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Diet Analysis of One Hundred and One Periodontoclasia Cases*
Tishler— D iet Analysis o f Periodontoclasia Cases P e lv ic o r g a n s : Sections th rou gh the b la d der, prostate, sem inal v esicles, v a s deferen s, testes and ep id id y m id e s present the norm al structure. N eck o r g a n s : T h e tonsils are sm all. T h e r e is no e v id e n ce o f old o r recent inflam m ation o f the to n silla r tissues. Sections through the laryn x, esop h a gu s and th y roid a p p e a r n or m al. Sections th rou g h the la cera ted gum in the righ t up p er ja w sh o w a superficial area o f necrosis, w ith an acute inflam m ation o f the gum s m an ifested by the p oly m o rp h o n u clea r leukocytes. T h e r e is distention o f the b lood vessels and lym phatics in these areas. In testin es: N o h isto lo g ic ch an g es are noted in the sections o f the intestines. B lo o d v e sse ls: T h e r e are slight subintim al thickenings in the sections through the aorta. C ra n ia l c a v ity : T h e brain , m eninges, n erv es an d b lood vessels are exam in ed . (F ig . 3.) Sections through the abscess o f the right tem poral lobe sh ow recent necrosis, n o at tem pt at fo rm a tio n o f the w a ll about the abscess an d the presence o f a la rg e num ber o f p h a g o cy tic cells o f the “ g itte rze lle n ” type,
1037
w h ich are a ctiv ely p h a g ocy tic. N o occlu d ed b lo o d vessels are seen n ea r the abscess. T h e n etw ork o f fibrin, p olym orp h on u clea r leu kocytes an d red b lo o d cells coats o v e r the m eninges on the righ t side. T h e sections taken through the g a sseria n g a n g lion and bran ch es sh ow that there is an acute inflam m a to ry reaction in v o lv in g this g a n g lion . It has ap p aren tly exten ded fr o m the m a x illa ry tissue a lon g the sheath o f the m a x illa ry n erv e an d the sheath is disten ded w ith an acute inflam m atory reaction . A sim ilar reaction in v o lv e s the tissues about the le ft orbit an d about the hypophysis. T h e r e is no m icr o sco p ic ev id en ce of in v olv em en t o f the c a v e rn o u s sinus on either side. C on clusión ,— T h e sequence o f events as tra ced at n ecrop sy w a s essen tially as f o l lo w s : osteom yelitis o f the u p p er righ t m a x i l l a ; acute m a x illa ry sin u sitis; extension o f in fe ctio n a lo n g the righ t m a x illa ry n erv e to the righ t sem ilunar g a n g lion , w ith resulting fibrin opu ru lent Staphylococcus aureus m en in gitis an d abscess o f the righ t tem p oral lobe o f the cerebru m .
DIET ANALYSIS OF ONE HUNDRED AND ONE PERIODONTOCLASIA CASES* By BENJAM IN TISHLER, D.M.D., Boston, Mass. H E follow in g report is an analysis of diet lists of a group of periodon toclasia cases taken from m y prac tice, with a few from the clinic of the Harvard D ental School. T h e purpose o f the analysis was to ascertain, with the limited material at hand, any facts which might be of interest. Each patient was requested to record carefully the amount o f all food and drink consumed for an entire week, whether at or between meals, and such extra items as candy, cakes and sodas consumed between these
T
* R e a d b e fo re the A m e rica n A c a d e m y o f P erio d o n to lo g y , Oct. 21, 1927, as a p ortion o f the R e p o rt o f the C om m ittee on Scientific In v estig ation .
Jo u r. A . D . A ., Jun e, 1929
periods. A s each list was presented, doubtful items were checked up in the presence o f the patient and any errors corrected. A s a consequence, many lists were eliminated as unsatisfactory, and the final analysis was made from 101, gathered over a period o f tw o years, rep resenting food eaten at all seasons, so that the entire list comprised more than 2,100 meals. T h e patients’ ages varied from 18 to 63 years, and the lesions pres ent from an incipient to a markedly ad vanced type of periodontoclasia, with or w ithout visible pus discharge. It should be understood that while the w ork has been closely carried out as regards the analysis, the amounts o f the
1038
T h e Journal of the American D en tal Association T a b le
F ood M a t e r ia l
I.— L i s t o f F o o d s a n d T h e i r V a l u e s *
W hole P o r t io n
O n e-H a lf P o r t io n
O ne-F ou rth P o r t io n
A.
M e a t , in c lu d in g lam b, veal, p ou l try and pork with the e x c e p t io n o f bacon
A m ou n t served at dinner: protein, 20 gm . (calories, 200 to 400)
A m o u n t se rv e d at luncheon, breakfast or supper, or at dinner as ingredient o f m eat pie, on toast; or other meat dish.
A m o u n t serv ed at breakfast, luncheon o r s u p p e r as i n g r e d ie n t o f h a sh , chicken on toast or other m eat dish
B.
F is h , in c lu d in g sea foods
P rotein, 20 grams (calories, 100 to 200)
See A
See A
C.
B a con or salt pork
A m o u n t s e r v e d as c h ie f protein dish at any m eal: protein, 4 gm . (calories,
A m o u n t s e r v e d w ith eggs, liver or other food
100) D . M ilk
1 glass: protein, 7 gm . (ca l ories, 150)
M ilk on c e re a l o r as prom inent ingredient o f s u c h d is h e s as m ilk toast and m ilk soup
A s one o f m any in gredients, as in cus ta rd or crea m ed vegetables
E.
E ggsf
1 egg: protein, 6 gm . (ca l ories, 75)
A s prom inent ingrediient (exam ple, creamed
N o n p r o m in e n t in g r e d i e n t , as o f sponge cake or spin ach with egg
F.
Cheese
C h ie f protein dish at any m eal, such as cottage cheese for luncheon: p rotein, 12 gm . (calories, 200)
In cheese sandwich
A s used in m acaroni and cheese or served w ith pie
G . W h o le grain cereal food s
SeeH
See H
SeeH
H. R e fin e d products
A s breakfast fo o d or any form o f rice or m acaroni w ith m eat or as ingredient o f bread (am ount unspeci fied ), cake or tw o-crust pie; crackers when served w ith m ilk, as ch ie f dish o f m eal: p rotein, 3 gm . (cal ories, 100)
One slice o f bread, or as ingredient o f one-crust pie or o f crackers served with soup
cerea l
I.
P ota toes (Irish)
1, m edium -sized: protein, 3 gm . (calories, 100)
A s ingredients o f hash o r other m eat dish
J.
D ried beans
A s ch ie f protein dish o f d in n e r : p r o t e in , 12 g m . (calories, 200)
A s ch ie f protein dish at lunch
K.
F resh sh elled le gum es
A s side dish] with m e a t: pro tein, 5 gm . (calories, 100)
A s ingredient o f salads, etc.
A s in g r e d ie n ts o f soup or other m eat dish
* A r r a n g e d by C a ro lin e L. H unt, associate sp ecia list in f o o d an d nutrition, B ureau o f H om e E con om ics, D ep artm en t o f A g ricu ltu re , W a sh in g to n , D . C., f o r the author. ■¡•Consider scram bled eggs o r om elet a d ou ble p ortion .
1039
Tishler— D iet Analysis o f Periodontoclasia Cases T a b le
F ood M a t e r ia l L.
Spinach
1.— ( C o n t i n u e d )
W hole P o r tio n
O ne -H a lf P ortion
A s side dish w ith m e a t: p ro tein, 1 gm . (calories, 25)
A s ingredient o f soup, etc.
M . Salad v egetables
W henever appearing on the bills o f fare: protein, 1 gm . (calories, 10)
N . T om a toes
As salad or side dish with m eat: protein, 1 gm . (cal ories, 25)
A s ingredient
0.
V egetables other than those under K , L , M and N
As side dish with m eat: pro tein, 2 gm . (calories, 50)
A s ingredient o f salad o r any such dishes as carrots and peas
P.
Citrus fruits
1 orange o r grape fruit: p rotein, 1 gm . (calories, 80)
A s ingredient o f salads, desserts, etc.
A s se rv e d u n c o o k e d fo r breakfast o r dessert: pro tein, 1 gm . (calories, 80)
A s ingredient o f cooked d ish es, su ch as ap p le sauce, pies and salads
Q. Other fresh fruits
R.
D ried fruits
Same as Q
See Q
S.
B utter
W hen served w ith an un specified am ount o f bread, 75 calories
W hen served w ith one slice o f bread or with one helping o f cooked vegetables
T.
O t h e r fa ts th a n bu tter, including oil and lard
A s ingredient o f tw o-crust pie or rich pastry or salad, 100 calories
A s in g red ien t o f on ecrust pie
U.
Cream {
O n breakfast cereal or des sert, 100 calories
In tea or coffee or m inor ingredient as whipped cream on pudding
V.
Sugar**
In coffee, 50 calories
O ne -F ourth P ortion
See Q
£ Ice crea m p ro v id e s a d ou ble p ortion . * * A s in g re d ie n t o f cake o r pie, 2 p o rtio n s; can d y , any am ount, 4 portions.
various nutrients on which it was based were computed from a standard devised by the analyst, from the portions of food and drink furnished by the patient. A c curate amounts could only have been obtained by weighing all solids and meas uring all liquids before eating or drink ing and the same process repeated with such as may have remained unconsumed, the difference having been the net amount
actually ingested. This, o f course, could not have been done under the circum stances. H ow ever, because o f the inter est shown by the patients and the care taken by them in recording the various items, it is felt that some interesting data have been obtained. T h e computation and analysis was made by M iss Caroline L . Hunt, associ ate specialist in food and nutrition of the
1Q40
T h e Journal of the Am erican D en tal Association
T a b l e 2 .— S t a n d a r d s U s e d b y C . L . H u n t f o r J u d g i n g B i l l s o f F a r e S u b m i t t e d b y A u t h o r
F or a M an
R e q u ir e d N u t r ie n t s
P rotein P rotein, efficient ( o f animal fo o d s , p e a n u ts an d s o y beans) C alcium Iron
V itam in A
V itam in B V itam in C
R oughage F uel value
A t least 75 gm . A t least 45 gm .
F o r a W om an
A t least 60 gm . A t least 40 gm .
0.67 gm . 0 .6 gm . (Judged chiefly by am ount o f m ilk and cheese) 15 m g. 12 m g. (Judged chiefly b y p rop ortion o f m eat, eggs, vegetables, fruits and whole-grain cereals) (T h is is considered adequate i f from 300 to 400 calories are obtained from m ilk, eggs, cream o r green-leaf vegetables, and butter is regularly used) (A d equ ate i f from 1,000 to 1;200 calories are p rovided by other food s than fats, sweets and refined cereals) (A dequ ate i f citrus fruits, tom atoes or raw green-leaf vegetables are regularly used; on ly alternative, abundant use o f p otatoes or o f fresh fruits in general) (A t least 500 calories should be p rovided b y whole-grain cereals, v eg e tables and fruits) 3,000 calories________________________2,500 calories______________________
T a b l e 3 .— F o r m U s e d S h o w i n g F i n a l A n a l y s i s o f D i e t L ist s ADEQUACY OF DIETS
Ju dg ed fr o m bills o f fa r e fo r on e w e e k (a m ou n ts not stated) : R ep ort by C. L. H unt, U. S. D ep artm ent o f A g ric u ltu r e , f o r the author.
C a s e N o _________ _____________________ N a m e . R e p o r t *
P rotein (estim ated g ra m s)................ P rotein, efficient (estim ated grams) C alciu m ................................................... Ir o n ........................................................ .. V itam in A .............................................. V itam in B .............................................. V itam in C .............................................. R ou g h a g e ................................................ W a te r....................................................... * S ignifican ce o f signs u s e d : l o w ; ?, n ot reported.
a d e q u a te ; -j------ , p ro b a b ly a d e q u a te ; — , l o w ; -------- , v ery
Tiskler— D iet Analysis of Periodontoclasia Cases S a m p l e D i e t L is t (N o . 70) a s S u b m i t t e d f o r A n a l y s i s *
T a b l e 4 .— A
DINNER
BREAKFAST
1 slice toast, 1 cup coffee w ith su gar and cream . D IN N E R
1 cup tom ato bisque, 1 slice roast lam b, 3 tablesp oon s squash, 1 sm all sw eet potato, 1 stick celery, 1 slice je lly , 2 tablespoons ch ocolate ice crea m , 1 slice cake, 1 cup tea. SU PPER
F ricassee o f chicken (sm a ll p o r tio n ), 2 tablesp oon s peas, 1 tablesp oon m ashed p o tato, 2 tablesp oons In d ia n p u d d in g w ith w h ip p e d cream . SUPPER
C rabm eat salad, 3 lettuce leaves, 3 h e a p in g tablesp oon s cra bm eat w ith m ayonnaise, 3 rolls, 1 cup coffee, eclair.
2 tablesp oon s baked beans, 2 tablespoons p icca lilli, 1 slice b r e a d and butter, 1 slice apple pie, 1 cup tea, 5 o r 6 chocolates. 12
p.
1041
12 P. 2 toasted muffins w ith
M .
M.
1 cup
coffee,
1 ap p le.
BREAKFAST
2 g ra h a m cra ck ers w ith cheese, 1 cup coffee.
1 slice
toast,
1 cup
coffee.
b r e a k f a s t
DINNER
1 slice toast, 1 cup co ffee. D IN N E R
1 cup soup, 1 slice c o ld lam b w ith hot g r a v y , 2 tablesp oons spinach, 1 slice squash pie, 1 cup tea.
1 cup soup, 1 lam b chop, 2 tablespoons cre a m e d ca u liflow er, 1 tablespoon m ashed p o tatoes, 2 tablesp oon s p ep p er relish, 2 ta b le spoons b rea d p u d d in g w ith h a rd sauce, 1 cup tea, 2 sw eet crackers.
SU PPER
1 e g g (J n o rn a y cheese d ressin g on to a st), 1 slice p ineap p le, 2 su ga r cook ies, 1 cup tea. 1
A . M .
1 je lly and cheese sa n d w ich , 1 cup coffee, y2 p ou n d candy.
SUPPER
2 slices bolog n a , 1 slice b rea d w ith butter, 1 tablesp oon ketchup, 1 cup tea, 2 bunches C o n co rd g rapes, 1 slice fu d g e cake, % p ou n d cand y.
12 P. 1 doughnut, 1 cup
BREAKFAST
1 slice toast, 1 cup coffee.
SU PPER
1 F ra n k fu rter, 2 tablespoons potato salad, 1 slice b r e a d and butter, 2 tablespoons c a r a m el cu sta rd w ith cream , 1 cup coffee. 12
p .
coffee.
break fast
1 slice
D IN N E R
Steak (v e r y little ), 2 tablespoons fr ie d onions, 1 tablesp oon m ashed potatoes, lettuce (2 le a v e s) and tom ato (3 slices) salad, F ren ch dressing, 2 tablespoons caram el cus ta rd .
M.
toast,
1 cup
coffee.
DINNER
1 slice fr ie d codfish, 2 tablespoons crea m ed carrots, 1 tablespoon m ashed potatoes, 2 tablespoons p icca lilli, 1 saucer o f sliced ora n g e s and ba n an as w ith w h ip p ed cream , 1 slice cake, 1 cup tea. su pper
1 sm all
p ortion sca llop ed fish, 2 slices b r e a d an d butter, 1 cup tea, 1 sm all slice squash pie.
M .
1 cup coffee, 1 doughnut, 12 chocolates.
12 p . m .
1 doughnut, 1 cup
1 slice toast, 1 cup coffee. * N o t e the excess o f sw e e ts; patient o v e rw e ig h t.
coffee.
BREAKFAST
BREAKFAST
1 slice
toast,
1 cup
coffee.
1042
T he Journal o f the American D en tal Association T a b l e 4 .— (
C on tin ued)
D IN N E R
12 P. M .
1 cup chicken soup, 1 bre a d e d p ork chop w ith tom ato sauce, 1 tablesp oon m ashed p o tato, 2 le a v e s o f lettuce w ith F ren ch dressing, 1 la rg e slice lem on m erin gu e pie, 1 cup tea.
T h e patient (M r s . F. P . B .) is v e r y fo n d o f p ep p er relish and p icca lilli, drinks from
SU P P E R
2 tablesp oon s baked beans, 3 b a k in g p o w d er biscuits, 1 cup tea, 2 tablesp oon s p icca lilli, 1 slice ap p le pie.
T able
2 g ra h a m cra ck ers w ith cheese, 1 cup coffee. A lm o s t one p ou n d o f candy.
5.— F i n a l A
F IN A L T A B U L A T IO N
6 to 8 glasses w a ter a d a y but n ev er w ith m eals and uses plenty o f butter in cook in g and se rv in g o f v egeta bles.
n a l y s is
OF A N
o f
D i e t L i s t N o. 70
IN D IV ID U A L D IE T LIST
A d e q u a cy o f diets ju d g e d fr o m bills o f fa r e f o r on e w e e k (a m ou n ts not stated) by C. L . H unt, U . S. D ep artm en t o f A g ricu ltu re C a s e N o . 70________________________________________________________ _____ ________ N a m e
M r s . F. P . B.
R e p o r t *
P rotein (estim ated grams)
—
P rotein efficient (estim ated grams)
—
Calcium
—
Iron
-
V itam in A
—
V itam in B
—
Vitam in C
—
R oughage
—
W ater
+
_
*Significance o f signs used: + , adequate; + _ , probably a d e q u a te ;__ , l o w ; ___, v ery l o w ; _____ , extrem ely low ; ?, not reported.
Bureau of Hom e Economics, Depart ment of Agriculture, W ashington, D . C., who employed a standard in grams for the various required nutrients in whole, half and quarter portions, both for a man and for a woman. From these, an analysis was prepared for each diet list using the terms, adequate, probably adequate, low and very low as the re sults indicated. T h e recorded nutrients were protein,, protein efficient, calcium, iron, vitamins A, B and C, roughage
and liquids. It was originally intended to include iodin, phosphorus and calories, but as the question o f the influence of iodin is still uncertain, it was omitted. M iss H unt also decided that the data on phosphorus were too insignificant to be included. Calories, on the other hand, are affected by the amount of sugar and fats in the food and also by the amount of butter, oil or syrups used. Because these foods are so concentrated and are used in varying amounts, it seemed use-
2
Cases Tishler— Diet Analysis of Periodontoclasia
Pro.
P ro. E. Ca.
+
Ir.
V itam in s
R ou g h W ater age
T a b l e 6.— D i e t A n a l y s e s , A g e s E i g h t e e n t o T h i r t y Y e a r s
Sex ---
+
Clinical Sym ptom s -----
General bu t early
C.
A ge
+
B.
N o.
+
A.
N am e F
+
18
+
104
+
L . O ...............................
—
+
A dvanced
+
L oca lly marked
A dvanced + -
M oderately advanced, with suppuration
—
+
—
-----
— —
—
— +
+
—
+
---
+
---
M oderately advanced L . S. lateral involved
---
+
—
-
—
—
Early
—
—
---
+
-----
+
+
+
—
+
+
+
—
+
L oca lly advanced w ith suppuration
F
+
_
M +
+
23 F
+
21
M
_
13
24
24
---
_ _
89 79
_
D . K ..............................
68
_
T . L ...............................
F. K ...............................
_ __
+ -
M . B . . . „ ......................
F
-
F
+
25 F
+
Generally advanced, with suppuration
_
V ery advanced, with suppuration
+
__
—
A dvanced
-
+
—
+
+
__
+
+
— +
+
+
—
+
+
M oderately advanced
_
+
+
+
_ +
—
+
+
_ +
---
+
—
_ —
+
+
-
+
+
M oderately advanced, w ith suppuration
A d vanced, with suppuration
-
+
-----
V ery advanced, with suppuration
A d vanced, w ith suppuration
+
_ +
-
+
—
+
—
-
+
—
---
+
-
—
—
_
-
+
+
_
+ -
—
+
—
_ _
-
25
F -
78
26
26
+
48 71
F
F
G. C ...............................
31
27
26
H . A ...............................
8
---
E . G .............................
L . K ...............................
41
-
-
—
....................
M. C
L . C ................................
+
+
F
—
F
M
—
F 28
F
28
29
F
28 111
30
56
E . C ...............................
73
30
24
J - B ................................
98
100
M
M . Q .............................
M . G .............................
30
F
D . M .............................
H . M .............................
86
30
—
A . B ...............................
30
+
E . G ...............................
57
55
113
66
82
61
S. K ...............................
G . M .............................
A . P ...............................
J . G ...............................
F
50
7
23
M . K .............................
50
2
16
F . A ...............................
L . H ...............................
49
50
50
50
37
T. H
J .A
69
F
52
93
..................... ....................
F
52
53
F
M
F
M
F
—
— _ + _
+
_
+
—
+
+
+
+
+
—
_
—
+
—. _ —
+
+
—
+
+
—
+
+
+
-----
—
—
+
—
A.
+
+
+
—
—
+
+
+
+
—
+
•+
—
B.
+
—
+
—
+
+
+
C.
V itam ins
+ +
_
+ +
+
+
+
- + + - + + — — — — + — — — __ _ — + — + — — — — — + — — + - — —
__
+
- + — + — — + - — + - + — — + ? — —
+
+
—
_
Ir.
?_ ? —
—
?
_
—
+
—
P ro. E. Ca.
4-
-
_ __
Pro.
+
+
+
+
+
-
—
—
+
—' _ +
+
— — —
+
+
+
A dvanced
—
+
-----
A d va n ced, with suppuration
A dvanced
A d va n ced, w ith suppuration
A dvanced
M oderately advanced
A dvanced
— +
A dvanced
M oderately advanced
A dvanced
V ery advanced, with suppuration
A dvanced
_
+
+
+
A dvanced
A dvanced
+
V ery advanced, with suppuration
+
A dvanced, with suppuration
V ery advanced, with suppuration
A d va n ced, w ith suppuration
M oderately advanced
A dvanced
Clinical S ym ptom s
—
+
+
+
+
+
R ough W ater age
The Journal of the American
M
M
53
51
M
65
M
54
109
55
M
M
M
M
.................... I. S ..................... E . D .................... R . R .................... E. G .................... B. C ....................
P. 0
40
59
81
E . C ...............................
57
60
52
C . F ...............................
F
F
60
18
E . H ..............................
F
F
62
62
99
96
E . K ..............................
Sex
A ge
G . B ...............................
N o.
N ame
T a b l e 7 .— D i e t A n a l y s e s * A g e s F o r t y - N i n e t o S i x t y - T w o Y e ' r ?
1044 Dental Association
1045
Tiskler— D iet Analysis o f Periodontoclasia Cases less to consider them except as they a f fected the rest o f the diet. A s an ex ample, when butter, sugar and such dishes were used in large amounts, it ^vas presumed to indicate that the diet was overabundant or deficient in essential nutrients such as protein, minerals and vitamins. T h e final computation o f the lists dis closed one conclusive fact, i. e., that a very great proportion of the patients, both young and old, ate a poorly balanced diet, in some cases, alarmingly so. M any T able
8 .— F i n a l T a b u l a t i o n
balanced diet; in other words, ninetyseven individuals were found to have eaten unwisely in one or more o f the recorded nutrients. Nine showed a defi ciency in every item (a 100 per cent un balanced d ie t). Seven were deficient in from five to eight items, with the bal ance, necessary to complete the nine, recorded as probably adequate only (n ot an adequate amount in the entire num ber of nutrients). T h e balance o f the diet lists varied from one to nine ade quate items, and the latter group, which
D ie t A n a l y se s o f O n e H u n d r e d a n d
O ne
P e r io d o n t o c l a s ia
C ases W it h P o c k e t F o r m a t io n
P ro b a b ly Q u e s tio n V ery able A dequate A dequate A d equ a te
L ow
V ery L ow
E xtrem ely L ow
Protein
40
10
47
3
1
P rotein E f.
46
9
42
3
1
Calcium
20
7
3
62
9
Iron
45
10
3
43
V itam in A .
24
10
4
60
3
V itam in B .
51
8
41
1
V itam in C .
59
6
34
1
R oughage
43
12
45
1
W ater
31
1
52
12
1
women gave the information that they were accustomed to restrict the amount and kind of food eaten to avoid an ac cumulation o f surplus flesh, a condition which, as far as could be determined, did not affect the men, whose diet analyses, by the way, disclosed an equally marked deficiency in many cases. In computing the averages of the various elements, it was found that three items of the nine already referred to were conspicuously lo w : calcium, vitamin A and liquids (m ostly w a ter). O f the 101 recorded cases, about 96 per cent showed an un
4
1
represented those w ho ate a balanced diet, numbered but four (o f the original 101 exam ined). In order that a definite idea o f the diets as a whole may be obtained, tw o groups of opposite age extremes have been chosen and recorded. O ne repre sents lists submitted by younger patients ( nineteen in num ber) whose ages ranged from 18 to 30 years. These showed a general nutrient deficiency, with but one exception, and this diet list was adequate in all items. T h ree lists were deficient in all nutrients, one in all but tw o and an
1046
T h e Journal o f the American D en tal Association
other in all but four, all of which were recorded as adequate. T h e clinical symptoms of both groups varied from an incipient to a markedly advanced type, with the advanced predominating. T h e other group of twenty, chosen from the opposite age extreme (4 9 to 6 3 ) dis closed a similar general diet deficiency. In fact, the lists of both groups could have been reversed without appreciably affecting the result. T h e balance o f the remainder of the lists, which completed the 101 chosen, i. e., those between 30 and 49 years, showed the same general deficiency and symptoms as the tw o groups just referred to, which would lead one to believe that, as far as the experiment is concerned, diet is not a conclusive etiologic factor in periodonto clasia when individuals are considered, but when the 101 cases are examined collectively, one cannot overlook the general lack of the calcium and vitamin A intake, and also that of water, which is so important in fecal elimination and bears a direct relationship to intestinal toxemia, long recognized as an etiologic factor in periodontoclasia. O f the tw o groups, just reported, it was hoped that the younger would offer the more promising material for consid eration because the periodontal disinte gration had its inception at a more recent date than in the case o f the older groups, but, as has been observed, it offers no conclusive results on which a positive
statement can be made. It would seem, therefore, that more definite data could be obtained by an examination of the diets of still younger patients, of high school age or younger, if found neces sary. T h e advantage of this is obvious, because it is apparent that a knowledge of the character o f the diet eaten during the formative period of life, when early periodontal lesions have their inception, is most important. It cannot be disputed that many persons make radical changes in their diet as soon as they are permit ted to choose it, as in adult life, thus making the task of relating diet to perio dontoclasia a difficult one. It is safe to assume that this could be determined with more certainty during childhood or youth, for the closer that the etiology (deficient diet) and the possible effect (periodontoclasia) can be brought to gether, the more definite should be the findings which w ill prove their exact re lationship. It is hoped that further w ork o f this kind w ill be undertaken, because those familiar with dietary problems who have been consulted are of the opinion that such experiments offer promising results. A suggestion is hereby offered to those w ho may desire to undertake w ork of this kind that a dietitian be enlisted to supervise the accumulation of the diet lists, because of her expert knowledge in such matters.
1037
w h ich are a ctiv ely p h a g ocy tic. N o occlu d ed b lo o d vessels are seen n ea r the abscess. T h e n etw ork o f fibrin, p olym orp h on u clea r leu kocytes an d red b lo o d cells coats o v e r the m eninges on the righ t side. T h e sections taken through the g a sseria n g a n g lion and bran ch es sh ow that there is an acute inflam m a to ry reaction in v o lv in g this g a n g lion . It has ap p aren tly exten ded fr o m the m a x illa ry tissue a lon g the sheath o f the m a x illa ry n erv e an d the sheath is disten ded w ith an acute inflam m atory reaction . A sim ilar reaction in v o lv e s the tissues about the le ft orbit an d about the hypophysis. T h e r e is no m icr o sco p ic ev id en ce of in v olv em en t o f the c a v e rn o u s sinus on either side. C on clusión ,— T h e sequence o f events as tra ced at n ecrop sy w a s essen tially as f o l lo w s : osteom yelitis o f the u p p er righ t m a x i l l a ; acute m a x illa ry sin u sitis; extension o f in fe ctio n a lo n g the righ t m a x illa ry n erv e to the righ t sem ilunar g a n g lion , w ith resulting fibrin opu ru lent Staphylococcus aureus m en in gitis an d abscess o f the righ t tem p oral lobe o f the cerebru m .
DIET ANALYSIS OF ONE HUNDRED AND ONE PERIODONTOCLASIA CASES* By BENJAM IN TISHLER, D.M.D., Boston, Mass. H E follow in g report is an analysis of diet lists of a group of periodon toclasia cases taken from m y prac tice, with a few from the clinic of the Harvard D ental School. T h e purpose o f the analysis was to ascertain, with the limited material at hand, any facts which might be of interest. Each patient was requested to record carefully the amount o f all food and drink consumed for an entire week, whether at or between meals, and such extra items as candy, cakes and sodas consumed between these
T
* R e a d b e fo re the A m e rica n A c a d e m y o f P erio d o n to lo g y , Oct. 21, 1927, as a p ortion o f the R e p o rt o f the C om m ittee on Scientific In v estig ation .
Jo u r. A . D . A ., Jun e, 1929
periods. A s each list was presented, doubtful items were checked up in the presence o f the patient and any errors corrected. A s a consequence, many lists were eliminated as unsatisfactory, and the final analysis was made from 101, gathered over a period o f tw o years, rep resenting food eaten at all seasons, so that the entire list comprised more than 2,100 meals. T h e patients’ ages varied from 18 to 63 years, and the lesions pres ent from an incipient to a markedly ad vanced type of periodontoclasia, with or w ithout visible pus discharge. It should be understood that while the w ork has been closely carried out as regards the analysis, the amounts o f the
1038
T h e Journal of the American D en tal Association T a b le
F ood M a t e r ia l
I.— L i s t o f F o o d s a n d T h e i r V a l u e s *
W hole P o r t io n
O n e-H a lf P o r t io n
O ne-F ou rth P o r t io n
A.
M e a t , in c lu d in g lam b, veal, p ou l try and pork with the e x c e p t io n o f bacon
A m ou n t served at dinner: protein, 20 gm . (calories, 200 to 400)
A m o u n t se rv e d at luncheon, breakfast or supper, or at dinner as ingredient o f m eat pie, on toast; or other meat dish.
A m o u n t serv ed at breakfast, luncheon o r s u p p e r as i n g r e d ie n t o f h a sh , chicken on toast or other m eat dish
B.
F is h , in c lu d in g sea foods
P rotein, 20 grams (calories, 100 to 200)
See A
See A
C.
B a con or salt pork
A m o u n t s e r v e d as c h ie f protein dish at any m eal: protein, 4 gm . (calories,
A m o u n t s e r v e d w ith eggs, liver or other food
100) D . M ilk
1 glass: protein, 7 gm . (ca l ories, 150)
M ilk on c e re a l o r as prom inent ingredient o f s u c h d is h e s as m ilk toast and m ilk soup
A s one o f m any in gredients, as in cus ta rd or crea m ed vegetables
E.
E ggsf
1 egg: protein, 6 gm . (ca l ories, 75)
A s prom inent ingrediient (exam ple, creamed
N o n p r o m in e n t in g r e d i e n t , as o f sponge cake or spin ach with egg
F.
Cheese
C h ie f protein dish at any m eal, such as cottage cheese for luncheon: p rotein, 12 gm . (calories, 200)
In cheese sandwich
A s used in m acaroni and cheese or served w ith pie
G . W h o le grain cereal food s
SeeH
See H
SeeH
H. R e fin e d products
A s breakfast fo o d or any form o f rice or m acaroni w ith m eat or as ingredient o f bread (am ount unspeci fied ), cake or tw o-crust pie; crackers when served w ith m ilk, as ch ie f dish o f m eal: p rotein, 3 gm . (cal ories, 100)
One slice o f bread, or as ingredient o f one-crust pie or o f crackers served with soup
cerea l
I.
P ota toes (Irish)
1, m edium -sized: protein, 3 gm . (calories, 100)
A s ingredients o f hash o r other m eat dish
J.
D ried beans
A s ch ie f protein dish o f d in n e r : p r o t e in , 12 g m . (calories, 200)
A s ch ie f protein dish at lunch
K.
F resh sh elled le gum es
A s side dish] with m e a t: pro tein, 5 gm . (calories, 100)
A s ingredient o f salads, etc.
A s in g r e d ie n ts o f soup or other m eat dish
* A r r a n g e d by C a ro lin e L. H unt, associate sp ecia list in f o o d an d nutrition, B ureau o f H om e E con om ics, D ep artm en t o f A g ricu ltu re , W a sh in g to n , D . C., f o r the author. ■¡•Consider scram bled eggs o r om elet a d ou ble p ortion .
1039
Tishler— D iet Analysis o f Periodontoclasia Cases T a b le
F ood M a t e r ia l L.
Spinach
1.— ( C o n t i n u e d )
W hole P o r tio n
O ne -H a lf P ortion
A s side dish w ith m e a t: p ro tein, 1 gm . (calories, 25)
A s ingredient o f soup, etc.
M . Salad v egetables
W henever appearing on the bills o f fare: protein, 1 gm . (calories, 10)
N . T om a toes
As salad or side dish with m eat: protein, 1 gm . (cal ories, 25)
A s ingredient
0.
V egetables other than those under K , L , M and N
As side dish with m eat: pro tein, 2 gm . (calories, 50)
A s ingredient o f salad o r any such dishes as carrots and peas
P.
Citrus fruits
1 orange o r grape fruit: p rotein, 1 gm . (calories, 80)
A s ingredient o f salads, desserts, etc.
A s se rv e d u n c o o k e d fo r breakfast o r dessert: pro tein, 1 gm . (calories, 80)
A s ingredient o f cooked d ish es, su ch as ap p le sauce, pies and salads
Q. Other fresh fruits
R.
D ried fruits
Same as Q
See Q
S.
B utter
W hen served w ith an un specified am ount o f bread, 75 calories
W hen served w ith one slice o f bread or with one helping o f cooked vegetables
T.
O t h e r fa ts th a n bu tter, including oil and lard
A s ingredient o f tw o-crust pie or rich pastry or salad, 100 calories
A s in g red ien t o f on ecrust pie
U.
Cream {
O n breakfast cereal or des sert, 100 calories
In tea or coffee or m inor ingredient as whipped cream on pudding
V.
Sugar**
In coffee, 50 calories
O ne -F ourth P ortion
See Q
£ Ice crea m p ro v id e s a d ou ble p ortion . * * A s in g re d ie n t o f cake o r pie, 2 p o rtio n s; can d y , any am ount, 4 portions.
various nutrients on which it was based were computed from a standard devised by the analyst, from the portions of food and drink furnished by the patient. A c curate amounts could only have been obtained by weighing all solids and meas uring all liquids before eating or drink ing and the same process repeated with such as may have remained unconsumed, the difference having been the net amount
actually ingested. This, o f course, could not have been done under the circum stances. H ow ever, because o f the inter est shown by the patients and the care taken by them in recording the various items, it is felt that some interesting data have been obtained. T h e computation and analysis was made by M iss Caroline L . Hunt, associ ate specialist in food and nutrition of the
1Q40
T h e Journal of the Am erican D en tal Association
T a b l e 2 .— S t a n d a r d s U s e d b y C . L . H u n t f o r J u d g i n g B i l l s o f F a r e S u b m i t t e d b y A u t h o r
F or a M an
R e q u ir e d N u t r ie n t s
P rotein P rotein, efficient ( o f animal fo o d s , p e a n u ts an d s o y beans) C alcium Iron
V itam in A
V itam in B V itam in C
R oughage F uel value
A t least 75 gm . A t least 45 gm .
F o r a W om an
A t least 60 gm . A t least 40 gm .
0.67 gm . 0 .6 gm . (Judged chiefly by am ount o f m ilk and cheese) 15 m g. 12 m g. (Judged chiefly b y p rop ortion o f m eat, eggs, vegetables, fruits and whole-grain cereals) (T h is is considered adequate i f from 300 to 400 calories are obtained from m ilk, eggs, cream o r green-leaf vegetables, and butter is regularly used) (A d equ ate i f from 1,000 to 1;200 calories are p rovided by other food s than fats, sweets and refined cereals) (A dequ ate i f citrus fruits, tom atoes or raw green-leaf vegetables are regularly used; on ly alternative, abundant use o f p otatoes or o f fresh fruits in general) (A t least 500 calories should be p rovided b y whole-grain cereals, v eg e tables and fruits) 3,000 calories________________________2,500 calories______________________
T a b l e 3 .— F o r m U s e d S h o w i n g F i n a l A n a l y s i s o f D i e t L ist s ADEQUACY OF DIETS
Ju dg ed fr o m bills o f fa r e fo r on e w e e k (a m ou n ts not stated) : R ep ort by C. L. H unt, U. S. D ep artm ent o f A g ric u ltu r e , f o r the author.
C a s e N o _________ _____________________ N a m e . R e p o r t *
P rotein (estim ated g ra m s)................ P rotein, efficient (estim ated grams) C alciu m ................................................... Ir o n ........................................................ .. V itam in A .............................................. V itam in B .............................................. V itam in C .............................................. R ou g h a g e ................................................ W a te r....................................................... * S ignifican ce o f signs u s e d : l o w ; ?, n ot reported.
a d e q u a te ; -j------ , p ro b a b ly a d e q u a te ; — , l o w ; -------- , v ery
Tiskler— D iet Analysis of Periodontoclasia Cases S a m p l e D i e t L is t (N o . 70) a s S u b m i t t e d f o r A n a l y s i s *
T a b l e 4 .— A
DINNER
BREAKFAST
1 slice toast, 1 cup coffee w ith su gar and cream . D IN N E R
1 cup tom ato bisque, 1 slice roast lam b, 3 tablesp oon s squash, 1 sm all sw eet potato, 1 stick celery, 1 slice je lly , 2 tablespoons ch ocolate ice crea m , 1 slice cake, 1 cup tea. SU PPER
F ricassee o f chicken (sm a ll p o r tio n ), 2 tablesp oon s peas, 1 tablesp oon m ashed p o tato, 2 tablesp oons In d ia n p u d d in g w ith w h ip p e d cream . SUPPER
C rabm eat salad, 3 lettuce leaves, 3 h e a p in g tablesp oon s cra bm eat w ith m ayonnaise, 3 rolls, 1 cup coffee, eclair.
2 tablesp oon s baked beans, 2 tablespoons p icca lilli, 1 slice b r e a d and butter, 1 slice apple pie, 1 cup tea, 5 o r 6 chocolates. 12
p.
1041
12 P. 2 toasted muffins w ith
M .
M.
1 cup
coffee,
1 ap p le.
BREAKFAST
2 g ra h a m cra ck ers w ith cheese, 1 cup coffee.
1 slice
toast,
1 cup
coffee.
b r e a k f a s t
DINNER
1 slice toast, 1 cup co ffee. D IN N E R
1 cup soup, 1 slice c o ld lam b w ith hot g r a v y , 2 tablesp oons spinach, 1 slice squash pie, 1 cup tea.
1 cup soup, 1 lam b chop, 2 tablespoons cre a m e d ca u liflow er, 1 tablespoon m ashed p o tatoes, 2 tablesp oon s p ep p er relish, 2 ta b le spoons b rea d p u d d in g w ith h a rd sauce, 1 cup tea, 2 sw eet crackers.
SU PPER
1 e g g (J n o rn a y cheese d ressin g on to a st), 1 slice p ineap p le, 2 su ga r cook ies, 1 cup tea. 1
A . M .
1 je lly and cheese sa n d w ich , 1 cup coffee, y2 p ou n d candy.
SUPPER
2 slices bolog n a , 1 slice b rea d w ith butter, 1 tablesp oon ketchup, 1 cup tea, 2 bunches C o n co rd g rapes, 1 slice fu d g e cake, % p ou n d cand y.
12 P. 1 doughnut, 1 cup
BREAKFAST
1 slice toast, 1 cup coffee.
SU PPER
1 F ra n k fu rter, 2 tablespoons potato salad, 1 slice b r e a d and butter, 2 tablespoons c a r a m el cu sta rd w ith cream , 1 cup coffee. 12
p .
coffee.
break fast
1 slice
D IN N E R
Steak (v e r y little ), 2 tablespoons fr ie d onions, 1 tablesp oon m ashed potatoes, lettuce (2 le a v e s) and tom ato (3 slices) salad, F ren ch dressing, 2 tablespoons caram el cus ta rd .
M.
toast,
1 cup
coffee.
DINNER
1 slice fr ie d codfish, 2 tablespoons crea m ed carrots, 1 tablespoon m ashed potatoes, 2 tablespoons p icca lilli, 1 saucer o f sliced ora n g e s and ba n an as w ith w h ip p ed cream , 1 slice cake, 1 cup tea. su pper
1 sm all
p ortion sca llop ed fish, 2 slices b r e a d an d butter, 1 cup tea, 1 sm all slice squash pie.
M .
1 cup coffee, 1 doughnut, 12 chocolates.
12 p . m .
1 doughnut, 1 cup
1 slice toast, 1 cup coffee. * N o t e the excess o f sw e e ts; patient o v e rw e ig h t.
coffee.
BREAKFAST
BREAKFAST
1 slice
toast,
1 cup
coffee.
1042
T he Journal o f the American D en tal Association T a b l e 4 .— (
C on tin ued)
D IN N E R
12 P. M .
1 cup chicken soup, 1 bre a d e d p ork chop w ith tom ato sauce, 1 tablesp oon m ashed p o tato, 2 le a v e s o f lettuce w ith F ren ch dressing, 1 la rg e slice lem on m erin gu e pie, 1 cup tea.
T h e patient (M r s . F. P . B .) is v e r y fo n d o f p ep p er relish and p icca lilli, drinks from
SU P P E R
2 tablesp oon s baked beans, 3 b a k in g p o w d er biscuits, 1 cup tea, 2 tablesp oon s p icca lilli, 1 slice ap p le pie.
T able
2 g ra h a m cra ck ers w ith cheese, 1 cup coffee. A lm o s t one p ou n d o f candy.
5.— F i n a l A
F IN A L T A B U L A T IO N
6 to 8 glasses w a ter a d a y but n ev er w ith m eals and uses plenty o f butter in cook in g and se rv in g o f v egeta bles.
n a l y s is
OF A N
o f
D i e t L i s t N o. 70
IN D IV ID U A L D IE T LIST
A d e q u a cy o f diets ju d g e d fr o m bills o f fa r e f o r on e w e e k (a m ou n ts not stated) by C. L . H unt, U . S. D ep artm en t o f A g ricu ltu re C a s e N o . 70________________________________________________________ _____ ________ N a m e
M r s . F. P . B.
R e p o r t *
P rotein (estim ated grams)
—
P rotein efficient (estim ated grams)
—
Calcium
—
Iron
-
V itam in A
—
V itam in B
—
Vitam in C
—
R oughage
—
W ater
+
_
*Significance o f signs used: + , adequate; + _ , probably a d e q u a te ;__ , l o w ; ___, v ery l o w ; _____ , extrem ely low ; ?, not reported.
Bureau of Hom e Economics, Depart ment of Agriculture, W ashington, D . C., who employed a standard in grams for the various required nutrients in whole, half and quarter portions, both for a man and for a woman. From these, an analysis was prepared for each diet list using the terms, adequate, probably adequate, low and very low as the re sults indicated. T h e recorded nutrients were protein,, protein efficient, calcium, iron, vitamins A, B and C, roughage
and liquids. It was originally intended to include iodin, phosphorus and calories, but as the question o f the influence of iodin is still uncertain, it was omitted. M iss H unt also decided that the data on phosphorus were too insignificant to be included. Calories, on the other hand, are affected by the amount of sugar and fats in the food and also by the amount of butter, oil or syrups used. Because these foods are so concentrated and are used in varying amounts, it seemed use-
2
Cases Tishler— Diet Analysis of Periodontoclasia
Pro.
P ro. E. Ca.
+
Ir.
V itam in s
R ou g h W ater age
T a b l e 6.— D i e t A n a l y s e s , A g e s E i g h t e e n t o T h i r t y Y e a r s
Sex ---
+
Clinical Sym ptom s -----
General bu t early
C.
A ge
+
B.
N o.
+
A.
N am e F
+
18
+
104
+
L . O ...............................
—
+
A dvanced
+
L oca lly marked
A dvanced + -
M oderately advanced, with suppuration
—
+
—
-----
— —
—
— +
+
—
+
---
+
---
M oderately advanced L . S. lateral involved
---
+
—
-
—
—
Early
—
—
---
+
-----
+
+
+
—
+
+
+
—
+
L oca lly advanced w ith suppuration
F
+
_
M +
+
23 F
+
21
M
_
13
24
24
---
_ _
89 79
_
D . K ..............................
68
_
T . L ...............................
F. K ...............................
_ __
+ -
M . B . . . „ ......................
F
-
F
+
25 F
+
Generally advanced, with suppuration
_
V ery advanced, with suppuration
+
__
—
A dvanced
-
+
—
+
+
__
+
+
— +
+
+
—
+
+
M oderately advanced
_
+
+
+
_ +
—
+
+
_ +
---
+
—
_ —
+
+
-
+
+
M oderately advanced, w ith suppuration
A d vanced, with suppuration
-
+
-----
V ery advanced, with suppuration
A d vanced, w ith suppuration
+
_ +
-
+
—
+
—
-
+
—
---
+
-
—
—
_
-
+
+
_
+ -
—
+
—
_ _
-
25
F -
78
26
26
+
48 71
F
F
G. C ...............................
31
27
26
H . A ...............................
8
---
E . G .............................
L . K ...............................
41
-
-
—
....................
M. C
L . C ................................
+
+
F
—
F
M
—
F 28
F
28
29
F
28 111
30
56
E . C ...............................
73
30
24
J - B ................................
98
100
M
M . Q .............................
M . G .............................
30
F
D . M .............................
H . M .............................
86
30
—
A . B ...............................
30
+
E . G ...............................
57
55
113
66
82
61
S. K ...............................
G . M .............................
A . P ...............................
J . G ...............................
F
50
7
23
M . K .............................
50
2
16
F . A ...............................
L . H ...............................
49
50
50
50
37
T. H
J .A
69
F
52
93
..................... ....................
F
52
53
F
M
F
M
F
—
— _ + _
+
_
+
—
+
+
+
+
+
—
_
—
+
—. _ —
+
+
—
+
+
—
+
+
+
-----
—
—
+
—
A.
+
+
+
—
—
+
+
+
+
—
+
•+
—
B.
+
—
+
—
+
+
+
C.
V itam ins
+ +
_
+ +
+
+
+
- + + - + + — — — — + — — — __ _ — + — + — — — — — + — — + - — —
__
+
- + — + — — + - — + - + — — + ? — —
+
+
—
_
Ir.
?_ ? —
—
?
_
—
+
—
P ro. E. Ca.
4-
-
_ __
Pro.
+
+
+
+
+
-
—
—
+
—' _ +
+
— — —
+
+
+
A dvanced
—
+
-----
A d va n ced, with suppuration
A dvanced
A d va n ced, w ith suppuration
A dvanced
M oderately advanced
A dvanced
— +
A dvanced
M oderately advanced
A dvanced
V ery advanced, with suppuration
A dvanced
_
+
+
+
A dvanced
A dvanced
+
V ery advanced, with suppuration
+
A dvanced, with suppuration
V ery advanced, with suppuration
A d va n ced, w ith suppuration
M oderately advanced
A dvanced
Clinical S ym ptom s
—
+
+
+
+
+
R ough W ater age
The Journal of the American
M
M
53
51
M
65
M
54
109
55
M
M
M
M
.................... I. S ..................... E . D .................... R . R .................... E. G .................... B. C ....................
P. 0
40
59
81
E . C ...............................
57
60
52
C . F ...............................
F
F
60
18
E . H ..............................
F
F
62
62
99
96
E . K ..............................
Sex
A ge
G . B ...............................
N o.
N ame
T a b l e 7 .— D i e t A n a l y s e s * A g e s F o r t y - N i n e t o S i x t y - T w o Y e ' r ?
1044 Dental Association
1045
Tiskler— D iet Analysis o f Periodontoclasia Cases less to consider them except as they a f fected the rest o f the diet. A s an ex ample, when butter, sugar and such dishes were used in large amounts, it ^vas presumed to indicate that the diet was overabundant or deficient in essential nutrients such as protein, minerals and vitamins. T h e final computation o f the lists dis closed one conclusive fact, i. e., that a very great proportion of the patients, both young and old, ate a poorly balanced diet, in some cases, alarmingly so. M any T able
8 .— F i n a l T a b u l a t i o n
balanced diet; in other words, ninetyseven individuals were found to have eaten unwisely in one or more o f the recorded nutrients. Nine showed a defi ciency in every item (a 100 per cent un balanced d ie t). Seven were deficient in from five to eight items, with the bal ance, necessary to complete the nine, recorded as probably adequate only (n ot an adequate amount in the entire num ber of nutrients). T h e balance o f the diet lists varied from one to nine ade quate items, and the latter group, which
D ie t A n a l y se s o f O n e H u n d r e d a n d
O ne
P e r io d o n t o c l a s ia
C ases W it h P o c k e t F o r m a t io n
P ro b a b ly Q u e s tio n V ery able A dequate A dequate A d equ a te
L ow
V ery L ow
E xtrem ely L ow
Protein
40
10
47
3
1
P rotein E f.
46
9
42
3
1
Calcium
20
7
3
62
9
Iron
45
10
3
43
V itam in A .
24
10
4
60
3
V itam in B .
51
8
41
1
V itam in C .
59
6
34
1
R oughage
43
12
45
1
W ater
31
1
52
12
1
women gave the information that they were accustomed to restrict the amount and kind of food eaten to avoid an ac cumulation o f surplus flesh, a condition which, as far as could be determined, did not affect the men, whose diet analyses, by the way, disclosed an equally marked deficiency in many cases. In computing the averages of the various elements, it was found that three items of the nine already referred to were conspicuously lo w : calcium, vitamin A and liquids (m ostly w a ter). O f the 101 recorded cases, about 96 per cent showed an un
4
1
represented those w ho ate a balanced diet, numbered but four (o f the original 101 exam ined). In order that a definite idea o f the diets as a whole may be obtained, tw o groups of opposite age extremes have been chosen and recorded. O ne repre sents lists submitted by younger patients ( nineteen in num ber) whose ages ranged from 18 to 30 years. These showed a general nutrient deficiency, with but one exception, and this diet list was adequate in all items. T h ree lists were deficient in all nutrients, one in all but tw o and an
1046
T h e Journal o f the American D en tal Association
other in all but four, all of which were recorded as adequate. T h e clinical symptoms of both groups varied from an incipient to a markedly advanced type, with the advanced predominating. T h e other group of twenty, chosen from the opposite age extreme (4 9 to 6 3 ) dis closed a similar general diet deficiency. In fact, the lists of both groups could have been reversed without appreciably affecting the result. T h e balance o f the remainder of the lists, which completed the 101 chosen, i. e., those between 30 and 49 years, showed the same general deficiency and symptoms as the tw o groups just referred to, which would lead one to believe that, as far as the experiment is concerned, diet is not a conclusive etiologic factor in periodonto clasia when individuals are considered, but when the 101 cases are examined collectively, one cannot overlook the general lack of the calcium and vitamin A intake, and also that of water, which is so important in fecal elimination and bears a direct relationship to intestinal toxemia, long recognized as an etiologic factor in periodontoclasia. O f the tw o groups, just reported, it was hoped that the younger would offer the more promising material for consid eration because the periodontal disinte gration had its inception at a more recent date than in the case o f the older groups, but, as has been observed, it offers no conclusive results on which a positive
statement can be made. It would seem, therefore, that more definite data could be obtained by an examination of the diets of still younger patients, of high school age or younger, if found neces sary. T h e advantage of this is obvious, because it is apparent that a knowledge of the character o f the diet eaten during the formative period of life, when early periodontal lesions have their inception, is most important. It cannot be disputed that many persons make radical changes in their diet as soon as they are permit ted to choose it, as in adult life, thus making the task of relating diet to perio dontoclasia a difficult one. It is safe to assume that this could be determined with more certainty during childhood or youth, for the closer that the etiology (deficient diet) and the possible effect (periodontoclasia) can be brought to gether, the more definite should be the findings which w ill prove their exact re lationship. It is hoped that further w ork o f this kind w ill be undertaken, because those familiar with dietary problems who have been consulted are of the opinion that such experiments offer promising results. A suggestion is hereby offered to those w ho may desire to undertake w ork of this kind that a dietitian be enlisted to supervise the accumulation of the diet lists, because of her expert knowledge in such matters.