46. Shellis RP. Relationship between human enamel structure and the formation of caries-like lesions in vitro. Arch Oral Biol 1984;29(12):975–981
47. Margolis HC, Moreno EC, Murphy BJ. Effect of low levels of fluoride in solution on enamel demineralization in vitro. J Dent Res 1986;65(1):23–29
48. ten Cate JM, Duijsters PPE. Influence of fluoride in solution on tooth demineralization. I. Chemical data. Caries Res 1983;17(3): 193–199, 513–519
49. Aoba T, Moriwaki Y, Doi Y, Ozkazaki M, Takahashi J, Yagi T. The intact surface layer in natural enamel caries and acid-dissolved hydroxyapatite pellets. An X-ray diffraction study. J Oral Pathol 1981;10(1):32–39
50. Arends J, Schuthof J, Christoffersen J. Inhibition of enamel demineralization by albumin in vitro. Caries Res 1986;20(4): 337–340
51. Schüpbach P, Guggenheim B, Lutz F. Histopathology of root surface caries. J Dent Res 1990;69(5):1195–1204
52. Johnson MW, Taylor BR, Berman DS. The response of deciduous dentine to caries studied by correlated light and electron microscopy. Caries Res 1969;3(4):348–368
53. Daculsi G, LeGeros RZ, Jean A, Kerebel B. Possible physico-chemical processes in human dentin caries. J Dent Res 1987;66(8): 1356–1359
54. Øgaard B, Rølla G, Arends J. In vivo progress of enamel and root surface lesions under plaque as a function of time. Caries Res 1988;22(5):302–305
55. ten Cate JM, Damen JJM, Buijs MJ. Inhibition of dentin demineralization by fluoride in vitro. Caries Res 1998;32(2):141–147
56. Rose RK, Shellis RP, Lee AR. The role of cation bridging in microbial fluoride binding. Caries Res 1996;30(6):458–464
57. Vogel GL, Carey CM, Ekstrand J. Distribution of fluoride in saliva and plaque fluid after a 0.048 mol/L NaF rinse. J Dent Res 1992;71(9):1553–1557
58. Dijkman AG, Schuthof J, Arends J. In vivo remineralization of plaque-induced initial enamel lesions—a microradiographic investigation. Caries Res 1986;20(3):202–208
59. Teranaka T, Koulourides T, Butler WT. Protein content and amino-acid content of consolidated carious lesions in human enamel and of experimental lesions in bovine enamel exposed to the human mouth. Arch Oral Biol 1986;31(6):405–410
60. Fujikawa H, Matsuyama K, Uchiyama A, Nakashima S, Ujiie T. Influence of salivary macromolecules and fluoride on enamel lesion remineralization in vitro. Caries Res 2008;42(1):37–45
61. Zantner C, Martus P, Kielbassa AM. Clinical monitoring of the effect of fluorides on long-existing white spot lesions. Acta Odontol Scand 2006;64(2):115–122
62. Zero DT, Lussi A. Etiology of erosion: intrinsic and extrinsic factors. In: Addy M, Embery G, Edgar WM, Orchardson R, eds. Tooth Wear and Sensitivity. London: Martin Dunitz; 2000: 121–130
63. Lussi A, Jaeggi T. Chemical Factors. Monogr Oral Sci 2006;20: 77–87
64. Millward A, Shaw L, Harrington E, Smith AJ. Continuous monitoring of salivary flow rate and pH at the surface of the dentition following consumption of acidic beverages. Caries Res 1997; 31(1):44–49
65. Addy M, Shellis RP. Interactions between attrition, abrasion and erosion in tooth wear. Monogr Oral Sci 2006;20:17–31
66. Ganss C, Schlueter N, Hardt M, von Hinckeldey J, Klimek J. Effects of toothbrushing on eroded dentine. Eur J Oral Sci 2007;115(5): 390–396
67. Shellis RP. A synthetic saliva for cultural studies of dental plaque. Arch Oral Biol 1978;23(6):485–489
68. Miller WD. The Microorganism of the Human Mouth [Article in German] Dtsch med Wochenschr 1892;18(45):1016–1018
3 Histological and Clinical Appearance of Caries
Wolfgang Buchalla
Activity of White and Brown Spot Lesions
Transmitted and Polarized Light Microscopy
Transverse Microradiography (TMR)
Scanning Electron Microscopy (SEM)
Transmission Electron Microscopy (TEM)
Early Signs of Dentin Reaction
Continuing Caries Progression into Dentin
Spread of Bacteria within Dentin
Fluorescence Properties of Carious and Healthy Dental Hard Tissue
Caries Arrest and Remineralization
Correlation of Histology with Radiography and Clinical Appearance of Caries
The clinical appearance of caries is of great interest to the dental professional, because it tells something of the history of a caries lesion and provides valuable information for adequate noninvasive and invasive treatment. The histology of the caries lesion provides fundamental understanding of the disease process; hence it supports the dental professional with information necessary to make the right treatment decision (Chapters 9 and 20). Much of today's histological knowledge of the caries process was discovered many years ago. Besides advances in oral biology, an understanding of the role of dental biofilm and the invention of the transmitted light microscope, particularly using polarized light, has fostered our knowledge of the caries process. But also other techniques, such as transmission and scanning electron microscopy, fluorescence microscopy, and microradiography have added to our understanding of how caries develops within a tooth.
This chapter will address the following:
• How do enamel and dentin caries appear clinically and histologically?
•