LOADING

Type to search

Restorative Dentistry

Opening the Conversation: Is Dental Caries an Infectious Disease?

This question is a conversation opener on the nature of the caries process

CariesDentists agree that demineralization of tooth surfaces from bacterial acid production is the direct cause of caries. However, the concept of dental caries as an infectious disease is less clear: dental caries are caused by bacteria that are resident flora in the oral cavity, not by an infection of a specific, foreign microorganism—the classical notion of an infectious disease. If the infection is caused by bacteria that originate from the host, can tooth decay be considered an infectious disease and why does it matter?

Many dentists were taken aback in 2011 when a United Nations High-level Meeting on Non-communicable Diseases made a political declaration grouping oral disease with other non-communicable diseases that share common risk factors. Similarly, an FDI policy statement on non-communicable diseases proposes incorporating oral health strategies in the non-communicable disease agenda.

Other professional health organizations treat tooth decay as an infectious disease and suggest behaviours to minimize transmission. For example, in a special report by the Ontario Dental Association, “Tooth Decay in Ontario’s Children: an Ounce of Prevention – A Pound of Cure,” one of the parental responsibilities is to treat tooth decay “as the infectious disease that it is.” Accordingly, tips to parents include not putting anything in your child’s mouth, if it has been in your mouth, and not sharing spoons, cups, food, toothbrushes, etc. Similarly, a Canadian Paediatric Society Position Statement, “Oral health care for children – a call for action,” suggests an oral health promotion strategy of “modifying the caregiver’s dental flora prior to infant colonization.”

Share your thoughts—should dental caries be treated as an infectious disease?

Reference

Ruby J, Barbeau J. The buccale puzzle: The symbiotic nature of endogenous infections of the oral cavity. Can J Infect Dis. 2002;13(1):34-41

 

23 Comments

  1. Louise Desnoyers August 27, 2013

    Upon my humble opinion, caries are caused by microbial organisms, but an opportunist way, wich for means that unless it finds all the condition to grow and developp acid, they will not cause enamel dissolution. In other term this statement ”caries is an infectious disease” is not completly right to say because without all the appropriate conditions and environment, the bacterias will not cause decay.

    Reply
    1. Alex Galo August 28, 2013

      I completely agree with you. None of us is born with bacteria in our mouths. We get them from our parents initially (strep mutans, etc.) through kissing, etc. However, the mere presence of bacteria doesn’t cause decay. We all have billions of bacteria in our mouths. It’s the combination of simple sugars and lack of hygiene. Therefore, let’s concentrate on stressing good oral hygiene and low sugar diets rather than not sharing spoons and not kissing our children for God’s sake. And ban gummy bear vitamins!

      Reply
    2. Juan Giuseppe February 3, 2016

      Excelent Desnoyers!

      Reply
  2. Louise Desnoyers August 27, 2013

    It is a MULTIFACTORIAL diseases, we must not forget that.

    Reply
    1. Dr Arun November 15, 2015

      Rightly said dental caries is multi-factored ranging specific time, type of microbes, amount of carbohydrates and also salivary flow rate.

      Reply
  3. Stephen Abrams August 27, 2013

    As one of the organizers and chair of the ODA /IADR Symposium in 2008, I was very pleased to see the ODA adopt the statement that dental caries is an infectious disease. This statement is based upon the outcome of the National Institute of Health 2001 Consensus Conference on Caries. They provided the definition that is accepted worldwide by cariology researchers. The definition is: “Dental caries is an infectious, communicable disease resulting in destruction of tooth structure by acid-forming bacteria found in dental plaque, an intraoral biofilm, in the presence of sugar.” This statement has now become the basis for not only providing care but constructing dental programs to deal with this disease. Lots more to say but look forward to seeing the comments on this thread.

    Reply
    1. Euan Swan September 6, 2013

      Ten years after the National Institute of Health 2001 Consensus Conference on Caries, the UN, WHO and FDI have taken the position that dental caries is a non-communicable disease. What happened in the intervening 10 years?

      Reply
  4. Carlos Quiñonez August 28, 2013

    This is a tough question! And I have no clear answer. Yet from my perspective, I do not think caries is infectious/transmissible. One of the causal agents, namely the ‘necessary cause,’ bacteria, are transmissible, but I’m not sure the disease is per se. As mentioned, the disease is multifactorial, and requires other ‘sufficient causes’ to result in caries. Maybe I’m splitting hairs, but I think it is important, inasmuch as recognizing that caries is likely both acute and chronic in nature.

    Reply
    1. Euan Swan September 6, 2013

      From Wikipedia. an acute disease is a disease with a rapid onset and/or a short course. Is the onset of tooth decay rapid enough to be considered acute?

      Reply
  5. Elaine August 28, 2013

    Cariogenic bacteria are transmissible and are necessary for dental caries to occur. Therefore dental caries is indeed a transmissible disease regardless of the necessity for other factors (host susceptibility and diet) to be present.

    Reply
    1. Euan Swan September 6, 2013

      Given that cariogenic bacteria are present in essentially all bioflims, could it be that the notion of “transmission” could also be interpreted as “reaching detectable limits” ; that is the cariogenic bacteria were there all along and reached detectable limits following ecological disturbances that resulted in the overgrowth of acidogenic / aciduric bacteria?

      Reply
  6. DR leonard b smith August 28, 2013

    I believe that dental caries ,caused by both aerobic and anaerobic bacteria ,is an infectious disease. It has been stated in a CDC document that ECC is the most chronic infectious disease in children between two and five years of age in the USA !
    There are case reports of children developing brain abscess secondary to a dental abscess resulting in serious morbidity issues and sadly mortality issues!

    Reply
  7. Norman Campbell August 31, 2013

    The infectious nature is an almost universal infection amongst humans. I would like to know what percentage of humans do not carry these caries creating organisms.

    The other factor at play here is political. It would seem that infectious diseases get better political support internationally. So there seems to be considerable pressure to keep it infectious. The problem is that reducing caries from that direction I do not see as possible. Pretending that we can keep someone uninfected for any significant period of time is silly. How do we uninfect someone?

    The real problem is that dental caries is a nutritional problem. Other solutions are temporary. Brushing in the absense of a fluoridated toothpaste is not effective against caries. Fluoride has a very finite window of control over caries and we in Canada have allowed diet to slide downward beyond fluoride’s ability to control it.

    With proper diet the infection is meaningless.

    Good to hear from you Steven

    Reply
    1. alex galo September 3, 2013

      I completely agree with everything you say except “brushing in the absence of a fluoridated toothpaste is not effective against caries”. Are you saying that a person that brushes their teeth and flosses three times a day with, say, Tom’s of Maine non fluoridated toothpaste is bound to get caries? I personally don’t think so. In the grand scheme of things proper brushing with any toothpaste is effective regardless if it contains fluoride or not.

      Reply
    2. Paul Dirkes September 4, 2013

      People who do not carry any of the acdiogenic bacteria are not healthy. It is a matter of balance of the micro flora, salivary flow and constituents of the salvia, availability of remineralizing ions to the tooth and the quality of the hydroxyapitite of the individual. Caries is the result of an deviation from the healthy micrological balance. A component of caries is infectious and tinfection is only part of the story.

      Reply
  8. Marielle Pariseau September 4, 2013

    This conversation is of most interest to me as I am in the second week of the CAMBRA course with Dr John Featherstone in collaboration with Coursera.org. This is an online accredited course open to all and I believe may still be open for enrolment.

    Dr Featherstone talks about an ongoing balancing act between protective factors (good quantity / quality of saliva; proteins; calcium; phosphate; fluoride; immunoglobuline, chlorhexedine, etc…) and pathological factors (acidogenic bactria, their types and numbers of CFU’s; decreased salivary function; increased frequency of fermentable carbohydrates ingestion). So clearly, caries is truly a multifactorial disease involving bacteria and many more factors not listed here.

    Dr Robert Berkowitz states in his “Acquisition and Transmission of Mutans Streptococci” paper that early colonization (before age 2) by Mutans Streptococci is a major risk for future caries experience. Many longitudinal studies have shown that the presence of Mutans Streptococci before age 2 is a strong predictor of caries by age 4. These findings can not be ignored. So for me, caries is a transmissible infectious disease compounded by multiple factors.

    In light of the above, there is a need for dentists to approach dentistry with a lot more than a panoply of beautiful filling materials and techniques. An approach that addresses bacterial loads and preventing transmission would be a great step forward.

    Reply
    1. Euan Swan September 6, 2013

      Should a disease that results from the activity of a microbe that is normally present in most people and often does not lead to disease, except under special circumstances, be considered an “infection” or is it something else ?

      Reply
  9. Euan Swan September 5, 2013

    To add to the discussion, here is a recent posting from the dental public health listserv in the USA on the same topic:

    “Koch’s postulates from 100 years ago did us well in understanding and controlling the major diseases of the day. Cholera, Tuberculosis, Plague etc. Discovering a single pathogen responsible for the disease and understanding the pathways of transfer has led us to a world which is for the moment, less “plagued”. WD Miller searched for the pathogen of caries in the 1880’s. He didn’t find it, but we seem to continue down that pathway even though the great William Costerton introduced the world to biofilm phenomena in 1978. Dental diseases, both caries and periodontal are classic biofilm diseases. The “pathogen” is an enormously complex multi species biofilm community that both inhabits and modifies it’s ecological environment, (Marsh). We must push our understanding of biofilm physiology in order to make progress in this field. After 160 years of trying to apply OLD thinking and technology to dental disease, let’s set aside out-dated thinking and use every tool available to fight this growing “Bio-behavioral” disease.”

    Reply
  10. Euan Swan September 11, 2013

    Based on the comments posted to date, there are differences of opinion on the nature of dental caries. Does this difference affect how the disease is managed ?

    Reply
  11. Euan Swan October 30, 2013

    Canada’s Chief Public Health Officer’s 2013 Report on the State of Public Health in Canada focuses on infectious disease without a mention of dental caries. Are you concerned?

    The report can be accessed at: http://www.phac-aspc.gc.ca/cphorsphc-respcacsp/2013/index-eng.php

    Reply
  12. Juan Giuseppe February 3, 2016

    I delighted reading each of the comments.

    Reply
  13. John Gabrovsek November 6, 2018

    Host respond to any infection. Why is not recognized in dental caries infection? This is why we can not reproduce dental caries in laboratory!

    Reply
  14. Sagir misilli April 5, 2021

    Bacteria only can’t cause dental Caries.

    Reply

Leave a Comment

Your email address will not be published. Required fields are marked *