Tuesday, June 24, 2014

Rampant caries - a really disgusting mouth

We all know that sugar destroys teeth, right? Well, not actually sugar itself, but the acids produced from sugar by bacteria that live in our mouths. Frequent exposure to an acidic environment causes the mineral components of teeth to break down, so that cavities form. This condition is known as dental caries - or, colloquially, as tooth decay. But how bad can tooth decay actually get, when it's really, REALLY bad? 

Rampant caries is a condition where a combination of three factors: high sugar consumption (especially in the form of fizzy drinks or chewy sweets), bad oral hygiene and scant saliva production, popularly known as "dry mouth", allows acid-producing bacteria to proliferate wildly in the mouth and destroy teeth in record time. The result - severe decay on multiple tooth surfaces, often culminating in a mouthful of blackened, eroded stumps. Rampant caries is especially prevalent in folks addicted to metamphetamine, in whom it is known as "meth mouth". 

Oral hygiene in drug addicts is, as a rule, very low. One study, recently performed in Spain, showed that a whopping 64.1% (n=41) of the surveyed drug users NEVER brushed their teeth; 17.2% (n=11) brushed once a day and 18.8% (n=12) twice or more.The respondents in this study were mostly addicted to heroin (96.8%) and cocaine (90.6%); the overwhelming majority also smoked tobacco. 81.3% of those surveyed suffered from periodontitis, and a full half of the respondents had rampant caries.

Below is a yucky example of rampant caries in a drug addict. Most of this person's teeth are completely gone, leaving bare gums. The few that still survive should probably be extracted as soon as possible. Ewww.

A drug addict's nearly toothless mouth. (Image from: Mateos-Moreno et al. 2013)

The mouth contains a wide variety of oral bacteria, but only a few specific species of bacteria are believed to cause dental caries: Streptococcus mutans and Lactobacilli among them. These organisms can produce high levels of lactic acid following fermentation of dietary sugars, and are resistant to the adverse effects of low pH. The frequency of tooth exposure to acid affects the speed at which cavities develop; thus, frequently sipping sweet drinks is an especially pernicious habit. "Baby bottle caries," "baby bottle tooth decay," or "bottle rot" is a pattern of decay found in young children with their baby teeth. This type of decay is usually a result of allowing children to fall asleep with sweetened liquids in their bottles or feeding children sweetened liquids multiple times during the day.

Rampant caries in a child's baby teeth. HIV infection was probably a predisposing factor in this patient's case. (Image from: Ponnam et al. 2012)

The bottom line? It's better to eat sweets only once or twice a day, if you have to eat them at all, and brush teeth directly afterwards. As for fizzy drinks and other sugar-sweetened beverages, your teeth will definitely be thankful if you stop drinking them.


Mateos-Moreno MV, del-Río-Highsmith J, Riobóo-García R, Solá- Ruiz MF, Celemín-Viñuela A. (2013) Dental profile of a community of recovering drug addicts: Biomedical aspects. Retrospective cohort study. Med Oral Patol Oral Cir Bucal. 18(4): e671–e679. 

Wikipedia: Dental caries

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