The American Academy of Pediatric Dentistry terms the cause of decay as a multifactorial process. These factors include: genetics, plaque accumulation, salivary composition, diet, and oral hygiene. Whether one child or another is afflicted with dental decay is based upon these factors which continue to be studied within the scope of dentistry. My hope is that this information will broaden parents’ understanding of the cause of decay.
Severe dental caries has been shown to be a significant contributor to the overall health of a child making it incumbent upon us to promote oral wellness. Scientific literature presents evidence of increased risk for heart disease and diabetes with untreated decay, gingivitis, and periodontal disease. The role of the pediatric dentist in an early assessment is not only to determine caries rate, but, more importantly, to determine caries risk. The pediatric dentist is able to resolve the acute symptoms, but the longer lasting treatment is the understanding and control, if possible, of risk factors.
Every clinic day includes parents asking me, “I do everything I’m supposed to do, why does my child have decay?” Another common question is; “Why is only one of my children affected?” The answer is not simple. The factors described will not necessarily be in order of priority as each one carries a contributory level of importance.
Factor number one is genetic predisposition. Enamel structure and porosity is not the same for everyone. If your parents or grandparents have a history of having multiple cavities, “trouble with their teeth”, or had dentures at an early age, you may have a risk dictated by your genes.
Secondly, levels and virulence of cariogenic bacteria (cavity causing bacteria) vary for all individuals. Streptococcus Mutans and Lactobacillus are the two main culprits. These bacteria inhabit all of our mouths, but their ability to produce acids (virulence) can be worse for some than others. We could compare it to the flu. Some flus just make you feel a little off while others can land you in the hospital. This extensive variability limits medical and dental researcher’s ability to formulate a vaccine to prevent tooth decay. This bacteria is transmissible so we discourage kissing babies on the mouth, sharing utensils, using the same straw, and even blowing on their food.
Thirdly, is our own salivary composition. If we did a litmus test, some of us would have a lower pH of saliva than our brother or sister. Compound this with virulent bacteria, xerostomia (dry mouth), and/or any other of the factors, the risk increases. Systemic diseases with an autoimmune component, radiation, chemotherapy, and certain medications with sweetners can also affect our saliva.
The next two seem to be what we all think are the primary factors: diet and oral hygiene. It is my opinion that the first three provide the niche and are, for the most part, beyond our control. Diet and oral hygiene are two factors which can positively impact control. I like to remind parents that frequency is much more critical than quantity. Snacking frequently increases risk. It is reasonable that if you snack on broccoli, carrots, and drink water all day then your risk is lower in comparison to snacking on chips and soda. Following recommended nutritional guidelines while encouraging water consumption should keep your child in the safe zone. A Hershey kiss as a dessert after a good meal is still a nice treat. Let’s have realistic goals. As far as oral hygiene goes, brushing is the first hurdle. Do it at least twice a day. If you are able, do it more often. If your child is able to spit well, use a fluoridated mouthwash after each brushing. The last hurdle is flossing. Let’s tackle that one when it does not involve tackling.
As a parent, I understand the time and energy constraints. I remind myself that it has been our responsibility as a parent team to encourage and teach our children good oral hygiene and healthy diet regimens. We have “control” for only a short period of time. Our goal is to encourage and demonstrate healthy habits. Children learn what they live. I try to remind myself of that everyday and hope for the best. I also try to remind myself that I control what I can control, accept what I can’t, and work really hard to change and direct the things I can. Good Luck to us all on our journey to excellent oral wellness.