New Preventive Approaches Part II: Role of Dentin Biomodifiers in Caries Progression

Dental caries is the most prevalent infectious chronic disease in children and adults. With a globally aging population, new demands in the management of dental caries are awakened by the rampant increase in the incidence of dental root caries. Like crown caries, root caries requires bacterial driven tissue demineralization followed by the degradation of the extracellular dentin matrix. Due to the complex composition and ultrastructure, preventive strategies targeting the mineral phase of dentin are insufficient for managing the prevention and progression of root caries. However, the composition and ultrastructure of dentin has inspired novel strategies for the effective management of highly susceptible root surfaces. Specifically, the complex and dynamic dentin extracellular matrix (ECM). The ECM of mature dentin contains a robust type I collagen fibrils scaffold, and carefully distributed non-collagenous components, such as proteoglycans, phosphoproteins, and proteases. In this chapter, we will review the experimental strategies of potential clinical impact to prevent root caries progression by site modifications of the mature extracellular dentin matrix. This approach, termed dentin biomodification, encompasses bioinspired strategies to locally enhance the biological and biomechanical characteristics of the tissue by mimicking natural processes. Here, synthetic and biosynthetic compounds can decrease the biodegradability of the dentin ECM and provide mechanical enhancement of dentin. The resulting effect is the maintenance of the dentin ECM to halt root caries progression and possibly mediate effective remineralization of the caries affected root dentin.