Arrested Caries is a type of Dental Caries affecting Teeth which are basically Caries which has become stationary or non-progressive or static without any signs of further progression or extending into the Enamel or dentist structure. Arrested Carious Lesion is usually Self-cleansing and is usually seen on the lingual or labial surfaces of the tooth. Due to the Self-cleaning property, there is a lack of any Food impaction or retention in the Arrested Carious lesion.
Arrested Caries is usually hard and glossy, it is due to the fact that the top layer of soft and decalcified Enamel (affected by caries) is lost due to the masticatory movements and forces and this leads to a brownish/black and polished/shiny surface which is hard in consistency. If arrested caries involves Dentin, it is called as – Eburnated Dentin. Sclerosis of Dentinal Tubules is seen and secondary dentin formation commonly occurs in arrested caries.
Common Features of Arrested Caries:
- Tooth-like Consistency (hard)
- Brown / Black color
- Glossy or Polished surface
- No progression of the carious lesion
- Mostly seen on the Buccal or Lingual surface – Interproximal areas below the contact point and besides the extracted tooth
- Resistant to future caries infection
- No food accumulation or stagnation seen
Location of Arrested Caries:
- Most commonly seen on Labial or Lingual Surfaces of the tooth
- Less Common in Interproximal surfaces of the tooth
In the Interproximal surface, the Arrested caries is located below the contact point of adjacent teeth and it appears brown in color. (usually seen after extraction of the adjacent tooth). This is because the Caries process has stopped after the removal of the tooth and it becomes self-cleaning.
Why is Color of Arrested Caries Black or Brown:
A Carious lesion which is halted in progression and starts to Remineralize is called as Arrested Caries, so the Enamel or Dentin structure which is present in the Carious lesion is discolored and hence it is seen as Black or Brown color in Arrested Caries.
- Black colored Arrested Caries – Enamel Caries
- Brown Colored Arrested Caries – Dentinal Caries
The Change in color is also due to the “Entrapment of organic debris and metallic ions within the Remineralized Enamel“ giving the Black color to it. The brown color is also seen in the Early form of the carious lesion which has turned into arrested caries.
Stages of Development of Arrested Caries:
Development of Arrested Caries is divided into three Stages based on the stage of Dissolution and Crystallization of the Carious lesion.
Stage 1 or First Stage: Minerals in the intertubular dentin has started to dissolve due to Acids produced by Bacteria. The accumulation of fluid in the tubules becomes saturated with calcium and magnesium ions.
Stage 2 or Second Stage: The Saturated Crystals start precipitation and lead to the formation of large crystals of tricalcium phosphate.
Stage 3 or Third Stage: Collagen in secreted into the dentin tubules due to Odontoblast process, this leads to blockage of the tubules with Hydroxyapatite crystals. The Growth of crystals takes place in the intertubular dentin.
According to Muhler, caries arrest has been seen after application of Stannous fluoride solution on tooth surfaces having carious lesions. Application of Stannous Fluoride on surfaces with incipient carious lesions, demineralized areas, etching or frank carious lesions. These surfaces started to show signs of Arrested Carious lesions.
References:
1 Nisha Garg – Textbook of Operative Dentistry
2. Shafer’s Textbook of Oral Pathology
Is arrested caries like affected dentin? Why?
Arrested Caries is a little different from Affected Dentin as
Affected Dentin – can or most likely has active caries while
Arrested Caries – does not have active caries but hard tooth structure left after caries attack.
Arrested caries if present on Dentin is called as – EBURNATED DENTIN. Hence arrested caries and Affected Dentin are both different.
Thank you Dr Varun Pandula for answering the above question. If arrested caries into affected dentin can be observed in patients, why is it assumed caries that are discovered through xrays into dentin must be active and restored immediately? Is there some possibility that such cavities can be turned into arrested dentin, covered with eburnated dentin, and not require restoration?
If so, how is eburnated dentin differentiated on xrays to confirm this is the case?
It is difficult to differentiate between active caries and arrested carried just based on X-rays as the radiological difference is quite minimal. Clinically on examining the affected dentin we can determine with the help of an explorer whether it is Active caries or otherwise.
X-rays can be the first line of diagnosis but it cannot be totally relied upon for differentiating between Arrested or Active Caries.
If an interproximal cavity is arrested,does this mean the loss tooth structure needs to be restored or a silver crown placed in pediatric dentistry? Or can the area just be kept clean and no further restoration needed?
You can plan the treatment depending on the space and whether it is leading to any food impaction interdentally. If there is no food impaction then it can be left as it is, in case there is a Class 2 type involvement Restoration can be done or a SS crown in case of extensive caries which cannot be restored using a Filling.
Can we do pit and fissure sealant over arrested caries?
Yes, you can.