pH-driven progression: Dental caries to pulpal and periapical disorders.

OBJECTIVE

This narrative review aims to examine the role of an acidic microenvironment in the pathogenesis of dental caries, pulpitis, and apical periodontitis.

DESIGN

The references in English language of this narrative review were sourced from PubMed and Web of Science by using the relevant keywords and by manually searching the bibliography of the included publications.

RESULTS

Acidic microenvironment in dental caries promotes the proliferation and adaptation of acidogenic and aciduric cariogenic bacteria, thereby accelerating the disease process and impairing treatment outcomes. In pulpitis, when pH drops in the microenvironment, normal pulpal functions are impaired, and pathogenic bacteria exhibit heightened virulence. Furthermore, acidic microenvironment in periapical tissue affects the activity of osteoblasts, osteoclasts and enzymatic processes, thereby increasing the bone resorption in apical periodontitis. Acidic microenvironment also compromises the effectiveness of endodontic treatment. Although many strategies have been developed to mitigate acid-related damage in dental caries, comparable approaches have received less attention for pulpal and periapical diseases.

CONCLUSION

An acidic environment causes demineralization of dental hard tissues and disrupts the function of cells and microorganisms. This promotes the progression of dental caries, pulpitis, and apical periodontitis, and also reduces the effectiveness of their treatment.