Integrated hypothesis of dental caries and periodontal diseases

Bente Nyvad, Nobuhiro Takahashi

Research output: Contribution to journalReview articlepeer-review

68 Citations (Scopus)


This review considers an integrated hypothesis of dental caries and periodontal diseases that builds on theoretical ecological principles. The backbone of the hypothesis is based on the dynamic stability stage of the oral microbiota, at which intrinsic (mainly saliva and gingival crevicular fluid) and bacterial (mainly metabolic) resilience factors maintain ecological dynamic stability, compatible with clinical health. However, loss of intrinsic resilience factors and/or prolonged changes in the availability of microbial metabolic substrates may shift the ecological balance of the microbiota into either saccharolytic (acidogenic) or amino acid-degrading/proteolytic (alkalinogenic) stages, depending on the nature of the predominant substrates, leading to clinical diseases. Therefore, to maintain and restore the dynamic stability of the oral microbiota, it is necessary to control the drivers of disease, such as salivary flow and influx of bacterial nutrients into the oral cavity. Contrary to conventional wisdom, excessive intake of fermentable carbohydrates may contribute to inflammation in periodontal tissues resulting from hyperglycaemia. An integrated hypothesis emphasizes that both dental caries and periodontal diseases originate in the dynamic stability stage and emerge in response to nutritional imbalances in the microbiota. Periodontal diseases may belong to the sugar driven inflammatory diseases, similar to diabetes, obesity, and cardiovascular diseases.

Original languageEnglish
Article number1710953
JournalJournal of Oral Microbiology
Issue number1
Publication statusPublished - 2020 Jan 1


  • Dental caries
  • carbohydrates
  • dynamic stability stage
  • ecological hypothesis
  • ecosystem
  • gingival crevicular fluid
  • microbiota
  • periodontal diseases
  • resilience factor

ASJC Scopus subject areas

  • Dentistry (miscellaneous)
  • Microbiology (medical)
  • Infectious Diseases


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