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Smiles For Tomorrow

Course Number: 4

Dental Caries and Prevention

Dental Caries

The Centers for Disease Control and Prevention reports that caries is the most prevalent infectious disease in our nation’s children. Early childhood caries (ECC) can be a particularly virulent form of caries, beginning soon after primary tooth eruption, usually developing first on smooth surfaces, progressing rapidly, having a lasting detrimental impact on the dentition.


Severe Early Childhood Caries (ECC)

Newer theories on the etiology of tooth decay and transmission of causative organisms highlight the fact that dental caries is an infectious and communicable disease. This review of the caries process covers:

  • Etiology and Transmission

  • The Caries Process

  • Patterns of Decay

  • Caries Risk Assessment

  • Anticipatory Guidance

Etiology and Transmission

In the simplest terms, the process of dental caries can be illustrated by this Venn diagram:

  • Susceptible tooth

  • Presence of bacteria

  • Access to fermentable carbohydrates and cooked starches

  • Time

Bacteria use dietary fermentable carbohydrates (principally sugars and cooked starches) as a substrate for acid production, resulting in a lowering of the pH of the area. Species of Streptococcus and Lactobacillus are most often implicated in the caries process.


Dental Caries Etiology:

However, we now know that caries is a multifactorial, chronic disease with many outside influences.

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Influences on Children's Oral Health: A Conceptual Model

Source: Fisher-Owens SA, Gansky SA, Platt LJ, et al. Influences on children's oral health: A conceptual model. Pediatrics. 2007;120(3):e510-20. doi: 120/3/e510 [pii].

Streptococcus mutans acquisition is usually associated with the eruption of the first primary teeth. However, S. mutans may appear as an oral microbe in the infant prior to the eruption of primary teeth primarily through direct transmission between caregiver and child. Transmission from caregivers with high levels of S. mutans can be delayed or prevented by the caregiver initiating a prevention program for that includes meticulous oral hygiene.


Streptococcus Mutans Transmission