The science and practice of caries prevention

J Am Dent Assoc. 2000 Jul;131(7):887-99. doi: 10.14219/jada.archive.2000.0307.


Background and overview: Dental caries is a bacterially based disease. When it progresses, acid produced by bacterial action on dietary fermentable carbohydrates diffuses into the tooth and dissolves the carbonated hydroxyapatite mineral--a process called demineralization. Pathological factors including acidogenic bacteria (mutans streptococci and lactobacilli), salivary dysfunction, and dietary carbohydrates are related to caries progression. Protective factors--which include salivary calcium, phosphate and proteins, salivary flow, fluoride in saliva, and antibacterial components or agents--can balance, prevent or reverse dental caries.

Conclusions: Caries progression or reversal is determined by the balance between protective and pathological factors. Fluoride, the key agent in battling caries, works primarily via topical mechanisms: inhibition of demineralization, enhancement of remineralization and inhibition of bacterial enzymes.

Clinical implications: Fluoride in drinking water and in fluoride-containing products reduces caries via these topical mechanisms. Antibacterial therapy must be used to combat a high bacterial challenge. For practical caries management and prevention or reversal of dental caries, the sum of the preventive factors must outweigh the pathological factors.

Publication types

  • Review

MeSH terms

  • Adolescent
  • Anti-Bacterial Agents / therapeutic use
  • Calcium / physiology
  • Cariostatic Agents / therapeutic use
  • Child
  • Child, Preschool
  • Dental Caries / microbiology
  • Dental Caries / prevention & control*
  • Dietary Carbohydrates / adverse effects
  • Fluorides / therapeutic use
  • Humans
  • Lactobacillus / drug effects
  • Lactobacillus / metabolism
  • Phosphates / physiology
  • Saliva / metabolism
  • Saliva / physiology
  • Salivary Proteins and Peptides / physiology
  • Streptococcus mutans / drug effects
  • Streptococcus mutans / metabolism
  • Tooth Demineralization / microbiology


  • Anti-Bacterial Agents
  • Cariostatic Agents
  • Dietary Carbohydrates
  • Phosphates
  • Salivary Proteins and Peptides
  • Fluorides
  • Calcium