Practice Essay: Differences Between Caries- Infected and Caries- Affected

Dentine

Intro
Caries is defined as a reversible (in its earliest stages) disease of the dental hard
tissues brought about by the metabolic action of cariogenic bacteria on
fermentable carbohydrates in the oral cavity leading to acid demineralisation
and ultimately proteolytic destruction of the organic component of the dental
hard tissues.
Caries is one of the most common diseases in humans, and a great deal of a
dental surgeons career is devoted to its diagnosis, prevention and treatment.
This essay will look at the histological and clinical manifestations of dentine
caries and its significance.
1 Caries- infected dentine
If caries is left long enough to penetrate enamel and reach the underlying
dentine (mICDAS 2/3) and is still left undisturbed the most superficial portions of
dentine are liable to become caries- infected dentine. This dentine is that which
suffers the greatest degree of damage due to the carious process, and its
manifestations are shown below:
-

Brown, mushy appearance- due to the prolonged demineralistaion

caused by the lactic acid produced by the cariogenic bacteria, coupled to
the degradation of the collagenous matrix by the bacterial proteolytic
enzymes and the hosts own matrix metalloproteinases, the dentine is
considered necrotic, has a very high bioload, and due to the loss of its
tubular structure, it is considered a very poor bonding substrate and must
be removed prior to restoration of the tooth.
Low compressive strength- the loss of the tubular structure found in sound
dentine and even caries- affected dentine means that in order for full
function to be returned to the tooth, and to prevent the tooth coming to
greater harm under occlusal load, the infected dentine must be removed.

2 Caries- infected dentine

This is the dentine found deep to the caries- infected dentine. Caries- affected
dentine differs greatly from caries- infected dentine not only histologically, but
clinically, and can e discerned using tactile and visual means.
-

Time under attack- in contrast to the longer time for which caries- infected
dentine has been under carious attack, caries- affected dentine has been
subjected to its effects for much less time.
Degree of demineralistaion- although demineralised compared to sound
dentine, caries- affected dentine, unlike caries- infected dentine, has the
capacity to remineralise under suitable conditions.

Collagenous matrix- in CAD, there is much less evidence of the action of

bacterial proteolytic enzymes and host matrix metalloproteinases,
meaning the collagen matrix is largely intact and retains it tubular
structure, making it suitable for bonding an adhesive restoration to.

Clinically
Caries- affected dentine is stained, but scratchy when a probe is run over it,
as well as being hard and is suitable to be left in the tooth and covered with a
suitable restoration/

Conclusion
The ability of the dentist to discern between the magnitude of damage done
t the tooth and its constituents by the carious process is the cornerstone of
operative and restorative dentistry, and a sound understanding of the
histology of the carious process underpins the clinical findings and how the
dentist elects to manage the situation.