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VIPEHOLM STUDY

Gustafsson et al., Acta Odontol Scand 1954; 11:232.

21

24-toffee (f)

N=436

Mean DMFT

19

17

Caramel Sucrose 8-toffee

Control

15

at meals

13

11

1946

1947

1948

1949

1950

1951

at & between meals

Demin/Remin Cycling

  • Saliva dilutes & buffers acid & contains concentrated calcium & phosphate ions

  • When sugar present, net demineralization rapidly occurs

  • Between sugar episodes, remineralization slowly occurs

  • If remin periods exceed demin periods, subsurface lesion will mineralize & arrest

  • If demin periods exceed remin periods, cavitation will occur

  • Demin periods exceed remin periods when sugar is frequent or prolonged

Mineral loss follows down the grain of the enamel rods

Leads to characteristic cone shape pointing at dentin

Stephan Curve (pH at plaque-tooth interface by time after sugar)

  • A.

    rapid pH drop indicates sugar instantaneously converted to acids--overwhelming salivary buffers

  • B.

    persistence of low pH (plateau) due to catabolism of ICP

    • --

      can be >60 minutes

  • C.

    gradual return to resting pH due to diffusion, dilution, & buffering of acid

mineral content

sugar

of lesion

sugar

sugar

sugar

sugar

sugar

sugar

sugar

sugar

mineral content

of lesion

demin

remin

MS too small to be removed by brushing & flossing

courtesy of Dr. Jorge Perdigao

For this reason, debriding procedures alone will not prevent decay

3

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