Tissue response to dental caries.

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Abstract Caries still represents the most widespread human disease. The pulp tissue sequelae of den tin caries are of utmost importance, because prevention of pulpal damage considerably reduces the need for extensive restorations and endodontic therapy. There is, however, considerable disagreement in the literature regarding how early the pulpal response to caries can be detected. The material in this article, gathered from the author's and his coauthors' earlier investigations, deals with pulp reactions from initial caries to increasingly extensive caries; caries in combination with attrition; the effect of carious den tin in experimental cavities of intact dentin; the effect of medicaments, restorative procedures and materials, and indirect pulp capping in the treatment of deep caries; microbiologic aspects of dentin caries; diagnosis criteria for treatment; light and electron microscopic study of teeth with carious exposure; periodontal disease and root caries in the geriatric population; pulp biopsies of teeth with periapical lesions, and the breakdown of the remaining pulp and its periapical sequelae. Pulpal reactions to initial caries detected as early as bacteria reach the dentinal tubules arc also discussed. As in medium and deep caries, this can be reversible following the removal of the infected dentin, except for irritation dentin and calcifications on the canal walls or free in the lumen. Bacteria remaining in dentinal tubules combined with iatrogenesis may be the reason for pulpal disintegration under deep restorations. Indirect pulp capping is not an acceptable procedure. Pain (or lack thereof) is not a predictable indicator of the inflammatory stage of the pulp. Root caries must be treated early to prevent pulpal destruction. Vital pulp tissue can be found in the roots of teeth with periapical radiolucencies that will ultimately show the presence of bacteria.