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of cakes and sweets, which stick around and between the teeth for up to an hour, are
broken down to acid within a few minutes. Thiti acid tends to be stabilised by the
saliva, and would not harm the teeth, if it were not for "dental plaque" or debris which
collects between the teeth and in fissures in the teeth, where normal cleaning and
mastication have little or no effect. It has been found from epidemiological observations,
that the absorption from the gut of fluoride ions and their presence in the
mouth, reduces the solubility of tooth enamel in acid.
Periodontal disease is closely related to diet and its refinement. Heret there is a
tendency for food to stick around the teeth, although the production of acid is not
important in this case. Periodontal disease is caused by toxins from bacteria in the
dental plaque seeping down into the crevice between the gum and the tooth and thence
through the epithelium to the underlying connective tissues. These toxins gradually
lead to the progressive destruction of the collagen fibres and alveolar bone supporting
the teeth. The crevice between gum and tooth becomes deepened to form a pocket in
which more debris and therefore bacteria can proliferate to accelerate the process.
From the latest available information it would appear that children's teeth in the
Borough conform very closely to the national picture of dental decay. Conventional
dental treatment consisting of the extraction of infected teeth and removing decay
from teeth and replacing it with a metal or synthetic filling has in no way prevented
or controlled the disease. Similarly deep scaling and polishing of teeth by the dental
surgeon can only hope to contain a condition which has been brought on by faulty
diet and oral hygiene.
The prevention of dental disease may be considered under the following headings:
(1) Public health measures, for the whole population.
(2) Social health measures, for specific sections of the population.
(3) Measures taken by dental surgeons.
(4) Measures taken by individuals.
(1) There is only one practicable public health measure at present, which is the
adjustment of the public water supply so that it contains 1.0 p.p.m. fluoride. There
are many different natural concentrations of fluoride in public water supplies. The
domestic water supplied to the Borough by the Metropolitan Water Board contains
0.20 p.p.m. natural fluoride as F. It cannot be claimed that an adjustment to 1 p.p.m. of
fluoride will solve the dental caries problem completely, but it would probably reduce
the incidence of dental caries by half. Fluoridation is relatively cheap and does not
depend for its efficiency on any measure of individual perseverance and there is no
proven evidence at present that it is harmful to health in any way.
(2) Dental decay is almost preventable by control of diet; unfortunately the foodstuffs
associated with dental disease are cheap, palatable and widely advertised. The
public is unwilling to give up pleasurable habits. It would be unrealistic to imagine
that widespread dental health education in the matter of diet would solve the problem
of dental caries unless public opinion as a whole had a change of heart. One of the
most dramatic examples of dental caries is the labial caries of deciduous teeth observed
in very young children. There is much circumstantial evidence to suggest that this
type of caries in children up to 2J years of age is due to the incorrect or over usage of
liquid vitamin C supplements. The vitamin preparations are maintained in an acid
sugar solution to prevent fermentation and their use in "dinkie" feeders or in comforting
bottles is strongly to be discouraged. Mothers are continually being advised
on the correct use and dosage of these supplements. A recent survey of schools in the
Twickenham area showed that biscuits, sweets, ice cream and mineral waters were sold
in classrooms, halls or playgrounds in 14 of 40 schools. The education authority was
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