Page 48 - Fall2012

It may be months or more. inclined to look on diabetic children as essen-
tially normal and as not differing from other chil-
The diabetes itself does not offer an expla-
safely said nation of the arrest of caries. A review of the dren in any definite manner. It seems reasonable
that these earlier examinations of many of these patients to us to suppose that the insulin given has done
diabetic at the time that they first came to the hospital nothing more than to assist in the maintenance
children ate showed the caries to have been definitely active. of normal sugar metabolism. If these premises
Furthermore, it is known that in diabetes not are granted, the only factor in the arrest of car-
regularly a under control and in ketosis there is a negative ies remaining to be considered is the character
diet more in mineral balance which of necessity must lead to of the diet. The arrest of caries in these children
accordance decalcification of teeth. was coincident with strict dietary regulation, and
Since arrest of caries was not noted in chil-
it seems probable that the diet was the essential

with the dren with any other disease or condition and factor leading to its arrest.
needs of a since it is not dependent on diabetes, it appears The menus which these patients received
normal child that it must depend on some factor in diabetic furnished the essentials of a complete diet, so
management. A further study of other diabetic far as our present knowledge can determine. The
than the patients revealed a parallelism between the estab- use of an abundance of dairy products, fruits
average child lishment of diabetic control and the quiescence and vegetables, supplemented with cod liver
receives. of the caries. oil, insured a considerable supply of mineral
salts and vitamins. It is probably of significance
RELATIONSHIP OF DIABETES that the ash of the diet was predominantly basic.
MANAGEMENT AND DENTAL CARIES This, together with an adequate and balanced
The principle of diabetic management in this ration, is the essential difference between the
clinic represents an attempt to approximate nor- diet of these children with arrested caries and
mal metabolism. Insulin is prescribed in amounts that of the child whose caries are progressive.
sufficient to keep the blood sugar as nearly within The average child is generally allowed to use
normal limits as possible. The diet is designed his appetite as an index of his food needs. His
to meet the requirements of a normal child for menu is determined by the choice of food offered
growth, activity, and health. It differs from the him. Menus employed in the home are often far
usual concept of an ideal diet for a normal child from complete in accessory food substances and
in that fat, rather than carbohydrate, is used as minerals. It may be safely said that these diabetic
the chief source of energy, the fatty acid: dextrose children ate regularly a diet more in accordance
ratio being 1.5:1. All these children were on the with the needs of a normal child than the average
same ratio of protein: carbohydrate: fat, namely, child receives.
7:9:21. The total amounts prescribed varied ac- The high incidence of caries during child-
cording to each child’s degree of development. hood, its activation in adults by pregnancy and
In general, the same foodstuffs were used lactation, and its frequent association with defi-
for all. To a large extent these consisted of milk, ciency diseases give evidence of its dependence
cream, butter, eggs, meat, cod liver oil, bulky on metabolic disturbances. Such disturbances
vegetables and fruits. The menu was designed to may depend in part or wholly on the character
include approximately a quart of milk and cream of the food intake. Howe, Grieves and Marshall
daily. The fat was furnished principally as cream, have demonstrated the development of caries in
butter, and egg-yolk. Each child received calories laboratory animals receiving diets inadequate
sufficient for full activity; the energy value was either in vitamins or in minerals. These dietary
higher than is frequently employed in diabetic deficiencies result in disturbances of the min-
diets. Adequacy of insulin dosage was verified by eral balance. Such disturbances can manifest
frequent blood sugar estimations. These values their effects within a surprisingly short time.
closely approximated normal concentrations. Demonstrable changes in tooth structure have
Glycosuria [excretion of glucose into the urine] been noted within a few hours after the inges-
was different. tion of various substances which affect the
When diabetes is well under control we are mineral metabolism of the body as whole. It is
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