Dental caries: an infectious and transmissible disease where have we been and where are we going?

Dental caries is often referred to as an infectious disease, which means different things to different people. Pediatric dentists may be tempted to liken caries to other childhood diseases they encounter yet treat caries from mostly a mechanical or surgical approach. On the other end of the spectrum are clinicians who view the oral cavity as a site teaming with bacteria and think that reducing the overall microbial mass using antimicrobial agents will somehow affect this infectious disease. Here, we argue for another view, that is, to combine the most effective portion of each therapy to yield an effective outcome: the treatment and prevention of dental caries. Because primary teeth are eventually shed, pediatric dentists may be in an advantageous position to implement this approach since restorations to primary teeth need not be as durable as those made to permanent teeth. Moreover, pediatric dentists use sealants extensively and are used to working, for example, with rubber dams, especially in young patients. It may turn out that after more research is completed on the ontogeny of the oral microbial flora, changes or ecological shifts made in childhood become lifelong. More specifically, drastic reductions or eliminations of cariogenic bacteria, along with their sites for colonization in the primary dentition, may prevent or delay their transfer to the permanent dentition. Similarly, reductions in a mother's levels of cariogenic bacteria may delay or interrupt the transfer of cariogenic bacteria to her infant. Here, the goal is to discuss several concepts before their final inception into practices and to stimulate discussion of ideas, reframing the design to meet the demands of everyday practice. Ultimately, the proof will come from a large clinical trial conducted in many practices and patient populations.