Caries Management – Science and Clinical Practice

Book Preface

Dental caries is still one of the most common diseases in human beings, causing smaller or larger problems to millions of people around the world every day. As dental professionals we have to help people to understand the disease to enable them to prevent caries by themselves (self-management). When more severe decay is diagnosed, we, together with the patient, should manage the caries disease in a minimally interventional way.

This introductory chapter will present some general thoughts about caries and where we come from in cariology. Moreover, we will explain why we think it is important to have another book about cariology and will describe the concept of the book, which is presented in two main parts: science and practice. Caries—Important but Preventable Dental caries is the term used for pathoanatomical changes of the dental hard tissues. These changes are caused by acids that are created in the dental plaque (biofilm) covering the affected tooth surface, when certain microorganisms ferment sugars, which in turn demineralize the dental hard tissues. Thus, the disease, which professionals perceive as changes of the dental hard tissues, in fact reflects activities within the overlying dental biofilm. If these unfavorable biofilm activities are occurring frequently, the signs of the caries process on the dental hard tissues will become more easily detectable.

Nonetheless, the caries “scar” starts with signs that are only visible with high magnification in the laboratory but end up with clinically visible alterations of the tooth surface integrity. Thus, caries is a term which actually covers changes in the dental hard tissue from the time the first mineral ion leaves the tissue to when no mineral is left.

This development takes several years, fortunately, giving the dental professional and the patient time to act. In the clinically nonvisible stages we can adopt a risk-related approach to intervene noninvasively; in the early visible stages of the disease, we can intervene noninvasively or microinvasively. Later stages of the disease need invasive intervention that aims to preserve the tooth as much as possible.

Where We Come From…

Numerous individuals or groups of scientists have contributed to our understanding of caries over time. In the following we have selected a few of the many contributors and taken the liberty to sketch their faces and make a small note about their contribution. We have not included those who are still among us. The figure captions will give the reader a good idea of the history and development of cariology including adhesive dentistry.

Do We Need Another Book about Cariology?

Nowadays the dental professional has to face an overwhelming amount of information concerning dental caries and its clinical management, which is derived from various “traditional” sources such as pre- and postgraduate courses at dental schools and from continuing educational programs. In addition, the Internet updates current knowledge not only for dental professionals, but also for their patients. As with everything else, when a variety of goods is on offer, the choice becomes more difficult!

From a researcher’s perspective this also holds true for the increasing variety of scientific journals that provide us with evidence on related issues for dental caries and allied topics such as tooth wear. Thus, the choice and assessment of scientific information are becomingmore difficult compared with former years, although this process has been formalized and professionalized in the form of evidence- based dentistry. Here, systematic reviews or even meta-analyses about a certain topic should help to inform the professional, being based on relevant science. Nonetheless, this systematic approach is not always feasible, either because there is not much clinical evidence available or the subject matter is quite complex. For the dental practitioner systematic reviews might even be too impracticable to provide clinical guidance in the daily grind.

In this area of conflict a textbook may be of help. Although, it cannot and need not be as objective as a scientific paper, the format of a book is capable of summing up the most relevant points in a readable manner, and is thus still an important tool in teaching. This is what we have aimed for, together with over 20 other authors from more than 10 countries, who are all experts in their respective fields of cariology.