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Some New Views on Dental Disease*
The Journal of the American D ental Association
2348
correct mechanics in structure, they have violated the law s of occlusion and have thus been the direct cause of periodontal disease of the teeth acting as bridge abut ments and of the opposing teeth. A
bridge, like a chain, is only as strong as its weakest link, and occlusion is a link which has frequently given w ay and brought about the destruction of an otherwise w ell executed restoration.
SOME NEW VIEWS ON DENTAL DISEASE* B y WILLIAM G. DOWNS, JR ., D.D.S., M .A ., Ph.D., New H aven, Conn.
W
H IL E for many centuries w hat ever of dentistry there was was done by the people who were prac ticing medicine or surgery or their equiv alents, and the one branch was insepar able from the other, with the beginning of dentistry as a separate profession in this country, approximately 100 years ago, a new situation began to be appar ent. From that time until this, dentistry has been viewed as something separate and apart from medicine and the biologic sciences. It is only within the past few years that any real effort has been made to bring it back into the fam ily of med ical sciences. Now, it becomes apparent that path ology of the mouth can not in any sense be separated from pathology in general. The fundamental tissues are essentially the same and the same biologic processes apply to the development, growth and metabolism of these tissues. T he same tissue fluids furnish nutriment to these cells as to cells elsewhere in the body, and they are susceptible to the deleterious effects of the same toxins. *Read before a joint meeting of the Vanderburg County M edical Society and the E vansville Dental Society, E vansville, Ind., M arch 10, 1931.
Jour. A . D. A., December, 1931
Changes in curriculums, substitution of academic degrees, erection of buildings and changes in licensing laws can do little to inject such a comprehensive view into dental philosophy. Only the acceptance of these fundamental facts by teachers and practitioners can bring about such understanding. Fact is fact, wherever expounded. W ith this in mind, we may begin our study of dental disease with the assur ance that an understanding of general biologic processes is necessary, as is the case with any other part of the body. W e may likewise feel sure that those influ ences which are damaging to dental or mouth tissues w ill likewise be injurious to the tissues of the body in general. W hile in a sense this complicates the study of dental disease, in another sense it simplifies it, because it means that the underlying phenomena and laws are those of medical science and are the result of centuries of trial and error, analysis and experimentation. W hile medicine as such has long since given up the idea of a philosopher’s stone which would give one a simple clue to the cause of a disease, such has not been the case with dentistry. It has been assumed that there is a cause for dental caries,
D ow ns— N e w View s on D ental Disease and that when that cause was found, the understanding and treatment of decay would be a simple matter. It was felt likewise that there was a cause for perio dontal disease, and that when that cause was discovered, the treatment and cure of periodontal disease would almost re solve itself. Viewed in the light of our understanding of disease processes in gen eral, this attitude now seems almost ri diculous, and is certainly obsolescent if not obsolete. I can say unhesitatingly that such is not the case and that no single cause w ill ever be found for either of these great dental diseases. Each of them is due to a blending, in different proportions, of numerous com plex conditions, which may be roughly grouped into four categories: 1. Congenital conditions, including those the outgrowth of heredity p e r se and those the result of variations in intra uterine conditions. 2. W h at I choose to call metabolic condition, being the metabolic state of the individual at any given time, influ enced as it is by his diet and total nutri tional intake. 3. Traum atic, physical and similar conditions. 4. A great group, generally classified under infection, including immunity, sus ceptibility and sensitization. Approaching the subject from this angle, it is difficult to understand why there should be the wide discrepancy found in the attitude of various research workers and groups. Certain groups have found a high degree of correlation be tween nutritional deficiencies and the dental diseases and have given us to un derstand that these diseases were the di rect outgrowth of such deficiencies. In other groups, in which the bacteriologic approach has been utilized, the feeling has
2349
been very strong that infection was of primary etiologic importance. Still others, who have approached dental disease from the hereditary angle, have found a great body of evidence for the influence of he reditary conditions on these diseases; while a few, working on periodontal dis ease, have felt that so-called traumatic occlusion, or mechanical damage, was th e cause of this condition. Undoubtedly, each of these groups is a factor in the etiology of any given case of either type of disease, and one must understand this fact thoroughly in ap proaching the handling of such disturb ances. In my own earlier studies, as w ell as in those of others, ample evidence was submitted regarding the importance of hereditary factors in the spacing, form and texture of the teeth and the form and regularity of the jaw s and investing structures. In a later series of studies, it was demonstrated that w hile it was diffi cult in a specific case to correlate a partic ular mouth disease with a single type of endocrine disturbance, caries in particu lar, and periodontal disease to a somewhat lesser degree, were found to be much more frequent among individuals suffer ing from endocrine disturbances despite the most scrupulous kind of dental and dietary care. Our later studies at nec ropsy have further borne out this idea, with respect to individuals in later age groups. For the past three years, I have had underway a quite comprehensive study of the effects of various metabolic states on the development, growth and condition of the teeth and their investing structure; and I can say with great definiteness that this influence is an important one. V aria tions in the endocrine state and variations in diet affect the rate of growth, texture and incidence of disease in the develop-
2350
T he Journal of the American D ental Association
ment of teeth and adnexa. W e have not in my own group made any comprehen sive study of the traumatic and physical factors. Adequate work in this direction has been done in other laboratories evidencing the striking importance of these features. I feel that the most important state ments which may be made are in con nection with the old bone of contention, focal infection. I know that the concept which I formerly had of focal infection, its importance and its mechanism, was that organisms themselves were trans mitted from the focus around the tooth socket or in the tonsil or wherever the primary focus might be, to some other specific part of the body, there to estab lish additional, similar foci of identical organisms. I believe that this is essen tially the concept which most men still have of these infections. In the past two years, our work, both experimental and at necropsy, has given us a somewhat new concept of the im portance of foci of infection. It is not my intention in this paper to cite experi mental evidence and illustrations, as I think they are frequently boring to a clinical audience, and o ne. who is suffi ciently interested may follow through my line of thought and basic data in the lit erature, either already published or in the process of publication. Following are the conclusions that I feel may be drawn, tentatively at least, from these studies to date. In correlating a large series of necropsy studies from our laboratory, it became obvious that there is a high degree of cor relation between periodontal disease and the cardiovascular diseases. Practically every case into which the anatomic diag nosis of “central” or “peripheral” arteri osclerosis, sclerotic changes in the kidney, or the peripheral sclerosis of diabetes
could be w ritten shows an almost parallel destruction of the pericemental mem brane and periodontium. Histologically, sclerosis of the minor vessels in this region is a constant picture. T his line of reasoning was accepted as a working hypothesis and further fol lowed until from postmortem and clinical findings I am convinced that one of the most common causes of periodontal disease lies in changes in the capillary network supplying these tissues. So often has this been seen that I am today con vinced that frequently the earliest observ able symptom of these vascular changes is the breaking down of these constantly traumatized tissues, and that the impend ing systemic change may be early diag nosed in this way. Periodontal “disease” is not an entity but a condition which may be brought about in varying degrees and in many ways. Not the least of these, and basic perhaps to the most stubborn cases, is a change in the vascular w alls. At the time that a periapical infection may be revealed by the roentgen rays, its most important stage has long since been passed. W hen one sees the large, w ellcircumscribed, clear-cut periapical area, so common in dental roentgenograms, the histopathologic picture which accom panies it is such as to lead one to believe that this lesion is largely scar tissue and that whatever organisms may in fact be present are pretty w ell walled off from the remainder of the tissues of the body. Not so with the earlier dental lesions, capable also of experimental production and ranging all the w ay from severe pulp itis to the earlier stages of the periapical lesion, not demonstrable by roentgeno gram. Here, we have excellent evidence that while the organisms involved are almost always of low virulence, they play a major role in sensitizing the individual
D ow ns— N e w Views on D ental Disease
2351
to both their own toxins and those of in blood pressure and heart rate are a ll other organisms which may later gain of primary importance in understanding entrance. , such conditions. Further, organisms from such mouth Further, if we admit these premises, foci seldom, if ever, localize in a perfectly the methods of treatment must be like healthy distant organ. It is not until wise in line w ith accepted medical and this organ has been weakened by vascu surgical procedures. In a vast number lar changes of some other type, such as of cases, mere extraction of an involved arteriosclerosis, or it has had its metabolic tooth is not sufficient to eradicate a sus state altered by these sensitizing toxins, pected or sure focus. Frequently, curet that it becomes the site of such a second tage, as it has generally been utilized in ary focus. I recognize that the term the past, is contraindicated. A careful “sensitization” or “allergy” is becoming flushing out and draining of such a socket a popular one for all conditions which is usually much wiser. If curettage may cannot otherwise be placed, but I am be utilized, it should be carefully and convinced that the most important role wisely done. Our necropsy studies have indicated which periapical infection can play in the production of disease lies i» the sensitiz that few if any root-canal fillings are ing influence which they urge on the tis ever a means of entirely eliminating or preventing foci of infection. Careful sues of the body at large. A ll these facts are, of course, of pri root-canal filling in conjunction with mary importance to the research worker surgical extirpation of an infected apex or the pathologist, but w hat, one may ask, and the subsequent encouragement of is their importance to the man in the healthy sterile, bone growth in this clinical practice of medicine or dentistry ? region, is acceptable from both the dental To me, the answer seems obvious. The and the surgical standpoint. Frequently, an extraction, in particu methods of diagnosis, understanding and treatment of dental disease must closely lar of an impacted third molar, becomes parallel those already in general use in a major operation just as dangerous and medicine and surgery, which presupposes requiring just as great skill as a major operation elsewhere. W hen this is true, fam iliarity with such methods. If we intend to recognize lesions be it should be carefully surrounded by all fore the roentgen rays may logically come of the surgical safeguards applicable to to our aid, we must make use of a rather other types of operation. No man would wide armamentarium of methods of di think of removing a gallbladder without agnosis. For this reason, the temperature a thorough knowledge of his patient, and of a person with a suspected pulpitis or without every conceivable safeguard. Y et other early dental lesion is of just as equally serious operations are constantly vital importance to the dentist as it performed in the mouth without any such would be to the physician trying to de safeguards, and, more frequently than termine some obscure disease condition. one realizes, the direct or indirect results The blood count, hemoglobin content, may be seen on the necropsy table. etc., over a period of days are likewise of C O N C L U SIO N great importance. The response to sen I wish to reiterate that dental disease sitization tests, changes in plasma makeup is in no sense different in its processes or and nonprotein nitrogen and variations mechanism from disease elsewhere in the
2352
The Journal of the American Dental Association
body, and that a thorough understand ing of the fundamentals of these proces ses and fam iliarity w ith the technics in volved are a positive essential for the understanding of these facts and of the
problems involved. Cooperation must be obtained between dentists and physicians, and m utual acceptance of each of the other’s methods and point of view must be secured.
ORAL VINCENT’S IN F E C T IO N -A GENERAL SURVEY OF DIAGNOSIS AND TREATMENT* B y JOSEPH JORDAN ELLER, M.D., and CHARLES ROBERT REIN, M.D., N ew York C ity
E shall endeavor to here present practical ideas concerning the handling of oral spirochetosis. T he dermatologist is frequently called on to diagnose and treat ulcerative stomatitis. It is, therefore, important that he have a comprehensive knowl edge of Vincent’s infection and, even though the Vincent organisms be dem onstrated, be able to differentiate this from such conditions as pemphigus, aphthous stomatitis, drug eruptions and other conditions which occasionally cause ulceration of the oral mucosa. T h e early diagnosis of Vincent’s in fection, w ith the proper use of intensive and judicious treatment, is necessary for the permanent eradication of the disease and for the prevention of its serious and often fatal complications. Vincent’s infection may be defined as an infectious ulceromembranous and sometimes gangrenous disease. W h ile it is seen most frequently in the mouth and throat, it may also involve any of the other organs of the body. It is caused by
W
*Read before the Northern District Dental Society, New Y ork City, Nov. 20, 1930. *From the Dept, of Derm atology and Syphilology, Broad Street Hospital and PanA m erican Clinics.
Jour. A , D. A ., December, 1981
the Vincent symbiosis of a large spirillum and a fusiform bacillus. T he Commit tee on Nomenclature of the American Dental Association, in 1923, adopted the term Vincent’s infection when the con dition affected the oral tissues, suggesting that the term Vincent’s angina was more applicable when there was involvement of the tonsils, uvula and pharynx. M ille r 1 (1883) observed the pres ence of spirochetes in the mouth, appar ently identical with T r e p o n e m a m a cr o d e n tiu m (N oguchi) and S pirochaeta v in ce n ti, associated w ith a comma bacil lus, which was subsequently identified as Vibrio p ro tea s. Vincent2 (1899) was the first to describe the fusiform bacil lus as a normal inhabitant of the mouth. He found the organism present in the dental tartar of 78 per cent of the normal subjects examined. Pratt, in her series, found them present normally in small numbers in the throats of 100 per cent of human beings examined. Kline 3 quotes 1. M iller, W . D. : M icro-Organisms of Mouth, P h iladelphia: S. S. W h ite Dental M fg. Co., 1890, p .80. 2. Vincent, M . H. : Ann. Inst. Pasteur, 13:609, 1899. 3. K line, B. S.: Relation of O ral Spiroche tosis to Pulm onary Gangrene, J. A . D. A., 16:64 (Jan .) 1928.
2348
correct mechanics in structure, they have violated the law s of occlusion and have thus been the direct cause of periodontal disease of the teeth acting as bridge abut ments and of the opposing teeth. A
bridge, like a chain, is only as strong as its weakest link, and occlusion is a link which has frequently given w ay and brought about the destruction of an otherwise w ell executed restoration.
SOME NEW VIEWS ON DENTAL DISEASE* B y WILLIAM G. DOWNS, JR ., D.D.S., M .A ., Ph.D., New H aven, Conn.
W
H IL E for many centuries w hat ever of dentistry there was was done by the people who were prac ticing medicine or surgery or their equiv alents, and the one branch was insepar able from the other, with the beginning of dentistry as a separate profession in this country, approximately 100 years ago, a new situation began to be appar ent. From that time until this, dentistry has been viewed as something separate and apart from medicine and the biologic sciences. It is only within the past few years that any real effort has been made to bring it back into the fam ily of med ical sciences. Now, it becomes apparent that path ology of the mouth can not in any sense be separated from pathology in general. The fundamental tissues are essentially the same and the same biologic processes apply to the development, growth and metabolism of these tissues. T he same tissue fluids furnish nutriment to these cells as to cells elsewhere in the body, and they are susceptible to the deleterious effects of the same toxins. *Read before a joint meeting of the Vanderburg County M edical Society and the E vansville Dental Society, E vansville, Ind., M arch 10, 1931.
Jour. A . D. A., December, 1931
Changes in curriculums, substitution of academic degrees, erection of buildings and changes in licensing laws can do little to inject such a comprehensive view into dental philosophy. Only the acceptance of these fundamental facts by teachers and practitioners can bring about such understanding. Fact is fact, wherever expounded. W ith this in mind, we may begin our study of dental disease with the assur ance that an understanding of general biologic processes is necessary, as is the case with any other part of the body. W e may likewise feel sure that those influ ences which are damaging to dental or mouth tissues w ill likewise be injurious to the tissues of the body in general. W hile in a sense this complicates the study of dental disease, in another sense it simplifies it, because it means that the underlying phenomena and laws are those of medical science and are the result of centuries of trial and error, analysis and experimentation. W hile medicine as such has long since given up the idea of a philosopher’s stone which would give one a simple clue to the cause of a disease, such has not been the case with dentistry. It has been assumed that there is a cause for dental caries,
D ow ns— N e w View s on D ental Disease and that when that cause was found, the understanding and treatment of decay would be a simple matter. It was felt likewise that there was a cause for perio dontal disease, and that when that cause was discovered, the treatment and cure of periodontal disease would almost re solve itself. Viewed in the light of our understanding of disease processes in gen eral, this attitude now seems almost ri diculous, and is certainly obsolescent if not obsolete. I can say unhesitatingly that such is not the case and that no single cause w ill ever be found for either of these great dental diseases. Each of them is due to a blending, in different proportions, of numerous com plex conditions, which may be roughly grouped into four categories: 1. Congenital conditions, including those the outgrowth of heredity p e r se and those the result of variations in intra uterine conditions. 2. W h at I choose to call metabolic condition, being the metabolic state of the individual at any given time, influ enced as it is by his diet and total nutri tional intake. 3. Traum atic, physical and similar conditions. 4. A great group, generally classified under infection, including immunity, sus ceptibility and sensitization. Approaching the subject from this angle, it is difficult to understand why there should be the wide discrepancy found in the attitude of various research workers and groups. Certain groups have found a high degree of correlation be tween nutritional deficiencies and the dental diseases and have given us to un derstand that these diseases were the di rect outgrowth of such deficiencies. In other groups, in which the bacteriologic approach has been utilized, the feeling has
2349
been very strong that infection was of primary etiologic importance. Still others, who have approached dental disease from the hereditary angle, have found a great body of evidence for the influence of he reditary conditions on these diseases; while a few, working on periodontal dis ease, have felt that so-called traumatic occlusion, or mechanical damage, was th e cause of this condition. Undoubtedly, each of these groups is a factor in the etiology of any given case of either type of disease, and one must understand this fact thoroughly in ap proaching the handling of such disturb ances. In my own earlier studies, as w ell as in those of others, ample evidence was submitted regarding the importance of hereditary factors in the spacing, form and texture of the teeth and the form and regularity of the jaw s and investing structures. In a later series of studies, it was demonstrated that w hile it was diffi cult in a specific case to correlate a partic ular mouth disease with a single type of endocrine disturbance, caries in particu lar, and periodontal disease to a somewhat lesser degree, were found to be much more frequent among individuals suffer ing from endocrine disturbances despite the most scrupulous kind of dental and dietary care. Our later studies at nec ropsy have further borne out this idea, with respect to individuals in later age groups. For the past three years, I have had underway a quite comprehensive study of the effects of various metabolic states on the development, growth and condition of the teeth and their investing structure; and I can say with great definiteness that this influence is an important one. V aria tions in the endocrine state and variations in diet affect the rate of growth, texture and incidence of disease in the develop-
2350
T he Journal of the American D ental Association
ment of teeth and adnexa. W e have not in my own group made any comprehen sive study of the traumatic and physical factors. Adequate work in this direction has been done in other laboratories evidencing the striking importance of these features. I feel that the most important state ments which may be made are in con nection with the old bone of contention, focal infection. I know that the concept which I formerly had of focal infection, its importance and its mechanism, was that organisms themselves were trans mitted from the focus around the tooth socket or in the tonsil or wherever the primary focus might be, to some other specific part of the body, there to estab lish additional, similar foci of identical organisms. I believe that this is essen tially the concept which most men still have of these infections. In the past two years, our work, both experimental and at necropsy, has given us a somewhat new concept of the im portance of foci of infection. It is not my intention in this paper to cite experi mental evidence and illustrations, as I think they are frequently boring to a clinical audience, and o ne. who is suffi ciently interested may follow through my line of thought and basic data in the lit erature, either already published or in the process of publication. Following are the conclusions that I feel may be drawn, tentatively at least, from these studies to date. In correlating a large series of necropsy studies from our laboratory, it became obvious that there is a high degree of cor relation between periodontal disease and the cardiovascular diseases. Practically every case into which the anatomic diag nosis of “central” or “peripheral” arteri osclerosis, sclerotic changes in the kidney, or the peripheral sclerosis of diabetes
could be w ritten shows an almost parallel destruction of the pericemental mem brane and periodontium. Histologically, sclerosis of the minor vessels in this region is a constant picture. T his line of reasoning was accepted as a working hypothesis and further fol lowed until from postmortem and clinical findings I am convinced that one of the most common causes of periodontal disease lies in changes in the capillary network supplying these tissues. So often has this been seen that I am today con vinced that frequently the earliest observ able symptom of these vascular changes is the breaking down of these constantly traumatized tissues, and that the impend ing systemic change may be early diag nosed in this way. Periodontal “disease” is not an entity but a condition which may be brought about in varying degrees and in many ways. Not the least of these, and basic perhaps to the most stubborn cases, is a change in the vascular w alls. At the time that a periapical infection may be revealed by the roentgen rays, its most important stage has long since been passed. W hen one sees the large, w ellcircumscribed, clear-cut periapical area, so common in dental roentgenograms, the histopathologic picture which accom panies it is such as to lead one to believe that this lesion is largely scar tissue and that whatever organisms may in fact be present are pretty w ell walled off from the remainder of the tissues of the body. Not so with the earlier dental lesions, capable also of experimental production and ranging all the w ay from severe pulp itis to the earlier stages of the periapical lesion, not demonstrable by roentgeno gram. Here, we have excellent evidence that while the organisms involved are almost always of low virulence, they play a major role in sensitizing the individual
D ow ns— N e w Views on D ental Disease
2351
to both their own toxins and those of in blood pressure and heart rate are a ll other organisms which may later gain of primary importance in understanding entrance. , such conditions. Further, organisms from such mouth Further, if we admit these premises, foci seldom, if ever, localize in a perfectly the methods of treatment must be like healthy distant organ. It is not until wise in line w ith accepted medical and this organ has been weakened by vascu surgical procedures. In a vast number lar changes of some other type, such as of cases, mere extraction of an involved arteriosclerosis, or it has had its metabolic tooth is not sufficient to eradicate a sus state altered by these sensitizing toxins, pected or sure focus. Frequently, curet that it becomes the site of such a second tage, as it has generally been utilized in ary focus. I recognize that the term the past, is contraindicated. A careful “sensitization” or “allergy” is becoming flushing out and draining of such a socket a popular one for all conditions which is usually much wiser. If curettage may cannot otherwise be placed, but I am be utilized, it should be carefully and convinced that the most important role wisely done. Our necropsy studies have indicated which periapical infection can play in the production of disease lies i» the sensitiz that few if any root-canal fillings are ing influence which they urge on the tis ever a means of entirely eliminating or preventing foci of infection. Careful sues of the body at large. A ll these facts are, of course, of pri root-canal filling in conjunction with mary importance to the research worker surgical extirpation of an infected apex or the pathologist, but w hat, one may ask, and the subsequent encouragement of is their importance to the man in the healthy sterile, bone growth in this clinical practice of medicine or dentistry ? region, is acceptable from both the dental To me, the answer seems obvious. The and the surgical standpoint. Frequently, an extraction, in particu methods of diagnosis, understanding and treatment of dental disease must closely lar of an impacted third molar, becomes parallel those already in general use in a major operation just as dangerous and medicine and surgery, which presupposes requiring just as great skill as a major operation elsewhere. W hen this is true, fam iliarity with such methods. If we intend to recognize lesions be it should be carefully surrounded by all fore the roentgen rays may logically come of the surgical safeguards applicable to to our aid, we must make use of a rather other types of operation. No man would wide armamentarium of methods of di think of removing a gallbladder without agnosis. For this reason, the temperature a thorough knowledge of his patient, and of a person with a suspected pulpitis or without every conceivable safeguard. Y et other early dental lesion is of just as equally serious operations are constantly vital importance to the dentist as it performed in the mouth without any such would be to the physician trying to de safeguards, and, more frequently than termine some obscure disease condition. one realizes, the direct or indirect results The blood count, hemoglobin content, may be seen on the necropsy table. etc., over a period of days are likewise of C O N C L U SIO N great importance. The response to sen I wish to reiterate that dental disease sitization tests, changes in plasma makeup is in no sense different in its processes or and nonprotein nitrogen and variations mechanism from disease elsewhere in the
2352
The Journal of the American Dental Association
body, and that a thorough understand ing of the fundamentals of these proces ses and fam iliarity w ith the technics in volved are a positive essential for the understanding of these facts and of the
problems involved. Cooperation must be obtained between dentists and physicians, and m utual acceptance of each of the other’s methods and point of view must be secured.
ORAL VINCENT’S IN F E C T IO N -A GENERAL SURVEY OF DIAGNOSIS AND TREATMENT* B y JOSEPH JORDAN ELLER, M.D., and CHARLES ROBERT REIN, M.D., N ew York C ity
E shall endeavor to here present practical ideas concerning the handling of oral spirochetosis. T he dermatologist is frequently called on to diagnose and treat ulcerative stomatitis. It is, therefore, important that he have a comprehensive knowl edge of Vincent’s infection and, even though the Vincent organisms be dem onstrated, be able to differentiate this from such conditions as pemphigus, aphthous stomatitis, drug eruptions and other conditions which occasionally cause ulceration of the oral mucosa. T h e early diagnosis of Vincent’s in fection, w ith the proper use of intensive and judicious treatment, is necessary for the permanent eradication of the disease and for the prevention of its serious and often fatal complications. Vincent’s infection may be defined as an infectious ulceromembranous and sometimes gangrenous disease. W h ile it is seen most frequently in the mouth and throat, it may also involve any of the other organs of the body. It is caused by
W
*Read before the Northern District Dental Society, New Y ork City, Nov. 20, 1930. *From the Dept, of Derm atology and Syphilology, Broad Street Hospital and PanA m erican Clinics.
Jour. A , D. A ., December, 1981
the Vincent symbiosis of a large spirillum and a fusiform bacillus. T he Commit tee on Nomenclature of the American Dental Association, in 1923, adopted the term Vincent’s infection when the con dition affected the oral tissues, suggesting that the term Vincent’s angina was more applicable when there was involvement of the tonsils, uvula and pharynx. M ille r 1 (1883) observed the pres ence of spirochetes in the mouth, appar ently identical with T r e p o n e m a m a cr o d e n tiu m (N oguchi) and S pirochaeta v in ce n ti, associated w ith a comma bacil lus, which was subsequently identified as Vibrio p ro tea s. Vincent2 (1899) was the first to describe the fusiform bacil lus as a normal inhabitant of the mouth. He found the organism present in the dental tartar of 78 per cent of the normal subjects examined. Pratt, in her series, found them present normally in small numbers in the throats of 100 per cent of human beings examined. Kline 3 quotes 1. M iller, W . D. : M icro-Organisms of Mouth, P h iladelphia: S. S. W h ite Dental M fg. Co., 1890, p .80. 2. Vincent, M . H. : Ann. Inst. Pasteur, 13:609, 1899. 3. K line, B. S.: Relation of O ral Spiroche tosis to Pulm onary Gangrene, J. A . D. A., 16:64 (Jan .) 1928.