Role of micro-organisms in caries etiology.
The microbial etiology of dental caries is discussed in terms of the dynamic relationship among the dental plaque microbiota, dietary carbohydrate, saliva, and the pH-lowering and cariogenic potential of dental plaque. The evidence supports a concept of caries as a dietary carbohydrate-modified bacterial infectious disease. Its key feature is a dietary carbohydrate-induced enrichment of the plaque microbiota with organisms such as the mutans streptococci and lactobacilli which causes an increase of plaque's pH-lowering and cariogenic potential. The shift in the plaque proportions of these organisms appears to be related to their relatively high acid tolerance. A large body of evidence also supports a major effect of saliva on caries development. Integration of salivary effects with the concept of caries as a dietary carbohydrate-modified bacterial infectious disease suggests a broader concept which includes a major role of saliva in the regulation of the exposure of tooth surfaces to carbohydrate and of plaque acidity and, hence, the microbial composition and the pH-lowering and cariogenic potential of dental plaque. It is proposed that caries occurs preferentially in dentition sites characterized by a relatively high exposure to carbohydrate and diminished salivary effects. Some implications of this concept are discussed.
van Houte
J
J
Forsyth Dental Center, Department of Oral Microbiology, Boston, Massachusetts 02115.
D003731:Dental Caries / Q000382:microbiology*; D003773:Dental Plaque / Q000737:chemistry / Q000378:metabolism / Q000382:microbiology; D004037:Diet, Cariogenic; D004040:Dietary Carbohydrates / Q000009:adverse effects* / Q000378:metabolism; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007778:Lactobacillus / Q000378:metabolism / Q000472:pathogenicity*; D012463:Saliva / Q000502:physiology; D013295:Streptococcus mutans / Q000378:metabolism / Q000472:pathogenicity*
D004040:Dietary Carbohydrates