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Tooth Decay

Tooth Decay

Untreated tooth decay is the most prevalent health condition worldwide, affecting 2.4 billion people. In the USA alone, spending for treatment of dental disease was estimated at $122 billion in 2014¹.

Tooth decay, or dental caries, manifests as a continuum of disease states ranging from very early undetectable lesions on the enamel surface through to destruction of enamel and dentine with infection of the pulp.


The cause of tooth decay is bacteria in plaque that produce acid when they metabolise sugar. This acid can dissolve tooth enamel in a process termed demineralisation. Saliva can reverse this process by supplying calcium and phosphate to the tooth and by helping to neutralise plaque acid in a process termed remineralisation. When the balance between demineralisation and remineralisation shifts in favour of the disease state, dental caries results.

Over time, the caries process leads to a loss of enamel mineral, resulting initially in a porous but invisible early caries lesion, then progressing to a white spot on the tooth surface (enamel caries), which can proceed ever-deeper into the tooth, ultimately reaching the dentine and pulp tissues resulting in tooth ache, abscess, and the need for urgent dental intervention.

There are also situations when caries can form as a result of interventions such as wearing orthodontic braces.

The above highlights the dental caries disease process, noting the cost of treatment increases steadily as progression through each stage.

The above highlights the dental caries disease process, noting the cost of treatment increases steadily as progression through each stage.


Common example of patient with enamel caries after removal of braces³.

Common example of patient with enamel caries after removal of braces³.


The elevated prevalence of demineralisation in patients undergoing orthodontic treatment and the speed at which these lesions can develop require the orthodontic clinician to remain vigilant throughout their course of care. Better yet, patients at risk of dental caries development should be identified so that lesion development can be prevented (Nathan Cochrane, 2013, University of Melbourne).  As many as 96% of orthodontic patients will develop white spot lesions that can be repaired if caught at an early stage².

Despite being so widespread, caries are largely preventable through careful oral hygiene, diet, and early intervention when the disease process first begins. The best therapies for early intervention are remineralisation products, which act by arresting and reversing the caries process. Unfortunately, these therapies show limited efficacy for caries lesions that have progressed beyond the earliest stages. There has been a strong push in the dental research field to come up with better ways of detecting those earliest stages of caries in order to give dentists the information they need to intervene effectively with the early lesion.


References –

¹Kassebaum et al. (2015) J Dent Res 94:650-658.

²Øgaard (1989) Am J Orthod Dentofacial Orthop. 96:423-427.

³Cochrane N (2013) Advanced Seminars in Orthodontics. University of Melbourne.