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In This Section by Trisha O’Hehir, RDH, MS Editorial Director, Hygienetown

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Dental Caries – Not Just a Hole in a Tooth

by Trisha O’Hehir, RDH, MS Editorial Director, Hygienetown

In the 1700s, it was thought that tooth decay began inside the tooth with tooth worms eating their way out of the tooth. Ivory tooth carvings depicted these tooth worms. It made sense at the time. However, the dental caries process is not as simple as tooth worms. Scientific research confirms that dental caries is in fact, a complex, multi-factorial process.

It was once thought that only two bacteria were involved – Streptococcus mutans and Lactobacillus acidophilus. Acid production creates an environment conducive to the growth of many bacteria that prefer living at low pH while non-acid-producing commensal oral bacteria can adapt to an acid environment and begin to produce acid. Estimates suggest the number of bacterial species in the mouth is as high as 800. Some researchers studying DNA implications suggest the numbers are actually 3,600 to 6,800, while other researchers suggest the number of oral bacteria is as high as 19,000. Perio Reports includes summaries of important caries research.

In the past, a sharp explorer and radiographs were all that was needed to diagnose dental caries, as all we looked for was a hole in the tooth. Today, the incorporation of Caries Risk Assessment (CRA) focuses on the entire caries process and not simply the resulting hole that requires repair. Determining why someone has dental caries is as important as providing the restorative care after the disease has damaged tooth structure. In this section devoted to dental caries, the message board discusses root caries. In the Profile in Oral Health, Townie Tim Ives, RDH from the U.K. presents his initial reluctance to accept CRA. Next month’s Part 2 will cover technology involved in evaluating oral bacteria, measuring pH, flow and buffering levels of saliva and appropriate measures to stop dental caries. Dealing with dental caries provides a challenge to evaluate and manage risk factors and not simply focus on the resulting tooth holes.
Inside This Section
110      Perio Reports
114      Profile in Oral Health: My Reluctance to Accept CAMBRA
118     Message Board: Rampant Root Caries
Dentaltown Magazine
September 2025
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