The Nation’s Teeth

Present Dietary Not Adequate to Maintain Dental Health.
Dr. Chalmers Watson Presents Scotland’s Problem.
Correspondence from Dr. J. Menzies Campbell, Glasgow.

                Dr. Chalmers Watson, consulting physician at the Royal Infirmary, Edinburgh, lectured in Glasgow recently to members of the West of Scotland Branch of the British Dental Association. The meeting was held in the North British Station Hotel. The subject of Dr. Watson’s lecture was “The Nation’s Teeth.”

“According to Sir John Orr,” said Dr. Watson, “Scotland today presents ‘a sorry picture,’ this depending very largely on the fact alleged that ‘the average diet of the poorest third of the population was not good enough to maintain perfect health. The poor lived on these foods which satisfied hunger at the lowest costs. They got very little of the foods which were essential for health—fresh milk, fresh eggs, fresh fruits, and vegetables.’ The remedy proposed by Sir John Orr is ‘that we begin with a national food policy which will put the glut of food stuff which is worrying our economists and politicians into the empty bellies, and follow it up with a great national housing scheme which will rid us forever of the slums of our cities.’ This, he states, could be done, ‘without any revolution or breakdown in the economical and social system which had served so well in the past.’”

Leaving aside the question of the definition of perfect health and its relation to physique, Dr. Watson continued, there were probably many who would retain an open mind as to the ease with which a remedy might be found for such under nutrition as undoubtedly existed throughout the country without a greater disturbances in our economic and social system than Sir John Orr envisaged. Others, again, might not quite agree with his statement that “we are a turbulent, energetic race,” but, on the contrary, might take the view that such racial degeneration as was threatened was not confined to the physical side, but involved equally the mental qualities of the race—their thinking power, their mental energy, their initiative, and their spirit of independence. Some useful relevant information on the nutrition question might be gleaned from the dental side.

Dental Caries

The importance of dental caries in school children was emphasized in the annual report (1934) of the Chief Medical Officer of the Board of Education for England, as follows:–“A disease which is met with in considerably more than 95 percent of the children attending elementary schools constitutes a formidable problem, and as yet there is no complete provision to deal with it.” Statistics of Scottish areas revealed an average incidence of 80 and 85 percent. These were arresting figures, the question might asked, how much had been accomplished by the statutory provision made in 1912 for dental treatment being made available for necessitous cases.

“I know of no data more likely to give reliable and useful information,” said Dr. Watson, “than those given in the Education Health Service Reports issued by the Glasgow Corporation.” The following table was instructive:–

The official commentary on the results of this work was as follows:–“A diminution in the number of very bad septic cases, so that a certain amount of preventive work is being accomplished,” and the table shows “that some degree of improvement has taken place, more particularly as regards the numbers showing marked degree  of dental caries.” The number of children with five or more carious teeth had decreased, while those with less than five had increased. That much was clearly established. It was equally clear that the results were unsatisfactory if we had regard to the non-curative nature of the treatment, the expense involved, and the limited part of the field necessarily covered.

A further point of interest was raised. If we were justified in assuming that the state of the teeth furnished a general guide to the physical condition of the child. The figures indicated the need for caution in assuming that the alleged physical deterioration was largely the result of trade depression associated with recent economic conditions. It was of interest to note that the Glasgow figures revealed a relatively trifling difference in the state of the teeth in “poor” schools, in a notably depressed are, and those in a “good” school, free of such depression.

“Poor” and “Good” Schools

“I have recently,’ said Dr. Watson, “ by favor of the Authorities, had the opportunity of personally examining, along with the dentist in charge, the state of the teeth and of general nutrition in a small series of 250 children between 10 and 12 years of age in two schools in East Lothian. In one, a ‘poor’ school in a notably depressed area, the proportion of teeth free from caries was 28 percent, in contrast with 44 percent, in a ‘good’ school in a seaside area, free from marked depression. The condition of the scholars in the ‘poor’ school, alike as to the number of teeth free from caries, the quality of the teeth, and general nutrition, was definitely inferior to that obtaining in the ‘good’ school. The relatively large proportion of teeth free from caries in the poor school may possibly be due to the fact that the water supply of the area is especially rich in lime. In relation to the ‘good’ school conditions, while exact figures of income are lacking, it can confidently be stated that the income of the wage-earners in quite a number of instances is definitely below the £2,10s. Figure assumed by Sir John Orr to be definitely a danger-zone figure. In this school, the standard of general nutrition could be classified as fairly good.”

The Cure of Caries

The cure of caries lay in its prevention. The knowledge required for its prevention was at our disposal, and flew made use of it. Faulty feeding—primarily the lack of lime and of fresh natural foodstuff—was the essential factor. The disease began, too frequently, in intra uterine life through faulty feeding during pregnancy. There was at present a good deal of loose talk about natural home-grown foods, the importance of quality, by which was largely meant freshness, being largely overlooked. This applied equally to legislators, doctors, dentists, and teachers of dietetics. Too few, when referring to the subject meant, said, and thought the same thing. The natural result of this had been that in our crowded towns, the amount of good fresh foods was at a minimum, and time and energy was devoted to providing substitutes and drugs to make up the deficiencies.

What was lacking was an adequate enthusiasm for health—positive health, attention being directed to the raising of resistance to disease. The important factors of parental education and sense of individual responsibility largely entered into the picture. Caution was necessary in estimating the value of new legislative measures, for promoting national health and prosperity by any new national food policy, valuable as that might prove to be.

In the consideration of any new policy, Dr. Watson said he would venture to emphasize the value of the following suggestions:–

(1)    The use of skim milk. Skim milk was a valuable food. An endeavor should be made to make more effective use of the skim milk derived from the present artificially induced glut of the milk supply, in the nutrition of necessitous cases, rather than by utilizing the product in the highly uneconomic way at present obtaining.

Health and Agriculture

(2)    The happy suggestion of the marriage of health and agriculture as a means of promoting national health and prosperity, proposed by Mr. Bruce, the Australian Premier, and supported by Sir John Orr, was an admirable one. It seemed clear, however, that unless there was something of the nature of a national awakening re the need of education—using that term in its widest sense—the results likely to follow would be gravely disappointing.

(3)    Care was essential in promoting legislation based too exclusively on modern laboratory research and statistics. Profoundly valuable as these were, there had for years been an increasingly prevailing tendency for such teaching to be absorbed too quickly into everyday medical practice. A very striking example of this had been seen in recent years in modern research work on “Vitamin D” in relation to the nutrition of the teeth.

(4)    While improved education re knowledge of sound nutrition and of capable housewifery was of great importance, an equal desideratum was a change in the system of education of the general medical practitioners of the future, whereby the spirit of preventive medicine replaced that of curative medicine at present obtaining. In Dr. Watson’s view, no single curative measure was more called for at the present time. If the nation was serious in this matter, and would support the admirable recommendations laid down by the British Medical Association for such advance, the results from this alone would, in the short period of, say, 10 years, be incalculable, and would cost the nation nothing.

(From the Scotsman, Edinburgh.)