By Herbert H. Schmitt, D.M.D.
Portland, Oregon
This important and somewhat newer branch of dental practice cannot be covered adequately in this brief consideration of the subject; and a discussion of the various aspects requires no apology.
Dentistry, a Part of Medicine
It is unfortunate perhaps that dentistry has reached its present developed state without recognition as a specialty of general medicine, as experience in recent years indicated the necessity of more intimate association and consultation between the two branches of health service in certain bodily ailments. The practice of preventive dental medicine is closely allied with general preventive medicine and therefore cannot stand apart from it. The general facts regarding the underlying cause of certain bodily ills apply also to dental ills in a large measure. The great value of the retention of the natural teeth and sanitary mouth conditions is generally recognized by other systems of health science and is becoming recognized also by the general public.
Many different theories are used to explain the probable origin of cause of dental disease not due to traumatism, including such as: faulty nutrition, bacterial infection, endocrine, nervous or mental disturbance, nervous or mental disturbance, alkalosis, acidosis, diathesis, dysfunction, heredity, and so on; but these various alleged factors are insufficient to explain the various clinical facts of dental disease. Of course, there are intricate processes and reactions which occur in the human systems, leading to tissue breakdowns or dysfunction, which are still beyond the definite comprehension of the mind.
Facts Only, to be Considered
The modern scientist realizes the limitations of the mind, in its present state of development, to fathom the complicated facts of the ultimate cause of disease or complicated disease processes and as to what constitute vitality and immunity. Perhaps in the future a different and more comprehensive method of procedure for investigating disease will be found and thereby enable the mind to penetrate much further into the realm of the now unknown facts concerning disease and health matters. In the meantime we should continue to rely on reliable facts available, rather than accept fantastic theories or presumptions based largely on speculation or laboratory manipulations, as reliable evidence concerning the true facts of bodily disease and health matters. We must recognize the necessity of first understanding the underlying cause and the clinical facts of dental disease, and its possible relation to other bodily ills, before we can even hope to bring about its correction and control through biologic and other constructive measures. Theories do not solve the problem of disease, but instead often complicate such matters and thus create more problems to solve.
Factors in Disease
Neglect and abuse of the body, especially its digestive system, including mental and nervous disturbances plus hereditary weaknesses, tend to start or accelerate the processes of destructive forces present in and around us. When we live in harmony with constructive forces of nature and evolutionary progress, a condition called good health results; and when disturbing forces predominate ill health or disease and dysfunction occur and death may be the result long before the end of the allotted span of life has been reached.
Although considerable progress has been made concerning dental matters despite crude methods and imperfect results, yet with all due respect to this progress, we are from the goal we are seeking to reach. The point is that is has been difficult and is becoming increasingly difficult, and too often well nigh impossible, to cope successfully with dental breakdowns through the use of external remedies or even by the most modern dental restorations. Dental disease and bad mouth conditions, we are finding, occur largely from processes which have an internal origin or connection, rather than due exclusively to alleged external factors or conditions that may be present in the oral cavity, or round the teeth.
The clinical practice of dentistry offers many opportunities for observing the effect on the dental tissues, especially the investing tissues of the teeth, of various forms of internal disturbances, a blood dyscrasia, or blood pollution. the ultimate causative factors of disease are veiled in obscurity which baffles the mind. It has been observed, however, that with few exceptions chronic diseased or disturbed conditions in the oral cavity, or round the teeth, which do not yield to any form of local treatment can be definitely classed as having a direct connection with certain internal conditions.
Past Conceptions of Dental Disease
It is a hundred years ago since dentistry developed into an organized profession in this country. During this time it sought to make possible the retention of the natural teeth in a state of health and normal usefulness throughout the span of life; and, in fact, this was one of the fundamental ideas which led to establishing the dental profession. Despite various efforts to improve the dental health, or despite various social changes instituted which were believed more favorable toward better living and better health conditions of man, the conservation of the dental mechanism has not been accomplished thus far as was expected.
The Bacterial Theory
In the etiologic field of dental disease, unfortunately, a dubious, fantastic, and futile theory of bacteriology, as the direct or primary cause of the various forms of dental disease, predominated for many years without bringing us any nearer the solution of the problem. There has been too great a tendency to believe, assume, or fancy, that primarily all dental ills were brought about by the presence and alleged action of various forms of mouth organisms and purely a matter that could easily be corrected by measures miscalled oral, mouth, or dental hygiene, and so on. The bacteriologist has failed to establish or prove satisfactorily his theories as to the primary cause of dental disease, or explain the utter failure of his remedies designed specially to halt dental disease supposedly or presumably arising from the alleged action of mouth organisms. However, we are coming to understand better that, in general, bodily disease with some exceptions, represents the reaction to injure, neglect or abuse, or to the effects, results, or symptoms of a disturbed or abnormal condition, altered functions, or metabolic disturbance existing within an organ or the bloodstream; and that primarily dental disease or disturbance, with some exceptions, represents certain reaction of certain dental tissues to certain abnormal internal conditions aided sometimes by certain mouth conditions, as secondary or accessory factors, which may develop with or are incidental to dental disease.
In the past the practice of dentistry has been directed very largely to the art of mending a broken down dental machine through restoring carious teeth or by using substitutes to replace lost teeth. However, a chain is no stronger than its weakest link; and one of the weak links in the dental chain so to speak is the lack of understanding how to deal effectively with dental disease in a constructive rather than palliative way. The science concerning the basic correction or prevention of dental disease and deformity, or the conservation of the entire dental mechanism, has not received the necessary attention, because reparative and palliative measures, rather than basic correction and prevention, were considered more important. The great advance made in general health matters in recent decades shows the necessity of handling dental matter on the basis of a biologic or health and social problem, rather than merely as a system of dental technology or reparative and palliative measures.
Dental Caries and Pyorrhea Alveolaris
In the matter of dental caries it appears to result from external and internal factors with the later predominating or both factors may be present simultaneously. Heredity and early childhood health conditions are of greater importance in cases of caries than is generally realized. Small or shallow cavities in teeth usually indicate an external origin and where extensive and deep formations takes place.
The conception of disturbed nutrition predominates as the chief etiologic factor in caries. This idea has existed in the minds on dentists for centuries and has withstood and discredit; and has to do the lack of assimilation and metabolism of starches or carbohydrates, more particular cereals and sugar or sugary foods of all kinds. These forms of concentrated foods have only a small amount of protein and other basic elements and hence would not sustain normal health or even life itself very long. Domestic animals, specially the horse, soon become affected if fed a little to much grain as these foods are difficult to digest; goats refuse food containing grain or seeds; and birds and other lower animals usually refuse foods containing seeds if other foods are available. Sugary foods are not very easily digested and tend to cause excessive fermentation in the digestive tract, and in the oral cavity give an acid reaction with a decalcifying action on tooth structure especially when consumed between regular meals.
Vitamin Theories
It is alleged by investigators that the lack of vitamins in the dietary is the prime factor in caries; but this claim is doubtful and thus far has not been substantiated. Also, it is claimed that primarily the liver controls the metabolism of starches and sugars; that the autonomic system and endocrines become over-stimulated by an unbalanced dietary; that the carbon foods form too much carbon dioxide in the bloodstream; that in case of acidosis the mouth secretions become more or less acid in reaction which aids the alleged action on tooth structure of acid-forming mouth organisms; and, last but not least, that the average dietary lacks in certain elementary substances or minerals, as also constituting etiologic factors in dental caries.
Starchy Foods
The dental clinical picture briefly of those who use the starches to excess discloses considerable caries and consequent loss of teeth with some exceptions, regardless of all manner of topical agents used to check it. Disturbed metabolism, it is claimed, may produce acidosis sooner or later, if such foods are used to excess, which brings about a disintegration of the organic matrix of the dentin and this in turn affects the enamel after which the process of caries or decalcification (external process) becomes established. The amount of pancreatic and gastric juices secreted may be too limited or of inferior quality which would result in faulty metabolism of concentrated carbon compounds when used to excess.
It has been found, the carbon compounds can be metabolized adequately by the use of insulin thus helping check the further progress of caries in some cases. Interesting results with insulin have been reported bb investigators in checking caries in children, and also in checking other bodily ailments. Of course, metabolism or body chemistry varies in different persons or races, climate, age, mental attitude, occupation, and so on. In the warmer climates it is less than in the cooler. Higher altitudes tend to increase it in some persons while sea level is favorable to others. Mental disturbance is also a factor especially in women and children.
Let us consider briefly the clinical picture of adults affected with so-called pyorrhea. Before the disease sets in, the alveolar process and overlying soft tissues are in normal health and the teeth in position. After the disease has run its full course the alveolar process will be found destroyed to the extent that the teeth become exfoliated, one by one, in both jaws after which the phenomenon disappears forever from the mouth of the victim.
These clinical facts indicate that primarily the disease localizes in and destroys the alveolar process, from within outward toward the external surface emerging n the gingival area, by an internal destructive process. There have been numerous different conceptions advanced, many of them centuries ago, concerning its nature and origin and likewise the various names used to identify it, based entirely on its local symptoms and effects, as being primarily a form of gingivitis or pericementitis. Also, the various forms of local treatment advocated for the condition have proven utterly inadequate to check or prevent it.
So-called pyorrhea may be produced experimentally by the use of drugs containing toxic elements or properties of which calomel is a good example. Calomel, taken in to the system in repeated doses, is quickly absorbed and diffused throughout the system but very slowly eliminated. It causes a temporary pollution of the blood stream which extends to the investing tissues of the teeth; and some of it becomes lodged in the cancellous alveolar process causing irritation resulting in the breaking down of the cancellous bone cells and a localized toxic condition within the bone itself to the extent that it becomes gradually resorbed with consequent exfoliation of the teeth. The alveolar process, being an end organ with an end organ blood circulation, has no adequate defense against the lodgement of toxic substances within itself. Also, phosphorus or other similar toxic substances inhaled, or absorbed through the skin, will produce the same destructive results, regardless of dietary or other health considerations. Other toxic substances regardless of whether they are formed within the system by toxic disease, or faulty metabolism, or getting into the system from a polluted environment or when contained in drugs or foodstuffs, will produce the same destructive results, except that it may require a longer period of time. Local irritants on or round the teeth may be present or absent in the diseased condition; when present may act as an accessory factor to the internal factor; and otherwise have only a limited destructive effect on the involved gingival tissues.
The rational treatment for this destructive dental condition, of course, is to overcome the toxic irritants lodged within the alveolar process and thus check the further progress of the disease process. The author discovered that this objective can be accomplished by injecting chemical antidotes into the venous circulation to be carried to the investing tissues of the teeth; and by coming in contact with the toxic substances present quickly changes them into inert substances which are then removed and eliminated from the system. Normal metabolism becomes restored in the investing tissues and soon the external symptoms and results of the disease, including bad mouth conditions, subside and disappear, in the large majority of cases. The lasting results obtained by this treatment must be experienced to be appreciated. This type of treatment alone would not be effective in those cases caused or complicated by any toxic disease, or blood dyscrasia, advanced endocrine disturbance, especially in women during the menopause.
In summarizing, attention is directed to the fact that the disease called pyorrhea is subject to much exaggeration by reason of the local infection by mouth organisms which is erroneously regarded by many as the principal or entire causative factor of the dental diseased condition itself when, in reality, it is a result, effect, an end point, or a later stage, of the destructive condition originating within the body of the alveolar process; and also by the wear and tear and general abuse to which the dental tissues are daily subjected. In this connection it may be added, that it is impossible to maintain the dental tissues in health, or restore the oral cavity to a normal sanitary condition, until the internal factors responsible for the bad conditions are overcome by internal corrective treatment.
Antidotes injected into the venous circulation at intervals, as a phophylactic, is a safe and effective method, and the only effective way in many cases, to prevent so called pyorrhea becoming established, excepting those cases complicated by chronic toxic disease, or a blood dyscrasia.
In the matter of dental caries, dietary restrictions pertaining to starches or cereals, sugar and sugary foods and confections of all kinds, or any other food, even milk or vegetables, used to excess, plus the use of foods containing the basic mineral elements, would be most helpful to prevent caries especially in children and young adults. Perhaps, insulin would also be helpful to those affected by or susceptible to caries through heredity. The injurious effect of toxic disease on the endocrines in childhood is apt to be overlooked; and this requires attention to avoid the later caries which often occurs, regardless of a good dietary. Dietary measures and remedies to correct internal disturbed glandular functions have been found helpful if given early attention, although hereditary glandular dysfunction is difficult to correct fully in one generation. Doubtless, a standard form of endocrine treatment plus a basic dietary for dental cases will be worked out in due time.