View Electronic Edition

Preventive Dentistry Primitive Style: A Case History

It is well known that primitive man ate harsh, fibrous foods, and it is possible that small particles of his rough diet wedged in the crevices of his teeth caused discomfort. To remove these unwanted objects no doubt he used the twigs, grasses and reeds that grew in the vicinity of his dwelling.   From this rough beginning, the crudely contrived toothpick made its inauspicious entry into the world.

In 5,000 B.C. the Babylonians, realizing the potentialities of the stick as a cleansing agent, utilized a "chew stick" for cleansing their teeth. This idea spread from the Babylonians to the Greeks, and from Greece the idea of the "chew stick" was passed on to Roman society.

It is not surprising that these societies used such primitive devices as the "chew stick" to clean their teeth.   It is, however, somewhat of a surprise to find such instruments being used today despite the existing availability of so many effective methods for cleansing the teeth and caring for the oral cavity generally.

The present case report deals with an instance of the apparently effective use of primitive measures for maintaining oral health in South Carolina in present times.

Case Report

The 63-year-old male patient presented himself to our clinic at our request. We had heard of him through another patient who was resisting a student's efforts to set up a preventive maintenance program for her by saying that she had always brushed her teeth with no apparent success and that her neighbor had never seen a dentist, didn't own a toothbrush and had "perfect" teeth. We had to see this for ourselves so we called the neighbor and asked if he would permit us to examine his mouth.  He very graciously, even anxiously, consented.

The patient, a farmer, was the magistrate in his area and a most cooperative and intelligent subject for our study. Radiographic and clinical examination showed:

1.    a mouth completely free of caries and with no existing restorations;

2.    thirty-two teeth in beautiful occlusion;

3.    an amazingly healthy periodontium with almost no bone loss;

4.    almost no plaque formation, but slight calculus formation on the lingual surfaces of the mandibular anterior teeth and the buccal of the maxillary molars; and

5.    no cervical erosion or abrasion, with only normal wear patterns on the occluding surfaces.

The patient's medical history was essentially negative and his personal hygiene very good.

When the patient was questioned, we learned that he had never before indeed been in a dental chair.   He said that he had owned a toothbrush for the past five or six years but seldom used it.  He was quick to add, however, that he had used a "gum twig" all his life. When asked what this "gum twig" was, he explained that he used sassafras root because it tasted good, that he chewed the end of a small piece of the root until it was frayed like a brush and that he carried this in his shirt pocket, using it after eating anything during the day. The patient stated that he couldn't stand to have anything in or between his teeth so he used this cleaning device often (six or eight times daily). The patient demonstrated how he used the "gum twig", and it was obvious that his method was very thorough and effective.   He cleaned the teeth and massaged the gingiva very thoroughly using his method.

The patient indicated that he learned the use of the "gum twig" from his father, who died at the age of eighty-four never having owned a toothbrush, never having visited a dentist and never having lost a tooth.

When questioned about diet, the patient stated a definite liking for raw vegetables (turnips, carrots, etc.) which he often took from his fields, washed as best he could and ate while working.

The patient stated that his wife and daughter had "terrible" teeth, but that their diet and oral hygiene habits were quite different from his. They did not share his enthusiasm for the "gum twig".

The patient had lived all his life in an area which reportedly had no natural fluoride in the water. To our knowledge, he had never been exposed to fluorides to any significant extent.


Some primitive methods of caring for the teeth and their supporting structures can be very effective when applied conscientiously and properly.

There can be no doubt that early environmental factors influenced this patient significantly and that his methods would not have been adequate for many patients.

It is also obvious that this man accomplished for himself somewhat by accident exactly what the practitioner who is preventive dentistry-oriented tries to accomplish with his patients— plaque control and care of the supporting structures with the resultant decreased need for restoration of needlessly diseased and damaged oral structures.