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. High bacterial metabolic activity
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 Alternativ
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. oral hygiene diet management fluorid fissure sealing
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