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 Much of this article reflects science which is outdated, and some of it reflects problems that have just this last couple of years been solved.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”.
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.
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