The Important Role and Implications of Citrate in the Composition, Structure, and Function of Oral/Periodontal/Craniofacial Tissues.

High citrate concentration is a major component in the structure of craniofacial bone, teeth and periodontal tissues of humans and other osteovertebrates. It is now established that citrate incorporation into the apatite/collagen complex of bone is essential for the manifestation of the important biomechanical properties of bone; such as stability, strength, and resistance to fracture. The osteoblasts are specialized citrate-producing cells that provide the citrate incorporated in bone during osteogenic stem cell differentiation for production of new bone; "citration" that occurs in concert with mineralization. Dentin and cementum contain high citrate levels; as contrasted with low citrate in enamel. There exists no information regarding the status and source of incorporated citrate in dentin or in cementum. These are important issues relating to oral, periodontal, craniofacial structures. For example, repair of defects should include new tissue that exhibits the composition, structure, and biomechanical properties of the "normal" tissue; which cannot be achieved in the absence of citrate incorporation in the new tissues. Unfortunately, the presence and role of citrate in these tissues have been largely ignored and unrecognized over the past about 40 years by the dental and medical community. The intent of this review is to re-establish the interest and research regarding the important citrate relationships and issues; with focus on related interests in dentistry.