Practical Application of Preventive Dental Medicine (Part I)

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

The author is fully aware that there may be and probably are other avenues of approach to the practice of preventive dental medicine. He offers this as onemethod worked out over the course of several years from the findings of many investigators in the field of prevention, both medical and dental.

The exposition of this method has been made as concise as possible with the idea in mind that the simpler the method, possible the more general it’s adoption. It has proved to be practical and what is more illumination, desired by a sufficient proportion of the public to warrant it’s practice as a mean of making one’s livelihood.

The writer is indebted to the many investigators in the field of prevention, Broderick, Bunting, Howe, Price, McCullom, Sherman and many others, also to Hoskins, Pende, Werner and especially to the Jarvis Group, particularly Wielage, Blackmar and more than any Dr. Jarvis himself, a great teacher.

Generalized Factors Predisposing to Dental Pathology

Practically all investigators into the causes of dental caries are agreed that nutrition is the primary causative factor. There is a great difference of opinion as to the immediate causes. Some favor the bacterial, while others say the bacterial invasion is secondary to certain other conditions which make this invasion possible. Again just what these certain other condition are, causes great difference of opinions. Whether they are localized in the mouth or are systemic in nature.

The author in convinced that localized conditions have little to do with the causes of dental caries, except as they are dependent upon more generalized or systemic conditions. The practice of preventive dental medicine then necessarily is practically synonymous with the practice of preventive medicine.

Again among those who are convinced that dental pathology originates from a generalized systemic condition, opinions differ as to the condition predominately causative of this pathology. Some hold to the acid-base theory, others to the oxidation theory, others to the endocrine theory.

The author favors the nutritional theory as modified by the endocrines, for reasons which will be brought out later in this article.

Although nutrition is, in the author’s mind, the basic fundamental factor in the causes of dental caries and other dental pathology, the state of efficiency of the endocrines will determine how well the food is assimilated and so exert a powerful influence upon the body nutrition. And although the endocrines themselves respond to an adequate nutrition, this response may be so delayed that our adequate nutritional intake becomes inadequate by faulty assimilation.

Since the practice of preventive Dental Medicine is founded upon an adequate nutrition, it may be well to define an adequate nutrition.

McCullom states that there are now known thirty-seven essentials in an adequate diet. He also states that there may be others not yet recognized.

These essentials are listed as follows: –

  1. Eighteen amino acids of which 4 must originate from animal proteins.
  2. Glucose.
  3. Eleven inorganic minerals.
  4. At least 6 vitamins.
  5. Linoleic acid.

The amino acids come from the breaking down of proteins in the digestive tract. They are composed chiefly of carbon, hydrogen and oxygen combined with nitrogen and sulphur and sometimes iron and phosphorus. Glucose, vitamins and fats are entirely composed of carbon, hydrogen and osygen.

Little attention will be paid in this article to the diet except to state the general requirements and to draw attention to the fact that plant life is capable of transforming the inorganic to the organic, in which state it can be used by animal organisms, and to the fact that the plant can manufacture all of these food principles with the exception of certain of the amino acids, and these for the great part, from air, water, and the action of sunlight.

There remains the great class of inorganic minerals of which there are eleven known to be essential. With the exception of calcium and phosphorus and to a lesser degree sulphur and iron, the importance of these mineral constituents of the diet is not measured by their bulk, for they, like the vitamins principally serve as catalysts. The importance of these so-called trace minerals in human nutrition is not widely known, but a great deal of work has been done as regard their place in animal and plant nutrition.

The author has found them to be equally important in human nutrition.


Soil, an Important Dietary Factor

Attention is drawn to the fact that these elements can not be made from air, water and sunshine by the plant, but that the plant must obtain what it gets of these minerals directly from the soil in which it grows. It is axiomatic then that there will be a deficiency of these minerals in foods prepared from plants if some of these minerals are absent or insufficiently available in our soils. Information as to the soils in each locality can be obtained from Government bulletins and from the State Colleges and County Agents.

Under the head of general requirements of the diet, comes the fact that these requirements differ for different people.

This fact is better known by the practicing physician and dentist than by some of our nutritional experts.

A diet adequate for one will not necessarily be adequate for another even in the same family. Between different races there is even greater distinction. In brothers of one family there will be marked differences in dietary requirements, especially marked if one is blue eyed and the other brown eyed. The incidence of dental decay is very apt to be greatly different in such an instance. In the south the incidence of decay among th epoor whites, is far greater than among the negroes, yet both live upon practically the same foods and in similar environment.

And why should there not be a difference? There are no exceptions to the laws of nature and heredity for man as from any other organism. We can readily see and admit that plants and other animals have adapted themselves to environmental conditions must be furnished these various organisms if they are to thrive and survive. Still some of our nutritionists insist that what is good enough for a guinea pig is good enough for us.

Racial Characteristics

Why is there a difference in individual and racial nutritional requirements? It isn’t hard to understand if we will look upon ourselves as just another species of living organism, subject to the same laws as any other organism.

We don’t have to take different races of people who have had extremely different environmental conditions to which to adapt themselves. A study of the three strains of the white race from which most of us had our origin, will show markedly different environmental backgrounds. Some of us descended from one strain, others from another and here in the New World a great share of us have blood from all three strains flowing in our veins.

We know from the laws of heredity that two sons of the same parents will not inherit the same characteristics unless they be identical twins. How different then must be the inherited characteristics of sons of different parents of the same race, and yet more different the inherited characteristics of sons of parents of different races, to say nothing to sons of parents of different species of animals altogether.

It is possible to determine from physical characteristics the racial strains predominant in the individual and hence be able to state with some degree of accuracy the nutritional requirements of that individual. We can do this in the same way that we can with plants. When we see a plant with certain characteristics we can say for instance that this plant is a cactus that has developed through countless generations, is immune to heat, has the ability to conserve moisture and that it will thrive best under just such conditions as its ancestors learned to combat and to use. Yet these conditions might be very unsatisfactory for a tomato plant of for water cress.

The three white racial strains of Europe are the Nordic, Alpine and Mediterranean. The Nordics lived in coastal regions in the north of Europe, which did not support vegetation for several months of the year. They therefore were largely fish and meat eaters.

The Alpines lived in central Europe and lived largely on meat which they procured from game or from flocks and herds, and upon grain and fruits in season.

The Mediterraneans living in a more favored climate than the others lived on all classes of goods, sea food, meats, dairy products, grains and fruits.

These racial strains are characterized by blue, grey or green eyes, blond hair and long heads in those of us having preponderately Nordic characteristics.

The Alpines are characterized by brown eyes, blond or brown hair and round heads, while the Mediterraneans have dark hair and eyes and long heads.

It must be remembered that a great change has taken place in recent times in the dietary habits of nearly all peoples.

With the development of machinery and transportation, it became possible to multiply a thousand fold the land under cultivation and hence increased enormously the available food supply.

This in turn allowed a greatly increased population which increased the more rapidly because of advances made in the control of epidemic disease. It also changed the character of the food from protein to carbohydrate and from sea food to land grown food.

This was no change at all practically for the people of Mediterranean descent, and not much change for those of Alpine descent, but was drastic for those of Nordic descent.

Today the United States, the mixing bowl of Europe, offers an unexcelled laboratory for the study of the effects of this changed mode of living upon descendants of these different racial strains.

Civilization Has Weakened Strains

Most of our patients are Nordics. Dental decay and arthritis are rampant among them. What was formerly considered the strongest and most aggressive strain has become the most vulnerable to the degenerative changes.

The Alpines are not greatly affected. Their body chemistry is efficient. How our foot-ball teams would dwindle if all those of Alpine or Mediterranean descent were eliminated from them.

It is very noticeable that most of our movie queens come from states bordering salt water, yet most of our population resides inland. It seems not unlikely that the body chemistry of Nordics is better in such regions, and that grace of figure depends upon body chemistry.

This difference in requirements as regards nutrition is very important to us as biochemists in diagnosis and in prescribing for the individual, for we must treat each case as an individual problem. We must learn if the individual has been meeting his individual requirements and in so far as we know how, remedy the food intake. The basic principle of preventive dental medicine is to supply first of all an adequate nutrition.

Refined Products

Yet other great changes in dietary habits have developed of recent times. These changes are also due to the mechanistic development of the times, and affect peoples of all races similarly. I refer to the use of refined products made from natural foods.

White flour is one of these, a product fostered upon the people as a matter of convenience because it is difficult to store and ship the whole grain flour because of spoilage, while no great difficulty is had with white flour. This being a case of what isn’t good enough for us.

White flour in itself is a good partial food. The danger in its use lies in the tendency of people to think that because their stomachs are full they have been fed.

It is possible for a person having a good understanding of nutrition, to eat of refined foods almost exclusively and by variety obtain the essentials of an adequate nutrition, but for the unthinking such foods to contain a great variety of the essentials, so that a fair selection gave us all the essentials. The more we change our foods the less likely that our intake contains all of the food principles we need.

But the chief villain of them all is a drug. Drugs have their uses when their actions and contra-indications are thoroughly known and are applied by those versed in such knowledge for the ills of mankind. But when the use of a drug becomes almost universal, and but few even of the healing profession are aware of the disaster caused by its use, then indeed is the situation serious. The situation is more than serious if the people do not recognize this drug to be what it is and to the contrary accept it as a delightful, valuable and harmless food, to the extent that it’s use steadily increases in all parts of the world, but especially so in our prosperous section of the world.

All of our organic drugs are obtained in a similar manner. The herb or plant is crushed and the juices extracted. The juices are then separated by heat and chemical processes into their component chemicals. These are then separated so that the desired chemical can be obtained in pure form, in which form it enters that marts of trade.


Such is the process through which the article of commerce known as sugar, passes. Part of our misconception of the true nature of this drug has come to us from the study of carbohydrates in nutrition.

Carbohydrates are an essential part of the diet of the human race. Nearly all of our foods contain some. These carbohydrates comprise a large portion of our meals, and start to undergo digestion at the very beginning of the alimentary tract, and are among the last to finish.

Before these carbohydrates can be useful to us, they must be broken down to sugar so that they can go through the intestinal wall into the blood stream and to the cells where they furnish most of the energy required by them.

The carbohydrates from five or six meals are in various stages of this breaking-down process at the same time so that a thin trickle of sugar is going through the intestinal wall all the time.

The amount of sugar in the blood normally is about one teaspoonful. This amount is so essential that if it were reduced to one-half teaspoonful, coma would ensue, and if it were increased for any great length of time glycosuria would follow with many serious results.

Our sugar mechanism has yet another safeguard. In times of plenty a place has been made for the storage of sugar in a slightly different form, a form called glycogen which is readily changed to sugar again should the blood sugar be reduced.

Thus is safeguarded a continuous level of this important food substance by a very wonderful body mechanism.

But through the ages this mechanism had only carbohydrates and a few quantity, to deal with. It was ill prepared to undertake the task assigned to it by modern man, an organism whose mental mechanistic attainments outran the ability of this physical being to cope with the results of this drastic change.

Instead of being required to handle a continuous thin trickle of this energy juice, it was asked to not only do this, but also to take care of frequent and voluminous floods of it also. The body mechanism often works admirably in spite of this unnatural load which the blood stream must take whether it likes it or not, for the intestinal wall was not built as a barrier to sugar, but must admit it at any time and in any volume, yet many are unable to withstand it’s effects forever.

As a nation we have been in a similar predicament. We deforested the land, and as a result our soil surfaces were unable to store water to the degree they had in the past, and as a result the nation also had disastrous floods of a substance which used correctly, was essential and life giving, but when out of control was disastrous and death dealing.

Like the nation, we must build dams to restore the continuous thin trickle that our bodily mechanism may once again function normally and safely.

Our consumption of sugar in the United States exceeds 115 lbs. per inhabitant per annum. In dealing with this excessive and unnatural drug our body mechanism does it’s very remarkable best. The blood disposes of some of it through the kidneys. The cells increase their consumption of it and the cells of the pancreas which manufacture a hormone used in the metabolism of sugar, work overtime. At times this mechanism beraks down and a disease known as diabetes ensues.

According to certain insurance statistics, more than half of those who die between the ages of 55 and 64 die of diabetes. Multiples of this number must have incipient but unrecognized diabetes.

We doing preventive dentistry, however, are chiefly concerned with the effect that sugar has upon the tissues of the oral cavity. Bunting and others have conclusively shown what the effects of sugar are upon the teeth as regards localized action. Later in this article the effects of sugar upon the nutrition of teeth and alveolar process as well as other bone will be shown. An effect in the author’s opinion, much more serious and far reaching than it’s localized effect.

Does it seem reasonable that the requirements as regards food intake for the peoples of today be dissimilar from that upon which our predecessors lived and managed to survive and thrive? And does it seems reasonable that our well being is in jeopardy unless we take viosterol, calcium phosphate, water soluble chlorophyl and what-not as a regular part of the dietary of everyone? Not that there may not be indications for the use of certain drugs for temporary treatment.

Continued in the February Issue.

January 11, 2018 · jagdish1 · Comments Closed