Dental Caries is a major new work on a subject of vital concern to all dentists. It builds on the work of two former books, Textbook of Clinical Cariology and Fluoride in Dentistry, to present a definitive resource on caries prevention and treatment. The management of dental caries is central to daily work in dental offices because caries is ubiquitous in all populations, lesion development continues lifelong and caries is the most common cause of tooth loss around the world. The book's logical structure consists of four parts, covering: The Disease; Diagnosis; Prevention, Non-Operative and Operative Treatment and Prognosis. It provides a clear understanding of the disease process, be it at an individual or population level. The Editors are joined by 28 expert authors who have contributed a wealth of chapters, ranging from the role of fluorides to restoring the tooth. Careful balance between prophylaxis and surgical intervention guides the reader through the maze of treatment decisions, while the breadth of the book reflects diverse, and sometimes controversial, opinion on dental caries. Key Features Contains over 400 illustrations, including many radiographs and color photographs Encompasses preventive measures and some illustrative operative dental therapies Features step-by-step case studies Digests key research findings Editors and contributors provide an international perspective Dental Caries is aimed at dental students and practitioners, and will be of value to dental hygienists and those involved with public health. Faculty and practice libraries will also wish to feature this authoritative book on their shelves. The Editors Ole Fejerskov is Director of the Danish National Research Foundation and is Adjunct Professor at the Royal Dental College, Aarhus University, Denmark. His previous books include Textbook of Clinical Cariology and Fluoride in Dentistry. Edwina Kidd is Professor of Cariology at Guy's, King's and St Thomas' Dental Institute, King's College, University of London, United Kingdom. Her previous books include Essentials of Dental Caries and Pickard's Manual of Operative Dentistry. View the preface online at www.blackwellpublishing.com/fejerskov from April 2003 Other Titles of Interest Clinical Periodontology and Implant Dentistry, Fourth Edition Edited by Jan Lindhe, Thorkild Karring and Niklaus P. Lang 1 4051 0236 5 Textbook of Endodontology Edited by Gunnar Bergenholtz, Preben H?rsted-Bindslev and Claes Reit 8 7161 2185 6 Pediatric Dentistry - A Clinical Approach Edited by Goran Koch and Sven Poulsen 8 7161 2271 2 Visit our website at www.blackwellmunksgaard.com

Preface: An Editors' guide to reading the book	p. xi
List of contributors	p. xvii
The Disease	p. 1
Clinical cariology and operative dentistry in the twenty-first century	p. 3
Introduction	p. 3
Standing on the shoulders of giants	p. 3
The caries situation by the middle of the twentieth century	p. 4
The aim of this book	p. 6
References	p. 6
Secretion and composition of saliva	p. 7
The oral cavity and saliva	p. 7
The salivary glands	p. 7
Quantity of salivary secretion	p. 13
Quality of saliva	p. 18
Pellicle	p. 24
Saliva and dental caries	p. 25
Background literature	p. 26
The oral microflora and biofilms on teeth	p. 29
Introduction	p. 29
Dental plaque: development, structure, composition and properties	p. 31
Dental plaque and caries	p. 42
Background literature	p. 47
References	p. 47
Chemical interactions between the tooth and oral fluids	p. 49
Introduction	p. 49
The importance of the mineral phase in enamel	p. 50
Enamel mineral and oral fluids	p. 52
Demineralization and remineralization of the dental hard tissues	p. 56
Erosion	p. 59
Remineralization	p. 60
Dentin caries	p. 60
Fluoride reactions in the oral environment	p. 64
Dental calculus	p. 68
Background literature	p. 68
References	p. 68
Clinical and histological manifestations of dental caries	p. 71
Introduction	p. 71
Terminology	p. 72
Clinical appearances of caries lesions	p. 72
Enamel reactions during eruption	p. 72
Enamel changes during early caries lesion development	p. 75
How rapidly may changes be recorded (microscopically and clinically) in enamel covered by dental plaque?	p. 75
Why does mineral loss predominantly occur underneath the enamel surface?	p. 77
How do such early lesions change when dental plaque is removed?	p. 78
The approximal white-spot lesion	p. 80
Progression of the enamel lesion	p. 83
Arrest of caries lesions	p. 83
Occlusal caries	p. 86
Dentin reactions to caries progression	p. 87
Pulpo-dentinal reactions before bacterial invasion into the dentin	p. 88
Enamel destruction and bacterial invasion	p. 90
Pulp reaction	p. 92
Root-surface caries	p. 92
Histopathological features of root caries lesions	p. 93
Background literature	p. 96
References	p. 96
Diagnosis	p. 99
Caries diagnosis: 'a mental resting place on the way to intervention'?	p. 101
Introduction	p. 101
Dental caries: a process	p. 101
Dental caries, a multifactorial disease?	p. 102
Three perspectives on dental caries	p. 103
Dental caries: do health and disease form a dichotomy?	p. 104
The purpose of diagnosis	p. 105
The caries diagnostic process	p. 106
Variation in clinical decisions	p. 107
Outcomes of caries interventions	p. 108
The decision nodes in clinical decision making	p. 109
Concluding remarks	p. 110
References	p. 110
Clinical and radiographic diagnosis	p. 111
Introduction	p. 111
What is diagnosis?	p. 111
An important detour	p. 112
Why is diagnosis important?	p. 115
Possible and 'appropriate' levels of diagnosis	p. 115
Prerequisites for detection and diagnosis	p. 116
Clinical criteria	p. 117
Radiography	p. 119
References	p. 127
Advanced methods of caries diagnosis and quantification	p. 129
Introduction	p. 129
Assessment of the performance of quantitative diagnostic methods	p. 129
Diagnostic methods based on X-rays	p. 130
Diagnostic methods based on visible light	p. 132
Diagnostic systems based on electrical current	p. 136
Diagnostic systems based on ultrasound measurements	p. 137
Conclusions and recommendations	p. 137
References	p. 138
Caries epidemiology, with special emphasis on diagnostic standards	p. 141
Introduction	p. 141
Epidemiology: what is it and why do we need it?	p. 141
Capturing relevant information about dental caries	p. 144
Epidemiological results and their use	p. 149
Glossary	p. 160
References	p. 161
Prevention, Non-operative and Operative Treatments	p. 165
Prevention of dental caries and the control of disease progression: concepts of preventive non-operative treatment	p. 167
Introduction	p. 167
Can the caries process be prevented?	p. 167
Controlling disease progression	p. 168
Should disease control be considered as 'treatment' of the caries lesion?	p. 168
Why use the term 'preventive non-operative treatment'?	p. 169
References	p. 169
The role of oral hygiene	p. 171
Introduction	p. 171
Some theoretical considerations	p. 171
The biological effect of tooth cleaning	p. 171
The clinical effect of tooth cleaning	p. 172
The individual level	p. 173
The population level	p. 175
The effect of professional tooth cleaning	p. 175
Concluding remarks	p. 176
References	p. 176
The role of antimicrobials	p. 179
Is there a rationale for the use of chemical antiplaque agents in caries prophylaxis?	p. 179
Biological activity of chemical antiplaque agents	p. 179
Principal modes of action of an antiplaque agent	p. 180
Administration of antiplaque agents: vehicles	p. 181
Agents	p. 182
Concluding remarks and future approaches	p. 186
Background literature	p. 187
References	p. 187
Clinical use of fluoride	p. 189
Introduction	p. 189
How fluoride came into dentistry	p. 189
Physiological and toxicological aspects of fluoride delivery	p. 194
Current methods of fluoride delivery	p. 203
Appropriate use of fluoride in caries control	p. 217
Background literature	p. 219
References	p. 219
The role of dietary control	p. 223
Introduction	p. 223
Diet and dental caries in humans	p. 223
Influence of different intake patterns	p. 227
Influence of fluoride on the relationship between sugars and caries	p. 228
Groups at increased risk of dental caries in relation to diet	p. 229
The relative cariogenicity of different sugars	p. 231
Novel carbohydrates and dental health	p. 231
Protective factors in foods	p. 237
Promoting good dietary habits for dental health	p. 239
References	p. 242
The role of operative treatment	p. 245
Introduction	p. 245
What is happening in your dental school?	p. 245
The outcome of non-operative or preventive treatment	p. 246
Initial lesions	p. 246
Cavitated lesions	p. 246
Free smooth surfaces	p. 246
Does this approach always work?	p. 246
Occlusal surfaces	p. 247
Approximal surfaces	p. 247
Recurrent caries	p. 247
Summary	p. 248
References	p. 250
The maze of treatment decisions	p. 251
Variability in decision making	p. 251
Elements of decision making	p. 253
Identification of the main caries condition	p. 259
Identification of treatment choices	p. 259
Identification of possible treatment outcomes	p. 260
Assigning values (utilities) to outcomes	p. 260
Influences on treatment decisions	p. 260
Benefits and risks of early caries lesion detection	p. 260
Reducing the risk of inappropriate decisions	p. 261
Influences on treatment decisions	p. 261
Medical/dental history	p. 261
Caries risk assessment	p. 261
Treatment strategy	p. 263
References	p. 264
Caries removal and the pulpo-dentinal complex	p. 267
Introduction	p. 267
Current practice of caries removal	p. 267
Summary of caries lesion progression in dentin	p. 267
The pulpo-dentinal complex and caries	p. 268
The relevance of pulpo-dentinal reactions to operative management	p. 270
The current operative tradition	p. 270
The infected dentin concept and its clinical consequence	p. 270
Preparation damage, filling toxicity and microleakage	p. 272
Future prospects for operative treatment of the caries lesion: indirect pulp capping	p. 272
Bacteria left in cavities	p. 273
Conclusion on caries removal and the pulpo-dentinal complex	p. 273
References	p. 273
Restoring the tooth: 'the seal is the deal'	p. 275
Introduction	p. 275
Materials	p. 276
Treatment of pit and fissure caries	p. 282
Treatment of approximal caries	p. 286
Treatment of smooth-surface caries	p. 289
Repair of restorations	p. 290
References	p. 290
Prognosis, Caries Control and Prediction	p. 293
Prognosis for caries and restorations	p. 295
Trends in dental caries	p. 295
The prognosis for caries lesions	p. 295
Prognoses of restorations	p. 300
Concluding remarks	p. 301
References	p. 301
Caries control for the individual patient	p. 303
Introduction	p. 303
How are current caries activity and risk of future caries progression assessed?	p. 303
How is the information used to categorize patients into risk groups?	p. 305
What preventive, non-operative, treatments are available?	p. 306
How is the individual helped to control disease progression?	p. 309
When should the patient be recalled?	p. 310
References	p. 311
Caries control for populations	p. 313
Introduction	p. 313
The determinants of caries	p. 313
Limits to current lifestyle-changing approaches	p. 315
A priority scale of preventiveness	p. 315
A common risk-factor approach to prevention	p. 317
The case for health promotion	p. 317
Strategy for oral health promotion: general principles	p. 318
Population and high-risk strategies	p. 318
Limitations of the high-risk approach	p. 320
The scientific basis for the whole-population approach	p. 321
Dental caries criteria for selecting an oral health strategy	p. 322
Some working rules of caries attack patterns and prevalence	p. 322
Policy selection	p. 322
Selection of strategy based on caries levels and trends	p. 322
Defining the caries situation	p. 323
A settings approach for preventive programs	p. 324
The role of dentists in oral health promotion	p. 324
Which way do we go from here?	p. 325
References	p. 325
Caries prediction	p. 327
Introduction	p. 327
Clinicians assess risk, researchers predict	p. 328
The course of a typical prediction study	p. 328
Practical examples	p. 330
What level of accuracy would be sufficient in everyday practice?	p. 335
What level of accuracy can be achieved?	p. 335
How valuable are the proposed measures?	p. 338
Background literature	p. 339
References	p. 339
Index	p. 343
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Dental Caries: The Disease and Its Clinical Management

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