Dental Health Conundrum: Prevention, Treatment, or Both?

In dentistry, we typically see issues that are either preventable, or need a mechanical treatment in order to resolve. But with caries or cavities, it appears it is not as clear cut as once thought.

For the longest time, the understanding of how cavities form was solely thought to be due to the effects of bacteria in the mouth. However, it appears there is more than just bacteria eating away at the teeth and causing cavities. Understanding the way the body’s immune system responds to the bacteria in the mouth is providing us with more insight into the prevention and treatment of cavities.

If you’ve ever heard the phrase, “when two elephants fight, the grass gets hurt the most,” the concept is strikingly similar. A study from the University of Toronto’s School of Dentistry suggests that as the body’s immune cells battle the bacteria in the mouth, there is significant collateral damage to the dental and gum structures, mainly due to harmful acids and inflammatory processes going on around these vulnerable structures. These processes result in tooth demineralization and decay, 

Demineralization first occurs at the level of enamel, the outermost layer of teeth, which can appear as white spots in the area that has lost much of its minerals. This is a sign of “incipient,” or very early caries. If this process goes uncontrolled, teeth can develop permanent damage in the form of cavities. 

After seeing a dentist for the cavities, the technique as well as the materials used for procedures are just as important to help reduce further inflammation. Since the material is foreign to the body, the body must react as little to it, if at all.

An example of this is seen when studying the breakdown of resin composite material, a tooth colored filling material, after treating a cavity. Over time, we generally see that use of this particular resin causes the cavity to return to the same tooth or surrounding areas despite good oral hygiene. How does something like this happen? The answer again may be related to how the immune system reacts to the foreign material and bacteria around it and while attempting to fight it off, produces more acid and inflammatory products.

Reducing the amount of bacteria in the mouth is one of the most important pillars of cavity prevention. Even though the role of nutrition and good home care techniques cannot go understated, the entire picture is more complicated than that. The future of cavity prevention and treatment will be in modulating the immune system by choosing the right materials and techniques in order to prevent the treatment from causing more harm.