Incipient caries and Remineralization

Dr. Eszter VargaDepartment of Conservative Dentistry

Definition of caries 1.

• multifactorial

• irreversibel disease of calcified tissues of teeth

• demineralization of the inorganic substance

• destruction of the organic substance

• leads to cavitation

Definition of caries 2.

• dynamic process

• imbalance between demineralization and remineralization of the dental surface

• potential to remineralize incipient lesion! (reversibel)

Etiology of caries

Caries

Diet Time

Host Plaque, micro- organisms

the major virulence factors of S.mutans

• acid production (acidogenicity)

• acid tolerance (aciduricity)

• intracellular polysaccharide synthesis (storage of carbohydrates)

• extracellular polysaccharide synthesis (increases adhesion)

• ability to adhere to other bacteria and tooth surface

Host (Saliva)

• Cleaning

• Buffering

• Antimicrobal effect (lysozyme, laktoferrin, lactoperoxidase)

• Normal vehicle for calcium, phosphat

Salivary disfunction

Poor salivary flow: (high caries risk)– hypertensive drugs,diuretics

– systemic diseases• Sjogren-syndrome, Diabetes mellitus, diseases of

salivary glands

– head and neck cancer treatment

Host(tooth)

• tooth morphology

• irregularities in arch form

crowding ,overlapping

• tooth composition

mineralization, fluorid

Carbohydrates

• Physical form

• Chemical composition

• texture of food

• frequency of ingestion

• presence of other food constituents

Enamel• Most mineralized, very hard, thin translucent layer• Inorganic materials

– 95% calcium and phosphate (hydroxiapatit crystals) Ca10(PO4)6OH2

– Trace minerals in crystal lattice (change the solubility of enamel)

• Fluorid, carbonate• Sodium, zinc, strontium, potassium

• Organic materials (1-2%)– Enamelins

• Water 4%

• Rods, rod sheath, interrod enamel

• Pores (enamel permeability!)– Fluid movement, diffusion– Variation of density and hardness

Enamel

• Primary contact with cariogenic bacteria

• Begin of demineralisation process

• Pellicula

• Plaque formation

• High bacterial metabolic activity– (carbohydrates→organic acids)– S.mutans,Lactobacillus acidophilus,

Actinomyces

• pH drop

• demineralization

• Incipient carious lesion (earliest phase of tooth decay)

• Capable of being reversed, arrested or progressing to cavitation

Demineralization Remineralization

• when sugar present demin. rapidly occurs• between sugar episods remin. slowly occurs• if remin. periods exceeds demin. periods

subsurface lesion will mineralize• if demin. periods exceed remin. cavitation will

occur• demin. periods exceed remin. periods when

sugar is frequent or prolonged

Histology of incipient caries

light microscope

polarized light microscope

• surface zone

• body of the lesion

• dark zone

• translucent zone

Diagnostic methods

• Clinical-visual method– Sharp eyes and magnification

• Alternativ– X-rays– FOTI, QLF– Laserfluorescence– ECM, electrical impedance measurement– Ultrasonic caries detector

Clinical characteristics of incipient lesion

• Colour (white, brown)

• Opacity, translucency

• surface texture

• surface hardness

! Fragile surface layer,damage from probing!

Common sites of occurence

• Cervical third of a tooth

• Pits and fissures

• Vestibular tooth surfaces after orthodontic treatment with multibonded appliances

• Cervical margins (in patients with prosthodontic restorations)

Treatment

• Preventiv,nonsurgical treatment

• Monitoring

Depending on risk level, oral hygiene , diet management, motivation, fluorid, fissure-sealing

Prevention 1.

Maintain an oral enviroment that prevent demineralisation and enhances remineralisation

• oral hygiene

• diet management

• fluorid

• fissure sealing

Treatment

• limit susbstrate (diet management)• modify microflora

• chlorhexidine, triclosan

• prevent plaque succession• plaque removal (oral hygiene)

• modify tooth surfacefluorides (increas resistance)

• stimulate saliva flowsugarless chewing gumnoncariogenic foods that require lots of chewing

Diet management

• Reduce number, duration and intensity of acid attacks

• reduce or eliminate sucrose from meals, eliminate from between-meal snacks

• consume all sweets in one episod preferably following a meal

Effects of fluoride

• Enhances the remineralization (precipitation into tooth structures)

• more acid resistant enamel

• antimicrobal activity