Lager Anders Hedenbjörk
Swed Dent J Suppl. 2014(233):9-94.
Dental caries is a common disease all over the world, despite the fact that it can be both effectively prevented and treated. It is driven by acids produced by oral microorganisms as a consequence of their metabolism of dietary carbohydrates. Given enough acid challenge, eventually the tooth enamel barrier will be broken down, and the carious lesion will extend into underlying hard tissue, forming a macroscopic cavity in the dentine. In comparison to biofilm on enamel, a dentine carious lesion provides a vastly different environment for the residing microorganisms. The environment influences the types and numbers of microorganisms that can colonize the dentine caries lesion. The overall aims for this thesis are to enumerate and further study microorganisms found in established dentine caries lesions and also to illuminate how host-derived proteolytic enzymes might contribute to this degradation, not only to better understand the caries process in dentine but also to find incitements for new methods to influence the natural progression of caries lesions. In Paper I, the numbers of remaining viable microorganisms after completed excavation using two excavation methods were investigated. Samples of carious dentine tissue were collected before and after excavation and cultivated on different agar media in different atmospheres. Analysis was performed by counting the number of colony-forming units (CFUs). Key findings: The number of remaining microorganisms after excavation was low for both methods, but some microorganisms always remained in the cavity floors even when the cavities were judged as caries free using normal clinical criteria. In Paper II, the acid tolerant microbiota in established dentine caries lesions was investigated. Samples were taken as in Paper I, but on three levels (superficial, center of lesion, floor of lesion after completed excavation). The samples were cultivated in anaerobic conditions on solid pH-selective agar media of different acidity. Key findings: Each investigated lesion harbored a unique microbiota in terms of both species composition and numbers of microorganisms. This indicates that various combinations of aciduric microorganisms can colonize, survive in and probably also propagate dentine carious lesions. We also found that solid pH-selective agars can be used successfully to select acid-tolerant microorganisms in caries lesions. This would preserve their phenotypic traits for further study. In Paper III, the relation between salivary levels of matrix metalloproteinase-8 (MMP-8), salivary levels of tissue inhibitor of MMP (TIMP-1), and the presence of manifest caries lesions in a large number of subjects was investigated. Saliva samples were collected and analyzed for concentrations of MMP-8, TIMP-1 and total protein using immunofluorometric assays, enzyme linked immunosorbent assays and Bradford assays, respectively. Key findings: Subjects with manifest caries lesions had significantly elevated levels of salivary MMP-8 compared to subjects without caries lesions. TIMP-1 was not significant in any case. In Paper IV, a new method for generating bioactive demineralized dentine matrix substrate (DDM) was developed using a dialysis system and two different demineralization approaches (acetic acid or EDTA). The generated DDM was subsequently analyzed for the presence of type 1 collagen, active MMP-8 and hydroxyproline (HYP) levels using SDS-PAGE, ELISA or immunofluorescence assay. Key findings: Both demineralization methods produced a substrate rich in collagen and with preserved MMP-8 activity. This report presents new knowledge on the composition of the acid tolerant dentine caries microbiota from three levels in dentine carious lesions and on the efficacy of operative caries removal on the numbers of viable microorganisms in the caries free cavity using two operative methods. Moreover, the basic mechanisms behind collagen degradation in the dentine caries process are studied from both a clinical and laboratory perspective. The report also provides a reference for further studies on dentine caries microbiology and dentine caries collagen degradation mechanisms, both of which are known only in part.
龋齿是一种全球常见的疾病,尽管它可以得到有效预防和治疗。龋齿是由口腔微生物代谢膳食碳水化合物产生的酸所引发的。在足够的酸侵蚀下,最终牙釉质屏障会被破坏,龋损会延伸至下方的硬组织,在牙本质中形成肉眼可见的空洞。与牙釉质上的生物膜相比,牙本质龋损为驻留的微生物提供了截然不同的环境。这种环境会影响能够在牙本质龋损处定殖的微生物种类和数量。本论文的总体目标是对已形成的牙本质龋损中发现的微生物进行计数并进一步研究,同时阐明宿主来源的蛋白水解酶可能如何促成这种破坏,不仅是为了更好地理解牙本质中的龋病过程,也是为了找到影响龋损自然进展新方法的切入点。在论文一中,研究了使用两种挖掘方法完成挖掘后剩余的存活微生物数量。在挖掘前后收集龋坏牙本质组织样本,并在不同气氛下的不同琼脂培养基上培养。通过计算菌落形成单位(CFU)的数量进行分析。主要发现:两种方法挖掘后剩余的微生物数量都很低,但即使根据正常临床标准判断龋洞无龋,仍有一些微生物始终残留在洞底。在论文二中,研究了已形成的牙本质龋损中的耐酸微生物群。样本采集方式与论文一相同,但分为三个层次(表层、病损中心、挖掘完成后的洞底)。样本在厌氧条件下于不同酸度的固体pH选择性琼脂培养基上培养。主要发现:就微生物种类组成和数量而言,每个被研究的病损都有独特的微生物群。这表明耐酸微生物的各种组合都可以在牙本质龋损处定殖、存活并可能繁殖。我们还发现固体pH选择性琼脂可成功用于筛选龋损中的耐酸微生物。这将保留它们的表型特征以供进一步研究。在论文三中,研究了大量受试者唾液中基质金属蛋白酶-8(MMP-8)水平、MMP组织抑制剂(TIMP-1)水平与明显龋损存在之间的关系。分别使用免疫荧光测定法、酶联免疫吸附测定法和考马斯亮蓝测定法收集唾液样本并分析MMP-8、TIMP-1和总蛋白的浓度。主要发现:与无龋损受试者相比,有明显龋损的受试者唾液MMP-8水平显著升高。在任何情况下TIMP-1都无显著差异。在论文四中,使用透析系统和两种不同的脱矿方法(乙酸或乙二胺四乙酸)开发了一种生成生物活性脱矿牙本质基质底物(DDM)的新方法。随后使用十二烷基硫酸钠-聚丙烯酰胺凝胶电泳、酶联免疫吸附测定法或免疫荧光测定法分析生成的DDM中I型胶原蛋白、活性MMP-8和羟脯氨酸(HYP)水平的存在情况。主要发现:两种脱矿方法都产生了富含胶原蛋白且保留了MMP-8活性的底物。本报告介绍了关于牙本质龋损三个层次中耐酸牙本质龋微生物群组成的新知识,以及使用两种手术方法对无龋洞中的存活微生物数量进行手术去龋的效果。此外,从临床和实验室角度研究了牙本质龋病过程中胶原蛋白降解的基本机制。该报告还为进一步研究牙本质龋微生物学和牙本质龋胶原蛋白降解机制提供了参考,目前这两方面都仅部分为人所知。