By Andrea Shepperson - 9 Mar 2011
Always getting cavities? You don't have to and the solution is simple.
The concept that dental decay is an infectious disease is a foreign notion for most patients. However biological manipulation of dental disease risk, and the ability to treat that infection, is here.
One of the first questions I ask a patient on our first visit is
"Tell me about your dental history?"
The response is commonly " Well, I've got lots of fillings and
no matter how well I brush my teeth I've always got something to do
when I go to the dentist."
Typically, on review of their mouths, the picture looks like
this:
- A relatively clean, well maintained
mouth.
- Lots of fillings.
- New decay.
- Root fillings.
- Possibly missing teeth.
The traditional response in the dental industry has been to take
a surgical approach to the problem, cutting out decay and filling a
hole, with little emphasis on treating the underlying infectious
disease.
Enlightened dentists have been treating the cause of decay for
some years, with a global view that dental decay (caries) is a
bacterial infection or imbalance. New, fast and cost
effective screening tools, and treatment regimes have been
developed to eliminate decay. For the the first time,
patients discover that their customary experience of dental care
can change.
To understand more about the modern concept of dental decay as
an infectious disease, watch this You
Tube clip from Carie Free...
Future proofing oral health is real... imagine knowing that this
might be the last filling you require, apart from simple repair and
replacement as old fillings wear out. Even better, imagine
knowing through a simple bacterial screen that you are at risk of
developing decay before you have decay.
The latter concept is hard to get one's head around. It
means that when environmental influences are in balance (mostly
what we eat and drink) the chance of expressing decay is lower,
even with a high bacterial risk. However, as soon as the
patient becomes exposed to different environmental selection
pressures, the decay process begins rapidly and the results can be
costly and destructive.
Take this example:
The teenager who has attended
the dentist diligently through school years with parental
insistence and guidance, completing orthodontics and arriving at 18
with no more than a few fissure sealants. Mum or Dad have
been shopping and cooking and eating habits have been moderated by
parental influence.
Returning home in November after
a year at university, Mum organises a visit to the dentist.
Both parent and student are shocked to discover that 6-8 fillings
are needed at a substantial cost. Parents often face
disbelief or worse - mistrust in the dentist making the
diagnosis. A dentist who has failed to diagnose the bacterial
risk is placed in a difficult position of defending a diagnosis
that seems contrary to past observations.
So what happened here? Our student adopted a diet and
lifestyle that created selection pressures that tipped the
bacterial balance into the danger zone, creating so much loss of
tooth mineral on a consistent basis that multiple cavities
formed. Those changes can be quite subtle. In the presence of
a cariogenic biofilm even small changes such as increased caffeine
intake, producing a drier mouth with less saliva, will be enough to
tip the balance in a high risk individual.
We know that the dominance of a cariogenic biofilm (bad
bacteria) is inherited. Children are infected in infancy by
oral contact with a parent, typically the mother. This
transmission of infection is called vertical transmission. We
have mixed evidence to support horizontal transmission - the
transfer of bacteria from genetically dissimilar individuals such
as partners. Intimate contact invariably involves transfer of
saliva and there are case reports of specific strains of bacteria
being transferred between spouses with a resultant increase in
decay rates.
Current treatment modalities involve a regime of high pH
mouthrinses to manipulate the biofilm content, allowing dominance
of good bacteria. Regular screening and monitoring is an
important part of decay prevention, as well as lifestyle awareness
on the part of the patient.
Find out how you can measure your risk and future proof your
mouth with us here
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