Incipient caries and Remineralization Dr Eszter Varga Department

Incipient caries and Remineralization Dr. Eszter Varga Department 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

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) Ca 10(PO 4)6 OH 2 – 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 • p. H 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, fissuresealing

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 surface fluorides (increas resistance) • stimulate saliva flow sugarless chewing gum noncariogenic 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