Ultrastructural study on human root caries

Genetic Association of MMP10, MMP14, and MMP16 with Dental Caries

Matrix metalloproteinases (MMPs), which degrade extracellular proteins as part of a variety of physiological processes, and their inhibitors have been implicated in the dental caries process. Here we investigated 28 genetic variants spanning the MMP10, MMP14, and MMP16 genes to detect association with dental caries experience in 13 age- and race-stratified (n = 3,587) samples from 6 parent studies. Analyses were performed separately for each sample, and results were combined across samples by meta-analysis. Two SNPs (rs2046315 and rs10429371) upstream of MMP16 were significantly associated with caries in an individual sample of white adults and via meta-analysis across 8 adult samples after gene-wise adjustment for multiple comparisons. Noteworthy is SNP rs2046315 (p = 8.14 × 10⁻⁸) association with caries in white adults. This SNP was originally nominated in a genome-wide-association study (GWAS) of dental caries in a sample of white adults and yielded associations in a subsequent GWAS of surface level caries in white adults as well. Therefore, in our study, we were able to recapture the association between rs2046315 and dental caries in white adults. Although we did not strengthen evidence that MMPs 10, 14, and 16 influence caries risk, MMP16 is still a likely candidate gene to pursue.

A Histological Study of Peripheral Dental Caries of Equine Cheek Teeth

Peripheral caries of equine cheek teeth is a poorly described disorder and, in particular, little is known of its histopathology. Histological examinations of decalcified sections of 21 equine peripheral caries-affected cheek teeth showed two different patterns of cemental lesions; including progressive enlargement of focal, flask-like lesions leading to breakdown of the adjacent cementum, and secondly; a more generalized flaking-off of thin layers of under-run, surface cementum. A thick layer of plaque and food material usually lay on the surface of affected cementum and also within cemental defects. Gram-stained sections showed large numbers of bacteria within the lacunae and canaliculi of affected peripheral cementum and within associated plaque. Pioneer bacteria were also seen within dentinal tubules of adjacent, normal-appearing dentin. Subgingival extension of peripheral caries lesions with localized periodontal destruction was rare. Grading of peripheral caries lesions by gross examination was found to underestimate the severity of the disorder as compared to histological grading.

Use of micro-Raman spectroscopy to investigate hybrid layer quality in demineralized root dentine

Treatment of early root caries using resin adhesives to stabilize demineralized dentine and deprive bacteria of nutrients is a recognized and conservative treatment option. Essential to its success is a stable resin-dentine interface, with effective infiltration of demineralized dentine and adequate resin curing. The objective of this study was therefore to examine degree of cure (DoC) and depth of penetration of dentine adhesives in demineralized dentine using micro-Raman spectroscopy. Three commercially available adhesives were applied essentially according to manufacturers' instructions to visibly wet demineralized dentine, with two coats of primer to reduce dilution. Specimens were sectioned perpendicular to the bonded interface and micro-Raman spectroscopy performed on the cross section. Molecules associated with the adhesive were detected to depths greater than 100 μm indicating a thicker hybrid layer than seen in sound dentine. The hybrid layer showed an increase in proportion of aliphatic C=C double bonds at the base of the hybrid layer, which may be a consequence of reduced DoC or phase separation. Micro-Raman spectra suggest deep zones contain an increased concentration of HEMA and a lower concentration of BisGMA, which is likely to be less stable and may contribute to early breakdown of the dentine adhesive interface.

Immunohistochemical localization of tissue inhibitor of matrix metalloproteinase-1 (TIMP-1) in human carious dentine

We evaluated if immunolocalization of tissue inhibitor of matrix metalloproteinase-1 (TIMP-1) in odontoblast dentinal tubuli changes in response to caries attack in human carious teeth. Ten permanent premolar teeth with moderate to advanced caries and two sound teeth were collected. The premolars were decalcified in ethylene-diamininetetracetic acid (EDTA) and processed for embedding in paraffin wax. Sections of 3-4mum thick were cut and processed for immunohistochemistry. A mouse monoclonal anti-TIMP-1 antibody was used for the localization of TIMP-1 using an immunperoxidase technique. TIMP-1 immunoreactivity was observed in dentine of both sound and carious teeth. In both cases, the density of immunolabelled dentinal tubuli was typically higher toward the pulp chamber. In all the carious teeth, most, but never all, dilated dentinal tubuli were strongly positively immunolabelled. In sound teeth, a weak immunoreaction, only slightly above the background, was observed in dentinal tubuli. These results provide evidence for increased TIMP-1 immunolabelling in dentinal tubuli of carious teeth, in contrast to sound teeth. Overall, these in vivo findings indicate a possible role for TIMP-1 in the pathology of adult human dental tissues following an injury such as a caries lesion.

In vitro growth, acidogenicity and cariogenicity of predominant human root caries flora

Streptococcus mutans (Sm), Lactobacillus acidophilus (La) and Actinomyces israelii (Ai) have been associated with root surface caries, which is an increasing problem in elderly Chinese. The aim of this study therefore, was to evaluate in vitro, the growth, acidogenicity and cariogenicity of these organisms, both in mono- and co-cultures using an in vitro model. Forty-eight root specimens were prepared using intact extracted human molars. Fresh, wild-type bacteria obtained from root caries lesions were assembled into seven experimental groups as either mono- or co-cultures and incubated with the root specimens. Appropriate controls were included. Growth curve of each experimental group was monitored for 24h, aerobically, at 37 degrees C using a microplate reader. The pH of the medium was recorded after 24-h incubation using a pH meter. Mean depths of artificial root lesions produced in each cultural group were measured using polarized light microscopy in specimens cut into thin sections (100+/-20 microm). Compared with mono-cultures, synergistic growth was observed in co-cultures of 'La+Sm', 'Ai+La' and 'Ai+La+Sm'. Mean lesion depth produced in La group was significantly shallower than other mono- or co-culture groups (p<0.01). The pH values of all culture media were similar after 24-h incubation. The current data elucidate the complex interactions of three predominant bacterial species considered prime agents of human root surface caries.

Bonding of self-etch and total-etch adhesives to carious dentin

Carious dentin is partially demineralized and contains mineral crystals in the tubules. This may permit the deeper etching of intertubular dentin but prevent resin tag formation during bonding. We hypothesize that resin adhesives will produce lower bond strengths to caries-infected and caries-affected dentin compared with normal dentin. We tested this by measuring the microtensile bond strength of a total-etch adhesive and an experimental self-etching adhesive (ABF) to caries-infected, caries-affected, and sound dentin and by correlating those results with ultrastructural observations. The bond strengths of both adhesives to sound dentin were significantly (p < 0.05) higher than those to caries-affected dentin, which, in turn were significantly (p < 0.05) higher than those to caries-infected dentin. For both adhesives, hybrid layers in caries-affected dentin were thicker but more porous than those in sound dentin. The lower bond strengths may be due to the lower tensile strength of caries-affected dentin. Clinically, this may not be a problem, since such lesions are normally surrounded by normal dentin or enamel.

Molecular pathogenesis of root dentin caries

Human dentin has a higher content of organic matrix and more non-ideal hydroxyapatite than human enamel. Ultrastructural studies indicate that root caries involves both mineral dissolution and breakdown of the organic matrix. Factors involved in the root caries process seem more complicated than those in enamel caries. Moreover, the distinct roles of acids and enzymes and the sequence of events in the root caries process are not well-understood. Although Streptococcus mutans and Actinomyces viscosus are considered to be major pathogenic micro-organisms of root caries, their roles in degradation of the organic matrix components of root dentin need clarification. The purpose of this paper is to review the basic composition of root dentin and the roles of acids and both endogenous and bacterial enzymes in the root caries process.

Dental caries in chronically disabled elders

Dental caries is the major cause of tooth loss in elderly individuals with physical and mental disabilities. The diagnosis of caries in elderly individuals is difficult due to a complicated oral environment compounded by the prevalence of physical and mental barriers to care. The restoration of tooth structure and the replacement of teeth lost due to caries result in considerable economic and biological cost to both individuals and society. Decisions to remineralize, restore, or extract teeth depend largely upon the extent of the structural damage caused by the infection. Teeth with small lesions can be remineralized with fluorides, whereas teeth with large lesions may be restored or extracted. Caries risk assessment based on the history of previous infection, salivary parameters, and ingestion of sugar can be used as a basis for placing a patient on a caries-preventive regimen. This paper discusses the pathophysiology of caries to explain the appropriate diagnosis, prevention, and treatment of dental caries in elderly individuals with chronic disabilities.

Effects of collagenase on root demineralization

The role of proteolytic enzymes in the root caries process remains unclear. The aim of this study was to investigate collagenase activity during tooth root demineralization and remineralization in an in vitro demineralization/remineralization pH-cycling model, Human tooth roots were subjected to pH cycling (alternating demineralization and remineralization) in one of two different time cycles for five days. Collagenase at 90, 180, or 360 micrograms per root was placed into either the demineralizing solution or the remineralizing solution in the pH-cycling system. The effects of additional exposure to collagenase before or after pH cycling were also studied. After the exposure, thin sections of the roots were examined histologically by polarized light microscopy. Changes of calcium and phosphate in the solutions were analyzed chemically. Surface erosion occurred only in the groups where collagenase was contained in the remineralizing solution and in which the root samples were exposed to severe demineralization. However, no differences among the control and experimental groups were found in calcium and phosphate changes in the pH-cycling solutions. These findings suggest that collagenase works during the remineralizing phase and predominantly attacks the organic matrix of the root after demineralization. Additional exposure to collagenase before or after pH cycling did not increase surface erosion except for exposure to collagenase in the absence of phosphate following pH cycling.

Constant composition dissolution kinetics studies of human dentin

The constant composition (CC) method has been used to study the dissolution kinetics of whole powdered human dentin as a function of calcium phosphate concentration at relative undersaturations with respect to hydroxyapatite (sigma HAP), ranging from +0.8 to -2.8, ionic strength from 0.05 to 0.30 mol/L-1 in sodium chloride or potassium nitrate, pH 4.00 to 5.50, and molar calcium/phosphate ratio in the reaction solutions from 0.05 to 11.1. The results suggest that human dentin behaves as a mixture of at least two calcium phosphate phases, HAP-like and octacalcium phosphate-like, OCP-like. Significant dissolution took place in solutions that were even supersaturated with respect to HAP, and the rates exhibited a striking insensitivity to relative undersaturation, while influenced by ionic strength, pH, and molar calcium/phosphate ratio in the reaction solutions. Although the dissolution was retarded in the presence of magnesium ion, the reaction rate showed the same insensitivity to undersaturation with respect to calcium phosphate.

Degradation of insoluble bovine collagen and human dentine collagen pretreated in vitro with lactic acid, pH 4.0 and 5.5

The purpose of the study was to test the hypothesis that both insoluble pure type I collagen from bovine Achilles tendon and dentine collagen in root dentine powder from human teeth required acid pretreatment for subsequent degradation by trypsin, a non-specific protease. Pure type I collagen or dentine powder was treated with lactic acid, at pH 4 or 5.5, or distilled, deionized water (pH 7) as a negative control. After incubation at 37 degrees C for 24 h, extracts of pure type I collagen solutions were analysed for soluble collagen with the hydroxyproline assay. Extracts of dentine powder solution were analysed for Ca2+, total protein, final pH, and hydroxyproline. Residual, undegraded pellets were washed and then treated with trypsin or collagenase. After 24 h of incubation, the soluble fractions from the enzyme-treated pure type I collagen and dentine powder solutions were analysed for hydroxyproline. Results showed that almost no pure type I collagen was degraded during acid pretreatment. Trypsin degraded significantly more pure type I collagen in the pH 4-treated group than in the other groups. Collagenase degraded about 70% of the pure type I collagen irrespective of acid pretreatment. While acid pretreatment at pH 4 did not degrade dentine collagen, data from Ca2+ analyses and collagen breakdown by trypsin suggested that pretreatment at pH 4 demineralized and denatured dentine collagen so that the collagen could be subsequently degraded by enzymes. After pretreatment at pH 4, about 27 and 57% of the dentine collagen was degraded by trypsin and collagenase, respectively, in contrast to minimal degradation of non-acid-treated dentine collagen by the same enzymes.(ABSTRACT TRUNCATED AT 250 WORDS)

The influence of the organic matrix on demineralization of bovine root dentin in vitro

The effect of matrix degradation on the rate of demineralization of dentin lesions was investigated. It was hypothesized that the demineralized matrix would inhibit the demineralization of the underlying mineralized dentin. Bovine root dentin specimens were alternately demineralized and incubated with either a bacterial collagenase or buffer (control). The demineralization was carried out under various conditions: Acetic acid solutions were used to form incipient and advanced erosive lesions, and lactic acid solutions containing a bisphosphonate were used to form incipient subsurface lesions. Under all conditions, the demineralization was found to be accelerated when the matrix was degraded by collagenase. This increase was more pronounced in advanced erosive lesions than in incipient lesions. Microscopic examination of collagenase-treated specimens revealed that the matrix of erosive lesions contained several layers of differently affected matrices, whereas the matrix of subsurface lesions appeared to be equally affected throughout the lesion. In conclusion, the matrix degradation was different in erosive and subsurface lesions but promoted the demineralization in both types of lesions.

Collagen mediates adhesion of Streptococcus mutans to human dentin

Some strains of Streptococcus mutans were found to recognize and bind collagen type I. Binding of 125I-labeled collagen type I was specific in that collagen types I and II, but not unrelated proteins, were able to inhibit binding of the labeled ligand to bacteria. Collagen binding to S. mutans was partially reversible and involved a limited number of bacterial binding sites per cell. S. mutans UA 140 cells bound collagen type I with high affinity (Kd = 8 x 10(-8) M). The number of binding sites per cell was 4 x 10(4). Collagen-binding strains of S. mutans were found to adhere to collagen-coated surfaces as well as to pulverized root tissue. S. mutans strains that did not bind the soluble ligand were unable to adhere to these substrata. Adherence to collagen-coated surfaces could be inhibited with collagen or clostridial collagenase-derived collagen peptides. Adherence of S. mutans to dentin was enhanced by collagen types I and II but inhibited by collagen peptides. S. mutans UA 140 bound significantly less 125I-collagen type I following treatment with peptidoglycan-degrading enzymes. These enzymes released a collagen-binding protein (collagen receptor) with a relative molecular size of 16 kDa. The results of this study suggest that collagen mediates adhesion of S. mutans to dentin. This interaction may target collagen-binding strains of S. mutans to dentin in the oral cavity and may play a role in the pathogenesis of root surface caries.

Solubilization of dentin matrix collagen in situ

The effects of the oral environment on dentin matrix collagen were studied. In the partial prostheses of 12 participants, two completely demineralized dentin specimens were mounted covered by a Dacron gauze. After an experimental period of seven weeks, the specimens were transferred to a trypsin-containing buffer for determination of the amount of denatured collagen. Subsequently, the specimens were incubated with a bacterial collagenase for assessment of the amount of collagen. After the intra-oral exposure, there was a collagen loss varying between 1 and 47 wt%. This variation might be due to differences in proteolytic activity of the colonizing microflora. After exposure to the oral environment, only about 0.5 wt% of the available collagen was trypsin-degradable. This indicates a rapid solubilization of the denatured collagen from the specimens into the oral cavity. A separate group of specimens was examined by light microscopy and transmission electron microscopy. Various degrees of breakdown could be discerned. Some experimental specimens showed loss of surface integrity and tubules heavily infected with different types of micro-organisms. The lumens of the tubules were enlarged, sometimes creating caverns as a result of the loss of the intertubular collagenous matrix.

Permeability of normal versus carious dentin

Although a number of reports have been published demonstrating that carious dentin is less permeable than normal dentin, these reports have been qualitative rather than quantitative. The purpose of this in vitro study was to apply a quantitative technique to the study of the permeability of carious human teeth before and after excavation, before and after removal of the smear layer and before and after preparation of a control cavity of similar size and depth in normal dentin subjected to the same measurements, for comparative purposes. Dentin permeability was measured as a hydraulic conductance. The permeability values measured at each step in the protocol were expressed as a percent of the maximum permeability of both cavities, permitting each tooth the serve as its own control. Carious lesions exhibited a slight degree of permeability (2.3 +/- 0.6% of controls) which remained unchanged after excavation of the lesions. Removal of the smear layer in the excavated carious lesions increased the permeability significantly to 6.9 +/- 3.2%. Preparation of a control cavity of the same area and depth increased the permeability slightly. Removal of its smear layer increased the permeability of the dentin 91%. These results confirm previous qualitative studies that carious dentin, even after excavation and removal of the smear layer has a very low permeability.

Histopathology of root surface caries

The histopathology of active and arrested human root caries was examined in extracted teeth by different optical methods. Significant differences were observed between the mechanisms operating on the various dental structures. Three different patterns of initial cementum and dentin lesions could be distinguished, depending on the severity of the cariogenic attack, the degree of sclerosis of the peripheral dentin, and the presence of calculus. Advanced lesions were characterized by various patterns of demineralization. In particular, a massive lateral spread of bacteria into intertubular dentin was observed. Consequently, unaffected dentinal areas became continuously undermined. In arrested lesions, either a partial or complete mineralization of the intertubular dentin was apparent. Dentinal tubules were sclerosed passively by re- or precipitation of Ca and PO4 ions. In contrast, tubules filled with ghosts of bacteria appeared mineralized by fine-granular crystals. Our observations indicate that both the arrestment and the remineralization of active lesions depend on (1) the degree of active sclerosis of dentinal tubules in areas underlying the lesion, (2) the degree of the bacterial infection of the dentin, (3) the degree of progression of the lesions, and (4) the location of the lesions at the various root surfaces. It is suggested that remineralization of active lesions can occur. This supports the concept of non-invasive treatment of root caries lesions without cavitation.

An ultrastructural study of bacterial invasion and tissue breakdown in human experimental root-surface caries

This study describes the structural features of the interface between microbial deposits and root cementum in actively progressing root-surface caries lesions developed experimentally in six elderly individuals. A total of 18 specimens was examined by microradiography, and a further 18 by light and transmission electron microscopy after intra-oral periods of one, two, and three months. All specimens showed various degrees of subsurface dissolution of mineral and bacterial invasion of the cementum. Although the microradiographic pattern of mineral loss was subsurface in nature, transmission electron microscopy showed dissolution of crystals in the outermost layers of the cementum, with a distinct gradient inward. Bacterial invasion occurred along the borders between bundles of relatively well-mineralized extrinsic collagen fibers in which the characteristic cross-banding remained intact. The pattern of bacterial invasion was influenced by the incremental lines and the cemento-dentinal junction. The invading bacteria were almost exclusively Gram-positive, of various shapes, and possessed thick, moderately electron-dense cell walls and electron-lucent "vacuoles" in the cytoplasm. It is concluded that because of pronounced mineral loss of the outermost cementum, accompanied by bacterial invasion, the surface of an active cementum caries lesion, as observed by transmission electron microscopy, is not identical to that seen in microradiograms.