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

From Volume 40, Issue 10, December 2013 | Page 853

Authors

Hasham Khan

Professor of Paediatric Dentistry, Khyber College of Dentistry, Peshawar, Pakistan

Articles by Hasham Khan

Article

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:

  • How frequently we have to disturb the biofilm mechanically to prevent or control caries?
  • What about the biofilm in the interdental areas near the contact points and in the deep pits and fissures?
  • Is it less important to address something which causes fluctuations in pH in the biofilm?

    • 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.

    The statement ‘Unfortunately, there is less evidence that it is possible to alter diets and persuade people to eat differently’ is quite true but the same may be true for oral hygiene measures, especially in the developing countries.

    It may be as important to restore cavities (to reduce the burden of micro-organisms) as to give instructions to patients for primary prevention (to prevent new lesions). Prevention of new lesions may not be possible in the face of numerous unrestored cavities (restorations may be temporary before the caries are arrested).