The Attainment of Dental Perfection

By Milton T. Hanke, Ph. D.
Chicago, III.
This is the first of a series of articles by Dr. Hanke, discussing the various phases of nutrition as applied to dental practice. Two other papers will follow in June and July. The titles will be “What Can Deit be Expected to do for People Who Do Not Enjoy Dental Perfection, I. Gingivitis, Acute Ulcerative Gingivitis and Supperative Periodontitis. II. Dental Caries.”
In spite of the dietary and other abuses to which we subject ourselves in this country, dental perfection is not entirely unknown. About three per cent of our people reach adult life with well formed teeth and jaws, a well calcified alveolar crest, a perfect occlusion, and no carious lesions or gingivitis. This small, privileged group secret a saliva that is alkaline and well buffered at all times, much as if the state of metabolic perfection that produced a perfect dentition also produced and maintained a mechanism to protect the teeth against destruction.
It would certainly be desirably to extend this state of dental perfection to a larger percentage of people; which immediately raises the question:
“Can dental perfection be produced at will in man or in animals by any process that is now known?”
It is a fact well known to biochemists and nutritionists, that physical and mental perfection in animals is largely a matter of diet. Adequately nourished animal mothers give birth to normal young. The mothers secrete a milk adequate for the nourishment and rapid symmetrical growth of the young. If the young, after weaning, are placed on an adequate diet, they continue to grow rapidly, are seldom ill and attain to a maximum of physical, mental, and dental perfection.
Poorly nourished female animals may, on the other hand, not become pregnant at all; though this is usually not the case. Nature guards jealously against any interference with the propagation of the species, and she is very partial to the developing embryo. Even though the body of the mother is sadly depleted in certain essential materials, the embryo takes what it needs if this is at all possible. The young born under such unauspicious circumstances, may be eaten by the mother, may be carelessly trampled to death or smothered by the mother, or may be lucky and survive. Even poorly nourished mothers usually secret some milk; but the milk is inadequate either in amount or in quality. The young must suffer in consequence. Any inadequacy in the mother’s milk will produce some defect in the young. This may be temporary and apparently disappear completely in later life if the post weaning nourishment is adequate; or it may be permanent and persist throughout life, irrespective of the diet.
A retardation of growth during the nursing period may, for example, be vitiated by a subsequent enhanced growth. Rachitic deformities in certain bones, due to a lack of Vitamin D, or an early osteoporosis or hemorrhagic condition, due to a lack of Vitamin C, may disappear completely if the diet is rendered adequate after or during the nursing period. There are cases, however, in which the early dietary deficiencies produce changes that cannot subsequently be overcome.
Infant rats, for example, nursed by rat mothers whose diet is deficient in Vitamin B complex, developed a defective nerve tissue, and they are apt to be imbeciles, even though the post weaning diet is excellent in every respect. The importance of this fact, for us, can be readily understood when we recall that the nerve tissue of infants is incompletely formed at birth, and undergoes its most radical constructive changes during the nursing period. It is reasonable to postulate that a certain percentage of our imbeciles owe their predicament to a lack of Vitamin B complex in the diet of their mothers.
The crowns of some of the permanent teeth, to cite a case more pertinent to dentistry, calcify during the nursing period; and the physical structure of the dental enamel will be permanently good or bad, depending upon the state of health of nourishment of the child during this period. This early period is also apt to be the one in which our metabolic characteristics develop. Some changes may occur which determine, for example, whether the saliva shall be alkaline and well buffered or whether it shall tend to be poorly buffered. Studies to ascertain the period in life that determines the quality of the saliva have, however, not as yet been made.
The importance of the growth period for the dental structure was clearly shown by the studies of May Mellanby on dogs and other animals. These studies have been referred to frequently; but their the author, been adequately stressed. Her studies can be briefly summarized as follows:
May Mellanby’s Conclusions
Dogs fed on a diet consisting of cooked cereal (100-200 grams), separated milk powder (10-30 grams), raw lean meat (10-20 grams), olive oil (7 c.c. or none), cod liver oil (3 c.c. or 10 c.c.), orange juice (3-5 c.c.), brewers’ yeast (5-10 grams), and sodium chloride (1-4 grams), develop dental structures that are entirely normal. The animals grow normally and are, apparently, healthy. Dental caries does not occur, suppurative periodontitis and gingivitis occur rarely and then only in conjunction with calculus deposits. Gingivitis seldom occurs even when calculus is present.
Substitution of olive oil for cod liver oil in the above formula, i.e., the almost complete elimination of Vitamins A and D, is associated with a series of profound developmental changes. There is a delayed eruption of deciduous teeth of puppies whose mothers were on a diet deficient in Vitamins A and D; but the teeth are usually of good quality. There is a delayed shedding of the deciduous teeth and a delayed eruption of the permanent teeth in puppies kept on the deficient diet. The mandible is thick, spongy and so soft that it can be indented with the finger nail and the bone is pliable and can be bent slightly. Such a bone is a poor supporting structure for the teeth; which leads to malucclusion. The roots of the teeth show very little calcification and are, in consequence, soft and pliable and displaced somewhat in their sockets. Enamel is rough and poorly calcified. Dentin is poorly calcified, full of interglobular spaces and thinner than normal. The teeth, taken as a whole, are deficient in calcium.
Profound changes also occur in the development of the soft tissues, such as the pulp, periodental membrane and gingivae.
May Mellanby has demonstrated, quite conclusively, that the hard tissue changes are due to a lack of Vitamin D in the diet and that the soft tissue changes are due to a deficiency in Vitamin A.
Among her most instructive studies are those made to determine the period, in life, when Vitamins A and D are most important for future dental health. Puppies that receive no added Vitamins A and D from age 2-5 months (and whose soft and hard tissues are, in consequence, poorly developed and imperfectly constructed) and who then receive 10 c.c. of cod liver oil daily during a subsequent 6 year period, never recover entirely form the effects of the early dietary deficiency.
Administration of cod liver oil leads to a rapid partial calcification of the teeth and their supporting structures; but the alveolar crest remains defective throughout life and is already partially absorbed at age two. Advancing age leads to loose teeth, fairly deep pockets, gingivitis and, perhaps, pyorrhea even though the diet has been adequate in all respects for nearly six years.
A puppy that received an adequate supply of Vitamins A and D during the first year of life and then subsisted during a subsequent four years’ period on a diet that contained almost none of these vitamins enjoyed perfect health at all times, and was not afflicted with any dental disease.
A state of dental perfection can, therefore, be attained by dogs if they are adequately nourished during the growth period. The perfectly formed and correctly calcified teeth and jaws do not become diseased in later life even though the diet is inadequate. Dogs that are inadequately nourished during the growth period –or even during the first few months of life –have imperfectly formed teeth and jaws. The defects cannot be corrected entirely by a subsequent adequate diet and dental diseases may occur in later life, regardless of the adequacy of the diet.
Nourishment During Growth Must be Adequate
The practical conclusion that can be arrived at from this study is that, to attain dental perfection, the nourishment of the child must be adequate in all respects during the growth period. Children, so nourished, can be expected to develop perfectly formed and correctly calcified teeth and jaws. The alveolar crest, being of good quality, will resist resorption in adult life, and thus reduce the incidence of gingivitis and pyorrhea to a minimum. The teeth, since they are rigidly supported, will not tend to drift, especially in view of the fact that they are in ideal occlusion at the moment of mastication. Dental caries is rare in such cases, possibly because of the ease with which a perfect set of teeth can be cleaned and possibly because the saliva is alkaline and well buffered at all times, and thus protects the enamel against decalcification by acids.
The basic conclusions arrived at from a study on dogs must be applicable to all animals and man, because growth is a fundamental biological phenomenon subject to the same general natural laws and forces. There are, of course, certain differences in food requirements that must not be lost sight of. The dog, for example, requires very little Vitamin C, probably because his body manufactures this Vitamin.
Tribal Dentition Correlated with Diet
The literature contains many references to the dental condition of tribes of people, showing the faulty condition (as the case may can be correlated with the diet. Correlations of this kind are however, suggestive rather an conclusive, because of the unknown effect of heredity and the possibility that certain tribes of less agitated people show less nervous instability than is the case with many of us. No one will, probably, seriously, doubt the importance of heredity and nervous temperament upon dentition.
It has been instructive, therefore, to watch the physical, mental and dental evolution of two children on a dietary regime as good as we now know how to make it. One of these children is a girl, now seven years of age, whose parents have the usual of dental diseases, and who sisters (age 18 and 20, respectively) have malocclusion, gingivitis, and dental caries. This child has been nourished in accordance with the precepts of the modern knowledge of nutrition which means that she has eaten as advance of food rich in vitamins, minerals, proteins, and other essential forms of nourishment. She has never been sick. Diseases such as measles, chicken pox, scarlet fever and influenza have passed by, although she has been exposed repeatedly all of them. She is a good looking, strong, vacious youngster with a broad, well formed jaw, and a perfect set of teeth. Some of the deciduous would have been shed painlessly to give way to what appear to be well focused permanent teeth. There has been no caries and there is no gingivitis.
Another child, now four years of age, with a similar background, and similarity fed, shows almost chemical, physical and dental characteristics. There are probably thousands of such cases on record, if one would just take the steps necessary to trace them.
It would seem to be a function of the dental profession to advice mothers regarding the diets of their children, if we hope to protect the future generations against the dental imperfections to which we have been subjected.
What then, can be recommended? Infants should be breast fed when possible; but human milk may be lacking in quality and quantity. It is frequently desirable, therefore, to augment the infants natural food. Diluted cow’s milk to which some lactose (milk sugar) has been added, is a good substitute for human milk. Maltose or cane sugar are not good substitutes for lactose. The latter contains galactose which is an essential constituent of the nervous system. Human milk contains more lactose than does any other milk, and the human infant requires more lactose than do other infants, because its nervous system is least complete at birth.
Most of the caloric requirements of infants can, for a time, be supplied by milk; but this is not a good source for some of the vitamins. Young infants should receive about an ounces of orange juice per day (to supply Vitamin C), and a child, at age two, will usually drink about four ounces a day without protest. At age six, this should be increased to eight ounces, and at age twelve, to sixteen ounces. Other sources of Vitamin C may, of course, be substituted for orange juice if desired, especially in older children. The best sources of Vitamins A and D are the fish liver oils or their concentrates. Young children should receive about six thousand international units of Vitamin A, and one thousand international units of Vitamin D per day. these Vitamins had best be supplied in their natural form, rather than as irradiated ergosterol, until the relative efficiency of these two products has been established. There is no good reason to suppose that children, at any age, require less than the above stipulated amounts of the Vitamins A and D.
It is commendable custom to start feeding egg yolks and vegetable extracts at an early age. One egg (or yolk) a day is probably sufficient up to about age twelve, or at any period other than those of pubescence or pregnancy.
No mother need worry about a Vitamin B or G deficiency as long as the child is receiving an abundance of milk. One quart of milk contains about 100 international units of Vitamin B.
Children’s Diets Should be Well Supervised
Children usually have excellent appetites and will automatically eat sufficient food to satisfy their energy requirements. They should be permitted to eat whenever they are hungry; but some control must be exercised upon the kind of food that is eaten. Candy and other sweet foods should only be eaten after meals, are fruits and certain vegetables (e.g. raw carrots). They will stimulate rather than destroy the appetite for the regular meal. An abundance of fruits and vegetables is to be recommend at any time of life after infancy.
Children seem stronger, and their muscle tissue is firmer when they eat meat. This seems logical, to the author, in view of the fact that meat proteins are similar, in chemical composition, to human muscle protein, and the one should be convertible into the other with a minimum amount of loss or effort. It might also be stated, in this connection, that gelatin has a chemical composition similar to that of the organic structural elements in bone and should, therefore, be most useful for the construction of bone. Gelatin is usually condemned because it is not a complete protein (it lacks certain amino acids); but it contains the amino acids in the correct proportions for the constructions of bones, tendons, and certain other connective tissues, and should be most readily convertible into these essential structures.
The next article of this series will show what can be accomplished by diet, when applied to people who do not enjoy dental perfection.
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