Caries: A Review on Recent Trends and Advances

Jianzhi Ma

Guangdong Medical University, China

Keywords:

Dental Caries, Pathogenesis, Oral Materials, Dental Caries Prevention.

Abstract:

Caries are one of the most common oral diseases in daily life. Its incidence rate increases year by year, and it

has excellent harm and poor prognosis. With the development of medical technology, although inevitable

progress has been made in preventing and treating caries, it is still clinically impossible to effectively control

and treat caries in the early stage of onset. Therefore, researchers still need to deepen the treatment of caries

further. According to the literature on caries in recent years, this article systematically summarizes the

research progress of caries, mainly discusses the pathogenesis, preventive measures, and treatment methods

of caries, aiming to lay a specific foundation for the prevention and treatment of caries.

1 INTRODUCTION

Caries is a prevalent oral disease in daily life. It can

be seen at any period after the eruption of deciduous

teeth. It is mainly manifested as a series of disease

states with increasing severity and tooth destruction,

from subclinical changes to dentin (Kassebaum,

2015). The World Health Organization (WHO)

reviewed the current epidemiological data in many

countries in the American Journal of dentistry in

2009, clearly showing that the prevalence of dental

caries is increasing significantly and has already

affected the coronal and root surfaces of deciduous

teeth and permanent teeth in children and adults. The

increase in the prevalence of dental caries occurred in

groups with low socio-economic status, new

immigrants and children. The reason for the increase

may be related to the prevention policy. For public

health, recognizing oral health and the level of dental

caries deterioration is significant (Bagramian, 2009).

Table 1: Age-standardized Prevalence and Incidence Rates and 95% Uncertainty Intervals of Untreated Dental Caries in

Permanent Teeth in 1990 and 2010 for Both Sexes Combined.

Prevalence

Region/Country 1990 2010

Global 35.5 33.7–37.6 35.4 33.7–37.3

Asia Pacific, high income 25.1 19.5–32.4 25.2 19.8–31.9a

Asia, Central 38.7 33.5–44.7 38.7 33.7–44.3

Asia, East 34.3 28.7–40.5 34.3 28.7–40.2

Asia, South 41.6 36.0–47.5 40.8 35.9–46.6

Asia, Southeast 34.6 30.7–39.4 35 30.9–39.7

Australasia 19.3 16.4–22.5 19.9 17.0–23.4a

Caribbean 35.5 30.1–41.2 35.9 30.6–42.1

Europe, Central 47.4 42.3–53.3 47.3 41.8–53.1b

Europe, Eastern 43.3 35.1–53.8 43.1 34.3–53.9

Europe, Western 35.3 32.5–38.6 35.8 33.1–39.0

Latin America, Andean 36.3 29.7–43.9 36.3 29.3–44.3

Latin America, Central 34.9 29.1–41.1 34.8 29.1–41.2

Latin America, Southern 44.7 38.1–52.8 44.9 38.1–52.4b

Latin America, Tropical 27.5 21.6–35.6 27.6 21.8–34.7

orth Africa / Middle East 34.2 30.2–38.9 34.1 30.2–38.5

Ma, J.

Caries: A Review on Recent Trends and Advances.

DOI: 10.5220/0012012600003633

In Proceedings of the 4th International Conference on Biotechnology and Biomedicine (ICBB 2022), pages 35-40

ISBN: 978-989-758-637-8

 2023 by SCITEPRESS – Science and Technology Publications, Lda. Under CC license (CC BY-NC-ND 4.0)

Prevalence

Region/Country 1990 2010

orth America, high income 22.3 19.2–25.4 22 19.1–25.4a

Oceania 35.4 28.3–44.1 35.2 27.7–43.6

Sub-Saharan Africa, Central 36.3 29.2–45.1 36.4 29.2–45.5

Sub-Saharan Africa, East 32.9 29.4–36.8 32.8 29.6–36.3

Sub-Saharan Africa, Southern 37.1 32.9–41.9 36.9 32.6–41.7

Sub-Saharan Africa, West 31.1 28.5–34.2 31 28.2–33.7

Incidence

Global 28,689 27,069–30,381 27,257 25,808–28,928

Asia Pacific, high income 49,883 41,697–59,384 50,197 41,917–59,874b

Asia, Central 34,736 29,982–40,412 34,406 29,231–40,694

Asia, East 19,209 14,923–24,191 19,057 15,042–24,052a

Asia, South 16,229 13,119–19,946 16,293 13,079–19,917a

Asia, Southeast 28,952 24,259–34,644 28,848 24,344–34,263

Australasia 14,857 12,433–17,854 14,029 11,557–16,911a

Caribbean 27,704 23,084–32,666 27,199 22,994–32,431

Europe, Central 47,378 41,509–54,190 46,876 41,146–53,486b

Europe, Eastern 35,208 27,090–45,781 35,184 27,020–45,042

Europe, Western 50,741 46,755–54,816 49,344 45,036–53,912b

Latin America, Andean 47,406 38,624–58,757 47,568 38,857–58,365b

Latin America, Central 25,572 21,473–29,972 25,660 21,751–30,150

Latin America, Southern 35,524 27,175–45,745 35,533 27,168–45,433

Latin America, Tropical 48,751 38,385–61,029 48,151 37,790–59,975b

orth Africa / Middle East 24,009 21,006–27,216 23,626 20,646–26,882

orth America, high income 60,821 51,817–71,377 62,610 52,773–74,950b

Oceania 28,855 22,265–37,155 28,669 21,527–37,532

Sub-Saharan Africa, Central 27,426 21,270–35,498 27,742 21,109–35,911

Sub-Saharan Africa, East 27,813 24,544–31,702 27,959 24,441–31,790

Sub-Saharan Africa, Southern 29,380 22,735–37,822 28,975 22,290–37,110

Sub-Saharan Africa, West 16,044 14,233–18,039 16,249 14,358–18,166

Prevalence, per 100 population; incidence rate, per 100,000 person-years.

a Indicates a prevalence or incidence significantly lower than the global mean for 2010.

b Indicates a prevalence or incidence significantly higher than the global mean for 2010.

If tooth decay occurs in children or adolescents, it

will lead to dentition infection and even tooth loss. It

is very important to use fluoride to prevent and

control dental caries at this stage. Fluoride can be

administered locally by fluorinated water or fluoride

salt, or systemic by using dietary supplements

(tablets, drops, tablets or gum) (Lampert, 2012). A

systematic review of evidence on dental floss use

showed that the use of professional floss in first grade

children during school reduced the risk of dental

caries by 40%, and this benefit was found only during

the period of children's deciduous teeth (Hujoel,

2006). There is clear evidence that daily use of

fluoride toothpaste has a significant effect on the

prevention of dental caries in children (the prevention

effect is about 24%). Parents supervise tooth brushing

every day, increase the frequency of tooth brushing to

twice a day, and use 1500 ppm fluoride toothpaste,

which will enhance the effect of preventing caries in

children (Rozier, 2010). Silver fluoride diamine is a

safe and effective drug for treating dental caries. A

clinical research report pointed out that using silver

fluoride diamine can reduce the prevalence of dental

caries in children (Llodra, 2005). In another study,

38% silver fluoride diamine was shown to prevent

and caries. The preventive effect of silver fluoride

diamine applied to caries and that directly applied to

other teeth and surfaces is similar. Single-use silver

fluoride diamine can not produce a sustained impact,

and it is more effective to use it twice a year (Horst,

2016).

a median value of three examiners; b all lesions

included; c caries-active children only; d results of

two different examiners. PF = prevented fraction

(DMFT/dmfs, DMFS/dmfs); LE = level of evidence

A-C; SV = supervised tooth brushing (daily or on

school days); NS = not statistically significant.

In this article, we mainly summarize the research

progress of dental caries, focusing on the

pathogenesis, treatment, and prevention of dental

ICBB 2022 - International Conference on Biotechnology and Biomedicine

caries, combining existing treatment measures to lay

the foundation for the prevention and treatment of

dental caries.

2 INTRODUCTION TO DENTAL

CARIES

Dental caries is a common multi-factor biofilm

disease. 60% to 90% of children are affected by it,

and it is one of the most common diseases in the

world population. The most common symptom of

dental caries is tooth pain, loss and so on (Bagramian,

2009).

The oral cavity is a complex environment in

which saliva flows continuously in the mouth, and the

teeth have multiple tooth surfaces. They are often

exposed to the external environment and substances.

Microorganisms, host factors (the buffering capacity

of saliva and the speed of saliva flow) interact with

foods that can ferment carbohydrates. There are

bacterial biofilm formation and dental plaque on the

surface of teeth. The symbiotic microbiota in the

mouth has an important influence on controlling the

reproduction of harmful bacteria. The bacterial group

in the mouth will change due to changes in the local

environment. These changes will lose the balance of

the composition of mobile phone biofilm to change

the overall metabolic activity of biofilm and then lead

to caries (Marsh, 2012). The biofilm formation begins

with constructing an acquired salivary membrane

(egglycosyltransferases; Gtfs) (Bowen, 2011) is

mainly a film layer formed by salivary proteins and

bacterial enzymes. Gtfs can directly adhere to some

bacteria, and it can also synthesize glucan, thereby

increasing the ability to adhere to bacteria (Bowen,

2011). The development of cariogenic biofilms is

mainly related to streptococcus mutants and sucrose

(Leme, 2006). In addition, the local demineralization

of pathogenic bacteria on the tooth surface will

eventually lead to the occurrence of caries. This

process is related to the following factors: (1) The

surface of the patient's teeth is susceptible to the

retention of food residues or deep pits and fissures

caused by dental defects. (2) The number of

pathogenic bacteria in dental plaque is sufficient. (3)

Sufferers often eat fermentable carbohydrates. (4)

Saliva decrease in oral (Murray, 1989; Marsh, 2006;

Selwitz, 2007).

The nutrition obtained by the human body may

have a systematic and local effect on dental caries.

Optimal energy and nutritional intake are critical to

tooth development. From the fetal stage, it is an

important period for the formation of the best teeth,

because this period is accompanied by the absorption

of energy and nutrition, and ends around the age of

six. Nutritional deficiency can affect tooth

mineralization, making teeth more prone to caries

(Hujoel, 2017). The local effect can be understood as

carbohydrates in tooth biofilm decompose by

microorganisms, and microorganisms release acidic

products, in which the primary acids are lactic acid

and acetic acid. Acid production in the caries-

promoting environment does not change significantly

among the different fermentable carbohydrates. This

depends on the local diet structure and is primarily

affected by the complex environment in the oral

cavity (biofilm composition, diet structure, saliva,

and saliva). With age, periodontal atrophy, and root

zone exposure, the relationship between caries and

carbohydrates may change accordingly. The dietary

recommendations for children and adolescents should

be compared with those for the elderly. The degree of

mineralization of teeth is affected by many

micronutrients. Vitamin D, calcium, and phosphate

play an essential role (Hujoel, 2013). Most

organizations globally believe that vitamin D

deficiency may lead to teeth hypoplasia or poor tooth

mineralization.

3 CAUSES AND TREATMENT OF

DENTAL CARIES

Caries is frequent bacterial damage to the tooth's hard

tissue. Changes in the patient's oral environment can

lead to tooth decay, resulting in tooth pain, tooth

sensitivity, and even pulp and periapical lesions,

resulting in infection, osteomyelitis, and cysts (31).

Usually, the teeth of caries patients will change as

follows: (1) the color turns yellow and black (2) the

appearance defect (3) there are infected tissue and

food debris in the caries hole (4) the bottom of the

caries hole is softer than regular teeth (32).

The latest theories on the etiology of dental caries

believe that oral pathogenic bacteria, cariogenic food,

susceptible host of dental caries and long enough

infection time are fundamental causes of dental

caries. The initial stage of caries begins with the

formation of dental plaque. This is because the

bacteria in the plaque metabolize sugar to multiply

and grow, and produce acidic substances, which

dissolve the mineral components of the teeth, thus

inducing caries (demineralization) (33). If peoples eat

more sugary foods and do not clean properly, it will

cause sugar to remain in the oral cavity. Eventually,

Caries: A Review on Recent Trends and Advances

bacteria decompose the sugar to produce acidic

products and cause tooth corrosion. Although the oral

flora is in a balanced state under normal

circumstances, the deterioration of the oral

environment, the decline of immunity, and the

reproduction of harmful flora will cause the balance

of the oral flora to be broken, which in turn leads to

the formation of dental plaque.

Caries can be divided into superficial, medium,

and deep caries according to the extent of the disease.

Among them, patients with surface caries rarely have

apparent symptoms. Patients with moderate caries

have symptoms of tooth sensitivity. And deep caries

can see noticeable cavities. According to the location

of the lesion, it can be divided into enamel caries,

dentin caries, cementum caries, root caries, pit and

fissure caries, smooth surface caries, and adjacent

surface caries. Cementum caries are common in

middle-aged and older adults, and root caries is

common in middle-aged people. According to the

course of the disease, it can be divided into acute,

chronic, and secondary caries. Children and

adolescents are more common in aggressive caries

(Van, 2021), and the progress of violent caries is

about to intervene in time (Khong, 2021).

The caries treatment usually uses a turbine head to

remove the decay and then a polymer material for

filling. Generally, the photosensitive composite resin

is used for light-curing/light curing in the tooth body

to bond with the tooth tissue. In the case of tooth

shape defects (single tooth surface functional defect),

inlay repair is used to restore the original shape and

function. If there are multiple facial defects, the high

inlay is selected for repair (the material selected for

inlay is generally zirconia). Study on the preventive

effect of fluorine-containing paint and fluorine-

containing foam on children's deciduous tooth caries

(Wu, 2021). This treatment needs to make an intraoral

dentition model, but the cost is relatively high. Laser

treatment is now a more advanced treatment method.

When the turbo drill bit is working, it will cause

discomfort to the patient, and the noise it produces

exceeds the human auditory sensitivity, which will

cause discomfort to patients (Xiong, 2021). Laser

treatment is a non-contact treatment. When decayed,

the dentin is cauterized, and no fluid flows out. The

solid-state laser cutting tooth tissue is more efficient

than the bur to rot. Under the intervention of solid-

state laser energy, the diseased tissue is decomposed,

and under the action of external water scouring, the

cavities cavity is cleaned up. The surrounding healthy

tooth tissue is not damaged during this process, and

the treatment process is more comfortable. In

addition, the laser can generate a large number of free

radicals without stimulating the dental pulp and can

reduce the inflammation of the dental pulp. In

addition, the laser will also increase the resistance of

tooth enamel to acid and caries.

In addition, for patients of lower age, general

anesthesia can be adopted (Xiong, 2021). Studies

have shown that general anesthesia can effectively

eliminate fear, reduce the patient's stress response,

and increase the patient's degree of cooperation

(Jiménez-Ramírez, 2021).

4 PREVENTION OF CARIES

The prevention of dental caries depends on all aspects

of life, mainly including the following points.

4.1 Personal Prevention

For the prevention of dental caries, the prevention of

dental caries is closely related to the individuals. Only

when individuals actively maintain the oral

environment can they effectively prevent the

occurrence of caries.

Individuals need to develop good oral hygiene

habits, such as brushing teeth in the morning and

evening, rinsing mouth after eating, and minimizing

or even avoiding eating acidic foods to irritate the

mouth. Excessive sugar intake is a significant cause

of caries, so reducing high-sugar foods, such as sugar

and chocolate is necessary. In daily life, People

should try to reduce the consumption of hard food and

pay attention to calcium intake. In addition, eat more

high-fiber foods to improve your immunity (Taiwan

defense forces Caries prevention: public health

practice of caries prevention, 2012).

4.2 Family Prevention

Compared with personal prevention, family

prevention plays a role in supervision. To help family

members develop good habits, patients can put up a

slogan about brushing their teeth in the morning and

evening as a reminder near the sink. Parents can

reduce the cost of foods with high sugar content, such

as chocolates when having family dinners or go

shopping. For families with children at home, parents

need to supervise the children to ensure that they

brush their teeth in the morning and evening, and at

the same time actively pay attention to the children's

oral hygiene. The elderly can drink more tea daily for

families with older adults because tea is rich in

fluoride ions, effectively preventing caries. For

people with inconvenient hands and feet, they can use

ICBB 2022 - International Conference on Biotechnology and Biomedicine

mouthwash or assisted tooth brushing to maintain oral

cleanliness, thereby preventing the occurrence of

caries (Lu, 2002).

4.3 Community Prevention

Communities can propaganda post-dental caries'

hazards, causes, and prevention methods on the

propaganda board and regularly carry out popular

science education on dental caries prevention to

community residents. At the same time, community

clinics can also hold lectures on widespread science

knowledge related to caries prevention (Deng, 2009).

In addition, Communities can also carry out related

activities (such as a “teeth-care day”) to convey the

awareness of oral hygiene safety and prevention to

community residents, and integrate the concept of

caries prevention into life and arouse everyone's

enthusiasm for teeth-care (Taiwan defense forces

Caries prevention: public health practice of caries

prevention, 2012).

4.4 Government Intervention

The government can formulate relevant policies to

show the concept of teeth-care to people across the

country and encourage the development of related

products to prevent caries, such as fluoride

toothpaste. And government can actively carry out

lectures about oral hygiene, and conduct treatment

programs such as pit and fissure sealing for young

people. These measures can reduce the occurrence of

caries (Duan, 2011).

4.5 Materials of Preventive Caries

4.5.1 Fluoride Toothpaste

Fluoride toothpaste is a good material for preventing

caries, and it contains fluoride ions. When the

appropriate fluoride ion concentration enters the

human oral cavity through toothpaste as a medium, it

will react with the tooth enamel to form a type of

fluorapatite, forming a protective film on the tooth

shell, thereby reducing the effect of dental plaque on

the enamel. In addition, fluoride ions can inhibit the

adhesion of cariogenic bacteria on the teeth and

reduce the number of bacteria (Rozier, 2010).

4.5.2 Resin and Glass Ion

Resin and glass ions are the primary materials for pit

and fissure sealing. They are also unique polymer

materials for dentistry, which can effectively prevent

the occurrence of caries (Autio-Gold, 2008). The

effects of resin and glass ionomer in preventing dental

caries are different. The advantage of the resin

material is that it has higher strength and patients do

not need to fasting for solids and liquids after use.

However, the treatment process of resin materials is

relatively cumbersome. If the moistureproof layer in

the mouth is poor, it may lead to the invalidation of

groove closure. The strength of the glass ionomer

material itself is slightly weaker than that of the resin

material. However, with the development of material

technology, it is now possible to combine resin and

glass ions to form a reinforced glass ion material,

which can slowly release fluoride ions around the

tooth to achieve sealing pits and fissures, thereby

preventing caries (Pizzo, 2007).

5 CONCLUSION

As one of the most common diseases in daily life,

caries is harmful and poor. How to reducing the

incidence of dental caries and how to deal with the

impact of dental caries are the direction that needs to

be worked hard at this stage. This article mainly

introduces caries, pathogenesis, preventive measures,

and corresponding treatment methods at various

levels.

Although with the development of medical

technology, there are more and more kinds of

materials for the treatment of caries. However, the

clinical treatment of caries is still unable to

effectively control and treat it in the early stage of

onset. Therefore, researchers still need to deepen

further the treatment research on the treatment of

dental caries. At the same time, the safety and

promotion of dental caries products still require joint

supervision and efforts from all walks of life. At

present, more and more social groups are beginning

to pay attention to oral hygiene and oral health, which

is conducive to the development of dental caries

prevention activities in society to promote oral health

to all walks of life. In addition, the prevalence of

dental caries varies from country to country.

Compared with developed countries, developing

countries have the most prominent caries problems.

The government can formulate relevant policies or

measures to reduce the risk of caries in the country,

thereby promoting the development of caries

prevention in the country.

Caries: A Review on Recent Trends and Advances

REFERENCES

Autio-Gold J. The Role of Chlorhexidine in Caries

Prevention[J]. Operative dentistry, 2008, 33(6): 710-

716.

Bagramian R A, Garcia-Godoy F, Volpe A R. The Global

Increase in Dental Caries. A Pending Public Health

Crisis[J]. American Journal of Dentistry, 2009, 22(1):

3-8.

Bowen W H, Koo H. Biology of Streptococcus Mutans-

Derived Glucosyltransferases: Role in Extracellular

Matrix Formation of Cariogenic Biofilms[J]. Caries

research, 2011, 45(1): 69-86.

Deng Hongbo Preventive measures of oral caries [J] China

modern drug application, 2009, (5).

Duan Qi, Huang Yanping, Xiao Cuihong The role of

preventive interventions in the prevention of dental

caries in scattered children [J] Chinese and foreign

medical research, 2011, 9 (22): 177-178.

Hujoel P P, Cunha-Cruz J, Banting D W, et al. Dental

Flossing and Interproximal Caries: A Systematic

Review[J]. Journal of dental research, 2006, 85(4): 298-

305.

Horst J A, Ellenikiotis H, Milgrom P M, et al. Ucsf Protocol

for Caries Arrest Using Silver Diamine Fluoride:

Rationale, Indications, and Consent[J]. Journal of the

California Dental Association, 2016, 44(1): 16-28.

Hujoel P P, Lingström P. Nutrition, Dental Caries and

Periodontal Disease: A Narrative Review[J]. Journal of

clinical periodontology, 2017, 44: S79-S84.

Hujoel P P. Vitamin D and Dental Caries in Controlled

Clinical Trials: Systematic Review and Meta-

Analysis[J]. Nutrition reviews, 2013, 71(2): 88-97.

Jiménez-Ramírez A J, Martínez-Martínez R E, Ayala-

Herrera J L, et al. Antimicrobial Activity of Silver

Nanoparticles against Clinical Biofilms from Patients

with and without Dental Caries[J]. Journal of

Nanomaterials, 2021, 2021.

Kassebaum N J, Bernabé E, Dahiya M, et al. Global Burden

of Untreated Caries: A Systematic Review and

Metaregression [J]. Journal of dental research, 2015,

94(5): 650-658.

Khong J S Y, Goh A T, Sim Y F, et al. Masticatory Function

after Comprehensive Dental Treatment in Children

with Severe Early Childhood Caries[J]. International

Journal of Paediatric Dentistry, 2021.

Lampert L M, Lo D. Limited Evidence for Preventing

Childhood Caries Using Fluoride Supplements[J].

Evidence-based dentistry, 2012, 13(4): 112-113.

Leme A F P, Koo H, Bellato C M, et al. The Role of Sucrose

in Cariogenic Dental Biofilm Formation—New Insight

[J]. Journal of dental research, 2006, 85(10): 878-887.

Llodra J C, Rodriguez A, Ferrer B, et al. Efficacy of Silver

Diamine Fluoride for Caries Reduction in Primary

Teeth and First Permanent Molars of Schoolchildren:

36-Month Clinical Trial[J]. Journal of dental research,

2005, 84(8): 721-724.

Lu Kejian Progress in caries prevention in children [J]

Selected works of medicine, 2002, 21 (3): 377-379.

Marsh P D. Contemporary Perspective on Plaque

Control[J]. British dental journal, 2012, 212(12): 601-

606.

Marsh P D. Dental Plaque as a Biofilm and a Microbial

Community–Implications for Health and Disease[C].

proceedings of the Biotechnology and Biomaterials to

Reduce the Caries Epidemic, Seattle, USA, 13-15 June,

2006. BioMed Central.

Murray J J. The Prevention of Dental Disease[M]. 2nd ed.

Oxford, UK: Oxford University Press, USA, 1989.

Pizzo G, Piscopo M R, Pizzo I, et al. Community Water

Fluoridation and Caries Prevention: A Critical Review

[J]. Clinical Oral Investigations, 2007, 11(3): 189-193.

Rozier R G, Adair S, Graham F, et al. Evidence-Based

Clinical Recommendations on the Prescription of

Dietary Fluoride Supplements for Caries Prevention: A

Report of the American Dental Association Council on

Scientific Affairs[J]. The Journal of the American

Dental Association, 2010, 141(12): 1480-1489.

Selwitz R H, Ismail A I, Pitts N B. Dental Caries[J]. The

Lancet, 2007, 369(9555): 51-59.

Taiwan defense forces Caries prevention: public health

practice of caries prevention [J] Chinese Journal of

Practical Stomatology, 2012, 5 (10): 577-579.

Van Chuyen N, Van Du V, Van Ba N, et al. The Prevalence

of Dental Caries and Associated Factors among

Secondary School Children in Rural Highland

Vietnam[J]. BMC Oral Health, 2021, 21(1): 1-7.

Wu Xiaoyan, Zhang Tianming Study on the preventive

effect of fluoride coating and fluoride foam on

deciduous teeth caries in children [J]. Contemporary

medicine, 2021,27 (23): 148-149.

Xiong Ying, Zeng Yong Application of Er YAG laser in the

treatment of primary dental caries in children [J] Laser

journal, 2021, 42 (9): 195-197.

ICBB 2022 - International Conference on Biotechnology and Biomedicine