Editorial. Confusion in Causes of Caries

EDITORIAL

Confusion in Causes of Dental Caries

 

                There seems to be considerable confusion among dentists as tot eh opinion of various investigators regarding dental caries. This is due to the presentation of so many different phases of eh subject which are forces having a part in the cause or prevention of decay.

While there appears to be some divergence of opinion among investigators, fundamentally most of the workers agree that caries is biologically systemic.

Since the problem has been attacked form so many different angles, there will naturally be confusion unless each meritorious contribution is viewed as a part of a group of factors, all of which may contribute to the explanation of the problem.

When the chemist presents his findings, and the pathologist his, the two may seem on the surface to be at cross-purposes, when actually they are not. Both, probably, cover phase which are related by being a part of the general problem of caries. Yet unless that relationship is kept in mind, confusion may result from seeming contradictory presentations.

This is equally true of the work of the bacteriologist, histologist, physiologist, anatomist, and others. Divergence of material in such presentation does not necessarily mean that he views are contradictory or that some are erroneous. Often, each will contain facts that are helpful in unraveling vexing and intricate mysteries of the complex problem of caries.

Generally speaking, two destructive forces are responsible for caries, systemic and local. Apparently, they work together, it appears that in the absence of systemic causes there is little activity of local destructive forces.

Although investigators sometimes believe that when decay occurs following experimental establishment of a systemic disturbance, the whole cause of caries has been discovered, they fail to consider that the condition they brought on might have activated local influences. There seems to be many ways of stimulating local destructive forces through changing the metabolic balance.

One phase of the problem, however, still remains largely a complete mystery, the reason for carious and non-carious teeth in the same mouth. One tooth may decay and the adjoining tooth be unaffected. Physical characteristics of teeth, plaques, and other theories fail to give a satisfactory explanation of this occurrence.

Dentists naturally are interested in causes of dental disease in order to establish effective preventive measures. Considerable progress has been made in this direction, through experimental work in institution. Use of groups of children, with controlled diets, has shown beyond reasonable doubt that proper dietary measures are effective in retarding or preventing dental disease. With this established, proper dietary measure should be a part of dental practice.

In working out the details of preventive practice, much is yet to be accomplished, but certain bread generalities certainly may be observed. One of these, for example, is that in utilization of minerals, Vitamin D is important as an activator.

Another of these generalities that has been receiving more and more thoughtful attention and credence recently is that control of dental caries appears related to control of the acid-base balance. A number of investigators have pointed out success in the control of caries by establishment of diets of an essentially alkaline nature, that is, leaving an alkaline ash. Conversely, these investigators have noted the coincidence of caries and largely acid diets. Various methods have been employed to establish the alkalinity, which investigatorssay, is an effective control.

In all presentations, one thing must be borne in mind, if they are to be of the greatest possible value. That is that though the research, and the theories and findings often appear at first sight to be unrelated, or actively contradictory, in the final analysis they are mostly a complement to each other in the general forward march toward solution of the problem of caries.