I am always amused by patients surprise when they are told during a dental exam that they have a carious cavity.
What do you mean I have a cavity? Or, how come I have a cavity?
As if I am making it up or worst I created the cavity in their mouth. A short inquiry of their oral habits, quite often will reveals the culprit: oral hygiene is lacking (they rarely floss or the frequency of brushing is irregular) or something new has been introduced that negatively affect their oral health. I have learned over my years of experience to no longer take it personal.
We are very fortunate, both patients and practitioners that there is very little unknown about dental caries today. Unfortunately, the disease process of dental caries is a not really well understood by most patients. Dental caries is a multi factorial disease, which means there are several factors at the root of it (dental pun). While some of these factors are easily manageable; others require the help of dental professional.
Among some of the factors that have an effect on the development of dental caries is age; children seem to experience more caries than adult due to the fact that the enamel of the baby teeth is more susceptible to acid demineralization. Other factors include tooth shape, which is as different as people; exposure of root surface due to gum recession generally in adults; diet (sugar vs. non sugar) and the rate of the saliva flow and its capacity to balance the pH of the mouth.
Teeth are usually less prone to carious lesions when the enamel has been strengthened by fluoride, or the diet is rich in nutrients such as magnesium and vitamin D, and/or the saliva has a neutral pH as previously mentioned.
Other factors that influence caries development are oral hygiene and clearance; food needs to be actively removed from the mouth after eating with brush or floss. If food is retained or not in the mouth after eating, it create a source for bacteria, which can either use it as fuel or transform it into a destructive byproduct (acid). Eating frequency and high consumption of carbohydrates, and other cariogenic food are a big factor in the level of dental caries found today in the developed countries. The average American currently consumes significantly more sugar per year than ever before. Sticky foods tend to increase the likelihood of dental caries because they stay longer in the oral environment. However, when foods with high detergency factor (tooth-cleaning foods like apples) are consumed, the likelihood of caries is lessened.
Beside all these factors, the development of dental caries depends on how much bacteria is present in the mouth (plaque) and the types of bacteria that lives in the plaque; some microbes being more cariogenic than others. In addition this plaque has to be able to produce a significant amount of acid and be able to survive in the acidic environment for a while. However, oral hygiene plays a significant role in the prevention of dental caries. As plaque is regularly removed by brushing and flossing or professional cleaning the amount of bacteria in the mouth is reduced, especially if fluoride is present.
Dental caries does not happen overnight. While the shift in microbial plaque can happen fairly quickly, a significant amount of time is needed for demineralization to lead to the development of white spot on teeth and/or carious lesions.
The production of acid by the bacterial plaque does not instantly start tooth decay, and in the early stages, the remineralization can restore enamel, keeping the effects of dental caries at bay. However changes in the saliva (medications, sleep apnea, mouth breathing, certain of illegal drugs, etc.) that negatively affects the sequence of remineralization can open the door to the occurrence of new dental caries.
To sum up, the bacteria in the plaque produce acid by fermenting the sugars and other cariogenic food that are consumed. This acid demineralizes the tooth enamel, and over time, this break down of tooth structure leads to the development of dental caries. Dental caries can be difficult to prevent because this combination of factors; however professional dental care based on current research and technological advances in caries control combined with good oral hygiene can lead to a healthy mouth that is free of disease.
As the holidays approach, while enjoying those sugary treats, just be sure to have your toothbrush at hand to fight those pesky sugar bugs. Happy Holidays everyone, from our family at Midtown Dentistry to yours.