Changing concepts in cariology: forty years on (dent update 2013; 40: 277–286)

This letter is in response to the article ‘Changing concepts in cariology: forty years on’ published in Dental Update in May, 2013. Edwina Kidd and Ole Fejerskov are great names in the science of cariology and enamel defects related to fluoride. The dental community is bound to recognize their untiring efforts to increase our understanding of caries process, its control and prevention and the role played by fluoride.

There are some questions aroused by the statement ‘The most important control measure (to prevent carious lesions formation) is to clean teeth regularly and thus disturb the biofilm mechanically, with a fluoride-containing toothpaste’. We know that carious lesions arise from numerous pH fluctuations in the biofilm on teeth. When biofilm is disturbed mechanically, it immediately starts reformation. So the questions are:

The evidence linking sugar and caries is well documented. The question is not what is important and what is not but what is the most important? In Khyber Pakhtunkhwa, we have a large group of Persian speaking Afghanis. These people are very keen on hygiene, especially oral hygiene. They maintain ‘excellent’ oral hygiene but, at the same time, they are very keen on taking sugar-containing foods frequently. In spite of maintaining excellent oral hygiene (most of them brushing their teeth three times a day with fluoride toothpaste), their caries index is so high that most of the dentists in Peshawar are making their bread and butter out of them.