Caries is universal among civilized peoples. Excepting rare instances, it does not occur on protected normal-enamel surfaces that are accessible to manual cleansing processes. It occurs most frequently on interproximal and occlusal surfaces of molars and bicuspids, on buccal and lingual surfaces of molars, and on interproximal surfaces of the other teeth. The lower six anterior teeth are the most resistant, and frequently are free from caries after all other teeth have been involved. Deciduous teeth may be attacked at a very early age. In some instances this has occurred prior to the eighteenth month. Resistance or susceptibility of deciduous teeth is not an index of resistance or susceptibility of secondary teeth, which may be attacked within a few months after eruption, or may resist for many years. In some individuals caries progresses rapidly; in others, slowly. Children of the same parents may show various degrees of resistance. Thus, one child may suffer rampant caries at a very early age ; another may resist, or suffer very little, for many years, and then may succumb to widespread attack ; another may fall into that comparatively small group which maintains resistance well past middle-age, or to very old age. Those having high degrees of resistance are the offspring of parents who—one or both—were highly resistant to caries. The child showing high resistance bears striking resemblance to the parent similarly favored—resemblances, for example, in shade, form and size of teeth; color of eyes ; shade and abundance or sparsity of hair ; temperamental characteristics ; etc. The author has never seen a highly resistant individual whose parents (both) had histories of caries susceptibility.
Dietary (nutritional) regulation, whether supplemented or not by vitamins and mineral salts, does not insure caries resistance. Encouraging results have been obtained for persons who were given corrective diets suggested by data of salivary analysis. General health is not necessarily an index of dental status. A person in otherwise splendid physical condition may exhibit widespread caries ; but some individuals, below par physically, have high resistance to caries. Numerous instances of high resistance have been observed in the presence of local conditions that ordinarily favor caries, such as misaligned and crowded teeth. High resistance to caries has been observed in individuals whose dietary habits do not conform with the conditions of so-called protective diets.
There is widespread belief that inclusion of sugar in the diet causes caries. Among the author’s patients for thirty years are three sisters whose present ages range between 30 and 35. Their father was a candy manufacturer. Throughout their entire childhood and adolescence a plentiful supply of candy was kept in the home at all times, and all of the children partook of it freely. The youngest and also the oldest have suffered very extensive and widespread caries, showing in this respect their mother’s high degree of susceptibility. The second child, although she ate candy as freely as the other two, has been remarkably free from caries, and at present might be classified as a notably resistant individual. She shows her father’s high degree of resistance to caries.
References: Internat. Clinics, 1932; Am. J. Pub. Health, 1932; J. Am. Den.
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Assoc., 1932, 1935, 1937; Den. Cosmos, 1934, 1936; N. Y. J. Den., 1936; J. Den. Res., 1937 (Proc. Int. Assoc. Den. Res.)