A smoker who constantly chews mints presents with numerous interproximal carious lesions. What is the most likely cause of his caries?

Correct answer: B. Frequent sugar exposure from the mints

• A. Smoking does reduce salivary flow, but the dominant modifiable factor here is the constant fermentable carbohydrate exposure.
• B. Correct. It is frequency, not quantity, that drives caries. Continuous mint consumption keeps plaque pH below the critical 5.5 threshold for most of the day, never allowing remineralization between challenges.
• C. Nicotine contributes to periodontal disease and xerostomia but is not directly cariogenic.
• D. The pattern reflects a behavioral etiology rather than a developmental defect.