Dental Caries, A Nutritional Deficiency Disease

A Balance of Mineral and Glands Aids Caries Prevention

Dr. Melvin E. Page Explains the Factors

Involved in Systemic Imbalance, in



                This talk is in nature of a report of progress in personal research. Research which though incomplete shows definitely that at least some, or rather all of dental decay that I have encountered is due to nutritional deficiency and as such is preventable.

According to some well known medical authorities, practice of medicine is passing from the infectious or bacterial concept al all disease to that of the physiological. That bacteria are the secondary invaders, the culture medium comes first. We all remember how hard it was to raise cultures in improper media. People in good health might be said to make poor culture media.

Knowledge of Deficiency Diseases is New

Dr. Russel Hayden in the January 25th issue of J.A.M.A. has this to say—

“The fact that disease may result from the lack of something has been appreciated only recently. Up to fifty years ago all disease was ascribed to tumors, microbes, poisons or other pathogenic agents. Then cretinism and myxedema were recognized as manifestations of a deficiency in thyroid secretion, and in 1891 thyroid extract was used as replacement therapy.

Now many symptoms and syndromes are known to result from defects in secretion of the endocrine glands. More recently symptoms due to a deficiency in specific factors in nutrition have been recognized, so that the group of negative diseases has been greatly enlarged. An insufficient intake of all food results in malnutrition, but with the exception of edema due to a low blood protein content a deficiency in protein, fat and carbohydrates causes no specific signs or symptoms.

The mineral salts are vital for all animal life. Each salt probably has a specific function, although a deficient supply with a characteristics clinical picture. A deficiency in calcium may cause tetany, and a deficiency in iodine, a goiter. A deficiency in iron is much more frequently followed by clinical symptoms than is a lack of other inorganic substances, since the reserve store in the body is small and anemia quickly develops if the supply is not sufficient.


Volume II September, 1936

                Read before Evanston Dental Society, Mar. 10, 1936.


With the discovery of the vitamins and the demonstration that they are essential to normal nutrition, signs and syndromes due to a deficient supply of these specific elements have been recognized. The mineral salts and vitamins must be taken into the gastro-intestinal tract, since the human body is unable to manufacture vitamins as well as mineral salts.

The field of deficiency disease is developing rapidly. A deficiency in each specific nutritional element results in characteristic signs and symptoms, and, if the deficiency is continued long enough and is sufficiently intense, a clinical syndrome which is designated a disease may result.”

Grant in his book “The Passing of the Great Race” which deals with the ethnology of the white race, brings out these pertinent facts. That the Nordics who are characterized by long heads, light hair and blue, grey or green eyes, have played a very important part in the history of the world. He claims that as a rule they are mentally and physically the superior of any other race or sub-species of race on the earth.

Sturdy Nordics Founded Country

The founders of our country were Nordics. They were pioneers, fighters and mentally above the average. Nordics were able to conquer a great many peoples with lesser endowment of these qualities. Through the course of history they penetrated as far east asIndia, as far south as the southern tip of Africa and as far west as theEast Indies.

Although comparatively few in numbers they became the rulers of these less fortunately endowed peoples with whim they came in contact, but mostly after a few centuries of rule they disappeared, being absorbed by these other races if they did not exterminate them, so that today in many of these lands but a few scattered individuals show traces of Nordic blood.

Grant’s contention is that the Nordics need a cold, moist climate for their well-being; that they do not survive in warm climates; being less well protected from the actinic rays of the sun than darker skinned peoples. Possibly there is a different explanation for the disappearance of these Nordic invaders.

Lower First Molars Decay Early

Doctor Breckhus of the University of Minnesota in classifying the prevalence of dental decay both as to age level and as to individual teeth, states that at the University where nearly a half-million teeth were examined, there were nearly only three percent perfect lower first molars in the mouths of people between the age levels of ten and twenty while in the age level above sixty there were approximately 13 percent sound lower first molars. Perhaps this is an indication of the gradual deterioration of descendants of Nordics only one or two generations removed from the original Nordic settlers of that region. If such a degree of deterioration were continued for several generations it is easy to see that the race might totally disappear.

Possibly the explanation lies in a different field, for the Nordics and their descendants in Minnesota do not live under such different climate conditions as their forbears did in Scandinavia.

According to Grant the Nordics have been for thousands of years dwellers in coastal regions and as such have depended very largely upon the sea for their food.

The sea contains minerals found but little or not at all in soils due to the leaching process of centuries or rainfall. All food grown in the sea contains these minerals while land grown food contains comparatively little since the plants must depend upon the soil in which they grow for them.

These sea minerals have become an essential ingredient to the adequate nutrition of long-headed individuals. This contention is born out by the fact that that only localities in which these Nordic descendants have survived through several generations are in coastal areas, and by the fact that inland living peoples are generally round-headed while all coastal peoples are long-headed.

I believe that my work upon the effect of these trace or sea minerals upon the endocrines and effect of the endocrines upon the calcium and phosphorus level of the blood throws light upon this subject and also upon the cause of dental decay.

If there is a general derangement of the metabolism throughout a great proportion of the peoples or the earth then this, and not dental decay, is the most prevalent disease, for dental decay is but one of the symptoms of altered metabolism. Recent research has shown that many previously unrecognized symptoms are due to faulty metabolism.

Dr. R. G. Hoskins, director of Neuro-Endocrine research atHarvardMedicalSchoolhas this to say about one of the endocrines, the thyroid:

“In the lower part of the neck lies the thyroid gland; when its secretion is completely lacking the individual lives at only about half the normal vital speed. He is listless, mentally stupid, and sluggish of memory. Aside from a tendency to subdued truculence, his emotional life is almost colorless.

Fortunately, thyroid deficiency of this marked grade is rare. Unfortunately, however, lesser degrees of thyroid deficiency are quite common and are frequently overlooked even by excellent physicians. The victims are likely to be over-weight, though this is by no means always the case. They fatigue easily and on slight provocation become cross and irritable. They are able to pull themselves together for brief periods, but soon relapse again into their feeling of inadequacy.

Statistics on this subject are not available, but it is altogether probable that a considerable proportion of the unfortunates who go through life labeled “neurasthenic” or “psychoneurotic” are victims of this mishap. It must be emphasized that there are many causes other than thyroid deficiency for this state of affairs, but in those cases in which it is the cause the condition is readily corrected. Sometimes even as little as one tenth of a grain of thyroid substance a day is sufficient to restore the individual to satisfying normality. Commonly less than one grain a day is needed.

Unfortunate as are the results of thyroid deficiency, even worse is the opposite condition. Over activity of this gland gives rise to a condition of alert tenseness by which the person may be driven to death. He may live at twice the normal speed. Even with a voracious appetite he is unable to keep the vital furnace adequately stoked, and often literally burns himself out.

Mineral Imbalance Causes Disease

Besides these clinical symptoms and syndromes there is supporting evidence that not only caries is mainly caused by abnormal metabolism, but also most forms of arthritis and other diseases due primarily to calcium-phosphorus imbalance.

In the light of these findings it becomes more easy to understand why the Nordics, after living for a few generations inland, become extinct.

A number of observes have thought for some time that if we knew what was in the blood serum and properly evaluated the contents, we would have the key to all bodily processes, for both the food supply, the hormones and the products of disintegration of the cells of every part of the body pass through the blood stream.

The blood stream can be likened to our highways, railroads and waterways. They are the avenues of commerce, through which our food supply, our raw materials for manufacturing and one manufactured products are shipped to the consuming points.

This principle is used by our economists to determine the commercial heath of the nation in daily reports of car-loadings.

The author also had the idea that analysis of the blood stream for calcium and phosphorus and its proper interpretation would throw light upon the problem of dental caries, since tooth structure is composed mainly of these minerals. Such analyses were made upon patients for a number of years, hoping that eventually they would have some significance. Very little progress was made for some time although it was noticed that those patients having both a high calcium and a high phosphorus level were immune to caries, while those patients having either a low calcium level or a low phosphorus level or both were susceptible to caries.

Insulin Therapy Stops Dental Caries

Except in this one respect very little progress was made until it was noted from the examination of the analyses of hospitalized patients that diabetic patients as a rule had very poor teeth but that after insulin therapy, active decay had stopped. Another interesting finding was that many of these patients, after insulin therapy, had a blood calcium and phosphorus of ten and four and that practically all of them it they did not have readings of these figures had ones in the same proportion  as ten is to four.

The author conceived the idea that possible calcium and phosphorus were not used singly by the tissues but together as a compound, and that these two elements unite in the proportions of 10 to 4 to form this usable compound. The evidence since that time supports this conclusion so that when we need a consistent 10 to 4 ration of the calcium and phosphorus of the blood stream we know that that patient has a correct metabolism.

This is a much more accurate method of determining correct metabolism than the method used generally, that of oxygen consumption measurement per a given period of time.

If the product of the usable calcium and phosphorus is thirty or more in people who have attended their growth which is generally above the age of 18, they are immune to caries. Before the age 18 this level must be higher to make them immune. After middle age this product can be lower than these persons be still immune to caries.

Since insulin is an endocrine product it was thought possible that some other endocrine product might have a like result. With thyroid this was found to be the case; those patients having a low phosphorus who also showed hypo-function were given thyroid and the phosphorus level increased. Some patients having hypo-function had a high phosphorus level, these were also given thyroid and the phosphorus level decreased; the end point being apparently about 40 % of the calcium.

Later on it was found that Kelp would do the same thing, not only in patients having hypo-function, but in patients having hyper-function. Since Kelp was much safer to use than insulin and thyroid, it practically supplanted these endocrine products, as the same result was obtained in a large percentage of the cases. Upon the re-examination of these patients using the usable product of the calcium-phosphorus level as a yard stick it was determined that with patients over 18 years of age having a usable product of 30 or more there was absence of dental decay. While nearly all of those patients having a usable product of 30 or less showed the present of active dental decay.

This threw light on another problem of dentistry—namely—the accumulation of calcular deposits upon the teeth—these deposits were found to be great in proportion as there was excess of calcium above the amount which would combine with the phosphorus present. And when a ratio of 10 of calcium and 4 of phosphorus is obtained, there was no evidence of calcular deposits. Therefore the assumption is—that calcium greater in amount than can be used by the phosphorus is more or less free calcium and is excreted through secretions made from the blood—one of which is the saliva.

Another fact noted was the presence of serumnal calculus, and irritated gums when the phosphorus level was more than 40% of the calcium level. When the phosphorus level was reduced to the correct proportions this irritation or gingivitis often cleared up without surgical interference. I do not mean to say that surgical interference is unnecessary when there are serumnal or salivary calculary deposits. I mean to say only that both local and systemic treatment should be used together rather than either one singly. Nor do I mean to say that the administration Kelp, thyroid, or insulin always brings the phosphorus level to correct proportions; it does not, but it does in a great percentage of the cases.

Calcium-Phosphorus Must be in Balance

Between the ages of 18 and 50 the usable calcium-phosphorus level must be 30 or more to insure against dental decay. To secure this minimum level there must be at least 8.7 mg of calcium present and 3.5 mg of phosphorus. Out of 745 tests examined but 85 were too low in calcium, while 235 were too low in phosphorus. These figures would indicate that the phosphorus level is three times more important than the calcium level as a cause of dental decay, yet we have heard very little about the phosphorus level of the blood, but a great deal about the calcium.

Below the age of eighteen the calcium-phosphorus level should be higher because in these years is the growth period and the demand for calcium and phosphorus as building materials is great. The proportions of calcium and phosphorus used is the same as at the other ages. In people past 50 the calcium and phosphorus levels may be quite considerably below the usable product level of 30 and that individual be still immune to dental decay, because at this period of life there is no material needed of growth, and the need of material for maintenance is greatly lessened.

Ordinary Diet Contains Sufficient Minerals

Naturally there are other things besides the functioning of the endocrines which affect the calcium phosphorus level of the blood. Such as for instance the amounts of calcium and phosphorus in our food.

Much has been written about this subject so the author will dwell but little on it, except to say that I think that in this territory a diet containing sufficient of these minerals is not hard to obtain and that the ordinary diet contains sufficient of them. The author believes that this phase of nutrition has been overly emphasized at least in our northern states. My reasons for so thinking is that our cereals and protein contain a plentiful supply of phosphorus and from the calcium levels recorded on over a thousand tests many of which were taken on people who have been on diets supplied by the county, there has been  but little evidence of insufficient calcium intake. Likewise I believe that vitamin D intake has also been overemphasized. Some no doubt is helpful due to our lessened exposure to ultra violet rays than our ancestors, especially those of us living in cities, and in all probably negroes living in the north get much less vitamin D than they need, but I fail to see where Nordics of this generation and in this latitude live under such different conditions in this respect than their ancestors.

The problem of round-headed peoples who live inland is different from that of peoples of Nordic descent. Their ancestors lived for centuries in inland regions and their descendants here do not live under so greatly different environmental conditions.

The chief problem of these Alpine descendants is to obtain food as good in mineral content as the foods of their ancestors. Apparently they require much less of the sea minerals in their diet for their endocrines to function normally.

This is reflected in their phosphorus levels, which are more nearly in balance with their calcium levels than other untreated people in this mineral deficient area.

Quite a little has been written upon the effect of sugar upon caries, but I do not know that anyone has brought out just what the process is.

That this is an important phase of dental nutrition was brought to my attention by my experience with two patients. One was a young woman who shortly after finishing her hospital training got married. She appeared with one or two cavities and several cervical areas of incipient caries. I was interested in determining the reason for them. The diet was investigated and found to be good. She had a nearly perfect set of teeth. Her metabolism test was nearly perfect, but her blood phosphorus was 3.2.

During the course of the following year I filled about twenty cavities and took several blood readings at short intervals. A great deal of attention was paid to her diet. Cod-liver oil, Kelp, citric fruit, milk and green leafy vegetables were in her daily diet but still her decay progressed.

Suddenly her phosphorus level went up to 3.8 for no reason I could understand. This gave her a usable product of 36, although throughout the previous year her usable product varies between 21 and 25. Then I learned the answer. She explained to me that after she became married she acquired the habit of eating candy to excess every day. She estimated that she ate at least one-quarter pound daily. I suppose this was the reaction to her rigorous training.

She concealed this fact from me until she was sure every other means of stopping her decay were ineffective. In the succeeding year she did not have any cavities at all.

Another girl, a nurse in training whose blood tests I have on record taken every three months and who had been immune to caries for a year, suddenly developed two cavities together with a drop in phosphorus from 4. to 2.9. She had spent the previous six weeks in the diet kitchen and during that time hardly ever ate a regular meal, but satisfied her hunger with cakes and sweets taken whenever the spirit moved her.

At the end of her dietary spree and after her cavities had been filled she has gone a year without further cavities.

These experiences led me to undertake experiments along these lines.

Candy Upsets Phosphorus Level

Subjects of whom I had had numerous blood tests were selected. Immediately after taking a blood test each was given all the candy she wanted and other blood tests were taken at intervals. There was no change in two hours, but in two and one-half hours the phosphorus level dropped five tenths of a milligram and in twenty hours the phosphorus level was still down six tenths of a milligram. This was after eating nine pieces of chocolate candy or one-fourth pound. This was enough to make a difference of nine points in the usable product, so that it can be easily seen that if this were continued daily, decay would be rampant in these people.

At another time four ounces of whiskey was tried upon one these subjects and in twenty hours the phosphorus level fell but four-tenths of a mg. Whiskey is but one-half alcohol so it would seem that alcohol and sugar have about the same effect upon the phosphorus level.

Now how do we know that the functioning of the endocrines controls the phosphorus level? First because we find that insulin and thyroid extract, both products of endocrines, will have this effect upon a low phosphorus level. Second, this is the only therapy known which can be used to raise the phosphorus level. Feeding of phosphorus will not do it.

However, the feeding of Kelp will do it, in most cases, these cases being the ones in which the endocrines retain the power to come back to normal under suitable treatment. Since Kelp contains no endocrine products, the minerals which are in Kelp must act upon the endocrines in such a manner as to enable them to produce a normal amount of the hormones characteristic of the endocrines affected thus enabling them to resume normal function which in turn enables them to control the phosphorus level.

This fits in with a theory recently brought forth. That the vitamins and the minerals do not have a direct effect upon the processes of the body, but have an indirect effect, being the foods of the endocrines.

The parathyroid gland controls the calcium level. Its main food supply is vitamin D. The thyroid is the source of the hormones which controls the phosphorus level. Its food supply is obtained from sea minerals.

The endocrines are all more or less inter-dependant. There are five endocrines which are known to have an influence upon the calcium level. Probably there are five which have an influence upon the phosphorus level.

Again when one endocrine is functioning to lesser degree than normal, there will be a series of endocrines also functioning to a lesser degree than normal, there will be a series of endocrines also functioning to a lesser degree than normal, but the balancing endocrines will be functioning to a greater degree than normal.

Endocrines Glands Affect Each Other

The endocrines may be likened to an endless chain, a chain composed of links each of which represents an endocrine. This chain being carried over a pulley. When one side is pulled down the other side goes up and vice versa.

Such usually happens to the parathyroid when the thyroid is functioning sub-normally. When the thyroid is functioning above normal the parathyroid functions sub-normally.

However, this is not always true. Sometimes both the calcium and phosphorus are low. In this case it may be likened to the moving of the pulley downward to which the chain is hung. Usually treatment which will then raise one of the endocrines to normal function will raise them all.

The use of insulin or thyroid extract or any other glandular extract is but replacement therapy. Replacement therapy while valuable does nothing to correct the condition necessitating such treatment. On the contrary some authorities contend that continued use of a glandular extract in replacement therapy necessitates increased use of these drugs, either due to anti-bodies set up or to the further decline of the endocrine treated.

I believe that no replacement therapy should be used without also an attempt made to supply the nutritional deficiency which was the causative factor in the functional decline of the gland or glands to be treated. In other words an adequate supply of the vitamins and sea minerals in the diet.

Metabolism registration by means of the oxygen consumption method has long been recognized as inaccurate. Not because the machine is inaccurate, but because the rate of body processes varies considerably over even a short period of time. Great pains are taken to have conditions as uniform as possible when undergoing a test, but seldom can two tests be taken on the same subject which will read alike.

Metabolic Rate Determined

Because of this inherent inaccuracy no relationship between metabolic rate and dental caries could be shown, although for some time it has been noted that dental trouble often was coincident with metabolic disorder.

Another method of determining metabolism has been evolved by the author, that of comparative body measurements of females. While this method does not apply to all people or even to all women, within certain limits it is very accurate.

It gives an indication of the metabolic history of the patient rather than of the metabolism at the time of taking the test. Its inaccuracy lies in that the patient may have changed her metabolism at the time the test was taken. Since the relative measurements change very slowly this method indicates rather the metabolism of the previous two or three years. However, 95% of untreated patients have the same metabolism, or approximately so, that they have had previously for some time, and is accurate enough so that the incidence of dental caries can be determined to a very large extent by these measurements.

History Chart Aids Diagnosis

This measurements have been of great value to me in enabling me to recognize obscure symptoms of altered metabolism. They have been of great aid, not only in determining the cause of dental caries, but in deciding the treatment necessary and the probable prognosis of such treatment. They have a great psychological value. It is very convincing to the patient for the dentist without asking questions to be able to enumerate her symptoms and if she has dental decay to tell her just how many she has had annually for several years.

In the examination of patients I use a form. It contains space for all of the information I need to have about the patient to prevent future dental decay in the adult. My practice is one of adults almost exclusively and hence have had very little experience with children.

This chart has place for annual caries average of the patient, the name, date, age, height, weight and where the patient has lived, for how long and where the patient’s parents were born and the ancestry of them; whether the patient has a round head, medium or long head. The chart also has space for the plotting of dental conditions and two columns, one for metabolic measurements and one for three separate blood tests.

Also there is a space to collect information as to the condition of the gums, and to record presence or absence of calcular deposits. Then follows a long list of foods of which those used habitually are underlined. There are lines for remarks, medical diagnosis, and history and another for dental diagnosis and recommendation as to treatment.

Repeated blood tests give us an indication as to the success of failure of our corrective treatment long before we can tell from mouth conditions the results of our treatment. Of this we are sure, when we obtain a high level of usuable calcium and phosphorus we are going to have no further decay, at least as long as this level is maintained. Once reached, this level is so easily maintained that there is very little chance of retrogression.

The effects of corrective treatment on the comparative measurements is less readily seen. On some people, notably young women of Holland descent, the change of relative measurements is very rapid. While in older women of other nationalities the change in measurements is very slight even after a period of two years.

One of most marked changes in those people having heavy calcular deposits is a noticeably lessened rate of deposit. When we get the calcium and phosphorus in correct balance and maintain it we have no calcular deposits on the teeth whatever.

In conclusion I would say that I believe my work, although not conclusive, tends to show that the cause of dental decay is primarily nutritional and that the nutritional factors are:–The presence of adequate amounts of calcium and phosphorus in the diet and the presence of the vitamins and sea minerals which being the foods of the endocrines controls their function which in turn control the assimilation of the calcium and phosphorus before mentioned.

And that the greatest causal factor of dental caries lies in the assimilation of calcium and phosphorus not in their procurement and that endocrine treatment is required to greater extent than any other treatment.

MELVIN E. PAGE, Muskegon, Mich.


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