Dental Infections, Oral and Systemic, 1923, by Weston Price (Sep 6, 1870-Jan 23, 1948)
It is a great and humbling honor to introduce Weston Price’s 1923 masterpiece, Dental Infections, Oral and Systemic, to a new generation of researchers. As embodied in this work, Price’s significance transcends that of the most renowned dental authorities of his time and beyond, even up to the present day. His original, ingenious and exhaustive studies continue to comprise the compleat bridge between all things dental and the primacy of oral pathology within a properly unified medicine of the future.
We currently live in a world of sharp distinction between dentistry and medicine, between “doctors” and “dentists”. It was not always this way. Certainly, as the healing arts developed so did specialists, and this continues to occur to the present day. But as for a somewhat rigid separation between entities of dentistry and medicine per se, this did not exist even in the “dark ages”, but rather is unique to the so-called “modern era”.
From the earliest times in a wide range of cultures, dental considerations were integrated within greater medicine, itself seemingly-universally subjugated within a religious authority (e.g., even in modern primitive societies we find the likes of “witch doctors”). Hippocrates (ca. 460 BC – ca. 370 BC) was himself born into this class, having studied medicine with his father and later in the temple at Cos. His exhaustive written works have correctly earned him the title of “Father of Medicine”. Historically his work documents the emergence of a more secular and less spiritual embodiment of medicine.
Nonetheless, even through the first millennium AD, the religious authority retained dominance over medicine, including those who assisted and were skilled in the use of the sharp blade, the barber-surgeons; it was not until early in the second millennium A.D. that the clergy in Europe formally ceded surgical tasks to the barber surgeons. The integration of tasks of surgeons and barbers generally persisted until the mid-18th Century, when surgeons and barbers were formally separated by decree in both France and England (subsequently in England only barbers were allowed to pull teeth). Thus, throughout history there has been a continually evolving process of separation of medical academicians from hands-on operators. Indeed, Hippocrates in his famed “oath” said he would not “cut for stone”, and rather left this to experienced practitioners.
Without going through a litany of confusing historical twists and turns, it may be gleaned that key functions falling within the purview of dentistry were relegated to “lesser” rungs on the professional rating scale, and that such separation contributed to the separate and unequal status that may arguably be viewed as characterizing the current relation between medicine and dentistry per se. The incredible irony of this evolution is that operative responsibility for overseeing the most prominent of primary infectious sites, i.e. dental, continues to rest with the dentists; whereas, operative responsibilities for the varied secondary infectious sites, e.g., brain, heart, stomach, etc., are the domain of a proliferation of medical specialists, i.e., neurologists, cardiologists, etc. for the most part ill-prepared to address the essential problem of primary (oral) infections.
Relatively recently within this admittedly overly-simplified historical setting, the “Father of Dentistry” Pierre Fauchard emerged in 1728 with his definitive and comprehensive landmark book, The Surgeon-Dentist. This was the first fully comprehensive treatise on treatment of the teeth, covering all aspects of dentistry and integrally incorporating both dental procedures and dental prosthesis. It served to formally separate the practice of dental procedures from the field of medical surgery, and thereby truly marks the beginning of dentistry as a distinct profession. Fauchard also discussed the relation between oral and systemic diseases, and spoke out eloquently against the use of mercury in medicine due to its ill effects on the teeth – a century before the popularization of the use of mercury within tooth-fillings.
The formal birth of dentistry in America in the mid 19th Century, through the prominent works of Chapin Harris, Horace Hayden and others, likewise involved such considerations. Their American Society of Dental Surgeons (America’s first such society) argued persuasively for a thorough integration of dentistry within medicine in recognition of the oral-systemic relation. Chapin and associates were also ardent and articulate opponents of the then-recent fad of using mercury in dental fillings. But their work was overwhelmed and their organization replaced by the emergence of a powerful new dental association that allowed and thereby greatly benefited financially from the use of mercury, the American Dental Association.
Thanks further to the creativity of G.V. Black, the father of modern American dentistry, the ADA flourished and was firmly in charge of dentistry at the turn of the 19th-20th Centuries. Black’s textbooks continued in publication for decades after his passing in 1915, and his procedures for stabilizing amalgam and methods for filling dental cavities persist in modern dental practice. Notably, in the year of his passing, 1915, he had expressed enthusiastic support for the then-“recent” work by Hunter, Billings and others regarding implications of oral infections, but this perspective is fundamentally absent from his seemingly bigger-than-life and continuing ADA/amalgam-supportive legacy.
Given the tremendous power of the ADA in his time, Price’s establishment of a genuine Research Institute within the auspices of the ADA, in conjunction with the huge body of research accomplished independently with his own funds, is all the more remarkable. (It is notable that Price did not discuss the mercury filling issue in his landmark 1923 book; however, on reflection it may be offered that this was likely not an oversight, but rather avoidance of an issue that could easily overshadow and detract from the essential scope of his work.)
In the grand scope of the history of dentistry, if we view Fauchard as having brought the field to its culmination as a hopeful prospective independent field of scientific endeavor, we may view Price’s significance as having definitively exposed these hopes as false and doomed. As his associate Martin Fischer would whisperingly note in his classic 1940 book Death and Dentistry, “all fillings are bad”; they are physiologically contraindicated. The bottom line is that dentistry as a stand-alone profession is not possible, and this is the core essence of Price’s dental legacy.
A most surprising and difficult to grasp corollary of this legacy is the greater danger from infections without symptoms, as compared to those with pain, inflammation or other signs. Price particularly emphasized this as one of the greatest paradoxes of oral infections, whereby the lack of discomfort or pain indicates the invader has not been quarantined and travels freely to other, secondary locations.
The knowledge that these infections continue to escape into the circulation and cause or aggravate infections elsewhere in the body is not “new” information. But somehow in humanity’s perpetual determination to frame current accomplishments as the nearly complete and final word, this most basic knowledge is ignored and then rediscovered over and over again. It was not new in U.S. revolutionary times when Philadelphia’s greatest physician, Benjamin Rush, ascended to his medical reputation by healing a number of crippled arthritis patients by extracting their diseased teeth. Nor was it even new in 7th Century BC Assyria, when Ashurbanipal’s physician retorted that he could not address the King’s illness complaints until he acceded to the extraction of his diseased teeth.
What is unique with the publication of Price’s masterpiece is its exhaustive assessment of the problem from the dental perspective, on a level never before attempted or accomplished. And therein lies Price’s supreme challenge to dentistry. Let it be known that advancement in medicine is hopeless, impossible, without the skills and tools of dentistry. Only the dentists are capable of correcting the implanted problems of countless millions of humans throughout the world. And this makes careful study of the Price legacy of paramount importance, today and into the future, as among the first principles of disease causation.
Another remarkable observation discussed with particular emphasis by Price concerns the role of oral infections as reservoirs for infectious agents other than the predominant streptococcus, including the ameba, protozoa and spirochete. (See Chapter XXXV, Volume I). The mystery of relapsing malaria and other intractable scourges may thereby be explained; the infectious agent may remain viable within the oral focus, as this location offers diminished resistance and may serve as a safe-haven. This circumstance also has direct implications for understanding a condition that has received particular attention in recent years, lymes disease, and the lingering, debilitating conditions associated with it. Thus serving to solidify and extend its pivotal place in the history of dentistry and medicine, Price’s work provides invaluable insights into a disease entity that was not even identified in his time. It is clear that this great work is not to be viewed as a mere artifact of history, but rather as a brilliant framework for the future.
George E. Meinig, DDS, FACD
Dental Infections, Oral and Systemic, 1923, by Weston Price (Sep 6, 1870-Jan 23, 1948)
Notwithstanding the epochal association of E.C. Rosenow and Frank Billings at the very start of the 20th century, and their collaboration with Weston Price not long afterwards, it is noted that Price’s own work in this area was independently initiated even earlier. Price became a dentist in 1893, and by his accounting from 1898 had begun compiling information that would be embodied in this great 1923 work. Of course Price’s legacy goes deeper still. Not content to merely demonstrate that dentistry as we know it is a failure, as shown particularly in Volume I of this two volume work; and that the involved infections are implicated in a range of other diseases, as emphasized in Volume II of this work; he also went on to explore how humanity fell into the sad circumstance of what must be regarded as the self-infliction of the modern chronic disease syndrome. In studies embodied in his subsequent 1939 book, Nutrition and Physical Degeneration, Price showed how diets of evolving human culture, predominantly the advent of white flour and sugar, provided the physical opening for invasion and colonization by microbial purveyors of chronic human disease.
In the following year, 1940, at the Dental Centenary Celebration, Price introduced E.C. Rosenow and his presentation, “Focal infection and elective localization in relation to systemic disease; review and results of further studies”. This paper incorporated results of more than 11,000 animal experiments by some 32 separate investigators, exhaustively documenting the fundamental findings of efforts to fully expose the facts and implications of the oral-systemic relation (Proceedings, Dental Centenary Celebration, Maryland State Dental Association, 1940, pp. 261‑282, 1940). The data presented in Rosenow’s paper have been compiled into a single summary table, presented below as a monument to and confirmation of Price’s vision and dedication.
For example, in the case of stomach ulcers, totals (first item, last column): 57% of 3050 animals injected with bacteria from patients with stomach ulcers developed stomach ulcer lesions, vs. 6% of 6135 animals injected with strains from other diseases, and 11% of 2294 animals injected with strains from persons with no systemic disease. Similar patterns were consistently observed involving bacteria from various other types of lesions, for totals of all investigators, as well as for each of the three categories of investigators listed (i.e., by Rosenow; by his co-workers; and by other investigators):
Table. ELECTIVE LOCALIZATION OF STREPTOCOCCI, 11,479 ANIMALS*
IN| SOURCE: DENTAL/OTHER |ROSENOW|ELEVEN |TWENTY|
Iritis, other eye dis. 272 42 328 43
186 53 786 45
36 61 39 38 94 59 169 54
891 72 50 58 86 56 1027 70
168 73 96 83 96 58 360 72
Ulcerative colitis 527
58 60 60 119 42 706 56
TOTALS 6209 3694 1576 11479
Rosenow, E. C., Dental Centenary Proceedings, Maryland
So what do these numbers mean, and why are they so significant? For the definitive affirmative answer, we return to the late 19th Century and the Koch-Henle principles, or “postulates”, of disease causation. These results fulfill the venerable “postulates” of causation; they prove that the various systemic diseases are indeed caused by bacteria emanating from oral “nests” of infection. And the affirmation of the applicability of these principles also reaffirms their validity.
Of course in a rational world the suggestion of a need for further validation of these proven principles would be absurd. Nonetheless, as the core of modern medicine was diverted from the grand Price-Billings-Rosenow legacy, the consequent inability to otherwise fulfill Koch’s postulates has incredibly been widely accepted as justification for their rejection. This has occurred hand-in-hand with the enshrinement of a fictional and truly oxymoronic concept of “autoimmunity” (for conditions previously shown by Price, Rosenow, etc. to actually be caused by infection). As a result modern medicine has been hopelessly mired in the inescapable complexity and confusion of a mechanistic, symptom-directed mentality; vulnerable to manipulation and exploitation, even dominance, by the focused efforts of a wildly profitable drug industry. Sadly this is the state of main-stream medicine today, clearly more closely aligned with a witch doctor heritage than a logical scientific one.
There is only one way out of this dilemna, and no amount of wishful thinking, government funding, or genius revelation in this or a foreseeable future generation can alter the facts of disease causation. Revival of the work of Price, beyond its direct practical effect on dentistry and medicine, is at the same time a reaffirmation of the venerable and irrefutable principles of Koch and Henle. Revival of Price is revival of the grand tradition of Pasteur, Koch, Henle, Ehrlich, Wright, Billings, and Rosenow, et al., with whom Price shall forever be prominently in proper company in the service of humanity.
George E. Meinig, DDS, FACD