{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T11:51:31Z","timestamp":1781783491068,"version":"3.54.5"},"reference-count":185,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T00:00:00Z","timestamp":1781740800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Dentistry Journal"],"abstract":"<jats:p>Dental diseases have long been taught and treated as separate entities: cariology, operative dentistry, endodontics, and periodontology, each working within its own boundaries. However, increasing biological and clinical evidence suggests that this classified view does not fully reflect how disease progresses in the mouth. Instead, dental disease should be understood as a continuum within the interconnected tooth\u2013pulp\u2013periodontium complex. This review provides current evidence showing how dental caries can serve as the starting point of a process that can progress through pulpitis and apical periodontitis and eventually affect surrounding periodontal tissues. Caries is now widely known as a biofilm-driven and host-influenced condition shaped by ecological imbalance rather than specific pathogens alone. As lesions penetrate deeper into dentin, the structure becomes more permeable, permitting diffusion of microbial metabolites and signaling molecules toward the pulp. This initiates a multifaceted inflammatory reaction within the pulp tissue. At this stage, pulpitis becomes a critical turning point, where the outcome depends on microbial load, lesion activity, host response, and quality of clinical intervention. If the disease is not well controlled, it may lead to pulp necrosis, allowing infection to spread beyond the root canal and initiate periapical inflammation. Through anatomical pathways such as apical foramina and lateral canals, these processes can extend further, sometimes resembling or overlapping with periodontal disease. This overlap creates diagnostic challenges, as conventional tests may not always distinguish between conditions. A structured, pathway-based diagnostic approach is therefore essential. From a treatment perspective, this continuum model highlights early intervention, minimally invasive care, preservation of pulp vitality when possible, and maintenance of a strong coronal seal. Ultimately, stronger integration across dental disciplines can improve diagnosis, guide treatment decisions, support long-term tooth preservation, and promote unified dental education. This article presents a narrative review supported by a structured literature search and proposes a clinically actionable framework that extends established endodontic\u2013periodontal concepts upstream to include caries initiation and restorative modulation.<\/jats:p>","DOI":"10.3390\/dj14060380","type":"journal-article","created":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T10:25:34Z","timestamp":1781778334000},"page":"380","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["From Caries to Periodontal Breakdown: A Biological and Clinical Continuum Linking Cariology, Operative Dentistry, Endodontics, and Periodontology"],"prefix":"10.3390","volume":"14","author":[{"given":"Yasir Dilshad","family":"Siddiqui","sequence":"first","affiliation":[{"name":"Department of Preventive Dentistry, College of Dentistry, Jouf University, Sakaka 72345, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nusrat","family":"Sultana","sequence":"additional","affiliation":[{"name":"Graduate School of Natural Science and Technology, Okayama University, 3-1-1 Tsushimanaka, Kita-Ku, Okayama 700-8530, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Osama","family":"Khattak","sequence":"additional","affiliation":[{"name":"Department of Restorative Dentistry, College of Dentistry, Jouf University, Sakaka 72345, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6041-1907","authenticated-orcid":false,"given":"Mohammed Zahedul Islam","family":"Nizami","sequence":"additional","affiliation":[{"name":"Mineralized Tissue Biology, ADA Forsyth Institute, 100 Chestnut Street, Somerville, MA 02143, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,18]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1111\/jcpe.70043","article-title":"The Interplay Between Periodontitis, Caries and Dental Restorations in an Adult Population","volume":"53","author":"Pitchika","year":"2026","journal-title":"J. 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