5-7 Introduction

Introduction
The term caries is derived from the Latin word meaning ‘rot’ or ‘decay’. It is a complex
dynamic process where a multitude of factors influence and initiate a cascade of disease. 1
"Dental caries is a microbial disease of the calcified tissues of the teeth, characterized by
demineralization of the inorganic portion and destruction of the organic substance of the
tooth, which often leads to cavitation".2
Despite advancements in oral disease science, dental caries continues to be a global
health concern. It is considered as a disease of modern civilization as anthropologic
studies shows no evidence of caries in preneolithic period (1200 BC) while there is presence
of caries in Neolithic period (1200-3000BC).2 The global increase in caries prevalence
affects children and adults, including deciduous and permanent teeth and affecting
coronal as well as radicular surface.3
Dental caries is a chronic, microbial, site specific disease caused by shift from protective
factors favoring the tooth remineralization to destructive factors leading to the
demineralization.3 It progresses to expand from the initial focus of enamel degeneration
and the subsequent exposure of underlying dentin to a point where microorganisms
access to the tubular gain network of dentin that extends to the dental pulp.3
The prevalence and incidence of dental caries in a population is influenced by a number of
risk factors such as age, gender, socioeconomic status and oral hygiene habits.4 Besides all,
genetics play an important role in caries susceptibility by determining the tooth
morphology, salivary function, immune response as well as taste sensitivity and preference,
which influences dietary habits and subsequent caries risk.4 Dental caries affects the hard
5
Introduction
tissue of a tooth i.e. Dentin, Enamel and Cementum. The histological appearance and
progression varies in these sites depending upon their respective histology and interaction
with the host and extrinsic factors.4
From ancient civilizations till date, various theories have attempted to explain the
etiopathogenesis of dental caries including worm theory and endogenous and exogenous
theories. Amongst these the chemicoparasitic theory has gained widest acceptance. 4
Dental caries occurs through a complex interaction over time between acid producing
bacteria and fermentable carbohydrates combined with host factors, including teeth
and saliva. 3 The hydroxy apatite crystals of enamel are susceptible to acid dissolution
produced by micro-organism present in the oral cavity and dental plaque.5 Dental
plaque is a microbial biofilm consisting of distinct micro-organisms that are
ubiquitous to oral cavity and colonize on tooth surface.6 A wide group of microorganisms
can be isolated from carious lesion of which Streptococcus Mutans (S.mutans),
Lactobacillus Acidiophillus, Lactbacillus Fermentum and Actinomyces viscous are the
main pathogenic species involved in initiation, development and progression of dental
caries.3 These microorganism are termed as Pioneer Bacteria as they are found
penetrating the dentinal tubules before any clinical evidence of the caries process.6
There is an interaction between three principle factors; the host, the microbial flora and the
carbohydrate substrate with time as an inevitable fourth factor. The role of saliva as a
defense mechanism against caries is well documented. The defense system includes
clearance, buffering, antimicrobial agent and remineralization. 7 The mouth is
provided with both the humoral and cellular arms of immune system, which
6
Introduction
influences the microbial communities in oral cavity. 8 Humoral immunity functions
through local immunoglobulins produced in saliva and gingival fluid, and through
systemic (serum) immunoglobulins entering via the gingival exudates. Cellular
immunity through Antibodies IgA and IgG fraction have been found with
agglutinating activity against oral isolates of hemolytic bacteria. 9
In the area of caries prevention, caries vaccine has always been a part of
discussion. 10 Vaccine is an immune-biological substance designated to produce
specific protection against a given disease.11 It stimulates the production of protective
antibodies and other immune mechanism.12 Current strategies for immunization against
dental caries are the use of virulence factors of S. mutans which act as a key antigen
and incorporating them into novel mucosal vaccine system.13 Active immunization against S.
mutans has been tested in rodents and primates. Progress in the development of
caries vaccine has increased due to advancements in molecular biology.3
Thus, dental caries is a complex phenomenon involving internal factors such as diet,
microbial flora colonizing on the teeth, saliva, tooth surface morphology, hormones
and numbers of external factors. The future management of dental caries requires early
detection, risk assessment and cost effective prevention as well as treatment for those
who need it most.I4

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Introduction

tooth, which often leads to cavitation".2

Despite advancements in oral disease science, dental caries continues to be a global

health concern. It is considered as a disease of modern civilization as anthropologic

of caries in Neolithic period (1200-3000BC).2 The global increase in caries prevalence

coronal as well as radicular surface.3

factors favoring the tooth remineralization to destructive factors leading to the

demineralization.3 It progresses to expand from the initial focus of enamel degeneration

and the subsequent exposure of underlying dentin to a point where microorganisms

The prevalence and incidence of dental caries in a population is influenced by a number of

genetics play an important role in caries susceptibility by determining the tooth

with the host and extrinsic factors.4

plaque is a microbial biofilm consisting of distinct micro-organisms that are

can be isolated from carious lesion of which Streptococcus Mutans (S.mutans),

Lactobacillus Acidiophillus, Lactbacillus Fermentum and Actinomyces viscous are the

main pathogenic species involved in initiation, development and progression of dental

clearance, buffering, antimicrobial agent and remineralization. 7 The mouth is

influences the microbial communities in oral cavity. 8 Humoral immunity functions

systemic (serum) immunoglobulins entering via the gingival exudates. Cellular

agglutinating activity against oral isolates of hemolytic bacteria. 9

discussion. 10 Vaccine is an immune-biological substance designated to produce

specific protection against a given disease.11 It stimulates the production of protective

caries vaccine has increased due to advancements in molecular biology.3

who need it most.I4

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