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Dentistry as a Factor in Preventive Medicine in the Army

AMEDD Corps History > U.S. Army Dental Corps > Walter D. Vail and the History of the U.S. Army Dental Corps

DENTAL BULLETIN SUPPLEMENT TO THE ARMY MEDICAL BULLETIN

VOLUME 7, No. 1 (JANUARY 1936)

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DENTISTRY AS A FACTOR IN PREVENTIVE

MEDICINE IN THE ARMY

By

W. D. Vail, Major, Dental Corps

(“Those who practice preventive dentistry are practicing preventive medicine.”*)

Military medicine is essentially preventive medicine. The prime function of the medical service of a military establishment is the conservation of man power—the preservation of the strength of military forces.

The physical requirements of military service are exacting. Not only must a soldier be able to see well, have good hearing and be sufficiently intelligent to understand and execute orders, but he must have the physical stamina to transport and protect himself as the exigencies of the service may demand. It is important, therefore, that the Army be recruited with persons in reasonably good health. To this end all applicants for enlistment and candidates for commission are required to meet certain minimum physical standards before they are accepted for military service. Physical examinations are conducted by medical officers of the Army or contract surgeons (and dental officers, when available). The examiners are authorized to use all diagnostic procedures at their disposal, including the use of the microscope, the X-ray, or other methods, with a view to determining the true condition in doubtful cases.1

After acceptance in the service military personnel are vaccinated against smallpox, typhoid and paratyphoid fevers and are re-vaccinated throughout their service as occasion may require. They are trained in personal hygiene and military sanita-

*(Chas. H. Mayo; The Unity of Preventive Dentistry and the Newer Preventive Medicine.—The Military Surgeon, 76:6 (June) 1935.


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tion and are surrounded with all the facilities and benefits that public health measures provide, and when disabled their disabilities are treated with the view to returning them, if possible, to full military duty in the shortest practicable time. These measures summed up represent the application of preventive medicine.

The effect of military medicine on the preservation of the strength of military forces is tremendous. Such diseases as typhoid and yellow fevers, plague, etc., are no longer scourges to armies. During the Spanish-American War there were 1,580 deaths from typhoid fever out of a total strength of 108,000. If the same rate had prevailed in the World War, there would have been slightly over 70,000 deaths in the American Forces alone. During the World War deaths from diseases were held to a point where they were almost exactly level with deaths from injuries, for the first time in the history of the American Army.2

With a few exceptions, infectious and parasitic diseases have been practically eliminated from military life. Virus diseases, diseases of the respiratory group, and venereal diseases continue to menace armies. However, the rates for venereal diseases have been reduced greatly and effective measures for their control are being employed.

The field of preventive medicine is extensive and has many phases. Further investigation in the fields of nutrition, endocrine glands, malignancies, for example, will undoubtedly yield excellent results. However, in the light of present day knowledge infectious diseases and degenerative changes caused by infections offer the best field for the application of practical preventive measures.

Degenerative changes caused by infections are metastatic manifestations of primary infections. It is generally recognized that the prevention of primary infections, or their removal before degenerative changes in vital organs have taken place, will do more to promote health and longevity than any other measure now available to medicine. It is in this phase that dentistry enters the field of preventive medicine.

Primary foci of infections due to dental diseases are the most common of all such infections. The prevention of these infections is what Dr. Mayo had in mind when he stated in 1913 —“The next great step in medical progress in the line of pre-


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ventive medicine should be taken by the dentists. The question is will they do it?”3

The mouth contains one of the greatest aggregations of bacteria found in any part of the body. Tooth decay and pyorrhea open the way for these bacteria to gain access to the blood stream. Having gained access to the blood stream, they invade vital organs and may cause degenerative changes with serious results. Their presence in the blood stream places an added load on resistance which in time of stress, or when another infection is superimposed, may be the indirect cause of death. It is certain, therefore, that adequate control of dental diseases in the Army would be an effective agent in the field of military medicine.

The control of dental diseases in the Army is attended with many difficulties, among which are—

(1) Dental infections are not a basis for rejection of applicants for admission to the military service. Requirements are based on a minimum number of incising and masticating teeth, and if an applicant for enlistment has the prescribed minimum in reasonably healthy condition, he can not be rejected even though his mouth is otherwise reeking with infection. Even carious teeth that may be restored with fillings are accepted as serviceable teeth to make up the minimum number required.

(2) No panacea, specific drug, or vaccine has been discovered which will exert a definite preventive action against dental diseases in the manner of typhoid and diphtheria immunization.*

(3) Personal oral hygiene is effective in the true prevention of dental diseases only when accompanied by periodical routine treatment and professional advice, whereas personal hygiene will accomplish much in the prevention of general diseases when supplemented by public health measures.

(4) Dentistry can not be practiced by prescription methods. On the whole it is a surgical procedure and is subject to

*(This is not an indictment of dentistry for progress in the prevention of a disease follows an understanding of its etiological factors. That the etiological factors of dental diseases are not well understood is evidence of the complexity of the causative factors involved. Let it be remembered that it took approximately 1600 years after the birth of Christ to discover that blood circulated in the body.).


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limitations with respect to personnel and facilities as are other surgical services.

These difficulties hamper dentistry in the full performance of its functions in the field of preventive medicine. Nevertheless the field is present and military dentistry is obligated to meet its responsibilities in that field to the greatest extent possible.

Military dentistry has multiple functions—

(1) Care of conditions causing pain and discomfort (emergency cases).

(2) Care of sick and injured.

(3) Maintenance of masticating efficiency.

(4) Routine remedial procedures for the improvement of dental health.

All of these functions involve principles of preventive medicine and it is unfortunate that the value of dentistry as a health factor is too often discussed in terms of “teeth.” The dentist does not fill a tooth for the sole purpose of restoring masticating function. He removes the carious infected tissues, sterilizes the prepared cavity and inserts a filling that hermetically seals the tooth. He does not extract an infected tooth root for the sole purpose of removing a local irritation. He performs these operations with the object of preventing and removing infections which menace health. Health factors are paramount and are never subordinate to other phases of dental practice.

The care of emergency conditions is given precedence in accordance with Army regulations. A soldier can not function efficiently while enduring pain.

It is routine procedure in Army general hospitals to refer cases to the dental service for removal of dental infections when the latter are known or suspected to be causative factors of disease. Dental officers specially trained in oral diagnostic procedures are assigned to hospitals to furnish this important type of service. Face and jaw injuries at general hospitals are also routinely referred to the dental surgeon for the care of the dental aspect of such cases.

Soldiers must have teeth to masticate the food they are provided with, especially when serving in the field. The records


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show that more teeth are replaced than are extracted. When it is considered that all teeth extracted do not require replacements (third molars, for example), the record from a replacement point of view is satisfactory.4

Routine remedial procedures are carried out to the limits imposed by personnel and facilities. It is realized that these procedures should be taken in a systematic manner with the greatest good to the greatest number. Army regulations provide that a dental survey of all commands be made at least once a year, when a dental officer is available for the survey. , These surveys cover only gross conditions that can be observed readily and rapidly without the use of explorers or other diagnostic aids usually employed when detailed examinations are made. (Exigencies of the service preclude 'detailed examinations when large groups of men must be examined with minimum interruption to military duties.).

During these surveys military persons are classified according to conditions and in the order that such conditions would ordinarily be cared for (1) to remove existing infections that menace the health; (2) to prevent further development of infections that may later cause systemic involvements, and (3) to make necessary replacements and place the mouth in a healthy functioning condition. Accordingly each person is Class I, II, III, or IV, the latter indicating that the case was not in need of treatment when surveyed. If Class I, II, and III conditions are present, the case is Class I; if II and III conditions are present, the case is Class II; and if Class III conditions only are present, the case is Class III. It is obvious, of course, that this classification covers only gross conditions. However, it serves as a basis for the systematic application of dental service and experienced dental surgeons are able to use it with great advantage.

The proper course to pursue would be to clean up all Class I cases in the command, then Class II cases, and subsequently Class III cases. It is rarely possible to proceed in this manner because emergency cases, and the sick and injured must be cared for first. Therefore this principle is applied so far as practicable to groups of individuals and in accordance with their value to the Army as a whole.

During 1929 dental survey reports showed that 138 per


6

1.000 enlisted men were Class I, 287 were Class II, 62 were Class III, and 513 were Class IV. In 1934 these figures were 110 Class I, 273 Class II, 67 Class III and 550 Class IV. The figures for the intervening years vary but slightly.6

It is apparent from the above that little is being accomplished in the true prevention of dental diseases. There is no question, however, that a vast amount of dental infections has been eliminated before they have caused much damage. Dental survey records indicate that approximately 50 of such infections have been removed.

It would be difficult to define the limits of benefits derived by the Army through the practice of preventive dentistry. The health of the Army since 1901, when a Corps of dental surgeons was organized, has improved greatly. No one will venture the statement that this improvement is entirely due to dental service. However, no one can deny, in the face of Dr. Mayo’s opinion on dental infections, that some improvement is due to dental service small as it may have been. Nor is there any question that an adequate service would be an effective factor in the field of military medicine.

When Dr. Mayo asked in 1913, will dentistry take the next great step in preventive, he had in mind the true prevention of dental diseases. That can not be accomplished at the present time. The only way to make military dentistry a more important factor in military medicine is to increase the amount of dental service. The question is, will the Army do it?

REFERENCES

1. Army Regulations 40-105; Standards of Physical Examinations.

2. Jay V. Grissinger: The Development of Military Medicine, Jr. N. Y. Acad. Med., 3:5 (May) 1927.

3. Chas. H. Mayo: Constitutional Diseases Secondary to Local Infections, Dent. Digest 19: 1913, p. 648.

4. Dental Bulletin, Supplmt. Army Med. Bul.: 6:3 (July) 1935 p. 161.

5. Army Regulations 40-510; Dental Attendance.

6. Annual Report, The Surgeon General 1929-1934.