Mineral Changes in Tooth Structure Result

Mineral Changes in Tooth Structure Result from Toxicity
A Russian Study of the Causes of Dental Disease is Reporte by Dr. L. I. Kaushansky in
“THE EFFECT OF CHRONIC INTESTINAL INTOXICATION ON THE CHEMICAL PROPERTIES OF THE SOLID TISSUES OF THE TOOTH”
From the Pathological Physiological Department (Chief –Prof. M. M. Pavlov) of the Leningrad Stomatological Institute (Director –Z. B. Piriatinsky, Manager of the Scientific Part –Prof. D. A. Entin).
In studying the influence of the alimentary factor on mineral metabolism we have obtained changes in the content of electrolytes in blood, in the enamel and dentin in dogs kept on different diet (“acid” and animals, when given the usual food. This fact directed our investigations towards a further study of deviations in mineral metabolism of the solid tissues of teeth, which might occur due to this or that effect produced by the gastro-intestinal tract.
Intestinal Toxins
The object of the present paper was to study the effect of chronic gastro-intestinal intoxication. This way of treating the question seemed all the more desirable because in the course of experimental work on gastro-intestinal intoxication, a number of authors have studied deviations from the normal standards in various organs of the body, including chemical changes in bones whereas no analyses of teeth were made.
Already as early as in 1846 Berth, and later Senator in 1868, described cases of auto-intoxication with intestinal toxines viz. with hydrogen sulphide which formed, owing to abnormal decomposition processes, in the alimentary canal. Bouchard point out that an abnormal process of decomposition secures conditions most favorable to the production of toxines by microbes which are normally and constantly present in the alimentary canal.
Processes of absorption of proteins substances occupy an important part in the question of gastro-intestinal intoxication, as even normal products of albuminous digestion, under certain conditions, are strong toxins for the animal organism.
In some cases the albuminous substances are absorbed from the alimentary canal in an unchanged state; this is favored by a disturbance of the normal function of the alimentary canal caused either by its being filled to excess with albumins, or by an pairment of the anatomic integrity of its mucous membrane.
Magnus Alsleben found in the upper portion of intestines, in dogs fed on meat, the formation of a very strong poison which produced cramps, such poison being absent in dogs fed on milk.
Intoxicants are formed in the intestines chiefly as a result of bacterial decomposition of albumins, which decomposition, contrary to a fermentative splitting, results in decarboxilation and, therefore, in the formation of amines. Under normal conditions poisonous substances are either formed in small quantities or are converted in the organism into non-poisonous compounds.
In cases of gastro-intestinal intoxication much attention is given to the action of histamine as this poison was found in fecal masses of persons suffering from enteritis, when a special variety of bacterium was discovered capable of giving off toxically acting histamine from nonpoisonous histidine; Hermann attributes to histamine toxicity of blood in cases of intestinal obstruction.
Poisons Exist in Excrements
Le Play’s experiments on rabbits showed that intravenous injections of the excrements extract taken from healthy children, as well as those suffering from gastro-enteritis, resulted in the death of the animals within 35-40 seconds.
The same author, as well as Charrin, has studied the effect of chronic intoxication with intestinal poisons on the intra uterine fetus, on growing and adult organisms. In the animals under experiment as compared to control animals, pathologic change were found to affect the heart, the liver, the kidney, the suprarenal glands, the bone marrow, the blood and the nervous tissue.
The growth of bones was greatly retarded and they became more brittle; the content of mineral substance, chiefly of calcium phosphate decreased.
Hetchmann, for the purpose of studying the effect of fatty acids, introduced per oz. and subcutaneously with a view of bringing about pathologic changes similar to those produced in intestinal intoxication. The experiments lasted from 4 to 11 months. In two weeks already, both in cases of subcutaneous injections and of introduction of lactic acid per oz., the following changes appeared in dogs and cats : the thickening of the epitheses of long bones and of the anterior ends of the ribs, curvature of bones, enuciation, diarrhea and catarrh of various mucous membranes.
Lactic Acid Causes Bone Softening
All these changes progressed at the beginning, but on the second-third month from the beginning of the experiment the changes decreased and the bones began to return to the normal conditions. If lactic acid was administered over 4-5 months a softening of the long bones occurred, reaching the flexibility of whale bone. The author comes to the conclusion that under the influence of lactic acid, chiefly in carnivorous animals, rachitis is developed first and is followed by osteomalacia.
According to Marfan and Lepsky, infection and intoxication contribute towards the development of rickets.
According the Shabad the ash content in the bones of rickety children reaches 21%, whereas in normal children it is equal to 60%, the decrease taking place at the expense of lime and phosphorus. Shabad, Howland and Findlay consider that the cause of the deteriorated balance of lime and phosphorus lies in the unfavorable conditions for the absorption of these substances from the intestines.
Gassman, Entin and Loukomsky dwell upon the general pathogenesis of rachitis and caries; Gassman discovered during rachitis and caries, besides the disturbed balance of lime and phosphorus, an accumulation of magnesium salts: a fact which is one of the important etiological factors of rachitis and caries, as magnesium disturbs the normal calcification of bones and teeth, the author’s paper on chemical analyses of carious teeth also proved a decrease of Ca and an accumulation of magnesium.
As is evident from the above, the etiology of rachitis is considered to be connected with gastro-intestinal intoxication, and a general etiologic factor is recognized to exist in caries and rachitis.
Bassler mentions the fact that little attention is given to the intestines as a source of teeth affection. According to this author a “dead tooth” –the cause of infection of which has not been discovered in the mouth cavity –is a symptom of infection and intestinal intoxication and requires attendance both of a stomatologist and therapeutist; these are teeth the crowns of which are unimpaired, or even completely intact, whereas the tooth is dead, although it has never been injured or touched with an instrument by a dentist; infection had penetrated it through blood owing to intestinal intoxication.
As mentioned above experimental work on animals with gastro-intestinal intoxication led to a number of pathologic changes in bones; brittleness, decrease of phosphoro-acid salt content, thickening of the epitheses of long bones and of anterior ends of the ribs. It was natural to expect that changes should take place also in solid tissues of the teeth; in the literature accessible to us, however, we discovered no articles dealing with this question, we, therefore willingly accepted Prof. M.M. Pavlov’s suggestion to study experimentally on animals chemical changes affecting the enamel and dentin; simultaneously deviations from the normal condition of the mouth cavity mucosa were observed.
The experiment was made on 4 dogs; with the object of producing decomposition of food in the intestines of the animal; a number of large intestine structures were made: 100 gr. meat was added to the daily food of the animal. No pathologic changes were observed either in the mucous membrane of the mouth, nor in the teeth before the experiment: the color of the gums was normal, the teeth were free from dental calculus deposit.
Already in a fortnight after the experiment, however, in dog No. 1 in the region of canines and bicuspids a clearly expressed red margin was noticeable at the neck of the teeth, which was more distinctly expressed on the upper than the lower jaw; the mucous membrane above the margin affected with hyperemia remained normal. A month after the experiment the red margin at the neck of the teeth was more marked the rest of the gum having acquired a darkish red color; a greenish deposit of calculus and a swelling of the gum were noticeable on the right upper canine.
Hyperemia Produced in All Teeth
In the region of the front teeth hyperemia was less marked that at the molars; at the latter the mucous membrane bore an inflammatory character. This dog was 70 days under observation. Towards the end of this period the mucous membrane of the gum begins to return to its normal condition with the exception of the region adjacent to the neck of the tooth, where the marginal parodontitis lasted the gum papillae bled at the molars and under pressure discharged pus.
In dog No. 2 the same symptoms were observed as in dog No. 1, the red margin at the neck of the teeth comprising a wider region. Ten days after the experiment changes were already observed in the mucous membrane. 25 days after the operation a small ulcer appeared on the gum in the region of the upper right lateral which increased in size during 6 days, reaching the size of a pea; it remained unaltered for another 10 days, then it began to diminish and disappeared altogether two months after the operation; a small ulcer also appeared on the gum at the second incisor and lasted for 20 days; a deposit of dental calculus on the molars, gingivitis in the region of the necks, easy bleeding of the gums were observed; at the neck of the upper right cuspid, the crown of which was removed with a saw, a small quantity of pus was discharged under pressure of the gum. The dog was 7 months under observation; the red margin remaining in the region of the dental necks and the rest of the gum bearing a bluish red tint.
In dog No. 3 the same changes of the mucosa were observed as in the first two animals.
The changes in the mucosa stood out with particular sharpness in dog No. 4 whose gums before the operation had been of a delicate pink color; five days after the operation s sharply outstanding red margin was denoted in the region of the canines and molars; a bleeding of the gums both on the upper and lower jaw was observed. The teeth, which had been absolutely white before the experiment, were now covered with a yellow coating; an erosion about 2 ctm. large appeared on the mucous membrane of the interior surface of the upper lip and lasted ten days.
Five weeks after the experiment the bleeding increased to such a degree that it was sufficient to open the mouth for the blood to appear. The dog was under observation for 6 months, the general condition of the gums improved but the red margin remained.

In the present paper we were interested chiefly in the mineral content of the enamel and dentin. The content of calcium, phosphorus and magnesium were determined before the experiment as well as at various intervals -1, 2, 3, 5 and 6 months after it; the date obtained in each separate analysis represent the mean number of all the four analyses.
Table I shows analyses of each dog separately made at different intervals. Diagram I shows the difference in percentage after the experiment as compared with data obtained before it; this table shows that the Ca content in enamel in dog No. 1 fell within 70 days by 5.8%; no changes were discovered in the dentin; later analyses could not be made in this case, the dog having died during anesthesia.
In dog No. 2 the decrease of the Ca content in enamel varied between 7.7 and 15.8% within the period from 2 to 6 months; in dentin it reached 18.5%
In dog No. 3 a successive decrease of the Ca content in the enamel was observed; in 38 days after the experiment by 2.6% ; in 80 days 8.9% and in 156 days by 12.1% ; here we came against the only case in which the Ca content in the dentin was increased (38 days following the experiment) ; in 80 days, however, a decrease by 8.7% was discovered.
In dog No. 4 during the entire period of the experiment (138 days) the lime content in the enamel remained unchanged, whereas in dentin a successively progressing decrease was observed; 4.3%, 11.0% and 18.6%
With regard to calcium exchange a decrease thereof has been noted in the enamel and dentin of three dogs – a picture similar to the one given, by analyses of carious and pyorrheal teeth in man (Gassman’s, Kaushansky’s and Ulrich’s papers) and in the enamel and dentin of animals as observed in the study of the neurotrophic factor (Entin and Kaushansky). The disturbance of phosphorus exchange also showed a tendency towards decreasing the P content in enamel decreased in three dogs, and in dentin in all four; the highest figures of the fall of the P content were as follows :
In Enamel In Dentin
Dog No. 1 ……………. 34% 37%
Dog No. 2 …………… 18% 31%
Dog No. 3 ……………. Without change 29%
Dog No. 4 …………… 11.5% 17%

The magnesium content, contrary to that of calcium and phosphorus, in pathological cases, showed a tendency to accumulation. We noted the same phenomenon in enamel and dentin in the present experimental work; the greatest of its increased content was as follows:
In Enamel In Dentin
Dog No. 1 …………….. 43% Without change
Dog No. 2 …………….. 170% 161%
Dog No. 3 …………….. 166% 295%
Dog No. 4 …………….. 146% 40%
The high per cent of the prevailing magnesium content in solid tissues of the teeth after the experiment will not seem surprising if we bear in mind analyses of carious teeth and rachitic bones made by Howe and Gassman, which is also showed a considerable per cent of the magnesium content increase.
It is very important not only to establish the electrolyte contents both in a normal and pathological condition, but also to determine their ratio : it is known, for instance, that for preventing of rickets a definite ratio must exist between Ca and P content in food. McCollen and Park proved that rickets can be caused in mice by keeping them on diet with a small Ca and a large P content, or the reverse, of food containing much Ca and little P. Insufficiently balanced Ca and P mixtures contribute to the development of rickets; the
Ca P in normal serum is equal to 2.0 ; when rachitis reaches its climax it is equal to 3.5 ; in tetanus it falls to 1.2 (Gyorgy).
In our experiment, as seen in diagram No. 2 the Ca coefficien of enamel deviates P from the normal average most markedly in dog No. 1, in the other animals the differences
is less considerable; with regard to dentin the ratio of these salts is notably disturbed in three dogs, while in the case of the last dog it is less noticeable. Magnesium accumulation in solid tissues of the teeth brought about a corresponding fall of the Ca coefficient; this Mg can be seen in the same diagram botn in the enamel and the dentin of all the animals with the exception of dog No. 1 in whose dentin this ratio was hardly at all distrubed.
Some indications of Ca coefficient values exist in literature, thus in blood it is equal Mg to 2.7-3.3 ; in the brain, the muscles and the heart it is below a

unit. In the bones this coefficient equals 46.7 ; we foundno indications with regard to teeth.
According to data of my chemical analyses of second teeth it can be established that the Ca coefficient is equal to 47.5 –a value approximating the ratio of these salts in bone.
Mg
The fact of the fall of the Ca coefficient in the tissues of the animals teeth after the
Mg
experiment indicates pathologic changes in salt metabolism which can be confirmed by indicators of said coeficient during various diseases as compared to the normal condition.
The data submitted by us have, so far, not yet been published, as the calculations based on separate Ca and Mg analyses were made by us but quite recently (see diagram No. 3).
Coefficient

(a) after Kaushansky’s paper –
In the entire tooth In the crown In the root
sound tooth ………. 47.5 63.1 35.7
carious tooth …….. 41.3 47.9 36.0
pyorrheal tooth … 29.0 44.5 20.3

(b) after Entin and Kaushansky’s paper, “The Effect of the Neurotrophic Factor on Mineral Exchange” –
In the maxila
First series of animals Second series of animals
Control …………… 88.57 98.05
Experimental .. 66.90 74.26
In the enamel
First series of animals Second series of animals
Control ………….. 73.55 89.61
Experimental .. 63.06 72.62

(c) after Gassman’s analyses –
Prehistoric canines ………………………. 93.19
Contemporary canines ……………….. 34.23
Normal bone …………………………………. 244.8
Rachitic bone ………………………………… 29.2
Summing up the present investigations we cna state that during experimentally cauesd intestinal intoxication in dog the following changes were observed :
(1) Inflammatory condition of the gum mucosa, bleeding and the appearance of ulcers.
(2) Deposit of dental calculus.
(3) Decrease of the Ca and P content in enamel and dentin.
(4) Magnesium accumulation in enamel and dentin.
(5) Deviations from the normal of the Ca coefficient in enamel and dentin.
Mg
(6) Deviations from the normal of the Ca coefficient in enamel and dentin. P

BIBLIOGRAPHY
1. Anchkov, N. P. –Manual on Pathological Physiology. 1928. Leningrad.
2. Astanin, P. P –Biochemistry. 1933. Moscow.
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11. Koreachevsky, V. –On the Theory of Gastro-Intestinal Auto-Intoxication, Dissertation. 1909. Moscow.
12. Kaushansky, L. –Dental Cosmos. 1935.
13. Kaushansky, L.-Dental Cosmos. 1932.
14. Lepsky –Complete Medical Encyclopedia. Vol. 28. 1934. Moscow.
15. Marfan –Quotations after Lepsky.
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17. Marfan –Quotations after Korenchevsky.
18. Samarin, N. L –Soviet Medical Periodical. 1935.
19. Charrin –Quotations after Korenchevsky.
20. Shabad – Quotations after Lepsky.
21. Entin, D. A., and Kaushansky, L. I. –Contemporary Problems in Stomatology, 1935. Leningrad –Moscow.

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