160 INANITION AND MALNUTRITION 



factors may be involved. " Until further facts are available, one can think only 

 of the necessity for a proper Ca-P-organic factor balance in any diet as the most 

 important in the formation and maintenance of normal bones and teeth and 

 healthy attaching-tissues." 



Marshall ('23) in puppies on diets "insufficient or improperly proportioned" 

 in calcium and phosphorus found a marked delay in dentition and relative 

 absence of dentine, with normal amount of enamel. 



Scorbutus. — In human adult scurvy, the involvement of the gums and teeth 

 usually forms one of the first and most conspicuous symptoms. The lesions 

 have recently been described and illustrated in detail by Aschoff and Koch 

 ('19). Comrie ('20) noted swollen and bleeding gums in 80 per cent and severe 

 gingivitis or pyorrhea in about half of 600 cases. Bierich ('19) found the 

 gingival swellings most pronounced in those with carious teeth. The lesions 

 have recently been summarized by Hess ('20). The gums become congested 

 and hemorrhagic. Later the teeth become loose and may fall out, and the 

 alveolar bone undergoes necrosis. Pyorrhea may be present. The gums 

 may become so swollen as to hide the teeth, forming foul, fungoid growths. 



In infantile scurvy (Barlow's disease) the gingival lesions are similar but some- 

 what less pronounced if teeth are present; and are slight or absent before the 

 eruption of teeth. Talbot ('19) emphasizes the susceptibility of the alveoli and 

 peridental membrane, rather than the teeth, to the changes produced by scurvy. 



In experimental scurvy the dental and gingival lesions have been frequently 

 studied. Hoist and Frolich ('07, '12) in their pioneer work on experimental 

 scurvy in the guinea pig noted loosening of the teeth, some gingival hyperemia 

 and hemorrhages, and rarely gingival ulcerations. Only 20 per cent of the scor- 

 butic guinea pigs show marked congestion of the gums. These results have 

 been confirmed by Cohen and Mendel (/18) and many others. Jackson and 

 Moore ('16) found congestion, hemorrhages and necrotic degeneration 

 in the pulp of both incisors and molars. 



The first detailed histological study of the teeth in scurvy was made by Zilva 

 and Wells ('19). They find that in guinea pigs on scorbutic diet profound 

 changes occur in the teeth very early (at 10 days), when only slight lesions are 

 seen elsewhere. In the teeth the pulp undergoes a fibroid degeneration. "In 

 complete pulpar fibrosis no cellular elements of any description occur . . . 

 Nerves, cells, blood vessels and odontoblasts have all shared the process of 

 fibrification and are no longer recognisable. The fine cellular connective tissue, 

 which is but a loose mass of network in the normal state, has either become 

 grossly hypertrophied or quite obliterated, and its place taken by a new firm 

 fibrous structure, devoid of cells, nuclei or any regular arrangement of constituted 

 parts . . . The irregular osteoid condition is well marked . . . In a scuivy 

 tooth the condition persists right up to the apex of the root; the change appears 

 to start first in the odontoblastic cells at the top of the pulp, working down to- 

 ward the apex, followed by distended blood vessels and hemorrhage; then com- 

 plete fibroid degeneration follows. . . In advanced cases of scurvy the teeth 

 were apparently sound but useless, inasmuch as .they had been loosened by the 

 gradual absorption of the cement membrane of the alveolar sockets, which had 



