A Look at Dental Diseases and Treatments

Consumers' Research Magazine, February 1997 | Go to article overview

A Look at Dental Diseases and Treatments


Open wide! This isn't your favorite way to spend time--with your mouth full of instruments while someone pokes and scrapes your teeth and gums. But it's usually time well spent. Good dental care will help you keep attractive teeth and avoid a lot of discomfort down the line.

The key is to get the right care from a dentist and to care properly for yourself. To be able to make good decisions about dentists and dental treatments, and to be able to do as much as you can for yourself, it's useful to know a little dental science, which is where we begin in part one this month. In part two next month, we will look at the ins and outs of choosing a dentist.

Tooth Decay

Throughout recorded history, tooth decay (dental caries) has probably caused more pain than any other infectious disease. Fortunately, much progress has been made, especially among children--evidenced by the fact that over half of school children ages five to 17 now are free of decay in their permanent teeth. But decay remains a serious problem, and is still responsible for the loss of more teeth, at all ages, than any other cause. More than two-thirds of children have caries by age 17, and 94% of adults have either untreated decay or fillings (evidence of past decay) in the crowns of their teeth. A particular problem among adults is root caries--difficult-to-treat decay that occurs in areas where gums have receded. More than 20% of adults have root caries.

Dental caries are caused by bacteria. But most bacteria found in the mouth don't cause decay. The chief culprit is a bacterium called S. mutans. To do its nasty work, S. mutans must find a way to cling to the surfaces of your teeth. It does this by converting sugar into sticky lengths of molecules which attach to tooth surfaces, along with other substances present in the mouth, to form plaque, a gelatinous mat of microorganisms and other matter.

S. mutans is tough. It must be able to live in an acid environment, to tide itself over during periods when nutrients (primarily the sugar you eat) are lacking, to survive with the low levels of oxygen that occur at deep levels of plaque, and to withstand assaults from various defenses your body throws at it.

The bacterium does its damage by producing acid from the sugars you eat. When the acid is sufficiently strong, it causes the calcium and phosphorous that make up the hard surface of your teeth--the enamel--to dissolve away. Each time you feed S. mutans by putting foods containing sugar into your mouth, the acid content of the plaque on your teeth rises sharply, then returns to a harmless level after about 20 minutes. It rises farther and subsides more slowly in individuals who are especially susceptible to caries than in other individuals.

At first, decay just weakens the enamel and makes it more porous. But eventually it breaks the enamel and moves into the dentin--the softer, bonelike material that lies beneath the enamel. If the decay's spread is not stopped by a dentist's drilling and filling, the decay will soon spread through the dentin into the tooth's pulp, which contains nerves and blood vessels. You will probably feel pain at this point, and the tooth will require root canal therapy if it is to be saved.

How Your Body Fights Back. Fortunately, your body does not stand still for the onslaught of S. mutans and other decay-causing bacteria. Indeed, if it did, the life of your teeth would be measured in days.

Your saliva helps in many ways. For example, it simply washes away both acid and clusters of acid-producing bacteria. It also contains chemicals that neutralize acid and chemicals that kill bacteria--by breaking down bacterial cell walls, for instance. In addition, it contains antibodies that inhibit the bacteria.

Another way of fighting back is through the ability of your teeth to repair themselves. When acid levels are high, calcium and phosphorous are dissolved away, but later these minerals, which are held in solution in the saliva, return to remineralize the tooth. …

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