Food Selection and Periodontal Hygiene

By Bernard B. Badanes, D.D.S., PH.G.

New York

and

Clara B. Parodneck, M.S., Instructor in Physiology

Brooklyn College, Brooklyn, N. Y.

            Of late years the dental profession, following in the footsteps of the medical profession, has been interested in a more or less academic way in preventive dentistry. As the dental profession began to make progress in the prevention of dental caries, the emphasis of preventive measures was more and more placed on this disorder. However, as our knowledge of the nature of periodontal disease has increased, we have approached the possibility of finding measures for preventing, also, the destructive effects of this formidable malady.

Available Preventive Measures

The two most available means, among others, at our command for the prevention of these widespread ailments are the selection of proper nutritional foods and the practice of oral hygiene. But, while dental caries may be prevented under optimal conditions, and this is the best we ever can hope for, it is not entirely against reason to expect that by using the same dietetic and hygienic means, periodontal ailments not only can be prevented but in many cases permanently cured if treatment is instituted early enough. To many of us preventive dentistry still means only the prevention of caries. In reality, what we should try to prevent is not dental caries alone, but each and every disease in the mouth.

There is an ever-increasing volume of evidence to support the assertion that the tooth is subject to nutritional changes. This may come from without by way of osmosis from the fluids bathing the crown of the tooth. The claim is put forth that the effect of systemic mineral equilibrium will also be mirrored in the saliva, and that there will come about a passage of calcium ions from saliva to enamel which will eventually lead to a recalcification of the tooth surface. More potent influences are, however to be anticipated through the medium of the dental pulp. Since this organ receives blood vessels from the portion of the periodontium which surrounds the apex of the root its nourishment will be affected by alterations in the health of the periodontium. The teeth and the periodontium are thus essentially interrelated as regards the problem of health maintenance. Results of recent investigations lead us to believe that faulty nutrition plays an important part in producing both periodontal disorders and dental lesions.

To be sure, there are other factors besides diet which may have a profound influence in modifying the etiology of diseases of the teeth and their supporting tissues, notably the complex activities of the endocrine glands, inherited inclinations, and the still more complex colloidal system of all the cells and tissues of the body, the physical state of which is easily affected by any slight change in acid-base balance.

Nevertheless, the selection of proper natural foods and their use in diet may help overcome to a certain extent even these difficulties. This may be true especially as regards some of the hormones, which originate, like some of the vitamins, in plants, and enter our systems with foods to be converted into animal hormones. There is some support for this theory since it is now known that true sex hormones and other hormones, known a auxins, are found in plants. They are mostly lost in the process of refining and purifying food, but in ordinary cooking are not entirely destroyed.

Importance of Nutrition

Food is the first of all the weapons of preventive medicine. Chemical factors alone are insufficient to achieve such ends, for we are physiological and not physical entities. Life is so complex that we are apt to overlook how entirely foods is its foundation and mainstay. Only recently we have learned that life depends on the concurrent balanced intervention of a considerable number of material agents in the food, some of them directly derived from the soil, others formed in plants, all indispensable in some as yet unknown way to health, even when required only in the most minute proportions.

All the rules of health which apply to the body as a whole should apply equally to the mouth. When health and immunity are in the ascendency, the protective biological faculties, with which the body is endowed, are adequate as physiological defences to safeguard against periodontal diseases.

Food Selection

The selection of proper food has engaged the attention of man since the first pangs of hunger created the demand essentials of life. As all of us eat, we are either kept well or become ill in proportion as our food selection is sound or faulty.

Most foods are incomplete in the various nutritional factors. By knowing the available factors in the different foods, we may make them adequate nutrients by combination; the good results of which will be reflected also in the paradentium and teeth.

There are very few natural foods that are in themselves so complete that any one of them would meet every need of the body and keep it in mineral balance and acid-base equilibrium were it made our sole diet; it also has all the known vitamins, but is deficient in iron and copper content, and is not suitable as a sole diet for adults since there is no functional stress for the teeth in mastication.

Protein Food

Many feeding experiments have shown that the mixtures of protein occurring in natural foods differ distinctly in nutritive value depending on the different proportions of amino acids contained in them. We know that the body can probably make several amino acids and that to omit them from our diet would not prevent our construction of body protein. There are, however, some amino acids that our body cannot make, and if the proteins we eat do not contain these particular amino acids in sufficient quantity, body proteins essential to life will not be produced. Another food essential which apparently the body is unable to produce is linoleic acid, being also linked with the fat-soluble vitamins. The list of indispensable amino acids is, however, yielded by all ordinary food proteins that have not undergone the process of putrefaction.

Food proteins of good quality of whatever source were shown to be resolved in the intestinal tract into their constituent amino acids, which were then absorbed and circulated in the body fluids, from which each tissue abstracted its quota and recombined them into new proteins having different proportions and arrangements of their amino acids.

Carbohydrate Food

It is also just as essential to understand the effect of eating the various carbohydrate foods, especially with regard to balancing the proportions of the mineral salts they contain. The proper balancing of base against acid in the selection of diet is sometimes very important. Many people believe that they can vary important. Many people believe that they can vary meant and potato and the result will be the same. This may be true from the organic nutrient viewpoint, but no from the mineral balance side, for rice yields an acid ash and potatoes a basic ash. Potatoes, then, tend to balance the acidity of the meat while rice accentuates the acidic content of the diet.

Taste alone as a guide to acidity or basicity of food is misleading. Only by burning the food and testing the ash, which represents the inorganic material of the food, can we tell with comparative ease whether a food is predominantly acid or basic in its effect.

In nature, potassium and sodium are usually combined with chlorine and sulphur as neutral salts. Therefore the acidity or basicity of a food ash is largely determined by the ratio of its calcium and magnesium to its phosphorus; the combined salt of which usually have an excess either of the base or of the acid. Calcium may be combined with phosphorus as a tricalcium phosphate or as an acid calcium phosphate.

The Chinese serve as an example of a race who subsist mostly on vegetables whose ash is basic, yet suffer less from calculosis than the Hindus, who also subsist mainly on vegetables, because in addition to vegetables the Chinese eat a great deal of rice, which counterbalances the alkalinity of the vegetables and contains no oxalates, besides.

In the balanced diet the proportion of carbohydrate bears an important relation to the assimilation of fact. While carbohydrates are completely burned in the normal body without the assistance of any other nutrient, the amount of fat which can be burnt with equal completeness is determined in part by the presence of carbohydrate. While both produce heat and energy, fats, unlike carbohydrates, may yield toxic end-products when not completely burned in the body.

The Sugars

There is also evidence that so simple a substance as sugar may exist in several forms, and that not all of these forms will burn equally in the body. Starch becomes glucose by digestion. Cane-sugar becomes glucose and fructose by digestion, and milk-sugar becomes glucose and galactose. Frustose and galactose differ from the glucose in many physical properties, notably taste. All the polysaccharides and dissaccharides must first be converted into the monosaccharide, glucose, before being assimilated by the blood and tissues. The organs of digestion in the adult, unlike those of infants, can convert lactose into glycogen and glucose only with great difficulty.

Bergeim, of Illinois Medical College, has shown that milk-sugar aids calcium retention, while the sugars, glucose and sucrose, do not have this effect. The lactose of milk may accomplish this by developing the sour milk bacteria, in turn tending to increase the acidity of the region where calcium is absorbed. In an acid medium calcium forms salts that are more soluble, and hence more readily absorbed. the same effect has been observed when hydrochloric acid is added to the milk of rachitic babies. It also makes for greater retention of calcium and less is eliminated in the feces as insoluble calcium soap.

 

 

Calcium Assimilation

The calcium salts in a diet, in order to control their assimilation and retention in the system, require the aid of other factors besides an acid medium. The most important are vitamin D, exposure to sunshine or artificially produced ultraviolet rays, and the active principle of parathyroid glands. The administration of the parathyroid hormone is, however, good only for temporary use since it abstracts calcium from the bones. Then, again, some cereals such as oatmeal and wheat germ contain a substance which is antagonistic to calcium assimilation. These factors do not depend upon the acid-base balance of food.

Balanced Diet

That food of the right quality, conditioned on long established habits, geographic location and climate, plays the major part in the prevention of mouth disorders is now universally conceded even by those that were inclined to doubt it not so very long ago. The importance of the diet as a causative factor in dental diseases is evidenced in some children previously fed an unbalanced diet by the missing enamel on the deciduous teeth even before these have emerged from the gums.

In the temperate zone, a well-balanced diet should be selected form natural foods as distinguished from refined and synthetic substances made to tempt the eye and the palate. Natural foods include bread made form whole grain, whether it be corn, barley or rye; an abundance of fresh dairy or cooked, and rich in mineral elements; seeds and tubers; all kinds of muscular and glandular meats or fish, natural fats, potatoes and fresh eggs.

In this country where the chief constituents of the daily diet are usually white bread and other foods made from white flour, sugar and muscle meats, milk and leafy vegetables form the most important protective foods which contain vitamins and minerals. For older groups some portion of meat and milk may be replaced by cheese. Jones and Crosland (1) warn of the dangers resulting from a diet containing too large a proportion of fruits and vegetables with a too high degree of potential alkalinity. Such diets will prevent caries of the enamel but will cause loosening of the teeth and, in advanced cases, resorbed roots and atrophy of the alveolar bone.

Those that subsist from their early childhood days upon foods high in bulk and low in energy, avoiding demineralized and purified soft low-bulk and high energy foods, hardly ever suffer from indigestion and chronic constipation. It has also been noted that such individuals have sound teeth and very seldom suffer form paradentosis.

To properly managed nutrition by be assigned the widest imaginable horizons. This is understandable when one considers that existing differences between higher and lower types in any country can be explained largely in terms of food. Diet in this country produces noticeable changes in the physical structure of children of the foreign-born. Diet is being rightly correlated with healthy teeth and good eyesight.

Oral Hygiene and Massage

Since their main function is to prepare solid food for digestion in the stomach it is reasonable to assume that the health and vigor of the teeth and jaws should, in addition to the other factors which they share with the general system, depend also on the exercise they receive from functional stress during the act of mastication. This process in its turn must be interpreted as local stimulation for all the organs of the mouth.

There results a great increase in the number of microorganisms in the mouth that is not kept clean, as has been shown by Gies and Kligler of Columbia University. They found 495,000,000 less bacteria per square millimeter in a fairly clean, healthy mouth than in the average insanitary mouth. It is true that the these organisms are for the most part saprophytic varieties, but some of them may becomes pathogenic when the resistance of the host is weakened due to an acute infection, a run-down condition or even a common cold.

With the use of a correct diet, the teeth and other tissues of the mouth would probably without any other special care, remain in a comparatively clean condition. However, most modern people live on civilized food and, unlike those that live on primitive food, fail to receive fully the benefits derived from the vigorous chewing on self-cleansing solid food, and the stimulation of all oral tissues resulting from the normal function of the masticating organs. Under such adverse conditions they must have recourse to artificial stress, in the form of massage, to produce the physiologic tissue-stimulating hormones so essential to the maintenance of the integrity of the dental organs.

According to Ruhmann, (2) the explanation of the great value of manage in substituting natural functions may be found in the fact that tissue-stimulating substances, the so-called tissue hormones, are liberated within the tissues by mechanical manipulation in the identical manner as by normal physiologic stimulation, and thereby increase the functional condition of the tissues or of their nerves and vascular apparatus, respectively.

By comparing the effects of the best tissue-stimulating substances, such as histamine, acetyl-choline and the circulatory hormone of the pancreas, with those of massage, he came to the conclusion that the tissue-stimulating substance liberated by massage is acetyl-choline or is very closely related to it. The importance of the hormone acetyl-choline has recently been demonstrated by such authorities at Sir Henry Dale. Professor Walter B. Cannon, and Dr. Oscar Riddle. They claim that all our activities depend largely on the presence of acetyl-choline which is found in motor-nerve endings and other tissues of the body.

The Dental Wafer

Preventive dentistry finds its most important application in childhood and youth. Clinical observation has shown that by far the greatest amount of damage to the dental organs among civilized races occurs before the age of eighteen years. Prevention begins with careful attention to cleanliness and mechanical stimulation of the teeth and associated structures. Civilized people miss the exercise of the dental organs on hard natural food obtained by primitive races. Even some of the pet animals in civilized countries suffer from gingivitis (3). The only substitute for this natural cleansing and beneficial stimulating effect, especially during the formative period of the individual, is mechanical cleansing of the teeth and massaging of the periodontium.

For this purpose the writers suggest an approved form of dentifrice that offers many advantages. It is a compressed oblong dental wafer about one-twelfth of an inch thick, five-sixteenths of an inch wide and about an inch of more long, weighing approximately one gram. The proper way to use it is to first chew it up well like food and work it around the teeth with the tongue. A wet toothbrush may then be used with it in the ordinary way. It is not only harmless but is decidedly healthful if part of it is swallowed. This simple process tends to make the act of cleaning the teeth much easier than with powder or paste with which many children –and adults too –experience some difficulty.

A dental wafer should be made according to the following formula:

Magnesium chloride ……………………………………..          ………   0.50

Magnesium sulphate …………………………………………..   0.50

Dicalcium phosphate …………………………………………..   85.00

Sucrose …………………………………………………………………..  10.00

Gum tragacanth …………………………………………………….  1.00

Gum acacia …………………………………………………………….. 2.00

Volatile oils …………………………………………………………….  1.00

Saccharine ……………………………………………………………… 0.03

 

It is essential that the magnesium salts shall not exceed one per cent of the total weight of the mass; otherwise its power to prevent tartar formation will be lost.

The Dental Finger Cot

The most striking feature of the dental wafer that no toothbrush is required for its use. It more adapted to use with the finger, which is of course covered with a sterile finger cut. The finger cut for dental use can be made of cloth, plain or rubberized, rubber or of a special kind of paper. For practical use, however, cloth with a slightly rough surface seems to serve well. Commercially, the cot can also be made in different sizes and packed in sterile containers. It should be discarded after once having been used, and its cost will amount to no more per month than the price of a good toothbrush.

The use of the finger cot instead of a brush has many advantages, the most important of which is that it is always sterile and therefore safe for use. Luciani proved that the toothbrush is not well adapted for vertical use in cleaning the teeth, since not enough pressure can be developed with the vertical strokes to make possible the thorough cleaning of all the surfaces of the teeth or the deeper recesses of the mouth. Not only can this be easily accomplished with the finger cot, but even the distal surfaces of the third molars can be properly cleaned and polished.

The greatest utility of the finger cot, however, lies in its perfect adaptation for massaging the gums. A brush is better adapted for scrubbing the skin, but it may scratch and otherwise irritate the delicate mucous membrane of the gums. Because of his food habits and the refined foods he is made to eat, massaging the gums is an absolute necessity for the modern man if he would keep his teeth and periodontium in a firm and healthy condition.

A few patients, following the advice and the example of the senior writer, who has used the finger cot method for a number of years, show the remarkable good results that may be obtained by proper use of the finger cot. Their gums and teeth are sound and healthy, which fact serves as proof of the value of careful and painstaking care of the mouth by the masses were they shown an easy way to do it. These few patients used home-made finger cots shaped of cloth, and for a dentifrice they employed magnesium sulphate.

  1. Jones, Martha R. and Crosland, George N: United States Naval Medical Bulletin, 34: 181, 1936.
  2. Ruhmann, W: Schweiz, med. Wochenschrift, 63:163, February 18, 1933.
  3. Badanes, B. B. and Amsher, P. J: Jour, amer, Vet. Metd. Ass., 87-325, September, 1935.

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