Caries Process, Prevention, and Management: Demineralization/Remineralization
Course Number: 714
Course Contents
Other Special Populations, Systemic Conditions and Salivary Function in Dental Caries
Certain medical conditions and special health care needs can increase susceptibility to enamel demineralization and development of dental caries. One such condition is amelogenesis imperfecta, a genetic disorder that disrupts normal enamel formation. In affected individuals, enamel may be hypoplastic, hypocalcified, or hypomature, resulting in a structurally weak surface that flakes or wears away easily, exposing underlying dentin to cariogenic bacteria and accelerating caries progression.
Figure 7. Amelogenesis Imperfecta
Other individuals at increased risk include those with physical, developmental, or cognitive disabilities that impair their ability to perform adequate oral hygiene. Patients with neuromuscular disorders, intellectual disabilities, or limited dexterity may struggle with plaque removal, placing them at heightened risk for caries and periodontal disease.
Xerostomia (dry mouth), whether caused by systemic diseases such as Sjögren’s Syndrome, use of several medications, or cancer treatments (e.g., radiation to the head and neck), is another major contributor to caries risk. Saliva plays a vital role in buffering acids, clearing food debris, and supporting remineralization. Reduced salivary flow significantly impairs these protective functions, increasing the vulnerability of teeth to the caries process. Any medical condition, or treatment, that reduces salivary flow significantly increases the risk of caries.
One of the most dramatic examples is head and neck cancer treated with radiation therapy, particularly when the parotid or other major salivary glands are within the radiation field. Radiation damages salivary gland tissue, leading to long-term or permanent xerostomia. As a result, patients may experience severe and rapid onset of caries, sometimes developing in one month what might typically occur over two years in a healthy individual.
Other systemic conditions such as diabetes mellitus or chronic kidney disease can also contribute to altered salivary flow or composition. Additionally, xerostomia is frequently reported in patients taking medications, and it is well established that a large proportion of commonly prescribed drugs, such as antihypertensives, antidepressants, antipsychotics, and antihistamines, have salivary reduction as a side effect. Thus, individuals taking multiple medications, particularly older adults, are at significantly increased risk for caries due to reduced salivary protection.
Preventive care for these populations often requires individualized strategies, including the use of high-fluoride products, saliva substitutes or stimulants, dietary counseling, and more frequent dental visits. Therefore, proactive caries prevention and salivary management strategies are essential in these populations.