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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—being 5 times more common than asthma and 7 times more common than hay fever.1Despite a decline in dental caries among the population as a whole, this decline has not translated to all age groups, and profound disparities exist among certain populations.2 The Centers for Disease Control and Prevention reported that among children surveyed during the years 1999 to 2002, 28% of 2- to 5-year-old children (representing approximately 4 million US children) have visually evident cavities. Prevalence is apparently trending upward from the 1988 to 1994 estimation that 24% of young children have caries.2 Approximately 80% of dental decay is concentrated in 25% of children.1 In the United States, children of racial and ethnic minorities or low-income families experience the worst oral health, are at the highest risk, and are less likely to obtain timely care compared to their higher-income, non-Hispanic white counterparts.1 Pediatriciansand other primary care professionals are in an ideal position to target these high-risk populations, as children may see their pediatrician for preventive visits up to 10 times before 2 years of age.


As dental caries is a disease process that may be established in infancy, understanding the pathophysiology of dental caries 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, or as soon as possible. The concept of a 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.3 Dental caries is the pathological disease process that leads to the loss of tooth mineral and eventually 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 one 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 along the gingival margin (Fig. 374-1). At this initial stage, the caries process is reversible through the process of remineralization. During remineralization, there ...

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