- Email: [email protected]
The “Decalcification Potential of Foods” and Caries
T HE R EA D E R C O M M E N T S . . . V O L U M E 44, M A R C H 1952 • 359
w ould have been in a position to retire com fortably if he had the benefits from the O ld Age and Survivors Insurance provisions o f the Social Security A ct, but was not included un der the A ct because the Am erican D ental A s sociation did n ot allow it, w ould be in a posi tion to press the Am erican Dental Association for the amounts he w ould have received through inclusion under the Social Security Act. Legislators tell me that all the dentists need to d o is to show them that the m ajority o f dentists favor inclusion and it w ould be done. N ot only w ould I like this letter printed in T H E J O U R N A L OF T H E AM ERICAN D E N T A L A S SO C IA TIO N , but I w ould like to know if the Am erican D ental Association intends to act on my suggestions. Rubin Fabricant, D .D .S., Brooklyn
Dr. Fabricant apparently does not know that the C ouncil on Insurance o f the Association conducted a survey on this question in 1951 and found that nationwide opinion among members o f the Association was about evenly divided. T h e H ouse o f Delegates based its decision on the results of this survey (see Novem ber 1951 j o u r n a l , page 6 2 0 ), a n d 'on the fact that apparently dentists needed to acquaint themselves further with the subject. T h ey recom m ended that discussion groups be form ed in the constituent and com ponent dental societies fo r that purpose. It is sug gested that D r. Fabricant join discussion groups in his loca l and state dental societies, which need the opinion o f D r. Fabricant and every other m em ber in order to instruct dele gates h ow to vote on the subject when it comes up for consideration at the ninety-third annual session in St. Louis next Septem ber.— Editor
T H E "D E C A L C IF IC A T IO N PO TE N T IA L OF FO OD S”
A N D CARIES
A prize article by Bibby, G oldberg, and Chen, entitled “ T he Caries Producing Potentialities o f Foodstuffs,” appearing in the M ay 1951 issue o f T H E JO U R N A L OF T H E AM E RICA N D EN T A L a s s o c i a t i o n , has received a considerable amount o f publicity in dental circles. In view o f the pu blic health implications of this article it is w ell to evaluate the experimental approach used by the authors. T h e original objective o f the article was to list carbohydrate foods according to their caries-producing potential. T h e selective rec omm endation o f foodstuffs for caries preven tion w ould then be justified. For this purpose
methods were devised to measure the retention of foods in the m outh and the amount o f acid form ed from the food when incubated in saliva during intervals o f 4 and 24 hours. T h e product o f these two measurements was des ignated as the “ décalcification potential” o f the food . A cid produced in 4 and 24 hrs.
R eten tion __D écalcification in mgs. potential
This property was to serve as an index o f the caries-producing capacity o f a given food. T h e décalcification potentials o f a number of foods were determined according to the m ethod described. A ccordin g to these results, potatoes or bran cereal and milk should have a higher caries-producing potential than sugar or apple pie. T h e authors, follow ing their determination of the decalcifying potential o f a num ber o f foods, m ade an attempt to correlate this value with the caries-producing capacity o f the food . T h e experiments on hamsters failed to relate definitely the decalcifying potential o f foods with their caries-producing potentialities. It w ould appear, therefore, that in view of the fact that decalcifying potentials of foods have not been correlated with their caries-produc ing ability there seems to be little justification for the title, “ Evaluation o f the Caries-Pro ducing Potentialities of Various Foodstuffs.” It is difficult, at present, to state the sig nificance o f the decalcifying potential index. T h e in dex is a product o f food retention and acid production in the mouth. Tables 4, 5, 6, 7 and 8 suggest that it is primarily a function o f food retention. T he authors state that “ the décalcification potentials o f foods are influ enced m ore by the wide range o f retention figures than they are by acid production .” A lthough retentivity o f a food may be im portant in the production o f dental caries, it falls short o f being the m ajor criterion by w hich the caries-producing potential o f food m ay be assessed. T h e significance of the am ount o f acid produced by a given food is difficult to assess. T h e acid produced was measured by incuba tion of. the food with saliva for periods of 4 and 24 hours. T h e acid produced was the result o f bacterial action upon monosaccharides and disaccharides that were foun d in the food and were made available by the action of salivary amylase and the enzyme maltase. Since m ost o f the carbohydrate retained was in the form o f starch, the action o f amylase becom es very im portant in determining the am ount o f acid produced by bacterial activity. T h ere appears to be little difference in the salivary amylase activity o f caries-free and caries-active individuals (Bergeim and Barn-
360 • T H E J O U R N A L O F T H E A M E R IC A N D EN T A L A S S O C IA T IO N
field,1 Hess and Smith2) . Furthermore, the m ore rapidly ferm enting sugars (m onosac charides and disaccharides) because o f their solubility, and consequently low retentive fig ures, contributed m uch less to the acid-pro duced figure than starches. H owever, the role o f monosaccharides and disaccharides appears to be m ore im portant in the production o f dental caries than that o f polysaccharides (Keyes,3 M cC lure4 and Stephan5,6) . These factors may, in part, explain w hy the figures for acid form ed from given foods varied and contributed m uch less to the décalcification potential index than retention. T h e decalcifying potential index represents an im portant attempt at a developm ent o f a practical m ethod of preventing dental caries. H ow ever, as determined, its relation to the caries-producing potentialities o f food is to be viewed w ith some reservation. G ordon Nikiforuk, T oron to, O nt., Canada
1. Bergeim, O ., and Barnfield, W. F. Lack of cor relation between dental caries and salivary amylase. J. D. Res. 24:141 (June) 1945. 2. Hess, W . C ., and Smith, B. T. Salivary amylase activity of carious and non-carious individuals. J. D. Res. 27:593 (Oct.) 1948. 3. Keyes, P. H. Dental caries in the Syrian hamster. II: _ Preliminary study of the effect^ of three different rations on caries activity. J. Nutrition 32:525 (Nov.) 1946. 4. McClure, F. J. Observations on induced caries in rats. V: Effect of excessive sugar in the diet. J. D. Res. 24:239 (Oct.) 1945. 5. Stephan, R. M. Hydrogen ton concentration of the dental plaque. J. D. Res'. 17:251 (June) 1938. 6. Stephan, R. M. Relative importance of polysac charides, disaccharides and monosaccharides in the production of caries. J.A .D .A . 37:530 (Nov.) 1948.
AN A PO LO G Y FO R T H E T E E T H
Controversy has recently brought to light a curious suggestion, advanced b y some dentists perhaps inadvertently, as to the value o f the teeth to general health. Unless the profession continue to extract teeth for the treatment o f extraoral disease, these practitioners intimate, dentistry must revert to a m echanical art with a purely cosmetic purpose. Such a belief assumes a com pletely negative attitude toward the value o f the teeth. So regarded, the teeth are only a menace if dis eased, and negligible if sound. Carried to a logical conclusion, this thinking should agree with that of zealots o f bygone years who ad vocated the elimination o f all permanent first molars as soon as they erupted, to make sure that sooner or later these teeth did not en danger the health o f their possessor. T h e idea is not greatly different from that of the in
temperate surgeon w ho w ould extirpate all tonsils and appendixes— except that the teeth can hardly be called vestigial organs. N o one would deny that it is often necessary to re move teeth because they are diseased, but it does not follow that getting rid o f such teeth is the only, or principal, function o f the den tist. Neither the dentist nor the layman will accept this altogether negative evaluation of the teeth. But not all dentists may be prepared to present an invincible defense o f the virtues o f the teeth, in face o f their frequent frailties. It m ight be well to consider the teeth as stand ing before the bar o f justice to give reason for their existence. W hat can their advocate say for them? First o f all is the esthetic claim , w hich has been spoken of somewhat slightingly. N o one can doubt that throughout the historical era o f mankind, from the time o f the Song of Solomon to the present, glistening and shapely teeth have been prized vfor their adornment o f the face and its expression. T rue, this vir tue may be somewhat superficial. If, as some theorists have prophesied, Nature should in an eon or so reduce the human denture to non-existence, it is likely that the human countenance, edentulous, w ould appear just as attractive as it does today with a full com plem ent o f teeth. M an would simply re vise his standard o f beauty. In the meantime, the natural teeth remain a requisite to the good looks o f human beings, especially during the most attractive and vigorous period o f their lives. T h e disastrous effects of deform ity on the social and psychic life o f persons with irregular or malposed teeth or w ithout the full com plem ent of teeth are well understood today. T h e teeth contribute to the cosm etic effect not merely through their appearance. By their presence alone or by their use, they prom ote the developm ent o f other structures o f the face. T h e jaws ow e their growth in part to the teeth. I f full developm ent is a necessary element in facial beauty, the teeth are essential. T he second positive merit o f the teeth is their contribution to health and physical well being. T h e teeth facilitate several functions o f the body, especially mastication and speech. It is generally believed, and probably rightly, that the teeth, through mastication, contribute to good digestion by com m inution and insali vation of the food. U pon this matter, not too much scientific inform ation is available. There have been numerous studies dealing with the strength o f the bite, the efficiency o f com m inu tion, and even the character o f excretion when the food has been m ore or less thoroughly
w ould have been in a position to retire com fortably if he had the benefits from the O ld Age and Survivors Insurance provisions o f the Social Security A ct, but was not included un der the A ct because the Am erican D ental A s sociation did n ot allow it, w ould be in a posi tion to press the Am erican Dental Association for the amounts he w ould have received through inclusion under the Social Security Act. Legislators tell me that all the dentists need to d o is to show them that the m ajority o f dentists favor inclusion and it w ould be done. N ot only w ould I like this letter printed in T H E J O U R N A L OF T H E AM ERICAN D E N T A L A S SO C IA TIO N , but I w ould like to know if the Am erican D ental Association intends to act on my suggestions. Rubin Fabricant, D .D .S., Brooklyn
Dr. Fabricant apparently does not know that the C ouncil on Insurance o f the Association conducted a survey on this question in 1951 and found that nationwide opinion among members o f the Association was about evenly divided. T h e H ouse o f Delegates based its decision on the results of this survey (see Novem ber 1951 j o u r n a l , page 6 2 0 ), a n d 'on the fact that apparently dentists needed to acquaint themselves further with the subject. T h ey recom m ended that discussion groups be form ed in the constituent and com ponent dental societies fo r that purpose. It is sug gested that D r. Fabricant join discussion groups in his loca l and state dental societies, which need the opinion o f D r. Fabricant and every other m em ber in order to instruct dele gates h ow to vote on the subject when it comes up for consideration at the ninety-third annual session in St. Louis next Septem ber.— Editor
T H E "D E C A L C IF IC A T IO N PO TE N T IA L OF FO OD S”
A N D CARIES
A prize article by Bibby, G oldberg, and Chen, entitled “ T he Caries Producing Potentialities o f Foodstuffs,” appearing in the M ay 1951 issue o f T H E JO U R N A L OF T H E AM E RICA N D EN T A L a s s o c i a t i o n , has received a considerable amount o f publicity in dental circles. In view o f the pu blic health implications of this article it is w ell to evaluate the experimental approach used by the authors. T h e original objective o f the article was to list carbohydrate foods according to their caries-producing potential. T h e selective rec omm endation o f foodstuffs for caries preven tion w ould then be justified. For this purpose
methods were devised to measure the retention of foods in the m outh and the amount o f acid form ed from the food when incubated in saliva during intervals o f 4 and 24 hours. T h e product o f these two measurements was des ignated as the “ décalcification potential” o f the food . A cid produced in 4 and 24 hrs.
R eten tion __D écalcification in mgs. potential
This property was to serve as an index o f the caries-producing capacity o f a given food. T h e décalcification potentials o f a number of foods were determined according to the m ethod described. A ccordin g to these results, potatoes or bran cereal and milk should have a higher caries-producing potential than sugar or apple pie. T h e authors, follow ing their determination of the decalcifying potential o f a num ber o f foods, m ade an attempt to correlate this value with the caries-producing capacity o f the food . T h e experiments on hamsters failed to relate definitely the decalcifying potential o f foods with their caries-producing potentialities. It w ould appear, therefore, that in view of the fact that decalcifying potentials of foods have not been correlated with their caries-produc ing ability there seems to be little justification for the title, “ Evaluation o f the Caries-Pro ducing Potentialities of Various Foodstuffs.” It is difficult, at present, to state the sig nificance o f the decalcifying potential index. T h e in dex is a product o f food retention and acid production in the mouth. Tables 4, 5, 6, 7 and 8 suggest that it is primarily a function o f food retention. T he authors state that “ the décalcification potentials o f foods are influ enced m ore by the wide range o f retention figures than they are by acid production .” A lthough retentivity o f a food may be im portant in the production o f dental caries, it falls short o f being the m ajor criterion by w hich the caries-producing potential o f food m ay be assessed. T h e significance of the am ount o f acid produced by a given food is difficult to assess. T h e acid produced was measured by incuba tion of. the food with saliva for periods of 4 and 24 hours. T h e acid produced was the result o f bacterial action upon monosaccharides and disaccharides that were foun d in the food and were made available by the action of salivary amylase and the enzyme maltase. Since m ost o f the carbohydrate retained was in the form o f starch, the action o f amylase becom es very im portant in determining the am ount o f acid produced by bacterial activity. T h ere appears to be little difference in the salivary amylase activity o f caries-free and caries-active individuals (Bergeim and Barn-
360 • T H E J O U R N A L O F T H E A M E R IC A N D EN T A L A S S O C IA T IO N
field,1 Hess and Smith2) . Furthermore, the m ore rapidly ferm enting sugars (m onosac charides and disaccharides) because o f their solubility, and consequently low retentive fig ures, contributed m uch less to the acid-pro duced figure than starches. H owever, the role o f monosaccharides and disaccharides appears to be m ore im portant in the production o f dental caries than that o f polysaccharides (Keyes,3 M cC lure4 and Stephan5,6) . These factors may, in part, explain w hy the figures for acid form ed from given foods varied and contributed m uch less to the décalcification potential index than retention. T h e decalcifying potential index represents an im portant attempt at a developm ent o f a practical m ethod of preventing dental caries. H ow ever, as determined, its relation to the caries-producing potentialities o f food is to be viewed w ith some reservation. G ordon Nikiforuk, T oron to, O nt., Canada
1. Bergeim, O ., and Barnfield, W. F. Lack of cor relation between dental caries and salivary amylase. J. D. Res. 24:141 (June) 1945. 2. Hess, W . C ., and Smith, B. T. Salivary amylase activity of carious and non-carious individuals. J. D. Res. 27:593 (Oct.) 1948. 3. Keyes, P. H. Dental caries in the Syrian hamster. II: _ Preliminary study of the effect^ of three different rations on caries activity. J. Nutrition 32:525 (Nov.) 1946. 4. McClure, F. J. Observations on induced caries in rats. V: Effect of excessive sugar in the diet. J. D. Res. 24:239 (Oct.) 1945. 5. Stephan, R. M. Hydrogen ton concentration of the dental plaque. J. D. Res'. 17:251 (June) 1938. 6. Stephan, R. M. Relative importance of polysac charides, disaccharides and monosaccharides in the production of caries. J.A .D .A . 37:530 (Nov.) 1948.
AN A PO LO G Y FO R T H E T E E T H
Controversy has recently brought to light a curious suggestion, advanced b y some dentists perhaps inadvertently, as to the value o f the teeth to general health. Unless the profession continue to extract teeth for the treatment o f extraoral disease, these practitioners intimate, dentistry must revert to a m echanical art with a purely cosmetic purpose. Such a belief assumes a com pletely negative attitude toward the value o f the teeth. So regarded, the teeth are only a menace if dis eased, and negligible if sound. Carried to a logical conclusion, this thinking should agree with that of zealots o f bygone years who ad vocated the elimination o f all permanent first molars as soon as they erupted, to make sure that sooner or later these teeth did not en danger the health o f their possessor. T h e idea is not greatly different from that of the in
temperate surgeon w ho w ould extirpate all tonsils and appendixes— except that the teeth can hardly be called vestigial organs. N o one would deny that it is often necessary to re move teeth because they are diseased, but it does not follow that getting rid o f such teeth is the only, or principal, function o f the den tist. Neither the dentist nor the layman will accept this altogether negative evaluation of the teeth. But not all dentists may be prepared to present an invincible defense o f the virtues o f the teeth, in face o f their frequent frailties. It m ight be well to consider the teeth as stand ing before the bar o f justice to give reason for their existence. W hat can their advocate say for them? First o f all is the esthetic claim , w hich has been spoken of somewhat slightingly. N o one can doubt that throughout the historical era o f mankind, from the time o f the Song of Solomon to the present, glistening and shapely teeth have been prized vfor their adornment o f the face and its expression. T rue, this vir tue may be somewhat superficial. If, as some theorists have prophesied, Nature should in an eon or so reduce the human denture to non-existence, it is likely that the human countenance, edentulous, w ould appear just as attractive as it does today with a full com plem ent o f teeth. M an would simply re vise his standard o f beauty. In the meantime, the natural teeth remain a requisite to the good looks o f human beings, especially during the most attractive and vigorous period o f their lives. T h e disastrous effects of deform ity on the social and psychic life o f persons with irregular or malposed teeth or w ithout the full com plem ent of teeth are well understood today. T h e teeth contribute to the cosm etic effect not merely through their appearance. By their presence alone or by their use, they prom ote the developm ent o f other structures o f the face. T h e jaws ow e their growth in part to the teeth. I f full developm ent is a necessary element in facial beauty, the teeth are essential. T he second positive merit o f the teeth is their contribution to health and physical well being. T h e teeth facilitate several functions o f the body, especially mastication and speech. It is generally believed, and probably rightly, that the teeth, through mastication, contribute to good digestion by com m inution and insali vation of the food. U pon this matter, not too much scientific inform ation is available. There have been numerous studies dealing with the strength o f the bite, the efficiency o f com m inu tion, and even the character o f excretion when the food has been m ore or less thoroughly