CHAPTER 1.

TEETH AND GENERAL HEALTH

It is only in very recent years that the true relation of the teeth to the general health has been adequately realized, either by the dental or medical professions.

As late as 1910, Dr. W. Hunter, a famous English physician, in an address on “_The Role of Sepsis and Antisepsis in Medicine_,” was the first to definitely stress the harm done by what he termed “septic dentistry.” He had observed the serious results in many cases from the attempt to treat teeth as if they bore no relation to the body as a whole.

With the best of intentions, there was a tendency before that time to save the tooth, regardless of its diseased condition, if it could be patched up in such a way that it would look presentable and contribute its share to mastication. It was a case of cosmetics and utilitarianism. The pathology behind the diseased tooth was not taken into consideration.

While Dr. Hunter’s criticism was at first bitterly resented by the dental profession, subsequent investigations disclosed in the main the soundness of his position. As a result dental procedure, since that time, with respect to the treatment of diseased and infected teeth, has been very largely revolutionized.

The up-to-date dentist no longer merely considers his patient’s tooth. Instead, he considers the patient as an organic entity, fully knowing that one diseased tooth may cause trouble in any organ, nerve or muscle of the body. Also, it may affect the mind, causing various sorts of mental aberrations, and in extreme cases has been known to cause death.

Of course, preventive dentistry, which is and has always been the great constructive goal of the profession, has not been essentially changed by the present knowledge of the constitutional character of dental sepsis. After all, the great field of dental and mouth hygiene lies in keeping the teeth sound and healthy from infancy, throughout life, and this is the premise which will be stressed in the present treatise.

It is infinitely more desirable to build a sound structure in the first place and keep it in a healthy condition, than it is, by neglect or ignorance, to build an imperfect one and allow it to run a quick course of deterioration and ruin. And as we shall show, a good, sound set of teeth can be built up in the individual, if we begin soon enough, and the teeth can be kept healthy and intact during a long lifetime.

Fortunately, by proper attention to diet, mouth hygiene and the precaution of periodical dental examinations, there is no reason why every individual, if correctly started out in infancy--or, more strictly, in the embryonic life--should not have sound, healthy teeth.

DENTAL “CARIES” OR TOOTH DECAY

Teeth as a factor in health and well-being, or in morbidity and disease, exert a profound influence in every individual’s life. Often this influence, whether for good or ill, is concealed and unsuspected. At the high-tide of health and vigor, we do not realize how tremendously indebted we are to our teeth.

On the other hand, in ill health and disease, we do not begin to suspect the role which the teeth play either as the principal or contributing cause of many of our maladies and miseries.

The most common of all the ills to which the human body is heir is decayed teeth. It is a disease to which all races and tribes are subject, and yet it is a disease preeminently of higher civilization.

While it is true, according to the data we have at hand, that no class of people in the past, whether savage, barbarian or semi-civilized, has escaped wholly from dental maladies, yet it is certain that, under existing conditions and with modern dietary habits, civilized people are particularly susceptible to diseased teeth.

Like many other diseases, decayed teeth and abnormal conditions of the mouth, play the greatest havoc with the poor.

There are many factors involved in the healthy upkeep of the teeth, and in their disintegration and destruction, which are not generally known to the layman.

As an instance, it is conceded by the dental profession that the prevalence of decayed teeth among females is decidedly more pronounced than among males, some authorities placing the ratio at three to one.

The periods immediately preceding motherhood and during nursing are particularly favorable to dental troubles, for reasons which will be set forth in a subsequent chapter.

Dental _caries_, or tooth decay, is but the beginning of a long series of maladies which may finally undermine the general health.

The accumulation of tartar deposits, and of particles of food between the teeth and in the crevices of the gums are the principal cause of tooth decay. Bacteria in colonies, called “plaques,” form on tartar-laden and unclean tooth surfaces, and especially in the interspaces.

The bacteria are nourished by food, especially the easily fermentable carbohydrates, of which the most prominent are sweets. As the colonies of bacteria are protected by a gelatine-like membrane from the neutralizing effect of the saliva, the sugar and other carbohydrates ferment underneath.

Lactic acid is thus produced which comes into direct contact with the tooth, dissolving the inorganic enamel. This is the beginning of the formation of a cavity.

It is true there is a great difference in the resisting powers of teeth. Hard and well-formed teeth resist decay, while teeth of poor quality readily fall prey to disease.

Tartar is a rough substance, dark brownish or greenish in appearance, and is usually the result of local causes, but general conditions may also be a factor.

The saliva contains a certain quantity of salts. These salts, mixed with food debris, cause the particles to adhere in deposits around the teeth. The quick formation of tartar is the product of organic decomposition. This, in turn, becomes a powerful irritant to the gum and induces inflammation.

A foul-smelling mouth and breath of objectionable odor are the usual accompaniments of tartar deposits. This may be followed by chronic spongy gums and perhaps pyorrhea--a discharge of pus from the gum pockets, often associated with complicated disturbances throughout the whole system.

It is perfectly evident that a filthy condition of the mouth which an accumulation of tartar produces, is a seat of active incubation for the germs of many diseases. Some characteristic cases of this kind will be taken up under the appropriate heading.

ANTIQUITY OF DENTAL DISEASES

There are very conclusive records of dental infections, and of elaborate, systematic attempts made to relieve these maladies, dating far back into human history. Anthropology and archæology contribute, with history, their testimony to mankind’s ancient dental disabilities.

Many Egyptian mummies, and even skulls of prehistoric periods, show very definite evidences of caries, or decayed teeth, and other diseases of the teeth. One of the oldest of these specimens, an Egyptian mummy of the period about 2800 B. C.--more than four thousand, seven hundred years ago--may be seen in the British Museum.

Herodotus, the Greek historian (born 484 B. C.), who visited the valley of the Nile to study the religion and sciences of the early Greeks, gives an interesting account of the customs and habits of these ancient people, who enjoyed a relatively high degree of civilization. He found in those early days that medicine and surgery were divided into distinct professions, and each of these branches had its trained specialists. There were specialists of the ears, eyes, teeth and internal organs. So we learn that dentistry had reached the dignity of a specialized profession more than two thousand, five hundred years ago.

Not only of the old world is there evidence of ancient dental pathology. There are in the National Museum in Washington collections of skulls of prehistoric inhabitants of North and South America, which betray the existence of dental caries, and even more so of alveolar abscesses, caused by death of the tooth pulp from wearing down of the teeth.

“DEAD” TEETH AND THEIR RESULTS

The living, organic part of the tooth is the pulp, which is supplied with nerves and blood vessels. The function of this important tissue is to give sensation and supply nourishment to the tooth, which means _life_. Like any other tissue that is nourished by blood, a tooth has little chance of surviving if it is deprived of its chief source of blood supply.

That is why it is so necessary, as soon as a small cavity appears in the tooth, to check it by means of a filling. If the small cavity is not attended to at once, the tooth is doomed to a troublesome career. The decay gradually saps the vitality of the pulp, endangering the very life of the tooth.

Many persons, probably under the influence of an older and now obsolete school of dentistry, are too anxious to have the “nerve” (pulp) removed, thinking that by so doing the pain will disappear forever. But this is only the beginning of more serious trouble. The tooth so deprived remains an easy prey to various changes that occur in the system and is very susceptible to blood derangements, making it a target of attack for ulcers, or abscesses.

Generally speaking, a “dead” tooth is a hazard one can ill afford to carry around in one’s mouth, and it may become a very real danger. When the nerve and blood supply to the tooth structure have been removed, there is bound to be a process of putrefaction going on. If the system is in perfect condition, it may be able to eliminate the putrid secretions from this source without _apparent_ ill effects.

On the other hand, if the vitality becomes low and the bodily resistance weakens, there is no telling what effect a “dead” tooth carried around in the mouth will have.

The pains are not by any means limited to the jaws and adjacent parts of the face, although these are common enough, such as neuralgia, which may attack the eye or ear in a most excruciating manner.

There are countless numbers of cases of bodily ailments, rheumatism, diseases of the blood, liver, kidneys, heart, eyes, swellings in the legs and finger joints, even nervous exhaustion and insanity, that are due to chronically infected teeth.

Dr. Henry A. Cotton, medical director of the New Jersey State Hospital, has proven with many cases under his care, that physical disorders, such as infected teeth and tonsils and infections of the stomach and intestines, _cause more insanity than heredity_.

One of the first things Dr. Cotton does when a so-called insane patient is brought to his institution is to examine and X-ray his teeth, and provide radical treatment when the result of the examination shows it to be necessary. Other physical disorders are, of course, searched for and treated when present.

Either mental aberrations, or physical ailments which result from infected teeth, are due to the accumulation of toxins (poisons) in the system, which lower the resistance of the organism, and assert themselves where the resistance is weakest. If one has a weakness in any part of the body, it may soon become the seat of serious trouble. If there is a predisposition to mental disturbances, these disorders may ensue.

FOCAL INFECTIONS

If an infection starts in one part of the body and is transported to another part, the process is termed a focal infection. The original site of the disease is called the focus, and the germs and toxic material (poisons) are absorbed by the blood and cause the secondary infection in the new location.

The most frequent dental focal infections (for there may be _foci_ in other parts of the body, as well) are the diseased pulp of a decayed tooth, an infection at the end of a root, and severe cases of pyorrhea.

It is important to remember that pain is not necessarily present in a focal infection--although it may be strongly in evidence. Nor is good general health a certain sign of the absence of a focal infection.

Good health may mean that the vitality is so great and the resistance to disease toxins so strong that the poisons emanating from the infected tissue are for the time being successfully eliminated from the system.

This process, however, is a constant, abnormal strain on the organism, and in a crisis, or when the vitality or bodily resistance is lowered from whatever cause, a serious reaction may occur. This will assert itself, probably not in the focal seat, but in some other part of the body, selecting some particular organ that is not quite as strong as the others, or it may become constitutional in character, and strike at the whole organism.

When there is a doubt or some question of the probability of a dental focal infection, even in the case of teeth of thoroughly sound appearance, it is desirable to have an X-ray taken of the teeth. If there is a latent infection or blind abscess, the X-ray will reveal the fact, and drastic action should be taken to rid the body of this liability to health, this menace to the welfare of the organism.

Besides specific organic disturbances that may result from focal infections, other troubles of a more general character sometimes occur--so-called constitutional defects. Among the symptoms of these are fever, rapid pulse and respiration, dry, hot skin, constipation, highly colored urine, later sweating, sometimes accompanied by delirium at night. Where the absorbed bacteria grow in the blood, the condition, which is a serious one, is known as _septicemia_, popularly called “blood-poisoning.”

As the process of chronic pus absorption takes place rather slowly, there are usually no sudden and acute symptoms. This gives the victim a sense of false security, which permits ever-present dangers to be underestimated or ignored, with results that are sometimes ruinous to the general health.

TEETH AND FACIAL DEVELOPMENT

The teeth influence our health and lives in many ways, as we have already shown, and which will further be elaborated upon in the chapters that follow.

It is worthy of mention, however, that the teeth have a definite influence in the formation of the jaws and face, and in facial expression, determining whether the expression shall be pleasing and attractive, or ugly and repellent.

There is no mistaking the fact that sound, symmetrical and healthy teeth beautify the face. This is not only a fact of cosmetic interest, but it implies that we should make the most of our natural resources, physical and mental. Besides the purely physical reflection of good dental economy, there are also mental influences that are worthy of mention.

The presence of a set of sound teeth in childhood, for instance, tends to the development of the jaw, which improves the contour and appearance of the face. If a child loses his deciduous (milk) teeth too soon, or if the first of the permanent teeth decay quickly, there is apt to be a shortening of the jawbone in the course of its growth, which will be anything but desirable for the appearance of the individual. Furthermore, a condition of this kind leaves its deleterious imprint in other ways.

The human teeth were meant to use (not for non-use or abuse), and use implies plenty of work on foods that have to be well chewed and masticated before they should be swallowed.

There is a grain of truth in the witticism “one can be what one chews to be.” If adequate teeth are lacking, or if, for other reasons, a person--particularly a young, growing person, does not chew his food sufficiently, or is in the habit of eating soft foods which require little chewing, this fact may have a pronounced influence on the shape of his face, his expression, his health and mental development.

If a child is backward physically, he is almost invariably backward mentally. After all, the organism--body and mind--is a unit, and one part of the organism cannot be neglected or abused without detriment to the rest of it.