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[Microradiographic investigations of carious changes in the enamel in the ground sections made perpendicularly to tooth axis].

Carious changes in the enamel in the undermineralized ground sections made perpendicularly to tooth axis were investigated using microradiography. By this way, relationship between carious invasion and the enamel lamellae and tuft, which has been not able to be examined in the longitudinal ground sections, could be clarified. 1) Direction of progress of demineralization and contour of demineralization front in the enamel are closely related to arrangement of enamel prisms. This findings strongly suggest that carious demineralization progresses along the enamel prisms. 2) Mode of carious demineralization in the enamel lamellae can be divided into two types; in the first type, demineralization progresses through the enamel lamellae more quickly than in the surrounding enamel and, in the second type, the enamel lamellae and its surrounding enamel show higher mineralization degree than the demineralized part in the rest of enamel, probably due to remineralization. The second type is observed more frequently than the first. 3) Mode of carious demineralization in the enamel tuft are also divided into two types; the first type which shows that demineralization progresses more quickly through the enamel tuft than the surrounding enamel and the second type that the enamel tuft and its surrounding narrow enamel are highly mineralized probably due to remineralization, whereas the rest of enamel is prominently demineralized. The second type is more frequently observed than the first. 4) In the ground sections made perpendicularly to tooth axis, it is more clearly observed that the interprismatic area is very highly remineralized whereas the main body of prism is easily demineralized, than in the longitudinal ground sections. 5) Striae of Retzius is composed of the band which appear to resist to demineralization and that which is easily demineralized. However, in the later case, demineralization which progresses laterally along the band can not be observed. 6) The degree and width of hypermineralized layer appeared in sound enamel along the demineralization front seem to be related to the rate of demineralization and arrangement of enamel prisms.

Dental Caries↗

In vitro caries-like lesion formation in F-containing tooth enamel.

In vitro caries-like lesion formation in F-containing tooth enamel (shark) showed a lower depth of penetration compared to that in human enamel (42 vs. 100%). After longer periods of exposure, the depth of penetration in shark enamel is only 33% relative to that in human enamel. The extent of dissolution in acetate buffer for powdered human enamel and for synthetic F-free calcium-carbonated-apatites was greater than for powdered shark enamel and for synthetic F-containing apatites. These results suggest that the cariostatic action of fluoride may be explained in terms of a combination of two effects: (a) the stabilizing effect against acid dissolution (caries) when fluoride is incorporated in the tooth mineral (apatite), and (b) a greater degree of remineralization (repair) in the presence of F solution.

Animals↗

The application of synthetic hydroxyapatite in children and adolescents in various clinical cases.

The possibility of application of HA-BIOCER synthetic hydroxyapatite in the treatment of enamel hypoplasia in children and adolescents manifested by mineralisation disorders, enamel underdevelopment, enamel deficiency and oversensitivity to mechanical, thermal and chemical stimuli was evaluated. The possibility of applying the same preparation in case of enamel fractures and teeth injuries type I according to Ellis was also examined. It was found that the application of hydroxyapatite stimulates processes of remineralization in decalcified places. It also causes removal of tooth oversensitivity to thermal and mechanical stimuli by closing open dentinal tubules or decrease in their size. HA-BIOCER preparation brings about smoothing and lighting of hypoplastic foci, improves aesthetic appearance and is not toxic to patients.

Administration, Topical↗

[Must caries be completely removed?].

Changes in restorative techniques and the development of new restorative materials have allowed the use of more conservative cavity preparations. Important questions are: What are the consequences of incomplete removal of caries-affected dentin? What are the bond strengths of adhesives to demineralized enamel and dentin? The non-invasive management of carious lesions with intact tooth surfaces in a manner that will bring about some remineralization offers a viable and superior alternative to conventional restorations. The bond strengths of adhesives to demineralized enamel seem to be similar to that on normal enamel. None of the modern filling technologies can guarantee the arrest of the carious process. The complete removal of the infected dentin is, however, still necessary irrespective of the restorative material used.

Dental Bonding↗

Effect of tumor therapeutic irradiation on the mechanical properties of teeth tissue.

Tumor irradiation of the head-neck area is accompanied by the development of a so-called radiation caries in the treated patients. In spite of conservative therapeutic measures, the process results in tooth destruction. The present study investigated the effects of irradiation on the demineralization and remineralization of the dental tissue. For this purpose, retained third molars were prepared and assigned either to a test group, which was exposed to fractional irradiation up to 60 Gy, or to a non-irradiated control group. Irradiated and non-irradiated teeth were then demineralized using acidic hydroxyl-cellulose gel; afterwards the teeth were remineralized using either Bifluorid12 or elmex gelee. The nanoindentation technique was used to measure the mechanical properties, hardness and elasticity, of the teeth in each of the conditions. The values were compared to the non-irradiated control group. Irradiation decreased dramatically the mechanical parameters of enamel and dentine. In nonirradiated teeth, demineralization had nearly the same effects of irradiation on the mechanical properties. In irradiated teeth, the effects of demineralization were negligible in comparison to non-irradiated teeth. Remineralization with Bifluorid12 or elmex gelee led to a partial improvement of the mechanical properties of the teeth. The enamel was more positively affected by remineralization than the dentine.

Elasticity↗

[Maturation of enamel and tooth eruption].

The tertiary maturation of the erupting tooth needs much more time than it is supposed in literature. Possibly the completion is in accord with the decline of the caries activity at the end of the second decade of lifetime. With the aid of polarizing microscopy, electron microprobe, microhardness testing (Vickers) and scanning electron microscopy different stages of posteruptive maturation from human and other mammalian teeth were analysed. The mineralization level in the outer surface of human enamel is completing little by little in more than 5 years after eruption. This state is in the ruminant tooth obvious never within reach in consequence of the specific physiological conditions. The maturating mineralization after our preliminary findings is fundamentally different to remineralization.

Animals↗

Saliva and dental caries.

A study of saliva and its tooth-protective components reveals at least four important functions of saliva: (1) buffering ability, (2) a cleansing effect, (3) antibacterial action, and (4) maintenance of a saliva supersaturated in calcium phosphate. Several salivary constituents subserve one or more of these functions. Research has yielded important information about organic and inorganic secretory products. It is also clear that saliva as a unique biologic fluid has to be considered in its entirety to account fully for its effects on teeth. Saliva is greater then the sum of its parts. One reason for this is that salivary components display redundancy of function, each often having more than one function. This redundancy, however, does not imply that proteins that share functional roles all contribute to the same degree. For instance, when comparing proteins that inhibit calcium phosphate precipitation, statherin and acidic proline-rich proteins are most potent, whereas histatins, cystatins, and mucins appear to play lesser roles. The complex interaction between proteins is another major factor contributing to saliva's function. In this regard, heterotypic complexes of various proteins have been shown to form on hydroxyapatite. Mucin binding to other salivary proteins, including proline-rich proteins, histatins, cystatins, and statherin, is well documented. The complexes, whether adsorbed to the tooth surface or in saliva, have important implications for bacterial clearance, selective bacterial aggregation on the tooth surface, and control of mineralization and demineralization. Finally, proteolytic activity of saliva generates numerous products whose biologic activities are often different from their parent compounds. Fluoride is another important component of saliva that is discussed separately in other articles in this issue. The ability of saliva to deliver fluoride to the tooth surface constantly makes salivary fluoride an important player in caries protection largely by promoting remineralization and reducing demineralization. Some key properties of salivary components discussed in this article are listed in Table 1. Saliva is well adapted to protection against dental caries. Saliva's buffering capability; the ability of the saliva to wash the tooth surface, to clear bacteria, and to control demineralization and mineralization; saliva's antibacterial activities; and perhaps other mechanisms all contribute to its essential role in the health of teeth. The fact that the protective function of saliva can be overwhelmed by bacterial action indicates the importance of prevention and therapy as in other infectious diseases. The knowledge of functional properties of saliva as well as those of its separate components may permit a better assessment of dental caries susceptibility. Future research is essential to characterize more fully salivary components and their interactions and how these affect the caries process. With such knowledge, the use of modified oral molecules as therapeutic agents may become a reality. Equally intriguing is the prospect of influencing the secretion of salivary components by greater knowledge and control over the secretory processes responsible for the delivery of those components.

Anti-Bacterial Agents↗

Glass ionomer cements and future research.

Once a root surface lesion has extended into tooth structure beyond the point at which it can be successfully remineralized it is necessary to carry out traditional restorative procedures. Often the extent of the lesion is difficult to define and development of a pulp exposure is an ever present risk. Access may be difficult and placement of a restorative material, such as amalgam, which requires positive condensation for correct placement, poses a problem. The principal requirement of a restoration in such a lesion is that it should completely seal the restoration/tooth interface and prevent the ingress of further bacteria or bacterial nutrients. As there will be no occlusal load, physical properties of the restorative material are not significant. As these lesions will often occur on anterior teeth it is desirable that the material be reasonably esthetic although there will be no need for a great depth of translucency. The modern trend to light curing of restorative materials facilitates placement but there are situations with these lesions where it is difficult or impossible to obtain proper access for the light and an auto cure material may be indicated. Because the patient who presents with root surface lesions is likely to pose a continuing problem, it is desirable that the restorative material have some degree of in-built protection against further demineralization. An ongoing fluoride release is very desirable. Glass ionomer cement fulfils all the above requirements and is therefore at present the material of choice. Either the original auto cure cement or the newer dual cure materials will provide a complete marginal seal with a continuing fluoride release throughout the life of the restoration and both varieties are sufficiently esthetic to be entirely acceptable.

Adhesiveness↗

The in vitro demineralization potential of a sodium fluoride, calcium and phosphate ion-containing dentifrice under various experimental conditions.

While fluoride has had a dramatic effect in reducing the rate of caries, it has failed to provide complete protection against caries development, and tooth decay is still widely prevalent. The objective of this study was to determine the demineralization prevention potential of a remineralizing dentifrice with fluoride (Enamelon), and an assured supply of calcium and phosphate ions on bovine enamel in a cyclic remin/demin regimen using various experimental conditions. A conventional fluoride toothpaste, Crest, and a placebo dentifrice were used as controls. One-hundred and forty-four ground and polished 4 mm bovine enamel cores were prepared and assigned to various test treatments using six specimens per treatment group. They were subjected to six cyclic treatments consisting of one-minute exposures at room temperature to the test product diluted 1:2 in water, remineralization for a specified time at 37 degrees C, and demineralization for a specified time at 37 degrees C. The enamel specimens were tested for micro-hardness initially, and after the first, third and sixth treatment, remineralization and demineralization cycles using a Buehler Micro-hardness Tester with a 200 g load. Differences in micro-hardness between the test groups were analyzed for significance by performing multiple pair-wise comparisons using Bonferroni significance levels at the 95% confidence level. The results of this study showed that Enamelon Toothpaste was generally more effective in preventing demineralization of enamel than the fluoride dentifrice at 0.5 and 1.5 hours, and the non-fluoride control dentifrice at all time measurements. Prevention of enamel demineralization by the dentifrices was affected by changes in demineralization time and pH, but not by changes in remineralization time.

Animals↗