Dental Infection in the Army

A Report from Great Britain.

 

                At a meeting of the United Services Section of the Royal Society of Medicine on December 9th, with Air-Commodore A. V. J. Richardson in the chair, a paper was read by Major S.H. Woods of the Army Dental Corps on chronic dental infection as a cause of inefficiency in the army.

Major Woods pointed out that the soldier class had continuous dental treatment, while the officer class had not. About 30,000 men of the soldier class left the Service annually, to be replaced by young recruits, most of whom had had no previous dental treatment other than the extraction of an aching tooth. They were examined annually, and received continuous treatment throughout their service. The highest dental standard of function was maintained, and maximum restoration was the aim. In 1933, excluding India, the number of men whose dental treatment was completed was 65,000; the number of teeth restored was 212,000; and the number of root fillings was 1,380, or approximately one root filling to every fifty men whose treatment was completed. Carious and traumatic dead teeth were invariably extracted, thus eliminating cases of periapical infection from this source. Paradontal disease was seldom seen in men with less than fifteen years’ service; it became more evident in soldiers approaching the age of 40. The dental condition of the soldier class was under continuous control, closed infection was practically non-existent, inefficiency due to dental causes was rare, and if he had had to rely on the soldier for the cases he proposed to bring before the Section his paper could hardly have been written. On the other hand, the treatment which the officer might receive in the Service was a matter of chance; he continued to receive treatment from civil dental practitioners, and his dental condition was not under continuous supervision. Hence disabilities directly attributable to or influenced by his dental condition was very common in the officer.

Some typical cases treated at Milbank were described, showing the systemic effects produced and the results of elimination of the dental focus. These included several cases of acute or chronic antritis; certain eye cases, of which choroiditis and iridocyclitis were the commonest; lupus erythematosus;  cases of gastritis and gastric and duodenal ulcer in which advanced paradontal disease was considered to be primarily responsible for the disability, though in each case the masticating efficiency was very good; various rheumatic infections, not, however, including osteo-arthritis, which, in the speaker’s experience, was not intimately connected with dental infection; and cardiac affections, tachycardia being frequently of dental origin, and myocarditis also having been observed. In all these categories of cases the elimination of a dental focus had led to a cure of the disability or modified its course. In the estimation of the degree of causal relationship between the dental infection and the disability each case required most careful clinical investigation as well as transillumination and radiography. He emphasized the need for close personal co-operation between the dental and medical officers.