Is dental caries really a disease of choice?
Every dental professional at one time or another (if we are being honest) has silently judged a patient that has cavities. We think that If only they would listen to me they wouldn’t be here.
I admit it is a seductive approach to believe that if our patients brushed and flossed every day and ate a healthy diet, they wouldn’t have dental problems. It’s not rocket science after all.
The problem with this way of thinking is first, it makes us less effective at building a relationship with them (nobody likes a judge-Judy) and second (and the real issue here) is that dental caries isn’t that simple.
We know it is a complex biofilm disease, and by and large, an effective diet and consistent home care should result in health for most patients. However, in my opinion, one of the most significant papers published this year on dental caries was a review on the genetic characteristics of the disease.1 The authors reviewed all of the genetic studies published in recent years that have found a correlation between a specific gene and dental caries risk. We now have the computer capability to take data from 1,000 patients and examine 500,000 gene sites and look for correlations. The significant finding in this paper is that there are now 27 different genes that have been identified as having an association with dental caries. Some of the genes are obvious and play a role in enamel development, while others influence bacteriolytic enzymes in the saliva. Still other genes influence taste and preferences. Then there were the less obvious genes, ones that play a role in white blood cells and matrix metalloproteinases. All told, the authors present a complex genetic picture of dental caries. And these are just the early studies. More discoveries are certain to follow.
At a recent meeting I had the opportunity discuss this paper with a researcher who believes upward of 40% of dental caries can be explained by genetics alone. At this point, I think we all accept the that genetics plays a role in periodontal disease. I’m comfortable with that research. We also know bacteria, diet, home care, and saliva play known roles in dental caries risk. We have established disease indicators and risk factors. Now we have information to suggest that genetics plays a major roll. What this means for me is that dental caries is not a disease of choice for many, if not most patients. There is more going on here.
We need to think differently and stop allowing ourselves to blame our patients, I know I am.
Vieira AR, Modesto A, Marazita ML. Caries: review of human genetics research. Caries Res. 2014;48(5):491-506