Food and the periodontal diseases

The periodontal diseases, as the name is intended to imply, are a group of diseases which affect the tissues around the teeth, the gingiva or gum, the alveolar bone, the fibrous joint or periodontal membrane, and the cementum. It is important to note that this is a motley collection of tissues, one epidermal, the gingiva, and three mesodermal, two of which, the alveolar bone and the cementum, are calcified. It is only to be expected, therefore, that the effect of particular dietary deficiencies is confused and the subject of controversy. If we look more closely at the fibrous joint between the tooth and the bone, we find that it is similar to other fibrous joints in the body. On the one side is the alveolar bone which is very cancellous, therefore very labile, and presumably easily affected by changes in the metabolism of the individual, and also by changes in the stresses applied to the tooth. From it, collagenous fibres run to the cementum, which invests the tooth and, as the name implies, cements the fibres to the tooth and is a very stable tissue which once formed is unlikely to be affected by the general bodily metabolism. This joint, however, differs from other fibrous joints in that, to all intents and purposes, the fibrous connective tissue of the periodontal membrane is exposed to the mouth, the ingress of bacteria and food debris being prevented by the physical adaptation of a cuff of epithelium around the neck of the tooth. If this cuff loses its tonicity for any reason, then invasion of the underlying tissues can occur. Although the loss of teeth is not a lethal disease, yet it presents a serious public health problem. If people have no teeth, they cannot masticate properly and their diet becomes restricted: they must therefore be provided with some at a cost to the country of millions of pounds a year. Unfortunately even this expenditure restores the masticatory efficiency at best to only about half of that of the natural dentition. Unfortunately, the denture wearers are in charge of the selection and preparation of food for the younger generation and their own inclination is to provide food that requires no chewing, which, as we shall see later, predisposes the rising generation to poorly developed periodontal tissues. Of the two dental-disease groups, dental caries and periodontal diseases, by far the greater number of teeth are lost as a result of the latter. The profession knows all too little about these diseases, so that what I have to say will be to a great extent theory rather than fact, and it will be important to distinguish the one from the other. Periodontal disease, like most other diseases to which man is prone, can be looked upon as the result of a battle between the forces of destruction on one side and the resistance of the individual on the other. In more particular terms, between the forces