Caries (cavity) management by risk assessment was a term first introduced to dentistry in 2007 and is currently a foundation of how we practice dentistry at Southern California Dental Health Associates. Basically dentistry has tried to adapt a medical model to help us to determine the risk of a patient getting cavities in the future. By assessing the risk we can then offer individualized plans to help our patients minimize their future risk of getting cavities.
Dr. Kim Kutsch, one of the dentists behind the CAMBRA movement, presented at the most recent World Congress of Minimally Invasive Dentistry in September, 2013. He pointed out that untreated dental cavities is the most common disease in the world today, and even with the advance use of fluoride in water the rate of cavities in the 0-5 year olds in this country is growing up at an alarming rate. It is also important to understand the filling a cavity does nothing to change the infection in your mouth.
The usual suspects in the disease of caries are
1. Bacteris (too much bacteria. Or the bacteria acting badly
2. pH
3. Diet (too much sugar or eating too frequently)
4. Saliva ( very important for the early reversal of the cavity process)
5. Genetics
Lets discuss these in a little more detail. I want to cover bacteria and pH together since they are very hard to separate. Cavities are really a pH driven biofilm (the entire mass of different bacteria found in the sticky film on teeth) disease meaning that if the biofilm gets acidic then nice bacteria can start behaving badly. No longer are there only 3 bacteria that cause cavities, but in acidic biofilms over 40 bacteria have been identified as players. When the pH of the environment goes below 5.5, minerals can be lost from the tooth structure and this is the first part of the cavity process. When the pH goes back up over 5.5 the minerals can be replaced from minerals found in the saliva and no harm no foul. You get a cavity when you don’t allow for remineralization.
Diet plays the following role. Let’s assume that every time you have a meal there is some form of carbohydrate involved so there is food for the bacteria in the biofilm on your teeth. This means acid production by the bacteria interacting with the carbs in your food. It takes 30 minutes for your mouth to level the playing field back to a neutral pH. While it may be obvious to you that sugar drives the pH down so does consumption of acidic beverages like sodas, juices, Gatorade and even some bottled waters (surprise here).
In addition, constant snaking sways the pendulum to having more of these acid exposures. And it is not just the 30 minutes of having the acids attack your teeth, during these acid exposures the bad bacteria in the biofilm start to grow more aggressively and also get the good bacteria to start behaving badly. Are you starting to see why fighting cavities are a pretty tough proposition given the food we eat today.
Saliva is so important since it is how the body starts the process of reversing the acid environment from any encounter with food. One of the biggest problems facing our patients today is what Dr. Kutch calls Hyopsalivation. 75% of all Americans take at least one prescription drug a day, 50% take 2, and 20% take 5 or more drugs. One of the most common side effects of all drugs (prescription or not) is the diminishing of salivary flow. You can see from what I have laid out for you that this is very dangerous as far as getting cavities is concerned. It is estimated that it takes 2 hours to get back to a state of neutral if you have hyposalivation. And what do people with dry mouth do…drink and if it is an acidic drink (even diet sodas) the race is one for cavities.
Genetics is the new field here. There are now 11 different genetic variations that science has identified that can alter one’s susceptibility to cavities. Unfortunately, the testing to help determine your risks are not available yet.
For the record, here are the factors that increase your risk of getting cavities: poor oral hygiene, growing up without access of fluoride, deep pits and fissures on your teeth, and a poor diet.
When it comes to lowering your risk there are so many tools to help you. At Southern California Dental Health Associates we believe in mechanical toothbrushes (the ones with times on them that can ensure you brush for at least 2 minutes), floss, soft picks (by Butler and they are the bomb). We carry rinses and other products that might specifically help you.
We also use the only tool on the market to measure the activity of the bacteria in your mouth, the CariScreen. We use information from this test, along with other criteria to determine where you are on the risk for cavities. And we offer the complete line of CariFree products that can influence the way the bacteria’s live in your mouth to help you slow down, if not stop, the viscous cycle of cavities that patients tend to get.