Dental Preceptorship Program was established.12
A dental preceptorship of one year each is offered to a young
unlicensed dentist recently graduated from an approved dental
school. He is assigned by the State Board of Health to a dental
public health position in a county health department under the
professional direction of a preceptorship committee of dentists
designated by the local dental society.
The preceptorship dentist serves in the dental public health
clinic to provide remedial dental care for indigent preschool and
elementary grade children. Only emergency treatment may be
provided for indigent children of the junior and senior high
The dental profession is meeting its responsibilities for public
health leadership through the dental preceptorship program.
This also satisfies its traditional responsibility for seeing that ade-
quate care is available for indigent children.
State Mobile Dental Corrective Clinics for Indigent Children13
"1American Medical Association, House of Delegates. "Statement on Fluoridation of
Public Water Supplies," p. 3-4.
TFlorida State Board of Health. Florida's Dental Preceptorship Program, p. 1.
s"Bureau of Dental Health, Florida State Board of Health. Health Education Material
for Florida Dentists and Teachers, Jacksonville, Florida, p. 24-25, 28.
Figure 50a: The dental preceptor con- Figure 50b: The Singletary Clinic in Lees-
ducts a survey of primary children, burg, Florida, houses the Lake County
Health Department and the office of the
Figure 50c: Volunteers from various serv-
ice organizations in Lake County transport
the children to the clinic for their appoint-
ments with the dental preceptor.
Figure 50d: The child then sees the
dentist who will make sure the primary
teeth are maintained in such a healthful
condition that they will last until the
permanent teeth erupt and that the per.
manent teeth will last a lifetime.
The State Board of Health operates two mobile dental correc-
tive clinics (one Negro, one white) on a full-time state-wide
basis under the direction of the Bureau of Dental Health.
Wherever a county health department has a dental clinic as a
part of their public health service, the mobile units are not as-
signed to that county.
These mobile units are to serve the smaller counties where
there are no dentists attached to the county health department.
To make dental inspections in areas contemplating the initia-
tion of a dental corrective and educational program and to give
corrective service to indigent elementary school children in com-
munities where there are no dentists, or an insufficient number
to take care of the dental needs of the indigent elementary
How to Obtain the Service:
Local health departments, PTA's, civic groups, or interested
individuals, submit a written request to the Bureau of Dental
Schedule of the Clinic:
Requests for the services of the mobile dental clinic must be
received by August 1 for scheduling the following school year.
When all requests have been received, a tentative schedule will
be formulated and each area requesting the clinic will be notified
of the date it will be available for their area. As soon as these
dates are confirmed by local officials, a definite schedule will be
made for the entire school year and the sponsoring agent will be
In the event of a cancellation, it may be possible to consider
requests received after the August 1 deadline.
The State Board of Health pays the salary of the dentist and
the cost of supplies and equipment. The sponsoring agencies will
pay the $11.00 per diem of the dentist for the actual number of
working days in the community, usually five days a week. The
State Board of Health will pay his per diem for each Saturday,
Sunday, and legal holiday while he is conducting the program.
In addition to financial support (dentist's per diem), local
health departments, PTA, and other civic groups will assist in
publicizing the program to parents and community. They will
arrange for transportation to and from the clinic, whenever nec-
essary. Members of local PTA groups and other civic organiza-
tions, and high school students may assist with clerical work in
the mobile clinic.
The dentist operating the mobile clinic is not provided an as-
sistant by the State Board of Health. The sponsoring agent in
each community is encouraged to make arrangements to provide
a dental assistant. Wherever possible, it would be advantageous
to have only one for the entire visit of the clinic. However, if
more than one assistant is to be used, the dentist should be pro-
vided with a schedule so that he will be informed as to who will
assist him and at what time.
Location of the Trailer:
The mobile dental clinic is to be stationed at one of the larger
schools in the community, or where it will be accessible to the
largest number of children and in a spot where there are least
number of disturbing noises. Running water and electricity (110
volts A.C.) must be accessible to the unit.
All children may receive dental examinations without parental
consent or cost but indigent children requiring dental treatment
must have a permission slip signed by a parent or guardian. These
permission slips are provided by local health departments and
distributed through the public health nurse or teacher.
Eligibility for Treatment:
Indigent children in the lower elementary grades (1, 2, 3).
These are to be selected by teachers, public health nurses, wel-
fare and social workers and may include the following categories:
1. Those unable to buy school lunches
2. Those unable to buy school supplies
3. Children from families with public health problems such
as tuberculosis or cancer
4. Children from broken homes
5. Children whose parents are physically or mentally
6. Children whom nurses, and teachers, in their professional
judgment consider medically and dentally indigent
7. Children whose parents are on public assistance
8. Children from foster homes.
Extreme care should be used in order to insure that only den-
tally indigent are referred to these clinics
Emergency treatment will be provided for indigent children
in all grades (1-12).
Official Public Health Dental Clinics
Corrective dental service is available for indigent elementary
school children. For information, contact the health departments
Alachua County Health Depart-
816 S.W. 4th Street
Broward County Health Depart-
605 S.W. 26th Street
Fort Lauderdale, Florida
Dade County Health Department
1350 N.W. 14th Street
Miami 35, Florida
Duval County Health Department
330 East Bay Street
*Highlands County Health Depart-
(*Headquarters for the Tri-
County unit of Glades, Hendry,
Hillsborough County Health De-
1420 Tampa Street
Jacksonville City Health Depart-
962 Main Street
Lake County Health Department
121 South Sinclair
Liberty County Health Depart-
Manatee County Health Depart-
202 6th Avenue, East
Marion County Health Department
Ft. King and Osceola Streets
Orange County Health Depart-
832 West Central Avenue
Palm Beach County Health De-
825 Evernia Street
West Palm Beach, Florida
Pinellas County Health Depart-
520 Second Avenue, North
St. Petersburg, Florida
Polk County Health Department
229 Avenue "D," N.W.
Winter Haven, Florida
Putnam County Health Depart-
819 Lemon Street
St. Johns County Health Depart- Sarasota County Health Depart-
49 Orange Street 1865 Hawthorne Street
St. Augustine, Florida Sarasota, Florida
Santa Rosa County Health De- Volusia County Health Depart-
North Stewart Street 440 South Beach Street
Milton, Florida Daytona Beach, Florida
Nutrition-As It Relates to Tooth Development
A well-balanced diet is important for good nutrition. Although
our knowledge of the relation of nutrition to dental disease is in-
complete, we do know that a well-balanced diet is needed for the
health of the expectant mother and the proper development of
the fetus. Since the structure of the teeth is laid down early in
the development of the fetus, any deficiency in the expectant
mother's diet should be corrected immediately. She should eat
adequate quantities of nourishing food, but it is not true that she
must eat for two. Contrary to an old belief, the fetus does not
absorb calcium from the teeth of the mother. 4
Phosphorous and calcium, which are deposited together, are of
equal importance in the formation and development of teeth.
This intricate process requires many nutrients besides minerals,
1. Protein, which is needed for the framework and for part
of every cell and the circulatory fluid
2. Vitamin A, which aids in the deposition of the minerals
3. Vitamin C, which is required for the cementing material
between the cells and for the firmness of the walls of the
4. Vitamin D, which is required for the proper utilization of
calcium and phosphorous.
Vitamin A plays a vital role in the formation of the teeth. If
a child gets too little vitamin A when his teeth are developing,
the enamel forming cells become abnormal and lose their effec-
tiveness in forming enamel prisms. If some of the six-sided prisms
of enamel are missing in the finished enamel, pits are formed
which later fill with food debris, leading to the formation of acids
that dissolve the enamel and thus cause decay. Vitamin A is
14American Dental Association. Your Child's Teeth. Chicago, Illinois, 1956, p. 4.
found in foods of animal origin, all milk products that include
milk fat, and green and yellow vegetables.
Vitamin C is important in the maintenance of healthy gingival
tissue and the prevention of malformation and deterioration of
dentin and pulp. Recommended daily allowances of vitamin C
are based on age and needs for rapid growth in children and ado-
lescents. Good vitamin C sources include citrus fruit, greens,
tomatoes, and members of the cabbage family.
Vitamin D is not found in many commonly used foods. Fish
oils are a rich source, and it is also present in egg yolk and liver.
Cow's milk generally is not a good source of vitamin D, but the
vitamin content is often increased by adding a vitamin concen-
trate. The human body can make vitamin D when ultraviolet
light from the sun shines directly on the skin.
Nutrition-As It Relates to Dental Caries
Research indicates that a good diet during the period of forma-
tion of enamel is an important and perhaps powerful factor in
building resistance to dental caries. It does not make them decay
resistant. However, good nutrition and a well-balanced diet are
fundamental for dental health at all ages.
There is evidence that lactic acid is formed when micro-
organisms ferment the carbohydrates. This acid is capable of dis-
solving the enamel of the tooth. Sugars and starches of sticky
consistency which lodge on and between the teeth are capable of
forming the lactic acid. Therefore, if children do eat between
meals, it is recommended that some raw fruit or vegetable be
eaten rather than the usual dessert and confections. A reduction
in the frequency of sugar intake is more important than is the
amount consumed, since there is a fresh attack upon the teeth
each time sugar is eaten.
Nutrition-As It Relates to Periodontal Disease
Healthy gums and healthy bone to support the teeth require
daily personal care, which includes adequate nutrition. Dietary
deficiencies often affect the health of the periodontal tissues.
Vitamin C is recommended to produce healthy tissue since a de-
ficiency of this vitamin leads to the lack of collagen, causing the
gingiva to become swollen and to bleed easily. When the de-
ficiency lasts a long time, the alveolar bone may be destroyed so
that the teeth loosen and fall out.
NUTRIENT PURPOSE SOURCE
1. Calorie Carriers
2. Mineral Elements
a. Vitamin A
To build, repair, and
regulate cells. Excess
supplies ready (or
To supply energy,
furnish heat, and save
protein to build and
To supply energy,
furnish heat, and save
protein to build and
To build red blood
cells which carry oxy-
gen to all parts of
To build bones and
teeth; for nerve and
To help thyroid gland
regulate cell activities
for physical and men-
To promote healthy
skin; prevent night
To help release en-
ergy from carbohy-
drates; to help regu-
late appetite; for a
healthy digestive tract
To convert food into
energy; for a healthy
skin; to help adjust
eyes to light
To help use carbohy-
drates, fats and pro-
teins; for smooth
skin, healthy diges-
tive tract, and nerves
Meat, fish, poultry,
eggs, milk, nuts, dry
peas, beans, bread,
Fruit, most vegeta-
bles, cereal, bread,
cream, oils, meat,
whole milk, peanuts,
Liver, egg yolk, red
meat, whole grain
bread and cereal,
deep green leafy veg-
etables, dried fruit
Milk, cheese, enriched
bread, deep green
leafy vegetables, can-
Seafood, iodized salt
Deep green and yel-
low vegetables, fruit,
watermelon, fresh as-
milk, cream, marga-
rine, butter, egg yolk
Enriched and whole
grain bread, cereal,
pork, liver, dry peas
and beans, potatoes
milk, meat, eggs,
whole grain bread
and cereal, deep green
Fish, poultry, en-
riched and whole
grain bread and ce-
real, potatoes, nuts,
Figure 51: Lean meat, fish, poultry, eggs, nuts, dry peas, and beans.
e. Vitamin C
f. Vitamin D
To help form cement-
ing material to hold
cells together in bones
To aid in absorption
and use of calcium
To supply body fluids
Citrus fruits, broccoli,
green pepper, melon,
greens, white and
sweet potatoes, toma-
toes, raw cabbage
Vitamin D milk, sal-
mon, tuna, herring,
mackerel, action of
sun on skin
Drinking water and
Figure 52: Fruits and Vegetables. Figure 53: Enriched whole grain bread
Nutrition-As It Relates to Maintaining Good Dental Health
Just as proper nutrition is essential for a child's general growth
and good health, so it is important to the development of his teeth
and their supporting structures and to the maintenance of a good
state of dental health. Good nutrition and a well-balanced diet
are fundamental for dental health at all ages.
There are certain nutrients which are recognized as being es-
sential for normal health and development. A food guide widely
used in planning nutritionally adequate meals is the "Basic Four
Group 1. Fruit-vegetable
Group 2. Enriched and whole grain bread-cereal
Group 3. Lean meat, fish, poultry, eggs, nuts, peanut butter,
dry peas and beans
Group 4. Milk-cheese.
A combination of these nutrients is needed each day to supply
energy, to build, maintain, and regulate the body. Listed in the
following chart are outstanding sources of each nutrient. Foods,
with few exceptions, carry more than one nutrient.
5"American Institute of Baking. Follow the Food Way. Chicago 11, Illinois; 1959.
Figure 54: Dairy products, milk, cheese.
Daily Meal Planning
Group I Fruit and vegetables
a. Four or more servings daily
1. Include one that is deep green or yellow for Vitamin
A at least every other day.
sweet potatoes papayas
leafy greens nectarines
Figure 55: Good
nutrition and a well-balanced diet are fundamental for dental health.
2. Include one that is rich in
brussel sprouts ma
raw pineapple pa:
3. Include potato.
Group II Enriched and whole-grain cereals
a. At least four servings daily
Group III Lean meat, fish, poultry, eggs, nuts, peanut butter, dry
peas and beans
a. Two or more servings daily
liver dry peas
heart dry beans
Group IV Milk-cheese
a. Daily, as such, or in cooking
b. Adults-2 or more cups
Children-3 or more cups
Teen-agers-4 or more cups
c. Evaporated, skim, dry, buttermilk, or cheese
d. One ounce cheese is equivalent to one cup of milk.
(These statements regarding nutrition have been reviewed by the Coun-
cil on Foods and Nutrition of the American Medical Association and
found to be consistent with current authoritative medical opinion.)
Adapted from: Follow the Food Way, American Institute of Baking,
400 East Ontario Street, Chicago, Illinois, copyright 1959.
Importance of the Physical Character of Food
The physical character of food is important in maintaining good
dental health. Foods that require thorough chewing, during which
they sweep over the teeth and soft tissues, are called detergent
foods. Such foods as fresh fruits and raw vegetables help keep the
mouth clean and provide the muscles with the exercise they need.
Chewing coarse foods causes the teeth to move up and down in
their sockets, which is conducive to their health. Foods that re-
quire little chewing tend to cling to the teeth and pack into the
fissures and grooves. Continuous use of such foods may cause
muscles to lose their tone, mucous membranes to become dull and
unhealthy, and dental plaques to form around the teeth. They are
called impacting foods.
Nutrition-Its Implication for School Lunches
An important function of dental health education is the selec-
tion of proper foods in school lunch programs. The school lunch
program should be planned and operated so that it will serve as a
laboratory for the practice of desirable health rules learned in
t ..7 ff
Figure 56: A Florida school dining-room.
The National School Lunch Act, which became effective in
1946, is administered by the United States Department of Agri-
culture with the cooperation of the Florida State Department of
Education. The Type A Lunch, designed to provide from one-
third to one-half of the child's daily nutritional requirements,
includes the following:
1. One-half pint of whole milk as a beverage
2. Two ounces fresh or processed meat, fish, poultry, or
cheese; one egg; one half cup cooked dry peas or beans;
or four tablespoons of peanut butter
3. Three-fourths cup of vegetables, or fruit, or both
4. One or more portions of bread, muffins, or other bread
made from whole grain or enriched flour
5. Two teaspoons of butter or fortified margarine 16
Providing sweet crackers or cookies with the morning milk for
young children is not consistent with the best thinking, for it fills
the mouth of the child with fermentable carbohydrates that will
attack the teeth within a few minutes after eating, unless the
mouth and teeth are cleaned immediately. If raw vegetables or
fruit cannot be provided for this snack, it would be better to per-
mit only the milk.
'"State Department of Education, Tallahassee, Florida. A Guide-School Lunch-County
Level, 1960, p. 24.