Tooth enamel demineralisation, triggered by an increase in the acidity of bacterial plaque, is the initiation of the caries process.1 In any discussion of the caries process, particular attention is paid to the enamel - the hard, outermost layer - because it is the primary contact with cariogenic bacteria, and where the demineralisation process that can lead to caries first begins. It is also the only tissue of the tooth that does not have the ability to grow or repair itself after maturation, making it even more crucial that its demineralisation is prevented.2 Caries can also develop in dentine, the hard layer under the enamel, so understanding the chemical composition of this layer, and how it is affected by demineralisation, is also important.

The process of remineralisation - the replacement of lost minerals in hard dental tissues - can halt, slow down, and, in some cases, reverse the caries process.1 Saliva and fluoride are two key players in remineralisation: Healthy saliva contains ample amounts of the calcium and phosphate ions that can replenish lost minerals in hard tooth structure, and fluoride can be incorporated into the tooth structure to strengthen it.1,3 For caries prevention, factors in the oral cavity must be highly favourable for remineralisation to occur, so that this process can be effective. If the environment is more favourable for demineralisation, the remineralisation process may have little or no influence, or not occur at all; and caries will develop.

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