Similar to coronal caries, root caries results from a disequilibrium of the de-remineralization balance in favor of the demineralization process. It mainly involves a bacterial shift in favor of an increase in the proportion of acidogenic and aciduric bacteria. This process permanently damages the dental mineralized tissues, namely the dental cementum and dentin. In addition to the demineralization and exposure of the dentin or the cementum organic matrix, acid production by cariogenic bacteria induces the activation of endogenous (host-derived) enzymes within the dentin and saliva. These enzymes include matrix metalloproteinases and cathepsins. Once activated, these potent proteolytic enzymes collectively have the capacity to degrade all the components of the exposed organic dentin and cementum matrices. In this chapter, the description of the healthy cement and dentin organic matrices and their endogenous proteases will be followed by the role of these proteases in the root caries process.
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