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INTRODUCTION

Dental caries is an infectious disease caused by a bacterial biofilm which is expressed in a predominantly pathologic oral environment. Although acid generating bacteria are the etiologic agents, dental caries has been thought of as a multifactorial disease since it is influenced by dietary and host factors. Dental plaque is the biofilm found naturally on teeth. Dental plaque is implicated in dental caries, which is associated with shifts in the microbial balance of the biofilm resulting in increased proportions of acid producing [acidogenic] and acid tolerating bacteria [aciduric] , especially Mutans Streptococci and Lactobacilli. The frequent intake of fermentable dietary sugars, or impaired saliva flow, produces persistent conditions of low pH within the biofilm, which selects for these cariogenic bacteria. It is preferable to prevent this disruption to the natural microbial balance of the biofilm, rather than merely treating its consequences by restoring cavities. The pathogenicity of the dental biofilm is modified by salivary and dietary factors, as well as by the characteristics of the tooth structure. The composition of the acquired pellicle can modify the mineral homeostasis of the tooth surfaces and the attachment of bacteria for the development of the biofilm. The substitution of sucrose from the diet by other less cariogenic sugars and/or sugar substitutes can contribute to reducing the pathogenicity of the biofilm. In addition, the role of saliva as a defence system against dental caries is well documented. These defence systems include clearance, buffering, antimicrobial agents and calcium and phosphate delivery for remineralisation. . Saliva clears, dilutes, neutralizes and buffers acids produced by the biofilm. In addition, saliva provides the biofilm/tooth structure with Ca2+ PO4 3 and F ions, which can positively affect the equilibrium between demineralizationremineralisation toward the remineralisation and modify the susceptibility of the tooth structure to caries progression. The caries process is dependent upon the interaction of protective and pathologic factors in saliva and plaque biofilm as well as the balance between the cariogenic and noncariogenic microbial populations that reside in plaque.

A caries lesion refers to the clinical manifestation of the disease process. Dental caries is a site-specific disease that undergoes many cycles of demineralization and remineralisation during lesion development. At the beginning of the disease process, bacterial pathogen activity leads to a reversible demineralization of the hard tooth structure. At this point of the disease process, the lesion is said to be sub clinical because it is not detectable by typical diagnostic means (visual, tactile, and radiographic). Because of its developmental characteristic dynamics, the caries lesion can be arrested and even repaired at its early stages without operative intervention by increasing the net mineral gain during the demineralization and remineralisation cycles. This result can be accomplished by reducing the effect of etiological factors such as cariogenic biofilm and diet and increasing the efficacy of remineralising agents such as saliva and fluoride. If remineralisation does not occur, the disease process continues to an irreversible stage where tissue morbidity occurs. Prevention, diagnosis, and treatment of the disease before or during the sub clinical stage should be the focus of our efforts. Many research efforts are currently focusing on the development of new diagnostic tools for detecting dental caries in the sub clinical stages. Beyond the traditional diagnostic methods, cutting-edge technology using electrical methods, optical methods, laser fluorescence (DIAGNOdent) and chemical dyes aid in the detection of sub clinical caries. Use of indices, like the International Caries Detection and Assessment System (ICDAS), can improve the detection and assessment of carious lesions. Using visual inspection, the clinician must decide about the presence, severity and activity of lesions. After this process, additional methods could aid the dentist in reaching a more appropriate treatment decision. The ICDAS, including the activity assessment system or the Nyvad system, seems to be the best option to reach final diagnoses for managing lesions. By using CAMBRA [Caries management by risk assessment] principles it is possible to assess the risk of individual patients and establish evidence-based management strategies based on that risk. The radiographic method is the most recommended additional method available for daily clinical practice.

During the past few decades, changes have been observed not only in the prevalence of dental caries, but also in the distribution and pattern of the disease in the population. It has been observed that the relative distribution of dental caries and the rate of lesion progression on tooth surfaces have changed. In order to make continued progress in eliminating this common disease, new strategies will be required to provide enhanced access for those who suffer disproportionately from the disease; to provide prevention, risk assessment, and early diagnosis and to create improved methods to arrest or reverse the non cavitated lesion while improving surgical management of the cavitated lesion. This library dissertation provides an overview of the current concepts in cariology and highlits the importance of on-going need to update in this field.

With advances in technology and material science there is a paradigm shift from the traditional surgical model (drill and fill) to the modern medical model of care, involving caries risk assessment, alteration of cariogenic environment, potential tissue remineralization and minimal tooth preparation.