Prevention against caries is not only based on fluoride
by As a bacterial disease associated with behaviour, dental caries is one of the most preventable diseases in the world. Even in developed countries where water fluoridation is carried out and there is easy access to fluoridated toothpastes, a large proportion of children still suffer from advanced caries. In the last 50 years, prevention against caries has mainly focused on fluoridation, either through the water supply, toothpaste or professional products in the dental practice.
Proper knowledge of the causative factors of dental caries, however, is important in the process of developing a holistic preventive program for humans.
Demineralization of the tooth surface is usually due to a decrease in pH below its critical value, which is about 5.6. The critical pH value is not a constant, but is related to the amount of calcium and phosphorus present, as well as the pH itself.
The dental biofilm microbiome develops after birth and is significantly influenced by the consumption of fermentable carbohydrates, particularly sucrose and fructose. The production of organic acids from sugar metabolism lowers the pH in the biofilm, creating an alteration in the microbiome known as the Marsh ecological shift.
Therefore, dietary change towards substantially reducing the consumption of sugary foods and drinks is the first step in preventing tooth decay.
In addition to nutrition, fluoride is still extremely important for the prevention of tooth decay. However, the action of fluoride, especially for remineralisation, is limited by the concentration of bioavailable calcium and phosphorus in the local environment (liquid biofilm). Remineralisation is only possible in the presence of bioavailable calcium and phosphorus. However, with saliva being the native source, the resource is limited. Recently, many products containing calcium and phosphorus have been developed and commercially available.
While there is a lot of research on the effectiveness of this method, the evidence for many is still limited. Inhibition of demineralization and subsequent remineralization in early caries (white spots) is sometimes considered unlikely due to the patient's inability to reduce risk factors such as sugar and poor oral hygiene habits, including interdental cleaning. Inadequate saliva flow and developmental defects in the enamel are also factors that prevent treatment.
In these cases, preventive sealants can be effective, but remineralisation of the area may not be possible afterwards. These products either seal the surface of the lesion or penetrate the porous part of the lesion to reduce metal loss from the tooth and prevent the progression of the lesion.
Preventing dental caries requires much more than simple fluoride treatments. Proper knowledge of the course of dental caries helps the clinician in formulating an individualized preventive program for patients.
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