Histopathology of Enamel and Dentine Caries
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Questions and Answers

What is the zone of demineralization most commonly associated with?

  • Pulp inflammation
  • Acid penetration (correct)
  • Bacterial invasion
  • Hypermineralization
  • Which zone is characterized by the presence of hypermineralization?

  • Translucent (Sclerotic) Zone (correct)
  • Zone of penetration
  • Zone of destruction
  • Zone of demineralization
  • What is the primary function of the translucent (sclerotic) zone?

  • To increase the rate of acid penetration
  • To promote bacterial invasion
  • To accelerate the formation of tertiary dentine
  • To slow acid and toxin penetration (correct)
  • What distinguishes reparative dentine from reactionary dentine?

    <p>Reparative dentine originates from surviving upregulated odontoblasts, while reactionary dentine originates from local cell death in the odontoblast layer. (D)</p> Signup and view all the answers

    Which zone is considered the advancing front of the lesion?

    <p>Zone of demineralization (A)</p> Signup and view all the answers

    Which of the following zones does NOT need to be removed?

    <p>Translucent (Sclerotic) Zone (B), Zone of demineralization (C)</p> Signup and view all the answers

    What is the primary function of tertiary dentine?

    <p>To provide protection for the pulp (D)</p> Signup and view all the answers

    What is the most likely reason why the zone of demineralization may feel softer than sound dentine?

    <p>The loss of mineral content (C)</p> Signup and view all the answers

    What is the primary cause of demineralization in teeth leading to caries?

    <p>Presence of fermentable carbohydrates (B)</p> Signup and view all the answers

    Which zone is NOT typically identified in dentine caries?

    <p>Zone of remineralization (A)</p> Signup and view all the answers

    What happens if the pH level in the oral environment does not neutralize?

    <p>Demineralization can lead to the development of caries (D)</p> Signup and view all the answers

    The histology of dentine caries includes which of the following features?

    <p>Bacterial invasion of dentinal tubules (C)</p> Signup and view all the answers

    What is one of the mechanisms dentine uses to protect itself from caries?

    <p>Secretion of antimicrobial peptides (D)</p> Signup and view all the answers

    What characterizes the progression of caries from enamel to dentine?

    <p>A lateral spread of caries under the enamel (A)</p> Signup and view all the answers

    At which ICDAS code does dentine first become exposed due to caries?

    <p>ICDAS Code 5 (B)</p> Signup and view all the answers

    What is a visible sign of extensive decay in the crown structure?

    <p>Grey shadowing under the enamel (A)</p> Signup and view all the answers

    What distinguishes the microscopic appearance of dentine caries from enamel caries?

    <p>Presence of a 'mushroom' shape (C)</p> Signup and view all the answers

    Why is it advised not to use a sharp probe on the cavity floor during examination?

    <p>It could displace infected dentine layers (D)</p> Signup and view all the answers

    Which of the following ICDAS codes represents a carious lesion with a distinct cavity and visible dentine?

    <p>Code 5 (B)</p> Signup and view all the answers

    What is the primary mineral component of dentine?

    <p>Hydroxyapatite (D)</p> Signup and view all the answers

    What is the significance of the dentinal tubules in the context of dentine caries?

    <p>They provide a pathway for bacterial invasion and contribute to the progression of caries. (A)</p> Signup and view all the answers

    Which of the following characterizes an ICDAS code 4 carious lesion?

    <p>A dark shadow from dentine with or without enamel breakdown (C)</p> Signup and view all the answers

    Why was ICDAS developed?

    <p>To address inconsistencies in caries diagnosis and facilitate research and clinical practice. (D)</p> Signup and view all the answers

    What characterizes the zone of destruction in dentine caries?

    <p>It is dark brown, soft, and mushy. (C)</p> Signup and view all the answers

    Which statements accurately describe the zone of penetration in bacterial invasion?

    <p>It contains intact dentinal tubules. (C)</p> Signup and view all the answers

    Which of the following are characteristics of the zone of demineralisation?

    <p>It involves decalcification of dentine. (A), It shows signs of bacterial penetration. (C)</p> Signup and view all the answers

    What clinical appearance is associated with rapidly progressing caries in the zone of destruction?

    <p>Soft and yellow texture. (C)</p> Signup and view all the answers

    Why is the zone of destruction considered inadequate for restoration?

    <p>It cannot form a proper seal. (A)</p> Signup and view all the answers

    What is true about the bacterial load in the zone of destruction?

    <p>It is high, contributing to decay. (A)</p> Signup and view all the answers

    What distinguishes the translucent zone in dentine caries?

    <p>It shows a gradual reduction in mineral content. (C)</p> Signup and view all the answers

    In which zone is liquefaction likely to occur?

    <p>Zone of destruction. (C)</p> Signup and view all the answers

    Flashcards

    Aetiology of Dental Caries

    The study of causes leading to dental caries development.

    Demineralization

    The process where minerals are lost from tooth structure due to low pH.

    Hydroxyapatite

    The main mineral component of tooth enamel and dentine.

    Four zones of destruction

    The layers affected by caries in dentine: outer, bacterial, decomposed, and sclerotic zones.

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    pH and caries

    A lower pH leads to tooth demineralization and can cause caries formation.

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    ICDAS

    The International Caries Detection and Assessment System for diagnosing caries stages.

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    Moderate Stage Caries (Code 4)

    Caries showing dark shadows from dentine and/or enamel breakdown, with wet white or brown spots.

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    Extensive Stage Caries (Code 5)

    A cavity in opaque enamel with visible dentine, showing demineralisation on the walls.

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    Extensive Stage Caries (Code 6)

    An extensive cavity where dentine is visibly extended.

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    Dentine Structure

    Dentine is made of hydroxyapatite mineral and collagen; it contains odontoblasts for defense.

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    ICDAS Code 4

    Represents macroscopic dentine caries with grey shadowing and crown integrity breakdown.

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    Lateral spread of caries

    Caries spreads horizontally beneath the enamel due to substrate hardness change.

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    ICDAS Code 5/6

    Indicates advanced caries where dentine is exposed and extensive cavities develop.

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    Bacterial destruction in dentine

    Bacterial activity softens dentine, creating areas that can be excavated.

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    Microscopic appearance of caries

    Caries manifests as a 'mushroom' shape, contrasting with enamel caries.

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    Zone of Destruction

    The outermost area of dental caries that is irreparably damaged, appearing dark brown and mushy.

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    Liquefaction Foci

    Round areas of liquefaction within dentinal tubules caused by high bacterial loads in caries infected dentine.

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    Transverse Clefts

    Cracks formed at 90° to dentinal tubules due to destruction from caries.

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    Zone of Penetration

    A zone where bacteria invade dentinal tubules without causing liquefaction, still allowing some structure to exist.

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    Proteolysis

    The process by which bacteria dissolve proteins within dentine during caries progression.

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    Caries Infected Dentine

    Dentine that is invaded by bacteria and shows signs of demineralization, but may not always need removal.

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    Dentin Structure Preservation

    The principle that some zones of dentine may not require removal if dentinal tubule structure remains intact.

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    Necrotic Area

    A region of tissue that has died due to the effects of caries, marked by soft and mushy texture.

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    Zone 3 – Demineralisation

    Area where acid demineralises dentine; no bacteria present.

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    Characteristics of Zone 3

    Zone of caries affected dentine; may feel softer and is pale brown.

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    Zone 4 – Translucent Zone

    Initially affected area where odontoblasts calcify tubules to protect pulp.

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    Radiographic appearance of Zone 4

    Zone shows as a whiter area radiographically due to hyper-mineralisation.

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    Tertiary Dentine

    New dentine laid down at pulp-dentine border for protection from acids.

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    Reactionary Dentine

    Type of tertiary dentine formed from mild irritants by surviving odontoblasts.

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    Reparative Dentine

    Dentine formed from strong irritants causing local cell death in odontoblasts.

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    The role of odontoblasts in caries

    Odontoblasts lay down dentine in response to irritation, protecting the pulp.

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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.

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