Caries, which is a Latin word meaning decay, describes the progressive destruction of enamel, dentine and cementum. These are the hard parts of a tooth and the process is initiated by germ activity at a susceptible surface.The consumption of sugar in its various forms has long been associated with the development of caries. In the United Kingdom, up until the seventeenth century, the diet consisted of unrefined whole foods, which wore down teeth. However, when fermentable carbohydrates became an important constituent of the Western diet in the seventeenth century, people began to develop caries. Also, changes in flour-milling methods, which made flour more refined, meant that less chewing was required and caries-prone fissures (grooves) were not worn away.
Eating patterns also began a slow, gradual change, for example, in the reign of Queen Elizabeth 1, sugar was imported and consumed by the wealthy. Dental caries became increasingly common following these changes in diet and as sugar became less expensive and more widely available to the general population.
The dental profession has been aware for over half a century that the frequency of sugar intake is far more significant in the development of caries than the amount consumed at any given time. In the present day, caries is one of the most common oral diseases found in industrialised countries, the most common cause of tooth loss in both children and adults in the Western world, and is more common in certain social classes.
The most recent survey (The Health and Social Care Information Centre – Leeds, England 2011) indicated that 24 percent of adults from managerial and professional occupation households had teeth with visible coronal caries (decay on crowns). There were 28 percent from intermediate occupation households had similar visible decay while 35 percent from routine and manual occupation households suffered the same fate.
Although our consumption of visible sugar is declining, it is increasingly found hidden in many processed foods, including confectionary, soft drinks, biscuits and cakes. It is thought that around 31 percent of children starting school have visible tooth decay. During the twenty-year period I worked as a dentist with the government, we did two National Surveys which showed that there was a gradual reduction of caries in school children aged between 5 and 12.
We concluded that this result was largely due to several factors, including improved oral health and dietary education of parents and children, wider availability and use of fluoride toothpaste (Colgate Palmolive was a co-sponsor with the Ministry of Health) , and regular dental check-ups identifying early problems . Incidentally, in recent years, there has also been an increase of the incidence of caries in non-Western countries as diets changed to more refined sugars.
There are three main types of caries: smooth surface (usually a brown spot on a flat part), pit and fissure (usually a dark streak in the grooves of the biting surface), and root caries (when root surfaces are exposed which occurs mostly in elderly persons).
For a tooth to decay four things must happen. First the tooth must be susceptible, meaning that the enamel must be exposed in the mouth (no crown, porcelain or gold covering). Then there must be the presence of bacterial plaque with the substrate which is essentially fermentable carbohydrate which feeds plaque bacteria to produce the acid to erode the tooth’s structure. Finally, time is of essence. When this combination occurs it indicates that it is now the crucial time to consult your dentist which should be as soon as possible.
Dr BERTRAND R. STUART D.D.S