7
'. DIET AND DENTAL DECAY By DR. JOSEF E CALER IJ (I I'/rye ",,,"ber oj II"rre: (} he oaked wllat kiPld oj proJe.,sioPlol Ireol- mc"l lit/(1 mosl jre'll/ellt/y "",I,·r:I'I/'r. 11,e rcplle.. wo,,1tI IlIldoul.t dly hott, tl"'l our tile/ii r 'II/Ire 1Hore auell/Jutl tI,r", '"ly ",he,. jll'lrt ()f VII' IJt)(/!I. Jl/'OI!J peQpu 0'1'0 du 1lv' yo (v 8('. {I dlJc/(Jr for y(ur."l !III rfy"lurl!J tu 11)/'1', del/tist. U'II!I i.• ;1 Ihol, oj /Ill t"e orgflll.< II"il" wll/e" 11"" lu,,'c I'ct'll '1uipp d I,y Salllre, our It'CI" W'O tlw UI/t'8 to Jnil U8 //lU81 0Jltllt A II itlt rcalin!! reply 10 Ih ilJ quc li"l1 i.< !lit·o, hy J)r. I';..rhl r, nil 0Ilt"t"ru1ill{! OerllloPl denial 8p€{;ia/i I ,diD ,i. ul 1)r ,elll ill Tokyu 1"r Ihe }J'lrl"'. oj re orrh. II rcai('NI hi" IJcielllific Irainillg fit Ih' UC1'II'fllI 1\orl l' "i.·, ,.,../I!! '" P"'f/IlC /I wel/ 'I" tit ",,,lIcrul/ ill lituJio'l8 G"d clillic"!. IlIcidcPltlllly. Dr. I,· ..,.h,,"r "I.,,, "1,,.'1 d (/ ']X,,.t in 'I.e of til I:Ud'J'1 () rmtlnJf for Iii ir illrlusioll filtH tile (JrrJltll1l H 1(-", He I/"h' f/ 1>oIi/icai lead r oj the, 'I/drtnl Verma" Party; in ,s,ple,."bu }'1]8 h< ,m<l cOlld '11"11 d lu be <lhol by Ih Cz ch ,"ilitury u/(II,orlli£d bill W/(II Jreed by Ih, .\1 1I1I,,.h (I'Jr IJI lit. /lis sciclllific 1)lIbl'WlioJl/', "",,,berilly 'Jlor IIr"" Ihifly, de«l "!,i,jly .cil" IlOlle hislfJloyy alld Ihe ",,,i"lc,"/"ce uJ l'lclh.-l\..Jl. T HE word" arier.;" lllean decny and i u 'ed in nwdieine fur dil:leM.:ed condition" of l)unc and teet h in which thc' oth('rwise hard organ' IJc- comc s ft Hnd di. ..;int·grate. The call' for tllis dccay. IIIJwl'\·cr. are different. in the case of bllllL'/' 'lnd t cth. In the l:a:-;o of the furmer. caries i' caused II.\' cells which eat •.t\ruy tlle vOile. ,,0 that the hune is replaced hy n .'oft. chees\' tissue Iin hie to in tia nlmat iOIl. Dental cU;'ies nriH's from other CHUH'.-. Herc we do not find any body cells eating away the touth; JIlOreo\·er. this is illl- po.. ince tho'e varts of the teeth which are at tnc·k,d by caries projc·t freely into tho oral cadty. and their exterior surfaces arc fonned not. by cells Lut by cell-Ie,'.:s, hard tissue: enlunel. 011 the whole. the ideas of the old (:"'1'- man .'cienti:st are still valid, nameh-, that d ntal caries is cau 'ed h\' eN;clltially proCell 'es. The stlb. tances of the t.eetb, the enamel as well as the den t ille. grad. ul:1,lly ·oft·en through lbe ('fleet of a.c-ids and bacteria. J n their place l here re- mains a soft n1l1i'S con. isting of hnl'leria. food particles, and the remaining !'I)ft 'ned enamel and dentine substance -which is then lowly washed away. Fina.IlY, when til, crown of the tooth has thus decayl'd und the caries ha.· ·tart d t affect th r/Jot. the whole to th i, Iv t. A UI.'t::AfolE OF Dental cnril'l-' CIlU. d In' many f<lrton;. sume of which play a hig rul and some a \es::;er une. Faulty did hu. long I,een hlanlec! as being OIW ,)f the Illu-in n'IlS0llS for till' trcnlcnd.lils i4Jlread of dcntal decay which. during th In .. t fe\\" centurie". hUl-lll""Umed the prop rtions of a world-wide dLease. The "tud\' uf the teeth and ,.kulls of our anccst(;rs. tho. e m Ide by the l:ermun scientists Euler, Crcth, ete., ns well as various experimental stndie,., have greatly contributed to\\"ard faulty diet nuwadays being regarded 1\.8 a vcry important if not the mo. t importunt factor for thi.' disea ·e. Indeed. in view of the good condition of the teeth of ancient mun and the rare u('currellec f dentalcariell. Eulc-r con"id r. th chan cd diet ClIU>'l,d by t he cultural and tc,.,!lnical dc\-elnprncnts during tbe la·t centuries as the ('hid factor. The onrcgian Toverud and other' have olJen:d mHny examples whi 'h prove that not until the last few decades, imultaneously with the can tl'uetion of road', tbe improvement of COffilllUDica-

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'.

DIET AND DENTAL DECAY

By DR. JOSEF E CALER

IJ (I I'/rye ",,,"ber oj J>~"/,I,' II"rre: (} he oaked wllat kiPld oj proJe.,sioPlol Ireol­mc"l I"~y lit/(1 mosl jre'll/ellt/y "",I,·r:I'I/'r. 11,e rcplle.. wo,,1tI IlIldoul.t dly hott, tl"'lour tile/ii r 'II/Ire 1Hore auell/Jutl tI,r", '"ly ",he,. jll'lrt ()f VII' IJt)(/!I. Jl/'OI!J peQpu 0'1'0du 1lv' yo (v 8('. {I dlJc/(Jr for y(ur."l 1Ir,·rrlhrle."',~ !III rfy"lurl!J tu 11)/'1', del/tist. U'II!Ii .• ;1 Ihol, oj /Ill t"e orgflll.< II"il" wll/e" 11"" lu,,'c I'ct'll '1uipp d I,y Salllre, our It'CI"W'O tlw UI/t'8 to Jnil U8 //lU81 0Jltllt

A II itlt rcalin!! reply 10 Ih ilJ quc li"l1 i.< !lit·o, hy J)r. I';..rhl r, nil 0Ilt"t"ru1ill{!OerllloPl denial 8p€{;ia/i I ,diD ,i. ul 1)r ,elll ill Tokyu 1"r Ihe }J'lrl"'. oj re orrh. IIrcai('NI hi" IJcielllific Irainillg fit Ih' UC1'II'fllI 1\orl l' "i.·, ,.,../I!! '" P"'f/IlC /I wel/ 'I"tit ",,,lIcrul/ ill lituJio'l8 G"d clillic"!. IlIcidcPltlllly. Dr. I,· ..,.h,,"r "I.,,, "1,,.'1 d (/ leadi,~t

']X,,.t in 'I.e ~trflg(//~ of til I:Ud'J'1 () rmtlnJf for Iii ir illrlusioll filtH tile (JrrJltll1l H 1(-",He I/"h' f/ 1>oIi/icai lead r oj the, 'I/drtnl Verma" Party; in ,s,ple,."bu }'1]8 h< ,m<lcOlld '11"11 d lu be <lhol by Ih Cz ch ,"ilitury u/(II,orlli£d bill W/(II Jreed by Ih, .\1 1I1I,,.h(I'Jr IJI lit. /lis sciclllific 1)lIbl'WlioJl/', "",,,berilly 'Jlor IIr"" Ihifly, de«l "!,i,jly.cil" IlOlle hislfJloyy alld Ihe ",,,i"lc,"/"ce uJ l'lclh.-l\..Jl.

THE word" arier.;" lllean decny andi u 'ed in nwdieine fur dil:leM.:edcondition" of l)unc and teet h in

which thc' oth('rwise hard organ' IJc­comc s ft Hnd di...;int·grate.

The call' for tllis dccay. IIIJwl'\·cr.are different. in the case of bllllL'/' 'lndt cth. In the l:a:-;o of the furmer. cariesi' caused II.\' cells which eat •.t\ruy tllevOile. ,,0 that the hune is replaced hy n.'oft. chees\' tissue Iin hie to in tia nlmat iOIl.

Dental cU;'ies nriH's from other CHUH'.-.

Herc we do not find any body cells eatingaway the touth; JIlOreo\·er. this is illl­po..~iblc ince tho'e varts of the teethwhich are at tnc·k,d by caries projc·tfreely into tho oral cadty. and theirexterior surfaces arc fonned not. by cellsLut by cell-Ie,'.:s, hard tissue: enlunel.011 the whole. the ideas of the old (:"'1'­man .'cienti:st ~Iillcr are still valid,nameh-, that d ntal caries is cau 'ed h\'che\lli~ul-vumsilical. eN;clltially Laett'riL~lproCell 'es.

The hard-ti~su stlb. tances of the t.eetb,the enamel as well as the den t ille. grad.ul:1,lly ·oft·en through lbe ('fleet of a.c-idsand bacteria. Jn their place l here re­mains a soft n1l1i'S con. isting of hnl'leria.food particles, and the remaining !'I)ft 'nedenamel and dentine substance -whichis then lowly washed away. Fina.IlY,

when til, crown of the tooth has thusdecayl'd und the caries ha.· ·tart d taffect th r/Jot. the whole to th i, Iv t.

A UI.'t::AfolE OF Cl\"TLIZATIU~

Dental cnril'l-' I~ CIlU. d In' manyf<lrton;. sume of which play a hig ruland some a \es::;er une. Faulty did hu.long I,een hlanlec! as being OIW ,)f theIllu-in n'IlS0llS for till' trcnlcnd.lils i4Jlreadof dcntal decay which. during th In.. tfe\\" centurie". hUl-lll""Umed the prop rtionsof a world-wide dLease.

The "tud\' uf the teeth and ,.kulls ofour anccst(;rs. &'pecialJ~' tho. e m Ide bythe l:ermun scientists Euler, Crcth, ete.,ns well as various experimental stndie,.,have greatly contributed to\\"ard faultydiet nuwadays being regarded 1\.8 a vcryimportant if not the mo. t importuntfactor for thi.' disea ·e. Indeed. in viewof the good condition of the teeth ofancient mun and the rare u('currellec fdentalcariell. Eulc-r con"id r. th chan cddiet ClIU>'l,d by t he cultural and tc,.,!lnicaldc\-elnprncnts during tbe la·t centuriesas the ('hid factor.

The ~onrcgian Toverud and other'have olJen:d mHny examples whi 'h provethat not until the last few decades,imultaneously with the can tl'uetion of

road', tbe improvement of COffilllUDica-

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25-& THE XXtb CENTURY

tions. and the progre of engineering,did dental caries appear, together withcivilization, in certain remote locatitie .

For civilization has dlllnged man sdiet. Th modern cooking tove andbakin oven finer griJ1(ung of wheat,poli hing of rice, baking of white brendand cakes, etc., made their triumphalentry. All the e thing wh..ic'h are general­ly considered to mean great progre sreprcf>ent, however n. certain drawback,at lea·t with regard to the health ofhumlln teeth. Teeth were created forchewillg; they are meant to be u ed toma.sticute food. But what clid the above­mentioned progress lead t01

The original primitive fireplace grad­ually developed into the modern gas orelectri to,e or large coal range. Allfood mu t now be co ked until it is oft;otherwise it is unpaIntable to modernman. It need hardly be emphasizedthat long cooking de troy the vitaminsand mineral. Of cour 'e, we do notmean to imply that the coking stovehould b done away with. But we do

recommend the sparing use of the flame,wh.ich otherwi e de kovs the most valu­abl Bubl:!tances. Many kinds of vege­ta,bl and fruit can be eaten raw; otherscan be mude palatable by steeping themin boiling water or parboiling them.

good enough for fodder. Although breadbecomes darker through a larger brancontent, it 0.1 0 becomes more nouri hingand-what is more importan~ontains

ub t,ances e ential to the building upof the human body. It i significantthat the German authorities hltve inrecent years prohibited the fine grindingof flour.

The mill was followed by the bakerand his oven to make the nice white floureven more palatable. But by t.his pr cessadditional es'ential body-building ub­stances, vitamins and mineral, whicheven the fine flour still contained, were lost.

'Ve know for certam now thut allthese proces es of modern food prepara­tion de troy l:!ub tances which nre e sen­tial to the formi.ng of hard te th. .-\sthe hardness i the result, of good ca.l­cification, one might assume t hat theplentiful addition of calcium suIts invarious forms uch as Ka.)zana, Cal ipot,Calcium Sandoz, etc., to the diet shouldsutlice for the formation of hard, well-alcified teeth. However in order for

the human body to benefit properlyfrom the e calcium ~a1ts, other sub tancesare needed. On the other hand, theage at which calcium and such othersubstances arc gi\'en plays an importantpart.

FILLINGS DO 1'0T erRE

As can be seen from FIG.J, the teeth are formed inthe jaw. They are formedhere by cells; the enamelfor instance, the hardestand outermost layer of thocrown by the amelobla ·ts(enamel-secreting cells)which, however, perish justbefore the teeth breakthrough the gUIDS. ThuBenamel can no longer beproduced once the crownhas appeared in th oralcavity, and hence can neverbe replaced after havingbeen destroyed by caries.The dentine under theenamel al '0 cannot be

0­0-

FIG. 1 DonJopment of tllcteeth: mllk tooth (right)and pennanent tooth (left,behind the milk tooth)

Ul - muooua membrane of thenKJutJl

j - ja"'bonoB - ameJoblwa (celis ....hlch

lleCreW !J.., cllAllIcl)c- enamel0- odolllobhUlta (cells ...bleb

secrete the deuUue)d - denUueD-Der\·,

WJIlTE DREAD: E.XE n' 1\0. I

Another technical ad­vance is represented bythe milll;, baIting ovens, andbakerie. The early stonemortars developed into millsequipped with intricate mR.­chinery, with the exprcsapurpose of removing amuch bran-and with itvitamin and minerals-lUIpo ible from the grain. Ofcour~e, it is easier to makecake and white brcan,preferred by so manypeuple, from such whitefI ur tha,n from the darkerflour that has not beenground 80 fine. And branis considered just about

-------------'-'..::J

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DIET AND DENTAL DECAY 255

replaoed after it has been de troyed bycarie. Thus a hole in the enamel andin th dentine will always remain fL hole.If it is not treated, it will become larger;but in no circumsta.nces will it everbecome smaller, much less be filled inby enamcl and dentine, in contrast t.othe healinll' of wound , which latter takepla,ce \Jy new ti"'slIe being formed amithe defect being filled in by tlli. newtissuc. Hence wo are forced to fill indefects in the tooth by artificial meanssuch a' fi.llings, inlays, crowns, etc. inorder to prevent the caries from prca.d­ing.

But can this be called curing? Forfirst of all we are even obliged to enlargethe hole in order to provide a durablefoundation for the filling or the crown.Then we ·top up the hole with a foreignsubstan e that is often harmful to theti . ue exerting a very muavorable in­fluence on the cell activity in the nerveof the tooth and sometimes entailing thedestruction of tbe cells. Indeed, we arenot even able to remove a sinlple in­flammation of the nerve---an intln.mma­tion that can be cured everywher·· eh;ein the botly while the tissue is' maintainedor replacc-d-without remo'i'ing the nerveitself and replacing it lJy au artificialdisinfe ·ting substance. Sometimes themost minute damage by substances wbichapparently do not ha,flD the tissues Jllaystill cause serious phy ical defects aftera number of years. \Ve need onlymention the focal iluection caused bynerve deadening.

What, nfter all, is a filling or a crown.however skillfully made, but a diminutiveprosthe is, with all itA advllJ1tllgca anddisadvantages? The purpose of this shortdigrcBl:!ion is only to empha-size our fur­ther remarks on the significance of acorrect diet for the maintenance of soundteeth.

WEEN '1'0 DEOUi

How can dental caries be preventedor at lea t reduced to a. minimum? Sinceit i a general beuef that, t.he harder atooth is the greater is its resistance,people hope to a.chieve such hard, caries·

resi tant teeth by feediJlg children suf­ficient calcium. How often do we hearfrom mothers that their children hnvebeen fed calcium ince birth or iJl('ethey were weaned. And when wo askwhat quantities of calcium ha\'c beenfed every day, we are told incrcf Ii bleamounts, as if fifty per cent of the humanbody were compo cd of calcium. In mo~t

ca 'es it i added to the diet in its pure tform, a mixture of calcium carbonate andphosphate of lime. This is done in theassulll ption that this pure calciumis used by the bOOy entircly to build upbone' and teeth. Yet at the age offive or 1....-: the child. ometimes bits not asingle ound tooth in its mouth. Thisfact, in turn, is often the cause of in­creased doses of calcium. and the mothersare surprised that the teeth continue toget wor e in spite of tills. Tbus thereason is not a la.ck of calcium alone,but of other sub tance which arc ableto deposit the calcium at those plRces ofthe body--especially the bones and teeth-which require it. The fact that thefeeding of calcium i often not lJe ununtil some considerable time alter IJirthis an added rea~on why so many childrensuffer from caries.

Knowing how and where the teethare formed, we must make every effortat the first indicat.ion of the forming ofteeth, not only to prevent a In'k ofcalcium in those cells, but al 0 to providethe necessary means that allow the bouyto absorb the available calcium. FlO. 2shows that the first indications of thecalcification of the milk incisor teethappear in about the sixth month ofpregnancy. During the eighth month ofpregnancy, the crowns of the.-milk molarsalso bogin to ca,lcify. Thus it is ncccssaryto begin at least at this period of thechild's development to provide sufficientcalcium to enable the teeth-forming cellsto pass it on to the hard-ti ue sub tancesof the teeth. But it is advisable to startthe feeding of calcium even earlier.

CALCIUM IS NOT L'OOUGH

However, as we have said before, thiscalcium alone is not enough to build up.

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256 THE XXth CENTURY

040 .......

caries throughout life. A hard enamel,produced by the simultaneous feeding ofcalcium and vitamins, thus represents atleast a certain guarantee for the main­tenance of sound teeth.

BIRTH AND ITS EFFECT

The most threatened tooth, the onethat most frequently suffers from caries,is the first permanent molar, whichappears at the age of five or six. Itadjoins the milk teeth, and for thatreason a caries of the milk teeth oftencauses contact caries of the permanentmolar. If only because of the possibilityof contact caries, decaying milk teethshould not be left without treatment.

However, in our opinion there is anadded factor, not to be lUlderestimated,which is responsible for the pronouncedtendency toward caries of the first. per­manent molar. Fro. 2 shows that themilk molars and the first permanentmolar are at the stage of stronge tdevelopment at the time of birth. Sincebirth means a tremendous change for thechild in its nourishment-while the childobtained its nourishment in preparedform from its mother up to the time ofbirth, it must now suddenly rely uponitself and extract the various substancesfrom its food-even a small deficiency ofthe substances needed for the calcifica'tionof bones and teeth will make itself feltespecially in the above-mentioned threeteet.h. The fact that the food BU b­stances are not fully made use of by thechild can be seen from the loss of weightthat always takes pla.co in tho first twoweeks of life. Thus for this reason, too,it is absolutely necessary for the motherto take sufficient quantities of vitnmillSand calcium before birt.h so as to providethe child with a certain reserve for itsfinlt few weeks of life.

The more the child's food consists ofsubstances which easily produce hyper­acidity of the blood, the more calciumand vitamins should be given. Thechief of these substances are carbohy­drates and cereals rich in carbohydratos,such as corn, oatmeal, and rice. Thuswhen babies are fed cornflour, porridge,

--'iiM,. ., -.

'P4'_ I'

OJ." .. \~t ..... ., .~ ...0At..1 --t:Jtj~

B

, ,...,. ----m..--u

... ) ... o ...~_~

}'IO. 2 Calcification of the «>cth(A) of the milk tt.'Ctll(Il) ot Hie pcrlllwumt t{lCUI

hard bones and hard teeth. We cangive a child as much calcium as we like,.and yet that child will develop seriousdental caries if the other factors arelacking. For, although the calcium isabsorbed by the process of digestion, itis not made use of for building-up pur­poses but passed out in its originalquantity if there is a lack of vitamins.'The best example of this is rickets, whichwe can neither prevent nor curc by thefcerlulg of calcium. And yet it is charac­tcrized by calcium deficiency of thebones. Experiments have proved that,together with the calcium, sufficient-quantities of vitamins must be given inorder to enable the cells in question toabsorb the calcium. Indeed, the vita­mins alone are often enough, as long a.sthe ordinary diet contains sufficient.quantities of calcium.

Thus the process of the calcification ofthe teeth consists, not in a simple cal­cification, but in a complicated processoften called mineralization. The hard­tissue substances of the teeth are at first.aecreted o,B Boft tissues, which then beginto mineralize. In the course of tlusmineralizing, certain changes take placein the tissuoe, cho,ngce which makc itimpossible for us to assume a simpledepositing of calcium. Thus we mustdefinitely begin to add calcium andvitamins to the diet as soon as the cellsbegin to secrete the hard-tissue substances.The forming of the enamel, for instance,is not completed until shortly before thetooth breaks through. The enamel formsthe outermost covering of the tooth andis supposed to protect the tooth from

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DiET A_'W DE:NTAL DE A Y 257

.and rice. n.Icium and vitamins houldbe added to the diet to provide a artainbalun e. i. . to provide the blood \\-ithuffici nt . nb_tancc which can b mo­

bilized to prevent th flll'mation of acids.

WIDCR VITAMI!'s1

Let u. f:OY a few word a. to which ith mosl in;portant vitamin fur th for­ma.tion f o-called hard t eth, and whichfood items contain th neec sary vit<lIninamI calcium.

The formation of the teeth is perhapthe best exa.mple of the neces it.y ofalmo·t all the \ritarnin. It is a. well­known fac that an infant cannot bebrough t up, \\ri thou t fall ing ill, if one orthe oth I,' vitamin is lacking. For theabsorption of calcium and for the ~trong

minera,lization of the enamel, Vitamin Dis the mo·t important. But clo ely boundup with it is Vitamin A, which is neededfor the be t po sible absorption of ca.lciumbv means of Vitamin D. Both thesevitamins nre contained together III naturalfi h-liv l' oil. -ext in importanoe isVitamin " which is n eded especially forthe cal ification of the dentine. TheB vitamin on the other hand ar ofminor importance ill lhe formalion ofthe teoth. ~Ioreover, they are containedin almo:t \'ery item of wet.

Vitamin D is probably the rare t ofaU .. inc it i to be found only in butter,milk. egg yolk mu broom, and tish­liver oil. I'lometillle it is also fonnd innark-hued fruit. Vitamin A is plentifulin egg yolk, milk, butter, and Ii h-liv \.oi1. Nor must vegetable be forgotten,which contain an abundance of Vit.aminsA and C. Raw egg yolk is one of themost important carriers of vitamin.\ itamin C is contained in large qUlLntitiesin almost all vegetable and fruit, eape ial­ly in I mon.. par ley, oraneres, lettuce,radish , all kinds of berries, and rawp tato .

The calcium content of the varioufo()d~tllfi': differs greatly according torerrion. Among tho e richest in cal iumare ch cs , milk. lemon , oranere , nuland I Huce. • everthele . it is alway.ad\'i able to add mall quantitie of

cal ium preparations even to a diet con­sisting of the above-mentioned it.em

DOOS AN D S GAR

Quite often the feeding of sugar isregarded as a cause for dental cariesdurin the development of the t thoAlthou h experimen on animals cannotalway b applied to humans, they tillpermit certain com pari ODS. Ja.pane escientu ts have been able to pI' dueeadvanced dental caries in dogs b. addingsmall quantities of Bugar to their diet.The G rman scientist Harndt, 011 theother hand. was able in his counter­ex perinI nt to show, if not the oppo ite,at least that the addition of sugar to thediet i of no important influence Oll thedevelopm nt of denta.l caries. AU thepuppies of these ugar-fed parent hadnormal t th, even when they con till uedto be fed with sugar long after birth.

In our opinion the cau e for these oon­trasting re:ults is to be found elsewhere,at Any rate not in the fact that thefeedin of ugar alone re ult in a redu edmineralization of the teeth. For theother inJlu nee of envil'lnment whichaffect n th dog in hoth ea e. weI'entirely diffcrent. hove all, the re­maininer di t. differed entirely. Whil thedogs in the German xperimen werefed "eal I one in addjtion to their ugarthe Japan e dog weI' fed with a mu hof rice containing a little vegetabl Ilndcut-up meat. Thi brings us to anotherimportant point of diet and its signif­icance for dental carie..

DA~OERO 'S CREVlCES

The \-eal bone gave the dogs an oppor­tunity to mfl.Sticate properly; at the sametime they provided the neces ary calciumand ntamins. In th ea'e of th Japa­ne e dog, the e item. were m' ing.Moreo" r. a mush cliet i one of thefactor cau ing carie, e pccially when themush cOIl~i·t . of carbohydrate', as i' thecase with rice mush. Mush obviatesmastication. Furthermore particles oft.he mu h very ea il) l' main at c rtnillplace in the teeth, where the acti\'ity ofthe ever-pre ent ba teria cause them to

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268 THE XXth CENTURY

decay. Especially in the case of humanteeth there are numerous such placespredisposed to caries. If, on the otherhand, we are forced to chew hard foods,these places are automatically cleansedin the course of mastication.

The places mo t predi posed to cariesare fine crevices on the chewing surface,the surfaces where the teeth adjoin, andthe places just above the gum. Heresoft particles are depo ited and remain;they form a fertile soil for bacteria. Theacid thus formed, together with theactivity of the bacteria, then destroythe ennmel and finally atta,ck the dentine.The energetio chewing necessitated byha,rd foods cleanses these places andremoves such remaining food particles.

.All this goes to show that small ad­ditions of sugar during the developmentof the teeth, i.e., up to the age of tweh-e,have no harmful effect on the degree ofcalcification and the hardness of theteeth as long as the main diet containssufficient vitamins and calcium and isotherwise healthy. A local effect ofsuga,r on the teeth does not take placeuntil they have come through, especially,as is usually the case, when the sugar isadded to a mush diet or is taken in theform of soft confectionery, which, al­though satisfying the appetite, lacks cal­cium and vitamins. Sugar forms lacticacid, which, in conjunction with bacteria"decalcifies the enamel and dentiJle andcau es carie. To this must be addedthat mushy food and soft bread and cakesrequire no mastication; instead of theurfaces of the teeth being cleansed by

chewing, food particles are left behind,c pecially auch food parliclel:! as form afavorable soil for bacteria. IncideutaUy,instead uf tmgar it is better to use honeyf r sweetening, 8-8 it contains ita.mins andbecause it produces formic aoid, whichhas a germicidal action.

THE LMPORTANCE OF CHE~O

Thus, in our efforts to prevent dentaldecay, we must fir t emphasize dietfactor which are e pecially importantduring the development of the teeth.The cells which build up enamel and

dentine must receive sufficient calciumand vitamins to enable them to formhard, well-calcified enamel and hard,faultles ly calcified dentine. And second­ly, there are the exterior influences whichare responsible for the development ofdental caries. Among these we havementioned mushy food rioh in carbohy­drates for infants, and cakes and con­fectionery for older children and grown­ups. In Germany aa well as in othercountries, school dental care haa producedgood resulta with the morning snackprovided for the children. The childreneat their snack together, and it consistsmainly of hard brown bread, butter orvitaminized margarine, milk, and fruit.This common meal has several purpo es.The hard bread is intended to force thechildren to use their teeth properly. Thefood cannot be swallowed as can mush,soup, or soft bread, but must be properlychewed. The jaws are strengthened; inthis way, a kind of morning gymnastics>of the masticating and facial muscles isachieved which baa a beneficial effect onthe position of the teeth and the shape ofthe jaw. At the same time the teethare cleansed be~ter than with a bru h,or rather the food particles have no chanceto be deposited at the caries-dispo cdspots. Moreover, the prolonged, thor­ough chewing stimulates the saliva; re­maining food particles are washed away,the well-masticated food surrounded withplenty of saliva and thus the carbohy­drate-splitting effect of the saliva fer­ments exploited to the utmost. Wellchewed is half digested! In addition,brown bread still contains sufficient vita­mins and, above all, the importantminerals. The fact that the children eattogether should alRo have a favorabloeffect on children who are slow at eatingand chewing.

Of course, the effect of mechanicalcleansing provided by the hard brownbread can also be produced by any otherhard food item. Among them, tho e arethe most preferable which also containvitamins, such aa apples (eaten raw withthe peel), raw carrots, kohlrabi, rusksand similar hard bakery products (such.

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SAILORS IN CO~\OYS 269

as the Japnnese sembe) made of coarseflour or cra ked wheat.

THE DEXTlST ~LEDS YO'(;"R HELP

Thus diet ha through ut life, indeed,even long be! re birth, an influ nee,often till undere timated, on the hard­n s of the teeth and th ir re8i tanceagainst caries. Not only the type offood r the ub tances add d to the dietare important, but also the preparingand the consi tency. It is not en ughto pay attention to one factor only. Ifa child, though stuffed with calciumpreparations and vitamins, is fed a lotof cakes and sweets in tead of at least

some hard foods that have not be ndeprived of their mo t important un­stances, its teeth will alway be threatenedby carie.

So we see that it is not within thepower of the dentist to exterminatecarie. All his efforts at maintainingthe health of the teeth are in vain unleevery ingle individual does his hare.In the whole wide field of public healththere are probably few imilar examplesto .how how, by following imple rulesof diet and living, a person may con­tribute to such an extent toward hisown health, the health of his children,and thus of his nation.

SAILORS IN CONVOYS

By ALBERTO Da CRUZ

Every day we read ill the nlllCitJXIpCr6 abollt the grim .lruggle laang placeb tlr en th .:llliw merchant fleet" and th AN () ·boaJ". .Jfany are thll account"of thill ittruggle .een throllgl. the ~e" of the pUriwer-the U·I>o<.t. BUJ we hardlykllow anything about how thi" struggle looks Ihrough the eye. of tIlll crew" of the pur·6UW Allied Jrciflhtcr.. III the Jollou.'ing article 1.1;11 pru ,tt an acco..,1/ of Ihi" duelCUI i4 ap~c.r. to them. How Ih mc.J rial for Ihi" article u''''' collected i.t told by thaauthor, a young Porlu(JUC81l jOllruali8t ill SI an(Jhc.i.-K..Jf.

WHEK the war broke out in thePa ilic almo t two years a'o itperformed a bloodl operation

in segregating for the duration a fewhundred 'candinavian allor from the ~ a.The war cut a wathe through their rank ,and to many of them it meant wakingup one Monday morning and realizingthat Shanghai wa to be their enforcedhome for as long as ho tilities might la t.A few accepted this uncertain period ofidleness as a ble"~ing to re tore themfrom war wrecks to a under balance fmind, but many inwardly re~ented beingdeprived of their natural element, the ea.

I am staying in a. place where a numberof the"e sailors have made their home.It ha not be n hard to get to knowthem well, as sallor are the frienclliestpeople alive, if you under tand theirmoods and lea,e well en u,h alone.They represent most of the northernEuropean countries whose young men

have taken to the "'ea, and almost allhave een war enice in one way oranoth r before being tranded so un­ex pectedly in Shanghai.

They I\.rC all neutral merchant ailorswho are not connected with the Alliedna'ies. From the way they expre stheir di 'like for navies in generalyou feel that there is too muchri"alry betw en them to make mutualfellowship pos iblc. Even the long part­nership of Janger that followed theoutbreak of the war in Europe ha notbrought about a relaxing of this ome­what instinctive di like. The e mer hantallors a.ppear to have a notion that too

much credit i given to the navy whenthey, too, have met with COt iderablehazards in the course of their war· timeduty.

They are a bunch of hardy fellow whohave been through it all. The intervalbetween the outbreak of the European