It has been established that the oral environment is one of the primary factors in the caries process. Only when acidity increases in the oral environment does demineralisation of enamel, and subsequently caries, occur. In this section, the role of fermentable carbohydrates is discussed, paying particular attention to how caries can be influenced by the cariogenic potential of ingested sugars and starches, the physical traits of ingested carbohydrates (such as their adhesiveness), and the frequency of intake and exposure to sugars. The Stephan curve, which illustrates the dental pH changes over time in response to a carbohydrate challenge, is also introduced, with a discussion of how factors such as the type of carbohydrate, the buffering capacity of saliva, and the type and amount of bacteria present in plaque affect dental plaque pH responses.
Clinical Significance Snapshots
Which environmental factors can easily be modified to aid in the prevention of dental caries?
If a patient or other family members have signs of caries, it is critically important to look for environmental factors that may be contributing to increased risk of developing the disease. While modifying environmental factors is always a challenge, success is more likely if the family unit’s environment is investigated as well as that of the specific at-risk individual family member; changing the environmental factors of only one family member is unlikely to succeed.
Although some factors are easier to modify than others, there are some things that can be done without too much effort that may have a significant impact toward the prevention of caries. These include: a) alteration in the consumption of sugars (as fermentable carbohydrates) to minimise the potential for demineralisation; b) controlling the dental plaque biofilm to reduce the quantity of cariogenic bacteria present (although there are few studies showing direct correlations between oral hygiene and the prevention of dental caries, likely due to the fact that it is impossible to remove all of the acidogenic/cariogenic bacteria present in the mouth, it makes sense to try to minimise the overall challenge as much as possible); and c) the encouragement of remineralisation processes to maximise the potential for mineral repair.
How can I work with my patient in modifying these environmental factors to reduce the risk of developing dental caries?
After making an overall assessment of the caries status of each patient, positive environmental changes can be suggested that will help reduce the risk of caries by minimising negative factors and encouraging positive ones.