A Quantitative Light Microscopic Study of the Odontoblast and Subodontoblastic Reactions to Active and Arrested Enamel Caries without Cavitation

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Abstract
This study describes cellular and microradiographic findings in thin undemineralized enamel-dentine sections from 36 enamel caries lesions from freshly extracted third molars. Lesions activity was determined by clinical examination and the estimated age of the lesion at extraction time. The cellular reactions to the enamel/dentine lesion complex were measured using computerized histomorphometry under the following conditions: (a) the cytoplasm:nucleus ratio of the odontoblast cell; (b) the odontoblast cell:dentinal tubule ratio, and (c) the adjacent predentine area (μm2). The first cellular reactions were observed beneath superficial enamel lesions before visible alterations in dentine mineralization. The cytoplasm:nucleus ratio of the odontoblast cells was markedly reduced, and only active lesions showed evidence of cellular proliferation into the cell-free zone. In more advanced active lesions the affected odontoblast cells had a significantly lower cytoplasm:nucleus ratio compared with the controls. Similar changes were not seen in arrested or slow-progressing lesions. Before onset of tertiary dentine formation there was a positive correlation between odontoblast cell size and predentine formation. Primary odontoblast cells were involved in early tertiary or reactionary dentine formation without odontoblast cell replacement. Reactionary dentine was only seen in active lesions, suggesting that reactions in the dentine/pulp complex are closely associated with the external environment.