Dentistry Looks to the Family Doctor

By  A. T. TAYLOR,  B. D. S.,  D. D. Sc.

We are living in an age of alarm, of challenge, of appeal. Public opinion, although ever changing, is being molded by tremendous new powers of publicity –the press, the radio, the cinematograph, and the lecture platform, and, perhaps not excepting politics and economics, HEALTH is the subject paramount in the interests of every one.

Despite the onslaughts of commercial interests and the fervor of the exponents of all the various “isms” and “ologies” that encompass present day health services, the family doctor, as far as the family circle is concerned, still remains the disciple of health and the arbiter of life and death. His influence for good is immeasurable and his power as an institution has grown and developed deservedly and surely from the very earliest days of medicine.

With the passing of the years, medical practice has taken many forms and suffered many changes, including in its tenets beliefs previously intolerable and unacceptable, seeing the development of new departments and subdivisions of medical science and ultimately the emergence of specialties. Continually during these periods of change there has occurred from time to time an altered emphasis even in regard to the manner of treatment of disease.

The acknowledgment that dental sepsis is a definite causative factor of ill health and that much focal infection has its origin in the teeth, directed attention to the elimination of these sites of infection as a necessary step in the treatment of disease.

The Elimination of Dental Sepsis

From the recognition of these factors comes logically the inference that an essential and positive step in disease prevention would be the elimination (if possible) of dental disease. Therefore, it surely becomes part of the physician’s essential responsibilities to assist, as far as possible, or to advise, or to direct his patients to achieve dental health as a necessary step in attaining optimum general health.

This, I feel, can best be achieved by his insistence no the building of sound teeth on sound dietetic principles, and the strict practice of oral hygiene.

Academic Caution

In discussion of this question of the prevention of dental disease, particularly from the dietetic aspect, one finds a tendency among doctors and dentists continually to shift the responsibility from one to the other.

This may be due either to ignorance of the findings of research worker in this field, or it may be due to a certain scientific caution creation a reluctance to draw definite conclusions from evidence or data of a conflicting or inconclusive nature. One finds among certain people a disinclination to take a stand on this subject and point out or apply that which is of practical value from the knowledge at present available.

It is not so much a question of “are teeth sound because a person is healthy”, or “is a person healthy because of sound teeth”. One admits the inter-dependence and the inter-relationship, particularly concerning the effect on health of diseased teeth. The point to emphasize is that resistance to dental disease can be built up and dental health can be maintained by adequate diet and proper mouth hygiene. These two factors must be recognized as fundamental keys to health and promulgated, preached, stressed and impressed by doctors as basic responsibilities for health maintenance.

Keeping People Well

One has noted the changing opinion in favor of “keeping people well”, attempting to put a premium on health rather than on disease. Nevertheless, it has not yet been sufficiently recognized, and certainly it has not been put into practice, or at all generally applied, that the reduction or elimination of dental disease by preventive means is one of the most necessary steps towards the reduction of the chronic ill health that marks the life of so many people to-day.

The inter-relationship of dental disease and ill health has been proven and has been demonstrated in clinical practice time and again by most of the leading teachers in the medical and dental professions. But most dental treatment is still reparative, and there is little emphasis placed on this aspect of disease prevention by the average consulting physician.

Examination of present day dental practice shows that except for the development of committees on dental health education, and certain semi-professional machinery for lay education in regard to dental health, the reparative side of dentistry has become increasingly highly developed, but yet cannot keep pace with the insistent urget call from sufferers from dental disease.

One can only find reduced incidence of dental caries and a higher ratio of healthy mouths in those places where dental health education is actively carried out as definite health project, where the emphasis has been placed on oral hygiene rather than where an attempt has been made to fill all available cavities and then pass on to the next group needing reparative treatment. The fact that great improvement can be demonstrated in those places where preventive routines have been applied is surely a true indication of the value of this work, and the wisdom of its being carried generally into private practice.

Teaching Simple Truths

These things obviously point to the value of phophylaxis, so let it be the key to our preventive efforts for the time being at any rate. The practical application of our research to date is all that can matter as far as lay education is concerned. One needs to stress this because there is still the tendency to inaction by  many but happily not all teachers and responsible leaders. They, sensing their status and academic responsibilities, like to be on safe ground in regard to their pronouncements and teaching. but they must get away from this attitude if preventive measures, now available, are to be of any general value and the campaign for better health is to have any force. One must teach people what they can grasp and apply, and though we do not yet know the root cause of dental caries, it is not at all helpful to withhold knowledge and advice of measures which we know will prove beneficial to sufferers from dental disease.

Health educators need to be safe but must not be hampered by over-caution. Some recognized authorities consider dietetics to be of little importance, while there are those who will concede no value to the tooth brush. Yet we know that both these things are of great value and offer us the only tangible and practical help yet available in combating dental disease.

Actual causes and certain cures are not known of many diseases, but that does not prevent medicine from applying available knowledge in attempting to combat these diseases. The common cold, for instance, continues to baffle research workers in their search for its cause and therefore its specific cure. But how unfortunate it would be were no action to be taken to relieve the victims of this condition on account of lack of complete knowledge in relation to it.

Many other parallels could be drawn –suffice it to say that despite incompleteness of our knowledge and certain conflict of opinion in regard to the specificity of our preventive measures, we can with assurance advise measures that, if correctly and faithfully followed, must lead to the amelioration, if not elimination, of dental disease.

The Role of the Family Doctor

Now as far as the family doctor is concerned, I have previously stated *what I believe to be his best line of attach in relation to this aspect of health maintenance.

“He can give counsel to patients in three distinct directions. He can give pre-marital, pre-natal and post-natal advice.

  1. “PRE-MARITAL ADVICE. This is the period most productive of good in any general attack on the problem of the prevention of dental disease by the building up of sound and healthy dental structures.
  2. “PRE-NATAL ADVICE. If a pregnant woman, seeking advice, has not already commenced to watch he dietary, she should immediately be advised to do so. Great stress must be placed on the need for a tooth-building diet.
  3. “POST-NATAL ADVICE. It is here that the family doctor has opportunities to follow up his work during the previous period and to endeavor to impress on the household and on the child itself the importance of a healthy mouth as an integral part of a healthy body. He can here prepare the way for the dentist and create in the child’s mind an appreciation of dental health.

“He can make parents (either prospective or actual) realize that one of the greatest benefits with which they can endow their children, is a perfect dentition and a sense of personal responsibility towards it.”

When the family doctor comes to appreciate and to emphasize that dental disease prevention is a general health measure, then will preventive dentistry start to become an actuality.

The dentist, in the people’s minds, is still very largely a repair man. It is to the doctor that they go about their health. Certainly they usually only visit the doctor when sick, but if medical men would only first convince themselves and then commence to convince their patients that much of their ill health can be prevented by attaining dental health, then will it gradually come to the public acceptance that these things lie very largely in their own hands.

What we are still concerned with is how to drive this message home and bring into being the principles of this aspect of healthy living.

As far as lay education is concerned one must recognize that, particularly in regard to dietetics, our appeal must be made to women.

We must concede that individual and even national food habits are in the hands of women. The family table is of their choosing, a task which for the most part they take seriously, and as far as they are informed, intelligently. It has been said that you cannot change the food habits of a nation, but I feel that this cannot be maintained in the light of the power of the advertiser governed by commercial interests. Dietetics and the choosing of food becomes a matter of the producer and his multitudinous selling agent creating a “consumer demand” and the personal likes and dislikes of the individual

Efforts to create “diets” are made on the one hand by physiologists, dietitians, and the like, and on the other hand by “selling agents”, who either seize on scientific recommendations to boost their lines, or impress the virtues of their products on the public consciousness, purely as a matter of “sales”.

Dentists Should Educate

One may say that the public is more “educated” by the advertisers and surveyers of foods than by those whose professional responsibility. These people are clever enough to sell their articles through feminine appeal.

One can suggest that our food habits are very largely formed for us by the purveyors of food stuffs themselves, and hence are not at all times to our own specific advantage. Without excusing for the vastly one can find the reason for the vastly increased consumption of sugar here; and so it is with very many modern (manufactured) food products.

In these days of baby clinics, maternal welfare centres, and so forth, much good work is being done in educating women along what we believe to be the right what we believe to be the right lines in regard to health matters generally. But these “enlightened” mother still constitute a great minority, and although endowed and reinforced with good dietetic knowledge, outside their own intimate family menage, they are subject to all the  psychological reactions that seem peculiar to women folk.

Most women dislike to appear to be “usual”, to be different – a sort of crank-they even develop an inferiority complex about it rather than having the courage of their convictions and persisting in their food habits in spite of the ignorance and prejudice of other less informed with whom they may come in contact. If people commit dietetic errors with their families, “why show them up”, and why let their child “feel out of it” when sweets, cakes, and other tasties are passed around between meals as is so often done these days.

This picture is not at all over drawn for it is an every day occurrence, particularly in the average middle class homes and its effect, particularly on the impressional pre-school child, is merely to inculcate dietetic habits which we know to be wrong and harmful at any stage of life, let alone during this early growth period.

The subject of dietetics as a health measure must be so presented to women fold that they will see that it is in the interests of their families that they should understand food values and also the harmful effects of wrong feeding.

In this, no less than in the other aspects of disease prevention already mentioned, lies the family doctor’s opportunity to guide the people under his care along an hitherto almost untrodden path to health. Because his opportunity, his voice, his authority, as the greater dentistry looks to the family doctor to include this guidance among his manifold obligations.


Scottish Teeth

“The state of the teeth of the citizens of Glasgow is appalling,” declared Dr. J. Forbes Webster, Dean of the Glasgow Dental Hospital and School, in a lecture which he gave yesterday under the auspices of the City of Glasgow Society of Social Service.

Dr. Webster, whose subject was “Teeth and Health” said that about 80 per cent. of the citizens of Glasgow had bad teeth, and the percentage among school children was probably greater. It was all very well for people to say they could get artificial teeth, but artificial teeth would not serve them as well as their own teeth.

Commenting on the fact that millions of pounds were to be spent of a physical fitness campaign, Dr. Webster asked what use the campaign was going to be if the teeth of the people were in a bad condition.

“It has been computed,” he added, “that if you take saliva from the mouth of a person with bad teeth and take an equal amount of sewage you will find there are more germs in the saliva than in the sewage.”

The mouth was the gateway to health and should always be kept clean, and if people took proper care of their teeth there was no reason why they should lose them. The true cause of decay of the teeth had not yet been discovered, but diet seemed to be mostly responsible.

-The Glasgow Herald, April 9, 1938.