The Dentifrice Situation

The Dentifrice Situation

By P. H. Belding, D.D.S.

Waucoma, Iowa

 

                This article by Dr. Belding is reprinted, by permission, from the bulletin of the Chicago     Dental Society. The editors wish to call your attention to another article by Dr. Belding, “Don               Quixot,” appearing in the June issue of The Journal of the American Dental Association. In this          article, Dr. Belding discusses the economic situation of dentistry, and calls attention to the             fact that dentists must arouse themselves to realize the true status of the profession and                 correct its weak points.

                Some years ago, to meet an urgent need, the American Dental Association caused to be formed the Council on Dental Therapeutics. The association was extremely fortunate in the selection of the Council members and, as a result, has a very able body to pass upon the merits of the various products which are brought before it. Due to the Council’s untiring efforts, it has placed in the hands of the profession an invaluable book entitled “Accepted Dental Remedies.”

No one can underestimate the tremendous value of this book to the practitioner, both now and in the future. By its use, the individual dentist can intelligently take advantage of not only the older drugs but also the newer products as they appear. In the years since this book first became available, it has more than demonstrated its worth.

The selected official drugs and the acceptable non-official preparations have proved their general sufficiency and have shown that many drugs which have been discussed in textbooks are superfluous and that many of the widely exploited preparations are either worthless or have no advantage over the materially less expensive products which are listed.

In a work of this nature, covering the broad field that it does, it would have been extremely difficult if not impossible for the Council to have always solved the problems presented for its consideration in the most satisfactory manner. The Council recognizes its imperfections and it is, therefore, in answer to the Council’s request for constructive criticism that the following lines are dedicated.

We believe that the efforts of the Council as pertains to drugs and medicaments admits of no criticism. It has been high minded, able, and scientifically exact. Some of the finest treatises which have appeared in recent literature have been the products of its efforts and by its labor the individual practitioner has been enabled to practice a fuller, broader, and more scientific dentistry.

On the other hand, we feel that the Council’s attitude on the acceptance of products which are sold to the public as aids to oral prophylaxis and mouth hygiene, is wrong. ORAL PROPHYLAXIS AND MOUTH HYGIENE CONSTITUTE THE LEGITIMATE BASIS UPON WHICH THE MODERN PRACTICE OF DENTISTRY IS FOUNDED; the profession and the Council should direct every effort to the extreme extent of their ethical limitations to promote and extend these activities.

At the present time, it is estimated that only 20 percent of the American people brush their teeth. In view of the incontrovertible evidence that mouth hygiene is the greatest single factor in the maintenance of oral health, it would appear that the greatest service that the profession could offer would be to make toothbrushing a universal habit.

It is generally held, and quite truly, that the individuals who brush their teeth are the only ones who ever receive adequate dental attention. Not from a selfish standpoint but from a knowledge of the relationship between dental disease and health, and a desire to render public service, it should be the duty of every practitioner to make every individual mouth-conscious by indoctrinating him with the message. “Brush Your Teeth for Health.”

Emphasis Must be on Health

It can only be by instilling in the minds of the people the value of mouth hygiene and its relationship to systemic disease that they can ever be made to develop the dental habit and maintain a lasting interest in their oral health.

We believe that the Council, not only by its “Holier than thou” attitude but also by its attempts to minimize the importance of mouth hygiene, is hindering the spread of the toothbrush habit. We further believe that its attitude on dentifrices is petty, undesirable, and scientifically unsound. By the dangerous method of assumption, it has proved that “The sole function of a dentifrice is to aid the toothbrush in keeping the surfaces of the teeth clean by the removal of loose debrisby the mechanical use of the brush.”

By this definition, the Council ignores the chemical nature of the cleansing process and it is apparent that it regards it more or less as a cosmetic aid and not as a therapeutic or prophylactic procedure, which it is. The most valuable benefits to be derived from brushing, namely the cleansing of the interdental and subgingival areas and the stimulation of the soft tissues, have apparently entirely escaped its attention.

The Council continues with a self evident truth, and, in so far as we know, never disputed “That a dentifrice may aid the process (cleaning the teeth), but it can never replace the brush.” This is suchan obvious truth that its mere mention verges on repetition and, when analyzed, this profound observation yields the thought that the soap can never replace the washing machine.

The Council has never honestly come out and stated that a good dentifrice is indispensable for the proper cleansing of the oral cavity. The toothbrush and the dentifrice constitute a single weapon and any attempt to divorce them is absurd; together they stand and together they fall, for as every housewife knows, a good detergent is essential for proper cleansing.

Theoretically, it would appear that the function of the Council in this connection should be predicated on the assumption that it could render a great service by protecting the public from fraudulent and dangerous products. In that none of the standard dentifrices are harmful, it would appear that the Council should direct its attention to the ferreting out and the elimination of the less well-known but dangerous brands.

Unfortunately, it has directed its energies to the harassment and reformation of the larger ethical producers. As a result of the stated “liberal policy” of the Council, virtually every known product has been refused acceptance. The harmful and the ethical products have all been grouped together in their rejection and the public has no means of knowing whether an article was refused on the basis of its advertising or its dangerousness. In that the public has consistently throughout the years used Council rejected products, it is apparent that the Council’s seal has no great weight and that it will continue to be without significance so long as the Council keeps up the ceaseless cry of Wolf! Wolf! Wolf! At the standard dentifrices and fails to direct its attention to the elimination of the dangerous products.

The Council, in its obvious antagonism against the dentifrices manufacturers, has let its antipathy get the better of its judgment to such an extent that it makes itself ridiculous by publishing the following: “The complexity of some dentifrices is no doubt due to the generally discarded (by the nutritionist perhaps) views that the incorporation of medicinal substances are useful. In view of the extremely short time in which these agents are in contact with the gums and the absence of convincing evidence that the daily use of a medicated dentifrice is beneficial in overcoming dental disease, they should not be prescribed.”

The Council’s unsupported opinion has collided head on into the stone wall of demonstrated scientific fact. Germicides are immediate and instantaneous in their action and by their use in dentifrices, the number of oral bacteria can be reduced tremendously. It these bacteria are at all related to the dental disease, it would appear that this procedure is not without virtue. The ethics of advertising to the public the specific therapeutic virtues of a dentifrice is debatable, but to state in a text directed exclusively to the profession that dentifrices could have no therapeutic value is contrary to demonstrated scientific fact.

Inconsistencies in Council’s Attitude    

This position is untenable and is contrary to the scientific interpretation of the basic factors at work in the production of dental disease. It may be that the Council’s attitude on germicides has been inspired by a sincere faith in the humoralistic theories, but we are inclined to believe that its position is due to its desire to harass the dentifrice manufacturers.

Such an attitude on the Council’s part is seriously hurting the profession, is instrumental in keeping alive the various vital theories, over-emphasizing the mechanical side of dentistry, and spreading the false doctrine of drug nihilism.

Caries and pyorrhea are bacteria diseases. There can be no question but that oral hygiene has a limiting influence on the spread of dental decay and that periodontal disease can be practically eliminated by its scientific application. As with other bacterial disease, the course of pyorrhea can be decidedly benefited by the topical use of the germicides by whatever method of application. There can be no question but that the bacterial qualities of some of the standard dentifrices greatly enhance their value.

Further, it is possible to compound dentifrices that have specific therapeutic value in the treatment of gingivitis pyorrhea. (Kritchewsky and Seguin, Eller and Rein, Kolmer, Hartzell.) The Council’s narrow and unscientific attitude has resulted in general chaos and confusion, not only among the members of the profession but also among the public as well. No matter what sacred ethics or principles originally inspired the Council, it is apparent that by its blanket rejection of dentifrices, it has failed in its function of affording the American public safe and honest oral hygienic aids.

In adjudging this question of dentifrices there is one consideration which the Council seems to have entirely overlooked and that is a question which has a very vital significance. In passing judgment on the acceptance or rejection of a standard dentifrice, the Council assumed the punctilious attitude that would virtually indicate that dentifrices were poisonous or at least possessed of harmful ingredients, and that, therefore, the public must be protected from them.

The absurdity of such an assumption must be only too apparent and the Council would have made itself less ridiculous if it had been less critical. In dealing with dentifrices, it at least was not dealing with products that were at all dangerous and, therefore, the attack made on dentifrices was essentially absurd.

Not All Dentifrices are Frauds

When there are some obvious frauds perpetuated an occasional dangerous product, and some evidence of over-optimistic advertising, but the large concerns have scientifically compounded harmless materials, which render an invaluable service in the promotion of oral hygiene.

It is difficult to understand why these ethical products are not acceptable to the Council until it is recognized that the motivating light behind their efforts must be the thought that dental diseases can be cured by diet and that dentistry is primarily a mechanical rather than a health service. It is not because the products are harmful, unethical, or inefficient but that the advertising by which they are presented to the public does not meet with the Mid-Victorian morals of the council.

The Council Limits Sales Efforts

The Council practically denies their manufacturers the right to advertise and would limit them to the statement that the dentifrices may in “some as yet undetermined manner assist the tooth-brush in keeping the surfaces of the teeth clean.” It is the implied if not the directly expressed opinion of the Council that oral hygiene is purely a mechanical cosmetic procedure; it calls down wrath upon the heads of those who contend that it is a prophylactic or therapeutic measure.

The manufacturers have found by actual experience that this depreciation of oral hygiene, in addition to being scientifically absurd, was economically unsound and that the type of advertising caused the sale of toothpaste to diminish and interest in mouth hygiene to lessen.

It is axiomatic among advertisers that “The Appeal to Health: is the most driving force that can be applied to the public. Why are so many electric refrigerators being sold today when only a few short years ago they were unknown? Because the manufacturers educated the public until today it feels that an electric refrigerator is not a luxury but a necessity to good health. Soaps are sold through the appeal to health; and certain breakfast foods are eaten for health.

The other day I saw a sign over the entrance to a bowling alley, “Bowl an appeal to the public interest in health, surely the dentifrice manufacturer is doing no more than spreading a great truth when he advertises “Brush your teeth for health.”

If the Council could get away from the biochemical concept of disease and realize that dentistry is primarily a health service and that the prime purpose of brushing the teeth is not cosmetic but the maintenance of oral and general health, a magnificent story could be truthfully presented to the public. It is generally recognized that 65 percent of the human ills enter through the mouth and that one-third of heart disease cases and 40 percent of arthritis cases are secondary to oral foci of infection. Offhand, it would appear that the significance of oral hygiene as a health service could not be overemphasized.

If the Council could forget its antagonism and help the honest dentifrice manufacturers in presenting the true facts about dentistry to the public, the good that would revert to the profession would be tenfold. The manufacturers are more than willing to meet dentistry half way for they realize that they are mutually benefited by improvement in dentistry. They have consistently shown a friendly attitude toward the profession and have done incalculable good.

Manufacturers Advertise Dentistry

In the words of Rider, “The toothpaste and mouth wash manufacturers have done far more to advertise dentistry and arouse the public to an interest in dental health than has the dental profession itself.” (J. A. D. A., February, 1935 p. 329.)

Think how this could be increased if the Council would adopt a broad, liberal attitude and assist the manufacturers in showing them how oral hygiene is related to general health and establish the fact that brushing the teeth is not an act in itself, is not merely a mechanical procedure, but a definite prophylactic or therapeutic measure.

The present attitude of the Council reminds us a great deal of the fruitless activity of the League of Nations in the prevention of the Ethiopian situation. The Council decries to high heaven the situation and deplores that and this, but the time has come when it must realize that it has lot the respect of not only the public but also the ethical advertisers.

The Council is completely without authority and completely out of touch with public opinion. Its rejection of all the standard brands of dentifrices has made it ridiculous and the public goes merrily on using whatever dentifrice it likes, irrespective of the edict of the Council.

The Council has failed so dismally in its public relations that recently Good Housekeeping, in response to a crying need, has taken over the approval of dentifrices. We are quite sure that this magazine’s acceptance has more weight with the public than the discredited Council policy.

In a recent edition of Good Housekeeping, its advertising policy was stated as follows: “It is the definite policy of Good Housekeeping to make its advertising pages trustworthy and reliable. Every product advertised in Good Housekeeping is guaranteed by us as advertised herein.” In that issue, eleven oral hygiene aids were listed and three of them bore the special seal of acceptance of Good Housekeeping Institute.

In view of the fact that Council acceptance has been discredited, this splendid service has sought a new source. Unfortunately, Good Housekeeping does not have the facilities of the scientifically trained investigators, as does the Council on Dental Therapeutics, to pass accurately upon the various products to determine the harmfulness to the public.

Good Housekeeping’s attitude on dentifrices is apparently predicated on the premise that advertising should be within the realm of scientific possibility, and is the product harmless? Criteria that could be well adopted by the Council. Until the Council’s seal of acceptance means something, a great number of products actually harmful are going to be presented to the public because the public has no adequate source of protection.

It is apparent that the Council will either have to change its policy regarding dentifrices or cease considering them, for, as it is, its seal carries absolutely no weight with the public. In view of the good which could be done to the public and the dental profession by a sane Council policy, we consider it imperative that the Council continue this function and devote its attention to regaining some of the public respect it has lost for the profession.

 

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Dr. Stanley D. Tylman to Serve Second Year as Head of Chicago Bulletin

As Editor of the weekly Bulletin published by the Chicago Dental Society, Dr. Stanley D. Tylman has recently completed his first year. So successful has he been that Dr. John B. LaDue, President of the Chicago Society, reappointed him to this important post for the coming year. At a special meeting of the Board of Directors held June 18, Dr. Tylman’s appointment was approved.