Dental caries - A complete changeover (Part I)

Abstract

In spite of a knowledge explosion in cariology science, dental caries still remains a misunderstood phenomenon by the clinicians. In order to effectively use the wide range of preventive and management strategies, it is imperative to look beyond those black and white spots that manifest on the tooth surfaces. This paper focuses on the revised versions of the etiopathogenesis and definition of dental caries disease in the present century.

Keywords: Dental caries; Lactobacilli; S. mutans; biofilm; cariogenic; demineralization; dental plaque; ecological plaque hypothesis; oral fluid; remineralization; sucrose.

Figure 1

Cause and effect models

Figure 2

‘Determinants - Confounders’ model in dental caries

Figure 3

Ecological plaque hypothesis

Figure 4

Influence of sucrose on the environmental change

Figure 5

Demineralization of hydroxyapatite (HA) and remineralization with fluorapatite (FA) - depicted as stage 1–5 Stage 1: Fermentable sucrose intake. Stage 2: Microbes in cariogenic plaque metabolise them releasing acid in the biofilm-tooth interface. The pH in the interface drops below the critical pH of HA Stage 3: Phosphate ions from oral fluid buffer the acidic ions resulting in undersaturation. Stage 4: HA disintegrates to release the phosphate ions back to the oral fluid till it supersaturates-Demineralization Stage 5: Supersaturated oral fluid re precipitates the minerals onto the disintegrated enamel. If fluoride also deposits FA is formed on the superficial layer - Remineralization. Sub surface demineralization remains.