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What are the four major oral diseases?

Oral health is extremely important for overall health and well-being. However, many people do not pay enough attention to oral hygiene and prevention of oral diseases. There are four major oral diseases that affect millions of people worldwide – dental caries, periodontal disease, oral cancer, and oral manifestations of HIV.

Dental Caries

Dental caries, also known as tooth decay or cavities, is the breakdown of teeth due to acids made by bacteria. It is one of the most common chronic infectious diseases worldwide. Without treatment, caries can lead to pain, tooth loss, infection, and even death.

Some quick facts about dental caries:

  • Caused by oral bacteria (streptococcus mutans and lactobacilli) that thrive on the surfaces of teeth.
  • These bacteria metabolize sugars and starches from the diet to produce acids that dissolve tooth enamel.
  • Fluoride strengthens enamel and prevents decay, but does not reverse existing decay.
  • Caries is transmitted through saliva. Mothers with high levels of caries bacteria can transfer it to their children.
  • Decay can begin as soon as teeth erupt in the mouth (as early as 6 months old). Baby bottle tooth decay affects many infants and toddlers.
  • If not treated properly, caries can cause severe tooth loss at a young age.

Some common risk factors for dental caries include:

  • Poor oral hygiene: Not brushing and flossing properly leads to plaque buildup.
  • Frequent snacking/sugary drinks: Carbs feed the bacteria and provide an acidic environment.
  • Dry mouth: Saliva helps neutralize acids and rinse food particles away.
  • Gingivitis: Inflamed gums provide an anaerobic environment for bacteria.
  • Deep pits/fissures: Provide areas for bacteria/food to become trapped.
  • Orthodontics: Braces and aligners increase plaque retention.
  • Genetics: Enamel quality, saliva composition, oral flora are inherited factors.

Preventing Dental Caries

Preventing dental caries relies heavily on maintaining good oral hygiene and reducing sugary/starchy foods in the diet. Recommendations include:

  • Brush teeth twice daily with fluoride toothpaste.
  • Clean between teeth once daily with floss or interdental brushes.
  • Use antibacterial mouthwashes to reduce bacteria.
  • Limit snacking and refined carbohydrates. Avoid sugary drinks.
  • Chew sugar-free gum to increase saliva flow.
  • Get regular dental cleanings and exams every 6 months.

Treating Dental Caries

Existing dental caries requires professional treatment. Options include:

  • Fillings: Removing decayed material and filling the cavity with gold, silver amalgam or tooth-colored composite resin.
  • Crowns: Covering and replacing the visible part of the tooth when there is extensive damage.
  • Root Canal Therapy: Cleaning out infected pulp and sealing the tooth when caries reach the inner pulp.
  • Extraction: Pulling the tooth when caries destruction is severe.

Periodontal Disease

Periodontal (gum) disease is an infection of the tissues surrounding and supporting the teeth. It is caused by a buildup of plaque bacteria on the teeth. If not treated properly, periodontal disease can lead to painful gum inflammation, receding gums, loosening of teeth, and eventual tooth loss.

Some quick facts about periodontal disease:

  • Caused when plaque builds up below the gumline and leads to gingivitis (gum inflammation).
  • As plaque spreads, the gums detach from the teeth forming pockets that become infected.
  • Bacteria toxins and the body’s immune response break down bone and connective tissues.
  • Progresses from gingivitis to mild periodontitis to severe periodontitis/advanced disease.
  • Common in adults but can affect children too. Hormonal changes in puberty increase risk.
  • Leading cause of tooth loss in adults over age 40.

Major risk factors for periodontal disease include:

  • Poor oral hygiene habits like inadequate brushing.
  • Smoking/tobacco use reduces blood flow and slows healing.
  • Diabetes lessens ability to fight infection.
  • Medications that cause dry mouth or gum enlargement.
  • Stress can lower immune response and increase inflammation.
  • Hormonal changes like pregnancy/puberty affect gum sensitivity.
  • Crooked teeth or fillings increase plaque retention.

Preventing Periodontal Disease

Preventing periodontal disease focuses heavily on plaque control and management of risk factors:

  • Brush properly twice a day and floss once daily.
  • Use antiseptic mouthwashes to reduce bacteria.
  • Get dental cleanings every 6 months.
  • Quit smoking and manage diabetes/stress levels.
  • Have crowded teeth corrected with braces or aligners.

Treating Periodontal Disease

Treating periodontal disease depends on the severity of the condition. Options include:

  • Deep cleanings to remove plaque and calculus from below the gumline.
  • Antibiotics or antimicrobials to reduce infection.
  • Laser therapy to remove diseased pockets and stimulate healing.
  • Flap surgery to clean roots and reattach healthy gum tissue.
  • Bone/tissue grafts to rebuild lost bone or gum line.
  • Extractions if teeth are loose or bone loss is severe.

Oral Cancer

Oral cancer refers to cancer that develops in the tissues of the oral cavity or oropharynx. It often starts as a small white or red lesion in the mouth. Without early detection, oral cancer can quickly spread into surrounding tissues and is associated with significant mortality.

Some quick facts about oral cancer:

  • Most are squamous cell carcinomas starting in the tissues lining the mouth/throat.
  • Can develop in the tongue, gums, lips, insides of the cheeks, roof of the mouth, etc.
  • Linked to tobacco/alcohol use. HPV infection also raises risk.
  • More common in older adults but increasing in younger nonsmokers.
  • Often goes unnoticed in early stages when most treatable.
  • Significant mortality if spreads. 5-year survival is 65% overall.

Major risk factors for oral cancer include:

  • Tobacco smoking, both current and former.
  • Heavy alcohol consumption.
  • HPV16/18 infections.
  • Age over 50 years old.
  • Gender, higher risk in males.
  • Sun exposure, especially for lip cancer.
  • Smokeless tobacco habit.

Preventing Oral Cancer

Preventing oral cancer focuses on reducing exposure to carcinogens and getting treated promptly if any lesions arise:

  • Avoid all tobacco products including vaping devices.
  • Limit alcohol intake and follow dietary guidelines.
  • Protect lips with SPF sunscreen.
  • Get the HPV vaccine if eligible.
  • Have regular oral cancer screenings during dental exams.
  • See a dentist if any oral lesions, sores, induration, or pain occurs.

Treating Oral Cancer

Treating oral cancer depends on the location, size and stage of the tumor. Options include:

  • Surgery to remove the tumor and surrounding margins or lymph nodes.
  • Radiation therapy to damage cancer cells and stop growth.
  • Chemotherapy drugs to kill cancer cells.
  • Targeted therapy to block specific changes in cancer cells.
  • Immunotherapy to boost immune response against cancer cells.

Oral Manifestations of HIV

Oral issues are common in people living with HIV/AIDS. The immune system destruction and opportunistic infections lead to various dental complications.

Some quick facts about oral health and HIV/AIDS:

  • Up to 40%–50% of HIV patients have oral fungal, bacterial or viral infections.
  • Oral candidiasis (thrush) and hairy leukoplakia especially occur early.
  • Periodontal disease is 2–3 times more prevalent.
  • Kaposi’s sarcoma (lesions) and other cancers can arise.
  • Dry mouth due to medications reduces saliva flow and pH.
  • Oral issues can indicate systemic infection or reduced CD4 counts.

Major contributory factors for oral manifestations include:

  • Immune system damage from HIV allows secondary infections.
  • Anti-retroviral medications can cause side effects like dry mouth.
  • Nutritional deficiencies due to AIDS compromise healing.
  • Avoidance of dental care due to stigma of HIV status.

Preventing and Treating Oral Issues with HIV

Oral care for patients with HIV focuses on careful monitoring, managing medications, and controlling infections when they occur. Recommendations include:

  • Brush and floss gently each day if possible.
  • Have more frequent dental cleanings/exams every 3-4 months.
  • Report any oral pain, discomfort, or lesions immediately.
  • Use topical antifungals, analgesics and coating agents as needed.
  • Avoid alcohol/smoking which aggravate infections.
  • Practice safe sex and keep immunizations current.
  • Take anti-retroviral medications regularly as prescribed.


Dental caries, periodontal diseases, oral cancers and HIV complications are four major categories of oral health issues affecting millions globally. While their specific causes and treatments differ, there are some common preventive strategies like reducing sugary foods, stopping tobacco use, practicing good hygiene and getting regular professional cleanings.

Oral health should not be neglected as it impacts physical, mental and social well-being. Detecting issues early and following dental advice provides the best chance at effective treatment and recovery. Public health efforts promoting oral health awareness, prevention and access to care remain vital for reducing the burden of these major oral diseases.