Oony_oon t1_jeekrcu wrote on March 31, 2023 at 1:24 PM

Reply to comment by Oony_oon in How does toothpaste fluoride make teeth stronger topically? by Gilem_Meklos

Featherstone, J. D. B. (2008). "Dental caries: A dynamic disease process". Australian Dental Journal. 53 (3): 286–291. doi:10.1111/j.1834-7819.2008.00064.x

https://onlinelibrary.wiley.com/doi/10.1111/j.1834-7819.2008.00064.x

I'm also a dentist, and did my training at a dental school where the research behind remineralisation and the dental caries process was heavily promoted and taught

Shark-Whisperer t1_jef5yah wrote on March 31, 2023 at 3:49 PM

That's a great review with clear photomicrographs and schematics. Enjoyed reading it. There are updated reviews available via Pubmed, too, for those that want the newest in-depth information--just search "dental caries pathophysiology" and screen for free full text.

Some examples are: https://pubmed.ncbi.nlm.nih.gov/35129809/ and https://pubmed.ncbi.nlm.nih.gov/35129809/

It is interesting that osteoporosis and dental caries have overlapping mechanisms, and together represent "the most prevalent chronic disease in the world" (per the first paper cited above). Osteoporosis affects approx 10% of the global populace and dental caries affect 100%...

Oony_oon t1_jefcmjc wrote on March 31, 2023 at 4:32 PM

It's a bit of a stretch for this article to say dental caries has a prevalence of 100% of people. (Somewhat technically correct, but really stretching it and trying to make a dramatic effect)

For it to be called dental caries, there has to be a bacteriological element to it. Meaning the demineralisation is due to acid-producing plaque bacteria.

Yes, if you were to hypothetically extract ALL the teeth of a random sample of people and examine every surface of those teeth, you'll find that everyone will likely have a spot on a tooth somewhere that has lost some mineral, even if it's a tiny, minuscule area. So what?

It's certainly near 100%, but I'd disagree with the idea that absolutely everyone has active decay in their mouth and is suffering the effects of it. As long as you're alive and eating food, there will be *some* demineralisation of teeth, but in most cases the minerals reconstitute back into the tooth shortly after. There's always a constant cycle of demineralisation and remineralisation every day, and it's not always due to bacteria. A lot of fruits have a pH below the critical pH for demineralisation.

Sure, at some point in anyone's life, the demineralisation can outstrip remineralisation and there is a net loss of mineral from a certain tooth surface. For the demineralisation to be clinically significant (i.e. detectable by visual or radiographic means), it takes months or years to develop. And if it's an early stage, shallow lesion, there's still a good chance for it to remineralise completely if the causative factors are addressed.

Bones are also in a constant state of resorption and deposition. When someone's bone density goes below a certain threshold (T score -2.5), suffered a pathological fracture, or has a combination of factors that puts them at high risk of pathological fracture, only then can it be called osteoporosis.

Whereas someone can technically be diagnosed with dental caries the moment a small spot of demineralisation is detected, regardless of where it is in the continuum of the demineralisation-remineralisation dynamic.

If the diagnostic criteria for osteoporosis were changed to "detection of any resorptive loss of bone mineral in any bone in the body", you could then technically say that 100% of people have osteoporosis too.