“Some Facts Which Physicians Should Know About Maintenance of Dental Health”
by Charles C. Bass, M.D. Dean and Professor of Experimental Medicine Emeritus of the School of Medicine Tulane University of Louisiana, New Orleans, La.
Reprint from The Bulletin of the Tulane Medical Faculty pp. 12-16, November 1949, Volume 9, Number 1
The two diseases - caries and periodontoclasia - from which almost all loss of teeth results, can be entirely prevented by following the right method of personal oral hygiene. They cannot be prevented in any other way now known. Not only is the initiation of lesions of these diseases preventable, but in most instances, further progress of lesions that already exist is also preventable. Only in instances of some far advanced lesions and under unusual circumstances, may the disease process continue to progress. The purpose of this paper is to direct attention to the necessary personal oral hygiene for prevention of caries and periodontoclasia, and for maintaining personal oral cleanliness. This is the information that every physician in any field of medicine must know and follow in order to maintain his own dental health and oral cleanliness. He must have this information also if he wishes to promote the dental health welfare of others. The physician who is not now maintaining his own teeth free from active disease is not in a position to advise his patients that they can and should maintain good dental health. Either he does not know how to keep his teeth free from these diseases or he is too neglectful of his own dental health and oral cleanliness to appreciate the benefits of effective personal oral hygiene. Both caries and periodontoclasia are local diseases caused and promoted by conditions that exist at the locations where the lesions originate. Measures for successful prevention of these diseases must provide for recognition and effective prevention or minimizing of these etiological conditions. Correct information as to what these conditions are is necessary. The causative organisms are microscopic, the pathological processes originate and progress microscopically, the tissues involved are composed of microscopic filaments and the lesions themselves at first, are only microscopic in extent. Therefore correct information about the conditions must be obtained through microscopic research. Information that has been established previously by the work of others, together with further information which I have secured through several years of intensive research on the subject, has enabled me to devise, formulate and specify a practical method of personal oral hygiene which not only meets the requirements indicated by the local microscopic conditions, but results in a high degree of prevention and control not attainable in any other way. My findings have been announced in a number of publications.1,8 More will appear in other papers presently in process of publication or in preparation.
The caries process consists first of partial decalcification of enamel resulting from the action of organic acids produced by bacterial breakdown of carbohydrate food material. The partially decalcified enamel appears white and becomes less resistant to physical force. It is frequently referred to as chalky enamel and the affected area as a "white spot." It is less resistant to physical force and can be cut or dug into with a hard sharp instrument, as if it were a piece of chalk. This is the early stage of caries. If the conditions causing this partial decalcification continue for a long period of time the process extends. Sooner or later the softened enamel breaks down and a cavity is formed. This is the advanced stage of caries. This cavity stage of the caries lesion is usually the first and only stage of the disease that is recognized by the individual. In general it is the only stage that is recognized by the dentist. When a person finds that he has a cavity he may seek advise and treatment by a dentist, who treats (fills) the lesion with varying degrees of success and durability. At best the tooth is impaired and its expectancy for usefulness is much reduced. How much better it would be for such a lesion to be prevented than to be treated, however successfully, after it developed! The time to prevent caries lesions is before they start. Measures to prevent caries lesions must be applied to the locations where such lesions originate, and must counteract or prevent the conditions there which would cause the disease. Caries lesions originate at locations on the tooth at which heavy bacterial film can grow and accumulate and where food material may be retained. These locations are mainly the embrasures between the teeth and in grooves and fissures on the occlusal surfaces of the grinders. The thick film pad in such areas (called dental plaque) consists of a pile of long rod and filamentous types of microorganisms, all having one characteristic in common, i.e., one end is attached to the tooth surface and the long stem or filament extends outwards toward the surface of the pad. All caries lesions develop beneath such thick bacterial film pads and never on exposed surfaces which are constantly or frequently cleaned by functional friction. It is necessary to reduce and prevent the accumulation and retention of the thick bacterial film pack at these caries-vulnerable areas, thereby maintaining conditions there similar to those that exist on areas where caries lesions do not occur.
Mechanical cleansing breaks off and removes the bulk of the long rod and filament organisms composing the thick film pack, but short stems and stubs of these organisms remain attached to the tooth. Many of these are viable and are able to grow to make long rods and filaments again, if allowed sufficient time.
If the long organisms attached to the tooth making up the film pad are removed (except for short stems) at night before retiring and any retained food material which could serve as culture media is removed at the same time, little growth of the remnants of bacteria takes place until food is taken the next day. There is not sufficient growth and retention of bacterial products during the day for harmful effects to result before time to clean the teeth again at night before retiring. It is a fact, although not generally known, that almost all caries damage occurs at night during sleep, when acids which are produced in retained carbohydrate food material attain greater concentration and remain in contact with the tooth for much longer time.
The statement that has often been repeated for more than fifty years that "a clean tooth does not decay", is as correct today as ever. To maintain the necessary cleanliness to prevent caries the teeth must be cleaned effectively every night before retiring, Nothing less produces the desired result.