There is almost universal agreement that caries is a disease of westernized conditions,1 although many of the data are uncritical or were collected inexpertly by archeologists and anthropologists. Although it is reasonable to assume that the chemical changes of the diet explain this effect of westernization, other aspects of feeding, such as, the timing of meals or the toughness of food or even nondietary differences, are difficult to exclude completely. There is no reason to believe that the same factors operate in all instances; eg, the traditional diet of the Eskimo contained no sugar and indeed virtually no carbohydrate, whereas the native diet of the African Bantu is high in carbohydrate, consisting largely of unrefined mealie meal.
Clinical Data on the Effect of WesternizationThe clinical data of Osborn and Noriskin2 on caries in the Bantus on native or European diets were carefully collected but do not show a really dramatic difference in incidence, eg, 43% of 143 who stated that they never had European food had caries, compared with 57% of 44 who ate European bread regularly. The data suffer from several defects, such as the ignorance of the Bantus about their own ages and reliance on their own testimony about the nature of their diet.Turner and Vickery3 reported an attempt to study the effects of white and whole meal flour on caries. The DMF scores among a group of 94 British children between 1 and 18 years old who had always eaten whole meal bread were compared with those from several typical British groups (eg, the controls in the fluoridation studies). The results did show considerably less caries in the whole meal group: DMF scores for the 5-, 6-, and 7-year-old children were below three 1318 in the whole meal group and between five and seven in the control groups. Unfortunately, these results cannot be taken at their face value, because 64 of the children were attending a "food reform school" at which the diet presumably differed from that eaten by the controls in several respects other than containing whole meal bread. The parents also stated that they "enforced significant control over the intake of sugar," which would obviously confuse the issue.The effect of raw sugar cane on caries is even less substantiated. Most of the clinical data are impossible to interpret, because no comparisons were made between caries incidence in workers in sugar-cane plantations who ate much raw sugar and subjects who ate the same quantities of refined sugar with the same frequency during the day. It is not disputed that a high caries incidence can occur in sugar-cane eaters4,5 so that crude cane cannot exert dramatic over all protection but, in the absence of a suitable control, it is simply not known whether crude cane exerts any protective influences at all.
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