Despite the increase in awareness campaigns on the importance of oral hygiene, fighting tooth decay, especially in developing countries, remains an important goal for dentistry.
How to fight tooth decay
Dental caries is one of the most common oral health problems in the world population. Despite prevention, tooth decay continues to affect a large part of the population, also due to poor eating habits.
The scientific community in the dental field is developing a series of strategies to combat tooth decay, 
mainly based on three main axes:
- avoid enamel demineralization;
- decrease sugar consumption;
- remineralize carious lesions.
These are three particular indications that could help fight tooth decay in those at particular risk.
Teeth and tooth decay: the oral microbiome
The most recent dental studies have identified caries as a microbiotic disease, which is a disease due to the imbalance of the oral microbiome. By oral microbiome we mean the set of bacterial species present in the oral cavity; in an equilibrium condition, the microbiome maintains a stable and proportionate amount of bacteria and the ph salivary it is neutral.
The intake of many sugars alters the proportions between the bacteria and causes the increase both of the species capable of tolerating the acids and of those that increase their production. This condition alters the biofilm present in the oral cavity, the pH changes from neutral to acid, the production of saliva is drastically reduced and the teeth are more exposed to caries.
Combat tooth decay: act on the microbiome
This new perspective involves a new therapeutic approach. In a recent article published in the Journal of Dental Research (February 2018), the topic of caries is addressed by aiming for new dental treatments. The theme of the prevention of enamel demineralization remains valid, but at the same time, for patients who are struggling to change their eating habits, it is proposed to remineralize the enamel with therapies capable of affecting the oral biofilm.
Therefore, dental treatments are proposed which are able to bring the oral microbiome back to a balanced condition. To follow this new therapeutic approach it is essential to start from the analysis of the patient’s oral macrobiota. The analysis of the biofilm present in the mouth allows to identify the cariogenic bacteria present, especially the most aggressive ones.
Intervening on the microbiota therefore means favoring the proliferation of non-cariogenic bacteria with pre and probiotic therapies that stimulate growth and restore balance in the oral cavity. In more complex clinical cases it will be possible to intervene with real pharmacological therapies with bioactive characteristics capable of counteracting the extracellular polysaccharide matrix of the biofilm.
Fighting tooth decay: the challenges of the future
The dental scientific community is therefore focusing on the in-depth study of the oral microbiota, in normal conditions and in pathological conditions. Knowing in detail the composition of the biofilm will allow:
- increase the bacteria useful for restoring balance;
- limiting the profiling of cariogenic bacteria;
- develop targeted and personalized probiotic or pharmacological therapies for each patient.
Certainly we are talking about research that will not give answers in the immediate future, but that show us how constant the efforts of research centers are to offer us a better future.
