The Beginning of the Decay Process

In a previous article the role of saliva in the prevention of the decay process was discussed. Let’s address exactly how decay begins so that we might take a proactive approach to prevent it.

The process begins when bacteria, which are normally present in the oral cavity, attach to the enamel surface with the aid of a film called the pellicle. This pellicle or covering is actually formed from salivary proteins for the purpose of protecting the tooth from abrasion and to reduce the friction between teeth and oral linings. Ironically, this medium allows the bacteria to adhere to the tooth and begin colonization. This then becomes a biofilm since it incorporates bacteria which metabolize residual sugars left in the mouth and create an even thicker film insulating the bacteria from some of the protective antibacterial substances, as previously discussed, found in saliva.

There are certain characteristics of bacteria such as Strep.Mutans and Lactobacilli which enable them to produce decay. They typically can convert any residual sugars to organic acids and this ability prevails even in adverse conditions. This acid production begins to demineralize the enamel and creates a “white spot” on the surface of the tooth. It has been found that the colony of bacteria over this beginning area of decay is usually composed of 11-18% Strep.Mutans. The ability of this bacteria, along with Lactobacilli, to produce an acidic environment immune to the buffering capacity of saliva and other advantageous bacteria facilitates the change from just a “white spot” area to a cavity. The individuals who present with many cavities typically have a very high level of Strep.Mutans and Lactobacilli, low salivary buffering capacity, a diet with frequent intakes of sugars, and low fluoride levels in the saliva.

Again the fact that only 10% of our children reach adulthood without decay is an astonishing fact to me. With the above facts we basically know that if the patient removes the acid-producing biofilm or plaque from the tooth surface  it will not be able to produce the concentrated acids necessary to decalcify the enamel and produce the cavity. It is comforting to know that this disease can be prevented if the patient takes the initiative to adopt responsible hygiene program. School age children should brush three times daily. Children with braces should brush four times daily. At our practice we can show you how to take care of your teeth and those of your children. Call our office and make an appointment.