Contributors xi
Part I Dental caries: what is it and how widespread is it globally?
Chapter 1 Prologue 3
O. Fejerskov, B. Nyvad, and E.A.M. Kidd
Introduction 3
The role of cariology in restorative dentistry 3
The content of this textbook 4
Chapter 2 Dental caries: what is it? 7
O. Fejerskov, B. Nyvad, and E.A.M. Kidd
The disease 7
Terminology 9
Background literature 9
References 10
Chapter 3 Clinical features of caries lesions 11
O. Fejerskov and B. Nyvad
What do caries lesions look like clinically? 11
The deciduous dentition 12
The permanent dentition 13
Chapter 4 How big is the problem? Epidemiological features of dental caries 21
V. Baelum and O. Fejerskov
Introduction 21
What? Defining the health issue at hand 21
Who? The distribution of caries in populations 28
Where? The geography of caries 35
When? Trends in caries 37
Why? The causes of caries 37
References 41
Part II The caries lesion and its biological determinants
Chapter 5 Pathology of dental caries 49
O. Fejerskov
Introduction 49
Human dental enamel at time of eruption 51
Enamel changes during early caries lesion development 55
The approximal white spot lesion 58
Progression of the enamel lesion 63
Arrest of the caries lesion 63
Occlusal caries 66
Dentin reactions to caries progression 71
Pulpo-dentinal reactions 71
Root-surface caries 77
Background literature 80
References 80
Chapter 6 Saliva and caries development 83
A. Bardow and A. Vissink
Introduction 83
Saliva and salivary glands 84
Saliva and caries development: biological aspects 87
Saliva and caries development: clinical aspects 98
Evaluation of salivary gland function 101
Management of salivary gland hypofunction 104
Concluding remarks 105
Background literature 105
References 105
Chapter 7 Biofilms in caries development 107
P.D. Marsh, N. Takahashi, and B. Nyvad
Introduction 107
The resident microflora 108
Dental biofilms: development, structure, composition, and properties 111
Caries microbiology: a brief historical perspective 121
Methodological problems in microbiological studies of dental caries 121
Microbiology of caries 122
Cariogenic features of dental biofilm bacteria 125
The 'ecological plaque hypothesis' to explain the role of dental biofilm bacteria in the etiology of dental caries 125
Concluding remarks 129
Background literature 129
References 129
Chapter 8 Diet and dental caries 133
C. van Loveren and P. Lingstroem
History 133
Early ecological studies 134
Experimental human studies 134
Influence of fluoride on the diet-caries relationship 135
Measuring cariogenicity 136
Sweeteners 141
Protective factors in foods 149
Diet and dental erosion 150
Conclusion 151
References 151
Chapter 9 Demineralization and remineralization: the key to understanding clinical manifestations of dental caries 155
O. Fejerskov and M.J. Larsen
Introduction 155
Enamel mineral 156
Stability of calcium phosphates 156
Crystal dissolution 157
Why is apatite solubility increased by acid? 158
Effect of carbonate and fluoride on apatite dissolution and growth 159
Demineralization and remineralization of the dental hard tissues 160
Caries demineralization 162
Remineralization of enamel 164
Remineralization of dentin 166
Background literature 169
References 170
Part III Diagnosis
Chapter 10 The foundations of good diagnostic practice 173
V. Baelum, B. Nyvad, H.-G. Groendahl, and O. Fejerskov
Introduction 173
The making of a dentist 174
The dental examination: in the best interest of our patients 175
What are we looking for? What is caries? 176
The wealth of caries diagnostic methods and criteria 178
The evolution in caries diagnostic methods 178
Diagnostic test assessment in the essentialistic gold-standard paradigm 179
Evaluating caries diagnostic methods 180
Leaps in the essentialistic gold-standard reasoning 181
Diagnostic test evaluation in the nominalistic caries paradigm 183
Inter- and intra-examiner errors in caries diagnosis 184
How do we deal with the unavoidable diagnostic uncertainty? 185
The additional diagnostic yield argument 186
Concluding remarks 187
References 188
Chapter 11 Visual-tactile caries diagnosis 191
B. Nyvad, V. Machiulskiene, V.M. Soviero, and V. Baelum
Introduction 191
The diagnostic process 192
Why do we diagnose caries? 193
Diagnosis from a dental caries perspective 193
How early should caries lesions be detected? 194
What are the best visual-tactile caries diagnostic criteria? 195
Commonly used visual-tactile criteria 197
Differential diagnosis 201
Visual-tactile caries examination: a systematic clinical approach 205
Additional aids in visual-tactile caries diagnosis 207
Benefits and limitations of visual-tactile caries diagnosis 208
References 209
Chapter 12 Additional caries detection methods 211
H. Hintze, A. Lussi, F. Cuisinier, and B. Nyvad
Introduction 211
Radiography 211
Methods based on light and electrical current 223
Are the additional methods suitable for use in clinical practice? 229
Can the methods serve as adjuncts to a visual-tactile caries examination? 229
References 229
Part IV Controlling dental caries
Chapter 13 The caries control concept 235
B. Nyvad and O. Fejerskov
Why the caries control concept should replace caries prevention 235
How caries control was managed in the past 236
Arrest of active enamel caries 237
Arrest of active root caries 238
Arrest of active cavitated caries 239
Role of fluoride in lesion arrest 242
Benefits and limitations of the caries control approach - and some recommendations 242
References 242
Chapter 14 Fluorides in caries control 245
O. Fejerskov, J.A. Cury, L.M. Tenuta, and V.C. Marinho
Introduction 245
Fluoride in caries prevention and control 246
Cariostatic mechanisms of fluoride 250
Dental fluorosis and metabolism of fluoride 253
The effectiveness of fluorides in the control of dental caries: evidence from systematic reviews 263
Rational use of fluorides in caries control in different parts of the world: recommendations 271
Background literature 272
References 272
Chapter 15 The role of oral hygiene 277
B. Nyvad
Introduction 277
Some theoretical considerations 277
The biological effect of tooth cleaning 278
The clinical effect of tooth cleaning 278
The effect of professional tooth cleaning 282
The effect of dental flossing 283
Concluding remarks 283
References 284
Chapter 16 Are antibacterials necessary in caries prophylaxis? 287
A.A. Scheie, H.V. Rukke, and F.C. Petersen
The biofilm lifestyle and the rationale for antibacterial intervention 287
Biological activity and mode of action 288
Vehicles for caries prophylactic agents 292
Specific agents 292
Other agents proposed for caries prophylaxis, but without documented anticaries effects 296
Risk of antibacterial resistance development? 298
Concluding remarks and future approaches 299
Background literature 299
References 299
Chapter 17 The principles of caries control for the individual patient 303
B. Nyvad and E.A.M. Kidd
Introduction 303
How are current caries activity and risk of future caries progression assessed? 304
How is the information used to categorize patients into risk groups? 307
What nonoperative treatments are available? 308
How is the individual helped to control disease progression? 312
When should the patient be recalled? 312
Caries control in children and adolescents 314
Patients with a dry mouth 317
Failure 318
References 319
Chapter 18 Caries control for frail elders 321
M.I. MacEntee, S.R. Bryant, H. Keller, C.T. Nguyen, and C.S. Yao
Introduction 321
A conceptual model of oral health 321
Frailty 322
Physical characteristics of caries in elderly mouths 323
Incidence of caries in frail adults 323
Recognizing the risk of caries 324
Impact of caries in frailty 326
Management of caries in frailty 327
Summary 329
References 330
Part V Operative intervention
Chapter 19 Classical restorative or the minimally invasive concept? 335
E.A.M. Kidd, J. Frencken, B. Nyvad, C.H. Splieth, and N.J.M. Opdam
Operative dentistry and caries control 335
Sealants 339
Atraumatic restorative treatment 345
Conventional minimal intervention methods 353
Minimal intervention and the deciduous dentition 365
References 370
Chapter 20 Caries 'removal' and the pulpo-dentinal complex 375
E.A.M. Kidd, L. Bjorndal, and O. Fejerskov
Introduction 375
The pulpo-dentinal complex and caries 376
Pulpitis and its clinical diagnosis 376
Why are pulpo-dentinal reactions important to the choice of operative management? 376
The infected dentin concept and its clinical consequence 377
Studies placing fissure sealants over carious dentin 379
Stepwise excavation studies 380
Randomized controlled clinical trials on stepwise excavation outcome 382
Do we need to reenter? 382
What happens if we do not remove caries at all but seal it in the tooth permanently? 384
Further consideration of deciduous teeth 384
Conclusion on caries removal and the pulpo-dentinal complex 385
References 385
Chapter 21 Longevity of restorations: 'the death spiral' 387
V. Qvist
Introduction 387
Clinical assessment of restorations 388
Assessment of restoration longevity 388
The amalgam debate and its consequences for restoration longevity 391
Longevity of restorations in the primary dentition 391
Longevity of restorations in the permanent dentition 394
Longevity of fissure sealants 395
Longevity of atraumatic restorative treatment restorations 396
Factors influencing restoration longevity 397
Consequences of restoration longevity for dental health and cost 398
Concluding remarks 399
References 400
Part VI From chair-side to population caries control
Chapter 22 Caries prevention and control in low- and middle-income countries 405
W. van Palenstein Helderman, C. Holmgren, B. Monse, and H. Benzian
Introduction 405
Caries: a public health problem in low- and middle-income countries 406
Health and oral health systems in low- and middle-income countries 408
Public health approaches to address caries in low- and middle-income countries 411
Conclusions and recommendations 417
References 420
Chapter 23 How accurately can we assess the risk for developing caries lesions? 423
H. Hausen and V. Baelum
Introduction 423
The risk of developing caries lesions cannot be observed directly for an individual patient 424
The course of a typical study for evaluating the accuracy of a prediction 425
A real-life example of using a single, dichotomous predictor 427
Interpretation and use of the measures of prediction accuracy 427
What level of accuracy would be sufficient in everyday practice? 432
What level of accuracy can be achieved? 433
Clinical caries risk assessment: is it possible? 435
How valuable are the proposed measures? 436
Concluding remarks 436
Background literature 436
References 436
Chapter 24 Caries control in low-caries populations 439
H. Hausen, M. Jossing, and O. Fejerskov
Introduction 439
A low caries frequency entails the polarization of the caries problem 439
Are effective and feasible measures available for protecting the high-risk individuals from dental decay? 440
Noninvasive treatment of early caries lesions among teenagers exposed to community-wide oral health promotion 441
A model for controlling caries in low-caries child populations 442
A demonstration case in 0-18-year-old Danes 443
Concluding remarks 446
References 447
Chapter 25 Epilogue. Controlling the global burden of dental caries: the evidence calls for a reorganization of the oral health-care system 449
O. Fejerskov, V. Baelum, B. Nyvad, and E.A.M. Kidd
Index 453
