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Knowing how to tackle it

Give caries no chance

A widely spread illness without any medication available to combat it – that is caries. But unlike many other illnesses, there is an effective prophylaxis.
Marta Campbell and Isabel Weinert
02.09.2020  16:00 Uhr

Two aspects play a decisive role in the development of caries: a person’s diet and the bacteria that feed on it. Bacteria in the oral cavity, especially streptococci, feed on sugars, including household sugar as much as for example dextrose and fructose. They can also break down starch into monosaccharide and disaccharide. For this reason, caries is promoted not only by food containing sugar but also food containing starch. As a waste product of the bacterial metabolism, acids are formed which corrode the tooth surface and withdraw important mineral substances from it. This effect is increased by acidic beverages.

Caries generally occurs on the grooves of the teeth’s chewing surfaces, at the gum base as well as the contact surfaces of neighbouring teeth. Here the living conditions for streptococci and other bacteria are ideal and here they like to settle. In the course of time, a bacterial lawn that grows increasingly thicker is formed: dental plaque. It consists of bacteria, their metabolism products and saliva components. If the plaque calcifies over time, the result is tartar.

It is possible to stop caries in its early stages. The white spots on the tooth enamel can be »repaired«, i.e. remineralised again. If, however, the caries penetrates into the dentine, the tooth substance cannot be saved any more. The dentist will have to grind down the affected and damaged part using for example a drill. As the tooth substance that has been removed does not grow back again, the dentist needs to fill the defect caused with filling material or to cap the tooth.

Keeping cool about it

Considering this course of the illness, it is clear: caries prophylaxis must start at the bacteria. Although it is not possible to remove them permanently from the oral cavity by consuming less sugar and less acidic beverages, the bacteria’s living conditions are substantially worsened. Here it is irrelevant if the sugar has been added to food or naturally occurs there, such as in fruits, juices or honey. If, in addition, food remnants and plaques are regularly removed from the teeth, streptococci et al find it increasingly difficult to survive on the teeth. The basis for the prophylaxis is therefore to thoroughly clean the teeth with a toothbrush and toothpaste containing fluoride twice a day. More important than the question if a manual or an electric toothbrush should be used is the actual thorough execution. Cleaning should last at least two minutes. During that time about 40 percent of the plaque can be removed – therefore it is advisable even to extend the cleaning. Depending on the teeth’s position, using just a toothbrush may not suffice to remove food remnants and biofilm. To reach areas that are not easily accessible suitable aids would be dental floss or interdental brushes. Mouth rinses are not an alternative to a mechanical plaque removal, they can only supplement the cleaning of teeth.

Next to the plaque removal, using fluoride is the most important measure to combat caries. Fluoride helps the remineralisation of the tooth enamel with calcium and phosphate and hinders the plaque bacteria to turn sugar into acids.

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