Multifactorial inter-action in the
etiology of dental caries.
GLOBAL DISTRIBUTION :-GLOBAL DISTRIBUTION :-
During most of the 20th
High prevalence developed
Low prevalence developing world.
The most obvious reason is DIET :-
High consumption of refined CHO .
Poor societies, survived on hunting and
on subsistence farming low CHO.
BY THE 20BY THE 20thth
PATTERN WAS CHANGEDPATTERN WAS CHANGED
Prevalence and intensity were increased in many
developing countries, at least in urban areas
marked decrease in caries experience among
children and young adults in developed countries.
The declination was less obvious among adults,
only new lesions were decrease in smooth
surfaces, while pit and fissure lesion is increase.
Evidence supports role of F.
Determinants and Risk Factors :-Determinants and Risk Factors :-
AGE :- caries is considered a childhood
disease, it increase sharply in youth & early
It decreases much in later years of life, and
much of the increase in adults is missing.
The opponent slowing down is due to:
All susceptible surfaces have been
attacked, and the build up of fluoride in
GENDER :-GENDER :-
Females develop higher DMFS score,
it is not a universal finding, and it
attributes to the earlier eruption of
their teeth and the more dentists
which considered as treatment
Race and Ethnicity :-Race and Ethnicity :-
Studies proved differences, but result
is due to environment than they are of
inherent racial attributes.
Certain racial groups when moved to
another areas show differences.
Socio-economic status (SES)Socio-economic status (SES)
SES is inversely related to many diseases, and
characteristics tough to affect health.
Low SES groups had high values of D, M teeth and lower
values of filled teeth.
High SES groups had lower mean number of D teeth and M.
while F component ballooned so much that lifted so much
the whole DMF
Studies noted that although fluoridation reduce differences
between the social classes, it does not remove it
SES is powerful determinant.
SES differences means
differences in :-
Education. Self care practices.
Available income. Access to health
Familial and genetic pattern :-Familial and genetic pattern :-
Familial tendencies are seen, may be
due to genetic basis or bacterial
transmission or continuing familial
dietary or behavioral traits.
Diet, Nutrition, and Caries :-Diet, Nutrition, and Caries :-
Diet : Refers to the total oral intake of
substance that provide nourishment and
Nutrition : Refers to the absorption of
So, Nutritional Counseling is more correctly
referred to as Dietary Counseling.
Prior to modern preventivePrior to modern preventive
methods :methods :
Caries prevalence was low in those
countries with low living standards, were
generalized malnutrition was the norm.
Current epidemiological evidences, favors
the conclusion that nutritional status does
not directly influence the prevalence of
dental caries (except perhaps the fluoride ).
Dietary factors by contrast withDietary factors by contrast with
nutritional adequacy :nutritional adequacy :
Have a clear influence on caries prevalence and severity.
In particular, refined CHO especially sugar are a major
Accumulation of fermentable CHO were the cause of caries
Such deposits could be removed by fibrous foods (such as
apple, the so called cleansing food).
Through, the physical cleansing effects and salivary flow.
Vipeholm study ( 1945-1952 )Vipeholm study ( 1945-1952 )
The participants were divided into groups
with controlled consumption of refined
sugars that varied in, amount, frequency,
physical forms, and whether taken with or
Sugar consumption increase caries.
The risk increases if sugar is in sticky form,
and taken between meals.
The increase in caries under uniform
conditions show great individual variation.
The increase in caries disappears on
withdrawal of sticky food stuff from the diet.
The importance of frequency of
consumption was the major finding.
Caries can still occur with the absence of
refined sugar, natural sugar, and total
it is recommended to
it is recommended to
finish a meal with
finish a meal with
stimulant such as
stimulant such as
OrOr an applean apple
British and U.S. studiesBritish and U.S. studies
(1980) :-(1980) :-
Consumption of sugar is not a major
risk factor, but for those who are
susceptible to caries.
Caries is a multi factorial disease.
Dental caries is a bacterial
Regardless of any other factor,
caries cannot occur in the
absence of bacteria.
•Dental caries is a transmissible
infectious disease as cariogenic
bacteria usually passed along
from mother to infant.
Strep. Mutans has the ability to:
1- Implantation on tooth surface by
synthesis of adhesive extra- cellular
polysaccharides (glucans) from sucrose
which they use to stick and colonize on
2- Store intra-cellular
polysaccharides which act as a
transient reserves of fermentable
3- Fermentation of dietary
carbohydrates as an energy
source for its metabolic activity
and produces lactic acid.
Nursing caries :-Nursing caries :-
Acute caries occur in the primary teeth, 1
to 3 years old.
Attributed to the practice of putting the
infant to bed with a bottle of sweetened
More prevalent in low SES population,
where infants are being cared by little
Prevention based on education of parents.
Root caries :-Root caries :-
Caries occur on the cement of the root surfaces,
where loss of periodontal attachment has led to
exposure of roots accumulation of bacterial
Strongly associated with :-
Loss of periodontal attachment
Number of remaining teeth
Use of dental services
Oral hygiene level
An important risk factor is also the use of
multiple medication among the elderly that
can promote xerostomia.
People who suffer from coronal caries also
seem likely to be a risk of root caries when
gingival recession occur.
Root caries is not common in high fluoride
areas as it is in low fluoride communities.