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Dental

2003-08-01 11:28:00

Preventing Pyorrhea

ANSWER: This month’s answer will conclude our discussion on Pyorrhea. You can read my first two responses from the June and July issues, or online at http://www.theqandatimes.com/.    The following information is taken from presentations at the Pediatric Restorative Dentistry Consensus Conference, April 15-16, San Antonio, Texas and published in Pediatric Dentistry, Vol. 24 - No. 5 - September/October 2002.  There is a model of disease that is used in understanding dental disease.  That model is termed "nonexclusive contributory disease model".  This model has three elements: "environmental", "genetic" and "infectious agent", and states that any specific element may contribute to, but does not necessarily "cause", the specific outcome of a cavity.  (With children, decay is the primary cause of concern regarding dental disease and as such, I will limit the discussion to kids’ cavities)  This fits the current understanding of this infectious disease process and can assist the dentist in determining the risk assessment for the child.Infectious Agents:    Streptococcus Mutans (S mutans) is the organism that causes plaque to form on the teeth.  They help form an intraoral biofilm (dental plaque) through their ability to adhere to tooth structure by laying down materials creating a highly sticky bacterial environment.  Once that film is laid down, Lactobacilli, associated with carbohydrate consumption, are associated with the progression of the disease process.  Studies show that levels of S mutans above 500,000 colony-forming units per milliliter of saliva are associated with higher levels of smooth surface cavities, while the presence of lower numbers of S mutans in saliva or their presence in fissure systems are predictive of fissure or chewing surface cavities.  Generally, mothers transmit the S mutans to their children.Genetics:   Children manifest the mother's immune system for the first months of life.  This immunity is transferred both by the placenta and via colostrums found in lactation products.  Since the child's temporarily acquired immune system is not particularly effective against the strain of S mutans resident in the mother, acquisition is more likely to occur from the mother than others.  Inherited disorders that affect tooth development or salivary flow and immune system competency increase the incidence of dental decay.  Dental enamel that is not well mineralized, such as in cases of ectodermal displasia, may also be more susceptible to dental caries.Environment:   Some environmental issues include the teeth present, the family cavity history, plaque control, carbohydrate (sugar), socioeconomic status (SES) and fluoride exposure.  It has been said that, 'bad teeth run in families'.  Bad teeth run in families with adopted kids as well, hence environmental factors play a prominent part in dental disease.  First of all, teeth must be present.  Persons with smooth surface cavities (in between the teeth and along the gum line) are at a higher risk of future decay.  Persons with fissure sealants (a plastic coating on the chewing surface of back teeth and grooves of some front teeth) have a reduced risk of both pit and fissure and smooth surface cavities.  Because the child's mother provides the most probable source of transmission of the cavity causing organisms, the level of the mother's infection directly correlates with the subsequent development of dental caries in the child.  In general, the greater and more frequent the exposure to carbohydrates, the greater the risk of developing cavities although this risk appears to be at least partially offset by twice-per-day brushing with a fluoridated dentifrice.  (Wait until about age 2 before using fluoridated toothpaste so the child will be able to keep from swallowing the toothpaste.)  The socioeconomic status (SES) is moderately well associated and inversely related to risk (the poorer the children, the greater the risk) for dental caries (decay) in children.  When studies capture the fluoridation status of the water supply, fluoride significantly reduces the SES risk.   What does this all mean to you and yours?  The same that it meant to me as my kids were growing up caries free.  My generation went to the dentist generally when there were problems.  I had plenty of problems.  When I received my dental education, I first applied my knowledge gained to myself, then to my family and once in practice, to my patients.  For my grandparents, it was too late for me to help them to keep their natural teeth.  My parents enjoy good dental health as does my wife and her side of the family.  Our kids grew up cavity free, and I expect they will remain so all their lives.  Their children are also on target for a cavity free life.  Water in the military was fluoridated, but back in Wichita, we supplemented the small amount of fluoride naturally in Wichita's water with fluoride tablets.  Their mother cleaned their teeth before bedtime until they were able to adequately provide for themselves.  With their grandparents' help, we limited the amount and especially the frequency of their intake of sweets.  They had regular dental checkups with topical fluoride (their fissure sealants are still effective and have been replaced over their adult years as needed) and although they didn't use toothpaste to clean their teeth, they did apply fluoride toothpaste or gel to freshen the mouth and protect the teeth by brushing with it for a minute or two before going to bed.  So, short of becoming a dentist, find one that will recommend specifics for your situation and if you are off tract, assist you in getting back on tract to good dental health.