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September 21, 1918


JAMA. 1918;71(12):973-974. doi:10.1001/jama.1918.02600380037005

If an attempt is made to bring some order out of the chaos in which the scientific aspects of dental caries seem to be involved, it appears not unlikely that several factors of unlike character are concerned. They have been fancifully represented as "defensive" on the one hand, and "attacking" on the other. Among the latter group, bacteria and carbohydrates probably deserve the foremost attention in the study of the etiology of decay of the teeth. The pioneer studies of Miller on the bacteriology of the mouth gave great weight to his views; hence even today his conception of dental decay still is prominent. Miller's idea was that lactic acid or similar acids produced by bacterial fermentation of the carbohydrates in the mouth are responsible for the decalcification of the enamel, and that the exposed dentin is further destroyed by the proteolytic ferments of the same or similar bacteria. But

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