Bad Teeth Research Articles

THE DETERMINATION OF PHYSICAL FITNESS

Among the many problems that will be given serious consideration in the program of medical preparedness will be that of physical fitness; physical fitness of the soldier to perform military service and physical fitness of the worker to perform useful productive and continuous work. That this matter is of importance can be seen in the recent press report which expressed the concern of the Army Medical Corps about the physical condition of many applicants for army service. At least 30 per cent have been rejected in the New York area because of bad teeth, poor vision, flat feet, bad hearing and other causes. 1 Such a high percentage of rejections would seem to indicate indeed a low state of physical fitness of the general population or too rigid a set of minimum requirements for acceptance. Physical fitness has been previously studied in respect to both military and industrial activity. However,

The promise of nutrition: Nourish and flourish

T HE real function of nutrition is to form and sustain the structures and functions of all organs and tissues in the body. Physiologically and psychologically we are the result of the food we have eaten. Therefore, it cannot be made too clear that a small deficiency in any one of three dozen or more substances and elements may cause subnormal health and, if long continued in infancy and youth, may cause permanent damage. In Drummond’s recent book, The Englishman’s Food, which is a chronicle of the English diet through more than five centuries, evidence is presented to show that mankind was best nourished during the era 1750 to 1850. Subsequent to this time the dietary has been progressively refined and processed to suit the palate. One effect of this development on the diet is shown by the replacement of the centuries-old process of grinding grains between stones by the modern roller mills. Within fifteen years this change dropped the per capita consumption of vitamin B, from about 1,000 I.U. daily to less than one-third that amount. From that day to this a large portion of the population has been subsisting on a diet deficient in vitamin B, all because of this change in milling procedure. Roller milling and subsequent bleaching also removed all the carotene, half the riboflavin, half the calcium, and two-thirds the iron of the wheat and corn, markedly reducing the total daily intake of these food essentials. This important effect of milling is but one of many which may be cited to prove that our “civilized” foods are definitely inferior in nutritional value to those eaten by our ancestors. There is no doubt whatever that during the nineteenth century bad teeth became more common, while during the present century the rise in the incidence of caries has been alarming. This increase in caries incidence coincided with decrease in intake of calcium, phosphorus, vitamins A, C, and D, each of which is essential for tooth formation. The parallelism is not hapinstance. In defense of our grandfathers, it should be said that they believed that they were improving foods. To them calories were of prime importance and foods were only fats, carbohydrates, and proteins. The discoveries that proteins differ in nutritive values and that foods contain physiologically essential vitamins and minerals had not been made. They can be excused for what they did not know. During the Middle Ages a failure in crops resulted in devastating famine. This famine was so often succeeded by pestilence that the phrase “famine and pestilence” has become a part of our language.

Carcinoma of the Lip and Mouth

THE literature produced by the larger cancer centers allots a role of ever-increasing importance to irradiation in the treatment of lesions in and about the mouth, but the average practitioner of medicine, whose judgment is based on his personal experience, is in most instances quite unconvinced of its value. Nor is he always to be condemned for his attitude, since his radiological confrères, especially those located at a distance from the large cities, are too frequently inclined to use inefficient methods, assuming perhaps that they cannot afford to equip themselves with the necessary apparatus needed for better results. It is the author's opinion that quite creditable work may be done with equipment of modest proportions, and this article is written in an effort to stimulate the interest of those radiotherapists who are not connected with large, richly endowed institutions. Their good work, displayed before their medical colleagues, will mold medical opinion as no amount of writing can possibly do. Carcinomas of the lip, mouth, and pharynx are, with few exceptions, of the squamous-cell variety, and, generally speaking, it may be stated that efficient treatment must be designed to take care of that kind of malignancy. Experimental work and clinical observation have evolved certain principles which should, when possible, be followed. They are: 1. Six to twelve erythema doses of irradiation are needed for the actual cure of squamous-cell carcinoma. 2. Recovery is more rapid and surrounding normal tissues show a quicker return to normal when the treatment is administered over a prolonged period, usually from seven to fourteen days. 3. Short wave lengths produced by heavy filtration lessen the injury to surrounding normal tissues but are not essential in treating superficial lesions on the lip. 4. An attempt should always be made to produce a cure with the first series of treatments, since the second attempt is never so successful and may produce injurious effects. 5. Infection and irritation (tobacco, bad teeth, etc.) interfere with healing and must be eliminated during treatment. Since the therapy accorded primary lesions is quite different from that used for metastases in the neck, the first portion of this paper will deal entirely with the primary conditions and the management of the neck will be taken up later. Cancer of the Lip Carcinoma of the lip is an accessible, easily recognized lesion which metastasizes very late. Any method of treatment which thoroughly eradicates the primary lesion will, therefore, produce a large number of cures, and the surgical statistics are universally good. However, both x-rays alone and radium alone have, in the hands of those therapists possessed of enough courage to give ample dosage, brought about equally good results.

The Report of Five Cases of Subacute Osteomyelitis of the Femur Resembling Sarcoma

WHILE osteomyelitis in the majority of cases is a disease of childhood, there is a slow subacute type which may appear at any age. In this type the process may go on for a long time, the result being an osseous formation quite difficult to differentiate from sarcoma. The causative agent in practically all the cases is an attenuated organism of low virulence, which has been present in the system for a long period of time. The patient gains a certain amount of resistance against this organism, the result being a subacute rather than an acute type of osteomyelitis. Because of the great difficulty in reaching a correct diagnosis and because the treatment depends so entirely upon the correct diagnosis, every means at one's disposal must be used to arrive at this important decision. A few days' delay will not affect the results. As in all bone lesions, the burden of proof should be to demonstrate the malignancy of the condition. A very careful history should be taken, a careful search made for a history of injury or of any acute infection, and above all an exhaustive examination must be carried out to locate any possible foci, however slight. A number of cases have entered the clinic in which a differential diagnosis has been exceedingly difficult. Some patients with an initial diagnosis of sarcoma are well today without radical treatment of any kind. In this group of cases, which is being reported as a group for the first time, there is a history of injury in two, bad teeth in one, a carbuncle in one, and osteomyelitis ten years before admission in another. In all these cases pain in and an enlargement of the part affected were the symptoms of the onset, and in all cases the femur has been involved. A leukocytosis in all but one case has been present, while the Wassermann was negative in all. Case 1.—Three months before entering the clinic the patient had an attack of “sciatica,” affecting the right leg. Five teeth were extracted and the back was strapped. A few weeks later he noticed soreness and swelling of the right thigh. Two weeks later he had more pain and swelling. The diagnosis of osteogenic sarcoma was made by an outside doctor. Examination.—The right thigh is much larger than the left and there seems to be a thickness of the femur at the upper and middle third. This thickness almost surrounds the entire femur. It is not tender. Tonsils infected and sinuses cloudy. White blood count 14,000. Wassermann negative. X-ray examination of chest negative. X-ray film shows a thickening of the periosteum but no real breaking through. There is a slight shadow in the medullary cavity and a tiny calcified spot about one and a half inches from the femur. This does not impress one as a malignant lesion, but, rather, as a benign infective process of osteomyelitis. The patient was kept at rest. The tonsils were removed and a submucous resection of the septum done. Three months after we saw him, a sequestrum about 8 by 3 mm. was removed from the thigh.

STUDIES IN ASTHMA

Current textbooks show that the diagnosis of eczema has been applied to a variety of skin conditions which depend on a number of causes. Recent progress has made it possible to remove many cases from the old classification of eczema by showing that the skin lesions depend on such local causes as chemical irritation, or on parasitic conditions, as ring worm or epidermophytosis. Eczema is becoming better defined. The local lesion frequently depends on some fundamental cause in the body as a whole, and is not necessarily a local disease of the skin itself. The more general causes include toxic, metabolic and allergic factors. Toxic causes include those in which the eczema depends on a well recognized focus of infection and clears when the bad teeth or diseased tonsils or constipation are treated. Under this heading, perhaps, may be grouped those children in whom eczema depends on a faulty digestion,

DEFECTS IN THE MEMBRANOUS BONES, DIABETES INSIPIDUS AND EXOPHTHALMOS

This case is being reported, first, because of its rarity (only eight others are to be found in the literature) and, second, because thus far the condition has been observed only in children (the oldest patient reported was 16 years of age). The subject, therefore, may be of interest to the pediatrician. <h3>REPORT OF CASE</h3> R. L., a boy, when 4½ years of age, was operated on for removal of tonsils because of repeated attacks of sore throat. Two months after, the mother noticed small tender spots on the head, and because of that complaint the child was admitted to Mt. Sinai Hospital. The examination showed pallor, bad teeth, spongy gums and many soft spots on the head, the size of which was not mentioned. The Pirquet and the Wassermann reactions of the boy and the Wassermann reactions of the father and mother were all negative. The blood was not

Correspondence

To the Editor—This morning (Nov. 3, 1923) a patient presented himself with a mass the size of an egg in the submental area and apparently somewhat fixed to the lower jaw. In March, seven months ago, a small ulcer on the lower lip was subjected to radium treatment and has healed, leaving a slight, umbilicated scar. The lesion, whatever its nature, had been present three months. It occupied the mucocutaneous border of the middle third of the left lower lip. It had apparently begun as a smoker's burn in a patient with bad teeth. These cases are increasing in number. That is, the lesion on the lip heals, or apparently heals, after the application of roentgen rays or radium, and then, a few months or years later, glands appear in the neck, which, when removed, prove to be metastatic carcinoma. I would appreciate an opportunity to present to the larger audience of the readers of The Journal the following facts: Some years ago I made one report on the operative treatment and results of cancer of the lip, and there is in preparation a second report on a larger number of cases. The conclusions of the first report are confirmed by the restudy of both old and new material, and the ultimate results up to date. If the lesion on the lip can be excised with a V-shaped piece and the wound closed without a plastic operation, there has never been a local recurrence, irrespective of the pathologic condition, whether the lesion was benign or malignant. This operation can be done under procain within one-half hour, and the patient should not lose more than a few hours from work. The cost of such a minor operation in material and in time of patient and operator is small as compared with that of any other treatment, and it is my opinion that the results are the best. The piece excised from the lower lip is subjected to microscopic study, and if the sections show cancer, the glands of the neck are removed (this can also be done under procain). When these glands show no evidence of metastasis, the percentage of cures has been 100. When the glands have shown metastasis, the percentage of cures in the first report was 50, and in the second report will be somewhat larger. Now that the community is educated to seek advice early, the moment the lesion is observed on the lower lip, I am able to divide the cases observed and reported by me into die following classes: 1. The lesion on the mucocutaneous border of the lower lip is small, of short duration—a few days up to two weeks; it is of the type of a burn, a fever blister, a vesicle, keratosis or a wart. The patient smokes or chews; the teeth may be ragged and dirty. The majority of these lesions heal by removal of the causes—tobacco and ragged, dirty teeth—and instructing the patient to keep the teeth clean and the lip lesion covered with petrolatum. 2. The lesion is of longer duration, but still distinctly benign—leukoplakia, or the chronic chapped lips of the smoker.

EXCISION OF A V-SHAPED PIECE OF THE LOWER LIP VERSUS ROENTGEN-RAY OR RADIUM TREATMENT

To the Editor: —This morning (Nov. 3, 1923) a patient presented himself with a mass the size of an egg in the submental area and apparently somewhat fixed to the lower jaw. In March, seven months ago, a small ulcer on the lower lip was subjected to radium treatment and has healed, leaving a slight, umbilicated scar. The lesion, whatever its nature, had been present three months. It occupied the mucocutaneous border of the middle third of the left lower lip. It had apparently begun as a smokers' burn in a patient with bad teeth. These cases are increasing in number. That is, the lesion on the lip heals, or apparently heals, after the application of roentgen rays or radium, and then, a few months or years later, glands appear in the neck, which, when removed, prove to be metastatic carcinoma. I would appreciate an opportunity to present to the

CHINA AS A FIELD FOR THE STUDY OF THE NUTRITION OF HUMAN TEETH

According to Pickerill, 1 bad teeth are the curse of civilization. He gives figures to show that dental caries increased in the Britons from the stone age to the bronze age, and from the bronze age to the Roman occupation, and in the Angles and Saxons after they came to England and among the English, so that in modern times about 95 per cent. of them have carious teeth. He also states that the same process took place but far more rapidly among the Maori of New Zealand, and that 95 per cent. of the Maori schoolchildren in the English schools have carious teeth. He places the Chinese among those races with little dental caries. We should remember, however, that while our ancestors led a barbaric life in the forests and swamps of northern Europe and had no agriculture, the Chinese had developed a thickly populated and comparatively civilized community.

Bad Teeth and Their Effect on the Laboring Man's Efficiency

Efficiency from a health standpoint is difficult to determine. We know, for instance, that if the water supply of a community is pure, the community is saved economic loss from typhoid; the same can be said of the milk supply and of all the precautions necessary to keep a community in health. This is true from a dental standpoint. If we teach a large body of people mouth hygiene we cannot say how much better their health will be, or how much we have saved them through the prevention of mouth aand systemic diseases. In the past sixteen months I have made 30,000 mouth examinations, for 17,000 Americans and 13,000 foreigners. Of this number, 96 per cent, are in need of dental service; only 4 per cent, have clean, healthy mouths; 9 per cent. are without cavities and could made healthy by a thorough cleaning; the balance have all the

Good and Bad Teeth

Good and Bad Teeth

A PLEA FOR THE PHYSICAL EXAMINATION OF ALL SCHOOL CHILDREN.

Education is compulsory in this country for all children from the ages of 6 to 14. In some states the duration of school life is longer. If the child is not presented by its parents for instruction, the parents must present some good excuse for its non-appearance; and social reasons are not accepted. There are numerous chronic ailments of childhood which absolutely prevent or militate against its receiving any instruction. The more important of these are serious congenital mental defects and defects of the heart or organs of speech. There exist, also, many minor defects, eradicable, provided the parents are informed that such defects exist. The existence of the minor defects, such as squint, nearsightedness, adenoids, enlarged tonsils, bad teeth, nervous twitchings, and so on, are often not discovered by the parents, nor is their seriousness realized until the child has for some time been under the influence of school