Pathogenesis of Dental Caries

The pathogenesis of dental caries may involve three distinct processes (1) adherence of the bacteria to the tooth, (2) formation of glycocalyx due to synthesis of a sticky glucan by the action of the bacterial enzyme glucosyl transferase on sucrose, and (3) accumulation of biobUm (plaque), within which there is continuing acid production by constituent bacteria (including streptococci and lactobacflli) able to metabolize carbohydrates at low pH values. This acid demineralizes an enamel. 

The second and third of these steps depend on a supply of appropriate carbohydrate substrates, most favorably sucrose, in the mouth. The latter can become available either directly (sugar ingested in food or drink) or be derived from dietary starch by the action of bacterial or salivary amylases, or both. Of particular relevance in this context is the trapping of carbohydrates as or on food particles remaining in the mouth for considerable periods. 

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T. Aoba, Solubility properties of human tooth mineral and pathogenesis of dental caries, Oral Dis. 10 (2004) 249-257. 

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