The science and practice of caries prevention.
BACKGROUND
Dental caries is a bacterially based disease. When it progresses, acid produced by bacterial action on dietary fermentable carbohydrates diffuses into the tooth and dissolves the carbonated hydroxyapatite mineral--a process called demineralization. Pathological factors including acidogenic bacteria (mutans streptococci and lactobacilli), salivary dysfunction, and dietary carbohydrates are related to caries progression. Protective factors--which include salivary calcium, phosphate and proteins, salivary flow, fluoride in saliva, and antibacterial components or agents--can balance, prevent or reverse dental caries.


CONCLUSIONS
Caries progression or reversal is determined by the balance between protective and pathological factors. Fluoride, the key agent in battling caries, works primarily via topical mechanisms: inhibition of demineralization, enhancement of remineralization and inhibition of bacterial enzymes.


CONCLUSIONS
Fluoride in drinking water and in fluoride-containing products reduces caries via these topical mechanisms. Antibacterial therapy must be used to combat a high bacterial challenge. For practical caries management and prevention or reversal of dental caries, the sum of the preventive factors must outweigh the pathological factors.
Department of Preventive and Restorative Dental Sciences, University of California, San Francisco 94143, USA. jdbf@itsa.ucsf.edu
J D
JD
Featherstone
D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002118:Calcium / Q000502:physiology; D002327:Cariostatic Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003731:Dental Caries / Q000382:microbiology / Q000517:prevention & control*; D004040:Dietary Carbohydrates / Q000009:adverse effects; D005459:Fluorides / Q000627:therapeutic use; D006801:Humans; D007778:Lactobacillus / Q000187:drug effects / Q000378:metabolism; D010710:Phosphates / Q000502:physiology; D012463:Saliva / Q000378:metabolism / Q000502:physiology; D012471:Salivary Proteins and Peptides / Q000502:physiology; D013295:Streptococcus mutans / Q000187:drug effects / Q000378:metabolism; D017001:Tooth Demineralization / Q000382:microbiology
D000900:Anti-Bacterial Agents; D002327:Cariostatic Agents; D004040:Dietary Carbohydrates; D010710:Phosphates; D012471:Salivary Proteins and Peptides; D005459:Fluorides; D002118:Calcium