Surfaces of the tooth
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Understanding the Surfaces of the Tooth: Composition, Caries Susceptibility, and Age-Related Changes
Tooth Surface Composition: Enamel, Dentin, and Cementum
The tooth is composed of three primary tissues: enamel, dentin, and cementum. Enamel, the outermost layer, is highly calcified and non-vital, providing a stable surface that undergoes minimal changes over time. Dentin, located beneath the enamel, is vital and continuously renewed through appositional growth. Cementum covers the root of the tooth and, like dentin, is involved in the attachment of the tooth to the surrounding bone 2. The composition of these tissues varies, with surface enamel differing significantly from subsurface enamel in terms of chemical composition and structural properties 2.
Caries Susceptibility of Tooth Surfaces
Approximal and Occlusal Surfaces
Caries susceptibility varies significantly across different tooth surfaces. Approximal surfaces, which are the contact points between adjacent teeth, are particularly prone to caries due to their inaccessibility for cleaning. Studies have shown that approximal surfaces of incisors, canines, and premolars exhibit high caries rates, ranging from 58.5% to 77.5% 6. Occlusal surfaces, especially the fissures and pits of molars, are also highly susceptible, with caries rates between 52.7% and 66.3% 6.
Age and Caries Distribution
Caries distribution also changes with age. Younger individuals, particularly those aged 17 to 25, show higher caries prevalence on approximal and occlusal surfaces. As individuals age, the incidence of caries decreases, likely due to changes in diet, oral hygiene practices, and the natural wear of tooth surfaces 6.
Age-Related Changes in Tooth Surfaces
Structural Changes
The surfaces of teeth undergo significant changes with age. In younger teeth, the enamel surface is characterized by visible enamel rod ends and perikymata. As teeth age, these features become less distinct due to attritional and environmental influences 3. The enamel surface layer, which can be up to 25 micrometers thick, shows a peak in caries incidence 2 to 4 years post-eruption, followed by a decline 8.
Morphological Relationships
The relationship between enamel and dentin surfaces is crucial for understanding tooth morphology. The dentino-enamel junction (DEJ) serves as a blueprint for the final shape of the tooth. Studies have shown that the occlusal surface of enamel closely mirrors the DEJ, indicating a uniform pattern of enamel deposition during tooth development 9.
Caries Clustering and Risk Factors
Hierarchical Clustering of Tooth Surfaces
Recent research has utilized hierarchical clustering to group tooth surfaces based on caries co-occurrence. This method identified five distinct clusters: pit and fissure molar surfaces, mandibular anterior surfaces, posterior non-pit and fissure surfaces, maxillary anterior surfaces, and mid-dentition surfaces 4. These clusters help in understanding the differential impact of risk factors such as age, sex, and oral hygiene habits on caries development 4.
Genetic and Environmental Influences
Some caries outcomes within these clusters are heritable, suggesting a genetic component to caries susceptibility. Additionally, factors like educational attainment and toothbrushing habits are associated with caries prevalence in specific clusters, highlighting the importance of both genetic and environmental influences on dental health 4.
Conclusion
Understanding the surfaces of the tooth involves a comprehensive analysis of their composition, susceptibility to caries, and changes over time. Enamel, dentin, and cementum each play distinct roles in tooth structure and function. Caries susceptibility varies across different surfaces and is influenced by age, genetic factors, and oral hygiene practices. By studying these aspects, we can better understand the complex phenomena affecting tooth health and develop more effective preventive and restorative dental treatments.
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Most relevant research papers on this topic
An in vivo comparison of radiographic and directly assessed clinical caries status of posterior approximal surfaces in primary and permanent teeth.
Primary teeth have significantly more cavitated radiolucencies than permanent teeth, suggesting a need for re-evaluation of the optimal threshold for restorative intervention at approximal sites.
Highly CitedINORGANIC AND ORGANIC COMPONENTS OF TOOTH STRUCTURE *
The study of tooth structure's composition reveals that surface enamel, dentin, and cementum undergo chemical changes with age, and tooth maturation is influenced by fluoride and other trace elements in food and drinking water.
Highly CitedReplica Studies of Changes in Tooth Surfaces with Age
Tooth surfaces of unerupted and recently erupted teeth closely resemble each other, but older teeth show significant alterations in surface structure due to attritional and environmental influences.
Clustering Tooth Surfaces into Biologically Informative Caries Outcomes
Clustering tooth surfaces into distinct groups can help understand factors influencing cariogenesis, with some cluster-based caries outcomes being heritable and others linked to factors like age, sex, education, and toothbrushing habits.
Observational StudyIncremental susceptibility of individual tooth surfaces to dental caries in Scottish adolescents.
Molar occlusal surfaces show the greatest susceptibility to dental caries in Scottish adolescents, with interproximal surfaces contributing 40%, 47%, and smooth surfaces 13% of caries prevalence.
Observational StudyPrevalence of Caries on Individual Tooth Surfaces and its Distribution by Age and Gender in University Clinic Patients
Caries prevalence on tooth surfaces is higher in younger age groups, with more caries experienced in females, and incidence decreases as age increases.
Observational Study
Rigorous JournalHighly Cited