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From Trisha's Desk: Are Caries Really Bacterial Infections? Trisha E. O'Hehir, RDH, BS Editorial Director, Hygienetown Magazine

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Are Caries Really Bacterial Infections?

Trisha E. O'Hehir, RDH, BS
Editorial Director,
Hygienetown Magazine 		Caries is a transmissible bacterial infection, spread vertically between parents and children and horizontally between siblings and even the family dog (in some cases). The cavitated lesion, the cavity, is the result of this bacterial infection that changes the normal, healthy environment in the mouth by lowering the salivary pH. Dr. Brian Nový, a Loma Linda University faculty member, sees the caries infection as a pH disease rather than a bacterial infection. It makes sense, since the salivary pH changes cause the breakdown of tooth enamel and pH changes are caused by more than just bacteria. Find out more about his perspective in this month’s Profile in Oral Health.

Periodontal disease is also considered a bacterial infection, but the actual tissue destruction is caused by the side effects of the body’s immune system. White blood cells travel from blood vessels in the underlying, healthy connective tissue to the site of the bacteria, the sulcus. To get there quickly, they use chemical machetes to destroy healthy connective tissue in their way. Consider it collateral damage.

The primary goal of the white blood cells is to phagocytize the bacteria. Funny thing about the location of the bacteria; they are technically outside the body. The tooth is technically "outside" the body as the tissue adapts around the tooth and the bacteria are on the tooth/root surface – not in the tissue. Yes, some bacteria will pass through the junctional epithelium and others will invade the pocket wall, but the majority are on the tooth surface, checked into calculus hotels and simply dumping their toxic waste out the windows.

Just how the bacterial toxins trigger the immune response and how the white blood cells cause tissue damage is well understood. How this process is stopped is just being revealed with scientific research. The key words to watch in this area are resolvins and protectins. Just as there are agents that trigger the immune response, these agents trigger a series of responses that stop the inflammatory process and protect the tissue from further damage.

Researchers are looking beyond the bacteria that trigger periodontal disease and are now focusing on interventions and drugs that will help the body stop the inflammatory process. Not to be confused with anti-inflammatory drugs that block aspects of inflammation, the future will bring drugs and therapeutics that actually work with the body’s own resolving mechanisms. This month’s Perio Reports includes an article that describes the new directions in host modulation and how they will impact periodontal disease.

Looks like both caries and periodontal disease are more than just bacterial infections.
Inside This Section Cover model: California native Suzanne Newkirk, RDH, graduated from the University of Alaska – Anchorage in 1981. She says her newest "passion" is the world of Perioscopy. "I have recently purchased a Perioscope and hope to incorporate this incredible technology into my daily practice." Suzanne currently lives in Washington State with her husband, Richard, and 18-year-old daughter, Marchie, where they enjoy skiing, golf and travel.
Dentaltown Magazine
September 2025
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