The paradigm shift in the etiology, prevention, and management of dental caries: its effect on the practice of clinical dentistry.

Treatment of dental caries as an infectious disease will require a paradigm shift in the way dentists and other health care professionals approach prevention and management of the disease. Prevention of dental caries has relied upon patient cooperation and often requires significant lifestyle changes that are at best difficult to implement and maintain or at worst ignored. This paradigm shift in the etiology, prevention, and treatment of dental caries demands that clinicians redirect their energies and emphasis from the "surgical" approach to dental caries to a "medical" strategy that focuses on early (prenatal if possible) risk assessment of the mother and implementation of appropriate therapeutic intervention, including use of antimicrobials, risk assessment of infants at 6 months of age, and a reduction in the levels of caries-producing bacteria. This revolution in how dentists practice and think will require that they develop strategies and curriculum to "retrain" practicing dentists and to train current and future dental students and residents as well as other medical colleagues on the essentials of the paradigm shift.