Table 2 Summary of obstacles to determining the microbial etiology of caries
Obstacle or Confounder | |
|---|---|
Sampling Choices | |
 - saliva instead of dental plaque  - plaque pooled from sites of caries and intact enamel  - microbiology of carious sites can vary considerably over small distances | |
Substrate Susceptibility | |
 - tooth sites may vary in susceptibility to dental plaque of similar composition | |
Caries Process | |
 - the microbiology of caries evolves as the lesion progresses in severity | |
Genetic Contributions | |
 - salivary composition and constituents may elevate or depress caries risk | |
Determination of the Plaque Microbiome | |
 - culture-based methods have a narrow focus  - next generation sequencing outcomes may differ from lab to lab analyzing the same sample  - 16S gene-based sequencing poorly differentiates species of oral streptococci | |
Biological Significance | |
 - little evidence for what constitutes biologically significant levels of individual plaque species | |
Caries Incidence | |
 - the microbial basis for occasional caries may typically differ from that for rampant caries |