Human studies have found at least three types of polyglucans synthesized in plaque. Therefore, the cariogenic role of Streptococcus mutans in humans has begun to be questioned [23].
In Vietnam, when studying MBR of Vietnamese people, people isolated and identified two strains 74 and 94 belonging to the genus Streptococus, which have the ability to produce strong acid and have high vitality against the effects of some experimental disinfectants [20], [21].
- Genetic factors
Good or bad teeth come from the family. Studies on families show that children take on characteristics from their parents. If parents have few cavities, their children will have few cavities, and vice versa, if parents have many cavities, their children will have many cavities as well.
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Mansbridge's study [89] found greater similarities in identical and fraternal twins than in unrelated children.
* Nutrition
Nutrition is a subjective factor because each individual, depending on their preferences, chooses the right food for themselves. Some people like protein while many people like foods rich in carbohydrates.
Lady May Mellanby (1943)[89] was the first to suggest that the shortage
Vitamin D is a causative factor in tooth decay and development.
Epidemiological evidence also suggests that prolonged nutritional deficiencies during tooth development can lead to hypoplasia and subsequent caries. Dietary influences on caries are due to their interaction with the enamel surface and the provision of substrates for cariogenic bacteria. Sucrose is thought to be the major cause of caries. Evidence of an association between caries and diet
Dietary habits are derived from epidemiological studies. Each person's food and drink are substrates for bacterial fermentation in dental plaque, producing organic acids that lead to demineralization of tooth structure and directly affect dental caries. The composition of food and eating habits of each individual also affect the development of the type of dental caries, the composition of bacteria found in dental plaque, thereby indirectly affecting the process of dental caries [118].
* Society.
- Mental stress
Stressful episodes are associated with a higher risk of caries, but this is difficult to determine, as caries is a chronic disease, and stress is difficult to determine. The low incidence of caries in schizophrenic patients may be due to increased salivation and a higher pH of saliva. In systemic diseases, emotional disturbances appear to lead to decreased salivation and increased caries.
- Socio-economic situation
It is difficult to link dental caries to socioeconomic status because of its complexity. The first study in the 1930s and 1940s by Klien and Palmer showed that the SMT index was not the same in countries with different socioeconomic status. This study also showed that countries with low socioeconomic status had more caries and missing teeth but more filled teeth. Since the 1960s, after fluoride and other caries prevention measures became known, the SMT index has decreased more in high socioeconomic countries than in low socioeconomic countries.
* Environment
- Geographical conditions
+ Latitude: In the United States, the Northeast has the highest rates of tooth decay and
The Central South region has the lowest rate, which is also true of the former Soviet Union.
+ Distance from the coast: The highest rate of tooth decay is in locations right on the coast.
sea and the further from the coast this ratio decreases.
The following geographical factors are influenced by the above two parameters: Sunlight, temperature, relative humidity, rainfall, fluoride, total water hardness ....
- Urbanization process
A study conducted by WHO found that the rate of tooth decay in rural areas is high.
than in urban areas, where more refined foods are consumed.
1.1.3.2. Gingivitis
When the gums are inflamed at different levels, there will be changes in color, shape and tone of the gums.
a. Causes and pathogenesis of gingivitis
* Reason
Through many studies from the 1960s by Greene, Ramfforg, Loe and up to today, people have confirmed the formation and role of MBR, the most important foreign agent in the causes of gingivitis and periodontitis [1].
In addition to the cause of gingivitis and periodontitis, which is dental plaque, mentioned above, there are other causes of gingivitis: Herpes virus, medication used in treatment, improper tooth filling, teething, and systemic diseases...
* Pathogenesis
- Bacteria can invade the area around the teeth and cause disease by
directly or indirectly:
+ Direct impact: Due to bacteria activity and production of enzymes such as
Hyaluronidase destroys the epithelial tissue of the gums, Collagennase destroys the tissue.
buffer function... In addition to enzymes, bacteria also secrete endotoxins and waste products, intermediate metabolism such as NH3 , Urea, hydrogen sulfide...
+ Indirect effects: Due to the antigenic properties of bacteria, they
diffuse across epithelia and initiate local and systemic immune responses.
- When the gums are inflamed at different levels, there will be changes in the color, shape, and tone of the gums.
- The easily visible manifestations are bleeding gums and inflammatory fluid in the gum fold.
- No pathological gingival pockets (no movement of the adherent epithelium, no
alveolar bone loss
- Gingivitis is often associated with poor oral hygiene.
lots of plaque, food residue, tartar.
b. Factors related to gingivitis [44]
* Age, gender
- Year old
Many studies have shown that the elderly have more and more severe periodontal disease than the young [50], [132]. Some studies also show that the elderly have more dental plaque and more severe gingivitis than the young. Other studies have concluded that the reason why the elderly have more severe periodontal disease than the young is due to the process of destruction of periodontal tissue that accumulates over time in a person's life and if the VSRM factor is properly taken care of, age is no longer a worrying risk factor for periodontal disease [50].
- Gender
Researchers also found that men have more periodontal disease than women of the same age group. According to a report by the National Center for
According to US health statistics, the reason for this difference is that men are less concerned about periodontal health and do not visit the dentist more often than women. However, in an analysis based on the same database, when adjusting for periodontal health status, socioeconomic status, age, and number of visits to the dentist, it was found that men still had more severe periodontal conditions than women.
* Body
- Local factors
+ Periodontal bacteria: There are more than 400 different strains of bacteria found in human oral fluid, however only a few of them act as pathogens, causing and developing periodontal disease.
+ Dental plaque and tartar
- Genetic factors
In modern medicine, attention has been paid to the influence of genetics on periodontal disease. Research approaches include:
+ Analysis of the association between periodontal disease and genetic markers, such as
blood group or human leukocyte antigen.
+ Research on twins.
+ Research on genetic polymorphism on specified genes.
Several studies have suggested that there is an association between human leukocyte antigen and genes in localized periodontal disease of the young [115]. In a study on twins, scientists also concluded that alveolar bone height is influenced by genetics. On the other hand, the authors also found a genetic influence on gingivitis, probing depth, periodontal attachment loss, and MBR [104]. In another study, Van Schie and colleagues demonstrated that the combined modulation of FcyRIIA-H/H131 and FcyRIIIB-NA2/NA2 genotypes was increased in the group with periodontal disease compared to the control group (18.8% and 3.8%), while
The combination of FcyRIIA-R/H131 and FcyRIIIB-NA2/NA2 genotypes was reduced in the periodontal disease group (6.3%) compared to the control group (22.9%). The study also concluded that due to the reduction in opsonization, through the combination of genotypes, it ultimately impaired the ability to phagocytose periodontal disease-causing bacteria in individuals carrying the above receptors [127].
* Bad habits
- Unbalanced diet
A balanced diet with adequate nutrition plays an important role in maintaining overall health and oral health in particular. A lack of vitamins and minerals, especially calcium and vitamin C, in the daily diet can be a risk factor for periodontal disease.
+ Calcium deficiency:
A recent analysis based on NHANES III (1988-1992) (National Health and Nutrition Examination Survey-USA) data showed that people with low dietary calcium intake had more periodontal disease than those with adequate dietary calcium intake [107].
+ Vitamin C deficiency:
Many studies have shown that vitamin C plays an important role in maintaining gum health. Also from the data of NHANES III (1988-1992), a study to evaluate the relationship between vitamin C deficiency and periodontal disease was conducted. The results of the study also showed that vitamin C deficiency increased the risk of periodontal disease, especially in the group of smokers, the odds ratio (OR) was 1.28 (95% CI: 1.04-1.59) and in those with a history of smoking, the OR was 1.21 (95% CI: 1.02-1.43) compared to non-smokers. This study also concluded that reducing the intake of vitamin C in the diet, especially
especially in smokers or those with a history of smoking, which increases the risk of periodontal disease [106].
- Smoking
In addition to the negative effects of causing respiratory and circulatory diseases, people also know the adverse effects of smoking on periodontal health. Studies have a common conclusion that smoking is a high risk factor for periodontal disease after adjusting for age, VSRM and socioeconomic status [93]. The general mechanism of the effects of smoking on periodontal tissue is as follows:
+ Smoking causes constriction of blood vessels and capillaries of the gums, leading to slowing down the flow of nutrients and elimination of toxic substances to the tissues surrounding the teeth [63].
+ Smoking reduces the function of leukocytes and macrophages in saliva and gingival fluid, and reduces the chemotaxis and activity of macrophages in the blood and neutrophils in the tissue. Thereby reducing the protective response against bacteria that cause periodontal disease [121].
+ In addition, smoking can directly affect the tissues around the teeth. Toxic products in cigarettes are toxic to gingival epithelial cells, affecting fibroblast cells, leading to slow wound healing [113].
* Society
- Economic conditions
According to the summary report, gingivitis in Asia and Africa is much higher than in Europe, Australia and the United States. It is also believed that in places with high material and cultural life, there is better awareness of oral care, more attention is paid to preventing gum disease, so gingivitis is also reduced.
- Stress and mental disorders: Since the early 1950s,
Scientists have proven that stress and mental disorders have adverse effects.
The role of stress and mental disorders in periodontal disease has recently received attention and there is growing evidence that they are real risk factors for periodontal disease [99], [105].
* Other systemic diseases
Currently, scientists have also proven that some systemic diseases affect the occurrence and development of periodontal disease: Diabetes, Down syndrome, HIV/AIDS syndrome.
1.1.4. Tooth decay and gingivitis.
1.1.4.1. World.
- Since 1969, WHO [128], [133] has been very interested in and continuously monitoring the oral health status, especially dental caries in different countries and the information is stored in the global oral health database in Geneva. This is a huge data set provided through many different channels.
According to the current WHO oral health database, there are two main trends in oral health:
- The trend is worsening for most developing countries: (SMT average
The average of 12-year-old children increased from 2 to 4.1).
- The trend is improving for most highly industrialized countries (SMT
The average of 12-year-olds has dropped from 7-10 to 2-4.
In developing countries: In the 1960s, the dental caries situation was much lower than in developed countries. The SMT index at age 12 in this period was generally from 1.3-3.0; Some countries were even below 1.0: Thailand, Uganda, Zaire. Recently, dental caries has tended to increase except for some countries such as Hong Kong, Singapore, Malaysia [15], [136].