Editing Tooth decay (section)

===Other factors===
Reduced salivary flow rate is associated with increased caries since the buffering capability of saliva is not present to counterbalance the acidic environment created by certain foods. As a result, medical conditions that reduce the amount of saliva produced by [[salivary gland]]s, in particular the [[submandibular gland]] and [[parotid gland]], are likely to lead to [[xerostomia|dry mouth]] and thus to widespread tooth decay. Examples include [[Sjögren syndrome]], [[diabetes mellitus]], [[diabetes insipidus]], and [[sarcoidosis]].<ref name="neville398">Neville, B. W., Douglas Damm, Carl Allen, Jerry Bouquot. ''Oral & Maxillofacial Pathology'' 2nd edition, 2002, p. 398. {{ISBN|0-7216-9003-3}}.</ref> Medications, such as antihistamines and antidepressants, can also impair salivary flow. Stimulants, most notoriously [[methylamphetamine]], also occlude the flow of saliva to an extreme degree. This is known as [[meth mouth]]. [[Tetrahydrocannabinol]] (THC), the active chemical substance in [[cannabis (drug)|cannabis]], also causes a nearly complete occlusion of salivation, known in colloquial terms as "cotton mouth". Moreover, 63% of the most commonly prescribed medications in the United States list dry mouth as a known side-effect.<ref name="neville398"/> Radiation therapy of the head and neck may also damage the [[cell (biology)|cell]]s in salivary glands, somewhat increasing the likelihood of caries formation.<ref>[http://www.cancer.gov/cancertopics/pdq/supportivecare/oralcomplications/Patient/page5 Oral Complications of Chemotherapy and Head/Neck Radiation] {{webarchive|url=https://web.archive.org/web/20081206081959/http://www.cancer.gov/cancertopics/pdq/supportivecare/oralcomplications/Patient/page5 |date=2008-12-06 }}, hosted on the [http://www.cancer.gov/ National Cancer Institute] {{webarchive|url=https://web.archive.org/web/20150312111454/http://www.cancer.gov/ |date=2015-03-12 }} website. Page accessed January 8, 2007.</ref><ref>See Common effects of cancer therapies on salivary glands at {{cite web |url=http://ebd.ada.org/SystematicReviewSummaryPage.aspx?srId=66bffb53-0043-4892-a8ab-f0cfe2231928 |title=ADA&nbsp;— EBD::Systematic Reviews |access-date=2013-07-30 |url-status=dead |archive-url=https://web.archive.org/web/20131202230733/http://ebd.ada.org/SystematicReviewSummaryPage.aspx?srId=66bffb53-0043-4892-a8ab-f0cfe2231928 |archive-date=2013-12-02 }}</ref>

Susceptibility to caries can be related to altered metabolism in the tooth, in particular to fluid flow in the dentin. Experiments on rats have shown that a high-sucrose, cariogenic diet "significantly suppresses the rate of fluid motion" in dentin.<ref>Ralph R. Steinman & John Leonora (1971) "Relationship of fluid transport through dentation to the incidence of dental caries", ''[[Journal of Dental Research]]'' 50(6): 1536 to 43</ref>

The use of [[tobacco]] may also increase the risk for caries formation. Some brands of [[dipping tobacco|smokeless tobacco]] contain high sugar content, increasing susceptibility to caries.<ref name="neville347">Neville, B.W., Douglas Damm, Carl Allen, Jerry Bouquot. ''Oral & Maxillofacial Pathology'' 2nd edition, 2002, p. 347. {{ISBN|0-7216-9003-3}}.</ref> Tobacco use is a significant risk factor for periodontal disease, which can cause the [[gingiva]] to [[receding gums|recede]].<ref>[http://www.perio.org/consumer/smoking.htm Tobacco Use Increases the Risk of Gum Disease] {{webarchive|url=https://web.archive.org/web/20070109123411/http://www.perio.org/consumer/smoking.htm |date=2007-01-09 }}, hosted on the [http://www.perio.org/index.html American Academy of Periodontology] {{webarchive|url=https://web.archive.org/web/20051214140958/http://www.perio.org/index.html |date=2005-12-14 }}. Page accessed January 9, 2007.</ref> As the gingiva loses attachment to the teeth due to gingival recession, the root surface becomes more visible in the mouth. If this occurs, root caries is a concern since the cementum covering the roots of teeth is more easily demineralized by acids than enamel.<ref>Banting, D. W. "[http://www.nidcr.nih.gov/NR/rdonlyres/5A4386A8-E750-43E9-8450-651F4789D09A/0/David_Banting.pdf The Diagnosis of Root Caries] {{webarchive|url=https://web.archive.org/web/20060930192216/http://www.nidcr.nih.gov/NR/rdonlyres/5A4386A8-E750-43E9-8450-651F4789D09A/0/David_Banting.pdf |date=2006-09-30 }}." Presentation to the National Institute of Health Consensus Development Conference on Diagnosis and Management of Dental Caries Throughout Life, in pdf format, hosted on the National Institute of Dental and Craniofacial Research, p. 19. Page accessed August 15, 2006.</ref> Currently, there is not enough evidence to support a causal relationship between smoking and coronal caries, but evidence does suggest a relationship between smoking and root-surface caries.<ref>[https://www.cdc.gov/tobacco/sgr/sgr_2004/pdf/executivesummary.pdf Executive Summary] {{webarchive|url=https://web.archive.org/web/20070216060432/http://www.cdc.gov/TOBACCO/SGR/sgr_2004/pdf/executivesummary.pdf |date=2007-02-16 }} of U.S. Surgeon General's report titled, "The Health Consequences of Smoking: A Report of the Surgeon General," hosted on the [https://www.cdc.gov CDC] {{webarchive|url=https://web.archive.org/web/20120320214638/http://www.cdc.gov/ |date=2012-03-20 }} website, p. 12. Page accessed January 9, 2007.</ref>
Exposure of children to [[passive smoking|secondhand tobacco smoke]] is associated with tooth decay.<ref>{{cite journal|last1=Zhou|first1=S|last2=Rosenthal|first2=DG|last3=Sherman|first3=S|last4=Zelikoff|first4=J|last5=Gordon|first5=T|last6=Weitzman|first6=M|title=Physical, behavioral, and cognitive effects of prenatal tobacco and postnatal secondhand smoke exposure|journal=Current Problems in Pediatric and Adolescent Health Care|date=September 2014|volume=44|issue=8|pages=219–41|pmid=25106748|doi=10.1016/j.cppeds.2014.03.007|pmc=6876620}}</ref>

Intrauterine and neonatal [[lead]] exposure promote tooth decay.<ref>{{cite journal |doi=10.1177/00220345560350031401 |vauthors=Brudevold F, Steadman LT |title=The distribution of lead in human enamel |journal=Journal of Dental Research|volume=35 |pages=430–437 |year=1956 |pmid=13332147 |issue=3 |s2cid=5453470 }}</ref><ref>{{cite journal |doi=10.1177/00220345770560100701 |vauthors=Brudevold F, Aasenden R, Srinivasian BN, Bakhos Y |title=Lead in enamel and saliva, dental caries and the use of enamel biopsies for measuring past exposure to lead |journal=Journal of Dental Research|volume=56 |pages=1165–1171 |year=1977 |pmid=272374 |issue=10 |s2cid=37185511 }}</ref><ref>{{cite journal |author=Goyer RA |title=Transplacental transport of lead |journal=Environmental Health Perspectives|volume=89 | pages=101–105 |year=1990 |pmid=2088735 |doi=10.2307/3430905 |pmc=1567784 |jstor=3430905 }}</ref><ref>{{cite journal |vauthors=Moss ME, Lanphear BP, Auinger P |title=Association of dental caries and blood lead levels |journal=JAMA|volume=281 |issue=24 |pages=2294–8 |year=1999 |pmid=10386553 |doi=10.1001/jama.281.24.2294|doi-access=free }}</ref><ref>{{cite journal |vauthors=Campbell JR, Moss ME, Raubertas RF |title=The association between caries and childhood lead exposure |journal=Environmental Health Perspectives|volume=108 |pages=1099–1102 |year=2000 |pmid=11102303 |doi=10.2307/3434965 |issue=11 |pmc=1240169 |jstor=3434965 }}</ref><ref>{{cite journal |doi=10.1289/ehp.021100625 |vauthors=Gemmel A, Tavares M, Alperin S, Soncini J, Daniel D, Dunn J, Crawford S, Braveman N, Clarkson TW, McKinlay S, Bellinger DC |title=Blood Lead Level and Dental Caries in School-Age Children |journal=Environmental Health Perspectives|volume=110 |pages=A625–A630 |year=2002 |pmid=12361944 |issue=10 |pmc=1241049 }}</ref><ref>{{cite journal |vauthors=Billings RJ, Berkowitz RJ, Watson G |title=Teeth |journal=Pediatrics|volume=113 |issue=4 |pages=1120–1127 |year=2004 |doi=10.1542/peds.113.S3.1120 |pmid=15060208 }}</ref> Besides lead, all [[atoms]] with [[electrical charge]] and [[ionic radius]] similar to bivalent [[calcium]],<ref>{{cite journal |vauthors=Leroy N, Bres E |title=Structure and substitutions in fluorapatite |journal=European Cells and Materials|volume=2 |pages=36–48 |year=2001 |pmid=14562256 |doi=10.22203/eCM.v002a05 |doi-access=free }}</ref>
such as [[cadmium]], mimic the calcium [[ion]] and therefore exposure to them may promote tooth decay.<ref>{{cite journal |doi=10.1289/ehp.10947 |vauthors=Arora M, Weuve J, Schwartz J, Wright RO |title=Association of environmental cadmium exposure with pediatric dental caries |journal=Environmental Health Perspectives|volume=116 |issue=6 |pages=821–825 |year=2008 |pmid=18560540 |pmc=2430240|bibcode=2008EnvHP.116..821A }}</ref>

Poverty is also a significant social determinant for oral health.<ref>{{cite journal | author = Dye B | year = 2010 | title = Trends in Oral Health by Poverty Status as Measured by Healthy People 2010 Objectives | pmid=21121227 | journal = Public Health Reports| volume = 125 | issue = 6| pages = 817–30 | pmc=2966663| doi = 10.1177/003335491012500609 }}</ref> Dental caries have been linked with lower socio-economic status and can be considered a disease of poverty.<ref>{{cite journal |author1=Selwitz R. H. |author2=Ismail A. I. |author3=Pitts N. B. | year = 2007 | title = Dental caries | journal = The Lancet| volume = 369 | issue = 9555| pages = 51–59 | doi=10.1016/s0140-6736(07)60031-2 | pmid=17208642|s2cid=204616785 }}</ref>

Forms are available for risk assessment for caries when treating dental cases; this system using the evidence-based [[CAMBRA|Caries Management by Risk Assessment]] (CAMBRA).<ref>[https://web.archive.org/web/20150201181112/http://public.health.oregon.gov/PreventionWellness/oralhealth/FirstTooth/Documents/ADA-CAMBRA.pdf ADA Caries Risk Assessment Form Completion Instructions]. American Dental Association</ref> It is still unknown if the identification of high-risk individuals can lead to more effective long-term patient management that prevents caries initiation and arrests or reverses the progression of lesions.<ref>{{cite journal|author=Tellez, M., Gomez, J., Pretty, I., Ellwood, R., Ismail, A.|title=Evidence on existing caries risk assessment systems: are they predictive of future caries? |journal=Community Dentistry and Oral Epidemiology|volume=41 |issue=1 |pages=67–78 |pmid=22978796|year=2013 |doi=10.1111/cdoe.12003 }}</ref>

Saliva also contains [[iodine]] and [[Epidermal growth factor|EGF]]. EGF results effective in cellular proliferation, differentiation and survival.<ref>{{cite journal | author = Herbst RS | title = Review of epidermal growth factor receptor biology | journal = International Journal of Radiation Oncology, Biology, Physics| volume = 59 | issue = 2 Suppl | pages = 21–6 | year = 2004 | pmid = 15142631 | doi = 10.1016/j.ijrobp.2003.11.041 | doi-access = free }}</ref> Salivary EGF, which seems also regulated by dietary inorganic iodine, plays an important physiological role in the maintenance of oral (and gastro-oesophageal) tissue integrity, and, on the other hand, iodine is effective in prevention of dental caries and oral health.<ref>{{cite journal |vauthors=Venturi S, Venturi M | title = Iodine in evolution of salivary glands and in oral health | journal = Nutrition and Health| volume = 20 | issue = 2 | pages = 119–134 | year = 2009 | pmid = 19835108 | doi = 10.1177/026010600902000204 | s2cid = 25710052 }}</ref>