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Preventive Dentistry for the Undergraduate
PREVENTIVE DENTISTRY FOR THE UNDER GRADUATE* By GEORGE KERR THOMSON, D.D.S., F.A.C.D., Halifax, Nova Scotia
P
R E V E N T IV E dentistry is, to me, sufficient knowledge o f anatomy, phys the most important branch o f our iology and biochemistry, and the effect profession, and until recent years o f food, exercise, etc. on the expectant mother to enable him to instruct his it has received the least consideration. During the last ten years, the literature patients so that his advice, i f followed, published and the time spent in dis w ill produce the desired results. cussing it and developing methods fo r His knowledge o f physical diagnosis its teaching and practice have equalized and o f various foods and their effects its neglect o f form er years in favor o f on the human body should be such that operative restorative measures. he w ill be able to diagnose the physical I first became really interested in the condition o f the expectant mother and, subject twenty years ago, when we in cooperation with her medical adviser, started some oral hygiene propaganda in prescribe the diet that with the necessary cooperation with educational and public exercise and mode o f living w ill be health institutions, and, in 19 0 8 , on the productive o f not only sound dental establishment o f our dental school, I organs, but also a healthy body. In this agreed to teach oral hygiene with crown connection, a knowledge o f the inves and bridge work and ceramics. tigations and conclusions o f Gies, Howe, Subsequently, we discovered that it Price and Pickerell is very desirable. was too important a subject to be taught T he idea o f cooperation with the fam ily as an appendage to other subjects and physician is o f great importance and on my appointment as dean, I accepted should be encouraged to a greater ex the newly established chair o f preven tent by our teachers and the profession tive dentistry. generally than is the case at present. In the teaching o f preventive den Now, how and when is the student tistry to undergraduates, two questions to obtain this knowledge? naturally arise: 1. W h at shall they A t recent meetings o f the American be taught? 2. How shall we teach Association o f Dental Schools, and else it? where, valuable suggestions have been W ith regard to the first question, offered, with which you doubtless are after careful consideration o f volumes fam iliar. In teaching o f preventive o f literature containing the ideas and dentistry, we must agree that the sub methods o f most eminent practitioners ject is so closely related to other and educators, doubtless we w ill agree branches o f dentistry and also to medi that the undergraduate should obtain cine, and so interwoven with them, that J o u r . A .D . A.}M a rch , 1927
424
T h o m so n —P r e v e n t i v e D en tistry f o r th e U n d ergra d u a te it is impossible to discuss it without mentioning them. T herefore, I recommend that, in the treatment o f the various subjects in our curriculums, preventive dentistry be con sidered as o f primary importance and that each teacher be requested to refer especially to its relation to his particular branch. In Canada, two o f our schools are follow ing this suggestion, teaching it as a separate subject and, from the beginning o f the course, especially em phasizing its importance. This is done also from the standpoint o f public health, and the student is encouraged to take an interest in this aspect o f it, the attention o f women bejng particularly directed to the sphere o f public health dentistry which is peculiarly their own. So fa r, I have been considering the subject from a prenatal standpoint. O f equal or possibly, as some o f our modern investigators affirm, o f more, importance is the treatment o f the child from birth to school age. It is u n for tunate that the child does not generally come under the observation o f the den tist earlier than is usually the case. A vast improvement can be made in this connection by educating the medical and dental student together, so that the teacher, dentist and physician can co operate to a greater extent. W hen the physician realizes his responsibility in this matter, and there is evidence that he is beginning to do so, it w ill facili tate materially the preventive dental treatment o f children from birth to preschool age. Some years ago, in Nova Scotia, we were fortunate in having established a preschool age dental clinic, the records o f which conclusively prove that, in stead o f having children enter school 90 per cent imperfect from a dental standpoint, it is quite possible, by pre
425
natal instruction to parents, and pro phylactic treatment including correct diet and operative procedures, to have them enter almost 100 per cent perfect, not only from a dental standpoint but also from that o f general health. This clinic is now conducted in our univer sity health center, and our university students, both medical and dental, re ceive practical demonstration o f pre ventive dentistry therein. It is my belief, and fo r several years I have advocated it repeatedly, that clinics o f this kind should be established wherever possible, not only throughout Canada and the United States, but also throughout the world. Propaganda fo r this particular phase o f preventive den tistry should be instituted at this meeting and should become one o f the important objectives o f our international congress. It is not only o f importance to the edu cation o f the dental student but also to the education o f the medical student and the general public. In Canada, in this connection, we are receiving the cooperation o f federal and provincial governments, and the Red Cross and other health organizations, as well as the medical profession. From an educational standpoint, then, we w ill suppose the student has received sufficient knowledge o f prenatal and preschool age treatment. Now, what about the operative stand point? Recent research by Bodecker, clinical experiments by Hyatt and radiographic investigations by Raper, with which you are all fam iliar, prove conclusively that members o f our profession generally have neglected obscure cavities, some o f which are noncarious and which even a toothbrush bristle w ill not enter, and in which the finest pointed explorer w ill not catch. Some o f these cavities, hav
426
The Journal of the American Dental Association
ing no more width than the thickness o f a hair, have been conservatively es timated by Bodecker to contain at least 5 ,4 0 0 ,0 0 0 ,0 0 0 bacteria. W h at shall we teach the undergraduate with regard to their preventive and operative treat ment? W e all realize that orthodontists, prosthetists and operative dentists con sider the idea o f prevention in every appliance inserted and operation per formed, but is this point emphasized sufficiently in teaching our undergrad uates? D r. Hyatt’s methods, as explained to me, although they seem radical to many o f our profession, are not really un reasonable and are certainly o f great value. Even i f they are not generally adopted, the discussion they have aroused has directed our attention to cavities, which, as I have said, have been neg lected, with disastrous results, and whether or not this method o f prevent ing their development is desirable, the attention o f our students should be directed to their existence, and practical methods o f prevention should be taught regarding them. D r. Hyatt says: “In those parts o f the tooth where the fis sures or pits do not penetrate more than one-third o f the thickness o f the enamel, they can be obliterated by operative means without filling, so that they can easily be kept clean by ordinary toilet o f the mouth. I f they are not removed they form lodging places fo r the fo r mation o f carbohydrate material and bacterial plaques with resultant disin tegration o f the enamel.” Another important factor in dental disease, possibly one o f the most com mon factors, is traumatic occlusion. Is the undergraduate sufficiently impressed
with its importance as a common cause o f periodontoclasia and other lesions? There is a great difference o f opinion regarding this, but it must be admitted that the elimination o f abnormal stress from diseased teeth does restore them to health and also prevents a recurrence o f disease. T herefore, a student should be thoroughly instructed in the diag nosis and treatment o f traumatic occlu sion. Research by Box, Stillman and M cC all proves that the first sign o f disturbance o f equilibrium by traumatic occlusion can be observed microscopi cally and, i f not corrected, w ill surely increase. The student should certainly be taught the use o f the microscope fo r the purpose o f recognizing these and early signs o f disintegration in other parts o f the mouth, and the proper pro cedure to prevent their development and recurrence. The demonstration o f the toothbrush on manikins and infirmary patients is a most important matter, and the stu dent should be taught how to demon strate to his patients the use o f the brush as advocated by Charters, Stillman and others. He should also be able to instruct them in the home care o f the mouth and teeth. I, therefore, recommend that under graduates be taught to conduct a thor ough prophylactic treatment, which shall include the above mentioned procedures. Did time permit, there are other phases o f teaching preventive dentistry that might be properly considered. I have simply suggested ideas which in my ex perience in practice, as w ell as in teach ing, have occurred to me as desirable o f general adoption and which in many schools are not given sufficient consid eration.
P
R E V E N T IV E dentistry is, to me, sufficient knowledge o f anatomy, phys the most important branch o f our iology and biochemistry, and the effect profession, and until recent years o f food, exercise, etc. on the expectant mother to enable him to instruct his it has received the least consideration. During the last ten years, the literature patients so that his advice, i f followed, published and the time spent in dis w ill produce the desired results. cussing it and developing methods fo r His knowledge o f physical diagnosis its teaching and practice have equalized and o f various foods and their effects its neglect o f form er years in favor o f on the human body should be such that operative restorative measures. he w ill be able to diagnose the physical I first became really interested in the condition o f the expectant mother and, subject twenty years ago, when we in cooperation with her medical adviser, started some oral hygiene propaganda in prescribe the diet that with the necessary cooperation with educational and public exercise and mode o f living w ill be health institutions, and, in 19 0 8 , on the productive o f not only sound dental establishment o f our dental school, I organs, but also a healthy body. In this agreed to teach oral hygiene with crown connection, a knowledge o f the inves and bridge work and ceramics. tigations and conclusions o f Gies, Howe, Subsequently, we discovered that it Price and Pickerell is very desirable. was too important a subject to be taught T he idea o f cooperation with the fam ily as an appendage to other subjects and physician is o f great importance and on my appointment as dean, I accepted should be encouraged to a greater ex the newly established chair o f preven tent by our teachers and the profession tive dentistry. generally than is the case at present. In the teaching o f preventive den Now, how and when is the student tistry to undergraduates, two questions to obtain this knowledge? naturally arise: 1. W h at shall they A t recent meetings o f the American be taught? 2. How shall we teach Association o f Dental Schools, and else it? where, valuable suggestions have been W ith regard to the first question, offered, with which you doubtless are after careful consideration o f volumes fam iliar. In teaching o f preventive o f literature containing the ideas and dentistry, we must agree that the sub methods o f most eminent practitioners ject is so closely related to other and educators, doubtless we w ill agree branches o f dentistry and also to medi that the undergraduate should obtain cine, and so interwoven with them, that J o u r . A .D . A.}M a rch , 1927
424
T h o m so n —P r e v e n t i v e D en tistry f o r th e U n d ergra d u a te it is impossible to discuss it without mentioning them. T herefore, I recommend that, in the treatment o f the various subjects in our curriculums, preventive dentistry be con sidered as o f primary importance and that each teacher be requested to refer especially to its relation to his particular branch. In Canada, two o f our schools are follow ing this suggestion, teaching it as a separate subject and, from the beginning o f the course, especially em phasizing its importance. This is done also from the standpoint o f public health, and the student is encouraged to take an interest in this aspect o f it, the attention o f women bejng particularly directed to the sphere o f public health dentistry which is peculiarly their own. So fa r, I have been considering the subject from a prenatal standpoint. O f equal or possibly, as some o f our modern investigators affirm, o f more, importance is the treatment o f the child from birth to school age. It is u n for tunate that the child does not generally come under the observation o f the den tist earlier than is usually the case. A vast improvement can be made in this connection by educating the medical and dental student together, so that the teacher, dentist and physician can co operate to a greater extent. W hen the physician realizes his responsibility in this matter, and there is evidence that he is beginning to do so, it w ill facili tate materially the preventive dental treatment o f children from birth to preschool age. Some years ago, in Nova Scotia, we were fortunate in having established a preschool age dental clinic, the records o f which conclusively prove that, in stead o f having children enter school 90 per cent imperfect from a dental standpoint, it is quite possible, by pre
425
natal instruction to parents, and pro phylactic treatment including correct diet and operative procedures, to have them enter almost 100 per cent perfect, not only from a dental standpoint but also from that o f general health. This clinic is now conducted in our univer sity health center, and our university students, both medical and dental, re ceive practical demonstration o f pre ventive dentistry therein. It is my belief, and fo r several years I have advocated it repeatedly, that clinics o f this kind should be established wherever possible, not only throughout Canada and the United States, but also throughout the world. Propaganda fo r this particular phase o f preventive den tistry should be instituted at this meeting and should become one o f the important objectives o f our international congress. It is not only o f importance to the edu cation o f the dental student but also to the education o f the medical student and the general public. In Canada, in this connection, we are receiving the cooperation o f federal and provincial governments, and the Red Cross and other health organizations, as well as the medical profession. From an educational standpoint, then, we w ill suppose the student has received sufficient knowledge o f prenatal and preschool age treatment. Now, what about the operative stand point? Recent research by Bodecker, clinical experiments by Hyatt and radiographic investigations by Raper, with which you are all fam iliar, prove conclusively that members o f our profession generally have neglected obscure cavities, some o f which are noncarious and which even a toothbrush bristle w ill not enter, and in which the finest pointed explorer w ill not catch. Some o f these cavities, hav
426
The Journal of the American Dental Association
ing no more width than the thickness o f a hair, have been conservatively es timated by Bodecker to contain at least 5 ,4 0 0 ,0 0 0 ,0 0 0 bacteria. W h at shall we teach the undergraduate with regard to their preventive and operative treat ment? W e all realize that orthodontists, prosthetists and operative dentists con sider the idea o f prevention in every appliance inserted and operation per formed, but is this point emphasized sufficiently in teaching our undergrad uates? D r. Hyatt’s methods, as explained to me, although they seem radical to many o f our profession, are not really un reasonable and are certainly o f great value. Even i f they are not generally adopted, the discussion they have aroused has directed our attention to cavities, which, as I have said, have been neg lected, with disastrous results, and whether or not this method o f prevent ing their development is desirable, the attention o f our students should be directed to their existence, and practical methods o f prevention should be taught regarding them. D r. Hyatt says: “In those parts o f the tooth where the fis sures or pits do not penetrate more than one-third o f the thickness o f the enamel, they can be obliterated by operative means without filling, so that they can easily be kept clean by ordinary toilet o f the mouth. I f they are not removed they form lodging places fo r the fo r mation o f carbohydrate material and bacterial plaques with resultant disin tegration o f the enamel.” Another important factor in dental disease, possibly one o f the most com mon factors, is traumatic occlusion. Is the undergraduate sufficiently impressed
with its importance as a common cause o f periodontoclasia and other lesions? There is a great difference o f opinion regarding this, but it must be admitted that the elimination o f abnormal stress from diseased teeth does restore them to health and also prevents a recurrence o f disease. T herefore, a student should be thoroughly instructed in the diag nosis and treatment o f traumatic occlu sion. Research by Box, Stillman and M cC all proves that the first sign o f disturbance o f equilibrium by traumatic occlusion can be observed microscopi cally and, i f not corrected, w ill surely increase. The student should certainly be taught the use o f the microscope fo r the purpose o f recognizing these and early signs o f disintegration in other parts o f the mouth, and the proper pro cedure to prevent their development and recurrence. The demonstration o f the toothbrush on manikins and infirmary patients is a most important matter, and the stu dent should be taught how to demon strate to his patients the use o f the brush as advocated by Charters, Stillman and others. He should also be able to instruct them in the home care o f the mouth and teeth. I, therefore, recommend that under graduates be taught to conduct a thor ough prophylactic treatment, which shall include the above mentioned procedures. Did time permit, there are other phases o f teaching preventive dentistry that might be properly considered. I have simply suggested ideas which in my ex perience in practice, as w ell as in teach ing, have occurred to me as desirable o f general adoption and which in many schools are not given sufficient consid eration.