While the incidence of caries has declined significantly in the UK since the 1970s, periodontal disease still causes concern. It is the principal cause of tooth loss in adults, especially those over 35 years old. The incidence of caries is determined by many factors. It is thought that plaque starts with the formation of a protein coating which adheres to the clean surface of the enamel. These bacteria ferment dietary carbohydrate, especially sucrose, producing organic acids, such as lactic acid, which lowers pH and demineralises the enamel.
Caries is the result.
Plaque does not form equally on all dental surfaces. Plaque, as well as being the site of bacterial fermentation, also prevents saliva washing and buffering the area, both actions which reduce caries formation. Demineralisation of the enamel leads to exposure of the softer dentine to acid attack. This acid both erodes the dentine and eventually reaches the pulp. Patients with toothache Most patients presenting with dental problems caused by caries use the word 'toothache'.