Dental caries, more widely known as tooth decay, is the most prevalent disease in man. It is currently the main reason for tooth loss. Essentially, it involves the breakdown of teeth due to bacterial activity (from simple sugars that we eat in our food), and if not controlled – will continue to develop and progress for a patient’s entire life.
Despite this, dental caries is easily controllable. Such methods include cleaning your teeth regularly with toothpaste containing fluoride, and eating a diet low in sugar. Even with these simple control measures, few people understand the true implications of tooth decay, and what we can do to stop it. With this in mind, we spoke with the authors of Essentials of Dental Caries, Edwina Kidd and Ole Fejerskov, to get to the root of the issue. They filled us in on what can be done to tackle the disease, how they got into dentistry – and why people are still so scared of going to the dentist!
Let’s start at the very beginning, what exactly is dental caries?
Edwina and Ole – Teeth are covered by a ‘biofilm’ which is a community of microorganisms. These live in our mouths and the film forms constantly. We disturb it when we brush our teeth. When we eat sugar, these microorganisms eat the sugar and make acid. It is this acid that can, in time, make holes in our teeth. However this does not have to happen, it can be controlled by tooth brushing and sensible diet.
What made you become a dentist?
Edwina – I was influenced by my mother, a hygienist in the 1930s. Her job was to go into very poor houses in the East End of London to educate people about tooth brushing, often in homes where the tap was floors away, and there was no money for brushes or toothpaste. My school friends said I should be a teacher, and what happened? I taught dentistry!
Ole – I became a dentist by mere chance!
Why are you so passionate about teaching dentistry?
Edwina – Teaching is such a privilege, the chance to educate and inspire. I passionately believe in disease control (i.e. preventing tooth decay) and the chance to teach that within the discipline of restorative dentistry was a challenge. The important factor is not the restoration but the caries control treatment to prevent the problem recurring. As a child I loved drama and lecturing is pure theatre, or it should be! To do this is tremendous, self-indulgent, fun. Similarly, to write simply and to hold the reader’s attention is a challenge. I was paid a lot of money to enjoy myself. Having said this, what has been achieved in the UK? Not enough! Dentists in some parts of UK are still not paid to prevent disease; they are paid to ‘treat’ it by placing fillings. The treatment of caries is the simple control measures. Fillings are a part of plaque control, because they mend a hole in a tooth so it can be cleaned again.
So, if you had limitless money and resources, how would you solve tooth decay?
Edwina and Ole – Our solution does not involve more money, but a redistribution of what is available. Dental caries is controllable by relatively simple means – all publicly available and comprehensible. The structure of the dental profession needs to change, so that there is more of a focus on public health and prevention, as opposed to fillings which in a way close the stable door after the horse has bolted. Caries control is not about expensive restorative dentistry, but about personal oral hygiene, sugar restrictions in diet, changing social deprivation, and reaching the community.
Do you think there is currently enough being done to tackle the issue, and how far should the state be involved?
Edina and Ole – Governments should certainly be involved in the personal health of the people. Many diseases are controllable by public health measures, and these measures should aim to make healthy choices the easy choices. A good example is banning smoking in public places. Even more fundamental than this, are policies to produce clean water. Does taxing a harmful product, such as sugar (e.g. George Osborne’s recent sugar tax) and tobacco, have a useful effect? We are unsure, but it displays an awareness of a problem, in turn, raising awareness amongst the population.
Finally, why do you think people are still so scared of going to the dentist?
Edwina – The mouth is a very intimate and sensitive area. Those who first meet a dentist when they have disease / pain may have an unpleasant experience that will put them off. The time to meet dental personnel is when you are healthy and happy, to be taught how to maintain health.
I cared for many nervous patients, but they told me they began to look forward to visits. I listened a lot and we talked about how to achieve their wish for healthy, pretty, teeth. It is important to realize this is time consuming and worthy of payment. If operating, I could give a totally painless local anaesthetic, and use of a rubber sheet (called a rubber dam) separated their mouth from me. This worked so well that patients often fell asleep – a bit of a nuisance as their mouths closed!
Ole – Children irrespective of age should be cared for and learn the importance of looking after their teeth – thus preventing decay. If this is done properly, and from a young age, people can avoid dental pain and traumatic experiences with dentists such as drilling, and much worse, general anaesthesia.
Featured Image Credit: ‘Toy, Mouth, Teeth’ by bebeplace, CC0 Public Domain, via Pixabay.