Reactionary changes in dentine
Peritubular dentine reduces the size of the dentinal tubules, preventing bacterial penetration and generating a more heavily mineralised dentine. Tubular sclerosis usually forms in a band about halfway between the pulp and amelodentinal junction. It forms a translucent zone which may be visible radiographically and is detectable with hand instruments when excavating caries.
Regular reactionary dentine
Forms at the pulp dentine interface and retains the tubular structure of dentine. Forms in response to mild stimuli and may obliterate pulp horns, increasing the dentine thickness between caries and pulp. Unfortunately it often forms most on the floor and sides of the pulp chamber where it is of little value in defence against caries.
Irregular reactionary dentine
Forms in response to moderate or severe insult by caries and correspondingly ranges from dentine with irregular tubules to a disorganised bone-like mineralised tissue (‘eburnoid’).
Formed when odontoblasts die and their tubules become sealed off. If peritubular dentine formation was extensive before odontoblast death the dead tract may be sclerotic and inhibit advance of caries. If not it may allow more rapid progress.
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