HISTOLOGY OF DENTAL CARIES

HISTOLOGY OF ENAMEL CARIES

PHYSICAL PROPERTIES OF ENAMEL:-

Hard mineralized epithelial tissue.
Translucent & light yellow to grayish white in color.
Thickness 2.5mm at the cusp tip & <100mm at neck of the teeth

CHEMICAL PROPERTIES OF ENAMEL:-

Inorganic – 96% - hydroxyl apatite crystals
Organic - 4% - Amelogenin & non amilogenin protein

DEFINITION OF DENTAL CARIES:-

It is an irreversible microbial diseases of calcified tissue of teeth, characterized by
demineralization of inorganic & destruction of organic substance of tooth, which leads to
cavitation.

ENAMEL CARIES:-
Studied through the use of ground section of tooth.
Preceded by microbial plaque.
Attack cores of rods & striae of retzius.

HISTOLOGY OF ENAMEL CARIES:-

Caries of enamel is studied through the use of ground sections of teeth that are usually
between 60μm to 100μm thickness.
Since the carious process is demineralization process the decalcification process
necessary for cutting thin sections usually result in loss of enamel.
Caries of enamel is preceded by the formation of a microbial plaque.
The carious process may occur due to the lesion on smooth surface or in pits or fissure.
Caries of enamel is discussed under two headings:
1) Smooth surface caries
2) Pit & fissure caries

1) SMOOTH SURFACE CARIES:-

The macroscopic evidence of smooth surface caries is the appearance of an area
of decalcification beneath the dental plaque which resemble a smooth chalky
white area.
Best observed on cervical margin of interdental facet on extracted tooth referred
as ‘white spot”.
Enamel surface over this spot can not be distinguished from adjacent sound
enamel surface macroscopically.
CHANGES;-
Study of early lesions by Scott by transmission electron microscope has shown
that the first change is usually a loss of inter rod substance of enamel with
increased prominence of rods.
Initial change may be roughening of enamel rods so that prism may be more
susceptible to attack.
Degradation of mucoolysaccharide present in interprismatic organic substance
occur early in caries process.
Appearance of transverse situations of enamel rod is due to changes occurring in
rods between calcospherites.
Accentuation of incremental striae of retzius.
Accentuation of perikymata.
Initial lesion may also appear brownish referred as brown space.
As the caries involve deeper layers of enamel, the smooth surface caries of
proximal surface has triangular or cone shape lesion with apex towards DEJ and
base towards surface of tooth.

There is loss of continuity of enamel surface and surface becomes rough and
roughness is due to disintegration of enamel prism after decalcification of
interprismatic substance and accumulation of debris & microorganism over
enamel rods.
With fissure caries, enamel lesion broadens as it approaches the underlying
dentin.
The small carious lesion has been divided into different zones based upon
histological appearance when longitudinal ground sections are examined.
Four zones- start from inner advancing front of region.
These are:_
a) translucent zone
b) dark zone
c) body of lesion
d) surface layer.

A) TRANSLUCENT ZONE:-
Lies at advancing front of enamel lesion & is first recognizable zone of
alteration from normal enamel
It is examined in cleaning agent like quinoline having refractive index
identical to that of enamel & this zone appear structure less.
 This zone is not always present.
Space or pores created in the tissue in this stage are located at prism
boundaries and other junctional sites. therefore when pores are filled with
quinoline, normal structural marking are not visible.
This zone is more porous than sound enamel having pore volume of 1%
compared with 0.1% in sound enamel/
Fluoride concentration of this zone is increased.
No protein loss.
Carious attack had preferentially remove magnesium and carbonate rich
mineral from this zone & not organic material.
Change in this zone are due to demineralization.

B) THE DARK ZONE:-

Lie adjacent & superficial to translucent zone.
Referred as positive zone because it is usually present
Formed as a result of demineralization & appear dark brown examined by
transmitted light after imbibitions with quinolone
Reduction of 6% of minerals/unit volume.\
Polarized light shows that dark zone has pore volume of 2-4%
Shows positive birefringence in contrast to negative birefringence of
sound enamel .so it is referred as positive zone.
This effect is due to presence of very small pores in this zone compared to
first stage.
When it is examined in mounting medium such as quinoline large
molecule of quinoline are unable to penetrate micro pore system of dark
zone. So the micro pore remain filled with air or vapour so light is
scattered on passing through this zone.
Presence of medium or low refractive index within micro pore systems
responsible fro reversal of birefringence when examined in polarized light.
Loss of 24% of mineral per unit volume
If it is is examined in aqueous medium having small molecule which
penetrate the micro pores, the dark zone is not visible
Formation of micro pore system must be regarded as a result of
demineralization
Translucent zone is less demineralized and have small pore size than dark
zone.
Appearance of dark zone was due to remineralization occurs at the
advancing front of lesion.

3) THE BODY OF THE LESION:-

Lies between relatively unaffected surface layer and dark zone.
 Area of greatest demineralization ( largest portion of incipent lesion)
Zone shows pore volume of 5% in spaces near the periphery to 25% in the
center of intact lesion.
When examined in quinoline, the body of lesion appear translucent
compared with sound enamel,
Striae of retzius are well marked.
When examined with polarized light after imbibition with ground water,
the body of lesion shows as a region of positive birefringence in contrast
to negative birefringence of rest of lesion & sound enamel.
Microradiograph confirm the radiolucent property of this zone.
Reduction of 24% mineral per unit volume compared with sound enamel.
Increase in unbound water & organic content due to increase of bacteria
& saliva.

4) SURFACE ZONE:
This zone indicate partial demineralization equivalent to about 1-10% loss
of mineral salts & pore volume of surface zone is less than 5% of space.
After imbibing with water although the porous substance surface zone is
seen to be positively birefringent, the surface zone retains a negative
birefringence.
This zone can be identified on micro radiographs as a sharply demarcated
from the underlying radiolucent regions of the lesion .
This zone is the zone of negative birefringence, superficial to the positive
birefringence body of lesion
All 4 zones cannot be seen if section is examined in a single medium.
The greater resistance of surface layer may be due to a greater degree of
mineralization or a greater concentration of fluoride in the surface enamel.
( relatively unaffected by caries attack)
This surface zone remain intact and well mineralized because it is a site
where calcium and phosphate ions, released by subsurface dissolution
become reprecipited. This process is remineralization high fluoride
concentration of enamel will favors this.
This zone is demineralized usually at the stage when lesion has penetrated
some way into the dentin.
Enamel lamellae may also play some role in development of caries by
invasion of proteolytic microorganism,
Scott & Wycoff reported no relation between enamel lamellae and caries.

PIT & FISSURE CARIES:-

Carious process of pit & fissure caries is same as that of smooth surface caries
except as the variation in anatomic and histologic structure.
Pit & fissure are often of such depth that food stagnation with bacterial
decomposition in base is to be expected.
Carious lesion start at both sides of fissure wall rather than at base and visual
changes such as chalkiness or yellow, brown or black discoloration may be seen.
 Sometimes early dentin involvement occurs because the enamel in the bottom of
pit or fissure may be very thin.
Sometimes pits & fissures are shallow and have thick layer of enamel covering
base.
In both cases enamel rod flare laterally in the bottom of pits & fissure.
Caries follow the direction of enamel rods and form cone shaped lesion with base
toward DEJ and apex at outer surface ( opposite shape to that of smooth surface)

When the lesion reaches the DEJ there is involvement of large no. of dentinal
tubules.
Pits & fissure caries of occlusal surface produce greater cavitiaions than proximal
smooth surface caries.\
Carious lesion is to be stained with brown pigment and tend to produce more
undermining of enamel because of different shape.
In newly erupted tooth, brown stain indicate underlying decay .in the teeth of
older individual it may be due to arrested lesion.
Histochemical staining of early lesions of enamel has shown to be more
permeable to methyl green and contain free Ca+2 detected with Alizarin reduction.
Normal enamel remains uncoloured.

ULTRASTRUCTURAL CHANGES IN ENAMEL CARIES:-

Ultra structural technique is slow in research of caries because of difficulty in
preparation of ultra thin section of enamel
First alteration found in enamel is scattered direction of individual apatite crystals
within the enamel prism and at their borders.\
Progressive dissolution of crystal result in broadening of inter crystalline spaces
when seen in transverse section.
Inter prismatic spacing & damage to crystals were not detectable unless the
section came from areas having a pore volume of 10-25%.
As the no. of dissolved crystals increases the densely calcified tissue becomes
more porous.
Crystals at the prism periphery are larger isodiametric and electron dense.
These large crystals are thought to be the result of remineralizaion of crystals that
have resisted dissolution.
Eventually with diffuse destruction of apatite crystals numerous bacterio can be
observed invading the enamel lesions