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Caries and Periodontitis: Contesting the Conventional Wisdom on Their Aetiology

Journal article
Authors F. Manji
Gunnar Dahlén
O. Fejerskov
Published in Caries Research
Volume 52
Issue 6
Pages 548-564
ISSN 0008-6568
Publication year 2018
Published at Institute of Odontology, Section 3
Pages 548-564
Language en
Keywords Aetiology, Dental caries, Oral health, Periodontitis, aged 3-80 years, oral microbiome, dental-caries, global burden, actinobacillus-actinomycetemcomitans, experimental gingivitis, transition dynamics, bacterial markers, gut microbiota, disease, Dentistry, Oral Surgery & Medicine, atus, future directions, may 09, 1991, boston, ma, v63, p322
Subject categories Dentistry


We review the literature on the oral microbiome and the role of the microbiota in the development of dental caries and periodontitis. While most research has been focused on identifying one or more specific determinants of these diseases, the results have provided limited predictive value and have not been able to explain the variation in the distribution of these diseases observed in epidemiological or clinical studies. Drawing on existing knowledge about the nature of the oral microbiota, we suggest that a stochastic model based on the Weiner process provides simple and parsimonious explanations for the pathogenesis of both caries and periodontitis, making few assumptions, and providing explanations for phenomena that have hitherto proved difficult, or have required complex arguments, to explain. These diseases occur as the result of the dental hard tissues and periodontal tissues integrating the random noise caused by normal metabolic activities of commensal microorganisms in the dental biofilm. The processes that result in the progression and regression of caries and periodontitis may be considered as natural, rather than pathological, even if, when left unchecked over long periods of time, they can result in the development of pathologies. The likelihood of progression or regression can be influenced by other determinants, but these processes will nevertheless occur in the absence of such influences. The distributional characteristics of the model approximate the findings of epidemiological studies indicating that, for both caries and periodontitis, there will be few sites affected in the early period after the eruption of the permanent dentition, but in those older there is an almost linear relationship with increasing age; furthermore, the longer a site survives without being affected, the less likely that it will be affected. We discuss the clinical and public health importance of these findings.

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