Эмаль зубов: состав, свойства и особенности

Major tissue that makes up part of the tooth in humans and many animals

Tooth enamel is one of the four major tissues that make up the tooth in humans and many animals, including some species of fish. It makes up the normally visible part of the tooth, covering the crown. The other major tissues are dentin, cementum, and dental pulp. It is a very hard, white to off white, highly mineralised substance that acts as a barrier to protect the tooth but can become susceptible to degradation, especially by acids from food and drink. In rare circumstances enamel fails to form, leaving the underlying dentin exposed on the surface.

Enamel is the hardest substance in the human body and contains the highest percentage of minerals (at 96%), with water and organic material composing the rest. The primary mineral is hydroxyapatite, which is a crystalline calcium phosphate. The normal color of enamel varies from light yellow to grayish (bluish) white. It has been suggested that the color is determined by differences in the translucency of enamel, yellowish teeth having a thin, translucent enamel through which the yellow color of the dentin is visible and grayish teeth having a more opaque enamel. The translucency may be attributable to variations in the degree of calcification and homogeneity of the enamel. At the edges of teeth where there is no dentin underlying the enamel, the color sometimes has a slightly blue or translucent off white tone, easily observable on the upper incisors. Since enamel is semitranslucent, the color of dentin and any material underneath the enamel strongly affects the appearance of a tooth. The enamel on primary teeth has a more opaque crystalline form and thus appears whiter than on permanent teeth. The large amount of mineral in enamel accounts not only for its strength but also for its brittleness. Tooth enamel ranks 5 on Mohs hardness scale (between steel and titanium) and has a Young's modulus of 83 GPa. Dentin, less mineralized and less brittle, 3–4 in hardness, compensates for enamel and is necessary as a support. On radiographs, the differences in the mineralization of different portions of the tooth and surrounding periodontium can be noted; enamel appears lighter than dentin or pulp since it is denser than both and more radiopaque. Enamel does not contain collagen, as found in other hard tissues such as dentin and bone, but it does contain two unique classes of proteins: amelogenins and enamelins. While the role of these proteins is not fully understood, it is believed that they aid in the development of enamel by serving as a framework for minerals to form on, among other functions.

Most dental professionals and organizations agree that the inclusion of fluoride in public water has been one of the most effective methods of decreasing the prevalence of tooth decay. Fluoride can be found in many locations naturally, such as the ocean and other water sources. The recommended dosage of fluoride in drinking water does not depend on air temperature. Some groups have spoken out against fluoridated drinking water, for reasons such as the neurotoxicity of fluoride or the damage fluoride can do as fluorosis. Fluorosis is a condition resulting from the overexposure to fluoride, especially between the ages of 6 months and 5 years, and appears as mottled enamel. These codes are supported by the American Dental Association and the American Academy of Pediatric Dentistry. Furthermore, whereas topical fluoride, found in toothpaste and mouthwashes, does not cause fluorosis, its effects are now considered more important than those of systemic fluoride, such as when drinking fluorinated water. However, systemic fluoride works topically as well with fluoride levels in saliva increase also when drinking fluoridated water. Lately, dental professionals are looking for other ways to present fluoride (such as in varnish) or other mineralizing products such as Amorphous calcium phosphate to the community in the form of topical procedures, either done by professionals or self administered. Mineralization of the incipient lesion instead of restoration later is a prime goal of most dental professionals.

Most dental restorations involve the removal of enamel. Frequently, the purpose of removal is to gain access to the underlying decay in the dentin or inflammation in the pulp. This is typically the case in amalgam restorations and endodontic treatment. Nonetheless, enamel can sometimes be removed before there is any decay present. The most popular example is the dental sealant. In the past, the process of placing dental sealants involved removing enamel in the deep fissures and grooves of a tooth, followed by replacing it with a restorative material. Presently, it is more common to only remove decayed enamel if present. In spite of this, there are still cases where deep fissures and grooves in enamel are removed in order to prevent decay, and a sealant may or may not be placed depending on the situation. Sealants are unique in that they are preventative restorations for protection from future decay, and have been shown to reduce the risk of decay by 55% over 7 years. Aesthetics is another reason for the removal of enamel. Removing enamel is necessary when placing crowns and veneers to enhance the appearance of teeth. In both of these instances, when unsupported by underlying dentin, that portion of the enamel is more vulnerable to fracture.

Invented in 1955, acid etching employs dental etchants and is used frequently when bonding dental restoration to teeth. This is important for long term use of some materials, such as composites and sealants. This roughens the enamel microscopically and results in a greater surface area on which to bond. The effects of acid etching on enamel can vary. Important variables are the amount of time the etchant is applied, the type of etchant used, and the current condition of the enamel. The staining occurs in the interprismatic region internally on the enamel, which causes the tooth to appear darker or more yellow overall. In a perfect state, enamel is colorless, but it does reflect underlying tooth structure with its stains since light reflection properties of the tooth are low. Tooth whitening or tooth bleaching procedures attempt to lighten a tooth's color in either of two ways: by chemical or mechanical action. Working chemically, a bleaching agent is used to carry out an oxidation reaction in the enamel and dentin. The agents most commonly used to intrinsically change the color of teeth are hydrogen peroxide and carbamide peroxide. Oxygen radicals from the peroxide in the whitening agents contact the stains in the interprismatic spaces within the enamel layer. When this occurs, stains will be bleached and the teeth now appear lighter in color. Teeth not only appear whiter but also reflect light in increased amounts, which makes the teeth appear brighter as well. Studies show that whitening does not produce any ultrastructural or microhardness changes in the dental tissues. However, a tooth whitening product with an overall low pH can put enamel at risk for decay or destruction by demineralization. Consequently, care should be taken and risk evaluated when choosing a product which is very acidic. Tooth whiteners in toothpastes work through a mechanical action. They have mild abrasives which aid in the removal of stains on enamel. Although this can be an effective method, it does not alter the intrinsic color of teeth. Microabrasion techniques employ both methods. An acid is used first to weaken the outer 22–27 micrometers of enamel in order to weaken it enough for the subsequent abrasive force. This allows for removal of superficial stains in the enamel. If the discoloration is deeper or in the dentin, this method of tooth whitening will not be successful.

Enamel or enameloid is found in the dermal denticles of sharks and many early vertebrates, and it appeared there before gnathostome teeth evolved. The ganoin that covers the scales of many actinopterygians is probably derived from enamel. Enamel like substances also coat the jaws of some crustacea, but this is not homologous with vertebrate enamel. Enameloid covers some fish scales.

Due to the unique structure of enamel, the mechanical properties are very interesting. Enamel is the hardest material in the body and is one of the most durable load bearing biological materials. It has been shown to have a fracture toughness three times greater than that of geological hydroxyapatite, the main mineral in enamel. Consisting of rod and interrod regions within the microstructure of enamel, the mechanical properties of enamel vary depending on the location within the microstructure. The rod and interrod structure causes anisotropy in enamel as both components have different mechanical properties. The interrod enamel has around 53% and 74% decreased hardness and elastic modulus when compared to the rod structures. This leads to a composite like hierarchical structure of enamel. The hardness and stiffness parallel to the rod axis results in high hardness and modulus, shown to have modulus values of 85–90 GPa and hardness values of 3.4 3.9 GPa. The fracture toughness is also anisotropic. The fracture toughness can vary by up to a factor of three due to the orientation of the rods. Also in enamel, Cracks do not easily penetrate the dentin, which may lead to the higher fracture toughness. Overall, enamel is a highly anisotropic material due to its microstructure, which leads to properties needed for the effective use of our teeth.