A Scientific Study of Dental Disease

Dr. and Mrs. M. Francis Wielage Discuss

“SOME NEWER LIGHT ON THE ACID-BASE BALANCE AND METHODS OF DETERMINATION WITHTHE POSSIBLE RELATIONSHIP TO DENTAL CARIES AND PARADENTOSIS”

This is the first of a series of articles by Dr. and Mrs. M. Francis Wielage on the relationship of  a sytemic imbalances to dental disease. Further discussion will appear in the February and March issues of Nutrition and Dental Health.

            The terms acidosis, acidemia and hyperacidity do not signify the same condition. Neither do alkalosis, alkalemia and hypoacidity. The terms have been used in a very confusing manner. A definition of the terms is in order:

Acidosis and Alkalosis designate changes in the reaction of the tissue to the one side or the other of the normal acid base balance.

Acidemia and Alkalemia designate changes in the reaction of the blood to the acid or alkaline side of the normal blood pH (7.3-7.4).

Hyperacidity refers to the increased quantity of acid in the stomach (hyperchlorhydria). A decreased quantity is referred to as hypoacidity (hypochlorhydria). A lack of acid secretion in the stomach is called achlorhydria.

Hypercapnia and hypocapnia designate that the bicarbonate content of the blood is either increased or diminished.

The confusion which exists is, that the determination of the pH of the blood does not give us an expression of acidosis or alkalosis (of the tissues). neither does the measuring of the changes of alkaline reserve by the CO2 –combining power method of Van Slyke.

Present Theories Not Adequate

Interpretations of laboratory findings seem at present only partially in accord with clinical observation and many times they are contradictory. This leads to the belief, that the present accepted theories are not adequate. As explained in the previous cemenlature, the present methods do not give us the degree of acidosis or alkalosis in the tissues. From here on we will use the terms acidosis and alkalosis as they are related to the state of tissue. Acidonia and alkalemia are used as an expression related to the state of the blood (fluids) and hyper and hypocapnia in relation to changes in the alkaline reserve in the blood.

Acid-Base Balance

It soon will become evident, that laboratory conclusion, which criticized the acid-base theory in regard to caries and paradentosis, cannot stand

The mechanism in the body which tried to maintain a normal acid-base equilibrium was supposed to depend on four methods:

  1. Alteration in respiration.
  2. Elimination of acid salts by the kidneys.
  3. The effect of buffersalts, mineral carbonates and phosphates.
  4. Neutralization of acid through the formation of ammonia.

Differentiation of nasal septum color, studied in the Jarvis study group, was first explained as an expression of the acid-base balance. Investigations and laboratory conclusions seemed to point to the fallacy of this concept. Efforts to establish a relationship between tooth decay and acid-base balance by different investigators have met with similar denouncing laboratory verdicts.

Clinical observation noticing results after instituted therapeutics, cannot be so easily discouraged. An effort was made to express the symptoms as a sympathcotonia –parasympathecotonia disbalance. Sometimes expressed as dynamia-adynamia disbalance.

Of interest became the effect of neutral NaCl in the diet and the intravenous injections of dilute HCI. The classical viewpoint did not allow explanations which coincided with clinical results obtained. This led to the idea, that these classical theories were perhaps not complete in their expressions. Additional factors seem to be necessary to clarify the picture, and this factor or factors may be important to allow correlation of findings, at the same time explaining apparently contradictory laboratory findings.

It was Ambard who introduced a new theory through his studies on the impregnation of proteins of the body by acid. His work found its origin in the fundamental experiments of Hamburger and J. Loeb. Hamburger has shown that blood, to which was added Potassium Oxalate, brought in contact with air, deprived of carbonic acid gas shows a lowering of the sodium bicarbonate content of the plasma, while the chlorine content of the red blood corpuscles is shifter to the plasma. Blood, in contact with an atmosphere rich in CO2, produced a chlorine shift from blood-plasma to the red blood corpuscles.

 

Accurate Test of Acid Invasion

To Chabanier and Loboo-Onell goes the honor of having shown, that the most accurate and precise test, which shows acid invasion, is expressed by the equation:

chlorine R(ed)       B(lood)         C(orpuscles)

Chlorine       P(lasma)

This equation measures the impregnation of the albumin by the acid and allows the study of its variations.

Ambard has shown that in man, the acid, which inpregnates the albumin, is HCI and the charge of acid in the protein depends upon the following factors:

  1. Increase of the quantity of acids (classical).
  2. Increase of the neutral salt content.

In 1 we will find the explanation of clinical results obtained by intravenous CH1 injections, even if the blood pH did not change.

In 2 we find the reason for clinical results obtained by increasing neutral salts intake. Ambard gives the following reaction:

NaCl+2CO3                           NaHCO3+HCl

Whereas this reaction gives birth to infinitesimal quantities of HCl, if it takes place in the presence of albumin, the acid will impregnate the albumin and a new quantity of NaCl can be decomposed and liberates a new fraction of chlorine.

Here then we have first of all a  new characteristic of proteins. It is therefore possible to perceive, that though the proteins are charged with acid, the medium many manifest a neutral reaction. Chabanier and Lobo-Onell have shown that even an increase of acid, producing an acidemia (of the medium), will allow the albumins to discharge themselves of HCl if the neutral salt content is diminished. It is possible, therefore, to have an acidemia (of the medium) and an alkalosis (of the albumin tissue) at the same time.

It becomes clear, that to judge the acid base equilibrium by the knowledge of the reaction of the medium alone is impossible. It also is explainable, why injections of small amounts of dilute Hcl do not have to change the blood pH.

To produce a physico- pathological acidosis, it is not sufficient, that an acid is introduced in the blood, not is it necessary that the blood pH is lowered.

It is necessary that an acid surcharge of the albumin (tissue) of the organism is present.

This ought to be of interest to the Jarvis group. One many now explain perhaps, the red nasal septum as a degree of acid surcharge of the albumin and the pale nasal septum as an undercharge of the albumin. The red-pale nasal septum still being a true expression of real acid-base equilibrium.

Parallel runs the possibility that an acid surcharge of the proteins in time produces caries of teeth and an undercharge of the protein in time produces paradentosis.

A low charge should be found in allergic individuals with pale nasal septum, or in patients in true alkalosis and therefore in the allergic zone. This agrees with Hulin’s theory of paradentosis, that the systemic underlying condition allows a local anaphylactic shock, which produces the necessary steps as mentioned in the “New Concept of Dental Medicine”. A neutral nasal septum, and immunity for caries and paradentosis would then correspond to the normal of the equation:

=0.50

=

Chlorine R B C                   Normal 180

Chlorine Plasma               Normal 360

The protein and salt intake are therefore of tremendous importance.

Equally might it be possible to correlate the surcharge of the albumin with sympathecotonia or with any of the factors mentioned of the left side of the Key Chart. An undercharge, with para-sympatheconia or with any of the factors, mentioned on the right side of the Key Chart.

The Key Chart, present in our “New Concept of Dental Medicine,” becomes much clearer and more easily understood.

It is now possible to perceive, that a surcharge of the albumin can be produced by (a) the invasion of the organism of an acid (diacetic, beta-oxybutyric), the neutral salt content being normal, or (b) by an increase of salt content. Inversely, the following causes may produce a diminution of the acid charge of the albumin:

(a)             Invasion of the organism by excess base, the neutral salt content being normal; or

(b)            A reduction of the neutral salt content.

 

 

In studying the relationship of the equation

chlorine R.B.C.

Chlorine Plasma

and the alkaline reserve, Lobo Onell were able to clarify the disturbing causes. The alkaline reserve is a mediocre test of the study of acid-base in the different pathologic disturbances of man. They insist that the alkaline reserve is but an indicator of the modification of the pulmonary ventilation. The blood pH depends upon the equation:

H2 CO3

NaHCO3

Pulmonary hyperventilation causes a diminution of CO3 and produces a drop in the bicarbonate content of the blood. The equation   H2 CO3          stays constant, and blood pH

NaHCO3         

reaction does not vary. An examination of the urine shows increased elimination of sodium bicarbonate.

INCREASED VALUE OF THE EQUATION

Chlorine R.B.C.

Chlorine Plasma

The value of the equation is changed by:

  1. An increase of neutral salt intake.
  2. If the salt intake is normal, by an excess of acid circulating in the blood.

Increase of neutral salt intake, according to the theory of Ambard follows the reaction:

H2 CO3 + Nacl                                 NaHCO3+Hcl

The HCL impregnates the protein. This impregnation manifests itself in all the albumins, also of the respiratory center, producing hyperexitation of the latter. Increased pulmonary ventilation follows and the alkaline reserve drops.

This then explains CO3 theraeutics.

There are two possibilities when it comes to excess acid:

  1. The acid in excess is CO2 or
  2. It is another acid.

(1)When any pathological condition interferes with pulmonary circulation of the alveolar air, as of the glottis, Broncho pneumonia, etc., the equation   Chlorine R.B.C.    will become

Chlorine Plasma

and retention of CO2 will cause an elevation of the alkaline reserve.

If the invasion by another acid, the equation        Chlorine R.B.C.    is elevated and the alka-

Chlorine Plasma

line reserve is lowered.

But an increased salt intake can produce acidosis, and would expect a low salt intake to be beneficial when Keton bodies accumulate in the system.

DECREASED VALUE OF THE EQUATION

Chlorine R.B.C.

Chlorine Plasma

The following three ways will produce this result:

  1. Diminution of neutral salt content of the blood dechlorination of the organism produces a drop in the equation        Chlorine R.B.C.    and an elevation of alkaline

Chlorine Plasma

reserve, observed in patients with pyloricstenosis, intestinal obstruction and uncontrollable vomiting.

  1. Invasion of the organism by excess base. Alkalosis produced by alkaline medicines and alkaline mineral water. The equation          Chlorine R.B.C.    is lowered and the

Chlorine Plasma                                                               alkaline reserve mounts.

  1. Hyperventilation, either voluntary or involuntary. Loss of CO2 with consequential diminution of bicarbonate content of plasma and finally diminution of equation chlorine R.B.C.       will give us, so far the most exact date expressing acid-base

chlorine Plasma

 

Elevation of equation     chlorine R.B.C. is significant of surcharge of the protein by

chlorine Plasma

Hcl.

We have real acidosis, no matter what the blood Ph may be.

  1. If the A. R. is low:

There is invasion by excess acid, or excess Nacl in the blood, or we have a combination of these two factors.

  1. If the A. R. is high:

There is gaseous acidosis, retention of CO2 due to the mechanical obstruction somewhere in the airways or disfunction of the respiratory center. Lowering of equation            chlorine R.B.C.

chlorine plasma    is significant of the discharge of the albumin of Hcl, thefore alkalosis, no matter what the pH reading may be.

  1. If the A.R. is high:

It will mean deficit of neutral salt, excess of base, or a combination of both

  1. If the A.R. is low:

There is a drop of CO2 content of alveolar air.

The above mentioned authors are of the opinion, that contrary to the classical theory, acidosis is not defined by the hydrion concentration of the solvent but by the surcharge of acid in the albumins and that the equation            chlorine R.B.C. gives the most

chlorine plasma

most precise indication.

The Jarvis group can now go back to its original concept. Satisfactory proof to the effect that, the concept of the red-pale nasal septum expressing the status of the acid-base balance was incorrect, has not yet been given. This study may help to better understand its proper relationship. Four ourselves, we are more convinced than ever that the acid-base bacterial is of the utmost importance and that the maintaining of its equilibrium is at the foundation of health-being the most important factor in the immunity of caries and paradentosis and as these dental diseases are oral manifestations of systemic disturbances, their true relations to all other diseases will someday become clear, as will the variation in color of the nasal septum.

 

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