CASE REPORTS*

By HAROLD CHAPMAN, L.D.S., LONDON, \V. 1, ENGLAND

INFANTILISM AND OCCLUSION

THE dental condition, from the orthodontic point of view, of cases of m­fantilism has not been reported on, so far as I am aware; the opportunity

is taken to present two cases.

Details of Case 1 (Figs. 1, 2 and 3). Male, aged twenty-four years. In­fantilism-type Lorain (pituitary tumor). Cheerful mentality. Occupation­clerk. Height 4 ft. 31;2 in. Weight 4 st. 3 lbs. Calvarium large, out of pro­portion to rest of head. Dental arches very small; teeth very crowded. Atage of eighteen years four teeth were removed from the mandible and twofrom behind the maxillary centrals; doubtless there have been other extrac­tions not recorded; several teeth are carious. Though the arches are small andin proportion to the rest of the face, the teeth are the size of those of an ordi­nary adult; the width of the maxillary central incisors is 8 mm. The arch rela­tionship is probably normal.

Details of Case 2 (Figs. 4 and 5). Male, aged fifteen years. Infan­tilism. Dr. Robert Hutchinson says that he supposes that "some peoplewould put the cause down to an anterior lobe pituitary defect." Height 4 ft.2 in. Weight 4 st. 2 lbs. (His brother, aged twelve years, is slightly taller andheavier.) Occlusion normal; the maxillary central incisors are 7.75 mm. wide;teeth excellent, the only defects being a few small cavities; there is only oneright mandibular premolar, and this is not perfectly formed, but the deciduousmandibular canine is in place on that side between the permanent lateral andcanine; the latter occludes between the maxillary canine and first premolar;there is much calculus on the six mandibular front teeth. X-ray pictures andphotographs are not available.

This child was so tiny when born that he "could have been put into aquart pot." He thrived and got fat until he was four years of age; was breast­fed for nine months. For a long time he ate very rapidly, in fact, bolted hisfood, but he eats slower now. His father is certain he did not masticate hisfood until he was thirteen years of age; he swallowed it rapidly in order to getout to play. He had a dummy from age four months to ten months. Atnight he was not entirely a nose breather; tonsils and adenoids were removedat age eleven years. He had rickets very badly at four years of age; he ceasedto grow at age twelve years. These details are of interest because they bringout the fact that this boy was subjected to a number of reputed causes of mal­occlusion, yet he has splendid arches and correct arch relationship.

'Transactions of British Society for the Study of Orthodontics.

865

866 H arold Chapm an

F'ig; I .-Photog raph of the patient whose mod els are shown in F [r;s. 2 a nd 3. H e is s tan d in gnext to a man sUffering from a cromeg al y, whose h eight is just under 5 ft. 6 in.

Case R eports 867

There is no sign of puberty or thyroid insufficiency . H e is intelli gent.His physical development is perfect, but h e is too small, except in regardto the h ead and face, which are normal in size. His brother has no featuresout of the ordinary.

Considerable r esearch work ha s been don e to show that ph ysical defectsof parts of the body other than the head and face, ar e concomitant with malde­velopment of the masticating face and the occlusion. The first case shown maybe cited as an example, Th e second case is an example of perfect developm entof the masticating face, including occlusion, but deficient development of therest of the body. The writer is not aware that a case of imperfect devel opm entof the masticating face, ac companied by malocclusion, with perfect develop­ment of the rest of the body, has been r eported, although there is probably not

868 Hm'old Ohapman

a practitioner here but could bring forward su ch a patient. In the light ofwhat has been stated above, t he followin g combinations of occlusion and bodydevelopment seem to exist:

Masti cating F ace andOcclusion

Normal.

Abnormal.

Development of theRest of the Body

{Good.Imperfect.

{Good.Imperfect.

Fig. 6.

AN IMMOVABLE TOOTH

Girl, aged thirteen years five months. (Figs. 6, 7 and 8.)Occlusion.-Class I; abnormal medial movement of th e left maxillary per­

manent molars. The left maxillary central and lateral incisors are almost edgeto edge with the mandibular teeth; the maxillary ri ght cent ral incisor has goodover bite. X-ray pictures show that the root of the left central incisor hasbeen almost entirely absorbed ; the other maxillary inci sors have roots nor­mal in length.

History.-At age eleven years th e lef t central overla pped t he right one;th e former was pulled dist all y by rubber bands ; to hasten treatment threebands wer e used simult aneously j the left cent ral in cisor was almost extracted ;it wa s pushed ba ck and held in position ; the probable duration of this p eriodwas about four weeks. At the age of thirteen years five months the left cen­tral incisor seems to be getting shorter than the corre sponding tooth on theright side. At age twelve years nin e months the second left maxillary premolarwas extracted.

Case R epori s 869

Tr eatment.-'l'he advice given was that the condit ion of the root of theleft central incisor was unfavorable to treatment with appliances, but theappearance would be improved if the right cent r al incisor were sh ortenedby grinding.

Three and a half years lat er a fri end of th e writer reported that he hallattempted to elongate the left central incisor , but, instead of moving, it hadmoved every tooth in th e head.

FIg . 7.

FIg. 8.

INJURY TO IN CISORS

Boy, aged eleven year" nine months. (F igs. 9 and 10.)

Occlusion.-Class II, division 1. Unilater al on th e right ; normal on theleft; the left maxillary permanent molar ha s moved medially to an abnormalextent; the overbite is excessive. General condition of the mouth is good.

History.-At age eight years nine months the ri ght maxillary central andlateral in cisors were knock ed out in an accident ; the central in cisor wa s re­placed at once and remains as seen in Fig. 9. Th e left maxillary lateralresponds normally to heat, cold and elect ric ity ; both centr als r espond muchmore slowly to cold and electr icity; no r esp onse to heat was obtained ; the

870 Harold Chapman

degree of response of the two teeth seemed to be similar; the x-ray pictures(Fig. 10) show the left central incisor root to be in better condition than thatof the right central incisor; no difference in the three incisors to palpationcould be detected.

The lateral was also replaced after the accident; as it went black it wasextracted.

Fig. 9.

FIg. 10.

The two first maxillary premolars were extracted at age nine years ninemonths, presumably with the object of facilitating orthodontic treatment.The right central incisor is said to get loose when it is moved.

The parents wish to know if orthodontic treatment is contraindicated.My opinion is that orthodontic treatment would confer little benefit andshould not be undertaken unless the parents realize that permanent reten­tion may be required and that the treatment may cause the central incisorsto be lost earlier than would otherwise be the case; in any event artificial sub­stitutes will probably be required in a few years.

15 UPPER WIMPOLE STREET.

Case Reports

DISCUSSION

871

Mr. A. T. Pitts said that the first of Mr. Chapman's communications raised some quiteinteresting questions, and suggested an investigation which might be worth carrying further.He had seen a good many children with infantilism, but had never been able to correlateany particular dental condition. There were various kinds of infantilism; the two examplesshown by Mr. Chapman were of dyspituitarism. He had seen some of these, and here againhe could not recall any particular abnormalities in the dentition. Then there was renalinfantilism, and in one case of this type he had seen a very marked retardation of theeruption of the teeth in a child of about eight or nine years, though in other cases he hadnot been able to observe any particular correlation. One might sometimes see very profoundconditions affecting the whole body, and yet the teeth and jaws might be absolutely un­affected. He recalled one child of ten years, with the physical development of a child ofsix-a wizened creature-although mentally extremely alert, she had suffered from cyclicalvomiting for many years, yet here again the jaws were perfectly well-formed, and there wasnot a trace of caries in the mouth. It would be very interesting indeed to correlate on alarger scale some of these conditions.

Mr. 11. C. Visick remarked that in the second of Mr. Chapman's cases, where there wasapparently absorption of the root, it seemed almost an impossibility that a tooth with sucha short root could resist movement with orthodontic appliances. If other photographsshowed the root at right angles, that would explain it, otherwise it seemed inexplicable, espe­cially as an attempt was made to pull it out of the socket. He had often noticed that theroots of teeth killed by a blow had slowly become absorbed away until they had just theappearance shown in the photograph. The tooth did not become septic, the pulp chamberseemed to be dried right up, and the tooth generally discolored, and there was hardly anyroot. The x-ray photograph which had been shown suggested to him a case of that sort.