Mechanisms of caries induced by sugars: a narratives review from microbial metabolism to oral ecological imbalance and public health strategies for caries prevention.

Dental caries is defined as a chronic, multifactorial disease characterized by the demineralization of dental hard tissues resulting from the acid production by oral microbial communities metabolizing dietary sugars. The ingestion of sugars is a pivotal ecological factor in the progression of caries, with mechanisms that extend beyond merely providing substrates for cariogenic bacteria. This review explores the influence of sugars on the metabolism, adhesion, biofilm formation, and interspecies interactions of oral microorganisms, with a particular focus on species such as Streptococcus mutans, Lactobacilli, Actinomyces, and Candida albicans. The disruption of the oral microbiome balance by these sugars initiates and promotes the process of caries. The review comprehensively summarizes contemporary public health strategies for caries prevention based on microbial ecological theories, including the limitations of sugar intake, fluoride application, probiotics, and ecological management, assessing their effectiveness and challenges. The objective of this study is to establish a theoretical framework and practical guidelines for the precise prevention of dental caries.