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Center for Oral Biology, University of Rochester, Rochester, NY 14642; william_bowen{at}urmc.rochester.edu
CONTROVERSY Caries is an unique dieto-bacterial disease and not simply an infection. The disease occurs on essentially an inanimate surface, and therefore the traditional methods of studying diseases may not apply. The following article brings into focus that, for decades, investigation of the pathogenesis of dental caries has been largely restricted to acid production. Now there is clear evidence that glucan production by bacteria from dietary substrate plays a critical role, and growing evidence that lack of alkali production by dental plaque is critical in the pathogenesis of this still-ubiquitous disease.
–Olav Alvares, Editor
Dental caries continues to be a pubic health problem despite claims that 50% of schoolchildren are caries-free. There are widespread variations in the prevalence of caries worldwide. Caries lesions are the clinical manifestation of a pathogenic process that may have been occurring on the tooth surface for months or years. Acid production by bacteria embedded in a biofilm termed "dental plaque" is a key aspect of the pathogenesis of dental caries; nevertheless, the ability of micro-organisms to survive in a hostile acid milieu and the influence of fluoride and additional agents on this acid tolerance receive scant attention. Study of cariogenic micro-organisms largely has been limited to observations made on them in the planktonic state; clearly dental caries is essentially a surface phenomenon, and micro-organisms behave distinctively when grown on a surface. Although significant progress has been made in our understanding of the etiology, pathogenesis, and prevention of dental caries, it still remains a scientific and clinical enigma worthy of the attention of the best scientists.
Key words. Dental caries, pathogenesis, glucans, fluoride
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