2.3 Impact Factors and Hazard of Dental Caries 

1.Factors known to influence dental caries

Reference material

• Saliva

  Although saliva was identified in the etiology section earlier as part of the host component and thus a primary part of the caries process, the role of saliva overall is unique. Any patient with a salivary deficiency, from any cause, is at a higher risk for caries activity. It is generally accepted that the dental caries process is controlled to a large extent by a natural protective mechanism inherent within the saliva. Many properties of saliva have been investigated for their possible role in the caries process.

• Socioeconomic status

  The Surgeon General’s report of 2010 notes that children and adolescents living in poverty suffer twice as much tooth decay as their more affluent peers, and that their disease is more likely to go untreated. A Census Bureau report published in March 2003 showed that the poverty rate for children in the United States rose in 2002, whereas it dropped for people 65 years and older. Nearly half of the 35 million people living in poverty were children.

• Anatomic characteristics of the teeth

  Because enamel calcification is incomplete at the time of eruption of the teeth and an additional period of about 2 years is required for the calcification process to be completed by exposure to saliva, the teeth are especially susceptible to caries formation during the first 2 years after eruption.

• Arrangement of the teeth in the arch

  Crowded and irregular teeth are not readily cleansed during the natural masticatory process. It is likewise difficult for the patient to clean the mouth properly with a toothbrush and floss if the teeth are crowded or overlapped. This condition therefore may contribute to the problem of dental caries.

• Presence of the dental appliances and restorations

  Space maintainers and orthodontic appliances often encourage the retention of food debris and plaque material and have been shown to result in an increase in the bacterial population. Dentists have known for many years that the tooth structure at the interface with restorative material is especially vulnerable to recurrent caries. Clinical studies suggest that dentists and their patients should not expect successful restorative treatment to reduce a patient’s risk for future development of caries lesions.

• Hereditary factors

  Although parents of children with excessive or rampant caries tend to blame the condition on hereditary factors or tendencies, and some scientific evidence acknowledges certain genetic influences on the caries process, most authors agree that genetic influences on dental caries are relatively minor in comparison with the overall effect of environmental factors.

2. Hazard of dental caries in children

Key points：

Topical hazard

• Masticatory function

• Anomaly of tooth eruption

• Dysplasia in permanent teeth

• Malocclusion

• Injury at oral mucosa

• Affect facial development
  

Systemic hazard

• Influence general development

• Impact on general immunity

• Focal infection

• Physical and mental development