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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References

  1. 1.

    & White paper on dental caries prevention and management. FDI World Dental Federation (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. 2.

    , & A curriculum vitae of teeth: evolution, generation, regeneration. Int. J. Biol. Sci. 5, 226–243 (2009).

  3. 3.

    , , , & The global burden of oral diseases and risks to oral health. Bull. World Health Organ. 83, 661–669 (2005).

  4. 4.

    , & 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.

  5. 5.

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

  6. 6.

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

  7. 7.

    US Department of Health and Human Services. Oral health in America: a report of the Surgeon General. National Institute of Dental and Craniofacial Research (2000).

  8. 8.

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

  9. 9.

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

  10. 10.

    , , , & Oral health status of children in Los Angeles County and in the United States, 1999–2004. Community Dent. Oral Epidemiol. 45, 135–144 (2016).

  11. 11.

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

  12. 12.

    & 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.

  13. 13.

    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).

  14. 14.

    , & Children's Dental Health Survey 2013. Report 2: dental disease and damage in children: England, Wales and Northern Ireland. National Health Service (2015).

  15. 15.

    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).

  16. 16.

    , , , & 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).

  17. 17.

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

  18. 18.

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

  19. 19.

    & 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.

  20. 20.

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

  21. 21.

    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).

  22. 22.

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

  23. 23.

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

  24. 24.

    , & Dental caries. Lancet 369, 51–59 (2007).

  25. 25.

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

  26. 26.

    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).

  27. 27.

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

  28. 28.

    & Mechanistic aspects of the interactions between fluoride and dental enamel. Crit. Rev. Oral Biol. Med. 2, 283–296 (1991).

  29. 29.

    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.

  30. 30.

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

  31. 31.

    , & Modulation of host responses by oral commensal bacteria. J. Oral Microbiol. 7, 26941 (2015).

  32. 32.

    , & Stick to your gums: mechanisms of oral microbial adherence. J. Dent. Res. 90, 1271–1278 (2011).

  33. 33.

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

  34. 34.

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

  35. 35.

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

  36. 36.

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

  37. 37.

    , & Community interactions of oral streptococci. Adv. Appl. Microbiol. 87, 43–110 (2014).

  38. 38.

    , , , & Streptococcus mutans-derived extracellular matrix in cariogenic oral biofilms. Front. Cell. Infect. Microbiol. 5, 10 (2015).

  39. 39.

    & 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).

  40. 40.

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

  41. 41.

    , , & Historical and contemporary hypotheses on the development of oral diseases: are we there yet? Front. Cell. Infect. Microbiol. 4, 92 (2014).

  42. 42.

    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.

  43. 43.

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

  44. 44.

    , , & Association between enamel hypoplasia and dental caries in primary second molars: a cohort study. Caries Res. 43, 345–353 (2009).

  45. 45.

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

  46. 46.

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

  47. 47.

    & 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.

  48. 48.

    International Caries Detection and Assessment System (ICDAS) Foundation. What is ICDAS. ICDAS Foundation (2017).

  49. 49.

    et al. ICCMS guide for practitioners and educators. ICDAS Foundation (2014). This guide outlines best evidence as to how the ICCMS caries management system can be used practically by both educators and clinicians.

  50. 50.

    , & The international caries classification and management system (ICCMSTM) an example of a caries management pathway. BMC Oral Health 15, S9 (2015).

  51. 51.

    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.

  52. 52.

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

  53. 53.

    World Health Organization. Oral health: action plan for promotion and integrated disease prevention. WHO (2006).

  54. 54.

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

  55. 55.

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

  56. 56.

    Alliance for a Cavity-Free Future. About the alliance for a cavity-free future. Alliance for a Cavity-Free Future (2016).

  57. 57.

    The Community Preventive Services Task Force. Dental caries (cavities): community water fluoridation. The Community Guide (2013).

  58. 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).

  59. 59.

    , & An economic evaluation of community water fluoridation. J. Public Health Dent. 61, 78–86 (2001).

  60. 60.

    World Health Organization. Guidelines for drinking-water quality. WHO (2011).

  61. 61.

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

  62. 62.

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

  63. 63.

    , & Milk fluoridation for the prevention of dental caries. Acta Med. Acad. 42, 156–167 (2013).

  64. 64.

    , & Fluoridated milk for preventing dental caries. Cochrane Database Syst. Rev. 3, CD003876 (2015).

  65. 65.

    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).

  66. 66.

    The Community Preventive Services Task Force. Dental caries (cavities): school-based dental sealant delivery programs. The Community Guide (2013).

  67. 67.

    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).

  68. 68.

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

  69. 69.

    , , & Treatment outcomes and costs of dental sealants among children enrolled in Medicaid. Am. J. Public Health. 91, 1877–1881 (2001).

  70. 70.

    , & Cost-effectiveness models for dental caries prevention programmes among Chilean schoolchildren. Community Dent. Health 29, 302–308 (2012).

  71. 71.

    , , & Reducing early childhood caries in a Medicaid population: a systems model analysis. J. Am. Dent. Assoc. 146, 224–232 (2015).

  72. 72.

    Public Health England. Delivering better oral health: an evidence-based toolkit for prevention — third edition. Gov.uk (2014).

  73. 73.

    Scottish Intercollegiate Guidelines Network. SIGN138. Dental interventions to prevent caries in children: a national clinical guideline. Scottish Intercollegiate Guidelines Network (2014).

  74. 74.

    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).

  75. 75.

    , , & Topical fluoride (toothpastes, mouthrinses, gels or varnishes) for preventing dental caries in children and adolescents. Cochrane Database Syst. Rev. 4, CD002782 (2003).

  76. 76.

    World Health Organization. Guideline: sugars intake for adults and children. WHO (2015).

  77. 77.

    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).

  78. 78.

    & Cariogram — a multifactorial risk assessment model for a multifactorial disease. Community Dent. Oral Epidemiol. 33, 256–264 (2005).

  79. 79.

    , & Caries — en biofilmmedieret sygdom. Tandlægebladet 17, 1–6 (English summary) (2013).

  80. 80.

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

  81. 81.

    , & Dental plaque and caries on occlusal surfaces of first permanent molars in relation to stage of eruption. J. Dent. Res. 68, 773–779 (1989).

  82. 82.

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

  83. 83.

    , & Unrestored dentin caries and deep dentin restorations in Swedish adolescents. Caries Res. 42, 164–170 (2008).

  84. 84.

    , & Plaque and gingival status as indicators for caries progression on approximal surfaces. Caries Res. 32, 41–45 (1998).

  85. 85.

    , , & Detection and activity assessment of primary coronal caries lesions: a methodologic study. Oper. Dent. 32, 225–235 (2007).

  86. 86.

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

  87. 87.

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

  88. 88.

    & Mechanistic aspects of the interactions between fluoride and dental enamel. Crit. Rev. Oral Biol. Med. 2, 283–296 (1991).

  89. 89.

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

  90. 90.

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

  91. 91.

    & Fluorides and non-fluoride remineralization systems. Monogr. Oral Sci. 23, 15–26 (2013).

  92. 92.

    & 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).

  93. 93.

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

  94. 94.

    , , & 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).

  95. 95.

    , , , & Gum containing calcium fluoride reinforces enamel subsurface lesions in situ. J. Dent. Res. 91, 370–375 (2012).

  96. 96.

    , , , & 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).

  97. 97.

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

  98. 98.

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

  99. 99.

    , , & 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).

  100. 100.

    , , , & Operative caries management in adults and children. Cochrane Database Syst. Rev. 3, CD003808 (2013).

  101. 101.

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

  102. 102.

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

  103. 103.

    , & Randomized controlled clinical trial on proximal caries infiltration: three-year follow-up. Caries Res. 46, 544–548 (2012).

  104. 104.

    , , , & Costs and effectiveness of treatment alternatives for proximal caries lesions. PLoS ONE 9, e86992 (2014).

  105. 105.

    , , & Detecting and treating occlusal caries lesions: a cost-effectiveness analysis. J. Dent. Res. 94, 272–280 (2015).

  106. 106.

    & Systematic review on noninvasive treatment of root caries lesions. J. Dent. Res. 94, 261–271 (2015).

  107. 107.

    , , & Non-surgical treatment of dentin caries in preschool children — systematic review. BMC Oral Health 15, 44 (2015).

  108. 108.

    & Noninvasive dentistry: a dream or reality? Caries Res. 49 (Suppl. 1), 11–17 (2015).

  109. 109.

    , & Prospects of oral disease control in the future — an opinion. J. Oral Microbiol. 6, 261–276 (2014).

  110. 110.

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

  111. 111.

    , , & Caries removal in primary teeth — a systematic review. Quintessence Int. 43, e9–e15 (2012).

  112. 112.

    , & 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).

  113. 113.

    & The use of stainless steel crowns: a systematic literature review. Pediatr. Dent. 37, 145–160 (2015).

  114. 114.

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

  115. 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 Dentistry (2014).

  116. 116.

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

  117. 117.

    & Into the future: keeping healthy teeth caries free: pediatric CAMBRA protocols. J. Calif. Dent. Assoc. 39, 723–733 (2011).

  118. 118.

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

  119. 119.

    & Fluoride plus functionalized β-TCP: a promising combination for robust remineralization. Adv. Dent. Res. 24, 48–52 (2012).

  120. 120.

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

  121. 121.

    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.

  122. 122.

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

  123. 123.

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

  124. 124.

    , , & Caries experience, the caries burden and associated factors in children in England, Wales and Northern Ireland 2013. Br. Dent. J. 221, 315–320 (2016).

  125. 125.

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

  126. 126.

    , , & The impact of oral conditions on children in England, Wales and Northern Ireland 2013. Br. Dent. J. 221, 173–178 (2016).

  127. 127.

    , , & Beyond the DMFT: the human and economic cost of early childhood caries. J. Am. Dent. Assoc. 140, 650–657 (2009).

  128. 128.

    , , & 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).

  129. 129.

    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).

  130. 130.

    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).

  131. 131.

    , & Malnutrition and dental caries: a review of the literature. Caries Res. 39, 441–447 (2005).

  132. 132.

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

  133. 133.

    , , , & Association between iron status, iron deficiency anaemia, and severe early childhood caries: a case–control study. BMC Pediatr. 13, 22 (2013).

  134. 134.

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

  135. 135.

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

  136. 136.

    , & Exploring the association of dental caries with social factors and nutritional status in Brazilian preschool children. Eur. J. Oral Sci. 116, 37–43 (2008).

  137. 137.

    , , , & Dental caries and growth in school-age children. Pediatrics 133, e616–e623 (2014).

  138. 138.

    , , & The effect of dental rehabilitation on the body weight of children with early childhood caries. Pediatr. Dent. 21, 109–113 (1999).

  139. 139.

    , & Childhood growth and dental caries. Community Dent. Health 26, 38–42 (2009).

  140. 140.

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

  141. 141.

    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).

  142. 142.

    , , , & Impact of poor oral health on children's school attendance and performance. Am. J. Public Health 101, 1900–1906 (2011).

  143. 143.

    , , & 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).

  144. 144.

    , , , & Dental services, costs, and factors associated with hospitalization for Medicaid-eligible children, Louisiana 1996–1997. J. Public Health Dent. 60, 21–27 (2000).

  145. 145.

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

  146. 146.

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

  147. 147.

    et al. Influences on children's oral health: a conceptual model. Pediatrics 120, e510–e520 (2007).

  148. 148.

    , & The global increase in dental caries. A pending public health crisis. Am. J. Dent. 22, 3–8 (2009).

  149. 149.

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

  150. 150.

    , & A review of longitudinal studies that compared periodontal therapies. J. Periodontol. 64, 243–253 (1993).

  151. 151.

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

  152. 152.

    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).

  153. 153.

    , , , & Sealants and dental caries: dentists’ perspectives on evidence-based recommendations. J. Am. Dent. Assoc. 142, 1033–1040 (2011).

  154. 154.

    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).

  155. 155.

    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).

  156. 156.

    , & Rational use of fluorides in caries prevention. A concept based on possible cariostatic mechanisms. Acta Odontol. Scand. 39, 241–249 (1981).

  157. 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).

  158. 158.

    & Systemic versus topical fluoride. Caries Res. 38, 258–262 (2004).

  159. 159.

    , & Effect of low levels of fluoride in solution on enamel demineralisation in vitro. J. Dent. Res. 65, 23–29 (1986).

  160. 160.

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

  161. 161.

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

  162. 162.

    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).

  163. 163.

    , , & Effectiveness of preventive dental treatments by physicians for young Medicaid enrollees. Pediatrics 127, e682–e689 (2011).

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Author information

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

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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.).

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.

Corresponding author

Correspondence to Nigel B. Pitts.

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DOI

https://doi.org/10.1038/nrdp.2017.30

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