The Journal
So , environmental acidification is the main driving force of the phenotypic and genotypic changes in the microbial community during the caries process .[ 46 ] It is conceivable that if such dietary alterations occur in biofilm populated with gram positive flora , mainly on the coronal part of the tooth , it might lead to a higher cariogenic potential , in such patients and this can be speculated as the reason for presence of caries , in the absence of periodontal disease . Root caries differs from coronal caries due to the different location , anatomy , histology and chemical composition of the dental hard tissues and harboring microflora . It has been shown that the critical ph for root cementum and dentin , is 6.0-6.7 , compared with 5.2-5.7 for enamel . It is convincing to understand the higher prevalence of root caries in patients suffering from periodontal disease . Caries is usually perceived as a disease of childhood , but the distribution of caries by tooth type and surfaces affected suggests that the availability of non-carious tooth surfaces may lead to continuing caries attack in older age groups if the challenge is present .[ 34 ] There are many reports on the close relationship between over hanged restorations , active caries and the development of periodontal disease .[ 37 ] This has even gone further with the involvement of periodontium at the sound adjacent teeth . Young individuals having multiple sites with such local factors are to be considered at risk of developing early periodontal lesions .[ 8 ] Incipient caries lesions and unrestored caries on smooth tooth surfaces act as local plaqueretention sites , and may therefore be regarded as potential etiologic factors in periodontal diseases . Bransvold found that over hanged margin in faulty restorations could change the pathogenic status of the subgingival microflora .[ 47 ] Broadbent JM found that approximal caries is an independent risk factor for future attachment loss .[ 48 ] A study by Uzel NG et al suggests that subgingival plaque redevelopment differs markedly for people having periodontal disease or healthy periodontium .[ 49 ]
Studies have also shown that smoking could shift the microbial composition of dental plaque biofilm towards colonization by periodontal pathogens such as T forsythia , P . gingivalis , T . denticola , P . intermedia .[ 22 ] Another important influence is the resting ph of saliva on the microbial ecology of dental plaque . The rate of clearance of acids from plaque into the overlying salivary film is greatly retarded at low salivary film velocities . Epidemiological links between periodontitis and caries , as observed in previous investigations were suggestive of entirely contradictory associations between these two conditions , Moeller suggested that the influences of both an individual ’ s environment and genetic make-up are involved in a complex manner in the ability to host specific bacteria in plaque and develop the oral conditions in question . So , it renders difficult to speculate that if periodontal disease and caries are always concurrent or not . The findings of the current investigation suggests that the two disease forms may exist in isolation as they share a commonality at the very initial stage of biofilm formation i . e acquired pellicle , progression for both need diverse factors to play in a complex manner which may or may not lead to the concurrence of the two , but if these co-exist , there appears a positive association in the prevalence of caries and the severity of periodontal disease . Limitations and future recommendations- The current investigation being a cross- sectional study , with limited sample size and resources could not support the complete portrayal of all the determining factors supported by the microbiological evidence for such an association . So , the findings from the present investigation definitely calls for large epidemiological nationwide multicentric studies for deeper analysis of these factors . Humphrey et al . suggested that longitudinal studies beginning in childhood and randomized controlled trials ( acknowledging the ethical issues ) be conducted .[ 50 ] In any study that is carried out , standardized definitions , identification of type and measurements of
71 8 Vol . 12 No . 23 May-August Sept-Dec 2016