Dental Caries: Etiology, Prevention & Management

Dental caries (tooth decay) is a biofilm‑mediated, sugar‑driven, dynamic disease causing net mineral loss from tooth hard tissues.

Pathophysiology (The Caries Balance)

• Pathologic factors: cariogenic bacteria (S. mutans, Lactobacillus), frequent fermentable carbohydrate intake, reduced salivary flow.
• Protective factors: saliva (buffer, calcium/phosphate, antimicrobial), fluoride (remineralization, antibacterial), antibacterial agents (chlorhexidine, xylitol), sealants.

Risk Assessment (CAMBRA)

Caries Management By Risk Assessment categorizes low/moderate/high/extreme risk based on clinical, behavioral, and biologic factors.

Prevention Strategies

1. Fluoride: community water (0.7 ppm), toothpaste (1000–1500 ppm), varnish q3–6 mo (high risk).
2. Oral hygiene: brush 2×/day with fluoride paste; floss/interdental clean daily.
3. Diet: limit frequency of sugary/acidic exposures; avoid sipping sweet drinks.
4. Sealants: pit‑and‑fissure sealants on permanent molars (reduce caries 80%).
5. Regular dental visits: risk‑based recall (3–12 mo).

Treatment by Stage

• Initial (non‑cavitated): fluoride, sealant, resin infiltration (ICON).
• Cavitated: minimally invasive removal + composite/GIC restoration.
• Deep / pulp involvement: indirect/direct pulp cap, pulpotomy, RCT.

Special Populations

• Early childhood caries (ECC): first dental visit by age 1.
• Xerostomia: saliva substitutes, high‑fluoride paste, frequent sips water.
• Orthodontic patients: enhanced hygiene, fluoride rinse.