Freedom from caries occurs when antenatal nutrition and postnatal nutrition have been sufficient to promote normal development and calcification. An important complementary local factor is the use of foodstuffs, such as fruits, etc., which require mastication and have cleansing action. Conversely, increased susceptibility to caries occurs where nutrition has been deficient and use of soft foodstuffs (sugary or starchy), such as sweets, biscuits, etc., has been excessive. Detrimental effects of sugary subtances are increased by conditions that favor stagnation around teeth, such as mouth-breathing, lack of oral hygiene, etc. Where nutrition has apparently been satisfactory, local factors are predominant in causation of caries. The combined influence of defective tooth structure and local use of sugar is shown by extensive caries of deciduous teeth in children who have a bad nutritional history and imperfect calcification, and who used baby ‘ comforters ‘ dipped in sugar. Heredity is not a factor in caries.
Of 2894 elementary school children (ages, 6 to 13), the proportions having complete dentitions free from caries ranged from 6 percent at six years to 0.5 percent at nine years, and 4 percent at thirteen years, the rise between nine and thirteen years being due to loss of the deciduous teeth. Children in the same family showed variations according to differences in diet and habits. An influence of heredity was not indicated. A study of twelve school children (ages, 5 to 14) having complete dentitions and freedom from caries (Group I) was undertaken to elucidate the main facts regarding their nurture and habits—in view of their remarkable freedom from caries, which was so prevalent among children in the same environment. Their economic circumstances varied. A characteristic feature of the group was the careful and intelligent manner of their up-bringing, including the poorer children. In only one case did infant-feeding appear to be imperfect, and this was followed by defective structure of permanent teeth. The general diet was well-balanced with adequate protein and fat, and green vegetables ; additional milk was taken by all ; fresh fruit, particularly apple, was eaten daily by each child—by seven children, abundantly ; meals were regular—no eating between meals—and the children enjoyed chewing hard foods ; variable amounts of cod-liver oil were taken by all but three. There was very limited consumption of sweets and other fermentable carbohydrates. All were nose-breathers; only two had used baby ” comforters ; ” all brushed their teeth, eight of them several times daily. A corresponding study of twelve children (ages, 3 to 14) having extensive caries (Group II) provided a comparison. These cases of rampant caries formed a striking contrast to Group I. The economic circumstances varied, a larger proportion of poor children than in Group I being included. Intelligent management of diet and habits was not so evident as for Group I. For a large majority, infant feeding had been unsatisfactory, and the general diet was deficient in protein and fat ; vegetables were decidedly lacking ; consumption of fresh fruit was not so abundant as in Group I; additional milk was taken by all, but cod-liver oil was received for variable periods by only six; considerable amounts of sweets, and fermentable carbohydrates such as biscuits, were taken daily by all. Baby ” comforters ” had been used by six—for five having extensive caries of deciduous teeth, sugar had been applied to the comforters; six were mouth-breathers; the hygiene of the mouth was generally unsatisfactory ; only two daily used tooth-brushes.
Reference: Brit. Den. J., 1938.