Other Factors Affecting the Epidemiology of Caries

The influence of other factors that might be expected to have a bearing on caries experience has proved difficult to establish for practical reasons. These include the susceptibility of particular sites within the dentition or in an individual's mouth and local salivary flow rates. Both of these factors are known to be strongly influenced by genetic inheritance. The morphology of the teeth and, especially, the depth and shape of the fissures on the surfaces of the molar teeth are strongly heritable. It is generally difficult to predict, in advance of caries developing, which sites will be particularly susceptible. But one successful preven-tative approach has been to identify children with deep fissures in their molar teeth at an early age and offer prophylactic treatment in the form of sealants. This addresses the most common site of early childhood caries (the molars) and targets those children most at risk because of unfavorable tooth morphology.

The rate of salivary flow, both at rest and when stimulated by eating or drinking, is also known to be a crucial influence on risk. Patients who have had a salivary duct removed for any reason have a far higher risk of caries than those with normal function. Some people have low salivary flow rates and, again, have a greater risk. Older people are inclined to suffer from a dry mouth, and a number of medications reduce salivary flow.

Epidemiological studies to assess the importance of salivary flow rates in altering the risk of caries have not been carried out because of the practical difficulty of measuring this factor. But the stimulation of salivary flow that accompanies chewing has been successfully exploited to reduce caries risk in experimental studies using chewing gum (usually sugar-free). Reductions in caries incidence were seen when subjects were encouraged to chew the gum, especially between and immediately after meals, while continuing their normal regular oralhygiene practices. Convincing evidence of an effect at the population level, however, is awaited.

See also: Calcium. Carbohydrates: Resistant Starch and Oligosaccharides. Fructose. Galactose. Glucose:

Chemistry and Dietary Sources. Sucrose: Dietary Sucrose and Disease. Vitamin D: Rickets and Osteomalacia.

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