Romanian Journal of Oral Rehabilitation

Vol. 3, No. 1, January 2011

DIET AND HYGIENE AS RISK FACTORS IN DENTAL CARIES

CASE REPORT
Ruxandra Margarit1), O.C. Andrei 2) , C. Daguci3) , C. Farcasiu4)
1)

of Medicine and Pharmacy, Bucharest

2)

of Medicine and Pharmacy, Bucharest

3)
Department of Oral Health, Faculty of Dentistry, University of
Medicine and Pharmacy, Craiova
4)
D
and Pharmacy, Bucharest

Abstract: Tooth decay is a disease with multifactorial etiology: diet, oral hygiene, dental tissue susceptibility,
cariogenic bacteria. In developed countries, dental decay is more prevalent due to increasing consumption of
carbohydrates. Caries occur because of demineralization of enamel and dentine by organic acids formed by
bacteria in dental plaque through the anaerobic metabolism of dietary sugars. Numerous studies have shown that
sugar is the most important factor in dental caries development and its correlation with poor hygiene leads to
irreversible damage of hard dental structures. This paper presents the case of a young male patient, 23 years old,
with a very high decay risk due to excessive consumption of carbohydrates, in the absence of proper oral
hygiene. The patient failed to significantly change his diet and hygiene for a period of six months. All the teeth
were affected on large surfaces. Since the lesions included almost the entire coronary volume reaching the
coronary pulp chamber, the teeth could no longer be restored by simple fillings. In order to complete oral
rehabilitation and to prevent early loss of teeth relative to the patient's age, we covered all the teeth with
porcelain-fused-to-metal crowns. Caries risk assessment is an important component of dental management. It
saliva
characteristics. Lack of hygiene combined with a diet based mainly on carbohydrates leads to an increased
number of caries. Caries complications affect the patient both in terms of chewing and psychological function.
For patients who fail to make c
prevented by covering those teeth with crowns.

Keywords: caries risk, diet, oral hygiene, crown, endodontics.

INTRODUCTION complex of variables that include

Dental caries is a disease strongly
related to diet, which nowadays is a
problem for a lot of patients. This is
important as the patients with high risk of
caries are young and prone to early loss of
teeth, especially from the posterior areas of
the mouth, thus being candidates at fixed
or removable prosthetics. This article
describes the clinical case of a patient,
only 23 years old, requiring endodontic
treatment of all teeth present in the mouth
and having them to be covered with
crowns because of the diet and inadequate
hygiene. Dietary factors contribute to a
growing number of chronic diseases,
among them the dental caries (1,2). The
diet of the people is influenced by a
socioeconomic status, the cost of food,
agricultural industrialization, and access to
grocery stores. Industrialization of
agriculture has had a major effect on
availability of processed foods in both our
country and the rest of the world. The use
of high fructose corn syrup (HFCS) has
resulted in increased use and consumption
of sweetened liquids and snack type
desserts. Studies showed that children,
adolescents, and young adults receive
about a third of daily calories from foods
consumed outside the home, which contain
more fats and carbohydrates than foods
consumed at home (3). Patients who tend
to eat snacks have a high degree of dental

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 Romanian Journal of Oral Rehabilitation
Vol. 3, No. 1, January 2011
caries occurrence compared with those
who do not have this habit. Several studies
have shown that there is a significant
association between tooth decay and
exposure to foods containing
carbohydrates (4-6). Barker and colleagues
have found that those who present a low
level of education consume fewer fruits
and vegetables, having mostly a diet high
in fat and carbohydrates which predisposes
them to dental caries (7).
PATIENT AND METHOD
Patient M.C., 23 years old, came to
the dental office for a complete oral
rehabilitation. After a complete clinical
examination we discovered that the patient
had a diet, life style and hygiene that
exposed him to a high risk of decay. He
was a major consumer of foods such as
snacks and sweets and regularly consumed
carbonated beverages, while spending
most of the time in front of the computer.
Even the minimum oral hygiene measures
were not followed properly by the patient,
being done at random and not twice a day
as recommended. He never used the
auxiliary methods of oral hygiene as
cleaning of interdentally spaces using
dental floss nor ever heard of it. Then, the
caries affected the entire oral cavity.
Fig.1- Initial aspect of the arches
in occlusion.
Fig. 3- Initial aspect of the lower arch.
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At the beginning of the treatment we
try to counsel him for diet modification
and improvement of oral hygiene. We
recommended him to reduce consumption
of snacks and sweets and to limit them to
the main meals. Between these meals,
eating noncariogene food, with a low
amount of carbohydrates was
recommended. Patient was advised to
increase consumption of foods rich in
carioprotective substances such as fruits
and vegetables and to brush the teeth if
possible after every meal. Also
recommended was lower consumption of
soft drinks. Trying to improve his oral
hygiene, we recommended fluoridated
toothpaste, brushing at least twice a day
and flossing for interdentally spaces
cleaning. In the meantime, we began the
restorations of some of the existent
cavities and supervised the case for six
month with once a week visits to the
dental office. There has been a worsening
clinical situation with the patient not
following the major changes in diet and
hygiene habits. The patient came regularly
to the office, but did not seem to assume
any other responsibility for the state of his
teeth (Fig. 1, 2, 3).
Fig.2- Initial aspect of the upper arch.
Fig. 4- Final restoration of upper arch.
 Romanian Journal of Oral Rehabilitation
Vol. 3, No. 1, January 2011
As the caries covered almost the
entire coronary volume, dramatically
progressing and reaching the pulp
chamber, endodontic treatment was
required. For preventing early loss of
teeth, we decided to cover them with
crowns. This was done initially in the
Fig.5- Endodontic treatments-intermediary
situation.
Fig. 7- Final prosthetic restoration of lower
arch.
RESULTS AND DISCUSSION
The fact that there is a correlation between
the consumption of snacks, lack of
hygiene, and the occurrence of dental
caries, was repeatedly explained to the
patient. He was advised to decrease
consumption of these foods while also
improving oral hygiene. The
recommendations for decreasing dental
decay included the reduction in the
consumption of sweetened foods and
beverages, and if possible, limiting their
intake during main meals only. It was also
recommended avoiding them at bedtime,
because salivary flow and buffering
capacity are reduced during the night [8,9].
If it is not possible to limit food
42
maxillary arch, mandibular arch was later
rehabilitated (Fig. 4). The teeth were
endodontically treated and filled with a
material based on calcium hydroxide and
gutta-percha cones (Fig.5,6.). Both arches
were restored with ceramic fused to metal
crowns (Fig. 7,8).
Fig.6- Endodontic treatment of lower
molars.
Fig. 8- Final prosthetic restoration in
occlusion.
consumption to the three main meals, then
patients was advised not to eat cariogenic
foods between main meals.
CONCLUSIONS
Eating habits, poor oral hygiene, and
plaque accumulation [10] plays an
important role in dental caries [11].
Consumption of products containing
carbohydrates between meals can increase
the incidence of dental caries, especially
for those with poor hygiene [12]. This
patient failed to make changes in diet and
s habits for a long
period, despite the fact that he visited the
dental office regularly. During six month,
the evolution of the caries was constant. In
 Romanian Journal of Oral Rehabilitation
Vol. 3, No. 1, January 2011

this case, the only solution to prevent the with crowns.

early loss of teeth was to cover those teeth

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