DENTISTRY AND RESEARCH
By EDWARD SAMSON
DENTAL disease, which is present in over go per cent, of the population, and is responsible for an incredible amount of illhealth, with its resulting loss to the nation of man-power and money, manifests itself primarily as caries (decay) and pyorrhoea. While much research has been conducted in an effort to cure or prevent these conditions, and while many claims of success have been made—even demonstrated within a limited field—so far no universal prevention or cure is available to the general dental practitioner. Thus, the present practice of dentistry, indispensable as it is, is confined largely to methods of extemporisation—extractions and fillings supplying the great proportion of its treatment.
Despite these facts, the recent Interim Report of the Interdepartmental Committee on Dentistry, though wisely stressing the necessity of educating the public to demand the extemporary treatment which is capable of maintaining mouths in health, if not of preventing disease, omits to mention the urgent need for organised research which might well reduce or obviate the need of such treatment. If the incidence of dental disease could be reduced, or eliminated, the enormous expense and elaborate machinery required to provide free dentistry for all would be saved ; indeed, it is surprising that so obvious a course as prevention has been given such little consideration.
Admittedly many of the theories relating to dental disease are in conflict ; some stressing the local causes in the mouth, others finding their reason in more profound, biochemical processes. Yet, however divergent the views, many of them have much in common, and nearly all are worthy of careful study. Despite this accumulation of valuable material, at no time has there been an attempt to coordinate the theories, to sift the probable from the improbable, or, more important, to approach the problem on a national basis. The only official body responsible for dental research has been severely limited in scope, producing results no more promising than those of individuals who have worked unaided ; dius the practising dentist is left with no authoritative guidance and his public still is susceptible to dental disease.
Despite its widespread economic and sociological effects, dental disease has never been attacked with a concerted effort ; perhaps because its immediate effects are not as spectacular nor as dramatic as those of other plagues. Yellow fever, Texas cattle fever, crop.. destroying pests, malaria and other enemies of man, appealing more to the imagination though ultimately less devastating than the wide spread dental affections, have all been overcome in their time. Neither is there any lack of material on which to work. In hospitals, schools and institutions there is ample scope for investi gating dental pathology anew, as well as for following newer trends. There are communities and races free of dental disease to provide all the necessary field work, the cause of whose unusual immunity has never been solved, for the very good reason that it has never been considered scientifically ; while sufficient evidence of the rela
tion between dental lesions and the properties of certain soils and water is, at this time, causing enough lively interest to justify the beginning of fruitful research at once. Moreover, it is agreed by a considerable majority that, even in the light of existing knowledge and experience, a properly controlled diet would do much to reduce the number of defective teeth—some say to preserve them intact. It is interesting to note that, although experiments with controlled diet have frequently produced—according to the experimenters—remarkably promising results, both in this country and abroad, they have never been furthered by the Governments concerned, though undoubtedly some of them could be adopted, with invaluable results to national health.
Whether the direct cause of dental disease is local, systemic or both, in no country has the problem been faced with an effort in proportion to its magnitude. Perhaps the rapid advance in the methods of filling, extracting and replacing teeth is responsible for this, so that concern for the ubiquitous persistence of the disease has taken only a secondary place or often been sadly neglected. But even if the entire nation, instead of only a small proportion, submined regularly to such treatment, the plague would still be with us. Thus, it is surely imperative to include in any programme for a national dental service a scheme of research, beginning with education with regard to diet, control of certain foods and the popularising of others ; following this with supervision of soil cultivation, while concurrently there must exist an .intensively conducted research and investigation of available evidence, not forgetting that anything which will improve teeth will benefit the entire body.
A recent letter in the British Dental Puma' gives point to this argument. It quotes Lord Teviot (who, incidentally, is chairman of the Dental White Paper committee) as writing, "There has been a suggestion in various quarters that a Nutrition Council should be formed to go into the question of food and food values, and I am most hopeful that this may happen. The necessity for it is obvious. .. . I am convinced from my own studies of the experiments, tests and experiences of many learned men that the chief cause of disease in man, plant and animal is due to their food, and undoubtedly there is outstanding evidence from -distinguished men that food produced from soil deficient in healthy humus is a source of ill-health." In a subsequent letter to the same journal another ,dentist corroborates this view by relating how the teeth of the 250 children in his care "improved out of all recognition," due to producing their food from "soil full of humus," resulting from using natural manure.
This alone may not be the complete answer to the problem of dental disease, but it seems likely that Lord Teviot is here nearer to creating a dentally perfect nation than are the proposals of his Committee's interim report. At least, it is reasonable to ask that so much promising material should not be wasted, and that a plan for controlling dental disease should be given as much prominence as that for treating its symptoms. This, surely, is the rational approach to establishing positive health—the ideal originally stressed in the Beveridge report. All of which, reduced to its simplest terms, means that prevention is better than cure, and in dentistry, even cure will be better than extemporisation.
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