Dental Caries - Historic Perspective

Theories about what cause cavities go as far back as 2500 BC in ancient China when it was thought that “tooth-worms” caused cavities.⁵ This belief continued for several centuries in many different cultures. Later, in 350 BC, Aristotle and others acknowledged that sweets and figs caused decay.⁶ It wasn’t until 1819, that Levi Parmly hinted at the real cause of caries: that decay begins on the surface of the teeth by bacteria growing on food particles which lodge around and between teeth, causing destruction of tooth structure.⁷

Caries theory was marked in the 1880s by Miles and Underwood stating in 1881 that acid and “germs” were necessary for decay, while W.D. Miller formulated the concept of caries as a local phenomenon associated with carbohydrate retention and acidogenic bacteria in 1889.⁸ In the early to mid-1900s, dental research uncovered several important findings: In 1938, H. Trendley Dean linked fluoride to caries reduction, and in later studies, high sugar consumption was linked to caries, but only in an environment where oral bacteria were present.^8,9

In 1955, Procter & Gamble introduced Crest®, the first fluoride toothpaste clinically proven to be effective in preventing dental caries. It was hailed as a major scientific breakthrough and received an endorsement from the American Dental Association (ADA) as an “effective decay-preventive dentifrice that can be of significant value.”

Figure 1. 1955, Procter & Gamble, Crest® toothpaste

In the 1990s, and repeatedly since, the ADA has emphasized the benefit of fluoride. In a 2018 executive summary on fluoridation facts developed by the National Fluoridation Advisory Committee (NFAC) and the American Dental Association (ADA) Council on Advocacy for Access and Prevention (CAAP) noted: “Fluoridation of community water supplies is the single most effective public health measure to prevent tooth decay.” In addition, “throughout more than 70 years of research and practical experience, the overwhelming weight of credible scientific evidence has consistently indicated that fluoridation of community water supplies is safe.”¹⁰

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