Chemical, Microstructural and Morphological Characterisation of Dentine Caries Simulation by pH-Cycling

In vitro simulation of natural caries is of great importance in dental research for the development of more effective clinical treatments. The pH-cycling (pHc) procedure consists of a dynamic caries process with alternating de-remineralisation periods. The current research aims to evaluate the effects of the pHc procedure on mineral dentine properties in comparison with sound dentine and natural residual caries. For this purpose, dentine slices from human third molars were submitted to cycling periods of 14 and 28 days. The chemical composition, morphological and microstructural properties of the dentine samples were examined by infrared and Raman spectroscopies, X-ray diffraction, and scanning electron microscopy techniques. In addition, the depth of the demineralisation front was evaluated by Masson’s trichrome (MT) staining. The results showed that the pHc procedure led to notable changes in the mineral composition and the crystalline characteristics with respect to sound dentine and some extent to natural caries. The MT results revealed that pHc 28 yields a deeper lesion than pHc 14, simulating potential progression of natural caries. The results of this study provide a better understanding of the mechanisms of demineralisation that could occur in an in vivo environment and provide a standardised substrate similar to natural residual caries.

Insight into Oral Biofilm: Primary, Secondary and Residual Caries and Phyto-Challenged Solutions

Introduction:Dental caries is known to be one of the most widespread, chronic infections affecting all ages and populations worldwide. The plethora of oral microbial population paves way for various endogenous infections and plays a crucial role in polymicrobial interactions contributing to biofilm-mediated diseases like caries and periodontal diseases.Methods:Extensive literature survey was conducted using the scientific databases like PubMed, Google scholar, Science Direct,etc. using the key words like dental caries, orodental infections, dental microbes, dental biofilm, secondary caries, phytotherapy,etc. The literature was analyzed thoroughly and critical review was performed.Results:The risk of development of secondary caries and residual caries further results in treatment failure. Drug resistance developed by oral microbes and further side effects pose serious hurdles in the current therapeutic strategies. The hyperactivities of various MMPs and the resulting massive ECM degradation are the challenging part in the design of effective therapeutic approaches. Anticariogenic phytotherapy is well appreciated owing to lesser side effects and versatility of their action. But appreciable outcomes regarding the phytochemical bioavailability and bioretention are still challenging. Site-specific delivery of phytoagents at the infected site may enhance the efficiency of these drugs. Accordingly emerging phytodentistry can be promising for the management of secondary and residual caries.Conclusion:This article presents major cariogens and their mechanisms in initiating and aggravating dental caries. Effectiveness of phytotherapy and different mode of action of phytochemicals against cariogens are outlined. The article also raises major concerns and possibilities of phytochemical based therapeutics to be applied in the clinical arena of caries management.

In vitro Induction of Residual Caries Lesions in Dentin: Comparative Mineral Loss and Nano-Hardness Analysis

Artificially inducing dentinal lesions mimicking those remaining after selective excavation should allow to investigate the effects and limits of such selective excavation, for example regarding the mechanical properties of treated teeth or the remineralisation of sealed residual lesions. Such analyses might otherwise be limited by the variability of natural lesions or ethical and practical concerns. This study compared different demineralisation protocols for their suitability to induce lesions similar to natural residual caries. Twelve natural deep lesions were excavated until leathery dentin remained, and analysed for their mineral loss (ΔZ), lesion depth (LD), mineral loss ratio (R), the slope of the mineral gradient and their nano-hardness profile. Artificial lesions were induced using four different demineralisation protocols (acetic acid pH = 4.95; 0.1 M lactic acid gel pH = 5.0; 0.5 M ethylenediaminetetraacetic acid pH = 7.2; Streptococcus mutans biofilms) and their depths monitored over different demineralisation times. Lesions with depths most according to those of natural lesions were analysed using transversal microradiography. Lesions induced by acetic acid solution did not significantly differ with regards to LD, ΔZ, R and mineral profile. Seven dentin specimens were subsequently submitted to a moderately acidic (pH = 5.3) methylhydroxydiphosphonate-buffered acetate solution for 12 weeks. Natural and artificial residual lesions were similarly deep (mean ± SD: LD = 626 ± 212 and 563 ± 88 µm), demineralised (R = 19.5 ± 4.7 and 29.8 ± 4.1%), showed a flat and continuous mineral gradient (slope = 0.10 ± 0.05 and 0.13 ± 0.06 vol%/µm) and did not significantly differ regarding their nano-hardness profile. The described protocol induces lesions with mineral content and mechanical properties similar to natural residual lesions.

Pulpal Remineralisation of Artificial Residual Caries Lesions in vitro

We assessed pulpal remineralisation of caries lesions in vitro. On the coronal aspect of human dentin discs (n = 70), artificial lesions [mineral loss ΔZ (mean ± SD) = 3,060 ± 604 vol% × µm] were induced, covered and pulpal surfaces exposed to pulpal fluid, remineralisation medium or water at pressures of 0, 1.47 or 2.94 kPa for 3 months. Mineral loss differences were assessed using transversal microradiography. No significant mineral gain occurred at 0 kPa and in samples exposed to water. At 1.47 and 2.94 kPa, pulpal and remineralisation fluid induced significant mineral gain [ΔΔZ = 1,317 (25th/75th percentiles: 735/1,541) vol% × µm; p < 0.001]. Pressure and fluid composition determined pulpal remineralisation in vitro.