There are 3 necessary requirements for the formation of dental caries — bacteria, sugar, and, of course, teeth. (Refer to the Chapter 2 Photo Gallery.)

Dental caries is an infectious process, so caries cannot form in the absence of 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 microscopic demineralization of the tooth enamel.

A dynamic and continual process of demineralization and remineralization takes place throughout the day. It takes 20-40 minutes for acids produced during a meal to be neutralized, and only then can the tooth begin to remineralize. Maintaining balance is the goal; however, various factors can tip the balance to one side or the other.

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
		A Non-cariogenic Diet: A diet not contributing to the formation of caries, low in sugar. non-cariogenic diet

It is important to remember that it is possible to reverse the demineralization process before cavitation occurs.