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Annual Meeting of the Council on Dental Therapeutics
COUNCIL ON DENTAL THERAPEUTICS ANNUAL MEETING OF THE COUNCIL ON DENTAL THERAPEUTICS I t is an established principle of the Council on D ental T herapeutics to advise the members of the dental profession and the public of its decisions as soon as circum stances perm it. In accordance w ith this established principle, the follow ing items discussed d u rin g the last m eeting of the Council, w hich m ay be of interest to both dentists and m anufacturers, are authorized for publication. S a m u e l M . G ordon , Secretary.
T h e C ouncil on D e n ta l T h erap e u tic s of the A m erican D e n ta l A ssociation held its seventh annual m eeting a t the C e n tra l Office, 212 E a st Superior St., Chicago, 111., Sun day and M onday, M a rc h 29 and 30, 1936. T h e follow ing m em bers w ere in attendance: J . H o w a rd B row n, P h .D ., associate professor of bacteriology, Jo h n s H opkins U n iv er sity, B altim ore, M d .; P a u l J . H a n z lik , M .D ., vice chairm an of the C ouncil, professor of pharm acology, Stanford U n iv ersity School of M edicine, San Francisco, C a lif.; T h o m as J . H ill, D .D .S., professor of clinical o ra l pathology and th erapeutics, W e ste rn Reserve U niversity School of D en tistry , C leveland, O h io ; M ilan A. L ogan, P h .D ., in stru cto r in biologic chem istry, H a rv a rd M ed ical School, Boston, M a ss.; A rn o B. L u ck h ard t, M .D ., P h .D ., Sc.D., L L .D ., professor of physiology, U niversity of Chicago, Chicago, 111.; H a r r y Lyons, D .D .S., professor of periodontia and o ra l pathology, M ed ical College of V irginia, School of D en tistry , Richm ond, V a .; Jo h n A. M a rsh all, P h .D ., D .D .S., p ro fessor of dental pathology and biochem istry, U niversity of C alifo rn ia, College of D e n tistry , San Francisco, C a lif.; V icto r C. M yers, P h .D ., Sc.D., professor of biochem istry, W e s te rn R eserve U niversity, schools of medicine and dentistry, C leveland, O h io ; U . G arfield R ickert, A .M ., D .D .S ., p rofessor of m ate ria medica and therapeutics and hy giene, U niversity of M ichigan, C ollege of D en tistry , A nn A rb o r, M ic h .; H a ro ld S. Sm ith, D .D .S ., chairm an of the Council, 180 N o rth M ichigan A venue, Chicago, 111.; Sam uel M . G ordon, P h .D ., secretary of the Council, C hief, A .D .A . B u reau of C hem istry, Chicago, 111.; C. N . Johnson, D .D .S ., L L .D ., E d ito r of T h e J o u r n a l , Chicago, 111., ex-officio m em ber; H a rry B. Pinney, D .D .S ., Secretary, A m erican D e n ta l Associa tion, Chicago, 111., ex-officio m em ber. G eorge A. M o rg an , T ru s te e of the A m erican D e n ta l A ssociation and a m em ber of the contact com m ittee betw een the B oard of T ru ste e s and the C ouncil, w as present on invitation. H a ro ld S. Sm ith and P a u l J . H a n z lik w ere reelected chairm an and vice chairm an of the C ouncil, respectively. STATISTICAL S U M M A R Y O F T H E C O U N C I L ’ SWORK
T h e C ouncil w as apprised of th e num erical sta tu s of the products before it as of Feb. 1, 1936. T h e tab u latio n is given below for the in terest of th e m em bers of the p ro fession: P ro d u cts announced in T h e J o u r n a l as accepted 216 P ro d u cts announced in T h e J o u r n a l as n o t acceptable (including N otices of Ju d g m en t) 273 P ro d u cts reaccepted (since A pril, 1935) 11 P ro d u cts om itted from A .D .R . 9
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Provisional acceptance and acceptance recommended 62 Acceptance not recommended, but still under consideration 2 Awaiting more evidence from proprietor for final disposition 8 Products acceptable, announcement delayed 2 Awaiting report of referee 3 Consideration postponed 21 Exempted list 35 Official drugs in A.D.R. 120 Products examined in the Bureau of Chemistry, findings not yet published 63 T otal 947 Minus items 4 and 5 ' 20 N et total 927 Products discussed in answer to inquiries, etc., not including the foregoing, approximately 850 T otal products brought to attention of the Council in one way or another 1,777 Such statistical information, while indicative of the trend of the Council’s work, does not represent the actual scope of the work being done by the Council or the work carried on in the Council’s office. No mention is made of the large correspondence between indi vidual members of the profession and the laity. O ther than the secretary, who also acts as chemist, there has been no technical as sistance available since the latter fcart of 1932. Consequently, many important projects are being postponed until such assistance is available. Many chemical problems of a general nature of immediate interest to the dental profession, such as the examination of new proprietary products of potential usefulness, and an examination of many products that are being sold to the profession with an aura of secrecy and mystery, and that, as a rule, are not submitted to the Council, cannot be considered. The time available for work in the laboratory is such that only the most urgent examinations can be made. The Council, from time to time, has made an appeal to the governing bodies for funds for additional help, and it hopes that its pleas in this direction will soon be heeded. As a result of the Council’s endeavors, T h e J o u r n a l can now asseverate that it carries more reliable advertising than any other journal in dentistry. A member reading the advertising pages can be assured that the Officers of the Association have taken steps to secure a realization of the hope expressed by many dentists. T he same cannot be said for some of the journals that are sent free to practically every dentist in the country. T he application of the policy laid down by the Association in 1930 regarding the re quirement that only those products within the scope of the Council that are acceptable could be eligible for exhibit has been instrumental in meeting the dilatory tactics of some manufacturers of products acceptable in other respects than the advertising. Thus, several firms have come to recognize the desirability of marketing their products in an acceptable manner in order that their products may have attached to them the prestige that comes from exhibiting in the Association’s Annual Session. Some manu facturers now consult the Council before placing new dental products on the market. T h e work of the Council has led to an increase in the number of requests for courses in pharmacology and therapeutics by dentists. Such courses have been given in various parts of the country and many dentists have sought such instruction. I t is gratifying to point out that, in all such courses, the place of the Council’s work in securing a rational ization of the materia medica has been the basis of the course. a cc e pt e d
d e n t a l
remedies
T he Council has again noted with appreciation the reception of the second edition of the book Accepted Dental Remedies. I t is still a matter of gratification that practically
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every dental school in the country continues to require o r recom m end the use of the book in one course o r another. A pproxim ately 4,000 copies of the book Accepted D e n tal Remedies, 1935 have been distributed. M o re copies could have been disposed of w ere it not fo r the fact th a t the book w as w ith d ra w n from the m a rk e t about A p ril 1 in antici pation of the appearance of Accepted D e n ta l Remedies, 1936. M uch of the inform atio n on actions and uses in Accepted D e n ta l Remedies, 1935 can be carried w ith o u t revision into the n ext edition of the book. T h e n ex t edition w ill re quire extensive revision in o rd er to harm onize it w ith U . S. P harm acopeia X I and the N atio n al F o rm u la ry V I, w hich become official Ju n e 1, 1936. T h e official drugs listed in A ccepted D e n ta l R em edies w ill be reviewed fo r th eir continued usefulness and the nom enclature and o th e r p ertin en t inform ation in the official books m entioned w ill be follow ed in fu tu re editions o f Accepted D en tal Remedies. Since the la s t appearance of the book, a num ber of p ro p rietary articles th a t are n o t now listed in the book have been announced as acceptable th ro u g h the pages of T h e J o u r n a l a t various periods. T h e y w ill be suitably edited and added to the book. T h o se p roprietaries th a t have been declared not acceptable since publication of th e second edi tion of the book w ill be added to the bibliographic index of those articles not included in A .D .R ., so th at, a t the tim e of the appearance of the new edition, the ow ner of a copy of the la te st edition of the book w ill have before him a statem en t as to the c u rren t statu s of all products considered by the C ouncil fo r w hich reports have been published. W h ile the book is published as a service to the profession, and no t fo r profit, it is gratifying to note th a t, in each instance, the sale of the book has n etted a profit, w hich has been retu rn ed to the gen eral funds of the A ssociation. T h is indicates to the Council the w illingness of dentists to su pport such a p roject as Accepted D e n ta l Remedies. T h e section on “F o rm u la s and P rescribing Suggestions” w as considered in detail by the C ouncil. T h is section w ill again be carefully studied in o rd e r to bring it up to date as nearly as possible. T h e re is alw ays a question as to which form ulas, or prescriptions, are m ost acceptable fo r given individual conditions. In the la s t analysis, the usefulness of the product depends on an understanding of the condition of the individual p atient for w hom m edication is applied. T h is, and conform ance to the principles laid dow n in the rules of the C ouncil and ex p lan ato ry comm ents thereon, w ill be the guiding principle in the revision of this chapter. T h e Council w ill give consideration to any suggestions th a t m em bers of the profession m ay care to tran sm it to it, w ith th e reason and any scientific evidence as to its usefulness. I t is the aim of the C ouncil to base its decisions relatin g to the inclusion of m aterial in A ccepted D e n ta l Rem edies on either acceptable experim ental o r clinical evidence, as nearly as possible. T h e C ouncil has no funds to g ra n t to experienced investigators to carry out m any of the studies th a t appear necessary in o rd er to clear up m oot questions th a t may arise in the p rep aratio n of A ccepted D en tal R em edies; b u t it has been fo r tu n ate in obtaining the in terest of collaborators, in addition to the experim ental w o rk carried on by m em bers of th e Council. A n associate of one of the m em bers of the Council has already evaluated, by th e blind m ethod, the usefulness of topical anesthetics. T h u s, the use of these agents is placed on a m ore scientific basis th a n has been the case form erly. C o u n terirritan ts, in the form of solutions or poultices, have been used in dentistry for a num ber of years. T h e evidence directly in support of such use is n o t available. Such an investigation is now being carried o u t by an investigator fo r the C ouncil. T h e com p arative m erits of local anesthetics fo r hypoderm ic injection, by the blind m ethod, is also the subject of an investigation by an o th er m em ber. T h e question of cold steriliza tion of instrum ents is one th a t has come up repeatedly. I t appears to be a w idely used practice in dentistry. W h e th e r such a m ethod is sound is, at the present tim e, open to discussion, although, to be sure, several drugs th a t have been used for this purpose w ith
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claims of success are listed in Accepted D en ta l Remedies. A m em ber of the Council rep orted on the prelim inary results obtained w ith some of these preparations. A n o th er m em ber of the Council is carrying o u t extended experim entation on chlorate because of the questions th a t have been raised, b u t not satisfactorily settled up to the present, con cerning its use in dentifrices and m outh washes. T h e question of “pain relievers” w ith potentially toxic properties, some of w hich have been advertised to the dental profession and to the public as being safe, is also the subject of investigation by a m em ber of the Council. O th e r projects, such as an investigation by physiologic m ethod of claims as to the deleterious action on the gums of the use of foods th a t do not require chewing m ust be postponed because of the inability of the Council to finance such an investigation. T h e C ouncil w as apprised of the fact th a t a few dentists cannot realize the fu ll bene fits of Accepted D en tal Remedies because they are in the habit of thinking of drugs in term s of p ro p rietary nam es. F o r example, instead of thinking of the agents used in pulp capping under the term s of zinc oxide w ith eugenol, m any practitioners, p a rtic u la rly of the older school, ask w hy Accepted D e n tal Rem edies does not contain inform ation on such and such a pro d u ct advertised fo r this purpose. In o rd e r to m eet this need as nearly as possible, the C ouncil has suggested in the past, and has renew ed its suggestion, to the governing bodies of the Association th a t a volum e containing the rep o rts of the Council on unacceptable products be published by the Council and the Association. A rm ed w ith such a book and w ith A ccepted D e n ta l Remedies, the den tist w ill be able to ascertain th a t such-and-such a p roduct has, as its essential ingredient, zinc oxide. By referrin g to zinc oxide in A ccepted D en ta l Remedies, he w ill be in a position to use the drug w ith due understanding of its uses and lim itations, and, not the least im portant, w ith a m onetary saving to him self and to his patients. B A CT E RI O L O G I C N O M E N C L A T U R E IN A C C E P T E D D E N T A L R EM E DI E S
A standardized nom enclature is one of the prim e requisites of science. I t enables investigators and others interested in a field to be a w are th a t they are talking of the same object. T h e A m erican D en tal A ssociation is appreciative of this and has, as one of its special com m ittees, a C om m ittee on N om enclature. G re a t progress has been m ade in the nom enclature of chemical compounds by the A m erican C hem ical Society, chemical term s applied to medicine by the C ouncil on P h arm acy and C hem istry of the A m erican M edical A ssociation, and dental term s, th ro u g h the C om m ittee on N o m en clatu re of the A m erican D en tal Association. B acteriologic nom enclature, because of the new ness of the science, has not advanced the sam e degree as some of the oth er fields m entioned. I t is the desire of the C ouncil to have A ccepted D e n ta l R em edies conform to acceptable bac teriologic nom enclature. T h is w as studied by a m em ber of the C ouncil, w ho presented the follow ing statem en t: T h e need fo r th e adoption of a m ore p ractical and scientific classification, o r nom en clature, fo r b acteria is b ro u g h t o u t in th e follow ing quotations. A bout 1905, H . M a rsh a ll W a rd w ro te : “T h e only really valid objection to a purely scientific classification is the old objection of the purely u tilita ria n practical m en; and even there the objection is relative. T h is leads me to bring o u t the point th a t the bac teriologists in the w idest sense of the w o rd are really looking a t the question of classifica tion from a t least tw o very different points of v iew : O n the one hand, w e have the botanists, w ho direct th e ir attention to the organism , the Schizomycete itself, as a biological phenomenon to be exam ined and rep o rted upon as thoroughly as possible. F o r them no classification is complete w hich does n o t record, o r (w hich am ounts to the same thing) imply in its records, all of the life phenom ena of the organism , including its pedigree. “ O n the o th er hand, w e have the pathologists, hygienists, brew ers, chemists, etc., w ho reg ard the organism simply as an object to be nam ed fo r convenience in reference, because
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it brings about certain changes in tissues, w aters, and o th er m edia which they are m ore especially concerned w ith. T h e y do not care, and n a tu ra lly so, w h a t vagaries the organism exhibits, so long as they can recognize it w hen they m eet w ith it. As a m a tte r of experi ence, how ever, it is ju s t these vagaries th a t bring about the sources of e rro r w hich beset them on all hands, and hence they a re equally in terested w ith the botanist in having them cleared up and explained. W h e n w e come to the conclusion th a t, w h atev er may be be lieved to the contrary , the re al in terests of bacteriologists of all kinds are identical.” In J o rd a n ’s “ G en eral B acteriology,” eleventh edition, 1935, it is sta te d : “T h e c u rre n t nom enclature of bacteriology may be criticized on tw o g ro u n d s: F irst, as already pointed out, fo r the unw ieldy size th a t c ertain ‘g en era’ have been allow ed to assume ; and second, for the h ap h azard w ay in w hich trin o m ial and even q u adrinom ial names have been bestowed. Such nam es can be properly employed only w ith reference to subspecies o r v arieties; and designations like B . coli communis, Granulobacillus saccharobutyricus nobilis nonliquefaciens, and Micrococcus acidi paralactici liquefaciens H alensi, are both cum bersom e and unscientific. T h e use of a single generic nam e fo r a m u ltitu d e of organism s is, in fact, responsible fo r the tendency to w a rd trin o m ial nom enclature, and the rem edy fo r both conditions w ould seem to lie in the fra n k establishm ent of new genera on the basis of m orphologic and physiologic ch aracters as rapidly as general intern atio n al agreem ent can be reached. U n til some such refo rm in nom enclature is brought about the nam es used to designate different kinds of bacteria w ill fail to m ake clear the group relationships w hich undoubtedly exist, and w ill continue to be a stum bling block to all students of the subject.” W h e n early bacteriologists recognized th ree distinct m orphologic types of bacteria, nam ely, cocci, bacilli and curved o r spiral form s, they h ad little appreciation of the fact th a t in each of these m orphologic groups, there w ere organism s of such w idely different physiologic characteristics th a t it w ould become necessary to distinguish m any different genera on physiologic ra th e r th an m orphologic grounds. In th e groups of higher plants and anim als, it is seldom necessary to consider physiologic differences, b u t these have assum ed p rim ary im portance from the very beginning of the science of bacteriology. In the rapid developm ent of the science of bacteriology, it w as th e activity of b acteria in disease and in bringing about chemical changes of in d u strial im portance th a t w as of prim ary interest. I t w as th e re fo re n a tu ra l th a t such fath ers of the science as P a ste u r and Koch gave little atten tio n to the classification and nom enclature of b acteria and w ere satisfied to employ names th a t coupled the simple m orphologic designations w ith one o r m ore descriptive term s w hich indicated th eir physiologic o r pathogenic activity. A s a m a tte r of fact, th ere had not yet developed any basis fo r a m ore ratio n al o r detailed classification. I t is probably fo r this reason th a t the indiscrim inate use of the w ord “bacillus” as a generic nam e has been handed dow n to the presen t tim e and that, when so used, it has become so inclusive as to have lost all significance except in designating a rodlike organism . In spite of h istorical sanctions, this is a situ atio n th a t cannot continue indefinitely, and the longer it continues, the m ore difficult it becomes to discard the older nom enclature and to adopt a new er and m ore ratio n al nom enclature. A lthough many persons have proposed systems of classification of bacteria, and some of these efforts have m et w ith considerable acceptance fo r the tim e being, it is doubtful th a t any of these proposals have m et w ith the acceptance accorded those of the C om m ittee of the Society of A m erican B acteriologists in th eir final rep o rt of 1920. T h ese suggestions have been subjected to m odification and fu rth e r developm ent by o th e r authors since 1920, b u t unquestionably they constitute a m ilestone in the developm ent of bacteriology. T h is classification is recognized, and o ften adopted, in m ost of the recent textbooks on bac teriology published in English, som etim es quite consistently, as for instance in the “T ex t-B o o k of B acteriology,” by F o rd , 1927 ; “P rinciples of B acteriology and Im m unity,” by T o p ley and W ilson, 1929 ; “ P athogenic M icroorganism s,” by P a rk and W illiam s, 1933 ;
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“General Bacteriology,” by Jordan, 1935; “Laboratory Methods of the U. S. Army,” by Simmons and Gentzkow, 1935, and “Agents of Disease and Host Resistance,” by F. P. Gay and associates, 1935. In other textbooks, this classification is recognized even though the nomenclature may not be so consistent throughout, as, for instance, in the “Text-Book of Bacteriology” by Zinsser and Bayne-Jones, 1934. Bergey’s “Manual of Determinative Bacteriology,” now in its fourth edition (1934), is based upon the 1920 report of the Committee of the Society of American Bacteriologists. It may be said, therefore, that the adoption of this classification and nomenclature is making rapid progress. It is employed in the textbooks that medical and dental students are using and the reference books and bacteriologic journals that dentists and medical men must read. Although it may at times be inconvenient for the older dentists and medical men to acquaint themselves with the newer terminology, it is less inconvenient than to require dental and medical students and the younger bacteriologists to resort to an older and less informative terminology. I believe that, at the present time, the Council is in a position to offer considerable encouragement toward the progress of bacteriologic nomenclature by adopting the motion proposed, at the same time clarifying its own attitude on problems in bacteriologic nomenclature, which must arise constantly. The Biological Section of the American Drug Manufac turers Association, with the approval of the National Institute of Health, has now under consideration the substitution of the newer generic names of the bacteria, to be used in their labels and literature, for the older names now in use by them, having the newer names followed by the older names in brackets. It would seem, therefore, that the time is opportune to take some action. On the basis of this statement, the following motions were adopted: 1. (a) T hat the Council recognize as acceptable for the nomenclature of bacteria the generic names proposed in the Final Report of the Committee of the Society of American Bacteriologists on Characterization and Classification of Bacterial Types (J. Bacteriol. 5: 191, 1920); (b) that these names be used in A. D. R. and other publications of the Council; (c) that the use of “common names,” not used in a generic sense, and the use of newer names for subdivisions of the genus Bacterium be also permitted, and (d ) that this action shall not preclude the use of names of products required in government licenses when used as such on package labels, in package enclosures, in advertising, in reports of the Council or as headings for descriptions of products in A. D. R., provided such names are followed by names acceptable to the Council. 2. T h at the Council request the Editor of T h e J o u r n a l to consider favorably the adoption of the revised bacteriologic nomenclature that has been adopted by the Council for use in publications of the A.D.A., and that this request also be transmitted to the Committee on Nomenclature of the A.D.A. [Abstracts of the Final Report of the Committee of the Society of American Bac teriologists on Characterization and Classification of Bacterial Types are available to those interested, on application to the Council office.]
CHLORINE-LIBERATING PREPARATIONS Chlorine-liberating preparations in aqueous solutions decompose on standing. Since such solutions for therapeutic use are generally made up on the basis of the amount of available chlorine present, the matter of labeling assumes importance to those who use these preparations, or are charged with regulatory acts. It was decided that products subject to deterioration, in order to be acceptable, should be labeled with a statement of composition at the date the product leaves the manufacturers, and that a supplemental statement be made either indicating the percentage of deterioration or the actual minimal amount at the end of a specified time.
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GERMICIDAL SOLUTIONS FOR COLD STERILIZATION OF INSTRUMENTS It was mentioned above that requests for information on solutions of chemicals for the cold sterilization of instruments come to the Council. A.D.R. carries information on certain of these that have been used in the past. Some of these are various solutions of formaldehyde, various preparations of mercury salts, various preparations of phenols, to mention a few. The subject has not received the investigation that its widespread use would indicate. In consideration of certain proprietary products submitted to the Council, a referee undertook an investigation, which is still underway. This investigation included examina tion of several preparations that have been compounded in the A.D.A. Bureau of Chemistry. While some of these solutions are able to kill bacteria under certain con ditions, the work has already indicated the difficulty of killing bacterial spores. I t was provisionally concluded that the claims made for solutions of chemicals for the cold sterilization of instruments should be accepted with reservations until more information than is available at the present time is at hand. T he Council regrets that it has not available a sum of money for a grant to a competent worker to undertake an examination of this important project.
CALCIUM COMPOUNDS In the course of the year, the Council published a report on “Calcium and Phosphorous Compounds in Dentistry.” After an extensive review of the literature, the Council con cluded that there was no evidence available to w arrant the use of these compounds for the prevention or treatment of dental caries, and concluded that many of the claims now currently being made for the usefulness of such products were without acceptable foundation. The Council also drew up reports on specific proprietary products, which were sent to the manufacturers marketing them. In no case did any manufacturer submit evidence to cause a revision of the Council’s position, but general statements were made as to the presumed lack of calcium in the American diet. After a consideration of these products, the Council concluded that no scientific evi dence has been presented to w arrant the reversal of the position of the Council on Dental Therapeutics on the nonacceptance of these products for A.D.R. As far as this Council is concerned, these products, to be acceptable, must have proven value as a prophylactic in the treatment of dental caries. No evidence has been presented that the addition of mineral supplements of calcium phosphate beyond that present in an adequate diet will prevent, overcome or retard dental caries. If and when acceptable evidence is presented demonstrating that supplementing the diet with compounds of calcium and phosphorus will favorably influence the incidence of dental caries, the Council will be glad to consider the admission of these products to A.D.R. ( T o be c o n tin u e d )
T h e C ouncil on D e n ta l T h erap e u tic s of the A m erican D e n ta l A ssociation held its seventh annual m eeting a t the C e n tra l Office, 212 E a st Superior St., Chicago, 111., Sun day and M onday, M a rc h 29 and 30, 1936. T h e follow ing m em bers w ere in attendance: J . H o w a rd B row n, P h .D ., associate professor of bacteriology, Jo h n s H opkins U n iv er sity, B altim ore, M d .; P a u l J . H a n z lik , M .D ., vice chairm an of the C ouncil, professor of pharm acology, Stanford U n iv ersity School of M edicine, San Francisco, C a lif.; T h o m as J . H ill, D .D .S., professor of clinical o ra l pathology and th erapeutics, W e ste rn Reserve U niversity School of D en tistry , C leveland, O h io ; M ilan A. L ogan, P h .D ., in stru cto r in biologic chem istry, H a rv a rd M ed ical School, Boston, M a ss.; A rn o B. L u ck h ard t, M .D ., P h .D ., Sc.D., L L .D ., professor of physiology, U niversity of Chicago, Chicago, 111.; H a r r y Lyons, D .D .S., professor of periodontia and o ra l pathology, M ed ical College of V irginia, School of D en tistry , Richm ond, V a .; Jo h n A. M a rsh all, P h .D ., D .D .S., p ro fessor of dental pathology and biochem istry, U niversity of C alifo rn ia, College of D e n tistry , San Francisco, C a lif.; V icto r C. M yers, P h .D ., Sc.D., professor of biochem istry, W e s te rn R eserve U niversity, schools of medicine and dentistry, C leveland, O h io ; U . G arfield R ickert, A .M ., D .D .S ., p rofessor of m ate ria medica and therapeutics and hy giene, U niversity of M ichigan, C ollege of D en tistry , A nn A rb o r, M ic h .; H a ro ld S. Sm ith, D .D .S ., chairm an of the Council, 180 N o rth M ichigan A venue, Chicago, 111.; Sam uel M . G ordon, P h .D ., secretary of the Council, C hief, A .D .A . B u reau of C hem istry, Chicago, 111.; C. N . Johnson, D .D .S ., L L .D ., E d ito r of T h e J o u r n a l , Chicago, 111., ex-officio m em ber; H a rry B. Pinney, D .D .S ., Secretary, A m erican D e n ta l Associa tion, Chicago, 111., ex-officio m em ber. G eorge A. M o rg an , T ru s te e of the A m erican D e n ta l A ssociation and a m em ber of the contact com m ittee betw een the B oard of T ru ste e s and the C ouncil, w as present on invitation. H a ro ld S. Sm ith and P a u l J . H a n z lik w ere reelected chairm an and vice chairm an of the C ouncil, respectively. STATISTICAL S U M M A R Y O F T H E C O U N C I L ’ SWORK
T h e C ouncil w as apprised of th e num erical sta tu s of the products before it as of Feb. 1, 1936. T h e tab u latio n is given below for the in terest of th e m em bers of the p ro fession: P ro d u cts announced in T h e J o u r n a l as accepted 216 P ro d u cts announced in T h e J o u r n a l as n o t acceptable (including N otices of Ju d g m en t) 273 P ro d u cts reaccepted (since A pril, 1935) 11 P ro d u cts om itted from A .D .R . 9
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Provisional acceptance and acceptance recommended 62 Acceptance not recommended, but still under consideration 2 Awaiting more evidence from proprietor for final disposition 8 Products acceptable, announcement delayed 2 Awaiting report of referee 3 Consideration postponed 21 Exempted list 35 Official drugs in A.D.R. 120 Products examined in the Bureau of Chemistry, findings not yet published 63 T otal 947 Minus items 4 and 5 ' 20 N et total 927 Products discussed in answer to inquiries, etc., not including the foregoing, approximately 850 T otal products brought to attention of the Council in one way or another 1,777 Such statistical information, while indicative of the trend of the Council’s work, does not represent the actual scope of the work being done by the Council or the work carried on in the Council’s office. No mention is made of the large correspondence between indi vidual members of the profession and the laity. O ther than the secretary, who also acts as chemist, there has been no technical as sistance available since the latter fcart of 1932. Consequently, many important projects are being postponed until such assistance is available. Many chemical problems of a general nature of immediate interest to the dental profession, such as the examination of new proprietary products of potential usefulness, and an examination of many products that are being sold to the profession with an aura of secrecy and mystery, and that, as a rule, are not submitted to the Council, cannot be considered. The time available for work in the laboratory is such that only the most urgent examinations can be made. The Council, from time to time, has made an appeal to the governing bodies for funds for additional help, and it hopes that its pleas in this direction will soon be heeded. As a result of the Council’s endeavors, T h e J o u r n a l can now asseverate that it carries more reliable advertising than any other journal in dentistry. A member reading the advertising pages can be assured that the Officers of the Association have taken steps to secure a realization of the hope expressed by many dentists. T he same cannot be said for some of the journals that are sent free to practically every dentist in the country. T he application of the policy laid down by the Association in 1930 regarding the re quirement that only those products within the scope of the Council that are acceptable could be eligible for exhibit has been instrumental in meeting the dilatory tactics of some manufacturers of products acceptable in other respects than the advertising. Thus, several firms have come to recognize the desirability of marketing their products in an acceptable manner in order that their products may have attached to them the prestige that comes from exhibiting in the Association’s Annual Session. Some manu facturers now consult the Council before placing new dental products on the market. T h e work of the Council has led to an increase in the number of requests for courses in pharmacology and therapeutics by dentists. Such courses have been given in various parts of the country and many dentists have sought such instruction. I t is gratifying to point out that, in all such courses, the place of the Council’s work in securing a rational ization of the materia medica has been the basis of the course. a cc e pt e d
d e n t a l
remedies
T he Council has again noted with appreciation the reception of the second edition of the book Accepted Dental Remedies. I t is still a matter of gratification that practically
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every dental school in the country continues to require o r recom m end the use of the book in one course o r another. A pproxim ately 4,000 copies of the book Accepted D e n tal Remedies, 1935 have been distributed. M o re copies could have been disposed of w ere it not fo r the fact th a t the book w as w ith d ra w n from the m a rk e t about A p ril 1 in antici pation of the appearance of Accepted D e n ta l Remedies, 1936. M uch of the inform atio n on actions and uses in Accepted D e n ta l Remedies, 1935 can be carried w ith o u t revision into the n ext edition of the book. T h e n ex t edition w ill re quire extensive revision in o rd er to harm onize it w ith U . S. P harm acopeia X I and the N atio n al F o rm u la ry V I, w hich become official Ju n e 1, 1936. T h e official drugs listed in A ccepted D e n ta l R em edies w ill be reviewed fo r th eir continued usefulness and the nom enclature and o th e r p ertin en t inform ation in the official books m entioned w ill be follow ed in fu tu re editions o f Accepted D en tal Remedies. Since the la s t appearance of the book, a num ber of p ro p rietary articles th a t are n o t now listed in the book have been announced as acceptable th ro u g h the pages of T h e J o u r n a l a t various periods. T h e y w ill be suitably edited and added to the book. T h o se p roprietaries th a t have been declared not acceptable since publication of th e second edi tion of the book w ill be added to the bibliographic index of those articles not included in A .D .R ., so th at, a t the tim e of the appearance of the new edition, the ow ner of a copy of the la te st edition of the book w ill have before him a statem en t as to the c u rren t statu s of all products considered by the C ouncil fo r w hich reports have been published. W h ile the book is published as a service to the profession, and no t fo r profit, it is gratifying to note th a t, in each instance, the sale of the book has n etted a profit, w hich has been retu rn ed to the gen eral funds of the A ssociation. T h is indicates to the Council the w illingness of dentists to su pport such a p roject as Accepted D e n ta l Remedies. T h e section on “F o rm u la s and P rescribing Suggestions” w as considered in detail by the C ouncil. T h is section w ill again be carefully studied in o rd e r to bring it up to date as nearly as possible. T h e re is alw ays a question as to which form ulas, or prescriptions, are m ost acceptable fo r given individual conditions. In the la s t analysis, the usefulness of the product depends on an understanding of the condition of the individual p atient for w hom m edication is applied. T h is, and conform ance to the principles laid dow n in the rules of the C ouncil and ex p lan ato ry comm ents thereon, w ill be the guiding principle in the revision of this chapter. T h e Council w ill give consideration to any suggestions th a t m em bers of the profession m ay care to tran sm it to it, w ith th e reason and any scientific evidence as to its usefulness. I t is the aim of the C ouncil to base its decisions relatin g to the inclusion of m aterial in A ccepted D e n ta l Rem edies on either acceptable experim ental o r clinical evidence, as nearly as possible. T h e C ouncil has no funds to g ra n t to experienced investigators to carry out m any of the studies th a t appear necessary in o rd er to clear up m oot questions th a t may arise in the p rep aratio n of A ccepted D en tal R em edies; b u t it has been fo r tu n ate in obtaining the in terest of collaborators, in addition to the experim ental w o rk carried on by m em bers of th e Council. A n associate of one of the m em bers of the Council has already evaluated, by th e blind m ethod, the usefulness of topical anesthetics. T h u s, the use of these agents is placed on a m ore scientific basis th a n has been the case form erly. C o u n terirritan ts, in the form of solutions or poultices, have been used in dentistry for a num ber of years. T h e evidence directly in support of such use is n o t available. Such an investigation is now being carried o u t by an investigator fo r the C ouncil. T h e com p arative m erits of local anesthetics fo r hypoderm ic injection, by the blind m ethod, is also the subject of an investigation by an o th er m em ber. T h e question of cold steriliza tion of instrum ents is one th a t has come up repeatedly. I t appears to be a w idely used practice in dentistry. W h e th e r such a m ethod is sound is, at the present tim e, open to discussion, although, to be sure, several drugs th a t have been used for this purpose w ith
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claims of success are listed in Accepted D en ta l Remedies. A m em ber of the Council rep orted on the prelim inary results obtained w ith some of these preparations. A n o th er m em ber of the Council is carrying o u t extended experim entation on chlorate because of the questions th a t have been raised, b u t not satisfactorily settled up to the present, con cerning its use in dentifrices and m outh washes. T h e question of “pain relievers” w ith potentially toxic properties, some of w hich have been advertised to the dental profession and to the public as being safe, is also the subject of investigation by a m em ber of the Council. O th e r projects, such as an investigation by physiologic m ethod of claims as to the deleterious action on the gums of the use of foods th a t do not require chewing m ust be postponed because of the inability of the Council to finance such an investigation. T h e C ouncil w as apprised of the fact th a t a few dentists cannot realize the fu ll bene fits of Accepted D en tal Remedies because they are in the habit of thinking of drugs in term s of p ro p rietary nam es. F o r example, instead of thinking of the agents used in pulp capping under the term s of zinc oxide w ith eugenol, m any practitioners, p a rtic u la rly of the older school, ask w hy Accepted D e n tal Rem edies does not contain inform ation on such and such a pro d u ct advertised fo r this purpose. In o rd e r to m eet this need as nearly as possible, the C ouncil has suggested in the past, and has renew ed its suggestion, to the governing bodies of the Association th a t a volum e containing the rep o rts of the Council on unacceptable products be published by the Council and the Association. A rm ed w ith such a book and w ith A ccepted D e n ta l Remedies, the den tist w ill be able to ascertain th a t such-and-such a p roduct has, as its essential ingredient, zinc oxide. By referrin g to zinc oxide in A ccepted D en ta l Remedies, he w ill be in a position to use the drug w ith due understanding of its uses and lim itations, and, not the least im portant, w ith a m onetary saving to him self and to his patients. B A CT E RI O L O G I C N O M E N C L A T U R E IN A C C E P T E D D E N T A L R EM E DI E S
A standardized nom enclature is one of the prim e requisites of science. I t enables investigators and others interested in a field to be a w are th a t they are talking of the same object. T h e A m erican D en tal A ssociation is appreciative of this and has, as one of its special com m ittees, a C om m ittee on N om enclature. G re a t progress has been m ade in the nom enclature of chemical compounds by the A m erican C hem ical Society, chemical term s applied to medicine by the C ouncil on P h arm acy and C hem istry of the A m erican M edical A ssociation, and dental term s, th ro u g h the C om m ittee on N o m en clatu re of the A m erican D en tal Association. B acteriologic nom enclature, because of the new ness of the science, has not advanced the sam e degree as some of the oth er fields m entioned. I t is the desire of the C ouncil to have A ccepted D e n ta l R em edies conform to acceptable bac teriologic nom enclature. T h is w as studied by a m em ber of the C ouncil, w ho presented the follow ing statem en t: T h e need fo r th e adoption of a m ore p ractical and scientific classification, o r nom en clature, fo r b acteria is b ro u g h t o u t in th e follow ing quotations. A bout 1905, H . M a rsh a ll W a rd w ro te : “T h e only really valid objection to a purely scientific classification is the old objection of the purely u tilita ria n practical m en; and even there the objection is relative. T h is leads me to bring o u t the point th a t the bac teriologists in the w idest sense of the w o rd are really looking a t the question of classifica tion from a t least tw o very different points of v iew : O n the one hand, w e have the botanists, w ho direct th e ir attention to the organism , the Schizomycete itself, as a biological phenomenon to be exam ined and rep o rted upon as thoroughly as possible. F o r them no classification is complete w hich does n o t record, o r (w hich am ounts to the same thing) imply in its records, all of the life phenom ena of the organism , including its pedigree. “ O n the o th er hand, w e have the pathologists, hygienists, brew ers, chemists, etc., w ho reg ard the organism simply as an object to be nam ed fo r convenience in reference, because
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it brings about certain changes in tissues, w aters, and o th er m edia which they are m ore especially concerned w ith. T h e y do not care, and n a tu ra lly so, w h a t vagaries the organism exhibits, so long as they can recognize it w hen they m eet w ith it. As a m a tte r of experi ence, how ever, it is ju s t these vagaries th a t bring about the sources of e rro r w hich beset them on all hands, and hence they a re equally in terested w ith the botanist in having them cleared up and explained. W h e n w e come to the conclusion th a t, w h atev er may be be lieved to the contrary , the re al in terests of bacteriologists of all kinds are identical.” In J o rd a n ’s “ G en eral B acteriology,” eleventh edition, 1935, it is sta te d : “T h e c u rre n t nom enclature of bacteriology may be criticized on tw o g ro u n d s: F irst, as already pointed out, fo r the unw ieldy size th a t c ertain ‘g en era’ have been allow ed to assume ; and second, for the h ap h azard w ay in w hich trin o m ial and even q u adrinom ial names have been bestowed. Such nam es can be properly employed only w ith reference to subspecies o r v arieties; and designations like B . coli communis, Granulobacillus saccharobutyricus nobilis nonliquefaciens, and Micrococcus acidi paralactici liquefaciens H alensi, are both cum bersom e and unscientific. T h e use of a single generic nam e fo r a m u ltitu d e of organism s is, in fact, responsible fo r the tendency to w a rd trin o m ial nom enclature, and the rem edy fo r both conditions w ould seem to lie in the fra n k establishm ent of new genera on the basis of m orphologic and physiologic ch aracters as rapidly as general intern atio n al agreem ent can be reached. U n til some such refo rm in nom enclature is brought about the nam es used to designate different kinds of bacteria w ill fail to m ake clear the group relationships w hich undoubtedly exist, and w ill continue to be a stum bling block to all students of the subject.” W h e n early bacteriologists recognized th ree distinct m orphologic types of bacteria, nam ely, cocci, bacilli and curved o r spiral form s, they h ad little appreciation of the fact th a t in each of these m orphologic groups, there w ere organism s of such w idely different physiologic characteristics th a t it w ould become necessary to distinguish m any different genera on physiologic ra th e r th an m orphologic grounds. In th e groups of higher plants and anim als, it is seldom necessary to consider physiologic differences, b u t these have assum ed p rim ary im portance from the very beginning of the science of bacteriology. In the rapid developm ent of the science of bacteriology, it w as th e activity of b acteria in disease and in bringing about chemical changes of in d u strial im portance th a t w as of prim ary interest. I t w as th e re fo re n a tu ra l th a t such fath ers of the science as P a ste u r and Koch gave little atten tio n to the classification and nom enclature of b acteria and w ere satisfied to employ names th a t coupled the simple m orphologic designations w ith one o r m ore descriptive term s w hich indicated th eir physiologic o r pathogenic activity. A s a m a tte r of fact, th ere had not yet developed any basis fo r a m ore ratio n al o r detailed classification. I t is probably fo r this reason th a t the indiscrim inate use of the w ord “bacillus” as a generic nam e has been handed dow n to the presen t tim e and that, when so used, it has become so inclusive as to have lost all significance except in designating a rodlike organism . In spite of h istorical sanctions, this is a situ atio n th a t cannot continue indefinitely, and the longer it continues, the m ore difficult it becomes to discard the older nom enclature and to adopt a new er and m ore ratio n al nom enclature. A lthough many persons have proposed systems of classification of bacteria, and some of these efforts have m et w ith considerable acceptance fo r the tim e being, it is doubtful th a t any of these proposals have m et w ith the acceptance accorded those of the C om m ittee of the Society of A m erican B acteriologists in th eir final rep o rt of 1920. T h ese suggestions have been subjected to m odification and fu rth e r developm ent by o th e r authors since 1920, b u t unquestionably they constitute a m ilestone in the developm ent of bacteriology. T h is classification is recognized, and o ften adopted, in m ost of the recent textbooks on bac teriology published in English, som etim es quite consistently, as for instance in the “T ex t-B o o k of B acteriology,” by F o rd , 1927 ; “P rinciples of B acteriology and Im m unity,” by T o p ley and W ilson, 1929 ; “ P athogenic M icroorganism s,” by P a rk and W illiam s, 1933 ;
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“General Bacteriology,” by Jordan, 1935; “Laboratory Methods of the U. S. Army,” by Simmons and Gentzkow, 1935, and “Agents of Disease and Host Resistance,” by F. P. Gay and associates, 1935. In other textbooks, this classification is recognized even though the nomenclature may not be so consistent throughout, as, for instance, in the “Text-Book of Bacteriology” by Zinsser and Bayne-Jones, 1934. Bergey’s “Manual of Determinative Bacteriology,” now in its fourth edition (1934), is based upon the 1920 report of the Committee of the Society of American Bacteriologists. It may be said, therefore, that the adoption of this classification and nomenclature is making rapid progress. It is employed in the textbooks that medical and dental students are using and the reference books and bacteriologic journals that dentists and medical men must read. Although it may at times be inconvenient for the older dentists and medical men to acquaint themselves with the newer terminology, it is less inconvenient than to require dental and medical students and the younger bacteriologists to resort to an older and less informative terminology. I believe that, at the present time, the Council is in a position to offer considerable encouragement toward the progress of bacteriologic nomenclature by adopting the motion proposed, at the same time clarifying its own attitude on problems in bacteriologic nomenclature, which must arise constantly. The Biological Section of the American Drug Manufac turers Association, with the approval of the National Institute of Health, has now under consideration the substitution of the newer generic names of the bacteria, to be used in their labels and literature, for the older names now in use by them, having the newer names followed by the older names in brackets. It would seem, therefore, that the time is opportune to take some action. On the basis of this statement, the following motions were adopted: 1. (a) T hat the Council recognize as acceptable for the nomenclature of bacteria the generic names proposed in the Final Report of the Committee of the Society of American Bacteriologists on Characterization and Classification of Bacterial Types (J. Bacteriol. 5: 191, 1920); (b) that these names be used in A. D. R. and other publications of the Council; (c) that the use of “common names,” not used in a generic sense, and the use of newer names for subdivisions of the genus Bacterium be also permitted, and (d ) that this action shall not preclude the use of names of products required in government licenses when used as such on package labels, in package enclosures, in advertising, in reports of the Council or as headings for descriptions of products in A. D. R., provided such names are followed by names acceptable to the Council. 2. T h at the Council request the Editor of T h e J o u r n a l to consider favorably the adoption of the revised bacteriologic nomenclature that has been adopted by the Council for use in publications of the A.D.A., and that this request also be transmitted to the Committee on Nomenclature of the A.D.A. [Abstracts of the Final Report of the Committee of the Society of American Bac teriologists on Characterization and Classification of Bacterial Types are available to those interested, on application to the Council office.]
CHLORINE-LIBERATING PREPARATIONS Chlorine-liberating preparations in aqueous solutions decompose on standing. Since such solutions for therapeutic use are generally made up on the basis of the amount of available chlorine present, the matter of labeling assumes importance to those who use these preparations, or are charged with regulatory acts. It was decided that products subject to deterioration, in order to be acceptable, should be labeled with a statement of composition at the date the product leaves the manufacturers, and that a supplemental statement be made either indicating the percentage of deterioration or the actual minimal amount at the end of a specified time.
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GERMICIDAL SOLUTIONS FOR COLD STERILIZATION OF INSTRUMENTS It was mentioned above that requests for information on solutions of chemicals for the cold sterilization of instruments come to the Council. A.D.R. carries information on certain of these that have been used in the past. Some of these are various solutions of formaldehyde, various preparations of mercury salts, various preparations of phenols, to mention a few. The subject has not received the investigation that its widespread use would indicate. In consideration of certain proprietary products submitted to the Council, a referee undertook an investigation, which is still underway. This investigation included examina tion of several preparations that have been compounded in the A.D.A. Bureau of Chemistry. While some of these solutions are able to kill bacteria under certain con ditions, the work has already indicated the difficulty of killing bacterial spores. I t was provisionally concluded that the claims made for solutions of chemicals for the cold sterilization of instruments should be accepted with reservations until more information than is available at the present time is at hand. T he Council regrets that it has not available a sum of money for a grant to a competent worker to undertake an examination of this important project.
CALCIUM COMPOUNDS In the course of the year, the Council published a report on “Calcium and Phosphorous Compounds in Dentistry.” After an extensive review of the literature, the Council con cluded that there was no evidence available to w arrant the use of these compounds for the prevention or treatment of dental caries, and concluded that many of the claims now currently being made for the usefulness of such products were without acceptable foundation. The Council also drew up reports on specific proprietary products, which were sent to the manufacturers marketing them. In no case did any manufacturer submit evidence to cause a revision of the Council’s position, but general statements were made as to the presumed lack of calcium in the American diet. After a consideration of these products, the Council concluded that no scientific evi dence has been presented to w arrant the reversal of the position of the Council on Dental Therapeutics on the nonacceptance of these products for A.D.R. As far as this Council is concerned, these products, to be acceptable, must have proven value as a prophylactic in the treatment of dental caries. No evidence has been presented that the addition of mineral supplements of calcium phosphate beyond that present in an adequate diet will prevent, overcome or retard dental caries. If and when acceptable evidence is presented demonstrating that supplementing the diet with compounds of calcium and phosphorus will favorably influence the incidence of dental caries, the Council will be glad to consider the admission of these products to A.D.R. ( T o be c o n tin u e d )