EDITORIAL
T
HE following statement was received in the form of a “letter to the Editor’ fromDr. Edna Miller of New York City, who commented, “What better way is there
to reach pediatricians than through the medium of their new publication PEDIATRICS ?“:
‘‘Dentists are constantly informing parents and others in charge of young children as
to the need for an early ‘first visit with the dentist.’
“Much of the irremedial damage, dentally and psychologically, is due to the pain
and traumatic experience that necessarily follow the discovery of decayed teeth by the
dentists, or the uncomfortable sensation of an acute dental abscess felt by a child.
“When children are first seen by the dentists at the age of two and one-half or three
years, and thereafter at frequent, regular intervals, the procedures are usually painless;
or, if pain is unavoidable, the dentist has already impressed the child with his sincerity.
He is then no longer a stranger, visited only at a moment of emergency, who does
un-familiar, unpleasant things with elaborate equipment. Instead, he is the child’s friend,
using customary technics and commonplace instruments. Pedodontists find few children
among their regular, ‘old’ patients who are uncooperative, or who present any behavior
problem during treatment.
‘‘Dental societies, school authorities, and lay organizations work continually to
pro-vide parents of young children with health information and guidance. Yet there remain
many who appear for dental care for the first time at the age of five or six years, in pain,
and in need of extractions.
“The pediatrician is the one person who can help to bridge the gap in our
applica-tion of health knowledge. He sees the child regularly from earliest infancy. His advice
and suggestions are welcomed by parents. Yet he may not refer a young child for dental
examination unless the defects are glaring.
‘‘Today, when the dentist has adequate technics at his disposal for diagnosis,
preven-tion and treatment of oral diseases, defects and abnormalities, the pediatrician can grant
his patients an inestimable service, in the fields of dental and mental health, merely by
early routine referral to children’s dentists ?“
(signed) Edna Miller, D.M.D., M.P.H.
The principal theme of the letter emphasizes the emotional control of children who
come under pediatric dental care, and the advantages that come from close cooperation
among doctors, dentists and parents. But Dr. Miller’s comment is timely and important also
because it calls attention to one of the most frequent problems in child health ; and
because this frequency makes it so commonplace that it is considered no problem at all.
The statement also serves to focus attention on : what is dental caries ; how can it be
prevented ; and through what agencies can care be provided ? Is dental care, alone,
adequate to prevent caries ? Suppose every child went to the dentist regularly for
clean-ing and whatever the dentist does for a child’s teeth, would the problem of caries be
solved?
Many dentists believe still that caries is a matter of carbohydrate metabolism and the
presence of certain bacteria in the mouth.*
The control of dental caries is far more than such care alone. Underlying it all is a
state of nutrition of the child, and the work of Boyd, Tisdall, Johnston, their co-workers
and many others, suggests that this basic nutrition may be more important than local
dental service. Good nutrition then becomes an integral part of a program of prevention.
Shall the dentist become a nutritionist, or shall the problem be handled by a
combina-tion of services from different groups?
Also, how far can our increasing understanding of growth and development with its
varied and complex factors be used in the control of dental caries ? Does cultivation of
good mouth and chewing habits of infants and young children enter in the incidence
of caries later ? Do emotional strain, physical fatigue, and infection play a part, even
indirectly ? Do enlarged and infected tonsils and adenoids bear any relation to dental
caries, mouth deformity and defective eating and breathing habits ? Are infected tonsils
and carious teeth joint results of a common cause ? How far does prenatal and maternal
nutrition go in the prevalence of caries and its control?
Dental caries is a condition that is so common and widespread that it may be accepted
as a natural result of growth in children. It was listed as one of the major physical
defects found in draftees inducted into military service in the recent war. A former
Surgeon General of the United States Public Health Service has declared recently that
it is the main challenge at the present in the arrangements proposed for rendering
Federal aid to children through funds set aside for school health services.
What are the criteria of dental caries and when does caries constitute a physical
defect ? The U. S. Public Health Service has set up certain quantitive criteria which
are in general use. But these seem entirely arbitrary and artificial. From the standpoint
of child health, even one carious area in a child’s tooth may indicate a trend towards
more serious lesions later ; and, if early recognition can lead to prevention, such
in-significant lesions, which fall short of U.S.P.H.S. standards for defects, become of
great importance.
The relatively recent discovery that the chemical element fluorine enters in the
nutrition of teeth may recast a great many proposals for caries control. Much remains
to be learned about the influence of fluorine and especially methods for using it. Its
use may resolve itself into some such practice as that for iodine in areas where endemic
goiter is prevalent. Shall the dentist apply fluorine to children’s teeth, shall the child
be given daily tablets containing fluorine, or should fluorine be added to municipal
sources of drinking water ? These are methods to be considered and decided on. Other
chemicals and elements also may enter into the problem. Recent work on disturbances
of bone metabolism suggest, for example, that protein enters into the picture, and teeth
are also bone structure.
How shall these questions be worked out and through what means shall the
informa-tion be made available to the public to promote child health ? Close reading of pediatric
literature reveals little that is being done for the solution of these problems.
The American Society for Dentistry for Children and the American Academy of
Pedodontics have an interest in this matter, as well as the American Academy of
program. It would seem that the main job is to coordinate resources already available,
in a plan to use the knowledge to be applied. The House of Representatives in the
present Congress has voted and sent to the Senate a bill which provides for the
ap-propriation to the Federal Security Agency of, among other things, one million dollars
for a national campaign to train dentists in the use of sodium fluoride to check dental
decay. The Study of Child Health Services, completed recently by the American Academy
of Pediatrics, included a survey of facilities for dental care and this received the support
of the American Dental Association. A secondary phase of the Study included a survey
of facilities for professional education. Information derived from this source is in a
form never before available. It should serve to point a way of approach.
Education of the public as well as professional education, seems equally important.
Sound, healthy teeth are part of sound, healthy bodies. Sound, healthy bodies are
acquired by the individual’s own desire to secure them. The desire can be introduced
and inculcated by training, but its attainment rests with the individual. Health cannot
be bought. It must be sought after and cultivated through education and training. The
Study of Child Health Services indicates very clearly that most of the children are
under health and medical care of general practitioners, and that trained specialists, both
pediatricians, and probably pediatric dentists, see and care for only small fractions of the
total number of children. Therefore, Dr. Miller’s letter is sound in so far as this small
group of children is concerned. But the same principle must apply also to all children.
