Charles C. Bass. M. D. - Dean, Emeritus, and Professor of Experimental Medicine, Emeritus. of the School of Medicine.
Reprinted from The Bulletin of the Tulane University Medical Faculty Vol. 13, No.3, May, 1954
An authoritative discussion based on extensive study concerning a much neglected subject.
Many different factors contribute, more or less, to the incidence and progress of the lesions of the two principal diseases of the teeth - caries and periodontoclasia. In general, more damage is caused by caries in early life; after about 30 or 35 years of age periodontoclasia is definitely the most important from the standpoint of prevalence, potential harmfulness of the disease process, and actual loss of teeth. Susceptibility to these diseases varies greatly in different individuals and in different teeth in the mouth of the same individual.
UNCLEANLINESS ESSENTIAL CAUSE
The essential etiological condition in each disease is uncleanliness at the particular locations where the lesions originate and advance. Without these conditions of uncleanliness no disease occurs. None of the other contributing factors can cause either of these diseases, without this essential condition of uncleanliness. A clean tooth does not decay; periodontoclasia does not occur about a clean tooth. All that is necessary for any person to maintain practically one hundred percent of freedom from incidence and advancement of the lesions of both caries and periodontoclasia is that he maintain the necessary degree of cleanliness about his teeth. Each tooth to be protected must be cleaned effectively, at suitable intervals, especially at the vulnerable locations where the lesions usually occur.
CARIES AND PERIODONTOCLASIA ALMOST UNIVERSAL
The dental health and oral cleanliness of every individual are determined largely by his or her habits and method of personal oral hygiene. Almost all people have more or less caries and periodontoclasia lesions, in varying degrees of activity, at any particular time. Every tooth that decays and every tooth about which periodontoclasia occurs was not kept adequately clean. Methods of cleaning the teeth followed heretofore have been more or less inadequate. This means that practically everyone must learn and follow a method which he has not followed before. The problem of dental health therefore requires first that we have available an effective method-of personal oral hygiene and second that this (effective) method be taught to, and followed by, those whose dental health and oral cleanliness are to be promoted.
MICROSCOPIC STUDY AND RESEARCH NECESSARY
These diseases are caused by microscopic organisms, the lesions at first are microscopic in extent, they advance microscopically, the tissues involved are composed of microscopic elements and the destructive process is mainly microchemical. Therefore all preventive measures must be based upon the fundamental facts which can be known only through microscopic research. By such research over a period of year, and from the recorded work of others, I have been able to secure information as to the essential local etiological conditions involved and to design an entirely effective practical method of personal oral hygiene based upon this information.
It is obvious that preventive measures based upon incorrect or confused and conflicting information as to the local etiological conditions to be counteracted would not be likely to be effective. The opinions and recommendations of the highest standing authorities are of little value unless they are based upon the fundamental facts about these diseases, and these facts can be secured only through microscopic study and research.
FUNDAMENTAL INFORMATION PUBLISHED
From time to time I have published several papers directing attention to some of the important fundamental information and the local etiological and pathological conditions in these diseases. These papers need not be reviewed or listed here. Those who are interested can find them! In a recent publication I have again presented the most important facts upon which prevention must be based, and have again accurately described the only effective method of personal oral hygiene now known, comprising practical application of correct microscopic information as to the etiology and pathology of these diseases.
For all practical purposes this method of oral hygiene is entirely effective in preventing these diseases and, at the same time, maintaining a far higher degree of oral cleanliness than could be done otherwise.
The method of personal oral hygiene which I have designed and described is encompassed in the key expression which has been formulated for the purpose, viz., "YOU MUST CLEAN YOUR TEETH RIGHT WITH THE RIGHT KIND OF BOTH TOOTHBRUSH AND DENTAL FLOSS EVERY NIGHT BEFORE RETIRING." When this is done no new lesions of either caries or periodontoclasia develop and lesions that already exist usually cease to advance further. It is obvious that the time to prevent lesions of these diseases is before they occur and the time to prevent further advancement of existing lesions is before further advancement takes place. Nothing can prevent damage that has already occurred.
RIGHT KIND OF TOOTHBRUSH AND DENTAL FLOSS REQUIRED
Not only must the teeth be cleaned right for it to be effective, but this can be done only with the right kind of both toothbrush and dental floss. After having accurate information as to the microscopic conditions at the locations that have to be cleaned, I was then able to design and work out the optimum characteristics and specifications for a suitable brush and floss. All information indicates that brushes and floss which deviate from these specifications to any considerable extent would be inappropriate to whatever extent they so deviate.
METHOD ENTIRELY DIFFERENT
Having the right kind of toothbrush and dental floss each person must know how to use them effectively. He must be taught by someone who knows and follows the method himself. Instruction from anyone else is likely to be inaccurate and misleading.
The method of brushing the teeth and cleaning them with dental floss which I have designed and specified is quite different from, and in some important particulars quite the opposite of, incorrect methods generally taught and followed. By this method the teeth are cleaned at the locations where caries lesions originate and also on the surfaces within the gingival crevices where foreign material (bacterial film, concretions etc.) on the tooth causes and promotes the advancement of peridontoclasia.
USE OF DENTAL FLOSS ESSENTIAL
Most people not only do not know how to brush their teeth right, but they do not know that it is necessary to clean them with dental floss at all. Oral cleanliness and dental health cannot be maintained without the proper use of dental floss. No amount or method of brushing alone is sufficient. For all practical purposes it is correct to say that any person who does not use dental floss now has, at all times, pathological conditions and shameful uncleanliness about part or all of his teeth. This applies to all people in whatever occupation or position in life.
PUBLIC APATHY TO DENTAL DISEASE AND ORAL UNCLEANLINESS
There is the greatest variation in the attitude of different people to damage or loss of their teeth. Some fully appreciate their value - functional, esthetic, and otherwise - and are willing to put forth any effort they know in order to maintain them; others are satisfied to seek relief from trouble when it arises and to have installed the more or less disfiguring repairs, appliances and replacements for damage or loss, after it occurs; still others are quite satisfied to have teeth extracted whenever they give trouble, or to let them fall out. They go through the remainder of life thus disfigured and crippled, without the full benefit of the functions and pleasure of their teeth. The victims of these several disfiguring and crippling conditions usually do not know or realize that they were caused by oral uncleanliness and, for all practical purposes, could have been entirely prevented. Display, when talking, laughing or otherwise, of decayed teeth, repaired teeth and replacements for missing teeth, too many of which have been lost needlessly, is an ever-present advertisement of the unclean conditions that existed when the damage occurred.
PERSONAL ORAL HYGIENE AN INDIVIDUAL MATTER
There is the greatest variation in the sensitivity of different people to oral uncleanliness or to their appreciation of cleanliness. It is amazing sometimes to see people who are scrupulously cleanly in their hygiene habits generally, but who have the foulest conditions around some or may of their teeth. They do not realize the presence of the conditions which are more or less not visible and are largely microscopic.
Now that we do know an effective method of personal oral hygiene - and this is quite different from methods generally believed and followed - the need is for it to be taught effectively to those whose dental health is to be promoted. Each individual must be taught so he or she understands and can follow it. This can be done by practicing dentists who have the information, in connection with their treatment, operative and restorative service. Others could be trained to teach the method successfully. The necessary personal instruction in this regard could be promoted by individuals, groups, welfare agencies, organizations, institutions and foundations interested in promoting dental health. The opportunity for contributing to human welfare in this way is very great.
The essential cause of the two principal diseases affecting the teeth - caries and periodontoclasia - is uncleanliness at the locations where the lesions originate and advance. Attention is directed to a method of personal oral hygiene whereby such conditions of uncleanliness can be prevented or minimized. The problem of dental health requires that this effective method of personal oral hygiene be taught to, and followed by, those whose health-welfare is to be promoted.
1. Bass. C. C.: Some Facts Which Physicians Should Know About Maintenance of Dental Health. Bull Tulane Med. Faculty 9:12. 1949.
2. Bass. C. C.: An Effective Method of Personal Oral Hygiene. J. Louisiana State Med. Soc. 106:57-73 and 100-112 1954.
3. Bass. C. C.: The Optimum Characteristics of Toothbrushes for Personal Oral Hygiene. Dent. Items Int. 70:679 1948.
4. Bass. C. C.: The Optimum Characteristics of Dental Floss for Personal Oral Hygiene. Dent. Items Int. 70:921 1948.
"A Clean Tooth Does Not Decay, nor does periodontoclasia occur about a clean tooth." C. C. Bass, M.D.