Dental-Caries

DENTAL CARIES is the most prevalent of all diseases. Very few persons now escape its attacks. It begins in early childhood and usually continues until most teeth have been affected. Arrest of caries, treatment of its sequelae, and repairs and restorations required by its destructive effects, are the most general present functions in the health-service of dentists. Despite the universal in­cidence of caries and its deleterious consequences, the causes of caries have not been completely established, and its general prevention has not been at­tained. Many careful researches and numerous competent clinical observa­tions relating to the etiology of caries have been made during a long succes­sion of years by able and devoted students of the problem, yet the results have been discordant, the conclusions contradictory, and the outcome confus­ing. Neither an assured body of facts relating to etiology, nor an accepted procedure for prevention, emerged from past efforts in research and clinical inquiry. Prevention of caries—like prevention of ” the common cold ” and cancer—awaits further discovery.

under these conditions, there has long been urgent need for a published compilation in this field to show directly the realities of this situation, to present the main data in conveniently accessible form, and this to provide a new threshold and a stronger impetus for more effective experimental and clinical research in caries. To meet this need the Research Commission of the American Dental Association authorized the attempt, in this book, to sum­marize the findings and conclusions of leading active observers and investi­gators in all parts of the world, in brief and direct statements of their views on caries, as restated by themselves—and representing in their own words the conclusions which, in their judgment, are the enduring results of their efforts and experiences. To obtain the maximum degree of cooperation in this public effort, we followed this procedure :

(1) Copies of an ” open letter to all investigators throughout the world in the field of dental caries ” were sent to all known students of caries, and pub­lished in whole or part in many dental journals in this country and abroad. This letter, dated April 18, 1938, included these invitations :

” Each living person who, from research or clinical observation, has published findings and conclusions that bear in any way, directly or indirectly, on the cause or on the control of dental caries in man or animals, is hereby cordially invited

” (a) to send, to the [Research] Commission [of the American Dental Asso­ciation], a concise summary of the basic findings of fact which, in his belief, war-rant the conclusions that, as of a date to be specified by him,* represent the essential results and his matured judgment of the outcome of his own study in this field ; also

” (b)        to indicate the location of the paper or papers in which his basic findings and conclusions have been published ; and

” (c)        to append, to the brief summary of his basic findings and conclusions, any supplementary statement that would seem to him to be necessary for adequate evaluation of his crucial results. . .. The proposed compilation of summaries will separate clearly from many disagreements, abundant mistakes, numerous irrel­evancies, multiple re-publications, etc., the findings and conclusions that each worker —regardless of the length of time during which he has labored, the past variations and revisions in his views, and the range of his studies—now regards as the out­standing basic results of his experience in this field. The compilation will be, in effect, not a series of abstracts of individual publications but, instead, a direct authoritative crystallization of basic findings and conclusions as they now stand in each worker’s studies of the cause or of the control of dental caries.”

(2)      A series of circular ” reminders ” was sent to all known special workers in this field who had not responded to the general open letter ; also to dental jour­nals for related announcements. These reminders, which included cumulative lists of the names of those who presented summaries, were dated successively July 28, 1938, Sep. 15, 1938, Oct. 4, 1938, Nov. 17, 1938, and May 10, 1939.

(3)      Additional personal letters were sent to the most active students of caries—several to some—who had not responded to the circular letters. These personal letters were issued occasionally during the period from October 1938 to July 1939.

This procedure was intended to awaken the interest of all who, in this field, are competent to present findings and conclusions and to express opinions. Some investigators have not participated because they feel that their findings ” are no longer significant ; ” others because they are ” unwilling to indicate . . . present views.” No ” minimum requirements ” for admission to this composite authorship were indicated or applied. The summaries of all who responded to our public and personal invitations were accepted into this com­pilation. The critical reader will be the judge of the relative values of the individual contributions.

As the summaries were received, copies of them were subjected to readjust­ments (a) to place the main findings and conclusions first ; (b) the supporting details second (to be in smaller type) ; (c) condensed in phraseology to reduce both the time required for reading, and the space and cost in printing ; and (d) clarified, from the reader’s standpoint, where uncertainty occurred—thus facilitat­ing direct comparisons among the summaries. Duplicate copies of each summary as thus rearranged were then forwarded to the respective authors, with a circular

* The dates of the summaries in this volume are those of original presentation or subse­quent revision.

explanation of the reasons for the readjustments, and requesting return of one copy with corrections, revisions or confirmation. There were many indications of cordial approval of this editorial procedure and none of dissatisfaction. The authors of all but 3 of the 195 summaries replied (Boots, Pedersen, Westin). In these circular explanations we also invited the personal assistance of each author in our effort to bring the compilation to the cooperative attention of colleagues who had not yet responded to our invitations.

Page 3 shows at a glance the arrangement of the contents of this volume. The placement of the summaries in the alphabetic order of the surnames of the primary authors, and the list of secondary authors on page 18, facilitate reference to the statement of any contributor, and make an author-index re­dundant. The ” general analysis ” of the findings and conclusions on the causes and control of caries (pages 173-188) is intended to take the place of a subject-index.

It was not our purpose to evaluate the findings and conclusions in this book, nor to suggest which views may be regarded as most significant. Pre­sumably, these functions will be performed publicly by reviewers and special students of caries. We aimed only to compile the data and to make them readily available for constructive use by those who will promote public discus­sion, and who will advance further research and clinical inquiry. It is hoped that philanthropic and public funds will soon be available for newly co­ordinated and more extended study of the urgent problems brought to view by this compilation. Prevention of ” the most prevalent of all diseases ” assuredly deserves special attention from all who aim to conserve the public health and who seek to provide protection against the economic consequences of illness and disability.—W. J. G.

New York City, September 16, 1939

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