COMMON CONDITIONS

Dental Caries

Dental caries is the clinical and scientific name for the disease process that creates cavities. It refers to the bacterial breakdown of tooth structure caused by acid produced when oral bacteria metabolize sugars and carbohydrates.

(DEN-tul KAIR-eez)

Also known as: Tooth decay, Cavities

This article is for educational purposes and is not medical advice. Consult Dr. Durrett, Dr. Wilson, Dr. Danielle Durrett, or Dr. Vasconez for diagnosis and treatment specific to your situation.

Quick Facts

alsoCalled:: Tooth decay, cavities
primaryCause:: Acid-producing bacteria (mainly Streptococcus mutans) feeding on dietary sugars
commonSymptoms:: Often none in early stages; later: sensitivity, pain, visible damage
diagnosis:: Visual exam, dental X-rays, laser fluorescence detection
primaryTreatment:: Varies by stage: fluoride and remineralization (early), fillings (moderate), crowns or extraction (advanced)
prevention:: Oral hygiene, fluoride, sealants, diet modification, risk-based prevention protocols

Overview

Dental caries is the formal name dental professionals use for what most people call cavities or tooth decay. The word 'caries' comes from the Latin term for 'rottenness,' and it refers specifically to the disease process — the demineralization and breakdown of tooth structure caused by oral bacteria — rather than the resulting hole. In other words, caries is the disease, and a cavity is the visible damage caused by the disease. Dental caries is the most common chronic disease worldwide, affecting an estimated 2 to 3 billion people globally. In the United States, the Centers for Disease Control and Prevention reports that nearly 26% of adults have untreated dental caries at any given time. Understanding caries as a disease — rather than just a hole that needs to be filled — has transformed how modern dentists approach treatment. Rather than just drilling and filling, today's dentists focus on identifying risk factors, monitoring the disease process, and intervening early to stop or even reverse decay before invasive treatment is needed.

The biology of dental caries

Dental caries develops through a complex interaction between bacteria, dietary sugars, tooth surface, and time. Your mouth normally contains hundreds of species of bacteria living in a balanced ecosystem called the oral microbiome. Most of these bacteria are harmless or even beneficial. However, certain species — most notably Streptococcus mutans and various Lactobacillus species — produce acid as a byproduct when they metabolize sugars and refined carbohydrates. These bacteria live in dental plaque, a sticky biofilm that forms on tooth surfaces. When you eat sugars or starches, the bacteria in plaque rapidly produce lactic acid, lowering the pH of plaque from a neutral 7 down to below 5.5. At this acidic pH, calcium and phosphate minerals begin dissolving out of the tooth enamel — a process called demineralization. When acid exposure stops (typically when saliva neutralizes the acid 20 to 40 minutes after eating), the demineralization halts and remineralization begins as minerals from saliva diffuse back into the enamel. In a healthy mouth, demineralization and remineralization are roughly balanced. Caries develops when the balance tips toward demineralization — too much acid, too often, with not enough recovery time.

Stages of caries progression

Dental caries progresses through identifiable stages, and treatment depends entirely on which stage the disease has reached. The first stage is incipient caries, also called a white spot lesion. At this stage, the enamel has begun to demineralize but hasn't yet broken down. The damage appears as a chalky white spot on the tooth surface. Crucially, incipient caries can be reversed with fluoride and remineralization — no drilling required. The second stage is enamel decay. The enamel has broken down and a small cavity has formed, but the decay hasn't reached the dentin layer beneath. This is still relatively easy to treat, usually with a small filling. The third stage is dentin decay. The cavity has progressed through the enamel into the softer dentin layer. Dentin is more porous and decays faster than enamel, so this stage progresses more quickly and may cause tooth sensitivity. A larger filling, inlay, or onlay is typically needed. The fourth stage involves the pulp. The decay has reached the soft inner tissue containing nerves and blood vessels, causing pain, infection, or both. Treatment requires a root canal or, if the tooth cannot be saved, extraction. The fifth stage is an abscess. The infection has spread beyond the tooth into surrounding tissues and bone, requiring emergency treatment to prevent serious health complications.

Risk assessment and the CAMBRA approach

Modern caries treatment uses a risk-based approach called Caries Management By Risk Assessment, or CAMBRA. Rather than treating all patients the same, CAMBRA classifies patients as low, moderate, high, or extreme risk for caries based on a structured assessment. Risk factors include diet (frequency of sugar and acid exposure), oral hygiene, fluoride exposure, saliva flow, existing cavities and recent fillings, medical conditions affecting oral health, and certain medications. Based on the risk classification, the dentist creates a personalized prevention plan that may include more frequent dental visits, prescription-strength fluoride toothpaste or rinses, calcium phosphate remineralization products, dental sealants on at-risk teeth, dietary counseling, or chairside chemistry tests to measure mouth acidity. At Lakeview Family Dentistry, our Cavity Prevention Program follows the CAMBRA approach, combining chairside risk assessment with personalized prevention plans. CAMBRA has been clinically shown to reduce caries development in high-risk patients.

Diagnosis methods

Diagnosing dental caries combines multiple methods to detect decay at every stage. Visual examination uses a dental mirror and good lighting to identify visible decay, discoloration, or surface changes. The dentist may use a dental explorer to feel for soft spots, though modern practice avoids excessive probing of early lesions because it can damage incipient caries that might otherwise remineralize. Dental X-rays (radiographs) reveal decay between teeth and beneath existing fillings — areas that cannot be seen during a visual exam. Bitewing X-rays are the standard for cavity detection in adult patients. Laser fluorescence devices like the DIAGNOdent emit a specific wavelength of light that fluoresces differently in decayed versus healthy tooth structure, allowing detection of very early decay. Air abrasion can remove suspect tooth material conservatively to assess whether decay is present. At Lakeview Family Dentistry, our 3D digital imaging system provides exceptional diagnostic detail with minimal radiation exposure.

Treatment philosophy: minimum intervention dentistry

The contemporary approach to dental caries is sometimes called minimum intervention dentistry or biological dentistry. The principle is straightforward: preserve as much natural tooth structure as possible, and intervene only when necessary. For incipient caries (white spot lesions), treatment is non-invasive: fluoride varnish, remineralization products, sealants, or simply improved home care and dietary changes. For early enamel decay, the smallest possible filling restores the tooth. For moderate to advanced decay, larger restorations like inlays, onlays, or crowns are needed. When the pulp is involved, a root canal (performed by an endodontic specialist) attempts to save the tooth. Extraction is the last resort, followed by replacement with a bridge, partial denture, or dental implant. The choice of restorative material has evolved as well. Tooth-colored composite resin has largely replaced amalgam (silver) fillings as the standard for new restorations, though amalgam remains a legitimate option in certain clinical situations. Ceramic and porcelain materials offer excellent aesthetics for larger restorations. Glass ionomer cement releases fluoride and is useful in specific situations like root caries in elderly patients.

Prevention

Preventing dental caries requires a multi-pronged approach attacking each part of the caries equation: bacteria, sugar, time, and tooth vulnerability. Reduce harmful bacteria with twice-daily brushing and daily flossing. Antibacterial mouth rinses can help in higher-risk patients. Limit sugar and refined carbohydrates, especially between meals — frequency matters more than total amount. If you snack, choose foods that don't stick to teeth: nuts, cheese, fresh vegetables, plain yogurt. Strengthen teeth with fluoride: toothpaste, drinking water, professional fluoride treatments, and prescription rinses for higher-risk patients. Protect chewing surfaces with dental sealants, especially on children's permanent molars. Maintain saliva flow by staying hydrated; if you have chronic dry mouth, talk to your dentist about saliva substitutes or stimulants. Visit your dentist every six months — or more frequently if you're at higher risk — for professional cleaning, examination, and personalized preventive care.

References & Further Reading

Medically reviewed by the doctors at Lakeview Family Dentistry.
Last reviewed: 2026-05-12