Conclusion - Questions to consider


Dental Caries - A Chronic or Infectious Disease


Can dental caries be classified into any other forms of disease other than those discussed above?

Due to its complex nature there is a possibility of it being classified as other types of diseases. Studies are still being done on dental caries and future research and findings may aid in its further classification.

How does the classification of dental caries aid in its prevention?



Early Caries - Enamel Changes
The method of examination of caries on occlusal surfaces by dentists is highly controversial (some reports say the examination using a dental probe is not accurate) due to its lack of consistency, therefore leading to waste in materials, finance, patient discomfort. There are some suggestions using radiography as a more accurate tool (especially for young children where caries is prevalant). Studies are still being done to find out the best method for dentists to accurately examine caries.


The wearing of orthodontic bands (braces) can also cause lesions due to prolonged plaque accumulation on irregular surfaces of brackets and wires. Research has shown that salivary buffering capacity/ salivary flow rate increases after fixation of orthodontic bands for long periods of time.
Therefore, one of the ways to minimize the onset of lesions is that dentists can access the patient suceptibility to caries, salivary flow rate, rate of formation of caries before administering treatment.
  • Are there other ways to minimize the rate of lesion onset beside brushing/flossing, such as through the use of topical fluoride?




Caries Progression and Dentine Changes

Caries progresssion is due to an imbalance from the protective and pathological factors. The degree to which the caries progress is dependant on the magnitude of the imbalance as well as any inherent genetic/structural susceptibilities in a person. After breaking through the enamel, caries often make use of the dentinal tubules to move towards the pulp chamber. In response, the dentine will react according for as long as it can, to hold back the advancement of the carious bacteria. However, the question remains whether the exposure of the pulp signals the end of the progress of caries and at what point does the break down of the collagen matrix become irreversible?

As much as it is important to know how a healthy dentine reacts to the onslaught of caries , it would be interesting if further research is done to understand whether the dentine anomalies (especially those with inherited genetic diseases) affects the dentinal changes that are observed as a result of caries. More research should be directing in understand the effects of caries in dentinogenesis imperfecta II/II as the dentine in these conditions would be softer and more suceptible as well as in the case of dentine dysplasia where the pulp chambers may be completely obliterated (odontoblasts reside in the pulp) and this in turn would affect the reactionary mechanism of dentine.



P
ulpo-dentinal Changes Due To Caries

Currently, not much is known about the possible chemical or electrical transmission mechanisms between odontoblasts and the nerve endings - can the odontoblasts send chemicals or electric signals to the nerve endings to initiate immune response? This is a highly exciting area to explore as discovery of such mechanisms may call for a re-look into the role of odontoblasts in eliciting pulpal response. Furthermore, the time taken for the pulp to respond to an attack on the tooth by caries might have a new regulatory pathway - by regulating chemical or electrical signalling of the odontoblasts to the pulp.

Current technology does not allow for us to look into the actual time frame for development of caries within dentin as restoration is typically done once the caries reaches the dentin. Yet this is less of a concern than the need to find out new diagnostic measures for pre-clinical diagnosis of caries, both root (dentine) or coronal, so as to arrest lesions early and prevent the spread of disease in the tooth - rather than wait to treat it after it has progressed to an irreversible stage.



Dental Fluorosis

How does fluoridation of the enamel cause the discolouration and staining frequently observed in more severe cases of fluorosed teeth?

Dentistry has slowly evolved with an emphasis on dental procedures concerned with enhancing the cosmetic and aesthetic beauty of teeth. Hence, understanding the origin of the discolouration could help dentists identify a solution to treat the discolouration and staining of enamel (frequently found on fluorosed teeth) central to the aesthetic beauty of our teeth.

Is water fluoridation still necessary in developed countries i.e. Singapore?

Water fluoridation makes fluorides easily available to the masses. It thefore leads to higher tendency of excessive fluoride intake, which has been associated with bone and mental disorders.The uptake of fluoride by teeth has been linked, but is not necessarily the reason for decreased caries incidence. A reduction in incidence of caries coincided with areas with fluoridated water supplies, but may not be directly linked. Areas with the means to fluoridate water supply may also be able to support a better dental hygiene programme that has managed to keep the incidence of caries low. Should an improved dental hygiene system be our main vehicle of prevention of caries instead of water fluoridation?



Tooth Erosion

Recent findings have suggested that fruit juices are indeed more acidic than carbonated drinks. Should this be a cause for concern, since fruit juice is generally accepted to be a healthier option as compared to soft drinks? Some schools have decided to ban soft drinks to counter obesity problems. Should highly acidic fruit juices also be banned?

Some research suggested that the addition of fluoride to drinks is unable to reduce the effects these consumables have on erosion of the teeth (Larsen MJ, Richards A., 2002). Furthermore, an excessive intake of fluoride could result in dental fluorosis. What then is the optimum range of fluoride to be added to our drinks if we want to avoid both tooth erosion and fluorosis?

In a recent news article, several researchers concluded that their study demonstrated that white wines are more likely than reds to erode teeth, and that frequently drinking white wine may lead to severe dental erosion. They soaked the teeth in wine for up to 24 hours then analysed the results under the microscope. It was found that the teeth which had been soaked in white wines suffered more damage than those which had been soaked in red.
What should the public make out of this study? Although the laboratory situation does not represent real life as teeth would never be soaked in wine for such prolonged periods, should we be concerned with this? What about occupations that have a high exposure to wine, for example wine tasters?





Links

An Introduction | Tooth Anatomy and Histology | Dental Caries | Dental Caries - An Infectious Disease or a Chronic Disease |

Early Caries and Enamel Changes | Caries Progression and Dentine Changes | Pulpo-dentinal Changes

Root Surface Caries and Changes in the Cementum | Dental Fluorosis | Erosion of the Teeth | Conclusion


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