Ultraviolet Ray Therapy in Treatment of Oral Lesions

By A. T. RASMUSSEN,

D. D. S., A. S. S.

La Crosse, Wis.

            Over a large portion of the northern hemisphere the fall and winter months are strikingly lacking in ultraviolet rays from the sun that reach the earth. It need not be argued that the rays n the ultraviolet zone of the solar spectrum are essential to life and health, but neither is it out of place to emphasize the important of the biologic effects of those bands of the spectrum that wholly, or nearly so, are absorbed by clouds, smoke, dust, etc., or the earth’s atmosphere due to the longer distance traveled when the sun is at a lower angle.

Fortunately we have at our disposal electrical equipment for generating ultraviolet rays, making possible treatment with this modality at times when weather or seasonal conditions prevent the use of the rays from the sun. We are also able, by means of such equipment, to shorten the length of exposures by intensifying the output of the desired rays over that of sunlight. In addition, by means of suitable speculums and quartz applicators we are able to direct the rays into body cavities when indicated. In selecting apparatus consideration should be given to three factors, names, efficiency, convenience of operation and application, and probably life of the equipment.

While all rays of the spectrum lying beyond the violet, or 4000 A (Angstrom units)* in wave length, that is all rays having a shorter wave-length than the violet, are ultraviolet, in medical literature the term ultraviolet rays is usually applied to that zone of the spectrum lying between 1850 A and 3200 A in wave-length. We shall use that interpretation of the term in this article, and confine our discussion to some of the biologic effects of those rays, and the rationale in their application to the treatment of disease, especially such as the dentist in his special field of the healing art is called upon to treat.

Ultraviolet and Vitamins

Ultraviolet rays and the vitamins are so intimately associated and bound up together that a discussion of the one is impossible without consideration of the other. It is a well established fact that ultraviolet rays, lying within the zone referred to above, acting upon the ergosterol of the cells of the skin, produce Vitamin D, a substance necessary to maintaining the body in a state of optimum health, and to life itself.

Space does not permit, nor is the writer inclined to enter into a general discussion of all the biologic effects of these rays when living human tissues are exposed to them, but certain of these effects are of so much importance that no apologies are offered for again calling attention to them in the hope that members of the healing profession, and especially dentists, will be spurred in a more intensive study and the biologic forces that affect the many complicated processes involved in the assimilation and the maintenance of life and health in the broadest sense.

All Food Factors Important

Obviously, in order to build a normal body, or to maintain in the state of health, it is necessary to supply the necessary building and maintenance materials, such as proteins, carbohydrates, fats, minerals, etc. All of these we get in a well balanced and normal diet. However, it is not enough that we take into our bodies these materials. They must be utilized; that is, these substances must be worked over and up into the forms in which they can be assimilated and built into the body structures. (Processed, I believe is the present political terminology.)

If one wishes to build a house it is not enough that a supply of brick, mortar, lumber, nails, paint, etc., be dumped in to the basement excavation. It requires certain forces in the form of man-power and tools to work this material into proper form and to place and fix it in the places needed. Above all it requires someone in control who can and does direct the activities of the whole crew, and sees that these things are properly done.

Just so in building and maintaining a normal and healthy body. The food taken in to the body may contain all the essential elements, but unless it is utilized, that is, assimilated and fixed in to the different tissues, or used in the production of energy, it is of no avail. There must be present the activating forces, or substances, that cause the different elements to take their proper places in the body structures. There is a continual breaking down of all the living tissues, and unless suitable replacement occurs a gradual declinement take place more or less rapidly, depending upon the relative rapidity of the two processes.

Calcium-Phosphorus

Of all the mineral elements found in the body calcium and phosphorus are the two most prevalent. They are always combined in very definite proportion, so that when we speak of one we may always know that the other is present in relative amount. All of the hard structures of the body are composed largely of these, while the denser ones like the teeth almost entirely so. They are present in lesser degree in all tissues.

Vitamin C is the fixing agent for these minerals. This is the factor or substance that has the power to cause calcium and phosphorus in their proper combination, to be assimilated and built or fixed into the tissues. Figuratively speaking this Vitamin is the agent that causes deposits to be made in the bank, to be drawn upon on order of the parathyroids as the need may arise.

The skeletal structures are the storehouse or reservoir of calcium and phosphorus; the bank, as it were, upon which Nature calls in time of need for a supply of these minerals to keep the concentration of the blood within physiological bounds.

The calcium-phosphorus level of the blood must be kept within rather narrow limits in order to live, and of course, still narrower limits for optimum health.

Keeping the calcium-phosphorus level of the blood within proper limits is the function of the parathyroid glands. This they will normally do at the expense of all else if necessary, in order that life may continue. Much has been said and written about the function of the parathyroids in connection with mineral metabolism. Too often, however, the fact is lost sight of that these glands are mobilizers of calcium and phosphorus; that they cause these minerals to be taken up from the skeletal structures whenever necessary to maintain the normal concentration of the blood.

Mineral Fixation

The effect of ultraviolet rays is different in that through their action on the ergosterol of the skin cells Vitamin D is formed, which in turn is the agent that causes these mineral substances to become fixed in the bones and teeth.

It will be seen, then, that through the effect of ultraviolet rays acting or ergosterol, calcium and phosphorus are deposited, as it were, in the calcium bank or depository, the bones and teeth, while the parathyroids cause these minerals to become mobile; to be absorbed from the bones and pass into the blood stream to replace that lost through elimination constantly going on.

Obviously, then, if there is more of these minerals being withdrawn than is being deposited in the bones a rachitic condition will eventually follow. In this classification belongs non-suppurative periodontoclasia, and in many cases where pyogenic infection has become superimposed on a rachitic lesion, the suppurative type also. From the foregoing it is apparent that with a patient in this condition ultraviolet ray therapy is indicated, but right here a word of warning.

Warning

Dentists are prone to think of treating the teeth and surrounding structures instead of treating the individual. The body is one composite whole. When any part of the whole is diseased the individual is ill. Likewise, any treatment applied to or given any part affects the whole; the individual. Then why in the name of common sense continue in the erroneous notion that dental treatments are local in their effect? Isn’t it about time that the rank and file of the dental profession awaken to the fact that their treatments, whether good or bad, are affecting the whole individual, and that they are not treating just something apart? Likewise, isn’t it time that the other branches of the healing art recognize more fully that stomatology or dentistry is as much of a health service as neurology, ophthalmology, or any of the other branches of the wide field of medicine?

Periodontoclasia, whether suppurative of non-suppurative is thought of in one of two ways by the average dentist. (We might well add the average of all the other branches of the medical profession.) Either it is thought of as incurable or something requiring some local treatment only. In a case where the disturbed mineral metabolism is either the etiologic factor, or the result of a long continued infection, nothing could be further from the truth. Such an individual is ill all over even though the most marked symptoms or manifestations may be in the mouth, and the only way to get worth while results from treatment is to find the cause and correct or remove it as the case may be.

If a disturbed mineral metabolism is either the causative factor in periodontoclasia, or the result of other conditions responsible for such a condition, local or intra-oral treatment of the periodontal structures with ultraviolet rays will only aggravate the disease, or at least the local symptoms, viz., the absorption of the alveolar process. This may seem paradoxical, after what has been said above. On the contrary, it is quite rational.

Ultraviolet rays are highly stimulating. This is especially true of the shorter wave-lengths. Dilation of the capillaries follows such a treatment, thus more blood is brought into the area. The calcium-phosphorus content of the blood being low, and the parathyroids attempting to raise it to normal by absorption from the bones, it follows that even greater absorption will take place with the increased circulation in the parts. However, actinotherapy, intelligently used, is a rational, practical, and accepted method of treatment in such cases, sued, of course, in conjunction with other indicated therapeutic, dietetic, or surgical treatment.

 

 

Technique

The technique of administration is to give body irradiations; that is, expose the skin surfaces not ordinarily exposed to the weather, giving a first degree erythema does to either the whole or part of the skin surface. Experience seems to teach that fractional exposures are sufficient, and preferable in that if tanning occurs the subsequent treatments can be given to other parts not so tanned, thus avoiding over-pigmentation, a condition to be avoided if best results are to be obtained. A first degree erythema dose to the chest and back is usually sufficient, except in rare cases. If care is taken treatments can be continued thus without undue tanning. If, however, tanning does occur, subsequent treatments can be given by exposing the lower limbs. Another method is to alternate, giving one treatment to the upper part and the next to the lower.

Exposure

The length of exposures depends upon three factors, viz., efficiency of the generator, distance from generator to skin, and tolerance of the patient. All of these factors have been discussed at length by the writer in previous articles, to which readers are referred. A series of ten or twelve treatments, usually given every two or three days, should be followed by further treatments spread father apart and continued for such time as conditions call for.

After steps have been taken to change the calcium balance of the blood from a negative to a positive phase the case presents quite a different picture. Then, and only then, are we justified in attempting to bring more blood in to the parts; that is, to increase the circulation in the periodontal structures. Now local treatment with ultraviolet rays is definitely indicated. Here the shorter wave-lengths are desirable, and equipment should be used that will deliver them in therapeutic dosages.

These rays, and especially those of shorter wave-lengths are stimulating in their effect, even to the point of being highly cytocidal. Stimulation causes an increased circulation in the parts treated. The blood being now in a positive phase of calcium concentration, in other words calcium plus, deposition of calcium-phosphorus will take place in the bones.

The cytocidal powers of these rays are responsible for their bacteriocidal qualities so often referred to. In sufficient concentration and exposure they will destroy all cell life. Fortunately pathogenic bacteria have a lower point of tolerance than the cells of living animal tissues. Few, if any, bacteria can survive five seconds of optical contact with these fays, especially those of shorter wave-lengths. Consequently they may be used to destroy pathogenic bacteria on or in the living tissues wherever optical contact can be secured. This form of treatment is valuable in suppurative or other types of infection of the skin and mucous membranes. Suitable speculums and quarts applicators facilitate the application of the rays to structures or areas within the mouth or other body activities.

It must be remembered, however, that the rays do not penetrate deeply, and that even a very thin film of blood will completely absorb them, while mucous, etc., does no only to a lesser degree. Thus, in order to get results it is necessary to have the surfaces being treated free from blood, mucous, or other substances that will prevent the passage of the rays. Further, in order to get the deepest possible penetration the tissues should be dehemotized by pressure of the applicator.

Osteomyelitis

Osteomyelitis is the dread of every bone surgeon. The so-called dry socket (a term that should be banished from the vocabulary of any one claiming to have any knowledge of pathology) is the result of osteomyelitis. This bone infection, with the resultant inflammation and necrosis, is a definite indication for this form of treatment. It will be benefited by intensive treatment with ultraviolet rays directed into the socket and on to the overlying tissues, provided the field can be free from blood, mucous, or other debris so that the rays actually reach the infected bone. Relief from pain will follow to a marked degree if such treatment can be efficiently given. Whether this is due to an analgesic effect directly, or the indirect result of inhibiting the activity of the infecting pathogenic organisms may be a question. Be that as it may, the relief is welcome to the patient suffering from this affliction.

In addition the increased circulation following such treatment will hasten the removal of waste products and bacterial toxins, and shorten the time of sequestration and full recovery. All of this is important to the patient and lies within the field of the dentist who would render his patients the kind of health service they have a right to demand from any one holding himself out as practicing this specialty of the healing art.

There are other conditions, of course, in which ultraviolet ray therapy is indicated and helpful but time and space does not permit further discussion at this time. Any one who will apply himself will find other opportunities a plenty, but just as surely those who may be inclined to purchase equipment and treat any and all kinds of conditions without a thorough study of the subject will fail to get the desired results. Actinotherapy is not a panacea for all the ills that afflict mankind, nor for even all dental or periodontal disturbances, but in the hands of the well informed it is a valuable adjunct or our armamentarium in the fight against disease, whether manifest mostly in the mouth or elsewhere.

211-212 Linker Bldg.