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Dental caries

Dental caries is a bacterial disease caused by the formation of acid on the teeth by bacteria. The pH in the mouth decreases, resulting in the demineralisation of the enamel and dentine of the teeth. There are four prerequisites for the formation of dental caries.

Factors that influence the formation of caries

1. A receptive tooth

2. Acid-forming bacteria

3. Digestible carbohydrates

4. Time

 

 



Bacteria such as Streptococcus mutans and Streptococcus sobrinus are present in the bacterial layer, or plaque, on the teeth, but lacto-bacteria can also break down carbohydrates in food, mainly to lactic acid. Corrosive damage is thus caused on the enamel of the teeth and the dentine, whereupon the calcium salts are successively dissolved. The risk of caries may be reduced or completely removed by good oral hygiene and regular intake of fluorine, for example, in fluorinated toothpaste. The use of fluorine has been the most important factor in the radical reduction of caries during recent decades.

Carbohydrates which contribute to the formation of caries are sucrose, glucose, fructose and some kinds of starch. Food with easily fermentable starch in a porous structure, such as cooked extruded products, such as puffed rice or cheese doodles, lead to a relatively large drop in pH in the mouth. Starch in a compact structure, such as pasta, is not readily fermented by oral bacteria and presents hardly any risk of caries. The risk of caries associated with sugar alcohols is low or non-existent. Xylitol is a special case as it has a certain retarding effect on oral bacteria. There is no risk of caries associated with the consumption of high-intensity sweeteners.

Fiids rich in fibre and sugar-free chewing-gum and lozenges, are good from a caries point of view, as they stimulate chewing and thus the production of saliva.

It is the frequency with which carbohydrates are consumed and not the amount which is important in determining the risk of caries. Upon the consumption of metabolizable carbohydrates, the pH falls in the plaque. If the pH falls below a certain critical level (~5.7 for enamel and 6.2 for dentine) calcium salts are removed. If, on the other hand, carbohydrates are eaten seldom, the saliva in the mouth can repair the corrosive damage which occurs after a meal.
 
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