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Protecting All Children's Teeth (PACT): A Pediatric Oral Health Training Program
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Etiology and Pathophysiology

There are 3 necessary requirements for the formation of dental caries (Refer to the Chapter 2 Photo Gallery.) :

  1. Cariogenic bacteria
  2. Sugar
  3. Teeth

Because dental caries has a microbial etiology, caries cannot form in the absence of cariogenic bacteria, regardless of sugar intake.

Bacteria adhere to the tooth surface in a biofilm called dental plaque.

When carbohydrates are consumed, they are metabolized by bacteria and produce acid as a byproduct.

The acid then causes demineralization of the tooth enamel over time.

The following factors contribute to demineralization:

Higher oral bacterial load - Results in more acid production
Frequent feedings - Allows less time for remineralization
Poor oral hygiene - Increases plaque and sugar remains longer
Decreased saliva production

These factors aid in the remineralization process:
Saliva - Acts as a buffer to return the pH above the demineralization level, strengthens tooth enamel, and is a fluoride source
Good oral hygiene - Delivers fluoride and removes bacterial energy sources
Non-cariogenic Diet: A diet not contributing to the formation of caries, low in sugar.
non-cariogenic diet

However, it is important to remember that it is possible to reverse the demineralization process before cavitation occurs.
Fast Facts
Bacteria, sugar, and teeth are each critical elements in the formation of caries.
Caries do not form in the absence of bacteria, regardless of sugar intake.
It takes 20-40 minutes for acids produced during a meal to be neutralized, at which time the tooth can begin to remineralize.
It is possible to reverse the demineralization process before cavitation occurs.
Chapter Photo Gallery
View the Chapter 4 Photo Gallery.
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