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Vitamin C

The importance of Vitamin C is of special interest to dentists because of its influence upon the developmental growth and the maintenance of oral tissue tone throughout life. Aside from the fact that a diet lacking in any one constituent is not balanced and therefore not conducive to dental or general health, an inadequate intake of Vitamin C has been shown by countless investigators to have a profound bearing upon oral health.

Vitamin C is the anti-scorbutic Vitamin and while its absence from the diet causes scurvy, even a small deficiency is responsible for many serious physical disorders.

Vitamin C is present in many of the raw foodstuffs, yet due to its instability and easy destruction by oxidation the dangers of an insufficient intake are numerous. Ordinary cooking in an open vessel, of the vegetables and other foods that contain godly amounts of this factor, readily destroys it by oxidation and very often our daily diet is deficient due to this procedure. Modern commercial canning has done much to retain and provide Vitamin C in the average dietary.

Modern science has succeeded in isolating and synthesizing Vitamin C, and this product is used in great quantities in hospitals all over the country, so important do they feel it is to provide the sick with this protection.

It is difficult to state a definite amount of Vitamin C required daily. Sherman states, “there is well-controlled experimental evidence that of Vitamins A and G increased liberality of intake continues to yield increased nutritional well being up to at least four times the amount demonstrably needed ; and there are clinical indications that something similar may be true in the case of Vitamin C,” and “that for best results the intakes of calcium, of Vitamin A and G and probably also of Vitamin C, should be much higher than the minimal-adequate or demonstrably needed amounts, and considerable higher than the usual allowances of the conventional so-called dietary standards.”

In view of these facts it is necessary that there be a greater consideration given to Vitamin C in the treatment of dental disorders.

Nutrition – and Your Dental Practice

As a dentist have you ever asked yourself- Am I primarily “mechanically minded” or do I fall in to the classification of those who could be called “medically minded”? Strange to say, your answer to this question will determine to a large degree your likelihood of making a success in the field of nutrition. It is true that there is a small percentage of persons who seem to possess both characteristics to a high degree, but the great majority have a quality of mind that causes them to lean strongly in one direction or the other as to our question.

As a teacher for fifteen years in one of our dental colleges, I have always been interested in this inborn difference in dental students. It is important for every dentist who contemplates doing nutritional work to evaluate himself and to ask himself the following questions. Am I primarily mechanically minded? Do I derive my greatest pleasure in my mechanical skill or am I medically minded and prefer to treat pyorrhea and Vincent’s infection cases? If you fall in the latter classification and are willing to make it a real study you can probably make a success with nutrition. The strictly mechanically minded dentist does not as a rule succeed in this latter field. I have given nutritional courses for a number of years to graduate dentists and find the most outstandingly successful men in this work are those whose chief interests are in biology, chemistry, physiology and pathology.

In emphasizing the above, I am actuated by the motive of trying to encourage those who might make good in the field of nutrition if they are willing to make a real study of the subject and discourage those who probably would fail.

Do you believe you should charge a fee for nutritional advice? The fact that a dentist has spent considerable time talking “diet” with his patient is not a sufficient reason for expecting a fee unless the professional man knows from experience that his advice and direction is worth something to the patient.

Introduce nutrition into your practice and carry on for six months of a year until you have convinced yourself that your nutritional efforts are of value. Then and only then should you attempt to make a charge. I find the public willing and glad to pay for nutritional services if they have reason to believe the dentist can help them.

Nutrition can be taken up as a specialty like exodontia or orthodontia, or it can be a valuable adjunct to a general dental practice. The author was in charge of a nutritional clinic for five years and has been practicing nutrition as a specialty in private practice (without a dental chair or instruments) for about six years.

There is a group of thirty or thirty-five dentists in Southern California who are practicing nutrition in conjunction with their dental practice. Some are doing general practice, others are in one of the dental specialties. Many of these men are doing outstanding work in the field of Dental Nutrition. They know from their own experience that they are stopping dental decay or are checking or arresting pyorrhea cases. These dentists meet once a month as a study group and discuss nutrition and their problem cases. They are trying to practice preventive dentistry and are succeeding very well indeed.

Diet Analysis

When diet is given simply as an adjunct to dental practice, the necessary data is probably best arrived at on the basis of history. The patient should be asked to furnish the dentist with a list of all food or drink consumed for a three day period or better still for a week. The dentist and his assistant can break down this diet list into its elements- as to the probable protein, carbohydrates, fats, and minerals and vitamins consumed- and make suitable suggestions to the patient for its correction.

If dental nutrition is taken up as a specialty, laboratory tests should be run to establish the degree and character of the dental pathology. A real biochemical study and possibly a bacteriological examination should be made of all cases so a basis can be found for sound nutritional advice.

The dentist specializing in nutrition should be prepared to handle a high degree of problem cases such as faulty assimilation and elimination, while the dentist using nutrition as an adjunct to his practice will probably be concerned more with balancing diets for fairly normal individuals.

Any dentist of physician who attempts to prescribe diets will be subjected to some criticism at times both from his own profession and possibly from one of the other professions. A few concrete cases will illustrate. A physician takes a colitis case that has suffered rampant decay for years. In his effort to control the colitis with diet the decay is completely checked. The patient is delighted and tells the glad news to her dentist who in turn resents the physician’s efforts to enter and practice dentistry. Then we have the dentist who prescribes a diet for dental decay. He is successful in stopping the decay, but also corrects constipation, migraine headaches and insomnia. The patient’s physician hears about the cures and wonders why that dentist does not practice dentistry instead of invading the field of medicine.

There is bound to be some overlapping between medicine and dentistry, particularly is this so in the field of nutrition. Cooperation between medicine and dentistry is the only way that order will be brought out of chaos. Nutrition has been and is a no-man’s-land and it behooves all engaged in this field to cooperate to the end that the public may receive correct information and advice. In time the mass of misinformation that now pervades will be dissipated.

Essential Factors in Nutritional Practice

Basing my conclusions upon more than four thousand diet cases that have been individually regulated with the aid of history and biochemical tests, I would suggest the following factors as essential for success in the nutritional field.

  1. The dentist must be quite medically minded.
  2. He must have a strong course in nutrition and be able to break down a diet into its constituents as protein, carbohydrates, fats, mineral elements and vitamins and be able to suggest the necessary changes for correction.
  3. 3. He must have had a strong course in physiology. He must know how each class of food is digested as well as their ultimate disposition in the body.
  4. He must have some knowledge of medical diagnosis.
  5. He must know how to take a medical and dental history.
  6. He must be methodical in his nutritional work and have a regular routine in which nothing is taken for granted.
  7. He must have the courage to take some cases and reject others. Experience will soon teach what cases he should handle and which cases are essentially medical and should be referred to the physician.
  8. He must have the ability to cooperate with the physicians and medical laboratories to the end that the patient receives the dental relief that he seeks.
  9. He should be willing to give sufficient time to each case he undertakes to treat nutritionally so the patient knows exactly what is expected of him as to food cooperation. Brief suggestions as “Eat more vegetables” and “Drink more milk” where there has been no real nutritional study of the case is not suitable diet advice.

Preventive Dentistry

Until the day arrives when our dental colleges feel the necessity of building up strong departments of Preventive Dentistry covering Nutrition, Physiology, Medical Diagnosis, Biochemistry and Oral Hygiene, the dentists will have to seek the necessary information from the various departments of our large universities.

The well trained dentist covering the above specialties can do a wonderful piece of work in preventing dental decay and pyorrhea alveolaris. The incidence of caries could easily be halved in a comparatively few years if the dentists of America would only catch the vision and act upon it.

The dentists are the only ones who can legitimately do this work as we alone are charge with the responsibility of the teeth and the supporting tissues. We are proud of our achievements in the restorative field, but not so proud of a national incidence of caries of about ninety six per cent.

During the past twenty years there has been no material lowering of the incidence of decay if we are to accept the various surveys and studies that have been recently made. During that period we encouraged, and rightly too, the use of the tooth brush and mouth cleanliness. We dentists must know by now the hopelessness of materially reducing the incidence of caries by oral hygiene alone. The only encouraging results which have been obtained to date are through adequate nutrition and the elimination of faulty pits and fissures by suitable means.

There is a crying need for dentists who feel that their natural bent fits them for this work to undertake the necessary training so they can qualify to do preventive work in the field of nutrition. There is an increasing number of patients who are demanding to know the cause of tooth decay and what can be done to stop it. The answer and the responsibility is in the hands of the dental profession.

851 Roosevelt Bldg.

Variant Value and Palatability of Coffee

Prescott, Emerson & Peakes in Food Research conclude that coffee kept in a vacuum is the best preserved. Kept in air, it becomes stale more quickly and in a moist atmosphere the deterioration is exceedingly rapid.

The results of the investigation were as follows:

The nature of the chemical changes in staling is not quite completely understood. The chief neutral constituent of the aromatic oils is furfuryl alcohol but the votatile portions is believed to be acetic acid by some, and the valeric acid by other.

The others extracted a mixture of volatile ingredients from the coffee and found that upon standing, it became darker, and finally resinified. Exposed to air this change occurred to a considerable extent even overnight whereas in a sealed evacuated tube it was much retarded. This change in the extract evidently has something to do with the bitter taste of stale coffee for mall portions of a dark portion when dissolved in water and tasted left a very unpleasant bitter taste in the mouth. A freshly distilled sample in an equal amount of water had no such bitter taste.

The volatile ingredients would appear to be part of the cause for staling of coffee but there are possibilities of other groups of compounds also.

______Medical Times.

Salmon as Food Factors

In the Journal of Home Economics are reported the results of experiments on canned salmon. Chinook and Red salmon were found to be richest in vitamin A and the red and pink varieties in vitamin D. Salmon is a food commonly included in all diets, and justly so, for it is one of the richest sources of vitamin D. Salmon also provides inexpensively excellent protein.

Unpasteurized Milk

More than one-half of the 123,000,000 people in the United States are still consuming potentially dangerous raw, or unpasteurized market milk even thought the public health importance of milk pasteurization has long been established. Dr. James A. Tobey, New York health expert, told the annual convention of the International Association of Milk Dealers at Dallas, Texas, on October 22.

Only about 47 per cent of the fluid milk produced in this country is pasteurized. The risk of epidemics due to contaminated raw milks of low grades is still very great.

—- Medical Times.

Sources of Vitamin D and Inhibitive Effects on Dental Carries (Part IV)

The reduction and prevention of dental caries is a problem uppermost in every Dentist’s mind. In this series of articles we have presented a resume of much authoritative clinical data from scientific journals on the Relation of Vitamin D to Dentistry with particular reference to the problem of caries.

Our initial article dealt with the factors n the cause and prevention of dental caries as defined and outlined by Dr. Kugelmass.

Nutritional Adequacy

Preventive dentistry is without question the greatest service that the dental profession can render the public. For the most part, preventive dentistry is an educational program, a program of educating patients to the proper way of caring for the mouth and body for the prevention of dental disease. It involves two great phases, the prophylactic and the nutritional.
Prophylaxis is a well established means of prevention. However, because it is so well established its emphasis is sometimes neglected, the assumption being that it is practiced universally.
The nutritional phase of prevention must be well understood and treatment carefully and intelligently carried out to be successful.
Nutritional therapy does not mean just the addition of more vegetables and fruits to the dietary. Dietetic and nutrition are not synonymous terms. Dietetics refers only to the foods consumes while is a broad term covering body metabolism. A balanced diet of the proteins, carbohydrates and fats is not sufficient for the maintenance of dental health. We must also consider the protective factors, the minerals and vitamins. These are not always so easily obtained if foods as it might appear. Soil erosion has played havoc with the mineral content of the soil in many localities. While there is no exact data available, it is known that the mineral content of the soil in many sections of the country is deplorably deficient. For this reason it is often necessary and advisable to resort to medication by advising the inclusion of additional known mineral products.
This is also true of the Vitamin content of the foods commonly consumed. Vitamin D is usually found in such minute quantities that its value is negative. The addition of a standard Vitamin D preparation is always necessary is the nutritional treatment of dental disease. Vitamins A and B is often inadequate due to improper ripening and cultivating conditions. Vitamin C is also easily destroyed by oxidation since foods cooked in open vessels render them useless as a source of this factor.
It is therefore necessary in the nutritional correction of dental disease to consider the problem of providing all the necessary dietary factors.
C. T. G.


Through wide publicity desensitization of dentin has for the past few months been foremost in the minds of the laity and dental profession. The public has hailed a new painless method of cavity preparation. Reports of the efficiency of Dr. Hartman’s solution have been varied. Some have reported favorably, others are doubtful.
However, the dental profession has accepted the challenge that a desensitizer is a necessary part of its armamentarium, a fact that has been treated with apathy for many years. Individuals forego dental attention because of the attendant evil of pain. Given the assurance of pain relief, many persons would keep their mouths in a better state of dental health. The public has given dentistry a challenge that can no longer be ignored as it has been in the past.
As long ago as twenty-five years we had desensitizing agents, yet how many have taken the trouble to give their patients the benefit of them. It should not be through force of public opinion that we progress.
In 1910, Dr. J. P. Buckley in his back, “Modern Dental Materia Media Pharmacology and Therapeutics,” presented to the dental profession the following formulae for the desensitization of dentin.
Zinc Chloride, 20 grains
Alcohol, 4 fluid drams
Chloroform, 4 fluid drams
Sig.—Apply to the cavity on a small pledget of cotton and gently evaporate to dryness.
Cocaine (alkaloid), 20 grains
Chloroform, 2 fluid drams
Ether, 6 fluid drams
(Menthol may be substituted for the cocaine with equally good results.)
Metycaine (Lilly), 22 grains
Thymol, 9 grains
Alcohol, 2 fluid drams
Ether, 6 fluid drams
(This is mixed in the proportion of 1-2-9, respectively.)
(These are in the proportion of 11-12 and 77 parts respectively. These are combined with a petroleum base, and incorporated in a fibrous vehicle and colored with an insoluble pigment.)

A small amount of the Desensitizing Paste is sealed in the cavity with cement for twenty-four to forty-eight hours, at which time the preparation of the cavity can be continued without sensitivity.
A detailed discussion of these agencies was presented in the May issue of Nutrition and Dental Health, by Dr. Buckley. Many progressive dentists have followed Dr. Buckley’s work and have profited by his research.
Now that we have had a forceful display of the public’s eagerness for a definite aid to painless cavity preparation, it is the responsibility of the individual dentist to employ an agent that will work effectively in his hands and take the pains to use it when necessary.
After all is said and done, if we had no cavities we would need no desensitizers. The fact that we need desensitizers is an evidence of failure on the part of our profession to prevent dental caries. It is not my intention to claim that dental caries, can be eliminated over night, but we can gradually, by education, prevent many of the sad experiences of tooth loss.
Not in the history of the dental profession have so many investigators been engaged in the study of the causes of dental disease. These studies have resulted in material gains and have shown the way to progress in our fight against the most wide spread disease of mankind. This we must recognize and practically follow its progress.

Metabolic and Local Factors
It has often been stated that there are two schools of thought in regard to the consideration of dental caries. There are those who believe in the local theory and others who consider the systemic phase. Those two thoughts seem to be at variance on the etiology of dental disease, but they are at variance only as they remain separate. While the terms local and systemic are convenient terms to describe a condition, a review of literature on these subjects seem to indicate one cannot be separated from the other. If the two thoughts would merge more effective means of treatment could be accomplished.
It must be remembered that the oral cavity is a part of the human body and an upset in the metabolic process has its influence on the fluids and tissues of the mouth. The head would have to be separated from the body to prevent its being affected by systemic derangements.
Bodecker has shown that there is a definite lymphatic circulation with the calcic structure of the tooth. Countless investigators have shown that the constituents of the saliva are quickly altered by metabolic imbalances. How then, can we consider the local factor without the systemic consideration and visa versa. A unit so complex as the human body is interrelated in all its processes.
It is only natural that some in their enthusiasm might feel that nutritional readjustment is the whole answer, yet failure of treatment is bound to result if the local cleansing and prophylactic measure are neglected. The old adage “A Clean Tooth Never Decays” is without question true, but clean tooth cannot exist if the body fluids are not in balance, and if the mouth is not kept free of objectionable debris.
All metabolic and prophylactic factors must be considered. Some investigators insist that Vitamin D is the controlling influence, yet without a sufficient intake of calcium and phosphorus, Vitamin D is ineffective. One must have the other.
Then there is the acid base balance to be considered. An excess of acid or base foods or an excess of either in the body fluids is abnormal and results in an upset that has a direct bearing on the well being of the dental structures. There is also the factor of endocrine derangement with its influence on all body processes.
From a nutritional standpoint we must strive toward a balanced diet, with a consideration of all dietary factors. Each and every one of the food elements must be included each day. Carbohydrates, proteins and fats must be in proper ratio. Vitamins A, B, C, D, E and G must be present. The minerals are most essential and the acids and bases equalized. These factors are within the scope of dentistry and dentistry alone can effectively institute this treatment. Glandular disorders must be treated by a competent internist.
Let us repeat the Pillars of Dental Health appearing regularly on the front cover of Nutrition and Dental Health and we will come very close to a complete consideration of all the important factors in preventive dentistry: Prophylaxis, Nutritional Balance, Glandular Equilibrium and Body Health.
C. T. G.

Public Dental Health Education
The matter of dental health education to inform the lay on subjects pertaining to a better understanding of the efforts and accomplishments of the dental profession in its struggle to control the ravages of dental diseases, is as yet greatly underdeveloped and its importance not fully appreciated.
We can do not greater service in the interest of better dental health then to provide the public with the necessary knowledge on dental health subjects, so that they can intelligently care for their mouth and teeth.
Effective dental health education can be accomplished in two ways. First, dentists should inform, instruct and advise every patient, specifically, as to the proper procedure for the prevention of dental disease. Secondly, dentists should take a greater part in public health talks before small groups in their communities and present sound dental health instructions. In the past few years members of the profession have take a greater interest in this work, but it is still far from a comprehensive program of dental health education.
No doubt dentists are deterred from addressing public groups because of a lack of experience in public speaking and because of the great tasks involved in the preparation of material which he feels will be of interest to his audience. The first obstacle should not be deterrent for the public is intensely interested in the subject and eager for authentic information and would appreciate an informal, rather simple discussion, not involving any special speaking ability or experience. The second problem of gathering and assembling material, is a task that is difficult and time consuming, and because of this, Nutrition and Dental Health will in the near future, present from time to time short discussions on various dental health subjects by men experienced in this field, and will be especially prepared so that they can be used verbatum if desired, or can be enlarged and altered to suit the individual circumstance obviating the difficulty of searching for material.
In the June number of Nutrition and Dental Health, Dr. David Bennett Hill of Salem, Oregon, will present a general discussion on dental health education, outlining a practical procedure. This will be followed by other discussions, the subjects of which will be chosen to meet the varying problems in dental health education. Suggestions as to subjects will be appreciated. We would also like to receive copies of talks from those who have had experience in this field and are interested in its development.