What Are the Major Factors in Dental Caries?
Dental caries is regarded mainly as a disease entity or process that results from the interaction of several local factors in the oral cavity, alongside a time that can eventually cause the demineralization of the inorganic structure of the tooth enamel that is formed by the calcium hydroxyapatite crystals. The main factor currently implicated in dental caries is how acidogenic or cariogenic bacterium infiltrate the dental enamel and cause its demineralization. Eventually, cavitation is the main factor.
These are-
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The direct role of dietary sugars in stimulating an acidic environment favorable for the dental bacterium to thrive or grow.
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Improper, ineffective, or inadequate oral hygiene methods.
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The passage of time (when dental caries are left untreated due to a lack of timely dental management or dental awareness).
The intermingling of these three major factors would mean that the caries progression into the tooth enamel can be more rapid or faster, especially with the patient's lack of dental awareness or lack of timely dental restorative management.
It is important to note first that the bacteria present in dental plaque or the biofilm that forms on the enamel (demineralizing the inorganic structure of the enamel) are produced by several organic acids produced by these pathogens.
By causing a drop in the normal oral pH within the dental plaque formed, these bacteria subsequently create a favorable acidogenic environment in which the caries process is facilitated. Also, when you consume more fermented sugars or dietary sugars, caries progresses faster, especially in deciduous dentition or primary teeth in younger children or infants (early childhood caries). These caries mechanisms are also primarily driven only by the interplay or the metabolism owing to the dietary carbohydrate intake.
What Is the Role of a Critical PH?
Following the consumption of dietary sugar and the fermentable carbohydrates produced thereby, the oral plaque’s pH usually plummets below the critical pH level of 5.5. This process, which can generally occur within a few minutes, indicates that repeated exposure of the enamel to a dental acidogenic environment or bacterial microorganisms can eventually lead to enamel demineralization at a faster pace.
With the use of remineralizing fluorides such as toothpaste, topical fluoride gels, or fluoride-based mouthwashes or by new-age remineralizing resin, laser, or ozone therapy, the pH can increase more than seven or higher, enabling your enamel to be capable of its reparative and effective remineralization process.
When the pH within the dental plaque tends to fall below the “critical level of pH repeatedly,” the teeth' enamel initiates a demineralization process. While the carious lesions or dental cavities in the tooth enamel are already formed initially, a lack of timely management will lead to more mineral loss from the layers of enamel, giving way for the pathogens to penetrate the tooth with increasing depth.
Dentists can be role players in creating awareness of the importance of proper dental hygiene and diet when halting these initial carious lesions. This is when there is a sufficient clinical depth of the carious lesions, meaning that enamel remineralization is impossible once the intact surface layers are lost. Hence, carious lesions in most dental cases must be treated promptly for restorative management.
When Can Remineralisation Happen?
The current research shows the acid-induced dissolution of enamel. Its structural loss can lead to permanent damage, and there is also a scope for remineralization. While in moderate to extensive dental caries, there is no scope for dental remineralization, in initial caries like incipient caries, white spot lesions, or in small pit caries, there is more scope for remineralization with the use of fluoridating or new age remineralizing agents or therapies.
Current research studies show that dental caries can almost develop on any tooth surface; however, they usually impact the teeth' chewing or occlusal surfaces maximally. Nearly 90 percent of the dental caries cases documented worldwide are on the occlusal surfaces of teeth because of a lack of proper oral hygiene, consumption of increased dietary sugars, and timely dental restorative management.
According to dental researchers, it is also true that the occlusal surfaces of the tooth are usually the most resistant surfaces to the remineralizing therapies used in dentistry. Remineralizing agents can only act partially. More research is being carried out for new-age non-invasive remineralizing therapies like low-viscosity resin therapies, lasers, and ozone therapy for managing occlusal dental caries.
What Is the Impact of Diet on Dental Caries Progression?
Streptococcus mutans is one of the primary acidogenic bacteria that is known to interact with dietary sugars and also interact with the polysaccharides present in foods to fasten the caries progression or the extent of enamel demineralization. In the initial stages of demineralization, the sub-surface proteins present in the enamel or the calcium hydroxyapatite crystals are not fully breached. However, when the sub-surface layers are lost over a while without dental management, the carious lesions spread to the second or dentinal layer of the tooth, creating dental hypersensitivity or a moderate to severe sensation of pain or sensitivity.
Numerous research studies on enamel are focused on the connection between dietary sugar and carbohydrate consumption and the subsequent occurrence of tooth decay or dental cavities. This is owing to the fermentable carbohydrate metabolism by cariogenic bacterium and their production of organic acids. This is one of the primary reasons dental professionals advise against increased consumption of natural and artificial sugars in food, as it is directly linked to caries progression.
Conclusion
Post-initial demineralization is caused by three main factors. The first is the lack of timely restorative management, which can initiate the further spread of the pathogens into the pulpal or root canal space of the tooth, causing periapical tooth infections. In such extensive lesions, there is a need for endodontic therapy or extraction and prosthetic rehabilitation.
