April 19, 2021

Healthy Teeth For Your Whole Life

Knowing the reasons for caries to occur, you can adapt your habits to prevent caries
15 minutes to read

CARIES (cavities) is the result of the combination of these factors

Bacteria (Cocci) in a dental biofilm

Bacteria do not only produce acid, they produce a sticky substance as well  which gives them a “home” and protection. Now the whole thing is called BIOFILM. Now things get more dangerous, because the thicker the biofilm, the more diverse it gets and in simple terms the “bad guys” are positively selected. This older biofilm can live under more acidic conditions and produce more acid as well.

The graphic summarizes the way dental enamel is attacked by the biofilm resulting in cavities. Every time sugar from food or beverages enters the biofilm, that is attached to the tooth enamel, the bacteria produce acid. The acid dissolves the minerals from the enamel and now the solved minerals are in the biofilm. This process is called demineralization. Once the acid is consumed, and no new acid is formed from the bacteria, the local environment becomes less acidic, which triggers the solved minerals to return into the crystal lattice of the tooth enamel. This process is the way nature heals the dammage and is called remmineralization. The ratio between demineralization and remineralization periods determines if cavities occur. If demineralization is predominant the result is disease (caries); if remineralization is the most frequent situation the teeth remain caries free (healthy).

Sugar and Time: Influence of Frequency of Sugar Intake

Rat experiment to show the importance of the frequency of sugar intake to the occurrence of caries

Right side top: If rats get fed with a sticky, cariogenic, sugar containing diet and eat their daily ratio within 2 h-> NO CARIES. The system is only for 2-3 h on DEMINERALIZATION and 21 h on REMINERALIZATION.

Right side bottom: If rats eat their daily ratio of the identical diet in 20 small portions every hour for 20 h-> LOTS of CARIES. The system is for 21 h on DEMINERALIZATION and only for 3h on REMINERALIZATION.

Proof of Principle: A Human Study Shows clearly the negative effect of the high frequency of sugar intake

DMFS = decayed, missed, filled surfaces of teeth

The observed individuals were assigned to3 groups. A normal diet; B normal diet plus 300g sugar with main meals; C normal dies plus 60g sugar as 24toffees during whole day.

Results: B 2.2x more caries; C 13.4x more caries. Less sugar, but more frequently consumed increased the caries risk dramatically.

Source: Gustafsson BE et al. The effect of different levels of carbohydrate intake on caries activity in 436 individuals observed for five years. Acta Odontol Scand 1954; 11: 232-364

Fluoride has a Caries Preventive Effect

The effect of Fluoride as addendum to basic tooth care. DMFS = decayed, missed, filled surfaces of teeth

 Fluoride from toothpaste, salt or water, deposited on the tooth enamel surface shifts the balance between demineralization and remineralization towards the latter, being caries preventive.

Source: Marthaler TM. Cariostatic efficacy of the combined use of fluorides. J Dent Res 1990; 69:797-800

The "Booster" Solution for Caries Prevention

Mean caries increment after 6 years of observation. DFS decayed, filled surfaces of teeth.

To show the effect of professional health care, 545 patients with restored dentitions were split into two groups. The control group was told to see their dentist once a year for a control. The other group was split into 3 age cohorts and told to see a dental hygienist 4 times a year (simplified). All patients were observed for 6 years. The results were mind boggling. While the patients of the control group had accumulated a mean of  14 new cavities/patient (DFS = decayed, filled surfaces), the patients seeing a dental hygienist had only 0.2  new cavities. This means 70 times less cavities!

Source: Axelsson P and Lindhe J: Effect of controlled oral hygiene procedures on caries and periodontal disease in adults. Results after 6 years.
J Clin Periodontol 8: 239-248, 1981

For ethical reasons the control group was subjected to professional health care by dental hygienists as well.

30 Years Later

•All groups (cohorts): lost between 0.4 -1.8 teeth/patient

•Patients between age 50-80y at the end point of study lost less than 1 tooth/patient

•Patients from the youngest cohort (20-35y) were now 50-65 y old.

     in average 26.3 teeth were present with 52% intact surfaces. (fully dentate = 28 teeth; with wisdom teeth 32 teeth)

Source:Axelsson P, Nyström B, Lindhe  J. The long term effect of a plaque control program on tooth mortality, caries and periodontal disease in adults.

J Clin Periopdontol 31: 749-757, 2004

Caries Prevention is Easy

Application of this knowledge for YOUR Teeth’s Health

•Brush and floss thoroughly at least once a day.

•Reduce the sugar ingestion frequency to a few events per day, best limited to main meals.

•Use fluoride in toothpaste, table salt, mouth rinse, or water.

•See your dental hygienist 2-4 times per year.

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