Dental Caries and Dysfunction

Normal Acid-Base Balance Necessaryfor Immunity to Dental Caries Local and General pH Changes Responsible for State of Oral Health. These Vital Forces are Discussed in “DENTAL CARIES AND DYSFUNCTION’

By S. Joseph Bregstein, D. D. S.

Dr. Weston A. Price1 has made the observation that the biological characteristics of organisms are not particularly responsible for the existence of systemic disturbances. Also, it has been shown that given a definite infection, for example, the structural changes created sub-dentally and in the teeth themselves will differ in different people.

We cannot generalize, then, and state that dental caries is a syndrome of some constitutional disturbance. Groups, though, might react similarly to a specific disease depending upon their susceptibility and also whether the tendency is acquired or inherited.

We cannot claim that individuals, per se, all react alike to caries as a systemic manifestation, because of their individual dissimilarity.

Nevertheless, we can without fear of scientific contradiction state that dysfunction, a local disturbance, may be the instigating factor for creating a localized drop in pH sufficient to be evidenced in the form of caries. Further, it matters little whether an individual is susceptible either through inheritance or otherwise, for dysfunction, when in exists, lowers the pH in all tissues anywhere in the body.

In the presence of dysfunction two effects are possible. First, there might be a compensating force such as the buffer salts of the blood. Second, there existing a steady and continued exposure of dental structures to a low pH with its attending hydrogen ion concentration, destructive acids by virtue of their cumulative effect, cause a molecular disintegration of tooth tissues starting in the subdental structures and working outward to the dento-enamel junction.

Caries progresses along the coalescence of the developmental lobes as has been shown by Hyatt and his study group, and we see it finally as a pit cavity in the enamel.

The odontoblasts which cover the pulp and are contiguous to the dentine, have protoplasmic processes which are within the canaliculi embedded into the calcific substance of the dentine.2

These fibrillae anastomose at the dento-enamel junction.

The enamel immediately next to its junction with the dentine has structures known as enamel spindels which are interpreted to be extensions of the dentinal tubules into the enamel.

In animal experimentation, Gottlieb and others have been able to stain the enamel of dogs’ teeth with a red dye, simply by introducing it into the general circulation.

This together with other experiments, leads us to believe that the circulation of lymph does not end in the pulp of a tooth.

If this premise be true, can we not logically expect that any disturbance or change of circulation inaugurated by dysfunction in subdental areas may transfer a hydrogen ion concentration into the enamel and cause a breakdown of that structure connecting at the dento-enamel junction?

In sections made of teeth containing caries which have not invaded the pulp, we notice frequency the following appearances microscopically:

  1. Vascular changes in the pulp tissues.
  2. Calcification in the lumina of the pulp capillaries.
  3. Pulp calcification and beginning fibrosis.
  4. Cemental degeneration.
  5. Odontoblastic Devitalization.

Western Price in discussing the relation of caries to pulp infection says, “This research has included the sectioning, culturing and animal experimentation on many teeth with deep caries which were found to have abnormal reactions though nothing was disclosed by the Roentgenograms; and has demonstrated to us that teeth with deep caries generally and moderate caries frequently, already have their pulps involved from that source, and cannot be dismissed as normal without further study by means other than the Roentgen ray.”

Radiographically, we cannot demonstrate the inception of caries from within the tooth outward, although Appelbaum and Bodecker have observed a few specimens of human teeth with the Grenz ray, where there was an apparent decalcification of the enamel prior to an external manifestation of caries. Much however, remains to be accomplished along these lines.

pH of Subdental Structures a Factor in Caries

We are of the opinion that caries start from within the tooth and is due to a dysfunctionaffecting the pH of subdental structures. The dysfunction may arise at the temporo-mandibular articulation, at contact points, as a result of missing teeth, disocclusion, attrition, changes in the inclined planes of cusps and probably by a host of other mechanical factors.

Lowered pH may be incited by dysfunction. Lowered pH means acid or hydrogen ion concentration.

Acid concentration destroys tissue.

Natural compensatory forces equilibrize destruction as in the process of metabolism.

An advanced acid-base relationship without due and sufficient compensation can only result in destruction of tissue and, as in the case of caries, destruction of tooth structures from the pulp outward to the enamel.

The incident of caries among the Eskimos was investigated by Dr. Leman Waugh together with examinations made upon the teeth of primitive types and proof was established that as we approach civilized man in our studies in caries, there do we find a more marked incidence and increase of the disease.

Primitive men have need for greater exercise of the muscles of mastication and their jaws in chewing raw and tough foods. Modern man encourages atrophic changes through lack of use. This lack of use brings us right back to our original theory of dysfunction as a cause of dental caries.

Among the many theories on the causes of dental caries, it has been suggested that we may find the etiology in a study of endocrinology. The thought occurs to us that where the glands of internal secretion have created a dysfunction there would we anticipate a greater caries incidence. Changes must take place though, first in the bony structures, as for example, in hyperpituitarism where a prognathism or acromegaly exists.

Dr. Isaac Schour3 of the College of Dentistry, University of Illinois, made some interesting research deductions wherein he claimed that in hyperfunction of the endocrine glands (suprarenals, thyroid, hypophysis) there is a tendency toward accelerated and marked development of the dentition while in hypofunction there is found to be a retarted eruption and incomplete development.

In either of these conditions, whether the maxillary or dental development is retarted or enhanced by the endocrines, there nevertheless, is created a very important concomitant factor—that of local dysfunction.

We cannot, for example, conceive of a tooth eruption prematurely without receiving masticatory stresses not naturally intended at that particular period of the patient’s dentition. Therefore, an immediate dysfunction is created and a latent weakness of subdental tissues (periodontium, lamina dura, alveolus) is originated which becomes more aggravated as the stresses are continued.

Dr. John Bethune Stein,4 Professor of Physiology in the New York University College of Dentistry believes “the coordinated physiological reactions which maintain most of the steady states in the body are very complex.”

There are so many forces engaged in an unending struggle with compensatory factors in an endeavor to alter the original pattern of function, that it will involve much study and experimentation to evaluate further the theory of dysfunction and the etiology of caries.

Vital Forces Must Have Healthy Action

Since life itself is dependent upon the healthy action of vital forces without which death occurs, we are prone to theorize that certain forces likewise exist which might predicate the inception of dental caries. These latter forces are within human comprehension and are controllable, such as, which creates improper stresses. Altered pH with a marked shift toward hydrogen ion concentration is the result of destructive forces.

With a more complete understanding of the interdependence of acid-base equilibrium with growth, reflexes, anatomic changes and the physiology and pathosis of tissues, we can anticipate for posterity a fuller appreciation of the importance of dysfunction.

S. JOSEPH BREGSTEIN, D.D.S.,
7825 Fourth Avenue, Brooklyn, N.Y.

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BIBLIOGRAPHY

  1. “Dental Infections, Oral and Systemic” Volume I. Weston Price.
  2. “Histopathology of the Teeth and Their Surrounding Structures.” Rudolph Kronfeld.
  3. “Dental Digest.” Editorial by Edward J. Ryan. March 1934.
  4. “A Study of Possible Waymarks of Abnormal Occlusion of the Mandible and Maxilla.” J. B. Stein—Cosmos—January 1934.