Sucrose and starches are the predominant dietary carbohydrates in modern societies. While the causal relationship between sucrose and dental caries development is indisputable, the relationship between food starch and dental caries continues to be debated and is the topic of this review. The current view of dental caries etiology suggests that in-depth evaluation of the starch-caries relationship requires the consideration of several critical cariogenic determinants: (1) the intensity (i.e., the amount and frequency) of exposure of tooth surfaces to both sugars and starches, (2) the bioavailability of the starches, (3) the nature of the microbial flora of dental plaque, (4) the pH-lowering capacity of dental plaque, and (5) the flow rate of saliva. Studies of caries in animals, human plaque pH response, and enamel/dentin demineralization leave no doubt that processed food starches in modern human diets possess a significant cariogenic potential. However, the available studies with humans do not provide unequivocal data on their actual cariogenicity. In this regard, we found it helpful to distinguish between two types of situations. The first, exemplified by our forebears, people in developing countries, and special subject groups in more modern countries, is characterized by starch consumption in combination with a low sugar intake, an eating frequency which is essentially limited to two or three meals per day, and a low-to-negligible caries activity. The second, exemplified by people in the more modern societies, e.g., urban populations, is characterized by starch consumption in combination with significantly increased sugar consumption, an eating frequency of three or more times per day, and a significantly elevated caries activity. It is in the first situation that food starches do not appear to be particularly caries-inducive. However, their contribution to caries development in the second situation is uncertain and requires further clarification. Although food starches do not appear to be particularly caries inducive in the first situation, the possibility cannot be excluded that they contribute significantly to caries activity in modern human populations. The commonly used term "dietary starch content" is misleading, since it represents a large array of single manufactured and processed foods of widely varying composition and potential cariogenicity. Hence, increased focus on the cariogenicity of single starchy foods is warranted. Other aspects of starchy foods consumption, deserving greater attention, include the bioavailability of starches in processed foods, their retentive properties, also in relation to sugars present (starches as co-cariogens), their consumption frequency, the effect of hyposalivation on their cariogenicity, and their impact on root caries. The starch-caries issue is a very complex problem, and much remains uncertain. More focused studies are needed. At present, it appears premature to consider or promote food starches in modern diets as safe for teeth. (+info)
Modern methods for assessing the cariogenic and erosive potential of foods.
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Assessment of the acidogenic and cariogenic erosive potential of foods requires the use of reproducible and standardised methods. The methodology laid down at the San Antonio conference in 1985 remain today the basis for research on and the testing of foods. The 1999 workshop has updated the appropriate methodology and introduced guidelines on the testing of erosive potential of foods. It is to be hoped that researchers wishing to evaluate foods and their effect on the teeth will continue to use these methods. (+info)
Intake of sweet foods and counts of cariogenic microorganisms in obese and normal-weight women.
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OBJECTIVE: To study the intake of sweet foods in obese and normal-weight women, while also taking menstrual cycle effects on eating behaviour into consideration. An objective test of the intake of sugar-containing foods was introduced by measuring salivary counts of mutans streptococci and lactobacilli. DESIGN: A cross-sectional comparison of the intake of sweet foods in obese and normal-weight women. The obese women were also studied longitudinally after 10 weeks in a weight reduction programme. SUBJECTS: Obese (n=72, body mass index (BMI) 42.0+/-5.2 kg/m2) and normal-weight women (n=67, BMI 22.2+/-1.6 kg/m2) participated. RESULTS: Mutans streptococci in saliva were higher in obese than in normal-weight women (P<0.0001), although the reported habitual daily intake of sweet foods did not differ. Of the menstruating women, 80% of the obese subjects and 62% of the normal-weight ones (P<0.05) reported periods during the menstrual cycle with an 'extra large' intake of sweet foods; these intakes were higher in obese than in normal-weight women (P<0.01). The obese women reduced their intake of sweet foods after 10 weeks of weight reduction, although these changes were not pronounced enough to significantly affect the counts of cariogenic microorganisms. CONCLUSIONS: In contrast to most previous cross-sectional studies, this study shows that obese women have a higher intake of sweet foods, especially pre-menstrually. This was indicated by higher salivary counts of cariogenic microorganisms. SPONSORSHIP: Karolinska Institute Research Funds. (+info)
A mixed-bacteria ecological approach to understanding the role of the oral bacteria in dental caries causation: an alternative to Streptococcus mutans and the specific-plaque hypothesis.
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For more than 100 years, investigators have tried to identify the bacteria responsible for dental caries formation and to determine whether their role is one of specificity. Frequent association of Lactobacillus acidophilus and Streptococcus mutans with caries activity gave credence to their being specific cariogens. However, dental caries occurrence in their absence, and the presence of other bacteria able to produce substantial amounts of acid from fermentable carbohydrate, provided arguments for non-specificity. In the 1940s, Stephan found that the mixed bacteria in dental plaque produced a rapid drop in pH following a sugar rinse and a slow pH return toward baseline. This response became a cornerstone of plaque and mixed-bacterial involvement in dental caries causation when Stephan showed that the pH decrease was inversely and clearly related to caries activity. Detailed examination of the pH (acid-base) metabolisms of oral pure cultures, dental plaque, and salivary sediment identified the main bacteria and metabolic processes responsible for the pH metabolism of dental plaque. It was discovered that this metabolism in different individuals, in plaque in different dentition locations within individuals, and in individuals of different levels of caries activity could be described in terms of a relatively small number of acid-base metabolic processes. This led to an overall bacterial metabolic vector concept for dental plaque, and helped unravel the bacterial involvement in the degradation of the carbohydrate and nitrogenous substrates that produce the acids and alkali that affect the pH and favor and inhibit dental caries production, respectively. A central role of oral arginolytic and non-arginolytic acidogens in the production of the Stephan pH curve was discovered. The non-arginolytics could produce only the pH fall part of this curve, whereas the arginolytics could produce both the fall and the rise. The net result of the latter was a less acidic Stephan pH curve. Both kinds of bacteria are numerous in dental plaque. By varying their ratios, we were easily able to produce Stephan pH curves indicative of different levels of caries activity. This and substantial related metabolic and microbial data indicated that it is the proportions and numbers of acid-base-producing bacteria that are at the core of dental caries activity. The elimination of S. mutans, as with a vaccine, was considered to have little chance of success in preventing dental caries in humans, since, in most cases, this would simply make more room for one or more of the many acidogens remaining. An understanding of mixed-bacterial metabolism, knowledge of how to manipulate and work with mixed bacteria, and the use of a bacterial metabolic vector approach as described in this article have led to (1) a more ecological focus for dealing with dental caries, and (2) new means of developing and evaluating anti-caries agents directed toward microbial mixtures that counter excess acid accumulation and tooth demineralization. (+info)
Do we need to be concerned about dental caries in the coming millennium?
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Dental caries continues to be a pubic health problem despite claims that 50% of schoolchildren are caries-free. There are widespread variations in the prevalence of caries worldwide. Caries lesions are the clinical manifestation of a pathogenic process that may have been occurring on the tooth surface for months or years. Acid production by bacteria embedded in a biofilm termed "dental plaque" is a key aspect of the pathogenesis of dental caries; nevertheless, the ability of micro-organisms to survive in a hostile acid milieu and the influence of fluoride and additional agents on this acid tolerance receive scant attention. Study of cariogenic micro-organisms largely has been limited to observations made on them in the planktonic state; clearly dental caries is essentially a surface phenomenon, and micro-organisms behave distinctively when grown on a surface. Although significant progress has been made in our understanding of the etiology, pathogenesis, and prevention of dental caries, it still remains a scientific and clinical enigma worthy of the attention of the best scientists. (+info)
Effect of a Brazilian regional basic diet on the prevalence of caries in rats.
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The aim of the present study was to determine the effect of a regional basic diet (RBD) on the prevalence of caries in the molar teeth of rats of both sexes aged 23 days. The animals were divided into six groups of 10 rats each receiving the following diets for 30 and 60 days after weaning: RBD, a cariogenic diet, and a commercial diet. The prevalence and penetration of caries in the molar teeth of the rats was then analyzed. The RBD produced caries in 37.5% of the teeth of animals fed 30 days, and in 83.4% of animals fed 60 days, while the cariogenic diet produced caries in 72.5% and 77.5% of the teeth of animals fed 30 and 60 days, respectively. Rats fed the RBD for 30 days had caries in the enamel in 38% of their teeth, 48% had superficial dentin caries, and 7.5% moderate dentin caries. The effect of the RBD did not differ significantly from that of the cariogenic diet in terms of the presence of caries in rats fed 60 days. The penetration depth of the caries produced by the RBD was the same as that produced by the cariogenic diet. Our results show that the RBD has the same cariogenic potential as the cariogenic diet. Since the RBD is the only option for the low-income population, there should be a study of how to compensate for the cariogenicity of this diet. (+info)
Genome sequence of Streptococcus mutans UA159, a cariogenic dental pathogen.
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Streptococcus mutans is the leading cause of dental caries (tooth decay) worldwide and is considered to be the most cariogenic of all of the oral streptococci. The genome of S. mutans UA159, a serotype c strain, has been completely sequenced and is composed of 2,030,936 base pairs. It contains 1,963 ORFs, 63% of which have been assigned putative functions. The genome analysis provides further insight into how S. mutans has adapted to surviving the oral environment through resource acquisition, defense against host factors, and use of gene products that maintain its niche against microbial competitors. S. mutans metabolizes a wide variety of carbohydrates via nonoxidative pathways, and all of these pathways have been identified, along with the associated transport systems whose genes account for almost 15% of the genome. Virulence genes associated with extracellular adherent glucan production, adhesins, acid tolerance, proteases, and putative hemolysins have been identified. Strain UA159 is naturally competent and contains all of the genes essential for competence and quorum sensing. Mobile genetic elements in the form of IS elements and transposons are prominent in the genome and include a previously uncharacterized conjugative transposon and a composite transposon containing genes for the synthesis of antibiotics of the gramicidin/bacitracin family; however, no bacteriophage genomes are present. (+info)
Composition of dental plaque formed in the presence of sucrose and after its interruption.
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Since dental plaque reservoirs of fluoride (F), calcium (Ca) and inorganic phosphorus (Pi) are susceptible to decreases in pH, this in situ crossover study was conducted to test the hypothesis that the low concentration of these ions in plaque, formed in the presence of sucrose, could be attributed merely to the fermentation of this sugar. Eleven volunteers wore palatal appliances containing 6 human enamel blocks during two stages. In each stage, the treatments were either 20% sucrose solution or distilled deionized water, which were dripped onto the blocks 8 times a day. After 28 days, in each stage, the dental plaque formed on two blocks was collected, the treatment was inverted and after a further 24 and 48 h, the biofilm formed was collected from the other blocks. The concentration of acid-soluble F, Ca and Pi, and the concentration of insoluble polysaccharide (IP) were determined in the dental plaque. Statistically lower concentrations of F, Ca and Pi, and a higher concentration of IP were found in the 28-day biofilm formed in the presence of sucrose than in its absence; after the treatment inversion the change in F, Ca and Pi was not statistically significant, but the IP concentration changed significantly. The hypothesis was rejected because change in concentration of F, Ca and Pi is not due to fermentation of the sucrose. (+info)