MOUTH HYGIENE
The late Dr. Osler, one of the great physicians of the present age, in
an address delivered 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 emphatic statement of this great teacher and physician to a class
of dental students is repeated here because it clearly emphasizes the
supreme importance of oral hygiene--mouth cleanliness.
Unfortunately, it is not widely recognized how close is the
relationship between an unhealthy and unclean mouth and many serious
general diseases of the body, both of the infectious and non-infectious
types.
Of the former, children, in particular are highly susceptible, because
of their common practice of carelessly putting into the mouth objects
without much regard to their nature, or possible germ-carrying
properties. As a result, germs are conveyed to the mouth, where, if the
utmost cleanliness does not prevail, they find a favorable field for
incubation, and only too often visiting disease upon the child.
A knowledge of the principle of hygiene, which is acquired by children
who are taught to keep their mouth clean and wholesome, makes them more
careful not to put casual objects into the mouth.
RESULTS OF ORAL HYGIENE
By many it may seem trite to stress the importance of oral cleanliness,
when mouth hygiene is now considered a routine matter in the daily
lives of millions of people. But, strange as it may seem, there are
more millions by far in this country who are strangers to the tooth
brush than there are patrons of this agency of cleanliness.
A statistician some time ago estimated that less than twenty-five
million people in America are habitual users of the tooth brush. Simple
arithmetic tells us, therefore, that over eighty-five millions of
Americans are still to be converted to the merits of elementary mouth
hygiene.
Dr. Alfred C. Fones, a pioneer in oral hygiene, initiated a system of
mouth hygiene in the public schools of Bridgeport, Conn., in 1914, from
which was traced a marked decrease not only in dental diseases, but in
the contagious diseases common to childhood.
Dental hygienists were placed in the various schools, and their number
was increased until, in 1919, twenty-six were appointed. These women,
who received intensive training, both scientific and practical, in a
special school for dental hygienists, supervised the care of the mouths
of nearly twenty thousand children.
All possible emphasis was laid on cleanliness, and the _prevention_ of
dental decay. After decay has once set in, all work is of necessity
palliative, and has to be more or less continuous, with results that
cannot be foreseen.
Dr. Fones began the first year with the first and second grades.
A careful system of four distinct parts was arranged. First, the
hygienist would clean the teeth of every child in the school.
Secondly, tooth brush drills were practiced to teach a method of
brushing the teeth at home.
Thirdly, class-room talks relating to food and cleanliness were given,
supplemented by stereopticon pictures.
Fourthly, the parents’ interest and co-operation were obtained through
special educational literature.
As a result of this systematic work, in 1921, the reduction in dental
decay in thirty schools where the children were under treatment
averaged 69.3 per cent. One of the remarkable results was that out
of 1,161 children in the fifth grade, only 65 had cavities in their
permanent teeth.
Furthermore, the reduction in decay was accompanied by a reduction in
the percentage of retarded pupils, from an average of forty to twenty.
Communicable diseases as we have already observed, are highly prevalent
among children with unhygienic mouths. The greatest harm is often done
before the child starts to school because of the neglect on the part of
the parents in caring for their children’s mouths.
After the mouth hygiene system had been in effect in Bridgeport for
four years, there was a marked decline in the death rate of three
common diseases among children. The following figures give the death
rate per 100,000 population in 1914, before introducing the system,
and four years later:
1914 1918
Diphtheria 36.6 18.7
Measles 20. 4.1
Scarlet fever 14.1 0.5
This represents a reduction in these three diseases from 24.6 to 7.8
per 100,000 population.
Of course, it is impossible to prove that the entire results were due
to the mouth hygiene campaign. Perhaps other factors entered into the
situation. But there is no doubt in the minds of those who witnessed
and studied the remarkable accomplishments in Bridgeport, that by far
the greatest single factor in reducing diseases among children was oral
hygiene--a well-taught lesson in cleanliness.
HOW TO CLEAN THE TEETH
Every one should be on intimate terms with a tooth brush and a good
dentifrice (powder or paste) recommended by a dentist. It is desirable
that the teeth be carefully brushed after each meal. While the brush
is looked upon by some members of the dental profession as a bacteria
carrier, nevertheless, with proper care of the brush by the user,
and until some more hygienic agency is devised, we must continue our
allegiance to the tooth brush.
Some authorities advocate the rotary or circular movement of the brush
upon the teeth and gums, while others prefer the rolling of the brush
from the neck of the gum toward the biting edges of the teeth.
The former claim that when the gums are not in a healthy state, injury
from the bristles of the brush might result and cause irritations,
opening up avenues of infection. The latter maintain that no harm can
result from such procedure.
A middle course may be suggested. First, ascertain whether the gums are
firm and in a perfectly healthy state. If so, carefully brush the teeth
with a suitable powder or paste, in front and in the back. Care must be
taken that the brush reaches surfaces of the grooves of the posterior
teeth, where particles of food are apt to lodge.
The gums should be brushed when cleaning the teeth, but with the utmost
care and without using pressure on the brush.
Of the three grades in which tooth brushes are usually made--“soft”,
“medium” and “hard”, the “medium” brush is to be recommended for
general use. The soft brush is usually too soft to be effective in
removing particles of food from crevices and spaces between the teeth;
while the “hard” brush, because of the stiff, wiry bristles, may injure
the delicate gum tissue.
Some authorities contend that when the gums are irritated constantly
in this way and made to bleed, the abrasions invite infection, and is
often the cause of acute stomatitis, and is also conducive to pyorrhea.
On the other hand, Dr. Paul R. Stillman, in a recent article on the
care of the gums, said one of the chief problems in managing cases
of gum tissue with a low tone is to arouse the regenerative forces
of nature and maintain a constantly high tone in the gum tissue. To
realize this end, stimulation and massaging of the gums by careful
brushing is advocated, and an occasional bleeding is not considered
injurious.
It is evident, from the foregoing statements, that until there is more
unanimity of opinion, a moderate course and the avoidance of extremes
are advisable.
The tooth brush alone should not be depended upon, and no cleansing
outfit is complete without a spool of silk dental floss. Food debris
will stick between the teeth, and the danger resulting from such germ
incubators as tend to propagate dental decay is best removed with silk
floss drawn between the teeth. Care must be taken that the gums are not
irritated by this procedure.
A little lime-water is excellent to rinse out the mouth after cleaning.
While the lime-water is in the mouth, force it back and forth between
the teeth with the tongue and cheeks. Continue this until the water
foams, which indicates that it has been in the mouth long enough to
have had a beneficial action on the teeth.
Lime-water has a very pronounced influence in preventing the decay of
the teeth, and when used in conjunction with a general regimen of mouth
hygiene, it is a valuable supplementary agent.
Milk of magnesia may be used as a mouth wash for children, particularly
in case of over acidity, such as when the teeth are sensitive and set
on edge when eating grape-fruit, grapes, lemons, etc.
When tooth picks are used--although it would be better to use silk
floss instead at all times--great care should be taken to avoid
injuring the gums. Wooden tooth picks are unsafe for this purpose,
as they are too thick and clumsy to enter the dental interspaces.
They have been known to break and leave slivers in the gums, causing
inflammation, suppuration and sometimes sepsis.
The only tooth picks to be recommended are thin, sterilized quills.
These can be used without injury to the tissue, and, when scraped
thin, will easily pass between the teeth. At the same time they are
sufficiently rigid to remove the ordinary fibrous food debris that
becomes lodged between the teeth.
The tooth brush should be kept in a sterile condition, so as to avoid
danger from infection. This can readily be accomplished. The brush
should be carefully washed with clean water each time after using, and
preferably immersed in ethyl alcohol. A glass holder, fitted with a
screw top, makes an ideal container for the brush.
THE TONGUE
As it is impossible to keep the mouth in an hygienic condition if the
tongue is unsanitary, this organ often requires special attention. The
upper surface of the tongue is equipped with numerous tiny _papillae_
and minute grooves or depressions surrounding them.
This uneven surface offers an attractive breeding ground for
objectionable micro-organisms. To have an hygienic mouth, the
dorsum--upper surface--of the tongue should, therefore, be cleaned
every morning. A simple instrument, known as a tongue-scraper, made of
ivory, celluloid, or bone, may be obtained for this purpose. It is a
bow or loop-shaped device, with a handle about six inches long. A home
devised substitute in the form of a silver butterknife, may be set
aside and used for this purpose.
In using this appliance, it should be placed well back in the mouth, to
the root of the tongue, and then drawn forward upon the surface to the
tip of the organ. This should be repeated a few times.
It is said that the Japanese include a tongue-scraper with every
tooth brush sold. In this respect, we Occidentals might well take
pattern after the scrupulously clean Japanese. In the absence of a
tongue-scraper, the tooth brush may be used for the purpose--drawing it
over the surface of the tongue--but it is not so comfortable or well
adapted.
MOUTH WASHES
Mouth washes, it should be understood, are not by any means a
substitute for thorough and regular brushing of the teeth. Real mouth
cleanliness can be obtained only by mechanical means. Washing the
mouth out with fluids will not remove food deposits left on the teeth,
particularly those lodged in crevices.
However, washes have their place, as an auxiliary measure, in the
regimen of mouth hygiene. They are especially useful in helping
temporarily to overcome an offensive breath--in connection with other
necessary treatment; in removing a “bad taste”; as a cooling agency,
and to allay an inflammatory condition of the mouth as a result of
disease or other cause.
There are mouth washes based upon both alkaline and mildly acid
principles. As most of the destructive germs of the mouth flourish in
an acid reaction, the alkaline solution neutralizes the acidity, thus
making the condition of the mouth less favorable for the propagation of
germs.
Of the alkaline group, the most readily available and one of the most
efficacious, is salt and water--a mixture of a teaspoonful of ordinary
table salt to a glass of water. If more salt is used, however, it will
do no harm. Soda bicarbonate, or common baking soda, in the proportion
of a teaspoonful to a glass of water, is also excellent.
Milk of magnesia, already referred to, is considered by some
authorities to be very good. When worked about the mouth and between
the teeth, it not only neutralizes the acidity, but protects the teeth
by leaving a coat of magnesia over their surface.
Of the mildly acid mouth washes, hydrogen peroxide, mixed one part
to two of water, is germicidal. The regular use of this preparation,
however, has a tendency to produce an unpleasant irritation and “set
the teeth on edge.” In fact, any acid element has this effect, more or
less.
Listerine, properly diluted, is a pleasant, mildly acid mouth wash with
antiseptic properties.
Dakin’s solution is another powerful antiseptic mouth wash, the product
of Dr. H. D. Dakin. It was widely and effectively used for treating
wounds in the World War, having been sponsored by Dr. Alexis Carrel,
the famous surgeon.
Dr. W. H. Dixler, in a paper read before the Pittsburgh Adontological
Society, described its action most interestingly as follows:
“The action of Dakin’s solution is an intensely germicidal one,
having a store of chemically combined chlorine in a form which is
non-irritating and non-toxic. When brought into contact with proteins
and blood serum micro-organisms and pus, it readily parts with its
chlorine to the basic substance, immediately exerting its antiseptic
and germicidal action.”
“We found that it performs this chemical action without irritation,
and that it does not coagulate albumen, nor does it interfere with
the digestive action of trypsin of protein, but it does actively
disintegrate protein, and influence a flow of lymph, thereby cleansing
the wounds, which is one of the most important features in wound
sterilization. We are inclined to believe that necrosed tissue is
dissolved and liquified, so that it may be carried away by drainage
or absorption, and in this way the germs on the clean surface of the
living tissue readily are exposed to its germicidal action.”
Dakin’s solution is also efficacious in combating pus formation in
pyorrhea. In fact, it is valuable in overcoming pus formation under any
conditions, and on this account proved itself so useful in treating the
suppurating wounds of soldiers during the World War. The remarkable
strength, combined with its non-toxicity, is attested, when we realize
that a one in one-thousandth solution of this germicide is more
effective than a five per cent solution of carbolic acid.
As a mouth wash, it is used in one-half to one per cent strength,
morning and night, or when needed. The mouth should be rinsed
thoroughly, retaining the solution for a minute or two in order to have
the antiseptic liquid act upon the germs.
BLEEDING GUMS.
Persons troubled with bleeding or sore gums should consult a dentist,
as this may prove to be a symptom of approaching pyorrhea, or other
deep-seated disorder. However, if home treatment is imperative, Dakin’s
solution may be recommended for temporary use; also sodium perborate
(Merk’s)--one teaspoonful to half a glass of water, used as a mouth
wash every two hours.
_Stomatitis_, or inflammation of the mouth, which generally
takes on the form of blisters or ulcers, is a very distressing
complaint. Attention should be given to diet, as well as to the most
thorough-going hygiene of the mouth, and a physician might well be
consulted to see if there is any general symptomatic trouble, or if the
inflammation is a symptom of any other more serious disease.