__________________________ Caries-Prone Patients: Prevention, Assessment, and Interventions, 3rd Edition
Infants are not born with pathogenic oral bacteria but can acquire them from the skin or vaginal area during delivery or from family members with whom they are in close contact [8]. It has been determined that these bacteria can be transmitted between individuals through kissing, sharing eating utensils or cups, and other interactions. Studies have demonstrated that the mouth of the neonate is colonized by bacteria that resemble those from the oral cavity of the mother [9]. Women of childbearing age, parents, and caregivers of young children should be educated about the potential to transmit the bacteria contributing to dental caries. SUSCEPTIBLE TOOTH SURFACE All erupted teeth have the potential to develop caries lesions. However, teeth with optimal fluoride content are more resis- tant to caries lesion development than are teeth lacking in fluoride, as fluoride has an essential role in protecting enamel from demineralization [10]. Patients with recession (exposed root surfaces) are at increased risk for dental caries because roots do not have enamel, the extremely hard and most caries- resistant material surrounding the crown of the tooth. DIET A diet high in sugar, including fermentable carbohydrates, increases the likelihood of developing dental caries. Included are foods that are innately sugary (e.g., juices), those with sugar added (e.g., soda and candy), and starchy foods that break down into sugars in the mouth (e.g., breads and crackers). When fermentable carbohydrates are introduced into the mouth, the sugars begin to be broken down to acid by oral bacteria. This acid lowers the pH of the saliva and oral plaque biofilm and may increase the rate of demineralization of tooth surfaces. Tooth enamel begins to demineralize at a pH of 5.5, and root surface demineralization occurs at an even milder pH of 6.2 [11]. Once the pH dips into these ranges, the outer layer of the tooth loses minerals. This causes a loss in surface hard- ness and increases the possibility of caries lesion progression. TIME/FREQUENCY Time is a contributing factor in the caries process because the probability of caries increases as the frequency of acid formation from fermentable carbohydrate–rich food sources increases [6]. Simply stated, the more often fermentable carbo- hydrates are ingested, the more often salivary pH will decrease, and the greater the likelihood that teeth will experience demin- eralization. The extent of demineralization depends on the length of time the acidic biofilm is in contact with the tooth surface and the frequency of this contact. Caries lesions are the result of repeated or extended periods of demineralization.
INTRODUCTION Dental caries is a preventable disease that affects a majority of the population. According to the 2011–2016 National Health and Nutritional Examination Survey, approximately 90% of adults 20 to 64 years of age had at least one decayed tooth [1]. Data collected between 2017 and 2020 indicate that among children and adolescents 2 to 19 years of age, 46.0% had one or more carious lesions in their primary or permanent teeth [2]. These statistics show the increase in caries incidence over time, making it important for dental professionals to develop strategies for determining caries risk and counseling patients to reduce risk and a future of dental caries. The impact of nutrition on the caries process is known in the dental field, but dental professionals need to continue to convey the importance of this relationship to patients. Work- ing as partners with patients, dental professionals can aid in the prevention of dental caries and help maintain patients’ overall health by offering nutritional counseling and behavior modification techniques. The incidence of caries in the United States could decrease significantly as dental professionals implement the advances available for early caries detection, recommend anticaries treatments, and offer nutritional analysis and counseling. This basic-level course is intended to equip all members of the dental team with the skills needed to realize this over-riding goal. THE CARIES PROCESS Dental caries is a multifactorial disease. It is also preventable. In order for caries disease to occur, a number of factors must be present, including caries-causing microorganisms, a susceptible tooth surface, fermentable carbohydrates, and time. Dental professionals have the obligation to inform adult patients and parents of young patients that they possess the power to prevent and reverse this disease process. In this section, the factors that affect caries development will be addressed.
MICRO-ORGANISMS AND DENTAL PLAQUE
Untreated dental caries among deciduous (“baby/milk”) teeth is the most prevalent childhood ailment, affecting 514 million children globally. Overall, dental caries affects 97% of the global population at some point in their lives [3; 4]. The accepted theory of caries formation is related to the acids produced by oral bacteria removing tooth surface minerals, eventually causing a cavitation. Streptococcus mutans ( S. mutans ), S. sobrinus , Bifidobacterium species , and Lactobacillus micro- organisms have all been found to aid in caries progression [5; 6]. These same bacteria are associated with root caries, as are the micro-organisms Actinomyces viscosus and A. naeslundii , which are notably present in active lesions [7].
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Book Code: DPA1525
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