If you were treating this decay, how deep would you remove the carious
dentin? Can you indicate with confident that “ Dentin must be removed this far
and no more”? The carious dentin is invaded by bacteria. The infected dentin
must be removed, but the dentin that is not infected must be saved because it is
the most important protector of dental pulp. Can you udge with confidence
that “!acteria have penetrated this far and no more”?
The following description gives a clinical guide to caries removal,
definitely supported by new scientific "nowledge.
B. Up until now, no reliable guide for caries removal has yet been available
#. Diagnosis of the softened dentin by cutting resistance is not reliable.
In conventional treatment the softened carious dentin, as determined
by feeling cutting resistance, is removed with a spoon e$cavator or a
round steel bur mounted on a slow speed engine. %ow for is the softened
dentin actually removed by such a techni&ue?
#. 'hen caries penetrates dentin, softening is always deepest,
discoloration is ne$t and bacterial invasion is last.
(. In chronic decay, discoloration is heavy and reaches the comparatively
harder and deeper layer, and so does bacterial invasion. Conse&uently
the softening )s*, discoloration )D*, and bacterial invasion )!* fronts are
comparatively closer to each other.
+. In acute decay discoloration is light and does not reach the harder layer.
!acterial invasion remains at the very soft and superficial layer.
Conse&uently the thic"ness of the layer that is softened but not infected
is generally greater, as great as #., mm in some cases.
#. %ardness cannot be used as a guide for caries removal, because the
hardness of the bacterial front is very inconsistent.
(. In chronic decay complete removal of remar"ably discolored dentin can
assure complete removal of infected dentin without e$cessive over
+. In acute of moderate decay the natural discoloration front is not only
unclear but also far distant from the bacterial front. Conse&uently
discoloration cannot be an ade&uate discoloration cannot be an ade&uate
guide for caries removal.
-. The softened but not infected dentin of acute decay should be saved if it
is reminerali.able.
/fter trying a variety of dyes and solvents presently available or ever used in
research laboratories, a successful result was finally obtained with a 0.12.
The 3allory4/.an techni&ue stains sound collagen blue and deteriorated
collagen red. /s seen in the middle and bottom pictures, the layer stained red
by the fuchsin staining was also stained red by the 3allory4/.an techni&ue,
indicating deterorated collagen, whereas the layer not stained by the fuchsin
was stained blue by the 3allory4/.an techni&ue, indicating sound collagen.
The boundaries shown by the two staining are completely correspondent with
each other, providing that the fuchsin staining shown e$actly the area of
deteriorated collagen.
#. The natural carious dentin of human teeth consists of two layers with
definite boundary.
(. The collagen fiber is deteriorated in the outer carious dentin but "eeps
its sound proper histochemical character in the inner carious dentin and
normal dentin.
+. The 0.12 solution of basic fuchsin in propylene glycol stains the outer
carious dentin clearly red but not the inner carious dentin and normal
#. The inner carious dentin, although deminerali.ed to some e$tent, has
essentially similar structure as the normal dentin, that is, shape and
arrangement or organic substance represented by collagen fibers,
inorganic substance consisting of needle li"e or small plate appetite
crystals, and odontoblastic processes.
!ecause reminerali.ation of dentin occurs on the basis of collagen fibers on the
periodic oints on which apatite crystals attach in fringes, it cannot occur in the
outer carious dentin in which collagen fibers are bro"en, losing intermolecular
crosslin", but it can occur in the inner carious dentin in which collagen fibers
"eep their characteristic crossband structure with intermolecular cross lin"s
only partly and reversibly shifting to precursors.
#. In acute or moderately acute decay the fuchsinstainable layer must be
entirely removed for complete removal of infected dentin.
8. Direction of treatment of carious dentin
!y e$ploitation of new "nowledge of the two layers of carious dentin described
above, the direction of caries treatment was established with a definite
scientific basis as follows.
#. The outer carious dentin in dead tissue that has both organic and
inorganic components irreversibly deteriorated and in infected and
unremineraliable. Conse&uently it must be completely removed.
(. The inner carious dentin is live tissue that has organic and inorganic
components with essentially sound structure and character but slightly
and reversibly degenerated and is uninfected and physiologically
reminerali.able. Conse&uently it must be preserved insofar as possible.
#. Caries Detector
a* Composition
)#* 5uspected carcinogenicity of fuchsin
as previously described, a 0.12 solution of basic fuchsin in propylene glycol
was used for differentiation of the two layers of dentin. %owever, it
carcinogenicity was suspected and was carefully investigated.
6uchsin )magenta* C
Cl is a dye of the phenylmethane group, which has
been widely used in industrial applications as well as in biological research. It
was discovered, however, in an old report that three bladder cancers had been
found among -1 wor"ers in a 8erman factory producing fuchsin in #9:1.
/nd finally found a &uite ade&uate dye. It is acid red C
7a )mol.
't. 190.<,* and chemically called :4)(=4sulfonium4-=4sulfophenyl*4<4
diethylamino4+4)7, 74diethylimino*4+4iso$anthene sodium salt.