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Questions and Answers
What is the zone of demineralization most commonly associated with?
What is the zone of demineralization most commonly associated with?
Which zone is characterized by the presence of hypermineralization?
Which zone is characterized by the presence of hypermineralization?
What is the primary function of the translucent (sclerotic) zone?
What is the primary function of the translucent (sclerotic) zone?
What distinguishes reparative dentine from reactionary dentine?
What distinguishes reparative dentine from reactionary dentine?
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Which zone is considered the advancing front of the lesion?
Which zone is considered the advancing front of the lesion?
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Which of the following zones does NOT need to be removed?
Which of the following zones does NOT need to be removed?
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What is the primary function of tertiary dentine?
What is the primary function of tertiary dentine?
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What is the most likely reason why the zone of demineralization may feel softer than sound dentine?
What is the most likely reason why the zone of demineralization may feel softer than sound dentine?
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What is the primary cause of demineralization in teeth leading to caries?
What is the primary cause of demineralization in teeth leading to caries?
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Which zone is NOT typically identified in dentine caries?
Which zone is NOT typically identified in dentine caries?
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What happens if the pH level in the oral environment does not neutralize?
What happens if the pH level in the oral environment does not neutralize?
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The histology of dentine caries includes which of the following features?
The histology of dentine caries includes which of the following features?
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What is one of the mechanisms dentine uses to protect itself from caries?
What is one of the mechanisms dentine uses to protect itself from caries?
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What characterizes the progression of caries from enamel to dentine?
What characterizes the progression of caries from enamel to dentine?
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At which ICDAS code does dentine first become exposed due to caries?
At which ICDAS code does dentine first become exposed due to caries?
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What is a visible sign of extensive decay in the crown structure?
What is a visible sign of extensive decay in the crown structure?
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What distinguishes the microscopic appearance of dentine caries from enamel caries?
What distinguishes the microscopic appearance of dentine caries from enamel caries?
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Why is it advised not to use a sharp probe on the cavity floor during examination?
Why is it advised not to use a sharp probe on the cavity floor during examination?
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Which of the following ICDAS codes represents a carious lesion with a distinct cavity and visible dentine?
Which of the following ICDAS codes represents a carious lesion with a distinct cavity and visible dentine?
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What is the primary mineral component of dentine?
What is the primary mineral component of dentine?
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What is the significance of the dentinal tubules in the context of dentine caries?
What is the significance of the dentinal tubules in the context of dentine caries?
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Which of the following characterizes an ICDAS code 4 carious lesion?
Which of the following characterizes an ICDAS code 4 carious lesion?
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Why was ICDAS developed?
Why was ICDAS developed?
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What characterizes the zone of destruction in dentine caries?
What characterizes the zone of destruction in dentine caries?
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Which statements accurately describe the zone of penetration in bacterial invasion?
Which statements accurately describe the zone of penetration in bacterial invasion?
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Which of the following are characteristics of the zone of demineralisation?
Which of the following are characteristics of the zone of demineralisation?
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What clinical appearance is associated with rapidly progressing caries in the zone of destruction?
What clinical appearance is associated with rapidly progressing caries in the zone of destruction?
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Why is the zone of destruction considered inadequate for restoration?
Why is the zone of destruction considered inadequate for restoration?
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What is true about the bacterial load in the zone of destruction?
What is true about the bacterial load in the zone of destruction?
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What distinguishes the translucent zone in dentine caries?
What distinguishes the translucent zone in dentine caries?
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In which zone is liquefaction likely to occur?
In which zone is liquefaction likely to occur?
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Flashcards
Aetiology of Dental Caries
Aetiology of Dental Caries
The study of causes leading to dental caries development.
Demineralization
Demineralization
The process where minerals are lost from tooth structure due to low pH.
Hydroxyapatite
Hydroxyapatite
The main mineral component of tooth enamel and dentine.
Four zones of destruction
Four zones of destruction
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pH and caries
pH and caries
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ICDAS
ICDAS
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Moderate Stage Caries (Code 4)
Moderate Stage Caries (Code 4)
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Extensive Stage Caries (Code 5)
Extensive Stage Caries (Code 5)
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Extensive Stage Caries (Code 6)
Extensive Stage Caries (Code 6)
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Dentine Structure
Dentine Structure
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ICDAS Code 4
ICDAS Code 4
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Lateral spread of caries
Lateral spread of caries
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ICDAS Code 5/6
ICDAS Code 5/6
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Bacterial destruction in dentine
Bacterial destruction in dentine
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Microscopic appearance of caries
Microscopic appearance of caries
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Zone of Destruction
Zone of Destruction
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Liquefaction Foci
Liquefaction Foci
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Transverse Clefts
Transverse Clefts
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Zone of Penetration
Zone of Penetration
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Proteolysis
Proteolysis
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Caries Infected Dentine
Caries Infected Dentine
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Dentin Structure Preservation
Dentin Structure Preservation
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Necrotic Area
Necrotic Area
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Zone 3 – Demineralisation
Zone 3 – Demineralisation
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Characteristics of Zone 3
Characteristics of Zone 3
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Zone 4 – Translucent Zone
Zone 4 – Translucent Zone
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Radiographic appearance of Zone 4
Radiographic appearance of Zone 4
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Tertiary Dentine
Tertiary Dentine
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Reactionary Dentine
Reactionary Dentine
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Reparative Dentine
Reparative Dentine
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The role of odontoblasts in caries
The role of odontoblasts in caries
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Study Notes
Histopathology of Enamel and Dentine Caries
- The presentation covers the histopathology of enamel and dentine caries, focusing on the aetiology and pathogenesis of oral disease.
- The GDC learning outcomes include describing oral diseases, their relevance to prevention, diagnosis and treatment, explaining the aetiology and pathogenesis of oral disease and describing relevant dental, oral, craniofacial and general anatomy.
Pre-reading
- The pre-reading material includes the aetiology of dental caries and histology of enamel and dentine lectures.
- Key factors in the aetiology of dental caries are time, susceptible tooth surface, plaque bacteria, and fermentable carbohydrates.
Histopathology of Dentine Caries
- Learning objectives for this section focus on the clinical appearance of dentine caries, the histology of dentine caries, identifying the 4 zones of destruction in dentine caries, and recognizing mechanisms for self-protection of dentine and the pulp.
Recap on Caries Aetiology
- Acidity (lower pH) leads to demineralization of tooth surfaces (hydroxyapatite).
- This process, if not neutralized, results in caries over time.
- The chemical reaction involves the breakdown of hydroxyapatite into calcium, phosphate, and hydroxyl ions.
ICDAS Scores
- ICDAS is an international system for detecting and assessing caries in clinical research , clinical practice, and epidemiology.
- It provides a standardized system to diagnose caries at various stages of the process.
- The system aids in characterizing the activity of the affected lesions owing to previous inconsistencies in caries diagnosis.
ICDAS Scores - Caries Stages
- Moderate Stage Caries (Code 4): Characterized by a dark shadow from dentine, with or without enamel breakdown, observed as a white or brown spot when wet, and darkened area of intrinsic shadow (grey, blue, brown).
- Extensive Stage Caries (Code 5/6): Shows a distinct cavity or a pronounced cavitation in opaque or discolored enamel with visible dentine and visible evidence of demineralization (white or brown walls). Code 6 shows more extensive cavity visually able to see extension into dentine.
Recap on Dentine Structure
- Dentine's mineral component is hydroxyapatite.
- The organic material is collagen.
- Dentinal tubules are permeated with odontoblast processes, making it a vital tissue.
- This pulp-dentinal complex protects both the dentine and the pulp.
How Does Dentine Caries Progress?
- The progression of dentine caries from enamel to dentine is marked by a change in the substrate's hardness, causing caries to spread laterally.
- This results in grey shadowing, eventually leading to breakdown in the crown integrity.
Macroscopic Dentine Caries - ICDAS Code 4/5/6
- Caries progression demonstrates a shift in substrate hardness.
- Extensive caries (Code 5/6) exhibits further enamel undermining, exposing dentine.
- More destruction results in increased restoration difficulty.
- Bacterial attack makes dentine softer and visible for removal.
Microscopic Dentine Caries
- Microscopic studies provide detailed insights into different zones of the carious lesion.
- These zones include the necrotic zone, contaminated zone, demineralized zone, translucent zone, sound dentine, and tertiary dentine.
Affected vs Infected Dentine
- Affected dentine shows signs of demineralization but isn't penetrated by bacteria.
- Infected dentine is under bacterial attack, showing softer and easier-to-remove features
Zone 1 - Zone of Destruction
- The zone of destruction is clinically characterized as dark brown, soft, and mushy or yellow with rapid caries.
- The zone presents difficulty for repair and restoration, lacking bonding potential.
Zone 2 - Zone of Penetration/Bacterial Invasion
- The tubules are not completely dissolved, however, bacteria are present.
- This zone includes dissolved proteins and a layer of caries within the dentine.
Zone 3 - Zone of Demineralisation
- This zone features acid spreading through un-occluded dentine tubules, causing demineralization.
- Bacteria are absent, making it reparable; appears as a paler, softer, browner area.
Zone 4 - Translucent (Sclerotic) Zone
- Acid penetration triggers odontoblast activity hardening tubules.
- This aims to slow acid and toxin penetration and protect the pulp, appearing radiographically as a whiter area.
Zone 5 - Tertiary Dentine
- Newly formed dentine outside the lesion, laid along the pulp-dentine border; protective to the pulp.
- Can result from mild or intense insults or infections to the pulp.
Video for Review
- A video summarising the process is available online.
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Description
This quiz explores the histopathology associated with enamel and dentine caries, emphasizing their aetiology and pathogenesis. Participants will review the clinical appearance, histology, and the mechanisms of self-protection in dentine. Prepare to enhance your understanding of oral diseases relevant to diagnosis and treatment in dentistry.