1912 Journal of the American Medical Association  
Enamel softening has been considered to be necessarily associated with roughening of the surface, loss of luster and dissolution of the cemental substance that binds the enamel rods together; and whenever enamel decalcification is associated with decay of dentin this conception of enamel softening is only too accurate. But this conception seems to be only a part of the story, so to speak \p=m-\ the final part rather than the complete process of enamel degeneration. For instance, 1 to 1,000
more » ... ce, 1 to 1,000 lactic acid and water at mouth temperature will cut tooth enamel in thirty minutes with a rough, white surface. A tooth placed in 1 to 500 lactic acid and some salivas will be unharmed. A tooth placed in this solution made with other salivas, after three or four days, may show the enamel perfectly smooth and to all appearances normal, and yet it can readily be pared to a slight distance with a lancet. A 1 to 500 saliva and lactic acid solution has an extremely acid taste and instantly turns litmus brilliantly red. A 1 to 20,000 lactic acid and water solution will, at the end of three or four days, leave the tooth enamel unharmed to all appearances, and yet the outer surface of the enamel will, with the edge of the lancet, be found to have* distinctly softened. A 1 to 500 lactic acid solution with my saliva, although the solution has a decidedly acid taste, will produce this identical effect. The appearance of the enamel is unchanged but distinctly softened to the cut of a lancet, although before the tooth has been immersed the lancet is unable to make any impression on it. The action of water solutions of acid calcium phosphate and acid sodium phosphate on the teeth has been mentioned by Kirk, stress being laid on the fact that those salts cause smooth white décalcification. As a matter of fact, many acids in water solutions cause smooth priinafy softening, if the solution is sufficiently weak. Saliva ordinarily restrains the action of most acids up to a certain point, and then begins with the smooth décalcification and ends with the saine rougi; white décalcification that we find in a water solution. The saliva solution is ordinarily from ten to twenty limes weaker in its action on enamel than is a water solution of the same acid strength. The acid sodium phosphate and acid calcium phosphate are, however, intensely interesting in their action, not only in water solutions bul in saliva solutions. Acid calcium phosphate 1 to 5,000 water solution, and acid sodium phosphate 1 to ¡¿0,000 water solution at the end of two days, will turn tooth enamel into a cloudy, pearly white, wiib a clear sinoolh surface. This surface is distinctly softened to the cut of n lancet. If, however, these teeth are removed from the solutions before the process advances too Ear, the cloudy appearance will in time, disappear, anil the tooth enamel will resume its normal appearance. This phenomenon occurred many times, but once when I retested the hardness of these teeth with a lancet I found that not only had the white color disappeared but the superficial softening of the enamel had disappeared also. At first I attributed this disappearance of the softening of the enamel to previous faulty observa- Read in the Section on Stomatology of the American Medical Association, at the Sixty-Third Annual Session, held at Atlantic City, June, 1912. tions, but the same phenomenon occurred in my lactic acid test. A tooth that had been placed in a 1 to 20,000 lactic acid watery solution, at the end of a few days was slightly softened to the cut of the lancet, but a month or so later the lancet would not cut it. It was then that the possibility was made apparent that partially softened 'smooth enamel could reharden itself if the décalcification had not progressed too far. I then made the following test: Two sound teeth with enamel impervious to the lancet were each placed in a lobe of a navel orange. These lobes were each placed in a bottle with a few drops of ether to prevent fermentation, and kept at body temperature for two days. At the end of that time the teeth were removed anil examined. The lobe around one of the teeth had fermented, the lobe around the other had not. The tooth in tho fermented lobe showed a smooth, white, translucent area of décalcification, running from 'the cutting edge to about one-third of the distance to the neck. The rest of the enamel was normal to all appearances, and yet the surface, both of the white and the apparently normal enamel, was readily pared with a lancet. The lobe in which the other tooth was embedded had not fermented, and the enamel also seemed normal, but here again the outer surface of the tooth enamel was distinctly softened. These teeth were then washed in water and kepi in some of my saliva at body temperature for two weeks. At the end of five days there was a decided rehardening of the enamel surface, and the white area of décalcification on the tooth mentioned bad half disappeared. At the end of ten days the enamel could no longer be scratched with a lancet; at the end of two weeks the white spot of décalcification had almost if not entirely disappeared, and both teeth appeared perfectly normal. That saliva does possess the power of restraining enamel from carbon dioxid décalcification was proved as follows: A sound extracted tooth was placed in a sparklet or automatic soda water, former, where the liquid within could be charged from a carbon dioxid cartridge. Thirty cubic centimeters of saliva were added which had been obtained by chewing rubber. The saliva was then charged with carbon dioxid and the sparklet placed in a culture oven at a temperature of !)8 F. for thirty days. At the end of that time it was taken out and appeared unharmed. The tooth was then washed with a little ether and replaced in the syphon with distilled water. This water was then charged with carbon dioxid and the flask replaced in Ihe culture oven for twenty-four hours. At Ih«! end of that time the enamel showed a chalky décalcification that could bo scaled off with the finger nail. This protective power of saliva is also exerted against lemon, orange, grape, grape fruit, strawberry, rhubarb and cherry, the special action of which was the subject of a paper1 I wrote in 1908. These experiments with extracted teeth, weak acid solutions and tests with a sharp lancet in the hand, while suggestive, seemed to me not sufficient to establish so reactionary a doctrine; so while morally convinced of the truth of my assertion that softened enamel could reharden, I immediately started to perfect a machine that would show in the minutest degree just how far a given force would drive a standard punch into sound enamel, partly decalcified enamel and rehnnlencd enamel, if it did reharden, from the effects of slight décalcification, I will not dwell on the discouraging task of making good mechanics work with a scientific
doi:10.1001/jama.1912.04270120103005 fatcat:wgqgl7hgyza2lks5bndk2lrn34