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Module 2: Dental Caries Process

2.1 Dental Caries

Dental caries (tooth decay) is the process whereby bacteria on teeth consume sugar to produce an acid that dissolves tooth mineral (demineralization). Tooth decay (cavitation) is the end result of the demineralization process. Demineralization is not necessarily an ongoing process. There can be periods of activity and periods of inactivity, depending upon which contributing and protective factors are present.

In 2000, the Surgeon General described dental caries as a silent epidemic, identifying it as the most common childhood illness in the United States.1 It is five times more common than asthma and seven times more common than hay fever. Dental caries is on the rise among children ages 2 to 5; among this age group, prevalence of the disease increased by 4 percent between 1988–1994 and 1999–2004. Over one-quarter of children ages 2 to 4 have had dental caries. Of these children, approximately 20 percent have untreated decay in primary teeth.2

The impact of untreated tooth decay was brought to national attention by the tragic death of 12-year-old Deamonte Driver, who lived in Prince Georges County, Maryland, and died from a brain infection caused by untreated tooth decay.3

Results of a statewide survey of children attending Head Start programs in Maryland found that:4

  • Forty-six percent of 3-year-olds and 64 percent of 4-year-olds had tooth decay.
  • Seventeen percent of the children with tooth decay had complained of a toothache, and nine percent had cried because of a toothache.
  • Fifty-two percent of the children with tooth decay had untreated decay, and only 16 percent of these children’s parents were aware that their child had untreated decay.

In Maryland, the use of preventive oral health care among young children (ages 1–5) is much less common than among older children (ages 6 and older). Among young children living in Maryland, the proportion of those who have had a dental visit for preventive care rises with age. Furthermore, children from families with low incomes are less likely to receive preventive oral health care than are children from families with higher incomes.5