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Dental caries — Treatment or prevention?
PUBLIC
HEALTH
The Journal of the Society of ,Medical Officers of Health ~..,,.._:
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gol. LXXIV DENTAL
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September 1960 CARIES--TREATMENT PREVENTION ?
2!!!
LL
No. 12 OR
THE sad plight of the School Dental Service is receiving plenty of attention in all quarters but there is little sign that things are likely to improve in the near future. It is indeed unrealistic to hope for substantial improvement in the recruitment of dental officers. With an overall shortage of dentists the financial inducements of general dental practice are certain to outweigh |he highest inducements which local authorities will be able to offer, so that the public services will continue to depend on the minority of dentists who find more reward in work among children than in the size of their salary cheques and those who for various reasons feel that clinic work for fixed hours is less strenuous than general dentistry. We await with interest the results of present experiments with such auxiliary and ancillary workers as de~ntal hyglemsts. If the hopes of enthusiasts are reatiscd, the employment of such workers may make a material contribution to the effectiveness of school dental work, though it cannot provide a complete solution to the problem. There is, however, another side to the question. If it is impossible to provide adequate treatment of d~tal caries in children, should not the public health service turn its attention to what is, after all, the basis of its philosophy, prevention ? There are two methods of approach. One is to do whatever can b¢ done to make teeth more resistam to caries and the other is to reduce, the intensity of attack by cariogcnia agents. The first of these aims is being diligently pursued through fluoridation. True, the diligence is at the moment limited. We are quite satisfied that the case for fluoridation of public water supplies is strong and equally satisfied that the case against it is ~v~k. There i~ abundant evidence that people who have been brought up in places where nature has already provided the wat~ supplies with the right content of fluoride are certainly no worse offin any aspect of health, so that atthe lowest estimate general fluoridation will certaJnlydo no harm and will probably do much good. It is a matter for regret:that admirable efforts at the periphery are rmt yet receiving total support at the centre. •
/
442
PUBLIC
HEALT}t
VOL. LXXIV
NO,
12
In the meantime, evidt,mce is steadily a~..-umulating on the way in which caries starts and develops. There are still a n~amber of qu~tions unanswered, but the paper by Mr. Swallow which we p~tbtish in this issue gives a most admirable summary of present knowledge and at the very least he convinces us that the eating of sweets and sweet snacks between meals is an important-perhaps the most important--factor in the production of caries. It is a timely warning, becau~ in recent months the School Health Service Group and the Dental Group of the SociCtryhave l-menmuch exercised about the way in which the ~hools, which ought to be pointing the way to dental health, are often positively encouraging children ~o hasten along the road to dental ruirl. The school "tuck shop" has economic value. As Mr. Swallow says, its profits help the school to buy useful and important items of equipment, a strong inducement to the teachers. The manufacturers of biscuits see in it an attractive market for their wares. Not only does it sell biscuits but it encourages the formation of a taste for biscuits. In developi0g this market the manufacturers have shown at times a singular lack of scruple. One firm circulated tq~schools a letter suggesting that it had been proved that many children.were unable to digest milk unless it was accompanied by some such solid food as biscuits. Since no nutritionist of standing would endorse this, various ~hoo! medical officers challenged the firm to produce its evidence. The reply naively admitted that there was no proof but said that some children did not like cold milk u n i t s biscuits were available as wellt in the face of this kind of thing" we are glad to know that steps are being taken to arrange for representatives of the Society to meet representatives of the N.U.T. to discuss the subject, We hope that the discussion will go somewhat further than the consideration of biscuits, because considerable positive effort in dental health education is needed as well as the mere restriction of carbohydrate consumption during school hours. Mr. Swallow's mention of experiments in the education of expectant mothers is encouraging. Pregnancy is a tim~ when mothers are ready to listen r o u n d to take advice and if education and persuasion lead them to start thci~ children in right habits in the first years of life, something will have been achieved. Doubtless those responsible for Ihe maternal and claild health services will take the point.
By a rdectslon o[ the Council" Public ltealth "" will in future be published once ever), secorut month instead of monthly and the first number to appear under the new arrangement will be the November issue. The bi-monthty numbers wilt be tm~reased m size to 64 pages and this increase wdl enable longer and tess con. densed articles t o ibepublished. When the journal l was publL~hed monthly the bMitorial C~omrnittee wa~ much /~ampeFedby ~haVtng to condense arac/e.¢ w r i t into the ,t,natt amount of spa~ avaitablel Now that greater elasticity ls possible the Society wiil be in pos~ssion of a journal capable of doing fu// justice to all a~pects of preventive medicine.
HEALTH
The Journal of the Society of ,Medical Officers of Health ~..,,.._:
:
:
:. . . . . .
.
~-
gol. LXXIV DENTAL
~ . q : _
: :: t, !,%L.:.
:==::=:g:
,
,
l
~
,
.
~
. . . .
-------:............ %
September 1960 CARIES--TREATMENT PREVENTION ?
2!!!
LL
No. 12 OR
THE sad plight of the School Dental Service is receiving plenty of attention in all quarters but there is little sign that things are likely to improve in the near future. It is indeed unrealistic to hope for substantial improvement in the recruitment of dental officers. With an overall shortage of dentists the financial inducements of general dental practice are certain to outweigh |he highest inducements which local authorities will be able to offer, so that the public services will continue to depend on the minority of dentists who find more reward in work among children than in the size of their salary cheques and those who for various reasons feel that clinic work for fixed hours is less strenuous than general dentistry. We await with interest the results of present experiments with such auxiliary and ancillary workers as de~ntal hyglemsts. If the hopes of enthusiasts are reatiscd, the employment of such workers may make a material contribution to the effectiveness of school dental work, though it cannot provide a complete solution to the problem. There is, however, another side to the question. If it is impossible to provide adequate treatment of d~tal caries in children, should not the public health service turn its attention to what is, after all, the basis of its philosophy, prevention ? There are two methods of approach. One is to do whatever can b¢ done to make teeth more resistam to caries and the other is to reduce, the intensity of attack by cariogcnia agents. The first of these aims is being diligently pursued through fluoridation. True, the diligence is at the moment limited. We are quite satisfied that the case for fluoridation of public water supplies is strong and equally satisfied that the case against it is ~v~k. There i~ abundant evidence that people who have been brought up in places where nature has already provided the wat~ supplies with the right content of fluoride are certainly no worse offin any aspect of health, so that atthe lowest estimate general fluoridation will certaJnlydo no harm and will probably do much good. It is a matter for regret:that admirable efforts at the periphery are rmt yet receiving total support at the centre. •
/
442
PUBLIC
HEALT}t
VOL. LXXIV
NO,
12
In the meantime, evidt,mce is steadily a~..-umulating on the way in which caries starts and develops. There are still a n~amber of qu~tions unanswered, but the paper by Mr. Swallow which we p~tbtish in this issue gives a most admirable summary of present knowledge and at the very least he convinces us that the eating of sweets and sweet snacks between meals is an important-perhaps the most important--factor in the production of caries. It is a timely warning, becau~ in recent months the School Health Service Group and the Dental Group of the SociCtryhave l-menmuch exercised about the way in which the ~hools, which ought to be pointing the way to dental health, are often positively encouraging children ~o hasten along the road to dental ruirl. The school "tuck shop" has economic value. As Mr. Swallow says, its profits help the school to buy useful and important items of equipment, a strong inducement to the teachers. The manufacturers of biscuits see in it an attractive market for their wares. Not only does it sell biscuits but it encourages the formation of a taste for biscuits. In developi0g this market the manufacturers have shown at times a singular lack of scruple. One firm circulated tq~schools a letter suggesting that it had been proved that many children.were unable to digest milk unless it was accompanied by some such solid food as biscuits. Since no nutritionist of standing would endorse this, various ~hoo! medical officers challenged the firm to produce its evidence. The reply naively admitted that there was no proof but said that some children did not like cold milk u n i t s biscuits were available as wellt in the face of this kind of thing" we are glad to know that steps are being taken to arrange for representatives of the Society to meet representatives of the N.U.T. to discuss the subject, We hope that the discussion will go somewhat further than the consideration of biscuits, because considerable positive effort in dental health education is needed as well as the mere restriction of carbohydrate consumption during school hours. Mr. Swallow's mention of experiments in the education of expectant mothers is encouraging. Pregnancy is a tim~ when mothers are ready to listen r o u n d to take advice and if education and persuasion lead them to start thci~ children in right habits in the first years of life, something will have been achieved. Doubtless those responsible for Ihe maternal and claild health services will take the point.
By a rdectslon o[ the Council" Public ltealth "" will in future be published once ever), secorut month instead of monthly and the first number to appear under the new arrangement will be the November issue. The bi-monthty numbers wilt be tm~reased m size to 64 pages and this increase wdl enable longer and tess con. densed articles t o ibepublished. When the journal l was publL~hed monthly the bMitorial C~omrnittee wa~ much /~ampeFedby ~haVtng to condense arac/e.¢ w r i t into the ,t,natt amount of spa~ avaitablel Now that greater elasticity ls possible the Society wiil be in pos~ssion of a journal capable of doing fu// justice to all a~pects of preventive medicine.