Faculty Bibliography

This paper discusses the role of dental biofilm and adjunctive therapies in the management of dental caries. Dental biofilm is a site of bacterial proliferation and growth, in addition to being a location of acid production. It also serves as a reservoir for calcium exchange between the tooth and saliva. The salivary pellicle, a protein-rich biofilm layer, regulates the reaction between tooth surface, saliva and erosive acids. The protective effects of this pellicle on enamel are well established. However, understanding the effects of the pellicle/biofilm interaction in protecting dentin from erosive conditions requires further research. Saliva interacts with the biofilm, and is important in reducing the cariogenic effects of dental plaque as acidogenic bacteria consume fermentable carbohydrates producing acids that may result in tooth demineralization. Adequate supplies of healthy saliva can provide ingredients for successful remineralization. Strategies for managing the cariogenic biofilm are discussed with emphasis on the effectiveness of over-the-counter (OTC) products. However, since many toothpaste components have been altered recently, new clinical trials may be required for true validation of product effectiveness. A new generation of calcium-based remineralizing technologies may offer the ability to reverse the effects of demineralization. Nevertheless, remineralization is a microscopic subsurface phenomenon, and it will not macroscopically replace tooth structure lost in a cavitated lesion. Optimal management of cavitations requires early detection. This, coupled with advances in adhesive restorative materials and microsurgical technique, will allow the tooth to be restored with minimal destruction to nearby healthy tissue

Dental caries is a dietary and host-modified biofilm disease process, transmissible early in life that, if left untreated, will cause destruction of dental hard tissues. If allowed to progress, the disease will result in the development of caries lesions on tooth surfaces, which initially are noncavitated (eg, white spots), and eventually can progress to cavitation. The 'medical model,' where the etiologic disease-driving agents are balanced against protective factors, in combination with risk assessment, offers the possibility of patient-centered disease prevention and management before there is irreversible damage done to the teeth. This article discusses how to use evidence supporting risk assessment and management strategies for the caries process