Birth of caries

Bacterial infections of teeth and gums (gingiva) begin early in life and continue to progress throughout life with the possibility of tooth loss. Mutan streptococci (MS) are transmitted by the mother to the child between 19 and 28 months of age.


The bacteria forms a biofilm, called plaque, which adheres to tooth surfaces and increases in amount unless disrupted daily. The film is made up of bacteria that can ferment sugars and other carbohydrates producing lactic acids. Continued production of acid can lead to demineralization of the enamel. If preventive interventions are not in place or initiated early and daily, a cavity will result. Therefore many preventive recommendations attempt to disrupt the process of demineralization, neutralize the acid attack and remineralize the early lesions.

Bacteria can live in your mouth in the form of plaque, causing cavities and gingivitis, which lead to periodontal (gum) disease. Tooth decay also known as caries or cavities, is an oral disease that affects many people. Unlike other diseases, however, caries is not life-threatening and is highly preventable.

What is plaque?

Natural bacteria live in your mouth and form plaque. Plaque is a sticky layer of material containing bacteria that accumulates on teeth. The plaque interacts with food deposits left on your teeth and produces acids. These acids damage tooth enamel over time by dissolving, or demineralizing enamel, which weakens the teeth and leads to tooth decay.

Many of the foods you eat cause the bacteria in your mouth to produce acids.

Sugary foodsare obvious sources of plaque. These are soft drinks, candy, ice cream, milk and cake, and even some fruits, vegetables, and juices, may contribute to tooth decay.

Starches—such as bread, crackers, and cereal—also cause acids to form.

Plaque also produces substances that irritate the gums, making them red, sensitive, and susceptible to bleeding. This can lead to gum disease, in which gums pull away from the teeth and form pockets that fill with bacteria and pus. If the gums are not treated, the bone around the teeth can be destroyed and teeth may become loose or have to be removed.

Remove plaque

The best way to remove plaque is by brushing and cleaning between your teeth every day. Brushing removes plaque from the tooth surfaces. Brush your teeth twice per day with a soft-bristled brush. The size and shape of your toothbrush should fit your mouth and allow you to reach all areas easily. Use an anti- microbial toothpaste containing fluoride, which helps protect your teeth from decay. Clean between the teeth once a day with floss or inter-dental cleaners to remove plaque from between the teeth, where the toothbrush can't reach. Flossing is essential to prevent gum disease.

In pediatric patients cavitation can begin as soon as teeth erupt (5-6 months of age) and increases in intensity especially in at-risk and vulnerable children. If allowed to continue, severe destruction of teeth can occur. Early childhood caries (ECC) is the presence of one or more decayed, missing or filled tooth surface in any primary tooth in a child 71 months of age or younger. ECC is associated with feeding practices that include prolonged use of the bottle during the day and night with carbohydrate containing liquids.

Not all children with habitual and prolonged use of the bottle are susceptible to this type of caries infection. Other risk factors have been identified and include tooth enamel abnormalities, altered saliva production and composition, defects in immune defense mechanisms, insufficient or inappropriate exposure to fluoride, absence of daily oral hygiene, lack of professional dental intervention, frequent liquid medications, and finally a number of social, educational, and cultural factors.

Little data is available on the prevalence of caries in young children in India. Over 40% of five year olds had decay in their primary teeth and by age nine the percent with decay was almost 60%, again demonstrating the progress of decay over time.

Other Infections

Decay that is not treated will progress through the enamel and into the dentin, the layer of tooth with sensory innervations. Complaints of sensitivity and discomfort will follow. Without intervention the disease process will progress through the dentin and into the pulp of the tooth. Discomfort and pain will increase. Pulpitis is a bacterial infection in the pulp, and in early stages, can be treated and the tooth restored. If allowed to continue, the infection can progress out of the tooth into the surrounding bone. It can further progress with the development of an intra or extra-oral fistula that allows for drainage of pus into the oral cavity.

If the infection spreads to the surrounding facial tissues, a cellulitis can result with swelling and inflammation. The sites can be on the neck or on the face. Cellulitis requires immediate intervention to prevent serious progression. Treatment involves removal of teeth, antibiotics and may require incision and drainage.

While water fluoridation, the use of fluoride products, dietary modification including sugar restriction, improved oral hygiene, and regular professional care have led to dramatic reductions in dental caries.