Novel Anticaries and Remineralization Agents: Future Research Needs:

More than 60 y have passed since the widespread introduction of fluoride use and 50 y since the introduction of sealant therapy. Yet, dental caries remains a significant disease, particularly in underserved and aging communities. An international conference dedicated to the topic of novel anticaries and remineralizing agents (ICNARA 3) was held in May 2017. The ICNARA 3 conference was the third in a series of ICNARA conferences (ICNARA 1 held in January 2008 and ICNARA 2 January 2012; ten Cate 2008, 2012). These conferences brought together scientists who could summarize the current status of caries management and highlight exciting new therapeutic possibilities, as well as research needs for the future. ICNARA 3 recognized that the new frontier in reducing caries experience and helping maintain health may not solely depend on developing cost-effective products or devices to target the biofilm and/or the tooth, but may rest in a series of behavioral modification and/or targeted approaches, such as efforts to reduce sugar consumption, for ultimate success, based on individual or community risks for dental caries. Dental caries is a microbial disease resulting from a dysbiosis in the oral microbiome. Ecological pressures, such as frequent intake of sugar and/or reductions in saliva flow, can result in extended period of low pH in the biofilm and change the proportions of the normal resident species. This in turn results in the selection of species with an acid-producing/acid-tolerating phenotype, thereby increasing the risk of dental caries (Marsh 2018). The progression of dental caries lesions to cavitation is dependent on the balance between demineralization, caused by biofilm dysbiosis, and remineralization, which is dependent on calcium, phosphate, and fluoride. Despite the significant reduction in caries prevalence in many parts of the world, dental caries remains a major public health problem affecting people of all ages, and remains one of the most common unmet health care needs of economically disadvantaged populations. Furthermore, the disease is not equally distributed, with multiple population groups at increased risk. Existing caries management strategies include, for example, the promotion of a healthy diet, including a low frequency and amount of exposure to fermentable carbohydrates/sugars, and frequent oral hygiene with fluoride-containing toothpaste. However, even with regular fluoride use, caries lesions can still develop if other caries risk factors are present. Thus, together with strategies to reduce sugar consumption, strategies to prevent demineralization and/or promote remineralization of caries lesions need to be enhanced and promoted to reach those at risk.