One factor that tips the balance towards caries progression is having less bicarbonate-rich saliva, which can result from conditions like Sjogren syndrome, radiation treatment for cancer, gastric reflux, or as a side effect of a medication or recreational drugs.

可以打破致病因素与保护因素的平衡使龋齿进展的一个原因是含有丰富碳酸氢盐的唾液减少，见于Sjogren综合征、癌症放疗、胃反流或毒品带来的副作用。