Enamel caries

Hallsworth, A. S. Weatherall, J. A. (1969). The microdistribution, uptake and loss of fluoride in human enamel. Caries Research, 3, 109-18. 

Bjorndal L and Thylstrup A (1995) A structural analysis of approximal enamel caries lesions and subjacent dentin reactions. Eur J Oral Sci 103, 25-31. 

Thylstrup A, Featherstone JDB and Fredebo L (1983) Surface morphology and dynamics of early enamel caries development. In Demineralisation and remineralisation of the teeth (eds. Leach SA and Edgar WM) pp. 165-184. IRL Press, Oxford UK. 

M. J. Larsen, A. Richards, The influence of saliva on the formation of calcium fluoridelike material on human dental enamel. Caries Res. 35 (2001) 57-60. 

Peck, S. D. and Briggs, G. A. D. (1986). A scanning acoustic microscope study of the small caries lesion in human enamel. Caries Res. 20, 356-60. [182,184]... 

Key words dental, oral cavity, cancer, microorganisms, materials characterization, enamel, caries, polarized Raman spectroscopy, optical coherence tomography, clinic, fibre optics... 

Early dental caries (incipient lesions) are non-cavitated and limited to the outer enamel surface. Clinically, these lesions are identified as visible white spots when the tooth is air-dried (Fig. 11.1). The incipient lesion is known as a subsurface lesion since the surface appears intact. However, histological investigations have shown that below the surface, there are zones that vary in porosity (voids from mineral loss) as well as biochemical composition (e.g. fluoride, water and carbonate content) [29]. The enamel caries can vary from a depth of 100-250 J.m (for incipient caries) to entirely through the enamel ( 1.5mm deep), at which point the cavitated lesion has extended into the underlying dentin [35]. The diagnostic challenge remains early caries detection and the focus has been on caries lesions that form on the tooth crown affecting the enamel. The remainder of the discussion will therefore concentrate on enamel caries. 

Losee FL, Cutress TW, Brown R. 1974. Natural elements of the periodic table in human dental enamel. Caries Res 8 123-134. 

Hallsworth AS, Robinson C, Weatherell JA Mineral and magnesium distribution within the approximal carious lesion of dental enamel. Caries Res 1972 6 156-168. 

Hallsworth AS, Weathered JA, Robinson C Loss of carbonate during the first stages of enamel caries. Caries Res 1973 7 345-348. 

Ruben J, Arends J, Christoffersen J The effect of window width on the demineralization of human dentine and enamel. Caries Res 1999 33 214-219. 

Amaechi BT, Higham SM, Edgar WM Use of transverse microradiography to quantify mineral loss by erosion in bovine enamel. Caries Res 1998 32 351-356. 

Meurman JH, Frank RM Progression and surface ultrastructure of in vitro caused erosive lesions in human and bovine enamel. Caries Res 1991 25 81-87. 

Eisenburger M, Shellis RP, Addy M Scanning electron microscopy of softened enamel. Caries Res 2004 38 67-74. 

White spot lesions are the earliest macroscopic evidence of enamel caries [37], The lesions are caused by acids formed by bacterial fermentation of dietary sugars. This leads to a fall in plaque pH and dissolution of the mineral component of the tooth enamel. Under normal conditions, the demineralization process is balanced by remineralization due to diffusion of ions (Ca, P and hydroxyl) from saliva into the enamel when plaque pH returns to neutrality. However, if demineralization extent exceeds that of remineralization, then an incipient lesion is formed. 

Xu HHK, Smith DT, Jahanmir S, Romberg E, Kelly JR, Thompson VP, Rekow ED Indentation damage and mechanical properties of human enamel and dentin. J Dent Res 1998 77 472-480. Kodaka T, Debari K, Yamada M, Kuroiwa M Correlation between microhardness and mineral content in sound human enamel. Caries Res 1992 26 139-141. 

Johnson NW Transmission electron microscopy of early carious enamel. Caries Res 1967 1 356-369. 

Gedalia, 1., Davidov, I., Lewinstein, 1., and Shapira, L. (1992). Effect of hard cheese exposure with or without fluoride prerinse, on the rehardening of softened human enamel. Caries Res. 26, 290-292. 

Several different types of dental caries have been described by clinicians. Specifically these are smooth-surface caries, pit and fissure caries, enamel caries, dentinal caries, secondary caries, early childhood caries and root caries [12], All occur by the same essential mechanism, as described above, and all arise as a consequence of a disturbance to the demineralization-remineralization balance. Attack by organic acids produced by bacteria in the plaque favours demineralization, but the natural remineralization processes of the mouth can reverse this. Certain dietary and hygiene behaviours as well as clinical treatments can enhance this natural remineralization provided they occur early enough in the demineralization part of the process. For example, complexes of casein phosphopeptide with amorphous calcium phosphate have been shown in various studies to be capable of enhancing the remineralization step under certain conditions and in specific groups of individuals [16,17]. These are now available commercially as an anticaries treatment for patients. 

Cutress, T.W. (1979) A preliminary study of the microelement composition of the outer layer of dental enamel. Caries Res., 13, 73-79. 

Paris, S., Bitter, K., Renz, H., HopfemnuUer, W., Meyer-Lueckel, H. Validation of two dual fluorescence techniques for confocal microscopic visuaUzaUon of resin penetration into enamel caries lesions. Microsc. Res. Tech. 72(7), 489-494 (2009)... 

J. (2009) Effect of fluoride on the morphology of calcium phosphate crystals grown on acid-etched human enamel. Caries Res., 43 (2), 132-136. 

Harris, D.M. et al. (2002) Selective ablation of surface enamel caries with a pulsed Nd YAG dental laser. Lasers Surg. Med, 30 (5), 342-350. 

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