Pathogenesis (development of disease)
Dental caries is a multifactorial disease.Only when the three main factors come together can dental caries actually develop. The three main factors are:
1. the host: in this case, this means mainly the human oral cavity and its respective characteristics, e.g.:
- Tooth morphology
- Tooth position
- Chemical composition of the tooth hard substances.
- Amount of saliva
- Saliva quality
- Immunological factors
2. plaque: plaque is a yellowish-white, textured, tough, felt-like dental plaque (called biofilm) made of saliva components, food residues, living and dead bacterial cells and their metabolic products. 3. substrate: substrate refers to the food that provides the bacteria with a nutrient medium. The composition of the food, as well as its consistency and exposure time, play an essential role.
The host
There are large individual differences in the development of caries and its progression. Different composition of dental hard tissues, surface microdefects, or tooth malocclusions associated with increased plaque accumulation are important parameters. However, saliva is also an important cofactor in the development of caries. Saliva has manifold functions:
- Rinsing function and self-cleaning of the teeth
- Food accumulation
- Coating of the oral cavity and teeth
- Buffering acids
- (Re-)Mineralization
- Antibacterial activity
It is now scientifically proven:
- Low salivary flow rate → High caries incidence.
- High salivary flow rate → Low caries incidence
Saliva composition and flow rate can also be negatively affected by general diseases and medications (see Risk Factors).
The plaque
Plaque is enriched with an enormously high number of bacteria. Among them, two bacterial species in particular have been shown to be responsible for the development of dental caries. Streptococcus mutans and lactobacilli. These bacteria are not present in the oral cavity from birth. They have to be transmitted. Children are usually infected by their parents: Licking the spoon or pacifier, saliva transmission. This means: where there are no above-mentioned bacteria, there is no caries development despite sugar intake. Meanwhile, there is evidence that in caries patients, the yeast Candida albicans is also present in the sticky substance that Streptococcus mutans forms to adhere to the teeth. Candida albicans is thought to be able to influence the virulence (infectious power) of Streptococcus mutans, thereby altering its pathogenicity (the ability of an influential factor acting on the body to cause disease).
The substrate
Foods that are particularly cariogenic (= promote caries) include:
- Short-chain carbohydrates
- Sucrose
- Glucose, maltose, fructose, lactose
- Starchz. B. Sugar, potato chips, white bread, sugary fruit juices and sodas, sugary sweets, candy, dried fruit.
Attention!In young children, the constant rinsing of teeth with sugary drinks leads to massive decay of milk teeth (so-called. “Nursing bottle syndrome”). Note: Even so-called “sugar-free fruit juices” contain natural fruit sugar (fructose) and fruit acid. The frequency of ingestion and, of course, the appropriate oral hygiene measures also play an important role.Caries formation: Due to the bacterial metabolic processes in the plaque, the pH value in the mouth drops drastically, i.e. the environment becomes more acidic. The acid attack causes minerals to be dissolved out of the tooth hard substances, which ultimately makes the tooth more susceptible (“softer”).
Etiology (causes)
Biographic causes
- Genetic burden from parents, grandparents (mutations in enamel proteins involved in the so-called Wnt signaling pathway → development of defects in enamel).
- Anatomical factors such as malformations of the salivary glands.
- Age – Caries activity is predominantly increased in teenagers and the elderly.
- Hormonal factors – pregnancy
Behavioral causes
- Nutrition
- Cariogenic diet – unbalanced diet high in carbohydrates (simple and multiple sugars) such as.B. Sweets, potato chips, sugary and acidic drinks such as fruit juices (For more see under causes).
- Micronutrient deficiency (vital substances) – insufficient supply of fluoride (eg fluoridated table salt) – see prevention with micronutrients.
- Pleasure food consumption
- Drug use
- Amphetamines (indirect sympathomimetic): ecstasy (3,4-methylenedioxy-N-methylamphetamine, MDMA), crystal meth (methamphetamine) or methylphenidate.
- Psycho-social situation
- Anxiety
- Stress
- Insufficient oral hygiene, which promotes the formation of plaque.
Causes related to disease
- Acute bacterial and viral infections such as angina, diphtheria, mumps, mononucleosis, scarlet fever, HIV.
- Impairment of the salivary glands and production.
- Malformations
- Hormonal changes
- Medication (see below)
- Damage due to irradiation in the head/neck area.
- Sjögren’s syndrome (group of sicca syndromes) – autoimmune disease from the group of collagenoses, which leads to a chronic inflammatory disease of the exocrine glands, most often the salivary and lacrimal glands; typical sequelae or complications of sicca syndrome are:
- Keratoconjunctivitis sicca (dry eye syndrome) due to lack of wetting of the cornea and conjunctiva with tear fluid.
- Increased susceptibility to caries due to xerostomia (dry mouth) due to reduced salivary secretion.
- Rhinitis sicca (dry nasal mucous membranes), hoarseness and chronic cough irritation and impaired sexual function due to disruption of mucous gland production of the respiratory tract and genital organs.
- Scleroderma – group of various rare diseases associated with connective tissue hardening of the skin alone or of the skin and internal organs (especially gastrointestinal tract, lungs, heart and kidneys).
- Tumors
- Chronic atrophic gastritis – chronic inflammation of the gastric mucosa leading to tissue atrophy.
- Depression
- Diabetes mellitus
- Hormonal changes due to
- General diseases
- Gravidity (pregnancy)
- Medication
- Molar incisor hypomineralization (MIH) – systemic structural abnormality primarily of the enamel, which is due to a mineralization disorder; localization: on one to all four first permanent molars (so-called “chalk teeth”); prevalence (disease frequency): > 30% of 12 year olds.
- Boeck’s disease (sarcoidosis) – inflammatory systemic disease affecting mainly the lymph nodes, lungs and joints.
- Oral mucosal diseases
- Gingivitis (inflammation of the gums)
- Infectious changes (e.g., oral herpes zoster) or benign or malignant tumors).
- Periodontitis (inflammation of the periodontium).
- Primary biliary cholangitis (PBC, synonyms: non-purulent destructive cholangitis; formerly primary biliary cirrhosis) – relatively rare autoimmune disease of the liver (affects women in about 90% of cases); starts primarily biliary, i.e. at the intra- and extrahepatic (“inside and outside the liver“) bile ducts, which are destroyed by inflammation (= chronic non-purulent destructive cholangitis). In the longer course, the inflammation spreads to the entire liver tissue and eventually leads to scarring and even cirrhosis; detection of antimitochondrial antibodies (AMA); PBC is often associated with autoimmune diseases (autoimmune thyroiditis, polymyositis, systemic lupus erythematosus (SLE), progressive systemic sclerosis, rheumatoid arthritis); Associated with ulcerative colitis (inflammatory bowel disease) in 80% of cases; long-term risk of cholangiocellular carcinoma (CCC; bile duct carcinoma, bile duct cancer) is 7-15%.
- Systemic lupus erythematosus (SLE) – systemic autoimmune disease from the group of collagenoses, which affects the skin and the connective tissue of the vessels and thus leads to vasculitides of numerous organs such as the heart, kidneys, or brain
- Conditions or diseases that limit general physical mobility and, therefore, the ability to provide adequate dental care, e.g.
- Apoplexy (stroke)
- Dementia
- Advanced age
- Paresis (paralysis)
- Parkinson’s syndrome
Drugs (When using salivation-inhibiting (saliva-inhibiting) drugs for long periods of time, there is a strong destruction of the tooth hard substances. There are about 400 such drugs known. Drugs from the following groups may have salivation-inhibiting effects).
- Antiadiposita, anorectics.
- Antiarrhythmics
- Anticholinergics
- Antiepileptic drugs, sedatives
- Antidepressants
- Antihistamines
- Antihypertensives
- Antiparkinsonian drugs
- Antipsychotics (neuroleptics)
- Anxiolytics
- Ataractics
- Diuretics
- Hypnotics
- Muscle relaxants
- Sedatives
- Spasmolytics
X-rays – irradiation for tumor diseases.
Operations
