New Theory of Dental Caries

by

M. Francis Wielage, D. D. S.

“We shall know how to deal with bone tissue only when we shall know precisely the means of dealing with the cause of osteolysis.”

Leriche and Policard.

The theory of dental caries as at present adhered to by practically all of dentistry is Miller’s theory which, as accepted today, is to the effect that –

……caries of the enamel consists in its entirety of the dissolution of the enamel by lactic acid formed in situ by the fermentation of carbohyrates which adhere to the surface of the enamel; and that caries of dentin and cementum consists of two distinct steps:

  1. The dissolution of the inorganic salts from these tissues, and
  2. A subsequent action by proteolytic bacterial enzymes upon the organic constituent of the dentin and cementum of the tooth.

Miller therefore is the exponent of the bacterial theory of dental caries. His theory was the result of the universal acceptance that enamel was ectodermal in origin. By considering enamel to be mesodermal in origin it becomes a specialized form of bone, as dentin and cementum are now considered. It therefore would become subject to the fundamental physico-chemical laws which underly osteogenesis and osteolysis. In the following pages an endeavor is made to prove this and replace Miller’s bacterial theory by a physico-chemical theory of dental caries.

Bone formation is a coagulation phenomenon, it is considered a calcified connective tissue and histologically it is determined by its connective tissue matrix. This connective tissue is derived from the mesoderm. According to Muller, bone is produced not by transformation and metaplasia, but by substitution and neoplasia. The cartilage which precedes bone formation becomes gradually replaced by embryonic connective tissue, which finally become ossified.

Preceding ossification, after fracture of a bone, for instance, it is observed that the connective tissue in the area swells. This swelling as well as the consequent bone formation is colloidal in nature. Fisher states that the water capacity of tissue colloids is responsible for the manifested edema. This is caused by the abnormal formation or accumulation of acids in the involved tissues. Inhibition or normal processes of oxidation and interference with normal circulation, a condition generally encountered in fracture, favors the formation and accumulation of acids.

The protoplasm of cells of the connective tissue is rich in gels. When gels are subjected to increased acid surroundings, they swell, or in other words, the acid increases the water holding capacity of gels. According to Fisher, hydrated gels show the phenomenon of syneresis, that is watery solution is given off, which is not water but a solution of all the constituents of the gel in both colloid and molecular degrees of dispersion.

The concentration of the syneretic fluid is lowered however. Leriche and Policard claim that this fluid excreted from the gel of connective tissue cells certainly contains fibrin. This fibrin is a globulin and belongs to the protein group. The fibrous filaments, which appear in this syneretic intercellular fluid are the source of the ever increasing connective tissue fibrils.

These become finally incorporated in bone. The continuous coagulation of the fibrin into filaments produces a dehydration of the liquid medium which becomes progressively more viscous as the quantity of fibrils increase. We then speak of the preosscous substance produces bone.

In bone formation, there must be present a coagulating factor, which finally clumps the molecules into micellae and finally into crystals. This bone formation, without mentioning osteoblasts, is called osteogenesis and seems to be subject to physico-chemical laws. The opposite phenomenon of osteogenesis is called osteolysis (dissolution of bone).

Leriche and Policard

“The disapperance of bone takes place generally without intervention of cellular elements. The bone trabeculae diminish progressively in thickness. The Haversian canals enlarge without the presence of osteoclasts. The phospho-calcareous complex purely and simply disappears without any special cells participating in the process. The calcium phospho-carbonate disappears like the glycogen of the hepatic cell of the fat of the adipose cell.”

Osteoblasts and osteoclasts seem to exert an action, which is superimposed on the physico-chemical phenomenon of bone formation. For instance when osteogenesis is taking place, osteoclasts are able to dissolve temporary tooth structure, or they shape the spaces for the reticuloendothelial system (to which they belong). Their action is considered to be phagocytotic. Through their presence and functional activity, bone dissolution can be produced locally, which makes them valuable alterators, producing modification of inner structure of bone. This goes also for osteoblasts.

Osteoblasts and modified osteoblasts, the bonecells (Studnicka, Retterer and Hatmann) retain their inherent capacity of secretion when alive. This secretion does not have to be calcium. The fluid may contain ferments or catalyzers or a coagulating agent or may well secrete globulin. The latter has an affinity for calcium and may so change the local constituency that increased calcification takes place. Again this local calcification can take place when osteolysis is dominant.

The requirements for osteogenesis are the folloiwng:

  1. The presence of an organic matrix (a quantity of acid, swelling of the fibrous tissue, syneretic infiltration, coagulation into fibrillar network).
  2. Stasis.
  3. The presence of an abundant quantity of minerals to be deposited.

To these three we have added a 4th one, namely:

  1. A depositing factor in the blood (which seems to be related or depending on the amount of chlorine charge on the protein network).

The confusion as to the cause of dental caries is no doubt due to the accepted fact that enamel is ectodermal in origin and that dentin, cementum and bone are mesodermal in origin.

Different investigators as Bodecker, Noyes, Radash and scores of others believe that enamel is histogenetically derived from the epiblastic germ layer, while all other calcified tissues arise from the mesoblast.

Bodecker states furthermore:

“The enamel is the only human calcified tissue which, possibly, is developed by secretion. Let us gather some data of the quantitative and qualitative consistency of bone, enamel and dentin:”

This chart suggests immediately that these three structures may have a similar origin. The possibility may revolutionize dental thought.

Calcium phosphate and fluoride …………………………………

Calcium carbonate …………………………………………………………

Mg phosphate …………………………………………………………………

Organic matter ………………………………………………………………..

Other salts ……………………………………………………………………….

Fat …………………………………………………………………………………….

Chlorine content ……………………………………………………………..

 

The experimental work by Kitchen on the enamel of the rat incisor leads him to the conclusion that a “Mass Change, subsequent to the completion of an organic matrix is supported,” and that: “the theory of the production of the finished and calcified enamel rod, by the individual ameloblast, is not supported by the observation on rat enamel development.

There seems to be sufficient evidence in the literature that enamel is not ectodermal in origin; that enamel, dentin, cementum and bone are all four derived from the mesoderm.

The possibility is great that the ectodermal ameloblasts modify the predentinuous (preosseeous) substance, which gives it the characteristic differentiation. All four of them would then be subject to the physico-chemical lows underlying osteogenesis and osteolysis.

For tooth structure we would use the terms odontogenesis and odontolysis.

This approach would immediately eliminate the possible but highly improbable condition that, “The enamel is the only calcified tissue from the epithelium.”

The different aspect now allows a correlation of phenomena which may lead to a new theory underlying dental caries. To succeed in this, it would be necessary to bring proof that all these structures, including enamel, contain an organic matrix, which would be continuous with the protein network of the entire body.

It is an accepted fact that the ameloblasts secrete a solution, which is most probably globulin. The globulin in the bloodstream shows an affinity for calcium. Calcium is bound to the globulin (calcium proteinate).

The predentinous substance, which is related to the preosseous substance, receives minerals in colloidal and molecular solution in the form of synergetic secretion of the cytoplasm of the odontoblastic fibrils.

The colloid-chemical phenomenon of adsorption will account for the uneven distribution of the molecules to the surface, when this predentinous substance touches another surface (the ameloblasts). The globulin secreted by the ameloblasts has an affinity for calcium, so one might suspect that the Ca. molecules will be found in greater concentration into that area which is characterized by the future enamel.

The diminished quantity of organic matrix in the enamel with the increased quantity of organic matter in the dentin will further explain the quantitative difference observed between enamel and dentin.

Enamel                                             Dentin                                  Bone

89.82%                                            66.72%                                87.8%

4.37%                                               3.36%                                10.18%

1.34%                                               1.08%                                   1.57%

0.88%                                               0.83%                                   1.00%

3.39%                                            27.61%

0.20%                                                0.40%

0.25%                                                1.75%

 

Noyes states: “Instead of odontoblasts forming first the organic matrix and then calcifying it, it is probably that the organic matrix is formed by one set of connective tissue cells, which produce fine collagenous fibrils, which are consolidated to form the organic matrix and then this is calcified by chemical combination with inorganic salts,”

      “A second set of cells, apparently the odontoblasts, are essential in the elaboration of these materials for calcification.”

Apparently this depends then, or is subject to the physico-chemical laws which have been observed in osteogenesis.

K. von Korff described connective tissue cells, lying in the pulp beyond the odontoblasts from which collagenous fibrils passed between the odontoblasts and entered into the formation of the dentin Matrix.

 

Fig. 1 Fibers of von Korff in toothgerm of cal, odontoblasts; f, fanlike expansion of fiber bundles; g, corkscrew-like fibers; z, odontogenetic zone; commencing calcification; ameloblasts.                                                                                                                                           From Noyes,

 

 

In regards to the intercellular substance of the pulp, Noyes states, that the appearance in the section is as if “structureless gelatinous material had less coagulated by the reagents. There are, of course, connective tissue fibers in connection with the walls of the larger blood vessels and nerves, and to a certain extent in the gelatinous material.” and

“There is need to further investigation of the character of the intercellular substance.”

The content of the connective tissue cells in the pulp is similar to those which play a part in osteogenesis.

The swelling again is produced through an accumulation of acid, through inhibition of normal oxidation processes, or through passive congestion, or through anatomical changes in the dental organ necessary for maintenance of proper circulation. The connective tissue cells, filled with a gel, which upon hydration becomes a hydrophylic colloid, starts spontaneously to secret (syneresis) a liquid, which is often rich in albumin and which in the formation of bone, according to Leriches and Policard, certainly contains fibrin. When this fibrin, in the manner of osmotic structures, start forming fibrils, we have accounted for the fibrous network.

The dehydration of the syneretic fluid, produced by the local coagulating phenomenon of the fibrils, makes this liquid more viscous. The viscous liquid plus the fibrin network becomes the predentinous mass, or better the precalcified material of the tooth. The degree of calcification depends on different factors. The laws underlying the formation of calcified structures in the dental organ are, therefore, similar to those which underly osteogenesis, providing we can prove that there exists a protein network is the enamel which is continuous with the protein network of the whole body.

We present here three pictures by Bodecker:

These photographs by Bodecker show distinctly the organic matter which is present in the enamel, Lamellae, tufts, etc., have a resistant stainable organic structure and they are connected internally with the dentinal tubules of the dentin and external with Nasmyth’s membrane.

Fig. 2 Photomicrograph of a tooth showing an enamel lamella (L) and numerous tufts (T) under the low enlargement.                                                                                                                                                                                                      From Bodecker.

 

Fig. 3 Photograph of a dentinal tubule in connection with an enamel lamella under high enlargement.                                                                                                        From Bodecker.

 

 

Fig. 4 An enamel lamella and tufts as seen in a thick ground section with a binocular microscope. N. M., Nasmyth’s Membrane; E., Ename; E. L., Enamel Lamella; T., Tufts; D., Dentin.                                                                                                                                                                                      From Bodecker.

 

 

Bodecker states: “The greatest amount of organic matter is found near the dento-enamel border and the outer third of the enamel.”

The foregoing definitely seems to prove that the organic material exists in “continuum” thru the tooth (dentin and enamel) and therefore is continuous with the mesodermal connective tissue and as such is directly influenced by acid-base changes.

Lysis of the dentin and enamel can thus be produced by acidosis (of the tissues) in time, or in other words through a prolonged surcharge of the HCL on the protein network.

 

While the effect of aciduric micro-organisms in the oral cavity may be considered a local factor in the production of caries, their effect would be successfully counteracted if the chlorine charge of the protein network of the enamel and dentin is a state concomitant with alkalosis (of the tissues) and when the blood is “in deposition in regards to inorganic salts.” This would readily explain the absence of caries in those individuals where aciduric organisms were found in the mouth.

The HCL surcharge on the protein network therefore is the peptizing factor which starts demineralization or odontolysis. A circulation therefore does not have to exist in the enamel. Colloid chemically, genesis and lysis in tooth structure can be explained in a satisfactory manner.

We have presented then, information which leads us to believe that enamel, which has been considered ectodermal in origin, is apparently mesodermal in origin and differs from dentin through the influence of an ectodermal secretion (globulin) of the ameloblasts.

Enamel, dentin, cementum and bone are then subject to physico-chemical laws which underly the formation and dissolution of all concretions in nature, this formation is a colloid chemical phenomenon.

The protein network of the tooth is apparently continuous with the protein network of the body. The charge of HCL on the protein network determines the acid-base balance of the tissues and therefore also of tooth tissue.

The how do we account for dental caries in view of the facts presented?

One should be extremely careful about so-called “truths.” Philosophy only recognizes an approach to truth.

The transmutation of elements by alchemists was considered impossible thirty years ago, but in the present era it is truth. High electrical discharge in a vacuum tube through a thin wire of tungsten leaves but helium gas. By means of the new cyclotron, elements are transmuted as a common feature.

Some present day authors of dental articles are so biased and have such a narrow view, that they would freeze the thoughts of a Pasteur, a Miller, a Black and a Williams into a cult and any progressive movement is fanatically stamped as a sacrilege.

The theories propounded by these great scientists in their time were more revolutionary than the physico-chemical approach now having its swing. No doubt the electro-dynamic theory will in time take the place of the physico-chemical theory. Such is progress.

If the problem of dental caries was solved by the bateriological theory, why is there still caries in abundance, why is there less caries in paradentosis when sepsis is increased? And why have the adherents of the bacteriological theory failed to produce an antiseptic which would eliminate the bacteria, which are supposed to produce caries, or why caries? They have apparently failed. Not until they produce results, have they a right to dominate the dental field.

We must remember then that caries means molecular destruction. Caries of a tooth therefore means molecular destruction of the organic matrix as well as of the inorganic salts in crystalline form.

We have accounted for the molecular dissolution of the inorganic salts in crystal form, through the peptizing agent (HCL) in the protein network.

Of necessity, we must consider molecular destruction of protein. Naturally we search for this in the process of proteolytic cleavage or digestion of proteins and our thoughts naturally turn to pepsin. This pepsin is the activated proenzym pepsinogen (by HCL). This pepsinogen is formed in quantities in the cardiac end of the stomach, sometimes it is found in the urine and may well be found in saliva. Certain micro-organisms may contain or produce it. The pepsinogen cannot act until it is converted into pepsin. For this activation hydrochloric acid is necessary.

The regurgitated pepsinogen, the pepsinogen in the saliva or the pepsinogen produced by bacteria, through the colloid chemical phenomenon of adsorption is brought into contact with the protein network of the enamel. When the network has a surcharge of HCL (acidosis of the tissue) denuding the end fibers of inorganic salt crystals, the exposed fibers with their HCL surcharge is able to activate the pepsinogen into pepsin.

Pepsin seems to act when proteins have been invaded by HCL producing a swelling and the amount of swelling has been shown to be proportionate to the action of pepsin. If the medium was changed to an alkaline one, the digestion by pepsin will carry on to some extent. The products of protein digestion produce favorable nourishment for bacteria, who promptly invade the digestive protein tract. This has been explained as if bacteria caused the destruction, whereas the great probability exists that they are active spectators at the process of protein digestion.

It becomes clear therefore that the HCL charge on the protein network of the enamel and dentin is all important.

If the Ambard equation registers  chlorine R. B. C.

cholorine Plasma

=0.50 seemed to have reached the iso-electric  point of the protein network. No chemical reactions can take place and we have immunity to dental caries. We also have immunity to dental caries when the

=0.50

Ambard equation registers  chlorine R. B. C.

cholorine Plasma

because there is no available HCL to activate the pepsinogen and mineralization is active.

As mentioned before the mineralizing and demineralizing factors depends on the HCL charge of the protein network, therefore information as to the Ambard equation is obtainable through mineral metabolism studies for Ca and P2 with powdered beef bone.

In presenting the new theory of dental caries, we come to the following conclusions:

1.        Enamel, dentin and cementum are specialized forms of bone tissue derived from the mesoderm.

2.        The protein network of the body is continuous throughout the tooth structure.

3.        True acidosis of the tissue (including bone tissue and tooth tissue) is depending upon a certain charge of HCL on the protein network of the body.

4.        When the Ambard equation

=0.50

chlorine R. B. C.

chlorine Plasma

we have normal acid-base balance and immunity to decay. If the Ambard equation is greater than 0.50 we have acidosis of the tissue, if less than 0.50 we have alkalosis of the tissue.

5.        Caries of bone means molecular destruction of bone. Caries of tooth structure is molecular destruction of tooth structure.

This means as well the destruction of the organic salt crystals as the protein network.

6.        The dissolution of the inorganic salts is produced by the peptizing factor, namely the HCL surcharge on the protein as expressed by the Ambard equation:

=0.50

chlorine R. B. C.

chlorine Plasma

7.        This acidosis (of the tissue) in time causes demineralization.

8.        The protein network devoid of mineral coverage becomes exposed to outside influences, as proteolytic enzymes or the pro-enzymes.

9.        Though these proteolytic enzymes can be produced by certain bacteria, they can be and are also of non-bacterial origin (regurgitated).

10.      The pro-proteolytic enzyme is called pepsinogen. It is inactive as such, circulates in the bloodstream and at times passes through the kidney mechanism into the urine.

11.      The tooth surface is not the smooth wall that one might think. Photo micrographs by Hanke show the tooth surface to be very uneven, presenting thereby to the mouth fluids as much increased surface area, favoring adsorption.

12.      The colloid chemical phenomenon of adsorption is active in the oral cavity as well; and saliva with its different constituents is adsorbed to the tooth surface. Pepsinogen in solution will also be present in the adsorbed fluid, but is inactive.

13.      Pepsinogen is very rapidly changed through the action of HCL into pepsin.

14.      We have traced the surcharge of HCL on the protein network producing a demineralization of inorganic salts and exposing the endings of the protein network in the tooth surface.The pepsinogen adsorbed to the protein network, which receives a surcharge of HCL, now activates the pepsinogen into pepsin producing molecular destruction of the exposed network in that part of the enamel.

15.      When the media reached a pH of 6-7 it has been shown that pepsin is no longer adsorbed to the protein.

16.      Pepsinogen was still able to be adsorbed, but without the activation of HCL into pepsin, no proteolytic cleavage can take place.

17.      The action of the proteolytic enzyme therefore is dependent on the pH of the medium, and the charge of HCL on the protein network. The control of salivary pH therefore plays an important role in the prevention of the caries process.

18.      The molecular destruction of the mineral constituents of HCL on the protein network plus the molecular destruction of the protein network through proteolytic enzymatic action constitutes caries of teeth (enamel, dentin and cementum).

901-903 Huntington Bldg.

Miami, Florida.

__________________________________

The Climatic and Dietetic Treatment of Exophthalmic Goitre

E. Szasz states that it is impossible to determine the climate or the altitude favorable to patients without taking into consideration the latitude of the place chosen. The climate at the altitude of 1,000 meters is very different in the Alps and in the Tatra Mountains.. The climate of the Tatra is specially favorable for patients with exophthalmic goitre because there the “climate of altitude” is already reached at a height of 1,000 meters whilst in the Alps the same climate is only found to begin at 1,500 meters of altitude, a height that can already determine the onset of discomfort chiefly neuropathic, to the patients.

Szasz is of opinion that the four principal atmospheric elements of the “climate of altitude” are very well developed in the Tatra Mountains: electric currents, intensity of the ultra-violet rays, lowered tension of the oxygen, and dryness of the air, these last factors being able to contribute to a modification of the elimination of iodine. Concerning diet, Szasz believes that in general the patient with exophthalmic goitre takes nourishment that is too rich and the excess of calories is injurious to the thyroid gland.

Szasz proposes a regime deficient in meat and fat, but rich in vegetables and fresh fruit, and according to him it is necessary to pay attention to the state of the liver ofr it is very often found to be disordered in these patients. –E. Szasz: Traitement Climatique et Dietetique du Goitre Exophthalmique. Med. Klinik, Vol. 31, No. 50, December 1935, pp. 1638-1640.

Carotin and Vitamin A of the Human Fetus

The amount of carotin and vitamin A has been determined in the serum of 40 pregnant women at different periods of pregnancy. In 15 per cent of them it was found that near term, carotin and vitamin A had markedly diminished, sometimes even disappearing. At other periods of gestation the rates were normal.

The human placenta contains a small quantity of carotin but not of vitamin A. Therefore the foetus is unable to satisfy its needs from this source as is the case for vitamin C and vitamin D.

Blood from the umbilical cord contains a small quantity of carotin and a very small quantity of carotin and a very small quantity of vitamin A.

The placenta acts by allowing a small part of these two principles (which circulate in the maternal blood) to pass. In the human foetal liver vitamin A is found in considerable quantity, but less than in the liver of the adult.

Towards the end of gestation the foetal reserves diminish so that one sometimes fails to find them in the newborn babe. In contradistinction to that which obtains in the adult, the liver of the foetus does not contain carotin –H. Wendt, Klin. Woch., Vol. 15, NO. 7, Feb. 17, 1936, pp. 222-225.

 

Incoming search terms: