Principles

The following principles have been followed to develop these caries diagnosis, risk assessment, and management protocols:

1. Dental caries should be diagnosed and managed as a dynamic disease of enamel and dentin.
   
   
2. The disease process is initiated whenever a tooth surface is exposed to acids produced by the fermentation of carbohydrates in cariogenic bacteria.
   
   
3. In enamel, calcium and phosphate are lost from the enamel crystals on the surface and sub-surface layers after the pH of the oral fluids drops to less than 5.5. This loss usually occurs if the defensive mechanisms in the oral cavity are not sufficient to protect enamel from the detrimental effects of frequent acid attacks.
   
   
4. If the loss of calcium and phosphate continues from the crystals, large microporous areas develop. These areas are identified visually as "white spots" when the tooth is dried, or are seen visually without drying when large microporous areas develop in enamel. If the loss of tooth structure continues, a cavity develops. On the roots, early carious lesions usually have softened and yellowish-colored dentin. These characteristics result from the loss of organic and inorganic components of dentin in the root.
   
   
5. The goal of examining a patient for presence of dental caries is to detect the earliest signs of this disease in enamel and root surfaces. If early signs of demineralization are detected, advise the patients and provide preventive care to reverse the caries process.
   
   
6. In the management of dental caries, it is also important to consider that dental caries is an infectious disease. "Drilling and filling" a tooth is not the only solution to the damage caused by the caries process and is not an effective method to treat the cariogenic infection (Gregory et al. 1998). A comprehensive preventive and treatment program is necessary to manage dental caries, especially for patients with progressive or rampant caries.
   
   
7. To provide a comprehensive preventive and treatment program for patients, dental students and faculty at the School of Dentistry are to obtain detailed information on presence of dental caries and other oral conditions. In caries active patients, an evaluation is carried out to identify factors such as dietary habits, use of fluoride products, microbial infection in the mouth, salivary flow and buffering capacity, and oral hygiene practices.
   
   
8. When examining patients, the goal is to predict the caries process as well as to diagnose the presence of dental caries