Histopathology of Enamel Caries
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Questions and Answers

What happens to hydroxyapatite when the pH decreases?

  • It remains stable and intact.
  • It demineralizes into component ions. (correct)
  • It becomes less soluble.
  • It is fortified and strengthened.

Which of the following is a zone of destruction identified in enamel caries?

  • Zone of mineral accumulation
  • Zone of demineralization (correct)
  • Zone of hypermineralization
  • Zone of remineralization

What is the primary aetiological factor in the development of enamel caries?

  • High levels of calcium
  • Plaque bacteria decomposition
  • Fermentable carbohydrates (correct)
  • Excessive fluoride exposure

What is the relevance of understanding the histopathology of enamel caries?

<p>It aids in the identification of caries stages. (C)</p> Signup and view all the answers

Which clinical sign indicates the presence of enamel caries?

<p>Translucent white spots (C)</p> Signup and view all the answers

What does an ICDAS score of 0 indicate?

<p>No evidence of caries in a sound tooth (A)</p> Signup and view all the answers

What visual characteristics are associated with an ICDAS score of 1?

<p>White spot and/or brown discolouration after air drying (B)</p> Signup and view all the answers

What does an ICDAS score of 3 indicate regarding caries status?

<p>Localized enamel breakdown without visible dentine exposure (C)</p> Signup and view all the answers

Which statement is true about the ICDAS scoring system?

<p>A score of 2 involves distinct visual changes visible when wet and dry (C)</p> Signup and view all the answers

What issue led to the development of the ICDAS scoring system?

<p>Inconsistencies in caries diagnosis (C)</p> Signup and view all the answers

Which statement accurately describes the pore volume of the Surface Zone?

<p>It possesses a pore volume below 5%. (B)</p> Signup and view all the answers

What characterizes the Body of the Lesion?

<p>It has porosities of a large diameter. (B)</p> Signup and view all the answers

Why does the Dark Zone appear dark under light microscopy?

<p>Its small porosities prevent the clearing medium from entering. (B)</p> Signup and view all the answers

What is the pore volume of the Translucent Zone?

<p>It has a pore volume of 1%. (C)</p> Signup and view all the answers

What occurs in the Translucent Zone during the carious process?

<p>Initial dissolution occurs along the rods' gaps. (D)</p> Signup and view all the answers

What is the initial indicator of the carious process in enamel?

<p>Slight etching of the enamel surface (B)</p> Signup and view all the answers

Under cariogenic conditions, where do microporosities typically form in the enamel?

<p>At prism boundaries (D)</p> Signup and view all the answers

What causes white spot lesions to appear in enamel?

<p>Greater scattering of light due to increased porosities (C)</p> Signup and view all the answers

What might the presence of brown coloration in white spot lesions indicate?

<p>The lesion has been present for a longer time (D)</p> Signup and view all the answers

What is a distinct shape of established enamel caries lesions?

<p>Wedge-shaped (D)</p> Signup and view all the answers

How are histological zones of established enamel caries identified?

<p>Using a clearing agent with identical refractive index (B)</p> Signup and view all the answers

What microscopy technique is commonly used to identify pore size and volume in enamel caries?

<p>Transmitted light microscopy (A)</p> Signup and view all the answers

What does the presence of porosities in the enamel correspond to in terms of dental health?

<p>Early stage of carious activity (C)</p> Signup and view all the answers

Flashcards

Enamel Demineralization

The process where tooth enamel, a hard mineral structure, breaks down due to acids produced by bacteria in plaque.

Low pH environment

An acidic environment in the mouth, often caused by consuming sugary foods, that promotes the demineralization of tooth enamel.

Clinical appearance of enamel caries

These are the observable changes on the tooth surface, like white spots or a cavity, that result from the progression of enamel caries.

Zones of Destruction in Enamel Caries

These are the areas of enamel damage as seen under a microscope, indicating the different stages of enamel breakdown.

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What are the 4 zones of destruction in enamel caries?

These are the areas of enamel damage as seen under a microscope, indicating the different stages of enamel breakdown. The zones include the Surface Zone, Body of Lesion, Translucent Zone, and Dark Zone.

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What is ICDAS?

The ICDAS is a clinical scoring system used to assess the progression of caries in teeth, providing a standardized method for diagnosis and treatment planning.

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What does ICDAS Code 0 indicate?

ICDAS Code 0 represents a sound tooth with no visible signs of caries, even when the surface is dry.

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What does ICDAS Code 1 indicate?

ICDAS Code 1 represents initial stage caries characterized by a white spot or brown discolouration on the tooth surface, visible only after air drying.

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What does ICDAS Code 2 indicate?

ICDAS Code 2 represents initial stage caries with distinct visual changes in the enamel, visible both when wet and dry.

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What does ICDAS Code 3 indicate?

ICDAS Code 3 represents moderate stage caries with localized enamel breakdown, but no visible dentine exposure. It becomes more apparent after prolonged drying.

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Initial Enamel Caries

Early enamel damage, where a slight etching occurs on the enamel surface, often under plaque, but is reversible.

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Microporosities in Enamel Caries

Small, porous areas in the enamel surface, typically located at the boundaries between prisms, where enamel is dissolving.

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White Spot Lesions

The first visible sign of tooth decay, characterized by white spots on the tooth surface.

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Pigmentation in White Spot Lesions

White spots can take on a yellowish or brownish color due to the accumulation of pigments in the porous areas.

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Established Enamel Caries

A well-established enamel lesion, characterized by distinct zones of demineralization, visible under a microscope.

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Surface Zone in Established Enamel Caries

The outermost zone of an established enamel lesion, where enamel is still relatively intact.

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Body of Lesion in Established Enamel Caries

The central part of an established enamel lesion, characterized by extensive porosity and demineralization.

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Translucent Zone in Established Enamel Caries

A zone in an established enamel lesion that appears translucent under a microscope, indicating significant demineralization.

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Surface Zone

This is the outermost layer of an enamel lesion, characterized by a relatively high mineral content and a low pore volume, and is often referred to as the intact or pseudo-intact surface. It has a pore volume less than 5% due to its remineralization ability.

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Body of the Lesion

This is the main portion of the enamel lesion, visible in radiographs. It has larger pores compared to the surface zone, with a pore volume between 5-25%. It appears translucent under a microscope.

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Dark Zone

This is a thin layer located below the Body of the Lesion, characterized by very small pores which don't allow the clearing medium to enter, resulting in a dark appearance under a microscope. Its pore volume is between 2-4%, and it may show signs of remineralization.

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Translucent Zone

Located at the advancing edge of the lesion, this zone marks the initial point of demineralization. It has a very low pore volume, around 1%, compared to the sound enamel's 0.1%.

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Study Notes

Histopathology of Enamel and Dentine Caries

  • Topic: Histopathology of enamel and dentine caries, Oral and Dental Science, Josh Hudson
  • Learning Outcomes: Describe oral diseases, their relevance to prevention, diagnosis, and treatment, aetiology and pathogenesis of oral disease, relevant dental, oral, craniofacial, and general anatomy, and their application to patient management.
  • Pre-reading: 'Aetiology of Dental Caries' lecture, 'Histology of enamel and dentine' lectures
  • ICDAS Score: An international caries detection and assessment system

ICDAS Score Codes

  • Code 0: Sound tooth; no evidence of caries when the tooth surface is wet or dry.
  • Code 1: Initial stage caries; no evidence of caries when the surface is wet, but white or brown spot/discoloration is visible after air drying.
  • Code 2: Initial stage caries; distinct visual changes in enamel that are visible when the tooth surface is wet or dry.
  • Code 3: Moderate stage caries; localized enamel breakdown without visible dentine exposure; visible when wet and dry, further drying reveals loss of enamel integrity.

Recap of Caries Aetiology

  • As pH lowers, the tooth surface (hydroxyapatite) demineralises and breaks down into its component ions.
  • If pH doesn't neutralize, this process continues leading to caries.

Enamel Caries Microscopic Appearance

  • Every carious process starts with slight etching of the enamel surface under dental plaque buildup, which is frequent and reversible.
  • Under cariogenic circumstances, the tooth dissolves further, resulting in microporosities at prism boundaries.
  • The first clinical signs are white spots. Their whiteness is due to decreased light scattering compared to surrounding enamel caused by increased porosities as minerals are lost.
  • Air or electrolytes in these porosities have a different refractive index to sound enamel.
  • Exogenous pigmentation can cause lesions to appear brown. Location and appearance suggests lesion duration.
  • Established enamel caries has four distinct zones: surface, dark, translucent, and body of the lesion.

Established Enamel Caries Histology

  • Surface Zone: Relatively unaffected enamel, able to remineralize, has low pore volume (<5%).
  • Body of Lesion: Largest area, significant demineralization, pore volume 5-25%.
  • Dark Zone: Thin layer with low light transmission, some remineralization, and pore volume 2-4%.
  • Translucent Zone: Advancing edge of the lesion, early demineralization in gaps between enamel rods, pore volume 1% (sound enamel 0.1%).
  • Clearing agents like quinoline are used to distinguish zones as they have similar refractive index to enamel.

Clinical Applications

  • Clinical assessment is related to the microscopic features for accurate diagnosis.

  • Applying this knowledge helps dentists to diagnose different stages of caries and potentially manage it better.

  • The provided information recommends reviewing a YouTube video (https://www.youtube.com/watch?v=Y_o0ygwA6CI) from timestamp 4:40 for further details.

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