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Tooth-related factors
29-03-2010
Tooth-related factors Physical characteristics of the teeth may increase the risk for caries: tooth size, tooth morphology, cusp and fissure patterns, enamel structure (defects, opacities, mottling, and roughness of the surface), the morphology of the cementoenamel junction, and exposed root surfaces. In addition, the chemistry of the enamel, dentin, and root cementum may influence caries susceptibility. Studies to date indicate that large teeth in crowded mouths are more likely to develop caries, but this cannot be predicted on an individual basis. Similarly, certain types of crown morphology (shovel-shaped incisors, deep convoluted fissures, buccal pits, and palatal grooves) render a tooth more caries prone if the diet is cariogenic, because they allow accumulation of undisturbed plaque. Structural defects of enamel allow cariogenic bacteria to colonize undisturbed and will also predispose a tooth to caries. Mottling, caused by fluoride, is associated with caries resistance, except when severe enough to cause substantial hypoplasia or loss of enamel, creating areas of plaque retention. The above factors increase caries susceptibility mainly by creating microenvironments for retention and stagnation of plaque. The concentrations of fluoride and other trace elements in whole and surface enamel have been shown to be related to tooth resistance. However, chemical analysis, particularly of surface enamel, is only a weak predictor of tooth resistance. For surface enamel fluoride, the predictive value reaches statistical significance only in large samples on a population basis and has limited practical application for identification and counseling of the high-risk patient. Far more important are the presence of fluoride in the plaque, pellicle, and enamel fluids and the presence of reservoirs of CaF2 in the pellicle. The enamel of erupting teeth is far more caries susceptible than enamel exposed to the oral environment for some years (after secondary maturation). Root caries is an increasing problem of the aging dentition, and to date there is no reliable predictor of tooth resistance. Mandibular posterior teeth are the most susceptible, and the use of fluoride lessens the chance of dentin caries. Finally, prediction based on tooth resistance on an individual or a population basis remains unsatisfactory, because of the multifactorial nature of the disease.
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Articles for theme “caries”:
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29-03-2010
Systemic and immunologic factorsOf the chronic systemic diseases, by far the most important risk factor and prognostic risk factor for dental caries is Sjogren’s syndrome, because of its extremely depressive effect on both the salivary secretion rate and the quality of the saliva. Indirectly, reduced SSR is associated with other chronic diseases in which medical management involves regular use of drugs with side effects on the salivary system. Some other general chronic diseases, such as leukemia, acquired immunodeficiency syndrome, diabetes mellitus, and Down’s syndrome, impair the immune system generally or specifically.
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29-03-2010
ConclusionsIntroductionThe most important internal modifying factors related to dental caries are salivary hypofunction, some chronic diseases, impaired host factors, and unfavorable macroanatomy and microanatomy and eruption stage of the teeth that favor plaque retention. Of utmost importance is impaired salivary function, particularly stimulated salivary secretion rate. Salivary factorsSalivary secretion rate, the buffering effect, and possibly the in vivo concentrations of some salivary constituents, such as fluoride, hypothiocyanite, and agglutinins (possibly including IgA), seem to be the most important determinants of caries susceptibility and/or activity.
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29-03-2010
Exposure of root surfacesIn the young, healthy adult, root surfaces, like the cementoenamel junctions, are not exposed to the oral cavity. At the population level, the prevalence of exposed root surfaces is strictly age related and is attributed to the long-term effects of trauma from toothbrushing (buccal surfaces) and gingival recession associated with periodontal disease. With the decline in prevalence and severity of enamel caries, and hence the preservation of an intact dentition into old age, root caries is becoming an increasing problem in clinical practice.
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29-03-2010
Enamel chemistryEnamel mottling apart, the fact that fluoride affects dental caries has been confirmed by many well-controlled studies of topical fluoride agents and studies of the posteruptive caries-preventive mechanisms of fluoride (for review, see Fejerskov et al, 1996a, b).For many years, it was believed that incorporation of fluoride into enamel increased the resistance of the tooth to dissolution and that the surface enamel fluoride concentration could be a marker of tooth resistance or susceptibility to caries.
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29-03-2010
Enamel structureEnamel development is conventionally described in five histologically recognizable stages: secretion (matrix deposition and transition), cell organization, preabsorption, early maturation, and late maturation. In later work, only four stages are described, based on chemical composition. Developmental disturbances may occur at any stage. There is, however, no clear clinical evidence that aberrations in enamel structure affect resistance to dental caries, unless the defects are major and result in rough surfaces that enhance plaque retention.
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