X-rays and toothache prevention 1925
This is the text of an article published in 1925 to promote the new
“bitewing” brand x-ray film packets that Kodak had just patented.
Much of this article reflects science which is outdated, and some of it
reflects problems that have just this last couple of years been solved.
But the entire article is a snapshot of the possibilities that the
dental arts have been trying to get the general public to adopt since
the time when the world was populated by former slaves and confederate
soldiers!
The period when dentists were transforming from “barbers with pliers”
to “tooth doctors” is reflected here. The italics are mine.
What can we prevent?
First of all, what can preventive dentistry prevent? Can it
prevent decay of teeth? Most articles written under the title of
prevention are written on this assumption. The pain fact is that
the best dentistry can do for the man, woman or child already
born and in possession of teeth is to say: “Eat a good mixed
diet, and keep your mouth clean. This will tend to lessen decay,
but, if you are an average person, it will not prevent it
altogether. So, watch out.” The only thing that can be added to this in the year 2002 is, “fluoride”.
Toothache preventable
If we cannot prevent decay, what can we prevent?
The answer is toothache. We can prevent toothache for 90% or more
of people. We cannot prevent all decay in 10%.
Imagine a school room of, say, 50 students. They are, let us
suppose entirely at our disposal for dental treatment. In how
many can we prevent all decay of teeth? Perhaps one or two,
probably not a single one can be fully delivered from tooth decay out
of 50.
On the other hand, suppose we make our goal the prevention of
toothache. For how many could we hope to prevent all
toothache? Why, for perhaps all of them, or at worst all save one
or two! (This is still the case now in 2002.)
Prevention of dental decay is something to strive for. Prevention of toothache is something to DO!
The disease dental caries is so common that it is not usually thought
of as a disease at all. Even by many dental and medical
men. Yet dental caries is a disease which attacks the hardest
substance in the body, and destroys it as cancer may attack and destroy
the tissues of the nose.
The first pangs of toothache occur when disease first reaches and
attacks the pulp. Toothaches may be looked upon as a warning, an
alarm sounded by Nature. To judge by the severity of the pain,
the occasion for alarm is great; something serious has
occurred. And indeed something serious has occurred. An
abscess like unto an appendicitis of the face is imminent.
I have pointed out that we cannot stop it by preventing decay, because
we cannot prevent all, or anywhere near all , decay. Nor can we
stop the progress of dental tisease with absolute and unquestioned
certainty after it has reached the dental pulp, i.e., after the disease
has reached the stage where toothache ordinarily occurs. (This was written before root canals were made predictable.)
If we cannot treat a disease with sufficiently satisfactory results
after it reaches a certain stage in its progress, it is obviously our
duty to prevent it altogether or to treat it before it reaches that
stage. And if we are unable to prevent it altogether as is the
case with dental caries all that is left is to treat it in its early
stages when it can still be stopped without great cost and with almost
invariable certainty of success. Such reasoning has long been
applied to tuberculosis and syphilis and other diseases. Why are
we so slow about making the application to dentistry?
Ordinary methods of finding cavities not adequate.
By carefully filling and refilling teeth, before the cavities are
allowed to get too large, dental disease can be kept from ever reaching
the pulp, and so toothache is prevented, and disease is kept not only
out of the pulp, but out of the bone and vital organs of the body also.
Cavities in teeth must, of course, be found before they can be
filled. This at once brings up the question: “Are the
methods now in common use such as to enable us to find all cavities in
teeth? That question may be answered, “yes” so far as the exposed
surfaces of the teeth are concerned. But how about the hidden
surfaces, ‘in between the teeth’ ?
All dental radiographers (dentists who own the newfangled x-ray machines)
of any experience or discernment know that dentists do not find all the
cavities between the teeth. I could, by taking sufficient space,
prove in a didactic manner, that it is a physical impossibility to do
so. It is common to use visual and tactile methods to examine
between the teeth, and this practice allows cavities to become
dangerously large and expose the pulp before they are found.
Case study
A young lady of about 20 was selected as the patient. And x-ray
examination of her mouth and teeth revealed seven cavities in various
parts of her mouth.
After the x-ray examination, the patient was examined by ten dentists
by ordinary ocular and instrumental methods. Two dentists found
only two cavities, six found only one cavity, and two found NONE of the
cavities! A 100% failure on the part of all 10 dentists to find
all, or even a moderate proportion of the lesions revealed on the
x-rays. (with the invention of the “diagnodent” we are discovering that we have made little progress as to our accuracy up until the last TWO years!)
A new and less expensive kind of x-ray examination
If it is true, as I contend it is that dentists fail to find proximal
cavities and these cavities can be found by the use of the x-rays, then
why are not the x-rays used more for this purpose?
There are two main reasons: 1, Only the dentists who have done a
considerable amount of x-ray work will realize to what extent one fails
to discover the proximal cavities by the ordinary ocular and
instrumental methods. 2. Until recently it has required 14 or
more exposures to make an examination which makes them difficult and
expensive. (This examination left the patient with a red face from the radiation burn!)
I have developed and have recently announced a new method of examining
the mouth with the x-rays for incipient decay which requires less than
half the number of exposures.
I recommend that the proximal x-ray examination be made yearly, or
bi-yearly, depending on the case. The patient will find it much
easier and cheaper to pay for periodic x-ray examinations than to pay
for the effects of toothache and its sequelae of trouble and expense
than to cling to the older custom of allowing teeth to ache before
treatment is sought. It can easily be demonstrated to cost the
patient more to neglect one or two teeth than to pay for a whole
lifetime of periodic x-ray examinations. Not to mention the pain
and ill-health caused by toothaches.
The faithful ones
There are literally hundreds of thousands of people in the United States (BUT NOT ONE MILLION)
who go to the dentist every six months or year. Why do they
go? Do they know exactly why? Do the dentists know exactly
why? Try asking them and you will discover that they do not. The
object of these faithful visits is not clearly defined in the minds of
either the patients or dentists. It’s time it should
be. The purpose of preventing toothache---that
is, of preventing pulp exposure---must become clear-cut and definitive
in the minds of both dentists and patients before dentists practice the
kind of dentistry that patients deserve from a profession trying to
lift itself out of the medieval barber’s chair.
It was way back in 1913 (10 years ago!)
that Dr. Charles Mayo said: “The next great step in medical
progess in the line of medicine should be made by the dentists.
The question is, “will they do it?” It can scarcely be said that
dentistry has taken the “great leap in preventive medicine” until we
have done more to prevent toothache and pulpless teeth.
Teeth and sickness
This
portion illustrates the nature of dental care before root canals were
invented. And how remarkably well people did without them.
One of the most unfortunate things about pulpless teeth is this:
they “kick the victim when he is down.” Let me explain. A
person in good health neglects a tooth or two until they ache severely
and then he has them treated and “saved”. (but not with a root canal)
The bill for the treatment is a little high, he thinks, but the teeth
are nonetheless ‘saved’ and everything is lovely. But in the
course of time the person becomes sick. He is depressed,
discouraged, in debt, worried, miserable. And just at this time
there is added to his troubles and expense the necessity of examining
and considering the pulpless teeth. They are radiographed, and it
develops that there is great difference in opinion among different
dentists and physicians as to whether they should be extracted or
not. In view of the fact that the pulpless ones are the kind of
teeth that may cause systemic disease (not the germs hiding in them?),
that their innocence cannot by indisputably established, the physician
in charge finally decides on extraction. And so the poor patient
must have added to the burden under which he already staggers the
necessity of extraction. A ‘radiodontist’ (A dentist who owns an x-ray machine) sees case after case of this sort. Pulpless teeth seem not so bad in the mouths of healthy people, (this is an astounding statement!)
but let these people be overtaken by sickness and those same teeth may
become a source of deep concern and worry, considered as possible
contributing factors to the ill-health.
Remember,
even at this early, infantile stage of dentistry birthed from “barber
shops”, toothaches were almost entirely a matter of choice |