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

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Presentation on theme: "Incipient caries and Remineralization Dr. Eszter Varga Department of Conservative Dentistry."— Presentation transcript:

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) 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%

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



17 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

18 Histology of incipient caries light microscope polarized light microscope surface zone body of the lesion dark zone translucent zone

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

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

21 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)

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

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

24 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

25 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

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

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