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Dental caries, more commonly known as tooth decay or cavities, is an infectious, transmissible, diet-mediated oral disease that is largely preventable. It is the most common chronic disease among US children—5 times more common than asthma and 7 times more common than hay fever. In the United States, approximately 1 in 4 children who are 2 to 5 years of age have experienced dental caries. Caries prevalence increases with age, such that approximately 1 in 2 children aged 6 to 8 years have experienced caries in their primary teeth. In permanent teeth, approximately 1 in 5 children aged 6 to 11 years, 1 in 2 adolescents aged 12 to 15 years, and 2 in 3 adolescents aged 16 to 19 years have experienced caries. Children of racial and ethnic minorities and low-income families have higher rates of dental caries and untreated dental caries compared to their higher-income, non-Hispanic white counterparts. Since young children see their pediatrician for preventive visits more often (up to 10 times before age 2 years) than they visit their dentist, it is important that pediatricians and other primary care providers are knowledgeable about addressing dental caries by assessing risk and intervening with various strategies to prevent dental caries and promote optimal oral health in children.


As dental caries is a disease process that may be established in infancy, understanding its pathogenesis enables the pediatrician to conduct a dental caries risk assessment; provide anticipatory guidance and preventive counseling; and, in collaboration with their dental colleagues, ensure the establishment of a dental home by age 1 year, or as soon as possible. The concept of the dental home is derived from the American Academy of Pediatrics’ definition of a medical home. The dental home is the ongoing relationship between the dentist and the patient, inclusive of all aspects of oral health care delivered in a comprehensive, continuously accessible, coordinated, and family-centered way.

Dental caries is the pathological disease process that leads to the loss of tooth mineral and eventually to cavitation of the tooth surface (“cavity”). The etiology of dental caries is multifactorial. The primary components required for dental caries activity to become established are 1 or more susceptible tooth surfaces, cariogenic (decay-causing) bacteria, fermentable carbohydrates (particularly sucrose), and time. Dental caries results from an overgrowth of specific oral bacteria that are present in dental plaque (the sticky white or yellow biofilm that forms on the tooth surface). The cariogenic bacteria are acidogenic, which means they produce acids by metabolizing fermentable carbohydrates. These acids lead to the loss of minerals (demineralization) such as calcium, phosphate, and carbonate from the tooth. The first sign of demineralization is a thin white line, typically along the gingival margin (Fig. 369-1). At this initial stage, the caries process is reversible through the process of remineralization. During remineralization, there is an uptake of ...

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