Page 47 - Fall2012

From the Archives

THE ARREST OF DENTAL CARIES IN CHILDHOOD
By Julian D. Boyd, MD and S.L. Drain, DDS
Journal of the American Medical Association, June 9, 1928

Editor's Note: This fascinating article, published tive of caries, and many adult mouths which do
in 1928, was almost certainly read by Dr. Price. not receive care and have exposed dentin show
little carious activity. That some other factor is
Dental caries may be properly considered involved from those mentioned is made presump-
as a disease of childhood, susceptibility at this tive by the observations which form the basis of
age period being almost universal. In surveys this study.
of school children it is unusual to find a mouth
free from caries. The average child will have UNUSUAL ARREST OF CARIES
seven or more affected teeth in various stages of The present report was prompted by some
destruction. The rate of progress of the carious unusual observations made in the course of
process and the number of teeth involved varies repeated routine examination of patients in the
with the individual. As the child approaches dental division of this clinic. The examinations
maturity, retardation of destruction becomes disclosed numerous instances of definite arrest
evident. In some instances active caries may be- of caries in children. Teeth containing large
come arrested spontaneously during childhood. cavities, which ordinarily would have an area
The factors involved in the inactivation have not of softened dentin surrounding the zone of de-
been understood, nor have many instances been struction, were found instead to be very dense.
recorded. In these mouths in which there was evidence of
rapid and extensive involvement of many teeth,
ETIOLOGY OF DENTAL CARIES further invasion was shown by subsequent exam-
The etiology of dental caries is a subject of inations to be checked, and open cavities did not
controversy. It is generally conceded that a break show any signs of progress months after they had
in the continuity of the enamel is a primary req- first been described. Moreover, the occurrence
uisite. The exposed dentin thus becomes suscep- of salivary calculous deposits on these teeth was
tible to attack by external agencies. Any factor almost universal, and it recurred rapidly after
leading to enamel defects will thus predispose a its thorough removal. Salivary calculus, though
tooth to caries. not uncommon in the adult, is very unusual in
It is evident, however, that other factors also the child. Otherwise, these patients did not show
are involved, for it is not unusual to find in the anything noteworthy from a dental standpoint.
middle aged all teeth abraded almost to the gin- Shedding and eruption were about normal in
gival margin, with the dentin widely exposed, yet most cases. The degree of oral hygiene varied
no evidence of active caries. Various strains of as greatly as in any unselected group of similar Some teeth
bacteria have been described as causative agents. size. Some teeth showing unquestionable arrest showing
It is obvious that the carious process involves a of caries were found in the most poorly kept
bacterial factor, but it is questionable whether this mouths. unquestionable
is due to any specific organism or is a secondary When these dental observations were cor- arrest of caries
invasion of dentin which has previously been related with the medical histories of the patients, were found in
injured in such a way that it cannot withstand it was found that without exception the children
the many organisms found in the normal mouth. with arrested caries were all diabetic patients the most poorly

Strict oral hygiene is not necessarily a preven- who had been under careful management for six kept mouths.
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