CHIAVARO, ANGELO : Royal Dental Clinic, University of Genoa, Genoa, Italy (June 19, 1939).

(1) Hard tissues of teeth, after their formation, are destroyed (in caries) only by external physical or chemical agents operating inward. (2) De­ficiency or abundance of any element in blood or lymph cannot have any in­fluence on dental hard-tissues after formation of the whole tooth. (3) (a) There is no truth in the saying that ” every pregnancy costs a tooth.” (b) Deficiency of mineral salts and vitamins in the circulation, owing to poor nutrition, pregnancy, or tuberculosis or any other disease, is not a predisposing, determining, or auxiliary cause of caries. (c) Mineral substances and vita­mins in the diet, during the formation of any dental hard-tissue, are necessary for normal construction of the tissue, but are not required by the tissue there­after. (4) Acidogenic bacteria, assembled in zoogleas (plaques), progres­sively decalcify dental hard-tissues. This action occurs only when these or­ganisms gather where functional friction does not dislodge them and where during periods of repose, as in a markedly unhygienic mouth, they are pro­tected by overlying food residues or otherwise against the diluting (and prob­ably antiseptic) action of saliva. (5) Under these conditions, acidogenic or­ganisms transform fermentable carbohydrates into lactic, succinic, or other acid, ra– of which, if sufficiently concentrated, decalcifies dental hard-tissues

where a tooth is not protected by enamel cuticle (called by theauthor perienamel). (6) Caries usually starts in these dental regions : in­tercuspidal fissures, pits and grooves of enamel, articular facets on contiguous crown-faces, cervical regions, and fractured or hypoplastic regions of the crowns.

(a) Rational dental prophylaxis, for prevention of caries, should be started when the teeth begin to form, i.e., on the fortieth day of fetal life, when the em­bryologic production of temporary teeth is inaugurated. After the diagnosis of pregnancy has been made, the mother, her teeth and gums having been put into hygienic condition by the dentist, should be counselled—always in consultation with an obstetrician—as to the foods best adapted for normal development of the child. Such foods are those rich in vitamins, and in salts of calcium, magnesium, and phosphorus ; e.g., fruits, raw greens, eggs, milk, butter, milk products, and meat. This prophylaxis—which should be followed continuously by the child—ends at about the eighteenth year, when, as a rule, development of the roots of third molars has been completed. (b) Rational dental hygiene for prevention of caries —means of keeping teeth healthy throughout life—to be efficient, must be made a ” natural habit.” “It must be begun after the child’s first feeding and continued all through life after each meal, tea included, both in health and in sickness.” After the child has been fed the first time, and after each successive feeding, its mouth should be wiped “with extreme care and delicacy” with a small piece of sterile gauze, wrapped around a finger and soaked in boiled water at body tem­perature. Thus the child acquires the “natural habit” of feeling his mouth clean after each meal. The author has observed that, if the beginning of this simple habit is delayed for a few months after birth, involuntary and persistent resistance is often shown proportional to the delay in initiating the procedure. But such resistance is completely avoided if the procedure is started before the child is able to oppose it. If put into practice ” with extreme care and delicacy,” from the first feeding, this procedure cannot do any harm, as the author has found during his last thirty-six years of experience, notwithstanding opposition on theoretical grounds from exponents of child welfare, who fear possible abrasions of oral mucous membranes. Immediately after the first teeth appear, they should be cleaned by the same method after each meal. Between the ages of 1 and 2 years, use of sterile gauze is substituted by that of a small tooth-brush. Between the ages of 2 and 3 years the child, under his mother’s guidance, should learn to clean his teeth after each meal. After having thus acquired the habit of cleaning the teeth after every meal no one ever forgets it, and teeth and gums are thus maintained in healthy condition for life, because “really clean teeth never decay and never acquire deposits of tartar.” Each meal should be terminated with fruit or raw vegetables. ” Rational dental hygiene ” signifies ” maintenance of the soundness of the teeth and adjacent tissues, when the teeth are healthy, in physiological posi­tion and occlusion and surrounded by healthy tissues.” When these conditions do not exist, they should be brought about before the rational after-meals hygiene is begun, otherwise the hygienic procedure may be harmful. During the period of treatment the dentist prescribes the dental hygiene best adapted. (c) The hygienic means of keeping teeth and adjacent tissues clean are use of tooth-brush, denti­frice, waxed dental floss-silk, tongue-scraper, gum massage, collutory (mouth wash, gargle).

References: Numerous since 1902, chiefly in Ann. Odont. (” Archivio Chiavaro”).

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