1.1 Etiology and Progression

The process whereby dental caries progresses from demineralization to tooth cavitation is a continuum, spanning the initial bacterial infection, the acid attack of tooth surfaces, and demineralization/remineralization cycles.

Basic Elements

This diagram illustrates the basic elements for dental caries formation. The interior circles represent the tooth (susceptible tooth surface), sugar and other fermentable carbohydrates, and bacteria (odontopathic plaque). A larger circle designating time, which the carious process requires, encompasses the interior circles.

Early Carious Lesions

Prior to cavitation in early carious lesions, the crystalline enamel structure of the tooth is compromised by loss of inorganic components. The enamel structure retains its organic matrix and can replace the inorganic components if they become available through saliva. When the enamel structure is compromised (i.e., it has lost significant inorganic content), it is highly susceptible to mechanical disturbance of the organic matrix.

The caries process progresses by destroying the organic matrix as well, culminating in irreparable damage that results in cavitation if any of the following occur:

• Organic matrix is disturbed.
• Saliva does not contain enough minerals.
• Acid attack is overwhelming.

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