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Etiology and Pathophysiology
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.
 
 
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.
View the Chapter 4 Photo Gallery.