Strategies for prevention and control of caries based on plaque ecology hypothesis

Strategies for prevention and control of caries based on plaque ecology hypothesis
According to the plaque ecology hypothesis, low pH (less than 5) will promote overgrowth of aciduric microorganisms, such as the cariogenic mutans streptococci and lactobacilli, at the expense of less acid-tolerant plaque microorganisms, such as S oralis, which are associated with healthy tooth surfaces. 
Therefore the treatment strategy would be to increase plaque pH and thereby promote reestablishment of the harmless normal microflora of the tooth surfaces.
Increased pH can successfully be achieved by a combination of the following preventive measures:
1. Frequent mechanical removal of the plaque from all tooth surfaces: “Clean teeth never decay,” and frequent removal of plaque (once or twice a day) limits the thickness of reaccumulated plaque, ensuring that saliva has accessibility for diluting and buffering the acid that is formed.
2. Reduction of sugar clearance time by reducing the intake of sticky sugar-containing products.
3. Use of sugarless chewing gums containing fluoride and chlorhexidine as a “dessert” for 15 to 20 minutes directly after every meal (including between-meal snacks).
Use of this kind of gum has several beneficial effects:
1. Salivary flow is increased and the acid formed during the meal is diluted and buffered.
2. Fluoride will reduce acid formation by the acidogenic microorganisms at low pH.
3. Chlorhexidine has not only a nonspecific antiplaque effect but also a specific effect on mutans streptococci and acid formation by acidogenic microorganisms.
4. Fluoride ions and minerals from the increased salivary flow will accelerate remineralization directly after the acid attack during the meal.
This recommendation is very important for caries-susceptible patients, particularly those with xerostomia (for reviews on plaque ecology related to caries etiology, see Bowden, 1997; Bowden and Edwardsson, 1994; Marsh, 1993.)
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OK allow me to play Devil’s advocate for a mintue.Take a close look at the two close ups and magnified photos I sent you and tell me if there is a whitish line around the tooth. In today’s day and age, it is quite easy to fake something.I guess we would never know………..:-)

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Articles for theme “caries”:
Effect of plaque ecologyOwing to differences in local environmental conditions, the microflora of mucosal surfaces differs in composition from that of dental plaque. Similarly, the plaque microflora varies in composition at distinct anatomic sites on the tooth ¾ for example, in fissures, on approximal surfaces, and in the gingival crevice. The resident microflora of a site acts as part of the host defenses by preventing colonization by exogenous (and often pathogenic) microorganisms.
Colonization of microenvironmentsThe oral cavity consists of several major and minor compartments, each constituting a separate microenvironment not easily affected by major events in the oral cavity. Examples of major compartments are the tongue, the oral mucosa, and the tonsils. The different approximal tooth surfaces, occlusal fissures, and gingival sulci are regarded as minor compartments. A specific area that supports a bacterial flora is termed a habitat. The flora of a habitat develops through a series of stages, collectively called colonization.
Role of the Oral EnvironmentIntroductionIn certain aspects, the oral cavity may be regarded as a single microbial ecosystem. A major regulatory factor is the flow rate of saliva, which decreases to almost 0.0 mL/min during sleep, is approximately 0.4 mL/min at rest, and increases to 2.0 mL/min after stimulation. Although saliva is not a good medium for supporting the growth of many bacteria, 1.0 mL of whole saliva may contain more than 200 million microorganisms, representing more than 300 different species.
Rate of accumulation (Plaque Formation Rate Index)The quantity of plaque that forms on clean tooth surfaces during a given time represents the net result of interactions among etiologic factors, many internal and external risk indicators and risk factors, and protective factors:· The total oral bacterial population· The quality of the oral bacterial flora· The anatomy and surface morphology of the dentition· The wettability and surface tension of the tooth surfaces· The salivary secretion rate and other properties of saliva· The intake of fermentable carbohydrates· The mobility of the tongue and lips· The exposure to chewing forces and abrasion from foods· The eruption stage of the teeth· The degree of gingival inflammation and volume of gingival exudate· The individual oral hygiene habits· The use of fluorides and other preventive products, such as chemical plaque control agents This observation has been the rationale for the development of the Plaque Formation Rate Index (PFRI) by Axelsson (1989, 1991).
Measurement of plaqueAmount of accumulationSeveral indices for recording supragingival plaque have been developed. The two most frequently used are the Plaque Index (PI), developed by Silness and Loe (1964), and O’Leary’s Plaque Index (O’Leary et al, 1972).The Silness and Loe Plaque Index has a four-point scale:· Score 0 = The tooth surface is clean.· Score 1 = The tooth surface appears clean, but dental plaque can be removed from the gingival third with a sharp explorer.