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Psychosomatic dental disease: Is mental stress in adults followed by acute dental caries in all racial groups?
Medical Hypotheses Me&d tfypotkam (1993) 41,279-281 Q IJlnpmn Group UK Ltd 1993
Psychosomatic Dental Disease: Is Mental Stress in Adults Followed by Acute Dental Caries in all Racial Groups? P.R.N. SUTTON P.0. Box 60, Lorne, Victoria, Australia 3232
Abstract-The following data indicate that the onset of acute dental circles in adults, following severe mental stress, is seen not only in people of European stock but also in Polynesians and Micronesians. This suggests that this reaction to stress might occur in all races.
Introduction Acute dental caries is not usually present in adults. It is characterized by the presence of a white halo around the cavity and soft yellowish-white dentine. In 1960, during routine semi-annual dental examinations of adults, using a mouth-mirror and probes, in a private practice in Melbourne, acute dental caries was observed, within 2 days, in 6 adults who were more than 40 years old. In 5 cases it was known that they had recently been through a period of severe mental stress. Therefore, a study was set up to test whether the onset of acute caries in adults was related to the presence of mental stress (1). The subjects comprised every Australian, of European stock, presenting for examination during the period of the study. Although the association between mental stress and the occurrence of acute dental caries was, statistically speaking, highly significant @zO.OOl), this association was disbelieved in dental circles, despite the fact that the finding was in agreement with the then-recent animal studies in which the prevalence of den-
tal caries increased following stress induced by such practices as confining the test animals in small cages (2) or by subjecting them to the sound of a loud bell (3). The general opinion of dental scientists appeared to be that this suggestion was not only unorthodox, but outlandish. Therefore, 2 years later a similar study was conducted on different patients (4), making a to tal of 1339 subjects. The results of the two studies were remarkably similar (1, 4, 5). In both cases the association between stress and acute dental caries was highly significant (pcO.001). In addition, in the last 141 subjects (78 females and 63 males) with acute caries examined, the regressions were calculated, estimating the duration of stress in months (y) from the assessed age of the cavities (x), judged by clinical experience of such lesions. These were: females y = 0.1840 + 0.9244x and males y = 0.1442 + 0.9166x (4). Because of the limitations of the methods used, caution should be exercised in interpreting these results, but they suggest that in these subjects there was a close relation between the time of commencement of the stress and the onset of acute
Date received 21 October 1993 Date accepted 7 January 1993
279
280 dental caries, and that these two events were separated by a period of considerably less than 1 month. An editorial in The Lancet in 1987 (6) reported that the results of observations on natural killer cell activity ‘...imply that it is the individual’s response to the stress that determines the effect on immunity rather than the stress itself’. This was observed in both the original studies (1,4). A number of subjects who had experienced a series of stressful events over a period of years did not develop acute caries following recent stress. It was as though they had developed a certain degress of tolerance to a stressful situation. Several years after the second study, whilst studying the subject of stress at the Maudsley Hospital, London, a pilot study on 100 subjects was set up to test the possibility that the presence of acute caries could be assessed with some accuracy from the answers to self-administered questionnaires (7). All these English subjects were unaware of the object of the investigation and all were strangers to the investigator. On the advice of psychiatrists at the Hospital, stress was assessed by the answers to the questions in the Recent Life Change Index which had revealed that life changes had been found to precede major health changes. Also, the subjects were asked 12 additional questions regarding recent periods of anxiety because of illness, home building, finance, overwork, marriage, employment, family and interpersonal problems. The assessments of the presence of acute caries were correct for 39 (72.2%) of the 54 individuals who had acute caries in one or more teeth, and for 33 (71.7%) of the 46 patients who did not have acute caries @
MEDICAL HYPOTHESES
At that time there was one obvious cause of stress: 3 months before their dental examination all of them had been told that, because the deposits of phosphate rock were almost exhausted, they would lose their jobs and be returned to their ‘home islands’. According to the Polynesian and Micronesian medical staff, the prospect of this move appeared to have been accepted more calmly by the women than by the men, many of whom had lived on the island for many years and had become accustomed to the considerable benefits of living there. The young unmarried adults showed much less concern. These differences in the acceptance of this imminent upheaval in their lives was reflected in the prevalence of acute caries which was seen in 39% of the males aged 35 years or more, in 15% of the females in that age range, but in only 10% of the younger females and 8% of the young males. These differences were significant-between males and females @
PsYCHOSOhfATIC DENTAL DISEASE
vances in Oral Biology 2. New York: Academic Press, 1966: 101-148. 6. Editorial. Depression, stress and immunity. Lancet 1987; 1: 1467-1468. 7. Sutton P R N. ‘Ihe use of anxiety questionnaire to assess the presence of acute dental caries. J Dental Research 1973; 52:
281
579-580. 8. Irwin M, Smith T L, Gillin J C. Low natural killer cytotoxicity in major depression. Life Sciences 1987; 41: 2127-2133. 9. Sutton P R N. Is the ingestion of fluoride an immunosuppressive practice? Med Hypoth: 1991; 35: l-3.
Psychosomatic Dental Disease: Is Mental Stress in Adults Followed by Acute Dental Caries in all Racial Groups? P.R.N. SUTTON P.0. Box 60, Lorne, Victoria, Australia 3232
Abstract-The following data indicate that the onset of acute dental circles in adults, following severe mental stress, is seen not only in people of European stock but also in Polynesians and Micronesians. This suggests that this reaction to stress might occur in all races.
Introduction Acute dental caries is not usually present in adults. It is characterized by the presence of a white halo around the cavity and soft yellowish-white dentine. In 1960, during routine semi-annual dental examinations of adults, using a mouth-mirror and probes, in a private practice in Melbourne, acute dental caries was observed, within 2 days, in 6 adults who were more than 40 years old. In 5 cases it was known that they had recently been through a period of severe mental stress. Therefore, a study was set up to test whether the onset of acute caries in adults was related to the presence of mental stress (1). The subjects comprised every Australian, of European stock, presenting for examination during the period of the study. Although the association between mental stress and the occurrence of acute dental caries was, statistically speaking, highly significant @zO.OOl), this association was disbelieved in dental circles, despite the fact that the finding was in agreement with the then-recent animal studies in which the prevalence of den-
tal caries increased following stress induced by such practices as confining the test animals in small cages (2) or by subjecting them to the sound of a loud bell (3). The general opinion of dental scientists appeared to be that this suggestion was not only unorthodox, but outlandish. Therefore, 2 years later a similar study was conducted on different patients (4), making a to tal of 1339 subjects. The results of the two studies were remarkably similar (1, 4, 5). In both cases the association between stress and acute dental caries was highly significant (pcO.001). In addition, in the last 141 subjects (78 females and 63 males) with acute caries examined, the regressions were calculated, estimating the duration of stress in months (y) from the assessed age of the cavities (x), judged by clinical experience of such lesions. These were: females y = 0.1840 + 0.9244x and males y = 0.1442 + 0.9166x (4). Because of the limitations of the methods used, caution should be exercised in interpreting these results, but they suggest that in these subjects there was a close relation between the time of commencement of the stress and the onset of acute
Date received 21 October 1993 Date accepted 7 January 1993
279
280 dental caries, and that these two events were separated by a period of considerably less than 1 month. An editorial in The Lancet in 1987 (6) reported that the results of observations on natural killer cell activity ‘...imply that it is the individual’s response to the stress that determines the effect on immunity rather than the stress itself’. This was observed in both the original studies (1,4). A number of subjects who had experienced a series of stressful events over a period of years did not develop acute caries following recent stress. It was as though they had developed a certain degress of tolerance to a stressful situation. Several years after the second study, whilst studying the subject of stress at the Maudsley Hospital, London, a pilot study on 100 subjects was set up to test the possibility that the presence of acute caries could be assessed with some accuracy from the answers to self-administered questionnaires (7). All these English subjects were unaware of the object of the investigation and all were strangers to the investigator. On the advice of psychiatrists at the Hospital, stress was assessed by the answers to the questions in the Recent Life Change Index which had revealed that life changes had been found to precede major health changes. Also, the subjects were asked 12 additional questions regarding recent periods of anxiety because of illness, home building, finance, overwork, marriage, employment, family and interpersonal problems. The assessments of the presence of acute caries were correct for 39 (72.2%) of the 54 individuals who had acute caries in one or more teeth, and for 33 (71.7%) of the 46 patients who did not have acute caries @
MEDICAL HYPOTHESES
At that time there was one obvious cause of stress: 3 months before their dental examination all of them had been told that, because the deposits of phosphate rock were almost exhausted, they would lose their jobs and be returned to their ‘home islands’. According to the Polynesian and Micronesian medical staff, the prospect of this move appeared to have been accepted more calmly by the women than by the men, many of whom had lived on the island for many years and had become accustomed to the considerable benefits of living there. The young unmarried adults showed much less concern. These differences in the acceptance of this imminent upheaval in their lives was reflected in the prevalence of acute caries which was seen in 39% of the males aged 35 years or more, in 15% of the females in that age range, but in only 10% of the younger females and 8% of the young males. These differences were significant-between males and females @
PsYCHOSOhfATIC DENTAL DISEASE
vances in Oral Biology 2. New York: Academic Press, 1966: 101-148. 6. Editorial. Depression, stress and immunity. Lancet 1987; 1: 1467-1468. 7. Sutton P R N. ‘Ihe use of anxiety questionnaire to assess the presence of acute dental caries. J Dental Research 1973; 52:
281
579-580. 8. Irwin M, Smith T L, Gillin J C. Low natural killer cytotoxicity in major depression. Life Sciences 1987; 41: 2127-2133. 9. Sutton P R N. Is the ingestion of fluoride an immunosuppressive practice? Med Hypoth: 1991; 35: l-3.