Often, this leads to opportunistic pathogens which may cause dental caries and periodontal disease. Water fluoridation and fluoride supplements decrease the incidence of dental caries. Silver diamine fluoride appears to be an effective intervention to reduce dental caries (tooth decay). Fluoride therapy is often recommended to protect against dental caries. Unlike enamel, the dentin reacts to the progression of dental caries. It is associated with active dental caries lesions. Diseases like sinusitis, meningitis and dental caries leave typical traces. Some "Lactobacillus" species have been associated with cases of dental caries (cavities). Compomers are recommended for patients at medium risk of developing dental caries. An extraction can also serve as treatment for dental caries. Glass ionomer cement is primarily used in the prevention of dental caries. Pits and fissure sealants are used as effective controls in preventing caries. Enamel cracks, early caries and resin restorations can be damaged during scaling. The largest increases in the prevalence of caries have been associated with dietary changes. The impact such sugars have on the progress of dental caries is called cariogenicity.