Sources of Vitamin D and Inhibitive Effects on Dental Carries

By S. M. WENGER, B. S., and R. L. HOESLY, B. A. of The Wisconsin Alumni Research Foundation

The reduction and prevention of dental caries is a problem uppermost in every Dentist’s mind. In this series of articles we have presented a resume of much authoritative clinical data from scientific journals on the Relation of Vitamin D to Dentistry with particular reference to the problem of caries.

Our initial article dealt with the factors n the cause and prevention of dental caries as defined and outlined by Dr. Kugelmass. Each Factor was further enlarged upon with citations of clinical studies by numerous other scientists.

The relations and importance of the tooth and bone building Vitamins D, and the minerals, calcium and phosphorus, in the prenatal diet were discussed in the second article.

The scarcity of Vitamins in average diets, and the relation of this dietary deficiency to the problem of the prevention of dental caries as well as that of rickets, plus a summary of the factors which obstruct the formation of Vitamin D in the body by sunlight, were discussed in the third article of this series.

The fourth and final part of this survey of the literature discusses the sources of Vitamin D and their inhibitive effects on caries.

“Sunshine” Vitamin Long Neglected

In retrospect, it now seems strange that the importance of sunlight and its effects in the building of the human body were so long ignored and so poorly understood. P. Armand Delille says, “For centuries medicine did not attach any importance to physical agents and did not recognize the action of light and specially sunlight, on the organism, on its equilibrium and development, although the gardener knew perfectly well that a plant cannot grow and give flowers in darkness.”

With the prophetic insight the French historian, essayist, and poet, Michelet, in the middle of the 19th century after he had been watching children playing on a sun-bathed beach, wrote, “De toutes les fleurs, c’est la fleur humaine qui a le plus besoin de soleil (of all the flowers, it is the human flower that most needs the sunshine).”

True, for centuries fish liver oils were known to be effective antirachitic medicinals. But the nature of the active principle remained unknown, and its general use was limited by the lack of scientific standing of the product, the crude methods for preparing this product, its former lack of standardization, and its non-too-pleasant taste.

Steenbock and Hess Discover Benefits of Ulta-Violet Light

The greatest progress in providing the essential Vitamin D dates from the discovery by Steenbock and Hess who almost simultaneously found a practical way for using ultraviolet light to synthesize this bone and tooth nourishing factor.

Sherman comments on this discovery when he says: “The production in the laboratory of an antirachitic substance was accomplished independently by Hess and by Steenbock, who noted that the exposure of many edible materials to ultra-violet light endows them with the ability to prevent or cure rickets.” Schlutz has named it one of the great biologic discoveries of the age.

Vitamin D Important in Prevention of Dental Caries

With reference to dentistry the following comments are significant. Agnew, Agnew and Tisdall have stated that, “In man, the addition of Vitamin D to diets previously considered adequate in all respects, including phosphorus, is an important factor in the prevention of dental caries.”

Jacobs has said, “If the baby’s diet lacks sufficient Vitamin D and insufficient calcium is deposited, rickets develops and there is delayed eruption and development of the deciduous teeth. Such teeth are soft and tend to decay readily, lose the alveolar crest and suffer from root exposure.”

Drake designates the constant necessity for ample Vitamin D when he says, “The literature of the decay of teeth, gives definite evidence that Vitamin D is necessary throughout the whole of life.”

That the influence of Vitamin D on the development and health of the teeth is extremely important, has also been substantiated in the studies conducted by May Mellanby who extended her observations to children and has shown that the addition of Vitamin D to the diet significantly retards the progress of dental caries.

McBeath has also obtained results similar to those of Mrs. Mellanby’s.

Jamison and Cox, working in New Zealand, reported a lowered incidence of tooth decay as a result of the administration of Vitamin D.

Eliot, Souther, Anderson and Arnim found that the incidence of hypoplastic defects as well as the lessened incidence of caries were possible with the administration of Vitamin D.

We have called attention in our other articles to the research work of such men as Boyd and Drain, Price, Bunting, Howe, Hanke and others who feel definitely that tooth decay can be markedly reduced by dietary means, provided sufficient amounts of Vitamin D are present.

Milk Excellent Carrier of Vitamin D

Milk, because it is “the most nearly perfect food,” a primary food for infants and growing children, and because it is the richest dietary source of calcium and phosphorus was at once considered for Vitamin D activation by means of the Irradiation process. In this connection, Friedman comments as follows; “Cows’ milk — the chief dietary substance of artificially fed infants has been endowed with a number of virtues by a kind of Providence, but it does exhibit a few deficiencies; one of these is a relative lack of the anti-rachitic factor, Vitamin D.”

He continues: “Rickets has always been an extremely common condition in childhood and even in recent times, n spite of our newer knowledge of nutrition and increasing number of anti-rachitic medicinal agents, has been and is fairly prevalent due either to the failure to offer anti-rachitic substances to babies of to the offering of insufficient amounts of these substances. Thus a milk in which the Vitamin D content is sufficiently high to afford complete protection against rickets is, a priori, distinctly advantageous inasmuch as it represents an automatic form of prophylactic therapy.”

That the choice of milk as a substance for Vitamin D enrichment was well founded is indicated editorially by the Council of Foods of the American Medical Association which has declared, milk is most suitable as a carrier of added Vitamin D since this vitamin is concerned with the utilization of calcium and phosphorus of which milk is an excellent source.”

Steenbock Process Applied to Four Kinds of Milk

Today, the Steenbock Process is applied to four types of milks: Irradiated Fluid, Irradiated Evaporated, Metabolized and Dry Milk. In the first two types, the milk is exposed directly to either carbon arc or quartz mercury ultra-violet generators as it flows over polished metal in machines known as irradiators. The ultra-violet light impinging upon certain sterols naturally present in milk converts them into active Vitamin D.

This process is identical to the manner in which ultra-violet rays of the sun create Vitamin D in the body, when it is possible to have them directly contact the skin.

Metabolized Vitamin D milk is produced by feeding accurately measured amounts of Irradiated dry yeast to milch cows, usually with the grain ration. The Vitamin D in the yeast is thus transmitted into the milk of the cow. Dry milk is also irradiated by direct exposure to ultra-violet light.

Commenting on the efficiency of Irradiated Vitamin D milk, the late Dr. C. U. Moore said, “Another important discovery is that milk, properly exposed to ultra-violet light, has its Vitamin D content increased ten-fold. In proportion to its content of standard Vitamin D units, Irradiated milk is much more effective for human beings than any other source of Vitamin D. This is doubtless due to the fact that the calcium and phosphorus are abundant in milk and are properly proportioned one to the other.”

Gerstenberger et al, in a carefully controlled curative study, fed Irradiated milk and yeast (Metabolized) milk to rachitic infants. By roentgenograms and serum calcium and phosphorous determinations, they concluded that both milks were equally effective.

Wyman et al in a similar study, reached an identical conclusion.

Vitamin D Supplies Tooth Essentials

In connection with the enrichment of milks with Vitamin D, Mary Swartz Rose has stated, “The practice of commercially increasing the Vitamin D content of milk is making another valuable source of Vitamin D available to everybody.”

“The peculiar effectiveness of a Vitamin-D-ized milk over any other antirachitic treatment,” according to Shrader, “lies in the fact that the same medium that carries the Vitamin D also supplies the calcium and phosphorus.” And of course, as we know, the minerals calcium and phosphorus plus the Vitamin D are the three factors most important in building and maintaining healthy bones and teeth.

Shrader carries the importance of a Vitamin-D-inclusive diet even further when he says, “Finally, the newer knowledge of the role of diet in dental caries together with a greater appreciation of the significance of calcium and phosphorus metabolism in optimum nutrition, places Vitamin D milk in the category of a food which is of great value to adolescents and adults.”

According to Armand-Delille, “At the age of puberty a very important need of a rich ration is called for. Calcium is very important in connection with the rapid development of the bones. Teeth often decalcify at that age.”

In addition to the Vitamin D enrichment processes which are based on the Steenbock Irradiation method, the Zucker process is also utilized extensively. It is based on a process through which Vitamin D is obtained in concentrated form from cod liver oil after which it is emulsified in cream and added directly to milk. This concentrate is also used for Vitamin D bread and other food products.

Other Foods Enriched With Vitamin

In addition to the Irradiated evaporated, fluid and dry milks, and metabolized milk, several other staple foods have an increased Vitamin D content through the application of the Steenbock process. These foods include only such logical Vitamin D carriers as cereals, milk drink accessory foods, flour and bread.

In commenting on the enrichment of cereals with Vitamin D, Dr. Gunderson has stated, “For reasons of economy and because of their physical character, the cereals are well adapted to act as vehicles for carrying certain vitamins and minerals inexpensively, conveniently, and automatically to the people who need those substances most. Cereals so enriched are more nourishing than the same products without those additional food adjuncts.”

Fortunately, Vitamin D is remarkably stable. When introduced into flour, and bread for instance, it is not destroyed by the heat of baking. Likewise in milk, pasteurizing does not injure the Vitamin D content. Moore brings out this fact in his statement concerning pasteurization, “The heat is not prolonged enough to affect the Vitamin D content of the milk.”

As prophylactic measures, the foods enriched with Vitamin D are valuable for the prevention of rickets and dental caries. Foods so enriched bring to the diet an automatic and easily available source of this Vitamin. Scott says, “Realizing our responsibility, we embarked upon a definite research plan some years ago in order to provide sufficient Vitamin D in some commonly consumed food stuff which could serve as an automatic method of preventing rickets and these calcium deficiencies. Our idea was not to make a medicine of this foodstuff, but to provide sufficient Vitamin D to maintain a normal calcium metabolism.”

Viosterol Used Extensively

The desirability for developing a medicinal product which could be administered readily in concentrated form was recognized when Steenbock announced to the discovery of the irradiation process. It was found that certain sterols could be activated with Vitamin D to a high potency, and when suspended in a bland oil and carefully standardized would provide an excellent medium for both prophylactic as well as therapeutic use. This product is marketed under the name of Viosterol.

Viosterol is also used to increase the Vitamin D content of cod and halibut liver oils and other products sold in vials, capsules and tablet.

The various studies discussed in our previous articles indicate the beneficial results obtained by the use of these medicinals in the cure of active rickets and caries. In cases of this kind, of course, these medicinals are administered under careful supervision, although the studies and statements of such men as Fishbein, Steck-Deutsch-Reed-Struck, and other, clearly indicate that animal as well as human subjects can tolerate thousands of times the daily therapeutic does without any harmful effect.

Anderson et al in amore recent study also concluded that, “The administration of Vitamin D in the form of irradiated ergostero to children living under good hygienic and dietetic conditions markedly decreased dental caries.

20,000 White Rats Used to Assure Uniform Potency

The Wisconsin Alumni Research Foundation, a non-profit organization, which licenses milk companies, pharmaceutical houses and food manufacturers to enrich their products with Vitamin D by means of the Irradiation Process, definitely limits the commercial use of this process to such products as are logical carriers of Vitamin D.

The potency of Irradiated products is carefully controlled. The equipment and methods used for Vitamin D enrichment are standardized so as to assure uniformity of Vitamin D content. In addition the potency of these products is periodically determined by bioassays employing the Johns Hopkins Line Test technique, not only by the manufacturers themselves but by the Foundation as well.

Last year 20,000 white rats were used in the Foundation’s laboratory alone, in order to assure constant uniformity and unvarying dependability of its licensed Irradiated Vitamin D products.

Madison, Wis.