Histopathology of Caries

Histopathology of Caries

Histopathology of Caries


By the end of these revision notes, you should:

The histopathology of caries varies in both pre-cavitated and cavitated lesions, as well as in enamel and dentine. These lesions have multiple zones that can be described. In this revision note, we will describe these various zones.

Enamel Caries (pre-cavitation)

Normal enamel is composed of various structures including:

  • Enamel prisms
  • Prism borders
  • Striations
  • Striae of Retzius (incremental growth bands)
  • Surface zone

Changes in these various regions/structures will determine the nature of the lesion. 

The common areas for carious to develop on enamel are smooth surfaces (below contact points), in pits and fissures and around existing restorations (recurrent caries). 

Smooth surface caries

Site: typically occurs below contact points

Appearance: typically hard and shiny. May be a white opaque lesion or a brown spot lesion


  • conical lesion with the apex towards the amelo-dentinal junction (ADJ)
  • Lateral spread at the ADJ
  • A larger dentinal lesion
Enamel Caries
Ground section demonstrating smooth surface enamel caries – apex extending towards the ADJ. Credit to Dr Nurul Islam.

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Pit and Fissure Caries


Microscopic Features of Enamel Caries

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1) Translucent Zone

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2) Dark Zone

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3) Body of the Lesion

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4) Surface Zone

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Dentinal Caries

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