Cause of dental caries
It is important to understand the cause of dental caries in order to understand how silver diamine fluoride works.
This figure highlights the exponential impact of sugar and other processed carbohydrates on the development of dental caries.
In addition to the total quantity of sugar and carbohydrates consumed, stickiness of food (such as chewy candy), frequency of consumption, and length of time in the mouth all contribute to higher cavity risk.
Sugar and overprocessed carbohydrates cause cavities. Counsel on:
- stickiness
- frequency
- duration
The Smiles for Life child oral health module section on cavity prevention provides detailed information on patient education about caries prevention. The overall important message is to reduce sugar intake.
Sugar + time on teeth = caries
Groupings by oral flora
- Dysbiosis is an imbalance in a person's oral flora (biome), shifting toward cariogenic (cavity-causing) bacteria. This shift creates sensitivity to sugar.
- Dysbiosis can be partially reversed with SDF and other antimicrobials (Povidone iodine, Arginine, Xylitol, etc.)
Figure 2 highlights the impact of sugar on the pH of the mouth.
Whether or not a patient reaches a sufficiently acidic pH to dissolve tooth enamel and cause dental caries is variable. An oral biome shifted more towards cariogenic flora is more sensitive to sugar intake.
Antimicrobials, including silver diamine fluoride, help reverse this dysbiosis and shift the oral microbiome back toward health, decreasing the risk for the development of future cavities.
While the SDF works on the microbiome and the hypersensitivity to sugar, decreasing sugar intake is also very important.
References:
Sheiham A, James WP. A reappraisal of the quantitative relationship between sugar intake and dental caries: the need for new criteria for developing goals for sugar intake. BMC Public Health. 2014 Sep 16;14:863. https://doi: 10.1186/1471-2458-14-863. PMID: 25228012; PMCID: PMC4168053.
Stephan RM. Intra-Oral Hydrogen-Ion Concentrations Associated With Dental Caries Activity. Journal of Dental Research. 1944;23(4):257-266. https://doi:10.1177/00220345440230040401