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Caries Research: The Current Status
C a r ie s r e s e a r c h : t h e c u r r e n t s ta tu s James P. Carlos, DDS, Bethesda
O n
a n o c c a s io n
m ile s t o n e , ye a rs
in
asse ss
one
an
s u c h a s t h is o n e , w h ic h n a t u r a lly
e ffo rt to
p ro gre ss,
d is c e r n
and
w h a t th e n e x t 5
or
lo o k s
to
back
re se a rch
m ake
10 o r 25
m a rk s a
over
re ce n t
tre n d s , to
p r e d ic t io n s
about
y e a rs a re lik e ly
to
a c c e le r a t io n T h is
d u r in g
th e
m o st
n o t a n d d id
phenom ena
had
been
e x a m in e d
re se a rch ,
m ix e d r e a c t io n s . A
t h is
r e t r o s p e c t io n
s u p e r f ic ia l r e v ie w
e lic it s
m ig h t s u g
te n
y e a rs.
in
p a in s t a k in g
v e n t io n t h e r e b y s u g g e s t e d . O f c o u rs e , th e o r ig in
c a r ie s
re ce n t
n o t o c c u r u n t il e t io lo g ic
d e t a il a n d t h e p o s s ib ilit y o f v a r io u s r o u t e s to p r e
p ro d u ce . In
c o u ld
u n d e rsto o d .
M uch
o f c a r ie s is n o t y e t f u lly
m o re
la b o r a t o r y - o r ie n t e d
re
s e a r c h m u s t p r o c e e d s im u lt a n e o u s ly w it h t h e c u r
g e s t th a t d u r in g th e f ir s t 15 o f th e p a s t 2 5 y e a r s ,
re n t e ff o r t s to d e v e lo p
r e la t iv e ly lit t le n e w
in f o r m a t io n w a s f o r t h c o m in g
o d s to t h e p o in t o f w id e s p r e a d a p p lic a t io n : F u r
r e g a r d in g th e o r ig in
a n d c o n t r o l o f c a r ie s . W h e n
th e rm o re , th e
p o s s ib le p r e v e n t iv e m e t h
d e v e lo p m e n t o f t h e s e m e t h o d s r e
t h is In s t it u t e w a s c r e a t e d in 1 9 4 8 , t h e e p id e m io lo g y
m a in s , in m o s t in s t a n c e s , in a n e a r ly a n d t e n t a t iv e
o f c a r ie s
s ta g e , a n d th e u lt im a t e u t ilit y o f d if fe r e n t a g e n ts
w as
r a t h e r c o m p le t e ly
d ie t o b a c t e r ia l
o r ig in
w as
d o c u m e n t e d , it s
r e c o g n iz e d ,
and
th e re
and
t e c h n iq u e s
cannot
yet be
c le a r ly
p e r c e iv e d .
w a s c o m p e llin g , i f n o t c o n c lu s iv e , e v id e n c e th a t in
V e r y p o s s ib ly , c o n t in u in g r e s e a r c h in c a r ie s c a u s a
g e s t io n o f f lu o r id a t e d w a t e r d u r in g t o o th d e v e lo p
t io n
m e n t c o u ld p r o t e c t a g a in s t th e d is e a s e t o a s i g n i f i
to
can t
im p o r t a n t p o in t s to e m p h a s iz e t o d a y a r e t h a t th e
d e g re e .
m a g n it u d e
N o
w as
new
k n o w le d g e
fo r t h c o m in g
o f c o m p a r a b le
d u r in g
th e
n e x t te n
Y e t, w hen
th e h is t o r y
p r e v e n t io n
of
ta rg e t
is
th a n
any now
id e n t if ie d , t h a t t h e
b e in g p u r s u e d . T h e
re so u rce s
a re
com
m it t e d , a n d t h a t p r o g r e s s is a lr e a d y e v id e n t .
y e a rs o f re se a rch .
th e
a n d p a t h o g e n e s is w i l l r e s u lt in b e t te r r o u t e s
p r e v e n t io n
o f re se a rch
c a r ie s
is
w r it t e n ,
p r o g r e s s in t h is
p e r io d
T h e p r e s e n t s it u a t io n , t h o u g h r ic h w it h p r o m is e , is n o t w it h o u t c e r t a in d a n g e r s . T h e e m p h a s is a n d
p r o b a b ly w ill b e r e c o g n iz e d a s th e c r it ic a l o n e in
p u b lic it y
t h e e v e n t u a l c o n q u e s t o f t h e d is e a s e . D u r in g t h is
se a rch
t im e , c a r ie s r e s e a r c h m o v e d f r o m
w e s h o u ld
c lin ic a l e m p ir i
r e c e n t ly
g iv e n
to
c a r ie s - p r e v e n t io n
re
h a v e a lr e a d y c a u s e d s o m e to s u g g e s t t h a t b e g in
to
d ir e c t o u r e f f o r t s e ls e w h e r e .
c is m , o ft e n o f u n d e n ia b le b r illia n c e , in t o t h e m a in
A n y s u c h t e n d e n c y to e q u a t e th e m a g n it u d e o f t h e
stre a m
a t ta c k o n t h e p r o b le m
of
m u lt id is c ip lin a r y
b io m e d ic a l
s c ie n c e .
R a t h e r t h a n h a v in g p r o d u c e d n o t e w o r t h y , d is c r e t e
w it h it s s o lu t io n s h o u ld b e
r e s t r a in e d b y t h e r a t h e r o b v io u s f a c t t h a t , in 1 9 7 3 ,
b r e a k t h r o u g h s , t h e in c r e a s in g ly s o p h is t ic a t e d w o r k
c a r ie s r e m a in s o n e o f th e m o s t p r e v a le n t d is e a s e s
o f d e n t a l s c ie n t is t s in m ic r o b io lo g y , b io c h e m is t r y ,
o f o u r c i v il i z a t i o n a n d c o n t in u e s to e x e r t a h e a lt h
a n d o th e r f u n d a m e n t a l s c ie n c e s b e g a n t o e x p la in
and
lo n g o b s e r v e d fa c ts a b o u t th e d is t r ib u t io n , c h a r a c
S im p le a r it h m e t ic a s s u r e s u s t h a t t h is w i l l r e m a in
t e r is t ic s ,
tru e f o r s o m e y e a r s to c o m e . E v e n
and
p a t h o g e n e s is
of hum an
c a r ie s
and
e c o n o m ic
im p a c t
e p id e m ic
as cu rre n t re
se a rch
su cceed s
to f u r t h e r r a t io n a l p r o g r e s s t o w a r d p r e v e n t io n o f
p le t e ly
p r e v e n t a b le , t h e
t h e d is e a s e .
z e r o c a r ie s in c id e n c e w i l l t a k e a t le a s t t w o d e c a d e s
se a rch
has
u n d e rg o n e
r a p id ,
even
s p e c t a c u la r ,
998 ■ SPECIAL ISSUE/JADA, Vol. 87, O ctober 1973
m a k in g
p r o p o r t io n s .
p r o v id e d t h e b a s e o f s c ie n t if ic k n o w le d g e e s s e n t ia l
I t is t h u s n o a c c id e n t t h a t c a r ie s - p r e v e n t io n r e
in
of
c a r ie s
a lm o s t
b e n e f it s o f z e r o
com
o r near
to b e f u l l y f e lt o n a n a t io n a l s c a le . It
has
s o m e t im e s
been
s a id
th a t
we
a lr e a d y
know
how
C e r t a in ly
to we
p r e v e n t c a r ie s , are
c o n f id e n t
a t le a s t
th a t
in
t h is
th e o ry .
k n o w le d g e
f e a s ib le
m e t h o d s o f a lt e r in g
each
e le m e n t in
th e
e t io lo g ic t r ia d : t h e m ic r o b io lo g ic a g e n t , t h e d ie t a r y
w ill b e p r o v id e d b y c u r r e n t r e s e a r c h . B u t th e t r a n s i
e n v ir o n m e n t , a n d t h e h o s t t o o t h e n a m e l. T h e p a
t io n f r o m
p e r s p r e s e n te d h e re w ill s u m m a r iz e e ffo r t s in e a c h
a
t h e k n o w le d g e t o it s im p le m e n t a t io n is to
o f th e se a re a s. I tru s t th a t, h a v in g h e a r d th e m , w e
p r o b le m s o f d e liv e r y v e h ic le s a n d p e r s o n n e l s y s
f o r m id a b le
ta sk .
It
w ill
r e q u ir e
s o lu t io n s
w ill a g re e th a t n o t o n ly d o th e y m ir r o r 2 5 y e a r s o f
te m s , lo g is t ic s a n d e c o n o m ic s , a n d p u b lic p r io r it ie s
e x c e lle n c e
and
p r o v id e a m p le r e a s o n f o r o p t im is m
in d iv id u a l
m o t iv a t io n s .
It
seem s
e s s e n t ia l
t h a t t h e y e a r s im m e d ia t e ly a h e a d b e c h a r a c t e r iz e d b y new
re se a rch
e ffo rts in
in
c a r ie s
re se a rch , b u t th a t th e y
a ls o
r e g a r d in g th e
o b s t a c le s s t ill to b e o v e r c o m e .
th e se a re a s th a t h a v e
I s u g g e s t th a t t h e e lim in a t io n o f c a r ie s a s a p u b
n o t p r e v io u s ly b e e n c o n s id e r e d w it h in t h e d o m a in
lic
o f c a r ie s - p r e v e n t io n
w a s a n o p t im is t ic h o p e , is n o w a r e a lis t ic e x p e c t a
re se a rch .
Th ese
e ffo rts
w ill
h e a lt h
p r o b le m ,
w h ic h
even
te n
y e a rs
ago
r e q u ir e h e a v y r e lia n c e o n e x p e r t s in f ie ld s o u t s id e
t io n .
o f b io m e d ic a l s c ie n c e , a n d t h e n e c e s s a r y r e s e a r c h
s e e m m o r e c e r t a in to s u c c u m b t o s u c h a n in t e n s iv e ,
w ill b e e x p e n s iv e . T h e
b a la n c e d ,
s o lu t io n
to
c a r ie s ,
to ta l co st o f th e e ve n tu a l
h o w e v e r,
w ill
be
n e g lig ib le
Few
o th e r
and
c o n te m p o ra ry
t e n a c io u s
h e a lt h
s c ie n t if ic
p r o b le m s
e ffo rt
w h ic h c h a r a c t e r iz e s c a r ie s r e s e a r c h i n
as
th a t
1973.
c o m p a r e d t o t h e c o s t to s o c ie t y o f c o n t in u in g to c o e x is t w it h t h is d is e a s e . T o d a y , h o w e v e r, w e
c o n c e n tra te
m ilia r t o p ic s . C u r r e n t s t r a t e g y in in v o lv e s
fin d in g
e ff e c t iv e ,
sa fe ,
on
m o re
fa
c a r ie s r e s e a r c h and
lo g is t ic a lly
D r.
C a r lo s
is
a s s o c ia t e
d ir e c t o r
fo r
th e
N a t io n a l
C a r i e s P r o g r a m , N a t io n a l In s t it u t e o f D e n t a l R e s e a r c h , 9 0 0 0 R o c k v ille P ik e i B e t h e s d a , 2 0 0 1 4 .
SPECIAL ISSUE/JADA, Vol. 87, O ctober 1973 ■ 999
O n
a n o c c a s io n
m ile s t o n e , ye a rs
in
asse ss
one
an
s u c h a s t h is o n e , w h ic h n a t u r a lly
e ffo rt to
p ro gre ss,
d is c e r n
and
w h a t th e n e x t 5
or
lo o k s
to
back
re se a rch
m ake
10 o r 25
m a rk s a
over
re ce n t
tre n d s , to
p r e d ic t io n s
about
y e a rs a re lik e ly
to
a c c e le r a t io n T h is
d u r in g
th e
m o st
n o t a n d d id
phenom ena
had
been
e x a m in e d
re se a rch ,
m ix e d r e a c t io n s . A
t h is
r e t r o s p e c t io n
s u p e r f ic ia l r e v ie w
e lic it s
m ig h t s u g
te n
y e a rs.
in
p a in s t a k in g
v e n t io n t h e r e b y s u g g e s t e d . O f c o u rs e , th e o r ig in
c a r ie s
re ce n t
n o t o c c u r u n t il e t io lo g ic
d e t a il a n d t h e p o s s ib ilit y o f v a r io u s r o u t e s to p r e
p ro d u ce . In
c o u ld
u n d e rsto o d .
M uch
o f c a r ie s is n o t y e t f u lly
m o re
la b o r a t o r y - o r ie n t e d
re
s e a r c h m u s t p r o c e e d s im u lt a n e o u s ly w it h t h e c u r
g e s t th a t d u r in g th e f ir s t 15 o f th e p a s t 2 5 y e a r s ,
re n t e ff o r t s to d e v e lo p
r e la t iv e ly lit t le n e w
in f o r m a t io n w a s f o r t h c o m in g
o d s to t h e p o in t o f w id e s p r e a d a p p lic a t io n : F u r
r e g a r d in g th e o r ig in
a n d c o n t r o l o f c a r ie s . W h e n
th e rm o re , th e
p o s s ib le p r e v e n t iv e m e t h
d e v e lo p m e n t o f t h e s e m e t h o d s r e
t h is In s t it u t e w a s c r e a t e d in 1 9 4 8 , t h e e p id e m io lo g y
m a in s , in m o s t in s t a n c e s , in a n e a r ly a n d t e n t a t iv e
o f c a r ie s
s ta g e , a n d th e u lt im a t e u t ilit y o f d if fe r e n t a g e n ts
w as
r a t h e r c o m p le t e ly
d ie t o b a c t e r ia l
o r ig in
w as
d o c u m e n t e d , it s
r e c o g n iz e d ,
and
th e re
and
t e c h n iq u e s
cannot
yet be
c le a r ly
p e r c e iv e d .
w a s c o m p e llin g , i f n o t c o n c lu s iv e , e v id e n c e th a t in
V e r y p o s s ib ly , c o n t in u in g r e s e a r c h in c a r ie s c a u s a
g e s t io n o f f lu o r id a t e d w a t e r d u r in g t o o th d e v e lo p
t io n
m e n t c o u ld p r o t e c t a g a in s t th e d is e a s e t o a s i g n i f i
to
can t
im p o r t a n t p o in t s to e m p h a s iz e t o d a y a r e t h a t th e
d e g re e .
m a g n it u d e
N o
w as
new
k n o w le d g e
fo r t h c o m in g
o f c o m p a r a b le
d u r in g
th e
n e x t te n
Y e t, w hen
th e h is t o r y
p r e v e n t io n
of
ta rg e t
is
th a n
any now
id e n t if ie d , t h a t t h e
b e in g p u r s u e d . T h e
re so u rce s
a re
com
m it t e d , a n d t h a t p r o g r e s s is a lr e a d y e v id e n t .
y e a rs o f re se a rch .
th e
a n d p a t h o g e n e s is w i l l r e s u lt in b e t te r r o u t e s
p r e v e n t io n
o f re se a rch
c a r ie s
is
w r it t e n ,
p r o g r e s s in t h is
p e r io d
T h e p r e s e n t s it u a t io n , t h o u g h r ic h w it h p r o m is e , is n o t w it h o u t c e r t a in d a n g e r s . T h e e m p h a s is a n d
p r o b a b ly w ill b e r e c o g n iz e d a s th e c r it ic a l o n e in
p u b lic it y
t h e e v e n t u a l c o n q u e s t o f t h e d is e a s e . D u r in g t h is
se a rch
t im e , c a r ie s r e s e a r c h m o v e d f r o m
w e s h o u ld
c lin ic a l e m p ir i
r e c e n t ly
g iv e n
to
c a r ie s - p r e v e n t io n
re
h a v e a lr e a d y c a u s e d s o m e to s u g g e s t t h a t b e g in
to
d ir e c t o u r e f f o r t s e ls e w h e r e .
c is m , o ft e n o f u n d e n ia b le b r illia n c e , in t o t h e m a in
A n y s u c h t e n d e n c y to e q u a t e th e m a g n it u d e o f t h e
stre a m
a t ta c k o n t h e p r o b le m
of
m u lt id is c ip lin a r y
b io m e d ic a l
s c ie n c e .
R a t h e r t h a n h a v in g p r o d u c e d n o t e w o r t h y , d is c r e t e
w it h it s s o lu t io n s h o u ld b e
r e s t r a in e d b y t h e r a t h e r o b v io u s f a c t t h a t , in 1 9 7 3 ,
b r e a k t h r o u g h s , t h e in c r e a s in g ly s o p h is t ic a t e d w o r k
c a r ie s r e m a in s o n e o f th e m o s t p r e v a le n t d is e a s e s
o f d e n t a l s c ie n t is t s in m ic r o b io lo g y , b io c h e m is t r y ,
o f o u r c i v il i z a t i o n a n d c o n t in u e s to e x e r t a h e a lt h
a n d o th e r f u n d a m e n t a l s c ie n c e s b e g a n t o e x p la in
and
lo n g o b s e r v e d fa c ts a b o u t th e d is t r ib u t io n , c h a r a c
S im p le a r it h m e t ic a s s u r e s u s t h a t t h is w i l l r e m a in
t e r is t ic s ,
tru e f o r s o m e y e a r s to c o m e . E v e n
and
p a t h o g e n e s is
of hum an
c a r ie s
and
e c o n o m ic
im p a c t
e p id e m ic
as cu rre n t re
se a rch
su cceed s
to f u r t h e r r a t io n a l p r o g r e s s t o w a r d p r e v e n t io n o f
p le t e ly
p r e v e n t a b le , t h e
t h e d is e a s e .
z e r o c a r ie s in c id e n c e w i l l t a k e a t le a s t t w o d e c a d e s
se a rch
has
u n d e rg o n e
r a p id ,
even
s p e c t a c u la r ,
998 ■ SPECIAL ISSUE/JADA, Vol. 87, O ctober 1973
m a k in g
p r o p o r t io n s .
p r o v id e d t h e b a s e o f s c ie n t if ic k n o w le d g e e s s e n t ia l
I t is t h u s n o a c c id e n t t h a t c a r ie s - p r e v e n t io n r e
in
of
c a r ie s
a lm o s t
b e n e f it s o f z e r o
com
o r near
to b e f u l l y f e lt o n a n a t io n a l s c a le . It
has
s o m e t im e s
been
s a id
th a t
we
a lr e a d y
know
how
C e r t a in ly
to we
p r e v e n t c a r ie s , are
c o n f id e n t
a t le a s t
th a t
in
t h is
th e o ry .
k n o w le d g e
f e a s ib le
m e t h o d s o f a lt e r in g
each
e le m e n t in
th e
e t io lo g ic t r ia d : t h e m ic r o b io lo g ic a g e n t , t h e d ie t a r y
w ill b e p r o v id e d b y c u r r e n t r e s e a r c h . B u t th e t r a n s i
e n v ir o n m e n t , a n d t h e h o s t t o o t h e n a m e l. T h e p a
t io n f r o m
p e r s p r e s e n te d h e re w ill s u m m a r iz e e ffo r t s in e a c h
a
t h e k n o w le d g e t o it s im p le m e n t a t io n is to
o f th e se a re a s. I tru s t th a t, h a v in g h e a r d th e m , w e
p r o b le m s o f d e liv e r y v e h ic le s a n d p e r s o n n e l s y s
f o r m id a b le
ta sk .
It
w ill
r e q u ir e
s o lu t io n s
w ill a g re e th a t n o t o n ly d o th e y m ir r o r 2 5 y e a r s o f
te m s , lo g is t ic s a n d e c o n o m ic s , a n d p u b lic p r io r it ie s
e x c e lle n c e
and
p r o v id e a m p le r e a s o n f o r o p t im is m
in d iv id u a l
m o t iv a t io n s .
It
seem s
e s s e n t ia l
t h a t t h e y e a r s im m e d ia t e ly a h e a d b e c h a r a c t e r iz e d b y new
re se a rch
e ffo rts in
in
c a r ie s
re se a rch , b u t th a t th e y
a ls o
r e g a r d in g th e
o b s t a c le s s t ill to b e o v e r c o m e .
th e se a re a s th a t h a v e
I s u g g e s t th a t t h e e lim in a t io n o f c a r ie s a s a p u b
n o t p r e v io u s ly b e e n c o n s id e r e d w it h in t h e d o m a in
lic
o f c a r ie s - p r e v e n t io n
w a s a n o p t im is t ic h o p e , is n o w a r e a lis t ic e x p e c t a
re se a rch .
Th ese
e ffo rts
w ill
h e a lt h
p r o b le m ,
w h ic h
even
te n
y e a rs
ago
r e q u ir e h e a v y r e lia n c e o n e x p e r t s in f ie ld s o u t s id e
t io n .
o f b io m e d ic a l s c ie n c e , a n d t h e n e c e s s a r y r e s e a r c h
s e e m m o r e c e r t a in to s u c c u m b t o s u c h a n in t e n s iv e ,
w ill b e e x p e n s iv e . T h e
b a la n c e d ,
s o lu t io n
to
c a r ie s ,
to ta l co st o f th e e ve n tu a l
h o w e v e r,
w ill
be
n e g lig ib le
Few
o th e r
and
c o n te m p o ra ry
t e n a c io u s
h e a lt h
s c ie n t if ic
p r o b le m s
e ffo rt
w h ic h c h a r a c t e r iz e s c a r ie s r e s e a r c h i n
as
th a t
1973.
c o m p a r e d t o t h e c o s t to s o c ie t y o f c o n t in u in g to c o e x is t w it h t h is d is e a s e . T o d a y , h o w e v e r, w e
c o n c e n tra te
m ilia r t o p ic s . C u r r e n t s t r a t e g y in in v o lv e s
fin d in g
e ff e c t iv e ,
sa fe ,
on
m o re
fa
c a r ie s r e s e a r c h and
lo g is t ic a lly
D r.
C a r lo s
is
a s s o c ia t e
d ir e c t o r
fo r
th e
N a t io n a l
C a r i e s P r o g r a m , N a t io n a l In s t it u t e o f D e n t a l R e s e a r c h , 9 0 0 0 R o c k v ille P ik e i B e t h e s d a , 2 0 0 1 4 .
SPECIAL ISSUE/JADA, Vol. 87, O ctober 1973 ■ 999