The aetiology of dental caries--an outline of current thought

Nearly 90 years after being put forward by W.D. Miller, the acidogenic theory of dental caries aetiology is supported by a wealth of experimental evidence. However, while explaining the basic mechanism of caries, it does not indicate how the effect of the mechanism is modified to give the observable pattern of caries attack. This explanation is attempted on the basis of the interaction of two groups of variable factors. Firstly, those which affect the tooth's resistance to caries attack, which include the chemical, microstructural and morphological nature of the enamel surface. Secondly the factors which determine the cariogenicity of the tooth's environment. These include the nature of the diet, plaque and saliva. Finally the caries initiation is considered at an atomic level in terms of the dynamic ionic exchange between enamel and plaque. This brief review highlights the need for considerably more research to shed more light on the nature of the variable aetiological factors of caries.