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This review focuses specifically on matrix metalloproteinases (MMPs) and their role in physiological and pathological extracellular matrix (ECM) remodeling and degradation processes in the oral environment. A group of enzymes capable of degrading almost all ECM proteins, MMPs contribute to both normal and pathological tissue remodeling. The expression of different MMPs may be upregulated in pathological conditions such as inflammation and tumor invasion. The balance between activated MMPs and tissue inhibitors of metalloproteinases (TIMPs) controls the extent of ECM remodeling. Prior to mineralization, MMPs may participate in the organization of enamel and dentin organic matrix, or they may regulate mineralization by controlling the proteoglycan turnover. There is evidence indicating that MMPs could be involved in the etiology of enamel fluorosis and amelogenesis imperfecta. They seem to play a part in dentinal caries progression, since they have a crucial role in dentin collagen breakdown in caries lesions. MMPs have been identified in pulpal and periapical inflammation and are strongly correlated with periodontal diseases, since they are the major players in collagen breakdown during periodontal tissue destruction. The use of MMP inhibitors could help the prevention and treatment of many MMP-related oral diseases.

Occlusar carious lesions from human molars, preserved in continuous humidity after extraction, were removed using conventional clinical techniques. Bacteriological samples were taken after rinsing the cavity with water only, after experimentally infecting the cavity and after treating uninfected cavities either with a saturated Ca(OH)2 solution or with a chlorhexidine based detergent. The samples were cultivated on blood agar plates aerobically and anaerobically. Cavities rinsed with water only showed very sparce bacterial growth. After experimental infection the growth was significant, but decreased radically after treatment with the test materials. In order to describe the effect of the two test materials on the microbial enzyme activity in infected dentin, cryostat sections of 10 micrometer were prepared from undermineralized carious dentin fragments excavated from freshly extracted human teeth. Conventional histochemical techniques were applied to demonstrate the aminopeptidase activity in the sections using N-L-leucyl-2-naphthylamide as a substrate. The aminopeptidase activity of carious dentin was inhibited totally with the Ca(OH)2 solution, whereas the chlorhexidine based detergent had no effect on the enzyme activity.

Coronal odontoblast-predentin tissue was taken from intact teeth and from teeth with carious lesions of varying depths, and the samples (20, 200 x g, saline-soluble fractions) were studied for their ability to hydrolyze adenosine triphosphate (ATP) and phosphoserine. A significantly higher rate of ATP hydrolysis at pH 9.8 was detected in enamel caries and a significantly lower rate in advanced caries than in intact teeth. The rates of the hydrolysis of phosphoserine at pH 9.8 did not differ between the various tooth groups, and the only clear trend indicating elevated enzyme activity was seen in the group of initial dentin caries. The ATP and phosphoserine hydrolysis at pH 9.8 were considered to have been due to the nonspecific alkaline phosphatase (EC 3.1.3.1) activity. In the presence of both levamisole and ouabain, maximal enzyme-dependent ATP hydrolysis was observed at pH 7.9. The remaining ATP-cleaving activity was thought to have been due to the Ca2+Mg2+-dependent ATPase (EC 3.6.1.3). The Ca2+Mg2+-dependent ATPase activities at pH 7.9 remained at constant levels in both the intact and carious groups. The parameters studied in vitro were thought to reflect changes in the mineralization rate of reparative dentin as a response to caries in vivo.