Transcript Incipient caries and Remineralisation

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
Plaque,
microorganisms
Host
Caries
Diet
Time
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
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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
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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, fissuresealing
Prevention 1.
Maintain an oral enviroment that prevent
demineralisation and enhances
remineralisation
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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