Dental caries is one of the most common diseases. Almost every adult resident of our country is familiar with him firsthand. Scientists have made many attempts to understand the causes of this phenomenon. After all, knowing the mechanism of development, you can find the ideal way to treat. The main mistake of each of the researchers was that they were looking for a single reason, but there were several of them. The modern concept is a combination of several previously proposed theories, modified and supplemented.
Chemical degradation and bacteria: Miller's theory
This scientist was one of the first to offer a clear explanation of the causes of the carious process. In his opinion, the primary is the chemical destruction of enamel in the acidic environment of the oral cavity. This is logical, because enamel consists of 96% calcium salts, which are easily dissolved under the action of acids. But the destruction of the deeper-lying dentin occurs already under the action of enzymes secreted by bacteria, because 30% of dentin is formed by complex protein molecules that cannot be taken in an ordinary acidic environment. Later it turned out that bacteria are also involved in the first phase of the carious process - this was, perhaps, Miller's only mistake.
Entin's semipermeable membrane theory
This author considered the hard tissues of the tooth as a semi-permeable membrane through which there is a constant flow of liquid with calcium salts and other components of hard tissues dissolved in it. Its centrifugal direction (from pulp to enamel) ensures normal nutrition of hard tissues, centripetal - leaching of salts and useful components, which leads to tooth destruction. Later it turned out that such processes do take place, but without additional local factors, such as the acidic environment of the oral cavity and cariogenic microorganisms, they do not lead to the development of caries.
Caries is the result of malnutrition of cells: Lukomsky's theory
The essence of this concept is that the integrity of dentin and enamel is ensured by the function of tooth cells - odontoblasts, whose bodies are located in the outer layer of the pulp, and the processes reach the level of enamel. In case of malnutrition, hormonal failures, lack of calcium or vitamin D, the function of these cells is disrupted, which leads to the destruction of enamel. Currently, scientists recognize the correctness of this theory, with the only difference that the dysfunction of odontoblasts is not a cause, but a predisposing factor that makes the development of caries more likely.
Charpinac's theory of destruction of the protein matrix
Sharpenak suggested that the primary link in the development of the carious process is the destruction or insufficient resynthesis of the protein matrix of the hard tissues of the tooth. Protein production is disrupted with insufficient intake of amino acids lysine and arginine, as well as B vitamins, and destruction is accelerated by elevated air temperature, pregnancy, and severe somatic diseases. However, subsequently, scientists were able to establish the absence of changes in the protein matrix during caries in the stain stage. Thus, the violation of hard tissue proteins cannot be primary, but plays a significant role in the progression of the process.
Rybakov's modern working concept
Each of the theories described above has strengths and weaknesses, advantages and disadvantages, true and erroneous postulates. Therefore, at present, caries is usually considered as a polyetiological, that is, having many causes, a disease. Factors contributing to the destruction of hard tissues of the tooth are divided into general and local. The first ones include:
- qualitative composition of the diet;
- hereditary predisposition;
- severe somatic diseases;
- hormonal disorders.
Local factors in the formation of a carious cavity are:
- diet (duration of contact of tooth enamel with acidic or carbohydrate-containing food);
- dental plaque and plaque;
- cariogenic microorganisms;
- crowding of teeth;
- change in the quantity or qualitative composition of saliva;
- defective structure of tooth tissues.
The influence of these factors is summed up, and when the resulting effect exceeds a certain threshold level, the destruction of the enamel begins.
