Introduction

Caries cannot develop without the presence of a host, which comprises tooth structure, the saliva that surrounds a tooth, and the immune responses of saliva and plasma in the oral cavity. In the caries process, particular attention is paid to the enamel - the hard, outermost layer - because it is the primary contact with cariogenic bacteria, and where demineralization first begins. It is also the only tissue of the tooth that does not have the ability to grow or repair itself after maturation. Saliva is also important to consider in the caries process because it has protective properties that can reduce caries risk: it neutralizes pH in the vicinity of the tooth, assists in remineralization, acts as an antibacterial agent, and plays a role in the immune responses to cariogenic oral bacteria.

Figure 1. Tooth Surface

Clinical Significance Snapshot

In managing patients at risk of dental caries, how should I approach managing ‘host’ factors involved in the caries process?
To manage host factors in patients at risk of dental caries, focus should be on protecting enamel and dentin. In younger individuals, enamel is the primary concern, while dentin becomes vulnerable later in life due to gingival recession and root exposure.

Saliva’s Role
Saliva plays a critical role by flushing away cariogenic substances and promoting remineralization through its calcium saturation. Reduced saliva flow, often caused by medications or medical conditions, increases caries risk. Dental professionals should assess saliva quantity and quality and collaborate with the patient's physician if concerns arise.

Fluoride Protection
Regular exposure to fluoride is essential. Brushing twice daily with fluoride toothpaste can reduce caries by over 50%. Additional protection can be achieved through fluoride rinses, gels, and professional applications. Preventing gingival recession is key to protecting roots from caries. For exposed roots, fluoride treatments and patient education on meticulous oral hygiene are crucial.

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