The caries process and its effect on the pulp: the science is changing and so is our understanding.

The understanding of the caries process and its effect on the pulp is presented in the context that caries does develop in various rates of progression. Early in the caries process, the pulp reflects changes within lesion activity. Thus, the early pulp response is reversible. Later, the rate of caries progression is reflected by the quality of the tertiary dentin. Slowly progressing lesions create tertiary dentin resembling normal tubular dentin. Rapidly progressing lesions lead to the production of atubular dentin or complete absence of tertiary dentin, as well as pulp necrosis and apical pathology. Finally, the nature of the untreated deep carious lesion is an ecosystem that might undergo significant changes. The untreated lesion is temporarily converted from an active and closed lesion environment into one that is open and slowly progressing. The analysis of untreated carious lesions has transformed the treatment philosophy of deep carious lesions.