Although significant progress has been made in reducing and controlling dental caries, the disease still remains a problem for many children and adults in the United States. The problem is much worse for children from poor families. More than a third of all children 2 to 9 years old living in poverty in the U.S. have one or more untreated primary teeth that are affected with caries. There are significant and persistent racial disparities in dental health and treatment.
Dental caries is an infectious, communicable disease resulting in destruction of tooth structure by acid-forming bacteria found in dental plaque, an intraoral biofilm. The disease results in tooth loss if left untreated. Fluoride in the mouth can inhibit demineralization in early carious lesions and promote remineralization – leading to rebuilt and stronger outer layers of the tooth (i.e., enamel on the crown of the tooth and cementum on the root). Water fluoridation, use of other fluoride therapies such as daily tooth brushing with fluoride-containing toothpaste, placement of dental sealants and fluoride-releasing filling materials, and other appropriate oral health care approaches currently are utilized in the prevention and control of dental caries. The mainstays of caries prevention, topical and systemic fluorides and pit and fissure sealants, are technologies developed in the 1950s and 1960s. Nevertheless, the relapse rates for children who have been treated for advanced caries are very high.
Science and technology have not produced sufficient practical tools for public health practitioners and the private delivery system to address the pandemic in dental caries that exists for children and adults from families with low incomes and for numerous ethnic and racial minority groups. Moreover, it is unclear whether the barriers are remediable bioengineering and technical problems or fundamental science questions. Nevertheless, the obligation to address the gap between scientific research and practical application is especially relevant today. The federal government and state governments bear the majority of the cost of trying to control this pandemic through Medicaid, the Public Health Service, Indian Health Service, and other public programs. These costs continue to escalate, and continued applications of existing technology are unlikely to reduce these disparities.
This paper reviews emerging biomaterials technologies that may be translated into strategies for more effective means of controlling oral biofilms, dental caries, and periodontal disease.