Dental caries is a disease created by bacterial plaque on the enamel of teeth. Gradual and progressive demineralization of the enamel, dentine, and cementum occurs. Many studies have suggested that carbohydrates, especially sugars and in particular sucrose, are important carie-promoting components of food. However, despite a huge amount of laboratory and clinical research, the relationship between sugar and caries is still poorly characterized. A major reason for this is the complexity of the problem, for the formation of caries involves multifactorial interactions such as nutrients and food components of diet, plaque bacteria, salivary flow and composition, minerals and fluoride status, genetics, age, and even the race of the individual (see also Chapter66). The most common organism in dental plaque associated with caries is Streptococcus mutans, but other bacteria contribute. Most studies have focused on the acids (lactic and acetic) generated from sugars (sucrose) by the bacteria, but the complex formation and accumulation of plaque from the insoluble dextran made from sucrose is an important feature ( 64, 65).
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