Julissa Orozco

Dental Caries Prevention

Dental caries is the most common dental disease not only in the United States but all over

the world. It has shown to lead to many harsh consequences on Americans each year. In a survey

by The National Health and Nutrition Examination, 92% of adults from ages 20-64 have had

dental caries in their permanent teeth and 42% of children ages 2-11 have had dental caries in

their primary teeth (NIH, 2014). Not to mention over 30% have untreated tooth decay in both

categories as well (NIH, 2014). Dental caries (tooth decay) is the destruction of teeth enamel that

occurs when masses of plaque form, which then turns into acidic-bacteria that breaks down a

person’s teeth (Dental Caries, 2017). Today there are many effective strategies throughout the

world that is said to “reverse” tooth decay and the formation of dental caries. The prevention of

tooth decay includes three major aspects, sugar consumption, direct or topical fluoridation, and

improvements of oral health behaviors. There are various studies to prove that these strategies

are effective in distinct communities, with that being said I believe that it is a significant topic to

learn about as a future dental hygienist. Having this information will allow me to be able to

educate my patients on maintaining well-balanced oral habits.

Dental caries is known to be the most prevalent disease in both children and adults.

Revealed in The National Health and Nutrition Examination survey in 2014, almost half of the

children in category ages 6-11 have had dental caries in their primary teeth (NIH, 2014). Not to

mention that the majority of adults from age 20-64 have had tooth decay of some sort (NIH,

2014). According to a research article by the American Journal of Clinical Nutrition, sugar

consumption has a dynamic relationship to tooth decay or oral health in general (Touger-Decker
& Van Loveren, 2003). Carbohydrates in sugar react with salivary glands causing plaque and

salivary pH to develop on dental enamel (Dental Caries, 2017). The result of this acidic reaction

leads to loss of calcium and phosphate from the enamel which is a process called

demineralisation (Dental Caries, 2017). Demineralisation is a process where acid and bacteria

causes the tooth to lose calcium and phosphate that lead to more severe consequences, such as

tooth complications that classify under: DMFT (D= decayed, M= missing, F= filled T= teeth).

Although this disease is very common, there have been many studies that pinpoint the effective

strategies of dental caries prevention. Later in this paper I will emphasize various factors of

dental caries prevention, according to differing trends in history among countries all over the

world. These include: limiting the amount of sugar intake, exposure to fluoride, and utilizing

dental services (Chi et al., 2015). The history for dental caries began in the 1900s when there

was a rise in sugar importation and advertisement in third world countries (Sheiham, 1984).

Before the 1980s dental caries were uncommon in western industrialized countries. It is amazing

to see the prevalence trends that came to be in dentistry from the beginning of the 19th century.

Looking at the scope of dental caries during the 19th century, this disease was not as

common as it is now. Trends within the 19th and 20th century have developed

for the prevention of dental caries in today’s society. Dental caries was at a rapid rate since the

rise of sugar consumption in the 1980s (Sheiham, 1984). The average number of caries per

12-year-old, assessed by the WHO data was 4.1 for third world countries and 3.2 for

industrialized countries in 1982. According to the data in the DMF index it was twenty years ago

when the index was less than 1-DMF teeth for most underdeveloped countries and as high as 10

DMF-teeth for developed countries. (Sheiham, 1984) However, since the 1970s there was an
annual reduction in 12 year-olds in developed countries such as the UK and USA. Many factors

contribute towards the declination of dental caries in these countries such as: dietary habits, use

of fluoride and well balanced oral health (Sheiham, 1984). On the other hand, underdeveloped

western European countries have struggled to fight against high DMF levels ever since the

1800s. Out of 20 countries, where two surveys had been conducted on 12-year olds, 15 have

recorded marked increases in caries levels (Sheiham, 1984). The average annual per capita sugar

consumption level increased in underdeveloped countries from 22.3 kg in 1968 to 27.4 kg in

1981 (Sheiham, 1984). As these countries being underdeveloped, sugar consumption was always

predicted to be higher than industrialized countries. As sugar importation and production was

significant to places such as the European countries, sugar was promoted almost everywhere

which is why levels were and are so high. Though countries such as Europe have struggled for

many years to reduce dental caries levels, they have improved in food labeling and classification

on well-balanced diets throughout the country.

Dental caries is based on the lifestyle a person chooses, it’s one of the most controllable

diseases there is (Touger-Decker & Van Loveren, 2003). There is a dynamic relation between

sugars and oral health, as mentioned in the previous paragraphs (Touger-Decker & Van Loveren,

2003). Diet plays a huge role in the formation of dental caries which results in countries such as

Europe to have excessive levels of DMFT. In the 1960s the caries theory was portrayed as three

circles representing the three prerequisites for dental caries: the tooth, diet, and dental plaque

(Touger-Decker & Van Loveren, 2003). There are also many other significant factors that

contribute to tooth decay including: saliva, immune system, time, socioeconomic status, lifestyle

behaviors, level of education, and the use of fluorides according to the American Journal of
Clinical Nutrition. Diet and nutrition both have their own relation to oral health: diet affects

primarily the “integrity of the tooth ph and composition of saliva and plaque” (Touger-Decker &

Van Loveren, 2003, para. 4). Nutrition on a valid stance has a “systemic effect on the oral

cavity” and structure of teeth (Touger-Decker & Van Loveren, 2003, para. 4). The 2 oral bacteria

exists in dietary carbohydrates, which are mutans streptococci and lactobacilli which is usually

linked with sucrose and fructose and are also considered as added sugars. (Touger-Decker & Van

Loveren, 2003). It is noted that added sugars are usually more likely to form carious surfaces

than natural sugars. Considering that added sugars are almost in everything a person consumes,

sugar consumption has a substantial role on dental caries formation.

In a research article by BioMed Central, they conducted a novel hair biomarker study on

Yup’ik children in Alaska showing a positive correlation with added sugar and the rates of dental

caries. As already mentioned in previous paragraphs, limiting sugar consumption is said to be an

effective strategy in the prevention of dental caries. In this study they recruited 60 participants

ages 6-17 years old and managed a 66-item survey administered by a Yup’ik member of the

research team. They then operated the biomarker study by cutting 20, 2 cm segments from the

back of each child’s head. One centimeter of hair corresponds to approximately 1 month of

growth and reflects added sugar intake from previous 1-2 months (Chi et al., 2015). Then the

hair segment was taped for isotope analyses at the Alaska Stable Isotope Facility to add sugar

intake for data collection. For data collection of oral behaviors they accessed demographic

statistics and survey data from linear regression analyses. It assessed the association between

added sugar intake and tooth decay. They then divided the added sugar intake and day by 40g of

sugar which is proportional to a 12-ounce soda. The results regarding beverage consumption data
collected via parent survey, 49% of children were reported to consume sugar-sweetened fruit

drinks (Chi., et al,. 2015). 43% of children consumed sodas 1-4 times a week (Chi., et al,. 2015)

and 70.6% of the children consumed sweets at least once a day (Chi., et al,. 2015). The mean

proportion of carious tooth surfaces was 30.8% (Chi., et al,. 2015). Caries also followed a

“U-shaped curve” decreasing from ages 6-12 then from ages 13-17 (Chi., et al,. 2015). In the

age-adjusted regression models “a 40-g/day increase in added sugar intake was associated with a

6.4% absolute increase in the proportion of carious tooth surfaces” (Chi., et al,. 2015, para. 25).

In the log-linear regression model, “a 40g/day increase in added sugar intake was associated with

a 24.2% relative increase in proportion of carious tooth surfaces”(Chi., et al,. 2015, para. 25).

This research proves the negative effects of sugar consumed beverages and dietary habits with

carious interactions. Not only is this happening in the Yup’ik community but many places

around the world. With reducing sugar-sweetened beverages, it could improve oral health

throughout the general population.

Another effective strategy for the prevention of dental caries is topical or direct

fluoridation within the community. Studies of fluoride have shown significant effectiveness of

the reduction of dental caries throughout the years. By the 1970s it was known that fluorides had

relation with evolving the dental caries epidemic (Sheiham, 1984). The function of fluoride

includes slowing down the demineralisation process and help remineralise enamel where calcium

and phosphate was lost (Dental Caries (Tooth Decay), 2017). Fluoride is found in water which is

the reasoning for higher water fluoridation levels and lower DMFT levels in distinct areas. There

are many benefits that come from water fluoridation such as it is safe to use for everyone, and it

is very effective towards the deprivation of dental caries (Dental Caries, 2017). In a 2012 study
by Public health England,​ ​the PHE formed a water fluoridation monitoring report in fluoridated

and non-fluoridated areas in England to identify the interaction of water fluoridation and carious

levels in 12 and 5 year-old children. Their methods of collecting data included: assessment of

fluoridation status, LSOA level exposure, local authority level, variable data, dental indicators,

statistical analysis, and mean D3MFT which is the average number of decayed teeth (​Public

Health England, 2014). ​The results for fluoridation status and D3MFT levels included analysis of

LSOAs (layer super output areas). Results revealed that most areas weren’t naturally fluoridated

throughout the 32,482 boundaries in England, out of 32,482 LSOAs: 28,433 (87%) were not

fluoridated; 3,991 (12.3%) were fluoridated, and 58 were naturally fluoridated (​Public Health

England, 2014). ​They received results according to dental indicators on conducted surveys of

levels of D3MFT in 12 and 5-year old children in England. The average number of D3MFT

score for 12-year olds was lower in fluoridated areas as it was 0.63 in fluoridated LSOAs and

0.71 in non-fluoridated areas (​Public Health England, 2014).​ The mean D3MFT was 0.07 lower

in fluoridated areas compared to non-fluoridated areas, whereas the mean score was 0.25 lower

in fluoridated areas of most deprived areas (​Public Health England, 2014). ​The sample of 5-year

old children resulted in levels of D3MFT being lower in fluoridated areas, 0.67 compared to 0.89

in non-fluoridated areas (​Public Health England, 2014). ​This research over shows the results of

the weighted D3MFT mean was 0.20 lower in fluoridated compared to non-fluoridated areas

(​Public Health England, 2014).​ The analyses in this report provides evidence for the reduction of

dental caries levels associated with water fluoridation, which is why in my opinion fluoride

should be more promoted within the community.

 Another effective strategy against dental caries is having good oral health habits and

guidance. In a study from BioMed Central, a team of 6 specialists conducted a survey that brings

awareness to the utilization and patterns of oral hygiene practices on adults in Nigeria. The study

was between January 2010 and June 2011 and was assessed by a rapid survey. They used a

multi-stage cluster sampling method to conduct this assessment. Out of the 36 states 18 states

participated according to the list of LGAs as a sampling frame (Olusile et al. 2014). Data

collection was taken place in a central location where data on demographic characteristics, oral

health service utilization, patterns of oral hygiene practices and self reported oral health status

were collected using a structured questionnaire. A total of 7,630 people aged 18-81 years

participated in the survey (Olusile et al. 2014). Overall 21.2% of the participants rated their oral

health status as very good, 37.1% as good, 27.4% as fair, 9.0% as poor or very poor (Olusile et

al. 2014). The results of oral behaviors included: 81% used tools such as toothbrushes and

toothpaste, 20% of participants used fluoride, 42% cleaned their mouth twice a day and only

26.4% visited dental services (Olusile et al. 2014). The study also revealed the association

between oral health service utilization and oral hygiene practices. They discovered that people

that were more educated and managed better oral hygiene habits had better oral health incomes.

Previous dental visit or exposure to oral health education also increased the likelihood of better

hygiene habits by 6.9% more than those who aren’t exposed to dental care services or utilization

(Olusile et al. 2014). This study supports the concept of the relationship of oral hygiene and

utilization with oral health outcomes.

The major aspects of this paper was the etiology and prevention of dental caries; sugar

consumption, well oral health habits, and of course effectiveness of fluoride. Not only have
they’ve shown to be effective in the U.S but all around the world. I was able to come to a

conclusion that these strategies work in preventing tooth decay with the distinctive studies

researchers have developed. Dental caries is one of the most common prevalent diseases that is

the process of the destruction of teeth enamel and main cause of tooth complications. As a future

dental hygienist I would like to be able to educate my patients on how oral diseases such as

dental caries develop, and how to prevent them. I one day would like to give guidance on how to

maintain a well-balanced oral health for all my future patients.

 References

Sheiham, A. (1984). Changing trends in dental caries. ​International Journal of Epidemiology​,

13​(2), 142-147. Retrieved from http://ajcn.nutrition.org/content/78/4/881S.full.pdf+html

Public Health England. (2014). Water fluoridation: Health monitoring report 2014. Retrieved

from

https://www.gov.uk/government/publications/water-fluoridation-health-monitoring-report

-for-england-2014

Touger-Decker, R., & Van Loveren, C. (2003). Sugars and dental caries. ​The American journal

of clinical nutrition​, ​78​(4), 881S-892S. Retrieved from

http://ajcn.nutrition.org/content/78/4/881S.short

Chi, D. L., Hopkins, S., O’Brien, D., Mancl, L., Orr, E., & Lenaker, D. (2015). Association

between added sugar intake and dental caries in Yup’ik children using a novel hair

biomarker. ​BMC oral health​, ​15​(1), 121.

DOI:10.1186/s12903-015-0101-z

Olusile, A. O., Adeniyi, A. A., & Orebanjo, O. (2014). Self-rated oral health status, oral health

service utilization, and oral hygiene practices among adult Nigerians. ​BMC Oral health​,

14​(1), 140. Retrieved from https://doi.org/10.1186/1472-6831-14-140

Dental Health Foundation: Ireland. (2017). Dental caries (tooth decay). Retrieved from

https://www.dentalhealth.ie/dentalhealth/causes/dentalcaries.html

Dental Caries (Age 2 to 11). (n.d.). Retrieved from

https://www.nidcr.nih.gov/research/data-statistics/dental-caries/children
Dental Caries (Tooth Decay) in Adults (Age 20 to 64). (n.d.). Retrieved from

https://www.nidcr.nih.gov/research/data-statistics/dental-caries/adults