[Neuere konzeptionen uber die Zahnkaries]

Usprkos opće poznatoj činjenici, da 98 % civiliziranog čovječanstva boluje od zubnog karijesa, ne može se točno d efinirati, što je zubni karijes. Budući da nije u tančine razjašnjen mehanizam nastajanja kariozne lezije, autori iznose uvodno nekoliko teorija , odnosno hipoteza, o postanku karijesa. Kritički se osvrću na koncepcije i ističu da neke nemaju znanstvenu potvrdu. U Članku se opisuju faktori, koji sudjeluju u karioznom zbivanju, a to su fizikalna i kemijska svojstva tvrdih supstancija zuba, mikroorganizmi usne šupljine te način i navike prehrane. Za vrijeme razvoja, zubi imaju prioritet u metabolizmu. Samo ekstremni nedostatak kalcija i fosfora, odražava se na tvrdim zubnim supstancama. Odlaganje fluorida u površni sloj cakline povećava rezistenciju prema karijesu. Najveće ulaganje fluorida je nakon formiranja cakline, a prije izbijanja zuba. Do razvoja karijesa ne može doći bez bakterija. Suprotno ranijem mišljenju uzročnici su možda streptokoki, koji stvaraju kiseline. Laktobacili pak igraju podređenu ulogu. Za metabolizam bakterija pri stvaranju kiselina potrebni su ugljikohidrati. Ugljikohidrati su kariogeni, ako se uzimaju između obroka i u ljep ljivom obliku. Karijes se razvija ispod dentobakterijskog plaka i to na retencijskim mjestima. Autori zaključuju , da površine bez plaka, što znači bez ostataka hrane i mikroorganizama, nemaju u pravilu nikad karijes pa smatraju, da je higijena usta važan faktor borbe protiv karijesa, osobito kod urbaniziranog i civiliziranog čovjeka, zbog konzumacije rafinirane hrane, koja ne zahtijeva jaču mastikaciju.In spite of the generally known fact that about 9 8% of the civilized human race suffer from dental caries, it is not possible to define precisely the essence of dental caries. Since the mechanism of the carious lesion has not been explained in detail, several theories respectively hypotheses about the development of caries are discussed. An attempt is made at criticaIly assessing the different conceptions and it is emphasized that some of thems till lack scientific confirmation . Factors are described in the article that take part in the development of caries, i.e. physical and chemical properties of the firm substance of teeth, microorganisms in the oral cavity and nutritive manners and habits.The teeth have priority in the metabolism during the development phase. Only extreme lack of calcium and phosphorus are reflected in the hard dental substance. Deposita of fluoride in the superficial layer of the enamel increase the resistance to caries. The greatest depositing of fluoride takes place during the forming of the enamel and before primary dentition is completed. The development of caries cannot progress with out the presence of bacteria. Contrary to earlier opinions the causative agents are streptococci forming acids. The lactob acilli, however, play a subordinate role. Carbohydrates are necessary for the metabolism of the bacteria during the production of acids. Carbohydrates are cariogenic if taken between meals and in the glutinous form . Caries forms below the dentobacterial plaque and in the retention sites. The authors conclude that as a rule caries never develops in the surfaces void of plaques, which means with out remnants of food and microorganisms. They consider that oral hygiene is an important factor in combating caries, particularly in the urban population and in civilised people because of the consumption of highly processed food which does not require vigorous mastication.Trotz der allgemein bekannten Tatsache dass 9 8% der zivilisierten Menschheit von Zahnkaries befallen ist, ist das Wesen der Erkrankung nicht genau bekannt. Eingangs werden einige Theorien, bzw. Hypothesen uber die Entstehung der Zahnkaries vorgebracht, und kritisch beleuchtet. Die Faktoren die am Kariesgeschehen teilnehmen, die physikalischen und chemischen Eigenschaften der Zahnhartsubstanzen, Mikroorganismen der Mundhohle und die Ernahrungsgevvonheiten, werden beschrieben. Im Entwicklungsstadium hat der Zahn der Vorzug im Metabolismus. Nur extrem er Kalzium- und Phosphor-Mangel wirkt sich an den Zahnhartsubstanzen aus. Die Ablagerung von Fluorsalzen in die Oberflachenschicht des Schmelzes erhoht die Resistenz auf Karies, besonders nachdem die Schmelzschichte schon gebildet ist und vor dem Zahndurchbruch. Ohne Bakterien gibt es keine Karies. Im Gegensatz zur bisherigen Meinung sind daran saureerzeugende Streptococcen beteiligt. Laktobazillen spielen nur eine untergeordnete Rolle. Fur die Saureentstehung mussen Kohlehydrate anwesend sein, welche kariogen wirken wenn sie zwischen den Mahlzeiten und in klebrigem Zustand eingenommen werden. Die Karies entsteht unter der dentobakteriellen Schicht und an Retentionsstellen. Die Autoren schliessen daraus, dass an plaquefreien Flachen keine Karies entsteht, daher die Mundpflege ein sehr wichtiger Faktor im Kampf gegen die Karies ist, besonders beim zivilisierten Menschen dessen Speisen keine starke Kautatigkeit erfordern