Minor Terata : Edentulousness

Anomalies and Curiosities of Medicine
by George M. Gould, M.D., Walter L. Pyle, M.D.

(Page 18 of 53)

We have already noticed the association of congenital alopecia with edentulousness, but, strange to say, Magitot has remarked that "l'homme-chien," was the subject of defective dentition. Borellus found atrophy of all the dental follicles in a woman of sixty who never had possessed any teeth. Fanton-Touvet saw a boy of nine who had never had teeth, and Fox a woman who had but four in both jaws; Tomes cites several similar instances. Hutchinson speaks of a child who was perfectly edentulous as to temporary teeth, but who had the permanent teeth duly and fully erupted. Guilford describes a man of forty-eight, who was edentulous from birth, who also totally lacked the sense of smell, and was almost without the sense of taste; the surface of his body was covered with fine hairs and he had never had visible perspiration. This is probably the same case quoted in the foregoing paragraph in regard to the anomalies of hair. Otto, quoted by Sedgwick, speaks of two brothers who were both totally edentulous. It might be interesting in this connection to note that Oudet found in a fetus at term all the dental follicles in a process of suppuration, leaving no doubt that, if the fetus had been born viable, it would have been edentulous. Giraldes mentions the absence of teeth in an infant of sixteen months. Bronzet describes a child of twelve, with only half its teeth, in whom the alveolar borders receded as in age. Baumes remarks that he had seen a man who never had any teeth.

The anomalies of excessive dentition are of several varieties, those of simple supernumerary teeth, double or triple rows, and those in anomalous positions. Ibbetson saw a child with five incisors in the inferior maxillary bone, and Fanton-Touvet describes a young lady who possessed five large incisors of the first dentition in the superior maxilla. Rayer notes a case of dentition of four canines, which first made their appearance after pain for eight days in the jaws and associated with convulsions. In an Ethiopian Soemmering has seen one molar too many on each side and in each jaw. Ploucquet and Tesmer have seen five incisors and Fanchard six. Many persons have the supernumerary teeth parallel with their neighbors, anteriorly or posteriorly. Costa reports a case in which there were five canine teeth in the upper jaw, two placed laterally on either side, and one on the right side behind the other two. The patient was twenty-six years of age, well formed and in good health.

In some cases there is fusion of the teeth. Pliny, Bartholinus, and Melanthon pretend to have seen the union of all the teeth, making a continuous mass. In the "Musee de l'ecole dentaire de Paris" there are several milk-teeth, both of the superior and inferior maxilla, which are fused together. Bloch cites a case in which there were two rows of teeth in the superior maxilla. Hellwig has observed three rows of teeth, and the Ephemerides contain an account of a similar anomaly.

Extraoral Dentition. Probably the most curious anomaly of teeth is that in which they are found in other than normal positions. Albinus speaks of teeth in the nose and orbit; Borellus, in the palate; Fabricius Hildanus, under the tongue; Schenck, from the palate; and there are many similar modern records. Heister in 1743 wrote a dissertation on extraoral teeth. The following is a recent quotation: -

"In the Norsk Magazin fur Laegevidenskaben, January, 1895, it is reported that Dr. Dave, at a meeting of the Medical Society in Christiania, showed a tooth removed from the nose of a woman aged fifty-three. The patient had consulted him for ear-trouble, and the tooth was found accidentally during the routine examination. It was easily removed, having been situated in a small depression at the junction of the floor and external wall of the nasal cavity, 22 mm. from the external nares. This patient had all her teeth; they were placed somewhat far from each other. The tooth resembled a milk canine; the end of the imperfect root was covered with a fold of mucous membrane, with stratified epithelium. The speaker suggested that part of the mucous membrane of the mouth with its tooth-germ had become impacted between the superior and premaxillary bones and thus cut off from the cavity of the mouth. Another speaker criticised this fetal dislocation and believed it to be due to an inversion - a development in the wrong direction - by which the tooth had grown upward into the nose. The same speaker also pointed out that the stratified epithelium of the mucous membrane did not prove a connection with the cavity of the mouth, as it is known that cylindric epithelium-cells after irritative processes are replaced by flat ones."

Delpech saw a young man in 1829 who had an opening in the palatine vault occasioned by the extraction of a tooth. This opening communicated with the nasal fossa by a fracture of the palatine and maxillary bones; the employment of an obturator was necessary. It is not rare to see teeth, generally canine, make their eruption from the vault of the palate; and these teeth are not generally supernumerary, but examples of vice and deviation of position. Fanton-Touvet, however, gives an example of a supernumerary tooth implanted in the palatine arch. Branch a describes a little negro boy who had two large teeth in the nose; his dentition was otherwise normal, but a portion of the nose was destroyed by ulceration. Roy describes a Hindoo lad of fourteen who had a tooth in the nose, supposed to have been a tumor. It was of the canine type, and was covered with enamel to the junction with the root, which was deeply imbedded in the side and upper part of the antrum. The boy had a perfect set of permanent teeth and no deformity, swelling, or cystic formation of the jaw. This was clearly a case of extrafollicular development and eruption of the tooth in an anomalous position, the peculiarity being that while in other similar cases the crown of the tooth shows itself at the floor of the nasal cavity from below upward, in this instance the dental follicle was transposed, the eruption being from above downward. Hall cites an instance in which the right upper canine of a girl erupted in the nose. The subject showed marked evidence of hereditary syphilis. Carver describes a child who had a tooth growing from the lower right eyelid. The number of deciduous teeth was perfect; although this tooth was canine it had a somewhat bulbulous fang.

Of anomalies of the head the first to be considered will be the anencephalous monsters who, strange to say, have been known to survive birth. Clericus cites an example of life for five days in a child without a cerebrum. Heysham records the birth of a child without a cerebrum and remarks that it was kept alive for six days. There was a child born alive in Italy in 1831 without a brain or a cerebellum - in fact, no cranial cavity - and yet it lived eleven hours. A somewhat similar case is recorded in the last century. In the Philosophical Transactions there is mentioned a child virtually born without a head who lived four days; and Le Duc records a case of a child born without brain, cerebellum, or medulla oblongata, and who lived half an hour. Brunet describes an anencephalous boy born at term who survived his birth. Saviard delivered an anencephalous child at term which died in thirty-six hours. Lawrence mentions a child with brain and cranium deficient that lived five days. Putnam speaks of a female nosencephalous monster that lived twenty-nine hours. Angell and Elsner in March, 1895, reported a case of anencephaly, or rather pseudencephaly, associated with double divergent strabismus and limbs in a state of constant spastic contraction.