Subject. This article analyzes existing theories about the prevalence and causes of dental caries, which is considered as a civilization disease. The crucial role of endogenous factors in the risk of caries, including a pulp and dental fluid, is noted. Data are given that acids do not actively participate in the process of demineralization, which is confirmed by numerous theoretical and hypothetical points. The role of some materials produced by dental industry based on this “pseudo-acidogenic” theory and used in the treatment of caries, as well as the false and negative consequences created by them in general, is analyzed, and adequate parallels are carried out. The purpose of the study was the theoretical justification of the key role of acetylcholine (the cholinomimetic mediator located on the Toms fibers) in the occurrence of dental caries. Methodology. Russian and foreign research works due to the etiology, prevalence and pathogenesis of dental caries were studied, and a comparative theoretical analysis of the available data on this issue was carried out. Results. Based on the results of numerous studies cited in the available literature and our studies, we performed an analysis of theoretical principles and substantiated the data that the process of demineralization occurring in dental caries cannot be caused by acids. Therefore, the only and decisive factor in the origin of the demineralization process is the occurrence of the process because of alkaline substances. Conclusions. Based on the studied references, we present the data that the most current theories of the etiopathogenesis of caries are imperfect in terms of solving the problem, which, in our opinion, requires further study of the process both of acetylcholine and the enzyme acetylcholinesterase inhibition in the local form and inside dental hard tissues.