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December 3, 1949


JAMA. 1949;141(14):995. doi:10.1001/jama.1949.02910140035011

The cause of dental caries, allegedly the most common physical defect in the United States and in many other parts of the Western World, has been a controversial question. Students of the problem appear to be divided into two main groups. One of these, the "constitutionalists," believe that the structure of the tooth and internal metabolic and nutritional factors are the primary causative factors in tooth decay. The other group, the "environmentalists," stress the primary importance of local factors in the mouth, such as bacterial acids, the physical state of the food, mechanical abrasion and the protective action of saliva.

Recent investigations appear to support the importance of local factors, particularly bacterial acids, as a primary causative agent in tooth erosion. Furthermore, current studies emphasize the relation of dietary carbohydrate intake to the formation of acids by the oral bacterial flora. One of the chief proponents of this view has

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