In the final portion of this chapter, we examine diverse fluoride applications for controlling tooth decay on the crown, and outline the evidence-based recommendations for combining these approaches.

Caries risk assessment (CRA) is a cornerstone of personalized approaches to managing caries. Existing computerized radiographic analysis (CRA) tools, lacking comprehensive formal evaluation and validation, impede the accurate forecasting of new lesions. Although this is the case, clinicians should still assess modifiable risk factors to design preventive strategies, and to accommodate each patient's specific needs to personalize care. The intricate and ever-shifting nature of caries implies that CRA is complex and responsive to various influences throughout a person's lifetime, thus demanding frequent re-assessment. Wortmannin in vitro Caries risk is affected by a multitude of individual, family, and community-level influences; however, unfortunately, existing caries experience remains a strong indicator of future caries risk. Validating, making affordable, and ensuring ease of use are crucial steps in the development and prioritization of CRA tools that will assist in decision-making to execute evidence-based, minimally invasive caries management strategies for coronal caries lesions affecting children, adults, and older people. CRA tool development efforts should prioritize the evaluation and reporting of pertinent internal and external validation data. Artificial intelligence and big data approaches may shape future risk predictions; cost-effectiveness analyses may then support the selection of pertinent risk thresholds for sound decision-making. Given the crucial role of CRA in treatment planning and decision-making, considerations for its implementation must address communication of risk for behavior modification, the creation of easily integrable and time-efficient tools within the clinical workflow, and appropriate reimbursement for the associated time investment.

Using clinical examination alongside radiographic imaging as an ancillary diagnostic technique, this chapter elucidates the fundamental principles of dental caries diagnosis. Trace biological evidence By evaluating clinical symptoms and signs of caries lesions, complemented by radiographic analysis, dental professionals skillfully diagnose caries disease. The process of diagnosis begins with a clinical examination, which must follow the removal of dental biofilm from tooth surfaces, air-drying, and optimal lighting. Clinical diagnostic methods for caries lesions use a system to classify them, taking into consideration both severity and, in some cases, the level of activity. The activity of caries lesions has been assessed by evaluating their surface reflection and texture profiles. A supplementary diagnostic strategy to evaluate caries lesion activity includes the identification of heavy or dense biofilm accumulation on teeth. A patient free from any manifestation of caries, presenting no clinical or radiographic evidence of caries lesions in their teeth, is considered caries-inactive. Inactive caries lesions/restorations are a possibility for patients who are not currently experiencing active caries. Patients are identified as caries-active when presenting either any clinically evident active carious lesions or radiographically demonstrated progressing lesions, confirmed by at least two bitewing radiographs taken at different time points. A key concern regarding caries-active patients is the tendency of caries lesions to progress if preventative strategies are not diligently employed to halt their worsening. Individualized bitewing radiographs furnish additional clinical information, assisting in identifying lesions of proximal enamel and the outer third of dentin, which might be treated non-surgically.

Recent decades have seen a substantial increase in the sophistication of dentistry in all its various applications. Past caries management strategies were typically surgical, but contemporary approaches favor non-invasive and minimally invasive methods, utilizing invasive procedures only when unavoidable. Early detection of caries is required for the most conservative and least invasive treatment, but achieving this remains a complex problem. Successfully managing the development of early or noncavitated caries lesions is now possible, similarly to arresting the progression of existing lesions by combining oral hygiene, the use of fluoride, sealants, or resin infiltration. The dental industry now provides X-ray-free caries detection, assessment, and monitoring through the implementation of methods such as near-infrared light transillumination, fiber-optic transillumination, digital fiber-optic transillumination, laser fluorescence, and quantitative light fluorescence measurements. For the purpose of detecting caries lesions in areas of the teeth that are not readily visible, bitewing radiography remains the standard diagnostic tool. Bitewing radiographs and clinical images now benefit from the burgeoning application of artificial intelligence to detect caries lesions, necessitating future research to fully understand this emerging technology. Within this chapter, we aim to survey a spectrum of methods for detecting coronal caries lesions and provide guidance on how to better manage and improve the detection process.

In this chapter, a global analysis of clinical data on coronal caries distribution is provided, with a focus on sociodemographic drivers affecting children, adults, and older individuals. Examining global caries prevalence rates revealed substantial differences, with some countries continuing to experience high levels. Prevalence of the disease, broken down by age and average affected teeth count, is shown for each group. Disparities in the incidence of tooth decay between developed and developing nations stem not just from varying age demographics, but also from diverse ethnicities, cultures, geographies, and developmental stages, alongside disparities in dental access, healthcare provision, oral hygiene practices, dietary habits, and overall lifestyles. While caries rates in Western children and adults have fallen, the uneven distribution of the disease, connected to individual and community conditions, continues to be a significant concern. In the elderly population, a significant prevalence of dental caries, reaching as high as 98%, has been documented, exhibiting substantial variation across and within various countries. Despite its continued high incidence, a decrease in the incidence of tooth loss was seen. Caries data, when analyzed alongside sociodemographic indicators, underscores the need for a comprehensive overhaul of the global oral healthcare system to address inequalities across the entire lifespan. The creation of national oral healthcare policies, built upon epidemiological models of care, necessitates the collection of further primary oral health data to support policy-makers.

Despite the wealth of current knowledge in cariology, the pursuit of methods to protect dental enamel against dental caries remains a subject of ongoing research. Recognizing the mineral-based nature of enamel, a concerted push has been made towards creating a more acid-resistant enamel against the dental biofilm-generated acids triggered by dietary sugars. Fluoride's role in preventing tooth decay, once perceived through its incorporation into tooth mineral structure as a micronutrient, is now recognized as primarily contingent upon complex surface interactions. Enamel's behavior, like that of every other slightly soluble mineral, is shaped by its environment, and the influence of saliva and biofilm fluid is especially critical within the dental crown. Enamel, while able to maintain its mineral balance, might also lose minerals, but it is capable of replenishing these losses. Hydro-biogeochemical model Following Le Chatelier's principle, the processes of equilibrium, and loss or gain are observed, and these phenomena are known as saturating, undersaturating, and supersaturating conditions, respectively, from a physicochemical perspective. Enamel's propensity to gain minerals is due to the supersaturation of saliva and biofilm fluid with calcium (Ca2+) and phosphate (PO43-), exceeding its solubility limit; this natural tendency makes saliva a remineralizing agent. Despite this, the decrease in acidity and the presence of unbound fluoride ions (F-) will ultimately determine the enamel's reaction. The act of lowering the pH of the medium creates an imbalance, yet fluoride at micromolar levels weakens the acid's impact. In this chapter, an up-to-date, evidence-supported perspective on the interplay between enamel and oral fluids is offered.

The oral cavity serves as a habitat for the oral microbiome, composed of bacteria, fungi, archaea, protozoa, viruses, and bacteriophages. The intricate dance of synergistic and antagonistic interactions within microbial communities ensures the coexistence of different microorganisms and the maintenance of microbial balance at distinct locations. The microbial equilibrium in this colonized region prevents the spread of potential pathogens, typically keeping their density at very low levels. Microbial communities, compatible with a healthy condition, coexist harmoniously with the host. On the flip side, stressors apply selective pressures to the microbiota, throwing off the equilibrium within the microbial community and leading to dysbiosis. During this procedure, the proliferation of potentially harmful microorganisms increases, leading to microbial communities with modified characteristics and roles. With the attainment of a dysbiotic state, there is an expected elevation in the probability of diseases. For caries to develop, biofilm is an indispensable factor. Knowledge of microbial community composition and metabolic interactions provides a cornerstone for the development of effective preventative and therapeutic interventions. An in-depth understanding of the disease process necessitates the study of both health and cariogenic factors. Recent advancements in omics methodologies offer a unique opportunity to uncover novel understandings of dental cavities.