Practical Application of Preventive Dental Medicine (Part II)

By MELVIN E. PAGE, D. D. S. Muskegon, Mich.

Index of Susceptibility to Dental Caries

In a recent article on Rheumatoid Arthritis in the Journal of the American Medical Association, the writer in effect has this to say. “The lack of a measuring stick in a disease of unknown etiology such as arthritis offers a serious obstacle to progress in its treatment.”
These words may well be used in reference to dental caries and pyorrhea, and one of our first considerations is to find such a “measuring stick.”
The author is convinced that such a measuring stick exists in calcium-phosphorus determinations of the blood plasma.
Many investigators have stated that calcium-phosphorus determinations show nothing as regards caries, susceptibility or immunity, whereas they should have stated that such tests do not show them that the patient is caries susceptible or caries immune.
We are surrounded by phenomena of nature which mean nothing to most of us or all of us but which, could we interpret correctly, would disclose many new facts of nature.
The author several years ago realized that if dental caries were systemic in origin, then the blood stream, which builds and maintains every part of the body, must have in it those factors essential to the completeness or incompleteness of the process. And since calcium and phosphorus were known to be the major constituents of teeth and bone, an analysis of the blood for these minerals must throw some light on the problem of dental caries and alveolar absorption.
Many analyses were studied on hospitalized patients. These people were selected because of the availability of other physical findings. Results were barren for a long time, but finally it was noticed that certain patients who were under insulin treatment for diabetes, had a calcium-phosphorus determinations of about ten to four.
A peculiarity of these findings was that these patients were almost the only ones whose plasma analyses did show these proportions. Another fact was noticed that these patients invariably had had very poor teeth, but at the time of the tests showed arrested decay, as evidenced by blackened carious substance.
The thought came in mind that possibly this ten to four ratio was the correct ratio, and that calcium and phosphorus united to form a compound having this proportion of the ingredients. Since a compound, if there was but one used in the formation of tooth and bone substance, must always be composed of proportional parts of its ingredients, a table was made having different values for calcium and the corresponding values of phosphorus with which these amounts of calcium would unite.
Since the amount of this compound in the blood plasma was determined by the amount of the lowest ingredient available the ingredients of the compound were usable and the portion of either the calcium or the phosphorus left over was called unusable.
For instance of the blood analyses showed there to be twelve mg of calcium and four mg of phosphorus, then the compound could use only ten of the calcium to combine with the four of phosphorus, leaving two mg of calcium in excess or unusable. By multiplying the usable amount of calcium with the usable amount of phosphorus, a figure known as the usable product was obtained. In the above example this usable product would be 10 x 4 or 40.

Tables were made in an attempt to fix the level which this usable product must have, to make donor of the blood immune to caries.
These tables did not show at once just where this level was, because of the difficulty of determining if decay were going on at the time or not and because the author at the time didn’t know that age made a difference.

Eventually it was found that a usable product of 35 or above was desirable for children and that a usable product of 30 or more created immunity in patients past the growing age, from 18 to 40, and from this age there was a gradual decline in the necessary usable product until at the age of seventy only a usable product of about 20 was needed to make that person immune to decay or alveolar absorption.

The author was much pleased to be substantiated in hid conception that calcium and phosphorus unite to form a compound in approximately the proportions of ten to four.
Broderick states that Barille has shows that calcium carbonate and calcium phosphate unite to form a double salt calcium-carbono-phosphate which serves as the nutrient matter for bone and dentine. The formula of this compound would indicate that 10.4 calcium unites with 4 of phosphorus.

Influence of Foods upon Calcium-Phosphorus Levels

In order to effect improvement upon the usable calcium-phosphorus levels, first of all the diet must be corrected so that it contains the essentials for an adequate nutrition for the individual treated, in so far as we know how, and harmful substances must be eliminated.

To this end inquiry is made as to the quantities and kinds of goods habitually eaten. Occasionally are found those who eat no fresh fruits or some who will not eat milk or eggs. Some very little meat or none at all. It is surprising how many have adopted this or that fadism in the way of eating or who have eliminated certain classes of foods altogether in the attempt to make themselves feel better or to reduce.
Almost invariably the author finds it necessary to have the patient eliminate white flour and sugar from their diet, telling the patient that only in this way can a correct estimate of the efficiency of his body chemistry be determined, as white flour and sugar so interfere with the calcium-phosphorus levels as to make the tests valueless.

In explaining that it will not be necessary to be so rigid forever, but for only a month, cooperation is invariably secured

Effects of White Flour and Sugar

The result of eliminating white flour and sugar is to lower the calcium and raise the phosphorus. Ordinarily this is to be desired in the patient susceptible to caries or alveolar absorption.

The effects of alcohol upon the calcium-phosphorus levels are the same as sugar. The author has been unable to determine any bad effects upon these levels from the use of tea or coffee, but has observed deleterious effects from the excessive use of tobacco in the form of smoke in some individuals. These individuals feel better generally when they use moderation in this respect.

Tests are usually taken at weekly intervals. The results of these tests are plotted and graphed. The patient invariably wishes to see his graph each week and takes a keen interest in the outcome. Occasionally a patient with an experimental turn of mind will eat or drink something tabooed without informing his guide, to check up on the dentist. These unknowing tests of the accuracy of the blood analyses are welcome and in fact sometimes it is advisable to inform the patient that he may try out certain tabooed things, as in that way he will find out what the tolerance limits of his body mechanism are.

We learn best by experience, and the chief value we give the biochemistry patient is in teaching him low to live that he may get the most out of life both mentally and physically; that his body chemistry be as efficient as nature intended it should be.

Endocrine Influence upon Calcium-Phosphorus Levels

If our food intake contains all of the essentials and has contained them for a long period, then our endocrines function normally. Practically the only way that the endocrines become unbalanced is by faulty nutrition.

By the same reasoning the only way in which the endocrines can be restored to normal function is by their own powers of recuperation after the diet has been made to conform to the needs of the individual whose endocrines are involved.

By substitution therapy, which is the feeding of injection of an endocrine substance to augment the function of an endocrine known to be producing less than its quota of hormonical substance, we can at times produce a rapid and great improvement in the patient’s well being, but unless we correct the nutrition we have done little to aid that patient’s own gland regeneration.

The endocrines or ductless glands are situated in various parts of the body. They control the chemical processes of the body which includes the assimilation of various food principles. They are the governors of our body processes. Their lessened function, abnormal or normal function, makes idiots, geniuses, or normal people of people otherwise similar.

From our ancestors we inherit tendencies, which if given the opportunity develop subnormal function of some and abnormal or normal function of other endocrines.

Our personalities are dependent greatly upon which endocrines are dominant and which sub-dominant. Countless combinations are possible. Much is known about the endocrines yet the subject has hardly been touched. The student is overawed by the in formation gathered on the subject, yet feels that the labyrinth has hardly been entered.

Fortunately, enough has been learned about the endocrines governing the assimilation of calcium and phosphorus, that we may practice endocrinology in the dental field with beneficial results.

Our first efforts are to balance the calcium-phosphorus levels of our patients by means of dietary correction alone.

The history of the patient and of his parents and of their predecessors gives us at times an inkling of the probabilities of so doing.

Hereditary Influences

We are apt to think of ourselves as independent from our ancestors, whereas we are in fact, but the last link (for a time) in a chain which goes back to the beginning. Nearly everything we are our ancestors were. We as individuals will soon be but a link somewhere back n the chain. May the rest of the chain not be weaker because of the present links. May we look with pride at our ancestors and may they not be ashamed of us.

They had the advantage over us of living under a fairly fixed set conditions, whereas we are the same kind of organism as theirselves but are living under drastically changed conditions. Have we the brains to cope with the situation or will our chain soon come to an end?

These substances are given when indicated, in minute doses. Thyroid in from one-tenth to one-half grain daily or less, and insulin in three unit doses one, two, or three times weekly.

Seldom are other endocrine substances necessary, for the action of these substances in small doses is not similar to their action in larger doses for known deficiencies of the endocrines.

Other substances may well be used at times; a persistently low calcium calls for tenth grain parathyroid substance administered once or more daily. Care must be used to insure an adequate calcium intake, for if there be insufficient calcium in the food intake for the needs of the blood, the parathyroid substance will draw it from other sources such as the bones.

A low phosphorus and high calcium is the characteristic blood picture of the parasympathetically dominant, while a low calcium and high phosphorus characterized the sympathetically dominant.
Concluded in March number.