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31 March 2008
Outline
Plaque fluid
Stephan curve
Enamel substrate
Plaque Composition
Plaque composition: About half of the plaque dry
weight is bacterial and salivary protein. About 25%
Bacterial and salivary protein 50%
Carbohydrates and lipids 20-30% of the dry weight is carbohydrates and lipids, and
Extra and intracellular polysaccharides
another 25% is inorganic component.
- Synthesized by bacteria
- Bacterial attachment and cohesion
Carbohydrates in plaque consist of polymers
- Reservoir of fermentable substrates
Bacteria cells contain carbohydrate in the form of intracellular glycogen-like polymers, which are stored
as granules in the cell. They also function as a reservoir when dietary substrates are depleted.
The inorganic components, especially Ca and P concentrations are several times higher than in saliva.
Most of the Ca found in plaque is non-ionic. As the pH drops, plaque calcium becomes ionized and is
important in determining rates of enamel dissolution and remineralization. Other ions present are, for
example, K, Na, Mg, and F.
Dental plaque is responsible for the majority of chemical activities on the tooth surface.
Resting plaque 56.3 - 102.1 5.69 - 6.54 Cariogenic conditions generated by plaque
Starved plaque 31.9 - 61.5 6.78 - 7.08
microorganisms can be seen by changes in the
ionic composition of plaque fluid.
1
Two types of plaque fluid reflect the metabolic activity of bacteria: resting plaque and starved plaque.
Resting plaque fluid is obtained one to several hours after eating. Starved plaque fluid is obtained
following overnight fasting.
Resting plaque has a higher organic acid concentration (56.3 to 102.1 mmol/1) than starved sample (31.9
to 61.5 mmol/1). pH in rested samples (pH 5.69 to 6.54) are lower than those found in starved samples
(pH 6.78 to 7.08). The lower pH in the rested samples result from the metabolism of residual energy
sources that are depleted during overnight fasting.
Stephan curve What contributes to the extent of pH drop after glucose challenge?
Stephan curve
The relationship between plaque pH and time after sugar challenge is known as the Stephan curve. In the
40s, Stephan demonstrated that dental plaque has the ability to produce rapid and substantial decreases
in pH in vivo. The pH rapidly decreases immediately following exposure to a sugar challenge by rinsing
with a glucose or sucrose solution. After reaching a minimum, the pH slowly rises to baseline, usually
in about an hour. A later study by Stephan was even more important. He showed that the period and
extent of pH drop was inversely related to the caries activities of the subjects. The extent of plaque pH
decrease (how low and how long) after glucose challenge is attributed to the type and amount of
carbohydrate available, bacteria present, other food ingested, salivary composition and flow, and
thickness and age of dental plaque.
2
Plaque pH after a glucose challenge
Enamel substrate
Enamel as a substrate for dental caries
Enamel: 96% by weight or 87% by volume mineral Enamel consists of 96% by weight or 87 % by
13 vol % interprismatic space is diffusion channel
volume of mineral. The other 13% by volume is
Major mineral component (teeth and bone):
Calcium phosphate crystals ~ Hydroxyapatite Ca10(PO4)6(OH)2 interprismatic space filled with protein, lipid, and
Hydroxyapatite lattice structure water that form diffusion channels. Enamel is a
Hydroxyl ions form microporous solid that allows a variety of ions to
columns of parallelogram
diffuse in and out.
Calcium ions form
triangle around hydroxyl ion
The major mineral components of teeth (and
Phosphates fill space
bones) are microcrystals of calcium phosphate
Nikiforuk G. Understanding Dental Caries. Karger 1985
with the arrangement of atoms resembling the
mineral hydroxyapatite (HAP).
This diagram represents the crystal structure of HAP. Hydroxyl ions form columns of parallelogram.
Calcium ions form triangles around hydroxyl ions, and phosphate ions fill the space.
3
Biological minerals like tooth enamel are
Biological mineral is nonstoichiometric Ca10(PO4)6(OH)2
'nonstiochiometric', the concentration of the
Concentration of the chemical components is different from pure HAP
chemical components is different from pure HAP.
Substitution of three primary constituents with
- carbonate
This is because the substitution of three primary
- other trace elements (impurities): F, Na, Cl, Mg, K, Zn, Si, Sr constituents with carbonate and other trace
elements, or by surface absorption and the
Dental mineral is carbonated HAP
presence of mineral deficient apatites. Current
Carbonate (CO3)2- substitute (PO4)3- or 2 (OH)-
Carbonate ions disturb the regular array of ions in the crystal lattice concept looks at enamel as a carbonated HAP.
More soluble in acid than pure HAP
Carbonate ions substitute either 1 phosphate or 2
hydroxyl ions. Carbonate disturbs the regular
array of ions in the crystal lattice, so the
carbonated HAP is much more soluble in acid.
Post-
Post-eruptive Maturation
Discussion (group of 5-6)
Newly erupted teeth have relatively greater caries susceptibility
When a tooth is just erupted into the oral cavity, it is During demineralization, carbonate is lost and excluded after remin
more susceptible to demineralization. Decrease carbonate & increase fluoride in enamel surface
= post-eruptive maturation
Carbonate and fluoride play an important role in enamel maturation. During demineralization,
carbonates dissolve easily and are excluded from the newly formed remineralized mineral. As enamel
matures the level of carbonate on the surface decreases and fluoride increase. This may explain the
relative caries susceptible of newly erupted teeth and less susceptible to the caries process of mature
teeth. The formula of our tooth mineral is: (Ca)10-x(Na)x(PO4)6-y(CO3)z(OH)2-u(F)u
When do teeth
Teeth dissolve when pH is lower than a critical pH When do teeth dissolve in acid?
dissolve?
Teeth dissolve when the pH is lower than a
Solubility product (Ksp)
critical pH. A few parameters are important
Ksp is the ionic activity products of substance at saturation
Ksp = Concentrations of the component ions to better understand the concept of critical
to the power in saturated solution pH: Ksp, IAP, and degree of saturation.
e.g., HAP Ca5(PO4)3OH ; Ksp(HAP) = [Ca2+]5[PO43-]3[OH-] = 7.36 x 10-60
Solubility product (Ksp) determines the
Higher Ksp =
Ksp(enamel) = 5.5 x 10-55
easier to dissolve Ksp(carbonated-HAP) = 4.57 x 10-49 solubility of substance such as
easy
4
For example: Ksp of hydroxyapatite [Ca]5[PO4]3[OH] is 7.36 x 10-60; Kenamel is 5.5 x 10-55, Kcarbonated-HAP
is 4.57 x 10-49. The higher (less negative power) Ksp, the easier for the mineral to dissolve. Therefore,
carbonated apatite dissolve easiest, follow by enamel and hydroxyapatite, respectively. This makes
sense, because enamel is in between carbonated apatite and hydroxyapatite.
Ksp is a constant value, which means that in an acidic solution where protons remove some of the PO43-
and OH-, [PO4] and [OH] concentrations are reduced. Therefore apatite mineral dissolves to increase the
concentration of PO43- and OH- ions to maintain the saturation level.
Critical pH
The concept of critical pH
= pH at which a solution is just saturated WRT a particular mineral
Critical pH is the pH at which a solution is
If the solution pH > critical pH supersaturated mineral precipitate just saturated with respect to a particular
If the solution pH < critical pH undersaturated mineral dissolve mineral. If the pH of the solution is above
Normal condition: Our teeth do not dissolve in saliva or plaque fluid the critical pH, the solution is supersaturated
Saliva and plaque fluid are supersaturated WRT tooth enamel
pH of saliva & plaque fluid > critical pH
and mineral will precipitate. If the pH of the
Saliva & plaque fluid contain Ca, P, OH IAP > Ksp tooth enamel solution is less than the critical pH, the
The tooth will dissolve when the pH of fluid phase is less than critical pH. solution is undersaturated and mineral will
dissolve until the solution becomes saturated.
Critical pH of carious formation in enamel ~ 4.5-
4.5-5.5
The effect of pH can be counteracted by an
Coincide with pH when plaque bacteria ferment carbohydrates
HAP is undersaturated & FAP is supersaturated increase in concentration of ionic species
(e.g., Ca2+) in the solution to restore the
equilibrium.
For example, the pH of saliva and plaque fluid are normally higher than the critical pH of tooth enamel.
The level of Ca, P and OH ions in saliva and plaque fluid is supersaturated with respect to tooth enamel
at that pH. In other words, IAP of saliva and plaque fluid is higher than Ksp for hydroxyapatite. Our
teeth do not dissolve in saliva or plaque fluid unless the pH is reduced to less than the critical pH.
Critical pH of caries formation in enamel is often referred to as pH between 4.5-5.5. This range
coincides with pH of acids formed when plaque bacteria ferment carbohydrates. At this pH range, HAP
is undersaturated while fluroapatite (FAP) is supersaturated.
5
Fluorapatite (FAP) is less soluble than
demineralization hydroxyapatite (HAP). FAP dissolves at pH
pH 6.5 6.0 5.5 5.0 4.5 4.0 3.5 3.0 4.5 and HAP at pH 5.5 Therefore, between pH
FAP 4.5-5.5, HAP is undersaturated and FAP is
Critical pH
HAP
supersaturated, i.e, HAP dissolves and FAP
deposit caries erosion precipitates to form subsurface lesion (initial
pH 6.5 6.0 5.5 5.0 4.5 4.0 3.5 3.0 caries lesion). If the pH was so low that FAP
remineralization was undersaturated, an erosive defect will be
formed.
Carious lesion forms at pH 4.5 - 5.5
Erosion lesion forms when pH < 4.5
1
HAP represent the just saturated condition. Above
0.1
0.0001
Persons with low concentration of calcium and
phosphate in saliva and plaque fluid, the upper
Current concepts on the theories of the mechanism of action of fluoride.
ten Cate JM. Acta Odontol Scand 1999;57:325-9. limit of critical pH of enamel may be as high
as 6.5. Plaque fluid with high calcium and
phosphate content may have the critical pH
close to 5.
6
1.
Surface
zone
2.
The larger crystals are also found in the
2 3 1 2 3 4
Body of
lesion 1 4 surface zone and the dark zone, one of the
evidence that remineralization take place in
3.
Dark zone these 2 zones.
Larger crystals in
surface zone and dark zone
4.
Translucent
zone Indication of remineralization
Sound
enamel
acid corrosion'
Erosion, or sometimes called (chemical)
Loss of dental hard tissue through chemical etching and dissolution 'corrosion', is the loss of dental hard tissue through
by acids of non-bacterial origin
Endogenous acid: gastric acid, gingival crevicular fluid chemical etching and dissolution by acids of non-
Gastroesophageal reflux disease, vomiting
Exogenous acid: diet, medicine, industry bacterial origin. Source of acid and be
Frequent and prolonged ingestion endogenous, from gastroesophageal reflux disease
of acidic fruits, fruit juices and
acidic beverages (GERD), or exogenous from medication or food.
3/4 of a bottle of white wine
Every evening for 34 years
Frequent and prolonged ingestion of acidic fruits,
Sipping over a 3 hours after dinner
Wine pH ranges about 3-4.
fruit juices and acidic beverages has been reported
Dental consumption due to wine consumption. Mandel L. JADA 2005;136:71-75 as causing dental erosion. In this case, a woman
drinks 3/4 of a bottle of white wine every evening
Can acidic food and drinks soften enamel surface?
Enamel samples alternately immersed, 5 sec each, in food or drink
for 34 years, sipping over a 3 hours period after
and in artificial saliva for 10 cycles.
dinner. pH of wine ranges about 3-4.
300
200
drinks soften tooth surface. Enamel samples were
150 * Before
100
After
dipped in food or drink alternating with artificial
50
0
saliva for 5 sec each, 10 cycles. That's not much
Cola Sports drink Orange Drinking Lemon-
juice yogurt grass soup time at all, but there was dramatic decrease in
pH 2.74 3.78 3.75 3.83 4.20