Ododntologia

Maintaining the integrity of the enamel
surface: The role of dental biofilm, saliva and
preventive agents in enamel demineralization
and remineralization
Franklin García-Godoy and M. John Hicks
J Am Dent Assoc 2008;139;25S-34S
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Maintaining the integrity of the enamel
surface
The role of dental biofilm, saliva and preventive agents
in enamel demineralization and remineralization
Franklin García-Godoy, DDS, MS; M. John Hicks, DDS,MS, PhD, MD

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B ackground. Dental caries is an infectious disease, and it affects 90 percent of late adolescents and
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young adults in the United States. It is a complex
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disease that occurs along the interface between the
I CLE
dental biofilm and the enamel surface.
Results. Many components in saliva aretaken up by dental biofilm and
protect the enamel surface. On the other hand, newly erupted teeth
depend on the enamel pellicle for posteruption maturation of acidsusceptible substituted hydroxyapatite. When Streptococcus mutans colonizes dental biofilm, it depends on vertical transmission, horizontal transmission or both. These acidogenic, aciduric bacteria are considered to be
the primaryorganisms responsible for enamel caries. The ability of the
biofilm to sequester calcium, phosphate and fluoride from the saliva, as
well as from sources outside the oral cavity allows enamel to undergo
remineralization after demineralization. Optimal remineralization
depends on the enamel surface’s being exposed to low concentrations of
calcium, phosphate and fluoride for prolonged periods.Outside sources of
bioavailable calcium, phosphate and fluoride can alter dental biofilm’s
cariogenicity.
Clinical Implications. The use of sugar alcohols, povidone-iodine,
delmopinol, triclosan and chlorhexidine may modulate the caries process.
In addition, studies involving probiotics and molecular genetics have provided results showing that these methods can replace and displace cariogenicbacteria with noncariogenic bacteria, while maintaining normal oral
homeostasis.
Key Words. Biofilms; caries; chewing gum; dental materials; fluoride;
saliva.
JADA 2008;139(5 suppl):25S-34S.

Dr. García-Godoy is a professor, the associate dean for research, and the director, Bioscience Research
Center, College of Dental Medicine, Nova Southeastern University, 3200 S. University Drive, FortLauderdale, Fla. 33328, e-mail “godoy@nova.edu”. Address reprint requests to Dr. García-Godoy.
Dr. Hicks is a professor of pathology, Texas Children’s Hospital, Baylor College of Medicine, Houston,
and an adjunct professor, Department of Pediatric Dentistry, University of Texas Health Science Center
at Houston.

JADA, Vol. 139

http://jada.ada.org

Copyright © 2008 American DentalAssociation. All rights reserved.

May 2008

25S

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ABSTRACT

CON

ental caries affects most
people in the United
States; only 10 percent of
late adolescents and
young adults are cariesfree.1-7 Caries continues throughout
adulthood, with more than 95 percent of adults experiencing caries on
enamel and root surfaces, and it
leads...