The Caries Process and its Effect on the Pulp: The Science is Changing and so is Our Understanding

Author(s): Lars Bjorndal, DDS, PhD
Journal: Pediatric Dentistry
Volume (number): Volume 30/ number 3
Month, Year: May/June 08
Major topic: Caries Pathology
Minor topic(s: the caries process and its effect on the pulp
Type of Article: Conference Paper
Main Purpose: To gain a better understanding in the differing opinions in the treatment of dental caries
Overview of method of research: Literature review
Findings: Recent survey findings showing dentists treatment methods for deep lesions in which one would expect pulpal exposure showed that 62% of dentists would remove all caries, 18% would partially remove caries, and 21% would initiate endodontic treatment. The deepest penetration of the entire caries lesion complex can be seen as the oldest lesion area along the dentin-pulp interface following the direction of the dentinal tubules. Consequently, the peripheral areas represent younger and less progressed areas along the dentin-pulp interface. Caries spreading along the DEJ subjacent the non –cavitated enamel lesion is misinterpreted. The lateral spread of demineralized dentin and enamel is related to the total breakdown of the enamel layer and therefore describes a later stage of tissue destruction than previously believed.
Key points/Summary : There are three varying opinions to the approach of dental caries. The classic cariologist opinion is focused on the prevention of caries and further progression of the established lesion. Excavation procedures are planned to avoid pulp exposures. The operative opinion is initiated when caries has progressed into a clinical breakdown of the enamel surface and with carious dentin exposure. The lesion is drilled and filled and if a lesion means an exposure of the pulp it may be avoided by leaving carious dentin behind. The endodontic opinion deals with the prevention of an infected pulp and subsequent apical pathosis, the issue of a lesion mainly concerns this region. Therefore, all carious dentin should be removed, even if the result is a pulp exposure. Instead of accepting that there is a steady progression through the tooth leading toward the same results if left untreated, it might be more appropriate to understand that caries activity constitutes many different rates of progression, each of them leading to different pulp reactions. Perhaps with the appropriate clinical intervention we can reduce the rate of caries progression and perhaps even arresting the subjacent pulpal inflammation.
Assessment of article: Our understanding of caries progression is in the newer stages and I’m sure will expand in the coming years. Article somewhat difficult to follow.