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lüll The science and practice of caries prevention Featherstone JDJ Am Dent Assoc 2000[Jul]; 131 (7): 887-99BACKGROUND 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.|Adolescent[MESH]|Anti-Bacterial Agents/therapeutic use[MESH]|Calcium/physiology[MESH]|Cariostatic Agents/therapeutic use[MESH]|Child[MESH]|Child, Preschool[MESH]|Dental Caries/microbiology/*prevention & control[MESH]|Dietary Carbohydrates/adverse effects[MESH]|Fluorides/therapeutic use[MESH]|Humans[MESH]|Lactobacillus/drug effects/metabolism[MESH]|Phosphates/physiology[MESH]|Saliva/metabolism/physiology[MESH]|Salivary Proteins and Peptides/physiology[MESH]|Streptococcus mutans/drug effects/metabolism[MESH]|Tooth Demineralization/microbiology[MESH] |