title: Dentin caries progression and the role of metalloproteinases: an update.
abstract: OBJECTIVE
  This review aims to summarise our understanding of the destructive role of acid environment and metalloproteinases in dentin caries progression using a review process.
  
  
  METHODS
  The acids resulting from consumption of sugars by acidogenic and aciduric bacteria can cause demineralisation of the tooth surface, but are not able to cause caries-like lesions. The appearance of such lesions requires the activation of enzymatic proteolysis in an acidic environment for degradation of the dentin organic matrix, leading to cavity formation. Bacterial collagenases have long been considered responsible for organic matrix destruction; host cell-derived matrix metalloproteinases (MMPs) have recently been considered to be involved in the dentinal matrix destruction of carious lesions.
  
  
  CONCLUSIONS
  MMPs are initially synthesised as inactive zymogens to be activated in acid environment of dentinal fluid during the carious process, resulting in destruction of the collagenous matrix. The role of acid environment on enamel and dentin demineralisation and the role of salivary and dentinal MMPs in dentin progression of caries has encouraged general dentists to include the monitoring of oral environment not only by control of bacterial oral flora in caries treatment protocol, but mainly by inhibition of dentinal and salivary MMPs through the use of toothpaste and/or mouthwash containing specific active agents.
authors.affiliation: Multidisciplinary Department of Medical-Surgical and Dental Specialties, Second University of Naples, Naples, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Femiano
authors.affiliation: Multidisciplinary Department of Medical-Surgical and Dental Specialties, Second University of Naples, Naples, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Femiano
authors.affiliation: Multidisciplinary Department of Medical-Surgical and Dental Specialties, Second University of Naples, Naples, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Femiano
authors.affiliation: Department of Orthodontics, Cranio-Maxillofacial Research Center, Islamic Azad University, Tehran, Iran.
authors.forename: A
authors.initials: A
authors.lastname: Jamilian
authors.affiliation: Multidisciplinary Department of Medical-Surgical and Dental Specialties, Second University of Naples, Naples, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Rullo
authors.affiliation: Multidisciplinary Department of Medical-Surgical and Dental Specialties, Second University of Naples, Naples, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Perillo
mesh_terms: D000143:Acids; D001419:Bacteria / Q000201:enzymology; D017364:Collagenases / Q000502:physiology; D003731:Dental Caries / Q000201:enzymology* / Q000503:physiopathology; D003804:Dentin / Q000201:enzymology*; D018450:Disease Progression; D004789:Enzyme Activation; D006801:Humans; D061965:Matrix Metalloproteinase Inhibitors / Q000627:therapeutic use; D020782:Matrix Metalloproteinases / Q000502:physiology*
chemical_list: D000143:Acids; D061965:Matrix Metalloproteinase Inhibitors; D017364:Collagenases; D020782:Matrix Metalloproteinases