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Dental caries

Nature Reviews Disease Primers volume 3, Article number: 17030 (2017) Cite this article

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Abstract

Dental caries is a biofilm-mediated, sugar-driven, multifactorial, dynamic disease that results in the phasic demineralization and remineralization of dental hard tissues. Caries can occur throughout life, both in primary and permanent dentitions, and can damage the tooth crown and, in later life, exposed root surfaces. The balance between pathological and protective factors influences the initiation and progression of caries. This interplay between factors underpins the classification of individuals and groups into caries risk categories, allowing an increasingly tailored approach to care. Dental caries is an unevenly distributed, preventable disease with considerable economic and quality-of-life burdens. The daily use of fluoride toothpaste is seen as the main reason for the overall decline of caries worldwide over recent decades. This Primer aims to provide a global overview of caries, acknowledging the historical era dominated by restoration of tooth decay by surgical means, but focuses on current, progressive and more holistic long-term, patient-centred, tooth-preserving preventive care.

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Figure 1: Normal tooth anatomy and developing dental biofilm.
Figure 2: Balancing pathological and protective factors in dental caries.
Figure 3: Impact of different disease detection thresholds on epidemiological surveys.
Figure 4: Ecological plaque hypothesis to explain the aetiology of dental caries.
Figure 5: Overview of the ICCMS™ system with its four key elements.
Figure 6: Clinical and radiographic appearance of the stages of severity of tooth decay.
Figure 7: ICCMS™ caries management plan.

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References

  1. Pitts, N. B. & Zero, D. T. White paper on dental caries prevention and management. FDI World Dental Federationhttp://www.fdiworlddental.org/sites/default/files/media/documents/2016-fdi_cpp-white_paper.pdf (2016). This paper outlines the background evidence and recommendations for action on issues that are deemed by the Council of the FDI World Dental Federation to be priorities in the field of dental caries prevention and management.

  2. Koussoulakou, D. S., Margaritis, L. H. & Koussoulakos, S. L. A curriculum vitae of teeth: evolution, generation, regeneration. Int. J. Biol. Sci. 5, 226–243 (2009).

    Google Scholar 

  3. Petersen, P.-E., Bourgeois, D., Ogawa, H., Estupinan-Day, S. & Ndiaye, C. The global burden of oral diseases and risks to oral health. Bull. World Health Organ. 83, 661–669 (2005).

    Google Scholar 

  4. Broadbent, J. M., Thomson, W. M. & Poulton, R. Trajectory patterns of dental caries experience in the permanent dentition to the fourth decade of life. J. Dent. Res. 87, 69–72 (2008). This paper provides a rare and excellent perspective on longitudinal caries data on adults and shows how caries develops over the life course.

    Google Scholar 

  5. Pitts, N. et al. Global oral heath inequalities: dental caries task group — research agenda. Adv. Dent. Res. 23, 211–220 (2011).

    Google Scholar 

  6. American Academy of Pediatric Dentistry. American Academy of Pediatric Dentistry reference manual 2014–2015. Pediatr. Dent. 36 (6 reference manual), 1–140 (2014).

    Google Scholar 

  7. US Department of Health and Human Services. Oral health in America: a report of the Surgeon General. National Institute of Dental and Craniofacial Researchhttps://www.nidcr.nih.gov/datastatistics/surgeongeneral/report/executivesummary.htm (2000).

  8. Dye, B. A. et al. Trends in pediatric dental caries by poverty status in the US. Int. J. Paediatr. Dent. 20, 132–143 (2010).

    Google Scholar 

  9. Dye, B. A. et al. Trends in oral health status: United States, 1988–1994 and 1999–2004. Vital Health Stat. 11, 1–92 (2007).

    Google Scholar 

  10. Dye, B. A., Vargas, C. M., Fryar, C. D., Ramos-Gomez, F. & Isman, R. Oral health status of children in Los Angeles County and in the United States, 1999–2004. Community Dent. Oral Epidemiol. 45, 135–144 (2016).

    Google Scholar 

  11. Pitts, N. B. Discovering dental public health: from Fisher to the future. Community Dent. Health 11, 172–178 (1994).

    Google Scholar 

  12. Topping, G. V. & Pitts, N. B. in Detection, Assessment, Diagnosis and Monitoring of Caries Vol. 21 (ed. Pitts, N. ) 15–41 (Karger, 2009). This paper outlines original consensus developments and literature supporting the ICDAS caries classification system, which is designed to be used in epidemiology, research, practice and education.

    Google Scholar 

  13. Kühnisch, J. et al. Occlusal caries detection in permanent molars according to WHO basic methods, ICDAS II and laser fluorescence measurements. Community Dent. Oral Epidemiol. 36, 475–484 (2008).

    Google Scholar 

  14. Pitts, N. B., Chadwick, B. & Anderson, T. Children's Dental Health Survey 2013. Report 2: dental disease and damage in children: England, Wales and Northern Ireland. National Health Servicehttp://content.digital.nhs.uk/catalogue/PUB17137/CDHS2013-Report2-Dental-Disease.pdf (2015).

  15. Patel, R. N. et al. Variability of methodologies used to determine national mean DMFT scores for 12-year-old children in European countries. Community Dent. Health 33, 286–291 (2016).

    Google Scholar 

  16. Pitts, N., Melo, P., Martignon, S., Ekstrand, K. & Ismail, A. Caries risk assessment, diagnosis and synthesis in the context of a European Core Curriculum in Cariology. Eur. J. Dent. Educ. 15 (Suppl. 1), 23–31 (2011).

    Google Scholar 

  17. Agustsdottir, H. et al. Caries prevalence of permanent teeth: a national survey of children in Iceland using ICDAS. Community Dent. Oral Epidemiol. 38, 299–309 (2010).

    Google Scholar 

  18. Marcenes, W. et al. Global burden of oral conditions in 1990–2010: a systematic analysis. J. Dent. Res. 92, 592–597 (2013).

    Google Scholar 

  19. Moynihan, P. J. & Kelly, S. A. Effect on caries of restricting sugars intake: systematic review to inform WHO guidelines. J. Dent. Res. 93, 8–18 (2014). This rigorous systematic review of the impact of sugar intake on caries development formed the basis of the recent WHO guidance on sugar consumption for caries, obesity and diabetes mellitus.

    Google Scholar 

  20. Sheiham, A. & James, W. P. Diet and dental caries: the pivotal role of free sugars reemphasized. J. Dent. Res. 94, 1341–1347 (2015).

    Google Scholar 

  21. Zero, D. T. et al. The biology, prevention, diagnosis and treatment of dental caries: scientific advances in the United States. J. Am. Dent. Assoc. 140 (Suppl. 1), 25S–34S (2009).

    Google Scholar 

  22. Reisine, S. & Litt, M. Social and psychological theories and their use for dental practice. Int. Dent. J. 43, 279–287 (1993).

    Google Scholar 

  23. Fejerskov, O. Concepts of dental caries and their consequences for understanding the disease. Community Dent. Oral Epidemiol. 25, 5–12 (1997).

    Google Scholar 

  24. Selwitz, R. H., Ismail, A. I. & Pitts, N. B. Dental caries. Lancet 369, 51–59 (2007).

    Google Scholar 

  25. Zero, D. T. Sugars — the arch criminal? Caries Res. 38, 277–285 (2004).

    Google Scholar 

  26. Takahashi, N. Microbial ecosystem in the oral cavity: metabolic diversity in an ecological niche and its relationship with oral diseases. Int. Congr. Ser. 1284, 103–112 (2005).

    Google Scholar 

  27. Zero, D. T. Dental caries process. Dent. Clin. North Am. 43, 635–664 (1999).

    Google Scholar 

  28. ten Cate, J. M. & Featherstone, J. D. Mechanistic aspects of the interactions between fluoride and dental enamel. Crit. Rev. Oral Biol. Med. 2, 283–296 (1991).

    Google Scholar 

  29. Featherstone, J. D. The continuum of dental caries — evidence for a dynamic disease process. J. Dent. Res. 83, C39–C42 (2004). This paper provides an overview of the dynamic nature of the caries process with alternating periods of demineralization and remineralization and how changing risk factors can affect the caries balance.

    Google Scholar 

  30. Wilson, M. Microbial Inhabitants of Humans. Their Ecology and Role in Health and Disease (Cambridge Univ. Press, 2005).

    Google Scholar 

  31. Devine, D. A., Marsh, P. D. & Meade, J. Modulation of host responses by oral commensal bacteria. J. Oral Microbiol. 7, 26941 (2015).

    Google Scholar 

  32. Nobbs, A. H., Jenkinson, H. F. & Jakubovics, N. S. Stick to your gums: mechanisms of oral microbial adherence. J. Dent. Res. 90, 1271–1278 (2011).

    Google Scholar 

  33. Zijnge, V. et al. Oral biofilm architecture on natural teeth. PLoS ONE 5, e9321 (2010).

    Google Scholar 

  34. Wright, C. J. et al. Microbial interactions in building of communities. Mol. Oral Microbiol. 28, 83–101 (2013).

    Google Scholar 

  35. Scannapieco, F. A. Saliva–bacterium interactions in oral microbial ecology. Crit. Rev. Oral Biol. Med. 5, 203–248 (1994).

    Google Scholar 

  36. Hara, A. T. & Zero, D. T. The caries environment: saliva, pellicle, diet, and hard tissue ultrastructure. Dent. Clin. North Am. 54, 455–467 (2010).

    Google Scholar 

  37. Jakubovics, N. S., Yassin, S. A. & Rickard, A. H. Community interactions of oral streptococci. Adv. Appl. Microbiol. 87, 43–110 (2014).

    Google Scholar 

  38. Klein, M. I., Hwang, G., Santos, P. H., Campanella, O. H. & Koo, H. Streptococcus mutans-derived extracellular matrix in cariogenic oral biofilms. Front. Cell. Infect. Microbiol. 5, 10 (2015).

    Google Scholar 

  39. Sheiham, A. & James, W. P. A reappraisal of the quantitative relationship between sugar intake and dental caries: the need for new criteria for developing goals for sugar intake. BMC Public Health 14, 863 (2014).

    Google Scholar 

  40. Loesche, W. J. Role of Streptococcus mutans in human dental decay. Microbiol. Rev. 50, 353–380 (1986).

    Google Scholar 

  41. Rosier, B. T., De Jager, M., Zaura, E. & Krom, B. P. Historical and contemporary hypotheses on the development of oral diseases: are we there yet? Front. Cell. Infect. Microbiol. 4, 92 (2014).

    Google Scholar 

  42. Marsh, P. D. Are dental diseases examples of ecological catastrophes? Microbiology 149, 279–294 (2003). This is an important paper outlining the shift of thinking around the ecological relationship between the biofilm and the tooth in health and disease and how this links to caries pathogenesis.

    Google Scholar 

  43. Takahashi, N. & Nyvad, B. Caries ecology revisited: microbial dynamics and the caries process. Caries Res. 42, 409–418 (2008).

    Google Scholar 

  44. Hong, L., Levy, S. M., Warren, J. J. & Broffitt, B. Association between enamel hypoplasia and dental caries in primary second molars: a cohort study. Caries Res. 43, 345–353 (2009).

    Google Scholar 

  45. Fisher, J. & Glick, M. A new model for caries classification and management: the FDI World Dental Federation caries matrix. J. Am. Dent. Assoc. 143, 546–551 (2012).

    Google Scholar 

  46. Ismail, A. et al. Caries management pathways preserve dental tissues and promote oral health. Community Dent. Oral Epidemiol. 41, e12–e40 (2013).

    Google Scholar 

  47. Pitts, N. B. & Ekstrand, K. R. International Caries Detection and Assessment System (ICDAS) and its International Caries Classification and Management System (ICCMS) — methods for staging of the caries process and enabling dentists to manage caries. Community Dent. Oral Epidemiol. 41, e41–e52 (2013). This paper describes the journey from the caries classification of the ICDAS system to the integrated clinical, radiographic and risk-based caries management system ICCMS™.

    Google Scholar 

  48. International Caries Detection and Assessment System (ICDAS) Foundation. What is ICDAS. ICDAS Foundationhttps://www.icdas.org/what-is-icdas (2017).

  49. Pitts, N. B. et al. ICCMS™ guide for practitioners and educators. ICDAS Foundationhttps://www.icdas.org/uploads/ICCMS-Guide_Full_Guide_With_Appendices_UK.pdf (2014). This guide outlines best evidence as to how the ICCMS™ caries management system can be used practically by both educators and clinicians.

  50. Ismail, A., Pitts, N. B. & Tellez, M. The international caries classification and management system (ICCMSTM) an example of a caries management pathway. BMC Oral Health 15, S9 (2015).

    Google Scholar 

  51. Watt, R. G. Social determinants of oral health inequalities: implications for action. Community Dent. Oral Epidemiol. 40 (Suppl. 2), 44–48 (2012). This paper considers the important social determinants underlying oral health inequalities and outlines action required to improve health equity.

    Google Scholar 

  52. Jürgensen, N. & Petersen, P. E. Promoting oral health of children through schools — results from a WHO global survey. Community Dent. Health 30, 204–218 (2013).

    Google Scholar 

  53. World Health Organization. Oral health: action plan for promotion and integrated disease prevention. WHOhttp://apps.who.int/iris/bitstream/10665/21909/1/b120_10-en.pdf (2006).

  54. Weintraub, J. A. Sustainable oral health interventions. J. Public Health Dent. 71, S95–S96 (2011).

    Google Scholar 

  55. Panagakos, F. Partners in prevention: a winning approach for communities and companies. J. Evid. Base Dent. Pract. 12, 58–61 (2012).

    Google Scholar 

  56. Alliance for a Cavity-Free Future. About the alliance for a cavity-free future. Alliance for a Cavity-Free Futurewww.allianceforacavityfreefuture.org/en/us/about-us (2016).

  57. The Community Preventive Services Task Force. Dental caries (cavities): community water fluoridation. The Community Guidewww.thecommunityguide.org/oral/fluoridation.html (2013).

  58. U.S. Department of Health and Human Services Federal Panel on Community Water Fluoridation. U.S. Public Health Service recommendation for fluoride concentration in drinking water for the prevention of dental caries. Public Health Rep. 130, 318–331 (2015).

    Google Scholar 

  59. Griffin, S. O., Jones, K. & Tomar, S. L. An economic evaluation of community water fluoridation. J. Public Health Dent. 61, 78–86 (2001).

    Google Scholar 

  60. World Health Organization. Guidelines for drinking-water quality. WHOhttp://apps.who.int/iris/bitstream/10665/44584/1/9789241548151_eng.pdf (2011).

  61. Pollick, H. F. Salt fluoridation: a review. J. Calif. Dent. Assoc. 41, 395–404 (2013).

    Google Scholar 

  62. Marthaler, T. M. Salt fluoridation and oral health. Acta Med. Acad. 42, 140–155 (2013).

    Google Scholar 

  63. Bánóczy, J., Rugg-Gunn, A. & Woodward, M. Milk fluoridation for the prevention of dental caries. Acta Med. Acad. 42, 156–167 (2013).

    Google Scholar 

  64. Yeung, C. A., Chong, L. Y. & Glenny, A. M. Fluoridated milk for preventing dental caries. Cochrane Database Syst. Rev. 3, CD003876 (2015).

    Google Scholar 

  65. Wright, J. T. et al. Evidence-based clinical practice guideline for the use of pit-and-fissure sealants: a report of the American Dental Association and the American Academy of Pediatric Dentistry. J. Am. Dent. Assoc. 147, 672–682 (2016).

    Google Scholar 

  66. The Community Preventive Services Task Force. Dental caries (cavities): school-based dental sealant delivery programs. The Community Guidewww.thecommunityguide.org/oral/schoolsealants.html (2013).

  67. Griffin, S. O. et al. Use of dental care and effective preventive services in preventing tooth decay among U.S. Children and adolescents — Medical Expenditure Panel Survey, United States, 2003–2009 and National Health and Nutrition Examination Survey, United States, 2005–2010. MMWR Suppl. 63, 54–60 (2014).

    Google Scholar 

  68. Siegal, M. D. & Detty, A. M. Do school-based dental sealant programs reach higher risk children? J. Public Health Dent. 70, 181–187 (2010).

    Google Scholar 

  69. Weintraub, J. A., Stearns, S. C., Rozier, R. G. & Huang, C. C. Treatment outcomes and costs of dental sealants among children enrolled in Medicaid. Am. J. Public Health. 91, 1877–1881 (2001).

    Google Scholar 

  70. Mariño, R., Fajardo, J. & Morgan, M. Cost-effectiveness models for dental caries prevention programmes among Chilean schoolchildren. Community Dent. Health 29, 302–308 (2012).

    Google Scholar 

  71. Edelstein, B. L., Hirsch, G., Frosh, M. & Kumar, J. Reducing early childhood caries in a Medicaid population: a systems model analysis. J. Am. Dent. Assoc. 146, 224–232 (2015).

    Google Scholar 

  72. Public Health England. Delivering better oral health: an evidence-based toolkit for prevention — third edition. Gov.ukhttps://www.gov.uk/government/uploads/system/uploads/attachment_data/file/601832/delivering_better_oral_health.pdf (2014).

  73. Scottish Intercollegiate Guidelines Network. SIGN138. Dental interventions to prevent caries in children: a national clinical guideline. Scottish Intercollegiate Guidelines Networkhttp://www.sign.ac.uk/pdf/SIGN138.pdf (2014).

  74. Weyant, R. J. et al. Topical fluoride for caries prevention: executive summary of the updated clinical recommendations and supporting systematic review. J. Am. Dent. Assoc. 144, 1279–1291 (2013).

    Google Scholar 

  75. Marinho, V. C., Higgins, J. P., Logan, S. & Sheiham, A. Topical fluoride (toothpastes, mouthrinses, gels or varnishes) for preventing dental caries in children and adolescents. Cochrane Database Syst. Rev. 4, CD002782 (2003).

    Google Scholar 

  76. World Health Organization. Guideline: sugars intake for adults and children. WHOhttp://apps.who.int/iris/bitstream/10665/149782/1/9789241549028_eng.pdf (2015).

  77. Disney, J. A. et al. The University of North Carolina Caries Risk Assessment study: further developments in caries risk prediction. Community Dent. Oral Epidemiol. 20, 64–75 (1992).

    Google Scholar 

  78. Bratthall, D. & Hänsel Petersson, G. Cariogram — a multifactorial risk assessment model for a multifactorial disease. Community Dent. Oral Epidemiol. 33, 256–264 (2005).

    Google Scholar 

  79. Twetman, S., Ekstrand, K. R. & Keller, M. K. Caries — en biofilmmedieret sygdom. Tandlægebladet 17, 1–6 (English summary) (2013).

    Google Scholar 

  80. Walsh, T. et al. Fluoride toothpastes of different concentrations for preventing dental caries in children and adolescents. Cochrane Database Syst. Rev. 1, CD007868 (2010).

    Google Scholar 

  81. Carvalho, J. C., Ekstrand, K. R. & Thylstrup, A. Dental plaque and caries on occlusal surfaces of first permanent molars in relation to stage of eruption. J. Dent. Res. 68, 773–779 (1989).

    Google Scholar 

  82. Mejàre, I. Bitewing examination to detect caries in children and adolescents — when and how often? Dent. Update 32, 588–590 (2005).

    Google Scholar 

  83. Ridell, K., Olsson, H. & Mejàre, I. Unrestored dentin caries and deep dentin restorations in Swedish adolescents. Caries Res. 42, 164–170 (2008).

    Google Scholar 

  84. Ekstrand, K. R., Bruun, G. & Bruun, M. Plaque and gingival status as indicators for caries progression on approximal surfaces. Caries Res. 32, 41–45 (1998).

    Google Scholar 

  85. Ekstrand, K. R., Martignon, S., Ricketts, D. J. & Qvist, V. Detection and activity assessment of primary coronal caries lesions: a methodologic study. Oper. Dent. 32, 225–235 (2007).

    Google Scholar 

  86. Amaechi, B. T. Remineralization therapies for initial caries lesions. Curr. Oral Health Rep. 2, 95–101 (2015).

    Google Scholar 

  87. Zero, D. T. Dentifrices, mouthwashes, and remineralization/caries arrestment strategies. BMC Oral Health 6, S9 (2006).

    Google Scholar 

  88. Ten Cate, J. M. & Fetherstone, J. D. Mechanistic aspects of the interactions between fluoride and dental enamel. Crit. Rev. Oral Biol. Med. 2, 283–296 (1991).

    Google Scholar 

  89. Newbrun, E. Topical fluorides in caries prevention and management: a North American perspective. J. Dent. Educ. 65, 1078–1083 (2001).

    Google Scholar 

  90. Lee, Y. E. et al. Comparison of remineralization effect of three topical fluoride regimens on enamel initial carious lesions. J. Dent. 38, 166–171 (2010).

    Google Scholar 

  91. Amaechi, B. T. & van Loveren, C. Fluorides and non-fluoride remineralization systems. Monogr. Oral Sci. 23, 15–26 (2013).

    Google Scholar 

  92. Kandelman, D. & Gagnon, G. A 24-month clinical study of the incidence and progression of dental caries in relation to consumption of chewing gum containing xylitol in school preventive programs. J. Dent. Res. 69, 1771–1775 (1990).

    Google Scholar 

  93. Featherstone, J. D. Prevention and reversal of dental caries: role of low level fluoride. Community Dent. Oral Epidemiol. 27, 31–40 (1999).

    Google Scholar 

  94. Reynolds, E. C., Cai, F., Shen, P. & Walker, G. D. Retention in plaque and remineralization of enamel lesions by various forms of calcium in a mouthrinse or sugar-free chewing gum. J. Dent. Res. 82, 206–211 (2003).

    Google Scholar 

  95. Kitasako, Y., Sadr, A., Hamba, H., Ikeda, M. & Tagami, J. Gum containing calcium fluoride reinforces enamel subsurface lesions in situ. J. Dent. Res. 91, 370–375 (2012).

    Google Scholar 

  96. Hamba, H., Nikaido, T., Inoue, G., Sadr, A. & Tagami, J. Effects of CPP-ACP with sodium fluoride on inhibition of bovine enamel demineralization: a quantitative assessment using micro-computed tomography. J. Dent. 39, 405–413 (2011).

    Google Scholar 

  97. Tay, F. R. et al. The glass-ionomer phase in presin-based restorative materials. J. Dent. Res. 80, 1808–1812 (2001).

    Google Scholar 

  98. Ito, S. et al. Effects of surface pre-reacted glass-ionomer fillers on mineral induction by phosphoprotein. J. Dent. 39, 72–79 (2011).

    Google Scholar 

  99. Holmgren, C., Gaucher, N., Decerle, N. & Doméjean, S. Minimal intervention dentistry II: part 3. Management of non-cavitated (initial) occlusal caries lesions — non-invasive approaches through remineralization and therapeutic sealants. Br. Dent. J. 216, 237–243 (2014).

    Google Scholar 

  100. Ricketts, D., Lamont, T., Innes, N. P., Kidd, E. & Clarkson, J. E. Operative caries management in adults and children. Cochrane Database Syst. Rev. 3, CD003808 (2013).

    Google Scholar 

  101. Kidd, E. & Fejerskov, O. Changing concepts in cariology: forty years on. Dent. Update 40, 277–286 (2013).

    Google Scholar 

  102. Zandona, A. F. & Swift, E. J. Jr. Critical appraisal. Evidence for sealing versus restoration of early caries lesions. J. Esthet. Restor. Dent. 27, 55–58 (2015).

    Google Scholar 

  103. Meyer-Lueckel, H., Bitter, K. & Paris, S. Randomized controlled clinical trial on proximal caries infiltration: three-year follow-up. Caries Res. 46, 544–548 (2012).

    Google Scholar 

  104. Schwendicke, F., Meyer-Lueckel, H., Stolpe, M., Dörfer, C. E. & Paris, S. Costs and effectiveness of treatment alternatives for proximal caries lesions. PLoS ONE 9, e86992 (2014).

    Google Scholar 

  105. Schwendicke, F., Stolpe, M., Meyer-Lueckel, H. & Paris, S. Detecting and treating occlusal caries lesions: a cost-effectiveness analysis. J. Dent. Res. 94, 272–280 (2015).

    Google Scholar 

  106. Wierichs, R. J. & Meyer-Lueckel, H. Systematic review on noninvasive treatment of root caries lesions. J. Dent. Res. 94, 261–271 (2015).

    Google Scholar 

  107. Duangthip, D., Jiang, M., Chu, C. H. & Lo, E. C. Non-surgical treatment of dentin caries in preschool children — systematic review. BMC Oral Health 15, 44 (2015).

    Google Scholar 

  108. Clarkson, B. H. & Exterkate, R. A. M. Noninvasive dentistry: a dream or reality? Caries Res. 49 (Suppl. 1), 11–17 (2015).

    Google Scholar 

  109. Marsh, P. D., Head, D. A. & Devine, D. A. Prospects of oral disease control in the future — an opinion. J. Oral Microbiol. 6, 261–276 (2014).

    Google Scholar 

  110. Rasines Alcaraz, M. G. et al. Direct composite resin fillings versus amalgam fillings for permanent or adult posterior teeth. Cochrane Database Syst. Rev. 3, CD005620 (2014).

    Google Scholar 

  111. Ferreira, J. M., Pinheiro, S. L., Sampaio, F. C. & de Menezes, V. A. Caries removal in primary teeth — a systematic review. Quintessence Int. 43, e9–e15 (2012).

    Google Scholar 

  112. Innes, N. P., Evans, D. J. & Stirrups, D. R. The Hall technique; a randomized controlled clinical trial of a novel method of managing carious primary molars in general dental practice: acceptability of the technique and outcomes at 23 months. BMC Oral Health 7, 18 (2007).

    Google Scholar 

  113. Seale, N. S. & Randall, R. The use of stainless steel crowns: a systematic literature review. Pediatr. Dent. 37, 145–160 (2015).

    Google Scholar 

  114. Gajendra, S. & Kuma, J. V. Oral health and pregnancy: a review. NY State Dent. J. 70, 40–44 (2004).

    Google Scholar 

  115. The American Academy of Pediatric Dentistry (AAPD) Council on Clinical Affairs. Guideline on caries-risk assessment and management for infants, children and adolescents. American Academy of Pediatric Dentistryhttp://www.aapd.org/media/policies_guidelines/g_cariesriskassessment.pdf (2014).

  116. Ramos-Gomez, F. J. A model for community-based pediatric oral health: implementation of an infant oral care program. Int. J. Dent. 2014, 156821 (2014).

    Google Scholar 

  117. Ramos-Gomez, F. & Ng, M.-W. Into the future: keeping healthy teeth caries free: pediatric CAMBRA protocols. J. Calif. Dent. Assoc. 39, 723–733 (2011).

    Google Scholar 

  118. Institute of Medicine. Oral Health Literacy. Roundtable on Health Literacy; Board on Population Health and Public Health Practice (National Academies Press, 2003).

  119. Karlinsey, R. L. & Pfarrer, A. M. Fluoride plus functionalized β-TCP: a promising combination for robust remineralization. Adv. Dent. Res. 24, 48–52 (2012).

    Google Scholar 

  120. American Dental Association Council on Scientific Affairs. Fluoride toothpaste use for young children. J. Am. Dent. Assoc. 145, 190–191 (2014).

    Google Scholar 

  121. Kassebaum, N. J. et al. Global burden of untreated caries: a systematic review and metaregression. J. Dent. Res. 94, 650–658 (2015). This systematic review considers the global burdens associated with untreated caries, how these can be quantified and compared with other non-communicable diseases.

    Google Scholar 

  122. White, D. A. et al. Adult Dental Health Survey 2009: common oral health conditions and their impact on the population. Br. Dent. J. 213, 567–572 (2012).

    Google Scholar 

  123. Thomson, W. M. Epidemiology of oral health conditions in older people. Gerodontology 31 (Suppl. 1), 9–16 (2014).

    Google Scholar 

  124. Vernazza, C. R., Rolland, S. L., Chadwick, B. & Pitts, N. Caries experience, the caries burden and associated factors in children in England, Wales and Northern Ireland 2013. Br. Dent. J. 221, 315–320 (2016).

    Google Scholar 

  125. Slade, G. D. Epidemiology of dental pain and dental caries among children and adolescents. Community Dent. Health 18, 219–227 (2001).

    Google Scholar 

  126. Ravaghi, V., Holmes, R. D., Steele, J. G. & Tsakos, G. The impact of oral conditions on children in England, Wales and Northern Ireland 2013. Br. Dent. J. 221, 173–178 (2016).

    Google Scholar 

  127. Casamassimo, P. S., Thikkurissy, S., Edelstein, B. L. & Maiorini, E. Beyond the DMFT: the human and economic cost of early childhood caries. J. Am. Dent. Assoc. 140, 650–657 (2009).

    Google Scholar 

  128. Krisdapong, S., Prasertsom, P., Rattanarangsima, K. & Sheiham, A. Relationships between oral diseases and impacts on Thai schoolchildren's quality of life: evidence from a Thai national oral health survey of 12- and 15-year-olds. Community Dent. Oral Epidemiol. 40, 550–559 (2012).

    Google Scholar 

  129. Montero, J. et al. Oral health-related quality of life in 6- to 12-year-old schoolchildren in Spain. Int. J. Paediatr. Dent. 26, 220–230 (2016).

    Google Scholar 

  130. Abanto, J. et al. Impact of dental caries and trauma on quality of life among 5- to 6-year-old children: perceptions of parents and children. Community Dent. Oral Epidemiol. 42, 385–394 (2014).

    Google Scholar 

  131. Psoter, W. J., Reid, B. C. & Katz, R. V. Malnutrition and dental caries: a review of the literature. Caries Res. 39, 441–447 (2005).

    Google Scholar 

  132. Schroth, R. J. et al. Vitamin D status of children with severe early childhood caries: a case–control study. BMC Pediatr. 13, 174 (2013).

    Google Scholar 

  133. Schroth, R. J., Levi, J., Kliewer, E., Friel, J. & Moffatt, M. E. Association between iron status, iron deficiency anaemia, and severe early childhood caries: a case–control study. BMC Pediatr. 13, 22 (2013).

    Google Scholar 

  134. Ayhan, H., Suskan, E. & Yildirim, S. The effect of nursing or rampant caries on height, body weight and head circumference. J. Clin. Pediatr. Dent. 20, 209–212 (1996).

    Google Scholar 

  135. Sheiham, A. Dental caries affects body weight, growth and quality of life in pre-school children. Br. Dent. J. 201, 625–626 (2006).

    Google Scholar 

  136. Oliveira, L. B., Sheiham, A. & Bönecker, M. Exploring the association of dental caries with social factors and nutritional status in Brazilian preschool children. Eur. J. Oral Sci. 116, 37–43 (2008).

    Google Scholar 

  137. Alkarimi, H. A., Watt, R. G., Pikhart, H., Sheiham, A. & Tsakos, G. Dental caries and growth in school-age children. Pediatrics 133, e616–e623 (2014).

    Google Scholar 

  138. Acs, G., Shulman, R., Ng, M. W. & Chussid, S. The effect of dental rehabilitation on the body weight of children with early childhood caries. Pediatr. Dent. 21, 109–113 (1999).

    Google Scholar 

  139. Malek Mohammadi, T., Wright, C. M. & Kay, E. J. Childhood growth and dental caries. Community Dent. Health 26, 38–42 (2009).

    Google Scholar 

  140. Gemert-Schriks, M. C. M. et al. The influence of dental caries on body growth in prepubertal children. Clin. Oral Invest. 15, 141–149 (2010).

    Google Scholar 

  141. Alkarimi, H. A. et al. Impact of treating dental caries on schoolchildren's anthropometric, dental, satisfaction and appetite outcomes: a randomized controlled trial. BMC Public Health 12, 706 (2012).

    Google Scholar 

  142. Jackson, S. L., Vann, W. F. Jr, Kotch, J. B., Pahel, B. T. & Lee, J. Y. Impact of poor oral health on children's school attendance and performance. Am. J. Public Health 101, 1900–1906 (2011).

    Google Scholar 

  143. Krisdapong, S., Prasertsom, P., Rattanarangsima, K. & Sheiham, A. School absence due to toothache associated with sociodemographic factors, dental caries status, and oral health-related quality of life in 12- and 15-year-old Thai children. J. Public Health Dent. 73, 321–328 (2013).

    Google Scholar 

  144. Griffin, S. O., Gooch, B. F., Beltrán, E., Sutherland, J. N. & Barsley, R. Dental services, costs, and factors associated with hospitalization for Medicaid-eligible children, Louisiana 1996–1997. J. Public Health Dent. 60, 21–27 (2000).

    Google Scholar 

  145. Moles, D. Epidemic of dental abscesses? Dental abscesses have increased most among poorer people. BMJ 336, 1323 (2008).

    Google Scholar 

  146. Schwendicke, F. et al. Socioeconomic inequality and caries: a systematic review and meta-analysis. J. Dent. Res. 94, 10–18 (2015).

    Google Scholar 

  147. Fisher-Owens, S. A. et al. Influences on children's oral health: a conceptual model. Pediatrics 120, e510–e520 (2007).

    Google Scholar 

  148. Bagramian, R. A., Garcia-Godoy, F. & Volpe, A. R. The global increase in dental caries. A pending public health crisis. Am. J. Dent. 22, 3–8 (2009).

    Google Scholar 

  149. Porter, M. E. A strategy for health care reform — toward a value-based system. N. Engl. J. Med. 361, 109–112 (2009).

    Google Scholar 

  150. Kaldahl, W. B., Kalkwarf, K. L. & Patil, K. D. A review of longitudinal studies that compared periodontal therapies. J. Periodontol. 64, 243–253 (1993).

    Google Scholar 

  151. Innes, N. & Evans, D. Association between parental guilt and oral health problems in preschool children. Br. Dent. J. 206, 549–550 (2009).

    Google Scholar 

  152. Eccles, M. P. et al. Developing clinical practice guidelines: target audiences, identifying topics for guidelines, guideline group composition and functioning and conflicts of interest. Implement. Sci. 7, 60 (2012).

    Google Scholar 

  153. Tellez, M., Gray, S. L., Gray, S., Lim, S. & Ismail, A. I. Sealants and dental caries: dentists’ perspectives on evidence-based recommendations. J. Am. Dent. Assoc. 142, 1033–1040 (2011).

    Google Scholar 

  154. Beauchamp, J. et al. Evidence-based clinical recommendations for the use of pit-and-fissure sealants: a report of the American Dental Association Council on Scientific Affairs. Dent. Clin. North Am. 53, 131–147 (2009).

    Google Scholar 

  155. Phelan, M. P. et al. A multifaceted intervention to improve electronic health record (EHR) nursing documentation for emergency department blood draws. Acad. Emerg. Med. 22, S322–S323 (2015).

    Google Scholar 

  156. Fejerskov, O., Thylstrup, A. & Larsen, M. J. Rational use of fluorides in caries prevention. A concept based on possible cariostatic mechanisms. Acta Odontol. Scand. 39, 241–249 (1981).

    Google Scholar 

  157. Fluoride Recommendations Work Group. Recommendations for using fluoride to prevent and control dental caries in the United States. Centers for Disease Control and Prevention. MMWR Recomm. Rep. 50, 1–42 (2001).

    Google Scholar 

  158. Hellwig, E. & Lennon, A. M. Systemic versus topical fluoride. Caries Res. 38, 258–262 (2004).

    Google Scholar 

  159. Margolis, H. C., Moreno, E. C. & Murphy, B. J. Effect of low levels of fluoride in solution on enamel demineralisation in vitro. J. Dent. Res. 65, 23–29 (1986).

  160. ten Cate, J. M. Current concepts on the theories of the mechanism of action of fluoride. Acta Odontol. Scand. 57, 325–329 (1999).

    Google Scholar 

  161. Iheozor-Ejiofor, Z. et al. Water fluoridation for the prevention of dental caries. Cochrane Database Syst. Rev. 6, CD010856 (2015).

    Google Scholar 

  162. Rugg-Gunn, A. J. et al. Critique of the review of ‘Water fluoridation for the prevention of dental caries’ published by the Cochrane Collaboration in 2015. Br. Dent. J. 220, 335–340 (2016).

    Google Scholar 

  163. Pahel, B. T., Rozier, R. G., Stearns, S. C. & Quiñonez, R. B. Effectiveness of preventive dental treatments by physicians for young Medicaid enrollees. Pediatrics 127, e682–e689 (2011).

    Google Scholar 

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Authors and Affiliations

  1. Dental Innovation and Translation Centre, King's College London Dental Institute, Floor 17 Tower Wing, Guy's Hospital, Great Maze Pond Road, London, SE1 9RT, UK

    Nigel B. Pitts

  2. Department of Cariology Operative Dentistry and Dental Public Health, Oral Health Research Institute, Indiana University School of Dentistry, Indianapolis, Indiana, USA

    Domenick T. Zero

  3. Department of Oral Biology, School of Dentistry, University of Leeds, Leeds, UK

    Phil D. Marsh

  4. Department of Odontology, University of Copenhagen, Copenhagen, Denmark

    Kim Ekstrand & Svante Twetman

  5. Department of Dental Ecology, University of North Carolina School of Dentistry, Chapel Hill, North Carolina, USA

    Jane A. Weintraub

  6. UCLA Center Children's Oral Health — UCCOH and Section of Pediatric Dentistry, UCLA School of Dentistry, University of California Los Angeles, Los Angeles, California, USA

    Francisco Ramos-Gomez

  7. Cariology and Operative Dentistry, Tokyo Medical and Dental University, Tokyo, Japan

    Junji Tagami

  8. Department of Epidemiology and Public Health, UCL, London, UK

    Georgios Tsakos

  9. Restorative Dentistry, Maurice H. Kornberg School of Dentistry, Temple University, Philadelphia, Pennsylvania, USA

    Amid Ismail

Authors
  1. Nigel B. Pitts
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  2. Domenick T. Zero
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  7. Junji Tagami
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  8. Svante Twetman
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  9. Georgios Tsakos
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  10. Amid Ismail
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Contributions

Introduction (N.B.P.); Epidemiology (N.B.P.); Mechanisms/pathophysiology (D.T.Z. and P.D.M.); Diagnosis, screening and prevention (K.E. and J.A.W.); Management (F.R.-G., J.T. and S.T.); Quality of life (G.T.); Outlook (A.I.); Overview of the Primer (N.B.P.).

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Correspondence to Nigel B. Pitts.

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Competing interests

N.B.P. has received honoraria and corporate and social responsibility support from Colgate, consultation fees from Calcivis and holds stock in a King's College London spin-out, Reminova. D.T.Z. has received contracted research funding from Johnson & Johnson, GlaxoSmithKline, C3-Jian and Noveome Biotherapeutics. All other authors declare no conflicts of interest.

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Pitts, N., Zero, D., Marsh, P. et al. Dental caries. Nat Rev Dis Primers 3, 17030 (2017). https://doi.org/10.1038/nrdp.2017.30

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