LIBRARY, A & M COLLEGE, CAMPUS. E97-6M-L180 TEXAS AfiRICULTURAL EXPERIMENT STATION A. B. CONNER, DIRECTOR BULLETIN NO. 491 AUGUST, 1934 DIVISION OF RURAL HOME RESEARCH DENTAL DECAY AMONG TEXAS SCHOOL CHILDREN T , ‘ - l, LI B R A R Y Agrlwlturalfliechanicalfiollfl‘! “m” mum Station. T0188- AGRICULTURAL AND MECHANICAL COLLEGE OF TEXAS T. 0. WALTON, President STATION STAFFT Administration : . A. B. Conner, M. S., Director R. E. Karper, M. S., Vice Director Clarice Mixson, B. A., Secretary M. P. Holleman, Chief Clerk J. K. Francklow, Asst. Chief Clerk Chester Higgs, Executive Assistant Howard Berry, B. S., Technical Asst. Chemistry: G. S. Fraps, Ph. D., Chief ; State Chemist S. E. Asbury, M. S., Chemist J. F. Fudge, Ph. D., Chemist E, C. Carlyle, M. S., Asst. Chemist T. L. Ogier, B. S., Asst. Chemist A. J. Sterges, M. S., Asst. Chemist Ray Treichler, M. S., Asst. Chemist W. H. Walker, Asst. Chemist Velma Graham, Asst. Chemist Jeanne F. DeMottier, Asst. Chemist R. L. Schwartz, B. S., Asst. Chemist C. M. Founders, B. S., Asst. Chemist Horticulture : S. H. Yarnell, Sc. D., Chief Range Animal Husbandry: J. M. Jones, A. M. Chief B. L. Warwick, Ph.D., Breeding Investiga. S. P. Davis, Wool Grader J." H. Jones, B. S., Animal Husb. Entomology: F. L. Thomas, Ph.D., Chief: State Entomologist H. J, Reinhard, B. S., Entomologist R. K. Fletcher, Ph. D., Entomologist W. L. Owen, Jr., M. S., Entomologist J. N. Roney, M. S., Entomologist J. C. Gaines, Jr., M. S., Entomologist S. E. Jones, M. S., Entomologist F. F. Bibby, B. S., Entomologist "E. W. Dunnam, Ph. D., Entomologist "R. W. Moreland, B. S., Asst. Entomologist C, E, Heard, B. S., Chief Inspector C. J . Burgin, B. S., Foulbrood Inspector - Agronomy: E. B. Reynolds, Ph. D., Chief R. E. Karper, M. S., Agronomist P. C. Mangelsdorf, Sc. D., Agronomist D. T. Killough, M. S., Agronomist Publications : . A, D. Jackson, Chief Veterinary Science: ‘M. Francis, D. V. M., Chief H. Schmidt, D. V. M., Veterinarian "F. P. Mathews, D. V. M., M. S., Veterinarian J. B. Mims, D. V. M., Asst. Veterinarian Plant Pathology and Physiology: J. J. Taubenhaus, Ph. D., Chief W. N. Ezekiel, Ph. D., Plant Pathologist Farm and Ranch Economics: L. P. Gabbard, M. S., Chief W, E. Paulson, Ph.D., Marketing C. A. Bonnen, M. S., Farm Management 1**W. R. Nisbet, B. S., Ranch Management "A. C. Magee, M. S., Ranch Management Rural Home Research: Jessie Whitacre, Ph. D., Chief Mary Anna Grimes, M. S., Textiles Sylvia Cover, Ph.D., Foods Soil Survey: "W. T. Carter, B. S., Chief E. H. Templin, B. S., Soil Surveyor J. W. Huckabee, B. S., Soil Surveyor R, M. Marshall, B. S., Soil Surveyor Botany: V. L. Cory, M. S., Acting Chief Swine Husbandry: Fred Hale, M. S., Chief Dairy Husbandry: O. C. Copeland. M. S., Dairy Husbandman Poultry Husbandry: R, M. Sherwood, M. S., Chief J . R. Couch, B. S., Asst. Poultry Husbandmsi Agricultural Engineering: H. P. Smith, M. S., Chief Main Station Farm: G. T. McNess, Superintendent Apiculture (San Antonio): H. B. Parks, B. S., Chief A. H. Alex, B. S., Queen Breeder Feed Control Service: F. D, Fuller, M. S., Chief James Sullivan, Asst. Chief D. Pearce, Secretary H. Rogers, Feed Inspector . L. Kirkland, B. S., Feed Inspector D. Reynolds, Jr., Feed Inspector . A. Moore, Feed Inspector . J. Wilson, B. S., Feed Inspector H. G. Wickes, D. V. M., Feed Inspector HTFINF-‘Ffl SUBSTATIONS No. 1, Beeville, Bee County: R. A. Hall, B. S., Superintendent No. 2, Tyler, Smith County: P, R. Johnson, M. S., Superintendent "B. H. Hendrickson, "R. W. Baird, M. S., Assoc. Agr. Engineer No. B, Angleton, Brazoria County: R. H. Stansel, M. S., Superintendent H. M. Reed, B. S., Horticulturist No. 4, Beaumont, Jefferson County: R. H. Wyche, B. S., Superintendent "H. M. Beachell, B. S., Junior Agronomist No. 5, Temple, Bell County: Henry Dunlavy, M. S., Superintendent C. H. Rogers, Ph. D., Plant Pathologist H. E. Rea, B. S., Agronomist S. E. Wolff, M. S., Botanist "E. B. Deeter, B. S., Soil Erosion "P. L. Hopkins, B. S., Junior Civil Engineer No. 6, Denton, Denton County: P. B. Dunkle, B. S., Superintendent "I. M. Atkins, B, S., Junior Agronomist No. 7, Spur, Dickens County: R. E. Dickson, B. S., Superintendent B. C. Langley, M. S., Agronomist No. 8, Lubbock, Lubbock County: D. L. Jones, Superintendent Frank Gaines, Irrig. and Forest Nurs. No. 9, Balmorhea, Reeves County: J. J, Bayles, B. S., Superintendent No. 10, College Station, Brazos County: R. M. Sherwood, M. S., In Charge B- S» Sci. in Soil Erosion L. J . McCall, Farm Superintendent No. 11, Nacogdoches, Nacogdoches County: H. F, Morris, M. S., Superintendent "No. 12, Chillicothe, Hardeman County: "J. R. Quinby, B. S., Superintendent "J. C. Stephens, M. A., Asst. Agronomist No. 14, Sonora, Sutton-Edwards Counties: W. H. Dameron, B. S., Superintendent I. B. Boughton, D. V. M., Veterinarian W. T. Hardy, D. V. M., Veterinarian O. L. Carpenter, Shepherd ‘"0. G. Babcock, B. S., Asst. Entomologist No. 15, Weslaco, Hidalgo County: W. H. Friend, B. S., Superintendent S. W, Clark, B. S., Entomologist W. J . Bach, M. S., Plant Pathologist J. F. Wood, B. S., Horticulturist No. 16, Iowa Park, Wichita County: C. H. McDowell, B. S., Superintendent L. E. Brooks, B. S., Horticulturist No. 19, Winterhaven, Dimmit County: E. Mortensen, B. S., Superintendent "L. R, Hawthorn, M. S., Horticulturist Members of Teaching Staff Carrying Cooperative Projects on the Station: G. W. Adriance, Ph. D., Horticulture S. W, Bilsing, Ph.D., Entomology D. Scoates, A. E., Agricultural Engineering A. K. Mackey, M. S., Animal Husbandry R. G. Reeves, Ph.D., Biology ‘Dean, School of Veterinary Medicine. J. S. Mogford, M. S., Agronomy F. R. Brison, M. S., Horticulture W. R. Horlacher, Ph.D., Genetics J. H. Knox, M. S., Animal Husbandry A. L. Darnell, M. A., Dairy Husbandry TAs of August 1, 19 "In cooperation with U. S. Department of Agriculture. tIn cooperation with Texas Extension Service. Among 6701 school children 0f Texas, dental decay was found in approximately 70 per cent of the white group, 65 per cent of the Mexican, and 45 per cent of the negro. The number of decayed teeth per child was greater among white children than among either Mexican or negro. One or more of the 6-year molars, the first permanent teeth, were decayed in about one-third of the children of each race. Among the white children however the 6- year molar constituted a smaller percentage of all decayed teeth than among Mexican or negro children. a More of the younger than the older children in San Antonio had decayed teeth, but among children in Brazos, Hidalgo, and Jefferson counties decayed teeth were more often found among the older than the younger ones. With all children the numbers having decayed 6-year molars increased rapidly with age up to 12 or 14 years. Slightly more girls than boys in each race had decayed teeth. The data secured in this study suggest a beneficial effect upon the teeth of liberal amounts of milk and a detrimental effect upon the teeth of excessive amounts of cereals and sweet foods in comparisons with other foods. CONTENTS Page The Problem of Dental Caries ............................................................... __________ __ E Source of Data ....... ................................................... .'_ ________________________________________ __ E Incidence of Carious Teeth _ _ _ . _ _ _ _ _ _ _ _ _ _ , _ __ ( Relation to Race and Sex ._ é Number of Carious Teeth per Child _________________________________________________________ V l Relation to Age ....................................................... ........ _.1i Relation of Diet to Caries .......................................... ______________________________________ "15 Comparison with Other Recent Studies- . . . . _ . . . . R _ . . . _ _ l _ _ . _ . _ _ . . _ _.2i Acknowledgments Summary .__-_ 21 Literature Cited BULLETIN NO. 491 AUGUST, 1934 DENTAL DECAY AMONG TEXAS SCHOOL CHILDREN* JESSIE WHITACRE The observation is frequently made that dental decay or “caries” is the most widespread physical defect today. It has afflicted mankind for many generations; Howe (28) has observed that there has been little or no improvement in the condition in the last four or five decades. A vast amount of attention especially in the past ten years has been given to the subject of dental defects and their causes. Investigations include both numerous surveys and many experiments for which usually animals, but sometimes human beings, have served as subjects. Nothwithstanding the extensive study of the problem no satisfactory solution has been reached. Several current theories as to the cause of caries have entire or qualified support from some workers, and some of them opposition from others. Among these theories may be mentioned heredity (11, 38), bac- terial action producing acid which in turn dissolves the enamel of the tooth (47, 9, 18, 14, 30, 27, 56), a systemic theory as opposed to localized agents (5, 3, 15, 28, 55, 6, 42), the acid-base balance theory applying sometimes to the blood stream, sometimes to the saliva, sometimes to the diet (6, 31, 32, 33, 34, 22, 23, 24, 37, 52, 40, 36), a poor diet according to current standards (7, 8, 29, 35), overabundance of cereals in the diet (22, 23, 24, 57, 45, 46, 50), and deficiency of particular nutrients as calcium, phosphorus, vitamin A, C, or D, (43, 17, 44, 25, 48, 41, 1, 26, 59, 12, 13, 19, 20, 21). Among most of the theories, there is general agreement that diet either directly or indirectly has much influence on the soundness of teeth. It is recognized that the influence of diet is not always im- mediately evident. Carious teeth in children who at a given time have a good diet may be the reflection of dietary inadequacies of some previous period, perhaps years earlier or even of prenatal malnutrition. The tooth most susceptible to decay (4, 39) is the “first molar” or “6-year molar”, so called because it appears at about the sixth year _of age and is the first tooth of the permanent set to erupt. Calcification of the 6-year molar tooth is begun before birth and hence it is subject to both prenatal and postnatal nutritional influences. It is therefore ex- posed to the factors of decay for a longer period of time than any other ' tooth. \ . SOURCE OF DATA Dental data were secured from two sources, first, the pupils of the schools of Brazos, Hidalgo, and Jefferson counties participating in the dietary study reported in Bulletin 489 (58), and, second, the pupils in three representative schools of San Antonio cooperating with the Di- vision of Rural Home Research in a study of growth in height and weight of school children. These two groups of school children are hereafter called respectively the 3-county group and the San Antonio group. "Submitted for publication February 22, 1934 6 BULLETIN NO. 491, TEXAS AGRICULTURAL EXPERIMENT STATION In the first study the teeth of each child were examined by local dentists, using a mirror and explorer. At the same time, one of the observers made an entry on a chart showing which teeth, both temporary and permanent, were decayed or abscessed. The number of teeth which had been filled and of the permanent ones which had been extracted were recorded also. No distinction was made as to size of cavities. All teeth which had unfilled cavities, fillings, abscesses, and the permanent ones which had been extracted were regarded as carious. Each unsound tooth was counted only once even though it might have more than one defect, for example, both a filling and an unfilled cavity. In each mouth which was free from cavities, abscesses, and fillings, and had not lost any permanent teeth, the teeth were classified as sound. In the second study, condition of the teeth was one item in the physical well-being of the pupils as judged by a pediatrician. A tongue depressor only (no mirror or dental explorer) was used in these inspections of the teeth, but the same criteria of defectiveness were used as in the first study. INCIDENCE OF SOUND AND CARIOUS TEETH Relation to Race and Sex In both studies from which dental data are taken, white, Mexican, and negro children* were included, the entire number totalling 6701. Tables 1 and 2 show the great extent to which dental decay had attacked the children of the three races. Owing to the difference in the method used in the two studies to identify carious teeth, the findings have been tabulated separately according to method. The consistently higher average number of carious teeth per child among comparable groups of children examined with mirror and explorer than without them, indicates that the former method was the more searching. Nevertheless the interrelations of races with respect to carious teeth are concordant in the two studies, which are used jointly in making generalizations. The best race record in both studies with respect to the proportion of children having one or more decayed teeth was held by the negroes, with approximately 45 per cent of their group affected; the Mexicans were second, with about 65 per cent affected; the white children were the worst, with about 70 per cent in the carious group. But there are no consist$nt race relationships which hold in the two studies with reference to per- centage of children having decayed 6-year molars. With respect to the average number of carious teeth per child, less pronounced and less con- sistent race and sex differences appear, yet the greater extent of decay among white children as compared to that among either Mexican or negro ~ is seen in the slightly higher average number of all carious teeth as well as of 6-year molars. *The children included in this study, all citizens of the United States, have been classified into three groups, Mexicans, other whites, and negroes. As a matter of convenience, these groups are referred to as race groups, and for the sake of brevity in this Bulletin the designation “white” is used for the second of these groups. DENTAL DECAY AMONG TEXAS SCHOOL CHILDREN $6 S: w; Ea Ea mmfi Wm as w? m5 W3 3a 3m fiom onwwZ 359$ omzowcdwmndwv no.5 xv wém in“. N; R5 ma» 2N m3 wmw v.3 mm» we» m5 m3 £06m cwaxwi Y? 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NN N3 NN N3 N»? mvflw i? 1 2N3 NNN 23 NNNH 5m NNS . .323 “.5 5s NN N3 ad 3a #2 28m _ mag 8N mug 2.2 EN $2 _ fluwwu mndfiOs wvwmso 7 fiwaOH. j New» i dz 32o E 150E “Emu .02 HGOO .02 . n .>< Nwm 55.5w pom pom woE Nwfio e2. .58“ Na dz _ avfifio £8» m. dz 5§Eo nwbzio -586 5w 8am wwfifiwwv . . dz Ram NWNMNMMmuWQmN wuflofi find msoiwO N525 msoisu 93E .3 ocO n33 95cm near-Eu mOOSQD wfiNQ-F NEG-HG SUQQGH nzciau HO 1:: mvfiflfim m0 voiofimoim v.3 MO OOHM JQIQ n: NQW MS maxi-Bum -N Oiaflvfi DENTAL DECAY AMONG TEXAS SCHOOL CHILDREN 9 From another viewpoint, however, the race relationships in the incidence of caries are reversed. The decayed 6-year molars among white children constitute a smaller percentage of the entire number of their decayed teeth than is true for either Mexicans or negroes of corresponding sex. Or, expressed otherwise, the excess of total caries among white children over that among Mexicans and negroes occurs more largely in the other teeth than in the 6-year molars. Apparently the 6-year molar was relatively a somewhat more vulnerable tooth among the Mexicans and negroes than the white children in the two studies reported here; or, the other teeth of the white children were relatively more vulnerable than were those of the Mexicans and negroes. Racial characteristics while probably having some weight in determining the proportion of children who succumb to caries may be less of a factor than is commonly supposed. I On the whole, though not uniformly (Table 2), the girls of the three races show somewhat higher percentages with decayed teeth than do the boys; but in one group of white children more boys than girls had one or more carious teeth, and in one of the Mexican groups percentages of the sexes having one or more carious teeth were equal, and more boys than girls had carious 6-year molars. The sex difference is too small, however, to be given serious consideration. Number of Carious Teeth per Child A distribution has been made for each of the three races of the children who had one or more carious teeth, according to the number of teeth in- volved per child. The occurrence of 1, 2, 3, and 4 carious 6-year molars has also been determined. Table 3 contains these data, and a graphic presentation of the percentage of children in each numerical class of carious teeth, from 1 tooth successively through 10, and for 11 or more teeth is given in Figures 1 and 2. - The most striking feature of these data as brought out in the graphs is the relatively larger proportion of the Mexican and negro groups hav- ing only 1 or 2 carious teeth as compared with the white children, among whom nearly as many had 3 or 4 carious teeth as had only 1 or 2. This race relationship holds both for “any tooth” and for the 6-year molars alone. The mo-re frequent occurrence among white children than among either Mexican or negro of the higher numbers of carious teeth (5 or more) is readily seen in the graphs, especially in the 3-county group. The highest number of carious teeth in the mouth of a negro child (a girl of 18 years) was 10, of a Mexican (a boy of 9 years) 12, and of a white child ( a boy of 18 years) 21. In these graphs as in the data given in Table 2, the small sex differences may be detected, the slightly worse record for carious teeth among the girls than the boys being more apparent with the 6-year molars than with “any tooth”. The three largest sex differences are in the case of the negro children in the 3-county group hav- ing one decayed 6-year molar, and the Mexican and negro childreniin‘ the San Antonio group having two decayed 6-year molars. The graphs also» ~—- 10 BULLETIN NO. 491, TEXAS AGRICULTURAL EXPERIMENT STATION Had. TH v.0 0H iqmN w0 imwimw m.H w v.0 N i. NH H.m flH HKHH Hm N.wH__0m mam?“ H.0m. 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DENTAL DECAY AMONG TEXAS SCHOOL CHILDREN 11 further emphasize that the carious 6-year molars constitute a higher percentage of all carious teeth among negro and Mexican than among white children. 4o wan: cnlwnxu 4Q mum 051mm I 301s I 150a E my; I 2-10 5° "R13 l] 1155 Q50 onus [l as: i n: p O r10 ‘$20 I Ii iw 31o = s i s: . o a- o 1?3*5¢7°91°11*!354 12s4ss1e91o11+12s4 _ IOJZAHIOUS _ H Q_¢ no. cmous mam m ‘room ‘hummus Hm cmmus mm__my Too-m gmfigous 4o IIKXEAI 0511-01!!! 4,0 uxxrcu CHILDREN I am | e5 E sows |12a lac anus [l as Q50 anus U144 ’ 5 l" 82o I w I10 ‘=3 E g 1O . o m o < 1=$45°1B91°1P1=54 12s4sa1as1o1u1zs4 nacluuous , |°- film“ mTb-m m" Qqgmqnqs no. omens warm-m! moon: gfygfigfgs 4° "Wm 651mm 4o usono cuxmm l 5°15 I 15$ 5 BOYS | 15s l” “m” U a“ 5 3o onus ll 18s = s :20 g 2o i ‘L’ ‘l0 H 1° E s l o 2i “~ o 1.2515515910110123‘ 123456789101131254 _ uacmuous _ I0. cuuous mm u! ‘room Nahum” N°_ CARIOUS TEETH__ANY TOOTH goigfxsxous ig. 1. Incidence of caries with respect to Fig. 2. Incidence of caries with respect to number of carious teeth per child. (3- number of carious teeth per child. (San county group.) Antonio group.) \ Relation to Age The distribution of the children with carious teeth among year-of-age classes was made for boys and girls together, since, sex difference in occurrence of caries was small and, since this procedure would provide larger numbers in the year-of-age classes, especially for the Mexicans and negroes. Data from the two studies were kept separate and are shown in Table 4. Figures 3, 4, and 5 present graphically the age incidence of carious teeth for the 7-year to 18-year groups inclusive for all groups composed of at least 24 individuals. 12 BULLETIN NO. 491, TEXAS AGRICULTURAL EXPERIMENT >STATION _ N N _YN\-| ._ _N _ _ _ _ _ _ _ _ _|.HNNNH _ NH 111.!_1H|_:\£,_ \w\_l1>:!_!HHl_\/NN|_ _.!lr_|1‘_ knLlk 1.N_N_.HNNNH\_,.|4-NH1II NNN _ NN _ NNN _ NNLINN _ N.NN _!N\_!N.NN!_IN1\_|NN _ _ _ _I4I_|H iL 5cm _ I NH r I NNN _ NN _ Ni _ NN _ NN _ NNN _ HN _ NNN NN _ NN _ _ H _ _ N. _ N _|£wm|_ Hm ‘NNN i _ INH L ANNNL» NN < _ NN \_ Ni _ NH. _ wdm NN _ NN _ NNN _ HH _ Ni NH NN HHNNNH _ NH NNN _ NN _ NNN _ NNLINN _ NHN _|NN _ NHN NN _ NNH _ N3 _ EN _ NNN NN NN Hfiwm~l_ NH - NHN _ HN N _ - NNN _ , HN _ NN _ NNN .,_ NN - _| NNN 4 I3 |_|wm.l|Fl~m~Hw-_|Nm|'_|w..oN|l iNNH|||NNH| |vH$om|_ HH NNN N S _ NNN _ NN _ HN _ NNN _ NN _ N.NN _ NN _ NN _ NNN _ NN _IN.,NNI._$HNH|_IRH.NH \|_l§om|_ NH iNNN _ HH _ NNN _ NN|_INN\|_INN.NH~\ _IHH\_IH.~.NN _lNu|l_lN.ml_¢iH\.ww||lwmu|_lw.w.N|_|wm1|_||wmH|\_IH$QQI_Nm I l N N _ _ NH _ S \ _ ¥| _ N \_ §| _ ‘N\_:N|v _ |N.N\_IN _ NNN _ NN _ INN‘? _H..Nml_i.l.Nill __ _H_N_ __ __ _ *N_ _NH_NN_.H8NH_ N Q5080 023:4 Gum _ _ _ _ NNN _ _ _|| . _ _ NNN _ _ NHNN 5cm HSPH. _ --._il!_l-| 711T,‘ _ l1; _ _ _ _ H HHNNNH HN _ N _ _ H. _ N _ _ H _ H H _ N _ a HH iNHllifiHNNml NNill |ll_|1HNl_1’_lN \_ I N‘_ T1 H _ N _ NH HN 5cm NH N.HN _ NH _ HNAN _ NN _ NN _ _ N N N _ NNN 3N _ N.NN NN NN HHNwm NH 3N _ NmX|_IH.wN|_|IoN1_I$!i_ _|NH| |» \| INHI |S| _ H...NN||NN\_IN.HNI ‘fir! llNNHxv IHHNNNH| ||| NH 1mm _ NN NNN NN _ NN _ NNN NH _ NNN NN NN NNN _ NHH _ NNN NNH SN 52H NH N.NH _ NH NNN NN _ NN _ NNN NH NNN NN NN NNN _ NNH _ NtHN NNN NHN 5cm NH NHN _ NN H.NH. NN _ NHH _ NwNaalwH NNN NN |NN| NNNL» NNN|_:H.NN.. 15ml |HNN|1 lfiNml 11:3 . N.NN _ NN _ H.NN NN _ NNH _ Ni _ NN H? NN _ NN _ NNN _ HNN _N NNN _ NNN _ o3 _ HHNNNH _ NH | NNN .,_ INN- _ - NNN T? _ NNH ._1N.NN.. _!H~.Hl. |N.NN » imu; rNN . , _I¢.wm\_|NHN| _:N.NN \ _|$m\_lli_m|_lspom, _z| NH xii NNN _ HN _ N.HN _ NN _ NN _ NNN N NNN _ NH _'§\_Iw.lmm\1_|rHoN|_¢ NNN!_INNNi_INNN\1_lHHNNm-_|l HHI NNN _ NH _ NNN _ NN _|NN _ N _ HA _ NH. _ Hi _ NNH _ NNN _ NNN _ N3 _ 48m _ NH NS _ N _ HiHm _ NH _ HN _ N _ N. _ S _ NNN _ 3% _ NNN _ HNN\|_'NNW|_|.H$NH _ Nl||l 1w.w|_-m \_»N.NN»_1NH|_|NN%_\ Ill _I,H\_IN _ NNN _ NN _ méw _ NNN _ NNN _ 5 NH _ N l||i_.!w | _1|[-._!NH|_ iNH _ _ H _ _ N. _ N|_ NN _ NH _ NNN NHH _ NNH _ HHNNNHL N _ _ _ N _ N N w _ _ H H _ _ N _ NH _ NN _ HHNNNH _ N NN _ az _ Q. _ azi ON. _ dz _ NN. _ dz NN. _ dz Q. dz H.208 ndné _ H500» hi4 .02 H308 nFTw _ H303 5H4 dz H305 urn-m £30» 5N4 .02 £0000 QQONHNO flwuONH. 3&8» mzoiso ~duOvfi Saga. mn-NOFHNO ~da0hw XUW mudwh 0.55 no N r33 QHOE .5 H 5T5 0.33 no H r33 0M4 QZNHHNN .582 HHNNNHHHHN HHSNNNS 5.2a? 3E3 55.5 nuance-m 0M6 6H OUQOHOMOM Jami nomad“- HQ oofiowmofim u‘ 05am. DENTAL DECAY AMONG TEXAS SCHOOL CHILDREN 13 For the 3-county group, the graphs for “any tooth” trend upward with age, the rise in percentage being much sharper for Mexican and negro than for white children, especially from age 13 years and over. At 16 years of age and above, the percentage of Mexican and negro children in this group having carious‘ teeth was found to be as high as among white children. This evidence is contradictory to the usually unqualified superiority of tooth condition credited to the Mexican and negro children compared with white children. The percentage of children with carious 6-year molars increased rapidly up to 12, 13, or 14 years in each race; fol- lowing this peak there was a fall in the percentage of white children having carious 6-year molars, but a further increase among later age groups of both the Mexican and negro children. With reference to the occurrence of decay in “any tooth” in the San Antonio group the graphs for all three races have a downward trend, the percentage of children with one or more carious teeth decreasing with age. This relationship between age and caries in “any tooth” is opposite to that found in the 3-county group. The graphs for carious 6-year molar teeth found in the San Antonio group have the same general trend for all three races up to the age of peak incidence, as in the group from the three counties. After the peak of incidence, the graph for white children is similar in the two studies, downward with age, but for the Mexicans and negroes in the San Antonio group there is a consistent decline as contrasted with the later rise in the 3-county group. These differences in downward trend of any one graph for 6-year molars have been found to be statistically significant, the probable error of the frequency distribution being more than four times the difference in the neighboring frequencies. From the graphs derived from the data of the one study it would seem that age of the child, or the length of time which the agents of decay have to act upon the teeth, may be one factor in determining the occur- rence of caries; but the opposite trend of the age-caries graphs from the other study indicates that age cannot be the only factor. Since all three races in the San Antonio group show_a decline with the age in the per- centage of children with one or more decayed teeth, and in this respect are consistently in contrast with the corresponding races in the 3-county group, some common predisposing factor (or factors) among younger children and protective factor (or factors) among older children must have been operating in the San Antonio locality, that differed from those operat- ing among the children in Brazos, Hidalgo, and Jefferson counties. The data of these two studies afford no clew to account for the differences found between the two groups of children. The three-day diet records kept by the children in San Antonio indicate that the average diet of this group is essentially like that of the children in the Brazos, Hidalgo, and Jeffer- son county group. San Antonio school physicians and elementary super- visors knew of no hygenic program in the school at or prior to the time of this study there that might have had an influence on the dental conditions found. The marked susceptibility of the 6-year molar to decay in comparison Fig. 14 BULLETIN N0. 491, TEXAS AGRICULTURAL EXPERIMENT STATION 8Q __ I léi/s-cowr! 7o b__ /"e i! iix-n-jl/x . “ sm urouzo 26o _./ _ D § , d n”, “x” “\\ ¢X~ 5 so _ / ‘w’ ‘w u. / \ o / \\ “‘ 4o x’ /’“~ x o 3 — ,’ ‘°~~~¢ sm mronxo 3'“ W" F‘ y I E x" l/ :1: 3° — z’ n. x/ °"_-° 20 / / "my room" (muons "-' l! I/ G-YRJIOLARS cuuous -- - / / 1o __x/ 0/ Q I I I I I I I I I I I I _ 1 a 9 1o 11 12 1s 14 1s 1e 11 1s m: EFSSFW 1as s25 see 44a 31s s14 40o 401 51s 211 16o 19 g3} @1410‘ W“ as 12s 164 192 s4 2a Fig. 3. Incidence of caries with reference to age—white children. 90 ._ 8'0 I S-CQUFTY 1o __ E so _ ‘3 E o 5° -- ---» s-comm ,,_ l‘ O E 4o __. 4 E sw Anrouxo v so g Ii D- 20 ... . sAn urono "u! 10m" cmxoms m _ e-mmonms cnuo - -- 0 I I I I I I I I I I I I 1 a 9 1o 11 12 1s 14 1s 1s 11 1e AGE 3.. g p-Silpmt" 24 so as as s4 24 °" “mwm” s2 s: 9a 12s 9e s1 2s 4. Incidence of caries with reference to age-Mexican children. DENTAL DECAY AMONG TEXAS SCHOOL CHILDREN 15 with any tooth is emphasized by the more rapid increase with age in decay of the 6-year molars in the age groups ranging from 8 to 12 or 14 years. so _ 7° — lcouurr g so _ E u-‘l F1 5 so .__ ‘é Q40 _ < i sm nmouxo E y l \ I‘_“*I\ 3o i. __°‘ / /I\ \\ I \_x E / /._:\,/// \ \ / s-counr! n‘ ’ ’ ' \ °‘/‘~ sm umzo ga’j-——x’ \ I a 2O ____ [I K \./ I If‘ "m! room" cmuous 1o .__ x,’ s-mmomns cuuous ——— o I I I I I I I I I I I I 1 a e 1o 11 12 1a 14 1s 1s 11 1a ma - 333ml‘? s4 s1 1o as 12o 10s 114 as 7s s4 42 um S P °' ii-‘tiffPm so 11 es as s1 es '1': 4s RELATION OF DIET TO CARIES The data analyzed to determine What relationship appeared between diet and condition of teeth were secured in the dietary study made in Brazos, Hidalgo, and Jefferson counties. As previously mentioned, the Fig. 5. Incidence of caries with reference to age—negro children. dental data are the findings of cooperating local dentists who used a mirror and explorer for the examinations. The children with one or more carious 6-year molars made up the group with carious teeth. This seemed the most desirable procedure, first, because the structural resemblance of the four 6-year molars among themselves is closer than to other teeth; second, because they are open to attack of the agents of decay for a longer period of time than any other teeth; and third, because of their higher susceptibility to decay (4, 39) compared to other teeth. The 6-year molar has been used by other workers also (10, 15, 16) as an index of decay. The information regarding diet was provided by Written records of all food eaten by the individual children for a week (58). The children of the three counties who kept diet records two seasons constituted the largest group used for this analysis. Because no significant seasonal differences in diet were found, an arbitary choice was ~made of diet records of that season in which the child’s teeth were examined. For the most part these diet records Were secured in fall and winter for the 765 White children and the 119 Mexican children, and they were about equally divided between spring and winter for the 428 negro children. 16 BULLETIN NO. 491, TEXAS AGRICULTURAL EXPERIMENT STATION In addition to the large group of all children in the three counties who kept diet records for two seasons, five smaller groups were also studied for relationship of diet to dental caries. These smaller groups were, first, the 399 white children of Brazos county, who were a part of the 3-county group; second, 312 negroes of Brazos county, this group, in order to have a larger number, being made to include children who kept diet records only one season as well as those who had records for two seasons; and the third, fourth, and fifth groups were white children from the 3-county group, 120 of 12 years of age, 106 of 13 years, and 108 of 14 years. These age groups are found at the,peak of the graph for the decayed 6-year molars. Since in the diet records the child reported what foods he ate, and only approximated the amounts in terms of “servings”, it was not possible to make any quantitative calculation for the nutritive value of the diets. The assumption was made, however, that “servings” were of average "size and that with more frequent servings greater amounts of the foods were eaten. Table 5. Caries in 6-year molars in relation to milk in the diet of white children Milk-average number cups daily 0 I 0.1-1.0 I 1.1-2.0 I 2.1-3.0 I 3.1-4.0 I 4.1-5.0 Group Teeth Boys Noj % No.I % No. % N0. % No. % |No.| % Sound 2 24 46 34 22 12 Carious 6-yr. molars 3 I 40 I 62.5 65 58.6 46 57.5 27 55.1 16 57.1 3-county Girls Sound 32 40 36 26 17 Carious 6-yr. molars I 51 I 61.4 I 81 66.9 76 67.9 45 63.4 24 58.5 Boys Sound 1 8 I 25 17 15 11 Carious I 6-yr. molars 3 17 68.0 28 52.8 22 56.4 10 I 40.0 13 | 54.2 Brazos county Girls I Sound 1'2 I 29 18 I 15 10 Carious I I I 6-yr. molars 30 I 71.4 46 61.3 41 69.5 18 54.5 10 I 5L Boys and Girls 12-year I Sound 8 12 9 10 1 in Carious 3-county 6-yr. molars I 12 60 0 22 64 7 21 70 0 17 63 0 8 13-year Sound I 7 13 12 5 5 in Carious 3-county 6-yr. molars 12 63.2 22 62.9 18 60.0 9 64.3 3 I I I 14-year Sound I I 11 I I 12 5 6 1 g in Carious I I I 3-county 6-yr. molars I I 24 68.6 I 24 67.0 17 77.3 11 64.7 7 DENTAL DECAY AMONG TEXAS SCHOOL CHILDREN - 17 One cup or one glass of milk (1/2 pint) was called one serving and estima- tions of amounts in milk-containing foods as custard, cream soups, ice cream, and cocoa were consistently applied to all records. Distributions of the children in each race having sound teeth and those having carious 6-year molars were made according to the number of servings eaten per day of milk, cereals, fruits, vegetables, and sweet foods. Sweet foods included candy, molasses, syrup, sugar, and all sweetened foods as pie, cake, cookies, ice cream, cocoa, etc. Cereals included all foods in which the only or chief constituent was a grain product as all kinds of bread, breakfastfoods, pie, cake, cookies, rice, and grits. Each class interval in each distribution was regarded as a unit and the number of children having sound and of those having carious 6-year molar teeth expressed as a percentage of the group. Percentages were not calculated for fewer than 10 children. Table 6. Caries in 6-year molars in relation to cereals in the diet of white children Cereals—average number servings daily 1.1-2.0 I 2.1-3.0 I 3.1-4.0 I 4.1-5.0 I 5.1-6.0 I 6.1&+ Group Teeth “" —‘ '— '””‘ “_~ m“ ’ _' Boys No.| % [No.| % {No.| % |No.| % iNo. % No. % I Sound 6 18 I 52 50 9 5 Carious I 6-yr. molars 12 67.0 34 | 65.4 83 61.5 48 49.0 16 64.0 4 3-county Girls I Sound 4 21 49 53 21 3 Carious I 6-yr. molars ] 4 I I 34 | 61.8 |100 | 67.1 87 62.1 43 67.2 9 75.0 I Boys I I Sound 4 9 32 26 4 2 Carious 6-yr. molars 4 12 57.1 39 54.9 27 50.9 7 63.6 4 Brazos county Girls Sound 1 9 I 32 30 10 2 Carious 6-yr. molars 2 13 59.1 52 61.9 5O 62.5 22 68.8 6 Boys and Girls I I I I I I I I I I 12-year Sound 1 2 21 12 | 4 in - Carious 3-county 6-yr. molars 2- 6 28 57.1 30 71.4 12 75.0 2 I 13-year Sound 2 6 I 9 19 4 2 in Carious I 3-county 6-yr. molars 5 12 67.0 21 70.0 10 34.5 12 75.0 4 14-year Sound 1 8 13 8 5 in Carious 3-county 6-yr. molars 3 13 61.9 32 71.1 23 74.2 10 67.0 2 18 BULLETIN NO. 491, TEXAS AGRICULTURAL EXPERIMENT STATION Suggestive evidence of relationship between caries and the several foor classes tried were found only for milk, cereals, and sweet foods. These data are given in Tables 5, 6, 7, 8, and 9, and a graphic presentatior of them in Figures 6, 7, and 8. Table 7. Caries in 6-year molars in relation to sweet foods in the dietof white children Sweet foods—average number servings daily 0-1.0 I 1.1-2.0 I 2.1-3.0 3.1-4.0 I 4.1-5.0 I \5.1-6.0 Group Teeth Boys N0.I % |No.| % |No.| % I No.I % INo.I % INO.I % I I I I Sound 20 53 I 47 16 3 1 Carious I I I 6-yr. molars I 37 64.9 I 83 I 51.0 47 50.0 23 59.0 6 1 3-county Girls ' I I I I I I I I I I I I Sound I14I I66I I45| I19I I6I 1I Carious I I I I I I I I . I 6-yr. molars 24 63.2 I 9s , 58.5 | ss | 66.2 | 55 74.3 12 67.0 5 | Boys ' I I Sound I 11 I 27 I 29 7 3 Carious I I I 6-yr. molars 19 63.3 I 34 I 55.7 22 I 43.1 13 65.0 5 Brazos county Girls I I I I I I I I I I I I Sound I 6I I38 I24| I11| I 5| I I Carious I I I I I I I I I I I I 6-yr. molars I 12 I 66.7 I 50 56.8 I 47 I 66.2 I 28 I 71.8 I 8 I 61.5 I I Boys and Girls I I I I 12-year I Sound I 3 I I 17 I I 16 4 I in I Carious I I I I I I I 3-county 6-yr. molars I 8 I 727 I 29 I 630 I 27 I 62.8 I 16 80.0 I I I I I I I I I 13-year Sound I 4 I I 19 I I 7 I I 12 I I I I I in Carious I I I I I 3-county 6-yr. molars I 6 60.0 22 I 53.7 15 I 68.2 21 I 63.6 I I I I I I i 14-year I Sound I 6 I I 11 I 9 I I 9 I I I I I in I Carious I I 3-county I 6-yr. molars 10 62.5 29 I 72.5 25 73.5 19 67.9 A beneficial effect of milk in the diet is suggested by the graphs. For both the 3-county and the Brazos county groups, the graphs trend down- ward, the percentage of children having carious 6-year molars declining as the amount of milk in the diet was greater. But in the age groups, only the graph for the 14-year group trends downward. Apparently some other factor had a greater influence than milk upon the condition of teeth among the 12-, 13-, and 14-year groups. The possibility that this factor might have been either cereals or sweets (or both) is suggested by the upward trend of the graphs for sweets and for cereals for these age groups. I DENTAL DECAY AMONG TEXAS SCHOOL CHILDREN 19 Table 8. Caries in 6-year molars in relation. to cereals in the diet of negro children Cerea1s—average number servings daily 1.1-2.0 I 2.1-3.0 I 3.1-4.0 I 4.1-5.0 I 5.1-6.0 I 6.1&+ Group Teeth Boys No.| % No. % INo.I % |No.| % |No.| % No. % I ~. Sound 3 24 I 46 38 11 2 Carious I I 6-yr. molars I 8 25.0 I 26 36.1 9 19.1 9 45.0 1 3-county I Girls Sound I I Is I4eI 'I5sI I21I Is Carious I I I I I I 6-yr. molars 3 I I 13 61.9 30 39.5 39 40.5 26 55.3 3 Boys Sound 1 I 20 36 9 2 Carious 6-yr. molars I 2 I I 12 I 37.5 I 28 I 43.8 I 10 I 52.6 2 I I Brazos county Girls Sound 11 38 26 6 I Carious I 6-yr. molars I 3 I I 14 I 56.0 I 42 52.5 I 32 55.2 I 18 I 75.0 I I A detrimental influence of cereals and ofsweets in excess as compared with other foods, is suggested by the upward trend of a preponderance of the graphs for cereals and sweets. As cereal foods were more abundant Table 9. Caries in 6-year molars in relation to sweet foods in the diet of negro children Sweet foods—average number servings daily 0-1.0 I 1.1-2.0 I 2.1-3.0 I 3.1-4.0 I 4.1-5.0 I 5.1-6.0 Group Teeth Boys No. % No. % |No.| % INo. % No. % No. % Sound I 37 51 I 26 I I 9 1 Carious I I I I I I I I I 6-yr. molars 15 I 28.8 I 17 25.0 18 40.9 I 3 25.0 3-county Girls I Sound 24 57 45 11 Carious 6-yr. molars 17 41.5 41 41.8 37 45.1 15 57.7 4 I Boys Sound 18 29 15 3 8 I I Carious I 6-yr. molars I 10 35.7 24 45.3 15 50.0 5 Brazos county Girls I I Sound I 18 35 23 5 Carious I 6-yr. molars I 20 I 52.6 48 57.8 28 54.9 10 67.0 3 20 BULLETIN NO. 491, TEXAS AGRICULTURAL EXPERIMENT STATION u mu an mm H1 a >4 on 2. Hm n 350+. ~ 2 .3 3 fi n 8 S 8 S n as» Hi H4O ma» wunfimuulfiuunm v3 HUM woflzflwlfiifiu T¢A.»_o.w.$_q1H.»_q»-H.~_ 3.3 36 7 a0 a 0N 3 m2 w» 3 ON 3 8 HZ" $ n 23v m: Ma mum mufiamlwamnrw 53 mum 355ml?» H4O ma» QSIEH: F.Q.H.%.@A¢_OQ.H.»_Q»-S_QWE S- o T a8-¢@én_.E-Q_QTH.»_Q.?S_3-3-36 _A.#%_n_3-§_o.~.3_SA¢_ o o o c \x \ p“ kw“: Mr? n oh... mm m Hm 3 Wm l 8mm l on 09 09 $0: $3 MR8 $3 8 w» l 89m “Win/l l 9w. U0 . O EMT/o s Ow . O n33. m n :1 \\ us l, \ l . m . m ill-la . m x1 \\ 2. mm l afiwm l 2. l 8 L 8 l 8 55:5 In“: DENTAL DECAY AMONG TEXAS SCHOOL CHILDREN 21 '57 '87 g‘ y Q2 a J! F. I)” i- a a -3- a 1: Egg K m I, 5K9. U) \ 0 a § '9‘ 8 a Es: , i Es; fi- w ’ m’ I l’ vi n A E33 °\ r4 W3 _-'_ x n} E ~' i? 581°- 5’: 5:: I I I I I\\ ° I I I I I I\\ ° 8 2 8 8 3 ‘V ° 8 2 8 S 3 8 W‘ sznnou ‘ax-o monrvo nun E szmou wu-s snomvo nun ' manna so aovznoaaa g manna ao-sovmnaoaaa 1r 5 1r ‘f no g ‘i: m '1 '1 3 s a .. é 3 a ~ O N - U - o‘ “f 3 7-193 e. ‘i’ a wr \ a fi ‘~\~ g a a a \\ "6." p, ~,‘\ m ‘z 2 g3?" ‘w 2 g2: , . I i- ‘ "' g I 1" s“; '\ ‘$5 g \ v-g “i!” ‘a. g | Y) a \\ T f3 I’ 3- 3 ‘o "“" I "5 an E ,1 gnu gm“ %' u g“ F’ N OI: I W” I I I I Li‘ 73' I I I I I - Ln‘ "' 8 SEIYI§I $9 mo?“ 3 ° 3 3 8 8 3 3 ‘ ° - ' - : m SHVIOR ‘ax-s snomvo mm 2 manna a0 aovarmaaa mqqmq 4o ggnflgggga 5° T . g “F as ‘s ,3 .2 g g “i “' % » a "é za ’ ‘ 1' a a: a5 g2 %-E ° ‘° a a B a mo» .5 b” E 3 o 3 "‘ .0 I? m8 ‘an q o s 0 _3_ “' g3 g g .2 *5; i as H ° "' g5 g g g “U é I I I I l» gs =8 2 g = ,5 0 o o o g \‘ o a w ,,_, f5 :3 g Q z~ o in g mid O Q c: u, g SHYIOK ‘ax-s snomva um Q, . o 35801150 J0 EOVIJISOKSJ e3 P" g g T; "a .25 H e 5 I Ln "‘ there was an increased percentage of children with carious 6-year molars among the white girls and the negro boys in the three counties, among both white and negro boys and girls in Brazos county, and in two of three age groups of white children. Similarly, as sweet foods were more fre- quently eaten by both the white and the negro girls of the three counties, 22 BULLETIN NO. 491, TEXAS AGRICULTURAL EXPERIMENT STATION by white girls and negroes of both sexes in Brazos county, and by the 12-, 13-, and 14-year old white children, the percentage of these groups having carious 6-year molars increased. The distribution of the Mexican children in all of the food classes was too narrow to permit test for relationship to caries, only 12 to 20 per cent of the group having more than two servings per day. Similarly there was too narrow a distribution of fruits and vegetables for negro, and of fruits for_ white children. No relationship was found between vegetable consumption by white children and the occurrence of caries. That more definite and more consistent relationships between diet and caries were not found in this study may be accounted for in part by the following suggestions. The diet records were qualitative; there is the possibility that different classes of food in the diet actually do have op- so so so ‘a u‘ 1° g 1o ‘gm i: E3 E0 a a ' e 5:60 . 0 H _ 3E‘ 6O 8° g“ 3° so so _ 356$ 2% 3E % *2 gs i! 4o Eu 4o E040 _. S E; “'9 5° 3Q $0 ._ 1: o 0 .1 [ o |o.n.o|1.1-z.o|z.1-s.o]§.1-4.o|4.1-s.o] |1.1-z.o12.1-so|s.1-4.o|4.1-s.o|s.1-s.ole.i-v.g _o-1o [Ill-CUPS rm m: csnms-sanvnlos ran on SIEBTS-SBRVIIOS PER on 12 n. 2o s4 so 21 9 s a 49 42 16 z 11 4s as 2o lol- 1s m. 19 ss so 14 a 1 1a so as 16 s 1o 41 22 as 14 m. as as z: 11 a 4 21 4s s1 1s z 1s 4o s4 za Fig. 8. Relation between certain classes of food and caries among 12-, 13-, and 14- year old white children in Brazos, Hidalgo, and Jefferson counties. lThe numbers include the children who had sound teeth and those who had carious 6-year molars. posite effects in influencing the soundness of the teeth; interrelations between various foods as well as the direct effect of individual foods or classes of foods may be conducive to caries; the condition of the teeth at the time of examination may be reflecting the effect not of the current diet but that of some earlier time; and probably food is only one of the determining factors in the process of decay. Nevertheless, such evidences as appear point to the desirability of continued emphasis upon the liberal use of milk, and caution against excessive amounts of cereals and sweet foods as compared with other classes of food in the diet of growing children. COMPARISON WITH OTHER STUDIES The findings in the dietary study which included the careful dental examinations have been compared with those of several other surveys made since 1925: for white children, these were made by Reynolds (49) in Virginia, by Davies (10) in Massachusetts, by Ahmann, Abbot, and Westover 23 DENTAL DECAY AMONG TEXAS SCHOOL CHILDREN £636 3252569. sumo» 5.6222596 N36 :62 “$5 .62 E8 .5 $.56 =3 éflflswhpmmw .3685 962m“ uoaowmmcou 56mm» ufiwcwfinom hmflon _ 6N 6N 66 6N6 666 .............................. .- 2.5m 3 HN 3 6N6 66m ............................. .- 6E5 Amhufimtfiv NH 6 6H 3 66 HN 66 66 6N6 2:6 33 .8666. 3 N. 6H .3 S. 6H w... >6 6N6 663. ............................ -. Q86 2% 53 Z86 _ 36 _ N656 .......................... MEN 3S 33 1:8 _ 36 1.666 ............................... .. $86 ANSGQE 3N =66 _ =2. _ 36 “$.66. ..... ..................... 1 2.2a 6E» cflzswflzzmv =3 =66 _ .56 _ 36 N566 .............................. .. when S3 :30 635mm 666 EN _ .66 _ 36 NN66 ............................. .. mEw 6616mm 23am .6 5 KN ~66 i 666 A 36 6N5. ............................. .. 986 6 6 NN 6N 66 66 36 NNm .............. ..2bw 65.. ESQ 298E 6.5 ~wm>wrmv _ £2 .366 ..o .m 66 66 66 $6 $66 ............. ..mimw 6.8 6.86 Aufiimzmv 6N3 .600 56:23» S 36 6E. ............................ .. 2:6 Ahyzzmw? 6.5 N6 6T6 5w ........................ .. Enos £254 écaqzil 663 dash $2M 6N 3 m: 6H S. 6H 66 $4. 5-6 6S. ............. ,.mw$:w...2 ion $61356 3 S 3 5 66 3 66 H66 E6 N6N .......... ..3:8o_ 65.61% 6N3 SSE .632 3 5 6H 3 6w Nu N6 H66 6T6 66H ...$:6uo_ wcrrzwwéo: 66 36 6N6 ............ ..2.zw E8 m>56 Gfioiwmv . J 5. Nv 66 .36 N66 ............ 12b» 6E6 986 6N3 :63». 36> w _ m _ N _ H v.35 7.6.55 k NJ _w.~oE 93E _ TH _0.~OE _ _ _ _.~ofi_.~om _.~oH_.~o6_ _.~oH wufioi .3966 cwuwmflo onmwz c3330 635$ monwwowz momwo .02 huwfiw mnomnmu 6.85 .5 H ma?» £60m» 6528.3 nonwmsu 3E? mo owwpcwunwm v.35 no H sflB Wmmvcmonom dot-mam mnooflaueaioeiou ma flcmisaionu ivico w: ouiowmucm A: 05am. 24 BULLETIN NO. 491, TEXAS AGRICULTURAL EXPERIMENT STATION (2) in Florida, by Frayser and Moser (16) in South Carolina, by Stoughton and Meaker under auspices of the United States Public Health Service (53, 54) in Illinois, Missouri, Georgia, and Maryland; for negroes, the survey was made by Sterling under auspices of the United States Public Health Service (51) in Atlanta, Georgia. The percentage of the children found to have defective teeth as reported in these contemporaneous studies is summarized in Table 10. In all these studies the carious teeth were identified by a dentist’s examination except in the case of Virginia, where the records of teachers’ inspection as well as those from the dental clinics were used for white children, while for negro children inspections were made byicollege-trained negro teachers or by public health nurses. In the Texas study, and in the Public Health Service surveys (studies by Stoughton and Meaker, and by Sterling) the carious class included all teeth decayed, abscessed, or filled, and the perm- anent teeth extracted; such teeth were referred to by Stoughton and Meaker as “total past decay”. The Massachusetts study considered only permanent teeth, whereas in the others both temporary and permanent teeth were included. The Florida workers included as carious both filled and unfilled teeth but not extracted ones. The South Carolina study did not include filled teeth but regarded stains and calculus as well as caries, abscesses, and extracted teeth as defects, since it was said that all these conditions indicate either present or past need of dental care. Confirmation is given by these seven contemporaneous studies to the common observation that dental defects exist in an appallingly large per- centage of all school children, but that fewer negroes are affected than whites. With respect to number of carious teeth per child, in the studies of white children of three states—-Virginia, Massachusetts, and Texas-a decidedly larger percentage of children was found with 1 to 4 decayed teeth than with 5 or more, whereas the reverse is reported in the Public Health Service survey of white children in Georgia, Illinois, Missouri, and Maryland. The study of negro children in Atlanta by Sterling (51) shows half again as many children to, be affected with caries as were found among the Texas negro children; in each study approximately equal percentages had caries in 1 or 2 teeth as in 3 or more. Since nearly half of Stoughton and Meaker’s group of white children lived in Georgia, it appears that there really was a higher incidence of caries among the Georgia children than among the Texas children with respect to the number of white and negro children affected, and also with respect to the number of teeth involved in the white children. Since no data are given by Stoughton and Meaker or by Sterling concerning factors such as dietary or hygenic habits which may have a bearing upon the soundness of the teeth, no attempt is made to suggest the reason for the greater prevalence of caries reported in these Public Health Service studies than was found in the Texas survey. The highest incidence of carious 6-year molars was found in the Mass- achusetts study, 74 per cent having one or more of these teeth decayed DENTAL DECAY AMONG TEXAS SCHOOL CHILDREN 25 as compared with 45 and 56 per cent respectively in Texas and South Carolina. Also a higher percentage of the Massachusetts children had three or four carious 6-year molars than did Texas or South Carolina children. As between the sexes, caries was found in this study to be slightly more prevalent among girls than boys, as was true in the case of the permanent teeth in Stoughton and Meaker’s survey of white children, but the reverse relationship was reported by Stoughton and Meaker for temporary teeth alone, and by the Florida workers for temporary and permanent teeth together. Stoughton and Meaker suggest that boys may be slower than girls in losing their temporary teeth, and thus had a larger number of such teeth to be counted than had girls at the time of examination. The positive relationship between larger amounts of milk and good teeth in the white children as found in this study agreeawith that found in the contemporaneous studies in Virginia (49), Florida (2), and Massachusetts (10). Reynolds reports for Virginia that “high positive correlations are found between the percentage that use the larger amounts of milk in each year of age and the percentage of perfect teeth in‘ both negro and white school groups.” Ahmann, Abbott, and Westover found that 54 per cent of the Florida children who used milk had sound teeth, but only 10 per cent of those not using milk. Also caries was twice as common among the non-users of milk as among the‘ users, the percentage of children affected being respectively 66 and 33. In the Massachusetts study, Davies found 35 per cent of the children in the dairying community had sound permanent teeth while there were but 17 per cent in the non-dairying community. A like difference appeared in the condition of 6-year molars. In the dairy- ing community, one-third of the group had sound 6-year molars in contrast to only one-eighth of the group in the non-dairying community. The negative relationship found in this study for both White and negro children between frequency of eating cereal and sound teeth harmonizes with the studies of Mellanby (45), Mellanby and Pattison (46), Hawkins (22, 24), and Sampson (50) The indication that sweet foods are harmful to teeth lends weight to the long-held distrust of sugar, which Hawkins in- cludes with the bread and pastries, against which he warns and which Eddy (12) recently observed could not be dismissed as a possibility in cause of tooth decay. It accords also with Reynolds’ (49) finding of the candy- eating habit common in 61 per cent of the pre-school children in her study associated with a high percentage of carious and stained teeth. ACKNOWLEDGMENTS Grateful acknowledgment is made to the staff members and to the many other persons who have had a share in this study. To Mr. T. R. Hamilton, Associate Professor of Accounting and Statistics for advice regarding statistical treatment of the data. To the personnel of the cooperating schools: the superintendent of each system—the late Mr. H. L. Durham of Bryan, Mr. Ernest W. Chaney and Mr. Edwin D. Martin of A. & M. Consolidated, the late Mr. D. J. MacDonald of Brazos county rural schools, Mr. J. D. Bramlette of Mc- 26 BULLETIN NO. 491, TEXAS AGRICULTURAL EXPERIMENT STATION Allen, Mr. H. C. Baker of Edinburg, Mr. M. E. Moore of Beaumont Mrs. Leroy McCall of Jefferson county rural schools, Mr. Roy Guess o Voth and Rosedale independent districts, Mr. Marshall Johnston, an< Mr. E. H. Hartley of San Antonio public school system; the supervisor. of elementary schools of San Antonio—~Misses Elma Neal and Alic~ Breeding; and to the principals, teachers, and pupils in each of thes~ school systems. To the dentists and pediatricians who examined the teeth of the pupils in Brazos county—Drs. W. H. Lawrence, A. Benbow, M. Lamar Jone: for white children, and Dr. A. Carter for the negroes; in Hidalg< county—Drs. F. G. Sigrist, Alan A. Kearby, and M. P. Wilson at Mc Allen, and Drs. J. C. Bibbs, J. C. Bullard, A. L. Litton, and H. W. Grif fith at Edinburg; in Jefferson county—Dr. Gerson Scheps for all o the white children and the negroes of Beaumont only, and Dr. S. M Pernetter for rural negroes; in San Antonio—Drs. Mary Harper, Editl Bonnet, and M. A. Ramsdell. To the school nurses who assisted in collecting the dental data: Miss Ell: Bandelin formerly of Brazos county, Miss Sonora Ponder of Edinburg and Mrs. Irma Frenzel of Beaumont. SUMMARY The condition of the teeth has been determined for 6701 school children including 4453 white, 807 Mexican, and 1441 negro. The decayed teetl of 4926 children were identified by dentist’s examinations with mirro and explorer; of the remaining 1775 children, by a pediatrician using : tongue depressor but no mirror or explorer. Decay was found to be wide spread among all three races. By bot] methods of examination the races ranked in the same order according t< the percentage of children having one or more decayed teeth, white poorest Mexican next, and negro best. White children had the poorest recor< also in average number of decayed teeth per child. The highest number o decayed teeth in any one negro child’s mouth was 10, in a Mexican’s 12 and in a white child’s 21. One or more of the 6-year molars were decayed in approximately one third of each race group but in the two studies the races were not ranke< in any consistent order. The decayed 6-year molars constituted a smalle percentage of all decayed teeth among white children than among eithe Mexican or negro. Apparently the 6-year molar was relatively a some what more vulnerable tooth among the Mexican and negro than among thi White children in this study. While inherent racial characteristics probabl; have some influence in determining susceptibility to decay, they ma; not be as great a factor as is commonly supposed. As to decay in any tooth in relation to age, the two groups of children one in San Antonio, the other in Brazos, Hidalgo, and Jefferson countie; show contrasting results. In all three races of the latter group the per centage of children having one or more decayed teeth increased with age while in the corresponding race groups in San Antonio the percentage o. children having caries decreased with age. Among all children the per centage with decayed 6-year molars increased rapidly up to 12 or 14 year of age, after which there was a decline in 4 of 6 age groups. Apparentl] DENTAL DECAY AMONG TEXAS SCHOOL CHILDREN 27 some factor (or factors) predisposing to decay in the younger children and protective in the older ones was operating in the San Antonio groups that was not operating among the children from Brazos, Hidalgo, and Jefferson counties. Age appears to be one factor, but not the only one, in determining the number of children in whom decay occurs. The girls for the most part had slightly higher percentages of their numbers with decayed teeth than did the boys of the same race and in this difference the 6-year molars predominated. The data of this study afford no suggestion to explain this small difference. An analysis of the data for relationship between diet and occurrence of caries was made. Among the classes of foods examined in this respect, only milk, cereals, and sweet foods were found to show suggestive relation- ship to caries. As the consumption of milk increased, the percentage hav- ing carious 6-year molars decreased in 5 out of 7 groups of white children. On the contrary, as the consumption of cereals increased, there was an increase in the percentage having decayed 6-year molars among 6 out of 7 groups of white children and 2 out of 4 groups of negroes; also as the consumption of sweets increased,. 5 out of 7 groups of white children and 3 out of 4 negro groups showed an increased percentage with decayed 6-year molars. This suggests that milk in the diet is conducive to soundness of teeth and that excessive amounts of cereals and sweet foods in comparison with other foods are detrimental. No difference was found in the diets of the three races to account for the lower prevalence of decayed teeth among the, Mexican and negro as compared with that among the white children, nor for the fact that 6-year molars constituted a larger proportion of all decayed teeth among Mexican and negro than among white children. _ The findings of this study, in general agree with those of contempo- raneous studies of similar nature in eastern and southern sections of the ‘United States, both with respect to the high incidence of caries, and to the relationship existing between certain classes of food and the occurrence of caries. LITERATURE CITED 1. Agnew, Mary C., Agnew, R. Gordon, and Tisdall, Fred F. 1933. The production and prevention of caries. J. Am. Dent. Assn., 20:193. i 2. Ahmann, Chester F., Abbott, Ouida Davis, and Westover, Georgia. 1930. a A nutritional study of the white school children in five representative counties of Florida. Fla. Agr. Exp. Sta., Bul. 216. Applebaum, Edmund. 1931. Concerning the permeability of human enamel. J. Dent. Res., 11:611. Bennett, Norman G. 1925. The incidence of dental disease in children. Med. Res. Council, Spec. Rpt. Ser. No. 97. Beust, Theodore B. 1930. Micro-organisms and caries. J. Am. Dent. Assn., 17:1536. Bodecker, Chas. F. 1929. A new theory of the cause of dental caries. Dent. Cosmos, 71:586. Boyd, J. D. and Drain, C. L. 1928. Arrest of dental caries in childhood. J. A. M. A., 90:1867. Boyd, J. D., Drain, C. L., and Nelson, M. V. 1929. Dietary control of dental caries. Am. J. Dis. Child., 38:721. 9°.*"9‘$“P9° 28 9. 10. 11. 12. 13. 14. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. 29. 30. 31. 32. 33. BULLETIN NO. 491, TEXAS AGRICULTURAL EXPERIMENT STATION Bunting, R. W., Hadley, Faith F., Jay, Phillip, and Hard, Dorothy G 1930. The problem of dental caries. Am. J. Dis. Child., 40:536. Davies, Esther S. 1928. The foo dconsumption of rural school childre: in relation to their health. Mass. Agr. Exp. Sta., Bul. 241. Denny, R. E. 1930. Heredity and its influence on the teeth. Den1 Cosmos, 72:596. Eddy, Walter H. 1931. Diet and dentition. Dent. Cosmos, 73:346. Eddy, Walter H. 1931. Dietary factors concerned in the building an~ maintenance of teeth. J. Dent. Res., 11:349. Enright, J. J., Friesell, H. E., and Trescher, M. S. 1932. Studies of th cause and nature of dental caries. J. Dent. Res., 12:759. Franzen, Raymond. 1930. Public health aspects of dental decay i: children. School Health Research Monograph III, Am. Child Healtl Assn. Frayser, Mary E and Moser, Ada M. 1930. The diet of school childre: in relation to their health. S. Car. Agr. Exp. Sta., Bul. 268. Grieves, Clarence J. 1922. The effect of defective diets on teeth. J A. M. A., 79:1567. Hadley, Faith P., Bunting, R. W., and Delves, Edna A. 1930. Recog nition of Bacillus Acidolphilus associated with dental caries: a pre liminary report. J. Am. Dent. Assn., 17:2041. Hanke, Milton T. 1929. 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The effect of a deficienc; of the antiscorbutic factor in guinea pigs and of fat-soluble A in rats J. Am. Dent. Assn., 131592.