Dental damage, sequelae, and prevention

doi:10.1136/bmj.320.7251.1717

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This article has a correction

Please see: ABC of oral health: Dental damage, sequelae, and prevention

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Ruth Holt,
Graham Roberts,
Crispian Scully

Tooth damage

Teeth may be damaged by dental caries, trauma, erosion, attrition, and abrasion or lost through periodontal disease.

Accumulation of dental plaque close to gingival margins and around the contact areas of teeth (top). Same teeth after brushing (bottom)

Disease

Caries and inflammatory periodontal disease are the most prevalent oral diseases, both a result of the activity of dental bacterial plaque. Plaque is a complex biofilm containing various microorganisms that forms mainly on teeth and particularly between them, along the gingival margin, and in fissures and pits, adhering by a variety of mechanisms. If plaque is not regularly removed the flora evolves, and plaque may calcify, forming calculus (tartar).

Calculus formed by calcification of plaque (top). Same teeth after calculus removed by scaling (bottom). Calculus cannot be removed by tooth brushing

Fermentation of sucrose and other non-milk extrinsic sugars by plaque bacteria to lactic and other acids causes tooth decalcification and, with proteolysis, results in caries (decay). The main causal organism is Streptococcus mutans. Caries has been declining for some years, mainly because of the protective effect of fluoride, but it is more prevalent in disadvantaged and deprived people, especially in preschool children.

Accumulation of plaque and a change in the microflora may also cause gingival inflammation (gingivitis). If conditions are appropriate this may progress to damage the periodontal membrane (chronic periodontitis) and lead to tooth loss.

Caries and periodontal disease are the main oral diseases, and dental bacterial plaque underlies these diseases
Fermentation of sugars by plaque bacteria causes caries by decalcification and proteolysis of enamel and dentine
Plaque can cause inflammation of the gingiva (gingivitis), and involvement of underlying tissues causes periodontitis