Podcast
Questions and Answers
What initiates the carious process on the enamel surface?
What initiates the carious process on the enamel surface?
Why do white spot lesions appear on the enamel?
Why do white spot lesions appear on the enamel?
What happens to the enamel under cariogenic conditions?
What happens to the enamel under cariogenic conditions?
What causes the brown appearance of white spot lesions?
What causes the brown appearance of white spot lesions?
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Why is drying the teeth important when assessing enamel lesions?
Why is drying the teeth important when assessing enamel lesions?
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What happens to the enamel when the pH decreases significantly in the oral environment?
What happens to the enamel when the pH decreases significantly in the oral environment?
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Which of the following best describes one of the zones of destruction observed in enamel caries?
Which of the following best describes one of the zones of destruction observed in enamel caries?
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Which bacteria are primarily responsible for the progression of dental caries?
Which bacteria are primarily responsible for the progression of dental caries?
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What is a consequence of prolonged low pH levels on the tooth surface?
What is a consequence of prolonged low pH levels on the tooth surface?
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How is the clinical appearance of enamel caries related to its histopathology?
How is the clinical appearance of enamel caries related to its histopathology?
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What does a score of 0 indicate in the ICDAS scoring system?
What does a score of 0 indicate in the ICDAS scoring system?
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What visual evidence is associated with a Code 1 in the ICDAS system?
What visual evidence is associated with a Code 1 in the ICDAS system?
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Which code in the ICDAS system indicates localized enamel breakdown without visible dentine exposure?
Which code in the ICDAS system indicates localized enamel breakdown without visible dentine exposure?
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What is the main purpose of the ICDAS scoring system?
What is the main purpose of the ICDAS scoring system?
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In the ICDAS scoring, what visual change is first noted at the initial stage of caries?
In the ICDAS scoring, what visual change is first noted at the initial stage of caries?
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What distinguishes Code 2 from Code 1 in the ICDAS system?
What distinguishes Code 2 from Code 1 in the ICDAS system?
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Why was the ICDAS developed?
Why was the ICDAS developed?
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What happens to the visibility of caries as the severity increases according to ICDAS?
What happens to the visibility of caries as the severity increases according to ICDAS?
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What does the presence of brown enamel caries likely indicate?
What does the presence of brown enamel caries likely indicate?
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What is the characteristic of white enamel caries?
What is the characteristic of white enamel caries?
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What is the effect of saliva on established enamel caries?
What is the effect of saliva on established enamel caries?
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Which of the following accurately describes a wedge-shaped lesion in smooth surface caries?
Which of the following accurately describes a wedge-shaped lesion in smooth surface caries?
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Why is it harder to remineralize deeper zones of enamel caries?
Why is it harder to remineralize deeper zones of enamel caries?
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What indicates that established enamel caries have not yet extended into the dentin?
What indicates that established enamel caries have not yet extended into the dentin?
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What implication does the staining of early enamel caries have?
What implication does the staining of early enamel caries have?
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What zone is typically the largest area of an enamel lesion?
What zone is typically the largest area of an enamel lesion?
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What is the significance of the surface zone in enamel caries?
What is the significance of the surface zone in enamel caries?
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Which histological zone of enamel caries is characterized by large diameter porosities?
Which histological zone of enamel caries is characterized by large diameter porosities?
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What does a high pore volume in the body of the lesion indicate?
What does a high pore volume in the body of the lesion indicate?
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Why does the dark zone appear darker under microscopy?
Why does the dark zone appear darker under microscopy?
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How can the histological zones of enamel caries be identified?
How can the histological zones of enamel caries be identified?
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What percentage range of pore volume characterizes the body of the lesion?
What percentage range of pore volume characterizes the body of the lesion?
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What role does saliva play in the surface zone of enamel caries?
What role does saliva play in the surface zone of enamel caries?
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What is the general appearance of the dark zone in comparison to other layers?
What is the general appearance of the dark zone in comparison to other layers?
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Study Notes
Histopathology of Enamel and Dentine Caries
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Learning Objectives:
- Describe the clinical appearance of enamel caries.
- Describe the histology of enamel caries.
- Identify and name the 4 zones of enamel caries destruction.
- Describe the clinical appearance of enamel caries in relation to its histopathology.
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GDC Learning Outcomes:
- Describe oral diseases and their relevance to prevention, diagnosis, and treatment.
- Explain the aetiology and pathogenesis of oral disease.
- Describe relevant and appropriate dental, oral, craniofacial, and general anatomy and explain their application to patient management.
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Aetiology of Dental Caries:
- Caries is a result of susceptible tooth surface, plaque bacteria, and fermentable carbohydrates, occurring over time.
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Recap on Caries Aetiology:
- Lowering pH causes tooth surface (hydroxyapatite) demineralisation, breaking it down into component ions.
- If pH doesn't neutralise, demineralisation leads to caries.
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ICDAS Score:
- An international caries detection and assessment system used in clinical research, clinical practice, and for epidemiological purposes.
- A clinical scoring system used to diagnose caries.
- ICDAS detects caries at every stage and characterises carious activity.
- Created to address the inconsistencies in caries diagnosis.
ICDAS Score - Specific Categories
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Score 0 (Sound Tooth):
- No visible caries evidence when the tooth surface is wet or dry.
- Clinically sound tooth.
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Score 1 (Initial Stage Caries):
- Caries only evident after drying the tooth surface.
- First visual changes in enamel, white spot and/or brown carious discolouration.
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Score 2 (Initial Stage Caries):
- Visible and distinct visual changes in enamel, both wet and dry.
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Score 3 (Moderate Stage Caries):
- Localised enamel breakdown without visible dentine exposure.
- Visible when wet and dry.
- Prolonged drying reveals loss of enamel integrity.
Enamel Caries Microscopic Appearance
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General Observations:
- Every carious process begins with slight enamel etching under plaque.
- This process is frequent and reversible.
- Healthy enamel exists adjacent to the etched enamel.
- Under cariogenic circumstances, the tooth dissolves further, resulting in enamel microporosities.
- These microporosities are frequently located at prism boundaries.
- Increased porosities and mineral loss cause white spots, appearing white due to scattered light compared to surrounding enamel.
- Air/electrolyte in porosities has a different refractive index.
- White spot lesions can incorporate exogenous pigmentation (staining), which turns lesions brown. This suggests longer lesion duration; however, it's not a guaranteed indicator.
Enamel Caries Histology - Established Caries
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4 Distinct Zones:
- Surface Zone: Relatively unaffected, able to remineralise, and has a low pore volume (below 5%).
- Body of Lesion: Largest area, significant demineralisation (with pore volume varying between 5-25%).
- Dark Zone: Does not transmit light, shows remineralisation and demineralisation.
- Translucent Zone: Advancing edge of lesion and initial area of destruction (with lowest pore volume, less than 1%).
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Additional Observations:
- Lesions follow a wedge shape (in smooth surface caries) and sometimes resemble an inverted triangle in pits and fissures.
- To precisely identify histological zones, samples must undergo clearing using an agent (like quinoline) with an identical refractive index to enamel.
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Microscopy Techniques: Clearings with different mediums are used with transmitted or polarised light microscopy to evaluate pore size and volume.
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Video for Review: https://www.youtube.com/watch?v=Y_o0ygwA6CI (view from 4:40)
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Description
This quiz explores the clinical and histological aspects of enamel caries. Learn to identify the zones of caries destruction and understand the aetiology and pathogenesis of dental caries. Gain insight into the relevance of oral diseases for effective prevention and management.
