Prevention of root caries

Anti-demineralization effect of desensitizer containing copolymer and sodium fluoride on root dentin - a transverse microradiographic study

Objective: To evaluate anti-demineralization effects of dentin desensitizer containing sodium fluoride and methacrylate-co-p-styrene sulfonic acid (MS polymer) on root dentin using transverse microradiography (TMR).

Material and methods: Twenty-four dentin specimens were divided into four groups: MSO (no fluoride), MSF (3000 ppm F), FJL (9000 ppm F), and Control. In MSO and MSF, each desensitizer was rubbed into the dentin surfaces for 10 s then left for 20 s. In FJL, paste containing 9000 ppm F was applied onto the surface for 30 s. All specimens, including the Controls, were rinsed with deionized water, dried and an area of their surface exposed to pH 5.0 acidic solution, refreshed every 24 h, for 4 days. Sections 300-µm-thick were assessed by TMR. Mineral profiles and integrated mineral loss (IML) of lesions were analyzed by dedicated software. IML was analyzed with one-way ANOVA and Tukey’s test.

Results: MSF and FJL specimens showed high mineral volume % at the surface and in lesions, and significantly lower IML than the other groups (p < .05).

Conclusion: Dentin desensitizer containing 3000 ppm fluoride and MS polymer has the same anti-demineralization effect as does a fluoride paste containing 9000 ppm F.

Molecular pathogenesis of root dentin caries

Human dentin has a higher content of organic matrix and more non-ideal hydroxyapatite than human enamel. Ultrastructural studies indicate that root caries involves both mineral dissolution and breakdown of the organic matrix. Factors involved in the root caries process seem more complicated than those in enamel caries. Moreover, the distinct roles of acids and enzymes and the sequence of events in the root caries process are not well-understood. Although Streptococcus mutans and Actinomyces viscosus are considered to be major pathogenic micro-organisms of root caries, their roles in degradation of the organic matrix components of root dentin need clarification. The purpose of this paper is to review the basic composition of root dentin and the roles of acids and both endogenous and bacterial enzymes in the root caries process.

In vitro demineralization by strains of Actinomyces viscosus and Streptococcus sobrinus of sound and demineralized root surfaces

Root sections were inoculated with one of two strains of Actinomyces viscosus or a strain of Streptococcus sobrinus and then incubated for 9 days in Trypticase soy broth (TSB) containing 0.25% glucose or TSB supplemented with 0.25% sucrose (TSB+S). Lesion progression was measured from microradiographs. One section from each group was examined with a transmission electron microscope. Lesion progression was associated with a fall in the pH of the medium. However, lesion progression was not correlated with the mean 48-hour pH of the medium. In both TSB and TSB + S, lesion progression with A. viscosus was significantly greater than in the S. sobrinus group. However, the mean 48-hour pH value in TSB + S was lower than that in the S. sobrinus group. Plaque formation in TSB was, subjectively, least in the S. sobrinus group. Examination of transmission electron micrographs revealed bacteria penetrating the surfaces of the sections and extending into the lesion in the A. viscosus groups but not in the S. sobrinus group. This in vitro bacterial plaque model of root caries may be suitable for investigations of the bacterial etiology of root-surface caries and the virulence factors associated with pathogenicity.

Preventing dental caries: current and prospective strategies

Strategies of caries prevention can be directed at the resistance of the host/teeth, at the diet, at the microflora or all three. The appropriate preventive interventions depend on the level of caries risk.

Caries on root surfaces exposed following gingivectomy in conventional rats infected with Streptococcus sobrinus and Actinomyces viscosus

To study the ability of bacteria associated with coronal caries to initiate root surface caries, a rat model was used. Root surfaces were exposed by gingivectomy in rats fed a caries-promoting diet and orally inoculated with either Actinomyces viscosus M-100, Streptococcus sobrinus (mutans) 6715, or both. A fourth group received a diet containing antibiotics. The animals were sacrificed 64 days following the gingivectomy performed on the right molar quadrants. Gingivectomy significantly increased exposed lingual root length and root caries incidence. There were no caries on non-gingivectomy root surfaces. Root surface caries incidence in the groups inoculated with A. viscosus and A. viscosus plus S. sobrinus did not differ. For both these groups, root caries incidence was significantly greater than that for the group inoculated with S. sobrinus alone. Root caries incidence in this latter group did not differ from that in the control group.

Human root caries: histopathology of initial lesions in cementum and dentin

The histopathology of human root caries was examined in extracted teeth by different optical methods. The present part of the study details the sequential stages of initial caries in both cementum and peripheral dentin. Significant differences are shown between the mechanisms operating on the various dental hard tissues during development of caries. Histologically distinguishable reaction patterns depended on both the degree of the cariogenic challenge and the respective structural features of cementum and peripheral dentin. Earliest lesions, histologically visible as small clefts traversing cementum and extending into peripheral dentin, were clinically not detectable. Cementum was stepwise destroyed until peripheral dentin became exposed. The exposed peripheral dentin was sclerosed and tubule-free. Demineralization of dentin preceded the degradation of the organic matrix. Frequently, a hypermineralized layer occurred in both cementum and exposed dentin. Its localization was not identical with the anatomical surface. Initial penetration of bacteria into peripheral dentin occurred along small clefts. Breakdown of the organic matrix was the final step in the destructive phase of the carious process.

A method of semi-quantitative microradiographic analysis of root surface lesion remineralization

The purpose of this study was to present a modified photometer based digital analysis system for image enhanced microradiographic semi-quantitation of reactions of demineralization and remineralization of root surface lesions. The system was used to determine effects of fluoride on abraded root surface dentin in vitro. Lesions of 30-40 micron depth were produced during 18 h exposure of 180 micron thick single sections in solution of 3 mM Ca (Ca/P 1.67) and 30 mM lactic acid at pH 5.1. Mean mineral content of the lesions was 32% relative to adjacent sound dentin. Exposure of 20 h in the same acid with 5 mM Ca (Ca/P 1.67) and 0.12 mM NaF at pH 6.1 restored the mean mineral content to 76% of normal and increased the resistance of the lesions to demineralization. Remineralization and subsequent demineralization characteristics indicated the growth of fluorapatites on residual minerals in the dentin lesions. The microradiographic analysis system proved to be sensitive and critical in these studies.