Dentin caries

Zones of dentinal caries

Zone 1: normal dentin. The deepest area is normal dentin, which has tubules with odontoblastic process that are smooth and no crystals are in the lumen. There is no bacteria. In the tubules. Stimulation of dentin by osmotic gradient (sucrose or salt), a bur produced sharp pain.

Zone 2: sub transparent dentin (zone of demineralization) Sub transparent zone is seen next to normal dentin. This is the zone of dentin of the intertubular dentin and initial formation of very fine crystals in the tubular lumen at the advancing front. There are no bacteria in this zone. The dentin in this zone is capable of remineralization.

Zone 3: Transparent dentin This zone is softer than normal dentin and show further loss of mineral from the intertubular dentin. No bacteria are present in this zone either. Collagen (organic) content is intact, which serves as a template for remineralization of the intertubular dentin. Thus, this region remains capable of self-repair provided the pulp remains vital.

Zone 4; turbid dentin is the zone of bacterial invasion and is marked by widening and distortion of dentinal tubules, which are filled with bacteria. Less mineral is present in this zone and collagen in this zone will not self-repair. This zone cannot be remineralized and must be removed before restoration.

Zone 5: infected dentin. The outer most zones, protected dentin, consist of decomposed dentin that is teeming with bacteria. There is no recognizable structure to the dentin, and collagen and mineral seem to be absent. Removal of infected dentin is essential to sound, successful restorative procedure as well as prevention of spreading the infection.

Advanced carious lesion Caries advancement in dentin proceeds through 3 changes: Weak organic acid demineralizes the dentin The organic material of the dentin, particularly collagen, degenerates and dissolves The loss of structural integrity is followed by invasion of bacteria Increasing frequent demineralization of the body of the enamel lesion over a period of time results in weaking of surface covering. This result in cavitation and provides an even more protective and retentive zone for the cariogenic plaque, thus help in accelerating the caries progression

Affected dentin
This is softened, demineralized dentin that is not yet invaded by bacteria (zones2 and 3) it is vital and no need to remove it as it can be repaired.

Infected dentin This is softened and contaminated with bacteria (zone 4, 5). It includes the superficial granular necrotic tissue, soft dry and leathery dentin. The zone of decomposed dentin (outer carious dentin) is soft infected dentin, which cannot be remineralized and must be removed during cavity preparation.

TEXT BOOK OF PREVENTIVE AND COMMUNITY DENT Hiremath 2007 Elsevier