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Explaining Gender Differences in Caries: A Multifactorial Approach to a Multifactorial Disease

DOI: 10.1155/2010/649643

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Many studies have demonstrated that caries rates are higher in women than in men. This review attempts to provide an explanation for this trend by examining each factor which contributes to caries and how the factor differs in men and women. Evidence has been provided to demonstrate that caries risk factors for women include a different salivary composition and flow rate, hormonal fluctuations, dietary habits, genetic variations, and particular social roles among their family. Systemic diseases that have been found to be associated with caries have also been found to have an association with the female gender. An extended exposure to the oral cavity or a more cariogenic oral microflora has not been proven to contribute to higher caries in women. Further research in these areas could be done in the future to explain their contribution, or lack thereof, to a higher caries rate in women. 1. Introduction The significant impact of caries on the world’s population makes the disease an important topic of understanding. The development of caries is multifactorial, depending on many interacting variables to promote its development. In particular, the presence of bacteria, a substrate for the bacteria (food/sugars), the host’s oral environment, as well as the passing of time are the main contributing factors in the formation of caries. Epidemiological and clinical studies, through the use of tools such as DMFT and DMFS scores, have revealed a consistent trend in caries development, with females having higher prevalence than males [1]. The mechanisms underlying the reasoning for this trend can possibly be explained by an investigation of the suggested factors involved in caries development. 2. Genetic Contributions: AMELX The underlying mechanisms of any genetic contributions to the increased prevalence of caries in females versus males can be speculated to reside in the sex chromosomes, exhibiting sex-linked modes of inheritance. Genes present on the X or Y chromosome whose function affects those factors which contribute to the development of caries can be investigated. Variations in these genes would alter the host’s oral environment and the host’s response to the initiation of caries. The Amelogenin (AMELX) gene resides on the p arm of the X chromosome. Its locus is Xp22.31-p22.1 [2]. This gene and its protein product contribute to enamel formation in the dentition. The amelogenin protein constitutes 90% of the enamel matrix [3]. A mutation/deletion in the AMELX gene results in X-linked amelogenesis imperfecta [2]. There is a possibility that a deficient

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