Lesson 2: Dental Decay

Overview: The healthcare provider gains an understanding of the biological cause of dental decay, and learns the physical and psychological effects of dental decay in children.

Goals: The health care provider will be able to describe:

¬ Dental decay or caries is the result of a bacterial infection

¬ Dental decay is transmissible (e.g. from caregiver to child)

¬ Plaque or biofilm is a sticky substance made up of bacteria

¬ Susceptible teeth, significant plaque and frequent carbohydrate intake lead to decay

¬ Removal of plaque on a daily basis is an effective decay preventive measure

Key Terms:

Abscess: localized collection of pus formed by tissue disintegration and surrounded by an inflamed area

Biofilm: a complex matrix of bacteria, glycoprotein, and carbohydrates; also known as plaque

Cavity/Cavitation: hollow area or hole caused by bacterial acids eating away at the tooth

Decay/Caries: an infectious disease process of the tooth that destroys the tooth structure and produces a cavity

Demineralization: the breakdown of enamel that occurs due to bacterial acid production

Mutans streptococci: bacteria that is primarily implicated in the development of tooth decay

Maine Smiles Matter DD 1 The Process of Dental Decay

Dental caries is a bacterial infection. Bacteria must have the proper environment to multiply and thrive. Until teeth are present in a baby’s mouth, mutans streptococci cannot proliferate. Once teeth erupt, however, biofilm forms and adheres to the tooth surface. This matrix (plaque) increases in amount unless disrupted daily. If allowed to remain, and other co-factors are present, dental disease is likely to result.

CARBOHYDRATES + PLAQUE = ACID + TOOTH = DECAY

The bacteria within the plaque are able to ferment the sugars and carbohydrates that they contact. They form lactic acid, which can cause demineralization of the enamel of the tooth. For 20 minutes following exposure to sugars (the breakdown of carbohydrates), the enamel of the tooth continues to be attacked by acid. Each repeated snack leads to another 20 minutes of acid formation that can quickly weaken the tooth surface.

Where Decay Begins

Once teeth have erupted into the mouth, there are surfaces that are more likely to develop decay at an earlier stage than others. The area along the gum line tends to collect plaque easily. This is where decalcification begins. The pits and fissures on molars tend to have a thinner layer of enamel and are prone to collect food and plaque. These are common sites for decay to occur. Plaque also tends to remain between teeth where the toothbrush cannot reach it. These areas then become susceptible to decay if the plaque is not removed by flossing. Biofilm does not form evenly on all teeth, thus some teeth are more vulnerable than others to decay.

Decalcification Pits and fissures

Maine Smiles Matter DD 2 Early Treatment is Most Effective

If decay is not treated at an early stage, it is likely that it will extend from the hard outer surface of the tooth to the inner living tissues known as the pulp. If the bacteria reach this level, infection of the tooth will most likely occur. The bacterial infection can then spread through the blood vessels to other parts of the body or localize as a facial swelling. Pain occurs for most children during the process of dental decay. The most severe pain usually occurs when the infection involves the pulp and becomes acute. Complications can arise from dental infection, especially in the child with compromised health.

Abscess

Dental decay can lead to the destruction of teeth, often resulting in soft tissue infection (abscess), sometimes serious. It can also cause difficulty eating, leading to poor nutrition and improper physical development. Speech problems and emotional issues can arise due to missing and unaesthetic teeth. Malpositioned adult teeth, due to premature loss of baby teeth, can result in chewing difficulties, jaw joint pain, and further dental disease. There is growing scientific evidence that dental disease may be linked to the following:

• Preterm low birth weight babies • Cardiovascular conditions • Cancer • Diabetes

Preventive Dental Care

Preventive dental care is the most effective method of reducing the risk of dental caries. If preventive measures are not initiated, cavitation will most likely result. Preventive interventions include removal of the plaque with brushing and flossing and development of an enamel surface more resistant to demineralization through the use of fluoride. Remineralization of the early lesion with fluoride compounds is also possible.

Maine Smiles Matter DD 3 Diet is a critical piece in the puzzle of decay. Carbohydrates are broken down to simple sugars that are utilized by mutans streptococci, producing acid as their by-product. Sugars in cookies, soda and candies are well known for their decay contributing potential. White bread, potato chips, pretzels and many other processed snacks may be harmful to teeth as they contain complex carbohydrates. It is true that the sugars found in fruit and fruit juices are equally implicated in the decay process. However, as part of a well-balanced diet, they are essential for good health, and, when consumed with a meal, are unlikely to be as harmful to teeth.

Transmission of Bacteria

As with other infections, decay-causing bacteria may be transmitted from one person to another, most often from the mother or primary caregiver to the infant. Elimination of oral disease in the child’s family members will help reduce the risk of decay for the child, since repeated introduction of the offending bacteria is more likely to result in infection of the baby’s mouth.

The following habits are potential ways of transferring bacteria to an infant and should be discouraged:

• Testing the temperature of baby food on a spoon prior to inserting into the infant’s mouth • Cleansing the dropped pacifier by the parent licking it before replacing it in the child’s mouth • Allowing the child to place his hand in the parent’s mouth, then placing it in his/her own mouth

While mutans streptococci are present in most human mouths, dental caries do not occur unless the bacteria are found in high concentration along with carbohydrates, and a tooth that is compromised (e.g. it has not been exposed to fluoride or has a surface irregularity such as a pit or fissure that is not cleansable).

Maine Smiles Matter DD 4