"Every tooth in a man's head is more valuable than a diamond" Miguel de Cervantes (1547-1616) in Don Quixote.
The above quote may sound funny, but Don Quixote was on to something. Healthy teeth are essential to general health. Dental decay or caries affects the majority of populations in industrialized and many developing countries. It is characterized by the dissolution of the dental enamel and dentine. This eventually destroys the affected tooth surface or the tooth itself.
The immediate cause is an organic acid produced by micro-organisms present on the tooth. Dental plaque consists of bacteria and a matrix of extracellular polysaccharides produced from sucrose by the bacteria. Tooth plaque, specific bacteria, diet, fluoride, and saliva are all involved in the dental caries process. In recent decades, preventive measures have helped to dramatically lower levels of dental caries in industrialized populations. The most important of these measures is exposure to an appropriate level of fluoride, from various sources, including water, food, and toothpaste.
Dental caries is a multifactorial disease, related to:
- the presence of microorganisms that cause caries, such as Streptococcus mutans, and Streptococcus sobrinus
- fermentable carbohydrates (e.g. sugars) in the diet, particularly when consumed frequently
- susceptible teeth, such as in the early stages of development, after injury or in malnutrition or chronic disease
- time: caries increase over time as teeth erupt and surfaces become at risk.
Good oral health requires a clean water supply, sufficient for brushing and cleaning teeth regularly from an early age. Poor oral hygiene may also result in periodical problems since the dental plaque may induce gingival inflammation and deep pockets.
While fluoride intake from drinking water and a balanced, low sugar diet is probably the most important factors in reducing dental caries, a lack of clean water for basic oral hygiene may tip the balance towards earlier and more severe patterns of caries. Where fluoride concentrations in water or in the diet are known to be low, community water fluoridation is safe and cost-effective. While there are established benefits from adding fluoride to waters with low natural fluoride, fluorosis remains a problem in areas of where the natural concentration of fluoride is high.