Risk Assesment cont.

I have seen older people who have started taking medicines for chronic illnesses that dry up the protective saliva. This has become so common that it has been called, MIX, for medicine induced xerostomia (dryness of the mouth.) When you eat, your mouth becomes acidic (low pH) as the beginning of the digestive process. The saliva buffers the pH of the mouth, so that in a normal mouth, the pH returns to normal within about a half hour of a meal. But in a person with a dry mouth, it can take hours. Indeed for the person with a dry mouth, the mouth can live in a highly acid environment from breakfast until hours after bedtime, because by time the limited saliva has had a chance to buffer the mouth from the last meal, the person has eaten again.

Type of bacteria and saliva amount (and pH) are predictors of risk for cavities. It is possible for dentists to evaluate you for that risk by testing the saliva. And it is possible to treat the saliva of those people determined to be at risk for cavities to reduce the risk, before the damage is done to the teeth. This is done with a series of mouth rinses that over a period of time lower the acidity of the saliva.

Risk for gum disease can likewise be assessed by determining the bacterial make up of the fluid next to the teeth at the deepest invaginations of the gums. The unhealthy bacteria, are anaerobes, or bacteria that prefer an environment that is without oxygen. The bacteria can be observed and generally identified as unhealthy with the use of a microscope. The exact make up of the gum disease-causing bacteria and the approximate numbers can be determined by a test called DNA-PCR, (DNA-polymerase chain reaction)

The presence of the unhealthy bacteria can be determined before the damage has started from the inflammatory process that results from gum disease. And science is finding that the damage to the body goes well beyond the teeth and gums.

The traditional dental exam, is a recording of historical damage; recent history in the case of those who visit the dentist regularly, or accumulated damage in the case of those who avoid the dentist for long periods of time. The exam is usually done with an explorer, a sharp instrument that allows a dentist to envision breaches in the continuity of the surface of the tooth, for the purpose of creating a plan of action to repair the damage.

There are some dentists who look beyond the teeth at the gums and surrounding structures in the mouth. The examination of the gums is usually done with a notched probe, and the invagination of the gums around the teeth is measured in millimeters. This gives a look at the historical damage to the gums and supporting bone for a plan of the repair.

But the pursuit of understanding of the microbiology of the disease processes can lead us to an examination process that can anticipate the damage before it has been done. This can be thought of as disease risk assessment and management.

The diseases that dentists deal with are intimately transmissible, bacterial infections. What you think of as dental diseases such as cavities or bleeding gums, are really the result of the disease process, not the diseases themselves. The disease is the bacterial infection, the hole in the tooth is only the symptom. If you repair the damage without treating the cause, the damage will recur. Those people think of themselves as “cavity prone.” There is an inherited host resistance component, but the occurrence of genuinely soft teeth is rare. Most people who have soft teeth, have softened them by diet to help make themselves cavity prone.

Regular risk assessment is important, because the risk changes throughout a lifetime. A baby’s risk of dental decay is transmitted directly from the mother. I witnessed just last night a loving mother feeding her one year old from her own soup bowl in a restaurant. One bite for mommy, one bite for baby. It was a joyous moment for the happy family, but the dark side of the ritual is the transmission of decay producing bacteria from the mother to the baby.

It is not uncommon for me to see a pre-teen girl who has been cavity-free all of her life, show up in my office with a mouth full of cavities. She had made it this far disease-free because she had not had the bacteria that caused cavities in her mouth. (Mommy either didn’t share her spoon, or didn’t have the bacteria) But as soon as she is inoculated with cavity causing bacteria by her first boyfriend, the cavities follow. Her risk for cavities has changed.