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PURPOSE:  Preventative strategies can be targeted at intercepting one or more of the necessary disease components of the Keyes Diagram. Using the classic Keyes diagram for dental caries as well as other new technology, there is hope that salivary testing can predict individual pts. the risk for cavities.

MATERIALS & METHODS: The tests traditionally used in these clinical studies are selective media cultures.  They use a media designed to grow streptococci while adding one or more ingredients that select against all streptococci except S mutans.  The selective ingredient is bacitracin.  S mutans grows in the presence of specific amounts of bacitracin while other streptococci find the same amount of bacitracin lethal.  However, the M & M seemed to consist of a retrospective study in the fact that it was just a collection of previous data and no new experiments or studies were accomplished.  Also, there was no defined methods or tests conducted to produce experimental results.

RESULTS: One of the features of human bacterial plaque is that plaque is a biofilm.  Biofilms are complex ecological systems that are able to achieve metabolic cooperation between different components through the use of the circulating water channels.  These complex biological systems can be disrupted through chemomechanical interventions.  In analyzing the treatment data, it was found that children who receive sealants are 72% less likely to experience any restorative services over the next 5 years compared to those who receive no sealants.  The findings argue that cost-effectiveness studies of sealants should assess total caries/restorative experience versus just occlusal surfaces.

DISCUSSION: The 2 primary diseases of dentistry, caries, and periodontal disease, seemingly require all 3 elements of the non-exclusive contributory model, which has been adapted into the classic Keyes diagram for dental caries.  The 3 elements are it takes a susceptible person (genetic), an infectious agent (the virus) and environmental factors to breed.  The infectious agents associated with dental caries are generally classified into 3 bacterial groups: the mutans streptococci, lactobacilli, and the actinomyces species.  The organism most often associated with dental caries are mutans streptococci.  While predictive of population disease patterns, predicting the risk for individual patients has been too low to be clinically useful.  

SUMMARY/COMMENTS: In conclusion, dental caries is a potentially treatable bacterial infection primarily transmitted within family units.  The fundamental bacteria involved are S mutans, Lactobacillus, and Actinomyces species.  Both the genotype and phenotype of a person with a cariogenic infection influence disease severity.  The primary efforts at defeating this disease are focused on the infecting organisms and limiting their reproduction  and acid production.

However,  I feel this article had no clear cut purpose as to why it was written.  The authors ideas were jumping around from one topic to a completely different one.  For example, it opens up by addressing the Keyes diagram and model of disease, then to sealant use and cost-effectiveness and then 3rd party payments and insurance to comparing amalgam versus posterior composites and then going full circle back to dental caries.  I felt that the author had covered too many topics in this article, rather than just focusing on one or two ideas which would have made an easier paper to follow.  If you want a reader to appreciate the time you put into your article, give the reader an idea or two to focus on.