DENTAL HYGIENE
[To the Editor of the SPECTATOR.]
SIR,—In your issue of May 21st there appeared a contribution by " Crusader " under the above heading. The title was surely a misnomer, since your contributor said little or nothing about the hygiene of the teeth. It was apparently a not very enthusiastic attempt to advocate treatment of children's teeth by unqualified practitioners.
Unfortunately here in New Zealand we have such a system inaugurated by the Government. Young women of no particular educational standard are " intensively " trained for two years in a so-called school and then are given State positions as " Dental Nurses," when they do not carry out the hygiene of the teeth as understood and carried out in America, but are authorized to operate in exactly the same manner as a qualified dentist upon both the permanent and milk teeth of children attending primary schools. They are permitted and have to decide which teeth are to be extracted and which filled, and they administer local anaesthetics for the most part
entirely without supervision. This is not dental hygiene ; it is cheap dentistry. It is obviously fundamentally wrong, and is having a most unfortunate effect upon the morale of New Zealand children and parents.
In the first place, it is one more responsibility of which the State is relieving the 'parent. The parents are saying there is no need to worry about teeth or their hygiene ; the State will fill up the holes. Secondly, to hope to check the incidence of dental caries by the mechanical means of filling holes as fast as they appear is as futile as it is thoughtless and'un- scientific.
It is not the duty of the State to interfere in treatment; It is the pre-eminent duty Of the State to initiate and carry out prevention. Dental caries can be prevented but it means care, thought, and sacrifice, and these things being highly unpopular, no politicians will have anything to do with them, much less take active measures to enforce them. On the other hand free (albeit unqualified) dentistry is highly popular and finds ready support. Sufficient is known of the cause and prevention of decay of the teeth to eliminate at least 70 to 80 per cent. of its incidence if the principles were thoroughly taught and enforced. My own investigations and those of others have shOWn that there are four factors at work, the attacking forces—diet and organisms, and the defending forces—the resistance of the surface of the teeth and the quality and quantity of the fluid in which they are bathed by Nature (saliva).
Whilst we may, to a considerable extent, lessen the force of the attack, by cleanliness of the teeth and by -reduction in
consumption of soft, sticky starches and sugars, yet our sheet anchor here as in other infections must be an increase in tissue resistance. In this case by increasing the density of the enamel surface of teeth (which has gone back considerably as compared with that of our ancestors) and by increasing the amount and alkalinity of the saliva (decay being initiated by small mole- cules of nascent lactic acid formed in the crevices of the teeth). Both these factors, enamel density and salivary secretion, are controllable -by diet, hygiene, and drugs. Of these the first two are preferable and could be adopted on a
wide and national scale. This would be true dental "'hygiene." If unhygienic teeth were popularly regarded as social and financial disabilities, as indeed they are, the demand for preventive measures would soon come from the people themselves.—I am, Sir, &c., H. G. PICKERILL, University of Otago, New Zealand. C.B.E., M.D.
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