It's a sad fact that most people might as well have never owned...
a toothbrush for all the good they've ever done with it. Most people can brush their teeth as many times a day as they want and keep right on having dental disease. Tragically, dentists cling to the concept that brushing will in fact stop dental disease and admonish their patients to do a better and better job. Both they and their patients get frustrated at the ineffectiveness of their efforts.
Dentistry has been on the wrong path for a long time. We've been under the assumption that we have to live with bacteria in our mouth, and we should attempt to cope with it by saying:
"Avoid eating sweets," and while twice a year we admonish our patients, young and old alike, to avoid eating sweets, the intake of sugar per capita increases almost meteorically. "We have to live with bacteria, let us brush after each meal to get rid of the food particles so the bacteria will not have so much raw material to produce the damaging toxins that destroy tooth structure." "We have to live with bacteria, let us put something in toothpaste that will soak into the teeth and make them more resistant to the waste products of the bacteria." This is the fluorides, and they have been proven to be helpful, but the bulk of the decay keeps right on happening and these toothpastes are almost totally ineffective at preventing periodontal disease. "We have to live with bacteria, let us put something in tooth paste that will soak into the bacteria and help prevent them from forming the waste products that dissolve teeth." This of course is guardol and the other anti-enzyme toothpastes. They, too, are effective at reducing decay, but ineffective with periodontal disease.
And then there is the new group that is making itself heard. We say, "You don't have to live with bacteria." We've learned how bacteria live, and once you understand your enemy, you can destroy him. We've learned how to destroy oral bacteria one time a day and stop both tooth decay and periodontal disease.
Undoubtedly the most disturbing thing that has been learned is that a toothbrush will not clean your mouth well enough to stop dental disease. Using a brush in a highly skillful manner, you can achieve removal of bacteria from about 85% of your tooth surface. This is where about 15% of our dental disease originates. The 15% that you consistently miss is where about 85% of all dental disease occurs. Bear in mind that this is under ideal circumstances which are rarely achieved. The "average" person cleans somewhat less than 85% of his teeth and probably eliminates not more than 10% of the dental disease with his brushing.
The net result of our effort in toothbrushing and our persistent efforts at getting people to brush after meals and our largely ineffective efforts all down the line in control of dental disease, has been mass frustration and apathy. It's part of the reason that an estimated 25 million people in the United States have decided dentistry has nothing better to offer and have had their teeth removed. It is part of the reason that I rarely have a dentist visit my office to study my preventive procedures that is personally under control. This also goes for hygienists and dental assistants. We are certainly a case where the blind leads the blind and the results speak for themselves.
Dr. L. D. Pankey says, "Yon can change people, but not very much." I can't tell you how accurately this statement fits American dentistry. The original research for the concept I'm discussing here was done by Dr. C. C. Bass, retired dean of Tulane University Medical School and Dr. Sumter S. Arnim of the Dental Branch of the University of Texas in Houston. Some of their research is now 20 years old and documented in a most comprehensive manner, yet dentists either completely ignore these findings or consider them idealistic and impractical in an everyday practice.
A short time ago I gave a seminar on the control of dental disease. A young colleague who had previously been exposed to this concept was in the audience. He listened somewhat sympathetically because he was convinced of the impracticality of my approach.
One week later a very attractive young expectant mother entered my office with severe pregnancy gingivitis. She had been told by her dentist in California that this was something that she would have to live with during her pregnancy. It had worsened as she had returned to Illinois.
Her sister-in-law, one of my former dental assistants, strongly urged that she seek some professional help. She went to this young dentist a few days after my seminar. He told her the same thing she had been told in California; and this only a few days after he had listened to my report on how to stop disease!
When my former assistant heard about it she advised the girl to go through our control program. She did just that, and brought her pregnancy gingivitis under control in less than one week. Furthermore, the knowledge she gained from that program can prevent her from having recurrent periodontal disease throughout the rest of her life.
The young dentist had preconceived ideas and prejudices like the huge majority of dentists, and he simply could not see the forest for the trees. I tell you, the American public deserves better than what we give them and when they learn better is available, they will go to the source of what is better in ever increasing numbers. Those of us who actively practice the new preventive concepts of Bass and Arnim are extremely contemptuous of those of you who do not. As periodontist Dr. Don Masters of San Antonio, Texas, says, "when people find out that they can control disease, they begin to see dentistry as a long term investment rather than just a wild haired gamble.
I would like to quote from The Journal of Prosthetic Dentistry.1
"Dentists have been very sensitive to statements that they are primarily repair men because so much of their time is devoted to the replacement of missing parts, either of teeth or of mouths. The dentist who terminates his service after merely restoring that which has been destroyed, without teaching the patient the way of preventing further trouble (whether or not the patient follows the prescription), is guilty of being a dental repair man. He is actually not much more than a highly trained and licensed technician. The dentist who educates his patients, as well as he is able, to prevent in the future the disasters of the past, is a physician of the highest order."
If you are still teaching toothbrushing with study models, films etc., as we have been taught in the past, and are as ineffective as I know you have to be, I have nothing but sympathy for you because you are doing this through ignorance and for this you cannot be blamed. If, after you become exposed to a truly effective method of teaching people to control their disease, you continue with your present methods, then this is stupidity and for this you can be blamed.
And then, if you continue your stupidity this will be neglect and those of us who do an active job of effective disease prevention will ultimately bury you.
1. Harding, J. C. Almy, Nutrition Therapy by Dentists. Dangers, Advantages, Technique. The Journal of Prosthetic Dentistry, Vol. 3, No.5, pp. 682-688, September, 1953.
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