158 INANITION AND MALNUTRITION 



rachitic children has frequently been observed (Seibold '27; Woronichin '76; 

 Jenner '95) and is one of the well-known clinical symptoms of rickets. 



Comby ('01) described the rachitic changes observed by himself and others in 

 the jaws and teeth. Eruption is retarded and pronounced deformities occur, 

 though fortunately rarely. "Ces dents sont malades dans leur germe; elles 

 sortent noiratres, fendillees, insumsamment revetues d'email; au lieu de se 

 developper normalement, elles tombent en poussiere, et les racines seules per- 

 sistent au milieu des gencives tumefiees, fongueuses et saignantes." The per- 

 manent teeth are usually good, though delayed in appearance. 



The work of Veve ('02) was inaccessible. 



In his comprehensive work on rickets, Wohlauer ('n) gave a detailed 

 account of the changes in the jaws and teeth, which are frequent and important. 

 The mandible becomes deformed, with the alveolar process slanting obliquely 

 inward (Fleischmann). The maxilla is bent inward at the attachment of the 

 zygomatic process, while the alveolar process is pressed outward. These 

 deformities of the jaws, which are caused primarily by tension of the 

 attached muscles upon the softened bones, naturally disturb the normal position 

 of the teeth and give rise to various degrees of malocclusion. 



The dentition is delayed, and the teeth appear at extended intervals and in 

 abnormal sequence (Baginsky) . Moreover the teeth show various abnormalities 

 in form. They may or may not be attacked by caries, depending upon the 

 time at which the rickets appears. If dentition occurs at the florid stage of 

 rickets, the teeth are markedly affected; but not if the dentition is completed 

 before the onset of rickets. The same principle applies to the permanent teeth, 

 according to Wohlauer. 



According to Burchard and Inglis (/08), Hopewell-Smith has described an 

 imperfect development of enamel during rickets, the first formed enamel con- 

 taining numerous spaces, probably filled with soft tissue. Wells ('19) found 

 delayed dentition in 32 out of 42 consecutive cases. There are frequently no 

 teeth erupted at the end of the first year; sometimes none up to 18 months. 

 The developmental process may be arrested, and there is a striking tendency to 

 early caries. The enamel may be completely destroyed even before the tooth is 

 fully erupted. 



According to Pfaundler ('22), in addition to the delay in dentition, the fol- 

 lowing peculiarities of the teeth may occur in rachitic children: "The individ- 

 ual teeth appear at unusually long intervals; erupt asymmetrically and 

 in atypical order. Particularly in the upper jaw, they are frequently small, 

 soft, easily broken and discolored by caries, to which they are peculiarly liable. 

 They are often frightfully misshaped and foreshortened. There is occasionally 

 an excessive formation of enamel. The temporary teeth show striped or circu- 

 lar erosions at neck and root. The permanent teeth, the germs of which are 

 also affected, show these erosions at the crown." 



Marfan ('22) and Ruden ('22) have recently likewise described delayed denti- 

 tion, abnormal development of the teeth, and malformation of the jaws as a 

 result of rickets in children. Park ('23a) holds that with proper diet during 

 pregnancy and by the use of sunlight and cod liver oil during infancy "more 



