Oral Hygiene and Periodontia in General Practice

ORAL HYGIENE AND PERIODONTIA IN GENERAL PRACTICE By O LIN K IR K L A N D , D .D.S., Montgomery, Alabama

(R ead before the Mississippi Dental Association, Jackson, Miss., M ay

E

XCEPT

fo r the teachings o f D r .

G . V . Black in preventive dentis­

19, 1925)

is not simply a matter o f c o m fo r t and beauty.

try, but little attention was given

I t is the solem n obligation o f every

the subject o f oral hygiene by the den­

practitioner o f dentistry to make a care­

Since

f u l study o f periodontal pathology, and

that tim e, interest in it has grow n until,

so to fam iliarize h im self with the early

in its various aspects, it n ow

symptoms o f disease that diagnosis o f

tal profession until ten years ago.

receives

more attention at our dental m eetings

these conditions m ay be as positive as

than

the

any

other

subject

in

dentistry.

diagnostic

results where

caries

is

T h is is partly due to the fa c t that tech­

concerned.

nical

quired only by a comparative study o f

procedures

have,

in

a

measure,

T h is know ledge can be ac­

been conquered, and do not require the

the gingivae in a state o f health, and

same attention as fo rm e rly

w hile undergoing the primary changes

leaders o f the profession.

fr o m

the

Failures in

o f disease.

m odern dental restorations are realized

W h e n a patient comes in fo r an oral

to be due to fa u lty hygiene, or fa u lty

exam ination, it is just as im portant that

diagnosis, and estimation o f

the resis­

we take note o f the tone and color o f

tance and vitality o f the supporting tis­

gu m

sues. T h u s , attention is veering fr o m the

gingival crevice a ll around each tooth

mechanics o f the cavity and restoration

extent periodontal disease has progressed

tissues and pass a probe into the

fo r the purpose o f ascertaining to what

fo r m to the means o f prom oting health

as it is to probe in the teeth fo r the pur­

and preventing furth er disease. Further­

pose o f locating cavities.

m ore, the profession is being impressed

awjay fr o m the idea that the only serv­

with

ice expected in a general practice is the

the

fa c t

that

dental

disease

is

W e m ust get

as rampant as ever in spite o f the per­

fillin g o f

fection o f dental technics, and that, so

and construction o f bridges, crow ns and

fa r , little has been done beyond repair

plates.

o f the ravages.

A new importance has

also been given to the biologic side o f

It

is

cavities, extraction o f

thought

by

m any

teeth

authorities

that the outstanding etiologic fa ctor in

dentistry by the know ledge that dental

the loss o f teeth that are condem ned to

disease

the forceps is periodontoclasia.

is

an

im portant

cause

of

ill

health, and that the health o f the mouth Jour. A . D . A ., October, 1925

1215

I f this

is true, it is very evident that the dental

1216

The Journal of the American Dental Association

profession

is not so

progressive

as

it

should b e ; and I am sure that m y criti­

tion and advice as is the physician or the law yer.

cism w ill not be considered too severe

I am reliably in fo rm ed that a m ove­

i f the fa ct that h a lf the teeth that are

m ent is n ow under w ay by the leaders

extracted

are

lost

fr o m

periodontal

in periodontia, fo r the preparation o f a

disease, and but little is being done to

textbook

prevent or cure it, is taken into consid­

phases o f oral hygiene, prevention and

eration.

periodontia in a comprehensive manner.

that

w ill

treat

the

various

T h is w ou ld be an unjust charge i f it

T h is same group o f scientific workers

were not possible to cure or prevent this

w ill recom m end to the association o f

disease, but it is n ow a w e ll know n and

dental colleges that provision be made

recognized fa c t, proved by the experi­

fo r

ence and observation o f leaders in re­

course o f the dental student to acquire

ample

tim e

during the collegiate

search w ork in periodontal pathology,

considerable know ledge and experience

that the m ajority o f cases o f this fo r m

in periodontal pathology.

of

oral

cured.

or

T h a t an ounce o f prevention is worth

T h e application o f correct oral

disease

can

be

prevented

m ore than a pound o f cure is as true in

hygiene and the h arm on izing

of

oc­

dentistry as in the practice o f m edicine,

clusal stress is the preventive rem edy,

but this truth is not given the same con­

and it must be resorted to early in life

sideration in the practice o f

i f the best results are to be anticipated.

as in the practice o f m edicine.

Instruction in m outh hygiene is be­

dentistry A s an

illustration o f the value o f prevention

yond a doubt the most valuable service

as compared with

the dentist can render his patient, in the

your attention to the procedure o f tw o

cure, I

w ou ld

call

practice o f preventive dentistry, and the

m en

results o f such teaching is very success­

gaged in the practice o f m edicine in ad­

fu l when the instructor is positive and

join in g com m unities:

fo r c e fu l in explaining the reasons fo r

that one o f them has acquired the ut­

givin g

the teeth

and their supporting

tissues the m ost carefu l

consideration.

w h om

w e w ill presume are en­ W e w ill suppose

most degree o f skill in the treatment o f preventable diseases.

H e enjoys a re­

T h e lack o f interest on the part o f the

markable degree o f success in handling

profession in preventive dentistry is not

the cases o f

due to intentional neglect.

It is per­

w h om he ministers, but knows nothing

haps due to the facts that but little at­

o f the science o f prevention, and does

tention is being given to this important

nothing to prevent the spread o f disease.

branch o f dentistry in the dental schools

T h e other one, w e w ill assume, is lack­

the unfortunate

ones to

throughout the country, and that there

ing in ability to treat his patients suc­

has never been a textbook written which

cessfully w hen affliction b efalls them ,

adequately odontia.

peri­

but is w e ll versed in preventive prac­

T h e r e is another outstanding

treats the subject o f

tice and is but seldom called to the bed­

cause fo r lack o f interest in periodontia

side to minister to his clientele.

in general practice, and that is the fee

of

fo r such service. A lth o u g h w e have not

higher type o f service to hum anity?

these

tw o

m en

is

W h ic h

rendering

the

acquired the practice o f m aking a charge

N otw ithstanding the fa ct that den­

fo r our kn ow ledge, the dentist is just

tistry has made rapid strides forw ard

as m uch entitled to a fee fo r exam ina­

and has become

indispensable

to

the

1217

Kirkland— Oral Hygiene and Periodontia in General Practice c o m fo r t

and

health

of

hum anity,

as

the part o f the average practitioner o f

practiced today it is about 5 0 per cent

dentistry, but a lack o f know ledge o f

failu re, and it cannot assume its true

periodontal pathology.

professional importance until w e , as a progressive

cause

fo r

failure

in

the

treatm ent o f these conditions is the re­

necessity o f fo llo w in g the exam ple o f

liance on drugs to accomplish the result

the m edical profession in the application

desired.

o f preventive measures.

fective

to

recognize

A n oth er

the

Failure

profession,

prevent

disease

in

the

m outh, by methods now in use, is due

M edicin al remedies are in e f­ in

this disease

and

should be

given no consideration whatever.

We

m ay use m ild antiseptics to irrigate a f ­

to failu re in diagnosis o f early m ani­

fected tissues as a general routine in

festations o f the disease and lack o f in­

surgical treatments, but strong drugs are

terest

not only unnecessary, but are also posi­

in

oral

hygiene.

disease is generally

Periodontal

recognized by the

tively contraindicated, and the operator

dentist w hen his attention is called to

w ho persists in their use w ill d efeat his

it by the patient, and that is usually

ow n efforts.

when there is visible pus, inflammation

a false impression a m o n g practitioners

and

m obility

nosis should ease1 first measures

of

the

be

teeth.

made

m anifests

diag­

o f dentistry, as w e ll as in the m in d o f

the

dis­

the laity, that disease o f the periodon­

presence

and

tium can be cured by the use o f m outh

its

washes or the application o f strong drugs

w hen

its

inaugurated

A

to

prevent

to the diseased areas.

furth er developm ent. The

general

T h e r e has always existed

practitioner

can,

and

T h e sooner w e

get the drug treatm ent idea out o f our

should, apply the principles o f oral hy­

m inds, the sooner w e w ill be in position

giene, and although he m ay not practice

to render w orth -w h ile service to those

periodontia, he should kn ow periodon-

w h o entrust the health o f their m ouths

tology,

so

that he m ay be capable o f

to our skill and ju d gm en t.

have

T h e first step to be considered in the

developed the prim ary stages o f perio­

successful treatment o f primary perio­

dontal

periodontologist

dontal lesions is diagnosis. T h e suspected

cannot serve all those w h o are in need

teeth should be studied fo r occlusal dis­

rendering

service

disease.

to The

those

w ho

o f such service because o f the lim ited

harm ony

num ber o f com petent specialists in this

T h o ro u g h odontexesis

field o f dentistry; therefore, i f w e get

the next step.

anywhere in prom oting health

ing

in the

human m outh, it must be done through

and

effort

to

deposits fr o m

any

trauma

corrected.

(prophylaxis)

is

I t m ay require painstak­ rem ove

a ll

stains

and

the exposed surfaces o f

the concerted efforts o f the dental pro­

the teeth, but this should be done, any

fession,

with

the

cooperation

of

the

detritus that m ay exist in the gingival

treatm ent

of

the

tient m ay then be given instruction in

crevice being rem oved also.

m edical profession. The

successful

The

pa­

early lesions in periodontal disease is not

the care o f the teeth and gingivae. M o st

such a difficult problem , and there is no

patients

reason w hy every practitioner o f den­

gum s, because, they tell us,

it makes does

refrain

bleed.

fr o m

patient

the

tistry should not handle his ow n cases.

them

T h e c h ie f cause o f failure in prevent­

realize

in g this disease is not a lack o f skill on

through vigorous brushing o f the dis­

that

The

brushing

stim ulation

not

produced

The Journal of the American Dental Association

1218

eased gingivae w ill restore these tissues

avoided, as exposure o f the dentin w ould

to a state o f health.

produce sensitiveness w ithout restoring

G reat stress should

therefore be laid on the importance o f

norm al cusp fo r m .

brushing

as the

viated by handling the stone with light

Since, o w in g to the dietary hab­

pressure and using a rotary m ovem ent

its o f civilization, the supporting struc­

o f the stone throughout the operation.

teeth.

the gingivae as w e ll

T h is m ay be ob­

tures o f the teeth do not get sufficient

T h e establishment o f a hygienic con­

exercise to encourage fre e circulation o f

dition o f the m outh through the applica­

blood in these tissues, it is necessary to

tion

supply these parts w ith

healthy blood

next consideration in the m anagem ent

by some artificial means.

T h is m ay be

accomplished by vigorously brushing the

of

prophylactic

treatment

o f any periodontal lesion.

is the

A l l deposit

stains and roughness should be rem oved,

gum s w ith the same effort used in brush­

fr o m

in g

extreme depth o f the gingival crevice.

the

teeth.

Too

cannot be laid brushing teeth,

the

and

much

emphasis

on the importance

gingivae

this

as w e ll

habit m ust

be

of

the tooth surfaces dow n to the

Prior to the developm ent

as the

methods

firm ly

ease,

of

treating

it was

of

modern

periodontal

customary

fo r

the

dis­ lead­

fixed in the m ind o f the patient i f we

ers in this branch o f

are to anticipate permanent results in

great stress on highly polishing the sur­

m aintaining health in the oral cavity.

faces

Since occlusal disharmony is perhaps

proved

of

the

teeth.

unnecessary.

dentistry to lay T h is It

has

is o f

been

course,

the most important etiologic factor in

important that the exposed tooth sur­

the developm ent o f periodontoclasia it

faces be made sm ooth, but it is useless

should be given first consideration.

to spend hours o f

A thorough know ledge o f traumatic occlusion and methods o f grinding the

laborious effort in

polishing the teeth until they shine like a mirror,

teeth is necessary in the correction o f

Periodical treatments, perhaps three

occlusal traum a, as there is danger o f

times w eekly, should be given, at which

grinding the teeth in such a w ay as to

times sm all bladed curets m ay be care­

destroy com pletely norm al cusp antag­

fu lly

onism and thereby render the patient

a ll round each tooth fo r the purpose o f

perm anently

rem oving any deposit or roughness ex­

know n

un com fortab le.

I

have

instances in which the patient

passed into the gingival crevice

isting on these surfaces.

In fo llo w in g

com plained that there was no position

this procedure, great benefit results fro m

in which the teeth could find occlusal

stimulation induced by fo rcin g the dis­

rest.

In

arising

view

fr o m

of

such

T h is is undoubtedly as valuable in pro­

m ay be preferable to stop a little short

m oting health in the gingivae as is the

of

rem oval o f the irritants.

we

m igh t

grinding,

eased blood out o f the congested tissues.

it

w hat

injudicious

complications

consider

perfect

restoration o f occlusal function. F in ger

palpation

of

the

I f the treatment outlined is fo llo w e d

suspected

in those cases generally know n as gingi­

teeth during the exercise o f the occlusal

vitis, w hich is nothing m ore or less than

m ovem ents o f mastication w ill nearly

the primary stages o f what is com m only

always reveal which teeth are most se­

recognized as pyorrhea, an absolute cure

riously involved in traumatic occlusion.

of

In

tions should result, and continued stim ­

grin din g,

flat

surfaces

m ust

be

this disease in its early m anifesta­

1219

Kirkland— Oral Hygiene and Periodontia in General Practice ulation o f the gingivae by the patient

patient makes any effort at all at clean­

should m aintain a perm anent state o f

ing the teeth, there exists a false im ­

health in the supporting structures o f

pression that the brush

the teeth.

correctly and that the m outh is kept in

is being

used

T h e outstanding, and m ost unbeliev­

a hygienic condition, and he cannot un ­

able, cause o f failure in the permanent

derstand w h y disease, i f it is caused by

r e lie f o f periodontal disease is reflected

neglect, should have developed

in the instructions given the patient in

m outh.

the hom e

T h is

o f the average person brushing the teeth

part o f the procedure seems very simple

gives a very good idea as to the m anner

care

of

the

m outh.

in his

Observation in a P u llm an car

and no doubt is given entirely too little

in w hich m outh hygiene is practiced in

consideration by the m ajority o f those

gen eral: a fe w vigorous horizontal rubs

w ho fa il to secure permanent results in

over the sm ilin g surfaces

the handling o f such cases.

cisors and cuspids, and the operation is

I lay great

emphasis on the fa c t that failure is due to lack o f tance o f

of

the

in­

complete.

appreciation o f the im por­

T h e methods o f prevention that are

educating the patient in the

n ow being practiced in m outh hygiene

hom e care o f the m outh.

Impressions

that are to exist in the hum an

by the people in this country have been

m ind

proved by the test o f tim e an utter fa il­

im ­

ure, and no group o f individuals knows

pressed on the consciousness o f the in­

this fa ct so w e ll as those engaged in the

throughout dividual.

hygiene

life

must

be

deeply

I f the habit o f correct oral

practice o f dentistry.

I f there is ever

is ever perm anently fixed in the

a change fo r the im provem ent in pres­

m ind o f your patient, it m ust be done

ent methods o f preventing disease in the

through fo r c e fu l argum ent and carefu l

hum an m outh, it m ust be accomplished

the pa­

through the efforts o f those w ho have

tient in one short sentence to brush the

assumed the obligation o f protecting the

teeth with an up and dow n m ovem ent

health o f the hum an oral cavity.

or rotary m ovem ent o f the brush w ill

periodontal

not suffice.

teaching.

Sim ply

instructing

disease

can

be

If

prevented,

patient forgets, and

and in the m ajority o f cases it can, some

loses interest, in about the same length

one is to blame fo r the appalling loss

o f tim e that it takes to give such in­

o f teeth, and the ill health that results

structions, and he continues to care fo r

to the

the m outh

these preventable diseases.

The

in the

old

careless

w ay,

which is but little better than no effort at all.

N o m atter how much filth is

people w h om

we

serve,

fr o m

Every practitioner o f dentistry should practice on the theory that preventive

permitted to accum ulate in the m outh,

dentistry is less expensive to the patient,

ow in g to lack o f know ledge as to the

and infinitely m ore valuable, than re­

correct use o f

parative dentistry.

the toothbrush,

if

the