C O R R E L A T I N G D E N T I S T R Y W I T H M E D I C I N E

"~VAI,TER T. McFAhL, D.I).S., MACON, GA.

I N P R E S E N T I N G this brief r~sum6 of correlating dent is t ry with medicine, I do so believing that dent is t ry is a necessary and integral par t of the great healing

art. Jus t as the proctologist, the rhinologist, the urologist, the neurologist and the pediatr ician have their parts in the practice of medicine, so has the dentist in that vast field he serves, which consists of much more than the mere cleaning, filling and extracting of teeth, more than replacing by prosthesis those masticatory and esthetic organs so necessary to good health and its maintenance. When we con- sider the task and responsibility which is the dentist 's, we must agree that his work is significant and important ; for the " m o u t h is tile gateway to the body , " and should be guarded, cared for and treated as such.

Jus t as medicine has made its splendid strides in the last century or two, so in the last half century dent is t ry has also risen from the plane of a mediocre t rade or an occupation to a professional level that is doing much to make life longer, happier and more useful. All branches of the healing ar t should strive to eliminate the cause for their necessity by making sickness, pain, and the inherited and ac- quired afflictions and ills, so common to the human race, frowned upon and prevented.

The members of all the healing professions are being sought out as leaders to guide, to teach, and to help others to be healthy, happy and useful; to be more concerned with the vital par t they have in shaping human destinies. We are fast coming to accept, as our symphony, that we, as members of this present generation, are living not only for ourselves but also for those generations which are to follow. Those forces which make or mar ttle destinies of man are more amenable to control today than they were twenty-five years ago. The present development of in- dustrial processes, the various sciences of conservation give us hope, at least, that the worst conditions of poverty, selfishness and i~moranee are being done away with. The amazing progress of medicine demonstrates that most of our dreaded ills can be overcome and many others eliminated by simple, I)reventive means ; and finally the laws of heredi ty when ful ly known and heeded are surely capable of raising the mental, moral and physical endowments well above where they now stand. Much progress and development are apparent ; and, while the average life has been added to some eight years, there is still a vast amount of ignorance about health and disease. The startling research work of a number of scientifie men is more than offset by the thousands who still buy patented cures for tuberculosis; by those who continue to use liverwort for jaundice because the leaf resembles the human liver; by those who treat infectious diseases by suggestion; by the thousands who still believe the care of deciduous teeth is not necessary, that they should not be preserved and saved until time for normal resorption and replace- ment, who have been told " f o r every child a too th ," who believe a body can be strong, healthy and nourished when food is taken into the stomach through a

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mouth whose very contents are filled with filth, decaying sore teeth and gums, harboring the pu t re fy ing and decaying food and germs, where pus of the most virulent na ture is found, who believe that infected tonsils, glands, and ears, that impaired masticatory efficiency do not cause a great handicap to a child in school and throughout life. We must work earnestly in answer to this appalling chal- lenge and weighty responsibility which come to every man of us. I am saying these things because I t remendously feel the obligation of it, and the need for it. "P rogress is the law of the universe ," and any one who will not bend his will to this law not only handicaps himself but grievously wrongs and deprives all those whom he should serve, of their r ightful par t in all which is highest and best.

I feel we all agree, in par t at least, with Dr. Charles Mayo, when he said, " T h e next great advance in the prevention of disease is the knowledge that chronic dis- eases, acute diseases, and special local diseases, such as neuritis, sciatica, and acute paralysis, come from mouth infections in most instances; also that appendicitis, diseases of the gall bladder and ulcerated stomach are caused by bacterial infarcts in the capil lary circulation at the base of the mucous cells in these organs, and are caused in the same manner f rom local infections. While there are several sources Jn the body for the entrance and growth of these bacteria, in a local focus the mouth is far the most common s i tuat ion." Yet we still see and know of certain practi t ioners in both the medical and dental professions who seem to feel they can work entirely free and separate from one another. I should like to say that I have never listened to a medical discussion, I have never read a pat ient ' s chart, I have never a t tended a minor or major operation, but that I learned something new and needful, and was improved as a doctor of dental surgery. The time has come when we all must believe, " N o man liveth to himself, yea, and no man dieth to h imself ." I sincerely believe that the dental profession stands ready, willing, and eager to assist, cooperate, and consult with the internist, the general practi- tioner, few of whom the dentist sees today, and any man in any specialty of medi- cine, to help the patient, the lai ty everywhere, to be healthy, happy and useful.

Our mutual problem in the fu ture is not so much one of correction and repara- tion as one of education. This education must be hammered home, night and morn- ing, and must begin with the grandparents . I f we all realized that just in propor- tion as a child is " s o l d " today on the prevention of communicable diseases and de- generative diseases, on regular examinations, on eradication of ignorance, poverty, and insanity, together with the endless category of preventable maladies that we fall heir to, just in this proport ion will the present day child produce a better, healthier, and more useful progeny. On the Post Office in Washington are these forceful and impressive words, " C a r r y t ru th and life to all men ." But are we do- ing this, are we fulfilling the aspirations, aims and purpose of our l ife 's work ? We cannot change public sentiment all at once ; nor can we get legislation without pre- ceding it by education. We must realize that our du ty and responsibility to the nation and state are not confined to the care of those diseased conditions of the body; this we have been doing; but we must be concerned as to the best possible health of our communities.

No reputable physician should honestly undertake to relieve or cure a patient suffering from some form of systemic trouble, from maladies of the lungs, heart,

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digestive organs or kidneys, without first ascertaining the condition of the mouth and teeth; having some reputable and conscientious dentist who is well informed from the medical side, to correct and clean up the mouth of the patient, thereby eliminating any possible trouble from this source.

Dr. Adolph Knopf, the great lung specialist, has said, " I defy any physician to help or cure a patient suffering with tuberculosis, who hag defective teeth." Surely this must be the honest opinion of a number of physicians regarding other systemic diseases. I shall not open that field of systemic foci generally because we never seem to get anywhere on that query and are very much like goldfish, merely going around in a circle without getting any further.

There is no malady of the human race which affects quite so many people as do defective teeth and gums. Because of the prevalence of dental caries and dis- eased gums, dental troubles have aptly been termed, " the people's disease." We learn that the entire body is affected, the influence being chiefly of four kinds: (1) decreased power of mastication or chewing, due either to decay or irregu- larities of the teeth ; (2) the toxic effect of pus, which is absorbed directly into the blood or is taken into the stomach and intestines ; (3) reflex nervous disturbances due to pain, impaction of teeth, cysts, infection, etc. ; (4) the possibility of the mouth acting as a breeding point for the bacteria which are well known to cause acute infectious diseases.

Dentistry can help medicine by cleaning and conserving every possible tooth for its maximum life and efficiency. If a man cannot chew, he cannot digest his food, for the first stage of digestion begins in the mouth where food is incorpo- rated with the ptyalin of the saliva and broken into smaller particles and simpler compounds. If a man cannot digest his food, his body is not nourished, tissues are starved and are liable to disease because of lack of nourishment and tone. If a patient 's mouth is filled with rotten decaying teeth which are sore and nonusable, which harbor putrefying food and filth to mix with each im- properly masticated mouthful of food taken into the body, how can he improve ? We need a closer relation and appreciation between physician and dentist, more frequent consultations, more earnest consideration of facts as presented. In the medical schools the students are given possibly three or four lectures on teeth and gums, and later many physicians feel competent to recommend this and that about the part of the human body they have been taught least about, and about the part they are possibly most inadequately informed.

No radiograph is an infallible, positive diagnosis; yet because the physician and the dentist fail to get together, many patients are forced to undergo a tardy restoration to health, forced to remain in a quandary, doubting both medicine and dentistry, their efficacy and necessity, or usually needlessly having sound serviceable teeth ruthlessly sacrificed. Many teeth are condemned by a one- angled, imperfect radiograph, and this alone. Many of these teeth are vital, healthy, useful teeth. Frankly now, can the physician judge better than the dentist? Can a dentist diagnose typhoid fever more effectively than a phy- sician? We all know the answer, but we do believe a dentist can make a better diagnosis regarding the elimination of a tooth or a mouth condition than can the average physician or roentgenologist. Physicians should consult the patient's den-

542 Walter T. McFall

tist or a dentist whose ability and judgment he respects before marking a tooth as dead, abscessed, or needing to be extracted. A dentist who has treated a pa- t ient 's mouth and teeth for some time should know best that patient 's mouth. The physician should call the dentist, just as the dentist calls the patient 's family physician when he needs him, in order to accomplish the most for the patient.

In recommending a dentist to a patient, the physician should not recommend a man who indiseretely practices dentistry or who extracts teeth simply be- cause the physician wants this done. He should have the dentist consult with him, have him see the patient with him, and give the same professional eonsidera- tion to the mouth and teeth as he does to the removal of an arm, an eye, or a gall bladder.

Dentistry can aid medicine in teaching the laity regarding the proper diet which will build and maintain healthy bones and teeth, thereby materially in- hibiting rickets, defective teeth and their allied sequelae. Good teeth, just as good bones, are born--not grown. Dentistry can aid pediatrics in numerous ways, by earing for the deciduous teeth, by aligning oncoming permanent teeth, by maintaining a normal arch and respiratory tract, by preventing malforma- tions of the jaws and head.

The rhinologist and dentist often find their work so close together it over- laps. Many times diseases of the sinuses, eyes, ears, and throat have a primary predisposition for trouble in the mouth. Many cures and alleviations are ren- dered in the field of rhinology through a strict dental correction.

Neurology with its many diversities is turning to dentistry as never before. No nervous disease is corrected without a dental correction now, and the neurol- ogist in a good measure depends upon the assistance tendered him by the dentist. All sanitariums and hospitals for psychic and nervous diseases maintain an ade- quate and efficient dental staff. Dr. Cotton, at the New Jersey State Hospital for the Insane, released more than 17 per cent of the inmates after a thorough mouth correction, and in this instance no other corrective or therapeutic treat- ment was administered.

There should be a close affiliation between the obstetrician and the dentist. Many pregnant women undergo torture from aching, sore teeth during preg- nancy because they fear the consequences of extraction or treatment. It is now a well-established fact in medicine, as well as in dentistry, that this fear and pain are needless and without foundation. A pregnant woman should consult her dentist, and by advising him of her condition avoid long' sittings, etc., about as soon as she consults her obstetrician, for tooth formation begins fifty days after conception. Any woman who does not follow a diet essentially balanced in those necessary bone and tooth building' substances, principally calcium and phosphorus, always has a materially impaired mouth thereafter, because nature goes to the most fruitful source for calcium and phosphorus if it is not supplied in the normal diet, for the new life must be supplied. Therefore without the proper dental attention and diet the pregnant woman's teeth and bones are usually irreparably damaged, and the child begins life as a dental cripple and a bone deficiency cripple because of this easily avoidable neglect upon the mother's part.

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The public health man and the general practitioner know they are greatly helped in their endeavors to obtain and maintain good health in children in the preschool and school age, by the part dentistry plays. Those children with healthy, well kept mouths more often miss the common infectious and epidemic diseases so generally encountered in this important period of growth and de- velopment. Children with clean mouths maintain a far better systemic im- nmnity ; they are more vigorous, attentive and prompt at school, and in play life.

The urologist obtains far better results from a patient with a well kept mouth than from one with a filthy mouth. Dentists often observe the primary lesion of syphilis in the mouth and can materially aid the specialist in this line by maintaining a clean oral cavity to aid in the administration of drugs, etc. The characteristic nose dip, the cleft palate, the lesion slow to heal, all help the dentist to inform the physician of his findings and to aid the patient to have treatment.

That vast field of surgery which considers more especially the mouth, jaws, and even the face, has in a good part been relegated to the dentist in the field of oral surgery. Fractures, ranulae, neoplasms, osteomyelitis, maxillary sinusitis, cleft palate, harelip, plastic surgery, tic douloureux, and many other infections affecting these vulnerable parts are rightfully referred to the oral surgeon.

Those wretched infections of the mouth are, of course, best treated by the dentist: the early forms of stomatitis in children, thrush, cancrum oris, noma, phagedenic gingivitis, herpes labialis, perl6che; as well as scurvy, mineral poi- sons such as mercury and phosphorus, etc., foot and mouth disease, scleroma, Vineent's stomatitis or trench mouth, Ludwig's angina, adenitis, cellulitis in adults. In all these diseases, first seen more often by the physician than by the dentist, dentistry must of course be employed, together with other needy sys- temic treatment by a physician.

I might well mention many other avenues in which dentistry can, does and should aid medicine, but this brief r~sum~ is intended to call only a few of the more important to mind, to ask both the physician and the dentist to consider that each can help in rendering the best possible service to the laity.

Dentistry is a most important branch of medicine ; it is the dentist 's duty to be thoroughly competent, and willing to advise in the care of the mouth as soon as the child is born. He should not have the erroneous idea that his duty begins only when the child is first brought to him with carious teeth, periodontal or apical abscesses, etc. The family dentist should be as responsible for the child's health as is the physician, and no parent considers the rights of the child unless there is such cooperation asked--nor is the physician doing his full duty to either parent or child unless he is at pains to impress this fact upon the parents.

May there dawn a day, and that not far distant, when both the physician and the dentist shall realize that each has a necessary part in fulfilling their obli- gations as guardians of a nation's health and nlay they with one accord rise up to help humanity obtain and maintain its desire of being a healthy, happy, useful people, well born and well fit, a desire which cannot be bought with gold.