Dental Caries Etiology: A Modified Six-Factor Model and Venn Diagram

Dietary fermentable carbohydrates or sucrose may be metabolized by cariogenic bacteria at a specific tooth surface site, which may result in an episode of the site having a pH of 5.5 or less, that may cause temporary net demineralization. Numerous demineralization episodes at a specific tooth surface may result in a carious lesion if saliva does not remineralize the surface after each episode of net demineralization. However, this general model of carious lesion causation does not explain why carious lesions occur at specific tooth surface sites. This article reviews dental caries etiology, and suggests a modified model of dental caries etiology, proposing that dental caries results from five known factors, namely a combination of a tooth surface site, frequent exposure to fermentable carbohydrates at that tooth site, cariogenic bacteria fermenting the carbohydrates, poor oral hygiene or dietary habits, inadequate natural anti-caries cleansing and re-mineralization processes, and a sixth factor, consisting of a factor that facilitates the retention of plaque or fermentable carbohydrates at a specific tooth surface site. This article describes forty different examples of facilitators of carbohydrate and plaque retention at tooth surface sites that help facilitate net demineralization at specific tooth surfaces, when combined with other caries-inducing factors. This caries etiology model is used to modify the conventional 3-factor Venn diagram illustrating caries etiology, resulting in a more comprehensive 6-factor Venn diagram.