Clinical correlations of dentin structure and function

Dentin, a porous, fluid-filled mineralized tissue, may provide critical mechanical support to overlying enamel. Once the enamel or cementum surface seals are lost by disease or trauma, the same organization that provided critical mechanical support then becomes a liability, offering millions of fluid-filled diffusion channels from the periphery directly to the pulp. If restorative materials placed in cavities do not seal the dentin, there is a fluid-filled continuum from the cavosurface margins, around gaps between the restorative material and the tooth, to dentin surfaces, then through dentin via its tubules to the pulp. Under most conditions these channels permit bidirectional diffusion of exogenous and endogenous substances across dentin. Occasionally, hydrodynamic stimuli will produce transient, rapid movement of dentinal fluid that will induce pain. The tubules are sometimes so close together in deep dentin that their intrinsic wetness interferes with the bonding of adhesive resins. This permits the formation of gaps, microleakage, dentin sensitivity, and, occasionally, pulpal irritation. Many clinical problems such as poor dentin bonding, microleakage, dentin sensitivity, and pulpal irritation have a common denominator in the structure and function of dentin.