Good Health and Bad Medicine:
Diet - Part 2
Diet - Part 3
Diet - Part 4
Diet - Part 5
Some Common Food Fallacies
Teeth - Part 1
Teeth - Part 2
Teeth - Part 3
Obesity - Part 1
Obesity - Part 2
Read More Articles About: Good Health and Bad Medicine
Teeth - Part 1
( Originally Published 1940 )
THERE is a vast array of misinformation and downright fraudulent advertising on the subject of the teeth and their care. Amidst the welter of powders, pastes, lotions, mouth washes and other "hygienic" remedies advertised by dentifrice manufacturers two main facts stand out:
1. That healthy teeth depend largely upon proper diet, and frequent visits to a dentist, and
2. That if all the dental remedies advertised to the public were dumped into the ocean, our teeth would be none the worse for it, and probably much the better.
Let's start with dentifrices. A booklet entitled Accepted Dental Remedies, published by the Council on Dental Therapeutics of the American Dental Association, states: "Dentifrices are generally mixtures used locally on the teeth in con-junction with a toothbrush, without demonstrated medicinal, curative or prophylactic virtues .. . they are used to assist the toothbrush in cleaning the surfaces of the teeth . . . there is no essential difference in the cleaning property of a tooth powder over a toothpaste . . . the sole function of a dentifrice is to aid the toothbrush in keeping the surfaces of the teeth dean, in the removal of loose debris by the mechanical use of the brush ... the dentifrice may aid the process but it cannot replace the brush." No toothpaste or powder, therefore, can fulfill the fantastic claims made by some advertisers. The only basis for all such claims is that the dentifrice may help in the mechanical cleaning of the teeth.
Many dentifrices have been promoted to fight dental decay. Since there is no problem in dentistry which is more important than that of dental decay, it is worth while discussing in detail the causes and methods of control of decay. Then we shall see what role a dentifrice can play in pre-venting decay.
It has long been known that decay is a process of dissolution of the mineral salts of which the enamel is almost exclusively composed. The dissolution is due to the action of acid-forming, fermentative bacteria on carbohydrate (starch and sugar) food particles which have been retained here and there on the surfaces of the teeth.
But everyone is exposed to acid-forming bacteria and everyone eats carbohydrate food, yet not everyone has caries. What are the reasons for the presence of decay in one mouth and its absence in another? This has been the focal question which the many theories about decay have attempted to answer.
The most important of the acid-forming bacteria of the mouth are known as the lactobacilli, germs which produce lactic acid and other acids. There appears little doubt that these bacteria contribute to the development of decay, and most investigators agree that their presence is necessary for the formation of a cavity.
But these germs are continually being introduced into all mouths with food and drink, and decay does not always result. In certain mouths they grow and persist in large numbers and, when they do, decay follows. In other mouths they are unable to grow and persist in large numbers and, in such mouths, decay does not follow. The crux of the problem of dental caries has been to determine the essential conditions which permit the growth and activity of these bacteria in the mouth.
We must dispose of all notions nourished by advertising that a toothpaste or powder, whatever its composition, will prevent the growth of these bacteria or will neutralize the acids that are formed. In the test-tube, milk of magnesia and other "alkaline" dentifrices may neutralize acids and may even have a slight antiseptic effect on bacteria, but in the mouth both of these actions are severely limited. There is no evidence that the use of any dentifrice can prevent dental caries or have any beneficial effect on its progress.
Another point about which experts agree is that dietary factors have a fundamental bearing on the cause of tooth decay. And it is further generally agreed that the dietary factors are associated in some way with civilization, with the choice and preparation of modern civilized diets; but there is no uniform opinion as to the precise dietary factors or mechanisms involved.
Dr. W. A. Price is an exponent of the school which believes that because the diets of primitive people are rich in certain factors, notably vitamins, dental decay is rare in these peoples, and that an abundance of vitamins, minerals and natural foods will prevent tooth decay. Experts who have had an opportunity to observe primitive races agree that decay is a disease of the white man's culture, and that it begins to appear in these people when they adopt some of the eating habits of civilized man. But beyond this, there is no agreement.
The high-protein, high-fat and low carbohydrate diet of the Eskimos, composed almost entirely of meat and fish, has little in common with the diets of tropical races, abundant in fruits and vegetables and therefore high in carbohydrate value; yet both groups show very little caries. Cereal grains were rare among the people at Tristan da Cunha and common among primitive African races, but both peoples were relatively free from caries. Abundance of fresh milk at Tristan da Cunha has been considered responsible for freedom from tooth decay among the natives; but the Eskimos and the natives of the Island of Lewis, with equally sound teeth, have little or no milk other than human. Taro and sweet potatoes were held responsible for the sound teeth of the Hawaiians, but an abundance of the same foods at Pitcairn Island is associated with rampant decay. Some primitive peoples with little caries have diets rich in fresh vegetables and fruits and therefore probably alkaline-forming in character; but the Eskimos and the natives of the Island of Lewis eat mainly acid-forming foods (meats and fish) and have no more caries.
From an analysis of these primitive diets there emerge two impressions about the role of diet in tooth decay. One is that the eating of carbohydrate foods tends to further the development of caries; and the second is that the relative immunity of primitive peoples to decay is at least partly attributable to the fact that they get an adequate amount of vitamin D; the Eskimos from fish-liver oils and the tropical peoples from exposure to sun (ultra-violet rays manufacture vitamin D in the skin).
But several reservations must be made. A high carbohydrate diet by itself need not cause decay (as witness the tropical tribes); a deficiency in vitamin D and other vitamins may occur without decay; and decay may continue to develop on an adequate diet rich in natural foods and vitamins, and even when large amounts of vitamin supplements are taken. Nor will the taking of mineral supplements such as preparations of calcium or phosphorus, or both (dicalcium phosphate, for example), prevent decay. All these facts emphasize the complexity of the problem of dental caries.
Experimenting with rats, Dr. T. Rosebury of Columbia University showed that decay was caused primarily by the presence in the diet of hard particles of carbohydrate-rich foods (raw rice and corn) which became forcibly impacted into the fissures of the teeth. Other dietary factors, such as vitamin deficiency and sugar intake, were found to contribute to the development of decay but to be incapable of causing it; they were not of primary importance.
In man, as in animals, it appears that sugary foods and candies increase decay but do not cause it; a diet adequate in vitamins and minerals reduces the incidence of decay without preventing it; and vitamin D, the vitamin that has been most studied, has a mitigating effect on decay in children similar to its effect on decay in rats.
Observations made by Dr. Rosebury at different settlements of Eskimos showed only one significant food item to be correlated with the prevalence of tooth decay. That food was pilot bread (also called ship biscuit or "hardtack"). Eskimos who came into contact with the whites and ate pilot bread developed caries. Eskimos at another settlement who did not eat pilot bread had very little caries.
Pilot bread, physically and chemically similar to the rice and corn particles that caused caries in rats, was then itself found to be capable of producing caries in rats.
The implication of all these findings was that the most prevalent kinds of dental caries in man are caused primarily by the eating of certain individual carbohydrate-rich foods having a physical character exemplified by hard biscuit.
The chief reason for the prevalence of caries then, according to this theory, is the widespread use of such foods as biscuits and crackers of many varieties, dry processed break-fast cereals, and perhaps chewy candies and other foods of the same sort.
Nobody knows as yet how much responsibility can be attached to individual foods. But the general principle, which is well supported by scientific evidence, incriminates all hard, non-porous, starchy or sweet foods, which take up moisture slowly, and which are chewed with force and pack so firmly into the crevices of the teeth that they are not quickly dislodged. Such durably impacted carbohydrate food provides material for fermentation by the acid-forming bacteria that are continually introduced into the mouth. And, by the same token, soft or porous carbohydrate foods such as bread, ice cream or soft sweet or starchy desserts are not in themselves caries producers (although they may aggravate caries already present).
Individuals probably vary in susceptibility to caries in degree as their teeth have deep retentive crevices or irregularly formed areas of contact. A few may be immune because of ideal dental formation and alignment; at the other extreme, retentive irregularities may sometimes be so pronounced as to collect soft as well as hard and compact fermentable foods.
If this theory is sound, avoidance of hard starchy and sweet foods that pack into the teeth under chewing pressure should prevent decay in the great majority, particularly in children and young people who suffer from it most. Attention to the suggested secondary factors in caries is also well worth while, and in line with good dietary practice; that is, obtain a diet containing adequate milk, fresh vegetables and fruits, supplemented with a good source of vitamin D (see page '71), and limit the consumption of sweets and starchy foods generally.
Tooth brushing cannot be depended upon to prevent caries, and in most instances is probably completely ineffective for the purpose. Proper brushing is nevertheless a valuable hygienic habit for other reasons. By helping to clean the tooth surfaces adjacent to the gums, the toothbrush can be an important factor in the prevention of gum diseases, which are nearly as prevalent and damaging among adults as dental caries is among children.
There is only one satisfactory means of treatment of dental caries: removal of the decayed portions and their replacement with a suitable filling-provided that the decay has not progressed so far as to make extraction the only recourse.
"Pink toothbrush" is a common advertiser's disease. A pink brush after brushing means that some bleeding has taken place, and bleeding may mein disease of the gums caused either by local mouth conditions or by a disorder of some system of the body. Among the local mouth conditions which can cause bleeding of the gums are: too vigorous massage of the gums, incorrectly fitted fillings, improper alignment of the teeth, food packed between teeth, accumulations of tartar and infections such as Vincent's Angina. If the disease of the gums is not due to one of these local causes, the conscientious dentist will recommend a careful examination by a physician to determine if the bleeding gums is a symptom of trouble elsewhere in the body. In no event is pink toothbrush ever due to failure to use a highly advertised dentifrice; nor is it ever cured by use of a dentifrice.
Pyorrhea is another term much abused in advertising. It has come to connote any disorder or disease involving the gums. There are many such disorders, and the sensible thing to do when troubled by bleeding or sore gums is to visit a dentist so that the cause may be determined. The trouble may be due to poor diet, incorrectly fitted fillings or crowns, infection or disease of the bone. At any rate, good dental treatment and hygiene, and not Forhan's, is the remedy.
The use of dentifrices for the purpose of removing "film" from the teeth is neither necessary nor desirable. According to the American Dental Association, "Honest dental scientists have no ready means of diagnosing between coverings on the teeth which may be protective and those involved in the production of decay." The fact is that whiteness of the teeth is not necessarily a sign of good dental health—dentists know that vital, healthy teeth may vary in hue and shade from a creamy white to a grayish color. In fact, Dr. Charles F. Bodecker, Professor of Oral Histology at Columbia University, and a foremost dental authority, states that the healthiest teeth have a yellowish hue, and that chalky white teeth are a sign of calcium deficiency.
"If you really want teeth that glisten and gleam," says a Pepsodent advertisement, "try Pepsodent Tooth Powder immediately." . . . "Why? Because Pepsodent Powder contains wonderful Irium." The word irium has a thrilling sound. Disappointingly enough, however, it is simply a trade name for a kind of soap known chemically as sodium alkyl sulphate. The American Dental Association states that it merely "performs essentially the function of soap" and that there is no evidence that it is superior to other soaps frequently included in other dentifrices.
Teeth that are dull and dirty due to lack of oral hygiene can be made clean and stains can be removed by a harmless method, which is taught in dental schools. However, dentists know that in the neglected mouth the cleansing process is a tedious task, requiring patience, care, proper instruments, and skill. No quick way or short cut is safe.
The use of so-called "stain removers" and "tartar removers" is dangerous. Several of them—Taxi, Stain Remover, Bleachodent, E -Key, Ex-Tartar, Snowy-White and Tartaroff, were the subjects of exposés at different times by the Re-search Council of the New York Academy of Dentistry and the Council on Dental Therapeutics. All these products were shown to contain hydrochloric acid and to have a definitely deleterious effect on the enamel.
Chewing gums have been endowed with new virtues recently. Claims that they promote health of teeth and gums or help to keep them clean are without foundation.
Since no toothpaste or powder can destroy acid, prevent decay, cure pyorrhea, safely whiten the teeth, disinfect the mouth, cure halitosis (see page 57), or prevent pink tooth-brush, what place has a dentifrice? It is valuable simply as an adjunct to proper brushing; it helps in the mechanical cleansing of the teeth, in the removal of food particles. And that is all.
Powders are generally cheaper than pastes but there is no essential difference in their cleansing properties.
The following ingredients which have been found in dentifrices are undesirable for daily use: sodium perborate, sugar, starch, potassium chlorate, acids, borax, betanaphthol, fluorides, orris root, and pumice or other harsh abrasives. Abrasive dentifrices, or overvigorous brushing, are likely to be especially harmful to older persons and others having poor contact between teeth and gum margins. In such people the cementum (softest. part of the tooth's surface) may be exposed, and become scratched.
For brushing the teeth the following. may be prepared at home:
Salt or baking soda. Dissolve 1/4 teaspoon of either or both in half a glass of warm water, and dip brush into solution. Don't use salt crystals directly on the brush.
Precipitated chalk, U.S.P., the finest obtainable. Purchase in pound lots at drug stores, 25C to 35C a lb. Cost per oz., about 2c. Use as an ordinary tooth powder. If flavor is desired, mix in a few drops of oil of peppermint or oil of wintergreen (3 to 6 drops for each 4 oz. of chalk).
The following ratings of dentifrices are based on tests reported by CU in December, 1939: