Mouth hygiene and mouth sepsis

Front matter

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Preface To Second Edition

It is with great pleasure that the writer has prepared the Second Edition of this little text-book. This pleasure has been enhanced by the fact that it has seemed, as was the hope, to meet the demand for information, and stimulated the evergrowing interest of the dental and medical professions, as well as the general public, in the subjects of mouth hygiene and mouth sepsis.

The interest which has been awakened all over the civilized world to the supreme importance of maintaining a healthful condition of the teeth and the mouth, and the great danger to individual health and life which lurks in a septic mouth, has already done much towards mitigating these evils by stimulating the people to give greater attention to oral hygiene.

vi

PREFACE TO SECOND EDITION

The book has been carefully revised and several new illustrations have been added.

It is the hope of the writer that those who read its pages may be inspired to arise to the relief of the poor, the indigent, and the unfortunate in their midst, who are in such vital need of appropriate dental treatment to safeguard their health and perhaps save their lives, by encouraging the establishment of free dental clinics in every community.

The writer and his publishers desire to acknowledge their obligations to the profession and the reading public for their generous patronage and trust that the revised and enlarged work will meet with the same generous support.

The Author.

Preface

In the preparation of this little text-book the writer has endeavored to meet the needs of the Dental Profession, of students of dentistry and medicine, trained nurses, school-teachers, sanitarians, and the general public, for a work on the subject of mouth hygiene and mouth sepsis that would be comprehensive and not too technical.

All technical terms when used have been explained, so that the lay reader will be able to grasp the subject with the same degree of understanding as would the student of dentistry or medicine.

The subject is one of such vast importance to individual and public health, intellectual progress, and good citizenship, that it is hoped that the facts here gathered, and the suggestions made, will not only prove instructive and interesting as

PREFACE

matters of reference, but may be instrumental in creating greater interest and enthusiasm in the subject of mouth hygiene, and thus save many children from lives of misery caused by preventable oral diseases, which, if uncorrected, may lead to invalidism, immorality, drunkenness, crime, or insanity.

Part I. Mouth Hygiene

CHAPTER PAGE

I. Introduction 1

II. Prevalence of Oral Diseases 19

III. The Human Mouth ; Its Care From Birth

to the Completion of First Dentition 34 IV. The Human Mouth ; Its Care During

Second Dentition 53

V. The Human Mouth; Its Care During

Illness 78

VI. Proper Mastication and Proper Breathing 91

VII. Oral Hygiene, and the School Curriculum 99

Part II

VIII. Mouth Sepsis 109

IX. Diseases of the Teeth and Mouth Caused

by Oral Sepsis 128

X. Diseases of the Throat, the Ear, the Eye, and the Cervical Glands Caused

by Oral Sepsis 141

xi. dlseabes of the stomach, intestines, and Other Viscera Caused by Oral

Sepsis 164

x

CONTENTS

XII. The Psychological Effects of Dental

and Oral Diseases and Sepsis 183

XIII. The Psychological Effects of Physical

Deformities 194

XIV. Oral Sepsis and Reflex Dental Irrita-

tion as Causes of Drunkenness, Neurasthenia, Melancholia, and Insanity 204

Part III

XV. The National Oral Hygiene Propaganda

and the Result of Experimental Work 225

ILLUSTRATIONS

no. PAGB

I. Head of Infant, Front View, showing Primary Dentition at about the Seventh

Month 40

II. Right Side of Same 40

III. Left Side of Same 40

IV. Head of Child, Front View, showing Com-

plete Primary Dentition and Secondary Dentition in Various Stages of Formation 54

V. Right Side of Same 54

VI. Left Sdde of Same 54

VII. Adult Head, showing Complete Secondary

Dentition. (After Dr. Cryer) 58

VIII. Calcification of Decdduous and Permanent Teeth 58

IX. Showing Unclean Mouth and Teeth. ... 68 X. Showing Same after the Teeth had been

Cleaned and Polished 68

XI. Watkins' Adult and Child's Tooth-brushes 72

XII. Prophylactic Tooth-brush 72

XIII. Floss Silk Holder (for Toilet Table). . 72

XIV. Floss Silk Holder (for Vest-pocket or

Chatelaine) 72

XV. Tongue Scraper 74

XVI. Pyogenic Bacteria 110

XVII. Mouth Bacteria 110

XVIII. Infected Dentine, showing Dental Tubuli Greatly Enlarged and Filled with

Micro-organisms 134

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ILLUSTRATIONS

VIO. PAGB

XIX. Infected Dentine, showing Coalescence of Enlarged Dental Tubuli, forming Cavities, and filled with Micro-organisms 134

XX. Showing Impacted Supernumerary Lower Molar. Dried Specimen. (After Dr.

Crter) 206

XXI. Showing Impacted Cuspid, Upper Jaw.

Dried Specimen. (After Dr. Cryer) . . 206 XXII. Showing Inverted Upper Thhid Molar,

Living Subject. (After Db. Crter) . . . 206

PARTI.

MOUTH HYGIENE.

MOUTH HYGIENE AND MOUTH SEPSIS

Introduction

Hygiene. — Hygiene is that branch of sanitary science which treats of the laws of health and its preservation.

Oral Hygiene. — Mouth hygiene treats of the bealth G f the mouth and its preservation.

Sanitary Science. — The science which includes a consideration of all that can be done for the prevention of disease and the promotion of public health.

Sanitation, therefore, is prophylaxis, and prophylaxis is the prevention of disease.

Health. — That condition of the body in which all its organs are performing their functions in a normal manner. A hale or whole condition of body.

A noted monarch once said, " The health of the people is the supreme law." A sentence more wise than this was never spoken by human lips, for the idea here expressed lies at the very foundation of all material, intellectual and spiritual progress of a nation; and without it no true national greatness can ever be attained.

This fact is becoming more and more generally recognized by all civilized nations, and much interest is being manifested by the public generally in the efforts that are being made to stamp out disease, improve the public health, and increase longevity.

With this end in view great efforts are being made by the national government, by the various State governments and municipal boards of health along the lines of scientific sanitation to protect the public and the individual from the detrimental effects of impure water, unwholesome foods and beverages; the poisonous emanations of decomposing garbage and sewerage; the harmful effects of bad and insufficient ventilation, and the overcrowding of tenement houses ; the isolation of all persons afflicted with infectious and contagious diseases, and the fumigation of clothing worn and buildings occupied by such persons; the fumigation of all vessels upon which such diseases are found and the cargoes therein contained.

Physicians generally are teaching their patients the value of observing the various common rules of hygiene and sanitation and personal cleanliness; and yet the majority, the great majority have not yet learned to appreciate the fact that an unclean mouth is a most prolific, if not the most prolific, source of danger to the health of the individual of which we have any knowledge.

Dr. Osier, in a recent address before the students of the Royal Dental Hospital of London, said, " You have just one gospel to preach, and you have got to preach it early, and you have got to preach it late, in season and out of season. It is the gospel of the cleanliness of the mouth; cleanliness of the teeth; cleanliness of the throat. These three things must be your text through life."

" Oral hygiene — the hygiene of the mouth — there is not one single thing more important to the public in the whole range of hygiene ; and it is with that which you, as practitioners, will have to deal."

The dentist is often thought to exaggerate the importance of a clean, healthful mouth and good, serviceable teeth; and to draw upon his imagination when he speaks of the dangers to the general health which lie hidden in decayed teeth, dento-alveolar abscesses, pyorrhoea alveolaris, and other dental diseases.

Upon this point Prof. Osier has also placed himself on record. He says, " If I were called upon to state which of the two, in my opinion, causes the most evil, alcohol or decayed teeth, I should unhesitatingly say decayed teeth."

Dr. Wiley, pure food expert, recently said, " One thousand children die daily in this country, their deaths due more to defective teeth than to other trouble."

Dr. Kirk, of the Dental Cosmos, says : " In Great Britain a systematic study of the mouth conditions of the public-school children revealed the alarming fact that only three or four per cent, had sound dentures, and that dental caries was an evil that was undermining the health of the nation. Similar studies in other countries furnished statistics which in general correspond with the figures obtained in England, showing that dental caries is a disease universal in its distribution and constituting a factor of ill health second in importance to no other which affects the human race."

Dr. D. D. Smith, in a paper, read before the New York Institute of Stomatology, upon Oral Prophylaxis, * says: " It may seem presumptuous to intimate that in this subject of oral prophylaxis, when fully comprehended, are matters of a magnitude to radically modify the present thought and conception of dentistry, and to greatly change the present methods of practice. To advance a step farther, and suggest that there are hidden away under the debris of the oral cavity secrets of greater importance to the comfort and welfare of civilization than the great discovery of vaccination by Jenner in 1796, will doubtless seem as a magnification verging upon absurdity. And yet we venture to predict that the future of dentistry will disclose this as a truism."

Dr. L. Ashley Faught, 2 in speaking

1 International Dental Journal, vol. xxii, p. 817, 1901.

2 Dental Cosmos, vol. xliv, p. 1021, 1902.

of Oral Hygiene, says: " It has come to be more appreciated that one of the great causes of decay in the teeth is lack of cleanliness, and that decay begins at the outer surface of the tooth, most frequently at the points most difficult to keep clean. . . . Clearly the work of the patient is oral hygiene, — the maintaining of the oral cavity in a state of health. The work of the dentist is dental prophylaxis, — the placing of the teeth in condition to prevent disease, a state favorable to oral hygiene. Thus it appears, from any strict definition of the two words, that the end to be obtained by either dentist or patient is one and the same, — prevention of disease, maintenance of health."

In an article on Oral Hygiene read by Dr. L. P. Bethel, 3 he quotes Dr. Knowlton, dental examiner at the Barberton, Ohio, Diamond-match Factory, as saying: " He is confident that the influence of oral hygiene is farther reaching than ordinarily imagined. Since its enforcement among these employees it has been

8 Fourth International Dental Congress, St. Louis, 1904. 6 a noticeable fact that fewer days are lost through sickness. He believes it has an influence on the digestive tract and that better general health is maintained. Also it has been noticed that during epidemics of disease fewer employees are affected by prevailing maladies than before these prophylactic measures were adopted."

THE UNCLEAN MOUTH.

We know of nothing that is more shocking and disgusting than a mouth which is a stranger to the tooth-brush, or one that only semi-occasionally is treated to a half-hearted scrubbing with this most invaluable toilet article. Do we not turn away from such individuals with positive loathing? Do we not shun them almost as much as we would an individual suffering from small-pox? And why? Because they are poisoning the air which you and I must breathe with myriads of disease-producing micro-organisms, perhaps the organisms of pulmonary tuberculosis, pneumonia, diphtheria, tonsillitis, bronchitis, la grippe, and numerous others.

The science of bacteriology applied to the study of the organisms found in the human mouth has demonstrated more than a hundred different forms, many of them ^disease-producing organisms. In, fact nearly every form of pathogenic micro-organisms known to bacteriologic science has been found at some time to in- 1 habit the human mouth. This being the fact, what an ever-present danger to the individual and the public is an unclean; unsanitary, unhygienic mouth!

In this connection it may be well to, consider for a few moments the rapidity with which some of the disease-producing micro-organisms reproduce themselves.

MULTIPLICATION OF BACTERIA. 4

The process of reproduction in bacteria is a very rapid one. Fliigge observed the process of segmentation in a coccus — a globular organism— to be completed ill twenty minutes. Cohn has made the calculation that if it should take one hour to complete this process of segmenta-

4 Marshall's Operative Dentistry, third edition, pp. 91, 92.

tion — division — and of the new cell to attain the size of the parent cell, one coccus, multiplying by this process, would in a single day produce 16,000,000 progeny; at the end of two days 281,000, 000,000; while at the end of the third day it would have reached the enormous number 46,000,000,000,000. Such figures are at first thought very startling, and if the multiplication could go on unhindered the earth might soon be dominated by these micro-organisms. There are, however, many curcumstances which constantly oppose them; one of the chief of these is their own delicate susceptibility to change of environment, the slightest difference in soil, amount of oxygen, temperature, or moisture being sufficient in many instances to arrest their growth or completely destroy them. Various specimens are found growing together, but the struggle for existence, and natural selection, is as active here as elsewhere; the stronger and more vigorous soon destroy the weaker. When they enter healthy bodies they are attacked by the phagocytes — the white cells of the blood — and destroyed, or they do not find a congenial soil in which to grow, and either die or are swept out of the body by the excretory organs.

Miller 5 has made the estimate that in a certain very unclean mouth there were not less than 1,140,000,000 micro-organisms. IThink of the vitiating effect of such a mouth upon the general health of the individual and upon the atmosphere of a room inhabited by such a person; of the myriads of these organisms that enter the lungs at every inspiration and of the myriads that are thrown into the atmosphere by every expiration and by every act of coughing or sneezing; of the multitudes that are swallowed with every mouthful of food or drink ; of their effect upon the delicate lining membrane of the bronchi and air-vescicles of the lungs, and upon the mucous membrane of the stomach and intestines. The wonder is that diseases of the throat, of the air-passages, of the lungs, and of the stomach and intestinal tract are not more common than they are.

The unclean mouth is always a dis-

6 Micro-organisms of the Human Mouth. 10 eased mouth. It has been said, " The man with the healthy mouth is never sick: the sick man never has a healthy mouth." The first part of this proposition may be open to question, but the latter never. A man with a healthy mouth may eat food or drink water or milk infected with the cholera bacillus or the typhoid bacillus, and die from their effects, in the former case in a few hours, in the latter in a few days or two or three weeks.

As a general proposition, however, the statement is correct, for the man with the healthy mouth is usually in vigorous health and will be able to resist these infections if the organisms are not introduced in overwhelming numbers. If^liis opsonic index is high, which is another way of saying, if his resistance power is high, he may escape altogether. The man, however, who has an unclean and diseased mouth has never a high resistance power against disease. " Cleanliness is next to godliness," and godliness is to be Godlike. Can any one conceive of our God being unclean? Therefore, if we are Godlike we must be clean physically, morally, and spiritually. If we are Godlike we will 11 be every whit clean physically as well as in other respects, and if we are every whit clean we will have clean mouths and keep them so.

The tooth-brush Is the yard-stick by which the degree of civilization of a people or a nation may be measured. From time immemorial the care which a people or a nation has given to its teeth, is the index of the degree of its civilization.

Booker Washington, of Tuskegee, has said, " (The tooth-brush is the greatest of all civilizing agents." He found that when he had succeeded in teaching his students to keep their teeth clean, he had stimulated in them a sense of self-respect, and this is necessary to civilization in its higher forms.

This is to be the age of the tooth-brush, and the gospel of the tooth-brush is to be preached from one end of the world to the other, and nothing shall stop it, for it is a righteous gospel and one that has for its aim the betterment of the health and consequently of the happiness of the human race.

Hygiene of the mouth must deal, not only with the question of cleanliness, but 12 also with diseased conditions and tHeir prevention. An unclean mouth leads to decay of the teeth, and decay of the teeth leads to exposure of pulps — miscalled nerves — which causes most excruciating pain. This condition if neglected leads to dento-alveolar abscess — miscalled ulcerated teeth — which not only causes severe pain and great swelling when the abscess is an acute one, but it may lead to acute septicaemia — blood-poisoning — and not infrequently to death. Or if the abscess pass into the chronic stage it may give rise to pyaemia — a chronic state of blood-poisoning— which may continue for months and finally end in death unless the cause is discovered and removed. Another diseased condition frequently found in the unclean mouth is gingivitis — inflammation of the gums — usually caused by the accumulation of salivary calculus — tartar — and the accumulations of food debris — particles of food left upon and between the teeth, which are soon in a state of acid fermentation from the action of certain bacteria always found in the human mouth, and which in a few hours forms acids which dissolve the lime salts in the enamel and dentine and thus establish dental decay; while the accumulation of the tartar and the food debris act as mechanical and chemical irritants to the gum tissue and thus establish inflammation of the gums.

This condition of inflammation of the gums frequently leads to atrophy — a wasting away of tissue — and to a loss of the alveolus — bony socket of the tooth — by a process of caries — an inflammatory condition which dissolves the bone by slow degrees — and ends in the final loss of the tooth.

Another disease that is frequently found in an unclean mouth is pyorrhoea alveolaris, or Riggs's disease — a chronic inflammation located in the pericementum — membrane covering the roots of the teeth — and in the alveolar process or sockets of the teeth, which produces a gradual and painful dissolution of these structures accompanied by a flow of pus from the alveolus or socket, resulting in an ultimate loss of the teeth, and due to constitutional causes, such as rheumatism, gout, diabetes, and Bright's disease, and aggravated by local irritation from salivary deposits— tartar — and the accumulation upon and around the teeth of food debris which is in a septic or putrefying condition.

Stomatitis — inflammation of the lining mucous membrane of the mouth — in its various forms is frequently present in an unclean mouth. This disease is most often found in the mouths of infants and little children, particularly in foundling hospitals and orphan asylums. It is an infectious disease and readily transmitted by nursing-bottles, spoons, and drinkingcups. The disease is mycotic — fungus micro-organisms — in its origin ; the organisms flourishing in unclean rubber nipples, nursing-bottles, rubber soothers or comforts, milk-bottles, and unsanitary refrigerators, etc.

Pharyngitis — inflammation of the back part of the throat — is another common disease often found associated with an unclean mouth, and is due usually to infection from the mouth.

Tonsillitis — inflammation of the glands lying upon either side of the inner surface of the throat — is usually found associated with an unclean mouth. It is an infectious disease, and is also due to micro-organisms. This disease spreads very rapidly among school-children housed in close and ill-ventilated school-rooms and who are permitted to use common drinking-cups, common towels, common slates, pencils, and pens. The public drinkingcup, public towels, common slates, pencils, and pens should be banished forever from our public schools as an imperative sanitary measure against the spread of such infectious and contagious diseases.

One of the precepts taught Japanese children in their schools, and has been for generations, is the following: " Disease, it is said, enters through the mouth. Be watchful as to what you eat and drink." This ought to be written in letters of gold and hung on the walls of all school-rooms.

During the hot season of the year city people who can afford to do so flee to the country with their children, to find cool, pure air and fresh food, and this is wise and beneficial, provided the sanitary conditions of the new environment are what they should be. Many of these summer resorts are far from being what they should be, from a sanitary stand-point. The ignorance or the cupidity of the management of many of these places is such that they make no adequate provision for the protection of the water supply from contamination with the sewerage of the premises, and, instead of burning all kitchen refuse, cart it into some back lot and allow it to rot and putrefy in the sun and breed flies by the million. Such places are more dangerous to the health and lives of the children than the heat and possible unsanitary conditions from which they have fled.

Flies are a prolific source of infection. They are the most filthy of all insects, and every effort should be made to prevent their propagation and multiplication by destroying all matter upon which they feed. Refuse from the kitchen, garbage, excreta of the body, stable droppings, and refuse should Be removed each day and destroyed by burning. All food and nursery apparatus should be protected from flies by proper cover-screens. Most of the sporadic cases of typhoid fever found in our cities can usually be traced to an infection received at some supposed health resort or summer camp.

2 17

Most people are extremely careful to have the foods and drink which enter their mouths free from everything that could be considered in any way unsanitary ; and yet many of these same people Have very unclean mouths, not seeming to recognize the fact that they carry within their mouths unsanitary conditions that are infinitely more dangerous to health and life than the dirt and possibly infectious materials that have been removed in the careful preparation of their food, and which, when thoroughly masticated in an unclean, unsanitary mouth, has been rendered positively unfit to enter the stomach. Is this failure to recognize the importance of a clean mouth due to ignorance, indifference, or inconsistency? We think we may safely say, in deference to the usual habits of the people generally, that it is due to ignorance of the facts. With this thought in mind it will be our endeavor to lay these facts, as best we may, before our readers in the following pages.

Chapter II

THE PREVALENCE OF ORAL DISEASES. ORAL DISEASES.

Diseases of the mouth are so prevalent that it may be said practically no one escapes. The writer during a practice, both civil and military, of more than forty years, in which he has examined many thousands of mouths, has never met with but four instances of persons who had reached adult life who were free from any form of dental or oral disease. One was a young lady twenty-four years of age, another a gentleman of fifty, the third an officer in the United States Army, twenty-four years old, a recent graduate of West Point, and the fourth a lady, a college graduate, twenty-five years of age.

Dental caries — dental decay — is without doubt the most common disease that affects the human family at the present time, and from which very few persons among civilized nations wholly escape. It seems to be pre-eminently a disease of higher civilization, as it is most common among those nations which are recognized as having the highest civilization; and yet no race or tribe of men yet discovered, whether savage, barbarous, semi-civilized, or civilized, ancient or modern, has ever wholly escaped it. Archseology, history, and anthropology all prove the correctness of this statement. Evidences are not lacking that the prehistoric man suffered from dental decay, alveolar abscesses, — miscalled ulcerated teeth — and other dental diseases. Many of the Egyptian mummies found in our great museums, and skulls of prehistoric periods, show wellmarked evidences of caries and other dental diseases. One Egyptian mummy in the British Museum, dating back to a period about 2800 B. C, or more than four thousand seven hundred years ago, shows undisputed evidences of dental caries and other dental lesions.

The collections of crania of the prehistoric inhabitants of North and South America in the National Museum in Washington show occasional evidences of dental caries and numerous evidences of alveolar abscess, from death of the tooth-pulp caused by the wearing down of the teeth. Evidences of pyorrhoea alveolaris are very rare. Dental anomalies, particularly irregularities in position, inverted teeth, and supernumerary teeth, are quite common.

It would be interesting to pursue this subject at greater length did space in this little volume permit.

PREVALENCE OF DENTAL DISEASES AMONG SCHOOL CHILDREN.

Very little interest has been manifested by the profession in the gathering of reliable statistics upon this subject until quite recently. The first comprehensive and reliable work of this kind was performed by the School Committee of the British Dental Association (Tomes). They reported having examined the mouths of 3368 boys and girls at the Hanwell and Sutton schools and at the Exmouth training-ship. Out of this number only twenty-three per cent, had sound dentures, or, in other words, seventyseven per cent, were affected with dental 21 decay. These boys and girls ranged from three and a half to seventeen years of age, but the majority were from five to fourteen. Two hundred and five children belonging to high-class schools did not compare favorably with those less fortunately placed. Further comparison was not made, as the number was too small to give conclusive results.

Major P. J. Probyn, of the medical service of the British Army, says : 1

" On comparing the various recruiting returns in the Army Medical Department reports, we find that an immense amount of good material is lost to the service from defective teeth, either due to carionecrosis — dental decay — or the actual loss of the members; and this, be it noted, occurs in otherwise strong and healthy youths, who, if fitted with artificial dentures, may still become useful fighting men. At one time the Government would not allow the enlistment of men with defective teeth, and not without a certain good reason, for what use is a man in the field with defective teeth? He vqH

1 British Journal of Dental Science, vol. li, p. 873, 1908.

soon lose his good state of health if he is not able to thoroughly masticate the hard biscuit and * bully ' beef. Now I am glad to say a much more liberal view is taken of the situation, and recruiting officers are not hampered, but must use their own discretion and may admit men with artificial dentures.

" In the last report of the Army Medical Department (1907) we find that 19 per cent, of the candidates were lost to the army on account of defective teeth."

Ottofy computed, from an examination of 14,644 teeth of American public-school children, that dental caries was present in 27.33 per cent, in the boys and 32.67 per cent, in the girls.

This statement gives a better showing for the American public-school children than for the children in the Hanwell and Sutton charity schools. This difference is explained by the fact that the latter children were from the poorest class of English society, while the Aonerican public school represents all classes of society, including many who receive regular attention from the family dentist.

The Schleswig-Holstein Dental Society, 2 in a recent examination of the mouths of the school-children in Northern Germany, conducted by Dr. Greve of Lubeck, reports that of 19,725 children examined, 95 per cent, showed dental caries. This investigation included the children of nineteen towns. The boys were found to have somewhat better teeth than the girls, the difference being about 3 per cent, in favor of the boys.

From the dental inspection of the public schools of the city of Antwerp in 1900 J the following facts were obtained: " The number of attendants of the schools in March were — boys 9543; girls 10,148; kindergarten 4778; total 24,469. The kindergartens are frequented by children of three to six years of age; in the other schools the ages vary between six and sixteen years. Amongst 12,000 children examined by Dr. Verhuysen, he found 1721 without caries, 2138 with one or two teeth affected, and 8141 with several teeth affected. During the first inspection 947 extractions were made, in the second 545,