“Treating Cavities with Medicine”
Posted on Wednesday, July 11th, 2012
You wouldn’t know from the opinion piece under that headline.
Having been trained as a microbiologist prior to going to dental school, I tend to look for the classic signs of disease progression, such as those found in Koch’s postulates. I was well aware that caries is an infectious transmissible disease, but I could not understand how those little bacteria could figure out what the income of their host was and preferentially colonize in low-income people. So the best predictor for dental disease is low socioeconomic status? It’s not that simple.
Indeed! So maybe we should look beyond the bacteria. How about risk factors that may make certain populations more prone to tooth decay – things like diet/nutrition, oral hygiene and access to care?
Not. A. Word.
Instead, he devotes the rest of his article to talk of historical caries treatment, especially placing silver nitrate on the leison – a procedure refined by G.V. Black to stop decay and ready the tooth for a gold restoration. Why silver nitrate? For its antimicrobial properties. And for its not being mercury.
But it’s not entirely benign, either:
As an oxidant, silver nitrate should be properly stored away from organic compounds. Despite being used in low concentrations to prevent gonorrhea and control nose bleeds, silver nitrate is toxic and corrosive. Brief exposure to the chemical will not produce immediate or even any side effects other than the purple, brown or black skin stains; but with more exposure, side effects will become more noticeable, including burns. Long-term exposure may cause eye damage. Short contact can lead to deposition of black silver stains on the skin. Besides being very destructive of mucous membranes, it is a skin and eye irritant.
Moreover, if other metals are present in the mouth – as they would have eventually been, following Black’s method – conditions are ripe for oral galvansim, which can have profound repercussions throughout the body.
Yet this procedure, suggests the author, is a fine example of “treating cavities with medicine.”
Treating cavities with medicine seems to have been well established in the early days of dentistry. Given that we are facing a new epidemic of dental disease and this situation affects those patients with the least access to care, perhaps it is time to dust off those old books and relearn the lessons taught by W.D. Miller and G.V. Black.
It’s not clear that he’s actually recommending the silver nitrate solution. What is clear is an idea that dentistry’s main concern is with after-the-fact, mechanical repair of teeth – and little more.
Fortunately, there are growing numbers of dental professional who understand that there’s much more to dentistry than just fixing teeth. Even the ADA has begun to acknowledge the possibility of links between oral and systemic health. And, of course, holistic, preventive care plays a critical role in reducing oral disease and dysfunction of all kinds, not just cavities.
As we mentioned last time, a reactive approach to oral care pretty much guarantees that problems like caries will persist.