Health Tips

Can you guess which non-infectious disease is the most widespread throughout the world? Not cardiovascular diseases, respiratory illness or even cancers– it’s tooth decay! According to the World Health Organization (WHO) and the 2015 Global Burden of Disease Study, 2.3 billion people suffer from tooth decay a.k.a dental caries. Although tooth decay does not sound as scary as other diseases such as cancers, it is a major public health problem globally. It is expensive to treat, can cause tremendous suffering, and is among the main reasons for hospitalization of children in some high-income countries.

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How does tooth decay?

Dental caries develop when bacteria in the mouth metabolise sugars to produce acid that can destroy the tooth’s surface, known as enamel. This can lead to a small hole in a tooth, called a cavity. If tooth decay is not treated, it can cause pain, infection, and even tooth loss. If you’re into the science of tooth decay, here’s a more in-depth explanation:

Microbe communities attach to tooth surfaces and create a biofilm. As the biofilm grows an anaerobic environment forms from the oxygen being used up. Microbes use sucrose and other dietary sugars as a food source. The dietary sugars go through anaerobic fermentation pathways producing lactate. The lactate is excreted from the cell onto the tooth enamel then ionizes. The lactate ions demineralize the hydroxyapatite crystals causing the tooth to be degraded. Source: Alsheik4, CC BY-SA 4.0, via Wikimedia Commons

What increases your risk of developing dental caries?

Diet high in free sugars

Free sugars does not include sugars naturally present in milk products, whole fruits, vegetables and grains. If you eat foods that contain free sugars (e.g. cakes, biscuits,sweetened cereals, honey, syrups and preserves) and drink sugary drinks (e.g. fizzy drinks), then you’re at a higher risk of developing dental caries. Fruit juices and smoothies also contain free sugars and often have a high acidic content, which raises the risk of dental caries and erosive tooth wear, respectively. A big fan of dried fruit? Well, dried fruit especially increases the risk of dental caries, as this can stick readily to the tooth surface. Ideally, no more than 5% of the energy an individual consumes should come from free sugars.

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Dry mouth/Unable to produce saliva

People with reduced saliva production, such as :

• Following radiotherapy to the head and neck

• Taking medications that cause dry mouth as a side effect. E.g. antidepressants

• Have eating disorders

 are at higher risks for dental caries. This is because in addition to lubrication, saliva also plays an important role in enamel remineralization and provides immunity to your teeth. If you experience salivary dysfunction, consult a healthcare professional for salivary replacement. Certain salivary replacement products may contain sugar, therefore, these products should only be offered to patients without natural teeth.

Developmental conditions

Developmental defects of the teeth (e.g. an enamel defect such as molar incisor hypomineralisation) may render the tooth surface more susceptible to breakdown and

dental caries. Young children are at risk for “early childhood caries,” sometimes called baby bottle tooth decay, which is severe tooth decay in baby teeth. Because many older adults experience receding gums, which allows decay-causing bacteria in the mouth to come into contact with the tooth’s root, they can get decay on the exposed root surfaces of their teeth.

Medically compromised

Individuals with immunocompromised conditions, such as leukemia, may develop periodontal inflammation as they lose their ability to fight infection.

Prevention of tooth decay

Although tooth decay still affects many people all around the world, we've seen great decline in tooth decay rates, thanks to the invention of water fluoridation. Water fluoridation, named by CDC as one of the ten great public health achievements of the 20th century, has been a major contributor to the decline of the rate of tooth decay. Studies have shown that water fluoridation can reduce the amount of decay in children’s teeth by 18-40%. 

In addition to fluoridated water, good oral hygiene can help prevent tooth decay:

• Brush twice a day with a fluoride toothpaste

• Clean between your teeth daily with floss or interdental cleaner

• Eat nutritious and balanced meals and limit snacking

• Visit your dentist regularly for professional cleanings and oral examination

• Check with your dentist about use of supplemental fluoride, which strengthens your teeth, and about use of dental sealants (a plastic protective coating) applied to the chewing surfaces of the back teeth to protect them from decay

Take care of your teeth, and bid goodbye to scary tooth extractions!

A word from Doc2Us

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References

1. CDC - Dental Caries (Tooth Decay)

2. NIH - Tooth Decay

3. WHO - Sugars and dental caries

4. Pitts, N., Zero, D., Marsh, P., Ekstrand, K., Weintraub, J., Ramos-Gomez, F., Tagami, J., Twetman, S., Tsakos, G. and Ismail, A., 2017. Dental caries. Nature Reviews Disease Primers, 3(1).

5. UpToDate - Oral and systemic health

Cover image credit: Caroline LM on Unsplash

Written By

Ms Joyce Toh