In Vivo Caries Models-Mechanisms for Caries Initiation and Arrestment

Abstract

The effects of intra-oral mechanical forces on caries initiation, progression, and arrestment are evaluated by examination of different in vivo caries models. The models are grouped in four categories: (1) a population study, (2) short-term clinical trials, (3) clinical experiments, and (4) controlled clinical observations. Taken together, these in vivo studies convincingly demonstrate that partial or total elimination of the intra-oral mechanical forces operating during mastication or toothbrushing leads to evolution of cariogenic plaque, resulting in localized carious enamel dissolution. In addition, they show that re-exposure to the partly or totally eliminated mechanical forces not only arrests further lesion progression, but also results in partial lesion regression. The data from in vivo caries studies also show that the clinical and structural changes associated with lesion arrestment or partial regression are not related to any salivary repair mechanism, but are solely the result of mechanical removal of the cariogenic biomass which is physically interrelated with the eroded surface of the active, dull-whitish enamel lesion. No indications of superficial mineral deposition or "blocking" of the external intercrystalline spaces are seen in the surface layer of lesions arrested in vivo. For this reason, the conventional usage of the terminology 'remineralization' is considered absolutely misleading when used to describe the mechanisms responsible for the arrest of lesion progression in vivo.

The Use of a Microscope for Restorative Treatment Decision-making on Occlusal Surfaces

“…Carious teeth with chalky, matte and rough surfaces were assessed as teeth having active lesions, and those with shiny and smooth surfaces were assessed as having inactive lesions. 6 Three dentists in academic positions with 17, 8 and 8 years of clinical experience, respectively, participated in the study. All the observers were calibrated for occlusal caries detection in previous studies.…”

“…referred to as inactive. 6 The progression rate of carious lesions differ according to the lesion's activity. Active lesions have a higher progression rate when compared to inactive lesions.…”

Cariës: diagnostiek, monitoren en begeleiden naar goed mondzorggedrag.Een heroriëntatie

“…De wittevleklaesie blijft zichtbaar, maar wordt glanzend. De porositeit van de 'subsurface' is weliswaar afgenomen door precipitatie van mineralen, maar de oorspronkelijke structuur en dichtheid van het glazuur keert niet terug en de wittevleklaesie blijft als litteken zichtbaar (bewerkte tekst en illustratie naar Thylstrup et al, 1994).…”

How to Diagnose Hidden Caries? The Role of Laser Fluorescence

“…We can also evaluate pigmentations, the presence or absence of soft tissues, or changes in enamel texture according to the degree of demineralization. According to some authors (Thylstrup et al, 1994), we are also able to establish whether the caries are active or inactive. The evaluation of these findings must be made following some classifying method or criterion capable of correlating the observed signs to the stage of the lesion.…”

“…In addition, there may be decoloration of the dentin through the enamel, as well as defects in the bottom or depth of the pit, which would confirm the diagnosis of dentin caries. Accordingly, clinical inspection is based on evaluation of the transparency changes of the enamel, loss of brightness, an opaque appearance, and integrity of the fissure (Thylstrup et al, 1994;Ekstrand et al, 1997). In order to appreciate these changes, the occlusal surfaces must be clean and dry during inspection of the grooves and fissures.…”