Dental Hygiene
WE learn that "the mouth is the gateway of health." The doctrine of focal infection warns us that the teeth may imperil vital organs, and others of great. im- portance, such as the joints. As we saw in a recent article, the fight against rheumatism requires us to clean U!) and keep clean all accessible places where germs may establish themselves, and *hence they may invade and infect the rest of the body. Notable amongst such places are the pulps and encircling membranes of the teeth. But Dr. Harry Campbell is doubtless right when he says that we have the worst teeth in the world, and this noto- rious failing may well be correlated with the grave inci- dence of the rheumatic disorders amongst us, though the evidence is not wholly conclusive. What should we do ?
The experience of our own and other countries shows, Iii the first place, that we have not enough dentists to deal with the problem—and naturally it is to the dentists that we first turn. Not only are there not enough den- tists, but there never will be and never can be. The dentist is a surgeon who specializes on the teeth. He had best have a general surgical qualification. His training Inuit be long and costly. His instruments and equipment and materials are very numerous, Very costly indeed, and ever increasing in complexity, number and costliness. He loves to use the most precious metals, such as gold and platinum.; nor will -any -others do his work. He must have X-ray equipment as a matter of course. How in the world is all this to be available every day for thousands and millions of school children, to say nothing of the pre- school child and the adolescent ? It is difficult enough to get an appointment with one's own dentist, to whom one will pay several guineas per hour. Whilst, therefore, the state of our teeth is as it is, we must invent some other .means for attending to them.
This means, adopted in several of our Dominions and elsewhere, has indeed been invented, with great success. They have established an order of people called dental hygienists, especially to work in the schools, where indeed a beginning should be made. Choose the right kind of intelligent and careful young girl : give her an intensive training in her job. Allow her to watch and clean the children's teeth, to remove tartar and even to fill super- ficial holes. The cost is bearable. More difficult cases will be referred to the fully qualified dentist, but this early preventive treatment which the dental hygienist applies will very quickly reduce the number of those more difficult eases. Objections may be raised on the part of those who fear that their monopoly is threatened, and questions of cost will arise ; but some such provision is clearly necessary. Writing far from my own reference library I cannot quote the startling figures showing the present outrageous disparity between the number of available dentists and the number of teeth needing attention, but the concerned reader may be referred to the valuable chapter on this subject in Dr. James Kerr's Fundamentals of School Health, reviewed in the Spectator of October 9th, 1926.
But ought our teeth to decay at all ? Indeed they should net. And if not, why do they decay so markedly in this country ? Certainly not because our standard of dentistry is low : that is not so, and would not be relevant if it were so. Is it because we are careless and indifferent in the use of the toothbrush, as compared with, say, Southern Italians ? Surely not. By all means let us persevere with the toothbrush. Let us use the expensive dentifrices widely advertised, or simpler things like common salt or common soap or bicarbonate of soda. Let us accept—with reserve, for it is not wholly true— the dictum that "clean teeth never decay." But in spite of all such efforts we shall still be plagued with dental caries and all its multifarious consequences.
Another and better way—inapplicable, alas ! to most or all of us who read and write—would be to begin at the beginning. "Most," I wrote, not " all " : for the ex- pectant mother and the nursing mother, in this as in so many other respects, begin at the beginning, at least of the next generation, and they may well adopt the teaching which, we hope, will help the due development of their children's jaws and teeth.
For the work of an English woman, Mrs. May Mellanby, whose husband is the distinguished worker upon the same subject, has shown that, in part at least, the problem of dental caries is an aspect of the problem of rickets. The qualifying clause is necessary, since, as i wrote in the Lancet seven years ago, the production of enamel and the protection of enamel are different things. But certainly the first thing is to produce the enamel, of good quality, and of adequate thickness. It should be produced in well-developed jaws, such that the teeth can all find room, and be suitably aligned and opposed to one another. Mrs. Mcllanby has shown that the development of the jaws and teeth is part of the general problem of bone formation. The factors that control the one control the other. Definite correspondence can be shown between the supply of vegetable margarine or butter to a puppy, and the quality and quantity of the enamel laid down upon its teeth during the supply of each. (Nothing makes hard teeth like soft butter.) Perhaps a previous article on rickets—" the English disease "—would have better prepared us for this subject ; but here we may say that the causes of rickets arc in part the causes of the poor development of the jaws and teeth of the people who inhabit the British Isles. If and when we remove the causes of rickets, by restoring sunlight and enough food containing the anti-rachitic vitamin—. which we call " D " for the moment—to our urban population, we shall improve their teeth. We may also thus hope to develop normal faces, with adequate width of palate, without the forward protrusion of nose and mouth and the " gnathic degeneration" which mark the Englishman wherever we see him, and which Sir Arthur Keith has so usefully described. Another agreeable result would be the production of forward-speaking and resonant voices, fit for speech and song, such as the sunlit Italian possesses as a matter of course. (To anyone possessed of a Musical ear, the voices of the negro atten- dants on the trains constitute one of the pleasures of travelling in the United States.) Lastly, there is the protection of -the teeth thus well formed, by Nature's means, which is, as with other organs, their appropriate use. Here we need the help of the dietary teaching of the New Health Society (39 Bedford Square, W.C.). Meanwhile one overhears millions of teeth saying to themselves, " If we are in wanted, we will go." And go they do, and seldon quietly.
Let us hope that the new knowledge, and Mr. Georg, Eastman's superb gift to London from Amarica, mv soon arrest this lamentable exodus.
CRUSADER,
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