The success of fluoridated toothpaste in preventing dental caries has resulted in a change in professional approaches to prevention. Instead of focusing simply on attempts to reverse the main causative factors, attention is now centered on exploiting protective influences. The interaction of the three main causative factors is illustrated in Figure 1. Numerous attempts to change the impact of any of these influences on caries have proved ineffective, except, perhaps, under the most extreme situations, such as during war time.
In contrast, exploiting the protective potentials of fluoride, tooth brushing, and salivary stimulation have proved successful. Figure 2 illustrates the roles of these factors in comparison with the
Window of risk
Figure 2 A new model to explain and guide caries prevention. The local factors - insufficient use of fluorides, insufficient oral hygiene, and protection from saliva - form a 'window of risk' through which the circle of cariogenic food (shown dashed) can be seen in the background. (A) In this example it is clear that it would be impossible to reduce the food circle to such an extent that the window is not completely filled (less caries risk). (B) If oral hygiene and, concomitantly, fluoride supply are neglected (large window of risk), a reduction in the burden of cariogenic food could reduce the caries risk. Reproduced with permission from van Loveren CM and Duggal MS (2001) The role of diet in caries prevention. International Dental Journal 51: 399-406.
pervasive challenge of diet. Where a tooth site is shielded from saliva (stagnation site) and oral hygiene and the availability of fluoride are insufficient it is likely that a dietary modification of sufficient magnitude could exert some influence on the final outcome. But where these protective factors are adequate it is highly unlikely that dietary variations will exert any material effect. These predictions are borne out by epidemiological observations. In most developed countries, where fluoride use is adequate, wide variations in dietary exposure to fermentable carbohydrates between individuals are not accompanied by predictable differences in caries experience.
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