Elsevier

The Lancet

Volume 369, Issue 9555, 6–12 January 2007, Pages 51-59
The Lancet

Seminar
Dental caries

https://doi.org/10.1016/S0140-6736(07)60031-2Get rights and content

Summary

Dental caries, otherwise known as tooth decay, is one of the most prevalent chronic diseases of people worldwide; individuals are susceptible to this disease throughout their lifetime. Dental caries forms through a complex interaction over time between acid-producing bacteria and fermentable carbohydrate, and many host factors including teeth and saliva. The disease develops in both the crowns and roots of teeth, and it can arise in early childhood as an aggressive tooth decay that affects the primary teeth of infants and toddlers. Risk for caries includes physical, biological, environmental, behavioural, and lifestyle-related factors such as high numbers of cariogenic bacteria, inadequate salivary flow, insufficient fluoride exposure, poor oral hygiene, inappropriate methods of feeding infants, and poverty. The approach to primary prevention should be based on common risk factors. Secondary prevention and treatment should focus on management of the caries process over time for individual patients, with a minimally invasive, tissue-preserving approach.

Section snippets

Definition

Dental caries is the localised destruction of susceptible dental hard tissues by acidic by-products from bacterial fermentation of dietary carbohydrates.4, 6 The signs of the carious demineralisation are seen on the hard dental tissues, but the disease process is initiated within the bacterial biofilm (dental plaque) that covers a tooth surface. Moreover, the very early changes in the enamel are not detected with traditional clinical and radiographic methods. Dental caries is a multifactorial

Pathogenesis

Dental caries results from interactions over time between bacteria that produce acid, a substrate that the bacteria can metabolise, and many host factors that include teeth and saliva. Dental caries results from an ecological imbalance in the physiological equilibrium between tooth minerals and oral microbial biofilms.13, 14 Bacteria live on teeth in microcolonies that are encapsulated in an organic matrix of polysaccharides, proteins, and DNA secreted by the cells, which provides protection

Risk factors

A person's risk of caries can vary with time since many risk factors are changeable. Physical and biological risk factors for enamel or root caries include inadequate salivary flow and composition, high numbers of cariogenic bacteria, insufficient fluoride exposure, gingival recession, immunological components, need for special health care, and genetic factors.4, 19, 20, 21, 22, 23 Caries is related to one's lifestyle, and behavioural factors under a person's control are clearly implicated.

Epidemiology

Comparisons of the global frequency and distribution of dental caries are complicated by diagnostic criteria that differ from study to study,4, 7, 32, 33 but a fall in the prevalence and severity of caries in permanent teeth has been seen in many developed countries over recent decades.3, 34, 35, 36, 37, 38, 39 Also, the rate of progression of the disease slows down with increased age.40 The disease is mainly found in specific teeth and tooth types in both primary and permanent teeth.22, 36 The

Diagnosis

International consensus57 recommends that caries diagnosis, (ie, comprehensive assessment of all patient information by a dentist) is differentiated from lesion detection, (use of objective method to detect disease) and lesion assessment (characterising and monitoring of a lesion once detected). Caries diagnosis, whether in the dental office, during a field survey, or as part of a clinical research project, is done by the visual examination of tooth surfaces, perhaps with the use of a dental

Treatment

Over a long period from the turn of the 20th century dentists have thought of tooth restoration as a cure for dental caries. The focus on restoration and retention of teeth was an advance on the previous treatment method of tooth extraction, and became widely used at a time when there was little knowledge of caries prevention, caries formed quickly, and progression rates were high, but there were few dental practitioners.

In clinical practice, caries management by restorative treatment, despite

Prevention

Discussions about improved methods for caries detection, assessment, and diagnosis for effective caries prevention should not be seen as an alternative to public health and health promotion strategies to reduce the burden of disease before a patient arrives at a dental practice with obvious disease. New clinical developments should work in conjunction with such public health approaches.

In dentistry, the promotion of evidence-based care and the production of clinical guidelines to support

Future research directions

Prevention or control of dental caries cannot be achieved by reliance only on current methods and models of dental care. We need to consider the integrated roles of dental, medical, and other health-care providers and assess effective public health interventions and the introduction of oral health promotion activity linked to general health promotion. Most importantly, caregivers of children could play a major part in keeping children free of obvious dental caries.

Initiatives recently announced

Search strategy and inclusion criteria

Sources of information for this Seminar were: (1) systematic reviews of dental caries (cariology), including the Cochrane Library, Centre for Reviews and Dissemination, University of York (restoration longevity), and the NIH Consensus Development Conference on Diagnosis and Management of Dental Caries Throughout Life; (2) formally constructed and peer reviewed consensus development papers and statements published in the Proceedings from the International Consensus Workshop on Caries

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