Dental Caries

The Editors Ole Fejerskov, DDS, PhD, DSc (Odont), DSc (Odont) (h.c. multpl) is Professor Emeritus in the Department of Biomedicine, Faculty of Health, at Aarhus University in Denmark. Bente Nyvad, DDS, MPH, PhD, DSc (Odont) is Professor of Oral Ecology and Caries Control in the Department of Dentistry and Oral Health, Faculty of Health at Aarhus University in Denmark.

Contributors xi Preface xiii Part I Dental caries: What is it and what is the magnitude of the problem? Chapter 1 Dental caries definitions and clinical features 3 Ole Fejerskov and Bente Nyvad The editors view on dental caries and introduction to the book 3 Terminology 5 Examples of dental caries 6 Background literature 15 Chapter 2 Strategic public health considerations for caries control in populations 17 Anja Heilmann and Richard G. Watt Introduction 17 The global burden of dental caries 18 The role of sugar in the etiology of dental caries 18 Public health principles for preventive action 21 Overview of upstream, midstream, and downstream strategies to prevent dental caries 27 Implications for the dental profession and oral health care systems 30 Conclusion 30 References 31 Chapter 3 Dental caries epidemiology 35 Firoze Manji and Ole Fejerskov Introduction 35 Probability of an outcome 36 Some standard terms used in epidemiology 40 Measures of central tendency: Mean, median, mode 42 Types of investigation 43 Problems of determining the role of specific factors 44 Analysis and interpretation of data 45 Drawing inferences about associations 51 Age and dental caries 54 International comparisons of occurrence of dental caries 54 Background literature 56 References 56 Part II Diagnosis and detection Chapter 4 Visualtactile caries diagnosis and the role of bitewing radiography 61 Bente Nyvad, Vita Machiulskiene, and Vibeke Baelum Introduction 62 The diagnostic process 62 Two differing perspectives on caries detection 63 Achieving the best health outcome for the patient by classifying caries lesions according to the best management options for each lesion type 63 How early should caries lesions be detected? 65 What are the best visualtactile caries diagnostic criteria? 65 Commonly used visualtactile criteria 68 Differential diagnosis 74 Visualtactile caries examination: A systematic clinical approach 76 Benefits and limitations of visualtactile caries diagnosis 78 Do we need radiographs for caries detection? 79 Conclusion 82 References 83 Chapter 5 The foundations of good diagnostic practice 85 Vibeke Baelum Introduction 85 The making of a dentist 86 The dental examination: In the best interest of our patients 87 What are we looking for? What is caries? 88 The wealth of caries diagnostic methods and criteria 90 The evolution in caries diagnostic methods 90 Diagnostic test assessment in the essentialistic gold-standard paradigm 91 Evaluating caries diagnostic methods 92 Leaps in the essentialistic gold-standard reasoning 93 Diagnostic test evaluation in the nominalistic caries paradigm 95 Inter- and intra-examiner errors in caries diagnosis 96 How do we deal with the unavoidable diagnostic uncertainty? 97 The additional diagnostic yield argument 98 Concluding remarks 99 References 100 Part III The oral environment and dental caries Chapter 6 The oral microbiome composition, acquisition, establishment, and maturation 105 Gunnar Dahln The microbiome 105 The composition of the oral microbiome 107 The composition and structure of oral mucosal and tongue microbiome 116 Dental plaque microbiome 117 The oral microbiome and immunity 120 Acquisition of the oral microbiome 123 Establishment of the oral microbiome 125 Maturation of the oral microbiome 125 Conclusions 129 Background literature 129 References 129 Chapter 7 Functions of the oral microbiome in caries and how they can be controlled 133 Nobuhiro Takahashi and Bente Nyvad Introduction 133 Bacterial metabolism and ecological factors affecting the cariogenic features of dental biofilm 134 The ecological plaque hypothesis to explain the role of dental biofilm bacteria in the etiology of dental caries 135 How to control a cariogenic drift of the oral microbiome 141 Clinical approaches to ca