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J Am Dent Assoc. 2000 Jul;131(7):887-99.

The science and practice of caries prevention.

Author information

1
Department of Preventive and Restorative Dental Sciences, University of California, San Francisco 94143, USA. jdbf@itsa.ucsf.edu

Abstract

BACKGROUND AND OVERVIEW:

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.

CLINICAL IMPLICATIONS:

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.

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PMID:
10916327
DOI:
10.14219/jada.archive.2000.0307
[Indexed for MEDLINE]

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