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Dental caries


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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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).

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