The Mechanism of Dental Decay by JOHN D. B, FEATHERSTONE, M.Sc., Ph.O., F.N.Z.LC. Current concepts of the mechanism of tooth decay are reviewed as a basis for the understanding of the role of dietary components in the decay process. v Dr. Featherstone is Chairman of the De pportment of Oral Biology at the Eastman Dental Center, Rochester, NY. and Deputy Director of the NIH/NIDR-funded Roch ester Cariology Center. He hes published centensively im the area of de- and remin: alization of teeth and the related role of, fluoride, His research interests cover most aspects of prevention of dental decay ental decay, or dental caries, D is well known to the whole population. Until. recently almost everyone had experienced tooth decay several or many times in their lifetime. However, during the 1960s, many cities and towns throughout the world added fluo- ride to their drinking water, with subsequent reductions in dental de. cay of 40-60%. It was later learned that this protection against _dental ‘Hecay was primary die tothe rex Soot uote ig he- out rather than by systemicroutes, Dur- fig the last 10-15 years there has been a further dramatic reduction in dental decay in several western world countries. This reduction has been a further 40-60%, depending on what survey we read, and has applied in areas with or without water fluondation, This reduction in dental decay in adults and in Ghildren Ras now Been attnbuted primarily to the almost _universal use_of fMluondated toothpastes.” ‘Siker actors silt under consider: tion are changes in dietary patterns, changes in oral bacteria, the advent of improved oral hygiene practices, more preventive approaches by the dental profession and possible other unidentified aspects. An even, more dramatic phenomenon of the last decade is that in excess of 30% of our teenagers are now canes free. That is, they have never ex- penenced dental decay. Another 30% have experienced almost no dental decay, and it 1s anticipated that these two groups will carry on into adult lfe with litle or no decay There are, however, at the other end of the scale, 20% or so of the population who still, for some rea- Son oF reasons, have high dental In excess of 30% of our teenagers are now car- ies-free. decay activity. In the adult popula- tion, tooth decay continues orbe a problem. paraculrly with ecurent caries around restorations (fillings) Shdcaries ofthe tooth root surfaces, cementum and dentin (Figure 1) when they become exposed as the gums recede when we age. Factors that may lead to high cares fuk te tase oF the use of medicines which reduce saliva function), frequent smacking on fermentable carbohy- Seats, Cactonal vience changes Trlillary components and other factors yet to be identified 10 NUTRITION TODAY May/une 1987 Fie