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Incipient caries and Remineralization

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.

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Incipient caries and Remineralization

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  1. Incipient caries and Remineralization Dr. Eszter Varga Department of Conservative Dentistry

  2. 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

  3. Definition of caries 2. • dynamic process • imbalance between demineralization and remineralization of the dental surface • potential to remineralize incipient lesion! (reversibel)

  4. Etiology of caries

  5. 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

  6. Host (Saliva) • Cleaning • Buffering • Antimicrobal effect (lysozyme, laktoferrin, lactoperoxidase) • Normal vehicle for calcium, phosphat

  7. 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

  8. Host(tooth) • tooth morphology • irregularities in arch form crowding ,overlapping • tooth composition mineralization, fluorid

  9. Carbohydrates • Physical form • Chemical composition • texture of food • frequency of ingestion • presence of other food constituents

  10. 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%

  11. Rods, rod sheath, interrod enamel • Pores (enamel permeability!) • Fluid movement, diffusion • Variation of density and hardness

  12. Enamel • Primary contact with cariogenic bacteria • Begin of demineralisation process

  13. Pellicula • Plaque formation • High bacterial metabolic activity • (carbohydrates→organic acids) • S.mutans,Lactobacillus acidophilus, Actinomyces • pH drop • demineralization

  14. Incipient carious lesion (earliest phase of tooth decay) • Capable of being reversed, arrested or progressing to cavitation

  15. 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

  16. Histology of incipient caries light microscope polarized light microscope • surface zone • body of the lesion • dark zone • translucent zone

  17. Diagnostic methods • Clinical-visual method • Sharp eyes and magnification • Alternativ • X-rays • FOTI, QLF • Laserfluorescence • ECM, electrical impedance measurement • Ultrasonic caries detector

  18. Clinical characteristics of incipient lesion • Colour (white, brown) • Opacity, translucency • surface texture • surface hardness ! Fragile surface layer,damage from probing!

  19. 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)

  20. Treatment • Preventiv,nonsurgical treatment • Monitoring Depending on risk level, oral hygiene , diet management, motivation, fluorid, fissure-sealing

  21. Prevention 1. Maintain an oral enviroment that prevent demineralisation and enhances remineralisation • oral hygiene • diet management • fluorid • fissure sealing

  22. 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

  23. 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

  24. Effects of fluoride • Enhances the remineralization (precipitation into tooth structures) • more acid resistant enamel • antimicrobal activity

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