Sir, - I enjoy Dr William Reville's Science Today column but would like to comment on a simple and important item which was not alluded to in his article of December 28th, namely the toothpick.
Although the experience of one person has little scientific validity, I am over 80, smoked pipe and cigars until quite recently, have all my own teeth (apart from lost one in an accident) and have what my dentists have agreed are healthy gums. This I attribute to the use of toothpicks, combined with the use of a firm toothbrush in the appropriate manner.
I believe that regular use of the toothpick, by removing dietary detritus and some plaque,
as well as gently massaging the gums, provides excellent dental hygiene, reproducing many aspects of the high vegetable fibre diet of Africans which we Westerers miss. Use of dental floss as a lifelong habit for most people seems to me vastly overoptimistic, compared with the benefits of a toothpick (which can be fashioned by anyone with a knife and a bit of wood); use of floss is almost acrobatic for some and where crowns are too close together becomes impractical. Electrically powered water jets certainly are helpful in situations where there is much gingival disease, but not very practical for the "hoi polloi"; anyhow, a good squirt of water between the teeth by one's own perioral muscles and tongue is almost as good.
Those who would wish to contradict what I have just said would have to produce the results of a trial proving the contrary; ideally, a thousand families would need to be enrolled and divided into two cohorts, one using toothpicks and one not, with the results being assessed annually in a "blind" manner by an independent group.
Far be it for me to decry the use of dental hygiene where it is necessary; my object in this letter is to emphasise the benefit of a practice which has been in use in Europe for centuries and probably millennia, but which in these islands has fallen into disuse - I partly, I think, due to mistaken Victorian prudery, and I regret to say, due to indifference or opposition from some members of the dental profession. - Yours, etc.,
Brian McNicholl MD, FRCP, FRCPI, Prof Emeritus of Paediatrics, National University of Ireland, Galway.